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There may not be empirical evidence that ‘it takes a village to raise a child’, but most would agree that ‘village’ schools play a critical role in helping adolescents' transition to adulthood. Similarly, there may not be irrefutable evidence indicating a causal link between substance use and academic performance; however, data continue to mount which suggest a strong relationship between substance use and school attendance, grades, high school graduation and degree attainment. Schools have a vested interest in seeing students succeed, but they may be missing important opportunities to enhance the success of certain students.

The evidence supporting the link between substance use and school performance comes from many sources. For example, data from the National Survey on Drug Use and Health [1] among the general population of 12–17-year-olds in the United States revealed a relationship between substance use and grades for the last grading period. Longitudinal studies in Australia and New Zealand have shown that increasing cannabis use (the drug used most frequently by adolescents) during middle childhood and early adolescence is related to dropping out of high school, even when controlling for a number of confounding variables such as social disadvantage, family functioning and mental health [2,3]. Similarly, in the United States, cannabis use was found to be related positively to school dropout and truancy, with weekly or more frequent use having a stronger association [4,5]. Other research has shown that decreased substance use by adolescents who attended treatment was related to improved school performance. Engberg & Morral [6] found a relationship between treated adolescents who had reduced their frequency of alcohol and other drugs, or eliminated marijuana use and increased school attendance. Brown & Ramo [7] found that the school performance of adolescents whose substance use outcomes improved over time began to mirror that of abstainers and non-problem drinkers. Unfortunately, prevalence studies continue to show high rates of alcohol and drug use by secondary school students [8].

The causes underlying the relationships between substance use and school performance are complex and challenging for researchers to unravel. Existing research reveals that substance use may lead to physical changes in the brain and neurocognitive functioning [9–12], which might impact academic performance. Other theories suggest that family, peer factors and a number of pre-existing individual characteristics such as poor academic self-esteem or externalizing disorders predict both school performance and substance use problems [2,3,13,14]. King and colleagues [14] found that substance use was a marker for problem behaviors that reduced academic achievement during adolescence, but that it also had a sequential impact on entry into and success in college.

While continued study of the mechanisms underlying the relationships between substance use and school performance remains important, the existing evidence that these relationships are strong, multi-dimensional and bidirectional suggest that action is warranted. Schools provide an unparalleled opportunity for prevention, intervention and continuing care which, if effective, may help to contain the costs of treating substance use disorders [15]. The timeliness of taking advantage of these opportunities is also important because once adolescents' use and problems become more chronic, they attend school much less than their peers [4,5]. There are already-existing mechanisms that can be used as the building blocks for these efforts, including existing prevention and student assistant programs (SAPs) in thousands of schools [16]. Additionally, there is a growing body of research that can help to focus the approaches that are used. Further, the effectiveness of these approaches and their adaptability for school settings can continue to improve through collaborative efforts between researchers and schools.

With regard to prevention approaches, the state of the science suggests that a public health model that uses a community-wide approach with complementary and mutually supportive strategies will be the most effective [17,18]. SAPs and community-based agencies with prevention programs in schools can certainly play a role in these efforts, with educational and skills development curricula directly related to alcohol and drugs, but the community and family also need to be targets of prevention efforts [19]. Research findings also suggest that certain students are at greater risk for developing substance use problems. Valid and reliable assessment tools are available for assessing the severity of substance use disorders; however, more work needs to focus on designing assessments that can identify students who are at risk of developing substance use disorders and the evaluation of prevention approaches targeting them specifically.

SAPs also provide a mechanism for early intervention in schools. Several different models of SAPs have evolved over the years; they work with a broad spectrum of students, and these programs have begun to move towards evidence-based practice [20,21]. It is timely for SAPs to adopt evidence-based brief interventions for early intervention with students who have substance use problems, as several researchers have begun to test brief school-based interventions in randomized clinical trials [16,22,23]. As noted by Winters et al. [15], these brief interventions fit with the developmental needs of adolescents, are appropriate for early intervention and are accessible. Godley & White [24] provided a description of the implementation of assessment and a brief intervention in 23 schools, targeting students with alcohol and drug problems over a 3-year period that involved a training and certification process in both the assessment and intervention. Participant data suggested that this school-based program did target those in need of early intervention because those seen in the school settings were significantly more likely to be younger and less likely to have been arrested in the past year compared to the adolescents seen in out-patient treatment.

The last role that schools can play is to provide continuing care or recovery support for students who have had a brief intervention in the school or who have attended either out-patient or residential treatment. Continued use or relapse is common among adolescents treated in out-patient and residential settings [25,26], and, once again, SAP services provide an accessible means of re-intervention either during school hours or by facilitating referrals to community-based treatment providers. There are promising models of continuing care for adolescents [27,28], but more research is needed to identify effective continuing care models that fit the school setting. Another recent development, also in need of further evaluation, is recovery schools which are dedicated to recovery support. There have been 25 recovery high schools and six collegiate recovery communities that have opened across the United States from 1999 to 2005 [29].

This discussion would not be complete without noting some of the barriers to what is proposed. First, there is a lack of professionals trained in evidence-based assessment, prevention and brief interventions appropriate for schools. Well-developed and low-cost technology transfer models are needed to improve this capacity. Secondly, school administrators would probably say that they are under increasing pressure to produce better and better educational outcomes, while simultaneously addressing ancillary student problems with fewer and fewer resources. Funding for prevention and SAP services is limited and often under attack. To convince school boards and lawmakers of the need for funds for these services, research efforts should include health economists who can provide cost–benefit data related to addressing these problems earlier rather than later. On the basis of data and heavy consumer involvement, lawmakers were eventually persuaded that driving while impaired was very costly and revolutionized how this problem was addressed. The most convincing argument for using ‘village’ schools as the key to identifying at-risk students, prevention and early intervention will be that the educational and economic benefits outweigh the effort and expense.

References

  1. Top of page
  2. References
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