Why Saying No to Drugs is Not Enough

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Why Saying No to Drugs is Not Enough

By Robert Schwebel 04/08/15

Empowering teens to consider their own path to recovery.

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Whether driven by parental concern, school intervention or the criminal justice system, our response to teen substance misuse continues to be dominated by punitive and coercive measures, zero-tolerance strategies and enforced abstinence. For decades, Dr. Robert Schwebel has disseminated the evidence base behind another approach—working with teens to consider the choices they make about substance use. Here he relates an early clinical example that highlights the underlying wisdom and value of helping young people create their own approach to recovery…Richard Juman

Parents can’t make kids quit using drugs and neither can the courts. It’s time that counselors face the truth and realize that they, too, can’t make kids quit. We have no magical powers. Furthermore, it’s not the job of counselors to dictate or control behavior. Our responsibility is to help the people we serve become aware of their options, expand their options, consider their own values, and make their own informed choices. So, in 1990 I began writing The Seven Challenges program to help adolescents and young adults make their own decisions about drugs, and for that matter, the rest of their lives. Over the years, we have found that, ironically, this is the most powerful way to influence the behavior of young people—far more effective than pushing an agenda that the youth will resist.

We help the youth weigh the costs and benefits of their various options, and when they decide to make changes, support them to succeed in the goals they set for themselves. Because "harm-based counseling" and the "mad rush for abstinence" have permeated the field for so long, it is very hard for the counselors we train to understand that people have to make their own decisions about drugs and that this includes understanding the benefits they get from drugs, which they would have to forsake if they were to choose to quit or cut back. This is part of an informed decision. It's hard for counselors to resist pounding away about the harm and pushing their agendas. 

The final obstacle in accepting a decision-making model is almost always what journalist Ann Fletcher has called the "drug du jour." Counselors will agree that “Yes, people have to make their own decisions, except what about heroin?” (The current drug du jour—in the past it might have been crack or OxyContin, or meth.) With this drug, they say “we have to focus narrowly on the harm. We have to insist upon abstinence. People who are addicted to heroin can't make their own decisions about it.” With fear about the "drug du jour," counselors want to revert to their old ways, naively believing they have the power to make people quit and that it is appropriate. We try to help our counselors and trainees calm themselves down from the media hype and social hysteria. 

With The Seven Challenges, we believe that recovery begins when people first begin to take a look at their drug use behavior, and consider the possibility that it might be problematic. It also begins as they address co-occurring psychological and situational issues. People who are in the earlier stages of change have begun the recovery process. They need support for their efforts every bit as much as people who are further along in the process.

We have been working to support decision-making in drug counseling for many years now. In 1991, while piloting The Seven Challenges program with a huge cross-section of adolescents and young adults in a variety of settings, I remember one particular session with a group of girls in juvenile corrections. Although a counselor led this group on a regular basis, I attended occasionally to keep an eye on things. The girls knew that I was writing some sort of new-fangled program, and liked to test my credibility. So on this day, one of them, age 16, looked me squarely in the eyes and said with a defiant tone: “I know you say that we’ve got to think for ourselves and make our own decisions about drugs. So I’ve been doing a lot of thinking and decided that when I get out of here, I’m gonna keep on smoking weed. How about that?” She might as well have said: “OK smarty pants. Try this one out.”

This girl seemed to believe that I would now try to talk her out of her decision. Most youth in counseling for drug problems start with this same expectation: that their counselors are totally determined to make them quit. This starting point stands as a barrier to effective counseling. No one wants to be subtly or overtly coerced into anything, especially adolescents and young adults who are supposed to be developing their own individual identities.

I thought for a moment about the girl’s request for an opinion about her plans, and stuck to my principles. “Nobody can tell you what to do. This is a time in life when you need to step up to the plate, do some hard thinking, and make your own decisions.” 

“So,” she retorted, “it’s OK if I decide to use?”

“I’m not saying it’s OK to use, or not OK to use. That’s not for me to say. Bottom line is, it’s your choice.” 

I knew my role as a counselor (not to prescribe behavior) as well as the limits of my power.

“Yes,” I continued, “this is a program based on the belief that you have to make your own decisions.” (I knew the importance of supporting self-determination.) 

Then I added: “If you’ve considered the pros and cons of continuing to smoke weed and have decided that this is in your best interest, then so be it.”

“Well wait,” she quickly replied. “I’m not so sure it’s in my best interest to smoke weed. It’ll get me in trouble with my mom.”

“OK,” I said, accepting her comment.

Then a couple more group members spoke up:

One said: “Girl. You told us, you wanted to get a job. When you get out of here, you’re gonna be on probation. Anywhere you work, even McDonald’s, you’re gonna get drug tested.”

Another group member piped in: “You said you wanted to do school. You told us that when you were smoking bud all the time, it was like you were all cloudy in the head. How you gonna do school?”

So, there I sat quietly listening as the girl who planned to smoke marijuana began to wonder whether it was such a good idea, then another girl wondered about it, and a third girl wondered.

Before I could utter a word, still another group member entered the fray with some disapproving remarks directed at me:

“There you go,” she said, “telling us all about how dangerous weed is. You know it’s natural and grows in the earth...” yadda, yadda, yadda. 

Funny thing was that I had not said even one negative word about weed. I pointed this out. I also noted that this girl who had just spoken was much more of a fan and advocate for the drug than I was a critic. It didn’t seem to matter that I had previously explained that this program allows participants to make up their own minds about drugs.

Looking back at this conversation, the lesson was clear to me: Youth are convinced that counselors want to make them quit using drugs. This, then, produces certain predictable results. In this case, the girls put up a fight, with one of them flaunting her intentions to resume smoking weed and another actively protesting against an assumed anti-drug position. In other situations, youth simply drop out of counseling (“Nobody’s going to tell me what to do.”). In still others, they fake compliance and tell the adults what they “want to hear.” That is, they say they want to quit using drugs, get taught how to be drug-free, but never really intend to make any changes. Nothing good happens when youth believe that their counselors are trying to make them quit.

So, how do clients with drug problems come up with this cockamamie idea about counselors trying to make them quit? They didn’t just dream it up. Historically, this has been precisely how counselors have viewed their role; and precisely how counselors have interacted with them—arguing vehemently about the dangers of drugs and asking one “brilliant question” after another, trying to convince them that they’ve been harmed, and that they need to quit. To this day, it’s the norm. 

Look around and you will find counselors pushing the agenda of abstinence and trying to control behavior. You’ll find youth cleverly resisting and fighting back in all kinds of creative ways. It’s a power struggle. Knowing, as we do, the enormous importance of the quality of the therapist/client relationship in determining counseling outcomes, a power struggle does not bode well. 

To avoid power struggles, counselors should return to their legitimate role when addressing drug problems. Rather than controlling behavior, their responsibility is to support clients in making their own informed and empowered choices. Easier said than done. Counselors find it hard to let go of the desire to control behavior and of their mistaken belief that they are capable of controlling it. They don’t trust the judgment of people who use drugs. They don’t trust the judgment of adolescents. They fear the consequences of continued drug use. So they try to control the situation, and fail.

Once counselors finally do let go of control, what remains is the legacy of youth expecting the counselor to be yet another adult telling them how to behave. Therefore, a basic challenge for working with this population is: To proactively undo the negative expectation of youth that it is the counselor’s job to make them quit using drugs. 

The undoing starts with introductions: “I’m not here to try to make you quit. My job is to support you in making your own wise decisions.” Then, counselors need to repeatedly show that they mean what they say: Stop harping on the harm from drugs. Stop arguing. Stop trying to outtalk or convince youth to quit. Help youth understand their own reasons for using—what needs they have been satisfying or attempting to satisfy with drugs. Help them expand their options. Help them solve problems and learn new coping skills. When the power struggle ends, youth can calmly think things through for themselves. They can consider the harm and benefits of their drug use, what it might entail to change, and the cost and benefits of changing. They can make their own informed decisions.

So, what finally happened in this session with the girl who planned to smoke weed? Turning my attention back to her, I said: “I’ve been swayed by some of what I’ve just heard. If you were saying that what you planned to do was in your best interest, then I would stick with what I said before: ‘So, be it.’ But now it sounds like you are talking about doing something that might not be so good for you. I’m wondering why you are planning to do something that is not necessarily in your best interest?”

“I’m not sure,” the girl responded. “I need to think about it.”

This opened a clear path back to helping her reconsider her decision. When counselors stop trying to control youth, and create a safe climate for free thought, youth can stop resisting them, and do the hard work of making their own informed decisions. Ultimately, people are much more likely to persist with their own decisions than with decisions that were imposed upon them.

Robert Schwebel, Ph.D., is a clinical psychologist who wrote and developed The Seven Challenges® Program for adolescents and young adults, an evidence-based program now widely used across the United States, and in Germany and Canada. Over the years, Robert wrote several books including Saying No Is Not Enough; and Who’s on Top, Who’s on Bottom: How Couples Can Learn to Share Power. He is regularly called for comments and interviews, and has appeared on Oprah, The Today Show, The CBS Early Show, CNN interviews and various other national media.

Website: www.sevenchallenges.com

email: [email protected]

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Robert Schwebel, Ph.D., is a clinical psychologist who wrote and developed The Seven Challenges® Program for adolescents and young adults, an evidence-based program now widely used across the United States, and in Germany and Canada. Over the years, Robert wrote several books including Saying No Is Not Enough and Who’s on Top, Who’s on Bottom: How Couples Can Learn to Share Power. He is regularly called for comments and interviews, and has appeared on Oprah, The Today Show, The CBS Early Show, CNN interviews, and more.

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