P2.255: Need for Integration Between Schools and Substance Use Treatment Programs

Introduction: There exists a bidirectional relationship between substance use and school avoidance. School avoidance has been described as a student having difficulty in attending or remaining in school for the entirety of the day, primarily fueled by anxiety about one’s ability to cope at school. Nearly 30% of students exhibit chronic absenteeism, which has worsened post-pandemic. An increase in unstructured time from school avoidance can lead to increased substance use. Alternatively, substance use disorder (SUD) itself and the treatment process may disrupt engagement with otherwise protective activities and development paths. School avoidance may trigger relapse, setting in motion a vicious cycle. 4 of 100 adolescents ages 12 to 17 years received substance use treatment in the past year. Therefore the number of students experiencing chronic absenteeism and participating in substance use treatment is not insignificant. Yet there is a scarcity of research on how schools and SUD programs might help young people navigate school re-entry during their recovery from SUD, reducing risk of relapse.

Case Description: Case #1: 13-year-old male with moderate cannabis and nicotine use disorders. After a relapse due to school stressors, he was enrolled in a partial hospitalization program (PHP). Post-completion of the program, he has 2 months of abstinence and improved school attendance.

Case #2: 17-year-old male with moderate cannabis use disorder. He had a relapse upon returning to traditional high school, including anxiety about his appearance leading to school avoidance. He subsequently enrolled in a therapeutic high school, after which he had an improvement in school attendance and a decrease in substance use.

Case #3: 13-year-old female with severe nicotine and cannabis use disorders. She was struggling to keep up in school, which caused her anxiety, leading to school avoidance and increased substance use. She then enrolled in an online school, which led to improvement in school attendance and continued abstinence.

Discussion: As demonstrated in these cases adolescents are seeking alternative educational models or intensive SUD treatment to help cope with school avoidance and co-occurring SUD. Addiction medicine providers should routinely assess school functioning and can incorporate assessments such as the School Refusal Assessment Scale. They can also collaborate with schools to help support 504 or individual learning plans. Schools should connect adolescents to school-based counselors if available, incorporate flexibility in the curriculum, and create safe communities.

Conclusion: While youths with SUD may have had school absenteeism prior to SUD treatment, they may be more vulnerable to relapse and school avoidance if they don’t receive adequate support from school and treatment programs. Potential for negative feedback between school avoidance and SUD can undermine treatment efficacy. Flexible educational models, support from school and addiction treatment professionals, may attenuate these feedback patterns, improving outcomes.