Prevention and Treatment On Friday afternoon, I left Juneau, Alaska — flying home to Seattle afterthe first two weeks of school. Amid all the management meetings,strategic planning and policy writing — the one experience that I knew Iwould miss was sixth period at Juneau Douglas High School. Everyschool day, I had led a community health class for a dozen young adultsin recovery from substance abuse or chemical dependency. All thestudents were in a parallel 80-hour service plan, where they receivedtheir own individualized treatment needs and prevention activities. Theyalso received credit for this 80-hour community health practicum wherethey developed their own portfolios of educational achievement.

It had been over a decade since I ran a “recovery class” in a high schoolsetting. So much had changed in that time. Most schools in the countryno longer have such classes, except in the occasional alternative schoolsetting where they are usually run by a chemical dependencyprofessional for therapeutic goals. Usually the classes are “aftercare” forkids who have finished treatment for addiction. Unfortunately, theschools also see it as a location to place a chemically dependent youththat has not received treatment — either from their own denial or theproblems with managed care. Sadly, over the years, the untreated youthoften overcome the ones in aftercare; the class becomes toxic and fadesout. Often, in its waning moments, it is a place of anger, frustration andaggressive behavior — another link in the behavioral health worlds ofsubstance abuse and violence.

In the chemical dependency field, we know that untreated chemicaldependency, either in the addict or co-addict, leads to violence againstthemselves or others. What persons in other helping professions don’t seeis that violence often leads to substance abuse in both the perpetratorand the victim. Now that the chemical dependency profession treatsboth substance abuse and chemical dependency, it is time to addressissues that lead to substance abuse without feeling we are giving themixed message that chemical dependency is not a physiological disease.

A Chemical Dependency Professional Finds HisRole in Violence Prevention and Treatment My chemical dependency counseling career began back in 1981,amidst the detoxification beds and crisis receiving mats of San Diego.

Eighteen years later, I returned to lead the program that was one of myintern sites during that first year, Scripps McDonald Center. Outsideof addressing anger as a part of chemical dependency recovery, I neverbelieved that my two decades of training and practice prepared me tobe a “violence” professional. The moment I emerged from that cocoonas a chemical dependency professional and realized that our field hadto take a leadership role in the emotional development of our youth,particularly violence prevention, stays in my mind with stark clarity.

It was a phone call on March 5th asking me to help coordinatethrowing a “human blanket” of therapeutic support over a high schoolthat had just been torn apart by 38 bullets and 13 wounded teenagerswho were receiving emergency trauma wound care in local hospitals.Two other students from Santana High did not make it to trauma care;one died at the feet of the shooter and the other made it halfwayacross the student commons, only to die in the arms of one of histeachers in front of hundreds of his classmates. Although we hadlearned a great deal from Columbine, there was not yet a very goodaction model to address this level of adolescent trauma for over 2,200young adults. Three weeks later, after learning a great deal, Santana’ssister high school three miles away was shot up by another studentgunman. This time, six students from Granite Hills High were intrauma care with no fatalities.

We had learned enough in the three weeks since Santana to place asheriff ’s deputy on campus. He brought down the shooter in agunfight in front of the administrative building. There were other,more important lessons that we learned from Santana as well: a) manyyouth had experienced their first intoxication on alcohol and otherdrugs in that time, b) those who were already using often increasedtheir use, c) and those in recovery were experiencing their mostdifficult struggle to avoid relapse. A turning point occurred for mewhen the Los Angeles Times writer who had been following two of usaround the campus for a week began to put together the connection.On March 20th, three days before the second shooting at GraniteHills, that reporter began the process of linking the chemicaldependency recovery field together with violence prevention andrecovery. Hopefully, this story continues the message she began withher article 18 months prior, where she wrote:

4 Community of Recovery • Fall 2002

LinkThe

by David D. Moore, Ph.D.

LinkBETWEEN

VIOLEnCECHEMICAL

DEPENDENCY

AND

The C-STARS Model of ViolencePrevention and TreatmentIn June of 2001, the University ofWashington’s Center for the Study and Teaching of At-Risk Students(www.uwcstars.org) entered a long-termrelationship with the community of Juneau, Alaska (www.asdn.org/JEPP) todevelop a comprehensive safe and drug-freecommunity. Having spent three monthsincorporating what we had learned at Santana High with what we hadlearned years ago in case managed student assistance programs, wewere able to build a strategic model that broadened the methods fromchemical dependency recovery for youth with a much broader groupof needs. In particular, those with “safety” needs in the safe and drug-free network. Three very formative experiences from Santana andGranite Hills were the underpinning of these groups. Most chemicaldependency professionals have long and deep understanding of allthree parts of this model:

1. The Johari’s Window of group communication: Theformative text written on chemical dependency counseling wasVernon Johnson’s I’ll Quit Tomorrow, written in 1971. It describes howpeople in pain form walls of defenses that block their ability to sharetheir feelings with other people. The appendices shows, in detail, howto use a “Johari’s Window” model of interpersonal communication toreduce defenses, regain trust and rebuild healthy development in apeer group process. When I helped therapists put together groups foryouth in shock and denial from the shootings, we used this basic

model to begin to reconnect them to one another. Then we supportedthe natural human dynamic of mutual support take root among theadolescents.

2. The Feelings Chart: What to do when feelings emerge?Although the final part of resolving sadness and fear is following thegrief and loss cycle of replacing life’s losses, making the connectionfrom sharing feelings to that model is a difficult one. A schoolpsychologist that had worked with me in the mid-nineties saw the keyto violence to be prevention long before I did. Mike Phimister is ashort, Sigmund Freud-looking elementary counselor who insisted onthe two of us treating youth with weapons violations in the FederalWay school district. His model was that most of the youth were eitherchildren of alcoholics or “dry” drunks. What he worked out was a“feeling chart” approach where youth could see that feelings identifiedlosses or gains in life. In addition, we borrowed the denial-anger partof the grief and loss cycle to show how anger was a secondary feelingthat covered up loss or fear of a loss. Once we helped them make thisdiscovery, we were able to move them to place their “loss or fear of

Community of Recovery • Fall 2002 5

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“And then there was thestudent who was once a user ofmarijuana and methamphetaminewho had successfully completeda drug treatment program. Nowfor the first time in two years, hewas feeling urges to use again.

Without hesitation, Mooreopened his own wallet and drewout a coin given to him tocommemorate 19 years of hisown sobriety. He pressed it intothe boy’s palm.

The boy’s insistence that thetherapists on campus couldnever understand him melted. Heput the coin in his own bag, nextto the coins given to him tocommemorate his own first andsecond years of sobriety. At thetime of the article, three weekslater, he had not relapsed.”

(LA Times, 3/20/2001)

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Community of Recovery • Fall 2002 7

loss” onto a version of the classic “Grief and Loss Chart” fromElizabeth Kubler Ross.

3. The C-STARS Grief and Loss Model: At Santana, we firstused a Critical Incident Debriefing to get all the youth talking aboutthe event and facing any tendency towards denial. Then, we showedthem that their experiences were normal for acute stress (nightmares,numbing, hyperarousal, etc.) and that they needed to work through itor it would grow into symptoms of Post Traumatic Stress Disorder overtime. The model that several of us refined at Santana and gave to thestudents in classes and groups is re-printed here. It is equally useful inshowing youth who have had past trauma that what they have gonethrough since is an understandable process — they do not have to stay“stuck” in anger, at themselves or others. The group then helps themrebuild what they lost in their lives. We have been doing this inchemical dependency recovery since the first treatment programswere built in Minneapolis, San Diego, Yakima and across the countryin the 1960s.

Minnesota Model Process in the Classroom “Isn’t there a stigma on the kids in that class as drug addicts?” Theschool counselor was worried, remembering the old “aftercareclass.” The classroom teacher and I shook our heads in unison,“No, the kids label the classroom culture by its content and, frankly,at least 30 percent of the kids aren’t chemically dependent. Somehave substance abuse or eating disorder problems and haveproblems with aggressive feelings towards themselves or others.”The content is all about using community resources to build healthydevelopment — treatment happens in the community. We had justtaught the youth the three parts to the C-STARS Model and theclass was becoming known around campus as a place where youngadults were working on building new relationships. Frankly,anything with the tag “relationships” in high school creates apositive interest. The final part of the model is that it is MinnesotaModel in nature, which means that anything that is used in thecurriculum will parallel the 12-Step Program to fully support anyyouth who are in those programs. Each youth has to have an 80-hour service plan that supports an abstinence lifestyle and anytherapeutic activities that they need for their individual needs. Inaddition, it is based on the building of assets using the MinnesotaModel. Each youth has one or more mentors with the goal that“each youth will be able to identify five adults that are concernedwith their success in life.” Obviously, the youth in the 12-StepProgram have sponsors. Each youth also has to choose an adult-ledpeer group activity where they can affiliate and enjoy socialdevelopment (athletics, community service groups, co-curricularstudy groups, scouting, etc.). The youth in the 12-Step Programshave a home group. Finally, the class chooses curricula wheremembers can practice personal responsibility and restoring brokenrelationships through activities that are parallel to steps 4-9.Meditative and reflective activities support whatever spiritual patheach student takes in their community life. The class, as a whole, isactive in developing class projects that “carry the message” ofhealthy development to the community as a whole. This is part oftheir community health practicum.

It hasn’t been an easy transition to consider myself part of theviolence professionals’ field. However, I am grateful for theopportunities that have come my way to play a role in ourcommunities’ needs for both drug-free and SAFE schools. And,remembering that most of the youth in the community health class(along with the teacher herself!) WERE in recovery from chemicaldependency, I was able to fall comfortably asleep during my flighthome and arrive in time for my 7-year-old daughter’s soccer game onSaturday morning. With both parents in recovery from chemicaldependency, there is a special satisfaction to seeing the spread of theMinnesota Model of Recovery throughout the teenage world that iswaiting for her and her biology.

For over 15 years, Dr. David D. Moore has been project director charged withdeveloping Safe and Drug-Free Schools programs at the Center for the Study andTeaching of At-Risk Students, University of Washington. This includes six field research and training projects funded by the U.S. Department of Education, the U.S.Department of Juvenile Justice and Delinquency Prevention and the U.S. Departmentof Substance Abuse and Mental Health Services. He has served as director of severalassociated mental health and chemical dependency agencies, including Scripps Health McDonald Center in San Diego. He currently leads the C-STARS nationalschool-community restructuring demonstration project in Juneau, Alaska. Dr. Mooreis a frequent presenter and contributor to medical journals on the subject ofcounseling and treatment for at-risk and addicted youths. Dr. Moore has been acertified and licensed Chemical Dependency Professional for 20 years and anaddictions psychologist since 1995.

Continued from page 5

Understanding the Meaning in our Emotions

PAST

GAIN

LOSS

EXCITEDGLAD

SAD AFRAID

FUTURE

Denial

Anger