SUBSTANCE ABUSE THROUGH MTSS 1

Substance Abuse Through Multi-Tiered Systems of Support

Vanessa Van

Chapman University

CSP 600: Multi-Tiered Systems of Support for School Counselors

Dr. Randee Kirkemo

2 March 2023
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There are almost 21 million Americans who have at least one drug addiction, and only 10

percent have received treatment (Yerby, 2019). Young adolescents are no exception; based on the

current study of 12th graders, 61.5% have tried alcohol, 43.7% have tried marijuana, and 17.6%

have tried illicit substances (Pederson et al., 2022). Substance abuse creates an issue that impacts

students' wellness and academic achievements, such as low self-esteem and violent occurrences

(Pederson et al., 2022; Kedia et al., 2020). Lack of neighborhood safety is associated with

frequent substance abuse due to a lack of adult and community support (Pederson et al., 2022).

Being connected with dangerous groups can contribute to a student's willingness to participate in

substance abuse (Kedia et al., 2021).

Students lacking neighborhood safety and community support are often associated with

increased substance abuse. Neighborhood characteristics contributing to poor neighborhood

safety include low socioeconomic status and neighborhood violence (Pederson et al., 2022).

Students surrounded by these environments can increase the risk of substance abuse (Pederson et

al., 2022). The most affected are high school and older students, especially since they can access

technology. Participating in illegal drug usage can prevent young students from reaching critical

developmental milestones and increase the chances of adverse health concerns in the future

(Kedia et al., 2021).

Substance abuse is an essential topic in the school counseling profession. The reason why

students indulge in it is an issue. Lower self-esteem can correlate with more significant substance

abuse, which school counselors can help alleviate (Pederson et al., 2022). School counselors can

help form groups where students can attend and help one another. In addition, counselors would

be able to provide resources to students to help with substance abuse. School counselors can

provide the opportunity to help students talk about their issues.

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Centers for Disease Control and Prevention (CDC) (2022) found the following:

Adolescents who abuse substances have a high risk of adverse outcomes such as injury, criminal

record, school dropout, and even death. Substance abuse includes misuse of prescription drugs,

illicit drugs, and injection drugs, which involves a high risk of infection with blood-borne

diseases such as HIV and hepatitis, 15% of high school students reported having tried illicit or

injected drugs, and 14% of students reported misusing prescription opioids. Youth opioid use

correlates with risky sexual behaviors. Students who reported using prescription drugs without a

doctor's prescription are likelier to be victims of physical and sexual dating abuse. Substance

abuse correlates with sexual risk behavior, experiences of violence, and mental health and

suicide risks. Some risk factors for high-risk substance users include family history, poor

parental monitoring, parental substance use, lack of school community, low academic

achievement, and childhood sexual abuse (Centers for Disease Control and Prevention, 2022).

Substance abuse can be addressed using evidence-based practices. The entire point of

these practices is to use methods that work with these individuals, including effective treatment

interventions. These inventions include cognitive-behavioral treatment (CBT), which would help

individuals modify their thoughts about risky behaviors, coping mechanisms, and life skills. It is

essential to educate individuals about the dangers of substance abuse; therefore, counselors

should inform students and adopt evidence-based practices in their profession for dealing with

substance abuse. In addition, it ensures that counselors can educate students not to have stigmas

about individuals struggling with drug abuse (Lanzillotta-Rangeley et al., 2021). Counselors

could use tier 1 prevention, such as LifeSkills Training which complies with classroom-based

lesson plans to build resilience and social skills (Lipien et al., 2021).

Multi-Tiered Systems of Support

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A Multi-Tiered System of Support (MTSS) is a framework for educators to use

high-quality implementation of evidence-based mental health practices so students can access

them if needed (Romer, 2017). MTSS is an excellent source for educators to use in helping

students because it offers the support and resources students need. MTSS can also be used for

substance abuse. Tier 1 is meant to be preventative and proactive for students. In tier 2, students

would receive interventions consisting of group counseling and sometimes individual

counseling. Tier 3 interventions are provided to students needing additional support beyond tier 1

or 2. In addition, if the student needs help beyond a school counselor's assistance and tier 3

support, the counselor may refer the student to outside resources. This would be an effective

strategy because, with the three tiers, counselors can address prevention, intervention, and

treatment. In tier 1, counselors could educate students about the dangers of substance abuse; this

would be taught to all students and be typically effective for 80%-90% of students

(Goodman-Scott et al., 2019). In tier 2, counselors can hold small groups for students at risk of

substance abuse. The population is between 10%-15% of students (Goodman-Scott et al., 2019).

Lastly, tier 3 is treatment, where students would receive individual counseling (Goodman-Scott

et al., 2019). These students would be already involved with substance abuse. The population of

students is relatively 5%-10% (Goodman-Scott et al., 2019). Being culturally responsive during

this framework is essential because it can be easily adaptable and modified for the population

served. Therefore, being culturally sensitive would create a comfortable environment for our

students (Goodman-Scott et al., 2019).

A school counselor plays an active role within the MTSS framework by suggesting using

evidence-based curriculum and interventions that target substance abuse. Counselors can provide

core curriculum lessons, such as teaching educators how to incorporate social-emotional learning
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in the classroom. In tier 1, they can implement universal screening measures to identify students

needing extra support before entering tier 2. Tier 1 is meant to be preventative and proactive for

students, building life skills and resilience. Counselors can provide data-driven small group and

individual counseling services in tiers 2 and 3. Within tier 2, school counselors can implement

trauma-informed practices and hold small groups for students who need extra support. Within

tier 3, counselors can refer students to licensed alcohol and drug counselor (LADC) and personal

mental health counseling services. Lastly, school counselors should collaborate with

stakeholders, including other educators, administration, parents, and community members, to

raise awareness about substance abuse. (Goodman-Scott et al., 2019)

Tier 1: Prevention

In the MTSS framework, all students receive tier 1 support. Tier 1 is meant to be

preventative and proactive for students; therefore, all students are supported to prevent substance

abuse. When implemented effectively, at least 80% of students can be supported within tier 1

interventions (Goodman-Scott et al., 2019). The support helps students learn about the dangers of

substance abuse, identify warning signs, and where they can seek help.

LifeSkills Training (LST), developed by Dr. Gilbert J. Botvin, is a drug prevention

program designed to address risk factors and build resilience and social skills (Lipien et al.,

2021, Botvin LifeSkills Training, 2023). Lessons and activities are included to showcase

self-esteem, problem-solving, and communication skills, which could help students reduce stress,

manage anger, avoid violence, and resist drug use (Lipien et al., 2021). LifeSkills training is split

into three components drug resistance skills, personal self-management skills, and general skills

(Botvin LifeSkills Training, 2023). During drug resistance skill lessons, students are taught about

misconceptions about tobacco, alcohol, and drug use (Botvin LifeSkills Training, 2023). During
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the personal self-management skills portion, students can self-reflect and set future goals for

themselves (Botvin LifeSkills Training, 2023). In general social skills, students can navigate

social gatherings and avoid social pressures (Botvin LifeSkills Training, 2023). With LifeSkills

Training, students learn different things from classroom lessons, therefore making it crucial for

tier 1 prevention.

LifeSkills Training is an example of tier 1 prevention because it provides classroom

lessons for at least 80% of students. Steeger and researchers researched adolescent vaping and

cannabis use and how LifeSkills Training can be effective (Steeger et al., 2022). The study was

used on high schoolers ranging from 9th to 10th grade (Steeger et al., 2022). The concluded

results were a decrease in nicotine and cannabis use, an increase in positive behaviors, and an

improvement in academic achievement (Steeger et al., 2022). LifeSkills Training had a positive

outcome for this study and would be beneficial to continue in schools (Steeger et al., 2022).

Tier 2: Intervention

Even with tier 1 support, a certain number of students may need additional assistance.

Within tier 2, about 10%-15% of the student population would receive services (Goodman-Scott

et al., 2019).

Dialectical Behavior Therapy (DBT), developed by Marsha Linehan, is a type of

cognitive therapy built over four components; individual therapy, skills-based training, coaching,

and therapist consultation team (Warner & Murphy, 2022; Marceau et al., 2021 ). DBT provides

skills training that includes mindfulness, emotional regulation, distress tolerance, and

interpersonal effectiveness (Warner & Murphy, 2022). DBT is implemented in a group format for

individuals with substance abuse (Warner & Murphy, 2022). Originally, DBT was meant for

Borderline Personality Disorder (BPD), but as time progressed, researchers correlated that DBT
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can reduce aggression, self-harm, suicidal thoughts, and substance abuse (Warner & Murphy,

2022). Therefore, currently, DBT is used for interventions for substance abuse.

DBT is an example of tier 2 intervention because it provides small group intervention and

life-skills training. The group intervention teaches individuals about coping strategies and how to

control their cravings (Warner & Murphy, 2022). Their training includes teaching individuals

about problem-solving skills and how to deal with peer pressure from others (Warner & Murphy,

2022). According to Warner and Murphy, their research done on Iranian males with addiction to

opioids using DBT had a lower relapse rate compared to Cognitive Behavioral Therapy (CBT)

(Warner & Murphy, 2022). This was one of the first data retrieved from DBT, suggesting that

DBT may be more effective than other evidence-based interventions such as CBT (Warner &

Murphy, 2022).

Another study conducted by Marceau and colleagues (2021) compared individuals

receiving DBT treatment over a ten-year period. There were two cohorts participating in the

same treatment. Cohort B's participants were older and had more education. Cohort A was the

opposite. However, improvements were more than likely in Cohort A compared to Cohort B

(Marceau et al., 2021). Both cohorts showed the same sobriety results (Marceau et al., 2021).

Marceau and colleagues concluded that individuals, who used DBT treatment, can hold on to

their urges to maintain sobriety (Marceau et al., 2021). Their conclusion states that future

research needs to be done because they were the first researchers to conduct a ten-year

comparison (Marceau et al., 2021). Fortunately, they believe that future studies would be

beneficial since DBT treatment has shown positive results (Marceau et al., 2021).

Tier 3: Treatment
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Tier 3 interventions are provided to students needing additional support beyond tier 1 or

2. Tier 3 interventions target 5%-10% of the student population and are more intensive than tier 1

or 2 interventions (Goodman-Scott et al., 2019). Tier 3 interventions are intended for individuals

and are unique to each; however, they can also be offered to small groups. The services may

include individual counseling on a limited basis and may also involve referring individuals to

outside resources.

Cognitive behavior therapy (CBT) is an effective intervention for psychological disorders

like depression and anxiety. In a study conducted by Winner, he used a 12-step program known

to be used for Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) to address

substance-related issues (Winner, 2021). This 12-step program and CBT can be used together to

create an effective treatment for individuals. "As relapse prevention and other CBT-based models

note, effective strategies for managing negative affect are crucial in recovery, and the 12-step

model largely aims at serving this purpose" (Winner, 2021). CBT is used to start and maintain

sobriety, and the 12-step program's main idea is to establish this. Therefore, it is the reason why

these two work incredibly with one another. CBT is a way to introduce individuals who struggle

with substance abuse.

Another study by Kiluk and researchers (2018) concluded that CBT could be a safe and

effective treatment for individuals struggling with substance abuse. They did a randomized trial

with 137 participants, where they were assigned to receive weekly CBT or brief morning CBT

treatment every day (Kiluk et al., 2018). This resulted in individuals who received either CBT

treatment having reduced the frequency of substance abuse (Kiluk et al., 2018). "A 6-month

follow-up demonstrated continuing efficacy for CBT4CBT compared with treatment as usual,

but not for clinician-delivered CBT compared with treatment as usual" (Kiluk et al., 2018).
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Individuals with brief morning CBT treatment had better sobriety results than participants with

weekly CBT treatment.

Discussion

Substance abuse is a serious issue that society is dealing with because it affects students'

academic achievement and mental development. By implementing more social awareness, such

as LifeSkills Training, students are more educated about the consequences of substance abuse

and how to help others who want to stop. Tier 2 interventions, including DBT, are helpful to

students who are at risk of substance abuse. Within DBT, students can learn about skill-based

learning (Warner & Murphy, 2022). When tier 2 does not provide enough support, students will

enter tier 3, which can include recovery high schools. Within CBT, students can receive

treatment and maintain their goals—individuals who have CBT treatment consistently maintain

sobriety (Kiluk et al., 2018). As stated, if all three tiers are beyond a student's need, the school

counselor should refer to outside resources.

Despite these promising resources, limitations can still occur within these evidence-based

programs and interventions. Future recommendations include studying a more extensive

population size when conducting research and increasing the diversity aspect. While researching

for this paper, many publications were shown on the Hispanic and African American

communities with low-socioeconomic statuses. The current research was done well but needed to

include more cultural and socioeconomic variation. It would be beneficial to look at a broader

scale to gain more cohesive data for our targeted age group, ages 14-19.

School counselors are essential in supporting all students to achieve academic,

social-emotional, and college success. This can be achieved through direct services, such as

providing prevention, intervention, and treatment, including both group and individual
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counseling for students who are at risk or engaging in substance abuse. Counselors can also

provide resources and support for families and communities to help reduce substance abuse.

Culturally sensitive and purposeful collaboration within the MTSS framework is critical in

helping students with substance abuse in today's education system.

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Frankforter, Donna M. LaPaglia, P. D., Srinivas B. Muvvala, M. D., & Kathleen M.

Carroll, P. D. (2018). Randomized Clinical Trial of Computerized and

Clinician-Delivered CBT in Comparison With Standard Outpatient Treatment for

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