Teens in Transition
Gale Saler and NorthStar Academy help recovering high school students (and their parents) smooth the transition from high school to college.
In middle school, Tyler started using marijuana regularly. By sophomore year of high school, Joey was a known alcoholic among his peers. Emily didn’t graduate from high school because she overdosed on a mix of alcohol and oxycodone. Clearly, substance misuse does not emerge only in college. It does not discriminate by age. So, what do young people (and their parents) do when they find themselves in the grips of addiction while in middle school or high school? How do they ensure a life of recovery once they have successfully completed treatment and are living substance-free?
Licensed clinician, master addiction counselor and board-certified interventionist Gale Saler has some answers. She knows all-too-well how addiction can affect 12- to 17-year-olds. She has spent 40 years in the mental health and rehabilitation field, and in her current position as founder of Rockville, Maryland-based NorthStar Academy, she works with teens every day. Although Saler praises the variety of treatment programs available to middle schoolers and high schoolers and admits she is a fan of collegiate recovery programs (CRPs) for students who want to pursue a degree, she also notices there is a gap between the two.
Understanding the Shift
“The transition from high school to college is crucial for every teen, whether they have a known substance or mental health issue or no issue,” Saler says. “It’s the first time many are away from home and taking care of things on their own. The transition is crucial for all teens.
“What we’re seeing more and more, even with teens who have never shown signs of having difficulty, [the issues] come out in the freshman and sophomore years. … For the teen who has had a substance use problem and/or emotional health problems, the transition becomes more important.”
Thus, the transition requires planning. Just as recovering 18- to 25-year-olds shifting from treatment back into college or into life after college benefit from assistance, so do teens in recovery as they graduate. Parents and children need to be prepared, but frequently, parents go into what Saler calls “magical thinking.”
“They just think it’s all going to be OK now,” she says. “They think, ‘My child has had drinking or emotional health problems, but they made it through high school, and they’ll be OK.’ They’re not seeing addiction as a disease. But if the child had diabetes or Crohn’s disease, no parent I know would send their child away without checking to see if there were medical facilities nearby.”
Saler believes addiction and the potentially co-occurring mental health issues are illnesses as serious as chronic physical diseases. That analogy and her perspective make it easier for parents and teens to understand the value of planning. Still, parents and young people have different needs and goals during the transition. Parents want assurances that their child is going to be safe and that they will have access to him or her. Teens, meanwhile, worry about fitting in among their peers. “Even with the best CRPs,” Saler says, “college is fraught with these feelings of ‘how do I fit in?’ It is easy [for a young person in recovery] to get sucked in.”
Feeling a part of something is important, she admits, but she also notes the importance of addressing the substance issues because college is a place of potential relapse. The access to drugs and alcohol is there, but people familiar with the student’s history are not. The only person holding the young person accountable is himself or herself. “If they don’t go into college in obvious recovery, they are frequently not around people who would support their recovery until they get so out of control that a friend calls a parent,” Saler says. Recovering teens — and even those not in recovery — need support.
Planning for Support
At a minimum, parents need their 18-year-old — now legally an adult — to sign a release allowing the college or university staff to talk to them about their student. Without it, parents cannot access grades, talk to officials about their child or even learn about their child’s health while on campus.
Additionally, parents should help their child find schools with CRPs or collegiate recovery communities (CRCs). These are perceived to be safe by both parents and teens.
“I’m a big supporter of CRPs,” Saler says. “I like all the programs, but I have a special affinity for those that have expanded to beyond substance issues, that have expanded into mental health” because substance misuse and emotional health issues are often co-occurring. Usually, the mental health issue has origins in elementary to middle school or middle school to high school; it just doesn’t show up until college, she notes. “You don’t ‘fix’ these things,” Saler says. “It’s not an event. It’s a process.”
Saler knows a young woman who suffered from a serious anxiety disorder and began self-medicating with Xanax and benzos while at college. She was hospitalized three times before her parents even knew she was struggling. She was 19 years old, living with roommates, and did not tell her parents. They found out only because one of her friends alerted them.
Most colleges are not equipped to handle long-term mental health problems, so parents and students need to plan for professional care near the school. “Knowing someone is there can be the difference for a teen who is struggling,” Saler says.
She shares another story of a young man who was attending Penn State. His parents did not realize the importance of planning, and then suddenly, their son was having a problem. “It took me some time to find a suitable therapist there,” Saler says. “They were all full.” His story has a happy ending in that Saler was able to set him up with a counselor, and that support allowed him to stay in college where he was.
“Using the diabetes example again, a teen with diabetes is going to need to check in with a doctor every few months and can’t always get home,” Saler says. “That youth would need support nearby. With addiction recovery, we need to create a safety net for teens. That safety net is like a trampoline — it can get teens jumped up and back on track.” Essentially, having someone act as that trampoline is why access to a therapist is important.
The point, she emphasizes, is: “Plan for support. If you don’t need it, fine.”
Saler knows that when a parent picks up the phone and calls NorthStar, the parent is already in crisis mode. She knows that something has stopped the student’s progress. Whether the barrier is substance-related, mental health-related or behavior-related, it is up to her team to work with the teen and get them back on track. The work is collaborative, meaning that both parents and their children are involved in the process. Both parties must be committed.
“A lot of the work that we do with the teens is with their parents,” Saler says. “We won’t take a teen whose parents won’t be in treatment with us.” Just as the students are getting treated, so are the parents — through individual family therapy, multifamily therapy and other programs.
Meanwhile, the students are moving through a program designed to help them improve their self-esteem, learn self-sufficiency, and become “contributing and happy teenagers.” NorthStar offers two programs: a day treatment option and an after-school program. Full-day participants benefit from a mix of academic, therapeutic and physical education blocks. At night, they return home to their families. After-school clients spend their afternoons and early evenings at NorthStar, attending therapy sessions and doing homework. Both groups have daily chores.
The chores are an integral part of the healing process and an intentional contribution to the NorthStar community. Saler believes being part of a community is one of the key elements in developing healthy teens. “Substance abuse and misuse are diseases of disconnection,” she says, “so by creating connection and community, you can give and receive help and support.” At NorthStar, the students are reminded that it is their community, and they are given responsibility for its care — the physical space as well as the people within it. Plus, they hold community meetings during which they come together, set goals, talk about how the community could be better, and learn how to give and receive compliments.
Parents, too, are part of the community, and their participation is vital for successful recovery. Many times, they are learning about boundaries, and if they can hold them, Saler says, “then we do really well. Boundaries are so important. Teens need boundaries. They’re scared without them. They push against them, but they still need them.”
Saler understands how hard it is for parents to stand their ground, but she also knows the benefits.
The connections parents make with their teens in high school — even those forged in the fire of creating boundaries — eventually become a foundational support for the young person’s recovery. The teens find comfort in their family communities, which are also tied to a larger recovery community. Both communities are essential to easing the transition from high school to college for a teen in recovery.