Insider’s Guide: Top 5 Things for Your College Student Transitioning to Fall Semester

Most of the students with whom I work have depression, anxiety and mild substance abuse. One of the easiest, cheapest and most effective tools for combating these struggles in college is detailed planning. Below, I’ve outlined the Top 5 things I tell every student to implement as they are showing up for Fall semester.

  1. Syllabi Dates. Encourage your college student to plug-in all dates into their calendar from the syllabi they receive over the coming days. Once all the test dates are put in, reverse engineer two weeks prior to the test dates and put study dates into the calendar for no longer than 90 minute chunks. If it’s not scheduled, it will get pushed off till the last minute.
  2. Professor Office Hours. Everyone will want to meet with professors the Thursday and Friday before Thanksgiving. Have your above-average college student pull their professor’s office hours from the syllabus (yes, all professors put office hours on there) and plug into the calendar.
  3. Download Your University’s Academic Calendar. In June, I downloaded the Indiana University’s academic calendar for Fall 2016. It is a small file from Indiana University’s Academic page for any student or parent to view or download. Once downloaded, your college student can upload it into their calendar. Now, they’ll know Add/Drop dates, Fall Break, Winter Break, Finals, etc.
  4. Don’t Talk Every Day. Plan to talk 2x/week – (eg. Wednesdays and Saturdays). It’s time to intentionally create more autonomy, build trust, and not feel like you need to hover over them.
  5. Set up Counseling Early. Counselors and mental health providers get slammed since there are so few of us in most college towns. There are even fewer psychiatrists for medication management. Start looking for a counselor/therapist now before the semester gets in full swing. Psychiatrists are often scheduled out 2-3 months.

Good luck and please reach out for more suggestions and strategies to mitigate the challenges your college student is facing with depress, anxiety or substance abuse. Don’t go it alone.

5 Signs of Suicide Risk in College Students

FACT: 15% of graduate and 18% of undergrads have seriously considered attempting suicide

FACT: 15% of graduate and 18% of undergrads have seriously considered attempting suicide

There is nothing more exciting than dropping of your college freshman in late August as the cool nights of Autumn return. But not all students carry with them the same energy and positive outlook for the Fall. Some are carrying some heavy baggage from High School or even younger while others don’t start to develop any major issues until they first get to college (and their first taste of freedom from parents). What parents don’t know is that you likely know your college friends (or at least a side of them) better than their own parents do, and you may be able to tell that something is wrong way before anyone else. This quick list is as much for parents as it is for you students out there. 

The following signs might indicate a student is considering suicide:

  1. A good student who’s behavior suddenly changes – they start ignoring assignments and missing classes which are likely signs of depression or drug and alcohol abuse, which can affect their health and happiness and put them at risk of suicide. And yes, good students and good kids use drugs. Seriously. 
  2. Anyone who doesn’t have friends or who suddenly rejects their friends may be at risk. A friend who suddenly rejects you, claiming, “You just don’t get it,” may be having emotional problems.
  3. College students may be physically or emotionally abused by a member of their family or their girlfriend or boyfriend – or suffering from abuse that occurred long ago but triggered by the new college environment. Abusive relationships can make a college student feel like crap about themselves. Signs that a person may be in an abusive relationship include unexplained bruises or other injuries that he or she refuses to discuss. 
  4. This is a common one – Significant changes in a someone’s weight, eating or sleeping patterns, and/or social interaction style may indicate that something is wrong. Eating disorders are super common at college. Lot’s of perceived competition, anxiety and stress that translates into really unhealthy views of one’s self. 
  5. Coming Out? College students may suffer from depression or have thoughts of suicide if they have a difficult time adjusting to their sexual orientation or gender identity. Gay, lesbian, bisexual, and transgendered students have higher suicide attempt rates than their heterosexual peers.

We understand regret and their could certainly be a real consequence of getting help for someone who seems to be really hurting. They might get pissed at you for not minding your own business. But think of it this way – is the regret of possibly losing a friend better or worse than the potential of knowing you could have saved your friend’s life but did nothing? Tough choice but that’s part of the burden of mental illness. 

Is CRAFT the Best Unused Substance Abuse Treatment?

Community Reinforcement Approach and Family Training

Today I’d like to introduce you to one of the most effective treatments/interventions for substance abuse that is rarely used and even-more rarely discussed. It’s called CRAFT and is a behavior therapy approach designed primarily for those with substance abuse issues. Developed by Nate Azrin in the 1970s, his technique focused on operant conditioning to help people learn to reduce the power of their addictions and enjoy healthy lifestyle. CRA was later combined with the FT (…family training), which equips family and friends with supportive techniques to encourage their loved ones to begin and continue treatment, and provides defenses against addiction’s damaging effects on loved ones.

The first part of this acronym – Community Reinforcement Approach (CRA) was originally created for individuals with alcohol issues. Clinicians later went on to apply it to a variety of substance use disorders for more than 35 years. The clinical premise is based on operant conditioning (…type of learning in which an individual’s behavior is modified by its antecedents and consequences), basically, CRA helps rearrange the client’s life so that healthy, drug-free living becomes more interesting/stimulating and thereby competes with substance use.

CRA is designed to be a time-limited intervention. The time limit is decided upon between the clinician and client. For example, a set number of sessions (for example, 16 sessions) or time limit (for example, one year) may be decided upon either at the very beginning of therapy or within the early stages of therapy.

One major goal of CRAFT is to increase the odds of the substance user who is refusing treatment to enter treatment through close support of family members, as well as improve the lives of the concerned family members. CRAFT clinician and participants teach and reinforce the use of healthy rewards to encourage positive behaviors. Additionally,  it focuses on helping both the substance user and the family strengthen their relationships which is often torn apart.

In the model, the following terms are used:

  • Identified Patient (IP) – the individual with the substance abuse issues that is refusing treatment
  • Concerned Significant Others (CSOs) – the relevant family and friends of the IP.

Three goals

When a loved one is abusing substances and refusing to get help, CRAFT is designed to help families learn practical and effective ways to accomplish these three goals:

  1. Move their loved one toward treatment
  2. Reduce their loved one’s substance use
  3. Improve their own lives

This comprehensive behavioral program accomplishes these objectives while avoiding both the detachment espoused by Al-Anon and the confrontational style taught to families by the Johnson Institute Intervention.

CRAFT and these traditional approaches all have been found to improve CSO functioning and increase CSO-IP relationship satisfaction. However, CRAFT has proven to be significantly more effective in engaging treatment-resistant substance users in comparison to the Johnson Institute Intervention and Al-Anon (or Nar-Anon) facilitation therapy. 

CRA Breakdown of Treatment

The following CRA procedures and descriptions are typical recommended clinical content areas for the substance user:

  1. Functional Analysis of Substance
    • explore the antecedents of a client’s substance use
    • explore the positive and negative consequences of a client’s substance use
  2. Sobriety Sampling
    • a gentle movement toward long-term abstinence that begins with a client’s agreement to sample a time-limited period of abstinence
  3. CRA Treatment Plan
    • establish meaningful, objective goals in client-selected areas
    • establish highly specified methods for obtaining those goals
    • tools: Happiness Scale, and Goals of Counseling form
  4. Behavior Skills Training
    • teach three basic skills through instruction and role-playing:
    1. Problem-solving
      • break overwhelming problems into smaller ones
      • address smaller problems
    2. Communication skills
      • a positive interaction style
    3. Drink/drug refusal training
      • identify high-risk situations
      • teach assertiveness
  5. Job Skills Training
    • provide basic steps for obtaining and keeping a valued job
  6. Social and Recreational Counseling
    • provide opportunities to sample new social and recreational activities
  7. Relapse Prevention
    • teach clients how to identify high-risk situations
    • teach clients how to anticipate and cope with a relapse
  8. Relationship Counseling
    • improve the interaction between the client and his or her partner

Communication 

With CRAFT, CSOs are trained in various strategies, including positive reinforcement, various communication skills and natural consequences. One of the big pieces that has a lot of influence over all the other strategies is positive communication. 

Here are the seven steps in the CRAFT model for implementing positive communication strategies.

  1. Be Brief
  2. Be Positive
  3. Refer to Specific Behaviors
  4. Label your Feelings
  5. Offer an Understanding Statement – For example, “I appreciate that you have these concerns, … [or] I understand that you really want to talk right now, and that this feels urgent, … [or] I would love to be there for you.”
  6. Accept Partial Responsibility – This step “is really designed to decrease defensiveness on the part of your loved one. … It’s not about accepting responsibility for things you are not responsible for. … [Rather, it’s to] direct you towards the piece that you can own for yourself. … [For example, ] what you can take responsibility for are the ways that you communicate,” etc.
  7. Offer to help

Take home message – Help decrease defensiveness on the part of the loved one that you are speaking to, and increase the chances that your message is really going to be heard—so, increasing the ability that you have to really get across the message that you want. 

Consequences with specific limits/expectations being in place is essential in terms of communicating your message, but it’s also really important, maybe even more so, to be consistent in following through with those consequences and rewards.

Al-Anon 

As an organization, Al-Anon does not currently adopt, hold, or promote the view that CSOs can make a positive, direct, and active contribution to arrest compulsive drinking, which is the opposite premise of CRAFT. Al-Anon is a fellowship with a focus on helping families and friends, themselves, without promoting a direct intervention process for alcoholics. Because “no one ever graduates” from Al-Anon, it can be viewed as an open-ended program, not time-limited.

Al-Anon view

Regarding the CSO’s relationship to alcoholism and sobriety, the view from the Al-Anon organization can be summarized:

  1. PowerlessnessAl-Anon‘s First Step promotes a powerless view for families and friends, “We admitted we were powerless over alcohol—that our lives had become unmanageable.”
  2. Disease viewAl-Anon writes, “As the American Medical Association will attest, alcoholism is a disease.” Al-Anon also states, “Although it can be arrested, alcoholism has no known cure.”
  3. Three C’sAl-Anon has a dictum called “the Three C’s—I didn’t cause alcoholism; I can’t control it; and I can’t cure it.”
  4. Loving detachment. Al-Anon “advocates ‘loving detachment’ from the substance abuser.”
  5. Family illnessAl-Anon writes, “Alcoholism is a family disease,” and “we believe alcoholism is a family illness and that changed attitudes can aid recovery.”

Summary

CRAFT is not perfect and is not easy to implement partially due to lack of clinician training and also because of having multiple people involved (ie. IP, concerned others, and clinician). Programs, agencies and clinicians may not even be aware of CRAFT if you ask so if you or a loved one are in need of a non-residential approach that’s well researched and effective, find a substance abuse therapist able and willing to use it. 

Virginia Senator Deeds Stabbed by Son (…And How it Could Have Been Avoided)

Virginia Senator Creigh Deeds was Stabbed by his 24 year old son Austin (Gus) Deeds  who then killed himself with a shotgun at their rural home just West of Charlottesville, Va.. Austin Deeds had just been ‘psychologically’ evaluated just hours before at Bath Community Hospital under an Emergency Custody Order (ECO). The ECO is only good for 4 hours with a possible 2 hour extension if ordered by the magistrate.  Hospital staff stated, working within the maximum 4 hour window, they were unable to find a treatment facility to address Austin Deeds’ psychiatric needs despite several hospitals reporting they did in fact have availability.

Here is some analysis/questions from someone (me) that’s been in this profession for years. I also provide some ideas of solutions if you know of someone struggling with a similar situation:

1. Diagnoses: If the hospital was looking for a treatment facility this means that something the evaluator found indicated Austin was either a threat to himself or others or needed a a level of medical intervention not available at the current hospital. I’m also thinking about the type of evaluation that was conducted and why it was even done at BCH, what the evaluator’s credentials are, and how it was reviewed with Austin and his family. 

2. Discharge: If there were no options (which there clearly were), I wonder if and how the hospital communicated their findings from the evaluation as well as their concerns about safety to the parents and authorities. I’m also wondering what kind of discharge meeting took place. When a client is stepping down from a hospital or residential setting, we always facilitate a comprehensive treatment team meeting to talk about discharge so everyone leaves understanding what the next steps are – action steps. When we work with families struggling with similar issues, we don’t wait for the hospital to give updates. But as mental health professionals, we are able to navigate the bureaucracy much easier and get clear answers much faster. 

3. Responsibility: Providers, whether big hospitals or little, ole’ therapists, have an ethical and legal responsibility to communicate to authorities if a patient is in eminent danger. So who is responsible here? If you ask the hospital, they’ll probably point fingers until the next news cycle. If you ask an attorney, they’ll go through the policy and procedures for the hospital regarding intake, evaluations, referrals, discharge, etc. and anyone of making decisions in that chain could be liable.

4. Intervention (Placement Options): The hospital staff at BCH clearly did not consider referring outside of the traditional placement list (psych beds at hospitals). It’s unlikely that it was due to financial constraints and certainly not due to a lack of treatment centers as some have speculated (Yes, there are certainly a lack of medicaid-funded psych units in VA). There are facilities all over the country that are extremely well-equipped to accept, stabilize and work with patients just like Austin. Most hospitals, though, follow a tired, out-dated protocol of calling three near-by psych hospitals to find out if they have a bed avail. If they here no at all three, patient is discharged with a list of therapists to contact to set up an appointment. Sound ridiculous? You’re right. 

5. Solutions: In my humble opinion, Austin would be alive today if earlier intervention had been provided by a treatment team including a psychologist, psychiatrist, therapist, and case manager. The psychologist provides the initial psychological evaluation to identify the issues, what is causing them, and create a specific list of interventions for the rest of the team. The psychiatrist (though in limited supply in Bath Co, VA) performs an initial psychiatric (medical/medication) evaluation and identify what, if any, medication is necessary to compliment any individual counseling being performed. The therapist provides weekly counseling either in-office or in the family’s home to address areas identified within the psychological evaluation. The case manager is the project manager for everyone and is on-call 24/7. This person also facilitates regular treatment team meetings to ensure updates are provided to the family and all professionals. For instance, if the therapist starts seeing signs of bizarre thinking patterns which are historically correlated with dangerous behavior, the case manager can alert the rest of the team and monitor the client more closely while also increasing the frequency of support. If a higher level of care (ie. psychiatric hospitalization) is recommended by any member of the team, the case manager not only identifies a placement but completes all intake paperwork. The case manager also provides psychoeducation to the family to help them understand the client’s diagnoses and what they can do to most effectively support him. 

If you or someone you know is in a similar mess, do not assume your local hospital has the expertise to handle the situation. Contact a mental health professional to find services that can manage the entire project from assessment to placement to discharge and aftercare. 

Treatment 101: Therapeutic Boarding Schools and Residential Treatment Centers

Today we examine some of the basic differences and similarities between therapeutic boarding schools and residential treatment centers (or programs).

 

THERAPEUTIC BOARDING SCHOOLS

Also known as Emotional Growth Boarding School (not used so much any more), is a boarding school based on the therapeutic community model that offers an educational program together with specialized structure and supervision for students with psychological, behavioral, substance abuse, or learning difficulties. Another newer term is Academy which lends some gravitas and impressions of legacy. Basically, it sounds fancier. 

In contrast with Residential Treatment Centers, which are more clinically focused and primarily provide Behavior therapy and treatment for adolescents with serious issues, the focus of a TBS is toward emotional and academic realignment involving clinical and academic oversight for physical, emotional, behavioral, family, social, intellectual and academic development. Therapeutic and educational approaches vary greatly; with the approaches best described as a combination of interventions often based on the founders’ perspective. The typical duration of student enrollment in a TBS range from one to two years with many schools mandating a minimum stay of at least 1 year. Students may receive either high school diplomas or credits for transfer to other secondary schools. Some therapeutic boarding schools hold educational accreditation within their respective states. TBS’s may be for-profit or non-profit entities and might also be owned by a much larger company (eg. Aspen Education Group, Red Cliff Ascent, Universal Health Services to name a few). 

Therapeutic boarding schools are generally middle schools and high schools that have comprehensive therapeutic interventions (medication management, individual/group counseling, life skills) for the students and a program to help them with self-esteem and problem behaviors. Some are more therapeutic than others while some boarding schools are actually therapeutic but will not list themselves in that category to avoid any negative connotation. 

Most of the therapeutic boarding schools do not have a medical plan for bipolar disorder, and do not provide psychiatrists on staff. If you want your child to attend a therapeutic boarding school he or she needs to be stable enough to attend school with therapy support (typically includes individual counseling 1-2x/wk, group counseling 1-2x/wk and 1 weekly phone conference with parents/therapist), while maintaining a relationship with an outside psychiatrist. Additionally, some schools do not wish to administer psychotropic meds. Ask the admissions folks if this is something important for you. 

 

RESIDENTIAL TREATMENT CENTERS

Sometimes the school that best meets the child’s needs just doesn’t exist anywhere near home, or the child may become too unstable to stay at home and attend school. It may become painfully obvious that a change in environment with a twenty-four-hour peer group and non-parental authority figures may help the child grow and mature in a safe environment. Maybe they are a danger to themselves or others and they need to be in a setting that can monitor their illness and behavior, as well as provide them with tools to understand and deal with their illness while not losing ground in school.

Residential Treatment Centers (RTCs) are medical facilities (most of the time). They should have psychiatrists and nurses on staff. They administer medications, make medication adjustments, and provide therapy and schooling. They are required to follow a student’s IEP.

Residential schools can cost anywhere from $56,000 to over $125,00 per year. A school district may pay part or most of the fee of such a placement, but typically only after a due process hearing. This process is not recommended for parents – Definitely bring in professional support for this (yes, a case manager or educational consultant with expertise in IEP/504 process and laws within your state). 

If you have not noticed the theme, here it is – Parents should ask for help from a clinical case manager or educational consultant. While the vetting and application may seem like an easy project for accomplished parents, the timing, financial and clinical complexities can create significant challenges. The case manager should have any professionals working with your child contribute to the discussion on placement strategies and options. Leave this to the professionals. It costs money on the front end but will save you thousands of dollars over months and years and also help you to understand your child, family and the education/psychological process much better. 

Here are some additional resources:

Program Tour: Pros and (Not Many) Cons of Edge Learning Community

Findings of a Summer Day Tour at Edge Learning and Collegiate Community in Chicago

Among the towering buildings and rattle of platformed trains in downtown Chicago is a vibrant support community for young adults called Edge Learning Community. I met with their Director of Business Development, Chris McClaughlin, on a toasty Summer day recently. He was kind enough to meet me in the downstairs lobby  – a modern but elegant entry convenient to one of the major stops for the Chicago Transit Authority (map here).  

Up we went to their expansive and deceptively large common area. Sleek, clean furniture juxtaposed the industrial feel of the exposed brick walls and weathered hardwood floors. This was just the beginning of an exceptional space and community.

To the left, Chris escorted me to their rooftop ‘backyard’ area complete with grass (actually astro turf), outdoor projector for movies, lounge chairs and hot tub. Sweet views of Chicago were the bonus. The space felt way more private than you would imagine. Despite giant glass and steel over shadowing the old building on multiple sides, one has a sense of serenity. Not a bad start to a tour.  

After talking about some of the history of the buildings and infamous Chicago characters, we cut through the inside common area out onto another patio on the West side. This was a super-call outdoor bar and grilling area which felt more like a bistro than therapeutic program. Chris pointed out the buildings where Al Capone had secret get-a-ways, we talked about the history of the city and then, after the late-morning sun started to cook us, we got around to talking about the program. It’s center around what they refer to as Core Competencies: Whole Brain Thinking (Rational & Irrational Thinking); Creativity and Continuous Learning; Effective Communication; Leading within Teams; Community Stewardship; Sustaining Healthy Relationships; Self Care; and Management of Resources and Technology. Rather than cutting and pasting from their site, I recommend going to their site to read through the details.

After lunch in the kitchen/dining room, we toured the rooms that, to be honest, felt way more like high-end apartments with large kitchens. High ceilings and plenty of space for single or multiple students make each room a great space for studying, hanging-out and even cooking. Chris and I spoke about the limitations of many programs that only accept young adults in recovery. Edge is well-prepared and works often with folks struggling with addiction but they don’t think of themselves as a substance abuse program. It is not for those in the very early stages of recovery. It is definitely not for those that do not have basic internal locus of control and responsibility for their behaviors. The heavy lifting of support for each resident is performed by coaches who, for all intents and purposes are therapists as shared with me by their clinical director Jason Wynkoop. They are highly trained and competent to work with young adults struggling with organization, recovery, mental health issues and behavioral support needs.

Our tour and day ended high above Chicago talking about Edge, it’s program and the bright future they have since so many older, more established programs are just not meeting the current needs of students today. To summarize, here are some Pros and Cons to consider. If you need more insight, contact us. We’re happy to share what we know to help you make the best decision.

Pros

Aesthetics: Fantastic common areas (no crappy This-End-Up blocky wood sofas that smell like dog). Mature, hip and nicely appointed apartments with great views . As a side-note, I had no idea This-End-Up was still in business until I researched the link for this review. Wow.

Location: If you are freaked out by silence, if you can’t stand wilderness, and if you prefer the hyper-rhythmic flow of the city, Edge is where you need to be, especially if you are in college and need support.  It’s close to huge parks, museums, great restaurants, entertainment and tons of public transportation. Cars are definitely not needed here.

Independence: For those needing collaborative but not overbearing support from super competent professionals, Edge is your place. There is an expectation you are in school and keeping busy during the day.

Cons

Model: It’s not a bad thing but if you are looking for a super traditional transition program this may not be for you (or your son or daughter). Their collaborative approach rocks for some but may feel overwhelming to those that just want a bed for their head.

Location: If the cacophony of big city life wears you down, this is not the program for you. Edge’s DNA is inseparably tied to the fast-paced hustle of 2.715 million neighbors. Fit is a big deal when looking for support during the already stressful (and fun) time of college and young adulthood.

To be honest, there just aren’t many Cons – nothing here is inherently bad. Quality, in this case, is clearly defined by fit. For those ready for the interdependence of young adulthood we highly recommend visiting Edge for one of their informational meetings/weekends, talking to alum and getting a tour before committing to Edge. Once you know it’s the right place for you, you’ll experience the intense, positive support of this fantastic, innovative community.

 

The Affordable Health Care Act (aka Obamacare): How it impacts Mental Health and Substance Abuse Service

The Affordable Health Care Act (aka Obamacare) has been ramping up over the last few months and goes into full-throttle (Health Insurance Marketplace enrollment starts October 1, 2013). Here are some of the important changes the healthcare law impacts. 

Expansion

The Affordable Care Act will expand mental health and substance use disorder benefits  and parity protections for 62 million Americans. Mental health and substance use disorder services: This includes behavioral health treatment, counseling, and psychotherapy, prescription drugs. It also covers services and devices to help you recover if you are injured, or have a disability or chronic condition. This includes physical and occupational therapy, speech-language pathology, psychiatric rehabilitation, and more. The healthcare act also includes a huge Medicaid/Medicare expansion to provide coverage to millions more Americans currently without insurance. Here are just a few other bullet points of the healthcare act going into effect soon: 

• National goals have been set to identify and reduce mental health care disparities in the U.S.

• More federally-qualified mental health care facilities will be made available and funded.

• There will be an increased focus on telemedicine, which will facilitate mental health services and collaborative efforts from a distance, through the use of telecommunication technologies.

• Additional funding will be allocated to mental health organizations, such as SAMHSA.

• State Health Homes will be made available for individuals recovering from substance abuse and mental health disorders.

• School-based mental health programs will be initiated for child mental health care.

• Grants will be allocated exclusively for training more mental health care professionals.

• No-cost and low-cost preventative screenings will include mental health services.

• Mental health benefits will be included in the Medicaid expansion.

Prevention

Most health plans must now cover preventative services like depression screening for adults and behavioral assessments for children at no cost. All Marketplace plans and many other plans must cover the following list of preventive services without charging you a copayment or coinsurance. This is true even if you haven’t met your yearly deductible. This applies only when these services are delivered by a network provider.

Pre-Existing Conditions

Starting in 2014, health insurance plans will not be able to deny clients customers coverage or charge extra for pre-existing health conditions including mental illness. 

Let’s Talk Access

Access through for those un- or under-insured is through Exchanges. Exchanges are set up through state websites designed to make it easy for people to find health coverage. Each state will have one. The District and 16 states, including Maryland, are running their own exchanges. The rest are either partnering with the federal government or, as in Virginia’s case, relying on the federal government to operate their exchanges. To find the correct site, go to www.healthcare.gov.

To learn more about how the Affordable Healthcare Act may impact services with Fonthill Counseling, please contact us with specific questions or concerns. 

 

China’s Growing Appetite for New Kinds of Luxury Goods: Illegal Drugs

Original article by  

The country’s economy has exploded over the past quarter-century. And so has the market for narcotics whose use was once virtually unheard of.

An exponential curve seems to describe most things in modern China — cars, housing, Louis Vuitton handbags, ice cream, iPads.

It also describes the growth of drug use and addicts. Only 25 years ago, narcotics and illicit drug use were nearly unheard of. Today, Chinese society and government authorities are increasingly grappling with the explosion in drug use and drug addicts, as well as how to respond to the phenomenon. With more relaxed borders, increased wealth, and greater individual freedoms, drug addiction and its consequences threaten to become a permanent fixture within Chinese society. As the Brookings Institution notes in a recent report on U.S.-China counter-narcotics cooperation, what was once called “the American disease” is now a global one.

Drug Growth in China

Drug consumption has grown rapidly in the past few years. According to the Brookings Institution, the number of officially registered addicts increased from 70,000 in 1990 to more than 1.79 million at the end of 2011 — a 16 percent annual growth rate. In reality, the number of actual addicts may run as high as12 million, although the distinction between addicts and users in China is not clearly made in these statistics. Moreover, about 32 percent of China’s HIV-positive population contracted the disease via intravenous drug use. In comparison, about 18 million people in the United States reported that they needed treatment for a drug abuse problem in 2009.

Drug use trends have been shifting away from heroin and toward designer and club drugs. Yunnan province, as part of the Golden Triangle, a hotbed of opium production since the 1920s, has also been a hub for heroin trafficking. A heroin fix could run as low as 70 cents in China-Burma border towns. This made drug addiction particularly cheap. Heroin remained the drug of choice among more than 70 percent of registered drug addicts up until 2010.

However, the share of heroin among registered addicts dropped to 64.5 percent in 2011. Meanwhile, China’s Xinhua news agency reports synthetic drugs such as methamphetamines, ecstasy, and ketamine accounted for 32.7 percent of registered addicts, while other hard drugs such as cocaine have also grown in popularity. Synthetic drug trafficking is not centralized within Yunnan, with drugs instead coming from North Korea, international transport hubs, and home-grown labs. Crucially, China is a huge source of precursor chemicals like ephedrine and pseudophedrine, which are used to create methamphetamines.

The influx of drugs into China has demanded more attention from law enforcement authorities. Record-breaking drug busts happen frequently, with Hong Kong making the city’s largest-ever cocaine bust just last week. In June 2010, Chinese officials seized 1,032.36 kg of heroin and arrested 16 suspects including eight Pakistanis, two Nigerians, one Kenyan, and one Ghanaian. It was the biggest drug trafficking case in the history of Chinese drug control since 1949.

Who’s Using?

Young, wealthy urbanites as well as rural youth are driving the popularity of synthetic drug use, with people under 35 years of age comprising more than 80 percent of all addicts. Urban areas like Shanghai, for example, reportedly experienced a 20 percent increase in the number of drug addicts just last year.

But illicit drug use is not confined to one single demographic, nor to one single purpose. In late April, a commercial bus driver who later tested positive for illegal narcotics crashed his bus, killing 14 people. A national drug testing campaign soon followed, with authorities suspending the licenses of 1,436 coach and truck drivers because of drug use between March and May of 2012. While urban youth may use drugs for partying, long-haul drivers oftentimes need uppers to help stay awake. Sometimes they unwittingly consume the stuff, in forms like methamphetamine-laced cigarettes.

Changing Perceptions

China has historically held to a hard-line, black-and-white view on narcotic drugs. For example, Lin Zexu, a Qing Dynasty official who initiated a war against British opium when most Chinese authorities tacitly allowed it, is widely honored and respected in China today.

Modern Chinese attitudes towards drugs, at least among the older generations, still contain strains of Lin’s approach. Chinese President Hu Jintao initiated a “National People’s War on Illicit Drugs” in 2005. And as one Chinese sociology professor stated in the Global Times, “In my opinion, the sub-culture created by new drug users stems from the youth’s pop culture of hedonism and consumerism…to many Chinese youths, Western pop culture means experiencing happiness, physical pleasure and an open attitude toward sex. All these could be realized through taking designer drugs.”

But online, the addict is slowly acquiring a human face. The most popular documentary currently available on Youku, a Chinese video sharing site, is titled “Fenghuang Road” (凤凰路). Debuting this year with sponsorship from the Guangdong regional government, Fenghuang Road has received nearly 7 million views. The series follows nine women addicted to heroin, who prostitute themselves and purposely get struck by cars to make money in order to feed their habit.

The documentary is so popular in part because it puts a human face on a rapidly growing problem. As one Youku user writes, “Every single one of them at times display great depravity and at other times pure innocence.” Another comments, “They are all ordinary, commonplace people, but all travel less-than-ordinary roads. Society’s indifference —  we never see the corners and nooks…” Indeed, one of the women in the video became addicted because her mother was locked up in jail and her father died when she was young.

The growth of the illegal drug problem is visible even in Chinese censorship. On China’s Twitter-like weibo platforms, searches for marijuana (大麻) and specific slang for other drugs such as ketamine (K粉) are blocked, perhaps owing to the growing use of the Internet to facilitate drug sales. But official names of drugs along with non-specific slang such as “ice skating” (溜冰, referring to crystal meth) or “postage stamp” (邮票, referring to LSD) are still searchable.

Government response

In light of the recent growth in drug use, several governments are sponsoring online dialogues and information campaigns, especially those targeted at youth.

For example, various civic organizations are partnering with the Tianjin city government to host a viral anti-drug campaign on Weibo, asking youth to retweet anti-drug messages to three of their friends. Participants are entered in a raffle for the chance to win an iPad, iPods, and other electric goods. These efforts should bear some fruit. Reports indicate that much misinformation currently circulates regarding designer drugs, including the pernicious myth that such drugs are not addictive.

One thread asks netizens to contribute their own ideas to stem the growing popularity of drugs among youth. Though netizens are quick to offer ideas, there’s also an acknowledgement that drug use may be here to stay and societal attitudes must adapt. As @只有我俩的分组  states, “I have many friends who do pot…I won’t ever do it and I’ll try and convince my friends otherwise. I think this problem depends a lot on how society is developing. It will be very difficult to stop this problem quickly.”

In what may be a sign of changing attitudes, some netizens argue that drug use touches on certain root problems beyond a mere lack of self-control. As @草儿922 writes, “Education about the generation gap is crucial. Adults don’t understand what kids are thinking, leading to internal dissatisfaction from kids…adults should connect with their kids, know their thoughts; and not let their lives seem hollow so that they are led to a path that they don’t want to travel.”