When John Edmonds was a teenager, a Maryland judge gave him an ultimatum: After racking up 16 felonies and struggling with addiction, he could either go to juvenile prison or a treatment program. He chose the latter and was sent to Phoenix High School, a public school in Montgomery County specifically tailored to keep at-risk youths sober and drug-free.
“I got clean in July of ‘89 and been sober ever since,” Mr. Edmonds said in an interview, “and I credit a lot of that to the great opportunity of recovery high school.”
Mr. Edmonds, who grew up in Potomac, is now part of a group working in the District to open a chartered “recovery high school,” part of a growing national trend that has yet to reach the District, Maryland or Virginia.
His alma mater was absorbed by the local high school before closing in 2013.
The opioid epidemic, which killed over 64,000 people in the U.S. last year, does not necessarily apply to this school-age group. Youths are more likely to be dealing with marijuana and alcohol abuse. But recovery school advocates argue that intervention at this age is critical to help head off larger substance abuse problems down the line.
According to the 2016 National Survey on Drug Use and Health, about 1.1 million Americans ages 12 to 17 — 4.4 percent of adolescents — needed treatment for drug abuse. Only 180,000 of them actually received treatment.
Last month, the National Vital Statistics System registered 772 deaths related to drug overdoses for 15- to 17-year-olds, with an increase related to heroin and fentanyl poisoning.
Forty recovery schools have opened in 15 states, according to the Association of Recovery Schools. California, Minnesota, Massachusetts and Texas have five to eight recovery high schools, and Florida, Pennsylvania, New Jersey and Rhode Island have at least one. Delaware, which federal data show has the most rapidly growing rate of drug overdose cases in the country, also is considering the concept.
The schools can be set up within the traditional public school system, as charter schools or as private schools structured by groups fighting drug abuse.
They can be funded by taxpayer dollars, private contributions or both. Some schools ask for tuition fees to help cover medical costs.
Supporters say the schools are not detoxification centers or rehabilitation treatment facilities, but rather transition points for adolescents who have gone through treatment programs but are still too vulnerable to be put back into their home environments and among peer groups that have encouraged their substance abuse.
The school populations are typically small, from 30 to 100 students, and the curriculum is complemented by therapy for addiction and mental health disorders. Students attend group therapy, take part in recovery-related discussions and undergo a 12-step program. They are subject to random urinalysis and breathalyzer tests.
“The reason why I think these schools have a chance to be successful is that given the right environment and the right staff, they can create an environment where the peer pressure is staying clean and staying sober,” Mr. Edmonds said.
Some schools even put an emphasis on addressing mental health issues. In a recent study evaluating the efficacy of recovery schools, a vast majority of students in the sample size met the criteria for at least one of nine mental health issues, including depression, anxiety, obsessive-compulsive disorder and suicide risk.
Starting a D.C. school
Students normally enter during their sophomore or junior years but are not obligated to spend the rest of their high school careers in the programs. Typical stays range from one month to two years.
Mr. Edmonds, along with a handful of other concerned D.C. residents, started the Association for Recovery & Education of Greater Washington in 2014 to raise funds for a school based in the District but open to struggling teens from Maryland and Virginia as well.
“A charter application is about $25,000, and obviously we need seed money for the school, which is another couple hundred thousand dollars. Finances are what’s holding it up,” Mr. Edmonds said. The group hopes to raise $250,000 to $300,000.
A review by Stateline.com, which specializes in state trends, has found a higher financial bar for recovery high schools given their dual function. According to Stateline, citing figures from the Denver-based Association of Recovery Schools, the average recovery school spends $16,000 to $18,000 per student annually — at least 49 percent more than the national average of $10,700 per student per year in regular public schools.
It’s not clear how many adolescents in the region have substance abuse problems and would qualify for a recovery school. Federal data suggest that those 26 and older are most at risk of heroin and opioid abuse, but the numbers don’t break down the risk on a state-by-state basis.
Addicts ages 12 to 19 account for less than 1 in 8 admissions to publicly funded rehabilitation sites. About half of students who go back to traditional schools after treatment return to substance abuse within a year.
Mr. Edmonds estimates that a recovery school in the District would attract 70 to 100 students.
The concept of recovery high schools has been around since the early 1980s, but hard research is just starting to emerge on their rates of success in helping students recover from substance use disorders and avoid relapses later in life.
Dr. John Kelly, the founder and director of the Recovery Research Institute at Harvard Medical School and Massachusetts General Hospital, is a supporter of recovery high schools. He said each major city in the country should have at least one.
“Given how prevalent substance use disorder is and the highly promising data emerging from the recovery high school research, I think every region at least should have one so that we can support recovery for our most vulnerable young people,” he said.
“One of the big hazards for young people is the environmental exposure to other young people who are using substances. So anything we can do to make their environments more supportive or more conducive to recovery, that is going to help them avoid exposure to drug-related cues. That’s a good thing.”
Dr. Kelly said the long-term efficacy of recovery schools is limited. It’s also unclear whether aspects of these schools could be incorporated into more traditional schools, which may be more cost-effective.
“We don’t know the answer yet because that study’s not been done,” he said.
He added that introducing recovery-specific programs in regular high schools could have a positive influence on the general school population by promoting healthier lifestyles without drugs and alcohol. “This is typically what is done in college settings,” he said.
“There’s arguments to be made for at least testing that out with high schools” he said.
The most recent study on the efficacy of recovery schools was published last month in The American Journal of Drug and Alcohol Abuse. Dr. Kelly was not part of that study but works closely with its lead author, Vanderbilt University associate professor Andrew Finch.
Mr. Finch is also a board member of the Association of Recovery Schools.
In the study, which was published in August, Mr. Finch and his colleagues followed 194 students — 134 in recovery high schools and 60 in regular high schools — who had completed either inpatient or intensive outpatient treatment programs for substance use disorder.
The researchers followed up with the students at three-, six- and nine-month intervals and measured how often they used marijuana, alcohol or other substances over these periods. They also evaluated students’ academic performances and truancy rates.
The students who attended recovery high schools “were significantly more likely to report being completely abstinent from alcohol, marijuana and other drugs at the 6-month follow-up and had significantly lower levels of marijuana use and absenteeism from school,” the researchers concluded.
But the study has limits. Students weren’t randomly assigned to either school — the researchers deemed it unethical to tell families that they couldn’t send their children to recovery schools — and there was little initial evidence of better academic performance at recovery schools compared with traditional schools.
Tenure at a recovery high school can vary, and the researchers noted that it was difficult to assess any specific time measure as more beneficial to overall recovery.
Mr. Finch said many students chose to stay in recovery schools.
“The most surprising finding to me was how few students chose to return to their former schools after treatment,” he said.
In general, most families chose to change high schools after their children finished treatment for substance abuse.
Mr. Finch said the use of recovery schools as a prevention model is not entirely understood and should be explored further.
“Even though we’re talking about kids who have already exhibited substance use problems if you are able to reach a teenager and help them learn some sober life skills, meet new peer groups, those kinds of things, help their brain heal and grow without drugs, then what you’re doing is preventing a worsening of the problem later,” he said, noting that the highest number of opiate drug users falls in the 18 to 25 age range
An estimated 19.8 million people 18 or older needed treatment for substance use problems last year, according to the National Survey on Drug Use and Health.
“The recovery high school profile would be the kids that would be a high risk of that. To help them get off of that track, so to speak, it’s also a prevention model,” he said.
Mr. Finch is also involved with a group of researchers at the University of Wisconsin who are conducting a cost-benefit analysis of recovery schools. They are quantifying the value of receiving a high school diploma, graduating from college, and staying out of jails and emergency rooms to further understand the long-term effects of recovery schools.
“Logic would tell you that if you have a program modality that’s helping kids stay clean and sober — at least for a period of time — they’re less likely to have those problems,” he said. “What I don’t have is: ‘What are the quantifiable aspects of that?’ That’s coming.”