CVAHEC Student Project Reports

Ian Spencer Zenlea
Freeman Scholar Program

Before I began teaching at Spectrum One-Stop, an adolescent homeless shelter and drop-in clinic affiliated with the Community Health Center in Burlington, Vermont, I had been unaware that there was a significant population of homeless people in this area. I was particularly surprised to discover that there were numerous homeless adolescents in Burlington, Vermont.

As a result of my experiences at Spectrum, I have gained valuable insight into the adolescent public health issues in Burlington, including homelessness, mental illness, teenage pregnancy, substance abuse, and sexually transmitted disease.

In the process of developing a health education curriculum, I have become aware of the community resources available to combat these health concerns. However, I gained my most valuable insight into adolescent health during one of my first teaching experiences.

I learned very early never to assume that individuals who suffer from a particular disease and receive treatment are necessarily educated about their disorder.

One of the first health topics that I volunteered to teach concerned the biochemistry and physiology of substance abuse. This topic had recently become very interesting and exciting to me, and I believed that since most of the adolescents at Spectrum are afflicted with mental illness, are recovering substance abusers, or suffer from both, this topic would be both relevant and pertinent to my target audience.

I had assumed that sometime amidst the numerous visits with psychiatrists, health professionals, and social workers, someone would have explained to these adolescents that substance abuse is a mental illness; it is not a weakness. I presumed that they understood that substances of abuse induce their effects by interacting with certain biochemical receptors present on the surfaces of cells in our brains to alter the levels of chemicals these cells use to communicate.

To my dismay, my assumption was incorrect, and I was dumbstruck by my own naivety.

Somehow I had forgotten that I come from a very well educated, stable background and that had I attended high school and college and was now in medical school, whereas most of my audience had not even completed high school.

What had I expected? When would they have learned about these topics in school? Most of the adolescents at Spectrum had been bounced from one foster home to another and thus one school system to another, eventually winding up homeless either by choice or by neglect. Their circumstances often prevented them from completing their educations.

Initially, I felt angry with myself for being so oblivious; however, after a few moments of gathering my racing thoughts, I directed my anger in the appropriate place, at the healthcare professionals who treated these adolescents.

I believe that medicine is an equal balance between treating the disorder and educating the patient. Somewhere during the treatment of these adolescents’ drug abuse problems, the educational aspect of their treatment had been lost.

How was it possible that it was not explained to these individuals that substance abuse is a biological and pathological process that alters the way in with the pleasure center of the brain functions? How could these adolescents, who throw around the terms “dopamine” and “serotonin”, who offered that cocaine is their drug of choice, who were perhaps taking prescription medications to alter their brain biochemistry, not have been told what this meant? It was not explained that these words referred to neurotransmitters used by neurons present in the part of the brainstem that relays messages about pleasure to the higher order processing centers in the brain.

I realize that the goal of recovery programs is to treat the substance abuse problem by removing the abuser from the substance and by teaching appropriate coping strategies in counseling sessions, but in order facilitate recovery, should not a patient be informed as to every aspect of his illness?

Perhaps the healthcare community believes that this information is not a necessary aspect of treatment. While presenting this information, I feared, however, that the reason that this information was not discussed was that it had been assumed that the target audience was not capable of understanding the workings of brain biochemistry and physiology.

To my pleasant surprise, this was far from true. By the end of the lesson, I was facing an informed audience.

The clients at Spectrum were eager to learn about these aspects of substance abuse, were attentive listeners, and asked insightful questions about their brains and bodies. We were discussing aspects of their own physiology that they had never even contemplated. They understood that they were not weak for having abuse problems because we all have the potential to abuse substances.

Even more exciting was, without hesitation, the adolescents at Spectrum were offering their own experiences for discussion, sharing their opinions about treatment options, treatment centers, and the roles of medical professionals during recovery.

By approaching their disorders from a scientific perspective, they felt more comfortable sharing their stories and discussing their situations. I was impressed with how forthcoming the adolescents were, and I felt immense gratitude that they had trusted me enough to share these experiences with both the group and myself.

This initial experience at Spectrum taught me two valuable lessons; never assume that information has already been taught and never assume that a target audience in incapable of understanding.

Overall, my experiences at Spectrum One-Stop have further fueled the interests I have in mental health and teaching medicine