Background: Chronic absenteeism from school is a pervasive problem with
complex causes and long-reaching consequences. School refusal has been associated with
increased likelihood to engage in criminal behavior, sexual risk behaviors, abuse of illicit
substances, and dropout of school entirely.
Objective: Based on a review of the available literature, the aim of this paper is to describe
the current state of research on school refusal, including the role of adolescent substance use,
and to discuss treatments for school refusal, including a comprehensive model developed
through a collaboration with the New York City Department of Education.
Methods: The authors conducted a literature survey using Pub-Med, Google Scholar, JSTOR
& Science Direct databases. Key search terms used included: "absenteeism",
"attendance", "school refusal", "school avoidance", "truancy", & "substance use".
Results: Students who are chronically absent display high rates of psychiatric comorbidities,
with anxiety disorders and disruptive behavior disorders being particularly prevalent.
Furthermore, substance use and absenteeism have been found to have a relationship of
mutual influence with cannabis use showing a strong positive relationship with absenteeism,
which in turn entails the need for appropriate screening and referrals for treatment. Current
data suggest that behavioral interventions, including social skills training, cognitive
behavioral, and dialectical behavioral therapies are the primary treatment modalities, with the
addition of pharmacological management when needed. Preliminary data from the
Comprehensive Adolescent Rehabilitation and Education Services program in New York
City may indicate the pairing of educational and clinical services may improve attendance
rates and decrease rates of substance use.