To Scare or Not To Scare: That is the Question RE Alcoholic Energy Drinks

Anyone with a passing interest in alcohol-relate issue, especially as they apply to collegians, has heard of the furor related to "Four Loco" and other caffeine infused, high-alcohol drinks. A good example of news coverage can be seen in an article in Carolyn Davis' piece in the 27 Oct edition of  Philadelphia Inquirer see http://bit.ly/bt2dJQ because of the hospitalizations, deaths, and various sundry "alcohol-related" emergencies associated with consuming such drinks, some campuses have banned these beverages and educators, political officials, parents, and others have called for action...from mandatory labeling of the number of standard doses of ethanol in a single 23.5 oz can of Four Loco (4.7) to outright banning of these products. Finding information on this issue is easy and if you are interested but having difficulty, you can post a comment or email directly and I will be pleased to share some sources.

The focus of this blog post, however, is not to participate in this debate so much as to step back from it and as two basic questions from a more global perspective: (1) Are there inherent risks associated with scare tactic approaches to "warning" individuals to not do something because it is risky and potentially harmful, and (2) have some earlier decisions made by prevention specialists and prevention researcher's diminished our credibility in the eyes of students to deliver reliable and therefore "to be listened to" information about alcohol and other drugs?

I suspect there may be a downside to efforts to emphasize the immediacy for responding to the alcoholic energy drink issue. The greater the urgency assigned to this issue, the more  likelihood that these products will appeal to a certain minority of students who are risk takers. As Linda Lederman, Dean of Social Sciences at Arizona State university, has admonished regarding the use of “high-risk drinking” as an alternative to “binge drinking” because of the potential to appeal to these students, we may want to target audiences to which we appeal with this in mind. It may result in a desired effect to raise the alarm with administrators and student affairs professionals, but cause quite a different result if that same message is delivered to students. (To risk-taking behavior and its impact on substance use further, read Tom Workman’s essay on edgework and risk takers entitled, “To the edge and back again: Edgework and Collegiate Drug Use” in my monograph, Collegiate Drug Use: A New Look at and Old Issue (http://www.rowan.edu/casa/resources/documents/chapmanfinalfinalap.pdf).  

Related to this cautionary word is the importance of considering how we wish to approach students with this information. As in so many things in our field, there is no “one size fits all” alert that will have the same impact on parents, administrators, students affairs pros and students. Remember, since we have all but acquiesced to accepting “binge drinking” as the term to describe 4+/5+ student drinking, we have lost credibility as purveyors of factual information in the eyes of some students.

In a recently published report from the Century Council—and yes, I know the CC is an arm of the distilled spirits council—students do not see this term as relevant or descriptive of their drinking – see http://bit.ly/bqZTbg Knowing this, we need to pay attention to: (1) What message about high-alcohol energy drinks do we wish to deliver to students and (2) who is it that we believe is best suited—and credible—to deliver this message? Remember the old adage, “what goes around, comes around”; it may be time to review our comfort as a field with the term “binge drinking” to describe how students drink. NOTE: Thanks Jim for not referring to 5+ drinks as “binge-drinking” in your missive J

Again, I do not attempt to “rain on the parade” and believe that social scientists, administrators in high education, and parents alike do need to address this issue as a unified entity. My caution is that we do so in such a way as to be consistent with sound prevention methodology, which has excluded "scare tactics" as a viable approach for almost 20-years..

What do you think?

Best regards,

Robert

Benign Neglect or Can Deception Ever Be Therapeutic?

The  rather brief podcast linked below suggests a novel approach for addressing the problem experienced by a German retirement home where residents suffering from dementia tended to wander off campus and become lost in the community. Irrespective of how closely the focus of this piece may parallel your professional work, there is an inherent ethical question associated with the proffered solution: Is it okay to intentionally deceive individuals, in a rather elaborate and premeditated way, when the result of the deception is a reduction in the likelihood of the demented individual experiencing harm?

Related to this is a story from my clinical experience over 30 years ago. While directing a clinical staffing in an in-patient addiction treatment program, the program’s consulting psychiatrist related the story of an elderly woman suffering from dementia who was living with her daughter. Each morning this woman would get up, happy as the proverbial clam, fix herself tea and toast, and then proceed to sit in the front-room of her daughter’s home for several hours “watching her friends as they would do their acrobatic tricks out front of the house.” Now, the friends were little people who used the telephone wires strung between the poles out-front of the house to practice their routine. As you have no doubt surmised there were no “little people” doing “acrobatic tricks” in the telephone wires in front of the house; this was the woman’s delusion.

The woman’s daughter became concerned about her mother’s hallucinations and her increasing fascination with them...in short, they because the highlight of her day and all she would talk about through the day. The psychiatrist interviewed to elderly woman, made a diagnosis, prescribed medication and in relatively short order the delusions ceased. The psychiatrist was satisfied with the result, the daughter was ecstatic with her mother’s return to sanity...and the elderly woman became severely depressed. The depression progressed to a point where the elderly woman became lethargic, inattentive to such things as eating and personal hygiene, and uncommunicative. The daughter again contacted the psychiatrist, outlined the new symptoms and her concerns for her mother after which the physician agreed to reexamine the elderly woman. He diagnosed her condition as related to the “loss of her friends” and the depression observed the result of the grieving associated with this loss.

His recommendation? Take the elderly woman off the medication and engage the daughter in supportive “talk therapy” so that she might better cope with her mother’s condition. With in a relatively short time, the elderly woman’s friends returned, she now was the one who was ecstatic and returned to her previously outlined daily routine. The daughter agreed to the therapy and as the result, was able to better cope with her embarrassment related to the stigma she perceived being associated with her mother’s “mental illness”; the case was closed.

My point in sharing this latter story is to approach the question mentioned initially above from a different perspective: Is the intentional deception of a client resulting in harm reduction or the intentional withholding of treatment that can effectively alleviate symptoms of pathology albeit with iatrogenic effect (1) justified, and if so (2) is it ethical?

What do you think?

Check out the referenced podcast on iTunes: http://ax.itunes.apple.com/us/podcast/wnycs-radiolab/id152249110  (#13, “The Bus Stop” episode)

Best regards,
Dr. Robert