Considering Collegiate Drinking; The Rest of the Story

When considering collegiate drinking, it is important to step back from issues such as student AOD use and consider a larger picture.  As a profession, substance use disorder prevention specialists have a tendency to be myopic in our consideration of "the problem."  As accurate as accounts of this problem may be, they are, nonetheless, incomplete.

Lists of strategies to address collegiate drinking generally include several important and proactive suggestions.  Approaches such as social norms marketing, environmental management along with clinical intervention strategies like Brief Alcohol Screening and Intervention for College Students (BASICS) are on the short list and are important steps that need to be considered when addressing the issue of alcohol and other drug use by students.  As important as these approaches are in addressing high-risk and dangerous collegiate drinking, they do not provide access to the "big picture."  If anything, these are “problem-oriented” strategies, but are the metaphorical equivalent of effective strategies for bailing the water from a sinking ship, but do little to solve the problem of taking on the water being removed from the bilge. 

What we need to ask is, when framing the issue of collegiate drinking, "what is just outside the framed shot.”  What would we capture in our picture of collegiate drinking if we used a wide-angle lens?  I suspect that there are several influential factors that heretofore have been overlooked at best or more likely, simply not considered...at all.  As Paul Harvey used to say in his syndicated radio program, what is, “the rest of the story”?

Just like Pluto--before it was demoted to a dwarf planet--was predicted to exist before it was actually discovered by Tombaugh in 1930, its existence was postulated via mathematical calculations.  So do "other forces" exist that affect the use of alcohol and other drugs by students?  Although I focus on this in great detail in the latter 2 monographs in my 3-monograph series on collegiate drinking, When They Drink (links included at the end of this post), here are three invisible, that is to say, "unstudied," forces I suggest affect collegiate substance use:

•                What do "alcohol" as a substance and "drinking" as a behavior mean to students?  This social constructionist view of collegiate drinking has never been seriously investigated.  "How" does alcohol reach its iconic status for students?  "What" affects the meaning ascribed to alcohol and drinking?  "Why" and more importantly, "how" does this meaning change with time...often in 2 to 3 semesters via the "maturing out" phenomenon?  If we better understood the social construction of use, we would be likely to incorporate this into prevention strategies...again, read my monographs.

•                Explore the "positive consequences" of abstinence and/or moderate use rather than the "negative consequences" of abuse.  We already know that students respond better to "positive" messages than to negative...and we know that "scare tactics" do not work.  How about investigating what students view as being the "pluses" of abstaining and moderating use rather than always hawking the negatives. 

•                "Bystander Behavior" - This comes in at least 2 forms: (1) "the silent majority," to quote Spiro Agnew, who say nothing when John Jones or Mary Brown act like a jerks at a drinking gathering, and (2) "most of us" when we fail to hold drinkers accountable for their irreverent, inappropriate, or otherwise untoward behavior because we "don't want to hurt his feelings" or "she'll get all Jersey Shore on me" if I say/do something.

We have learned much in the last 15 years regarding how to affect the campus drinking culture; this is very good news.  That said, we have a long way to go and, unfortunately, much of the interest and money that drove discoveries of the past 15 – 20 years has gone other places.  But just as we knew Pluto was there before we were able to "see it," so is it likely that "something else" is there as regards changing the campus drinking and drugging culture.

Solution-Focused counselors suggest asking individuals to consider a time "before" the problem existed or imagine "when" the problem no longer exists.  By doing this, they invite us to explore how we acted before the problem existed or consider what happened or was done to solve the problem in the future.  This becomes the focus of the practitioner's intervention...get us thinking about possible solutions rather than being preoccupied with the consequences of problems.  

We all know the old adage about the glass being half empty or half full.  There is another option, however, when looking at that glass, namely, that it is always "fully full."  Think about it…the glass is half full of water and half full of air!  We need to look at the "air in the glass" in order to appreciate that the glass is, indeed, always full.  So, when considering collegiate drinking, with what is the rest of that glass filled?

What do you think?

         When They Drink:Is Collegiate Drinking the Problem We Think It Is? (PDF)

         When They Drink:Deconstructing Collegiate Alcohol Use (PDF)

NJ Legislature Votes to Permit Sale of Syringes W/O Prescription

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Designed to address the transfer of blood-borne diseases via “dirty needles,” the NJ legislature has passed a bill permitting the sale of up to 10 syringes w/o a prescription.  Interestingly, this will not become law until and unless the governor signs it into law, an outcome that is “up in the air.’  Having opposed “needle exchanges” while a US Attorney, Gov Christie is on record indicating he is open to revisiting that opinion. For more on the story, visit http://bit.ly/sYsLHZ

NOTE: making the sale of “up to 10 syringes w/o a prescription” legal presents an interesting spin on the harm reduction strategy of ‘needle exchange.”

1. 1.     By “purchasing” syringes rather than “exchanging them,” some of the potential stigma of “self-identifying” as a “drug addict” is removed in the effort to put clean needles in the hands of intravenous drug users (those in a pre-contemplative stage of readiness to change)
2. “   Purchasing” needles rather than “exchanging” them is consistent with the old adage that, “Something for something is worth more than something for nothing” 
3. 3.    “Purchasing” needles rather than “exchanging” them may permit those who have historically be opponents of needle exchange programs on the groups that they promote drug use to support the intended purpose of such programs—reduce the spread of blood-borne disease—w/o having to “give users paraphernalia

Of course as with all things, there is a down side.  Potential issues related with this Jersey bill include:

1. 1.     Unless regulating the cost of needles, there is nothing to stop pharmacies from charging whatever they like for “loose needles.”  Although most pharmacies will not want to gouge their customers with “legitimate” reasons to purchase syringes, some may want to gouge “drug users” or discourage “them” from coming in their stores by charging an outrageous price for “loose” needles
2. 2.     What becomes of the “dirty” needles?  In the exchange programs, they were disposed of properly, but in a “purchase” type exchange, the “dirty” needles remain “on the street”

Nothing is ever simple and without its controversy, but a tip of the hat to the jersey legislature for considering a new approach to a perennial problem.  Hopefully Governor Christie will weigh in on this issues based of fact and what is in the best interest of the citizens of NJ and not simply make a political decision.

If you are from Jersey or have connections with others who are, you may want to consider contacting the Governor and voicing your opinion.

What do you think?

Dr. Robert

Energy Drinks and Their Potential for Risk

A sharp increase in ER visits by individuals having consumed “energy drinks” is noted between 2005 and 2009; the status of this trend between 2009and 22011 remains to be seen. 

As may be expected by those familiar with substance use disorders, “other substance use” frequently exacerbates the potential for energy drinks to facilitate these ER visits, but interestingly, “which” other substances seems to vary by gender.  To read more, visit http://www.nlm.nih.gov/medlineplus/news/fullstory_118979.html

For different perspectives (similar details) on this topic, see  http://bit.ly/uA3E8H, http://bit.ly/uVOxqs, and http://www.rodale.com/research-feed/side-effects-energy-drinks  

Popular Media and Preventing Substance Use Disorders

A colleague contacted me earlier today asking if I and other on a discussion list had seen a video clip on "weed bracelets" - see http://www.blackmediascoop.com/2011/11/02/is-your-kid-wearing-a-weed-bracelet/

My response follows:

Thank you J; very interesting.

A couple thoughts:

1.     “It is always gonna be somethin'"

2.     News media that sensationalize things such as this not only make adults/parents aware of such things—in a sensationalistic and therefore questionably responsible (ethical? moral?) way—but romanticize, glamorize, and otherwise proselytize items such as this in the eyes of adolescents à how many adolescents saw this and thought, “Damn, how do I get me one of them?” “Oh…there’s a website? Cool.”

3.     What is the “call to arms” the media are sounding by making this a focal point for parents? Namely, your kids are pulling a fast one and you are oblivious to it, that is, “you are failing as parents.”

4.     This is reactive journalism at best, not proactive…note the parental interviews that were selected to punctuate the piece, especially the guy who is particularly interesting in his passionate plea to send anyone selling these things directly to jail.

This leads to my last point…

5.     This is “problem oriented” prevention rather than solution oriented. It is scare tactics, but not to get high-risk users to lower risk…rather to inflame fears in the population most likely to demand immediate action (reaction?) in the form of more $ for interdiction, punishment, and other like efforts to ‘win the war on drug.’

Remember Carl Jung’s famous quote: What your resist, persists. See http://www.youtube.com/watch?v=95EH9G1c_4o

What do you think?

Dr. Robert

Does Optimism—or a Lack of It—Affect Collegiate Drinking?

An article published recently in Nature Neuroscience entitled, “How unrealistic optimism is maintained in the face of reality” (see http://www.nature.com/neuro/journal/vaop/ncurrent/full/nn.2949.html for abstract and full citation) suggests one mitigating factors that may shed light on the apparent intransience of collegiate drinking behavior – optimism.

Although neither the article nor the BBC report on it (see http://www.bbc.co.uk/news/health-15214080) speak of collegiate drinking per se, one cannot help but wonder if there is a connection.

“If” a natural propensity to remain optimistic out weighs risk-related information made available to collegiate drinkers via prevention program, PSAs, and/or direct observation of peers and their experiences, then this could be an important factor for those focused on preventing high-risk and dangerous collegiate drinking to consider as they think about the next step in proactive programming targeting collegians.

This may also be a further argument for considering a suggestion I have been advocating, namely that better understanding of the “maturing out” or “aging out” phenomenon that seems to result in third and fourth-year students viewing alcohol as a substance and drinking as a behavior differently than they did when first and second-year students may be the next logical step in prevention efforts. This may be an important step in addressing the apparent intractability of collegiate drinking – see my 2nd and 3rd monographs in the When They Drink series - #2 - “When They Drink: Deconstructing Collegiate Alcohol Use” http://www.robertchapman.net/essays/When_They_Drink2.pdf  and #3 - “When They Drink: Is Collegiate Drinking the Problem We Think It Is?” http://www.robertchapman.net/essays/When_They_Drink3.pdf

In these two monographs I argue that a student’s understanding of alcohol as a substance and drinking as a behavior is a function of how these symbols of contemporary collegiate life come to be understood by students. That understanding, born in middle and high school, drives collegiate behavior upon arrival at college only to be modified over the first 3 to 4 semester by experience and interaction with upperclassmen, resulting in a more moderate approach to alcohol and its use. This “social constructionist” view of collegiate drinking suggests that if we, as prevention specialists, were to study and better understand the process by which meaning is ascribed to alcohol as a substance and drinking as a behavior, then we would be in a position to affect this process in such a way as to hasten this maturing out process. This could result in expediting the passage from “high-risk use” to social or at least “lower-risk” use in months rather than semester, thereby closing the window of risk out of which so many contemporary collegians see to fall while trying to glean a better view of “the wonder of the college years” they have heard so much about from parents, older siblings, the popular media, etc.

In short, “if” we have a predilection to optimism and “if” this results in down-grading if not ignoring negative information or risk associated with personal behavior, “then” it is likely the prevention field will not move much past the gains it has made in recent years as the result of using current evidence-based strategies. It also means that efforts like BASICS (Brief Alcohol Screening and Intervention for College Students) may be successful, in part, because students exposed to such programs have the opportunity to revisit the meaning they had ascribed to “alcohol” and “drinking” moderate the meaning for this icons of contemporary collegiate life and hasten the very maturing out phenomenon that researchers have noted in collegians for years.

What do you think?

Do Scare tactics Work in Preventing Substance Use?

A reader recently asked what I thought about a scare tactics campaign initiated by a sheriff in Oregon – see http://www.facesofmeth.us/drugs_to_mugs.html

The literature tells us—and has consistently done so now for years—that scare tactics do not work. This, however, does not mean that there is not a place for such campaigns in what we do as prevention specialists.

First, when the literature tells us that scare tactics do not work, what they report in the discussion of the findings on which the article is based is that individuals who engage in the high-risk behavior to which the scare tactic refers do not change their behavior as a result of the scare tactic. So whether it is a “mug shots” campaign referenced above or, my personal favorite, “this is your brain on drugs” (see http://www.youtube.com/watch?v=qyXFN4ocN_o) neither results in someone doing things differently on Friday night simply because of having watch/seen the PSA on Thursday.

We know that many (most?) high-risk viewers of such PSA find it easy to disconnect. They either mistakenly believe, “Oh, that will never happen to me because…” or “Well he/she/they were just stupid and not careful” or “that is just a stupid video.” Interestingly, the key element in such campaigns is their ability to get folks who watch who are not the subject of the PSA in order to get them to react, which is to say, these are the real intended audience for such PSAs…in the readers note to me, he included the statement, “(It) may be scare tactic – but it sure got my attention sent me.

We, the viewers, are the audience, not the drug users in society. When parents/concerned citizens/conservatives/law abiding adults/victims of drug-related crime/etc. view such PSAs, we are galvanized and tend to demand that something be done. Frequently this “something” is more related to the “supply side” of the drug issue (interdiction) than the “demand” side (prevention and treatment). Yet there is a role for such PSAs to play in the work that we as prevention specialists and concerned professionals do to address the alcohol and other drug problem that exists in our culture.

The literature also tells us that people proceed towards change by passing along a continuum of readiness to make that change. When a high-risk user is in the earlier stages of readiness to change—in the literature this is called a pre-contemplative stage—and exposed to such PSAs, they DO NOT change because of the PSA message. What they may do, however, is take notice and add the information to an archive of stored info on AOD use and perhaps eventually move to the next stage on the continuum…contemplation.

If pre-contemplation is the capital “D” Denial stage, the “I-don’t-have-a-drug-problem-but-a-drug-solution” stage, then contemplation is the small “d” denial stage, a stage where one begins to question if what I am doing might just be presenting a problem. From here individuals work through the successive stages of change until they reach a point of “action” and it is here that the user essentially says, “The war is over, I lost; give me the articles of surrender and I will sign.” I will not bore you with the details of how to get from “pre-contemplation to action,” but suffice it to say that scare tactics may, and I emphasize MAY, play a role.

No one has ever moved from pre-contemplation to action and on to maintenance (maintaining the change once made) without coming to a point of realizing that “to go on doing what I have been doing is more of a hassle than to change.” Our challenge as prevention specialists is to expedite that movement through these stages…and scare tactics may be able to play a (small) role in this movement. What scare tactics cannot do, however, is move someone from pre-contemplation—or even contemplation—to action…it is just too easy to find countless examples of individuals who are not experiencing the “problem” the PSA rails against and to point to them as proof of the PSA’s spurious message.

In closing, I am not “against” scare tactics so much a I do not believe they change behavior. I believe we must first recognize the limitations of scare tactics PSA before even considering their utility.  Second, we need to accept that they are at least as focused on upsetting you and me as they are in trying to influence the behavior of high-risk users—do they intend to get users to stop or “everyone else” to be upset? Third, we need to accept that no PSA or campaign based on scare tactics is ever going to keep someone with a substance use disorder, in and of itself,  from using. There is no “silver-bullet” that will bring down the werewolf of addiction. There is, however, hope that we can affect change and help move someone along the continuum of readiness to change.

To learn more about the stages of readiness to change, visit: http://www.aafp.org/afp/20000301/1409.html

To read more about a comprehensive plan to address high-risk collegiate drinking, which may serve as a model for affecting any high-risk behavior, visit: http://www.robertchapman.net/essays/when_they_drink1.pdf

To read more on my views regarding a more comprehensive understanding of collegiate drinking and my thoughts on what is missing from a comprehensive plan to address such, visit: http://www.robertchapman.net/essays/When_They_Drink2.pdf

What do you think?

Dr. Robert

Using Self-Disclosing or Self-Involving Counselor Statements 

when Treating Substance Use Disorders

While corresponding with a former student who is in her first professional position post-bachelor's degree, the topic of using self-disclosure came up. Although discussed in classes, the issue took on greater significance for the student given her personal recovery from a substance use disorder, her position in a SUD treatment program, and a recent experience with a client. I thought that sharing the gist of this correspondence as a post might be of interest to followers of this blog.

Congratulations on the offer to go full-time. This speaks to both the quality of your work as a practitioner and your value to the program as a “member of the team”; I am not surprised. My experience has always been that as individuals with substance use disorders recover, they do not just get well, they get really, REALLY well :) Over the years as I have come to watch those individuals who find recovery in 12-step programs, some of whom really seem to thrive and truly blossom, I have come to realize that people with addictive disorders tend to be among the more sensitive and therefore empathetic people I have met—when using, that was a big part of the problem. As you know, this is not, in and of itself, sufficient to make an effective counselor, but when it is harnessed, in tandem with training and education in counseling technique and practice, these individuals can mature into, to quote folks of your generation, “awesome” practitioners.

Your comment about the young gentleman who seems to have opened up to you when learning that you have “walked the walk” is not uncommon. The challenge for you as a professional contemplating the use of this type of disclosure, however, is to be sure you know: (1) why you are self-disclosing and to what purpose, and (2) realize that for self-disclosure to be useful, it must be employed to benefit the client and not the counselor. This is why it is generally a good idea to self-disclose “later” rather than “sooner” in the counseling relationship, perhaps as the response to a client’s inquiry if you are in recovery after having watched you and come to suspect you may be by your actions rather than to simply “put it out there,” wearing it like a badge of honor. As the old saying goes, let your action do the speaking for you. When you “act like” a recovering person, people will notice, and one “acts like” a recovering person by doing what he or she needs to do to to stay clean and sober “one day at a time." As the slogan in the program suggests, just “do the next right thing.”

Remember from our classes about the difference between self-involving and self-disclosing statements a counselor can make. Both may be able to convey a personal connection and allow the client to relate more easily to the counselor. The self-disclosing statement, however, necessitates having to place the focus on you in order to enter the client’s space and demonstrate the ability to connect. The self-involving statement, however, maintains the focus on the client and still allows the counselor to meet the client on a personal level and demonstrate the ability to empathize. A self-disclosing statement is something like, “I know what you mean because in my early recovery I felt alone and afraid most of the time too” notice all the “I” statements...the focus is on the counselor and not the client. 


The self-involving statement goes, “You really seem to be struggling with the fear that feeling isolated and alone tends to create - (this is empathic reflection as you learned in class). The fact that you are willing to share this with me, in our session, and accept my suggestion to take it to group really shows the progress you have made in your recovery. 6-weeks ago, you would have just said ‘screw it’ and gotten high; today, you shared it with me and are ready to work on it; I am proud of you” - (this is the self-involving part of the statement).

Remember, “you do best what you do most.” The more you do what you learned in school and continue to learn on the job and in supervision, the better you will become at doing it.
You are a better counselor today, "student's name," than you were yesterday; you are nowhere near the counselor today you will become tomorrow :)


Self-disclosure is easy and seem like an effective way to help someone feel comfortable and trusting; but it can be a double-edged sword. Perhaps better to engage the client by entering her or his experience, as a parent might do with a young child, than by expecting she/he enter yours.


What do you think?


Dr. Robert

1. What Causes a Problem Is a Problem if It Causes a Problem

With the publicity surrounding the recent publication of the ASAM (American Society of Addiction Medicine) update on the definition of addiction, it is likely useful to review some of the “indicators of a problem” to which non-professionals can better relate and therefore more quickly use to recognize a problem with substance use. First a quick review of the new ASAM definition:

Short Definition of Addiction: Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.

Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death. To review this in more detail, visit http://www.asam.org/DefinitionofAddiction-LongVersion.html

As precise as this definition is for professionals, my experience when working with individuals in earlier stages of readiness to change their drinking and other drug use has been that such definitions present easy targets for those looking to deny their problem. Because defining addiction for professionals and for “consumers” can yield wildly different responses, this post will focus creating a “short list” of indicators that may suggest one’s use is not so much use as it is reason for concern.

In no specific order, here is a short list of indicators. Having but one of these does not necessarily suggest a problem, but as the number of indicators increases, so does the likelihood that one’s use is problematic if not indicative of addiction:

1. “What causes a problem is a problem if it causes a problem.” This ‘bumper-sticker’ wisdom comes from a well know lecturer in the alcoholism field, Fr. Joseph Martin. What it means is, if I am wondering if my substance use is becoming a problem for me or if I wonder if my significant other’s use is becoming a problem, guess what...it is becoming a problem.
2. Increasing time spent thinking about using, planning to use, or finding the economic means to support that use. For the professional this suggests “compulsion”; for the consumer it is rationalized as “preoccupation with an enjoyable activity.”
3. Similar to #2, my use has become an increasingly important determinant of how I budget my time. For example, previously enjoyed or favored past times are bypassed to make time to use. Drinks with friends rather than ball games with kids; smoking-up in the basement rather than watching TV with the family;
4. Protecting the supply. Although most people have some beer, wine and/or spirits in the house they do not have “cases” of their favorite beverage stockpiled. NOTE: The well stocked wine cellar does not necessarily mean the “oenophilist” or connoisseur of fine wines has a drinking problem. Related to this is the need to use more to gain the desired effect...which increases the importance of protecting the supply.
5. Changes in the people with whom I use. To change the people I socialize with and/or the places I socialize in in order to accommodate changes in my use pattern can foreshadow a movement towards a problem. To spend less time with John and Mary who go home after 2 in order to hang with Bill and Flo who “really know how to party,” signals a change worth noting.
6. A shift from 2 beers/sours on Fridays to 3 or 4 shots and beers “a couple nights a week” warrants consideration. Likewise, when “splitting a bowl” a couple times a month morphs into finishing a blunt a couple times a week, or Tylenol-III 2X/day for 3 days becomes Oxycodone PRN.
   

These indicators are more environmental or behavioral; personal indicators include:

1. Minimizing reported use or using secretively. Social users have too much and say, “Boy, did I over do it last night; I’m going to have to be more careful in the future.” The problem user says nothing about the overdose and deftly changes the subject if someone brings it up.
2. When considering how to budget money or time, use moves from being a “want” to becoming a “need”; from being a luxury to a necessity.
3. Changing other factors in my life in order to accommodate the use...I eat less so I can drink more (concern about weight); I switch from “good stuff I like” to “less good stuff I can afford” to consume more on the same budget; spending less on clothes or entertainment to accommodate expanded patterns of use.
4. Becoming a different person when using or the “Dr. Jekyll (the accomplished, “nice guy when sober”) / Mr. Hyde (“bestial” ghoul when using) syndrome – young kids are particularly adept at both noting this and commenting on it.
5. Sincere pledges, to self or others, regarding change are easily overturned. NOTE: The true mark of control is not saying “no” to “a” drink or drug—anyone can do this; it is saying “no” to a drink or drug I want.
6. A questionable ability to predict when I will next use and/or once starting, when I will stop.
   

There are numerous screening check lists and indicators available online (for example, see http://www.ncadd.org/). Likewise, any bookstore has numerous publications in the “self-help” section. Some are good, others, not so much. Irrespective of what you read, hear, or listen to, the bottom line regarding one’s use is, what do I tell myself? This reflects back to the first item on the first list noted above: What causes a problem is a problem if it causes a problem.

Substance use disorders are bona fide health care issues, a brain disease if you will. We have stigmatized these disorders in our culture and these stigmas have prevented individuals from recognizing that something is amiss until what was amiss becomes “a mess.” If you think something is amiss regarding your pattern of use, speak with someone who can help you step back, revisit the facts in your life, and consider an objective albeit candid new perspective from which to view these facts.

What do you think?

Dr. Robert

Can a Significant Other Provide Therapy to The Other?                                                   

Not being an ethicist I cannot speak to this question with any authority. I can, however, reflect on it as it does raise at least one intriguing clinical issue: Is it possible for a former “significant," that is to suggest intimate, "other” to be viewed objectively by either the practitioner or the client or one seeking therapy? If the answer is yes, it is feasible, does this possibility assume this objectivity is simultaneous for both parties, that is to say that both parties will be equally objective and detached from the previous relationship at the moment of their reintroduction as practitioner and client? If the answer remains yes, does this necessitate a quantifiable period of time between one’s status as significant other and becoming either practitioner or client in order for this objectivity to be realized? Assuming the answer to all these question continues to be yes and that objectivity is indeed possible, are there other implications raised by the fact that one or both parties have specific intimate knowledge regarding the other that may impact judgment as regards treatment planning and/or follow-through irrespective of objectivity? 

Just as the admiral and captain on a naval flagship dine separately from each other as well as from the crew at large—they literally dine alone so as to discourage the development of close friendships and emotional ties that could affect personal judgment regarding command decisions that necessitate the sending of one's subordinates into harm’s way—can a practitioner every truly detach him or herself from “what once was” in order to thoroughly engage in the pursuit of “what might become”?

Please know that I do not doubt the sincerity of my colleagues who suggest seeing former significant other's professionally is possible and I recognize that the vast majority of us would never intentionally jeopardize the clinical outcome of work with a client if thinking that previous knowledge of said client could result in providing subjective treatment, but we all know what we have learned and learned what we were taught, be it in the classroom, home, or previous intimate relationships. AA has a saying that is somewhat apropos here: You can always turn a cucumber into a pickle, but you can never change a pickle back into a cucumber. Albeit a bit folksy, it is nonetheless a poignant statement that speaks to the clinical issues raised in my initial ethical question: If I had been your lover, could you ever see me as other than that former lover? I am not sure I could see you as otherwise.


What do you think?
Dr.Robert

Towards an Eclectic Theory of Counseling

Counselor Educators have discussed and debated the role of theory in professional counseling since, "forever." Generally the discussion includes references to the importance of being grounded in theory so that the practitioner is "doing counseling" instead of "chatting up" an acquaintance. To this end, understanding theory and using it to center oneself as a counseling professional is productive. However, when theory becomes the issue of primacy for the practitioner, everything else tends to follow...including the services the client/patient/individual receives from the counselor. Hence, the importance of identifying a theory of eclecticism or and integrated approach to counseling that recognizes the importance of theory-drive practice, but is nonetheless sensitive to the needs of the individual with whom the counselor is working.


I have found Prochaska’s Transtheoretical Model of Counseling (sometimes referred to as the "stages of readiness to change" model - see http://www.aafp.org/afp/20000301/1409.html) to be the closest thing I have yet found to a bona fide “eclectic theory” of counseling. Its refocusing of the practitioner’s attention on the client by attending to his or her stage of readiness to change rather than presuming the primacy of the practitioner’s theoretical orientation is both refreshing as well as productive.

I agree that it is important to teach counseling theory as a “walk through the museum,” but the benefit of such a course is not that it shows student “how” to do counseling effectively so much as proffer an understanding of from “where” it originated. Personally, I have discovered that I need to have three things in order to “do” counseling effectively: (1) an understanding of why humans think and act the way we do – Personality Theory, (2) an understanding of the options available to me to do counseling – Counseling Theory, and (3) a personal “bag of tricks” born of training, experience, mentoring, etc. Whether one’s personal approach to counseling is a more fundamentalist’s adherence to “X” theory or integrated and eclectic personal approach, my argument is, one’s personal theory of counseling is essentially an amalgam of these three elements.

Prochaska’s model, for me, is a nice way to both honor the contributions of “theorists of yester year” while providing me the opportunity to practice “person-first” approaches that focus on meeting the client/patient/consumer where he or she is in the counseling process. If counseling is more about what we do with the individuals with whom we work than what we do to them, it seems that theory may well be an important component in the design of an effective vehicle to move folks from where they are to where they want to be, but it likely should not be “driving the bus.”


What do you think?


Dr. Robert

Inviting Organizational Change: Lessons from Counseling Individuals

As challenging as it may be to motivate an individual to consider changing a personal behavior, inviting an organization to move towards change can be even more daunting. To motivate a clinical staff steeped in traditional addictions counseling techniques or what William Miller refers to as attack therapy can cause any supervising counselor or clinical director to age prematurely.


First, the literature seems to suggest that the process of change for an organization is similar to that followed by an individual. This means that the organization will need to pass through the stages or readiness just as an individual does. What is a bit more complex when contemplating change in an organization made up of individuals, however, is that different individuals in the organization will likely be at different stages of readiness to change. You will therefore need to target these different segments or "changers" of your organization separately. Depending on the size of the organization with which you are working, this may already have been done for you. If so, this enables you to move directly to designing interventions based on the mean stage of readiness to change in your target group or the segment of the organization with which you will be doing the training--more on this in a moment.

If, however, you are not sure of the stage of readiness to change in your target group, you may want to do a bit of assessment first, preferably prior to engaging your audience in any particular activities. You may find one of the SORtC (stages of readiness to change) tools to be useful, for example, see the SOCRATES or Stages of Change Readiness and Treatment Eagerness Scale (see http://casaa.unm.edu/inst/SOCRATESv8.pdf). Once you have a sense of which segments of the organization are at what stage of readiness to change, you can then tailor your interventions based on the SOCtC. To get a sense of “which” interventions work best with “what” stage of RTC, visit http://bit.ly/mIQ6mL

Matching the “process of change” to the “stage of readiness” is very important given the task of facilitating change, be that when working with an individual or a group. If your target audience is in an earlier stages of RTC, then you are going to want to focus on consciousness raising, increasing awareness, social support, and related activities to move the audience toward an “ah ha” moment or epiphany. This can be done in a relatively short amount of time, but senior management or administration will need to understand your objective and more to the point, “why” you are doing it. Remember, managers tend to be more interested in “pushing” subordinates towards the change they believe needs to be made than “leading” employees towards personal growth and corporate development. 

When attempting to motivate individuals to change remember a few simply--although not necessarily easy to implement--steps:

1. Although you may be able to lead a horse to water, but you cannot make it drink...you CAN salt the oats
2. It is easier to motivate employees to move toward what they discover they want than away from what management no longer wish them to do
3. Change happens in stages. The objective of change is to move from their current stage to the next stage on the continuum, not the last stage
4. As William Miller suggests, when considering motivating individuals to change you have two choices of how to proceed: you can wrestle with them or you can dance with them...Dancing with the Stars is always more productive than WW Smack Down
5. Remember Sandra Anice Barnes' line from Life is the Way It Is, "It is so hard when I have to, and so easy when I want to." Our task as agents of change is to invite individuals to "want to."

What do you think?

Dr. Robert

Collegiate Policies on Drugs Other than Alcohol

Is it important that policies in higher ed that address "alcohol" and "other drugs" like marijuana be consistent and equitable?  Although controversial in some ways, this is essentially an issue related to equity, consistent enforcement of policies, and—perhaps most of all—money.

A bit of history: A point I have advocated for 40+ years is that alcohol is indeed a drug and should be treated as such.  The problem is that this is a position, however, that the alcohol industry has invested hundreds of millions of dollars in successfully discouraging—watch any super bowl beer advertisement.  Because alcohol “is legal” (for those 21+) it has been relegated to a different position in the panoply of drugs than most others and this is no better exemplified than by its absence (along with nicotine and caffeine, which make up the “unholy trinity” of most abused drugs that constitute the most costly in terms of untoward consequences—health costs, domestic violence, litigation, etc.) from the federal government’s schedule of drugs – see http://www.justice.gov/dea/pubs/scheduling.html

With all the models that explain drug use and addiction, public policy in this country—and this trickles down to the state, local and even campus policy makers—continues to be driven by the Moral Model of addiction postulated since time immemorial.  Interestingly, there are two versions of this model, the “dry” moral model and the “wet” (this goes back to the later 19^th and early 20^th centuries and prohibition).  The “dry” moral model suggests that the drug itself is evil/bad and therefore those who use it are, by association, “bad” as well and should be punished for their transgression of use.  This is the model that prevails to this day as regard “real drugs,” that is to say, the illicit substances.  The “wet” moral model is the model that suggests the drug is not in and of itself bad, but when not used correctly—this by the way is a social construction, but I will refer to this in a moment—problems result.  This model advocates that substance use disorders are the result of weak willed individuals whose moral fiber is lacking.  In essence the substance is ok, but those who cannot manage it are not.  These unfortunates should be pitied and, marginally, better tolerated than those who use illicit substances, but they remain social if not moral outcasts.  This model is still well ensconced in our society as regards alcohol.

A second factor tends to affects public policy and treat alcohol-related violations/behavior differently from “real drug” use; litigation and public opinion.  Higher education, if nothing else, is a business.  As such, consideration of the bottom line is always a factor in decisions regarding policy and procedures and this is nowhere better seen than as regards drug use.  As regards the issue of drugs, that is “real drugs,” whether it is federal student loan policies that penalize applicants with drug arrests, federal guidelines regards receipt and administration of grants, pressure from parents and alumni, or simply the personal attitudes, values, and beliefs of benefactors who decide where and to whom to bequeath huge donations, the pressure is on senior administrators to take a hard line on drugs, to “play to the audience” if you will.

My comments so far shed just a bit of light on why things are the way they are…there is much more history here, but such is not necessary to make my point.  What is of more pressing concern is “what can be done” in the face of this history to affect public policy on campus and do so in such a way as to (1) not leave a trail of damaged student reputations that can jeopardize future opportunities, licenses, or careers in its wake and/or (2) appear to be pandering to “druggies” or those who “advocate for the complete legalization of all drugs.” NOTE: Decriminalization is one way that many municipalities have taken to extricate themselves from this issue.  In the City of Philadelphia, the DA has essentially said that marijuana changes involving less than 30 grams of weed will be treated as a summary offense with a $300 fine; no criminal record.  Although do to reduce the burden on the courts rather than for more altruistic reasons, “6 of one, a half dozen of the other.”

AFFECTING PUBLIC POLICY IN HIGHER ED

First, I would recommend NOT lecturing on what addiction is or how it should be treated.  To begin with, this is not the issue as most students are not addicted or even “diagnosable” as having a substance use disorder—the vast majority of cases involving alcohol or marijuana cases on a college campus have less to do with addiction than they have to do with poor judgment or a socially constructed understanding of alcohol/other drugs as substances or their use as a behavior—see my 3-part monograph on this topic entitled, When they drink, available at http://robertchapman.net/essays.htm.  Second, senior administrators are not going to read a long treatise attached to a memo advocating more equitable public policy regarding drug use.

Second, the bottom line is a factor affecting the formation of public policy in higher ed.  Consequently, use the bottom line as a factor in advocating for more equitable policies that are less draconian and more proactive.  Case in point: If students found holding “X” amount of marijuana suspended for 2 terms are not paying tuition this represents a loss of roughly $25K to the institution…not to mention that I believe there are data that show a significant portion of these students do not return to the school that suspended them.

Third, argue that punishment has never been an effective deterrent to perceived/actual errant behavior whereas education is.  Just as there are effective strategies to engage high-risk and dangerous collegiate drinking in such a way as to invite drinker consideration of change (Brief Alcohol Screening and Intervention for College Students, AKA BASICS), so can these approaches be applied to other drug use, such as marijuana.  NOTE: There is a difference between the student found holding several grams of weed and a half kilo.

Fourth, leave existing policies in place but present students found in violation of said policy with a choice as regards the consequences that result from that violation.  For example, students found with less than “X” marijuana will automatically get “X,” “Y,” and “Z” sanctions, but instead of a 2 term suspension from the institution they get a choice between that 2-term suspension or the opportunity to participate in a specially designed psychoeducational program steeped in evidence-based approaches to changing student behavior.  NOTE: First question you get when raising this issue with senior administrators is, “How are we going to pay for this?!?” ANSWER: With the $25K (or some portion of it) you would have lost by suspending the student.

Obviously, there is far more to this discussion that what I have written here, but suffice it to say that this sets out a couple arguable points.

In closing, keep in mind a couple “cultural” issues that have a HUGE impact on this discussion and debate:

1. Academics and Student Affairs professionals are as different from each other culturally as are Americans and Russians.  We may both be predominantly Caucasians, but our world views are very different.

2. Higher education is NOT just about education at the upper levels of administration; it is about business too…perhaps predominantly.  Yes, everyone talks about education and we are steeped in the traditions of such, but remember that higher ed is first and foremost a business.  Therefore this discussion needs to be conducted in the language of business.

3. Perception is everything.  21^st century America is a myopic culture.  We do not see the big picture; we are all about quick fixes and the “do-not-upset-my-standard-of-living” perspectives…look at global warming, social security, federal deficit, etc.  Parents, alums, benefactors are emotional creatures, not rational ones.  They “see” a reasoned response to “drug use” and they “think” the institution is “soft on drugs.”  

The outcome of this debate is NOT going to swing on a hinge of logic; it will pivot on one of reason as vetted by those in the positions of power.  Best to educate those in that position with the logic and reason translated into the language they speak.

What do you think?

Dr. Robert