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21 December 2011


Considering Collegiate Drinking; The Rest of the Story
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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?



06 December 2011

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

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

02 December 2011


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