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28 October 2009

All College Students Drink the Same...or Is that a Myth?


College students drink. And that, it is safe to say, is not news. But how many people know that one-third of the students consume three-quarters of the booze on American campuses?

Why is it that these intelligent people put themselves at risk, and what can be done about it?

My university counseling experience and time in the classroom has taught me that most students believe they are immune to the consequences of heavy drinking. Students claim that alcohol related tragedies are results of “bad luck” or that they occur because the victims were “stupid.” In short, they cannot imagine themselves experiencing a similar tragedy. Even when students would see me when referred by the University judicial system after a crisis resulting from a bout of heavy drinking, they often used the same reasoning to explain their own experience: “I have the worst luck” or “I was just stupid.”

This attitude is similar to social psychology’s just world hypothesis. This phenomenon suggests that "people get what they deserve"...good things happen to good people and bad things happen to bad people. Applying this to college students, most feel immune to danger when engaged in high-risk behavior because they believe that they are good people, and therefore bad things will not happen to them...they are "bullet proof" as one student informed me. So, even when students have been educated about the risks of alcohol abuse, it comes as no surprise that they often experience serious, and sometimes tragic, consequences from excessive alcohol consumption.

Another contributing phenomenon that may help explain why some engage in excessive consumption also comes from social psychology; Groupthink. This phenomenon occurs when the leader of a cohesive group influences the other members, often resulting in poor decision making during stressful situations. The hallmarks of such flawed decision making include a group’s belief that it is invincible and has a moral responsibility to act in a particular fashion. There is also a tendency to view individuals outside the group as "others" and to justify this by using stereotypes. The group employs a buffer that insulates it from outside influence and censors contrary or alternative views to those expressed by the group. As a result, individual members are led to support the group’s decision. This may explain the hazing phenomenon seen in some collegiate groups or lend an explanation to the violence that can emerge when rival groups, for example, Greek lettered organizations, clash following an evening of drinking.

Taking these phenomena into consideration, it is helpful to recognize that the beliefs and perspectives of students who do not drink or who do so moderately are a valuable source of information about campus culture. It is important to understand why these students act responsibly, and then apply this understanding in approaches to programming. For instance, many first-year students tell me that they arrive on campus believing alcohol is integral to an active collegiate social life. This is important to know because it provides an indication as to what these students expect of a successful university experience. To the extent that students expect drinking to be associated with collegiate life, they are primed to pursue that expectation. Recognizing this allows us to develop proactive means for confronting these student misperceptions. It is important to alert students to the myth of collegiate drinking: that not everyone drinks and for those who do, not everyone gets drunk. This may shift the desire from conformity through alcohol abuse to abstinence or moderation, teaching students that just because they are sober, their collegiate experience is not wasted.

Robert

22 October 2009

Pursuing a Graduate Degree in Counseling

A student recently wrote to thank me for assisting him in a course he was taking and to ask about graduate schools...and whether I thought the rewards were worth the investment of time, money, and effort. I share my reply here...

Emails like yours bring a smile to a professor’s face because they mean that what you have accomplished in “all” your education to date is exactly what should happen in all educational opportunities...that you had most of the questions you brought to the course answered only to be replaced by 1.5 times as many new questions. Of course, these new questions mean that you need to return to the classroom — or read more books and journals or attend workshop or apprenticeship or “whatever" — to get those new questions answered. Of course, as you can see by the formula outlined at the start of this missive, you will always have more questions than when you started, but the trick is to ensure that these are “new questions” that result from the answers you received to your “old questions.” In short, this make learning a life-long commitment that is never completed, and this, in part, is the joy of learning...and the pursuit of wisdom. My efforts to articulate this are likely a bit boring and perhaps difficult to follow so I suggest you read the lyrics to Dan Fogelburg’s song, “The Higher You Climb” – click on http://bit.ly/1D0GN and to listen to the cut from the Dan Fogelberg "High Country Snow" album, http://bit.ly/1OWeHB.

Regarding your questions about graduate schools, I suggest several questions for your consideration:

Why do you want a doctoral degree? There are many reasons for pursuing a doctorate and all are good reasons because they are your reasons. This question is not intended to discourage you, but sharpen your focus. Once you know “why” you want a doctorate, this can help inform the final decision you make as to what type of program you will pursue.

What would you like to do with this doctorate? I am assuming you are interested in a doctoral degree in behavioral health or counseling or some related human service. If you want to teach, you are likely looking at a PhD rather than a PsyD or EdD, although both of these doctorates will enable one to secure a teaching position, although both tend to be more “applied” degrees than “academic” degrees — the exception is EdD when teaching teachers, but I do not suspect that is what interests you. You can always teach adjunct with any terminal degree, but a tenure-track position is likely going to require a PhD.

Why do you want to go directly from a bachelor’s program to a doctoral program? This can significantly increase the difficulty of finding entrance to a program, especially if you are interested in a doctorate in counseling. The competition is immense for PhD programs in clinical and counseling psychology and you will be competing with individuals for admission who have already earned a master’s degree as many people earn master’s degrees in counseling and then pursue the PhD. The upside is that an earned master’s plus any published writing or research completed while earning that degree — not to mention the grades earned that will likely surpass those earned in one’s bachelor’s program — can make the applicant more attractive to a doctoral program. The down side, of course, is that it could be 2 to 3 years to get the master’s and then another 4 to 5 to get the PhD, depending on how many of the master’s credits can be transferred into the doctoral program. NOTE: Some doctoral programs allow a student to pick up a master’s on the way to the doctorate, which can be useful in that the faculty making decisions about who gets into the doctoral program know the applicant who did his master’s in that program.

What do you want your doctorate in? There are a number of degrees that can prepare one for teaching and/or applied work in behavioral health. Which type of degree to pursue goes back to questions 1 & 2 above. You can do a PhD in clinical or counseling Psych; a PsyD in Psych; a PhD or EdD in Counselor Education; a DSW in social work, just for some examples. What degree you pursue should be a function of what you want to ultimately do professionally...and to a lesser, but nonetheless important degree, what you want to study. For example, my PhD is in Counselor Education. That degree, from Syracuse, was awarded by the school of education. Although I was taught “about” counseling, the focus was on “teaching” counseling to future counselors rather than “practicing” counseling — my master’s degree is an applied master’s, i.e., “how to do counseling.” I did not want to be a psychologist so I was not drawn to a doctorate in psychology. Because my interest was not there I never would have been able to remain focused and driven to do the work that was required to accomplish a doctoral degree had that been in psychology.

In summary, the decision to pursue an advanced degree or degrees (master’s and doctorate) is wonderful. Having come to that conclusion, you now need to zero in on just how to pursue your dream and that should be rooted in what “you” want to do...and become. Remember there is no wrong decision, just various forms of the right decision.

Dr. Robert

11 October 2009

Rain in My Heart: Understanding the Affects of Alcoholism

Shortly after I started to work in the addictions field in January of 1974, a colleague in social services, what was then called the "welfare department," suggested that I shadow him on house calls as he would visit his case load. He introduced me to 4 alcoholic gentlemen whom I befriended...his clients. They all lived in what used to be called a “flop house,” up over a paint store on North Union St. in Olean, NY. Each had one room, which consisted of a bed, a table, a hot plate, and a chair; there was a communal bath on the floor. There was exposed wiring in the halls and rooms, a single light bulb hanging on a wire from the ceiling, and these gentlemen would cook on and heat the room with the hot plate - NOTE: this was rural Western NY where it was not uncommon for the temperature in the winter to reach –30’ F...why the building never burned down was beyond me.

These gentlemen were all acquaintances and would, on occasion, drink together. They generally drank muscatel (a fortified wine), usually 3 to 4 bottles a day each, and as many as 8 (each) on a bender when they had the money. One shared his room from time to time with an alcoholic woman, but unfortunately I never got to know her or her story very well. In the winter I would visit with them in their rooms...in the warmer weather I would visit them as the drank in the tall grass by the railroad tracks as they sat on the switch box for the Erie Lackawanna Railroad in a “bottle gang.” I did not know it at the time, but I was conducting ethnographic research. The gentlemen came to trust me and accepted me as I would listen to their stories about their “early days” of drinking and try to understand the etiology of their alcoholism. They would always pass the bottle to me, inviting me to drink with them as the bottle made its rounds in the group...I always passed the bottle along w/o imbibing. I remember being floored by their candor as every one of these gentlemen readily admitted that he was an alcoholic and when I would proffer help, that he had no desire to quit. It was as if they had resigned themselves to the fact that life had passed them by and there was no hope for any of them...life would just run its course and they would eventually die of their alcoholism.

I can remember calling on them on occasion when they were in much the same shape as the alcoholic individuals in the BBC documentary, “Rain in My Heart,” which is available online along with commentary (http://news.bbc.co.uk/2/hi/programmes/newsnight/7140605.stm)...eyes yellow with jaundice, unable to leave their beds, hardly eating and only drinking.

The first gentleman to expire due to his alcoholism died, if I remember correctly almost 35 years later, from massive organ failure, a complication of his long drinking history; he was in his 30s. The 2nd was stomped and beaten so severely by the 3rd, over a bottle of wine, that he was admitted to hospital and never left...he died of the beating. I can remember visiting him in the hospital and watching as he smoked cigarettes through the tracheotomy tube in his throat...the first time I ever saw that...yet another addiction he had--yes, patients were permitted to smoke in their rooms 35 years ago. The gentleman who put "Lavern" there was convicted of manslaughter and sentenced to Attica, where he died before completing his sentence—a side bar story is “Don’s” stories about making alcohol in prison when previously incarcerated...he would ferment peach juice he would get by bartering with trustees working in the kitchen where large cans of peaches would be used to serve inmates. The recipe for the "prison hooch" was peach juice, water, and bread (for yeast), and place the mix behind the dryers in the laundry to ferment.

The 4th gentleman, “Francis” had peripheral neuropathy so advanced that he could not walk...but, believe it or not, he could ride a bike! It was quite amazing to watch "Francis" ride all over town, but when he would stop his bike, he could hardly move. When he was the only one of the group left, he went on a bender one time and found himself in a sever alcohol-induced crisis. I managed to play a role in getting him admitted to a local hospital to be detoxed—keep in mind that in 1975 in Olean, NY there were no such thing as a detox unit. Individuals had to be "dried out" in a med-surge ward under a general med diagnosis in what was affectionately known as “scatter bed detox”—and while he was being dried out I arranged for him to go to the Alcohol Rehab Unit at Gowanda State Hospital, south of Buffalo NY. Interestingly, he linked up with some other patients, got involved in AA and managed to stay sober after discharge—although some would have argued he was little more than “dry.”

These 4 gentleman, plus the 100s of AA meeting I attended and about 4 or 5 other specific “late stage” or “sever alcoholics” as they were referred to in the BBC documentary, "Rain in My Heart," were clients I recall vividly. These individuals thought me as much about alcoholism as any book, workshop, or training program I ever attended. What moved me most about the BBC documentary was that “I knew these people” and I had worked with each of the 4 individuals whose stories were chronicled. Although the documentary was made in Kent, England in the UK, I had nonetheless known each of these individuals and had dealt with the same issues as were documented in the film. If anything, the film falls short of portraying the extent of devastation that can be caused by late stage alcoholism because you can only see and hear what was going on...you could not smell, taste, or touch the consequences of alcoholism as it would permeate the very environment in which they were living and drinking and, unfortunately, dying.

The entire documentary, about 90+ minutes, can be viewed on YouTube in 10 installment. The first can be found at http://www.youtube.com/watch?v=NP0InrPZpjg From there, just click on links to #2, 3, etc. NOTE: This is NOT an easy film to watch, but it is “spot on” in its portrayal of alcoholism and its impact on late stage alcoholic individuals and their families.

Robert

05 October 2009

Harm Reduction:
Managing One's Use of Psychoactive Substances

________________________________________
Marijuana, along with alcohol, nicotine, and caffeine, are among the most widely used drugs of choice by collegiate students in the U.S. Although U.S. policy regarding drugs is driven by a definition of drugs as being illicit substances and its overarching objective when establishing public policy regarding such drugs is interdiction, all four of these substances, plus prescription medications and many over-the-counter compounds (OTC) available without prescription include psychoactive compounds.

These four common drugs of use for college students should be viewed with equity when discussing substance use with contemporary collegians, especially if a Student Affairs professional is discussing the results of the substance use assessment with an individual student. This is meant to suggest that students need to be asked about their use of these legal substances and their declaration of "in moderation" when acknowledging use, of whichever substances are reported, be discussed from a "harm reduction" point of view. Although few readers will likely have a problem with talking about "low risk" use of caffeine, some, I suspect, will question doing this with alcohol and many will likely question the appropriateness of doing so with marijuana and tobacco…let alone other real drugs. Keep in mind, however, that when doing this I use my definition of low risk and not the client's, and I have yet to find a reasonable definition of "no risk" for any of these substances. In short, the consumption of any psychoactive substance—but especially these four psychoactive substances—all include risk, be that health, legal, social, vocational, personal (a.k.a., impaired judgment) or whatever.

Now, when talking about the management of psychoactive substances, there are certain guidelines, or as an old friend of mine who first introduced me to these guidelines almost 30 years ago called them, "rules for psychoactive management" (Weitzel, 1981) that need to be heeded. These include:

1. When there is an opportunity or inclination to consume a psychoactive, especially in order to feel good or get high, consider zero consumption. As a matter of fact there are clear indications when no use is responsible use, e.g., alcohol and driving, Central Nervous System depressant substances and operating machinery, e.g., antihistamines, or tobacco when being treated for asthma.
2. When a decision to consume has been made, consume as LITTLE as necessary, rather than AS MUCH as possible.
3. Discuss the sought after effects of the substance being used with another
4. Research the side effects and discuss with others
5. Include, among those with whom you discuss these effects, non-consumers of the substance you are considering using.
(NOTE: These suggestions were first presented by William Weitzel at workshop at the PA "Governor's Council" Drug & Alcohol Conference, Oct. 28, 1981)

We need to be careful in our rush to "do the right thing" that we do not close the door on the one place that students can turn to get objective information, us. If we are perceived as "narcs" or the "campus DEA," as students wish to discuss the dangers of drugs, we will only have mandated conversations with closed mouthed students. Student Affairs professionals and faculty ARE the appropriate individuals on campus with whom students should be discussing issues of drug use, and this means open and frank discussions.

Of course, as professionals working in higher education, we should not advocate the use of any drug, licit or illicit, for any reason. Rather, we should recognize that many students do use drugs, especially the "big four" mentioned above, frequently with minimal risk. Does this mean we should say, "Hey, if it feels good and you're not hurting anyone, go for it?” absolutely not. If anything we should be inviting students to review the first rule mentioned above" and the risks associated with ANY psychoactive use in order to make objective decision based on accurate facts. A likely motto for the effective Student Affairs professional in higher education may well be, "Good decisions begin with accurate information."

It is entirely possible that there is a continuum for marijuana use just as there is for alcohol, caffeine, or other drug use. This continuum runs from "no risk," i.e. abstinence, to "guaranteed risk," i.e., dependence. I believe it is part of our responsibility to invite students to consider this fact and to make decisions accordingly. Students have come to expect our professional reaction to a discussion of psychoactive use to only include the "no risk" end of the continuum. If we act as they expect we all but guarantee failure in affecting the decisions our students/clients are making as regards drug use as we argue with each other from across the resulting abyss.

When inviting students to look at "the big picture," which includes the risk end of the continuum, we may well be confronted, sometimes quite bluntly, with a student’s perception that we are being subjective and trying to tell them how to live their lives. Be this as it may, there are students who have decided to continue to smoke pot - drink caffeine/alcohol, smoke tobacco, use OTC compounds contrary to directions, etc. - even after our conversations. What is interesting, however, is that they frequently do so, but on a level of significant reduction in frequency and quantity from that presented when seeking counsel or feedback from a professional familiar with the rules outlined above. Is this a no-risk decision? Again, this is absolutely not true. But is it a more proactive approach to engaging contemporary collegians in a discussion about the choices they make? You decide.

To close as I began, often we are the source of accurate information and to deliver that information requires that we recognize that sometimes to deliver "all" of the information necessitates that we include "some" of the information that, in and of itself, we do not condone.

What do you think?