Despite Efforts Over the Years, Heavy Drinking Among Students Remains Steady

The Chronicle of Higher Education, March 29

Campus efforts to raise students' understanding of the hazards of alcohol abuse ramped up through the 1980s and have since tapered off. Nonetheless, the incidence of heavy drinking among students has remained relatively steady—and a cause for concern—for the past three decades, said a speaker at the annual conference of ACPA—College Student Educators International.

Link to story

This is a continuation of thoughts noted in my previous post

Collegiate drinking is nothing if not a perennial problem and has been since Harvard opened “Butteries” in the 18^th century J Interestingly, the reason that collegiate drinking rates wax and wane, often in sync with available funding to address “problem collegiate drinking” is because we focus on the problem primarily and to a much lesser degree, on the solution.

Interestingly, when we do look at the “solution” it is the solution to the collegiate drinking problem—and we have made substantial headway in this area over the past 20 years…environmental management, social norms, social marketing, BASICS, etc. The issue is that these strategies continue to focus on the minority of students associated directly with the problems cause by collegiate drinkers, that is the “binge drinkers.” What we to this point have never addressed is a consideration of the solution as to how to motivate the majority of college students who are moderate in their drinking if not abstainers to become more proactive in their interactions with peers. In short, how do we learn why moderate drinkers and abstainers approach alcohol and drinking as they do so as to support and/or advance those student characteristics…to move towards what we want rather than always try and avoid/stop if not flee what we do not want. Instead of talking about collegiate drinking in the positive/proactive way, that is, why is moderation the norm for drinkers and/or why do abstainers abstain, all our attention goes to the “problem.” It is like asking someone, continually, for decades, to “not think about pink elephants with purple spots!....guess what they are thinking about?

The classic example of what I am suggesting is the shift in social norms regarding cigarette smoking. EVERYWHERE you went in the early 60s had ash trays and often matches. Good hosts and hostesses even offered guests cigarettes—you can even see the armrest ashtrays on older planes! 50 years later—and this is the key to this change 50 year—not only is this not the case, people cannot smoke in most public spaces and must stand a minimum distance from the main entrances to such buildings if they do choose to smoke.

Such changes take time as do any time we set out to change the culture in a demonstrable way. To change the way alcohol and drinking are viewed in higher ed is no small task and will take years if not decades, but we are not a patient field and lose interest and motivation to “do something” soon after the soft state or federal money disappears.

I can go on and on about this…you can read “a little more” about this in my previous post or you can read “a lot more” in the 2^nd and 3^rd volumes of my monograph series, “When They Drink” – see http://robertchapman.net/essays.htm

Dr. robert

Activities Key to Cutting College Binge Drinking

Drops in binge and “problem” drinking among college students are being attributed to more late-night and alcohol-free activities being offered regularly. Although some argue that these activities will only attract non-drinkers or light drinkers, higher-education officials believe that it is important to support that crowd as well, because in the absence of those activities, they will likely become drinkers, too. http://bit.ly/gRFlwq

This item, which comes from the latest edition of The Network's newsletter, News from the Front (March 2011 - http://thenetwork.ws/?page_id=305), is interesting in and of itself, but particularly provocative is its last statement referring to the need for colleges and universities to address the needs of their non-drinking or moderate drinking students in their alcohol-related programming. I take this statement one step farther and suggest that these students may be an untapped resource that can be helpful in addressing the quest to change campus culture as regards the role that alcohol as a substance and drinking as a behavior play in contemporary collegiate life.

It seems that whenever we hear about collegiate drinking it is either a report on the latest travesty resulting from some student’s drunken comportment—invariably courtesy of the popular media--or research article and clinical report related to high-risk collegiate drinking. Yet we know from study after study that most collegians are moderate in their consumption of alcohol if they drink at all--about 20% of college students nationally chose not to drink last year. Access to information about collegiate drinking tends to set up what social psychologists call “confirmation bias” or the tendency to look for evidence that supports a belief one already holds while overlooking or discounting evidence to the contrary.

With better than half of all college students either moderate in their drinking or abstaining all together and better than another quarter reporting high-risk drinking (defined as having 5 or more drinks in a 2-hr period) no more than once in the previous 2-weeks, these media reports have suggested a problem that is exaggerated and therefore unnecessarily pessimistic .

This does not, of course, suggest that the high-risk and dangerous drinking of a quarter of contemporary collegians should be overlooked or is of little concern; it is indeed a problem and is among the most significant public health issues facing contemporary college students. It does suggest, however, that most students are moderate in their behavior and exercise more than a modicum of restraint when it comes to making personal choices about alcohol and drinking.

This would seem to suggest that an important resource in the quest to change the campus drinking culture has gone untapped or at the least, under utilized, namely, the moderate drinker and the abstainer. What is it that affects the choices these students make? Why are they moderate when they drink or what factors influence their decision to abstain altogether? And even if John Jones or Mary Brown does decide to “drink a belly full of beer” on a Friday night but that may be one of a few times that is done in a semester, what factors affect his or her decision to remain moderate if not abstain on other occasions when alcohol is available and drinking is the perceived norm for the immediate group with which he/she is socializing?

The next chapter in an already significant text on collegiate drinking is about to be written. In a series of monographs on the topic of collegiate drinking entitled When They Drink, I explore the issues of why students who do drink, drink in the way they do (see Monograph at http://robertchapman.net/essays.htm). Now we need to look at what we can learn from “the rest of the students,” namely those who are moderate in their consumption or abstain altogether. I suggest that we ask these students to tell us their stories and that we then learn from them what affects the choice they make to abstain or remain moderate in their consumption when they choose to drink.

Like the story of the Good Samaritan who stopped to help a older gentleman looking for his car keys under a street light, when asked where he lost his car keys the gentleman pointed down a dark alley to his right and said, “Down there.” The Good Samaritan, looking puzzled, ask, “Then why are you looking here if you lost them way over there?” The older gentleman, glancing up with a perplexed look on his face said, “Because the light is better here!”

Perhaps we need to look at the stories of those students who are already doing what we would like to see their high-risk peers doing…decreasing the frequency of drinking episodes and reducing the quantity of alcohol consumed per occasion when choosing to drink. The light shining on the moderate drinkers and abstainers is nowhere as bright as that shining on the "binge drinkers," but perhaps we need to look where the answers are for the burning questions we ask.

What do you think?

Dr. Robert

Matching Psychotherapy to the Patient/Client

(Copied verbatim from the Effectiveness Bank alerts from Drug and Alcohol Findings).

This bulletin is devoted to reports from a high-level task force convened by the American Psychological Association to identify effective psychotherapy relationships and ways to adapt therapy to characteristics of patients other than their diagnosis, such as their personalities or cultural backgrounds. The task force commissioned reviews synthesising research on promising ways to match therapeutic approaches to different types of patients, which were published in a special issue (2011, volume 67, issue 2) of the Journal of Clinical Psychology. These reviews and the introductory article are listed below. While not specific to drug or alcohol problems, many of the studies included in the reviews concern these problems and a high proportion of drug or alcohol patients suffer from the mental health problems addressed by the other studies. The reviews offer comprehensive, evidence-based recommendations on how to maximise the benefits of psychosocial therapy.

To view entries click on a link or paste it in to your web browser address box, being sure to enter the whole address. This link:

http://findings.org.uk/count/downloads/download.php?file=bulletins/CAB_11_03_11.php

takes you to the bulletin as a whole. Links below take you to your chosen entry.

**************************************

WHAT WORKS FOR WHOM: TAILORING PSYCHOTHERAPY TO THE PERSON

Introduces the special issue of the Journal of Clinical Psychology and summarises the conclusions reached by the task force. Prime amongst these was that outcomes demonstrably improved when therapists appropriately adapted their approaches to the reactance/resistance, preferences, culture, and religion/spirituality of their clients.

http://findings.org.uk/count/downloads/download.php?file=Norcross_JC_5.cab

ADAPTING PSYCHOTHERAPY TO THE INDIVIDUAL PATIENT: STAGES OF CHANGE

Review concludes that the stages of change developed by Prochaska and DiClemente reliably predict how well psychotherapy patients will do, but no adequate studies have tested whether matching therapy to initial stage of change actually improves outcomes.

http://findings.org.uk/count/downloads/download.php?file=Norcross_JC_4.cab

ADAPTING PSYCHOTHERAPY TO THE INDIVIDUAL PATIENT: PREFERENCES

Review concludes that patients stay longer and do better if they get the type of therapy, type of therapist and type of therapeutic style they prefer.

http://findings.org.uk/count/downloads/download.php?file=Swift_JK_2.cab

ADAPTING PSYCHOTHERAPY TO THE INDIVIDUAL PATIENT: CULTURE

Review concludes that mental health services targeted to a specific cultural group were several times more effective than those for clients from a variety of backgrounds, and that more effective treatments had more cultural adaptations.

http://findings.org.uk/count/downloads/download.php?file=Smith_TB_2.cab

ADAPTING PSYCHOTHERAPY TO THE INDIVIDUAL PATIENT: COPING STYLE

Review concludes that externalising patients are best matched to psychotherapies focused on skill-building and symptom change, while those characterised by self-criticism and emotional avoidance benefit most from interpersonally focused and insight-oriented approaches.

http://findings.org.uk/count/downloads/download.php?file=Beutler_LE_3.cab

ADAPTING PSYCHOTHERAPY TO THE INDIVIDUAL PATIENT: EXPECTATIONS

Review concludes that patients who enter psychotherapy with positive expectations about outcomes tend actually to have better outcomes, suggesting that therapists should regularly assess expectations and take steps to enhance them if appropriate.

http://findings.org.uk/count/downloads/download.php?file=Constantino_M_1.cab

ADAPTING PSYCHOTHERAPY TO THE INDIVIDUAL PATIENT: ATTACHMENT STYLE

Review concludes that psychotherapy patients who feel secure in and easily form close and trusting intimate relationships have better outcomes, while the reverse is the case for those anxious about close relationships.

http://findings.org.uk/count/downloads/download.php?file=Levy_KN_1.cab

ADAPTING PSYCHOTHERAPY TO THE INDIVIDUAL PATIENT: RESISTANCE/REACTANCE LEVEL

Review concludes that patients who characteristically exhibit low levels of resistance to being led by others respond better to directive types of treatment, while patients prone to resist direction respond best to non-directive approaches.

http://findings.org.uk/count/downloads/download.php?file=Beutler_LE_2.cab

ADAPTING PSYCHOTHERAPY TO THE INDIVIDUAL PATIENT: RELIGION AND SPIRITUALITY

Review concludes that psychotherapy patients who identify with the religious or spiritual orientation of a therapy improve more than if untreated. Generally they also improve more than if treated with secular therapies, but not if these are equivalent in every other way to the religious/spiritual therapy.

http://findings.org.uk/count/downloads/download.php?file=Worthington_EL_1.cab

The Role of Technology in Training the Next Generation of Counselors

There are certainly “issues” associated with using avatars and virtual reality in the training of counselors, but the technology is both here to stay and likely to be applied to many professions, ours more than likely being on the short list.

Visit http://bit.ly/fSa5jb and watch this video on the next generation of Microsoft’s X-Box 360 Kinnect. Not only does Kinnect allow one to operate the controller through body motion; it is about to read and mimic facial expressions. This enables the avatar on screen to communicate with facial expressions much as we do in the ‘real world.” The potential to apply this technology to training counselors if not permitting individuals to be effective treated with counseling in virtual reality are provocative to say the least.

Although I have had serious concerns about “online counseling services” and online graduate programs in counseling including little or no residency requirement etc., the point remains that the technology is going to be applied to both the delivery of service and the preparation of and CEUs (continuing education units) for professional counselors. If this is to happen in a controlled fashion with the primacy of ethics and effectiveness clearly established, it is going to likely come as the result of the old guard (those currently delivering counseling services) working with the newbies (the next generation) who are tech savvy in order to bring about a judicious and efficacious blending of skill and technology. What is true today will remain true in the future as regards counseling...“it’s all about the client.”

Just as Rogers was criticized for bringing audio equipment into the counseling sanctuary in the 1950, video equipment was introduced in the late 60s and 70s, practicum students and interns were mandated to provide video tapes of sessions to be autopsied in class in the 80s, and all manner of computer software becoming not only ubiquitous in the counselor profession, but one standard by which effective practice standards are measured, this technological tide is flooding and as John Kennedy once quipped, “The rising tide lifts all the ships.”

I agree that the avatars in the Kinnect video are crude when compared to sitting in an actual session with a student, client, or group, but this is the next step in the development of this technology, not the last stop on the line. Avatars that can accurately replicate facial expressions represent nothing if not a quantum step forward in virtual reality. I agree that we need to be cautious and not rush to employ the technology simply because we can. By the same token, however, I suggest that those of us who know how to do what we do so well “with old technology” might be wise to consult with those who are ringing the bell technologically while still naïve regarding all the subtle nuances of the truly skilled counselor.

From bringing counseling services and/or education to individuals in rural areas miles from either opportunity to supplementing existing service menus in order to increase access to services for individuals with various obstacles that preclude “mainstream” counseling and/or training, I believe it appropriate for educators and clinicians alike to be cognizant of the future and what the technology holds in store for us lest we find ourselves being criticized in the not too distant future for being resistant to change in the same way we criticize some of our colleagues today who resist evidence-based treatment strategies, new medications, Motivational Interviewing, and Harm reduction, simply because “they are not the way we did it.”

I am not the spokesperson or advocate for the use of avatars and virtual reality as the primary vehicle for training counselors because I am not. I would, however, like to point out that there are issues here that we (the counseling field as a whole and not INCASE as an organization) best address lest they sneak up on us. Just as there has been a successful marriage between the “art” of counseling and the “science” of counseling, resulting in many of the best practices we presently incorporate into our academic programs and clinical practices, so should there be a collaboration between the “practice” of counseling and the “application” of technology as we look to the next generation of counselor education and service delivery.

A secondary issue worthy of consideration in this discussion is the role the “delivery system” plays in engaging the student in training or the client in practice. To refuse to consider adapting a technology that has been embraced by the likely next generation of counselors and their clients simply because we find it alien and representative of our fears that the miasma of virtual reality is restricting the development of essential interpersonal social skills is to ignore an essential point...the next generation of counselors and their likely client are in the process of if not already having embraced it.

Again, we should neither dismiss this technology out of hand as ineffective if not dangerous nor ignore it as inconsequential. Rather, we should be informing those who create and promote these technological advances in virtual reality to do so in such a way as to consistently ask the following questions:

1.      Because something can be done (technologically) should it be done? Some of us have already answered this question with a clear no; others, including myself, answer saying, “probably not, but that does not mean that something beneficial cannot come from exploring this issue.” NOTE: I am not proposing something akin to Neville Chamberlain’s attempt to appease German aggression in the late 30s—or as Churchill said, “feeding others to the alligator hoping to be the last one eaten” (pardon the paraphrasing)—but rather, a more evocative collaboration that more closely resembles brainstorming.

2.     Are there risks associated with making the synth world so attractive that it risks, directly or indirectly, prompt individuals to “drop out, tune in, and turn on.”? Until and unless human service professionals in general and counseling professionals specifically educate the tech development folks about the risks associated with making the synth world so seductive that it cannot be resisted, such developments will simply be seen as the next cool, neat advance. If, however, we work with the tech folks, outlining our concerns by proffering advice as to how to “use” the technology to accomplish our goals—training and clinical—rather than chastise them for developing a reality we believe to be harmful or dangerous or more succinctly,  “wrong,” we are likely to facilitate a “win-win” scenario. 

The metaphor of counseling an adolescent is not all that out of line when considering this discussion. If we are the experienced human service professional, the “sage adult” if you will, concerned about the high-risk behavior of our adolescent client, would we not engage that adolescent in a way that was uniquely suited to meet the client where he or she was in order to engage that adolescent in conversation rather than demand that he or she simple “stop” doing the high-risk behavior or simply refusing to consider what was being proffered? 

Allow me to close as I began...I neither wish to be nor see myself qualified as a champion for the use of technology in general and virtual reality more specifically as where counselor education should advance. I have as many concerns as do many of my colleagues on this list. There are countless examples of substances and practices that are essentially harmful and toxic in and of themselves but this does not preclude considering their use to further our quest to employ them in advancing the quality of life of individuals or advancement of the human condition. I simply suggest that we not throw out the baby of technology with the bath water of avatars as we reflect on the possible nexus of “counseling” and “virtual reality.”

As an aside, the original link to the video I posted that started this discussion was sent to the CESNET (Counselor Education & Supervision Network) listserv by Dr. Russell Sabbella of Florida Gulf Coast University (http://www.schoolcounselor.com/about-sabella.htm). He is one of the foremost researchers and advocates for incorporating technology in the training of counselor educators. Should you visit the link provided, look at the links to online article on the use of technology in counseling as well as the “Schoolcounselor.net “newsletter.”

As always, thank you for the opportunity to share my ideas and taking the time to consider them.