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