Getting “Unstuck” in Our Thinking about Drinking

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This is a copy of a letter I sent to the Council of Southeast Pennsylvania regarding a recent newsletter – see newsletter at http://bit.ly/H14bFw

Thank you for sending the recent SEPA Council newsletter; Binge Drinking is a Nationwide Problem.  Although the newsletter points out some obvious issues of concerns regarding drinking, I write to share some thoughts on which I would appreciate your reaction if not those of your colleagues at the Council.

First, as important as the shared information is, the newsletter’s design and format presents it in a classic “scare tactics” approach.  From the two photos—one of the young male whose head is on the bar in desperation if not passed out and the other of the dower looking EMT, complete with stethoscope around the neck, perched in front of an ambulance—to the headline itself, complete with exclamation point, the Council’s proactive message about S-BIRT and its evidence-based approach to addressing high-risk and dangerous drinkers is somewhat lost in the implied message of concern if not danger.

Next, as much as the term “binge drinking” has been accepted as part of the lexicon used to describe high-risk and dangerous drinking, it is nonetheless a term that is perceived as being ludicrous by underage and young “of age” drinkers not to mention be called into question by many clinicians who view a binge as being an extended period of excessive use rather than consuming 4+/5+ drinks in a 2-hour period of time type of drinking.  NOTE: I do NOT argue the risk associated with this type of drinking.  Rather, I am concerned about our insistence as a field on using language to share a concern that the population we try to reach rejects as nonsensical, which therefore defeats our purpose.

I suggest that the Council consider these points as it prepares future copy for PSAs and other community-based publications, but more than this, I suggest it also recognize that there is more to the issue of prevention than pointing out what is not working in our system and demonstrating that with an endless parade of reports about “the problem.”  Just as research is showing us that clinical interventions designed to meet individuals with substance use disorders (SUD) where they are ideologically rather than insist that they come to the clinician’s views of substance use and treatment, and/or how the use of “strengths-based” counseling interventions motivate greater numbers of individuals with SUDs to move towards change, so can we who are involved in prevention learn something by listening to what these “binge drinkers” have to tell us about the majority of the time when they choose to drink moderately if not abstain altogether.

In this very newsletter article on “binge drinking,” it points out that the average member of this group drinks “4 times per month” and “8 drinks per occasion.”  Again…this is very high-risk.  But the point that goes unaddressed when focusing on these factoids is that 26-days a month they do not drink and they stop at 8 on those occasions when they do drink.  The question becomes, why?  This is interesting information at the least and potentially very useful when our objective is to reduce harm for both the community in which these drinkers drink and for them as individuals.

We first need to change our thinking about “doing prevention” if we hope to change the thinking of the public at large and ultimately that position of the public that “binge drinks.”  We start this when we begin to ask, Why do those who do not drink until 21 and those who if they do drink, do so in moderation, make the choices they make?

What I propose is nothing short of a paradigm shift when it comes to looking at the issue addressed in the newsletter; I appreciate this.  I also appreciate that fact that this shift is not going to be easy as many stakeholders in prevention efforts find themselves locked into their current way of thinking, which makes any suggestions coming from outside that paradigm automatically suspect.  But let me close with a simple question I use to illustrate being “stuck” in one’s own thinking when addressing this with my students:

Answer this question: What color is a “yield sign”? 

Now, visit images.google.com and in the search box type, “yield sign,” complete with quotes. 

What is the predominate color of all the pictures that appear?

Is this what you expected?

NOTE: If you are like most people above the age of 30, you likely thought, “yellow”; I did.  But “yellow” has not been the color of traffic yield signs since 1971.  So why do most people when asked this question “get it wrong”...because we are “stuck in our thinking.”  We see what we expect to see or worse yet, only look for evidence that supports our position and ignore everything else that does not.  In social psychology this is confirmation bias.

Until and unless we change OUR thinking, we have no hope of changing the thinking of those individuals we target with our programs and PSAs.

Thanks for reading to this point and allowing me to share my position.  I hope that I will be able to converse with you or other council members further.

What do you think?

Dr. Robert

Understanding Twelve-Step Programs

Elevator to sobriety out; use the steps

For 40 years I have had people ask why I would/how I could work with people who have a substance use disorder.  I have stopped trying to answer the question in such a way as to help the asker appreciate my reasons.  Instead, I ask what prompts the question.

Frequently I hear something along the lines of how difficult "those people" are to work with or how frustrating/heartbreaking/exasperating it is to try and facilitate change with someone who "just is not ready."  Instead of an answer intended to change the views of someone who has likely already made up his or her mind about "those people," I ask if they have ever visited places where "the changed" congregate.  I generally get a look that communicates, "what are you talking about" to which I say, "You know...to a 12-step meeting."  Invariably the answer is no.

If anyone has doubts that individuals with substance use disorders change, they need go no further than the nearest "open" AA or NA meeting, take a seat at the back of the room, settle in, and just listen.  The stories of recovery range from heartbreaking to hilarious, but they are all genuine and inspirational.

If you have ever wondered about addiction or are curious about what leads someone with a substance use disorder to pursue change, then attending several open 12-step meetings is highly recommended.  If this sounds like something you might consider, here are some guidelines I provide to my students when directing them to attend meetings as part of my Introduction to Addictive Disorders class.  Considering them may make attending a bit less intimidating and significantly more enjoyable:

What to Expect When Attending “Open” 12-Step Meetings:

 Suggestions regarding Etiquette

1.    Unless you are personally addicted to the substance being addressed at a particular 12-step meeting, e.g., alcohol at an AA meeting, only attend "open" meetings of a 12-step group. "Open" meetings are just that, open to anyone who may want to attend a meeting or learn more about the 12-step program of recovery.

2.    Expect to be greeted at the door when you arrive. The greeter may shake hands occasionally s/he may offer a "hug" (this is not all that common). Be prepared for the greeter to ask something like, "Is this you first meeting?" or "Have you been to a ___ meeting before?" Do not hesitate to say that you are attending because you want to learn more about ___ meetings and this is part of a class assignment. Ask to be sure that the meeting is "open."

3.    While rare, do not be surprised if the person becomes a bit "cool" if you say you are attending as a student in order to learn (this is more likely indicative of the person's lack of confidence when speaking with "a professional" than a rejection of you as a person or "outsider." Remember that "open" meetings are open to anyone.

4.   Unless advertised as a "non-smoking" meeting, expect smoking.

5.    Expect the meetings to last between 1 and 1.5 hours. Some will take a brief break after 30 - 45 minutes (usually the smoke-free meetings).

6.    Most meetings begin with some variation of the following ritual - the Serenity Prayer, greetings from the "chair" for the evening, a reading of the 12-step (perhaps the 12-traditions), perhaps a reading from the big book or other 12-step literature to set the stage for the group.

7.    Expect the chair to ask if there are any new comers attending for the first time. DO NOT feel obligated to raise your hand. If you do, expect to be personally welcomed. It is also likely that someone will approach you at the break or after the meeting and ask if you have questions. DO NOT hesitate to say you are a student and attending the meeting to learn. The person may appear "cool," but this is probably because s/he felt comfortable approaching you as a new comer to the program, i.e., an addict, but is uncomfortable speaking with you as "a counselor."

8.     Expect that a basket will be passed for donations. DO NOT feel obligated to put something in the basket, but if you do, $1 is plenty.

9.    Do not be surprised if you are asked to read something or asked if you would care to speak. I suggest reading the paragraph or step or whatever, but as regards speaking, just say, "I'm here to learn and would like to pass" or something of the sort.

10.       Do not hesitate to let anyone know you are a student and why you are there. MOST members are pleased to answer questions and may even tell you how pleased they are that you are.

111.         Do not be surprised if someone approaches you after the meeting and offers you her/his phone number. This is common practice and part of the tradition of helping, NOT someone trying to hit on you.

112.         Consider attending the meetings with a friend, preferably someone from the class. This will assuage the anxiousness some students experience when attending their first meeting. It is also an excellent way to process the experience after the meeting - remember, you have to write a paper on your experience attending the meetings.

    Enjoy yourself   

    Dr. Robert