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