Tips for Collegiate Drinkers

That some collegians choose to drink is not news. That some of these drinkers actually choose to, or unintentionally, become intoxicated when drinking alcohol and experience an array of possible untoward consequences is likewise no secret. What may be a revelation for some is learning that most publications regarding collegiate drinking focus exclusively on these untoward consequences and covertly, if not overtly, imply that they are proof that all collegiate drinking is problematic.

If “the problem” is all collegiate drinking, then there can be but one possible objective of prevention…abstinence. However, such a goal suggests two questions: First, just as there has never been a time when alcohol was not used by some college students, can there ever be a time when no collegians drink (although it is likely that current percentages of students reporting use can be lessened and the frequency of that use and quantity consumed can be reduced)? Second, has the focus of research and prevention programming been too a posteriori and should that focus be directed instead to a priori considerations of drinking? Put more succinctly, we have been more concerned about the untoward consequences after students drink than in pursuing a better understanding of the meaning students ascribe to alcohol and drinking before consumption that influence their decision to drink in the first place. One argument in this essay is that such a priori considerations of collegiate drinking are likely to shed light on factors that affect individual decisions to drink…not to mention influencing student decisions when to drink, how to drink, or determine what circumstances warrant drinking, etc.

So if collegiate drinking is not “the” problem, but rather the drinking “some” collegians do is, here are a couple suggestions to minimize the likelihood of untoward consequences should you choose to drink:

1.  Water is a frequently cited nonalcoholic beverage many students report consuming. Remember that when drinking, the more nonalcoholic beverages that are consumed, the longer the time between alcoholic drinks and the slower the absorption rate of the alcohol already consumed. In addition, alcohol is a diuretic drug meaning that it absorbs water out of body tissue. Drinking water re-hydrates and may lessen some hangover symptoms. Ideally, those drinking alcohol should consume 1 8-oz serving of water for each standard alcoholic beverage.

2.  Students are creatures of habit. A routine of consuming “X” drinks at a sitting can yield the perception that “X” is moderate consumption, especially if friends are also drinking “X” or “X+1, 2, etc.” Consider your “routine” consumption. Multiply your “usual” amount by the number of days a week you drink. Multiply that by the number of calories per drink—90 for lite beer, 130 regular beer or  “per shot” in a mixed drink (do not forget to add calories for any mixer). The total is the number of calories consumed in a week/month/year. To get exact calorie readings for 100 different beers, visit http://www.beer100.com/beercalories.htm (remember that 12-oz of beer = 350 ml).

3.  Track your drinking over a couple typical weeks. Once you have a baseline, divide the number of drinks by the hours spent consuming them. This is your “drinks per hour” ratio. Once the pace has been determined, for example, “4/hr,” consider if you were to have a drink every 20 minutes instead of every 15. By simply adding 5 minutes between drinks you affect a 25% reduction in drinks consumed for the evening - from 4 per hour to 3. What happens if you add 15 minutes between drinks...50% reduction in alcohol consumed.

4.  Next, explore creative ways to add those 5 - 15 minutes between drinks...drink a nonalcoholic beverage like bottled water between alcoholic beverages, don't stand next to the keg, etc. Lastly, consider the pros and cons for pursuing such a change...fewer hangovers, better class attendance, clearer memory, fewer calories consumed, more money saved, etc. All this by simply adding 5 – 15-min between drinks...go figure!

5.    Ask yourself, when you have a headache, how many aspirin or Tylenol or Advil do you take? Chances are you take 2, perhaps three. If they work so well, why don’t you take 6 or 10 or 15? Before you shake your head in disbelief at this apparently idiotic question remember that most individuals that report drinking alcohol get the benefit of alcohol from just a few—and no more than 5—standard drinks (12-oz domestic beer, 10-oz malt liquor, 5-oz table wine, 1.5-oz 80 proof spirits) over an outing, but go on to drink 6 or 10 or 15+ and then find themselves dealing with the frequent consequences of heavy drinking. Remember, what causes a problem is a problem when it causes problems. Again, is it the drinking or the amount consumed that is the issue? NOTE: This tip is not suggested for those with a bona fide alcohol use disorder.

6.  Drinking on an empty stomach? What time do you generally eat dinner. If you live on campus, most dining halls are open from 4:30 PM – 7 PM, with many students eating between 5:30 and 6:30, “just like home.” What time do you generally go out when you socialize. Chances are pretty good not until 10 PM or later. Now, if the time between dinner and socializing, that is, "imbibing," is 3+ hours, you are essentially drinking on an empty stomach. Eat dinner later on nights you intend to go out and “snack” before leaving (and through your time out).

7. "Add your harm reduction suggestion as a comment."

Dr. Robert

Preventing Relapse: A Look at Marlatt's Cognitive-Behavioral Model

Relapse prevention is an important topic in the training of any counselor, irrespective of her or his ultimate specialty. That said, any consideration of relapse need at least consider Marlatt's cognitive-behavioral therapy approach – see Larimer, Palmer, & Marlatt’s 1999 article in Alcohol Research & Health, “Relapse Prevention: An Overview of Marlatt’s Cognitive-Behavioral Model.” As for a text for a relapse prevention course, I recommend Marlatt and Donovan’s edited text, Relapse Prevention, Second Edition: Maintenance Strategies in the Treatment of Addictive Behaviors  (link to book on Amazon). Be sure to review the table of contents as you will quickly see this text truly considers the subject of relapse across ALL addictive disorders.

As an aside, an important aspects of Marlatt’s consideration of relapse is the role the “abstinence

violation effect” (AVE) plays in the onset of a true relapse. The AVE is essentially the guilt that is associated with having used after a period of abstinence. It is this guilt that plays a major role in turning the “slip” into a “fall off the wagon.” Marlatt argued that before one can relapse, the recovering individual must first “lapse.” The distinction between a “lapse” and a “relapse” being that a lapse is a temporary return to use whereas the relapse is a return to the lifestyle of the active user. It is important for counselor-ed students to recognize this difference as this concept—“lapse” precedes “relapse”—coupled with CBT enables the practitioner to “act on” the lapse rather than “react to” the relapse.

I have had individuals with whom I addressed a SUD (substance use disorder) contact me in a panic the day after a lapse, filled with guilt and shame about their use. I always begin the conversation by asking what they have done with the remainder of the alcohol, weed, cigarettes or “whatever.” Frequently, they tell me that they felt so bad about the use that they flushed the weed, dumped the alcohol down the drain, or discarded the remainder of “whatever.” I then suggest that while we can discuss the use later, “right now” what I am really interested in is the fact that they appear so committed to change that they threw away $X of product. I then suggest this shows how far they have come in their recovery and that their experience is what is called a lapse rather than a relapse. Obviously there is more to this approach than a simple 3-min conversation with a client. The point is, the practitioner follows a true “solution-focused” path; by concentrating on what the client has done well, we can move further away from the AVE and its associated guilt and shame. This guilt and shame then all but ensures the lapse progresses into the proverbial “full blown relapse.” This blending of harm reduction with CBT is a very effective strategy in “true” relapse prevention.

To put some closure on these comments, there is no distinct line of demarkation between recovery and relapse. Just as the 21-year-old at 12:01 AM on her 21st b-day has not magically become better able to drink safely than at 11:59 PM, neither does someone with a substance use disorder relapse upon taking the first sip/toke/drag. Now, do not misunderstand my comments to mean that it is “okay” to use “just a little” or we should not be concerned about that sip/toke/drag etc. Clearly, we need to be sensitive to any early indicators of someone who is skating on the proverbial thin ice as regards recovery; risk is risk and those who ignore this fact will fall through that ice. That said, Miller’s admonishment that we “dance” with clients rather than “wrestle” with them suggests that we teach our students the difference between a “lapse” and a "relapse” so that as practitioners they can proffer the guidance and support necessary to get the “train back on the tracks.”

What do you think?

Dr. Robert