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To find additional essays and "professional musings" related to counseling, collegiate drinking, personal change, and other topics, please visit my LinkedIn Profile and check out its "Posts" section.

Thank you for visiting this blog site and I trust that you will enjoy the more than 100 essays archived here. You can always contact me via my professional email: chapman.phd@gmail.com or through LinkedIn.

Best regards,
Dr. Robert

Applying Behavioral Economics to College Drinking

In my retirement I have found time for more reading; I am becoming a student of "behavioral economics" (BE) - see books like Thinking Fast and Slow by Kahneman and Nudge by Thaler & Sunstein. One aspect of BE is the concept of "choice architecture" or engineering the environment so as to offer individuals subtle "nudges" designed to help them make personal choices and behavioral decisions that enhance their quality of life, personal health, social responsibility, etcetera. One such architectural device is "priming."

Priming refers to subtle influences that can affect the likelihood that certain information comes to mind when considering various topics...like whether to drink or not, and if so, how much, how fast, etcetera. By priming students regarding these choices, it is possible to affect the decisions they make. Although there are numerous ways to engage in priming, one way that occurs to me as relatively easy to implement and of possible significance regarding collegiate drinking is to simply ask individuals if they intend to drink and then ask about their plan regarding that intention.

Assume for the sake of discussion that a nurse in the campus health center is conducting a routine interview with a student--it can just as easily be a counselor in the counseling center, faculty member in an advising session, or coach in the athletic center. The presenting issues is unimportant; what is, is that the nurse is conversing with the student. During the conversation the nurse asks, "If you plan to drink during the coming week, how likely are you to moderate use?" Irrespective of how the student answers, the nurse then says, "I'm curious; how do you intend to do this?" NOTE: Authority figures like coaches and faculty members will likely elicit a less than truthful, "I have no plans to drink" response. This is fine...more on "less than truthful" responses in a moment. 

The simple act of asking about intent increases the likelihood that the student will engage in the expressed behavior. This has resulted when asking individuals about their intentions regarding everything from plans to vote, to flossing their teeth, to exercising. To follow the first question with a second that specifically asks about "the plan," causes the student to first, think about "how" to moderate drinking and second, what might that plan look like. 

When routinely interviewing students about drinking, I used to take this a step further and would ask what "moderate consumption" means. Generally, I would get answers like, "3 to 5 drinks." NOTE: Even if this is a lie, the fact that the student defines moderate as "3 to 5" creates dissonance in any consumption that exceeds 5 as it creates an uncomfortable emotional state that students tend to dissipate by acting in accordance with their original statement. I would then give the student 5 cardboard "poker chips" (actually, the were the "holes" from state Liquor Control Board door hangers on blood alcohol level) and instruct students to place these "chips" where they keep keys, cell phone, etc. in their residence.

I then suggested that before going out: (1) ask yourself, "am I going to drink?" (2) if yes, "how many," and then place that number of chips in the dominant-hand pocket, then (3) when having a drink, move one chip from the dominant pocket to another pocket. I would then ask the student, "When you put your hand in your dominant pocket and the chips are gone, what does that mean?" The student generally would say it meant 3 - 5 drinks were consumed. I would agree and then ask, "will that ensure that you will not have another?" Usually, the student would look at me and pause. I would smile and comment that, "no, it does not keep you from having more, but it does ensure that if you do, you will know that you have decided to exceed your own limit for the outing." 

Generally, this conversation ends by discussing the "gimmick" as a simple way to ensure thinking about whether or not one wants to drink before going out and if so, how much. In short, the entire activity was an exercise in priming.

Historically, prevention projects have sought to change behavior by controlling physical environments, increasing awareness about risks and social norms, and utilizing non-invasive conversations with students to invite them to consider their behavior. The point of this post is to suggest that considering BE--with priming being but one example--may enable us to add additional arrows to the prevention specialist's quiver.

What do you think?

Dr. Robert

Self-Directed Behavior Change: A 9-Part series on personal change

Who has not identified a personal behavior in need of modification…if not a major overhaul? How often have resolutions made on December 31st been abandoned, justified with rationalizations that indicate a return to the “status quo,” often before the 1st of February?

Behavior change, although difficult to accomplish, actually involves a rather simple process. As with any “process,” there are steps or “tasks” to complete, in succession, in order to realize “success.” In the case of changing a personal behavior or “a habit,” there are 9 of these steps or “tasks,” which I will outline in a series of posts here. For more detailed information regarding self-directed behavior change, read Watson & Tharp’s 2013 book, Self-Directed Behavior, 10th edition, Wadsworth (9th edition available, used to reference this post, used online).

1 of 9: Clearly, specifically, and objectively outline the behavior you wish to change. Deciding to “lose weight” is not a particularly helpful behavioral objective; it is too vague. How much weight? Over what period of time? Instead, use a “My goal is…when…” formula to specify the desired change: My goal is to eat less  when I am very hungry. This simple statement opens a path to several specific behavior change options. For example, eating small amounts, several times a day to avoid ravenous hunger, or drinking an 8-oz glass of water before eating and then slowing down when eating, perhaps chewing my food a minimum of 10 times, giving time for food consumed to register as satisfying hunger.

Next post: Listing the details of the behavioral change objective.

Dr. Robert

Studies Report New Data RE Collegiate Drinkers

Although it is not surprising that collegiate women reporting blackouts also consume more alcohol, experience more alcohol problems, report drinking for enhancement reasons, and have lower semester grade point average (GPA), documentation of this fact may be of use when interviewing these women clinically. At a recent meeting of the Research Society on Alcoholism (RSA) in San Antonio, researchers from Miami University of Ohio reported a significant correlation between blackouts in women and these drinking-related characteristics. The significance of this small study (N = 424) remains to be determined by subsequent investigation, but suggests that practitioners may find such correlational data useful when conducting brief motivational interviews with collegiate women. For example, frequent use or reports of higher consumption may warrant additional exploration of blackouts, or as some students suggest, brown out for partial blackouts or trouble recalling all aspects of a drinking experience. The presence of these significant behavioral indicators of a substance use disorder may become useful data when facilitating “change talk” (Miller & Rollnick, 2013).

In a related presentation at the RSA conference in San Antonio, researchers at the U of Nebraska-Lincoln reported on the relationship between drinking, sleep deprivation, and academic performance. Although it comes as no surprise to those familiar with collegiate drinking, poorer academic performance appears related to the impact of drinking on a student’s amount and quality of sleep. Prevailing opinions regarding the negative correlation between drinking and academic performance suggest that it is the time spent drinking and recovering from its effects that explain poorer academic performance, but this study suggests it may be the mitigating effects of disrupted sleep patterns that explain issues related to poorer academic performance and drinking. NOTE: There is ample evidence suggesting alcohol’s ability to disrupted REM sleep –  To read more, search alcohol REM Sleep disruption using your favorite search engine.

In yet another presentation from the RSA conference in San Antonio with significance for those interested in collegiate drinking, investigators at the U of Houston in Texas report on an emerging drinking-related phenomenon resulting from the nexus of “collegiate drinking” and “social media” like Instagram, Facebook, Pinterest, and similar digital outlets that permit the posting of photos. Called Body Vandalism, this phenomenon involves drawing pictures on individuals, giving them unflattering haircuts, posing them in suggestive positions, etcetera, and then photographing the individual and posting on social media. Although alcohol consumption is involved in both victim and perpetrator, victims tend to report being more highly intoxicated. Poor decision making and victimization are nothing new when considering high-risk drinking, the advent of digital media and the ease with which such photos are placed online suggest yet another consequence of drinking that practitioners may wish to explore when interviewing collegians regarding their drinking—To read more, search Body Vandalism Drinking using your favorite search engine.

The 3 studies reviewed in this post suggest additional areas of interest for contemporary practitioners to explore when working with college students. Engaging students in such a way as to invite the telling of their individual stories related to collegiate drinking can increase the likelihood of helping arrange conversations so that students talk themselves into change.

What do you think?
Dr. Robert

Miller & Rollnick (2013). Motivational Interviewing: Helping People Change, 3rd Edition.

Is It a “Minor Relapse” or a Lapse?

Is It a “Minor Relapse” or a Lapse?

Pop culture is alive with Jonathan Rhys Meyers comment about his "Minor Relapse.”  Quoting from US Magazine, The Byrd and the Bees actor — who has struggled with substance abuse for years — opened up about a "minor relapse" he recently had via Instagram on Tuesday, May 26 - see http://usm.ag/1d1P1k2 

What is described in this article is not so much a "minor relapse" as a "lapse," or a temporary return to substance use. The distinguishing characteristics of a "lapse," as opposed to a "relapse," include: (1) a prompt return to abstinence, and (2) steps taken to learn from the lapse so that one's recovery is enhanced as the result of the experience.

Experiencing a lapse, although never recommended as a therapeutic step in recovery, can provide insight regarding vulnerable points in one's recovery and alert one to "triggers" that can initiate the urge to use. It is as likely that such "vulnerability" is related to positive or "good things" as it is to problems and challenges as they both represent risks to one's recovery.

When experiencing a lapse, it is important to take steps to ensure it results in a "prolapse" rather than a "relapse." A "prolapse" is the realization of the issue(s) that prompted the return to temporary use and learning from it (them) so as to strengthen both one's resolve to remain sober and ability to do so. This generally involves the opportunity to review if not deconstruct the "lapse" with a sponsor in a self-help program or professional counselor or therapist, but can result from serious self-reflection. The most important element of a "prolapse" is the ability to get outside one's own head and look, objectively, at the factor(s) that facilitated the lapse in the first place. It is also important to recognize that a relapse is NEVER an event; it is always a process. This process can start hours or days or even weeks before the "event" of picking up. Recognizing the process can often result in averting the lapse and, unaddressed, an ultimate relapse.

In summary, a "prolapse" results from acting on a lapse rather than reacting to it. When one "acts on" the lapse, there is the opportunity to learn from the experience and, paraphrasing Nietzsche, realize that, "what does not kill you make you stronger." If one simply feels guilty because of the lapse, what is called the "abstinence violation effect," that guilt is a reaction to the experience and all but guarantees progressing into relapse.

To read more on the topic of “lapse” vs. “relapse,” visit http://pubs.niaaa.nih.gov/publications/arh23-2/151-160.pdf

What do you think?

Dr. Robert

Addressing Substance Use Issues in Higher Ed: Lessons Learned from Treatment Providers

Addressing Substance Use Issues in Higher Ed:

Lessons Learned from Treatment Providers

When considering issues related to alcohol and other drug (AOD) use in higher education, the focus is frequently placed on collegiate binge drinking.  Like a family preoccupied with the substance use of a member, higher education tends to focus on its student drinkers.  However, because one drinker in a family has a problem, that does not mean all drinkers in the family do. Likewise, because some students are high-risk drinkers does not mean all students are.  What if an entire college or university were approached as an identified client in need of assistance, in much the same way a treatment provider engages the family of a problem drinker when providing assistance?  What has the treatment community learned over the years that enable it to work effectively with families?  Perhaps such topics of importance to those treating families might be of interest to senior administrators in higher education looking to approach collegiate drinking differently.

Treatment facilities focus on helping families recognize that…what causes a problem is a problem when it causes a problem.  This truism is pretty clear when dealing with individuals and families; it is less clear, however, when considering how this applies to a college of university.  How do we help Institutions of Higher Education (IHE) to understand "their AOD problem" is not exclusively the student drinker? 

Focusing attention on the high-risk drinker has yielded evidence-informed approaches to intervention with these consumers, but this is more an informed “reaction” to the “perceived problem" than indicative of definitive “action taken” to prevent it.  Just as families learn that they cannot stop a member from drinking or drugging, IHEs need to recognize that neither can they stop collegiate drinking.  What families learn in treatment is how to focus on their issues and concentrate on that over which they do have control.

For families, change manifests itself in the form of establishing and consistently maintaining appropriate boundaries, assertively and proactively intervening when encountering unacceptable behavior, understanding the true nature of substance use disorders (SUD), and accepting that the issue of primacy is not changing the user, but recognizing that the family, as a whole, must address its problem.  Families working on their issues accept the things they cannot change, but nonetheless work to change the things they can.  For IHEs, addressing issues of concern regarding AOD use re remarkably similar to the objectives of families in treatment. 

Like the family, an IHE needs to establish and maintain realistic boundaries.  In the prevention literature this is part of what is called environmental management.  Where families assertively and proactively intervene with members displaying maladaptive behaviors, IHE employ brief motivational interventions or employ evidence-informed programs like Brief Alcohol Screening and Intervention for College Students (BASICS).  When families come together to consider that its problem is not the result of an individual with a SUD, but the family as a unit that needs to accept its responsibility to act on its needs rather than react to the member “with the problem,” IHEs can collaborate with its stakeholders in the community, both on and off campus, to establish and then embrace a collaborative, solution-focused approach to a perennial and heretofore perceived intractable problem.

There is much that IHEs can learn from families that have received treatment for a SUD.  Although social scientists of all descriptions are consistently contributing to the body of knowledge related to campus “binge drinking” and drug use, there is room for the SUD treatment community to proffer assistance to its colleagues in IHEs.

What do you think?

Short College Programs Only Briefly Successful in Helping Students Reduce Drinking  - click to read entire article

Brief alcohol education programs are only temporarily effective in convincing college students to reduce their drinking, a new study suggests.

Some thoughts regarding “short term"/awareness programs:

As stand-alone efforts to change drinking behaviors, “awareness” programs are of little use affecting long-term behavior change.  NIAAA lists such programs a Tier 4, Evidence of NIAAA Tiers of Effectiveness.  This is not to say, however, that such programs are useless or have no value.

Ineffectiveness

For those familiar with Prochaska’s Tran-theoretical Model of Change, you will recall that there are processes of change that work best for each stage of readiness to change (for a quick tutorial on the TMC, visit.  The purpose of these processes of change or “stage-specific interventions” is to motivate movement to the next stage on the continuum of readiness.  To move from the 1st stage of readiness to change, which essentially is no sense of readiness to change, what Prochaska calls pre-contemplation, one needs to become aware that, as Joe Martin used to say, what causes a problem is a problem when it causes a problem.

“Short college programs” as the headline suggests may not be very effective as regards long-term behavior change, but they can play an important role in a comprehensive campus program of prevention and intervention.  In short, no one changes a behavior until reaching a point where it is discovered that to continue the status quo is more hassle than the change.  These “short college programs” can be helpful in making individuals aware of “what constitutes a problem…and the possible connection between “X behavior” and “Y experience.”  Although few will “hear a lecture” and immediately change their drinking behavior, that lecture/poster/program/phone app/mouse pad/water bottle logo/screen saver/etc., especially if similar messages are shared consistently via various media and coordinated in their use around campus over an extended period of time, can motive individuals to “start to think” about their behavior.  Now, “thinking about my behavior” is not going to result in making a change—we all have personal stories to document that fact—but thinking if change might be appropriate is essentially the 2nd stage in Prochaska’s continuum; contemplation.

Not to make this a dissertation, suffice it to say, short college programs do not work if behavior change is the objective and the short program is the be all and end all of the campus program.  They can be useful, however, f employed as a part of a comprehensive plan designed to affect the campus culture. 

As an aside, how many of you have “contemplated a change” in your auto insurance after a 5+ year exposure to annoying TV ads :)

What do you think?

Dr. Robert

Can colleges and universities reduce incidences of high-risk, dangerous drinking by adding civility and social consciousness criteria to their admissions process?

Can colleges and universities reduce incidences of high-risk, dangerous drinking by adding civility and social consciousness criteria to their admissions process?  

Currently, most colleges and universities assume a defensive position regarding high-risk, dangerous drinking, and other drug use, often reacting to their untoward consequences after-the-fact.  Policies outline what is and is not permissible behavior, residence life and campus security concentrate on

enforcement of said policies, faculty tend to view substance use issues as other than their responsibility, and campus recruiters often proffer a “wink-wink, nudge-nudge” response to questions about partying, while some administrators theorize the solution to the "collegiate drinking problem" is to lower the drinking age.

Might a more proactive approach to the problem of how "some collegians drink," rather than seeing all collegiate drinking as THE problem, be to screen applicants at least as judiciously regarding their views on and activities related to civility and social consciousness as they screen for SAT scores, quintile standings, and other indicators of academic performance?

The past 20-years have enabled us to learn much about high-risk drinking and its associated behaviors, including which students are most likely to engage in behaviors resulting in untoward consequences.  Many of these untoward consequences translate into the quality-of-life issues that become the reason many students transfers from one institution of higher education (IHE) to another, not to mention being a mitigating factor in academic probation, academic dismissal, or behavioral dismissal from the IHE.  

With personal essays specifically crafted to solicit student views on social behaviors, expectations of collegiate life "outside the classroom," and specific instruction regarding letters of recommendation and their need to address issues of civility and social consciousness, can IHEs affect the frequency of high-risk and dangerous drinking and other drug use following matriculation by changing their recruiting and admissions practices?

What do you think?

Dr. Robert

The Likely Cause of Addiction Has Been Discovered, and It Is Not What You Think

http://www.huffingtonpost.com/johann-hari/the-real-cause-of-addicti_b_6506936.html

There is much to be said about the merits of Hari's argument outlined in the essay.  First—and foremost—the War on Drugs is, at best, an antiquated response to the drug problem and, at the worst, a monumental disconnect from the real problem of understanding SUD.  It is essentially based on the 18th-19th Century Moral Model of addiction that suggests that drugs are bad and therefore so are the people who use them.  Consequently, this view of addiction suggests that the way you deal with “bad people” is to punish them, and in our culture you punish “bad people” by incarcerating them.  As noted in the article, this not only does not deter use, it likely reinforces it. 

Next, we have long understood that boredom is highly correlated with both use and, for those pursuing recovery, relapse.  AA addresses this with its famous acronym, H.A.L.T.  When someone is “hungry,” “angry,” “lonely,” or “tired,” that individual is standing on the slippery slope of relapse.  It is tempting to infer that the Alexander “Rat studies” seem to indicate that the results of rats living in isolation vs. residing in “Rat Park” “explains” their penchant for consuming drugs and is somehow transferable to explaining human drug use, but we all know this is a spurious connection at best – correlation is not causation…and rat behavior, although informative, does not necessarily equate with human behavior.

I do believe, however, that the basic premise of this article—and I must confess that I have not read its author’s book nor those referenced in the article—that “drugs” do not cause addiction. I suspect that the etiology of addiction is more readily explained by social science than biological science.  It will not surprise me, for instance, to see our understanding of addiction move away from the current mainstream argument that addiction is a brain disease and that for those with this disease, that drugs "hijack the brain."  This does not mean that there is no physiological/genetic predisposition to addiction, as I suspect that there may well be, but I am becoming less convinced that addiction will ever be something that can be predicted via a simple blood test added to the mandated screen panel conducted on newborns labeling them at birth as “one of them."  I suggest this for many of the reasons Hari outlines in his article, namely that there are more likely socioeconomic and psychological variables that increase or decrease the one’s susceptibility to a SUD.

What the article does not seem to address is how do we explain the absence of addictive behavior in individuals who are exposed to the same isolated or socially dystopian environment yet do not turn to drugs?  Just as the argument that alcohol, tobacco, and marijuana are “gateway drugs” is questionable because it does not consider all users of these substances, including those who experimented with these substances, but do not go on to use these drugs let alone become addicted; we must be cautious about claiming that living in The Hunger Game’s “district 12-type” environment is the "cause" of addiction.

That said, it is not a new argument to suggest that the environment to which a recovering person returns affects the prognosis for sustained recovery.  We have known for decades that an unsupportive and/or drug using environment all but guarantees relapse.  What is interesting and worthy of further study, however, is the extent to which such environments affect the etiology of addiction.  What is it about/in those individuals who do not “turn to drugs” although exposed to the same environments that precludes their becoming SUD? (NOTE: I have raised a similar concern regarding high-risk collegiate drinking when suggesting that we can learn much to prevent such behavior by studying moderate drinkers and abstainers in order to understand why they make the choices they do when exposed to the same collegiate environment as the “binge-drinkers.” We spend way too much time and money studying the problem drinker rather than those who seem immune to it, but this is another discussion).

Frankly, I believe that there are multiple variables associated with “becoming addicted.”  These include the drugs themselves, but although drugs may be necessary for "drug addiction” to occur, they are not likely sufficient to explain its etiology.

Lastly, in this brief reaction to the article, a large area concerning addiction goes unaddressed and this suggests, at least for me, a potential “fly in the ointment” of Hari’s argument: what about the process addictions?  I suspect that individuals may seek refuge or relief from the boredom of a socioeconomically deprived existence, one with no access to job, education, adequate housing, etc., by turning to sex or gambling or other “addictive” behaviors, but this too requires more study :)

What do you think?

Robert

Cognitive-Behavioral Counseling and Effective Treatment

With any technique, there are a number of variables that affect the clinical outcome.  For example, a practitioner’s level of proficiency in employing a particular technique is a significant variable, as is

the individual’s basic prowess as a counselor.  Add to this the variables that can affect an individual’s ability to respond to counseling, for example, personal expectations of counseling, the propensity for optimism or pessimism, family/community support, etc., and you begin to see how the significance of a particular therapeutic approach can quickly  when considering “what works.”

Scott Miller, Mark Hubble, and Barry Duncan wrote an article entitled, No More Bells, and Whistles (to download a copy, visit http://bit.ly/1INZHhh) that reviews the sources of efficacious counseling.  They suggest that there are “4 common factors” that determine the outcome of counseling: (1) Therapeutic Technique (accounts for 15% of the outcome of counseling), (2) Expectancy and Placebo (15% of outcome) , (3) Therapeutic Relationship (30% of outcome), and (4) Client Factors (40%).  I will skip reviewing each of these 4 “factors,” but suffice it to say that in affecting but 15% of the outcome of counseling, debating the merits of a particular therapeutic approach while stimulating may be more of a footnote in the discussion than than issue of primacy.

It seems to me—and CBT-related techniques and cognitive theory (I always liked George Kelly’s Personal Construct Psychology) are frequently used tools in my counseling toolbox—that IF there were a theory of counseling that truly outperformed all the others, we would at least have a clear indication of its existence by now.  Rather we find practitioners employing various approaches claiming success in their work and the individuals they counseled reporting symptom relief.  This would seem to confirm, albeit unscientifically, what Miller et al. suggest in their article; that it is the therapeutic relationship itself and the individual factors the client brings to therapy that contribute the lion’s share of efficacious outcome in counseling.

There is no doubt that CBT has passed the rigors of scientific scrutiny regarding its efficacy.  What this suggests, to me however, is not so much that it should be used exclusively or even predominantly, but rather that it is deserving of consideration as an evidence-informed, best practice to which our students should be exposed.  So the issue for me is not that CBT is used “too much” or that it has taken on “rock star” status.  The issue is, does CBT—or any other counseling theory for that matter—enable me, as the practitioner, to understand my client’s presenting problem(s) in such as way that I can: (1) design an appropriate treatment strategy to affect symptom relief, (2) assist my client in understanding the nature of the presenting problem and its origin, and do so in such a way that ensures that the client recognizes that she or he has a problem rather than is the problem, and (3) can accomplish this in a reasonable amount of time with non-invasive and cost-effective strategies.

What do you think?

Robert