More on Willpower or, One’s ‘I Will’ is More Important than IQ.

A number of readers responded to my last post; some on the blog itself, others in a personal email. I suspect that we are fairly close in agreement, although the language we each use may differ. I agree there is a collection of behaviors labeled “willpower” in our culture. To this end, those who display these behaviors to some degree exist along a continuum of “dependence.” The point of my last post was to suggest the difference between one having mastered a set of behaviors, i.e., “skills,” and one having an inherent trait called “willpower.” Although both manifest themselves in the same way—the ability or inability to “resist temptation”—the impact of viewing willpower as a trait is that, like skin color, we humans tend to discriminate against individuals based on a socially constructed system of values.

If I view willpower as a skill or set of skills that I do not possess, then I understand my “inability to resist temptation” as a function of “knowledge” rather than a “character.” I may or may not be motivated to learn the requisite skills to change my behavior, but that is a choice I make and for which I am responsible. If, however, I view my inability to “resist temptation” as being indicative of a character defect, then I am left with no recourse but to continue on with no hope of changing behavior short of divine intervention. This is somewhat melodramatic, but change is an “inside job.” For one to first recognize and then attempt to do something about this, the individual first needs to engage in what I refer to as “possibility thinking.”

The old school view of willpower—even in AA, which suggests that willpower is not a solution for addiction—is that we individuals are capable of doing anything we put our minds to doing...the old “pull yourself up by the bootstraps” argument. Those who can do this, change, while those who cannot suffer. Interestingly, there is a cultural spin on this whole willpower thing too. The concept of willpower as a character trait is grounded in the Western belief in the primacy of individualism...a focus on “me” and “my” ability to do whatever I put “my” mind to doing, the “anyone can grow up to be president of the United States” argument. Interestingly, this cultural perspective is a relative minority as most of the world cultures relate to some extent to a collectivistic world view...the individual is NOT the building block of cultures and societies. Rather, one’s focus is on the family and community, with individual acts not so much asserting one’s inherent right to “be all that you can be” but rather, furthering the greater, common good. But I wax philosophical and this strays from the original point: willpower is a social construction and not an entity or character trait.

What I find interesting about AA—and one of its many endearing qualities—is that the steps suggest that I cannot manage change alone, but that any change made is nevertheless an inside job. This is another of the myriad paradoxes in 12-step programs/philosophy: To change, that is to say, “recover,” I must surrender to a power greater than myself, but in so doing, I find the ability to make personal changes that allow me to grow and develop. The willpower of 12-step philosophy is the power of commitment to change coupled with a realization that the change process necessitates the input and support of others, including a power greater than myself. Put another way, willpower in 12-step recovery—at least as I understand it—is better stated as “I will, power”—this is also why I believe that 12-step programs are so compatible with Cognitive-Behavioral Theory in that AA cautions against “stinkin’-thinkin’,” Beck exhorts challenging cognitive distortions, and Ellis admonished to refute irrational beliefs. These are all points along the same path to change.

Willpower only exists to the extent that one does not respond to temptation in a fashion deemed appropriate by the culture in which the individual exhibits his or her behavior. It is not like physical strength measured in “foot-pounds of torque” exerted or electrical units expended. Rather, recognition of willpower occurs after the fact and only then when an observer evaluates one’s behavior by comparing it to a predetermined, that is, social constructed hierarchy of “acceptable/unacceptable” behavior.

This is all “angels on the head of a pin” stuff except for the impact not having willpower has on one’s personal belief in an ability to change. My argument is that if I see this thing called willpower as being a set of skills, then if I do not have them, I can get them if I am willing to do what is necessary to develop said skills. On the other hand, if willpower is not a skill set, then I am fated to see myself as do others, personally “weak” and incapable affecting change.

Understanding Willpower: Urban Myth or Social Construct?

The amount of research associated with substance use disorders—a.k.a. “addiction,” “substance abuse,” “alcoholism,” etc.--is staggering; this is a good thing. Our understanding of this disorder seems to change almost monthly. From recognizing it as a biopsychosocial disorder to realizing that effective treatment necessitates a collaboration with the individual in treatment to affect change, it would seem that the 21st century will see prevention and treatment of this disorder advance at an even faster pace. Again, this is the good news...The less than good news, however, is that some remnants of the early days of the “addictions treatment industry” persistent; the advent of addiction being a function of an absence of willpower being a case in point.

“Willpower” is viewed as if its existence--or absence--is a discernable fact, something that can be measured and therefore quantified...he has no willpower, she has some willpower, etc. In other words, we act as though we can tell who “has it” and who does not simply by observing individual behavior. Those with willpower work hard in the face of adversity, overcome temptations, and remain faithful to goals and commitments while those without it are perceived as weak, unmotivated, untrustworthy, and unfortunately, lack the innate ability to see a task through to completion. But this supposed bedrock of Western character values neglects to recognize that “willpower” is not a “thing” but simply a word coined to describe a social construction we, as a culture, view as socially desirable and productive behavior. In short, one either has willpower or is devoid of it and depending on which side of that line in the dirt one stands, so is that individual’s worth as an individual determined by others.

If this were true, however, we should see this same absence of willpower when it comes to an individual following through with any behavior? For example, if I cannot seem to “stop smoking” because of my absence of willpower, I should also be incapable of remaining monogamous in my relationship with my spouse, correct? Yet there are countless example of individuals who have difficulty making certain changes in behavior attributed to a lack of willpower who are highly successful in making changes in other areas of their lives, often with relative ease...the former cigarette smoker who cannot seem to follow through with efforts to increase physical exercise or the individual who has successfully negotiated 12 challenging years of college and medical school to become a physician yet is unable to shed 15-pounds.

Willpower appears to be “situational” not because it is something tangible that one either has or does not, but rather it is a skill—or more correctly, a set of skills—that enable one to act in a particular way in a given situation. In those situations where this skill set is present...I have the requisite “willpower” to affect change; where the skills are absent, so is the “willpower." These life skills are learned, intentionally or coincidentally as I live my life, in the same way all life skills are acquired, the result of choices made and consequences realized.

All behavior is preceded by an antecedent, that is, something that comes immediately before the behavior is displayed...the “itch before the scratch.” Likewise, all behavior is followed by a consequence...the relief I feel after having scratched said itch. The consequence can be pleasant and therefore desirable or it can be unpleasant andtherefore undesirable...it must be one or the other.  is this “A – B – C” continuum that explains the acquisition of various skills, be they socially desirable or not. It is also attending to this continuum that enables one to understand behavior and, consequently, affect changes in that behavior—even changes in one’s own behavior—by understanding this simple equation and its impact on “why I do the things I do.”

This particular post does not present the time nor space to thoroughly explore this simple fact, so suffice it to say that I tend to repeat those behaviors that tend to result in a desirable consequence. An excellent book on the topic of self-directed change is, Self-Directed Behavior, 9th edition, by Watson & Tharp (Wadsworth Cengage Learning – see http://amzn.to/ajyv3L to read reviews at Amazon). The problem is that if I do not step back and look at the big picture, I may not recognize that the reinforcing consequence I am realizing are actually denying me the opportunity to perfect a skill that can change the behavior that I continue to repeat in spite of my wishes to the contrary. Allow me to explain with an example.

I want to lose 10 pounds. I know I have to eat less and exercise more to accomplish this objective. However, when I attempt to eat less I am overcome by the compulsion to eat. I tell myself that I cannot bear this discomfort, and dwell on how I will never be able to repeatedly resist this craving and tell myself this over and over until I give in and eat. When I eat, I feel better and even though I know that I caved and broke my vow, the consequence that followed my eating behavior is that I feel satiated. The “A” is the craving (or the stress or the depression or the “whatever”); the “B” is my eating, and the “C” is feeling satiated—or the passing of the craving, assuaging the stress/depression. Society looks at me and thinks, “Robert has no willpower” and it is a very short distance from that belief to being pitied or viewed as a weak an ineffectual person.

On the other hand, what if when I feel the urge to eat (or the stress, depression, “whatever”) that is the antecedent to my eating, and I was to engage in a different behavior? What if I “changed the ‘B’” and went for a walk or spoke with a friend or “did something else”? As I became distracted and the craving passed/depression/stress were assuaged, the consequence for this behavior would increase the likelihood that I would have learned a competing skill, one that would enable me to avoid eating, exercise more, and eventually drop the 10-pounds and keep it off.

So I end this post as I began...suggesting that there is no such thing as “willpower”; rather it is a social construction created to simply explain socially desirable behavior. The problem is that we have accepted that this social construction is a measurable personality trait. The problem with this is that if I buy into this belief personally and define myself as someone with little or no willpower, I unnecessarily stack the deck against myself when it comes to identifying the role I can play in making desired changes in my personal behavior. This is not to suggest that I can “do whatever I put my mind to alone” or that addicted individuals can “learn to use responsibly.” It does suggest, however, that diffiulty in making personal changes in behavior is less the function of personal weakness or a lack of so-called willpower than it has to do with an absence of a particular skill set necessary to make the desired change.

What do you think?
Dr. Robert

Inviting Students to Reduce at Risk Behaviors w/o Appearing to Lecture or Preach 

There is no shortage of information regarding the risks associated with underage or high-risk drinking. There are dozens of web sites that are dedicated to this very topic...all are good, that is, informative, and the majority if not all present to an adult audience. Students will likely not spend more than the few seconds it takes to discern the parental tone of a "prevention site" before leaving with the belief that al prevention is "bogus" and committed to just one thing...keeping students from having the good time that is their perceived right, the "rites of passage" if you will.

To present information to students does not have to involve the traditional "dad or mom talk" with its student-perceived "thou shall not" litany of directives designed to ensure that students trade personal safety for the hope of having a "good time."

Fortunately, motivating students to look at the "big picture" and trusting in their ability to learn from the experiences they and their peers have, is not beyond the ability of parents or educators. The challenge is to avoid the temptation to address a behavioral concern with intellectual interventions.

The historic approach to prevention argues that if students have enough information about the risks associated with underage and high-risk drinking, they will make good choices and avoid risk. Interestingly, most students already do this, but not because of a parental admonishment about drinking, but because they know the difference between the "good things" related to drinking and the "less good things." These students do not change their behavior because their intellectual understanding of the risks associated with use goes up, they change their behaviors when they realize that what they want from alcohol use has less to do with the use and more to do with realizing one's social and interpersonal objectives. When the use of alcohol is perceived as enhancing one's social status, it will continue. If, however, one's social status is sabotaged by one's antics when drinking, consumption is modified.

Simply stated, when the costs--social, familial, legal, health, economic--of drinking exceed the perceived benefits received, students change their drinking behavior. This is the objective of prevention, but historically millions of dollars and countless hours of professional and parental hours have been invested in trying to alert students to the risks and dangers associated with drinking in the mistaken belief that information alone results in behavior change.

Two of the more effective ways to engage anyone, but especially students in considering behavior change are humor and parody. Both engage students in considering the issues related to drinking--their issues, not a parent's or educator's--from a different perspective. No longer is the student asked to change his or her behavior, but rather is asked to consider if what he or she gets from current patterns of behavior are worth what must be invested to obtain them.

This shift from trying to make proverbial horse drink from the watering hole when it is not thirsty to salting the oats so the horse becomes thirsty and therefore wants to do so, is nothing short of revolutionary. Humor and parody can do this.

Here are some of my favorites vehicles by which to invite students to revisit their personal choices about drinking:

Use the 1987 Bill Cosby drinking clip from his "Himself" concert. In his, “What I really want to know about is drinking, getting drunk, and saying you are having a good time” piece - http://www.youtube.com/watch?v=qYsko_tc3a0, Cosby pokes fun at those who engage in high-risk drinking. He is taking about adults, which increases the likelihood that students will list, but the points he makes are universal in their indication of "all time dumb behavior" when drinking...by anyone.

I used this to start discussions with students about "getting drunk." After watching the clip—and even though it is dated by Cosby’s age and dress, its message and humor are timeless—I would ask students to come up with as many synonyms for “drunk” as they could. I would write these on the board and collect at least 12 to 15…e.g., wasted, bombed, hammered, smashed, trashed, etc. I always get “shit faced” and I would write it down, and the snickering would tell me that the audience was “thinking” “all f _ _ _ _ _ d-up” so I would acknowledge this and write it on the board. I then would ask, besides referring to being intoxicated, what else do these terms have in common? I would wait, perhaps 30-seconds before the silence would become a bit uncomfortable and someone would say something like, “they are all negative.” I would acknowledge this and then ask why do we refer to being intoxicated with terms that could just as easily be found on the front page of the daily newspaper…and bring a copy with me to illustrate.

I would end up the presentation by asking the audience to proffer ideas on how the language we use may affect the behaviors we display when drinking, especially to intoxication.

Some other video clips that may be useful – you will need to “set them up” with a lead in and then process them in a particular way in order set up their “drinking related” context:

· To demonstrate the illogical thinking/reasoning that student may use to justify continued high-risk if not stupid behaviors and ways of drinking - http://www.youtube.com/watch?v=Bfq5kju627c
· To demonstrate how people see what they are looking for and miss the obvious (this is a clip that can be used in many different presentation): http://www.youtube.com/watch?v=6yQexTsAhjY
· To demonstrate “point of view” or the need to attend to the “big picture”: http://www.youtube.com/watch?v=voAntzB7EwE
· To demonstrate how do we learn to drink in a high-risk fashon use this clip from Disney’s Beauty & the Beast. Everyone will have seen the film and few if any will have made the connedtion that men are being taught to womanize, be violent when drinking, guzzle beer, etc.: http://www.youtube.com/watch?v=fhG9hKiplfQ NOTE: Women are also being taught how to look, how to act around men, etc. There are MANY cultural messages…high-risk messages…inherent in this clip
· To demonstrate either (1) addiction of (2) co-dependency (or both): http://www.youtube.com/watch?v=T0m9iu6O3dg This is the 1st of 2 10-min video clips that are very powerful. A link to the second clip can be found on the site of the first.

Story telling has always been an effective way to deliver advice, raise concern about typical behavior, and motivate individuals to review their own behavior. In this age of digital media, this has become convenient...all it takes is a bit of creative thinking on our part to blend the myriad resources available online into a tapestry of drinking related introspection that students are willing to consume. Remember, it is easier to salt the oats than to beat the horse to motivate changes in its behavior.

What do you think?

Dr. Robert

Sending email to yourself in the future: A possible tool for counselors

When working as the clinical director of an inpatient treatment program for individuals with substance use disorders I would often suggest that before completing treatment, individuals compose a letter to themselves. In this letter I would suggest that thoughts on change (early recovery) be recorded: What challenges will I face in early recovery? What resources are at my disposal to meet those challenges? Where do I believe that I will be in my recovery in “X” amount of time? What did I learn in treatment? What possibilities await me in the future now that I have “put the train back on the tracks”?

There are literally countless “spins” that can be placed on this assignment, but the common denominator for most is the creation of a fixed point in time where one engages in “possibility thinking” and then casts that message into the future to be reviewed at a later date, not unlike placing a message in a bottle—as an aside, for an interesting true story about messages in bottles, recovery, and connections, visit http://www.robertchapman.net/essays/Anyport.pdf

Regardless of your reaction to my thoughts on letters to oneself, you may find this website, http://www.futureme.org to be of interest and use as you look to create innovative ways to blend your personal approach to counseling with 21st Century technology :)

What do you think?
Dr. Robert

Personal Breath Testing (PBT): A Pursuit for Higher Ed?
Because PBT devices are available on the market, is it advisable for colleges and universities to invest in such technology and provide it to students in order to monitor their consumption? Although not an option being considered by many schools, this is an approach to moderating high-risk and dangerous collegiate drinking on some campuses. Although not an expert on this topic, this post considers some of the issues if not potential risks associated with such a practice. For example:

1. If the decision is made to use some sort of PBT device, one will need to train students to use it...this will not be easy, not to mention time consuming and therefore expensive.
There a variety of personal breath testing devices available on the market and the cost will vary. As with all things in life, you get what you pay for. The more accurate and precise the device's measurement of blood alcohol level, the more costly per unit.

2. Once the decision has been made to use a “particular device,” training will need to be designed around that particular device and its limitations. For example, if the device is accurate to within “X% BAL,” then students will need to be educated to know this AND how to gage “their individual reading” and then abide by it.

3. With devices that simply indicate if the user has exceeded a particular BAL, say .05%, and do not record a “specific” BAL, will students pay attention to this? In other words, if my PBT device suggests that I am now at the .05% level, will I stop or even slow down or will I think, “okay, I am getting close to the legal limit, but I am not there yet; I can go on a bit longer.”

4. What about that particular type of student who sees this as an invitation to a new type of drinking game...who can make the PBT go off first or who can get the highest BAL before having to urinate, or whatever?

Personally, to motivate proactive decision making related to alcohol, I prefer activities that reward students for doing what is positive or protective rather than simply providing warnings or punishing them for doing something risky. For example, instead of PBTs for everyone — which I believe will be incredibly expensive when you factor in training — what about a breath testing station at each residence hall where student VOLUNTARILY can have their breath tested, have no judicial consequences irrespective of BAL (although a trip to the ER may be mandated if above “X” BAL) and anyone with a BAL under “Y” (.05%?) gets “Z,” a gift card for a free coffee/tea/hot chocolate at the campus coffee shop or gets a dining hall pass for a guest, etc.

Before anything is done, if a campus is leaning towards going with a "PBTs for everyone" decision, CONSULT YOUR ATTORNEY! I can see the law suit now if the school implements this program and John Jones or Mary Brown has a PBT and dies from an alcohol overdose. Yes, the campus can argue the PBT device was an attempt to reduce harm to help students who choose to drink, but a cleaver plaintiff’s attorney is going to argue, “Well, thank you very much, but you knew this was a high risk and all you did was provide a means to measure the risk, not address assertively or reduce it” or something like this.

As in counseling, there are two choices as to how to proceed...to move towards a desired outcome or away from a feared consequence. I suppose the PBT discussion could be framed as an example of either of these, but my personal thoughts regarding PBTs is more akin to an attempt to move away from a feared consequence.

To read more about PBT devises, visit http://bit.ly/bvmaKK or http://bit.ly/a8EmUj

What do you think?

Dr. Robert

Coping with Urges & Cravings

Black and white thinking is a mitigating factor that can often make urges and cravings seem "unbearable." The belief that "I cannot stand this" or "I am never going to be able change this" can, at times, be overwhelming. That said, remember the 12-step slogan, “Bring the body and the mind will follow.” What this means is that even if something does not “feel” like the small, immediate steps taken to affect change or deal with the cravings to use are producing results, "knowing" that they can and do for others in recovery, and repeating these small steps as often as is necessary to affect change, will eventually enable one’s “feelings” to catch up. “Knowing/understanding” the basic principle of cognitive therapy, namely, "you feel the way you think," allows one to appreciate the positive, proactive alternatives to the “cognitive distortions” or “irrational beliefs” (what AA calls stinkin' thinkin') that amplify the cravings to use. Knowing this enables one to continue to refute the negative automatic thoughts and (this is very important) engage in other more positive behaviors/activities, which slowly but surely begin to compete with the negative self-talk. As the negative self-talk that intensifies the cravings to use is assuaged, it becomes possible to "see past the cravings" and recognize that as difficult as this may seem at the moment, "this too shall pass" as another of AA's slogans exhorts.

It is like when you get a dumb song stuck in your head and cannot, seemingly, stop thinking about it. The more you tell yourself I should not be thinking this, the more entrenched the obdurate tune becomes. The way you “break the cycle” is to occupy the mind with other things...busy work, challenging intellectual conversation, etc. By diverting attention to the positive, the negative is eliminated. Even if the negative thought returns, then I engage in the antidote again—refocusing my attention on something else and/or simply doing something else—the negative thought is again “starved for attention” and dissipates. This does not happen “like that,” and it takes a commitment to follow through, hence the “between session practice activities” (a.k.a. Homework) counselors often prescribes for their client.

In short, trying not to think about something by telling yourself “I should not be thinking about this” or concentrating all my energy and attention on refuting the negative thought is to make the negative the issue of primacy...and it is reinforced. The way out of this cycle is to simply say, “I am not going to do this any more” and then do something else. This is why in 12-step programs they suggest the way to combat an obsession is to “don’t drink; go to a meeting; pray if you can.” Now this may seem like a rather narrow and somewhat overly simplistic as an answer to an otherwise overwhelming and frustrating problem, but it is based on a very simple but nonetheless effective premise: You cannot dwell on the negative when you are busy doing something else...even if you have to make yourself do that something else. Remember...the definition of a crisis is a period of instability and chaos sandwiched between two periods of relative stability and calm. The same is true for cravings...in the moment, it seems insurmountable, but by its definition a craving is temporary.

As silly as this exercise may seem, consider the following:

(Imagine me saying this and not writing it) - “Can you spell “Mississippi?”
Next, “Can you add: 23 + 48 + 74 + 96 + 13?”
The answer to both is yes
However, can you spell Mississippi WHILE YOU ADD—that is, at the same time as you add—23 + 48 + 74 + 96 + 13?

The answer is no, you cannot because the two separate tasks require two different mental processes that go on in 2 different areas of the brain. If “spelling Mississippi” is the equivalent of “negative automatic thoughts” or craving to use, then start “adding columns of 2-diget numbers” until the “negative automatic thought” ceases. This may not be “fun” and it may seem “silly” or “boring” or “hopeless,” but remember, “you do best what you do most.” The choice is the changer’s to make...will what I do be something that reinforces the negative or moves me in another direction? As Voltaire said in his book, Candide, “Argue for your limitations and you shall have then.”

What do you think?

Robert

Drug Overdoses and the Environments in Which They Occur: Is There a Relationship?

Shepherd Siegle at McMaster University in Canada has conducted interesting research into the phenomenon of “drug overdoses.” Although first reported more than 20 years ago, it is only now entering the mainstream of applied social science.

Siegle and his colleagues have postulated that as drug users--his research has centered on opiates--continually use in a familiar environment, the body's tendency to anticipate the drug and prepare to counter its effects are conditioned by that environment. As a result, when using a typical dose in an unfamiliar environment the individual overdoses. In essence he argues that people do not so much "overdose" as "under prepare" to handle their usual dose in a strange environment. In other words, Pavlovian or “Classical Conditioning” impacts the way an individual is affected by the heroin (other drugs, including alcohol?) consumed based upon the environment in which the drug was consumed.

This research has far reaching implications for many areas of substance use disorder prevention and treatment. Not only may Siegle's research hold some meaning as regards the recent rise of "overdoses" on prescription medication, it will be interesting to consider its implications regarding collegiate alcohol "overdose." As high school students used to drinking in a familiar environment attempt to transplant their drinking behaviors to an alien collegiate environment, this could help social scientists understand the phenomenon of collegiate alcohol poisoning.

To read more, visit:

General overview of the theory - http://www.druglibrary.org/schaffer/heroin/heroin2.htm or http://www.psywww.com/intropsych/ch05_conditioning/conditioning_and_drug_tolerance.html

A more detailed and referenced review of the theory - http://serendip.brynmawr.edu/bb/neuro/neuro03/web1/crichards.html

A 1986 paper by Siegle explaining the phenomenon - http://www1.appstate.edu/~kms/classes/psy5150/Documents/Siegel_CaseHistory.pdf

Another Siegle paper on the topic - http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1469825/pdf/envhper00327-0117.pdf

PowerPoint on Classical/Pavlovian Conditioning - http://dogsbody.psych.mun.ca/~bmckim/2800/Chapter3.ppt See slides 32 – 40 for an explanation of Siegle’s findings.

What Causes a Problem is a Problem Because it Causes a Problem

We are all familiar with the types of problems associated with AOD use, the type that make the headlines in the local paper or are related to the crime reported on News Radio. Although important, these are not typical of the issues we all face with unfortunate regularity.

Interestingly, most who choose to consume alcohol do so moderately and without problem. Beer, wine, and spirits are a regular part of many ethnic and cultural celebrations and observances and an integral part of many religious ceremonies, my own Christian faith being a ready example. As a matter of fact, in both the New and Old Testaments there are in excess of 300 references to alcohol...actually “wine” and “strong drink”...equally split between cautions against the use of such beverages—LEVITICUS 10:9 (King James): Do not drink wine nor strong drink, thou, nor thy sons with thee, when ye go into the tabernacle of the congregation, lest ye die: it shall be a statute for ever throughout your generations—and exhortations regarding its use—1 TIMOTHY 5:23 (King James): Drink no longer water, but use a little wine for thy stomach's sake and thine often infirmities. Alcohol is legal for those of age and a source of revenue in the form of taxes for local, state, and federal governments, and enjoyed by many.

So if alcohol is a drug and if it is used by many without problem, how do we recognize drinking as a problem before it becomes obvious to everyone? The answer is actually quite simple, but in its simplicity it escapes serious consideration by most who inadvertently step over the invisible line that separates “social” consumption from its more challenging counterpart, problem drinking. The simple “rule of thumb” is, What causes a problem is a problem, because it causes a problem. It is when my consumption is responsible, directly or indirectly, for a more obvious problem that I must consider the consumption of alcohol itself to be a problem as well. Allow me to illustrate with a couple metaphors.

Imagine you ordered the “Blue Plate Special” at the local diner and 30-minutes later you became ill. Would you ever eat at that diner again? Most of us would say yes as it was probably coincidence that we became ill after eating. Two weeks later you once again eat at the same dinner and become ill within an hour of eating...would you return? Chances are many of us would think twice before doing so. Yet how many of us might have “too much to drink” on a social occasion experience a hangover if not become ill only to dismiss this as part of the price paid for having a good time and drink in much the same way two-weeks later, experiencing similar consequences and think nothing of it, other than, "it is part of the price paid to have a good time?"

Those familiar with treating alcohol problems suggest that problems resulting from the consumption of alcohol, e.g., employment issues - attendance, job performance, productivity; health issues – hangover, vomiting, medical conditions caused by or exacerbated by drinking; family issues – arguments, verbal or physical violence, infidelity, inconsistent parenting; legal issues – DUI, assault, civil suits related to negligence, fraud; interpersonal relationships – estrangement from friends, arguments, embarrassment of self or significant others, suggest that the consumption itself is a problem if not the problem.

Here is a simple test to see if one’s drinking is becoming an issue in need of attention—and this does not necessarily mean alcoholism, but simply “something” I need to consider changing. It consists of two simple questions: (1) When was the last time I wondered if drinking milk was becoming a problem? Next: (2) When was the last time I wondered if alcohol, i.e., “my drinking,” was becoming a problem? Chances are most of us do not think twice about milk, at least beyond whether we care for it or not. I will bet at least one someone reading this has wondered about his or her drinking, however. The variation on these questions is, “When was the last time my (family, wife, girlfriend, son, etc.) wondered if my drinking was becoming a problem?"

There are other online and anonymous questionnaires that can shed light on the nature of one’s drinking and a couple are listed at the end, but suffice it to say that “what causes a problem is a problem when it causes problems." If you are not sure, find someone who understands alcohol related problems and discuss it.

Online Screening Resources:
http://www.alcoholscreening.org/Home.aspx
http://www.mentalhelp.net/poc/view_doc.php?type=doc&id=1860&cn=14

What to do if you want to change:
http://rethinkingdrinking.niaaa.nih.gov/ToolsResources/DrinkRefusalSkills.asp
http://helpguide.org/mental/alcohol_abuse_alcoholism_help_treatment_prevention.htm

What do you think?
Robert

Motivational Writing: Increasing the likelihood that your views will be considered

Sharing personal opinion is by no means a new endeavor. Since Eve suggested to Adam that the fruit of the tree of knowledge was sweeter and more desirable than all others in the garden, we humans have been trying to persuade each others to consider our opinions if not follow our lead. This has never been easier to do than today with text messaging, blogs, YouTube videos, not to mention old favorites like letters to the editor, radio talk shows, and "coffee at the corner diner." But preparing a formal written argument or position paper, however, is something a bit more demanding.

Included below are links to 3 web sites that attempt to do just this. The first 2 are focused more on business and preparing White Papers related to products or services one wishes to provide. Although the examples used are not particularly useful given your objective, the methods outlines for accomplishing the goal are. The last link is to a rather good outline—and from a web site I refer to regularly with regards to anything related to writing, The Owl at Purdue university.

My formula has always been to prepare such a (see http://www.robertchapman.net/essays/parent.htm for an example ) paper from a perspective similar to on used when working with resistant, unmotivated, or disinterested clients in counseling. Counselors can never tell such clients what they need to know as this will invariably result in their dismissing you as either insufficiently knowledgeable to proffer anything worth considering or they will see you as a zealot with a personal agenda. In either case you lose the audience almost as soon as you start from such a position. Like the old adage suggests, “You can lead a horse to water, but cannot make it drink.” An interesting counter perspective is, however, “but you can salt the oats.” When you do this the horse becomes thirsty and its thirst motivates it to do what you had intended from the start. In short, the trick is to prepare a document that “makes the horse thirsty” so it decides to do what you had originally intended. In your case, to see the role that addressing collegiate drinking can play in resolving a financial dilemma that is a more prominent blip on senior administration’s radar screen. So you spend less time talking about the public health reasons for addressing collegiate drinking and more time addressing the quality of life consequences of it that cause students to transfer or not come to the school in the first place because of the reputation that results from the misperception of the social norms.

Reread Richard Bach's Jonathan Livingston Seagull; pay particular to Fletcher Gull at the end of the story, after Jonathan transcends to the next level of spiritual being. Fletcher tries to tell all the young, ignorant, egocentric gulls what they need to know to transcend their current 2-dimensional, limited, restricted lives as he takes over Jonathan’s role as teacher. The “know-it-all,” spiritually blind, adolescent gulls start to rebel and dismiss Fletcher as some old fart who has nothing to teach because he is not with the times and therefore burned out. Fletcher then remembers Jonathan’s most important lesson about the path to spiritual enlightenment…start with level flight, or as AA suggest, Keep it simple.

My grandfather used to say, “Sometimes you have to give folks what they want in order to get the chance to given them what they need…he was among the wisest people I have ever met, and he never got beyond the 8th grade.

The key points to remember when preparing something like a White Paper is not unlike what an effective counselor considers when interacting with a client who may be at an earlier stage of readiness to change—collaborate with the client (your audience) and persuasively invite him/her/it to look at the facts from a different perspective in order to come to new conclusions regarding them. If successful, these new conclusions will require a new or different course of action. Think of Professor Harold Hill in The Music Man and how he sold River City on its need for a boys band. I do not propose manipulation and deceit as as hill's style as a flimflam man, but I do suggest presenting the facts as they exist in such a way as to suggest the point your paper tries to make regarding a possible solution to an existing problem is viewed in a positive light.

A mentor once suggested to me, never approach a anyone regarding a problem by just sounding an alarm or asking what will be done; approach with a solution to the problem and an argument for why your solution should receive serious consideration.

Here are the links:

1. http://www.stelzner.com/copy-HowTo-whitepapers.php
2. http://www.mwknowles.com/free_articles/white_paper/white_paper.html
3. http://owl.english.purdue.edu/owl/resource/546/1/

What do you think?
Robert

Spirituality and Addiction: An Experiential Project to Foster Student Understanding

The linked poem (http://bit.ly/9AzbTU) was created by the entirety of an undergraduate class taking a course entitled: Introduction to Addictive Disorders. Students in the course, about 20, come from a variety of majors across the curriculum at Drexel University. The first line of the poem was drafted by the instructor, without a significant amount of forethought I might add…it just “came to me.” The sheet on which this single line was written was then given to a student, any student; the first student that volunteered to accept the sheet when a volunteer was solicited. That student was instructed to write the next line, which for him or her seemed to be suggested by the one line visible on the sheet. The top line was then folded under so that only the student’s line could be read by the next student and then the sheet was passed on and the process was repeated, the next student writing another single line suggested by "the only visible line on the sheet."

As a result of this process, each line represents the thoughts of a single student who was responding to only the line immediately preceding it that represented the thoughts of that single student who wrote it. As an aside, this was going on as the day’s lecture and discussion was continuing. In other words, the class did not stop while this activity was conducted. NOTE: The theme of the class was the role of spirituality in understanding and treating addictive disorders and it was suggested that spirituality is more than religion and is something more like worldview. In short, it was suggested that although “spirituality” and “religion” overlap, there may be less in common between the two than there is between spirituality and a sense of connectedness…connection between oneself and the Earth, other beings, other people, to a Higher Power, etc. Although waxing metaphysical, the point of the class was to invite students to appreciate the importance of considering addiction as a spiritual disorder or disease as well as physical and mental…in other words, to help them make sense of the AA belief that alcoholism (addiction) is a threefold disease of body, mind, and spirit.

To fully appreciate the result of this project, be sure to return to the first sentence after the last one is read in order to sense the connectivity and cyclical nature this exercise represents.

Dr. Robert

More on Alcohol, Marijuana, and Collegiate Life: Can Colleges & Universities Craft More Equitable Policies Regarding Illicit Behavior?

I am heartened by the umber of readers who have chosen to comment on my last post. Although most seemed to be in agreement with the argument that the penalties for alcohol and marijuana violations on campus should be the same, several questioned if such could ever be because of the illegal nature of marijuana.

This post is not intended to be an argument to legalize marijuana...that is another discussion and one fraught with any number of provocative issues. Rather, it is intended to address a common concern I hear about the hands of higher ed being tied by the current laws governing marijuana and the need to retain current policies regarding use and possession of this controlled substance by students. It is a misnomer to suggest that simply because a substance is illegal that a college or university has no flexibility as regards its response to a student's decision to use or possess illicit substances, in this case, marijuana.

Colleges and universities routinely establish and enforce policies regarding alcohol use and possession for underage students that may well differ from state statutes. For example, it may be a summary violation or at worst, a misdemeanor, to possess or consume alcohol if under the age of 21. This said, a college or university may hold students accountable for their violation of the institution’s policies but not necessarily turn the student over to the local authorities for prosecution. The truth be told, most local police departments do not want to be bothered with underage alcohol violations referred by a college or university. If, for example, a Resident Assistant (RA) finds an underage student drinking in his or her residence hall room, that student is likely to have an IR (incident report) written that documents this act and its violation of institutional policy. This violation is then dealt with via the institution’s own internal judicial system. Unless there is some related criminal activity associate with the drinking, it is unlikely that the institution is going to report this student to the local police for arrest and prosecution. If, on the other hand, it is the local police that find the underage student drinking, the student may well be cited by the police and then this be routinely reported to the college or university where its judicial system will review the case and likely mete out additional consequences.

If the college or university has a “campus police” force as opposed to a “campus security” department, the campus police, as sworn police officers, must enforce the laws of the state in which the college or university is located. This will result in the student receiving both institutional as well as state consequences associated with the underage use or possession even if this occurs on campus only. Campus security, on the other hand, are not sworn police officers and simply monitor and enforce campus policies. These officers do not have the power to arrest and, consequently, will likely intervene in policy violations and document them for review and adjudication by the campus judicial system. This is what happens with alcohol violations...campus policies are enforced and these often mirror if not exceed the underage drinking statues in the state where the IHE is located, but again, such violations are often not reported to the local police.

This same approach can be implemented as regards student use or possession of marijuana. Should a student choose to possess or use marijuana and “get caught,” the institution could choose to deal with this internally...and often does. The problem is—-and this was the focus of my previous post—-is that this frequently results in the student being suspended from campus if not expelled. This strikes me as a missed opportunity to engage the student in a conversation around his or her use of marijuana. This conversation should focus on conducting a cost-benefit analysis of the use rather than lecture, preach, or moralize about what the student should be doing...or not doing as the case may be. In brief, help students look at their use objectively and address a simple question: is the benefit you perceive receiving from your use worth the costs associated with that use? This is what is being done regarding alcohol use, with underage as well as of age consumers...and it works. Students frequently will embrace an opportunity to engage in an objective review of personal use that is devoid of recriminations and recognize that the “good things” about use are related with consumption at the lower end of the range of “typical drinks consumed” while the “less good things” are associated with use at the upper end of their range of use.

Students are insightful, intelligent, and able to see the proverbial forest from the trees when presented with the opportunity to do so in an objective, non-confrontational and collaborative way. If this can be done regarding student use of alcohol, we should provided students with the opportunity to do the same thing as regards their decisions to use marijuana. For this to happen, however, colleges and universities need to amend their “drug use policies” so as to afford the opportunity to engage such students in this conversation rather than punish them for breaking the drug law with suspension or expulsion. NOTE: We are not talking about the student holding pounds of marijuana for distribution on campus, but relatively small quantities associated with personal use.

Not only does the lack of parity in the way alcohol and marijuana are addressed on campus make no sense, it is also way behind the curve as regards current thinking by the law enforcement community and the criminal justice system in general as regards marijuana use. In the last month the new District Attorney for the City of Philadelphia announced that the City will no longer prosecute individuals for possessing 30 grams (about an ounce) of marijuana or less (see http://www.philly.com/philly/news/homepage/89894257.html. This has been reduce to a summary violation and those found holding will forfeit the marijuana and pay a fine of about $300...that is it...no criminal record. This de facto decriminalization of relatively small amounts of marijuana simply presents another argument for why colleges and universities should rethink how they address marijuana use and possession on campus...move towards “acting on” this issue rather than “reacting to it.”

Please do not misinterpret this post...I am NOT advocating marijuana use or suggesting that it is better than drinking or admonishing colleges and universities for having policies regarding marijuana possession or use. Rather I am suggesting that the number one objective of these policies should be to engage students in a conversation about their use essentially fostering a consideration of the question, "is what you get worth what it costs you the get it?" For this to happen a first step is the pursuit of parity between alcohol and marijuana policies on campus.

What do you think?

Robert

Marijuana instead of Alcohol; advocating "responsible partying" rather than "responsible drinking": Interesting topics for higher ed's consideration

There is a provocative editorial in the Chronicle of Higher Education entitled, Waiting to Inhale (click title to read). As with any "provocative" editorial, it gives one pause to think...initially about the article itself and then about one's own views on the topics discussed. This is such an article.

I tend to agree with the editorial's cited argument that the penalties for the use or possession of marijuana should be no greater, or different, than those associated with the use or possession of alcohol. It does not, for instance, make sense to provide students who have violated an institution’s policies regarding alcohol with options for alcohol education if not an intervention grounded in an evidence-based approach like BASICS for changing personal behavior and then to suspend a student for a similar violation where the only difference is the substance. For example, it is quite possible that a student found with alcohol in his or her room, say a “relatively significant amount” like a “handle,” may have the alcohol confiscated, a fine levied, and be placed on deferred suspension from housing (if a residential student) and referred to an alcohol education program while the same student could be suspended from the institution for having a “relatively small quantity” of marijuana, e.g., say, a gram or less. Although marijuana is an illegal substance, so is alcohol for those under 21.

Regarding the argument to substitute marijuana for alcohol, there seems to be an informal logic to this argument when looking at the types of consequences that tend to follow from the excessive use of either of these substances—the cases of alcohol related violence are notorious while such does not appear to be the case with marijuana. The excessive use of either of these substances, however, strikes me as being equally deleterious when considering the scope of consequences associated with each drug and therefore renders this argument something of a non sequitur. True, the student who smokes to excess may be less of a threat to other students on campus as a rapist or physical aggressor—the operative word here being “less” assuming that student is not engaging in overtly violent acts like fighting or sexual assault. That said, if driving a car, operating machinery, or attempting to negotiate an escape from a burning building, etc. I suspect it is all but irrelevant regarding which substance is responsible for the student’s inebriety and the resulting risk to self and others. Suffice it to say that impaired is impaired.

The question about pursuing “responsible partying” rather than “responsible drinking” is, in my opinion, perhaps the most compelling argument outlined in the piece. “Responsible partying” implies so much more than just “responsible drinking.” First, it means that I may or may not have anything to drink yet still be charged with “partying responsibly.” This could mean that I assume certain responsibilities while at the party...to speak up if I witness a social injustice, to interrupt a racial joke being told, attempt to deter others from engaging in self-demeaning or embarrassing acts, or attempt to initiate protective factors that may result in harm reduction for any and all at the party. I must agree that I support this argument and suspect that this is, indeed, a worthy pursuit and that groups such as the Amethyst Initiative be advised to add this to its mantra if not adopt it as its new objective.

This is a provocative article, one that invites the reader to rethink his or her position on a number of alcohol-related issues as they impact higher education. I am a big fan of dialogue. I believe that if anything, as a nation we have tended to move away from meaningful discussion and debate in the pursuit of partisan “drum banging,” the purpose of which appears to be more focused on deterring such open dialogue. Frankly, any discussion that generates more light than heat is a productive discussion.

Regarding the reference to the "Amethyst Initiative" and its admonishment to lower the drinking age, I suspect there is as much evidence to support its increase to 25 as there is to support its lowering to 18...let’s face it, auto rental companies have not permitted anyone under the age of 25 to rent a car for years...what do they know that we do not? In addition, how come there is not a “Hermes Initiative” to roll back this age discrimination? NOTE: If Amethyst is the Greek sober stone named after the maiden of Greek myth who was turned to a pillar of quartz by Artemis to protect her from the wrath of Dionysus who unleashed his tigers in rage to punish her for violating his garden on her way to worship at Hermes's temple only to feel pity for her and pour his “tears of wine” on the quartz staining it “amethyst,” then the "Hermes Initiative," Hermes being the Greek god of roads and travel, might be the appropriate name sake for a contemporary group looking to change the age when one can rent a car.

To return to seriousness, however: (1) a discussion about the penalties for marijuana possession and use in higher ed as compared to those related to alcohol does make sense; (2) the argument to substitute "weed" for "booze" by college students seems a bit of a stretch to me; (3) pursuing “responsible partying” does strike me as a more noble and altruistic objective than “responsible drinking,” which is, by the way, the tag line for any number of brewers and distillers—not to mention, “drink responsibly” implies the command that all college students should drink.

What do you think?
Robert

Legends, Urban Myths, and Collegiate Drinking
Legends, actual and urban, are fascinating. They capture both the interest and the admiration of those who hear them and then the listener feels compelled to pass them along. For instance, Ernest Hemingway purportedly wrote the world’s shortest story on a bet while lunching with friends at the Algonquin Hotel’s famed “round table.” Hemingway bet his lunch mates that he could write a complete short story, including a distinct beginning, middle, and end, in just 6-words. No one present agreed and so accepted the bet. Hemingway took out a pen and on a table napkin wrote, “For sale. Baby shoes. Never worn”; he won the bet.

Although frequently cited and repeated online ad nauseam—Hemingway and baby shoes yields 17,500 Google hits—there is no actual evidence that this event ever took place…or if it did, that Hemingway was the original author of the baby shoes story. A variation on this theme is Garrison Keeler’s 1997 quip in which he includes all five elements of humor—religion, money, family relationships, sex, and mystery—in one cogent sentence: “God,” said the banker’s daughter, “I’m pregnant! I wonder who it was?”

As mildly entertaining as this introduction may be, what does it have to do with collegiate drinking? The connection lies in the almost irresistible obsession we humans have to repeat a provocative or “sexy” sound bite and elevate it to the status of legend. This has happened with the term “binge drinking” as it relates to college and university students. Coined in December of 1994 in an article published in the Journal of the American Medical Association, “Health and Behavioral Consequences of Binge Drinking in College: A National Survey of Students at 140 Campuses,” this term referred to “…five or more drinks in a row for men and four or more for women at least once during the 2 weeks preceding the survey” (see http://www.hsph.harvard.edu/cas/Documents/54/).

This post does not question the “risk of harm” or “dangerous nature” of consuming 4+/5+ drinks “in a row,” but it does raise question regarding the utility of calling such consumption a binge (see details of this concern in my essay on this at http://www.robertchapman.net/essays/about.htm). The point of this blog post is to cite the transition of this term from a “sexy sound bite” that captured the attention of the media in the mid 1990s, became the rally cry of parents and student affairs professionals to “do something” regarding collegiate drinking through the mid 2000s and is now firmly ensconced in the lexicon of all who refer to the use of alcohol by anyone, irrespective of age, academic status, or problems associate with alcohol use, when consuming 4+/5+ drinks in a row (1).

Where a “binge” was once a quasi-clinical term that referred to drinking similar to Ray Milland’s in the 1945 classic film, The Lost Weekend, Jack Lemmon’s and Lee Remick’s drinking in the 1962 classic, Days of Wine and Roses, or the more recent Nicholas Cage portrayal of an alcohol dependent drinker in the 1995 Leaving Las Vegas, it is now used to reference any drinker’s consumption of 4+ drinks if a woman or 5+ if a man…and we wonder why college students consider the warnings of adults regarding their behavior to be spurious.
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(1) The NIAAA redefined a “binge” about 5 years ago (see http://pubs.niaaa.nih.gov/publications/arh283/111-120.htm) to inclued a peak blood alcohol level of .08 when consuming in a 2-hour period. Although an improvement, this still does not address a number of the issues raised in my essay on this cited above.

Collegiate Drinking and GPA - A Negative Correlation, But Not a Slam Dunk

The negative correlation between “number of drinks consumed per week” and “grade point average” is well know, but somewhat deceiving. Although it is clear that this correlation exists, we cannot infer that drinking more will result in lower grades—or the inverse, that drinking less will increase grades. Although both outcomes are possible—even likely—we have to be careful when looking at academic probation as being a potential access point to engage high risk drinkers.

This is not to suggest that such screening not be done—personally, if we could afford it, I would recommend screening all students if not providing them with the chance to complete BASICS (brief alcohol screening and intervention for college students). What I do suggest, however, is that this screening not result in an automatic assumption that drinking is: (1) the reason for the academic difficulties if the student indicates use or (2) that reducing drinking for high-risk and dangerous drinkers is all that needs be done to enhance academic performance.

Just as faculty and administrators who neglect to consider alcohol or other drug use as a mitigating factor in academic or other collegiate life problems may seem naïve if not truculent if they refuse to do so, those of us who know collegiate drinking is a major public health problem for contemporary collegians need to be careful that we are not so myopic as to view reducing it as the panacea for all contemporary student problems. As with so many things in life, reality exists somewhere between the extremes.

Knowing as we do, however, that the negative correlation between collegiate drinking and grade point averages is a strong as it is suggests that remedial efforts to address such risk factors are warranted. Just as we know that certain collegiate sub-populations are at higher risk—first-year students, athletes, Greek-letter associations—so do we now know that there are other high-risk populations on campus, e.g., those in academic distress. And just as we know that all first-year students, athletes, and Greeks are not high-risk and dangerous drinkers, so do we need to be mindful that neither are all students in academic distress.

That said, any S-BIRT (Screening-Brief Intervention, Referral to Treatment) that can be done with any higher risk population, e.g., academic probation, is warranted.

Robert

What About the 21-Year-Old Drinking Age?

Taking a formal position on whether the current minimum drinking age should be changed is one that at first glance seems easy to defend. To make such a decision, however, and do so based on fact rather than emotion--something we Americans are not prone to do, by the way...we want what we want and we want it right now...is clearly an act that should result from a formal vetting process; there are pros and cons on both sides of the issue that need to be discussed and then considered.

That said, I believe that having a frank and thoughtful discussion on the subject is a good thing. This can be argued in light of the fact that no one under the age of 25 was alive the last time this topic was aired publicly and completely. As a result, many under the age of 21 now see the 21-year-old drinking law as “arbitrary and capricious” and resulting from the efforts of old timers who are looking to cramp the style of contemporary young people.

There are many groups qualified to weigh in on the debate, although I am not prepared at this time to do so on the “pro change side” or the “maintain 21 side” of the debate. Think about what has changed as regards what we know about alcohol and those who consume it today as opposed to the last time it was publically debated in 1984. Although it is true that the then Reagan administration held highway safety dollars hostage until individual states signed on to the 21-minimum drinking age law, the issue was publicly debated and the latest science on both sides was on the radar screen of the popular media. Whether the age remains the same, is lowered or—and this is not proffered facetiously—raised to 25 (hey...car rental companies have discriminated against under 25 drivers for years) based on the new brain research, I, for one, think that INCASE can champion this discussion.

So much has been learned about alcohol, its affects on the body, how it affects the behavior of those who consume it, risk facts for alcohol use disorders, not to mention the development of the human brain. Suffice it to say that at the end of the day, increased access to more (rather than less) evidenced based information vetted via the scientific method regarding this topic is a good thing.

What do you think?
Robert

Can we train students to be empathetic?
Although it is true that there are certain skills associated with being empathetic and I can teach students to display (feign?) these, but is this conveying empathy? Is the “genuineness” we seek something that can be instilled or rather are we relegated to simply cultivate that which is present when a student arrives for training? I tend to lean towards the latter. As I question my ability to teach empathy, I have resigned myself to teach about it and include experiential exercises and assignments that tend to hone existing skills in an effort to expose the “empathy” within, like the gemologist cleaves the raw crystal to reveal the gemstone within.
Here are 2 sample exercises I use to accomplish this:

1. Attend open 12-step meetings…and not just one, but a minimum of 2 and preferably a number. By hearing recovering people share their stories…their experience, strength, and hope…students are able to understand addiction and recovery and see the “person who may have the diagnosis” as opposed to just the diagnosis that needs to be addressed when working with a person. A byproduct of this exercise is the opportunity to talk about “listening with the heart” rather than just “hearing with the ears.” And what is empathy if not understanding those with whom we work on a more affective level?

2. Change a personal behavior…in this exercise, students are instructed to “add, eliminate, and significantly change” a personal behavior and do start this within the first week of class and report on the experience at the end of the course. Students are told they can, “add 20-minutes of exercise 3X/wk, eliminate eating chocolate chip cookies, or shower in the evening rather than the morning”…in short “anything” is acceptable as a personal behavior change. The must keep a journal, they must report in the journal regularly, and they must write a detailed personal account of their experience that chronicles the entire experience.

a. This is often done in concert with classes/readings related to stages of readiness to change

b. Students almost always discover early on that what they thought was going to be an “easy ‘A’ grade” is at least a challenge if not a “pain in the a__,” but this then becomes a wonderful opportunity to discuss how change is almost never accomplished by changing only one thing…to add 20-minutes of exercise 3X/wk, e.g., I have to “dress to exercise,” go to the gym, shower after, schedule my day to “find the time, etc. NOTE: As students become more familiar with the stages of readiness to change, they often realize they are at an “action stage” of readiness regarding one aspect of the change challenge but at a contemplative if not pre-contemplative stage at other associated changes…this can do wonders as regards understanding, nay, empathizing with how difficult change can be for a person in counseling

c. Students learn to appreciate how difficult change can be to make, and if this challenging when they want to make the change in something “as simple/easy” as exercising or not eating chocolate chips cookies for example, then how challenging it must be to quit drinking/drugging/smoking, etc. And if I can better understand how difficult change is “first hand,” am I not better able to empathize with the “struggling changer in counseling” who says he/she wants to change but is sputtering and hesitating in working on identified changes in the treatment plan?

What do you think?
Robert

Adolescent Risk Taking: They May Be More Rational Than We First Thought

A truism in the field of alcohol, other drug, and violence prevention, at least historically, has been that adolescent risk taking is the result of impulsive choices driven by an under developed capacity to think rationally. This belief has driven the work of AODV prevention professionals for years...up to and including the present. But recent research coming out of Temple and Cornell Universities is suggesting that this staple of conceptualizing prevention programming for high school and college adolescents may need to be revisited...if not rethought.

" Decision research shows that adolescents make the risky judgments they do because they are actually, in some ways, more rational than adults. Grownups tend to quickly and intuitively grasp that certain risks (e.g., drunk driving, unprotected sex, and most anything involving sharks) are just too great to be worth thinking about, so they don't proceed down the "slippery slope" of actually calculating the odds. Adolescents, on the other hand, actually take the time to weigh risks and benefits — possibly deciding that the latter outweigh the former. (It is during adolescence, in fact, that the parts of the frontal lobe that govern risk/reward calculations undergo significant maturation.)" This is a quote from a piece published in the Association of Psychological Science's Observer - see http://bit.ly/aJBUr3 for the full piece.

This is a very intriguing piece of information. If this is true--and the science appears to exist to suggest that it is--this may mean that we involved in the prevention of "high-risk" drinking and other drug use by high school and college students may need to rethink our approach to prevention, not to mention the term used to refer to the type of drinking these students do. Most of us involved in the prevention of "high-risk" collegiate drinking are aware of the controversy that has existed in the field regarding how to refer to collegiate drinking since the Harvard School of Public Health coined the term "binge drinking" in 1994 to refer to the consumption of 4+ drinks for women and 5+ drinks for men during an outing. The field has been divided as to the utility of this term when discussing the phenomenon of collegiate drinking ever since - see my essay on the subject -- http://bit.ly/aT3UgS

In that 2003 essay I suggested referring to this type of collegiate drinking as being "high-risk," but it would appear that this too may be no better a moniker for this type of collegiate imbibing than is "binge drinking." If, as I suspect, Drs. Reyna at Cornell and Farley at Temple are correct, we in the prevention field need to not only rethink how we approach adolescents with our prevention messages, but revisit the language we use when doing so as well. If there is a "Type-T" personality (Thrill-seeking) as these researches proffer, this type of student may actually be titillated by our messages designed to reduce "high-risk" consumption. Perhaps Linda Lederman's suggestion to refer to this type of collegiate drinking as dangerous is the more appropriate way to proceed.

What do you think?

Robert

Your Cerebral Cortex Can't Overcome Your Nucleus Accumbens...

...or so a physician friend tells me. The point he was making is that we--practitioners treating addictive disorders or individuals experiencing them--cannot change addictive behavior with information and knowledge alone. True, information can be useful in motivating an individual to move from a pre-contemplative stage of readiness to change to a contemplative stage, but this is movement as regards "readiness to change" and does not directly translate into change per se.

It is true that one will never move from a point of seeing alcohol or other drug use as a solution to a life problem until and unless able to recognize his or her substance use as a problem--the cost of continuing is greater than the cost of changing. It is likewise true that the first step in this metamorphosis is beginning to question the substance use as a "solution" to one's life problems. This happens as individuals step back and can see the bigger picture, thereby beginning to recognize that, "what cause a problem is a problem because it causes a problem."

The cerebral cortex is that part of the brain responsible for much of the higher functioning that separates us humans from other creatures in the animal kingdom. It is our ability to think and reason, to problem solve and to learn as the result of our experience that builds the bridge from the past through the present to the future where change can take place. This earns us our cherished position at the top of the evolutionary ladder. But the physiological and neurochemical rewards that are associated with substance use, rewards that can be connected to a much more primitive but nonetheless necessary function of the human brain, that helps explain addiction.

Once addicted, there is a demonstrable process by which the use of substances results in the activation of a "pleasure pathway" of sorts, and the nucleus accumbens is an integral part of that pathway. Once activated, mere information and knowledge about addiction, substance use disorders and/or consequences associated with the continued use of my drugs of choice are not going to supersede the physiological rewards associated with continued substance use.

To be succinct, logic and reason are no match for the physiology of addiction or, to reiterate my friend's quip, "your cerebral cortex can't overcome your nucleus accumbens." That said, the prevention of substance use disorders requires a concerted effort that addresses a number of factors. As individuals with addictions are able to move along the continuum of readiness to change from a pre-contemplative stage of readiness where the substance use is actually perceived to be a solution to life's problems to the next stage on the continuum, "contemplation," where change is not yet a perceived option, but the use is no longer viewed as a solution. It is this ambivalence that is actually welcomed by those practicing motivational interviewing rather than viewed with disdain and attacked as indicative of denial.

This movement along the continuum of readiness to change comes as practitioners resist the temptation to confront the user, which historically has been predicated upon the belief that a refusal to change behavior, even when willing to change perspective, is tantamount to denial. The traditional approach to counseling addicted individuals, even in a contemplative stage of readiness to change, has been to confront the user directly in an attempt to "break through" the denial and, as William Miller, the father of Motivational Interviewing has written, "wrestle" the addicted individual into submission. This is tantamount to the bully on the playground that engages his adversary and does not stop until the victim cry, "uncle!"

Miller goes on to suggest that counselors therefore have two choices when engaging an addicted individual: (1) to wrestle with that client in an adversarial relationship where counseling’s success necessitates client failure, or (2) to dance with the client. Notice the difference in these two metaphors; both clearly cast the counselor in the lead position, but as any ballroom dancer will tell you, the pair collaborate in a symbiotic relationship built on mutual respect for the other and his or her role in accomplishing the end goal..

To return to my opening admonishment; knowledge may appeal to the cerebral cortex, but it does not hold sway over the nucleus accumbens. Yet historically, prevention programs have been heavily if not exclusively steeped in delivering information in the misguided belief that rational beings will make good choices, avoiding high-risk and dangerous behaviors, if only they are given the information and knowledge on which to base those decisions. And as if this placement of all the prevention eggs in the knowledge enhancement basket were not enough, the information presented has tended to be at the same time negative--"this is your brain...this is your brain on drugs..." and steeped in scare tactics, as if the combination of knowledge and fear would be sufficient to void the activation of the pleasure pathway in the brain.

So the next time you are tempted to intervene in the high-risk behavior of a client, acquaintance, or loved one with a lecture or information about the risks and consequences associated with substance use, remember, "Your cerebral cortex can't overcome your nucleus accumbens."

What do you think?

Robert

Motivating Physicians to View Treating Addictions Differently

I suspect that an important part of having an impact on an audience composed of medical students and physicians is being able to invite them to see beyond any individual case of effective treatment, e.g., "the case of Brad," and focus on a more generic patient with an addictive disorder. They will all know of or at least heard of patients who “quit.” For them to become motivated to consider doing something different, however, they are going to have to see beyond "Brad" and recognize that “these patients,” that is, "addicted patients," can change and the way they change is by my doing “more of this” and “less of that.” This is the challenge I believe we face when inviting physicians to rethink the treatment of patients with addictive disorders. I suspect physicians may be more motivated to consider changes in their treatment strategies if seeing the “The case of Brad” as the result of an effective process to which "Brad" responded rather than something idiosyncratic about him as an individual that resulted in, for lack of a better term, a spontaneous remission.

When presented with the opportunity to speak with physicians or medical students, my goal is to impress upon at least some in the audience that: (1) change is an inside job, i.e., “physicians do not change patients (at least those with addictive disorders), but patients change patients,” and (2) the physician’s job with addicted patients is almost counter intuitive when considering what physicians generally do when treating “real” diseases. Historically, physicians conduct a differential diagnosis, prescribe a course of medical treatment, administer that treatment, follow-up on that treatment, and then discharge the patient...end of story. At best, the patient is a passive participant in the change process. With addictive disorders, however, nothing changes until and unless the patient makes that internal decision—choice, if you will, to change...the “inside job” mentioned earlier. Basic factors in the “keys to success” when treating an addictive disorder are: (1) recognizing that the addicted individual has progressed from a pre-contemplative stage of readiness to change to an action stage and eventually on to a maintenance stage, and (2) this happened because the individual realized he or she wanted to change rather than felt obligated or manipulated or forced to do so...again, the “inside job.”

I do not believe that the way to motivate physicians to think about treating addiction differently is to charm them into doing medicine with addicts differently—they will have 100 examples of how treatment does not work and even more reasons why this is so. Rather, it is to present them with a way to lessen their personal frustration when working with addicted patients. Put another way, we cannot push them into treating addicted patients differently, but we might be able to lure them into reducing their personal frustration when interacting with such a patient. It is sort of like Tom Sawyer getting his buddy to paint Aunt Polly’s fence...he entices the buddy to want to have the experience rather than talk him into doing his work for him.

As Sandra Anise Barnes has suggested in her poetry, "It is so hard when I have to (change), and so easy when I want to."

What do you think?

Robert

Keeping it Green:
Maintaining a Positive Focus as a Professional Counselor

The issue—or some might say problem—of managing frustration and avoiding cynicism as a counseling professional is one that may be more pervasive than many in higher education imagine. Addressing the issues of high-risk student behaviors like underage and dangerous drinking, indiscriminate use of illicit substances, or unprotected sexual activity to mention but a few of the more frequently cited examples from the media, is enough to dampen the spirits of even the most stalwart counseling professional. Not only can media-reported national stats about percentages of high-risk drinkers and untoward incidents related to alcohol or other drug use on campus prove to be frustrating for counseling professionals, the potential threat to their optimism in and efficacy regarding the COUNSELING profession would appear to be an all too likely consequence of a steady diet of bad news from the media and personal stories of heartache resulting from high-risk student behavior on their individual campuses. At times it may seem that practitioners are like the knot in the middle of a rope in a huge tug-of-war with individual clients refusing to change their individual behaviors on one end and national trends regarding high-risk or "dangerous" drinking on the other. Yet not only do we not see COUNSELING professionals leaving the field in droves, unlike many religious orders, the number of vocations that attract young professionals to a calling to work in counseling in higher education are encouraging.

It would seem that regardless if individual counseling professionals weather the problems on their individual campuses or know something the media seems to be oblivious to that allows them to keep their collective heads above water, it would appear that as much—if not more—of the frustration and cynicism experienced by some counseling practitioners results from their personal perceptions on the issues that arise when working in this field. In other words, dealing with high-risk students and their behaviors may be an occupational hazard associated with being a counseling professional, but that does not mean that each professional in the field will experience the chronic frustration and institutional cynicism. As with so many things in life, one tends to find what is expected. The practitioner that expects to see new prevention strategies fail or individual students refuse to change, regardless of the evidence presented to them supporting such, will likely find evidence to support this belief.

If this sounds vaguely familiar, I suggest you dust off your old notebooks from undergraduate social psych and review "confirmation bias" and "illusory correlation." Because one thinks something is true, the relatively few cases experienced that support the belief held are touted as proof that the hypothesis IS true. The classic example of this in addiction counseling is the belief that effective addictions counseling necessitates breaking through a client's denial with directive confrontation (some call this "attack therapy") in order to enable clients to improve. True, some clients exposed to such counseling techniques respond and get sober, this being the illusion of support for the practice that has become the mainstay of the addictions treatment industry for 30 years. Unfortunately, most clients introduced to treatment via attack therapy drop out prematurely. Ironically, these clients are deemed "not ready" to get sober so the client is blamed for the failure to improve when it is more than likely that an inappropriate treatment choice was made by the counselor. This is also roughly similar to what we have seen over that past several years in the published research from the Harvard School of Public Health. This research reports on the steady if not increasing rates of "binge drinking" and then assigns "blame" to social norms and other proactive strategies as being ineffective and unsubstantiated. NOTE: Unsubstantiated does not mean "ineffective," it simply means the technique has yet to be substantiated, but this is another essay :)

So how does the counseling practitioner keep from burning out or becoming so cynical about addressing high-risk student behavior as to consider a career change to welding? There are numerous ways to accomplish this and here is a representative sample:

1. Like the bumper sticker on a liberal's hybrid gas-electric powered auto might suggest, "Think globally, but act locally." Counseling professionals know what they are doing on their individual campuses. They all know the prevention programs, therapy groups, policy reforms, and environmental changes they have been able to affect. We still confer virtually and in person regarding the field, including the "bad news" nationally, but we do so knowing that we make a difference. Just as people do not change by dwelling on mistakes and missed opportunities or by obsessing on the final goal, counseling professionals realize that change is a process rather than an event; they know that on their best days they can help others, but we cannot save them.

2. Many in the Counseling field have come to realize many think and believe as they do. This realization results in most of these professionals seeking out these "others" and conversing with them. The best antidote for the "six o'clock news syndrome" is to speak with others about what is really going on. Just like we all know that not" all 16 to 25 year old members of a particular racial group" are doing what the six o'clock news constantly suggests is the norm, so SA aware of the myriad opportunities to receive various points of view. To paraphrase Woody Guthrie, "Let them that have eyes see and them that have ears hear!" With online news services like JoinTogether.com, newsletters like NASPA’s AOD Knowledge Community and The Network's News From the Front; conventions, workshops, and seminars like the U.S. Department of Education’s National Meeting the field has access to "what's what." This is a powerful antidote to the media's constant barrage of, "We’ve got trouble, right here in River City, and that starts with "T" and that rhymes with "B" and that stands for BOOZE."

3. We are also becoming more sophisticated as a field. Many (most?) have become familiar with Prochaska's Transtheoretical model of counseling with its view of readiness to change occurring on a continuum (see http://robertchapman.net/treatingaddictions.htm for additional information). The appropriateness of meeting someone on this change continuum where he or she is and working to motivate movement to the next stage of readiness rather than instantly trying to move that person to the last stage is very empowering and a powerful inoculation against burnout. To read more, see my essay "IF It Walks Like a Duck and Looks Like a Duck, Why Should I Be Surprised When it Quacks?" - http://www.robertchapman.net/essays/essay.htm click on "Preventing burnout when working with substance abusers."

Counseling professionals are a resilient bunch. We know how important our work is. We know that academic success cannot occur until and unless addressing the issues of students outside the classroom. This does not mean that every student that enrolls in college or university will receive a degree after completing the requisite number of courses. Likewise, anticipating and addressing every high-risk student behavior before it results in a tragedy is unrealistic. That said, it does mean that counseling professionals need to be cognizant of where they seek information lest they inadvertently place themselves on an informational junk food diet. Just as too much fast food can result in hardening of the arteries, too much fast information can result in hardening of the attitudes, a condition just as prone to shortening careers.

Robert

Intervening with Individuals with Addictions Always Works...100% of the Time

I believe that every intervention with addicted individuals always works, 100% of the time…never fails. I cannot prove this, I just know it.

I learned this in the 1970s when I would call at the Olean (NY) City Jail each morning and interview anyone intoxicated when arrested the night before. The entire interview might last 5-minutes, which was just enough time to introduce myself and convey the message, “You do not have to feel this way anymore…there is something you can do.” I would like to say that most interviewees had a “Paul on the road to Damascus” epiphany and immediately asked for help; that was the rare exception rather than the rule. There was, however, one gentleman who showed up in my office the better part of a year later, with a crumpled up copy of my business card in his hand, asking if I remembered speaking with him in the jail many months before. Of course I did not, but this was one of those occasions when God lets us tell a lie and still leaves open the gate to Heaven…"yes," I respond, “I remember.” He proceeded to share about what those in AA refer to as having become, “sick and tired of being sick and tired”; he went into treatment.

It was at this point that I realized that any and every effort made to proffer assistance works because although it may take 50 crises, interventions, and “trips to the bottom,” there could not be the 50th event that resulted in change had there not been the 25th…the 10th…the first! We never know…and whether we mount intervention #1 and never see the person again or intervention #50 and shepherd the individual to recovery, there could be no "final intervention" if there was no "initial intervention."

A related experience involved a student I saw when working in a university counseling center. I had conducted an assessment, shared my concerns — rather bluntly I might add — and proffered assistance. The student politely declined and left. A number of years went by before this student returned…quite a number of years. He asked to see me and told me that he left my office that day and went back out and “did his thing” until he hit that final brick wall; he turned to AA; he got sober. He then reached in his pocket and took out his 5-year brass medallion celebrating his 5-years of sobriety in AA and gave it to me saying that his process of change started the day we had our last session when I shared that, “what causes a problem is a problem when it causes problems” and he wanted me to have it as his way of saying thank you. You just never know…

By way of closing — and to not extend this post too much — I include two web links to further experiences I have had that serve to ground my belief that interventions always work. I share them as I know you will appreciate them:

• http://bit.ly/Hvq1h
• http://bit.ly/8IpGJ4 - scroll down to “Rain in My Heart” (this is an earlier post recorded on this blog)

Robert

How do you spell “addiction”?
________________________________________

"Addiction" may not be what most people think it is at first glance. Most of us "know" what addiction is "when we see it," but too often this recognition is of the disorder in its latter stages.

Can someone be addicted when not using a drug? Can someone be physically dependent on a substance, but not be addicted to it? Is there one all encompassing definition that would address the beliefs of all who wish to describe an addiction or more importantly, diagnose an addicted individual? These are questions that have not been answered with anything approaching a consensus in the “helping professions” so I do not expect that we will reach a consensus this semester where the fields of medicine, psychology, biology, sociology, and numerous other disciplines have failed to accomplish such to date.

This post attempts to expand on what you have hopefully begun to recognize as the foundation for your approach to “understanding addiction,” namely, a personal consideration of the etiology or “origins” of an addictive disorder. This is of the utmost importance for the counselor providing counseling services to the addicted client and her/his family.

If a counselor is unable to explain the diagnosis to the diagnosed individual’s satisfaction (understanding), it will be difficult if not impossible to engage that individual in the recommended course of treatment. If you tell me, assuming I’m your client, that after having conducted an assessment, it is your opinion that my presenting problem involves the abuse of or dependence on substance “X,” but you are unable to help me understand what that means other than the judgmental meaning ascribed by "the public," I am not very likely to embrace the treatment suggestions that you might make. And if you can explain an addictive disorder, but that explanation is steeped in hearsay rather than documented fact, then your efforts to “get the horse to drink” once you have led it to the water is rather slim.

In this post you are invited to consider some of the major models that have been used to explain the etiology or “origins” of an addictive disorder. Reviewing these models and determining which has the greatest utility in effectively treating an individual's addiction, is a crucial piece in engaging that person in treatment. If your he or she hears you calling him a bum or her a tramp when you suggest that s/he is an “alcoholic” or an “addict,” then that client will resist your treatment efforts if not refuse to work with you altogether. Remember: just as you and I have formulated an opinion of what an addiction is and what an addicted person is like from our “observations on life,” so have our clients. Many “hear” addict/alcoholic/etc and think “failure,” "loser," "degenerate," etc.

As you read the assigned material this week (http://wings.buffalo.edu/aru/ARUreport04.html), I would like you to identify which outlined model most closely captures your understanding of the etiology of an addictive disorder. Consider posting your comments on this topic/reading, be prepared to explain: 1) what is attractive about the model you most strongly related to; and/or 2) what argument might you mount if you were to use this model in order to explain it to a client you have diagnosed as having an addiction. NOTE: In responding to your positions, I may pretend to be your client, listening to your explanation of my addiction in the context of your model. I will then “give you feedback” as I would anticipate a resistant client might do in response to your explanation :)

Later in this series of posts we will talk about “premature” treatment, that is, suggesting action oriented treatment before the client has made a commitment to change. For now, however, we will assume that the client is at least willing to consider changing in order to improve—although that does not mean this change will automatically include a willingness to abstain from “X” simply because you have suggested it.

If you have the time, you may enjoy this review of various models that are used to explain addictive disorders - http://www.indiana.edu/~engs/cbook/chap1.html