Benign Neglect or Can Deception Ever Be Therapeutic?

The  rather brief podcast linked below suggests a novel approach for addressing the problem experienced by a German retirement home where residents suffering from dementia tended to wander off campus and become lost in the community. Irrespective of how closely the focus of this piece may parallel your professional work, there is an inherent ethical question associated with the proffered solution: Is it okay to intentionally deceive individuals, in a rather elaborate and premeditated way, when the result of the deception is a reduction in the likelihood of the demented individual experiencing harm?

Related to this is a story from my clinical experience over 30 years ago. While directing a clinical staffing in an in-patient addiction treatment program, the program’s consulting psychiatrist related the story of an elderly woman suffering from dementia who was living with her daughter. Each morning this woman would get up, happy as the proverbial clam, fix herself tea and toast, and then proceed to sit in the front-room of her daughter’s home for several hours “watching her friends as they would do their acrobatic tricks out front of the house.” Now, the friends were little people who used the telephone wires strung between the poles out-front of the house to practice their routine. As you have no doubt surmised there were no “little people” doing “acrobatic tricks” in the telephone wires in front of the house; this was the woman’s delusion.

The woman’s daughter became concerned about her mother’s hallucinations and her increasing fascination with them...in short, they because the highlight of her day and all she would talk about through the day. The psychiatrist interviewed to elderly woman, made a diagnosis, prescribed medication and in relatively short order the delusions ceased. The psychiatrist was satisfied with the result, the daughter was ecstatic with her mother’s return to sanity...and the elderly woman became severely depressed. The depression progressed to a point where the elderly woman became lethargic, inattentive to such things as eating and personal hygiene, and uncommunicative. The daughter again contacted the psychiatrist, outlined the new symptoms and her concerns for her mother after which the physician agreed to reexamine the elderly woman. He diagnosed her condition as related to the “loss of her friends” and the depression observed the result of the grieving associated with this loss.

His recommendation? Take the elderly woman off the medication and engage the daughter in supportive “talk therapy” so that she might better cope with her mother’s condition. With in a relatively short time, the elderly woman’s friends returned, she now was the one who was ecstatic and returned to her previously outlined daily routine. The daughter agreed to the therapy and as the result, was able to better cope with her embarrassment related to the stigma she perceived being associated with her mother’s “mental illness”; the case was closed.

My point in sharing this latter story is to approach the question mentioned initially above from a different perspective: Is the intentional deception of a client resulting in harm reduction or the intentional withholding of treatment that can effectively alleviate symptoms of pathology albeit with iatrogenic effect (1) justified, and if so (2) is it ethical?

What do you think?

Check out the referenced podcast on iTunes: http://ax.itunes.apple.com/us/podcast/wnycs-radiolab/id152249110  (#13, “The Bus Stop” episode)

Best regards,
Dr. Robert

Art as a Reflection on Counseling: What Does the Client See?

The attached is a quick snapshot of a piece of art I discovered when cleaning out my home office. It is somewhat difficult to tell what you are looking at unless you look closely…and perhaps with a magnifying glass…but if ever in Philly, you are invited to stop by, have some tea, and take a look, “up close and personal.” 

About 20-some-years ago I did an alcohol and other drug assessment with a young man who was mandated following a drug violation…marijuana. We did the assessment and although he was not a candidate for in-patient “drug treatment,” he was well on his way to developing a substance use disorder.


At the end of the assessment, I was looking for some way to make its results more personally meaningful for him. Because he was an artist and a huge fan of graphic novels, I asked him to prepare a review our assessment graphically: The artwork below was his rendition of the outcome of that meeting.

Essentially he storyboarded his insights regarding his drug use, projecting into the future where it might take him if he chose to ignore the results of our assessment. Although I suspect he took some artistic license in producing this piece—I did not see a violent death to be very likely in his future even if his continued use did progress to addiction—it nonetheless tells a cogent story and presents a somewhat accurate picture of the progression of a SUD, at least in Philly. More importantly, it was his interpretation of where his use might lead lest he make changes.

In any event, I thought I would share this as a way of suggesting that individuals can be invited to react to counseling in ways other than just words. What do you think?


Dr. Robert

Giving Away Beer to Attract Younger Customers: Crisis in the Making or Desperate Attempt to Counter a Shrinking Market?

AA, Spirituality, Religion, and Professional Counseling: Part II

As mentioned in my last post, AA (and other 12-step fellowships) neither advocate for nor against any issues, including whether those with symptoms of substance use disorders should become involved with AA. The issue of primacy in this discussion is how do we, practitioners of counseling, interact with AA and, more to the point, the role it plays in the care plans we negotiate with individuals involved with us in counseling.

As with many issues that surface in counseling, counselors are taught to explore all options with clients and eschew pushing a personal agenda. This does not mean that we do not have professional opinions about what works best or better than other things, but it does mean that we need to assess the client’s wishes and attempt to find a course of treatment that is appropriate in our professional opinion while at the same time consistent with the individuals wishes.

True, AA is not for everyone. That said, it seems to work well for many--and whether this means initially finding sobriety or pursuing recovery once  "dry"--this is an issue that the practitioner should consider when determining: (1) If a referral should be discussed and, more to the point, (2) when that discussion should take place in the counseling relationship. Because of the success so many recovering people attribute to 12-step programs, contemporary counselors cannot not consider such programs as a potential adjunct to professional counseling. This does not mean that “all” clients should be referred, but neither does it mean that none should be referred. It is part of what professional counselors do to determine: (1) What will work best, (2) for this individual, (3) at this particular time, (4) to best address this or her needs.


If counseling practice has changed at all over the years it is to have moved away from treating the diagnosis a client has and focus on providing service to the individual who presents seeking care for his or her needs. True, one’s diagnosis will inform the course of this treatment, but as I mentioned in my earlier post on this topic, “there are many paths to the same destination.” 


So, it seems to me that the issue is not “if” AA is appropriate, i.e., is it evidence-based treatment? Is it too religious/not religious enough, etc.? Rather the issue is how and when do I, as a professional counselor, address this issue with individuals for whom a diagnosis of a substance use disorder is appropriate. For John Jones the decision may be to not discuss this now, but perhaps later. For Mary Brown it may be to refer her immediately, and for little Johnny Middleschool, it may be to not discuss this option at all unless Johnny bring it up.

The second issue of importance in this discussion seems to be mandating individuals to attend meetings. I have to agree that mandating treatment of any sort is questionable in its effectiveness. Like the old saying goes, “Never teach a pig to sing; it annoys the pig and frustrates the teacher.” That said, there is something to be said for mandating attending “X” meetings. This is not mandated treatment as much as mandated window shopping. Any first-year psych major exposed to Bandura’s Social Learning Theory quickly can appreciate the significance of vicarious learning, which is exactly what happens when individuals attend meetings, even when mandated. For counselors to rail against the criminal justice system for its infringement on the civil rights of individuals mandated by the court to attend “X” meetings may be missing the point. 


AA and other 12-step fellowships are not treatment. First of all AA will never even discuss this as it is a violation of its tradition to remain silent on issues of politics, religion, etc. So mandating attendance to a specific number of meetings may be a hassle for the individual referred, may be perceived as having been made to “go to church,” or may simply be viewed as a waste of time, but we forget Bandura’s findings resulting from all that research in the 70s...you know what you learn and learn what you are taught...and life is a most effective teacher. And as with so many things, something new is only learned when something new is presented in such a way as to allow the observer to recognize that “the new” costs less and has fewer hassles than what was previously believed.


In my counseling career, I have told individuals, both those who voluntarily attend and those mandated to do so, to: (1) Go to a larger, open meeting, (2) arrive as the meeting is about to start, (3) sit in the back and do not say anything unless you want to, (4) leave when the meeting is over, and (5) do not just listen to the speaker but watch the other people at the meeting...what are they doing? Are they complaining or simply talking? Are they laughing or sitting sullen with their arms folded on their chest? Are they smiling or frowning? I suggest that we discuss what was seen and heard, but not just what the speaker or chair had to say, but what were the dynamics of the whole meeting they attended.


In summary, our issue as professional counselors is to determine what is best for the individuals with whom we work, but to do so in concert with their input. This means that what some may consider as controversial options, such as attending mutual aid groups as an adjunct to professional counseling, need to be considered and evaluated for appropriateness not based on their merits—they all have merits in their own right and these are clear for those who are actively involved—but based on what the individual with whom we are working wants to accomplish.

What do you think?

Dr. Robert

AA, Spirituality, Religion, and Professional Counseling: Part I

This is a topic of  importance and one that is appropriate for consideration at the start of a new academic year where the next generation of counselors—especially addiction counselors—will begin their education and training. That said, I suspect that commenting on this topic may result in a post more the length of an essay than a concise blog entry. I mention this so that readers can exercise the option to use the delete key—if you will pardon the pun—as this is why a Higher Power placed it on the keyboard…Bill Gates? Steve Job? J

A risk, I suspect, in discussing this topic is that it could be like trying to explain health care reform to your 90-year-old parents who consider Fox News and its pundits the only credible source of information on life in these United States; so be it…I love my parents dearly irrespective of their news retrieval habits and political bent.

So, concerning the question of the religiosity in 12-step recovery programs, my experience over the past 36 years as a professional counselor specializing in substance use disorders is that most of my colleagues who have voiced this concern have attended relatively few open 12-step meetings and many of those they may have attended were often the same meeting, meaning, a “particular” group on a particular day and time, attended by specific individuals where one or more indeed placed a distinctly religious spin on the “suggested steps” for recovery. As the old adage suggests, “You never get a 2^nd chance to make a 1^st impression.” If my understanding of 12-step programs had been influenced by such first-hand contact with 12-step programs or my understanding had come exclusively from what others have told me—addicted individuals who eschewed 12-step programs and/or colleagues who voiced concerns—then I too would risk engaging in what our field refers to as “confirmation bias” or the tendency to discount information inconsistent with a held belief while pointing to isolated examples of my belief as evidence of its veracity. Personally, I have been to hundreds of AA meetings in 36 years and have a larger sample on which to base my points in this post.

I do not doubt that some, both in the “addiction treatment industry” and in personal recovery, see “spirituality” and “religion” as all but synonymous, but this is neither universal in its acceptance in the counseling field nor supported in the literature of AA—I am not as familiar with the literature of NA, OA, or the other 12-step groups, so I will not make a blanket statement regarding “all” 12-step-oriented literature. I address this issue of the difference between spirituality and religion in an article I published some years ago (Chapman, R. J. [1996].  Spirituality in the treatment of alcoholism: A worldview approach.  Counseling and values, 41[411], 39-50 - see http://www.robertchapman.net/essays/spirit.pdf for a PDF of the article). Likewise, in my classes I use an unpublished essay I wrote that provides a “counselor’s perspective” on each of the 12-steps in AA when addressing 12-step programs in my Intro to Addictions course. As this is unpublished, I invite requests (Chapman.phd@gmail.com) for copies by those who may be interested.

The question regarding involving individuals in treatment for a substance use disorder in mutual aid groups such as AA needs to be based on more issues than the perceived religiosity of such programs by the counselor—either the counselor who refuses to refer or the counselor who insists on it. There are numerous reasons why a referral should be made as an adjunct to professional treatment even if the practitioner believes that there is too much God in 12-step programs—by the way, AA suggests that if the “G-word” is too upsetting, view it as an acronym – Good Orderly Direction. In an article entitled, Mutual support helps sustain treatment gains (see http://findings.org.uk/docs/nug_4_3.pdf), one study found that the irrespective of the philosophical tenets of mutual aid or self-help groups, the social support and networking alone is reason to consider such programs as an adjunct to professional treatment. In a conceptual article entitled, Self help: don't leave it to the patients (click title to read) “Keith Humphreys and colleagues report on a workgroup of US experts on substance abuse self-help organizations. Main conclusion: self-help groups are too valuable to leave to chance. They should be actively promoted and facilitated by treatment services and policymakers” (http://findings.org.uk).

My experience has been that many colleagues who have voiced concerns about the religiosity of 12-step programs have focused on this issue to the exclusion of other potential benefits that such referrals may proffer for individuals in early recovery. The concern voiced to justify avoiding such programs when developing service plans for individuals in treatment is that involvement in AA is to trade one addiction for another. Although most recovering people I have met have viewed their involvement in a 12-step program as being critical to their sustained recovery, they are quick to point out that one cannot hide in 12-step programs to the exclusion of responsibilities to family, job, or community. As a matter of facts the middle third of the 12-steps is about personal responsibility and obligation in these critical personal areas of one’s life and therefore recovery.

Another justification for avoiding 12-step program referrals espoused by some because of a concern for their perceived religiosity is the language of the 12-step and in AA literature. There is no denying that the language of 12-step literature is, by today’s standards, sexist and speaks of “most” referring to their Higher Power as “God.” This is, perhaps, one of the more legitimate arguments concerning this issue. Be that as it may, one needs to realize that this language was written in the late 1930s and 1940s and at a time when these words were the proverbial “coin of the realm.” We need to remember that “words” are but verbal symbols (when spoken), imbued with meaning by those who use them and by those who hear them. To assume a word’s meaning today when written 60+ years ago may not necessarily yield an accurate interpretation of the author(s)’ original intent. Like when my then 14-year old son took me to task for listening to the Drifters singing Under the Boardwalk in the early 90s as we rode in the car listening to the oldies station when they crooned about “making love” under the boardwalk—we had recently discussed my concern regarding the lyrics of the Heavy Metal music to which he listened—the socially constructed meaning of language can change…he heard a song about having sex when in the 1950s, “making love” meant so much more that the physical act of intercourse.

What I have found through the decades is that I can address potential concerns a “client’ may have by: (1) prepping individuals for what they will experience at 12-step meetings, (2) suggesting that “the words” they may hear/read are just that, words, and their meaning as regards change is not religious in nature, and (3) outlining how there is more to a 12-step group and its potential to aid in recovery than “the meetings” or “the steps” or the whatever. It is a package: Available 24/7…Presenting an opportunity to observe others who have learned a skill set that has served them well as regards making difficult changes…Presenting an opportunity to meet individuals who have similar social/cultural/athletic/political/’whatever” interests and yet, still do not use.

I do not agree with everything in the platform of the political party to which I am registered; I do not subscribe to all the teachings of the religion that I practice; I certainly do not agree with my parents and their views on “most things social and all things political,” but I nonetheless find all these to be critical to finding my way through the challenges of my contemporary living.

I have worked with individuals with substance use disorders for too many years to believe that there is anything like “the” way to recovery—as I learned when working on a reservation with Native Americans, “There are many paths to the same destination.” AA, NA, and the other “anonymous” fellowships have worked too well for too many for too long to be dismissed “out of hand” based on a single issue.

In closing, as I pen this post, I find myself thinking about the core ethical principles that Corey & Corey espoused in their ethics text ( Issues and Ethics in the helping professions, 7^th edition,) and that I share in my ethics course with undergraduate behavioral health counseling students: Autonomy, Nonmaleficence, Beneficence, Justice, Fidelity, and Veracity—especially Autonomy or the right for the client to make his or her own decision as to what course to follow ( p. 17 - 19). I realize that those who disagree with my arguments in this post can turn this closing point on me and suggest these are exactly the reasons they do not refer to 12-step programs, but, to paraphrase myself from above, I have seen too many individuals over the years not only get sober in AA, but find a serenity and quality of life that leads me to believe that while it may not be for everyone, it is certainly for many and who am I to decide who those “many” will be for whom AA (or other such fellowships) are a fit. I discuss 12-step programs with all clients; I mandate that all students in my addiction class attend a minimum of 2 meetings and write a critical essay on the experience; I invite members of the Cooperation with the Professional Community committee of AA to speak in my addiction class. My students will make up their own minds about the appropriateness of including 12-step programs in their approach to professional counseling, but this decision is made, hopefully, with first hand information plus my personal attempt to invite that their consideration be based on “the big picture” rather than their propensity towards “confirmation bias.”

 What do you think?

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