Physics for Prevention Specialists

Imagine you are standing in the aisle of an express train moving down the tracks, bouncing a ball. The ball leaves your hand at point “A,” drops to the floor and bounces straight back, which to all in the passenger car is in the same place as when the ball was released, point “A.” Meanwhile, outside, standing on a platform in a station as the express passes through, an observer views you bouncing the ball. However, to the observer, the ball leaves your hand at point “A,” drops to the floor and bounces back to you at point “B” several feet in front of where first dropping the ball. Although it is true that we can accurately calculate the distance between points “A” and “B,” mathematically, from the perspective of the passenger on the train there has been no such movement. Quite simply, the experience of the observer and that of the observed are decidedly different. 

Ironically, neither the observer nor the observed is aware of this dissonance as each is comfortable in his or her perception of what is real. The variance between these two realities is of no consequence to either, that is until and unless a discussion between the two were to develop as to whose perception was correct. And if both the observer and the observed are not theoretical mathematicians and one was to present his or her perception of reality to the other, it would be rejected out of hand as absurd. 

Taking some liberties with this high school physics example, what if we consider the observed passenger on the train to be our collegiate drinker (the student) and the observer on the platform in the station us? It may be clear to "us" that "the student’s" behavior is high-risk if not problematic; something easily demonstrated. From the perspective of "the student," however, nothing has changed: Remember that what causes a problem, is a problem, only when it causes a perceived problem. If what causes a problem for "us" is not perceived to be a problem for "the student," why would he or she be motivated to consider changing that behavior…especially if it proffered a successful solution to a perceived real personal problem, say, social shyness or anxiety? To "us," "the student’s" drinking is a problem because he or she is under 21 and/or misses class or engages in some troublesome or nefarious behavior. To the drinker, that is to say, "the student," the drinking has accomplished what it was intended to accomplish…social engagement and interpersonal confidence with any resulting missed class an acceptable consequence of an otherwise successful ploy to address what, for the student, is the real problem.

It is a question of perspective and until and unless prevention specialists first grasp this reality and then explore it to better understand "the student's" perspective, we will continue to miss a key portion of the equation for solving the problem associated with the drinking some students do, much like the old cartoon depicted here:

Prevention specialists need to recognize that students have ascribed meaning to alcohol as a substance and "drinking" as a behavior. It is this meaning that affects their choices regarding these icons of contemporary youthful socializing. Until and unless the meaning ascribed to these icons changes, the likelihood that their behavior will change is in question. Fortunately, we know that the "maturing out" phenomenon will result in such changes in the meaning ascribed to these icons, but this generally takes several semesters if not years. This period represents a rather significant "window of opportunity" for the untoward consequences of collegiate drinking that so frequently consume the agenda of student affairs planning sessions at this time of the year.

It is recommended that prevention specialists concern themselves with better understanding the "physics" of how students ascribe meaning to these icons of youthful socializing in order to hasten the "maturing out phenomenon," thereby closing the window on risk of untoward consequences sooner.

What do you think?

Dr. Robert

Counseling with Special Populations

There are numerous and varied definitions of what constitute a “special population.” These vary depending on if we are considering the topic as a sociologist, politician, theologian, or “whatever.” One factor common to all definitions, however, is likely to be that a special population is composed of individuals who have special needs.

When counseling such individuals, it is incumbent upon practitioners to recognize that the resistance some individuals display in counseling may have less to do with their denial or hesitancy about committing to counseling than about the apparent lack of understanding displayed by the practitioner for their special needs. The old “blame the client/patient” excuse for less than desired results in counseling and therapy is not only antiquated, it is, as we used to say in the 60s, “a copout.”

I teach a course in Addiction Counseling with Special Populations where we look at “adolescents” and “older adults” as two examples of special population – AKA, populations with “special needs.” As an assignment in that course, I invite students to visit several YouTube clips and watch them, considering them in the context of our course and the materials we review and discuss in the course. In this post, I will share this assignment for your consideration. If you have the time, I welcome your thoughts.

Here are the video clips of which I speak. I have added a couple sentences of "introduction" for each in order to set them up and prepare your consideration of each in the context of our course.

1.       Adolescence as portrayed as portrayed in film - This is a montage of brief clips from popular films illustrating various aspects of adolescences...as seen through the eyes of adults. What, if anything, does this say about adolescence…or is this just a stereotypical view presented by an adult film maker?
2.       Older adults and the power of music - This clip takes place in a nursing home. The documentary, narrated by Oliver Sack, introduces us to several patients that are unresponsive or difficult to reach by facility staff. In particular, we meet one gentleman whose unresponsiveness is particularly acute. The clip suggests that the use of music can have a profound effect on older adult patients, perhaps even accomplishing what counselors using traditional "talk therapy" cannot.
3.       My First Mister - In this clip from what I believe was a “sleeper film” of a few years back, portrays an adolescent girl—who we know from scenes earlier in the film, but not shown here, comes from a troubled and emotionally charged background—who interacts with a middle-class, white, middle-aged male. Their initial interaction appears charged with both the “typical adolescent” and “typical (parental) adult” reactions we expect from stereotypes, but towards the end of the clip, when the male speaks to the girl from the doorway of the shop as she sits on a bench in the mall, watch how the male approaches her. Ask yourself, what lesson can we learn as counselors approaching adolescents as we consider the male's behavior? What does he do that enables him to be firm yet engaging?
4.       Call me maybe - This is just a fun clip (I think). Once you open the clip in your browser and the “ad” plays a couple seconds so you can click and make it disappear, but before the video itself "gets going," close your eyes, listen to the music, and picture what you think you will see when you open your eyes to watch the video...keep your eyes closed for about 5 - 10-seconds of the music. When you open your eyes, note your first impressions and then ask yourself, what does this say about my interacting with a special population? More to the point, does it suggest anything I need to watch for when working with culturally different individuals or those with special needs?
5.       Stand by me” - This is another "feel good" clip, but as you watch, ask yourself what does the divergence of cultures and peoples performing this song suggest about how we are all different yet the same...and what does that have to say about treating individuals from special populations who have special needs? How does this video suggest the importance of a collaborative nature of therapy? HINT: Think about this from the perspective of the PRODUCER of the video (practitioner), not just the performers (clients).

Involving Students in Collegiate AOD Programming

Helping or advising specific campus groups or individuals as they develop community education programs or requests for funding for AOD prevention activities can be daunting. For example, most collegiate “alcohol education” activities have traditionally included a “risk-based” approach, one that essentially attempts to educate individuals about the “bad things that can happen” when using. Another “traditional approach” is the didactic “alcohol/other drug specific” theme, that is, the focus is on delivering information about the substance rather than engaging the audience in a discussion about the individual or group that may be considering its use. What if the emphasis when advising event planners was to: (1) avoid either of these foci, or (2) suggest skill-based and/or strength-based approaches to programming…if not both?

As regards avoiding the “AOD risk-based” program, I wonder how students would respond to an event designed to: (1) engage attendees in exploring the “benefits/pay-offs” of moderation rather than the risk associated with abuse—to move towards the light rather than away from the darkness—and/or (2) look at AOD-related topics, but with the emphasis on the student as a “student” rather than a consumer. For example, looking at how alcohol is marketed and considering the ethical implications of an ad campaign that is only concerned with increasing sales and ignores the social implications of those increased sales, especially if targeting “underage” consumers; or one that looks at interesting historical facts related to AOD and presents interesting trivia…like how the term “proof” came to be related to alcohol or that the Pentagon is built on the geographic site of one of the largest 18th century hemp plantations in the Western Hemisphere or that “canvas” comes from the Dutch word for  Cannabis, etc. (see Loosening theGrip by Kinney for this type of historical data or explore www.Mentalfloss.com. One could do something on FAE—Fetal Alcohol Effect—for a program attended by bio, nursing, or pre-med majors or consider the role of psychoactive substances in religious ritual for Religion or Sociology majors. For Psych majors, design programs that look at the nexus of AOD use and social psych, exploring phenomena such as “Alcohol Myopia,” “state dependent learning,” etc. Notice how such programs are more likely to engage students as students than traditional programs that try and engage them strictly as “consumers”; yet insight is insight, whether it is gleaned by a “student” or “consumer” and is just as likely—and perhaps, more so—to affect the future thinking of “students” about consumption.

As regards avoiding the “AOD specific focus,” considering decision making skills (see http://www.samhsa.gov/consumersurvivor/sdm/Workbooks/SDM_Workbooks/Helper%20Workbook_508.pdf) or exploring the prevalence of “harm reduction” in contemporary culture—fire extinguishers, seatbelts and airbags, handrail on stairs, fire retardant infant clothing, etc. From this discussion, the presenter(s) can then invite the audience to identify existing HR strategies in their specific collegiate environment and from there, can be invited to hypothesize how HR can be more directly inserted into their every days lives, including socializing. If a budget exists for this event, perhaps the presenting group could purchase “give-aways” to be awarded to those in the audience that proffer suggestions, with the group deciding which individual idea is best—2^nd place…3^rd place?—and then award a “grand prize,” a college hoodie or something donated by the bookstore or “whatever” with T-shirts or whatever for 2^nd and 3^rd places.

Contemporary collegians are both well informed and sophisticated. They are not only disinterested in the traditional “AOD Talk,” they find such to be off-putting if not condescending. Yet when approached as the “students” they are, they will respond differently because we condition them to respond differently.

Remember Mark Twain’s famous quote about perspective when approaching others:  When I was a boy of 14, my father was so ignorant I could hardly stand to have the old man around. But when I got to be 21, I was astonished at how much the old man had learned in seven years.  

What do you think?

Dr. Robert

An Argument against the Legalization of Marijuana

As a controlled substance, marijuana has been a topic of discussion for decades. As with a number of controversial contemporary social issues, opinions on the topic seem to gravitate to either of the poles on the ideological continuum, resulting in something approaching the opposite of what statisticians refer to as a “normal distribution” or where the majority of responses cluster around the mean.  

Having reflected on this topic for the better part of 40 years—having once even participated in a discussion of the topic when arbitrarily assigned to the “pro side” of a public debate of this issue in the late 1970s—arguments for legalizing marijuana are both numerous and, frankly, compelling. True, there are persuasive points of view in support of retaining marijuana’s status as a controlled substance and therefore “illegal,” but it appears that with the passage of legislation in Washington and Colorado legalizing “recreational use” and others states recognizing the legitimacy of “medical use,” the tide of public opinion is shifting on this controversial subject.

Although in my career as a professional counselor specializing in the prevention and treatment of substance use disorders I have come to view the problems associated with alcohol and tobacco as being far more costly and injurious than those associated with marijuana, I do not support efforts to legalize “weed.” Again, the arguments in favor of legalization are compelling and we all know the financial case made by estimating tax revenues likely generated by the sale of marijuana, but my opposition is steeped in clinical concern rather than political, economic, or sociological ideology.

If legalized, then not only will marijuana become legal to purchase, its commercial sale becomes legitimate as well. With this legitimacy comes commercial competition by manufacturers—presumably big tobacco—to secure a share of the newly created public market. As we all experience on a regular basis, efforts to attract customers general include significant advertising.

Whether this advertising resembles the thrill and allure of television, cable, billboards, and periodical ads for beer, wine, spirits, and cigarettes or those related to sponsoring sporting events with race cars emblazoned with various brewer and distiller corporate logos—now there is an incongruous image if ever there was one—the ads for marijuana will likely employ many of the same gimmicks and strategies as have so successfully marketed nicotine, ethanol, and, increasingly of late, prescription medications, a.k.a, “drugs.”

Research suggests that jurisdictions that decriminalize marijuana possession and use—production and distribution remaining illicit acts—do NOT see an increase in use in the general population. Yet when legalized, use increases, but not because of the change in legal status of the drug as much as because of the advertising involved in its legal distribution and the inherent messages in those advertisements related to the benefits, implied or stated, of use.

The consumption of marijuana is almost certainly less of a problem in our culture than that related to either alcohol or tobacco use, let alone both. Irrespective of the relative risks associated with marijuana use, however, it remains a psychoactive substance. As such, when consumed to excess, it is not without its risks. Nevertheless, the issue surrounding legal status of marijuana, for me, is less one of individual rights than of personal and societal well being. As such, the decriminalization of possession and use make more sense than the legalizing of the substance, especially when considering the way that this drug will likely be presented to the public by those intent on making a profit through its legal distribution.

What do you think?

Dr. Robert

Capturing Student Attention: Motivating Interest in the Uninteresting

Inviting students to give serious consideration to a topic like "alcohol" or "drinking" is a daunting task at best. That is, unless you are able to meet them where they least expect to find such information...at the corner of "Silly and Humorous."

A YouTube video clip from a friend at the PA LCB - http://www.youtube.com/watch?v=L6dzUOYTQtQ - got me thinking about creative ways to invite students to consider serious information that might otherwise be ignored.

This video is humorous and likely to be a useful “conversation starter” for discussions regarding drinking with students.

Although it goes by very fast, as you watch it be sure to note that in the clip we are reminded that ethanol is essentially yeast excrement.

NOTE: I have historically gotten quite a bit of mileage out of this analogy and similar “absurd” analogies when I set them up as a discussion about alcohol. By “technically” explaining what ethanol is and then launching into a discussion about alcohol by suggesting that students who enjoy partying are essentially declaring their fondness for consuming “yeast piss” generally has student nervously tittering as we begin to look at the serious side of alcohol but from a humorous or silly perspective J This may seem a bit “crude,” but mark my words…it gets student attention. As my grandfather used to remind me, “sometimes you have to give folks what they want to get the chance to give them what they need.”

From here—the use of humor or silliness to segue into a more serious look at alcohol and drinking—it is possible to branch off into other similarly “unexpected” topics for conversation, proffering a technical explanation and/or discussion of other alcohol-related  experiences, for example, “beer goggles”:

Although “shock and scare” videos and graphics are of little if any use in serious prevention programming, when used to “set up” a discussion, especially if used to infuse some humor or serve as a “visual anchor” designed to fix an idea in a student’s consciousness for further consideration regarding your intended prevention message, such gimmicks may be useful.

Related to these strategies are cleaver uses of technology that, by their very nature, garner shock, awe, or simply amazement - for an example, visit http://vimeo.com/56772409. Again, it is the ad hoc nature of such resources that is of value. None is going to cause students to drink differently when they next go out. They may, however, affect how students think about alcohol as a substance and drinking as a behavior, which, after all, may influence drinking behavior at some point in the future.

Remember: PSAs, video clips, photographs, and the like are not likely to translate into changed behavior, especially for a persistent high-risk drinker. What they may be useful for, however, is an “attention grabbing” prelude to a more serious point that you wish the viewer to ponder.

What do you think?

Dr. Robert

Is JoinTogether Becoming the Fox News of AOD Prevention?

I have been reading about latest Monitoring the Future 2012 report regarding AOD use by 8^th, 10^th, and 12^th grade high school students from various sources this morning (easily available “all over the web,” but here is the link to the MTF webpage with related info - http://www.monitoringthefuture.org/). Please look at this headline below from JoinTogether, which is at CASA at Columbia and associate with the Partnership for a Drug Free America and compare this to other announcements regarding the report. As you compare, ask yourself: Is JoinTogether becoming the FoxNews of the AOD prevention field?

Survey: Almost One-Fourth of 12th Graders Have Smoked Marijuana in Past Month

December 19, 2012

Almost one-quarter of the nation’s high school seniors say they have smoked marijuana in the past month, and just over 36 percent admit to using the drug in the past year, according to the 2012 Monitoring the Future Survey. View article...

Where most reports on the MTF 2012 findings are meant to suggest the glass is half full, it would appear that JoinTogether saw the glass as half empty…

What do you think?

Dr. Robert

Can the short term benefits of my ability to assuage pain create long term problems of addiction?

Fr. Joseph martin, a well know lecturer in the field of addiction and founder of “Fr. Martin’s Ashley,” an inpatient SUD treatment center in MD, used to argue that, “Pain is God’s greatest gift to mankind.” It is the pain associated with a situation that eventually motivates one to take the necessary steps to affect change. Like the sleeper awakened in the night by the chill autumn air, but is not quite uncomfortable enough yet to get up from a warm bed to close the window, does prescribing enough medication--both the dosage and the number of doses prescribed—to assuage all pain actually delay making proactive changes in one's lifestyle and foster dependence? Does not “managing pain” mean reducing it to a tolerable level rather than assuaging it completely? And because my patient/client “demands” that I do what needs doing to make the pain “go away,” does this necessitate that I prescribe “more” rather than refer to other practitioners who utilize behavioral medicine for analgesic purposes?

If, as Jim Croce crooned back in the 70s, "nobody ever had a rainbow until they had the rain," does "a little bit of pain" remind us that change is needed; change in my behavior as I live my life, not change in yours as a potential writer of prescriptions?

Click on the title below to visit the article and then share your thoughts.

To ReducePrescription Drug Abuse, Focus Less on Patient Satisfaction

Pain management education must help prescribers focus less on patient satisfaction, and more on their functional improvement, according to Sherry Green, the CEO of the National Alliance for Model State Drug Laws.

What do you think?

Dr. Robert

A Serious Look Inside Computer Delivered Interventions (CDI) for College Students: Part II

This post continues a review of the chapter entitled, “Computer Interventions” by Campbell & Hester in the text, College Student Alcohol Abuse: A guide to assessment, intervention, and prevention. As you likely quickly surmised when reading, “Part I” of this review, I found this chapter provocative, informative, and a “must read” for the contemporary student affairs professional and administrator in higher education.

Perhaps this chapter’s greatest significance, at least in this reviewer’s opinion, is a brief section of the article entitled, "commercially available CDIs: summary of empirical findings” (p.260-261) that follows 10 pages of descriptions of each program and a review of their evidence of effectiveness. In this short three-paragraph section we find both a frank review of the limitations of CDI programs as well as an admonishment of caveat emptor and “buyer beware.” As effective as CDI's may be, they are not a panacea for high-risk and dangerous collegiate drinking. Ironically, some CDIs with the greatest price tags and longest completion times perform less effectively then less expensive, briefer programs. More isn't necessarily better. But one point the authors make is that more research on CDIs is necessary, as some have not even received a rudimentary review regarding their effectiveness.

In summarizing this chapter, there are four key points:

1. Most agree that CDI holds great potential for use with heavy drinking collegians. Conversely, they are relatively ineffective at motivating overt change in the drinking behavior of a low-risk, moderate drinking population.
2. Although empirical evidence is available on some CDI programs, this is neither definitive nor universal as regards the different programs that are available.
3. Empirical data that are available on CDI programs result from traditional controlled experiments. It is unknown if the plethora of digital competitors for college student interest will affect either student attention when engaged in a CDI program in a nonclinical environment, i.e., college residence halls, or if its impact will be diminished by other distractions in a controlled, nonclinical environment.
4. Further study is needed to explore adjuncts to simple completion of CDI programs in order to facilitate retention and/or application. For example, involving students in more traditional means of considering the information to which they have been exposed. Further examples include, various means of recording the feedback received from CDI programs and/or literally reading a summary of feedback or information provided by a CDI program.

Recommendations to the field

1.  That administrators employ CDI programs to pursue NIAAA recommended means of intervention with collegians.
2.  That CDI programs be readily available to students by strategically deploying computers with access to such programs to implement a stepped–care approach to campus-wide intervention and prevention.
3. That administrators be mindful of the importance of using CDI programs that students will want to use—the best program will have little impact if students find it tedious, burdensome to use, or simply “not fun.”
4.  That administrators remain mindful of "where" the CDI program will be available. For example, providing for access in controlled, quasi-anonymous environments like classroom buildings, clinical settings, and the like.

Prophesying About the Field

The authors conclude their chapter by prophesying regarding the coming decade. Although it is worth the time to read their complete predictions about the future of CDI programs in their entirety, a preview of their prognostication is warranted:

1.  CDI will continue to improve in scope, in its ability to deliver interventions, and ability to engage collegiate users.
2. CDI programs are in their infancy. As such, they have yet to incorporate all we have learned about effective intervention strategy and traditional face-to-face interventions. In short…stay tuned.
3. The marriage of CDI programs and online social media will likely resemble the proverbial match made in heaven.
4. Merging text messaging capabilities with alternative low-risk collegiate behavior—think "Arab Spring meets Spring Fling.”
5. As smart phones have done to cellular telephones, imagine what CDI will do for interventions with a prevention of high-risk and dangerous collegiate drinking…not to mention other behaviors.
6. Biosensors in cell phones, innovative smartphone apps, perhaps even sensors embedded in clothing able to deliver real-time blood-alcohol level data to gauge personal risk.

In 21 short, easily read pages, including references (three pages) Campbell and Hester have managed to review the role of CDI programs as well as their utility in addressing high-risk and dangerous collegiate drinking. They do this while providing the field with a detailed road map through the commercial minefield of available computer delivered interventions targeting heavy drinkers. This chapter is definitely recommended as a “must read” for any serious student affairs professional or administrator in higher education.

This has been a review, in 2-parts, of “Computer Interventions,” authored by William Campbell and Reid Hester, (chapter #10, pages 246 – 267, in College Student Alcohol Abuse: A guide to assessment, intervention, and prevention, Christopher Correia, James Murphy, and Nancy Barnet editors, copyright 2012, John Wiley & Sons, Hoboken, N.J. ).

What do you think?
Dr. Robert