A Rose by Any Other Name...

The title of this post comes from Romeo and Juliet, Act II, Scene II, by Shakespeare. Although this Shakespearian tragedy has little to do with drinking and nothing to do with collegiate prevention strategies, it makes a point that AOD preventionists may wish to consider when plying their trade on campus.

Few involved in addressing high-risk and dangerous drinking on college campuses are unaware of BASICS, Brief Alcohol Screening and Intervention for College Students. This is an evidence-based, highly effective strategy for addressing high-risk drinking behaviors with students. Its use enables practitioners to motivate students to make changes in their alcohol use behaviors. That said, most of the students who are exposed to BASICS do so as either the result of a violation of an institution’s alcohol policies or are actually mandated to do so following a particularly untoward consequence of drinking, like hospitalization.

That BASICS exists, to use collegiate vernacular, is “awesome”; that it is primarily used after the fact of an alcohol violation or serious consequence of drinking suggests that it may not be utilized to its full potential. If students are exposed to BASCIS after the fact it is not so much a preventive strategy as a proactive clinical strategy. Do not get me wrong as I am not complaining about BASICS or its use; I was an early user of the practice in 2000 and have had the opportunity to discuss my experiences in its use with some of those who created BASICS and were involved in its rigorous vetting. My point is, perhaps there are ways to expand the approach beyond its current use as a proactive intervention and transform it into an effective intercession with students before untoward consequences of their drinking occur. NOTE: To read more on the difference between an “intervention” and an “intercession” read my article in the June 2016, Vol. 2, Issue 1 edition of The Addiction Educator – pp. 4 – 6: http://www.incase.org/attachments/AE-Vol2.pdf ).

Involving students before they violate institutional policy or find themselves in a situation where they are mandated to complete a BASICS program necessitates students making self-referrals to the program. Although self-referrals can result when individuals find themselves between the proverbial rock and a hard place, most often these referrals happen when there is an equilibrium between student curiosity about a particular behavior and their apprehensions about the process in which they would involve themselves in order to learn more. To that end, the term “BASICS,” when the acronym is spelled out in campus advertising, includes terms that, to be blunt, are off-putting…Brief Alcohol Screening and Intervention for College Students. Terms such as “screening” and “intervention” are likely red flags for many college students and likely deter self-referrals for many students.

Nancy Reynolds of Ithaca College raised this point in a recent discussion on the BASICS Listserv. She suggested that on her campus, students were “scared off” by such “researchy-clinical terms” when a traditional interpretation of the BASICS acronym was proffered. What she reported doing at Ithaca College is to reinterpret the acronym making BASICS, Balancing Alcohol and Substances to Improve College Success.

Nancy’s suggestion strikes me as not only logical, it is genius in its simplicity as well as sensitivity to how students think. By simply attending to the role language plays in affecting how a program is perceived can likely increase student self-referrals. Students are much more likely to view an intercession as preferable to an intervention, especially in an age when the meaning of “intervention” in cases involving alcohol and other drug use has been determined by cable shows such as A & E’s Intervention and Celebrity Rehab.

Returning to Shakespeare, I wonder if he was not a closet AOD preventionist? We know that “traditional BASICS” works – see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3499225/. If interpreting the acronym for students in such a way as to increase the likelihood that they will engage in self-referral, then I would suggest that indeed, “a rose by any other name DOES smell as sweet.”

What do you think?

Dr. Robert

It Is That Time of the (Academic) Year Again

Well, with the end of August comes the start of a new academic year, at least at schools on the semester system. Along with the start of the new year comes the addition of new recruits to the ranks of collegians...the incoming class of 2021...or 22 or 23 or 24 :)

These new recruits bring with them their high school attitudes, values, and beliefs, which will directly influence the decisions they make, especially during the first 6-weeks and likely through their entire 1st semester. Unfortunately, for some of these students, their "pre-arrival" attitude--and to borrow a quote from Martin Luther King, Jr, although with apologies for its use for purposes other than those intended by Dr. King--that we are...Free at last, free at last. Thank God we are free at last serves to make them vulnerable to the untoward consequences associated with the high-risk and dangerous drinking that too often accompanies no curfews and the absence of parental supervision. 

For others, their value system suggests that as consumers, college is an adventure, purchased like a trip and from which satisfaction is expected...and the guarantee of such the responsibility of campus staff, faculty, and administrators. Like the traveler on a cruise ship having purchased the "free drinks" package, these students expect to be entertained and provided unfettered access to all they have come to expect of their "cruise" through 4-years of college...or 5 or 6 or...

Still, others have unpacked belief systems that suggest, bad things do not happen to good people and because I am good people, bad things cannot happen to me. Unfortunately, this "bubble of security" tends to burst, too often early in their collegiate experience, perhaps as early as 24- to 48-hours after arriving on campus.

Now, with 30+ years of experience in higher ed and 45-years of experience altogether in working with AOD-related issues, I know the students I described above represent the minority. That said, this is a sizable minority nonetheless. As student affairs professionals we often find ourselves struggling to ensure that as few students become disillusioned during their collegiate experience...or more to the point, "injured," either emotionally or/and physically...as possible. For this reason, I have included a link to a workbook I developed, along with Tom Workman who at the time was at the University of Houston - Downtown. This workbook was designed to guide students through a decision-making process in order to minimize the likelihood of experiencing an untoward incident related to choices made during a collegiate experience.

Although the workbook targets "Edgework" specifically - find out more about edgework at http://bit.ly/2xGoZhc - this workbook may be useful as you work with students during the coming year.

If you have the time and believe me, I remember how precious a student affairs professional's time is...and how scarce...at this time of the year, I would love to hear from you regarding what you think of this workbook.

Dr. Robert

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

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

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

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

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

What do you think?

Screening Adolescents for Alcohol Use Disorders

You may find the following of interest - see  Screening for underage drinking and Diagnostic and Statistical Manual of Mental Disorders, 5th Edition alcohol use disorder in rural primary care practice - http://findings.org.uk/PHP/dl.php?file=Clark_DB_2.abs&s=eb

One  of the more frequent challenges professionals in counter when interviewing college students in adolescence is obtaining accurate information. Without reliable information, it is difficult if not impossible to accurately screen or assess someone regarding her or his drinking. This article seems to suggest that asking students to less charged question, "how often do you drink" is perhaps more effective when screening for an alcohol use disorder than asking the more invasive, "how many do you have when you drink" or other "amount-based" questions.  In addition, asking students about the number of drinks they have when consuming is not only invasive, it likely results in inaccurate estimates. Either because of poor recall, a lack of familiarity with standard drink sizes and a realization that "a drink" can measure 2, 3, or more "standard servinugs" of alcohol--or both--student estimates regarding how much they drink can result in notoriously inaccurate responses to such questions when asked by screeners.  

There are several key elements involved in conducting an effective screening interview with a young adult or adolescent. First, the relationship is of paramount importance.  Anyone conducting a screening interview like a parent or cop conducting an investigation can expect resistance. Unfortunately, this resistance is then interpreted as denial, which in turn is viewed as suggestive of a problem. Ironically, this resistance says more about the interviewer's ineffective approach than about the adolescent's use.

Next, effective interviewers know that it is as important to identify low-risk as it is important to recognize high-risk when screening for alcohol use disorders (AUD). The referenced article suggests that as useful as a single question about frequency of use is in identifying high-risk of an AUD, it is more effective in identifying low-risk. NOTE: We are talking about determining low-risk for an alcohol use disorder here. It is possible to drink infrequently and have a low-risk of an AUD, yet still drink enough on any single occasion as to be at risk of an untoward incident.

A third element of an effective screening interview is recognize the importance of autonomy when it comes to considering recommendations following the interview. If behavior change appears warranted, the typical adolescent is not likely to respond to directives based on what the interviewer believed the adolescent "should do." Adolescents, like most people faced with a decision about considering behavior change, tend to move towards a change they "want to make" rather than changes they feel "directed to make." 

The referenced abstract--including its link to the entire research article on which it is based--suggests the efficacy of a simple question based on the frequency of one's drinking rather than the quantity. Such an approach to screening will likely reduce the likelihood of what William Miller of "Motivational Interviewing" fame calls "wrestling" with a client and, instead, facilitates what he recommends instead...dancing. What do you think?

Dr. Robert 

Peering Through the Smokescreen - II: Recommendations for Higher Education

Determining where to plant one’s flag regarding the issue of marijuana is challenging, to say the least. With the increasing attention marijuana receives in the media, it comes as little surprise that numerous states have approved the sale of medical marijuana and 4 additional states have joined Colorado, Washington, and the District of Columbia in making “recreational marijuana” legal. We are, as a culture, “all over the map” as the saying goes regarding this issue.

So, what are student affairs professionals and administrators in higher education to do regarding not only the public policy issues surrounding marijuana but how to address the issue if not the use of marijuana where our students are concerned? This second part considering this issue will address this question by proffering suggestions and recommendations tailored for the student affairs professional.

1.    Conduct more research regarding student use – traditionally marijuana research has focused on adolescents in general and middle and high school students specifically. This research has essentially been concerned with “who is doing what and how often.” Higher education needs a more robust understanding of marijuana and its use on campus in order to develop and implement more meaningful programs of prevention, intervention, and treatment. For example, student affairs professionals need to understand not only “who is using” and why, but who chooses not to use and why. Understanding why students who choose to eschew marijuana use do so will likely yield useful information regarding prevention. In essence, such research enables higher ed to focus less on preventing use and more on promoting alternative behaviors. Our research on marijuana and its use needs a focus on contemporary collegians, not just adolescents in general or those in middle school or high school.

2.    Be mindful that not all students use or have ever used marijuana – as noted in #1, understanding why students who choose to abstain do so is of great value when considering the development of proactive prevention strategies and effective policies and procedures related to marijuana and its use. In addition, for those students who do use, that use frequently tends to be periodic; for those more frequent users, that use is not always—or necessarily even predominantly—to “feel good or get high.” Self-medication of social anxiety is often cited by students who use when asked about their consumption. Learning more about such reasons for use through research will not only aid in the development of proactive prevention strategies but better inform student affairs professionals regarding the need to address issues of anxiety in general and social anxiety more specifically.

3.    Listen to understand and not just to respond - When listening to students regarding their involvement with marijuana, it is important to truly listen so as to understand what these students have to tell us rather than to simply hear them out in order to reply with a “one-size-fits-all” reactive response that comes from the policy and procedure playbook.

4.    Know where you stand personally - Student affairs professionals and those in higher education, in general, are advised to carefully consider their personal opinions about marijuana and its use as such will significantly frame any discussions on the topic. Whether one is on the “pro” or “con” side of the marijuana debate, it is difficult to remain objective and “act on” rather than “react to” issues related to marijuana and higher education without first having seriously considered one’s personal position on this topic. Even having done so, it is suggested that student affairs professionals discuss how best to serve the needs of students and/or adhere to an institution’s mission statement with campus peers and colleagues.

5.    Avoid minimizing the significance of high-risk drinking - It may appear as if marijuana is the issue of primacy when considering student substance using behaviors, but issues related to the use of all drugs together pales into insignificance when considering the problems associated with high-risk and dangerous collegiate drinking.

6.    Avoid talking about marijuana use as “smoking marijuana” - when addressing the topic of marijuana on campus, be mindful that the phrase “smoking” refers to the means of consumption. Although smoking may be the more common way marijuana is consumed on a campus, it is far from the only way it is consumed. As students choose to experiment with marijuana and realize that the smell of its smoke is the single largest contributor to “being caught,” they will likely increasingly turn to drinking or eating it in order to realize its psychoactive effects. Use terms like, “marijuana use” or “marijuana consumption” as alternatives.

7.    Irrespective of the law in the state where a college or university may be located, remember that federal laws regarding marijuana supersede state statutes -This means that students may believe they have the right to possess and use marijuana because of laws in the state where they reside and/or attend university, but federal law prevails for institution accepting ANY federal funds…student aid, federal grants, etcetera. Most institutions are conscious of this and their policies reflect this awareness, but students are not. The perception of an institution’s “Draconian measures” when encountering an institution’s efforts to comply with federal mandates may well lead to debates if not confrontations with students found in violation of marijuana policies and may even result in the involvement of their parents if not costly litigation.

These are but a few recommendations for the student affairs professional when considering the issue of marijuana and its use on campus. Although these suggestions do not ensure resolution of any, let alone all issues related to marijuana and its use on campus, they may, if taken under advisement, enable student affairs professionals to generate more “light than heat” when engaging in discussions on the topic.

It is important to note that there are many arguments, both for and against marijuana and its use. For this reason, it is not likely that marijuana will be far from the headlines anytime soon. Likewise, as long as the media keep marijuana in the spotlight, higher education will find itself dealing with how to address its use on campus. For this reason, it is incumbent upon student affairs professionals if not senior administrators, in general, to be proactive when considering this issue.

As the old adage goes, where there is smoke, there is fire. As regards marijuana, there is definitely smoke on our college and university campuses.

To watch 2 brief lectures (about 20-min each) on this topic delivered by Dr. Chapman at a colloquium in the Philadelphia area in January of 2016, visit the following links:

1. Framing the issue of collegiate marijuana use: http://bit.ly/2gyLb5F
2. Wrap up: http://bit.ly/2eDoDnK

Peering Through the Smokescreen

Allow me to begin with an apology for my recent hiatus. I have been preoccupied with relocating to a new residence in a different state and all that entails. 

This essay is the first of a two-part consideration of Marijuana on campus. It is intended to present an objective look at marijuana and collegiate life (Part I) and proffer some recommendations...or at least suggestions...regarding what contemporary preventionists might consider as regards addressing marijuana and its use on campus (Part II).

Part I

Students tend to maximize what researchers call “utility” when considering options during their collegiate experience. What this means is that options that register as yielding subjective payoffs like “happiness,” “satisfaction,” and “contentment” tend to receive priority over those that result in “good grades,” “recognized leadership potential,” and “career or professional development.” AOD-related options, especially alcohol and marijuana-related options tend to maximize utility, at least in the short run, for example, an opportunity to party can win out over studying or engaging in other activities that may result in a more lasting and tangible payoff.

Students are essentially two types of people; doers and planners. Each of these personas are in competition with one another and all students tend to possess both, albeit one or the other may tend to be dominant depending on the individual student. The “doer” makes decisions when emotions are hot and “planners” when they are cool. Ask students on Tuesday what they are likely to do on Saturday and their “planner” will provide a reasoned response like, “hangout with some friends and watch a movie” or “go to the ball game.” Ask these same students on Saturday night, in the heat of the moment when passed a pipe with marijuana or standing at the keg at a “buy the cup and drink what you want” party, and the “doer” will respond.

Such dual personality collegians present contemporary preventionists with a rather challenging if not a daunting task; how to prevent high-risk drinking and marijuana use when almost exclusively they are restricted to reaching students when they are in their “planner” mode. Such prevention efforts are often dismissed by students because they believe they do not apply to them because they would never be the type of student that would take the risks that traditional prevention messages address.

Prevention specialists have traditionally used strategies steeped in what are called social-cognitive theory to inform their efforts in AOD prevention. Historically, prevention efforts have essentially focused on alcohol, but with increased concern regarding the risks associated with excessive drinking and the increased attention given to legalized medical if not recreational marijuana use make it incumbent upon preventionists to address marijuana use on campus.

The social-cognitive theory has tended to focus prevention efforts on exploring expectancies related to use and to teach students coping skills related to how to moderate behaviors like drinking. As we begin to focus more specifically on marijuana, we tend to do what we know how to do and therefore look at marijuana as simply a different pew in the same church of prevention. For example, as useful as social norms marketing is when addressing high-risk behavior and as important as it is to champion strengthening intrinsic motivation in order to lessen students taking unnecessary risks with alcohol and marijuana, these remain “thinking-related” strategies best suited for the rational “planner” but are not particularly effective when attempting to influence the emotional “doer.” Add to this that “planners” tend to dismiss social-cognitive related approaches to avoiding risks associated with excessive alcohol or marijuana use because they do not find them personally realistic and the stage is set for prevention to expend maximum effort in order to realize minimum results.

This two-part essay is dedicated to specifically addressing the issues associated with marijuana use on campus. It considers the issues marijuana use pose for contemporary campuses and, more specifically, student affairs administrators and prevention specialists.

Marijuana presents a particularly interesting challenge to those involved in higher education because of the media attention it receives and the way this attention tends to frame the issue. This in no small way affects the public’s understanding of marijuana and its use. 

In Part II of this essay, you will find a list of suggestions and recommendations related to approaching marijuana and its use on college and university campuses. Although none of these can ensure a problem-free campus as regards marijuana and its use, they will likely serve as food for thought and likely generate proactive discussions on this topic. 

What do you think?

Dr. Robert

New Essays Now on LinkedIn

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

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

Best regards,
Dr. Robert