Seeing What You Expect to See
Stephen King once said in an interview, "Belief is the wellspring of myth and imagination." When I came to this quote while reading a book on brief therapy, in particular the sections on constructivism and narrative therapy, I could not help but think of the way contemporary collegians look at alcohol as a substance and drinking it as a behavior.
Alcohol and its consumption have become significant icons of collegiate life and a mythology surrounding drinking has evolved that is so entrenched in the minds of students entering college--not to mention their parents who recall its role from their college days--as to resist even the latest efforts to address the misperceptions many hold regarding it.
Alcohol and drinking have meaning because we ascribe that meaning to these icons of contemporary collegiate life. Michael Hoyt in (Some Stories are Better than Others: Doing what Works in Brief Therapy and Managed Care (2000) suggests that the essence of being human is that we are "meaning makers" and by our very nature cannot not participate in explaining, by whatever means, that which we experience. This is an apt explanation of how meaning is ascribed to alcohol and drinking...those who are aware of these aspects of college life maintain that awareness in the context of the meaning they have attributed to them. Unfortunately, the meaning we ascribe to an event in order to explain and understand it is does not guarantee its accuracy, hence the role of myth in explaining all manner of natural events and phenomenon.
For example, when I understand that alcohol is a prerequisite of "having a good time," it quickly becomes synonymous with having that good time. In fact, the mention of alcohol is no longer required because the party itself has become imbued with the meaning that alcohol will be present and those attending will be consuming it. Interestingly, the noun becomes a verb, which itself is a euphemism for drinking, that is to say, "to party" mean to drink.
Although this meaning is not isolated to collegiate life--many in high school have already become familiar with alcohol and understand its importance in a successful social life--it changes as students progress through successive terms in their collegiate experience. The meaning attributed to alcohol as a substance and drinking as a behavior "change." Where first-year students expect and then seek out the collegiate "keg party" with its obligatory "drinking games" and related "drunken comportment," the lure of this type of past time lessens.
In research that I have conducted the meaning ascribed to alcohol and drinking changed significantly as students progressed from their first-year to their later years in college--see my second monograph on collegiate drinking for an in depth look at this phenomenon - http://www.community.rowancas.org/Monographs/Monograph_510.pdf. It would appear that the meaning students ascribe to these collegiate icons changes as the result of experiences they have with them, either personally or vicariously--or more likely both. Whether this is a result of developmental movement from adolescence to young adult with the accompanying development of one's ability to reason with the further physiological development of the prefrontal cortex of the brain or whether it is learned through progressive experiences where drunken comportment becomes less attractive, the point remains, the behavior of many (most?) collegians who choose to drink in a high-risk fashion changes.
What is of interest to me, as a professional interested in issues of prevention and intervention, is how this naturally occurring process can be better understood and then incorporated into contemporary approaches to preventing untoward consequences associated with drinking. It stands to reason that if collegiate drinkers "mature out" of their high-risk approaches and this happens because the meaning hey ascribe to alcohol as a substance and drinking as a behavior have changed, then if we can understand this process we can likely hasten this process.
I suspect this is the next chapter that will need to be written in the handbook on preventing high-risk and dangerous drinking.
07 July 2009
30 June 2009
Taking the Risk to Change
My 6-year-old grandson called the other evening. “Poppy,” he asked, “...when you were a boy, did they have furniture?” I was somewhat taken aback, in part by the unexpected question and mostly because of having been presented with one of those moments I believe John Lennon referred to when he said during an interview, “Life is what happens while you are busy making plans.” I was mowing the lawn and felt the phone vibrate in my pocket and stopped to answer, certainly not expecting anything quite like this question.
Apparently, my grandson had been talking with his father and had asked him this question. My son-in-law—in part recognizing the humor in the question and knowing that I would appreciate it—and in part recognizing its innocence and simple beauty, suggested that his son call his grandfather and ask him the question directly. Bobby—named after his dad who was named after his dad, making him “the third”--called, dialing the phone by himself and posing his question to his grandfather directly. I assured him that indeed, furniture was invented long before his grandfather had been a boy, but found myself marveling at the significance of this question after we ended our conversation. The more I considered our brief conversation the more I realized that my grandson was beginning to ask questions about what he thinks about the world in which he lives. It then occurred to me how similar this may be to the experience of individuals with whom I have worked in counseling over the past 35+ years.
Like my grandson, individuals in counseling begin to experience change when we they feel safe enough to ask questions about what they believe are the facts in their lives, what they think and believe if you will, and do so without fear of retribution. “Change,” as I once heard said at an AA meeting, “...is an inside job.” But this change only occurs when one is able to see life—the “facts” if you will—from a new perspective. I can then choose to move from where I am to where I now want to be, based on my new perspective. To gain that new perspective, one often must take risks, most notably the move from a place of comfort to one at best unknown and often potentially unsettling. Before one can take that risk two things have to happen. First, I must become aware that what I think may not be all there is to be known on a given topic. Second, I must find a way to explore what there is to be known about the topic in question, a.k.a., "the world," and here in lies the “quest” in asking the the “question.”
My grandson truly believed that his grandfather predated the invention of furniture. This is not such an odd question for a six-year-old to ask...my grandfather was six in 1903 when the Wright Brothers first flew. I could have asked him, “Poppy"--I called my grandfather Poppy too--"Did they have airplanes when you were a boy?” The questions we ask are not as important as feeling safe enough to take the risk of asking them. It is likely that no two individuals see the world through the same set of lenses...we all have our own unique prescription. What is important is feeling safe enough to ask our questions and encouraged to pursue the development of new information on which to base our choices and decisions as regards how to live our lives.
My grandson now knows just a little bit more about his life...at least how his view of that life comes to make sense to him in the context of the “big picture.” But he has taken that tiny step forward because he was encouraged by his dad to, “ask Poppy,” and when he did, he was able to get an answer from Poppy. The funny thing is that while he is likely clueless of how significant that experience was in his development as a person, his grandfather could only marvel at its significance...and how like professional counseling in that it is only when someone feels safe enough to ask the spontaneous question that the opportunity for growth is presented.
When I apply this personal life experience to my work as an educator I wonder how do we who are just a bit further along the road of discovery in life encourage those who follow us to appreciate the journey? How do we who encounter those who believe they “know it all” to explore what they know in order to discover there is more? As my grandfather used to tell me, “Wisdom is the gift received when recognizing the limits of one’s knowledge.”
(NOTE: For a musical treat listen to Dan Foggleburg’s “The Higher I Climb” cut from his High Country Snow CD – see lyrics at the bottom on my web page, http://www.robertchapman.net/home1.htm )
My 6-year-old grandson called the other evening. “Poppy,” he asked, “...when you were a boy, did they have furniture?” I was somewhat taken aback, in part by the unexpected question and mostly because of having been presented with one of those moments I believe John Lennon referred to when he said during an interview, “Life is what happens while you are busy making plans.” I was mowing the lawn and felt the phone vibrate in my pocket and stopped to answer, certainly not expecting anything quite like this question.
Apparently, my grandson had been talking with his father and had asked him this question. My son-in-law—in part recognizing the humor in the question and knowing that I would appreciate it—and in part recognizing its innocence and simple beauty, suggested that his son call his grandfather and ask him the question directly. Bobby—named after his dad who was named after his dad, making him “the third”--called, dialing the phone by himself and posing his question to his grandfather directly. I assured him that indeed, furniture was invented long before his grandfather had been a boy, but found myself marveling at the significance of this question after we ended our conversation. The more I considered our brief conversation the more I realized that my grandson was beginning to ask questions about what he thinks about the world in which he lives. It then occurred to me how similar this may be to the experience of individuals with whom I have worked in counseling over the past 35+ years.
Like my grandson, individuals in counseling begin to experience change when we they feel safe enough to ask questions about what they believe are the facts in their lives, what they think and believe if you will, and do so without fear of retribution. “Change,” as I once heard said at an AA meeting, “...is an inside job.” But this change only occurs when one is able to see life—the “facts” if you will—from a new perspective. I can then choose to move from where I am to where I now want to be, based on my new perspective. To gain that new perspective, one often must take risks, most notably the move from a place of comfort to one at best unknown and often potentially unsettling. Before one can take that risk two things have to happen. First, I must become aware that what I think may not be all there is to be known on a given topic. Second, I must find a way to explore what there is to be known about the topic in question, a.k.a., "the world," and here in lies the “quest” in asking the the “question.”
My grandson truly believed that his grandfather predated the invention of furniture. This is not such an odd question for a six-year-old to ask...my grandfather was six in 1903 when the Wright Brothers first flew. I could have asked him, “Poppy"--I called my grandfather Poppy too--"Did they have airplanes when you were a boy?” The questions we ask are not as important as feeling safe enough to take the risk of asking them. It is likely that no two individuals see the world through the same set of lenses...we all have our own unique prescription. What is important is feeling safe enough to ask our questions and encouraged to pursue the development of new information on which to base our choices and decisions as regards how to live our lives.
My grandson now knows just a little bit more about his life...at least how his view of that life comes to make sense to him in the context of the “big picture.” But he has taken that tiny step forward because he was encouraged by his dad to, “ask Poppy,” and when he did, he was able to get an answer from Poppy. The funny thing is that while he is likely clueless of how significant that experience was in his development as a person, his grandfather could only marvel at its significance...and how like professional counseling in that it is only when someone feels safe enough to ask the spontaneous question that the opportunity for growth is presented.
When I apply this personal life experience to my work as an educator I wonder how do we who are just a bit further along the road of discovery in life encourage those who follow us to appreciate the journey? How do we who encounter those who believe they “know it all” to explore what they know in order to discover there is more? As my grandfather used to tell me, “Wisdom is the gift received when recognizing the limits of one’s knowledge.”
(NOTE: For a musical treat listen to Dan Foggleburg’s “The Higher I Climb” cut from his High Country Snow CD – see lyrics at the bottom on my web page, http://www.robertchapman.net/home1.htm )
23 June 2009
First-Person Language and the “Collegiate Drinking Problem”: Is a Problem a Problem Simply Because "Everyone" Says It Is?
In professional counseling the term “first-person language” refers to how a counseling professional refers to the individual being treated. Person-first language respects the fact that the person is not to be labeled as his or her diagnosis. For example, labeling someone as a diagnosis is to say, she is “a schizophrenic” or he is “an addict.” These forms of labeling are disrespectful to the individual. Person-first language is considerate and respectful. You are a person first, not the diagnosis you may have. For example, the person being seen is “an individual with a diagnosis of schizophrenia” or he or she is “a person with an addictive disorder.” Professionally, this translates into a clinical choice the counselor has to make: am I treating the diagnosis given to an individual I am seeing or am I treating an individual who happens to have a particular diagnosis?
In this post I pose the question: Does the fact that “some students choose to drink” and of these, “some" do so in a high-risk and dangerous ways that results in untoward consequences for themselves and/or others mean that “all” collegiate drinking is “the” problem that needs to be addressed in higher ed? Do not read more into this question than I intend...this is not a prelude to a piece on lowering the drinking age—I am pro-21—neither do I suggest that drinking is a “rite of passage” that all students should be permitted to enjoy; such would be totally naïve. What I do ask, however, is, as regards collegiate drinking, have we correctly identified who or what the focus is to which we should direct our attention and our resources?
Although a sizeable minority of college students choose not to drink—this number is estimated to be about 20% nationally—the majority acknowledge that they do, with perhaps 90%+ of college students in some geographic regions of the country admitting such. With “most” students acknowledging that they drink, at least occasionally, the bulk of the problems related to this collegiate drinking can be attributed to that heaviest drinking minority of collegiate drinkers, approximately 22% according to the Harvard School of Public Health reporting on its College Alcohol Study (CAS) referring to this group as “frequent binge-drinkers.” These are male students who consumes 5 or more drinks (4+ for women) during a drinking occasion at least twice during the two-week period prior to being surveyed. If we add to the “frequent binge-drinkers” those who “binge” only once in the two weeks prior to being survey, the number of collegiate drinkers in this group raises to approximately 44%, a sizeable increase—it doubles. This group accounts for almost all alcohol-related untoward incidents on campus and is therefore an important group to target with prevention and intervention efforts grounded in evidence-based “best practices.”
There is no doubt that these high-risk drinkers account for virtually all untoward incidents and this is cause for concern and represents a significant issue to address assertively. But the question remains, does this minority of student drinkers, however large, with its majority stake in the problems so frequently associated with collegiate drinking make “all” collegiate drinking “the” problem? This becomes a question of some significance when we consider the impact of an affirmative answer has on how policies are developed and where resources are allocated. This is not unlike suggesting that because some consumers eat an unhealthy diet, that fast food restaurants are the cause of heart disease and obesity or because some people commit crimes with guns, guns are the problem. NOTE: This does not mean there should not be gun control...there should. Likewise, this does not mean that I advocate deregulation of any and all industry...I believe that the absence of regulations is partly responsible for our current economic condition. Rather, the question I ask is: Is collegiate drinking “the” problem or is it the way some collegians drink that constitutes the problem?
To return to my opening analogy regarding “first-person language” and its impact on how individuals in counseling are viewed and, as a result, how they are treated...if we consider higher education “the individual,” is “collegiate drinking problem” the diagnosis by which we refer to it or do we recognize that some collegians who choose to drink have a problem and it is that problem that we need to address?
If interested you can read much more on this topic in my monograph, “When They Drink: Is Collegiate Drinking the Problem We Say It Is?” at http://www.rowan.edu/cas/resources/documents/CollegiateDrinking.doc.doc
In professional counseling the term “first-person language” refers to how a counseling professional refers to the individual being treated. Person-first language respects the fact that the person is not to be labeled as his or her diagnosis. For example, labeling someone as a diagnosis is to say, she is “a schizophrenic” or he is “an addict.” These forms of labeling are disrespectful to the individual. Person-first language is considerate and respectful. You are a person first, not the diagnosis you may have. For example, the person being seen is “an individual with a diagnosis of schizophrenia” or he or she is “a person with an addictive disorder.” Professionally, this translates into a clinical choice the counselor has to make: am I treating the diagnosis given to an individual I am seeing or am I treating an individual who happens to have a particular diagnosis?
In this post I pose the question: Does the fact that “some students choose to drink” and of these, “some" do so in a high-risk and dangerous ways that results in untoward consequences for themselves and/or others mean that “all” collegiate drinking is “the” problem that needs to be addressed in higher ed? Do not read more into this question than I intend...this is not a prelude to a piece on lowering the drinking age—I am pro-21—neither do I suggest that drinking is a “rite of passage” that all students should be permitted to enjoy; such would be totally naïve. What I do ask, however, is, as regards collegiate drinking, have we correctly identified who or what the focus is to which we should direct our attention and our resources?
Although a sizeable minority of college students choose not to drink—this number is estimated to be about 20% nationally—the majority acknowledge that they do, with perhaps 90%+ of college students in some geographic regions of the country admitting such. With “most” students acknowledging that they drink, at least occasionally, the bulk of the problems related to this collegiate drinking can be attributed to that heaviest drinking minority of collegiate drinkers, approximately 22% according to the Harvard School of Public Health reporting on its College Alcohol Study (CAS) referring to this group as “frequent binge-drinkers.” These are male students who consumes 5 or more drinks (4+ for women) during a drinking occasion at least twice during the two-week period prior to being surveyed. If we add to the “frequent binge-drinkers” those who “binge” only once in the two weeks prior to being survey, the number of collegiate drinkers in this group raises to approximately 44%, a sizeable increase—it doubles. This group accounts for almost all alcohol-related untoward incidents on campus and is therefore an important group to target with prevention and intervention efforts grounded in evidence-based “best practices.”
There is no doubt that these high-risk drinkers account for virtually all untoward incidents and this is cause for concern and represents a significant issue to address assertively. But the question remains, does this minority of student drinkers, however large, with its majority stake in the problems so frequently associated with collegiate drinking make “all” collegiate drinking “the” problem? This becomes a question of some significance when we consider the impact of an affirmative answer has on how policies are developed and where resources are allocated. This is not unlike suggesting that because some consumers eat an unhealthy diet, that fast food restaurants are the cause of heart disease and obesity or because some people commit crimes with guns, guns are the problem. NOTE: This does not mean there should not be gun control...there should. Likewise, this does not mean that I advocate deregulation of any and all industry...I believe that the absence of regulations is partly responsible for our current economic condition. Rather, the question I ask is: Is collegiate drinking “the” problem or is it the way some collegians drink that constitutes the problem?
To return to my opening analogy regarding “first-person language” and its impact on how individuals in counseling are viewed and, as a result, how they are treated...if we consider higher education “the individual,” is “collegiate drinking problem” the diagnosis by which we refer to it or do we recognize that some collegians who choose to drink have a problem and it is that problem that we need to address?
If interested you can read much more on this topic in my monograph, “When They Drink: Is Collegiate Drinking the Problem We Say It Is?” at http://www.rowan.edu/cas/resources/documents/CollegiateDrinking.doc.doc
16 June 2009
Wrestling Control from the Media: Considering the Methodology
The latest update on reported data concerning collegiate drinking was released earlier today - see http://www.sciencedaily.com/releases/2009/06/090615093919.htm. I have followed this story with interest, including its 2 previous iterations going back to the original 2002 NIAAA Call to Action.
We who are concerned about this issue have to be careful, however, when considering data such as those reported, that we do not read too much into them. It is easy to have an "Oh, my God, we are going to hell in a booze-soaked hand basket..." reaction. This is what the media seek as they are motivated to prompt such reactions from readers/viewers as these are what prompt us to visit web sites and purchases newspapers and magazines.
When we consider the methodology used to deduce the numbers reported in this update, however, there may be room to question its accurateness and therefore question the veracity of the findings...and again, I am not a researcher and therefore not fully qualified to vet Dr. Hingson's research. There is an interesting article that focuses on fuzzy methodology and how the media can sometime jump to wrong conclusions and create a whole new reality to which the general public reacts within its customary "knee-jerk" fashion. See White Blankets Many Make You Smarter and Other Questionable Social Science Findings by Gregory Blimling (http://media.wiley.com/assets/774/94/jrnls_ABC_JB_blimling903.pdf).
These questions regarding the methodology of the collegiate drinking death and injury statistics were raised by FoxNews (http://www.foxnews.com/story/0,2933,50104,00.html) following the publication of the original 2002 Call to Action by the NIAAA. The Bliming article presents a more reasoned consideration of the questions surrounding these data (see account of the methodology used on page 3 of the article), but the point remains…can we generalize results to a population somewhat different than that from which the original data were collected?
I do not question that the problems associated with collegiate drinking are legion. Neither do I wish to minimize those problems or suggest that Ralph Hingson is “Chicken Little.” I do believe, however, that we who work in the field of prevention need to look beyond the headlines offered by by the media regarding scientific reports. We need to read the actual research to which the media snippets refer, including an account of the methodology employed to generate the reported data, to determine for ourselves if, "...we're not making progress..." and that this should be "...very concerning" as Dr. Hingson states in the article.
It is easy to become cynical, which is the step-father of “burn-out.” We certainly have more work to do…and our work is cut out for us, but I suggest that we step back and look at the big picture and not allow the media to educate us on the realities of our own field.
Robert J. Chapman, PhD
The latest update on reported data concerning collegiate drinking was released earlier today - see http://www.sciencedaily.com/releases/2009/06/090615093919.htm. I have followed this story with interest, including its 2 previous iterations going back to the original 2002 NIAAA Call to Action.
We who are concerned about this issue have to be careful, however, when considering data such as those reported, that we do not read too much into them. It is easy to have an "Oh, my God, we are going to hell in a booze-soaked hand basket..." reaction. This is what the media seek as they are motivated to prompt such reactions from readers/viewers as these are what prompt us to visit web sites and purchases newspapers and magazines.
When we consider the methodology used to deduce the numbers reported in this update, however, there may be room to question its accurateness and therefore question the veracity of the findings...and again, I am not a researcher and therefore not fully qualified to vet Dr. Hingson's research. There is an interesting article that focuses on fuzzy methodology and how the media can sometime jump to wrong conclusions and create a whole new reality to which the general public reacts within its customary "knee-jerk" fashion. See White Blankets Many Make You Smarter and Other Questionable Social Science Findings by Gregory Blimling (http://media.wiley.com/assets/774/94/jrnls_ABC_JB_blimling903.pdf).
These questions regarding the methodology of the collegiate drinking death and injury statistics were raised by FoxNews (http://www.foxnews.com/story/0,2933,50104,00.html) following the publication of the original 2002 Call to Action by the NIAAA. The Bliming article presents a more reasoned consideration of the questions surrounding these data (see account of the methodology used on page 3 of the article), but the point remains…can we generalize results to a population somewhat different than that from which the original data were collected?
I do not question that the problems associated with collegiate drinking are legion. Neither do I wish to minimize those problems or suggest that Ralph Hingson is “Chicken Little.” I do believe, however, that we who work in the field of prevention need to look beyond the headlines offered by by the media regarding scientific reports. We need to read the actual research to which the media snippets refer, including an account of the methodology employed to generate the reported data, to determine for ourselves if, "...we're not making progress..." and that this should be "...very concerning" as Dr. Hingson states in the article.
It is easy to become cynical, which is the step-father of “burn-out.” We certainly have more work to do…and our work is cut out for us, but I suggest that we step back and look at the big picture and not allow the media to educate us on the realities of our own field.
Robert J. Chapman, PhD
10 June 2009
Screening and Brief Interventions as a Means to Prevent Underage Drinking
Regarding the appropriateness of brief interventions with 14 to 21 year old secondary ed students—or anyone of any age for that matter—such approaches work and are effective in motivating change in personal behavior. The interesting challenge inherent in a consideration of such interventions when considering the prevention of underage drinking is, can such an approach to intervening with or “treating” high-risk behavior be effective as a means of preventing: (1) high-risk behavior in general in a universal population, and/or (2) underage drinking altogether? Although I am not aware of research on this specific topic or pilot projects that have attempted to accomplish this—most of the research regarding the prevention of underage drinking with which I am aware has to do with using social norms marketing techniques with this age group (see http://alcohol.hws.edu/consultation/schools.htm)–I have been thinking about and have outlined an approach for this age group that does consider brief interventions as a prevention strategy.
The use of brief interventions based with high-risk and dangerous drinking among college students based on motivational interviewing (MI) and harm reduction (HR) has been pioneered at the University of Washington in what has affectionately become known as BASICS. This stands for Brief Alcohol Screening and Interventions for College Students. This has been shown to work exceptionally well with college students, primarily as an intervention for those students already engaged in drinking, be they underage or not. The approach uses MI as a way of establishing a rapport with college students in order to invite them to revisit their choices for drinking. Once revisited, students frequently move in the direction of change, essentially reducing risk (harm) by conducting what is called a “cost-benefit analysis” of one’s drinking. Essentially, this enables the student to ask him- or herself, "is what I get worth what I have to pay to get it?" (where “pay” refers to not only $ but time, missed classes, embarrassment, arrest/campus violations, grades, etc.). I know from years of personal experience employing this approach that students will frequently modify their behaviors significantly as the result of participating in such a program, but herein lies the rub with regards to the approach's utility as a strategy to prevent underage drinking…this personal change does not usually involve abstaining from drinking altogether.
The challenges when looking at the 14-21 year old population in secondary ed are: (1) There needs to be a clear message that no drinking is acceptable if a student is under 21 and, (2) reducing risk, while an objective we all have when working with students of any age, will never be tolerated by school boards or parents as the sole criterion of determining effective outcome of a prevention strategy as regards “underage” drinking. It is for this reason that I am developing—still in outline form—an approach that adapts the principles of BASICS for use in secondary ed. In short, instead of engaging college students as the actual drinkers in order to reduce "their" harm, engaging the secondary ed student as the friend of the underage drinker so as to become an agent of change. In essence the shift is from “therapeutic intervention” with an established high-risk drinker to student-on-student “social intervention.”
There is also an ancillary benefit in considering such an approach, namely, that one cannot learn how to intervene with a peer about drinking without considering his or her own personal decision about drinking in the process. The beauty of this strategy is that it does not target the student’s own use but rather targets student use in general by empowering students to become more proactive with their peers and thereby creating what is referred to as “cognitive dissonance,” which can result in personal change as a side effect. The down side is that it is questionable that such an approach would result in a discernible reduction in the overall number of underage drinkers, and this may make this idea totally untenable in a secondary ed setting. What is more likely is that the number of underage drinkers engaging in high-risk and dangerous behavior would diminish.
Ironically, while most parents are quick to point out the problems of underage drinking, most report that this was at least of passing interest in their pre-21 socializing. Consequently, many parents are supportive of preventing underage drinking, but what they are truly concerned about is not their sons or daughters consuming “2 12-oz beers in an evening out” but the consumption of enough to become impaired and engage in the 3-Vs so frequently reported in news accounts of “underage drinking” – vomiting, violence, and vandalism. To reduce the likelihood of the 3-Vs is significant…but perhaps unacceptable as a “stand alone” stated objective of a prevention strategy targeting underage individuals.
However, I stray from the simple focus of this essay…
Brief interventions are very effective. Brief interventions with 14-21 year old students are likely to be as effective as with anyone else. A topic appropriate for further discussion is, are there aspects of these techniques that are applicable to: (1) the 14 – 21 year-old secondary ed student, and (2) consistent with the overall agenda of a particular school district or community agency searching for an effective prevention strategyI look forward to further dialogue and perhaps the opportunity to chat if not meet in person.
Best regards,
Robert
Robert J. Chapman, PhD
Clinical Associate Professor of Behavioral Health Counseling
College of Nursing & Health Professions
Drexel University
245 N. 15th Street/MS507
Philadelphia, PA 19102
Office: 215-762-6922
Fax: 215-762-7889
http://www.robertchapman.net
LinkedIn profile: http://www.linkedin.com/in/rjchapman
Regarding the appropriateness of brief interventions with 14 to 21 year old secondary ed students—or anyone of any age for that matter—such approaches work and are effective in motivating change in personal behavior. The interesting challenge inherent in a consideration of such interventions when considering the prevention of underage drinking is, can such an approach to intervening with or “treating” high-risk behavior be effective as a means of preventing: (1) high-risk behavior in general in a universal population, and/or (2) underage drinking altogether? Although I am not aware of research on this specific topic or pilot projects that have attempted to accomplish this—most of the research regarding the prevention of underage drinking with which I am aware has to do with using social norms marketing techniques with this age group (see http://alcohol.hws.edu/consultation/schools.htm)–I have been thinking about and have outlined an approach for this age group that does consider brief interventions as a prevention strategy.
The use of brief interventions based with high-risk and dangerous drinking among college students based on motivational interviewing (MI) and harm reduction (HR) has been pioneered at the University of Washington in what has affectionately become known as BASICS. This stands for Brief Alcohol Screening and Interventions for College Students. This has been shown to work exceptionally well with college students, primarily as an intervention for those students already engaged in drinking, be they underage or not. The approach uses MI as a way of establishing a rapport with college students in order to invite them to revisit their choices for drinking. Once revisited, students frequently move in the direction of change, essentially reducing risk (harm) by conducting what is called a “cost-benefit analysis” of one’s drinking. Essentially, this enables the student to ask him- or herself, "is what I get worth what I have to pay to get it?" (where “pay” refers to not only $ but time, missed classes, embarrassment, arrest/campus violations, grades, etc.). I know from years of personal experience employing this approach that students will frequently modify their behaviors significantly as the result of participating in such a program, but herein lies the rub with regards to the approach's utility as a strategy to prevent underage drinking…this personal change does not usually involve abstaining from drinking altogether.
The challenges when looking at the 14-21 year old population in secondary ed are: (1) There needs to be a clear message that no drinking is acceptable if a student is under 21 and, (2) reducing risk, while an objective we all have when working with students of any age, will never be tolerated by school boards or parents as the sole criterion of determining effective outcome of a prevention strategy as regards “underage” drinking. It is for this reason that I am developing—still in outline form—an approach that adapts the principles of BASICS for use in secondary ed. In short, instead of engaging college students as the actual drinkers in order to reduce "their" harm, engaging the secondary ed student as the friend of the underage drinker so as to become an agent of change. In essence the shift is from “therapeutic intervention” with an established high-risk drinker to student-on-student “social intervention.”
There is also an ancillary benefit in considering such an approach, namely, that one cannot learn how to intervene with a peer about drinking without considering his or her own personal decision about drinking in the process. The beauty of this strategy is that it does not target the student’s own use but rather targets student use in general by empowering students to become more proactive with their peers and thereby creating what is referred to as “cognitive dissonance,” which can result in personal change as a side effect. The down side is that it is questionable that such an approach would result in a discernible reduction in the overall number of underage drinkers, and this may make this idea totally untenable in a secondary ed setting. What is more likely is that the number of underage drinkers engaging in high-risk and dangerous behavior would diminish.
Ironically, while most parents are quick to point out the problems of underage drinking, most report that this was at least of passing interest in their pre-21 socializing. Consequently, many parents are supportive of preventing underage drinking, but what they are truly concerned about is not their sons or daughters consuming “2 12-oz beers in an evening out” but the consumption of enough to become impaired and engage in the 3-Vs so frequently reported in news accounts of “underage drinking” – vomiting, violence, and vandalism. To reduce the likelihood of the 3-Vs is significant…but perhaps unacceptable as a “stand alone” stated objective of a prevention strategy targeting underage individuals.
However, I stray from the simple focus of this essay…
Brief interventions are very effective. Brief interventions with 14-21 year old students are likely to be as effective as with anyone else. A topic appropriate for further discussion is, are there aspects of these techniques that are applicable to: (1) the 14 – 21 year-old secondary ed student, and (2) consistent with the overall agenda of a particular school district or community agency searching for an effective prevention strategyI look forward to further dialogue and perhaps the opportunity to chat if not meet in person.
Best regards,
Robert
Robert J. Chapman, PhD
Clinical Associate Professor of Behavioral Health Counseling
College of Nursing & Health Professions
Drexel University
245 N. 15th Street/MS507
Philadelphia, PA 19102
Office: 215-762-6922
Fax: 215-762-7889
http://www.robertchapman.net
LinkedIn profile: http://www.linkedin.com/in/rjchapman
05 June 2009
What You Resist Persists - Carl Jung
This is an interesting brief video that may have a profound message for prevention professionals…or professionals of any stripe who are concerned about preventing “whatever.” Watch http://www.youtube.com/watch?v=95EH9G1c_4o
This reminds me of an exercise I do with students when we discuss working with clients who are preoccupied with negativism. I ask the students, in various voices and with varying words and descriptors to “not think about purple elephants with yellow spots.” I repeat the admonishment several times as described, but always in some variant of the negative…“Do not…” After “setting them up,” I then ask, “What are you thinking about right now?” and they always smile and say, sometimes in unison, “Purple elephants with yellow spots.”
I think I am going to switch to this youtube clip :)
Robert
Robert J. Chapman, PhD
Clinical Associate Professor of Behavioral Health Counseling
College of Nursing & Health Professions
Drexel University
245 N. 15th Street/MS507
Philadelphia, PA 19102
Office: 215-762-6922
Fax: 215-762-7889
http://www.robertchapman.net
LinkedIn profile: http://www.linkedin.com/in/rjchapman
This is an interesting brief video that may have a profound message for prevention professionals…or professionals of any stripe who are concerned about preventing “whatever.” Watch http://www.youtube.com/watch?v=95EH9G1c_4o
This reminds me of an exercise I do with students when we discuss working with clients who are preoccupied with negativism. I ask the students, in various voices and with varying words and descriptors to “not think about purple elephants with yellow spots.” I repeat the admonishment several times as described, but always in some variant of the negative…“Do not…” After “setting them up,” I then ask, “What are you thinking about right now?” and they always smile and say, sometimes in unison, “Purple elephants with yellow spots.”
I think I am going to switch to this youtube clip :)
Robert
Robert J. Chapman, PhD
Clinical Associate Professor of Behavioral Health Counseling
College of Nursing & Health Professions
Drexel University
245 N. 15th Street/MS507
Philadelphia, PA 19102
Office: 215-762-6922
Fax: 215-762-7889
http://www.robertchapman.net
LinkedIn profile: http://www.linkedin.com/in/rjchapman
02 June 2009
Responding to Resistance
In the introduction to Chapter 8, "Responding to Resistance" (p. 98) of Miller & Rollnick's Motivational Interviewing, 2nd Edition (2002)--and please note that this is a text that addresses alcohol and other substance abuse specifically, but I sense that its principles are applicable across the counseling spectrum--the authors suggest that some practitioners view resistance to therapy as something inherent in the client's character if not indicative of a presenting problem such as alcohol or other drug dependence, symptomatic, if you will, of the disorder to be treated. They argue that attributing client resistance to an inherent personality characteristic may be something of an erroneous assumption. This may be particularly apropos if the counselor's perception of client resistance is viewed as a clinical defense mechanism and the denial of "the problem" that must be breached if therapy is to progress. Miller & Rollnick suggest instead that resistance, "...to a significant extent, arises from the interpersonal interaction between counselor and client."
I found this argument provocative in light of my long standing problem with the traditional, "kick in the front door" S.W.A.T. team approach to "confronting" client denial and "breaking down" resistance to treatment as the prerequisite to change for addicted clients. These clients, presenting in what Prochaska would refer to as a "precontemplative" stage of readiness to change, are likely to be steeled in their resolve to resist what they must see as "attack therapy" with treatment offered by counselors that seem to suggest that, "addiction is the problem" and "my way or the highway" is the answer. As early as 1973 Lieberman, Yalom, & Miles (Encounter Groups: First Facts, NY: Basic Books) suggested that confrontational group therapy was likely to result in more harmful and adverse outcomes in therapy than alternative approaches. If the first order of clinical business for a practicing counselor or therapist is to "do not harm," then avoiding an iatrogenic result of that counseling may be what Miller and Rollnick are addressing in their argument that resistance is a result of interpersonal dynamics in a session rather than client pathology.
My grandfather used to say that you do not remove a hornet's nest on the porch by beating it with a stick. I am wondering if this was not a layman's equivalent to Miller and Rollnick's argument suggesting that resistance arises more from the interaction between client and practitioner than the pathology of the client...the bees were likely not resisting until the first blow from the stick
You can read more on "Motivational Interviewing" and "Stages of Readiness to Change" at my website, http://www.robertchapman.net...click "Treating Addictions" in the menu
Robert J. Chapman, PhD
http://www.robertchapman.net
LinkedIn profile: http://www.linkedin.com/in/rjchapman
In the introduction to Chapter 8, "Responding to Resistance" (p. 98) of Miller & Rollnick's Motivational Interviewing, 2nd Edition (2002)--and please note that this is a text that addresses alcohol and other substance abuse specifically, but I sense that its principles are applicable across the counseling spectrum--the authors suggest that some practitioners view resistance to therapy as something inherent in the client's character if not indicative of a presenting problem such as alcohol or other drug dependence, symptomatic, if you will, of the disorder to be treated. They argue that attributing client resistance to an inherent personality characteristic may be something of an erroneous assumption. This may be particularly apropos if the counselor's perception of client resistance is viewed as a clinical defense mechanism and the denial of "the problem" that must be breached if therapy is to progress. Miller & Rollnick suggest instead that resistance, "...to a significant extent, arises from the interpersonal interaction between counselor and client."
I found this argument provocative in light of my long standing problem with the traditional, "kick in the front door" S.W.A.T. team approach to "confronting" client denial and "breaking down" resistance to treatment as the prerequisite to change for addicted clients. These clients, presenting in what Prochaska would refer to as a "precontemplative" stage of readiness to change, are likely to be steeled in their resolve to resist what they must see as "attack therapy" with treatment offered by counselors that seem to suggest that, "addiction is the problem" and "my way or the highway" is the answer. As early as 1973 Lieberman, Yalom, & Miles (Encounter Groups: First Facts, NY: Basic Books) suggested that confrontational group therapy was likely to result in more harmful and adverse outcomes in therapy than alternative approaches. If the first order of clinical business for a practicing counselor or therapist is to "do not harm," then avoiding an iatrogenic result of that counseling may be what Miller and Rollnick are addressing in their argument that resistance is a result of interpersonal dynamics in a session rather than client pathology.
My grandfather used to say that you do not remove a hornet's nest on the porch by beating it with a stick. I am wondering if this was not a layman's equivalent to Miller and Rollnick's argument suggesting that resistance arises more from the interaction between client and practitioner than the pathology of the client...the bees were likely not resisting until the first blow from the stick
You can read more on "Motivational Interviewing" and "Stages of Readiness to Change" at my website, http://www.robertchapman.net...click "Treating Addictions" in the menu
Robert J. Chapman, PhD
http://www.robertchapman.net
LinkedIn profile: http://www.linkedin.com/in/rjchapman
22 May 2009
Adolescent Risk-Taking and Drinking
A truism in the field of alcohol, other drug, and violence prevention, at
least historically, has been that adolescent risk taking is the result of
impulsive choices driven by an under developed capacity to think rationally.
This belief has driven the work of AODV prevention professionals for
years...up to and including the present. But new research coming out of
Temple and Cornell Universities is suggesting that this staple of
conceptualizing prevention programming for high school and college
adolescents may need to be revisited...if not rethought.
" Decision research shows that adolescents make the risky judgments they do
because they are actually, in some ways, *more rational* than adults.
Grownups tend to quickly and intuitively grasp that certain risks (e.g.,
drunk driving, unprotected sex, and most anything involving sharks) are just
too great to be worth thinking about, so they don't proceed down the
"slippery slope" of actually calculating the odds. Adolescents, on the other
hand, actually take the time to weigh risks and benefits — possibly deciding
that the latter outweigh the former. (It is during adolescence, in fact,
that the parts of the frontal lobe that govern risk/reward calculations
undergo significant maturation.)" This is a quote from a piece published in
the Association of Psychological Science's Observer - see
http://www.psychologicalscience.org/observer/getArticle.cfm?id=2098 for the
full piece.
This is a very intriguing piece of information. If this is true--and the
science appears to exist to suggest that it is--this may mean that we
involved in the prevention of "high-risk" drinking and other drug use by
high school and college students may need to rethink our approach to
prevention, not to mention the term used to refer to the type of drinking
these students do. Most of us involved in the prevention of "high-risk"
collegiate drinking are aware of the controversy that has existed in the
field regarding how to refer to collegiate drinking since the Harvard School
of Public Health coined the term "binge drinking" in 1994 to refer to the
consumption of 4+ drinks for women and 5+ drinks for men during an outing.
The field has been divided as to the utility of this term when discussing
the phenomenon of collegiate drinking ever since - see my essay on the
subject -- http://www.robertchapman.net/essays/about.htm
In that 2003 essay I suggested referring to this type of collegiate drinking
as being "high-risk," but it would appear that this too may be no better a
moniker for this type of collegiate imbibing than is "binge drinking." If,
as I suspect, Drs. Reyna at Cornell and Farley at Temple are correct, we in
the prevention field need to not only rethink how we approach adolescents
with our prevention messages, but revisit the language we use when doing so
as well. If there is a "Type-T" personality (Thrill-seeking) as these
researches proffer, this type of student may actually be titillated by our
messages designed to reduce "high-risk" consumption. Perhaps Linda
Lederman's suggestion to refer to this type of collegiate drinking as
dangerous is the more appropriate way to proceed.
What do you think?
Best regards,
Robert
Read my three-monograph series, "When They Drink," at http://www.robertchapman.net and clicking "online resources"
15 May 2009
Understanding Co-Dependency Using Online Video
I respect the fact that the term “co-dependent” is at least troublesome for some who see it as just so much jargon and difficult to operationally define, but it is term to which we must nonetheless introduce our students—and a construct we best prepare them to address—if they are to work effectively in the addictions field. We cannot prepare our students to work with addictions without providing them with at least some understanding of and preparation for working with the families of addicted individuals and in particular, those “chief enablers” who are so often referred to as being “co-dependent.”To pursue addressing these issues with my students, I have always been hard pressed to explain “co-dependence” and “primary/chief enabler” in a clinical manner. Historically, I have found the work of Virginia Satir (“roles” in dysfunctional, or as I like to call them, chaotic families) and Salvitore Minuchin (regarding “boundaries”) to be most useful, I have always thought, however, as though I did not quite clear the bar when trying to “inform” my students about the dynamics of the relationship that exists between the addicted member of a significant relationship and his/her oft perceived manipulated if not “used” significant other. I have tried using classic Disney characters to both demonstrate the dynamic between aggressive males and “their women”—re-watch “Beauty and the Beast” (see http://www.youtube.com/watch?v=byaMd_PNyIY for YouTube clip on Disney’s impact on gender values/roles...in particular, from the 3-min point to end) and see what conclusion you draw as to what Disney is telling young woman...ney, “little girls”...about the role they should play when encountering controlling, demanding, and brutish men. Likewise I have used “The Simpsons” as the virtual personification of the addicted family with Marge as the stereotypical chief enabler. These have worked well and the clips serve to entertain students and hold their interest as well a proffer a somewhat better understanding of the family dynamics to which I am attempting to sensitize them. Again...progress is made, but I nonetheless do not believe that I clear the intended bar.
At the graduate level, practica and internships can provide the opportunity to observe these family dynamic “in vivo” and process them under supervision. For undergrads this experience is a bit more elusive, that is until I discovered a brace of videos on YouTube that present the opportunity to demonstrate this dynamic in such a way that students can experience a visceral reaction to what they are watching yet because the film does NOT involve addiction-affected relationships, this seems to free up discussion as I suspect that 20 to 25% of my students come from chaotic families and therefore have a difficult time openly discussing this topic because of their own unaddressed issues.
The videos are actual 2 parts of a short film, each part being approximately 10-min, entitled, “The Man on the Back.” Part I can be found at http://www.youtube.com/watch?v=T0m9iu6O3dg&feature=related and Part II at http://www.youtube.com/watch?v=1yDONtxVLLc&feature=related This film takes place in Iceland and the actors speak Icelandic with English subtitles, but surprisingly, this does not detract from the impact it has on students, at least my students seemed to enthusiastically respond to the film. The discussion of each part (paused the film periodically to discuss the changing dynamic) and the issues they bring to the surface regarding “how” dysfunctional/toxic relationships start and, more to the point, how they are/can be continued, often over extended periods in spite of escalating abuse, are most encouraging and I will continue to use these “visual aids” regarding this topic in the future.
Not knowing how long the videos will remain at these URLs, I downloaded both and saved to my hard drive so that I could ensure future use. In invite you to consider this film and correspond with me (rchapman@drexel.edu) as I am interested in your thoughts and more to the point, your ideas on how you might use the film in your classes.
Best regards,
Robert
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