The “Bic Syndrome”
There is a phenomenon in contemporary American culture that appears to be at least 20 years old. As a counselor who both teaches and practices the art of counseling, I have observed this phenomenon in both my students and the individuals with whom I do counseling throughout this period. I refer to this “quirk” in contemporary human behavior as the "Bic Syndrome."
While I must admit that I most frequently observe this phenomenon in clients who seek counseling to address a personal problem or students in the classroom who are more interested in a degree than the knowledge afforded by education, I have also noted the Bic Syndrome in part time employees in entry level positions, couples in relationships where the initial passion of the pursuit gives way to the challenges of learning to live together, and even those who believe that life’s offerings by a particular birthday are not fulfilling, boring, or just plain dull. The "Bic Syndrome" takes its name from the popular disposable razor so successfully marketed for the past 15 to 20 years.
The beauty of the disposable razor is that its relative economy allows one to simply discard the razor when it is perceived to be dull and replace it with another "new" and sharper one. There's no muss, no fuss, and no one thinks twice about the practice. Now with razors--and cigarette lighters for that matter--this may be convenient and economical. It would seem, however, that we have become something of a "disposable" society. It often seems easier and more convenient to discard an item that becomes “dull” or is “old” when compared to the latest model. Sometimes it even seems that we would rather discard and replace an item than invest the effort or time necessary to properly maintain or fix it. If this is true on any level, does it suggest that we have become a pleasure-seeking culture that believes it is somehow our right to expect immediate gratification and not have to tolerate things “inconvenient, dull or tedious”? To discard razors and lighters may be a relatively harmless practice in the grand scheme of things, but what happens if this “consumer’s view” of convenience affects our commitment to jobs, friends, or relationships, especially at those times that will always surface when they become dull or tedious or are in need of maintenance?
To a large extent, we humans know what we have learned and learn what we have been taught. Now, this does not mean that one cannot predetermine her/his own course in life and pursue the learning that permits the pursuit of a dream, but if one is overly involved in the Bic Syndrome, the desire for the newest, sharpest, brightest reality can undermine one's resolution to work on a problem relationship rather than to simply discard it and move one.
I have often overheared the rumblings of students about "how hard" school is and how "professors should know we have jobs and personal lives" when receiving an assignment that requires significant reading, field work, or unyielding demands for quality in papers or other assignments that require significant investments of time or effort. The expectation is that professors should "lighten-up" and required standards should be driven by the convenience of the student rather than the professor’s expectation of scholarship. While this may be a minority of students, I question if the "Bic Syndrome" has not affected our next generation of students. And what of the impact of the Bic Syndrome on relationships? What relationship maintains the same level of passion and intensity through month and years of togetherness that was present when the parties first became involved? How is it possible to avoid differences of opinion or the problems related to blending two independent personalities into the intimacy of a maturing relationship?
There is something to be said for the old "straight edge and razor strop" approach to maintaining the edge on one’s personal relationships. Richard Bach perhaps said it best in his book, Illusions, “There is no such thing as a problem without its gift inside. The reason we have problems is because we need their gifts.” To discover that my Bic razor no longer has an edge and I risk cutting myself if I shave with it may justify discarding the blade and replacing with a new one. But if I discover that my relationship with my kids or spouse or lover is strained or dull or requires maintenance, I think I will consider the lesson of the straight-edge and barber’s strop.
What do you think?
24 September 2009
16 September 2009
Changing collegiate drinking is a lot like ridding a lawn of dandelions: nothing changes until you address the taproot.
There is an interesting piece on collegiate drinking in the latest edition of Hazelden’s Recovery Matters – see http://www.hazelden.org/web/public/prev70430.page It is “sort of” right, in MHO :) To a certain extent, the article proffers what those of us familiar with the field of collegiate drinking might tend to view as “same ole, same ole.” The impetus for changing collegiate drinking is placed on changing the campus culture that supports that drinking. This is, as far as it goes, fine and not something of concern to me...there are things that campuses and communities can and should be doing to address this concern. What is of greater concern to me is the fact that the focus for such interventions and strategies to affect change is placed on external factors controlled by the administrators and other “adults,” that is, the “dominant culture” on campus, e.g., environmental management, and again this is good. But to solve the collegiate drinking problem is for “us” (adults) to change “them” (students)—and to suggest that all collegiate drinking is a problem necessitating a solution is perhaps misguided and another argument I have outlined in my 3rd monograph on collegiate drinking, “Is Collegiate Drinking the Problem We Think It Is?” (see http://bit.ly/DeeCg).
Although what is suggested in the Hazelden article is sound and appropriate to pursue, it is not all there is that needs to be pursued regarding high-risk and dangerous collegiate drinking. My argument has been that until and unless we understand: (1) the symbolic meaning that alcohol and drinking hold for contemporary collegians, (2) the process by which that meaning is ascribed by students...and more to the point, re-ascribed, and (3) how to employ that information to hasten the process by which students pass through the period of high-risk and dangerous drinking, “the problem” is not going to change. Because students essentially disagree with us that “any” drinking is a problem they will resist efforts by schools and their administrators to change their involvement in this behavior. And because what administrators are trying to change and what students perceived administrators trying to change are two different things, there will be continued resistance.
We need individual-based, campus-based, and community-based intervention as suggested in the article, but until and unless we acknowledge that what students perceive alcohol and drinking to be as icons of collegiate life and recognize the different from what administrators and parents and law enforcement professionals perceive them to be, we will continue to generate more heat than light when attempting to change the campus culture.
It is hubris on the part of administrators to think that they can ever end the use of all alcohol by college students--change how and when and where it is used, yes, but end it, not likely. And it is naïve to state that students do not arrive on campus already prepped if not preordained to engage in the type of drinking that has come to be described as “binge drinking.” The irony is that the very factor that fans the flames of collegiate drinking goes unnoticed if not ignored as an important determinant of this collegiate behavior. It is like the conflict that has existed in PA for sometime regarding efforts to regulate gun sales in Philadelphia.
For 20-years, the City of Philadelphia has tried to regulate the sale of guns. Each time this happens, Philly is told by Harrisburg that such regulation is not within the City’s purview. When the issue is then introduced in Harrisburg by Philly legislators, such efforts are soundly defeated. It would seem that “Philly” hates guns and “Harrisburg” loves them, but that is a biased and overly simplistic assessment of the difference. The issue is that Philly views guns as “weapons,” which it seeks to regulate for purposes of public safety, and Harrisburg views them as “recreational equipment” that are a right for residents to possess, use, and enjoy.
The language used by the legislators in Philly and in Harrisburg is the same, but the perception of these legislators as regards the symbolic meaning of the term being debated is different. A “gun” in Philly is used to break the law and reek havoc on the public whereas in most of the rest of PA, a gun is a sporting person's recreational device used in licensed hunting and recreational target shooting. In short, a gun is what the person referring to it says it is. This understanding will, in turn, affect how that person uses the gun and also how that individual responds to the efforts of another to “change the culture” surrounding the gun and its users. It is no different when we look at alcohol, drinking, and collegiate life.
It would seem logical that we can operationally define “alcohol” and “consumption/drinking,” but we would be wrong. Ask students, as I have for the past 20-years, what alcohol is and what drinking is and what these icons of collegiate life are and how they affect one’s collegiate experience and you will discover a different perspective than if asking student affairs professionals, law enforcement professionals, parents, and residents whose properties are contiguous to campus or student-occupied housing.
To end as I began, I do not take exception with most of what is suggested in the Hazelden article. What I suggest is that it does not look at the root of the issue. Like trying to clear your lawn of dandelions by just picking the blossoms, the next day the lawn is again full of dandelions. Until and unless the taproot is addressed, nothing changes...and the number of dandelions may actually expand. The “taproot” in collegiate drinking is the meaning students give to alcohol and drinking and therefore, the way to change the campus drinking culture is to change this meaning. Study what these icons of collegiate life mean, understand the dynamic that generates that meaning so we can better affect it and you will see a change in student behavior and many such individual changes equals a change in the campus culture. The irony is, this happens naturally in the maturing out phenomenon—I write about this in the 2nd of the 3 monographs I have written on collegiate drinking (see http://bit.ly/qrpJA). The problem is that this maturing out takes 2 to 3 years and a lot of the untoward consequences of collegiate drinking that are showcased on the NIAAA web page cited in the Hazelden article can happen during that time. If we can hasten this process we will not only reduce the untoward consequences, but change the campus culture. As experienced students change their behavior sooner they will influence less experienced students and instead of the negative peer pressure mentioned in the article, positive peer pressure can increase the likelihood of moderating behavior, a.k.a., change the campus drinking culture.
There is an interesting piece on collegiate drinking in the latest edition of Hazelden’s Recovery Matters – see http://www.hazelden.org/web/public/prev70430.page It is “sort of” right, in MHO :) To a certain extent, the article proffers what those of us familiar with the field of collegiate drinking might tend to view as “same ole, same ole.” The impetus for changing collegiate drinking is placed on changing the campus culture that supports that drinking. This is, as far as it goes, fine and not something of concern to me...there are things that campuses and communities can and should be doing to address this concern. What is of greater concern to me is the fact that the focus for such interventions and strategies to affect change is placed on external factors controlled by the administrators and other “adults,” that is, the “dominant culture” on campus, e.g., environmental management, and again this is good. But to solve the collegiate drinking problem is for “us” (adults) to change “them” (students)—and to suggest that all collegiate drinking is a problem necessitating a solution is perhaps misguided and another argument I have outlined in my 3rd monograph on collegiate drinking, “Is Collegiate Drinking the Problem We Think It Is?” (see http://bit.ly/DeeCg).
Although what is suggested in the Hazelden article is sound and appropriate to pursue, it is not all there is that needs to be pursued regarding high-risk and dangerous collegiate drinking. My argument has been that until and unless we understand: (1) the symbolic meaning that alcohol and drinking hold for contemporary collegians, (2) the process by which that meaning is ascribed by students...and more to the point, re-ascribed, and (3) how to employ that information to hasten the process by which students pass through the period of high-risk and dangerous drinking, “the problem” is not going to change. Because students essentially disagree with us that “any” drinking is a problem they will resist efforts by schools and their administrators to change their involvement in this behavior. And because what administrators are trying to change and what students perceived administrators trying to change are two different things, there will be continued resistance.
We need individual-based, campus-based, and community-based intervention as suggested in the article, but until and unless we acknowledge that what students perceive alcohol and drinking to be as icons of collegiate life and recognize the different from what administrators and parents and law enforcement professionals perceive them to be, we will continue to generate more heat than light when attempting to change the campus culture.
It is hubris on the part of administrators to think that they can ever end the use of all alcohol by college students--change how and when and where it is used, yes, but end it, not likely. And it is naïve to state that students do not arrive on campus already prepped if not preordained to engage in the type of drinking that has come to be described as “binge drinking.” The irony is that the very factor that fans the flames of collegiate drinking goes unnoticed if not ignored as an important determinant of this collegiate behavior. It is like the conflict that has existed in PA for sometime regarding efforts to regulate gun sales in Philadelphia.
For 20-years, the City of Philadelphia has tried to regulate the sale of guns. Each time this happens, Philly is told by Harrisburg that such regulation is not within the City’s purview. When the issue is then introduced in Harrisburg by Philly legislators, such efforts are soundly defeated. It would seem that “Philly” hates guns and “Harrisburg” loves them, but that is a biased and overly simplistic assessment of the difference. The issue is that Philly views guns as “weapons,” which it seeks to regulate for purposes of public safety, and Harrisburg views them as “recreational equipment” that are a right for residents to possess, use, and enjoy.
The language used by the legislators in Philly and in Harrisburg is the same, but the perception of these legislators as regards the symbolic meaning of the term being debated is different. A “gun” in Philly is used to break the law and reek havoc on the public whereas in most of the rest of PA, a gun is a sporting person's recreational device used in licensed hunting and recreational target shooting. In short, a gun is what the person referring to it says it is. This understanding will, in turn, affect how that person uses the gun and also how that individual responds to the efforts of another to “change the culture” surrounding the gun and its users. It is no different when we look at alcohol, drinking, and collegiate life.
It would seem logical that we can operationally define “alcohol” and “consumption/drinking,” but we would be wrong. Ask students, as I have for the past 20-years, what alcohol is and what drinking is and what these icons of collegiate life are and how they affect one’s collegiate experience and you will discover a different perspective than if asking student affairs professionals, law enforcement professionals, parents, and residents whose properties are contiguous to campus or student-occupied housing.
To end as I began, I do not take exception with most of what is suggested in the Hazelden article. What I suggest is that it does not look at the root of the issue. Like trying to clear your lawn of dandelions by just picking the blossoms, the next day the lawn is again full of dandelions. Until and unless the taproot is addressed, nothing changes...and the number of dandelions may actually expand. The “taproot” in collegiate drinking is the meaning students give to alcohol and drinking and therefore, the way to change the campus drinking culture is to change this meaning. Study what these icons of collegiate life mean, understand the dynamic that generates that meaning so we can better affect it and you will see a change in student behavior and many such individual changes equals a change in the campus culture. The irony is, this happens naturally in the maturing out phenomenon—I write about this in the 2nd of the 3 monographs I have written on collegiate drinking (see http://bit.ly/qrpJA). The problem is that this maturing out takes 2 to 3 years and a lot of the untoward consequences of collegiate drinking that are showcased on the NIAAA web page cited in the Hazelden article can happen during that time. If we can hasten this process we will not only reduce the untoward consequences, but change the campus culture. As experienced students change their behavior sooner they will influence less experienced students and instead of the negative peer pressure mentioned in the article, positive peer pressure can increase the likelihood of moderating behavior, a.k.a., change the campus drinking culture.
08 September 2009
Conducting Assessments of Drinking/Substance Use
A reader contacted me asking my thoughts on conducting assessment and which instruments I might recommend...good topic and question, although I may not have “the” answer...I do have an opinion and a couple thoughts...
I find the BASICS (Brief Alcohol Screening and Intervention with College Students) approach to provide the best “assessment.” Although it does not yield a “likelihood” of a particular pathology or individual scales that can be indicative of co-occurring issues like the SASSI (Substance Abuse Subtle Screening Inventory), its opportunity to provide genuine feedback in a “what do you think” manner open more conversations and ultimate referrals than other “instruments.” That said, I do like the ASI (Addiction Severity Index) as it is relatively non-invasive when administered by a trained practitioner and its results tie in nicely with the development of a formal treatment plan, although it is something of a bear to administer and can take time. It is also not likely that a pre-contemplative or even a contemplative (early stage of readiness to change) client will be very helpful/compliant in completing the ASI.
I have found that the old standards work quite well too – MAST, CAGE, etc. — but I have modified their use. Instead of ask the questions associated with these screening tools, I answer them for the client after having invited the client to share his/her story. This “narrative” approach accomplished 2 things: (1) it recognizes that clients are “more willing to share their stories” with someone willing to listen than to “tell an ‘interrogator’ their business” and, (2) I can always answer questions like the closed-ended MAST or CAGE based on a history in which the client has addressed these “areas” in response to individual open-ended questions intended to facilitate conversation. Coincidentally, by the time I have listened to a client’s story, perhaps through 2 sessions, I have often earned my “street creds” that enable me to provide the feedback, including an interpretation of the MAST and CAGE without having the client, “up and run.”
Almost as an aside, how one looks at assessments is as important a determinant affecting outcome as is what is done during the assessment. For example, if I am interested in uncovering pathology and categorizing problems, I will approach the individual with whom I am working in a different manner than if I am interested in encouraging that individual to look at the “facts” in his or her life from a different perspective in order to better answer the basic question, “Is what I am getting worth what I have to pay to get it.” The “old objective” suggests that it is “me,” the practitioner, who needs to know what is really going on with a client so that I can then “fix the problem.” This works well when the ‘patient’ has shoulder problems and a diagnosis of a torn rotator cuff is made and a surgical intervention is planned to fix the problem. Such an approach, I believe, is not quite so well suited to interacting with a substance using individual in order to “address the drug problem.”
We know from the literature and research done on Motivational Interviewing that the old “you have a problem and I know this because of these diagnostic symptoms and this is how you can fix it” approach does not work well...as a matter of fact this results in counseling being more about “wrestling” with clients than “dancing” with them to borrow from Wm. Miller’s metaphor. If I approach assessment as not so much the pursuit of what “I need” to “fix your problem,” but rather a process by which I invite the individual to consider the facts related to personal use in such as to more accurately answer the question, “is what you get worth what it costs you to get it,” then the outcome can be much different. It is something akin to the City Slicker’s experience in this old “Pa and Pa Kettle” movie clip from the 40s – see http://www.youtube.com/watch?v=yG7vq0EMvgE In the clip Ma & Pa argue their position much like individuals with no intention of changing behavior argue theirs, in other words, like many collegians when approached about their drinking...I do not need to change because you are wrong in your assertion that a problem exists. If the goal of counseling is to show the client the errors of his or her way, then this is a contest where someone can only win by someone else losing. Traditional assessment tools often facilitate this “battle of the wills” approach to addressing questions related to drinking “problems.”
To summarize, we professional counselors have to assess client needs before attempting to treat them. But the onus is on us to determine why we are doing this. If it is so I know if John or Mary has problem “X” or not, that may yield an entirely different result—mind you, not necessarily “wrong,” just different—than if my quest is to invite John and Mary to looks at the facts in their lives from a different perspective. Remember Sandra Anise Barnes’ quote, “It’s so hard when I have to, and so easy when I want to.” It is like someone living in Boston considering how to get to Philadelphia...is I-95 always (ever?) the best way? The answer is, “it depends.” If the assessment process helps us better articulate the variables that affect the admonition, “it depends,” I submit that the assessment process will be beneficial. If, however, the assessment is to stockpile facts and evidence to prove why the client is wrong or quantify “the problem,” I am not so sure the result is the same.
What do you think?
A reader contacted me asking my thoughts on conducting assessment and which instruments I might recommend...good topic and question, although I may not have “the” answer...I do have an opinion and a couple thoughts...
I find the BASICS (Brief Alcohol Screening and Intervention with College Students) approach to provide the best “assessment.” Although it does not yield a “likelihood” of a particular pathology or individual scales that can be indicative of co-occurring issues like the SASSI (Substance Abuse Subtle Screening Inventory), its opportunity to provide genuine feedback in a “what do you think” manner open more conversations and ultimate referrals than other “instruments.” That said, I do like the ASI (Addiction Severity Index) as it is relatively non-invasive when administered by a trained practitioner and its results tie in nicely with the development of a formal treatment plan, although it is something of a bear to administer and can take time. It is also not likely that a pre-contemplative or even a contemplative (early stage of readiness to change) client will be very helpful/compliant in completing the ASI.
I have found that the old standards work quite well too – MAST, CAGE, etc. — but I have modified their use. Instead of ask the questions associated with these screening tools, I answer them for the client after having invited the client to share his/her story. This “narrative” approach accomplished 2 things: (1) it recognizes that clients are “more willing to share their stories” with someone willing to listen than to “tell an ‘interrogator’ their business” and, (2) I can always answer questions like the closed-ended MAST or CAGE based on a history in which the client has addressed these “areas” in response to individual open-ended questions intended to facilitate conversation. Coincidentally, by the time I have listened to a client’s story, perhaps through 2 sessions, I have often earned my “street creds” that enable me to provide the feedback, including an interpretation of the MAST and CAGE without having the client, “up and run.”
Almost as an aside, how one looks at assessments is as important a determinant affecting outcome as is what is done during the assessment. For example, if I am interested in uncovering pathology and categorizing problems, I will approach the individual with whom I am working in a different manner than if I am interested in encouraging that individual to look at the “facts” in his or her life from a different perspective in order to better answer the basic question, “Is what I am getting worth what I have to pay to get it.” The “old objective” suggests that it is “me,” the practitioner, who needs to know what is really going on with a client so that I can then “fix the problem.” This works well when the ‘patient’ has shoulder problems and a diagnosis of a torn rotator cuff is made and a surgical intervention is planned to fix the problem. Such an approach, I believe, is not quite so well suited to interacting with a substance using individual in order to “address the drug problem.”
We know from the literature and research done on Motivational Interviewing that the old “you have a problem and I know this because of these diagnostic symptoms and this is how you can fix it” approach does not work well...as a matter of fact this results in counseling being more about “wrestling” with clients than “dancing” with them to borrow from Wm. Miller’s metaphor. If I approach assessment as not so much the pursuit of what “I need” to “fix your problem,” but rather a process by which I invite the individual to consider the facts related to personal use in such as to more accurately answer the question, “is what you get worth what it costs you to get it,” then the outcome can be much different. It is something akin to the City Slicker’s experience in this old “Pa and Pa Kettle” movie clip from the 40s – see http://www.youtube.com/watch?v=yG7vq0EMvgE In the clip Ma & Pa argue their position much like individuals with no intention of changing behavior argue theirs, in other words, like many collegians when approached about their drinking...I do not need to change because you are wrong in your assertion that a problem exists. If the goal of counseling is to show the client the errors of his or her way, then this is a contest where someone can only win by someone else losing. Traditional assessment tools often facilitate this “battle of the wills” approach to addressing questions related to drinking “problems.”
To summarize, we professional counselors have to assess client needs before attempting to treat them. But the onus is on us to determine why we are doing this. If it is so I know if John or Mary has problem “X” or not, that may yield an entirely different result—mind you, not necessarily “wrong,” just different—than if my quest is to invite John and Mary to looks at the facts in their lives from a different perspective. Remember Sandra Anise Barnes’ quote, “It’s so hard when I have to, and so easy when I want to.” It is like someone living in Boston considering how to get to Philadelphia...is I-95 always (ever?) the best way? The answer is, “it depends.” If the assessment process helps us better articulate the variables that affect the admonition, “it depends,” I submit that the assessment process will be beneficial. If, however, the assessment is to stockpile facts and evidence to prove why the client is wrong or quantify “the problem,” I am not so sure the result is the same.
What do you think?
30 August 2009
IN-Patient Treatment for Internet Addiction?
Last week, Mashable.com reported, "First U. S. Rehab Center for Internet Addiction Opens Its Doors." In the story, the case of a 19-year-old male who "could not remove himself from World of Warcraft," a popular online multi-player war game, was used to segue to an essay on inpatient treatment for Internet addiction. This prompted a rather provocative question from a reader: "I'm not sure I buy it. I spent two years in grad school reading books 16 hours a day and not going out in the 'real world.' Should I have ponied up $15k for some 'education' rehab?"
The “treatment” provided the 19-year-old is treatment for what is referred to as a “process addiction,” something akin to gambling or sex “addiction.” As with any addiction, a diagnosis can only be made when several diagnostic criteria have been met…and as the article reports, these have yet to be quantified in the Diagnostic and Statistical Manual of Mental Diseases for Internet addiction. Generally, the “non-scientific” diagnostic criteria for addiction include: (1) compulsive behavior that is (2) chronic and (3) continues in spite of known associated negative consequences, and (4) attempts at changing the behavior result in relapse (meaning a return to the compulsive behavior). With gambling and sexual addictions, which not only meet these criteria, but result in demonstrable chemical changes in the brain, a key element in discerning why process addictions are considered by many to be true “addictions" even though the individual does not consume a psychoactive substance (see "Gamblers's Brains") is met.
Clearly the jury is still out on this with many behaviorally oriented practitioners seeing process addiction as being more the result of “cognition and/or learned behavior” than “organic and/or physical processes." That said, there are demonstrable chemical changes (able to be documented with PET scans) that occur when addicted individuals are presented non-substance related stimuli. This means that the reward pathway in the brain is activated by behavior in a similar fashion to when psychoactive substances--or anticipation of their use--are administered (see Drugs Alter the Brain's Reward Pathway). In the case of the experienced user, it is the anticipation of the chemical that results in these chemical changes in the brain; in the gambler—and perhaps the video gamer cited in the article—it is the behavior that results in the stimulation of the chemical rewards that translate into “addiction,” i.e., “compulsion,” “chronicity,” and “relapse.”
Although one may have spent 16-hours a day reading and studying when in grad schools, the reasons for doing so were different than those of the 19-year old “addicted” to War Craft. In addition, once an individual completed his or her degree—the reason those hours were spent studying—the “studying behavior" changed without negative consequences, i.e., “withdrawal.” True, the student may have learned to enjoy this studying behavior/pattern and may continue that behavior to this day, but likely in a significantly different way, not to mention that the change was not marked by repeated failures to realize the change. In short there is a difference between engaging in a behavior because you “cannot not” stop and continuing a behavior because it is a means to a desired end. Eating is a good example of this.
Compulsive eaters, a.k.a., "food addicts," cannot not eat—or cannot not binge and purge, etc. Their treatment does not have the same goal, however, as treatment for a cocaine or alcohol dependency—abstinence, although some still argue that abstinence is not necessary as a condition of change when treating substance use disorders, but this is a topic for another discussion. The objective of treatment for this individual is to establish a new and different “relationship with food,” a constructive rather than destructive relationship. Whereas one can live without alcohol or heroin, one cannot live without food, hence, the objective of treatment for the two similar disorders is different. What is not clear in the cited Mashable article is if the objective of the treatment is abstinence from the Internet or learning to use it constructively; I suspect that the objective is similar to that in treating gambling…abstinence.
In short, I am not sure, yet, where I stand on the need for in-patient treatment or 12-step groups for Internet Addicted individuals. I do embrace the argument that “treatment” in the form of counseling and behaviorally oriented skills training can be useful, but then I believe that most people can benefit from “counseling’ where the focus is either overcoming obstacles that preclude success in a particular area of one’s life and/or learning new skills that allow one to move towards realizing a stated goal.
I suspect that as we learn more about dependence (a.k.a. addiction) we will learn that there are behavioral stimuli that initiate the same physiological and neurological responses seen in individuals addicted to psychoactive substances. I have watched the addictions field progress far in the last 35 years and it is likely that we have but "merely opened the book" on what there is to be known. There is compelling information to argue that "Internet addiction" is a real disorder, but documenting that--and more importantly--identifying the best course of treatment remains to be seen.
What do you think? Leave a comment.
Last week, Mashable.com reported, "First U. S. Rehab Center for Internet Addiction Opens Its Doors." In the story, the case of a 19-year-old male who "could not remove himself from World of Warcraft," a popular online multi-player war game, was used to segue to an essay on inpatient treatment for Internet addiction. This prompted a rather provocative question from a reader: "I'm not sure I buy it. I spent two years in grad school reading books 16 hours a day and not going out in the 'real world.' Should I have ponied up $15k for some 'education' rehab?"
The “treatment” provided the 19-year-old is treatment for what is referred to as a “process addiction,” something akin to gambling or sex “addiction.” As with any addiction, a diagnosis can only be made when several diagnostic criteria have been met…and as the article reports, these have yet to be quantified in the Diagnostic and Statistical Manual of Mental Diseases for Internet addiction. Generally, the “non-scientific” diagnostic criteria for addiction include: (1) compulsive behavior that is (2) chronic and (3) continues in spite of known associated negative consequences, and (4) attempts at changing the behavior result in relapse (meaning a return to the compulsive behavior). With gambling and sexual addictions, which not only meet these criteria, but result in demonstrable chemical changes in the brain, a key element in discerning why process addictions are considered by many to be true “addictions" even though the individual does not consume a psychoactive substance (see "Gamblers's Brains") is met.
Clearly the jury is still out on this with many behaviorally oriented practitioners seeing process addiction as being more the result of “cognition and/or learned behavior” than “organic and/or physical processes." That said, there are demonstrable chemical changes (able to be documented with PET scans) that occur when addicted individuals are presented non-substance related stimuli. This means that the reward pathway in the brain is activated by behavior in a similar fashion to when psychoactive substances--or anticipation of their use--are administered (see Drugs Alter the Brain's Reward Pathway). In the case of the experienced user, it is the anticipation of the chemical that results in these chemical changes in the brain; in the gambler—and perhaps the video gamer cited in the article—it is the behavior that results in the stimulation of the chemical rewards that translate into “addiction,” i.e., “compulsion,” “chronicity,” and “relapse.”
Although one may have spent 16-hours a day reading and studying when in grad schools, the reasons for doing so were different than those of the 19-year old “addicted” to War Craft. In addition, once an individual completed his or her degree—the reason those hours were spent studying—the “studying behavior" changed without negative consequences, i.e., “withdrawal.” True, the student may have learned to enjoy this studying behavior/pattern and may continue that behavior to this day, but likely in a significantly different way, not to mention that the change was not marked by repeated failures to realize the change. In short there is a difference between engaging in a behavior because you “cannot not” stop and continuing a behavior because it is a means to a desired end. Eating is a good example of this.
Compulsive eaters, a.k.a., "food addicts," cannot not eat—or cannot not binge and purge, etc. Their treatment does not have the same goal, however, as treatment for a cocaine or alcohol dependency—abstinence, although some still argue that abstinence is not necessary as a condition of change when treating substance use disorders, but this is a topic for another discussion. The objective of treatment for this individual is to establish a new and different “relationship with food,” a constructive rather than destructive relationship. Whereas one can live without alcohol or heroin, one cannot live without food, hence, the objective of treatment for the two similar disorders is different. What is not clear in the cited Mashable article is if the objective of the treatment is abstinence from the Internet or learning to use it constructively; I suspect that the objective is similar to that in treating gambling…abstinence.
In short, I am not sure, yet, where I stand on the need for in-patient treatment or 12-step groups for Internet Addicted individuals. I do embrace the argument that “treatment” in the form of counseling and behaviorally oriented skills training can be useful, but then I believe that most people can benefit from “counseling’ where the focus is either overcoming obstacles that preclude success in a particular area of one’s life and/or learning new skills that allow one to move towards realizing a stated goal.
I suspect that as we learn more about dependence (a.k.a. addiction) we will learn that there are behavioral stimuli that initiate the same physiological and neurological responses seen in individuals addicted to psychoactive substances. I have watched the addictions field progress far in the last 35 years and it is likely that we have but "merely opened the book" on what there is to be known. There is compelling information to argue that "Internet addiction" is a real disorder, but documenting that--and more importantly--identifying the best course of treatment remains to be seen.
What do you think? Leave a comment.
24 August 2009
Keeping Up with The Field
My grandfather used to say, “Wisdom is the gift received when recognizing the limits of one’s knowledge.” The more aware I became of the limits of my knowledge related to addiction and AOD issues in general, the more I sought out direct and indirect sources of that information. When first entering the field of addiction treatment in the early 70s I invested time in several activities that continue to pay dividends to this day. This entry is intended to share a few of this "FYI."
(1)Attend open 12-step meetings. It is at such meetings that one can learn about addiction and recovery (and the “early years,” perhaps before addiction, which can be useful when doing counseling with collegians).
(2)Training opportunities where funding may very well support doing so, but also look into “free” workshops and seminars that were available in the community. In the 21st century, this is somewhat easier in that there are online seminars and discussion groups as well as workshops run by different treatment programs and such. NOTE: Addiction treatment programs or hospitals in your area sponsor free monthly free workshops. NOTE: Not only are such workshops useful for what can be learned, but also (and perhaps more importantly) for who you can meet professionally.
(3) Read as much as you can on the topic(s) of your choice. Although no one can ever read “everything” that is available to be read, here are some tricks you can try to increase the amount of information you can expose yourself to. For example, you can do a key word search for journal articles that have several keywords that related to a topic of interest. For example, you can search “collegiate drinking,” “prevention” and “strategies.” You can do this at http://scholar.google.com (or just plain google.com) or one of the online databases, for example, project CORK at Dartmouth (http://www.projectcork.org/) or NIAAA’s ETOH database (see http://etoh.niaaa.nih.gov/). If you search at a database and get “X” hits, read the abstracts for the more interesting ones or just the first 5 or 10 or however many. These abstracts give you a sense of what is happening as well as what is being published.
For those abstracts you find interesting (or for anything else you may find online that is interesting and in print form) you can download the .doc or .pdf (or “.whatever” text file) and then convert it to a mp3 audio file at http://zamzar.com and then listen to it on you mp3 player when commuting or exercising, etc. NOTE: It takes a few minutes to get used to listening to the computerized “text-to-speech” syntax, but once you catch on, it is an easy way to “read" more stuff related to a topic of interest.
(4) As they say in AA, look around for someone who has what you want and then get to know that person. In AA it is called “getting a sponsor”; in professional development it is called finding a mentor(s). Ask that person if you can meet and chat. Invite the person to coffee. Ask if you can exchange emails. In short, do what you can to learn from that individual(s). You may need to invest some time in traveling to that person’s office or suggested location, but once a month or however often you do this can be a small investment for what you get in return…and you are not restricted to one mentor at a time
(5) Join several listserv discussion groups and/or sign up for daily or weekly email reports on “what’s what” in your chose field. For example, you can get daily news from http://www.JoinTogether.org or “drug and alcohol findings” at http://findings.org.uk/ In short, there are likely “countless” places where you can have folks send you snippets of information on a regular basis and you read what you have time/interest to read. Add to this the countless blogs and pod
casts that are available and you have more than enough to keep you busy with your “knowledge quest” for years to come
If you have additional suggestions,please leave a comment.
Robert
My grandfather used to say, “Wisdom is the gift received when recognizing the limits of one’s knowledge.” The more aware I became of the limits of my knowledge related to addiction and AOD issues in general, the more I sought out direct and indirect sources of that information. When first entering the field of addiction treatment in the early 70s I invested time in several activities that continue to pay dividends to this day. This entry is intended to share a few of this "FYI."
(1)Attend open 12-step meetings. It is at such meetings that one can learn about addiction and recovery (and the “early years,” perhaps before addiction, which can be useful when doing counseling with collegians).
(2)Training opportunities where funding may very well support doing so, but also look into “free” workshops and seminars that were available in the community. In the 21st century, this is somewhat easier in that there are online seminars and discussion groups as well as workshops run by different treatment programs and such. NOTE: Addiction treatment programs or hospitals in your area sponsor free monthly free workshops. NOTE: Not only are such workshops useful for what can be learned, but also (and perhaps more importantly) for who you can meet professionally.
(3) Read as much as you can on the topic(s) of your choice. Although no one can ever read “everything” that is available to be read, here are some tricks you can try to increase the amount of information you can expose yourself to. For example, you can do a key word search for journal articles that have several keywords that related to a topic of interest. For example, you can search “collegiate drinking,” “prevention” and “strategies.” You can do this at http://scholar.google.com (or just plain google.com) or one of the online databases, for example, project CORK at Dartmouth (http://www.projectcork.org/) or NIAAA’s ETOH database (see http://etoh.niaaa.nih.gov/). If you search at a database and get “X” hits, read the abstracts for the more interesting ones or just the first 5 or 10 or however many. These abstracts give you a sense of what is happening as well as what is being published.
For those abstracts you find interesting (or for anything else you may find online that is interesting and in print form) you can download the .doc or .pdf (or “.whatever” text file) and then convert it to a mp3 audio file at http://zamzar.com and then listen to it on you mp3 player when commuting or exercising, etc. NOTE: It takes a few minutes to get used to listening to the computerized “text-to-speech” syntax, but once you catch on, it is an easy way to “read" more stuff related to a topic of interest.
(4) As they say in AA, look around for someone who has what you want and then get to know that person. In AA it is called “getting a sponsor”; in professional development it is called finding a mentor(s). Ask that person if you can meet and chat. Invite the person to coffee. Ask if you can exchange emails. In short, do what you can to learn from that individual(s). You may need to invest some time in traveling to that person’s office or suggested location, but once a month or however often you do this can be a small investment for what you get in return…and you are not restricted to one mentor at a time
(5) Join several listserv discussion groups and/or sign up for daily or weekly email reports on “what’s what” in your chose field. For example, you can get daily news from http://www.JoinTogether.org or “drug and alcohol findings” at http://findings.org.uk/ In short, there are likely “countless” places where you can have folks send you snippets of information on a regular basis and you read what you have time/interest to read. Add to this the countless blogs and pod
casts that are available and you have more than enough to keep you busy with your “knowledge quest” for years to come
If you have additional suggestions,please leave a comment.
Robert
17 August 2009
There is an interesting article in today's Washington Post. The article, entitled, "It's Time to Legalize Drugs," by Peter Moskos and Stanford "Neill" Franklin is representative of a growing public opinion regarding drugs and more particularly, an opinion on our historically moralistic public policy on addressing their use. Although I am an advocate of changes in this policy, I am not sure the views expressed in the Post article are in our best interest as a country in the long run. Allow me to first comment on the positive points the authors make...there are two:
1. If drugs were legal then drugs could be prepared like any other commodity. This would move production out of the back alley and place it under the scrutiny of some regulatory body that could ensure that what is sold in Philly is the same as what is sold in DC as in LA, etc. In short, there is something to be said for regulating production from a harm reduction point of view...less harm to the individual who consumes the drug and less harm (most likely in the form of financial savings) to the public when it does not have to pay for the consequences of consuming “bad” drugs.
2. There is a lot of money to be saved and made by legalizing drugs. Regarding savings, the billions of dollars are no longer spent on interdiction and other law enforcement efforts to stop manufacture and distribution, to prosecute offenders, to incarcerate offenders, etc. Regarding earning, the state and federal taxes to be collected. Ironically, most drugs of abuse could be manufactured inexpensively and then taxed in an outrageous fashion and still be no more expensive to the consumer than they are now.
As attractive as these two “benefits” of legalization may be, they do not, however, off-set the potential consequences. The biggest “drug problems” we have in this country—and likely this is true around the world—is with those drugs that are already legal...alcohol (ethanol) and tobacco (nicotine). These substances are regulated and taxed yet they are together many times more costly to us as a nation than all illicit drug use combined. This is to suggest that making substances “legal” is not to redeem the country or any of its residents from the consequences associated with the use of the now legal drugs. Add to this that some of the more popular illicit drugs of abuse, namely prescription drugs taken without a prescription, are already legal and this just adds to the argument that legalization is not, in and of itself, a solution to "the drug problem."
I liken legalization of drugs as a solution to building more roads to solve the traffic problem. There may be an immediate beneficial result from the effort, but as driving becomes easier, more individuals will choose to drive and this leads to more vehicles on the road, which results eventually in a return of the original traffic problem. Legalization may appear to be a fix, but it would be a band aid on a major, hemorrhaging wound, addiction and other substance use disorders. True, marijuana would probably result in far more people “using” the substance than “abusing,” it, something on a par with alcohol, but consider that 10% of drinkers consume 50% of all alcohol consumed and you can begin to see how even small percentages of “problem users” can result in significant problems for individuals, families, and the society as a whole.
I believe a better solution is something akin to what the Netherlands did 30 years ago and Portugal, Mexico, British Columbia, and other countries are experimenting with today...decriminalization. True, this does not do much to solve the problem of “quality control” problems in the production of drugs—and this is no small problem as regulating production with something like the FDA is probably “the” strongest argument for legalization. What decriminalization does do, however, is it allows us to continue to address substance use as a public health problem where addressing the “agent” (the drugs), “host” (individual who chooses to use the drugs), and “environment” (where the drugs are used, etc.) becomes the focus and prevention of and intervention with use, not interdiction in “the war on drugs,” is the issue of primacy.
When interdiction ceases to be the predominant response to substance use disorders, prevention and treatment can take over that position. When the demand drops then the consequences associated with consumption—especially clandestine and surreptitious consumption—will likely be reduced. Just as we do not prosecute and incarcerate those who consume “trans fats” or “empty calorie” processed foods, neither should we prosecute individuals with substance use disorders.
Drugs, that is, substances with psychoactive properties have been around longer than have we humans who at times seem preoccupied with consuming them. This means that drugs are neither good nor bad, they “just are.” It is the way these drugs are used that determines if they are problematic of not, that is, “a social problem,” and as with all social problems, they are a social construction. This means that a social issue only becomes a problem when a majority of those in power in the society in which the social issue is occurring deem the issue to be problematic. For example, most people do not argue that “child abuse” or “driving while intoxicated” are “social problems.” Interestingly, though, prior to the 1960’s you did not hear about “child abuse” and prior to the 1980 you did not hear much about “drinking and driving.” This does not mean that these issues did not exist, they just were not deemed problematic by the society in which they occurred and were therefore not denoted as “social problems.”
Take “abortion” or “smoking marijuana” on the other hand and there is great debate as to whether or not either or both of these is a “social problem” because there is no consensus on either issue. Consequently, until and unless a majority of individuals in power clearly decide one way or the other, the debate will continue. Probably the clearest example of this is the slow but inexorable growth of the temperance movement in the 19th century into a movement that transformed “drunkenness” from the social problem to “alcohol itself” as the social problem and resulted in the passage of the 18th amendment in 1920. For 13 years, “alcohol” was a social problem...just as “drugs” have been since the Harrison Act was passed in the early part of the 20th century—but even that had an interesting twist in that it was not concern about the use of drugs, but racism that resulted in the passage of early drug laws...certain ethic groups tended to use certain drugs so in an effort to “get rid of the racial problem,” their drugs of choice were made illegal in order to legitimize persecution...but this is another story (see “Hooked: Illegal Drugs and How They Became That Way,” available on Youtube).
In any event, I “hear” the argument of the authors of the Post article and I “feel” their frustration, I just do not “buy” their reasoning for legalizing drugs. One thing is certain, however, and that is the old “war on drugs” approach to dealing with psychoactive substances is going to go the way of the dinosaur...its just a question if that will be with a cataclysmic event that results in mass extinction of something more “evolutionary.”
What do you think?
1. If drugs were legal then drugs could be prepared like any other commodity. This would move production out of the back alley and place it under the scrutiny of some regulatory body that could ensure that what is sold in Philly is the same as what is sold in DC as in LA, etc. In short, there is something to be said for regulating production from a harm reduction point of view...less harm to the individual who consumes the drug and less harm (most likely in the form of financial savings) to the public when it does not have to pay for the consequences of consuming “bad” drugs.
2. There is a lot of money to be saved and made by legalizing drugs. Regarding savings, the billions of dollars are no longer spent on interdiction and other law enforcement efforts to stop manufacture and distribution, to prosecute offenders, to incarcerate offenders, etc. Regarding earning, the state and federal taxes to be collected. Ironically, most drugs of abuse could be manufactured inexpensively and then taxed in an outrageous fashion and still be no more expensive to the consumer than they are now.
As attractive as these two “benefits” of legalization may be, they do not, however, off-set the potential consequences. The biggest “drug problems” we have in this country—and likely this is true around the world—is with those drugs that are already legal...alcohol (ethanol) and tobacco (nicotine). These substances are regulated and taxed yet they are together many times more costly to us as a nation than all illicit drug use combined. This is to suggest that making substances “legal” is not to redeem the country or any of its residents from the consequences associated with the use of the now legal drugs. Add to this that some of the more popular illicit drugs of abuse, namely prescription drugs taken without a prescription, are already legal and this just adds to the argument that legalization is not, in and of itself, a solution to "the drug problem."
I liken legalization of drugs as a solution to building more roads to solve the traffic problem. There may be an immediate beneficial result from the effort, but as driving becomes easier, more individuals will choose to drive and this leads to more vehicles on the road, which results eventually in a return of the original traffic problem. Legalization may appear to be a fix, but it would be a band aid on a major, hemorrhaging wound, addiction and other substance use disorders. True, marijuana would probably result in far more people “using” the substance than “abusing,” it, something on a par with alcohol, but consider that 10% of drinkers consume 50% of all alcohol consumed and you can begin to see how even small percentages of “problem users” can result in significant problems for individuals, families, and the society as a whole.
I believe a better solution is something akin to what the Netherlands did 30 years ago and Portugal, Mexico, British Columbia, and other countries are experimenting with today...decriminalization. True, this does not do much to solve the problem of “quality control” problems in the production of drugs—and this is no small problem as regulating production with something like the FDA is probably “the” strongest argument for legalization. What decriminalization does do, however, is it allows us to continue to address substance use as a public health problem where addressing the “agent” (the drugs), “host” (individual who chooses to use the drugs), and “environment” (where the drugs are used, etc.) becomes the focus and prevention of and intervention with use, not interdiction in “the war on drugs,” is the issue of primacy.
When interdiction ceases to be the predominant response to substance use disorders, prevention and treatment can take over that position. When the demand drops then the consequences associated with consumption—especially clandestine and surreptitious consumption—will likely be reduced. Just as we do not prosecute and incarcerate those who consume “trans fats” or “empty calorie” processed foods, neither should we prosecute individuals with substance use disorders.
Drugs, that is, substances with psychoactive properties have been around longer than have we humans who at times seem preoccupied with consuming them. This means that drugs are neither good nor bad, they “just are.” It is the way these drugs are used that determines if they are problematic of not, that is, “a social problem,” and as with all social problems, they are a social construction. This means that a social issue only becomes a problem when a majority of those in power in the society in which the social issue is occurring deem the issue to be problematic. For example, most people do not argue that “child abuse” or “driving while intoxicated” are “social problems.” Interestingly, though, prior to the 1960’s you did not hear about “child abuse” and prior to the 1980 you did not hear much about “drinking and driving.” This does not mean that these issues did not exist, they just were not deemed problematic by the society in which they occurred and were therefore not denoted as “social problems.”
Take “abortion” or “smoking marijuana” on the other hand and there is great debate as to whether or not either or both of these is a “social problem” because there is no consensus on either issue. Consequently, until and unless a majority of individuals in power clearly decide one way or the other, the debate will continue. Probably the clearest example of this is the slow but inexorable growth of the temperance movement in the 19th century into a movement that transformed “drunkenness” from the social problem to “alcohol itself” as the social problem and resulted in the passage of the 18th amendment in 1920. For 13 years, “alcohol” was a social problem...just as “drugs” have been since the Harrison Act was passed in the early part of the 20th century—but even that had an interesting twist in that it was not concern about the use of drugs, but racism that resulted in the passage of early drug laws...certain ethic groups tended to use certain drugs so in an effort to “get rid of the racial problem,” their drugs of choice were made illegal in order to legitimize persecution...but this is another story (see “Hooked: Illegal Drugs and How They Became That Way,” available on Youtube).
In any event, I “hear” the argument of the authors of the Post article and I “feel” their frustration, I just do not “buy” their reasoning for legalizing drugs. One thing is certain, however, and that is the old “war on drugs” approach to dealing with psychoactive substances is going to go the way of the dinosaur...its just a question if that will be with a cataclysmic event that results in mass extinction of something more “evolutionary.”
What do you think?
13 August 2009
The following is an OP-ED piece a colleague and I have written for a local Philly newspaper...I share it here FYI
Back to the Future: What’s New in Response to College Drinking
By Robert J. Chapman, PhD & Stephen F. Gambescia, PhD
Drexel University—Philadelphia, PA
College of Nursing & Health Professions
With the approach of Labor Day and its symbolic close of summer comes another annual event that hearkens the change of seasons: Back to the classroom. In colleges & universities across the country administrators are acutely aware of the perennial issue of student drinking, given its potentially adverse academic and public health consequences, not to mention being in the midst of our current economic recession, the fiscal impact—retaining students through graduation naturally makes for sound fiscal policy.
Alcohol and collegiate life have been social contemporaries since Thomas Jefferson noticed its affects on good student form at the University of Virginia and butlers distributed wine and beer to students at Yale and Harvard, which were easily dispensed from the “Buttery,” adjacent to the Commons and an integral part of colonial collegiate life. But the convivial drinking of collegians in centuries past has been replaced by the ubiquitous consumption of contemporary students, approximately 25% of which are described as “frequent” (2 or more times in a 2-week period) “binge” drinkers (having 5 or more standard drinks in an outing, 4 or more for women).
So pervasive is collegiate drinking that colleges have attempted to control consumption. One particular approach that has been effective is called, “environmental management.” Included are five strategies:
1. Offer alcohol-free social, extracurricular, and public service options
2. Create a health-promoting normative environment
3. Restrict the marketing and promotion of alcoholic beverages both on and off
campus
4. Limit alcohol availability
5. Increase enforcement of laws and policies
In short, these steps to influence the campus environment have resulted in changes in collegiate drinking; most good, but some give pause for reflection. Although campus drinking has been reduced, “frequent binge drinkers” have tended to move off-campus to avoid increased enforcement of alcohol policies. This shift increases certain other high-risk and dangerous student practices; namely, drinking and driving as well as drinking in unsupervised and clandestine locations where excessive consumption is encouraged and alcohol poisoning is not monitored. Both of these consequences may serve to alienate residents of the community in which such drinking occurs thus straining any historic “town-gown” tensions.
As college personnel have become aware of this shift in student drinking behavior, they have changed their strategies. Most effective in encouraging a proactive response is the use of campus-community coalitions. Such partnerships of administrative and student groups “on-campus” with residents, businesses, law enforcement, and public health groups “off-campus” have resulted in significant change in curbing student off-campus drinking – see http://tinyurl.com/qsdz62.
In addition to such coalitions, campus officials that hold students responsible for their behavior off-campus and subject them to the same consequences as if the drinking was done on-campus often direct these students to participate in brief motivational screening – see http://tinyurl.com/lohw6p. Other strategies are being piloted to address these issues, but like a medication that accomplishes its primary objective but necessitating a second prescription to assuage side effects, environmental management strategies have contributed significantly to affecting collegiate drinking.
With the return of students and the adverse consequences of drinking done by some of their number, new and innovative strategies have been implemented by colleges and universities to act on rather than react to this perennial vestige of collegiate life. Although alcohol and its consumption will remain regular parts of contemporary campus life, these inventive strategies will likely result in changed student behavior.
Back to the Future: What’s New in Response to College Drinking
By Robert J. Chapman, PhD & Stephen F. Gambescia, PhD
Drexel University—Philadelphia, PA
College of Nursing & Health Professions
With the approach of Labor Day and its symbolic close of summer comes another annual event that hearkens the change of seasons: Back to the classroom. In colleges & universities across the country administrators are acutely aware of the perennial issue of student drinking, given its potentially adverse academic and public health consequences, not to mention being in the midst of our current economic recession, the fiscal impact—retaining students through graduation naturally makes for sound fiscal policy.
Alcohol and collegiate life have been social contemporaries since Thomas Jefferson noticed its affects on good student form at the University of Virginia and butlers distributed wine and beer to students at Yale and Harvard, which were easily dispensed from the “Buttery,” adjacent to the Commons and an integral part of colonial collegiate life. But the convivial drinking of collegians in centuries past has been replaced by the ubiquitous consumption of contemporary students, approximately 25% of which are described as “frequent” (2 or more times in a 2-week period) “binge” drinkers (having 5 or more standard drinks in an outing, 4 or more for women).
So pervasive is collegiate drinking that colleges have attempted to control consumption. One particular approach that has been effective is called, “environmental management.” Included are five strategies:
1. Offer alcohol-free social, extracurricular, and public service options
2. Create a health-promoting normative environment
3. Restrict the marketing and promotion of alcoholic beverages both on and off
campus
4. Limit alcohol availability
5. Increase enforcement of laws and policies
In short, these steps to influence the campus environment have resulted in changes in collegiate drinking; most good, but some give pause for reflection. Although campus drinking has been reduced, “frequent binge drinkers” have tended to move off-campus to avoid increased enforcement of alcohol policies. This shift increases certain other high-risk and dangerous student practices; namely, drinking and driving as well as drinking in unsupervised and clandestine locations where excessive consumption is encouraged and alcohol poisoning is not monitored. Both of these consequences may serve to alienate residents of the community in which such drinking occurs thus straining any historic “town-gown” tensions.
As college personnel have become aware of this shift in student drinking behavior, they have changed their strategies. Most effective in encouraging a proactive response is the use of campus-community coalitions. Such partnerships of administrative and student groups “on-campus” with residents, businesses, law enforcement, and public health groups “off-campus” have resulted in significant change in curbing student off-campus drinking – see http://tinyurl.com/qsdz62.
In addition to such coalitions, campus officials that hold students responsible for their behavior off-campus and subject them to the same consequences as if the drinking was done on-campus often direct these students to participate in brief motivational screening – see http://tinyurl.com/lohw6p. Other strategies are being piloted to address these issues, but like a medication that accomplishes its primary objective but necessitating a second prescription to assuage side effects, environmental management strategies have contributed significantly to affecting collegiate drinking.
With the return of students and the adverse consequences of drinking done by some of their number, new and innovative strategies have been implemented by colleges and universities to act on rather than react to this perennial vestige of collegiate life. Although alcohol and its consumption will remain regular parts of contemporary campus life, these inventive strategies will likely result in changed student behavior.
02 August 2009
Looking at Collegiate Drinking: Part II
Deconstructing Collegiate Drinking
If what alcohol and drinking mean as icons of contemporary collegiate life are important, then such meanings likely impact the choices students make regarding drinking. And if we can understand the process by which these meanings are ascribed, then we will likely be able to move one step closer to impacting collegiate drinking.
I suspect that the importance of alcohol in collegiate life is such that it will never cease or be controlled to the extent that only those of legal age will consume and then only in accordance with medical guidelines recommended by experts—no more than 2 standard drinks per day for males, 1 for females. That said, I do believe that collegiate drinking can be influenced and in a way that sees the percentage of students that choose to drink reduced and the frequency and quantity of those who do imbibe reduced as well.
There will always be those who experience a problem with alcohol and find themselves drinking because they “cannot not drink,” a.k.a. alcohol dependence, but such drinking by college students is limited—although some (many?) may progress to “alcoholism” propelled by their collegiate experience. The number of problems, however, associated with collegiate drinking—what I call, “untoward consequences"—can be reduced below the apparently intractable numbers that have been reported consistently for years. Ironically, this will not be because of more clever policies regarding alcohol. Likewise, changes will not result from innovative programs alone or smart and witty publicity campaigns. Rather, change will come as students move through the process by which they re-ascribe meaning to alcohol and drinking that affects the choices they make regarding the use of the drug and the circumstances that warrant that use.
There is the old adage we are so familiar with as to have made it a trite cliché—“You can lead a horse to water, but you cannot make it drink.” Although this may be true, you can salt the oats. If I shift my focus from trying to “make students” do the right thing and, instead, shift that focus to affecting the reasoning they employ that results in choices to “do the wrong thing,” students may well move in the direction of change of their own volition. We know this will happen because it already has been documented in the “maturing out” process. And whether this process is learning the “cause and effect” relationship between high-risk behavior and untoward consequences or simply the result of the natural developmental as students age from late adolescence to early adulthood during the span of a traditional collegiate career is all but irrelevant. What is pertinent is that students change and they do so of their own volition. As Sandra Anise Barnes, the poet, wrote, “It is so hard when I have to, and easy when I want to.”
The challenge for those concerned about collegiate drinking is not to “reinvent the wheel” but to keep from reinventing the flat tire. We may already have the answer to reducing the unacceptable number of untoward consequences associated with drinking…we see this as students progress through the aging-out process. The challenge is to hasten this process so as to close the window of opportunity for those untoward consequences to occur.
If we study the process by which students change the meaning they ascribe to alcohol and drinking we can artificially hasten this process, and in so doing, reduce the untoward consequences. This will not necessarily reduce the number of students who choose to drink, but it is likely to affect the number who choose to drink on a given occasion and, more importantly, the way they drink.
If we can resist the temptation to use public policy exclusively as the means by which we “solve the collegiate drinking problem” and instead focus on altering the meaning students place on the drug and its consumption, it is entirely likely that students will fix “the problem” themselves.
In conclusion, we have come a long way. Environmental management strategies and programs like social norms marketing, Brief Alcohol Screening and Intervention for College Students (BASICS), Screening/Brief Intervention/Referral to Treatment (SBIRT), have done much to address high-risk and dangerous collegiate drinking. But such external programs and approaches that serve to “do something to” students are not enough to change a culture. For the culture of campus drinking to change, students must come to a point where the meaning they ascribe to alcohol and drinking change. Then and only then will the culture on American college campuses change. As in psychotherapy, effective therapists know that individual change is an “inside job.”
To read more on this topic in some detail look at When They Drink: Deconstructing Collegiate Drinking (http://www.community.rowancas.org/node/21) and When They Drink: Is Collegiate Drinking the Problem We Think It Is? (http://www.rowan.edu/cas/resources/documents/CollegiateDrinking.doc.doc)
Comments welcome at chapman.phd@gmail.com
Deconstructing Collegiate Drinking
If what alcohol and drinking mean as icons of contemporary collegiate life are important, then such meanings likely impact the choices students make regarding drinking. And if we can understand the process by which these meanings are ascribed, then we will likely be able to move one step closer to impacting collegiate drinking.
I suspect that the importance of alcohol in collegiate life is such that it will never cease or be controlled to the extent that only those of legal age will consume and then only in accordance with medical guidelines recommended by experts—no more than 2 standard drinks per day for males, 1 for females. That said, I do believe that collegiate drinking can be influenced and in a way that sees the percentage of students that choose to drink reduced and the frequency and quantity of those who do imbibe reduced as well.
There will always be those who experience a problem with alcohol and find themselves drinking because they “cannot not drink,” a.k.a. alcohol dependence, but such drinking by college students is limited—although some (many?) may progress to “alcoholism” propelled by their collegiate experience. The number of problems, however, associated with collegiate drinking—what I call, “untoward consequences"—can be reduced below the apparently intractable numbers that have been reported consistently for years. Ironically, this will not be because of more clever policies regarding alcohol. Likewise, changes will not result from innovative programs alone or smart and witty publicity campaigns. Rather, change will come as students move through the process by which they re-ascribe meaning to alcohol and drinking that affects the choices they make regarding the use of the drug and the circumstances that warrant that use.
There is the old adage we are so familiar with as to have made it a trite cliché—“You can lead a horse to water, but you cannot make it drink.” Although this may be true, you can salt the oats. If I shift my focus from trying to “make students” do the right thing and, instead, shift that focus to affecting the reasoning they employ that results in choices to “do the wrong thing,” students may well move in the direction of change of their own volition. We know this will happen because it already has been documented in the “maturing out” process. And whether this process is learning the “cause and effect” relationship between high-risk behavior and untoward consequences or simply the result of the natural developmental as students age from late adolescence to early adulthood during the span of a traditional collegiate career is all but irrelevant. What is pertinent is that students change and they do so of their own volition. As Sandra Anise Barnes, the poet, wrote, “It is so hard when I have to, and easy when I want to.”
The challenge for those concerned about collegiate drinking is not to “reinvent the wheel” but to keep from reinventing the flat tire. We may already have the answer to reducing the unacceptable number of untoward consequences associated with drinking…we see this as students progress through the aging-out process. The challenge is to hasten this process so as to close the window of opportunity for those untoward consequences to occur.
If we study the process by which students change the meaning they ascribe to alcohol and drinking we can artificially hasten this process, and in so doing, reduce the untoward consequences. This will not necessarily reduce the number of students who choose to drink, but it is likely to affect the number who choose to drink on a given occasion and, more importantly, the way they drink.
If we can resist the temptation to use public policy exclusively as the means by which we “solve the collegiate drinking problem” and instead focus on altering the meaning students place on the drug and its consumption, it is entirely likely that students will fix “the problem” themselves.
In conclusion, we have come a long way. Environmental management strategies and programs like social norms marketing, Brief Alcohol Screening and Intervention for College Students (BASICS), Screening/Brief Intervention/Referral to Treatment (SBIRT), have done much to address high-risk and dangerous collegiate drinking. But such external programs and approaches that serve to “do something to” students are not enough to change a culture. For the culture of campus drinking to change, students must come to a point where the meaning they ascribe to alcohol and drinking change. Then and only then will the culture on American college campuses change. As in psychotherapy, effective therapists know that individual change is an “inside job.”
To read more on this topic in some detail look at When They Drink: Deconstructing Collegiate Drinking (http://www.community.rowancas.org/node/21) and When They Drink: Is Collegiate Drinking the Problem We Think It Is? (http://www.rowan.edu/cas/resources/documents/CollegiateDrinking.doc.doc)
Comments welcome at chapman.phd@gmail.com
19 July 2009
Looking at Collegiate Drinking: Part I
That some college and university students choose to drink is not news. That some of these drinkers actually choose to, or unintentionally, become intoxicated when drinking alcohol and experience an array of possible untoward consequences is likewise no secret. What may be a revelation for some is learning that most publications regarding collegiate drinking focus exclusively on these untoward consequences and covertly, if not overtly, imply that they are proof that all collegiate drinking is problematic.
If “the problem” is all collegiate drinking, then there can be but one possible objective of prevention…abstinence. However, such a goal suggests two questions: First, just as there has never been a time when alcohol was not used by some college students, can there ever be a time when no collegians drink (although it is likely that current percentages of students reporting use can be lessened and the frequency of that use and quantity consumed can be reduced)? Second, has the focus of research and prevention programming been too a posteriori and should that focus be directed instead to a priori considerations of drinking? Put more succinctly, we have been more concerned about the untoward consequences after students drink than in pursuing a better understanding of the meaning students ascribe to alcohol and drinking before consumption that influence their decision to drink in the first place. One argument in this essay is that such a priori considerations of collegiate drinking are likely to shed light on factors that affect individual decisions to drink…not to mention influencing student decisions when to drink, how to drink, or determine what circumstances warrant drinking, etc.
To understand how students view alcohol as a substance and drinking as a behavior is tantamount to having an insider’s perspective from which to consider factors affecting decisions made by students regarding collegiate drinking. This would permit a greater understanding of the means by which drinking has become an integral part of the social organization and culture of contemporary collegiate life…not to mention a fresh perspective from which to consider affecting change.
Efforts to “address” collegiate drinking have been historically focused on public policy approaches to control what has been described as a “social problem.” But this is remarkably similar to what was done in the 19th and early 20th centuries to address a similar national social problem, “alcohol” as perceived by the temperance movement. What is interesting in both situations—American’s concern about alcohol as a perceived social problem and higher education’s similar concern about student use—is the perception of what constitutes a “social problem” is essentially a social construction. This means that what causes a problem in the eyes of those who hold the power in a group or social body, is deemed a problem simply because it is perceived to cause a problem by those in a position of power. Because alcohol is involved in acts of violence or is correlated with poor academic performance by some students who drink, its consumption by any student is therefore perceived as a social problem, irrespective of the fact that untoward consequences are not experienced by the majority of drinkers especially on each occasion the decision is made to drink. As a social problem--and one that has increasingly been cited as "the" social problem in higher education--it demands attention and, therefore, must be solved by the most direct means available to accomplish such a solution, namely, via public policy.
This essay is not a plea to permit collegiate drinking or deny that the drinking done by some students is a significant issue in need of immediate attention. It is, however, an invitation to consider that the problem may not be what we think it is as regards alcohol and collegiate life. If, for example, the views of the majority in a particular social group are in agreement with what constitutes a social problem, public policy efforts to address that problem, i.e., "control it," are universally supported and the consequences associated with violating such policies are sanctioned. Examples of this can be seen when considering “driving while intoxicated,” “child abuse,” or “domestic violence.” Because the majority of Americans recognize that operating a motor vehicle while intoxicated is dangerous, that physically or sexually abusing a child is reprehensible, or assaulting a domestic partner is predatory, there is little if any protest when designating these behaviors as “social problems.” The majority of the populace are in agreement and these acts are deemed social problems because they cause problems for the society in which they occur.
But to suggest that issues such as abortion, smoking marihuana, or guns represent “social problems” is to all but instantly ignite a debate that is sure to generate more heat than light. These are issues for which there are significant advocates of at least two different points of view so there can be no clear consensus as to whether the issue is or is not a “social problem.” In short, those who hold the power to affect public policy will eventually settle the decision as to what constitutes a problem, prohibition being a good example of this in 1920 and those opposed to prohibition affecting its repeal in 1933. As in recording history, it is the victor to whom go the spoils, namely the opportunity to “record the truth.”
As regards collegiate drinking, because most if not all students understand that many if not most students who choose to drink—even those who choose to or unintentionally become intoxicated—do not experience untoward consequences as the result of any given drinking occasion, they do not see collegiate drinking as a “social problem.” Yet the issue of primacy for social scientists studying collegiate drinking and student affairs professionals addressing it on a daily basis are the untoward consequences associated with collegiate drinking.
Part II of this essay will consider student meaning for alcohol and drinking and how this may shed light on the difficulty students have in accepting "collegiate drinking" as the preeminent social problem in higher education today. To read more on this topic in some detail look at When They Drink: Deconstructing Collegiate Drinking (http://www.community.rowancas.org/node/21) and When They Drink: Is Collegiate Drinking the Problem We Think It Is? (http://www.rowan.edu/cas/resources/documents/CollegiateDrinking.doc.doc)
That some college and university students choose to drink is not news. That some of these drinkers actually choose to, or unintentionally, become intoxicated when drinking alcohol and experience an array of possible untoward consequences is likewise no secret. What may be a revelation for some is learning that most publications regarding collegiate drinking focus exclusively on these untoward consequences and covertly, if not overtly, imply that they are proof that all collegiate drinking is problematic.
If “the problem” is all collegiate drinking, then there can be but one possible objective of prevention…abstinence. However, such a goal suggests two questions: First, just as there has never been a time when alcohol was not used by some college students, can there ever be a time when no collegians drink (although it is likely that current percentages of students reporting use can be lessened and the frequency of that use and quantity consumed can be reduced)? Second, has the focus of research and prevention programming been too a posteriori and should that focus be directed instead to a priori considerations of drinking? Put more succinctly, we have been more concerned about the untoward consequences after students drink than in pursuing a better understanding of the meaning students ascribe to alcohol and drinking before consumption that influence their decision to drink in the first place. One argument in this essay is that such a priori considerations of collegiate drinking are likely to shed light on factors that affect individual decisions to drink…not to mention influencing student decisions when to drink, how to drink, or determine what circumstances warrant drinking, etc.
To understand how students view alcohol as a substance and drinking as a behavior is tantamount to having an insider’s perspective from which to consider factors affecting decisions made by students regarding collegiate drinking. This would permit a greater understanding of the means by which drinking has become an integral part of the social organization and culture of contemporary collegiate life…not to mention a fresh perspective from which to consider affecting change.
Efforts to “address” collegiate drinking have been historically focused on public policy approaches to control what has been described as a “social problem.” But this is remarkably similar to what was done in the 19th and early 20th centuries to address a similar national social problem, “alcohol” as perceived by the temperance movement. What is interesting in both situations—American’s concern about alcohol as a perceived social problem and higher education’s similar concern about student use—is the perception of what constitutes a “social problem” is essentially a social construction. This means that what causes a problem in the eyes of those who hold the power in a group or social body, is deemed a problem simply because it is perceived to cause a problem by those in a position of power. Because alcohol is involved in acts of violence or is correlated with poor academic performance by some students who drink, its consumption by any student is therefore perceived as a social problem, irrespective of the fact that untoward consequences are not experienced by the majority of drinkers especially on each occasion the decision is made to drink. As a social problem--and one that has increasingly been cited as "the" social problem in higher education--it demands attention and, therefore, must be solved by the most direct means available to accomplish such a solution, namely, via public policy.
This essay is not a plea to permit collegiate drinking or deny that the drinking done by some students is a significant issue in need of immediate attention. It is, however, an invitation to consider that the problem may not be what we think it is as regards alcohol and collegiate life. If, for example, the views of the majority in a particular social group are in agreement with what constitutes a social problem, public policy efforts to address that problem, i.e., "control it," are universally supported and the consequences associated with violating such policies are sanctioned. Examples of this can be seen when considering “driving while intoxicated,” “child abuse,” or “domestic violence.” Because the majority of Americans recognize that operating a motor vehicle while intoxicated is dangerous, that physically or sexually abusing a child is reprehensible, or assaulting a domestic partner is predatory, there is little if any protest when designating these behaviors as “social problems.” The majority of the populace are in agreement and these acts are deemed social problems because they cause problems for the society in which they occur.
But to suggest that issues such as abortion, smoking marihuana, or guns represent “social problems” is to all but instantly ignite a debate that is sure to generate more heat than light. These are issues for which there are significant advocates of at least two different points of view so there can be no clear consensus as to whether the issue is or is not a “social problem.” In short, those who hold the power to affect public policy will eventually settle the decision as to what constitutes a problem, prohibition being a good example of this in 1920 and those opposed to prohibition affecting its repeal in 1933. As in recording history, it is the victor to whom go the spoils, namely the opportunity to “record the truth.”
As regards collegiate drinking, because most if not all students understand that many if not most students who choose to drink—even those who choose to or unintentionally become intoxicated—do not experience untoward consequences as the result of any given drinking occasion, they do not see collegiate drinking as a “social problem.” Yet the issue of primacy for social scientists studying collegiate drinking and student affairs professionals addressing it on a daily basis are the untoward consequences associated with collegiate drinking.
Part II of this essay will consider student meaning for alcohol and drinking and how this may shed light on the difficulty students have in accepting "collegiate drinking" as the preeminent social problem in higher education today. To read more on this topic in some detail look at When They Drink: Deconstructing Collegiate Drinking (http://www.community.rowancas.org/node/21) and When They Drink: Is Collegiate Drinking the Problem We Think It Is? (http://www.rowan.edu/cas/resources/documents/CollegiateDrinking.doc.doc)
13 July 2009
Ice Fishing
My grandfather used to tell me, "Robert, you've got to cut a hole in the ice before you can catch any fish." This was one of his folksy ways of instructing me in the need to prepare for a job in order to increase the likelihood of success. It seems the older I get and the more experience I glean as a counselor, the more I value the wisdom of this mentor with a DHW...that's, "Dr. of Hard Work." Pop seemed to be prepping me for the work I would find myself doing decades later with 18 - 22 year old students, some of whom are mandated for an alcohol or other drug assessment.
Quite by accident I found myself some years ago with 120 coffee mugs hanging on the wall of my office; they are still there today. These mementos of individual or family excursions through the years found their way to my wall when there was no more room on the book shelves to display such curios. As the number grew from a few oddities to an unmistakable collection, students would often gaze about my office when entering. A few years ago a student quipped, "Like coffee, eh doc?" to which I spontaneously responded, "Pick one."
The student pointed to a mug, quite at random, and I told her the story that accompanied that particular piece of paraphernalia used to administer my preferred drug of choice. Admittedly, the stories are not very exciting, PG rated at best--remember that many were collected while on family vacations :) However, the fact that the story was shared seemed to open a portal to conversation that became a wonderful segue to the business that brought the student to my office in the first place.
Through the years, I have used this technique whenever a student would comment on the mugs - I never force the issue. One of my greatest compliments as a counselor came from one student a couple years ago who got up to leave a session and commented, looking around an office with a "curio shop" decor, "you know doc, your office looks a lot like Robin Williams' in Good Will Hunting." As the Existential counselor I am, I have come to treasure that simple statement, one I chose to accept as a compliment.
I share this by way of inviting readers to think about strategies discovered over the years that have provided useful segues to approaching resistant, shy, closed, or even angry clients. I look forward to any responses as I am always looking to add to my "bag of tricks." I also believe that these "tricks" can be useful pedagogical tools to employ when teaching, affording students the opportunity to recognize the importance of being an affective person while at the same time striving to be an effective teacher or counselor. What do you think? Email me at: chapman.phd@gmail.com and I will post ideas and suggestions in a subsequent blog entry.
Robert
My grandfather used to tell me, "Robert, you've got to cut a hole in the ice before you can catch any fish." This was one of his folksy ways of instructing me in the need to prepare for a job in order to increase the likelihood of success. It seems the older I get and the more experience I glean as a counselor, the more I value the wisdom of this mentor with a DHW...that's, "Dr. of Hard Work." Pop seemed to be prepping me for the work I would find myself doing decades later with 18 - 22 year old students, some of whom are mandated for an alcohol or other drug assessment.
Quite by accident I found myself some years ago with 120 coffee mugs hanging on the wall of my office; they are still there today. These mementos of individual or family excursions through the years found their way to my wall when there was no more room on the book shelves to display such curios. As the number grew from a few oddities to an unmistakable collection, students would often gaze about my office when entering. A few years ago a student quipped, "Like coffee, eh doc?" to which I spontaneously responded, "Pick one."
The student pointed to a mug, quite at random, and I told her the story that accompanied that particular piece of paraphernalia used to administer my preferred drug of choice. Admittedly, the stories are not very exciting, PG rated at best--remember that many were collected while on family vacations :) However, the fact that the story was shared seemed to open a portal to conversation that became a wonderful segue to the business that brought the student to my office in the first place.
Through the years, I have used this technique whenever a student would comment on the mugs - I never force the issue. One of my greatest compliments as a counselor came from one student a couple years ago who got up to leave a session and commented, looking around an office with a "curio shop" decor, "you know doc, your office looks a lot like Robin Williams' in Good Will Hunting." As the Existential counselor I am, I have come to treasure that simple statement, one I chose to accept as a compliment.
I share this by way of inviting readers to think about strategies discovered over the years that have provided useful segues to approaching resistant, shy, closed, or even angry clients. I look forward to any responses as I am always looking to add to my "bag of tricks." I also believe that these "tricks" can be useful pedagogical tools to employ when teaching, affording students the opportunity to recognize the importance of being an affective person while at the same time striving to be an effective teacher or counselor. What do you think? Email me at: chapman.phd@gmail.com and I will post ideas and suggestions in a subsequent blog entry.
Robert
07 July 2009
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.
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.
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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