Despite Efforts Over the Years, Heavy Drinking Among Students Remains Steady

The Chronicle of Higher Education, March 29

Campus efforts to raise students' understanding of the hazards of alcohol abuse ramped up through the 1980s and have since tapered off. Nonetheless, the incidence of heavy drinking among students has remained relatively steady—and a cause for concern—for the past three decades, said a speaker at the annual conference of ACPA—College Student Educators International.

Link to story

This is a continuation of thoughts noted in my previous post

Collegiate drinking is nothing if not a perennial problem and has been since Harvard opened “Butteries” in the 18^th century J Interestingly, the reason that collegiate drinking rates wax and wane, often in sync with available funding to address “problem collegiate drinking” is because we focus on the problem primarily and to a much lesser degree, on the solution.

Interestingly, when we do look at the “solution” it is the solution to the collegiate drinking problem—and we have made substantial headway in this area over the past 20 years…environmental management, social norms, social marketing, BASICS, etc. The issue is that these strategies continue to focus on the minority of students associated directly with the problems cause by collegiate drinkers, that is the “binge drinkers.” What we to this point have never addressed is a consideration of the solution as to how to motivate the majority of college students who are moderate in their drinking if not abstainers to become more proactive in their interactions with peers. In short, how do we learn why moderate drinkers and abstainers approach alcohol and drinking as they do so as to support and/or advance those student characteristics…to move towards what we want rather than always try and avoid/stop if not flee what we do not want. Instead of talking about collegiate drinking in the positive/proactive way, that is, why is moderation the norm for drinkers and/or why do abstainers abstain, all our attention goes to the “problem.” It is like asking someone, continually, for decades, to “not think about pink elephants with purple spots!....guess what they are thinking about?

The classic example of what I am suggesting is the shift in social norms regarding cigarette smoking. EVERYWHERE you went in the early 60s had ash trays and often matches. Good hosts and hostesses even offered guests cigarettes—you can even see the armrest ashtrays on older planes! 50 years later—and this is the key to this change 50 year—not only is this not the case, people cannot smoke in most public spaces and must stand a minimum distance from the main entrances to such buildings if they do choose to smoke.

Such changes take time as do any time we set out to change the culture in a demonstrable way. To change the way alcohol and drinking are viewed in higher ed is no small task and will take years if not decades, but we are not a patient field and lose interest and motivation to “do something” soon after the soft state or federal money disappears.

I can go on and on about this…you can read “a little more” about this in my previous post or you can read “a lot more” in the 2^nd and 3^rd volumes of my monograph series, “When They Drink” – see http://robertchapman.net/essays.htm

Dr. robert

Activities Key to Cutting College Binge Drinking

Drops in binge and “problem” drinking among college students are being attributed to more late-night and alcohol-free activities being offered regularly. Although some argue that these activities will only attract non-drinkers or light drinkers, higher-education officials believe that it is important to support that crowd as well, because in the absence of those activities, they will likely become drinkers, too. http://bit.ly/gRFlwq

This item, which comes from the latest edition of The Network's newsletter, News from the Front (March 2011 - http://thenetwork.ws/?page_id=305), is interesting in and of itself, but particularly provocative is its last statement referring to the need for colleges and universities to address the needs of their non-drinking or moderate drinking students in their alcohol-related programming. I take this statement one step farther and suggest that these students may be an untapped resource that can be helpful in addressing the quest to change campus culture as regards the role that alcohol as a substance and drinking as a behavior play in contemporary collegiate life.

It seems that whenever we hear about collegiate drinking it is either a report on the latest travesty resulting from some student’s drunken comportment—invariably courtesy of the popular media--or research article and clinical report related to high-risk collegiate drinking. Yet we know from study after study that most collegians are moderate in their consumption of alcohol if they drink at all--about 20% of college students nationally chose not to drink last year. Access to information about collegiate drinking tends to set up what social psychologists call “confirmation bias” or the tendency to look for evidence that supports a belief one already holds while overlooking or discounting evidence to the contrary.

With better than half of all college students either moderate in their drinking or abstaining all together and better than another quarter reporting high-risk drinking (defined as having 5 or more drinks in a 2-hr period) no more than once in the previous 2-weeks, these media reports have suggested a problem that is exaggerated and therefore unnecessarily pessimistic .

This does not, of course, suggest that the high-risk and dangerous drinking of a quarter of contemporary collegians should be overlooked or is of little concern; it is indeed a problem and is among the most significant public health issues facing contemporary college students. It does suggest, however, that most students are moderate in their behavior and exercise more than a modicum of restraint when it comes to making personal choices about alcohol and drinking.

This would seem to suggest that an important resource in the quest to change the campus drinking culture has gone untapped or at the least, under utilized, namely, the moderate drinker and the abstainer. What is it that affects the choices these students make? Why are they moderate when they drink or what factors influence their decision to abstain altogether? And even if John Jones or Mary Brown does decide to “drink a belly full of beer” on a Friday night but that may be one of a few times that is done in a semester, what factors affect his or her decision to remain moderate if not abstain on other occasions when alcohol is available and drinking is the perceived norm for the immediate group with which he/she is socializing?

The next chapter in an already significant text on collegiate drinking is about to be written. In a series of monographs on the topic of collegiate drinking entitled When They Drink, I explore the issues of why students who do drink, drink in the way they do (see Monograph at http://robertchapman.net/essays.htm). Now we need to look at what we can learn from “the rest of the students,” namely those who are moderate in their consumption or abstain altogether. I suggest that we ask these students to tell us their stories and that we then learn from them what affects the choice they make to abstain or remain moderate in their consumption when they choose to drink.

Like the story of the Good Samaritan who stopped to help a older gentleman looking for his car keys under a street light, when asked where he lost his car keys the gentleman pointed down a dark alley to his right and said, “Down there.” The Good Samaritan, looking puzzled, ask, “Then why are you looking here if you lost them way over there?” The older gentleman, glancing up with a perplexed look on his face said, “Because the light is better here!”

Perhaps we need to look at the stories of those students who are already doing what we would like to see their high-risk peers doing…decreasing the frequency of drinking episodes and reducing the quantity of alcohol consumed per occasion when choosing to drink. The light shining on the moderate drinkers and abstainers is nowhere as bright as that shining on the "binge drinkers," but perhaps we need to look where the answers are for the burning questions we ask.

What do you think?

Dr. Robert

Matching Psychotherapy to the Patient/Client

(Copied verbatim from the Effectiveness Bank alerts from Drug and Alcohol Findings).

This bulletin is devoted to reports from a high-level task force convened by the American Psychological Association to identify effective psychotherapy relationships and ways to adapt therapy to characteristics of patients other than their diagnosis, such as their personalities or cultural backgrounds. The task force commissioned reviews synthesising research on promising ways to match therapeutic approaches to different types of patients, which were published in a special issue (2011, volume 67, issue 2) of the Journal of Clinical Psychology. These reviews and the introductory article are listed below. While not specific to drug or alcohol problems, many of the studies included in the reviews concern these problems and a high proportion of drug or alcohol patients suffer from the mental health problems addressed by the other studies. The reviews offer comprehensive, evidence-based recommendations on how to maximise the benefits of psychosocial therapy.

To view entries click on a link or paste it in to your web browser address box, being sure to enter the whole address. This link:

http://findings.org.uk/count/downloads/download.php?file=bulletins/CAB_11_03_11.php

takes you to the bulletin as a whole. Links below take you to your chosen entry.

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WHAT WORKS FOR WHOM: TAILORING PSYCHOTHERAPY TO THE PERSON

Introduces the special issue of the Journal of Clinical Psychology and summarises the conclusions reached by the task force. Prime amongst these was that outcomes demonstrably improved when therapists appropriately adapted their approaches to the reactance/resistance, preferences, culture, and religion/spirituality of their clients.

http://findings.org.uk/count/downloads/download.php?file=Norcross_JC_5.cab

ADAPTING PSYCHOTHERAPY TO THE INDIVIDUAL PATIENT: STAGES OF CHANGE

Review concludes that the stages of change developed by Prochaska and DiClemente reliably predict how well psychotherapy patients will do, but no adequate studies have tested whether matching therapy to initial stage of change actually improves outcomes.

http://findings.org.uk/count/downloads/download.php?file=Norcross_JC_4.cab

ADAPTING PSYCHOTHERAPY TO THE INDIVIDUAL PATIENT: PREFERENCES

Review concludes that patients stay longer and do better if they get the type of therapy, type of therapist and type of therapeutic style they prefer.

http://findings.org.uk/count/downloads/download.php?file=Swift_JK_2.cab

ADAPTING PSYCHOTHERAPY TO THE INDIVIDUAL PATIENT: CULTURE

Review concludes that mental health services targeted to a specific cultural group were several times more effective than those for clients from a variety of backgrounds, and that more effective treatments had more cultural adaptations.

http://findings.org.uk/count/downloads/download.php?file=Smith_TB_2.cab

ADAPTING PSYCHOTHERAPY TO THE INDIVIDUAL PATIENT: COPING STYLE

Review concludes that externalising patients are best matched to psychotherapies focused on skill-building and symptom change, while those characterised by self-criticism and emotional avoidance benefit most from interpersonally focused and insight-oriented approaches.

http://findings.org.uk/count/downloads/download.php?file=Beutler_LE_3.cab

ADAPTING PSYCHOTHERAPY TO THE INDIVIDUAL PATIENT: EXPECTATIONS

Review concludes that patients who enter psychotherapy with positive expectations about outcomes tend actually to have better outcomes, suggesting that therapists should regularly assess expectations and take steps to enhance them if appropriate.

http://findings.org.uk/count/downloads/download.php?file=Constantino_M_1.cab

ADAPTING PSYCHOTHERAPY TO THE INDIVIDUAL PATIENT: ATTACHMENT STYLE

Review concludes that psychotherapy patients who feel secure in and easily form close and trusting intimate relationships have better outcomes, while the reverse is the case for those anxious about close relationships.

http://findings.org.uk/count/downloads/download.php?file=Levy_KN_1.cab

ADAPTING PSYCHOTHERAPY TO THE INDIVIDUAL PATIENT: RESISTANCE/REACTANCE LEVEL

Review concludes that patients who characteristically exhibit low levels of resistance to being led by others respond better to directive types of treatment, while patients prone to resist direction respond best to non-directive approaches.

http://findings.org.uk/count/downloads/download.php?file=Beutler_LE_2.cab

ADAPTING PSYCHOTHERAPY TO THE INDIVIDUAL PATIENT: RELIGION AND SPIRITUALITY

Review concludes that psychotherapy patients who identify with the religious or spiritual orientation of a therapy improve more than if untreated. Generally they also improve more than if treated with secular therapies, but not if these are equivalent in every other way to the religious/spiritual therapy.

http://findings.org.uk/count/downloads/download.php?file=Worthington_EL_1.cab

The Role of Technology in Training the Next Generation of Counselors

There are certainly “issues” associated with using avatars and virtual reality in the training of counselors, but the technology is both here to stay and likely to be applied to many professions, ours more than likely being on the short list.

Visit http://bit.ly/fSa5jb and watch this video on the next generation of Microsoft’s X-Box 360 Kinnect. Not only does Kinnect allow one to operate the controller through body motion; it is about to read and mimic facial expressions. This enables the avatar on screen to communicate with facial expressions much as we do in the ‘real world.” The potential to apply this technology to training counselors if not permitting individuals to be effective treated with counseling in virtual reality are provocative to say the least.

Although I have had serious concerns about “online counseling services” and online graduate programs in counseling including little or no residency requirement etc., the point remains that the technology is going to be applied to both the delivery of service and the preparation of and CEUs (continuing education units) for professional counselors. If this is to happen in a controlled fashion with the primacy of ethics and effectiveness clearly established, it is going to likely come as the result of the old guard (those currently delivering counseling services) working with the newbies (the next generation) who are tech savvy in order to bring about a judicious and efficacious blending of skill and technology. What is true today will remain true in the future as regards counseling...“it’s all about the client.”

Just as Rogers was criticized for bringing audio equipment into the counseling sanctuary in the 1950, video equipment was introduced in the late 60s and 70s, practicum students and interns were mandated to provide video tapes of sessions to be autopsied in class in the 80s, and all manner of computer software becoming not only ubiquitous in the counselor profession, but one standard by which effective practice standards are measured, this technological tide is flooding and as John Kennedy once quipped, “The rising tide lifts all the ships.”

I agree that the avatars in the Kinnect video are crude when compared to sitting in an actual session with a student, client, or group, but this is the next step in the development of this technology, not the last stop on the line. Avatars that can accurately replicate facial expressions represent nothing if not a quantum step forward in virtual reality. I agree that we need to be cautious and not rush to employ the technology simply because we can. By the same token, however, I suggest that those of us who know how to do what we do so well “with old technology” might be wise to consult with those who are ringing the bell technologically while still naïve regarding all the subtle nuances of the truly skilled counselor.

From bringing counseling services and/or education to individuals in rural areas miles from either opportunity to supplementing existing service menus in order to increase access to services for individuals with various obstacles that preclude “mainstream” counseling and/or training, I believe it appropriate for educators and clinicians alike to be cognizant of the future and what the technology holds in store for us lest we find ourselves being criticized in the not too distant future for being resistant to change in the same way we criticize some of our colleagues today who resist evidence-based treatment strategies, new medications, Motivational Interviewing, and Harm reduction, simply because “they are not the way we did it.”

I am not the spokesperson or advocate for the use of avatars and virtual reality as the primary vehicle for training counselors because I am not. I would, however, like to point out that there are issues here that we (the counseling field as a whole and not INCASE as an organization) best address lest they sneak up on us. Just as there has been a successful marriage between the “art” of counseling and the “science” of counseling, resulting in many of the best practices we presently incorporate into our academic programs and clinical practices, so should there be a collaboration between the “practice” of counseling and the “application” of technology as we look to the next generation of counselor education and service delivery.

A secondary issue worthy of consideration in this discussion is the role the “delivery system” plays in engaging the student in training or the client in practice. To refuse to consider adapting a technology that has been embraced by the likely next generation of counselors and their clients simply because we find it alien and representative of our fears that the miasma of virtual reality is restricting the development of essential interpersonal social skills is to ignore an essential point...the next generation of counselors and their likely client are in the process of if not already having embraced it.

Again, we should neither dismiss this technology out of hand as ineffective if not dangerous nor ignore it as inconsequential. Rather, we should be informing those who create and promote these technological advances in virtual reality to do so in such a way as to consistently ask the following questions:

1.      Because something can be done (technologically) should it be done? Some of us have already answered this question with a clear no; others, including myself, answer saying, “probably not, but that does not mean that something beneficial cannot come from exploring this issue.” NOTE: I am not proposing something akin to Neville Chamberlain’s attempt to appease German aggression in the late 30s—or as Churchill said, “feeding others to the alligator hoping to be the last one eaten” (pardon the paraphrasing)—but rather, a more evocative collaboration that more closely resembles brainstorming.

2.     Are there risks associated with making the synth world so attractive that it risks, directly or indirectly, prompt individuals to “drop out, tune in, and turn on.”? Until and unless human service professionals in general and counseling professionals specifically educate the tech development folks about the risks associated with making the synth world so seductive that it cannot be resisted, such developments will simply be seen as the next cool, neat advance. If, however, we work with the tech folks, outlining our concerns by proffering advice as to how to “use” the technology to accomplish our goals—training and clinical—rather than chastise them for developing a reality we believe to be harmful or dangerous or more succinctly,  “wrong,” we are likely to facilitate a “win-win” scenario. 

The metaphor of counseling an adolescent is not all that out of line when considering this discussion. If we are the experienced human service professional, the “sage adult” if you will, concerned about the high-risk behavior of our adolescent client, would we not engage that adolescent in a way that was uniquely suited to meet the client where he or she was in order to engage that adolescent in conversation rather than demand that he or she simple “stop” doing the high-risk behavior or simply refusing to consider what was being proffered? 

Allow me to close as I began...I neither wish to be nor see myself qualified as a champion for the use of technology in general and virtual reality more specifically as where counselor education should advance. I have as many concerns as do many of my colleagues on this list. There are countless examples of substances and practices that are essentially harmful and toxic in and of themselves but this does not preclude considering their use to further our quest to employ them in advancing the quality of life of individuals or advancement of the human condition. I simply suggest that we not throw out the baby of technology with the bath water of avatars as we reflect on the possible nexus of “counseling” and “virtual reality.”

As an aside, the original link to the video I posted that started this discussion was sent to the CESNET (Counselor Education & Supervision Network) listserv by Dr. Russell Sabbella of Florida Gulf Coast University (http://www.schoolcounselor.com/about-sabella.htm). He is one of the foremost researchers and advocates for incorporating technology in the training of counselor educators. Should you visit the link provided, look at the links to online article on the use of technology in counseling as well as the “Schoolcounselor.net “newsletter.”

As always, thank you for the opportunity to share my ideas and taking the time to consider them.

Whether Bold by the Front Door or Reticent at the Back, It is Just as Warm by the Fire

This wisdom of my grandfather has served me well through the years. In counseling, it is often the quiet, sometimes gentle, but nonetheless persistent pursuit of facts that can guide someone in counseling to insight. The funny thing about insight is that once gleaned, change soon follows. 

Sandra Anice Barns wrote, It is so hard when I have to, and so easy when I want to. I have come to look at this line as speaking to what individual dealing with addiction or compulsive behaviors often realize when realizing that the hassle of change is less than that of continuing. 

Change is many things, but first, it is an "inside job." People do not change other people, but they can influence others to change themselves. I have found that humor, metaphor, and allegory are all pretty good means by which to invite people to step back, look at themselves and their behaviors from a new perspective and answer a simple question: Is what I get by following this path worth what it costs me to continue taking it?

When the answer is yes, the journey continues along its present trajectory. If, however, the answer is no--or, and this is the precursor of change, I am ambivalent and therefore unsure--I contemplate change. When this contemplation is internal, when the tipping point in my cost-benefit analysis of my behavior is reached, I do not so much decide to change because something or someone external to me "made me," but because, as Barnes suggests, I move from feeling I have to change to deciding I want to change.

I have found many stories, cartoons films, music and other examples from the popular culture that have served to be useful in my efforts to invite individuals to evaluate the facts in their lives from a different perspective. Last week I found another and wish to share it here.

I found this video clip - see http://bit.ly/dT6d8g - humorous. It was sent as a link in one of the ubiquitous emails I receive from friends and acquaintances who share "stuff from the web," the purpose of which is to prompt a smile. Although I smiled when I watched, the potential the video held to stimulate a serious conversation about drinking to excess, particularly in a collegiate population, struck me.

If you have a moment--the video is only 3-min long--watch it and enjoy. If you have a thought regarding the video in general or, more specifically, if use in stimulating serious discussion with a group regarding prompting change, I will look forward to your comments here...or you can write directly to chapman.phd@gmail.com


Dr. Robert

Educating Family and Close Friends of Individuals with 
Substance Use Disorders: 

Blooming Where You are Planted

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Generally, those who provide counseling services related to substance use disorders (SUD) do so when working with the person who uses. Another all too often overlooked but nonetheless important individual affected by SUD is the family member or close friend of the user. Finding psychoeducational materials designed to assist these individuals in understanding both the disorder and the way it affects the loved one is essentially to seek the Holy Grail of addictions literature. As with substance users involved in treatment, it is important for practitioners to meet the “individual” where he or she is on the continuum of readiness to pursue change. Frequently family and friends of substance users are at a very early stage of changing their behavior, what practitioners sometimes refer to as a pre-contemplative stage of readiness—I do not need to change, the user must make the change—or a contemplative stage—I can see how making some personal changes may help, but I am not ready to do so—at best. As such, I proffer several resources and suggestions for your consideration.

First, it might be helpful for the family member(s) or friend(s) to read some firsthand accounts of addiction and recovery. By reading first-person accounts of what it is like to be addicted, what is involved in the addicted person’s life that results in a movement towards change, and what life after change is like, family and friend glean an “insider’s perspective” on addiction. This can be quite helpful in letting go of the all too often tendency to think that all the user needs to do is “just stop”—for a humorous look at how effective this expectation is, watch this brief YouTube clip - http://www.youtube.com/watch?v=T1g3ENYxg9k

 Here is a link to some of the stories in the Big Book of AA that presents the stories of recovery from some of the early members of Alcoholics Anonymous. Granted, the drug used by the authors of these stories is alcohol, but the stories tend to give an accurate picture of the compulsion and obsession associated with addiction and, as the result, set the stage for viewing addiction as a bona fide health care problem and not a question of willpower - http://www.aa.org/bigbookonline/en_personalstoriesii.cfm

Next, it is useful to revisit the issue of “willpower” and consider it as more than an issue of perseverance or determination. According to the moral model of addiction, either “drugs are perceived as being bad and therefore so are those who use them,” this is often referred to as the “dry moral model,” or, drugs “may or may not be bad” depending on the drug (heroin/meth = bad; caffeine/alcohol = good), and strong (willed) people can use them without problems...the “wet moral model”…implying that those who experience problems are “weak willed” individuals.

An earlier essay I posted on this blog -  http://robertchapman.blogspot.com/2010/08/understanding-willpower-urban-myth-or.html may be interesting to review. Likewise, there is a collection of essays on my web page (http://www.robertchapman.net click on the essays link in the menu) that may be useful as well...be sure to check out the “counselor’s holiday message” posts. Again, you will need to scan these in order to discern which may be apropos to your interest in this topic.

Next, the film, “Rain in My Heart” may be useful. This is a documentary on alcoholism, but it allows the viewer to see the “down and dirty” reality of alcoholism/addiction and how it is not a question of will, but rather a medical disorder if not an illness or “disease.” The documentary lacks the “canned” or “preachy” feel of many professionally produced videos on addiction. It is available on YouTube in 10 installments of about 8 – 9 min each. The URL for the first being http://www.youtube.com/watch?v=NP0InrPZpjg with the next installment usually listed on the right side of each subsequent screen.

Related to this is another two-part YouTube video entitled, “The Man on the Back.” This you will need to screen carefully as it may not be useful, either in its focus or the fact that it is in Icelandic with English subtitles, but trust me that the subtitle do NOT detract from the power of this video. It has nothing “overtly” to do with addiction, but is a powerful piece on co-dependency and enabling, useful as a metaphor for addiction...the “hiker” in the film being the individual “with” an addiction and the man on the back the personification of the addiction itself. This is a bit of a reach for a lay person to get, however, without having a trained/experienced addiction professional or perhaps recovering person to “set the stage” before watching the video and then processing it at the end. The entire video, both parts, is 20 minutes, so it is brief. The URL for the first installment is: http://www.youtube.com/watch?v=T0m9iu6O3dg with the second linked from the menu on the right side of the page.

The challenge when trying to reach someone who: (1) believes he or she already knows ‘what’s what’ as regards addiction and (2) is so angry, hurt, and/or scared that hearing about let alone investing time and effort to read material that will “educate” about addiction is perceived as “fruitless” at best and a complete waste of time at worst. For this reason I suspect that “at this stage” it might be more productive to help the individual to understand addiction on an emotional level rather than try to engage him or her in a more cerebral or “intellectual” investigation of the disorder. Remember…this individual has been frustrated if not deeply wounded by the loved one’s behavior as dictated by his or her addiction.

Do not expect those who have been personally and profoundly affected by the SUD of another to accept any of these suggestions or “psychoeducational” interventions willingly or with thanks. As a matter of fact, initial overtures of help are frequently met with resentment. If, however, the information is proffered, with an emphasis on “I care” rather than “you need to know,” it is not uncommon that the individual will consider the material if not return in order to seek your counsel and support.

Dr. Robert

Understanding Aspiration: Revisiting the Term Dead Drunk

Aspirating stomach contents is most commonly experienced by individuals who are in an altered state of consciousness, e.g., head trauma, under anesthesia, under the influence of alcohol or other drugs, etc.

When in such an altered state of consciousness, bile and other stomach contents, i.e. vomit, can be aspirated or "inhaled" into the lungs if the individual is lying on his or her back and vomits while passed out.

This is a phenomenon that has been known for most of recorded history, e.g., Atilla the Hun is reported to have died on his wedding night in 467 AD as a result of aspirating vomit and/or blood while in a drunken state; aspirated vomit contributed to the deaths of Janis Joplin, John Belushi, Jimmi Hendrix

Problems associated with aspirated stomach contents fall into three broad categories - 1) obstruction of the airway and flooding of the lungs, i.e., "drowning," 2) chemical pneumonia or damage to the lining of the lungs due to acid burning - if the ph of the aspirated material is lower than 2.5, the result is chemical damage to the lining of the lungs, which precludes normal respiration, 3) bacterial pneumonia, which results from inhaling pathogens or "bacteria."

Recovery from the effects of inhaling a small quantity of aspirant is rather quick, 24 to 48 hours. Chemical or bacterial pneumonia, i.e., "aspiration pneumonia" is much more serious and treatment can take an extended period of time and require the use of antibiotic medications.

Standard training for resident life staff in most colleges and universities includes the early detection and prevention of aspirating stomach contents when intoxicated. This phenomenon, often mistakenly referred to as "alcohol poisoning, can result in "aspiration pneumonia." This training consists of knowing the signs of individuals who are at high-risk for this phenomenon and precautions when caring for the excessively intoxicated student. These include, 1) place the individual's back to a wall, pillows in front to preclude rolling onto one's back or stomach, thereby lessening the chance of aspirating vomit should the individual become sick.

True "alcohol poisoning" results from achieving a blood alcohol level so high as to anesthetize the vital reflexes associated with circulation and respiration. This is a true "alcohol overdose" with the same consequences as those associated with an overdose of any central nervous system depressant drug, barbiturates for example.

While not an uncommon phenomenon, a relatively small portion of any collegiate student body is at risk of aspiration as the majority of college students (56%) drink 4 or fewer drinks per outing and of those who drink more, many do not consume enough to suppress their gag reflex or become so intoxicated as to be unable to right themselves if they need to vomit.

To read more about the risks associated with aspirating stomach contents when excessively intoxicated, visit this webpage at Loyola Marymount University - http://www.lmu.edu/Page25064.aspx

A Counselor’s Holiday Message

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I saw an interesting quote today. It struck me as particularly apropos to the holiday season…Christmas, New Year, Kwanza, Hanukkah... Although apparently religious at first glance, albeit ecumenical, I suspect, universal nonetheless;

An important part of praying,

Is a willingness to be part of the answer.

When discussing spirituality in counseling, especially counseling individuals with substance use disorders, I tell my students that I believe there is more to spirituality than just its theological interpretation. I suggest that it may be as much a world-view that, like a Venn Diagram, includes the theological, sectarian meaning so many associate with the term, yet still leaves room for the more secular constructs of harmony and connectedness.

This understanding of connectedness is similar to the Native American concept of harmony and the belief that all things in this existence are interconnected; that all that exists is the product of the creator and as such, all imbued with a spirit that must be respected  in order for me to be respected. It is in the recognition of a thing’s spirit that we acknowledge its significance and ultimate importance to our own well being—it is acknowledgement of a “thing’s” essence and my understanding of its meaning that gives us significance. This recognition then becomes, in and of itself, a prayer when we interpret “prayer” to be an appeal, a plea, a request, a desire, a wish, or a hope—all synonyms proffered courtesy of MS Word J This prayer may be directed to a “supreme being,” but then again it can just as easily be directed to a “human being,” that is, another human in the act of becoming or secular group, like AA. This is, of course, one of the ways AA explains the spiritual aspect of the suggested program of recovery to new comers who are concerned about if not put-off by the seemingly sectarian nature of the 12-steps.

The Navajo—and I apologize if I cite the incorrect Native American tribe—have a saying:

Beauty to the right of me,

Beauty to the left of me;

Beauty before me,

Beauty behind me;

Beauty above me,

Beauty below me;

I am on the pollen path.

This is, to me, similar to what my grandfather with his 8^th grade formal education and DHW (doctor of hard work) in common sense used to tell me. “Robert,” he would say, “no matter where you go, there you are.” I now know that was not an original quote of his, but it was one of the many things pop taught me that shaped me as a boy and influenced the adult I would become; he taught me that no matter where I stand, at any given time, I am where I need to be at that time to make a difference, both in my life and in the life of another…directly, meaning today, and indirectly, meaning tomorrow and through others via their actions.

Through the years, I have come to realize that all things exist for a reason and that with the exception of us sentient human beings, that reason…that purpose…is clear and is pursued relentlessly from birth through death by all creation. We human beings also have the same purpose but, I believe, have been placed on this earth to consciously affect that purpose intentionally, namely, to assist in making this world…this place where we coexist…just a little bit better for our having been here.

To listen to the 6 O'clock news or access one’s usual source of information, however, is to get a daily dose of doubt regarding this potential to affect the world in a positive way. Yet there is “beauty to the right of me, beauty to the left of me…” if I will just look for it…more to the point, I just expect to see it.

So if praying is not just speaking with a higher power, but includes voicing an appeal or making a plea or proffering  a request or expressing a desire, or producing a wish, or cultivating a hope, then expecting a result may well necessitate being prepared to become part of the answer.

Gandhi said, We must be the change we wish to see in the world. AA says, Just do the next right thing.

Apropos to this, I share with my students another of my grandfather’s lessons, albeit updated with my own personal homage to my journey through the 60s:

Change is possible;

Change is possible for me.

Change is possible for me right now;

Change is possible for me…

… right now…

…with a little help from my friends.

At this festive holiday time of the year I wish you and all those important to you peace, good health, and faith, faith in the belief that change is possible through prayer in all its many and varied forms.

Dr. Robert

Has the new technology precluded students from learning in traditional settings and ways?

There was a time in the not too distant past when we were so unfamiliar with the new digital technology available to us that when referring someone to a web site, the entire URL would be printed or read aloud in an advertisement. Today, the bare essentials appear because "everyone knows" to enter http://www in order to visit the site--and many browser are so intuitive that all one needs to type is the essential information.

My point is that not only has the technology expanded at a pace that for many seems dizzying, but we have learned how to use that technology and, in many cases, have become dependent on it. And those who have been born in the last 20-years--the millennial generation as they have been dubbed by some--have grown up  having always known that the Internet existed, that email and text messages are as common as today as ashtrays  in restaurants and airplane seat armrests were in 1960. Times change and those who live through the change are aware of it, but those born into the change see it as just the way things are.

So what are the implications of the technological revolution of the 21st century? Will society be affected as much by it as the 19th and 20th centuries were by the industrial revolution? I suspect that this YouTube clip, may set the stage for some interesting considerations regarding this. Visit http://www.youtube.com/watch?v=SkhpmEZWuRQ

Although apparently staged, the point this clip raises is nonetheless interesting…can today’s high school students “learn” from printed textbooks if they become frustrated by their dissimilarity with where they glean most of their information…the internet? Has the disconnect between electronic media and the (in student eyes) antiquated “hardcopy” print alternative become so great as to prejudice the student and affect his or her willingness to learn? And if the answer is yes, what are the implications of this reality for us as educators, remembering that today’s high school students are tomorrow’s under grads and graduate students? More to the point, whose responsibility is it to change…the students who need to “appreciate the value of printed information” and “realize that everything on the Internet cannot be trusted” or is the problem ours to address by revisiting our pedagogy, doing much the same as educators as we have been taught to do as counselors…meet the “client” where the client is?

Just a thought…what are yours?

To consider the impact of digital technology on eduction further, watch http://www.youtube.com/watch?v=dGCJ46vyR9o

Dr. Robert

Alcoholic Energy Drink Producers to Remove Stimulants: Good News?

Although at first glance the FDA's decision today reported by CNN (http://bit.ly/buH8Ep ) may appear a victory and  “good news,” we need to realize this is also akin to what social psychologists like to call “the foot in the door” phenomenon (see http://bit.ly/cYW6Ut ). Literally, this is when I ask you to do something or give me something small in order to give me/do something larger that I was not likely to have done/granted right away. In other words, by asking for something one does not need to think much about and is likely to grant, when I ask for what I really want, the ice has already been broken and you will give me what I want. The argument goes that if you have already provided something you are more likely to provide more.

When I say that Four-Loko’s manufacturer’s offer is “akin” to the foot in the door, I mean that “we”—those who are protesting four-loco and other alcoholic energy drinks—are not likely to object to this offer and may even applaud the proffered change as we saw the added stimulants in these beverages as a major—although not the only—concern regarding these drinks. However, is the wind is then taken out of the protest movement’s sails? Is the momentum we have amassed lessened? Do sweet-tasting, high-sugar drinks equal to 4.7 standard servings/container drinks continue to be sold?

Another variation on this theme is that the producers of alcoholic energy drinks respond to our continued protests about alcohol content, calories, and potential for overdose by suggesting that we are “zealots” who are “neo-prohibitionists” because they removed the stimulants we said were so harmful yet we still are not satisfied. In short, can they spin their efforts and our response them to their advantage?

I do not have the answers to the questions I ask, but we nonetheless, as a field, need to be very careful how we proceed here. On the one hand, the removal of stimulants is a good thing; on the other, do we risk losing momentum and/or being cast as a group of “fundamentalist neo-prohibitionists”?

What do you think?

Dr. Robert

 12-Steps & Religion: Is AA Secular? 

As a professional counselor for 38-years, the last 35 of which have been spent exclusively addressing issues related to alcohol and other substance use, a frequently asked question has had something to do with the apparent religiosity of AA or other 12-step mutual aid groups. Most frequently such questions come from those being referred to AA and are based on either a limited previous exposure - "a couple" meetings "years ago" - or what had been "heard" about AA or how it was portrayed in a film or TV program. I must admit that addressing this concern was something of a challenge in the early days of my career, but as with so many things in life, it has become easier as time...and opportunities to practice...have passed. As my grandfather used to say, "We do best what we do most." Consequently, I have a couple specific thoughts to share for your consideration:

1. 1.      I have found that with individuals reluctant to consider AA or other 12-step programs--and more recently, my students who are asked to consider if they will use 12-step programs as an adjunct to their professional counseling--a bit of prep work in advance of a “first meeting" or more informal exposure, e.g., AA/NA literature, can be quite helpful. This includes accentuating the positive aspects of meetings that may be realized specifically or involvement with “the fellowship” in general. Examples of this include, the opportunity to socialize with those who do not use, the opportunity to recognize that one’s use (and the results of it) are not unique to “me,” or the simple “something to do with my time rather than use." Likewise to help him/her understand that the language used at meetings and in the literature is not necessarily as the individual interprets it. By this I mean, help the individual recognize that “language” is composed of words that are mere “auditory symbols” that only have meaning as the result of the way they are used and in the context of how they are conveyed by those who use them. Consequently, the “meaning” of words can change over time and/or the meaning of the speaker may not be the same as that of the listener who is interpreting them. I often use the example with students of the word “gay.” When AA was being formed, 1935 – 1939, “gay” meant “happy” or “joyous.” Today, of course, many people 60 or younger understand “gay” to mean being homosexual, particularly being a male homosexual. Although “gay” continues to also mean happy and joyous, it is often the context in which the word is used that enables the listener to discern the speaker’s meaning. This, unfortunately, is a bit more difficult when it comes to the perceived religious-speak used in 12-step literature and at AA and NA meetings. Consequently, the counselor has to work a bit harder to help the individual who may be agnostic if not atheist, and whom she or he wishes to refer, to be able to tolerate, let alone embrace, the program of recovery that has come to be known as AA’s/NA’s 12 suggested steps.
2. Related to the first, is to proffer a “different set of lenses” through which the agnostic or atheist can view AA's or NA's 12 suggested steps and the “language of recovery” spoken at 12-step/mutual aid meetings. One vehicle I use is B. F. Skinner’s—the famous behavioral psychologist—“humanistic alternatives” to the 12-steps. Although AA/NA is not going to alter one word or even syllable of any of its texts, we can help individuals who we believe may benefit from the program to clear the hurdle presented by the language that results in a misperception that unnecessarily precludes one from benefiting from such mutual aid groups because of a perception of their religious tone if not orientation. You can find Skinner’s “alternative steps” at http://silkworth.net/magazine_newspaper/humanist_jul_aug_1987.html
3. Another, albeit more academic resource in addressing this question is a paper I wrote on understanding (interpreting?) the 12-steps of AA. Although written for my counseling students to help them better grasp the potential12-step programs hold to provide a useful adjunct to professional counseling, this might be of use, at least as a source of “talking points” if addressing the issues of “GOD” or “Higher Power” and other things “apparently” religious in AA. Visit http://bit.ly/cI4dNh 

In closing--and to answer my opening question--"yes, I do believe that AA is secular...non-religious...focused on moving further away from the last drink or drug use rather than closer to "God." As I once heard at an open meeting of AA I attended when someone was railing about all the "god talk," "if the word bothers you as a reference to a supreme being, then use it as an acronym...Good Orderly Direction."

What do you think?

Dr. Robert

To Scare or Not To Scare: That is the Question RE Alcoholic Energy Drinks

Anyone with a passing interest in alcohol-relate issue, especially as they apply to collegians, has heard of the furor related to "Four Loco" and other caffeine infused, high-alcohol drinks. A good example of news coverage can be seen in an article in Carolyn Davis' piece in the 27 Oct edition of  Philadelphia Inquirer see http://bit.ly/bt2dJQ because of the hospitalizations, deaths, and various sundry "alcohol-related" emergencies associated with consuming such drinks, some campuses have banned these beverages and educators, political officials, parents, and others have called for action...from mandatory labeling of the number of standard doses of ethanol in a single 23.5 oz can of Four Loco (4.7) to outright banning of these products. Finding information on this issue is easy and if you are interested but having difficulty, you can post a comment or email directly and I will be pleased to share some sources.

The focus of this blog post, however, is not to participate in this debate so much as to step back from it and as two basic questions from a more global perspective: (1) Are there inherent risks associated with scare tactic approaches to "warning" individuals to not do something because it is risky and potentially harmful, and (2) have some earlier decisions made by prevention specialists and prevention researcher's diminished our credibility in the eyes of students to deliver reliable and therefore "to be listened to" information about alcohol and other drugs?

I suspect there may be a downside to efforts to emphasize the immediacy for responding to the alcoholic energy drink issue. The greater the urgency assigned to this issue, the more  likelihood that these products will appeal to a certain minority of students who are risk takers. As Linda Lederman, Dean of Social Sciences at Arizona State university, has admonished regarding the use of “high-risk drinking” as an alternative to “binge drinking” because of the potential to appeal to these students, we may want to target audiences to which we appeal with this in mind. It may result in a desired effect to raise the alarm with administrators and student affairs professionals, but cause quite a different result if that same message is delivered to students. (To risk-taking behavior and its impact on substance use further, read Tom Workman’s essay on edgework and risk takers entitled, “To the edge and back again: Edgework and Collegiate Drug Use” in my monograph, Collegiate Drug Use: A New Look at and Old Issue (http://www.rowan.edu/casa/resources/documents/chapmanfinalfinalap.pdf).  

Related to this cautionary word is the importance of considering how we wish to approach students with this information. As in so many things in our field, there is no “one size fits all” alert that will have the same impact on parents, administrators, students affairs pros and students. Remember, since we have all but acquiesced to accepting “binge drinking” as the term to describe 4+/5+ student drinking, we have lost credibility as purveyors of factual information in the eyes of some students.

In a recently published report from the Century Council—and yes, I know the CC is an arm of the distilled spirits council—students do not see this term as relevant or descriptive of their drinking – see http://bit.ly/bqZTbg Knowing this, we need to pay attention to: (1) What message about high-alcohol energy drinks do we wish to deliver to students and (2) who is it that we believe is best suited—and credible—to deliver this message? Remember the old adage, “what goes around, comes around”; it may be time to review our comfort as a field with the term “binge drinking” to describe how students drink. NOTE: Thanks Jim for not referring to 5+ drinks as “binge-drinking” in your missive J

Again, I do not attempt to “rain on the parade” and believe that social scientists, administrators in high education, and parents alike do need to address this issue as a unified entity. My caution is that we do so in such a way as to be consistent with sound prevention methodology, which has excluded "scare tactics" as a viable approach for almost 20-years..

What do you think?

Best regards,

Robert

Benign Neglect or Can Deception Ever Be Therapeutic?

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

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

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

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

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

What do you think?

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

Best regards,
Dr. Robert

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

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

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


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

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

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


Dr. Robert