The Buzz about Fermentation is as Silent as the "P" in Alcohol

Have you ever eaten a hotdog…a char-broiled, foot-long with diced onions and catsup or perhaps smothered in sauerkraut with mustard…or however you “like your dogs”…and enjoyed it? Ever heard someone say, “If you knew how they were made, you would never eat another one”? Yet, chances are many reading this not only have eaten those dogs, but truly enjoy…if not love…them. Well, what if we were to take a look at alcohol in much the same way. Is it possible that one could say, “If you knew how alcohol was made, you would never take another drink”?

Alcohol is a naturally occurring compound composed of oxygen, carbon, and hydrogen. The chemical formula for the alcoholic beverages most consumers drink--ethanol--is C2 H5 OH. In a proverbial

“nutshell,” alcohol is created via a process called fermentation when naturally existing organisms called yeast act upon the sugars in organic compounds as they are broken down in the natural process of decomposition. When left to their own devices, yeast continue to live and produce alcohol until the concentration of alcohol in the mixture reaches a point of approximately 12%, at which point the alcohol content causes the mixture to become toxic, killing the yeast. Beverages with an alcohol content in excess of 12% (24 proof) are created by distilling the naturally produced "mash" or "wort" to its desired strength.

After ingesting organic matter, yeast digest the sugar and produce alcohol, which is the byproduct of this digestive process. In essence, yeast ingest the sugars in organic compounds and excrete alcohol as a waste product. Yes, you read correctly, alcohol is essentially “yeast piss.” So the next time a friend asks if you want to stop by the One-Eyed Jack for a couple drinks after work, remember the process on which John Barleycorn relies to produce your favorite wine or beer or spirits.

Whether you are a connoisseur of top shelf fare or restricted to the dregs from the bottom of the barrel, do not forget to tip your hat as a sign of gratitude to the lowly yeast, for as we have all heard before, "one man’s trash is another man's treasure."

Tips for Collegiate Drinkers

6 Ways to Moderate Consumption if Choosing to Drink in College[RC1] 

By Dr. Robert Chapman, Associate Clinical Professor, Behavioral Health Counseling Department 

 

[RC2]  It’s no secret that some college students choose to drink alcohol. Nor is it surprising that some of these drinkers either intentionally or accidentally become intoxicated and face various consequences. What might be new to some is that most articles about college drinking focus almost entirely on these consequences and suggest that they prove that all college drinking is problematic.

If “the problem” is solely collegiate drinking, then the only reasonable prevention goal is abstinence. However, this goal raises questions. Is there ever a time when students do not drink? We have focused more on the consequences after students drink than on understanding the meaning they assign to alcohol and drinking before they consume it. This understanding influences their decisions to drink—when to drink, how to drink, and what circumstances justify drinking.

So, if college drinking isn't the problem, but rather the drinking some students do is, here are a few suggestions to reduce the risk of adverse consequences if you decide to drink.

1.     Water is a commonly mentioned nonalcoholic beverage that many students report drinking. Remember that when drinking, the more nonalcoholic beverages you consume, the longer it takes between alcoholic drinks and the more time there is for the alcohol already consumed to be absorbed. Additionally, alcohol is a diuretic that draws water from body tissues. Drinking water rehydrates the body and may help reduce some hangover symptoms. Ideally, those who drink alcohol should consume an 8-ounce serving of water for each standard alcoholic beverage.

 

2.     Students tend to develop habits. Drinking a certain amount of "X” drinks in one sitting can create the illusion that “X” is moderate intake, especially if friends are also drinking “X” or “X+1, 2, etc.” Think about your usual drinking habits. Multiply your typical amount by the number of days you drink each week. Then, multiply that total by the calories per drink: 90 for light beer, 130 for regular beer, or "per shot" in a mixed drink (don't forget to include calories from mixers). The result is your total calorie intake per week, month, or year. For accurate calorie counts for 100 beers, visit http://www.beer100.com/beercalories.htm (keep in mind that 12 ounces of beer equals 350 ml).

 

3.     Track your drinking over a couple of typical weeks. Once you have a baseline, divide the number of drinks by the hours spent consuming them. The resulting number is your "drinks per hour" ratio. Once the pace has been determined, for example, "4/hr," consider if you were to have a drink every 20 minutes instead of every 15. By adding 5 minutes between drinks, you realize a 25% reduction in drinks consumed in the evening—from 4 per hour to 3. What happens if you add 15 minutes between drinks? A 50% reduction in drinking. 

 

4.     Next, explore creative ways to add those 5 to 15 minutes between drinks. Drink a nonalcoholic beverage like bottled water, or avoid standing directly next to the keg. Finally, consider the benefits of this simple change, such as fewer hangovers, improved class attendance, fewer regrets the next day, fewer calories consumed, more money saved, and more. All of this can be achieved just by adding 5 to 15 minutes between drinks.

 

5. When you have a headache, consider how much aspirin, Tylenol, or Advil you actually take. Chances are, you take two, perhaps three. So why not take 6, 10, or 15 if they work so well? Before you dismiss this as an foolish question, keep in mind that most people who drink alcohol find the effects from 1 to 3—and no more than 5—standard drinks (12-oz beer, 10-oz malt liquor, 5-oz wine, 1.5-oz spirits) during an outing. Yet they often go on to drink 6, 10, or even 15+ drinks and face the common consequences of heavy drinking. 

 

6.     I like to ask students what time they usually eat dinner. If they live on campus, most dining halls are open from 4:30 PM to 7 PM, with many students eating between 5:30 and 6:30, "just like home." Then I ask what time they usually go out when they socialize. Chances are high that most students go out after 9 PM, with many not until 10 PM or later. If there is a gap of over three hours between dinner and socializing, the student may drink on an empty stomach. Students could eat dinner later if they plan to go out and then snack before leaving and throughout the outing. 

7. "Add your harm reduction suggestion as a comment."

 

Although no tips can prevent someone determined to get drunk from reaching that goal, those who choose to drink but want to reduce the chance of adverse outcomes may find one or more of these tips helpful.

  

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 [RC1]I am uncomfortable with this title as it places the emphasis on drinking—wrong message. How about something like: 6 Ways to Moderate Consumption if Choosing to Drink

Thank you. Good suggestion, and the title is changed.

 [RC2]I suggest a different “less negative” picture. I believe a tipped “dead soldier” (empty bottle of alcohol) is inconsistent with the emphasis of the essay.

Thank you. Good suggestion and the graphic is changed.

Dr. Robert

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

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

As an aside, an important aspects of Marlatt’s consideration of relapse is the role the “abstinence

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

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

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

What do you think?

Dr. Robert

"Study Drugs": The Rest of the Story

As important as the issue of off-label and "self-prescribed" use of psychostimulants, Adderall and Ritalin, is for all in higher ed to consider, the focus has historically and unfortunately remained stubbornly on the user of these drugs rather than the student who provides access. True, these drugs can be purchased "on the street," as can any other psychoactive substance, but all to frequently, access is via a friend or known peer. Although higher ed is appropriately concerned about this issue, its focus in addressing it is routinely--and all but exclusively--on the risks associated with that use, and then only for the user, not the purveyor. As there is much written about both of these issues--the use of psychostimulants and the associated risks for the user of "study drugs" (for an excellent overview, read this 9 June 2012 NY Times article on the subject, "In Their Own Words: 'Study Drugs'),  I will restrict my comments to what Paul Harvey used to call, “the rest of the story.”

1. The literature shows that when approaching collegians regarding losses associated with high-risk drinking as opposed to the gains realized by avoid such consumption, students respond more and better to gains-based information than to loss-based info. Although anecdotal information, my experience and that of colleagues across the country is that loss-based prevention efforts all but ensure that a prevention message is ignored. 
• Recommendation: Identify the benefits of avoiding the use of psychostimulants unless prescribed and then focus on these. If including any information about risks, make this a secondary focus; an almost, “oh, by the way,” type after thought. 
2. Focus on the legitimate user who has the prescription if not make this the primary focus on at least ’some’ prevention messages. Many students with legitimate prescriptions are hounded by peers for these drugs because of their perceived mythical ability to enhance cognition and academic prowess. "Assertively challenged" students are ill equipped to resist the manipulation of a determined, aggressive collegian.
• Recommendation #1: Again, focus on the gains of not sharing rather than the losses, either for the provider or the user
• Recommendation #2: Provide tips on basic refusal skills. This may be as simple as the printed handout with suggested ways to resist the insistent friend or roommate to the more formal production of BRIEF video clips (no more that 1.5 – 2-min) for YouTube, demonstrating a series of professionally scripted and well produced demonstrations of refusal skills, for example: Something that informs students that “Faux excuses” for not doing something high-risk are lies God lets you tell and still get into Heaven :)

As with so many issues of social significance, addressing something as provocative as the off-label use of prescription drugs is rarely as simple as just dealing with its most obvious elements. All social problems are complex. They are the result of what epidemiologists so often discover are multiple factors: the host or in this case the student who uses psychostimulants off-label, the agent or the psyhcostimulants themselves, and the environment, again in our case, the college campus. Consequently, the resolution of the problem is going to take a concerted effort that addresses each of these elements and its contributions to the problem with an integrated strategy. 

Regarding the "host," student's view these drugs as legitimate "study aids" that can enhance their cognitive performance and provide the competitive edge believed necessary to succeed. This is why there seems to be a correlation between the proportion of students reporting the use of these drugs and institutions with the most competitive entrance requirements. Regarding the "agent," there are significant numbers of students legitimately taking these drugs to effectively control an otherwise debilitating disorders that seriously challenges the academic performance of otherwise capable students. Lastly, regarding the "environment," college and university campuses represent a unique culture complete with its own attitudes, values, and beliefs. Affecting this culture in any significant fashion, let alone trying to completely change it, is a task that has challenged administrators and student affairs professionals since institutions of higher education were chartered in the 17th century.

Addressing the use of "study drugs," as with collegiate drinking, sexual behavior, or any other behavior, necessitates taking a comprehensive look at student perceptions regarding impossibly complex social issues--what middle aged administrators see and what traditionally aged collegians believe are frequently "horses of a different color." As such, many of the strategies designed to prevent high-risk and dangerous drinking are likely to be as useful in changing student perceptions regarding "study drugs." Social Norms campaigns, environmental management strategies, and harm reduction techniques employing evidence-based intervention strategies such as BASICS--Brief Alcohol Screening and Intervention for College Students--hold promise. In addition higher education is advised to address the issue of student understanding of these drugs and their use. As with alcohol and drinking, students ascribe meaning to psychostimulants based on their interactions with peers who use them and others who pass along their beliefs regarding these drugs. Until and unless we are able to change the way these drugs are viewed by students, we are not going to change the way they are used.

There is no easy fix; any effective effort is likely to necessitate a consideration of both those who choose to use these substances and those from whom these users procure them. Further, higher education's efforts to affect how each party views its role is likely to result from efforts to motivate change by showcasing gains-based incentives rather than engaging in the more traditional loss-based approach.

What do you think?

Dr. Robert

Writing as a Counseling Skill

Writing IS a counseling skill. Think what you may, but it is and that is that! Need proof: What will that doctor, lawyer, judge, probation office, employer, or any other professional think about your clinical recommendations for a client if the letter, report, or discharge summary you have written to outline such

includes misspelled words—“there” when you meant to write “their”—or run-on or incomplete sentences; poor grammar—too many or too few commas or their use in the wrong places—or improperly employed pronouns—“Me and her got along well in group…”? The last thing a professional counselor wants or needs is someone second guessing his or her clinical recommendations simply because they are discounted when the reader of a report questions the writer’s clinical judgment because of the quality of the written report.

Here are a few thoughts—and recommendations—from a professor of counseling who once read on a student’s end-of-term course evaluation; Dr. Chapman seems to have forgotten that this was a counseling course and NOT a writing course!

As many of my students have heard me say so often in class, “you do best what you do most,” so “doing” more writing will help improve one's writing skills. That said, you need to get feedback on this writing that you will do. Certainly, should a student ask a professor, he or she may be willing to be particularly critical on any papers submitted and provide feedback on what a student has written, perhaps even including referrals to an online tutorial related to the indicated issue. For example, pointing out instances where specific writing issues occur, as in the use of the “passive voice” or “split infinitives” and proffer a suggestion regarding how best to correct the issue as well as perhaps suggesting a link to resources online where you can learn more.

Another option, of course, is to frequent your university’s writing center. At Drexel, the Center’s website is - http://drexel.edu/engphil/about/DrexelWritingCenter/

Another option—and this may sound like work, but it simply involves paying a different sort of attention to the reading assignments you have for your courses—is to read professional writing in a critical fashion. By this I mean, paying particularly close attention to “how” what you are reading was written. Notice the phrasing, sentence structure, and syntax. Pay particular attention to those reading assignments that seem “effortless” and those that are quite tedious. I suspect that the way an article or chapter is written will affect how easy or difficult it is to read. By this I mean, does it hold your interest? – ask yourself why and what it is about the writing that makes it so clear; is it easy or difficult to concentrate on the writing – again, ask yourself why and what the author(s) do to facilitate or frustrate your concentration.

Next, look for and complete at least one or more workshops on APA style. NO ONE will ever know all there is to  know about APA style, and by the time you think you have a handle on it, APA will come out with a new edition. You can, however, familiarize yourself with the basics and then turn to online resources if not the actual manual itself for the details or info on some obscure challenge you face in your writing. Your library likely has workshops, perhaps even an online webinar, and there are numerous resources available online that can be very helpful. The APA itself has an online tutorial regarding the “basics” of APA style.

Lastly, in this missive that is, as there are obviously many more ideas and suggestion that can be pursued, take the time necessary to construct a well written paper. To do so, consider these suggestions:

• ·         Never EVER sit down, write a draft, and then turn that in as your paper…EVER. Enough said!
• ·         Read what you have written out loud. You will discover most of the problems, especially those related to syntax, when doing so. If it does not “sound right,” chances are it is not, and there is a problem you can fix
• ·         Let some time pass between “writing” and “proofreading” your document. If you review immediately after you have written something, the fact that you know and understand what you were thinking can result in your prose “seeming” clear when they actually are not. Remember: Your familiarity with your subject may lead to “filling in the gaps” in the logic and reasoning as you proofread your manuscript.
• ·         Set up your word processor to check grammar as well as to check the document’s readability. NOTE: The links here are to instructions regarding the use of Microsoft Word 2010, but such instructions likely exist for whatever word processing program you employ.
• ·         Invest in a “pocket handbook” on writing, something like Kirszner & Mandell’s, The Pocket Handbook for Psychology, 2^nd Edition. You can find it used for as little as $4 – click the link to check online for used copies via addall.com.

These are just a couple ideas related to improving your professional and academic writing. Feel free to leave additional suggestions or writing resources as comments.

Best regards,

Dr. Robert

 Thanksgiving, Christmas, & College Students:

Home for the Hellidays

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Students, being human, are sentient beings, which basically means they are attentive, responsive, and

most of all “thinking” beings. Such characteristics are on the short list of reasons why counseling in general and “talk-therapy” specifically work. Yet on some occasions, for some students, this gift of sentience would appear to exacerbate rather than ease the onset of some truly horrific emotional experiences. Such experiences are not uncommon in the presenting problems of students who are addicted or come from addicted families of origin and for whom cognitive behavior therapy is the counselor’s treatment strategy of choice. Likewise, addressing one’s propensity to “think too much” is all but a regular part of the repertoire of 12-step sponsors who extol the virtues of avoiding, “‘stinkin’ thinkin’” for those new in recovery

While information processing and attribution errors are not unique to individuals in treatment for a personal or familial addictive disorder, such individuals do seem to be particularly vulnerable to misinterpreting certain cues that they tend to view as harbingers of doom or strife that represent what Albert Ellis, Ph.D. calls “catastrophizing” [1] or David Burns, M.D. calls “mind reading or the fortune teller error.” [2] These cognitive distortions of events or facts tend to set clients up for expectations of a less than positive if not unbearable emotional experience. Depending on the severity of these distortions, treatment gains can be placed in jeopardy. The prevention of a relapse in treatment for addicted individuals and/or their families may well hinge on teaching clients to recognize the emotional cues that hold the potential to trigger a lapse in treatment objectives if not relapse to pre-treatment levels of functioning[3].

Considering this human potential to cognitively distort reality, situational cues exist that can trigger emotional reactions in our clients so palpable as to cause them to literally panic and “catastrophize” as they are overwhelmed by the flood of memories triggered by the cue(s) encountered. The pending holiday season is just such a situation that, for addicted individuals and their families, represents a time machine that all too often instantly transports them back to a place/time and the events so vividly remembered that the mere thought of returning to an addicted home--or being visited by an addicted family member--during this season is enough to provoke anxiety and depression. As if the intense emotional reactions triggered by such cues were not enough, the behavioral reaction to these recollections of holidays past can prompt everything from a frenzied search for plausible justification to avoid traveling home/inviting relatives to visit to attempts to emulate “Martha Stewart” in order to ensure the perfect “Hallmark” holiday in the irrational belief that, “this time it will be different…I will see to that!”

The problem of catastrophizing over the prospects of returning “home for the hellidays” is particularly noticeable in late adolescence and early adults, those individuals who have often fled dysfunctional families, perhaps to college, a marriage, or to the service, primarily to escape the chaos of their family of origin.

This prospect of returning home during the holiday season is emotionally distressing and can prompt all manner of clinical problems for those being seen in such situations. The likelihood of relapse for clients working on addictive disorders of their own or problems associated with addictions are obviously escalated as such intense emotional stress can threaten even the most committed of clients in early recovery. On the flip side of this coin are the parents that are torn between a longing to have their son or daughter with them for the holidays and the dread that the season will somehow be transformed from occasion to share gifts to something akin to a storyboard for a holiday episode of the Simpson's.

Some people have anxiously awaited the opportunity to share the season with their addicted loved one(s), believing in true co-dependent style that their time apart will somehow have enabled the family to have miraculously resolved its previous problems. Often, students who have been away and return to an addicted family unit have just been away long enough for the memories of the family’s chaotic behavior to have been eroded by time. They wonder what will happen when returning home. Still others are paralyzed by the fear of what awaits them when they return to this likely chaos. They remember all too vividly drawing that “1000 mile radius from home” circle on the map and making it the number one criterion for selecting a college, place to relocate when seeking employment, or joining the armed forces. In short, these young adults are all, at the least, anxious about returning home for the holiday season and many, too many, are petrified about “going home for the helidays.”

While the picture I paint is not hard to envision and most counselors who have worked in the addiction field for any time, especially with addicted families, are likely to relate to the particular problem the holiday season can present to students, must we resign ourselves to simply helping them “get

through” the pending hellidays or are there steps that can be taken that both lessen their anxiety while at the same time pursuing the identified treatment goals? Can counselor better assist students to ‘accept the things they cannot change and change the things they can’? Here are several proactive steps counselors can suggest their client consider in order to better prepare for surviving the helidays:

1. Help students remember: Just as no family member made the alcohol or other drug dependent individual an addict and no member can make any other family member drink or use, neither can anyone keep him/her from drinking or using. This is arguably the single most frequent irrational belief held by untreated members of an addicted family. Even though on a cognitive level family member “know this,” on an emotional level they have failed to “accept this.” This one point is of paramount importance when helping students prepare for the hellidays. It is the foundation on which all of the remaining suggestions are based. In short, if a student cannot accept her/his limits when interacting with the addicted family member, she or he has all but assured reacting to the family problem rather than acting on a personal solution.

Case in point: Phyllis was a 22 year old senior in college who was dreading the holiday season because of the all but certain reality that her alcoholic father would ruin the Thanksgiving dinner by, “Making one of his scenes.” As we spoke it became clear that Phyllis would help her mother all day in the preparation of the meal, cleaning the house before the company would arrive, and, then number one job, “Make sure your father does not get drunk before dinner.” Phyllis discussed her growing anxiety knowing that her father would get intoxicated, make a scene, leaving her to deal with her mother’s rage over not preventing this. When asked for proof that she could accomplish what her mother assigned, she quipped, “Are you kidding, keep my father from drinking”? We discussed not setting herself up for a “traditional” Thanksgiving by refusing to accept the task of keeping dad sober. Instead, we discussed how Phyllis could avoid getting caught in the crossfire between mom and dad.

2. Help students remember: The 1st rule of codependency to be challenged is the need to put the addicted individual first and in front of all else in one's life. To this end, discuss with your student the merits of inviting the addicted family member to celebrate and socialize with the family, but if he/she refuses, so be it... GO ON AND CELEBRATE YOUR HOLIDAY ANYWAY!  We have all encountered individuals who, in essence, have told us that a good day is when it is a good day for the addicted person in his or her life, so untold energy is invested in trying to assure that “today is a good day.”

Case in point: I worked with a first-year college student who was very anxious to return home for the holidays. She came to college in order to escape the chaos of her alcoholic family, but quickly became concerned about her younger brothers and sisters living in that environment…who was making sure they were up for school; who was doing the laundry and cooking for them; who was buffering them from their fathers alcohol induced rages? This student did not return from the holidays, choosing instead to remain at home, attend community college, and care for the family.

3. Help students remember: As difficult as an obnoxious intoxicant may be to deal with, avoid confrontations when the addicted individual is ‘under the influence.’ While difficult to do, especially if the inebriate is acting out in the midst of the festivities, confrontation is to the intoxicated person as kerosene is to a flame! Remember, "You can’t make friends with a mad dog.”

Case in point: I once had a student who would plead with his mother to not drink during the holidays and every holiday season, mom would “have just a couple to celebrate with the family,” and eventually become intoxicated and embarrass my client in front of his friends. This would prompt an angry exchange, born of shame, which would result in his leaving the house and vowing to, “never let that happen again.” I asked my client to envision walking down a dark street and encountering a mad dog. I asked what the chances were that he would approach the dog in order to stroke it and reason with it in order to assuage his fears. He looked at me as if I was as dumb as a box of rocks and said he would cross the street and stay as far away from the dog as possible. I then asked why he thought he could reason with his mother when she was drinking?

4. Help students remember: While there is no excuse for the addicted individual's behavior, it is understandable. Believe it or not, most addicted individuals do not intend to do what they do. True, they may intentionally drink or drug, but they do not necessarily intend to “act out” when they do so. In addiction counseling 101 we all learned that the working definition for the insanity of addiction is the belief that “this time it will be different,” Einstein's famous quote. Individuals with addictions drink/drug, get drunk/high and as such, do intoxicated things. This thought will not lessen our frustration when around the intoxicant, but it may help prevent being hooked and drawn into the craziness of addiction;

Case in point: A student walks into my office after the holidays and is livid. He unloads about his “hop-head brother” and how he totally ruined the holidays. Long story short, the holidays had not been ruined, at least for the rest of the family, it’s just that my client could not understand that his brother was simply doing what he knew how to do. I suggested that if he wanted to continue our conversation, he was going to have to switch to speaking French. He looked at me like I was insane and said he could not speak French. I suggested I did not care, if he wanted my attention, he was going to have to speak in the language I wanted to speak in. He saw my point, smiled, and we talked about how we all know what we learn and learn what we are taught. His brother could no more not use simply because it was Christmas than my client could speak French on demand. I ended the discussion by asking if he could learn French given enough time and support and he smiled and said, “Probably.”

5. Help students remember: Addiction is an issue of health not one of morality. As the diabetic can no more tolerate sugar during the holidays than at any other time of the year, neither can the addicted person tolerate alcohol or pills any better just because it is Christmas or New Years. While it is true that the holidays seem to be a time when “more” of everything is somehow associated with successful celebrating, this increased “presence or temptation” does not mean that the addicted reveler less susceptible or any better able to assuage the effects of intoxicating drink or other drugs.

Case in point: A student was discussing the likelihood that his grandfather would get drunk when visiting for Christmas and spoil the holiday, “as usual.” When I asked why he was so angry about this pending event, he replied, “You’d think he could stay sober just one day out of the year and not spoil everything for everybody else.” I simply asked, “What makes you think Christmas would be any different than any other day”? I got the expected litany of reason, but I reiterated my original question suggesting that if an addiction is an issue of health as is diabetes, what is so special about “that” day that could suspend the symptoms of an illness? Our conversation was longer than this brief exchange, but he was able to see the illogic in his previous reasoning.

In short, addicted people use alcohol and other drugs because they cannot not use, try as they may. To this end, if families of addicted individuals do not expect them to act differently simply because it is a holiday, then an addict’s using on the holiday does not come as such a frustration. Again, this does not help family members ‘like’ the behavior any more, but perhaps it does help them avoid being drawn into the craziness of an addicted person's intoxicated logic. In this season of great expectations with media reinforced pictures of the way the holiday ‘should be,' remember that quote in Luke, Ch. 2:14, in the Christian Bible, "Peace on earth to men/women of good will." Remember: People with addictions are people with health problems, as obnoxious as their behavior may be. While it may appear they could not drink/use for “just one day if they really wanted to,” addiction does not work that way. As addictions professionals, we accept this, but do our clients? As a recovering friend once said to me, "Bad things DO happen to good people."

References

See Ten Irrational Ideas (Irrational Idea #6)  

[1] See Feeling good: The new mood therapy by David Burns, M.D., 1999

[1] See Beck, A. T., Wright, F. W., Newman, C. F., & Liese, B. (1993). Cognitive                        therapy of substance abuse. New York: Guilford.

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What Makes Counseling Effective?:

Is it the wand or way the magician waves it that creates the magic?

As a counselor educator, I found the linked review below appropriate as we begin another academic year. With a new cadre for “future counselors” populating our classes, it is easy to

become myopic in our approach to counselor education and disproportionately attend to “the theory of counseling,” with all its associated erudite foci,  and inadvertently relegate the “practice of counseling” to an “also ran” category in our pedagogy. The review is of an article that indirectly revisits an old topic, one familiar to most counselor educators, namely, the importance of the relationship to an efficacious outcome in counseling.

Although the “Four Common Factors” of counseling are not the focus of the article, I could not help but flash back to the significance of these determinants of counseling outcome as I read the review, in particular the significance of the therapeutic alliance or what we so often refer to as the “relationship” between the practitioner and the individual being treated—Hans Beihl wrote an interesting essay on this in his review of the findings of Task Force on Evidence-Based Therapy Relationships commissioned by the American Psychological Association – see http://bit.ly/1eaPSLW.

In any event, this is not intended to be an essay, but an invitation to “review the review” linked below as it gave me pause to consider what the issue of primacy “should be” when training the entering “next generation of professional counselors”…and provides me with further pause to consider just how I can best teach this…can I teach empathy? As I consider my role as a counselor educator, I find myself realizing that much of what I learned about “effective counseling” came at my grandfather’s knee rather than in a graduate school classroom. Like Fulghum wrote in Everything I needed to know I learned in kindergarten, it is the basic principles of the “Golden Rule” that serve as the glue that binds practitioner and client in an effective therapeutic relationship…or as Pancho Sanza sings when asked why he stays with Don Quixote as his “squire” in The Man of La Mancha, “I like him; I simply like him…”

Enjoy…and ponder

Dr. Robert

For more on the significance of the practitioner is affecting treatment outcome consider:

Treatment: staff do matter (click to visit article)

For most research, the impact of the therapist is noise in the system – a nuisance to be adjusted out of the analysis in order to focus on the therapy. This risks sacrificing what matters for what so often does not, so we stretched our hot topics to an issue which arguably ought to be sizzling in the research, offering a reminder of lessons from the past and from general psychotherapy.

Collegiate Drinking: The Prevention Paradox

Another academic year is upon us and with it its challenges, many continued from the previous spring…if not time immemorial. Among those challenges is the perennial

alcohol and other drug (AOD) use. As I have addressed in previous posts, social scientists in general and student affairs professionals specifically have made great strides in addressing high-risk and dangerous drinking, yet the numbers of students who report drinking underage remains stubbornly constant. Likewise, those students in general that report consuming higher-risk quantities of alcohol during a single outing, what has been (inappropriately) dubbed “binge drinking” by the media, remains unbroken as well. Although data regarding the proportion of students in a given geographic area reporting these behaviors may differ, the point remains that consistency in those numbers remain, unfortunately, dependable in that particular geographic area.

Previous essays have chronicled the advances made in addressing AOD issues in higher ed. Interestingly, and I suspect inadvertently, these advances fall into two large groups…those that target the individual student and those that target college students in general or sub-populations of college students. Without intending to, higher ed has followed the lead of epidemiologists who long ago realized that issues regarding health need to be addressed at both the “micro” level, that is, “treat the individual with the disease,” while at the same time attempting to prevent others in the general population from contracting the disease, that is, addressing disease on a “macro level.” Not only has this understanding been around for 30+ years, influencing the work of public health professional and epidemiologists alike, but Geoffrey Rose (see the original Rose article -  [Department of Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E7HT, UK]. “Sick individuals and sick populations.” International Journal of Epidemiology 1985, 14: 32-38 – an online copy is available at http://ije.oxfordjournals.org/content/14/1/32.full.pdf+html), an epidemiologist, identified what he called the “prevention paradox.” Only now has this become an issue of interest to social scientists and student affairs professionals regarding higher education’s “collegiate drinking” dilemma.

The Prevention Paradox essentially suggests that although the likelihood of “getting a disease” is much greater for members of a high-risk sub-population, the total number of those “with the disease” will be greater in the general population. A simple example will illustrate this point: if 33% of a sub-population contract the disease because of their high-risk behavior when only 5% of the general population do, if there are 1 million individuals in the high-risk sub-population this will result in 330,000 individuals with the disease yet 5% of the 10 million in the general population equals 500,000 individuals with the disease. If prevention efforts are focused on the high-risk population alone, there is likely little change in the total number of cases of reported disease and in all likelihood, that number will grow. If, however, “individual treatment” is developed for those with the disease while designing effective prevention strategies that target the general population, it is reasonable to believe that eventually the disease will be controlled if not one day eliminated…HIV being a current example of addressing a disease on both the “micro” and “macro” levels.

Higher education has “sort of” been doing this for the last 20 years. It has developed environmental management strategies that have affected general student drinking behaviors and augmented this with social norms campaigns designed to address misperceptions of the general population regarding the normative behavior of one’s peers—both being “macro approaches.” Likewise, brief individual student interventions using motivational counseling technique, e.g., BASICS (Brief Alcohol Screening and Intervention for College Students), have proven effective in intervening with high-risk collegiate drinkers—a “micro approach.” Yet in spite of this, higher ed seems to reach a plateau with intractable 80+% of all students reporting that they drink, at least occasionally, and 20+%  reporting that they frequently “binge.”

To return to the original Rose article, he posits that a dilemma exists regarding how best to address this paradox. To concentrate on the macro of general population alone, which higher ed has tended to do historically:

...offers only a small benefit to each individual, since most of them were going to be all right anyway, at least for many years. This leads to the prevention paradox: “A preventive measure which brings much benefit to the population [however] offers little to each participating individual” … and thus there is poor motivation for the subject. … In mass prevention each individual has usually only a small expectation of benefit, and this small benefit can easily be outweighed by a small risk’.^(p.38)

Consequently, our traditional approach to preventing high-risk and dangerous behavior falls on proverbial “deaf ears” because students see neither the opportunity for personal benefit nor likelihood of needing to avoid what is perceived as unlikely personal risk. Add to this that we adults deliver health care messages to students suggesting things like 4+ drinks for a woman or 5+ drinks for a man is a “binge,” and our credibility as professionals becomes suspect. Consequently, the result of these apparently disparate but nonetheless connected facts may explain the apparent student intransigence regarding collegiate drinking.

Higher ed adopted a course correction in the early 2000s and moved from viewing prevention as “primary, secondary, or tertiary” with its focus on the individual user, to a more realistic current consideration where “universal, selective, and indicated” strategies focus on target populations; this has helped. Further, the development of the NIAAA Tier System for rating prevention strategy effectiveness has likewise moved prevention areas in a more orderly, intentional direction. The point remains, however, that although we continue to pursue new prevention strategies, we tend to evaluate their effectiveness using dated criteria. Consequently, I would like to pose a new way of thinking about our efforts to address high-risk collegiate drinking..

Instead of attempting to “prevent what we fear,” what about promoting what we know? Efforts with college students are less about preventing, to use Rose’s word, “disease”—and in the case of drinking, addition—and more about promoting wellness…or at the least promoting harm reduction. The majority of high-risk collegiate drinkers will likely NOT progress to alcohol dependence…although they will likely experience a disproportionally greater percentage of untoward consequences associated with their drinking. Having said this I suggest several steps:

• ·        Continue the employ environmental management strategies, social norms campaigns, BASICS, and like “macro” and “micro” prevention strategies. We do not need to put new wheels on the bus, just acknowledge that it has need for more than 3.
• ·       Concentrate on making health promotion messages that target universal populations more attractive and easier to consume by the individual members of that population. Such messages need to stress the likely personal, social, and academic benefits of abstinence and moderate use rather than the possible consequences of use
• ·        Explore the symbolic meaning of “alcohol” as a substance and “drinking” as a behavior for college student in order to understand the role such play in personal choice. In particular, explore the process by which most student “mature out” of their high-risk adolescent perspectives in order to facilitate a quicker, more proactive behavioral transition via this natural phenomenon

Remember that no one, especially college students, will change a behavior until reaching a point where the change represents less hassle and greater potential reward than a continuation of current attitudes, values, and beliefs. It is our role as student development and student affairs professionals to motivate this change by facilitating contemporary students to engage in what economists refer to as a “cost benefit analysis” of their current behavior and its consequences.

What do you think?

Dr. Robert

To read more regarding Rose’ Prevention Paradox, consider:

http://archive.sph.harvard.edu/cas/Documents/paradox/Prev_Paradox.pdf

http://www.healthknowledge.org.uk/public-health-textbook/disease-causation-diagnostic/2h-principles-health-promotion/prevention-paradox

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1466795/

http://www.ncbi.nlm.nih.gov/pubmed/16393194

http://www.ncbi.nlm.nih.gov/pubmed/10563040

http://chip.org/college-student-binge-drinking-and-prevention-paradox-implications-prevention-and-harm-reduction