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When They Drink: Is Collegiate Drinking the Problem We Think it is? Monograph 3 PDF

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When They Drink: Is Collegiate Drinking the Problem We Think it is? © 2008 by Robert J. Chapman, PhD The third monograph in the ―When They Drink‖ series exploring the issue of campus drinking A Publication of the New Jersey Higher Education Consortium Funded by the New Jersey Department of Human Services, Division of Addiction Services Project Developed by the New Jersey Higher Education Consortium on Alcohol and Other Drug Prevention and Education Distributed through the Rowan University Center for Addiction Studies When They Drink: Is Collegiate Drinking the Problem We Think it is? Introduction The Issue I once heard that accepting one‘s aging is correlated with the awareness that one is not so much approaching life as a follower, but embracing it as a leader. As professional counselors and educators, we started our careers pursuing the ideals of favored theorists, mentors, professors, or admired colleagues only to awake one morning realizing that we had become these very theorists, mentors, professors or admired colleagues for the next generation. My grandfather used to tell me that the challenge at this point in life is to accept the mantle conveyed by the new generation with humility and never lose sight of one‘s ability to wonder…a necessary prerequisite for continued growth. With this in mind, this monograph is dedicated to exploring some personal thoughts that I have found myself considering as I teach the next generation of theorists & practitioners about high- risk and troublesome1 collegiate drinking. When I started my career as a professional counselor in 1972, I was committed to the pursuit of solving problems experienced by my clients, ―fixing what was broken‖ if you will. Consequently, I was enamored of behaviorism and the tools it provided to ―extinguish‖ maladaptive behaviors, fostering instead new more ―adaptive‖ skills and behaviors. This approach to counseling and its myriad techniques remain favored tools in my counselor‘s toolbox, readily available for regular use. But behaviorism no longer represents the panacea from which I once mounted my clinical and preventive interventions. Rather, these tools now serve as valuable adjuncts to the counseling I do, arrows in the quiver if you will, serving as available means to an end, that is, assisting students to affect change in their lives. They are used, however, only as specific tools for specific students to address specific problems; they are not a ―one-size-fits-all‖ recipe for change. Theoretically speaking, I next evolved into a practitioner, whose attention focused on potential solutions rather than a preoccupation with maladaptive behavior. I must admit that this continues to be an exciting prospect as the pursuit of mental health rather than the treatment of mental illness is more consistent with my philosophy of life in general and my metaphysical view of the world. Yet, as useful and rewarding as this ―solution- focused‖ approach to counseling continues to be, I find myself in transition yet again. I seem to be moving further away from ―treating‖ anything in counseling and headed rather in the direction of helping clients understand the meaning they attribute to the 1 Troublesome, as a term used to refer to some collegiate drinking, is coined by Kathleen Carroll and William Miller in the first chapter of their book, Rethinking substance abuse: What the science shows, and what we should do about it, Guilford Press, 2006. In that chapter they qualify the use of this term,…not because it is preferable but precisely because it was unfamiliar and shook us loose from comfortable custom (p.6). myriad events, experiences, symbols, and icons that compose their lives. In my theoretical wanderlust I find myself attempting to create the opportunity—an epiphany if you will—to better appreciate that life and its seemingly unrelenting problems can actually present a perspective from which the decision to change becomes a personal choice rather than an outside mandate. As Viktor Frankl mused in Man’s Search for Meaning, ―Those who have a ‗why‘ to live, can bear with almost any ‗how.‘‖ Perhaps it is time to consider a similar paradigm shift as we pursue the means by which to prevent high-risk and troublesome individual behavior, particularly when working with contemporary college students. There appear to be two separate and distinct issues involved in what we have collectively come to refer to as the collegiate drinking problem. First, there is the fact that large numbers of college students—80% according to the Harvard College Alcohol Survey—regularly use alcohol with two-thirds to three- quarters of these students being under the legal age to purchase and consume alcohol. Although this issue will be addressed in greater detail later in this monograph, it is important to introduce it in here as a cultural issue in order to prepare the reader to question the traditional view of collegiate drinking as a problem perpetuated by collegians rather than a phenomenon unique to them. Second, of those students that choose to drink, some significantly increase the likelihood of experiencing an ―untoward‖2 consequence themselves if not creating one for bystanders in the environment where they drink. These phenomena will also be addressed in more detail in the monograph, but at this point it is important to differentiate the drinker from the culture in which he or she drinks. Just as there are two issues to be addressed, there need to be two different approaches to addressing these issues. Although the behavior of an individual who is the member of a cultural minority may require a specific intervention to address the problem it represents, if the minority culture from which the individual presenting the problem comes was viewed as the problem, this would constitute ethnocentrism if not racism, or some other “ism,” and that is no solution. Student affairs professionals as well as collegiate administrators and legislative bodies on the state and federal level have done an excellent job of shifting from a historic ―reaction‖ to the problem represented by the behavior of individual collegians that choose to drink as they move toward a more proactive response. With strategies like environmental management3 and interventions like Brief Alcohol Screening for College Students (BASICS),4 changes in individual drinking behavior have been noted and this is encouraging. It is not as clear, however, that efforts have been made to address the second and separate issue of how to change the campus drinking culture. It appears that our innovative approaches to addressing issue one mentioned above have been assumed 2 Untoward consequence is a term coined for use in this monograph in order to move away from the connotation that all ―consequence‖ is negative 3 To read more about environmental management visit http://www.highereducationcenter.org/pubs/prev- updates/em101.pdf Last visited 24 July 2007 4 To learn more about BASICS visit http://www.childtrends.org/Lifecourse/programs/BriefAlcoholScreeningBASICS.htm Last visited 24 July 2007 to be all that is needed to address issue two as well. Unfortunately, this does not appear to be the fact and herein lays an important focus for this monograph: Should collegiate drinking be broken into its component parts with an action plan designed to address each, independent of the other? To Act or to React, That is the Question Considering such a shift is nothing short of radical. It suggests moving from the current trend to view all collegiate drinking as the problem that needs to be eliminated, to suggesting that it is a dilemma requiring a proactive resolution. Elimination conjures up draconian attempts at eradication and this is simply never, as regards the propensity for college students to drink, going to happen. Resolution, however, implies a reduction in the untoward consequences of this collegiate drinking, and this is a more reasonable objective for prevention specialists and administrators alike. Such a paradigm shift will be provocative for many and tantamount to heresy for some, especially those steeped in the medical model with its need to identify etiological causes for diagnosable problems in order to prescribe definitive interventions to eliminate diseases, which is to say, problems. What if, however, student affairs professionals were to consider collegiate drinking as a phenomenon that results in untoward consequences for some collegiate drinkers rather than as a ubiquitous problem for all, that is to suggest, a cultural problem, in need of elimination? High-risk or troublesome student behaviors occur and those individual students who choose to engage in them need to be encouraged to ―deconstruct‖ their individual views/interpretations regarding drinking and reconsider the antecedents of a personal decision to drink. Although some individual students may experience personal problems or untoward consequences related to their personal choices about alcohol and its consumption, the question remains: Is collegiate drinking, in and of itself, the issue of primacy with which risk managers need to be concerned? I do not suggest that disorders or bona fide medical conditions with etiologies steeped in physiological and/or neuro-chemical imbalances should be viewed as simple ―dilemmas.‖ I do, however, suggest that many of the classic ―disorders‖ traditionally addressed in counseling and psychotherapy may be more effectively treated if approached in this fashion. Even disorders like substance use and dependence, where evidence seems to be rather convincing that they may be exacerbated if not caused by neuro-anatomy and/or genetic anomalies, the treatment of individuals with these ―medical‖ conditions may be effectuated by inviting the client to view recovery as the resolution of a dilemma exacerbated by their physical dependence. A Case Study Allow me to present something of a case study to illustrate my preceding point: I once saw a student who reluctantly agreed to meet with me at the insistence of a friend—a phenomenon all too infrequent in the delivery of counseling services in higher education, the ―facilitated self-referral.‖ The student had a history of high-risk use of alcohol and over the counter (OTC) substances, e.g., benedryl, ibuprophen, etc. Both behaviors were severe enough to have resulted in significant untoward consequences for the student, for example, transport to the ER for evaluation following excessive intoxication by alcohol, but no admission. Upon intake, the student was not determined to be suicidal, although there was clearly ―something going on.‖ But was this something necessarily a problem and was it necessarily or exclusively a ―medical condition‖ that needed to be treated? And if so, did that treatment necessitate the involvement of an external professional? My client presented, both in word and affect, like a ―battered puppy.‖ Eye contact was non-existent—and this was a white, middle-class woman for whom direct eye contact was a cultural hallmark of assertive attentiveness. Interestingly, this student was on the dean‘s list, had no history of chronic interpersonal problems, had a supportive network of friends, and had maintained a monogamous relationship, although recently ended by mutual consent. To all practical purposes, this was a successful student that simply was not happy. Okay, ―did you screen for depression?‖ you might ask; no, not technically. However, before you second-guess my clinical judgment, let me share with you that by asking a couple simple questions, in the context of a metaphorical story, in order to refocus the student on ―the big picture,‖ direct eye contact returned along with an occasional smile followed by a more spontaneous exchange in our interaction. I asked the student to image doing some ―serious cleaning‖ at home—I asked if that would focus on the basement or the garage and the student stated with a smile, ―basement!‖ I then asked her to look around the basement and notice all the old stuff lying about, the obsolete, moldy with age, or just plain ―funky‖ stuff many of us have in the basement. I asked what should be done with this, to which she said the junk should be hauled to the curb for trash pick up. I agreed that this was a reasonable plan and asked, ―What might your neighbor across the street say if seeing you doing this?‖ The student said, getting into the rhythm of the story, ―Oh, cleaning out your basement I see, eh?‖ (I think my student might have been Canadian). I then asked, ―What would your neighbor think if an hour later as the trash truck was coming up the street you were to suddenly dash out to the curb and retrieve all the trash and haul it back into the basement?‖ She deftly remained in step and said the neighbor would think this to be odd in the extreme if not consider her to be crazy. I then asked how often she had hauled her ―psychic trash‖ back into storage. We went on to talk about the student‘s relationship with mom and her alcoholic stepfather, but my point is, we did so by viewing the student‘s distress and ―depression‖ less like problems to be solved in the traditional clinical sense of treatment and more like dilemmas to be resolved in the context of our counseling relationship—a basement full of ―psychic trash‖ and a reluctance to discard it. As we debriefed after the first session, I found myself talking with a different student. Gone was the indirect eye contact and down-turned mouth. Like the student that identifies two-minutes as ―a short time‖ only to be asked to hold her breath for two- minutes can perceive the change in ―how long two-minutes is,‖ so it would appear that this student was able to perceive options and choices simply by assuming a new perspective from which to view ―the problem.‖ But was there a problem in a clinical sense of the term or a dilemma for which this student could find no resolution? In short, by refusing to define a problem based solely on its observed ―symptoms‖ and instead, considering the objective facts in the context of ―the big picture,‖ it may be possible to differentiate between a problem that requires treatment by a professional and a dilemma the student is able to resolve. As William Miller suggests, sometime individuals simply get ―stuck‖ in their lives and counseling is more about getting ―unstuck‖ than about treating disorders. Put another way, most people tend to act in ways that are consistent with how we communicate we expect them to act. The Lay of the Land Before further considering the utility of a paradigm shift regarding the prevention of troublesome collegiate drinking, we first need to differentiate between the two perspectives being addressed: The ―problem – solution‖ continuum and the ―dilemma – resolution‖ continuum. The former presumes that ―something is not right.‖ In this scenario, a specific treatment is applied or intervention initiated by an outside practitioner. As a result of the treatment or intervention, ―something‖ is changed if not removed so that it no longer represents a threat or encumbrance for the community. This way of conceptualizing the phenomenon of collegiate drinking supposes that student drinking is the problem and that it can theoretically be eliminated. The latter perspective acknowledges that there may be issues related to collegiate drinking, but collegians, as a population, are not the problem. The dilemma is, although many students drink, only some experience untoward consequences. Others drink and may periodically experience untoward consequences while still others drink and experience untoward consequences on a regular basis. There must be a variable beyond student drinking itself that accounts for this variance in the consequences experienced by those who choose to engage in the behavior. This then is a dilemma or conundrum to be resolved rather than a problem to be eliminated. Once we unlock the secret of the variance in consequences for collegiate drinkers we will be better prepared to apply this knowledge to the quest to reduce the prevalence of these untoward consequences. As consistent as the problem approach to addressing the phenomenon may be with American if not all Western thinking—you can do anything that you put your mind to doing—I suspect that there are those consequences of living that we simply cannot eliminate. I suppose that such problems can at best be contained and their negative impact minimized; a sort of a harm reduction approach to public policy if you will. As with the eventuality that life culminates in death, we cannot eliminate underage and collegiate drinking. But as science, nutrition, and technology have doubled the life expectancy over the last 100-years for those born in the United States, we almost certainly can affect change in the way alcohol is consumed by contemporary college students. This, then, is roughly analogous to the dilemma – resolution continuum. But to truly appreciate this conundrum, we must first address the issue of what constitutes a problem. Is there such a thing as a ―universal‖ problem meaning that no matter where or when a situation is encountered it will consistently be viewed as, ―a problem‖? And when considering what constitutes ―a problem,‖ are there criteria that determine what is or is not one, or is the designation simply a moniker ascribed to a particular behavior or phenomenon that is deemed inappropriate or unacceptable by the individual or group identifying the problem? As Wayne Dyer, a popular lecturer and author on issues related to popular culture and spirituality once quipped, ―The only difference between a flower and a weed is a judgment.‖ These questions may seem ludicrous at first glace. They do, however, have meaning regarding the question of high-risk and troublesome collegiate drinking. When is a Problem a Problem? It has been suggested above that collegiate drinking is a phenomenon. As such, it is one that has captivated the interest of social scientists and student affairs professionals for better than a decade. The concerns regarding the consequences of this collegiate behavior are legion and the attention this concern has generated has spawned such provocative titles on the subject as Weschler‘s Dying to Drink5. But what is referred to as the problem of collegiate drinking is perhaps a significant portion of the reason this collegiate behavior remains so intractable. What if the perceived problem is just that, a perception of the observer rather than a quantifiable reality? This is not to suggest that there are not negative consequences associated with collegiate drinking or that these consequences are varied, significant, and costly. But what if the difficulty in addressing, and that is to say, reducing, preventing, or eliminating, this problem is not so much a function of the collegiate drinking being targeted as it is due to attempts to categorize and explain it in order to eventually change it? Collegiate drinking is a behavior that exists on a continuum much the same as any other behavior. This continuum ranges from a total abstinence at one pole to excesses in consumption and the resulting untoward consequences at the other. Yet, the particular point on that continuum where we differentiate between what is and what is not a problem is left to the observer of the behavior to define. As regards the issue of collegiate drinking, this point is a function of how one‘s behavior is perceived, and for the student drinker and the observer of his/her behavior this can yield two very different points of demarcation. This is akin to the suggestion made above that the observer who perceives a problem is essentially a member of the dominant culture who views the behavior of some members of the minority culture and then deems the problem to be a function of the minority, en masse, rather than the behavior of some members of that minority. Students of social psychology will find this roughly analogous to what is referred to as confirmation bias as one tends to find evidence in support of a particular belief. There is an old adage, first heard by the author in 1978 during a lecture delivered by Father Joseph Martin, a well know lecturer and advocate for the proactive treatment of alcoholism. When speaking of addiction in general and alcoholism specifically, Fr. Martin suggested that, ―What causes a problem is a problem because it causes problems.‖ This struck me as profound then and thirty years later is no less prophetic. But the point remains, who determines what is—and equally as important—what is not a problem? 5 To access my review of this book visit http://www.unhooked.com/booktalk/dying_to_drink.htm Last accessed 26 July 2007. Let‘s consider the old example from high school physics that attempts to explain, in part, the theory of relativity: Imagine a person standing in the aisle of an express train moving down the tracks. This individual is bouncing a ball…the ball leaves the bouncer‘s hand at point ―A,‖ drops to the floor and bounces straight back to the individual‘s hand, which to all in the passenger car is in the same place as when the ball was released, point ―A.‖ Outside the train, standing on a platform in a station as the express passes through, an observer views the passenger bouncing the ball. However, to the observer, the ball leaves the passenger‘s hand at point ―A,‖ drops to the floor and bounces back to the passenger at point ―B‖ several feet in front of where the ball was first dropped. Although it is true that we can explain, mathematically, the outside observer‘s perceived distance between points ―A‖ and ―B,‖ from the perspective of the passenger on the train there has been no such movement. Even though the passenger is aware of the forward momentum of the train, the experience of the observer and that of the observed are quite different. Ironically, neither the observer nor the observed is aware of this dissonance as each is comfortable in his or her belief that what has been perceived is real. The variance between these two realities is of no consequence to either, that is until and unless a discussion between the two were to develop as to whose perception was correct. And assuming that both the observer and the observed are not theoretical mathematicians, if one was to present his or her perception of reality to the other, it would be rejected out of hand as absurd. Note that countries have gone to war over smaller differences in perspective as to what is truth, and Galileo was subject to house arrest by the Church of Rome because he refused to recant his assertion that the Earth revolved around the sun. Truth, apparently, is what those in power—the dominant culture—declare it to be. Taking some liberties with the high school physics example, what if we consider the observed passenger on the train to be the collegiate drinker (the student) and the observer on the platform in the station the adult? It may be clear to the adult that the student‘s behavior is high-risk if not problematic and something that can be easily documented— and this will be discussed further in this monograph. From the perspective of the student, however, nothing has changed: Remember that what causes a problem is a problem only when it causes what is perceived to be a problem. If what causes a problem in the eyes of the adult is not perceived to be a problem by the student, why would the student be motivated to consider changing that behavior…especially if it proffered a successful solution to a perceived real personal problem, for example, social shyness or anxiety? To the adult, the student‘s drinking is a problem because the student is under 21 and/or misses class or engages in some troublesome or nefarious behavior. To the drinker, however, the drinking has accomplished what it was intended to accomplish…social engagement and interpersonal confidence with the resulting missed class an acceptable consequence of an otherwise successful ploy to address what, for the student, is a real problem. Let‘s return to Fr. Martin‘s adage regarding a drinking problem, but modify it just a bit. Instead of looking at this admonishment as suggesting, ―what causes a problem is a problem because it causes a problem,‖ what if we look at it from a slightly different perspective, namely, what causes a problem is a problem when it causes a problem. As much as this may appear to be the author's attempt to dabble in semantics there is more to this change than simple word play. The issue of language as a symbolic representation of the reporter‘s reality will be addressed further in a subsequent section of this monograph, but for now, note that there is a perceptible difference in the meaning of these two seemingly identical statements. In the first ―…because it causes a problem‖ is a declarative statement. It is a declaration made by the observer based on his or her assessment of the other‘s behavior and an evaluation of it—what I observe is true because I know it to be so. And although this declaration may be consistent with a cultural truism, it is nonetheless a subjective interpretation of the behavior being observed from the perspective of the observer. In our example of the student drinker being observed by the adult, the problem associated with the drinking is only a problem because the observer has deemed it to be so, from her/his perspective. This is what a sociologist & social psychologist like Peter Cohen of the University of Amsterdam might call a socially constructed problem.6 Put another way, if I drink and miss class, this can only be perceived as a problem if I perceive missing class as being a problem and that my drinking was the cause for that absence. Therefore, from the perspective of the student affairs professional or faculty member, this consequence of student drinking is a clear and definitive example of how collegiate drinking can be problematic. But for the student who does not see missing ―a class‖ as being problematic—and may or may not agree that drinking was a mitigating factor in that absence—the observer‘s perception is ludicrous, particularly if the drinking accomplished what the student intended it to accomplish in the first place. If, however, we rephrase Fr. Martin‘s adage just a bit, noting that what causes a problem is a problem when it causes a problem, we shift the focus of discerning problematic behavior from the observer to the observed. In the case of the collegiate drinker, when he/she perceives the cost/benefit ratio between drinking and its consequences to be too high, a problem is then recognized by the drinker. It is at this point that the drinker begins to entertain the possibility that change may be both realistic as an objective and appropriate as a personal goal. It is facilitating this shift in the student‘s perception of reality that has made approaches to intervening with high-risk and collegiate drinking such as BASICS (Brief Alcohol Screening and Intervention for College Students) type programs so effective7. The Collegiate Drinking Problem High-risk drinking is a phenomenon that has been the focus of attention in higher education for almost two decades. Since the first Harvard School of Public Health ―College Alcohol Survey‖ results were published in 1994, this phenomenon has been frequently observed and at least anecdotally documented by anyone that has attended a college, worked in higher education or owned property contiguous to a college campus. 6 See Is the addiction doctor the Voodoo Priest of Western man, http://www.cedro- uva.org/lib/cohen.addiction.html last viewed 6 July 2007 7 For an overview see Brief interventions for heavy-drinking college students: 4-year follow-up and natural history by Baer, Kivlahan, Blumne, McNight, and Marlatt. http://www.ajph.org/cgi/reprint/91/8/1310.pdf Last viewed 5 July 2007. Students view collegiate drinking as a phenomenon so ubiquitous as to be considered a developmental ―rite of passage.‖ ―Older‖ adults remember their experiences with alcohol in college fondly and find it difficult to find fault with the consumption of alcohol by any aged collegian, all the time voicing increasing concern for student consumption of ―other drugs.‖ It would seem that in the U.S. most adults have taken a ―laisser faire‖ approach to collegiate drinking—they disapprove of its impact on student behavior but all but celebrate its role in ensuring a meaningful college experience. This is a love-hate relationship and many members of the ―lay community‖ have gone to great lengths in recent years to rail against the ―problem of binge drinking‖ while defending a collegian‘s right to ―drink responsibly.‖ There have been fluctuations in the numbers of students engaging in troublesome drinking thanks in part to innovative programming like social norms campaigns and brief motivational interviews with high-risk drinkers as well as an increasing awareness of the role that environmental and ecological strategies can play in shaping a campus culture. Yet the rates of student drinking persist—approximately 80% of collegians nationally drink according to the recent Harvard CAS studies, and this can be as high as 90+% in some areas of the country—whereas about 66% of adults nationally report drinking. The rates of high-risk or troublesome drinking—terms much more suited to this phenomenon than ―binge-drinking‖—show no signs of yielding with about 44% of contemporary collegians reporting that they drank at least once in a high-risk fashion (5+ standard drinks8 in an outing) in the two-weeks prior to being surveyed in these same Harvard CAS samples. Although this could lead one to hypothesize that contemporary collegians are, ―Going to Hell in a booze soaked hand basket,‖ there may be more to this story than is apparent at first glance. The ―rest of the story,‖ as the famed newscaster Paul Harvey used to say in his radio broadcasts, may hold something of significance for student affairs professionals, as they consider ―better‖ addressing this stubborn, if not intractable problem of high-risk collegiate drinking. So, Just How Prevalent is the Problem? Let‘s take another look at those Harvard CAS samples that suggest so many contemporary collegians drink and that a sizeable minority of them do so in a high-risk fashion. There is no doubt that these numbers are alarming, but it is incumbent upon the student affairs professional to look at these data a little closer and note ―which‖ collegians are doing the drinking. Of the high-risk drinkers on a given campus, what proportion of them are first or second-year students? We know that the majority—some estimates run as high as 75%—of entering first-year students bring their high school drinking habits and preferences with them. With the newly acquired freedom that accompanies collegiate life, these high school preferences and practices flourish if not expand. The result is that first- and second-year students are among the highest-risk 8 To review a standard drink visit http://pubs.niaaa.nih.gov/publications/Practitioner/PocketGuide/pocket_guide2.htm

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