Getting “Unstuck”in Our Thinking about Drinking

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This is a copy of aletter I sent to the Council of Southeast Pennsylvania regarding a recentnewsletter – see newsletter at http://bit.ly/H14bFw

Thank you forsending the recent SEPA Council newsletter; Binge Drinking is a NationwideProblem.  Although the newsletter points out some obvious issues ofconcerns regarding drinking, I write to share some thoughts on which I wouldappreciate your reaction if not those of your colleagues at the Council.

First, as importantas the shared information is, the newsletter’s design and format presents it ina classic “scare tactics” approach.  From the two photos—one of the youngmale whose head is on the bar in desperation if not passed out and the other ofthe dower looking EMT, complete with stethoscope around the neck, perched in frontof an ambulance—to the headline itself, complete with exclamation point, theCouncil’s proactive message about S-BIRT and its evidence-based approach toaddressing high-risk and dangerous drinkers is somewhat lost in the impliedmessage of concern if not danger.

Next, as much as theterm “binge drinking” has been accepted as part of the lexicon used to describehigh-risk and dangerous drinking, it is nonetheless a term that is perceived asbeing ludicrous by underage and young “of age” drinkers not to mention becalled into question by many clinicians who view a binge as being an extendedperiod of excessive use rather than consuming 4+/5+ drinks in a 2-hour periodof time type of drinking.  NOTE: I do NOT argue the risk associated withthis type of drinking.  Rather, I am concerned about our insistence as afield on using language to share a concern that the population we try to reachrejects as nonsensical, which therefore defeats our purpose.

I suggest that theCouncil consider these points as it prepares future copy for PSAs and othercommunity-based publications, but more than this, I suggest it also recognizethat there is more to the issue of prevention than pointing out what is notworking in our system and demonstrating that with an endless parade of reportsabout “the problem.”  Just as research is showing us that clinicalinterventions designed to meet individuals with substance use disorders (SUD) wherethey are ideologically rather than insist that they come to the clinician’sviews of substance use and treatment, and/or how the use of “strengths-based”counseling interventions motivate greater numbers of individuals with SUDs tomove towards change, so can we who are involved in prevention learn somethingby listening to what these “binge drinkers” have to tell us about the majorityof the time when they choose to drink moderately if not abstain altogether.

In this verynewsletter article on “binge drinking,” it points out that the average memberof this group drinks “4 times per month” and “8 drinks per occasion.” Again…this is very high-risk.  But the point that goes unaddressed when focusingon these factoids is that 26-days a month they do not drink and they stop at 8on those occasions when they do drink.  The question becomes, why? This is interesting information at the least and potentially very useful whenour objective is to reduce harm for both the community in which these drinkersdrink and for them as individuals.

We first need to changeour thinking about “doing prevention” if we hope to change the thinking of thepublic at large and ultimately that position of the public that “bingedrinks.”  We start this when we begin to ask, Why do those who do notdrink until 21 and those who if they do drink, do so in moderation, make thechoices they make?

What I propose isnothing short of a paradigm shift when it comes to looking at the issueaddressed in the newsletter; I appreciate this.  I also appreciate thatfact that this shift is not going to be easy as many stakeholders in preventionefforts find themselves locked into their current way of thinking, which makesany suggestions coming from outside that paradigm automatically suspect. But let me close with a simple question I use to illustrate being “stuck” inone’s own thinking when addressing this with my students:

Answer thisquestion: What color is a “yield sign”? 

Now, visit images.google.com and in the search boxtype, “yield sign,” complete with quotes. 

What is thepredominate color of all the pictures that appear?

Is this what youexpected?

NOTE: If you are likemost people above the age of 30, you likely thought, “yellow”; I did.  But“yellow” has not been the color of traffic yield signs since 1971.  So whydo most people when asked this question “get it wrong”...because we are “stuckin our thinking.”  We see what we expect to see or worse yet, only lookfor evidence that supports our position and ignore everything else that doesnot.  In social psychology this is confirmationbias.

Until and unless wechange OUR thinking, we have no hope of changing the thinking of thoseindividuals we target with our programs and PSAs.

Thanks for readingto this point and allowing me to share my position.  I hope that I will beable to converse with you or other council members further.

What do you think?

Dr. Robert

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Understanding Twelve-Step Programs

Elevator to sobriety out; use the steps

For 40 years I have had people ask why I would/how I could work with people who have a substance use disorder.  I have stopped trying to answer the question in such a way as to help the asker appreciate my reasons.  Instead, I ask what prompts the question.

Frequently I hear something along the lines of how difficult "those people" are to work with or how frustrating/heartbreaking/exasperating it is to try and facilitate change with someone who "just is not ready."  Instead of an answer intended to change the views of someone who has likely already made up his or her mind about "those people," I ask if they have ever visited places where "the changed" congregate.  I generally get a look that communicates, "what are you talking about" to which I say, "You know...to a 12-step meeting."  Invariably the answer is no.

If anyone has doubts that individuals with substance use disorders change, they need go no further than the nearest "open" AA or NA meeting, take a seat at the back of the room, settle in, and just listen.  The stories of recovery range from heartbreaking to hilarious, but they are all genuine and inspirational.

If you have ever wondered about addiction or are curious about what leads someone with a substance use disorder to pursue change, then attending several open 12-step meetings is highly recommended.  If this sounds like something you might consider, here are some guidelines I provide to my students when directing them to attend meetings as part of my Introduction to Addictive Disorders class.  Considering them may make attending a bit less intimidating and significantly more enjoyable:

What to Expect When Attending “Open” 12-Step Meetings:

 Suggestionsregarding Etiquette

1.    Unlessyou are personally addicted to the substance being addressed at a particular12-step meeting, e.g., alcohol at an AA meeting, only attend "open"meetings of a 12-step group. "Open" meetings are just that, open toanyone who may want to attend a meeting or learn more about the 12-step programof recovery.

2.    Expectto be greeted at the door when you arrive. The greeter may shake hands occasionallys/he may offer a "hug" (this is not all that common). Be prepared forthe greeter to ask something like, "Is this you first meeting?" or"Have you been to a ___ meeting before?" Do not hesitate to say thatyou are attending because you want to learn more about ___ meetings and this ispart of a class assignment. Ask to be sure that the meeting is"open."

3.    Whilerare, do not be surprised if the person becomes a bit "cool" if yousay you are attending as a student in order to learn (this is more likelyindicative of the person's lack of confidence when speaking with "aprofessional" than a rejection of you as a person or "outsider."Remember that "open" meetings are open to anyone.

4.   Unlessadvertised as a "non-smoking" meeting, expect smoking.

5.    Expectthe meetings to last between 1 and 1.5 hours. Some will take a brief breakafter 30 - 45 minutes (usually the smoke-free meetings).

6.    Mostmeetings begin with some variation of the following ritual - the SerenityPrayer, greetings from the "chair" for the evening, a reading of the12-step (perhaps the 12-traditions), perhaps a reading from the big book orother 12-step literature to set the stage for the group.

7.    Expectthe chair to ask if there are any new comers attending for the first time. DONOT feel obligated to raise your hand. If you do, expect to be personallywelcomed. It is also likely that someone will approach you at the break orafter the meeting and ask if you have questions. DO NOT hesitate to say you area student and attending the meeting to learn. The person may appear"cool," but this is probably because s/he felt comfortableapproaching you as a new comer to the program, i.e., an addict, but isuncomfortable speaking with you as "a counselor."

8.    Expect that a basket will be passed fordonations. DO NOT feel obligated to put something in the basket, but if you do,$1 is plenty.

9.   Do not be surprised if you are asked toread something or asked if you would care to speak. I suggest reading theparagraph or step or whatever, but as regards speaking, just say, "I'mhere to learn and would like to pass" or something of the sort.

10.      Do not hesitate to let anyone know youare a student and why you are there. MOST members are pleased to answerquestions and may even tell you how pleased they are that you are.

111.        Do not be surprised if someoneapproaches you after the meeting and offers you her/his phone number. This iscommon practice and part of the tradition of helping, NOT someone trying to hiton you.

112.        Consider attending the meetings with afriend, preferably someone from the class. This will assuage the anxiousnesssome students experience when attending their first meeting. It is also anexcellent way to process the experience after the meeting - remember, you haveto write a paper on your experience attending the meetings.

    Enjoy yourself   

    Dr. Robert

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