An Argument for Harm Reduction to Address Collegiate Drinking

HarmReduction (HR) and its utility as an approach to address substance use isnothing if not controversial. Although most are aware of HR as regards Methadone maintenance or Needle Exchange, but there is more tothis behavioral and public policy objective than these two strategies.

Inbrief, HR is about considering ways to engage individuals committed to a particularpattern of behavior so as to reduce the likelihood of their doing harm to themselves and/orthe community in which they reside and operate.  For a brief overview of HR as it applies tocollegiate drinking, visit this article that you may find useful as regardsjustifying HR techniques and strategies when looking to approach a high-riskcommunity (an indicated population) in a pre-contemplative (not ready) stageof readiness to change.  Visit http://peele.net/lib/reducing.htmland scrolldown to, Is Harm Reduction a Viable Policy forAmerican Collegiate Drinking?

In brief, our biggest challenge in addressing the concerns relatedto HR is that arguments against such policies tend to be grounded in moral and/orlegal principles while the rationale for HR is steeped in public health andquality of life issues.  Until and unless both sides of the HR debate canfind a common ground where they can talk about the issue in neutral terms,there will always be more heat than light generated by this debate.

It seems to me that our challenge is to level the proverbial playingfield.  Those advocating HR as one strategy in a comprehensive plan toaddress collegiate drinking will never trump the moral and legal rhetoric directedagainst HR with a logic-based appeal that addresses the quality of life ofthose who choose to use.  You and I can likely appreciate this logic and asthe result embrace it, but for those who see drug use as “illegal” and those whouse drugs as “criminals”—or its first cousin, “if drugs are bad then those whouse them are bad people”—HR is tantamount to “giving in,” “permitting use,”“the first step to legalization,” and/or “pushing current non-users towardsuse.”

An alternative in this debate is to shift the focus for HRaway from the reduction of harm for the user and direct it instead onto thereduction of harm for the community in which the user uses.  In thecase of the Greeks, a high-risk community of drinkers on college and university campuses, for example, it is improving the quality of life for thecommunity in which the Greeks live (this is where programs like the Good Neighbor Project at Clarion Universityin Clarion, PA can be useful – see http://www.clarion.edu/267773/) orreducing costs to the university related to violence and vandalism.  If acase can be made to lower high-risk Greek drinking, its related behaviors, and its negative impacton quality of life issues in general, especially if those quality of life issuesaffect student decisions to transfer before graduation, then one can argue forHR not so much to benefit to “miscreant drinkers,” but the individual“well-behaved student” in the general university community.

Put another way, if there are “indicated populations” that alreadymanifest indications of problems related to drinking on campus, then theuniversity community as a whole--and not just the errant consumers--is the most likely benefactor of the HR effortstargeting those communities.

What do you think?

Dr. Robert

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ProvidingAOD Services to Students in College

Acolleague posed the following questions on an online discussion group to whichI subscribe:

I am seeking feedback about how private,Christian colleges provide substance abuse treatment for students. Specifically, how are referrals from administrative sources such as judicialaffairs handled?  Are there separate mandated and voluntarytreatments?  How is student confidentiality maintained or addressed inlight of community abstinence policies? 

Hereis the reply I posted to the list:

Theseare wonderful questions and ones that get asked all to infrequently,especially by administrators in higher ed. The good news, as the saying goes,is that there are literally thousands of pages written on this general topicand these specific questions…the bad news is, there are literally thousandsof pages written on this general topic and these questions J So, where to start…

  

Howare referrals from administrative sources such as judicial affairs handled? When student affairsand judicial affairs are walking in sync, this is a relatively easy question toaddress. When at a small, urban, Catholic university, we negotiated what wecalled an “alternate sanctions program” for those first-offenders or subsequentoffenders where the infractions were minor, e.g., no hospitalization; noinjuries. In this program, there were set consequences that would followspecific violations—deferred suspension of housing, probation, etc.—butstudents were offered the choice between a hefty monetary fine or toparticipate in an alcohol awareness program modeled on harm reduction andMotivational Interviewing as the last consequence of the violation. Thisincreased the likelihood that students would participate in the educationalalternative and do so “voluntarily,” which allowed the practitioner presentingthe program to be the “good guy” who allowed the student to save $X, not tomention used choice to more directly involve the student in the process.

Howis student confidentiality maintained or addressed in light of communityabstinence policies? Regarding the issue ofconfidentiality, students would be told at the first session that everythingthat went on in the sessions was confidential and nothing, including attendanceinfo, would be released w/o a written consent to do so. That said, studentswere reminded that it would be in their best interest to allow judicial affairsto at least know about their attendance. NOTE: A written report would beprepared for Judicial Affairs, but again would not be released until (1) thestudent reviewed the report with the practitioner and (2) provided the writtenconsent. A similar process was used with MANDATED students. NOTE: As acounselor I addressed the “seeing mandated clients” dilemma by ensuringstudents that I “work for you and not judicial affairs” and for this reasonwould not release info unless such was indicative of likely harm to oneself orothers. For details/copies of forms/etc. please contact me back channel: Chapman.phd@gmail.com

Atthe end of every semester I would routinely hear from judicial affairs abouthow students actually found the alcohol sessions interesting if not enjoyable.I would be asked, “What are you doing over there? When we sent him/her yourway, he/she went kicking and screaming.” It was this student compliance withthe program that allowed judicial affairs to recognize that approachinghigh-risk student behavior as something done “with a student” rather than “to astudent” was actually more productive…a collaborative rather than adversarialapproach.

Wherethe issues you raise become challenging is when senior administration and/orjudicial affairs folks see violation of institutional policy as being a hangingoffense AND assert their need to know everything that goes on as the result ofthat violations. In this day and age we tend to see institutions open to mysuggestions above regarding alcohol, but closed to them when the violation isfor “drugs other than alcohol.”

Isuggest that you look at the literature related to (1) environmental managementand (2) Brief Alcohol Screening and Intervention with College Students, BASICS.Basic info on both can be found on my web site. I also suggest that looking atmy 3-monograph series entitled, When They Drink, especially the first one,which includes invited essays on all aspects of addressing high-risk anddangerous collegiate drinking. Links can be found at http://robertchapman.net/essays.htm

What do you think?

Dr. Robert

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