Keynote: Bringing Evidence-Based Strategies to Campus

David Merriman Author

08/10/2023 Added

37 Plays

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2023 NECPA Statewide Convening

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[00:00:04.440]Great, thank you very, very much
[00:00:05.940]and thanks for putting up with
[00:00:08.310]a slightly congested Jason Kilmer.
[00:00:10.200]I learned that if I stand, I feel like I cough less.
[00:00:13.050]I don't know the physics of that,
[00:00:14.190]but apparently I just never sit down.
[00:00:18.164]I gotta say, every time I aim to have the chance
[00:00:21.180]to do anything with you,
[00:00:22.920]not only do I feel lucky to get to do that,
[00:00:26.190]I always feel like a bit of an imposter.
[00:00:27.510]I'm like, you have such amazing expertise right there
[00:00:30.090]in your own state.
[00:00:31.290]I certainly hope I'm value added
[00:00:32.760]and I certainly hope I deliver on what it is
[00:00:35.600]that I was asked to address.
[00:00:37.500]Big thank you to MeLissa Butler, Haley Irons,
[00:00:40.560]Megan Hopkins, and I feel like
[00:00:42.510]my chance to even do things in Nebraska.
[00:00:44.400]And when I look at the nationwide impact
[00:00:47.760]that's been felt because of expertise in Nebraska,
[00:00:50.850]it's been because of contributions from Linda Major.
[00:00:53.190]So I just, I can't present in Nebraska
[00:00:55.590]and not thank and acknowledge her
[00:00:56.910]for her contributions as well.
[00:00:59.400]And honestly, thanks for all of you for doing
[00:01:01.110]what you do to support your community.
[00:01:04.050]The email I got from Melissa said,
[00:01:06.337]"Our members have requested more information
[00:01:08.040]on the NIAAA Matrix,
[00:01:09.630]so that would be the topic of discussion."
[00:01:14.112]And I was like, wow, we could talk about that forever.
[00:01:14.945]And we obviously won't do that.
[00:01:16.110]I have the coveted lunchtime slot,
[00:01:18.810]so I need to keep it a little entertaining
[00:01:21.270]and also make sure that people can eat
[00:01:23.040]and ask questions as you go.
[00:01:25.110]So what I said I'd cover is that CollegeAIM reviews
[00:01:28.350]over 60 individually and environmentally-focused strategies
[00:01:32.340]for reducing alcohol-related harms on campus.
[00:01:35.100]And I mentioned we would talk about how partners
[00:01:37.740]can work together to select a mix of strategies
[00:01:40.890]with a focus on individually-focused programs
[00:01:43.320]with higher effectiveness.
[00:01:45.360]I'm gonna start though talking not about alcohol.
[00:01:48.150]I'm gonna start talking about signs
[00:01:50.340]as evidenced by this slide that simply says, "Signs".
[00:01:55.170]I take lots of pictures of stuff
[00:01:56.700]that usually either makes me laugh
[00:02:00.210]or I'm like, wow, I feel like this ties into
[00:02:02.070]some of what we do.
[00:02:03.870]There's more than one way to communicate a message.
[00:02:06.000]That's true when it comes to drinking.
[00:02:07.830]That's true when it comes to mental health.
[00:02:10.590]That's also true when it comes to encouraging people
[00:02:12.660]to clean up after their pet.
[00:02:14.370]This is a weird series of signs
[00:02:15.720]to have a collection of on your phone,
[00:02:17.250]but I took this picture in Boston
[00:02:19.920]largely 'cause I couldn't believe how much was on that sign.
[00:02:22.170]No one's gonna read that walking by.
[00:02:23.790]You gotta stop and read it.
[00:02:25.650]Plus, there's a super regal-looking dog there.
[00:02:28.110]I saw a much cuter and simpler sign in Oregon that said,
[00:02:31.087]"Dear dogs, please don't water the playground, thank you."
[00:02:34.500]That's pretty cute.
[00:02:35.610]But the sign that I've just been obsessed with
[00:02:37.230]I saw in British Columbia,
[00:02:38.790]and it's a picture of a dog actively pooping.
[00:02:41.250]And I think that's a classy slide for lunch.
[00:02:43.320]Sorry about that.
[00:02:44.280]But I think the reason why I like the slide so much
[00:02:46.470]or the sign so much is not the sign,
[00:02:48.930]but imagining the conversation that had to have happened
[00:02:52.170]between the graphic designer and their boss, right?
[00:02:57.000]The graphic designer was like, "Huh, what do you think
[00:02:59.340]about the picture I drew?"
[00:03:00.600]And their boss was like, "We're gonna need more poop."
[00:03:03.990]And the graphic designer said, "But I made a pile."
[00:03:06.750]And their boss said, "Show it falling."
[00:03:09.090]That feels like a very unnecessary detail
[00:03:11.790]and I'm obsessed with this sign.
[00:03:13.830]Here's a picture of the most chill person ever
[00:03:16.680]leaving a fire.
[00:03:19.020]That cool.
[00:03:19.853]Oh, look at that, there's a fire.
[00:03:22.110]Exact same warning, way different way of doing it,
[00:03:25.590]in Clemson, South Carolina.
[00:03:27.277]"In case of fire use enclosed stairways,"
[00:03:29.910]otherwise die a fiery death in an elevator.
[00:03:34.410]That's the most freaky sign I've ever seen.
[00:03:36.330]South Carolina's intense.
[00:03:38.460]Don't go to South Carolina.
[00:03:40.710]Some signs need a little bit more context.
[00:03:44.100]What's happening here?
[00:03:45.780]I love this sign.
[00:03:46.980]This was by an elevator,
[00:03:48.120]and it was meant to say, "Hey kid on the left,
[00:03:49.920]don't ride the elevator alone.
[00:03:51.360]Be like the cool kid on the right and hold a parent's hand."
[00:03:54.690]Now, I have two little brothers
[00:03:57.450]so I took this picture, texted both of them
[00:03:59.610]and I said, "This is proof that when you have
[00:04:01.350]more than one kid in a family,
[00:04:02.940]mom clearly has a favorite."
[00:04:06.510]So if you're a sibling or if you're a parent,
[00:04:09.210]you know what's up.
[00:04:11.610]With that, I actually feel like this does set up
[00:04:14.340]pretty nicely this conversation.
[00:04:16.440]There is more than one way to communicate a message.
[00:04:18.510]You have to consider context.
[00:04:21.180]All of that is true.
[00:04:22.500]I can practically end the presentation right there,
[00:04:24.210]but I would not 'cause that's not me doing my job.
[00:04:27.750]I hear a lot of people say, "Well the good thing is
[00:04:31.320]we're using evidence-based strategies."
[00:04:34.260]And if that's what they're doing, good.
[00:04:39.990]But I wonder sometimes how often people are
[00:04:42.480]throwing that term out.
[00:04:43.950]I mean, for years we wanted people to talk this language,
[00:04:47.130]be aware of evidence-based strategies.
[00:04:49.620]Is there a downside to people throwing that term around
[00:04:51.900]when they may not know what it means?
[00:04:55.410]We've been re-watching lots of different 1980s movies
[00:04:58.719]'cause the '80s were awesome, thank you.
[00:05:00.570]And re-watching "The Princess Bride" made me think of this
[00:05:04.290]because when Vizzini says, "He didn't fall?
[00:05:07.140]Inconceivable,"
[00:05:08.310]Inigo Montoya says, "You keep using that word.
[00:05:10.980]I don't think it means what you think it means."
[00:05:13.380]I worry how often people say evidence-based strategies
[00:05:16.560]and don't know what that actually means.
[00:05:18.900]What counts as evidence-based has actually been defined
[00:05:23.010]by the Center for Substance Abuse Prevention.
[00:05:25.830]And they even have a guide on identifying and selecting
[00:05:29.340]evidence-based interventions.
[00:05:30.990]And they say really there's three definitions.
[00:05:34.200]I mean, I feel like the circular definition as well,
[00:05:36.840]it's an intervention that's based in the evidence,
[00:05:39.240]but that's, it's too circular.
[00:05:41.820]What are definitions of evidence-based strategies?
[00:05:45.510]One, inclusion in federal registries
[00:05:48.990]of evidence-based interventions.
[00:05:52.890]So the College Alcohol Intervention Matrix,
[00:05:54.720]as you'll come to see, counts there.
[00:05:57.510]Two, reports with positive effects
[00:05:59.940]on variables of interest in peer-reviewed journals.
[00:06:03.540]Presenting at conferences is often
[00:06:05.640]the step toward publication.
[00:06:08.280]A lot of times that'll be the intermediate step
[00:06:10.200]that when people are preparing something for publication,
[00:06:12.600]they disseminate the results more rapidly,
[00:06:14.670]but it's getting findings out there
[00:06:16.890]in the published literature.
[00:06:18.720]And the third I think is interesting
[00:06:21.390]because it does mean there's some room
[00:06:24.180]almost for creativity, for flexibility,
[00:06:27.390]and it's documented effectiveness
[00:06:29.460]by four additional guidelines.
[00:06:30.870]I just wanna show you those four.
[00:06:33.330]The first, the intervention is based on a theory of change
[00:06:36.960]that's documented in a clear logic or conceptual model.
[00:06:40.620]So if you're doing something on campus
[00:06:45.030]that maybe is more novel,
[00:06:48.870]it doesn't mean don't do it.
[00:06:49.703]It certainly means evaluate it.
[00:06:51.240]But can you start looking at these four criteria?
[00:06:54.060]What's the theory?
[00:06:56.220]What is the logic or conceptual model?
[00:06:58.740]Two, the intervention's similar in content and structure
[00:07:02.310]to interventions that appear in registries
[00:07:04.080]and/or the peer-reviewed literature.
[00:07:06.960]Three, the intervention is supported by documentation
[00:07:10.020]that has been effectively implemented in the past
[00:07:12.960]and multiple times in a manner attentive
[00:07:15.720]to scientific standards of evidence
[00:07:17.940]and with results that show a consistent pattern
[00:07:20.250]of credible and positive effects.
[00:07:23.160]And fourth, the intervention is reviewed
[00:07:25.710]and deemed appropriate by a panel
[00:07:27.780]of informed prevention experts
[00:07:29.520]that includes well-qualified prevention researchers
[00:07:32.760]who are experienced in evaluating prevention interventions
[00:07:35.490]similar to those under review,
[00:07:37.740]local prevention practitioners
[00:07:40.080]and key community leaders as appropriate,
[00:07:42.450]including officials from law enforcement, education sectors
[00:07:45.900]or Elders within Indigenous cultures.
[00:07:49.230]When I look at the coalition work
[00:07:50.580]that's been done in Nebraska,
[00:07:51.690]I mean I look at this number four
[00:07:53.790]and I think that if there was any approach
[00:07:56.580]where you were looking at guidelines one, two, and three,
[00:07:59.310]more than most states, you're so well poised
[00:08:02.490]to bring number four to scale
[00:08:04.860]because you do such a great job of making connections,
[00:08:08.130]of building bridges, of getting key collaborators
[00:08:10.620]and key partners to the table.
[00:08:12.570]So I do think that that's something to keep in mind as well.
[00:08:17.460]I'm gonna go back though to this inclusion
[00:08:19.500]in federal registries of evidence-based interventions.
[00:08:23.280]College student drinking has kind of been around
[00:08:25.410]for a while.
[00:08:26.970]Our successes in addressing it have not.
[00:08:32.100]The first study published on college student drinking
[00:08:35.697]was 1945.
[00:08:38.730]I've heard people say that the first study
[00:08:41.640]was Straus and Bacon in the '50s.
[00:08:43.680]That was the first survey,
[00:08:45.600]but the first published article
[00:08:47.820]about college student drinking, 1945.
[00:08:50.940]Some of it is comical to read.
[00:08:54.150]Some of it could have been written yesterday
[00:08:56.340]and it's aged really well.
[00:08:58.860]This article did not exist as a PDF.
[00:09:01.860]I had to request it from the library
[00:09:03.810]and they had to do a special order.
[00:09:05.460]I got to go in this room with gloves.
[00:09:08.010]I mean that's fancy, right?
[00:09:10.980]I made the choice to smell the article.
[00:09:12.840]I'd like to recommend not doing that
[00:09:14.370]whenever you get the chance.
[00:09:17.100]But I really nerded out.
[00:09:18.210]I was like, I'm smelling history,
[00:09:20.040]and I'm pretty sure I developed a mold problem.
[00:09:22.140]But what Fry said is you wanna know who the biggest problems
[00:09:26.850]on college campuses are?
[00:09:28.290]Faculty.
[00:09:29.857]"These parties are often attended by faculty members,
[00:09:32.730]some of whom are selected to respond to the chant
[00:09:35.250]'Old Professor so-and-so is in the alcohol ward,'"
[00:09:38.040]say the person's name, "'Drink, drink, drink'.
[00:09:41.100]Cheers or moans and laughter follow this performance
[00:09:44.970]according to the speed which with
[00:09:46.410]the professor empties their glass.
[00:09:48.450]These parties break up after a few hours of song
[00:09:51.330]and good fellowship."
[00:09:53.280]Wait for it.
[00:09:54.637]"They do not occur often,
[00:09:56.160]but are part of the life of colleges
[00:09:58.230]and are accepted by the community as such."
[00:10:02.040]We would never accept this now.
[00:10:05.670]So when I hear people say,
[00:10:07.417]"Oh, that tradition, it's been around forever,
[00:10:10.380]that's not going anywhere,"
[00:10:12.120]or, "Yeah, that's been something that's happened for years.
[00:10:14.520]Everyone knows about it.
[00:10:15.390]It's really, really risky but what are we gonna do?"
[00:10:20.730]Things can change.
[00:10:21.840]Things do change.
[00:10:23.700]I look at the successes that University of Nebraska had
[00:10:26.880]on tailgating behavior with everything from geocoding
[00:10:30.060]to approaching it in a very systematic and strategic way.
[00:10:34.590]Things that you say, "We don't want this anymore
[00:10:37.200]or we want to impact this,"
[00:10:39.060]there is something that can be done.
[00:10:40.950]Fry goes on to say that in fraternities,
[00:10:43.777]"Wine is often served in the hopes
[00:10:45.720]that members will learn to appreciate
[00:10:46.950]proper wines with food."
[00:10:49.320]And that, "Although milk and soft drinks
[00:10:51.060]are extremely popular in American colleges,
[00:10:54.090]the consumption of them being greater than other beverages,
[00:10:56.970]a special snobbism is sometimes to be associated
[00:10:59.730]with the appreciation and knowledge of fine wines."
[00:11:03.570]Fry goes on to say though, but heads up,
[00:11:06.750]I'm starting to wonder if a "state of intoxication"
[00:11:10.110]is the point of some of these wine tastings,
[00:11:14.100]is the point of some of these gatherings,
[00:11:16.800]and if it is, shouldn't we do something about that?
[00:11:22.020]Fry also says as World War II comes to an end
[00:11:26.340]and as returning veterans attend college,
[00:11:29.497]"What do we need to do to make sure we're supporting people?
[00:11:31.950]What role might alcohol play related to coping
[00:11:35.430]when under pressure in the college setting?
[00:11:38.910]Shouldn't we be addressing the whole student?"
[00:11:40.920]That gives me goosebumps.
[00:11:42.960]1945, I mean even related to the pandemic,
[00:11:47.700]when we were acknowledging that people were more isolated,
[00:11:51.150]people were dealing with loss,
[00:11:53.790]with social awkwardness, with anxiety,
[00:11:56.010]with giving up serious life events,
[00:12:01.200]and even though the narrative was
[00:12:02.310]that people were drinking more,
[00:12:03.780]the research showed that wasn't completely true.
[00:12:06.330]But this highlighted, well, what are we gonna do
[00:12:08.580]when students did come back
[00:12:10.170]to make sure they have strategies in place for coping?
[00:12:13.800]Jump forward almost 40 years.
[00:12:17.760]When presenting down the freeway from me here in Washington,
[00:12:20.550]in Oakland, California in 1982,
[00:12:23.400]First Lady Nancy Reagan was asked,
[00:12:25.477]"What do you do if someone offers you drugs?"
[00:12:27.480]She said, "Well, you just say no."
[00:12:31.530]By the end of 1988,
[00:12:34.770]the number of published studies we had
[00:12:37.860]on college campuses showing significant reductions
[00:12:41.520]in drinking, consequences or both
[00:12:46.890]was none.
[00:12:48.450]We had nothing in the published literature.
[00:12:51.270]Fry made that article in 1945.
[00:12:53.750]43 years later, there wasn't a single prevention success.
[00:12:58.200]What did we have?
[00:13:00.270]Over 12,000 Just Say No clubs.
[00:13:03.960]So even by 1988
[00:13:08.550]we were very abstinence-only, very don't do it,
[00:13:12.480]very just say no
[00:13:13.950]and really didn't have approaches that worked.
[00:13:17.730]But it was one of, in my eyes,
[00:13:19.080]one of the legends in our field, David Hanson,
[00:13:21.480]who showed, look, if you look at the research
[00:13:23.700]on prevention strategies,
[00:13:25.650]if you do a program like that, people learn stuff,
[00:13:29.070]it doesn't change behavior.
[00:13:30.600]Knowledge might go up, attitudes are much harder to change,
[00:13:34.650]but most of these approaches just aren't changing behavior.
[00:13:39.540]Research started happening in a much more robust way.
[00:13:44.190]And finally in 2002,
[00:13:47.220]this Call to Action Task Force Report came out.
[00:13:50.850]Those of you who've been working in this field
[00:13:52.590]for a while might remember when this was released.
[00:13:54.930]It was a big deal
[00:13:57.270]because they had four tiers of effectiveness.
[00:14:01.440]Working backwards, tier four, what doesn't work?
[00:14:05.040]Tier three, what has logical or theoretical promise
[00:14:07.890]but just needs more research?
[00:14:09.600]Tier two, what works with the general adult population
[00:14:12.390]but needs to be studied with college students?
[00:14:14.340]And tier one, what works with college students?
[00:14:17.640]The list of what works was three things long.
[00:14:21.450]That was it, but at least we had some successes.
[00:14:25.230]By 2015, the College Alcohol Intervention Matrix
[00:14:29.250]was reviewed and the idea it was developed
[00:14:32.130]and the idea was this wasn't gonna be this static PDF
[00:14:36.720]that never gets updated.
[00:14:37.860]It's gonna be updated,
[00:14:39.300]and the most significant update happened in 2019.
[00:14:44.070]If you're familiar with this,
[00:14:46.440]I hope that what I present is still value added.
[00:14:49.710]If you're not familiar with this,
[00:14:51.480]go to this website and get to know CollegeAIM.
[00:14:55.470]Listen, whenever you can play on the internet at work
[00:14:57.750]and let it count as work, that's a good day.
[00:15:00.300]So I would say go to this website
[00:15:02.430]and make sure you get a chance to understand how this works.
[00:15:05.430]We've, I say we,
[00:15:06.990]I was honored to be one of the six scientific contributors
[00:15:11.790]who partnered with 10 scientific peer reviewers.
[00:15:15.210]16 people had to agree what goes in here,
[00:15:18.990]and I don't expect you to be able to read this,
[00:15:20.550]I just want you to see visually
[00:15:22.200]that we organize the individually-focused matrix
[00:15:25.320]into columns of relative cost
[00:15:28.440]and rows of relative effectiveness,
[00:15:30.690]going with higher effectiveness, moderate, lower,
[00:15:34.020]what just doesn't work
[00:15:36.120]and what has too few studies to rate.
[00:15:39.150]Environment similarly had columns of relative cost,
[00:15:43.200]rows of relative effectiveness.
[00:15:46.290]So I'm gonna talk a bit about what that looks like.
[00:15:48.750]It plays to none of my comforts to not hear any of you
[00:15:51.840]and to not be able to touch base as we go,
[00:15:54.270]so hopefully someone in the room's able to play moderator
[00:15:56.490]in case any questions have emerged so far.
[00:15:59.280]But let me pause for a second just to see
[00:16:01.530]what questions people have at this point,
[00:16:03.570]what I can clarify and even if someone is a moderator,
[00:16:06.150]can unmute and just say, "Nope, no questions,"
[00:16:08.790]that would be helpful.
[00:16:09.623]But let me pause and see what questions people have
[00:16:12.090]or what I can clarify.
[00:16:14.371](no audio present)
[00:16:26.010]Any questions anyone has currently?
[00:16:29.550]Okay, well if during Jason's presentation
[00:16:31.440]you have a question or a comment,
[00:16:33.390]feel free to raise your hand.
[00:16:34.350]Either Antoinette and I will come to you with a microphone
[00:16:36.630]so that he can hear you, okay?
[00:16:39.150]We're good, Jason.
[00:16:40.020]All right, thanks for checking.
[00:16:40.980]I appreciate it.
[00:16:41.813]And I know there's people joining virtually.
[00:16:43.200]Feel free to use the chat
[00:16:44.640]if there are questions you have as well.
[00:16:46.770]So the idea of CollegeAIM is on the one hand,
[00:16:51.000]there's all these approaches reviewed,
[00:16:53.040]and on the other hand the idea is
[00:16:56.580]how can we go shopping?
[00:16:57.990]How can we get a group of people on campus together,
[00:17:01.740]partners, collaborators, hopefully influential folks
[00:17:05.610]to really take stock of what do we got?
[00:17:07.980]What could we be doing?
[00:17:10.080]When you go to CollegeAIM,
[00:17:11.850]you click where it says Worksheet,
[00:17:15.210]and when you click on Worksheet,
[00:17:17.541]it gives you this worksheet
[00:17:19.650]that they make as clear as they can
[00:17:21.570]this should not just be filled out by the alcohol person.
[00:17:25.770]Having played that role on a large campus
[00:17:28.520]at one point in my career,
[00:17:30.120]you can feel very lonely doing that
[00:17:32.460]and the alcohol person knows what you're doing.
[00:17:38.160]Get campus police involved,
[00:17:39.600]get people from the residence halls,
[00:17:41.070]get people from fraternity and sorority life
[00:17:43.170]and collegiate athletics,
[00:17:44.610]hopefully a vice president of student affairs
[00:17:47.010]or student life.
[00:17:49.500]What are we doing?
[00:17:50.940]What are our current strategies?
[00:17:53.220]And they set this up so that it can be a commentary.
[00:17:56.730]Write down what you're doing.
[00:17:57.990]Is it individual, environmental and is it even rated?
[00:18:02.220]If it's not effective,
[00:18:05.130]can we replace it with something else?
[00:18:07.590]If it's super expensive,
[00:18:10.020]is there something more budget friendly
[00:18:13.440]that would buy more bang for the proverbial buck?
[00:18:17.040]I think the most important column is right here,
[00:18:19.380]notes and next steps.
[00:18:23.640]I've talked to schools that say, "We have
[00:18:25.290]commercially available products
[00:18:27.120]that we "require" of all
[00:18:29.820]incoming first-year students.
[00:18:31.740]90% of students complete it."
[00:18:34.200]Well, then it's not required.
[00:18:36.180]And one in 10 of your incoming students learn
[00:18:38.460]nothing gets enforced around here.
[00:18:41.070]So if there's something you're truly requiring,
[00:18:44.370]how do you get that 100% compliance?
[00:18:47.760]Then what could we be doing instead?
[00:18:51.690]What are possible new strategies?
[00:18:54.090]Honestly, this is such an important part of CollegeAIM
[00:18:57.840]and I can't stress to you enough ideally,
[00:19:00.210]it is not completed by a person.
[00:19:02.760]It's completed by a committee of folks.
[00:19:06.720]And if you're trying to kind of jumpstart change
[00:19:11.010]on your campus,
[00:19:12.420]this conversation I honestly think can do it.
[00:19:15.810]Are things being offered that the main AOD person
[00:19:18.240]didn't even know about?
[00:19:20.820]Are there things that you're doing as the AOD person
[00:19:23.850]that administrators aren't aware of?
[00:19:26.880]Are things that you desperately want to do,
[00:19:30.090]but the budget hasn't been there?
[00:19:33.210]And then go shopping, consult CollegeAIM.
[00:19:37.050]So the idea is you can click on
[00:19:39.270]the individual-focused strategies
[00:19:41.220]or the environmental-focused strategies.
[00:19:43.350]And while there is a PDF version,
[00:19:47.370]while there's actual hard copy you can order,
[00:19:49.710]in some ways resist the temptation just to rely on that
[00:19:53.190]because the HTML version is pretty incredible.
[00:19:56.790]So if you go to, for example,
[00:20:00.480]you wanna, you select on environmental strategies,
[00:20:03.720]and let's say we click on Enforce Age 21 Drinking Age,
[00:20:08.280]you click on it and this is what comes up.
[00:20:11.070]It gives you a summary that shows it's super effective.
[00:20:14.820]And if you're like, well, I wanna know
[00:20:16.260]how do they know it's so effective?
[00:20:17.910]Click on References and when you click on References,
[00:20:20.820]it gives you all the articles
[00:20:22.680]and every article where the title is in blue,
[00:20:26.010]it's hyperlinked and it brings you
[00:20:27.780]right to the article itself.
[00:20:29.790]Where was that when I was in grad school doing lit reviews?
[00:20:34.020]Still do lit reviews,
[00:20:35.310]but this is an amazing tool to put the original articles
[00:20:39.300]in people's hands.
[00:20:41.070]And so any of those that are hyperlinked,
[00:20:43.380]here it's these two,
[00:20:44.550]you can get to the article itself.
[00:20:47.250]You can also compare strategies.
[00:20:49.200]So you click on what you want
[00:20:52.410]and in the upper right-hand corner it says
[00:20:53.700]Print Preview Strategies,
[00:20:55.920]click on that and you can either save it as a PDF
[00:20:58.683]that you can send to your colleagues,
[00:21:00.630]it's something you could literally print out
[00:21:02.430]and it gives you everything you would need.
[00:21:06.090]I mentioned that I would focus on
[00:21:08.340]the individual level strategies.
[00:21:09.870]That is my area of expertise.
[00:21:12.480]That's the side of the matrix that I was most involved in
[00:21:16.830]and I mentioned I would try and shed light
[00:21:18.840]on what's in that area of higher effectiveness.
[00:21:22.290]There are eight approaches with higher effectiveness.
[00:21:24.990]Two of them include commercially available products,
[00:21:29.310]and so especially since those are
[00:21:31.020]commercially available products, I won't put it,
[00:21:34.620]I won't spend too much time discussing those
[00:21:36.720]with no disservice to that,
[00:21:38.520]but I wanna make sure one isn't perceived
[00:21:40.560]as getting more airtime than the other
[00:21:42.270]or anything like that.
[00:21:44.460]You can see though with higher effectiveness,
[00:21:46.680]there's three under lower cost,
[00:21:48.660]four under mid range and one under higher cost.
[00:21:53.880]Three of these involve PNF or PFI.
[00:21:58.080]PNF is personalized normative feedback,
[00:22:01.020]PFI, personalized feedback intervention.
[00:22:04.980]This includes electronic or mailed
[00:22:08.220]personalized normative feedback.
[00:22:10.290]This includes one commercially available product,
[00:22:13.260]eCHECKUP TO GO,
[00:22:14.820]and this includes PFI feedback intervention,
[00:22:17.580]what they just call generic/other.
[00:22:22.350]When you look at what makes the difference between these,
[00:22:26.700]they're based on research since the 1980s.
[00:22:29.730]Alan Berkowitz, Wes Perkins,
[00:22:32.781](indistinct), Jeff Linkenbach,
[00:22:35.430]Michael Haines,
[00:22:36.780]these were the big five who in the '80s started showing
[00:22:40.140]that students way overestimated three things.
[00:22:44.910]When we talk about norms,
[00:22:45.960]we talk about injunctive norms and descriptive norms.
[00:22:49.530]Injunctive norms are attitudes,
[00:22:54.043]the acceptability of behaviors.
[00:22:55.950]Descriptive norms are rates.
[00:22:59.310]How many people drink,
[00:23:00.330]how much do they actually drink?
[00:23:04.290]What research showed is that students way overestimate
[00:23:08.280]the acceptability of excessive behavior.
[00:23:10.680]What does that mean?
[00:23:11.880]If you survey 1,000 college students
[00:23:14.070]and you ask them, "How do you feel
[00:23:15.840]about someone blasting their music on a school night
[00:23:19.230]at two in the morning because they're partying?"
[00:23:22.800]I hate that.
[00:23:24.097]"How do you think the typical student at our school feels?"
[00:23:27.840]Well, it's college.
[00:23:29.700]I don't want to be the one buzzkill.
[00:23:31.290]They're all probably cool with it.
[00:23:33.210]When you pool all the data together,
[00:23:35.310]99.9% of people disapprove,
[00:23:39.060]but they mistakenly say and do nothing
[00:23:42.330]because they think, "No one thinks like I do.
[00:23:45.180]No one will support me if I say,
[00:23:46.960]'Hey, could you turn that down?'"
[00:23:50.070]The 0.1% of people who do it are like, "That's cool,"
[00:23:53.130]but the majority of people who disapprove of it
[00:23:55.800]choose not to act.
[00:23:57.960]The field that I think has just won this whole thing
[00:24:02.160]is the bystander field.
[00:24:04.770]The role of injunctive norms in impacting bystander behavior
[00:24:08.790]has been impressive.
[00:24:11.520]If someone sees someone pouring drinks into someone,
[00:24:14.520]isolating them from their friends
[00:24:15.750]and they're like, "This does not look good.
[00:24:17.700]This looks like a potential sexual assault situation.
[00:24:20.580]I should do something."
[00:24:23.820]If there's that little bit where they're like,
[00:24:25.297]"Uh, but maybe everyone thinks
[00:24:27.390]I should mind my own business,"
[00:24:28.890]they may be less likely to intervene.
[00:24:31.110]If you have data that 99% of students at your campus
[00:24:34.950]would think that someone that steps in
[00:24:37.170]in a potential sexual assault situation would be a hero,
[00:24:41.700]you're more likely to increase bystander behavior.
[00:24:46.920]That person looks like they've had too much to drink,
[00:24:48.450]maybe we should call 911.
[00:24:50.670]Eh, I, they just want to sleep it off.
[00:24:54.750]If 99% of your students say,
[00:24:57.457]"If I was in a health emergency,
[00:24:58.950]I would want someone to call for help,"
[00:25:01.050]you're gonna increase bystander behavior.
[00:25:04.230]So when you look at attitudes, again,
[00:25:07.320]it's the bystander field that I think has had
[00:25:09.600]the most successes.
[00:25:10.860]What we've done a lot of research with
[00:25:12.840]in impacting drinking is the bottom part,
[00:25:15.630]descriptive norms.
[00:25:18.150]Students tend to think that way more people drink
[00:25:20.430]than actually do,
[00:25:21.690]and they think that those that drink
[00:25:23.880]drink more than they actually do.
[00:25:27.210]I've literally talked to students when I say,
[00:25:29.227]"What percentage of students
[00:25:30.300]do you think drink at our campus?"
[00:25:31.500]They're like, "Everybody.
[00:25:33.810]Wait, there's old people, 96%,"
[00:25:38.226]and I'm like, "Old people?"
[00:25:40.800]Those that drink four per occasion are convinced
[00:25:42.930]the typical student drinks five or six.
[00:25:45.300]Those that drink six per occasion are like,
[00:25:46.627]"Yeah, but most people drink seven or eight."
[00:25:48.690]Those who drink 10 per occasion think
[00:25:50.820]the typical person drinks 11 or 12.
[00:25:55.170]There's decades of research that shows
[00:25:57.900]that if you can correct a misperceived norm,
[00:26:01.230]not for everyone, but it can lead to people making a change
[00:26:04.410]in their drinking.
[00:26:06.270]What if someone's value is,
[00:26:08.580]listen, I want to have fun in college.
[00:26:10.440]I just don't want to be like that person
[00:26:12.300]who's the heaviest drinker that everyone thinks
[00:26:13.890]is a partier?
[00:26:15.840]What's the status quo?
[00:26:17.100]I drink a lot compared to my peers.
[00:26:20.100]So it could be the hook that prompts
[00:26:22.650]consideration of change.
[00:26:25.230]It could also be that when you correct a misperceived norm,
[00:26:29.010]let's say someone's like,
[00:26:30.710]"Tonight, I really only want to drink two,
[00:26:32.400]but if I drink two, am I gonna be like the only one?"
[00:26:35.040]If you have data that show that that's actually
[00:26:36.900]the average quantity for most students on your campus,
[00:26:41.760]you can boost and support the self-efficacy
[00:26:45.540]of someone considering making a change.
[00:26:48.090]So PNF is typically delivered web-based or online.
[00:26:54.240]It's simple, but don't sleep on the simplicity.
[00:26:57.810]The data are compelling.
[00:27:00.270]Clayton Neighbors at the University of Houston was
[00:27:02.220]one of the first researchers to show
[00:27:04.230]you can boost the impact of PNF when you show three things.
[00:27:09.570]These are data from female community college students.
[00:27:13.830]This person, they put them,
[00:27:16.140]here's your days per week,
[00:27:18.180]here's what you perceive everyone's days per week to be.
[00:27:21.450]Here's the actual.
[00:27:24.660]Clayton's work showed charting all three of these at once
[00:27:28.530]leads to outperforming just doing perceived and actual,
[00:27:33.030]making sure you can anchor the student on there.
[00:27:38.730]PFI is much more multi-component.
[00:27:43.230]I was a co-author on a study that actually looked
[00:27:45.240]at mailed feedback using this actual example
[00:27:48.903]that you see in front of you.
[00:27:50.940]People got it in the mail.
[00:27:55.020]Abstainers that got the mailed feedback were
[00:27:58.050]more likely to still be abstaining a year later.
[00:28:00.930]People who were engaging in heavy episodic
[00:28:03.600]or binge drinking compared to people in a control group,
[00:28:07.290]that changed.
[00:28:08.970]A mailed intervention worked.
[00:28:12.060]It can include personalized normative feedback.
[00:28:14.700]Here, the norms were where my cursor is hovering
[00:28:19.350]and norms were built in in comparing people
[00:28:22.380]with their BAC and even their overall normative comparison.
[00:28:28.050]This can be delivered web-based or online,
[00:28:30.090]but the most robust findings and the largest effect sizes
[00:28:33.750]are with in-person delivery
[00:28:35.670]as a brief motivational intervention,
[00:28:37.890]and I'll talk more about that in just a bit.
[00:28:40.710]There's no way to do justice to all of these interventions
[00:28:44.280]in the time we have,
[00:28:45.990]but I hope that overview of PNF and PFI is helpful.
[00:28:50.640]I'm going to again pause to see what questions people have
[00:28:54.270]or see what I can clarify about this section
[00:28:57.240]before I continue,
[00:28:59.310]with apologies to whomever's playing moderator,
[00:29:02.040]so thank you.
[00:29:10.659]And I invite the folks joining virtually
[00:29:11.492]if there's questions as well, to let me know.
[00:29:14.827](no audio present)
[00:29:30.120]No questions here in the room, Jason.
[00:29:31.800]Alright, thank you.
[00:29:32.633]Sorry for the hassle to you, but I appreciate it.
[00:29:36.750]Next is skills training, and this is
[00:29:42.150]I mentioned that when the 2002
[00:29:44.520]Call to Action Task Force Report was reviewed,
[00:29:47.130]there was a tier one with only three interventions in it.
[00:29:50.070]One of those three was the Alcohol Skills Training Program.
[00:29:53.760]I do what I do today because of Alan Marlatt.
[00:29:57.330]Alan was my advisor in graduate school
[00:29:59.430]and he passed away in 2011.
[00:30:03.150]His impact is still felt in our field.
[00:30:06.030]Most of our biggest prevention successes,
[00:30:08.670]he laid the foundation for
[00:30:10.350]on that individually-focused side.
[00:30:13.380]The Alcohol Skills Training Program is
[00:30:16.620]a skills training approach done in groups
[00:30:19.710]using motivational interviewing techniques
[00:30:21.660]in its delivery with a focus on drinking
[00:30:24.120]in a less dangerous and less risky way
[00:30:26.670]for those who make the choice to drink.
[00:30:29.580]Keep in mind that in 1988 we had no prevention successes,
[00:30:34.530]but we had 12,000 Just Say No clubs.
[00:30:37.080]Alan started researching this right about then.
[00:30:40.740]To address harm reduction is not where we were as a country.
[00:30:46.050]It was seen as very bold,
[00:30:48.870]but Alan always made clear
[00:30:51.330]if there's a misunderstanding of harm reduction
[00:30:53.520]is that it's somehow anti-abstinence
[00:30:56.580]or solely equals moderation
[00:30:59.250]and nothing could be farther from the truth.
[00:31:01.980]If a student says, "I wanna avoid
[00:31:03.960]all of alcohol's unwanted effects," then don't drink.
[00:31:08.580]Abstinence is the best way to do that.
[00:31:11.550]But what a harm reduction approach acknowledges is
[00:31:13.980]that any steps towards reduced risk are
[00:31:16.290]steps in the right direction.
[00:31:18.900]I come to you drinking 40 drinks a week
[00:31:21.510]and experiencing lots of consequences
[00:31:24.210]and I go through a program at your college.
[00:31:27.300]Now I reduce my drinking to 10 drinks per week,
[00:31:30.570]way fewer consequences.
[00:31:32.670]Well done.
[00:31:33.930]If your treatment outcome goal is abstinence, however,
[00:31:37.530]I'm a treatment failure
[00:31:39.990]and you can't pretend to call me anything but that.
[00:31:43.110]In most programs in both of our states,
[00:31:45.750]in both Washington and Nebraska,
[00:31:48.180]I'm kicked out because I'm still drinking.
[00:31:51.840]But how could we overlook a reduction that significant,
[00:31:54.720]particularly if it's associated with a reduction in harm?
[00:31:59.550]Sometimes reducing harm
[00:32:01.890]makes it look like we've done nothing
[00:32:03.240]to their actual drinking.
[00:32:05.670]Imagine you're evaluating a program
[00:32:07.860]simply by asking people, "How many drinks do you have
[00:32:10.380]each day of a typical week?"
[00:32:13.350]We're working with a student that says,
[00:32:15.877]"I have five drinks every Friday,
[00:32:17.730]five drinks every Saturday."
[00:32:19.740]Pretty small person.
[00:32:21.930]They make clear that all five of those drinks are
[00:32:24.210]shots of hard alcohol on an empty stomach over two minutes.
[00:32:30.390]They acknowledge they get pretty intoxicated pretty quickly.
[00:32:33.810]They often feel gross the next day.
[00:32:36.780]They say that they say or do things they regret
[00:32:39.510]and they're embarrassed to admit that they drive
[00:32:41.670]at least once per month when they probably are
[00:32:43.410]too impaired to do driving.
[00:32:46.320]Now they go through a harm reduction focused approach.
[00:32:49.620]They decide, "I'm done with shots.
[00:32:53.460]I'm gonna drink beer.
[00:32:55.170]I'm done with empty stomach.
[00:32:57.480]I'm gonna eat prior to and while drinking.
[00:33:00.690]I'm done with two minutes.
[00:33:02.580]I'm gonna stretch my alcohol use out
[00:33:03.990]over three and a half hours.
[00:33:07.890]I've told my friends what I'm doing.
[00:33:09.840]We've downloaded every rideshare app known to humanity.
[00:33:12.810]I will not be driving again.
[00:33:15.690]What's that, how much am I gonna drink?
[00:33:17.130]Five on Friday, five on Saturday."
[00:33:19.650]If all we do is look at their quantity,
[00:33:21.150]it's really easy to say nothing changed.
[00:33:24.450]They're using more protective behavioral strategies,
[00:33:27.690]more harm reduction strategies,
[00:33:29.580]getting to a lower blood alcohol level
[00:33:32.220]and experiencing fewer consequences.
[00:33:35.820]The key though is this.
[00:33:37.680]So often when people think of Just Say No programs,
[00:33:42.060]they laugh.
[00:33:42.893]They're like, "That wouldn't work."
[00:33:44.190]How come?
[00:33:45.480]Why would Just Say No not work?
[00:33:47.370]If I was in front of you
[00:33:48.240]I'd actually love to have this conversation,
[00:33:51.150]but I imagine you would tell me things like,
[00:33:52.747]"Well, when you tell people not to do it
[00:33:54.930]makes 'em wanna do it more.
[00:33:56.790]It's too simplistic, Just Say No.
[00:34:00.030]These are critically-thinking college students.
[00:34:02.070]The critical thought's not there.
[00:34:04.470]Some of them have already said yes.
[00:34:07.050]What if they're about to be able to legally say yes?"
[00:34:10.380]And while all of those possibilities might be true,
[00:34:15.420]we actually view it through a very different lens.
[00:34:19.475]Prochaska and DiClemente develop
[00:34:21.120]the transtheoretical model of change,
[00:34:23.160]readiness to change model,
[00:34:24.660]stages of change model,
[00:34:26.250]in response to tobacco cessation.
[00:34:29.490]They said they had never met someone that smoked cigarettes
[00:34:33.270]who was unaware of the health consequences, right?
[00:34:37.200]We don't see people that are like, "Wait, what?
[00:34:39.150]These are bad for me?
[00:34:40.200]No one told me."
[00:34:41.310]But there are different levels of readiness to have
[00:34:44.160]a friend, family member,
[00:34:47.310]a loved one, a healthcare provider, say,
[00:34:49.987]"Hey, heads up, you need to quit."
[00:34:52.890]Depending on which version of their publication you pick up,
[00:34:55.350]is either five, six, or seven of these stages of change
[00:34:59.400]drawn as a ladder, a wheel or a spiral.
[00:35:06.270]Just for the sake of discussion,
[00:35:08.220]let's look at these five stages of change.
[00:35:11.370]Pre-contemplation is a made-up word.
[00:35:13.920]How cool is that?
[00:35:15.270]If you're gonna invent a theory, invent a word.
[00:35:18.060]These are the people aren't just pre,
[00:35:19.740]aren't just contemplating, they're pre-contemplating.
[00:35:23.070]They haven't even begun to think,
[00:35:24.727]"Why would I need to make a change?"
[00:35:27.390]Someone has 15 drinks on campus,
[00:35:29.730]break stuff, has to go through conduct,
[00:35:32.760]lost in the shuffle's they had 15 drinks and broke stuff.
[00:35:36.060]And instead they make statements like,
[00:35:38.227]"Well, doesn't campus security have anything better to do
[00:35:41.310]than pick on college students?"
[00:35:43.200]Or, "This isn't my fault, this is my roommate's fault
[00:35:46.680]'cause my roommate answered the door when the RA knocked."
[00:35:50.070]Or, "Why don't we just lower the drinking age?
[00:35:51.990]Then this wouldn't even be an issue."
[00:35:54.330]No recognition of need to change.
[00:35:57.060]Contemplation is what it sounds like.
[00:35:59.520]Maybe a person's noticing stuff.
[00:36:01.800]The key to this stage of change is ambivalence.
[00:36:05.010]If you hear the word but,
[00:36:07.230]they're probably in contemplation.
[00:36:10.350]Sometimes I think about cutting down on my drinking,
[00:36:12.270]but I wouldn't have as much fun as my friends are having
[00:36:15.090]and that would suck.
[00:36:17.130]I feel like I should exercise more, but when?
[00:36:20.070]I'm so busy and I'm really tired at the end of the day.
[00:36:24.420]I really want to eat healthier but kale is disgusting.
[00:36:29.100]Contemplation.
[00:36:30.510]Preparation, a person's thought about it and said,
[00:36:32.947]"I'm gonna make a change."
[00:36:34.350]New Year's resolutions are a great example of this.
[00:36:38.490]Action is what it sounds like.
[00:36:39.660]A person's actively making a change in their behavior.
[00:36:42.330]Maintenance is also what it sounds like.
[00:36:44.640]A person made a change six months or more ago.
[00:36:48.720]Does Just Say No work with college students?
[00:36:51.270]No, it does not
[00:36:53.520]but not for the reasons why people often say.
[00:36:56.790]Why do we think Just Say No doesn't work?
[00:37:00.060]Because just stop, just don't do it,
[00:37:03.930]just say no is an action stage request.
[00:37:07.410]And if you say it to a student or group of students
[00:37:10.740]who are in pre-contemplation or contemplation,
[00:37:13.590]there's an absolute disconnect between what we're asking for
[00:37:18.540]as the facilitator, the program provider,
[00:37:21.420]and where that student or group of students may be
[00:37:24.540]in terms of their level of readiness to change.
[00:37:27.060]What that means, my friends, is just say cut down.
[00:37:31.740]Just say moderate.
[00:37:33.570]Just say drink in a less dangerous or less risky way
[00:37:36.630]would be as equally dismissible and equally laughable
[00:37:40.440]a goal as just say no
[00:37:42.930]if it's asking for action of people who aren't there yet.
[00:37:47.430]And would you believe the data backed that up?
[00:37:51.570]Kim Fromme, University of Texas at Austin,
[00:37:53.520]Will Corbin, Arizona State University,
[00:37:56.250]did a study with incoming first-year students
[00:37:58.500]where they said, "Welcome to college.
[00:38:00.930]We're done with that high school messaging.
[00:38:03.540]Here's how to drink in a less dangerous
[00:38:05.670]or less risky way."
[00:38:06.810]Click, they showed all the strategies.
[00:38:09.900]The program performed just like a Just Say No program.
[00:38:13.680]Knowledge went up,
[00:38:14.910]there was no change in behavior.
[00:38:17.430]In the discussion section they said,
[00:38:19.507]"Well, we think we know why.
[00:38:21.180]We dove right in with do this.
[00:38:25.410]And people who were like,
[00:38:26.570]'I haven't even met my roommate yet,'
[00:38:30.420]or who thought, 'So I really want to be successful
[00:38:34.590]in school academically,
[00:38:35.970]but I also wanna be successful socially.
[00:38:38.520]I don't know what I wanna do yet.'"
[00:38:41.700]What that means is our job changes.
[00:38:44.610]If someone says, "I haven't had a sip of alcohol
[00:38:46.880]in three years and I'm starting to feel kind of triggered,"
[00:38:51.510]we can line them up with recovery support,
[00:38:54.390]relapse prevention strategies, you name it.
[00:38:57.060]If someone says, "I know I wanna make a change,
[00:39:00.060]I just don't know how," we assess them
[00:39:02.070]and provide skills training.
[00:39:04.920]On that top row of CollegeAIM,
[00:39:10.174]in the Alcohol Skills Training Program,
[00:39:12.000]the idea was it's likely mandated students.
[00:39:15.120]It's likely students required
[00:39:17.970]to go through alcohol prevention,
[00:39:21.240]not all of whom but for the most part might be
[00:39:23.700]in pre-contemplation or contemplation.
[00:39:25.890]And these are the people for whom
[00:39:27.750]motivational enhancement approaches would be indicated.
[00:39:30.690]Motivational enhancement approaches can be used
[00:39:33.180]to prompt contemplation of change
[00:39:36.000]in those that used to be in pre-contemplation
[00:39:38.430]and for those that are ambivalent or stuck,
[00:39:40.830]it could result in them getting unstuck.
[00:39:43.410]It could prompt commitment to change or even taking steps.
[00:39:48.210]You all do what you do 'cause you want to help people
[00:39:52.260]and bless you all for that.
[00:39:55.818]I think it's amazing how many well-intended
[00:39:58.920]action stage suggestions you'll hear people give
[00:40:02.370]on college campuses
[00:40:05.100]and it's not coming from anything other than wanting
[00:40:06.990]to help people.
[00:40:08.370]But when the student doesn't take our advice,
[00:40:09.990]we're like, "Well, maybe they didn't want our help."
[00:40:12.900]A student says, "These last three and a half years
[00:40:15.300]have been brutal.
[00:40:17.160]I am so tense, I am so anxious,
[00:40:22.830]I don't know what to do."
[00:40:24.690]Go to the counseling center, it's free.
[00:40:27.720]They literally said, "I don't know what to do."
[00:40:29.520]They're ambivalent.
[00:40:32.610]My roommate is driving me crazy.
[00:40:34.170]Talk to them.
[00:40:37.380]Am I in the right major?
[00:40:38.520]Academic advising will help you.
[00:40:41.146]I don't know if my resume is good enough.
[00:40:42.270]Go to career development.
[00:40:43.950]We're wanting to help people,
[00:40:46.230]but if we go faster than they're, than where they're at,
[00:40:49.500]there's a disconnect,
[00:40:50.670]and all of that's true even with the work with alcohol.
[00:40:54.660]Now it's impossible to teach about motivational interviewing
[00:40:58.080]on one slide.
[00:40:58.913]I'm not even gonna try,
[00:41:00.780]but one of the big reasons we think
[00:41:02.130]motivational interviewing works is number two.
[00:41:05.940]If you can develop discrepancies
[00:41:08.460]between values and goals of importance to the student
[00:41:11.910]and ways in which the status quo
[00:41:13.740]could be in conflict with that.
[00:41:17.010]What's my value?
[00:41:18.540]I want to kick butt academically.
[00:41:20.580]What's the status quo?
[00:41:22.080]I haven't been to class the last three mornings
[00:41:23.640]because I was hung over.
[00:41:25.950]What's my value?
[00:41:27.240]Trying to watch what I eat, stay in shape.
[00:41:30.330]What's the status quo?
[00:41:31.680]I drink 40 beers a week,
[00:41:33.210]which is 6,000 calories a week coming from alcohol.
[00:41:37.770]What's my value?
[00:41:39.960]I want to be a good partner in relationships.
[00:41:42.300]What's the status quo?
[00:41:43.770]Ah, I did it again.
[00:41:45.720]I said such hurtful things.
[00:41:47.700]That's not me.
[00:41:48.930]Why did I even say that?
[00:41:51.780]Miller and Rollnick say
[00:41:53.430]we allow the data to be confrontational, not us.
[00:41:57.870]So is there alcohol information in ASTP?
[00:42:00.990]Yes, but it's delivered in a motivational framework.
[00:42:06.870]What's my value?
[00:42:07.890]I'm work hard, play hard,
[00:42:09.870]so I drink a lot
[00:42:11.250]but then I'm gonna get a lot of stuff done tomorrow
[00:42:13.290]and I'm gonna guarantee I'll be on my game
[00:42:15.420]because I'm gonna eat a bunch of bread and drink water
[00:42:18.150]to sober up quickly.
[00:42:19.890]What might they learn?
[00:42:21.000]There is no way to sober up quickly.
[00:42:23.340]Meaning if you have important things to do the next day
[00:42:26.700]you might choose to not drink at all
[00:42:28.650]or don't get to quite as high a peak blood alcohol level.
[00:42:32.460]So in a group you can do motivational enhancement techniques
[00:42:37.500]different than one-on-one,
[00:42:38.610]sustained motivational interviewing.
[00:42:41.910]They're non-judgmental, non-confrontational.
[00:42:44.700]You cast a wide net to be inclusive of the audience.
[00:42:49.200]I'll give you an example.
[00:42:51.270]If someone says, "Tonight I wanna be as control
[00:42:54.150]of my night as possible,
[00:42:56.670]what are some strategies a person could use?"
[00:42:59.970]Someone who doesn't really drink could answer that.
[00:43:03.901]A person in pre-contemplation could answer that
[00:43:07.626]and as their peers answer it,
[00:43:10.730]it boosts the credibility of the strategies
[00:43:13.320]'cause it's coming from their peers
[00:43:15.210]not from us clicking and showing a PowerPoint slide.
[00:43:18.780]We ask open-ended questions as much as possible.
[00:43:21.570]We reflect when possible.
[00:43:23.850]We can consider hooks for the group.
[00:43:27.060]I work with all the student athletes on our campus.
[00:43:30.480]How do I start every ASTP?
[00:43:33.967]"What are your goals for the season,
[00:43:36.570]both in your sport and in the classroom?
[00:43:40.650]What's gonna help get you there?
[00:43:42.630]What might get in the way?
[00:43:44.520]Where can I bring in science
[00:43:46.470]that will help develop discrepancies?"
[00:43:49.200]You elicit personally relevant reasons to change
[00:43:51.870]and again, let the group generate the strategies
[00:43:54.870]for making a change.
[00:43:56.760]And then these strategies include
[00:43:58.860]everything from setting limits,
[00:44:01.110]eating prior to and while drinking.
[00:44:03.480]None of these necessarily are that magical.
[00:44:07.980]What was different about ASTP is the inclusion
[00:44:11.490]of the motivational framework.
[00:44:15.150]Can we just put all of these on a poster and say, "Do this"?
[00:44:18.180]Sure, but they're all action stage suggestions.
[00:44:22.290]If done with fidelity to motivational interviewing,
[00:44:26.174]the students are walking out saying,
[00:44:27.157]"I'm gonna try all these different strategies."
[00:44:33.660]That one took a long time to define.
[00:44:35.880]BASICS is the program
[00:44:38.433]that the Alcohol Skills Training Program led to.
[00:44:43.350]When Alan first tested the Alcohol Skills Training Program,
[00:44:47.070]he compared the gold standard in the State of Washington
[00:44:49.980]was an eight-hour alcohol information school.
[00:44:53.520]He compared a eight-hour Alcohol Skills Training Program.
[00:44:56.850]He was such good friends with Bill Miller,
[00:44:58.410]who developed motivational interviewing,
[00:45:00.360]that he compared a six-session
[00:45:02.430]Alcohol Skills Training Program
[00:45:04.290]to one hour with an individual.
[00:45:07.710]That led, because both of those approaches worked,
[00:45:10.920]that led to the development of BASICS.
[00:45:13.110]And then in the very Lion King-ish circle of life
[00:45:15.210]we find ourselves in,
[00:45:16.710]the research started moving to
[00:45:18.720]how do we do ASTP in two sessions and even one session?
[00:45:23.220]BASICS is our most efficacious intervention.
[00:45:27.660]It's brief alcohol screening
[00:45:29.790]and intervention for college students.
[00:45:33.390]I hear a lot of schools say they do BASICS
[00:45:35.970]and I get nervous that they're doing something
[00:45:38.370]but it's not BASICS.
[00:45:41.902]The AS is the alcohol screening.
[00:45:45.570]It was originally a separate, in-person session
[00:45:48.720]with all of our mandated students.
[00:45:50.610]We still do it that way.
[00:45:52.530]The first session is in-person.
[00:45:55.200]Research shows that subsequently,
[00:45:56.730]that was achieved online,
[00:45:58.200]but it does require screening.
[00:46:00.600]The I is the intervention part.
[00:46:03.030]And that was originally a second in-person session
[00:46:08.010]guided by personalized graphic feedback.
[00:46:12.300]Feedback delivered online, in print,
[00:46:15.450]without interaction, without a facilitator,
[00:46:17.550]that's not BASICS.
[00:46:19.230]Distributing feedback in a group, that's not BASICS.
[00:46:26.790]I hate to simplify the research,
[00:46:28.410]but bottom line the research shows this.
[00:46:31.800]When this approach is done with fidelity
[00:46:34.470]to motivational interviewing,
[00:46:36.090]meaning adherence to the motivation interviewing spirit,
[00:46:38.640]style and strategies, it works.
[00:46:42.060]When it's not done with fidelity, it doesn't work.
[00:46:45.780]If you lecture, it's gonna backfire.
[00:46:50.460]The feedback doesn't have to be gorgeous.
[00:46:52.320]I love showing this.
[00:46:53.250]The older I get, the more I appreciate old stuff.
[00:46:57.120]The very first BASICS feedback
[00:46:58.740]that was associated with four years in reductions
[00:47:01.740]in drinking and consequences was this.
[00:47:04.440]This was side one,
[00:47:05.820]this was side two.
[00:47:07.980]This was made in WordPerfect for DOS.
[00:47:11.490]Yeah, where are my DOS fans out there?
[00:47:16.620]We even had to hire a graphic designer
[00:47:18.630]to make that really big number one,
[00:47:20.340]that really big number two
[00:47:21.840]and that shadowy 1994.
[00:47:24.057]And we were like, "Whoa, look at those special effects."
[00:47:26.880]And then a couple years later,
[00:47:28.440]Windows came out and there was clip art
[00:47:30.660]and we had to let her go.
[00:47:32.160]But
[00:47:34.080]I've seen people say,
[00:47:37.387]"Yeah, we have like 25 pages of BASICS feedback."
[00:47:40.080]I don't know how you would do that in a feedback session.
[00:47:45.840]If you have really, really, really lengthy feedback,
[00:47:48.360]evaluate the impact of it.
[00:47:50.040]I want you to know the gold standard sample or example
[00:47:53.520]of BASICS feedback was one sheet of paper.
[00:47:56.010]This was the front, this was the back.
[00:47:59.580]It guides a conversation with the student,
[00:48:02.400]where you get a sense of what do they like,
[00:48:04.200]what do they not like so much?
[00:48:05.820]And if there's things they don't like so much,
[00:48:07.680]what changes could they implement
[00:48:10.830]that would reduce those not so good things?
[00:48:13.980]So we tend to give feedback on quantity and frequency,
[00:48:17.910]norms, how the drinking changed since high school,
[00:48:22.350]peak BAC,
[00:48:23.880]again perceived and actual norms,
[00:48:26.520]consequences they endorse,
[00:48:28.230]family history risk, symptoms of substance use disorder,
[00:48:31.560]expectancies and own self-reported concern
[00:48:34.800]about their drinking.
[00:48:38.970]With no expectation that COVID was gonna happen,
[00:48:44.040]Dr. Christine Lee said,
[00:48:46.237]"Wouldn't it be cool if we could do this virtually?"
[00:48:49.470]This was totally pre-pandemic.
[00:48:53.520]BASICS was tested in four-year schools only.
[00:48:56.550]And she said,
[00:48:57.637]"What if we tried it with community college students?"
[00:49:01.200]And because a number of community college students
[00:49:04.950]were not only students but they were working a job,
[00:49:07.170]some of them were parents,
[00:49:09.450]did they have time to come in and do a BASICS session?
[00:49:13.650]So she found a HIPAA-compliant virtual platform
[00:49:17.730]and we did BASICS sessions with students wherever they were.
[00:49:22.860]And when we were done and we showed that it worked,
[00:49:25.020]we're like, "Well other than if traffic really sucks,
[00:49:27.840]I wonder if we'll ever need this virtual thing?"
[00:49:30.330]So I mean we felt really lucky in some ways
[00:49:32.580]that we had tested this.
[00:49:34.818]At a three month follow-up,
[00:49:36.720]community college students that had gotten
[00:49:38.790]a virtual feedback session compared to assessment only had
[00:49:42.810]lower peak blood alcohol level,
[00:49:45.390]29% fewer drinks per week,
[00:49:48.210]62% fewer episodes of heavy episodic or "binge drinking"
[00:49:53.307]and 24% fewer consequences than those
[00:49:56.370]in the assessment-only condition.
[00:49:58.290]Those are cool findings.
[00:50:01.590]And then in magenta,
[00:50:05.730]self-monitoring on its own is highly effective.
[00:50:11.940]Have people monitor their behavior.
[00:50:15.360]A lot of times people don't even realize.
[00:50:17.640]They'll say, "I remember drinks one, two, three and four.
[00:50:20.310]I didn't remember drinks five, six and seven,"
[00:50:23.460]or monitoring kind of clunks up this very automatic process.
[00:50:28.027]"I drank five days in a row,
[00:50:29.310]do I really wanna drink on a sixth?"
[00:50:31.500]Monitoring works.
[00:50:34.410]What also works, goal intention setting alone.
[00:50:40.200]Not, how do you change your whole life?
[00:50:44.010]One thing, what's one thing you could try tonight
[00:50:47.880]that would bring you closer to the evening
[00:50:49.500]you'd like to have?
[00:50:52.830]I need to drink water.
[00:50:54.090]I feel like I always get that cotton mouth,
[00:50:55.620]sore muscle feeling.
[00:50:57.450]That works.
[00:50:59.910]Immediate, attainable goals set by the student.
[00:51:05.670]And then rounding all of this out,
[00:51:07.380]Multi-Component Education-Focused Program.
[00:51:09.870]This is another commercially available program,
[00:51:12.060]AlcoholEdu.
[00:51:13.920]I hope I did justice to showing you what's in this.
[00:51:17.760]And so if as you take stock
[00:51:21.090]you've got a lot of the stuff that's lower effective,
[00:51:23.700]are there things that could be replaced that would be,
[00:51:26.610]or even just complement your existing programs
[00:51:29.190]that would bring higher effectiveness to it?
[00:51:32.580]My favorite sentence in CollegeAIM is this.
[00:51:35.887]"Consider a mix of strategies.
[00:51:37.890]Your best chance for creating a safer campus
[00:51:40.590]could come from a combination of individual
[00:51:43.230]and environmental-level interventions
[00:51:45.390]that work together to maximize positive effects."
[00:51:49.710]I think that's a million percent true.
[00:51:51.750]And that mix includes but is not limited to policies,
[00:51:56.280]but then enforcement of those policies.
[00:52:00.270]Education, prevention,
[00:52:03.180]intervention, treatment and recovery support.
[00:52:07.650]This is not just on you as the AOD person.
[00:52:12.360]So when I tried to work on this presentation
[00:52:14.550]and think who could we bring to the table?
[00:52:17.400]Who are these partners?
[00:52:19.110]When it comes to policies and enforcement,
[00:52:22.260]off-campus law enforcement as well as
[00:52:24.180]on-campus law enforcement, police or security,
[00:52:28.380]conduct or the judicial office,
[00:52:31.260]RAs and Res Life, who have a responsibility
[00:52:33.360]for documenting violations,
[00:52:36.180]upper level administrators,
[00:52:38.220]fraternities and sorority members
[00:52:40.290]who may have their own judicial board.
[00:52:43.740]When it comes to education, prevention,
[00:52:45.510]prevention professionals, peer health educators,
[00:52:49.140]health promotion office.
[00:52:51.420]Intervention includes the counseling center,
[00:52:54.870]parents, BASICS providers.
[00:52:58.830]And then when we look at treatment and recovery support,
[00:53:00.600]community providers, campus recovery communities
[00:53:03.870]and campus community coalitions.
[00:53:06.660]This slide took me 20 minutes to make,
[00:53:08.610]so I'm gonna leave it up for about five more seconds.
[00:53:14.250]Joking aside, it's great 'cause I can't hear anything,
[00:53:16.680]so I have no idea if any of this is sticking.
[00:53:18.600]But this, I really believe in this slide
[00:53:22.650]and here's what I believe in even more.
[00:53:25.170]I've been giving this quote out since I learned about it
[00:53:27.750]over 10 years ago.
[00:53:29.280]It feels different now
[00:53:31.560]after all we've been through as a planet with the pandemic.
[00:53:36.090]But Fixsen and colleagues said,
[00:53:38.377]"How do you get evidence-based strategies out there?"
[00:53:42.060]And they said, "Use of effective interventions
[00:53:45.210]on a scale sufficient to benefit society requires
[00:53:48.720]careful attention to implementation strategies as well.
[00:53:53.010]One without the other
[00:53:55.560]is like serum without a syringe.
[00:53:58.620]The cure is available but the delivery system is not."
[00:54:03.090]Wow.
[00:54:04.740]You could have the most effective program
[00:54:08.160]for mandated students ever,
[00:54:12.300]but if you don't have consistent enforcement of policy,
[00:54:16.200]the cure is available, the delivery system is not.
[00:54:21.360]Dan Eisenberg at the University of Michigan
[00:54:23.940]has done research screening students for depression.
[00:54:28.080]And when they flagged for depression, he asked them,
[00:54:30.607]"Do you feel like you need help?"
[00:54:32.130]When they said "Yes,"
[00:54:33.210]he asked, "Did you get help?"
[00:54:34.710]When they said, "Yes," he said, "Cool."
[00:54:37.140]When they said "No," he asked why.
[00:54:39.630]Guess what the number one reason students don't get help is.
[00:54:42.570]They don't know where to go.
[00:54:44.610]That's fixable.
[00:54:46.320]Therapy works, treatment works,
[00:54:49.080]the cure is available, the delivery system is not.
[00:54:52.860]I think part of our challenge in compiling
[00:54:56.400]something like the CollegeAIM worksheet is
[00:54:59.730]bringing people to the table
[00:55:01.530]who can be part of that delivery system.
[00:55:07.410]When you look at all of these,
[00:55:11.820]you know again,
[00:55:14.730]messaging from orientation leaders,
[00:55:18.960]from student leaders,
[00:55:22.170]from vice presidents matter as that delivery system.
[00:55:26.160]We've got these things that work.
[00:55:28.020]How do we get people to 'em?
[00:55:31.050]The goal isn't let's just go out and bust college students
[00:55:33.390]and make them do stuff.
[00:55:35.280]But if you have policies, enforce them
[00:55:37.920]and enforce them consistently.
[00:55:39.750]That matters.
[00:55:42.390]What's the delivery system?
[00:55:43.920]If the cure is available,
[00:55:46.020]how do you make sure the delivery system's in place too?
[00:55:49.200]I wanna give you an example of how a mix of strategies can
[00:55:51.600]result in a package of programs.
[00:55:55.230]Anne Fairlie, who I work with
[00:55:56.880]at the University of Washington,
[00:55:59.100]did this amazing study with Mark Wood and Robert Laird.
[00:56:03.780]Right before students started college,
[00:56:06.510]end of their first year of college
[00:56:07.587]and the end of their second year of college,
[00:56:11.580]they wanted to predict binge drinking,
[00:56:14.070]five drinks in a row for males,
[00:56:15.270]four drinks in a row for females,
[00:56:17.580]and predict that as a function of social modeling,
[00:56:20.040]number of close friends who drink heavily,
[00:56:22.170]perceived friend approval of drinking, getting drunk,
[00:56:24.810]as well as parental permissiveness.
[00:56:26.700]Data never turn out this perfect.
[00:56:28.530]Wanna see a perfect figure?
[00:56:30.390]This.
[00:56:32.250]Y axis is heavy episodic drinking episodes.
[00:56:36.240]X axis is time.
[00:56:37.740]What's the top line?
[00:56:39.240]High social modeling,
[00:56:41.040]high parental permissiveness.
[00:56:42.780]What's the next line down?
[00:56:44.370]High social modeling,
[00:56:45.810]low parental permissiveness.
[00:56:47.520]Wow.
[00:56:49.830]Messaging from parents alters the college experience
[00:56:54.090]of students that go to a high-risk friend group
[00:56:57.060]or a high-risk setting like a fraternity or sorority,
[00:57:00.630]and potentially a campus with a reputation for partying.
[00:57:06.750]Next line down, low social modeling,
[00:57:09.510]high parental permissiveness.
[00:57:11.070]Next line down, low social modeling,
[00:57:13.080]low parental permissiveness.
[00:57:15.330]Parents are very influential.
[00:57:18.690]In CollegeAIM under moderate effectiveness
[00:57:21.300]is skills training,
[00:57:22.800]parent-based alcohol communication training.
[00:57:26.820]Now,
[00:57:28.680]the Surgeon General's report on alcohol, drugs and health,
[00:57:34.230]instead of reviewing almost 60 approaches
[00:57:37.110]literally said, "We think there are two things
[00:57:40.163]that work well."
[00:57:40.996]Two, that's it.
[00:57:43.110]They say BASICS and they say the Parent Handbook,
[00:57:46.560]which came from Rob Turrisi.
[00:57:49.050]And they go on and talk about the Parent Handbook
[00:57:52.380]and they even say,
[00:57:53.677]"One study showed the combination of BASICS
[00:57:56.160]and the Parent Handbook significantly reduced
[00:57:58.830]alcohol consumption among incoming college students
[00:58:02.340]who showed heavy rates of high school drinking."
[00:58:05.220]I was honored to be co-author on that article.
[00:58:08.580]It's exactly what we tested.
[00:58:10.200]We tested BASICS only, parent only or the package deal.
[00:58:15.000]And the package deal worked better.
[00:58:18.540]We concluded the parent intervention delivered
[00:58:22.230]before college may serve to enhance the efficacy of BASICS,
[00:58:26.490]potentially priming students
[00:58:28.320]to the subsequent BASICS message.
[00:58:30.450]So parents matter in a big way.
[00:58:32.820]Figure out how to bring them into the mix.
[00:58:37.260]Look, I'm going back to "The Princess Bride".
[00:58:41.430]So when we talk about fidelity,
[00:58:42.780]you can't talk about fidelity and not think about
[00:58:44.520]the great scene about marriage.
[00:58:46.560]But when we talk about doing something with fidelity,
[00:58:49.980]implementation fidelity is the degree to which
[00:58:52.890]programs are implemented as intended
[00:58:55.320]by the program developers.
[00:58:59.940]And when we look at adherence,
[00:59:04.936]"Adherence is essentially the bottom-line measurement
[00:59:06.630]of implementation fidelity.
[00:59:08.460]If an implemented intervention adheres completely
[00:59:11.130]to the content, frequency,
[00:59:13.200]duration and coverage prescribed by its designers,
[00:59:16.920]fidelity can be said to be high."
[00:59:20.160]This is the active ingredient.
[00:59:21.990]Content, that's the dose.
[00:59:25.920]So even social norms,
[00:59:29.610]you could have the best data possible on your campus
[00:59:34.260]but if you do a social norms mass marketing campaign,
[00:59:37.230]did you dose properly?
[00:59:39.180]If you throw up one poster,
[00:59:41.310]that's probably not appropriate dosing.
[00:59:44.220]So going back to this original definition,
[00:59:47.730]if you tweak a program, you've tweaked it.
[00:59:51.480]It might not be the evidence-based strategy anymore.
[00:59:55.110]It doesn't mean don't tweak it.
[00:59:56.093]It just means probably should evaluate
[00:59:59.220]whatever you've done to adjust or alter it.
[01:00:05.010]And if you're doing anything,
[01:00:08.430]are you getting the active ingredient in place?
[01:00:11.220]Are you dosing properly?
[01:00:15.000]I love this quote from "The Princess Bride."
[01:00:16.747]"You rush a miracle, man, you get rotten miracles."
[01:00:20.250]I've heard people say, "Hey, can you do,
[01:00:22.767]can you train us in motivational interviewing over lunch?"
[01:00:26.250]No, I can't.
[01:00:27.870]I can introduce you to the concepts.
[01:00:29.940]If you're gonna do it, do it right.
[01:00:32.430]It is worth investing in.
[01:00:36.780]I'm on the home stretch.
[01:00:37.740]I'm gonna pause one last time to see
[01:00:39.210]what questions people have before I do my final slides
[01:00:42.600]and we open it up for discussion.
[01:00:45.240]I don't mind, one more time in the room,
[01:00:46.950]see what questions or comments there might be.
[01:00:58.650]No questions, Jason.
[01:01:00.360]Thank you for letting me know.
[01:01:02.580]Be aware of what doesn't work or can even make things worse.
[01:01:06.607]What doesn't work in CollegeAIM?
[01:01:10.440]Expectancy challenge lecture alone.
[01:01:17.160]Alan Marlatt's bar lab research is
[01:01:20.040]actually an important component of BASICS
[01:01:22.500]and it's an important component
[01:01:24.120]of the Alcohol Skills Training program.
[01:01:26.400]If all you do is a lecture about expectancy challenge,
[01:01:31.350]knowledge increases, it doesn't change behavior.
[01:01:35.820]Information, knowledge, education alone.
[01:01:39.660]Increases knowledge, no change in behavior.
[01:01:42.780]Information has its place.
[01:01:44.550]It's delivering in a motivational framework.
[01:01:48.180]Values clarification alone, not effective
[01:01:52.560]and live, instantaneous, breathalyzer feedback.
[01:01:58.290]Estimating BAC, distribution of BAC charts
[01:02:02.400]are key components of the Alcohol Skills Training Program,
[01:02:05.520]of BASICS, of most web-based PFIs.
[01:02:08.850]That's not what this means.
[01:02:10.560]What this means, researchers said,
[01:02:14.167]"What if students don't realize how drunk they're getting?
[01:02:17.730]What if we brought a breathalyzer to a party and said,
[01:02:20.940]'Come here, friend, let's have you blow this,'
[01:02:24.810]and give people real-time feedback?"
[01:02:26.670]When this is evaluated, what happens?
[01:02:28.860]It turns into a drinking game.
[01:02:31.560]So when people say, "Well, shouldn't we just have
[01:02:34.170]a breathalyzer at an event?"
[01:02:36.510]That does not, that's on what's not effective.
[01:02:39.960]Now, some of what we research in CollegeAIM
[01:02:42.720]hasn't been tested with college students
[01:02:45.330]because it's already been shown not to work
[01:02:46.680]with high school students.
[01:02:49.230]You can go to, in my own state, TheAthenaForum/EBP
[01:02:54.000]and there's a best practices toolkit
[01:02:57.510]that reviews what works and what doesn't
[01:03:00.330]when we look at school age kids,
[01:03:02.700]and there's two things on that list
[01:03:06.494]that I far too often hear college campuses
[01:03:08.940]considering doing.
[01:03:10.500]One is a mock car crash.
[01:03:15.660]When evaluated,
[01:03:18.300]does not have an impact.
[01:03:21.060]When evaluated, it can have the unintended impact
[01:03:25.590]of re-triggering or re-traumatizing survivors of accidents
[01:03:30.900]or those who've lost loved ones in car crashes.
[01:03:37.110]There's a grim study done on the East Coast
[01:03:41.970]where the mock car crash,
[01:03:43.410]where the car that they actually showed
[01:03:46.590]was the car a classmate had died in.
[01:03:50.670]That's terrifying.
[01:03:53.100]Any measurable impact of that car being displayed
[01:03:55.590]was gone within a couple weeks.
[01:03:57.720]Cognitive dissonance theory says
[01:04:00.390]if we're uncomfortable, we'll resolve that dissonance.
[01:04:04.140]Seeing the vehicle a classmate died in,
[01:04:07.110]that would never happen to me.
[01:04:08.190]That's, ah, no.
[01:04:10.710]We can do better than mock car crashes.
[01:04:14.730]Fatal Vision Goggles, what's the idea?
[01:04:17.310]Let's simulate what it's like to be intoxicated.
[01:04:21.120]When those are evaluated, two things happen.
[01:04:24.120]One, everyone's laughing,
[01:04:27.720]everyone's having a good time, they're pointing.
[01:04:30.930]What's the takeaway message?
[01:04:32.940]Being drunk is pretty fun.
[01:04:36.150]Second, it never fails,
[01:04:38.460]there's at least one person who doesn't suck.
[01:04:42.660]And what's their takeaway?
[01:04:44.100]Well, I guess I should be the designated driver
[01:04:46.440]'cause I'm the best drunk driver.
[01:04:49.140]So when in doubt, look at the data.
[01:04:52.770]If you're generating public health and prevention content,
[01:04:55.770]I will say this, pilot test it.
[01:04:58.080]Pilot test all of it, images, words.
[01:05:01.470]Make sure people understand
[01:05:02.880]what you're trying to communicate.
[01:05:05.610]And I'll also tell you this,
[01:05:10.230]we have fallen in love with this tool
[01:05:13.110]and I'll make sure this is in the handouts
[01:05:15.000]I send to Melissa,
[01:05:16.860]but this guide from the Centers for Disease Control
[01:05:20.730]about how we churn change our terminology
[01:05:23.970]is really, really important.
[01:05:25.770]It has been very influential in the work that we've done.
[01:05:29.970]And I learned about this the month it was released
[01:05:33.270]after hearing
[01:05:36.660]a parent say,
[01:05:38.737]"Could we quit talking about targeting things?"
[01:05:41.460]Because this parent explained
[01:05:43.860]that their child had been in a school shooting
[01:05:47.670]and the parent said,
[01:05:48.877]"I've come to learn that nothing good is
[01:05:50.400]ever on the other end of a target."
[01:05:53.940]And that just hit me in the heart.
[01:05:56.310]And the Centers for Disease Control say,
[01:05:58.327]"You know, we should avoid saying things like that."
[01:06:01.440]So instead of target population, targeting this,
[01:06:04.980]tackling this, combating this,
[01:06:07.170]it's looking at how we engage, how we focus on,
[01:06:12.540]and I even think that gives us more buy-in.
[01:06:15.870]We're not targeting our Greeks, we're engaging.
[01:06:19.620]We are partnering with
[01:06:22.080]our students in fraternities and sororities.
[01:06:24.750]So among the many great tools in this guide is that.
[01:06:29.310]There's also a great resource
[01:06:30.450]in the American Psychological Association
[01:06:32.790]that has just shown that when we do people-first language,
[01:06:35.670]it makes such an impact
[01:06:37.080]on people's resistance and defensiveness.
[01:06:40.710]I hope none of you ever question for a second
[01:06:43.050]the value of the work that we do.
[01:06:45.120]What you do in prevention contributes to student success.
[01:06:49.140]Decades of research show the more students drink,
[01:06:52.830]the more they report being tired all the time,
[01:06:55.320]less likely they are to be engaged in their coursework
[01:06:58.380]and the lower their grade point average tends to be.
[01:07:02.553]The more frequent college students use cannabis,
[01:07:04.980]the more classes they skip,
[01:07:06.870]the lower grade point averages they tend to have,
[01:07:09.150]the longer they take to graduate,
[01:07:11.070]if they even make it there.
[01:07:13.470]Students who use both cannabis and alcohol
[01:07:15.510]at moderate to high levels have lower GPAs over two years.
[01:07:18.900]Those that make a change do better.
[01:07:22.290]I have heard upper level administrators say,
[01:07:24.847]"I want to be the biggest champion ever for student success,
[01:07:30.090]for graduation rates, retention,
[01:07:33.330]academic outcomes."
[01:07:36.300]Good, then be a champion for prevention
[01:07:40.650]because what we do about substance use
[01:07:43.620]will one million percent pay dividends in the classroom.
[01:07:47.940]So if you've got buy-in on your campus, awesome.
[01:07:50.820]If you don't, putting a spotlight on findings like this,
[01:07:54.840]when in doubt transform the narrative.
[01:07:57.930]I think the school that's done this as well as anybody
[01:08:00.660]is Texas Tech.
[01:08:01.950]This is their original report in 2005.
[01:08:05.550]That was 2005 tuition dollars.
[01:08:07.830]I'd like to see what it is now.
[01:08:10.320]They had said, "We want additional funding to support
[01:08:13.800]students in recovery."
[01:08:16.050]What was the potential narrative?
[01:08:17.490]Well, we don't, we're not rolling in the money.
[01:08:20.280]So what they did is they surveyed the students
[01:08:23.640]that were in recovery who were able to say,
[01:08:26.347]"My ability to be here is because of this recovery support.
[01:08:31.800]If this wasn't here for me,
[01:08:32.850]I would've dropped out a long time ago.
[01:08:35.430]I was on the way to dropout
[01:08:37.230]until I learned there was recovery support."
[01:08:40.350]They support 80.
[01:08:42.450]This was data that they used back then.
[01:08:45.540]They said, "The Center for the Study of Addiction Recovery
[01:08:47.820]supports 80 of the estimated 213 students dealing
[01:08:51.120]with addiction at Texas Tech.
[01:08:53.580]By ensuring their enrollment in the university,
[01:08:55.950]the Collegiate Recovery Community estimates
[01:08:57.720]retaining $430,500 annually in direct tuition revenue
[01:09:03.060]that could potentially be lost due to relapse
[01:09:05.160]and subsequent dropout."
[01:09:06.540]That changed the discussion.
[01:09:08.880]The discussion became not can we afford this?
[01:09:11.670]The discussion became can we afford not to?
[01:09:15.510]So in wrapping up, utilize your coalition
[01:09:18.600]and your partners on and off campus.
[01:09:21.600]In CollegeAIM it says,
[01:09:23.287]"Some of the most effective strategies"
[01:09:25.587]are actually done in the community,
[01:09:28.020]like enforcing the minimum legal drinking age.
[01:09:32.167]"To achieve success off campus,
[01:09:34.560]partner with leaders and coalitions
[01:09:36.180]in your community and state.
[01:09:38.310]Building these partnerships takes time."
[01:09:40.350]Make it part of your long-term plan.
[01:09:42.210]You all do this so well.
[01:09:46.320]So if you're doing everything in the world on campus
[01:09:49.020]but across the street there's a bar not carding people,
[01:09:52.050]get them involved too.
[01:09:54.030]Looking at those environmental
[01:09:55.470]and individually-focused approaches.
[01:09:58.110]Again, I was one of the people that reviewed
[01:10:00.780]the individually-focused side.
[01:10:01.950]You could have a whole other talk
[01:10:03.720]on the environmental-focused side,
[01:10:05.700]but I hope you see that this mix of strategies is key.
[01:10:09.510]If there's a limited budget for prevention,
[01:10:11.730]invest in evidence-based strategies.
[01:10:14.430]Go to CollegeAIM, find out what's there.
[01:10:17.010]If it's other things, CampusDrugPrevention.gov
[01:10:21.240]is a possibility
[01:10:22.500]if you're looking at evidence-based strategies
[01:10:25.800]or substances other than alcohol.
[01:10:28.260]The Suicide Prevention Resource Center
[01:10:30.660]Best Practices Registry,
[01:10:32.970]you can look there for evidence-based approaches.
[01:10:36.090]TheCommunityGuide.org,
[01:10:39.600]SAMHSA's resource search that replaced NREPP,
[01:10:43.080]the National Registry of Effective Prevention Programs.
[01:10:47.100]And then if you're gonna invest
[01:10:49.560]in evidence-based strategies, implement them with fidelity.
[01:10:52.832](no audio present)
[01:11:09.030]Sorry about that.
[01:11:09.863]I'm very, very sick right now.
[01:11:15.060]When we look at barriers to implementing fidelity,
[01:11:17.940]I'm sorry, I have to cough again.
[01:11:20.341](no audio present)
[01:11:28.740]When we look at barriers to implementing,
[01:11:31.530]one of the things that is identified
[01:11:33.840]in the scientific literature
[01:11:35.640]is that there's not proper training.
[01:11:39.030]Again, if you're gonna invest in an evidence-based strategy,
[01:11:41.940]get the proper training.
[01:11:43.500]There's also a tendency to reinvent innovations.
[01:11:46.470]Some of our best advances in this field happened
[01:11:48.930]when people took a chance.
[01:11:50.460]But if you reinvent an innovation,
[01:11:51.990]it maybe is not the evidence-based strategy anymore.
[01:11:56.220]Be aware of your delivery strategy
[01:11:58.020]and what's in your campus' mix of strategies.
[01:12:01.170]And if people don't seem on board with prevention,
[01:12:03.960]tell the story differently.
[01:12:06.360]Show how what you do in one domain pays dividends elsewhere.
[01:12:11.370]Transform the narrative to make clear
[01:12:13.440]why prevention matters.
[01:12:16.020]Because sometimes we just need to tell a story
[01:12:18.510]in more than one way to get people on board
[01:12:20.427]and you have that ability.
[01:12:23.670]The oldest thing I cited is not going to be
[01:12:26.010]C. C. Fry from 1945.
[01:12:28.320]The oldest thing I cite is going to be Milne from 1926
[01:12:33.000]in the glorious book, "Winnie the Pooh."
[01:12:39.017]"'When you wake up in the morning, Pooh,'
[01:12:40.110]said Piglet at last,
[01:12:41.990]'What's the first thing you say to yourself?'
[01:12:44.550]'What's for breakfast?' said Pooh.
[01:12:46.820]'What do you say, Piglet?'
[01:12:48.480]I say, 'I wonder what's gonna happen exciting today?'
[01:12:51.300]said Piglet.
[01:12:52.920]Pooh nodded thoughtfully.
[01:12:55.289]'It's the same thing,' he said."
[01:12:59.100]When you hear someone say,
[01:13:00.307]"Listen, shouldn't we be focusing
[01:13:02.040]on mental health right now?"
[01:13:05.190]It's the same thing.
[01:13:07.020]What we do about alcohol and the drug use
[01:13:10.500]is gonna have impacts on mental health.
[01:13:13.830]Lori Davidson from the Suicide Prevention Resource Center
[01:13:16.230]said, "Wanna be a campus that does good suicide prevention?
[01:13:19.500]Do good alcohol prevention
[01:13:21.330]because alcohol prevention is suicide prevention."
[01:13:24.510]When people say,
[01:13:25.387]"Shouldn't we be focusing on student success?"
[01:13:27.930]It's the same thing.
[01:13:29.970]What you do about substance use
[01:13:32.160]will pay dividends in the classroom.
[01:13:34.680]I know that I was asked to go
[01:13:37.680]right to the top of the hour to leave time for questions
[01:13:39.780]and we're almost there.
[01:13:41.730]Have fun storming the castle,
[01:13:43.200]as they say in "The Princess Bride."
[01:13:45.420]My email address is there, jkilmer@uw.edu.
[01:13:48.810]I almost made it through the whole talk
[01:13:50.160]without a coughing spell.
[01:13:51.690]Sorry about that.
[01:13:52.650]I'd like to thank the mute button for being available.
[01:13:55.620]And with that I will tag back over
[01:13:58.250]to the folks in the room to confirm
[01:14:00.000]how much time we have for discussion,
[01:14:03.000]questions and comments.
[01:14:04.860]I really hope this met people's needs and interests.
[01:14:07.500]Thank you for the chance to work with you again
[01:14:09.420]and I'll tag you back over to the folks in the room.
[01:14:13.500]Thank you, Jason, you did great.
[01:14:15.780]Thank you.
[01:14:20.310]What questions or comments do people have?
[01:14:22.230]We do have about 15 minutes
[01:14:23.700]for questions and comments,
[01:14:24.780]so if you have a question or comment for Jason
[01:14:27.030]just raise your hand and Antoinette will meet you
[01:14:28.770]with the microphone.
[01:14:40.230]Jason, I will say I think your point regarding
[01:14:44.160]the fact that we have a lot of programs
[01:14:46.590]that we know work was really well received.
[01:14:49.170]It's always great to hear you talk about what should be done
[01:14:52.140]because I realize that a lot of what we're doing
[01:14:54.060]is among that list.
[01:14:55.860]But I think the challenge that you noted is
[01:14:57.840]kind of where I see most of our institutions struggle
[01:15:00.180]in terms of that delivery of those strategies.
[01:15:03.000]And I was wondering if there was anything else
[01:15:04.557]you could speak to regarding that,
[01:15:06.660]in terms of maybe ways that you've seen that bridge crossed
[01:15:09.420]in terms of getting that,
[01:15:11.100]getting to where students are at
[01:15:12.390]or bridging
[01:15:15.240]across campus to get to the folks
[01:15:17.460]who are also working in delivery but maybe not are
[01:15:20.070]as well versed in this area around prevention
[01:15:22.410]or mental health.
[01:15:24.493]That's a great question.
[01:15:25.326]I think that if you buy that idea of a delivery system,
[01:15:30.120]the cure is available, right?
[01:15:31.890]Serum without a syringe.
[01:15:33.570]It's looking at these possible delivery systems.
[01:15:35.730]I genuinely think parents are a delivery system
[01:15:38.700]and could and should be part of what we do.
[01:15:41.940]If we send a parent intervention booklet
[01:15:43.710]to every parent or caregiver,
[01:15:45.480]it doesn't mean they're gonna use it
[01:15:47.700]but the hope is that many of them will.
[01:15:49.950]Peers are a part of this.
[01:15:51.720]I mean, I genuinely think
[01:15:54.240]the value and role of making sure that orientation leaders
[01:15:57.180]and student leaders truly appreciate
[01:15:59.400]how influential they are becomes important.
[01:16:01.830]That extends to training with RAs well, obviously.
[01:16:07.380]Coaches and trainers,
[01:16:10.260]I mean even the setup we get,
[01:16:15.000]you could do the exact same program,
[01:16:18.060]you don't do anything differently.
[01:16:19.500]One coach says, "Hey everybody, instead of practice today,
[01:16:23.430]I've brought in this person to talk about substance use
[01:16:26.280]because this is important.
[01:16:29.700]Decisions made about substance use could derail
[01:16:32.430]our goals for the season.
[01:16:33.960]It can affect your health and your success.
[01:16:36.750]This is important.
[01:16:38.550]I'm giving this person all the time they need."
[01:16:41.430]Now, same program.
[01:16:42.840]You're not gonna change a thing,
[01:16:45.210]you get this intro.
[01:16:46.417]"Hey everybody, we gotta do this
[01:16:47.820]because they make us do this required programming.
[01:16:50.610]I've asked them to keep it short.
[01:16:52.440]And here's the alcohol person."
[01:16:55.158](indistinct chatter)
[01:16:58.290]Sorry?
[01:16:59.910]You're just getting chuckles,
[01:17:01.050]I think of agreement.
[01:17:02.539]Oh, oh.
[01:17:03.540]So some of you've had that introduction before.
[01:17:06.009](indistinct chatter)
[01:17:08.226]Yeah I mean, think of that.
[01:17:10.242]You could do the same program,
[01:17:11.550]you could do literally the same program.
[01:17:14.520]My God, that intro makes a difference.
[01:17:17.220]So I think if you're gonna spend the time
[01:17:21.210]that buy-in just matters.
[01:17:23.040]And I think that not only having those delivery systems
[01:17:27.270]but making sure those delivery systems realize
[01:17:29.760]why what they say and do matter.
[01:17:34.860]I just feel like that's key.
[01:17:36.690]I really do think that if a school's gonna require
[01:17:38.910]a program of incoming first year students,
[01:17:40.740]you also have to have 100%.
[01:17:42.990]If you're like, "Well we got 90%, that's pretty good,"
[01:17:45.360]literally 10% of your students went, "Ha ha,
[01:17:48.450]they don't enforce anything around here."
[01:17:50.010]When they do get written up,
[01:17:51.540]they're the loudest, most vocal people
[01:17:53.040]'cause they say, "Why are you picking on me?"
[01:17:56.610]Consistent enforcement of policy is a good thing.
[01:17:59.070]It impacts student health
[01:18:00.120]and I just think that anything like that
[01:18:03.720]that enhances your delivery system becomes important.
[01:18:07.410]Thank you.
[01:18:08.340]You're welcome.
[01:18:09.810]We've got one question, just a second.
[01:18:12.277]Sure.
[01:18:21.673]I'm just gonna ask you
[01:18:22.506]what your most fun, like most successful,
[01:18:25.140]like happy, fun program that you've run on your own campus
[01:18:28.800]specifically for cannabis prevention education?
[01:18:31.290]Like, a fun memory specifically about a cannabis program?
[01:18:35.100]Wow.
[01:18:39.206]Hmm.
[01:18:41.340]I think that the thing that I try and do,
[01:18:47.070]I don't even know that there's a program that we did
[01:18:49.050]that was necessarily fun,
[01:18:51.960]but I think, you know, I try and involve humor
[01:18:53.730]when I present,
[01:18:54.563]especially when I present with students.
[01:18:56.850]And I was delighted when I did a lit review at one point
[01:19:00.210]to find there's actually research that shows
[01:19:03.180]that infusing humor when done appropriately, sensitively,
[01:19:08.490]not at any one person's expense,
[01:19:10.410]it can lower defensiveness, it can lower resistance,
[01:19:13.380]it lowers anxiety.
[01:19:15.300]There's this great study that looks at
[01:19:21.469]a math test and having like an inspirational poem,
[01:19:28.470]a pep talk or a funny cartoon.
[01:19:32.670]That's the only thing you vary,
[01:19:33.840]and students do better when there's the funny cartoon.
[01:19:35.880]It's not that cartoons make people better at math.
[01:19:38.310]It's that laughing reduces anxiety
[01:19:40.140]and reducing anxiety improves test performance.
[01:19:43.530]So much of the research on cannabis is
[01:19:46.920]pretty scary right now.
[01:19:48.540]I mean what's very, very clear is that weed in 2023
[01:19:52.380]has nothing to do with even what my state legalized in 2012.
[01:19:56.880]This is a different animal and
[01:20:00.900]I almost feel like that if I just get that,
[01:20:04.033]I mean I try and keep in mind
[01:20:05.910]that if we give people facts and knowledge,
[01:20:07.590]they learn stuff but it doesn't change behavior.
[01:20:09.780]So it has to be delivered in a motivational framework.
[01:20:12.510]I almost feel like if there's an element of ha, ha, ha
[01:20:16.350]and then we fit in the heavy stuff, that makes a difference.
[01:20:20.760]I've heard too many things pitched to me
[01:20:23.340]that I've tried to veto,
[01:20:25.500]people that are like,
[01:20:26.347]"What if we had an event on 4/20 and had munchies?"
[01:20:28.860]And I'm like, "I don't know that I would do that."
[01:20:31.620]Is it sending a mixed message?
[01:20:33.000]Is it too wink wink?
[01:20:34.440]Will students misunderstand and actually show up high?
[01:20:38.730]That feels less helpful.
[01:20:40.860]So I actually think that the most fun programs
[01:20:43.740]have been those where the students have been like,
[01:20:45.787]"What is happening?
[01:20:47.370]Like, I came in as a big fan of cannabis use
[01:20:50.937]and I'm leaving going, 'Yikes.
[01:20:52.590]What, how do I make a change?'"
[01:20:54.900]To me, what's cool about that is that
[01:20:58.740]students do want, they're hungry for this information.
[01:21:02.520]We just have to find a way to get it out there
[01:21:04.380]in a motivational framework
[01:21:06.240]and I have found that trying to keep it lighthearted
[01:21:09.480]can make all the difference in the world.
[01:21:12.540]I will say my most funny memory
[01:21:16.770]came with talking about,
[01:21:18.390]there was one student who was very visibly
[01:21:20.910]not digging anything I was saying
[01:21:22.860]and very visibly thought I sucked.
[01:21:25.470]And his arms are crossed and he is like leaning back
[01:21:28.320]and he goes, "All right, drug expert."
[01:21:30.689](audience laughs)
[01:21:32.190]He's like, "What happens when you combine
[01:21:33.810]alcohol and marzipan?"
[01:21:37.720]And I said, "What?"
[01:21:39.816](audience laughs)
[01:21:40.649]And he said, "What happens when you combine
[01:21:41.482]alcohol and marzipan?"
[01:21:42.750]To which I again said, "What?"
[01:21:46.384]He goes, "I thought you were some big drug expert."
[01:21:47.610]I'm like, "Listen, I'm not using that term at all,
[01:21:49.800]but marzipan is the delicious almond paste
[01:21:52.050]that you shape into little fruits."
[01:21:54.840]And I'm racking my brain.
[01:21:55.890]I go, "Did you mean lorazepam?"
[01:22:00.900]And he goes, "Ah, shit,"
[01:22:04.440]and proceeded to talk about how he feared
[01:22:07.020]his street credibility may have taken a big hit
[01:22:10.470]as he tried to score marzipan at a party.
[01:22:13.650]And I was like, "This is my favorite moment professionally."
[01:22:18.960]Can you even imagine some dude walking around like,
[01:22:20.527]"You know where I can get some marzipan?
[01:22:21.960]I got the strawberries, but don't eat the stems.
[01:22:23.670]They're plastic."
[01:22:28.063](audience laughs)
[01:22:30.420]Anyone else have any questions or comments?
[01:22:33.540]I haven't thought about that in a long time.
[01:22:35.220]Now I want marzipan too, sounds kind of delicious.
[01:22:39.210]This is a boring one
[01:22:40.380]to follow that up with but when you talk about
[01:22:42.837]the parent booklets,
[01:22:44.850]is there any efficacy,
[01:22:46.470]and maybe I missed it and I'm sorry if I did,
[01:22:48.330]between emailing it versus sending a hard copy
[01:22:51.750]or somehow getting them a hard copy?
[01:22:53.610]I think the hard copy has been
[01:22:55.440]what the original Turrisi studies evaluated.
[01:22:58.740]They've moved to it being emailed
[01:23:00.330]especially because they can track what gets opened that way.
[01:23:04.350]I know that's a possibility.
[01:23:06.060]When schools have said,
[01:23:09.660]you know,
[01:23:12.037]"We don't have the budget for that
[01:23:13.680]but we still want to get something out there."
[01:23:15.480]Let me really, really fast.
[01:23:17.040]I might share my screen one more time.
[01:23:19.080]Gimme a sec.
[01:23:27.000]So I realized that I can hear her saying, you know,
[01:23:30.930]realize that this is well intended,
[01:23:33.360]but we've never evaluated it
[01:23:34.920]in a like randomized, controlled trial.
[01:23:37.200]But one of the really, really cool tools for parents
[01:23:41.220]is this, College Parents Matter.
[01:23:44.970]Amelia Arria, my friend and colleague
[01:23:46.650]at the University of Maryland
[01:23:48.000]is one of the big drivers behind this.
[01:23:49.980]I think this website is so cool.
[01:23:52.200]And one of the things that I think that's so cool
[01:23:53.850]about what they've done is if you go Topics,
[01:23:56.730]you can see that they cover 21st birthdays.
[01:23:59.790]They cover housing and roommate, sexual assaults,
[01:24:02.880]spring break, cannabis, off-campus.
[01:24:04.770]Would you believe they even include Halloween,
[01:24:06.390]and they cite research that shows
[01:24:09.180]people that wear a mask and have more anonymity
[01:24:12.540]act out and drink more heavily
[01:24:14.640]than people that it's like, "Oh look, that's Jason."
[01:24:17.550]So they even say asking your student,
[01:24:19.957]"What are you gonna be?"
[01:24:21.870]can help you know,
[01:24:23.160]is this person walking into a potential situation
[01:24:26.280]where they're more anonymous?
[01:24:27.420]But like I'll even show you, if you click on Cannabis,
[01:24:31.440]one of the things that they do
[01:24:33.510]is it's kind of like a choose your own adventure book.
[01:24:37.200]So it even lets you know,
[01:24:39.300]what do I do if I'm not sure if my kid's using?
[01:24:41.610]My kid uses, but I don't know how much or how often,
[01:24:43.920]or my kid uses regularly.
[01:24:45.780]I show you this just to say the following.
[01:24:49.110]I know that in the Maryland collaborative
[01:24:51.930]there were schools that used Turrisi's guide,
[01:24:54.570]the Parent Handbook,
[01:24:56.400]and they as a complement had the parents,
[01:24:59.700]College Parents Matter go out as well.
[01:25:02.040]So long-winded way of saying it can,
[01:25:05.700]the original research was when it was done in booklet form.
[01:25:08.550]There are evaluations that have looked at it web-based
[01:25:11.070]and you can even package it with that free resource
[01:25:15.780]and free is a great price and that's,
[01:25:17.250]it's really a great tool.
[01:25:20.212]And I'll just add on to that to say
[01:25:21.270]that we have done something similar in the state since 2012
[01:25:24.030]when we worked with Rob Turrisi to develop
[01:25:25.950]our Power of Parenting website.
[01:25:27.901]Fantastic. Which I think
[01:25:29.220]eight institutions in the consortium have
[01:25:31.830]their own personalized website for their campus,
[01:25:34.740]and several other institutions have also coupled that
[01:25:37.290]with Rob Turrisi's booklet.
[01:25:39.030]And again, like Jason said,
[01:25:40.620]some schools use that as a physical copy.
[01:25:42.960]When we're able to support that with grant funding,
[01:25:44.910]we have done that.
[01:25:46.170]And then we've also done some digital copies as well,
[01:25:49.680]and also dual language,
[01:25:51.030]so we have a Spanish version
[01:25:52.350]that we've recently utilized as well.
[01:25:54.900]And we're currently revamping the Power of Parenting website
[01:25:57.390]to update it and include a little bit more
[01:26:00.420]of our conversations around cannabis
[01:26:02.400]and some mental health issues as well.
[01:26:04.260]So,
[01:26:06.630]well Jason, we wanna thank you again so much for you time.
[01:26:09.305]Thank you.
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Keynote: Bringing Evidence-Based Strategies to Campus

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