National Institute on Alcohol Abuse and Alcoholism’s College Alcohol Intervention Matrix 4 of 5
Review of the National Institute on Alcohol Abuse and Alcoholism's College Alcohol Intervention Matrix (AIM) and practical application for professionals working in higher education to reduce high-risk drinking and associated harms.
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[00:00:01.120]So, I have the task of trying to introduce
[00:00:04.090]you to individually focused strategies
[00:00:06.560]over the course of the next time slot.
[00:00:08.420]And the truth is my overwhelming disclaimer
[00:00:10.440]is that I mean we can spend all day on some of these.
[00:00:12.810]And I'm obviously not gonna do that.
[00:00:14.360]So, with no disrespect to any that I spend less time on
[00:00:18.480]or perhaps even don't mention,
[00:00:19.960]It's recognizing again it's a mix of strategies.
[00:00:22.670]But, there are some underlining common threads
[00:00:24.560]of the mix of strategies.
[00:00:25.650]So, over the course of the afternoon
[00:00:27.490]I'll tell you about messaging
[00:00:28.890]in the individually focused interventions.
[00:00:30.850]We'll talk a bit about the role of norms.
[00:00:32.890]We'll talk about the role of expectancies,
[00:00:36.280]development of the Alcohol Skills Training Program
[00:00:38.390]and how that gave birth to BASICS,
[00:00:40.430]Brief Alcohol Screening and Intervention
[00:00:42.270]for College Students.
[00:00:43.420]We'll talk about personalized feedback interventions
[00:00:45.400]that don't even involve another human being
[00:00:47.680]sitting across from someone,
[00:00:49.150]as well as some other individually focused strategies.
[00:00:52.650]If time permits, largely fueled by
[00:00:55.540]some input I got at lunch,
[00:00:56.840]I have a couple of bonus slides just to show you some
[00:01:00.410]of the things we're dealing with
[00:01:01.610]in Washington as we consider
[00:01:03.287]alcohol still is the primary drug of choice.
[00:01:05.970]But, things that have happened post marijuana legalization.
[00:01:09.340]It's been a weird last couple of years,
[00:01:12.390]when I've had the honor of presenting
[00:01:13.960]at places across the country.
[00:01:15.570]'Cause when people find out I'm from Seattle
[00:01:17.850]for a full year, they knew us as the team
[00:01:19.740]that had won the Super Bowl.
[00:01:21.600]For a full 12 months after they knew us as
[00:01:23.930]the team that lost the Super Bowl. (audience laughs)
[00:01:26.470]That's what sadness looks like.
[00:01:28.505]And they also knew us as the state that legalized marijuana
[00:01:31.340]for recreational purposes.
[00:01:32.730]Marijuana is the one drug most associated,
[00:01:35.640]not with just exacerbating, but causing attention,
[00:01:39.170]concentration, and memory problems.
[00:01:41.330]And that leads to driving behind Seahawks fans
[00:01:43.810]who can't spell the word Seahawks. (audience laughs)
[00:01:51.280]What blows my mind about the Seahawaks there
[00:01:53.520]is that that's not in concrete,
[00:01:55.000]that's not a tattoo, they could have changed it.
[00:01:56.770]But, they're like, ah close enough,
[00:01:58.186]and went ahead and kept it up there.
[00:02:01.920]the highlight of the academic year so far
[00:02:05.300]for me truthfully, as the guy that always loved
[00:02:11.720]pro sports and pro athletes and stuff,
[00:02:13.620]I was asked to do, this is not just unique
[00:02:15.610]to college campuses that we're trying to figure
[00:02:17.070]this stuff out.
[00:02:18.040]I was asked to present to the treating clinicians
[00:02:21.210]for the National Football League in October.
[00:02:24.075]When they called and invited I thought it was a joke
[00:02:25.210]from one of my friends, and I'm like okay
[00:02:27.260]I'll get back to you.
[00:02:28.093]Then I Google the guy and I'm like, oh my God it's real.
[00:02:31.540]So, I called him back and I was like, I wanna show,
[00:02:33.140]I know what I think is funny to colleges,
[00:02:34.920]and I know it's funny to college students.
[00:02:37.289]And I was like, but I want something funny
[00:02:38.460]to these guys.
[00:02:39.293]I'm like what can I possibly do.
[00:02:40.560]So, I ended, I don't know why I'm showing you this,
[00:02:42.180]but I ended my presentation with them.
[00:02:44.370]And I said, "I just wanna thank you
[00:02:45.987]"for the honor and opportunity of presenting to you all.
[00:02:49.097]"Plus, it's a chance for me to give back to a league
[00:02:51.657]"that I was a part of for eight years. (audience laughs)
[00:02:54.047]"Which is not true," I said, "but on PlayStation
[00:02:58.767]"I'm not gonna lie I've had a hell of a run."
[00:03:02.611]Because on, (audience laughs)
[00:03:04.000]on Madden for the PlayStation 4
[00:03:06.454]you can create yourself.
[00:03:08.215]And I pointed out to them two really impressive things
[00:03:09.620]about this really great graphic program.
[00:03:12.314]One is my unbelievably impressive 153 and 0 record,
[00:03:15.080]as head coach of the Seattle Seahawks.
[00:03:16.890]And second is the unbelievably life-like sweater vest
[00:03:19.700]that is on it.
[00:03:23.112]It's so life like.
[00:03:26.617]Alright so, when we look at why the need
[00:03:29.150]for potential individually focused approaches,
[00:03:31.720]Keeping in mind that it has to be
[00:03:34.730]in that context of environmental too.
[00:03:37.480]I actually took this slide out.
[00:03:38.720]I stuck it back in after a lunch time conversation.
[00:03:41.680]I always feel bad showing this slide
[00:03:44.092]'cause I feel like I'm making fun of another college
[00:03:44.925]and that's not the intent.
[00:03:46.830]But, it's Duke.
[00:03:49.190]I was asked to be the opening speaker
[00:03:51.370]at a conference that Duke University was hosting
[00:03:53.300]on college-student drinking and drug use prevention.
[00:03:56.900]I was so geeked up, because if you looked
[00:03:58.660]at the lineup of speakers they were like my idols
[00:04:00.530]in the field.
[00:04:01.363]I'm like how do I even belong at this thing.
[00:04:03.805]And so, when we got the conference center
[00:04:05.120]to check in at the hotel,
[00:04:06.740]they're like, "What are you here for?"
[00:04:07.610]And I'm like, "The alcohol and drug thing."
[00:04:09.150]And they're like "That's a weird call."
[00:04:12.858]I'm like what, "No it's not."
[00:04:13.736]People seemed pissed that we were there
[00:04:15.100]and nobody could figure out why
[00:04:16.510]until we got to the Duke University conference center.
[00:04:19.610]Here's a tip, if you're making a sign advertising
[00:04:22.010]for an event, proof it.
[00:04:23.247]See if there's any missing words or anything like that,
[00:04:26.100]'cause it can fundamentally change
[00:04:27.250]what you're trying to advertise.
[00:04:28.400]Because blocked off in all the parking lots
[00:04:30.450]surrounding Duke University conference center
[00:04:32.530]was the following sign,
[00:04:34.110]Lot Reserved for College Student Drinking
[00:04:35.760]and Drug Use May 18&19, 2010.
[00:04:43.070]The sign maker of course left off
[00:04:44.520]the word conference or meeting
[00:04:45.690]or anything that would have made that look less creepy
[00:04:47.480]to people walking by.
[00:04:52.718]What I love about that is you gotta figure
[00:04:53.551]at least one guy walking his dog,
[00:04:54.710]was like, "Well, at least they're cutting
[00:04:56.637]"those kids off at five."
[00:04:57.470]That's, (audience laughs)
[00:05:01.053]I think they call that harm reduction.
[00:05:03.290]But, you were told, I mentioned the Monitoring
[00:05:06.560]the Future study.
[00:05:07.570]The most recent Monitoring the Future study
[00:05:09.510]showed the following.
[00:05:10.530]And I just wanna show that to you for a couple of things.
[00:05:13.275]One, three quarters of students report
[00:05:14.520]that they have consumed alcohol in the past year.
[00:05:16.560]To me there's two very important conclusions
[00:05:18.920]to draw from that.
[00:05:19.920]One, is that one in four students don't drink.
[00:05:22.840]Whether they're life long abstainers,
[00:05:24.300]students in recovery, students that have drank,
[00:05:26.410]but it's been more than 12 months.
[00:05:28.000]We have to keep these folks in mind
[00:05:29.220]with what we're doing as well.
[00:05:30.310]It's important for those students to feel supported
[00:05:32.190]in their decision to abstain and know they're not alone
[00:05:33.023]in the decision to abstain.
[00:05:35.659]But, the second thing we can conclude
[00:05:37.670]is obviously 75% of college students aren't over 21.
[00:05:42.040]So we do have some underage students drinking.
[00:05:44.320]If you look at that past month data
[00:05:46.670]63%, the numbers shrink reporting in drinking.
[00:05:50.846]Where actually under half report
[00:05:51.960]that they have been drunk.
[00:05:53.070]What does that mean?
[00:05:54.380]That means that most students in the last 30 days
[00:05:55.900]either don't drink at all,
[00:05:57.080]or if they do drink, they do so in a way
[00:05:58.810]that doesn't involve getting drunk.
[00:06:00.520]Obviously, if you work in conduct,
[00:06:02.507]if you work in law enforcement,
[00:06:03.340]you've seen the group that's doing things
[00:06:04.810]in a more extreme manner.
[00:06:06.160]But, it's keeping that range of students in mind
[00:06:08.910]when we think about it.
[00:06:10.660]When you ask people this question
[00:06:11.863]it's gonna result in a very different answer.
[00:06:15.390]You know your campuses best
[00:06:16.680]but as you think back over the course of the year,
[00:06:19.081]and I will repeat for people listening remotely.
[00:06:20.660]What holidays, what events, what times
[00:06:22.540]of yours stand out as being kind of bigger drinking days?
[00:06:25.630]What would you all say?
[00:06:27.813]St. Patrick's day?
[00:06:28.982]Fortunately it's very far away.
[00:06:34.257]Yeah, and so some people say there's a study
[00:06:36.060]by Dan Neal at the University of Texas
[00:06:37.780]had often called hook' em horns and it looks at UT Austin.
[00:06:40.016]And he actually found at home and away games
[00:06:43.820]actually were associated with elevated drinking.
[00:06:46.670]What else in terms of holidays or times of year?
[00:06:49.664]Finals, New Years.
[00:06:54.610]They go home and they--
[00:06:57.330]So, what's the not so good news?
[00:06:59.150]Obviously, a lot of unwanted consequences
[00:07:01.280]can go along on with those events.
[00:07:02.650]What's the better news?
[00:07:04.577]We know when all of those are.
[00:07:07.040]So the opportunity to do events specific prevention
[00:07:09.700]is very, very, much there.
[00:07:11.730]There's a study of Frandell Boke
[00:07:14.070]is the first research that did this.
[00:07:15.012]But, there's a study at Canada that initially
[00:07:16.560]it looks like a headache of a slide,
[00:07:18.330]but it's most easier to digest
[00:07:19.580]if you understand that the bold line at the top
[00:07:22.040]are weekly drinking totals.
[00:07:23.810]That kind of littler line at the bottom
[00:07:25.890]are actually daily totals.
[00:07:27.590]They had students keep diaries of their drinking
[00:07:29.720]their entire academic year.
[00:07:32.750]It was online, it wasn't like, dear diary
[00:07:34.650]I had a beer today.
[00:07:36.769]You know, xoxo. (audience laughs)
[00:07:37.871]Look at the variability.
[00:07:39.820]If you did a screening you'd say
[00:07:41.040]what's the most you've had to drink in the last two weeks.
[00:07:42.630]You might miss students
[00:07:43.630]that might otherwise be struggling.
[00:07:45.090]Or have an elevated risk for folks
[00:07:47.300]who genuinely aren't drinking that heavily.
[00:07:49.230]But, of note is that in this particular sample
[00:07:52.170]they even highlighted that it's
[00:07:53.210]the weekends surrounding holidays.
[00:07:55.330]Halloween happened to fall on a Tuesday.
[00:07:57.230]But, the weekend before, it's brutal.
[00:07:59.290]St. Patrick's day was the single biggest drinking day
[00:08:01.530]of the year, happened to fall on a Saturday.
[00:08:03.880]But, whether it's alcohol, whether it's marijuana,
[00:08:06.440]420, things like this,
[00:08:07.527]there's a chance for event specific prevention,
[00:08:10.360]but this also highlights the importance
[00:08:11.920]of keeping in mind events like this
[00:08:13.770]when you're planning assessments.
[00:08:16.350]When you ask students what they have experienced
[00:08:18.460]when drinking, the National College Health Assessment
[00:08:20.970]showed that among students that drank
[00:08:22.380]within the past year, doing something they later regretted,
[00:08:25.380]number one most endorsed effect.
[00:08:27.910]Blacking out, forgetting where they were, what they did
[00:08:29.740]at just under a third, one in five had unprotected sex.
[00:08:33.020]This is a check all that apply.
[00:08:34.810]So, realize that all these things can happen in one night.
[00:08:37.160]Someone says I hooked up with someone,
[00:08:39.440]don't totally remember if he used protection or not.
[00:08:42.600]Something's not sitting right.
[00:08:43.760]So, realizing, and of course brings it into
[00:08:47.233]the realm of conversation, the important work we do
[00:08:50.382]around issues of consent, I co-present and tag team
[00:08:53.640]with our sexual assault prevention program coordinator
[00:08:55.990]quite a bit for that reason.
[00:08:58.430]In fourth place physically injuring themselves.
[00:09:00.820]I put in here, and we'll talk about this in a bit,
[00:09:03.160]about the language we use
[00:09:04.280]in individually-focused interventions.
[00:09:06.310]We can look at this and go wow,
[00:09:07.520]those are negative consequences.
[00:09:09.410]But, how do the students see these?
[00:09:12.800]Kim Marrow used to work with us and now
[00:09:14.420]works at Penn State University.
[00:09:16.150]And she asked college students,
[00:09:17.353]this around to the nearest integer or so,
[00:09:20.220]so some of these will add up to like 101%.
[00:09:22.930]But, she asked students, here are some unwanted effects
[00:09:25.440]or just here are some effects.
[00:09:26.790]Rate if they're negative, neutral, or positive.
[00:09:29.440]Our foot in the door of college campus
[00:09:30.950]is that there's not a single student
[00:09:32.440]that says that getting a lower grade
[00:09:33.730]because they're drinking is a good thing.
[00:09:36.880]What's interesting is I've talked to people
[00:09:38.043]that say I don't wanna write up this person,
[00:09:39.910]I wanna document them, I don't wanna arrest them
[00:09:41.500]I'll ruin their life.
[00:09:42.970]3% of students say, "Getting documented saved my life.
[00:09:46.327]"I was the one that was like, nothing's bad
[00:09:48.167]"ever happened to me.
[00:09:49.317]"And it's a wake up call."
[00:09:50.400]If a student sees himself as I'm the good kid
[00:09:52.520]that hasn't got in trouble, and now they're across
[00:09:54.640]from a police officer that could be a wake up call.
[00:09:57.700]Look at even vomiting.
[00:09:59.230]You got one in a 11 students saying vomiting
[00:10:01.640]is a good thing.
[00:10:02.473]If you puked, that's, you must've had an epic night.
[00:10:06.080]Move down to this middle realm.
[00:10:08.030]Only half of the students agree
[00:10:09.350]that blacking out is a not good thing.
[00:10:11.820]You've got a good chunk that see it as neutral.
[00:10:13.820]12% see it as a good thing.
[00:10:16.411]The one that blows my mind,
[00:10:18.495]I mean you've got movies dedicated
[00:10:19.820]to the whole, let's piece our night together, hangover.
[00:10:23.186]A quarter of the students say a hangover is a good thing.
[00:10:25.260]I've seen people, their foot in the door that's been,
[00:10:27.990]think of all the, you'll feel better in the morning.
[00:10:30.240]Think how great it would be if you don't have hangovers.
[00:10:32.630]We're asking students one in four of them
[00:10:34.470]to part with something that they see is actually
[00:10:36.150]part of the epic experience.
[00:10:38.220]Not only did you probably have a crazy night,
[00:10:40.160]you now get to go out for breakfast
[00:10:41.500]and eat greasy food, and bond with your friends
[00:10:43.080]who also feel like crap.
[00:10:44.320]And so, I think that when even how
[00:10:46.320]we talk about negative consequences,
[00:10:48.813]it's important to keep in mind
[00:10:50.520]because it comes down to what does the student
[00:10:52.370]we're working with see as good and not good.
[00:10:56.360]Obviously, all of these conversations
[00:10:58.480]about alcohol are being done in the context
[00:11:00.100]of other substances.
[00:11:01.700]Any illicit drug use are reported
[00:11:03.060]by 38 and a half percent of students.
[00:11:04.930]If you just ask about weed 34.4%.
[00:11:08.440]Dump marijuana from the equation,
[00:11:10.120]any illicit drug other than marijuana,
[00:11:11.880]20.8% report past year use.
[00:11:14.100]Obviously, this plus this doesn't equal this.
[00:11:16.830]And that's because in that 38 and a half percent
[00:11:19.510]are people that use marijuana
[00:11:21.060]and something else, poly-substance usee.
[00:11:24.020]They have over 40 drug categories.
[00:11:25.520]In Monitoring the Future, I arbitrarily drew a line at 5%.
[00:11:29.680]These were the three categories endorsed
[00:11:31.670]by over 5% of the students.
[00:11:33.470]Amphetamines, this is largely prescription stimulants
[00:11:36.520]taken for non-medical reasons.
[00:11:38.170]This excludes people with legit prescriptions.
[00:11:40.560]Adderall drives most of that.
[00:11:43.220]And around finals I mean there's gross enormity
[00:11:45.370]of misconceptions about how frequent this is.
[00:11:47.570]And then, Ecstasy, MDMA, Molly at least once
[00:11:51.330]in the past year by 5%.
[00:11:54.027]I think it's worth pointing out
[00:11:56.183]that a lot of students could be slipping through the cracks.
[00:11:58.340]And this not just about substance use,
[00:12:00.040]but other health issues.
[00:12:02.240]Wu and colleagues documented
[00:12:05.280]as many other studies have,
[00:12:06.410]that one in five college students
[00:12:07.770]meet past year criteria
[00:12:09.250]for an alcohol use disorder.
[00:12:11.743]A stunning 3.9% of them, that's it,
[00:12:14.040]actually wind up getting connected to services
[00:12:15.910]of any kind.
[00:12:17.030]96%, did nothing.
[00:12:21.140]Only 36% used screened positive for depression,
[00:12:25.813]wind up getting help.
[00:12:27.120]And this breaks my heart.
[00:12:28.290]Bob Gallagher at the University of Pittsburgh
[00:12:29.730]runs the counseling center director surveyed,
[00:12:32.030]whenever there's suicide people will ask
[00:12:33.900]was the person getting counseling.
[00:12:35.180]And the overwhelming percentage of suicides
[00:12:37.460]on college campuses, the person never made it
[00:12:39.710]through the front door of counseling.
[00:12:41.140]Only 14% were current or past clients.
[00:12:43.890]So, this raises the idea of how might we actually reach
[00:12:46.260]some of the students who are high risk
[00:12:49.266]or struggling a great deal.
[00:12:50.430]And finally, just knowing that what we do about this
[00:12:52.940]will pay dividends in the classroom.
[00:12:55.100]The last time I saw Ralph Hingson present,
[00:12:57.420]and I thanked Ralph for this.
[00:13:00.590]He's done a great job highlighting some of the data
[00:13:03.040]about the cost and impact on mortality and morbidity.
[00:13:06.210]But, he's actually moved to even showing some of this.
[00:13:08.310]Some of these slides.
[00:13:09.330]And some of this data.
[00:13:10.620]And it was good inter-reliability for me
[00:13:12.450]to see that every site that I have on this slide
[00:13:15.325]he showed as well, and deemed as a decent
[00:13:18.710]and worthwhile study.
[00:13:20.210]Students the more that they drink
[00:13:21.530]the more they report being tired all the time
[00:13:23.027]and lower their GPA is.
[00:13:25.660]What's interesting about that is, of course,
[00:13:27.160]is alcohol affects quality of sleep.
[00:13:29.300]Heavy drinking is associated with lower GPA in general.
[00:13:32.370]Students at research universities who are heavy episodic
[00:13:35.370]or binge drinkers, are less likely to be engaged
[00:13:38.080]in interactions with faculty.
[00:13:40.550]AAC&U is among the many groups that show faculty engagement
[00:13:43.116]is an important predictor of thriving, flourishing,
[00:13:46.440]and even retention.
[00:13:48.120]And finally, not just doing binge drinking
[00:13:50.410]but doing it often is associated with lower grades.
[00:13:54.370]So, that highlights then the importance
[00:13:57.083]of what we look at when it comes to messaging.
[00:14:00.707]I spent most of the last couple of weeks
[00:14:04.520]presenting to different student groups.
[00:14:06.410]When a fraternities hears, hooray the alcohol guy
[00:14:08.980]is coming to our chapter, hooray.
[00:14:12.320]People tend to have a stereotype in mind
[00:14:14.270]about what someone like me is gonna say.
[00:14:16.110]What do students expect to hear?
[00:14:18.230]In terms of an alcohol prevention message.
[00:14:22.100]Don't drink, that's a good finger wag too.
[00:14:23.980]Don't drink, you're bad if you do, Just Say No.
[00:14:27.030]Does Just Say No work with college students?
[00:14:29.492][Audience Members] No.
[00:14:31.018]Not only no, but some laughter with that no.
[00:14:32.560]Why does Just Say No not work with college students?
[00:14:37.513]They might not be underage.
[00:14:38.480]So, what if they're over 21, you ask them
[00:14:39.850]to say no to something that's actually legal for them?
[00:14:42.300]Why else might Just Say No not work with college students?
[00:14:46.405]They're adults and they're experimenting.
[00:14:49.080]They're trying to figure out what works for them
[00:14:51.017]and what doesn't work,
[00:14:51.850]and here's somebody telling them, don't drink.
[00:14:54.550]Why else might Just Say No not work with college students?
[00:14:58.530]Yeah, there's that whole
[00:14:59.370]if you tell me not to do something,
[00:15:01.110]for those listening remotely, a rebellion factor,
[00:15:04.610]some people are like if you tell me not
[00:15:05.950]to do something I kinda wanna do it even more now.
[00:15:11.300]Yeah, look how good, they say you did it,
[00:15:12.930]why can't I you turned out great.
[00:15:14.297]So, and you're like, thank you.
[00:15:16.748]They're like why can't I do this too?
[00:15:20.730]You save researchers a lot of time and grant money
[00:15:23.327]because you look at the research and fact only,
[00:15:25.260]information only, typically abstinence only approaches
[00:15:28.740]you already saw Toben say, these are not effective.
[00:15:31.640]At best they show an increase in knowledge,
[00:15:33.830]but no change in behavior.
[00:15:35.980]And we're really worried about that change in behavior.
[00:15:38.760]We'll keep that in mind as we talk about that
[00:15:40.440]because anything we do has to fit in the overall puzzle.
[00:15:44.770]Toben showed you an adaptation of this
[00:15:46.740]and I'll show you a different adaptation.
[00:15:48.550]Along the top, this is from the Institute of Medicine,
[00:15:50.500]are the consequence associated
[00:15:51.850]with a person's use.
[00:15:53.040]Along the bottom are the strategies
[00:15:54.300]we might use in response to those.
[00:15:56.700]What often gets lost in the shuffle
[00:15:58.110]is that the majority of students at my school,
[00:16:00.150]at your schools are on the left.
[00:16:03.344]They either don't drink at all
[00:16:04.177]or if they do, have no to mild problems associated
[00:16:07.080]with their use.
[00:16:08.160]This is still an important group of people
[00:16:10.350]to keep in mind when it comes to prevention.
[00:16:13.110]Primary prevention or using more recent terminology,
[00:16:15.380]universal prevention, targets the whole campus,
[00:16:17.870]it casts a wide net.
[00:16:19.010]And the goal of universal prevention
[00:16:20.950]is to keep abstainers abstaining,
[00:16:22.650]so delay the initiation of use,
[00:16:24.500]or have whatever use is out there,
[00:16:26.210]keep that from progressing any further.
[00:16:28.920]You can absolutely see universal prevention
[00:16:31.310]on college campuses.
[00:16:32.270]But, classic universal prevention you see
[00:16:35.154]in like younger high school, middle school,
[00:16:38.100]even elementary school.
[00:16:39.760]I took these next slides out,
[00:16:41.729]but I saw the guy that I experienced this with
[00:16:43.430]just a little bit ago.
[00:16:44.263]So, I stuck' em back in.
[00:16:45.410]Clayton Neighbors who's a good friend of ours
[00:16:47.712]left the University of Washington a few years ago
[00:16:49.840]for the University of Houston.
[00:16:51.430]We were presenting at a school district
[00:16:53.930]north of Seattle and we put up this slide
[00:16:56.130]and one of the prevention specialists raised his hand.
[00:16:58.500]And he said, "I've been cursed by primary prevention."
[00:17:02.520]We were like, really, that's a weird thing
[00:17:04.960]to be cursed by.
[00:17:05.860]Frankly, like vampires I get that.
[00:17:07.770]But, why would you say primary prevention?
[00:17:09.930]He's like "I'll be right back."
[00:17:12.000]This guy brings me this box of proof.
[00:17:12.860]If I hadn't seen the box, I'm not sure
[00:17:14.110]I would've believed him.
[00:17:15.743]He was asked by the superintendent
[00:17:16.576]only get something cheap, effective,
[00:17:19.150]one more time, cheap, that will help,
[00:17:22.140]that we can get in every kid's hands
[00:17:23.880]from first through fifth grade
[00:17:25.410]with a drug prevention message on it.
[00:17:27.450]That's hard, I have no idea what I would suggest.
[00:17:29.950]But, he was like wait.
[00:17:31.130]Little kids are learning how to tell stories.
[00:17:32.790]And they're learning how to write cursive
[00:17:34.260]on those really big sheets of paper
[00:17:35.470]that are like half picture and three lines.
[00:17:38.675]So he was like, "What if I ordered pencils?"
[00:17:39.508]So, this guy worth thousands of pencils
[00:17:40.830]that said "Friends Don't Let Friends Do Drugs."
[00:17:43.370]And they were hit.
[00:17:44.800]The little kids got the pencils.
[00:17:45.980]The little kids used the pencils.
[00:17:48.114]And they liked the pencils.
[00:17:48.947]And they sharpened the pencils,
[00:17:49.780]first winding up with pencils
[00:17:53.376]that say let friends do drugs.
[00:17:54.293]And then finally, just do drugs.
[00:18:00.941]He said the first time he walked
[00:18:02.079]by an eight year old with a do drugs pencil
[00:18:03.050]he was like, "Shit we're gonna have
[00:18:05.457]"to get those pencils back."
[00:18:09.200]So, the poor guy ordered all these mechanical pencils
[00:18:13.460]and little kids are like can't use them,
[00:18:14.877]and they're shooting lead everywhere.
[00:18:16.440]So, he was right, he was cursed
[00:18:18.610]by primary prevention.
[00:18:20.240]On the far side are the people for whom, as Toben mentioned,
[00:18:23.290]more specialized treatment might be indicated.
[00:18:25.240]Who do I work with, what's most of what I'm going
[00:18:26.800]to be talking about, the folks in the middle.
[00:18:28.900]But, again mix of strategies,
[00:18:30.760]keep these multiple audiences in mind.
[00:18:33.180]Brief interventions are for those people
[00:18:34.540]that have made a choice to drink,
[00:18:36.060]may be experiencing mild to moderate consequences.
[00:18:38.780]I asked you about if Just Say No works
[00:18:41.150]with college students and you gave me
[00:18:42.290]perfectly great reasons why it probably does not.
[00:18:44.810]Reason why students will also chime in and say
[00:18:47.380]is that it has that very, I like the finger wag.
[00:18:50.180]It has that very parental or preachy kind of
[00:18:52.600]you know, bad, bad college student,
[00:18:56.024]and nobody wants to be on the delivery end of that.
[00:18:57.562]And I imagine certainly wants to be in the receiving
[00:18:58.870]end of that either.
[00:19:00.450]The other thing is we want that message
[00:19:02.842]that fits on a pencil.
[00:19:04.430]I get asked, I don't think I'm exaggerating
[00:19:06.200]when I say I get asked on a monthly basis minium.
[00:19:09.360]Is it true if you have a drink
[00:19:10.420]an hour you're fine?
[00:19:11.730]First, for a small woman that could be
[00:19:12.635]a very dangerous night.
[00:19:14.580]Secondly, what are you calling a drink?
[00:19:17.850]This next picture has not been photoshopped, it is real.
[00:19:21.000]I was speaking at a fraternity risk management training.
[00:19:24.870]And the guys said, "I just sent you a picture,
[00:19:26.554]"you have my permission to use it,
[00:19:27.647]"just don't say where you got it."
[00:19:28.770]And so I continue to honor that.
[00:19:31.000]But they had an alumni group that had a tailgating event
[00:19:33.700]that was getting crazy out of control.
[00:19:36.473]They were gonna shut the Alumni group down.
[00:19:38.590]But the alums came back with a counter proposal,
[00:19:40.530]and said, "What if we have a one drink maximum
[00:19:42.487]"at our tailgate?"
[00:19:43.630]And they were like, "Well that sounds fair."
[00:19:45.170]And he sent me this picture.
[00:19:49.720]That's ha ha, there's your one drink.
[00:19:53.219]That guy in the green coat in the middle
[00:19:54.052]is gonna have back problems when he's older
[00:19:55.050]because he's not lifting with his legs.
[00:19:56.320]Lift with your legs. (audience laughs)
[00:19:58.660]But, as stupid as this is you don't have to go any further.
[00:20:00.750]My state, a couple of years ago.
[00:20:02.540]We had over a dozen students in one of our state schools
[00:20:05.040]hospitalized for alcohol poisoning.
[00:20:07.010]The ones that had not lost consciousness
[00:20:08.790]said at the ER, "We've been roofied.
[00:20:11.589]"Please test us for rohypnol."
[00:20:13.265]They said, "Why do you think that?"
[00:20:14.198]And they said, "Because a lot of people only had one drink.
[00:20:16.127]"Nobody had more than two."
[00:20:18.340]It made national news when results came back,
[00:20:20.580]nothing but alcohol.
[00:20:22.339]And it later came out that the one or two drinks
[00:20:23.700]people were having were one or two cans of Four Loko.
[00:20:26.580]Four Loko is 12% alcohol by volume.
[00:20:28.880]What does that mean?
[00:20:29.713]Every 4.2 ounces counts as a standard drink.
[00:20:32.860]What's the catch?
[00:20:33.730]It comes in a 23 and half ounce can.
[00:20:36.901]That means one of those is five and a half standard drinks.
[00:20:39.280]The students that were only having two, got 11.
[00:20:43.320]For women 145 pounds and lighter, that's a lethal dose.
[00:20:46.341]And thank God, knock on wood, none of those students died.
[00:20:49.390]For a couple of them that was very close.
[00:20:52.310]So, sometimes we need a message
[00:20:54.250]that's a bit more complex than simply a blanket rate
[00:20:57.920]for everyone to appeal to.
[00:20:59.310]And finally there is the sense that college
[00:21:02.340]is where this happens.
[00:21:04.110]I mean I watch more television
[00:21:05.500]than anybody should ever admit to, frankly.
[00:21:09.100]Like when I leave the house for a trip like this,
[00:21:11.305]it's like bye to my partner
[00:21:12.138]and then DVR don't let me down.
[00:21:14.518]You've gotta remember to record everything.
[00:21:19.470]But, from season three of South Park
[00:21:21.910]you have to go way back, but in South Park
[00:21:23.373]there's an episode where Mr. Mackey tells the kids
[00:21:26.070]that drugs are bad.
[00:21:27.400]And Chef, voiced by the late Issac Hayes
[00:21:29.760]is debriefing with the kids if they know why drugs are bad.
[00:21:32.550]And Carmen says something a lot of people
[00:21:34.140]in Washington think is funny.
[00:21:35.600]Carmen says I know why drugs are bad
[00:21:37.636]because if you use drugs you're a hippy.
[00:21:39.430]And hippies suck.
[00:21:42.871]And there is some research that's looked at.
[00:21:46.097]But, what Chef ultimately settles on
[00:21:49.830]is he says, "Look children, this is all
[00:21:51.467]"I'm gonna say about drugs, stay away from them.
[00:21:53.537]"There's a time and a place for everything,
[00:21:54.947]"and it's called college."
[00:21:57.080]I remember the first time I heard that
[00:21:58.230]I was like, "No, don't say that."
[00:22:00.957]Because some people think South Park is a documentary
[00:22:02.540]and that's why we're all in here for six hours on a Friday.
[00:22:07.180]So, if we can't just tell people to Just Say No,
[00:22:09.040]what can we do?
[00:22:10.330]And this is where very controversially
[00:22:11.940]in the 1980s, Alan Marlatt said
[00:22:14.447]"What about harm reduction?"
[00:22:16.887]It's certainly a thing in Europe.
[00:22:17.860]But, what if we don't just tell people
[00:22:19.010]to Just Say No and conversely,
[00:22:20.480]we don't just tell them to just say yes.
[00:22:22.130]What if they do say yes?
[00:22:23.660]Can we talk about ways to do it
[00:22:25.490]in a less dangerous or less risky way?
[00:22:28.843]Why was this so controversial when Alan proposed this?
[00:22:30.650]Well, at the time there was not
[00:22:32.060]as single published study of a randomized control trial
[00:22:36.400]with college students that showed reductions
[00:22:37.960]in drinking and consequences in the US, not one.
[00:22:41.510]What did we have according to the Reagan National Library?
[00:22:44.670]12,000 Just Say No clubs.
[00:22:47.640]So, to suggest anything other than Just Say No,
[00:22:50.420]was actively in the face of and against
[00:22:53.410]what was happening very nationally.
[00:22:55.070]If there's a misunderstanding of harm reduction
[00:22:57.150]is that it is some how anti-abstinence.
[00:22:59.080]And nothing could be further from the truth.
[00:23:00.780]If a student says, "I want to avoid all
[00:23:03.747]"of alcohol's unwanted affects," stop drinking.
[00:23:07.365]The most risk free and harm free outcome
[00:23:09.260]after harm reduction approach
[00:23:11.230]in fact is abstinence.
[00:23:13.410]What a harm reduction approach acknowledges
[00:23:15.190]is that any steps toward reduced risk
[00:23:17.050]are steps in the right direction.
[00:23:19.090]I come to you drinking 40 drinks a week,
[00:23:20.860]and you sit down with me and do something
[00:23:22.750]and now I'm drinking 10 drinks a week
[00:23:24.100]with way fewer consequences.
[00:23:27.090]If your treatment outcome goal is abstinence though
[00:23:29.230]I'm a treatment failure.
[00:23:30.830]You can't pretend to call me anything but that.
[00:23:33.090]In a lot of programs in our country, I'm kicked out.
[00:23:36.470]Because I'm still drinking.
[00:23:38.194]But, it's like but how could you overlook
[00:23:39.027]a reduction that dramatically,
[00:23:40.670]particularly if this was with a population
[00:23:43.592]that maybe didn't even need treatment.
[00:23:45.130]Sometimes reducing harm makes look it like we did nothing,
[00:23:49.570]You're working with a student,
[00:23:52.440]not a huge person, pretty smallish,
[00:23:54.310]they tell you I drink six every Thursday,
[00:23:56.240]six every Friday.
[00:23:57.300]They admit those six are all shots
[00:23:59.680]over about three minutes, each on an empty stomach.
[00:24:02.580]They get to a pretty high blood alcohol level,
[00:24:04.500]lots of unwanted affects.
[00:24:06.020]Now, we go through a program that emphasizes harm reduction.
[00:24:09.290]They decide I'm gonna switch from hard alcohol
[00:24:11.530]to beer, I'm gonna alternate with water,
[00:24:13.810]I'm gonna eat prior to or while drinking.
[00:24:17.300]I'm gonna stretch out my drinking over five hours.
[00:24:19.930]Way lower blood alcohol level.
[00:24:21.520]Way fewer consequences.
[00:24:22.620]But, we look at their data pre, post.
[00:24:24.600]They were drinking six when they got to us,
[00:24:26.130]they're drinking six now.
[00:24:27.900]Awe, we didn't do anything.
[00:24:29.240]That's not true.
[00:24:30.820]If it's a reduction in harm, even keeping quantity
[00:24:34.130]the same, if people are using more protective behavioral
[00:24:36.190]strategies or achieving fewer consequences,
[00:24:38.650]or achieving a lower alcohol blood level
[00:24:40.424]still it's that idea of a step in the right direction.
[00:24:44.460]The question is how do you give a message like that
[00:24:46.807]and not seem like you're being flippant
[00:24:48.450]about policy or law, or sending a mixed message?
[00:24:51.720]Legal issues are always acknowledged.
[00:24:53.440]Everything we give students make clear
[00:24:56.297]if there's any we hand them,
[00:24:57.401]if they're under 21 it's illegal to drink.
[00:24:58.530]Driving after drinking, not recommended.
[00:25:01.670]If the main harm a student is trying to avoid
[00:25:05.897]are legal based things,
[00:25:06.730]some that have said, "I've gotten in trouble once
[00:25:07.567]"and I'm on probation," they may in fact choose to abstain.
[00:25:10.210]That may be the best way
[00:25:11.570]to avoid subsequent legal harm.
[00:25:13.500]For those who want to quit,
[00:25:15.120]strategies on how to abstain are provided.
[00:25:17.970]But, the language here is clear.
[00:25:20.010]This is very deliberate.
[00:25:22.427]We never tell students
[00:25:23.260]how to drink safely,
[00:25:24.420]because any positive blood alcohol level
[00:25:27.630]there could be unwanted consequences and risks.
[00:25:30.400]You don't make statement like "Listen,
[00:25:32.027]"I know you guys are all gonna drink
[00:25:34.445]"so if you do duh, duh, duh, duh, duh."
[00:25:36.367]There's a number of misconceptions,
[00:25:37.200]but now we as health educators have
[00:25:38.033]helped throughout the.
[00:25:39.410]For the abstainers in the room
[00:25:40.390]they're like, "Wow, that person thinks
[00:25:41.787]"we're all gonna drink.
[00:25:42.777]"Is that true, does everyone drink?"
[00:25:44.940]The language is important.
[00:25:45.870]If you make the choice to drink
[00:25:48.460]we can talk about ways to do that
[00:25:49.660]in a less dangerous or a less risky way.
[00:25:52.280]That wording is very deliberate,
[00:25:54.090]because it keeps the choice on them.
[00:25:55.920]It's not a mixed message.
[00:25:57.110]It's not a normative misperception
[00:25:59.210]of wink, wink, I know you're all gonna drink.
[00:26:01.420]Nor does it suggest that there is somehow
[00:26:02.910]a way that this can be safe.
[00:26:04.300]Here's the key, if I'm an 18 year old
[00:26:07.110]and some guy in a sweater vest, what up,
[00:26:10.100]is telling me here's how you can drink
[00:26:11.983]in a less dangerous or less risky way,
[00:26:14.080]why would I even want to do that?
[00:26:15.430]Like, what's in it for me, to do that?
[00:26:17.610]That's where a facilitator, a provider,
[00:26:19.900]a student affairs professional, a program provider,
[00:26:22.550]has to elicit personally relevant reasons for changing.
[00:26:26.800]What's in it for me, as that college freshmen?
[00:26:29.010]What's in it for me as that person a week away
[00:26:30.720]from my 21 run, to make a change in my drinking?
[00:26:34.170]And that's done using the Stages of Change model
[00:26:36.940]and the Motivational Interviewing.
[00:26:38.260]I wanna introduce you to those two things next
[00:26:40.050]and that then lays the foundation
[00:26:41.840]for examining the individual strategies
[00:26:44.177]that are housed within CollegeAIM.
[00:26:48.026]Before I talk about Stages of Change
[00:26:49.921]and Motivational Interviewing
[00:26:50.754]can I just see in general either what questions,
[00:26:52.810]what comments people have
[00:26:54.320]or anything I can clarify at this point?
[00:26:59.840]Alright, this is not new.
[00:27:02.170]This came out by Jim Prochaska and Carlo DiClemente
[00:27:06.070]in the early 80s.
[00:27:07.370]Actually, the publications were all throughout the 80s.
[00:27:09.872]In response to tobacco cessation,
[00:27:12.520]they pointed out that rarely do you meet
[00:27:14.200]the tobacco user who's unaware of the health consequences.
[00:27:18.210]We don't talk to students that are like wait, what,
[00:27:20.300]this is bad for me?
[00:27:21.730]No one told me.
[00:27:22.720]But there are different levels of readiness
[00:27:24.280]to have a healthcare provider say,
[00:27:27.728]"You need to quit smoking."
[00:27:28.561]And depending on which version of the publication
[00:27:29.830]you pick, there's your five, six or seven
[00:27:31.810]of these stages of change.
[00:27:33.742]It's either drawn as a ladder, a continuum like this,
[00:27:36.360]a wheel with different entry and exit points.
[00:27:38.840]But, just for the sake of discussion
[00:27:40.120]let's look at these five different stages of change.
[00:27:43.500]Just by show of hands how many people are
[00:27:44.580]already familiar with this model?
[00:27:47.230]Some of you, okay, a few people who are not.
[00:27:49.140]For those familiar with it
[00:27:50.820]I hope this is a generally brief review,
[00:27:52.740]but I hope this is still helpful
[00:27:55.086]in conceptualizing messaging.
[00:27:55.980]Pre-contemplation, that's a made up word.
[00:27:58.820]I think that's pretty cool.
[00:27:59.653]Like if you're gonna make up a theory,
[00:28:01.211]you might as well make up a word too.
[00:28:03.130]Because every time you type pre-contemplation
[00:28:04.630]into Word you get the little red squiggle.
[00:28:07.300]Bless you, and with pre-contemplation
[00:28:09.440]this tries to capture the student
[00:28:10.980]who is not just contemplating, they're pre-contemplating.
[00:28:13.890]They haven't even begun to think
[00:28:15.370]why do I need to make a change in my drinking.
[00:28:18.640]Someone has 15 drinks on campus break stuff
[00:28:21.100]and have to go through conduct.
[00:28:24.050]Lost in the shuffle, they had 15 drinks and broke stuff
[00:28:26.558]and instead they make statements
[00:28:27.391]like, "Don't the cops have anything better do
[00:28:28.777]"than pick on college students?
[00:28:30.180]Or, "This isn't my fault, this is my roommate's fault,
[00:28:32.397]"because my roommate answered the door when the RA knocked.
[00:28:35.177]"Why don't we just lower the drinking age?
[00:28:37.203]"Then there wouldn't be a problem."
[00:28:38.460]No recognition of a need to change.
[00:28:40.980]Contemplation is what it sounds like.
[00:28:44.408]Maybe a person is noticing stuff.
[00:28:45.977]"Wow, this is the third weekend in a row
[00:28:47.537]"where I don't remember part of my weekend.
[00:28:50.487]"That can't be good."
[00:28:52.610]What if they notice, "I had 100 bucks in my wallet
[00:28:54.307]"on Friday, only place I went was the bars all weekend.
[00:28:57.237]"It's now Sunday and I have zero dollars."
[00:29:00.940]Like five grand a year.
[00:29:02.862]Spending a lot on alcohol.
[00:29:03.920]So they may be noticing stuff.
[00:29:05.640]They may be weighing the pros and cons of change.
[00:29:08.870]The key to this stage of change is ambivalence.
[00:29:11.430]If you hear the word, but, the person's probably
[00:29:13.970]in a stage of change.
[00:29:16.250]I really wanted a fifth pizza in the buffet,
[00:29:19.290]but I know it's not very good for me, ambivalence.
[00:29:22.252]Yeah, I wish I could exercise more, but when,
[00:29:24.170]where would I fit it into my day?
[00:29:25.790]If I cut down on my drinking, sure I'd feel better
[00:29:29.210]in the morning and I'd probably do better at school,
[00:29:30.630]but what would I do for fun and I wouldn't be having
[00:29:32.440]as much fun as my friends are having and that would suck.
[00:29:35.720]I carpool with a woman that I'm convinced had the worst job
[00:29:37.934]known to humanity when she was in graduate school.
[00:29:40.990]She was a student of Bill Miller's,
[00:29:42.430]the man who, along with Steve Rollnick,
[00:29:43.890]developed Motivational Interviewing.
[00:29:45.611]At one point in grad school for 20 hours a week,
[00:29:48.229]she had to listen to therapy videos for a study
[00:29:50.720]and every time the client spoke,
[00:29:52.600]code which of these stages of change
[00:29:54.320]their statement was most in alignment with.
[00:29:56.290]That is a horribly dull job
[00:29:57.850]and that has no choice but to trickle
[00:29:59.370]into your daily life.
[00:30:02.106]So, we'll pull over to a drive-through coffee place
[00:30:06.514]on I-5 and they're like, "Hi, can I help you?"
[00:30:07.460]And Denise is like, "Ooh, that's contemplative."
[00:30:11.384]I'm like, "Wow, you really need to stop that,"
[00:30:12.287]and that's not contemplative.
[00:30:14.340]But there's times when we're stuck in traffic on I-5,
[00:30:16.330]which increasingly feels like all the time,
[00:30:18.440]where we will assign different stages of change
[00:30:21.440]to different songs we're listening to
[00:30:23.490]which is a little bit nerdy
[00:30:25.540]and also an unbelievably fun road-trip game
[00:30:27.840]if you get the chance to play that,
[00:30:29.290]but she pointed out one song, at least a portion of which
[00:30:32.240]sums up contemplation, probably better
[00:30:33.880]than anything out there and it comes from Michael Jackson's
[00:30:36.200]1982 Thriller album and it's the song
[00:30:38.360]Wanna Be Starting Something.
[00:30:39.630]In the song, Michael says, "Wanna be starting something,
[00:30:42.147]"Gotta be starting something.
[00:30:43.477]"You wanna be starting something,
[00:30:44.735]"you gotta be starting something.
[00:30:46.737]"Too high to get over, yeah, yeah
[00:30:48.897]"too low to get under, yeah, yeah,
[00:30:51.227]"You're stuck in the middle, yeah, yeah,
[00:30:53.153]"and the pain is thunder, yeah, yeah."
[00:30:59.070]Now this is the same song that later says
[00:31:00.960]you're a vegetable, you're a buffet,
[00:31:02.310]still they eat you, you're a vegetable.
[00:31:04.620]You shouldn't read too much into this song
[00:31:05.930]because that's crazy talk, as we call it in psychology,
[00:31:08.940]but too high to get over, too low to get under,
[00:31:11.214]you're stuck in the middle and the pain is thunder.
[00:31:14.060]This is not just a wishy-washy stage
[00:31:15.840]where people are like, eh.
[00:31:17.060]It can suck to be in this stage.
[00:31:19.530]I have a colleague who told me about a client she saw
[00:31:21.300]who with tears in his eyes said,
[00:31:22.637]"My partner of the last 10 years told me,
[00:31:24.247]"'Show up drunk again and we're done.'
[00:31:26.367]"I can not do this any more."
[00:31:28.330]The person said, "This is the love of my life,
[00:31:30.073]"and I got drunk last night.
[00:31:32.344]"I had to lie about my car breaking down
[00:31:34.117]"so I didn't have to face my partner."
[00:31:35.400]The person that gets bad results at the doctor
[00:31:37.570]who says, "You must change X health behavior,"
[00:31:40.550]then promptly goes out and engages in that health behavior.
[00:31:43.530]I've talked to students who with tears in their eyes say,
[00:31:45.247]"I'm the first person in my family to go to college.
[00:31:47.176]"Getting a degree, most important thing.
[00:31:49.952]"I've already gotten in trouble once.
[00:31:52.547]"If I get in trouble again, I'm out,
[00:31:53.827]"and I was at a party that got busted last night.
[00:31:56.037]"I had to go out a back window to avoid getting caught.
[00:31:57.917]"Why would I risk this?"
[00:31:59.450]So this isn't just a, eh,
[00:32:01.420]it can be hard for people to be in this stage of change.
[00:32:04.210]Preparation, a person's thought about it
[00:32:05.670]and says, "I'm gonna make a change."
[00:32:08.492]They haven't changed yet and if they are very bold,
[00:32:11.440]they're declaring their intent to people around them.
[00:32:13.510]The high season in our country for this stage of change
[00:32:15.242]is late December.
[00:32:17.250]Why would you imagine?
[00:32:18.900]Good, New Years resolutions.
[00:32:20.570]Think of the difference.
[00:32:21.403]A pre-contemplator's like, "I don't need to exercise,
[00:32:24.970]A contemplator might say, "I do want to exercise more,
[00:32:27.257]"but I'm really tired, I don't know where
[00:32:29.017]"I would fit it into my schedule."
[00:32:30.950]A person who's in preparation says,
[00:32:32.347]"I'm gonna start exercising January 1st."
[00:32:34.950]Action's what it sounds like,
[00:32:36.020]a person's actively making a change in a behavior.
[00:32:38.570]Maintenance is also what it sounds like.
[00:32:40.094]A person's made a change and they have now maintained that
[00:32:43.080]for six months or more.
[00:32:45.460]I asked you, 10, 15 minutes ago,
[00:32:48.050]does Just Say No work with college students?
[00:32:49.790]And you gave me perfectly great reasons
[00:32:51.270]why it probably does not,
[00:32:53.640]but I would encourage you to rethink the answer
[00:32:55.710]to that question through the eyes of this model.
[00:32:58.360]Truthfully, do with all of this as you wish,
[00:32:59.900]but I feel like if there's three things to take out
[00:33:02.830]of today, I actually think it's the messaging
[00:33:04.350]around this that's one of those.
[00:33:06.430]Just Say No is an action-stage request
[00:33:08.508]and if we're saying it to a group of students
[00:33:12.030]that are pre-contemplative or contemplative,
[00:33:13.733]there's an absolute disconnect between what we're asking for
[00:33:16.589]as the prevention specialist, the program provider,
[00:33:19.412]the peer health educator, and where that student
[00:33:22.330]or group of students may be in terms of their level
[00:33:24.450]of readiness to change.
[00:33:26.078]What that means is just say cut down,
[00:33:27.974]just say moderate, just say drink in a less dangerous
[00:33:30.744]or less risky way, based on this theory
[00:33:33.454]would be as equally dismissible
[00:33:35.700]and equally laughable a goal as Just Say No
[00:33:38.380]if it's asking for action in people
[00:33:40.330]who aren't there yet and would you believe,
[00:33:42.360]the data backed that up.
[00:33:44.360]Kim Fromee, University of Texas Austin,
[00:33:46.132]Will Corbin who worked with her and is now
[00:33:48.080]at Arizona State University, they did a study
[00:33:50.510]saying welcome to college 18-year-old first-year students.
[00:33:54.730]We're done with that high school stuff,
[00:33:56.100]you're in college now.
[00:33:56.933]Here's how to drink in a less dangerous or less risky way.
[00:33:59.446]It behaved just like an abstinence-only program.
[00:34:02.480]Knowledge increased, no change in behavior.
[00:34:05.500]What was missing, based on their argument?
[00:34:08.070]Something, they were diving right in with how to change
[00:34:11.110]with people who weren't even thinking about it yet.
[00:34:12.939]The question became, what could we do for those
[00:34:15.810]that are in pre-contemplation to perhaps plant seeds
[00:34:17.920]or prompt thinking about it?
[00:34:20.770]For those that are contemplating,
[00:34:22.330]or feeling stuck, what might help them get unstuck?
[00:34:25.620]How can we explore and resolve ambivalence.
[00:34:27.288]What might we do to have them either prepare
[00:34:30.520]to make a change or even make a commitment to change
[00:34:33.170]if that's in line with what's important to them, ultimately?
[00:34:36.870]So what that means is, think about how many
[00:34:38.610]action-stage messages our undergrads hear.
[00:34:41.256]Oh, you should go to the academic advisor.
[00:34:43.629]That's an action-stage request
[00:34:45.544]and if they're at the stage of, "I'm not sure
[00:34:48.020]"that I need help, I just don't think my professor likes me
[00:34:50.370]"or maybe I should be in a different major,"
[00:34:52.680]we're giving them advice, the people aren't there yet.
[00:34:56.980]Having problems with my roommate.
[00:34:57.813]"Oh, talk to your RA, you should talk to your RA.
[00:34:59.805]"Have you talked to your roommate?
[00:35:01.794]"You should talk to your roommate."
[00:35:02.805]What they should do, action stage, with people
[00:35:04.130]who aren't there yet
[00:35:05.430]and so what that means is, again, what can we do
[00:35:07.810]to maybe move people beyond this?
[00:35:10.290]I hope we have time for this, I know we started
[00:35:12.320]10 minutes late, and largely because I told you
[00:35:14.140]I like television shows, I'm gonna do it anyway
[00:35:16.474]because I really like game shows
[00:35:18.484]and this is a game show that has no chance
[00:35:20.670]of ever making it in the real world, but it's a game show
[00:35:23.720]called Name That Stage!
[00:35:25.540]So, the problem with the, (audience laughs)
[00:35:27.840]please contain your enthusiasm.
[00:35:30.750]The problem with this terminology is we don't identify
[00:35:33.135]using these terms, right?
[00:35:34.760]You can't walk into a group and go,
[00:35:35.817]"Where are my contemplators at?,"
[00:35:37.470]because people don't identify that way,
[00:35:39.140]so you need to hear it.
[00:35:40.290]I'm gonna show you statements a student could make.
[00:35:42.220]Let me know as a group what stage of change
[00:35:44.170]that best reflects.
[00:35:45.770]My drinking's a problem sometimes.
[00:35:47.510]What stage of change is that?
[00:35:49.787]Contemplation, well done.
[00:35:50.690]I don't think I drink too much.
[00:35:53.650]I quit drinking right after my sanction last week.
[00:35:56.962]I quit drinking right after my sanction last year.
[00:35:59.118]Maintenance, also good.
[00:36:00.349]I'm planning to limit myself to two drinks
[00:36:02.530]at the next party.
[00:36:04.440]Well done, awesome,
[00:36:05.640]so especially if you're working with a single individual,
[00:36:07.400]there's a chance to kind of read the room,
[00:36:10.110]get a sense of where are they coming from,
[00:36:12.455]but it's keeping that in mind.
[00:36:13.989]I mentioned that the good news is that there is a strategy
[00:36:17.600]for meeting people where they are
[00:36:19.941]and perhaps either prompting contemplation
[00:36:22.550]among pre-contemplators or even a movement toward action
[00:36:25.630]among those who are in contemplation
[00:36:27.310]and that comes from Bill Miller and Steve Rollnick,
[00:36:31.342]They're up to their third edition.
[00:36:32.848]I always joke that they're on an about every 10 years
[00:36:34.110]schedule of a new edition, so we're looking forward
[00:36:35.890]to the fourth edition in 2022,
[00:36:37.607]but Motivational Interviewing, it's changed what we do.
[00:36:41.160]It's absolutely changed what we do.
[00:36:42.870]Motivational Interviewing is a non-judgmental,
[00:36:45.160]non-confrontational clinical approach.
[00:36:47.206]It was designed for one-on-one work
[00:36:49.510]with individuals, but you'll hear me say
[00:36:51.173]this can be done in groups.
[00:36:52.730]When it's done in groups, we talk about MET,
[00:36:54.690]Motivational Enhancement Techniques
[00:36:56.930]and Motivational Enhancement Therapy,
[00:36:58.580]if it's done in a therapy context.
[00:37:00.710]It very much emphasizes meeting people where they are
[00:37:03.235]and it's all about eliciting personally relevant reasons
[00:37:08.023]What's in it for me?
[00:37:09.040]To maybe drink a little less tonight, tomorrow night.
[00:37:11.700]What's in it for me to try something different.
[00:37:13.894]When people are ambivalent, explores and resolves
[00:37:15.768]that ambivalence and if relevant,
[00:37:18.163]discusses behavior change strategies.
[00:37:21.050]It acknowledges that one of the biggest predictors we have
[00:37:23.360]of people not changing is resistance.
[00:37:26.217]We have very few absolutes in our field.
[00:37:28.720]One of them is this.
[00:37:30.090]As resistance goes up, outcome goes down.
[00:37:33.840]That's the bottom line.
[00:37:34.690]And what do we know about resistance?
[00:37:37.120]It's very much affected by how we talk to someone.
[00:37:40.890]It is expected, it is normal, it's verbal.
[00:37:43.690]I used to struggle with that because in grad school
[00:37:45.930]we learn about non-verbal communication,
[00:37:47.327]but you can read a transcript and you can say,
[00:37:49.877]"Oh, there's the resistance right there."
[00:37:53.060]Why is it expected and normal?
[00:37:54.490]Because it sucks being told we're doing something wrong.
[00:37:57.270]Sucks being told we don't get it.
[00:38:02.458]I, couple months ago, I had a dentist appointment.
[00:38:07.350]And if you're anything like me,
[00:38:08.740]I floss like crazy for the three days
[00:38:10.410]leading up to the appointment to maintain the illusion
[00:38:13.850]that I've been doing this every day for the last six months
[00:38:16.280]because I know the speech is coming.
[00:38:18.185]It's like, "You need to floss more."
[00:38:19.800]I'm like, "You need a hobby, seriously."
[00:38:22.738]Go on, floss with your little dental friends.
[00:38:25.890]Because it sucks being told,
[00:38:28.065]"Well we would have been out of here sooner
[00:38:29.492]"if you would have flossed better,"
[00:38:30.493]or "You're the bad patient."
[00:38:31.326]That's hard, but that's no different than when people say,
[00:38:33.386]"You need to cut down on your drinking,"
[00:38:36.410]or somehow make the appeal of
[00:38:38.164]"Well couldn't you just do this?"
[00:38:40.170]or "Couldn't you just do that?"
[00:38:41.930]When people are ambivalent, direct persuasion
[00:38:43.990]is not a horribly effective strategy.
[00:38:45.790]We know this.
[00:38:47.368]Take it out of alcohol.
[00:38:49.310]You're talking with a senior who's like,
[00:38:51.302]"I don't know if I should go straight to grad school
[00:38:52.977]"or take some time off, travel a bit, make some money,
[00:38:55.801]"and then go to grad school."
[00:38:58.860]If we say, "You're one of the smartest students
[00:39:01.037]"I've ever met, I'd go straight into grad school,"
[00:39:03.502]999 times out of a 1,000, what will they do?
[00:39:06.610]Defend the opposite.
[00:39:08.007]"Yeah, but if I took the time off, I could travel a bit,
[00:39:10.987]"recharge, and maybe even get into
[00:39:12.743]"an even better grad school and do better when I get there."
[00:39:15.740]Alright, well, do that then.
[00:39:18.517]"Yeah, but use it or lose it.
[00:39:19.497]"If I go straight into grad school,
[00:39:20.497]"I could keep the momentum going."
[00:39:22.000]So it's not the Jedi mind trick.
[00:39:23.600]It's not that we're telling them the opposite,
[00:39:24.930]but if they're genuinely stuck,
[00:39:27.303]trying to persuade them, this is not the key.
[00:39:28.370]If we go faster than them, it could result in resistance.
[00:39:31.660]Because it's so associated with not changing
[00:39:33.900]and so responsive to our style, we want to do what we can
[00:39:36.284]to reduce resistance.
[00:39:38.090]I want to make very, very clear,
[00:39:39.400]just between these two, the impact of non-judgmental,
[00:39:42.430]non-confrontational in the impact of resistance.
[00:39:44.625]The research on this and the research on avoiding arguing
[00:39:46.821]has gotten so clear that it's causing us
[00:39:49.375]to rethink some pretty classic concepts in our field.
[00:39:55.004]Even the concept of, in quotes, "denial."
[00:39:58.180]If someone sits me down and says,
[00:39:59.457]"Jase, I'm worried about you, man,
[00:40:01.777]"I think you have a problem,
[00:40:02.747]"I think you're an alcoholic,
[00:40:04.727]"you need help and we're here for you,
[00:40:06.617]"I think you need treatment."
[00:40:09.790]If I go, "Whoa, back off, you got a problem,
[00:40:11.627]"you need treatment," classically, we'd say
[00:40:15.300]I'm in denial, but the research on motivational interviewing
[00:40:17.030]would say, really, what's the person supposed to say?
[00:40:19.630]You labeled me.
[00:40:20.933]Diagnosed me, you got a problem.
[00:40:23.460]You told me what I need to do.
[00:40:24.630]You need to go to treatment.
[00:40:26.060]The current state of the science on denial
[00:40:27.980]is that it is not a characteristic of the individual,
[00:40:30.380]it's a byproduct of a conversation.
[00:40:32.510]I can make a student sound in denial in five seconds.
[00:40:34.690]I wouldn't want to, but I could.
[00:40:35.982]Let me talk with you about the problems
[00:40:37.950]you've been having with drinking.
[00:40:39.613]What problems have you had?
[00:40:41.430]I don't have a problem, I gotta meet with you.
[00:40:43.240]There we go, resistance,
[00:40:44.890]so I can't believe I'm still defining theory,
[00:40:47.220]but this will hopefully make the rest of this
[00:40:48.560]go very smoothly.
[00:40:50.100]So what are the goals of a brief intervention
[00:40:51.840]if there are signs of potential risks
[00:40:53.640]or existing harms, we could provide early intervention
[00:40:56.470]and perhaps alter a trajectory.
[00:40:57.717]If ultimately in line with what motivates the person,
[00:41:00.740]prompt contemplation of change.
[00:41:02.350]That's what's key.
[00:41:03.290]We can't decide for someone if they change or not.
[00:41:05.298]We talk about finding the proverbial hook.
[00:41:07.927]What if a hook for someone is I want to do well in school?
[00:41:11.010]Or athletic performance is key to me?
[00:41:13.778]A big thing that can prompt thinking about change
[00:41:16.380]is developing discrepancies between what's of importance
[00:41:18.900]to the student and ways in which the status quo
[00:41:21.200]could be in conflict with that.
[00:41:22.850]What's my value?
[00:41:23.730]I want to kick butt academically?
[00:41:25.170]What's the reality?
[00:41:26.402]I haven't been to class in the last three mornings
[00:41:27.980]because I was hung over.
[00:41:30.020]What's my value?
[00:41:30.853]I want to be a good partner in a relationship.
[00:41:32.430]What's the reality?
[00:41:33.874]I'm a jerk when I'm drunk.
[00:41:36.050]What's the value?
[00:41:37.180]I've been working my tail off in the training room.
[00:41:40.360]I want to have the best season possible.
[00:41:41.400]What's the reality?
[00:41:42.575]Drink 40 beers a week, that's 6,000 calories a week
[00:41:44.122]coming from alcohol, interfering with probably
[00:41:46.191]the time they're putting into training,
[00:41:49.126]so it's really about that idea of what's of importance
[00:41:52.810]to the student, what's in conflict with that.
[00:41:54.670]If ultimately in line with what motivates the person,
[00:41:57.370]prompt commitment to change or even initial action.
[00:42:00.386]If the only thing you do is reduce resistance
[00:42:02.580]or defensiveness, that's something.
[00:42:05.240]One of the studies on the Alcohol Skills Training Program
[00:42:07.460]that I'll show you in a bit looked at predictors
[00:42:09.660]of outcome among mandated students.
[00:42:11.900]One of the predictors of fairing well in that program
[00:42:14.647]was having a lower degree of defensiveness
[00:42:16.980]when they left the meeting with the conduct officer.
[00:42:19.890]The conduct officer does not need to be the one
[00:42:21.570]to deliver the intervention, but if they use
[00:42:24.110]more non-judgmental and non-confrontational,
[00:42:28.022]it sets the student up for success and the facilitator
[00:42:30.709]up for success.
[00:42:32.310]And explore behavior change strategies
[00:42:34.377]and discuss skills.
[00:42:36.950]One last thing about motivational interviewing
[00:42:38.470]and then I'll introduce you to,
[00:42:40.210]I'll take questions, introduce you
[00:42:41.990]to the individually-focused stuff.
[00:42:43.860]The four basic strategies of MI
[00:42:45.660]include open-ended questions, affirming,
[00:42:47.460]reflections, which are the biggest strategy,
[00:42:50.450]But I just want to show you again
[00:42:52.180]how important word choice is when talking to a group
[00:42:54.930]or even an individual student.
[00:42:56.436]Open-ended questions are ones that can't be answered
[00:42:58.840]with yes or no.
[00:42:59.760]When we're pressed for time, we ask a lot
[00:43:01.590]of closed-ended questions.
[00:43:02.980]Were you there?
[00:43:03.813]Were you drinking?
[00:43:04.646]Were you drunk?
[00:43:05.660]Were other people drinking?
[00:43:06.630]Were you scared?
[00:43:07.750]They're going, no, yes, no.
[00:43:09.190]And we're like, "Wow, that person was quiet."
[00:43:12.294]Well actually, we didn't give them a chance to talk.
[00:43:14.784]It was all closed-ended questions.
[00:43:17.254]We don't know where the answer will go.
[00:43:19.290]What do you make of this?
[00:43:20.160]Where do you want to go with this now?
[00:43:21.810]What ideas do you have about things that might work for you?
[00:43:23.740]How are you feeling about stuff?
[00:43:24.930]How is the school year going?
[00:43:26.390]The one open-ended question that ends with a period,
[00:43:28.270]tell me more about that.
[00:43:29.800]That is very different than the closed-ended,
[00:43:31.410]could you or can you tell me more about that?
[00:43:35.938]I'm having a tough time this quarter, this semester.
[00:43:38.480]Tell me more about that.
[00:43:39.313]Well, I've noticed that duh, duh, duh, duh.
[00:43:41.030]I've been having a tough time this semester.
[00:43:42.730]Could you tell me more about that?
[00:43:45.750]It performs differently and we have the data
[00:43:47.740]to show this.
[00:43:49.120]And so it's even keeping that in mind.
[00:43:50.776]I want to show you that you need no expertise at all
[00:43:53.315]on a substance to be able to ask a student questions
[00:43:56.290]about things that might prompt thinking about,
[00:43:59.160]in quotes, "consequences,"
[00:44:00.530]things that might prompt talking about what gains
[00:44:02.190]they would make if they made a change.
[00:44:03.830]And even identifying strategies for change.
[00:44:05.998]We can ask a student, what are the good things
[00:44:08.770]about fill in the blank, what are the good things
[00:44:10.250]about drinking for you?
[00:44:11.320]They will be delighted to tell you.
[00:44:15.528]I talked with someone at one college that says,
[00:44:16.527]"We tried that and it totally backfired."
[00:44:18.820]I said, "How did it backfire?"
[00:44:20.330]And they said, "Well, we walked up in front of the group,
[00:44:22.051]"and we said, 'So what's so good about drinking?'"
[00:44:23.423]I was like, wow, that's a way different question.
[00:44:27.270]What are the good things for you?
[00:44:28.800]What are the not so good things?
[00:44:29.923]That is a fundamentally different word choice
[00:44:32.360]than what are the negative consequences,
[00:44:34.050]what are the problems, what are the harms?
[00:44:36.500]I have the honor of running the Mandated Student Groups
[00:44:38.981]for students that have violated marijuana policy
[00:44:41.321]in a state that has legalized marijuana
[00:44:43.650]for recreational purposes.
[00:44:46.105]When I'm in front of a group of eight to 10 students,
[00:44:47.040]usually two of whom are wearing clothing
[00:44:48.610]with a pot leaf on it, and I ask them,
[00:44:51.087]"What are the not so good things
[00:44:52.317]"about marijuana use for you?,"
[00:44:53.900]how long a list am I getting from them?
[00:44:58.620]Getting lots of very pessimistic, none, very little.
[00:45:01.970]Purely for illustrative purposes,
[00:45:03.820]from two back to back groups, and I eliminated
[00:45:05.700]the duplicates, here's my list.
[00:45:09.040]Actually, the last group I ran I had a new staff member
[00:45:13.460]I said, "I'll give you the contents of my wallet
[00:45:15.237]"if the not so good list is shorter than the good,"
[00:45:18.626]and I got to keep my money, because I knew,
[00:45:19.730]every single time, these are students
[00:45:21.890]that are huge marijuana fans, but when you ask them,
[00:45:24.486]"What are the things you like?
[00:45:25.600]"What are the things you don't like as much?
[00:45:26.597]"What are the good things, what are the not so good things?"
[00:45:29.120]They will tell you.
[00:45:30.240]If you start with the not so good things,
[00:45:32.201]they'll tell you less.
[00:45:33.812]When you start with the good, you're saying,
[00:45:35.647]"I want to know why this matters to you,"
[00:45:37.840]and that's part of expressing empathy.
[00:45:39.660]What are the not so good things?
[00:45:41.195]They will tell you.
[00:45:42.800]What would it be like if some of those not so good things
[00:45:44.570]happened less often?
[00:45:46.260]Anything they say that's affirmative is,
[00:45:48.510]in motivational interviewing, what we call change talk.
[00:45:50.500]It's them saying if I were to change,
[00:45:52.270]these are the gains I could expect.
[00:45:54.210]You said you don't like blacking out.
[00:45:55.720]What would make that happen less often?
[00:45:57.370]Well, I never keep track, so if I keep,
[00:45:59.130]anything they come up with is a student-identified strategy
[00:46:01.509]for making a change in behavior.
[00:46:04.410]So I show you this not to try and derail this
[00:46:06.380]and turn it into a mini-motivational interviewing training,
[00:46:08.870]but so much of what works in the individually focused matrix
[00:46:11.920]involves understanding MI, readiness to change, and so on,
[00:46:16.280]so I hope I've laid the foundation for considering that.
[00:46:19.600]Sometimes, truthfully, even when you ask
[00:46:21.340]an open-ended question, it can still backfire.
[00:46:23.400]This is my single favorite text exchange of all time.
[00:46:26.340]Mom texts and says, "What does IDK, LY & TTYL mean?"
[00:46:31.340]So that's an open-ended question.
[00:46:32.810]So we tell mom, "I don't know, love you, talk to you later."
[00:46:36.250]And mom says, "OK, I will ask your sister."
[00:46:41.357]"Well mom, that's what those mean."
[00:46:43.850]Alright, so, before I talk about the individually-focused
[00:46:47.110]strategies, let me call time out for a sec,
[00:46:48.951]see what questions people have, comments,
[00:46:51.120]or anything I can clarify about the theoretical stuff
[00:46:53.560]I've discussed so far.
[00:46:57.640]I hope this is helpful and I fully realize
[00:46:59.280]in the post-lunch slot, I hope this is okay for folks,
[00:47:00.881]so I'll keep moving forward.
[00:47:05.780]Norms play pretty prominently in the individual matrix
[00:47:08.800]and the key to understanding norms is,
[00:47:10.530]again, this is not new.
[00:47:12.200]We've known since the '40s that we as people
[00:47:14.360]are influenced by a subjective sense of a situation
[00:47:17.206]than the actual situation.
[00:47:19.570]If you walk into a room and you go,
[00:47:21.247]"This is sketchy and I'm getting out of here,"
[00:47:22.670]you leave, even if it's not a sketchy situation.
[00:47:25.780]We're influenced by our perception of others' attitudes,
[00:47:28.064]behaviors, and expectation rather than
[00:47:30.780]their actual attitudes, behaviors, and expectations
[00:47:33.480]and unfortunately, our perceptions and interpretations
[00:47:35.741]aren't always so accurate.
[00:47:39.166]What do we know about norms clarification?
[00:47:41.000]Alan Berkewicz, Wes Perkins, Carinne Johanneson,
[00:47:44.300]Pat Fabiano, Jeff Linkenbock,
[00:47:46.260]these are all the people that really,
[00:47:48.340]late 80s, early 90s, helped us as a field move forward
[00:47:49.964]and they showed that there are three very predictable
[00:47:55.350]realms in which students misperceive norms.
[00:47:58.800]One is the acceptability of excessive behavior.
[00:48:01.970]We talk about attitudes like that,
[00:48:03.340]those are called injunctive norms.
[00:48:05.530]We know a little bit less what to do with injunctive norms
[00:48:08.750]in individually-focused programs,
[00:48:11.182]largely because injunctive norms can feel confrontational.
[00:48:14.416]You say you're okay with this, but your peers
[00:48:16.590]say they're not.
[00:48:17.870]That feels confrontational,
[00:48:19.470]but there may be more universal prevention opportunities
[00:48:22.115]and I have been reading a lot of literature lately
[00:48:24.890]that talks about the value of injunctive norms
[00:48:26.700]in things like bystander approaches
[00:48:28.684]for everything from drinking to sexual violence
[00:48:31.120]to you name it.
[00:48:32.302]What does this mean, acceptability of excessive behavior?
[00:48:34.600]If you ask a student, how do you feel about someone,
[00:48:36.697]on a school night, staying up until two in the morning
[00:48:39.380]in the residence hall playing their music loud
[00:48:40.810]because they're partying?
[00:48:42.207]I hate that.
[00:48:43.040]How do you think the typical fill in your school name here
[00:48:46.653]Well they're probably cool with it,
[00:48:48.003]because it's college, whatever.
[00:48:49.890]We pool all the data together, 99% of people hate it.
[00:48:53.990]The 1% of people who do it are like, "That's cool,"
[00:48:56.220]but the 99% of people who hate it
[00:48:57.920]mistakenly say and do nothing because they believe
[00:49:00.270]they're in the minority and they believe
[00:49:01.670]everyone's okay with it.
[00:49:03.350]And again, may then choose to not intervene,
[00:49:05.970]may choose to not check in on someone.
[00:49:08.240]Again, those are injunctive norms.
[00:49:09.860]Where the research has gone a lot further
[00:49:11.260]is descriptive norms.
[00:49:12.850]Students tend to way overestimate how many people drink
[00:49:15.860]and they tend to think that those who drink
[00:49:17.590]drink more than they really do.
[00:49:19.630]This is not unique to college students
[00:49:22.064]and this is not unique to alcohol.
[00:49:23.602]Take it away from alcohol for a minute.
[00:49:26.500]The best example of this I've ever heard
[00:49:28.150]came from Jeff Linkenbock.
[00:49:29.756]Imagine you're driving on the interstate for 30 minutes
[00:49:32.398]and there's no crazy traffic, there's no backup.
[00:49:34.825]In 30 minutes on the freeway,
[00:49:36.700]what are the cars that really stand out to you
[00:49:38.790]and really get your attention?
[00:49:40.070]What would you say?
[00:49:43.396]I hear some people whispering answers.
[00:49:47.320]Cars that really stand out to you and get your attention.
[00:49:52.136]Ones driving fast.
[00:49:53.144]Ones driving fast.
[00:49:54.142]Either answer works.
[00:49:54.975]How many police cars do we see in 30 minutes?
[00:49:56.720]Three, four, five?
[00:49:58.080]How many of the ones weaving in and out of traffic
[00:49:59.410]do we see, three, four five?
[00:50:00.860]What's the first thing we say when we get out of the car?
[00:50:02.477]"Man, cops were everywhere today!"
[00:50:05.230]Or, "God, no one knows how to drive around here,
[00:50:06.807]"everyone drives crazy!"
[00:50:08.440]For whatever reason, we don't notice
[00:50:09.700]the 1,000s of cars that weren't police officers.
[00:50:11.830]For whatever reason, we don't notice all the ones
[00:50:14.140]doing exactly what we're doing.
[00:50:15.620]We don't notice the ones going slower than us,
[00:50:16.990]because they're all behind us,
[00:50:18.040]except for the people in the left lane
[00:50:19.130]who need to get over.
[00:50:21.403]You know who you are.
[00:50:22.800]Just get over.
[00:50:24.530]But, the same thing happens with college student
[00:50:28.400]If you had 100 typical students at a party,
[00:50:30.130]based on the data I showed you earlier,
[00:50:31.760]40 of them are drinking water or soda,
[00:50:33.593]based on past 30 day data.
[00:50:35.950]Another are drinking one the whole night.
[00:50:38.030]Another 20-ish are drinking two the whole night.
[00:50:40.070]It's only three students drinking five, six,
[00:50:42.450]seven, eight, nine, or more.
[00:50:43.640]Well who does everyone talk about on Monday?
[00:50:45.267]Right, you don't hear people say,
[00:50:47.156]"I was at a party this weekend and there was one guy
[00:50:49.607]"drinking a beer and it's like, whoa, slow down buddy."
[00:50:52.389]You hear about the extreme.
[00:50:54.070]Shawn McCabe has done this research with Adderall.
[00:50:56.134]What do you hear about at finals?
[00:50:59.360]You don't hear people sit down at the dining hall
[00:51:01.430]finals week and be like, "I stayed up on the reading
[00:51:03.487]"all quarter long, and I went
[00:51:05.557]"to bed early last night, what?"
[00:51:06.390]You don't hear about that.
[00:51:07.223]You hear about the person that loudly boasts
[00:51:09.030]that they haven't slept for two days
[00:51:10.350]and wrote a paper in the last 48 hours.
[00:51:12.080]Everyone's like, "Oh man, everyone's taking Adderall."
[00:51:13.675]You saw the data, that's not true.
[00:51:17.440]Just shy of 10% that even do it once in the past year,
[00:51:19.569]so this provides an opportunity then for correcting norms
[00:51:24.200]through a range of different approaches.
[00:51:26.889]Certainly, and this was on the environment,
[00:51:29.566]it looks at social norms mass media campaigns.
[00:51:32.270]I'm not even gonna get into that,
[00:51:33.950]I only want to show and share something with you.
[00:51:36.270]I think that in this field we've always said
[00:51:38.060]a compliment is when things even get done
[00:51:40.580]in a parodying kind of way, as a parody.
[00:51:44.420]Christine Lee was at a farmers market
[00:51:46.330]in Victoria, British Columbia and took this picture
[00:51:48.810]and sent it to me.
[00:51:49.970]It was an ad about farming and it said, one in five
[00:51:53.790]teenagers will experiment with farming
[00:51:55.970]and they add stuff like digging is a gateway to gardening,
[00:51:58.759]a mom confronting her child,
[00:52:00.937]"I found heirloom seeds in your room...we need to talk."
[00:52:04.798]"Answer me honestly, how long have you been planting."
[00:52:06.632]"Your mother and I raised you to do more than this."
[00:52:09.077]"Stop labeling GMO foods at the supermarket!"
[00:52:11.524]Know the warning signs of farming.
[00:52:13.470]So, I saw thought, when she sent that I'm like,
[00:52:17.860]but there is obviously mass media opportunities.
[00:52:20.980]I'm gonna be talking to you about
[00:52:22.130]the individually-focused normative re-education.
[00:52:24.238]Expectancies are another part that plays prominently
[00:52:28.422]in a number of other interventions
[00:52:29.870]and even solely on the matrix.
[00:52:31.810]And if we ask students the very questions I'm gonna ask you,
[00:52:34.395]what are some of the ways alcohol affects you positively
[00:52:36.809]in social situations, whether you personally believe
[00:52:39.570]what you're about to tell me or not,
[00:52:40.910]what do students tell us?
[00:52:41.960]How does alcohol affect them in a good way socially?
[00:52:46.201]Helps them talk or be more social.
[00:52:48.045]Lowers inhibitions in general.
[00:52:50.369]Calms them down.
[00:52:51.202]Makes them funnier.
[00:52:52.380]Makes them funnier.
[00:52:54.390]Better dancer. (audience laughs)
[00:52:55.381]People say that and then they see the video
[00:52:58.510]and they're like, "Wow, not so much, actually."
[00:53:01.600]How do I delete that from the cloud?
[00:53:04.549]You get the general idea.
[00:53:06.260]People say more funny, more outgoing, more talkative,
[00:53:08.310]more social, more sexy, more flirty,
[00:53:10.240]get the better dancer thing.
[00:53:11.677]What are some of the ways alcohol might affect people
[00:53:13.284]in a not so good way in social situations?
[00:53:16.286]They slur when they talk.
[00:53:19.263]Slur their speech, go ahead in the back.
[00:53:20.787]Makes you mean sometimes.
[00:53:21.880]Get mean or aggressive, one of the top three things
[00:53:23.517]people tell us.
[00:53:25.351]Do stuff they wouldn't normally do,
[00:53:29.410]say stuff they wouldn't normally say.
[00:53:31.040]We then ask people, "Have you ever had alcohol
[00:53:32.607]"do different things for you at different times?"
[00:53:34.650]People will always say yes to this question.
[00:53:35.980]That should seem really weird, right?
[00:53:38.909]We never say that, usually we can say
[00:53:41.540]if you take this drug, this happens,
[00:53:42.750]if you take that drug, that happens.
[00:53:44.160]With alcohol, you do not see that same level
[00:53:47.600]You could have all in one weekend.
[00:53:48.640]Someone drinks on Friday, life of the party,
[00:53:50.740]more outgoing, social, funny, talkative,
[00:53:52.917]got the better dancer thing happening.
[00:53:54.870]The very next day, getting ready to go out,
[00:53:56.910]they grab their phone, they get a text,
[00:53:58.730]and the person they've been dating dumped them by text.
[00:54:02.520]We always tell students don't do that to people.
[00:54:04.480]Now, they go out and they drink the same stuff
[00:54:06.170]they drank the night before, they even drink
[00:54:07.810]the same number of drinks they had before,
[00:54:09.840]but instead of having all that great social stuff happen,
[00:54:11.449]now they're drinking and getting really down
[00:54:13.931]and giving really long, philosophical speeches
[00:54:16.270]about love to people, right?
[00:54:19.040]Trying to find friends to watch The Notebook with them,
[00:54:21.000]which if that happens, you should call for help.
[00:54:24.600]Or make them watch The Vow, because it's so good.
[00:54:28.412]But the question is, what's going on?
[00:54:29.510]It was Alan Marlatt that said, "I think it's expectancies."
[00:54:31.664]When someone says tequila, whoo, that makes me crazy.
[00:54:35.240]That's an expectancy.
[00:54:36.120]There's no crazy ingredient in tequila.
[00:54:38.310]He's credited with research on alcohol's placebo affect
[00:54:43.620]using the balanced placebo design.
[00:54:45.590]Truly in interest of time, I will describe this briefly,
[00:54:47.975]but you can bring students who are over 21 into the lab.
[00:54:52.530]They all drink, they're all over 21,
[00:54:54.191]they all sign consent forms that say,
[00:54:55.647]"If you give me alcohol, I give permission for that."
[00:54:58.510]You then tell them, "We're gonna have you drink
[00:54:59.877]"with classmates in a simulated tavern.
[00:55:02.317]"We're gonna serve you alcohol or we're gonna give you
[00:55:05.840]We then actually give them alcohol or give them no alcohol.
[00:55:10.823]If alcohol makes people more social,
[00:55:12.030]the entire group at the top should be social
[00:55:14.170]because they got it.
[00:55:15.180]If there's more to the belief they've been drinking,
[00:55:17.722]it'd be everybody on the left.
[00:55:19.400]Upper left hand corner, we say we're gonna,
[00:55:21.036]pardon me, any time you do research,
[00:55:22.900]you want to generalize to the outside world,
[00:55:24.780]so in Guthrie Hall, our psych department, Room 242,
[00:55:27.992]from the outside it looks like a regular class.
[00:55:30.140]On the inside, Alan built a bar.
[00:55:32.730]Everything in our field has to spell a cool acronym,
[00:55:35.080]it's one of our laws, and it's the BAR lab,
[00:55:37.750]the Behavioral Alcohol Research Laboratory.
[00:55:40.210]This is the BAR lab.
[00:55:42.580]Awesome looking setup, looks like a bar,
[00:55:44.680]very much a lab.
[00:55:45.620]The mirror, two-way mirror.
[00:55:47.342]The Dos Equis sign, camera.
[00:55:50.386]There are sprinklers on the ceiling for fire code reasons
[00:55:55.000]and the pointer doesn't work but if you look
[00:55:56.610]at the Oley beer sign, the neon sign,
[00:55:58.250]go up to the light over to like 10:00,
[00:56:00.420]there's a little dot on the ceiling,
[00:56:02.770]that's a microphone.
[00:56:04.509]We can tune in to different conversations
[00:56:05.588]around the room at different times.
[00:56:06.672]So it's an awesome way to study behavior
[00:56:07.822]in a non-intrusive way.
[00:56:08.920]Upper left-hand corner is told they're getting alcohol
[00:56:10.940]and they get it.
[00:56:12.111]They drink beer or vodka and tonic and we sit back
[00:56:13.510]and watch a group that looks like college students drinking.
[00:56:16.550]Nothing magical happens here.
[00:56:17.720]Clear them out, lower right-hand corner,
[00:56:20.030]tell them they're getting tonic water or near beer,
[00:56:22.235]actually give them that.
[00:56:23.552]It's a much quieter group.
[00:56:25.480]At best, it looked like students who don't know each other
[00:56:27.569]were asked to hang out and drink water together for an hour.
[00:56:32.030]Where do we see the really cool stuff happen?
[00:56:33.530]Lower left-hand corner.
[00:56:36.690]Again, I tell you this, I hope I'm not going too fast.
[00:56:38.590]I tell you this in the name of science,
[00:56:39.670]not to go mess with people.
[00:56:41.000]You can make the most convincing vodka and tonic
[00:56:43.291]in the world if you take tonic water,
[00:56:45.154]put a lot of lime in it and all you do
[00:56:46.779]is put vodka right around the rim of the glass.
[00:56:48.270]I made hundreds of these in grad school.
[00:56:49.900]I got pretty good at it.
[00:56:51.661]But think about it.
[00:56:52.667]Vodka's on the lower end of taste and smell anyway.
[00:56:53.900]When people bring the glass to their mouth,
[00:56:55.690]they smell the hard alcohol on the rim of the glass,
[00:56:57.770]but the clincher is that first sip.
[00:56:59.340]First thing touching their lips is the hard alcohol
[00:57:01.390]on the rim of the glass, so we have a lot of students
[00:57:04.244]on that Dos Equis home video who take one sip
[00:57:05.740]and they go, "Woo, that's a strong drink,
[00:57:07.427]"well done, scientist." (audience laughs)
[00:57:08.600]And they stir it up and don't even think twice about it.
[00:57:12.745]Sometimes people will drink the non-alcoholic beers
[00:57:14.979]and be like, "Man, not even close, doesn't taste like beer."
[00:57:17.930]Knowing that was the concern, Alan did an independent study,
[00:57:20.600]took four different types of near beer,
[00:57:22.140]made this El Primo near beer blend,
[00:57:22.973]did a little bit of dumping, made this concoction
[00:57:25.960]that, in taste tests, people couldn't tell the difference
[00:57:29.694]between this near beer blend and the real thing.
[00:57:31.427]We had students at the end of this say,
[00:57:32.747]"Man, you should bottle that and sell it."
[00:57:35.929]And we looked into that and that's actually really illegal.
[00:57:42.430]Again, everyone was over 21, they all signed consent forms,
[00:57:45.278]said, "If you give me alcohol I'm cool with this."
[00:57:47.497]We had them blow breathalyzers to make sure
[00:57:49.180]they hadn't pre-partied or pre-gamed for the experiment.
[00:57:51.550]They come in, what do we see?
[00:57:54.860]Coders can not tell the difference between the two groups
[00:57:57.180]on the left.
[00:57:58.013]By the 20 minute mark, that lower left-hand group,
[00:57:59.740]the volume of the group has increased,
[00:58:01.210]people are interacting a lot more.
[00:58:02.460]They do not look different than this other side.
[00:58:04.820]By the 40 minute mark, that's when you start seeing
[00:58:06.780]the ridiculously awesome stuff happen.
[00:58:08.770]The original experimenters did not predict
[00:58:10.370]people were going to report feeling physical effects,
[00:58:12.100]but it never fails, some people report physical effects.
[00:58:14.880]Some students talk about what a great buzz
[00:58:16.190]they think they have.
[00:58:17.300]Some students are really conscientious,
[00:58:18.550]which is a good thing, I don't mean to make light of that,
[00:58:20.027]but you'll hear students who say,
[00:58:22.495]"Man I'm really glad this experiment's on campus,
[00:58:25.284]"because I know me, shouldn't be driving right now."
[00:58:27.167]We're always like, "Okay, you should get that checked out."
[00:58:36.528]In the social realm, it's incredible, though,
[00:58:38.035]someone usually serves as kind of the standup comedian
[00:58:39.090]of the group, someone usually surfaces as the loud,
[00:58:41.100]annoying person of the group.
[00:58:42.480]What would you guess is the top interpersonal behavior
[00:58:44.800]we see more than anything else?
[00:58:48.530]Hooking up, flirting, and really shmoozy stuff too.
[00:58:51.120]We see people walking up to people going,
[00:58:52.747]"So, uh, what are you doing after the experiment?"
[00:58:55.500]and hitting on people.
[00:58:56.410]We're behind the mirror going,
[00:58:57.243]"Wow, good line there brother."
[00:58:59.540]Going home alone, friend.
[00:59:02.990]We've at times, I mean people are pushing tables together
[00:59:04.940]and playing drinking games.
[00:59:06.280]End of the hour, lights go on bright,
[00:59:07.610]stereo goes off, we say,
[00:59:08.527]"Surprise, you didn't get any alcohol."
[00:59:12.440]All the years these studies have been done,
[00:59:13.730]no one's ever been pissed off at that announcement.
[00:59:15.670]Depending on what you said or did during that hour,
[00:59:17.720]you definitely differ in your reaction to that announcement.
[00:59:19.435]I've seen groups of women who, never in a scary way,
[00:59:21.993]women who will scream.
[00:59:23.900]Guys are the funniest for me to watch,
[00:59:25.770]because it never fails, there's the one guy
[00:59:27.350]that kind of looks around and goes,
[00:59:28.675]"Yeah, I knew there was no alcohol."
[00:59:33.600]But what's crazy is the belief they were drinking
[00:59:35.460]led to all that social stuff happening.
[00:59:37.170]Upper right-hand corner,
[00:59:38.350]oh go ahead, there's a hand up here.
[00:59:41.397]Quick two quick questions.
[00:59:42.402]How many drinks did they get
[00:59:43.796]and how many were there?
[00:59:47.070]I can't stress to you enough
[00:59:47.960]that this is exactly one of the most well-researched things.
[00:59:50.240]The question for people listening remotely
[00:59:51.690]is how many drinks did they get.
[00:59:53.110]That's been varied.
[00:59:54.090]We've done some where it's like,
[00:59:55.200]drink as you normally would.
[00:59:56.340]We've done some where we put a cap on it.
[01:00:00.942]The best study was people said,
[01:00:03.957]"What if it's just contagious?
[01:00:05.097]"What if it's about being around people?"
[01:00:06.930]So at the University of Wisconsin they said,
[01:00:08.800]okay, we're gonna do this with one person.
[01:00:12.930]Person's alone, like, hey.
[01:00:16.159]And it even extends that way.
[01:00:18.740]You see it's more important what a person believes
[01:00:20.984]than what they got.
[01:00:22.270]Truly in the interest of time,
[01:00:23.630]upper right hand corner, they're told they're getting
[01:00:25.760]no alcohol but they actually get it.
[01:00:28.063]They're all over 21, they all do drink,
[01:00:29.700]they sign consent forms that said that's okay
[01:00:31.660]if you give me alcohol.
[01:00:33.990]This usually do control for,
[01:00:35.849]because what if someone's like, "Yes, tonic water!"
[01:00:37.190]and starts pounding, we have to be careful with that.
[01:00:39.128]We've either given them up to .06,
[01:00:42.440]based on their birth, sex, and weight.
[01:00:44.640]That Wisconsin study got them to .1.
[01:00:46.930]What happens here?
[01:00:47.930]They don't act any different.
[01:00:49.900]But the physical effects kick in.
[01:00:51.840]They make different attributions.
[01:00:52.967]"I'm tired, I've had a long day."
[01:00:54.290]Well it's a depressant.
[01:00:56.440]Flushing, "It's hot in here."
[01:00:57.995]Get a little clumsy, they're like, "Sorry I'm clumsy."
[01:01:00.264]The science shows that alcohol does a lot of stuff,
[01:01:02.986]but the social things we get from drinking
[01:01:04.880]are way more due to what's up here
[01:01:06.597]and the setting we're in than what's coming from
[01:01:08.410]the big red cup, the can, the bottle,
[01:01:10.170]the shot glass and so on.
[01:01:11.770]Research by Jack Derkiss and Mark Goldman
[01:01:13.410]showed that the mere act of going through this
[01:01:15.780]leads to people cutting down their drinking.
[01:01:17.830]We do not send this out to try and take the fun
[01:01:19.730]out of drinking for students,
[01:01:21.050]but instead if someone says,
[01:01:22.327]"I drink drinks one, two, and three because I like the taste
[01:01:24.067]"and I like the buzz," there you go.
[01:01:26.280]If they say, "I drink drinks four through 10,
[01:01:27.977]"because it makes me more funny, talkative, and outgoing,"
[01:01:30.990]we have no evidence that's coming from the alcohol
[01:01:32.847]and by drinking four through 10,
[01:01:34.440]it's costing more, they feel like crap the next day.
[01:01:36.423]If this lessens a barrier to making a change,
[01:01:39.300]we've done something good.
[01:01:40.860]The research in the matrix shows that if all you do
[01:01:42.710]is lecture about this, that's not effective.
[01:01:44.880]If it's folded in to motivational interviewing-based
[01:01:47.400]brief interventions, it's an effective component
[01:01:49.290]of both the Alcohol Skills Training Program
[01:01:52.520]The live expectancy challenge in and of itself
[01:01:54.930]is associated with reductions in drinking,
[01:01:56.830]so by telling you this I've actually conquered
[01:01:58.720]three parts of the individual matrix,
[01:02:00.570]just because this was reflected in those other domains.
[01:02:03.360]I did that in a third of the time I would normally do,
[01:02:06.386]but again, it's like what do I cut here.
[01:02:08.940]So before I move on, can I see what questions people have
[01:02:10.928]or comments about expectancies?
[01:02:16.310]Alright, the Alcohol Skills Training Program.
[01:02:19.984]This was developed in the late 80s.
[01:02:21.450]I mention Alan Marlatt quite a bit.
[01:02:23.040]I do what I do today because of Alan.
[01:02:26.040]Alan was my advisor in grad school.
[01:02:27.690]I started working in his lab, you heard me say,
[01:02:29.650]for then grad student Ray Larimar in '89.
[01:02:31.982]Alan passed away five years ago last week, actually,
[01:02:37.160]and he continues to influence this field dramatically.
[01:02:40.480]And on top of a obviously big personal loss
[01:02:43.060]to those that worked with him,
[01:02:44.559]it was a big loss in the field, but Alan developed
[01:02:47.497]the Alcohol Skills Training Program and compared it
[01:02:50.180]in a randomized controlled trial to a control group
[01:02:53.140]in the state's alcohol information school,
[01:02:55.150]which was abstinence only, very physiologically focused.
[01:02:58.230]The abstinence information school focused on cirrhosis,
[01:03:00.705]death, Korsakoff syndrome, all legitimate concerns
[01:03:03.612]of drinking but things that are like, potentially,
[01:03:05.568]to a college student, 48 years into the futuree.
[01:03:09.482]Alan said, "What about 48 hours into the future?
[01:03:12.987]"What are the things that are the most salient the
[01:03:15.757]"and relevant to a student?
[01:03:16.990]"How do we meet them where they're at
[01:03:18.197]"and elicit what's important the them?"
[01:03:20.380]And NASTP really wanted to focus on if you make the choice
[01:03:23.876]to drink, ways to do it in a less dangerous,
[01:03:26.530]less risky way.
[01:03:27.620]He did this using research that had come out of Europe
[01:03:30.700]on alcohol's biphasic effect.
[01:03:32.470]We asked students, "If you're at a party, get a buzz,
[01:03:34.707]"start to lose that buzz, what do you usually do?"
[01:03:37.120]And a room full of students will tell you, drink more.
[01:03:40.380]The million dollar question is do you ever get
[01:03:42.160]that same buzz back?
[01:03:43.280]And students will tell you no.
[01:03:45.870]I have never heard yes and I've been doing presentations
[01:03:49.695]on this stuff since 1991.
[01:03:51.830]One day I will.
[01:03:52.760]That's an impressive streak.
[01:03:54.850]I've never heard a yes.
[01:03:55.683]What do they say and feel instead?
[01:03:57.230]The drunk feeling, sick, tired, sleepy.
[01:03:59.870]Scientifically, we totally know why.
[01:04:02.170]We can ask people with tolerance,
[01:04:03.187]"Is the buzz you get now as good as the buzz
[01:04:04.757]"you used to get when you first started drinking?"
[01:04:06.770]People never say yes to this.
[01:04:08.123]Here is why.
[01:04:08.956]Even though alcohol is a depressant,
[01:04:10.300]it's a funky depressant, because the initial effects
[01:04:11.904]have a buzz.
[01:04:13.710]If a person takes a sip of alcohol,
[01:04:15.376]the body's initial experience of alcohol
[01:04:17.363]is the stimulant effect.
[01:04:19.190]Depressant effects kick in,
[01:04:20.770]depressant effects get done doing what they're doing,
[01:04:22.920]body goes back to the baseline.
[01:04:24.390]If you tap out after one sip and you're like,
[01:04:26.337]"That's it, I'm out," you'll still experience
[01:04:28.500]a curve like this, but as we drink,
[01:04:30.710]while our blood alcohol level is going up,
[01:04:32.550]this is actually at a constant for a while
[01:04:34.780]until we hit and exceed a certain blood alcohol level.
[01:04:37.920]Once we hit and exceed that level,
[01:04:39.520]the effects of alcohol change irreversibly
[01:04:41.730]for the remainder of that drinking occasion.
[01:04:43.570]So now, the positives get less positive,
[01:04:45.940]the depressant effects get more pronounced.
[01:04:47.830]This is why the more we drink, the more we don't
[01:04:49.418]get our buzz back, and the more we feel, in quotes,
[01:04:52.530]the "drunk part."
[01:04:53.580]What's the cool news as a field?
[01:04:54.883]Well, certainly, there's a very clear point
[01:04:57.105]where the positive effects have been maximized,
[01:04:59.248]the depressant effects have been minimized
[01:05:01.344]and a very clear point when you clear it,
[01:05:03.322]positives get less positive, depressant effects
[01:05:05.840]get more pronounced.
[01:05:06.673]What's the even better news as a field?
[01:05:09.250]We've tracked this shift down to between
[01:05:11.354]a hundredth of a decimal.
[01:05:12.360]We know that shift occurs at a blood alcohol level
[01:05:14.638]of between .05 and .06%, so if a student says,
[01:05:17.058]"I do want to drink, but I want to drink
[01:05:19.577]"in a less dangerous, less risky way,
[01:05:21.477]"I want to avoid hangovers, I want to avoid blacking out,"
[01:05:23.555]setting a limit that goes up to but doesn't exceed
[01:05:26.510]this point can allow that shift beyond 06
[01:05:29.593]to be avoided.
[01:05:30.978]Why do people with tolerance not get as good a buzz
[01:05:33.057]as when they first started drinking?
[01:05:35.080]Because for people with tolerance,
[01:05:36.520]this shift has actually already occurred.
[01:05:38.100]Far from handling alcohol better,
[01:05:39.504]the blow to the system's actually more pronounced
[01:05:42.089]and you don't get as good a buzz.
[01:05:44.375]Tolerance, when you ask students about tolerance,
[01:05:46.534]on the one hand there's the status,
[01:05:48.547]I can hold my liquor thing.
[01:05:50.650]But students will tell you it's expensive to have tolerance
[01:05:53.390]and they're not trying to be funny.
[01:05:55.020]And they'll say they actually don't feel it as good,
[01:05:57.062]so the good news about tolerance,
[01:05:59.090]it's like weight, you can gain it, you can lose it,
[01:06:01.000]they can lose it by calling time out for a while.
[01:06:02.683]Science shows as short as two weeks, but typically a month,
[01:06:05.692]and then if they lose their tolerance,
[01:06:07.623]that will shift back up and they can reunite themselves
[01:06:10.169]with that buzz.
[01:06:11.820]We go over strategies, and these are just some examples
[01:06:14.614]of protective behavioral strategies
[01:06:16.143]that we would elicit from the student.
[01:06:18.180]If you make the choice to drink, what are ways
[01:06:19.608]to reduce the risks associated with that?
[01:06:21.820]When it comes to setting limits,
[01:06:23.474]part of it is making sure they're on the same page
[01:06:26.180]about what counts as one drink
[01:06:27.810]and we make sure they're very clear on that,
[01:06:29.616]but it also is based on their sex and weight.
[01:06:31.992]What would a limit be?
[01:06:35.980]Again, the pointer doesn't work,
[01:06:37.030]so I can't show you, but I can walk you through it.
[01:06:38.906]Imagine we've got a woman that says,
[01:06:40.477]"I always drink six drinks over three hours."
[01:06:42.410]Go down six, she'd be at a .102 blood alcohol level.
[01:06:45.367]And she says, "I want to set a new limit.
[01:06:47.306]"I'm gonna be out for three hours."
[01:06:49.330]Go to the three hour column and go down
[01:06:51.440]until you find a point that doesn't exceed .06.
[01:06:53.176]You see .052, you go to the left,
[01:06:56.030]you look at what that translates to.
[01:06:57.305]All she does is shave off two drinks,
[01:06:59.377]but she cuts her blood alcohol level in half.
[01:07:01.171]If she says, "Four, I wouldn't even feel that,"
[01:07:03.670]probably means she's developed tolerance.
[01:07:05.661]If she goes, "Four, I was thinking
[01:07:07.677]"of cutting down to three," well stick with the three.
[01:07:10.335]But if she says, "Four, that's a limit
[01:07:12.857]"that would work for me,"
[01:07:13.857]you can again explore these different strategies
[01:07:16.266]and it's all about eliciting from the student
[01:07:18.388]what makes some sense.
[01:07:20.500]What did the Alcohol Skills Training Program show?
[01:07:22.435]In going over things like expectancies, standard drink,
[01:07:25.802]norms, how alcohol gets in and out of the body,
[01:07:28.441]blood alcohol level, the biphasic effect,
[01:07:30.607]giving people charts, talking about consequences
[01:07:33.670]from the student, and talking
[01:07:35.600]about harm reduction strategies,
[01:07:36.844]ASTP, compared to the alcohol information school
[01:07:39.389]and a control group showed significant reductions
[01:07:41.679]in drinking and consequences.
[01:07:43.871]The good news, it worked,
[01:07:45.880]the not so good news, at least in the initial version,
[01:07:47.940]it was actually eight sessions long.
[01:07:51.172]He did a followup looking at a six session
[01:07:53.223]compared to, there were these rumblings out in New Mexico
[01:07:55.962]about motivational interviewing,
[01:07:57.930]six session with a group,
[01:07:59.730]one session with an individual.
[01:08:01.940]That's the study that gave birth to BASICS.
[01:08:04.360]In that time, there have been evaluations
[01:08:05.920]of two-session ASTPs, ASTPs with mandated students
[01:08:08.540]and even one-session ASTPs.
[01:08:10.879]We were talking at dinner last night about the chance
[01:08:12.920]to even do ASTP content in contexts
[01:08:14.948]that focused on high-risk contexts.
[01:08:18.780]Hugh Spitler, at Clemson, for example,
[01:08:21.030]did research on delivery to Greek students
[01:08:24.747]as a way of looking at this.
[01:08:26.620]It is a piece of the puzzle, it is a mix of strategies,
[01:08:29.397]but this could be part of that plan.
[01:08:32.530]It is a group and so it's done a bit more structured,
[01:08:34.943]but you see more individual flexibility
[01:08:37.592]when you do an approach like BASICS.
[01:08:39.468]BASICS came out as a book in 1999.
[01:08:46.380]Baer, Kivlahan, and Marlatt were three
[01:08:47.770]of the six members of my dissertation committee,
[01:08:49.530]so I still get nervous when I look at this slide.
[01:08:51.697]I'm like, "Don't ask me about moderators,"
[01:08:54.290]but this was developed, again,
[01:08:56.962]it came out of ASTP.
[01:08:58.682]It looked at a six-session group compared
[01:09:01.870]to a one-session, feedback session,
[01:09:04.490]using motivational interviewing,
[01:09:06.150]compared to a control group.
[01:09:07.410]The group, the individual session,
[01:09:09.685]significant reductions in drinking and consequences
[01:09:11.879]compared to the control group.
[01:09:13.740]No differences between the two groups.
[01:09:15.513]You got as much in one 50-minute feedback session
[01:09:18.368]with an individual as you did in six hours with a group.
[01:09:21.354]That laid the foundation for BASICS.
[01:09:24.890]BASICS looked at following incoming first-years students
[01:09:28.110]to a large northwest university, as the article said,
[01:09:30.514]and compared them to a high-risk control group
[01:09:34.747]and a general college student control group.
[01:09:36.713]I'll cut to the punch line.
[01:09:38.108]Four years after getting BASICS,
[01:09:40.029]significant reduction in drinking and related consequences
[01:09:42.873]after a 50-minute intervention.
[01:09:45.122]What does BASICS involve?
[01:09:47.920]There is an assessment.
[01:09:49.600]When this was first developed, that was in person
[01:09:52.360]and with paper and pencil surveys.
[01:09:54.593]It was 1990 and there was no internet
[01:09:56.440]and there was no surveys online.
[01:09:59.230]Subsequent studies have shown you can replace
[01:10:01.930]that entire first session as long as the alcohol screening
[01:10:04.160]happens, online even.
[01:10:06.417]Students would self-monitor, come back and get
[01:10:08.748]a feedback sheet and a provider trained
[01:10:11.010]in motivational interviewing would review the feedback,
[01:10:12.974]go over the information and skills training content
[01:10:16.160]when relevant to the person.
[01:10:18.155]What does it mean to do BASICS?
[01:10:20.670]The AS is the alcohol screen
[01:10:22.417]and it was originally a separate in-person session.
[01:10:25.410]Again, it was achieved online in subsequent studies.
[01:10:29.020]It does need that screening though.
[01:10:30.640]The I is the intervention.
[01:10:32.500]That was originally the second session
[01:10:33.880]that was done in person, so still a one-session intervention
[01:10:36.060]but a second in-person session,
[01:10:38.136]guided by personalized graphic feedback.
[01:10:40.590]If you give feedback online or in print,
[01:10:42.760]that's not BASICS.
[01:10:44.067]That's delivering a PFI and we'll talk about that too.
[01:10:48.020]But it must be delivered with fidelity
[01:10:49.900]to motivational interviewing,
[01:10:51.120]adherence to MI spirit, style and strategies.
[01:10:54.411]It allows you to flop around a bit more
[01:10:56.624]based on what's of interest to the student.
[01:10:59.210]So if I'm meeting with a student that says,
[01:11:00.347]"Well what about tolerance?"
[01:11:01.830]you would never be like, "Slow down, that's coming."
[01:11:03.900]We'd move right to there and meet them where they are.
[01:11:06.195]The original BASICS feedback did not look gorgeous.
[01:11:10.990]This was side one, this was side two.
[01:11:13.387]This was associated with four years later
[01:11:15.860]reductions of drinking and consequences.
[01:11:17.910]This feedback sheet was made in WordPerfect for DOS.
[01:11:22.893]We had to hire a graphic designer, for real,
[01:11:25.270]to make that big number one and that big number two
[01:11:27.840]and the logo of the named Lifestyles '94 Project,
[01:11:30.924]which was the first working name of BASICS
[01:11:33.910]and then clip art came out and we had to let her go.
[01:11:40.120]It went over feedback on things like
[01:11:42.640]how much they drank, their blood alcohol level,
[01:11:44.750]how that changed since high school,
[01:11:46.220]perceived and actual norms.
[01:11:47.740]This was early application of normative feedback.
[01:11:51.540]Consequences they endorsed, family history risks,
[01:11:53.650]symptoms associated with dependence,
[01:11:55.277]using at the time DSM-IIIR terminology,
[01:11:57.494]beliefs about alcohol, expectancies,
[01:12:00.061]and their own concern and perceived risk.
[01:12:02.610]It got a little prettier in subsequent years.
[01:12:04.810]Here's one from 2002, but it was a similarly
[01:12:07.751]just one sheet of paper.
[01:12:09.270]Side one, side two.
[01:12:10.979]I told you that the hardest part of doing,
[01:12:13.560]we always have to name things with acronyms.
[01:12:15.239]Hardest part of getting a new grant
[01:12:17.080]is coming up with a cool name for the study.
[01:12:18.801]We came up with, for this one, MC squared,
[01:12:21.260]which stood for Motivating Campus Change.
[01:12:23.120]We're like, "That's awesome!"
[01:12:24.432]No it wasn't.
[01:12:26.090]That stupid little superscript two
[01:12:27.550]was the bane of my existence for the entire life
[01:12:29.210]of that project, because depending on what program
[01:12:31.030]we were using at the time, that was hard
[01:12:33.180]to make that number two.
[01:12:35.110]I feel bad showing this because I feel like I'm picking
[01:12:37.040]on the guy that made this sign,
[01:12:38.470]but I used to work at a different school.
[01:12:40.430]One day I was walking into the building.
[01:12:42.330]I saw this sign that was the directory
[01:12:44.120]and I'm like, how long has that been there?
[01:12:46.560]Not only had it been up for a year,
[01:12:48.350]it was up an additional four years.
[01:12:49.970]Here's me in front of the sign
[01:12:51.530]and it actually said, "MC2 (Bob, this should be squared)
[01:12:54.547]"Motivating Campus Change."
[01:12:59.254]Gonna go out on a limb and say that Bob
[01:13:02.080]the sign maker didn't think very critically
[01:13:03.760]about the note he had received.
[01:13:06.800]And they put that up.
[01:13:08.180]That sign is actually in my office
[01:13:10.470]at the University of Washington now
[01:13:12.399]because my wife told me we had to get it out
[01:13:14.550]of our dining room.
[01:13:16.810]But when they remodeled the building,
[01:13:18.130]I'm like, "Please let me have that sign,"
[01:13:19.970]so I'm the proud owner of it,
[01:13:21.530]but we can give feedback on,
[01:13:22.982]it goes back to what's of importance to the student.
[01:13:25.335]Imagine this is someone that said,
[01:13:26.657]"I lost a friend to drinking and driving,
[01:13:27.917]"I would never drink and drive.
[01:13:29.127]"That's why I party, stay the night at my friend's house,
[01:13:31.509]"drive home the next day."
[01:13:33.194]This is a person for whom their peak blood alcohol level
[01:13:35.820]takes 17 hours to get back to zero.
[01:13:37.969]If they're at their peak of .27 at midnight,
[01:13:43.010]they're not blowing a zero until five
[01:13:45.037]in the afternoon the next day.
[01:13:47.200]If they realize, what's important to me,
[01:13:48.770]not drinking and driving, what am I learning?
[01:13:50.310]I'm drunk driving every weekend.
[01:13:52.299]That could be some of the prompts,
[01:13:54.725]contemplation of change,
[01:13:56.350]or even active commitment to change.
[01:13:58.794]The issues with BASICS.
[01:14:00.240]BASICS is the most well studied
[01:14:01.750]of the individually-focused interventions,
[01:14:03.640]clearly shows an impact, but I gotta say,
[01:14:06.010]these are some of the things,
[01:14:06.843]there's still more research that needs to be done,
[01:14:08.510]adjustments in feedback length or content
[01:14:11.560]I was at one school where they said,
[01:14:13.444]"Hey we want to show you are BASICS feedback,"
[01:14:14.277]and it was 22 pages long!
[01:14:17.290]I was like, "How are you even discussing this
[01:14:18.797]"in a 50-minute session?"
[01:14:21.430]That's a research question.
[01:14:22.880]Again, the feedback doesn't have to be gorgeous
[01:14:24.830]and you saw that the best outcome data ever,
[01:14:26.748]from a sheet of paper.
[01:14:28.710]Conflicting or confusing measures is about what's effective.
[01:14:32.040]We get, at least at my school,
[01:14:35.000]everything from messages from sales people,
[01:14:36.530]like, this is the most effective, things like that,
[01:14:38.840]so knowing what is the best way to go,
[01:14:40.970]especially even in, in quotes, "buying feedback" is hard.
[01:14:43.705]You heard me say in the morning,
[01:14:45.120]best practices in training for BASICS.
[01:14:47.340]Staffing and practical needs.
[01:14:49.260]I talked to one school that they said,
[01:14:50.093]"We don't have enough people,
[01:14:51.847]"so we made the intervention 30 minutes."
[01:14:55.490]They're like, "Are we still doing BASICS?"
[01:14:56.550]I'm like, you might be but you have to evaluate that.
[01:14:58.436]Bringing the intervention to scale.
[01:15:01.360]I'm at a school of 44,000 people.
[01:15:02.841]The needs to bring that to scale might be different
[01:15:06.030]than at a school, the old school I used to work at
[01:15:08.512]was 4,400, so I've seen a ten-fold increase,
[01:15:10.897]just by switching jobs and the size of the campus.
[01:15:13.206]MI adherence and issues of fidelity.
[01:15:17.610]If people get trained in motivational interviewing
[01:15:18.837]and then kind of stop doing that, that becomes a problem.
[01:15:21.002]And again, reaching students that might slip
[01:15:23.480]through the crack.
[01:15:24.570]What we then saw happen in the field
[01:15:26.180]is because BASICS worked,
[01:15:27.355]people looked at, in quotes, "BASICS-like interventions."
[01:15:31.140]Can you have no graphic feedback?
[01:15:34.620]Can you just do the motivational interviewing?
[01:15:37.650]Motivational interviewing in healthcare settings.
[01:15:39.270]Paul Grossberg, I know was out here at Lincoln,
[01:15:41.477]in particular, showed that adherence to MI was the key.
[01:15:45.448]But a healthcare provider, kid come in for a flu shot,
[01:15:49.053]do an alcohol screening, do a brief intervention.
[01:15:53.380]The most reliable interaction components
[01:15:55.067]reflected the underlying principles of MI.
[01:15:57.281]In Paul's study, he identified the top ten clinical tools
[01:16:00.347]and looked at how they hung with expressing empathy,
[01:16:03.520]developing discrepancy between values and goals
[01:16:05.706]that were of importance to the students,
[01:16:07.800]supporting their confidence or optimism
[01:16:09.650]that they could change, and rolling with resistance.
[01:16:12.020]And the top 10 things were going through the things
[01:16:14.330]they liked, the things they didn't like,
[01:16:15.990]the good things, the not so good things,
[01:16:18.050]looking at their goals, considering how alcohol
[01:16:19.931]was in conflict with that, making a decision
[01:16:22.990]to reduce drinking, making a risk agreement,
[01:16:25.063]feedback on how much they drink and how much they,
[01:16:28.580]in quotes, "binge", per month, tracking drinks,
[01:16:30.864]rating their readiness to change,
[01:16:32.777]just asking about those stages of change,
[01:16:35.130]scale of one to 10, how important is it for you
[01:16:38.130]to make a change in your drinking, giving norms,
[01:16:41.870]number seven, compared to national,
[01:16:43.640]caloric feedback, BAC, and also,
[01:16:46.383]norms explicitly in number 10.
[01:16:49.466]What about personalized graphic feedback
[01:16:51.490]if there's no person to discuss it with?
[01:16:53.760]This is the idea of everything from mailed feedback
[01:16:55.885]to web-delivered feedback to some
[01:16:58.210]of commercially available products,
[01:16:59.910]because a number of them were commercially available,
[01:17:01.560]rather than show you any one as an example
[01:17:03.640]at the expense of showing the others,
[01:17:05.280]know that there are commercially available products
[01:17:08.810]But I mentioned MC squared, this was one we stuck in
[01:17:11.560]through the mail.
[01:17:12.470]We had 1,488 people, we assigned them to get feedback
[01:17:16.590]in the mail with these little tip postcards
[01:17:19.080]or they just filled out surveys.
[01:17:20.771]And we gave them this.
[01:17:23.530]It included things like norms, expectancies,
[01:17:25.925]money spent, weight concerns, you name it.
[01:17:28.907]Participants that got the feedback
[01:17:30.975]drank less at followups than the people
[01:17:33.590]that got the control
[01:17:35.060]and when we did a composite score
[01:17:36.250]looking at peak BAC, monthly frequency,
[01:17:38.670]past-year frequency, total drinks,
[01:17:40.607]the feedback participants were more likely to refrain
[01:17:43.632]from heavy episodic or binge drinking
[01:17:46.407]than people in the control group
[01:17:47.757]and to show you graphically what that looked like,
[01:17:50.124]you know when we're talking about percentages of students,
[01:17:53.860]this becomes a big deal from a population level impact
[01:17:56.063]in terms of the groups that got no feedback,
[01:17:58.270]compared to people in the feedback condition.
[01:18:00.880]I mentioned we always try and keep standards in mind.
[01:18:02.920]One of the cool side effects of our study,
[01:18:04.624]is abstainers that got personalized feedback
[01:18:07.005]were two times as likely, one year later,
[01:18:09.321]to still be abstainers than abstainers
[01:18:11.560]in the controlled condition.
[01:18:12.960]Think about what they got.
[01:18:13.793]They got norms saying look at all the things
[01:18:15.580]you're avoiding not drinking,
[01:18:17.210]look at how many people have joined you
[01:18:18.570]in the decision to abstain
[01:18:19.997]and what we found is that again, the percentage
[01:18:22.134]of people in the feedback condition,
[01:18:24.779]compared to the people in no feedback
[01:18:27.658]when we looked at the percentage of students
[01:18:29.428]made a big difference.
[01:18:32.620]Protective behaviors mediated intervention efficacy
[01:18:34.976]in the people that got the intervention
[01:18:37.670]increased the frequency of protective behaviors
[01:18:39.960]relative to the control group.
[01:18:41.930]The web-based stuff I can't do justice.
[01:18:44.491]As examples, just from colleagues
[01:18:46.500]that I've collaborated with, Clay Neighbors,
[01:18:48.400]who I shared the pencil story with,
[01:18:49.955]looked at 21st birthdays and showed that giving
[01:18:52.727]personalized feedback reduced BAC levels
[01:18:55.315]on the day of their 21st birthday.
[01:18:58.290]Alcohol-related sexual behaviors, Melissa Lewis,
[01:19:01.326]another friend and colleague at U dub,
[01:19:03.419]in the handouts that you'll be sent as a PDF,
[01:19:06.250]there's a link from one of NI triple A's journals
[01:19:09.280]that reviews 32 electronic or web-based interventions,
[01:19:12.930]including several of the commercially available products.
[01:19:15.380]There's a way to give this feedback out there
[01:19:17.430]as part of that mix of strategies.
[01:19:21.140]You know, Ralph Hingson had a study where he asked people,
[01:19:23.337]the only inclusion criteria was do you drink
[01:19:26.180]and have you been to the doctor?
[01:19:27.610]He asked people then about the degree to which
[01:19:29.730]they were asked about their drinking by their physician.
[01:19:32.780]Only 14% of those exceeding low risk drinking guidelines
[01:19:35.543]were asked and advised about risky drinking by their doctor.
[01:19:38.730]The age group most likely to exceed the guidelines
[01:19:40.730]but least often asked were 18 to 25 year olds.
[01:19:44.130]We're at the point where the efficacy of screening
[01:19:46.270]and brief interventions in health centers
[01:19:48.450]has been established.
[01:19:49.283]Jim Schaus, my idol, University of Central Florida,
[01:19:52.884]I've heard people say, "I don't know,
[01:19:54.497]"we have a pretty busy health center."
[01:19:56.237]They're one of the top five largest health centers
[01:19:57.780]in the country.
[01:19:58.650]They screen every student for every presenting issue
[01:20:03.510]If they flag, they get connected with a brief intervention.
[01:20:05.702]Mike Fleming, now at Northwestern
[01:20:08.130]but was at Wisconsin.
[01:20:09.234]The findings are so cool that it's led Ralph Hingson
[01:20:12.080]to conclude that if more campuses screened,
[01:20:13.739]and referred interventions, it would achieve, ultimately,
[01:20:15.899]population-level benefits, because you connect people
[01:20:19.025]to services that could be having an impact.
[01:20:22.630]The barriers related to screening is, again,
[01:20:24.220]picking the right tool.
[01:20:25.840]If you're like, everyone's flagging,
[01:20:27.470]we're having too many false positives, that's an issue.
[01:20:29.559]Training people to do that,
[01:20:31.333]resistance toward conducting screenings,
[01:20:33.695]if there are already busy healthcare providers
[01:20:35.860]concerned about more work,
[01:20:37.220]or concerned about, what if someone flags,
[01:20:38.730]then what do we do?
[01:20:39.783]Real world issues related to resources,
[01:20:41.781]plus the idea that it still requires someone
[01:20:44.032]to come to a health center or counseling center,
[01:20:46.350]so, again, how do we catch the students
[01:20:48.133]that might slip through the cracks.
[01:20:49.995]I mentioned that I'd let you know
[01:20:51.083]that you can do motivational interviewing in groups.
[01:20:53.316]It's still non-judgmental, it's still non-confrontational,
[01:20:56.817]but you cast a much wider net.
[01:20:58.859]You acknowledge that there might be a blend
[01:21:01.160]of drinking practices in the group,
[01:21:02.927]so you ask open-ended questions as much as possible
[01:21:06.160]and you reflect when possible.
[01:21:08.160]When someone in the group goes, "Whoa,"
[01:21:10.244]and we say, "That's really different than you thought
[01:21:12.417]"it would be," all the other 10 people
[01:21:13.673]that didn't say whoa but thought it
[01:21:15.725]are nodding too.
[01:21:17.510]You can reflect to one and impact the others
[01:21:19.340]in the group and the science shows this.
[01:21:21.024]Consider hooks for the group.
[01:21:22.702]We talked at dinner last night about the work
[01:21:24.750]we're doing with Greeks,
[01:21:26.270]asking a fraternity or sorority,
[01:21:27.559]"How would you like to be seen as a chapter?"
[01:21:31.170]And they'll say things like respectful,
[01:21:32.680]fun but responsible, good guys, whatever it might be.
[01:21:36.560]How do you think you are seen?
[01:21:38.610]What gets in the way of being seen the way you'd like?
[01:21:40.777]And if any of that is alcohol-related,
[01:21:42.519]there's an opportunity to consider
[01:21:44.060]what that shift might be.
[01:21:45.690]Eliciting personally relevant reasons for change
[01:21:46.942]and letting the group generate protective
[01:21:49.660]behavioral strategies, then filling in what they miss.
[01:21:52.300]I showed you on a slide in the interest of time,
[01:21:53.835]here are some protective behavioral strategies.
[01:21:55.656]Well what would that be?
[01:21:57.419]Going with action-stage suggestions with people
[01:22:00.320]who might not be there yet.
[01:22:01.960]If we ask the group, "If you make the choice to drink,
[01:22:04.960]"what are some strategies a person could use
[01:22:07.197]"that would allow them to stick to a limit
[01:22:09.847]"or in general, be more in control of their night?",
[01:22:11.870]a pre-contemplator can answer that question.
[01:22:16.090]Well I suppose they could set a limit.
[01:22:18.159]Does that mean they're gonna?
[01:22:20.162]But if they're generating it, it's coming from them,
[01:22:21.370]not us in the front of the room.
[01:22:23.630]So, why is it collectively also important
[01:22:25.366]they can all be part of that mix of strategies
[01:22:27.623]considered through CollegeAIM.
[01:22:29.970]When you look at CollegeAIM, in that upper left-hand corner,
[01:22:33.080]including normative re-education,
[01:22:35.167]and this was electric or personalized normative feedback,
[01:22:38.679]skills training strategies with an alcohol focus,
[01:22:41.133]including just self-monitoring and self-assessment.
[01:22:45.244]There is research that shows if you have people
[01:22:47.800]fill out surveys a lot, their drinking will go down.
[01:22:52.350]This is the fourth survey these people are giving me
[01:22:54.550]where I endorsed doing less well in school
[01:22:56.730]than I wanted because of my drinking.
[01:22:58.270]Wow, maybe I should do something.
[01:23:00.130]Literally, even monitoring can make a difference.
[01:23:02.540]There is, again, the commercialized available stuff
[01:23:05.300]in that middle realm.
[01:23:06.440]You can see that it includes skills training, again,
[01:23:08.970]with an alcohol focus, exploring goals,
[01:23:11.070]there's the Alcohol Skills Training Program
[01:23:12.550]mentioned by name, there's BASICS mentioned by name,
[01:23:14.846]there's personalized feedback interventions,
[01:23:16.815]generic or other.
[01:23:18.880]If you're a NCAAA Division III school,
[01:23:21.014]one of the studies that lays the foundation
[01:23:23.010]for the 360 Proof program that was a collaborative launch
[01:23:26.640]between NASPA and NI triple A,
[01:23:28.420]the entire PFI is based on an article cited in that section.
[01:23:31.108]That is a personalized feedback intervention
[01:23:34.050]free to all NASPA small colleges and Division III schools.
[01:23:36.669]Linda Major's gonna be presenting in our next
[01:23:39.150]learning collaborative webinar, in fact.
[01:23:42.357]When you look at some of the ones that are
[01:23:43.970]moderate effectiveness, the expectancy challenge on its own,
[01:23:45.972]there are these other skills trainings.
[01:23:48.890]You see the word skills training
[01:23:49.910]and motivational intervention a lot.
[01:23:52.790]Parent interventions, the work that Rob Tereesee has done,
[01:23:57.137]When we look at the fact, in the time I have left,
[01:23:59.377]that there are these barriers, though,
[01:24:02.230]to getting it out there.
[01:24:05.153]You, on your campuses, as you're discussing these,
[01:24:06.440]have a chance to overcome those barriers.
[01:24:08.640]Part of the hope is that CollegeAIM helped lessen
[01:24:12.453]Among the barriers to getting evidence-based programs
[01:24:15.512]in place is dissemination.
[01:24:18.230]That's on researchers, in many ways.
[01:24:20.234]A lot of researchers publish in journals
[01:24:22.180]that no person would ever have a reason to read.
[01:24:26.331]I have a colleague that just got her work summarized
[01:24:29.907]in Cosmo and her mom was like, "Now you've made it."
[01:24:33.970]And she wasn't trying to be funny.
[01:24:34.803]It's like, now this has real world meaning.
[01:24:36.587]It didn't have real-world meaning when it was
[01:24:38.040]in the Journal of Something Fancy.
[01:24:40.166]And even if it is published in a journal,
[01:24:42.000]it doesn't say how to do it,
[01:24:43.370]plus some publications or evaluations
[01:24:45.330]are not very user friendly.
[01:24:46.700]We log-transformed the data and,
[01:24:48.737]and you're like, "Wait, so what's the mean?"
[01:24:50.480]You're not even sure what you're interpreting any more.
[01:24:52.694]Adoption, reactions from key people involved in the process.
[01:24:56.090]They feel strongly, no, we must do it this way
[01:24:58.287]if that leads to moving forward.
[01:25:00.370]Diversity of opinion is great and we encourage it
[01:25:04.000]on college campuses, but it could lead to difficulty
[01:25:07.737]The Try-ath-an Cultural Center in Colorado
[01:25:10.574]actually has an institutional readiness to change
[01:25:15.510]I showed you the stages of change.
[01:25:17.090]You can fill it out as a department,
[01:25:19.470]pool it all together and say,
[01:25:20.567]"Maybe we're all in agreement something needs to change,
[01:25:22.887]"we're contemplative about what that should be."
[01:25:24.850]Or maybe we are in fact all on the same page.
[01:25:27.070]Or, man, everyone's in totally different places,
[01:25:29.450]so we maybe need to go a bit slower.
[01:25:32.230]Another barrier to adoption is unreasonable expectations.
[01:25:34.733]Okay, fine, we'll buy this one program
[01:25:36.800]and all this will go away.
[01:25:38.280]Well, no, that's one program and it's one part
[01:25:39.682]of that mix.
[01:25:44.640]The campus that does a norms campaign
[01:25:46.320]but puts up a single poster.
[01:25:48.555]That's not appropriate buy-in.
[01:25:50.230]Not enough time working with the folks
[01:25:52.760]that are gonna be involved in developing or delivering
[01:25:56.970]The implementation, for the third time I'll say,
[01:25:59.870]and plus there's a tendency to reinvent innovations.
[01:26:02.800]That's okay, but if you tweak it too much,
[01:26:05.060]it's not the evidence-based strategy any more.
[01:26:06.920]Instead, it's just a new program that needs to be evaluated.
[01:26:09.466]Organizational factors, like resources, money-wise,
[01:26:13.897]issues in the real world impacting effective delivery,
[01:26:16.795]attitudes among leaders, resistance amongst staff
[01:26:20.252]familiar and comfortable with just doing it
[01:26:22.100]the way we've been doing it,
[01:26:23.805]and finally, the idea of therapist drift,
[01:26:26.059]again, the idea that we have to do continuing education
[01:26:28.981]in issues of delivering an intervention with fidelity.
[01:26:32.410]This highlights the need to monitor and provide
[01:26:36.490]There's also a tendency to move toward
[01:26:37.750]the next best thing.
[01:26:39.130]Ooh, let's do this.
[01:26:40.047]Or some administrators that believe if we direct
[01:26:42.120]too much attention to this, does that suggest
[01:26:45.160]to the community that there's a problem?
[01:26:46.600]I would think on the contrary.
[01:26:48.300]It shows that you're looking at the health
[01:26:50.060]and wellness of your students.
[01:26:52.370]So in wrapping up, this was a lot and I appreciate
[01:26:54.070]you guys putting up with a whirlwind tour,
[01:26:56.188]but I added this because we talked about it as well.
[01:27:00.631]Bob Salts, who is one of the nicest human beings
[01:27:02.970]I have ever met, has one of the greatest smiles
[01:27:05.180]on the planet Earth, and is just a genuinely great guy,
[01:27:09.580]has really warned, as we're looking these approaches,
[01:27:12.126]that there may be more support for policies
[01:27:15.960]than we realize.
[01:27:16.793]I thought Toben did such a great job of highlighting
[01:27:18.707]the importance of that policy on the front end.
[01:27:21.070]What if you've got a program like BASICS?
[01:27:23.645]What if people aren't getting referred to it consistently?
[01:27:26.893]What if there's not consistent enforcement of policy?
[01:27:29.620]What if you want a new policy, but people are dragging
[01:27:31.950]their feet to do it?
[01:27:33.050]One article showed that a small group of students
[01:27:35.590]might be so vocal on campus to the point
[01:27:36.991]administrators don't make policy changes
[01:27:39.086]because they mistakenly assume the student body
[01:27:41.233]doesn't support them, but Bob showed
[01:27:43.821]there was a universal tendency to underestimate
[01:27:46.423]student support for policies.
[01:27:48.360]Because I'm firmly of the belief that he can say it
[01:27:50.210]better than anybody else, quoting directly from his article,
[01:27:53.590]"campuses would actually have more incipient support
[01:27:56.217]"for a variety of alcohol prevention policies
[01:27:57.917]"than is likely to be perceived by the students themselves,
[01:28:00.527]"and, by extension, administrators and others
[01:28:03.317]"belonging to the campus community."
[01:28:05.247]"Unless students are persuaded that such support
[01:28:07.167]"is not limited to a fringe element, new policies
[01:28:08.944]"are likely to be met with at least passive,
[01:28:11.777]"if not active, resistance."
[01:28:14.157]"This then, suggests that today's campus prevention
[01:28:16.117]"interventions, which now often comprise campaigns
[01:28:18.547]"to correct students' perceptions of peer alcohol
[01:28:20.867]"consumption, may want to incorporate a parallel effort
[01:28:24.227]"to correct their perception of peer support
[01:28:26.947]"for policies as well."
[01:28:28.567]"This information may prove revelatory to some,
[01:28:30.684]"and critical to the chances of having a significant impact
[01:28:33.397]"on alcohol-related problems on campus,
[01:28:35.697]"which is the ultimate target."
[01:28:38.050]In the spirit of that idea of, a mix of strategies is best,
[01:28:41.203]consider the audience and targets for a variety
[01:28:43.780]of what you're doing.
[01:28:44.670]What are you offering your abstainers?
[01:28:46.187]What are you offering in terms of programs
[01:28:48.200]for returning veterans?
[01:28:49.390]Study abroad programs?
[01:28:50.865]I'll talk about that in just a bit.
[01:28:52.730]Students in recovery, Greek members, student athletes,
[01:28:55.608]high-risk events, St. Patrick's Day.
[01:28:58.120]I made the joke, well at least that's far away.
[01:28:59.560]That's in 13 days.
[01:29:00.786]There's a chance to do something there.
[01:29:02.969]Recognize and utilize expertise in your community for sure
[01:29:06.185]and add to the science on what works,
[01:29:08.980]not only in affecting alcohol use, but help advance
[01:29:10.940]the field on other drug use, violence, the overlap
[01:29:13.629]of these issues.
[01:29:15.490]Certainly things like prescription drugs and marijuana.
[01:29:18.139]With the time I have left, I did, at the request
[01:29:20.341]of a couple people in the audience, just want to say
[01:29:22.650]a quick word about the science that,
[01:29:24.400]I'm not being dramatic when I say this keeps me up at night.
[01:29:26.292]I worry a lot.
[01:29:27.666]I hope I outgrow that some day, but given where I am
[01:29:31.170]age-wise, apparently I will not outgrow it,
[01:29:33.109]but this research is insane
[01:29:35.268]and it has implications for Spring Break,
[01:29:38.650]it has implications for 21 Runs,
[01:29:40.880]students studying abroad, new students in the fall.
[01:29:43.412]It's an article that came out,
[01:29:45.006]the article that kicked this all off came out in 2002,
[01:29:48.235]Siegel and Ramos, and they said,
[01:29:50.017]"What's up, addictive behaviors field?
[01:29:51.877]"We failed to pay attention in Intro to Psych,
[01:29:54.169]"because if we looked at Intro to Psych,
[01:29:56.977]"we would be scared to death of tolerance."
[01:29:59.940]Pavlov taught us that if you food in front of a dog
[01:30:02.096]and ring a bell, it looks at you funny.
[01:30:03.644]If you put food in front of a dog and ring a bell
[01:30:05.140]over and over and over, in time, ring the bell,
[01:30:08.000]the dog salivates.
[01:30:09.070]The bell can elicit salivation as a conditioned response.
[01:30:13.653]When I teach in the med school, I always show this slide.
[01:30:15.642]It's Pavlov from the view of the dog.
[01:30:18.020]The dog says, "Watch what I can make Pavlov do.
[01:30:20.207]"As soon as I drool, he'll smile and write
[01:30:22.302]"in his little book."
[01:30:25.280]I think it went down that way,
[01:30:26.113]but jump forward to human beings and drinking.
[01:30:28.730]I know this is not true, but imagine the only place
[01:30:30.910]you ever drank was right in here.
[01:30:32.600]If you're in this room, it's drinking time.
[01:30:34.760]You walk in this room, drink.
[01:30:37.000]Walk in this room, drink, walk in this room, drink,
[01:30:39.330]walk in this room, drink, what are you doing?
[01:30:41.310]You're probably violating a policy of some kind,
[01:30:43.349](audience laughs) but you're also pairing this room
[01:30:45.713]with drinking, no different than that bell
[01:30:47.027]to Pavlov's dog.
[01:30:49.720]Why does that matter?
[01:30:50.860]In physiology, we know there's something called
[01:30:52.130]the opponent process theory that says,
[01:30:54.010]shove the body one way, body shoves back the other.
[01:30:56.400]Jack up the heat, we sweat, make it really cold, we shiver.
[01:31:00.000]If you have a drug like alcohol that has a depressant,
[01:31:01.981]slows the body down, walk in this room and drink,
[01:31:04.538]slows the body down, walk in this room and drink, slows
[01:31:06.908]the body down, in time, walk in this room,
[01:31:09.490]body starts speeding up.
[01:31:11.190]The cues that tell the body, oh, we're about
[01:31:13.960]to receive a big dose of a depressant
[01:31:15.700]lead to the body making an anticipatory response
[01:31:17.344]in the direction opposite the way the drug acts.
[01:31:20.150]Researchers call this a conditioned compensatory response.
[01:31:23.330]Without using all the fancy words,
[01:31:24.480]imagine this is the level of a depressant
[01:31:27.000]that lets someone say,
[01:31:27.967]"I'm good, I'm gonna call it a night."
[01:31:29.690]They come on here on Day 1, drink, Day 2, Day 3,
[01:31:33.191]Day 4, Day whatever.
[01:31:35.213]At some point, they walk in the room,
[01:31:37.560]the body sees these cues, the body goes,
[01:31:39.717]"Okay, we're drinking," ever so slightly,
[01:31:40.966]the central nervous system starts to speed up,
[01:31:43.389]heart rate increases, Galvanicks-Ginn response changes,
[01:31:46.554]blood pressure changes.
[01:31:48.330]What's the catch?
[01:31:49.340]Here's how much the person drank the last 50 times
[01:31:50.849]they went out.
[01:31:52.290]They now drink that exact same amount.
[01:31:54.350]Subjectively, do they feel it in the same way?
[01:31:56.108]Nope, so what do they do?
[01:31:59.610]Do they feel it now?
[01:32:00.630]Yeah they do?
[01:32:02.223]Do they look any different?
[01:32:03.227]No, they're holding their liquor,
[01:32:04.060]they're developing tolerance.
[01:32:05.700]And we can see over a great deal of time
[01:32:07.041]that this is then what tolerance could be.
[01:32:10.740]This is how tolerance develops.
[01:32:12.085]Now, what's the relevance to us in a college setting?
[01:32:15.411]Researchers then said, "Oh my god, then maybe
[01:32:17.307]"if what have we've been calling a drug overdose
[01:32:19.446]"all these years, what if what we've been calling
[01:32:21.577]"alcohol poisoning has less to do with someone
[01:32:24.087]"going out and just having a big damn dose of alcohol?"
[01:32:26.830]Instead, what if they drink the exact same amount
[01:32:29.340]they've had the last 80 times they went out,
[01:32:31.409]but they go out around a completely brand-new set of cues?
[01:32:34.555]Well, as crudely and simply measured
[01:32:37.521]as a brand new environment.
[01:32:39.500]In a brand new environment the cues
[01:32:40.919]that would make this anticipatory response happen
[01:32:44.850]If the person pounds the same amount they've been drinking,
[01:32:48.330]isn't it conceivable that that could happen?
[01:32:50.630]Isn't it conceivable that that is what
[01:32:53.020]an alcohol poisoning is, that that is what
[01:32:55.490]a drug overdose is?
[01:32:57.240]Study in Michigan looked at 61 consecutive drug overdose
[01:32:59.830]admissions into a hospital setting to see
[01:33:01.600]if they had anything in common.
[01:33:02.920]60 of the 61, what did they have in common?
[01:33:08.110]The language used in our field at this moment
[01:33:10.000]is the word fail.
[01:33:11.050]Tolerance fails to follow someone to a new environment.
[01:33:16.350]Why does that make me nervous about Spring Break?
[01:33:18.412]What does Spring Break represent for a lot of students?
[01:33:20.643]What does that road trip represent?
[01:33:21.910]Brand new environment.
[01:33:23.150]The tolerance they had on campus will fail to follow them
[01:33:24.995]wherever they go for vacation.
[01:33:28.300]Students studying abroad.
[01:33:29.407]"Hooray I'm in a new country, and guess what,
[01:33:30.907]"there's even a legal drinking age now."
[01:33:32.760]What does that new country represent?
[01:33:33.956]Brand new environment.
[01:33:35.470]The tolerance they had on campus, wherever they live,
[01:33:37.980]will fail to follow them there.
[01:33:40.436]I'm in a bar for the first time,
[01:33:41.269]happy 21st birthday to me!
[01:33:42.630]Brand new environment.
[01:33:43.763]Why does this keep me up at night in the fall?
[01:33:46.300]What do our incoming students represent to us?
[01:33:47.850]People for whom our campus is a brand-new environment.
[01:33:51.040]If the only harm a student is trying to avoid
[01:33:53.520]is like, they say, "I want to drink and have fun,
[01:33:55.327]"but I don't want to wind up dying,"
[01:33:57.010]I mean, good goal, and that would mean
[01:33:58.429]that this even could be a foot in the door
[01:34:01.841]and a hook to discuss with students.
[01:34:04.400]I can look you in the eye and say the science on this
[01:34:06.479]has gotten ahead of our knowledge of what to do with it
[01:34:10.263]I can also look you in the eye and say
[01:34:12.333]that in our Spring Break interventions,
[01:34:14.270]our 21st birthday interventions, we're making sure
[01:34:16.650]all of our BASICS facilitators know about this,
[01:34:19.000]because the implications here are huge.
[01:34:20.923]In fact, keep in mind that cues can be a lot of things
[01:34:24.480]and one study even acknowledged that taste
[01:34:26.520]could be a cue.
[01:34:28.120]If you have a favorite drink and you take a sip
[01:34:29.950]and you're like, "Oh, yeah, there we go,"
[01:34:31.800]that's a cue.
[01:34:32.801]So that a study in Canada, with 19-year-old college students
[01:34:36.280]looked at what if we give them drinks
[01:34:37.680]that are the same size, same alcohol by volume,
[01:34:40.240]get to the same blood alcohol level,
[01:34:41.538]but one tastes insane.
[01:34:45.130]We'll have one look, taste, smell like beer,
[01:34:47.140]the other one be insanely bright blue
[01:34:48.620]and really pepperminty.
[01:34:49.460]Their theory was, drink the one that's kind of like beer,
[01:34:51.880]the body goes, "We're drinking,"
[01:34:53.440]makes the anticipatory response.
[01:34:55.144]People drink a drink they've never had before,
[01:34:57.383]no anticipatory response, they'll feel the full effect
[01:34:59.655]of what they've consumed in a more pronounced way.
[01:35:02.490]Exactly what the science shows.
[01:35:04.130]Students say subjectively, "I feel it, what did you put
[01:35:06.327]"in this blue thing?"
[01:35:07.670]They feel it more and objectively they showed
[01:35:09.410]greater signs of impairment.
[01:35:10.829]Again, I'm asking out loud, "Do you drink beer?"
[01:35:15.500]"Do you drink green beer?"
[01:35:16.703]That's a change in visual cues,
[01:35:19.423]that even makes St. Patrick's Day,
[01:35:21.460]the same six they always have, could be different
[01:35:23.970]if we've changed appearance or taste.
[01:35:26.030]So I show you this just as one other example
[01:35:29.040]of we've got a lot more work to do as a field.
[01:35:31.960]So, we've talked about the situational specificity
[01:35:35.140]of tolerance, says that if alcohol is presented
[01:35:37.280]in a manner divorced from the usual stimuli,
[01:35:39.210]the effects are enhanced.
[01:35:41.400]I started 10 minutes late, and I tried to catch up
[01:35:43.740]and I think I caught up, but I'll end just by saying
[01:35:46.360]I love what I do, it's easy in this field
[01:35:49.290]to feel outnumbered and I always love stuff like this
[01:35:51.083]because we're not alone in this
[01:35:52.417]and I hope, I genuinely, when I said let's clap
[01:35:55.050]for the people new to the field,
[01:35:56.370]that's so important, but all of us
[01:35:58.540]that have been doing this, we're very much in this together.
[01:36:00.730]I talk a lot about why I do what I do
[01:36:02.910]and sadly, I bore my family with it all the time
[01:36:05.590]and I don't have any kids, so I have embraced
[01:36:08.790]the cool uncle role as best as I can
[01:36:10.387]and I have a niece, I actually texted
[01:36:12.810]and asked for permission to share this
[01:36:14.640]and I was told that she said yes.
[01:36:16.970]I told her I was gonna be talking with people
[01:36:19.240]about alcohol and why are you talking with them
[01:36:23.943]Well, because it's what advice we should give
[01:36:25.520]college students and she says, "I totally know
[01:36:27.026]"what advice I would give college students."
[01:36:28.640]I'm like, "Go on."
[01:36:30.479]So this is the last time we were hanging out.
[01:36:31.312]So this is Amelia, Amelia says hello to everybody.
[01:36:34.650]Amelia said four things
[01:36:35.493]that you should tell college students.
[01:36:37.060]One, don't smoke, two, don't use drugs,
[01:36:38.791]three, don't drink, but if you do, only drink a little.
[01:36:41.927]And I was like, "Wow, good job."
[01:36:43.670]And number four, don't walk on the train tracks,
[01:36:45.830]which I was like, "Really that's your advice?"
[01:36:49.260]But I thought it was kind of cute.
[01:36:50.709]I will again thank the team I work with
[01:36:55.200]and again, Toben, for the chance to tag team.
[01:36:57.150]I put Amelia on there.
[01:36:58.520]If there's any of the studies I made reference to
[01:37:00.630]or if there's anything I can send your way
[01:37:02.870]that makes your life easier, that's my email address
[01:37:06.230]So I was asked to end at 2:30, it's 2:31.
[01:37:08.930]I'm gonna hand the mic back over to Ian, I believe.
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