CHAPTER 15 HELPING FOR ALCOHOL AND DRUG ABUSE MARCEL A. DUCLOS MARIANNE GFROERER The statistics describing the use and abuse of alcohol and other mind-altering drugs ring familiar on the nightly news, find bold print in the newspapers, and flavor everyday conversations. General hospitals treat medical/surgical patients suffering from medical complications due to abuse and dependency. Emergency mental health and medical services are often faced with management of the intoxicated person. Community mental health centers daily confront the detrimental poly-drug use of scores of deinstitutionalized patients, including the dually diagnosed. School personnel, counselors, teachers, and administrators alike witness the ebb and flow of the season’s most preferred or most accessible substance on the school grounds. They must additionally contend with the farreaching effects of substance use on students, families, and neighborhoods. Along with community workers and social service agency staff, law enforcement officers also struggle to overcome a gnawing defeatism when children and youth sustain, as victims, the ravages of their own or others’ use in a cycle of destruction and even death. No age group, no socioeconomic status, no level of education, no geographic area—urban, suburban, or rural, mountain, plain, or coast—no occupation or profession, and no religious affiliation—whether church, temple, synagogue, or mosque—protects from the insidious and infectious spread of the problem. Our society’s cultural heritage of ambivalence reveals itself by the earliest promotion of the use of alcohol in the colonies and the colonial militia, combined with a primitive “righteous” response to inebriation. No time period in U.S. history, not even the years of Prohibition, provided a drug abuse–free environment for the growth and development of citizens. Nor can such an environment be anticipated for the near future. It is a dream, an idealistic vision. Human service practitioners must face the disillusionment of the present reality and continue to attend hopefully in the expectation of manageable goals realistically attainable by troubled and afflicted clients. At-risk behaviors due to disinhibition and impaired judgment caused by mind-altering substances obligate human service practitioners to consider strategies—educational, medical, economic, political, sociological, psychological, and spiritual—to address the problems on the contemporary scene. These problems include the ones the nation shuns the most: the growing AIDS epidemic, all forms of child abuse, and the persisting plague of violence in our society. The long multicultural history of the human services teaches that the “cure” of human ills, including substance abuse problems, cannot come from logic alone but requires authentic caring. For the human service practitioner, caring in its concrete, active form means consistent and care-filled attention to the details of a realistic treatment plan. CHALLENGES FACED BY HUMAN SERVICE WORKERS The human service worker stands, as a generalist, in the middle of a network of providers, ready to work cooperatively with the many specialists assessing, developing treatment/service plans, delivering care, evaluations, and outcomes. In the arena of alcohol and drug abuse, the key challenge to the worker remains the same: achieving the earliest detection for possible prevention. Yet in the reality of the service delivery systems, the challenge almost always involves the detection of intoxication, the history of abuse, the possibility of dependence, and/or risk as victim or victimizer. No accurate or appropriate care can be designed and provided in any context without knowledge of the effects of drugs on a client’s life. Failure to identify the contributing and resulting connections between substance abuse and the client’s presenting problems with health, the law, money, work, school, society, family, and self will spell a decisive failure in care, however well packaged the plan and well intentioned the delivery. The old psychiatric rule “diagnosis predicts prognosis and therefore directs treatment” applies here as well. The first challenge, then, is one of accuracy. However, much client care may be a matter of heart; it must be guided by knowledge and experience. Accurate knowledge of the psychoactive substance use disorders and their associated intoxication and withdrawal syndromes arms the worker with necessary information to intervene at the earliest possible moment. The continuum of care reaches from direct immediate crisis intervention to consultation and referral as required. The second challenge lies in the subjective domain, in the human service worker’s own personal story. Few individuals can claim never to have been touched by the effects of substance-induced behaviors, though they might claim, for themselves, lifelong abstinence. Whether in personal, social, or professional experiences, the human service worker will have accumulated learned responses to this population. The challenge of empathic acceptance, of healthy emotional distance, or disidentification of a client-enhancing response to countertransference calls for clear, helpful supervision. Whether the service being delivered to the client entails modest assistance with some agency paperwork or involves the complex, long-term work of case management, the energy at the meeting of client and practitioner will generate the atmosphere of change. It therefore becomes an inner challenge for the worker to know her or his own story and to use that level of awareness to promote the client’s good and to attempt to cause no harm. The third challenge pertains to the temptation of the human service practitioner to view himself or herself as competent to function as a substance abuse counselor despite a lack of specialized academic training and clinical experience. The treatment of substance abuse and dependence is a multidisciplinary enterprise. The work of a substance abuse counselor is defined by observable and measurable competencies. For the human service worker who serves an addicted population, it is an ethical imperative to know one’s limits of competence and role within the agency and to consult and refer as necessary. The worker who is unfamiliar with the neurological impairments caused by particular substances abused would be in danger of placing the client, self, and others in physical and/or psychological jeopardy. Depressants, stimulants, narcotics, and hallucinogens present their own sets of impairments and their own relative levels of danger. Confusion about the client’s antecedent or resultant developmental and personality disorders would make the adoption of an individualized helping style difficult. Early trauma in combination with many years, even decades, of substance abuse exacts heroic transformational work on the part of the recovering person. Overestimation of the addicted person’s ability to stop using and become sober without sufficient time for emotional healing and behavior change would lead to errors in the selection of strategy, in the expectation of outcomes, and in the fundamental process of defining the real problems. The nature of the disorder and of rehabilitation leads to paradoxes for the recovering addict as well as for the human service practitioner. Again, the history of drug use gives us a clue about the paradoxical nature of psychoactive substances, of the disease of substance addiction, and of the recovery process. The ancients and the alchemists taught that nature cured disease with either similars or opposites, depending on the illness. Substance abuse and dependence is such a disease. The substances themselves produce their opposites: depressants can rebound into anxiety; stimulants can plunge into depression; narcotics produce their own pain; hallucinogens can lead to loss of self. That which the user originally sought through partaking of the drug eventually eludes the abuser. The drug exacts due payment for all experiences—soothing, exciting, painless, or expansive. All that was beyond the ego’s humble ability to integrate into the psyche and beyond the body’s physiological capacity to metabolize into vital energy returns with a vengeance. The enslaving addiction to the drug releases the abuser to an opposite dependence, binding her or him to a committed pursuit of inner freedom hard won by selfless courage. In the tradition of recovery, the paradox of the twelve-step program of Alcoholics Anonymous (and Narcotics Anonymous) describe that which will nurse the recovering person back to sanity with an elixir of opposites—a bitter medicine that many will reject. No recovery program anywhere can sidestep the necessary laws of nature that direct bodies, minds, and souls from illness to health. The client’s life calls for a complete turn-around—nothing less will do. The cleverness and cunning that characterized the addiction must become slowness and carefulness, accepting the wisdom of another, allowing the unshakable inner self to put aside the false grandiose ego projected by the substance. A new life begins only with the death of the old one. It is ultimately the paradox of life and death because substance dependency is a matter of life and death. HUMAN SERVICE RESPONSES TO SUBSTANCE ABUSE The human services respond to the problem of addiction in society in three ways: education, prevention, and treatment. The choice of response is determined by the level of addiction, which is the target of the approach. Limiting considerations to the individual, the human services distinguish between the person who has never used drugs for recreation, the one who only rarely uses chemicals for recreation, the person who uses frequently and whose abuse leads to some personal and professional problems, the individual who is dependent to the point of resulting medical complications, and the small percentage of individuals who, in their chemical dependency, are also socially isolated and face predictable death. Because chemical dependency is potentially life threatening, the human services respond according to the immediacy of the danger to self and others. Education Successful drug education programs have incorporated in their materials and services the knowledge, attitudes, and behavior necessary to optimize the choice of a drug abuse–free life. Some programs emphasize convincing the audience of the dangers of drugs, whereas other programs underline the objective facts about the substances, advocating neither abstinence nor reasonable use. Other programs utilize the power of identification with a noteworthy person in recovery to score a point with the listeners or viewers. Still other programs, especially those geared toward the school- and college-age population, are even more direct in their approach, providing training in assertively resisting encircling pressures. Prevention Prevention does not only refer to those persuasive efforts aimed at stopping abuse before it starts. It also involves those interventions aimed at signaling to a user in the early stages of abuse that continued use could result in damaging consequences. Early diagnosis with crisis monitoring, crisis intervention, and referral are such interventions. For those individuals who are in the later stages of abuse that lead to dependency, the prevention efforts address the goal of halting the slide to that conclusion. In this instance, intervention efforts could take the form of early treatment, monitored maintenance, or social/medical detoxification. The motto “the best defense is a good offense” applies in this domain. Treatment Because drug abuse and drug dependence are characterized as mental disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), medicine, nursing, and psychology are the disciplines that have traditionally taken responsibility for the treatment of these illnesses. Social work and mental health counseling have also sought to remedy the social and societal ills related to substance addiction. The profession of substance abuse counseling, newly emergent in the early 1970s, has now taken on a prominent role in the treatment of individuals suffering from substance- related disorders. Human service providers who are certified by the International Certification Reciprocity Consortium as alcohol and drug abuse counselors have given evidence of specialized competence in their assigned roles and functions as they work alongside some of the other traditional professions. These particular individuals have passed an objective exam and have been successful in an oral defense of a case presentation before a member state board. They also may choose to become a member of the National Association of Alcoholism and Drug Abuse Counselors (NAADAC). All of these professionals, according to their own training and skills, cooperate to promote the client’s achievement of physical and psychological health, social and financial stability, and behavioral and interpersonal satisfaction. In all of this there still remains a key role for the generalist in the human service field: that of case manager, as the coordinator of all those services that promote follow-through and attainment of the treatment goals. Whether the goals are abstinence after detoxification, management of disruptive behavior, stability of employment or housing, or improved overall self-care and health, the variety of treatment settings and assortment of approaches employed is as diverse as the developmental needs and problems of the clients. Depending on the severity of the addiction, the setting might be an in-hospital treatment program, a residential center, or a day program or out-patient individual, family, or group contact. The human service worker plays a valuable role in all of these settings as a team member with other providers. It is important to note that treatment facilities vary, depending on the population served and the substance treated. Though they have commonalities worth acknowledging, treatment facilities may, in order to focus on specific areas of need, specialize in work with the elderly, adolescents, women’s issues, cocaine or heroin abuse, homeless individuals, or the dually diagnosed. In each case, the facility will function along standard guidelines of substance abuse treatment but with its own particular focus. With this in mind, an outline of the most commonly found treatment facilities follows. In-Hospital Treatment Program Used for: ● ● Detoxification from physical dependence Individuals unable to remain substance-free without supervision Provides: ● Medical monitoring of withdrawal ● Group psychoeducational counseling and introduction to support groups such as AA/NA ● Possibly some social services/case management Length of stay: ● Twelve to twenty-eight days (some may be as brief as three to seven days, depending on insurance coverage) ● May transition into outpatient program Residential Treatment Center Used for: ● ● Long-term maintenance of sobriety/drug abstinence after detoxification Individuals without financial resources in need of halfway house/therapeutic community for recovery Provides: ● ● Necessities of daily living (shelter, nutrition, life-skills training, education) Role modeling, direct reality-based feedback in daily living situations, and promotion of self-discipline Length of stay: ● Three months to two years (usually funded by public or private nonprofit agencies) ● Includes assistance for vocational, social, and emotional transition back into community/family living Outpatient Services Used for: ● ● Transitional treatment after detoxification or residential treatment Individuals with early stage or less severe problems, those not physically addicted, those able to maintain employment during treatment, or those living in a stable and supportive environment ● Individuals unable to afford or not eligible for inhospital or residential treatment programs Provides: ● ● ● Counseling, education, support system for individual, couple, family, or group Possibly some case management, transportation, and socialization Assessment and referral to more intensive types of treatment if needed Length of stay: ● Participation varies according to need and facility; may be once a day, all day, each evening, twice weekly, or once every two weeks; some facilities provide openended “drop-in” groups for occasional support of program “graduates” ● No set limit on length of service use; may be feefor-service based on ability to pay or supported by public or private funds Skills and Training Needed by Human Service Workers To function as a valuable and valued team member in such settings, the human service student must be attentive to the skills needed in the field. Employers expect trained human service practitioners to understand how the health and human services work. Students must, therefore, gain skills in coordinating the services a client receives while being able to help the same client access the services of other agencies as the need arises. Given the multiplicity of needs and problems that the substance abuser presents, the student is obligated to at least know how to access the multiple services required to meet treatment goals developed by the program. Knowing the resources is one thing, but helping the client to choose and use a service is another. Perhaps the most fundamental skill that the student has to offer this troubled client is the skill of professional helping. To be more specific, this is the art of attending: the quiet, focused, other-centered attention that develops an investment in the process of change on the part of the client. Consistent, focused attending can raise a client’s self-esteem; foster, perhaps even repair, trust; and increase feelings of effectiveness. These basic building blocks of a successful life are the inevitable results of the authentic, professional, helping relationship. This is really the central gift at the heart of all the human service practitioner’s efforts. To attend in a way that invites the client into eventual self-direction stands out as the main contribution that can enliven the delivery of care. Students in the field of human services who seek additional proficiency in the area of alcohol and drug abuse may seek specific training in the following skills: ● ● ● ● ● ● 1. Taking an alcohol and drug use history 2. Identifying abuse and dependency, including the withdrawal syndromes 3. Recognizing the complications of drug interactions 4. Using the pertinent resources in the community 5. Imparting accurate information about abusable substances 6. Adapting services to the needs of specific populations A question remains to be addressed: What specific body of knowledge and array of skills would provide the proficiency required to work effectively in the service delivery field of alcohol and drug abuse as an independent professional? For the sake of brevity, this article will only identify and parenthetically discuss major categories of competency. These categories have been grouped under the headings of the Twelve Core Functions of a Counselor, which define and describe a professional human service provider as a specialist in more than forty states. Furthermore, training for these core functions is available at the associate’s, bach-elor’s, and master’s levels of formal education. It is also available to individuals through approved professional workshops, staff development, and continuing education courses. Currently, the federally funded network of Addiction Training Centers (ATCs) and the Center for Substance Abuse Treatment have identified and published the Addiction Counselor Competencies report, which summarizes the knowledge- and skillbased instruction leading to eligibility for certification, registration, or licensing through the aforementioned consortium under the laws of member state boards. These same competencies ensure competent and ethical practice for the protection of the consumers of substance abuse services. Under these guidelines, a specialist/counselor in this field must be able to screen potential clients to determine whether they are eligible and appropriate for admission into the available program. If the person in need meets the established criteria for admission, the counselor will conduct the intake process to ensure the clarity of the emerging treatment contract and development of trust and rapport between the client and the program. At this point, the counselor will orient the client in the ways and means, rules, and structure of the recovery program, providing an inner and outer safe millieu for the start of the work of recovery. With the information gathered so far by all the professionals involved, the counselor will pursue the formulation of an assessment of the individual’s strengths, weaknesses, problems, and needs relevant to the mutual work of change. The focus of both client and counselor becomes the partnership necessary to decide on an individualized treatment plan. Problem identification, rank ordering of changeable problems, time lines of change, and methodologies all become part of the client-approved plan or strategy for change. This plan must be multidimensional. It must include all the domains of human growth and development and all the health and human services as necessary. To this end, the specialist must be a fundamentally sound individual, group, and family counselor. Because of the problems and needs of clients beset by the ravages of chemical addiction, the specialist must be able to coordinate the many services prescribed in the treatment plan. In the course of treatment, there will almost always be at least one crisis. The certified counselor will be able to respond to crises in a way that maximizes safeguarding the client’s rehabilitation and turns the threat to recovery into an opportunity for continuing growth. Throughout the treatment efforts, imparting accurate and germane information about addictions and the road to recovery remains a major function of the trained counselor. When the needs of the client cannot be met by a particular provider or by a particular program, the obligation to refer guides the accessing of other sources of help. This obligation may be exercised from the moment of screening to the time of discharge, aftercare, and follow-up. Finally, in carrying out all of the above functions, including intra- and interagency consultations, the human service specialist in this field of addictions as in all other branches of this profession must be able to accurately keep records and write reports. It is essential that all records and reports maintain overall privacy and confidentiality while being clear, understandable, and complete. Careful handling of information allows for the effective continuum of care for the client’s benefit. Alcohol and drugs are perhaps the most constant variable in the synergistic forces that trouble the lives of human service clients. The arguments in favor of continued specialized training flow from the case management records of service delivery agencies. Whether as a generalist, specialist/counselor, or student practitioner, the goals of the human service worker in helping for alcohol and drug abuse remain ultimately the same. The worker’s purpose is to encourage, assist, and enhance the recovery process with specific skills, knowledge, humanity, and genuine caring. It is to promote a life that will empower the recovering person to be, as an anonymous poet wrote, “tender enough to cry, human enough to make mistakes, strong enough to absorb pain, and resilient enough to come back and try again.” SUGGESTED FURTHER READING Abadinsky, H. (1993). Drug Abuse: An Introduction, 2nd ed. Chicago: Nelson-Hall. Ackerman, R. J., ed. (1986). Growing in the Shadow: Children of Alcoholics. Pompano Beach, FL: Health Communications. Addiction Counselor Competencies (1993). Addiction Training Center Program. Washington, DC: U.S. Department of Health and Human Services. Alcoholics Anonymous. (1976). The Story of How Many Thousands of Men and Women Have Recovered from Alcoholism. New York Alcoholics Anonymous World Services. Bauer, J. (1982). Alcoholism and Women: The Background and the Psychology. Toronto: Inner City Books. Boaz, D. (1993). Embrace Your Child-Self, Change Your Life—A Workbook. Seattle: Lane’s End Publishing. Chandler, M. (1987). Whiskey’s Song: An Explicit Story of Surviving in an Alcoholic Home. Pompano Beach, FL: Health Communications. Chappelle, F., T. G. Durham, D. Lauderman, D. J. Powell, L. Siembad, and N. Simonds, eds. (1992). Counselor Development: A Training Manual for Drug and Alcohol Abuse Counselors. Clancy, J. (1996). Anger and Addiction: Breaking the Relapse Cycle. Madison, CT: Psychological Press. Clayton, L., and R. Van Nostrand (1993). The Professional Alcohol and Drug Counselor Supervisor’s Handbook. Holmes Beach, FL: Learning Publications, Inc. Clemmens, M. C. (1997). Getting beyond Sobriety: Clinical Approaches to Long-Term Recovery. San Francisco: Jossey-Bass. Columbia Assessment Services, Inc. (1996). Role Delineation Study for Alcohol and Other Drug Abuse Counselors. Raleigh, NC: ICRC/AODA. Cultural Competence for Evaluators: Guide for Alcohol and Other Drug Abuse Practitioners Working with Ethnic and Racial Communities (1992). DHHS-A&DA and MH Administration. Doweiko, H. F., (1993). Concepts of Chemical Dependence, 2nd ed. Pacific Grove, CA: Brooks/Cole. Dusek, D. E., and D. A. Girdano (1993). Drug: A Factual Account. New York: McGraw-Hill. Estes, N. J., and M. Heinemann (1992). Alcoholism: Development, Consequences and Interventions. St. Louis: Mosby. Evans, K., and J. M. Sullivan (1990). Dual Diagnosis: Counseling the Mentally Ill Substance Abuser. New York: Guilford. Evans, K., and J. M. Sullivan (1995) Treating Addicted Survivors of Trauma. New York: Guilford. Flores, P. J. (1988). Group Psychotherapy with Addicted Populations. New York: Haworth. Freeman, E. M. (1992). The Addiction Process: Effective Social Work Approaches. New York: Longman. Galanter, M. and H. D. Kleher (1994). Textbook of Substance Abuse Treatment. Washington, DC: American Psychiatric Press. Goode, E. (1993). Drugs in American Society. New York: McGraw-Hill. Goodwin, D. (1975). Is Alcoholism Hereditary? New York: Oxford University Press. Hanson, G., and P. Venturelli (1995). Drugs and Society. Boston: Jones and Bartlett. Herdman, J. W. (1994). Global Criteria: The 12 Core Functions of the Substance Abuse Counselor. Holmes Beach, FL: Learning Publications. Inaba, D. S. and W. H. Cohen (1993). Uppers, Downers, All Arounders: Physical and Mental Effects of Psychoactive Drugs. Ashland, OR: CNS Productions, Inc. Jacobs, M. R. (1981). Problems Presented by Alcoholic Clients: A Handbook of Counseling Strategies. Toronto: Addiction Research Foundation. Fourth Force in Counseling. Vol. 70. Khantzian, E. J., K. S. Halliday, and W. E. McAuliffe (1990). Addiction and the Vulnerable Self: Modified Dynamic Group Therapy for Substance Abusers. New York: Guilford. Kinney, J. K. (1992). Clinical Manual of Substance Abuse. St. Louis: Mosby. Kinney, J. K., and G. Leaton (1995). Loosening the Grip. St. Louis: Mosby. Kleinman, M. A. (1992). Against Excess: Drug Policy for Results. New York: Basic Books. Kulewicz, S. F. (1990). The Twelve Core Functions of a Counselor. Marlborough: Counselor Publications. Lawson, G., and A. Lawson (1989). Alcoholism and Substance Abuse in Special Populations. Rockville, MD: Aspen. Leonard, L. S. (1989). Witness to the Fire: Creativity and the Veil of Addiction. Boston: Shambala. McNeece, C. A., and D. M. DiNitto (1994). Chemical Dependency: A Systems Approach. Englewood Cliffs, NJ: Prentice-Hall. Mark, L., J. Olesen, and J. Fallon (1993). A Manual for Chemical Dependency and Psychiatric Treatment. Santa Fe, NM: CL Productions. Miller, Norman S. (1995). Addiction Psychiatry: Current Diagnosis and Treatment. New York: Wiley-Liss. Roebuck, J. B., and R. G. Kessler (1972). The Etiology of Alcoholism. Springfield, IL: Charles C. Thomas. Roy, O., and C. Ksir (1993). Drugs, Society, and Human Behavior. St. Louis: Mosby. Royce, J. E. (1989). Alcohol Problems and Alcoholism: A Comprehensive Survey. New York: Free Press. Steinglass, P. (1987). The Alcoholic Family. New York: Basic Books. Thombs, D. L. (1994). Introduction to Addictive Behaviors. New York: Guilford. Vaillant, G. E. (1983). The Natural History of Alcoholism. Cambridge, MA: Harvard University Press. Ward, D. A.. (1983). Alcoholism: Introduction to Theory and Treatment. Dubuque, IA: Kendall/Hunt. Washton, A. M., ed. (1995). Psychotherapy and Substance Abuse. New York: Guilford. SPECIAL FOCUS FEATURE: A SOCIAL NORMS APPROACH TO REDUCTION OF ALCOHOL AND DRUG ABUSE AMONG COLLEGE STUDENTS FRANKLYN M. ROTHER HISTORICAL OVERVIEW During the late 1980s colleges and universities experienced a growing number of serious alcohol and drug problems among students both on and off campus (Haines, 1996). Bingedrinking rates varied greatly according to the individual campus culture, yet headlines in the national media highlighting deaths and injuries during campus parties, class breaks, and other social events propelled this problem into the national spotlight. College students were just beginning to be recognized as an “at-risk” group for alcohol and drug abuse. Prevention and education program initiatives funded by FIPSE (Fund for the Improvement of Postsecondary Education) grants and New Jersey State Department of Health had produced “disappointing outcomes” in terms of reducing use and abuse of alcohol and drugs among college students (Haines, 1996). The experiences of higher education institutions conducting and publishing research in this area were replicated in the results of prevention and education awareness programs at colleges and universities throughout the state of New Jersey (Rowan, 2001). In 1985, a Monmouth County addictions services coordinator and a State Department of Health addictions director approached the coordinator for the human service program at Brookdale Community College to propose the development of courses in addiction studies for students seeking careers in the addictions field. They also requested that a representative of the college participate in a statewide task force to discuss the college’s potential involvement in professional training efforts, and to report on campus prevention and education efforts. In 1987, a task force supported by the Division of Alcoholism of the New Jersey State Department of Health, consisting of representatives from sixteen colleges and universities, evolved into New Jersey Higher Education Consortium on Alcohol and Other Drug Abuse Prevention and Education (Rowan). The Brookdale Community College representative became the first elected president of the statewide consortium. In 1989, the Southern and Northern Regional Consortia were established through FIPSE grants, and in 1993, a FIPSEsponsored regional consortium was formed in central New Jersey. During this era, college administrative practices favoring disciplinary intervention actions, as well as general acceptance of alcohol abuse as a “rite of passage” for college students, impeded prevention program efforts. The members of the four New Jersey consortia recognized that public acceptance of the traditional view of college student drinking behavior could be countered only by a structured, specific, and persistent informational program. College students needed to be recognized as an “at-risk” population for drug and alcohol abuse (Rowan). Across the country, prevention interventions at colleges were meeting the same public resistance, with the same tragic effects. A PARADIGM EMERGES During the 1980s, Wesley Perkins and Alan Berkowitz of Hobart and William Smith Colleges (HWS) began to study the linkage between student perceptions of their peers’ drinking behavior and students’ self-reports of their own alcohol consumption. As these researchers collected data from other institutions across the country, evidence emerged indicating that mis-perceptions of drinking norms greatly influenced individual alcohol abuse. Perkins and Berkowitz theorized that discussing student misperceptions and presenting authentic data on college student drinking behavior could reduce actual highrisk drinking behavior (Berkowitz and Perkins, 1986). The research conducted by Perkins and Berkowitz on misperceptions of drinking norms demonstrated a relationship between actual alcohol use reported by students and their misperceptions of the amount their peers used. They found this relationship between misperceptions and behavior on every campus studied, and they concluded that a “reign of error” led to increased negative drinking behavior. Thus, “imaginary peers” influenced students’ drinking behavior because of the belief that “everyone was doing it!” (Berkowitz, 1998). This self-fulfilling prophesy led to an assumption that binge drinking was the peer norm among college students, thus promoting actual increases in this behavior. High-risk drinking was found to have greater prevalence ● ● ● ● ● ● ● ● in the Northeast region of the United States; at smaller colleges without graduate programs; among single undergraduates, 17–24 years old; in residential student housing environments; among student bodies with low religious participation and affiliation; at colleges with predominantly students of European American descent; at colleges oriented toward sports and athletic events; at institutions with fraternities and sororities. (Perkins, 2002) In addition to the physiological effects of misuse of alcohol among students, other alcoholrelated problems surfaced in the studies conducted by Perkins and Berkowitz, including the following: ● ● ● ● ● ● ● accidents while intoxicated; DWI/DUI convictions; interference with other students’ academic pursuits and sleep; attempts to make unwanted sexual contact; unprotected sexual activity; violent behavior; destruction of property. The consortium decided to adopt a social norms approach in the form of a media campaign called “Know It!” COMPONENTS OF A SOCIAL NORMS PROJECT Brookdale Community College implemented a Social Norms Misperceptions Campaign in 1998–1999. The campaign has been expanded yearly as new activities were added. Currently, Brookdale’s social norms project includes the following components, which will be explained individually: ● ● ● ● ● ● ● ● ● ● ● ● ● The “Hunt” Test/survey Campus banners Special events Campus newsletter and student publications Blues Net/Cable Curriculum infusion and overheads Faculty and staff training and involvement Peer educator training Non-alcoholic happy hours Website banners Campaign materials Peer norms survey ● Evaluation The Hunt In August 2001, the grant director met with a small committee to determine a strategy for the Social Norms Campaign. The college marketing director offered a singular proposal for the fall semester: a contest or “Hunt” for facts about student drinking behavior. A prize would be awarded to each student who completed The Hunt: a T-shirt imprinted with the words, “I Won the Know It Hunt.” Signs were posted around the campus with social norms statistics about Brookdale Students. One sign was placed in three high-traffic areas. During orientation week and the opening of the semester, approximately 6,000 flyers were distributed to students. Faculty members continued to distribute instructions for participating in The Hunt throughout the fall semester and into the spring 2002 semester. Test/Survey During the spring semester, The Hunt became a search for “factoids” about binge drinking. Faculty members were recruited to distribute more flyers, newsletters, and the T-shirts. Nearly thirty faculty members participated, but only about a half dozen consistently distributed every flyer and newsletter in their classes prior to implementing The Hunt for the “factoids” that would lead to winning a T-shirt. Distribution of the same materials also continued through the efforts of two college work study students, a faculty member, and other students. At least 5,000 additional flyers and newsletters were distributed during the first half of the spring semester. Campus Banners Two “Know It!” banners, each 50 feet long and 3 feet high, were produced and raised over the library entrance and the college commons during the spring semester. The banners supplemented “The Hunt” begun in the fall. These large banners remained up until midApril. Special Events A faculty member from the psychology department organized a group of students in the spring semester to carry a banner stating “Free Sex,” with one student dressed in a beer can costume and several other students clustered around her. The group spent two hours walking around the campus distributing flyers and newsletters about misperceptions regarding binge drinking among Brookdale students. This event attracted much attention and controversy. Some faculty members reported that their afternoon classes on that day were buzzing about the event. Discussion focused on its “taste” or “lack thereof,” as well as the use of a message about “free sex” to bring attention to a different message about binge drinking. Campus Newsletter and Student Publications Dr. Eugene DeRobertis of Brookdale’s psychology department researched and published a newsletter on the Social Norms project, entitled The Sobering News. The newsletter was printed on a single sheet of brightly colored paper and published biweekly from October to April. The “factoids” for the second Hunt were included in several of the newsletter publications (The Sobering News) so that students could find the answers and win the Tshirt. Between 500 and 1,000 copies of each issue were published and distributed. The Student Life weekly publication Brookdale Happenings regularly includes “Know It!” factoids. The Stall, the student newspaper, has published a story each year about the Social Norms project. Blues Net/Cable The Brookdale Blues Net/Cable Station broadcasted 15-second “factoids” concerning misperceptions about alcohol use among students. These announcements were broadcast continuously during the fall and spring. At approximately 50 TV sites throughout the campus, Blues Net broadcasts included one “factoid” every few minutes. The cable station broadcasts occur during breaks in the broadcast of course media instruction and other productions. The campus radio station also offered public service announcements. Curriculum Infusion and Overheads Over the years learning modules about Social Norms Theory have been developed in psychology, sociology, history and education. Overheads were produced for seventy-five faculty members teaching introductory psychology, sociology, human service, and criminal justice courses. The overheads summarized the “factoids” about binge drinking and provided information about the social science research method utilized, and explain “misperceptions theory” in relation to attribution theory. Most faculty members distributed the Social Norms facts flyers without much discussion. Some faculty members reported that students wanted to discuss the survey messages. Students often questioned the survey results, disputed the definition of binge drinking, and suggested that the “factoids” did not reflect their experiences. Distribution of flyers by faculty members during class sessions appeared to bring about greater depth of discussion that was lacking when posting the messages around campus. Some faculty members were interested in their students’ reactions, and several questioned the timing of the surveys in the early part of the spring semester and speculated on the impact that certain holidays and testing periods might have had on the survey results. Often faculty members reported critical class discussion that demonstrated relevant application of course content to the survey facts. Faculty and Staff Training and Involvement During the fall 2000 adjunct meeting, part-time faculty in the psychology department were introduced to curriculum infusion materials developed by full-time faculty. The Peer Norms modules are correlated with the Biology of the Brain, Attribution Theory, Social Science Statistics, and Perception and Sensation. Feedback from the faculty who used these materials indicated that students engaged in lively discussions about the meaning of the survey results and the “real” effects of binge drinking. Continuation of the “Know It!” campaign has led to ongoing dialogue between faculty and students regarding the meaning of the messages. One of the messages, concerning drinking at athletic events, was particularly controversial. There were concerns about the perception that students drink at these events. These “Know It!” posters were removed from areas in and around athletic facilities. Peer Educator Training Recruiting students and training them as peer educators can assist the effective implementation of a Social Norms campaign. This core student group participates in the oncampus distribution of campaign materials and related activities. Student interest has been high and consistent in some years and low and inconsistent in others. Non-Alcoholic Happy Hours Five Non-Alcoholic Happy Hours are held during the year. Between 200 and 400 students, faculty, and staff members attend each event. Flyers and newsletters are distributed, together with food and non-alcoholic beverages. These Non-Alcoholic Happy Hours garner the most consistent attendance of all campus activities. Literature distributed at each event includes information concerning drug/alcohol abuse prevention and the role of the Social Norms Project. This activity has also generated interest in student clubs regarding participation in abuse prevention activities. It also serves as a way of recruiting students into the Human Service club, where they can be trained as peer educators. Materials concerning the NonAlcoholic Happy Hours are imprinted with the “Know It!” logo and, where possible, one of the misperception messages. Website Banners Production of website banners has been delayed because of a number of technological changes at the college and questions about the “ethics” issues that might have to be addressed in promoting these messages. Campaign Materials “Factoids” highlighting aspects of the campus peer norms survey of Brookdale students are printed on posters and flyers distributed in the classrooms of participating faculty and throughout the campus. Thousands of flyers are distributed in these classrooms. Some faculty members have presented students with pens, highlighters, stress balls, or keychains as rewards for class participation. The “Know It!” campaign, and other prevention messages appear on these materials. Peer Norms Survey Peer norms surveys are collected from the introductory general education courses during the spring semester of each year. Approximately 500 surveys are collected in a “convenience survey” of students during their freshman year. Faculty members have been very cooperative in supporting the project. Evaluation In the 2000–2001 Social Norms campaign evaluation, Dr. Wesley Perkins indicated that Brookdale Community College had basically flat-lined in the exposure to the message categories (going up by a few percentage points). The data remained the same from year to year in “actual use reported” and “perceptions of peers’ use,” with one notable increase in “perceptions of peer drinking in the last two weeks.” Dr. Perkins pointed out that the two categories of “exposure to the message” revealed that 55 percent of the students were somewhat familiar with the Social Norms campaign, with only 30 percent reporting nonexposure. We can work toward increasing this exposure. Looking at the data more closely, members of the Social Norms Project found that Brookdale students tended to cluster their own use below the “binge drinking” thresholds, with 80 percent reporting consumption of two drinks or fewer in a row in the last two weeks. This suggests that the low thresholds of “actual drinking” among our students (particularly binge drinking) makes it more difficult to achieve reductions. Cross-tabulation report data from 2000 and 2001 actually demonstrated an increase of students reporting consumption of fewer than three drinks, from 78.9 percent in 2000 to 80.5 percent in 2001. When you add in the percentages of “less than five drinks,” with five drinks being the binge drinking threshold, there is a wider gap: 88.7 percent (2000) versus 91.6 percent in (2001). In 2000, 3 percent were invalid responses, the remaining 97 percent of responses were at or above the binge threshold and in 2001 2 percent were invalid responses with the remaining 98 percent of responses above the binge threshold. This is good news! More than two-thirds of the students reported “actual use” at or below the binge threshold. Over 50 percent believed that their friends consumed five or fewer drinks in a row at a party. CONSIDERATIONS AND CONCLUSIONS Implementing an effective social norms project requires the following steps: ● ● ● ● ● Collecting baseline data. Developing a message that highlights non-binge norms. Ensuring credibility of the message source. Delivering the message to the target student population. Supporting message retention within the target student population. To implement the above steps, human service educators involved in a social norms project must have a campus environment with the following elements: ● 1. Leadership support, from the college’s president to the deans ● 2. Involvement of key campus administrative personnel: ○ Dean of Students ○ Director of Student Life ○ Health Administrator ○ Campus Police Chief ○ Director of Marketing ○ Public Relations Administrator ● 3. Commitment from faculty members to serve in the following capacities: ○ Advisors and/or task committee members ○ Participants in classroom activities ○ Presenters at conferences and workshops ○ Developers of materials ● 4. Involvement and participation of students in the following roles: ○ Peer educators ○ Advisors on what works ○ Participants in social norms activities ○ Messengers carrying the “Know It!” Facts Social norms projects also require consistent, substantial, and sustained resources. Minigrants to New Jersey Statewide Consortia member colleges through the New Jersey Department of Health and Rowan University were reduced by one-third in 2002–2003 due to state budgetary restraints in the current economic climate. The college contributes substantial financial support through the Marketing and Student Life departments, and is expected to continue that support. Large commuter colleges in high population markets with a diverse student population face especially difficult challenges in maintaining a focused and sustained labor-intensive media campaign. REFERENCES Annual Grant Reports of Brookdale Community College—Center for Addictions Studies— unpublished. Berkowitz, A. D. (1998). “The Proactive Prevention Model: Helping Students Translate Healthy Beliefs into Health Actions.” About Campus, September/Octover 1998. Berkowitz, A. D. (2002). Responding to the Critics: Answers to Common Questions and Concerns About the Social Norms Approach. The Report on Social Norms: Working Paper #7. Little Falls, NJ: PaperClip Communications. Berkowitz, A. D. & Perkins, H. W. (1986). Problem Drinking Among College Students: A Review of Recent Research. Journal of American College Health. Haines, M. P. (1996). A Social Norms Approach to Preventing Drinking at Colleges and Universities. Newton, MA: The Higher Education Center for Alcohol and Other Drug Prevention, Education Development Center, Inc. Perkins, H.W. (2002). Social Norms and the Prevention of Alcohol Misuse in Collegiate Contexts. Journal of Studies on Alcohol, Supplement 14: 164–172. Rother, F. (2001). Annual Grant Report-Brookdale Community College. Lincroft, NJ: Center for Addictions Studies, Brookdale Community College. Rother, F. (2002). Annual Grant Report-Brookdale Community College. Lincroft, NJ: Center for Addictions Studies, Brookdale Community College. http://www.edc.org/hec/socialnorms/theory/html http://www.rowan.edu/open/depts/cas/tabacco_social http://www.socialnorm.org 
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