Monday, December 23, 2013

You Can't Be an Alcoholic If You're in College, Right?

Have you heard this one before? It's not uncommon to find it on the lips of college students. For some it's almost a rallying cry.

The sheer prevalence of binge drinking and the youth of college drinkers can mislead students into thinking that heavy drinking is just a college thing, a rite of passage that they'll mature out of, and that it therefore poses little risk to them in the short or long term.

For many students that may be true. But some students won't outgrow their dangerous drinking habits, while others are already suffering the negative consequences of excessive drinking.

Young Adults and Alcohol Dependency

Contrary to college lore, there is no minimum age for alcoholism. Sadly, many young adults do meet the criteria for alcohol dependency and abuse. A 2002 study found that 31% of college students abused alcohol and 6% could be diagnosed with alcohol dependency.

A 2007 study identified five "subtypes" of alcohol dependency: young adult, young antisocial, intermediate familial, functional, and chronic severe. Only the chronic severe abusers fit into popular stereotypes of what most of us associate with alcohol abuse, yet they are the smallest percentage of problem drinkers.

Shockingly, young adults made up the largest subtype (31.5%), according to the study. They are also the least likely to seek help for their drinking.

In an interview with Psychiatric News, the researchers themselves expressed surprise with their finding "that so many of the individuals who met diagnostic criteria for alcohol dependence were young adults [in their early 20s]."

Young adult drinkers drank less frequently than other subtypes, but when they drank, they tended to binge (73% of the time). Since over a third of young adult drinkers are still in school, the researchers suggested that "they may be an unrecognized part of the college drinking problem."

More recently, the American Psychiatric Association (APA) has changed how they define substance use disorder.

Previously, the APA treated substance abuse and dependency as an either/or scenario: either you had a problem or you didn't. In contrast, the newest Diagnostic and Statistical Manual of Mental Disorders (DSM-5) treats substance use disorders on a continuum from mild or moderate to severe.

As Dr. Charles O'Brien explained, "In DS- 4, we had essentially two diagnoses: one was abuse and the other, dependence...By doing a lot of research, we've discovered addiction doesn't work that way. It starts off mild at the beginning and becomes gradually more severe."

There was some controversy over the new standards. Critics claimed as many as 40% of college students could end up being labelled as alcoholics if the DSM 5's new diagnoses are followed.

This increase in diagnoses, critics argued, could do more harm than good. Rather than encouraging students to seek help, the diagnosis might lock them into the identity of an alcoholic or addict, causing them to act and think accordingly.

"And that poses a huge problem," wrote Maia Szalavitz for Time,  "particularly for adolescents and young adults with mild problems who may be pushed to adopt an addict identity and to see themselves as having no way to control their drinking or drug use if they ever 'relapse'. Rather than empowering those who do have control to use it, these programs essentially tell kids that if they ever have just one drink or puff on a joint, they’re lost."

But if telling students that they're problem drinkers doesn't work, then what other solutions are available?

Drinking Problem versus Problems with Drinking

Some researchers have suggested another approach that avoids the labels associated with substance use disorders. The Harvard School of Public Health, for example, has recently released a series of books that addresses the grey area between normal and problem drinking.

The series is called the "almost effect" and discusses circumstances where individuals may experience negative consequences from their drinking, such as poor sleep, depression, a drop off in work performance, or relationship troubles, but may not qualify for a formal diagnosis of alcohol dependency. They call these individuals "almost alcoholics."

Though they may not be formally diagnosed for a substance use disorder, they may nonetheless benefit from counseling or a brief intervention in order to help them see the connection between their drinking and its consequences.

Dr. Joseph Nowinski, one of the series' authors, explains that the decision that your drinking is a problem "does not imply that you admit to having a 'diagnosis', or that you are 'mentally ill'. Rather, it simply means that you have decided to make some changes in your lifestyle in the interest of your overall health."

In other words, perhaps the problem isn't that students think you can't be an alcoholic in college, but that they're thinking in terms of alcoholic or not alcoholic. Such binary thinking prevents them from seeing how their drinking is beginning to cause them problems and from doing something about it. Even if it's not an official diagnosis and even if it doesn't lead to problems later in life, college drinking can still be a problem now.

Tuesday, December 17, 2013

Confidentiality vs. Student Safety

A victim's request for confidentiality is a problem that schools often grapple with under the difficult circumstances of a sexual assault case. In a previous post we discussed how FERPA allows public disclosure of the outcome of student conduct hearings when accused students are found responsible for sexual assault. But what about a victim's request for confidentiality when the report is made? Does the school have an obligation to respect the victim's wishes? The following case provides one example of how following a school's reporting policies can have unintended results.

Seventeen-year-old Anna Livia Chen told her residential assistant she would not participate in Swarthmore College's Acquaintance Sexual Assault Prevention workshop for incoming freshmen. As a childhood sexual abuse survivor, Anna said it would be too emotionally difficult for her to listen to other survivor's stories, which is a standard part of the program.

Anna was abused when she was a junior high school student in California. Given that the incident occurred years before and thousands of miles away, Anna and her RA didn't think this needed to be reported to the Title IX coordinator. Swarthmore's sexual assault policy "applies to off-campus conduct that is likely to have a substantial adverse effect on any member of the Swarthmore College community or Swarthmore College … ."

However, a facilitator who contacted Anna to arrange a private session told the RA that Swarthmore's new interim policy requiring all college employees to report information about sexual assault to Public Safety applied to Anna's case. The RA complied by reporting the incident to Swarthmore's Title IX coordinator, but stressed that Anna "was no longer in any danger whatsoever" and had "all the support" she needed from her family, friends, and therapist back home.

The Title IX coordinator, in turn, was required by the school's policy to report the information to the school's general counsel who advised that under Swarthmore's policy the abuse must be reported to the Pennsylvania child abuse hotline. It should be noted that pending Senate Bill 31 would add postsecondary school employees to the list of mandatory child abuse reporters in Pennsylvania.

When she was contacted by child protective services, Anna told CPS that she did not want them to investigate her case. Later, on Anna's 18th birthday, CPS informed her that it was legally required to notify local police about her case.

Swarthmore's Policy Goal

According to Swarthmore's secretary of college, the reporting policy that set this chain of events into motion was meant "to not only meet the letter and spirit of the law, but to ensure that our policies assure the safety of our students, provide meaningful support to victim/survivors, and enable us to respond with the highest levels of fairness, compassion, and respect for privacy."

But this is how Anna described her experience: "So much of my time was being drained by having meetings with various administrators and resources, not to mention the emotional energy it took. I had no time for self-care, which is something that I desperately needed with everything that was going on. I am still frustrated that this process got to a point where it overtook my life in the way that it did."

Now Anna is working on changing Swarthmore's policy and procedures to prevent other victims from having to go through the same experience.

Title IX and Victim Confidentiality

What does Title IX require schools to do to protect a sexual assault victim's confidentiality? First, Anna should have been told that school employees are required to report information they receive about sexual assault. If she wanted the information to remain confidential, she should have been referred to confidential resources, such as religious and professional counselors.

Second, Title IX requires schools to respect a victim's request for confidentiality in a sexual assault investigation and response except when it interferes with the school's ability to stop harassment and protect the safety of its students. The OCR's 2001 Handbook explains: 
In all cases, a school should discuss confidentiality standards and concerns with the complainant initially. The school should inform the student that a confidentiality request may limit the school’s ability to respond … If the student continues to ask that his or her name not be revealed, the school should take all reasonable steps to investigate and respond to the complaint consistent with the student’s request as long as doing so does not prevent the school from responding effectively to the harassment and preventing harassment of other students.

In its 2008 publication, "Sexual Harassment: It's Not Academic," the OCR listed three factors that must be weighed against the victim's request for confidentiality in light of the school's "responsibility to provide a safe and nondiscriminatory environment for all students":
·              seriousness of the alleged harassment;
·              age of the harassed student; and
·              other complaints that the same individual has harassed others.
Additionally, state or local laws may require schools to report incidents to the police.

In addition, the April 2011 "Dear Colleague Letter" included a fourth factor that must be weighed against the victim's request for confidentiality: "the alleged harasser’s rights to receive information about the allegations if the information is maintained by the school as an 'education record' under [FERPA]." The bottom line is that the victim should be told if the school cannot ensure confidentiality.

The OCR's latest official word on victim confidentiality is found in the Resolution Agreement between the OCR and the University of Montana. As part of that settlement agreement, UM adopted a policy with "an assurance that the University will keep the complaint and investigation confidential to the extent possible." Below is UM's policy protecting victim confidentiality:

UM's Policy 507 – Title IX adopted May 25, 2012

IV. Confidentiality of the Alleged Victim:

Student confidentiality will be respected to the extent possible. Even if the alleged victim requests confidentiality or asks that the complaint not be pursued, a campus is required to:
A. take all reasonable steps to investigate and respond to the complaint to the extent possible consistent with the alleged victim’s wishes;
B. notify the alleged victim that the failure of the alleged victim to pursue a complaint may limit the campus’ ability to fully address the matter; and
C. report the incident or assault to local law enforcement authorities if a health or safety emergency as defined by state or federal law is found by the campus to require such reporting.


To summarize, these are the essential points that college employees need to know about a victim's confidentiality:
·              if you expect to or do receive information about sexual assault, explain that you need to make a report to the school's Title IX coordinator
·              maintaining confidentiality may limit the school's ability to fully respond to the alleged assault
·              students who desire a confidential conversation should meet with a counselor or other confidential resource
·              if individuals prefer no action be taken at that time, let them know you will share their preference with the Title IX coordinator
·              explain to the victim that their request for confidentiality will be respected to the extent possible, however:
o               the school must respond to sexual assault effectively and prevent harm to other students
o               the accused student may have a right to receive information about the allegations if it is included in the school's education records

Finally, if disciplinary action is not possible because the victim insists on confidentiality, the OCR says the school "should pursue other steps to limit the effects of the alleged harassment and prevent its recurrence." Those "other steps" are education and prevention, such as defining sexual misconduct, deciding what the school's policies and disciplinary procedures are, and possible sanctions for violating the school's rules of student conduct.

Monday, December 9, 2013

Why Are Students So Unhealthy during Finals Week?

It's that time of the year: the trees are all bare, a coat of frost shines on the sidewalk, the smell of  anxietys hangs in the air, and sleep-deprived students lumber around campus unshowered and unshaven. Ah, finals season!

Most of us intuitively understand that stress is connected to students' failure to fulfill even the most basic self-care during finals, but why? After all, students usually don't have class or other commitments during finals week, so they should be able to focus exclusively on studying without ignoring the basics like brushing their teeth and getting enough to eat.

Indeed, one might think that faced with the intense pressure of finals, students would renew their focus and effort. In fact, research suggests otherwise, demonstrating how stress alters the way we make decisions.

When stressed out we tend to focus on short-term rewards and pleasurable outcomes of a decision while ignoring the less savory and long-term consequences. That's why it's so hard to resist eating that pint of ice cream in your freezer after a tough day or to forgo buying that new pair of shoes you covet but can't afford after a miserable meeting at the office.

In other words, it is exactly because students have to study for five finals that a friend's invitation to party tempts them so much. The stress causes them to focus on the immediate reward of going to the party (socializing and drinking) and not the downside of losing a night's sleep to late night carousing (hang over and poor grades).

Stress also makes it more difficult for students to connect bad decisions to their consequences. Even if students go out the night before a test, stress will help them remember the pleasurable experience of socializing and drinking and forget the fact that they were horribly hung over for the exam. This is one reason why researchers also link stress to substance abuse and addiction. Under stress, you focus on the pleasures of the drug and lose sight of the negative consequences.

Am I saying that stress makes us short-sighted and irresponsible? Not quite. Another recent study shows that under stress some people are actually more likely to sacrifice their time to help someone they care about. The research supports the uplifting hypothesis that humankind's default setting is to self-sacrifice (when it comes to close relationships). This is well and good for our species, but it also explains why some harried students take on big social commitments during finals week when they should be making more time for themselves.

All this rather paradoxically suggests that exactly when we need to buckle down and get the most done, we have the fewest cognitive resources to do so because stress saps our willpower. Given this fact, a nudge in the right direction might help students keep their cool and improve their grades.

A few common tips worth reminding students about:

Exercise (like walking) has long been touted as an important stress reliever and memory aid. Recent studies suggest that regular exercise also boosts creativity.

Mindfulness and meditation are also good ways to decompress and still the turbulent waters of daily life.

Also remind students to wait until after finals to make big decisions. The simple act of waiting can help students make better, more reflective choices.

Monday, December 2, 2013

Social Media and Sexual Assault

Audrie Pott's sexual assault was just the beginning of her nightmare.  On Sunday night of Labor Day Weekend, Audrie passed out drunk at a friend's house.  Three male classmates took her to an upstairs bedroom, where they stripped her down to her underwear, drew on her naked body in green marker, and sexually assaulted her.  They also took pictures.  Audrie spent the next eight days frantically trying to find out how far those pictures had spread, and enduring the abuse of classmates who had already seen them.  Then she hung herself.

Sadly, this narrative of the tragic results of the combination of sexual assault, bullying, and social media is by now a familiar one. 17-year-old Rehtae Parsons hung herself after a year of bullying prompted by the distribution of photos showing her rape. The nationally infamous rape case in Steubenville, Ohio, in which two high school football players were convicted of sexually assaulting a sixteen-year-old girl, featured similar bullying and documentation of the assault on social media. Two thirteen-year-old girls were called "whores" on Twitter after a pair of eighteen-year-old football players were arrested for statutory rape.

In an age when everything that's newsworthy, and plenty that's not, is Tweeted, Facebooked, or Instagrammed, it may come as no surprise that social media has invaded even this particularly ugly aspect of our lives. However, sexual violence activist and expert Dr. Rebecca Campbell, whose research we've written about in the past, suggests that the relationship between sexual assault and social media may be deeper and more disturbing. "Sexual assault is a crime of power and dominance," she says. "By distributing images of the rape through social media, it's a way of asserting dominance and power to hurt the victim over and over again."

Of course, as the cases described above demonstrate, the continued trauma endured by sexual assault victims through social media isn't perpetrated solely by their attackers. Any number of their peers share photos and videos or use social media as a platform from which to bully victims, often for having reported the assault. In this way, social media discourages victims from reporting these crimes by facilitating a reaction to assault comparable to the secondary victimization suffered at the hands of law enforcement that we've previously written about. Such bullying seems to be both a symptom of and a contributing factor to a society that blames victims for their sexual assaults.

Yet the very photos and videos whose dissemination can torture victims of sexual assault can also lead to convictions for their assailants. Indeed, visual images like these can be essential to securing a criminal conviction in cases of sexual assault, where muddled recollections and conflicting accounts can make it very difficult to prove a perpetrator's guilt beyond a reasonable doubt.

Moreover, some of the very aspects of social media that make it such a virulent breeding ground for bullying also make it the ideal platform for survivors to find communities where they can share their stories and receive much-needed support.  The anonymity of such spaces makes it possible for survivors not yet ready to reveal their experiences to friends and family to share their stories, allowing them to spread awareness and, in some cases, help the healing process.

Perhaps its most important aspect though is the potential role social media plays to prevent assaults in the first place by changing the culture that tolerates and indeed encourages such behavior. In an article for the Fordham Observer, Alissa Fajek argues that the outrage over cases like Steubenville, often fostered and spread via social media, can help to spread awareness and begin to change that toxic culture.

Clearly, the story of social media and sexual assault is more complicated than social media simply being used as a platform to fight sexual assault or as an extension of the crime itself. Because, like any other tool, the person using it must decide whether social media is used to hurt or to heal. Educating students about the enormous impact their decisions have on the survivors of sexual assault suggests the importance of harm-prevention training. The more students know about social media's effect on sexual assault victims — the damage it can cause or, alternatively, its power to solve the problem of sexual assault — the better equipped they'll be to use social media in way that heals instead of hurts.