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On-Campus Recovery Programs: Friend or Foe?

These are young people with a range of issues related to drinking who will all now embrace the one true 12-step philosophy, including that they can no longer control their own destinies when it comes to substance use.
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Alan Marlatt, a long-time colleague who died recently, was a leading harm reduction psychologist. Alan developed -- and repeatedly showed the effectiveness of -- the collegiate Alcohol Skills Training Program.

As its name implies, the ASTP teaches young people how to consume alcohol more safely and wisely. There are several reasons Alan selected college students as a good group to teach drinking skills to. In the first place, almost none display the traits of full-blown alcoholism and, in the second, a large majority outgrow their collegiate heavy drinking. So, Alan reasoned, to teach kids at this age they are alcoholics who must abstain for the rest of their lives -- which might cover seven decades -- makes little sense.

This hasn't stopped the growing phenomenon of on-campus recovery communities, where 18- to 22-year-olds are encouraged to declare themselves alcoholics, turn themselves over to recovery gurus and vow forevermore never to drink or consume other psychoactive substances. They don't interact with the rest of the student body on campus. Instead, they busy themselves in sober activities and surround themselves with fellow recovering students.

Ever see the 1956 Don Siegel cult classic, "Invasion of the Body Snatchers," where hero Kevin McCarthy discovers pod people are taking over the identities of everyone in town -- including his girlfriend? The pods are strictly limited in their range of emotional responses -- they all seem to be programmed by the same source.

It seems that we are intent on recreating this experience with a new group of pods. These are young people with a range of issues related to drinking who will all now embrace the one true 12-step philosophy, including that they can no longer control their own destinies when it comes to substance use. For that, they must rely on a higher power and the support of their fellow alcoholics in AA.

I watched as NBC's "The Today Show" several Sundays ago made the point that we are finally coming to grips with youthful drinking by no longer concerning ourselves with how kids learn to drink but only in making sure they, or a least problem drinkers, never drink at all. Prominently featured on the segment was a shot of AA's "Big Book," the only treatment resource referenced. Several experts commended this program as a great step forward.

I don't see it that way. And I have reason to be dubious. Based on the most comprehensive alcoholism survey ever conducted, the National Institute on Alcohol Abuse and Alcoholism placed on its website a piece titled: "Alcoholism Isn't What It Used To Be":

The realization dawned gradually as researchers analyzed data from NIAAA's 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). In most persons affected, alcohol dependence (commonly known as alcoholism) looks less like Nicolas Cage in "Leaving Las Vegas" than it does your party-hardy college roommate or that hard-driving colleague in the next cubicle.

"We knew ... that alcohol dependence is most prevalent among younger adults aged 18 to 29 ... However, it was not until we examined the NESARC data that we pinpointed age 22 as the mean age of alcohol dependence onset [and we learned] that nearly half of people who become alcohol dependent do so by age 21 and two-thirds by age 25 ... "

About 70 percent of affected persons have a single episode of less than 4 years ...

Twenty years after onset of alcohol dependence, about three-fourths of individuals are in full recovery; more than half of those who have fully recovered drink at low-risk levels without symptoms of alcohol dependence ...

Only 13 percent of people with alcohol dependence ever receive specialty alcohol treatment.

In other words, a lot of young people develop drinking problems but, for the large majority, these are limited to their youth. Most don't receive alcoholism treatment or go to AA, but they nonetheless outgrow the problem, even though most continue drinking. That is, unless they receive treatment or enter recovery, when they are more likely both (a) to abstain, but also (b) to remain alcoholic and not be able to become normal drinkers, which may mean continuing their collegiate binge drinking.

Here is one description of the usual process of outgrowing problem drinking following college in a interview of a sociologist who studied why college students binge drink. The sociologist, Thomas Vander Ven, described how most college binge drinkers (a group he placed at more than 40 percent of undergraduate students) are drinking to overcome social anxieties and to gain a sense of belonging in their first time living away from home:

They're more likely to say and do things [when they drink] that they normally wouldn't do -- show affection to their peers, get angry at them, get more emboldened to sing and dance and take risks and act crazy and there's a ton of laughing that goes on. It creates this world of adventure. It creates war stories. It creates bonding rituals.

The researcher's comments elicited a very strong response from the interviewer:

A lot of what you say really rings true. I definitely had a lot of social anxiety when I was in college. I was on a varsity rowing team, and I was gay, and I drank partly to get over the awkwardness that came with that.

Oh god. Yeah, that makes sense. Did that work for you?

I don't know if it helped my social skills but it did give me a sense of camaraderie. After a race, everyone would get shitfaced and the next morning we would all feel like crap, and it was like we had survived something together -- like seeing a horror movie. Just being part of that experience made me feel less like an outsider.

The analogy to the horror movie is very consistent with my data. Putting a positive spin on something like a hangover is part of this stuff. Because nobody wants to be sick, but if you're doing it with a bunch of other people and kind of laughing at it, like, "Oh my god I feel like shit," it brings a group together.

And as soon as I left college -- it was almost instantaneous -- the idea of being hungover just became extraordinarily unappealing and I stopped drinking so much.

That's a lot of people's experience -- drinking in college is just a very different enterprise than once you graduate.

They outgrow it -- that is, unless they are convinced they have a lifetime disease. My colleague Ilse Thompson, proprietress of Stinkin-Thinkin, notes that getting kids in the recovery process is like the tobacco companies' effort to create so-called "replacement smokers" among the young. In this horror movie, however, the recovery movement is creating replacement alcoholics. Or is that pods they are creating? Did you see the 1978 remake of "Invasion," starring Donald Sutherland? The pods win.