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01 JunFeaturedSelfSubstance use

Opioid epidemic: What it looks like, what it means, & what to do

by Lucy Berrington0 Comments
Reading Time: 4 minutes

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What do you know about opioid abuse and addiction? Take our quiz to see how your knowledge compares to other students’, and find answers to questions like these:

  • Is it risky to take prescription pain meds?
  • Who’s at risk for addiction?
  • How rare is opioid abuse among college students?
  • Does opioid overdose reversal always work?
Take our quiz. Can a single painkiller dose lead to addiction? And other questions

The US is experiencing a brutal opioid epidemic. In 2015, 33,000 Americans died from overdoses involving prescription painkillers, heroin, and synthetic opioids, according to the National Institutes of Health. Many opioid overdoses can be reversed with timely medical treatment, however—someday, you may be in a position to save a life. This brief guide shows you how.

The illicit use of heroin and prescription painkillers is rare among college students. Yet this epidemic is affecting demographics that were previously considered relatively immune to drug crises. “My freshman year of college, my older sister went to rehab for heroin addiction. People from all ethnicities and social classes are struggling with opioid addiction,” says a third-year undergraduate at Saint Louis University, Missouri.

In this article, “opioid” covers heroin, prescription painkillers, and synthetic opioids sold on the street. For info on getting help with abuse and addiction, see Get help or find out more.

What to do if someone may have overdosed: Call 911 immediately

  • Act quickly: Most deaths occur one to three hours after the overdose, so you have a window for intervention.
  • Get medical help: When people survive an overdose, it is because professional help was available. You do not need to be sure the person has overdosed on opioids (or any other substance) before calling 911. Calling 911 usually ensures quicker medical help than taking the victim to the hospital yourself.
  • Tell the 911 dispatcher: Let them know if the person’s breathing has slowed or stopped and if they are unresponsive. Give the dispatcher the exact location.
  • Be aware of Good Samaritan laws: In most states, people who seek help with a suspected overdose are immune from drug-related criminal charges under Good Samaritan laws (also known as 911 Immunity Laws). Your college may have similar policies (sometimes called medical amnesty). For information about your state, see Get help or find out more.

What does an opioid overdose look like?

Upset cartoon man

Âŧ The signs of opioid overdose include:

  • Small pupils
  • Droopy arms and legs, and the inability to stand or walk
  • Itching
  • Slurred speech
  • Shallow and uneven breathing
  • Being unresponsive
  • Loss of consciousness

Âŧ As the window for intervening narrows, signs include:

  • Pale face
  • Blue lips
  • Gurgling chest sounds

Could I be at risk for opioid abuse?

Opioid addiction is difficult to treat. Avoiding illicit drug use is the safest strategy. Here’s how to look out for yourself:

  • If you are using a prescription opioid medication that was not prescribed to you, seek help.
  • If you are using an opioid medication prescribed to you, be self-aware about your reasons: Opioid medications are prescribed for long-term pain associated with various medical issues or for short-term pain control after surgery or an injury. If you are using opioids for other reasons—e.g., to get high or buzzed—seek help.
  • If you are using opioids for pain relief, and your pain is becoming more difficult to control, discuss that with your physician immediately.
  • If you have a family history of drug abuse/addiction and need medication for short-term pain, consider asking your physician for a pain medication other than opioids. Having a family history of drug abuse/addiction puts you at a higher risk for abuse/addiction.
  • If you are abusing opioids or may be addicted, you will need support with your recovery. See Get help or find out more (below).

Where can I get help with opioid abuse or addiction?

  • Ask your physician or other health care provider for a referral to an addiction specialist.
  • If you have health insurance, check the insurance company website for addiction specialists covered by your plan.
  • Ask at your student health center, counseling center, place of worship, or community center about addiction assistance.
  • Call your local hospital for help finding medical professionals with addiction expertise.
  • Look at community directories or online for a specialist in your area: Make sure the person is licensed or certified in mental or behavioral health, or is a licensed counselor in social work or professional counseling.
  • Try Narcotics Anonymous for local, free, anonymous support groups.
  • Many detox centers offer free initial consultations.
  • For more key info and resources, see Get help or find out more (below).

What are the options for accessing reversal treatment?

Many opioid overdoses can be reversed with treatment. The opioid reversal medications naloxone and naltrexone can be delivered via a nasal spray, by injection, or intravenously. These reversal drugs (or antidotes) are also known by various brand names (e.g., NarcanÂŪ).

Naloxone treatment can be accessed in several ways:

  • At hospital emergency rooms
  • Via police departments and paramedics (ambulance responders), after calling 911
  • Via some fire departments
  • In most states, via some trained laypeople (not medical professionals) who may have a history of opioid abuse or family members who are abusing opioids
  • Some states allow pharmacies to dispense naloxone to people meeting certain criteria without a physician’s direct involvement (this is often reported as over-the-counter availability, although that term is technically incorrect)

What exactly does “unresponsive” mean?

Here’s what being unresponsive looks like, according to the Harm Reduction Coalition:

  • Not answering to their name
  • Not responding to information they may not want to hear (e.g., “I’m going to call 911”)
  • Not responding to physical stimulation (e.g., rubbing your knuckles into their sternum, the place in the middle of their chest where the ribs meet, or pinching their earlobes)
  • If the person wakes up but their breathing seems shallow or their chest feels tight, call 911 anyway

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Centers for Disease Control and Prevention. (2016). Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics.

Centers for Disease Control and Prevention. (2017). Heroin overdose data. Retrieved from https://www.cdc.gov/drugoverdose/data/heroin.html

Cicero, T. J., Ellis, M. S., Surratt, H. L., & Kurtz, S. P. (2014). The changing face of heroin use in the United States: A retrospective analysis of the past 50 years. JAMA Psychiatry, 71(7), 821–826.

Compton, W. M., Jones, C. M., & Baldwin, G. T. (2016). Relationship between nonmedical prescription-opioid use and heroin use. New England Journal of Medicine, 374(2), 154–163. Retrieved from https://www.nejm.org/doi/full/10.1056/NEJMra1508490#t=article

Coomber, R., & Sutton, C. (2006). Harm Reduction Digest 34: How quick to heroin dependence? Drug and Alcohol Review, 25(5), 463–471. Retrieved from https://onlinelibrary.wiley.com/doi/10.1080/09595230600883347/abstract

Darke, S. (2012). Pathways to heroin dependence: Time to re-appraise self-medication. Addiction, 108(4), 659–667.

Davis, C. (2016, March 1). “Over the counter” naloxone access, explained. The Network for Public Health Law. Retrieved from https://www.networkforphl.org/the_network_blog/2016/03/01/745/over_the_counter_naloxone_access_explained

Grattan, A., Sullivan, M. D., Saunders, K. W., Campbell, C. I., et al. (2012). Depression and prescription opioid misuse among chronic opioid therapy recipients with no history of substanceabuse. Annals of Family Medicine, 10(4), 304–311.

Jones, C. M., Baldwin, G. T., Manocchio, T., White, J. O., et al. (2016). Trends in methadone distribution for pain treatment, methadone diversion, and overdose deaths—United States, 2002–2014. Morbidity and Mortality Weekly Report, 65(26), 667–671.

Jones, C. M., Paulozzi, L. J., & Mack, K. A. (2014). Sources of prescription opioid pain relievers by frequency of past-year nonmedical use United States, 2008–2011. JAMA Internal Medicine, 174(5), 802–803.

Lankenau, S. E., Teti, M., Silva, K., Jackson Bloom, J., et al. (2012). Initiation into prescription opioid misuse amongst young injection drug users. International Journal of Drug Policy, 23(1), 37–44.

Ludden, J. (September 2, 2016). An even deadlier opioid, Carfentanil, is hitting the streets. National Public Radio. Retrieved from https://www.npr.org/sections/health-shots/2016/09/02/492108992/an-even-deadlier-opioid-carfentanil-is-hitting-the-streets

Mahoney, K. (2016, August 10). FDA supports greater access to naloxone to help reduce opioid overdose deaths. FDA Voice; US Food and Drug Administration. Retrieved from https://blogs.fda.gov/fdavoice/index.php/2016/08/fda-supports-greater-access-to-naloxone-to-help-reduce-opioid-overdose-deaths/

Miech, R., Johnston, L., O’Malley, P. M., Keyes, K. M., et al. (2015). Prescription opioids in adolescence and future opioid misuse. Pediatrics, 136(5), e1169–e1177.

National Institute on Drug Abuse. (2015). Prescription opioid use is a risk factor for heroin use. Retrieved from https://www.drugabuse.gov/publications/research-reports/relationship-between-prescription-drug-heroin-abuse/prescription-opioid-use-risk-factor-heroin-use

National Institutes of Health. (2017, January). Overdose death rates. Retrieved from https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates

Noble, M., Treadwell, J. R., Tregear, S. J., Coates, V. H., et al. (2010). Opioids for long-term treatment of noncancer pain. The Cochrane Collaboration. Retrieved from https://www.cochrane.org/CD006605/SYMPT_opioids-long-term-treatment-noncancer-pain

Paulozzi, L. J., Budnitz, D. S., & Xi, Y. (2006). Increasing deaths from opioid analgesics in the United States. Pharmacoepidemiology of Drug Safety, 15(9), 618–627.

Popovich, N. (2016, May 25). A deadly crisis: Mapping the spread of America’s drug overdose epidemic. Guardian. Retrieved from https://www.theguardian.com/society/ng-interactive/2016/may/25/opioid-epidemic-overdose-deaths-map

Rudd, R. A., Seth, P., David, F., & Scholl, L. (2016). Increases in drug and opioid-involved overdose deaths—United States, 2010–2015. Mortality and Morbidity Weekly Report, 65(50–51), 1445–1452.

Schwartz, A. (2015, April 25). Michael Botticelli is a drug czar who knows addiction firsthand. New York Times. Retrieved from https://www.nytimes.com/2015/04/26/us/michael-botticelli-is-a-drug-czar-who-knows-addiction-firsthand.html?_r=0

Senate Caucus on International Narcotics Control Substance Abuse and Mental Health Services Administration. Results from the 2012 National Survey on Drug Use and Health: Summary of  National Findings, NSDUH Series H-46, HHS Publication No. 13-4795. Rockville, MD: SAMHSA, 2013.

Stobbe, M. (2016, December 9). A grim tally soars: More than 50,000 overdose deaths in US. STAT. Retrieved from https://www.statnews.com/2016/12/09/opoid-overdose-deaths-us/

Szalavitz, M. (2016, May 10). Opioid addiction is a huge problem, but pain prescriptions are not the cause. Scientific American. Retrieved from https://blogs.scientificamerican.com/mind-guest-blog/opioid-addiction-is-a-huge-problem-but-pain-prescriptions-are-not-the-cause/

Utah Department of Health. (2016). Prescription opioid deaths. Retrieved from https://health.utah.gov/vipp/pdf/RxDrugs/PDODeaths2015.pdf

Volkow, N. D. (2014, May 14). America’s addiction to opioids: Heroin and prescription drug abuse. National Institute of Drug Abuse. Retrieved from https://www.drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2016/americas-addiction-to-opioids-heroin-prescription-drug-abuse

Vowles, K. E., McEntee, M. L., Julnes, P. S., Frohe, T., et al. (2015). Rates of opioid misuse, abuse, and addiction in chronic pain: A systematic review and data synthesis. Journal of Pain, 156(4), 569–576.

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01 MayBodyFeaturedPhysical activity

Attitude adjustment: How to work it so you can work out more

by Lucy Berrington0 Comments
Reading Time: 16 minutes

Rate this article and enter to win
Struggling to start strength training, slay the cardio combat class, or even prioritize a walk on a sunny day through flowering meadows? We’ve all been there. Many of us are there right now (as in: on the couch, wondering how we’ll ever get up again). How and why we think about physical activity, and how we decide or plan to incorporate it into our lives, has a lot to do with whether or not we’re successful in staying active, research shows.

Our quiz helps you figure out how to maximize your workout success—and your friends’ (if they want it maximized). Check out the scenarios below and pick the option(s) you think might work. For each question, at least one of the options is a YAAASSS. Some options may not help much (NOOOOOO). Others aren’t ideal, but aren’t hopeless either (NOT REALLY BUT). CLICK on your answer to find out how it ranks and why.

1You’ve been inactive for a year and want to start working out again. You struggle with negative body image and tend to take an all-or-nothing approach to nutrition and working out (super-healthy vs. whatever). What might help you make physical activity an ongoing thing?

A. Make this about your general well-being, not your weight or body shape. Find stuff to like about your body. It’s harder to take care of yourself if you’re self-shaming.

Open mouth smile emojiYAAASSS

Looking after ourselves gets easier when our goals are feeling good and being healthier in general. When we focus on our body weight and shape, there’s usually an element of shame and stigma—and this tends to backfire, studies show. In contrast, when our goals are health and well-being, healthy behaviors are more accessible and sustainable, according to 2014 review of studies in the Journal of Obesity.

“There is this cultural belief that people have to be dissatisfied with themselves in order to make behavioral changes to improve their health,” says Sara Stahlman, marketing and communication coordinator of Campus Health Services at the University of North Carolina at Chapel Hill. “In fact, the opposite has been shown; people take better care of their bodies when they hold their bodies in high regard.”

Student perspective

“As someone who has struggled with body image, I understand the temptation to push my limits in a negative sense. Physical exercise forces you to come to terms with the fact that your body is a miracle.”
—Name and college withheld

B. Commit for the long term: Find a six-month training program for a marathon or triathlon.

Closed mouth emojiNOT REALLY BUT

Big goals work great for some people, when they’re ready. Right now, we’re thinking this may not be the best approach for you. The bigger the goal, the higher the chance of not getting there. Your all-or-nothing history (which isn’t unusual) shows the pitfalls. Try looking for ways to have fun with working out first (see Q2).

That includes racking up some small successes. How does 2 percent sound? Two percent lifestyle change is the key to full-on success, says Dr. Edward Phillips, director of the Institute of Lifestyle Medicine at Harvard Medical School, Massachusetts. That’s because small steps are realistic and sustainable, and can lead to big results.

“If your goal is to go to the gym every day of the week for two hours a day, ask how confident you are that you’ll stick to that plan for the next three to four weeks,” says Dr. Phillips. “If your confidence level is low, think about dialing it back and going to the gym three times a week for an hour, or going to a Zumba class once a week as a start. What’s your confidence level in that? It’s easier and probably more attainable to achieve the smaller goal first.”

If you keep getting stuck, try talking with a personal trainer; you may be able to get a free session or two at your campus gym. Another option for some: Cognitive behavioral therapy (CBT) can help us reframe the thinking that’s holding us back.

Intro to cognitive behavioral therapy: PsychCentral

C. Spend more time with friends who are active. Physical activity is contagious.

Open mouth smile emojiYAAASSS

Hanging out with active people helps us get active. “If our friends work out regularly and support our exercise goals we are more likely to exercise,” says Dr. Xiaomeng Xu, professor of psychology at Idaho State University. Arrange with your friends to join them for the bike ride or that cardio groove class.

In a 2015 study, finding a new workout partner made people more physically active, especially when the partner was emotionally supportive (British Journal of Health Psychology). Another bonus: Working out with others means we work out longer or harder, a 2012 study suggests (Annals of Behavioral Medicine).

Student perspective

“Just the other day I didn’t want to go run but I had told my friend that I would run with him. Once I made that commitment I know that I was going to do it no matter what. I hate backing out.”
—Fifth-year undergraduate, Midwestern State University, Texas

Friends not in the mood? Look for groups and communities that exist specifically to get active, such as the November Project and Meetup groups.

November Project

Meetup

2You know physical activity is the greatest thing you can ever do for yourself bar not much. But for you, the gym is a soulless wasteland. In high school you enjoyed track, but you’re having a hard time seeing yourself getting back into that kind of shape. What’s a good way to get moving anyway?

A. Get tough on yourself. Use your self-perceived flaws and weaknesses for motivation.

Frown emojiNOOOOOO

As a motivational strategy, beating yourself up doesn’t work long term. Life rule: Shaming ourselves or others does not work, and studies prove it. Stigmatizing body size makes people “sicker, poorer, lonelier, and less secure,” says Dr. Deb Burgard, a psychologist in California who specializes in body image, weight, and health issues. For more on this backfire effect, see Q1.

There are far more effective (and less demoralizing) tactics than this. Keep reading.

B. Make this so not about fitness. Look for physical activities that don’t feel like exercise, with its icky clinical associations. Focus on how getting active can help you feel good right now.

Open mouth smile emojiYAAASSS

Moving isn’t just about moving. It’s also about being with friends, letting go of your stress and angst, or even the task of getting from your residence hall to downtown. What works is doing stuff you like, at a pace you like, in places you like.

Try loosening up your thinking in general. “Toss out any rules you might have about how to exercise, because research shows you won’t keep it up [if those rules don’t reflect your feelings],” says Dr. Michelle Segar, author of No Sweat: How the Simple Science of Motivation Can Bring You a Lifetime of Fitness (Amacom, 2015).

Physical activity actually feels better than we expect, studies show. And recognizing this may help us do it. For example, in a 2016 study, participants ran for 30 minutes on a treadmill. Some were told in advance that running helped people feel refreshed and relaxed (Health Psychology). The participants were asked to keep up their runs through the week. Those who’d been primed to feel good about the run reported that the treadmill workout was less fatiguing, and intended to run more, than those who had not been primed this way.

In a recent survey by Student Health 101, many students described fitness as a mind game. “I usually trick myself into thinking I am just having fun, even though I am getting a lot of physical activity in,” says a second-year undergraduate at the University of Wisconsin–Plattville.

For more on reframing the way you think about this, see Q5.

Student Perspective

“Realize life is short and you might as well spend it feeling good and alive.”
—Ethan G., second-year undergraduate, University of Maryland, Baltimore County

C. Give yourself a new skill: Take swim lessons and start swimming laps. The 10-block walk to the pool is a good warm-up.

NOT REALLY BUT

Swimming is awesome. Learning new stuff is awesome. Walking 10 blocks is awesome. So why are we hesitating about this plan? Because building healthier habits has to be as easy as possible. The 10-block schlep to the pool is an ideal excuse to not follow through. It’s too hot. It’s raining. The hamster ate your shoes. Plus, learning to swim is a major prerequisite for getting more active—and if you struggle, your plan’s dead in the water.

Think about activities that (a) you already know you can enjoy, and (b) you can work into your day conveniently. Maybe that’s running or biking the route back to your residence hall after the lecture. Maybe you can go to on-campus yoga or high-intensity cardio with a friend twice a week. Also—don’t forget to track your steps and factor in the value of what you’re already doing. That counts too.

When setting goals and planning, bear in mind that adults aged 18–64 should get at least 150 minutes of moderate-intensity aerobic physical activity throughout the week, according to the World Health Organization. You can substitute at least 75 minutes of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate and vigorous activity.

  • Moderate aerobic activity requires some effort and makes your heart beat faster—e.g., brisk walking, yard work, and dancing.
  • Vigorous aerobic activity requires a lot of effort; it causes rapid breathing and ramps up your heart rate—e.g., running, climbing hills, and fast cycling.

App and tracker comparisons (Wellocracy)

3Candy, a third-year student in biology class, has moderate cerebral palsy and uses leg braces. She tells you she wants to build upper-body strength and generally tone up. How do you respond?

A. Ask Candy for her thoughts about starting a fitness regimen together, because no kidding, you could use this too. If she feels OK to join you, talk about what might work and what you’re both likely to stick with.

Open mouth smile emojiYAAASSS

This plan is practical, social, and could work well for both of you. Some disabilities and other pre-existing conditions have implications for working out. Your friend knows her own body and can seek medical clearance if needed. This is her call.

As for making a plan you can stick with—effective strategies are flexible, research shows. Expect your fitness approach to change over time. As we adopt new behaviors and try to turn those into habits, we benefit from evolving messages, strategies, and tools. The same motivational messages that got us up off the sofa in the first place may not be exactly what we need six weeks later (this idea is sometimes known as “stages of change”). In the liveWell wellness program for students, the messages and tools shift appropriately as you make progress.

liveWell program (Pro-Change Behavior Systems, Inc.)

B. Suggest she invests in basic fitness equipment so she can exercise alone without self-consciousness. Alternatively, help her search online for a special needs gym.

Frown emojiNOOOOO

Self-consciousness can be a barrier to working out, yes. Candy hasn’t said that’s a problem for her, though. Many people with disabilities are marginalized and excluded. We all do better when we’re socially integrated into our communities. For example, people with robust social networks (supportive friends and family) experience lower rates of chronic disease and longer lives, and more job opportunities, according to a 2011 report from the National Research Council.

This isn’t just about being nice (though being nice is nice). A more inclusive, accessible environment is good for many people besides those with disabilities: older adults, pregnant women, parents with small children, people with less education, and speakers of a second language, says a 2011 report by the World Bank and World Health Organization. We’ll all be in at least one of those groups some day.

C. Let her know how inspirational she is for even thinking about it. Turn her photo into an Instagram meme, adding a quotation about the human spirit.

Frown emoji

NOOOOO

Disability advocates call this “inspiration porn.” It’s condescending. Why should you be amazed that Candy wants to do something with her life?

Speaking of, let’s not be so quick to share memes and posts that are based on the idea that disabled people are a burden. Sure, invite your autistic classmate to the dance. But that gesture at inclusion backfires if you’re applauded for your self-sacrifice. This is about forming connections that work for everyone.

4You share your apartment with three other guys. Imran is having a hard time getting to Ultimate Frisbee, and he tells you how much he’s missing it. On top of his usual workload, he’s rehearsing for a performance and is involved in the care of his sick father, so he doesn’t even have much time to hang out.

A. Post a calendar inside the bathroom door with Ultimate Frisbee!!! highlighted on the relevant days. Ask Imran to take you along, and liaise about the logistics.

Open mouth smile emojiYAAASSS

The calendar presents a plan and serves as a cue to action (reminder)—two effective strategies for making this happen. Joining Imran for Ultimate Frisbee is reinforcing and rewarding for both of you, while adding accountability—you’ll nudge each other to get there. Just make sure the calendar doesn’t become so familiar that you guys start tuning it out. Switch up your reminders every so often.

Point to note: Planning is key to establishing new habits. In a 2006 study of people with cardiac issues, participants who wrote down their workout plan (and anticipated how they would handle any obstacles) were far more likely to be physically active over the next two months than those who did not make a plan (British Journal of Health Psychology).

For more on buddy workouts and why they help, see Q1.

B. On Frisbee day, use your free hour to tackle the household chores that generally fall to Imran. Let him know that on your way to the lab, which passes the pharmacy, you can pick up his dad’s medication.

Open mouth smile emojiYAAASSS

Providing invisible support is an act of true friendship. You understand the barriers Imran faces and you’re helping reduce them, without drawing attention to yourself, without expecting to be repaid in some way, and without insisting that he use the time to play Frisbee. It’s great if he does, but sometimes that might not be an option.

C. Understand how pressured Imran’s life is currently. Let him know it’s OK to wait until he has time for this.

NOT REALLY BUT

Sympathy is a good thing. Acknowledging reality is too. That said, Imran has told you he’s missing Frisbee. Getting back into the game would give him a break from the pressure, help him reconnect with friends, and keep his spirits up. You can’t impose a solution, of course, but you can probably make it easier.

Lack of time is a problem for many of us, which is why those small goals are so helpful (see Q1). If you can’t run for your usual 40 minutes, run for 15—that will still help you feel good, as well as sustaining the habit. Or go lower. “If all you can fit in is an extra five minutes a day, make that your plan and go from there,” says Dr. Michelle Segar, author of No Sweat: How the Simple Science of Motivation Can Bring You a Lifetime of Fitness (Amacom, 2015).

Student perspective

“Running is like therapy to me. I am able to clear my mind of negative thoughts and I also feel better when I done. I breathe more smoothly and am more relaxed.”
—Fourth-year undergraduate, Illinois State University

5You have a family history of chronic illness. You worry that your sedentary lifestyle is setting you up for pain and disability down the road, but you have trouble sustaining your motivation to be active. What do you say to yourself?

A. It’s difficult with my relatives as role models. But nothing is impossible with willpower. I just have to want this enough.

Frown emoji

NOOOOO

This isn’t an effective motivational strategy. Judging and shaming your family, and implicitly yourself, is unlikely to work long term (see Q1 and Q2).

Your belief in willpower may let you down too. In experiments, willpower seems to be a finite, inconsistent resource. In other words, when we’re physically or mentally fatigued, we’re less likely to make it to the pool than we are to pick up a pizza. Even social interaction can drain our willpower, according to a 2005 study in the Journal of Personality and Social Psychology. (That said, this can go both ways. Being in a good mood gives us a willpower boost, and our own attitudes and beliefs can affect willpower too, according to the American Psychological Association.) Bottom line: Don’t count on willpower always being there for you.

Instead, two key approaches can help you make changes that stick:

  • Set up your home and schedule in ways that make physical activity more convenient
  • Think differently about physical activity: See Q2 and answer B (next slide).

Student perspective

“When I’m not in the mood to get active, I motivate myself by listening to workout music.
I steadily start to get pumped up.”
—Third-year undergraduate, Michigan Technology University

B. Let’s say I go for a short run or climbed a hill right now. How would that make me feel?

Open mouth smile emojiYAAASSS

Immediate benefits are far more motivating than the distant prospect of better health, according to behavioral scientists.

Identify the immediate perks of taking that run or climbing the hill. These likely include a better mood, increased energy, a brainpower boost, stress relief, sharper focus, and feeling good about yourself. High-energy music helps bring about a rapid attitude adjustment (try the latest trap beat).

Not feeling it? Put on workout gear anyway. “Sometimes I actively think about how much I don’t want to go for a run while I put my body mindlessly through the actions of starting anyway,” says a second-year undergraduate at Colorado College. “I let my mind think it’s talked me out of it, but I keep putting on my shoes and shorts. I might even still be thinking about excuses when I take my first few steps into a warm-up jog, but by then it’s too late and I’ve already started.”

Other mind tricks can help make this not just about fitness (see Q2). Take a walk through the woods, ending up somewhere pretty where you can sit and read. Ride to the beach to watch the sunset. Get a friend to join you in a kayak. Put on some music and dance.

Student perspective

“I’ll remember the time I was in a dull meeting and had to run outside to grab something, then how much more alert I felt afterward.”
—Third-year undergraduate, Rochester Institute of Technology, New York

C. I’ll go by the health center tomorrow and pick up some leaflets on heart disease and diabetes.

NOT REALLY BUT

It’s always good to be informed. Health info can help us think about how susceptible we are to a disease and how that disease might affect us. That said, health information alone rarely enables us to change our habits.

Instead, think about specific barriers to getting active.  What’s stopping you? Maybe it’s something practical (the logistics of getting to the basketball court). Maybe it’s psychological (working out feels like a chore). Maybe it’s financial (the cost of a personal trainer).

Now think about ways you can minimize those barriers. The basketball court is not your only option; what’s nearby? Have you noticed that when you do get active it actually feels pretty good (for real)? Do you have access to a free training session on campus—and what app or video series could substitute for a personal trainer?

Student perspective

“I was pre-diabetic before I started to be physically active. I am now 100 pounds lighter. My mental clarity is way better than it was before. I never thought I would ever hear myself say that.”
—Second-year undergraduate, Park University (online)

App and tracker comparisons (Wellocracy)

6Your on-trend friend Issa wants to work out with you. She’s into Barry’s Bootcamp and SoulCycle, but right now those are beyond her budget. Instead, she’s sitting around watching reality shows (she enjoys those too). What’s a good strategy here?

A.Celeb trainer Sergeant Squat is coming to campus for a free YOLO Boot Camp and will be giving away workout DVDs. Bam. You’ve got this.

Open mouth smile emojiYAAASSS

Issa is hooked in to popular culture and likes to be ahead of the crowd. When influential people spearhead activities and campaigns, there’s a social ripple effect. Here, Sergeant Squat is poised to turn Issa (and you) on to a new fitness approach. Maybe you and she will transmit it to others.

In addition, you’re making a specific plan and working out together—two keys to success (see Q4 and Q1). Just make sure that if the new workout feels good, you plan how to keep at it. And if it’s not for you, look around for alternatives.

B. Join Issa for two reality shows a week. Turn them into buddy workouts. Bonus: Reality shows make more sense when viewed upside down through your legs in Downward Dog.

Open mouth smile emojiYAAASSS

Buddy workouts are gang (see Q1).

To keep things fresh, use the Deck of Cards approach. Take turns to draw a card from a deck. Each suit represents a different move. For example: hearts = squats, spades = burpees, diamonds = planks, clubs = lunges. The number on the card is your number of reps. You can change up the moves with each show or round, of course.

Student perspective

“It’s a lot easier to get off the couch if you know your friends are waiting for you.”
—Third-year undergraduate, University of Dallas, Texas

C. Agree together that you only get to watch The Handmaid’s Tale or Twin Peaks when you’re on a StairMasterÂŪ, stationary bike, or elliptical.

Open mouth smile emojiYAAASSS

Rewards can be strategic and effective. You can switch them up. Maybe your workout time is when you listen to a killer audio book. Maybe you get a smoothie afterward, give each other a pedi, or download a new app or podcast.

Another approach to rewards: the commitment contract. “For example, you give money to a friend. If you hit your exercise target, you get the money back, but if you don’t, your friend gets to keep it,” says Dr. Fred Zimmerman, a professor in the Department of Health Policy and Management at the University of California, Los Angeles, who researches exercise behavior. “Or the money would be donated to the opposite political party than which you agree or a group you’re not too fond of. This way, missing your goal is painful.”

To sign up for a commitment contract, see Stickk.com. To earn money rewards for workouts, check out the app Pact—but remember that if you’re the one missing your workouts, your cash rewards others.

Student perspective

“The hardest thing to do for me is to work out in the morning. So I would make a rule that if I don’t get out of bed to work out, then I only get to drink water the entire day. Yes, no coffee.  :(”
—Second-year undergraduate, college withheld

Stickk commitment contract

Pact cash rewards (or penalties)
+  iOS
+  Android

[survey_plugin] Article sources

Chris Stuck-Girard, MPH, JD, contributed to this article.

Deb Burgard, PhD, psychologist, California.

Sara Stahlman, MA, marketing and communication coordinator, Campus Health Services, University of North Carolina at Chapel Hill.

Edward Phillips, MD, founder and director, Institute of Lifestyle Medicine, Harvard Medical School, Massachusetts.

Michelle Segar, PhD, MPH, author; No Sweat: How the Simple Science of Motivation Can Bring You a Lifetime of Fitness (Amacom, 2015).

Xiaomeng Xu, PhD, professor of psychology, Idaho State University.

Fred Zimmerman, PhD, professor, Department of Health Policy and Management, University of California, Los Angeles.

American Psychological Association. (2017). What you need to know about willpower. Retrieved from https://www.apa.org/helpcenter/willpower.aspx

Irwin, B. C., Scorniaenchi, J., Kerr, N. L., Eisenmann, J., et al. (2012). Aerobic exercise is promoted when individual performance affects the group: A test of the Kohler motivation gain effect. Annals of Behavioral Medicine, 44(2), 151–159.

Kawn, B. M., Stevens, C. J., & Bryan, A. D. (2016). What to expect when you’re exercising: An experimental test of the anticipated affect-exercise relationship. Health Psychology.

National Research Council. (2011). Explaining divergent levels of longevity in high-income countries. [Report]. Retrieved from https://www.nap.edu/read/13089/chapter/8

Pro-Change Behavior Systems: LiveWell. [Website]. Retrieved from https://www.prochange.com/college-health

Rackow, P., Scholz, U., & Hornung, R. (2015). Received social support and exercising: An intervention study to test the enabling hypothesis. British Journal of Health Psychology, 20(4), 763–776.

Rimer, B. K., & Glanz, K. (2005). Theory at a glance: A guide to health promotion practice [pdf]. US Department of Health and Human Services, National Institutes of Health, National Cancer Institute. Retrieved from https://sbccimplementationkits.org/demandrmnch/ikitresources/theory-at-a-glance-a-guide-for-health-promotion-practice-second-edition/

Sniehotta, F. F., Scholz, U., & Schwarzer, R. (2006). Action plans and coping plans for physical exercise: A longitudinal intervention study in cardiac rehabilitation. British Journal of Health Psychology, 11(1), 23–37.

Student Health 101 surveys, April 2015 and December 2014.

Vohs, K., Baumeister, R. F., & Ciarocca, N. J. (2005). Self-regulation and self-presentation: regulatory resource depletion impairs impression management and effortful self-presentation depletes regulatory resources. Journal of Personality and Social Psychology, 88(4), 632–657.

Wellocracy. (n.d.). Activity apps. Partners HealthCare. Retrieved from https://www.wellocracy.com/mobile-activity-apps

World Health Organization. (2017). Physical activity and adults. Retrieved from https://www.who.int/dietphysicalactivity/factsheet_adults/en/

World Health Organization. (2017). What is moderate-intensity and vigorous-intensity physical activity? Retrieved from https://www.who.int/dietphysicalactivity/physical_activity_intensity/en/

World Health Organization & World Bank. (2011). World report on disability. [Report]. Retrieved from https://www.who.int/disabilities/world_report/2011/report.pdf

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01 MayBodyFeaturedSleep

Take a nap or push on through?

by Lucy Berrington0 Comments
Reading Time: 7 minutes

Rate this article and enter to win
What’s in a nap? If you’re doing it right, napping brings a bunch of benefits: improved learning ability, memory, alertness, physical and mental stamina, and relief from stress. To avoid grogginess and other possible side effects, however, you need to be strategic about napping. This flowchart helps you figure out whether a nap will work for you or against you.

What are you hoping a nap will do for you?

Brainpower, energy, or performance boost

Napping can make you smarter and improve your performance and alertness on the job. It can help you learn more, remember what you’re studying, and feel better.

Napping improves learning and memory:
  • College students with GPAs of 3.5 and higher were much more likely to be nappers than were their peers with lower GPAs in a 2010 study in Sleep and Breathing.
  • A 10-minute nap significantly improved alertness and cognitive performance in young adults, according to a 2001 study in the Journal of Sleep Research.
  • Napping for 90 minutes improves young adults’ capacity to learn, a small 2010 study found.
  • Napping is generally more effective than caffeine, especially for memory improvement, according to a 2008 study in Behavioral Brain Research.

Other effects

Napping improves tolerance and decision-making

In a 2015 study, participants who napped for an hour in the afternoon were better able to tolerate frustration and less prone to impulsive decision-making compared to the non-nappers, according to the journal Personality and Individual Differences.

Napping relieves stress

A 45- to 60-minute nap reduced the effects of stress in undergraduate students in a 2011 study in the International Journal of Behavioral Medicine. The students recovered from a stressor more quickly than stressed students who didn’t nap.

Napping improves physical performance

Athletes had quicker reaction times and performed better after a one-hour nap, according to a 2013 study in the Journal of Shangqiu Normal University.

If you’re looking to make all your troubles go away, napping isn’t the answer.

“Sleep can be a great way to help yourself if you’re sick, but it’s not the best way to cope with tough times,” says Dr. Sharon Sevier, chair of the board of directors of the American School Counselor Association. “When you’re asleep, you’re avoiding your problems, but when you’re awake, you can get the support you need from yourself and others.”

Continue to next question

Compensate for missed sleep

Need to compensate for missed sleep?

Skimping on sleep seriously affects our performance—and makes us oblivious to just how poorly we’re doing. That’s according to a 2003 study in which researchers at the University of Pennsylvania restricted people’s sleep. Even as the participants became less able to sustain their attention and succeed at memory tasks, they insisted they had adjusted to the shorter sleep hours, according to the journal Sleep.

Expecting a late night?

If you’re expecting to be up later than usual that night, planned napping—taking a nap before you get sleepy—may help. Remember, though, that all-nighters are highly disruptive to your body and mind. Sleep-deprived cramming is unlikely to help you perform better on tests, research shows.

Continue to next question

Make all my troubles go away

Don’t take a nap this time. SORRY.

Are you low on energy and planning to drive?

Yes

GO FOR IT. Take that nap.

No

If you’re sleepy and planning to drive, take an emergency nap.

This is critical. Sleep-deprived drivers are as dangerous as drunken drivers, according to a study in the journal Nature (1997). Napping improves our alertness and reaction times. Pilots who nap during flights are better at landing planes, according to a classic study in the Journal of Sleep Research.

If you feel sleepy while driving…

Pull into a safe, well-lit area, such as a rest stop or restaurant parking lot, and take a 15- to 20-minute nap minute nap, says the National Sleep Foundation.

If you can’t nap before driving long distances, and are not really tired, use caffeine.

Long-distance commercial drivers who used caffeinated substances were less likely to crash their vehicles than those who didn’t, a 2013 study in The BMJ found. But if you’re really tired, caffeine is not enough. Don’t drive.

Continue to next question

What’s the time?

Before 3 p.m.

The best time to nap is in the early afternoon: 1–3 p.m.

Fortunately, this is probably when you most want to snooze. “This sleepiness comes from a true physiologic process, because we have a dip in the alerting signal of our circadian rhythm,” says Dr. Shelley Hershner, director of the Collegiate Sleep Disorder Clinic at the University of Michigan (quoted on the graduate school website).

Napping later than 3 p.m., however, could set you up for a wakeful night. Try another way to pick up your energy:

  • Snack on vegetables, fruit, beans, and nuts. The nutrients in these food groups are natural energy boosters, according to the Cleveland Clinic.
  • Drink water or herbal tea. Dehydration can cause fatigue, according to dietitians at the University of Michigan. From midafternoon onward, avoid caffeine; that will keep you up at night, too.
  • Don’t just sit there. A few jumping jacks or yoga moves, or a quick walk, will help you feel more alive. Even a 15-minute walk can give you an energy boost, says the National Health Service in the UK.

Nap wheel: What’s your ideal nap time? 

Continue to next question

After 3 p.m.

Don’t take a nap this time. SORRY.

How much time do you have for a nap?

15 minutes or more

You need at least 10 minutes, and sometimes that’s enough. Even brief naps can result in measurable performance improvements, research shows. “Did you know that a six-minute nap increased subjects’ memorization of a list of words by 11 percent? Hey, most of us would be happy to take a letter grade higher, especially for a 10-minute investment in time,” writes Dr. Shelley Hershner of the University of Michigan (on the graduate school website, referencing the Journal of Sleep Research, 2008). Allow a few extra minutes for falling asleep.

If you don’t have time to nap, caffeine might help. Caffeine does not have the same brain benefits as napping, but it makes us feel more physically awake (because napping can induce grogginess), according to a 2008 study in Behavioral Brain Research. 

But the same time limit applies: Don’t consume caffeine after 3 p.m., or you risk your nighttime sleep.

Do you have more than 10 minutes?
The optimal length of a nap is disputed. Check out these options, then see what works for you.

Up to half an hour

Napping for 10–30 minutes gets you some brain benefits without inducing grogginess, so how do you wake up on time? Some studies have found benefits in “coffee naps.” If you’re confident you can fall asleep quickly, try drinking a cup of coffee and taking your nap; around 25 minutes in, the caffeine will kick in and wake you. A small study in the journal Ergonomics suggested coffee naps may be more effective for alertness and performance than napping alone.

Up to an hour

Some evidence suggests we can nap for up to an hour without feeling that grogginess and inertia. In a 2012 study, naps of 40 and 60 minutes allowed for more slow-wave (deep) sleep and led to bigger performance improvements than 20-minute naps did, according to Chronobiology International.

Up to 90 minutes

A typical sleep cycle (incorporating deep sleep and REM sleep) takes about 90 minutes. In studies, naps of 60 or 90 minutes have resulted in greater benefits for visual and memory tasks, compared with shorter naps.

Be wary of napping beyond 90 minutes. If you nap longer, “it’s harder to wake up and leaves you groggy because you’ve interrupted a sleep cycle,” says Nancy H. Rothstein, director of corporate sleep programs at Circadian, a workplace performance and safety consultancy based in Massachusetts.

Continue to next question

Less than 15 minutes

Don’t take a nap this time. SORRY.

Are you having trouble sleeping at night?

No

If you’re having difficulty falling asleep at night, a nap will likely make that worse.

Continue to next question

Yes

Do you have insomnia?

Insomnia is difficulty falling asleep or staying asleep at night, accompanied by daytime exhaustion, that is not explained by lifestyle and behavioral factors. It can be related to stress, transitions, psychiatric conditions, medications, or substance use. Most adults experience insomnia at some point in their lives, according to the Mayo Clinic.

If you are having difficulty falling asleep or staying asleep, behavioral changes can help, such as being physically active during the day and avoiding stimulating activities (including screen use) close to bedtime.

Insomnia treatment

If you think you are experiencing insomnia, talk with your health care provider or go to your counseling center. Medication may help in the short term. Cognitive behavioral therapy is a proven treatment for insomnia, and can be effectively delivered in the traditional therapeutic setting or online, according to the Journal of Psychology Research and Behavioral Management (2011).

More about insomnia

Don’t take a nap this time. SORRY.

 

Do you have access to a quiet, comfortable location?

Yes

GO FOR IT. Take that nap.

No

A promising nap environment looks like this:

  • You can lie down; it’s harder to fall asleep when you’re sitting up.
  • You have a blanket nearby in case you get cold, but you won’t get so warm and comfy that it’s a struggle to get up.
  • You can darken the room or use an eye mask.
  • You won’t be disturbed by noise; if necessary, use headphones or a noise machine.

Bonus! Some colleges provide napping stations for students.

Don’t take a nap this time. SORRY.

[survey_plugin] Article sources


Shelley Hershner, MD, director, Collegiate Sleep Disorder Clinic, University of Michigan.

Nancy H. Rothstein, director, corporate sleep programs, Circadian, Massachusetts.

Sharon Sevier, PhD, chair, board of directors, American School Counselor Association.

Ackerman, J., & Zarracina, J. (n.d.). How to nap. [Infographic]. Boston Globe. Retrieved from: https://www.boston.com/bostonglobe/ideas/naps/

American College Health Association. (Spring 2014). National College Health Assessment. Retrieved from https://www.acha-ncha.org/docs/ACHA-NCHA-II_ReferenceGroup_ExecutiveSummary_Spring2014.pdf

Anwar, Y. (2010). An afternoon nap markedly boosts the brain’s learning capacity. Berkeley News. Retrieved from https://news.berkeley.edu/2010/02/22/naps_boost_learning_capacity/

Bonnet, M. H., & Arand, D. L. (1994). The use of prophylactic naps and caffeine to maintain performance during a continuous operation. Ergonomics, 37(6), 1009–1020.

BorbÃĐly, A. (1982). A two-process model of sleep regulation. Human Neurobiology, 1(3), 195–204.

Brindle, R. C., & Conklin, S. (2012). Daytime sleep accelerates cardiovascular recovery after psychological stress. International Journal of Behavioral Medicine, 19(1), 111–114.

Dawson, D., & Reid, K. (1997). Fatigue, alcohol, and performance impairment. Nature, 388, 235.

Eliasson, A. H., Lettieri, C. J., & Eliasson, A. H. (2010). Early to bed, early to rise! Sleep habits and academic performance in college students. Sleep and Breathing, 14(1), 71–75.

Fenn, K. M., Nusbaum, H. C., & Margoliash, D. (2003). Consolidation during sleep of perceptual learning of spoken language. Nature, 425(6958), 614–616.

Goldschmied, J. R., Cheng, P., Kemp, K., Caccamo, L., et al. (2015). Napping to modulate frustration and impulsivity: A pilot study. Personality and Individual Differences, 86, 164–167.

Hershner, S. (2014). How to nap. University of Michigan. Retrieved from https://www.rackham.umich.edu/blog/how-nap

Hershner, S. (2014). Why you should nap. University of Michigan. Retrieved from https://www.rackham.umich.edu/blog/why-you-should-nap

Jamieson-Petonic, A. (2013). 5 ways to fight fatigue with food. Cleveland Clinic. Retrieved from https://health.clevelandclinic.org/2013/05/5-ways-to-fight-fatigue-with-food/

Lahl, O., Wispel, C., Willigens, B., & Pietrowsky, R. (2008). An ultra-short episode of sleep is sufficient to promote declarative memory performance. Journal of Sleep Research, 17(1), 3–10.

Lo, J. C., Dijk, D. J., & Groeger, J. A. (2014). Comparing the effects of nocturnal sleep and daytime napping on declarative memory consolidation. PLoS ONE, 9(9).

Mayo Clinic. (November 21, 2012). Napping: Do’s and don’ts for healthy adults. Retrieved from: https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/napping/art-20048319

Mayo Clinic. (2014). Insomnia. Retrieved from https://www.mayoclinic.org/diseases-conditions/insomnia/basics/definition/con-20024293

Mednick, S. C., Cai, D. J., Kanady, J., & Drummond, S. (2008). Comparing the benefits of caffeine, naps, and placebo on verbal, motor, and perceptual memory. Behavioral Brain Research, 193(1), 79–86.

Mulrine, H. M., Signal, T. L., van den Berg, M. J., & Gander, P. H. (2012). Post-sleep inertia performance benefits of longer naps in simulated nightwork and extended operations. Chronobiology International, 29(9), 1249–1257.

National Health Service. (2015). Self-help tips to fight fatigue. Retrieved from: https://www.nhs.uk/Livewell/tiredness-and-fatigue/Pages/self-help-energy-tips.aspx

National Sleep Foundation. (n.d.). Napping. Retrieved from https://sleepfoundation.org/sleep-topics/napping

National Sleep Foundation. (2015). How much sleep do we really need? Retrieved from https://sleepfoundation.org/how-sleep-works/how-much-sleep-do-we-really-need

Rosekind, M. R., Smith, R. M., Miller, D. L., Co, E. L., et al. (1995). Alertness management: Strategic naps in operational settings. Journal of Sleep Research, 4(S2), 62–66.

Sharwood, L., Elkington, J., Meuleners, L., Ivers, R., et al. (2013). Use of caffeinated substances and risk of crashes in long-distance drivers of commercial vehicles: Case-control study. British Medical Journal, 346.

Siebern, A. T., & Manber, R. (2011). New developments in cognitive behavioral therapy as the first-line treatment of insomnia. Journal of Psychology Research and Behavioral Management, 4, 21–28.

Tietzel, A. J., & Lack, L. C. (2002). The recuperative value of brief and ultra-brief naps on alertness and cognitive performance. Journal of Sleep Research, 11(3), 213–218.

Twery, M. (2014, December 29). Why is sleep important? US Department of Health and Human Services. Retrieved from https://www.hhs.gov/blog/2014/12/29/why-sleep-important.html

University of Michigan. (2011). Fight fatigue with food and exercise. Comprehensive Cancer Center. Retrieved from https://www.mcancer.org/living-with-cancer/mind-body-side-effects/nutrition/healthy-boost

Van Dongen, H. P., Maislin, G., Mullington, J. M., & Dinges, D. F. (2003). The cumulative cost of additional wakefulness: Dose-response effects on neurobehavioral functions and sleep physiology from chronic sleep restriction and total sleep deprivation. Sleep, 26(2), 117–26.

Walker, M. P., & Stickgold, R. (2004). Sleep-dependent learning and memory consolidation. Neuron, 44(1), 121–133.

Yan, L., & Zhou, Y. (2013). Effect of nap on physical function after sport training for athletes. Journal of Shangqiu Normal University, 2013(3).

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01 AprFeaturedMental healthMindRelationshipsRomantic relationshipsSexual assault and harassmentSexual culture

Yes, it’s still coercion or assault: Relationship abuse and what to do about it

by Lucy Berrington0 Comments
Reading Time: 20 minutes

Rate this article and enter to win
Romantic relationships can be a great source of joy and fulfillment. But when a relationship is unhealthy or abusive, it can cause major harm. Relationship abuse is characterized by a pattern of control, disrespect, and emotional manipulation. Sometimes that pattern involves sexual or physical assault or coercion.

“My boyfriend refused to listen to my explicit ‘Nos’ or even ‘It hurts,’” wrote an undergraduate in New Hampshire. “At the time, I didn’t realize it was considered sexual assault. I thought that because we were dating, that wasn’t a thing.”

When sexual assault or coercion happens within the context of a relationship, it is still sexual assault or coercion. Most likely it isn’t an isolated incident but instead part of a pattern of abusive behaviors. “After I broke up with him, I started to realize how abusive the relationship was and how badly it impacted my self-esteem and grades,” the student said (in a recent survey by SH101). “It took a long time for me to realize that this problem did not have to define my time in college.”

Abuse can be emotional or physical

Sexual assault or coercion within relationships is only one category of abusive relationship behavior. It is common for abuse to be entirely or largely emotional, not physical. That said, studies suggest that sexual violence by partners is not rare. Like all unmistakable signs of abuse, it tends to happen out of sight. We are more likely to witness the “small things”—incidents of disrespectful or belittling behavior by one partner to another. These may signal that abuse is happening, or will happen in future.

We can look out for each otherTwo girls talking

Most of the steps for supporting a friend are actions that people appreciate whether or not they are experiencing abuse. Being an active bystander is about the things we do every day to look out for our friends and communities. In short: Know the warning signs of relationship abuse, and if you’re not sure, check in anyway.

Why does this matter so much? Unconditional support via social networks is vital to coping with relationship abuse, research shows. Supportive friends may be especially important for people of color, who tend to receive less backup than white women (Women’s Studies International Forum, 2004).

Abuse does not target any one type of person

Research has traditionally focused on abuse experienced by women in heterosexual relationships. Male and LBGTQ survivors have been overlooked until relatively recently. Men and women may experience emotional abuse at similar rates, according to the Centers for Disease Control and Prevention (2014). “Anyone can be in an abusive relationship: female/male, gay/straight, any ethnic or cultural background, any physical size, ability, or strength,” says Dr. Rachel Pain, a professor of human geography at Durham University in the UK, who studies relationship abuse. “We all have a strong tendency to think it would never happen to us, but abusive partners are not abusive when we meet them.”

Common signs of abuse

You don’t have to be sure that this is abuse, but it’s helpful to know the signs. Abusive behaviors form a pattern of control, disrespect, and emotional manipulation. Click for info and examples.

Social manipulation and surveilance

Isolating the other person from friends and family
In a healthy relationship, each person talks to and communicates with their friends as they’d like. Abusive behaviors include preventing a partner from spending time alone with friends or family, or constantly calling or texting to keep tabs on a partner. “If he starts to notice that your family and friends are concerned about your relationship, he may be looking to keep you away from them,” says Dana Cuomo, coordinator of victim advocacy services at the University of Washington. (Because of this dynamic, don’t give up on your friend if they stop calling you—be there for them and stay supportive.)

Checking the other person’s phone, email, or social media without permission (or pressuring them for access)
In a relationship, each partner is entitled to privacy. Violating that privacy is a major warning sign.

Intruding on another person’s private communications may also be a means of changing or influencing their decisions and opportunities. “Maybe you get a job interview, but your partner deletes the email so that you never know about it,” says Casey Corcoran, a program director of Futures Without Violence, an advocacy organization working to end violence against women and children.

Red flags include:

  • Checking a partner’s emails, texts, social media, and so on without their permission
  • Obsessively keeping tabs on the partner via texting, calling, or social media
  • Monitoring where a partner goes, whom they see, or what they do
  • Making personal decisions on behalf of a partner, or pressurizing them in their decisions, such as who to hang out with, or where to study or work

Using social status or peer pressure to manipulate the other person
Abusive partners may use the threat of social pressure, gossip, or lies to manipulate their partners. Often, they’ll also claim to be the authority on how men or women, or romantic or sexual partners, are supposed to behave. This is a way of justifying their own behaviors or condemning their partner’s.

Leveraging their power as “gatekeeper” to a social community
Some partners provide an important link to a social community (e.g., a group of friends, a club or organization based around a shared interest or identity, or an academic or professional group). Abusive partners may try and use that community link as a way to pressure their partner to stay in the relationship. Abusers may similarly use financial resources or pressure to control their partner.

Example  “If a partner who’s abusive is someone’s main link to an LGBTQ community, or maybe was that person’s first same-gender partner, that relationship can be very much tied up in their sexual identity,” says Gabe Murchison, senior research manager at the Human Rights Campaign, an LGBTQ advocacy organization. “They may be especially afraid to end that relationship, and they may feel they’ll lose a concrete part of their LGBTQ identity by ending it.”

Emotional manipulation

Making belittling comments and put-downs
Calling a partner names, making them feel small or ashamed, or humiliating them are common warning signs. No one should use shame to control their partner.

Getting angry suddenly
“This can be a sign of a bigger issue, especially if your partner becomes physically or emotionally abusive when they ‘lose it,’” says Corcoran.

Example  You can’t ever be sure you’re saying the right thing. It seems like anything might set your partner off. “You may feel as though you are on a roller coaster all the time,” says Corcoran. “One minute everything is fine, and the next he’s yelling.” In these cases, you feel like you can’t relax because you don’t know what to expect.

Being possessive and jealous
Warning signs include suddenly becoming jealous or angry, or making false accusations of infidelity.

Example  You’re at the bar and run into someone you’ve been intimate with before. When your partner finds out, they get very upset. “This happens when the abuser sees you as their property,” says Cuomo. “It is part of the pattern of power and control in abusive relationships in which you aren’t allowed to make choices about your own life.”

Those choices may include what you wear. They may be thinking that “if you’re wearing something sexy or flirty, you’ll draw the attention of another person, and that will be your fault,” says Cuomo. “It is very manipulative because it isn’t your fault at all; it’s because they don’t trust you not to act on another person’s advances.”

Making over-the-top gestures
Expensive gifts at the beginning of a relationship, or a rush to spend a ton of time together, can be red flags. Overcompensating is a distraction tactic—maybe she doesn’t want you looking too closely at other aspects of the relationship—and can also be used as leverage.

Extravagant gestures can also be part of the pattern of abuse and making up, which is common in abusive relationships. For example, “He might get so angry that he hits you during a fight. Then later he brings you a bouquet of flowers,” says Corcoran.

These episodes of kindness and hope can position the targeted person to deny the fear and anger that they feel toward the abuser, research indicates (Feminism & Psychology, 2011). “This is the time when the abuser tries to regain control,” says Cuomo. “The cycle has three stages: The tension builds, it turns into a fight, and then they apologize and say they’ll never do it again.”

Engaging in “gaslighting”
“Gaslighting” (the term references a 1938 play) is when an abusive partner manipulates the other by trying to make them doubt their own reality, experiences, and emotional health. The abusive partner might say, “It’s in your head,” or “It didn’t happen like that.” They may trivialize their partner’s emotions or pretend not to understand what they are talking about.

Physical or sexual pressure or violence

Using physical violence, the threat of violence, or fear
This can mean anything from destroying possessions—phones, glasses, tables, or other property—to physically harming a partner. Sometimes violence will be used or threatened in connection to sex. Some abusers threaten self-harm as a kind of manipulation.

Making someone nervous or uncomfortable can be a deliberate power tactic. “In unhealthy relationships, your partner does things that are meant to make you fearful,” says Corcoran.

Example  There’s no excuse for driving recklessly, especially with someone else in the car. If it’s intended to frighten the other person, this is abusive.

Pressuring or forcing sex
This includes sexual pressure, coercion, or force. It is common in physically abusive relationships, research shows. For example, in a 2005 study, two out of three women who’d been physically assaulted by a partner had also been sexually assaulted or coerced by that partner (Department of Justice).

Red flags include:

  • Threatening or using alcohol or drugs to pressure a partner to have sex
  • Ignoring a partner’s lack of interest in sex or even their explicit “nos” to sexual activity
  • Demanding sex in return for a gift
  • Refusing to use condoms or other kinds of birth control

Example  “When your partner doesn’t respect your decisions around sex, she may try to manipulate or blame you,” says Corcoran. “Why do we need to use a condom? Is it because you are sleeping with someone else?”

8 steps to supporting a friend in an abusive relationship

Couple in close gripsPeople experiencing abusive encounters and relationships tend to tell a friend, studies show. If you are that friend, you can make a difference. If you are experiencing abuse, these steps can help outline what seeking support may look like.

1   Be there and listen

This sounds simple, and it goes a long way. Abusive relationships often function by isolating the abused person from their support network, especially friends and family. Being present for your friend can be powerful in and of itself, counteracting the isolation they experience.

What to know about listening

When people reach out for support, it’s usually to a friend. For example, in a small study of college women who had experienced unwanted sexual contact, three out of four had disclosed the assault or abuse—the vast majority to a friend, according to Feminism & Psychology (2012).

Listening has many benefits. In a classic study of abuse survivors, people said they had valued the opportunity to talk and vent about their experiences, to receive comfort and emotional support, and to observe their friends’ anger toward abusers (Feminism & Psychology, 1993).

Be aware of factors and feelings that may make it harder for someone to disclose. Frequently, people in unhealthy relationships minimize the abuse they are experiencing (“It’s no big deal”); this may be especially likely if the abuse does not involve extreme physical or sexual violence. Some are concerned that others won’t understand and/or may respond in unhelpful ways. Some may be held back by embarrassment or shame, or fear for their safety if they tell anyone.

Self-blame is another powerful obstacle. In a 2015 study, people who had experienced sexual violence and understood it was not their fault were more likely to disclose it than were those who blamed themselves (Violence Against Women).

2  Be open to individual experiences

Stay attuned to your friend’s needs, regardless of whether or not their relationship conforms to what you’ve heard before about abuse. Be alert to common misconceptions about what abusive relationships look like and who they happen to.

Stereotype-busters to keep in mind

While abusive relationships have similarities—the pattern of controlling behavior, for example—no two are the same.

Keep in mind:

  • Abuse can take place in relationships of all types.
  • Abuse can take place in relationships involving people of any sexual orientation and/or gender combination.
  • Abuse can happen to anyone. Men can be abused in relationships. Outwardly strong, assertive people can be abused in relationships. Experts on relationship abuse can be abused in relationships.

How professionals moved past victim blaming
Professionals’ understanding of relationship abuse has shifted in recent decades. “In the mid-20th century, psychiatrists believed that only certain types of women ‘fell into’ abusive relationships,” says Dr. Pain. “Now it’s widely recognized that they were mistaking the symptoms of being abused (especially the mental health effects) for factors that predisposed certain people to being abused. This was a kind of medically sanctioned victim blaming that meant hefty challenges for the women’s movement and others trying to end relationship abuse. It also left men and LGBT victims out of the picture until relatively recently.”

3  Be clear that your friend is not to blame

Part of your role is to emphasize that the abuser is responsible for the abuse. Aggressors try to shift the blame: “I wouldn’t have to shout if you listened the first time”; “It wouldn’t be like this if I could trust you.” Self-blame is a common and powerful obstacle to disclosing abuse and seeking help.

4  Show your support

Ask: “What can I do to help?” The answer may be something seemingly small, like having breakfast with your friend regularly or walking them to class. Maybe you can help schedule an appointment with a doctor or counselor. In any case, follow your friend’s lead on how to help. Avoid saying anything that might trivialize your friend’s experience.

5  Remind yourself that your friend is in charge

Abusive relationships often involve repeated violations of a person’s autonomy. It is crucial that you not replicate that dynamic when you offer help. Your friend is (and should remain in) the driver’s seat. The decision of what to do and when is theirs.

6  Resist advising your friend to leave the relationship

Dumping the abuser may seem like a no-brainer. But many people find this advice unhelpful, in part because it can come across as victim blaming. Consider asking for guidance: “I’m not here to tell you to leave. That said, if you ever want to leave, I’ll support you. I’ll have your back, whatever your decision.”

Why leaving can be so difficult

It may seem baffling that someone does not immediately walk away from an abusive relationship. Researchers have found that the dynamics of abuse, and the decision to stay or leave, are highly complicated (Behavior and Social Issues, 2005).

People’s reasons for staying in abusive relationships are often rational and considered (for example, relating to safety, children, and finances), studies show. Individuals’ sense of belonging is important in deciding how to respond to abuse. For nonwhite people, the decision to leave a family or community can be especially seismic, research suggests (Women’s Studies International Forum, 2004). Researchers now understand that leaving an abusive relationship is a process and may take multiple attempts (Trauma, Violence, & Abuse, 2003).

Is it ever helpful to advise someone to leave?
Here’s the caveat: Some people report that the advice to leave an abusive relationship was helpful. This difference appears to depend on where each individual is at, research suggests. In a 2011 study, some women who had already considered leaving or had made preparations for leaving found it helpful to be advised to leave (Feminism & Psychology). For those who had not considered leaving, the same advice was unhelpful. Check in with your friend and ask what kind of support they need.

7  Suggest helpful resources

Suggest additional sources of support that might help your friend. These may be on campus, in the community, or online. Whatever you suggest, the decision on how to proceed belongs to your friend.

Where to start with accessing support

Researching the available support resources is a quick and practical way to help a friend. For example:

  • On campus: Your friend could consider discussing the situation with a counselor, the Title IX coordinator, a trusted dean, or an RA. Most campus staff and faculty have reporting obligations that require them to share any reports of violence or abuse with the Title IX coordinator. You may want to ask staff or faculty about this before disclosing.
  • In the community: Your friend may be interested in discussing their experiences with a rape or sexual assault crisis center, or other victim advocacy organization.
  • Online: Your friend may find it helpful to talk with an advocate via an anonymous, confidential hotline or online chat service. This may be a general relationship abuse resource or one that supports a specific community (e.g., LGBTQ). For resources, see Find out more today.

When is it OK to take the decision to seek further help out of their hands?
Only if someone is experiencing an acute threat or might harm themselves or others. In that case, talk to a campus counselor, the campus safety office, or Title IX staff.

Girl with hands in face8  Seek out support for yourself too

Supporting a friend through an abusive relationship can take a toll on you. Seek support whenever you need it from friends, family, mentors, or professionals. Relationship abuse hotlines are for you too (see Find out more today). Respect your friend’s privacy throughout.

Why it’s important to reach out

You may have noticed similarities between abusive relationships and abuse or misconduct in other contexts. You can likely tell when someone is experiencing pressure, disrespect, or unwanted attention. This makes your job as an active bystander that much easier.

What to do when you’re not sure this is abuse—and why their relationship is your business
Recognizing troubling dynamics within established relationships is not much different from recognizing such dynamics elsewhere. Whether the interaction involves a couple, acquaintances, or strangers, you can likely tell when someone is experiencing pressure, disrespect, or unwanted attention.

What if I’m not sure this is abuse?
You might be thinking of a friend whose relationship is not entirely respectful or fulfilling. Low-level disregard and disrespect are not the same as a pattern of controlling behaviors. Still, we should be wary. Everyone deserves to have their boundaries and desires respected. As a good friend, you would still be concerned for your friend, their well-being, and their happiness. These skills and strategies—listening, being present, showing support—are still useful in these contexts.

And what if it’s actually abusive?
The negative consequences of relationship abuse are far-reaching, both for individuals, communities, and society. These examples may surprise you:

Mass shootings
“Many high-profile mass shooters are also domestic abusers, and most ‘mass shootings’ are actually domestic violence incidents,” reported Vox, following the shooting at Fort Lauderdale airport in January. Researchers are exploring the parallels between relationship abuse and acts of terror. “While the two forms of violence are different in important ways, they are similar in the way that they work: largely, through fear,” says Dr. Rachel Pain, who co-directs the Centre for Social Justice and Community Action at Durham University, UK. “The physical incidents of violence are only part of the story; the threat of violence is used to exert control. And the fear that creates—either for the individual, children, or for a wider community—is one of the most important effects.”

Economic impact
Relationship abuse accounts for enormous costs in healthcare services, lost productivity, missed work, homelessness, and the ripple effects of intergenerational trauma (the impact on children and teens who are exposed to relationship abuse in their families). In the US, the cost of relationship abuse exceeded $5.8 billion a year, in a 2003 study for the Centers for Disease Control and Prevention (CDC).

Students share: What we learned about relationship abuse

Here’s why social support matters

“Much of what he did was very subtle, but he also said things that were flattering but aimed to control me (‘We should get married;’ ‘We love each other so condoms aren’t necessary, besides I haven’t used one in years’). After I got away, he stalked me via phone and email for two years. To this day, when I see someone who looks like him I tense up.

“People in my community said I was making the whole thing up. That was the hardest thing in the world. They invited him to come into spaces where I normally would be, so I had to always be on guard. It might not be the most dramatic story, but it lingers. There are people who I don’t speak to because of how they dealt with those issues. There are places I still don’t feel comfortable because I associate them with that time in my life.”
—Graduate student, Canadian university

Talking to someone is huge

“It isn’t your fault. It can happen to anyone. It happened to me. It helps to talk to someone you trust when it first happens. I wish I had.”
—Fourth-year student, Ashford University (online)

“Victims of trauma and abuse have a tendency to blame themselves and downplay their experience because someone had it worse. It is important to realize that your pain and anger are valid.”
—Third-year undergraduate, Kwantlen Polytechnic University, British Columbia

“Being a friend to someone, especially a victim, is the best thing one can do. Knowing when to take a step back, when to ask for help from someone more experienced, and finding the proper resources is the best way to help someone. There is always someone who can help.”
—Second-year undergraduate, Suffolk University, Massachusetts

“Don’t be ashamed to report the abuse and be vocal. Your voice establishes others’ rights.”
—Third-year graduate student, University of Windsor, Ontario

Quality partners value mutual enthusiastic consent

“Some days I think I was sexually abused in my last relationship. I felt that he knew I didn’t want to but went ahead anyway, knowing I wouldn’t speak up or call him out on it. Other days I just think I’m over-thinking it. I’ve never spoken out about it because I’m not sure if it was my fault.”
—Second-year undergraduate, Florida International University

“A previous sexual encounter with someone is not an all-access pass which excuses forceful or threatening behavior.”
—First-year graduate student, Ashford University (online)

“Out of my 5+ relationships there have only been two partners that completely respected my boundaries and asked for consent.”
—Fourth-year undergraduate, University of Waterloo, Ontario

Recognizing abusive behaviors can be a process

“About two months into the relationship, I was beginning to notice how controlling and emotionally manipulative he was. I was drinking at his house with him and some friends. After I drank too much, he became angry. He wanted to have sex with me. I told him I felt sick, saying over and over again that I did not want to. He got on top of me anyway and I was too intoxicated to push him off. I stayed with him for six more months. There were several instances of him pushing me to do things and have sex with him. I regret that I pretended that what he did was OK. I have learned to never stay silent about sexual abuse and assault.”
—Second-year undergraduate, University of Central Arkansas

“Looking back on it, what my ex-boyfriend was doing was more subtle than coercion. He was very manipulative and I fell into the trap of wanting to please him all the time, which led to thinking I wanted to have sex with him, but after, I felt really icky. My subconscious was telling me to leave and that I didn’t want to have sex with him, but I ignored it. I don’t like thinking about it. I would tell anyone to listen to those thoughts and free yourself. It’s OK if you let down the other person. You have to protect yourself.”
—Fourth-year undergraduate, University of California, San Diego

Ending an abusive relationship can be a process, too

“I told the guy that I felt awful. Rather than comfort me [when I was sick], he took my hand and put it on his penis. I told him that was ridiculous and made it clear I did not want him to come to [my campus apartment] any more. He called me a bitch and told me I was making everything about myself. It took him weeks to understand I had dumped him. He kept telling me to ‘think about it,’ as if my breaking up with him was not real. I never allowed him to see me again. I don’t feel bad about dumping him in a text rather than making a scene in public or risking myself in my apartment.”
—First-year graduate student, Kutztown University of Pennsylvania

“A boyfriend forced me to have sex with him even after I had said no. He kept insisting and I was afraid of what would happen if I didn’t give in. So I just did what he wanted. It happened on a Sunday and I ended the relationship on Monday. It took months to get rid of him fully, and he still haunts my dreams now and then. I never filed charges or reported it. [I felt] no one would believe it was rape. I still feel violated, and this happened years ago.”
—Second-year undergraduate, Ashford University (online)

When intimacy feels like an obligation—red flag

“I have a friend who felt obligated to comply with his sexual demands because they were dating. We had to pull her out of the situation ourselves.”
—Third-year undergraduate, Collin College, Texas

“My boyfriend when I was younger had a bad temper and would hit walls or do really mean things. He was also fairly forceful in bed and made me feel guilty when I said no.”
—Second-year graduate student, University of Washington

“It is really frustrating to feel obligated to have sex with someone you love. When I am overwhelmed with tasks, my significant other does not recognize the hints I give him to back off. He had the audacity to act upset after I firmly said no, I would not interrupt my work to satisfy his urges. Later, after telling him I needed to sleep because I needed to be up in four hours, I finally just gave in. I love him, but it never feels good to be coerced into sex.”
—First-year student, Des Moines Area Community College, Iowa

Intimacy is not about pressure or proof

“We broke up over the course of a year, and we still had sex sometimes, as if we were still together. It was assumed that I was always comfortable with it, since they were the one wavering in our relationship and I was not. I wasn’t all right with it, though. I did want it to work out eventually, and felt that meant maintaining intimacy through everything.”
—Third-year undergraduate, University of Victoria, British Columbia

“When I was married, my husband made it clear that if he wanted it and I didn’t, his desire would rule, because it was my duty to meet his needs and any lack of desire was my problem. I quickly learned to dread sex. Now that we are divorced, I’m worried that I will continue to view it as a negative experience.”
—Third-year undergraduate, Metropolitan State University of Denver, Colorado

Trauma can be long-term—and support is available

Someone sitting down bent over, upset“My first relationship was when I was 14 years old. The boy was such a charmer and no one knew what was going on. The first three months he was sweet as can be, but then he changed. He said the reason our relationship was bad was because I wouldn’t have sex with him. He did some sexual things against my will that are too painful to go into detail about. Because of him, I believed I was stupid, unlovable, and ugly.

“One day he said that he was unhappy and it was my job to make him happy. So I said we were through. I lost friends because he said I lied and cried rape. I was bullied on social media. I have PTSD from the abuse. This past year I feel into a deep dark place. I wanted to kill myself. I realized I had been running from the pain and never dealt with it. I am on medicine now, and working with someone on my anxiety, PTSD, and depression. Everyday is a battle that I slowly am winning. I refuse to let the butthead continue hurting me. Those sexual assault videos always like to quote that ‘1 in 4’ statistic; what many don’t realize is for me that isn’t just a statistic, it’s my life.”
—Second-year graduate student, California State University, Stanislaus

Keep going and seek help—happiness is possible

“My first husband beat and raped me and went to prison for it. I got addicted to opiates shortly after and lost my home. It took me years to come to terms with it. The most helpful thing was my comfort animal.”
—Fourth-year undergraduate, Portland State University, Oregon

“I was in an emotionally abusive relationship. My sight was thwarted because I was in love; it was very confusing. I knew something was not right but couldn’t place my finger on it. After this relationship, my subsequent relationships were unbalanced. I had lost the potential for innocence and trust. It was not until the birth of my now year-old daughter, and extensive therapy, that I have achieved a harmonious relationship. I am ecstatic!”
—Second-year undergraduate, Berea College, Kentucky

In a recent survey by SH101, most stories of relationship abuse were reported by female students describing heterosexual relationships. This is the most common abuse dynamic, research shows. That said, relationship abuse can happen to anyone. This slideshow includes comments from students of varying genders and sexualities.

The frequency and health impact of sexual assault by partners
Abuse of all types can affect people in relationships of any sexual orientation or gender-identity. The research on sexual assault and coercion within relationships is limited. Existing studies focus primarily on women experiencing abuse in heterosexual relationships.

  • Sexual assault and coercion in relationships is not rare: In several studies of women who had been married or cohabiting, 8 to 23 percent reported having been sexually assaulted by an intimate partner, according to a 2003 review in Trauma, Violence, & Abuse. The study definitions of intimate partner and sexual assault varied.
  • Sexual violence may be relatively common in young people’s relationships: In a UK study involving teens, 31 percent of girls and 16 percent of boys reported some form of sexual coercion or assault (NSPCC, 2009).
  • Physical and sexual violence may go together: Many abusive relationships that involve physical violence involve sexual violence too, research shows (Department of Justice, 2005). Within relationships, the mental and physical health impact of sexual assault can be worse than the harms caused by physical violence, according to the same study. Sexual assaults by partners are more likely to cause physical injury than sexual assaults by strangers or acquaintances are (Partner Abuse, 2012).
  • Sexual assault by partners can cause serious physical and emotional harm: Women who have been sexually assaulted within relationships had more post-traumatic stress disorder (PTSD) symptoms, more pregnancies resulting from rape, more sexually transmitted infections, and more suicide attempts, compared to women who had been physically but not sexually assaulted by partners, according to the 2005 study for the Department of Justice.
  • Sexual assault by partners is a risk factor for drug use: In the 2005 study, 27 percent of the women began or increased their use of nicotine, alcohol, or illicit drugs (usually cocaine) after they were sexually assaulted by an intimate partner.
  • The sexual assault risk can vary according to circumstances: Women who are disabled, pregnant, or attempting to leave their abusers are at greatest risk for intimate partner rape, says the National Coalition Against Domestic Abuse.

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van Schalkwyk, S., Boonzaier, F., & Gobodo-Madikizela, P. (2014). “Selves” in contradiction: Power and powerlessness in South African shelter residents’ narratives of leaving abusive heterosexual relationships. Feminism & Psychology, 24(3), 314–331.

WNYC. (2015, September 16). Where to find help. Retrieved from https://www.wnyc.org/story/where-find-help/

Woodyatt, C. R., & Stephenson, R. (2016). Emotional intimate partner violence experienced by men in same-sex relationships. Culture, Health & Sexuality, 18(10), 1137–1149.

Yale Sexual Harassment and Assault Response & Education Center. (n.d.). Sexual Misconduct—Intimate Partner Violence. Retrieved from https://sharecenter.yale.edu/information-about-sexual-misconduct/forms-sexual-violence/intimate-partner-violence

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01 MarSelfSubstance use

Sober support: What works for students in recovery?

by Lucy Berrington0 Comments
Reading Time: 10 minutes

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What if students have gone through treatment for alcohol addiction or drug abuse, and now they’re back on track, focusing on their education and future? Their success in school depends on managing their sobriety. But college comes with stress, academic challenges, and exposure to alcohol or drugs—factors that can raise the risk of relapsing, studies show. Increasingly, substance dependency (or addiction) is understood as a chronic condition that requires ongoing management. For sober students, this is the dilemma: How can they steer clear of those triggers and manage their addiction while also having a fulfilling college experience?

Students are joining recovery programs on campusClose up of hands

“I have found a fantastic group of friends within our recovery organization, and my relationships with them extend far beyond the meetings and events we hold. We hang out on the weekends, we do fun stuff like any other group of college students, we just don’t drink or drug in the process.”Increasingly, students who are “in recovery”—working to maintain their sobriety—are finding the solution in dedicated recovery programs on campuses. These programs vary, but may include drug-free housing, sober hangout space, social events with supportive peers, and meetings, counseling, and academic supports tailored to address the pressures and triggers associated with staying free of alcohol and/or drugs.

More than 170 university campuses now offer some level of recovery programming, according to Transforming Youth Recovery, a nonprofit that provides schools with funding and other resources for this purpose. The organization has a pilot project underway to expand capacity for recovery services at 100 community colleges.

“People are starting to know there is recovery support on college campuses and are looking around for it,” says John Ruyak, an alcohol, drug, and recovery specialist at Oregon State University. In a 2016 study involving nearly 500 students at 29 campus recovery programs, one in three said they would not be in college were it not for that program (Journal of American College Health).

Shifting medical and societal attitudes toward addiction appear to be helping. “There’s a trend to recognize dependency/addiction as a chronic illness, like diabetes or Crohn’s disease,” says Dr. Davis Smith, a staff physician at the University of Connecticut Student Health Center, and medical director of Student Health 101. “Like those physical conditions, substance dependency behaves differently in different individuals, is not a marker of physical or spiritual weakness, and requires ongoing attention/treatment to manage it.”

This increasingly empathic understanding of drug dependency makes it easier for people to seek the resources that could help them. “Students have changed enough that they are not so worried about anonymity as they are about finding the support,” says Dr. Ann Quinn-Zobeck, former senior director of BACCHUS initiatives and training at NASPA (Student Affairs Administrators in Higher Education), a leader in peer-education initiatives addressing alcohol use at US colleges.

It also helps that students in recovery are not the only ones who are avoiding alcohol and drugs. “The data on student alcohol and other drug use makes it clear that while many students do use at some level, more and more are abstaining for a variety of reasons,” says Dr. Beth DeRicco, director of higher education outreach for Caron Treatment Centers, who has extensive experience developing policies and programs that address dangerous drinking and drug use on campuses and in our broader communities. Among more than 29,000 US students who responded to a national, anonymous survey, 20 percent reported that they had never drunk alcohol, and 16 percent said they had drunk alcohol but not in the past 30 days (National College Health Assessment, spring 2016).

Campus recovery programs help students succeed and graduateTeacher and student at computer

Early research suggests that these programs can help students succeed academically and graduate from college. A 2014 study involving 29 collegiate recovery communities found that their students had higher GPAs and graduation rates than the general student populations at the same colleges (Journal of Social Work Practice in the Addictions).

That success reflects the determination of these students to move forward, says Joan Masters, senior coordinator at Partners in Prevention, a consortium addressing substance abuse on Missouri campuses. “Students in recovery take every choice seriously and day-by-day. Going back into higher education is a commitment, their second chance.” The relapse rates of students in these programs appears to be well below those of adults accessing community-based recovery services, according to the same 2014 study.

Peer support is key to recovery“Certain aspects of college life tend to feel inappropriate for traditional 12-step groups. It doesn’t feel right for me to walk into a 12-step meeting and express my struggles with the stress of midterms, or the paper that I’m not as prepared for as I’d like to be, when there is a newcomer in the room who is struggling to put days of sobriety together.”

Recovery supports work better when they are designed to meet the needs associated with specific life stages and environments, research shows (SAMHSA, 2009). “For most students in recovery, collegiate recovery programs provide the social support and peer network critical to maintaining recovery,” says Dr. DeRicco.

The key components of campus programs may be peer-based groups, 12-step recovery supports, and academic supports, according to a 2011 study in Alcoholism Treatment Quarterly. College administrations are well positioned to facilitate these.

Part of the solution is as simple as physical infrastructure. “Universities can help facilitate students getting together and supporting themselves and each other; having dedicated space makes that easier,” says Ruyak. Early class registration means students don’t have to choose between accessing recovery supports and meeting their academic requirements, he says. “Students need to put their recovery first. If you don’t, it’s hard to be the best student you can be.”

What does campus recovery programming look like?Group of happy students

Collegiate recovery communities vary widely, both in the types of services available and in what they require of the students who access them. “There are many models of different types,” says Masters. “In Missouri, we allow each college to pick what works for them while maintaining fidelity to various tenets of recovery.”

Campus recovery programs typically include some (but not necessarily all) of the following elements:

  • Meetings on campus; meetings typically emphasize peer support. These can take various formats, such as the 12-step approach of Alcoholics Anonymous and Narcotics Anonymous, the coping strategies emphasized in SMART Recovery, or the Christian fellowship of Celebrate Recovery (see Find out more today).
  • Sober or drug-free housing, such as a residential building or dorm restricted to students who don’t use
  • Academic support, such as priority registration to help students organize their class schedule around their recovery programming
  • Individual or group counseling to address recovery-related issues, such as relapse prevention and coping strategies
  • Sober leisure activities and social events
  • Dedicated staff with expertise in recovery
  • Financial support, such as scholarship and grant opportunities
  • Classes dedicated to addiction recovery

Programs may specify a particular recovery approach or allow students to choose what works for them. For example, at Oregon State University, “We want students to choose their path of recovery. We don’t define what that looks like as long as it is positive for the community and they are not using,” says Ruyak. 

Who's in campus recovery and how do they get there?

The average age of students in college recovery programs is 26, according to the Journal of American College Health (2016)—a number that hints at the nontraditional routes of many students in recovery (as explained below). “In our program, they’re from age 19 into their 40s, ranging from people who are literally just getting sober to people with nine years of sobriety,” says Sarah Nerad, program manager of the collegiate recovery community at The Ohio State University.

The campus recovery population may include:

  • Students who got sober or stopped using in high school; some take a gap year before going to college
  • Students who took time out of college in order to access alcohol and/or drug treatment, and returned to college once their recovery was on track
  • Students who did not go to college after graduating from high school, but instead worked, had children, became sober, and returned to education in their 30s, 40s, or 50s
  • Students who got sober in college (e.g., accessing outpatient alcohol and/or drug treatment)

Many recovery communities are open to others, including:

  • Students who are not in recovery but are sober and/or don’t use drugs; e.g., because of their religious beliefs or a family history of addiction
  • Students in recovery who are sober and do not need major supports
  • Students who are taking a break from drinking or substance use as a lifestyle choice or who are considering getting sober
  • Students who are not sober but are allies to their sober peers

How do I join a campus recovery program?

If you’re already in college, ask about recovery services at your disability services office, counseling center, or student health center. If you’re not in school or are considering a transfer, check college websites and/or contact their student health centers. The membership requirements for recovery programs are variable. “There are many campus programs and policies that support substance-free living, and students in recovery benefit from these as does the general population of students,” says Dr. DeRicco. “If you have taken time out for substance use treatment and are looking to return to school, factors that improve your chance of success include the presence of a campus recovery program, psychoeducational programming (e.g., handling stress and triggers), and access to group meetings.”

Some elements of programming (e.g., sober housing and early class registration) may be restricted to students who meet specific membership requirements. Other elements (e.g., sober meeting space and social events) may be open to students who are not members of the recovery program but can benefit from those resources and/or support students in recovery.

To be admitted to recovery programming, staff may consider:

  • Your treatment history
  • Your duration of abstinence/sobriety before you start the program
  • Your enrollment status (e.g., a minimum number of credit hours)

The program may require:

  • Your regular participation in a specified program (e.g., 12-step meetings) or a program of your choice that supports recovery
  • A signed sobriety contract (sobriety may be defined in various ways)
  • Your agreement to drug testing
  • Costs or fees for some services

How can I start a recovery community on campus?

Supportive peers are highly valuable to recovery. If you are new to recovery and want to start a group on campus, reach out to other students who have more experience. “When you have a year or two of recovery under your belt, a leadership role comes more naturally,” says Nerad.

  • Contact your college administrators: Start with health educators, the disability services office, the counseling center, and the dean of student life or residence life. “Students in recovery [may be] an anonymous population. Help your college know that this community exists.” says Masters.
  • Reach out to likely allies: Talk with faculty and students in departments and programs that prioritize community service and can help you strategize and organize (e.g., social work, psychology, sociology, and counseling). Be sure to involve your disability services staff on campus; they are well positioned to support students in recovery.
  • Organize a Meet & Greet: When you have gathered a core group of students and allies, help other students connect with their peers in recovery. Talk with your staff and faculty allies about what space will work for a meeting and how to offer free pizza. Promote the event around campus. Invite student government representatives to show their support.
  • Locate space for meetings and support groups: Liaise with administrators, health educators, and counseling staff about access to meeting space and other resources, such as free photocopying and coffee.
  • Form a student organization: Reach out to your student government to learn the process and protocol.
  • Look for community-based allies: Check out meetings run by AA, NA, or other organizations including local rehab centers. “From doing a bit of networking in that community you will be able to find other local resources to help you start programs on campus,” says a fourth-year student at Ashford University (online).

What if starting a campus-based group is not an option?

This may be an issue on small campuses where there are not enough students in recovery to maintain an ongoing group. “You can find a lot of the same benefits in traditional models of recovery.  There are 12-step meetings and counseling opportunities everywhere, and those can work as a starting point to build the fellowship that comes out of a campus org,” says a fourth-year undergraduate member of a campus recovery program at a midwestern university.

How do I know if my drinking and/ or drug use is a problem?

It’s not necessarily easy to know if your own alcohol and/or drug use has become problematic. If alcohol and/or drugs are negatively affecting your life, or you’re having trouble moderating your use, it’s important to seek help earlier rather than later. “People in their late 20s, 30s, and 40s say, ‘I wish I’d got sober in college’,” says Nerad. Under diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), addiction or dependency (termed substance use disorder), can be mild, moderate, severe, or in remission.

Six percent of the US student population meets the diagnostic criteria for alcohol dependency, according to the Journal of Studies on Alcohol and Drugs (2002). For some students, risk-taking is a developmental stage that they outgrow. Others may be self-medicating in response to an underlying emotional and/or physical health issue that isn’t being addressed in healthier ways.

When students seek help managing their alcohol or drug use, it’s usually in response to an alarming experience. “They woke up one day and realized their situation was not good; they got black-out drunk, they need help,” says Nerad. “They go to the student health center, counseling center, or health educator. Some students look up AA.” Many colleges have online screening tools for identifying risky substance use and assessing the need for further support, and brief interventions that can help students manage their use and avoid further negative consequences.

These questions can help you figure out if your drinking or drug use is problematic:

  • When you start drinking and/or using, are you able to stop before you start to experience negative consequences?
  • Are you able to set rules for your drinking or use and comply with them? For example: using only marijuana, not other drugs; drinking only on weekends.
  • Is your drinking or drug use having a negative impact on your life? For example: declining grades; friends losing patience with you; legal or disciplinary consequences; spending more money than you can afford on alcohol or drugs; life starting to feel unmanageable.

11 criteria that indicate problematic use (VeryWell.com)

Treatment for alcohol and/or drug misuse can take a variety of forms

“Depending on the level of care needed, a young person may or may not need to take a medical leave from campus,” says Dr. DeRicco. She outlines these treatment options:

  • Depending on the campus location, off-campus services in conjunction with on-campus supports may be sufficient.  When it is clinically appropriate, combining academics with treatment, and/or having academic goals imbedded in a treatment plan, can provide important motivation for success.
  • For many, medically assisted treatment is critical. Inpatient, outpatient, or residential treatment may be indicated and may require time out from academic life.
  • A few campuses (e.g., Augsburg College, Minnesota, and Texas Tech University) are associated with therapeutic treatment communities. Far more commonly, a collegiate recovery program or collegiate recovery community supports students before or after treatment.

[survey_plugin] Article sources

Beth DeRicco, PhD, director, higher education outreach, Caron Treatment Centers, Pennsylvania.

Joan Masters, MEd, senior coordinator, Partners in Prevention, University of Missouri Wellness Resource Center; regional consultant, The BACCHUS Network, NASPA.

Sarah Nerad, MPA; program manager, Collegiate Recovery Community; director of recovery, Higher Education Center for Alcohol and Drug Misuse Prevention and Recovery, Office of Student Life, Ohio State University.

Ann Quinn-Zobeck, PhD, former senior director of initiatives and training, The BACCHUS Network, NASPA.

John Ruyak, MPH, alcohol, drug, and recovery specialist, Oregon State University.

Davis Smith, MD, staff physician, University of Connecticut Student Health Center; medical director, Student Health 101.

American College Health Association. (2016, Spring). American College Health Association—National College Health Assessment (ACHA-NCHA) reference group data report. Retrieved from https://www.acha-ncha.org/docs/NCHA-II%20SPRING%202016%20US%20REFERENCE%20GROUP%20DATA%20REPORT.pdf

Association of Recovery in Higher Education. (2016). The collegiate recovery movement: A history. Retrieved from https://collegiaterecovery.org/the-collegiate-recovery-movement-a-history/

Borsari, B., & Carey, K. B. (2006). How the quality of peer relationships influences college alcohol use. Drug and Alcohol Review, 25(4), 361–370.

Bugbee, B. A., Caldeira, K. M., Soong, A. M., Vincent, K. B., et al. (2016, August.) Collegiate recovery programs: A win-win proposition for students and colleges.
University of Maryland School of Public Health. Retrieved from https://www.cls.umd.edu/docs/CRP.pdf

Clapp, J. D. (2014, February 28). [Review of the book Substance Abuse Recovery in College: Community Supported Abstinence, by H. H. Cleveland, K. S. Harris, & R. Wiebe (Eds)]. Journal of Social Work Practice in the Addictions, 14(1), 113–114.

Harrington, C. H., Harris, K. S., Baker, A. K., Herbert, R., et al. (2007). Characteristics of a collegiate recovery community: Maintaining recovery in an abstinence-hostile environment. Journal of Substance Abuse Treatment, 33(1), 13–23.

Harrington, C. H., Harris, K. S., & Wiebe, R.P. eds. (2010). Substance abuse recovery in college: Community supported abstinence. Advancing responsible adolescent development. New York: Springer, 2010.

Johnston, L. D., O’Malley, P. M., Bachman, J. G., Schulenberg, J. E., et al. (2015). National survey results on drug use 1975–2015: College students and adults ages 19–55. Monitoring the Future/National Institute on Drug Abuse. Retrieved from https://www.monitoringthefuture.org/pubs/monographs/mtf-vol2_2015.pdf

Kilmer, J. R., & Logan, D. E. (2012). Applying harm reduction strategies on college campuses. In C. Correia, J. Murphy, and N. Barnett (Eds.) College student alcohol abuse: A guide to assessment, intervention, and prevention. Hoboken, NJ: John Wiley & Sons.

Knight, J. R., Wechsler, H., Kuo, M., Seibring, M., et al. (2002). Alcohol abuse and dependence among US college students. Journal of Studies on Alcohol and Drugs, 63(3), 263.

Laitman, L., Kachur-Karavites, B., & Stewart, L. P. (2014). Building, engaging, and sustaining a continuum of care from harm reduction to recovery support: The Rutgers Alcohol and Other Drug Assistance Program. Journal of Social Work Practice in the Addictions , 14(1), 64–83.

Laudet, A., Harris, K., Kimball, T., Winters, K. C. et al. (2016). In college and in recovery: Reasons for joining a collegiate recovery program. Journal of American College Health, 64(3), 238–246.

Laudet, A., Harris, K., Kimball, T., Winters, K. C., et al. (2014). Recovery community programs: What do we know and what do we need to know? Journal of Social Work Practice in the Addictions, 14(1), 84–100.

Laudet, A. B., Harris, K., Kimball, T., Winters, K. C., et al. (2015). Characteristics of students participating in collegiate recovery programs: A national survey. Journal of Substance Abuse Treatment, 51, 38–46.

National Institute on Alcohol Abuse and Alcoholism. (2005). A pocket guide for alcohol screening and brief intervention. Retrieved from https://pubs.niaaa.nih.gov/publications/practitioner/PocketGuide/pocket.pdf

Quinn-Zobeck, A. (2007). Screening and brief intervention tool kit for college and university campuses. National Highway Traffic Safety Administration/BACCHUS Network.
Retrieved from https://www.integration.samhsa.gov/clinical-practice/sbirt/NHTSA_SBIRT_for_Colleges_and_Universities.pdf

Smock, S. A., Baker, A., Harris, K. S., & D’Sauza, C. (2011). The role of social support in collegiate recovery communities: A review of the literature. Alcoholism Treatment Quarterly, 29(1), 35–44.

Student Health 101 survey, December 2016.

Substance Abuse and Mental Health Services Administration. (2009). Designing a recovery-oriented care model for adolescents and transition age youth with substance use or co-occurring mental health disorders. US Department of Health and Human Services; Rockville, MD.

Substance Abuse and Mental Health Services Administration. (2009). Treatment episode data set (TEDS) highlights—2007: National admissions to substance abuse treatment services. SAMHSA, Office of Applied Studies: Rockville, MD.

Substance Abuse and Mental Health Services Administration. (n.d.). Medication assisted treatment. Retrieved from
https://www.integration.samhsa.gov/clinical-practice/mat/mat-overview

Substance Abuse and Mental Health Services Administration. (2015). Substance use disorders. Retrieved from https://www.samhsa.gov/disorders/substance-use

Substance Abuse and Mental Health Services Administration. (2016). Treatments for substance use disorders. Retrieved from https://www.samhsa.gov/treatment/substance-use-disorders

Transforming Youth Recovery. (2017). Areas of focus. Retrieved from https://www.transformingyouthrecovery.org/focus

White, W., & Finch, A. (2006). The recovery school movement: Its history and future. Counselor, 7(2), 54–57.

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01 MarFeaturedFinancesMoney

Your everyday money mistakes: 5 ways to spend smarter

by Lucy Berrington0 Comments
Reading Time: 3 minutes

Rate this article and enter to win
Except for those times when a credit or debit card is a necessity, seriously consider leaving it behind. In studies, using cash is consistently associated with lower spending, and more deliberate (and healthier) purchasing choices. Use these strategies to keep your bank balances up and your credit card balances down.

1 Carry cash, not cards

We’re more likely to buy something if we’re paying with plastic than if we’re paying with cash, says a 2012 study in the Journal of Consumer Research. That’s because handing over cash gives us a painful emotional jolt, while paying with plastic is just too comfortable, according to the Journal of Experimental Psychology (2008).

For those occasions when you do use plastic, set up transaction notifications (e.g., texts) on your banking or budgeting app. This may help you maintain a more realistic sense of your spending. If you use a credit card, never spend more than you can pay off in full that month.

How paying with credit affects our food choices

Paying with credit cards is associated with less healthy food choices. A 2011 study of shopping behavior found that shoppers using credit or debit cards picked up more food items that were considered unhealthy; cash buyers were more likely to avoid junk foods.

When we encounter cookies, cakes, and pies—and when we’re paying with plastic—“the emotive imagery and associated desire trigger impulsive purchase decisions,” researchers wrote (Journal of Consumer Research, 2011).

Speaking of grocery shopping, watch out for free samples and how they affect your buying decisions. Even those nano-servings of prepped food in grocery stores invoke our sense of reciprocity, according to a 2011 study in the British Food Journal. This can make us more likely to buy products we don’t need.

2  Ditch the gift cards—request money gifts in cash

As we’ve seen, cash gives us the gift of uncomfortable self-awareness about our expenditure. We don’t like parting with real money. In contrast, we see gift certificates (and credit cards) as “play money,” and we’re more inclined to get reckless with them, wrote researchers in the Journal of Experimental Psychology (2008).

3  Review your automatic payments

Paying bills automatically can help protect us from overdue charges and bad credit. The downside: Automatic payments are another example of passive transactions, and these have risks. When we pay bills automatically, we’re not watching our spending or looking around for better options. Review those bills routinely, and sign up for payment alerts.

4   Pay off your credit card in full every month

Credit cards involve passive, behind-the-scenes transactions. They make spending too comfortable and going into debt too easy. Consumers using plastic are focused on the benefits of the product instead of thinking about the cost, according to a 2011 study in the Journal of Consumer Research.

Passive transactions can work if you use them to avoid debt and save money. For example, when you automatically pay off your credit card every month using online banking “Bill Pay,” you’re building your credit score while avoiding racking up interest charges. If you overspend and can’t pay the credit card bill in full, pay as much as you can—more than the minimum required payment.

Every credit card use = a high-interest loan

Every time you use your credit card, even on smaller items, you’re taking out a high-interest loan. Small credit card loans add up quickly. They incur high financial penalties for late repayment and contribute to serious debt. A video game, night out, or pair of sneakers is so not worth this.

Credit card companies may “require” a relatively low repayment each month. We may feel we’re in good standing if we pay off that $25, but if we spent $50 that month using our credit card, we start racking up interest charges on top of the amount we already owe. If you can’t pay the full bill, always try to pay more than the minimum. As a rule, avoid spending more than you can repay that month.

“A major problem is that some consumers underestimate the total costs of piecemeal borrowing. Apparently people who would never take out a big loan are willing to take out a number of small loans that are big in the aggregate,” writes Dr. Cass Sunstein, a leading behavioral researcher (in New Republic). “One survey found that small purchases of nonessential goods (including movies and DVDs) are a major contributor to credit card debt. Financial distress, including consumer bankruptcies, is a possible consequence.”

Calculate your credit card interest and repayment timeline

5  Watch your bank fees

Millennials are the age group most likely to overdraw their bank accounts, according to the Consumer Financial Protection Bureau (2014). Often, overdrafts are the result of small transactions. Going overdrawn effectively makes these transactions far more expensive because they incur bank fees.

ATM charges are added fees. If you’re paying $2.95 to withdraw cash from an ATM that isn’t “partnered” with your bank, two withdrawals a week are costing you more than $300 a year. It’s time to find out where you can make free withdrawals. Some stores provide cash-back services without a fee.

[survey_plugin] Article sources

Bakker, T., Kelly, N., Leary, J., & Nagypal, E. (2014, July). Data point: Checking account overdraft. Consumer Financial Protection Bureau. Retrieved from https://files.consumerfinance.gov/f/201407_cfpb_report_data-point_overdrafts.pdf

Chatterjee, P., & Rose, R. L. (2011). Do payment mechanisms change the way consumers perceive products? Journal of Consumer Research, 38.

Dratch, D. (2014, January 7). How behavioral economics explains six common money mistakes. CreditCards.com. Retrieved from https://www.creditcards.com/credit-card-news/behavioral-economics-6-money-mistakes-1267.php

Heilman, C.,  Lakishyk, K., & Radas, S. (2011). An empirical investigation of in-store sampling promotions. British Food Journal, 113(10), 1252–1266.

Raghubir, P., & Srivastava, J. (2008). Monopoly money: The effect of payment coupling and form on spending behavior. Journal of Experimental Psychology: Applied, 14(3), 213–225.

Renzulli, K. A. (2014, August 27). The spending mistake that millennials are making. Time.com. Retrieved from https://time.com/money/3182089/millennials-spending-mistakes/

Sunstein, C. R. (2012, October 5). Show me the money. New Republic. Retrieved from https://newrepublic.com/article/108153/show-me-the-money

Thomas, M., Desai, K. K., & Seenivasan, S. (2011). How credit card payments increase unhealthy food purchases: Visceral regulation of vices. Journal of Consumer Research, 38. Retrieved from https://forum.johnson.cornell.edu/faculty/mthomas/VisceralRegulationofVices.pdf

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01 JanFeaturedSelfSelf-improvement

Systems that stick: The science of changing yourself

by Lucy Berrington0 Comments
Reading Time: 6 minutes

Rate this article and enter to win
A brand-new year, a brand-new you. Sound familiar? Many of us start the year with high achievements in mind (make straight As, quit the sugar habit, finally run that marathon) only to end up making no progress. But being in college can cause a decline in healthy behaviors like physical activity and nutritious eating, research shows. Science has shown us that noble goals and willpower aren’t enough to change our behavior long-term.

The science of healthy habits

Fortunately, science is also telling us how to develop healthier, more productive habits. “We actually know a great deal about strategies for helping people change behavior,” says Dr. Timothy Edgar, a professor in the Department of Public Health and Community Medicine, Tufts University, Massachusetts. “Unfortunately, those who design interventions still rely too heavily on telling people the reasons why they should make a change, instead of identifying the barriers, real and perceived. Once those barriers have been identified, the key is to find ways to make it as easy as possible for people to engage in the desired behaviors.”

The technology of healthy habits

That’s becoming easier all the time. Technology is harnessing behavioral change strategies and delivering them to us in increasingly useful forms. “With the tools we have now, people are able to get a lot more information about not just their own health currently, but also a better sense of their motivations. And that’s because if you measure something, it’s something you can manage,” says Khinlei Myint-U, product director for patient engagement at Iora Health, a consultancy based in Boston, Massachusetts.

The habits students want most

In a recent CampusWell survey, respondents ranked sleep, fitness, and study habits among the top behaviors they’d like to address. “My system is one of slow and gradual changes. I make little improvements each day to reach a goal. For studying, I like to spread it into several 30 minute or hour increments,” says Mia K., a first-year undergraduate at Georgia College and State University. Mia’s on the right track by setting up a realistic system that lowers the barriers. Here’s how you can get on board and have your best semester—with new habits that last through June (at least).

1. Translate your goal into a system or action

Goals represent the person we’d like to be: fit, healthy, productive, and respected, with an enviable credit report. But those goals are both too big and too vague to be helpful. To make progress, we need systems or actions. Here’s the difference:

Goal Get more sleep
Action Use a sleep schedule to increase my average sleep by 15 minutes a night per week until I reach my target of [—] hours per night and [—] hours per week

Example of a sleep schedule chart

Goal Reduce my junk food intake to one snack or dish every other day
Action Pack alternative snacks: e.g., fruit, whole-grain crackers, veggies, and granola

Goal Ace my midterm
Action Create a study plan for reviewing the material daily

Woman with exercise ball

2. Incorporate these features into your system or action

The features listed in the what works column have been proven to help change our behaviors. Incorporate as many as possible.

What works Example 1
Get more physically fit		 Example 2
Get more organized
Target one goal at a time â€Ē Improve my physical fitness â€Ē Improve my organization
Take a realistic action or approach â€Ē I love running (or at least don’t hate it) â€Ē Calendar and planning tools on laptop synced to phone for easy access
Start small â€Ē Incremental training program with realistic goal, e.g., Couch 2 5K running plan â€Ē Make half my deadlines without requesting an extension
Join a team â€Ē Find or start a running group â€Ē Recruit friend with the same goal
Make a specific plan â€Ē Group runs on Sat & Tues at 8 a.m.; solo runs on Sun & Thurs at 6 p.m. â€Ē Meet Sunday afternoons to review and plan; check schedule three times a day
Incorporate cues and rewards â€Ē Group brunch on Sundays; fame and glory via student blog â€Ē Flag upcoming deadlines; for each success, see a movie
Tweak your environment â€Ē Keep sneakers and rain jacket by the door â€Ē Baskets to hold papers and books for each class; large desk calendar highlighting due dates
Anticipate and plan for obstacles â€Ē Run an hour earlier or in the evening to beat the summer heat â€Ē Two papers due same day; adjust schedule in advance

3. Consider using a behavior change tool

We’re seeing an explosion of new digital and online tools designed to help us manage our behavior. How to choose one? Check out Wellocracy, a site for choosing and using personal health and wellness technologies, from the Center for Connected Health at Partners HealthCare, a major health system based in Massachusetts. Helpful tools provide:

  • Immediate feedback
  • Motivation (e.g., smiley faces)
  • Easy access (e.g., via your phone)
  • Updates through the day

“You want to know, ‘I’ve done 6,000 steps! If I just walk home or take the stairs, I might make it to my goal of 10,000 steps today,’” says Khinlei Myint-U.

Popular behavior change mobile apps

Habit Streak

Learn more

Features
This app helps you set goals, reminds you of them, prompts you to record your progress, and visually presents your new habit streak as it forms, inspiring you not to break it.

Evidence base
Habit Streak appears to have been inspired by Jerry Seinfeld’s approach to productivity: cross off days on a paper calendar. The crosses form a chain that steadily lengthens, inspiring you not break it.

Devices
Android

Cost
Free

My Life Organized

Learn more

Features

This time-management system helps you prioritize, automatically generates to-do lists, and alerts you to pending tasks.

Evidence base

Unclear (the company did not respond to our request for info), though the website provides links to favorable reviews.

Devices

iPad
iPhone
Android

Cost

Free

C25K

Learn more

Features

This incremental running program takes place over nine weeks. It is also available in a 5K-to-10K version.

Evidence base

We found qualitative data only. Which is to say, our friends and favorite bloggers insist it works.

Devices

iPhone
Android

Printable training chart

Cost

Free for basic version
$1.99 for added features

Low-tech behavior change tools

Try paper and a pen (remember those?). Snag some templates to get you started, and don’t underestimate their value. Here’s an example: “For each course, I lay out my assignments on my personal monthly calendar and check them off as each is done. On my personal weekly calendar, I schedule what assignment or reading I will work on each day and set it for a specific time so that it becomes an appointment that I must keep. Thinking of it as an appointment helps to keep me from putting it off,” says Catherine F., a fourth-year undergraduate at Ashford University online.

Sleep chart and tracker: Become a morning person in only two weeks

Food and activity tracking tools (USDA)

Weekly study schedule (Portland Community College)

Note-taking systems (California Polytechnic State University)

Online behavior change tools that work

These free and low-cost online tools and resources are based in decades of research on health-related behavior and motivation

stickK.com

Make a Commitment Contract to achieve your weekly target (e.g., “go to the gym twice”). This site is free to join and use. For accountability, you can commit to making an automatic financial donation to a charity you despise any week that you don’t meet your target. You can appoint a friend to monitor your progress and others to cheer you on.

This tool was designed by Yale University economists and is based in evidence that we do better when stakes are on the table. (That’s stakes, not steaks.) We tend to be motivated by money and reputation, research shows.

Behavioral economists back up what we kind of knew anyway—we don’t always do what we claim we want to do, but incentives help us do it. Ian Ayres, a co-creator of the site, is the author of Carrots and Sticks: Unlock the Power of Incentives to Get Things Done (Bantam, 2010).

Cost: This is up to you. It depends on what you pledge and how closely you stick to your plan.

Check out stickK.com

Tiny Habits

This program empowers behavior change by targeting your environment and promoting baby steps. It targets three new habits over five days. You’ll interact by email with Dr. B. J. Fogg, the social scientist who created this tool and directs the Persuasive Tech lab at Stanford University, California. New sessions start each Monday.

Many years of research lie behind the creator’s behavior model—which emphasizes motivation, ability, and environmental tweaks—and also the use of mobile phones as a prime platform for behavior change systems.

Cost: Free

Check out Tiny Habits

liveWell

from Prochange Behavior Systems

This online mobile-compatible program is designed to help college students eat healthily, exercise regularly, manage stress, and improve their well-being.

It’s a self-administered program with questions and feedback individualized to each student. It can be assigned by a professor as part of a course curriculum or group project.

Web activities are matched to individuals’ readiness to change. Sample activities include workout videos, budget grocery shopping lists and tips, and stress management tools.

Extensive research supports the Transtheoretical (Stages of Change) behavior change model, which matches tools and approaches to individuals’ readiness and progress. In tests, students whose classes incorporated liveWell did better on almost all measures (physical activity, diet, stress, and well-being) than students whose classes did not.

Check out liveWell

Your Best Instagram

Your Best Instagram
“My tip for developing healthy eating habits is to remove some of the temptation. It is really easy to do this if you already have healthy options ready to go. People go for fast food because it is ready instantly. Meal prepping allows you to have the instant meal but way healthier.”
—Jake Murray, fourth-year undergraduate, University of Wyoming

Follow us on Instagram, and don’t forget to use the hashtag #SH101SelfTransformation

[survey_plugin]

Article sources

Timothy Edgar, PhD, professor, Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts.

Khinlei Myint-U, MBA, product director for patient engagement, Iora Health, Boston, Massachusetts.

Ashraf, N., Karlan, D., & Yin, W. (2006). Tying Odysseus to the mast: Evidence from a commitment savings product in the Philippines. The Quarterly Journal of Economics, 121(2), 635–672.

Ayres, I. (2010). Carrots and Sticks: Unlock the Power of Incentives to Get Things Done. New York City, New York: Bantam.

Crombie, A., Ilich, J. Z., Dulton, G. R., Panton, L. B., et al. (2009). The freshman weight gain phenomenon revisited. Nutritional Review, 67(2), 83–94.

Dzewaltowski, D. A., Estabrooks, P. A., & Glasgow, R. E. (2004). The future of physical activity behavior change research: What is needed to improve translation of research into health promotion practice? Exercise and Sport Sciences Reviews, 32(2), 57–63.

EdX. (2014). Unlocking the immunity to change: A new approach to personal improvement. Retrieved from https://www.edx.org/course/harvardx/harvardx-gse1x-unlocking-immunity-change-940#.Uz4iXFctaaU

Kang, J., Ciecierski, C. G., Malin, E. L., Carroll, A. J., et al.  (2014). A latent class analysis of cancer risk behaviors among US college students. Preventive Medicine, 64, 121–125.

Proactive Sleep. (n.d.). Publications. Retrieved from https://www.proactivesleep.com/PressReleases.php

Radogna, M. (2014). Stop hitting snooze: How to make the most of your morning. Student Health 101, 9(6). Retrieved from https://www.readsh101.com/l/library.html?id=23edd36d

Student Health 101 surveys, June 2014 and November 2016.

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01 JanFeaturedSelfSubstance use

When is marijuana use a problem? And why that’s hard to answer

by Lucy Berrington0 Comments
Reading Time: 9 minutes

Rate this article and enter to win
This content was developed with extensive input from the Professional Advisory Board of Student Health 101, which includes two physicians and 12 campus health educators and related specialists.

As the federal government considers legalizing recreational marijuana use, the drug is becoming more accessible in Canada. For anyone who’s choosing to use (or considering using) marijuana, it’s important to unravel what this might mean for them. “Like all drugs, using marijuana can be beneficial or harmful depending on how, when, where, in what dosage, in what form, and by whom it is being used,” says Dr. Gerald Thomas, Collaborating Scientist at the Centre for Addictions Research of British Columbia.

If recreational use becomes legal, responsibly using marijuana involves making decisions based on the best information available. What is that best info? Much of what we hear about marijuana comes via sources pushing their own agenda (pro- or anti-legalization). For various reasons, the effects of mind-altering substances, especially illegal ones, are difficult to determine. “The science of marijuana is still developing,” says Dr. Neil Boyd, Professor and Director of the School of Criminology at Simon Fraser University, British Columbia. “Prohibition has generally limited scientific efforts to expand our knowledge of the drug.”

If you choose to use, here’s how to reduce your risk [printable]

Athletics and driving: Marijuana on the field and in the car

Your athletics
“Extracurricular activities, like sports, can also be impaired, because marijuana can lower your motor coordination skills and your motivation,” says Dr. Ruben Baler, a health scientist at the National Institute on Drug Abuse, Washington DC.

Your driving
“There is no question that driving under the influence of alcohol raises the risk of an accident, and studies suggest that alcohol and marijuana in combination raises the risk even further,” says Dr. Misch, associate vice chancellor for health and wellness at the University of Colorado School of Medicine. “Marijuana users should not drive for at least three to four hours after getting high.” Some studies have found that using marijuana without alcohol also impairs our driving ability; marijuana, like alcohol, impairs our decision-making skills and reaction times.

What does problematic marijuana use look like?

What effect does marijuana have on the user’s life?
One size will never fit all. Some people are able to use a lot of pot and have a high quality of life, while others suffer academically or emotionally, or become dependent. “Problematic” use is defined loosely by the impact of marijuana use on an individual. Here’s what to look at:

Tolerance “Excessive cannabis use can lead to a higher tolerance to the effects of the drug (meaning you’ll need to smoke more to get the desired effect), and even symptoms of withdrawal when use is abruptly stopped,” says Dr. Ryan Vandrey, associate professor at the Behavioral Pharmacology Research Unit of Johns Hopkins University School of Medicine, Maryland.

Goals and quality of life “Frequent use of cannabis [can] interfere with attaining goals, tending to responsibilities, and interpersonal relationships, and [even with those negative consequences] it gets harder to quit or reduce use,” says Dr. Vandrey.

Reason for use Using marijuana to cope with anxiety, stress, and other issues carries the risk of dependence and learning problems. In addition, self-medicating can prevent users from developing healthy coping skills (such as exercising, journaling, reading, and talking to friends and family). “I would challenge students to consider why they are smoking [or using marijuana in other ways] in the first place,” says Dr. Jose Valdes, assistant professor of neuropsychiatry at Nova Southeastern University, Florida.

Why “problematic use” is not easy to define
Marijuana affects people differently The amount of money a user spends on marijuana, and even the amount of marijuana consumed, do not align neatly with the impact on users’ functioning, according to a study by researchers at the University of Southern California (presented at the American Public Health Association conference, 2015).

Safety and risk depend on how a drug is used “Safety of a drug is much more complicated than a yes or no question, and whether it is legal/illegal,” says Dr. Vandrey. “There are many medications and products that are legal but are damaging or lethal if used incorrectly or by a person who has an allergy.”

It’s hard to know what causes problematic outcomes  Some studies link marijuana use to other risky behaviors or poor outcomes. For example, in a study of college students, the following experiences were associated with using marijuana within the last 30 days: being taken advantage of sexually, not using condoms in sexual encounters, heavy drinking, poor exam performance, missing class, and getting hurt or injured. But correlation is not causation. Maybe marijuana caused bad test scores; maybe students used marijuana in an attempt to cope with bad test scores; or maybe the students who used marijuana also skipped class, resulting in bad test scores. Researchers are working to figure out cause and effect.

Source: Correlates and predictors of marijuana use among US undergraduates. In 143rd APHA Annual Meeting and Exposition (October 31–November 4, 2015).

Signs of problematic marijuana use
Signs of a marijuana use disorder include certain health problems and failure to meet goals and responsibilities at school or work.

  • Wanting marijuana and/or being high much of the time
  • Needing increased amounts of marijuana to maintain the desired effects
  • Withdrawal symptoms (e.g., mood or sleep changes)
  • Using marijuana in combination with alcohol and/or other drugs
  • Using marijuana to the point that it negatively affects life and functioning (e.g., driving under the influence or social withdrawal)
  • Using marijuana to cope with anxiety, stress, insomnia, or other issues
  • Using high-potency forms of marijuana, such as hash oil extracts and concentrates (sometimes called “wax” or “shatter”)

Nearly three in ten marijuana users had a marijuana use disorder in 2012–13, according to a 2015 study in the Journal of the American Medical Association.

Help with drug dependence (National Association of Addiction Treatment Providers)

Marijuana use may increase alcohol risk
Marijuana users may be more likely to develop an alcohol use problem, recent research suggests. Marijuana users are five times more likely than non-users to abuse alcohol or become dependent on it, according to a 2016 study in Drug and Alcohol Dependence. In adults with an existing alcohol use disorder, using marijuana was associated with ongoing drinking problems; the adults who did not use marijuana appeared better able to abstain from alcohol, the same study suggests.

For help with problematic substance use, make an appointment with student health or counseling services on your campus.

Your brain on pot later: What’s up with long-term use?

Long-term, frequent marijuana use starting in adolescence or early adulthood may impair the brain chronically and irreversibly—or it may not. That uncertainty speaks to the difficulties inherent in researching the effects of substance use.

If marijuana can cause long-term harms, those effects likely vary according to when the individual started using, how much and how often they used, how recently they used, the potency of the marijuana used, and other factors.

Marijuana may affect IQ
In a 2012 study of New Zealanders, those who started using marijuana heavily in adolescence experienced an average decline of 8 IQ points by age 38 (non-users experienced an average 1 IQ point increase over the same time span). The IQ drop persisted even after the users quit marijuana. The participants who started using marijuana as adults did not experience the same IQ decline, suggesting that marijuana use may have neurotoxic effects during critical developmental stages (Proceedings of the National Academy of Sciences).

Marijuana may affect life outcomes
Chronic marijuana use is associated with life setbacks, research suggests. A 2003 study compared frequent marijuana users with their peers from similar socioeconomic backgrounds who reported much less marijuana use. The frequent users were less likely to have graduated from college and had lower incomes, according to Psychological Medicine (2003). The frequent, chronic users believed that marijuana was to blame for their ongoing struggles.

But we don’t know for sure
These research findings are difficult to interpret. It’s possible that other factors explain the effects. For example, maybe the people who used marijuana heavily also used alcohol or other potentially harmful substances, or routinely skipped class as teens, resulting in lower IQ scores later. Which comes first? Maybe less motivated people use more marijuana, rather than marijuana causing that loss of motivation.

Marijuana on campus: What it means for you

In states that have legalized the medicinal and/or recreational use of marijuana, college administrators may feel caught between state and federal law. If a college allows marijuana use, it may risk losing federal funding. Some colleges are exploring exemptions that could allow medical use on campus.

On the upside, for students who are interested in grappling with these issues constructively, this is a good time to get involved. “The reality is that students need to be at the table with the administration and faculty to come up with policies around marijuana use,” says Dr. Seamon.

Real concerns remain. Getting caught using marijuana can narrow your opportunities in various ways:

  • Academics Any student convicted of a drug offense while receiving federal student grants or loans can temporarily or permanently become ineligible for federal aid.
  • Athletics Drug policies around testing and penalties for college athletes vary from school to school. Under National Collegiate Athletic Association rules, testing positive for marijuana at a bowl game or postseason championship can result in a half-season suspension. The NCAA is reported to be reviewing this policy and moving toward a rehabilitative (rather than penalizing) response to marijuana use.
  • Employment Some employers conduct drug tests as part of their hiring process, most typically for lower-skill jobs. THC can be detected in your system using a urine test for up to 12 weeks after usage (depending on how much and how often you use). Some companies also drug test their employees.
  • Driving Driving under the influence of marijuana is illegal. If you’re caught you could get fined, lose your license, or do jail time. In some states drivers can be penalized for having traces of marijuana in their blood, even if they are not impaired.

How does your state penalize drivers who use marijuana?

Is moderate marijuana use safer than drinking?

“The key to using marijuana responsibly is to consume it in moderation, in ways that do no harm to oneself or others,” says Dr. Ethan Nadelmann, executive director of the Drug Policy Alliance, which advocates for evidence-based drug policy.

Marijuana effects are highly variable
The effects depend on its potency, the method of delivery, and how it is used (where, why, how often, etc).

Moderate use is not clearly defined
“For marijuana, I advise (for those who choose to use) smaller doses of lower potency preparations, less frequently. That may mean several hits from a joint once or twice a week, ” says Dr. Davis Smith, a practicing internist based in Connecticut and medical director of Student Health 101. (Yes, this is still vague; it’s difficult to determine potency or define a hit. The absence of clarity is a reason to be cautious.)

It makes sense to avoid edibles and resins
Dried marijuana (the flowering tops and leaves of plants) is generally less potent than hashish (dried and compressed resin extracts) and hash oil extracts. Edibles take longer to have an effect on the user, and the quantity consumed is trickier to control (compared to smoking), increasing the likelihood of overuse.

It’s difficult to compare marijuana and alcohol for safety
Any comparison with alcohol depends on the potency of the substances, how they are consumed, and other factors. “Infrequent, small consumption of THC [the component of cannabis responsible for most of its psychological and physiological effects] is, in most cases, unlikely to be more harmful than low-risk alcohol use (e.g., a couple of beers twice a week),” says Dr. Smith. “It is probably less harmful than heavy alcohol use, especially when you factor in the risks that can come with alcohol, like fighting, vandalism, vomiting, etc.” (Until we have a better understanding of marijuana’s effects, this type of comparison is tentative.)

Frequent, heavy THC consumption appears harmful
Researchers are working to better understand what that harm looks like. The risks of alcohol are better researched than the risks of marijuana. Emerging research in states that have legalized marijuana use, such as Colorado, is revealing increased emergency room visits and traffic accidents related to marijuana use.

Your brain on pot now: Your mood

When marijuana feels awe-ful
For many people, marijuana feels good. Some find marijuana helps them relax or feel more enthusiastic about life. They may express themselves more freely or feel more empathic, potentially deepening their social bonds. For some, marijuana heightens sensory experiences (e.g., food tastes better) and creative thinking.

When marijuana feels awful
“Pleasant experiences with marijuana are by no means universal,” says Dr. Ruben Baler, health scientist at the National Institute on Drug Abuse, Washington DC. “Instead of relaxation and euphoria, some people will experience anxiety, fear, distrust, or panic. These effects are more common when too much is taken, the marijuana has an unexpectedly high potency, or when a user is inexperienced.”

When is euphoria a red flag?
“Some users are primed to have an especially fabulous experience of substance use; they have very receptive reward centers in their brains,” says Dr. Smith. “Such individuals are at much greater risk of developing substance use disorders. Starting later reduces that risk. Those with strong family history of substance abuse may be especially good candidates for abstinence.”

Your brain on pot now: Your grades

There is clear evidence that marijuana impairs memory and learning during use and for several days afterward. “Students who go to class high are not getting their money’s worth,” says Dr. Misch.

As use increases, so does risk. “The more a person uses marijuana, the more there are well-documented decreases in attention, concentration, and memory,” says Dr. Jason Kilmer, assistant professor of psychiatry at the University of Washington.

What does heavy use mean for students? “Daily marijuana users may find themselves consistently intellectually impaired. For near-daily or daily users, even stopping for several days may not lessen the intellectual impairment,” says Dr. Misch.

Right side of the law

Federal laws around marijuana remain relatively strict. Students who use marijuana risk a range of negative consequences. Young people, especially those of color, are disproportionately targeted by law enforcement for marijuana-related crimes, an ACLU study showed (2013).

Your state may allow medical use, recreational use, both, or neither. Wherever you live, it is important to “understand the laws and work within the letter of the law,” says Dr. Seamon. For info on what your state allows, see Find out more.

[survey_plugin] Article sources

Ruben Baler, PhD, health scientist, National Institute on Drug Abuse, Washington, DC.

Jason R., Kilmer, PhD, assistant professor, psychiatry and behavioral sciences; assistant director, Health and Wellness for Alcohol and Other Drug Education, University of Washington.

Donald Misch, MD, associate vice chancellor for health and wellness, associate professor, University of Colorado School of Medicine.

Ethan Nadelmann, JD, PhD, executive director, Drug Policy Alliance.

Marsha Rosenbaum, PhD, director emerita, Drug Policy Alliance (San Francisco office); author, Safety First: A Reality-Based Approach to Teens, Drugs and Drug Education (Drug Policy Alliance, 2014).

Matthew J. Seamon, PharmD., chair and associate professor of pharmacy practice, Nova Southeastern University, College of Pharmacy, Florida.

P. Davis Smith, MD, internist, director of health services, Westminster School, Simsbury, Connecticut; medical director, Student Health 101.

Lori Holleran Steiker, PhD, ACSW, associate professor, University Distinguished Teaching Professor, University of Texas at Austin School of Social Work.

Jose Valdes, PharmD, BCPP, assistant professor, neurology and neuropsychiatry, Nova Southeastern University College of Pharmacy, Florida.

Ryan Vandrey, PhD, associate professor, Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, Maryland.

American Civil Liberties Union. (2013, June). The war on marijuana in black and white. ACLU Foundation.

American College Health Association. (2015). American College Health Association—National College Health Assessment II: Reference Group Executive Summary Spring 2015. Hanover, MD: American College Health Association, 2015.

Barton, B., Bulmer, S., & Misencik, L. (2015, November). Correlates and predictors of marijuana use among US undergraduates. In 143rd APHA Annual Meeting and Exposition (October 31–November 4, 2015). American Public Health Association. Retrieved from https://apha.confex.com/apha/143am/webprogram/Paper318939.html

Blaszczak-Boxe, A. (2014, September 30). Hidden risk? Marijuana may be bad for your heart. Live Science. Retrieved from https://www.livescience.com/48073-marijuana-heart-attack-risk.html

Crane, N. A., Schuster, R. M., Fusar-Poli, P., & Gonzalez, R. (2013). Effects of cannabis on neurocognitive functioning: Recent advances, neurodevelopmental influences, and sex differences. Neuropsychology Review, 23(2), 117–137.

Filbey, F. M., Aslan, S., Calhoun, V. D., Spence, J. S., et al. (2014). Long-term effects of marijuana use on the brain. Proceedings of the National Academy of Sciences, 111(47), 16913–16918.

Gorski, D. (2014, July 7). Medical marijuana as the new herbalism. Science-Based Medicine. Retrieved from https://www.sciencebasedmedicine.org/medical-marijuana-as-the-new-herbalism-part-1-the-politics-of-weed-versus-science/

Gruber, A. J., Pope, H. G., Hudson, J. I., & Yurgelun-Todd, D. (2003). Attributes of long-term heavy cannabis users: A case-control study. Psychological Medicine, 33(8), 1415–1422.

Hasin, D. S., Saha, T. D., Kerridge, B. T., Goldstein, R. B., et al. (2015). Prevalence of marijuana use disorders in the United States between 2001–2002 and 2012–2013. JAMA Psychiatry, 72(12), 1235–1242.

Johnston, L. D., O’Malley, P. M., Bachman, J. G., Schulenberg, J. E., et al. (2015). Monitoring the Future national survey results on drug use, 1975-2014: Volume II, college students and adults ages 19–55. Ann Arbor, MI: Institute for Social Research, The University of Michigan, 416 pp.

Mayotte, B. (2015, April 15). Drug convictions can send financial aid up in smoke. US News & World Report. Retrieved from https://www.usnews.com/education/blogs/student-loan-ranger/2015/04/15/drug-convictions-can-send-financial-aid-up-in-smoke

Meier, M. H., Caspi, A., Ambler, A., Harrington, H., et al. (2012). Persistent cannabis users show neuropsychological decline from childhood to midlife. Proceedings of the National Academy of Sciences, 109(40), E2657–E2664.

Mittelman, M. A., Lewis, R. A., Maclure, M., Sherwood, J. B., et al. (2001). Triggering myocardial infarction by marijuana. Circulation, 103, 2805–2809.

National Institute on Drug Abuse. (2015). Marijuana. Retrieved from https://www.drugabuse.gov/publications/drugfacts/marijuana

Perkins, H. W. (1997). College student misperceptions of alcohol and other drug norms among peers: Exploring causes, consequences, and implications for prevention programs. Designing alcohol and other drug prevention programs in higher education. Bringing Theory Into Practice. 177–206.

Pope, H. G., Gruber, A. J., & Hudson, J. I., Cohane, G., et al. (2003). Early-onset cannabis use and cognitive deficits: What is the nature of the association? Drug & Alcohol Dependence, 69(3), 303–310.

Russell, L. D., & Arthur, T. (2015). “That’s what ‘college experience’ is”: Exploring cultural narratives and descriptive norms college students construct for legitimizing alcohol use. Health Communication, 1–9.

Substance Abuse and Mental Health Services Administration. Results from the 2014 National Survey on Drug Use and Health: Summary of national findings. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2014. HHS Publication No. (SMA) 14-4887. NSDUH Series H-49.

Urbina, I. (2013, June 3). Blacks are singled out for marijuana arrests, federal data suggests. New York Times. Retrieved from https://www.nytimes.com/2013/06/04/us/marijuana-arrests-four-times-as-likely-for-blacks.html

Volkow, N. D., Baler, R. D., Compton, W. M., & Weiss, S. (2014). Adverse health effects of marijuana use. New England Journal of Medicine, 370, 2219–2227.

Weinberger, A. H., Platt, J., & Goodwin, R. D. (2016). Is cannabis use associated with an increased risk of onset and persistence of alcohol use disorders? A three-year prospective study among adults in the United States. Drug and Alcohol Dependence, DOI:10.1016/j.drugalcdep.2016.01.014

Wong, C. F., Iverson, E., Sperandeo, M., Kaplan, C., et al. (2015). Conceptualizing problematic marijuana use among marijuana-using young adults: One size does not fit all. In 143rd APHA Annual Meeting and Exposition (October 31-November 4, 2015). American Public Health Association. Retrieved from https://apha.confex.com/apha/143am/webprogram/Paper330179.html

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01 JanAcademicsAccessibilityFeaturedMental healthMindSelf

Unbroken: Accepting who you are and what you need

by Lucy Berrington0 Comments
Reading Time: 9 minutes

Rate this article and enter to win

What’s up with our personalities and behaviors? Many of us have a diagnosis that has something to do with the way our mind works—and if not, we probably know someone who does. It’s hard to hang out in the 21st century without encountering people who have attention deficit hyperactivity disorder (ADHD), bipolar disorder, anxiety disorder, obsessive compulsive disorder (OCD), depression, autism spectrum disorder (ASD), and other neuropsychological diagnoses.

These diagnoses can help us understand ourselves and figure out what helps us meet our potential. This might involve environmental supports (e.g., a quiet classroom), behavioral approaches (e.g., a mindfulness routine), some kind of therapy or life coaching, friends and partners who get it, or medication.

For some, though, the prospect of a diagnosis is problematic. A diagnosis may seem judgmental, stigmatizing, or overly simplistic. We may ask ourselves:

  • Does this mean I’m not “normal”? Can I be happy with myself as I am? Does this label me?
  • What should I do with my diagnosis?
  • How can it help me?

What’s “normal” & does it matter?

When does a personality trait or behavior become a diagnosis? “I think we are restraining what is perhaps a very normal spectrum of human personalities into a very narrow idea of what is normal,” says Deneil H., an undergraduate at Binghamton University in New York. In our student surveys, this was a common concern.

What we’re talking about is medicalization, “the idea that we’re turning all human difference into a disease, a disorder, a syndrome,” says Dr. Peter Conrad, professor of sociology at Brandeis University, Massachusetts. He specializes in “how conditions get to be called a disease and what the consequences are.”

In recent decades, the diagnostic criteria for many neuropsychological conditions have broadened. “More and more human behavior has been defined as a disorder, especially around the edges,” says Dr. Conrad. “Human problems are increasingly medicalized, especially sadness. Eleven percent of the population has ADHD, according to the CDC. At that rate, it’s something that’s fairly normal and not necessarily a pathology.” This does not mean medicalization is a bad thing; it has helped countless people access treatment and supports that work for them. There are pros and cons.

The pros & cons of medicalization

Like anything, medicalization has risks and benefits.

The risks of medicalization include:

  • Discomfort with the premise that there’s something wrong with us.
  • Neglecting to tackle relevant societal factors, such as discrimination and poverty, that prevent people from meeting their potential. “Medicalizing behavioral issues, like substance abuse, frames them primarily as individual problems as opposed to collective social problems,” says Dr. Peter Conrad, professor of sociology at Brandeis University, Massachusetts.

“I am concerned that other underlying issues may be ignored (the diagnosis could be an easy explanation for a more complicated problem).”
—Online student, State University of New York, Empire State College

The benefits of medicalization include:

  • Reducing any negative judgment attached to certain conditions.
  • Conditions defined as illnesses can be covered by health insurance, improving access to treatment and accommodations.

“It used to be thought that the devil had come to people with epilepsy, but with better medicines and reduced stigma, more people with epilepsy have been able to survive.”
—Dr. Conrad

Got neurodiversity?

Behavioral health and disability advocates are working to change the way that these conditions are understood. Their key point: Different kinds of minds come with different kinds of strengths (as well as challenges). Many unusual thinkers and innovators—people who may have been considered mentally ill, disabled, or eccentric—have made critical leaps in the sciences, arts, and technology.

The concept of neurodiversity acknowledges and helps us accept these natural human differences. “Neurodiversity may be every bit as crucial for the human race as biodiversity is for life in general,” wrote journalist Harvey Blume, who introduced this idea to a mainstream audience in The Atlantic (1998); “Cybernetics and computer culture, for example, may favor a somewhat autistic cast of mind.” The neurodiversity concept is particularly associated with autism, but embraces all other neuropsychological conditions too.

In the pro-neurodiversity model, the goal is to help us all thrive without judgment and negativity. “One way to understand neurodiversity is to remember that just because a PC is not running Windows doesn’t mean that it’s broken. Not all the features of atypical human operating systems are bugs,” wrote Steve Silberman in Wired magazine. Silberman is author of the award-winning book NeuroTribes: The Legacy of Autism and the Future of Neurodiversity (Avery, 2015).

How neurodiversity helps

Dr. Christina Nicolaidis, a professor at Portland State University, Oregon, is committed to a pro-neurodioversity approach in her clinical practice and academic research. She points to ways that this mindset supports us:

Valuing ourselves & accepting our needs

“A neurodiversity-based approach can be conducive to dealing with the dissonance between accepting yourself, understanding yourself, and being happy with who you are, while also acknowledging that you may need supports, accommodations, and medical treatments.”

Advocating for ourselves and others

“The neurodiversity movement sees people with disabilities as members of a minority group that have a right to be treated equitably. It encourages you to work towards reducing stigma and discrimination, to advocate for one’s legal rights, and to fight for equal access to health care and other services.”

Accessing health care & other supports

“In my clinical experience, a strengths-based and neurodiversity-type approach is extremely important for helping doctors understand, communicate with, and support their patients.”

Students' stories: “Diagnosis was a totally positive change”

“After finally being diagnosed with OCD and ADHD, I am so relieved and feel as though my life has had a totally positive change. I now have so much more freedom and controlâ€Ķ When you find a medication that is right for you, you will know, because your life can be so positively different. I believe many people’s lives can be made so much better, but they are not seeking the help they need. No one knows what is normal and what is not; no one knows what goes on in others’ heads.”
—Undergraduate, Temple University, Pennsylvania

“For years I dealt with chronic depression and never knew that I had it. Had there been better education and an openness to discuss the various kinds of depression, I may have been able to get help earlier and could have prevented a significant time of my life not being able to live life to the fullest.”
—Fourth-year undergraduate, Kwantlen Polytechnic University, British Columbia

How getting a diagnosis can help us

Access to medical and academic supports
“These conditions are probably under-diagnosed in students due to a general impression that certain feelings (e.g., symptoms of depression or anxiety) are ‘normal’ for being in school. The lack of a diagnosis may severely impact a student’s academic success and/or future (e.g., deciding to drop out of school because of constant anxiety). Identifying/diagnosing these conditions is providing appropriate help to those who need it and who could be successful (e.g., academically) if their condition was treated.”
—Graduate student, University of Massachusetts, Amherst

Self-acceptance
“Recognizing and titling a concern can be invaluable in feeling at peace with that disorder, recognizing its symptoms, and understanding how to manage it.”
—Second-year graduate student, University of Wyoming

Personal choice
“If people want to integrate better into society, then it should be their choice to take the meds.”
—Undergraduate, Humboldt State University, California

Reconciliation of strengths and struggles
“I feel like these ‘conditions’ are fundamental differences in us, that make us unique. People are not broken because they feel compelled to move, or because their minds get more distracted. Of course, it needs to be addressed. We can all use some practices to keep ourselves from acting on impulse.”
—Fourth-year undergraduate, Metropolitan State University of Denver, Colorado

Adjustment to big-picture changes
“The increasing diagnosing of neuropsychiatric conditions could be well within a normal response to our changing society. I am encouraged that there are people taking time out of their day to go seek help. That kind of behavior, at a minimum, will help us prepare for the future.”
—Fourth-year graduate student, Temple University School of Medicine, Pennsylvania

Should I worry about the medical “industry?”

What is perceived to be the problem?
“The conspiracy theory behind doctors over-diagnosing something is that they are paid by the pharmaceutical companies, which is hopefully a bold lie.”
—Recent graduate, Kutztown University, Pennsylvania

“While it is important to consider that neuropsychiatric conditions are real issues people face, it is also important not to ‘textbook’ these people.”
—Fourth-year undergraduate, The College of New Jersey

On the other hand
It is inaccurate to say that physicians are paid to prescribe certain medications. Some physicians do work with pharmaceutical companies (for example, in developing new treatments), or receive gifts or samples from them.

A government website enables you to see any payments and other gifts your doctor or teaching hospital has received from pharmaceutical companies or medical device companies. The “Sunshine Act”—part of the Affordable Care Act (Obamacare)—requires transparency around these gifts and payments.

Is your doctor friendly with Big Pharma? Search here

Disability is a societal idea

Many of the challenges that come with disability are intrinsic to our society and culture, not to the disability itself.

“Imagine a world where 99 percent of people were deaf,” wrote Dr. Christina Nicolaidis, a physician and a professor at Portland State University, in the AMA Journal of Ethics (2012). “That society would likely not have developed spoken language. With no reason for society to curtail loud sounds, a hearing person may be disabled by the constant barrage of loud, distracting, painful noises… The deaf majority might not even notice that the ability to hear could be a ‘strength’ or might just view it as a cool party trick or savant skill.” She notes that homosexuality was considered a psychiatric condition until 1973.

“[This] reflects on society not working out for us, not [necessarily the] faultiness of the brain. Our culture is what needs to be diagnosed.”
—Second-year graduate student, Portland State University, Oregon

Is my disagnosis accurate?

What’s the problem?
“Though there have been improvements to the diagnostic manual [the physicians’ guidebook to neuropsychological conditions], it is still limiting, vague, and left to be interpreted by the clinical professional.”
—Graduate student, San Diego State University, California

“As someone in the mental health field, there are cases in which people are misdiagnosed, or their symptoms are overpathologized or disregarded. A psychological assessment reflects a snap shot of that person at that particular time, and people’s functioning and circumstances can change. However, on the whole, as much as the conversation around mental health has increased, there are many people who are uninformed and therefore do not seek help when needed. Thus, I believe that [these conditions are] still under-diagnosed.”
—Fourth-year graduate student, University of Windsor, Ontario

On the other hand
The way that neuropsychological conditions are diagnosed and categorized is evolving in line with the research. This is also true of many physical health conditions.

Scientists and physicians now understand that what can look like the same neuropsychological condition likely reflects varying causes and biological mechanisms; for example, one person’s depression may involve different biological pathways than the next person’s. This is probably why people with the same diagnosis respond differently to medications and why a range of treatment options is needed. Similarly, the same biological mechanisms may present differently in people, resulting in varying diagnoses.

Consequently, federal research funding has shifted away from targeting diagnoses. Scientists are focusing instead on specific states of mind—such as anhedonia, a loss of pleasure—and specific biological processes.

Am I neurotypical? (satire)

Disability advocates diagnose “normality”

The term “neurotypical” arose in the disability community as a label for people who have typically-developing minds. Descriptions of “neurotypical syndrome” are satirical; they make the point that disability and “normality” can be a matter of perspective. For example:

Neurotypical syndrome is a neurobiological disorder characterized by preoccupation with social concerns, delusions of superiority, and obsession with conformity.

Neurotypical individuals (NTs) often assume that their experience of the world is either the only one, or the only correct one. NTs find it difficult to be alone. NTs are often intolerant of seemingly minor differences in others. When in groups, NTs are socially and behaviorally rigid and frequently insist upon the performance of dysfunctional, destructive, and even impossible rituals as a way of maintaining group identity. NTs find it difficult to communicate directly.

Neurotypical syndrome is believed to be genetic in origin. As many as 9,625 out of every 10,000 individuals may be neurotypical. There is no known cure for neurotypical syndrome.

Source: The Institute for the Study of the Neurologically Typical (parody)

Neurodivergent geniuses and celebrities

Diagnosing geniuses and celebrities, dead or alive, has become commonplace. In the absence of modern neuropsychological testing and openness on the part of the individual, such diagnoses are speculative—but in some cases the evidence is strong.

The super-scientists Albert Einstein (the theory of relativity) and Isaac Newton (the law of gravity) were probably autistic, according to a 2003 article in the Journal of the Royal Society of Medicine.

Thomas Jefferson, our third president, likely had Asperger syndrome (a form of autism), according to Norm Ledgin, author of Diagnosing Jefferson: Evidence of a Condition That Guided His Beliefs, Behavior, and Personal Associations (Future Horizons, 2000).

Richard Branson, businessman extraordinaire and founder of Virgin Group, has acknowledged in interviews that he has dyslexia and ADHD.

Sinead O’Connor has talked about her experience with bipolar disorder. Other candidates for this diagnosis include Kurt Cobain, Marilyn Monroe, Vincent Van Gogh, and Emily Dickinson.

Actor Leonardo DiCaprio, who has OCD, played Howard Hughes, who also has OCD, in The Aviator. “He let his own mild OCD get worse to play the part,” said the psychiatrist who advised him on set (speaking to Scotland on Sunday, 2005).

“The more we learn about the spectrum of neuropsychiatric behaviors in humans, the better we can regulate conditions that may pose a risk to a person’s ability to function. [That said,] I am concerned that there’s an overemphasis on what’s ‘normal’ when we ought to celebrate our differences in varying capacities.”
—Second-year graduate student, Boise State University, Idaho

Spoon Theory

My friend is “running low on spoons.” What does that mean?

Your friend is running out of energy for reasons relating to a disability or health issue—maybe a condition that isn’t visible to others. In the “spoon theory” analogy, spoons represent emotional and physical energy. We start each day with a fixed number of spoons and every action uses some of them up. The more demanding the task, the more spoons it requires. “I’m running low on spoons” is a way to tell friends and family that you need to postpone your plans for the evening (for example). It can help others appreciate when you’re flagging for reasons related to sensory overload, chronic pain, or other challenges.

Sources: Christine Miserandino, https://goo.gl/QKtK44, The Guardian (2012)

[survey_plugin] Article sources

Peter Conrad, PhD, professor of social sciences, Brandeis University, Massachusetts.

Ari Ne’eman, co-founder, Autistic Self Advocacy Network, Washington DC., Former Obama-appointed member, National Council on Disability.

Christina Nicolaidis, MD, MPH; professor in social determinants of health, Portland State University, Oregon; co-director, Academic Autistic Spectrum Partnership in Research and Education (AASPIRE).

AASPIRE. (2014). Healthcare toolkit. [Website]. Retrieved from https://autismandhealth.org/?p=home&theme=ltlc&size=small

Conrad, P. (2005). The shifting engines of medicalization. Journal of Health and Social Behavior, 46(1), 3–14.

Conrad, P., & Bergey, M. R. (2014). The impending globalization of ADHD: Notes on the expansion and growth of a medicalized disorder. Social Science & Medicine, 122, 31–43.

James, I. (2003). Singular scientists. Journal of the Royal Society of Medicine, 96(1), 36–39. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC539373/

Larsen, A. (2013). Neurotypical. [Documentary]. United States: Point of View. Retrieved from https://www.pbs.org/pov/neurotypical/

Martin, R. H. (2010, October 30). ABCs of accommodations. New York Times. Retrieved from
https://www.nytimes.com/2012/11/04/education/edlife/guide-to-accommodations-for-college-students-with-disabilities.html?_r=0

Neurotypical Syndrome. (2002). The Institute for the Study of the Neurologically Typical. [Website]. Retrieved from https://isnt.autistics.org/

Nicolaidis, C. (2012). What physicians can learn from the neurodiversity movement. AMA Journal of Ethics, 14(6), 503–510. Retrieved from
https://journalofethics.ama-assn.org/2012/06/oped1-1206.html

Psychology Research Laboratory. (2014). Maclean Hospital. Retrieved from https://www.mcleanhospital.org/research-programs/psychology-research-laboratory

Schaber, A. (2014, August 28). Ask an autistic: What is neurodiversity? [Video]. Retrieved from https://www.youtube.com/watch?v=H6xl_yJKWVU

Silberman, S. (2013, April 16). Neurodiversity rewires conventional thinking about brains. Wired.com. Retrieved from https://www.wired.com/2013/04/neurodiversity/

Student Health 101 survey, February 2015.

Vickers, M. Z. (2010). Accommodating college students with learning disabilities: ADD, ADHD, and dyslexia. The John William Pope Center for Higher Education. Retrieved from https://www.popecenter.org/acrobat/vickers-mar2010.pdf

Walker, N. (2015). Neurocosmopolitanism. [Website]. Retrieved from https://neurocosmopolitanism.com/

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01 NovCommunicationFeaturedFriendshipsMental healthMindRelationshipsSexual assault and harassment

Being stalked? 8 ways to help a friend

by Lucy Berrington0 Comments
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What are we talking about when we talk about stalking? The word has become a reference to nosing around each other’s Facebook timelines—or to unhealthy but not persistent choices, like that one miserable weekend when you drove past your ex’s place three times. We’re not here to talk about those. We’re talking about patterns of behaviors that cause substantial emotional distress to another person and may seriously compromise their sense of safety. Sometimes, these behaviors escalate to attempted sexual assault or other kinds of violence.

Stalking is more common on campuses than off, studies show. It is widely underreported and can affect anyone. “Most stalking is by men of women, but men can be stalked too,” says Detective Mark Kurkowski of the St. Louis Metropolitan Police Department’s Domestic Abuse Response Team, Missouri. Students who are transgender, genderqueer, or gender nonconforming may be especially vulnerable, a 2015 survey suggests (AAU Climate Survey on Sexual Assault and Sexual Misconduct).

Although stalking is a crime in all 50 states, it is often missed or minimized—even by people whose lives are disrupted by it. See Students’ stories; Stalking it over (next page).

Would you recognize stalking?

Most definitions of stalking come from the Violence Against Women Act and its 2013 reauthorization. “Stalking’ means engaging in a course of conduct directed at a specific person that would cause a reasonable person to (A) fear for his or her safety or the safety of others, or (B) suffer substantial emotional distress.”

Two things are important about this, experts say:

  1. Stalking is a “course” of conduct; a pattern of unwanted behaviors. It may include persistent texts and calls, online harassment, physically or digitally tracking or following the targeted person, and more.
  2. This legal standard judges the effects of stalking—a person’s fear for their safety or substantial emotional distress. People sometimes get caught up on the question of what constitutes “substantial emotional distress,” says Jennifer Landhuis, director of social change at the Idaho Coalition Against Sexual and Domestic Violence. “Does substantial emotional distress mean they have to go to counseling? No, it could be changing how they go to classes, feeling like they have to look over their shoulder—that kind of stuff.”

What stalking may look like

This list of stalking behaviors comes from the Stalking Resource Center, a collaboration between the National Center for Victims of Crime and the US Department of Justice Office on Violence Against Women. Stalking does not necessarily involve all of these behaviors.

  • Follow you and show up wherever you are
  • Send unwanted gifts, letters, cards, or emails
  • Damage your home, car, or other property
  • Monitor your phone calls or computer use
  • Use technology to track you
  • Drive by or hang out at your home, school, or work
  • Threaten to hurt you, your family, friends, or pets
  • Find out about you via public records, online searches, contacting your friends or family, and other methods
  • Posting information about you or spreading rumors about you online or in public
  • Other actions that control, track, or frighten you
Why stalking can be difficult to spot

We may not recognize stalking or be reluctant to label it.
Here are some of the reasons:

  • Stalking may criminalize otherwise noncriminal behaviors
    It may be difficult to understand why someone is frightened by the gifts they are receiving.
  • Stalking involves actions that may have a specific but not apparent meaning
    The implicit threat in some actions may be understood only by the offender and victim. Those actions could include going into the targeted person’s home or room in their absence and moving things around.
  • Some stalking-type feelings and behaviors are normal
    “Normal brain development continues till you’re 25, so some of that behavior that happens in pursuit of a dating relationship is typical,” says Jennifer Landhuis, the director of social change at the Idaho Coalition Against Sexual and Domestic Violence. “That can get confusing when you’re asking whether you’re following someone, whether you’re texting them too much. How do we decide when it passes the line and goes into stalking? That depends on the person who’s experiencing it. Is that behavior scary?”
  • Stalking often intersects with other abuses
    When stalking intersects with intimate partner abuse or sexual violence, it is more easily missed, says Detective Mark Kurkowski of the St. Louis Metropolitan Police Department’s Domestic Abuse Response Team, Missouri.
Who's being stalked and by whom
  • People aged 18–24 experience the highest rates of being stalked (Bureau of Justice, 2009).

  • In a 2015 study of sexual misconduct on campuses, the undergraduates most likely to have been stalked while in college were transgender, gender nonconforming, and genderqueer (12 percent) (AAU Climate Survey on Sexual Assault and Sexual Misconduct). Four percent of students overall, and seven percent of female undergraduates, reported that they had been stalked in college.

  • In another study of college students, one in four women (25 percent) and one in ten men (11 percent) had been stalked at some point in their lives (Violence and Victims, 2000).

  • Most victims know their stalker: In the 2015 college survey, 40 percent said their stalker was a friend or acquaintance, and 24 percent said it was someone they had dated or a former sexual partner.

  • Stalkers who are the current or former partners of their victim are more likely to physically approach the victim, are more insulting and threatening, are more likely to use a weapon, are more likely to escalate quickly, and are more likely to reoffend (Journal of Forensic Science, 2006).
What to do if your obsessive thoughts about someone else are driving your behavior

Don’t be that person: How to handle your obsessive thoughts

Therapeutic approaches

If you have engaged in stalking behaviors, you could benefit from developing your interpersonal and social skills.

You would likely also benefit from an emotional health evaluation. Stalking can overlap with conditions such as depression, substance abuse, and personality issues, which may be alleviated or managed through treatment and support.

Next steps

  • Make an appointment with your campus counseling center or a therapist based in the community; request help finding a counselor who has expertise in obsessive thoughts and behaviors
  • Try a support group, such as Co-Dependents Anonymous
  • If you have addiction issues, ask at your counseling center about relevant resources
  • Confide in a close friend or mentor, if possible: Ask them to help you keep things in perspective, steer you away from recurring thoughts, and fill your time with other activities
  • Seek out distractions: sign up for a team, club, or extracurricular

+  Co-Dependents Anonymous

Therapy for obsessive thoughts and behaviors
Appropriate therapy for stalking-related issues involves you working individually with a clinician. The approach is guided by your mindset and the underlying issue (for example, whether you are struggling with rejection, social awkwardness, or delusional thinking). The therapeutic work may include:

  • A mental health assessment and treatment if indicated (for example, medication may help with false beliefs)
  • Cognitive behavioral therapy and/or motivational interviewing to build more realistic perceptions and empathic perspectives (for example, understanding how your behavior affects the other person)
  • Programming to enhance your interpersonal and social skills, such as expanding social activities

Looking back: what I did, why I did it, how I stopped

Stalking-type behaviors can show up in students who are not yet well-adjusted to the dating environment of college. Behaviors such as excessive texting may not reflect malign intent or emotional illness. Students making this mistake are in many cases open to hearing from peers, an RA, or a staff or faculty member about how their behaviors are being perceived and experienced by others.

“I followed her social media closely and thought about her a lot. It was difficult to not call her (and I often did it late at night after drinking...which I regret). Taking better care of my own mental and physical self would have helped. Counseling would probably have helped too. It was a close friend who got me through all that.”
—Male third-year undergraduate, Johns Hopkins University, Maryland

“I was feeling lovesick after a breakup. Nothing malicious, but I found myself wanting to hang out in areas where they might be, and search for them online. Therapy helped, as did finding constructive ways to distract myself.”
—Female third-year undergraduate, Sonoma State University, California

“I have intentionally loitered or taken a certain route in hopes of running into a certain person. I could have managed my feelings more constructively by doing something more productive with my time, and accepting that the person was probably bored of our conversations.”
—Female fourth-year undergraduate, University of Waterloo, Ontario

“The first few times when you fall in love, you won’t know how to deal with these feelings. These are mistakes anyone can make, especially those who have deep ingrained trust issues.”
—Male, fourth-year undergraduate, University of Waterloo, Ontario

“I wanted to be closer friends with this person, and the thought of that person being happy with other people made a little sad. I have a ‘need to be needed’ so that may have influenced the desire to give that particular person lots of gifts. I didn’t do anything else. It was a valuable learning experience in terms of interpersonal relationships and how to manage them. It also allowed me to slightly empathize with those who are currently similar to that ‘Past-Me.’”
—Female fourth-year undergraduate, University of Waterloo, Ontario

8 ways to help a friend who’s being stalked

Chances are your friend isn’t quoting the Violence Against Women Act. They may not even use the word “stalking.” Even so, it’s important to take seriously initial concerns about stalking behaviors, and to act early, says Detective Mark Kurkowski, of the St. Louis Metropolitan Police Department’s Domestic Abuse Response Team, Missouri. “Respond to stalking cases before [they involve] violent threats or [run to] years of stalking,” he says. Here’s how to do that:

1. Listen to your friend’s story and believe it

Allow them to tell their story the way they want to tell it. Do not underestimate how powerful listening is.

“Allow them to tell their story the way they want to tell it,” says Jennifer Landhuis of the Idaho Coalition Against Sexual and Domestic Violence. Do not underestimate how powerful listening is. “Sometimes the trauma will make them minimize what’s been happening, because they’re in the middle of it. That outside touchstone can make a big difference.”

2. Recognize that you are not in a position to say what they should do

All the methods they’ve tried have failed.

â€Ķ or what you think they should have done to make the stalking behavior stop. “By the time stalking victims are reaching out and telling people about what’s going on, all the methods they’ve tried have failed,” says Landhuis.

3. Consider their full context and situation

As their friend, you’ll have some idea of what other challenges they may be facing; the stalking might be one part of a difficult semester.

Your friend is your friend, not just a stalking victim. As their friend, you’ll have some idea what other challenges they may be facing; the stalking might be one part of a difficult semester. All the pressures and challenges in their life are important in how you think about helping. “Unless you try to consider everything they come to the table with, you might not be able to help,” says Landhuis.

4. Help them explore their options and access to resources

Stalking resources are less familiar to most of us than sexual assault; options are available on and off campus.

  • Although many of us are learning what resources exist for people affected by sexual assault and domestic violence, stalking resources are less well known.
  • If the victim or others is (or feels) threatened with violence, call the police. “Whenever you have a credible threat, law enforcement should be involved,” says Det. Kurkowski.
  • Check out the reporting, advocate support, and counseling options on campus. A good place to start is your campus counseling center or public safety/security office. Even if the stalking is also reported to the police, the school has responsibilities under Title IX. Look for a campus advocate, such as a residence assistant or someone in school administration, like the Title IX office. Your job as a friend may be finding which advocate on campus is best equipped to help. Advocates on campus can help in various ways:
    • Accessing accommodations, such as getting the person being stalked into a different residence hall or classes
    • Taking action through the school’s disciplinary process, and/or going to the police, with a view to interventions such as no contact orders. “Sometimes campus stalking codes are stricter than state law, and the university can hold the offender accountable in a number of ways, like suspension,” says Det. Kurkowski. “And just because you’re going to talk to someone about it doesn’t mean it’s going to get reported to law enforcement.” (Before reporting to a campus authority, ask about the school’s policies and procedures for involving local law enforcement.)

5. Activate your friend network

Check out these 4 ways to harness the power of your social network.

Social networks are powerful. Here’s how to harness that power:

  • When someone who’s been stalked talks to a friend, they may find someone who’s been through the same thing and knows what to do, says Det. Kurkowski.
  • If you know people who are friends with the stalker, they might be able to help. Landhuis says, “You can absolutely engage whatever peer group might have influence on the person who’s conducting the behavior.”
  • Help protect the victim’s privacy. It’s not realistic to ask your friend to get off social media, but you can be very aware of how you use your own. “What kinds of information is the victim or their friends sharing?” asks Landhuis. “Often a stalker finds out where a victim is because the victim’s friends have posted on social media that they’re going out.” To strip online posts of automatic location information, search “how to disable geotagging on [phone make/model].”
  • Actively support your friend’s safety when you’re together. If you’re heading to a bar with your friend who’s been stalked, ask your crew, “How are we going to keep an eye on them? What kinds of bystander supports are going to keep our friend feeling safe?”

6. Make a safety plan and check out safety apps

Safety plans and apps can help.

“In any stalking situation, you should be doing safety planning,” Det. Kurkowski says. Safety plans use what a victim knows about a stalker to reduce the risk of harm to themselves and those around them. For example, avoid places where the stalker tends to hang out; if the stalker shows up, have a safe exit plan ready. In addition, look for evaluated safety apps that can address your friend’s needs.

7. Document the pattern of stalking

This is essential to any disciplinary process or police report.

“Documentation is key—whether it be text messages, emails, Facebook postings, whatever. Don’t erase anything, don’t delete anything, make sure there’s a way to prove that this happened over a period of time,” says Det. Kurkowski. Take screenshots of social media posts and learn how to download a copy of Facebook messages.

8. Help others understand what stalking is

Avoid using language that minimizes how harmful and dangerous stalking can be.

Some victims minimize the behaviors that threaten their safety, or blame themselves. In that case, look at those behaviors: Is someone following them around, tracking them somehow, or not taking “no” for an answer? “Many people who don’t use the word ‘stalking’ will say, ‘That is happening to me,’” says Landhuis. “Help to educate your friend. What does stalking look like, what does it feel like, what does it sound like?”


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National Network to End Domestic Violence. (n.d.-b). TechSafety.org. Retrieved from https://techsafety.org/

Stalking Resource Center. (n.d.). The model stalking policy. Victimsofcrime.org. Retrieved from
https://www.victimsofcrime.org/docs/default-source/src/the-model-stalking-policy.pdf?sfvrsn=6
           
US Congress. (2013). Federal Register | Violence Against Women Act. Retrieved from https://www.federalregister.gov/articles/2014/10/20/2014-24284/violence-against-women-act

Victim Connect. (n.d.). Stalking. Retrieved from https://victimconnect.org/crime-resources/stalking/

Walters, M. L., Chen, J., & Breiding, M. J. (2013). The National Intimate Partner and Sexual Violence Survey (NISVS): 2010 Findings on Victimization by Sexual Orientation. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. Retrieved from
https://www.cdc.gov/violenceprevention/pdf/nisvs_sofindings.pdf

Zitek, B. (2002). What to do if you—or a patient—is a victim of stalking. Current Psychiatry, 1(3), 34–40.

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01 NovBodySelfStaying healthySubstance use

Drinking? 7 ways to get what you want from it

by Lucy Berrington0 Comments
Reading Time: 6 minutes

 

Having the drink without the downside

Do you choose to drink alcohol? If so, chances are you’re interested in figuring out how to get alcohol’s buzz (feeling chatty, relaxed, and socially connected) while avoiding its negative effects (feeling tired, sick, embarrassed, and all set to fail Monday’s test).

You may have noticed that once you’ve passed the euphoric stage of drinking, and started to slump, consuming more alcohol does not bring back the buzz. This is always the case (science has figured out why, but that’s another story).

This guide is about how to get the effects of alcohol that you want without ending up with its baggage too. A key skill is knowing how to take care of yourself while still being part of the party. Here, we outline seven realistic ways to do this.

Note: Our emphasis is on realistic. Most of you are using some of these strategies already, a large national survey shows. To find out how to make this easier, while expanding your options for having fun and staying in control, keep reading. These strategies are especially important when you’re new to college, new to drinking, or both. (The minimum legal age for consuming alcohol in the US is 21.)

First things first: Be confident in your choice to drink mindfully

Alcohol seems (and is) part of the social culture on many campuses. But over and over, studies show that students perceive alcohol use among their peers to be far more common and frequent than it really is.“Most people drink responsibly or not at all, but don’t boast about that, so they may think they’re the only ones.” —Dr. Ann Quinn-Zobeck, former senior director of initiatives and training, The BACCHUS Network (national association of peer education initiatives addressing alcohol use at US colleges)Here’s what undergrads think their peers are drinking, compared to how much undergrads report they are actually drinking:Alcohol use among undergraduates graphSource: National College Health Assessment, Fall 2015; 19,800 respondents, anonymous and randomized

7 ways to get what you want from alcohol:

1 Make a plan in advance

Planning what you’ll drink through the evening is key to staying in control. “You may deviate from your plan a little. It still helps lower your risk.” —Joan Masters, substance abuse prevention provider, University of MissouriConsider:

  • What you will drink
  • How many alcoholic drinks you will have
  • How you will pace those drinks through the event
  • Whether or not you will have access to the drink of your choice

To figure out what works for you, see Know what you can drink—at what pace later in this slideshow.

Part of planning is anticipating whether you will have control over your own alcohol choices. For example, if jungle juice or mystery punch is all that’s available, the healthiest choice is not to drink or to bring your own.Plan: Take own beer, 4 beers total, 1 beer/hr Alternate w. non-alc, —refill can (water & lime)

2  Set your limits up front

Let your friends know that you’re looking forward to hanging out with them and that you’re choosing to not overdo it. Can’t afford a late penalty for your assignment or a missed team practice? Your friends will get it.Person 1: I’m training tomorrow—tonight I’m all about the seltzer. Person 2: So much to get done the next few days. I’m stopping at two drinks this evening.

3 Tag team with a friend

You’re not the only one who wants to be in control when you go out. Tag team with a friend, help each other out, and celebrate the people who step in and let you know when you’ve had enough.“This is the effect of alcohol myopia: The more we drink, the more we attend to impelling cues (like the person urging you to play beer pong) and the less we attend to inhibiting cues (like the test you have to study for tomorrow). When you tag team, you can change that.” —Ryan Travia, associate dean of students for wellness, Babson College, Massachusetts

Person 1: A glass of wine every hour, up to three glasses. Person 2: Then I’ll cut you off. If I look like I’m up for a shot, stage an intervention.

4  Alternate alcoholic and nonalcoholic drinks

We feel more comfortable when we have a cup in our hand, whether or not that cup contains alcohol, studies show.“In reality, we deal with peer pressure throughout our whole lives. I once had a professor tell me he carried around the same can of beer all night at faculty parties and just filled it with water so no one would push him to drink more.” —Dr. Ann Quinn-Zobeck, The BACCHUS Network

  • If you usually have eight alcoholic drinks and you want to cut that to four, you can still have eight drinks: alternate alcoholic and nonalcoholic beverages.
  • No one has to know what is in your cup or can: Refilling your beer can with water or juice keeps others from worrying that you haven’t had enough to drink or aren’t having fun.
  • Bonus: Add ice to your drinks—studies show you’ll drink more slowly (and the alcohol will be diluted).
  • Caution: Carbonated drinks may be best avoided when you’re drinking alcohol; carbonation appears to speed up the rate at which alcohol is absorbed into the blood stream, according to researchers. Instead, go for water (add fruit for flavoring), juice, or a sports drink.

Good to know: Studies of the placebo effects related to alcohol show that the chatty, witty persona we associate with drinking is more about our expectations of alcohol than the alcohol itself. In other words, we can be that person without alcohol.

5  Delay the next drink

You can delay your next drink without seeming to reject the person who’s offering it or distancing yourself from the social scene.

When someone offers to get you a drink, show appreciation, and give them a reason to hold off.Person 1: I’m going to the bar—can I get you anything? Response 2: I’m good right now, thanks, but I’ll get the next one. Response 2: Oh, I’ll get it in a few—I’m going to the bathroom first. Response 3: I’m just going to talk to someone and then I’ll go grab one. Response 4: Thanks, I’m all set.

Bonus: This sets you up to get your own drink directly from the bartender—the safest source of alcohol. Here’s why:

  • You’ll know what you’re getting. This is very different from jungle juice or mystery punch, when you have no way of knowing how concentrated the alcohol is. (If you expect punch to be the only alcohol served at a party, bring your own drinks.)
  • You’ll more easily stick to your plan. Bartenders know what a standard serving size looks like—and can also recognize a person who shouldn’t drink any more.
  • You’ll reduce the risk of your drink being spiked. “Date-rape drugs” are tasteless, odorless, colorless, and rapidly dissolving.

6  Show that you’re having a good time

The person offering you a drink wants you to have a good time and include you in the fun. Let them see that you’re enjoying yourself.

Response 1: No thanks, I need my wits tonight. I’m about to join them over there for ping pong. Response 2: I’m taking it easy—I overdid it last time. I’m dying to get my trivia fix. Want to take me on? Response 3: I’m exhausted—the alcohol will race through me. Got a cold Gatorade and an update on what happened at rehearsal?

7 Be thoughtful about drinking games

Drinking games vary in their safety and risk. If you participate, choose wisely.

Be cautious about matching your alcohol intake with someone else’s. When participating in drinking games, we often consume more than we had anticipated, and we drink more quickly than usual. This hikes up the risk of illness, impairment, and regret.“We don’t all process alcohol the same way. For example, women get drunk faster than men on the same amount of alcohol, even if they have the same body weight.” —Dr. Jason Kilmer, associate professor of psychiatry and behavioral science, University of WashingtonConsider adapting drinking games in these ways:

  • Take a sip, not a shot
  • Play all or some rounds with nonalcoholic beverages
  • Take breaks

Know what you can drink—at what pace

Those strategies are helpful in social and professional situations involving alcohol. Being mindful about your alcohol use also means knowing what you typically drink and how your body and mind respond to it. Here’s how to figure that out:

A  Ask yourself three questions:

  • What do I drink?  The amount of alcohol you consume depends partly on what you’re drinking. Alcoholic beverages vary enormously in their alcohol content.
  • What’s my usual serving size?  The amount of alcohol you consume also depends on the shape and size of your glass or cup. A standard serving size is unlikely to be whatever your friend just ladled into that red solo cup.
  • How long will I be out for?  Think about pacing your drinking. If you’ll be out for four hours and you plan to have three alcoholic drinks, you may decide to have one alcoholic drink per hour for the first three hours. Pregaming—drinking before you go out—means you hit “peak buzz” earlier, and your mood declines earlier too.

How to calculate your alcohol intake (Rethinking Drinking: NIAAA)

B  Consult a BAC calculator or chart:

This helps you estimate the amount of drink servings you can consume, and how you should pace them, before your Blood Alcohol Content (BAC) reaches “peak buzz”. For many people, “peak buzz” is around 0.06 percent BAC. For some, it’s between 0.04 and 0.06.

Predict how you’ll feel through the evening (Yale University)

Estimate your BAC during dinner (Éduc’alcool)

Are you already doing this when you drink?

Almost all college students (98 percent) who responded to a national survey reported that they routinely took one or more smart measures when socializing with alcohol in the past 12 months.

“Most of the time” or “always”
Alternate non-alcoholic with alcoholic beverages 35 percent
Avoid drinking games 37 percent
Choose not to drink alcohol 26 percent
Decide in advance not to exceed a set number of drinks 43 percent
Eat before and/or during drinking 80 percent
Have a friend let you know when you have had enough 44 percent
Keep track of how many drinks being consumed 68 percent
Pace drinks to one or fewer an hour 34 percent
Stay with the same friends the entire time drinking 88 percent
Stick with only one kind of alcohol when drinking 52 percent
Use a designated driver 89 percent

Source: National College Health Assessment, Fall 2015; 19,800 respondents, anonymous and randomized

[survey_plugin] Article sources

Jason Kilmer, PhD, associate professor of psychiatry and behavioral science, University of Washington; assistant director of health and wellness for alcohol and other drug education, Division of Student Life, University of Washington.

Joan Masters, MEd, senior coordinator, Partners in Prevention, University of Missouri Wellness Resource Center; area consultant, The BACCHUS Network.

Ann Quinn-Zobeck, PhD, former senior director of initiatives and training, The BACCHUS Network.

Ryan Travia, MEd, associate dean of students for wellness, Babson College, Massachusetts; founding director, Office of Alcohol & Other Drug Services (AODS), Harvard University.

American College Health Association. American College Health
Association–National College Health Assessment II: Reference Group
Undergraduates Executive Summary Fall 2015. Hanover, MD: American
College Health Association; 2016.

Borsari, B., & Carey, K. B. (2001). Peer influences on college drinking: A review of the research. Journal of Substance Abuse, 13, 391–424. Retrieved from https://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.602.7429&rep=rep1&type=pdf

Borsari, B., & Carey, K. B. (2006). How the quality of peer relationships influences students’ alcohol use. Drug and Alcohol Review, 25(4), 361–370.

Crawford, L. A., & Novak, K. B. (2007). Resisting peer pressure: Characteristics associated with other-self discrepancies in college students’ levels of alcohol consumption. Journal of Alcohol and Drug Education, 51(1), 35–62.

Harrington, N. G. (1997). Strategies used by college students to persuade peers to drink. Southern Communication Journal, 62(3), 229–242. Retrieved from https://www.tandfonline.com/doi/abs/10.1080/10417949709373057?journalCode=rsjc20

Kilmer, J., Cronce, J. M., & Logan, D. E. (2014). “Seems I’m not alone at being alone:” Contributing factors and interventions for drinking games in the college setting. The American Journal of Drug and Alcohol Abuse, 40(5),  411–414.

Neighbors, C., Lee, C. M., Lewis, M. A., Fossos, N., et al. (2007). Are social norms the best predictor of outcomes among heavy-drinking college students? Journal of Studies on Alcohol and Drugs, 68(4), 556–565.

Neighbors, C., Jensen, M., Tidwell, J., Walter, T., et al. (2011). Social-norms interventions for light and nondrinking students. Group Processes & Intergroup Relations, 14(5), 651-669. doi: 10.1177/1368430210398014

Palmeri, J. M. (2016). Peer pressure and alcohol use among college students. Applied Psychology Opus, NYU Steinhardt. Retrieved from
https://steinhardt.nyu.edu/appsych/opus/issues/2011/fall/peer

Perkins, H. W., Linkenbach, J. W., Lewis, M. A., & Neighbors, C. (2010). Effectiveness of social norms media marketing in reducing drinking and driving: A statewide campaign. Addictive Behaviors, 35(10), 866–874.

Roberts, C., & Robinson, S. P. (2007). Alcohol concentration and carbonation of drinks: The effect on blood alcohol levels. Journal of Forensic and Legal Medicine, 14(7), 398–405.

Rohsenow, D.J., & Marlatt, G. A. (1981). The balanced placebo design: Methodological considerations. Addictive Behaviors, 6(2), 107–122. https://dx.doi.org/10.1016/0306-4603(81)90003-4

Student Health 101 survey, July 2016.

Turner, J., Perkins, H. W., & Bauerle, J. (2008). Declining negative consequences related to alcohol misuse among students exposed to social norms marketing intervention on a college campus. Journal of American College Health, 57, 85−93.

Wechsler, H., Nelson, T. E., Lee, J. E., Seibring, M., et al. (2003). Perception and reality: A national evaluation of social norms marketing interventions to reduce college students’ heavy alcohol use. Journal of Studies on Alcohol, 64, 484–494.

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01 OctBodySelfStaying healthySubstance use

Drinking? The science of the buzz and how you can control it

by Lucy Berrington0 Comments
Reading Time: 5 minutes

 

The science of drinking: How to make it work better for you

If you choose to drink alcohol, you’re likely familiar with the relaxed, chatty buzz that may come early in the evening—and the slump that sometimes follows (the tiredness, the nausea, maybe the fear of what you posted online). If you’re drinking in school, you can learn how to get that buzz without the slump. For those who drink alcohol, this skill is key to a night—no, a lifetime—of positive experiences and few, if any, regrets.

What makes alcohol tricky to navigate? First, we need to understand how alcohol affects us—which in certain key respects is different from popular myth. With those basic concepts, we can choose to drink alcohol in ways that give us what we want from it.

Second, we all like to believe that we make our own choices, and to some extent, we do. But it’s complicated. A ton of research shows that our behavior, including what we drink, is highly dependent on what’s happening around us. In college, getting the alcohol buzz without the slump means grappling smartly with social dynamics, in addition to understanding the science of how alcohol affects us. This is especially relevant when you’re new to college, new to drinking, or both. (The minimum legal age for consuming alcohol in the US is 21.)

This guide is designed to help you figure out: What experience you want to get from alcohol and how to get this experience without negative consequences—that’s how much you can drink, what you can drink, and at what pace

Why some alcohol can feel fun—and more alcohol doesn’t

Getting a buzz on

If you choose to drink alcohol, it may help you relax, socialize, and have fun—up to a point. Depending on what you drink, how much you drink, and how quickly or slowly you drink it, the alcohol level in your blood will rise to a certain level—let’s call it “peak buzz.”

For most people of average tolerance, peak buzz happens when your Blood Alcohol Content (BAC)—the concentration of alcohol in your bloodstream—approaches 0.06 percent. For most people, two to three drinks within an hour will have this effect. Some research indicates that 0.06 percent BAC is on the high side; you may find peak buzz comes at any point after 0.04 BAC.

After the buzz, the slump

Beyond that point—0.06 percent BAC—the enjoyable effects of alcohol decline and wear off. You may feel sleepy, flat, disconnected. You may get moody or sick, or make unwise decisions. From here, there’s no going back to peak buzz. Drinking more alcohol can only take you deeper into the slump and toward regret territory.

The science of the slump—and why you can’t get the buzz back

Explained by Dr. Jason Kilmer, associate professor of psychiatry and behavioral science, University of Washington:

“The biphasic aspect actually occurs within the brain. The brain center that inhibits our actions is the first to be affected (depressed) by alcohol. So without the inhibiting center the other areas somewhat go wild, and we feel uninhibited, etc. Later, the brain functions that allow us to act bolder and less shy also get depressed, and then we slump.” —Dr. Pierre-Paul Tellier, director of student health services at McGill University, Quebec

These buzz effects and slump effects in the chart are examples of how people may experience alcohol; the sequence of effects on each side of the chart is in no particular order.

The key to getting what you want from alcohol

Three questions to match your alcohol intake with peak buzz

What do I drink?

The amount of alcohol you consume depends partly on what you’re drinking. Alcoholic beverages vary enormously in their alcohol content.“I’ve had students say, ‘I only had a few drinks.’ But they’re talking about shots, and they don’t realize that five shots in an hour is the equivalent of five beers in an hour.” —Joan Masters, substance abuse prevention provider, University of Missouri

12 fl ox of regular = 8-9 fl oz of malt liquor = 5 fl oz table wine = 2-3 fl oz of cordial, liqueur, or aperitif = 1.5 fl oz shot of 80-proof distilled spirits

What’s my usual serving size?

The amount of alcohol you consume also depends on the shape and size of your glass or cup. A standard serving size is unlikely to be whatever your new friend just ladled into that solo cup.

How to get the hang of serving sizes:

  • Take bartending classes: Many campuses and community organizations offer classes in bartending and safe serving practices—often for free.
  • Practice measuring and pouring, so you know what 5 oz. wine (for example) looks like in a red solo cup. Remember:
    • Red solo cups come in different sizes.
    • The lines on red solo cups are not reliable measures of serving size.

Try this size calculator (NIAAA)

3 different sized solo cups with 5 fl oz of liquid each

The same size beverage can look very different depending on the size and shape of the cup or glass.

How long will I be out for?

Think about pacing your drinking. Most people take about one hour to metabolize one standard drink. If you’ll be out for, say, four hours, and you plan to have three alcoholic drinks, you may decide to have one alcoholic drink per hour for the first three hours.

Pregaming—drinking before you go out—means you hit peak buzz earlier. If you keep drinking, your mood declines earlier too.

How to estimate your Blood Alcohol Content

BAC calculators and charts help you estimate the number of standard drinks you can consume before your BAC reaches peak buzz (0.06 percent).

Example:
Woman (155 lb, 5’7″): 3 standard drinks in 3 hours
Man (155 lb, 5’7″): 3 Â― standard drinks in 3 hours

Check out this BAC chart (Yale University)

Or this one (Cleveland Clinic)

BAC charts and calculators are useful but limited tools:

  • They estimate how much alcohol someone of your body type and sex can typically drink before experiencing certain effects (positive and negative).

  • They do not account for various other factors that may influence your alcohol tolerance (e.g., age, health, fatigue, medications, food consumed, and whether or not the environment is familiar).

  • You may need to adjust the BAC percentage to account for the amount of time you’re drinking.

[survey_plugin]

Article sources

Jason Kilmer, PhD, associate professor of psychiatry and behavioral science, University of Washington; assistant director of health and wellness for alcohol and other drug education, Division of Student Life, University of Washington.

Joan Masters, MEd, senior coordinator, Partners in Prevention, University of Missouri Wellness Resource Center; area consultant, The BACCHUS Network.

Ann Quinn-Zobeck, PhD, former senior director of BACCHUS initiatives and training, NASPA - Student Affairs Professionals in Higher Education (peer education initiatives addressing collegiate health issues at US colleges).

Pierre-Paul Tellier, MD, director of student health services, McGill University, Quebec.

Ryan Travia, MEd, associate dean of students for wellness, Babson College, Massachusetts; founding director, Office of Alcohol & Other Drug Services (AODS), Harvard University.

American College Health Association. American College Health Association–National College Health Assessment II: Reference Group Undergraduates Executive Summary Fall 2015. Hanover, MD: American College Health Association; 2016.

Borsari, B., & Carey, K. B. (2001). Peer influences on college drinking: A review of the research. Journal of Substance Abuse, 13, 391–424. Retrieved from https://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.602.7429&rep=rep1&type=pdf

Borsari, B., & Carey, K. B. (2006). How the quality of peer relationships influences students’ alcohol use. Drug and Alcohol Review, 25(4), 361–370.

Crawford, L. A., & Novak, K. B. (2007). Resisting peer pressure: Characteristics associated with other-self discrepancies in college students’ levels of alcohol consumption. Journal of Alcohol and Drug Education, 51(1), 35–62.

Harrington, N. G. (1997). Strategies used by college students to persuade peers to drink. Southern Communication Journal, 62(3),  229–242. Retrieved from https://www.tandfonline.com/doi/abs/10.1080/10417949709373057?journalCode=rsjc20

Kilmer, J., Cronce, J. M., & Logan, D. E. (2014). “Seems I’m not alone at being alone:” Contributing factors and interventions for drinking games in the college setting. The American Journal of Drug and Alcohol Abuse, 40(5),  411–414.

Neighbors, C., Lee, C. M., Lewis, M. A., Fossos, N., & Larimer, M. E. (2007). Are social norms the best predictor of outcomes among heavy-drinking college students? Journal of Studies on Alcohol and Drugs, 68, 556–565.

Neighbors, C., Jensen, M., Tidwell, J., Walter, T., Fossos, N., & Lewis, M. A. (2011). Social-norms interventions for light and nondrinking students. Group Processes & Intergroup Relations, 14(5), 651-669. doi: 10.1177/1368430210398014

Palmeri, J. M. (2016). Peer pressure and alcohol use among college students. Applied Psychology Opus, NYU Steinhardt. Retrieved from https://steinhardt.nyu.edu/appsych/opus/issues/2011/fall/peer

Perkins, H. W., Linkenbach, J. W., Lewis, M. A., & Neighbors, C. (2010). Effectiveness of social norms media marketing in reducing drinking and driving: A statewide campaign. Addictive Behaviors, 35, 866–874.

Seigel, S. (2011). The four-loko effect. Perspectives on Psychological Science, 6(4), 357–362.

Student Health 101 survey, July 2016.

Turner, J., Perkins, H.W., & Bauerle, J. (2008). Declining negative consequences related to alcohol misuse among students exposed to social norms marketing intervention on a college campus. Journal of American College Health, 57, 85−93.

Wechsler, H., Nelson, T. E., Lee, J. E., Seibring, M., Lewis, C., & Keeling, R. P. (2003). Perception and reality: A national evaluation of social norms marketing interventions to reduce college students’ heavy alcohol use. Journal of Studies on Alcohol, 64, 484–494.

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