Why Cornell’s Clinicians Need Cross Training

As Cornell University administrators consider the recommendations from a mental health review released last October, Cornell Health needs to cross train all of its clinicians to diagnose and treat substance abuse disorders and other mental health disorders as soon as possible.

Cross training is an important consideration in all health services, but it is especially necessary for clinicians who work with college students. For example, a female student sought help from her college’s counseling program because she was feeling anxious and depressed. She met with a counselor for several weeks but experienced no relief. Her counselor decided to seek advice and brought her case to the counseling service’s weekly clinical meeting. After a lengthy discussion, another counselor asked, “Did you ask about her drinking?” No, the counselor had not asked about her drinking because she focused on the presenting problems, anxiety and depression. In the end, the counselor diagnosed the student as having a serious alcohol use disorder and treated her successfully for both addiction and depression.

Another in an occasional series of articles about student mentaOne in an occasional series of articles about student mental health. For more information, go to The Sophie Fund’s Student Mental Health Page

Clinical services, whether in the workplace or on a college campus, have a common problem: most clinicians do not have sufficient training to diagnose and treat both substance use disorders and other mental health disorders. This occurs primarily because clinical training programs often do not provide social workers, psychologists, and psychiatrists with sufficient background and skills to diagnose and treat substance abuse disorders, particularly addiction.

At the same time, programs specializing in training counselors about substance use disorders may give short shrift to the diagnosis and treatment of other mental health disorders. Clinical services can rectify this problem by ensuring that all clinicians are cross-trained to the point of competence where they can identify, assess, and intervene on both substance abuse disorders and other mental health issues.

Cross training is especially important for college counseling services because college students drink, sometimes excessively, and use and abuse other drugs such as marijuana, prescription drugs (e.g. Adderall and Ritalin), Ecstasy, and cocaine. Since the 1990s, college health practitioners have utilized two approaches to prevent and treat substance use disorders among students.

The first is a harm reduction model. For example, it seeks to reduce the harm associated with excessive drinking by teaching students to drink responsibly. Within this framework, college health practitioners think of heavy drinking as a symptom of an underlying social problem, a dysfunctional “culture,” and they create programs such as social norming campaigns and BASICS (Brief Alcohol Screening & Intervention for College Students) to teach students moderate drinking norms with the expectation that students will change their behavior and drink moderately or not at all.

The second approach conceives of substance use as a coping mechanism that students use to relieve stress, anxiety, and depression. By treating the stress, anxiety, and depression, clinicians believe that students will be less reliant on alcohol and other drugs to cope and use alcohol and other drugs responsibly. These interventions work well with students who are not addicted and are abusing alcohol or other drugs, but they are inadequate for treating those who are addicted to alcohol and other drugs.

More recently, colleges have begun to recognize that many college students who drink excessively and abuse other drugs cannot control their consumption because they are dependent upon alcohol and other drugs and many college health services have begun to develop recovery programs to treat their addiction. One study, for example, found that 18 percent of college students have an alcohol use disorder: 12 percent met the criteria for a diagnosis for alcohol abuse and six percent met the criteria for a diagnosis of alcohol dependence.

Interview skills are essential for making an accurate diagnosis and ensuring effective treatment. Mental health clinicians and addiction specialists can learn from one another to improve their skills.

Again, the classic example is the depressed client who seeks help from a mental health practitioner for depression. A male student sees a mental health clinician who focuses the interview on his symptoms of depression and reasonably prescribes anti-depressants and talk therapy. However, the clinician misses the fact that the client is implying that his alcohol consumption is minimal but is actually consuming large quantities of a depressant (i.e. alcohol). The therapist does not consider the patient’s self-medication and prescribes antidepressants.

In the opposite scenario, the same male student sees an alcohol and drug counselor to discuss his potential abuse of alcohol. The counselor does a standard intake evaluation and determines that he does meet all the criteria for alcohol addiction but, because of the nature of the questions asked, the counselor misses the fact that this person has had all the symptoms of depression since before he ever took his first drink. In both scenarios, the most effective treatment requires the clinician to diagnose both the addiction and depression and treat them in an integrated manner. Treating only the depression will perpetuate the addiction, the pain, and dysfunction. Only treating the addiction will perpetuate the depression and likely lead to ongoing suffering and relapse.

         Cross training ensures that health services deliver the most competent care in the most cost effective manner. The only thing worse than not getting the help one needs is thinking you are getting help when you are not. Clinicians owe it to their patients to be able to assess issues across the mental health spectrum. As Cornell Health responds to the mental health review, it can ensure that students receive the most effective care by guaranteeing that all of its clinicians have sufficient training to diagnose and treat both substance use disorders and other mental health disorders.

—By William J. Sonnenstuhl and G.P. Zurenda

William J. Sonnenstuhl is an emeritus professor in the School of Industrial and Labor Relations (ILR) at Cornell University. His primary research examines alcohol and drug problems in the workplace and on college campuses. He is the faculty advisor for Sober@Cornell, President of Cornell Collegiate Recovery, Inc., board member of Cayuga’s Watchers, and member of the Fraternity, Sorority, and Alumni Council.

G.P. Zurenda is a social worker and addiction specialist. He holds an MBA from the SC Johnson College of Business.

Walking to Save Lives

What a turnout it was on September 18 for the Greater Ithaca “Out of the Darkness” Walk in Myers Park in Lansing! Fundraising teams and individuals collected more than $45,000 to support the American Foundation for Suicide Prevention.

Ithaca College Bombers Women’s Lacrosse

The annual event, organized by the AFSP’s Greater Central New York Chapter and co-chaired by Crystal Howser and Amber Parker, helps the foundation invest in life-saving research, education, advocacy, and support for those impacted by suicide. The walk included teams from Cornell University’s College of Agriculture and Life Sciences and the Ithaca College Bombers Women’s Lacrosse squad.

Click here to learn more, donate, or volunteer with AFSP.

In opening remarks, Crystal Howser thanked the throng of walkers who participated:

“By showing up today, you are sending the message that mental health is as real as physical health. You are sending the message that reaching out for help is the strong thing to do. You are showing others that suicide can no longer be swept under the rug.

“By showing up, you let others know they are not alone. Because of you, we can fight for a day when no one will die by suicide.

“By walking with us, you honor the memory of the loved ones we’ve lost. I also want to acknowledge those of you who have suffered personally from suicidal thoughts. We are so glad to have you here with us in this fight. Your presence and openness allow others to know they are not alone in their struggle.

“Together, we are strong, together we are making a difference. Our mission to save lives and bring hope to those affected by suicide would not be possible without each of you.”

Corporate sponsors for the event included The Strebel Planning Group and its Fund for Community Enrichment; Central New York Tuesdays and Upstate Shredding; Maguire Family of Dealerships; CFCU Community Credit Union; BorgWarner; Ithaca Apartment Management/Solomon Organization; Midstate Basement Authorities; Cayuga Medical Center; Warren Real Estate; Visions Federal Credit Union; and the Suicide Prevention and Crisis Service.

Special thanks to John Brehm of Brehmstone Photography!

Co-Chair Crystal Howser, New York State Assembly Member Anna Kelles, and Co-Chair Amber Parker

Top fundraising team

Greater Ithaca “Out of the Darkness” Walk

Sigma Alpha, Cornell University

In memory of Lisa Cabral Mastroberti

In memory of Nicholas Cooper and Jeremy Vicedomini

Team Hope—Remembering Jerry Howser

Suicide Prevention and Crisis Service

Message stones

The Sophie Fund

“Together to Fight Suicide”

Myers Park, Lansing, September 18, 2021

A Cornell Mental Health Resources Guide

When I started my first year at Cornell University, I experienced imposter syndrome and overwhelming feelings of depression and anxiety. I questioned whether I belonged at an Ivy League school and had doubts about whether I could be successful on my own. I began having a negative view about myself and my capabilities, started self-isolating, and worked to attain a level of perfection that isn’t possible in my classes.

Memorial Room, Willard Straight Hall, Cornell University

While I was going through all this, I realized I never heard or had any information about the groups and initiatives on campus that were directed toward addressing student mental health. I believe that I could have benefited from them when I felt so alone.

It is essential that incoming students have this indispensable information if they ever need support or a community to turn to if they are struggling. Turning to someone who understands or even talking to someone while you’re dealing with a hardship makes a big difference. Getting out of your own head gives you perspective about what you’re going through and how you perceive the situation. You are never alone. Your struggles and vulnerabilities do not make you weak. Sharing makes you stronger and more connected with others.

One in an occasional series of articles about student mental health. For more information, go to The Sophie Fund’s Student Mental Health Page

My experience, and then learning about the deaths of Cornell students earlier this year, motivated me to create the Cornell Mental Health Resources Guide to empower incoming and current students to find and ask for emotional support when they need it—whether they’re going through a crisis or need someone to talk to. The transition to college is very difficult. It’s important more than ever, given the Covid-19 pandemic, that new students know that they are supported and that there are communities of students that are here to support them and have their own experiences related to dealing with mental health and negative body image.

Through this guide, I hope to inform students about where they can find support and the kinds of resources and communities that exist on campus to address their personal, mental health, academic, and/or spiritual needs. I want to further the idea that asking for help is a strength and challenge the societal belief that emotions should be pushed aside.

DOWNLOAD: Cornell Mental Health Resources Guide 2021-22

Mental health should be a number one priority. Many students buy into a hustle culture in college that encourages you to struggle and put yourself last, but your wellbeing should reside in the center of everything you do. Taking care of yourself allows you to feel better about yourself, put struggles into perspective and see challenges objectively, be less tired and stressed, focus and perform better in your academics, be a better friend, be present, etc. Only by taking care of yourself can you show up as who you truly are. Investing time in relationships is also important as human connection makes us happier.

Over the summer, I distributed my work to more than 800 organizations, professors, and departments on campus. It was sponsored by student organizations working to address mental health on campus including Cornell Minds Matter, EARS, Reflect at Cornell, and Body Positive Cornell. It was shared with freshmen through Cornell’s new student orientation, the Tatkon Center, Cornell residential housing, Cornell athletics sports teams, and students coming back from health leaves of absence. It has also been shared by some professors in their course syllabi.

In receiving a lot of positive responses from the Cornell community, I’ve been able to see that there are many people who care about student wellbeing at Cornell and want the best experience for every student. Together, we can work to make Cornell an even better campus and environment for students to grow and thrive.

—By Katie Gorton

Katie Gorton is a sophomore at Cornell University hoping to study Communications.

DOWNLOAD: Cornell Mental Health Resources Guide 2021-22

How We Can Treat Addiction on Campus

Cornell University, like other colleges, recognizes that some students are addicted to alcohol and other drugs and is exploring the development of a collegiate recovery program. Some elements for a comprehensive program already exist on campus; others are yet to be created. A successful program, however, will embed a firm understanding of addiction and recovery into Cornell Health’s public health approach to mental health.

Addiction is characterized by the psychodynamics of denial, and collegiate recovery programs must confront those psychodynamics within the framework of a comprehensive public health approach. Anyone who has attempted to talk with a loved one about his or her addiction knows that their first reaction is to deny that there is anything wrong with their drinking. “I am not an alcoholic. I drink like everyone else.” “Alcoholic” and “addict” are highly stigmatized labels, heavily freighted with accusations of moral failing. In American culture, nobody wants to be seen as out of control, especially unable to exercise control over one’s alcohol or drug use. Denial makes helping addicted individuals difficult; nevertheless, it is possible to overcome their denial and set them on the pathway to recovery.

One in an occasional series of articles about student mental health. For more information, go to The Sophie Fund’s Student Mental Health Page

Employee Assistance Programs use the constructive confrontation strategy to break through denial and motivate employees to accept help. Supervisors, for example, focus on job performance. When they see an employee’s performance deteriorate, they use progressive discipline and offers of help to motivate the employee to seek assistance from the program. When supervisors implement this strategy, employees are most likely to accept help and recover from their addiction. The constructive confrontation strategy can be used in a variety of settings, including schools and hospitals. The crucial balance—disciple and assistance—motivates addicts to accept treatment and recover.

Collegiate recovery programs can embed the crucial balance in the comprehensive public health approach—education/prevention, intervention, and treatment—used by colleges to address student mental health. Within each approach, it is important to highlight that addiction is a real phenomenon on college campuses, that addiction is characterized by denial, and that students can be motivated to accept help by focusing on their performance (e.g. grades, personal relations, campus code) and offering them assistance in correcting the problems. It is most important to emphasize that addiction is a medical problem and not a moral one, that recovery is possible, and that many students and alumni have recovered and are living sober, rewarding lives.

Education: Colleges already educate students about alcohol, responsible drinking, and the consequences associated with excessive use, but they can do more to educate the campus—students, faculty, and staff—about addiction and recovery. Campus alcohol and drug policies should state clearly that addiction is a medical problem and that the college is committed to providing students with the support required to recover and live sober and successful lives. College presidents and other campus leaders can amplify this message across campuses.

Likewise, addiction and recovery can be included as part of education efforts such AlcoholEdu, the Alcohol Literacy Challenge, or eCHECKUP TO GO and social norming campaigns. Cornell Health, for example, is incorporating a segment on addiction and recovery into its online alcohol and drug program required of all freshmen and transfer students. It is crucial that everyone understand that students’ use of alcohol lies along a continuum: many students choose abstinence; most students consume alcohol responsibly; some students get into trouble with alcohol and can learn to moderate their drinking; some students get into trouble because they are addicted to alcohol and they can recover and live sober lives.

To reduce the stigma associated with addiction, colleges can bring successful recovering alumni back to campus to talk with students about their college experience, addiction, and recovery. At Cornell, for example, the Panhellenic Society and Interfraternity Council have sponsored alumni talks, which enable students to distinguish between normal drinking and addiction. From the talks, students learn that help is available for themselves or friends and that sobriety and success are realities for addicted students.

Intervention: Intervention means taking direct action to help someone. On campus, many individuals are well situated to identify students with a potential problem and intervene. Among those well situated to intervene are faculty, peers, student advisors, health care professionals, campus police, and judicial administrators. Unfortunately, intervention often receives short shrift in mental health programs, whether they occur in the community, workplace, or campus because clinicians are uncomfortable with the constructive confrontation strategy and prefer that clients recognize their own problems and choose to come to the program on their own. At the same time, Americans are reluctant to intervene because we prize self-control, expecting others to behave responsibly and seek help on their own. Unfortunately, individuals suffering from addiction do not seek help on their own and require external motivation to accept assistance. The good news is that programs can train individuals such as peers, faculty, and advisors to identify students with problems, to intervene constructively, and to motivate them to seek help.

Many colleges are developing bystander intervention programs, which train students to identify problematic situations and intervene. For example, the NCAA’s program, Step UP!, is an excellent bystander intervention program that trains students to take action in a variety of situations—alcohol and drugs, sexual assault, cheating. It has been adopted by many colleges. Cornell has an award-winning video and workshop, Intervene, which depicts students intervening constructively in a variety of situations. While bystander intervention training increases students’ openness to intervention, the training efforts have yet to create a norm for intervention so that it is embedded in the campus culture and that students take it for granted and feel a duty to intervene.

Comprehensive recovery programs can do more to teach intervention strategies to intervene and ensure that students who have substance use and mental health disorders receive help. This means creating a web of support for individuals to intervene so that intervention is taken-for-granted as part of their role, whether one is an advisor, professor, doctor, or police officer. It also means teaching that college students can be addicted to alcohol and other drugs, that they can motivate students to change their behavior by using the constructive confrontation strategy, and that students can recover from their addiction, live sober lives, and have successful academic and professional careers.

Creating this web of support requires commitment from the top, making it a priority so that individuals feel a duty to intervene when they see students in need of help for addiction and other serious mental health disorders. It also requires some creativity. For example, at Cornell, some fraternities and sororities are implementing peer-based health and safety committees to educate chapter members about health related issues. These committees, like successful peer-based Member Assistance Programs, could train fraternity and sorority members to intervene, refer students for help, and support them in recovery. Similar programs could be developed for faculty, advisors, and health practitioners to create a web of support and duty to intervene and make a referral to the college’s student health center.

Treatment: Treatment refers to health practitioners accurately diagnosing a student’s medical condition, providing appropriate treatment, and following up to make sure that the treatment was effective and the student has recovered. It is important that clinicians are cross-trained in mental health and substance use disorder. That capability is crucial for differentiating between students who are abusing alcohol and other drugs and those who are dependent upon substances. Like Cornell, many colleges have two programs that can help students who are abusing alcohol to control their drinking. BASICS is a harm reduction strategy, which teaches students responsible drinking by highlighting campus norms and encouraging future compliance. Research finds that most students learn their lesson and drink responsibly. Some have difficulty learning, continue to abuse alcohol, and are candidates for Moderation Management, which is typically a group program. Students agree to abstain from drinking for 30 days and are taught techniques for moderating their alcohol use. Students who are abusing alcohol will learn to control their consumption. Students who are addicted to alcohol will not be able to implement the techniques and control their drinking. These students are candidates for addiction treatment.

Sixty years ago, addiction treatment was limited to a few in-patient programs, often 30 days in length, and Alcoholics Anonymous (AA) or Narcotics Anonymous (NA) to support one’s long term sobriety. Today, there are many treatment options. However, abstinence still remains the goal for addicted individuals and long-term support by attending self-help, mutual aid groups still works for maintaining sobriety. Some people are able to utilize out-patient programs, which teach them about addiction, abstinence, and managing their sobriety. Individuals attend individual and group sessions multiple times a week, often daily. They allow patients to maintain some involvement in their normal lives (e.g. working and attending classes) while requiring them to avoid activities that can trigger a return to drinking such as hanging out with drinking buddies and attending parties and to attend AA or NA meetings. In-patient programs remove individuals from their normal lives, put them in a congregate living situation with other addicts, and immerse them in an intensive education experience about their addiction, abstinence, and long-term sobriety.

Treatment for college students is not easy. Colleges located in urban settings may have many options, both in-patient and out-patient, where students can be referred for treatment. Colleges in rural settings may have few or no local options, especially for out-patient treatment. Indeed, local options may be limited to a single program designed for a wide range of adults and, therefore, less able to focus on the special needs of students and the demands of college life. Fortunately, there are excellent in-patient programs for college students, but they do require students to take a leave from campus life and focus on treatment and recovery. Typically, this means taking a semester off, completing the program, and finishing up at home with one’s parents and attending AA or NA meetings.

The congregate college life with its parties is not the ideal environment for students learning to abstain from alcohol and embrace a sober lifestyle. Imagine trying to adopt a sober lifestyle while living in a fraternity, apartment, or dorm with one’s drinking buddies. In this context, in-patient treatment offers a refuge where students can focus on their recovery and enjoy the support of others.

Whether one opts for out-patient or in-patient treatment, long-term recovery requires the support of others such as fellow students, faculty, and advisors. Colleges can do a great deal to support addicted students in their recovery. They can begin by telling everyone that addiction is a medical problem and that students who recover from their addictions have excellent GPAs, graduate, and have successful careers. They can provide group support through local AA and NA meetings and create campus self-help, mutual aid groups such as Sober@Cornell. Student health services can provide counseling to help students with adjustments to campus life and prevent relapse. They can also provide safe spaces such as sober dormitories and club rooms, where students can hang out and enjoy the company of other students in recovery. Colleges can connect students with alumni in recovery, who are able to share their stories of recovery.

Addiction to alcohol and other drugs is a serious problem on college campuses. Nevertheless, recovery is possible and students can live sober and rewarding lives. Cornell Health’s effort to develop a collegiate recovery program can achieve success by embedding it into its public health approach to mental health.

—By William J. Sonnenstuhl

William J. Sonnenstuhl is an emeritus professor in the School of Industrial and Labor Relations (ILR) at Cornell University. His primary research examines alcohol and drug problems in the workplace and on college campuses. He is the faculty advisor for Sober@Cornell, President of Cornell Collegiate Recovery, Inc., board member of Cayuga’s Watchers, and member of the Fraternity, Sorority, and Alumni Council.

Yes! It’s the 6th Annual Ithaca Cupcake Baking Contest!

The world is excited to see what Ithaca’s amateur bakers come up with in 2021!

The judges are still feeling deliciously gobsmacked by last year’s entries. Who can forget the Hidden Treasure or Kahlua Me Crazy cupcakes? Or the Apple Cider or Banana Split or It’s Fall Y’all Apple Crisp cupcakes? Or the creations celebrating blue dogs, roosters, Baby Yoda, and Wewe Bears? As Halloween neared, even Frankenstein came out of an oven and made an appearance.

With an abundance of caution and concern for everyone’s health amid the Covid-19 pandemic, the 2021 contest will again be held entirely online.

Click here for all the information on contest procedures and rules, and to download a registration form.

Contestants of all ages are invited and will be eligible for dozens of prizes including a Grand Prize valued at $250. (Open to amateur bakers only.)

To enter, you will bake and decorate cupcakes, of course. The judges are anticipating the sweet and spicy bouquets coming from your stoves!

Then you’ll take photos of your masterpieces and email them along with a brief description and your recipe to The Sophie Fund.

You will also tell us a brief story about your cupcakes—perhaps a person, place, or thing that inspired your recipe and decoration. Or what special techniques you used. Or what fun you had baking them. Or what challenges you had to overcome making your cupcake dream a reality.

The deadline for submissions is 11:59 pm on Saturday October 16.

Entries will then be judged by professionals from Ithaca’s bakeries and restaurants. Judging is based on decoration, originality, and the story about the cupcake.

Judges will announce finalists and choose winners during an Online Live Event on Saturday October 23. The Sophie Fund will notify the winners and mail prizes to them. The names of winners will also be announced on www.thesophiefund.org.

Additional Prizes:

Teens and Pre-Teens: A $100 gift certificate redeemable at dozens of downtown Ithaca shops will be presented with this year’s Youth Award!

Movie Makers: All contestants MUST submit photos and a story, but you can ALSO make a short movie about your cupcakes to win a separate $100 Video Award prize!

The 6th Annual Ithaca Cupcake Baking Contest is sponsored by GreenStar Food Co+op, Alternatives Federal Credit Union, and Well Said Media.

The contest is organized every year by The Sophie Fund, which was established in 2016 in memory of Cornell University art student Sophie Hack MacLeod to support mental health initiatives aiding young people.

Sophie’s passion for baking cupcakes inspired the launch of the first Ithaca Cupcake Baking Contest in 2016. At the time of her death by suicide at age 23, while on a medical leave of absence from Cornell, Sophie was active in Ithaca’s vibrant culinary scene. According to her family, she hoped to open her own bakery after completing her Cornell degree.