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.