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2018 Issue 4: The public health issue

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Harm reduction: tackling the campus alcohol culture

Harm reduction: tackling the campus alcohol culture

[photo of three students sitting in the AMS office]
Bernard Clark

Members of the Queen's community, like Quinn Scarlett, Miguel Martinez, and Michael Doerksen, all Artsci'19, use a toolkit of resources to address student health and safety related to alcohol use.

Excessive student drinking, long a concern on college and university campuses, is a complex health and safety issue. Endeavouring to address this many-sided challenge requires an entire toolkit of resources and responses to address, from peer-to-peer outreach to policy development. At Queen’s, the longstanding Alcohol Working Group, with representation from staff and students, continues to work to promote and sustain a safer campus culture.

In 2016, Queen’s formally joined forces with colleges and universities across Canada to address the issue. The Postsecondary Education Partnership – Alcohol Harms (PEP-AH) aims to reduce harms related to alcohol consumption at Canadian universities and colleges using an evidence-based approach, common indicators, and an open sharing of strategies and results.

One best practice is for administrators, staff, and students to work collaboratively to address campus alcohol use. Queen’s was an early adopter of this strategy with the introduction, 28 years ago, of the Campus Observation Room.

Diversion tactics work

In 1989, the Principal’s Advisory Committee on Alcohol Awareness made what was then a bold recommendation: to establish a Campus Observation Room to look after severely intoxicated students. The COR opened Sept. 1, 1990, as an eight-cot facility in the basement of Victoria Hall. Under the supervision of staff from the Hotel Dieu Detox Centre, trained student volunteers looked after their peers. In its first year, COR was open for 16 days, during times of peak alcohol use (alumni weekend, the last day of exams, and the days of home football games.) Each admission was screened for medical trauma and concurrent illness: those who didn’t need medical attention stayed at the COR.

"COR was one of the first, if not the first of its kind in Canada,” says Beth Blackett, Health Promotion Coordinator with Queen’s Student Wellness Services. “And while we have modified it a little over the years, the idea behind it is that for every person who comes to COR, there’s one more bed available in hospital for a critically ill patient.”

For every person who comes to COR, there’s one more bed available in hospital for a critically ill patient.

In its early days, COR also worked to identify students whose drinking habits placed them at high risk for alcohol-related problems. At the time, the policy was to identify students upon admission; provide them, at the end of their stay, with educational material promoting the responsible use of alcohol; and provide information to Student Health Services on repeat COR admissions.

Today, however, COR is a completely confidential and non-judgmental service. Campus stakeholders recognize that the reasons for binge drinking are complex, often relying on subtle systemic cues, misconceptions of peer behaviour, or the reliance on alcohol as a substitute for more appropriate coping mechanisms.

Shame doesn’t help

Michael Doerksen, Artsci’19, is a volunteer with COR. “We’re here to help people,” he says. “We don’t do interventions. We don’t shame them for drinking. If we did, perhaps they would opt not to go to COR when they needed it. And then they put themselves and others at risk because there would be no one to help them if they need it.”

Being there for students and keeping them safe when they are under the influence is one half of the COR harm reduction approach. The other half is outreach, talking to students about alcohol before they start drinking.

Harm reduction, not prohibition

"We give them tips and tricks to stay safe,” says Mr. Doerksen. “For instance, we may say, “Consider using a shot glass if you’re pouring drinks, so you know how much you’re taking in.” It’s a simple step, but it helps make people more aware of their own actions. COR volunteers are also highly visible at Queen’s events. “We do a lot of promotion, especially during Orientation Week, when people – especially first-years – don’t necessarily know us. It’s important for us to get out and talk with students face-to-face and answer any questions they might have about the COR. But we do outreach throughout the year as well.”

Mr. Doerksen began volunteering with COR in second year as a way to give back and help out other students. As a team leader, he now schedules the volunteers for each shift. There are always four students volunteering at COR with a staff member from the Detox Centre. Four more volunteers are on-call for each shift.

“It can definitely be stressful at times,” he says, “just seeing people in an uncomfortable position. Obviously, when they’re not feeling well, you have some sympathy for them. So when people come in and they’re very sick, it’s not the nicest thing to see, and so it can be stressful, but working through that, working with the Detox staff, and just helping them, makes it a lot easier. Often, they – and their friends – are very thankful. So it’s rewarding in some respects and stressful in others.”

And has working at COR changed his relationship with alcohol?

“I think, with my experiences at COR, I’ve changed my ways,” Mr. Doerksen says with a laugh. “In first year, it’s no surprise that, well, it’s your first time being away from your family, your first time being independent. People can get reckless in first year. And in my own case, I did partake. Now, I drink less, but I still do drink. “Sometimes people think that the COR volunteers are anti-alcohol. We’re not. COR volunteers are certainly allowed to drink. And some do, some don’t. It’s a personal choice. I drink less since my first year, for a number of reasons. It’s mostly because I don’t have time. I’m busy with other things. But I still enjoy having fun with friends in a social setting.”

Coming to campus

By the time first-year students arrive on campus, many of them have already used alcohol. And many of them have also heard of the university’s reputation as a “work hard, play hard” school. So the conversations about alcohol use at university need to start even before Orientation Week.

Over the summer, Ann Tierney, Vice-Provost and Dean of Student Affairs, talks to incoming first-year students and their families about alcohol use, stress, and mental health, among other important topics. It is all part of eaSd, the Summer Orientation to Academics and Resources, a day-long faculty-specific program held on campus over several days in July; she gives the same talk at first-year family events in Calgary and Vancouver, and again at a mid-fall-term check-in event in the GTA with first-year families.

“We know many university students tend to drink,” she says. “We also know that the incidence of binge drinking at residential universities like Queen’s tends to be even higher.

“Many students manage their alcohol consumption just fine. But some students get themselves into a lot of trouble with excessive alcohol consumption. They put themselves and their friends at risk of harm and they may seriously jeopardize their academic progress.

“Think about this, about what you can manage, and about your own safety when drinking, and the safety and well-being of others around you.”

Shifting the culture

Around the same time as these conversations, 2018 Orientation student leaders – all 1,300 of them – were talking about the role that they play in helping their peers reduce alcohol-related harms. This was part of a workshop developed by the AMS and the Office of the Rector with help from student club Queen’s For The Boys.

When Miguel Martinez, Artsci’19,was elected AMS president for 2018-19, he and his team consulted with student groups on what their priorities should be this year. The answer? Mental health and addressing the alcohol culture on campus. So together, student leaders this year created mandatory workshops for the students who would be introducing first-year students to the Queen’s experience.

“We asked, ‘What can we do to really start to shift the culture?’” says Mr. Martinez. “And one of the things that we had to accept right from the very beginning, in order to move forward, was that we are not going to change the culture overnight; we’re not going to change the culture over a year.

“So what needs to happen in order for the cultural shift to begin? The first thing we identified is that sometimes students don’t necessarily feel that drinking is a problem or that our partying culture is a problem, or when there’s broader impact, some students brush it off and say, ‘You know what, it’s not me; it’s everybody.’

“We decided that it was important to cultivate a sense of social awareness among our peers to really understand, first, why our culture is the way that it is, and second, why it’s problematic and what are the broader impacts.”

Systemic behaviours

“We learn, from a young age, to recognize direct peer pressure,” says Mr. Martinez. “But one of the things our research told us when we were developing this workshop is how much of an impact indirect peer pressure has. And that’s where we get into the systemic behaviours and becoming aware of how your own actions, your own words, have a larger impact on others. So little things like saying, ‘Let’s have a great night tonight!’ can affect another person’s behaviour.”

Your own actions, your own words, have a larger impact on others.

“When you hear ‘Let’s have a great night tonight!’ you want to participate in that. You don’t want to be left out. It can pressure people to drink past their comfort zone. So that was the first focus of our workshop, exploring systemic behaviours and understanding how we can influence our friends, even when we don’t mean to.

“I’ve definitely done that myself. And becoming aware of that behaviour has been crucial to the way I engage with my peers. So, here’s another example: in the past, I’d gladly pour drinks for my friends, and in a subtle kind of way, decide almost for them how much they’re going to be drinking. I’m no longer comfortable doing that, because I really want them to be in control of how much they’re pouring for themselves, and how much they’re drinking.”

Looking out for each other

“A lot of people don’t know the difference between somebody who is passed out and somebody who is experiencing alcohol poisoning,” says Quinn Scarlett, Artsci’19, who helped develop the workshops. “And that’s a public health issue. Period. We educate people on how to spot those differences, and on how to get people out of dangerous situations.” This type of information can assist students to know when to take an intoxicated friend to COR and when they need to go to the hospital.

“We wanted to take a very peer-based approach to the issue,” says Mr. Martinez. “Because when students see the university administration or staff, for instance, promoting safe drinking habits or the health risks that come with binge drinking, it’s almost seen as them just doing their job. And it might go in one ear and out the other.”

One piece of the puzzle

Beth Blackett agrees. “Education is a key piece of the bigger puzzle,” she says, “but it doesn’t automatically follow that education equals behaviour change. For example, we know that fruits and vegetables are good for us, but when presented with fruits or vegetables versus high-sugar, high-fat foods, we tend to like things that taste good rather than those that are good for us.”

And in terms of addressing alcohol use, Ms. Blackett says, “The education piece that some people think would be really valuable, like talking about how alcohol impacts different areas of the brain or the liver, isn’t really as helpful. Students don’t like the long-term, they like being in the moment. “So we actually do something called social norming. We use data from the National College Health Assessment Survey. It gave us an idea of how much – and how often – students actually drink. But we also ask them how much they thought the typical Queen’s student drank.”

“Some people perceive that others drink a lot more, and a lot more often, than they actually do. We’re pretty social beings. We like to be part of the norm; we like to fit in,” says Ms. Blackett

Social norming was built into the workshops for Orientation student leaders, as well as specific tactics that every student can use to help reduce the risk of alcohol-related harms. “We talk about different strategies that make it normal to create safer drinking habits,” says Mr. Martinez. “Anything as simple as getting water for everybody when you’re at the bar, and having snacks and water on hand at home. Simple things that often students don’t think about or don’t act on.”

Sending a message

It can take some effort to change the norms. “Queen’s Residence Life does a really good job of offering alternative, alcohol-free events during Homecoming and St. Patrick’s Day,” says Ms. Blackett. “There can be a concern, because a lot of effort goes into planning those events, and sometimes people worry, ‘What if we hold them and no one attends?’ But when we give the impression that drinking is the only thing to do at an event, then we’re sending that message, ‘This is what you need to do, because there isn’t anything else available.’”

Digging deeper

Quinn Scarlett knows that social norming won’t work on everybody. “When someone says, ‘Oh, did you know your average student only consumes six drinks a night?’ then realistically, someone else going to think, ‘Well, that’s a dumb statistic; those are probably nerds. I’m gonna do ten!’”

Mr. Scarlett knows the reality of life at Queen’s. “People are stressed, all the time. And when you finish your work, on Thursday or Friday, the first thing some people want to do is – not just drink – but get “blackout,” go to the extreme. So we’ve been exploring these questions for the last few years: why does it need to be that way? Why do you need to compensate for an exhausting week with destroying your body? Why is that a pleasure?”

The student club Queen’s For The Boys (QFTB) works to fuel awareness of mental health issues and their relation to substance abuse. The club originated as part of research led by Heather Stuart, Queen’s Bell Canada Mental Health and Anti-Stigma Research Chair, that aimed to reduce risks associated with mental health and substance misuse among first-year male students, and create a more supportive campus environment. (The three-year project, funded by Movember Canada, also ran at two other universities.)

What Mr. Scarlett and his partners in QFTB are trying to do is explore some sensitive topics with their peers. “People are self-medicating,” he says, “men in particularly. Instead of talking about their issues or reaching out to the plethora of resources at Queen’s, they’re going for the bottle first; they’re going for the bong instead. We can’t stop that point-blank. But we want to engage in dialogue and hope that change will come. Because at the end of the day, the desire to change has to come from within. And that’s all we want to do, is to be a catalyst, to give people the understanding that there are better alternatives.”

Learn more about the work being done at Queen’s to address the campus alcohol culture: queensu.ca/studentaffairs/health-and-wellness/alcohol-working-group

[illustration for 'the public health' issue of the Queen's Alumni Review]