Jean Kilbourne Unplugged - Prevention Research Institute

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November 2006
Jean Kilbourne Unplugged
We’ve seen her again and again on the videos in PRIME
for Life, but instructors in Georgia and Indiana had the
opportunity to experience Dr. Jean Kilbourne in person
over the past six months. Instructors in several other
states will have
the opportunity
to meet Jean at
continuing education conferences
throughout 2007
and 2008.
with opportunities for informal chats and to ask
questions during “Coffee with Jean” sessions. She
encouraged participants to become more critical
media viewers and provided empowering suggestions
for countering ads in our own communities and
building awareness of the subconscious messages used in advertising to help lessen
the
impact. “We need to educate people
very specifically about high-risk
choices. Vague slogans such as
‘Drink Responsibly’ do more
harm than good. We need to
be as specific about risks of
high-risk drinking choices as
we have become about heart
disease in recent years.”
Jean Kilbourne
is internationally
recognized for her
work analyzing
and challenging
PRI President Ray Daugherty and Dr. Jean Kilbourne provided interesting insight to instructors at the Savannah, GA continuing education
Jean’s outreach extends to
media images. In
conference.
a variety
PRIME For Life,
of audiJean points out
Jean Kilbourne’s latest book “Can’t Buy My Love” examines
ences including the promises and strategies of advertising.
although the ads may seem harmless and even silly, they
young people.
are a powerful social influence on drinking choices. Jean
“We need to model low-risk behavior for our young
reminds us of the important role instructors play helping
clients become aware of the subconscious and often subtle people. We also need to help them find healthful
ways to be euphoric and joyful, to find positive ways to
messages of the ads so they are better prepared to deal
achieve the things that drugs promise (and sometimes
with how ads influence choices.
even deliver for a short time and then take away).” A
resource list and other info about media images can be
During her opening plenary sessions at the continuing
found on Jean’s website at www.jeankilbourne.com.
education conferences, Dr. Kilbourne shared thoughtprovoking
We thank Jean for the knowledge, grace, and humor she
tidbits about
brings to an important topic and hope instructors, and in
alcohol and
tobacco adver- turn, students, benefit from her important message. PRI
tising and
On the Inside
media images
to deepen
4Author’s Notes
2
instructors’
4New PRI Staff
3
understand4From The Experts
ing of the
4
role of media.
4Ask PRI
5
PRI Master Instructors Lynn Hayes (left) and Mala Pritchard (right) visit Participants
with Dr. Jean Kilbourne during a break.
4Found In Translation
6
were provided
Research Reviews
8
A uthor ’s Notes
Ray Travels Full Circle
PRIME For Life Co-Authors Ray Daugherty
and Terry O’Bryan
I
n the spring of 1971, President Nixon
signed an order establishing alcohol
and drug programs at all overseas
U.S. Army installations for the first time.
This was, of course, during the Vietnam
War and drug use was at unprecedented
levels both in the USA and in the military. I was working at Letterman Army
Hospital in San Francisco at the time in
what the army called a “Social Work/
Psychology Specialist” position. The
unit supervisor had moved me into a
slot where he thought I would be protected from transfers for the remaining
two years of my military term. But one
morning I walked in and was told that
I had one week to get ready to go overseas—they usually gave a 90-day notice,
but this was a priority program and was
in no way typical. They gave each of us
going a list of locations and told us we
could take our pick. One week later I
had moved from San Francisco back to
Kentucky, and was headed on to Camp
Zama in Japan.
I knew little about alcohol and drug prevention and treatment services and neither did any of the rest of the people sent
to set up the first “drug team” in Japan.
I don’t know that it was such a profound
2
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As my career unfolded, I dreamed of
providing alcohol and drug services
to the military. Fortunately, within
three years after Terry and I started
PRI, we had the opportunity to
begin working with the US Army
in both Fort Knox, Kentucky and
Schoefield Barracks, Hawaii with
a variation of the Talking About
Alcohol Program, which later grew
into PRIME for Life. I secretly
hoped that someday the army
would expand their use of PRI’s
services and the program would find its
way to Camp Zama.
Water Wheel that I remembered eating at
all those years ago, so Terry and I went
there for dinner. This is a local landmark
that has great food, traditional Japanese
style, complete with gardens and an
incredible collection of samurai dress
and swords. We had trouble finding the
“
Fast forward to the spring of 2006—35
years later—when that secret hope
became a reality. The U.S. Army did
indeed bring PRIME For Life to Camp
Zama, Japan—and brought us with it!
It is hard to describe the excitement
and satisfaction of going back. A fine
collection of US Army civilian personnel from Japan, Okinawa, Alaska, and
Hawaii—as well as two people from the
US Air Force—came to be trained in
PRIME For Life, and it was a fulfilling
training. One of the real pleasures was
that Bill Castro, who had
brought PRI to the US Army
in Hawaii and has advocated
for its adoption by the Army
ever since, was able to be
at this training—almost 20
years later!
The area around Zama has
changed a lot. There was one
special restaurant called the
It is an honor
I can hardly wrap
my mind around to bring PRIME For Life—our
true life’s work—back
“
experience for the others involved, nor
why it was for me, but the next two
years would leave a mark on the rest of
my life. It was not just a job; it was the
beginning of a career.
to the place where
it all began for me.
place, and we finally went to the police
station for help. No one spoke English
so Terry drew a picture of a water wheel
and samurai, and they figured it out. But
the directions were too complicated, so
the Assistant Police Inspector personally escorted us to the restaurant. When
I told the young woman serving us that I
had eaten there 35 years earlier, she was
amazed and said her mother and grandmother would want to know. It turns out
her grandparents had started the restaurant in 1968 and her mother had been
the one who cooked Terry’s sukiyaki at
our table. They loved the story of how
we got there and showed the drawing to
the guests in the restaurant. After about 45 minutes of bowing,
laughing, and shaking hands, Terry gave them the drawing
which they asked us to sign. What memories!
It is an honor I can hardly wrap my mind around to bring
PRIME For Life—our true life’s work—back to the place
where it all began for me. Had it not been for the Camp Zama
experience in 1971-73, I suppose I would have never entered
the alcohol and drug field…Terry and I would have never
met…there would be no PRI…and there would be no PRIME
for Life. PRI
Linda Martinez attended to numerous details to make the Camp Zama new
instructor training a reality. Bill Castro had the vision to bring PRIME For Life to the
US Army in Hawaii 20 years ago and continues to support its implementation.
N ew PRI Staff
PRI Welcomes Melanie Downs
W
e are pleased to announce that Melanie Downs has
joined the staff of Prevention Research Institute. As
the Kentucky Program Consultant and Trainer, Melanie will be providing support to the network of PRIME For Life
instructors in Kentucky with a focus on instructor development.
Melanie was initially trained in 2003 while a health educator
at Georgia Institute of Technology. She has taught PRIME For
Life to hundreds of college students and DUI clients throughout
the Atlanta area. She has extensive experience teaching college
health classes and facilitating health-related trainings.
Melanie has a background in public health and is a Certified Health Education Specialist. She earned a Bachelors
degree in Psychology at the University of Central Florida
and a Masters degree in Community Health Education at
Florida State University. Prior to joining PRI, Melanie was
the Director of Health Promotion at Georgia Tech where she
chaired the Alcohol and Other Drugs Task Force. She also
worked as a health educator at Florida Atlantic University.
We are excited to have Melanie on board. She can be reached at
859-296-5039 or 1-800-922-9489, and by email at
[email protected]. Welcome Melanie! PRI
November 2006
3
F rom the Experts
Experiencing PRIME For Life
R
eceiving delivery suggestions and coaching often
provokes anxiety, as PRIME For Life instructors
learn in new instructor training. Yet, we also learn it
is a necessary tool for growth and a movement toward excellence. So with a little anxiety, Ejna Mitchell of the PRI
program development team invited Dr. Theresa Moyers to
attend a PRIME For Life DUI group, experience it with
actual DUI offenders, and give PRI staff her suggestions
regarding the program.
Many instructors may recognize Dr. Moyers from her work
in Motivational Interviewing, a technique designed to assist
individuals in making change by exploring and resolving
ambivalence. She is a clinical psychologist at the University of New Mexico and is internationally recognized as an
expert in the topic. PRIME For Life uses approaches consistent with Motivational Interviewing, including the role
of instructor empathy and the management of resistance.
Dr. Moyers admitted she was somewhat reluctant and
pessimistic before attending the DUI group last fall. According to Dr. Moyers, “I was pretty sure I would be frustrated by the same old ineffective instruction and
finger-wagging.”
Yet just as instructors often hear from their participants,
Dr. Moyers’ experience was worthwhile and eye-opening.
After experiencing a group facilitated by Ray Daugherty
and Michelle Ellison, she reported that “I saw an intensive,
two-day educational and experiential program that encompassed the very best that behavioral interventions have to
offer. The instructors were vibrant and knowledgeable. The
curriculum was state of the art, creative and engaging. The
participants, far from slinking in their chairs and sleeping,
E rrata!
W
e hope all instructors have received a copy of
the Instructor Development DVD. The DVD is
intended to give instructors a boost in developing
competency with PRIME For Life. It includes modeling
certain segments and key activities that typically require
special preparation and thorough understanding to deliver
smoothly.
4
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Dr. Theresa Moyers is an internationally recognized expert on Motivational Interviewing
and is a clinical psychologist at the University of New Mexico.
were listening, nodding, writing, and volunteering
information.”
Since her PRIME For Life experience, Dr. Moyers has
agreed to serve as a consultant in the development of the
PRIME For Life Treatment program. “After that experience, I knew I wanted to be part of the team that put
together the treatment program. When I think of the usual
treatment experience of DUI offenders, it is very satisfying
to be working toward a creative and cutting edge intervention that could make a real difference.”
Thank you, Dr. Moyers, for your involvement with PRIME
For Life. We are honored to have you on our team and welcome your contributions. And thank you for reinforcing the
growth that often comes from feedback! PRI
Please note that when Tom “Frosty” Frostman is modeling
the opening values activity, the portion where he is marking
off the last three values was unintentionally edited from
the disc. However, when he describes the activity, all the
steps are included as well as commentary from Ray. We
hope the omission does not cause confusion. Thank you to
Janet Fitzgerald of Smyrna, Georgia, for bringing this to
our attention! PRI
A sk PRI
Answering Questions or Concerns Raised by PRIME For Life Instructors
Q: Last night someone in my class asked, “Can you get
drunk quicker drinking through a straw?” I wasn’t
sure how to respond.
A: Before we address the research, let’s address a persuasion tool. Participants often ask questions like this using
the word “drunk.” When responding, gently reframe the
term “drunk” by replacing it with the word “impaired.”
For example, “Many people wonder if it is possible to get
impaired quicker drinking through a straw.” We want to
reinforce learning that has been established through the impairment section of Preventing where we have learned that
impairment occurs far sooner than being “drunk or high.”
In replying to the specific question, the only reason a
person would get impaired more quickly using a straw is
because the alcohol might be consumed more quickly than
by sipping. It is not the straw, per se, but rather the rate of
consumption which could lead to more impairment.
Several risks are related to drinking through a straw. First,
with rapid consumption, a person may consume much more
alcohol than intended and therefore get more intoxicated
than intended. Second, rapid consumption causes higher
peak blood alcohol levels, resulting in more rapid increases
in tolerance and other brain changes and a more rapid
progression toward Phase 4. In addition, risk for impairment problems and a variety of health problems, including
alcoholism, increases.
This would be a good opportunity to remind groups of the
importance of the “1” in the 0-1-2-3 guidelines. Remember,
the “1” stands for no more than 1 drink per hour to prevent
impairment, and the upper limit of 3 on any day is designed
to prevent health problems. Drinking alcohol quickly
through a straw increases risk for both types of problems.
Q: I heard about the study saying that marijuana may
help prevent Alzheimer’s. How can it help memory if it
also impedes memory?
A: This is a good example of the media reports making an
assertion that does not exist in the article or the reported
findings of the researchers. First, let’s look at the suspected
cause of Alzheimer’s disease. While the mechanism is not
fully understood, the brain loses some capacity to produce
one of its natural neurotransmitters, acetylcholine. This
seems to increase the development of amyloid plaques in
certain sections of the brain related to learning and memory
and impairing those functions. The body’s immune response to these clumps of plaque also causes inflammation
in those regions which seems to create even more problems. Researchers believe that reducing the brain’s production of a substance known as acetylcholinesterase that
metabolizes acetylcholine will raise acetylcholine levels
and slow the progression of Alzheimer’s.
The good news reported in this study is that pure ∆9-THC
seems to significantly reduce the action of acetylcholinesterase. The results in this study from the use of pure
∆9-THC to decrease some potential causes of Alzheimer’s
disease were truly impressive. The researchers state that
they hope that this will give researchers information on
how to create new medicines that will do the same things,
but not have the downside of ∆9-THC—causing impairment from its psychoactive effects..
For our purposes, it is important to note that this study
explored the effects of pure ∆9-THC on inhibiting acetylcholinesterase. However, the media reports jumped from
this exploration of pure ∆9-THC’s effects in mouse brain
cells in a Petri dish to humans smoking marijuana. This
article does not study human marijuana use or its effects
on Alzheimer’s disease at all. In fact, multiple studies have
found that marijuana use in humans impairs short-term
memory, but seems to have little effect—good or bad—on
long-term memory. Alzheimer’s involves the destruction
of both the short-term and long-term memory. It seems that
∆9-THC can help to slow the process of that destruction,
but a person inhaling marijuana smoke or vapors may or
may not ever see that effect. There are multiple substances
in marijuana that may alter the effect of the ∆9-THC in the
human brain. Using marijuana might slow the progression
of Alzheimer’s disease and help maintain long-term memory, but will also decrease the person’s short-term memory.
Thus to answer the question about memory, we do not
know if marijuana use helps long-term memory in humans;
it might or might not, but we do know that it impairs shortterm memory in humans. We do not know, and this article
does not tell us, what smoking marijuana does on the issue
of human Alzheimer’s. We will not know until we examine
the human brains of those who both have Alzheimer’s and
smoke marijuana to those who have Alzheimer’s and do
not smoke marijuana. They will also need to control for
those who do and do not smoke marijuana and do and do
not have a family history of Alzheimer’s disease. It is going
to be a very complex and costly study.
continued page 12
November 2006
5
F ound In Translation
I
t was a great honor and a great responsibility to have
been chosen as the lead translator for PRIME De Por
Vida Versión 8. I was honored to work with Rosa Barron
who was chosen as the lead reviewer. We truly believe we
made a good team. Rosa has over 10 years of experience
teaching PRIME for Life and a unique ability (I call it a
gift) to identify little mistakes and to remember the word(s)
previously used for a particular phrase. I have been translating and interpreting for more than 15 years. According to
Rosa, my ability is to find the words that accurately convey
the meaning.
It was a lot of fun, and funny situations arose almost every
day. Our “I got it!” moments came around at some of the
oddest times. Perhaps it was while we were showering, eating, sleeping, or even talking to other people. For instance,
I might call Rosa who was peacefully sleeping at 2:00 in
the morning and say “I got it!!!” (the word we were looking for) and she would say… “What? WHAT???? Oh great,
but could you have just waited a few more hours to tell
me?????” We both laughed, and I was able to finally go to
sleep, while Rosa, who had been suddenly awakened, could
not.
We will never forget those nights of struggling with that
wonderful world of words—discussion, analysis, search of
terms from one dictionary to another—and a lot of reflecting.
When I “got” a word after hours of research and discussion,
I would say “me quedé hueca,” which means “my brain
is drained.” If Rosa came out with the word we needed, I
would tell her “eres la bestia” (you are the beast), which is
a huge compliment. Often, when we struggled with a term
and could not reach a consensus on the translation, I would
say to Rosa “Think of your class and teach me the concept like I’m a participant.” This worked many times. We
laughed, argued, and learned from our interchanges. Our
conversations usually began with the sharing of something
that happened during the day, an event from our childhood, or something about our family, so our bond deepened
throughout the process.
Rosa and I had never met, so our primary concern was to
develop a rapport and bond between us. A common tendency among people of different nationalities is to say: “That’s
the way we say it in my country.” Rosa and I established
from the beginning that “Spanish is from Spain” and that
the selected terms should be the ones that convey the meaning without altering the material. After all, Ray and Terry
didn’t spend years writing this material for us to change
their way of writing. Most important, we established that
our work was about PRIME and would not reflect egos or
“country flavors,” although the “country flavors” did make
the task more enjoyable. We always considered how instructors from different countries would accept the translation. One of our greatest concerns was their opinions. With
these principles in place, we formed a professional and
personal bond.
What was the process? First, I translated by groups of pages
and emailed them to Rosa. She reviewed and made comments and/or suggestions and returned them to me. Then,
we discussed, analyzed, and reached consensus. Once that
was completed, I met with Frosty [Tom Frostman], the
PRI Spanish project coordinator, on the phone and read the
material in both languages, making sure nothing was missing. Frosty played a critical role in our work. His support,
encouragement and knowledge of the material were invaluable, and his sense of humor was refreshing.
6
by Magally Smith
www.askpri.org
Magally Smith and Rosa Barron, translators for PRIME de Por Vida.
Now, let’s share
some of the most
controversial
words:
Impairment could
be translated as
“incapacidad,” but
it can also be impedimento, deterioro,
daño, afectación or
ineptitud. However
none of these reflect
the
real
meaning in our context as well as “capacidad disminuida.” Since the person
is not really “incapacitada” (incapacitated), but instead the
ability to do something (such as driving) is reduced or decreased for some time, “capacidad disminuida” or “disminucion de capacidad” became the most accurate translation.
Trigger was a real big “I got it!” In many dictionaries that
word translates as gatillo, (which refers to the trigger on
firearms only) or causar, provocar, (to cause, to provoke).
None of those describe the meaning of “trigger level.” We
can’t say “nivel de provocar” or “nivel de causar,” (level of
provoke or cause), but if we think about it, what is really
happening is an unchaining of events or reactions, which is
what “desencadenar” is in Spanish “to unchain, to trigger,
to unleash.” Voilà! “Nivel de desencadenamiento” it is.
And last, but not least: Withdrawal which translates
among other things, to “desprendimiento (emocional),” “retiro o extraccion de fondos,” “síndrome de abstinencia,” or
“retraimiento (social).” None of these words fits satisfactorily. The term “aislamiento” is isolation and insulation, but
it is also: “on one’s own, alone,” which is the experience of
the body attempting to adjust and function without alcohol
or drugs. Thus, “aislamiento,” either emotional or physical,
became the best translation.
There were countless experiences that left us with a great
sense of accomplishment, both professionally and personally. We hope that each instructor who teaches the Spanish
version benefits and finds that it makes their jobs easier.
Perhaps one day we can gather to share the wonderful
experiences of translating PRIME for Life and discuss specific words and why they were selected. Until then, happy
teaching.
By the way, as usual, Rosa and I reached consensus on this
article! PRI
S panish Materials Completed
A
ll PRIME For Life Version 8 materials are now
available in Spanish, including the instructor
manual, participant workbooks and program DVD
discs. PRI has distributed Spanish materials to instructors
who indicated they delivered PRIME For Life to Spanish
groups. If you would like Spanish materials, please call us
at 800-922-9489 or email Maggie at [email protected].
A
hora todos los materiales de la Versión 8 PRIME
De Por Vida están disponibles en español, incluyendo el manual del instructor, el cuaderno de
trabajo del participante y el programa en discos DVD. PRI
distribuyó los materiales en español a los instructores que
dijeron que enseñaban PRIME De Por Vida a grupos que
hablan español. Si usted desea obtener los materiales en
español, por favor llámenos al 800-922-9489 o envíe un
email a Maggie al correo electrónico [email protected]
November 2006
7
D rug Research
Copersino, M., Boyd, S., Tashkin, D., Huestis, M., Heishman, S., Dermand, J., Simmons, M., & Gorelick, D. (2006).
Cannabis withdrawal among non-treatment-seeking adult cannabis users. The American Journal on
Addictions, 15, 8-14.
Purpose
Approximately 10% of
people ever using cannabis become dependent, a rate similar to
the rate of alcoholism among drinkers.
Cannabis dependence
is a recognized diagnosis in the DSM-IV
and in the International
Classification of
Diseases-10 [ICD-10]
PRIME For Life Research Analyst Allan Barger
used in Canada and
Europe. Drug dependence in the DSM may
include a substance-specific withdrawal syndrome made
up of several features:
• the onset of distress after ending substance use;
• re-using that substance or similar substances to
relieve or prevent withdrawal symptoms;
• co-occurring, multiple symptoms across a consistent time course;
• and symptoms potent enough to motivate the person into relief-seeking activity.
Both the DSM and the ICD report cannabis withdrawal,
but neither describe it or give guidance to define its presence. This study examines non-treatment-seeking adults
to determine if they experience clinically significant
withdrawal symptoms when trying to halt cannabis
use.
Method
A 176-item Marijuana Quit Questionnaire was given to
104 cannabis-using adults aged 21 to 60 with a mean age
of 35 already enrolled in two studies examining health outcomes of cannabis use. None were in or seeking treatment,
taking prescription medications, or had any other substance abuse or dependence diagnosis except for nicotine.
All were former and current users of cannabis as their primary substance of choice. All reported at least one serious
attempt to quit using cannabis that did not involve formal
treatment. The group was 52% white and 78% male
which is a lower percentage of whites and a higher percentage of males than in the general cannabis-using U.S.
population. While all persons studied had been regular
cannabis users at some point, 78% of the group members
were current cannabis users. Statistical analysis was done
using the SPSS data analysis program with the two-tailed
alpha level set at 0.05.
Results
• The group averaged 3.3 joints per day with an
individual range from 1 to 24 joints per day when
using.
• Subjects averaged 3.9 serious attempts to quit using cannabis with an average duration of quitting
for 146 days (4-5 months).
• Statistical data analysis found two significant
symptom clusters: A psychological withdrawal
cluster— anxiety, difficulty sleeping, depression,
irritability, and boredom—and a physical withdrawal cluster—general discomfort, tremor or
shakiness, muscle twitches, nausea, vomiting, diarrhea and upset stomach.
• Most subjects (89%) experienced at least one
withdrawal symptom, 81% reported two or more
symptoms, and 49% reported 4 or more symptoms.
• The three most common symptoms were craving
for cannabis reported by 66%, followed by irritability (48%) and boredom (45%).
• While physical withdrawal symptoms were relatively rare, they began 1-3 days after last cannabis
use and ended 2 -19 days later.
• Psychological symptoms typically started after and
lasted longer than physical symptoms, beginning 210 days after last cannabis use and ending 5 weeks
to one year later.
continued page 10
8
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A lcohol Research
Duncan, A. E., Scherrer, J., Fu, Q., Bucholz, K. K., Heath, A. C., True, W. R., Haber, J. R., Howell, D., & Jacob,
T. (2006). Exposure to paternal alcoholism does not predict development of alcohol-use disorders in offspring:
evidence from an offspring-of-twins study. Journal of Studies on Alcohol, 67, 649-656.
Background
Several previous studies (half
sibling, adoption
and twin) suggest
that being raised
in a home with a
parent with alcoholism does not
seem to increase
risk for developing alcoholism
as adults. These
PRIME For Life Research Analyst Mark Nason
studies, however,
have not examined the risk for alcohol use disorders in
adolescence.
Purpose
This study examines whether children raised by a
father in remission for alcohol dependence are less likely to develop an alcohol disorder during adolescence
or young adulthood, as compared to children raised by
alcohol-dependent fathers who were not in remission.
Sample and Methods
877 offspring (ages 12-26) of male twins from the Vietnam
Era Twin registry and their 512 fathers and 507 mothers
were interviewed via telephone in 1999. These computerassisted interviews included use of the Semi-Structured
Assessment for the Genetics of Alcoholism to determine
DSM-IV diagnoses for alcohol and drug use disorders,
major depression, childhood conduct disorder, oppositional and defiant disorder, and anxiety disorders in the
offspring. The twins (fathers and uncles of the offspring)
were administered an adaptation of the Lifetime Drinking
History questionnaire to determine their drinking and
symptom status during the first twelve years of their
offspring’s lives. In addition to the diagnostic interview,
mothers were asked about substance use during pregnancy
and information about family background and child-rearing practices.
Data for the offspring were compared based on the following groupings:
• Group 1—exposed: fathers were determined to
have had alcohol dependence sometime in their
lives (based on DSM-III-R; assessed in 1992), and
who were not in remission during all of the first 12
years of the youth’s lives. Fathers were involved
with rearing their children but did not necessarily
live in the same household.
• Group 1—unexposed: fathers were in remission for
alcohol dependence during the first 12 years of the
youth’s lives.
• Group 2: fathers did not have alcohol dependence,
but their fathers had an identical twin brother with
alcohol dependence.
• Group 3: fathers did not have alcohol dependence,
but their fathers had a fraternal twin brother with
alcohol dependence.
• Group 4 (controls): offspring of randomly chosen
fathers without alcohol dependence and whose
twin brothers did not have alcohol dependence.
Statistical Analysis
STATA, Version 8 was used for data analysis, along with
Pearson chi-square statistic for univariate analysis. Cox
proportional hazards models were used for multivariate
regression. A number of offspring and parental characteristics were examined to see if they were potential confounders. Characteristics assessed for the youth included
gender, age at interview and evidence of conduct disorder,
major depression, and marijuana abuse and dependence.
Variables assessed for the fathers included employment
status, race, education, antisocial personality disorder, drug
abuse or dependence and major depression. For mothers,
alcohol abuse or dependence, major depression and antisocial personality disorder symptoms were assessed.
Major Results
• The offspring who lived with their fathers with active alcohol dependence (Group 1—exposed) were
more likely to have used alcohol and marijuana at
continued page 11
November 2006
9
Drug Research from page 8
• Fifty-six percent of those reporting withdrawal
symptoms took action to relieve them.
• The most common action taken to relieve symptoms was substance use (77% of those taking some
action) involving one or more uses of alcohol
(25%), tobacco (23%), tranquilizers (23%), or
resumption of cannabis use (19%).
Limitations as Noted by Authors
This is a relatively small sample of people giving retrospective data, but there was no consequence, positive or
negative, for accuracy, and participants had no reason to be
dishonest. Still, memory cannot be fully trusted in reports
of past experiences. This non-treatment sample may have
experienced less severe symptoms than would be found in
a treatment group and thus this data may not generalize to
those in treatment.
Author’s Conclusions
“The findings provide evidence for the clinical significance of cannabis withdrawal.” The fact that 19% of a
non-treatment sample reinstated cannabis use to cope with
symptoms suggests that cannabis withdrawal contributes
to relapse among those planning to halt cannabis use.
Furthermore, the co-occurrence of multiple symptoms
within a specified timeframe for which subjects sought
relief by various activities—substance use, exercise, meditation, and others—suggests a definable cannabis withdrawal syndrome. Further studies are needed with nontreatment and treatment populations to determine if a cannabis withdrawal syndrome should be included in future
revisions of the DSM or ICD.
Implications for Risk Reduction Instructors
PRIME For Life states in Phase 4 that cannabis can be
addictive, including loss of control. Part of that assertion
is based on research with those in treatment for cannabis
dependence experiencing withdrawal symptoms, a sign of
physiological dependence. This article complements those
findings with a study of adults who are regular cannabis
users not in treatment. Because all group members had
attempted to quit cannabis at least once, yet most group
members (78%) were still using, a significant number
of them had failed to quit. Using more than intended or
failing to stop or cut down when desired are diagnostic
criteria for drug dependence in the DSM-IV. These data
suggest that cannabis withdrawal occurs in non-treatment,
cannabis-using groups and has power to create clinically
10
www.askpri.org
significant symptoms that contribute to relapse.
This article makes a distinction between relatively rare
physical symptoms—tremor, muscle twitch, nausea—compared to more common psychological symptoms—boredom, anxiety, irritability and depression. The most common symptom, craving for cannabis, was considered
neither physical nor psychological but as a motivational
symptom. Among those who favor or promote marijuana
use, much is made of its being “only” psychologically
addictive but not physically addictive. There is an important issue here.
PRIME For Life presenters should be aware that current
research is rapidly erasing the line between physical and
psychological dependence. Just as drug euphoria is a direct
result of the drug’s action on the brain, the psychological
withdrawal events result from the brain’s physical response
to the drug’s absence. Thus, “psychological” withdrawal
symptoms such as anxiety, irritability and depression,
while often felt as emotional states, actually arise from
altered brain biology, that is, they are a part of physical
withdrawal. Craving is both biological and psychological
in a complex array of brain responses to a changed environment – the accustomed drug is missing and the brain
is both seeking it and readjusting to its absence. What is
characterized as “physical” withdrawal is usually defined
by symptoms in the body, e.g. muscle twitch or nausea.
Newer research clarifies that “psychological” withdrawal
symptoms are often in fact the brain’s physical withdrawal.
Note also that while the body’s physical symptoms generally resolved in a few days to a few weeks, the “psychological” brain symptoms persisted for a period of months
and were the ones most associated with relapse to cannabis
use or the use of other substances to relieve the withdrawal. Thus, the so-called psychological symptoms may
be the most important to consider in what actually leads to
relapse. In Phase 4 we learned that loss of control is a key
indicator of addiction. If someone cannot stop their marijuana use because of these psychological symptoms based
in the brain then this is contributing to loss of control.
Marijuana’s power to create loss of control and relapse
into use is typically underestimated by the public. As occasions arise, we have the opportunity to gently help those
dealing with these brain symptoms to see that it is problematic in its own right and is an indicator that they are at
least in Phase 3 and possibly in Phase 4. PRI
Alcohol Research from page 9
some time in their lives compared to controls and
to offspring who lived with their fathers in remission (Group 1—unexposed). [This might be partially explained by the Group 1—exposed youth being
somewhat younger than Group 1—unexposed.]
• Offspring who lived with fathers with drug abuse
or dependence diagnoses were less likely to have
alcohol dependence compared to controls.
• Although the highest rat for alcohol dependence
was among those who lived with their fathers with
active alcohol dependence (Group 1—exposed)
and the lowest was among the control group, no
statistically significant differences were found
between the groups in rates of alcohol dependence
and alcohol abuse/dependence.
• In both groups of offspring with fathers with
alcohol dependence, the mothers had higher rates
of current alcohol abuse or dependence than did
the controls, although the findings were not quite
statistically significant.
• After controlling for potential confounders, listed
under “statistical analysis” above, the offspring
who lived with their fathers with active alcohol
dependence (Group 1—exposed) had a statistically
significant greater likelihood of developing alcohol
abuse or dependence as compared to the control
group. The offspring who lived with their fathers
in remission (Group 1—unexposed) had nearly the
same increased likelihood of developing alcohol
abuse or dependence as compared to the control
group. Though this difference was not quite statistically significant, the researchers believe this was
likely due to the unexposed group having much
smaller numbers than the exposed group.
Authors’ Conclusions
Contrary to what the authors expected, they concluded
“although we found some increased risk for alcoholism
in offspring exposed to alcoholic fathers as compared
with controls, the lack of differences between offspring
of alcoholics who were either exposed or unexposed to
paternal alcoholism in the first 12 years of life indicate
that the increased risk may be due to genetic influences.
Of the other variables related to comorbid psychopathol-
ogy in fathers and offspring, maternal psychiatric status,
and sociodemographics examined, only paternal illicit drug
abuse or dependence influenced the effect of paternal alcoholism exposure.”
Limitations Noted by Authors
Many of the youth had not yet reached young adulthood,
so the results might be different if a longer period of exposure occurs and more of the sample become young adults.
The youth in Group 1—exposed were not asked about
whether or not they had observed their fathers’ drinking,
so some of the fathers might have hidden their heavier
drinking. Some of the fathers might not have accurately
remembered their drinking history and/or when they quit
having symptoms. The final sample of fathers excluded
30% of the original sample who were inconsistent in
reporting symptoms which could have influenced the findings. The mothers’ alcohol dependence status during the
first 12 years of their children’s lives was unknown. The
research protocol included the requirement that only youth
whose mothers granted permission would be interviewed.
The mothers with a history of alcohol dependence might
have been less likely to grant permission to interview their
children.
Reviewer’s Comments
As is true with all research, this study has a number of
strengths and limitations. The fact that the results were
different from what the researchers expected and that
studies (with adults) using very different methodologies
have come to the same basic conclusion adds a significant
degree of credibility to the results.
As several other studies have suggested, this study indicates that the risk for developing alcohol dependence is
influenced by biology more than is the risk for developing
alcohol abuse.
This study (and similar ones) does not indicate that parents’ behaviors do not influence their children’s choices.
Some children will not drink or drink less because they
experienced what high-risk drinking can do to a family.
[Previous research suggests that when youth perceive their
parents to have a drinking problem they are more likely
to abstain or drink little than if they do not perceive their
parents to have a drinking problem.] Others might be
more likely to drink because of the easy availability and
modeling by the father. The mothers’ drinking choices and
continued page 14
November 2006
11
Ask PRI from page 5
In addition, the other risky effects of marijuana—the
potential for impairment problems, its impact on shortterm memory, executive function and potential for addiction—remain unchanged. Unfortunately, the message the
public has gotten from this poor reporting of the facts is
that marijuana is harmless and beneficial. It is not harmless and the benefits of marijuana are, as of yet, unknown
except that smoked marijuana can decrease nausea and
increase appetite. We do not even know for certain if whole
marijuana reduces inflammation.
It is interesting to note that George Koob, one of the chief
researchers in this study, also published a textbook this
year called Neurobiology of Addiction in which he devotes
an entire chapter to more fully understanding and defining
the nature of cannabis addiction. Thus, the media reports a
potential benefit while ignoring reports on known risks.
Q: Do you have any advice for working with low-level
readers?
A: We can check if we have low-level readers in our groups
by asking whether anyone has difficulty reading. Stating
that sometimes people are intimidated by reading or have
vision problems takes away from embarrassment or shame
a student may feel in not being able to read or read well.
Invite them to speak with us during the first break to discuss how we will proceed for the class.
Start by asking the nonreaders if they want to work with
another participant or if they want us (instructors) to work
with them. Usually they choose the person next to them. On
occasion it may be necessary for us to be their partner for
all the activities.
For any activity that requires the participant to read or
write, it is helpful for the instructor to read the questions or
statements aloud so nonreaders or those who have difficulty
can follow along. For the card activity (after The Toll, The
Tears video), the instructor can hold the cards and ask each
participant a question.
If we know there are low-level readers, then we can define
words along the way. Some of this is already done in the
manual. Sometimes it is necessary to modify more. Our
students will appreciate the extra effort.
12
www.askpri.org
Q: Could you please clarify the correct answer to #6 in
“Understanding the 1-2-3 guidelines” on page 25 of the
participant workbook? Also, please explain the reason
why it is within the low-risk range.
A: This activity tests participants’ understanding of the
1-2-3 guidelines. The instructor leads the group in a review
of the largest amount considered to be low risk in one week
(14) and in one day (3). To process, read the questions
aloud to the group and pause for a response. After they
respond, ask why or why not for each question.
The correct responses are:
1. No. It is more than 3 drinks on one day.
2. Yes. It is not more than 14 drinks in a week and no
more than 2 drinks per day.
3. No. It is more than 3 drinks on one day.
4. No. It is more than 3 drinks on one day.
5. No. It is more than 14 drinks in a week.
6. Yes. It is not more than 3 drinks on one day and no
more than 14 drinks in a week.
Q: How long does THC stay in the blood?
A: When marijuana is smoked or inhaled from a vaporizer, THC peaks in the blood in a matter of 7-8 minutes
and stays in the blood 2-4 hours. With alcohol, impairment
follows the blood levels. That is, as BAL goes up and then
down, impairment goes up and then down. THC impairment is different. It can be increasing even as THC blood
levels are dropping. This is because THC goes into lipids
(fats) while alcohol is diluted in the body water. The brain
is rich in lipids, and therefore the level of THC is increasing in the brain, while the levels in the blood are falling.
This question may arise when students hear the research
showing a 6.6x increased risk of causing a fatal crash under
the influence of marijuana. Some in our groups may believe
that the drivers were not impaired at the time of their
crashes or that the THC was “left over” from smoking days
ago. The researchers were careful to control for these and
other factors. They measured THC alone, not carboxy-THC
which is also in the blood but is not impairing. In addition, they did not use blood samples that were more than
one hour old, so all participants had marijuana blood levels
indicating impairment at the time of the crash in which
they died. The study was carefully conducted to reach these
conclusions about THC impairment. PRI
To
M a r k e t , To M a r k e t
N
eed to market
PRIME For
Life in your
community? We have
two brochures available which briefly
describe the program
to assist you in your efforts. The Universal brochure can be distributed
to decision makers at
schools and other agencies who are considering
a program for a more universal prevention audience. The Indicated brochure
is
intended for judges and other decision makers involved in
agencies needing programming for indicated audiences or
P FL
those already making high-risk choices.
The four-color brochures address basic questions about
PRIME for Life including target audiences and program
effectiveness. We hope the brochures will be a worthwhile
tool to motivate people to contact instructors or PRI to
learn more about the programs.
There is no charge to instructors for the brochures which
can be downloaded at http://askpri.org/materials.asp.
Instructors may also call PRI at 1-800-922-9489 or email
[email protected] to order. Please indicate which brochure and the quantity you need. PRI
for Parents
P
RI is pleased to announce that PRIME For Life for Parents is now downloadable for instructors who teach parent
groups or those who would like to begin teaching parent groups. Log onto the instructor website, click the Materials tab, then click Parent Materials. You will see several
documents including:
•
Parent Program Syllabus
•
Starting PRIME For Life for Parents
•
Starting PRIME For Life PowerPoint
•
Protecting for Parents
•
Protecting for Parents PowerPoint
•
Parent Handout Packet
Additionally, we have a tab titled “Parents” on the PRI general
site (http://www.askpri.org/) for parents who have attended the
PRIME For Life program. A Guide For Talking With Your Teenager will provide more information about talking to teenagers about alcohol and drugs.
PRI
November 2006
13
Alcohol Research from page 11
responses to the fathers’ drinking would also likely influence their children’s drinking choices. It is not uncommon
for children within the same family to be influenced differently. Importantly, parental behaviors are just one of many
social influences on drinking.
The influence of fathers’ active alcohol dependence on
their children’s risk for alcohol dependence will be even
clearer as the youth age.
ences on drinking choices and the eventual development of
alcohol dependence, but biology also clearly plays a major
role in affecting who will develop alcohol dependence. Of
the factors within the family, biology seems to be the best
predictor of increased risk for developing alcohol dependence in adolescence and adulthood. PRI
Implications for PRIME For Life Instructors
The findings from this study strengthen the conclusion
from adoption research that alcoholism runs in families
more because of biology than the social influences of the
parents.
There is no question that social factors are strong influ-
C EU Corner
F
or decades there has been confusion in the world of
continuing education about how to award credit and
how to define it. PRI has chosen to adopt the definition of the founder and caretaker of the CEU (continuing
education unit), namely, IACET (International Association
for Continuing Education and Training). PRI was one of
the first Authorized Providers of CEUs under IACET, and
for the past two years, I have served as Chair of the IACET
Commission which is the body that reviews Authorized
Provider applications and conducts site visits as part of the
review process.
IACET, for whatever reason, decided to define 1 CEU as
10 contact hours of continuing education. So please keep in
mind there is no difference between 1 CEU and 10 contact
hours, sometimes referred to as professional hours (yet
another term that different organizations use to refer to the
14
www.askpri.org
By Tom “Frosty” Frostman
same credit). Rest assured, when a new instructor receives
3.2 CEUs for completing a four-day PRIME For Life
instructor workshop, they are, at the same time, getting 32
contact hours.
Now, what we cannot assure anyone is that our CEUs will
count toward a particular certification or accreditation goal.
It is up to each instructor to check that out for him/herself.
We simply have no control over who will accept PRI CEUs
and who will not, but IACET CEUs are the standard of the
industry. We award CEUs with our educational programs as
a service to our instructors and hope they can benefit from
same.
Whether instructors think of the credit they have earned
as CEUs or contact hours, PRI knows they are all most
deserving for the time and effort put forth to earn it. PRI
R e a c h i n g Yo u r S t u d e n t s
S
ometimes it is easy to feel disconnected as an
instructor. We have this great experience leading a
group, but we may not have the opportunity to share
the experience with other instructors. We invite you to share
those PRIME moments with us—those moments leading
a group that we never forget—those moments that keep us
doing this work.
Share your Prime For Life moments
Share your PRIME Moments with us. We may feature them
in the newsletter, website, or continuing education workshop.
The following letter was written by a student as part of the
closing letter-writing activity. Thanks to Nadine Blyseth, a
Georgia instructor, for sharing one of her PRIME For Life
moments.
Tell us what keeps you motivated to teach. Is there a story
from your groups that particularly touched you? Is there a
segment in PRIME For Life that especially speaks to you?
Dear Mary Jane,
I’m not quite sure how to say this but I don’t think we should
see each other anymore. Please understand that I never
meant to hurt you but this relationship is just not good for me.
You know that I love you and probably always will, but I’m not
in love with you anymore. My family never sees me, my job
has become secondary, and the stress is killing me. I know
that there are still plenty of people out there who need the
kind of comfort & solace only you can give but it’s time for me
to move on. You are a fine lady and I’m sure I will miss you
greatly, but this has to be the end. Please forgive me.
Love Always,
xxxxxx
A
s PRI continues to provide ongoing instructor
support, we will increasingly use email as a
communications tool. Please take a moment to ensure
that PRI staff have been added to your safe senders list
so that you receive future information.
November 2006
15
T raining Schedule
New Instructor Training
Many new instructor trainings are for state residents only. Please call PRI if you are interested in attending an out-of-state training. Training
dates and locations are subject to change. Please call PRI to confirm.
1/23-1/26/2007
Indianapolis, IN
7/16-19/2007
Duluth, GA
2/19-2/22/2007
Lexington, KY
7/24-27/2007
Indianapolis, IN
3/12-15/2007
Portsmouth, NH
7/30-8/2/2007
TBA, Maine
4/16-19/2007
Georgia
8/13-16/2007
Covington, KY
4/23-26/2007
Columbia, SC
10/22-25/2007
Richmond, KY
5/1-5/4/2997
St. George, UT
10/23-26/2007
Carmel, IN
5/14-17/2007
Richmond, KY
10/30-11/2/2007
Park City, UT
6/18-21/2007
Iowa City, IA
11/12-/15/2007
Ankeny, IA
6/25-28/2007
Mandan, ND
PRI is an Authorized Provider of
continuing education and training
programs by the International
Association for Continuing
Education and Training.
Continuing Education
PRI regularly conducts continuing
education opportunities for trained
PRI instructors. A current schedule
of continuing education events can
be found at www.askpri.org.
PRIME TIMES is published by Prevention Research Institute, Inc.,
841 Corporate Drive, Suite 300, Lexington, Kentucky 40503
859-223-3392. Send correspondence to Jill Crouch at [email protected]
Copyright 2006 by Prevention Research Institute
prime times
times
prime
a newsletter from Prevention Research Institute
a newsletter from Prevention Research Institute
www.askpri.org
November 2006
Prevention Research Institute, Inc.
841 Corporate Dr., Suite 300
Lexington, KY 40503
RETURN SERVICE REQUESTED
www.askpri.org
February 2005