(00:00:00) The topic in this hour is drug and alcohol abuse and specifically how communities as a whole can help combat the problem my guest. Dr. James Schaefer director of The Office of Alcohol and Other Drug Abuse Prevention at the University of Minnesota's School of Public Health Jim welcome. It's a pleasure to have you with (00:00:20) us today. Thank you Bob. Nice to be here. (00:00:22) Well, how about the drug and alcohol abuse problem in general? Is it getting better? Is it getting worse and staying about the same over the course of the past several years? (00:00:31) Well, I think that certainly the awareness that people have around the country of the existence of alcohol and drug abuse problems is very very high and that's very encouraging and I think that as the perception of problems goes higher solutions to the problems are going to go the same way that we'll have more and more solutions. I would say that in general that the use of alcohol is down nationally the After consumption has been declining since about nineteen eighty-three use of marijuana and cocaine about the same over the past three or four years the cocaine use in this country peaked about 1982. We've seen a steady decline in actual first use of cocaine, but the number of individuals showing up at treatment centers people having abuse problems. I think in both marijuana and cocaine is is on the increase not only Minnesota, but around the country the alcohol abuse problem appears to be about the same there appears to be a steady 7 to 10% of the population keeps cropping up with serious problems that require some kind of attention (00:01:51) in our area and specifically in Minnesota. I would assume that the biggest problem is alcohol. What about the Other so-called illicit drugs in comparison to other parts of the country. How does Minnesota (00:02:04) fair? We're pretty clean. We do have marijuana cocaine other street drugs, but by comparison to other parts of the country were very very clean alcohol is still the drug of choice in the one that we're trying to be most creative about (00:02:23) but it seems like we still don't really get as tough as we possibly could I mean you look at the Scandinavian countries where somebody who's caught for driving while intoxicated. I mean, they're really terrible things happen to them. What is it? They lose their driving privilege for a long period of time where they get thrown in jail II can't remember quite what it is, but I know that it's real tough and we don't do that (00:02:42) here. Well, I think we're pretty tough. I really do. I think the Scandinavians are quite tough in Norway. For example, there's three weeks of mandatory jail time for conviction of DWI and DWI there is point zero five, which is half of our blood alcohol level 4 Driving while intoxicated they however do not have the kind of sophisticated Continuum of Care and concern about intoxicated people that we do. So we we not only arrest the drunk driver but we attempt to arrest the disease we attempt to to intervene in the disease process and I think that's one of the unique contributions of the American Chemical Dependency systems of the world in Norway. They sure have been tough. They've passed tough laws. They have very very strict authoritarian rules on their highways. You don't you don't drive on their highways without having the the possibility of being stopped for any reason whatsoever by the police authorities. You really consider it a privilege to drive on the highways there. Whereas here we kind of look at it as a right. It's our right to go out and drive and we like to drive. Asked and we like our big cars. I think that there are a lot of cultural differences between two systems. But but frankly, I think that American justice system with respect to issues like drunk driving our are fair and they're tough and it depends on how tough the police want to be. They certainly have the laws and they certainly have the community support to enforce the laws, but there are a lot of other things worrisome things that take the time of cops domestic violence serious crime problems assault and battery all of those things. I think we would like to see a lot more attention paid to and perhaps the actual percentage of time the police spend on alcohol drug problems is waxes and wanes depending on their perception of the community need for solving. These other problems of (00:04:53) crime. Jim Schaefer is with us today in the studio. He is director of The Office of Alcohol and Other Drug abuse. Mention at the school of Public Health at the University of Minnesota. And if you have a question for him about Community response to this problem, you're certainly welcome to give us a call in the Minneapolis st. Paul area 2276 thousand is our phone. Number two two seven six thousand. The lines are all open right now in other parts of Minnesota toll-free 1-800 659 7000 and if you're listening to one of the surrounding states, you can call us directly in the Twin Cities at area code 612 2276 thousand. Let's talk for just a moment Jim about the responsibility of the industry bars restaurants the liquor industry. Where's that fit into this whole picture? (00:05:42) Well, we certainly have a set of laws that pertain to the sale and service of Beverage alcohol those laws, of course have been laid down since prohibition was repealed 1934. These laws are administered Minnesota by the Department of Public Safety in the Bureau of And we have essentially a three-tier system in the state, of course the state control system and then we have a very decentralized system of liquor licensing usually at the city council level and the municipal liquor stores are also another system that was set up back in 1934-35 time frame essentially, they make alcohol available to people and must enforce the liquor laws and regulations and liquor licenses are manually reviewed by City councils throughout the state of Minnesota some 800 communities essentially sitting down and deciding what if any problems are occurring in their city with regard to the licenses that are in existence and it gives the public an opportunity to comment on the problems that perhaps are perceived to be occurring in and around bars and liquor stores. I think. Very caring system of very helpful system. There are areas that we think need to be improved. I think that certainly the sale and serve as a beverage alcohol to minors is a serious problem. Now that they're drinking age has been raised to 21 and the state around the country certainly the willingness and ability of people to intervene and stop illegal sales is a very very significant problem certainly training is needed recognizing false IDs and also recognizing just what if a person that's 21 22 1918. Looks like we need to sharpen skills in that area. Also server training is a very big thing that's coming in server intervention. That is to say Training people who are in the sale and service end to recognize and deal with customers both in a hospitable way, but also in a way that monitors their intoxication and terminate service to people who are obviously intoxicated and who are in danger of injuring themselves and others in the establishment and who one could say it is foreseeable that they might go out on the highway and endanger the lives of others that skill that training is a very important part of the hospitality business these days and we see not only in this statement are other states around the country a great deal of concern by the professional trade associations, the Minnesota license beverage Association, the municipal liquor stores Association Bowlers Association, and so forth where the vast majority of Professionals in the trade come in and have annual conventions. They have educational seminars on on issues of the sort that I'm talking about. So we're seeing in Minnesota and in other other places Tavern League doing a remarkable job of Shoring up the sail and service end of the industry and I think the customers are responding to this in a very favorable way. They tolerate the perhaps inconvenience of having some of their friends cut off. They are receptive to the non-alcoholic drinks that are being promoted. They are receptive to a termination of service and perhaps alternative transportation for patrons these things I think are all indications of the progressive nature of the Upper Midwest and and frankly other parts of the country are following our (00:09:21) lead. We have some folks on the line with questions as we talked with Jim Schaefer today about the community response to alcohol and drug abuse. Go ahead. Please your (00:09:30) first yes so far. It seems you're concentrating mostly on, you know handling the problem after its there and most of literature, you know tends to place emphasis on prevention. Obviously, if you could prevent the drinking all these things wouldn't happen, but it I'd like the question I have to ask as many do with this reading of the literature. It seems that the two main reasons people are involved in drugs and especially alcohol is one for the kind of self medication for dysphoric symptoms depression and anxiety and to just for the experience itself and both those things would be difficult to prevent because somebody might because of a loss of a job and so on has been pointed out and I in range and Farms that were they permit problems happen these people tend to go in the self-medication thing. The third thing is that there may be some physiological reasons. And of course, that's that's something you know that it would be a medical problem is handled with his illness, but I just wonder how much your agreement with the literature I've read that says that the greater part of this is self medication for dysphoric symptoms as a result of deaths my family layoffs things like this. (00:10:46) Mmm, all right Jim. Well, that's certainly leading theory that alcohol is used as a way of reducing anxiety and reducing tension. It's been a preponderant social psychological theory for literally centuries. I don't think there's any question about that, but that's not the only reason why people train people drink and people use other drugs for enjoyment and for having a good time. We tend to think about the social Gathering of men and women and and bars and communities as a kind of a way of socially in socially appropriate way of letting off steam of having a good time of catching up on the latest gossip frankly bars and taverns saloons. Historically have been Gathering points in small communities and in neighborhoods where people get together and meet over a casual drink. I don't think that we're questioning. The appropriate social use of alcohol. I think where we start drawing. The line is one that use becomes abuse and want to abuse becomes obnoxious behavior and life-threatening behavior and violent behavior. And so prevention really is oriented toward the policy end of things establishing individual values around what is and is not appropriate what is and is not appropriate for groups for families for businesses for schools for churches other institutions in the community. And I think that what prevention policy is all about is drawing up a set of values that are agreeable to all of us and that help individuals maintain their sense of what is right and wrong and wherever we have that sense of right and wrong we need to be empowered either individually or in groups to take action where we see things going off the deep end and I think that's what I was illustrating in the bar industry the willingness of establishments who sell and serve Average alcohol under the provisions of current existing law a legal drug are attending to the needs of people who perhaps occasionally get into abuse. And I think that that's part of prevention is creating a social environment where people can have fun within limits and avoid trouble. (00:13:07) Let's move on to another listener who has a question for Jim Shaffer today. Hi, you're on the (00:13:10) air. I was told something by a psychology teacher in high school about 21 years ago that has stuck with me and I want to get your gas could comment on it that in both France and Italy children start drinking wine from about the time are able to hold a cup and yet France has one of the highest alcoholism rates in the world. Whereas Italy has one of the lowest and the difference according to this teacher. Was it an Italy? It is simply not socially acceptable to be drunk. You'd know more be drunk. Then you would walk down the street with your dress. Inside out or something and I'm wondering if if that is true. And if so, do you think that we're moving towards that direction in this country and I'll hang up and listen. Thank you. (00:13:58) Sure. First of all, I don't think that we're moving in that direction in this country. Although the wine industry would like us to move in that direction. There is a sea of wine that is being produced in California New York. And there's essentially an effort to try to Market and merchandize wine in any number of ways trying to break down the availability distribution system that are set up in various states by bills such as we've had in the last several legislators to put wine and grocery stores and so forth, but that's really not your question. Your question is about the the early use of alcohol as a kind of a pump primer for possible alcoholism later in life. I don't think that there's there's very much doubt that The early experience with alcohol in the Mediterranean countries has certainly provided interesting medical and physical questions for us about the ultimate role of that early practice on addiction. We do know that in Italy France Spain and Portugal which is to say essentially the wine drinking countries. The rate of cirrhosis of the liver alcoholic liver disease is the highest in the world it is it is three or four times the rate that it is in this country the per capita consumption in those same countries is certainly very very high the compared to the United States and to many other parts of Northern Europe. As to whether or not these practices are increasing the rate of alcoholism. I think is a serious question. I just don't see it. I have traveled in Europe recently. I was there this summer I've lived in France. I see the rate of alcohol abuse and chemical dependency in those countries at about the same rate as I see it everywhere. I don't think that it is necessarily A causal causal chain from the early onset of the children drinking in the home or I think that actually having kids drink around the table in the hole maybe a healthy practice. They do not get intoxicated in the home and they are less likely when they are teenagers and when they are young adults in peer groups to abuse alcohol as a result of that early inoculation, so I don't see the relationship that your professor saw. I could be mistaken, but it seems to me that the actual significant total consumption of alcohol in France and Italy and Spain and Portugal maybe the underlying problem but actual addiction and actual dependency on the drug is in the neighborhood of 10 to 15 percent of the population in America. We see it in the neighborhood of maybe seven to ten percent of the population. So it's it's perhaps slightly higher but not dramatically so and I don't think that the kids early drinking has an awful lot to do with it. Although that it is certainly a factor (00:17:15) Jim Schaefer is with us today director of The Office of Alcohol and Other Drug Abuse Prevention at the school of Public Health at the University of Minnesota. We have some lines available. If you've got questions to to 76 thousand is the number in the Minneapolis st. Paul area and our toll-free number one 865 29 Evans 004 anybody within the state of Minnesota well to follow up briefly on another comment made by our listener moment ago is restricting availability of wine a good idea. For example, the wine and grocery store bill has failed efforts to have the bars open longer don't get very far in the legislature. If it's to open the liquor stores longer don't get very far. Does that make a difference? (00:18:02) I think it does. I think that there's a certain amount of sense to the control system. But I think that there's a point Beyond which the state control system in the community current control system will not be effective that is to say the laws if they are past will certainly not be (00:18:19) followed. Well a Prohibition (00:18:21) best. Yes. I think that's the classic Model prohibition certainly did work for an awful lot of people it did cut down the the death rate of cirrhosis of the liver and cut down an awful lot of alcohol abuse, but it created more problems than it solves and that's one of the reasons why it was repealed but I would say that the most effective solution to alcohol and drug abuse problems is informal social control. It is informal social control. That's the basic value system of individuals and families. And that's the stuff of prevention. It's essentially getting folks to recognize and deal with the issue and the their perception of the problem the minute you start to get squared away on how you think you ought to behave. Around alcohol and around other drugs and that value system gets formulated and spread among your peer group the quicker you're all going to be better off now clearly. There are people who in some communities where the value system is going to be. We're all for getting drunk and being somebody and that's perhaps where the larger control system needs to step in but frankly the informal control system is probably an informal social control is probably the most effective Ally that we have when it comes to alcohol drugs after all people who get in trouble need help from their peer group need help from the people that love them it is it is that kind of system that the treatment Community motivates to get a person back to being a little bit better as a human (00:20:02) being. Yeah. Let's move on to some more folks with questions here for Jim Shaffer. Hi you're on with him (00:20:07) now. Yeah. I've got a couple. Concerns one is in my life rappers are had an 80-acre farm and when we'd be out there on Sundays. He put a little wine and some water and we'd have a Shirley Temple while other people were having homemade wine with her meal. This was during the time of prohibition and the relationship between alcoholic beverage and food when they are side by side and one enhances, the enjoyment of the other is a thing that a lot of Americans have had a long time discovering the second concern is last week when I had lunch with a friend who is a hey we got talking about this and he said well, you know, some people just have addictive kind of personalities and if crack and cocaine had been around when he was looking for some mood-altering substance. He probably would have gone through that but now he's off alko. Tobacco Etc the third comment, I would enjoy hearing about is what we read in the paper about what vodka does to productivity for example in Russia. (00:21:21) All right, (00:21:22) what does vodka do to productivity in Russia other than make it decline. It seems to me that Russia is has turned the corner on alcohol and they essentially dictated from the top that alcohol was no longer going to be tolerated in Affairs of the state and they also of course have a monopoly system and and essentially for a long period of time did cut down dramatically the availability of vodka through the state stores that affected the people that were in the big cities, but it never affected the farm and so it seems to me that this ultimate prohibition control system as we've seen it evolve. Loving and so the Soviet Union is perhaps going to fail to it's going to fail because the demand is going to continue and in fact, we've seen recently A reversal of the policy to reduce the amount that a particular individual could buy the lines were getting longer and longer and people were not going to work and even even a communist system can't tolerate the lack of work. So it is a very curious and very interesting experiment that we're watching very carefully as to the comments. You were making you're making about drinking during prohibition. I too have heard many stories. In fact, my grandfather told me stories during prohibition. He made bathtub gin and provided a drink for the family a drink for friends during that particular period of time and I think that that was probably a very A socially meaningful in a very important ritual and so we see that alcohol despite the law continues to enter into the lives of individuals and have a meaningful relationship. (00:23:23) Okay, then what about the addictive personality (00:23:25) issue? Well, the the the jury's still out on the real cause of alcohol abuse alcohol addiction. I think that there certainly are some personality profiles that make for people that get into trouble and certainly the fact that alcohol was the drug of choice and continues to be the drug of choice is is something but the fact that the cocaine and other fantastic mood-altering drugs are available and and are being used by an increasing number of people is is something that we're all we also have to watch but but whether it's biochemical whether it's social whether its environmental we don't really The ultimate cause there's certainly a lot of research going on to try to understand it. It's probably going to be an intricate combination of all of the above and to try to find a real solution. I think we still have to go internal. I think we still have to form a value system that puts it in perspective. And I think that most of the prevention policy people the most the people that work in prevention realize that you got to start with yourself and you got to start with a policy and if if there happens to be a biochemical if there happens to be a gene if there happens to be some kind of something that we inherit then we're then we're going to be that much more knowledgeable about it, but we still have to deal with it as human beings and we human beings are social and we're going to see alcohol and and drugs around for a long time to come. So we better learn how to deal with it. (00:24:57) Tim Schafer is with us today and we'll take some more questions from folks who have called in your next. Hello there. (00:25:03) Yeah. Hello, I guess mr. Schaefer just briefly touched on the question. I was going to ask I have a relative that just completed treatment for alcoholism and the genetic inheritance Factor was strongly stressed and that's what I was just going to ask how he feels about genetic inheritance being a major cause of alcoholism. (00:25:31) That's a very interesting question. I've spent some time researching this myself. And of course, I've read many many papers on the topic. Certainly we have very good scientific evidence of the inheritance of alcohol abuse and dependency as shown in studies of adopted twins in this in Scandinavia. There is a very fascinating register of of twins who are born and Researcher by the name of Don Goodwin out of Kansas City studied a good number of those Twins and found that where there the twins had a common parent. That was an alcoholic if one twin lived away from the alcoholic parent that is to say in a non alcoholic family setting he or she developed alcoholism. Now, that's pretty interesting evidence that there's something going on that is not part of the environment that is certainly something biological going on there. We also see an in animal studies the animal model studies that that certain kinds of rats and certain kinds of other experimental animals have offspring that have certain predispositions for drinking very heavily. We see also that almost Three alcoholic family often times will have individuals Offspring Sons and Daughters Grand children that run into alcohol abuse problems studies done at his at the Hazelden Foundation of shown three or four generations of alcoholism pattern showing up. So there's something going on there whether this is purely genetic whether it is a combination of genes and behavior. We don't know but we have pretty clear evidence that if you have a blood relative with serious alcohol drug abuse problems, it is best to be informed and to pass that word on to be very careful and perhaps perhaps avoid use of a beverage Alcohol and Other Drugs because there may be a predisposition. So if you want to be really safe don't use if you do use be aware of your reaction and and perhaps if you find yourself, Able to stop that maybe a clear sign that you have inherited something that you need to deal with. So clearly the leading authorities feel that there is a genetic Factor whether it is able to explain all of the behavior not I don't know I would guess right now maybe 20 25 percent of the variation can be explained by genetics. The rest is all behavior and (00:28:32) environment. It's about a half past the hour now, we're talking with Jim Schaefer director of The Office of Alcohol and Other Drug Abuse Prevention at the University of Minnesota School of Public Health. Our topic is community response to alcohol and drug abuse problems, and you have a question. Go ahead, please your (00:28:48) next gym is less than your last question and answer and I have heard that scanning Scandinavian. People are more susceptible to alcoholism than others other nationalities. I'll hang up and listen for your answer. (00:29:02) Thank you. Well, that's a real hard one because it was probably a Scandinavian that told you that it's really difficult to say if there is any one population that has more propensity for alcohol abuse. We do have some evidence in other parts of the world of the opposite. We know that the Chinese Japanese other members of if we want to call it the Asiatic gene pool tend to have a lower rate of alcohol and drug abuse problems. That's principally we think because of the significant control societal controls an individual controls and an attitude that they have about the use there's also a physiological reaction that many Oriental folks have to beverage alcohol called the Oriental flushing syndrome a very discomfortable kind of reaction. Dysphoria that sets in because of some genetic bio physiological mechanism that they have essentially an enzyme deficiency that does not process alcohol beverage alcohol the way that others do and so that's a kind of built-in protection. So we have a huge maybe even a quarter of the world's population that has a biologically built in protection from abuse addiction. So from that point of view, perhaps the northern European Anglo population may have perhaps a larger propensity for alcohol abuse. We don't know yet certainly more research has to be done on that. But as to whether we could say Scandinavians have larger propensity for it or not. I don't know certainly we know that the Scandinavian Germanic Lutheran Heritage is one where Expression of emotions camaraderie and a lot of outward display of behavior is controlled and it may be that that kind of internalizing that propensity to tough it out might set people up for the use of a drug that relieves them from that felt tension from that point of view. I suppose we could say there might be a behavioral psychological Dimension to the uptight nature of the stoic northerner that might bring about propensity to use a substance but whether or not that clicks into immediate abuse addiction, I would I would doubt it very (00:31:52) much. How about the higher reported instance of alcoholism among American (00:31:57) Indians? Well, that's a very interesting story. I actually actually part of the Search that I was involved in was looking at the very question of American Indian metabolism of alcohol as a possible factor in there and the statistics that we see four or five times the rate of death on the highway due to drunk driving among offspring of seven times the national average for fetal alcohol syndrome fetal alcohol effects due to possible complications of male contribution to fetal alcohol syndrome as well as the heavy drinking of the of the mother during the first trimester, which we know as probably a very significant factor in the development of that syndrome violence and crime in the like is that genetic is that environment from the point of view of the theory that I was mentioning about the Oriental gene pool. We know that American Indians are originally part of the Asiatic gene pool their part of that group that came over maybe 50,000 years ago over the Bering Straits land bridge following big game into this country and then down into South America. They did not over an extremely long period of time did not have beverage alcohol beverage alcohol was a product that was brought in by the missionaries and by the fur trade and by the by the Russian see people with hunting whales and the like so alcohol has been a very recent experience for American Indians that may be a factor that their bodies simply have not adapted to the use of Beverage alcohol in the relatively short period of time the some perhaps 500 years of exposure that may not be enough for a whole race of people to develop the necessary biological enzymatic responses. So that alcohol can be consumed and and voided easily. That's a that's a theory. We don't know if that's that's the case. But certainly the American Indian problem has also been one of disenfranchisement. They have been a society that has had its culture and its roots ripped away from it by the United States government. The institution of the reservation system has been a very incredible force in their lives essentially creating dependency on an outside government for payment and support certainly the kind of freedom and democracy that we that we preach is not practiced on the on the reservations. We have essentially taken the culture in the value system in the spirituality away from these people slowly. They have been gaining it back. My sense is that this loss of cultural roots And disorientation of their cultural value system by the dominant American culture has been as much a factor in alcohol abuse and chemical dependency and American Indians as anything and to the extent that culturally specific prevention and treatment programs are now becoming more and more in with American Indians. They're probably going to get better for (00:35:27) it. All right. Let's move on to some more folks with questions as we continue visiting with Jim Schaffer from the University of Minnesota School of Public Health here on with him (00:35:34) now. Hi, would you please talk about effective prevention strategies used on college (00:35:38) campuses? Well, I thought we had a really effective one until they passed the 21 drinking age and then we couldn't talk to students anymore. So it's really up in the air at this point. I'm being sarcastic. One of the things that we have found to be very effective on college campuses has been peer education programs. We have found that today's youth and by here I'm 44 years old so I can talk about college students as youth young adults young men and women these people are incredibly squared away much more so than I certainly was when I was in college terms of expressing their values and having a good time. And what we have found is that many of them do not warm up to formal lectures formal presentations organized campaigns and the like there are certainly quite a few that will go along with that. But for the most part these have been rather ineffective that is to say the classroom Jason's in the like what we have found to be more successful. We have found great enthusiasm for in social groups fraternities sororities. And on the main campuses is peer-led educational programs that are informal in nature where we essentially have provided training for Motivated student leaders people who have been recruited for their leadership ability to go as college students to dormitories fraternities and sororities to hold open meetings on various topics. Over the past six or seven years we have run on the University of Minnesota system campuses programs of this nature where students talking to students about perceptions of problems solving these problems using mechanisms that the students themselves come up with has been the most effective technique for getting a people to consider drinking responsibility be intervening among their friends and getting help for their friends who are having problems and making stands on things like sexuality gang rape as it relates to intoxicants as it relates to party planning. We've had very successful workshops where a non-alcoholic alternative bar has been a featured aspect of social Gatherings on campus these kinds of things and there maybe eight or nine maybe 15 workshops have been created by students. With students talking to students as peers very effective. We've also seen some warming up to campaigns like project Lifesaver on the University campus. We did have a fair response to project Lifesaver. It was not as well organized on campus as it might have been certainly it was not as well organized as it was as a campaign Statewide. So I would say that if I had money to spend on prevention programming for college students, it would be using the peer education system and peer counseling system. And these are things that we're now beginning to experiment with on not only the University of Minnesota campus. But also on other campuses including the privates (00:39:09) we have about 20 minutes left with Jim Schaefer today and we'll take some more questions for him right now. Hi, you're on with him. Go ahead, (00:39:15) please. I could you please comment on what separates an alcoholic from someone. Moderately uses alcohol say whether how many drinks are we going or what circumstances would actually prove to someone that you've gone over the line and do alcohol abuse? Thank you. (00:39:32) That's a real challenging question. Let me make a stab at it. Essentially the way I look at chemical dependency is if alcohol is being used by you in such a way that you are continuing to use alcohol despite negative social consequences. Then you may have a alcohol problem and you may need some help. Let me explain let's say that you go out once a week once a week you go out to a bar and you have three or four drinks and you go home and the fact that you have been out at a bar causes such a disruption in your family and such a disruption in your life that it is absolutely unlivable that may be defined by your family as an alcohol problem. And you may have to deal with it. Now the way you deal with it may be that you just don't go out that one night a week or you may be able to talk to them about what you get out of going out that one night a week. But you see what I'm talking about. Usually that is not a problem. Usually that solves. I mean that kind that is a problem but it solves itself what we're really talking about when we talk about a chemical dependency problem is where an individual has a compulsion to drink to excess. And that drinking to excess or that drugging to excess and usually we find combination of Alcohol and Other Drugs these days so I have to talk about drugging at the same time. But we're that lifestyle of compulsive use despite negative consequences like notices by people at your job that they are concerned about your drinking problem or that they're concerned about you because you're not the same way. You used to be you're not you're not as creative. You're not as productive. You're not doing your job as well other people are beginning to cover up for you. All of these are negative social consequences complaints by family members complaints by your buddies Joe. Dang it. I don't want you to drive your car tonight because I don't think you can drive it safely. That's a hassle any of those hassles. They start to mount and pretty soon. If you continue to deny that this is a problem. That's the beginnings of a very very serious problem. So to me where abuse becomes dependency is where perhaps on occasion you are abusing substances and the informal social control system around you is working that is to say the informal social control says Joe don't do it and you stop or you slow down that's not dependency dependency is where you continue abusing despite the informal system of controls around you listening to people around you and being willing to talk to others about their alcohol problem is part of this informal social control that I keep referring to (00:42:39) More people with questions for Jim Shaffer. He runs the office of Alcohol and Other Drug Abuse Prevention at the University of Minnesota School of Public Health Alliance are just Jam. So let's keep going high. You're next. (00:42:50) Yes. I'd like to ask more about defining use abuse and amongst peer groups. We're using these terms and any definitions would be very helpful. Thank you. (00:43:02) Sure. As you were asking your question. I thought of the other person's question with regard to the number of drinks. I think that there is a kind of a handy measure of abuse and that is for most individuals. And again, we have to be careful here because bodyweight figures in but but let us say the average individual probably drinking in excess of five drinks in one sitting One session five drinks in excess of that is probably defined by most people as abuse. So let us say we need to talk about an alcohol diet. We know that there is relatively low risk for developing alcohol problems from huge number of statistical studies two drinks a day on average over a lifetime is probably not going to cause chemical dependency two drinks a day. That means 14 drinks a week. (00:44:05) That's a lot that is a (00:44:07) lot by most people's sense of it. But again, I'm quoting statistical studies looking at alcoholism cirrhosis of the liver cardiovascular heart disease cancer as caused by alcohol. We see that for the most part. With a few exceptions two drinks a day is probably not going to expose a person to dependency now clearly if a person is at risk for developing chemical dependency namely a son or daughter of an alcoholic that to drink a day rule is not going to work. We take a very conservative approach we cut the number of drinks per week in half for that low risk level. So we say an average individual probably ought not to drink more than seven drinks a week or eight drinks a week. Which means let us say you go out. Or have people with your home on one night a week or two nights a week. Usually our recommendation is to plan an event or to plan your evening around the social social activity the Sochi ability aspect of it to dissenter alcohol to have alcohol there, but to have lots of choices around so that if an individual is driving or chooses not to drink they feel very comfortable sitting down and enjoying a non-alcoholic drink water coffee D. Alcoholized wind the alcohol I champagne or the alcoholized beer that is the the hostess with the mostess has those choices these days but let's say you start drinking a drink and our up to four drinks. In a given evening is probably what your limit ought to be. So we talked about an alcohol diet. You have a maximum of seven eight drinks no more than four drinks in a given sitting and you're probably going to be okay. You're probably not going to expose yourself to the likelihood of crossing over the border into addiction you're using you're not abusing and you're not likely to become addicted people who drink a lot more than that on occasion are probably exposing themselves to moderate to high risk of developing chemical dependency. (00:46:23) Okay. Do you want to say anything further about that last caller's question on on use abuse peer groups. What do you mean by peer groups? (00:46:31) Well, I think he is raising the question of both the positive nature of peer groups in the negative nature peer groups. We all operate in peer groups. I have peers and go along with my peers and go against my peers. It's a very important social And we Americans have to tune into I think it's a general social phenomenon and certainly going along with the group is something that we have to be willing to deal with if we are uncomfortable if we feel uncomfortable going along with a group. We've got to have the intestinal fortitude to say no and to have ways of saying no the perhaps don't turn the whole party off. If you know, you have reached your personal limit it often times. It's difficult to say no to use that prevention message message and so often times you just have to be very blatant about it and say no I'm doing such and such or I'm I want to I want to go home and have something to eat and I if I have one more drink, I'm not going to enjoy my meal if I have one more drink. I'm not going to enjoy my friend later on tonight. It's that kind of thinking that you have to be willing to get into despite the peer pressure to go along with a crowd to buy that next round to to do that behavior. I think that what we see is a more is more and more willingness to tune into that peer pressure and to perhaps be a leader in the opposite direction saying Let's do such-and-such. Let's not have another drink. (00:48:04) Okay, let's move on to some more folks with questions here. We've got a lot of people waiting and your next hi there. (00:48:10) Hi. I was just wondering if you could address the chemical nicotine in cigarettes smoking and if anything is being done for that because that's probably a serious as some alcohol abuse has and it certainly causes a lot of death and sickness and illness and it's also a social ill and that an amount of money that has to be spent on people who smoke and get heart disease and lung disease and emphysema and all that says wondering if you could address that. I see that as a kind of a bad social issue too. (00:48:39) Okay? Yeah. I'm we're sure dealing with it here in Minnesota unbelievable boy go any other part of the country and any other part of the world and and the fact that you're from, Minnesota. Makes you very uncomfortable because other places in other parts of the world other parts of the US just are not dealing with smoking the way we are we are essentially drawing the wagons around the smokers and creating for them a lot of social discomfort and encouraging them. I think by our actions to quit unlike alcohol. Smokers need to quit there is no such thing as moderate smoking you either smoke or you don't smoke and so the smoke prevention message is to have a policy of no smoke policy smoke-free environments smoke-free environments make for better work and those people who smoke and and who cannot stop smoking need help in quitting and nicotine addiction is one of the toughest addictions to break. It's not a very easy thing. There is there are a lot of quit smoke programs in Minnesota most of them behavioral in nature. There is some research looking into the actual biochemical mechanism, but I dare say that most of the smoke quit programs that work are just simply long-term hammering away at changing behaviors and encouraging people to relax and And a lot of Bio bio feedback and certainly changing some habits around the time when you usually picked up a cigarette and smoke I suppose if there is I have to back off a little bit and say there may well be a socially acceptable smoking time and and historically if you look back several hundred years at the way in which tobacco was used in England and was used in places where the British Empire went smoking after a meal seems to have been the time when the nicotine effect was most pleasurable. Now that may sound rather weird coming from someone who has already indicated that he's against smoking but I suppose that if we could ever get to Simply a a a cigarette after a meal and One cigarette after a meal in a smoking parlor that might be the only socially acceptable smoking that we ought to permit all the rest of it ought to be somehow eliminated and however creative we can be about getting people to quit we ought to (00:51:34) let's take some more questions for Jim Shaffer today. Hi you're on with him now. (00:51:37) Hello. Hi. I'd like to ask also about the abuse versus use question if you've talked about alcohol, but what's the dividing line when you get to some of the other drugs there appears to be some confusion among professionals you talked about a certain recreational use level of alcohol, but with let's say marijuana or cocaine seems to me that a lot of people a lot of professionals and government officials would call use abuse. I wonder if you would comment on that. (00:52:12) Yeah, that's a real naughty problem. Isn't it? I think that we've essentially defined ourselves by the law into saying that use of marijuana use of cocaine use of speed use of illicit drugs in general is abuse. I don't see any other way around the definitional problem. So a person who is smoking marijuana is by that definition already abusing the substance Now by our other definition looking at the social behaviors involved. I think we have another dimension to it. If a person is using marijuana and is not causing discomfort among other people. And is not compulsive about that used to the point where his or her behavior is dramatically affecting or negatively affecting the social aspect of their use then by the definition that we applied to alcohol. We can't really say that that's abuse. Can we when it comes to cocaine? I don't really think that we have a an abuse definition at all. I think that we are are right into if you're using it you're more than likely abusing it. The occasional cocaine user is a rare bird because of the incredibly reinforcing effects of cocaine. We typically find the cocaine user to be using compulsively in to be using as much as they possibly can depending on disposable income. And so when it comes to cocaine, I have not seen any way that we can Define Socially acceptable use of cocaine now. They're probably cocaine users who would disagree but I would say that in my experience and in talking with people who have been abusing cocaine. I don't see any of the sociability aspects of it. It's a rare a rarely used drug in terms of the general drugging culture. It is very attractive euphoric incredible trip that has a very, you know, potentially life-threatening aspects to it and frankly the experimental use is down. So it's in that area of marijuana use in the social aspects of marijuana that I think we have a lot of definitional problems and I agree with you that the government the campaign's that are being organized and I tend to agree agree with them say that any use is abuse and any abuse is probably bad and it's Better to not if you can avoid it is (00:55:09) marijuana use more or less common now than it was say 10 15 years (00:55:12) ago. I think it's more common simply because of the availability. But again, we haven't seen dramatic changes in the last 15 years. Although the the strength the the active ingredient Delta 9 THC has increased that is to say the the actual product that is that is out on the market is probably two or three times stronger than it was back in the 60s and 70s. (00:55:37) We don't have more than a couple of minutes left. Let's take one more brief question. I there (00:55:42) I just tuned in about 30 minutes ago. So I don't know if you've addressed this earlier, but it appears to me and what I've heard that you're using the terms and maybe I'm not clear about it either but the terms of for alcohol addiction alcohol abuse and alcohol problem almost interchangeably, it seems that time could you make us Pacific definition are of those terms. (00:56:09) No because I think you have to be very fluid and flexible on the use of those terms. I think that problems that are human are defined largely in terms of the perception of individuals and people around them about the nature of that problem. So we have to have a lot of different terms that we can use and I don't like to get locked into one particular definition. I think that folks that are using beverage alcohol and then having problems in their Social Circles are moving into the area of abuse now it may or may not be related to the amount of that beverage that they're consuming. It just may simply be a product of the value system where they are living where they exist for example, let's let's take the Muslim culture if we were in a mecha right now and we're using beverage alcohol. By definition we would be abusing it because the Koran forbids it similarly a value system that forbids it any use is going to create a problem. So we have to have the cultural context and the definitions of that cultural context in mind. And so I think that getting into hard definitions is really really difficult. We've got to focus on the behavior first. We've got to realize that the informal social control system is going to help Define that problem and help Define a solution (00:57:39) Jim Schaefer. I'm afraid we have about run out of time. Thank you very much for coming and visiting with us today. (00:57:44) Thank you. Bob has been enjoyable. (00:57:45) Jim Schaefer is director of The Office of Alcohol and Other Drug Abuse Prevention at the University of Minnesota School of Public Health. We had one or two people left on the line. Sorry, we couldn't get to you but unfortunately the clock is an absolute Stern Taskmaster there is enough time to tell you that the weather is going to be nice around Minnesota today and tomorrow highs this afternoon ranging from the 60s North East to the 70s South West partly cloudy tonight and warmer with lows in the upper 40s to Upper. 50s tomorrow warmer still with the winds picking up again and highs tomorrow from the 70s North East to the upper 80s in the southwest do stay tuned. There's more good things to listen to on this station coming right straight ahead. Today's broadcast of midday was made possible by Ka re news 11. This is Bob Potter speaking. In the Minneapolis st. Paul area the forecast calls for a high today in the mid 70s the low tonight in the low to mid 50s and the high tomorrow in the low 80s Skies should be clear right through tomorrow. This is ksjn Minneapolis st. Paul 1330 the news and information service of MPR one o'clock.