Prevention Profiles: Take Five - Dr. Michael McNeil (Chief of Administration for Columbia Health)

Rich Lucey:  Hi, this is Rich Lucey and the Drug Enforcement Administration’s Community Outreach and Prevention Support Section and I welcome you to this episode of our podcast series, "Prevention Profiles: Take Five."

I’m excited about today’s guest, who I’ve known for quite a while throughout my career and I want to introduce you to Michael McNeil.

And let me tell you a little bit about Michael before we get started.

Dr. Michael McNeil is the Chief of Administration for Columbia Health, Adjunct Assistant Professor of Socio-Medical Sciences at the Mailman School of Public Health and Program Director for the Registered Opioid Overdose Prevention Program at Columbia University.

He also is a co-investigator, both of Columbia’s Opioid Research Grants to understand and evaluate opioid education and Naloxone training on campus, which is funded as a collaborative and multidisciplinary pilot research award through support from the National Institutes of Health.

Prior to his current role, Michael led health promotion offices at three campuses, including Alice! Health Promotion at Columbia University.

Michael holds a Doctorate in higher education leadership, a Master’s Degree in health education.

He is a certified health education specialist and he is a Fellow of the American College Health Association.

With that introduction, Michael, welcome to the podcast.
 
Dr. Michael McNeil: Thanks very much, pleasure to be here.

Lucey: Absolutely.

So, we’re going to jump right into our first question and it might sound familiar to our listeners, because I actually asked this same question of a mutual colleague of ours some time ago, Joan Masters.

You started your career in drug misuse prevention among college students first as a student trustee for the Bacchus Network.

And then moving into the professional ranks with health promotion efforts at a number of college campuses.

So Michael, what was different about working on the drug misuse prevention issue as a professional after several years of looking at is a, from a student’s perspective?
 
McNeil: So it really shifted for me, seeing things versus a student, then as a professional.

You know, as a student I had this kind of a well-meaning drive to support my peers in healthier decision making, but I didn’t necessarily understand all of the science behind the work.

I really, initially bought into the “if you help one, you’ve made … it’s all worth it” and I’ve learned that you can’t give up at just helping one; it’s a much bigger piece and there’s a lot of science behind this work that not every student understood.

And, and I really didn’t fully see that until I completed my, you know, advanced studies and transitioned into the professional world.

I can say, though, looking back that as a professional, when people say kind of what’s happening on campus, what’s the conversation about substances, my response now is always let’s talk to our students, right.

It needs to be a partnership and being on both sides of it really helped  me understand how students and administrators, faculty, etcetera on a campus can really come together, to learn from each other and figure out best how to address issues in their community.

I think I also learned that each community’s top issues are going to be a little bit different and the, you know, the topic of conversation on one campus may not have relevance on another, so we should be really careful not to just straight-up replicate what other people are doing, but work student and, and staff together to figure out what matters on our individual campuses.

Lucey: So I, I’m going to, to presume that students can be obviously a bit more outspoken than professionals can at times.

And you’re working with students now, in your previous roles as a leading health promotion efforts on campus, your current role, as you work with peers, is part of what you work with them on helping them find their voice as a peer educator, so that they, they can be, you know, vocal about the issue and what’s important to them?
 
McNeil: Absolutely.

There really is a piece about helping students learn, grow, develop, how to be more affective advocates.

You know, I think part of it is having that internal drive and that’s fantastic and you want to nurture that, but it’s also helping people understand how things get done and how systems work and why there are times when people are like, why doesn’t somebody just do something, help?

That’s such an educational moment to help students understand that sometimes issues aren’t as simple as they may appear on the surface.

And that, you know, that’s something you may not know when you’re a student, for example, whereas you transition to the kind of administrative side, you learn like wow, there’s this whole system piece and, and moving the system is a part of making those positive changes in a community.

But you … I find that you really need to help students figure out how to channel that voice and, and very carefully do so, so as to not present a scenario where it seems like you’re trying to suppress the voice.

Lucey: I also have to imagine that it’s difficult … I appreciate what you said about, you know, when, when you were a student and, and working on helping to support your peers, that you didn’t fully understand prevention science at that time.

And I would imagine that one of the challenges now and I certainly face this when I’m talking to our interns or young people around the country, is, is trying to gather up all the years of experience and education that we have in this field and, and getting students to understand science, the science of prevention while also really trying to get their input into programming, even though it kind of runs counter to the science.

So they might want to do the crashed cars or the scare tactics or what have you, because that’s what they know, but we have to impart on them that really doesn’t work.
 
McNeil: Right, right.

I mean, I’ve faced that challenge.

And that’s some of the same stuff that I learned when I made that transition, kind of from student to professional, is some of the thing … I can look back on, you know, I was a peer educator even in high school and I look back on some of the things that we were doing and realizing these are not evidence-informed practices.

We just didn’t know better.

And I do think the science has come a long way, part of the conversation, though, is that much of what I hear students wanting to do, especially when working with first year undergraduates, is they’re referring back to what they did in high school and it’s teaching them that this is a different environment, this is a different life stage and this is the place where we have access to more of that science.

So how do we bring that passion, that interest, that drive and merge that with the science to figure out what we should offer for community, whether it’s a campus-wide effort or whether it’s an indicative prevention piece with, with a subpopulation of focus and really kind of connect the dots between what I know, what they, their drive, you know, my drive and bring that together.

And I think it’s being done very successfully on many campuses.

Lucey: Well, I appreciate you having that dual perspective and, and those experiences and how they’ve shaped your work as a professional and sharing that with our listeners, so, so thank you for that.

Our, my next two questions; I want to talk a little bit about some specific efforts that are happening at, at Columbia.

So first I want to talk about Columbia University’s, I would say, you know, maybe its, its highest profile.

Not sure, but I know it’s one of the more higher profile drug education efforts, Go Ask Alice, which I’ve known of for a good part of my career.

Can you explain for our listeners exactly what Go Ask Alice is and how it came about?
 
McNeil:  Sure, my pleasure.

And it’s actually an incredible time to be talking about this, because Go Ask Alice is celebrating 25 years.

So …

Lucey: Nice.

McNeil:  And our campaign slogan is “25 Years of Questionable [stumbles over words] … sorry; Questionable Behavior, which will make more sense when I explain it.

Lucey: That’s good.

McNeil: So Go Ask Alice started in 1993 as an opportunity to provide accurate, reliable culturally competent health information to Columbia students.

In a way, they could access it without having to talk to a live human being, meaning basically 24/7 access to trusted information.

The office was work … taking questions that they were getting from students, researching them, creating evidence-informed answers and then sharing them.

First … in 1993, it was on the intranet within Columbia, but in 1994 it moved to the Internet, so it could be available to the world.

And that, that move was driven by the fact that, the fact that not every student lives on campus and you want to be able to access information when you’re not logged in the campus network.

What happened was that it became the biggest health Q&A website for college students in the world.

Millions of visitors per month these days, with thousands of Q&As from 1993 forward, which are now, not only are new questions published, but constantly updating the content, so that it stays relevant.

So we’ve got thousands of questions we’ve answered over the years to make sure people have the most accurate, reliable, culturally competent health information and we always say a range of thoughtful perspectives.

In most cases the site does not tell people what to do, but provides them with true evidence-informed information to make their own health and wellbeing decisions.
 
Lucey: That’s excellent and I love the tagline about celebrating 25 Years of Questionable Behavior.

I think that’s great.

And, and we know from prevention science, which we just talked about, that education and awareness is a foundation.

It’s one of the first steps and having credible information in a nonjudgmental way that is strictly fact-based and science-based is hallmark of, of, of the service.

And I imagine that when you, when that transformed from inter to … or intra to Internet, there was just, it had to have exploded at the time.

McNeil: It did, it really did.

And part of the reason explode, it exploded is because from the beginning the approach to answering these questions was to take the science and bring it into a conversational tone and to really make the language of this accessible to people; to not read like a science report, but rather like a conversation with a trusted friend.

And one of the, to me and this is personally interesting piece is, is you know, when this launched in the, in the mid-90s there, early to mid-90s, Columbia didn’t have the resources to do all this research on their own, at that time.

They actually had a network of volunteers at other colleges and the universities who would take the questions, conduct the research, draft an initial response and then send it to the team at Columbia to kind of, kind of finalize and get published.

And I actually was one of those volunteers when I was a graduate student and to then be on the other side of it eventually has kind of coming full circle with Go Ask Alice, has been both fascinating and really enlightening and it’s actually great.

The alcohol and other drug questions were some of the ones, those early questions, were some of the first ones I worked on as a volunteer.

And some of them, most of, well, actually nearly every one of them is still live on the site now, having been updated many times over the years to keep the information current.

Lucey: so I know that the service is wide-ranging in terms of topics; it’s not just related to substance abuse.

There’s mental health, nutrition, other health-related behaviors and such, but to home in on the drug-related piece of that for a moment, just based on your experience and what you know people are searching now, what seem to be some of the top substances that, that people are searching for?
  
McNeil: Sure.

So we, we’re constantly monitoring the, you know, the use of the site and both what people are reading in terms of what’s already published as long, as well as the questions that are coming in and we do get hundreds of new submissions a day from across the globe.

Interestingly, you know, alcohol is in the top ten, but it’s not the number one thing people look for, even though it is, you know, one of the, one of the biggest substances abused on campus.

The number two question right now in the category in terms of people reading it is actually about caffeine, which people often don’t think about, you know, in the, in the substance category.

But other kind of popular topics at the moment include things like stimulants, like Adderall and Ritalin, tobacco and smoke.

There are of course, some alcohol questions, but one of the my favorites from the top ten is actually our question on natural highs, which is from a student wanting to, to … who’s a non-user saying how do I have these great college experiences that aren’t driven by substance use?

And I think that question really speaks to a, a number of people throughout colleges and universities, because even among those who do use some substance, it’s not all the time and they have a lot of great times in college that aren’t driven by or connected to substance use.

Lucey:  I would imagine that, you mentioned that stimulants like Adderall and Ritalin is up in the top ten and what we know obviously from the data, national data as well as, you know, campus specific data, prescription drug misuse among college students is certainly of a concern and the class of drugs of most concern, while opioids is certainly an issue among college students, it’s prescription stimulant misuse and I would imagine that might somehow correlate to, you know, why those two substances are popping up in the top ten.

McNeil: Sure.

You know, I would agree with you.

I think there is, there is data to suggest, you know, why people would be searching for that content.

You know, I will temper that by saying, you know, when we look at not only our campus data, but some of the national data, our experience is the story around stimulant use; it’s usually much more pervasive than the actual consumption of the substances.
I don’t want to downplay it.

You know, we definitely see students on college campuses who are using these substances, both for legitimate medical reasons and those that may be misusing them, but it, you know, the story tend … as it is often the case in these issues, the story can be a bit stronger than the, the data bears out.

Lucey:  Yeah, and I’m sure that likely ties into the whole idea of norms misperceptions that students obviously are perceiving that other peers are using this, these or any other substances a lot more than they actually are.

McNeil: Correct.

Lucey: Yeah, yeah.

I want to pivot with my third question to another thing that’s happened at Columbia and I know that Columbia actually got to attend a meeting last fall I believe it was with the Office of National Drug Control Policy, around prescription drug misuse and specifically talking about Naloxone.

So the University designed and implemented a Naloxone training program geared toward the entire campus community.

So what was the planning process like for developing this program and what have been the results so far?
 
McNeil:  So the, the process started actually through some of our work with the JED Foundation and one of our committees looking at both our prescribing practices and making sure those were in line with best practices and you know, we’re glad to say they were when we reviewed.

No changes were necessary.

But also recognizing an increased interest in members of our campus community in learning how to use Naloxone and when to use Naloxone.

We were seeing an increase in that, so we pursued some funding, as you know, through the NIH and CTSA process, which allowed us to conduct a planning, it was a planning grant of three months.

And we used it as a research initiative.

One of the things we found is there was no literature that was showing an evidence-based education and training program specific for college students.

So we said, you know, if there isn’t one in the literature, then we should study this.

So the planning grant was really about understanding what were the facilitators and barriers to students participating in trainings and then also around their willingness and comfort with using a lifesaving tool like Naloxone.

So really understanding that, so that we could take what is required of us by the city and the state as a registered program and customize that content to be very Columbia-specific and address those facilitators and barriers when we then turned around and went out and did training.

And that’s what our second phase is really doing, is we’re implementing that training that was developed out of the planning process and evaluating it to see if we’re actually meeting the needs of the community, are we, you know, are we addressing the concerns people had, for example about participation.

I can tell you demand for this training is what we are calling, we are labeling it unprecedented.

Our grant had a target of hoping to train up to 400 people in the first twelve months.

I personally trained almost 700 people in the span of four months and we know of at least one life saved from that, from that training.

It was one of our undergraduate students who administered Naloxone to a non-affiliate off-campus, but they had the Naloxone kit with them and they recognized what was happening and they were able to step in and, and help save that life.

And as we’ve been talking, I, I see a little pop-up on my screen reporting across the University.

We just got a report of the fourth life saved through the administration of Naloxone between this campus and our Medical Center campus.

Lucey:  Wow.

That’s, that’s, I mean, that’s got to have wildly exceeded any kind of expectations when you were in that three-month planning phase.

McNeil:  Absolutely.

I mean, like we said, we really … this is part helping build the science and it’s also part helping people have the skills and the tools to save lives.

To have that level of demand, have you know, hundreds of first-year students say how do I get trained?

To make it available to RAs and have more than half of the RAs take their free time during their training week to come and, and participate, to see athletic teams requesting, fraternities and sororities asking for it, faculty.

I’m doing a training later today for employees.

Our law library staff has asked for it.

I mean, it’s just … they’re kind of coming out of everywhere and saying can you please teach us about this?

Can you show us how to use it?

Can you help answer our questions?

And you know, people are carrying these kits all over New York and beyond.
 
Lucey:  So by highlighting this, obviously on the podcast, I’m being very careful not to create a demand that can’t be supplied, but is, is it within Columbia’s plan whether it expected or not, that other campuses have been contacting the University to, to get some advice or possibly help train their campus in this or the, you know, best practices to roll out a Naloxone training program?

Has any that kind of thing happened?
 
McNeil: It, it is happening.

It’s part of our process and our plan.

We have presented on this work at the NASPA Strategies meeting recently.

We have several other presentations coming up, part of what we are sharing with folks is we’re happy to give you drafts of, you know, a copy of our curriculum as it’s currently written.

If you want the, the slides that go with it or the images or if you want some guidance on how to set up a tracking program, you know, we’re happy to do that and kind of provide that technical assistance.

What we are encouraging folks to do is hang out just a little bit longer if you can, because we will have more evidence around this as the data collection continues.

So we’re, you know, we’re most of the way through the quantitative data collection for one, one portion of the grant.

We have, we have begun the qualitative follow-up that goes with that, because we’re trying to understand things like those that sign up for a training but don’t show up, right.

Is there, is it, is it a simple logistics … I didn’t feel well, I realized I had a class or is it something about the topic?

We’re also trying to qualitatively understand things like people who go through the training, but choose not to take a kit at the end.

Now I will tell you of the seven that we’ve trained, just over 700 people now.

We’ve had seven people not take kits.

So the, the number is very, very small, but we’re trying to understand if there’s something specific that would help us, you know, better the trainings, so that people do want to definitely take those kits.

So we will have more that we’ll be able to share with the field and that is a part of our objectives with this grant and this research process, is really to help bolster the field.

Lucey:  Great.

And thank you for sharing what you can so far about what’s happening with the training program at the University.

I’m sure listeners will certainly be on the lookout for hearing more formal data and findings as you’re ready to release them.

So, so thank you for that.

I want to move onto my fourth question and it, it delves into, you know, one of your research interests and I know that you’ve looked at the length between health promotion and academic success.

I’ve had plenty of guests on previous podcast episodes, Dr. Amelia Aria, for example.

We’ve talked about this issue.

What, you know, you’ve had now a wealth of experience, a long time in the field, just about as long as I have, if maybe starting like you said with your high school and your college student work, but what advice do you have for people listening to the podcast on how best to frame the work that they’re doing around prevention and linking it to the school’s academic mission, which seems to be on the minds of a lot of senior administrators on campus.

McNeil: You know, I think it’s a perpetual question in our field.

 And I start by reminding myself why individuals join our community, our campus community as a student, right.

They’re here to learn.

And, but it’s more than just learning.

It’s not just taking a class for the sake of taking a class, but they’re here to earn certificates or they’re here to earn degrees.

They may be doing an undergraduate that’s a foundation to their future studies.

For some of them, it’s the step before they go into their chosen career path.

And it’s really thinking back to that mission and saying, you know, what are the facilitators of achieving those objectives and what are the things that could be potential barriers to getting there, right?

For most of our students, substances are probably not going to get in the way, not in terms of the big picture.

But there will be some that will have some setbacks and we have for example, well-researched programs like Basics, which help students who may have an adverse incident related to alcohol, kind of make sure that that’s an isolated incident as opposed to a pattern.

But the other part of this and I, I think it’s gaining momentum in the field, is actually thinking about students who arrive at our campuses in recovery and saying, how do they become partners with us to think about substances and how it supports the academic mission, right?

On my own campus, I’ve had the fortune, we have students on several of working groups and some of them are students at Columbia now that stopped or dropped out of another institution due to substance related concerns.

And learning from them about kind of what was supporting them and what was hindering their success related to their own substance use and then how do we learn from that, to then channel and support.

Health promotion can be so nuanced and of course, at many levels, so we need to really think about our, our policies actually supporting academic success.

Are our programs, whether they be campus-wide programs like the orientation work we do or the more indicated pieces, populations with, with potentially higher risks or concerns around select substances.

You know, how are we partnering and working with them, because they probably have that same mission.

And I always remind myself when I’m out there volunteering and helping at commencement, that that’s, you know, families are so proud and students are so excited and you know, I have to remember that the work we’re doing is to help students get to that point, right.

It’s not about the nitty-gritty of the day-to-day.

I mean, I can’t neglect that, but, but I have to remember the bigger picture and understanding the motivations of why people join our community help me leverage the science around the work we’re doing to help them achieve the reasons they came here.

Lucey:  I would say that and I don’t want to name schools for fear of leaving anyone out, but you know, I’ve and you have met our colleagues from around the country.

Based on the work that I had done when I was at the US Department of Education, I think some of the more and I’ll use the word advisably, “successful” schools that have sustained their programming over a number of years, they’ve been able to make this link between the work that they do in prevention and how it connects to the school’s overall mission, which is rooted in, you know, academic mission and retention.

And I think that that’s, you know, that’s what folks should be doing, is making that big picture connection.

McNeil: Right.

Lucey:  Absolutely.

So as we wind up, I’m going to end with kind of the last thoughts type of question for you, as you have the opportunity to, to speak directly to the listeners.

What is it that you would like to say to encourage your peers from prevention practitioners to senior administrators, faculty members and students.

What do you want to say to them to encourage them as they continue to work on preventing drug misuse among college students?
 
McNeil:  The, the first thing I would say is talk to each other, right?

Because we all ultimately share the same common mission, right?

We’re here to educate, support, to see those students at commencement as I was just mentioning and we do that best when we don’t worry about the org-chart of higher education, but we think about what is the cross-cutting opportunity to support students.

And, and the way you get to each other is through, through active communication.

I do want to extend that line, though, and say let’s make sure students are an active part of that conversation.

Far too often I see things on, for example, list serves to say, you know, what are you doing about this issue?

Or what should I be doing on my campus about this issue?

And you know, I often privately respond to people and say, what have your students told you about this?

Because I do think people are asking their colleagues, but I’m hopeful that they’re also asking their students.

It’s part of what’s driving our research with Naloxone pieces.

We, we want to know what’s going to help or hinder here and then we also want to share the process of learning that with our colleagues, so that they can learn it for their campus.

It really comes down to figuring out how we come together.

Health is a, to me is a collective community responsibility.

It isn’t the domain of campus health, if you will.

I think everybody can play a part.

And different people will play different roles.

I’m not asking the faculty member to be the, you know, the substance abuse counselor.

I’m asking the faculty member to know that you have one on your campus, so if a student asks, you can be that affective referral agent.

I’m encouraging senior administrators to really know that they’ve got campus-level experts who would be thrilled to have conversations about this work is supporting the academic mission.

So invite them to the table and, and do those connections.

If you look at the literature across the years, many high level administrators are very worried about the role of substances and how that helps or hinders student success.

So let’s, let’s, let’s continue to talk to each other.

Let’s continue to reach out.

Let’s continue to do some studies and publish those studies so that we can advance the science, because as our students change and as our systems evolve, we need to continually study them, so that we’re, we stay rooted in the evidence, informed and theory-informed practice.

Lucey:  Well, this interview has been, it’s been exactly what I had hoped for.

I really, you know, appreciate and thank the, thank you for the perspective you’ve provided and, and just the advice you’ve given our listeners and also talking about some of the efforts that are happening directly at Columbia and the willingness to share that information with others as more details become available.

So Michael, thank you for the time that you’ve given today to be part of this and it’s always been great to have you as a colleague over the years and I just appreciate the work that you do.

McNeil: Well, thank you, Rich.

I very much appreciate the opportunity and I want to thank you for the work you’ve done to amplify what’s happening on college campuses and to connect us and make sure those  resources are available to all of us.

Lucey: Well, thank you.

And to our listeners, I do want to say that if you haven’t checked out one of the newest sections of our website where this interview is posted, check out the Peer Education portal, which is in the Student Center, since we talked about talking with students and peer education programs on campuses.

Be sure to check out that new section, so that peer education programs from around the country can now start sharing ideas with each other, as students work with their mentors and the professional staff on campuses to continue their prevention efforts on campus.

And so with that, to our listeners, I thank you for joining us and have a great day.