Prevention Profiles: Take Five - Fran Harding (SAMHSA)

Rich Lucey (host):

Hi. This is Rich Lucey. I am with the Drug Enforcement Administration's Community Outreach and Prevention Support Section and I am excited to have you join us for a new feature that we are placing on our website, CampusDrugPrevention.gov.

This new feature is a podcast series called, “Prevention Profiles: Take Five.” And the purpose of these podcasts is for me to interview individuals at the federal, national, state, and local levels to talk about current and emerging issues around drug abuse among college students.

I'm very excited about this new feature and I'm especially excited about today's guest Fran Harding.

Fran is the director of the Substance Abuse and Mental Health Services Administration Center for Substance Abuse Prevention and she is recognized as one of the nation's leading experts in the field of alcohol and drug policy.

Fran is SAMHSA's liaison to the Office of National Drug Control Policy and she served as the prevention subcommittees chair for the federal government's National Heroin Task Force.

Fran has held numerous positions at the national level, including serving as president of the National Prevention Network and as New York state's representative to the board of directors for the National Association of State Alcohol and Drug Abuse Directors. And in 2004 she became the first non-researcher to receive the prestigious Science to Practice award from the International Society for Prevention Research.

I'm also excited because Fran and I go back about 20 years plus. She's been my boss in a couple of different capacities in my career, but more importantly than that she's been my mentor and my friend.

So, Fran welcome to our podcast series.

Fran Harding:

Thank you, Rich.

Lucey:

And the whole purpose of these podcasts is to really have five foundational questions for our conversation. And a couple of questions might come out of the conversation but we're going to start with these five basic conversations.

And so we'll start right in with this first question:

Fran, your passion for preventing drug abuse among college students really started early in your career when you took a job on a college campus. Can you tell us about that experience and how it shaped your career going forward?

Harding:

I'd love to.

It seemed to me back in 2008 – actually starting much earlier – that's when I started with SAMHSA. But when I started with the colleges it was 80… it was 1982, believe it or not.

Taking my first job as a on a college campus – and it was a small New England private college – and it was a natural progression for me because in college I was an RA (Regional Advisor) for three years and an RD regional director … not regional … residential director for two years. So when this job opportunity came up after school I really didn't know what I was going to do with myself.

And I thought, well I think I really would like to stay in college education.

The focus on drinking was just beginning when I was … so that would have been 80, oh early 80s and we started … just began talking about the fact that college students drink too much and relating it with all the problems on campus.

So this was an opportunity for me to get out of the state of New York and to try my hand at doing this full-time because I really wanted to be a vice president, eventually a president, of a college. So I thought.

And I took the job real quickly and I was very disappointed because I had no idea just how the alcohol abuse on college campuses affected so many individuals – people grades and everything we've talked and learned about but I really never experienced it myself.

The one thing that finally made my decision to get out of the college field was because when running a dorm full-time I had to confiscate the beer in this state. That was their policy. And if you were under the age – in this state [it] was 19 – I had to take your beer away. And I did. And then I found out about a month later as I was doing this every night and weekend that the security guards in the colleges were in my office consuming the confiscated beer.

So I went to the administration – my boss – and explained this and he said, “Well there's no harm, no foul.” And I said I'm in the wrong business. It is not right that this is gonna be.

And I just got very lucky. Sometimes you just have to admit that when you get lucky you get lucky. And the door opened up, and New York State was looking for a person that … they wanted a college manual on underage drinking written. And I couldn't believe it. And applied for the job got to go home and in the rest is history.

Lucey:

Hmm. So like you said very disappointing in one respect—because that's an indication of how the efforts you were trying to do around prevention on campus were totally being undermined by, you know, I say colleagues but they weren't really, but still professionals on the campus.

So as I said, we've gone back quite a ways. You've talked about this as, you know, the mid-80s when the drinking age was 18, 19, 21 depending on what state you were in. So your career spans 30 years plus.

What are one or two positive things that have occurred in prevention during that time?

Harding:

Well there is one thing I also want to add to this because it would make the rest of the conversation make more sense. In those early years in college when I was starting to face myself and I had to make decisions on underage – well, we didn't call it under drinking but just plain drinking – on college campuses, I never knew there was a field called prevention. Not to mention, prevention of underage drinking on a college campus. So this all came to light.

So I have to say that the development of the field … it started I believe by the researchers around the country that began to look at alcohol abuse and then later drugs and how damaging they were to the young person in general.

And I didn't even at that time know that there were specialty areas to actually study college behavior. I learned all of that in the process, in my journey in New York. So I have to say that that's the most positive thing that had an effect on the drinking rates and the deaths and everything else we'll get into I'm sure about what happens on college campuses, was the fact that a curriculum was built, studies were done, and then all the sudden there was a profession called prevention.

And then we learned every year it seemed like we got more and more details more and more refined and then it was turning into careers. So, again, right place right time. You're gonna hear a lot of that.

The other thing was the 21 year old drinking age. Now, I understand that the 21 year old drinking age when we were working in the field at the time when this happened, it was not rolled out very well and it was horrible to be a prevention leader and going to college campuses – which was my job – and trying to get them to accept that 21 was the right age that we needed to have in our country. So we struggled with that. But the country stayed with it and there are, you know, the stories as well as I do that this was the federal government almost blackmailing states because of the highway safety dollars that … you were going to lose if you didn't go for the 21 drinking age.

But then the numbers started to come in and the amount of deaths that we prevented just by having that law gave us, I think for myself, gave me a lot of encouragement and strength to go forward with the programming that we were trying to teach on a college campus.

So, the two is the science itself of prevention; those early scientists, the prevention scientists that brought the field together as a whole and the 21 year old drinking age. Although it was a painful growth it remains to be one of the driving factors of saving lives on senseless lives with so many issues not just drinking and driving.

Lucey:

Well we know from, you know, we have federal partners all across the government and one of those partners that we look to in terms of the research are the folks at NIAAA, the National Institute on Alcohol Abuse and Alcoholism, and as well as NIDA which is the National Institute on Drug Abuse are looking at the drugs other than alcohol. But the numbers are still so alarming. I mean, when it comes to obviously alcohol, which still remains the drug of choice, on college campuses (but marijuana is certainly catching up) you know 1,800 deaths a year is related to this. Not to mention, you know, the almost 100,000 sexual assaults each year and just general assaults is around 700,000 why does this seem so sometimes intractable like we can't make headway?

Harding:

I think if we had the answer to that we'd be sitting here talking about more of our successes and the positive value as some people would like to talk about with alcohol. This is – and this kind of leads into one of your questions – the most difficult problem that you wish that it would change. And I think it's this in its and over the years you know the older you get and you stay in the same field the more you start to look back and not be so critical of what people are not doing but to look at and answer the question why. Why does this still happen?

I have said many times –I stand in front of a new fresh group new audience I said I cannot believe I'm here talking about the same problems with alcohol that I spoke about 25-30 years ago. It is, it's embedded in our culture and for whatever reason we cannot seem to get our country to understand that it's that we are not looking for people not to drink alcohol. This is our choice if you are not predisposed for having a disease. We covet our alcohol so well. And that I think it's a combination of that and the fact that parents don't like to tell their children not to do something they're doing themselves.

So the culture issues could take us hours to look at and cultural issues are more on how alcohol has wound its way into our culture to use for celebration, to use for when we're depressed, and we want to get over a sad situation, to use to feel good and also it's almost unheard of in the majority of our culture that you don't have a party is not complete unless you offer alcohol.  And I don't even have time to talk about the media which doesn't help because they perpetuate, and always have, the need to have alcohol. And not only out having alcohol, I'm not against that. But it's the quantity. You open up a refrigerator in a beer ad and you see the whole refrigerator is full from bottom to top. You see people talking about certain liquor. And it's every single person is having more than one drink of that particular [liquor] … I mean we are a drinking culture.  

So my biggest disappointment is, and the reason why I think we continue to see these numbers, is because adults who choose to do the right thing (if they believe it- let's say that they did read something or they did hear a lecture and we they find that the data that they believe in or they had a close call with themselves or one of their loved ones) … they're embarrassed. I mean and we have almost enabled the culture to be the way it is by not really having … we develop things like after-school prom parties and why do we have an after-school prom party they just went to a prom what do they need a party? They need a party because they need to go somewhere where they can guarantee they're not going to drink alcohol. Rather than have strict rules and consequences after the prom if you are get caught drinking and God forbid a parent should pick up a junior or a senior person in high school.

So parents, and we'll get to parents, but parents play a critical role. Neighbors play a critical role. How about, oh I don't remember the name, but there was a program that was very popular when I was working in New York where parents would sign a document that says that you can come to my … your child can come to my house and have a party because I'm going to be there. And there will be no drinking.

And then we started, you know what do you remember …

Lucey:

It was the safe home pledges or something like that.

Harding:

Right. They have pledge of the kids and then you'd have a directory. I actually got a directory. And then I think I really don't know what happened but we keep working on it and, thankfully, government both local state and federal, continue to follow the science … continues to see that the will still go out and will teach.

I remember you and I talking about sometimes. We go to an event and there'd be 15 people in the audience and we'd be like, “Wow. They were really attentive and we really got to them.”

Other times we go to an organization to speak and we'd have 2 … 300 people, but of the 2 to 300 roomful of individuals a quarter of them were watching. So we learned our tactics of just talking to people wasn't enough. We had to get them involved, we had to engage them more, we had to have students set up their programs. We've learned a lot and I think that's what we have to continue to do.

Lucy:

So I really was glad that you brought up that … was the third question about what hasn't changed much but you wish it would because there's a lot but you've given me the perfect segue into the fourth question that we wanted to talk to you about which is around parents because you've mentioned parents.

I've known you for a long time … I'll just put it right out there or in this field quite a while. We're seasoned individuals in this field. You are a very strong supporter of parents and advocates for parents in drug abuse prevention. So what advice and guidance do you have for parents who have young adult children in college? Because one of the things unfortunately we've heard for so long is once they're in college … ‘you know what my job is done!’

So what's your… what's your take on that?

Harding:

Well, first and foremost, messages have to get to young parents first. This is not something that parents can learn when their child is getting ready to choose a college. These are messages that should be ingrained in young people's minds of the attitudes and behaviors and consequences of a parent when they when their child breaks rules. And you start out with the easy rules as kids … as little ones. And then you know, “Don’t jump on the bed cuz you're gonna hurt yourself” right straight through to no drinking and driving, or then no drinking at all because of the consequences.

So that's the first and foremost. Then you don't, just as you said, you can't pretend that they're adults at age 16 and 17 because that's the age that some of our young people are going to college now. And you can't just keep looking the other way and say, ‘well the college … it’s the college's fault.’

I think college orientations are having now parents … a parent orientation. I don't know of any colleges that don't do that now. It used to be … that's another thing over these are years that we're working in this business we've seen perfect program. Because in my day we were concerned more about sexually transmitted disease, if you can imagine, it was a long time ago. And that was the pregnancy and sexually transmitted diseases were the biggest fear of a parent.

But it wasn't until much later into the late 90s did we start to associate those kinds of behaviors with drinking. And the studies started to come out to show the … you know you drink, you get drunk, you make unsafe choices. And so parents started to think about this and they, hopefully, you just tried to get them to speak. When a young person 17, 18, 19 even 20 year old knows what their parents believe in, knows what their parents expect of them, and carry it through, and they do the same behavior in the house as they expect them to do in college, is when we begin complete things change. Those are the students that are joining clubs in school to help with drinking and binge drinking and those kinds of activities, because we've associated the cut the negative consequences with drinking and it wasn't just the obsession of telling them they can't drink because as I’ve just stated, drinking as a part of our culture. When you become an adult you're supposed to. If I could change anything it would be that that sense of a rite of passage. That when you go to college you are expected to be part of this drinking, you know, fraternity … well I shouldn’t say fraternity that would be wrong … group organization.

So I guess that if parents could stick to the rules instead and anybody in our business are used to this, parents will say … I’d be at parties and, you know, and I know their children, 18, 19-years-old would be drinking right along with the party that we'd be having for a family and friends gathering. And I would say, you know, this is really not very healthy and safe and they say, ‘No, no. The kid’s 18 now they can they can handle it. They've got to learn to handle their liquor.’ So I don't think the countries made a big impact on helping parents and helping the culture of our country to understand there's a place for alcohol and then there's not a place for alcohol. And we’ve tried so many things, making an analogy of driving: would you let a fifteen-year-old drive a car without a license? No? But then why do you let them start experimenting with drinking in the home so that they can learn how to handle their liquor? I mean it's the same kind of association.

Parents need to understand the message that they are very much listened to. The whole, ‘I'm wiping your hands of a child,’ has even gotten different because more than half of parents now pay for the child's education. So now they have more of an investment in this young person being successful, not getting hurt, not dying, dropping out of school early because they never got up for their classes.

All these things that we know we could go on forever all the negative. Parents are a strong influence and if only we had more campaigns that focus on that. Because we have lots of campaigns that focus on parents of young people, what to do and if they listen. But young people … I'm telling you I have children of my own, they are there almost all out of college but when they were in they really truly listened.

Now that doesn't mean they didn't do their normal children and some of them … children will often make their own decisions but hopefully they have your your message in the back of their mind.

Lucy:

So before I get to our wrap-up question, it was another question I wanted to ask you and obviously we've focused a lot on alcohol because it is, like I said, the significant issue on college campuses but over the years we now know that marijuana use daily or near daily use of marijuana by college students is at its highest rate in the last 30 years.

And the prescription drug misuse issue, while not so much opioids although that is a problem, we see that most of the issues around the non-medical use of prescription stimulants among college students there – I would imagine that – there are lessons that we can we have learned from alcohol misuse prevention that also could apply to the other drugs as well. I mean science is science right? I mean so can you just [talk] a little bit about what we can learn?

Harding:

Yeah. One of the things that we can learn is that we have much more leverage on the illicit, illegal drugs than we do on the drugs that are legal. And I think that is really our biggest hurdle with alcohol, tobacco being another a drug of choice and marijuana in some states.

[There are] mixed messages with marijuana now, where you have some states that allow it to be used for individual purposes and, of course, the medical marijuana which unfortunately is there for a purpose and people report that they do feel better when they have this this drug especially now in the opioid crisis where they're gonna choose marijuana … medical marijuana over taking opioids. It's kind of one of those difficult decisions that you can only make for yourself.

But all the illicit drugs, we know that colleges are more inclined to have stricter messages in their handbooks – and I'm kind of chuckling to myself because I know that you know if you were to go around the country and gather all the student handbooks, all of these issues would be outlined in them: the rules around drinking, the rules around drugging, the rules around marijuana (which I haven't really looked at but I'd be interested to see what some of the rules in some of the states say about marijuana on college campus because we did some exploration about that as well).  But we learned, one of those lessons learned, just because it's in the book doesn't mean anybody’s following it so someone at the right choice.

So illicit drugs go back to parents, and community leaders, and faith leaders. And illicit drugs are bad, heroin is bad, prescription drugs misuse is bad. So we’re a big labeling society on many things and drugs are one of them. So I think it's a little bit easier to get messages and to get people behind them. I think we did a really good job with tobacco and … we didn't really see any advances with that legal substance. Even though there was an age you couldn't purchase it until you were 17 (and now it's up to 21 depending upon where you live) but the difference is it was when we found out that ‘me’ the nonsmoker could also get cancer because ‘Rich’ is smoking and I live with him and I'm breathing in his toxins and then I'm the one with the lung cancer and he's not.

So we never found our “secondhand smoke issue” with alcohol, and I think if you have a legal substance that's what's gonna have to happen.

I think with the legal substances – with the exception of the crisis we're currently enduring with opioids – it’s just a strange issue that has come up.  I think that with illicit drugs you can get the college administrators to rally around that easier.

It's not that the job of stopping use is easy. But you can crack down on sales. Law enforcement is right there to help you. Law enforcement, bless their heart, their job isn't any easier. And if we're not all working together with law enforcement – and the community, and the school, and the student administration and the parents where need be – if we're not working together, you're not going to tackle the alcohol problem. It's a real community problem.

Illicit drugs you can have a smaller group of people paying attention to that. You can do set up raids, you can have your enforcement both on campus and off campus helping out, you will have most parents that will help you, unless they have addiction problems themselves. So and yeah on and on and on.

And you can um you know it's it's almost cut and dry and many campuses if you're caught with certain amount of drugs then you're suspended.

The difficult part is what you had mentioned: there's enhancing drugs and the drugs like Adderall which gets you more into the whole prescription drug issue that we're currently dealing with, which is a whole different way of looking and prevention programs have to start seeing that you must deal with that differently. And you must have different messages. And an alcohol message isn't going to have an effect on a campus that has a real serious prescription drug problem.

Lucy:

So we're going to wrap up with our fifth question here and this is the inspirational part of conversation. So, and I know a lot of people look to you and I've seen you in action speaking both at national conferences, state conferences, and local conferences. They're looking for that inspiration. So what would you say to encourage the professionals who are working to prevent drug abuse in college students, as well as the students themselves who are listening to this podcast?

Harding:

The first thing I think I would say – I was talking to a colleague this morning about this – and the first thing a good preventionist has learned over time is that this is a marathon not a 5k run.

This is going to take a very long time. We're trying to change culture, we're trying to change norms, we're trying to change learned behavior over time and we're trying to change the way our college campuses across the country view legal substances like tobacco and marijuana.

Tobacco and alcohol and in some cases marijuana versus all of the variety of illicit drugs and we don't have time to talk about what's really killing us which is the synthetics and all that variety that's out there. So if you go into this understanding two main things: one, you're not going to get a lot of quick wins. Sometimes you fall into it. You develop a program on your college campus and it's intended to intervene on campus partying and you're able to change that and you got a … and you have a win for a whole year that's a real rare, fantastic, “I want to know how you did it win.” Usually what happens is you have to be in it for the long haul. And that's the difficult message to send for people that are only in the environment from anywhere from two to four to six and maybe eight years. So, you're not there long enough. It's almost like a policymaker. They're not often in the chair to see the results of our work.

So why go? Why join this field? You have to have the desire to know that you are gonna get a few quick wins but you're laying the foundation and working with your colleagues before you, and laying step-by- step the foundation of good health and safety. And that's really your message. You cannot belabor the number of deaths that you have and that it's your fault because your messages aren’t getting out there. You're dealing with human culture, human thinking, human behavior, and if you're going to jump into this field with us – and we welcome all of you – you need to know that if you want a challenge of a lifetime then this is where you want to be because we are learning advances every single day on how to help people change their culture and their minds around alcohol and substance abuse.

And then the last thing I would say is when you see students that were really in trouble with their drinking or their drugging and even if they have to go off and spend a semester in some type of treatment and come back and they end up graduating with a 4.0 or they end up being the first person in their generation/family … in their family's culture to get a college degree, whatever degree that it is. Do they have to be the ‘A’ student? No. But they have the same piece of paper and they've been able to manage. And you know your program that you've developed has assisted with that development.

I don't need anything more than that. I don't think that most people who are in the behavioral health field – human services field, public health field – we go into these fields knowing that we may never see the results of our labor. Sometimes we do and boy do we have a happy day. But most times we're there for the long haul trying to change the environment to become a healthier and safer nation.

There was a time when we used to talk about being one of the best countries to live, safe and healthy. I don't hear that a lot anymore. And I think it's just a glitch thing that we're now in a prescription drug, heroin, fentanyl, carfentanyl, synthetics – we're into that piece of it. We are going to beat this. We're going to drive down this obsession with prescription drugs and leading to these other substances that kill because that's who we are.  That's who we are in America, that's who we are in this field of prevention.

We’re scrappers, we work very, very hard and we very rarely get a pat on the back. But as long as you're in it for a different reason and if you're not, do not be shameful because I need more researchers out there. I need more people that are policymakers to help work with me and not get down into the trenches. But you and I, just the two of us, have almost hundreds of friends that are in this fight with us.

And the reason why we do it is because we see the numbers. And I know underage drinking is still horribly high, but it's just reduced another ten percent of underage drinkers. And binge drinking is still lowering and it's going down, except just now it's a slight tick.

So you can't let that get you down. You have to work harder and go forward then just speak the truth put a lot of passion and we're speaking put a lot of energy in your speaking because you have to almost get their attention and then give them all the information you need.

Lucey:

Well, I thank you. And it's a great message to end on. We know in this field there are some incredible lows and not-so-great days we have in prevention. And then there are some exhilarating highs. And I think you said it we will beat this we will make headway and we will drive these numbers down.

So with that I will close out this version of our podcast on “Prevention Profiles: Take Five.” We're happy that you were able to listen to us and I encourage you to check out all of the resources on CampusDrugPrevention.gov, which include not only resources from the DEA, but our federal partners at SAMHSA, NIAAA and NIDA. So thank you, have a good day.