If you're a teenager or adult with attention deficit hyperactivity disorder (ADHD), the following tips may help you cope with your ADHD symptoms.

1. If you can't remember an instruction, ask your teacher or boss to repeat it. Don't just guess.
2. Break big jobs into smaller stages, and reward yourself as you finish each one.
3. Make a list of what you need to do each day. Then put these tasks in the order you intend to do them. Cross each thing off the list as soon as you've done it.
4. Work in a quiet area.
5. Do one thing at a time.
6. Take regular short breaks.
7. Carry a notebook and write down things you need to remember.
8. Use Post-it notes to remind yourself of things you need to do. Put them where you will notice them, such as on your fridge or car dashboard.
9. Store similar things together. CDs should be in one place, videos in another. Bills should be separate from personal letters.
10. Create a routine. Get up and go to bed at the same times each day.
11. Exercise, eat a balanced diet and try to get enough sleep.

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With a growing interest in Celtic Christianity, one might ask why would a 7th Century faith be relevant to a 21^st Century world. Put more directly: how would a 7^th Century Celt respond to the predicament of 21^st Century man faced with global warming? And if this ancient individual were magically transported to the 21^st Century, what would he think of the movie "An Inconvenient Truth"?

In all likelihood he would be dismayed and saddened. He would be dismayed that a spiritual world had been so thoroughly displaced by a material world. He would be saddened that the significance of creation had been so totally lost. He would wonder how reverence for a natural world had been completely forgotten. He would ask, "Had modern man no appreciation for any of God's creatures, himself included?" To understand this "older world view", it is necessary to step back a few thousand years.

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Several centuries before the birth of Christ, Celtic territory extended all across continental Europe and into what is now Asia. By the time of the 2nd Century AD, this territory was reduced to the British Isles. Pushed relentlessly westward by the Roman Army, the Celts could only claim these remaining islands. Oddly, it was here that initial Celtic contact with Christianity occurred, provided by a few Roman soldiers who were Christians themselves. Except for the missionary work of St. Alban in the 3^rd Century, no further Roman presence would occur for another 300 years. The Celtic church would develop in isolation, influenced only by local custom and tradition. These would leave traces of Druid mysticism, a genuine reverence for the natural world, and a strong sense of interconnectedness between the seen and unseen worlds.

Late in the 4^th Century, the first Celtic theologian Pelagius would develop Celtic beliefs a bit further. Significantly, that:

1. Christ commanded man to love not only his human neighbor, but all life forms.

2. Christ was the perfect fulfillment of wisdom and humility, and what mattered more than believing in him was becoming like him.

3. Every child was conceived and born in the image of God - the embodiment of the original unsullied goodness of creation. This did not deny that man was capable of sin, only that sin masked man's essential goodness. Redemption, as offered through Christ, liberated man from his "failures" and returned him to his fundamental goodness.

During the time of St. Patrick, circa 430, new aspects of Celtic Christianity emerged. These included a sense of the Goodness of Creation, an awareness of heaven's presence on earth, and creation of endlessly interwoven designs representing the inter-relatedness of spiritual and material realms, of heaven and earth, and of time and eternity. Ultimately these found expression in the high crosses of Iona, the glorious illustrations of the Lindesfarne Gospels, and countless hymns and prayers.

There existed also an extraordinary desire to integrate the gospel with the older Celtic traditions. Rather than discard these older beliefs, the Celts merged them with newer Christian ones. They welcomed a gospel that offered hope of an eternal life, and a living spirit that was not confined to matter alone. They allowed the gospel to do its transforming work, and in the process found the fulfillment of their older Celtic mythologies.

The gospel of St. John the Evangelist was particularly significant. It represented the heart of Celtic Christianity. Rich in metaphors (expressed as "Light" and "Word" and "Stillness"), this gospel appealed to Celtic imagination and spirituality. Their special love for St. John was their memory of him leaning against Jesus at the last supper. It is said that St. John heard the heart beat of God. The related imagery of stillness and listening, of heart and Love, became central to the Celtic understanding of the word of God.

Likewise the Creation Stories were seen as an expression of God's Goodness in all aspects of the natural world. It is here that the truth of God is revealed. Not hidden away, it's found deep within all that has life. In God's Creation, all creatures are equal, and all that God has created is good. God's command to "Be still and know that I am God" is a command to appreciate the natural world, to listen to the words of the heart, and to see the goodness creation offers. Mankind is not an alien to the natural world; he is a part of it. If he loves not the natural world, then he loves not his neighbor, and he loves not God.

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Columba's arrival to the Isle of Iona in 563 was the final phase of Celtic Christianity. It represented a restlessness to go to wilderness areas - a place to be tested, to be upset, a place to find one's self. Iona was not only a wilderness place, but also "A Thin Place" where the sky and sea and land came together. It was a place where the seen and unseen worlds met one another, and a place where a deeper meaning to life might be found. Iona also represented the culmination of a pilgrimage and a chance encounter with the unknown. Without maps or destination, Columba set out from Ireland, rudderless, and adrift on the sea. By chance he landed at Iona. His journey imitated the homeless journey of Christ and His disciples, wandering about the wider world, totally dependent on the world's hospitality. By setting out on similar journeys, he and others discovered how small and insular their world could be. Determined to get themselves beyond these boundaries, they continuously pushed at the edges, moving physically outwards in one direction, but spiritually inwards in another toward wholeness.

Celts also had a wonderful sense of companionship with Jesus. "He was a great reminder of what it is to be fully human: fully here in human life, fully here to the world around us, and fully present to the unseen worlds, able to go back and forth through the doorway where the worlds meet." To the Celtic world, Iona was one such place - a doorway where the worlds meet, where one could experience the presence of Jesus.

By mid 7^th Century, Celtic beliefs created significant tension between the Roman Church and themselves. The minor differences over tonsure and the celebration of Easter had become insurmountable. Celtic Christianity had moved significantly further away from its counter part in Rome. Where the Celtic Church was monastic, without central organization and focused on the Goodness of Man, the Roman Church by contrast was hierarchical, institutionalized with ever-increasing papal authority, and heavily influenced by the Augustinian doctrine of Man's Depravity and Fall from Grace. At the Synod of Whitby in 664, the collision finally occurred. King Oswy, a Celtic Christian, was faced with a momentous decision: Would his Kingdom practice Celtic Christianity or Roman Christianity. He chose in favor of the Roman tradition. From that point forward Celtic Christianity experienced a slow decline. By the 12^th Century it had become little more than an oral tradition.

However, in outlying areas of Scotland and Ireland, prayers and hymns continued as a part of daily life. In the mid 19^th Century Alexander Carmichael collected and published those that he could find in a volume entitled Carmina Gadelica. At the same time, author George MacDonald began writing short stories and novels that reflected the essence of Celtic spirituality. In the early 20^th Century, the influence of George MacLeod (a Presbyterian Minister) brought Celtic Christianity into the mainstream of British Christianity. "He taught that we should not look away from the material world in some spiritual realm but rather more deeply in the life of the world. The spiritual is not opposed to the physical, he believed. For God is to be found in the material realm of creation, not in escape from it." Ultimately this earlier heresy had come full circle. It now was acceptable doctrine.

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In 1938, MacLeod made the decision to rebuild the Abbey at Iona, the place where Columba had first landed nearly 1400 years earlier. This marked the re-emergence of Celtic Christianity in a very tangible way.

Today, tens of thousands visit the Isle of Iona just to glimpse this venerable place, to pilgrimage around the island, and to experience the mystery of an ancient faith made new. And, if they listen carefully, they may hear an ageless response to An Inconvenient Truth, or perhaps, more poignant, this prayer offered on behalf of mankind.

Give me a candle of the

spirit, O God, as I go

down into the deep of

my own being.

Show me the hidden things.

Take me down to the spring

of my life and tell me my

nature and my name.

Give me freedom to grow so

that I may become my true

self----

the fulfillment of the seed

which you planted in me at

my making.

Out of the deep I cry unto

thee, O God. Amen

next:Articles: Healing Our Wounds

American alcohol education and prevention efforts for youth emphasize abstinence. In support of this approach, epidemiologists conclude that early drinking by adolescents increases the lifetime likelihood of alcohol dependence and that overall drinking levels in a society are directly linked to drinking problems. At the same time, cultural, ethnic, and social differences in drinking indicate that drinking styles are socialized and that those groups that encourage regular but controlled drinking yield lower rates of binge drinking and alcohol-related problems. Recent international epidemiologic research has found that societies in which men and women consume their alcohol in bursts have more drinking problems. The same cultures with high binge drinking rates for adults have high rates of adolescent drunkenness. It has, however, proven difficult to impose a moderate-drinking template on cultures, including notably American adolescent and college cultures. Nonetheless, approaches that focus on preventing problems rather than on abstinence per se - called harm reduction - may have value in reversing problems created by youthful drinking. The question is whether the socialization of moderate drinking can be incorporated as a harm reduction technique for young people, at least for college students.

Journal of Alcohol and Drug Education, Vol. 50(4), Dec. 2006, pp. 67-87

Introduction

Youthful drinking is of tremendous concern in the United States and elsewhere. Alcohol is the psychoactive substance used the most often by adolescents and college students and is associated with more youthful dysfunction and morbidity than any other drug. [1], [2], [3], [4] Alcohol use by youth contributes significantly to academic and social problems, risky sexual behavior, and traffic and other accidents, and is a risk factor for the development of alcohol-related problems during adulthood. As a result, youthful drinking - and particularly binge drinking - has been a target for public health interventions. It is thus highly troubling that these efforts have produced few benefits; high-risk drinking by both adolescents [5] and college students [6], [7] has not declined over the past decade. According to the Monitoring the Future (MTF) survey, the percentage of high seniors who have been drunk in the past month has gone below 30 percent one year in the last decade and a half (in 1993 the figure was 29%; in 2005 it was 30%; Table 1). Some data show startling increases in binge drinking by young people: the National Survey on Drug Use and Health (NSDUH) reported for 1997 that 27 percent of Americans aged 18 to 25 had consumed five or more drinks at one time in the prior month (Table 7.7) [8]; in 2004, the figure was 41 percent (Table 2.3B). [9]

Although research has found that American adolescents who begin drinking earlier in life are more likely to display adult alcohol dependence [10], another body of research has found that drinking varies tremendously among religious, ethnic, and national groups. [11], [12], [13] In particular, those groups that are less proscriptive towards alcohol and in fact permit and even teach drinking in childhood, and in which drinking is a regular integrated part of social life, display fewer alcohol problems. This work has usually been the province of sociology and anthropology. As such, it has not had a firm status in epidemiology and public health. The thrust in the public health field has been towards labeling alcohol an addictive drug and towards reducing and even eliminating youthful drinking. [14], [15]

Recently, however, several large international epidemiologic surveys have supported principal components of the sociocultural model of drinking patterns and alcohol problems. Among these studies are the European Comparative Alcohol Study (ECAS)12; the World Health Organization's ongoing Health Behaviour in School-aged Children (HBSC) survey tracking drinking and other behavior by young adolescents in 35 nations in Europe and (in the survey completed in 2001-2002) the U.S., Canada, and Israel)13; and the European School Survey Project on Alcohol and Other Drugs (ESPAD) surveying 15-16 year olds in 35 European countries (but not the United States and Canada), last completed in 2003. [16]

Religious/Ethnic Differences in Drinking Styles and Problems

Differences in drinking have frequently been noted among religious groups in the U.S. and elsewhere, including among youth and college students. Drinking by Jews has been one special object of attention due to their apparently low level of drinking problems. Weiss indicated that, although drinking problems in Israel have increased in recent decades, absolute rates of problem drinking and alcoholism in Israel remain low compared with Western and Eastern European countries, North America, and Australia. [17] The HBSC study found that Israel, among 35 Western nations, had the second lowest rates of drunkenness among 15-year-olds: 5% of girls and 10% of boys have been drunk two or more times, compared with 23% and 30% for the U.S. (Figure 3.12).[13]

Studies of drinking by Jews compared with other groups have included a study of male Jewish and Christian students at an American university by Monteiro and Schuckit, in which Jewish students were less likely to have 2 or more alcohol problems (13% v. 22%), or to have more than five drinks on a single occasion (36% v. 47%). Weiss compared drinking by Jewish and Arab youths, and found Arab drinking is far more frequently excessive, despite the Moslem prohibition on drinking. [19] Weiss explained such differences as follows: "The early socialization of Jewish children to a ritual, ceremonial and family use of alcoholic beverages provides a comprehensive orientation to the when, where, and how of drinking" (p111).[17]

The nonproscriptive approach to alcohol characterizes not only Jewish drinking. Some American Protestant sects are highly proscriptive towards alcohol (e.g., Baptists); others (e.g., Unitarians) not at all. Kutter and McDermott studied drinking by adolescents of various Protestant affiliations. [20] More proscriptive denominations were more likely to produce abstinent youth, but at the same time to produce youth who binged, and who binged frequently. That is, while 90 percent of youth in nonproscriptive sects had consumed alcohol, only 7 percent overall (or 8% of drinkers) had binged 5 or more times in their lives, compared with 66 percent of those in proscriptive sects who had ever consumed alcohol, while 22 percent overall in these sects (33% of drinkers) had binged 5 or more times.

At the same time that youth in proscriptive groups have less exposure to controlled drinking, these groups set up a "forbidden fruit" scenario. According to Weiss, "Forbidding drinking and conveying negative attitudes toward alcohol may prevent some members from experimenting with alcohol, but when members violate that prohibition by using alcohol, they have no guidelines by which to control their behavior and are at increased risk of heavy use" (p116).[17]

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NSDUH presents abstinence and binge-drinking rates (defined as 5 or more drinks at a single sitting in the past month) for racial-ethnic groups.9 Examining drinkers 18 and older, ethnic-racial groups with higher abstinence rates are more prone to binge. Among whites, the only group among whom a majority drink, 42 percent of drinkers binge. Fewer than half of all other racial/ethnic groups listed have drunk in the past month, but more of these binge. Among African Americans, 49 percent of drinkers binge; Hispanics, 55 percent; and Native Americans, 71 percent. See Table 1. The exception to this pattern is Asians, among whom a low percentage drink and a low percentage of these (33 percent) binge. This is true as well for collegiate Asian-American and Pacific Islanders (APIs): "rates of drinking and heavy drinking have been found to be lower among API college students than among other ethnic groups." [21] (p270)

Table 1 Percentage of past-month drinkers 18 and older who binge drink by ethnic/racial group
Racial/ethnic Group	% Currently Drink	Binge Drinkers/Drinkers*
White	59	42
African American	41	49
Hispanic	44	59
Native American	39	71
Asian	41	33
*Binge is defined as five or more drinks on a single occasion Source: 2004 National Survey on Drug Use and Health (Table 2.56B)

National Differences in Binge Drinking and Alcohol Problems

Although differences in cross-cultural drinking have long been noted, such differences have not been quantified. Recent international epidemiological research has filled in this gap. For example, Ramstedt and Hope compared Irish drinking with drinking in six European nations measured in the ECAS [22]:

Table 2 Percentage males drinking daily, binge drinking, and experiencing adverse consequences in selected countries
	Drink Daily	Binge Drinking per Drinking Occasion	Experience Adverse Consequences
Ireland	2	58	39
Finland	4	29	47
Sweden	3	33	36
UK	9	40	45
Germany	12	14	34
France	21	9	27
Italy	42	13	18
Source: Ramstedt and Hope (2003)

These European data show regular drinking is inversely related to binge drinking. Countries in which people are unlikely to drink daily (Ireland, UK, Sweden, and Finland) have high binge drinking rates, while countries with higher rates of daily drinking (e.g., France, Italy) have lower levels of binge drinking. Germany is intermediate. Ireland combines the highest level of abstinence, the lowest level of daily drinking, and by far the highest rate of binge drinking. Furthermore, according to the ECAS study, the countries with greater binge-drinking occasions tend to have more negative consequences (including fights, accidents, problems on the job or at home, etc.), while those countries with the highest frequency of drinking have fewer adverse consequences. (Table 2)

Boback et al. compared Russian, Polish, and Czech rates of problem drinking and of negative consequences of drinking. [23] Both were much higher in Russian men (35% and 18%, respectively) than in Czechs (19% and 10%) or Poles (14% and 8%). Although the Russian men had a substantially lower average annual intake (4.6 liters) than Czech men (8.5 liters) and drank far less frequently (67 drinking sessions per year, compared with 179 sessions among Czech men), they consumed the highest dose of alcohol per drinking session (means = 71 g for Russians, 46 g for Czechs, and 45 g for Poles) and had the highest prevalence of binge drinking.

Adolescent Drinking Cross-Culturally

The claim is frequently made now that adolescent intoxication is becoming homogenized across cultures - that is, traditional differences are diminishing, or have in fact already disappeared. "Increased binge drinking and intoxication in young people - the pattern of consumption associated with Northern Europe - is now reported even in countries such as France and Spain in which drunkenness was traditionally alien to the drinking cultures . . . ." [24] (p 16)

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The WHO's Health Behavior in School-Aged Children (HBSC)13, which measures drinking and drunkenness among 15-year olds, and the European School Survey Project on Alcohol and Other Drugs (ESPAD) includes data about 15-16 year-olds from 35 countries16, do not support these contentions. The results of these studies show large, continuing discrepancies between Northern and Southern European countries, differences that in some regards are increasing.

Table 3 Intoxicated 3+ occasions past 30 days, 15-16-year-olds, selected countries: 2003 ESPAD
Nation	Percentage
Denmark	26
Ireland	26
United Kingdom	23
Norway	12
Russia	11
Netherlands	7
France	3
Turkey	1
Source: 2003 ESPAD

The HBSC were summarized by the authors of the alcohol chapter as follows:

Countries and regions can be clustered according to their traditions in alcohol use. One cluster comprises countries on the Mediterranean sea. . . . (such as France, Greece, Italy, and Spain). Here, 15-year-olds have a relatively late onset and a low proportion of drunkenness.

Another cluster of countries (such as Denmark, Finland, Norway and Sweden) may be defined as representative of the Nordic drinking tradition. . . On some of these, drunkenness has a rather early onset (Denmark, Finland and Sweden) and is widespread in young people (Denmark in particular). [25] (pp79, 82)

Thus, we see that cross-cultural differences in drinking patterns persist with remarkable vitality among the young. These cultural drinking styles express underlying views of alcohol that are passed across generations. As expressed by one ECAS scientist:

In the northern countries, alcohol is described as a psychotropic agent. It helps one to perform, maintains a Bacchic and heroic approach, and elates the self. It is used as an instrument to overcome obstacles, or to prove one's manliness. It has to do with the issue of control and with its opposite - "discontrol" or transgression.

In the southern countries, alcoholic beverages - mainly wine - are drunk for their taste and smell, and are perceived as intimately related to food, thus as an integral part of meals and family life. . . . It is traditionally consumed daily, at meals, in the family and other social contexts. . . . [26] (p197)

Abstinence Versus Reality - Are Our Current Policies Counterproductive?

Alcohol education programs are prevalent in secondary schools and earlier in the United States. Their emphasis is typically abstinence. Indeed, since drinking is illegal for virtually every American high school student, as well as most college students (which is not true in Europe), it might seem abstinence is the only possible alcohol education goal for minors. In 2006, the U.S. Surgeon General issued a "call to action on preventing underage drinking" (emphasis added).[27]

There are nonetheless obvious deficiencies in a solely, or primarily, abstinence approach. According to NSDUH, in 2004 a majority (51%) of 15-year-olds, three quarters (76%) of 18-year-olds, and 85 percent of 20-year-olds have consumed alcohol - 56 percent of 20-year-olds have done so - and 40 percent overall have binged - in the past month (Table 2.24B).9 According to the 2005 MTF, three quarters of high school seniors have consumed alcohol, and well over half (58%) have been drunk (Table 1).[1] What would be a realist goal of a program to eliminate underage drinking, particularly considering this age group has been bombarded with no-drinking messages already? Seemingly, large numbers of underage drinkers will remain given even the most optimistic scenario.

Moreover, at age 21, young Americans are legally able to drink alcohol, and 90 percent have done so - 70 percent in the last month. They have not drunk well. More than 40 percent of those in every age group between 20 and 25 have binge drunk in the past month (Table H.20).9 The highest figure is for 21-year-olds, 48 percent of whom have binge drunk in the past month, or nearly 7 in 10 drinkers (69%). Although alcohol is not separately calculated, 21 percent of those ages 18 to 25 are classified as abusing or being dependent on alcohol or a drug. (Table H.38). How exactly are young people to be prepared for what will shortly be their legal introduction to drinking? The danger from failing to learn the value of moderation is that underage drinkers will continue to binge drink, even after they achieve legal drinking age.

Although there is a strong tendency for alcohol problems to diminish with age, recent American epidemiological research has found this maturation pattern to have slowed - that is, youthful binge and excessive drinking is continuing until later ages than previously noted.[28] NSDUH indicates binge drinking is frequent for adults - while 54 percent of Americans over 21 have consumed alcohol in the past month, 23 percent (43% of drinkers) have binged in the past month (Table 2.114B). Among college students, binge drinking is extremely frequent, as revealed by the College Alcohol Study (CAS), which found the overall rate for such drinking over the past two weeks to be 44 percent of all college students.[6]

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Moreover, the collegiate binge-drinking figure remained the same from 1993 to 2001, despite a host of efforts to cut the rate.[6] A funded program to reduce such intensive drinking did show higher rates of abstainers (19 percent in 1999 compared with 15 percent in 1993), but also an increase in frequent bingers (from 19 percent in 1993 to 23 percent in 1999).[29] Other research combining several data bases has shown that collegiate risk-drinking persists; indeed, driving under the influence of alcohol increased from 26 to 31 percent between 1998 and 2001.[7]

Data also show that recent age cohorts are more likely to become and remain alcohol dependent. Examining the National Longitudinal Alcohol Epidemiologic Survey (NLAES) conducted in 1992, Grant found the youngest cohort (those born between 1968 and 1974) was most likely to become, and persist in, alcohol dependence, even though this cohort overall was less likely as a group to drink than the cohort just before it.[30] The follow-up National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), conducted in 2001-2002, found that alcohol dependence (median age of incidence = 21) was slower to show remission than in the 1992 NLAES study.[31]

Finally, "medical epidemiology has generally accepted as established . . . . the protective effects of light drinking for general mortality." [32] These results have been acknowledged in the Dietary Guidelines for Americans.[33] And binge drinking, as this paper has shown, is associated with more adverse consequences. Yet young people do not believe regular moderate drinking is better than binge drinking. MTF finds that more high school seniors disapprove of people 18 and older having "one or two drinks nearly every day" (78%) than disapprove of having "five or more drink once or twice each weekend" (69%) (Table 10).[1]

Is a Reorientation of American Alcohol Policy and Education Advisable?

The data we have reviewed show that the current (and, in terms of the Surgeon General's initiative, intensifying) efforts to encourage abstinence have not reduced binge drinking and alcohol dependence. Indeed, major American surveys have shown clinical problems from drinking, for young people and beyond, to be increasing, even though overall drinking rates have declined. The combination of high abstinence and high binge drinking is typical in many contexts, as this paper has shown.

Comparisons of two primary cultural patterns of drinking - one in which alcohol is consumed regularly and moderately versus one in which alcohol is consumed sporadically but drinking occasions often involve high levels of consumption - show that the regular, moderate style leads to fewer adverse social consequences. Cultures where moderate drinking is socially accepted and supported also have less youthful binge drinking and drunkenness.

Conveying the advantages of one cultural style to those in other cultures, however, remains problematic. It is possible that drinking styles are so rooted in a given cultural upbringing that it is impossible to extirpate the binge drinking style in cultures where it is indigenous in order to teach moderate drinking on a broad cultural level. Nonetheless, there may still be benefits to educating youth to drink moderately in cultures where binge drinking is commonplace.

The approach propagated by many international policy groups (and many epidemiologists and other researchers) favors reducing overall drinking in a society and zero-tolerance (no-drinking) policies for the young. Yet, as indicated by variations in legal drinking ages, most Western nations continue to follow a different model. For example, the United States is the only Western country that restricts drinking to those 21 years of age or older. The typical age of majority for drinking in Europe is 18; but some Southern countries have lower age limits. Age limits may also be lower (for example, in the UK) when drinking occurs in a restaurant when a youth is accompanied by adults.

The United States, by restricting drinking to those 21 years of age and older, has adopted a model of alcohol problems that assumes drinking per se raises the risk of problems. Evidence supports that raising the drinking age lowers drinking rates and accidents among the young - primarily in precollegiate populations.[34] Nonetheless, most Western nations continue to accept the concept that encouraging youthful drinking in socially governed public environments is a positive societal goal. By learning to drink in such settings, it is hoped, youth will develop moderate drinking patterns from an early age.

Indeed, the policy of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) when it was initially created in 1970 under its first director, Morris Chafetz, included the creation of moderate drinking contexts for young people.[35] But this approach was never widely adopted in the United States and declined in popularity when youthful drinking accelerated in the late 1970s. One contemporary alternative to a zero-tolerance or decreased-overall-consumption model is the "social norms" model. The social norms approach informs students that many more students abstain, or drink moderately, than they are aware, assuming this will lead students to drink less themselves. However, CAS investigators found that colleges adopting the social norms approach showed no reduction in drinking levels and harms.[36]

A New Paradigm - Harm Reduction

At this point, it is obviously easier to point to failures in alcohol education and prevention programs for youths than to identify successes. As a result, leading researchers continue to uncover a growth in risk drinking among college students and to advocate stricter enforcement of zero-tolerance:

Among college students ages 18-24 from 1998 to 2001, alcohol-related unintentional injury deaths increased from nearly 1600 to more than 1700, an increase of 6% per college population. The proportion of 18-24-year-old college students who reported driving under the influence of alcohol increased from 26.5% to 31.4%, an increase from 2.3 million students to 2.8 million. During both years more than 500,000 students were unintentionally injured because of drinking and more than 600,000 were hit/assaulted by another drinking student. Greater enforcement of the legal drinking age of 21 and zero tolerance laws, increases in alcohol taxes, and wider implementation of screening and counseling programs and comprehensive community interventions can reduce college drinking and associated harm to students and others.[7] (p259) [emphasis added]

However, Hingson et al. in their recommendations also adumbrate a newer approach to youthful alcohol-related problems (and other substance abuse). Called "harm reduction," this approach does not insist on abstinence and instead focuses on reducing identifiable harms that result from overimbibing. Two examples of harm reduction in the substance abuse field are clean needle programs for injecting drug users and safe driver programs for drinking youths (like those encouraged by MADD). Teaching moderate drinking is another example of harm reduction. Any policy that recognizes drug use and underage drinking occur, while seeking to reduce their negative consequences, represents harm reduction.

 

CAS has tested a program that focuses on reducing harms rather than on abstinence per se.[37] The program, "A Matter of Degree" (AMOD), is funded by the Robert Wood Johnson Foundation and supported by the American Medical Association. AMOD entails a wide panoply of techniques, including advertising restrictions, enforcement of underage drinking violations, opening hours for alcohol sales, community norms against excessive drinking, and other environmental and local cultural factors. Many of these techniques, for instance enforcement of age restrictions on drinking, are part of existing zero-tolerance programs. Nonetheless, AMOD explicitly aims to forestall "heavy alcohol consumption" (p188) and acknowledges youthful drinking while attempting to reduce binge drinking. A test of AMOD at ten sites found no significant changes in actual drinking or harm associated with drinking. Nonetheless, the investigators conducted an internal analysis - based on those schools that implemented the most specific elements of AMOD - and found reduction of both alcohol consumption and alcohol-related harm due to adoption of AMOD policies.

Is Harm Reduction a Viable Policy for American Collegiate Drinking?

The AMOD goal of "reducing drinking" (like the phrase "reducing underage drinking") is actually ambiguous, in a significant way. It can mean either (a) reducing the number of people under 21 who drink at all with a goal of having few or no underage drinkers, or (b) reducing the amount of alcohol that underage age drinkers typically consume. Both would reduce the overall levels of alcohol consumed by young people. The first is a zero-tolerance approach, the second is harm reduction. Of course, the goal could be to increase both phenomena. An important question is whether it is possible to combine these policies - the question involves both political and technical, programmatic considerations.

AMOD does not explicitly endorse teaching students how to drink moderately, at the same time that the program aims to reduce excessive drinking. AMOD thus incorporates harm reduction without accepting underage drinking as a natural passage into adulthood, as is customary in cultures which inculcate moderate drinking patterns. Socializing children into drinking remains outside the pale of harm reduction programs like those represented by AMOD. It may be that exclusion of moderate-drinking concepts is necessary in the mixed cultural environment presented in the United States, at least in terms of gaining popular acceptance for harm reduction ideas.

Hope and Byrne, ECAS researchers working in the Irish context, analyzed the policy implications of ECAS results. These investigators recommend importing into Irish and other binge-drinking cultures what might be called the Mediterranean approach to youthful drinking:

The experience of the southern countries suggests that it is important to avoid both demonizing alcohol and promoting abstinence as key elements of alcohol control. In order to emulate the success of the alcohol control policies of the southern countries, the EU should consider a strategy that includes the following elements:

• Encourage moderate drinking among those who choose to drink with moderate drinking and abstinence being presented as equally acceptable choices.
• Clarify and promote the distinction between acceptable and unacceptable drinking.
• Firmly penalize unacceptable drinking, both legally and socially. Intoxication must never be humoured or accepted as an excuse for bad behavior. Avoid stigmatising alcohol as inherently harmful, as such stigmatization can create emotionalism and ambivalence.[38] (pp211-212, emphasis adde

In fact, Hope and Byrne themselves fall short of fully adopting harm reduction approaches, just as AMOD does, by understanding that a certain amount of drunkenness will inevitably occur, and that even intoxicated young people should also be protected from irreversible harmful consequences of their own actions - like accidents or medical harms.

Finally, the goal of achieving moderate drinking is most controversial in the United States in the case of alcoholism treatment. Although research continues to point to the value of such approaches [39], Alcoholics Anonymous and virtually all American treatment programs emphasize abstinence as the only way to resolve an alcohol problem. Moderation training for problem drinkers is one form of harm reduction. Research on training heavy or problematic collegiate drinkers to moderate their usage has proven highly successful, although this approach is still extremely limited in its utilization across the United States. [40]

There is no single optimal policy for youth drinking - there are dangers and drawbacks to both zero-tolerance and moderate-drinking approaches. Nonetheless, especially given the current policy imbalance that strongly favors the former, collegiate officials and health professionals should consider the following in developing harm reduction policies:

• Epidemiologic research has established advantages to moderate drinking, particularly when compared with binge drinking, advantages that should be acknowledged and encouraged as a model for alcohol use on campuses.
• Insisting on abstinence does not guarantee the absence of drinking on campus, and harm-reduction techniques for reducing the extent and impact of binge or other excessive collegiate drinking should be developed and implemented (e.g., safe rides, providing protected settings for intoxicated students).
• Alternative treatment/prevention approaches - approaches that recognize and encourage moderation - are particularly appropriate for younger drinkers for whom moderation is more achievable than it is for long-term alcoholics and for whom lifelong abstinence is very unlikely.

Unhealthy (or at least less than optimal) American attitudes towards alcohol are regularly promoted by governmental and public health officials, researchers, clinicians, and college administrators. Indeed, even when such individuals adopt moderate drinking practices in their personal lives, they are reluctant to consider them in formulating public policy. This disconnect between sensible drinking practices, identified both individually and epidemiologically, and policy implementation is not a healthy state of affairs for American alcohol policy towards young people.

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References

Allamani A. Policy implications of the ECAS results: A southern European perspective. (2002). In T. Norström (Ed.), Alcohol in postwar Europe: Consumption, drinking patterns, consequences and policy responses in 15 European countries (pp. 196-205). Stockholm, SW: National Institute of Public Health.

Babor, T. (Ed.). (2003). Alcohol: No ordinary commodity: Research and public policy. New York: Oxford University Press.

Baer, J.S., Kivlahan, D.R., Blume, A.W., McKnight, P., & Marlatt, G.A. (2001). Brief intervention for heavy-drinking college students: Four-year follow-up and natural history. American Journal of Public Health, 91, 1310-1316.

Bobak, M., Room, R., Pikhart, H., Kubinova, R., Malyutina, S., Pajak, A., et al.. (2004). Contribution of drinking patterns to differences in rates of alcohol related problems between three urban populations. Journal of Epidemiology and CommunityHealth, 58, 238-242.

Currie C., Robert, C., Morgan, A., Smith, R., Settertobulte, W., Samdal, O., et al. (Eds.). (2004). Young People's Health in Context. Copenhagen: World Health Organization.

Dawson, D.A., Grant, B.F., Stinson, F.S., Chou, P.S., Huang, B., & Ruan, W.J. (2005). Recovery from DSM-IV alcohol dependence: United States, 2001-2002. Addiction, 100, 281-292.

Departments of Agriculture and Health and Human Services. (2005). Dietary guidelines for Americans 2005. Washington, DC: U.S. Department of Health and Human Services.

Department of Health and Human Services. (2006). Surgeon General's call to action on preventing underage drinking. Federal Register, 71(35), 9133-9134.

Faden, V.B. & Fay, M.P. (2004). Trends in drinking among Americans age 18 and younger: 1975-2002. Alcoholism: Clinical and Experimental Research, 28, 1388-1395.

Grant, B.F. (1997). Prevalence and correlates of alcohol use and DSM-IV alcohol dependence in the United States: Results of the National Longitudinal Alcohol Epidemiologic Survey. Journal of Studies on Alcohol, 58, 464-473.

Harford, T.C. & Gaines, L.S. (Eds.). (1982). Social drinking contexts. Rockville, MD: NIAAA.

Heath, D.B. (2000). Drinking occasions: Comparative perspectives on alcohol and culture. Philadelphia, PA: Brunner/Mazel.

Hibell, B., Andersson, B., Bjarnason, T., Ahlström, S., Balakireva, O., Kokkevi, A., et al. (2004). The ESPAD report 2003: Alcohol and other drug use among students in 35 European countries. Stockholm: Swedish Council for Information on Alcohol and Other Drugs.

Hingson, R., Heeren, T., Winter, M., & Wechsler, H. (2005). Magnitude of alcohol-related mortality and morbidity among U.S. college students ages 18-24: Changes from 1998 to 2001. Annual Review of Public Health, 26, 259-279.

Hope, A. & Byrne, S. (2002) ECAS findings: Policy implications from an EU perspective. In T. Norström (Ed.). Alcohol in postwar Europe: Consumption, drinking patterns, consequences and policy responses in 15 European Countries (pp. 206-212). Stockholm: National Institute of Public Health.

Johnston, L.D., O'Malley, P.M., Bachman, J.G., & Schulenburg, J.E. (2006). National results on adolescent drug use: Overview of key findings, 2005 (NIH Publication No. 06-5882). Bethesda, MD: National Institute on Drug Use.

Kutter, C., & McDermott, D.S. (1997). The role of church in adolescent drug education. Journal of Drug Education, 27, 293-305.

Makimoto, K. (1998). Drinking patterns and drinking problems among Asian-Americans and Pacific Islanders. Alcohol Health & Research World, 22, 270-275.

McNeil, A. (2000). Alcohol and young people in Europe. In A. Varley (Ed.). Towards a global alcohol policy:Proceedings of the Global Alcohol Policy Advocacy Conference (pp. 13-20). Syracuse, NY.

Monitoring the Future. (2006). MTF data tables and figures. Retrieved April 10, 2006, from http://monitoringthefuture.org/data/05data.html#2005data-drugs.

Monteiro, M.G. & Schuckit, M.A. (1989). Alcohol, drug and mental health problems among Jewish and Christian men at a university. American Journal of Drug and Alcohol Abuse, 15, 403-412.

Moore, A.A., Gould, R.R., Reuben, D.B., Greendale, G.A., Carter, M.K., Zhou, K., & Karlamangla, A.(2005). Longitudinal patterns and predictors of alcohol consumption in the United States. American Journal of Public Health, 95, 458-465.

National Survey on Drug Use and Health. (1997/2005). 1997 National survey on drug use and health. Retrieved April 10, 2006, from http://www.oas.samhsa.gov/nsduhLatest.htm.

National Survey on Drug Use and Health. (2005). 2004 National survey on drug use and health. Retrieved April 10, 2006, from http://www.oas.samhsa.gov/nsduhLatest.htm.

Norström, T. (Ed.). (2002). Alcohol in postwar Europe: Consumption, drinking patterns, consequences and policy responses in 15 European countries. Stockholm:National Institute of Public Health.

Perkins, H.W. (2002) Social norms and prevention of alcohol misuse in collegiate contexts. Journal of Studies on Alcohol Supplement, 14, 164-172.

Ramstedt, M. & Hope, A. (2003). The Irish drinking culture: Drinking and drinking-related harm, a European comparison. Retrieved May 24, 2006, from http://www.healthpromotion.ie/uploaded_docs/Irish_Drinking_Culture.PDF.

Rehm, J., Room, R., Graham, K., Monteiro, M., Gmel, G., & Sempos, C.T. (2003). Relationship of average volume of alcohol consumption and patterns of drinking to burden of disease: An overview. Addiction, 98, 1209-1228.

Room, R. (2006). Looking towards policy in thinking about alcohol and the heart. In J. Elster, O. Gjelvik, A. Hylland, & K. Moene K (Eds.). Understanding choice, explaining behavior (pp. 249-258). Oslo: Academic Press.

Saladin, M.E., & Santa Ana, E.J. (2004). Controlled drinking: More than just a controversy. Current Opinion in Psychiatry, 17, 175-187.

Schmid, H., & Nic Gabhainn, S. (2004). Alcohol use. In C. Currie, et al. (Eds.). Young people's health in context. Health Behaviour in School-Aged Children (HBSC) study:International report from the 2001/2002 survey (pp. 73-83). Geneva: World Health Organization Regional Office for Europe.

Wagenaar, A.C., & Toomey, T.L. (2002). Effects of minimum drinking age laws: Review and analyses of the literature from 1960 to 2000. Journal of Studies on Alcohol Supplement, 14, 206-225.

Warner, L.A., & White, H.R. (2003). Longitudinal effects of age at onset and first drinking situations on problem drinking. Substance Use and Misuse, 38, 1983-2016.

Wechsler, H., Lee, J.E., Kuo, M., & Lee, H. (2000). College binge drinking in the 1990s: A continuing problem — Results of the Harvard School of Public Health 1999 College Alcohol Study. Journal of American College Health, 48, 199-210.

Wechsler, H., Lee, J.E., Kuo, M., Seibring, M., Nelson, T.F., & Lee, H. (2002). Trends in college binge drinking during a period of increased prevention efforts: Findings from 4 Harvard School of Public Health College Alcohol Study surveys. Journal of American College Health, 50, 203-217.

Wechsler, H., Nelson, T.F., Lee, J.E., Seibring, M., Lewis, C., & Keeling, R.P. (2003). Perception and reality: A national evaluation of social norms marketing interventions to reduce college students' heavy alcohol use. Journal of Studies on Alcohol, 64, 484-494.

Weiss, S. (1997). Urgent need for prevention among Arab youth in 1996 (in Herbew). Harefuah, 132, 229-231.

Weiss, S. (2001). Religious influences on drinking: Influences from select groups. In E. Houghton & A.M. Roche (Eds.). Learning about Drinking (pp. 109-127). Philadelphia: Brunner-Routledge.

Weitzman, E.R., Nelson, T.F., Lee, H., & Wechsler, H. (2004). Reducing drinking and related harms in college: Evaluation of the "A Matter of Degree" program. American Journal of Preventive Medicine, 27, 187-196.

White, A.M., Jamieson-Drake, D., & Swartzwelder, H.S. (2002). Prevalence and correlates of alcohol-induced blackouts among college students: Results of an e-mail survey. Journal of American College Health, 51, 117-131.

World Health Organization. (2000). International guide for monitoring alcohol consumptionand related harm. Geneva: Author.

Acknowledgement and Disclosure

I am indebted to Archie Brodsky and Amy McCarley for assistance in writing this article. Research for the article was supported by a small grant from the International Center for Alcohol Policies.

Notes

1. Johnston LD, O'Malley PM, Bachman JG, Schulenburg JE. National Results on Adolescent Drug Use: Overview of Key Findings, 2005. Bethesda, MD: National Institute on Drug Use; 2006.
2. World Health Organization. International Guide for Monitoring Alcohol Consumption and Related Harm. Geneva, SW: Author; 2000.
3. Perkins, HW. Social norms and prevention of alcohol misuse in collegiate contexts. J Stud Alcohol Suppl 2002;14:164-172.
4. White AM, Jamieson-Drake D, Swartzwelder HS. Prevalence and correlates of alcohol-induced blackouts among college students: Results of an e-mail survey. J Am Coll Health 2002;51:117-131.
5. Faden VB, Fay MP. Trends in drinking among Americans age 18 and younger: 1975-2002. Alcohol Clin Exp Res 2004;28:1388-1395.
6. Wechsler H, Lee JE, Kuo M, Seibring M, Nelson TF, Lee H. Trends in college binge drinking during a period of increased prevention efforts: Findings from 4 Harvard School of Public Health College Alcohol Study surveys. J Am Coll Health 2002;50:203-217.
7. Hingson R, Heeren T, Winter M, Wechsler H. Magnitude of alcohol-related mortality and morbidity among U.S. college students ages 18-24: Changes from 1998 to 2001. Annu Rev Public Health 2005;26:259-279.
8. Substance Use and Mental Health Administration. National Household Survey on Drug Abuse: Main Findings 1997. Washington, DC: U.S. Department of Health and HumanServices;1998.
9. Substance Abuse and Mental Health Services Administration. 2004 National Survey on Drug Use & Health. Washington, DC: U.S. Department of Health and HumanServices; 2005.
10. Warner LA, White HR. Longitudinal effects of age at onset and first drinking situations on problem drinking. Subst Use Misuse 2003;38:1983-2016.
11. Heath DB. Drinking Occasions: Comparative Perspectives on Alcohol and Culture. Philadelphia, PA: Brunner/Mazel; 2000.
12. Norström T, ed. Alcohol in Postwar Europe: Consumption, Drinking Patterns, Consequences and Policy Responses in 15 European Countries. Stockholm, Sweden:National Institute of Public Health; 2002.
13. Currie C, et al. eds. Young People's Health in Context. Copenhagen, World Health Organization, 2004.
14. Babor T. Alcohol: No Ordinary Commodity: Research and Public Policy. New York: Oxford University Press; 2003.
15. Rehm J, Room R, Graham K, Monteiro M, Gmel G, Sempos CT. Relationship of average volume of alcohol consumption and patterns of drinking to burden of disease: An overview. Addiction 2003;98:1209-1228, 2003.
16. Hibell B, Andersson B, Bjarnason T, Ahlström S, Balakireva O, Kokkevi A, Morgan M. The ESPAD Report 2003: Alcohol and Other Drug Use Among Students in 35 European Countries. Stockholm, Sweden: Swedish Council for Information on Alcohol and Other Drugs; 2004.
17. Weiss S. Religious influences on drinking: Influences from select groups. In Houghton E, Roche AM, eds. Learning About Drinking. Philadelphia: Brunner-Routledge; 2001:109-127.
18. Monteiro MG, Schuckit MA. Alcohol, drug and mental health problems among Jewish and Christian men at a university. Am J Drug Alcohol Abuse 1989;15:403-412.
19. Weiss S. Urgent need for prevention among Arab youth in 1996 (in Herbew). Harefuah 1997;132:229-231.
20. Kutter C, McDermott DS. The role of church in adolescent drug education. J Drug Educ. 1997;27:293-305.
21. Makimoto K. Drinking patterns and drinking problems among Asian-Americans and Pacific Islanders. Alcohol Health Res World 1998;22:270-275.
22. Ramstedt M, Hope A. The Irish Drinking Culture: Drinking and Drinking-Related Harm, a European Comparison. Dublin, Ireland: Report for the Health Promotion Unit, Ministry of Health and Children; 2003.
23. Bobak M, Room R, Pikhart H, Kubinova R, Malyutina S, Pajak A, Kurilovitch S, Topor R, Nikitin Y, Marmot M. Contribution of drinking patterns to differences in rates of alcohol related problems between three urban populations. J Epidemiol CommunityHealth 2004;58:238-242.
24. McNeil A. Alcohol and young people in Europe. In Varley A, ed. Towards a Global Alcohol Policy. Proceedings of the Global Alcohol Policy Advocacy Conference, Syracuse, NY; August 2000:13-20.
25. Schmid H, Nic Gabhainn S. Alcohol use. In Currie C, et al., eds. Young People's Health in Context. Health Behaviour in School-Aged Children (HBSC) Study:International Report from the 2001/2002 Survey. Geneva, Switzerland: World Health Organization Regional Office for Europe; 2004:73-83.
26. Allamani A. Policy implications of the ECAS results: A southern European perspective. In Norström T, ed. Alcohol in Postwar Europe: Consumption, Drinking Patterns, Consequences and Policy Responses in 15 European Countries. Stockholm, SW: National Institute of Public Health; 2002:196-205.
27. Department of Health and Human Services. Surgeon General's call to action on preventing underage drinking. Federal Register February 22, 2006:71(35);9133-9134.
28. Moore AA, Gould RR, Reuben DB, Greendale GA, Carter MK, Zhou K, Karlamangla A. Longitudinal patterns and predictors of alcohol consumption in the United States. Am J Public Health, 2005; 95:458-465.
29. Wechsler H, Lee JE, Kuo M, Lee H. College binge drinking in the 1990s: A continuing problem — Results of the Harvard School of Public Health 1999 College Alcohol Study. J Am Coll Health 2000;48:199-210.
30. Grant BF. Prevalence and correlates of alcohol use and DSM-IV alcohol dependence in the United States: Results of the National Longitudinal Alcohol Epidemiologic Survey. J Stud Alcohol 1997;58:464-473.
31. Dawson DA, Grant BF, Stinson FS, Chou PS, et al. Recovery from DSM-IV alcohol dependence: United States, 2001-2002. Addiction, 2005;100:281-292.
32. Room, R. Looking towards policy in thinking about alcohol and the heart. In Elster J, Gjelvik O, Hylland, A, Moene K, eds., Understanding Choice, Explaining Behavior.Oslo, Norway: Oslo Academic Press; 2006:249-258.
33. Departments of Agriculture and Health and Human Services. Dietary Guidelines for Americans. Washington, DC: U.S. Department of Health and Human Services; 2000.
34. Wagenaar AC, Toomey TL. Effects of minimum drinking age laws: Review and analyses of the literature from 1960 to 2000. J Stud Alcohol Suppl 2002;14:206-225.
35. Harford TC, Gaines LS, eds. Social Drinking Contexts (Res Mon 7). Rockville, MD: NIAAA; 1982.
36. Wechsler H, Nelson TF, Lee JE, Seibring M, Lewis C, Keeling RP. Perception and reality: A national evaluation of social norms marketing interventions to reduce college students' heavy alcohol use. J Stud Alcohol 2003;64:484-494.
37. Weitzman ER, Nelson TF, Lee H, Wechsler H. Reducing drinking and related harms in college: Evaluation of the "A Matter of Degree" program. American Journal of Preventive Medicine 2004;27:187-196.
38. Hope A, Byrne S. ECAS findings: Policy implications from an EU perspective. In Norström T, ed. Alcohol in Postwar Europe: Consumption, Drinking Patterns, Consequences and Policy Responses in 15 European Countries. Stockholm, SW: National Institute of Public Health; 2002:206-212.
39. Saladin ME, Santa Ana EJ. Controlled drinking: More than just a controversy.
    Curr Opin Psychiatry 2004;17:175-187.
40. Baer JS, Kivlahan DR, Blume AW, McKnight P, Marlatt GA. Brief intervention for heavy-drinking college students: Four-year follow-up and natural history. Am J Public Health 2001;91:1310-1316.

 

How to obtain student records in the UK.

Under the Education (Pupil Information) (England) Regulations 2000 parents are entitled to have their child's educational records disclosed to them, free of charge, within 15 school days of making a written request.

The Data Protection Act 1998 came into force on 1 March 2000. It gives all individuals who are the subject of personal data ("data subjects") a general right of access to the personal data which relates to them. These rights are known as "subject access rights". Requests for access to records and for other information about those records are known as "subject access requests." Personal data may take the form of computerised or, in some cases, paper records.

The Data Protection Act gives all school students, regardless of age, the right of access to their school pupil records. Requests to see or receive copies of records should be made in writing to head teachers.

Below is a sample letter that can be used to send to the Local Education Authority or the School itself if you want to apply for access to or copies of your child's school records.

Normally you would send first to the school and if you do that make sure that you also send a copy to the Local Education Authority as well so that if you get no reply or anything from the school you can send direct to the LEA and refer to that previous letter that was copied to them.

YOUR ADDRESS

DATE

Dear Sir,

Childs Name Under the Data Protection Act 1998 which came into force on 1 March 2000. It gives all individuals who are the subject of personal data ("data subjects") a general right of access to the personal data which relates to them. These rights are known as "subject access rights". Requests for access to records and for other information about those records are known as "subject access requests." Personal data may take the form of computerised or, in some cases, paper records.

The Act also sets out specific rights for school students in relation to educational records held within the state education system whether these are held in computerised or paper form. Educational records are the official records for which head teachers are responsible. The rights of students lie alongside the rights of parents to obtain copies of the educational records relating to their children. These are set out in separate education regulations The Education (Pupil Information) (England) Regulations 2000.

I am therefore writing to request copies of the full school records for my child CHILDS NAME. The records should include records for all schools CHILDS NAME attended: LIST SCHOOLS AND DATES THERE IF POSSIBLE Yours sincerely YOU SIGN c.c. Local Education Authority

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Covers the components of school policy as it applies to children with disabilities in the UK.

Access Audit of the School Environment. Carry out a full access audit of your building. Involve pupils. Cost and set targets of major and minor works to be included in the School Development Plan.

Audit Access to the Learning Environment. Audit software and hardware suitable for supporting learning difficulty; maintain up-to-date information on adaptations e.g. Brailling, vocalising, touch screen, laptops, switching.

Ensure Disability Issues are in the Curriculum. When planning curriculum unit, topic or module, think of including a disability dimension. Build up resources and literature that are nondiscriminatory. Promote the 'social model'.

Disabled people are positively portrayed - images. Ensure all children have access to positive images of disabled adults and children.

Diversify the curriculum - use a variety of approaches. Use a wide variety of approaches when planning the curriculum to draw on different strengths and aptitudes of the pupils. Build up a resource bank of ideas and lessons allowing time for joint planning and review. Make sure all staff use the QCA General Inclusion Guidelines in planning and delivery of teaching and learning.

Develop collaborative learning and peer tutoring. The biggest learning resource in any school are the pupils. Involve them in pairing with children of different abilities and groups. All benefit.

Effective team approach for learning support and curriculum planning. Ensure that learning support is effectively co-ordinated throughout the school by allowing time for joint planning in school day involving teams of teachers & welfare assistants.

British Sign Language taught and used. When a school includes deaf children, make use of British Sign Language translators and teachers. Offer deaf children the chance to work with native signers. Offer hearing children the chance to study sign language as part of the curriculum.

Accessible communication in school/to parents. Recognise that not everyone communicates by written or spoken English. Audit the communication needs within the school and of parents and provide notices, reports, information & directions in the relevant format, e.g. large print, Braille, tape, videos in BSL, computer disk & pictograms.

Be critical of disablist language used. Examine language used to describe pupils, in teaching and by pupils. Much of it is disablist and impairment derived. Develop a critical reappraisal through Disability Equality Training, assemblies and in class.

Challenge impairment derived abuse, name calling and bullying as part of school behavior policy. Introduce effective policy to prevent abuse, name calling and bullying because of physical, mental or sensory differences. Involve all pupils in developing behaviour policy.

Intentionally build relationships. Policies devised by pupil involvement & based on principles of self-regulation & mutual respect are the most effective. Sometimes it is necessary for adults to take a lead in setting up circles of friends & buddy systems. All children should remain on role even if for some time they are out of class. Devise systems where distressed children can take 'time-out'.

Develop a whole-school ethos on accepting difference.

Develop empowerment and self-representation of disabled pupils. Set up structures through which disabled puplis/those with SEN cab express their views, develop self-esteem, & have some influence on school policies. Involve disabled adults in this process.

Physical Education. Ensure PE and sporting activities involve all pupils, develop collaboration & encourage all pupils to improve their personal performance. Use adaptation and creative imagination to succeed in this.

Transport and having a school trips policy that includes all. Ensure transport to and from the school for disabled pupils fit in with the school day and allow for attendance at after school activities. Allow friends and siblings to use to break down isolation. Ensure no pupil is excluded from a trip or visit because their access or other needs are not met. This means careful advanced planning and pre-visits.

Have an increasing inclusion ethos in school development plan. The school should examine every aspect of its activity for barriers to inclusion and then set a series of targets for their eradication describing how this is to be achieved. Remember the SEN and Disability Act is anticipatory.

Include Outside Specialist Support. Plan the work of speech, physiotherapy and occupational therapists in a co-ordinated way which best supports pupils' curriculum needs and reduces disruption to their learning and social needs.

Have policy on Administering Medication and Personal Assistance. Devise a policy on administering routine medication that is easy for pupils to use and develop systems that maintain their dignity on personal hygiene issues. Have a system for handling medical emergencies that is easy for everyone to use. Volunteers should be trained by medical practitioners, then they are indemnified.

Maintain Equipment. Ensure that specialist equipment is properly maintained, stored and replaced when necessary; mobility aids, e.g. wheelchairs and walking frames, are regularly checked; and that staff are trained in their proper use.

Increase the employment of disabled staff. The Disability Discrimination Act Part II since 1995 has applied to employment in most schools. From 2003 it will apply to all schools when the small employer exemption is lifted. Revise your equal opportunity employment policy to increase the employment of disabled teaching and non-teaching staff. There is Access to Work money available. All children need disabled adult role models.

Disability Equality Training and ongoing INSET for Staff and Governors. Organise a programme of in-service training for teachers, support staff and governors to help them move towards inclusion and disability equality. Ensure all staff are involved in and understand the process of inclusion.

Governing Body representation. Appoint a governor to have a brief for inclusion, with the whole governing body involved in developing inclusion policy. Try to get disabled governors. Make your meetings accessible.

Consultation with and involvement of parents. Ensure there are effective arrangements for involving parents in all parts of their child's school life and decisions that have to be made. These arrangements should involve counseling and support in helping a child towards independence. With their permission, maintain information about parents who are themselves disabled so their access and their needs can be met.

The above information has been written by Disability Equality in Education.

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A complete medical assessment is important when diagnosing eating disorders. Talk with your doctor about performing specific laboratory tests.

With eating disorders, the most important first step toward diagnosis and recovery is to have a complete assessment. This includes a medical evaluation to rule out any other physical cause for the symptoms, to assess the impact the illness has had to date, and to determine whether immediate medical intervention is needed. (See Table 1 for specific tests.) Equally important is the mental health assessment, preferably by an eating disorder expert to provide a full diagnostic picture. Many people with eating disorders have other problems (comorbidity) as well, including depression, trauma, obsessive-compulsive disorder, anxiety, or chemical dependence. This assessment will determine what level of care is needed (inpatient eating disorder treatment, outpatient, partial hospital, residential) and what professionals should be involved in the treatment.

TABLE 1--Recommended Laboratory Tests When Diagnosing Eating Disorders

Standard

• Complete Blood Count (CBC) with differential
• Urinalysis
• Complete Metabolic Profile: Sodium, Chloride, Potassium, Glucose, Blood Urea Nitrogen, Creatinine, Total Protein, Albumin, Globulin, Calcium, Carbon Dioxide, AST, Alkaline Phosphates, Total Bilirubin
• Serum magnesium
• Thyroid Screen (T3, T4, TSH)
• Electrocardiogram (ECG)

Special Circumstances

15% or more below ideal body weight (IBW)

• Chest X-Ray
• Complement 3 (C3)
• 24 Creatinine Clearance
• Uric Acid

20% or more below IBW or any neurological sign

• Brain Scan

20% or more below IBW or sign of mitral valve prolapse

Echocardiogram 30% or more below IBW

Skin Testing for Immune Functioning

Weight loss 15% or more below IBW lasting 6 months or longer at any time during course of eating disorder

• Dual Energy X-Ray Absorptiometry (DEXA) to assess bone mineral density
• Estadiol Level (or testosterone in males)

TABLE 2--Criteria for Level of Care

Inpatient

Medically Unstable

• Unstable or depressed vital signs
• Laboratory findings presenting acute risk
• Complications due to coexisting medical problems such as diabetes

Psychiatrically Unstable

• Symptoms of eating disorders worsening at rapid rate
• Suicidal and unable to contract for safety

Residential

• Medically stable so does not require intensive medical interventions
• Psychiatrically impaired and unable to respond to partial hospital or outpatient treatment

Partial Hospital

Medically stable

• Eating disorder may impair functioning but not causing immediate acute risk
• Needs daily assessment of physiological and mental status

Psychiatrically stable

• Unable to function in normal social, educational, or vocational situations
• Daily binge eating, purging, severely restricted intake, or other pathogenic weight control techniques

Intensive Outpatient/Outpatient

Medically stable

• No longer needs daily medical monitoring

Psychiatrically stable

• Symptoms in sufficient control to be able to function in normal social, educational, or vocational situations and continue to make progress in eating disorder recovery.

Compiled for the National Eating Disorders Association by Margo Maine, PhD

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Research has shown that combining criminal justice sanctions with addiction treatment can be effective in decreasing drug use and related crime. Individuals under legal coercion tend to stay in treatment for a longer period of time and do as well as or better than others not under legal pressure. Often, drug abusers come into contact with the criminal justice system earlier than other health or social systems, and intervention by the criminal justice system to engage the individual in treatment may help interrupt and shorten a career of drug use. Treatment for the criminal justice-involved drug abuser or drug addict may be delivered prior to, during, after, or in lieu of incarceration.

Combining criminal justice sanctions with drug treatment can be effective in decreasing drug use and related crime.

Prison-Based Drug Treatment Programs

Offenders with drug disorders may encounter a number of treatment options while incarcerated, including didactic drug education classes, self-help programs, and treatment based on therapeutic community or residential milieu therapy models. The TC model has been studied extensively and can be quite effective in reducing drug use and recidivism to criminal behavior. Those in treatment should be segregated from the general prison population so that the "prison culture" does not overwhelm progress toward recovery. As might be expected, treatment gains can be lost if inmates are returned to the general prison population after drug addiction treatment. Research shows that relapse to drug use and recidivism to crime are significantly lower if the drug offender continues treatment after returning to the community.

Community-Based Addiction Treatment for Criminal Justice Populations

A number of criminal justice alternatives to incarceration have been tried with offenders who have drug disorders, including limited diversion programs, pretrial release conditional on entry into treatment, and conditional probation with sanctions. The drug court is a promising approach. Drug courts mandate and arrange for drug addiction treatment, actively monitor progress in treatment, and arrange for other services to drug-involved offenders. Federal support for planning, implementation, and enhancement of drug courts is provided under the U.S. Department of Justice Drug Courts Program Office.

As a well-studied example, the Treatment Accountability and Safer Communities (TASC) program provides an alternative to incarceration by addressing the multiple needs of drug-addicted offenders in a community-based setting. TASC programs typically include counseling, medical care, parenting instruction, family counseling, school and job training, and legal and employment services. The key features of TASC include (1) coordination of criminal justice and drug treatment; (2) early identification, assessment, and referral of drug-involved offenders; (3) monitoring offenders through drug testing; and (4) use of legal sanctions as inducements to remain in treatment.

Further Reading:

Anglin, M.D. and Hser, Y. Treatment of drug abuse. In: Tonry M. and Wilson J.Q., eds. Drugs and crime. Chicago: University of Chicago Press, 1990, pp. 393-460.

Hiller, M.L.; Knight, K.; Broome, K.M.; and Simpson, D.D. Compulsory community-based substance abuse treatment and the mentally ill criminal offender. The Prison Journal 76(2), 180-191, 1996.

Hubbard, R.L.; Collins, J.J.; Rachal, J.V.; and Cavanaugh, E.R. The criminal justice client in drug abuse treatment. In Leukefeld C.G. and Tims F.M., eds. Compulsory treatment of drug abuse: Research and clinical practice [NIDA Research Monograph 86]. Washington, DC: U.S. Government Printing Office, 1998.

Inciardi, J.A.; Martin, S.S.; Butzin, C.A.; Hooper, R.M.; and Harrison, L.D. An effective model of prison-based treatment for drug-involved offenders. Journal of Drug Issues 27 (2): 261-278, 1997.

Wexler, H.K. The success of therapeutic communities for substance abusers in American prisons. Journal of Psychoactive Drugs 27(1): 57-66, 1997.

Wexler, H.K. Therapeutic communities in American prisons. In Cullen, E.; Jones, L.; and Woodward R., eds. Therapeutic Communities in American Prisons. New York: Wiley and Sons, 1997.

Wexler, H.K.; Falkin, G.P.; and Lipton, D.S. (1990). Outcome evaluation of a prison therapeutic community for substance abuse treatment. Criminal Justice and Behavior 17(1): 71-92, 1990.

Source: National Institute of Drug Abuse, "Principles of Drug Addiction Treatment: A Research Based Guide." Last updated September 27, 2006.

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Self-Therapy For People Who ENJOY Learning About Themselves

The best measure of emotional health is: How well do we handle the problems and opportunities we face in our daily lives? If you are extremely neurotic but you've found a way to survive a difficult life, you are healthier than those who avoid such labels only because they have had easier lives.

THE BIG THREE

The three most important signs of emotional health are: Spontaneity, Intimacy, and Awareness.

SPONTANEITY

Spontaneity refers to the immediacy with which we express ourselves. If you usually "think first" before you speak, or if you always "wait" before taking action, you are not very spontaneous.

Being spontaneous shows that we trust who we are. Ask yourself: "How often do I just react to things, without thinking?" If you answer "almost always," you are spontaneous and very healthy emotionally.

INTIMACY

Intimacy refers to being able to feel safe when we are close to others. If you usually look away when people look your way, or if you are often lonely, you are not very intimate.

Being intimate shows we trust ourselves, and others, socially. Ask Yourself: "How often do I feel completely safe when I look into other people's eyes?" If you answer "almost always," you are intimate and very healthy emotionally.

AWARENESS

Awareness refers to our ability to see and hear clearly and to believe what we see and hear.

If you often doubt your own perception of people and situations you are not very aware (or you are very aware and don't know it - a common problem).

Being aware shows we are alert, rather than mentally preoccupied. Ask Yourself: "How often do I think I am wrong about my perceptions?" "How often do I ask other people to confirm my perceptions and thinking?" If you answer "almost never" you are aware and very healthy emotionally.

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OTHER SIGNS OF EMOTIONAL HEALTH: A CHECKLIST

Can You Answer "Yes" To These Questions?

• Are you usually energetic (not frenetic)?

• Do you seldom make comparisons between yourself and others (less than once a day)?

• Do you laugh genuinely and often (many times most days)?

• Are you a "self-starter"?

• Are you quick and appropriate with your anger?

• Are you slowed down significantly by depression less than two days a year?

• Do you almost never feel guilty?

• Do you have a good, long-lasting relationship with your partner?

• Do you have good, long-lasting friendships (at least two or three)?

• Do you almost never spend social or family time with people who mistreat you?

• Do you seldom regret your decisions?

• Do you make most decisions quickly?

• Is your sex life exciting?

• Do you recognize sadness, anger, scare, joy, and excitement easily in yourself?

• Are you seldom told that you are controlling or manipulative?

• Do you never wonder if you abuse alcohol or other drugs?

• Do you know you could survive and thrive (after a long grieving period) even if you lost all of the important people in your life?

• Do you make friends easily?

• Are you seldom thought of as bigoted?

EVALUATING YOUR RESULTS

Each "Yes" is a remarkable achievement accomplished by a small percentage of people! Complement yourself sincerely and proudly for every "yes" on this page! Each "No" is a way that you are "about average" in this culture. Read each "no" again and say: "I could improve this if I wanted to!"

MAKING CHANGES

Decide whether to change by deciding how much emotional pain your problems cause for you and for those you love.

Then, if you are not successful on your own, decide whether to work on these problems in therapy by weighing this pain against the various costs involved (financial, time, privacy, inconvenience, etc.).

next: Growing Up Emotionally

Alzheimer's Disease Articles' Supporting Research

Archana R, Namasivayan A. Antistressor effect of Withania somnifera. J Ethnopharmacol. 1999;64:91-93.

Bird TD. Alzheimer's disease and other primary dementias. In: Fauci AS, Braunwald E, Isselbacher KJ, et al, eds. Harrison's Principles of Internal Medicine. 14th ed. New York, NY: McGraw-Hill; 1998:2348-2352.

Blumenthal M, ed. Herbal Medicine: Expanded Commission E. Newton, Mass: Integrative Medicine Communications, Inc.; 2000.

Bone K. Botanical therapies for Alzheimer's disease. Presented at: Clinical Practice and Assessment Skills. American Herbalist Guild Symposium 2000; October 20-22, 2000; Mount Madonna, Watsonville, Calif.

Bottiglieri T, Godfrey P, Flynn T, Carney MWP, Toone BK, Reynolds EH. Cerebrospinal fluid S-adenosylmethionine in depression and dementia: effects of treatment with parental and oral -adenosylmethionine. J Neurol Neurosurg Psychiatry. 1990;53:1096-1098.

Christen Y. Oxidative stress and Alzheimer disease. Am J Clin Nutr. 2000;71(suppl):621S-629S.

Clarke R, Smith AD, Jobst KA, Refsum H, Sutton L, Veland PM. Folate, vitamin B12, and serum total homocysteine levels in confirmed Alzheimer disease. Arch Neurol. 1998;55:1449-1455.

Dhuley JN. Effect of ashwagandha on lipid peroxidation in stress-induced animals. J Ethnopharmacol. 1998;60:173-178.

Diamond BJ, Shiflett SC, Feiwel N, et al. Ginkgo biloba extract: mechanisms and clinical indications. Arch Phys Med Rehabil. 2000;81:669-678.

Ernst E, Pittler MH. Ginkgo biloba for dementia: a systematic review of double-blind, placebo-controlled trials. Clin Drug Invest. 1999;17:301-308.

Forbes DA. Strategies for managing behavioural symptomatology associated with dementia of the Alzheimer type: a systematic overview. Can J Nurs Res. 1998;30:67-86.

Gwyther LP. Social issues of the Alzheimer's patient and family. Am J Med. 1998;104(4A):17S-21S.

Hagerty E. Twelve steps for caregivers. American Journal of Alzheimer's Care and Related Disorders and Research. November-December 1989;4(6). Accessed at http://www.alzheimers.org/ on February 16, 2001.

Hendrie HC, Ogunniyi A, Hall KS, et al. Incidence of dementia and Alzheimer disease in 2 communities. JAMA. 2001;285(6):739-747.

Higgins JPT, Flicker L. Lecithin for dementia and cognitive impairment (Cochrane Review). In: The Cochrane Library, Issue 4, 2000. Oxford: Update Software.

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Jimenez-Jimenez FJ, Molina JA, de Bustos F, et al. Serum levels of beta-carotene, alpha-carotene and vitamin A in patients with Alzheimer's disease. Eur J Neurol. 1999;6:495-497.

Kidd PM. A review of nutrients and botanicals in the integrative management of cognitive dysfunction. Altern Med Rev. 1999;4:144-161.

Kim EJ, Buschmann MT. The effect of expressive physical touch on patients with dementia. International Journal of Nursing Studies. 1999;36:235-243.

Koger SM, Brotons M. Music therapy for dementia symptoms (Cochrane Review). In: The Cochrane Library, Issue 4, 2000. Oxford: Update Software.

Kumar AM, Tims F, Cruess DG, et al. Music therapy increases serum melatonin levels in patients with Alzheimer's disease. Altern Ther Health Med. 1999;5:49-57.

Le Bars PL, Katz MM, Berman N, et al. A placebo controlled, double-blind, randomized trial of an extract of Ginkgo biloba for dementia. JAMA. 1997;278:1327-1332.

Le Bars PL, Kieser M, Itil KZ. A 26-week analysis of a double-blind, placebo-controlled trial of the Ginkgo biloba extract EGb761 in dementia. Dement Geriatr Cogn Disord. 2000;11:230-237.

Lim GP, Yang F, Chu T, et al. Ibuprofen suppresses plaque pathology and inflammation in a mouse model for Alzheimer's disease. J Neurosci. 2000;20(15):5709-5714.

Masaki KH, Losonczy KG, Izmirlian G. Association of vitamin E and C supplement use with cognitive function and dementia in elderly men. Neurology. 2000;54:1265-1272.

Mantle D, Pickering AT, Perry AK. Medicinal plant extracts for the treatment of dementia: a review of their pharmacology, efficacy and tolerability. CNS Drugs. 2000;13:201-213.

Morris MC, Beckett LA, Scherr PA, et al. Vitamin E and vitamin C supplement use and risk of incident Alzheimer disease. Alzheimer Dis Assoc Disord. 1998;12:121-126.

Morrison LD, Smith DD, Kish SJ. Brain S-adenosylmethione levels are severely decreased in Alzheimer's disease. J Neurochem. 1996;67:1328-1331.

Oken BS, Storzbach DM, Kaye JA. The efficacy of Ginkgo biloba on cognitive funciton in Alzheimer disease. Arch Neurol. 1998;55:1409-1415.

Ott BR, Owens NJ. Complementary and alternative medicines for Alzheimer's disease. J Geriatr Psychiatry Neurol. 1998;11:163-173.

Pettegrew JW, Levine J, McClure RJ. Acetyl-L-carnitine physical-chemical, metabolic, and therapeutic properties: relevance for its mode of action in Alzheimer's disease and geriatric depression. Mol Psychiatry. 2000;5:616-632.

Pitchumoni SS, Doraiswamy M. Current status of antioxidant therapy for Alzheimer's disease. J Am Geriatr Soc. 1998;46:1566-1572.

Sano M, Ernesto C, Thomas RG, et al. A controlled trial of selegiline, alpha-tocopherol, or both as treatment for Alzheimer's disease. N Engl J Med. 1997;336:1216-1222.

Scherder EJ, Bouma A, Steen AM. Effects of short-term transcutaneous electrical nerve stimulation on memory and affective behaviour in patients with probable Alzheimer's disease. Behav Brain Res. 1995;67(2):211-219.

Scherder EJ, Van Someren EJ, Bouma A, vd Berg M. Effects of transcutaneous electrical nerve stimulation (TENS) on cognition and behavior in aging. Behav Brain Res. 2000;111(1-2):223-225.

Snowdon DA, Tully CL, Smith CD, Riley KR, Markesbery WR. Serum folate and the severity of atrophy of the neocortex in Alzheimer disease: findings from the Nun Study. Am J Clin Nutr. 2000;71:993-998.

Spagnoli A, Lucca U, Menasce G, et al. Long-term acetyl-L-carnitine treatment in Alzheimer's disease. Neurology. 1991;41:1726-1732.

Tabak N, Ehrenfeld M, Alpert R. Feelings of anger among caregivers of patients with Alzheimer's disease. Int J Nurs Pract. 1997;3(2):84-88.

Tabet N, Birks J, Grimley Evans J. Vitamin E for Alzheimer's disease (Cochrane Review). In: The Cochrane Library, Issue 4, 2000. Oxford: Update Software.

Thal LJ, Carta A, Clarke WR, et al. A 1-year multicenter placebo-controlled study of acetyl-L-carnitine in patients with Alzheimer's disease. Neurology. 1996;47:705-711.

Thompson C, Briggs M. Support for careers of people with Alzheimer's type dementia. Cochrane Database Syst Rev. 2000;(2):CD000454.

Wettstein A. Cholinesterase inhibitors and ginkgo extracts—are they comparable in the treatment of dementia? Phytomed. 2000;6:393-401.

In families with children and adolescents with ADHD, mothers play an important role in reducing family conflict.

Modeling ADHD Child and Family Relationships

J Kendall, MC Leo, N Perrin, and D Hatton

West J Nurs Res 1 Jun 2005 27(4): p. 500. http://highwire.stanford.edu/cgi/medline/pmid;15870246

School of Nursing, Oregon Health & Science University.

Little information is available on how to help families manage common negative sequelae of attention deficit/hyperactivity disorder (ADHD). This article is a report of the extent to which a theoretical formulation of child behavior, maternal distress, and family conflict was explained by data obtained from a community sample of families with children and adolescents with ADHD. Structural equation modeling was used to test the theoretical model. The primary variables of interest were (a) child behavior problems, (b) maternal distress, and (c) family conflict. The results suggest that maternal distress may mediate the relationship between child behavior problems and family conflict, indicating the critical importance of mothers in ADHD families and the need to provide them with additional support.

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