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Vital Signs

Play is an opening act for alcohol initiative

By Jennifer Durgin

The fact that alcohol creates "only the illusion of connection" is a key point of this play, which recently came to Dartmouth.

In 1898, I left home for Dartmouth College. Drink soon cured my shyness. I had an enormous capacity for the stuff!"

Those are among the opening lines spoken by a character named Dr. Bob in the play Bill W. and Dr. Bob, which recently came to Dartmouth. A play about two alcoholics from the early 1900s may seem like an odd way to kick off a 2011 initiative to combat binge drinking. But the themes in Bill W. and Dr. Bob resonate even today.

Sober: Despite being an alcoholic, the real Dr. Bob—Robert Smith, a 1902 Dartmouth graduate—became a surgeon and practiced in Akron, Ohio. He struggled with his addiction for years until, one day in 1935, he met Bill Wilson, also an alcoholic. Together, the two discovered they could stay sober by sharing their stories with each other and with other alcoholics. Soon after, they founded Alcoholics Anonymous.

But the play isn't just about addiction; it's also about "the danger of isolation and the healing power of connection," says one of its authors, Dr. Stephen Bergman. Bergman, a psychiatrist, writes under the pen name Samuel Shem and is best known for the 1978 novel House of God, an expose of residency training at one of Boston's top teaching hospitals.

Combating alcohol abuse

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People drink to feel connected, Bergman argues, to feel like they belong. But alcohol creates "only the illusion of connection," he says, "and can lead to all kinds of trouble."

About 1,800 college students in the U.S. die each year from alcohol-related injuries, and an estimated 600,000 are injured, according to the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Close to 40% of college students engage in binge drinking (that is, having more than five drinks on at least one occasion in the past month), almost 30% admit to driving drunk, and 2% report being sexually assaulted or date raped by another drinking college student, according to a 2009 NIAAA study in the Journal of Studies on Alcohol and Drugs.

Binge: "People ask me all the time what keeps me up at night as president," Dr. Jim Yong Kim, the president of Dartmouth College, recently told the Wall Street Journal. "My answer is really pretty straightforward: I think a lot about the possibility of losing one of our students to binge drinking, and I think about all the harms that can happen, everything from injuries to sexual assaults."

Instead of just worrying about binge drinking, Kim decided to join forces with 13 other universities around the country. The schools have formed a group called the Learning Collaborative on High-Risk Drinking, which will study, implement, and test the most effective ways to curb excessive drinking on college campuses.

The play is about addiction and also "the healing power of connection."

Evaluate: The Learning Collaborative will draw on the evaluation and measurement expertise of the Dartmouth Institute for Health Policy and Clinical Practice. It will also use techniques developed by the Institute for Healthcare Improvement (IHI) that have been used repeatedly to make improvements in clinical medicine, public health, and other fields. In keeping with IHI methodology, any efforts that are tried will be evaluated based on their ability to produce measurable changes. The collaborative expects to publish its findings sometime after 2012.

Given Kim's background as a cofounder of the international nonprofit Partners in Health and then as director of the World Health Organization HIV/AIDS program, it's not surprising that the collaborative is taking a population-health approach to tackling this issue.

Leery: Most college presidents are leery of talking about the problem of binge drinking because they don't want to damage the reputation of their institution, Bergman said during a lecture at DHMC that was offered in conjunction with the play's run at Dartmouth. DMS's Koop Institute helped fund the production's visit, and one of the six performances was targeted to medical professionals, with a discussion afterward on how to recognize and intervene in cases of addiction.

Binge drinking is common on nearly all college campuses. "Isolation—Dr. Bob's 'shyness'—is often acutely felt by college students in many ways, especially in the first years of leaving home and high school," wrote Bergman and his wife and coauthor, Janet Surrey, in the playbill for Bill W. and Dr. Bob. "Often students try to break through their isolation and social anxiety by turning to drink or drugs, to feel 'connected.' "

Framework: Only true connections and community can heal, they explain. "All of our initiatives must be undertaken within this framework." That's just the kind of framework—mixed with proven methodologies—that the members of the new Learning Collaborative hope to build.

If you'd like to offer feedback about this article, we'd welcome getting your comments at DartMed@Dartmouth.edu.

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