Risky
Behavior:
Drugs and Sex
Friends and
Lovers
By Charalambos C.
Cleanthous, Ph.D.
and Ryan C. Sain, Ph.D.
Published by Charalambos C. Cleanthous & Ryan C. Sain at Smashwords
Copyright 2012 Charalambos C. Cleanthous & Ryan C. Sain
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Chapter 1: RISKY BEHAVIOR
Decision Making
Risky Behavior is about our lives, it is about living our lives to the fullest but also remaining safe. We will examine the process about how we make decisions. Some of these decisions are so important that they have life altering implications, yet others have life and death implications.
The area we are concerned with is decision making about risky behavior. Such behavior includes drug use, both alcohol and other drugs, relationships with friends and lovers, and sexuality. Let us take a brief look at sexuality. There are many decisions we have to make concerning our sexual lives. The first decision is whether we will become sexually involved with another person. Whether our sexual behavior will be heterosexual, homosexual, or bisexual is a second decision each one of us must make (we are not taking a position on how sexual orientation behaviors emerge.)
A third area where decision making and sexuality are involved is the type of relationship or relationships we will be involved with. The typical relationship is often described as monogamous, but there are two variations. One form of monogamy is with one partner for an extended period of time (Monogamy, 2008). An alternative form is serial monogamy, meaning that we are involved with one partner at a time but one after the other with short intervals between the relationships (Serial monogamy, 2008). These are simply two of the very many variations of sexual interaction. The approaches are not limited to male female relationships. (If you would like to review additional sexual relationship variations see the link for “The new monogamy” in the references.)
Of course, sexual decision-making involves protection of both ourselves and our partner or partners. The fourth area of concern, then, is biological protection, that is, taking the steps necessary to prevent infection and/or pregnancy. Such measures will range from abstinence to correct and 100% condom use. Some measures will help to protect us from sexually transmitted infections (STIs). We should note that such protection is not guaranteed; we will discuss these issues in the appropriate chapter. Other measures will help to prevent the likelihood of pregnancy; these are the various contraceptive measures.
Related to biological protection is psychological protection, the fifth area of concern. Psychological protection refers to being able to communicate our wants and needs without fear of repercussion from our partner or partners. Such a stance includes the right not to engage in any form of sexual interaction, or to drink alcoholic drinks we do not want, or take drugs we do not want. Thus, communication skills become a critical component in our interactions with strangers, friends, partners, and lovers.
It is almost impossible to tune into a TV program and not be inundated with the “advantages” of a particular manufacturer's drugs. Drugs in the contemporary world are very much a part of life. Both licit and illicit drugs can be involved in risky behavior. Thus, a sixth concern is the use of drugs that may enhance the likelihood of our engaging in risky behaviors. Such behaviors include engaging in unprotected sexual intercourse, or with multiple partners, serially or otherwise, combining drugs that we would not otherwise do, not being clear about our own boundaries, or allowing others to determine for us what activities we will engage in.
Infection and Disease Distribution
The United Nations (2007), the World Health Organization (2006), and the US Centers for Disease Control and Prevention (CDC, 2006) call the spread of the human immunodeficiency virus (HIV) a pandemic. We will have more to say about HIV later. For now, it is important to understand such terms as endemic, epidemic and pandemic that refers to the pattern of infection distribution. The importance lies in how at-risk we are of becoming infected with a particular infection when we engage in risky behavior.
What It All Means: Endemic, Epidemic and Pandemic
An endemic is found in a community at all times but the frequency is relatively low. The term comes from the conjunction of two Greek words: “en” which means “in” and “demic” (people or population). Thus, endemic is something that is among the people. In some cases, the endemic is continuous, for example, the presence of malaria in parts of Africa. In other cases the endemic may be the presence of illicit drugs in particular neighborhoods.
The second term is epidemic; this term, too, comes from the conjunction of two Greek words: "epi" which means "upon" and demic. Thus, an epidemic is a disease or problem that comes upon the people. For example, every year during the influenza ("flu") season, a certain number of cases are expected. If more people than expected are found to be infected with the influenza virus, we have an epidemic.
To complete the contrast, pandemic is from the Greek "pan" meaning “all” and demic. Putting the two together, we have pan + demic resulting in "pandemic" or "all the people." Thus, a pandemic can potentially impact all or nearly all the people. For example, the H1N1 influenza virus was referred to as a pandemic because it had spread throughout the world (Writing Committee of the WHO Consultation on Clinical Aspects of Pandemic (H1N1) 2009 Influenza, 2010).
To make sense of what happens when we have a pandemic, we can compare its effects to an epidemic and an endemic. In the early 1980s a new disease was being observed that had not previously been seen in the numbers being reported. Moreover, the initial observations happened to occur in a small subgroup of the homosexual population. The disease is now known as acquired immunodeficiency syndrome (AIDS) that would eventually be attributed to the HIV.
An epidemic occurs when a contagion, during a given period of time, impacts more than the expected number of people in a community or region. Such was the case, initially, in the United States and western Europe, with HIV/AIDS in the gay community. However, it soon became obvious that the heterosexual community in Africa, and closely thereafter, other parts of the world, was also becoming infected with HIV and developing AIDS. Additionally, another group that was developing AIDS in relatively large numbers was intravenous drug users. Thus an epidemic developed into a pandemic.
The World Health Organization (WHO) uses three criteria to determine if a pandemic is in place. First, a new contagion or contagion subtype emerges to which humans have no natural immunity. Second, when infected, humans can become very sick and/or die. Third, the virus is contagious and spreads efficiently from person to person. However, what makes the outbreak a pandemic is that the spread of the disease covers a whole region, continent, or the world.
The spread of HIV and the development of AIDS are not our only concerns regarding our sexuality. Sexually transmitted infections (STIs) are also widespread throughout the world. The United Nations program on HIV/AIDS (UNAIDS) estimates that there are 340 million new STIs globally (Sexually transmitted infections, 2008). In the United States, the Centers for Disease Control and Prevention reports that there are 19 million new STI cases each year (STD Surveillance 2006). Moreover, about half of the STIs are among youth between 15 to 24 years of age (Weinstock, Berman, & 2004). Even more disconcerting is that the aforementioned youth make up only 25% of the sexually active population.
As we can see, risky behavior can put our well-being in great risk. To deal with the risks involves learning how to protect ourselves from becoming infected in the first place. We now turn to these issues that we will give more attention to in the proceeding chapters.
Health Strategies
Prevention
It is obvious that the world faces a tremendous problem with the spread of STIs. There is sufficient evidence that something needs to be done to bring the spread of STIs under control. The costs, in both human potential and economics are too huge to ignore (Eng & Butler, 1997), yet little is done in a systematic manner to prevent the spread of STIs in the greater part of the world.
We are fortunate in that many of the measures needed, and that we will discuss, to have an effective prevention program are identical or very similar both for a variety of target populations and in teaching excellent life skills. For example, the components of such a program include the teaching and promotion of safer sex practices through educational and skills training prevention programs (Eng & Butler, 1997; Sexually Transmitted Disease, 2008; UNAIDS, 2007).
Throughout Risky Behavior, we will deal with these issues and how to effectively deal with them. To achieve the stated goal, Risky Behavior will focus on prevention. The World Health Organization (WHO, 1948) identified three progressive stages of prevention. The goal is to deal with ways to prevent (a) the development of pathologies, (b) ways of reducing the spread of an illness through treatment and, (c) to reintegrate the person into society. Although the WHO was concerned with population level illnesses, we will adapt the model for the individual.
Primary prevention is concerned with all activities whose goal is to decrease the illness in a population. Of course, the ultimate goal is to stop new cases from appearing. One example comes from medicine. Immunizations are used to prevent the disease, such as polio, from infecting the person. In addition, primary prevention provides the requisite training for those individuals who have a critical role to play within the population, such as health workers. In other words, these people need to have the requisite knowledge and skills. In our situation, our concern is with preventing or managing risky behavior. We attempt to do this by providing current information and skills training to the population we are concerned with. The population may range from pre-adolescents through old age. Risky Behavior will focus almost exclusively on primary prevention.
Secondary prevention seeks to reduce the pervasiveness of an illness in a population. By so doing, the illness’s duration is reduced. To achieve the aforementioned goal, it is necessary to identify those at greatest risk for infection and provide the appropriate testing and treatment for the infection. For example, many who are infected with one or more STIs do not show any symptoms of the disease. Identifying these people and providing them with the requisite treatment reduces the spread of the disease and improves the infected person’s life (American Social Health Association, 1998).
Tertiary prevention deals with the chronic impact of the disease. The goal is to reduce the recurrences or incapacity experienced by a person. For example, HIV can be transmitted to an unborn child, or during labor and deliver, or breastfeeding. Without treatment of the mother during pregnancy, up to 30% of these babies will become infected with the HIV during pregnancy or delivery. Breastfeeding puts the baby at additional risk; up to 20% more will become infected (Preventing Mother-to-child HIV Transmission, 2008, April 03).
Health Promotion
One can argue that prevention focuses on management of negative behaviors, such as risky behavior including sex, smoking, drugs and alcohol, lack of exercise, and overeating among many others. An extension of the ideas behind prevention is health promotion that is concerned with the variables that contribute to the behaviors that enhance a person’s health and quality of life (Evans, 1994. 1997; Evans & Kazarian, 2001). Health promotion, in other words, is focused on the promotion of positive behaviors, such as appropriate alcohol consumption, regular exercise and healthy eating, good interpersonal relations and sexuality. What we will introduce next is one approach to health promotion that focuses primarily on the individual.
Self-Management
It is not enough to simply point to the problems that confront us. We also need to provide the best solutions that are available to us. We have reviewed much of the literature that deals with sexually risky behavior and have identified the best practices (“Best Practice”, 2008, May 16), that is, the methods, processes, activities, and techniques that are the most effective in teaching preventative measures (Kirby, 2006). We have incorporated the efficacious techniques into Risky Behavior.
The core of the techniques is a set of concepts and procedures that, collectively, are referred to as self-management (Brigham, 1982, 1989). The idea behind the self management techniques is how we can individually modify our own behavior. At the most fundamental level, we learn to identify and manage the antecedents and consequences to our behavior. We also learn new behaviors to replace undesirable behaviors with more desirable behavior. In terms of risky behavior, the use of the self-management techniques allow us to have a safer and healthier life.
As we will discuss in the upcoming chapters, risky behavior can and does span many areas of our life. Although our concern with STIs, HIV/AIDS, pregnancy and so on are very serious, we are just as concerned about how we end up in those situations. It is fair to conclude that the behaviors that put us at risk for contracting STIs also cause many other problems in our life.
The question that arises, of course, is what we, individually and collectively, can do to bring a change in the rates of STIs, sexual assault, poor communication, and drug use and abuse. The position we take is that, first, we must better understand ourselves and the causes of our behavior. Secondly, we believe that self-management principles can help us to better understand ourselves and the causes of our behavior.
By the time we complete this course, we will have at our disposal a variety of techniques, what are referred to as self management techniques; that will, collectively, allow us to have a more enjoyable life and, hopefully, a long and healthy life.
Scenarios
Unplanned Sexuality
Bob is away from home, for a significant amount of time, for the first time in his 18 years. He is attending a university several hundred miles away from home. Parties galore, but Bob remains faithful to his promise to do his very best at the university. After several weeks of following a rigorous class schedule, work, study, exercise and weekly religious functions, he decides to accept an offer to go to a party with his roommate. As the evening wears on, he finds himself talking to Vicky, a junior at the university. Although Bob always limited himself to one alcoholic drink, tonight he took up Vicky’s offer for a couple more.
Bob and Vicky leave the party together; he made the offer to walk her back to her dorm room. Bob’s feeling a little woozy from the alcohol and the excitement of being with Vicky. As he says goodnight, Vicky asks him if he’d like to come up to her room and chat. They chat and sip on another beer. Vicky leans over and kisses Bob; her hands gently caress him. He protests, rather quietly, and sheepishly admits that he’s a virgin, and that premarital sex is against his beliefs; Bob is committed to remaining abstinent. Vicky proceeds as if she didn’t hear him protesting. Bob’s sheepish protests cease and they end up having oral sex. Bob felt bad for violating his beliefs, but comforted himself by convincing himself that he did not have intercourse.
About a week later, Bob noticed he had some painful blisters on the inside of his mouth and lips. He ignored them thinking that they were simply cold sores. As the end of the first session was approaching, Bob began to experience the stress of final exams and papers that were due. The bumps in his mouth and lips also re-appeared. He went to see the doctor at the student health center. The doctor’s diagnosis: Herpes labialis, that is, herpes of the lips or oral (mouth) area. Moreover, the diagnosis was that the infection was due to the herpes simplex virus Type 2 (HSV-2), also known as genital herpes. The cold sores that over 99% of the population will have at one time or another is a slightly different type of herpes virus and is technically referred to as herpes simplex virus Type 1 (HSV-1).
Bob now had a lifelong viral disease.
Date Rape
Exams. Work. Relationships. Demands, demands, and more demands. Trish had a long week and was looking forward to going out with her girl friends. A new club in town had a “Lady’s night”, so Trish and her girl friends decided to visit the club. From the moment they walked in to the club they felt relaxed. The atmosphere was conducive to having a good time.
The girls ordered a round of drinks. “Hi. I’m Colin. Would you like to dance?” How can I resist? Trish asked herself. Finally! She felt the weight of the week lifting off her shoulders. It was not long before all Trish’s friends were dancing. As the night wore on, the drinking and euphoric states increased, inhibitions decreased.
Trish woke up the next afternoon naked. For a moment she did not know where she was. As she tried focusing she realized she was in her own apartment. She did not know how she got home; she did not know who brought her home. She saw obvious signs of having had sexual intercourse, but could not remember with whom or of actually having had intercourse. She’d heard of date rape happening to others. But to her?
Trish called Alexa, a friend, and, through the mumbling and crying, told her what she thought had happened. Alexa rushed over and saw the state Trish was in. She convinced Trish to go to the Emergency Medical Center.
A urine sample was taken to be analyzed. The results yielded a diagnosis that Trish had ingested gamma-hydroxybutyrate (GHB). A couple of its effects include memory loss and, potentially, unconsciousness. One of GHB’s illegal uses is as a date rape drug.
Trish felt devastated. Violated. She did not know who had spiked her drink.
Emergency Room
Spring break. The time in the academic year every college student looks forward to. Whether it’s taking a break from classes or simply rewarding oneself for working hard, spring break is a welcome relief. Colin and his buddies planned on getting away from college and heading south. Just what the doctor ordered to bid farewell to a long and dreary winter. So they were going to head south of the border.
The tour operator they contacted promised them a great time. A new culture to immerse themselves, ancient ruins to visit, beaches where they could soak up the sun’s rays, and, she promised, more alcohol in a week than they could drink in a year. On arrival, they noticed that there was a “VIP Party Pass” for a mere $100. The pass allowed them entry into all the clubs and all the alcohol they could drink—at no additional cost (Leinwand, 2003). They gladly took the offer.
Night after night they partied—hard. Night after night they would stumble back to their hotel rooms, the alcohol taking its toll. On the morning of the sixth day, waking from a groggy sleep early in the afternoon, Colin’s roommates found him unconscious in a pool of vomit. Try as they might, Colin was unresponsive. In desperation, they called the front desk and the clerk proceeded to call for an ambulance.
At the hospital, the news was that Colin had suffered a severe case of alcohol poisoning. It would take more time to determine if he had suffered any permanent damage.
No immersion in the new culture. No visits to the ancient ruins.
Clean-cut Gentleman
Mary just turned 50 and has been divorced for a couple of years. She feels she's ready to start dating again. Mary has only had one partner in her life, her ex-husband, and is no longer concerned about pregnancy. She signs-up on one of the internet-based dating sites.
Within a couple of days, she is exchanging emails with a couple of gentlemen. The emails turn into live dates. In due time, she finds herself really attracted to James who truly is a gentleman. Although they do not rush into sexual activity, neither do they take any precautions, after all, Mary cannot get pregnant.
A routine blood test revealed that Mary was HIV positive. Mary could not believe it. James was a clean-cut gentleman. She had only had one partner. How could she be HIV positive? A follow-up test confirmed the results of the first test: Mary was definitely HIV positive (see Bodley-Tickell, et al., 2008).
What Is In A Term
Sexually Transmitted Infection vs. Sexually Transmitted Disease
Before proceeding with the description and definition of risky behavior, we need a momentary deviation to clarify terms we will be using.
We are witnessing a change in the terminology used to refer to disease and infection due to sexual activity. Two terms that are frequently used interchangeably are "sexually transmitted disease” (STD) and "sexually transmitted infection” (STI). The use of the terms in an interchangeable manner is unfortunate as they do not refer to identical issues (Hendricks, 2004).
The more inclusive term is STI. We know that a person may be the host of dangerous pathogenic organisms. What this means is that the person is infected with the but has not developed the symptoms of the disease the pathogens are capable of producing. Not developing the disease symptoms, such as pus, sores, or warts, but being a host of the pathogen indicates that the person is asymptomatic. When we are asymptomatic, it is accurate to refer to the condition as a STI. Once the STI has progressed to the point where it produces damage, such as warts or sores, the condition is referred to as a STD.
It is accurate to say that all STDs are preceded by STIs, but not all STIs necessarily develop into STDs. For example, approximately 90% of women infected with the human papillomavirus virus (HPV) do not show any signs of the infection within two years of the initial infection. Essentially, the immune system deals with the pathogen (Ho, Bierman, Beardsley, Chang, & Burk, 1998). Such a possibility should not be taken as an indicator that one should not worry about HPV. One of the dangers of HPV is that the woman may develop cervical cancer. However, only those with persistent HPV infection are at risk for developing cervical cancer (Centers for Disease Control and Prevention. 2008).
It is important to remember that it is not necessary to have a disease, or any symptoms at all, in order to be contagious. Many people who are infected with STIs that have not yet progressed to STDs can and do infect their partner or partners.
If one waits for the infection to develop into the disease, much more serious consequences may result. Thus, it is important to understand the difference between infection and disease. Understanding that a person infected with the pathogen is contagious, that is, the person can transmit the infection to another person, then early screening and treatment of STIs can prevent the more troublesome STDs (Hendricks, 2004).
It is also true that many STIs, although highly contagious, are also asymptomatic. Thus, testing for STIs should not be dependent on the development of disease symptoms, such as warts, pus, or sores. Rather, STI testing must be based on risky behavior, such as engaging in sex without protection, with multiple partners, and/or intravenous drug use. Early testing based on risky behaviors, is advantageous in that infections can be diagnosed and treated before damage is caused when they develop into full-blown diseases, or the infected person has had opportunities to spread the infection to other sexual partners.
For these reasons, we will use the term STI and reserve STD only when appropriate.
Defining Risky Behavior
The previous scenarios have something in common even though the age range and circumstances are quite varied. The commonality that these situations represent is the nature of risky behavior.
First, let’s take a look at the characteristics of risky behavior.
Younger
or older
Fun or unpleasant.
Safe or dangerous.
Planned or
unplanned.
Willing or unwilling.
These polar adjectives cover a lot of ground. Risky behavior covers the spectrum of life, from the young to the old. Risky behavior covers the spectrum of activities, from having a drink to relax to having one’s drink spiked.
A list of characteristics is useful in describing the behavior we are concerned with. The definition of risky behavior, however, must go beyond simply a description of the characteristics.
The definition has to be broad enough to encompass the phenomenon we are concerned with, but not so broad that any behavior can be thought of as risky. For example, we could say that all chemical substances can potentially be abused. Although the statement might be accurate, it is too broad for our purposes as milk and orange juice are chemical substances and both can be abused!
The definition must set limits to what is considered risky behavior, but the limits cannot be so stringent that there are too many exceptions. For example, we cannot simply restrict drug abuse to those that are illegal as legal drugs can also be abused. The definition must also encompass situations in which the person is an unwitting participant, such as the date rape victim or one who has had his or her drink spiked. Yet other situations must also be considered, for example, the person who is not prepared to deal with unexpected situations such as petting leading to sexual intercourse without the appropriate precautions.
The most obvious way of defining risky behavior, then, is to examine the behavior itself (Hall, Holmqvist, & Sherry, 2008). For example, unprotected vaginal, oral, or anal intercourse is the primary way of transmitting STIs. Unprotected refers to not using a condom for vaginal, oral, or anal intercourse 100% of the time. In other words, even if a condom is used “most of the time”, every time a condom is not used, we put ourselves at risk for contracting a STI or a pregnancy.
A definition of risky behavior is what we do or what is done to us when we put our well-being in harm's way. Our well-being includes both our biological and psychological health. An example of putting our biological well-being at risk is using drugs in an irresponsible manner (the reason for stating the matter in this way is that we are not merely concerned with illicit but also with licit drugs). When we drink too much alcohol in too short a period of time, we are putting ourselves at risk for alcohol poisoning that could lead to coma or death (“Alcohol poisoning, 2007, February 12).
Another possibility we must consider is whether our partner is an intravenous drug user. When a needle is shared, the probability that an infected partner passes on an infection increases. Thus, even if we, ourselves, are not intravenous drug users, our partner may pass on an infection that in the worst case could be deadly, such as HIV, or something less deadly but equally as lifelong, such as Hepatitis B ("Hepatitis B virus", 2008).
We must also be cognizant of both our own and our partner’s infectious status. We or our partner may be infected with one or more sexually transmitted infections such as syphilis, gonorrhea, the human papillomavirus (HPV), or HIV among many others. The fact that our partner shows no symptoms of the infection does not mean that she or he is not infected with one or more STIs (Witte, El-Bassel, Gilbert, Wu, & Chang, 2010).
Monogamy is another phenomenon we must be cognizant of (see Table 1.1: The New Monogamy). In other words, we or our partner must be sexually exclusive, that is, we are having vaginal, oral, or anal sex only with our partner who we know is not infected with a STI. The greater the number of people we have intercourse with, the greater the likelihood that one or more of our sexual partners is infected with a STI (Santelli, Brener, Lowry, Bhatt, & Zabin, 1998).
A psychological consequence of risky behavior is becoming infected with a STI. For example, the psychological effects of herpes are often considerably worse than the physical symptoms. Psychological reactions include low self-esteem, guilt, anger, shock and fear of transmitting the infection to others. Some people infected with genital herpes report that the depression they experienced when first diagnosed with the infection lasted a good part of a year (Kimberlin & Rouse, 2004).
Other examples of risky behavior include activities that are not done to hold risky behavior at bay. The person who decides not to have sexual intercourse until marriage, for example, must have strategies for dealing with those times when the sexual desire arises. Similarly, the person who does not want to get drunk or use illicit drugs must have strategies for dealing with those situations. Finally, avoiding contracting a STI or getting pregnant or getting someone else pregnant also requires the necessary competencies, including using condoms flawlessly 100% of the time and/or other efficacious birth control methods. What we see is that risky behavior covers a considerable amount of ground.
Risky behavior involves putting ourselves in danger. The danger includes both our biological and/or psychological health and increases with the number and frequency of risky acts we engage in.
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Table 1.1: THE NEW MONOGAMY
Managed monogamy: Above-the-waist rule: An agreement that any touching abovethe beltline is fair game.
Body-fluid monogamy: When a couple forgoes the latex with each other but requires it for all outside sexual activity.
Celebrity trading card: As seen on Friends: an imaginary laminated card in your wallet—proof that your partner has given permission for you to sleep with the stars listed.
Cheating: Secret, extracurricular romantic and/or sexual activity that breaks the rules. So nineties, so lame.
Closed relationship: How some people in open relationships refer to “old-fashioned” monogamy.
Don’t ask, don’t tell: A policy whereby people in a committed relationship may screw around, so long as they are discreet.
Ethical slut: A promiscuous person who strives to approach partners with respect and honesty.
Fifty-mile rule: You don’t sleep with anyone who lives in your city. (Also the title of a 2002 book by Judith Brandt.)
Make-out party: Events open to the public where semi-nudity and above-the-waist fondling are encouraged.
Open flirting policy: An understanding that flirting is healthy, harmless fun.
Open relationship: A long-term, committed relationship in which the couple explicitly agrees to extracurricular sexual activity, either together or individually.
Party bisexual: A woman or a man who engages in same-sex sex-play after multiple martinis.
Pinch hitter: Someone a couple brings in to spice up their love life, e.g., to watch them have sex or to get together with one-half of the couple while the partner watches.
Physical monogamy: You can look, fantasize, and engage in dirty talk— but no touching.
Polyamory: A philosophy of being involved with multiple long-term, intimate partners.
Polyfidelity: Having more than one long-term partner but being closed to additions, e.g. trinogamy (see below).
Polygamy: Multiple spouses.
Swinging: Partner-swapping. Sometimes referred to as “the Lifestyle.”
Trinogamous: To be in a committed threesome.
Work boyfriend/girlfriend: A colleague—your lunchmate, IM partner, smoking buddy, etc. No sex, though.
Em & Lo (2005)
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Probability and Risky Behavior
What we see is that behavioral factors are the best predictors of risky behavior. To best combat risky behavior, it is important to understand how the probability of engaging in risky behavior increases as we take certain actions.
The probability of engaging in risky behavior increases when we act on (a) ill-considered decisions due to (b) a lack, incomplete or disregard of our knowledge about the activity under (c) threatening or tempting situations, and/or (d) lacking effective skills to deal with these situations. Only one of these factors is necessary for risky behavior to occur. The more factors that are involved, however, the greater the likelihood that risky behavior will transpire (Bruine de Bruin, Downs, , Fischhoff , & Palmgren, 2007).
The probability of risky behavior occurring indicates that there are four areas of concern. The first area is concerned with decision-making. For example, when we decide to use drugs and know the potential dangers of drug use and abuse. In this case, we set aside the facts in favor of whatever consequences the activity produces. Any number of influences, both past and present, will act on us to increase or decrease the likelihood of risky behavior. Negative emotional states, such as being upset, tend to increase the likelihood of deciding to participate in risky behavior (Sayette, 2004; Shiffman & Waters, 2004).
The second area is concerned with our knowledge. Knowledge by itself will not prevent the risky behavior; it is not, however, entirely unrelated to risky behavior (Wellings, 2007). Essentially, knowledge is transportable so that when confronted with a new situation, we must be able to use the prior knowledge to deal with the situation. For example, Xanax is used to treat anxiety and panic disorders (“Xanax”, 2007). One of the interaction effects Xanax has is with alcohol as the former enhances the effects of the latter, that is, alcohol’s effects are exaggerated. Thus, to remain safe while taking Xanax, one’s knowledge, must include the interaction effects with alcohol. Lacking such knowledge can be deadly.
The third area of concern is putting ourselves in tempting situations. A tempting situation is one in which the probability for performing a risky behavior increases and one or both partners is unprepared to deal with the tempting situation. The couple, for example, who would like to refrain from sexual intercourse (vaginal, oral, or anal) until marriage puts each other in a situation where the risk increases when the romantic dinner is accompanied with alcohol or when they are totally alone.
A threatening situation, is a fourth area of concern and is one in which we are at a disadvantage and find it difficult to protect ourselves, thus the probability of risky behavior increases. If we go to a club and leave our drink unprotected, it is very easy to have it spiked with one of the date rape drugs (“Date-Rape Drugs”, 2005). Another possibility involves a partner who is aggressive and does not take "no" as an answer.
The fifth area involves our skill level. It is impossible to intentionally avoid or deal with risky situations if we do not have the requisite skills. We can look at skill in terms of our verbal and practical skills.
An example of our verbal skills potentially influencing the outcome of an unwelcome situation is when we lack the skill to assertively decline undesirable requests. The request may be for sexual intercourse, drug use, or any other activity we find disagreeable. Lacking the skill to assertively decline the disagreeable request, we participate in the act and thus in risky behavior (Rickert, Sanghvi, & Wiemann, 2002). An example of lacking a practical skill is when we do not know how to correctly use condoms. Such a situation exists when we do not put the condom on the penis prior to approaching the contact area—vagina, mouth, or anus (Grimley, Annang, Houser, & Chen, 2005).
In both situations, the manner with which we deal with the situation is going to affect the outcome. If we assertively make our intentions known to our partner and we know how to correctly use a condom, we are more likely to control the situation and have a positive outcome.
Risk Proofing Our Behavior
Obviously, there are many obstacles that will stand in our protecting our well-being. We must, in the final analysis, take a stand against risky behavior. We simply cannot be idle bystanders hoping that nothing problematic will come our way.
In the present manual, we will introduce a curriculum that is based on the empirical literature (Kirby, 2006). In other words, we will promote only what has been demonstrated to work. When we say that a particular strategy works, that does not mean that that particular technique is perfect. Rather, it will be a number of strategies that, together, empower us to protect our well-being (Watson & Tharp, 2007). Discussing self-management strategies will be the focus of the next Chapter.
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Exercise 1.1
Identifying Risky Behavior
If we are going to successfully deal with risky behavior, we must identify the activities that put us at risk. The activities are not likely to be identical for each person. To help identify the areas that put you in risky situations we have developed the following questionnaire. We ask that you keep reminding yourself of the risky situations you expose yourself to as we proceed.
Scoring
Yes =
I agree with the statement
No = I disagree with the
statement
DK = I do not have the knowledge to answer the
statement
NA = The statement does not apply to me (for example, if
one has never engaged in vaginal, oral, or anal sex, some of the
questions simply do not apply)
A. Own sexual activity
1. I
have never had unprotected vaginal sex; that is, I or my partner have
always used a condom.
2. I have never had unprotected oral sex;
that is, I or my partner have always used a condom.
3. I have
never had unprotected anal sex; that is, I or my partner have always
used a condom.