- Promoting "harm reduction" rather than abstinence, and providing an opportunity to discuss alcohol-related information in a non-judgmental format, can help reduce alcohol use.
- High-risk groups appear to benefit greatly from motivational intervention and "booster sessions."
- Targeting the social network of mandated students may help change their drinking perceptions and/or behaviors.
- Peer-directed sessions show promise for both universal and targeted interventions.
College students who are "mandated" to receive alcohol interventions tend to comprise a disproportionate number of heavy drinkers and alcohol abusers, yet few studies have examined these students or the effectiveness of the sanctions they receive. Four presentations given during a symposium at the June 2003 Research Society on Alcoholism meeting in Fort Lauderdale, Florida reviewed what is known about these high-risk students as well as the effectiveness of intervention approaches used with them.
"A few studies have shown that referred students are more severe in their drinking habits than others," said Nancy P. Barnett, assistant professor of research at Brown University and corresponding author for the study. "For example, one study found rates of binge drinking at 69 percent for males and 55 percent for females versus 45 percent for the nonreferred undergraduate population at a university. The referred students also had significantly higher scores on an alcohol-problem scale. These findings are not surprising and are almost self-evident - that people who get into trouble with alcohol are likely to drink more than those who don't - but it's important to have data to support such claims."
Highlights of the proceedings, which are published in the June issue of Alcoholism: Clinical & Experimental Research, are presented below.
- Brief motivational intervention (BMI) and alcohol education (AE) sessions were effective. Referred students were particularly receptive to BMI, responding favorably to the concept of "harm reduction" rather than abstinence. Students receiving AE also reduced their alcohol use, suggesting that simply providing an opportunity to discuss alcohol-related information in a non-judgmental format can influence drinking behaviors.
"Harm-reduction approaches make a great deal of sense in both college-student populations generally and with mandated students more specifically," said Mark Wood, an associate professor psychology at the University of Rhode Island who is not associated with the study. "First, it's important to note that harm reduction exists on a continuum that begins with abstinence and ranges to practices that minimize the likelihood of negative consequences, such as moderating consumption and using designated drivers. Obviously, the most effective way to avoid negative consequences is not to drink. However, despite the minimum legal drinking age of 21, that's not the reality for the overwhelming majority of college students. Therefore, harm-reduction approaches reason that it's ultimately more effective to try and meet someone 'where they're at' and work together to reduce risks and negative consequences."
"In my experience," added co-author Brian Borsari, " the majority of alcohol education programs for mandated students are either group or individual abstinence-based browbeating sessions. The reductions in alcohol use that we found in the AE group, as well as the high satisfaction ratings, demonstrate that the environment in which the intervention occurs is very important. Simply creating a non-judgmental context in which alcohol information was provided appears to have a therapeutic effect."
- High-risk groups, such as students required to attend alcohol counseling after a serious medical or disciplinary event related to alcohol, appear to benefit from motivational interventions in conjunction with "booster sessions."
"Regardless the actual content of the session," said Barnett, "booster sessions provide the individual an opportunity to review their issues around alcohol. In our AE session, it provided the participant more time with the alcohol-information computer program to seek information that they were particularly interested in. In the motivational intervention (MI) approach, the interventionist and the participant had the opportunity to raise issues that were not addressed in the first session or return to topics that warranted more discussion. I think it is likely that issues that are quite important to the participant, and central to their alcohol use, may not be raised by the participant or detected by the interventionist until the two have had more time together. Maybe most importantly, booster sessions provide an opportunity to review alcohol-related experiences that have occurred in the interim. In our case, we conducted the booster sessions one month after baseline so as to provide the participants enough opportunity to make decisions about drinking, possibly try alternatives or adjustments to their drinking patterns, and see the results."
"The biggest benefit of MI approaches is that, unlike most other preventive intervention approaches that have been used and studied to date, they actually work in reducing alcohol use and related problems," said Wood. "Although we don't really know how they work, there are many likely reasons. First, MI is a collaborative, non-confrontational way of addressing behaviors like drinking. It is well suited for use with 'emerging adults,' who are likely to actively resist authoritarian edicts. Second, the approach focuses on assessing where a given student is at motivationally and tailors the intervention accordingly. For example, with a student who is drinking heavily and experiencing substantial negative consequences, but has given little thought to changing this behavior, the intervention would focus on increasing awareness of these negative consequences and both current and future risks related to them. Third, MI is relatively cost effective, can be implemented by trained nonprofessionals such as undergraduates, and may increase the likelihood of additional help seeking. These benefits are particularly pertinent for mandated students who are likely to enter the situation in a more defensive and resistant state."
- Targeting the social network of mandated students may be an effective strategy for changing their drinking perceptions and/or behaviors.
"College students typically drink in social situations with friends and roommates," said co-author Tracy O'Leary Tevyaw. "Mandated students drink on average more than students who are not mandated. However, mandated students typically report that their friends drink as much or more than they do. Their perceptions about what constitutes 'normative drinking' are influenced by having peers who also drink heavily. If we can effect changes in these perceptions as well as in the student's social network, by offering a targeted intervention to their heavy drinking peers, many of whose drinking is occurring under the radar, we might see enhanced short- and long-term outcomes."
- The Lifestyle Management Project (LMC) - designed to reduce heavy drinking, associated negative consequences of acute intoxication, driving after drinking, and perceived drinking norms - shows promise as both a universal and targeted intervention tool. LMC utilizes both peer and professional leaders.
"LMC was an effective universal intervention because it was successful with voluntary, that is, students not identified as being at-risk," said Barnett, "and it was an effective targeted intervention because it was also successful with referred or at-risk students."
"From a practical standpoint," added Wood, "peer interventions are already a popular approach at universities, and students represent a cost-effective way to deliver interventions. Students can receive course credit and valuable practical experience learning about interventions and research in ways that nicely augment classroom-learning experiences."
"Though there is strong evidence that brief interventions are effective with high-risk college students," said Barnett, "mandated students are a somewhat different population. It is only in the past few years that well-designed studies with these students have been conducted. I think it is important for administrators to remember that many college students can and do change their alcohol use to safer patterns, and there are a number of things that administrators can do to facilitate this. Our job as researchers is to provide empirically based interventions that are well received by students and staff alike, while also being cost-effective for campuses."
Alcoholism: Clinical & Experimental Research (ACER) is the official journal of the Research Society on Alcoholism and the International Society for Biomedical Research on Alcoholism. Co-authors/presenters of the symposium proceedings published in ACER, "Brief Alcohol Interventions with Mandated or Adjudicated College Students," were: Tracy O'Leary Tevyaw, Brian Borsari, and Suzanne M. Colby of the Center for Alcohol and Addiction Studies at Brown University; Kim Fromme and William R. Corbin of The University of Texas at Austin; Kate B. Carey of Syracuse University; and Peter M. Monti of the Center for Alcohol and Addiction Studies at Brown University and Providence Veterans Affairs Medical Center. The studies were funded by the National Institute on Alcohol Abuse and Alcoholism, and the Department of Veterans Affairs.