NIAAA's College Alcohol Intervention Matrix

The College Alcohol Intervention Matrix (CollegeAIM) is a user-friendly, interactive decision tool based on a synthesis of the substantial and growing literature on campus alcohol use prevention. It includes strategies targeted at both the individual and environmental levels. Commissioned by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), CollegeAIM reflects the collective knowledge of 16 separate experts in the field, which makes it unique relative to other summaries of the science. CollegeAIM is designed to help college stakeholders compare and contrast different evidence-based prevention strategies to select a mix of individual and environmental strategies that will work best on and around their campuses. CollegeAIM is a living document, which will be updated to keep pace with the science. Colleges are therefore encouraged to ensure that evaluations of individual- or environmental-focused strategies on their campuses or in their communities make it into the published literature.

Perceived academic benefit is associated with nonmedical prescription stimulant use among college students

INTRODUCTION

College students are at higher than average risk for nonmedical use of prescription stimulants (NPS). A commonly identified motive among students who engage in NPS is to improve grades. Several research studies have observed that NPS most likely does not confer an academic advantage, and is associated with excessive drinking and other drug use. This study documents the proportion of the general college student population who believe that NPS will lead to improvements in academic performance.

METHODS

This study gathered online survey data from a large, demographically diverse sample of college students to document the prevalence of perceived academic benefit of NPS for improving grades and to examine the association between such belief and NPS.

RESULTS

Overall, 28.6% agreed or strongly agreed that NPS could help students earn higher grades, and an additional 38.0% were unsure. Students with a higher level of perceived academic benefit of NPS and more frequent patterns of drinking and marijuana use were more likely to engage in NPS, even after adjustment for a wide range of covariates.

CONCLUSIONS

The results underscore the need for interventions that simultaneously correct misperceptions related to academic benefit and target alcohol and marijuana use to reduce NPS.

Do college students improve their grades by using prescription stimulants nonmedically?

INTRODUCTION

Many college students engage in nonmedical use of prescription stimulants (NPS) because they believe it provides academic benefits, but studies are lacking to support or refute this belief.

METHODS

Using a longitudinal design, 898 undergraduates who did not have an ADHD diagnosis were studied. Year 3 GPA (from college records) of four groups was compared: Abstainers (did not engage in NPS either year; 68.8%); Initiators (NPS in Year 3 but not Year 2; 8.7%); Desisters (NPS in Year 2 but not Year 3; 5.8%); and Persisters (NPS in both years; 16.7%). Generalized estimating equations regression was used to estimate the association between NPS and change in GPA, controlling for sex and Year 2 GPA.

RESULTS

GPA increased significantly within Abstainers (p<0.05), but did not change significantly within the other groups. Overall, the relationship between NPS pattern group and change in GPA was not statistically significant (p=0.081). NPS was generally infrequent, but Persisters used more frequently than Desisters (11.7 versus 3.4days in Year 2) and Initiators (13.6 versus 4.0days in Year 3, both ps<0.001), controlling for sex and Year 2 GPA.

CONCLUSIONS

We cannot rule out the possibility that NPS prevented declines in GPA, but we can conclude that students who engaged in NPS showed no increases in their GPAs and gained no detectable advantages over their peers. The results suggest that prevention and intervention strategies should emphasize that the promise of academic benefits from NPS is likely illusory.

College Student Drug Prevention: A Review of Individually-Oriented Prevention Strategies

The current paper highlights the college years as a risk period for development, continuation, and escalation of illicit substance use and substance use disorders and reviews the literature related to the prevention and treatment of these disorders in college populations. Despite widespread implementation of college drug prevention programs, a review of the literature reveals few controlled trials targeting this population. However, alcohol prevention has been extensively studied, and many efficacious interventions for college drinking share theoretical and methodological underpinnings with interventions shown to be efficacious in drug prevention and treatment with other populations (i.e., school-based prevention, adolescent and adult drug treatment). These interventions could be adapted to target drug prevention on college campuses. Barriers to implementation and evaluation of these interventions on campus are discussed, and suggestions are made for future research and programmatic directions.

Drinking norms, readiness to change, and gender as moderators of a combined alcohol intervention for first-year college students

INTRODUCTION

Alcohol interventions targeting college students and their parents have been shown to be efficacious. Little research has examined moderators of intervention efficacy to help tailor interventions for subgroups of students.

METHOD

This study is a secondary data analysis of readiness to change, drinking norms, and gender as moderators of an efficacious peer- and parent-based intervention (Turrisi et al., 2009). Students (n=680) were randomized to the combined peer and parent intervention (n=342) or assessment-only control (n=338).

RESULTS

The combined intervention reduced peak blood alcohol content (BAC) compared to control. Gender and norms did not moderate the relationship between the intervention and drinking. Significant interactions were found between gender, precontemplation, and intervention. Students in the combined condition with higher precontemplation had lower weekly drinking compared to those with lower precontemplation. This pattern was also found among men for peak BAC and alcohol-related consequences but not among women, indicating a three-way interaction.

CONCLUSION

Interventions may need to consider readiness to change and gender to optimize effectiveness.

Impacts of Changing Marijuana Policies on Alcohol Use in the United States

BACKGROUND

Marijuana policies are rapidly evolving. In the United States, recreational use of marijuana is now legal in 4 states and medical marijuana is legal in 23 states. Research evaluating such policies has focused primarily on how policies affect issues of price, access to, use, and consequences of marijuana. Due to potential spillover effects, researchers also need to examine how marijuana policies may impact use and consequences of alcohol.

METHODS

The current paper is a critical review of articles evaluating alcohol outcomes associated with marijuana decriminalization, medical marijuana legalization, and nonmedical or recreational marijuana legalization. We identified articles and reports through (1) online searches of EBSCO host database including Academic Search Premier, Econlit, Legal Collection, Medline, PsycARTICLES, and PsycINFO, as well as PubMed and Google Scholar databases; (2) review of additional articles cited in papers identified through electronic searches; and (3) targeted searches of state and local government records regarding marijuana law implementation. We reviewed studies with respect to their data sources and sample characteristics, methodology, and the margin of alcohol and marijuana use, timing of policy change, and the aspects of laws examined.

RESULTS

The extant literature provides some evidence for both substitution (i.e., more liberal marijuana policies related to less alcohol use as marijuana becomes a substitute) and complementary (i.e., more liberal marijuana policies related to increases in both marijuana and alcohol use) relationships in the context of liberalization of marijuana policies in the United States.

CONCLUSIONS

Impact of more liberal marijuana policies on alcohol use is complex, and likely depends on specific aspects of policy implementation, including how long the policy has been in place. Furthermore, evaluation of marijuana policy effects on alcohol use may be sensitive to the age group studied and the margin of alcohol use examined. Design of policy evaluation research requires careful consideration of these issues.

The impact of defensiveness and incident reactions on post-sanction drinking behaviors among mandated students

INTRODUCTION

Prior studies with mandated students (students referred for an intervention following violation of a campus alcohol policy) have suggested that decreases in drinking behaviors may occur before clinical intervention. Others studies have suggested that greater reductions were associated with lower defensiveness and stronger incident reactions, such as responsibility and aversiveness. The current study sought to integrate these findings and examine the influence of pre-sanction drinking and perceptions on mandated students' post-sanction drinking levels prior to attending a brief intervention.

METHODS

Data were collected as part of a longitudinal study of brief interventions in a mandated student sample (N=61, 43% female, 97% White). Participants completed demographic measures, scales measuring incident reactions and defensiveness, and a Time Line Follow Back assessing drinking quantity and frequency both pre- and post-sanction.

RESULTS

Analyses revealed significant post-sanction decreases in quantity (average total drinks per month) and frequency (number of monthly drinking days). Pre-sanction drinking quantity and frequency significantly predicted post-sanction quantity and frequency, respectively. Interaction effects suggest higher post-sanction quantities among moderate and heavier drinkers with higher defensiveness and lower aversiveness perceptions, while perceptions did not influence outcomes among light drinkers. None of the interactions involving blame or responsibility, or predicting post-sanction frequency, were significant.

CONCLUSIONS

These findings suggest a complex relationship between pre-sanction drinking and student reactions. Implications for mandated student interactions and future research directions are discussed.

College Students' Perceptions of Depressed Mood: Exploring Accuracy and Associations

College is a time of high risk for depressed mood. Theories about depression (i.e. Cognitive Theory and Depressive Realism theory) are well researched, but suggest different venues of understanding the cognitive underpinnings of mood. In addition, much research is available about normative perceptions around substance use and how those perceptions relate to behaviors. However, there are no studies examining normative perceptions around depressed mood nor how these perceptions may relate to students' own well-being. Undergraduates (N=1577) ages 18-24 responded to an online survey as part of a larger study on drinking and depressed mood. The survey assessed symptoms of depression and feelings of sadness, depression and suicidal ideation experienced in the past 2 weeks, as well as students' perceptions of the prevalence of these feelings among other students. Rates of sadness and depression reported in the sample were relatively high; whereas rates of reported suicidal ideation were low. Most students under-estimated the prevalence of sadness and depression experienced by other students; a finding that was especially true for male students. Conversely, most students over-estimated the prevalence of suicidal ideation. Students who reported experiencing a given feeling in the past two weeks perceived greater rates of the feeling among other students. Depression symptoms were associated with both greater perceived prevalence of sadness, depression and suicidal ideation, as well as correct and over-estimates of the prevalence of sadness and depression. Implications for future directions in prevention and interventions efforts are discussed.

"Seems I'm not alone at being alone:" contributing factors and interventions for drinking games in the college setting

Alcohol use among college students is prevalent and sometimes takes the form of drinking games, in which players are required to drink in accordance with a set of pre-defined rules. Drinking games are typically associated with elevated alcohol consumption and risk to the individual. This perspective piece considers the potential role of social anxiety in motivating participation in drinking games, perceived norms surrounding drinking games (including ways they are portrayed and discussed in popular media), and the role of competitiveness. Implications for skills training-based prevention and intervention efforts are discussed.

Normative perceptions of non-medical stimulant use: associations with actual use and hazardous drinking

Approximately 10% of US college students are engaged in non-medical use of prescription stimulants (NMUPS) and that use is linked to concerning health, educational, and societal consequences. Few studies have assessed normative perceptions surrounding NMUPS. Accordingly, we examined self-reported use and normative perceptions for NMUPS and demographic factors that may be associated with them. We also investigated whether higher normative perceptions for NMUPS were related to the most commonly used and abused substance among college students (alcohol).

METHOD

1106 undergraduates participated in an online survey of normative perceptions of NMUPS and students' own drinking and stimulant use habits.

RESULTS

Students overestimated NMUPS by other students and those normative estimates were associated with higher NMUPS. Living in a fraternity or sorority was related to higher NMUPS and perceived norms. Finally, higher normative perceptions of NMUPS were associated with higher hazardous drinking.

CONCLUSION

The large discrepancy between actual use (generally low) and students' perceptions (generally high), and the relationship of these perceptions to both one's own use of NMUPS and alcohol suggests that interventions aimed at correcting norms may be useful.

Alcohol interventions for mandated students: behavioral outcomes from a randomized controlled pilot study

OBJECTIVE

This study investigated the effectiveness of three single-session interventions with high-risk mandated students while considering the influence of motivational interviewing (MI) microskills.

METHOD

This randomized, controlled pilot trial evaluated single-session interventions: Alcohol Skills Training Program (ASTP), Brief Alcohol Screening and Intervention for College Students (BASICS) feedback sessions, and treatment-as-usual Alcohol Diversion Program (ADP) educational groups. Participants were 61 full-time undergraduates at a southern U.S. campus sanctioned to a clinical program following violation of an on-campus alcohol policy (Mage = 19.16 years; 42.6% female).

RESULTS

RESULTS revealed a significant effect of time for reductions in estimated blood alcohol concentration (eBAC) and number of weekly drinks but not in alcohol-related consequences. Although ASTP and BASICS participants reported significant decreases in eBAC over time, ADP participant levels did not change (with no intervention effects on quantity or consequences). MI microskills were not related to outcomes.

CONCLUSIONS

RESULTS from this study suggest equivalent behavioral impacts for the MI-based interventions, although individual differences in outcome trajectories suggest that research is needed to further customize mandated interventions. Given the overall decrease in eBAC following the sanction, the lack of reduction in the ADP condition warrants caution when using education-only interventions.

Change IS Possible: Reducing High-Risk Drinking Using a Collaborative Improvement Model

OBJECTIVE

To describe the adoption of public health and improvement methodologies to address college students' high-risk drinking behaviors and to aid in prevention efforts.

PARTICIPANTS

Members of 32 colleges and universities, content experts, and staff members of the National College Health Improvement Program (NCHIP).

METHODS

A 2-year learning collaborative developed by NCHIP trained individuals from 32 different college and universities in using the Plan-Do-Study-Act cycle as a method to create and implement initiatives aimed at reducing students' high-risk drinking behaviors and related harms.

RESULTS

Participants experienced success ranging from noteworthy increases in type and amount of interventions directed at reducing high-risk drinking, to creating collaboratives across campus, the local community, and stakeholders. Challenges related to data collection and creating lasting cultural change remain.

CONCLUSIONS

The use of quality improvement methodologies and creation of a national collaborative successfully effected meaningful change in high-risk drinking behaviors on college campuses.

Use of drinking protective behavioral strategies and sexual perceptions and behaviors in U.S. college students

Alcohol use among college students is linked to an increased likelihood of engaging in risky sexual behaviors, including casual sex and unprotected sex. These behaviors increase college students' risks for negative social and health-related consequences. This study examined the relationship between drinking behaviors and protective behavioral strategies (PBS), expectancies and perceptions of sexual risk, and actual alcohol-related sexual behaviors and consequences. Sexually active college students completed Web-based self-report measures of drinking behaviors and use of PBS, alcohol expectancies and perceptions of risk, and sexual behaviors and related consequences (n = 524; 57.1% women). Findings indicated that PBS were related to lower expectancies of sexual risk and sexual disinhibition, and among lighter drinkers, lower expectancies of sexual enhancement from alcohol. PBS were also related to decreased perceptions of sexual-related risks, some alcohol-related sexual behaviors, including number of drinks before/during sex, and number of sexual consequences, but were not related to abstaining during sex, frequency of alcohol-related sexual behaviors, or general condom use. These findings demonstrate a disconnect between perceived and actual risks among college students, such that decreased perceptions of risk may not be associated with protective behaviors. Prevention and intervention implications are discussed.

Randomized controlled trial of a Spring Break intervention to reduce high-risk drinking

OBJECTIVE

Although recent studies have documented high-risk drinking occurring during Spring Break (SB), particularly on SB trips with friends, published intervention studies are few. In the present study, we evaluated the efficacy of event specific prevention strategies for reducing SB drinking among college students, compared to general prevention strategies and an assessment-only control group, as well as evaluated inclusion of peers in interventions and mode of intervention delivery (in-person vs. web).

METHOD

Participants included 783 undergraduates (56.1% women; average age = 20.5 years) intending to go on a SB trip with friends as well as to drink heavily on at least 1 day of SB. Participants completed assessments prior to SB and were randomized to 1 of 5 intervention conditions: SB in-person Brief Alcohol Screening and Intervention for College Students (BASICS; Dimeff, Baer, Kivlahan, & Marlatt, 1999), SB web BASICS, SB in-person BASICS with friend, SB web BASICS with friend, general BASICS, or an attention control condition. Follow-up assessment was completed 1 week after SB.

RESULTS

Although the SB web BASICS (with and without friends) and general BASICS interventions were not effective at reducing SB drinking, results indicated significant intervention effects for SB in-person BASICS in reducing SB drinking, particularly on trip days. Follow-up analyses indicated that change in descriptive norms mediated treatment effect and reductions in drinking, whereas SB drinking intentions and positive expectancies did not.

CONCLUSIONS

Overall, results suggest that an in-person SB-specific intervention is effective at reducing SB drinking, especially during trips. In contrast, interventions that contain non-SB-related content, are web-based, or seek to involve friends may be less effective at reducing SB drinking.

Electronic Feedback in College Student Drinking Prevention and Intervention

Alcohol consumption is prevalent among college students and can be associated with serious negative consequences. Several efficacious programs using one-on-one brief intervention techniques have been developed to target high-risk drinking by individual students, such as the Brief Alcohol Screening and Intervention for College Students (BASICS) (Dimeff et al. 1999). To reach a larger population (e.g., the incoming freshman class), researchers have adapted these interventions so that students can access them via the Internet or in some other electronic format.The purpose of this review is to discuss specific alcohol intervention programs that were (1) designed to be delivered remotely (e.g., via the Web or on an electronic device) without interaction with a provider and (2) were tested among college students using a randomized controlled trial design. Specific studies were drawn from earlier reviews as well as a comprehensive literature search. Although many programs have limited research support, and some findings are mixed, components that were directly translated from in-person BASICS to remote-delivery mediums (i.e., personalized feedback interventions [PFIs], personalized normative feedback [PNF] interventions), and broader programs that incorporate PFI/ PNF, show promise in reducing alcohol use and/or negative consequences. However, more research is needed and suggestions for how the field can move these interventions forward are discussed.

Social identity as a moderator of the association between perceived norms and marijuana use

OBJECTIVE

This study extends previous examinations of social influences and marijuana use in considering how heavy marijuana users view themselves relative to their peers. We were specifically interested in evaluating whether (a) heavy-using marijuana users would identify more strongly with other users than with typical students, (b) identification with other marijuana users would be more strongly associated with own use, and (c) the association between perceived norms and marijuana use would be moderated by identification with peers.

METHOD

Participants were 107 heavy (five or more times per month) marijuana users who completed an online survey assessing perceived norms for marijuana use, identification with typical students and other marijuana-using students, and marijuana use (frequency of use, joints per week, and hours high).

RESULTS

Participants unexpectedly identified more strongly with typical students rather than with other marijuana-using students. Identification with other marijuana users was, however, associated with more use. In addition, perceived norms were associated with more use but primarily among those who identified more with other users but not with typical students.

CONCLUSIONS

Heavy marijuana users may be reluctant to identify themselves as users and may prefer to think of themselves as typical students. This may provide clinical opportunities to highlight discrepancies. In addition, identification with other users and lack of identification with typical students may be risk factors for heavier use and good indicators of candidacy for norms-based interventions. In sum, the present findings extend our understanding of the influence of social identity among young adult marijuana users and suggest novel directions for intervention strategies.

RCT of web-based personalized normative feedback for college drinking prevention: are typical student norms good enough?

OBJECTIVES

Personalized normative feedback (PNF) interventions are generally effective at correcting normative misperceptions and reducing risky alcohol consumption among college students. However, research has yet to establish what level of reference group specificity is most efficacious in delivering PNF. This study compared the efficacy of a web-based PNF intervention using 8 increasingly specific reference groups against a Web-BASICS intervention and a repeated-assessment control in reducing risky drinking and associated consequences.

METHOD

Participants were 1,663 heavy-drinking Caucasian and Asian undergraduates at 2 universities. The referent for web-based PNF was either the typical same-campus student or a same-campus student at 1 (either gender, race, or Greek affiliation), or a combination of 2 (e.g., gender and race), or all 3 levels of specificity (i.e., gender, race, and Greek affiliation). Hypotheses were tested using quasi-Poisson generalized linear models fit by generalized estimating equations.

RESULTS

The PNF intervention participants showed modest reductions in all 4 outcomes (average total drinks, peak drinking, drinking days, and drinking consequences) compared with control participants. No significant differences in drinking outcomes were found between the PNF group as a whole and the Web-BASICS group. Among the 8 PNF conditions, participants receiving typical student PNF demonstrated greater reductions in all 4 outcomes compared with those receiving PNF for more specific reference groups. Perceived drinking norms and discrepancies between individual behavior and actual norms mediated the efficacy of the intervention.

CONCLUSIONS

Findings suggest a web-based PNF intervention using the typical student referent offers a parsimonious approach to reducing problematic alcohol use outcomes among college students.

Indicated prevention for college student marijuana use: a randomized controlled trial

OBJECTIVE

Marijuana is the most frequently reported illicit substance used on college campuses. Despite the prevalence, few published intervention studies have focused specifically on addressing high-risk marijuana use on college campuses. The present study evaluated the efficacy of an in-person brief motivational enhancement intervention for reducing marijuana use and related consequences among frequently using college students.

METHOD

Participants included 212 college students from 2 campuses who reported frequent marijuana use (i.e., using marijuana at least 5 times in the past month). Participants completed Web-based screening and baseline assessments and upon completion of the baseline survey were randomized to either an in-person brief intervention or an assessment control group. Follow-up assessments were completed approximately 3 and 6 months post-baseline. Marijuana use was measured by number of days used in the past 30 days, typical number of joints used in a typical week in the last 60 days, and marijuana-related consequences.

RESULTS

Results indicated significant intervention effects on number of joints smoked in a typical week and a trend toward fewer marijuana-related consequences compared with the control group at 3-month follow-up.

CONCLUSION

This study provides preliminary data on short-term effects of a focused marijuana intervention for college students at reducing marijuana use during the academic quarter.

Predictors of hooking up sexual behaviors and emotional reactions among U.S. college students

The present study examined factors associated with engaging in oral and vaginal sex and condom use during the most recent hookup, a term that refers to a range of physically intimate behaviors outside of a committed relationship, among college students. In addition, this research aimed to evaluate factors associated with experiencing positive and negative affect resulting from the most recent hookup. A random sample (N = 1,468) of undergraduates (56.4% female) completed a Web-based survey that was comprised of measures of drinking and sexual behavior. Participants (n = 824; 56.1%) who indicated they had ever hooked up were included in data analysis. Findings indicated that sex, partner type, alcohol use, attitudes towards hooking up, and attitudes towards sexual activity during hookups explained significant variance for oral sex, vaginal sex, condom use, and positive and negative affect related to the most recent hookup experience. Clinical implications regarding the role of situational stressors, such as the impact on affect following a hookup, and ways to reduce risks associated with stressors are discussed.

Pick your poison: stimuli selection in alcohol-related implicit measures

It is common for people to report strong preferences for certain types of alcohol, often as a function of past positive or negative experiences with particular types of drinks. Despite this individual difference, implicit measures related to alcohol frequently use nomothetic approaches--i.e., use a standard set of alcohol beverage stimuli--which may not match individuals' actual drinking behavior. Moreover, this mismatch may account for some of the inconsistencies across studies using implicit measures. The present study used an idiographic variant of the Implicit Association Test (IAT) in which participants (N=300) selected alcohol images that matched their drinking behavior (non-drinkers selected what they were offered most often). Results were consistent with previous research on alcohol preference: women selected more liquor and wine images, men selected more beer images; heavy episodic drinkers selected more beer and liquor images and selected fewer wine images than lighter drinkers and non-drinkers. In addition, IAT scores were sensitive to drinking levels in the expected direction and, importantly, were robust to stimuli selected. Thus, results provide initial validation of idiographic approaches to stimuli selection.