College alcohol citations result in modest reductions in student drinking

Evaluation of a Community-Based Harm Reduction Intervention Aimed at Adjudicated College Students

The purpose of this study was to develop, test, and use an instrument to measure the effectiveness of a community-based, mandated drug education intervention program, Youthful Offenders Program (YOP), targeting college students at risk. A total of N = 350 students voluntarily agreed to participate in an evaluation of program effectiveness using the Alcohol Use Disorders Identification Test (AUDIT) and a newly developed measure to compare changes in substance related behaviors over time. Results revealed sound psychometric structure for the new scale for use in program evaluation; results suggest that YOP significantly enhanced safety practices and reduced hazardous drinking and recidivism, but not avoidance of risky behaviors.

Impact of a University Alcohol Policy Change on Bystander Responses to Alcohol-Related Medical Emergencies

Two studies evaluated the implementation of a stricter campus underage drinking policy on service utilization and bystander helping behaviors for alcohol-related medical emergencies. A program evaluation (Study 1) examined campus emergency medical service logs assessing changes in call volume and service utilization, finding a 30% reduction in call volume postpolicy change. Study 2 provided a qualitative data summarizing campus first responder ( N =  35) accounts of off-duty alcohol-related emergency calls. Off-duty calls increased postpolicy change and thematic analyses indicated they were (a) motivated by fear of campus sanctions, (b) often yielded delays or failures to contact campus emergency staff, and (c) resulted from student misunderstandings of policy implications for bystander helpers. Findings highlight potential challenges in executing environmental strategies to reduce college drinking.

The Impact of University Sanctions on Cannabis Use: Individual Difference Factors that Predict Change in Cannabis Use

Over one-third of college students use cannabis, yet the majority of students experiencing cannabis-use problems are not interested in seeking treatment. Therefore, the campus judicial process following a violation of university cannabis policies may be an important point of intervention. This study examined whether cannabis use decreased following being sanctioned by the university for violation of campus drug policy. We also identified individual difference factors related to changes in post-infraction use. University students (N = 98, 73.1% White, 88.2% Male) were referred to participate in a brief motivational intervention study as a component of their sanctions following violation of campus cannabis policies. Data were collected during the intake appointment. Approximately 91% of participants reported decreased post-infraction cannabis use and 58% of the sample reported abstinence in the month prior to intake. The following variables were significantly related to both abstinence or to reducing frequent use (from at least four times per month to less frequently): using less frequently prior to their infraction, descriptive friend norms, and enhancement motives. The following variables were significantly related only to reducing frequent use: injunctive norms regarding parents and expansion motives. Students sanctioned for cannabis violations appear to decrease cannabis use post-infraction. Thus, results support campus efforts to sanction students for violation of campus cannabis use policies. Identification of individual difference variables that predict post-infraction change in cannabis use can inform treatment and prevention efforts.

Mechanisms of Behavior Change Within Peer-Implemented Alcohol Interventions

OBJECTIVE

Colleges continue to experience a high number of referred students because of campus alcohol violations. Subsequently, there has been a trend to use peer-implemented minimal interventions (PMIs), often using motivational interviewing (MI). However, little is known about how PMIs facilitate behavior change. This study aims to examine the mechanisms of behavior change within PMIs and their influence on alcohol reduction among mandated students.

METHOD

Participants (N = 146; mean age = 18.7 years; 67% male; 94% White) were college students who violated campus alcohol policy at a Northeastern liberal arts college who received a 15-minute PMI addressing their alcohol use. The Motivational Interviewing Skill Code (Miller et al., 2003) was used to identify peer counselor behaviors that were MI consistent (MICO), client change talk (CT), and client self-exploration.

RESULTS

MICO behaviors were positively associated with CT and self-exploration. Client CT and self-exploration were negatively associated with alcohol-related outcomes. Furthermore, mediational models examining MICO behaviors revealed effects for two paths: (a) from MICO to client CT to reduced alcohol use; and (b) from MICO to client self-exploration to reduced alcohol-related consequences and use.

CONCLUSIONS

These data support the primary causal chain examining the influence of MICO on in-session client behaviors and related post-session behavior change in PMIs among at-risk students.

Mechanisms of Behavior Change Within Peer-Implemented Alcohol Interventions

OBJECTIVE

Colleges continue to experience a high number of referred students because of campus alcohol violations. Subsequently, there has been a trend to use peer-implemented minimal interventions (PMIs), often using motivational interviewing (MI). However, little is known about how PMIs facilitate behavior change. This study aims to examine the mechanisms of behavior change within PMIs and their influence on alcohol reduction among mandated students.

METHOD

Participants (N = 146; mean age = 18.7 years; 67% male; 94% White) were college students who violated campus alcohol policy at a Northeastern liberal arts college who received a 15-minute PMI addressing their alcohol use. The Motivational Interviewing Skill Code (Miller et al., 2003) was used to identify peer counselor behaviors that were MI consistent (MICO), client change talk (CT), and client self-exploration.

RESULTS

MICO behaviors were positively associated with CT and self-exploration. Client CT and self-exploration were negatively associated with alcohol-related outcomes. Furthermore, mediational models examining MICO behaviors revealed effects for two paths: (a) from MICO to client CT to reduced alcohol use; and (b) from MICO to client self-exploration to reduced alcohol-related consequences and use.

CONCLUSIONS

These data support the primary causal chain examining the influence of MICO on in-session client behaviors and related post-session behavior change in PMIs among at-risk students.

A text message program as a booster to in-person brief interventions for mandated college students to prevent weekend binge drinking

OBJECTIVE

To evaluate a text message (SMS) program as a booster to an in-person alcohol intervention with mandated college students.

PARTICIPANTS

Undergraduates (N = 224; 46% female) who violated an on-campus alcohol policy over a 2-semester period in 2014.

METHODS

The SMS program sent drinking-related queries each Thursday and Sunday and provided tailored feedback for 6 weeks. Response rates to SMS drinking-related queries and the associations between weekend drinking plans, drinking-limit goal commitment, and alcohol consumption were examined. Gender differences were explored.

RESULTS

Ninety percent of SMS queries were completed. Weekend binge drinking decreased over 6 weeks, and drinking-limit goal commitment was associated with less alcohol consumption. Compared with women, men had greater reductions in alcohol consumption when they committed to a drinking-limit goal.

CONCLUSIONS

Preliminary evidence suggests that an SMS program could be useful as a booster for helping mandated students reduce weekend binge drinking.

Alcohol interventions for mandated college students: A meta-analytic review

OBJECTIVE

When college students violate campus alcohol policies, they typically receive disciplinary sanctions that include alcohol education or counseling. This meta-analysis evaluated the efficacy of these "mandated interventions" to prevent future alcohol misuse.

METHOD

Studies were included if they evaluated an individual- or group-level intervention, sampled students mandated to an alcohol program, used a pretest-posttest design, and assessed alcohol use as an outcome. Thirty-one studies with 68 separate interventions (N = 8,621 participants; 35% women; 85% White) were coded by independent raters with respect to sample, design, methodological features, and intervention content; the raters also calculated weighted mean effect sizes, using random-effects models. A priori predictors were examined to explain variability in effect sizes.

RESULTS

In the 5 studies that used assessment-only control groups, mandated students reported significantly less drinking relative to controls (between-groups contrasts), d+ ranged from 0.13-0.20 for quantity and intoxication outcomes. In the 31 studies that provided within-group contrasts, significant effects were observed for all outcomes in the short-term (i.e., ≤ 3 months postintervention), with d+ ranging from 0.14-0.27; however, fewer significant effects appeared at longer follow-ups. Four commercially available intervention protocols (i.e., BASICS, e-CHUG, Alcohol 101, and Alcohol Skills Training Program) were associated with risk reduction.

CONCLUSIONS

Providing mandated interventions to students who violate campus alcohol policies is an effective short-term risk reduction strategy. Continued research is needed to maintain initial gains, identify the most useful intervention components, and determine the cost-effectiveness of delivery modes. (PsycINFO Database Record

Randomized controlled trial of brief alcohol screening and intervention for college students for heavy-drinking mandated and volunteer undergraduates: 12-month outcomes

This is the first randomized trial testing whether heavy-drinking undergraduates mandated to the Brief Alcohol Screening and Intervention for College Students (BASICS) program following a campus alcohol violation would benefit as much as heavy-drinking volunteers up to 1 year postintervention using control groups with high-risk drinkers to model disciplinary-related and naturalistic changes in drinking. Participants (61% male; 51% mandated; 84% Caucasian; M age = 20.14 years) were screened for heavy drinking and randomized to BASICS (n = 115) or assessment-only control (n = 110). Outcome measures (drinking, alcohol problems) were collected at baseline, 4 weeks, 3, 6, and 12 months postintervention. At 4 weeks postintervention, intent-to-treat multilevel longitudinal models showed that regardless of referral group (mandated or volunteer), BASICS significantly decreased weekly drinking, typical drinks, and peak drinks relative to controls (ds = .41-.92). BASICS had a large effect on decreases in alcohol problems (d = .87). At 12 months postintervention, BASICS participants (regardless of referral group) reported significantly fewer alcohol problems (d = .56) compared with controls. Significant long-term intervention gains for peak and typical drinks were sustained in both referral groups relative to controls (ds = .42; .11). Referral group had no significant main effect and did not interact with intervention condition to predict outcomes. Given that BASICS was associated with less drinking and fewer alcohol problems (even among heavier drinking mandated students up to 1 year postintervention), provision of BASICS-style programs within disciplinary settings may help reduce heavy and problematic drinking among at-risk students. (PsycINFO Database Record

Mandated college students' response to sequentially administered alcohol interventions in a randomized clinical trial using stepped care

OBJECTIVE

Students referred to school administration for alcohol policies violations currently receive a wide variety of interventions. This study examined predictors of response to 2 interventions delivered to mandated college students (N = 598) using a stepped care approach incorporating a peer-delivered 15-min brief advice (BA) session (Step 1) and a 60- to 90-min brief motivational intervention (BMI) delivered by trained interventionists (Step 2).

METHOD

Analyses were completed in 2 stages. First, 3 types of variables (screening variables, alcohol-related cognitions, mandated student profile) were examined in a logistic regression model as putative predictors of lower risk drinking (defined as 3 or fewer heavy episodic drinking [HED] episodes and/or 4 or fewer alcohol-related consequences in the past month) 6 weeks following the BA session. Second, we used generalized estimating equations to examine putative moderators of BMI effects on HED and peak blood alcohol content compared with assessment only (AO) control over the 3-, 6-, and 9-month follow-ups.

RESULTS

Participants reporting lower scores on the Alcohol Use Disorders Identification Test, more benefits to changing alcohol use, and those who fit the "Bad Incident" profile at baseline were more likely to report lower risk drinking 6 weeks after the BA session. Moderation analyses revealed that Bad Incident students who received the BMI reported more HED at 9-month follow-up than those who received AO.

CONCLUSION

Current alcohol use as well as personal reaction to the referral event may have clinical utility in identifying which mandated students benefit from treatments of varying content and intensity.

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.

The comparative effectiveness of individual and group brief motivational interventions for mandated college students

Individual brief motivational intervention (iBMI) is an efficacious strategy to reduce heavy drinking by students who are mandated to receive an alcohol intervention following an alcohol-related event. However, despite the strong empirical support for iBMI, it is unknown if the results from rigorously controlled research on iBMI translate to real-world settings. Furthermore, many colleges lack the resources to provide iBMI to mandated students. Therefore, group-delivered BMI (gBMI) might be a cost-effective alternative that can be delivered to a large number of individuals. The purpose of this study was to conduct a comparative effectiveness evaluation of iBMI and gBMI as delivered by staff at a university health services center. Participants (N = 278) were college students who were mandated to receive an alcohol intervention following an alcohol-related incident. Participants were randomized to receive an individual (iBMI; n = 133) or a Group BMI (gBMI; n = 145). Results indicated that both iBMI and gBMI participants reduced their peak estimated blood alcohol concentration (BAC) and the number of negative alcohol-related consequences at 1-, 3-, and 6-months postintervention. The iBMI and gBMI conditions were not significantly different at follow-up. These findings provide preliminary support for the use of iBMI and gBMIs for college students in real-world settings.

Brief motivational intervention for heavy drinking mandated and voluntary freshmen: A 1-year follow-up assessment

BACKGROUND

Alcohol abuse among freshmen university students is a major public health issue with associated costs to individuals and the society of substantial morbidity, high-risk negative behaviors (e.g., blackouts, rape, suicide, and violence), and mortality. This longitudinal study compared the effectiveness of a brief motivational intervention (MI) in decreasing alcohol consumption and related consequences among mandated students and voluntary students. Readiness to change drinking behaviors was compared between the groups.

METHODS

Eligible participants (710 voluntary and 190 mandated, N = 900) received MI at baseline and again at 2 weeks with boosters at 3, 6, and 12 months. Repeated-measures analysis of variance was used to compare the two groups.

RESULTS

Alcohol use and related consequences in both groups decreased significantly between baseline and 12 months. At baseline, a significantly larger percent of students from the mandated group than the voluntary group were in the action stage of change (52.1% vs. 27.5%), and a significantly smaller percentage of mandated students were in the precontemplation stage (p < .0001).

DISCUSSION

MI effects were sustained over 12 months. Alcohol consumption and related consequences decreased significantly among the freshmen who were mandated to attend the program as well as among students who volunteered to participate in the study. The findings support the importance of advanced practice nurses conducting MI as an intervention with college students.

In-session processes of brief motivational interventions in two trials with mandated college students

OBJECTIVE

Each year, thousands of college students receive mandated intervention as a sanction for alcohol use or alcohol-related behavior. For these mandated students, brief motivational interventions (BMIs) are currently the most efficacious individual intervention. However, little is known about how the technical (therapist behaviors) and relational (e.g., global ratings of therapist empathy) components of BMIs influence client language as well as subsequent change in alcohol use and consequences.

METHOD

This study used the Motivational Interviewing Skills Code (MISC 2.0; Miller, Moyers, Ernst, & Amrhein, 2003) to code BMI sessions from 2 randomized clinical trials that facilitated significant reductions in alcohol use (Study 1, n = 91) and alcohol-related consequences (Study 2, n = 158) in mandated students.

RESULTS

There were significant relationships among therapist behaviors, global scores, and client language both for and against change, yet there were no links between in-session client language and subsequent changes in alcohol use or problems. In contrast, relational aspects of motivational interviewing (MI; global ratings of therapist MI Spirit and client self-exploration) were most predictive of postsession alcohol use. Mediation models incorporating both technical and relational components revealed that higher levels of client self-exploration mediated the relationship between higher therapist ratings of MI Spirit and reduced drinking at follow-up.

CONCLUSIONS

Findings highlight the importance of considering how both technical and relational components of MI may influence alcohol use in mandated college students and also suggest more exact analyses to better understand this complex relationship.

Predictors of motivation to change in mandated college students following a referral incident

The purpose of present study was to understand factors that are related to a desire or motivation to change (MTC) alcohol use in a sample of college students mandated to receive an alcohol intervention. We examined characteristics of and reactions to the referral event, typical alcohol use involvement, and alcohol beliefs about the perceived importance of drinking in college assessed by the College Life Alcohol Salience Scale (CLASS; Osberg et al., 2010) as predictors of MTC following referral to an alcohol intervention. College students (N = 932) who presented for a mandatory alcohol intervention following a referral event (e.g., citation for underage drinking, medical attention for an alcohol-related incident, or driving under the influence) completed an assessment prior to receiving an alcohol intervention. Higher perceived aversiveness of the referral event and higher personal responsibility one felt for the occurrence of the event were positively related to higher MTC. Although alcohol beliefs about the role of drinking in college were not significantly related to either event aversiveness or responsibility, it was negatively related to MTC even after controlling for alcohol use involvement variables. Alcohol beliefs about the role of drinking in college represent an important construct that is related to increased alcohol use and alcohol-related problems and decreased MTC in a sample of college students. Interventions aimed at reducing alcohol beliefs about the role of drinking in college may be an effective strategy to reduce alcohol use and alcohol-related problems by college students.

Addressing alcohol use and problems in mandated college students: a randomized clinical trial using stepped care

OBJECTIVE

Over the past 2 decades, colleges and universities have seen a large increase in the number of students referred to the administration for alcohol policies violations. However, a substantial portion of mandated students may not require extensive treatment. Stepped care may maximize treatment efficiency and greatly reduce the demands on campus alcohol programs.

METHOD

Participants in the study (N = 598) were college students mandated to attend an alcohol program following a campus-based alcohol citation. All participants received Step 1: a 15-min brief advice session that included the provision of a booklet containing advice to reduce drinking. Participants were assessed 6 weeks after receiving the brief advice, and those who continued to exhibit risky alcohol use (n = 405) were randomized to Step 2, a 60- to 90-min brief motivational intervention (n = 211), or an assessment-only control (n = 194). Follow-up assessments were conducted 3, 6, and 9 months after Step 2.

RESULTS

Results indicated that the participants who received a brief motivational intervention showed a significantly reduced number of alcohol-related problems compared to those who received assessment only, despite no significant group differences in alcohol use. In addition, low-risk drinkers (n = 102; who reported low alcohol use and related harms at 6-week follow-up and were not randomized to stepped care) showed a stable alcohol use pattern throughout the follow-up period, indicating they required no additional intervention.

CONCLUSION

Stepped care is an efficient and cost-effective method to reduce harms associated with alcohol use by mandated students.

Feedback-based alcohol interventions for mandated students: an effectiveness study of three modalities

The present study used a randomized clinical trial design to examine the effectiveness of personalized alcohol feedback delivered individually, in a group and via computer on alcohol use and related negative consequences in a sample of 173 college students referred for alcohol-related violations. Findings revealed statistically significant reductions in alcohol use and related harms for the individually delivered intervention, with significant reductions in alcohol-related harms for the electronically delivered intervention. No statistically significant results were found for the group-delivered intervention or between groups, and a main effect of time was noted for all outcome variables. This study adds to the literature by being the first randomized clinical trial to include analyses of an empirically supported individually delivered personalized alcohol feedback intervention with more cost-effective group-delivered and electronically delivered feedback formats within a single research design, by expanding the range of participant drinking habits reported at baseline to include all drinking levels and not solely those classified as 'heavy drinking' and by providing anonymity pre-intervention and post-intervention given the potential demand characteristics to underreport illegal and/or illicit behaviours in this vulnerable population.

KEY PRACTITIONER MESSAGE

Personalized alcohol feedback delivered in a one-on-one, face-to-face format serves to decrease both alcohol use and harms in mandated college students. The use of web-delivered personalized alcohol feedback may be clinically useful when working with a mandated student population to reduce alcohol-related harms. Personalized alcohol feedback delivered in a group setting may not be indicated for use with a mandated student population as it does not demonstrate decreases in either alcohol use or harms, possibly because of the normalization of deviant behaviour.