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Addictions: Tools for "Controlled" Drinking
6 CEUs Addictions: Tools for Controlled Drinking

Section 10
A Brief Controlled Drinking Intervention for College Freshmen

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Lifetime consumption of alcohol typically reaches its highest levels during an individual's late teens and early 20s. Numerous studies document a range of negative consequences of high levels of alcohol consumption, including violence, date rape, accidents, academic problems, and family conflict. The college campus is one setting where the pattern of youthful heavy drinking is felt acutely. College students, on average, drink more than their noncollege peers of the same age and routinely report negative consequences from both their own and others' drinking. While heavy drinking in college is associated with personality factors such as impulsivity, noncomformity, and depression, contextual factors such as distance from parents, close association with peers, dormitory residence, association with fraternities and sororities, large-group social events, and athletics appear to support and exacerbate heavy drinking as well.

Heavy drinking in college should not be confused with dependent drinking in later life, however. Several studies note significant reductions in heavy drinking in the 20s. At the individual level, Schulenberg and colleagues followed the drinking patterns of high school seniors for at least 6 years and noted that a subset of individuals (17%) reported more than isolated patterns of heavy drinking over time. Thus, college administration and health officials, who are under increasing pressure to provide both preventive and treatment services as a public health service for college students, are faced with a multifaceted social problem that is common, risky, and limited in time for most but chronic for some.

Preventive Intervention
Freshman participants who had been randomly assigned to the intervention group were contacted during the winter term and scheduled for an individualized feedback session. Participants were instructed to self-monitor drinking patterns 2 weeks before the scheduled session. Eight interviewers using a written manual provided personal feedback concerning the consumption patterns as reported on diary cards and at baseline assessment. Norms of drinking were compared with norms for same-age peers. Individualized feedback also included information about perceived risks and benefits of drinking, mythology concerning drinking behavior, the biphasic effects of alcohol, and placebo and tolerance effects, The style of the intervention was consistent with motivational interviewing client-centered in tone, but nevertheless seeking to highlight and explore discrepancies between current behavior and plans, goals, and aspirations. Each participant was also given a 1-page list of tips for reducing risks associated with drinking.

During the winter term of their second year in college, participants randomized into the prevention condition were mailed feedback results comparing their drinking and its consequences with the norms of their college peers. The summary sheets contained bar graph results from 3 assessments (baseline, spring of the freshman year, and fall quarter of the sophomore year) and concluded with a paragraph that personalized the feedback for each participant. After the mailing, we also phoned prevention group participants in the highest-risk categories (n=56) to express concern about risk and offer additional feedback sessions. Thirty-four motivational interviews were conducted in the second year, most over the phone (n=26).

Central findings suggest that much heavy drinking among college students is transitory, despite some students who report a pattern of continued or worsening consequences over time. Changes in drinking are reflected in specific dimensions of drinking behavior, Compared with a high-risk control sample, in this randomized trial, participants receiving a brief individual preventive intervention had significantly greater reductions in negative consequences that persisted over a 4-year period. Individual change analyses suggest that the dependence symptoms of those receiving the brief intervention are more likely to decrease and less likely to increase.

To understand the impact of the preventive intervention in a broader context, we report the natural history of different dimensions of drinking through the participants' 4 years of college. The frequency of drinking did not change dramatically over 4 years for either high-risk or normative samples. Normative comparison participants, representing the general student body, reported slight increases in drinking frequency over time, particularly at the 3-year follow-up, when many in the sample had reached 21 years of age. Drinking frequency among high-risk students declined only minimally over the 4-year period.

Mean drinking quantity end negative consequences increased only marginally within our normative comparison group, suggesting that students in general do not commonly or routinely develop drinking problems during the college years. However, drinking quantity and associated problems declined steadily over time for high-risk students who entered college with a history of heavy drinking. Recruitment of high-risk students was based on drinking during high school, and thus both developmental and statistical trends probably move toward less extreme behavior (but these same individuals reported mean increases drinking upon entry into college. Four years after matriculation, our high-risk control students continued to drink more frequently than the normative comparison students, but their problem scores had markedly decreased and, although still above those of the comparison group, were much less elevated (standardized difference about 0.62) than they were at baseline (standardized difference about 1.40). This pattern of data is consistent with other longitudinal studies showing that adolescents with problem behaviors (including heavy drinking) remain less conventional than others as they age into adulthood, but do not have worse psychosocial adjustment.

Prevention effects were observed for only some dimensions of drinking behavior, The dimension of greatest interest, negative consequences of drinking, shows the greatest effects. This is important not only because negative consequences measure the degree to which individuals may be harmed as a result of drinking, but also because the preventive intervention targeted individual choices and reduction of risk, rather than drinking rates per se. Our findings are consistent with the goals of harm reduction interventions, approaches that focus on minimizing the harmful effects of high-risk drinking. The duration of our prevention effects is also noteworthy. Modest differential changes in drinking quantity and frequency, described in our earlier report of 2-year outcomes, do not appear to persist for longer periods of time, yet we found significantly reduced negative consequences 3 1/2 years after the preventive intervention. We are unaware of other studies (much less randomized trials) of prevention efforts among college students that demonstrate such long-lasting effects.
- Baer, John S.; Kivlahan, Daniel R.; Blume, Arthur W.; McKnight, Patrick; Marlatt, G. Alan; Brief Intervention for Heavy-Drinking College Students: 4-Year Follow-Up and Natural History; American Journal of Public Health, Aug2001, Vol. 91 Issue 8

Personal Reflection Exercise #3
The preceding section contained information about a brief controlled drinking intervention for college freshmen.  Write three case study examples regarding how you might use the content of this section in your practice.

According to Baer, what was the most important result of the motivational-interview controlled drinking intervention? Record the letter of the correct answer the Test

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