ArticlePDF Available

Feedback-Based Alcohol Interventions for Mandated Students: An Effectiveness Study of Three Modalities

Abstract and Figures

Unlabelled: 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.
Content may be subject to copyright.
Feedback-Based Alcohol Interventions for
Mandated Students: An Effectiveness Study of
Three Modalities
Jacqueline Alfonso,
*Thomas V. Hall
and Michael E. Dunn
Emmanuel College, Boston, Massachusetts, USA
University of Central Florida, Orlando, Florida, USA
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 nega-
tive consequences in a sample of 173 college students referred for alcohol-related violations. Findings
revealed statistically signicant reductions in alcohol use and related harms for the individually deliv-
ered intervention, with signicant reductions in alcohol-related harms for the electronically delivered
intervention. No statistically signicant 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 rst randomized clinical trial to include analyses of an empirically sup-
ported 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 classied as heavy drinkingand by providing anonymity pre-intervention and
post-intervention given the potential demand characteristics to underreport illegal and/or illicit behav-
iours in this vulnerable population. Copyright © 2012 John Wiley & Sons, Ltd.
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 man-
dated student population as it does not demonstrate decreases in either alcohol use or harms, possibly
because of the normalization of deviant behaviour.
Keywords: Alcohol Intervention, Electronic Intervention, Personalized Feedback, Mandated Students,
Randomized Clinical Trial, Brief Motivational Interventions
College Student Alcohol Use and Related
The Substance Abuse and Mental Health Services Admin-
istration reports that young adults aged 1825 years show
the highest prevalence of problem drinking (2006).
Among this age group, rates of current and binge drink-
ing (dened as a blood alcohol concentration of 0.08 g%
achieved in 2 h) rank highest, as does the likelihood of
having met criteria for alcohol abuse and dependence
(NIAAA, 2007; SAMHSA, 2006). College student alcohol
use in particular is linked to a variety of serious conse-
quences, with more than 696 000 individuals assaulted
by a student peer who had been drinking and more
than 1700 student deaths each year from injuries related
to alcohol use (Hingson, Heeren, Winter, & Wechsler,
2005). In fact, the National Survey on Drug Use and
Health reports that college students are more likely than
their non-student cohorts to engage in high-risk drink-
ing behaviour and to drive while under the inuence
of alcohol (SAMHSA, 2006). Given this information, col-
lege students are not only placing themselves at a
greater risk for harmful alcohol consequences but are
also elevating the risk for their peers and surrounding
community as well.
* Correspondence to: Jacqueline Alfonso, PhD, Assistant Professor of
Psychology, Emmanuel College, 400 The Fenway, Boston, MA 02115,
United States.
Clinical Psychology and Psychotherapy
Clin. Psychol. Psychother. (2012)
Published online in Wiley Online Library ( DOI: 10.1002/cpp.1786
Copyright © 2012 John Wiley & Sons, Ltd.
Interventions for College Students
The high-risk nature of college student drinking has cre-
ated the need to develop effective alcohol prevention
and intervention programmes tailored specically for
use with college student populations (see Larimer, Cronce,
Lee, & Kilmer, 2004 for a review). One such programme is
the Brief Alcohol Screening and Intervention for College
Students (BASICS; Dimeff, Baer, Kivlahan, & Marlatt,
1999): a two-session individually delivered intervention
specically developed for use with college students that
incorporates motivational enhancement (see Miller &
Rollnick, 2002) and cognitive-behavioural skills training
and has garnered substantial empirical support (e.g., Baer,
Kivlahan, Blume, McKnight, & Marlatt, 2001; Murphy
et al., 2001; White et al., 2006). Several studies evaluating
BASICS in high-risk college student samples have demon-
strated reductions in both alcohol consumption and
related negative consequences (Dimeff et al., 1999; Murphy
et al., 2001), with results lasting as long as 4 years post-
intervention (Baer et al., 2001).
Although effective and supported by research, the high
cost of providing an individually delivered alcohol inter-
vention has led institutions of higher education to utilize
group programmes. CHOICES (Parks & Woodford, 2005)
is one such programme that is modelled after the
BASICS and includes many of the same elements (i.e.,
cognitive-behavioural skills training, psychoeducation,
harm-reduction principles), with the addition of an
interactive journal to encourage participant engagement.
Prior studies implementing CHOICES have done so in
a college classroom setting, with some nding that
the programme may improve descriptive drinking
norms (Henry, Lange, & Wilson, 2004; Wilson, Henry,
& Lange, 2005).
Murphy and colleagues (2004) examined the effective-
ness of providing a specic BASICS component, persona-
lized feedback (PF), on the reduction of alcohol use. PF
provides detailed information related to alcohol (e.g.,
quantity and frequency of use, comparison of use to a
referent norm group, risk factors) tailored from an indivi-
duals self-report data. The study compared the provision
of PF within the context of a BASICS motivational inter-
view to feedback delivered as a stand-alone intervention.
Comparison of feedback provided with and without a
one-on-one motivational interview revealed comparable
reductions in alcohol consumption, supporting the contin-
ued search for more cost-effective interventions that
incorporate feedback as an intervention component.
Interventions that utilize feedback have demonstrated
signicant reductions in alcohol consumption (see Riper
et al., 2009 for a meta-analytic review), with several stud-
ies having implemented PF as a stand-alone alcohol inter-
vention effectively (Agostinelli, Brown, & Miller, 1995;
Collins, Carey, & Sliwinski, 2002; Walters, 2000). A review
by Walters & Neighbors (2005) of feedback interventions
in college student samples found feedback to be effective
in reducing alcohol consumption whether delivered face-
to-face, by mail, or via computer. In fact, Kypri et al.
(2003) report that college students prefer to use electronic
methods of receiving alcohol screening and feedback to
individually delivered interventions similar in content.
Additionally, employing electronic methods has been
found to increase the likelihood of intervention utilization,
as well as the reporting of undesirable behaviours
(McCabe, Boyd, Couper, & DArcy, 2002; Turner, Ku,
Rogers, Lindberg, & Pleck, 1998), with research nding
no signicant differences between data collected electron-
ically versus more traditional paper-and-pencil methods
(Kypri, Gallagher, & Cashell-Smith, 2004; McCabe et al.,
2002; Miller et al., 2002).
A web-based intervention called the eCHECKUP TO
GO(e-CHUG; Moyer, Rikard, Van Sickle, Walters, &
Wilson, 2004) incorporates several of the aforementioned
elements found to be effective in reducing college stu-
dent alcohol use. This brief, web-based, commercially
available assessment and feedback tool uses motivational
enhancement strategies to provide detailed normative
and risk factor alcohol information personalized to each
individual (Walters, Miller, & Chiauzzi, 2005). A self-
administered intervention that requires only 1530 min
to complete, the e-CHUG eliminates the need for face-
to-face contact with a provider while disseminating the
content found in the most successful brief PF interven-
tions. Randomized trials conducted with the e-CHUG
have demonstrated signicant reductions in alcohol
consumption (Steiner, Woodall, & Yeagley, 2005; Walters,
Vader, & Harris, 2007).
Mandated College Students
Although the BASICS and stand-alone feedback interven-
tions such as the e-CHUG have garnered empirical sup-
port for use with heavy-drinking college students,
relatively few studies have included individuals who
have violated campus alcohol policies, a specic subpopu-
lation known as mandated,sanctionedor judicially
referredstudents, in their investigations. Research com-
paring sanctioned versus non-sanctioned students has
highlighted the need for heightened concern. A study by
Caldwell (2002) comparing the alcohol consumption
habits of mandated versus non-mandated students found
that individuals who are sanctioned for alcohol violations
tend to be heavier drinkers and more frequent alcohol
abusers than their non-mandated counterparts. Addi-
tional investigations have found that mandated students
also experience a greater number of alcohol-related prob-
lems than non-mandated students (Barnett et al., 2004),
J. Alfonso et al.
Copyright © 2012 John Wiley & Sons, Ltd. Clin. Psychol. Psychother. (2012)
DOI: 10.1002/cpp
supporting prior research that college students who vio-
late alcohol policies not only engage in riskier alcohol
use but also exhibit increased problems related to their
use as well (Flynn & Brown, 1991; OHare, 1997).
Recent attempts at improving the extant literature of
mandated student interventions have focused on the im-
plementation of brief motivational interventions (e.g.,
Borsari & Carey, 2005; Fromme & Corbin, 2004; White
et al., 2006). Although the investigations to date vary
in terms of modality (individual versus group, individ-
ual versus electronic), quantity of sessions (one versus
two) and length of intervention (from less than 1 h to
4 h), the literature is clearly supportive of interventions
that utilize a motivational enhancement approach and
incorporate cognitive-behavioural skills training and
personalized drinking feedback. In a comprehensive re-
view of the mandated student literature, Barnett and
Read (2005) identied specic strategies future investi-
gations should use to ll key gaps in the knowledge
base regarding effective mandated student interventions.
Of particular importance were the inclusion of referred
students regardless of risk level, as well as evaluations
comparing the efcacy of different intervention formats
(p. 156).
The Present Study
Although research supports the provision of interventions
such as the BASICS, face-to-face formats are not optimal
for reaching large numbers of students and are costly to
deliver. Fortunately, stand-alone feedback interventions
also are supported by the research, are cost-effective and
can be disseminated easily to an entire college student
population. No study to date has examined the relative
effectiveness of all three commonly used intervention
formats in a single research design. The current examina-
tion addressed this issue by providing participants with
individualized feedback within individual, group and
electronic formats while adding to the literature by includ-
ing a range of risk levels and drinking habits, from light-
drinking through heavy alcohol usenot those solely
dened as heavy drinking. Additionally, this investiga-
tion is the rst to provide participants with anonymity at
both baseline and 3-month follow-up in an effort to
minimize potential demand characteristics associated
with adjudication.
Drawing from the existing literature, we hypothesized
a priori that participants in all three conditions would
exhibit comparable reductions in alcohol consumption
post-intervention as evidenced by decreases in average
and peak blood alcohol content (BAC) levels, as well as
peak number of drinks consumed in one sitting as
reported at follow-up. We also hypothesized that partici-
pants in all three conditions would exhibit comparable
reductions in negative alcohol-related consequences post-
intervention as evidenced by a decrease in the total num-
ber of consequences reported at follow-up.
Two-hundred and sixty-nine participants were recruited
successfully from a large open-enrollment state university
in the southeastern United States. Of those recruited, 91
did not meet the inclusion criteria for further analyses
given that they did not report alcohol consumption at
baseline. Although mandated for an alcohol violation,
several reasons could have accounted for this nding, in-
cluding the act of getting caught itself (see Hustad et al.,
2011; White, Young, & Morgan, 2008), that some viola-
tions were not for actual drinking but rather for being in
the presence of alcohol while under the age of 21 years
(e.g., being at a dorm party where alcohol was present
but the individual was not drinking) and that despite
assurances of anonymity, individuals were still hesitant
to report drinking given that they were referred for a man-
dated alcohol assessment/intervention. Therefore, the
present study examined the resulting 173 undergraduate
students who were mandated to an alcohol intervention
and met inclusion criteria for this study. The sample con-
sisted of 57% men (n= 98) and ranged in age from 18 to
25 years, with a mean age of 18.77 (SD = 1.08). See Table 1
for additional sample characteristics.
Screening Measures
Screening Questionnaire
A screening instrument was developed to identify fac-
tors related to problematic and high-risk drinking and
consisted of the Alcohol Use Disorders Identication Test
(AUDIT; Saunders, Aasland, Babor, de la Fuente, & Grant,
1993), assessing for alcohol dependence as dened by the
Diagnostic and Statistical Manual, Fourth Edition, Text
Revision (DSM-IV-TR; American Psychiatric Association,
2000) and inquiring about participation in prior, as well
as current substance-abuse treatment. The AUDIT is a
widely used 10-item screening instrument that assesses
hazardous drinking patterns by asking respondents to re-
port drinking quantity and frequency, alcohol harms and
symptoms of alcohol dependence. Total scores range from
0 to 40 and are broken down into four riskzones (Babor,
Higgins-Biddle, Saunders, & Monteiro, 2001). When used
with college students, the AUDIT has demonstrated in-
ternal consistency ranging from 0.77 (Neal & Carey,
2004) to 0.80 (Fleming, Barry, & MacDonald, 1991), with
several studies having used the AUDIT with mandated
Feedback RCT with Mandated Students
Copyright © 2012 John Wiley & Sons, Ltd. Clin. Psychol. Psychother. (2012)
DOI: 10.1002/cpp
students in particular (Barnett et al., 2004; Borsari & Carey,
2005; OHare, 1997).
Study Measures
Demographics Questionnaire
Participants were asked to provide general demo-
graphic information such as their age, sex, race, ethnicity,
class standing and type of housing.
Alcohol Timeline Followback
Alcohol consumption was measured using the Alcohol
Timeline Followback procedure (TLFB; Sobell & Sobell,
1992). Respondents were provided with the denition of
astandard alcoholic drinkand used assisted recall tech-
niques to indicate the number of drinks consumed during
each drinking occasion for the previous 4-week period.
The TLFB provides detailed alcohol information such as
peak and average BAC levels, peak number of standard
drinks consumed per week and typical pattern of drink-
ing (e.g., steady, binge) by using the number of standard
drinks consumed, as well as the time over which they
were consumed, to calculate accurate BAC levels. The
TLFB is a well-established measure with good reliability
and validity (Sobell, Brown, Leo, & Sobell, 1996; Sobell
& Sobell, 1992).
Blood Alcohol Content
Blood alcohol content was calculated using the same
formula employed in a previous study with mandated
students (Borsari & Carey, 2005):
BAC ¼consumption=2ðÞGC=weightðÞ½
0:016 hoursðÞ
where consumption is the number of standard alcohol
drinks consumed in one drinking session, hours is the
number of hours over which drinks were consumed,
weight is weight in pounds and GC is gender constant
(9.0 for women, 7.5 for men).
Negative Alcohol-Related Consequences Questionnaire
The 23-item Rutgers Alcohol Problem Index (RAPI;
White & Labouvie, 1989) was the primary instrument
used to assess alcohol-related harms as it has demon-
strated good internal consistency with adolescents (White
& Labouvie, 1989) and with college student populations
specically (Borsari & Carey, 2000; Neal & Carey, 2004).
In the standard version, answer choices range from
never(0) to more than 10 times(4), but because this
study sought to obtain more detailed information regard-
ing the harms mandated students may experience as a
result of alcohol use, answer choices were modied such
Table 1. Participant demographics by intervention condition
Individual intervention Group intervention Electronic intervention Overall sample
nn nn
Age 18.79 (1.12) 53 18.79 (1.23) 72 18.71 (0.74) 48 173
Male 66% 35 57% 41 46% 22 98
Female 34% 18 43% 31 54% 26 75
Non-Hispanic/Latino(a) 94% 50 90% 65 92% 44 159
Hispanic/Latino(a) 6% 3 10% 7 8% 4 14
American Indian/Alaska native 0% 0 0% 0 4% 2 2
Asian 4% 2 3% 2 4% 2 6
Black 6% 3 1% 1 7% 3 7
White 83% 44 86% 62 75% 36 142
Other/prefer not to respond 7% 4 10% 7 10% 5 16
Class standing
Freshman 72% 38 65% 47 71% 34 119
Sophomore 13% 7 24% 17 25% 12 36
Junior 7.5% 4 7% 5 4% 2 11
Senior 7.5% 4 4% 3 0% 0 7
Type of residence
On-campus residence Hall 51% 27 47% 34 58% 28 89
Fraternity/sorority house 0% 0 3% 2 0% 0 2
University-afliated off-campus 19% 10 22% 16 17% 8 34
Off-campus without parents 24.5% 13 25% 18 23% 11 42
Off-campus with parents 3.5% 2 1.5% 1 0% 0 3
Other 2% 1 1.5% 1 2% 1 3
J. Alfonso et al.
Copyright © 2012 John Wiley & Sons, Ltd. Clin. Psychol. Psychother. (2012)
DOI: 10.1002/cpp
that respondents were asked to provide the actual
number of times each harm occurred during the previous
30 days. An additional eight items were included from the
Drinker Inventory of Consequences (Forcehimes, Tonigan,
& Miller, 2007) to represent harms for which mandated
students are typically referred for services but which are
not included on the RAPI (i.e., drinking and driving).
The total negative alcohol-related consequences score
was obtained by adding the number of times each harm
was experienced.
The Motivational Interviewing Treatment Integrity Code
The most recent version of the Motivational Interview-
ing Treatment Integrity Code (MITI v. 3.0; Moyers, Martin,
Manuel, Miller, & Ernst, 2007) was used to assess delity
to motivational interviewing (MI) using a coding system
that is comprised of six global scales (Evocation, Collabo-
ration, Autonomy/Support, Direction, Empathy and MI
Spirit). Global scale ratings are derived by having trained
raters select from among a ve-point Likert scale ranging
from low(1) to high(5) on each dimension, with the ex-
ception of the MI Spirit score, which is derived by taking
the average of Evocation, Collaboration and Autonomy/
Support ratings.
Intervention Conditions
Brief Alcohol Screening and Intervention for College
The BASICS (Dimeff et al., 1999) is an individualized
alcohol assessment and feedback intervention for college
students that is designed for delivery in two 50-min
sessions and includes cognitive-behavioural skills train-
ing, motivational enhancement and PF. In the current
study, intervention providers met with participants for
an initial session to introduce the BASICS using a moti-
vational enhancement approach and to gather assessment
data that served as the PF information provided to each
participant during the subsequent session. PF included in-
formation about alcohol consumption, perceived drinking
norms, alcohol-related problems, alcohol expectancies and
alcohol-related protective factors. Moderation training
(e.g., setting limits, monitoring drinking and managing
drinking situations) also was included as part of the
CHOICES (Parks & Woodford, 2005) is a group alcohol
intervention modelled after the BASICS intervention. A
group intervention was selected for comparison in this
study given that it is often a preferred modality across
colleges and universities for students who incur alcohol-
related infractions because of ease of dissemination and
reduced cost over individualized interventions. CHOICES
uses a motivational enhancement framework to incorpo-
rate cognitive-behavioural skills training, psychoeduca-
tion and harm-reduction principles delivered in the span
of 120 min. In CHOICES, each participant is provided with
a journal that illustrates intervention content to encourage
an interactive journaling process meant to increase the
level of participant engagement. In addition to the stan-
dard CHOICES protocol, this study provided each partici-
pant with the identical personalized alcohol feedback
information used in the BASICS condition to maximize
its similarity to the BASICS intervention content.
The e-CHUG (Moyer et al., 2004) is an electronically
delivered alcohol intervention that utilizes social norms
feedback theory and motivational enhancement principles
to motivate students to reduce their alcohol consumption
via brief assessment of alcohol-related behaviours and
beliefs such as typical alcohol consumption, level of alco-
hol tolerance, family history of alcohol-related problems
and perceived drinking norms. The e-CHUG provides
immediate PF by using the information obtained during
the brief self-assessment.
Intervention Provider Training
Prior to the delivery of individual and group alcohol
interventions, clinical psychology doctoral students
underwent 40 h of didactic training, as well as an addi-
tional 20 h of experiential training. The principal investi-
gator, who was certied as an intervention trainer,
conducted the didactic sessions. The didactic portion
of provider training included information about alcohol
(e.g., standard drink equivalents and BAC), MI (e.g., prin-
ciples and techniques), the BASICS intervention (e.g., con-
tent, structure and drink monitoring cards), the CHOICES
intervention (e.g., journal content and group dynamics),
PF (e.g., content and how to deliver feedback) and general
ofce policies and procedures (e.g., schedules and record
keeping). Experiential training consisted of providers con-
ducting mock sessions with undergraduate research assis-
tants playing the role of mandatedstudents. All sessions
were videotaped, and each provider role-played sessions
one and two of the BASICS intervention, as well as facili-
tated a CHOICES group. The principal investigator
reviewed all practice sessions, assessed for competence
using the MITI code and veried intervention content
with a structured checklist tailored to each condition.
The principal investigator provided individualized feed-
back on the basis of intervention provider prociency,
and sessions were scheduled with study participants only
once prociency had been met. In an effort to address pos-
sible intervention drift, weekly supervision sessions were
Feedback RCT with Mandated Students
Copyright © 2012 John Wiley & Sons, Ltd. Clin. Psychol. Psychother. (2012)
DOI: 10.1002/cpp
held with providers that included discussions centred on
MI principles (e.g., techniques providers were using on
the basis of their clients current stage of change), inter-
vention content and addressing questions that may have
surfaced during intervention delivery.
MITI Code V. 3.0 Rater Training
A total of three independent raters, two senior-level
undergraduate psychology research assistants and one
rst-year clinical psychology doctoral student, were
trained by the principal investigator in using the MITI
protocol as suggested in the MITI, (see Miller, Rollnick,
& Moyers, 1998).
Study Procedures
After the approval to conduct this investigation was
obtained from the Institutional Review Board of the uni-
versity at which it was conducted, participants who were
at least 18 years of age were recruited from alcohol-related
violation referrals to the university alcohol and other drug
counselling centre. Violations included those incurred on-
campus (e.g., possession of an alcoholic beverage while
under the age of 21 years, being visibly intoxicated on
alcohol while under the age of 21 years), as well as off-
campus (e.g., legal citation for possession of an alcoholic
beverage while under the age of 21 years, being charged
with driving while under the inuence of alcohol). Partici-
pants rst completed an initial session with a clinical
psychology doctoral student who administered the
screening questionnaire. Participants were deemed ineli-
gible to participate if they met criteria for Alcohol De-
pendence as delineated in the DSM-IV-TR (2000), fell
into the highest risk category (Zone 4) on the AUDIT by
scoring a 20 or higher and/or endorsed previous or
current substance-abuse treatment for alcohol. Screeners
reviewed the purpose and procedures of the study with
those screened eligible to participate and informed those
who agreed to be a part of the research study that
although they were receiving alcohol screening and inter-
vention services, they reserved the right not to respond to
the 3-month follow-up survey online.
Participants were informed that there were no fore-
seeable risks involved with participation, that they main-
tained the right to withdraw from the study at any time
without penalty and that they would receive full re-
imbursement of the $45.00 fee paid initially to receive
services upon completion of the 3-month follow-up ques-
tionnaire as incentive for participation. In addition, parti-
cipants in the individual and group conditions were
informed that their session would be audiotaped for as-
sessment of intervention integrity. Screeners informed
participants that audiotapes would not contain their full
name, would be stored in a locked le cabinet separate
from study materials, would be accessed by the principal
investigator only and would be used solely for the pur-
pose of rating intervention providers.
After a student agreed in writing to participate in the
study by signing the informed consent form, they were
assigned randomly to one of the three intervention con-
ditions using a computer-generated randomized number
list and asked to complete the anonymous baseline ques-
tionnaire online via a secure web server. All participants
completed baseline measures alone in a room dedicated
for this purpose. Surveys were linked from baseline to
follow-up using a unique participant-generated code that
could not be tied to their identity to ensure anonymity.
The only way to link baseline and follow-up data, there-
fore, was to have participants who completed both pre-
intervention and post-intervention measures provide their
unique code at follow-up. For this reason, it was not
possible to conduct intention-to-treat analyses, but the
present study implemented this particular design focused
on anonymity in an effort to decrease socially desirable
To generate the PF report utilized during the second
session of the individual and group interventions, partici-
pants assigned to those conditions were asked to complete
a condential paper-and-pencil self-report packet com-
prised of a different set of measures than those completed
online but that assessed similar behaviours, beliefs and
constructs. The paper-and-pencil packet included the
assessment of alcohol-related behaviours and beliefs
such as typical weekly consumption, peak 30-day con-
sumption, protective behaviours, expectancies, perceived
norms and readiness to change. After the completion of
indicated measures, participants were scheduled to return
to the centre for participation in their respective feedback
intervention. Following participation in their respective
intervention, participants were asked to complete the
anonymous online fo llow-up questionnaire at 3 months
post-intervention via an email reminder. Upon completion
of the 3-month follow-up questionnaire, participants were
debriefed as to the nature of the study in writing and were
reimbursed the initial $45.00 fee. To maintain anonymity
when seeking reimbursement at 3-month follow-up, parti-
cipants provided their unique ID number verbally to an
administrative assistant who veried completion using a
list of ID numbers eligible for reimbursement.
Adherence to Motivational Interviewing
A total of 94 sessions (individual = 67, group = 27) were
audiotaped for MI adherence. Of those audiotapes, 9 con-
tained no audio and 11 were inaudible. The remaining 74
audiotapes were pooled, and a random sample of 33
(45%) were selected for rating. Per the MITI Code v. 3.0
J. Alfonso et al.
Copyright © 2012 John Wiley & Sons, Ltd. Clin. Psychol. Psychother. (2012)
DOI: 10.1002/cpp
instructions, 20-min segments were selected at random
from each audiotape for coding. All 20-min segments
were transcribed, and each segment was coded twice by
independent raters trained in the MITI scoring protocol.
Analyses indicated that all six global scales exceeded be-
ginnerstandards and met criteria for competenceas
dened by the MITI, with mean scores above 4 on the
ve-point Likert scale.
Baseline Differences
Chi-square analyses were conducted on discrete partici-
pant characteristics of sex, race, ethnicity, class standing
and type of residence at baseline across treatment condi-
tions. No signicant differences were found. A univariate
analysis of variance was conducted to examine alcohol-
related harms, which yielded no signicant differences.
A multivariate analysis of variance was used to examine
all dependent variables measuring alcohol use (i.e., aver-
age and peak BAC, peak number of drinks consumed in
one sitting) and indicated a signicant difference among
intervention groups at baseline for average BAC [F(2,
174) = 3.159, p= 0.045]. Given this nding, subsequent
analyses examining between-group drinking changes for
average BAC accounted for this difference as noted
below. All alcohol-related variables were assessed using
3 (individual, group, and electronic intervention) 2
(pre-intervention, 3-month follow-up) mixed-model anal-
yses of variance.
Negative Alcohol-Related Consequences
Results revealed a signicant main effect of time [F(1,
165) = 10.460, p<0.001]. Simple effect tests indicated sig-
nicant reductions in alcohol-related harms from pre-
intervention to post-intervention in the individual [F(1,
165) = 7.308, p= 0.008; within-group (WG) effect size
(Cohensd) = 0.41] and electronic [F(1, 165) = 7.214,
p= 0.008; WG effect size (Cohensd) = 0.40] conditions,
with participants experiencing an average decrease in
harms of 8.92 and 9.04, respectively (see Table 2). No sig-
nicant condition by time interaction was found [F(1,
165) = 3.027, p= 0.051]. Results were not signicant for
the group condition (see Figure 1).
Average Blood Alcohol Content over a 4-Week Period
Average BAC was calculated using the following formula:
Average BAC =(average weekly BAC/no. of drinking weeks)
where average weekly BAC is the sum of all BACs over
1 week divided by the number of drinking occasions in
that week and no. of drinking weeks is the number of
weeks containing at least one drinking occasion. Because
of signicant baseline differences across conditions for
average BAC, a univariate analysis of covariance was per-
formed with baseline average BAC levels as the covariate
to examine potential differences at post-intervention
across groups. No signicant between-group differences
were found. A signicant main effect of time was noted
[F(1, 166) = 4.129, p= 0.044], with further simple effects
analyses that indicated trends toward signicant reduc-
tions in average BAC pre-intervention to post-intervention
for the individual [F(1, 166) = 3.561, p= 0.061; WG effect
size (Cohensd) = 0.29] and group [F(1, 166) = 3.791,
p= 0.053; WG effect size (Cohensd) = 0.23] conditions
(see Figure 2). No signicant condition by time interaction
was found [F(1, 166) = 0.934, p= 0.3 95].
Peak Blood Alcohol Content over a 4-Week Period
Peak BAC was determined by selecting the single highest
BAC reached during the 4-week period. A signicant main
effect of time was found for peak BAC [F(1, 166) = 5.098,
p= 0.025], with reductions pre-intervention to post-inter-
vention in the individual condition [F(1, 166) = 6.304,
p= 0.013; WG effect size (Cohensd) = 0.45]. Participants
in the individual condition experienced an average de-
crease in peak BAC of 0.03 or the approximate equivalent
of consuming one standard alcoholic drink. No signicant
condition by time interaction was found [F(1, 166) = 1.642,
p= 0.197]. It was noted that decreases in the group condi-
tion approached signicance [F(1, 166) = 3.770, p= 0.054;
WG effect size (Cohensd) = 0.23]. Results for the electronic
condition were not signicant (see Figure 3).
Peak Number of Drinks Consumed in One Sitting over
a 4-Week Period
Analyses indicated a signicant main effect of time
for peak number of drinks consumed in one sitting
[F(1, 166) = 4.517, p= 0.035], with signicant reductions
pre-intervention to post-intervention in the individual
condition [F(1, 166) = 7.079, p= 0.009; WG effect size
(Cohensd) = 0.33]. Participants in the individual condi-
tion experienced an average decrease of 1.5 standard
alcoholic drinks consumed during a single drinking
occasion. No signicant condition by time interaction
was found [F(1, 166) = 1.930, p= 0.148]. Results for the
group and electronic conditions were not signicant
(see Figure 4 and Table 2).
The present study sought to contribute meaningful infor-
mation to the growing body of literature concerning brief
alcohol interventions for mandated student populations.
Feedback RCT with Mandated Students
Copyright © 2012 John Wiley & Sons, Ltd. Clin. Psychol. Psychother. (2012)
DOI: 10.1002/cpp
Table 2. Unadjusted means and standard deviations for measures of alcohol use and negative alcohol-related consequences at
baseline and 3-month follow-up
Individual intervention
(n= 53)
Group intervention
(n= 72)
Electronic intervention
(n= 48)
Measure Baseline Follow-up Baseline Follow-up Baseline Follow-up
Average BAC 0.061 (0.047) 0.048 (0.041) 0.073 (0.051) 0.062 (0.050) 0.050 (0.044) 0.050 (0.051)
Peak BAC 0.112 (0.093) 0.082 (0.070)* 0.125 (0.088) 0.105 (0.083) 0.092 (0.094) 0.096 (0.099)
Peak number of drinks
consumed in one sitting
7.02 (5.00) 5.49 (4.23)** 7.46 (4.53) 6.73 (4.88) 6.38 (4.03) 6.55 (5.41)
Negative alcohol-related
21.26 (23.19) 12.33 (20.11)** 17.87 (22.30) 18.00 (27.01) 19.00 (23.85) 9.18 (17.44)**
BAC = blood alcohol content.
*p<0.05. **p<0.01.
Time of Assessment
Number of Negative Alcohol-Related Consequences
Figure 1. Unadjusted mean number of negative alcohol-related consequences at (1) baseline and (2) 3-month follow-up
Blood Alcohol Content (BAC)
Time of Assessment
Figure 2. Unadjusted means for average blood alcohol content at (1) baseline and (2) 3-month follow-up
J. Alfonso et al.
Copyright © 2012 John Wiley & Sons, Ltd. Clin. Psychol. Psychother. (2012)
DOI: 10.1002/cpp
This is the rst RCT to compare an individually delivered
personalized alcohol feedback intervention that is well
supported (Dimeff et al., 1999), with more cost-effective
group-delivered and electronically delivered feedback for-
mats within a single research design. Despite the typical
convention of including only heavydrinking college stu-
dents in brief intervention studies (i.e., Borsari & Carey,
2005; Fromme & Corbin, 2004), the present investigation
expanded the range of drinking habits reported at base-
line to include, e.g., participants whose average drinks
per week fell below one standard drink, to those who
averaged 25 drinks per week. Additionally, given the
potential demand characteristics to underreport illegal
and/or illicit behaviours, this is the rst study to our
knowledge that provided mandated participants with
The rst aim of the present study was to examine the
effectiveness of each feedback intervention format on the
reduction of alcohol use. We hypothesized that all three
interventions would signicantly decrease alcohol con-
sumption, which was not supported. Participant alcohol
use was assessed using several drinking variables in an
effort to obtain a more specic understanding of alcohol
use patterns. Examination of average and peak BAC and
the peak number of drinks consumed in one sitting
revealed that feedback delivered individually in a
face-to-face format is effective in decreasing alcohol
usespecically alcohol consumed in larger amounts.
The individual intervention produced signicant reduc-
tions in the highest number of drinks consumed during a
single drinking occasion, as well as peak BAC. These
ndings are consistent with extant research that supports
Blood Alcohol Content (BAC)
Time of Assessment
Figure 3. Unadjusted means for peak blood alcohol content at (1) baseline and (2) 3-month follow-up
Time of Assessment
Number of Standard Alcoholic Drinks
Figure 4. Unadjusted peak number of drinks consumed in one sitting at (1) baseline and (2) 3-month follow-up
Feedback RCT with Mandated Students
Copyright © 2012 John Wiley & Sons, Ltd. Clin. Psychol. Psychother. (2012)
DOI: 10.1002/cpp
the use of brief motivational interventions with college
students (i.e., Baer et al., 2001; Borsari & Carey, 2005;
Murphy et al., 2004) and points to the utility of this format
in reducing more hazardous drinking habits. Despite what
may seem as modest decreases in peak BAC (0.03) and
drinks consumed (1.5 standard alcoholic drinks), such
reductions can mean the difference between a driving under
the inuence charge or moving from a BAC that produces a
sense of relaxationto one of impairedjudgement.
Although statistical signicance was not achieved, there
was a trend toward a signicant reduction of alcohol use
for the individual and group conditions on average BAC
and for the group condition on peak BAC. No signicant
alcohol use decreases were found for the electronic inter-
vention. Our ndings are in line with previous research
that compared the group and electronic interventions
used in the present study, and also failed to nd signi-
cant between-group differences on alcohol consumption
(e.g., Henry et al., 2004; Wilson et al., 2005).
One reason for the differential treatment effects on
alcohol reduction may be found in the PF content of the
electronic condition. Both the individual and group condi-
tions were derived from the efcacious Alcohol Skills
Training Program (Fromme, Marlatt, Baer, & Kivlahan,
1994) and contain specic harm-reduction drinking strat-
egies aimed at managing alcohol use effectively (e.g.,
alternating alcoholic drinks with non-alcoholic drinks,
pacing and spacing drinks), whereas the version of the
electronic condition used in this study did not. A meta-
analytic review examining alcohol interventions in college
student populations (Carey, Scott-Sheldon, Carey, &
DeMartini, 2007) supports the present ndings, citing
risk-reduction strategies such as those provided in the in-
dividual and group conditions, as factors that contribute
to students engaging in less-extreme drinking behaviour
(p. 2487). Our ndings are also consistent with those of
Walters and colleagues (2009), who found that a face-to-
face intervention that included both MI and PF was super-
ior to a computer-delivered feedback-only intervention in
the reduction of alcohol use (Walters, Vader, Harris, Field,
& Jouriles, 2009). Also, because the individual and group
interventions were conducted in a face-to-face format, it
was possible to conrm that the provision of feedback
and discussion of report contents (e.g., BAC, tolerance
and comparison of own drinking to others) occurred dur-
ing every feedback session. The very nature of the remote
feedback delivery in the electronic condition precludes the
verication that participants reviewed their PF reports at
the time of the intervention.
Because of the greater likelihood of mandated students
experiencing harms associated with alcohol use when
compared with their non-mandated peers (Caldwell,
2002; LaBrie, Tawalbeh, & Earleywine, 2006), the second
aim was to examine the impact of feedback inter-
ventions on negative alcohol-related consequences. We
hypothesized that all three feedback interventions
would reduce alcohol-related harms; however, this
hypothesis was not supported. Signicant reductions
in harms were noted solely in the individual and elec-
tronic conditions. The present ndings are consistent
with previous research (e.g., Baer et al., 2001) that the
individual brief motivational feedback intervention
reduces both alcohol use and alcohol-related harmsa
nding that is not surprising given the widespread use
and research of the BASICS intervention within college
student populations. What is interesting, however, is the
positive impact of the electronic intervention on the reduc-
tion of alcohol-related harms, given the lack of signicant
reductions in drinking. A study examining the independent
and collective roles of PF and MI found similar results, with
students exhibiting reductions in the amount of negative
consequences experienced related to alcohol use, without
concomitant reductions in drinking (Juarez, Walters,
Daugherty, & Radi, 2006).
Further examination of the content included in the
electronic feedback intervention may shed light on the
decrease in alcohol harms despite the absence of drink-
ing changes. First, although topics concerning drinking
(e.g., BAC, tolerance) were present in the web-based
feedback report, there were no specictipsor strategies
focused on reducing alcohol consumption. In fact, the
feedback report provided participants personalized
information related to alcohol use in an objective, factual
and non-judgmental manner, steering clear of direct
attempts to modify drinking behaviour, which is consis-
tent with MI principles (Miller & Rollnick, 2002). Second,
closer inspection of the web-based feedback report
revealed specic references to the number and type of
alcohol-related consequences a participant had experi-
enced, with an additional chart that detailed statistics
related to drinking and driving. Moreover, although
the electronically generated feedback did not present par-
ticipants with harm-reduction drinking strategies, it did
provide harm-reduction drinking and driving strategies
by offering specic referral information when a desig-
nated driver is needed (e.g., the university-sponsored taxi
cab programme). It is possible that similar to offering
participants drinking strategies, providing them with
safer drinking and driving strategies served to decrease
the occurrence of those specic types of alcohol-related
incidents, which in turn led to the observed signicant
decreases in harms.
The use of identical feedback reports in the individual
and group conditions was implemented to maximize
intervention similarity despite differences in delivery for-
mat and yet a discrepancy in negative alcohol-related
harms was observed. Although perplexing, moderator
analyses conducted in the aforementioned meta-analytic
review (Carey et al., 2007) bolster the ndings in the
present study. The review concluded that interventions
J. Alfonso et al.
Copyright © 2012 John Wiley & Sons, Ltd. Clin. Psychol. Psychother. (2012)
DOI: 10.1002/cpp
that incorporate MI, normative drinking comparisons,
feedback on expectancies and a decisional balance exer-
cise (all of which are included in this investigations
feedback report), and are delivered in an individual for-
mat outperform those delivered in a group format on the
reduction of harms (Carey et al., 2007). Additionally, a
comprehensive review of peer contagion(i.e., inuence
of peers resulting in null or iatrogenic intervention
effects) within adolescent populations highlighted the
potential for group interventions conducted with devi-
ant youth to dampen positive intervention outcomes at
best and foster negative effects at worst (Dishion &
Dodge, 2005). Mandated students who have been sanc-
tioned by the university and/or the law are by virtue
of their offence(s) considered deviantfrom their non-
adjudicated peersanding that is supported by data
that mandated students experience higher rates of harms
(Caldwell, 2002; Flynn & Brown, 1991; LaBrie et al.,
2006). Furthermore, the group intervention in the
present study was implemented as a selected prevention
strategy, or one geared towards high-risk youth in an ef-
fort to prevent the worsening of target behaviours.
According to Dishion and Dodge (2005), using a group
intervention in such a population can be particularly
problematic when the group includes adolescents who
are moderately deviant or are still developing deviant
behaviour patternsbecause of peer contagion effects
(p. 396). The grouping of youth who have engaged in
deviant behaviour may serve to normalize the experi-
ence, contributing to the absence of positive behaviour
change. Lastly, it is also possible that expected reduc-
tions in problem behaviours were not demonstrated in
the group condition because the intervention utilized in
this study (see Parks & Woodford, 2005) was originally
developed for use as a primary prevention strategy and
not a selected prevention strategy geared towards
known at-risk youth.
The present study offers valuable new information to
the existing literature regarding alcohol interventions
that target mandated college student populations. The
very use of underutilized methodological techniques that
add to this studys strengths, however, also contribute to
some of its limitations. First, the decision to employ an
RCT of three active interventions allowed for the com-
parison of varying delivery formats on the effectiveness
of personalized alcohol feedback within one research
design. The comparison of three active treatments, how-
ever, cannot rule out the effect of time or the sanction
itself on the modication of behaviouralthough the
use of a no-treatment control or wait-list condition
would have introduced ethical problems given the
high-risk nature of this particular population. Studies
attempting to untangle the impact of the citation from
actual intervention effects have found reductions in
drinking, albeit modest ones (Hustad et al, 2011; White
et al., 2008). The present study expands upon such nd-
ings by employing anonymity to reduce the likelihood
of desirable responding at follow-up. Given that partici-
pants were assured anonymity at baseline and follow-
up, however, intention-to-treat analyses were unable to
be conducted, resulting in the inability to assess possible
patterns of attrition.
Second, the use of a 3-month follow-up assessment
limits the ability to determine the long-term impact of
these interventions. A recent study by Carey et al. (2011)
comparing a face-to-face brief motivational intervention
to computer-delivered interventions demonstrates the
importance of employing longer follow-up assessments
with mandated students, as intervention effects may not
only decay over time, as a function of intervention
modality. Lastly, although initial recruitment efforts met
the guidelines of a total sample size of 252, or 84 partici-
pants per condition as set forth by the a priori power
analysis (GPOWER; Erdfelder, Faul, & Buchner, 1996),
the loss of participants at follow-up, coupled with parti-
cipants failing to endorse any alcohol use during the
baseline assessment, resulted in a sample size smaller
than the one suggested. The ability of the present study
to detect changes in drinking and harms despite these
limitations, however, speaks to the encouraging ndings
this examination provides.
Future investigations focused on improving services
for mandated college students would benet from repli-
cating the ndings of this study using an anonymous
data collection design while increasing the recruitment
of students who report drinking behaviour following
the incident. Extending the follow-up period of these
interventions with mandated students would also con-
tribute to our understanding of the longer-term effects
these interventions may have (see Carey et al., 2011).
Given the high cost of delivering face-to-face services,
a cost-effectiveness analysis (see Kaplan & Frosch,
2005, for a review) would inform institutions of higher
education looking to maximize clinical gains. Lastly,
the reduction in higher drinking levels (i.e., peak BAC)
within intervention conditions that incorporated harm-
reduction drinking strategies points to the utility of
measuring these behaviours in future investigations.
Although a recent study by Larimer and colleagues
(2007) using feedback with embedded drinking strat-
egies found a mediating effect of protective drinking
behaviours on alcohol use, the study was not conducted
on mandated students. The one study to date that has
examined the mediational relationship of protective
behaviours on drinking in mandated students (Barnett,
Murphy, Colby, & Monti, 2007) did not incorporate a
control group with which to compare their ndings. In
sum, although the present study contributes to the man-
dated student literature, there is still much work that
can be accomplished.
Feedback RCT with Mandated Students
Copyright © 2012 John Wiley & Sons, Ltd. Clin. Psychol. Psychother. (2012)
DOI: 10.1002/cpp
Agostinelli, G., Brown, J.M., & Miller, W.R. (1995). Effects of
normative feedback on consumption among heavy drinking
college students. Journal of Drug Education,25(1), 3140.
American Psychiatric Association. (2000). Diagnostic and statistical
manual of mental disorders: DSM-IV-TR. Washington, DC:
American Psychiatric Association.
Babor T.F., Higgins-Biddle J.C., Saunders J.B., & Monteiro M.G.
(2001). The Alcohol Use Disorders Identication Test: Guide-
lines for use in primary care. Retrieved, 2007, from: http://
Baer, J.S., Kivlahan, D.R., Blume, A.W., McKnight, P., & Marlatt,
G.A. (2001). Brief intervention for heavy-drinking college
students: 4-year follow-up and natural history. American
Journal of Public Health,91(8), 13101316.
Barnett, N.P., Murphy, J.G., Colby, S.M., & Monti, P.M. (2007).
Efcacy of counselor vs. computer-delivered intervention
with mandated college students. Addictive Behaviors,32(11),
Barnett, N.P. & Read, J.P. (2005). Mandatory alcohol intervention
for alcohol-abusing college students: A systematic review. Jour-
nal of Substance Abuse Treatment,29(2), 147158.
Barnett, N.P., Tevyaw, T.O., Fromme, K., Borsari, B., Carey, K.B.,
Corbin, W.R., Colby, S.M., & Monti, P.M. (2004). Brief alcohol
interventions with mandated or adjudicated college students.
Alcoholism, Clinical and Experimental Research,28(6), 966975.
Borsari, B., & Carey, K.B. (2000). Effects of a brief motivational
intervention with college student drinkers. Journal of Consulting
and Clinical Psychology,68(4), 728733.
Borsari, B., & Carey, K.B. (2005). Two brief alcohol interventions
for mandated students. Psychology of Addictive Behaviors,19(3),
Caldwell, P.E. (2002). Drinking levels, related problems and
readiness to change in a college sample. Alcoholism Treatment
Quarterly,20(2), 115.
Carey, K.B., Carey, M.P., Henson, J.M., Maisto, S.A., & DeMartini,
K.S. (2011). Brief alcohol interventions for mandated college
students: Comparison of face-to-face counseling and com-
puter-delivered interventions. Addiction,106, 528537.
Carey, K.B., Scott-Sheldon, L.A.J., Carey, M.P., & DeMartini, K.S.
(2007). Individual-level interventions to reduce college student
drinking: A meta-analytic review. Addictive Behaviors,32(11),
Collins, S.E., Carey, K.B., & Sliwinski, M.J. (2002). Mailed perso-
nalized feedback as a brief intervention for at-risk college drin-
kers. Journal of Studies on Alcohol,63, 559576.
Dimeff, L.A., Baer, J.S., Kivlahan, D.R., & Marlatt, G.A. (1999).
Brief Alcohol Screening and Intervention for College Students
(BASICS): A harm reduction approach. New York: Guilford
Dishion, T.J. & Dodge, K.A. (2005). Peer contagion in interven-
tions for children and adolescents: Moving towards an under-
standing of the ecology and dynamics of change. Journal of
Abnormal Child Psychology,33(3), 395400.
Erdfelder, E., Faul, F., & Buchner, A. (1996) GPOWER: A general
power analysis program. Behavior Research Methods, Instru-
ments, & Computers,28(1), 111.
Fleming, M.F., Barry, K.L., & MacDonald, R. (1991). The Alcohol
Use Disorders Identication Test (AUDIT) in a college sample.
International Journal of the Addictions,26(11), 11731185.
Flynn, C.A. & Brown, W.E. (1991). The effects of a mandatory
alcohol education program on college student problem drin-
kers. Journal of Alcohol and Drug Education,37(1), 1524.
Forcehimes, A.A., Tonigan, J.S., & Miller, W.R. (2007). Psycho-
metrics of the Drinker Inventory of Consequences (DrInC).
Addictive Behaviors,32(8), 16991704.
Fromme, K., & Corbin, W. (2004). Prevention of heavy drinking
and associated negative consequences among mandated and
voluntary college students. Journal of Consulting and Clinical
Psychology,72(6), 10381049.
Fromme, K., Marlatt, G.A., Baer, J.S., & Kivlahan, D.R. (1994). The
Alcohol Skills Training Program: A group intervention for
young adult drinkers. Journal of Substance Abuse Treatment,11 (2),
Henry, S., Lange, J., & Wilson, L. (2004). Evaluation of e-CHUG
integrated into two classroom-based alcohol interventions.
[PDF document]. Retrieved from: http://www.aodinitiatives.
Hingson, R., Heeren, T., Winter, M., & Wechsler, H. (2005).
Magnitude of alcohol-related mortality and morbidity among
U.S. college students ages 1824: Changes from 19982001.
Annual Review of Public Health,26, 259279.
Hustad, J.T., Eaton Short, E., Borsari, B., Barnett, N.P.,
OLeary Tevyaw, T., & Kahler, C.W. (2011). College alcohol cita-
tions result in modest reductions in student drinking. Journal of
Substance Abuse Treatment,40(3), 281286.
Juarez, P., Walters, S.T., Daugherty, M., & Radi, C. (2006). A ran-
domized trial of motivational interviewing and feedback with
heavy drinking college students. Journal of Drug Education,36(3),
Kaplan, R.M., & Frosch, D.L. (2005). Decision making in medi-
cine and health care. Annual Review of Clinical Psychology,1(1),
Kypri, K., Gallagher, S.J., & Cashell-Smith, M.L. (2004). An
Internet-based survey method for college student drinking
research. Drug and Alcohol Dependence,76(1), 4553.
Kypri, K., Saunders, J.B., & Gallagher, S.J. (2003). Acceptability
of various brief intervention approaches for hazardous drink-
ing among university students. Alcohol and Alcoholism,38(6),
LaBrie, J.W., Tawalbeh, S., & Earleywine, M. (2006). Differentiat-
ing adjudicated from nonadjudicated freshmen men: The role
of alcohol expectancies, tension, and concern about health.
Journal of College Student Development,47(5), 521.
Larimer, M.E., Cronce, J.M., Lee, C.M., & Kilmer, J.R. (2004). Brief
intervention in college setting. Alcohol Research & Health,28(2),
Larimer, M.E., Lee, C.M., Kilmer, J.R., Fabiano, P., Stark, C.,
Geisner, I., Mallett, K., Lostutter, T.W., Cronce, J.M., Freeney,
M., & Neighbors, C., Neighbors, C. (2007). Personalized mailed
feedback for college drinking prevention: A randomized clin-
ical trial. Journal of Consulting and Clinical Psychology,75(2),
McCabe, S.E., Boyd, C.J., Couper, M.P., & DArcy, H. (2002).
Mode effects for collecting alcohol and other drug use data:
Web and U.S. mail. Journal of Studies on Alcohol,63(6), 755761.
Miller, E.T., Neal, D.J., Roberts, L.J., Baer, J.S., Cressler, S.O., &
Metrik, J. (2002). Test-retest reliability of alcohol measures: Is
there a difference between internet-based assessment and trad-
itional methods? Psychology of Addictive Behaviors,16,5663.
Miller, W.R., & Rollnick, S. (2002). Motivational interviewing: Pre-
paring people to change addictive behavior (2nd ed.). New York:
Guilford Press.
Miller, W.R., Rollnick, S., & Moyers, T.B. (1998). Motivational
Interviewing: Professional training videotape series (2 tran-
scripts of 6-part series). Retrieved, 2006, from: http://casaa.
J. Alfonso et al.
Copyright © 2012 John Wiley & Sons, Ltd. Clin. Psychol. Psychother. (2012)
DOI: 10.1002/cpp
Moyer, R., Rikard, J., Van Sickle, D., Walters, S.T., & Wilson, L.
(2004). The electronic CHECKUP TO GO. Developed at San
Diego State University. San Diego, California.
Moyers, T.B., Martin, T., Manuel, J.K., Miller, W.R. & Ernst, D.
(2007). Revised global scales: Motivational Interviewing Treat-
ment Integrity (MITI) v. 3.0. Retrieved from http://casaa.unm.
Murphy, J.G., Benson, T.A., Vuchinich, R.E., Deskins, M.M.,
Eakin, D., Flood, A.M., McDevitt-Murphy, M.E., Torrealday,
O. (2004). A comparison of personalized feedback for college
student drinkers delivered with and without a motivational
interview. Journal of Studies on Alcohol,65(2), 200203.
Murphy, J.G., Duchnick, J.J., Vuchinich, R.E., Davison, J.W., Karg,
R.S., Olson, A.M., Smith, A.F., Coffey, T.T. (2001). Relative efcacy
of a brief motivational intervention for college student drinkers
[Special issue]. Psychology of Addictive Behaviors,15(4), 373379.
National Institute on Alcohol Abuse and Alcoholism. (2007).
What colleges need to know now: An update on college drink-
ing research. Retrieved from http://collegedrinkingpreven-
Neal, D.J., & Carey, K.B. (2004). Developing discrepancy within
self-regulation theory: Use of personalized normative feedback
and personal strivings with heavy-drinking college students.
Addictive Behaviors,29(2), 281297.
OHare, T. (1997). Measuring problem drinking in rst time
offenders: Development and validation of the College Alcohol
Problem Scale (CAPS). Journal of Substance Abuse Treatment,14(4),
Parks, G.A., & Woodford, M.S. (2005). CHOICES about alcohol:
A brief alcohol abuse prevention and harm reduction program
for college students. In G.R. Walz & R.K. Yep (Eds.), Compelling
perspectives on counseling. Alexandria, VA: American Counsel-
ing Association.
Riper, H., van Straten, A., Keuken, M., Smit, F., Schippers, G., &
Cuijpers, P. (2009). Curbing problem drinking with persona-
lized feedback interventions. American Journal of Preventive
Medicine,36(3), 247255.
Saunders, J.B., Aasland, O.G., Babor, T.F., De La Fuente, J.R., &
Grant, M. (1993). Development of the Alcohol Use Disorders
Identication Test (AUDIT): WHO collaborative project on
early detection of persons with harmful alcohol consumption:
II. Addiction,88(6), 791804.
Sobell, L.C., Brown, J., Leo, G.I., & Sobell, M.B. (1996). The reli-
ability of the Alcohol Timeline Followback when administered
by telephone and by computer. Drug and Alcohol Dependence,
42(1), 4954.
technique for assessing self-report alcohol consumption. In
R.Z. Litten, & J.P. Allen (Eds.), Measuring alcohol consumption:
Psychology and biochemical methods. Totowa NJ: Humana
Steiner, J., Woodall, W.G., & Yeagley, J.A. (2005). The e-Chug: A
randomized, controlled study of a web-based binge drinking
intervention with college freshmen. Poster session presented
at the annual convention of the Society for Prevention Re-
search, Washington, D.C.
Substance Abuse and Mental Health Services Administration.
(2006). Results from the 2005 National Survey on Drug Use
and Health: National Findings (Ofce of Applied Studies,
NSDUH Series H-30, DHHS Publication No. SMA 064194).
Rockville, MD.
Turner, C.F., Ku, L., Rogers, S.M., Lindberg, L.D., & Pleck, J.H.
(1998). Adolescent sexual behavior, drug use, and violence:
Increased reporting with computer survey technology. Science,
280(5365), 867873.
Walters, S.T. (2000). In praise of feedback: An effective interven-
tion for college students who are heavy drinkers. Journal of
American College Health,48, 235238.
Walters, S.T., Miller, E., & Chiauzzi, E. (2005). Wired for wellness:
e-Interventions for addressing college drinking. Journal of Sub-
stance Abuse Treatment,29, 139145.
Walters, S.T., & Neighbors, C. (2005). Feedback interventions for
college alcohol misuse: What, why, and for whom? Addictive
Behaviors,30(6), 11681182.
Walters, S.T., Vader, A.M., & Harris, T.R. (2007). A controlled trial
of web-based feedback for heavy drinking college students.
Prevention Science,8(2), 8388.
Walters, S.T., Vader, A.M., Harris T.R., Field, C.A., & Jouriles, E.
N. (2009). Dismantling motivational interviewing and feed-
back for college drinkers: A randomized clinical trial. Journal
of Consulting and Clinical Psychology,77(1), 6473.
White, H.R., & Labouvie, E.W. (1989). Towards the assessment of
adolescent problem drinking. Journal of Studies on Alcohol,50(1),
White, H.R., Morgan, T.J., Pugh, L.A., Celinska, K., Labouvie, E.
W., & Pandina, R.J. (2006). Evaluating two brief substance-
use interventions for mandated students. Journal of Studies on
Alcohol,67(2), 309317.
White, H.R., Young, M.E.., & Morgan, T.J. (2008). Do brief perso-
nalized feedback interventions work for mandated students or
is it just getting caught that works? Psychology of Addictive
Behaviors,22(1), 107116.
Wilson, L., Henry, S., & Lange, J. (2005). Evaluation of e-CHUG
integrated into two classroom interventions. Presented at
the 4
annual CSU Alcohol Education Conference, San Jose,
Feedback RCT with Mandated Students
Copyright © 2012 John Wiley & Sons, Ltd. Clin. Psychol. Psychother. (2012)
DOI: 10.1002/cpp
... Research suggests that individual delivery of PNF produces better outcomes in reducing subsequent alcohol use and related harm (Alfonso et al., 2013;Borsari & Carey, 2005;Carey et al., 2016). One problem is that the high cost of delivering individual services in health care (Kaplan & Frosch, 2005) makes the delivery of PNF interventions in individual format less viable in most circumstances. ...
... Because of the disparity between student demand and available staffing for individually delivered PNF interventions, college campuses have looked for providing similar programs in group formats (Alfonso et al., 2013). Wellknown programs in a group format, such as CHOICES (Calhoon et al., 2005), are similar to BASICS and are based on social norming through normative feedback with some additional components, such as cognitive behavior skills training, interactive journaling, and psychoeducation (Parks & Woodford, 2005). ...
... Wellknown programs in a group format, such as CHOICES (Calhoon et al., 2005), are similar to BASICS and are based on social norming through normative feedback with some additional components, such as cognitive behavior skills training, interactive journaling, and psychoeducation (Parks & Woodford, 2005). CHOICES was found to be effective in improving descriptive drinking norms, but it did not demonstrate a significant improvement in either alcohol use or related harm (Alfonso et al., 2013). ...
AWARE is a brief group intervention that was built upon the principles of personalized normative feedback with novel components (Penn State Altoona, n.d.). The purpose of this study was to pilot test the intervention with mandated college students who were referred for alcohol‐related violations (N = 283). Results showed significant postintervention changes. Significant interaction effects between time and race and between time and gender were found. Reduction in the consumption of alcohol use and perception of peer alcohol use were significantly different among non‐White and female participants.
... Node-splitting, however, supported the consistency model. When compared against all other interventions BASICS had the largest SUCRA value, followed by Alcohol101 (Table 8) Sensitivity Analysis: Quantity of Alcohol Use during Peak Consumption, 3-6 Months Removing the two studies that utilized a mandated sample from this network (Alfonso et al. 2012;Horner 2010) resulted in removing one comparison involving e-CHUG and two comparisons of BASICS, but did not substantively change the model results (Tables 7 and 8). The global test for inconsistency remained nonsignificant (χ 2 = 2.35, df = 2, p = 0.3086). ...
... SUCRA values include the uncertainty of the different effect estimates and probabilities of assuming another possible treatment ranking so are more stable than the probability of being the best treatment: SUCRA values are thus focused on in the text; however, both values are presented inTable 3.2 Alfonso et al. 2012;Carey et al. 2011;Horner 2010;Logan 2013;Terlecki 2011;Terlecki et al. 2011 ...
Late adolescence is a time of increased drinking, and alcohol plays a predominant role in college social experiences. Colleges seeking to prevent students’ hazardous drinking may elect to implement brief alcohol interventions (BAIs). However, numerous manualized BAIs exist, so an important question remains regarding the comparative effectiveness of these different types of BAIs for college students. This study uses network meta-analyses (NMA) to compare seven manualized BAIs for reducing problematic alcohol use among college students. We systematically searched multiple sources for literature, and we screened studies and extracted data in duplicate. For the quantitative synthesis, we employed a random-effects frequentist NMA to determine the effectiveness of different BAIs compared to controls and estimated the relative effectiveness ranking of each BAI. A systematic literature search resulted in 52 included studies: On average, 58% of participants were male, 75% were binge drinkers, and 20% were fraternity/sorority-affiliated students. Consistency models demonstrated that BASICS was consistently effective in reducing students’ problematic alcohol use (ES range: g = − 0.23, 95%CI [− 0.36, − 0.16] to g = − 0.36, 95% CI [− 0.55, − 0.18]), but AlcoholEDU (g = − 0.13, 95%CI [− 0.22, − 0.04]), e-CHUG (g = − 0.35, 95%CI [− 0.45, − 0.05]), and THRIVE (g = − 0.47, 95%CI [− 0.60, − 0.33]) were also effective for some outcomes. Intervention rankings indicated that BASICS, THRIVE, and AlcoholEDU hold the most promise for future trials. Several BAIs appear effective for college students. BASICS was the most effective but is resource intensive and may be better suited for higher risk students; THRIVE and e-CHUG are less resource intensive and show promise for universal prevention efforts.
... 23 Así también, hubo intervenciones encaminadas a disminuir el consumo de éxtasis 11 y marihuana. 21 Por otra parte, el enfoque o marco teórico que guío el diseño de la mayoría de las intervenciones fue la Teoría de la Influencia Social, 13,14,15 y otras relacionadas con las normas sociales. 16,32 Por otro lado, se presentó muy frecuentemente el reclutamiento vía folletos u otros medios impresos y vía correo electrónico. ...
... Una posibilidad para la explicación de estos resultados, es que los adolescentes de mayor edad han desarrollado un patrón de consumo episódico mayor que los de menor edad, por lo que sería necesario un enfoque basado en cambio de hábitos 18 . Con relación al consumo de alcohol, Alfonso et al. 21 no encontraron diferencias significativas para el promedio de alcohol en sangre, y contrario a lo esperado, para la variable de consecuencias relacionadas al consumo, se observó un aumento estadísticamente significativo a 3 meses de finalizada la intervención (p<0.001), mientras que en el grupo control disminuyeron significativamente (p<0.001). ...
Full-text available
El consumo de drogas psicoactivas se asocia con la pérdida de 28 millones de años de vida sana. En México la demanda entre adolescentes se incrementó al doble en los últimos cinco años. Es de vital importancia evitar que los jóvenes se inicien en el consumo de drogas, o bien, retrasar la edad de inicio para el consumo de drogas legales. Las acciones de prevención deben estar ajustadas a las prácticas culturales de los adolescentes, por lo que una alternativa son las Intervenciones de Prevención Basadas en las Tecnologías de Comunicación (IPBTC) ya que ofrecen ventajas como bajo costo, anonimato de los participantes, además de facilitar el reclutamiento y el monitoreo de la conducta. Con base en lo anterior se realizó una revisión sistemática para dar respuesta a las preguntas: ¿cuáles son las características de las IPBTC mediante el uso de ordenadores (Intervenciones por ordenador IO) y telefonía móvil (Intervenciones por telefonía móvil ITM)? y sí; ¿han sido efectivas para prevenir y/o disminuir el consumo de sustancias psicoactivas en adolescentes escolarizados? En este sentido, se evaluaron 21 estudios realizados en diversos países y los resultados en general muestran efectividad en la reducción de la frecuencia y cantidad de consumo de alcohol y otras drogas.
... A significant body of literature supports the efficacy of the eCHECKUP TO GO with college students (Alfonso, Hall, & Dunn, 2013;Doumas & Anderson, 2009;Doumas, Kane, Navarro, & Roman, 2011;Doumas, Nelson, DeYoung, & Conrad, 2014;Doumas, Workman, Navarro, & Smith, 2011;Hustad, Barnett, Borsari, & Jackson, 2010). On the basis of this body of research, Doumas, Esp, Turrisi, and Schottelkorb (2015) suggested that the eCHECKUP TO GO may be a promising approach for reducing drinking and the associated consequences among high school students given that high school students often benefit from effective college interventions (Sher & Rutledge, 2007). ...
The authors examined the efficacy of a brief, web‐based personalized feedback intervention on reducing alcohol‐related consequences among high school seniors (N = 105) using a group‐randomized controlled design. Results of repeated measures mixed‐models analyses indicated significant intervention effects over time for alcohol‐related consequences at 30‐day and 6‐month follow‐up assessments. Drinking risk status moderated intervention effects such that results were only significant for high‐risk drinkers (i.e., students reporting initiation of heavy episodic drinking at baseline).
... Studie Alfonso et al.2 ...
Full-text available
This is an update of our systematic review which we have done in 2011. The new data cover the time frame from 2010 - 2016. 74 studies with youth until the age of 25 years have been included. The programs which have been analyzed were School, college, university and community prevention, family- based , multi-component and emergency room interventions
... The eCHECKUP TO GO is a brief, web-based personalized feedback program based on motivational enhancement and social norms approaches. Research indicates that the eCHECKUP TO GO program is an effective brief intervention for college students (Alfonso, Hall, & Dunn, 2013;, as well as an effective universal preventive intervention for first-year college students when administered during orientation (Doumas, Kane, Navarro, & Roman, 2011;Doumas, Nelson, DeYoung, & Conrad, 2014) or first-year seminar (Doumas & Anderson, 2009). Although originally developed for college students, recent research suggests that the eCHECKUP TO GO program is a promising universal preventive intervention approach for reducing drinking and the associated consequences among high school seniors (Doumas, Esp, Turrisi, & Schottelkorb, 2015). ...
This randomized controlled study evaluated the efficacy of a web‐based program alone and in combination with a parent campaign among 9th‐grade students (N = 205). Results indicate lower drinking rates in both programs compared with traditional education for female students.
... Of these, the eCHECKUP TO GO (San Diego State University Research Foundation, n.d.) may be a particularly useful intervention program for high school juniors and seniors due to length, content, and cost of the program. Several researchers have reported that the eCHECKUP TO GO is effective among college students, including first year students (Doumas & Anderson, 2009;Doumas, Kane, Navarro, & Roman, 2011;Doumas, Nelson, DeYoung, & Conrad, in press;Hustad, Barnett, Borsari, & Jackson, 2010;Walters, Vader, & Harris, 2007), student athletes (Doumas, Haustveit, & Coll, 2010), and students sanctioned for campus alcohol policy violations (Alfonso, Hall, & Dunn, 2012;. Collectively, the above studies provide support for a reduction in alcohol use and alcohol-related consequences among students completing the eCHECK UP TO GO, relative to students in assessment-only control groups or comparison conditions. ...
Adolescent drinking represents a significant problem in the United States. Although high school juniors and seniors are particularly vulnerable to the negative consequences associated with alcohol use, evidence-based interventions for this age group are limited. The purpose of this article is to introduce a Web-based alcohol intervention with promising evidence as a best practice for a school-based program.
Despite the escalation of alcohol use through high school, the majority of research on school‐based alcohol interventions has been conducted with junior high students or first and second‐year high school students. Preliminary research indicates a brief, web‐based personalized feedback intervention developed for college students (eCHECKUP TO GO) may be a promising program for high school seniors. Although these studies demonstrate positive intervention effects, there is some evidence for greater program efficacy for females in this age group. The current study investigates sex differences in program acceptability of the eCHECKUP TO GO and its relationship to short‐term alcohol outcomes among high school seniors (N = 135). Overall, the majority of students reported they found the program to be acceptable (i.e., user‐friendly and useful). However, contrary to our hypothesis, results indicated that male students reported significantly higher perceptions of program acceptability than females. Although we did not find sex differences in alcohol outcomes, program user‐friendliness was related to reductions in alcohol use for males. The results of this study add to the literature supporting the eCHECKUP TO GO for high school seniors and highlight the importance of program user‐friendliness for males. Implications for implementing the program as a school‐based intervention are discussed.
Technical Report
Full-text available
Given the documented gender differences in characteristics of alcohol use disorder, men and women might also respond differently to some treatments for this disorder. If so, this would be important for physicians to consider when selecting treatment. The purpose of this systematic review was to synthesize the evidence for gender differences in effects of treatments for the disorder. RAND researchers culled 13,771 citations, contacted authors, and reviewed 1,434 publications as full text. Of the 1,434 publications reviewed, only 24 original studies published in 63 publications and four systematic reviews met inclusion criteria. Studies reported efficacy or safety results for men and women separately or presented analyses of gender differences. The review used innovative analytic methods to assess gender differences in treatment effects by analyzing the differences in outcome between active and control treatments in studies with US adults undergoing evidence-based treatments. Although individual studies demonstrated gender differences in treatment effects, researchers did not identify systematic differences across studies. Most notably, despite an extensive search and thorough screening procedure, very few studies were found to report on treatment effects according to gender, hindering all analyses. The review showed a profound lack of information on the presence and absence of gender differences. Those studies that met inclusion criteria tended to be smaller and/or did not enroll comparable numbers of men and women; tended to assess a wide variety of outcomes, making cross-study comparisons difficult; and tended to have relatively high risk of bias.
Objective: To evaluate the effectiveness of interventions targeting alcohol consumption, drug use and smoking for college/university students. Participants: College/University students Methods: Studies were eligible if: (1)included students attending universities/colleges; (2)implemented in a university/college setting; (3)aimed to improve at least one of the following behaviors: alcohol and/or drug use and/or smoking; (4)were RCTs. The effect of the interventions on behaviors was determined by the percentage of studies that reported an effect. Due to the heterogeneity of outcomes meta-analysis was not conducted. Results: 88 studies met criteria. University-based interventions were effective for reducing alcohol-related outcomes (drinking patterns, BAC, consequences, problem drinking). Inconsistent findings for drug and smoking were observed. Conclusions: University-based interventions have the potential to improve health for students. While there is a breadth of research examining the efficacy of interventions to reduce alcohol consumption, further research is needed to determine the best approach for addressing smoking and drug use among students.
Identifying students at risk for violating alcohol policies could help college administrators minimize many problems. In this study, 154 male college freshmen [mean age 18.01 (SD = .50); 63% (n = 54) Caucasian], 68 of whom had been adjudicated for violating alcohol policies, completed an initial questionnaire assessing demographic characteristics and beliefs about drinking as well as a Timeline Followback of previous drinking behavior. Compared to the 86 nonadjudicated participants, adjudicated men were more likely to be Caucasian, from higher income families, involved in heavy drinking, and higher on positive alcohol expectancies. They reported less concern about their health and less tension. A logistic regression with these variables successfully distinguished between the two groups. Health and tension items alone correctly classified the groups almost as well. Results suggest that simple assessments about tension and concern for health may identify male students in need of prevention efforts.
Drinking levels, related problems, and readiness to change alcohol use were assessed among college students (N = 179) referred to a university-based, early-intervention program. As expected, alcohol use and related problems within this sample exceeded university-wide norms, but problems were concentrated within a small sub-group who drank well above customarily defined “binge” levels. Furthermore, some individuals experienced significant problems drinking below binge levels. In general, participants showed limited acknowledgment of a drinking problem or interest in changing their behavior. Findings suggest that prevention and early intervention efforts should be based on college students' diverse drinking patterns and risk profiles, and support the argument against the dichotomous binge-drinking characterization of the problem.
Evaluated the effectiveness of alcohol information school, a 7-hr classroom experience required for 26 male and 5 female university students who were involved in conduct violations while using alcohol. Program evaluation research consisted of administration of a questionnaire and an attitude scale before and after participation. Results show significant increases in knowledge and suggest long-term effects of decreased use and decreased incidence of problems associated with alcohol. (PsycINFO Database Record (c) 2012 APA, all rights reserved)