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Group-based motivational interviewing for alcohol use among college students: An exploratory study

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Abstract

How can practicing psychologists help reduce excessive alcohol consumption among college students? Over 80% of college students consume alcohol, and a significant percentage drinks excessively with myriad problems. Brief interventions based on motivational interviewing (MI) have been identified for use with college populations. The authors randomly assigned 91 freshman students to a brief, classroom-based MI intervention or an assessment control condition. At the end of the semester, MI group participants reported fewer drinks per occasion and fewer episodes of intoxication compared to controls. A classroom-based, MI-style intervention might be an efficient, sustainable, and effective means of reducing heavy drinking among college students.
Group-Based Motivational Interviewing for Alcohol Use Among College
Students: An Exploratory Study
Kurt D. Michael, Lisa Curtin, Dale E. Kirkley, and
Dan L. Jones
Appalachian State University
Rafael Harris Jr.
University of Florida
How can practicing psychologists help reduce excessive alcohol consumption among college students?
Over 80% of college students consume alcohol, and a significant percentage drinks excessively with
myriad problems. Brief interventions based on motivational interviewing (MI) have been identified for
use with college populations. The authors randomly assigned 91 freshman students to a brief, classroom-
based MI intervention or an assessment control condition. At the end of the semester, MI group
participants reported fewer drinks per occasion and fewer episodes of intoxication compared to controls.
A classroom-based, MI-style intervention might be an efficient, sustainable, and effective means of
reducing heavy drinking among college students.
Keywords: motivational interviewing, alcohol, college student, brief intervention
College student alcohol consumption is a significant public
health problem (Ham & Hope, 2003). Over 80% of college stu-
dents report drinking alcohol (Johnston, O’Malley, Bachman, &
Schulenberg, 2004), and about 40% report a heavy drinking epi-
sode in the previous 2 weeks (O’Malley & Johnston, 2002; Wech-
sler, Davenport, Dowdall, Moeykens, & Castillo, 1994). Heavy
episodic drinking (typically defined as at least four or five drinks
in a single sitting) among college students is associated with poor
academic performance, legal problems, risky sexual behaviors, and
alcohol-related injuries and deaths (Hingson, Heeren, Zakocs, Kop-
stein, & Wechsler, 2002; Perkins, 2002). Lowering the proportion of
students engaging in heavy drinking is an objective of the surgeon
general’s national health promotion and disease prevention initiative
(U.S. Department of Health and Human Services, 2000).
Alcohol prevention interventions on college campuses typically
include traditional programs such as alcohol awareness weeks,
wrecked car exhibits, and educational campaigns. Although easy
to deliver, traditional primary prevention interventions are not
often considered effective by college substance abuse prevention
coordinators in changing alcohol consumption or reducing
alcohol-related problems (Werch, Pappas, & Castellon-Vogel,
1996), and broad-based drug prevention initiatives may relate to
increased drinking (Werch & Owen, 2002). Social norms cam-
paigns have become a popular primary prevention strategy across
the past 10 years. Social norms campaigns provide students with
information via posters, public service announcements, advertise-
ments, flyers, and pamphlets of survey results about college stu-
dent drinking in a positive manner (e.g., the majority of students
drink five or fewer drinks when they party), designed to challenge
the perception that everyone in college drinks heavily. A number
of uncontrolled longitudinal studies of social norm campaigns
(e.g., Haines & Spear, 1996) found decreases in the perception of
campus heavy drinking and corresponding decreases in self-
reported student drinking. However, some quasi-experimental in-
vestigations associated with social norm programs found de-
creased perceptions of peer drinking but no change in drinking
behavior and some evidence of increased drinking (Clapp, Lange,
Russell, Shillington, & Voas, 2003).
KURT D. MICHAEL earned his PhD in clinical psychology at Utah State
University and completed his clinical internship at Duke University Med-
ical Center. He is an associate professor of psychology at Appalachian
State University (ASU) and associate director of clinical services at the
ASU Institute for Health and Human Services. His primary area of research
is psychotherapy outcome.
LISA CURTIN earned her PhD in clinical psychology at Virginia Polytechnic
Institute and State University and completed her clinical internship at
Brown University School of Medicine. She is an associate professor of
psychology at Appalachian State University and associate director of
research at the ASU Institute for Health and Human Services. Her primary
area of research is in addictive behaviors.
DALE E. KIRKLEY earned his MA in human development and psychological
counseling from Appalachian State University. He is coordinator of the
Alcohol and Drug Assistance Program at ASU Counseling and Psycho-
logical Services Center. His primary research interest is in the area of
motivational interviewing.
DAN L. JONES earned his PhD in counseling psychology at the University
of Kansas. He is the director and chief psychologist of the ASU Counseling
and Psychological Services Center. His area of research is college mental
health issues.
RAFAEL HARRIS JR. earned his PsyD in clinical psychology from Florida
Institute of Technology in 1999. He is assistant director for clinical services
and clinical assistant professor in the Counseling Center at the University
of Florida and an affiliate professor in the Department of Counselor
Education. His research interests are currently in the areas of substance
abuse treatment, group counseling, and psychotherapy outcome.
THE ORDER OF THE FIRST AND SECOND AUTHORS was chosen at random. We wish
to express our gratitude to the Freshman Seminar Program at ASU for
collaborating with the clinical and research teams on this study. Further, we are
thankful for the capable assistance of a cadre of students and colleagues,
including Kim Pratt, Kendal McDevitt, Geri Miller, Diana Quealy-Berge,
Garrett Hazelton, Laura Ritchie, Kate Tucker, Patrik Stridh, and Anna Coil.
CORRESPONDENCE CONCERNING THIS ARTICLE should be addressed to Kurt D.
Michael, Department of Psychology, Appalachian State University, 222 Joyce
Lawrence Drive, Boone, NC 28608-2109. E-mail: michaelkd@appstate.edu
Professional Psychology: Research and Practice Copyright 2006 by the American Psychological Association
2006, Vol. 37, No. 6, 629– 634 0735-7028/06/$12.00 DOI: 10.1037/0735-7028.37.6.629
629
Brief motivational interventions are well supported in the alco-
hol treatment literature and show promise as interventions for
college students. Brief assessment and feedback interventions for
problem drinkers have moderately exceeded the effect of control
conditions and have been nearly equal in effect to more extensive
interventions (Bien, Miller, & Tonnigan, 1993). Motivational in-
terviewing (MI), a therapeutic style focused on the principles of
expressing empathy, developing discrepancy, rolling with resis-
tance, and supporting self-efficacy in order to increase intrinsic
motivation to change and reduce ambivalence (Miller & Rollnick,
2002), is frequently used in the context of brief interventions.
Similarly, Burke, Arkowitz, and Menchola (2003) found that MI
was equivalent to other active treatments and superior to no
treatment and placebo controls, relative to reducing alcohol use in
their meta-analytic review of MI.
Brief interventions and MI have been used in the context of
secondary and tertiary prevention interventions with college stu-
dents. Several studies have found that individual brief assessment
and feedback interventions that used an MI style related to de-
creased drinking and drinking-related problems among heavy-
drinking college students compared with assessment-only control
groups (Baer et al., 1992; Borsari & Carey, 2000; Larimer, Cronce,
Lee, & Kilmer, 2001). Moreover, McNally and Palfai (2003)
assigned freshman college students who endorsed a recent heavy
drinking episode to one of two brief MI-style group discussion
interventions (i.e., norm-based discrepancy discussion, actual-
self–ideal-self discrepancy discussion) or to an assessment-only
control condition. The norm-based discrepancy discussion effects
(i.e., personal drinking compared with normative drinking) ex-
ceeded the actual–ideal discrepancy discussion effects (i.e., per-
sonal current drinking vs. personal ideal drinking), and both active
interventions exceeded the effects of the assessment alone on
drinking behavior measured 4 weeks later.
Although brief motivational interventions are considered effica-
cious for college students, they have been tested with selected
heavy drinkers only and almost exclusively in an individual for-
mat. College freshmen may represent a broad and diverse at-risk
group. In general, first semester students and students living on
campus are at greater risk for heavy drinking (Engs, Diebold, &
Hanson, 1996; Turrisi, Padilla, & Wiersma, 2000) and adverse
events such as academic underperformance and dropout than other
cohorts (for further review, see Tobolowsky, Cox, & Wagner,
2005). Several universities have freshman seminar programs
(FSPs) designed to enhance the college experience, to increase
retention, and to address potential pitfalls of college life before
they become problematic. These programs are associated with
higher retention and graduation rates, better psychological adjust-
ment, improved academic performance, and increased student sat-
isfaction (Barefoot, Warnock, Dickinson, Richardson, & Roberts,
1999).
Focusing alcohol prevention efforts on students shortly after
their arrival on campus makes good sense from empirical and
prevention standpoints. Further, a group-based alcohol prevention
intervention in an FSP class context has sustainable potential
within a college environment. We delivered and tested a group-
based psychoeducational intervention using an MI style to fresh-
men participating in an FSP. The group-based intervention, de-
scribed in detail below, used an MI style (Miller & Rollnick,
2002), a decisional balance activity (Mann, 1972), and incorpo-
rated a discussion of perceived college student drinking in relation
to normative data. The present intervention differs from past brief
interventions in format (group vs. individual), context (existing
class vs. research group), and relation to participants (freshmen vs.
identified heavy drinkers).
Detailed Description of Group MI Prevention Intervention
The brief group intervention (developed by Dale E. Kirkley and
Rafael Harris Jr.) delivered in the present study used the MI
counseling style (Miller & Rollnick, 2002). The principles of MI
style (nonlabeling and empathy-based style, creation of discrep-
ancy, developing of confidence, rolling with resistance) were used
throughout the group-based intervention. The spirit of MI is that it
is a way of being with people that is collaborative rather than
confrontational or authoritative. The counselor creates a welcom-
ing, nonthreatening environment and a relationship that activates
the student’s capacity for beneficial change. Within the spirit of
MI, students in the classes are approached in a respectful manner,
without their instructor of record present, to accentuate the non-
judgmental, nonlabeling premise of MI that may elicit participant
argument for change, known in MI as change talk (Miller &
Rollnick, 2002). Student experiences and perspectives are heard
and not judged. Discussion and dialogue take on a partnership
quality that is supportive and understanding and create an envi-
ronment for change.
An important first step in the group brief intervention is to
develop rapport with the students and seek to dissolve any resis-
tance that students may harbor about addressing alcohol use. The
facilitators give the students nothing to resist and simply start the
process by “coming along beside them.” Facilitators communicate
to students that they are not judging students’ alcohol use and have
no intention of telling students what decisions they should make.
The students’ autonomy and self-efficacy are reinforced through
acknowledging awareness that the students have reached a stage of
independence and budding adulthood and are thus responsible for
making many of their own decisions.
The process promoted through MI is supportive and collabora-
tive but also evocative. The facilitator does not seek to provide
information or insight to a passive student audience. In a tradi-
tional education and/or information-based classroom intervention
program on alcohol issues, a facilitator might impart correct in-
formation and direct students on the actions and decisions to be
healthy, safe, avoid negative consequences, and lower their risk for
problem drinking. MI is based on the belief that the resources and
motivation for change reside within the individual. The facilitators
draw on the perceptions, values, and goals of the students to
activate intrinsic motivation for change. The MI style respects the
autonomy of the students and their capacity to choose from an
informed perspective what is best for them. Change that is intrin-
sically motivated serves each student’s own goals and values.
The central discussion activity for the brief group intervention is
to examine the pros and cons of alcohol use from a student
perspective with a decisional balance paradigm (Mann, 1972). In
description, this activity sounds quite simple, yet it can be a very
powerful tool for eliciting statements of desire, ability, reasons,
and need for change from the students. Students are first asked to
brainstorm and explore what they like, find enjoyable, or experi-
ence as perceived benefits from alcohol use. The facilitators re-
630 MICHAEL, CURTIN, KIRKLEY, JONES, AND HARRIS
spond to the input from the students nonjudgmentally and record
this information on the board. Care is taken to patiently exhaust the
various perspectives of the students and explore with them the
nature of their collegiate drinking culture, weaving in humor and
communicating understanding of what they experience without
judgment. The facilitator responds to students reflectively in order
to engage further conversation and gain clarity about their expe-
riences and feelings. The students may use this portion of the
activity to test the facilitator’s reaction to their comments and
attitudes about alcohol use, making neutrality and the use of
reflection very important for the facilitators.
The facilitators then guide a process of having the students
brainstorm and discuss the “not so good” things or cons about
alcohol use. Again, care is taken to exhaust the “not so good”
things concerning their thoughts about and experiences with alco-
hol use. Students are likely to engage actively and openly in this
activity because they felt understood when expressing their posi-
tive thoughts about and experiences regarding alcohol use. This
powerful and deceptively simple process of discussion sets the
stage for a broad examination of the discrepancy that occurs in
their culture of collegiate alcohol use. In MI, recognition of dis-
crepancy between current behavior and personal goals and values
can serve as a catalyst for change. Students are asked to reflect and
comment on the discrepancies they have acknowledged between
what they enjoy about alcohol use and the unpleasant or harmful
consequences they may also experience. This nonthreatening way
of having students actively discuss potential discrepancies between
their current and desired behavior and outcomes is used to facili-
tate change talk. Skillful reflective listening, summaries, and ex-
ploratory open-ended questions are used to guide students in
elaborating and expounding on change talk. Reflections can be
complex, directive, skillful responses used to respond to resistance,
to redirect the focus and meaning of a comment, or to increase
elaboration of reasons, perceived ability, or commitment to change
drinking behavior.
In MI, ambivalence is expected and can occur at any time during
a change process. Although MI is often thought of as a nondirec-
tive intervention style, it is actually directive in its primary goal of
aiding resolution of ambivalence (Miller & Rollnick, 2002). Stu-
dents may strongly think “two ways” about drinking. Facilitators
respond to ambivalence reflectively, avoid argumentation, and
guide a discussion of how students might seek to resolve their
ambivalence. They may be asked, “How can you have the enjoy-
able, nonharmful aspects of alcohol use if you make the choice to
drink, without experiencing these negative consequences?” The
facilitators then guide the students in brainstorming and specifying
means of achieving low-risk alcohol use. Facilitators also lead a
discussion about the difficulties and challenges as well as the
support and commitment the students may have for acting on their
suggestions for resolving personal ambivalence related to alcohol
use.
Throughout the group activity, a number of psychoeducational
opportunities often present. For example, students may discuss
concerns about or ask questions concerning issues of biological
risk factors (e.g., family history, tolerance) and alcohol poisoning.
These teachable moments are actively discussed with the nonla-
beling MI spirit. Teaching moments are purposely brief and to the
point, providing important risk reduction information, usually
leading to an engaged discussion and eliciting further change talk.
These teachable moments are not lengthy enough to distract from
the process or to create an expert perception of the facilitators.
An additional activity included in the brief intervention program
is a limited but engaged discussion of perceptions of alcohol use
among college students. College students tend to overestimate
their peers’ alcohol consumption (Perkins, Meilman, Leichliter,
Cashin, & Presley, 1999) and often believe their peers consume
more alcohol than they themselves do (Borsari & Carey, 2003). In
addition, perceptions of normative college student drinking corre-
late positively with personal alcohol consumption (Perkins &
Wechsler, 1996). College student overestimation of peer drinking
behavior may contribute to a heavy drinking environment by
justifying heavy personal drinking behavior and/or guiding per-
sonal drinking behavior (e.g., perceived pressure to match norma-
tive drinking). Group facilitators seek student reaction to the
discussion of campus and nationwide misperceptions of collegiate
drinking. Facilitating a discussion regarding moderate use or ab-
stinence can support the low-risk suggestions that have resulted
from the decisional balance activity, providing an increased sense
of normalcy to moderate, nonabusive drinking.
The group intervention culminated in a serious discussion in
which the following question was asked: “What would it take, or
what would have to happen to cause you to be concerned enough
to make changes in your alcohol use?” This powerful question may
personalize the issue of potential alcohol misuse so that the impe-
tus for change is defined by the student, not the expert clinician.
Asking students to consider this question can offer a very thought
provoking zinger of change talk that may be well remembered by
the students.
The MI Study
Beginning in 2003, three small controlled MI pilot trials have
been implemented (fall 2003, spring 2004, fall 2004) within the
context of a comprehensive southeastern university’s FSP. Incom-
ing freshman students enrolled into one of several FSP classrooms
during registration. Each semester, a subset of FSP instructors
were given a brief presentation describing the study and invited to
allow the research team into their classrooms to discuss the project
with their students. A research team member came to all partici-
pating classes and provided a brief presentation about the project
to the FSP students and requested participation via an informed
consent procedure. The freshman students who elected to partici-
pate in the study provided their informed consent and attended a
pretreatment assessment session (outside of class) that took ap-
proximately 60 min. The pretreatment assessments were conducted
in a separate research facility, administered and monitored by
graduate research assistants. The freshman students completed a
demographics questionnaire, provided self-report data on drinking
(i.e., 2-week Alcohol Time Line Follow-Back, Sobell, Sobell,
Klajner, Pavan, & Basian, 1986; self-reported number of drinking
days during the past 30 days, number of intoxicating events during
the past 30 days), alcohol-related problems during the past 30 days
(Rutgers Alcohol Problem Index; White & Labouvie, 1989), psy-
chopathology (Symptom Checklist 90 –Revised; Derogatis, 1994),
and the Big Five personality traits (International Personality Item
Pool; Goldberg, 1999). Students who completed the assessment
were paid $10 for their time.
631
SPECIAL SECTION: GROUP-BASED MOTIVATIONAL INTERVIEWING
Across the three trials, a total of 91 freshmen (34 men, 57
women) participated in the study. The sample was 93.7% Cauca-
sian, 4.3% African American, 1% Hispanic, and 1% Asian Amer-
ican. The FSP classroom was assigned randomly as either an
assessment control classroom (N7) or an MI group prevention
classroom (N7). Of the 91 freshmen who took part in the
project, 44 were from control classrooms and 47 were from MI
group prevention classrooms. At pretreatment evaluation, the
groups did not differ significantly on age, t(89) ⫽⫺1.63, p.11;
sex,
2
(1, N91) 1.12, p.29; age at first alcohol use, t(76)
1.51, p.12; number of drinking days during the past 30 days,
t(89) 0.53; p.60; number of drinks consumed during the past
14 days, t(89) 0.14, p.89; number of times drinking to
intoxication during the past 30 days, t(89) 1.51, p.73; and
alcohol-related problems during the past 30 days, t(89)
1.05, p.30. Within each group, the percentage of freshmen
who did not report any drinking during either the pre- or
posttreatment assessments was roughly equivalent (18.2% for
control; 17.0% for MI). The preintervention descriptive data are
summarized in Table 1.
After the preintervention assessment, the FSP students assigned
to MI classrooms took part in an MI-style psychoeducational
intervention. The MI facilitators were experienced therapists with
considerable MI training (two master’s-level counselors, one
doctoral-level psychologist; mean years of experience 12) and
two of the therapists were formally trained to use the MI style by
Miller and associates. The intervention was not manualized, and
evidence suggests lower effect sizes for manualized MI interven-
tions compared with nonmanualized MI interventions (Hettema,
Steele, & Miller, 2005). In fall 2003 and spring 2004, the sessions
were 50 min in duration (100 min total; approximately 2 weeks
apart); whereas in fall 2004, one session (75 min in duration) was
conducted. The students enrolled in the control classrooms partic-
ipated in only the assessment sessions.
At posttreatment, all participants were contacted for follow-up
assessment that took place between 30 and 45 days after the MI
intervention. The posttreatment assessments were conducted out-
side the classroom setting in a separate research facility, adminis-
tered and monitored by graduate research assistants. Longitudinal
assessments (2–2.5 years after the pretreatment evaluation) are
planned (spring 2006) but have yet to be conducted.
Postintervention Outcomes
As reported in Table 2, the average number of drinking days
during the past 30 days was virtually unchanged across both
groups (effect size 0.09). In addition, self-reported alcohol
problems did not change differentially across groups (effect size
0.09). However, students in the MI group consumed an average
of 4.5 fewer drinks during the previous 14 days at postintervention,
compared with the control group students (effect size 0.19).
Moreover, the MI participants reported an average of 1.5 fewer
episodes of intoxication during the previous 30 days at postassess-
ment, compared with the control group participants (effect size
0.34). Thus, although both groups drank about as frequently after
the intervention, on average the MI participants consumed fewer
drinks and became intoxicated less often than the control group
participants. These data are summarized in Table 2.
Clinical Implications and Applications
The findings from this study suggest that a brief group inter-
vention that used an MI style, decisional balance exercise, and
norm-based discussion was reasonably effective at reducing self-
reported drinking quantity and episodes of intoxication for those
who participated in the prevention intervention. A previous com-
parison of alcohol-using college students randomly assigned to an
assessment control, written decisional balance, or individual in-
person decision balance exercise did not result in differences
between conditions on 2-week drinking outcomes (Collins &
Carey, 2005), suggesting the current findings exceed the effects of
the decisional balance activity alone and that the MI style is an
integral component of the intervention. The only other group-
based MI intervention for college students compared two discrep-
ancy producing discussions and selected for heavy drinkers (Mc-
Nally & Palfai, 2003). Our intervention also involved an MI style
and norm-based discussion; however, the main discussion re-
volved around the decisional balance exercise, and we did not
select for heavy drinkers.
The current intervention was delivered in the context of an FSP
already associated with student benefits (Barefoot et al., 1999).
Thus, the assessment-only control condition served as a relatively
conservative control. Although the magnitude and scope of the
effects are modest at best, perhaps the most compelling finding is
the reduction of the average number of intoxicating events each
month by approximately 1.5 episodes. Moreover, this effect was
achieved with a relatively small dosage (75–100 min) of preven-
tion intervention that was delivered in the context of an existing
classroom (group) context. The effects of the current intervention
have practical implications within a typical college setting, as the
intervention can be delivered in a relatively efficient and cost-
effective way.
In future studies of this type, it will be important to examine
whether a higher dosage of MI might lead to more substantial
changes in drinking behavior and the associated consequences
among college students. For example, provision of individualized
feedback based on assessment information might be a relatively
efficient way to increase the intensity of the current group-based
intervention. In addition, it will be important to assess effects
across time, given potential for diminishing effects (Hettema et al.,
2005). Although the majority of brief intervention studies with
Table 1
Descriptive Statistics by Group at Pretreatment
Variable
Control
(n44)
Experimental
(n47)
MSDMSD
Age (years) 18.2 0.7 18.5 0.9
Age of first use (years) 15.4 1.7 14.7 2.2
Drinking days (past 30 days) 5.9 6.1 5.3 5.8
TLFB (past 14 days) 15.9 23.7 16.5 19.3
Intoxicating events (past 30 days) 4.4 5.1 4.1 5.2
Mean RAPI score 5.4 6.1 6.7 6.0
Note. TLFB Time Line Follow-Back; RAPI Rutgers Alcohol Prob-
lem Index.
632 MICHAEL, CURTIN, KIRKLEY, JONES, AND HARRIS
college students assess short-term outcomes (Larimer et al., 2001),
there is some evidence of 4-year maintenance effects (Baer et al.,
1992). We plan to continue to follow our sample to assess main-
tenance effects. Finally, although intervention providers were ex-
perienced MI therapists we did not use an independent manipula-
tion check of intervention integrity.
In summary, on the basis of the results of this study, psychol-
ogists and other professionals working with college students may
want to consider the addition of an MI style to their outreach
services, although the long-term effects of this intervention have
yet to be assessed. This study showed that even a short-term
prevention intervention effectively reduced quantity of alcohol
consumption among college freshmen. Further, such a program
could be readily integrated and sustained into the college curric-
ulum with existing campus resources although institutional support
for classroom infusion will likely be necessary.
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Table 2
Posttreatment Outcomes
Variable
Control
(n44)
Experimental
(n47)
MSDMSD
Drinking days (past 30 days) 5.8 5.5 5.3 4.7
TLFB (past 14 days) 18.1 29.4 13.6 16.7
Intoxicating events (past 30 days) 4.2 5.3 2.7 3.2
Mean RAPI score 4.6 5.9 5.1 5.7
Note. TLFB Time Line Follow-Back; RAPI Rutgers Alcohol Prob-
lem Index.
633
SPECIAL SECTION: GROUP-BASED MOTIVATIONAL INTERVIEWING
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Received November 10, 2005
Revision received March 27, 2006
Accepted May 1, 2006
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634 MICHAEL, CURTIN, KIRKLEY, JONES, AND HARRIS
... In conclusion, while preliminary findings indicate the applicability and significance of the CHOICES Group intervention, expansion of this pilot study through additional research is needed. There are only a few examples of randomized clinical trials using MI groups to address issues other than AEP risk (D'Amico, Hunter, Miles, Ewing, & Osilla, 2013;LaChance, Feldstein Ewing, Bryan, & Hutchison, 2009;Noonan, 2001;Sobell, Sobell, & Agrawal, 2009), with other studies being nonrandomized trials, non-comparison studies, and pilot designs (Brown et al., 2007;Foote et al., 1999;LaBrie, Thompson, Huchting, Lac, & Buckley, 2007;Lincourt, Kuettel, & Bombardier, 2002;Michael, Curtin, Kirkley, Jones, & Harris, 2006;Santa Ana, Wulfert, & Nietert, 2007). While the CHOICES Group intervention pilot study found that it positively engaged members, had low levels of anger or tension, and had average avoidance of personal responsibility, the intervention needs additional investigating with a greater number of groups and participants. ...
... Evidence-based group education programming ensued for those recommended for further education. Group modalities using MI strategies have been shown to be effective with college students [34]. Students at the lowest risk and no apparent continued or ongoing AOD use (e.g. ...
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We included only studies that had checked video or sound recordings of the therapies in order to be certain that what was given really was MI. The results in this review are based on 59 studies. The results show that people who have received MI have reduced their use of substances more than people who have not received any treatment. However, it seems that other active treatments, treatment as usual and being assessed and receiving feedback can be as effective as motivational interviewing. There was not enough data to conclude about the effects of MI on retention in treatment, readiness to change, or repeat convictions. The quality of the research forces us to be careful about our conclusions, and new research may change them. ABSTRACT Background There are 76.3 million people with alcohol use disorders worldwide and 15.3 million with drug use disorders. Motivational interviewing (MI) is a client‐centred, semi‐directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence. The intervention is used widely, and therefore it is important to find out whether it helps, harms or is ineffective. Objectives To assess the effectiveness of motivational interviewing for substance abuse on drug use, retention in treatment, readiness to change, and number of repeat convictions. Search strategy We searched 18 electronic databases, 5 web sites, 4 mailing lists, and reference lists from included studies and reviews. Search dates were November 30, 2010 for Cochrane Library, Medline, Embase and PsychINFO. Selection criteria Randomized controlled trials with persons dependent or abusing substance. Interventions were MI or motivational enhancement therapy. The outcomes were extent of substance abuse, retention in treatment, motivation for change, repeat conviction. Data collection and analysis Three authors independently assessed studies for inclusion, and two authors extracted data. Results were categorized into (1) MI versus no‐treatment control, (2) MI versus treatment as usual, (3) MI versus assessment and feedback, and (4) MI versus other active treatment. Within each category, we computed meta‐analyses separately for post‐intervention, short, medium and long follow‐ups. Main results We included 59 studies with a total of 13,342 participants. Compared to no treatment control MI showed a significant effect on substance use which was strongest at post‐intervention SMD 0.79, (95% CI 0.48 to 1.09) and weaker at short SMD 0.17 (95% CI 0.09 to 0.26], and medium follow‐up SMD 0.15 (95% CI 0.04 to 0.25]). For long follow‐up, the effect was not significant SMD 0.06 (95% CI‐0.16 to 0.28). There were no significant differences between MI and treatment as usual for either follow‐up post‐intervention, short and medium follow up. MI did better than assessment and feedback for medium follow‐up SMD 0.38 (95% CI 0.10 to 0.66). For short follow‐up, there was no significant effect . For other active intervention there were no significant effects for either follow‐up. There was not enough data to conclude about effects of MI on the secondary outcomes. Authors' conclusions MI can reduce the extent of substance abuse compared to no intervention. The evidence is mostly of low quality, so further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. PLAIN LANGUAGE SUMMARY Motivational interviewing is a short psychological treatment that can help people cut down on drugs and alcohol More than 76 million people worldwide have alcohol problems, and another 15 million have drug problems. Motivational interviewing (MI) is a psychological treatment that aims to help people cut down or stop using drugs and alcohol. The drug abuser and counsellor typically meet between one and four times for about one hour each time. The counsellor expresses that he or she understands how the clients feel about their problem and supports the clients in making their own decisions. He or she does not try to convince the client to change anything, but discusses with the client possible consequences of changing or staying the same. Finally, they discuss the clients' goals and where they are today relative to these goals. We searched for studies that had included people with alcohol or drug problems and that had divided them by chance into MI or a control group that either received nothing or some other treatment. We included only studies that had checked video or sound recordings of the therapies in order to be certain that what was given really was MI. The results in this review are based on 59 studies. The results show that people who have received MI have reduced their use of substances more than people who have not received any treatment. However, it seems that other active treatments, treatment as usual and being assessed and receiving feedback can be as effective as motivational interviewing. There was not enough data to conclude about the effects of MI on retention in treatment, readiness to change, or repeat convictions. The quality of the research forces us to be careful about our conclusions, and new research may change them.
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Background: Drinking is influenced by youth perceptions of how their peers drink. These perceptions are often incorrect, overestimating peer drinking norms. If inaccurate perceptions can be corrected, young people may drink less. Objectives: To determine whether social norms interventions reduce alcohol-related negative consequences, alcohol misuse or alcohol consumption when compared with a control (ranging from assessment only/no intervention to other educational or psychosocial interventions) among university and college students. Search methods: The following electronic databases were searched up to July 2015: the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE, EMBASE, PsycINFO. The Cumulative Index to Nursing and Allied Health Literature (CINAHL) only to March 2008. Reference lists of included studies and review articles were manually searched. No restriction based on language or date was applied. Selection criteria: Randomised controlled trials or cluster-randomised controlled trials that compared a social normative intervention versus no intervention, alcohol education leaflet or other 'non-normative feedback' alcohol intervention and reported on alcohol consumption or alcohol-related problems in university or college students. Data collection and analysis: We used standard methodological procedures as expected by Cochrane. Each outcome was analysed by mode of delivery: mailed normative feedback (MF); web/computer normative feedback (WF); individual face-to-face normative feedback (IFF); group face-to-face normative feedback (GFF); and normative marketing campaign (MC). Main results: A total of 70 studies (44,958 participants) were included in the review, and 63 studies (42,784 participants) in the meta-analyses. Overall, the risk of bias assessment showed that these studies provided moderate or low quality evidence. Outcomes at four or more months post-intervention were of particular interest to assess when effects were sustained beyond the immediate short term. We have reported pooled effects across delivery modes only for those analyses for which heterogeneity across delivery modes is not substantial (I² < 50%). Alcohol-related problems at four or more months: IFF standardised mean difference (SMD) -0.14, 95% confidence interval (CI) -0.24 to -0.04 (participants = 2327; studies = 11; moderate quality evidence), equivalent to a decrease of 1.28 points in the 69-point alcohol problems scale score. No effects were found for WF or MF. Binge drinking at four or more months: results pooled across delivery modes: SMD -0.06, 95% CI -0.11 to -0.02 (participants = 11,292; studies = 16; moderate quality evidence), equivalent to 2.7% fewer binge drinkers if 30-day prevalence is 43.9%. Drinking quantity at four or more months: results pooled across delivery modes: SMD -0.08, 95% CI -0.12 to -0.04 (participants = 21,169; studies = 32; moderate quality evidence), equivalent to a reduction of 0.9 drinks consumed each week, from a baseline of 13.7 drinks per week. Drinking frequency at four or more months: WF SMD -0.11, 95% CI -0.17 to -0.04 (participants = 9929; studies = 10; moderate quality evidence), equivalent to a decrease of 0.17 drinking days/wk, from a baseline of 2.74 days/wk; IFF SMD -0.21, 95% CI -0.31 to -0.10 (participants = 1464; studies = 8; moderate quality evidence), equivalent to a decrease of 0.32 drinking days/wk, from a baseline of 2.74 days/wk. No effects were found for GFF or MC. Estimated blood alcohol concentration (BAC) at four or more months: peak BAC results pooled across delivery modes: SMD -0.08, 95% CI -0.17 to 0.00 (participants = 7198; studies = 11; low quality evidence), equivalent to a reduction in peak BAC from an average of 0.144% to 0.135%. No effects were found for typical BAC with IFF. Authors' conclusions: The results of this review indicate that no substantive meaningful benefits are associated with social norms interventions for prevention of alcohol misuse among college/university students. Although some significant effects were found, we interpret the effect sizes as too small, given the measurement scales used in the studies included in this review, to be of relevance for policy or practice. Moreover, the significant effects are not consistent for all misuse measures, heterogeneity was a problem in some analyses and bias cannot be discounted as a potential cause of these findings.
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Background: Alcohol use and misuse in young people is a major risk behaviour for mortality and morbidity. Motivational interviewing (MI) is a popular technique for addressing excessive drinking in young adults. Objectives: To assess the effects of motivational interviewing (MI) interventions for preventing alcohol misuse and alcohol-related problems in young adults. Search methods: We identified relevant evidence from the Cochrane Central Register of Controlled Trials (CENTRAL) (2015, Issue 12), MEDLINE (January 1966 to July 2015), EMBASE (January 1988 to July 2015), and PsycINFO (1985 to July 2015). We also searched clinical trial registers and handsearched references of topic-related systematic reviews and the included studies. Selection criteria: We included randomised controlled trials in young adults up to the age of 25 years comparing MIs for prevention of alcohol misuse and alcohol-related problems with no intervention, assessment only or alternative interventions for preventing alcohol misuse and alcohol-related problems. Data collection and analysis: We used the standard methodological procedures expected by Cochrane. Main results: We included a total of 84 trials (22,872 participants), with 70/84 studies reporting interventions in higher risk individuals or settings. Studies with follow-up periods of at least four months were of more interest in assessing the sustainability of intervention effects and were also less susceptible to short-term reporting or publication bias. Overall, the risk of bias assessment showed that these studies provided moderate or low quality evidence.At four or more months follow-up, we found effects in favour of MI for the quantity of alcohol consumed (standardised mean difference (SMD) -0.11, 95% confidence interval (CI) -0.15 to -0.06 or a reduction from 13.7 drinks/week to 12.5 drinks/week; moderate quality evidence); frequency of alcohol consumption (SMD -0.14, 95% CI -0.21 to -0.07 or a reduction in the number of days/week alcohol was consumed from 2.74 days to 2.52 days; moderate quality evidence); and peak blood alcohol concentration, or BAC (SMD -0.12, 95% CI -0.20 to 0.05, or a reduction from 0.144% to 0.131%; moderate quality evidence).We found a marginal effect in favour of MI for alcohol problems (SMD -0.08, 95% CI -0.17 to 0.00 or a reduction in an alcohol problems scale score from 8.91 to 8.18; low quality evidence) and no effects for binge drinking (SMD -0.04, 95% CI -0.09 to 0.02, moderate quality evidence) or for average BAC (SMD -0.05, 95% CI -0.18 to 0.08; moderate quality evidence). We also considered other alcohol-related behavioural outcomes, and at four or more months follow-up, we found no effects on drink-driving (SMD -0.13, 95% CI -0.36 to 0.10; moderate quality of evidence) or other alcohol-related risky behaviour (SMD -0.15, 95% CI -0.31 to 0.01; moderate quality evidence).Further analyses showed that there was no clear relationship between the duration of the MI intervention (in minutes) and effect size. Subgroup analyses revealed no clear subgroup effects for longer-term outcomes (four or more months) for assessment only versus alternative intervention controls; for university/college vs other settings; or for higher risk vs all/low risk participants.None of the studies reported harms related to MI. Authors' conclusions: The results of this review indicate that there are no substantive, meaningful benefits of MI interventions for preventing alcohol use, misuse or alcohol-related problems. Although we found some statistically significant effects, the effect sizes were too small, given the measurement scales used in the included studies, to be of relevance to policy or practice. Moreover, the statistically significant effects are not consistent for all misuse measures, and the quality of evidence is not strong, implying that any effects could be inflated by risk of bias.
Chapter
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Adolescence and emerging adulthood are transitional periods in the lives of Western youth, many of whom experiment with alcohol and drugs, along with volitional lifestyle and identity choices. The most commonly used substances are those that are legal, including alcohol and tobacco, followed closely by marijuana. These substances are tried commonly enough that such minor experimentation can be seen as normative. Experimentation with alcohol and drugs is a rite of passage that does not lead to irrevocable harm for the majority of people. However, a minority show heavier patterns of drinking, more frequent binge drinking, or early onset of drug use, all of which are related to numerous health harms. For a subset of these young people, preventive interventions may be needed to alter a course toward aberrant, hazardous, and health-harming substance use. Preventive interventions for adolescents generally strive to delay the initiation of use, while those for emerging adults attempt to minimize any consequences or harms of drinking or drug use. The next wave of preventive and treatment interventions will take advantage of advances in identifying those with the highest risk of progressing to dependence and early health problems and will tailor treatment to each individual to forestall future problems.
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This study was conducted to investigate the effectiveness of motivational interviewing in reducing the of Substance Users' impulsivity who were under the Methadone Treatment. In a semi-experimental study, 40 methadone users of one of the addiction treatment centers in Yazd city were selected through availability sampling method and were then divided into two experimental and control group of twenty. In both groups two variables, age and economic satisfaction, were under control. In this research Barrat Impulsivity Scale was used to obtain the data. The experimental group underwent seven 90 minute sessions of motivational interviewing. Following the intervention, the two groups completed the above-mentioned scale as the post test. The post test revealed that motivational interviewing had an effect in reducing cognitive, motor impulsivity and non-planning in the subjects of the experimental group. Results of the study showed that motivational interviewing could significantly decrease cognitive, motor impulsivity and non-planning in experimental group in comparison to the control group.
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Drinking is influenced by youth (mis)perceptions of how their peers drink. If misperceptions can be corrected, young people may drink less. To determine whether social norms interventions reduce alcohol-related negative consequences, alcohol misuse or alcohol consumption when compared with a control (ranging from assessment only/no intervention to other educational or psychosocial interventions) among university and college students. The following electronic databases were searched up to May 2014: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (only to March 2008). Reference lists of included studies and review articles were manually searched. Randomised controlled trials or cluster-randomised controlled trials that compared a social normative intervention versus no intervention, alcohol education leaflet or other 'non-normative feedback' alcohol intervention and reported on alcohol consumption or alcohol-related problems in university or college students. We used standard methodological procedures as expected by The Cochrane Collaboration. Each outcome was analysed by mode of delivery: mailed normative feedback (MF); Web/computer normative feedback (WF); individual face-to-face normative feedback (IFF); group face-to-face normative feedback (GFF); and normative marketing campaign (MC). A total of 66 studies (43,125 participants) were included in the review, and 59 studies (40,951 participants) in the meta-analyses. Outcomes at 4+ months post intervention were of particular interest to assess when effects were sustained beyond the immediate short term. We have reported pooled effects across delivery modes only for those analyses for which heterogeneity across delivery modes is not substantial (I(2) < 50%). Alcohol-related problems at 4+ months: IFF standardised mean difference (SMD) -0.16, 95% confidence interval (CI) -0.31 to -0.01 (participants = 1065; studies = 7; moderate quality of evidence), equivalent to a decrease of 1.5 points in the 69-point alcohol problems scale score. No effects were found for WF or MF. Binge drinking at 4+ months: results pooled across delivery modes: SMD -0.06, 95% CI -0.11 to -0.02 (participants = 11,292; studies = 16; moderate quality of evidence), equivalent to 2.7% fewer binge drinkers if 30-day prevalence is 43.9%. Drinking quantity at 4+ months: results pooled across delivery modes: SMD -0.08, 95% CI -0.12 to -0.05 (participants = 20,696; studies = 33; moderate quality of evidence), equivalent to a reduction of 0.9 drinks consumed each week, from a baseline of 13.7 drinks per week. Drinking frequency at 4+ months: WF SMD -0.12, 95% CI -0.18 to -0.05 (participants = 9456; studies = 9; moderate quality of evidence), equivalent to a decrease of 0.19 drinking days/wk, from a baseline of 2.74 days/wk; IFF SMD -0.21, 95% CI -0.31 to -0.10 (participants = 1464; studies = 8; moderate quality of evidence), equivalent to a decrease of 0.32 drinking days/wk, from a baseline of 2.74 days/wk. No effects were found for GFF or MC. Estimated blood alcohol concentration (BAC) at 4+ months: peak BAC results pooled across delivery modes: SMD -0.08, 95% CI -0.17 to 0.00 (participants = 7198; studies = 13; low quality of evidence), equivalent to a reduction in peak PAC from an average of 0.144% to 0.135%. No effects were found for typical BAC with IFF. The results of this review indicate that no substantive meaningful benefits are associated with social norms interventions for prevention of alcohol misuse among college/university students. Although some significant effects were found, we interpret the effect sizes as too small, given the measurement scales used in the studies included in this review, to be of relevance for policy or practice. Moreover, the statistically significant effects are not consistent for all misuse measures, heterogeneity was a problem in some analyses and bias cannot be discounted as a potential cause of these findings.
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Full-text available
This study tested 3 forms of alcohol risk reduction programming for young adults. Volunteers were randomly assigned to receive a 6-week class and discussion group, a 6-unit self-help manual, or a single 1-hr feedback and advice session with professional staff. Results reveal significant reductions in self-reported drinking at the end of the intervention phase and maintenance of drinking changes throughout a 2-year follow-up period. Comparable drinking reductions were rated across treatments; however, noncompliance with the self-help reading program suggested limited utility. Treatment response was related to subject age, as subjects showed increased drinking during the year they reached legal drinking status. The efficacy of brief motivational interventions and client matching in prevention programs is discussed.
Article
Over 12/XX) university students from every state were administered the Student Alchol Questionnaire during the 1993-1994 academic year. Of all students 72.0% consumed alcohol at least once a year and 20.6% were heavy drinkers (consuming 5 or more drinks per occasion once a week or more). A mean of 9.6 drinks per week was consumed by all students in the sample, 31% of males consumed over 21 drinks per week and 19.2% of females consumed over 14 drinks a week of the drinkers, 28.4% were heavy and 71.6% were light to moderate drinkers and they consumed a mean of 10.9 drinks per week A significantly higher proportion of men, whites, under 21 years old, Roman Catholics, individuals to whom religion was not important, individuals with low grade point averages, fraternity/sorority members, students attending college in the North East part of the United States, in small communities, private schools and colleges under 1OJXX) students exhibited heavier drinking and a higher incidence of problems related to drinking. These results are similar to other studies, which have been accomplished over the past two decades. The results do not support dramatic changes in the demography of heavier drinkers within most demographic categories. It was concluded that demographic variables need to be taken into consideration when planning campus educational and prevention programs. In times of limited budgets, the primary target needs to be these high risk students. Over 12/XX) university students from every state were administered the Student Alchol Questionnaire during the 1993-1994 academic year. Of all students 72.0% consumed alcohol at least once a year and 20.6% were heavy drinkers (consuming 5 or more drinks per occasion once a week or more). A mean of 9.6 drinks per week was consumed by all students in the sample, 31% of males consumed over 21 drinks per week and 19.2% of females consumed over 14 drinks a week of the drinkers, 28.4% were heavy and 71.6% were light to moderate drinkers and they consumed a mean of 10.9 drinks per week A significantly higher proportion of men, whites, under 21 years old, Roman Catholics, individuals to whom religion was not important, individuals with low grade point averages, fraternity/sorority members, students attending college in the North East part of the United States, in small communities, private schools and colleges under 1OJXX) students exhibited heavier drinking and a higher incidence of problems related to drinking. These results are similar to other studies, which have been accomplished over the past two decades. The results do not support dramatic changes in the demography of heavier drinkers within most demographic categories. It was concluded that demographic variables need to be taken into consideration when planning campus educational and prevention programs. In times of limited budgets, the primary target needs to be these high risk students.
Article
This study tested the effectiveness of a “balance-sheet” or tallying procedure used to induce high school seniors to think carefully about considerations relevant to their choice of college. Students who were exposed to the balance-sheet procedure three months before their choice of college were compared with a control group six weeks after making their decision. In comparison with control subjects, students administered the balance-sheet procedure tended (though the findings were not always significant at the 0.05 level) (1) to select a wider array of alternatives in formulating the decision, (2) to take into account more self-related and fewer social considerations, (3) to express less regret and report less concern about their choice following the decision, and (4) were less interested in receiving supportive, dissonance-reducing information. The balance-sheet procedure appears to make salient the importance of the decision, helps clarify the merits of the choice alternatives, and stimulates a search for feasible alternatives.
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Examined 17,592 college and university students' perceptions of campus norms about alcohol use and the impact of these perceptions on personal alcohol abuse. A S's particular collegiate environment accounted for only a small portion of the overall variation in perceptions of campus drinking norms. Within each campus context, perceptions varied widely. More permissive perceptions of the norm were significantly associated with greater personal alcohol abuse even after controlling for personal attitudes, thus suggesting that perceiving a permissive environment encourages students to drink more heavily than they would otherwise based on their personal attitudes. The detrimental impact of perceiving more permissive drinking norms was greatest for Ss whose own attitudes about drinking were already permissive. Implications are discussed for campus alcohol abuse prevention efforts. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Client ambivalence is a key stumbling block to therapeutic efforts toward constructive change. Motivational interviewing—a nonauthoritative approach to helping people to free up their own motivations and resources—is a powerful technique for overcoming ambivalence and helping clients to get "unstuck." The first full presentation of this powerful technique for practitioners, this volume is written by the psychologists who introduced and have been developing motivational interviewing since the early 1980s. In Part I, the authors review the conceptual and research background from which motivational interviewing was derived. The concept of ambivalence, or dilemma of change, is examined and the critical conditions necessary for change are delineated. Other features include concise summaries of research on successful strategies for motivating change and on the impact of brief but well-executed interventions for addictive behaviors. Part II constitutes a practical introduction to the what, why, and how of motivational interviewing. . . . Chapters define the guiding principles of motivational interviewing and examine specific strategies for building motivation and strengthening commitment for change. Rounding out the volume, Part III brings together contributions from international experts describing their work with motivational interviewing in a broad range of populations from general medical patients, couples, and young people, to heroin addicts, alcoholics, sex offenders, and people at risk for HIV [human immunodeficiency virus] infection. Their programs span the spectrum from community prevention to the treatment of chronic dependence. All professionals whose work involves therapeutic engagement with such individuals—psychologists, addictions counselors, social workers, probations officers, physicians, and nurses—will find both enlightenment and proven strategies for effecting therapeutic change. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Outpatients from a V.A. outpatient substance abuse treatment program (N = 32) were assigned at random either to receive or not receive a brief motivational intervention in addition to standard outpatient treatment. The additional intervention consisted of two additional hours of assessment and a one-hour motivational interview. Control subjects received the same additional assessment, but with an attention-placebo interview in place of the motivational interview. Those assigned to receive the additional intervention demonstrated superior clinical outcome at three month follow-up on a composite variable composed of three individual variables: (1) total standard drinks, (2) peak blood alcohol level, and (3) percent days abstinent. These results were substantially corroborated by reports of significant others. By six month follow-up, the superiority of the treatment group was modest, and no longer significant. These findings support the utility of this approach for use with clinically severe alcohol populations on at least a time-limited basis.
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It is well established that college students have high rates of alcohol use and misuse and suffer the negative consequences of this behavior. Research evaluating the results of brief interventions with high-risk college students has shown these approaches to be successful in reducing alcohol consumption and/or related consequences. Several screening tools have been developed to detect the presence of problematic alcohol use and associated disorders, and some are designed specifically for use in a college student population. College campuses offer several opportunities to implement screening and interventions, including universal or large-scale assessments; health services, counseling centers, or local emergency rooms; or via established judicial or grievance systems set up to deal with students who violate campus alcohol policies. Issues to consider when implementing screening and brief interventions in college populations include who should deliver the interventions--peer or professional counselors--and how students should be encouraged to participate in the interventions. Regardless of how the measures are implemented, the content and process of the brief interventions should be based on the available scientific evidence regarding established efficacious interventions.
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The test-retest reliability of male (n = 40) and female (n = 40) college students' reports of recent drinking behavior was evaluated using a timeline (TL) procedure. The students also completed a quantity-frequency (QF) questionnaire (Cahalan, Cisin, & Crossley, 1969) often used to categorize subjects' drinking histories in alcohol research studies. The TL-derived data were found to have generally high reliability (usually r's greater than or equal to .87) for both males and females, with males having slightly higher reliabilities overall. Subjects were classified into drinker categories based on the QF questionnaire answers, and the resulting groups were compared using their TL-derived data on quantity, frequency, and quantity X frequency (mean number of drinks per drinking day) measures of drinking. The drinking behavior of subjects (as assessed by the TL) had great variability within the QF categories, and there was extensive overlap between subjects classified by the QF method as heavy, moderate and light drinkers. Thus, QF categorization provides a relatively insensitive measure of individual differences in drinking behavior as compared to TL-derived data. The TL method also can be used to generate a variety of potentially useful dependent variables, whereas the QF method generates a single variable.