Group-Based Motivational Interviewing for Alcohol Use Among College Students: An Exploratory Study

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.

Full text

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 (N⫽7) or an MI group prevention
classroom (N⫽7). 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, N⫽91) ⫽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
(n⫽44)
Experimental
(n⫽47)
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
(n⫽44)
Experimental
(n⫽47)
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.
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SPECIAL SECTION: GROUP-BASED MOTIVATIONAL INTERVIEWING

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Received November 10, 2005
Revision received March 27, 2006
Accepted May 1, 2006 䡲
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