A brief non-confrontational intervention program administered to high-risk college-age drinkers when they entered college had long-lasting effects that persisted over four years in reducing the number of alcohol-related problems.
The finding comes from a study being published in the August issue of the American Journal of Public Health by a team of researchers headed by University of Washington psychologist John Baer. The study, funded by the National Institute on Alcohol Abuse and Alcoholism, tracked the drinking habits of more than 360 high-risk drinkers and normal students through college.
The intervention was tested relative to different developmental, or maturational, trends in the drinking habits of high-risk and normal students, said Baer, who is a UW research associate professor of psychology and education coordinator at the National Center of Excellence in Substance Abuse Treatment and Education at the U.S. Veterans Administration Puget Sound Health Care System.
"It appears that our intervention effort is directed at a moving target, that is, drinking by college-age students is not stable over time," said Baer. "And it looks as if we can accelerate a trend toward decreasing drinking among high-risk students, making this program true prevention."
The trend among students drawn from the general student body was basically stable over time, although they experienced a slight increase in drinking frequency around the time they turned 21, he said. These students had few alcohol-related problems. Drinking frequency among high-risk students increased when they entered college and remained at about the same level throughout college. However, the quantity of alcohol high-risk students consumed and the number of alcohol-related problems they experienced steadily declined over time.
"Our prevention program resulted in significant differences in self-reported rates of drinking problems four years later. This is a long time and we are unaware that anyone else has shown effects of this duration," Baer said.
Forty-three percent of the high-risk drinkers who received the intervention reported drops in negative consequences, or alcohol-related problems, taking them out of the high-risk category at the end of the study. This compares to 33 percent of the high-risk drinkers who did not receive the intervention. In addition, just 4 percent of the intervention group were worse or considered newly at risk, compared to 11 percent of the controls after four years.
Students in the study were recruited from among freshman younger than 19 who had been accepted for admission to the University of Washington. More than 450 high-risk drinkers and other students initially participated. The high-risk drinkers were identified through questionnaires. Students were considered high-risk if they reported drinking at least once per month and had consumed five or six drinks on one occasion in the last month. This amount of drinking is often called binge drinking, and other studies have shown that about 40 percent of American college students engage in it.
Students were also classified high-risk if they had experienced three alcohol-related problems three to five times over the past three years. Alcohol-related problems included such behaviors as sleeping in class, getting into fights, blackouts, vandalism, doing poorly on an exam or having other people complain about their behavior.
All of the students filled out a variety of questionnaires at the start of the study that measured such things as their attitudes about alcohol and drinking, their personal alcohol use and a family history of alcohol use. Similar data was collected annually for the next four years. During their freshman year, half of the high-risk drinkers were given an individual intervention called BASICS, which was developed at the UW.
This program consists of a 45-minute interview for assessment and a follow-up interview three months later. Additional feedback was mailed the second year. The interviews were non-confrontational and motivational, providing the students with information about drinking and its consequences and offering them a chance to examine their own alcohol use and beliefs about drinking. The other high-risk drinkers and the students recruited from the general incoming freshman class were not given the intervention. A total of 363 students participated in the full four years of the study.
Baer said that although the number of alcohol-related negative consequences among high-risk drinkers remained higher than among the normal students, the developmental trend and the intervention program moderated that figure.
"While drinking among high-risk students is still higher than for the average college student, alcohol problems do not seem to commonly develop during college. It is not routine or normal for students to have alcohol problems in college," Baer said.
Alcohol problems worsen or develop for some students in college, but far more students show declines in alcohol-related problems and the prevention program seems to affect both patterns, he said.
"It does appear that the effects of the intervention last a long time, although we don't know why it persists. We think this type of intervention causes people to compare their current behavior with their own internal values and standards. It helps them examine what their choices are in their life in ways that the media and impersonal lectures do not."
Co-authors of the study are Daniel Kivlahan, UW associate professor of psychiatry and behavioral sciences and director of the National Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System; Alan Marlatt, UW psychology professor; Arthur Blume, a recent UW psychology doctoral graduate; and Patrick McKnight, University of Arizona research psychologist.