Addressing Risky Drinking by Male College Students Through Screening and Brief

Interventions

Arthur J. Lurigio, Ph.D.College of Arts and Sciences

Susan Cushman, MPH, CHES Wellness Center

Molly K. Pachan, M.A.Department of Psychology

Loyola University Chicago

Grant Overview

• U.S. Department of Education Grant Award Amount: $292,000 (2 years)

• Ranked 4th out of 128 submissions (NIAAA inspired)

• Original Project Team: Diane Asaro, MSN, RN; Susan Cushman, MPH; Alissa Eischens, MPH; Arthur J. Lurigio, Ph.D.

• Collaboration between Student and Academic Affairs

Philosophical/Practical Underpinnings • Powerful Endorsements: Vice President, Deans,

Director • University’s Message in the Making: Choice. Control.

Character.• Encouraging prudent decisions about drinking• Supports University’s Longstanding Goal: Reduce

harm from alcohol–academic, physical, social, emotional, or legal–for students who drink and those around them.

• Safety Net Committee

Three Major Components of Grant

• A program of proactive screening and brief interventions for male, first-year students (individual component) (BASICS based)

• Strategic engagement of faculty, staff, and parents in alcohol misuse prevention efforts (campus component)

• Assessment of local environmental factors that either support or discourage high-risk drinking among students (community component)

Alcohol-Related Harm among 18-24 Year-old College Students in US

Each year:• 1,700 deaths• 599,000 injuries • 696,000 assaults • 97,000 sexual assaults • Unsafe sex:

– 400,000 unprotected; 100,000 unable to consent • Other:

– Vandalism – Academic problems– Abuse and dependence

* National Institute on Alcohol Abuse and Alcoholism, 2007

Good News: Loyola Students & Alcohol

• 29% of undergrads typically don’t drink. • Most students (65%) have 0-4 drinks

on a night out. • Most students (89%) drink twice

a week or less. • Most students (59%) do not drink to the

point of impairment, i.e., eBAC <.08%.

2009 Loyola Core AOD Survey and Nat’l College Health Assessment

Not So Good News: Loyola Students & Alcohol

• About 7 in 10 students drink alcohol

• 40% to 50% drink heavily

• 41% of those who reported drinking were legally impaired (i.e., eBAC >.08%) the last time they partied

• 18% drink 3 or more nights/week

2009 Loyola Core AOD Survey and Nat’l College Health Assessment

Implications for Academics,Health & Safety

• 32% have had studying interrupted• 30% missed a class• 21% performed poorly on test• 38% had memory loss/black-out• 16% were hurt or injured• 38% engaged in public misconduct

2008 Core AOD Survey, n=1,346 LUC undergraduates

Drinking- or Drug-Related Problems for

First-Year LUC Students

• Blacked out (37%) • Regrets (32%)• Missed class (14%)• Performed poorly on test/project (12%)

Source: 2008 Core Alcohol & Other Drug Survey; n=372 LUC freshmen

Drinking- or Drug-Related Problems for

First-Year LUC Students

• Argument or fight (25%)

• Hurt or injured (18%)

• Unprotected sex (7%)

Source: 2008 Core Alcohol & Other Drug Survey; n=372 LUC freshmen

A Proactive, Stepped-Care Approach

2. Motivational Intervention (MI)

for ‘at-risk’ students

30-45 minutes1. Screening & Brief Advice

(SBA) 10-15 minutes

3. Referral for Counseling

Screening & Brief Advice in Residence Halls

1) Screening Using the AUDIT (5 min.)

2) Graduate Student Facilitators

3) Recruitment Strategies

4) Standard Messages (up to 10 min.)

5) If high-risk, invite student to participate in

motivational interviewing.

Motivational Interviewing • Student’s Reflections on Screening & Brief Advice

Session• Personalized feedback

– Frequency & quantity, peak BAC– Comparison to LUC first-year males– Misuse/Abuse/Dependence– Negative consequences

• Confidence and Importance Rulers• Readiness to Change • Referral (if indicated) • Next steps (What? How?)

Screening Results

Risk LevelAUDIT Scores n %

Low 0-5 124 43.0

Medium 6-15 153 52.2

High 16-19 8 2.7

Very High 20-40 6 2.1

High Risk versus Low Risk Students

Data at pretest: Low Risk High Risk

Average Blood Alcohol Concentration (BAC) for peak night

0.01% 0.11%

Hours spent drinking on heaviest night

1.03 3.97

Number of days drinking in typical week.

0.44 2.18

Number of drinks consumed in a typical week

1.42 14.99

Student Participation291 Screened

(39%)

LOW-RISKn= 124 (43%)

AT-RISKn= 167 (57%)

Decline or No-Show MIn= 98 (59%)

Completed MI

n= 69(41%)

Posttest did not match pretest ID

n= 38Pretest and Posttest

were matchedn= 31

…to those who completed the MI

Pretest and Posttest were matched, No MI

n= 38

Posttest did not match pretest ID

n= 60

Compare those who did not attend the MI…

Major Research Questions and Design

• Did at-risk, first-year, male participants change from pretest to posttest on study’s outcome measures?

• How did at-risk, first-year, male students who received brief advice only compare with those who received brief advice + MI?

Analytic Procedure A Repeated Measures MANOVA

• Tested main effects across time (pretest, posttest, and follow-up) for all first-year, at-risk, male students who attended the brief advice session alone and the brief advice and MI sessions.

• Tested interactions across time (pretest, posttest, and follow-up) by comparing those who did not attend the MI session (no MI, brief advice-only) with those who did attend the MI session (brief advice and MI).

Students’ Reactions to 45-minute MI Intervention

• 82% of students’ comments about the MI were positive.– “It was helpful to receive the BAC sheet and it was

nice to have a facilitator that understood and helped me.”

– “Very helpful, actually – I thought that some of the stats were good and did not feel attacked like I sometimes do with these things.”

– “It made me realize that I drink a lot and that it isn't good. I will stop drinking, well not stop, but much less.”

• Most students found the MI session to be informative, non-threatening, and well-run.

Favorable Responses to Facilitators and Content

• Facilitator-related comments:– Felt that the facilitator answered their questions (96%)

– Felt at ease (100%)

– Felt that the facilitator understood them (97%)

– Felt that the facilitator was telling them what to do (3%)

• Intervention-related comments:– Raised questions not previously considered (59%)

– Believe that others at LUC would benefit (93%)

– Thought the session was of no help (21%)

Overall Effects of Brief Advice and Motivational Interviewing

• Both brief advice-only and brief advice + MI groups changed on the outcome measures from pretest to posttest.

• No statistically significant differences were found on the between-group comparisons (MI vs. no MI.)

Specific Effects of the Interventions

VariableChange from pre

to post?Greater effect

with MI?

B.A.C. No

Nights /week drinking No

Nights /week binge drinking No

Hours drinking at peak B.A.C. No change No

Total drinks in typical week No

Importance of changing? No

Confidence to change? No change No

>5 drinks in one sitting in past 2 weeks No

Frequency of Binge Drinking

Number of Drinks Per Week

Effect of the MI intervention on Drinking: Pre/Post/Follow-Up

Results at follow- up demonstrated that some of the improvement shown at post-test was lost over time. However, MI group showed steeper declines at both post-test and follow-up.

Confidence to Change: Pre/Post/Follow-Up

Confidence to change at post-test shows a non-significant trend, which was reversed at follow-up.

Consequences of Drinking The study examined self-reported

consequences of drinking within the past 30 days.– Less Serious: missed a class, did something that

was later regretted, forgot where you were or what you did, felt bad about yourself.

– Serious Personal: performed poorly on a test, been hurt or injured, unplanned sex, unprotected sex.

– Public Misconduct: arguments, physical altercations

Research Questions: Consequences of Drinking

• Did negative consequences of drinking diminish over time for all at-risk participants?

• Did the MI intervention affect students’ self-reported, drinking-related consequences above and beyond the brief advice-only intervention?

Consequences of Drinking

Baseline%

Post, Medium RiskFollow up, Medium

Risk

MI No MI MI No MI

Reports ONE or more less serious consequence 74.6% 45.5% 52.6% 18.2% 57.9%

Reports ONE or more serious personal consequence 36.6% 21.2% 51.8% 18.9% 21.1%

Reports ONE or more public misconduct consequence 32.4% 9.1% 15.8% 18.9% 21.1%

In general, reported consequences of drinking decreased over time for both groups.

Less Serious ConsequencesMI attendees

Posttest

No MI Posttest No MI Follow up

MI attendees Follow up

Pretest

ONE ormore

None

Serious Personal ConsequencesMI attendees

Posttest

No MI Posttest No MI Follow up

MI attendees Follow up

Pretest

ONEormore

None

Public Misconduct Consequences

Pretest

None

ONE ormore

MI attendees Posttest

No MI Posttest No MI Follow up

MI attendees Follow up

Summary: Consequences of Drinking• All at-risk students reported reductions in

negative consequences over time. • At posttest, greater improvements were

found in the MI group, compared with the no-MI group, on the less serious, more serious personal, and public misconduct measures. The only difference at follow-up was on less serious consequences.

• No statistically significant differences or interactions were found but trends are notable.

Conclusion 1: Intervention Was Well-Received

LUC proactively and successfully screened freshman males for at-risk drinking behavior.– A sizable portion of at-risk drinkers (41%) completed a

Motivational Interviewing Session.– Students' evaluations of the MI intervention’s

facilitators and content were overwhelmingly positive.– Possibly built positive rapport with Wellness Center

staff. (We did not test this, but infer it from students’ favorable experiences in the MI session).

Conclusion 2: The Brief Advice Intervention/MI Overall Were Effective

• Freshman males who reported at-risk drinking behaviors and attended the brief advice/MI sessions reported significant reductions in drinking behaviors as well as the negative consequences of drinking.

• Most of these gains diminished at follow-up, but they still represented marked improvements over the pretest measures.

• “Therapeutic alliance" between one health educator and one student has unique and intangible potency.

Conclusion 3: Both Groups (MI/non-MI) Changed

– Brief advice was enough to change student behavior.

– The MI was not an effective or a value-added intervention.

– At-risk students who declined the MI did not need any additional intervention.

– Maturation could account for pre-post changes.

– History could account for pre-post changes. (Other LUC interventions were also being implemented.)

– The MANOVA had too few at-risk participants to demonstrate MI’s effectiveness (Low Power)

Limitations• Groups were self-selected, not randomly assigned.• No control group was used to assess the brief

advice-only, MI only, or brief advice/MI interventions.

• Recruitment of participants was limited by population size and time.

• Attrition was high. (Not permitted to contact participants to remind them of MI appointment.)

• Sample size was too small to detect significant results.

• Self-report measures are unreliable. (BAC)

Future Research

• Studies should employ random assignment, control groups, and longer follow-up periods.

• To Whom? How Long? How Often?• Booster sessions should be tested to determine if

they produce longer-term results.• Replications with larger sample sizes and a

greater variety of students should be undertaken.• Replications in other schools at LUC and in other

AJCU schools would be useful.