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Brief Interventions with College Student
Drinkers: BASICS
Jason R. Kilmer, Ph.D.
The Evergreen State College
Saint Martin’s University
What does research show about college student
drinking?Up to ninety percent of college
students drink alcohol Twenty-five to fifty percent are
“heavy episodic” or “binge” drinkers
Students who abuse alcohol are at high risk for a number of negative consequences
Specialized
Treatment
Primary
Prevention
Brief
Intervention
None
Mild
Moderate
SevereThresholds
for Action
Spectrum of Intervention Response
What is Harm Reduction?The ultimate goal of harm reduction is
abstinence – this is clearly the best way to reduce and eliminate negative consequences.
However, harm reduction approaches acknowledge that any steps toward reduced risk are steps in the right direction
How are these principles implemented in an intervention with college students? Legal issues are acknowledged – if you are under
the age of 21, it is illegal to drink. For those who want to abstain, appropriate skills
and strategies are reviewed. However, if one makes the choice to drink, skills
are described on ways to do so in a less dangerous and less risky way.
A clinician or program provider must elicit personally relevant reasons for changing.
This is done using the Stages of Change model and Motivational Interviewing.
The Stages of Change Model (Prochaska & DiClemente, 1982, 1984, 1985, 1986)
PrecontemplationContemplationPreparation/Determination
ActionMaintenance
PrecontemplationStage
Relapse Stage
ContemplationStage
ActionStage
Maintenanceof
RecoveryStage
MOTIVATIONALENHANCEMENT
STRATEGIES
ASSESSMENTAND TREATMENT
MATCHING
RELAPSEPREVENTION
& MANAGEMENT
Stages of Change in Substance Abuse and Dependence: Intervention Strategies
Motivational Interviewing Basic Principles
(Miller and Rollnick, 1991, 2002)
1. Express Empathy
2. Develop Discrepancy
3. Roll with Resistance
4. Support Self-Efficacy
A non-confrontational, harm reduction approach that helps students reduce their alcohol consumption and decrease the behavioral and health risks associated with heavy drinking.
Brief Alcohol Screening and Intervention for College
Students (BASICS)
BASICS is individually focused and involves the delivery of personalized feedbackAlcohol content and the skills-
training information is introduced throughout the intervention when relevant, applicable, or of interest to the participant
Brief Alcohol Screening and Intervention for College
Students (BASICS)
The Basics on BASICS Brief Alcohol Screening and Intervention For
College Students
•Assessment
•Self-Monitoring
•Feedback Sheet
•Review of Information and Skills Training Content
(Dimeff, Baer, Kivlahan, & Marlatt, 1999)
What to assess? Some areas used for feedback include...
Drinking Patterns Quantity/Frequency Daily Drinking
Questionnaire BAL Estimates
Drinking Problems RAPI YAAPST
Drinking Norms
Alcohol Outcome Expectancies
Stages of Change
BASICS 4-year Drinking Outcomes by Treatment Condition
4 Years 3 Years 2 Years 1 Year Baseline
Drin
king
Pat
tern
Z-s
core
1.0
.8
.6
.4
.2
0.0
-.2
Random Comparison
High -Risk Treatment
High -Risk Control
Examines students’ perceptions about:Acceptability of excessive behaviorPerceptions about the rates of their
peersPerception about the prevalence of
their peers
Norm Misperception
EXPECT
Alcohol No AlcoholG
ET
No A
lcoh
ol
Alc
oh
ol
• What Is A Standard Drink?• Absorption and Oxidation• Blood Alcohol Level and Effects• Factors Affecting Blood Alcohol Level• Tolerance• Biphasic Effect • Drug Interactions
Information Reviewed During Feedback
What Is A Standard Drink? 12 oz. beer 10 oz. microbrew 10 oz. wine cooler 8 oz. malt liquor 8 oz. Canadian beer 8 oz. ice beer 6 oz. ice malt liquor 4 oz. wine 2 1/2 oz. fortified wine 1 1/4 oz. 80 proof hard alcohol 1 oz. 100 proof hard alcohol
Absorption and Oxidation of Alcohol
Factors affecting absorptionFood in stomachWhat one is drinkingRate of consumptionEffervescence
Factors affecting oxidationTime!People burn off a very
predictable .016% from their BAC per hour
Blood Alcohol Level
.02% Relaxed.04% Relaxation continues,
Buzz develops.06% Cognitive judgment is
impaired
.08% Nausea can appear, Motor coordination is impaired
Blood Alcohol Level (continued)
.10% Clear deterioration in cognitive judgment and motor
coordination.15%-.25% Black outs.25%-.35% Pass out
Lose consciousness Risk of Death
.40%-.45% Lethal dose
Factors Affecting Blood Alcohol Level
TimeB.A.L. is reduced by .016% every
hour
WeightSex differences
Very pronounced differences between men and women
Example
Example of B.A.L. differences between men and women
160 pound man120 pound woman
Both have 5 drinks over 3 hours
What blood alcohol level will they obtain?
Tolerance
Siegel, S. & Ramos, B.M.C. (2002) Applying laboratory research: Drug anticipation and the treatment of drug addiction. Experimental and Clinical Psychopharmacology, 10, 162-183.
When people start to lose their buzz, what do they usually do?
Do they ever get their buzz back?For people with tolerance, is the
buzz you get now as good as the buzz you used to get when you first started drinking?
Questions…
Time
FeelingScale
+
__
0
Dysphoria - Down
Euphoria - Up Point of Diminishing
Returns
Cultural Myth About
Alcohol
After Tolerance Develops
Alcohol’s Biphasic Effect
How Explanation of Alcohol’s Biphasic Effect is Used
Point of Diminishing ReturnsHighlights point at which positives
are maximized and negatives are minimized
Demonstrate Why Tolerance Results in Increase In Negative Health Risks
Help Put Student Experiences In a Context
Drug Interactions
Potentiation
Antagonistic
Areas In Which College Students May Experience
ConsequencesAcademic FailureBlackoutsHangoversWeight GainToleranceDecisions Impaired sleep
FinancesFamily HistoryAlcohol-Related AccidentsTime Spent IntoxicatedRelationshipsLegal ProblemsWork-Related Problems
Areas In Which College Students May Experience Consequences (continued)
Specific Tips for Reducing the Risk of Alcohol Use
Set limitsKeep track of how much you drinkSpace your drinksAlternate alcoholic drinks w/non-alcoholic
drinksDrink for quality, not quantityAvoid drinking gamesIf you choose to drink, drink slowlyDon’t leave your drink unattendedDon’t accept a drink when you don’t know
what’s in it
Motivational Interviewing: A DefinitionMotivational Interviewing is a
Person-centeredDirectiveMethod of communicationFor enhancing intrinsic motivation to change by exploring and resolving ambivalence
What is resistance?Resistance is a function of
interpersonal communicationContinued resistance is predictive of
(non) changeResistance is highly responsive to
counselor styleGetting resistance? Change
strategies.
Direct persuasion is not an effective method for resolving ambivalence.
The counseling style is generally a quiet and eliciting one.
The counselor is directive in helping the client to examine and resolve ambivalence.
Readiness to change is not a client trait, but a fluctuating product of interpersonal interaction.
The therapeutic relationship is more like a partnership than expert/recipient roles.
The Spirit of Motivational Interviewing
Four Principles of Motivational InterviewingExpress Empathy
Research indicating importance of empathy
Develop Discrepancy Client’s values and goals for future as
potent contrast to status quo Client must present arguments for
change: provider declines expert role
Four Principles of Motivational Interviewing
Roll with Resistance Avoid argumentation Confrontation increases client resistance to
change Labeling is unnecessary Provider’s role is to reduce resistance,
since this is correlated with poorer client outcomes
If resistance increases, providers shift to different strategies
Client objections or minimization do not demand a therapist response
Four Principles of Motivational Interviewing
Support Self-Efficacy Clients are responsible for choosing
and implementing change Confidence and optimism are
predictors of good outcome in both therapists and clients
OARS: Building Blocks for a FoundationAsk Open-Ended Questions
Cannot be answered with yes or noProvider does not know where
answer will leadAffirm
Takes skill to find positivesShould be offered only when sincere
Examples of Key Questions
What do you make of this?Where do you want to go with this
now?What thoughts do you have about
what you might want to do about this?
What ideas do you have about things that might work for you?
Listen ReflectivelyEffortful process: Involves
Hypothesis TestingCan be used strategically (amplify
meaning or evaluation or contrast)Summarize
Periodically through sessionsDemonstrates to client you are
listeningProvides opportunity for shifting
OARS: Building Blocks for a Foundation
Building Blocks for a FoundationStrategic goal:Elicit Self-Motivational
StatementsSelf motivational statements
indicate client concern or recognition of need for change
Arrange the conversation so that client makes arguments for change
Reflective Listening: A Primary Skill“Hypothesis testing” approach to
listeningStatements, not questionsVoice goes downCan amplify meaning or feelingCan be used strategicallyTakes hard work and practice
Hypothesis Testing Model
2. What speaker 3. What listener says hears
1. What speaker 4. What listener means thinks speaker
means
Reflection
My partner won’t stop giving me crap about my drinking.
Your partner is concerned about your drinking. -- or --And that annoys you. -- or --It feels like your partner is always on your
case.
Motivational Interviewing Strategies
Amplified Reflection
I don’t see any reasons to change my drinking...I mean, I just like drinking alcohol.
Sounds like there no bad things about drinking for you.
Motivational Interviewing Strategies
Double-Sided Reflection
Student: I’ve been drinking with my friends in the dorm. My parents are pissed about it. They’re always saying that it makes my depression worse.
Clinician: Sounds like you get a hard time from your parents about how drinking affects your depression.
Student: Yeah… I mean, I know that it affects my mood a little, but I don’t drink that much and when I do, I really enjoy it, you know?
Motivational Interviewing Strategies
Double-Sided Reflection
Clinician: What do you enjoy about drinking?
Student: I like the fact that it helps me chill out with my friends.
Clinician: Let me see if I am getting you right.. Sounds like on the one hand you enjoy drinking because you feel that it helps you chill out with your friends, and on the other hand it you’ve noticed that it has some effect on your mood.
Motivational Interviewing Strategies
Resistance Strategies
Why is it important to pay attention to resistance? Research relevant to resistance and client
outcomes Motivational interviewing focuses on
reducing resistance
Types of ResistanceArgument
Challenging Discounting Hostility
Interruption Talking over Cutting off
Ignoring Inattention Non-response Non-answer Side-tracking
Denial Blaming Disagreeing Excusing Reluctance Claiming Impunity Minimizing Pessimism Unwillingness to change
Signs of Readiness for Change
Decreased resistance. The client stops arguing, interrupting, denying, or objecting.
Decreased questions about the problem. The client seems to have enough information about his or her problem, and stops asking questions. There is a sense of being finished.
Increased questions about change. The client asks what he or she could do about the problem, how people change if they decide to, etc.
Signs of Readiness for Change
Resolve. The client appears to have reached a resolution, and may seem more peaceful, relaxed, calm, unburdened, or settled.
Self-motivational statements. The client makes direct self-motivational statements.
Envisioning. The client begins to talk about how life might be after a change.
Experimenting. If the client has had time between sessions, he or she may have begun experimenting with possible change approaches (e.g., going to an A.A. meeting, going without drinking for a few days, reading a self-help book).
Research on brief individualized feedback interventions using peers
and professionalsWith Greek System students,
Larimer, et al. (2001) found: Fraternity men in intervention condition
decreased drinks per week & peak BAC No change for sorority women Peers were at least as effective at
promoting change in drinking behavior as professionals
O’Leary, et al. (2002) found peer providers were not as effective for women as were professional providers
The Alcohol Research Collaborative (ARC)
In ARC, for first-year students with at least one heavy drinking episode, compare several approaches, including three brief interventions Peer-delivered BASICS intervention Peer-delivered Alcohol Skills Training
Program (ASTP) Web-BASICS
ARC assignment to conditionAfter screening and baseline, 637
students were randomized to a condition of the study
399 participants were randomized to BASICS, ASTP, Web-BASICS or Control
86% completed 3-month follow-up, and 83% completed 6-month follow-up
Participant completion rates by condition:Web-BASICS 83.7%BASICS 74.7%ASTP 67.0%
Satisfaction Ratings
Overall high satisfaction, with ASTP (M=5.35) & BASICS (M=4.99) higher than web-BASICS (M=4.58)
More learned about alcohol in ASTP (M=5.68) and BASICS (M=5.49) than Web-BASICS (M=4.87)
Web-BASICS more convenient to participate in (M=5.79) than ASTP (M=4.78) (no difference between groups with convenience of BASICS (M=5.24))
Post-Intervention Impressions of Peers: Percentage rating
mildly/moderately/strongly agree
Participants agreed presenters seemed… Warm and understanding (90.9% of ASTP;
97.3% of BASICS)
Competent and well-trained (97.0% of ASTP; 98.6% of BASICS)
Knowledgeable about alcohol use (93.9% of ASTP; 91.8% of BASICS)
Well organized (87.9% of ASTP; 93.2% of BASICS)
Limitations prior to data analysis
Randomization issues (students assigned to BASICS had fewer drinks per week and lower RAPI scores than in other conditions)
Outcome variables were skewed, so data were log transformed for analytic purposes
p < .01
Total Drinks per Week
4
5
6
7
8
9
10
11
12
Baseline 3 Month 6 Month
Control BASICS web BASICS ASTP
No time by group interactions for total drinks or negative consequences
Specific planned comparisons indicated that BASICS reduced total drinks per week more than control did
p < .01
Peak Drinks per Occasion
4
5
6
7
8
9
10
Baseline 3 Month 6 Month
Control BASICS web BASICS ASTP
Time by group interaction for peak drinks
Significant reductions for ASTP from baseline to 3-mo. and 3-mo. to 6-mo.
Significant reductions for BASICS and web-BASICS from baseline to 3-mo.
Conclusions
Baseline differences make it hard to interpret results
Implementing a peer-led intervention is feasible
Support for all three interventions reducing peak drinks/occasion; only BASICS significantly reduced total drinks per week
Some delayed effects in ASTP Initial reactivity in assessment for controls
on peak drinks that failed to be maintained over time
Peer Therapist Training for ARC
Reading packet for facilitatorsInitial 8 hours of training on alcohol
content & clinical technique Practice facilitating with a mock
participant volunteerWeekly group supervisionPossibility of individual meetings for
more practice and supervision
Peer Therapist Training (continued)
MITI Coding Team reviews for adherence and compliance assessment
Detailed review/feedback written after tape is reviewed by supervisors
Peer therapist facilitates only once MITI Coding Adherence is reached
While interventions occur, facilitators attend weekly group supervision
Facilitators may need to attend an hour individual or pair supervision with an RA during weeks when an session is completed
Implementing BASICS
Determining Assessment/MeasuresGenerating Graphic
Feedback/Personalized BAC cardsTraining of providersSupervision/Consultation if needed
Therapist drift (issues of fidelity) Need for ongoing assessment and, if
needed, training
Thank You!
Special thanks to Ann Quinn-Zobeck
All the best in your prevention efforts!
Jason [email protected](360) 867-6775
