Putting the Pieces of the Prevention Puzzle Together ... consideration of change among intercollegiate

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    Jason R. Kilmer, Ph.D. University of Washington Assistant Professor Psychiatry & Behavioral Sciences Assistant Director of Health & Wellness for Alcohol & Other Drug Education Division of Student Life

    Putting the Pieces of the Prevention Puzzle Together: Making a Difference on your Campus

    Overview of this presentation…

    • Big thanks to Holly Deering and Susie Bruce

    • Prevention approaches and what the science says about them

    • Examples of potential “hooks” in prevention

    • Impacting change on campus

    Specialized

    Treatment

    Primary

    Prevention

    Brief

    Intervention

    None

    Mild

    Moderate

    Severe Thresholds for

    Action

    Spectrum of Intervention Response

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    Traditional Messages

    Harm Reduction

    What is Harm Reduction?

    • The most harm-free or risk-free outcome after a harm reduction intervention is abstinence.

    • However, harm reduction approaches acknowledge that any steps toward reduced risk are steps in the right direction

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    How are these principles implemented in an intervention with college students?

    • Legal issues are acknowledged. • Skills and strategies for abstinence are offered. • However, if one makes the choice to drink, discuss ways

    to do so in a less dangerous and less risky way. • A peer educator, presenter, or program provider must

    elicit personally relevant reasons for changing.  This is done using the Stages of Change model and

    Motivational Interviewing.

    Trans-Theoretical Model (The Stages of Change) (Prochaska & DiClemente, 1982, 1984, 1985, 1986)

    •Precontemplation

    •Contemplation

    •Preparation/Determination

    •Action

    •Maintenance

    •Relapse

    Essentials of a Motivational Enhancement Approach

    • Non-judgmental and non-confrontational (“the spirit” of MI)

    • Emphasizes meeting people where they are in terms of their level of readiness to change

    • Utilize MI strategies to elicit personally relevant reasons to change

    • Often can find the “hook” that prompts contemplation of or commitment to change

    • When person is ambivalent, considers ways to explore and resolve ambivalence

    Miller and Rollnick (1991, 2002, 2012)

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    What is resistance?

    • Resistance is verbal behaviors

    • It is expected and normal

    • It is a function of interpersonal communication

    • Continued resistance is predictive of (non) change

    • Resistance is highly responsive to our style

    OARS: Building Blocks for a Foundation

    • Ask Open-Ended Questions ▫ Cannot be answered with yes or no

    ▫ We, as the ones asking the question, do not know where answer will lead  “What do you make of this?”

     “Where do you want to go with this now?”

     “What ideas do you have about things that might work for you?”

     “How are you feeling about everything?”

     “How’s the school year going for you?”

     “Tell me more about that.”

     This is different than the closed-ended “Can you tell me more about that?” or “Could you tell me more about that?”

    Goals of a Brief Intervention

    Prompt consideration of change

    Prompt commitment to change

    Reduce resistance/defensiveness

    Plant seeds

    Explore behavior change strategies

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    Considering Responses: What Works?

    The field has, most definitely, identified efficacious strategies that result in significant reductions in alcohol use and related consequences.

    Tier 1: Evidence of Effectiveness Among College Students

    • Combining cognitive-behavioral skills with norms clarification and motivational enhancement interventions.

    • Offering brief motivational enhancement interventions.

    • Challenging alcohol expectancies.

    From: “A Call to Action: Changing the Culture of Drinking at U.S. Colleges,” NIAAA Task Force

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    • People are influenced by their subjective interpretation of a situations rather than by the actual situation (Lewin, 1943).

    • We are influenced by our perception of others’ attitudes, behaviors, and expectations rather than by their actual attitudes, behaviors, or expectations.

    • Our perceptions and interpretations are often inaccurate.

    Social norms: Perception versus reality

    Source: Neighbors & Kilmer (2008)

    • Examines people’s perceptions about: ▫ Acceptability of excessive behavior

    ▫ Perceptions about the prevalence of drinking among peers

    ▫ Perception about the rates of drinking by peers

    Norms Clarification

    Specific Tips for Reducing the Risk of Alcohol Use

    • Set limits • Eat prior to or while drinking • Keep track of how much you drink • Space your drinks ▫ Alternate alcoholic drinks w/non-alcoholic drinks

    • Avoid trying to “out drink” or keep up with others • Avoid or alter approach to drinking games • If you choose to drink, drink slowly • Use a designated driver • Don’t accept a drink when you don’t know what’s in it • Have a friend let you know when you’ve had enough

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    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

    • 4.5 oz. fruit-flavored, high-ethyl alcohol content malt beverages (formerly alcoholic energy drinks)*

    • 4 oz. wine

    • 2.5 oz. fortified wine

    • 1.25 oz. 80 proof hard alcohol

    • 1 oz. 100 proof hard alcohol

    •When people start to lose their buzz, what do they usually do?

    •Do they ever get that same buzz back?

    Questions…

    Baseline (normal activity)

    Stimulant or “buzz”

    feeling

    Depressant effects

    .05%-.06%

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