Program

Feb 09, 2009

OVERVIEW

Brief Alcohol Screening and Intervention of College Students (BASICS) is a preventive intervention program to reduce drinking and enhance awareness about alcohol-related issues. BASICS targets college students who are considered at risk because of heavy drinking behaviors. The brief intervention relies primarily on a motivational interview to provide students with the skills, knowledge, and insight into the consequences of drinking. Studies have evaluated various applications of BASICS and found promising results. One such evaluation found that the BASICS intervention had an impact on various drinking behaviors, such as drinking quantity and perception of drinking consequences, as much as four years after program completion. Follow-up assessments over a two-year period showed significant reductions in both drinking rates and harmful consequences for students who received the intervention. Program impacts did not vary by gender, parental history of alcoholism, conduct disorder history, or student residence type.

DESCRIPTION OF PROGRAM

Target population: high-risk college student drinkers

Based on previous brief interventions’ research conducted with college students, researchers implemented an alcohol intervention, targeting students at the beginning of their freshman year of college, a time in which risk is high and receptivity to prevention messages are greater. The intervention was anchored in the researchers’ knowledge of motivational interviewing principles, which focuses on sharing available evidence, rather than expression of moralistic judgments and arguments. In keeping with the principles of motivational interviewing, 2 doctoral-level clinical psychologists, 2 postdoctoral-level clinical psychologists and 4 advanced graduate students in clinical psychology, trained on using a written manual, role playing and piloting were assigned to conduct interviews.

The duration of the intervention was approximately 3 months, with 2 follow-up assessments at 6- and 12-months. In the winter term of the 1st year, students were provided with alcohol consumption monitoring cards and asked to keep track of their drinking on a daily basis for 2 weeks prior to their scheduled feedback interview. After 2 weeks, the interviewer reviewed students’ alcohol self-monitoring cards and met individually to discuss risk factors (e.g. family history of alcohol problems or conduct disorder). Suggestions for risk reduction were outlined, and the interviewers provided students with concrete individualized feedback about their drinking patterns, risks, and beliefs about alcohol.

During the winter term of the 2nd year of the study (1 year after the individual feedback interviews) members of the motivational intervention group were mailed graphic personalized feedback pertaining to their reports of drinking at baseline and 6- and 12-month follow-ups. Each feedback sheet contained baseline and subsequent levels of drinking quantity, drinking frequency, and alcohol-related problems. Each intervention participant was provided with individualized feedback about his or her level of risk and encouraged to seek assistance, if so desired. Participants in the high and extreme risk categories were also contacted by phone to offer assistance and encouragement to reduce their risks associated with alcohol use.

EVALUATION(S) OF PROGRAM

Marlatt, G. A., Baer, J. S., Dimeff, L. A., Larimer, M. E., Quigley, L. A., Somers, J. M., & Williams, E. (1998). Screening and brief intervention for high-risk college student drinkers: Results from a 2-year follow-up assessment. Journal of Consulting and Clinical Psychology,66 , 604-615.

Evaluated population: A total of 348 high-risk students (188 female students and 160 male students) participated in the intervention. High risk was defined as (a) drinking at least monthly and consuming at least 5-6 drinks on one drinking occasion in the past month or (b) reporting the experience of three alcohol-related problems on 3 to 5 occasions in the past 3 years on the Rutgers Alcohol Problem Inventory (RAPI). The sample reported on at two childhood conduct incidents on average, with 72% reporting between 0 and 3. Over half of the sample had a first degree relative with drinking problems.

Approach: “High-risk” high school seniors (l9 years or less) who had been accepted and indicated enrollment into the University of Washington were mailed personal invitations to solicit participation in the intervention. To ensure receipt of the letter, phone calls were placed to students. Following receipt confirmation, questionnaires were administered and interviews were conducted for consenting students, in exchange for a monetary incentive. Consenting students identified as high-risk were also randomly assigned to participate in the intervention. Students were randomly assigned by computer-generated random numbers to the intervention condition or to the assessment only control condition.

On the basis of reported peak drinking experiences and alcohol-related related problems, participants were categorized into four risk categories: low (neither elevated), medium (one elevated), high (both elevated) and extreme (both elevated and RAPI problems greater than 10). Alcohol use (quantity, frequency, and peak) was measured using self-report data on daily drinking and alcohol dependence was assessed using diagnostic interviews and self-reports on a social and health functioning scale and an alcohol dependence measure.

Results: High-risk students who received the brief intervention in their freshman year showed significant reductions in both drinking rates and harmful consequences in comparison with students in a no-treatment control condition. Although on average, all high-risk students drank less and reported fewer alcohol-related problems over the 2-year follow-up period, participants who received the brief intervention showed a significantly greater deceleration of drinking rates and problems over time in comparison with participants in the control group. Significant reductions were found for both harmful consequences on the drinking problem inventory (on the RAPI) and for alcohol dependence for high-risk students who the intervention in comparison with those in the no-treatment control condition. Although main effects on drinking and problems were found for gender and for history of conduct disorder, no significant interactions with treatment condition were found, suggesting that the brief intervention was effective independent of individual risk factors.

Baer, J.S., Kivlahan, D.R., Blume, A.W., McKnight, P., & Marlatt, A. (2001). Brief intervention for heavy-drinking college students: 4 Year follow-up and natural history. American Journal of Public Health, 91(8), 1310-1316.

Evaluated population: Students under 19 years of age planning to matriculate at the University of Washington in the fall of 1990. Among students designated as high risk drinkers (n=348), 55 percent were female and 84 were percent white. In a normative sample (n=113), 54 percent were female and 78 percent were white.

Approach: Students were mailed a questionnaire in the spring of 1990 that assessed the quantity and frequency of alcohol consumption, in addition to alcohol-related consequences. Of the two thousand and forty-one students who completed the questionnaires, 508 were identified as high risk drinkers. These students reported drinking at least once per month and consuming five to six drinks on a single occasion or experienced at least three negative consequences because of drinking behaviors. Among those identified as high risk drinkers, n=348 agreed to participate in the evaluation and were randomly assigned to either the BASICS intervention or no-treatment control group. A normative sample was also selected for purposes of comparison. Of the 151 students selected, n=113 agreed to participate.

Students were asked to complete questionnaires that assessed the following measures: quantity and frequency of drinking; negative drinking consequences; family history; conduct problems; perceived drinking norms; sexual behavior; problem drinking and stress. Only the first three measures are included in this evaluation. Students completed their interview and the first questionnaire at baseline. Follow-up questionnaires were mailed to students six months after baseline data were collected and annually for four years. Students were also asked to provide two collateral contacts who could be contacted after each assessment to confirm participants’ self-reported drinking behaviors.

During students’ sophomore year, participants were also mailed personalized feedback. This included a comparison of students’ drinking behavior to college peers and a brief history of drinking patterns from baseline through sophomore year. During this time, participants identified at highest risk (n=56) were telephoned to express concern. These students were offered an additional interview session, of which twenty-six agreed.

Students missing data at the four-year follow-up were eliminated from analyses. Of the original sample, n=363 students had data at four years and n=328 had data at all time points. No significant differences were found between prevention and control groups at baseline. Furthermore, attrition did not affect the groups differently over the course of the study nor was there any indication of attrition bias on demographic and drinking measures.

Results: Main effects over the entire four-year evaluation period revealed that BASICS significantly decreased drinking problems among college student participants. The greatest change was seen on mean scores of negative drinking consequences, followed by drinking quantity and drinking frequency (p<.001). Group comparisons from baseline to the four-year follow-up revealed that the experimental group reported significantly greater reductions in drinking quantity (p<.001) and negative drinking consequences (p<.05) when compared with the control group.

Comparing group differences at individual time points revealed significant group differences on negative drinking consequences at all time points (p<.05). At the one-year follow-up, analyses also revealed that the experimental group differed significantly from the control group on measures of drinking frequency (p=.03) and quantity (p=.0002). At all other time points, however, differences between groups were nonsignificant indicating that BASICS had its primary effect during the first year.

Analyses among the normative comparison sample revealed that drinking frequency increased significantly from baseline to the three and four year follow-ups (p<.05). Drinking quantity also increased significantly from baseline to the two year follow-up (p<.05).

To assess the impact of the intervention among individuals, evaluators used responses to the Alcohol Dependency Scale and established a “high risk” drinking cutpoint. Participants were categorized according to their responses at baseline and the four-year follow-up. Students who scored above the high risk cutpoint at baseline but moved to below the cutpoint at four years were classified as “resolved”. Students who decreased scores but did not move below the cutpoint were classified as “reliably improved”. Similarly, students who increased their scores but did not surpass the high risk cutpoint were classified as “reliably worse”. Finally, students whose scores increased from below to above the cutpoint were classified as “new cases”.

Results indicate that, among the original high risk sample, 32.8 percent of control students and 42.6 percent of experimental students were classified as resolved. While 18.5 percent of control students were classified as reliably worse or new cases, only 10 percent of students in the experimental condition were classified similarly. Overall, 67 percent of experimental students and 55 percent of controls had good outcomes over the four years (i.e., classified as resolved, reliably improved, or no change).

Limitations to the study include the homogenous sample (participants all attended the same university) and the fact that drinking behaviors are based on self-report and therefore subject to social desirability bias. The use of collateral contacts, however, has been found to help ensure reliability of self-report measures.

Murphy, J.G., Duchnick, J.J., Vuchinich, R.E., Davison, J.W., Karg, R.S., Olson, A.M., Smith, A.F., & Coffey, T.T. (2001). Relative efficacy of a brief motivational intervention for college student drinkers. Psychology of Addictive Behaviors, 15(4), 373-379.

Evaluated population:Undergraduate students at Auburn University (n=84). Participants were 54 percent female and 94 percent Caucasian. Approximately 83 percent of the sample was college freshmen or sophomores.

Approach: This evaluation assessed the impact of the BASICS intervention relative to an educational intervention and a no-treatment control group. The BASICS intervention consisted of a single 50-minute session with a graduate clinician, as described above. The educational intervention also took place during a 50-minute session. During the educational intervention, students watched a 30-minute video called “Eddie Talks”. The video portrayed a male college student discussing the negative consequences of his alcohol abuse. The video had been previously used with students who violate college alcohol polices. Following the video clip, students meet individually with graduate clinicians for twenty minutes to discuss the video and more general risks associated with alcohol consumption.

All undergraduate students at Auburn University were invited to participate in the evaluation in exchange for course credit. Two hundred and ninety-nine students completed the pre-treatment assessment. Heavy drinkers who comprised the top 33 percent of the sample (n=99) were identified and randomly assigned to one of the three conditions. In total, 84 students actually participated in the evaluation (n=30 BASICS; n=29 education intervention; n=25 control).

Following the pre-treatment assessment and intervention, follow-up assessments were conducted at three and nine months. Self-report measures included average total drinks per week, number of drinking days per week, and number of binge drinking days per week over the previous two months. Students also reported on alcohol-related problems (e.g., driving drunk) and alcohol dependence.

Results: No significant differences were found between the three conditions on demographic or drinking measures at baseline. Ninety-four percent of the sample completed at least one follow-up, and evaluators reported that attrition did not differentially affect the groups.

At the three-month follow-up, the study found a significant group effect on all four drinking measures (alcohol dependence was not assessed at three months). Among participants who consumed at least 25 drinks per week, BASICS participants reported a significantly greater reduction in drinks per week than those in the education intervention (p<.05). Also, among participants who consumed at least 26 drinks per week, BASICS students reported significantly greater reductions in drinks per week than heavy drinkers in the control group (p<.05). Among students reporting three binge drinking nights per week, BASICS participants also had significantly greater reductions in binge drinking days than control students (p<.05). BASICS participants reporting four days of binge drinking per week also experienced significantly greater reductions in binge drinking days than their education group counterparts (p<.05). No significant group differences were found on measures of drinking frequency or alcohol-related problems at three months.

BASICS was also shown to have a considerable impact on the heaviest drinking participants (top 50% of the sample). Among this subsample, BASICS participants achieved a larger reduction in average drinks per week when compared to heavy drinkers in the education and control groups. Effect sizes were .99, .19, and .24, respectively.

At the nine-month follow-up, however, many of the short-term effects disappeared. No significant group impact was found on the drinking outcomes at this timepoint. In general, BASICS participants showed small to moderate advantages over control and education participants on total drinks per week, drinking days per week, and binge drinking days per week. BASICS participants also showed slight advantages over control students on measures of alcohol-related problems, and alcohol dependence. Overall at nine months, BASICS students maintained the effects experienced at three months, while control and education students improved their outcomes. The gains made by heavier drinking BASICS participants were also maintained at nine months.

Finally, students were asked to evaluate the “perceived impact” of the intervention on personal drinking habits. At three months, 52 percent of BASICS participants felt the intervention had a significant impact on their drinking, compared with 20 percent of students in the educational intervention. When all participants were asked to report if they felt their drinking had decreased by three months, 69 percent of BASICS participants agreed in comparison to 24 percent of education students and 17 percent of controls (p=.002). At nine months, BASICS participants were still significantly more likely to report their drinking had decreased (63%) when compared with education participants (29%) and controls (40%) (p=.031).

Limitations of this evaluation include the relatively small sample sizes and the use of self-report drinking measures. As mentioned in the previous study, self-report measures are subject to social desirability bias and may therefore be underreported.

SOURCES FOR MORE INFORMATION

Link to program curriculum: http://www.amazon.com/Alcohol-Screening-Intervention-College-Students/dp/1572303921

References

Baer, J.S., Kivlahan, D.R., Blume, A.W., McKnight, P., & Marlatt, A. (2001). Brief intervention for heavy-drinking college students: 4 Year follow-up and natural history. American Journal of Public Health, 91(8), 1310-1316.

Marlatt, G. A., Baer, J. S., Dimeff, L. A., Larimer, M. E., Quigley, L. A., Somers, J. M., and Williams, E. (1998). Screening and brief intervention for high-risk college student drinkers: Results from a 2-year follow-up assessment. Journal of Consulting and Clinical Psychology, 66, 604-615.

Murphy, J.G., Duchnick, J.J., Vuchinich, R.E., Davison, J.W., Karg, R.S., Olson, A.M., Smith, A.F., & Coffey, T.T. (2001). Relative efficacy of a brief motivational intervention for college student drinkers. Psychology of Addictive Behaviors, 15(4), 373-379.

KEYWORDS: Adolescents, Alcohol Use, Behavioral Problems, Clinic-based, Conduct/Disruptive Disorders, Provider-based, School-based, co-ed, manual, Skills Training, any substance use, White/Caucasian, Young Adults, Youth

Program information last updated 2/9/2009.

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