Screening and Brief Interventions for Alcohol on Campus

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Screening and Brief Interventions for Alcohol on
Campus

• ROCKY MOUNTAIN COLLEGE HEALTH ASSOCIATION
• SEPTEMBER 29, 2007
• Jenny Haubenreiser
• Director, MSU Health Promotion
• Dave Palaia
• MSU BASICS Coordinator

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Program objectives

• Need for substance abuse prevention
• Evidence-based prevention strategies
• Screening and brief interventions/BASICS
• Techniques and implementation

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Alcohol is the number one public health issue
facing college campuses

• National Institute on Alcohol Abuse Alcoholism
  (NIAAA)
• 1700 college students die each year from
  alcohol-related injuries
• 2.8 million student drive under the influence of
  alcohol each year
• More than 696,000 students (18-24) are assaulted
  each year by another student who has been
  drinking
• More than 97,000 students (18-24) are victims of
  alcohol-related sexual assault or date rape
• 400,000 students (18-24) had unprotected sex and
  more than 100,000 students report having been too
  intoxicated to know if they consented to having
  sex
• 25 of college students report academic
  consequences due to drinking (missed classes,
  falling behind, lower grades, etc.)
• Core Institute (Southern Illinois Univ.) Heavy
  Frequent drinkers (20 drinks/week)
• 66 of these students reported drinking
  driving, compared to 33 of all drinkers
• these students are 2X more likely to have
  suicidal thoughts 3X more likely to be involved
  in a sexual assault (either victim or aggressor).

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Negative consequences of substance abuse

• Academic failure
• Impaired driving
• Student conduct violations
• Blackouts
• Hangovers
• Tolerance
• Unsafe decisions around sex
• Impaired sleep
• Finances

• Weight gain
• Sexual assault
• Violence and assault
• Relationship problems
• MIP other legal problems
• Work-related problems
• Disruption of other students environment
  (second-hand effects)

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Effective prevention significant research

• National Institute on Alcohol Abuse and
  Alcoholism (NIAAA, 2002) A Call to Action
  Changing the Culture of Drinking at U. S.
  Colleges
• Task force recommends intervention on 3 levels
• With at-risk individual students
• With entire student body
• In the broader college and community environment
• Four tiers of effectiveness
• Known effective for college students combining
  cognitive-behavioral skills, brief motivational
  enhancement, challenging expectancies
• Effective with the general population
  environmental strategies
• No evidence of effectiveness education when used
  alone

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Effective Prevention comprehensive plan

• Environmental strategies
• Campus, community state laws and policies
• Alcohol-free social, rec. housing options
• Elimination of marketing that promotes alcohol
• Limiting access and low cost sources of alcohol
• Promoting healthy norms protective behaviors
• Individual strategies
• Education and awareness
• Early intervention (Insight, MIP Program)
• Screening and Brief Interventions (SBI, BASICS)
• Treatment

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Threshold for Action
Environmental strategies
Brief Interventions
Treatment
Few or no problems
Moderate problems
Severe problems
Mild problems
Tertiary prevention
Secondary prevention
Primary prevention
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Documenting the College Effect 2005
2005 national aggregate data collected from
AlcoholEdu Survey 1 BEFORE students were exposed
to the course
Heavy episodic drinkers increased by 100.
Abstainers decreased by 41.
Problematic drinkers increased by 183
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What do students think about drinking?

• In general, students are less concerned about
  alcohol than older campus/community members.
• Some amount of alcohol-related harm is tolerable
  and expected by many students.
• Most students have mixed feelings about alcohol,
  but see drinking as part of a normal college
  experience.

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What factors influence drinking during college?

• Demography male, white, or belonging to an
  athletic team or a Greek organization.
• Personality more impulsive, stimulus-seeking,
  depressed or social.
• Social environment permissive attitudes about
  AOD, social norms, easy access to AOD.
• Expectancies about role of AOD in college life
  and impact on the body.
• Genetic factors are not strongly related to
  drinking during college.

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What isnt said

• Not every student drinks heavily approx.
  one-third drink very little or not at all many
  others drink moderately.
• Not all heavy drinkers drink frequentlyapprox.
  20 drink heavily and frequently.
• Heavy drinking in college, for the most part,
  does not lead to chronic problems later in life.

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How students view alcoholEntering students
Experienced students

• Prerequisite for having a good time and ensuring
  fun in college.
• A common denominator among all students on
  different campuses.
• Necessary for collegiate socializing.
• Serves as problem solver, reward, relaxant.
• Need to consume until intoxicated.
• THE reason for socializing.

• Way to release inhibitions and have fun.
• Common denominator between many students on
  different campuses.
• Often present, but not necessary for collegiate
  socializing.
• Celebratory or gregarious activity.
• Consumed, occasionally to intoxication.
• Part of socializing.

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What Makes People Change?

• Most people change problem drinking habits
  without formal assistance, even those with more
  severe problems.
• When students change, they usually do so on their
  own they dont ask for help.
• Change does not usually occur all at once, for
  most students its a gradual process.
• Students are more likely to change behavior they
  recognize as impeding personal goals and values.

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Stages of Change Goal is to move along a
continuum of risk reduction

Precontemplation
Permanent exit
RELAPSE
CONTEMPLATION
MAINTENANCE
PREPARATION
ACTION
Transtheoretical Stages of Change Model from
Velasquez, Maurer, Crouch DiClemente 2001
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What motivates in brief interactions?

• Effective interventions move students along
  stages of change and target stage-specific needs.
• Goal is not to get student to stop drinking, but
  to move student along the continuum of risk
  reduction.
• Brief encounters can be as effective as longer
  counseling sessions.
• Techniques not only for trained counselors, but
  also for non-specialists and concerned others,
  such as coaches, trainers, peers, staff and
  faculty.

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What motivates in brief interactions?

• Arguments or authoritative advice are rarely
  effective.
• Avoid coming across either confrontational and
  blaming, or overly sympathetic and parental.
• People become more committed to an idea they feel
  they have authored.
• The style of the interactionconcern, empathy,
  and reflective listeningis the best predictor of
  outcome.

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What are SBIs (screening and brief interventions)?

• Individual and group interactions can be used in
  both formal and opportunistic settings.
• Often starts with a screening question or set
  of questions, which can be used to initiate the
  process.
• Screening includes assessment of use and
  readiness to change.
• Screening and brief interventions can vary in
  length
• Brief (1-5 minutes) single question or first 3
  questions from the AUDIT, assess key patterns of
  use and risks to support brief advice.
• Moderate (5-15 minutes) AUDIT, assess more
  dimensions to support longer conversations.
• Lengthy (15 minutes) assess details of use and
  consequences to support BASICS, counseling or
  other feedback sessions.
• Self-assessment (alcoholscreening.org)

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Brief Alcohol Screening Intervention for
College Students (BASICS)

• Designed for college students who typically drink
  heavily several times a week or who have
  experienced alcohol-related problems.
• Used with students who are typically low in
  problem recognition and resistant to prevention
  programs and other types of intervention.
• Recognizes that
• Student-chosen goals are more powerful than goals
  suggested or required by others.
• Factors that maintain heavy drinking among
  college students are different from those that
  maintain heavy drinking in older adults.
• Risk reduction or sustained moderation is an
  appropriate goal rather than complete abstinence.

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Dave tools and techniques
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BAC Function of drinks consumed and time taken
to consume
Male 185 lbs.
Hours
No. of drinks
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Factors Affecting Blood Alcohol Content

• Time BAC is reduced by .016 every hour
• Weight
• Sex pronounced differences between men and women
• Factors affecting absorption
• Food in stomach
• What one is drinking
• Rate of consumption
• Effervescence

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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.
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Alcohols Biphasic Effect
Euphoria - Up
Point of Diminishing Returns

Cultural Myth About Alcohol
Feeling Scale
0
After Tolerance Develops
__
Dysphoria - Down
Time
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Specific tips for reducing the risk of high risk
alcohol use

• Set limits
• Keep track of how much you drink
• Space your drinks
• Alternate alcoholic drinks with non-alcoholic
  drinks
• Drink for quality, not quantity
• Avoid drinking games
• If you choose to drink, drink slowly
• Dont leave your drink unattended
• Dont accept a drink when you dont know whats
  in it

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Open Ended Questions

• Open ended questions can not be answered with one
  word.
• Examples of open ended vs. close ended
• How would you describe your drinking? (Open)
• What did you learn from that experience? (Open)
• Do you think those consequences will make you
  stop drinking? (Closed)
• Do you think you have a problem with alcohol?
  (Closed)

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Open Ended Questions

• A student tells you that they used to drink too
  much and you want to know more.

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Open Ended Questions (cont.)

• A student is telling you about an alcohol related
  incident and they seem to have finished, but you
  want to keep them on that train of thought.

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Open Ended Questions (cont.)

• You see that a student is having a lot of
  negative consequences related to alcohol, and you
  want to know if the student thinks he\she has a
  problem.

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Reflections

• Reflections are statements that seek to capture
  the intent of what a person is saying.
• Examples
• 1) Student Drinking doesnt bother me. I never
  get sick
• You So you havent had many unpleasant
  effects.
• 2) Student I cant believe I have to come do
  this interview
• You It sounds like you arent very happy to be
  here.

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Reflections

• I drink just as much as everyone else at
  college. This is a time when we are supposed to
  be able to drink.

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Reflections (cont.)

• Yeah, I drink a lot, but it doesnt really cause
  me any problems. I know people that drink way
  more, and they are the ones with problems.

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Reflections (cont.)

• I am only here because my stupid roommate let
  the RAs in the room. If it wasnt for him\her
  we would not have even gotten caught.

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Reflections (cont.)

• Drinking everyday is good for you. Havent you
  heard about those studies?

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Reflections (cont.)

• So what if I drink a little bitI bet you do
  too.

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Reflections (cont.)

• I have fun drinking with my friends, so there is
  no reason for me to stop.

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Reflections (cont.)

• Okay, maybe I do drink a lot, but I can stop any
  time I want. I am just not interested in cutting
  back right now.