Transcript Prevention of Alcohol Problems on Campus: A Harm Reduction Approach for Frequent Binge Drinkers UW/ABRC G.

Prevention of Alcohol Problems on Campus:
A Harm Reduction Approach for Frequent Binge Drinkers
UW/ABRC
G. Alan Marlatt, Ph.D.
Addictive Behaviors Research Center
Department of Psychology
University of Washington
VM: 206.685.1200 E-mail: [email protected]
http://depts.washington.edu/abrc/marlatt_presentations.htm
Young Heavy Drinkers
UW/ABRC
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Heaviest drinking period in life
Problems common, yet more isolated
Development in adulthood?
Problems associated with peer influence,
impulsivity, conduct history
 Do not see drinking as a problem
Adolescents and Alcohol:
An Overview of the Problem
UW/ABRC
Factors Influencing Adolescent Alcohol Problem Development
Peer Influences
 (mis)perceived peer norms
 modeling of heavy drinking
 affiliation with deviant peers
Cognitive Factors
 low personal risk perception
(perceived invulnerability)
 positive alcohol outcome
expectancies
Parental Influences
 family conflict
 insufficient parental
monitoring
 parental drinking history
Ecological
 price
 availability
Adolescents and Alcohol:
An Overview of the Problem
UW/ABRC
Prevalence & Problems: Critical Issues of Adolescent Drinking
 Binge drinking is associated with negative consequences such as,
academic failure, physical injury (resulting from fights, falling, or
automobile accidents), and unplanned/unprotected sex.
 Alcohol-related injury remains the leading cause of death in this
population, (44% of all traffic-related deaths ages 15-24 are alcoholrelated).
 44% of college students report binge drinking at least once in a 2-week
period.
 Does binge drinking behavior lead to alcohol dependence or is this
alcohol abuse that most college students mature-out of?
 What are the best policies and programs for people who are underage
and drinking?
 Zero tolerance prohibition approach of cracking down on students.
 Harm Reduction shown to be effective in those who are already drinking.
Maturing Out
UW/ABRC
 Substantial decline in use from adolescence to adulthood
 Lack of correlation between alcohol use and psychosocial
problems among adolescents, suggesting “stage”
 Alcohol problems in adulthood predicted by adolescent
problem behavior and nonconformity NOT by amount
consumed or patterns of use (Baer, McLean, & Marlatt, 1998)
Spectrum of Intervention Response
Thresholds for Action
No
Problems
Mild
Problems
Moderate
Problems
Severe
Problems
Treatment
Brief Intervention
Primary Prevention
Social Norms and
the Prevention of
Alcohol Misuse in
Collegiate Contexts
H. WESLEY PERKINS, PH.D.
Department of Anthropology
and Sociology, Hobart and
William Smith Colleges,
Geneva, New York 14456
(315) 781-3437
[email protected]
Alcohol Skills Training Program
Alcoholism Information School (AIS) Course Outline
UW/ABRC
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Introduction & Dispelling Myths about Alcohol
Bodily & Behavioral Effects of Alcohol
Effects of Drugs and Their Interaction with Alcohol
The Alcohol Industry
Alcoholism
Alcoholism & the Family
Alcohol & the Law
Responsible Decision Making about Alcohol
Alcohol Skills Training Program
Components of Skills Training Program for Secondary Prevention
UW/ABRC
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Training in self-monitoring of blood alcohol levels and
drinking moderation techniques
Training to anticipate and prepare for situations
involving increased risk of heavy drinking (e.g. social
pressure, or negative emotional states)
Training to recognize and modify alcohol outcome
expectancies (i.e. placebo vs. drug effects)
Training to alternate stress coping skills (e.g.
relaxation & aerobic exercise)
Training in relapse prevention to enhance
maintenance of drinking behavior change
Peak Blood Alcohol Concentration
by Group
UW/ABRC
0.14
0.12
BAC
0.1
0.08
0.06
0.04
0.02
0
Pre
Post
4-month
8-month
12-month
Assessment Interval
Skills Training Program
Alcohol Information
Assessment Control
Alcohol Skills Training Program:
Estimated Peak BAL Over Two Years by Treatment Format
UW/ABRC
0.18
Estimated Peak BAL
0.16
0.14
0.12
0.1
0.08
0.06
0.04
0.02
0
Baseline
Post-Rx
3-month
6-month
1 Year
Time of Assessment
Classroom
Correspondence
Professional Advice
2 Year
Project
Brief Alcohol Screening and Intervention for College Students
UW/ABRC
Principal Investigator
Co-Principal Investigator
Co-Principal Investigator
Project Coordinators
Research Coordinator
Research Study Assistant
Graduate Research Assistant
Funding By:
The National Institute of
Alcohol Abuse and
Alcoholism
Grant # 5R37-AA05591
G. Alan Marlatt, Ph.D
John S. Baer, Ph.D.
Daniel R. Kivlahan, Ph.D.
Lori Quigley, Ph.D.
Mary E. Larimer, Ph.D.
Sally Weatherford, Ph.D.
Dan Irvine, BS
Ken Weingardt, MS
Lisa Roberts, MA
Lizza Miller, BA
Jason Kilmer, MS
Linda Dimeff, MS
Stages of Change Intervention Strategies
UW/ABRC
Assessment
& Treatment
Matching
Precontemplation a Contemplation a Preparation a Action a Maintenance a Relapse
Motivational
Enhancement
Strategies
Relapse
Prevention &
Relapse
Management
Prevalence of Alcohol-Related Consequences
Among Fraternity and Sorority Members
UW/ABRC
50.0%
47.8%
41.7%
40.0%
39.2%
38.9%
36.8%
36.6%
36.3%
33.7%
29.8%
24.2%
21.9%
16.2%
16.1%
8.1%
7.9%
7.5%
Neglected your responsibilities
Missed a day (or part of a day) of school or work
Not able to do your homework or study for a test
Got into fights, acted bad, or did mean things
Felt you needed more alcohol . . . to get same effect
Caused shame or embarrassment to someone
Had a fight, an argument or bad feelings with a friend
Drove shortly after having more than two drinks
Had blackouts
Noticed a change in your personality
Passed out
Missed out on things . . . spent too much . . . on alcohol
Drove shortly after drinking more than four drinks
Went to work or school high or drunk
Felt that you had a problem with alcohol
Felt physically or psychologically dependent
Felt you were going crazy
Had withdrawal symptoms
BASICS Design
Freshman Year of University
Spring
Quarter
Autumn
Quarter
Select and
assess
high-risk
sample
(random
assignment)
Treatment
No
Treatment
Winter
Quarter
Spring
Quarter
Autumn
Quarter
Feedback
And
Advise
Stepped
Care
Options
Stepped
Care
Options
Assessment
Assessment
Assessment
Assessment
Assessment
Assessment
Assessment
Assessment
Assessment
Screen all
incoming
Freshman
Select and
assess
control
sample
Participant Recruitment
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UW/ABRC
4000 Screening Questionnaires mailed
2179 Returned Questionnaires (54%)
2041 Usable Questionnaires interested in participation (51%)
508 High-risk identified (25%)
366 High-risk agreed to participate
- 11 clinical cases
- 7 late responders
- 348 randomized for intervention
174 – High-risk control
174 – High-risk intervention
151 Randomized control group selected
- 115 agreed to participate
(overlap of 26 with high-risk group)
Constructs and Measures
Drinking Measures
UW/ABRC
Construct
Measure
Time Frame___
Alcohol
Quantity (6pt)
All points
Consumption
Frequency (7pt)
Peak (6pt)
Alcohol Negative
Consequences
Collateral Report
Daily Drinking Questionnaire
Baseline & FU
Rutgers Alcohol Problem Index (RAPI)
All points
Alcohol Dependence Scale
Baseline& FU
DSM IIIr Dependency Scale (SCID)
Baseline & FU
Quantity, Frequency, & Problems
Baseline & FU
Sample RAPI Items
(Rutgers Alcohol Problem Index)
UW/ABRC
 Got into fights, acted bad, or did mean things
 Missed out on other things because you spent too much
money on alcohol
 Caused shame or embarrassment to someone
 Not able to do your homework or study for a test
 Felt physically or psychologically dependent on alcohol
 Had withdrawal symptoms, that is, felt sick because you
stopped or cut down drinking
Constructs and Measures
Other Measures
UW/ABRC
Construct
Measure
Time Frame___
Sociopathy
DSM IIIr Conduct Disorder (SCID)
Screening &
Baseline
Family History
Family Tree Interview (Screening-MAST)
Baseline
Environment
Residential Type (Greek, dorm, off-campus) Ongoing
Beliefs
Alcohol Effects
Perceived Norms
Baseline & FU
All Points
Cues for Overdrinking
UW/ABRC
 The people you are with
 The place where you are drinking
 The time and Day
 Hunger and Thirst
 Special Situational Factors
 Emotional Factors
Blood Alcohol Concentration*
as a Function of Drinks Consumed
and Time Taken to Consume
Number of Drinks
Number of Hours
1
2
3
4
5
6
7
8
9
10
11
12
0
0.020
0.040
0.060
0.080
0.100
0.120
0.140
0.160
0.180
0.200
0.220
0.240
1
0.004
0.024
0.044
0.064
0.084
0.104
0.124
0.144
0.164
0.184
0.204
0.224
2
0.000
0.008
0.028
0.048
0.068
0.088
0.108
0.128
0.148
0.168
0.188
0.208
3
0.000
0.000
0.012
0.032
0.052
0.072
0.092
0.112
0.132
0.152
0.172
0.192
4
0.000
0.000
0.000
0.016
0.036
0.056
0.076
0.096
0.116
0.136
0.156
0.176
5
0.000
0.000
0.000
0.000
0.020
0.040
0.060
0.080
0.100
0.120
0.140
0.160
6
0.000
0.000
0.000
0.000
0.004
0.024
0.044
0.064
0.084
0.104
0.124
0.144
7
0.000
0.000
0.000
0.000
0.000
0.008
0.028
0.048
0.068
0.088
0.108
0.128
8
0.000
0.000
0.000
0.000
0.000
0.000
0.012
0.032
0.052
0.072
0.092
0.112
9
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.016
0.036
0.056
0.076
0.096
10
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.020
0.040
0.060
0.080
* for a MALE, 185 lbs.
Five General Principles
UW/ABRC
 Express Empathy
 Develop Discrepancy
 Avoid Argumentation
 Roll with Resistance
 Support Self-Efficacy
Therapist tasks during PRECONTEMPLATION
UW/ABRC
 Raise doubt about current behavior
 Increase the client’s awareness of the
risks of current behavior
 Increase the client’s awareness of the
problems caused by current behavior
Therapist tasks during CONTEMPLATION
UW/ABRC
 Tip the balance
 Evoke reasons to change
 Highlight the risk of not changing
 Strengthen the client’s self-efficacy for
changing the current behavior
Negotiating a Plan for Change
UW/ABRC
 Settings Goals
 Considering Options
 Arriving at a Plan
 Encouraging Action
Strategies to Reduce
Alcohol Consumption
UW/ABRC
 Keep Track
 Slow Down
 Space Your Drinks
 Select Different Types of Drinks
 Drink for Quality instead of Quantity
 Enjoy Mild Effects
BASICS
Graphic Feedback
Frequency of Alcohol Consumption
from High School to College
Frequency Scale
3
2.5
2
1.5
1
0.5
0
Spring High School
Random Sample
Autumn College
High Risk Sample
Four Year Outcome Results
Drinking Problems
Drinking Problem Z-Score
1.4
1.2
1
0.8
0.6
0.4
0.2
0
-0.2
-0.4
Baseline
Year 1
Year 2
Random Comparison
High-Risk Control
Year 3
Year 4
High-Risk Treatment
Four Year Outcome Results
Drinking Rates
Drinking Pattern Z-Score
1
0.8
0.6
0.4
0.2
0
-0.2
Baseline
Year 1
Year 2
Random Comparison
High-Risk Control
Year 3
Year 4
High-Risk Treatment
for Young Heavy Drinkers
 Low Threshold
- Avoids Labels
- Avoids Rules
 Public Health Model
-Treats young people as adults
-Tolerates “illegal” activity
 Flexible
-Tailored to personal history
-Tailored to risk status
UW/ABRC
The Three Dangerous Drives in
Adolescent Motivation
Drinking
Dating
Driving
UW/ABRC
Thank You.