Transcript Trends in Alcohol Prevention Among Young Adults Scott T. Walters, Ph.D. UT School of Public Health Southwestern Medical Center at Dallas.

Trends in Alcohol
Prevention Among
Young Adults
Scott T. Walters, Ph.D.
UT School of Public Health
Southwestern Medical Center at Dallas
“Binge” Drinking, Past 2 Weeks
50
45
40
35
30
% 25
20
15
10
5
0
Military
College
Other Young
Adults
Substance Use, Past Month
60
Any Illicit Drug Use
Any Cigarette Use
50
Heavy Drinking
40
% 30
20
10
0
1980
1982
1985
1988
1992
Year
1995
1998
2002
Ozs. Ethanol/Day, Past Month
1.6
Unadjusted rates
1.4
Adjusted Rates
Ozs/Day
1.2
1
0.8
0.6
0.4
0.2
1980
1982
1985
1988
1992
Year
1995
1998
2002
Drinking Rates by Group
40
Abstainer
35
Heavy
30
25
% 20
15
10
5
0
1980
1982
1985
1988
1992
Year
1995
1998
2002
Negative Effects, Past 12 Months
Serious Consequ
25
Productivity Loss
Dependence Sxs
20
15
%
10
5
0
Army
Navy
Corps
Branch
Force
Total DoD
Risk Factors for Heavy Drinking
Younger age
Male gender
Single (or married with spouse absent)
Non-Hispanic white, compared with
other ethnicities
Pay grades E1 - E3 through O1 - O3
compared with O4 - O10
Less formal education
Army and Marine Corps, compared with
Air Force personnel
Addressing Alcohol In Young
Adults: What We Know
Educational approaches show least effect.
Attitudinal and skills-based approaches produce
roughly equivalent and modest reductions.
Program length unrelated to outcome.
In some cases (e.g., expectancy challenge,
normative feedback) briefest interventions show
best outcome.
Difficulty approaching problem from a traditional
alcohol treatment perspective
Sources: Walters & Bennett (2000), Larimer & Cronce (2002).
Motivational
Feedback
Motivational Feedback
 Based on motivational theories of
change—students have knowledge and
skills if so motivated
 Confidential, “neutral” information based
on personal responses
 Use for in-person interventions or
delivered as an alternative to “generic”
message
 Personalized, cost-effective way to reach
large numbers of students
Individual Feedback Intervention
 Design: Randomized clinical trial
 Population: 60 “binge drinking” students
randomized to:
a. control
b. 60-minute motivational interview (with
feedback)
 All participants assessed at baseline and
6 weeks
Source: Borsari & Carey (2000)
Individual Feedback Intervention
40
MI
35
% Reduction
35
Control
30
25
20
20
15
15
13
10
5
0
0
0
Drinks Per Mo
Frequency
Binges Per Mo
6-Week Drinking Reductions
Source: Borsari & Carey (2000)
“No Touch” Feedback Interventions
Q/F, BAC, population comparison
Amount and percent of income spent on
alcohol
Tolerance level
AUDIT, family risk score
Drove/rode with intoxicated? Smoker?
Norm estimates, correct percentages
Explanation, advice, referral information
Other novel information/comparisons (e.g.,
cheeseburgers & Cameros)
Mailed Feedback Interventions
60
60
Feedback
50
50
40
40
% Reduction
% Reduction
53
30
20
No Feedback
33
30
20
11
10
10
1
0
0
Drinks per Month
6-Week Drinking Reductions
Source: Walters, Bennett & Miller (2000)
Drinks per Month
6-Week Drinking Reductions
Source: Walters (2000)
College Drinking Feedback Efficacy
Study
Baer, et al (1992)
Population
HD college
students
Agostinelli, Brown HD college
& Miller (1995)
students
Marlatt, et al.
HD college
(1998)
freshman
Walters, Bennett & HD college
Miller (2000)
students
Walters (2000)
HD college
students
Borsari & Carey
HD college
(2001)
students
Larimer, et al.
Frat/Sorority
(2001)
Pledges
Format
F/Up
Results
In-person 24 mo.  drinking
Mailed
6 wk
 drinking
In-person 24 mo.  drinking, 
consequences
Mailed
6 wk
 drinking, n/s
consequences
Mailed
6 wk
n/s drinking, n/s
consequences
In-person 6 wk
 drinking
In-person 12 mo.  drinking for
males
e-Interventions
Web-Based College Drinking
Interventions
 Alcohol101plus.com
 Alcoholedu.com
 Bacchusgamma.org
 E-chug.com
 Mystudentbody.com
 Undertheinfluence.com
Advantages of e-Interventions
 Provides cheap, accurate and
immediate information.
 Confidential and private.
 Requires little/no “human” effort.
 Easily integrated with counseling or
other approaches.
 Ability to collect data from students and
track over time.
 Young adults computer/internet literate,
colleges almost universally linked
e-CHUG: The User’s Perspective
1. Personal drinking profile
 Amount consumed in typical week and month
 Amount and percent of income spent on alcohol
 Caloric intake “cheeseburger” equivalent
2. Peak monthly and weekly BACs
3. Personal risk factors
 Tolerance, dependence, negative consequences
 Genetic risk of alcoholism
 Risky choices
4. Drinking in relation to peers
5. Perception of drinking in relation to actual amts
6. Local community resources
e-CHUG: Interventionist’s Perspective
1. Draws from motivational interviewing and
social norms theories.
2. Intentionally obtrusive; more than
assessment.
3. Employs motivational “hooks” to raise
discrepancy and motivation for change.
4. Mechanism thought to be discrepancy and
increased importance of change.
5. Safe for general prevention efforts, not likely
to “harm” non-drinkers.
Applications of the e-CHUG
 Orientation classes.
 Referrals for alcohol-related infractions;
Adjunct to individual counseling.
 High-risk groups (e.g., fraternities,
sororities, athletes).
 Mass marketing, Alcohol awareness day
 Waiting rooms of student service offices
 Standardized personalized information
for large multi-site groups.
Example: ASPIRE Program
 San Diego State University, Counseling
and Psych Serv’s
 Disciplinary referrals from judicial and
residence life systems.
 Stepped care: Level (1-3 sessions)
determined after initial interview.
 Intervention components:
a. Motivational Interview (1-3 sessions)
b. Feedback from CHUG/e-CHUG and
Brief Symptom Inventory
ASPIRE Disciplinary Program
 350 students referred, mandated to
attend in 2002-3.
 No. sessions: 25% one, 26% two, 49%
three.
 Confidential follow-up 6 weeks after
completion. Among 3 session
attendees:
– 93% reported decreased alcohol consumption
(average reduction of 12.6 drinks per week)
– 73% reported decreased “binge” episodes
– 91% reported decreased money spent on
alcohol (average savings of $12/week)
Skills-Based
Approaches
CHOICES Skills-Training Program
Core Components
 Group & interactive
journal
 Psychoeducational, skills
training material
 Facilitator guide &
supporting materials
Implementation
 Facilitated by peer eds,
faculty or staff
 Small groups, 90-180
minutes, 1-2 sessions
 Verified self-study
CHOICES Journal
Reflections upon current relationship with
and attitude toward alcohol
Facts about how alcohol works, how it affects you
(physiology, BAL, intoxication and oxidation)
Risks associated with excessive consumption
and common harm associated with use
Strategies to reduce exposure to harm
from alcohol consumption
Reflections
Facts
Risks
Strategies
Example: SC CHOICES Program
Program being implemented by
Sigma Chi national fraternity.
Materials customized to unique
characteristics of male,
undergraduate, fraternity life.
– Specialized e-CHUG feedback
– Integrated CHOICES workbook
Group facilitation by trained peer
educators.
Freshman Project
Purpose: To examine the e-CHUG as an
adjunct to two prevention curricula.
190 freshman students
Randomized to:
–
–
–
–
CHOICES workbook, facilitated group
CHOICES workbook, facilitated group + e-CHUG
Alcohol 101 CD-ROM
Alcohol 101 CD-ROM + e-CHUG
4 week follow-up
SDSU Choices/e-CHUG Project
1.5
No e-CHUG
Drinks/hr.
e-CHUG
1
0.5
0
Alcohol 101
Curriculum
Choices
Source: Lange, et al. (2004)
Advantages of Hybrid Approach
Motivational, skills-based and informational
techniques in a standardized curriculum.
Accessible and understandable.
Personalizes “generic” message to the
individual.
Customized to demography, risk factors,
goals. Local logos, norms, referral
information.
Self-study, or delivered in “manualized” group
format. Includes group facilitators training.
Can gather information, measure changes.
Trends in Alcohol
Prevention Among
Young Adults
For more information about e-CHUG, contact:
Scott Walters, Ph.D.
[email protected]
Or visit: www.e-chug.com
For more information about CHOICES, contact:
John Calhoon
Scott T. Walters, Ph.D.
[email protected]
UT School of Public Health
Or visit: www.changecompanies.net
Southwestern Medical Center at Dallas