University of California Santa Barbara Debbie Fleming, M.P.H. Associate Dean of Students

1. University of California Santa Barbara Debbie Fleming, M.P.H. Associate Dean of Students Ian Kaminsky, Ph.D. Director, Alcohol and Drug Program

2. UCSB Context • High rates of binge drinking (51% per 2005 California Safer Universities study) • Unique influence of Isla Vista • Alcohol and Drug Program embedded in Student Health Service • Aggressive adoption of best practices in alcohol and drug prevention • Strong support from Vice Chancellor for Student Affairs

3. Early Intervention Strategiesfor AOD at UCSB - AOD Counseling and Assessment - Parent Notification - Resident Assistant Training - Monthly E-Newsletters - On-Line Assessment/Feedback - 21st Birthday E-Mails (MyStudentBody.com, E-Chug, E-Toke) - Social Worker - Brief Motivational Interviewing - Parent Education - Emergency Room Referrals - On Call AOD Counseling (SBIRT)

4. Development of CASE GOALS: • Increased accountability and heightened consequences for alcohol/drug policy violations in the residence halls • Partnership between multiple departments • Housing and Residential Services • Alcohol and Drug Program • Dean of Students/Office of Student Life • Office of Judicial Affairs • Gevirtz Graduate School of Education • Harm-reduction and skills-development approach using evidenced-based strategies

5. CASE Program Overview • Referral to CASE by Resident Director • Intake Assessment and Personalized Programming • 5 Weekly Group Meetings (75 minutes each) • Follow-up Session (2-3 weeks later) • Appropriate Referrals to On-Campus and Community Resources

6. CASE Behavior Change Goals • Reduce frequency of use • Reduce amount • Reduce negative consequences • Eliminate blackouts • Increase responsible drinking strategies • Change style of drinking “CASE made me realize that the way I was drinking was the cause of my blackouts, and decisions that I would not have made sober.”

7. Evidence-Based Strategies • Brief Motivational Interviewing • Alcohol Skills Training Program (ASTP) • NIAAA Clinical Protocols to Reduce High Risk Drinking in College Students • Behavior Modification • Life Skills CASE incorporates strategies proven to be effective with college students

8. Abstinence vs. Harm Reduction • Abstinence from alcohol is theonly no-risk alternativeand the only legal option for those under 21 years of age. • College students who choose to drink should learn to do so with the least risk and harm possible. “My group leader was not judgmental, but open and honest. She seemed to care, not condemn.” “They didn’t judge my use, but helped me to use responsibly.”

9. How CASE Works • Through in-class discussion and out-of-class assignments and exercises students: • Receive individualized feedback on their drinking behavior • Examine how their behavior affects their goals • Discuss the pros and cons of their use • Develop a plan for change • Test their skills and review results weekly

10. CASE Curriculum Day 1:Program Description and Requirements Psychology of Substance Use What is Alcohol? What is One Drink? Alcohol and Women BAC/ Self-Monitoring Form AOD Emergency/ Alcohol Poisoning Day 2:Alcohol and the Body Sobering Up Use-Abuse Continuum Tolerance Bi-Phasic Response

11. CASE Curriculum Day 3:Alcohol/Marijuana and the Brain Alcohol/Marijuana and Memory Binge Drinking Drinking Games Blackouts Day 4: Pros and Cons of Marijuana Brain Scans Alcohol and Sex Sexual Assault

12. CASE Curriculum Day 5:Addiction Dependence Uppers Downers All-Arounders

13. 2005-2006 (N=481) Gender Male 62% Female 38% Ethnicity European-American 73% Latino/a 8% Asian-American 7% African-American 1% Other/Bicultural 11% 2006-2007 (N= 238) Characteristics of CASE Participants in Evaluation Study Gender Male 66% Female 34% Ethnicity European-American 61% Latino/a 7% Asian-American 13% African-American 1% Other/Bicultural 18%

14. CASE Evaluation Results • Less dangerous drinking • Statistically significant reductions in amount and frequency of drinks per week • increase in use of behavioral harm reduction strategies • 75% participant satisfaction with program despite mandatory nature and $75 fee • Program more helpful for some students than others “I liked the small groups, familiar faces, instructor, and safe environment. I liked how casual it was, but at the same time we were able to learn a lot, get resources, and share openly.”

15. 2005-2006 (N=172) 2006-2007 (N=238) Changes in Drinks in a Typical Week

16. 2005-2006 (N=172) 2006-2007 (N=238) Changes in Drinks in a Typical Week for Students with and without Blackouts

17. High School History 2006-2007 (N=234) Family History 2006-2007 (N=234) Changes in Drinks in a Typical Week by Group

18. Harm-Reduction Strategies Reported at Follow-Up Strategies2005-062006-07 N=297 N=237 • Eating before/while drinking 75% 61% • Monitoring drinking 68% 53% • Pacing drinks over time 67% 52% • Counting drinks 66% 57% • Talking about their drinking 61% 54% • Talking about others’ drinking 54% 47% • Pacing drinks with water 53% 31% • Calculating BAC 33% 26% • Pre-partying less 21% 16% • Playing fewer drinking games 17% 9%

19. Unexpected Consequences of CASE • CASE has become a tool for early identification of mental health issues • CASE has become an effective mechanism for getting students the care they need • Managing high risk students in CASE has created the need for development of new protocols and increased communication and collaboration

20. Identification of High-Risk Students Intake process (evaluations, questionnaires) and weekly small group participation allows for assessment of risk indicators such as: • Stress/Anxiety • Depression • Suicide • Family History of AOD Use • Academic/ Social/ Financial/ Health-Related Pressures Consent forms allow CASE staff to contact students if appropriate

21. Screening, Identification, Tracking • Individual AOD screens for each student • Classification of each student based on level of risk • High levels of AOD severity are often an indicator of underlying mental health issues • System in place to help counselors keep track of at risk students (e.g., suicide, depression, sexual assault) • Confidentiality issues

22. 2005-062006-07 N=481 N=238 Family history of AOD problems31% 43% Saw counselor before college5% 11% AOD treatment before college4% 15% Diagnosed with learning disability 3% 3% History of physical abuse2% 4% Participant History

23. Depression Anxiety Stress Blackouts Passing Out Drinking Games Competitive Drinking Greek/Athlete Community Rituals Use of Study Drugs Intense Peer Pressure to Drink and Use Hazing Arguments and Fights Trouble with Police Sleep Difficulties Self Medication Abuse of Prescription Medication Fear for Personal Safety Disgust with Friends and Peers Relationship Problems Roommate Problems Academic Problems Additional Issues

24. How We Know Who Needs Help • Standardized assessments • Small groups over multiple weeks • Counselors make time after groups to chat • CASE counselors are trained to look for students who have more than an AOD issue (e.g., we look at body posture, clothing, hygiene, eye contact) • Homework -- Students write one journal at the end of the program (often this is when students feel safe to discuss their mental health challenges) • Follow up appointments

25. Clinical Supervision • Held weekly • Digital picture of each student • Discussion/review of 1:1 treatment plans • Discussion of group technique • Role play motivational interviewing and challenging cases • Audiotape of some sessions

26. Summary of CASE Impacts • 600+ students x 7 visits = 4,200 visits/clinical contacts absorbed into Student Health each year • Increase in staffing and student contact = need for additional space and funding • Need for increased collaboration and communication between departments serving mental health needs of students • Increase in number of students referred by others and self-referred for AOD counseling and assessment • Reduction in number of repeat AOD violations in residence halls

27. UCSB Contact Information • Debbie Fleming, M.P.H. • Associate Dean of Students, debbie.fleming@sa.ucsb.edu • Ian Kaminsky, Ph.D. • Director, Alcohol and Drug Program, ian.kaminsky@sa.ucsb.edu • Merith Cosden, Professor • Dept. of Counseling, Clinical & School Psychology, cosden@education.ucsb.edu