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Brief Interventions with College Student Drinkers: BASICS. Jason R. Kilmer, Ph.D. The Evergreen State College Saint Martin’s University. What does research show about college student drinking?.

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brief interventions with college student drinkers basics

Brief Interventions with College Student Drinkers: BASICS

Jason R. Kilmer, Ph.D.

The Evergreen State College Saint Martin’s University

what does research show about college student drinking
What does research show about college student drinking?
  • Up to ninety percent of college students drink alcohol
  • Twenty-five to fifty percent are “heavy episodic” or “binge” drinkers
  • Students who abuse alcohol are at high risk for a number of negative consequences
slide3

Spectrum of Intervention Response

None

Mild

Moderate

Severe

Thresholds for Action

Specialized

Treatment

Brief

Intervention

Primary

Prevention

what is harm reduction
What is Harm Reduction?
  • The ultimate goal of harm reduction is abstinence – this is clearly the best way to reduce and eliminate negative consequences.
  • However, harm reduction approaches acknowledge that any steps toward reduced risk are steps in the right direction
how are these principles implemented in an intervention with college students
How are these principles implemented in an intervention with college students?
  • Legal issues are acknowledged – if you are under the age of 21, it is illegal to drink.
  • For those who want to abstain, appropriate skills and strategies are reviewed.
  • However, if one makes the choice to drink, skills are described on ways to do so in a less dangerous and less risky way.
  • A clinician or program provider must elicit personally relevant reasons for changing.
      • This is done using the Stages of Change model and Motivational Interviewing.
the stages of change model prochaska diclemente 1982 1984 1985 1986
The Stages of Change Model (Prochaska & DiClemente, 1982, 1984, 1985, 1986)
  • Precontemplation
  • Contemplation
  • Preparation/Determination
  • Action
  • Maintenance
slide7

Stages of Change in Substance Abuse and Dependence: Intervention Strategies

Maintenance

of

Recovery

Stage

Precontemplation

Stage

Contemplation

Stage

Action

Stage

Relapse Stage

MOTIVATIONAL

ENHANCEMENT

STRATEGIES

ASSESSMENT

AND TREATMENT

MATCHING

RELAPSE

PREVENTION

& MANAGEMENT

slide8

Motivational Interviewing Basic Principles(Miller and Rollnick, 1991, 2002)

1. Express Empathy

2. Develop Discrepancy

3. Roll with Resistance

4. Support Self-Efficacy

slide9

Brief Alcohol Screening and Intervention for College Students (BASICS)

  • A non-confrontational, harm reduction approach that helps students reduce their alcohol consumption and decrease the behavioral and health risks associated with heavy drinking.
slide10

Brief Alcohol Screening and Intervention for College Students (BASICS)

  • BASICS is individually focused and involves the delivery of personalized feedback
    • Alcohol content and the skills-training information is introduced throughout the intervention when relevant, applicable, or of interest to the participant
slide11

The Basics on BASICS Brief Alcohol Screening and Intervention For College Students

  • Assessment
  • Self-Monitoring
  • Feedback Sheet
  • Review of Information and Skills Training Content

(Dimeff, Baer, Kivlahan, & Marlatt, 1999)

what to assess some areas used for feedback include
What to assess? Some areas used for feedback include...
  • Drinking Patterns
    • Quantity/Frequency
    • Daily Drinking Questionnaire
    • BAL Estimates
  • Drinking Problems
    • RAPI
    • YAAPST
  • Drinking Norms
  • Alcohol Outcome Expectancies
  • Stages of Change
basics 4 year drinking outcomes by treatment condition

1.0

.8

score

-

.6

.4

Drinking Pattern Z

.2

Random Comparison

0.0

High

-

Risk Treatment

High

-

Risk Control

-

.2

Baseline

1 Year

3 Years

4 Years

2 Years

BASICS 4-year Drinking Outcomes by Treatment Condition
slide18

Norm Misperception

  • Examines students’ perceptions about:
    • Acceptability of excessive behavior
    • Perceptions about the rates of their peers
    • Perception about the prevalence of their peers
slide19

EXPECT

Alcohol No Alcohol

GET

No Alcohol Alcohol

slide20

• What Is A Standard Drink?• Absorption and Oxidation• Blood Alcohol Level and Effects• Factors Affecting Blood Alcohol Level• Tolerance• Biphasic Effect • Drug Interactions

Information Reviewed During Feedback

what is a standard drink
What Is A Standard Drink?
  • 12 oz. beer
  • 10 oz. microbrew
  • 10 oz. wine cooler
  • 8 oz. malt liquor
  • 8 oz. Canadian beer
  • 8 oz. ice beer
  • 6 oz. ice malt liquor
  • 4 oz. wine
  • 2 1/2 oz. fortified wine
  • 1 1/4 oz. 80 proof hard alcohol
  • 1 oz. 100 proof hard alcohol
absorption and oxidation of alcohol
Absorption and Oxidation of Alcohol
  • Factors affecting absorption
    • Food in stomach
    • What one is drinking
    • Rate of consumption
    • Effervescence
  • Factors affecting oxidation
    • Time!
    • People burn off a very predictable .016% from their BAC per hour
blood alcohol level
Blood Alcohol Level
  • .02% Relaxed
  • .04% Relaxation continues, Buzz develops
  • .06% Cognitive judgment is impaired
  • .08% Nausea can appear, Motor coordination is impaired
blood alcohol level continued
Blood Alcohol Level(continued)
  • .10% Clear deterioration in cognitive judgment and motor coordination
  • .15%-.25% Black outs
  • .25%-.35% Pass out Lose consciousness Risk of Death
  • .40%-.45% Lethal dose
factors affecting blood alcohol level
Factors Affecting Blood Alcohol Level
  • Time
    • B.A.L. is reduced by .016% every hour
  • Weight
  • Sex differences
    • Very pronounced differences between men and women
    • Example
example of b a l differences between men and women
Example of B.A.L. differences between men and women
  • 160 pound man
  • 120 pound woman
  • Both have 5 drinks over 3 hours
  • What blood alcohol level will they obtain?
tolerance
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.

slide28

Questions…

  • When people start to lose their buzz, what do they usually do?
  • Do they ever get their buzz back?
  • For people with tolerance, is the buzz you get now as good as the buzz you used to get when you first started drinking?
slide29

Alcohol’s Biphasic Effect

Euphoria - Up

Point of Diminishing Returns

+

Cultural Myth About Alcohol

Feeling

Scale

0

After Tolerance Develops

__

Dysphoria - Down

Time

how explanation of alcohol s biphasic effect is used
How Explanation of Alcohol’s Biphasic Effect is Used
  • Point of Diminishing Returns
    • Highlights point at which positives are maximized and negatives are minimized
  • Demonstrate Why Tolerance Results in Increase In Negative Health Risks
  • Help Put Student Experiences In a Context
drug interactions
Drug Interactions
  • Potentiation
  • Antagonistic
areas in which college students may experience consequences
Areas In Which College Students May Experience Consequences
  • Academic Failure
  • Blackouts
  • Hangovers
  • Weight Gain
  • Tolerance
  • Decisions
  • Impaired sleep
areas in which college students may experience consequences continued
Areas In Which College Students May Experience Consequences (continued)
  • Finances
  • Family History
  • Alcohol-Related Accidents
  • Time Spent Intoxicated
  • Relationships
  • Legal Problems
  • Work-Related Problems
specific tips for reducing the risk of alcohol use
Specific Tips for Reducing the Risk of Alcohol Use
  • Set limits
  • Keep track of how much you drink
  • Space your drinks
  • Alternate alcoholic drinks w/non-alcoholic drinks
  • Drink for quality, not quantity
  • Avoid drinking games
  • If you choose to drink, drink slowly
  • Don’t leave your drink unattended
  • Don’t accept a drink when you don’t know what’s in it
motivational interviewing a definition
Motivational Interviewing: A Definition
  • Motivational Interviewing is a
    • Person-centered
    • Directive
    • Method of communication
    • For enhancing intrinsic motivation to change by exploring and resolving ambivalence
what is resistance
What is resistance?
  • Resistance is a function of interpersonal communication
  • Continued resistance is predictive of (non) change
  • Resistance is highly responsive to counselor style
  • Getting resistance? Change strategies.
the spirit of motivational interviewing
The Spirit of Motivational Interviewing
  • Direct persuasion is not an effective method for resolving ambivalence.
  • The counseling style is generally a quiet and eliciting one.
  • The counselor is directive in helping the client to examine and resolve ambivalence.
  • Readiness to change is not a client trait, but a fluctuating product of interpersonal interaction.
  • The therapeutic relationship is more like a partnership than expert/recipient roles.
four principles of motivational interviewing
Four Principles of Motivational Interviewing
  • Express Empathy
    • Research indicating importance of empathy
  • Develop Discrepancy
    • Client’s values and goals for future as potent contrast to status quo
    • Client must present arguments for change: provider declines expert role
four principles of motivational interviewing43
Four Principles of Motivational Interviewing
  • Roll with Resistance
    • Avoid argumentation
    • Confrontation increases client resistance to change
    • Labeling is unnecessary
    • Provider’s role is to reduce resistance, since this is correlated with poorer client outcomes
    • If resistance increases, providers shift to different strategies
    • Client objections or minimization do not demand a therapist response
four principles of motivational interviewing44
Four Principles of Motivational Interviewing
  • Support Self-Efficacy
    • Clients are responsible for choosing and implementing change
    • Confidence and optimism are predictors of good outcome in both therapists and clients
oars building blocks for a foundation
OARS: Building Blocks for a Foundation
  • Ask Open-Ended Questions
    • Cannot be answered with yes or no
    • Provider does not know where answer will lead
  • Affirm
    • Takes skill to find positives
    • Should be offered only when sincere
examples of key questions
Examples of Key Questions
  • What do you make of this?
  • Where do you want to go with this now?
  • What thoughts do you have about what you might want to do about this?
  • What ideas do you have about things that might work for you?
oars building blocks for a foundation47
OARS: Building Blocks for a Foundation
  • Listen Reflectively
    • Effortful process: Involves Hypothesis Testing
    • Can be used strategically (amplify meaning or evaluation or contrast)
  • Summarize
    • Periodically through sessions
    • Demonstrates to client you are listening
    • Provides opportunity for shifting
building blocks for a foundation
Building Blocks for a Foundation

Strategic goal:

  • Elicit Self-Motivational Statements
    • Self motivational statements indicate client concern or recognition of need for change
    • Arrange the conversation so that client makes arguments for change
reflective listening a primary skill
Reflective Listening: A Primary Skill
  • “Hypothesis testing” approach to listening
  • Statements, not questions
  • Voice goes down
  • Can amplify meaning or feeling
  • Can be used strategically
  • Takes hard work and practice
motivational interviewing strategies
Motivational Interviewing Strategies
  • Reflection

My partner won’t stop giving me crap about my drinking.

Your partner is concerned about your drinking.

-- or --

And that annoys you.

-- or --

It feels like your partner is always on your case.

motivational interviewing strategies52
Motivational Interviewing Strategies
  • Amplified Reflection

I don’t see any reasons to change my drinking...I mean, I just like drinking alcohol.

Sounds like there no bad things about drinking for you.

motivational interviewing strategies53
Motivational Interviewing Strategies
  • Double-Sided Reflection

Student: I’ve been drinking with my friends in the dorm. My parents are pissed about it. They’re always saying that it makes my depression worse.

Clinician: Sounds like you get a hard time from your parents about how drinking affects your depression.

Student: Yeah… I mean, I know that it affects my mood a little, but I don’t drink that much and when I do, I really enjoy it, you know?

motivational interviewing strategies54
Motivational Interviewing Strategies
  • Double-Sided Reflection

Clinician: What do you enjoy about drinking?

Student: I like the fact that it helps me chill out with my friends.

Clinician: Let me see if I am getting you right.. Sounds like on the one hand you enjoy drinking because you feel that it helps you chill out with your friends, and on the other hand it you’ve noticed that it has some effect on your mood.

resistance strategies
Resistance Strategies
  • Why is it important to pay attention to resistance?
    • Research relevant to resistance and client outcomes
    • Motivational interviewing focuses on reducing resistance
types of resistance
Argument

Challenging

Discounting

Hostility

Interruption

Talking over

Cutting off

Ignoring

Inattention

Non-response

Non-answer

Side-tracking

Denial

Blaming

Disagreeing

Excusing

Reluctance

Claiming Impunity

Minimizing

Pessimism

Unwillingness to change

Types of Resistance
signs of readiness for change
Signs of Readiness for Change
  • Decreased resistance.The client stops arguing, interrupting, denying, or objecting.
  • Decreased questions about the problem.The client seems to have enough information about his or her problem, and stops asking questions. There is a sense of being finished.
  • Increased questions about change.The client asks what he or she could do about the problem, how people change if they decide to, etc.
signs of readiness for change58
Signs of Readiness for Change
  • Resolve.The client appears to have reached a resolution, and may seem more peaceful, relaxed, calm, unburdened, or settled.
  • Self-motivational statements.The client makes direct self-motivational statements.
  • Envisioning.The client begins to talk about how life might be after a change.
  • Experimenting.If the client has had time between sessions, he or she may have begun experimenting with possible change approaches (e.g., going to an A.A. meeting, going without drinking for a few days, reading a self-help book).
research on brief individualized feedback interventions using peers and professionals
Research on brief individualized feedback interventions using peers and professionals
  • With Greek System students, Larimer, et al. (2001) found:
    • Fraternity men in intervention condition decreased drinks per week & peak BAC
    • No change for sorority women
    • Peers were at least as effective at promoting change in drinking behavior as professionals
      • O’Leary, et al. (2002) found peer providers were not as effective for women as were professional providers
the alcohol research collaborative arc
The Alcohol Research Collaborative (ARC)
  • In ARC, for first-year students with at least one heavy drinking episode, compare several approaches, including three brief interventions
    • Peer-delivered BASICS intervention
    • Peer-delivered Alcohol Skills Training Program (ASTP)
    • Web-BASICS
arc assignment to condition
ARC assignment to condition
  • After screening and baseline, 637 students were randomized to a condition of the study
  • 399 participants were randomized to BASICS, ASTP, Web-BASICS or Control
      • 86% completed 3-month follow-up, and 83% completed 6-month follow-up
  • Participant completion rates by condition:
    • Web-BASICS 83.7%
    • BASICS 74.7%
    • ASTP 67.0%
satisfaction ratings
Satisfaction Ratings
  • Overall high satisfaction, with ASTP (M=5.35) & BASICS (M=4.99) higher than web-BASICS (M=4.58)
  • More learned about alcohol in ASTP (M=5.68) and BASICS (M=5.49) than Web-BASICS (M=4.87)
  • Web-BASICS more convenient to participate in (M=5.79) than ASTP (M=4.78)(no difference between groups with convenience of BASICS (M=5.24))
post intervention impressions of peers percentage rating mildly moderately strongly agree
Post-Intervention Impressions of Peers: Percentage rating mildly/moderately/strongly agree
  • Participants agreed presenters seemed…
    • Warm and understanding(90.9% of ASTP; 97.3% of BASICS)
    • Competent and well-trained(97.0% of ASTP; 98.6% of BASICS)
    • Knowledgeable about alcohol use(93.9% of ASTP; 91.8% of BASICS)
    • Well organized(87.9% of ASTP; 93.2% of BASICS)
limitations prior to data analysis
Limitations prior to data analysis
  • Randomization issues (students assigned to BASICS had fewer drinks per week and lower RAPI scores than in other conditions)
  • Outcome variables were skewed, so data were log transformed for analytic purposes
slide65

No time by group interactions for total drinks or negative consequences

    • Specific planned comparisons indicated that BASICS reduced total drinks per week more than control did

Total Drinks per Week

p < .01

slide66

Time by group interaction for peak drinks

    • Significant reductions for ASTP from baseline to 3-mo. and 3-mo. to 6-mo.
    • Significant reductions for BASICS and web-BASICS from baseline to 3-mo.

Peak Drinks per Occasion

p < .01

conclusions
Conclusions
  • Baseline differences make it hard to interpret results
  • Implementing a peer-led intervention is feasible
  • Support for all three interventions reducing peak drinks/occasion; only BASICS significantly reduced total drinks per week
  • Some delayed effects in ASTP
  • Initial reactivity in assessment for controls on peak drinks that failed to be maintained over time
peer therapist training for arc
Peer Therapist Training for ARC
  • Reading packet for facilitators
  • Initial 8 hours of training on alcohol content & clinical technique
  • Practice facilitating with a mock participant volunteer
  • Weekly group supervision
  • Possibility of individual meetings for more practice and supervision
peer therapist training continued
Peer Therapist Training (continued)
  • MITI Coding Team reviews for adherence and compliance assessment
  • Detailed review/feedback written after tape is reviewed by supervisors
  • Peer therapist facilitates only once MITI Coding Adherence is reached
  • While interventions occur, facilitators attend weekly group supervision
  • Facilitators may need to attend an hour individual or pair supervision with an RA during weeks when an session is completed
implementing basics
Implementing BASICS
  • Determining Assessment/Measures
  • Generating Graphic Feedback/Personalized BAC cards
  • Training of providers
  • Supervision/Consultation if needed
    • Therapist drift (issues of fidelity)
    • Need for ongoing assessment and, if needed, training
thank you
Thank You!

Special thanks to Ann Quinn-Zobeck

All the best in your prevention efforts!

Jason Kilmer

kilmerj@evergreen.edu

(360) 867-6775