Brief Interventions with College Student Drinkers: BASICS

1. Brief Interventions with College Student Drinkers: BASICS Jason R. Kilmer, Ph.D. The Evergreen State College Saint Martin’s University

2. 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

3. Spectrum of Intervention Response None Mild Moderate Severe Thresholds for Action Specialized Treatment Brief Intervention Primary Prevention

4. 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

5. 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.

6. The Stages of Change Model (Prochaska & DiClemente, 1982, 1984, 1985, 1986) • Precontemplation • Contemplation • Preparation/Determination • Action • Maintenance

7. 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

8. Motivational Interviewing Basic Principles(Miller and Rollnick, 1991, 2002) 1. Express Empathy 2. Develop Discrepancy 3. Roll with Resistance 4. Support Self-Efficacy

9. 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.

10. 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

11. 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)

12. 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

13. 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

18. Norm Misperception • Examines students’ perceptions about: • Acceptability of excessive behavior • Perceptions about the rates of their peers • Perception about the prevalence of their peers

19. EXPECT Alcohol No Alcohol GET No Alcohol Alcohol

20. • 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

21. 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

22. 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

23. Blood Alcohol Level • .02% Relaxed • .04% Relaxation continues, Buzz develops • .06% Cognitive judgment is impaired • .08% Nausea can appear, Motor coordination is impaired

24. 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

25. 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

26. 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?

27. 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.

28. 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?

29. Alcohol’s Biphasic Effect Euphoria - Up Point of Diminishing Returns + Cultural Myth About Alcohol Feeling Scale 0 After Tolerance Develops __ Dysphoria - Down Time

30. 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

31. Drug Interactions • Potentiation • Antagonistic

32. Areas In Which College Students May Experience Consequences • Academic Failure • Blackouts • Hangovers • Weight Gain • Tolerance • Decisions • Impaired sleep

33. Areas In Which College Students May Experience Consequences (continued) • Finances • Family History • Alcohol-Related Accidents • Time Spent Intoxicated • Relationships • Legal Problems • Work-Related Problems

37. 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

39. 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

40. 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.

41. 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.

42. 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

43. 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

44. 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

45. 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

46. 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?

47. 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

48. 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

49. 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

50. Hypothesis Testing Model