Online prevention of substance abuse among students with eCHUG -D

1. Online prevention of substance abuseamong students with eCHUG-D Marion Laging, Michael Braun, Thomas Ganz, Thomas Heidenreich LisbonAddictions, October 2017

2. Overview • Background • Alcohol consumption among german students • Web-based prevention: Acceptance among students • Research Questions and Results • Adaptation of eCHUG for Germany (eCHUG-D) • Implementation of eCHUG in German Universities • Evaluation of effectiveness of eCHUG-D • Discussion Esslingen University of Applied Sciences

3. Background - Prevalence • Preliminary studies have shown: risky consumption of alcohol is prevalent among students at Esslingen University of Applied Sciences • 2012: n = 783; CAGE-Test • 23.6 % have already felt at least once that they ought to reduce their alcohol consumption • 22.6 % have had felt guilty because of their alcohol consumption • 2013: n = 791; AUDIT-Screening • 44.1 % had a total number of points > 5 • 21.1 % had a total number of points >= 8 • 36 % drink six or more standard drinks at least once a month when the opportunity arises Esslingen University of Applied Sciences

4. Background - Acceptance • Online survey regarding acceptance of prevention programs Esslingen University of Applied Sciences

5. Background - Acceptance • Online survey regarding acceptance of prevention programs n = 575 students of all faculties Esslingen University of Applied Sciences

6. Background - Effectiveness • A meta-analysis regarding the effectiveness of web-based programs: web-based interventions addressing college students drinking, published in „SUCHT“. • Included studies: Studies withRCT-Design, Outcome: drinkingbehavior and drinking problems • 17 studies were identified including7,803 college students • 8 studies evaluated effects until oneyear: 6 of these studies showed effects Esslingen University of Applied Sciences

7. Background Summary • Conclusions: • Several studies indicate that hazardous alcohol consumption is widespread among students • Binge-Drinking and alcohol misuse play a special role • Students favor preventative measures that assure anonymity and do not imply face-to-face contact. • Computer-based offers could be a possible approach matching the expressed preferences of students. Esslingen University of Applied Sciences

8. Adapation, implementationandevaluationofeCHUG-D • The idea of the project (2013-2016), funded by the Federal Ministry of Health, was to bring together online and offline prevention in the university setting: • Offering of an anonymous online prevention program • the Alcohol eCHECKUP TO GO • Low-threshold initiatives have to be conducted to make sure, that drinking behavior is a topic “in real” – not only online: • Peer-counselors approaching and counseling students • Outreach activities (initiatives on campus to communicate the problems associated with risky alcohol consumption and advertise the online program) • Referral to the counseling network (addiction counseling centers) Esslingen University of Applied Sciences

9. Adaptation oftheeCHUG • The Alcohol eCHECKUP TO GO is an online prevention & intervention program, designed by San Diego State University counseling center psychologists, to reduce destructive alcohol use at the individual and population-levels. • Internationally, over 600 campuses are using eCHECKUP TO GO interventions. Esslingen University of Applied Sciences

10. Adaptation oftheeCHUG The setting in San Diego State University (i. a.): • Alcohol consumption under the age of 21 is prohibited in the USA • US universities (have to) take care about their students, cf. legal drinking age • Most of the students live on campus (compulsory for students in the first few semesters) • Violations of university regulations are pursued by the campus police Esslingen University of Applied Sciences

11. Adaptation oftheeCHUG • The setting in San Diego State University (i. a.): • Doing the eCHUG is compulsory for first-year students (freshmen) and mandated students • There are several psychotherapists available via (crisis) hotline for all student problems • Printings of the eCHUG feedback reports are discussed in individual and group meetings when necessary Esslingen University of Applied Sciences

12. Adaptation oftheeCHUG • Contents of the eCHUG: • The feedback is personalized to each student, and provides feedback about their own: • Individual Drinking Patterns • Specific Health & Personal Consequences • Unique Personal & Family Risk Factors • Campus & Community Support and Emergency Services • Students are provided with campus-specific social norms information • Provision of strategies to reduce consumption • Comparison of the student‘s life goals and negative experiences with alcohol Esslingen University of Applied Sciences

13. Adaptation oftheeCHUG • The adaptation was carried out in collaboration with students: • Preliminary study (October 2013) • i. a. collection of data on drinking norms • Focus groups (February 2014) • At five locations: University of Stuttgart, University of Tübingen, Esslingen University of Applied Sciences – Hilltop Campus and City Campus, DHBW Stuttgart • General feedback on the program and suggestions for improvement Esslingen University of Applied Sciences

14. Adaptation oftheeCHUG • Focus group findings: Students‘ wants and needs, i. a.: • Students had difficulties to describe a “typical drinking week” • the acceptance of feedback seems to depend on this • Development, evaluation, and implementation of optional identification of drinking behavior in the eCHUG-D. Esslingen University of Applied Sciences

15. Adaptation oftheeCHUG • How much alcohol do you drink? • The following is about identifying your alcohol consumption. Here, the eCHECKUP TO GO gives you two options to choose between: • Option 1 – if your alcohol consumption does not vary / change during the semester • Option 2 – If your alcohol consumption varies / changes during the semester • You chose option 2. Now you can give details of your alcohol consumption for the three phases: lecture phase / examination & revision phase / lecture-free phase. As these three phases can be different for different students, please indicate how long these phases are in the following section. • Please enter how long each semester phase lasts (1 semester = 26 weeks) • Enter your average alcohol consumption for a typical week in each phase. Breakdown of the semester in weeks Lecture phase 14 weeks Examination/revision phase 6 weeks Lecture-free phase 6 weeks Total: 26 from 26 weeks Esslingen University of Applied Sciences

16. Adaptation oftheeCHUG • Focus group findings: Students‘ wants and needs, i. a.: • German version should adequately reinforce students who are already drinking less. • Adaptation of the feedback on willingness to change – low consumption does not have to be changed. • German version should replace US citations and cite European sources, whenever possible (as well as additional citations and explanations) • Addition of further sources and notes on why certain questions are necessary. Esslingen University of Applied Sciences

17. Adaptation oftheeCHUG:Start Page on Esslingen University Website Esslingen University of Applied Sciences

18. Adaptation oftheeCHUGAdaptation forotherUniversities Esslingen University of Applied Sciences

19. Evaluation of the german eCHUG Hochschule Esslingen

20. Evaluation of the German eCHUG • Randomization after confirmation of informed consent: • assessment only (AO) [n = 514 (52,4%)] • e-SBI (eCHUG-D) [n = 467 (47,6%)] • intervention group only received a link to eCHUG-D • Sample: total baseline included in analyses n = 981 • 3-month follow-up n = 425 • e-SBI [n = 194], AO [n = 231] • 6-month follow-up n = 346 • e-SBI [n = 146], AO [n = 200] • Descriptive statistics: • female: 51.6 %, male: 48.4 % • age: M = 23.29 (SD = 3.05) Esslingen University of Applied Sciences

21. Evaluation of the German eCHUG • Instruments • Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) (Bush, Kivlahan, McDonell, Fihn and Bradley, 1998) • total sample: M = 4.04 (SD = 2.48) • cut-off values ≥ 3 for women, ≥ 4 for men • division in low-risk and at-risk drinkers • Daily Drinking Questionnaire (Dimeff et al., 1999) • overall consumption in previous four weeks: • number of weeks of alcohol consumption • number of standard drinks consumed in each day of typical week • Peak blood alcohol concentration (BAC) • Estimation based on frequency of heavy drinking and maximum of standard drinks • Rutgers Alcohol Problem Index (RAPI) (Arnaud et al., 2016) Esslingen University of Applied Sciences

22. Evaluation of the German eCHUG • Significant effects: • - time, F(2, 457.622) = 4.77, p < 0.01 • - treatment, F(1,1058.312) =6.73, p ≤0.01 • - time x treatment interaction, F (2, 457.91) = 5.65, p < 0.01 • significant after both three months and six months Compared to AO, e-SBI group reported consuming fewer standard drinks - after 3 months: 4.11 - after 6 months: 4.78 Esslingen University of Applied Sciences

23. Evaluation of the German eCHUG • We found positive significant between group effects on students’ drinking behavior (after three and six months), supporting the eCHUG-D program. • Compared to AO condition, e-SBI group reduced alcohol consumption per week by approximately 1.2 standard drinks. • Evidence on and knowledge of web-based e-SBIs based on US college student samples is transferable to German university students of legal drinking age. Esslingen University of Applied Sciences

24. Discussion • The german eCHUG is an online prevention program, adapted to the living environment of students in German-speaking countries. • Research consistently demonstrate that the eCHUG (as well the eCHUG-D) significantly reduces students’ drinking and risk-taking behaviors • The eCHUG-D is a very economical intervention • In an RCT, alcohol consumption of students in eCHUG was reduced signifcantly stronger than in assessment only (1.2 standard drinks per week) Esslingen University of Applied Sciences

25. Discussion:Sustainability and Dissemination • Implementing prevention programs in universities requires changes in the setting. • For effective measures to be sustainably disseminated, this must be carried out proactively. • For prevention programs to be successfully implemented, they have to be adapted to local conditions. Universities should receive advice and supervision in this process. Esslingen University of Applied Sciences

26. Thank you very much for your attention! • Esslingen University of Applied Sciences – Project Team • Prof. Dr. Marion Laging • Prof. Dr. Thomas Heidenreich • Michael Braun, M.A. • Thomas Ganz, Dipl.-Psych. • Cooperations Esslingen University of Applied Sciences