Talking with College Students about Alcohol

1. Talking with College Students about Alcohol Scott T. Walters John S. Baer

2. What’s Happeningon Campus?

3. Ways to Measure Drinking • Standard Drinks • Quantity • Frequency • Heavy Episodes • Drinking-Related Consequences

4. Do College Students Drink More Than Other Young Adults? • Yes! • Young adults tend to accelerate drinking upon entrance to college. • Young adults enrolled in college drink more than those not enrolled. • In high school, college-bound students drink less than their non-college-bound peers, but their drinking accelerates upon college matriculation.

5. Has College DrinkingGotten Worse? • Maybe, maybe not … • Rates appear to be stable over the last 20 years. • There is some evidence of a “polarization” of drinking over the last decade. • Since the 1950s, heavy drinking rates have increased greatly for women, somewhat for men.

6. Does Drinking Vary from College to College? • Yes! • By region—Southern schools, the lowest; Northeast schools, the highest • Campus factors—Males, younger student body, residential, “Greek” system, white students • Campus and community norms can generate a “party school” reputation.

7. How Different Is College Drinking from Older Adult Drinking? • The majority of students reduce heavy-drinking episodes after leaving college. • Heavy drinking becomes less common, but daily drinking doesn’t decline much. • Heavy episodes are still relatively common among otherwise moderate-drinking adults.

8. What Isn’t Said • Not every student drinks heavily—one-third don’t drink at all; many others drink moderately. • Not all heavy drinkers drink frequently—19% drink heavily and frequently. • Heavy drinking in college, for the most part, does not lead to chronic problems later in life.

9. What Do Students Think about Drinking? • In general, students are less concerned about alcohol than older community members. • Some amount of alcohol-related consequences is tolerable to most students. • Most students have mixed feelings about alcohol but see drinking as a normal college experience.

10. Responding to College Drinking

11. What Causes Alcohol Problems? • Models help explain why people drink in ways that cause problems. • Beliefs about etiology may also determine a problem-solving approach. • Models include moral, spiritual, disease process, genetic, biology, learning history, character, and society and culture. • The public health model looks at the problem broadly, taking into account agent, host, and environment.

12. What Factors Influence Drinking during College? • Demography—male, white, or belong to a fraternity, sorority, or athletic team • Personality—more impulsive, depressed, or social • Environment—permissive norms and easier access to alcohol • Genetic factors are not strongly related to drinking during college. • Individual and environmental factors may interact.

13. How Does Development Relate to Drinking? • “Emerging adulthood” stage, ages 18–25 • College drinking is a window of risk. • Drinking may help students to act and feel independent. • Drinking may help to manage stress of life transitions. • Most students reduce risky use over time (especially after graduating).

14. What Makes People Change? • Most people change drinking habits without formal assistance, even those with more severe problems. • When students change, they usually do so on their own; they don’t ask for help. • Change does not usually occur all at once. For most, it’s a gradual process. • “Stages of change” describe how people progress in thinking about change.

15. The “Stages-of-Change” Model Change tends to happen in predictable stages: • Precontemplation • Contemplation • Preparation • Action • Maintenance

16. Implications for Intervention • Effective interventions move students along stages of change and target stage-specific needs. • Programs that address only one risk factor, assume readiness for change, or tell students what to do will be less effective. • Effective interventions are developmentally appropriate and target multiple risk factors.

17. Which InterventionsReduce Drinking? • Effective with college students: • Cognitive-Behavioral Skills Training • Motivational Counseling Approaches • Alcohol Expectancy Challenges • Program length unrelated to outcome—in some cases the briefest show excellent outcomes. • National Institute on Alcohol Abuse and Alcoholism (NIAA) Task Force Report Tiers

18. NIAAA Task ForceReport Findings • Effective in General Population • Minimum-age laws, retail restrictions, DWI enforcement, increased price, beverage-service policies, campus–community coalitions • Promising Prevention Approaches • Alcohol-free residences, banning alcohol at alumni and faculty events, alcohol policy enforcement, and social norms campaigns. • Ineffective Prevention Approaches • Informational, knowledge-based, values clarification, or providing BAC feedback—when used alone.

19. How Does Brief Counseling Fit In? • Individual and group interactions can help in formal and opportunistic settings. • Can be structured to leave a lasting impact. • Can support other prevention and intervention efforts. • Techniques not only for therapists in counseling centers but also for “nonspecialists” and concerned others.

20. Assessing Drinkingand Related Behaviors

21. Why Assess Drinking? • Helps us direct students to appropriate services • Allows us to tailor how we might best intervene • Sincere and candid questions show the student that we care

22. How Much Time Is Available? Kind and number of questions depend on available time and purpose of contact. • Brief (1–5 minutes) • Moderate (5–15 minutes) • Lengthy (>15 minutes)

23. Purpose of Assessment • Brief (1–5 minutes): Assess key patterns of use and risks to support brief advice • Moderate (5–15 minutes): Assess more dimensions to support longer consultations • Lengthy (>15 minutes): Assess details of use and consequences to support counseling and feedback sessions

24. Alcohol Consumption • Brief (1–5 minutes): Quantity–Frequency Questions • Moderate (5–15 minutes): Daily Drinking Questionnaire • Lengthy (>15 minutes): Time Line Follow-Back

25. Negative Consequences • Brief (1–5 minutes): College Alcohol Problems Scale—Revised (CAPS-r) • Moderate (5–15 minutes): Young Adult Alcohol Problems Screening Test (YAAPST; 20-items) • Lengthy (>15 minutes): 20-item YAAPST

26. Alcohol Screening • Brief (1–5 minutes): Alcohol Use Disorders Identification Test (AUDIT) (AUDIT-C; first three questions from the AUDIT) • Moderate (5–15 minutes): AUDIT • Lengthy (>15 minutes): AUDIT

27. Motivation • Brief (1–5 minutes): Importance and Confidence Rulers • Moderate (5–15 minutes): Readiness to Change Questionnaire (RTCQ) • Lengthy (>15 minutes): RTCQ

28. Alcohol Expectancies • Moderate (5–15 minutes): Comprehensive Effects of Alcohol Scale (CEOA) • Lengthy (>15 minutes): Comprehensive Effects of Alcohol Scale (CEOA)—full version

29. Family History of Alcoholism • Brief (1–5 minutes): “Number of blood relatives” question • Moderate (5–15 minutes): “Number of blood relatives” question • Lengthy (>15 minutes): Family Tree Questionnaire (FTQ)

30. Conclusions • Regularly screen students for alcohol use and problems. • A few key questions can be asked in fewer than 3 minutes. • Select measures that are based on available time and purpose of contact. • Discuss alcohol use without judgment or embarrassment. • Use an open, honest, and calm assessment style.

31. Style of the Interaction

32. Motivation and Change • Motivation is malleable, rather than fixed. • Provider, student, and the interaction between them all influence desire to change. • Motivation includes components of estimated importance of change and confidence in ability. • How you talk to a student about alcohol makes a difference.

33. What Is Motivational Interviewing? Motivational interviewing (MI) is a person-centered, directive method of communication for enhancing intrinsic motivation to change by exploring and resolving ambivalence. From Miller and Rollnick (Motivational Interviewing, Guilford Press, 2002)

34. Motivational Interviewing • Person-centered—Each student has the capacity and responsibility for making choices in how to behave. • Directive—Counselor guides the conversation in a particular direction to influence outcome. • Ambivalence—Students have mixed feelings about alcohol.

35. Principles of Motivational Interviewing • Express Empathy • Develop Discrepancy • Roll with Resistance • Support Self-Efficacy

36. Simplified Motivational Categories

37. Working with Motivation • Listen for the two dimensions of motivation—importance and confidence. • Tailor plans based on importance and confidence. • Most students are in Group 3—they think they could (or will) change but aren’t interested at this time.

38. Core Techniques: “OARS” • Open-Ended Questions • Affirm • Reflect • Summarize

39. Ask Open-Ended Questions Ask questions that have more than one possible answer; encourage student to think about and elaborate on concerns. • “Tell me a little bit about your drinking.” • “What are some things that you like about your drinking? Don’t like about it?” • “Tell me about a recent time where you had too much to drink.” • “In what situations is it hardest for you not to drink?”

40. Affirm the Person Talk about positive things the student has done or intends to do. • “Thanks for talking to me today.” • “You bring up a good point.” • “You certainly see a number of areas where drinking is affecting your schoolwork.” • “That’s a good idea.” • “You really do want to do the right thing here.”

41. Listen Reflectively • Listen to the student and reflect back what he or she said, verbally and nonverbally. • Use reflections to roll with resistance, highlight something, or encourage more talk like it. • Initiate conversation with an open question and reflect the response. • Try to use more reflections than questions.

42. Kinds ofReflections • Repeat—Repeat an element of what the student said. • Rephrase—Restate content using different words. • Emotive—Paraphrase the emotional dimension using feeling statements, metaphor, and the like. • Double-Sided—Make explicit a contradiction or mixed feelings.

43. Examples of Reflections

44. Summarize Feed back information to let students hear what they have been saying and that you understand what they have said. • “Let me pull together what you’ve said and you can tell me if I’ve missed anything.” • “What I see you saying so far is that . . .” • “You said . . .” “You thought that . . .” • “Is that a pretty good summary? Did I miss anything?” • “We’ve talked about . . .”

45. Change Talk: What to Look For • Discomfort/disadvantages of status quo • Consequences, personal concerns, others’ concerns • Advantages of change • Good things (or reduction in negatives) about change • Optimism/ability to change • Personal resources, skills, confidence • Intention/commitment to change • What change would look like; concrete or hypothetical plans

46. Eliciting Change Talk • Ask the student about his or her concerns, or share your own. • Provide nonjudgmental feedback or information. • Look for signs of discomfort with the status quo; interest in or ability to change. • Use reflections, questions, and summaries to draw out “change” talk.

47. Brief Individual Interactions

48. What Motivates in Brief Interactions? • Quick arguments or advice are rarely persuading. • People become more committed to an idea they feel they have authored. • The style of the interaction—concern, empathy, and reflective listening—predicts outcome.

49. Broaching the Subject • Share your concerns • “I noticed that . . . I wonder if . . . ” • Use clear language and specific examples. • Avoid pejorative terms. • Do not assume initial readiness. • Ask about the student’s own concerns • “What concerns do you have about your . . .?” • Include a screening or checklist.

50. Giving Advice and Suggestions • Ask for permission. • “There’s something that concerns me. Would it be okay if I asked you about . . .?” • Preface advice with permission to disagree. • “This may or may not apply to you, but . . .” • Give a small amount of essential information. • “The main thing I’m concerned about is . . .”