Young Adults and Drinking : Brief Interventions

by National Institute of Health

(Page 3 of 5)

Traditional alcohol education programs, which provide information about the risks of alcohol use, have been implemented in a variety of ways (e.g., individual sessions, lectures, multisession groups). However, these approaches have not resulted in drinking reductions in either nonstudent or student populations. Given the variety of drinking patterns evident in the young adult population and the minimal effect of traditional alcohol education programs, more targeted, systematic approaches are needed to help young adults recognize and reduce their hazardous drinking.

Young adults engaging in risky levels of alcohol use may respond more favorably to brief, more intensive interventions than to traditional longer-term treatments, which originally were designed for adults with longer histories of alcohol use and alcohol-related problems. The precise definition of what constitutes a "brief intervention" has been the source of some debate. Typically, brief interventions consist of one to four sessions with a trained interventionist (e.g., physician, psychologist, social worker), with each session ranging from 30 minutes to an hour. A recent meta-analysis of 34 studies found that people being treated for problems other than alcohol use (i.e., non-treatment-seeking participants) who received such brief interventions consistently showed greater reductions in alcohol use than did those assigned to no-treatment control groups. Among people seeking treatment for alcohol use, brief interventions and extended treatments (consisting of five or more sessions) were associated with similar reductions in alcohol use. Overall, the findings indicate that brief interventions can be an effective way to reduce drinking, especially among non-treatment-seeking people who do not have severe drinking problems that would require more intensive treatment.

A brief intervention that includes motivational interviewing is called a brief motivational intervention (BMI). BMI is a collaborative method that makes use of reflective listening and empathy as well as specific techniques (e.g., asking key questions, anticipating the future) to enable clients with alcohol-related problems to explore and resolve their ambivalence about reducing their alcohol use. This combination of reflective, empathic listening and specific techniques for change is known as motivational interviewing (MI). (Motivational interviewing is a client-centered counseling style to help clients change their behavior by enabling them to deal with their ambivalence about the change. MI can be either directive [e.g., when selectively eliciting and discussing possible change] or nondirective [e.g., when exploring ambivalence and maintaining a neutral stance regarding the person's options].) Interventions that use MI and incorporate other components are known as "adaptations of motivational interviewing" (AMIs). Brief motivational interventions can be considered AMIs, as they often involve giving the client individualized feedback regarding his or her drinking and the risks associated with it.

In a meta-analysis of the clinical impact of BMIs on alcohol and marijuana use, Burke and colleagues found that 51 percent of clients who received BMIs reduced their substance use, compared with 37 percent of those who received assessment only or treatment as usual. For alcohol use specifically, BMIs showed large effects (average d = .82), with participants reducing their alcohol use by 56 percent following a BMI. BMI effects also were maintained over time (as long as 4 years after treatment), even though BMIs took less time than the interventions with which they were compared.

BMIs are intended for people who do not have detectable signs or symptoms of a diagnosable disorder; as such, they can be considered "indicated preventive interventions". People who are experiencing more severe problems probably require more intensive treatment. Many BMIs have been effective in reducing alcohol use among nondependent adult drinkers, which suggests that they could be successfully implemented with young adults.

Nonstudents

Although a significant percentage of young adults who are not college students engage in risky drinking and experience its consequences, BMIs have not yet been implemented extensively with this population. Several contexts appear promising for administering BMIs with young adults.

Emergency Departments. Hospital emergency departments are perhaps the places where young adults with drinking problems are most commonly identified. A study of 250 18- and 19-year-old patients in an urban ED found that nonstudents were at risk for alcohol use and problems, and that older adolescents tended to be more experienced drinkers.

Fortunately, several studies have shown BMIs to be effective interventions with young adults who sought medical treatment in hospital emergency departments. Monti and colleagues randomly assigned 18- and 19-year-old ED patients to receive either BMI or standard care, which consisted of a handout on the hazards of drinking and of driving after drinking. During the intervention, a treatment provider assessed the participant at bedside with the help of a laptop computer that provided immediate personalized feedback on the participant's drinking behavior. In addition to discussing this feedback, during the BMI the clinician and participant focused on the participant's perceptions of norms regarding alcohol use; perceptions of the pros and cons of drinking, drinking and driving, and other alcohol-related risk behaviors; and expectations about alcohol use. The clinician also provided educational material about drinking. Followup data collected for 94 of the participants 6 months after the intervention demonstrated that the BMI group had significantly fewer alcohol-related injuries, traffic violations, and other alcohol-related problems than the standard-care group.

A more recent study added two booster sessions to the BMI and compared this treatment with a feedback-only condition, which consisted of patients receiving the same baseline assessment and computer- generated personalized feedback sheet as did patients receiving a BMI. With participants receiving feedback only, counselors briefly stated that the sheet provided information from the assessment, but there was no further discussion. Two hundred and fifteen young adults were recruited into this trial. Results at 12 months show significant differences on several drinking variables such as number of drinking days and number of heavy-drinking days as well as on average blood alcohol concentrations, but no differences in alcohol-related consequences such as alcohol-related injuries and drinking and driving.

The results of these two studies show that emergency departments afford a unique opportunity to provide effective BMIs to young adults who engage in risky drinking.

About the Author

NIH is the nation's medical research agency - making important medical discoveries that improve health and save lives. The National Institutes of Health (NIH), a part of the U.S. Department of Health and Human Services, is the primary Federal agency for conducting and supporting medical research.