Young Adults and Drinking : Interventions, Part 2

by National Institute of Health

(Page 4 of 5)

Worksite Employee Assistance Programs. These programs, which have grown in number and use in the past 25 years, provide counseling and treatment at the worksite to workers who are experiencing problems, including problems related to alcohol and other substance abuse. Given the variety of work settings and the types of problems encountered, the format of EAP interventions varies widely. Research indicates that when these programs focus on alcohol problems they can have positive results, enabling participants to reduce their alcohol use, especially when the EAP intervention includes strategies to prevent relapse. About 80 percent of workers who enter EAPs do so on their own initiative. Most are women and are in their late thirties or early forties. Little is known about the use of EAPs by younger adults, who tend not to seek any kind of treatment.

Because most young adults who are not attending college are employed full time, EAPs are a promising context for intervening with those who have developed problems with alcohol. EAPs may be particularly effective with this population if these programs include proactive alcohol screenings to identify these workers. The brief, nonconfrontational nature of BMIs may make them ideally suited for early indicated interventions with young workers who have not yet developed more serious alcohol problems.

DUI Programs. Almost 35 percent of people arrested for driving under the influence are younger than 25 years old, and 10 percent are under age 21. In addition, drivers younger than 21 years of age are at greater risk for repeat DUI arrests than older drivers. Because so many people arrested for drinking and driving are young, DUI treatment programs are a promising context for implementing BMIs. However, standard programs developed for DUI offenders, which range from group educational interventions to individual psychotherapy, require multiple sessions. A comprehensive meta-analysis of 215 studies of DUI programs revealed that standard interventions reduce repeat arrests by 8 to 9 percent, suggesting that DUI offenders can benefit from interventions aimed at changing behaviors. In recent years, DUI programs have increasingly targeted individual client attributes and needs. In one recent study of depressed adults, enhancing standard treatment with personalized feedback reduced repeat DUI arrests by 35 percent.

Prison and Parole Programs. Young adults make up a large proportion of the U.S. prison population: A 1996 survey found that 34 percent of inmates were 24 years old or younger, and 75 percent of State inmates and 31 percent of Federal inmates require substance abuse treatment. As in EAPs and DUI programs, most young adults receiving substance abuse treatment in the prison system receive standard treatments, which might include self-help groups, individual and group counseling, therapeutic communities, and methadone maintenance.

Research indicates that providing substance abuse treatment during both incarceration and parole to those who need it is associated with reductions in criminal activity, substance use, and recidivism after release. Younger parolees who use alcohol and other drugs also are at greater risk of recidivism, and addressing the treatment needs of youthful offenders has been recognized as one of the challenges facing prison alcoholism programs.

Methodological issues have limited the conclusions that can be drawn from research implementing motivational interventions with incarcerated adults. However, several aspects of BMIs recommend their use with young adult offenders. Specifically, lack of motivation to change substance use has been recognized as a primary issue with this population. BMIs explicitly attempt to increase one's motivation to reduce substance use. In addition, the warm, genuine, and empathetic style of motivational interviewing may be more acceptable than a confrontational approach for prisoners and parolees. Furthermore, providing prisoners and parolees with information in a nonjudgmental setting and permitting them to take an active role in the intervention may facilitate reductions in the use of alcohol and other drugs. Indeed, preliminary research with incarcerated young adults indicates that a brief motivational intervention enhanced treatment engagement.

College Students

Much more research has been devoted to developing, implementing, and evaluating BMIs for college students than for nonstudents. In 1999, national concern regarding the widespread adverse effects of heavy alcohol use on college campuses led to the formation of the Task Force on College Drinking, convened by the National Institute on Alcohol Abuse and Alcoholism and consisting of educators, researchers, and students. In a review of the task force's findings, Larimer and Cronce found BMIs to be more effective at reducing alcohol use among college students than other interventions. Therefore, BMIs delivered in one-on-one sessions continue to be developed and implemented for college students engaging in risky alcohol use.

Emergency Departments. Hospital emergency rooms are likely places for identifying alcohol problems among college students as well as nonstudents. In a recent study, students presenting to a hospital emergency room for both alcohol and non-alcohol-related problems were screened for alcohol use. Students who reported an AUDIT score of 6 or greater were invited to receive a brief open-ended counseling sessions. During the session, counselors used motivational interviewing techniques to help students examine their alcohol use and gave them a brochure addressing alcohol-related risks and providing a menu of strategies for reducing those risks. Three months later, these students demonstrated significant reductions in alcohol use, problems, and dependence symptoms, and more than 77 percent of participants viewed the BMI as somewhat or very helpful. Although limited by the lack of a no-treatment control group, findings of this study indicate that BMIs may be an appropriate and effective treatment for college students taken to the ED for alcohol-related injuries.

College Campuses. Six published studies have evaluated BMIs provided to college students who have drinking problems. Baer and colleagues found that alcohol consumption dropped by up to 40 percent among college students who received 1 hour of feedback and advice using motivational interviewing, similar to those who participated in a 6-week skills training group. For both groups, these effects were maintained at the 2-year followup.

Marlatt and colleagues randomly assigned incoming college students who reported binge drinking or problems with alcohol use to a brief intervention or an assessment-only condition. Four-year followup showed that students in the brief intervention group experienced significant reductions in drinking rates and problems associated with alcohol, compared with their own baseline levels and with students in the assessment-only condition. This study produced a manual, Brief Alcohol Screening and Intervention for College Students, describing the brief intervention these researchers used. Borsari and Carey implemented the BASICS approach at a Northeastern university; compared with an assessment-only control group, BMI participants showed significant reductions in alcohol use at 6-week followup.

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.