Young Adults and Drinking : Interventions, Part 3

by National Institute of Health

(Page 5 of 5)

Three more recent evaluations compared BMIs with other active interventions. Murphy and colleagues compared a BMI with an assessment-only condition and an individualized educational intervention that consisted of watching a video detailing alcohol-related risks. Although participants in the three conditions showed no overall significant differences in alcohol use at the 3- and 9-month followups, BMI participants who drank 25 or more drinks per week reduced their weekly alcohol consumption and binge drinking by greater amounts than did heavy drinkers in the other two groups.

In a study of college fraternity members, Larimer and colleagues compared (a) a one-on-one BMI paired with a 1-hour group feedback session provided to the whole fraternity with (b) a 1-hour didactic presentation on alcohol use, with no personalized feedback. At the 1-year followup, students who had received the BMI reported greater reductions in average use and self-reported typical peak blood alcohol content. No reductions in alcohol-related consequences were observed.

Finally, in a study of heavy-drinking college students, Murphy and colleagues provided personalized feedback with or without a motivational interviewing session. A 6-month followup revealed significant, small-to-moderate reductions in alcohol use, but no differences between the groups and no change in alcohol-related problems for either group.

Overall, this research indicates that personalized feedback and motivational interviewing appear to influence changes in drinking behaviors and, to a much lesser extent, alcohol-related problems.

Mandated Students. Mandated students are students who have violated campus alcohol policies. Given that these students are often the heavier drinkers on campus, several projects using BMIs with mandated students have been implemented in the past 5 years. For example, Borsari and Carey randomly assigned mandated students to receive either a 60- to 90-minute motivational interview or a 60- to 90-minute alcohol education session in which the student was provided information about alcohol and its effects. Following their referral incident, all eligible participants had continued to binge drink (defined as having had two or more binge-drinking episodes in the past month). At 3- and 6-month followups, both treatment groups demonstrated significant drinking reductions, with BMI students reporting significantly fewer alcohol-related problems than the alcohol education students at the 6-month followup.

Recently, adaptations of BMIs for mandated students have been developed. For example, BMIs incorporating booster sessions have been compared with a 45-minute interactive computer program that provides the student with information about the effects of alcohol and the risks associated with excessive alcohol use. In addition, students in both conditions were randomly assigned to receive booster sessions 1 month after the intervention. The booster sessions were a shorter version of the original intervention, lasting 25 to 30 minutes. Reductions in alcohol use were evident in both groups at a 3-month followup, suggesting that both approaches may be valuable in reducing drinking in mandated students. In addition, students who received a BMI with a booster session were most likely to seek further assistance, suggesting that face-to-face contact in BMI may facilitate problem recognition in mandated students.

Another BMI adaptation involves the active participation of a peer of the mandated student in the intervention. This peer, selected by the mandated student, also receives personalized feedback about his or her own alcohol use and supports the student's goals for reducing hazardous alcohol use. Although this study did not include a control condition, results indicated that students receiving peer-enhanced BMIs reported reductions in alcohol use similar to those reported by students receiving standard BMIs.

Taken together, these findings demonstrate the flexibility of BMIs and indicate that they are an effective option for campus alcohol programs intended to reduce heavy episodic drinking in mandated students.

Conclusions

Excessive alcohol use among young adults is a major public health concern. Although drinking among college students has received the most research attention, it is a problem among noncollege students as well. Young adults in both groups rarely identify themselves as problem drinkers, which suggests that proactive screening approaches may be warranted. Several screening methods recently have proven effective and deserve further research attention.

Most interventions studied with young problem drinkers have incorporated BMIs. Promising contexts in which to implement BMIs with nonstudents include hospital EDs, EAPs, DUI programs, and prison- and parole-based programs. Among college populations, where more research on BMIs has been conducted, outcomes are impressive. Convincing results have been obtained for BMIs with students whose alcohol problems were identified in emergency departments and with students from the general college population who were identified as having drinking problems. In general, findings suggest that personalized feedback and motivational interviewing influence change in drinking variables and, to a lesser degree, in alcohol-related problems. Results with students mandated to alcohol treatment demonstrate the effectiveness of BMIs in reducing heavy episodes of alcohol use and alcohol-related problems.

BMIs have been implemented in a variety of contexts, with varying ranges of alcohol use and problems, and with both treatment-seeking and non-treatment-seeking populations. The flexibility and effectiveness of BMIs make them a promising component of stepped care, in which people first are assigned to the least restrictive, intrusive, and costly treatment that has a good chance of success and, if they do not respond to this initial level of treatment, are provided more intensive care. Thus, BMIs could address different degrees of alcohol use and problems by serving as a stand-alone intervention for people with less severe alcohol problems or as an initial screening and intervention tool for people who will require more intensive treatment.

Despite the promise of BMIs, further research is needed to determine precisely how these interventions facilitate behavior change. For example, which interviewer and client in-session behaviors are related to change? Furthermore, does the inclusion of significant others or peers enhance the BMI session for the participant? If so, what is the responsible mechanism? Addressing these and other research questions likely will improve the efficacy of BMIs in addressing alcohol use and problems in young adults.

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.