"College drinking is one of those cases where the majority of harms or alcohol-related problems that accumulate on a campus can be attributed not to the relatively small number of really problematic drinkers, but to the majority of moderate drinkers because there are so many of them," says Kate Carey. (Credit: Harlan Harris/Flickr)

To cut drinking for college freshmen, double up on interventions

Combining interventions can help curtail drinking among college freshmen at risk for alcohol-related problems, according to a systematic review of more than 40 studies documenting 62 interventions.

Based on those findings, a new study recommends that colleges screen all freshmen within their first few weeks on campus for alcohol risk and offer effective combinations of interventions for those who report drinking.

“Adoption of our recommended strategies would enable colleges to become more proactive—that is, targeting interventions to those students who have initiated alcohol use and may experience some alcohol-related problems but before their alcohol use meets criteria for alcohol dependence or abuse,” says Lori Scott-Sheldon, assistant professor of psychiatry and human behavior (research) at Brown University and a researcher in the Centers for Behavioral and Preventive Medicine at the Miriam Hospital.

Even the best interventions studied don’t completely stop freshmen from drinking, but even “small effect sizes” can have a large impact when implemented broadly, a phenomenon known as the “prevention paradox.” Small changes on the individual level sum to large effects on the population of students on a campus.

“College drinking is one of those cases where the majority of harms or alcohol-related problems that accumulate on a campus can be attributed not to the relatively small number of really problematic drinkers, but to the majority of moderate drinkers because there are so many of them,” says Kate Carey, professor of behavioral and social sciences.

“Thus small effect sizes mean that any given person may change just a little as a result of an intervention, but when we expand the effects to the whole freshman class we would expect prevention programs like those we reviewed to have a public health impact.”

Best results

In the analysis, published in the Journal of Consulting and Clinical Psychology, researchers examined the efficacy of 62 interventions delivered in randomized, controlled clinical trials involving more than 24,000 freshmen around the country during the last decade. They looked for patterns emerging from these trials that would reveal which interventions reduce drinking amount and frequency and reduce alcohol-related problems.

The single technique that provided the broadest benefits was providing students with a personalized feedback report that can include details such as how self-reported drinking compares to peers, the financial cost of alcohol consumed, the calories consumed, and sometimes even blood-alcohol levels.

Laying out this kind of information significantly helped students reduce the dimensions of drinking frequency, quantity, and alcohol-related problems.

In general, however, the researchers found that different intervention techniques affected different things.

For example, challenging students’ alcohol-related expectancies—for instance by sorting out what popular aspects of drinking are really related to alcohol as opposed to the social context of partying—significantly reduced the incidence of alcohol-related problems, but didn’t significantly affect alcohol quantity, frequency of drinking days, or frequency of heavy drinking.

More are better

Interventions that combined several techniques proved most effective because they accumulated the differing efficacy of the multiple techniques.

“Interventions with four or more components . . . were the most effective at reducing first-year students’ alcohol consumption and alcohol-related problems,” the study reports.

The intervention they recommend for would combine personalized feedback, moderation strategies (e.g., alternating alcoholic beverages with non-alcoholic beverages), goal setting (e.g., setting blood alcohol level limits), and identifying especially risky situations (e.g., fraternity house parties).

Widespread screening and multi-technique interventions would be novel for many colleges, the researchers say. Studies have found that most colleges offer only alcohol education (which was not especially effective), and only half offer personal feedback and moderation strategies to all students who request or are referred to intervention.

Tailored interventions

Results indicate that widespread screening and multi-technique interventions are feasible.

With the exception of affecting the frequency of heavy drinking, interventions were similarly successful whether they were delivered individually or in groups, and whether they were provided in person or online (for heavy drinking in-person interventions were better).

Although the response of students varied somewhat by gender and race for a few specific aspects of drinking, interventions were generally similar in efficacy across gender and race, meaning that interventions don’t have to be finely tailored for many different groups.

The broad efficacy of interventions combined with the relative low cost and ease of delivering them mean that colleges have worthwhile means at their disposal to make a greater impact on freshman drinking.

“(Our) recommendations are relatively inexpensive, but would require allocation of more resources to alcohol prevention than is generally allocated on most campuses now,” Carey says.

“But what is rarely discussed is the cost of not investing in these prevention measures: continued property damage, maintenance, security and emergency transport expenses associated with alcohol misuse, or student assaults and injuries.”

Researchers from Columbia University and the University of Houston contributed to the study, which was funded by the National Institute on Alcohol Abuse and Alcoholism.

Source: Brown University

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