Addressing Risky Drinking by Male College Students Through Screening and Brief Interventions

1. Addressing Risky Drinking by Male College Students Through Screening and Brief Interventions Arthur J. Lurigio, Ph.D. College of Arts and Sciences Susan Cushman, MPH, CHES Wellness Center Molly K. Pachan, M.A. Department of Psychology Loyola University Chicago

2. U.S. Department of Education Grant Award Amount: $292,000 (2 years) Ranked 4th out of 128 submissions (NIAAA inspired) Original Project Team: Diane Asaro, MSN, RN; Susan Cushman, MPH; Alissa Eischens, MPH; Arthur J. Lurigio, Ph.D. Collaboration between Student and Academic Affairs Grant Overview

3. Philosophical/Practical Underpinnings • Powerful Endorsements: Vice President, Deans, Director • University’s Message in the Making: Choice. Control. Character. • Encouraging prudent decisions about drinking • Supports University’s Longstanding Goal: Reduce harm from alcohol–academic, physical, social, emotional, or legal–for students who drink and those around them. • Safety Net Committee

4. Three Major Components of Grant • A program of proactive screening and brief interventions for male, first-year students (individual component) (BASICS based) • Strategic engagement of faculty, staff, and parents in alcohol misuse prevention efforts (campus component) • Assessment of local environmental factors that either support or discourage high-risk drinking among students (community component)

5. Each year: 1,700 deaths 599,000 injuries 696,000 assaults 97,000 sexual assaults Unsafe sex: 400,000 unprotected; 100,000 unable to consent Other: Vandalism Academic problems Abuse and dependence Alcohol-Related Harmamong 18-24 Year-old College Students in US * National Institute on Alcohol Abuse and Alcoholism, 2007

6. 29% of undergrads typically don’t drink. Most students (65%) have 0-4 drinks on a night out. Most students (89%) drink twice a week or less. Most students (59%) do not drink to the point of impairment, i.e., eBAC <.08%. 2009 Loyola Core AOD Survey and Nat’l College Health Assessment Good News: Loyola Students & Alcohol

7. Not So Good News: Loyola Students & Alcohol • About 7 in 10 students drink alcohol • 40% to 50% drink heavily • 41% of those who reported drinking were legally impaired (i.e., eBAC >.08%) the last time they partied • 18% drink 3 or more nights/week 2009 Loyola Core AOD Survey and Nat’l College Health Assessment

8. 32% have had studying interrupted 30% missed a class 21% performed poorly on test 38% had memory loss/black-out 16% were hurt or injured 38% engaged in public misconduct 2008 Core AOD Survey, n=1,346 LUC undergraduates Implications for Academics,Health & Safety

9. Blacked out (37%) Regrets (32%) Missed class (14%) Performed poorly on test/project (12%) Drinking- or Drug-Related Problems forFirst-Year LUC Students Source: 2008 Core Alcohol & Other Drug Survey; n=372 LUC freshmen

10. Argument or fight (25%) Hurt or injured (18%) Unprotected sex (7%) Drinking- or Drug-Related Problems forFirst-Year LUC Students Source: 2008 Core Alcohol & Other Drug Survey; n=372 LUC freshmen

11. A Proactive, Stepped-Care Approach 3. Referral for Counseling 2. Motivational Intervention (MI) for ‘at-risk’ students 30-45 minutes 1. Screening & Brief Advice (SBA) 10-15 minutes

12. Screening Using the AUDIT (5 min.) Graduate Student Facilitators Recruitment Strategies Standard Messages (up to 10 min.) If high-risk, invite student to participate in motivational interviewing. Screening & Brief Advice in Residence Halls

13. Student’s Reflections on Screening & Brief Advice Session Personalized feedback Frequency & quantity, peak BAC Comparison to LUC first-year males Misuse/Abuse/Dependence Negative consequences Confidence and Importance Rulers Readiness to Change Referral (if indicated) Next steps (What? How?) Motivational Interviewing

14. Screening Results

15. High Risk versus Low Risk Students

16. 291 Screened (39%) Student Participation LOW-RISK n= 124 (43%) AT-RISK n= 167 (57%) Completed MI n= 69 (41%) Decline or No-Show MI n= 98 (59%) Compare those who did not attend the MI… Posttest did not match pretest ID n= 60 Pretest and Posttest were matched, No MI n= 38 Pretest and Posttest were matched n= 31 Posttest did not match pretest ID n= 38 …to those who completed the MI

17. Major Research Questions and Design • Did at-risk, first-year, male participants change from pretest to posttest on study’s outcome measures? • How did at-risk, first-year, male students who received brief advice only compare with those who received brief advice + MI?

18. A Repeated Measures MANOVA Tested main effects across time (pretest, posttest, and follow-up) for all first-year, at-risk, male students who attended the brief advice session alone and the brief advice and MI sessions. Tested interactions across time (pretest, posttest, and follow-up) by comparing those who did not attend the MI session (no MI, brief advice-only) with those who did attend the MI session (brief advice and MI). Analytic Procedure

19. Students’ Reactions to 45-minute MI Intervention • 82% of students’ comments about the MI were positive. • “It was helpful to receive the BAC sheet and it was nice to have a facilitator that understood and helped me.” • “Very helpful, actually – I thought that some of the stats were good and did not feel attacked like I sometimes do with these things.” • “It made me realize that I drink a lot and that it isn't good. I will stop drinking, well not stop, but much less.” • Most students found the MI session to be informative, non-threatening, and well-run.

20. Facilitator-related comments: Felt that the facilitator answered their questions (96%) Felt at ease (100%) Felt that the facilitator understood them (97%) Felt that the facilitator was telling them what to do (3%) Intervention-related comments: Raised questions not previously considered (59%) Believe that others at LUC would benefit (93%) Thought the session was of no help (21%) Favorable Responses to Facilitators and Content

21. Both brief advice-only and brief advice + MI groups changed on the outcome measures from pretest to posttest. No statistically significant differences were found on the between-group comparisons (MI vs. no MI.) Overall Effects of Brief Advice and Motivational Interviewing

22. Specific Effects of the Interventions

23. Frequency of Binge Drinking

24. Number of Drinks Per Week

25. Results at follow- up demonstrated that some of the improvement shown at post-test was lost over time. However, MI group showed steeper declines at both post-test and follow-up. Effect of the MI intervention on Drinking: Pre/Post/Follow-Up

26. Confidence to change at post-test shows a non-significant trend, which was reversed at follow-up. Confidence to Change: Pre/Post/Follow-Up

27. The study examined self-reported consequences of drinking within the past 30 days. Less Serious: missed a class, did something that was later regretted, forgot where you were or what you did, felt bad about yourself. Serious Personal: performed poorly on a test, been hurt or injured, unplanned sex, unprotected sex. Public Misconduct: arguments, physical altercations Consequences of Drinking

28. Did negative consequences of drinking diminish over time for all at-risk participants? Did the MI intervention affect students’ self-reported, drinking-related consequences above and beyond the brief advice-only intervention? Research Questions: Consequences of Drinking

29. Consequences of Drinking In general, reported consequences of drinking decreased over time for both groups.

30. Less Serious Consequences

31. Serious Personal Consequences

32. Public Misconduct Consequences

33. All at-risk students reported reductions in negative consequences over time. At posttest, greater improvements were found in the MI group, compared with the no-MI group, on the less serious, more serious personal, and public misconduct measures. The only difference at follow-up was on less serious consequences. No statistically significant differences or interactions were found but trends are notable. Summary: Consequences of Drinking

34. LUC proactively and successfully screened freshman males for at-risk drinking behavior. A sizable portion of at-risk drinkers (41%) completed a Motivational Interviewing Session. Students' evaluations of the MI intervention’s facilitators and content were overwhelmingly positive. Possibly built positive rapport with Wellness Center staff. (We did not test this, but infer it from students’ favorable experiences in the MI session). Conclusion 1: Intervention Was Well-Received

35. Freshman males who reported at-risk drinking behaviors and attended the brief advice/MI sessions reported significant reductions in drinking behaviors as well as the negative consequences of drinking. Most of these gains diminished at follow-up, but they still represented marked improvements over the pretest measures. “Therapeutic alliance" between one health educator and one student has unique and intangible potency. Conclusion 2: The Brief Advice Intervention/MI Overall Were Effective

36. Brief advice was enough to change student behavior. The MI was not an effective or a value-added intervention. At-risk students who declined the MI did not need any additional intervention. Maturation could account for pre-post changes. History could account for pre-post changes. (Other LUC interventions were also being implemented.) The MANOVA had too few at-risk participants to demonstrate MI’s effectiveness (Low Power) Conclusion 3: Both Groups (MI/non-MI) Changed

37. Groups were self-selected, not randomly assigned. No control group was used to assess the brief advice-only, MI only, or brief advice/MI interventions. Recruitment of participants was limited by population size and time. Attrition was high. (Not permitted to contact participants to remind them of MI appointment.) Sample size was too small to detect significant results. Self-report measures are unreliable. (BAC) Limitations

38. Studies should employ random assignment, control groups, and longer follow-up periods. To Whom? How Long? How Often? Booster sessions should be tested to determine if they produce longer-term results. Replications with larger sample sizes and a greater variety of students should be undertaken. Replications in other schools at LUC and in other AJCU schools would be useful. Future Research