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Talking with College Students about Alcohol

Talking with College Students about Alcohol. Scott T. Walters John S. Baer. What’s Happening on Campus?. Ways to Measure Drinking. Standard Drinks Quantity Frequency Heavy Episodes Drinking-Related Consequences. Do College Students Drink More Than Other Young Adults?. Yes!

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Talking with College Students about Alcohol

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  1. Talking with College Students about Alcohol Scott T. Walters John S. Baer

  2. What’s Happeningon Campus?

  3. Ways to Measure Drinking • Standard Drinks • Quantity • Frequency • Heavy Episodes • Drinking-Related Consequences

  4. Do College Students Drink More Than Other Young Adults? • Yes! • Young adults tend to accelerate drinking upon entrance to college. • Young adults enrolled in college drink more than those not enrolled. • In high school, college-bound students drink less than their non-college-bound peers, but their drinking accelerates upon college matriculation.

  5. Has College DrinkingGotten Worse? • Maybe, maybe not … • Rates appear to be stable over the last 20 years. • There is some evidence of a “polarization” of drinking over the last decade. • Since the 1950s, heavy drinking rates have increased greatly for women, somewhat for men.

  6. Does Drinking Vary from College to College? • Yes! • By region—Southern schools, the lowest; Northeast schools, the highest • Campus factors—Males, younger student body, residential, “Greek” system, white students • Campus and community norms can generate a “party school” reputation.

  7. How Different Is College Drinking from Older Adult Drinking? • The majority of students reduce heavy-drinking episodes after leaving college. • Heavy drinking becomes less common, but daily drinking doesn’t decline much. • Heavy episodes are still relatively common among otherwise moderate-drinking adults.

  8. What Isn’t Said • Not every student drinks heavily—one-third don’t drink at all; many others drink moderately. • Not all heavy drinkers drink frequently—19% drink heavily and frequently. • Heavy drinking in college, for the most part, does not lead to chronic problems later in life.

  9. What Do Students Think about Drinking? • In general, students are less concerned about alcohol than older community members. • Some amount of alcohol-related consequences is tolerable to most students. • Most students have mixed feelings about alcohol but see drinking as a normal college experience.

  10. Responding to College Drinking

  11. What Causes Alcohol Problems? • Models help explain why people drink in ways that cause problems. • Beliefs about etiology may also determine a problem-solving approach. • Models include moral, spiritual, disease process, genetic, biology, learning history, character, and society and culture. • The public health model looks at the problem broadly, taking into account agent, host, and environment.

  12. What Factors Influence Drinking during College? • Demography—male, white, or belong to a fraternity, sorority, or athletic team • Personality—more impulsive, depressed, or social • Environment—permissive norms and easier access to alcohol • Genetic factors are not strongly related to drinking during college. • Individual and environmental factors may interact.

  13. How Does Development Relate to Drinking? • “Emerging adulthood” stage, ages 18–25 • College drinking is a window of risk. • Drinking may help students to act and feel independent. • Drinking may help to manage stress of life transitions. • Most students reduce risky use over time (especially after graduating).

  14. What Makes People Change? • Most people change drinking habits without formal assistance, even those with more severe problems. • When students change, they usually do so on their own; they don’t ask for help. • Change does not usually occur all at once. For most, it’s a gradual process. • “Stages of change” describe how people progress in thinking about change.

  15. The “Stages-of-Change” Model Change tends to happen in predictable stages: • Precontemplation • Contemplation • Preparation • Action • Maintenance

  16. Implications for Intervention • Effective interventions move students along stages of change and target stage-specific needs. • Programs that address only one risk factor, assume readiness for change, or tell students what to do will be less effective. • Effective interventions are developmentally appropriate and target multiple risk factors.

  17. Which InterventionsReduce Drinking? • Effective with college students: • Cognitive-Behavioral Skills Training • Motivational Counseling Approaches • Alcohol Expectancy Challenges • Program length unrelated to outcome—in some cases the briefest show excellent outcomes. • National Institute on Alcohol Abuse and Alcoholism (NIAA) Task Force Report Tiers

  18. NIAAA Task ForceReport Findings • Effective in General Population • Minimum-age laws, retail restrictions, DWI enforcement, increased price, beverage-service policies, campus–community coalitions • Promising Prevention Approaches • Alcohol-free residences, banning alcohol at alumni and faculty events, alcohol policy enforcement, and social norms campaigns. • Ineffective Prevention Approaches • Informational, knowledge-based, values clarification, or providing BAC feedback—when used alone.

  19. How Does Brief Counseling Fit In? • Individual and group interactions can help in formal and opportunistic settings. • Can be structured to leave a lasting impact. • Can support other prevention and intervention efforts. • Techniques not only for therapists in counseling centers but also for “nonspecialists” and concerned others.

  20. Assessing Drinkingand Related Behaviors

  21. Why Assess Drinking? • Helps us direct students to appropriate services • Allows us to tailor how we might best intervene • Sincere and candid questions show the student that we care

  22. How Much Time Is Available? Kind and number of questions depend on available time and purpose of contact. • Brief (1–5 minutes) • Moderate (5–15 minutes) • Lengthy (>15 minutes)

  23. Purpose of Assessment • Brief (1–5 minutes): Assess key patterns of use and risks to support brief advice • Moderate (5–15 minutes): Assess more dimensions to support longer consultations • Lengthy (>15 minutes): Assess details of use and consequences to support counseling and feedback sessions

  24. Alcohol Consumption • Brief (1–5 minutes): Quantity–Frequency Questions • Moderate (5–15 minutes): Daily Drinking Questionnaire • Lengthy (>15 minutes): Time Line Follow-Back

  25. Negative Consequences • Brief (1–5 minutes): College Alcohol Problems Scale—Revised (CAPS-r) • Moderate (5–15 minutes): Young Adult Alcohol Problems Screening Test (YAAPST; 20-items) • Lengthy (>15 minutes): 20-item YAAPST

  26. Alcohol Screening • Brief (1–5 minutes): Alcohol Use Disorders Identification Test (AUDIT) (AUDIT-C; first three questions from the AUDIT) • Moderate (5–15 minutes): AUDIT • Lengthy (>15 minutes): AUDIT

  27. Motivation • Brief (1–5 minutes): Importance and Confidence Rulers • Moderate (5–15 minutes): Readiness to Change Questionnaire (RTCQ) • Lengthy (>15 minutes): RTCQ

  28. Alcohol Expectancies • Moderate (5–15 minutes): Comprehensive Effects of Alcohol Scale (CEOA) • Lengthy (>15 minutes): Comprehensive Effects of Alcohol Scale (CEOA)—full version

  29. Family History of Alcoholism • Brief (1–5 minutes): “Number of blood relatives” question • Moderate (5–15 minutes): “Number of blood relatives” question • Lengthy (>15 minutes): Family Tree Questionnaire (FTQ)

  30. Conclusions • Regularly screen students for alcohol use and problems. • A few key questions can be asked in fewer than 3 minutes. • Select measures that are based on available time and purpose of contact. • Discuss alcohol use without judgment or embarrassment. • Use an open, honest, and calm assessment style.

  31. Style of the Interaction

  32. Motivation and Change • Motivation is malleable, rather than fixed. • Provider, student, and the interaction between them all influence desire to change. • Motivation includes components of estimated importance of change and confidence in ability. • How you talk to a student about alcohol makes a difference.

  33. What Is Motivational Interviewing? Motivational interviewing (MI) is a person-centered, directive method of communication for enhancing intrinsic motivation to change by exploring and resolving ambivalence. From Miller and Rollnick (Motivational Interviewing, Guilford Press, 2002)

  34. Motivational Interviewing • Person-centered—Each student has the capacity and responsibility for making choices in how to behave. • Directive—Counselor guides the conversation in a particular direction to influence outcome. • Ambivalence—Students have mixed feelings about alcohol.

  35. Principles of Motivational Interviewing • Express Empathy • Develop Discrepancy • Roll with Resistance • Support Self-Efficacy

  36. Simplified Motivational Categories

  37. Working with Motivation • Listen for the two dimensions of motivation—importance and confidence. • Tailor plans based on importance and confidence. • Most students are in Group 3—they think they could (or will) change but aren’t interested at this time.

  38. Core Techniques: “OARS” • Open-Ended Questions • Affirm • Reflect • Summarize

  39. Ask Open-Ended Questions Ask questions that have more than one possible answer; encourage student to think about and elaborate on concerns. • “Tell me a little bit about your drinking.” • “What are some things that you like about your drinking? Don’t like about it?” • “Tell me about a recent time where you had too much to drink.” • “In what situations is it hardest for you not to drink?”

  40. Affirm the Person Talk about positive things the student has done or intends to do. • “Thanks for talking to me today.” • “You bring up a good point.” • “You certainly see a number of areas where drinking is affecting your schoolwork.” • “That’s a good idea.” • “You really do want to do the right thing here.”

  41. Listen Reflectively • Listen to the student and reflect back what he or she said, verbally and nonverbally. • Use reflections to roll with resistance, highlight something, or encourage more talk like it. • Initiate conversation with an open question and reflect the response. • Try to use more reflections than questions.

  42. Kinds ofReflections • Repeat—Repeat an element of what the student said. • Rephrase—Restate content using different words. • Emotive—Paraphrase the emotional dimension using feeling statements, metaphor, and the like. • Double-Sided—Make explicit a contradiction or mixed feelings.

  43. Examples of Reflections

  44. Summarize Feed back information to let students hear what they have been saying and that you understand what they have said. • “Let me pull together what you’ve said and you can tell me if I’ve missed anything.” • “What I see you saying so far is that . . .” • “You said . . .” “You thought that . . .” • “Is that a pretty good summary? Did I miss anything?” • “We’ve talked about . . .”

  45. Change Talk: What to Look For • Discomfort/disadvantages of status quo • Consequences, personal concerns, others’ concerns • Advantages of change • Good things (or reduction in negatives) about change • Optimism/ability to change • Personal resources, skills, confidence • Intention/commitment to change • What change would look like; concrete or hypothetical plans

  46. Eliciting Change Talk • Ask the student about his or her concerns, or share your own. • Provide nonjudgmental feedback or information. • Look for signs of discomfort with the status quo; interest in or ability to change. • Use reflections, questions, and summaries to draw out “change” talk.

  47. Brief Individual Interactions

  48. What Motivates in Brief Interactions? • Quick arguments or advice are rarely persuading. • People become more committed to an idea they feel they have authored. • The style of the interaction—concern, empathy, and reflective listening—predicts outcome.

  49. Broaching the Subject • Share your concerns • “I noticed that . . . I wonder if . . . ” • Use clear language and specific examples. • Avoid pejorative terms. • Do not assume initial readiness. • Ask about the student’s own concerns • “What concerns do you have about your . . .?” • Include a screening or checklist.

  50. Giving Advice and Suggestions • Ask for permission. • “There’s something that concerns me. Would it be okay if I asked you about . . .?” • Preface advice with permission to disagree. • “This may or may not apply to you, but . . .” • Give a small amount of essential information. • “The main thing I’m concerned about is . . .”

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