Scott T. Walters, Ph.D.UT School of Public Health

Southwestern Medical Center at Dallas

Trends in Alcohol Prevention Among Young Adults

“Binge” Drinking, Past 2 Weeks

0

5

10

15

20

25

30

35

40

45

50

Military College Other YoungAdults

%

Substance Use, Past Month

0

10

20

30

40

50

60

1980 1982 1985 1988 1992 1995 1998 2002

Year

%

Any Illicit Drug Use

Any Cigarette Use

Heavy Drinking

Ozs. Ethanol/Day, Past Month

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

1980 1982 1985 1988 1992 1995 1998 2002

Year

Ozs

/Da

y

Unadjusted rates

Adjusted Rates

Drinking Rates by Group

0

5

10

15

20

25

30

35

40

1980 1982 1985 1988 1992 1995 1998 2002

Year

%

Abstainer

Heavy

Negative Effects, Past 12 Months

0

5

10

15

20

25

Army Navy Corps Force Total DoD

Branch

%

Serious Consequ

Productivity Loss

Dependence Sxs

Risk Factors for Heavy Drinking

Younger ageMale genderSingle (or married with spouse absent) Non-Hispanic white, compared with

other ethnicities Pay grades E1 - E3 through O1 - O3

compared with O4 - O10 Less formal educationArmy and Marine Corps, compared with

Air Force personnel

Addressing Alcohol In Young Adults: What We Know

Sources: Walters & Bennett (2000), Larimer & Cronce (2002).

Educational approaches show least effect.Attitudinal and skills-based approaches produce

roughly equivalent and modest reductions.Program length unrelated to outcome. In some cases (e.g., expectancy challenge,

normative feedback) briefest interventions show best outcome.

Difficulty approaching problem from a traditional alcohol treatment perspective

Motivational Feedback

Motivational Feedback

Based on motivational theories of change—students have knowledge and skills if so motivated

Confidential, “neutral” information based on personal responses

Use for in-person interventions or delivered as an alternative to “generic” message

Personalized, cost-effective way to reach large numbers of students

Individual Feedback Intervention

Design: Randomized clinical trial Population: 60 “binge drinking” students

randomized to:a. controlb. 60-minute motivational interview (with

feedback) All participants assessed at baseline and

6 weeks

Source: Borsari & Carey (2000)

Individual Feedback Intervention

6-Week Drinking Reductions

35

13

20

15

0 00

5

10

15

20

25

30

35

40

Drinks Per Mo Frequency Binges Per Mo

% R

edu

ctio

n

MI

Control

Source: Borsari & Carey (2000)

“No Touch” Feedback InterventionsQ/F, BAC, population comparisonAmount and percent of income spent on

alcoholTolerance levelAUDIT, family risk scoreDrove/rode with intoxicated? Smoker?Norm estimates, correct percentagesExplanation, advice, referral informationOther novel information/comparisons (e.g.,

cheeseburgers & Cameros)

Mailed Feedback Interventions

6-Week Drinking Reductions

53

1

0

10

20

30

40

50

60

Drinks per Month

% R

ed

uc

tio

n

Source: Walters, Bennett & Miller (2000)

6-Week Drinking Reductions

33

11

0

10

20

30

40

50

60

Drinks per Month

% R

ed

uc

tio

n

Feedback

No Feedback

Source: Walters (2000)

College Drinking Feedback EfficacyStudy Population Format F/Up Results Baer, et al (1992) Agostinelli, Brown

& Miller (1995) Marlatt, et al.

(1998) Walters, Bennett &

Miller (2000) Walters (2000) Borsari & Carey

(2001) Larimer, et al.

(2001)

HD college students HD college students HD college freshman HD college students HD college students HD college students Frat/Sorority Pledges

In-person Mailed In-person Mailed Mailed In-person In-person

24 mo. 6 wk 24 mo. 6 wk 6 wk 6 wk 12 mo.

drinking drinking drinking, consequences drinking, n/s consequences n/s drinking, n/s consequences drinking drinking for males

e-Interventions

Web-Based College Drinking Interventions

Alcohol101plus.comAlcoholedu.comBacchusgamma.orgE-chug.com Mystudentbody.comUndertheinfluence.com

Provides cheap, accurate and immediate information.

Confidential and private. Requires little/no “human” effort. Easily integrated with counseling or

other approaches. Ability to collect data from students and

track over time. Young adults computer/internet literate,

colleges almost universally linked

Advantages of e-Interventions

1. Personal drinking profile Amount consumed in typical week and month Amount and percent of income spent on alcohol Caloric intake “cheeseburger” equivalent

2. Peak monthly and weekly BACs3. Personal risk factors

Tolerance, dependence, negative consequences Genetic risk of alcoholism Risky choices

4. Drinking in relation to peers5. Perception of drinking in relation to actual amts6. Local community resources

e-CHUG: The User’s Perspective

1. Draws from motivational interviewing and social norms theories.

2. Intentionally obtrusive; more than assessment.

3. Employs motivational “hooks” to raise discrepancy and motivation for change.

4. Mechanism thought to be discrepancy and increased importance of change.

5. Safe for general prevention efforts, not likely to “harm” non-drinkers.

e-CHUG: Interventionist’s Perspective

Applications of the e-CHUG Orientation classes. Referrals for alcohol-related infractions;

Adjunct to individual counseling. High-risk groups (e.g., fraternities,

sororities, athletes). Mass marketing, Alcohol awareness day Waiting rooms of student service offices Standardized personalized information

for large multi-site groups.

Example: ASPIRE Program San Diego State University, Counseling and

Psych Serv’s Disciplinary referrals from judicial and

residence life systems. Stepped care: Level (1-3 sessions) determined

after initial interview. Intervention components:

a. Motivational Interview (1-3 sessions) b. Feedback from CHUG/e-CHUG and

Brief Symptom Inventory

350 students referred, mandated to attend in 2002-3.

No. sessions: 25% one, 26% two, 49% three.

Confidential follow-up 6 weeks after completion. Among 3 session attendees:– 93% reported decreased alcohol consumption

(average reduction of 12.6 drinks per week)– 73% reported decreased “binge” episodes– 91% reported decreased money spent on alcohol

(average savings of $12/week)

ASPIRE Disciplinary Program

Skills-Based Approaches

CHOICES Skills-Training ProgramCore Components

Group & interactive journal

Psychoeducational, skills training material

Facilitator guide & supporting materials

Implementation Facilitated by peer eds,

faculty or staff Small groups, 90-180

minutes, 1-2 sessions Verified self-study

CHOICES Journal

Reflections upon current relationship withand attitude toward alcohol

Facts about how alcohol works, how it affects you(physiology, BAL, intoxication and oxidation)

Risks associated with excessive consumption and common harm associated with use

Strategies to reduce exposure to harmfrom alcohol consumption

Reflections

Facts

Risks

Strategies

Example: CHOICES Program

Program being implemented by Sigma Chi national fraternity.

Materials customized to unique characteristics of male, undergraduate, fraternity life.– Specialized e-CHUG feedback– Integrated CHOICES workbook

Group facilitation by trained peer educators.

Purpose: To examine the e-CHUG as an adjunct to two prevention curricula.

190 freshman studentsRandomized to:

– CHOICES workbook, facilitated group – CHOICES workbook, facilitated group + e-CHUG– Alcohol 101 CD-ROM– Alcohol 101 CD-ROM + e-CHUG

4 week follow-up

Freshman Project

SDSU Choices/e-CHUG Project

Source: Lange, et al. (2004)

0

0.5

1

1.5

Alcohol 101 ChoicesCurriculum

Dri

nks/

hr.

No e-CHUG

e-CHUG

Advantages of Hybrid ApproachMotivational, skills-based and informational

techniques in a standardized curriculum.Accessible and understandable.Personalizes “generic” message to the

individual. Customized to demography, risk factors,

goals. Local logos, norms, referral information.

Self-study, or delivered in “manualized” group format. Includes group facilitators training.

Can gather information, measure changes.

Scott T. Walters, Ph.D.UT School of Public Health

Southwestern Medical Center at Dallas

Trends in Alcohol Prevention Among Young Adults

For more information about e-CHUG, contact:Scott Walters, Ph.D.scott.walters@utsouthwestern.eduOr visit: www.e-chug.com

For more information about CHOICES, contact:John Calhoonjcalhoon@changecompanies.netOr visit: www.changecompanies.net