Preventative Intervention for Alcohol Abuse among College Students

The two articles reviewed both focused on preventative programs for alcohol abuse aimed at college students. The first article (Study A), is titled Prevention of Heavy Drinking and Associated Negative Consequences Among Mandated and Voluntary College Students and was written by Kim Fromme and William Corbin (2004) from the University of Texas. The intervention that was evaluated in this study was a Lifestyle Management Class which was run by either peers or professionals.

Both the peers and the professionals all had to go through a minimum of 16 hours of training targeting “group process skills, counseling techniques, lifestyle and stress management skills, information about college drinking and drug use, and the philosophy of balance and moderation” (Fromme & Corbin, 2004). Other essential elements of the Lifestyle Management Class were the approaches of using a nonjudgmental and empathetic attitude along with usage of motivational interviewing (Fromme & Corbin).

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The second article (Study B), is titled Brief Intervention for Heavy-Drinking College Students: 4-Year Follow-Up and Natural History and was written by J. S. Baer, D. R. Kivlahan, A. W. Blume, P. McKnight and lastly G. A. Marlatt (2001). The intervention used in this study was an individually tailored alcohol prevention program for college freshmen who reported drinking in heavy amounts in high school. Similarly to study A, motivational interviewing was a major part in personalizing the intervention for the college students and having an impact in the results.

Another basic part of the education portion in this intervention was providing a written one-page list of tips for harm reduction of alcohol abuse to each of their participants. A final note even though it is obvious in the title, is the unique aspect of this intervention being an ongoing assessment lasting a total of four years (Baer, Kivlahan, Blume, McKnight & Marlatt, 2001). Critical Appraisal of the Evidence Study a. The purpose of study A was to examine the Lifestyle Management Class (LMC) as an alcohol prevention program with regards to versatility and effectiveness with both mandated and voluntary college students.

For more of a universal population, participants either volunteered through campus-wide recruitment or were disciplinary referrals in which they had to take the LMC before registering for the next semester. There were two different groups in which campus recruitment and disciplinary referrals were randomly assigned to which included both peer-led and professional-led LMCs. In addition to the LMCs, the control groups consisted of an assessment only control group for recruited participants or a wait-list control group for disciplinary referrals.

In all the groups, neither the leaders nor the participants were aware of mandatory or voluntary status between the participants (Fromme & Corbin, 2004). A total of 462 people volunteered through campus recruitment and in the end a total of 221 (49%) completed the study. A total of 124 people volunteered out of a possible 238 students who were required to take the LMC class by the next semester. Out of this 124, 100 were randomized into either the peer-led or professional-led groups and the remaining 24 went into the control.

In the end, 61 participants (61%) of the disciplinary referrals made it to the completion of the study (Fromme & Corbin, 2004). A six-month follow-up was used in determining the continuing effectiveness of the LMC intervention. “The 6-month follow-up period for the current study is shorter than some but longer than most” (Fromme & Corbin, 2004). A longer follow-up period would be ideal but six months in the college setting is a substantial amount of time to test the effects of the intervention and its effectiveness.

Fromme and Corbin (2004), defend the six-month follow-up assessment by stating that multiple and extended assessments may “be tapping into natural developmental trajectories of college student drinkers” (Fromme & Corbin, 2004). In summary, multiple long-term assessments may be working as interventions themselves and disrupting the possible natural tract of behavior of the participants. Privacy and confidentiality were provided as the participants answered questionnaires in one of two locations which included either the University of Texas health center or in the laboratory’s in their psychology department which were supplied by their staff.

The demographic questionnaire was only assessed at the pre-test but the other questionnaires which took approximately 75 minutes were collected at the pretest, posttest and follow-up assessments. Demographic information was collected by using a standard assessment form which included “age, sex, ethnicity, socioeconomic status, years in school, and reason(s) for disciplinary referral” (Fromme ; Corbin, 2004). Motivation to change was assessed using a version of the University of Rhode Island Change Assessment.

Alcohol use, which included usual and heaviest weekly alcohol consumption, was assessed using the Daily Drinking Questionnaire. Using items from the Positive and Negative Consequences Experienced Questionnaire assessed the consequences of becoming intoxicated during the past month. Options for this particular assessment included throwing up, passing out, experiencing a hangover, saying things they normally would not say, hurting themselves or others, getting caught or arrested and finally getting embarrassed in some way or feeling guilty (Fromme ; Corbin).

A monthly questionnaire evaluating drinking and driving was given that had two different assessments; the number of times the participant drank alcohol and then drove and how many times the participant drove after having five or more drinks. Adherence and quality of the LMC co-leaders along with the evaluation of the LMC was also filled out by the participants which were rated with likert-type questionnaires (Fromme ; Corbin). The demographics between campus recruitment volunteers and disciplinary referrals differed slightly in a few aspects.

Although there was not a high amount of demographic information, the disciplinary referrals did tend to be younger and more likely to be male. Also in the disciplinary referrals, when considering ethnicity, there was a higher incidence in Caucasian participants and lower incidents of Asian Americans. I could not find any mentioning of baseline clinical variables in the article. In the discussion section, the article did compare some of their findings with prior research. An example of this is comparing their finding that profession-led LMCs were viewed more positively than peer-led LMCs (Fromme ; Corbin, 2004).

When discussing this finding, Fromme and Corbin (2004) state that “these results do not support prior qualitative evaluations that have suggested that peer-led interventions are better received by students than those led by older professionals”. The study concluded that most importantly “a brief, moderation-oriented, group intervention led to substantial decreases in heavy alcohol use and the frequency of DD reported by both mandated and voluntary college student drinkers” (Fromme ; Corbin, 2004).

The study suggests that university providers consider combining a peer and professional-led group together once the findings confirmed that there were no major differences in effectiveness between the two. However, there was some difference in the results of adherence and quality of performance actually being higher and more effective in professionally led groups. Lastly, the findings showed positive results in the use of motivational and nonjudgmental approaches which is strongly recommended in future similar types of intervention programs (Fromme ; Corbin).

Study b. The purpose of study B was to evaluate a four-year response of an alcohol prevention intervention in college students who were high-risk college drinkers when considering their drinking history. Assignment to the study included a mass mailing of a questionnaire to 4000 incoming freshman regarding alcohol consumption. Out of 2041 students who completed the questionnaire, 508 were considered being high risk. Of the identified high risk, 348 were randomized into either an intervention group or nonintervention group.

For the normal student comparison, 113 randomly selected responders (including 28 high risk) were used to track the natural changes of drinking behavior that occurs over time (Baer et al. , 2001). Unlike study A, study B did not have clear kept data on the rate of adherence throughout the assessments but it does state that “80% provided data at 4 of 5 time points, including 4 year. Consistent with university norms, 53% of the sample reported having graduated at the 4-year follow-up” (Baer et al. . Excluding an initial six month follow-up, “follow-up assessments, which repeated the questionnaire measures included at baseline, were completed by mail annually” (Baer et al. , 2004). Also, at the end of the first assessment roughly 50% of participants completed the phone interview in addition to completing the questionnaire. The phone interview is the time when the trained professionals would collect data and use motivational interviewing in creating change.

Interestingly enough, this study was actually referenced in study A as the longest range of time for follow-up assessments. Also, although much more difficult to complete, long-term results in the end did show effectiveness in measuring the intervention that were instilled in their participants their freshman year (Baer et al. ). For this particular study, the “how and who” parts of the instrument section was not defined in many aspects especially in regarding the distribution of the questionnaires.

To assess how much and how often the participants were drinking which included their highest consumption drinking occasions, six-point liker-type scales were used. This was the type of questionnaire that was initially sent to 4000 of their incoming freshmen. Similar to study A, the Daily Drinking Questionnaire was used to assess the average alcohol consumption in a week for the participant. The Rutgers Alcohol Problem Inventory was used to assess the negative aspects and occurrence of drinking in the participants.

To assess the intensity of the drinking problems, the Alcohol Dependency Scale was used. Next, the Brief Drinker Profile along with alcohol dependence questions from the Diagnostic Interview Schedule was conducted by eight trained interviewers during the first assessment only. The Brief Drinker Profile was used to assess the current trends in their drinking pattern as well as occurring consequences due to the alcohol abuse (Baer et al. , 2001). Interview sections were also used “to assess family history of alcoholism and personal history of conduct problems” (Baer et al. . Unlike study A, the demographics section was not clearly defined in many aspects but there was enough information to be gathered to get comparisons of sorts. All students who were mailed the initial questionnaire were all under the age of 19 years old and incoming freshman to the University of Washington (Baer et al. , 2001). This age range is closely related to the average age ranges in study A being that the campus-recruitment groups average age was 19. 56 and the disciplinary referral groups average age was 18. 96 (Fromme ; Corbin, 2004).

For the differences in demographics between the high-risk participants and the normative participants in study B, the high-risk participants included 55% female and were 84% Caucasian, while the normative group was 54% female and 78% Caucasian (Baer, et al. ). These numbers differ more substantially from study A being that the campus recruitment sample was 59% men and 59% Caucasian and the disciplinary referral group being 76% male and 75% Caucasian (Fromme ; Corbin). Similar to study A, there is no mentioning of baseline clinical variables in this study.

Similar to study A, there were a couple instances in which the authors did compare some of their results to prior data. One example of this is incorporated in their conclusion stating that their “data are consistent with a broad literature showing that brief interventions are effective in reducing alcohol and drugs” (Baer et al. , 2004). In the conclusion, it also states that although the results show that the interventions are effective they are however limited in knowing how detailed these interventions work and recognizes the need for future research.

Overall, a unique conclusion that can be drawn from the long-term follow-up especially collecting data from under 19 past the age of 21 is that the study can conclude “brief individual preventive interventions for high-risk college drinkers can achieve long-term benefits in the context of maturational trends” (Baer et al. ). Application to the Population Both studies A and B have major strengths and weaknesses when trying to apply these findings to a larger portion of the population.

Both of these studies were performed at one only public university which included the University of Texas (study A) and University of Washington (study B). One school can show if it worked for them personally, but because of both their high incidence of Caucasian participant rates and differing gender data it may be hard to apply to other universities with differing demographics. Missing data was a major weakness in study B in which some cases the researchers had to perform maximum likelihood estimation to replace missing data (Baer et al. 2001). In regards to effectiveness and outcomes, I believe study A is a more realistic intervention in the university setting because of it was well-defined and well-intervened in almost all aspects and it was able to measure effective results in a realistic time frame. A major area in which I believe study A excelled is that the LMC was much more personal and connecting with its participants than its counterpart of study B which was getting its results by mail and phone interviews.

Finally, the mandatory training for the leaders in study A was essential to making it more consistent study of effectiveness while the eight phone interviewers in study B were only using a written manual as their guide. For study A, I would recommend increasing the follow-up assessment to a time frame from six months to approximately a year to get more of a longer effective time frame. I would also recommend that they follow through with their hypothesis of replacing a strictly peer-led or professional-led group by combining a peer leader with a professional leader for future interventions.

For study B, I would recommend shortening their follow-up assessment from four years down to one-two years to limit possible missing data and necessity of funds. I would also recommend that study B have a standardized form that is analyzed in getting more definitive demographics so that generalization to different populations is easily made more clear. Risks of studies A and B are very similar. First, as mentioned earlier, the risk of participants dropping out can really skew the data especially in study B being a four-year follow-up assessment. Second of all, the data is heavily dependent on self-report.

Self-report data can be skewed in many different ways including participants who want to look good for the researchers while minimizing their answers to participants who exaggerate or not take seriously their answering of the assessments. Both studies offered some sort of financial gain at each assessment to try and get continuous participation and this can attract people who are more interested in the financial gain then really helping in the study. A major risk included in study A at the six-month follow-up may not show long-term adherence to change.

However, the four-year follow-up of study B, can have the benefit of showing a more fixed change in how the intervention really worked. Another major effective tool that both studies had in common was the application of motivational interviewing and the ability to create discrepancies in the students’ goals versus their drinking habits which helped create the environment for change. In addition, the biggest benefits of both the studies includes that both of them showed evidence of how a preventive intervention in college students can have a positive effect in decreasing overall alcohol abuse in the participants.

This can be used as a major finding and gives not only evidence but also hope for universities to possibly take part of reaching out to their student body for this common high-risk behavior. I believe that overall, study A is most feasible study for the clinical setting. The interacting that takes place in study A reminds me very much of the process and theory behind many individual and group therapies that I have seen in clinical settings and with the professional or peer-led groups it can be very effective.

Realistically, I believe study B is not very feasible in the clinical setting because of the lack of human connection in just being mailed questionnaires along with the an occasional phone call for support. Hypothetically, a possible mix between the strengths of both these studies to help minimize their weaknesses and could create an environment for a very effective alcohol prevention program. In conclusion, I believe that study A over study B outlined their overall process and data collection in a more realistic and well-defined manner in possibly being able to apply it to other campuses or even clinical settings.