Peer enhancement of a brief motivational intervention with mandated college students.

In this pilot study, the authors evaluated whether incorporating a peer in a brief motivational intervention would lead to significant reductions in alcohol use and problems in students mandated to receive treatment after violating campus alcohol policy. Thirty-six participant-peer dyads (66% male) were randomly assigned to receive either two 45-min sessions of an individual motivational intervention (IMI, n = 18) or a peer-enhanced motivational intervention (PMI, n = 18). The IMI included exploration of motivation to change alcohol use, perceived positive and negative effects of drinking, personalized feedback, and goals for changing alcohol consumption and related behaviors. The PMI included all elements of the IMI plus the presence of a supportive peer of the participant during both sessions. Although both groups significantly reduced number of drinking days and heavy drinking days at 1-month follow-up, the magnitude of within-group reductions in alcohol use and problems was 3 times larger on average for the PMI group than for the IMI group, based on effect-size calculations. Peers and participants endorsed high satisfaction ratings on the PMI. Findings indicate the promise of including peers in brief motivational interventions for mandated students.

Mandated college students' response to sequentially administered alcohol interventions in a randomized clinical trial using stepped care.

OBJECTIVE: Students referred to school administration for alcohol policies violations currently receive a wide variety of interventions. This study examined predictors of response to 2 interventions delivered to mandated college students (N = 598) using a stepped care approach incorporating a peer-delivered 15-min brief advice (BA) session (Step 1) and a 60- to 90-min brief motivational intervention (BMI) delivered by trained interventionists (Step 2). METHOD: Analyses were completed in 2 stages. First, 3 types of variables (screening variables, alcohol-related cognitions, mandated student profile) were examined in a logistic regression model as putative predictors of lower risk drinking (defined as 3 or fewer heavy episodic drinking [HED] episodes and/or 4 or fewer alcohol-related consequences in the past month) 6 weeks following the BA session. Second, we used generalized estimating equations to examine putative moderators of BMI effects on HED and peak blood alcohol content compared with assessment only (AO) control over the 3-, 6-, and 9-month follow-ups. RESULTS: Participants reporting lower scores on the Alcohol Use Disorders Identification Test, more benefits to changing alcohol use, and those who fit the "Bad Incident" profile at baseline were more likely to report lower risk drinking 6 weeks after the BA session. Moderation analyses revealed that Bad Incident students who received the BMI reported more HED at 9-month follow-up than those who received AO. CONCLUSION: Current alcohol use as well as personal reaction to the referral event may have clinical utility in identifying which mandated students benefit from treatments of varying content and intensity.

Validation of the timeline follow-back in the assessment of adolescent smoking.

The timeline follow-back instrument (TLFB) is a valid and reliable method of quantifying alcohol use patterns. The use of this instrument has been expanded to assess other behaviors, such as drug use, sexual behavior, binge eating, and panic attacks. Some evidence for the validity and reliability of this assessment instrument has emerged in the area of adult smoking. However, to date, there is no published evidence of its reliability and validity in the assessment of adolescent smoking. The purpose of this study is to present early evidence of the utility of the TLFB to collect information on adolescent smoking behavior. Through secondary data analysis of four studies on adolescent smokers, we examined the associations between the TLFB and measures of dependence, smoking history, respiratory symptoms, and saliva cotinine. Moreover, we examined the stability of the TLFB data across two 15-day time periods. Results provide preliminary evidence of the validity and reliability of the TLFB in the assessment of adolescent smoking. In particular, the TLFB instrument offered important data on the heterogeneity of adolescent smoking patterns beyond a global measure of cigarettes per day, and the reduction of digit bias. Implications of these findings for the assessment of adolescent smoking are discussed.

Descriptive norms and expectancies as mediators of a brief motivational intervention for mandated college students receiving stepped care for alcohol use.

Stepped care approaches for mandated college students provide individual brief motivational interventions (BMI) only for individuals who do not respond to an initial, low-intensity level of treatment such as Brief Advice (BA). However, how BMIs facilitate change in this higher-risk group of mandated students remains unclear. Perceived descriptive norms and alcohol-related expectancies are the most commonly examined mediators of BMI efficacy but have yet to be examined in the context of stepped care. Participants were mandated college students (N = 598) participating in a stepped care trial in which mandated students first received BA. Those who reported continued risky drinking 6 weeks following a BA session were randomized to either a single-session BMI (N = 163) or an assessment-only comparison condition (AO; N = 165). BMI participants reduced alcohol-related problems at the 9 month follow up significantly more than AO participants. Multiple mediation analyses using bootstrapping techniques examined whether perceived descriptive norms and alcohol-related expectancies mediated the observed outcomes. Reductions in perceptions of average student drinking (B = -.24; 95% CI [-.61, -.04]) and negative expectancies (B = -.13; 95% CI [-.38, -.01]) mediated the BMI effects. Furthermore, perceived average student norms were reduced after the BMI to levels approximating those of students who had exhibited lower risk drinking following the BA session. Findings highlight the utility of addressing perceived norms and expectancies in BMIs, especially for students who have not responded to less intensive prevention efforts.

Motivational enhancement and other brief interventions for adolescent substance abuse: foundations, applications and evaluations.

AIMS: To present a comprehensive review of the use of motivational enhancement and other brief interventions for substance use in adolescents. METHODS: In this paper, we review the major theoretical foundations and influences of brief interventions (including motivational interviewing), consider developmental issues in its application for adolescents, discuss methodological issues in the design and implementation of brief interventions, including the assessment of treatment fidelity, evaluate and interpret the latest findings on brief interventions for adolescents and young people and discuss the issue of translating and exporting effective research into practice. FINDINGS: Results from recent clinical trials using motivational interventions indicate that these approaches result in decreases in substance-related negative consequences and problems, decrements in substance use and increased treatment engagement, with results particularly strong for those with heavier substance use patterns and/or less motivation to change. CONCLUSION: While results are promising, more research is needed to examine the essential elements of motivational interventions, for whom they work best, and their impact on developmental transitions during adolescence.

Phone-delivered brief motivational interventions for mandated college students delivered during the summer months.

OBJECTIVE: Across the United States, tens of thousands of college students are mandated to receive an alcohol intervention following an alcohol policy violation. Telephone interventions may be an efficient method to provide mandated students with an intervention, especially when they are away from campus during summer vacation. However, little is known about the utility of telephone-delivered brief motivational interventions. METHOD: Participants in the study (N=57) were college students mandated to attend an alcohol program following a campus-based alcohol citation. Participants were randomized to a brief motivational phone intervention (pBMI) (n=36) or assessment only (n=21). Ten participants (27.8%) randomized to the pBMI did not complete the intervention. Follow-up assessments were conducted 3, 6, and 9 months post-intervention. RESULTS: Results indicated the pBMI significantly reduced the number of alcohol-related problems compared to the assessment-only group. Participants who did not complete the pBMI appeared to be lighter drinkers at baseline and randomization, suggesting the presence of alternate influences on alcohol-related problems. CONCLUSION: Phone BMIs may be an efficient and cost-effective method to reduce harms associated with alcohol use by heavy-drinking mandated students during the summer months.

Enhanced motivational interviewing versus brief advice for adolescent smoking cessation: results from a randomized clinical trial.

BACKGROUND: Motivational interviewing (MI) is widely used for adolescent smoking cessation but empirical support for this approach is mixed. METHODS: Adolescent cigarette smokers 14-18 years old (N=162) were recruited from medical, school, and community settings and randomly assigned to enhanced MI or brief advice (BA) for smoking cessation. MI comprised an in-person individual session, a telephone booster session one week later, and a brief telephone-based parent intervention. BA consisted of standardized brief advice to quit smoking. Assessments occurred at baseline, post-treatment and at 1-, 3-, and 6-month follow ups. RESULTS: Biochemically-confirmed 7-day point prevalence abstinence rates were low (e.g., 4.5% for MI; 1.4% for BA at 1 month) and did not differ significantly by group at any follow up. Only those in MI reported significant decreases in cigarettes smoked per day (CPD) from baseline to 1 month. At 3 and 6 months, smokers in both groups reported significantly reduced CPD with no differences between groups. MI reduced perceived norms regarding peer and adult smoking rates, while BA had no effect on normative perceptions. No group differences emerged for self-reported motivation or self-efficacy to quit smoking. CONCLUSIONS: Findings support the efficacy of MI for addressing normative misperceptions regarding peer and adult smoking and for modestly reducing CPD in the short-term; however, these effects did not translate to greater smoking abstinence. MI may have more promise as a prelude to more intensive smoking intervention with adolescents than as a stand-alone intervention.

Addressing alcohol use and problems in mandated college students: a randomized clinical trial using stepped care.

OBJECTIVE: Over the past 2 decades, colleges and universities have seen a large increase in the number of students referred to the administration for alcohol policies violations. However, a substantial portion of mandated students may not require extensive treatment. Stepped care may maximize treatment efficiency and greatly reduce the demands on campus alcohol programs. METHOD: Participants in the study (N = 598) were college students mandated to attend an alcohol program following a campus-based alcohol citation. All participants received Step 1: a 15-min brief advice session that included the provision of a booklet containing advice to reduce drinking. Participants were assessed 6 weeks after receiving the brief advice, and those who continued to exhibit risky alcohol use (n = 405) were randomized to Step 2, a 60- to 90-min brief motivational intervention (n = 211), or an assessment-only control (n = 194). Follow-up assessments were conducted 3, 6, and 9 months after Step 2. RESULTS: Results indicated that the participants who received a brief motivational intervention showed a significantly reduced number of alcohol-related problems compared to those who received assessment only, despite no significant group differences in alcohol use. In addition, low-risk drinkers (n = 102; who reported low alcohol use and related harms at 6-week follow-up and were not randomized to stepped care) showed a stable alcohol use pattern throughout the follow-up period, indicating they required no additional intervention. CONCLUSION: Stepped care is an efficient and cost-effective method to reduce harms associated with alcohol use by mandated students.

Profiles of college students mandated to alcohol intervention.

OBJECTIVE: Most colleges have sanctions or required interventions for students who receive alcohol violations or medical evaluation for intoxication. The aim of this study was to establish profiles of mandated students from a combined data set using exploratory and replication cluster analysis. METHOD: Data sets from three samples of mandated students (total participant n=393) were combined for exploratory analyses, and a fourth sample (n=289) was analyzed for replication. Clustering variables were past-month heavy drinking, past-year alcohol problems, incident alcohol use, responsibility for the incident, and aversiveness of the incident. RESULTS: A three-cluster solution was produced in the exploratory analysis and confirmed in replication and cross-replication analyses. Clusters formed included a "Why Me?" cluster characterized by a pattern of relatively low heavy drinking and alcohol-related problems, very little incident drinking, and low responsibility and aversiveness. A "So What?" cluster was characterized by high heavy drinking and alcohol-related problems, moderate incident drinking and responsibility, and low aversiveness. A "Bad Incident" cluster was characterized by low scores for heavy drinking and problems and high levels of incident drinking, responsibility, and aversiveness. External variables supported the validity of the cluster solution. CONCLUSIONS: Mandated students form clinically meaningful profiles on easily measured constructs.

Brief alcohol interventions with mandated or adjudicated college students.

This article summarizes the proceedings of a symposium presented at the 2003 RSA Meeting in Ft. Lauderdale, Florida, organized and chaired by Nancy Barnett. The purpose of the symposium was to present information and efficacy data about approaches to brief intervention with students who get into trouble on their campuses for alcohol and as a result are required to attend alcohol education or counseling. Presentations were (1) Differences Between Mandated College Students and Their Peers on Alcohol Use and Readiness to Change, by Tracy O'Leary Tevyaw; (2) An Effective Alcohol Prevention Program for Mandated College Students, by Kim Fromme; (3) Two Brief Alcohol Interventions for a Referred College Population, by Kate Carey; and (4) Brief Motivational Intervention With College Students Following Medical Treatment or Discipline for Alcohol, by Nancy Barnett. The data presented in this symposium indicated that students who are evaluated or disciplined for alcohol use are on average heavy drinkers who drink more heavily than their closest peers. Brief intervention approaches described by the speakers included group classroom sessions, individual motivational intervention, individual alcohol education, and computerized alcohol education. Reductions in consumption and problems were noted across the various intervention groups. Brief motivational intervention as a general approach with mandated students shows promise in that it reduced alcohol problems in a group of mandated students who were screened for being at risk (in the Borsari and Carey study) and increased the likelihood that students would attend further counseling (in the Barnett study).