1. Scott T. Walters, Ph.D. UT School of Public Health Southwestern Medical Center at Dallas Trends in Alcohol Prevention Among Young Adults

4. “Binge” Drinking, Past 2 Weeks

5. Substance Use, Past Month

6. Ozs. Ethanol/Day, Past Month

7. Drinking Rates by Group

8. Negative Effects, Past 12 Months

9. Risk Factors for Heavy Drinking  Younger age  Male gender  Single (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 education  Army and Marine Corps, compared with Air Force personnel

11. 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

13. Motivational Feedback

14.  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

15. Individual Feedback Intervention  Design: Randomized clinical trial  Population: 60 “binge drinking” students randomized to: a. control b. 60-minute motivational interview (with feedback)  All participants assessed at baseline and 6 weeks Source: Borsari & Carey (2000)

16. Individual Feedback Intervention Source: Borsari & Carey (2000)

17. “No Touch” Feedback Interventions  Q/F, BAC, population comparison  Amount and percent of income spent on alcohol  Tolerance level  AUDIT, family risk score  Drove/rode with intoxicated? Smoker?  Norm estimates, correct percentages  Explanation, advice, referral information  Other novel information/comparisons (e.g., cheeseburgers & Cameros)

18. Mailed Feedback Interventions Source: Walters, Bennett & Miller (2000) Source: Walters (2000)

19. College Drinking Feedback Efficacy

20. e-Interventions

21. Web-Based College Drinking Interventions  Alcohol101plus.com  Alcoholedu.com  Bacchusgamma.org  E-chug.com  Mystudentbody.com  Undertheinfluence.com

22.  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

27. 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 BACs 3. Personal risk factors  Tolerance, dependence, negative consequences  Genetic risk of alcoholism  Risky choices 4.Drinking in relation to peers 5.Perception of drinking in relation to actual amts 6. Local community resources e-CHUG: The User’s Perspective

28. 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

29. 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.

30. 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

31.  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

32. Skills-Based Approaches

33. CHOICES Skills-Training Program Core 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

34. CHOICES Journal Reflections upon current relationship with and 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 harm from alcohol consumption

35. Reflections

36. Facts

37. Risks

38. Strategies

39. 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.

48.  Purpose: To examine the e-CHUG as an adjunct to two prevention curricula.  190 freshman students  Randomized 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

49. SDSU Choices/e-CHUG Project Source: Lange, et al. (2004)

50. Advantages of Hybrid Approach  Motivational, 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.

51. 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.edu Or visit: www.e-chug.com For more information about CHOICES, contact: John Calhoon jcalhoon@changecompanies.net Or visit: www.changecompanies.net