John S. Baer

Screening and brief intervention for high-risk college student drinkers: results from a 2-year follow-up assessment

This randomized controlled trial evaluated the efficacy of a brief intervention designed to reduce the harmful consequences of heavy drinking among high-risk college students. Students screened for risk while in their senior year of high school (188 women and 160 men) were randomly assigned to receive an individualized motivational brief intervention in their freshman year of college or to a no-treatment control condition. A normative group selected from the entire screening pool provided a natural history comparison. Follow-up assessments over a 2-year period showed significant reductions in both drinking rates and harmful consequences, favoring students receiving the intervention. Although high-risk students continued to experience more alcohol problems than the natural history comparison group over the 2-year period, most showed a decline in problems over time, suggesting a developmental maturational effect.

Brief Intervention for Heavy-Drinking College Students: 4-Year Follow-Up and Natural History

OBJECTIVES This study examined long-term response to an individual preventive intervention for high-risk college drinkers relative to the natural history of college drinking. METHODS A single-session, individualized preventive intervention was evaluated within a randomized controlled trial with college freshmen who reported drinking heavily while in high school. An additional group randomly selected from the entire screening pool provided a normative comparison. Participant self-report was assessed annually for 4 years. RESULTS High-risk controls showed secular trends for reduced drinking quantity and negative consequences without changes in drinking frequency. Those receiving the brief preventive intervention reported significant additional reductions, particularly with respect to negative consequences. Categorical individual change analyses show that remission is normative, and they suggest that participants receiving the brief intervention are more likely to improve and less likely to worsen regarding negative drinking consequences. CONCLUSIONS Brief individual preventive interventions for high-risk college drinkers can achieve long-term benefits even in the context of maturational trends.

Test-retest reliability of alcohol measures: is there a difference between internet-based assessment and traditional methods?

This study compared Web-based assessment techniques with traditional paper-based methods of commonly used measures of alcohol use. Test-retest reliabilities were obtained, and tests of validity were conducted. A total of 255 participants were randomly assigned to 1 of 3 conditions: paper-based (P&P), Web-based (Web), or Web-based with interruption (Web-I). Follow-up assessments 1 week later indicated reliabilities ranging from .59 to .93 within all measures and across all assessment methods. Significantly high test-retest reliability coefficients support the use of these measures for research and clinical applications. Furthermore, no significant differences were found between assessment techniques, suggesting that Web-based methods are a suitable alternative to more traditional methods. This cost-efficient alternative has the advantage of minimizing data collection and entry errors while increasing survey accessibility.

Short-term effects of a brief motivational intervention to reduce alcohol and drug risk among homeless adolescents

The short-term results of a randomized trial testing a brief feedback and motivational intervention for substance use among homeless adolescents are presented. Homeless adolescents ages 14-19 (N = 285) recruited from drop-in centers at agencies and from street intercept were randomly assigned to either a brief motivational enhancement (ME) group or 1 of 2 control groups. The 1-session motivational intervention presented personal feedback about patterns of risks related to alcohol or substance use in a style consistent with motivational interviewing. Follow-up interviews were conducted at 1 and 3 months postintervention. Youths who received the motivational intervention reported reduced illicit drug use other than marijuana at 1-month follow-up compared with youths in the control groups. Treatment effects were not found with respect to alcohol or marijuana. Post hoc analyses within the ME group suggested that those who were rated as more engaged and more likely to benefit showed greater drug use reduction than did those rated as less engaged. Limitations of the study are discussed as are implications for development of future substance use interventions for this high-risk group.

The alcohol skills training program: A group intervention for young adult drinkers

Development, content, and evaluation of the Alcohol Skills Training Program (ASTP) is described. Patterned after strategies for relapse prevention, the ASTP is a cognitive behavioral approach to the secondary prevention of alcohol problems. Format and context of the six group sessions are detailed, and process considerations are discussed. Results are summarized for two controlled investigations of the ASTP with young adult drinkers. The psychoeducational approach of the ASTP is recommended as an effective means for changing drinking patterns among young adults who are at risk for alcohol-related problems.

Adolescent Change Language Within a Brief Motivational Intervention and Substance Use Outcomes

Homeless adolescents who used alcohol or illicit substances but were not seeking treatment (n = 54) were recorded during brief motivational interventions. Adolescent language during sessions was coded on the basis of motivational interviewing concepts (global ratings of engagement and affect, counts of commitment to change, statements about reasons for change, and statements about desire or ability to change), and ratings were tested as predictors of rates of substance use over time. Results indicate that statements about desire or ability against change, although infrequent (M = 0.61 per 5 min), were strongly and negatively predictive of changes in substance use rates (days of abstinence over the prior month) at both 1- and 3-month postbaseline assessment (ps < .001). Statements about reasons for change were associated with greater reductions in days of substance use at 1-month assessment (p < .05). Commitment language was not associated with outcomes. Results suggest that specific aspects of adolescent speech in brief interventions may be important in the prediction of change in substance use. These relationships should be examined within larger samples and other clinical contexts.

Harm reduction for alcohol problems: Moving beyond the controlled drinking controversy

Controlled drinking has long been a controversial topic in behavior therapy. The historical context of this debate is reviewed, with special attention paid to the pioneering research conducted by Mark and Linda Sobell (the first behavior therapists to publish a controlled trial of controlled drinking with alcoholics). After updating the research findings and predictors of controlled drinking with alcohol-dependent drinkers, literature on the effects of moderation training (including brief interventions) designed to reduce the risks of alcohol abuse is reviewed. As an illustration of this approach, preliminary data are presented from an ongoing study investigating the effects of a stepped-care secondary prevention program for high-risk adolescent and young-adult drinkers. Throughout the paper, harm reduction is presented as an overarching model of behavior change that encompasses both controlled drinking for alcohol dependence and moderation training in the prevention and treatment of alcohol abuse. Unlike abstinence-only or “zero-tolerance” approaches, the harm-reduction model supports any behavior change, from moderation to abstinence, that reduces the harm of problems due to alcohol.

Agency context and tailored training in technology transfer: A pilot evaluation of motivational interviewing training for community counselors

Few empirical studies are available to guide best practices for transferring evidenced-based treatments to community substance abuse providers. To maximize the learning and maintenance of new clinical skills, this study tested a context-tailored training (CTT) model, which used standardized patient actors in role-plays tailored to agency clinical context, repetitive cycles of practice and feedback, and enhanced organizational support. This study reports the results of a randomized pilot evaluation of CTT for motivational interviewing (MI). Investigators randomly assigned community substance abuse treatment agencies to receive either CTT or a standard 2-day MI workshop. The study also evaluated the effects of counselor-level and organizational-level variables on the learning of MI. No between-condition differences were observed on the acquisition and maintenance of MI skills despite reported higher satisfaction with the more costly context-tailored model. Analyses revealed that those counselors with more formal education and less endorsement of a disease model of addiction made the greatest gains in MI skills, irrespective of training condition. Similarly, agencies whose individual counselors viewed their organization as being more open to change and less supportive of autonomy showed greater average staff gains in MI skills, again, irrespective of training method. Posttraining activities within agencies that supported the ongoing learning and implementation of MI mediated the effects of organizational openness to change. This pilot study suggests that tailored training methods may not produce better outcomes than traditional workshops for the acquisition of evidence-based practice, and that efforts to enhance skill acquisition can be focused on characteristics of learners and ongoing organizational support of learning.

An Individual in Context: Predictors of Alcohol Use and Drinking Problems Among Greek and Residence Hall Students

Fraternity, sorority, and residence hall residents were compared on drinking rates and patterns, drinking-related problems, family history of alcohol problems, alcohol outcome expectancies, and high school drinking patterns. Results indicated residence in a fraternity was related to more frequent alcohol consumption and greater negative consequences even after accounting for family history, expectancies, and high school drinking rates. Family history of alcohol problems was only related to negative consequences for men. Only high school drinking rates were related to amount of alcohol consumed per occasion, for both men and women. Fraternity residence was found to be related to more negative consequences even after accounting for current drinking habits. However, sorority residence was found to moderate the relationship between current drinking and negative consequences. Both high and low drinkers in sororities indicated similar rates of alcohol-related negative consequences, whereas high frequency female drinkers in the residence hall sample reported significantly more problems.

Individual drinking changes following a brief intervention among college students: clinical significance in an indicated preventive context.

This study investigated the clinical significance of previously reported statistically significant mean reductions in drinking and related problems among college students in a randomized trial of a brief indicated preventive intervention (G. A. Marlatt et al., 1998). Data were analyzed over a 2-year follow-up for participants from a high-risk intervention group (n = 153), a high-risk control group (n = 160), and a functional comparison group (n = 77). A risk cutpoint for each dependent measure was based on the functional comparison group distribution. Compared with the high-risk controls, more individuals in the high-risk intervention group improved and fewer worsened, especially on alcohol-related problems and, to a lesser extent, on drinking pattern variables. These data from a prevention context clarify the magnitude and direction of individual change obscured by group means.