Kate B. Carey

Peer influences on college drinking: A review of the research

Peer pressure is consistently implicated in the excessive drinking of college students. However, both theory and empirical findings suggest that peer pressure is a combination of three distinct influences: overt offers of alcohol, modeling, and social norms. Overt offers of alcohol can range from polite gestures to intense goading or commands to drink. Modeling occurs when the students behavior corresponds to another students concurrent drinking behavior. Perceived social norms can serve to make excessive alcohol use appear common and acceptable to the student. This review critically examines the literature on each form of peer influence and provides suggestions for future research.

Psychometric properties of the Drug Abuse Screening Test in psychiatric outpatients

Individuals with severe mental illness frequently have substance abuse and dependence problems, placing them at increased risk for poor treatment outcome. However, the reliability and validity of self-report measures assessing substance abuse and dependence remains understudied in this population. This investigation evaluates 2 versions of the Drug Abuse Screening Test (DAST; H. Skinner, 1982) as screening tools for an outpatient psychiatric sample. Participants were 73 men and 24 women Who had been receiving treatment at a public psychiatric facility. All participants completed the DAST along with other measures of substance use and psychiatric status. The DAST demonstrated adequate internal consistency and temporal stability in this sample. Factor analysis supports a multidimensional scale. We evaluated criterion-related, concurrent and discriminant evidence for validity, and we have concluded that both tested versions of the DAST have sound psychometric properties when used with psychiatric outpatients.

Two brief alcohol interventions for mandated college students.

Encouraging but limited research indicates that brief motivational interventions may be an effective way to reduce heavy episodic drinking in college students. At 2 campuses, students (83% male) mandated to a substance use prevention program were randomly assigned to 1 of 2 individually administered conditions: (a) a brief motivational interview (BMI; n = 34) or (b) an alcohol education session (AE; n = 30). Students in the BMI condition reported fewer alcohol-related problems than the AE students at 3-and 6-month assessments. Trends toward reductions in number of binge drinking episodes and typical blood alcohol levels were seen in both groups. Process measures confirmed the integrity of both interventions. The findings demonstrate that mandated BMIs can reduce alcohol problems in students referred for alcohol violations.

Brief Motivational Interventions for Heavy College Drinkers: A Randomized Controlled Trial

In this randomized controlled trial, the authors evaluated brief motivational interventions (BMIs) for at-risk college drinkers. Heavy drinking students (N = 509; 65% women, 35% men) were randomized into 1 of 6 intervention conditions formed by crossing the baseline Timeline Followback (TLFB) interview (present versus absent) and intervention type (basic BMI, BMI enhanced with a decisional balance module, or none). Assessments completed at baseline, 1, 6, and 12 months measured typical and risky drinking as well as drinking-related problems. Relative to controls, the TLFB interview reduced consumption but not problems at 1 month. The basic BMI improved all drinking outcomes beyond the effects of the TLFB interview at 1 month, whereas the enhanced BMI did not. Risk reduction achieved by brief interventions maintained throughout the follow-up year.

Reactivity to smoking cues and relapse: Two studies of discriminant validity

Little is known about the role that smoking cues play in relapse after smoking cessation. Two studies examined the psychophysiologic, behavioral and cognitive reactions of Ss who participated in a smoking cue-exposure trial (CUET). Study 1 compared male relapsers, long-term quitters and nevers-mokers (controls). Relapsers had significantly higher anxiety and urges to smoke than either quitters or controls. Relapsers also had greater heart-rate (HR) reactivity and were rated by judges as having less effective coping skills than controls. In Study 2 the CUET was tested prospectively in a treatment outcome study for smoking cessation. Responses on the CUET at pre-treatment were related to smoking status at 6 months post-treatment. Prospective quitters had significantly less HR reactivity during the CUET and reported less anxiety than the smokers. There was some lack of consistency across response modes in the results of Studies 1 and 2. Taken together, the two studies suggest that reactivity to smoking cues may play a role in smoking relapse.

Risk for human immunodeficiency virus (HIV) infection among persons with severe mental illnesses

Individuals diagnosed with a severe mental illness are at significantly enhanced risk for infection with the human immunodeficiency virus (HIV). To better understand elevated seroprevalence in this population, we review the research literature that has investigated HIV-related risk behavior among adults who have a severe and persistent mental illness. This review indicates that 54%-74% of adults report that they have been sexually active in the last year with approximately one third reporting two or more partners. Among those who were sexually active, condom use was inconsistent. A significant minority (4%-35%) of adults also reported a history of injection drug use. Overall, the data indicate that the severely mentally ill engage regularly in practices known to involve increased risk for HIV transmission. We introduce and modify Fisher and Fishers (1992) theoretical model to organize the possible determinants of HIV-related risk taking among severely mentally ill adults, and encourage use of this model in the design of behavioral epidemiological and risk reduction studies. We also identify several methodological challenges to HIV-related research, including problems associated with the use of self-report measures; diagnostic imprecision; and participant recruitment and retention.

Computer-delivered interventions to reduce college student drinking: a meta-analysis

AIMS This meta-analysis evaluates the efficacy of computer-delivered interventions (CDIs) to reduce alcohol use among college students. METHODS We included 35 manuscripts with 43 separate interventions, and calculated both between-group and within-group effect sizes for alcohol consumption and alcohol-related problems. Effects sizes were calculated for short-term (< or =5 weeks) and long-term (> or =6 weeks) intervals. All studies were coded for study descriptors, participant characteristics and intervention components. RESULTS The effects of CDIs depended on the nature of the comparison condition: CDIs reduced quantity and frequency measures relative to assessment-only controls, but rarely differed from comparison conditions that included alcohol-relevant content. Small-to-medium within-group effect sizes can be expected for CDIs at short- and long-term follow-ups; these changes are less than or equivalent to the within-group effect sizes observed for more intensive interventions. CONCLUSIONS CDIs reduce the quantity and frequency of drinking among college students. CDIs are generally equivalent to alternative alcohol-related comparison interventions.

Substance use reduction in the context of outpatient psychiatric treatment: A collaborative, motivational, harm reduction approach

A conceptual model for reducing substance use within the context of outpatient psychiatric treatment is described. The proposed model incorporates four themes from the psychological treatment literature: treatment intensity, stages of change, motivational interventions, and harm reduction. The five steps of the model include (1) establishing a working alliance, (2) evaluating the cost-benefit ratio of continued substance use, (3) individualizing goals for change, (4) building an environment and lifestyle supportive of abstinence, and (5) anticipating and coping with crises. This model attempts to integrate clinical realities of mental health treatment with empirically-grounded strategies applicable to substance abuse problems.

A comparison of motives for marijuana and alcohol use among experienced users

Motivational models suggest that individuals use substances to achieve desired effects. Given different pharmacological effects across drug classes, and variations in social context, one would expect that the motives instigating use differ by drug class. However, commonalties in motives across drugs have also been observed. The purpose of this study was to examine similarities and differences across a common set of motives for alcohol and marijuana among experienced users of both drugs. Participants were 46 college students (21 women) who completed a motives assessment twice, once for marijuana and once for alcohol. All had used each drug 60 or more times in their lifetime. Social motives were more highly endorsed for alcohol than marijuana. Expansion motives were more highly endorsed for marijuana. Enhancement motives were more highly endorsed for marijuana than alcohol among women but not men. Endorsement of coping and conformity motives did not differ across drugs. Experienced users of marijuana and alcohol discriminate between their reasons for using the two drugs. These findings are discussed with regard to the differentiation between and commonalties among substances of abuse.

Associations Among Health Behaviors and Time Perspective in Young Adults: Model Testing with Boot-Strapping Replication

Previous research suggests that time perspective relates to health behavior; however, researchers have frequently employed inconsistent operational definitions and have often used projective or unpublished measures. The Zimbardo Time Perspective Inventory was created to provide a sound, objective measure of five distinct time perspective components. We examined the independent prediction of both risky and protective health behaviors from future, hedonistic, and fatalistic time perspective in 1,568 undergraduates using the Zimbardo Time Perspective Inventory. Health behaviors included alcohol, drug, tobacco, and seat belt use, sex behaviors, and exercise. Future time perspective was related to increased protective and decreased risky health behaviors, whereas hedonism exhibited an opposite pattern though was a stronger predictor; fatalism was related only to health-destructive behaviors. Gender interactions reveal that hedonism is a stronger predictor of risky health behaviors for females.