Tracy O’Leary Tevyaw

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.

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.

Stepped Care for Mandated College Students: A Pilot Study

In the past decade, colleges and universities have seen a large increase in the number of students referred for the violation of alcohol policies. Stepped care assigns individuals to different levels of care according to treatment response, thereby maximizing efficiency. This pilot study implemented stepped care with students mandated to attend an alcohol program at a private northeastern university. High retention rates and participant satisfaction ratings suggest the promise of implementing stepped care with this population. Considerations for future applications of stepped care with mandated students are discussed.

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.

Contingency management and motivational enhancement: A randomized clinical trial for college student smokers

INTRODUCTION The efficacy of contingency-management (CM) and motivational enhancement therapy (MET) for college student smoking cessation was examined. METHODS Nontreatment-seeking daily smokers (N = 110) were randomly assigned to 3 weeks of CM versus noncontingent reinforcement (NR) and to three individual sessions of MET versus a relaxation control in a 2 x 2 experimental design. Expired carbon monoxide (CO) samples were collected twice daily for 3 weeks. Participants earned 5 US dollars for providing each sample; additionally, those randomized to CM earned escalating monetary rewards based on CO reductions (Week 1) and smoking abstinence (Weeks 2-3). RESULTS Compared with NR, CM resulted in significantly lower CO levels and greater total and consecutive abstinence during the intervention. Those in the CM and MET groups reported greater interest in quitting smoking posttreatment, but rates of confirmed abstinence at follow-up were very low (4% at 6-month follow-up) and did not differ by group. DISCUSSION Findings support the short-term efficacy of CM for reducing smoking among college students. Future research should explore enhancements to CM in this population, including a longer intervention period and the recruitment of smokers who are motivated to quit.

College alcohol citations result in modest reductions in student drinking

College students who are cited for violating campus alcohol policy are often fined or sanctioned to complete an intervention or public service. Although some interventions have been found efficacious for mandated students, it is possible that being cited for an alcohol-related incident alone may be sufficient to reduce alcohol consumption. The purpose of this study was to investigate the course of alcohol consumption patterns following a citation for an alcohol policy violation. Participants were college students (N = 445) who received a citation for a campus alcohol policy violation at a small northeastern liberal arts college. Participants completed a Timeline Follow-Back indicating their daily alcohol use 2 weeks prior to the citation through 2 weeks after the citation. Results indicated that participants decreased their alcohol use following a citation event. However, the reduction in alcohol consumption was modest, suggesting that the citation event itself has a very temporary influence on the drinking of college students. Additional research is needed to reconcile these findings with those from other studies that found a more meaningful citation effect.

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.

Contingency Management for Adolescent Smokers: An Exploratory Study

ABSTRACT This exploratory study investigated the efficacy and feasibility of a contingency management (CM) protocol for adolescent smokers that included use of a reduction phase. Using a within-participants design, 19 adolescents completed three 7-day phases: (1) reinforcement for attendance and provision of breath samples (RA) phase, (2) a washout phase, (3) a CM phase, with order of CM and RA counterbalanced. In addition, participants were randomized to one of two reinforcement conditions during the CM phase: (1) CM-Abstinence condition (n = 9), wherein participants earned reinforcement only for carbon monoxide levels (CO) indicating abstinence; (2) CM-Reduction condition (n = 10), wherein participants earned reinforcement for reductions from baseline CO levels for the first half of the CM phase, followed by an abstinence contingency for the remainder of the phase. Compared with CM-Abstinence, adolescents in CM-Reduction demonstrated trends for more abstinent readings and had a significantly higher percentage of readings meeting criteria for reinforcement during the CM phase. Adolescents who received the RA phase first had lower CO readings during the subsequent CM phase than those who received CM first. Future research is warranted on the effects of introducing RA and other control conditions prior to administration of CM, on strengthening the magnitude of the reinforcement, on instituting reinforcement schedules that program more rein-forcers and with longer duration to maximize the efficacy of CM-based interventions, and on increasing the exportability of CM for smoking through advances in biochemical data collection and assessment techniques.

Stepped Care: A Promising Treatment Strategy for Mandated Students.

Over the past decade, there has been a steady increase in the number of mandated students who have been referred to campus alcohol programs for violating campus alcohol policies. However, the severity of alcohol use and problems varies widely in mandated students, indicating that a “one size fits all” delivery of treatment may be inappropriate. Instead, an approach that tailors treatment may be more clinically effective, efficient, and cost-effective. Stepped care assigns individuals to different levels of treatment based on personal characteristics. This article discusses the promise of implementing stepped care with mandated students. We review previous applications of stepped care in the alcohol field, along with empirically validated interventions that could be incorporated into this approach. In addition, we address several issues to be considered when implementing stepped care with mandated students.

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.