A variety of interventions – especially combinations of interventions – have curtailed freshmen drinking on campuses across the country, according to a systematic review of more than 40 studies documenting 62 interventions. Given that efficacy, colleges should consider assessing alcohol risk among all new freshmen and providing multifaceted interventions for those who report drinking, the review’s authors recommend.
PROVIDENCE, R.I. [Brown University] — A new systematic review of data published in more than 40 studies of freshman alcohol interventions finds there are many effective ways for colleges to mitigate common drinking patterns and problems among new students.
Based on their findings, published online Jan. 20 in the Journal of Consulting and Clinical Psychology, the team of researchers at Brown University and The Miriam Hospital recommends that colleges screen all freshmen within their first few weeks for alcohol risk and offer effective combinations of interventions for those who report drinking.
“Adoption of our recommended strategies would enable colleges to become more proactive – that is, targeting interventions to those students who have initiated alcohol use and may experience some alcohol-related problems but before their alcohol use meets criteria for alcohol dependence or abuse,” said study lead author Lori Scott-Sheldon, assistant professor of psychiatry and human behavior (research) at Brown and researcher in the Centers for Behavioral and Preventive Medicine at The Miriam Hospital.
Even the best interventions studied don’t completely stop freshman from drinking, the researchers said, but even “small effect sizes” can have a large impact when implemened broadly, a phenomenon known as the “prevention paradox.” Small changes on the individual level sum to large effects on the population of students on a campus.
“College drinking is one of those cases where the majority of harms or alcohol-related problems that accumulate on a campus can be attributed not to the relatively small number of really problematic drinkers, but to the majority of moderate drinkers because there are so many of them,” said co-author Kate Carey, professor of behavioral and social sciences in the Brown University School of Public Health. “Thus small effect sizes mean that any given person may change just a little as a result of an intervention, but when we expand the effects to the whole freshman class we would expect prevention programs like those we reviewed to have a public health impact.”
In the analysis, the team examined the efficacy of 62 interventions delivered in randomized, controlled clinical trials involving more than 24,000 freshmen around the country during the last decade. The researchers looked for patterns emerging from these trials that would reveal which interventions reduce drinking amount and frequency and reduce alcohol-related problems.
The single technique that provided the broadest benefits was providing students with a personalized feedback report that can include details such as how self-reported drinking compares to peers, the financial cost of alcohol consumed, the calories consumed, and sometimes even blood-alcohol levels. Laying out this kind of information significantly helped students reduce the dimensions of drinking frequency, quantity, and alcohol-related problems.
In general, however, Scott-Sheldon, Carey, and their colleagues found that different intervention techniques affected different things.
For example, challenging students’ alcohol-related expectancies — for instance by sorting out what popular aspects of drinking are really related to alcohol as opposed to the social context of partying — significantly reduced the incidence of alcohol-related problems, but didn’t significantly affect alcohol quantity, frequency of drinking days, or frequency of heavy drinking.
Interventions that combined several techniques proved most effective because they accumulated the differing efficacy of the multiple techniques.
“Interventions with four or more components ... were the most effective at reducing first-year students’ alcohol consumption and alcohol-related problems,” the researchers wrote.
The intervention they recommend for colleges, Scott-Sheldon said, would combine personalized feedback, moderation strategies (e.g., alternating alcoholic beverages with non-alcoholic beverages), goal setting (e.g., setting blood alcohol level limits), and identifying especially risky situations (e.g., fraternity house parties).
What colleges can do
The team’s recommendations for widespread screening and multi-technique interventions would be novel for many colleges. Studies have found that most colleges offer only alcohol education (which was not especially effective), and only half offer personal feedback and moderation strategies to all students who request or are referred to intervention. Results from work by Scott-Sheldon and colleagues indicate that widespread screening and multi-technique interventions are feasible.
With the exception of affecting the frequency of heavy drinking, interventions were similarly successful whether they were delivered individually or in groups, and whether they were provided in person or online (for heavy drinking in-person interventions were better).
Although the response of students varied somewhat by gender and race for a few specific aspects of drinking, interventions were generally similar in efficacy across gender and race, meaning that interventions don’t have to be finely tailored for many different groups.
The broad efficacy of interventions combined with the relative low cost and ease of delivering them mean that colleges have worthwhile means at their disposal to make a greater impact on freshman drinking, the researchers concluded.
“[Our] recommendations are relatively inexpensive, but would require allocation of more resources to alcohol prevention than is generally allocated on most campuses now,” Carey said. “But what is rarely discussed is the cost of not investing in these prevention measures: continued property damage, maintenance, security and emergency transport expenses associated with alcohol misuse, or student assaults and injuries.”
In addition to Scott-Sheldon and Carey, other authors are Michael Carey of Brown and The Miriam Hospital, Lorra Garrey of the University of Houston, and Jennifer Elliott of Columbia University.
The National Institute on Alcohol Abuse and Alcoholism funded the study (grant R01-AA012518).