Feedback interventions for college alcohol misuse: What, why and for whom?
Introduction
Recent media attention to the alcohol-related deaths on college campuses has brought mainstream attention to the persistent problem of college drinking. Almost half of students report a heavy drinking episode over the last 2 weeks (Johnston et al., 2000, Wechsler et al., 2002), and one quarter engage in heavy or problematic drinking (Barnes et al., 1992, Berkowitz & Perkins, 1986). Surveys find a heavy episodic drinking pattern to be associated with poorer grade point averages, higher rates of drinking and driving, greater incidences of assault and rape, and a substantial cost burden to colleges, hospitals, and the legal system (Frinter & Rubinson, 1993, Hingson et al., 2002, Schuckit et al., 1994). Residents who live close to college campuses report decreased quality of life in proportion to campus drinking rates (Wechsler et al., 2002), and students who live on campuses with high rates of drinking are more likely to be assaulted and to have their studies disturbed (Wechsler et al., 1994, Wechsler et al., 1995).
In response, colleges and universities have instituted a range of alcohol intervention and prevention programs. Unfortunately, relatively few have been shown to be effective at reducing consumption (Larimer & Cronce, 2002, Walters & Bennett, 2000). Even among those programs that have empirical support, outcome studies have often been limited to qualitative assessments, prospective estimates of change, and/or changes in something other than drinking (e.g., knowledge). Although there is empirical support for a subset of skills-based, attitudinal, and motivational interventions, these approaches are less well disseminated because of their relatively high cost (NIAAA, 2002).
One exception to this trend has been the proliferation of feedback-based interventions (Walters, 2000). Drawing on motivational (Miller & Rollnick, 2002) and social psychology (Bandura, 1982, Bandura, 1994) literature, feedback interventions rely on a presentation of discrepant information, such as a personal drinking profile (e.g., quantity-frequency consumed, peak blood alcohol level, amount of money spent on alcohol, caloric intake), risk factors (e.g., genetic risk of alcoholism, tolerance, dependence, negative consequences), and normative comparisons (e.g., beliefs about peers' drinking, amount consumed in relation to peers). In two recent reviews of the college treatment literature (Larimer & Cronce, 2002, Walters & Bennett, 2000), nearly every individual intervention that showed a reduction in drinking employed personalized drinking feedback. In some contexts, feedback is used as an adjunct to an individual or group counseling session. For instance, a student might be asked to complete drinking assessments prior to meeting with a counselor. A drinking profile is then presented to the student as part of the counseling session. In other contexts, feedback is used as a stand-alone intervention. In practice, colleges may utilize feedback as an adjunct to interventions targeted to groups of high-risk students (e.g., freshman, athletes, Greek-affiliated) or provide mailed or electronic feedback to other large groups. In a recent review of computerized prevention programs, every commercially available program used feedback as one aspect of the intervention (Walters, Miller, & Chiauzzi, 2004). These results alone mean that potentially tens of thousands of students are receiving drinking feedback each year.
Section snippets
Rationale for the present review
While it is encouraging to see an evidence-based intervention being adopted in practice, the popularity of this approach has, in some cases, outstripped available evidence and theory. For instance, there appears to be no systematic review of feedback approaches used to intervene with college drinking. Likewise, we have very little understanding of the mechanisms and conditions under which feedback might work. There has been relatively little discussion of how it might be used more
Methods
This article focuses on published outcome studies that have utilized feedback as a major component of an alcohol intervention for college students. For purposes of this review, we define “feedback” as information about one or more aspects of personal drinking, such as consumption, risk factors, and/or normative comparisons. Most often, feedback has been allied with the counseling approach of motivational interviewing (e.g., Miller & Rollnick, 2002) in terms of the specific items included in the
Results
The studies varied widely in terms of population characteristics, control/comparison group, and follow-up period. Seven studies utilized feedback as an adjunct to an individual or group meeting, three studies tested feedback as a stand-alone intervention delivered through the mail or Internet, and three studies examined some combination of these two formats. Most studies used undergraduate volunteers screened out of psychology testing pools, though a few studies used students identified as
Discussion
The numerous differences among this relatively small number of studies combined with methodological limitations make any inferences tentative. However, for the moment, existing data seem to suggest a number of conclusions.
First, it appears that personalized feedback can be effective whether delivered via an individual interview, mail, or computer. Effect sizes were similar across the various feedback-delivery formats. For example, Collins et al. (2000) and Borsari and Carey (2000) report
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- 1
Scott T. Walters is Assistant Professor at the University of Texas School of Public Health and Southwestern Medical Center at Dallas.
- 2
Clayton Neighbors is Assistant Professor at the University of Washington, Department of Psychiatry. Tel.: +1 206 685 8704; fax: +1 206 543 9520.