Selecting an alcohol and other drug prevention program in times of declining resources.Dear Editor: Institutions of higher education higher education Study beyond the level of secondary education. Institutions of higher education include not only colleges and universities but also professional schools in such fields as law, theology, medicine, business, music, and art. have been struggling with budget reductions in recent years and many have experienced program eliminations or downsizing (1) Converting mainframe and mini-based systems to client/server LANs. (2) To reduce equipment and associated costs by switching to a less-expensive system. (jargon) downsizing . Some institutions have reduced or dismantled dis·man·tle tr.v. dis·man·tled, dis·man·tling, dis·man·tles 1. a. To take apart; disassemble; tear down. b. their alcohol and other drug prevention programs in an effort to adjust to funding decreases. Numerous residential student housing programs have often taken the lead or been very involved in their campus alcohol and other drug prevention programs. As underage drinking or other drug use is high with undergraduate students (Weshsler & Wuethrich, 2002), ongoing prevention and treatment efforts must be maintained. Colleges and universities need to determine best practices in prevention programs in order to select and fund only the most promising strategies. This article reviews the most effective alcohol and other drug prevention programs used in higher education. As all campuses are unique, selection of programming depends on the campus setting and overall environment. Individually focused programs are generally divided into three major categories: (a) Educational/awareness approaches, (b) cognitive-behavioral approaches, and (c) motivational enhancement techniques. An assessment of each strategy's degree of efficacy was based on an extensive literature review that was conducted by Larimer and Cronce: Educational/awareness approaches include traditional knowledge based programming, peer provided re-education programming, and values clarification. Outcome studies that have been conducted regarding the effects of these programs on college students over the past 15 years are sparse sparse - A sparse matrix (or vector, or array) is one in which most of the elements are zero. If storage space is more important than access speed, it may be preferable to store a sparse matrix as a list of (index, value) pairs or use some kind of hash scheme or associative memory. . Based on the few randomized controlled trials A randomized controlled trial (RCT) is a scientific procedure most commonly used in testing medicines or medical procedures. RCTs are considered the most reliable form of scientific evidence because it eliminates all forms of spurious causality. , educational/awareness approaches do not appear to be effective on their own, producing only small effects on behavior change Behavior change refers to any transformation or modification of human behavior. Such changes can occur intentionally, through behavior modification, without intention, or change rapidly in situations of mental illness. (2002). The cognitive behavioral approach is newer to college prevention (Larimar & Cronce, 2002). Cognitive-behavioral programs include alcohol focused skills training, self monitoring/self assessment of alcohol use or problems, and general life skills training. The goal of this approach is to teach students skills to modify beliefs and/or behaviors associated with alcohol abuse. Most programs have been multimodal Two or more modes of operation. The term is used to refer to a myriad of functions and conditions in which two or more different methods, processes or forms of delivery are used. On the Web, it refers to asking for something one way and receiving the answer another; for example requesting including specific alcohol focused skill development and teaching general life skills (Larimar & Cronce, 2002). In review of the outcome literature as reported by Larimar and Cronce, several studies indicated that these programs have been associated with behavioral changes in student drinking. The amount of change that occurred depended on the specific interventions and particular populations, but generally the efficacy of these strategies are supported (2002). Motivational/feedback approaches are brief (one to six sessions), individual, or group motivational enhancement interventions designed to increase motivation to change drinking. The assumption of this model, (Zweben & Fleming, 1999), is that change is activated activated a state of being more than usually active. In biological systems this is usually brought about by chemical or electrical means. Commonly said of pharmaceutical and chemical products. when perceived benefits of chemical use are outweighed by the costs of continuing those behaviors. An approach to conducting brief interventions A Brief intervention is a technique, similar to an intervention, to help reduce alcohol misuse. It work in two ways:
NIAAA National Interscholastic Athletic Administrators Association NIAAA Northwestern Illinois Area Agency on Aging ) that recommended an assessment with feedback, contracting with goal setting, behavioral modification and a self reflection component (Zweben & Fleming, 1999). Brief interventions have been used with individuals who are experiencing mild to moderate alcohol problems as well as used with smokers. These interventions focus on reducing the amount of drinking in order to reduce risk rather than abstinence abstinence: see fasting; temperance movements. (1999). Brief intervention approaches were described by Larimer and Cronce (2002) as the hybrid of skills training, refusal skills Refusal skills are a set of skills designed to help children avoid participating in high-risk behaviors. Programs designed to discourage drug use, violence, and/or sexual activity frequently include refusal skills in their curriculums to help students resist peer pressure while training, social norms reeducation Reeducation may refer to:
tr.v. ran·dom·ized, ran·dom·iz·ing, ran·dom·iz·es To make random in arrangement, especially in order to control the variables in an experiment. , well described, and large sample sizes. Results from these studies indicated a stronger support for brief, motivational enhancement strategies with college students compared to using single approaches (2002). The recognition of environmental forces as a significant role in substance abuse was an important step in moving forward in the field of prevention because researchers no longer located the problem of alcohol misusage mis·us·age n. 1. Abusive treatment. 2. Improper application, as of words. solely within the individual (Jones-Webb, Toomey, Short, Murray, Wagenaar, & Wolfson, 1997). As Jones-Webb et al. articulated, "environmental factors motivate and reinforce behaviors while personal factors alter the way individuals perceive or respond to the environment" (p.1262). Toomey and Wagenaar (2002) stated that the drinking behavior of individuals is influenced by countless environmental forces that include community norms and attitudes about drinking, messages from the media, institutional policies and practices, and economic factors (2002). Chassin and DeLucia (1996) reported that one of the most important risk factors affecting youth drinking is the degree of access to alcohol. Existing research indicated that greater alcohol availability is associated with higher rates of drinking. Conversely con·verse 1 intr.v. con·versed, con·vers·ing, con·vers·es 1. To engage in a spoken exchange of thoughts, ideas, or feelings; talk. See Synonyms at speak. 2. , greater regulation of alcohol availability as an environmental strategy is associated with an older age of first use, decreased consumption, and fewer alcohol related problems. "Research has shown that changes in many of these policies, by reducing the availability of alcohol, decrease alcohol consumption and related problems" (p. 194). These findings concur CONCUR - ["CONCUR, A Language for Continuous Concurrent Processes", R.M. Salter et al, Comp Langs 5(3):163-189 (1981)]. with what other researchers have previously found (Grossman et al., 1994; MacKinnon, 1995; Single, 1994) as reported by Chassin and Delucia, adding to the growing body of evidence that alcohol availability is one environmental factor associated with increased drinking rates. Researchers have also found an inverse relationship A inverse or negative relationship is a mathematical relationship in which one variable decreases as another increases. For example, there is an inverse relationship between education and unemployment — that is, as education increases, the rate of unemployment between alcohol consumption and retail alcohol pricing. As alcohol taxes increased, retail pricing increased and underage drinking decreased significantly (Casswell, 1997). Casswell reported that there is a great deal of cross cultural evidence (1) that has documented the impact of pricing and alcohol related harms. Studies from numerous countries spanning from the 1940's through the 1990's demonstrated that changes in the price of alcohol affected aggregate consumption. These cross cultural studies also demonstrated that increases in liquor liquor /li·quor/ (lik´er) (li´kwor) pl. liquors, liquo´res [L.] 1. a liquid, especially an aqueous solution containing a medicinal substance. 2. taxes effected rates of traffic fatalities (1997) "... It is estimated that if U.S. tax policy had taxed the alcohol in beer and distilled spirits at the same rate and had also offset the erosion in beer tax which had occurred since 1951 this would have resulted in a 54% decline in the number of youths killed in traffic crashes between 1975 to 1981" (Casswell, 1997, p.7). Dowdell and Wechsler reported that a large body of research has also demonstrated that a substantial relationship exists between the proximity of alcohol outlets to colleges and rates of binge drinking binge drinking An early phase of chronic alcoholism, characterized by episodic 'flirtation' with the bottle by binges of drinking to the point of stupor, followed by periods of abstinence; BD is accompanied by alcoholic ketoacidosis–accelerated lipolysis and . Colleges that were located within one mile of an alcohol outlet had noticeably higher rates of binge drinking than colleges located more than one mile away. Availability, pricing, marketing, local drinking traditions, and enforcement of existing ordinances that control the sale and laws concerning behavior while under the influence, should all be explored more extensively (2002). A study conducted by Cook and Moore (1993) were the first to measure effects of underage drinking on college graduation Graduation is the action of receiving or conferring an academic degree or the associated ceremony. The date of event is often called degree day. The event itself is also called commencement, convocation or invocation. rates. The researcher's instruments included what the minimum purchase age was and the number of years of college completed after high school. They found that "both beer tax and the minimum legal purchase age have a statistically significant and quite important effect on the likelihood of eventual graduation with a four-year college degree" (p.412). Furthermore, states with more restrictive alcohol policies were more likely to have adolescents that successfully graduated from college when compared to states without such policies. Reductions in alcohol abuse and the problems associated with high risk drinking are facilitated by changing these environmental factors. The social environment that encourages high risk drinking practices and influences availability is dramatically shaped by public and institutional policies that can be changed (Toomey & Wagenaar, 2002). Toomey and Wagenaar (2002) identified that four groups of environmental strategies can be used to reduce high risk drinking practices and alcohol availability. These are: (a). Strategies that are aimed at increasing adherence to minimum drinking age Noun 1. drinking age - the age at which is legal for a person to buy alcoholic beverages eld, age - a time of life (usually defined in years) at which some particular qualification or power arises; "she was now of school age"; "tall for his eld" laws (b) Strategies that focus on a reduction of overall levels of consumption and high risk alcohol among adolescents (c) Strategies that focus on reducing incidences of specific alcohol related problems such as drinking and driving (d) Strategies that minimize alcohol as a necessary part of life (p. 194). In 1998 the National Institute on Alcohol Abuse and Alcoholism (NIAAA) established a task force that consisted of college presidents, alcohol researchers, and students to review 24 empirical studies Empirical studies in social sciences are when the research ends are based on evidence and not just theory. This is done to comply with the scientific method that asserts the objective discovery of knowledge based on verifiable facts of evidence. that examined the serious problem of high risk drinking and resulting negative consequences among U.S. college students. Their final report, "A Call to Action," summarized the results of these studies and made recommendations for colleges to effectively reduce binge drinking rates ("A Call to Action", 2002). According to according to prep. 1. As stated or indicated by; on the authority of: according to historians. 2. In keeping with: according to instructions. 3. the report, research has demonstrated that a number of personal factors affect drinking behavior, from family background to a history of drinking in high school, as well as the college environment. For example, living in a fraternity or sorority sorority: see fraternity. , participating in sports, same sex dormitory living, being male, white are all risk factors that increase the risk for binge drinking. Other environmental factors such as size of the college, geographic location, distance from alcohol outlets, and the proportion of commuter students also appear to affect drinking patterns of college students ("Changing the Culture", 2002). Central to these research findings was the need to change the culture of college drinking if change was to occur. To bring about this cultural change, research has indicated that schools must intervene at three levels: with the individual-student, with the entire student body, and also at the community level ("Changing the Culture", 2002). In order to reduce college students' binge drinking, the recommended prevention model for the college setting would adhere to adhere to verb 1. follow, keep, maintain, respect, observe, be true, fulfil, obey, heed, keep to, abide by, be loyal, mind, be constant, be faithful 2. the following evidence based guidelines guidelines, n.pl a set of standards, criteria, or specifications to be used or followed in the performance of certain tasks. that have been outlined by the NIAAA Task Force ("A Call to Action", 2002): Tier 1: Evidence of Effectiveness among College Students --Prevention programs should combine cognitive-behavioral skill development with norms clarification and motivational enhancement interventions ("A Call to Action", 2002). Research indicates that used together, these strategies are effective in reducing consumption. An example of a combination program is the Alcohol Skills Training Program (ASTP ASTP Apollo Soyuz Test Project ASTP Army Specialized Training Program ASTP Advanced Space Transportation Program (NASA) ASTP Association of European Science & Technology Transfer Professionals ASTP American Society of Transplant Physicians ), which was designed for group intervention. Controlled outcome studies by Baer et al., (1992), as reported by NIAAA, revealed that ASTP significantly reduced drinking rates and negative consequences at one and two year follow ups. --Offer brief motivational enhancement interventions delivered individually or in groups specific to high risk groups. Students that received a brief (45 minute) session reduced their consumption and negative consequences --The Brief Alcohol Screening and Intervention for College Students (BASICS) is based on the ASTP and is administered in two individual sessions ("A Call to Action", 2002). Students receive feedback about their drinking and are given an opportunity to negotiate a plan for change. High risk drinkers who took part in the program significantly reduced their consumption rates and negative consequences --Effective prevention programming must challenge alcohol expectancies by using a combination of information and learning opportunities to alter students' expectations regarding alcohol's anticipated effects, such as believing alcohol increases sexual attractiveness and sociability. Research has indicated the effects of challenging alcohol expectancies lasts up to six weeks in men. Further research needs to be completed on the effects on women. Tier 2: Evidence of Success with the General Population That Could Be Applied to College Environments ("A Call to Action", 2002) --Increase the legal age for purchasing and consuming alcohol has been the most successful effort in reducing problems of underage drinking and alcohol related problems. Colleges need to support the enforcement of minimum age drinking laws on and off campus. --Colleges need to support increased publicity of laws that reduce driving impairment Impairment 1. A reduction in a company's stated capital. 2. The total capital that is less than the par value of the company's capital stock. Notes: 1. This is usually reduced because of poorly estimated losses or gains. 2. , as well as support the enforcement of such laws in order to reduce alcohol impaired driving. Some examples of these laws would be the use of sobriety check points, alcohol server training, and license revocation The recall of some power or authority that has been granted. Revocation by the act of a party is intentional and voluntary, such as when a person cancels a Power of Attorney that he has given or a will that he has written. laws. Supporting these laws has shown reductions in alcohol related crashes. --Restrict alcohol retail outlet retail outlet n → punto de venta retail outlet n → point m de vente retail outlet retail n → density near colleges. Studies have shown a relationship between the density of outlets, consumption and negative consequences due to drinking, as well as being located within one mile of the campus. Outlets may be restricted through policies that make licenses more difficult to obtain near a college. --Support price increases and taxes on alcoholic beverages
--With so many alcohol outlets frequently in close proximity to the college, supporting responsible beverage service policies, such as slowing service or refusing service to someone intoxicated in·tox·i·cate v. in·tox·i·cat·ed, in·tox·i·cat·ing, in·tox·i·cates v.tr. 1. To stupefy or excite by the action of a chemical substance such as alcohol. 2. , checking age, detecting false identification, as well as supporting penalties for noncompliance noncompliance failure of the owner to follow instructions, particularly in administering medication as prescribed; a cause of a less than expected response to treatment. noncompliance , would be an important component to a comprehensive approach in the reduction of binge drinking. Tier 3: Evidence of Logical and Theoretical Promise, but Requires More Comprehensive Evaluation ("A Call to Action", 2002) --The Task Force recommends a strong evaluation component to test selected interventions in order to document the effectiveness of strategies. --Adopt campus based policies and practices that support low risk drinking or abstinence. Several examples are: reinstating Friday classes, alcohol free late night activities, employ older, salaried resident assistants, refusing sponsorship of gifts from the alcohol industry, banning alcohol on campus. --Increase enforcement at campus based events that promote drinking. --Consistently enforce disciplinary actions with policy violators. --Conduct social norms marketing Social norms marketing typically involves reducing the disparity between student perceptions and the actual extent of alcohol consumption by their peers. Research has demonstrated that most college and other students hold greatly exaggerated beliefs about the proportion of campaigns to correct misperceptions about alcohol use. --Provide a "safe rides" program --Regulate happy hour sales --Inform new students and parents about alcohol policies during orientation week Orientation week is the first week of the academic year at a university or other tertiary institution, and a variety of events are held to help orient and welcome new students. It goes by a variety of names in different countries. . After careful review of the current practices in alcohol and other drug prevention programs, the most effective programs appear to include a combination of techniques. These programs are specific enough to focus on the unique needs of students at individual campuses, but are general enough to be utilized on most campuses with small modifications. The individually focused programs showed varied degrees of success with cognitive-behavioral approaches ranked positively, while educational/awareness programs generally proved to be not as successful. The combination programs, which may include any or all of the following, seem to be the most effective. Examples of combination programs include: 1. Raising alcohol prices leading to less overall alcohol usage and fewer fatalities 2. Ensuring that alcohol outlets are not in close proximity to colleges and universities, leading to less binge drinking 3. Increasing adherence to drinking age laws 4. Reduction of overall levels of consumption and high risk 5. Concentrating on reducing incidences of specific alcohol related problems, such as drinking and driving 6. Minimizing alcohol use as a perceived necessary part of college life. Cultural changes must take place with intervention programs aimed at the individual student, the entire student body, and the community. Many cultural changes are addressed in the combination programs since these programs cannot be successful without the cooperation of the student, the campus, and the community. An evaluation component for each program is essential in order to determine its value, usefulness and success. In this time of budget restraints and reductions, best practices in prevention programs for alcohol and other drugs are being offered, and are successful. For programs to be successful it takes a combination of individual and environmental strategies along with a consortium of students, campus and community leaders, business owners, and other stakeholders Stakeholders All parties that have an interest, financial or otherwise, in a firm-stockholders, creditors, bondholders, employees, customers, management, the community, and the government. to work together toward this common goal. REFERENCES Casswell, S. (1997). Population level policies on alcohol: Are they still appropriate given that 'alcohol is good for the heart?' Addiction [Electronic Journal], 92(3), 1-13. Chassin, L. & DeLucia, C. (1996). Drinking during adolescence adolescence, time of life from onset of puberty to full adulthood. The exact period of adolescence, which varies from person to person, falls approximately between the ages 12 and 20 and encompasses both physiological and psychological changes. . Alcohol Health & Research World, 20(3), 175-181. Cook, P.J. & Moore, M.J. (1993). Drinking and schooling. Journal of Health Economies, 12, 411-429. Dowdall, G. & Wechsler, H. (2002). Studying college alcohol use: Widening the lens, sharpening For image sharpening, see . Sharpening is the process of creating or refining a sharp edge on a tool or implement. The term has a wide application but can be expressed as the creation of two intersecting planes which produce an edge that is sharp enough to cut through the target the focus. Journal of Studies on Alcohol, Supplement 14, 14-21. Jones-Webb, R., Toomey, T., Short, B., Murray, D., Wagenaar, A., & Wolfson, M. (1997). Relationships among alcohol availability, drinking location, alcohol consumption, and drinking problems in adolescents. Substance Use & Misuse, 32(10), 1261-1285. Larimer, M. & Cronce, J. (2002). Identification, prevention and treatment: a review of individual-focused strategies to reduce problematic alcohol consumption by college students. Journal of Studies on Alcohol, Supplement 14, 148-163. National Institute on Alcohol Abuse and Alcoholism (NIAAA). (2002). A call to action: Changing the culture of drinking at US. colleges. Retrieved August 6, 2003 from http://www. niaaa.nih.gov/publications/aa46htm National Institute on Alcohol Abuse and Alcoholism (NIAAA). Alcohol Alert No. 58 (2002). Changing the culture of campus drinking. Retrieved October 17, 2004 from http://www.niaaa. nih.gov/publications/aa58.htm Toomey, T. & Wagenaar, A. (2002). Environmental policies to reduce college drinking: options and research findings. Journal of Studies on Alcohol, Supplement 14, 193-205. Zweben, A., & Fleming, M. (1999). Brief interventions for alcohol and drug problems. In J. Tucker, D. Donovan, & G. Marlatt (Eds.). Changing Addictive Behavior Addictive behavior is any activity, substance, object, or behavior that has become the major focus of a person's life to the exclusion of other activities, or that has begun to harm the individual or others physically, mentally, or socially. (3rd ed., pp. 251-282). NY: The Guilford Press.Running head: Drinking on Dry Campuses. Helen Karamitros North Iowa Area Community College The North Iowa Area Community College (commonly known as NIACC) is a community college in Mason City, Iowa. History NIACC began as Mason City Junior College in 1918, becoming the first public two-year college in Iowa. Mark Minelli Central Michigan University Central Michigan University, at Mount Pleasant, Mich.; coeducational; est. 1892 as a normal school, became Central State Teachers College in 1927, achieved university status in 1959. The university maintains a forest that is used for botanical and biological research. Joan Schmidt Central Michigan University (1) Cross cultural data were collected from the United Kingdom, the Netherlands, Sweden, Finland and Norway. |
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