Curr Addict Rep (2015) 2:47–57
DOI 10.1007/s40429-015-0043-1
ALCOHOL (RF LEEMAN, SECTION EDITOR)
Novel Approaches to Individual Alcohol Interventions for Heavy
Drinking College Students and Young Adults
Kelly S. DeMartini & Lisa M. Fucito &
Stephanie S. O’Malley
Published online: 31 January 2015
# Springer International Publishing AG 2015
Abstract Efficacious alcohol interventions for college students and young adults have been developed but produce
small effects of limited duration. This paper provides a review
and critique of novel (e.g., a significant deviation from a traditional, brief, and motivational intervention) interventions
published between 2009 and 2014 to reduce alcohol use in
this population and covers intervention format/components
and efficacy on alcohol outcomes. We reviewed 12 randomized controlled trials of novel, individual-level alcohol interventions that reported alcohol outcomes. Four domains of
novel interventions are discussed: content (e.g., pharmacotherapy and automatic action tendency retraining), setting
(e.g., health centers and ED), modality (e.g., mobile technology), and treatment integration. Findings were mixed for intervention efficacy to reduce amount and frequency of alcohol
consumption. Few studies assessed impact on alcohol-related
problems. Despite the prevalence of efficacious interventions,
there is still an urgent need for novel treatment approaches and
delivery mechanisms for this difficult-to-treat population.
Keywords Alcohol . College . Intervention . Young adult .
Alcohol-related consequences . Technology
This article is part of the Topical Collection on Alcohol
K. S. DeMartini (*) : L. M. Fucito
Department of Psychiatry, Yale School of Medicine, 1 Long Wharf
Drive, Box 18, New Haven, CT 06511, USA
e-mail: kelly.demartini@yale.edu
L. M. Fucito
e-mail: lisa.fucito@yale.edu
S. S. O’Malley
Department of Psychiatry, Yale School of Medicine and Yale
Comprehensive Cancer Center, Connecticut Mental Health Center SAC 202, 34 Park St., New Haven, CT 06519, USA
e-mail: stephanie.omalley@yale.edu
Introduction
High rates of alcohol consumption and alcohol use disorders
in college students and young adults are a substantial public
health concern. Heavy episodic drinking, defined as the consumption of five or more drinks on one occasion for a man and
the consumption of four or more drinks for a woman, is common; four in ten students engage in heavy drinking [1•, 2].
Heavy drinking episodes, in particular, are associated with
greater alcohol-related consequences, including physical injury and unprotected sex [3]. While college students are significantly more likely to consume a higher maximum number of
drinks, college students and their non-college attending peers
report typical average quantities of alcohol consumed that are
similar [4]. Moreover, many students and young adults meet
diagnostic criteria for an alcohol use disorder. Approximately
32 % of college students meet the criteria for past-year alcohol
abuse; approximately 6 % meet the criteria for alcohol dependence [5]. Non-college attending young adults also experience
high rates of alcohol use disorders [4], and recent estimates
indicate that after adjusting for background sociodemographic
characteristics, the risk of any alcohol use disorder is the same
for both college students and their non-college attending peers
[6]. These persistently high rates of alcohol consumption and
associated problems highlight the urgent need for the development of efficacious interventions.
To address this known problem, research on the development of alcohol interventions for this age cohort has
burgeoned in the past few decades. Colleges and universities
have bolstered efforts to reduce alcohol consumption among
their students. Indeed, a recent survey of college administrators from 351 4-year colleges indicated that nearly all (98 %)
provide some type of educational program to address alcohol
consumption [7]. Only 50 % of the schools, however, provide
programs with documented efficacy [7]. Randomized trials of
individual alcohol interventions alone number in the hundreds
48
[8, 9, 10•, 11, 12]. Overall, these interventions have included
mostly first year college student volunteers [10•], and most
trials are conducted at large, public universities [8].
Research on these individual alcohol interventions for college students and young adults has produced interventions that
effectively reduce rates of alcohol consumption and alcoholrelated problems [8, 13, 14]. Meta-analysis results indicate
that the alcohol interventions that are most effective at reducing consumption and problems are individual, face-to-face
interventions that utilize motivational interviewing techniques
and include personalized, normative alcohol consumption
feedback [8]. Accordingly, several of these face-to-face interventions are considered recommended Tier 1 interventions by
the National Institute on Alcohol Abuse and Alcoholism [15].
These interventions, however, produce relatively small effects
of limited duration and are less effective for the heaviest
drinkers or other high-risk groups of young adults or students
[8]. Moreover, because this type of intervention requires an inperson intervention session with a counselor, they can be costly, labor-intensive, and hard to disseminate on a large-scale
[8].
To address the challenges of face-to-face interventions and
meet the needs of college students and young adults, numerous randomized clinical trials have investigated the efficacy of
computer-delivered individual brief alcohol interventions. It
has been suggested that computer-delivered interventions are
well suited to the lifestyle of young adults and that young
adults prefer them [16, 17]. In accordance with the recent
increase in interest in these interventions, the efficacy of
computer-delivered interventions has been recently reviewed
in both narrative reviews and meta-analyses [9, 18]. When
compared with wait-list, no-treatment, and assessment-only
treatment conditions, the effects of computer-delivered interventions are positive but small. When compared with other
active interventions, meta-analysis results indicate that
computer-delivered interventions do not show an advantage
[9]. A more recent meta-analysis reviewed individual alcohol interventions conducted between 1998 and 2010
and included trials that directly compared computerdelivered interventions with face-to-face interventions
[10•]. When these intervention modalities were directly
compared, participants reported greater decreases in quantity (including peak blood alcohol concentration) and
alcohol-related problems when they received a face-toface intervention [10•]. Therefore, despite the fact that
participants who received computer-delivered interventions had better alcohol outcomes than if they received
no intervention or a control condition, these interventions
have not been able to yield better outcomes than traditional in-person, motivational interventions. Computerdelivered interventions, however, offer significant advantages in terms of clinician-time and cost-efficiency and
may have particular utility for early intervention.
Curr Addict Rep (2015) 2:47–57
It is clear, therefore, that more work needs to be done to
build interventions that produce larger effect sizes for young
adults in general and/or are more effective at reducing alcohol
consumption and alcohol-related problems for heavier and atrisk drinkers. As noted, the majority of individual alcohol
interventions, both the face-to-face and computerized, for
this population use motivational interviewing techniques,
are built around the efficacious Brief Alcohol Screening
and Intervention for College Students (BASICS; [19])
model, include personalized feedback, and are conducted
with mostly freshmen on the campuses of colleges and
universities. Developing and testing interventions that
significantly differ from this model could be one way
to improve both alcohol consumption and problems outcomes for young adult drinkers.
The purpose of this review is twofold. The first aim is to
provide an overview of treatment components in novel,
individual-level alcohol interventions (both face-to-face and
via other modalities, including technologically-based interventions) designed to reduce alcohol consumption in young
adults. The second aim is to summarize the efficacy of these
interventions to reduce alcohol consumption outcomes. To be
included, studies needed to (a) be specifically designed to
reduce alcohol use in college students and/or young adults;
(b) use random assignment to treatment conditions; and (c)
report outcomes related to alcohol consumption. Importantly,
to be included, studies had to be considered novel. As will be
further detailed below, interventions were considered novel if
they represented a significant deviation from a traditional,
brief, and motivational intervention (either computerized or
face-to-face). The deviation had to be such that the efficacy
of the intervention could be impacted by the deviation. Studies
were excluded if they evaluated interventions that were not
administered to individuals (i.e., were administered campuswide), because the intervention dose could not be determined
in these trials.
Method
Sample of Studies
Several search strategies were used to obtain relevant published or in press manuscripts. First, we conducted database
searches of PsycINFO, PsycARTICLES, and PubMed using a
Boolean search strategy with the following key words:
alcohol and (college or university) and intervention. Additional searches were conducted with the following key
words: alcohol and young adults and (intervention or
treatment). Second, we reviewed the reference sections
of relevant published manuscripts. Third, we sent requests for in press manuscripts to the authors.
Overview of studies’ sample characteristics, intervention conditions, assessments, and outcomes
Study citation
Demographics
Novel Content Domain
[27] [O’Malley] N=128 heavy drinking
young adults (18–25)
31 % Female
23 % Caucasian
[28] [Wiers]
[29] [Murphy]
N=42 hazardous drinking
young adults (18–28)
100 % Male
N=82 heavy drinking
university freshmen
Study conditions
Follow-ups Outcome measures
E=25 mg daily nal
+25 mg targeted nal
+60 min BASICS
+4, 15 min FU visits
C=daily placebo +
targeted placebo +
60 min BASICS +
4, 15 min FU visits
Duration=8 weeks
E1 =alcohol AAT (push images)
In-treatment
2 weeks
4 weeks
6 weeks
Post
8 weeks
PDA
PHDD
DPDD
eBAC≥0.08 g%
Problems
Posttest
Taste-test: no. of
drinks consumed
E1 >E2: no. of drinks (when restricted analysis
to participants successfully trained)
1 month
DPW, Binge
E1 >E2: DPW, Binge, Problems
E2 =alcohol AAT
(pull images)
E1 =BMI (50 min) +SFAS (50 min)
Summary of findings
8 weeks
E=C: PHDD, PDD, Problems
E>C: DPDD, eBAC
Curr Addict Rep (2015) 2:47–57
Table 1
6 months
50 % Female
82 % Caucasian
Novel Modality Domain
[30] [Bryant]
N=191 university freshmen
E2 =BMI (50 min) +relaxation session
(30 min)
Problems
E=email feedback
C=email education
6 weeks
DPW, Days Drunk
Days alc. high
AUDIT
Binge
Problems
E>C: DPW, Days drunk
E=C: Days alc. high, AUDIT, Problems
E1 =smartphone app BCheck your
BAC.^ Real-time BAC feedback.
Post
DPW, Binge
eBAC/week
Peak BAC
Frequency
C>E1: frequency
E2 =C: all outcomes
1 month
DPW, Max drinks, DPDD
E=C: all outcomes
76 % Female
82 % Caucasian
[31] [Gajecki]
N=1932 hazardous drinking
university students
52 % Female
[32] [Mason]
N=18 hazardous drinking
university students
56 % Female
67 % Caucasian
E2 =smartphone app BPartyplanner.^
Real-time BAC feedback +
pre-occasion planning
C=assessment only
Duration=7 weeks
E=4–6 SMS/day
C=assessment only
Duration=4 days
49
50
Table 1 (continued)
Study citation
Demographics
[33] [Witkiewitz] N=94 heavy drinking and
smoking university
students
28 % Female
Study conditions
Follow-ups Outcome measures
Summary of findings
E1 =BASICS-Mobile + smk urge
surfing + daily assessment
EMA days
DPDD, Binge
E1 =E2 =C: DPDD, Binge, Concurrent,
Problems
1 month
Concurrent alc and smoking E1: more intervention modules
associated with lower likelihood
of any drinking during EMA
Problems
3 month
DPW, Binge
E=C: all consumption, all time points
6 month
Peak BAC
Frequency
Problems
E>C: Problems (3 months, 6 months)
Mean drinks/mo Binge
E>C: Mean drinks (12 months),
Problems (6 and 12 months)
E2 =daily assessment
C=minimum assessment
71 % Caucasian
[34] [Borsari]
N=57 mandated university
students
Duration=14 days
E=telephone BASICS (35–40 min)
39 % Female
C=assessment only
96 % Caucasian
* all received brief advice
(15 min) 6 weeks prior
9 month
Novel Setting Domain
[35] [Fleming]
N=986 heavy drinking
university students
E=2 MI counseling sessions (15 min) + 2 phone/email 6 months
12 months
49 % Female
Frequency
Problems
E=C: Binge, Frequency
C=usual care
[36] [Schaus]
91 % Caucasian
N=363 heavy drinking
university students
E=2 brief MI, BASICS (20 min)
52 % Female
C=usual care + alcohol education
77 % Caucasian
brochure
3 months
Typical eBAC, Peak eBAC 3 months E>C: Typical BAC, Peak BAC, Max,
6 months
DPDD
Binge
Max/occasion
DPW
9 months
12 months
[37] [Suffoletto]
N=765 hazardous drinking
young adults (18–25)
65 % Female
49 % Caucasian
E1=SMS messages + feedback
E2=SMS messages
C = no messages
Duration=12 weeks
3 months
DPDD, Binge
6 months E>C: Typical BAC, Peak
BAC, DPDD,
Binge, Max, DPW, Drunk, Problems
9 months E>C: Problems E=C: all
consumption outcomes
12 months E=C: all outcomes
E1>E2 & C: Binge, DPDD
Curr Addict Rep (2015) 2:47–57
Frequency Drunk/week
Problems
DPW, Frequency
E=C: DPDD, Binge, Problems
N.B. The greater than sign is used to signify when a condition performed better than another. It does not indicate the direction of the outcome variable
93 % Caucasian
49 % Female
Notes E experimental condition, C control condition, nal naltrexone pharmacotherapy, FU follow-up, BASICS brief alcohol and screening intervention for college students, PDA percent days abstinent,
PHDD percent heavy drinking days, DPDD drinks per drinking day, eBAC estimated BAC, Problems alcohol-related problems, AAT approach avoidance test, SFAS substance-free activity session, DPW
drinks per week, AUDIT alcohol use disorders identification test, BAC blood alcohol content, SMS, short message service, smk smoking, EMA ecological momentary assessment, MI motivational
interviewing, DHHS department of health and human services, DPM drinks per month
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E=C: all outcomes
Binge, DPM
Frequency
Post
Week 24
E=8 sessions
Integrated Treatment
(DHHS Tobacco
Guidelines) +
nicotine replacement
+ BASICS
(1st 6=30 min; last 2=10 min)
C=8 sessions Treatment (DHHS
Guidelines) +nicotine replacement
Duration=12 weeks
Novel Treatment Integration Domain
[38] [Ames]
N=41 young adult binge
drinking smokers (18–30)
Study citation
Table 1 (continued)
Demographics
Study conditions
Follow-ups Outcome measures
Summary of findings
Curr Addict Rep (2015) 2:47–57
Selection Criteria
English language articles published in peer-reviewed journals
were screened for inclusion. Published (or in press) studies
were included if they met all of the following criteria: (a)
examined a behavioral or psychological alcohol intervention;
(b) sampled college or university students or specifically sampled young adults (ages 18–30 years); (c) used a randomized
controlled trial experimental design; and (d) included at least
one alcohol consumption outcome variable (e.g., frequency or
quantity of alcohol consumption). Accordingly, studies were
excluded if the intervention did not focus specifically on alcohol, but rather tested an intervention of another disorder
(e.g., depression) and examined alcohol outcomes postintervention (e.g., [20]).
Additionally and importantly, the intervention had to be
considered novel. Because numerous reviews of the literature on individual-level brief interventions for college students and young adults have been published in the past
10 years, interventions that would typically be the subject
of these reviews were excluded, including traditional brief
motivational interventions delivered on-campus to either
student volunteers or mandated students by counselor or
computer [8, 9, 10•, 13, 14, 18, 21] and expectancy challenge interventions [11].
Interventions were considered novel if they represented a
marked deviation from the traditional brief, motivational intervention (whether computerized or face-to-face) in an important way that could impact the efficacy of the intervention.
For example, deviations could occur in treatment setting or
with the inclusion a novel, previously untested intervention
component. Manuscripts examining permutations (e.g., duration of intervention [22]), delivery of a traditional intervention
tailored for a specifically timed event (e.g., 21st birthday celebrations [23]), and use of a different type of counselor for the
intervention (e.g., peer-led interventions [24, 25]) of a typical
motivational intervention were excluded. Manuscripts were
also excluded if they represented an intervention targeted at
such a specific subgroup of young adults that results would
only be applicable to that group (e.g., pregnant college binge
drinkers, [26]). To further highlight novel interventions, only
studies that fulfilled all selection criteria and had been published within the past 5 years (e.g., studies published or in
press between 2009 and 2014) were included. Two authors
independently reviewed potential manuscripts to determine
whether the study in question represented a significant change
from a traditional brief intervention. Disagreements were
resolved through discussion. Thus, this review is not
intended to be an exhaustive review of alcohol interventions for young adults. Rather, we sought to highlight
particularly novel approaches to interventions for this population. Using these criteria, 12 manuscripts were included
in the review (see Table 1).
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Results
Between 2009 and 2014, 12 novel randomized controlled trials of alcohol interventions for college students and young
adults had been published or were in press. The studies evaluated a wide range of interventions of varying modalities
across a number of different treatment settings. Intervention
format also varied widely from brief feedback to text message
to pharmacological treatment. To provide an organizational
framework for review, studies were clustered by the domain
on which they were considered most novel. Four novel domains were represented: (a) content (k=3), (b) modality (k=
5), (c) setting (k=3), and (d) treatment integration (k=1). It
should be noted that some studies could have been considered
novel in multiple domains. In those cases, we elected to categorize them where we considered them to be most novel and
note which studies could have differently categorized. The
categories, therefore, serve as a heuristic guide for the reader.
Novel content interventions were interventions that contained
components that have not been typically included in a brief,
motivational interviewing-based, face-to-face, or computerized intervention. Treatment components could be added onto
a BASICS intervention (e.g., pharmacotherapy and a behavioral economics module) or could be a totally unique intervention (e.g., cognitive retraining). Studies with novel treatment
modalities were studies in which the method of intervention
delivery was different from either a counselor-based, face-toface intervention, or a computerized program. This included
text-message-based and smartphone application. Lastly, the
trial examining integrated treatment was a trial that integrated
treatment for binge drinking into an evidence-based treatment
for smoking cessation. Taken together, these trials each represented a marked deviation from a traditional face-to-face or
computerized brief motivational intervention.
Within each domain, an overview of the intervention approach(es) and study design(s) is reviewed; this is followed by
a summary of intervention efficacy on alcohol outcomes. This
organizational approach was selected to best highlight the variety of advances in intervention development.
Novel Intervention Content
Description of Studies Table 1 provides sample characteristics, intervention details, and trial outcomes for the 12 studies
reviewed. Three interventions were identified that utilized
novel intervention components [27–29]. Of those, two examined the addition of a novel treatment to a traditional, brief
motivational intervention [27, 29], and one was a laboratorybased study that examined the impact of a cognitive retraining
task [28]. These studies differed dramatically in their content.
Focusing first on the two studies that added components to a
typical BASICS intervention, one tested pharmacological
treatment with naltrexone [27], and the other randomized
Curr Addict Rep (2015) 2:47–57
participants to either BASICS plus relaxation training or BASICS plus a behavioral economic supplement (i.e., SubstanceFree Activity Session, a 50 min individual counseling session
that emphasized the salience of students’ academic and career
goals to highlight the discordance between heavy alcohol consumption and goal achievement [29]). Duration of treatment
varied significantly. Pharmacotherapy was administered for
8 weeks and was combined with bi-weekly, 15–20 min sessions with a nurse practitioner who reviewed treatment goals
[27]. The behavioral economic supplement was administered
in a 50 min, individual counseling session [29]. In both trials,
all participants received a BASICS-type individual, motivational intervention approximately 60 min in length. Follow-up
treatment occurred either with a nurse [27] or with relaxation
training [29]. The studies had comparable sample sizes of 128
treatment starters [27] and 82 starters [29]. The pharmacotherapy trial included participants between the ages of 18–25 years
who reported ≥4 heavy drinking days (e.g., consuming at least
four drinks on one drinking occasion for a woman; five or
more for a man) in the past month and did not require college
attendance. The behavioral economics trial included only college freshmen [27].
The other study in this domain did not test a motivational
intervention. The study was a laboratory-based test of a cognitive retraining intervention that examined two variations of
the alcohol Approach-Avoidance Task [28]. The study
assessed whether the tendency to approach alcohol cues in
the environment on the part of heavy drinkers could be
changed following a retraining designed to increase or decrease this automatic tendency. The study employed a
single-session design in which participants completed a computerized joystick task that asked them to push or pull on the
joystick in response to pictures of alcoholic and non-alcoholic
beverages. Participants were randomly assigned to either push
away (active condition) or pull (control condition) alcohol
images toward them. Participants were 42 heavy drinking
males (i.e., males that scored at least an 8 on the Alcohol
Use Disorders Identification Test (AUDIT; Babor et al.,
2001) between the ages of 18–28 years [28]).
Intervention Efficacy On alcohol consumption outcomes,
both the pharmacotherapy trial and the cognitive retraining
study had significant effects on quantity. At the end of 8 weeks
of treatment, pharmacotherapy reduced typical drinks consumed per drinking day [27]. Examination of the whole sample indicated that cognitive retraining had no effect on quantity consumed after the trials. When data from only those who
were successfully trained (e.g., those in the Bapproach^ condition who pulled alcohol images toward them more quickly
following retraining and those in the Bavoid^ condition who
pushed alcohol images away more quickly after retraining)
were examined, at immediate posttest, cognitive retraining
reduced number of drinks consumed [28]. Pharmacotherapy
Curr Addict Rep (2015) 2:47–57
treatment also significantly reduced the number of drinking
days with an estimated blood alcohol content ≥0.08 g%.
Long-term follow-up results were not reported [27]. The behavioral economic intervention did not produce a benefit over
active control on quantity consumed; both the behavioral economic intervention and active control reduced drinks per week
and heavy drinking. Participants in both conditions maintained reductions in heavy drinking at 6 months posttreatment,
though the behavioral economics condition had a greater effect size [29]. On alcohol-related problems, the behavioral
economic intervention produced an effect that was greater
than active control. This was maintained 6 months posttreatment [29]. The cognitive retraining trial did not assess impact
on alcohol-related problems [28]. Overall, therefore, pharmacotherapy produced the most durable effects on quantity and
the behavioral economic intervention produced the most durable effects on alcohol-related consequences.
Novel Intervention Modality
Description of Studies Five interventions were identified that
utilized a novel intervention modality [30–34]. Three trials
evaluated the use of mobile technology for intervention delivery, including text messaging and smartphone applications
(EMA) [31–33], one tested a telephone-delivered intervention
[34], and one tested an electronic-mail-delivered intervention
[30]. Sample sizes ranged from 18 [32] to 1932 [31], and all
studies used mixed gender samples of college or university
students. One trial used a sample of introductory psychology
students [30]; all others used samples of heavy/hazardous
drinkers, as defined by either a positive screen on the Alcohol
Use Disorders Identification Test or frequency of heavy drinking episodes [31–34], or students mandated to receive intervention due to a campus alcohol violation [34].
Across these five trials, control conditions varied. One trial
used a no-intervention control condition [31], three trials used
minimal assessment/assessment-only control conditions
[32–34], and one used e-mail-delivered alcohol education
[30]. In four of the five trials, participants in active treatment
conditions received interventions based on principles of motivational interviewing [30, 32–34]. Of the studies that utilized
mobile technology for active treatment conditions, one tested
an MI-based, text-message delivered intervention [32]; and
two tested mobile-based applications either with (e.g., daily
[33]) or without [31] text-message prompts. Mobile applications included either real-time electronic blood alcohol content with or without the ability to pre-plan a drinking episode
[31] or contained BASICS material and feedback [33]. Active
treatment duration also varied significantly, ranging from
7 weeks of mobile application access to one email/phone call
with personalized alcohol feedback [30, 34]. Follow-up assessments occurred at a range of time-points, including immediate posttreatment [31], 1 month posttreatment (n=2) [32,
53
33], 6 weeks posttreatment [30], and 3-, 6-, and 9-months
posttreatment [34].
Intervention Efficacy Of the five interventions, two reported
significant group effects on alcohol consumption [30, 33].
Relative to control, personalized feedback via e-mail reduced
number of drinks on a typical day and number of days that
participants felt drunk 6 weeks after intervention [30]. Receiving more modules of text message plus mobile application
intervention, including daily assessments, was associated with
a decreased likelihood of any alcohol consumption on a given
occasion during treatment only compared to control condition.
This effect was not seen at 1-month follow-up [33]. Phone
intervention, text-message-only intervention, and estimated
BAC (e-BAC) feedback plus mobile application were not different from control on alcohol consumption outcomes [31, 32,
34]. Estimated BAC feedback only significantly increased the
frequency of alcohol consumption [31], and e-mail alcohol
education significantly increased typical drinks per drinking
day [30]. Effectiveness of intervention on alcohol-related
problems was only assessed in one trial. Compared to control,
telephone-delivered intervention significantly reduced
alcohol-related problems at 3- and 6-month follow-up [34].
Overall, mobile technology interventions produced weak findings on alcohol consumption, and few studies assessed impact
on alcohol-related problems.
Novel Intervention Setting
Description of Studies Three interventions were identified
that utilized a novel intervention setting rather than the typical
setting (i.e., a research office) used for the administration of
brief motivational interventions [35–37]. Please note that one
trial could have also been categorized in the modality section,
but was highlighted here because the rationale for the technology used in the study was based on the novel setting [37]. Two
of the trials took place in university student health centers [35,
36] and one took place in an emergency department [37]. All
studies used mixed gender samples of heavy or hazardous
university students who screened positive for heavy drinking
on either formal assessments (e.g., scores of ≥3 for women
and ≥4 for men on the AUDIT) [37] or screened positive by
recent history of heavy drinking episodes (>14 drinks per
week for men/ >11 drinks per week for women; >five drinks
more than four times in the previous 28 days; and/or two or
more positive responses to the CAGE [35]; having at least one
heavy drinking occasion in the previous 2 weeks [36]). Sample sizes ranged from 363 [36] to 986 [35].
The two trials that took place in university health centers
examined the impact of in-person brief treatment sessions delivered by physicians, nurse practitioners, and physician assistants [35, 36]. The trial that occurred in the emergency department (ED) examined the impact of two active text-message
54
Curr Addict Rep (2015) 2:47–57
interventions: text messages plus feedback and text messages
only [37]. Two trials used health brochures/booklets as control
conditions [35, 36]; one used a no-treatment control [37]. Both
in-person interventions were delivered in two 15–20 min treatment sessions [35, 36]; text message interventions were provided for 12 weeks [37]. Additional contact with a health
provider by phone or email was provided in only one trial
[35]. Posttreatment follow-up assessments occurred at a minimum of 3 months after treatment [36, 37] and a maximum of
12 months [35, 37].
least twice in the past 3 months. The control condition
consisted of eight sessions of individual, semi-structured
counseling based on the United States Department of Health
and Human Services Clinical Practice Guidelines for Treating
Tobacco Use and Dependence plus 8 weeks of nicotine patch
therapy. The first six sessions were 30 min and the last two
were 10 min. The intervention condition consisted of eight
sessions based on the same U.S. Guidelines plus nicotine replacement therapy but also included BASICS. The sessions
were matched for time [38].
Intervention Efficacy All three trials reported significant reductions in alcohol consumption compared to control. At
3 months posttreatment, the text message plus feedback intervention for ED patients had significantly reduced binge drinking and drinks consumed on weekends [37]. The brief intervention provided at a university health clinic significantly reduced all alcohol consumption outcomes, including typical
drinks per drinking day and typical and peak BAC at 3 months
posttreatment. At 6 months, these effects were maintained; at
9 and 12 months, however, there were no differences on quantity consumed [36]. In the third study, there were no differences between brief physician advice and control on drinks
per month or heavy drinking episodes at 6 months posttreatment [35]. At 12 months, mean drinks in the past 28 days were
significantly less than control. There was no difference on
heavy drinking episodes or drinking frequency [35].
Effectiveness of intervention on alcohol-related problems
was assessed in two trials [35, 36]. Compared to control, brief
physician advice and brief intervention significantly reduced
alcohol-related problems at 6 months; brief intervention significantly reduced problems at 9 months; and both treatments
significantly reduced problems at 12 months [35, 36]. Overall,
both in-person and text message interventions delivered in
these alternative treatment settings were effective at reducing
alcohol consumption in heavy drinkers and both in-person
treatments demonstrated long-term effectiveness at reducing
alcohol-related problems.
Intervention Efficacy Compared to standard treatment, more
participants in the integrated condition were abstinent from
smoking posttreatment and at 2 months posttreatment although these differences were not statistically significant. At
end of treatment and 2 months posttreatment, change from
baseline in binge drinking, drinks consumed, and number of
drinking days was equivalent between the groups [38].
Novel Treatment Integration
Description of Studies One intervention was identified that
integrated alcohol treatment with treatment for another condition (i.e., cigarette smoking) [38]. One other study could have
also been categorized here, as it also provided integrated treatment for smoking and drinking [33]. Results of that trial are
described in the modality section, so as to cluster all
technology-based treatments together. In the integrated intervention to be described here, a binge drinking intervention
was integrated into treatment for smoking cessation. Participants were 41 young adults (age range: 18–30 years; mean
age=23 years) who smoked at least ten cigarettes per day for
the past 6 months and reported heavy drinking episodes at
Conclusions
The purpose of this review was to provide an overview of
novel, individual-level alcohol intervention components, and
to summarize the efficacy of these interventions to reduce
alcohol consumption and/or alcohol-related problems in college students and young adults. The current narrative review
examined 12 randomized clinical trials. These 12 trials were
subdivided into four different domains (e.g., components, setting, modality, and treatment integration) that highlight the
ways in which new interventions are building upon and extending past models of treatment for college students and
young adults. Overall, findings were mixed for reductions in
alcohol frequency and alcohol consumption outcomes, and
few of these novel treatments examined impact on alcoholrelated problems.
Two domains contained the most interventions that demonstrated efficacy to reduce alcohol consumption and/or
alcohol-related problems. The content domain, which included interventions that deviated the most from the traditional 1–
2 session brief alcohol intervention (e.g., pharmacotherapy,
cognitive retraining, and behavioral economic supplement),
contained three interventions that produced change in consumption and/or problems. The setting domain also contained
three trials that produced change in consumption and problems; this setting included the trials that contained the longest
follow-up assessments and therefore, included the trials that
documented the most durable change. This is particularly important because these domains contained trials that demonstrated efficacy and utilized models of treatment (e.g., pharmacotherapy and treatment in health centers/emergency
Curr Addict Rep (2015) 2:47–57
departments) that were not limited to mandated students or
even solely undergraduate students.
By moving treatment out of the research offices and training physicians and other medical staff to screen for hazardous
alcohol use and to deliver brief alcohol interventions, more
students and young adults can have access to needed alcohol
interventions. This is important because despite high rates of
heavy drinking, college students do not often seek out specialty treatment for alcohol problems. Even though college students have a higher risk of experiencing an alcohol use disorder than their non-college attending peers, they are less likely
to seek treatment [39]. Rather, many students feel more comfortable seeing primary care providers than therapists [40].
Thus, treatment for college students should not solely rely
on self-identification in specialty clinics. Because a higher
proportion of students use campus health clinics than campus
mental health clinics [41], university health centers have the
potential to screen and provide interventions for larger numbers of students. That the trials highlighted in this review
reported results indicating durable reduction in alcohol consumption and problems for heavy drinkers provides early evidence for wider dissemination of this treatment model.
The sole pharmacotherapy treatment (i.e., naltrexone) produced intervention effects that were greater than the traditional
brief intervention [22]. This is notable because, while single
brief interventions are efficacious, their effects often dissipate
by 6 months posttreatment, are small, and are weaker for
heavy drinkers [8]. Thus, treatments that produce effects
greater than these interventions and for at-risk samples are
particularly needed. While pharmacotherapy clinical trials
are commonplace for treatment of alcohol abuse and dependence in middle aged adults, the focus of this trial on young
adults and college students is unique. The results suggest that
adjunctive treatment with naltrexone could provide an effective way to treat college students and young adults most in
need of intervention services.
As noted in a recent summary of the history of college
student alcohol interventions, the past decade has seen a dramatic change in the way in which students and young adults
interact with the world. Social network platforms, including
Facebook and Twitter, have replaced in-person social communication. Accordingly, the past 5 years have seen a dramatic
increase in the number of studied examining text messagebased interventions [42•]. Indeed, more trials reviewed here
were text message or mobile-based interventions than any
other single modality. Because of their clear dissemination
potential, these types of interventions have the theoretical ability to reach more students and young adults than other types of
interventions. However, these studies had the most mixed effects. The studies were widely divergent in the number of text
messages sent, the duration for which participants received
messages, and the content of the messages. Indeed, some of
the content, including real-time feedback on blood alcohol
55
level, was shown to increase alcohol consumption [31]. A
great deal more basic research on the types of messages in
which students are interested, the phrasing of mobile content,
the optimal number of messages sent, how and whether these
messages should be combined with other intervention modalities, and the optimal duration of time for students to receive
messages remains to be done before the potential of these
types of interventions is maximized.
Even among these novel interventions, few of them are
dramatically divergent from the traditional brief intervention
approach. Two trials, cognitive retraining and treatment integration (i.e., incorporating alcohol treatment into the course of
treatment for another conditions/disorder) [28, 38], attempt to
reach students and young adults in new ways. By integrating
alcohol treatment into efficacious smoking treatment, this type
of combined intervention could help target drinkers with other
conditions that increase their risk of alcohol-related harm [43,
44]. This type of integration could also provide a way for
young adults to receive alcohol content if they are more motivated to engage in behavior change for another disorder or
condition. Only one integrated treatment that was specifically
designed to include an alcohol component was identified; it
produced mixed results [38]. Future research could consider
this type of approach as a way to engage young adults with
additional risk factors. Cognitive retraining provides a particularly novel way to intervene on alcohol use and could be
particularly useful for students and young adults with low
motivation to change drinking behavior, because it could be
perceived as a less threatening intervention. Early results of
this approach show promise. Much more work needs to be
done to develop truly divergent intervention approaches.
The primary limitation of this review is the narrowness of
scope. To create a specific, targeted review and identify novel
interventions in an area of literature that has been reviewed
numerous times recently, we used narrow search terms to best
filter through recent trials. This strategy, while advantageous
for reviewing a burgeoning area of science, may have inadvertently eliminated studies that did not include these search
terms but were testing new mechanisms for intervention. Future analysis of this area should consider utilizing broader
search terms.
This review highlights potential directions for future studies. First, our review found that novel content interventions
yielded significant, positive outcomes. Pharmacotherapy, cognitive retraining, and behavioral economics were significant
departures from the traditional BASICS model. Researchers
should look to other areas of study (e.g., economics and neuroscience) to build new interventions that harness findings
from other fields to target alcohol consumption. Second, the
findings from the setting section of this review highlight that
interventions need to be tested outside of research offices. As
young adults and college students do not often seek specialty
services for alcohol treatment, more work needs to be done on
56
how and where to screen and intervene effectively. Many
questions remain unanswered in that domain. With which
parts of the health care system do young adults most interact?
Are there other co-occurring health problems (e.g., obesity,
sleep, anxiety, etc.) that contribute to alcohol consumption
for which college students and young adults would be more
open to treatment and in which alcohol treatment could be
integrated? Finding better ways to engage college students
and young adults in alcohol interventions, instead of relying
on voluntary research participation or on-campus violations, is
an important next step in the alcohol intervention field. Lastly,
replication studies of treatment effects are needed. Though
some approaches, including cognitive retraining, have been
replicated in other populations (see 45, 46), most of these
studies are, by our definition, novel ways of conducting interventions and additional confirmatory studies will increase the
probability that they will be adopted. Pharmacotherapy with
naltrexone is an effective, FDA-approved treatment for alcohol dependence; the findings reviewed here provide further
evidence that naltrexone can help reduce sub-clinical levels
of heavy drinking. Similarly, brief interventions conducted in
emergency departments have been shown to be efficacious in
older populations (for review, see 47). The results here suggest
that conducting interventions in the ED or similar on-campus
locations might be a particularly promising way to reach
young adults and college students.
The high rate of heavy alcohol use among college students
and non-student young adults continues to be a problem and is
associated with a host of negative alcohol-related consequences. Despite the past development of efficacious interventions, more work needs to be done to build interventions
that are effective for heavy drinkers and are accessible to more
students and young adults. Of the interventions reviewed here,
pharmacotherapy and brief interventions delivered in health
centers appear to hold particular promise. Overall, however,
with limited evidence for consistent and durable change in
alcohol consumption and problems in these interventions, an
urgent need remains for the development of new treatments
for this population.
Compliance with Ethics Guidelines
Conflict of Interest Dr. O’Malley has served as a consultant to or
advisory board member for Pfizer, Alkermes, Arkeo Pharmaceuticals,
and the Hazelden Betty Ford Foundation; she is a member of the American Society of Clinical Psychopharmacology/ACNP’s Alcohol Clinical
Trials Initiative, which has been supported by Abbott Laboratories,
Alkermes, Eli Lilly & Company, Schering Plough, Lundbeck, Janssen,
GlaxoSmithKline, Pfizer and Ethypharm; she has received study supplies
from Pfizer and contracts from Eli Lilly and NABI Biopharmaceuticals as
a study site for a multi-site trial; and is a past partner of Applied Behavioral Research. Drs. DeMartini and Fucito declare no conflicts.
Support for this work was provided by P50 AA012870 (KSD), K05
AA014715 (SSO), and NR014126 (KSD & LMF) from the National
Institute on Alcohol Abuse and Alcoholism, the National Institute of
Nursing Research and by the Connecticut Department of Mental Health
Curr Addict Rep (2015) 2:47–57
and Addiction Services. The content is solely the responsibility of the
authors and does not necessarily represent the official views of the
funding agencies.
Human and Animal Rights and Informed Consent This article includes a review of a study performed by these authors (see O’Malley
et al.). All study procedures for that trial were approved by Yale
University’s Institutional Review Board.
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