Screening and Brief Interventions as a Means to Prevent Underage Drinking

Regarding the appropriateness of brief interventions with 14 to 21 year old secondary ed students—or anyone of any age for that matter—such approaches work and are effective in motivating change in personal behavior. The interesting challenge inherent in a consideration of such interventions when considering the prevention of underage drinking is, can such an approach to intervening with or “treating” high-risk behavior be effective as a means of preventing: (1) high-risk behavior in general in a universal population, and/or (2) underage drinking altogether? Although I am not aware of research on this specific topic or pilot projects that have attempted to accomplish this—most of the research regarding the prevention of underage drinking with which I am aware has to do with using social norms marketing techniques with this age group (see http://alcohol.hws.edu/consultation/schools.htm)–I have been thinking about and have outlined an approach for this age group that does consider brief interventions as a prevention strategy.

The use of brief interventions based with high-risk and dangerous drinking among college students based on motivational interviewing (MI) and harm reduction (HR) has been pioneered at the University of Washington in what has affectionately become known as BASICS. This stands for Brief Alcohol Screening and Interventions for College Students. This has been shown to work exceptionally well with college students, primarily as an intervention for those students already engaged in drinking, be they underage or not. The approach uses MI as a way of establishing a rapport with college students in order to invite them to revisit their choices for drinking. Once revisited, students frequently move in the direction of change, essentially reducing risk (harm) by conducting what is called a “cost-benefit analysis” of one’s drinking. Essentially, this enables the student to ask him- or herself, "is what I get worth what I have to pay to get it?" (where “pay” refers to not only $ but time, missed classes, embarrassment, arrest/campus violations, grades, etc.). I know from years of personal experience employing this approach that students will frequently modify their behaviors significantly as the result of participating in such a program, but herein lies the rub with regards to the approach's utility as a strategy to prevent underage drinking…this personal change does not usually involve abstaining from drinking altogether.

The challenges when looking at the 14-21 year old population in secondary ed are: (1) There needs to be a clear message that no drinking is acceptable if a student is under 21 and, (2) reducing risk, while an objective we all have when working with students of any age, will never be tolerated by school boards or parents as the sole criterion of determining effective outcome of a prevention strategy as regards “underage” drinking. It is for this reason that I am developing—still in outline form—an approach that adapts the principles of BASICS for use in secondary ed. In short, instead of engaging college students as the actual drinkers in order to reduce "their" harm, engaging the secondary ed student as the friend of the underage drinker so as to become an agent of change. In essence the shift is from “therapeutic intervention” with an established high-risk drinker to student-on-student “social intervention.”

There is also an ancillary benefit in considering such an approach, namely, that one cannot learn how to intervene with a peer about drinking without considering his or her own personal decision about drinking in the process. The beauty of this strategy is that it does not target the student’s own use but rather targets student use in general by empowering students to become more proactive with their peers and thereby creating what is referred to as “cognitive dissonance,” which can result in personal change as a side effect. The down side is that it is questionable that such an approach would result in a discernible reduction in the overall number of underage drinkers, and this may make this idea totally untenable in a secondary ed setting. What is more likely is that the number of underage drinkers engaging in high-risk and dangerous behavior would diminish.

Ironically, while most parents are quick to point out the problems of underage drinking, most report that this was at least of passing interest in their pre-21 socializing. Consequently, many parents are supportive of preventing underage drinking, but what they are truly concerned about is not their sons or daughters consuming “2 12-oz beers in an evening out” but the consumption of enough to become impaired and engage in the 3-Vs so frequently reported in news accounts of “underage drinking” – vomiting, violence, and vandalism. To reduce the likelihood of the 3-Vs is significant…but perhaps unacceptable as a “stand alone” stated objective of a prevention strategy targeting underage individuals.

However, I stray from the simple focus of this essay…

Brief interventions are very effective. Brief interventions with 14-21 year old students are likely to be as effective as with anyone else. A topic appropriate for further discussion is, are there aspects of these techniques that are applicable to: (1) the 14 – 21 year-old secondary ed student, and (2) consistent with the overall agenda of a particular school district or community agency searching for an effective prevention strategyI look forward to further dialogue and perhaps the opportunity to chat if not meet in person.

Best regards,
Robert

Robert J. Chapman, PhD
Clinical Associate Professor of Behavioral Health Counseling
College of Nursing & Health Professions
Drexel University
245 N. 15th Street/MS507
Philadelphia, PA 19102
Office: 215-762-6922
Fax: 215-762-7889
http://www.robertchapman.net
LinkedIn profile: http://www.linkedin.com/in/rjchapman