Prevention 2.0: Taking Efforts to Affect Collegiate Drinking to the Next Level

Nudging student behavior is a too often overlooked approach to addressing the prevention of high-risk and dangerous drinking practiced by some collegians. College administrators, student affairs professionals, faculty, and others concerned about the role alcohol plays in contemporary collegiate life have attempted to change the campus drinking culture for years but have done so, primarily, by focusing on preventing the high-risk behavior rather than promoting low-risk.

That said, significant progress in the area of prevention is recorded in the literature with environmental management, social norms marketing, brief motivational interventions, and the use of the ecological model among the more frequently cited strategies that have yielded results. Yet, with all the gains realized to this point, high-risk and dangerous drinking remains at a stubborn, apparently intractable level of “40-some percent” of students reporting consuming in excess of 5-standard drinks on an occasion and “20-some percent” classified as what have been called frequent binge drinkers because of reporting 2 or more such episodes during the 2-weeks prior to completing surveys.

Skeptics tend to look at the apparently intractable nature of this type of drinking and lament, resigning themselves to it being ‘just student nature’ with likely ‘nothing more’ we can do to redress this problem. Those willing to look outside the proverbial box when considering options, however, disagree. Because prevention efforts appear to have reached an impasse, this is no reason to surrender to these percentages and just “learn to live with them.” Other approaches do exist, albeit coming from beyond the traditional student health and wellness purview.

Behavioral economics, a topic about which I have written before, is one of those “other approaches” that can help address this “immutable problem.” This essay began with the notion of “nudging student behavior” so as to increase the likelihood that students will make low-risk choices. As with the old adage about leading horses to water but being unable to make them drink, if we salt the oats, we make the horses thirsty and they will decide of their own accord to drink. (Yes, I realize the analogy may level something to be desired when addressing collegiate drinking, but the principle is sound; present students with an opportunity to view their decision about drinking from a different perspective and they may just come to different conclusions...with different behavioral outcomes.)

Richard Thaler, an economist at the University of Chicago, along with his co-author Cas Sunstein in their book, Nudge: Improving Decisions about Health, Wealth, and Happiness outline numerous strategies that can “nudge” us to do everything from increase savings for retirement to exercising more to healthier eating. I will mention one example of these “nudges” and speculate on how it may affect student choice regarding alcohol consumption: The anchoring heuristic.

Simply stated, anchoring suggests that when we make numerical estimates we are influenced by available reference points. For example, in one experiment, individuals looking at a menu were asked what they would be willing to spend for a meal in the restaurant. Two separate groups, comprised of randomly selected subjects, were shown the same menu, without prices, in the same setting. The only difference was the name of the restaurant on the menu. For the first group of subjects, the menu was for dishes at “Studio 17”; the name of the second restaurant was “Studio 97.” Subjects looking at “Studio 17’s” menu reported they would pay, on average, $24 for a meal; those looking at “Studio 97’s” menu reported they would pay $32. The difference in the number in the restaurants’ names “nudged” decisions regarding how much subjects were willing to pay for a meal.

Building on this, how can we “nudge” students to make a lower-risk decision about alcohol using anchoring as a “new arrow in the prevention quiver”?

What if…when interviewing a student and taking a drinking history, after asking about the average number of times per week the student drinks we were to ask what percentage of students (in the same school, in the “student’s class,” on the “student’s team,” etc.) drink? Might this create an opportunity for a discussion regarding frequency?

What if…when speaking with students about the typical number of standard drinks consumed when drinking we asked them what percentage of their peers/classmates/teammates/etc. consume that number of drinks or more? Might the result usher in a conversation about consumption and BAC?

What if…after sharing data on actual social norms and asking if the student intends to drink during the coming week we asked: “how many standard drinks do you think you will have when you drink?”

In the 1940s & 1950s, the psychologist Kurt Lewin postulated what he called “field theory.” One aspect of this theory suggested that individuals are influenced by one or both of two forces when making a decision; driving forces that move one in a particular direction and restraining forces that preclude getting there. Historically, those interested in changing behavior have focused on restraining behaviors when targeting change, in this case, high-risk drinking. This is like trying to make the horse drink after leading (forcing?) it to the water. What, however, would happen if we were to better understand what the driving forces are for students to engage in the high-risk behavior in the first place? NOTE: Student reported “driving forces” may be perceived as “dangerous,” “risky,” or otherwise inappropriate; remember, driving force, like beauty, is in the eye of the beholder.

Rather than try to prevent students from doing what they want to do because we know it is high-risk, might we be able to move to the next level of prevention…prevention 2.0…if we were to better assess and then understand what motivates their high-risk behavior in the first place and then concentrate on lowering those incentives? NOTE: For more on understanding student motives, reread my previous essay on the art of gentle persuasion.

I do not propose a different course of action for preventionists, just an additional route, another arrow for the prevention quiver if you will. I used to tell my students that there are many ways to get from Philadelphia to New York City aside from I-95—Drexel University is in Philadelphia, about 100-miles from NYC. These many and varied routes not only would result in arriving at the same destination, they afforded the opportunity to avoid trucks and/or tolls, enhance the pleasure of the trip with relaxed driving through scenic country, or any of a number of alternative reasons one might have for taking an alternate route. Students were quick to point out that one could even avoid driving altogether by taking a train, bus, or flying. The point is, if what I want is to get to NYC, there may be other ways to get there aside from the way “everyone else seems to go.”

What if the principles of behavioral economics were coupled with Lewin’s suggestion that understanding one’s motivation to pursue a particular behavior presented additional insight as to how to approach those apparently intractable high-risk drinkers? Carl Jung once said that which you resist persists. Is it possible that we can take prevention to the next level in reducing high-risk drinking by simply expanding our focus rather than insisting students change theirs?

Dr. Robert