There once was a student who entered college a somewhat
experienced drinker, having begun in high school. Upon arrival, absent a curfew
and any parental supervision, his periodic drinking expanded in both frequency
and consumption. This pattern soon brought him to the attention of residence
life officials when following one outing he returned to the residence hall, intoxicated, and mistaking the elevator for a restroom, was written up after relieving himself between the 1st and 4th floors of the
hall where he resided. As this was the first documented violation of university
policy, he was given the option of choosing between a $300 fine and parental
notification of the exact nature of his violation or to complete an alcohol
assessment led by a practitioner familiar with the principles of Motivational
Interviewing and trained in the use of BASICS, Brief Alcohol Screening and Intervention for College Students.
The brief two-session assessment was far more attractive than parental notification and a significant fine so he opted for the screening. Although expecting the sessions to be akin to a mandated “dad-talk” type lecture, he was pleasantly surprised when upon arriving for the first session, the practitioner seemed less concerned with his violation and more interested in initiating an open conversation about the role alcohol and drinking play in his social life. As a result, a decision he made to avoid parental repercussions and to save money presented him with an opportunity to step back from his drinking and consider if the price he was paying for a good time was worth what he was consistently having to pay to realize it. Following the two-mandated sessions, the student agreed to extend his contacts with the practitioner to learn more about how he could moderate his use to avoid further violations and other consequences associated with high-risk drinking yet continuing to socialize with friends and enjoy his college experience.
This parable is far from unique and certainly is not fictional. Such collegiate experiences are realized on campuses across the country on a regular basis. In my own career this very scenario—although the alcohol-related violations resulting in a referral for an assessment would vary tremendously—would occur regularly with outcomes that were frequently the same.
Motivational Interviewing (MI) and its use in BASICS interviews have a long and well-documented history of effectiveness. However, this essay is not intended to champion either MI or BASICS as clinical strategies for addressing high-risk collegiate drinking. Rather, the focus of this essay is the consideration of one possible explanation for why these intercessions with students seem to work so well.
Cognitive Dissonance is a psychological state of emotional discomfort resulting from the presence of opposing beliefs, ideas, or values. A classic example used to illustrate this point in intro psych courses references a hypothetical child told by its parents that all blue-eyed people are bad and not to be trusted yet when the child meets blue-eyed children and finds them fun to be with and enjoys their company, the beliefs instilled by the child’s parents conflict with the experience the child has in the real world resulting in a state of cognitive dissonance. When experiencing such, there are two primary ways one can assuage this dissonance: (1) change one’s behavior and/or (2) change one’s attitude.
The practitioner utilizing the principles of MI and conducting BASICS interviews is tantamount to the blue-eyed child our student meets who presents an opportunity to consider established beliefs about alcohol as a substance and drinking as a behavior, creating dissonance for the student. One of the primary ways the BASICS practitioner accomplishes this is with a series of very simple open-ended questions, asking, what are the good things about drinking and then following this with, what are the less good things about drinking? Then by presenting an opportunity to overlay the student’s alcohol use history atop this continuum of “good things to less good things” consequences—the good things representing the positive consequences of drinking for the student and the less good things representing the more negative consequences—the student is able to discern that there is a negative correlation between the number of drinks consumed and the cited good things happening (fewer drinks consumed is associated with more of the good things happening) while there is a positive correlation between less good things happening and the number of drinks consumed (as the number of drinks goes up so does the frequency of experiencing the less good things).
Remember that the two primary ways to assuage such dissonance are to change behavior and/or change attitude. In this case, the practitioner, because he or she employed the principles of MI thereby gaining the respect and trust of the student can, therefore, invite the student to continue with additional sessions where they can explore how to moderate consumption and thereby change behavior. There is a saying in A.A., bring the body and the mind will follow or its behaviorist corollary, it is easier to act your way into a new way of thinking than it is to think your way into a new way of acting.
Be that as it may, cognitive dissonance, instilled by the practitioner appreciative of the principles of MI and practicing BASICS, likely explains, in part, why so many students respond to motivational, brief interviews. Avoiding the “dad/mom-talk,” becoming engaged in a nonjudgmental conversation designed to explore one’s drinking history, and presented with the opportunity to conduct a personal cost-benefit analysis of one’s use of alcohol can and does result in changed student behavior, which in turn can result in changed attitudes and beliefs regarding alcohol as a substance and drinking as a behavior.
What do you think?
Dr. Robert
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