Screening and Brief Intervention for High-Risk College Student Drinkers Results From a 2-Year Follow-Up Assessment G. Alan Marlatt Department of Psychology University of Washington John S. Baer Department of Psychology University of Washington Daniel R. Kivlahan Department of Psychology University of Washington Linda A. Dimeff Department of Psychology University of Washington Mary E. Larimer Department of Psychology University of Washington Lori A. Quigley Department of Psychology University of Washington Julian M. Somers Department of Psychology University of Washington Ellen Williams Department of Psychology University of Washington ABSTRACT This randomized controlled trial evaluated the efficacy of a brief intervention designed to reduce the harmful consequences of heavy drinking among high-risk college students. Students screened for risk while in their senior year of high school (188 women and 160 men) were randomly assigned to receive an individualized motivational brief intervention in their freshman year of college or to a no-treatment control condition. A normative group selected from the entire screening pool provided a natural history comparison. Follow-up assessments over a 2-year period showed significant reductions in both drinking rates and harmful consequences, favoring students receiving the intervention. Although high-risk students continued to experience more alcohol problems than the natural history comparison group over the 2-year period, most showed a decline in problems over time, suggesting a developmental maturational effect. Preparation of this article was supported in part by Merit Award AA 5R37AA05591 and Research Scientist Award AA 5K05AA00113 from the National Institute on Alcohol Abuse and Alcoholism (National Institutes of Health). We acknowledge the support and assistance of Kim Barrett, Jewel Brien, Dan Irvine, Jason Kilmer, George Parks, Martin Stern, Susan Tapert, and Sally Weatherford. Correspondence may be addressed to G. Alan Marlatt, Department of Psychology, University of Washington, Seattle, Washington, 98195-1525. Received: September 23, 1996 Revised: August 29, 1997 Accepted: December 8, 1997 Journal of Consulting and Clinical Psychology © 1998 by the American Psychological Association August 1998 Vol. 66, No. 4, 604-615 For personal use only--not for distribution. Page 1 of 1911/20/2000http://spider.apa.org/ftdocs/ccp/1998/august/ccp664604.htmlFrom the first comprehensive study ( Straus & Bacon, 1953 ) to recent national surveys (e.g., Johnston, O'Malley, & Bachman, 1997 ), widespread drinking and a variety of associated problems among college students has been amply documented in the literature. In one comprehensive national survey of over 17,000 college students, Wechsler, Davenport, Dowdall, Moeykens, and Castillo (1994) reported that almost half the sample (44% overall; 50% of the men and 39% of the women) engaged in binge drinking, defined as the successive consumption of five or more drinks for men (four or more for women) at least on one occasion during the 2 weeks prior to the survey. Survey results from the study showed that frequent binge drinkers were 7 to 10 times more likely than nonbinge drinkers to engage in unplanned and unprotected sexual intercourse, to get into trouble with campus police, to damage property, to get hurt or injured, or to drive under the influence of alcohol. College student health servicesreport high rates of alcohol-related injuries ( Meilman, Yanofsky, Gaylor, & Turco, 1989 ), and alcohol-related injury remains a leading cause of death in this population ( McGinnis & Foege, 1993 ). Research on the determinants of adolescent college student drinking behavior has identified a number of risk factors that span both individual and socioenvironmental levels of influence ( Boyd, Howard, & Zucker, 1995 ). In terms of individual risk factors, researchers have investigated the impact of biobehavioral vulnerability, including gender ( Wechsler, Dowdall, Davenport, & Rimm, 1995 ), family history of alcohol problems ( Sher, 1994 ), decreased perceived sensitivity to alcohol's intoxicating effects ( Schuckit & Smith, 1996 ), and personal history of conduct disorder or delinquent behavior ( Jessor, Donovan, & Costa, 1991 ). Studies of social and environmental determinants reveal that although parental and family factors continue to influence adolescent drinking prior to college, by the time most students arrive on campus, exposure to peers and their normative influence significantly impacts student drinking ( Baer, 1994 ). Expectancy for alcohol effects, often shaped by peer influence, appears to be a mediating variable in this regard ( Smith & Goldman, 1995 ). Although treatment services for students with drinking problems exist on some campuses ( Keller, Bennett, McCrady, Paulus, & Frankenstein, 1994 ), most college programs focus on prevention as the goal. Primary prevention on college campuses typically includes educational programs designed to increase student awareness of the risks of alcohol problems and to develop alternative recreational activities that do not involve drinking. Primary prevention programs also include community-based programs designed to modify the campus environment as a whole and policy changes that impact alcohol pricing and availability to underage youth or raise the legal drinking age. Overall, the effectiveness of primary or universal prevention programs in reducing harmful drinking appears to be limited ( Moskowitz, 1989 ). Secondary prevention programs target students who are already drinking. Previous work in our laboratory has targeted high-risk college students who volunteered to participate in a series of secondary prevention programs conducted at the University of Washington ( Marlatt, Baer, & Larimer, 1995 ). In the first study ( Kivlahan, Marlatt, Fromme, Coppel, & Williams, 1990 ), students who were taught moderate drinking skills in a group format showed significant reductions in high-volume drinking at a 1-year follow-up, in comparison with students who received only information about drinking risks or those in an assessment-only control condition. In another study ( Baer et al., 1992 ), students who drank heavily on campus were randomly assigned to one of three conditions: group training in moderate drinking skills, a self-help manual-only condition (presented as a correspondence course), or a single session of feedback and advice about
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