Brief mail- and computer-generated interventions work best for problem drinking among young people
Health professionals who are concerned about hazardous drinking among young people can take heart: research indicates that brief intervention methods relying on mail or computers are both appealing and effective among this hard-to-reach population.
Findings were presented during a symposium given at the joint June 2002 Research Society on Alcoholism/International Society for Biomedical Research on Alcoholism meeting in San Francisco. Symposium proceedings are published in the February issue of Alcoholism: Clinical & Experimental Research.
"The purpose of this research is first and foremost to determine whether brief intervention is effective in reducing hazardous drinking among young people, and secondly, to figure out the specific conditions which make it effective, that is, setting, duration, and method of presentation," said Kypros Kypri, research fellow at the University of Otago in New Zealand and corresponding author for the symposium proceedings. "In contrast with brief-intervention research in older populations, which has been going on for about 20 years," he added, "there have been relatively few studies of brief intervention with young people, those aged 15 to 24 years."
Symposium presentations addressed what is known about the efficacy of brief interventions in the general population, a review of college student drinking in four countries, a review and commentary on brief motivational interventions with college students, and the preliminary results of a large trial of a brief intervention for college students. Some of the key points were:
In-person brief interventions are best directed toward those who engage in hazardous drinking and/or abuse of alcohol rather than those who are alcohol dependent.
"The vast majority of hazardous drinkers do not develop chronic alcohol dependence," explained Kypri, "but instead experience transient or intermittent periods of problem drinking. Studies show that the majority of hazardous drinkers … can benefit from a brief intervention designed to reduce hazardous drinking. Individuals with clear signs of alcohol dependence, on the other hand, may warrant interventions of greater duration, sometimes including pharmacotherapy. Nonetheless, brief interventions … are a way of identifying individuals who are possibly alcohol dependent, and referring them for treatment. In this sense, a brief intervention may be regarded as a component of a 'stepped-care' approach."
A five-minute in-person intervention has proven to be as effective as longer interventions.
"It is generally impracticable for a health practitioner to deliver a one-hour intervention to a young person whose drinking is risky," said Kypri. "Ten to 15 minutes of assessment and advice in the waiting room, however, may be quite deliverable to a large proportion of individuals with hazardous-drinking habits."
Among college students, hazardous drinkers respond well to electronic assessment and feedback about their alcohol consumption, as opposed to a discussion about their drinking with a doctor or other health professional.
"Our research suggests that young people who are not seeking treatment for an alcohol problem would be disinclined to discuss their drinking with a health practitioner through fear of being judged," said Kypri. "Young people are nonetheless curious about how risky their drinking is and how it compares with that of their peers. Computerized approaches capitalize on this curiosity while reducing the potential that young people will be put off by the prospect of having to discuss their drinking and its consequences with a health practitioner."
Kypri added that web-based approaches can also address what he called the "tyranny of distance" experienced by people in remote areas. "If designed well, web-based intervention can mimic some aspects of the clinical interview, in particular, the assessment, presentation of feedback, and encouragement to make healthier choices," he noted. "This is an area where more research is needed, but it shows great promise."
The use of "motivational feedback" among college students is most effective when private – for example, mailed to the individual – and could reach even more students if disseminated through electronic means.
"'Motivational feedback' is information provided to an individual which draws attention to discrepancies between their health goals and his or her actual behavior," explained Kypri. "It is information which draws the individual's attention to their risk status in a non-threatening and non-judgmental fashion."
In the college-based trial (n=1,638), "individualized feedback" showed considerable success in terms of recruitment, retention and intervention.
"Clinical experience suggests that to be effective in producing behavioral change, motivational feedback has to be individualized," said Kypri. "In the context of computerized brief interventions, 'individualized feedback' is information about a person's risk status or a comparison of their drinking with that of other relevant reference groups."
Although symposium presenters agreed that recent findings clearly demonstrate the promise of a relatively inexpensive style of intervention in addressing an important public health problem in a high-risk group, they noted that a number of questions still remain about precisely how brief intervention works, what the most effective design of its components and content might be, and how it might best be delivered, using what style (non-judgmental versus directive), and to whom.
In addition, added Kypri, although much of the presented research focused on college students, there is a need to develop and evaluate interventions for non-students. "The main challenges concern how individuals are located and approached, the appropriate content of the intervention, and the means of evaluating efficacy in a group which may be geographically dispersed," he said.
Source: Eurekalert & othersLast reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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