A randomized controlled trial of a behavioral economic supplement to brief motivational interventions for college drinking.

Abstract

Objective Behavioral economic theory suggests that a reduction in substance use is most likely when there is an increase in rewarding substance-free activities. The goal of this randomized controlled clinical trial was to evaluate the incremental efficacy of a novel behavioral economic supplement (Substance-Free Activity Session, SFAS) to a standard alcohol brief motivational interviewing (BMI) session for heavy drinking college students. Method Participants were 82 first-year college students (50% female, 81.7% White/European American, Mean age = 18.5 years, SD = .71) who reported two or more past-month heavy drinking episodes. After completing a baseline assessment and an individual alcohol-focused BMI, participants were randomized to either the SFAS or to a Relaxation Training (RT) control session. The SFAS was delivered in an MI style and attempted to increase the salience of delayed academic and career rewards and the patterns of behavior leading to those rewards. Results The combination of an alcohol BMI plus the SFAS was associated with significantly greater reductions in alcohol problems compared to an alcohol BMI plus RT at the 1-month and 6-month follow-up assessments (p = .015, ηp2 = .07), an effect that was partially mediated by increases in protective behavioral strategies. BMI + SFAS was also associated with greater reductions in heavy drinking among participants who at baseline reported low levels of substance-free reinforcement or symptoms of depression. Conclusion These results are consistent with behavioral economic theory and suggest that a single session focused on increasing engagement in alternatives to drinking can enhance the effects of brief alcohol interventions.

Protective Behavioral Strategies as a Mediator Between Depressive Symptom Fluctuations and Alcohol Consumption: A Longitudinal Examination Among College Students

“…Extant harm-reduction interventions, such as BASICS (Dimeff et al, 1999), are evidenced to address heavy drinking among college students in general. Further, intervention work has shown that PBS appears to be a relevant component in drinking reduction in this population (Barnett et al, 2007;Larimer et al, 2007;Murphy et al, 2012). Given that individuals experiencing increased mental health symptomatology are at elevated risk for problematic alcohol use, they may benefi t from tailored interventions that emphasize PBS in drinking contexts, particularly during drinking occasions where they experience greater symptoms of depression.…”

“…For example, the Brief Alcohol Screening and Intervention for College Students (BASICS; Dimeff et al, 1999), an empirically supported brief motivational drinking intervention, includes PBS to help control one's drinking. College alcohol intervention programs have found that changes in PBS use mediate intervention effects (e.g., Barnett et al, 2007;Murphy et al, 2012). Therefore, the use of PBS appears to be an important component in reducing alcohol-related harms.…”

Drinking Motives in the Prospective Prediction of Unique Alcohol-Related Consequences in College Students

“…For individuals reporting enhancement motives, a more direct focus on the quantity and frequency of their drinking within the context of intervention would seem appropriate. Such drinkers could be provided with alternative behaviors from which to derive positive reinforcement (e.g., Murphy et al, 2012). As an alternative, personalized feedback regarding the types of consequences students have experienced, or might expect to experience given their drinking motives, could be provided.…”

A Multiple Replication Examination of Distal Antecedents to Alcohol Protective Behavioral Strategies

“…Much evidence from cross-sectional and longitudinal studies suggests that PBS use is associated with less alcohol use and/or fewer alcohol-related problems (Pearson et al, 2012a). Further, PBS use has also been found to mediate the effects of multiple interventions (Barnett et al, 2007;Larimer et al, 2007;Murphy et al, 2012), providing some evidence that the use of PBS is a proximal mechanism of changing one's alcohol use and related outcomes (Prince et al, 2013). An important next step in PBS research is to determine the extent to which PBS use is one mechanism through which various distal antecedents relate to alcoholrelated outcomes among college students.…”