National Institute on Alcohol Abuse and Alcoholism’s College Alcohol Intervention Matrix Part 5 of 5

Jason Kilmer, Ph.D. and Toben Nelson Sc.D. Author

08/04/2017 Added

39 Plays

Description

Review of the National Institute on Alcohol Abuse and Alcoholism's College Alcohol Intervention Matrix (AIM) and practical application for professionals working in higher education to reduce high-risk drinking and associated harms.

Searchable Transcript

Search:

[00:00:03.470]I think we probably need to be developing
[00:00:07.100]some of those more effectively.
[00:00:10.550]I think a lot of the stuff I talk...
[00:00:17.110]Yes, on again.
[00:00:18.400]A lot of the stuff that I talk, I'm good.
[00:00:20.454](audience laughter)
[00:00:23.320]You're no boom mic operator.
[00:00:24.630]I try, though.
[00:00:25.890]A lot of the stuff that I talked about
[00:00:27.910]I think can be particularly effective with administrators.
[00:00:33.540]One of the things that we've been doing
[00:00:36.700]is borrowing a lot of the concepts
[00:00:40.460]and approaches from motivational interviewing
[00:00:43.640]to work with groups and to work and try
[00:00:47.650]to help advance a policy agenda.
[00:00:50.440]It doesn't fit directly in all cases.
[00:00:53.560]But I think some of those principles can be very effective.
[00:00:58.550]So, meeting people where they're at,
[00:01:03.921]and eliciting some change talk,
[00:01:07.530]trying to get to a common place,
[00:01:10.200]and asking, "Can I tell you more about
[00:01:14.717]"the approach that I'm taking
[00:01:16.047]"or a strategy I think might be useful?"
[00:01:19.440]I think really can be effective.
[00:01:22.230]And part of that is very simply relationship development,
[00:01:28.790]and understanding the self-interest
[00:01:31.355]of the people that you're talking to.
[00:01:34.600]So if you know where that person is coming from,
[00:01:37.400]and you can try and help align your strategies
[00:01:40.920]with where they're coming from and give them something
[00:01:45.250]to jump on board with you, you're not gonna totally align,
[00:01:49.240]but the extent that you can,
[00:01:51.640]or the extent that you can accentuate those alignments,
[00:01:55.660]I think the better chances you have for success.
[00:01:59.940]But the foundation for that is having a good relationship.
[00:02:04.360]And I'm kind of a jerk, so I understand
[00:02:06.490]that that's not my role. (laughs)
[00:02:11.250]Yeah, oh, go ahead.
[00:02:12.180]I was curious, Jason, about screen--
[00:02:14.730]Repeating the question
[00:02:15.660]for people listening remotely:
[00:02:16.700]what screening recommendations are there?
[00:02:19.150]You know, if it's for an assessment,
[00:02:21.370]there are a lot of tools that guide it.
[00:02:22.570]If it's literally a brief screening,
[00:02:24.410]arguably the most well-known and most well-studied
[00:02:27.890]screening instrument is the AUDIT,
[00:02:29.200]the Alcohol Use Disorders Identification Test.
[00:02:31.730]That comes from the World Health Organization
[00:02:33.310]and has particular value because
[00:02:35.740]of its value outside of North America.
[00:02:37.580]With the campuses that are increasingly seeing
[00:02:39.380]more international students, that's very useful.
[00:02:43.063]The other nice thing about the AUDIT
[00:02:44.730]is you can actually make referral recommendations
[00:02:50.600]and document why that was made.
[00:02:53.160]If you google AUDIT, A-U-D-I-T, and WHO, one of the first
[00:02:57.200]three things you get on Google is the AUDIT guide.
[00:02:59.930]In the AUDIT guide is a list of four zones.
[00:03:02.650]If it's this score, ah, best giving you simple advice.
[00:03:05.340]If it's this score, they probably need a brief intervention.
[00:03:07.600]If it's above this, you should refer them
[00:03:09.450]to a more thorough assessment than just the AUDIT.
[00:03:12.310]So for true screening, that's a great tool.
[00:03:14.467]And you can even justify next steps with it.
[00:03:16.940]If you're using it a counseling or health center,
[00:03:18.480]you're like, "Wow, that's 10 items."
[00:03:19.870]There's an AUDIT-C, which is only three items.
[00:03:22.520]And if people are like, "I don't have time
[00:03:23.353]"for three items," NIAAA has a single item.
[00:03:26.370]It just gets that binge idea.
[00:03:28.220]How many times within the last two weeks
[00:03:29.930]have you had five or more drinks for a man,
[00:03:31.750]four or more drinks for a woman.
[00:03:33.120]But I would think the AUDIT is a
[00:03:34.570]tool you could certainly do.
[00:03:36.330]If you're doing a formal assessment,
[00:03:37.921]I mean, there are so many tools.
[00:03:39.930]We use the Brief Drinker Profile,
[00:03:43.070]just because it's free and it's in the public domain.
[00:03:45.730]And it's been well-researched.
[00:03:48.060]It was developed by Bill Miller,
[00:03:49.530]father of motivational interviewing,
[00:03:51.020]and Alan Marlatt, who did relapse prevention
[00:03:53.820]in the work I showed you here.
[00:03:55.620]And again, just for a more
[00:03:57.010]thorough assessment, that's a nice tool.
[00:03:59.036]I don't know what you would add to--
[00:04:00.390]Yeah, actually some of the work that we've done
[00:04:03.430]as part of our college systems project
[00:04:06.850]working with Ken Winters on our campus
[00:04:09.780]actually went through and assessed the different
[00:04:13.470]brief screening tools and provide kind of
[00:04:17.482]a matrix of its own just of screening tools.
[00:04:20.712]And that's published, as well.
[00:04:24.430]What we found when we surveyed colleges were
[00:04:29.940]the majority of schools were using something
[00:04:32.430]that wasn't validated and had never
[00:04:37.760]been tested with college-level students.
[00:04:40.540]But the beauty of that is, there are actually
[00:04:42.270]several of them that are validated,
[00:04:45.000]that are tested with the college students,
[00:04:47.140]and, very importantly, are free.
[00:04:49.960]So we make some recommendations about what those are
[00:04:53.340]and advocate for schools and places that are interfacing
[00:04:57.680]with students to use those kinds of tools.
[00:05:00.730]The AUDIT is my particular favorite.
[00:05:03.933](man speaking faintly)
[00:05:05.190]Yeah, we've heard about those,
[00:05:06.120]and they use as part of their program eCHECKUP.
[00:05:09.257]And eCHECKUP is in CollegeAIM.
[00:05:12.330]They use a lot of other programs
[00:05:13.490]that were either outside of the scope of CollegeAIM review.
[00:05:16.260]One last thing is, I'm glad to hear you say the AUDIT,
[00:05:18.000]'cause I was like, "Uh-oh, what would you recommend?"
[00:05:20.020]The main thing I would say, though, is,
[00:05:21.250]when you're asking about drinks,
[00:05:22.850]again, you have to define what counts as a drink.
[00:05:25.160]I'm an author on a study where we did
[00:05:26.390]market intercept interviews on college campuses.
[00:05:29.090]And we said, "Tell us how much you've had
[00:05:30.827]"to drink in the last two weeks," and they fill it out.
[00:05:32.480]And then we trained the provider
[00:05:33.730]to act like they screwed up.
[00:05:34.870]They go, "Oh, sorry, I'm so stupid.
[00:05:37.467]"I was supposed to tell you,
[00:05:38.457]"a drink means this, this, this, or this.
[00:05:40.197]"Could you do it one more time?"
[00:05:41.920]And the estimates on how much
[00:05:42.810]they drink went up 30 seconds later.
[00:05:45.610]So, if you just say, "How many drinks have you had?"
[00:05:47.237]"Well, I only have two."
[00:05:48.070]Oh, okay, phew.
[00:05:49.380]Two what?
[00:05:50.420]And really do what you can to define that
[00:05:51.950]before completing a measure like that.
[00:05:53.400]That's important, too.
[00:05:55.130]What else in terms of questions or comments people have?
[00:05:57.900]Just slightly back
[00:05:58.733]to the environment, on that.
[00:06:02.300]That's a complicated question, of course.
[00:06:05.430]And it's one that, you know what, a lot of the issues
[00:06:09.340]we are dealing with on this topic,
[00:06:14.870]it kinda cuts both ways, right?
[00:06:17.260]So, if you have kind of unregulated,
[00:06:21.860]heavy use outside that's surreptitious,
[00:06:26.240]happening in a parking lot or maybe
[00:06:27.950]in a commercial establishment that's
[00:06:30.800]maybe not directly under control.
[00:06:33.650]If you wanna argue that bringing
[00:06:36.270]alcohol inside of a sports stadium
[00:06:41.017]is safer, that argument has been routinely made.
[00:06:46.300]I'm not sure I believe it, but there's some kernels
[00:06:48.880]of truth in there, I think, one of which is,
[00:06:53.140]if you're selling alcohol at $8 a cup,
[00:06:57.790]you have now some environmental
[00:07:01.240]economic availability control over that.
[00:07:06.280]So, I think you have to look at the broader mix.
[00:07:10.660]You also have to look at the motivations
[00:07:12.629]of the NCAA and vendors like Aramark.
[00:07:18.720]I mean, they want a piece of that pie, as well.
[00:07:22.360]So, how can you leverage that very
[00:07:26.810]complicated situation into prevention?
[00:07:30.890]I think it's an open question,
[00:07:32.310]and I think it's one that needs a lot more research.
[00:07:36.179]I mean, I can think of maybe a dozen studies
[00:07:38.730]that have looked at that broad issue.
[00:07:41.630]We need a lot more work in that area.
[00:07:45.510]NCAA has been very reluctant to engage
[00:07:50.920]with researchers like myself on these topics
[00:07:53.900]because they think we're gonna tell 'em
[00:07:56.320]not to do something that they're gonna make money at.
[00:07:59.560]So, that's one of the challenges.
[00:08:01.050]We have a challenge with our own athletic department
[00:08:04.990]in terms of even having a conversation about these issues.
[00:08:08.970]And your colleague to your right
[00:08:12.100]brought up the sponsorship issue.
[00:08:16.330]At our place, even though I have personal relationships
[00:08:19.230]with some of the folks in athletics,
[00:08:21.160]they do not wanna talk to me about any of this stuff.
[00:08:26.370]And so it's hard to even make progress.
[00:08:30.890]I can take two of those parts.
[00:08:33.134]And there are two-- Summarize those four
[00:08:34.630]questions I think I heard.
[00:08:35.800]Well first, thank you for the very nice feedback.
[00:08:37.390]And for those listening remotely,
[00:08:38.410]the two that I can mention, I mentioned that there's more
[00:08:41.270]research that needs to be done on cultural adaptations.
[00:08:43.740]And you asked about what research
[00:08:45.341]has looked at the impact of culture.
[00:08:48.250]I mean, everything from social norms and what is acceptable.
[00:08:51.550]Do we do things in bars here that we would never do
[00:08:54.170]in other cultures, other countries?
[00:08:55.660]And, I mean, we work on that one looking at
[00:08:58.220]students studying abroad, as well, as an example.
[00:09:00.820]The two main things that have been looked at is,
[00:09:03.500]looking at adaptations in any, and the thing
[00:09:05.730]that has been explored the most is norms.
[00:09:08.450]If you go, "You say this, but here's what
[00:09:10.857]"the typical person does," what if I don't
[00:09:12.850]identify with the typical person?
[00:09:15.420]And so it's getting a sense of,
[00:09:17.020]who in the referent group is gonna be most
[00:09:18.850]salient and relevant to anyone that you do research with?
[00:09:21.560]That research has been done to a degree,
[00:09:23.630]but so much more needs to be done.
[00:09:25.500]We find that a lotta times, it's still,
[00:09:28.180]looking at what the typical person does
[00:09:30.150]results in the biggest behavior change.
[00:09:32.170]But being thoughtful and sensitive about norms
[00:09:34.310]that are given, for example, becomes important, too.
[00:09:37.790]The other piece, well you mentioned, again,
[00:09:41.270]there are multiple pieces in there.
[00:09:43.180]The idea about causation, correlation.
[00:09:45.260]I think you're very right.
[00:09:46.410]There are things that generally will hang together.
[00:09:48.410]I showed you the information on,
[00:09:49.980]as drinking goes up, students saying they're tired
[00:09:52.330]all the time increases, and GPA goes down.
[00:09:54.970]I mean, what's interesting is, if you ask students,
[00:09:56.887]"What gets in the way of your academic success?"
[00:09:59.280]the top three answers from the National College
[00:10:00.980]Health Assessment aren't drinking or drug use.
[00:10:03.680]It's being stressed, being tired
[00:10:05.410]all the time, and being anxious.
[00:10:07.250]But what do we know about going to bed
[00:10:08.273]with a positive blood alcohol level?
[00:10:10.350]Throws off REM sleep, and the next day,
[00:10:12.360]increases in anxiety, increases in sleepiness,
[00:10:15.130]increases in sleepiness, increases in irritability.
[00:10:18.030]So even if it's not causal, but there's
[00:10:20.210]something correlational, it goes back to,
[00:10:22.200]what's important to the student?
[00:10:23.700]If a student says, "I don't wanna talk about my drinking.
[00:10:26.047]"I wanna talk about how to make my sleep better,"
[00:10:28.120]there's a backdoor conversation
[00:10:29.410]we can have about alcohol that will still get at sleep
[00:10:32.290]as the topic that's most important to the student.
[00:10:34.530]And the other ones are more environmental, in your realm.
[00:10:36.600]Yeah, I mean, a couple thing.
[00:10:38.360]I'll touch on the cultural question.
[00:10:41.260]And this comes up a lot.
[00:10:42.920]I used to have a slide on this
[00:10:44.130]in some of the talks that I give.
[00:10:46.860]The sort of hand-wringing about,
[00:10:48.980]oh, it's cultural, it's this big amorphous
[00:10:53.100]thing that we can't really do a good job
[00:10:55.660]of defining or doing anything about,
[00:10:58.550]and that kinda leads to sort of
[00:11:00.670]throwing up our hands and being frustrated.
[00:11:04.290]And I think that relates a little bit
[00:11:05.880]to your question about, what are these cultural influences?
[00:11:09.820]Culture, or cultural influences,
[00:11:13.230]tends to be kind of a catchall
[00:11:14.840]for this amorphous set of causes
[00:11:18.070]that are impacting on people's behavior
[00:11:21.950]and on their outcomes that we might care about.
[00:11:25.619]And I think we need to be very particular
[00:11:29.690]about how we're defining, what does culture mean?
[00:11:33.550]And what does culture mean very specifically for alcohol?
[00:11:39.100]Culture is routinely defined as,
[00:11:42.807]"Well, in this culture, it's this thing.
[00:11:45.817]"And in this culture, it's another thing."
[00:11:48.150]It's probably a whole range of different,
[00:11:51.570]very specific things, so we do need to be
[00:11:54.000]more specific about what we mean by culture.
[00:11:57.320]I also think culture is one of the things that,
[00:12:00.650]how we define what our community standards are,
[00:12:04.210]particularly as it relates to alcohol,
[00:12:06.710]what's acceptable and what's not acceptable,
[00:12:09.810]and there are certain things that are
[00:12:11.677]and are not acceptable as they vary by culture.
[00:12:14.990]So being more specific I think is
[00:12:17.780]my attempt at answering what that is.
[00:12:21.190]And then when we're more specific about what culture means,
[00:12:24.300]we can be more specific about what's influencing drinking.
[00:12:29.720]You brought up the drinking age.
[00:12:33.550]That's an area that's probably the most
[00:12:35.750]well-researched in our field.
[00:12:39.060]The evidence is crystal clear.
[00:12:42.470]Places that have lower drinking ages,
[00:12:44.950]more access to alcohol, more likely to drink.
[00:12:48.320]There's been changes in those drinking ages,
[00:12:51.510]both in the United States and in other countries.
[00:12:54.220]When we lower the drinking age,
[00:12:56.950]drinking goes up, particularly among those
[00:12:59.460]who are not quite of that age.
[00:13:02.190]So what's happened in the United States,
[00:13:05.540]as a specific example, when we had an 18 drinking age,
[00:13:10.360]lots of access for students who were in high school.
[00:13:13.630]15, 16, 17-year-olds were drinking heavily
[00:13:17.430]and accessing alcohol through social sources
[00:13:20.410]of people who were able to legally purchase.
[00:13:22.820]When that age goes up to 21,
[00:13:27.530]the high school students don't have as direct access
[00:13:30.610]to those social sources of alcohol
[00:13:32.600]because they know fewer people who are 21.
[00:13:35.900]So, that's made a gigantic impact,
[00:13:39.170]particularly on high-school drinking.
[00:13:41.430]The problem for the population that you're talking about,
[00:13:44.610]college students, is now we've moved that problem
[00:13:47.670]from a high-school problem into the college realm.
[00:13:51.660]And I know a lot of college administrators
[00:13:54.360]would like to say, "Well, let's redefine it
[00:13:57.447]"and make it a high-school problem again."
[00:13:59.950]And I think that would be an enormous,
[00:14:02.950]enormous error in doing that.
[00:14:06.570]And when we've seen New Zealand, in particular,
[00:14:11.600]reduce their drinking age, they've seen a whole host
[00:14:14.430]of negative consequences creep back down
[00:14:18.160]into those younger age groups.
[00:14:20.780]So, in my view, that would be a terrible idea.
[00:14:25.890]And that's been the consistent conclusions
[00:14:30.400]of researchers who've looked at that particular issue.
[00:14:34.150]On Sunday sales, it's a challenging issue.
[00:14:38.030]And it's very similar for
[00:14:42.810]hours of sale, as well.
[00:14:45.080]There's certainly the phenomenon that you described,
[00:14:47.930]which is, well, if we can't get alcohol
[00:14:50.230]on Sunday, there's this rush on Saturday
[00:14:53.690]before closing time to go get some.
[00:14:56.690]And that may not be there if
[00:14:59.810]there were Sunday sales available.
[00:15:01.610]But we know that when Sunday sales are available
[00:15:05.830]that there's a lot more overall consumption
[00:15:09.460]that's happening on those dates.
[00:15:12.540]And the reason the producers of alcohol
[00:15:15.560]want to open up Sunday sales is because
[00:15:18.540]they're gonna sell more alcohol,
[00:15:20.970]and people are gonna drink more alcohol and be more
[00:15:24.020]intoxicated and experience more problems as a result.
[00:15:29.100]So, I think the evidence is pretty clear
[00:15:31.790]on Sunday sales in particular.
[00:15:35.010]A resource that I can point you to
[00:15:36.540]is The Community Guide from the CDC.
[00:15:38.580]It goes through pretty carefully.
[00:15:41.840]There's a nice review article that you can download
[00:15:43.880]from their website, if you're interested
[00:15:45.800]in that topic a little bit more.
[00:15:47.820]And then I think the last topic,
[00:15:52.350]oh, now I'm blanking on what else you were,
[00:15:55.030]oh, the mediators and moderators.
[00:15:58.360]I think there's no question that we can
[00:16:02.490]be more specific and do better research
[00:16:05.930]to try and identify the specific causal mechanisms,
[00:16:10.530]physiologic and psychologic, that are happening
[00:16:13.190]from the relationship between consumption
[00:16:16.150]and the negative consequences that result.
[00:16:19.250]We certainly can do better.
[00:16:21.100]But as a general theme, from a population level,
[00:16:24.930]and I do epidemiologic research,
[00:16:28.310]it's very consistent that the more consumption there is,
[00:16:32.310]the more negative consequences of alcohol
[00:16:36.270]that we might care about from a public health perspective.
[00:16:42.070]There's more nuance that Jason can talk about there,
[00:16:45.410]some of which we understand, but a lot
[00:16:47.020]of which I would say we don't.
[00:16:50.088]With the time we have left,
[00:16:50.921]we have 17 minutes left, what else in terms
[00:16:52.930]of other questions, comments, or things that
[00:16:54.310]would be helpful to support your efforts with this?
[00:16:59.150]I'd say the short answer is,
[00:17:00.430]no, there's not a lot of research on that.
[00:17:03.070]You're right in characterizing
[00:17:04.650]the research that's been done.
[00:17:05.940]It's primarily focused on suppliers.
[00:17:10.303]And that's been a very effective strategy.
[00:17:13.900]I'm very sympathetic to the plight
[00:17:17.240]that you're bringing up, which is, how do you enforce that
[00:17:22.170]out in the neighborhoods at a house party?
[00:17:25.960]And I don't think there's been
[00:17:28.530]a lot of great research on that topic.
[00:17:30.950]What I would say is, we're sort of back to
[00:17:34.640]sort of classic deterrence theory.
[00:17:36.840]And I breezed over that slide in my presentation,
[00:17:42.530]but I'll come back and hit it now.
[00:17:46.090]The way that people sort of reflexively
[00:17:49.640]try to think about punishment or deterrence
[00:17:52.530]is to really ramp up the severity of the consequence.
[00:17:56.230]So, "Oh, we're gonna give him a really big fine,"
[00:17:57.990]or, "We're gonna throw him in jail for five days,"
[00:18:00.030]or something that is perceived as severe.
[00:18:03.680]And that goes over really well when you're passing a policy
[00:18:07.810]and when you are publicizing it
[00:18:09.750]or it's being written up in the newspaper.
[00:18:11.490]It's like, "Oh, that's a tough policy."
[00:18:15.590]The problem is, then you've got
[00:18:18.640]people who are trying to enforce that
[00:18:20.790]that may be backing off on enforcing it.
[00:18:24.570]And actually, having a severe punishment
[00:18:28.510]really undermines the two other really important
[00:18:31.140]components of deterrence theory, which is,
[00:18:35.010]the swiftness, how quickly that consequence happens,
[00:18:40.200]it doesn't have to be a real severe one,
[00:18:43.550]from the time that the discretion happens
[00:18:48.010]to the time where the consequence is administered,
[00:18:50.540]and the shorter that time period is, the better.
[00:18:53.580]And what happens in the judicial system oftentimes is,
[00:18:57.280]that period gets really, really long.
[00:18:59.610]So three years later, I get a consequence
[00:19:01.800]from something that happened long ago.
[00:19:04.660]And then the certainty of the consequence.
[00:19:10.850]So, is it every time that I violate this?
[00:19:16.190]Or is it only every once in a while, or sort of a randomness
[00:19:22.250]that if I have a transgression, I'm gonna get caught?
[00:19:27.010]And students have a very clear perception of,
[00:19:29.670]the likelihood of me getting caught is next to zero.
[00:19:34.180]So, that has no deterrent effect if there's a policy.
[00:19:39.280]And I think what I'm arguing is,
[00:19:42.720]having a severe penalty really undermines
[00:19:46.170]the certainty and the celerity of those punishments.
[00:19:49.870]So that's sort of falling back on theory
[00:19:53.100]when there's the absence of literature
[00:19:55.190]and empirical evidence on it, is where I'd go.
[00:20:01.438]Does that help? One more question,
[00:20:02.590]we were just told.
[00:20:04.360]What else, if anything?

The screen size you are trying to search captions on is too small!

You can always jump over to MediaHub and check it out there.

Comments

0 Comments

National Institute on Alcohol Abuse and Alcoholism’s College Alcohol Intervention Matrix Part 5 of 5

Description

Searchable Transcript

Comments icon comment

Related Channels

Comments