Reducing Substance Abuse Among College Freshman Nursing

Motivational Interviewing as an Intervention for Substance Abuse Problems among College Freshman

Motivational Interviewing as an Intervention for Substance Abuse Problems among College Freshman

Kazemi and colleagues (2013) were interested in understanding whether a behavioral intervention would reduce the prevalence of substance abuse among college freshman in the United States. The independent variable was motivational peer-counseling sessions (motivational interviews) about the risks of alcohol abuse and illicit drug use. The dependent variables were scores obtained on two questionnaires. These scores were then used to determine if there was a statistically significant association between blackout frequency, illicit drug use, and alcohol consumption. Demographic information (attribute variables) was also collected and the attributes of primary interest were ethnicity and gender. The hypothesis tested by the researchers is whether the intervention could reduce the prevalence of self-reported high risk behaviors among college freshman at a representative university campus.

Motivational interviewing is based on the transtheoretical model for behavior change (Jackson, 2013). The transtheoretical model was introduced to the scientific community by DiClemente and Prochaska (1982) as a synthesis of 18 therapy systems and relevant empirical findings. The five main change processes proposed by this model are: (1) consciousness raising, (2) catharsis, (3) commitment, (4) conditional stimuli, and (5) contingency management. The two categories of factors that influence each change process are individual and environment. For example, under consciousness raising an individual factor might be feeling bad about having to purchase jeans with a larger waist size, while an environmental factor could be public information campaigns about the obesity epidemic. The transtheoretical model is therefore focused on the change processes that an individual goes through as they become aware of a health issue, attempt to change the behavior(s) causing the health issue, actually change the behavior, and maintain the behavior change. What motivational interviewing can provide is a safe environment within which a person's own desire for health can be explored and reinforced (Barnett, Sussman, Smith, Rohrbach, & Pruijt-Metz, 2012). The motivational interviewing used by Kazemi and colleagues (2013) relies on peer counselors to achieve these goals.

To justify the study, Kazemi and colleagues (2013) reviewed the substance abuse behaviors of college freshman, including binge drinking, illicit drug use, and the combination of the two. The authors then introduced blackouts as an indicator of substance abuse behavior, along with the risk factors. The emphasis on blackouts as a health indicator continues as the authors describe the neurobiological effects of acute alcohol ingestion; however, only one study was reviewed that examined the association between alcohol/drug abuse and blackouts. This review of the literature, according to the authors, established a clear association between blackouts and alcohol/drug abuse. The literature review then briefly presented motivational interviewing as an effective and widely used behavioral intervention. For the purposes of this study, the literature was relevant and source material cited were largely published within the last five years. Based on how detailed the authors were when reviewing the literature about substance abuse among young adults, the overall impression was that the literature review was comprehensive enough for all topics covered. The limited source material cited for blackouts among college freshman is consistent with the results of a Medline search using the string 'freshman blackouts,' which retrieved no results. If, however, the Medline is searched using the string 'college students blackouts,' 24 citations were retrieved. Many of these 24 citations were probably relevant to the study; therefore, the literature review was not as comprehensive for a discussion of the association between college student substance abuse and blackouts.

The study design used by Kazemi and colleagues (2013) is quasi-experimental without a control group. Initially, 300 freshman were screened using the inclusion and exclusion criteria and 188 racially and ethnically diverse students participated in the study. The main inclusion criteria were age between 18 and 20 years, full-time enrollment, and consumption of alcohol within the past 30 days. The instruments used to evaluate substance use and abuse was the Daily Drinking Questionnaire (DDQ) and the Rutgers Alcohol Problem Index (RAPI), both well validated and reliable instruments with a long history of clinical and research use. These instruments were administered at baseline and six months later. Demographic data was collected at baseline using the Government Performance and Results Act (GPRA).

The study design was approved by the Institutional Review Board for human studies prior to the start of data collection (Kazemi et al., 2013). All students who agreed to participate in the study were required to sign...

The researchers chose not to include a control group, which means the entire cohort of freshman that met the inclusion criteria were exposed to the intervention. In one sense, the researchers were remarkable lucky that all the students meeting the inclusion criteria gave consent and completed all stages of the study. This turn of events eliminated the possibility of an attrition bias. The study design was therefore a prospective, pretest-posttest cohort study without a control group. The variable data was presented as descriptive statistics, but to test for a significant relationship between the intervention and outcome variables, generalized estimating equation (GEE) and logistic regression was used.
The prevalence of blackouts among the freshman at baseline was 40%, but at six months it had dropped to 16% (p < .0001) (Kazemi et al., 2013). This result was interpreted by the authors as supporting the efficacy of motivational interviewing for reducing substance abuse behavior among college freshman. Average weekly drinks declined from 11.1 at baseline to 7.3 and the amount of time spent drinking went from 7.6 to 5.5 hours per week. Overall, the majority of students experiencing blackouts at baseline were no longer blacking out after the intervention. In addition, a significant association was found between the risk of blackouts and alcohol and drug use. These findings are limited by the narrow inclusion criteria and the lack of a control group, which undermine generalizability of the findings to all college freshman and degrade internal validity. The authors concluded that the results support the use of motivational interviewing for reducing substance abuse problems among college freshman.

Research Critique

Summary

Kazemi and colleagues (2013) identified an important gap in the research literature concerning the causal interaction between substance abuse prevalence among college freshman and motivational interviewing. Prior studies had discovered that motivational interviewing was effective in reducing alcohol abuse among college students, but no studies had been conducted which investigated the relationship between illicit drug use, alcohol abuse, and college student status. In an effort to fill this gap, Kazemi and colleagues (2013) conducted a quasi-experimental, prospective, cohort study without a control group. Two instruments were used to evaluate whether the intervention, peer-mediated motivational interviewing, would have a significant impact on substance abuse behaviors between the start of the intervention and six months later. Based on their analysis of the data, motivational interviewing significantly reduced the prevalence of substance abuse among the college students enrolled in the study. The outcome measures included blackouts, number of drinks per week, amount of time spent drinking per week, and the use of illicit drugs. The authors concluded that motivational interviewing would be an effective intervention for reducing substance abuse behaviors among freshman college students.

Reviewer Reaction

The prevalence of blackouts suffered by college freshman is an important topic. As Kazemi and colleagues (2013) discuss, 63% of full-time college students consume alcohol, 42% binge drink, and 16% considered themselves heavy drinkers. Binge drinking for this age group is considered to be four and five consecutive drinks for women and men, respectively. What was not mentioned by Kazemi et al. (2013) is that binge drinking among college women has been increasing at an alarming rate and no improvements have occurred for college men (Grucza, Norberg, & Bierut, 2009). This increase and lack of improvement stand out because binge drinking among age-matched, non-student peers has been declining (males) or increasing at a significantly slower rate (females). Although Kazemi and colleagues (2013) adequately justified conducting the study based on the research they cited, the inclusion of the findings by Grucza et al. (2009) and similar studies would have strengthened their argument and provided convincing evidence of their subject mastery. There was also a noticeable absence of empirical findings from published studies that would conflict with the current findings, which created the appearance of a selection bias for source material.

Kazemi and colleagues (2013) mentioned the risks of alcohol abuse among college students, such as sexual victimization, unplanned pregnancies, and suicide. Grucza and colleagues (2009) would add to this list the following: motor vehicle accidents, homicide, impaired brain development, psychiatric disorders, low-level criminality, and poor academic performance. If Kazemi et al. (2013) had included these adverse outcomes to their comparatively short list, the reader would probably have been more convinced of the study's value.

As mentioned in the introduction, the literature review provided by Kazemi et al. (2013) for motivational interviewing efficacy in relation to college student substance abuse was sparse (Kazemi et al., 2013). One of the articles retrieved from a Medline search described an investigation into whether subjective experiences of…