Addiction Messenger Featured Article - May 2023
Novel Approaches to Engaging Emerging Adults with Risky Alcohol Use and Enhancing the Efficacy of Alcohol Brief Motivational Interventions
Dr. James G. Murphy, PhD, University of Memphis
Emerging Adults (EAs; ages 18–25) report greater alcohol use than any other age group (roughly 35% report recent heavy episodic or binge drinking ) (Hingson et al., 2017), yet very few voluntarily participate in existing brief intervention programs (Helle et al., 2021). Although most young people gradually reduce their drinking without any treatment as they assume more adult responsibilities in their mid to late 20s, many show a developmentally persistent pattern of alcohol use disorder, and even those who eventually reduce their drinking experience substantial alcohol-related harm prior to “maturing out” (Liguori & Lonbaken, 2015).
Brief Motivational Interventions (BMIs) that include personalized drinking feedback delivered in a motivational interviewing style are a promising approach to reaching young people who demonstrate risk drinking in educational or health care settings and have demonstrated reductions in drinking across numerous clinical trials with emerging adults (Cronce et al., 2022; Tanner-Smith & Lipsey, 2015)). However, there are three key limitations to the potential public health impact of BMIs as an alcohol risk reduction approach (Murphy et al., 2022). First, BMIs are not widely available outside of university settings (Becker et al., 2022; Larimer et al., 2022). Second, even when these single-session approaches are readily available and free, very few young people complete them unless they are mandated by a university or legal sanction, or they are compensated as part of a research study (Helle et al., 2021). Third, even for EAs who do complete BMIs, drinking reductions are generally small to moderate (Huh et al., 2015). Thus, there is a need to evaluate novel alcohol intervention content that non-treatment seeking EAs find appealing and that might provide either an effective supplement or alternative to traditional alcohol BMIs (Murphy et al., 2022).
The authors conducted a review of various approaches to reduce alcohol risk among emerging adults (Murphy et al., 2022) that updated and extended an earlier review by DeMartini and colleagues (2015). The focus was on brief (1-5 sessions) approaches that would be relevant for emerging adults who are not seeking formal alcohol treatment. One general category of approaches was potential additions to existing BMIs (approaches that provided alternative content often not directly related to alcohol and could thus be combined with a BMI) and another was alcohol-focused approaches that could serve as an alternative to BMIs. Consistent with previous reviews (Tanner-Smith & Lipsey, 2015), one key conclusion was that in-person counselor-delivered BMIs that include personalized drinking feedback delivered in a motivational interviewing style have the greatest empirical support and should continue to be the default approach when available.
However, the review also identified a number of promising approaches that can enhance BMIs for higher risk EAs. Many also have the advantage of enhancing other aspects of health or wellness that may be appealing to young people and serve as a “gateway” to a more alcohol-focused approach, such as a BMI (Fucito et al., 2017; Murphy et al., 2019). These include 1) brief behavioral activation and behavioral economic approaches that attempt to identifying long and short term goals and increase positive alcohol-free activities that are mood-enhancing and consistent with the individual’s goals (e.g., increasing exercise, time with friends/family who do not drink, academic or vocational activities, hobbies, community service, cultural or religious activities), 2) approaches that attempt to enhance sleep quality, and discuss sleep hygiene and the impact of alcohol use on sleep , 3) approaches that teach relaxation or mindfulness skills, 4) brief future visualization and expressive writing approaches that involve either vividly imaging positive future outcomes that do not involve drinking (e.g., imaging your college graduation or a personal or work accomplishment) or writing about a past negative event resulting from drinking, 5) brief approaches that identify and challenge erroneous positive expectancies about the effects of drinking, 6) approaches that attempt to increase physical activity, and 7) approaches that teach parents about how to communicate more effectively about risks alcohol with their young adult children (e.g., providing credible information about risks without judgement).
Several of these approaches may be especially helpful as an adjunct to BMIs for young people who show more severe drinking patterns and/or who experience psychiatric comorbidity, perhaps as part of a “stepped-care” approach where additional services are offered to individuals who do not reduce drinking following a standard alcohol BMI. Approaches that enhance health and positive activities or help EAs to manage negative affect may be a useful way to increase help-seeking and serve as a “gateway” to more alcohol-specific interventions, but further research with larger samples is required to evaluate the relative efficacy of these approaches and their utility for increasing help-seeking. Ideally, universities, worksites, community agencies, and other institutions that serve EAs would provide a variety of gateway options to enhance health and wellness, allowing EAs to select based on their interests and/or using a brief assessment to make assignments based on their specific co-occurring risk or personality profile.
Becker, S. J., Scott, K., & Elwy, A. R. (2022). You have an effective brief intervention (BI) for young adults, now what? Concrete strategies to advance BI implementation in usual care settings. Psychology of addictive behaviors : journal of the Society of Psychologists in Addictive Behaviors, 36(6), 724–735. https://doi.org/10.1037/adb0000731
DeMartini, K. S., Fucito, L. M., & O’Malley, S. S. (2015). Novel approaches to individual alcohol interventions for heavy drinking college students and young adults. Current Addiction Reports, 2(1), 47–57. https://doi.org/10 .1007/s40429-015-0043-1
Fucito, L. M., DeMartini, K. S., Hanrahan, T. H., Yaggi, H. K., Heffern, C., & Redeker, N. S. (2017). Using sleep interventions to engage and treat heavy-drinking college students: A randomized pilot study. Alcoholism: Clinical and Experimental Research, 41(4), 798–809. https://doi.org/10.1111/acer.13342
Helle, A. C., Boness, C. L., & Sher, K. J. (2021). College students’ receptiveness to intervention approaches for alcohol and cannabis use. Psychology of Addictive Behaviors. Advance online publication. https:// doi.org/10.1037/adb0000699
Hingson, R. W., Zha, W., &White, A. M. (2017). Drinking beyond the binge threshold: Predictors, consequences, and changes in the U.S. American Journal of Preventive Medicine, 52(6), 717–727. https://doi.org/10.1016/j .amepre.2017.02.014
Huh, D., Mun, E. Y., Larimer, M. E., White, H. R., Ray, A. E., Rhew, I. C., Kim, S. Y., Jiao, Y., & Atkins, D. C. (2015). Brief motivational interventions for college student drinking may not be as powerful as we think: An individual participant-level data meta-analysis. Alcoholism: Clinical and Experimental Research, 39(5), 919–931. https://doi.org/10.1111/acer .12714
Larimer, M. E., Kilmer, J. R., Cronce, J. M., Hultgren, B. A., Gilson, M. S., & Lee, C. M. (2022). Thirty years of BASICS: Dissemination and implementation progress and challenges. Psychology of addictive behaviors : journal of the Society of Psychologists in Addictive Behaviors, 36(6), 664–677. https://doi.org/10.1037/adb0000794
Liguori, G., & Lonbaken, B. (2015). Alcohol consumption and academic retention in first-year college students. College Student Journal, 49(1), 69–77.
Murphy, J. G., Dennhardt, A. A.,Martens,M. P., Borsari, B.,Witkiewitz, K.,& Meshesha, L. Z. (2019). A randomized clinical trial evaluating the efficacy of a brief alcohol intervention supplemented with a substance-free activity session or relaxation training. Journal of Consulting and Clinical Psychology, 87(7), 657–669. https://doi.org/10.1037/ccp0000412
Murphy, J. G., Gex, K. S., Dennhardt, A. A., Miller, A. P., O'Neill, S. E., & Borsari, B. (2022). Beyond BASICS: A scoping review of novel intervention content to enhance the efficacy of brief alcohol interventions for emerging adults. Psychology of addictive behaviors : journal of the Society of Psychologists in Addictive Behaviors, 36(6), 607-618. https://doi.org/10.1037/adb0000811
Tanner-Smith, E. E., & Lipsey, M. W. (2015). Brief alcohol interventions for adolescents and young adults: A systematic review and meta-analysis. Journal of Substance Abuse Treatment, 51, 1–18. https://doi.org/10.1016/j .jsat.2014.09.001