A better approach to college drinking prevention?

CHS researchers are developing a program that focuses less on student drinking, and more on the underlying factors that lead people to drink.
student in a bar drinking a beer

For more than 15 years, most alcohol prevention programming on college campuses has focused on measuring consumption habits and then providing students with information about how their drinking compares to others, alongside education about the consequences of heavy alcohol use, and strategies for harm reduction.

Research has shown that these programs are only somewhat effective. And there have been no major improvements or changes to college student substance use prevention programming over that time.

A new project led by two Virginia Commonwealth University researchers will develop what they believe will be a more effective approach.

They are designing a new type of prevention program that focuses not on drinking, per se, but on the underlying factors that contribute to why students might use alcohol or other drugs in risky ways in the first place.

The National Institute on Alcohol Abuse and Alcoholism has awarded a three-year, $600,000 grant to the researchers — Danielle Dick, Ph.D., Commonwealth Professor in the Department of Psychology in the College of Humanities and Sciences and in the Department of Human and Molecular Genetics in the School of Medicine; and Joshua Langberg, Ph.D., a professor in the Department of Psychology and associate dean for research and interim associate dean for graduate studies in the College of Humanities and Sciences — to develop and test their new approach to preventing risky college drinking.

Dick, also director of the College Behavioral and Emotional Health Institute at VCU, studies underlying risk factors and pathways of risk. Langberg has expertise in prevention programs, including among college students.

“We know that people use and abuse alcohol and other drugs for many different reasons,” Dick said. “Our lab studies those risk pathways, and we’ve learned a lot about what leads people to develop problems.”

The researchers will apply information about underlying risk pathways to build an online tool that will provide students with information about their temperaments and proclivities, including positive and negative outcomes — such as risky substance use — that can come with certain personality styles.

“What we’re trying to do is shift the paradigm from talking to students about their current alcohol use to [asking] what are the underlying risk factors that you may or may not carry?” Dick said. “Let’s talk about those instead.”

Two of the biggest risk pathways associated with unsafe drinking behavior can be described as “externalizing” and “internalizing.”

Externalizing describes personality traits like impulsivity and sensation seeking, which can lead to heavier alcohol use, but can also have positive outcomes too. People who have high levels of sensation seeking, for example, tend to be good at entrepreneurship and are more likely to be a CEO or a fighter pilot, Dick said.

“They like being around lots of people who are doing risky things, especially when they’re adolescents and their brains are programmed to really like immediate rewards,” she said. “These are not bad characteristics in and of themselves. There are great things associated with being a sensation seeker, with being highly sociable. And so that’s one of the things that we want to emphasize: The risk factors that can potentially lead to problems can also be channeled for other really productive, wonderful things which are likely more in line with what you want out of life.”

"With this approach, we’re saying: Let’s talk about you and what you’re like. Here are the good things associated with your personality traits and temperaments. And here are some of the not so good things that can come from some of your natural dispositions if you’re not careful."

Internalizing risk factors, meanwhile, includes people who are more prone toward depression and anxiety, who may use alcohol and drugs to cope.

“We know that the externalizing pathway, the impulsivity pathway, is a much more common risk pathway. There are more people that have those characteristics and use in risky ways in college populations than people who are using [substances] to cope,” Dick said. “But we also know that those who are using substances to cope and to deal with depression, anxiety and related problems are more likely to have persistent problems with substances.”

The new approach, she said, will shift the conversation away from drinking and focus more on the individual’s behavioral traits.

“With this approach, we’re saying: Let’s talk about you and what you’re like. Here are the good things associated with your personality traits and temperaments. And here are some of the not so good things that can come from some of your natural dispositions if you’re not careful.”

The idea, Dick said, is similar to the personalized medicine approach increasingly found in medical treatment — but without the need for genetic testing to determine if someone has a genetic predisposition toward risky drinking.

“What we’re essentially saying is we don’t even need to know the specific genes yet. We don’t need to be doing any biological tests on individuals. We know that risky genetic predispositions show up via these behavioral traits — via impulsivity and sensation seeking and depressive effect and anxiety sensitivity — via things that we can pick up on through different personality styles,” she said. “So that’s what we are focusing on in this prevention program.”

The researchers are collaborating with the Wellness Resource Center at VCU to develop a prototype online tool that will ask students about themselves and then provide feedback about their traits and risk pathways. The researchers plan to hold focus groups with students and practitioners to get feedback.

They will then conduct a randomized clinical trial in which one group of students will take the traditional alcohol prevention program, one group will get the new program that focuses on underlying dispositional traits, a third group will participate in a combination of the current program and the new approach, and a final control group won’t go through either program.

“What we expect to find is that by removing the focus on alcohol and instead making a program that’s more engaging for students, and that focuses on them and the positive parts of themselves and how to channel that for good, along with providing information about some of the ways that their dispositions might potentially lead them to trouble, we think our new personalized risk assessment is going to be more effective,” Dick said.

The grant from NIAAA for the team’s study, “Development of a Novel Personalized Risk Assessment for College Alcohol Prevention,” is a special mechanism that is meant to fund cutting-edge ideas to collect initial data with the goal of ultimately scaling up the idea for more large-scale study.

In October, Dick will visit NIAAA to discuss the project with college prevention program leaders from across the country.

“The idea is that we will all work together because when we find approaches that are more effective we want to see them implemented universally across colleges,” she said.

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