High Risk Alcohol Prevention

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Beth Hoffman RN., MN is the Coordinator of Student Health and Wellness at Santiago Canyon College (SCC), part of the Rancho Santiago Community College District. She recently served a three year appointment for the Health Services Association of California Community Colleges to the Governor’s Prevention Advisory Council (GPAC). The GPAC meets quarterly to coordinate the state's strategic efforts to achieve measurable reductions in the incidence and prevalence of the inappropriate use of alcohol and other drugs by youth and adults. Beginning in the spring of 2007, she directed a three year grant specifically for community college students targeting High Risk Alcohol Prevention for the County of Orange Health Care Agency. Sustainability efforts for the grant include collaborating with SCC faculty to incorporate an online tool into existing curriculum for alcohol prevention. Ms. Hoffman graduated from UCLA with a Masters Degree in Nursing Administration in 1993.

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Beth Hoffman RN., MN, Coord, Student Health & Wellness, Santiago Canyon College
Abstract: 

Students enrolled in community college participate in fewer high risk alcohol-related events than their four-year university counterparts.  However the catastrophic secondary effects or consequences are no less traumatic, violent or dangerous for any student Effectively engaging the broader population of community college students to reduce high risk alcohol usage is compelling and important. In this article, the consequences and intervention techniques are outlined so that an effort to increase our reach toward high risk alcohol prevention with community college students is achieved.

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Introduction
It may seem that students enrolled in community college participate in fewer high risk alcohol-related events than their four-year university counterparts. The press is far more likely to recount the sordid facts which can be attributed to an elite institution with a NCAA Division I football team.  However the catastrophic secondary effects or consequences are no less traumatic, violent or dangerous for any student, including those who routinely commute to school and hold down a fulltime job.  Effectively engaging the broader population of community college students to reduce high risk alcohol usage is compelling and important. Fortification work may be accomplished by blending intervention amid college curriculum best attainable if the framework connects with pupils on a personal level. Caring for our learners in both an academic and cognitive behavioral context may now be facilitated using web-based screening, assessment and feedback in a motivational interview, a co-curricular tool that shows promise in reducing destruction due to alcohol.

Online Alcohol Screening and Brief Intervention

We know from myriad heartbreaking headlines that excessive use of alcohol among college age students all too frequently results in blackouts, injury, physical disabilities and death. Among the college age population excessive use of alcohol also contributes to missed or dropped classes, auto accidents, fights, unprotected sex, sexual assault, unintended pregnancies and sexually transmitted infections. Students between 18 and 24 years comprise a large proportion of these troublesome outcomes. It may not seem that community college students drink as frequently as their on-campus housed college peers but they too have a tendency to drink excessively and sustain similarly serious outcomes when they do. 

 Most individuals who engage in heavy episodic substance use are not habituated alcoholics; heavy episodic use behavior is now simply described as “high risk”. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines high risk alcohol use as consuming more than five drinks by a male or more than four drinks by a female within a period of two consecutive hours. The Harvard School of Public Health has studied heavy episodic use of alcohol among college students with the College Alcohol Study.  In his book entitled “Dying to Drink”, Harvard Researcher Henry Wechsler Ph.D. describes numerous campus rituals where anything goes alcohol use is tolerated by scores of universities across the U.S. Although notoriously associated with four year schools with on campus residences and Greek fraternity houses, high risk use of alcohol is also occurring for us locally at just over one third of our community college students.

National College Health Assessment

In the spring of 2006, The American College Health Association’s National College Health Assessment (NCHA) a nationally normed college health assessment tool was conducted among 500 students at Santiago Canyon College (SCC) in Orange, CA. The survey was conducted as a baseline assessment, part of a three year grant for high risk alcohol prevention among community college students. SCC’s NCHA data revealed that 34% of the student respondents had consumed five or more drinks in one sitting within the previous two weeks. Among the same student cohort, the following untoward consequences were also reported;

            Doing something they later regretted – 44.6%
            Forgetting where they were or what they had done – 33.5%
            Being Physically Injured – 26.2%
            Having unprotected sex – 23.9%
            Being involved in a fight – 12.1%
            Physically injuring another person – 10.2%
            Having someone use force or threat of force to have sex      with them -4.4%

These troubling outcomes provided impetus for us to seek out a best practice method for promoting harm reduction behaviors.

Effective prevention of high risk alcohol

Effective prevention of high risk alcohol among the collegiate population is widely sought after. Many institutions of higher education provide mandatory alcohol education annually. Simply addressing the alcohol challenge with freshman education programs unfortunately serves only as a top dressing and sadly not much measurable behavioral change has been demonstrated.  Mitigation requires employing evidence based practice with population based applications.  In 1990, the Institute of Medicine released a report which identified one single counseling session was as effective as intensive inpatient and outpatient therapy for alcoholism.  This single strategic encounter has more recently come to be called Screening Brief Intervention and Referral to Treatment (SBIRT).  The cognitive behavioral therapeutic components of SBIRT may be concisely described as follows:                                                                                                                                                  
          Screening - Very briefly identifying substance use related problems with a predetermined tool such as the Alcohol Use Disorders Inventory Test or “AUDIT”.   

          Brief Intervention - Raising awareness of personal risks and motivating a client toward acknowledgement the problem.    

          Referral - Threshold numbers above the point of habituation are referred for longer term support (> 15 points on the AUDIT).    

          Treatment - The individual become newly aware of their predicament and seeks out help to change.    

Individuals with more serious substance addictions are at once provided with referrals for more intensive ongoing treatment.  Optimally, SBIRT techniques are performed face to face in a confidential health care setting, which is also incorporated in the SCC Health Center. Although using technological applications such as individual web-based screening and intervention have also been shown to effectively reduce risky alcohol use.

e-CHUG Online Tool

At SCC, we subscribed to the “e-CHUG online tool”, a proprietary product developed by San Diego State University. Chosen as a promising interactive prevention tool, e-CHUG utilizes both SBIRT motivational interviewing and a social normative approach which refers to perceptions and beliefs about what is “normal” peer behavior. Individually students may believe that their peers drink heavily, which may influence and inflate their own drinking behavior, yet much of peer influence is the result of incorrect perceptions. Normative feedback relies on the presentation of objective information in effect correcting misperceptions about others personal drinking profiles such as frequency and volume, percent of personal income spent, familial risk factors for habituation, and broader normative comparisons from among 550 current higher education institutional users across the country. Rapid email feedback is provided to the user online which ultimately informs the user where they rank among the total data base and what is considered high risk.  The e-CHUG tool is currently used in several academic courses at SCC as both curriculum enrichment and as syllabus assignments along with papers, oral presentations, and group projects. 

Student Learning Outcomes (SLO’s) measures and data

The Health and Wellness Center’s (HWC) current Student Learning Outcomes (SLO’s) measures and data are also driven by the aggregate figures from the e-CHUG online tool.  Once the tool is completed, students have the option of sending additional confidential responses via email to the HWC Psychologist as a part of the e-CHUG expanded protocol.  We capture their responses and anonymously group them into domains to describe an overall level of cognitive dissonance.  A few examples of student responses include:

I wasn’t aware that I was drinking so many calories, the information provided here also gave me a better sense of the money I spend every week on alcohol”.

“I actually thought more college students drank, the fact that 48% don’t drink at all that surprises me”.

Academic partnerships

Academic partnerships at SCC currently using the online tool include: Several sections of English, Political Science, Counseling, Early Childhood Development, Interpersonal Communication, Human Sexuality, Exercise Science, The Student Leadership Institute, Psychology and Women’s Studies. True Population based prevention programming implies that the entire college enrollment participates. Each semester more faculty participants are invited to further engage students to reflect on their lives and how alcohol choices may affect their immediate goals as students.  We’re delighted to be making headway and continue to have conversations and build faculty affiliations to increase our reach toward high risk alcohol prevention.  Published research studies which support use of the e-CHUG online tool as part of a comprehensive prevention program may be viewed on the San Diego State website or @ echug.com.