1. What makes group MET work? A randomized controlled trial of college student drinkers in mandated alcohol diversion.
LaChance H., Feldstein Ewing S.W., Bryan A.D. et al. Psychology of Addictive Behaviors: 2009, 23(4), p. 598–612.

US students who broke college drinking rules and were required to undertake an alcohol programme responded better to three hours of group motivational interviewing than six of alcohol education; enhanced confidence that they could resist risky drinking was the key. For colleges it offers an effective but economical response to problem drinkers.

Summary
A review of studies of interventions to reduce drinking among college students found these on average worked best when they incorporated elements of motivational interviewing, and also when some techniques often used during this approach were included – specifically, feedback to the student on how their drinking compares to the norm, feedback on what the student expects from drinking or why they drink, and exercises weighing the pros and cons of drinking.

The review also found that face-to-face interventions and those delivered one-to-one had the greatest impacts on drinking. However, such interventions are not always feasible or cost effective. Court-referred or university-based alcohol education and diversion programmes are commonly provided in a group modality, and with some success have adapted motivational interviewing to this setting with consequent drinking reductions. But how they work is poorly understood. Studies to date have highlighted the impact on social and enhancement motives for drinking but found no support for other expected mechanisms such as enhancing readiness to change one's drinking. Knowing more about the mechanisms should enable us to develop more effective interventions and/or training for interventionists.

To explore these mechanisms, at a US university the study successfully recruited 206 students required to attend alcohol education classes as one of the sanctions for minor underage drinking infractions of the institution's rules. They were randomly assigned to one of three small-group interventions:
• the university's standard two three-hour interactive alcohol education groups;
• one three-hour motivational interviewing session; or
• one three-hour lecture-format alcohol information session.

Responses from baseline questionnaires were used to create personal feedback handouts for students assigned to motivational interviewing on how their drinking compared to national averages. During the group, exercises conducted along motivational lines involved responses written on board so all the group could evaluate and discuss, and finally help each other develop strategies to alter high-risk drinking, substance abuse, and risktaking. Neither of the other two group options featured individualised information or collaborative harm reduction exercises and discussions.

Follow-ups which re-assessed drinking were completed via the internet three and six months later when responses were received from 80% and 76% respectively of the students.


2. Drink less or drink slower: the effects of instruction on alcohol consumption and drinking control strategy use.
Sugarman D.E., Carey K.B. Psychology of Addictive Behaviors: 2009, 23(4), p. 577–585.

What happens when instead of asking students to cut drinking, you ask them to use more moderation strategies such as spacing or avoiding heavy drinking situations? The results of this US study suggest that changes in strategy use may bear little relation to changes in drinking, and that intention to cut back is the most important factor.

Summary
Studies have not consistently found that teaching college students strategies to moderate their drinking are actually followed by less drinking, and students who use these strategies more intensely do not necessarily drink less. Such strategies include spacing out drinks, drinking slowly, refusing drinks or spirits in particular, eating before drinking, finding non-alcoholic alternatives, and avoiding drink-promoting situations. Some studies have found that moderate use of such strategies is associated with less drinking than using them very little or very much. On the other hand, at least one study found that mailed feedback on their drinking did curb college student drinking, and seemingly did so because it promoted the use of protective strategies.

The featured study at a US college sought to clarify the relation between strategy use and drinking by instructing students to either use more strategies or to drink less. Issues addressed included whether using more or certain kinds of strategies would reduce drinking, and whether more and what types of strategies were used when the student was trying to cut down.

The study recruited 177 mainly female and campus-resident college student drinkers aged at least 18. At first they reconstructed the amount they had drunk over the past two weeks as a baseline against which to assess whether in the following fortnight they changed the amount they drank. During the fortnight all were asked to record each day how much they had drank and what moderation strategies they had used. Following the initial assessment, they were allocated at random to merely conduct this monitoring, or additionally to an instruction to over the next fortnight halve the amount they drank, or to double their use of a list or moderation strategies. Over 80% returned to be re-assessed at the end of the fortnight.