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Article Excerpt
APPROXIMATELY 68% OF COLLEGE STUDENTS report drinking alcohol at least once in the past month, with 42% reporting heavy episodic drinking (five or more drinks in a row in the past 2 weeks; Johnston et al., 2005). Excessive alcohol use in college students is linked to physical illness (Engs and Aldo-Benson, 1995), unintentional injury (Presley et al., 1996), and a wide range of behavioral problems, including decrements in academic performance (Montgomery and Haemmerlie, 1993; Wood et al., 2000), fighting and physical aggression (Giancola, 2002; Marcus and Reio, 2002), and risky sexual behavior (Abbey et al., 1998; Wechsler et al., 2000). College drinkers also often consume large quantities of alcohol over relatively brief time periods, which can result in dangerously high blood alcohol concentrations (Fournier et al., 2004).
On college campuses, alcohol use and its associated behaviors are among the most common reasons for disciplinary infractions and emergency medical care (Bergen-Cico, 2000; Dannells, 1991; Stone and Lucas, 1994; Wright and Slovis, 1996). A survey of 194 college officials found that alcohol consumption was a factor in 60% of all violent behavior, half of physical injuries, and two thirds of vandalism damage on campus (Anderson and Gadaleto, 2001). Arrests and violations of campus alcohol and drug policies have been increasing over the past decade (Hoover, 2004; Nicklin, 2000). Studies have determined that undergraduates who received university alcohol violations were more likely to be heavy drinkers, compared with nonadjudicated students (O'Hare, 1997) and had higher alcohol-related problem scores relative to campus norms (Caldwell, 2002). However, very little other information is available about students who have been identified by their college as having had an alcohol-related incident.
There is evidence that certain incidents--such as hospitalization and medical problems--are related to subsequent drinking reductions among adults (Dunn et al., 2003; Perreira and Sloan, 2001) and that intention to change behavior is high after salient events. For example, Apodaca and Schermer (2001) found that most adult patients hospitalized for alcohol-related trauma intended to change their drinking. Barnett et al. (2003) reported that young adult Emergency-Room (ER) patients were more likely to be contemplating reducing heavy drinking if they were being treated for an alcohol-related incident, compared with patients with similar patterns of alcohol severity who were not being treated for alcohol-related reasons. In the only identified similar study with college students, Reis et al. (2004) assessed first-year students who had been transported to a hospital for alcohol overdose and reported that 83% of these students stated that they planned to decrease the amount they drank.
In studies of natural recovery from alcohol problems, individuals commonly identify specific events as precursors to change. Sobell et al. (1993) found that nearly one third of adults who had resolved their alcohol problem without treatment attributed their resolution to a specific event, "such as a traumatic health problem or a frightening experience" (p. 221). In their review of studies on natural recovery, Watson and Sher (1998) also established that events that promote self-evaluation often provide a catalyst for change. Although these studies are limited by possible retrospective bias, their findings are consistent with those already described that assessed individuals immediately following specific alcohol incidents; together, they indicate that discrete events can compel some individuals to change their drinking behavior.
Although such critical events have presented opportunities to provide education and/or intervention for a target behavior (e.g., Dunn et al., 2003; Minugh et al., 1997; Monti et al., 2001), little is known about the effects of these incidents themselves and their potential for promoting behavior change. To best design intervention strategies, researchers and clinicians must first understand the individual and event or incident-level characteristics that are related to client motivation to change drinking. Individual characteristics can be instrumental in either leading to continued heavy drinking or to self-evaluation and subsequent change following an alcohol-related incident. For example, prior drinking experience is likely to influence one's response to a specific alcohol consequence. In samples of adolescents (Barnett et al., 2002) and young adults (Barnett et al., 2003) treated in an ER for alcohol-related reasons, we found that less prior experience with alcohol and fewer prior alcohol problems predicted greater intention to change at the time of the ER visit.
It is also likely that immediate affective and cognitive responses to an alcohol-related incident are associated with plans to change. Barnett and colleagues (2002, 2003) found that greater fear or distress about the incident, greater belief that the patients' alcohol use was responsible, and belief that the precipitating incident was their fault and that their risk-taking was responsible predicted greater motivation to change. Studies with older adults found similar relations; Longabaugh and colleagues (1995) reported that the attribution of alcohol as a cause of injury in combination with the perception of aversiveness of the injury predicted motivation to change drinking in a sample of injured adult drinkers presenting for treatment at an ER.
Research with college samples suggests that men drink more often and more heavily than women and are more likely to experience "public" alcohol-related consequences (Johnston et al., 2004; Perkins, 2002), but no studies have examined gender in the context of identified incidents. Specifically, gender may be associated with the characteristics of alcohol-related incidents, attributions and affective responses to the incident, and motivation to change drinking. The relations among these characteristics also may differ for men and women.
There is very little information about college students who have specific, identified alcohol-related incidents on campus, and whether characteristics of these incidents, the students' prior experience with alcohol, and the students' reactions to the incidents are related to motivation to change drinking. The objective of this study was to describe college students who experienced an alcohol-related incident and to examine predictors of motivation to change, with particular attention to gender.
"Motivation" has been operationalized as statements of problem recognition or intention to change. Measurement of the construct of motivation with college students is challenging, however, because there is generally a low rate of problem recognition (an assumption of many measures of motivation to change), and because some measures contain items that refer to being in treatment, whereas college students are not typically assessed in the context of treatment-seeking (Carey and Hester, 2005). The motivational target can also vary (e.g., it can refer to drinking or heavy drinking and can target reduction or abstinence). To best explore the associations with motivation in our population, we focused on two targets of motivation: motivation to change drinking in general and motivation to reduce heavy drinking. Investigating motivation to change heavy drinking allowed us to examine the impact of background variables and incident characteristics on commitment to change problematic drinking, which has recently been shown to be important for predicting treatment outcomes (Amrhein et al., 2003). Data for this study were collected as part of the baseline assessment for a randomized clinical trial testing the efficacy of brief interventions with students who were required to attend a session of alcohol education. We expected that lower alcohol use and fewer alcohol problems before the incident, greater perceived aversiveness of the incident, and...
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