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How Much is Enough? Willingness to Participate in Alcohol Interventions Chudley E. Werch PhD
a
a
College of Health, Center for Alcohol and Drug Studies , University of North Florida , Jacksonville, USA Published online: 09 Jul 2010.
To cite this article: Chudley E. Werch PhD (1991) How Much is Enough? Willingness to Participate in Alcohol Interventions, Journal of American College Health, 39:6, 269-274, DOI: 10.1080/07448481.1991.9936244 To link to this article: http://dx.doi.org/10.1080/07448481.1991.9936244
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http:// www.tandfonline.com/page/terms-and-conditions
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How Much Is Enough? Willingness to Participate in Alcohol Intewentions CHUDLEY E. WERCH, PhD
This study examined the willingness of drinkers to participate in alcohol interventions designed to cut down or stop alcohol use by degree of serviceprovider contact. One hundred fifty-six university students and staff who attended a campus health fair participated in an alcohol survey. Of the college drinkers, 73.7% reported they were willing to participate in one or more alcohol interventions with minimal p r e vider contact, compared with 48.5% who said they would participate in programs with high provider contact. Respondents preferred minimal-contact strategies (use of nonalce holic or low-alcohol beverages, information pamphlets, cash awards, television programs, and mailed instructions) to high-contact approaches. Men were significantly more willing @s < .05) than women to participate in nearly half (11 to 21) of the alcohol interventions. Three measures indicative of motivation to control drinking were significantly associated with greater willingness to participate in nearly all strategies. This study also suggested that drinkers who were highly motivated to control their drinking did not prefer minimal-contact interventions over high-contact interventions.
Research on smoking’,* has begun to identify the types of cessation approaches that smokers find most attractive and are presumably more motivated to use. These studies indicate that, to help them stop smoking, smokers prefer self-help and other minimal-contact strategies rather than formal treatment programs. Minimal-provider contact interventions are those that involve limited face-to-face dealings with the service provider, as opposed to high-contact interventions, which involve extensive or continuous contact between the service provider and the client. Traditional 30-day alcohol treatment programs are high-contact interventions. ~
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_
_
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Chudley E. Werch is an associate professor with the College of Health, Center for Alcohol and Drug Studies, at the University of North Florida in Jacksonville.
V 0 1 3 9 , MAY 7997
Alcohol researchers3 have stated that many drinkers who are unwilling to attend formal alcohol programs might be more motivated to participate in minimalcontact interventions. The minimal-contact interventions offer a host of potential advantages when compared with traditional programs. These include their appeal to drinkers who would not participate in more intensive programs, their low unit cost, and their ability to reach large numbers of at-risk individuals. Previous college-based alcohol prevention programs such as those described by Kraft4 have had difficulty in attracting and retaining participants in traditional highcontact interventions like workshops and classes. Alternatives to those traditional intensive interventions have been largely restricted to such media strategies as pamphlets, posters, and radio announcements. Innovative nontraditional strategies must therefore be examined for the majority of students and university staff who will not participate in intensive, time-consuming programs. An important first step in deciding whether various minimal-contact alcohol strategies might motivate college drinkers to initiate, successfully modify, and maintain alcohol-related behavioral change i s to determine if college drinkers prefer these alcohol interventions to traditional approaches. Although preference for certain interventions does not always correlate with actual participation, stated willingness to participate in alcohol strategies is an indication of one‘s intention to participate. If minimal-contact interventions are found to be more attractive to college drinkers than traditional alcohol interventions, they should be studied further. for their potential to reach large numbers of drinkers in campus alcohol programs and to reduce students’ alcohol consumption. This study examined the willingness of drinkers to participate in alcohol interventions, categorized by the degree of contact with the service provider. Specifically, I examined the following questions: (1) What types
269
COLLEGE HEALTH of interventions designed to assist individuals to cut down or stop alcohol use will drinkers indicate they are most willing to participate in? (2) Do men and women differ in their selection of alcohol interventions?and (3) What other variables are associated with indications of willingness to participate in programs to limit drinking?
METHOD
Downloaded by [Temple University Libraries] at 12:39 14 November 2014
Subjects Subjects included 156 students and staff who agreed to participate in an alcohol survey while attending a 2-day health fair at a southern university. The mean age of the subjects was 24.7 years (SD = 8.5)’ and 58% were women. The majority (68%)were single, and 82% were white. Reported year in school included 19% freshman, 19% sophomore, 20% junior, 19% senior, 14% graduate or other classification, and 7% not attending school (does not total 100% because of rounding). Seventy-eight percent reported they had consumed an alcoholic beverage in the past year. These subjects were demographically similar to those in a recent random survey of students attending the u n i v e r ~ i t y , ~ except that the present sample included a larger proportion of women. Procedure Self-selected subjects were informed that their participation was voluntary and that they did not have to answer any questions they found objectionable. Participants were then seated and given pencils, informedconsent sheets, and the alcohol-use survey. To ensure continuity in communicating with the participants, all research assistants followed a printed protocol. Measures The survey asked for demographic information and included three items that measured alcohol consumption. One item assessed whether subjects had had a drink of alcohol in the past year; those who responded no were not asked to complete the questionnaire. The second item measured the number of times subjects reported they had been intoxicated, by their own definition, in the past year. This item was scored on the following 6-point scale: I = none; 2 = once; 3 = 2 or 3 times; 4 = 4 or 5 times; 5 = 6 to 9 times; 6 = 70 or more times. I used a 7-day retrospective diary to measure weekly alcohol consumption, asking: ”Exactly, how much of each beverage (beer, wine, and liquor) did you consume on each day of the last week? Start with yesterday and work backward through each day of the week.” Subjects then identified the number of each of the three types of alcoholic beverages they had consumed during the past 7 days. This diary measure was based on those described by other researcher^.^,'
2 70
Three items on the survey were related to motivation to control alcohol consumption. One measured the number of times subjects seriously attempted to stop or cut down on the amount they drank during the past year. It was scored on a 6-point scale of 1 = none; 2 = once; 3 = 2 or 3 times; 4 = 4 or 5 times; 5 = 6 to 9 times; 6 = 10 or more times. The second item assessed the number of hours a day subjects would be willing to invest in cutting down on their alcohol consumption. The third item measured willingness to limit alcohol consumption. Phrased, “If there were an easy way to cut down on drinking, I would definitely do it,” this item was scored on a 5-point Likert scale. Last, the willingness of subjects to participate in common alcohol interventions was measured by asking, “How willing would you be to participate, at no cost to you, in any of the following ways to help you cut down or stop alcohol use?” These items were each scored on a 5-point scale of 1 = not at all willing, to 5 = extremely willing. I used a list of 21 alcohol interventions that was generated from a review of the current literature on alcohol and tobacco programs. The 21 interventions were then identified as either low- or high-contact strategies. Low-contact strategies were those involving limited faceto-face contact between the service provider and the participants such as mailed instructions, books or manuals, alcohol information pamphlets, recorded telephone messages, television programs, audiotapes, videotapes, correspondence courses, computer programs, stopdrinking contests, cash awards, self-help groups, and use of nonalcoholic beverages or lowalcohol beverages. High-contact strategies were those categorized as involving extensive or continuous service-provider contact with participants, including group therapy, individual counseling, dropin centers, acupuncture, hypnosis, lecturedclasses, and telephone hotlines. Fourteen of the interventions were identified as low contact and 7 were labeled as high contact.
RESULTS The first question I examined was what types of interventions drinkers were most willing to participate in. The data in Table 1 show that drinkers preferred lowcontact interventions to high-contact interventions. A greater proportion (73.7%) of drinkers reported they were willing to participate in one or more low-contact strategies compared with 48.5% who opted for highcontact strategies. The greatest percentage of drinkers reporting to be at least somewhat willing to participate in alcohol strategies preferred (1) nonalcoholic beverages, 52.3%, (2) alcohol-information pamphlets, 51.8%, (3) cash awards, 47.1 %, (4) television programs, 47.1 %, (5) mailed instructions, 46.6%, and (6) low-alcohol beverages, 45.7%. The smallest percentage of drinkers at least somewhat willing to participate in an alcohol intervention identified the high-contact approach acupuncture (17.1%I. Similarly, when I examined those drinkers
IACH
ALCOHOL lNTERVENT/ONS TABLE 1 Drinkers’ Willingness to Participate in Interventions to Cut Down or Stop Alcohol Use, by Degree of Provider Contact
Not at all willing
Not very willing
Somewhat willing
Very willing
Extremely wi Iling
OIO
OIO
OIO
OIO
OIO
Low contact Mailed instructions Books or manuals Alcohol information pamphlets Recorded telephone messages Television programs Audiotapes Videotapes Correspondence courses Computer programs Stop-drinking contests Cash awards Nonalcoholic beverages Low-alcohol beverages Self-help groups
36.19 37.50 30.19 53.77 35.85 42.45 37.74 54.72 47.17 48.1 1 34.91 35.24 36.19 37.74
17.14 19.23 17.92 19.81 16.98 23.58 19.81 17.92 22.64 17.92 17.92 12.38 18.10 19.81
23.81 21.15 28.30 14.15 21.70 16.04 20.75 14.15 15.09 14.15 14.15 20.95 17.14 17.92
11.43 10.58 11.32 3.77 11.32 6.60 8.49 6.60 7.55 9.43 9.43 15.24 14.29 10.38
11.43 11.54 12.26 8.49 14.15 11.32 13.21 6.60 7.55 10.38 23.58 16.18 14.29 14.15
High contact Group therapy Individual counseling Drop-in centers Acupuncture Hypnosis Lectureslclasses Telephone hotlines
52.38 48.57 41.90 73.33 68.27 52.38 47.17
13.33 13.33 22.86 9.52 9.62 20.00 19.81
11.43 16.19 16.19 8.57 10.58 13.33 17.92
13.33 12.38 6.67 3.81 7.69 6.67 3.77
9.52 9.52 12.38 4.76 3.85 7.62 11.32
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Degree provider contact/ intervention
Note: Some totals do no equal 100% because of rounding.
who were extremely willing to participate in alcohol interventions, I identified the following options: (1) cash awards, 23.5%, (2) nonalcoholic beverages, 18.1%, (3) low-alcohol beverages, 14.2%, (4) self-help groups, 14.1%, and (5) television programs, 14.1%.The smallest percentage of subjects extremely willing to participate in an alcohol intervention identified the high-contact a p proach of hypnosis (3.8%). Do men and women differ in their selection of alcohol interventions? Data in Table 2 suggest that certain alcohol interventions appeal more to men than to women. Men reported significantly greater willingness to participate in 7 of the 14 low-contact and 4 of the 7 high-contact strategies (t tests, all ps < .05). The lowcontact strategies that men preferred included mailed instructions, books or manuals, alcohol-information pamphlets, videotapes, correspondence courses, computer programs, and self-help groups. High-contact strategies the men preferred included group therapy, individual counseling, drop-in centers, and lectures/ c Iasses. The final question was what other variables are associated with willingness to participate in interventions to limit drinking. I found that older drinkers were less willing than younger persons to use books or manuals, recorded telephone messages, audiotapes, correspond-
VOL 39, MAY 7 991
ence courses, stopdrinking contests, drop-in centers, and telephone hotlines to control drinking (see Table 3). Those drinkers who reported being intoxicated the greatest number of times were less willing to participate by receiving information pamphlets or attending selfhelp or group-therapy alcohol strategies. No significant associations (Pearson correlations, ps < .05) were found between the number of alcoholic beverages consumed in a week and willingness to participate in alcohol strategies. All three measures that were related to motivation to control drinking, however, were associated with all or nearly all alcohol strategies. The variable most highly associated with an indication of willingness to participate in alcohol interventions was willingness to cut down on drinking. The number of times drinkers attempted to limit the amount they drank was also significantly associated with alcohol interventions. Drinkers who reported the most attempts to limit alcohol use reported greater willingness to participate in each of the alcohol strategies except for lectures/classes. DISCUSSION
This study indicated that a considerable proportion of selected college drinkers were willing to participate
271
COLLEGE HEALTH TABLE 2 Mean Scores Indicating Men’s and Women’s Willingness to Participate in Interventions to Cut Down or Stop Alcohol Use
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Sex
Intervention
Men
Women
f
P
Low contact Mailed instructions Books or manuals Alcohol information pamphlets Recorded telephone messages Television programs Audiotapes Videotapes Correspondence courses Computer programs Stop-drinking contests Cash awards Nonalcoholic beverages Low-alcohol beverages Self-help groups
2.67 2.62 2.81 2.00 2.67 2.33 2.67 2.15 2.38 2.29 2.85 2.85 2.50 2.73
2.24 2.19 2.35 1.87 2.35 2.09 2.13 1.70 1.74 2.04 2.54 2.45 2.55 2.15
- 1.59 - 1.61 - 1.75 - 0.52 -1.15 - 0.88 - 2.01 - 1.87 - 2.68 - 0.93 - 0.99 - 1.35 0.16 - 2.1 1
.05 .05 .03 .30 .12 .19 .02 .02 .004 .18 .17 .08 .43 .01
High contact Group therapy Individual counseling Drop-in centers Acupuncture Hypnosis Lectureslclasses Telephone hot1ines
2.40 2.50 2.49 1.73 1.76 2.23 2.19
1.89 1.92 2.02 1.42 1.62 1.72 2.06
- 1.88 -2.13 -1.76 - 1.46 -0.61 - 2.09 -0.51
.02 .01 .03 .07 .27 .01 .30
Note: 1
=
not at a// willing, 5
=
extremely willing.
in interventions designed to help control alcohol consumption. Drinkers preferred low-contact strategies over high-contact strategies, and nearly three quarters were willing to try at least one low-contact strategy. More drinkers were willing to participate in various low-contact interventions, including using low-alcohol or nonalcoholic beverages, information pamphlets, cash awards, television programs, and mailed instructions. Because low-contact alcohol strategies are believed to be less costly and can potentially reach more people than traditional high-contact programs, they should be examined further for their feasibility and effectiveness as alcohol interventions. Literature on smoking cessation, which is more advanced than alcohol-intervention literature, indicates that such minimalcontact and self-help smoking approaches are relatively effective.’-’’ Substance-abuse researchers” have recently called for development and testing of methods to enhance motivation to initiate, modify, and maintain behavioral change. Low-contact strategies, in which this study showed college drinkers were willing to participate, could be particularly useful in initiating drinkingrelated behavioral change. Thus, we need to study the effectiveness of specific minimal-contact intervent ions
2 72
in moving college-aged drinkers through the various stages of the behavioral change.”-’“ This study found that men were more willing than women to participate in nearly half of the strategies I examined. Alcohol programs targeting men should emphasize these types of strategies (seven of which are minimal contact) to enhance the probability of reaching as many male drinkers as possible. Willingness to participate in alcohol interventions was also associated with a number of subject variables other than gender. Older drinkers and those who had experienced more frequent episodes of intoxication were less willing to participate in selected strategies to limit drinking. This information may also be useful in matching strategies to clients. For example, if older college drinkers are being targeted, using correspondence courses or a drop-in center might be less successful than other strategies because these approaches are unlikely to appeal to the older students. All three measures indicative of motivation to control drinking, particularly the item concerning willingness to cut down, were significantly associated with greater willingness to participate in nearly all interventions. Further studies should examine the usefulness of such motivation indices as those used in this study to screen
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ALCOHOL IN TERVENTIONS TABLE 3 Pearson Product-Moment Correlations of Willingness to Participate in Interventions to Cut Down or Stop Alcohol Use, by Subject Variables
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Intervention
Age
Low contact Mailed instructions Books or manuals Alcohol information pamphlets Recorded telephone messages Television programs Audiotapes Videotapes Correspondence courses Computer programs Stop-drinking contests Cash awards NonaIco hol ic beverages Low-alcohol beverages Self-help groups High contact Group therapy Individual counseling Drop-in centers Acupuncture Hypnosis Lectures/classes Telephone hotlines *p
< .05;* * p < .01;
***p
-.14 -.19* -.11 - .19* -.14 -.17* -.15 - .23** -.13 -.16* -.14 -
Times drunk
Drinks/ week
- .07
-.11
-.11 -.17* -.11 - .03 -.lo - .04 -.14 -.14
-.11 -.11 - .07 .06 - .03
- .oo
.oo
.11 -.14
- .04
.03
-
.oo
.07 .02
- .04
-.15*
- .09
.11 -.15 - .21** - .01
- .16* - .09 - .08 - .03
- .03
- .08
.03 -.11 - .07
-
.oo
- .23**
.oo
- .05 .05
.05 - .04 - .09
.30** .26** .16* .24** .29** .25** .27** .26** .16* .31** .28** .15* .29** .19*
.18* .16* .18* .13 .18* .22** .22** .17* .14 .26** .23** .20* .18* .20*
.22** .24** .23** .16* .19* .13 .21**
.21* .25** .24** .11 .22** .21** .23**
Willingness to cut down on drinking
- #*** - M*** -*L#***
-.a*** -.42*** -.42*** -.48***
- L#***
- .35** -.52*** - .34** - .27** - .18* - .49** * - .55*** -.55*** -.50*** - .32** - .36** -.45*** -.45***
< .oOOl.
drinkers who might be at an optimal "readiness stage" for behavioral change. These data suggest that if drinkers are highly motivated to control their drinking, they do not prefer minimal-provider contact interventions over high-contact interventions. This study was limited to a self-selected sample, primarily university students, who were attending a health fair; it was also confined to an examination of expressed willingness to participate in alcohol interventions, rather than actual participation rates. In addition, although many college-aged drinkers were interested in participating in interventions to reduce their alcohol use, a number of drinkers were not interested at all. Nonetheless, the present study represents an initial step in determining what types of alcohol interventions may be more valuable within a carnpus-based alcoholabuse prevention program.
INDEX TERMS alcohol interventions, drug education, health education, participation, self-help
VOL 39, MAY 7991
.oo
- .03 - .04 - .03
Subject variables Hours willing to Attempts to work toward limit alcohol limiting drinking
REFERENCES 1. Gallup Opinion Index, Report No 108. Princeton, NJ: Gallup Opinion Index; 1974; 20-21. 2. Schwartz JL, Dubitzky M. Expressed willingness of smokers to try 10 smoking withdrawal methods. Pub Health Rep. 1987;82:855-861. 3. Miller WR. Therapy without therapists: Recent research on bibliotherapy and other minimal contact treatments. Presented at the annual meeting of the Rocky Mountain Psychological Association; April 1982; Albuquerque, New Mexico. 4. Kraft DP. A comprehensive program for college students. In: Miller PM, Nirenburg TD, eds. Prevention of Alcohol Abuse. New York: Plenum Press; 1984. 5. Bakema D, Werch CE. University of Arkansas Student Substance Use Survey Report. Unpublished, 1987. 6. Millwood JE, McKay AM. Measurement of alcohol consumption in the Australian population. Community Health Stud. 1978;2:123-132. 7. Redman S, Sanson-Fisher RW, Wilkinson C, Fahey PP, Gibberd RW. Agreement between two measures of alcohol consumption. ) Stud Alcohol. 1987;48:104-108. 8. Davis AL, Foust R, Ordentlich M. Self-help smoking cessation and maintenance programs: A comparative study with 12-month follow-up by the American Lung Association. Am ) Pub Health. 1984;74:1212-1 21 7.
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COLLEGE HEALTH 13. DiClemente CC, Prochaska 10. Self-change and therapy change of smoking behavior: A comparison of processes of change in cessation and maintenance. Addict Behav. 1982;7: 133-142. 14. Marlatt GA, Gordon JR. Relapse Prevention: Maintenance Strategies in the Treatment of Addictive Behaviors. New York: Guilford; 1985. 15. Prochaska JO, DiClemente CC. Stages and processes of self-change of smoking: Toward an integrative model of change. Consult Clin Psycho/. 1983;51:390-395. 16. Prochaska 10, DiClemente CC. The Transtheoretical Approach: Crossing Traditional Boundaries of Therapy. Homewood, IL: Dow Jones/lrwin; 1984.
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9. Janz NK, Becker MH, Kirscht JP, Eraker SA, Billi JE, Wolliscrolt JO. Evaluation of a minimal contact smoking cessation intervention in an outpatient setting. Am / Pub Health. 1987; 77:805-809. 10. Windsor RA, Bartlett EE. Employee self-help smoking cessation programs: A review of the literature. Health Educ Q. 1984;11:349-359. 11. Miller WR. Motivation for treatment: A review with special emphasis on alcoholism. Psychol Bull. 1985;98:84107. 12. Brownell KD, Marlatt GA, Lichtenstein E, Wilson GT. Understanding and preventing relapse. Am Psychol. 1986;41: 765-782.
EDUCATION
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OREGON STATEUNIVERSITY
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he Mental Health Clinic, Student Health Center announces one opening for Ph.D., Psy.D., or M.S.W. for a fixed-term, 9 month position. Duties include development of a chemical dependency outpatient treatment program and regular psychotherapeutic, diagnostic, and consultative services within the Clinic. Applicants must show evidence of interest and training in the treatment of substance abuse and related issues as well as expertise in the assessment and treatment of university students with emotional problems. Ph.D. and Psy.D. must obtain Oregon license within two years. M.S.W. must have current
Oregon license. The position will begin September 15, 1991. The salary range is $26-32,000. Send resume and three letters of recommendation to: Raymond S. Sanders, Ph.D., Director, Mental Health Clinic, Oregon State University, Corvallis, O R 9733 1-5801. Application deadline is June 1, 1991, Oregon State University is an Affirmative Action/ Equal Opportunity Employer and complies with Section 504 of the Rehabilitation Act of 1973. O.S.U. has a policy of being responsive to the needs of dual career couples.
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How Much is Enough? Willingness to Participate in Alcohol Interventions Chudley E. Werch PhD
a
a
College of Health, Center for Alcohol and Drug Studies , University of North Florida , Jacksonville, USA Published online: 09 Jul 2010.
To cite this article: Chudley E. Werch PhD (1991) How Much is Enough? Willingness to Participate in Alcohol Interventions, Journal of American College Health, 39:6, 269-274, DOI: 10.1080/07448481.1991.9936244 To link to this article: http://dx.doi.org/10.1080/07448481.1991.9936244
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http:// www.tandfonline.com/page/terms-and-conditions
Downloaded by [Temple University Libraries] at 12:39 14 November 2014
How Much Is Enough? Willingness to Participate in Alcohol Intewentions CHUDLEY E. WERCH, PhD
This study examined the willingness of drinkers to participate in alcohol interventions designed to cut down or stop alcohol use by degree of serviceprovider contact. One hundred fifty-six university students and staff who attended a campus health fair participated in an alcohol survey. Of the college drinkers, 73.7% reported they were willing to participate in one or more alcohol interventions with minimal p r e vider contact, compared with 48.5% who said they would participate in programs with high provider contact. Respondents preferred minimal-contact strategies (use of nonalce holic or low-alcohol beverages, information pamphlets, cash awards, television programs, and mailed instructions) to high-contact approaches. Men were significantly more willing @s < .05) than women to participate in nearly half (11 to 21) of the alcohol interventions. Three measures indicative of motivation to control drinking were significantly associated with greater willingness to participate in nearly all strategies. This study also suggested that drinkers who were highly motivated to control their drinking did not prefer minimal-contact interventions over high-contact interventions.
Research on smoking’,* has begun to identify the types of cessation approaches that smokers find most attractive and are presumably more motivated to use. These studies indicate that, to help them stop smoking, smokers prefer self-help and other minimal-contact strategies rather than formal treatment programs. Minimal-provider contact interventions are those that involve limited face-to-face dealings with the service provider, as opposed to high-contact interventions, which involve extensive or continuous contact between the service provider and the client. Traditional 30-day alcohol treatment programs are high-contact interventions. ~
_
_
_
~
~
___
Chudley E. Werch is an associate professor with the College of Health, Center for Alcohol and Drug Studies, at the University of North Florida in Jacksonville.
V 0 1 3 9 , MAY 7997
Alcohol researchers3 have stated that many drinkers who are unwilling to attend formal alcohol programs might be more motivated to participate in minimalcontact interventions. The minimal-contact interventions offer a host of potential advantages when compared with traditional programs. These include their appeal to drinkers who would not participate in more intensive programs, their low unit cost, and their ability to reach large numbers of at-risk individuals. Previous college-based alcohol prevention programs such as those described by Kraft4 have had difficulty in attracting and retaining participants in traditional highcontact interventions like workshops and classes. Alternatives to those traditional intensive interventions have been largely restricted to such media strategies as pamphlets, posters, and radio announcements. Innovative nontraditional strategies must therefore be examined for the majority of students and university staff who will not participate in intensive, time-consuming programs. An important first step in deciding whether various minimal-contact alcohol strategies might motivate college drinkers to initiate, successfully modify, and maintain alcohol-related behavioral change i s to determine if college drinkers prefer these alcohol interventions to traditional approaches. Although preference for certain interventions does not always correlate with actual participation, stated willingness to participate in alcohol strategies is an indication of one‘s intention to participate. If minimal-contact interventions are found to be more attractive to college drinkers than traditional alcohol interventions, they should be studied further. for their potential to reach large numbers of drinkers in campus alcohol programs and to reduce students’ alcohol consumption. This study examined the willingness of drinkers to participate in alcohol interventions, categorized by the degree of contact with the service provider. Specifically, I examined the following questions: (1) What types
269
COLLEGE HEALTH of interventions designed to assist individuals to cut down or stop alcohol use will drinkers indicate they are most willing to participate in? (2) Do men and women differ in their selection of alcohol interventions?and (3) What other variables are associated with indications of willingness to participate in programs to limit drinking?
METHOD
Downloaded by [Temple University Libraries] at 12:39 14 November 2014
Subjects Subjects included 156 students and staff who agreed to participate in an alcohol survey while attending a 2-day health fair at a southern university. The mean age of the subjects was 24.7 years (SD = 8.5)’ and 58% were women. The majority (68%)were single, and 82% were white. Reported year in school included 19% freshman, 19% sophomore, 20% junior, 19% senior, 14% graduate or other classification, and 7% not attending school (does not total 100% because of rounding). Seventy-eight percent reported they had consumed an alcoholic beverage in the past year. These subjects were demographically similar to those in a recent random survey of students attending the u n i v e r ~ i t y , ~ except that the present sample included a larger proportion of women. Procedure Self-selected subjects were informed that their participation was voluntary and that they did not have to answer any questions they found objectionable. Participants were then seated and given pencils, informedconsent sheets, and the alcohol-use survey. To ensure continuity in communicating with the participants, all research assistants followed a printed protocol. Measures The survey asked for demographic information and included three items that measured alcohol consumption. One item assessed whether subjects had had a drink of alcohol in the past year; those who responded no were not asked to complete the questionnaire. The second item measured the number of times subjects reported they had been intoxicated, by their own definition, in the past year. This item was scored on the following 6-point scale: I = none; 2 = once; 3 = 2 or 3 times; 4 = 4 or 5 times; 5 = 6 to 9 times; 6 = 70 or more times. I used a 7-day retrospective diary to measure weekly alcohol consumption, asking: ”Exactly, how much of each beverage (beer, wine, and liquor) did you consume on each day of the last week? Start with yesterday and work backward through each day of the week.” Subjects then identified the number of each of the three types of alcoholic beverages they had consumed during the past 7 days. This diary measure was based on those described by other researcher^.^,'
2 70
Three items on the survey were related to motivation to control alcohol consumption. One measured the number of times subjects seriously attempted to stop or cut down on the amount they drank during the past year. It was scored on a 6-point scale of 1 = none; 2 = once; 3 = 2 or 3 times; 4 = 4 or 5 times; 5 = 6 to 9 times; 6 = 10 or more times. The second item assessed the number of hours a day subjects would be willing to invest in cutting down on their alcohol consumption. The third item measured willingness to limit alcohol consumption. Phrased, “If there were an easy way to cut down on drinking, I would definitely do it,” this item was scored on a 5-point Likert scale. Last, the willingness of subjects to participate in common alcohol interventions was measured by asking, “How willing would you be to participate, at no cost to you, in any of the following ways to help you cut down or stop alcohol use?” These items were each scored on a 5-point scale of 1 = not at all willing, to 5 = extremely willing. I used a list of 21 alcohol interventions that was generated from a review of the current literature on alcohol and tobacco programs. The 21 interventions were then identified as either low- or high-contact strategies. Low-contact strategies were those involving limited faceto-face contact between the service provider and the participants such as mailed instructions, books or manuals, alcohol information pamphlets, recorded telephone messages, television programs, audiotapes, videotapes, correspondence courses, computer programs, stopdrinking contests, cash awards, self-help groups, and use of nonalcoholic beverages or lowalcohol beverages. High-contact strategies were those categorized as involving extensive or continuous service-provider contact with participants, including group therapy, individual counseling, dropin centers, acupuncture, hypnosis, lecturedclasses, and telephone hotlines. Fourteen of the interventions were identified as low contact and 7 were labeled as high contact.
RESULTS The first question I examined was what types of interventions drinkers were most willing to participate in. The data in Table 1 show that drinkers preferred lowcontact interventions to high-contact interventions. A greater proportion (73.7%) of drinkers reported they were willing to participate in one or more low-contact strategies compared with 48.5% who opted for highcontact strategies. The greatest percentage of drinkers reporting to be at least somewhat willing to participate in alcohol strategies preferred (1) nonalcoholic beverages, 52.3%, (2) alcohol-information pamphlets, 51.8%, (3) cash awards, 47.1 %, (4) television programs, 47.1 %, (5) mailed instructions, 46.6%, and (6) low-alcohol beverages, 45.7%. The smallest percentage of drinkers at least somewhat willing to participate in an alcohol intervention identified the high-contact approach acupuncture (17.1%I. Similarly, when I examined those drinkers
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ALCOHOL lNTERVENT/ONS TABLE 1 Drinkers’ Willingness to Participate in Interventions to Cut Down or Stop Alcohol Use, by Degree of Provider Contact
Not at all willing
Not very willing
Somewhat willing
Very willing
Extremely wi Iling
OIO
OIO
OIO
OIO
OIO
Low contact Mailed instructions Books or manuals Alcohol information pamphlets Recorded telephone messages Television programs Audiotapes Videotapes Correspondence courses Computer programs Stop-drinking contests Cash awards Nonalcoholic beverages Low-alcohol beverages Self-help groups
36.19 37.50 30.19 53.77 35.85 42.45 37.74 54.72 47.17 48.1 1 34.91 35.24 36.19 37.74
17.14 19.23 17.92 19.81 16.98 23.58 19.81 17.92 22.64 17.92 17.92 12.38 18.10 19.81
23.81 21.15 28.30 14.15 21.70 16.04 20.75 14.15 15.09 14.15 14.15 20.95 17.14 17.92
11.43 10.58 11.32 3.77 11.32 6.60 8.49 6.60 7.55 9.43 9.43 15.24 14.29 10.38
11.43 11.54 12.26 8.49 14.15 11.32 13.21 6.60 7.55 10.38 23.58 16.18 14.29 14.15
High contact Group therapy Individual counseling Drop-in centers Acupuncture Hypnosis Lectureslclasses Telephone hotlines
52.38 48.57 41.90 73.33 68.27 52.38 47.17
13.33 13.33 22.86 9.52 9.62 20.00 19.81
11.43 16.19 16.19 8.57 10.58 13.33 17.92
13.33 12.38 6.67 3.81 7.69 6.67 3.77
9.52 9.52 12.38 4.76 3.85 7.62 11.32
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Degree provider contact/ intervention
Note: Some totals do no equal 100% because of rounding.
who were extremely willing to participate in alcohol interventions, I identified the following options: (1) cash awards, 23.5%, (2) nonalcoholic beverages, 18.1%, (3) low-alcohol beverages, 14.2%, (4) self-help groups, 14.1%, and (5) television programs, 14.1%.The smallest percentage of subjects extremely willing to participate in an alcohol intervention identified the high-contact a p proach of hypnosis (3.8%). Do men and women differ in their selection of alcohol interventions? Data in Table 2 suggest that certain alcohol interventions appeal more to men than to women. Men reported significantly greater willingness to participate in 7 of the 14 low-contact and 4 of the 7 high-contact strategies (t tests, all ps < .05). The lowcontact strategies that men preferred included mailed instructions, books or manuals, alcohol-information pamphlets, videotapes, correspondence courses, computer programs, and self-help groups. High-contact strategies the men preferred included group therapy, individual counseling, drop-in centers, and lectures/ c Iasses. The final question was what other variables are associated with willingness to participate in interventions to limit drinking. I found that older drinkers were less willing than younger persons to use books or manuals, recorded telephone messages, audiotapes, correspond-
VOL 39, MAY 7 991
ence courses, stopdrinking contests, drop-in centers, and telephone hotlines to control drinking (see Table 3). Those drinkers who reported being intoxicated the greatest number of times were less willing to participate by receiving information pamphlets or attending selfhelp or group-therapy alcohol strategies. No significant associations (Pearson correlations, ps < .05) were found between the number of alcoholic beverages consumed in a week and willingness to participate in alcohol strategies. All three measures that were related to motivation to control drinking, however, were associated with all or nearly all alcohol strategies. The variable most highly associated with an indication of willingness to participate in alcohol interventions was willingness to cut down on drinking. The number of times drinkers attempted to limit the amount they drank was also significantly associated with alcohol interventions. Drinkers who reported the most attempts to limit alcohol use reported greater willingness to participate in each of the alcohol strategies except for lectures/classes. DISCUSSION
This study indicated that a considerable proportion of selected college drinkers were willing to participate
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COLLEGE HEALTH TABLE 2 Mean Scores Indicating Men’s and Women’s Willingness to Participate in Interventions to Cut Down or Stop Alcohol Use
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Sex
Intervention
Men
Women
f
P
Low contact Mailed instructions Books or manuals Alcohol information pamphlets Recorded telephone messages Television programs Audiotapes Videotapes Correspondence courses Computer programs Stop-drinking contests Cash awards Nonalcoholic beverages Low-alcohol beverages Self-help groups
2.67 2.62 2.81 2.00 2.67 2.33 2.67 2.15 2.38 2.29 2.85 2.85 2.50 2.73
2.24 2.19 2.35 1.87 2.35 2.09 2.13 1.70 1.74 2.04 2.54 2.45 2.55 2.15
- 1.59 - 1.61 - 1.75 - 0.52 -1.15 - 0.88 - 2.01 - 1.87 - 2.68 - 0.93 - 0.99 - 1.35 0.16 - 2.1 1
.05 .05 .03 .30 .12 .19 .02 .02 .004 .18 .17 .08 .43 .01
High contact Group therapy Individual counseling Drop-in centers Acupuncture Hypnosis Lectureslclasses Telephone hot1ines
2.40 2.50 2.49 1.73 1.76 2.23 2.19
1.89 1.92 2.02 1.42 1.62 1.72 2.06
- 1.88 -2.13 -1.76 - 1.46 -0.61 - 2.09 -0.51
.02 .01 .03 .07 .27 .01 .30
Note: 1
=
not at a// willing, 5
=
extremely willing.
in interventions designed to help control alcohol consumption. Drinkers preferred low-contact strategies over high-contact strategies, and nearly three quarters were willing to try at least one low-contact strategy. More drinkers were willing to participate in various low-contact interventions, including using low-alcohol or nonalcoholic beverages, information pamphlets, cash awards, television programs, and mailed instructions. Because low-contact alcohol strategies are believed to be less costly and can potentially reach more people than traditional high-contact programs, they should be examined further for their feasibility and effectiveness as alcohol interventions. Literature on smoking cessation, which is more advanced than alcohol-intervention literature, indicates that such minimalcontact and self-help smoking approaches are relatively effective.’-’’ Substance-abuse researchers” have recently called for development and testing of methods to enhance motivation to initiate, modify, and maintain behavioral change. Low-contact strategies, in which this study showed college drinkers were willing to participate, could be particularly useful in initiating drinkingrelated behavioral change. Thus, we need to study the effectiveness of specific minimal-contact intervent ions
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in moving college-aged drinkers through the various stages of the behavioral change.”-’“ This study found that men were more willing than women to participate in nearly half of the strategies I examined. Alcohol programs targeting men should emphasize these types of strategies (seven of which are minimal contact) to enhance the probability of reaching as many male drinkers as possible. Willingness to participate in alcohol interventions was also associated with a number of subject variables other than gender. Older drinkers and those who had experienced more frequent episodes of intoxication were less willing to participate in selected strategies to limit drinking. This information may also be useful in matching strategies to clients. For example, if older college drinkers are being targeted, using correspondence courses or a drop-in center might be less successful than other strategies because these approaches are unlikely to appeal to the older students. All three measures indicative of motivation to control drinking, particularly the item concerning willingness to cut down, were significantly associated with greater willingness to participate in nearly all interventions. Further studies should examine the usefulness of such motivation indices as those used in this study to screen
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ALCOHOL IN TERVENTIONS TABLE 3 Pearson Product-Moment Correlations of Willingness to Participate in Interventions to Cut Down or Stop Alcohol Use, by Subject Variables
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Intervention
Age
Low contact Mailed instructions Books or manuals Alcohol information pamphlets Recorded telephone messages Television programs Audiotapes Videotapes Correspondence courses Computer programs Stop-drinking contests Cash awards NonaIco hol ic beverages Low-alcohol beverages Self-help groups High contact Group therapy Individual counseling Drop-in centers Acupuncture Hypnosis Lectures/classes Telephone hotlines *p
< .05;* * p < .01;
***p
-.14 -.19* -.11 - .19* -.14 -.17* -.15 - .23** -.13 -.16* -.14 -
Times drunk
Drinks/ week
- .07
-.11
-.11 -.17* -.11 - .03 -.lo - .04 -.14 -.14
-.11 -.11 - .07 .06 - .03
- .oo
.oo
.11 -.14
- .04
.03
-
.oo
.07 .02
- .04
-.15*
- .09
.11 -.15 - .21** - .01
- .16* - .09 - .08 - .03
- .03
- .08
.03 -.11 - .07
-
.oo
- .23**
.oo
- .05 .05
.05 - .04 - .09
.30** .26** .16* .24** .29** .25** .27** .26** .16* .31** .28** .15* .29** .19*
.18* .16* .18* .13 .18* .22** .22** .17* .14 .26** .23** .20* .18* .20*
.22** .24** .23** .16* .19* .13 .21**
.21* .25** .24** .11 .22** .21** .23**
Willingness to cut down on drinking
- #*** - M*** -*L#***
-.a*** -.42*** -.42*** -.48***
- L#***
- .35** -.52*** - .34** - .27** - .18* - .49** * - .55*** -.55*** -.50*** - .32** - .36** -.45*** -.45***
< .oOOl.
drinkers who might be at an optimal "readiness stage" for behavioral change. These data suggest that if drinkers are highly motivated to control their drinking, they do not prefer minimal-provider contact interventions over high-contact interventions. This study was limited to a self-selected sample, primarily university students, who were attending a health fair; it was also confined to an examination of expressed willingness to participate in alcohol interventions, rather than actual participation rates. In addition, although many college-aged drinkers were interested in participating in interventions to reduce their alcohol use, a number of drinkers were not interested at all. Nonetheless, the present study represents an initial step in determining what types of alcohol interventions may be more valuable within a carnpus-based alcoholabuse prevention program.
INDEX TERMS alcohol interventions, drug education, health education, participation, self-help
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.oo
- .03 - .04 - .03
Subject variables Hours willing to Attempts to work toward limit alcohol limiting drinking
REFERENCES 1. Gallup Opinion Index, Report No 108. Princeton, NJ: Gallup Opinion Index; 1974; 20-21. 2. Schwartz JL, Dubitzky M. Expressed willingness of smokers to try 10 smoking withdrawal methods. Pub Health Rep. 1987;82:855-861. 3. Miller WR. Therapy without therapists: Recent research on bibliotherapy and other minimal contact treatments. Presented at the annual meeting of the Rocky Mountain Psychological Association; April 1982; Albuquerque, New Mexico. 4. Kraft DP. A comprehensive program for college students. In: Miller PM, Nirenburg TD, eds. Prevention of Alcohol Abuse. New York: Plenum Press; 1984. 5. Bakema D, Werch CE. University of Arkansas Student Substance Use Survey Report. Unpublished, 1987. 6. Millwood JE, McKay AM. Measurement of alcohol consumption in the Australian population. Community Health Stud. 1978;2:123-132. 7. Redman S, Sanson-Fisher RW, Wilkinson C, Fahey PP, Gibberd RW. Agreement between two measures of alcohol consumption. ) Stud Alcohol. 1987;48:104-108. 8. Davis AL, Foust R, Ordentlich M. Self-help smoking cessation and maintenance programs: A comparative study with 12-month follow-up by the American Lung Association. Am ) Pub Health. 1984;74:1212-1 21 7.
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COLLEGE HEALTH 13. DiClemente CC, Prochaska 10. Self-change and therapy change of smoking behavior: A comparison of processes of change in cessation and maintenance. Addict Behav. 1982;7: 133-142. 14. Marlatt GA, Gordon JR. Relapse Prevention: Maintenance Strategies in the Treatment of Addictive Behaviors. New York: Guilford; 1985. 15. Prochaska JO, DiClemente CC. Stages and processes of self-change of smoking: Toward an integrative model of change. Consult Clin Psycho/. 1983;51:390-395. 16. Prochaska 10, DiClemente CC. The Transtheoretical Approach: Crossing Traditional Boundaries of Therapy. Homewood, IL: Dow Jones/lrwin; 1984.
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9. Janz NK, Becker MH, Kirscht JP, Eraker SA, Billi JE, Wolliscrolt JO. Evaluation of a minimal contact smoking cessation intervention in an outpatient setting. Am / Pub Health. 1987; 77:805-809. 10. Windsor RA, Bartlett EE. Employee self-help smoking cessation programs: A review of the literature. Health Educ Q. 1984;11:349-359. 11. Miller WR. Motivation for treatment: A review with special emphasis on alcoholism. Psychol Bull. 1985;98:84107. 12. Brownell KD, Marlatt GA, Lichtenstein E, Wilson GT. Understanding and preventing relapse. Am Psychol. 1986;41: 765-782.
EDUCATION
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OREGON STATEUNIVERSITY
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he Mental Health Clinic, Student Health Center announces one opening for Ph.D., Psy.D., or M.S.W. for a fixed-term, 9 month position. Duties include development of a chemical dependency outpatient treatment program and regular psychotherapeutic, diagnostic, and consultative services within the Clinic. Applicants must show evidence of interest and training in the treatment of substance abuse and related issues as well as expertise in the assessment and treatment of university students with emotional problems. Ph.D. and Psy.D. must obtain Oregon license within two years. M.S.W. must have current
Oregon license. The position will begin September 15, 1991. The salary range is $26-32,000. Send resume and three letters of recommendation to: Raymond S. Sanders, Ph.D., Director, Mental Health Clinic, Oregon State University, Corvallis, O R 9733 1-5801. Application deadline is June 1, 1991, Oregon State University is an Affirmative Action/ Equal Opportunity Employer and complies with Section 504 of the Rehabilitation Act of 1973. O.S.U. has a policy of being responsive to the needs of dual career couples.
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