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Fachini A., Aliane P.P., Martinez E.Z. et al.
Substance Abuse Treatment, Prevention, and Policy: 2012, 7:40.
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Synthesis of randomised trials of one of the most widely implemented and studied approaches to heavy-drinking among college students finds it does reduce both drinking and related problems, but compared to what is unclear, and none of the individual trials was convincing.
Summary In many countries college students are at high risk for heavy drinking, with its associated serious short- or long-term negative consequences. The formative college years may present an opportunity for preventive efforts to change their drinking. Brief interventions have emerged as a promising early intervention approach. The featured review synthesised results from studies of a standardised brief intervention called Brief Alcohol Screening Intervention for College Students (BASICS). It differed from some previous reviews by confining itself to studies of college students who did not have special reasons to change their drinking, such as having been required to undergo the intervention by the college, an attempt to ensure like was being combined with like.
Based on motivational interviewing, BASICS is a brief intervention designed for heavy-drinking college students.
The featured review synthesised results from 18 trials which had randomly allocated heavy-drinking students to BASICS versus no or an alternative intervention.
In relation to the comparison conditions, the BASICS protocol seemed to reduce drinking and alcohol-related problems as assessed 12 months later.
However, none of the individual studies registered a statistically significant difference, reducing confidence in the validity of the amalgamated findings.
Also the analysis did not take in to account what the approach was being compared to, leaving it unclear whether it is merely better than doing nothing, or more effective than alternative, well structured interventions.
BASICS is specially designed for heavy-drinking college students. Typically it is delivered face-to-face over the course of two structured sessions and is characterised by a warm, empathic motivational interviewing approach featuring personalised feedback for the student on how their drinking compares with that of their peers. By highlighting discrepancies between the student’s risky drinking and their goals and values, counsellors aim to help them establish specific goals and build skills for changing their drinking.
The reviewers looked for trials which had randomly allocated students engaged in heavy drinking to a face-to-face BASICS intervention (or a very similar approach) versus either no intervention apart from screening/assessment, or versus an alternative intervention. Reports could be in any language. Findings in relation to changes in alcohol consumption and alcohol-related problems were synthesised by the reviewers using meta-analytic techniques.
Eighteen such trials were found involving 6,233 students aged on average 20 years old. All attended public universities and had been identified as at-risk drinkers. Nearly three quarters of the trials tested a two-session BASICS intervention, the remainder one session, each session lasting 30 to 90 minutes. Most commonly, drinking and related problems were assessed 12 months after intervention.
About 12 months after the interventions, across all the studies students allocated to BASICS were drinking on average 1.5 drinks per week less than comparison students and had experienced fewer or less severe alcohol-related problems, both statistically significant differences.
However, differences in drinking and drink-related consequences between BASICS and comparison students varied significantly over the studies. As a result, the analysis assumed there was no single ‘true’ degree of impact which varied just by chance, but that BASICS really did have differing impacts in different studies.
In relation to the comparison conditions, brief intervention using the BASICS protocol seemed to reduce drinking and alcohol-related problems among heavy-drinking college students as assessed 12 months later, suggesting that a counsellor-administered motivational interview plus feedback may be an ideal first-line intervention for such students. Resulting reductions in drinking and alcohol-related problems may generate corresponding savings in medical and societal costs. An advantage of BASICS is that it can be delivered at low cost by a trained assistant.
commentary BASICS is one of the most widely implemented and studied approaches to student drinking, making an assessment of its effectiveness important for college administrators and others interested in containing the escalation in drinking typical of the transition away from school and home to college. Though in this synthesis of results from BASICS studies it shaded alternative or no interventions, for several reasons the results may not be seen as convincing enough to warrant widescale adoption.
The analysis did not take in to account the critical issue of what BASICS was being compared to, leaving it unclear whether it is merely better than doing nothing except screening, or more effective than alternative, well structured interventions – a common limitation of meta-analyses which hampers the derivation of practice recommendations.
The finding of 1.5 drinks fewer (assuming a US drink of about 14gm alcohol) per week equates to 2.6 UK units. Though this small gap was statistically significant across all amalgamated studies, none of the individual studies appear to have registered anything approaching a statistically significant difference. Assuming they were well designed and implemented, it is only within each study that we can be assured of an even playing field; we can be less confident that this amalgamation of non-significant results across studies conducted in different circumstances truly reflects a statistically significant advantage for BASICS over the comparators. The same applies to the extra reductions in drink-related problems.
BASICS is built on motivational interviewing principles, an approach investigated under the rigorous procedures of the Cochrane collaboration. The reviewers concluded that among young adults, relative to no or an alternative intervention it had not been shown to have substantive, meaningful benefits in terms of reducing drinking or drink-related problems. An important BASICS tactic is showing students how their drinking compares with that of their peers, one for which another Cochrane review could find no evidence of substantive meaningful benefits in the prevention of alcohol misuse among college students.
Last revised 16 March 2015. First uploaded 09 March 2015
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