Mechanisms of Behavior Change within Peer-Implemented Alcohol Interventions

Erica M. Eaton, Fielding's School of Psychology

College campuses have experienced a large increase in referred students due to alcohol violations. Offenses vary in severity and therefore all mandated students do not necessarily need extensive treatment. Further, in the effort to reduce the demand on university alcohol programs, there has been a trend to use peer-implemented interventions. Fifteen-minute peer-based minimal interventions (PMIs) are a promising approach to reduce alcohol use and problems among mandated students. However, little is known about how these minimal interventions facilitate behavior change in at-risk college students. By examining the mechanisms of behavior change (MOBC) within these sessions, defined as the process leading to therapeutic improvement (Kazdin & Nock, 2003), the field will gain a better understanding of how minimal interventions influence post-session behaviors. Participants (N = 146; M age = 18.7, SD = 0.90; 67% male gender; 94% Caucasian) were college students who violated campus alcohol policy at a small northeastern liberal arts college. The current project conducted secondary data analyses with audio-recorded session tapes from a clinical trial delivering PMIs with mandated students. Peer therapist behaviors consistent (MICO; e.g., affirming) and inconsistent with motivational interviewing (MIIN; e.g., warning), along with therapist global scores, client change talk (CT), counter-change talk (CCT), and client self-exploration were coded using the Motivational Interviewing Skill Code (MISC). In addition, past-month alcohol consumption and alcohol-related negative consequences were assessed at baseline and 6-week follow-up. Regression analyses revealed a significant positive relationship between MICO peer therapist behaviors and CT (p < .01) and client self-exploration (p < .05). Peer therapist global scores (acceptance, empathy, and MI spirit) were also positively related to CT (p < .05) and client self-exploration (p < .05). No associations were found between MIIN peer therapist behaviors and CT or client self-exploration, but a positive association was found between MIIN peer therapist behaviors and CCT (p<.05). Furthermore, a significant negative relationship was supported between CT and alcohol-related problems (p =.04), average drinks per occasion (p = .02), peak drinks per occasion (p = .02), typical BAC (p = .002), and peak BAC (p = .003) at the 6-week follow-up. Specifically, increase in CT was related to lower levels of alcohol-related problems, average drinks per occasion, peak drinks per occasion, typical BAC, and peak BAC. No significant relationship between CCT and drinking outcomes was found. This study suggests that peer-implemented behaviors influence client behaviors, and subsequently alcohol-related consumption. Results will be discussed further as they relate to training of peer therapists. Future research directions and limitations will also be noted.



Keywords: alcohol, mandated college students, peer therapists, motivational interviewing, therapy process