Research has shown that drinking alcohol results in a variety of emotional, physical, and behavioral changes (West & Sutker, 1990). Alcohol is a necessary underlying cause for more than 30 conditions and a contributing factor to many more. The most common disease categories that are entirely or partly caused by alcohol consumption include infectious diseases, cancer, diabetes, neuropsychiatric diseases, cardiovascular disease, liver and pancreas disease (Shield et al 2014). For many conditions there is an increasing risk with increasing levels of alcohol consumption (Rehm et al. 2003) and with the level of risk varying by gender (Corrao et al. 2004). With respect to neuropsychiatric disorders, alcohol consumption has by far the greatest impact on risk for alcohol dependence. There is substantial evidence that alcohol consumption can cause unprovoked seizures, and researchers have identified plausible biological pathways that may underlie this relationship (Samokhvalov et al. 2010). Although these points reflect the consequences of all alcohol consumption, it is clear that most of the burden associated with alcohol use stems from regular heavier drinking, defined, for instance, as drinking more than 40 grams of pure alcohol per day for men and 20 grams of pure alcohol per day for women (Patra et al. 2009). Knowledge of these risks has helped in the development of psychological interventions to help reduce alcohol consumption.
Feedback interventions rely on a presentation of discrepant information, such as a personal drinking profile, risk factors, and normative comparisons (Walters, 2000). The main element of feedback is provision of normative information about where an individual’s own drinking lies in relation to others’ drinking. In some cases, feedback is used in conjunction to an individual or group counseling session. Neighbors, Larimer, and Lewis (2004) tested the efficacy of computerized normative feedback among heavy drinking college students. Participants in the intervention condition were provided with computerized information detailing their own drinking behaviour, their perceptions of typical student drinking, and actual typical student drinking. Results indicated that normative feedback was effective in changing perceived norms and alcohol consumption at 3- and 6-month follow-up assessments. This study demonstrated that personalized normative feedback alone is sufficient to considerably reduce drinking among heavy-drinking college students for up to 6 months. The intervention had relatively small effects on drinking at 3- and 6-month follow-ups and medium effects on misperceptions in drinking norms at both 3- and 6-month follow-up sessions. The relatively small effect size reported with the outcome of this study may be due to the consistency of drinking behaviour over short time intervals. Results also revealed that the changes in perceived norms were responsible for reduced drinking behaviour among the participants that underwent the intervention, providing additional support for the use of feedback intervention. One limitation of this study however concerns the sample, it was comprised only of psychology undergraduates. Although this raises some concern in regards to generalisability, the sample used in this study were relatively representative of the campus population and so results should be applicable to other students at this college.
Feedback intervention appears to remain effective even when it is administered via email. Collins, Carey, and Sliwinski’s (2002) study showed that feedback remained effective when participants received feedback via email. They reported that, at 6 weeks, participants who received mailed feedback reported consuming significantly fewer drinks per heaviest drinking week and engaging in drinking less frequently than control participants. However, these between-group differences were no longer evident at 6 months. Similar results were found in Walters et al. (2000) study; they examined the effectiveness of adding a psychoeducational class to mailed feedback. Results showed that at a 6-week follow-up, feedback participants reduced their drinking, relative to control and that the addition of a psychoeducational group did not increase the effectiveness of the feedback. The findings from this study in conjunction with the findings from Neighbours et al (2004) show that feedback intervention remains effective without interpersonal interaction. Both studies mentioned provide evidence for the short term effectiveness of feedback intervention but not for long term efficacy. An additional limitation of these studies is that all of the drinking outcome measures were self-reported.
Although the accuracy of self-reported drinking and other drug use has been the subject of debate, there is good evidence supporting the reliability and validity of self-report measures among college students and adolescents (Johnston, O'Malley, & Bachman, 2001). Also these studies vary widely on a number of different dimensions, which causes difficulties when trying to make comparisons between results. Collins et al. (2002) compared mailed motivational feedback to an educational brochure about alcohol's effects. Feedback participants significantly reduced drinks per heaviest drinking week and frequency of heavy episodic drinking at 6 weeks in comparison to education participants, but this effect was no longer significant at 6 months. There was no effect on negative consequences of drinking. The study was limited by attrition and small sample size, as well as lack of an assessment only (AO) control condition. These findings suggest that feedback intervention does not remain effective in the long term.
Motivational Interviewing (MI; Miller & Rollnick, 2002) is a psychological intervention based around being supportive and non-judgmental, it is specifically designed to reduce the ambivalence that often accompanies health behaviour change. Participants have the opportunity to discuss their alcohol use during a brief counselling session, including both the benefits and consequences of drinking, and their potential interest in moderating consumption and avoiding related high-risk behaviours. Miller and Rollnick (1991) named five key techniques of MI: expresses empathy, develops discrepancy, avoids argumentation, rolls with resistance, and supports self-efficacy. Visalaki et al (2006) carried out a meta-analysis of studies that used MI as an intervention method to reducing alcohol consumption. This review of fifteen randomized controlled trials revealed that brief MI is an effective strategy for reducing alcohol consumption. It was found that 87 minutes of MI was more effective than no treatment in reducing alcohol consumption among non-dependent drinkers in the short term (≤3 months), 53 minutes of MI was more efficacious than an aggregated set of diverse comparison treatments. In regard to the limitations of this meta-analysis, it was found that effect sizes in favour of MI compared with no treatment were largest at first follow-up, suggesting that MI's effects fade across time. These findings are further supported by Wood et al (2007) study, MI resulted in reduced overall alcohol use, heavy episodic drinking, and alcohol-related problems. In Shakeshaft et al.'s (2002) study, the participants strongly agreed that MI helped them to achieve and maintain their treatment goal. However, there was no difference between MI and CBT in participants' level of satisfaction. It should be mentioned that clients' initial expectations from an intervention might influence treatment outcomes. MI alone does not seem able to promote significant and lasting changes, especially when other vulnerabilities may be interfering with the drinking behaviour of these young people, such as social expectation of use and the easy access of alcoholic beverages (Segattoe et al., 2011).
Both feedback intervention and motivational interviewing have their limitations when it comes to reducing alcohol consumption and so it may be best to combine the two interventions. Borsari and Carey (2000) did in fact evaluate the efficacy of feedback intervention when delivered with and without motivational interviewing. They randomized heavy drinking students to either a single MI session with feedback, or a no-treatment control condition. This intervention was modeled more strictly along the lines of a motivational interview, with little skills-based content. At a 6-week follow-up, the MI group significantly reduced their alcohol use, relative to control. Participants who had received the MI intervention reduced their drinking from 17.57 to 11.40 DPW, while participants in the control group reduced their drinking from 18.45 to 15.78 DPW. In this study, changes in consumption were mediated by changes in estimates of typical student drinking. However, when it comes to this study, the conclusions presented are limited due to some of the methods that were used. The follow-up period was relatively short and so there is uncertainty as to whether or not this reduction in alcohol consumption would have been maintained long term. Also the participants signed up willingly to take part in the study, it is possible that heavy drinkers avoided taking part in the study and so therefore this intervention may not be effective with heavier drinkers. Finally, an “active” comparison group was not used, as a result, it is impossible to exclude the influence of nonspecific factors in the process of providing feedback (e.g., interviewer attention). Nevertheless, the brief intervention implemented shows promise as an effective method of reducing the alcohol consumption of binge drinking college students. Murphy et al (2015) found carried out a similar study; feedback intervention when delivered with and without motivational interviewing. Results showed that participants’ showed greater drinking reductions when feedback intervention was combined with motivational interviewing. However, White et al (2007) study found that MI showed an advantage over feedback intervention at 15 month follow up which wasn’t evident a 6 month follow up, so it is possible that these studies would have found different results had they used a longer follow up period.
Ultimately whether or not psychological interventions are effective in reducing alcohol consumption would be dependent on who is using the intervention. Feedback intervention for example would work best with participants who drink primarily for social reasons as they are likely to care most about how their drinking compares to their peers. Whereas people who do not drink for social reasons should be less concerned about how their drinking compares their peers and so should be less affected by feedback (Neighbours et al. 2004). It may in fact be the case that psychological interventions work best when they are combined together