Expert on High-Risk Drinking Praises Dartmouth’s Effort

9/24/2014
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Jason Kilmer received his PhD in clinical psychology from the University of Washington (UW), and now works at UW in both a student affairs and a research capacity. He is an assistant professor in psychiatry and behavioral sciences at UW, where his research includes several studies evaluating prevention and intervention efforts for alcohol and other drug use by college students. He is also the assistant director of Health & Wellness for Alcohol & Other Drug Education, working with offices across campus to increase student access to evidence-based approaches.

Kilmer consulted with Dartmouth during the development of the Dartmouth College Health Improvement Program (DCHIP) and has spoken about alcohol abuse prevention to the Presidential Steering Committee for Moving Dartmouth Forward, a group tasked with making recommendations about ways to combat the causes of high-risk behavior on campus.

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“When we look at reducing harms, it is all about realizing that any steps toward reduced risk for those who make the choice to drink are steps in the right direction,” says clinical psychologist Jason Kilmer. (Photo courtesy of Jason Kilmer)

You have spent much of your career looking at ways to reduce harm from high-risk drinking among college students. What do top college administrators need to understand as they tackle this problem?That any one thing we do is a part of an overall puzzle. Over the past several decades, research has looked at the impact of prevention, intervention, education, enforcement of policy, and other approaches. It is clear that a balance of individually focused and environmentally focused approaches sets the stage for success for students and campuses. When we look at reducing harms, it is all about realizing that any steps toward reduced risk for those who make the choice to drink are steps in the right direction.

The issue of high-risk drinking on campus is very much in the news today. Does this mean the problem is getting worse, or is it the reflection of a change in attitudes nationally?The issue of college student alcohol use was first addressed in the scientific literature in the 1940s—this is not a new issue. I think the attention on high-risk drinking could be a function of more research highlighting a number of things, including that many students who meet criteria for an alcohol-use disorder are slipping through the cracks and not getting connected with services of any kind; the link between excessive alcohol use and academic struggles; the challenges experienced by students with co-occurring issues, such as depression or anxiety; and the successes our field has achieved in reducing the harms associated with high-risk alcohol use.

You have been involved for a number of years in Dartmouth’s efforts to address high-risk drinking through a technique known as Brief Alcohol Screening and Intervention for College Students (BASICS). Can you explain the technique?BASICS was developed by clinical psychologist Alan Marlatt in the early 1990s as an alternative to the “Just Say No” approaches of the 1980s, and focused on providing students with personalized feedback about their alcohol use. It’s not a test to pass or fail, and there are no wrong answers—instead, students complete a survey about their alcohol use and the personalized feedback summarizes and computes things such as their peak blood alcohol level, how long it takes to get back to a .000 percent blood alcohol level, unwanted effects the student has experienced, and information on norms. For students who see unwanted effects that they would like lessened or eliminated, and for those interested in making a change in their alcohol use, BASICS explores ways to drink in a less dangerous or less risky way if and when students make the choice to drink.

How do we maintain and gauge the effectiveness of brief motivational interviewing techniques on campus?When programs have demonstrated efficacy, the key to remaining effective is ensuring that they are being implemented with fidelity. So, are they being implemented in the style and way in which research has shown they can have an impact? Some studies that have shown a program didn’t have the desired effect or outcome have, after further review, also been shown to have strayed from the program style, delivery method, and/or content. So we maintain the effectiveness of such approaches by assessing the impact on students and checking with providers to see what, if any, follow-up, support, or additional training is needed.

On some level, do institutions and social groups have to arrive at a point where they are prepared to make a change, much as individuals do when confronting substance abuse? If so, how do we help them get to that point?The Tri-Ethnic Center at Colorado State University has developed a community readiness model that allows institutions and communities to determine where they might be in terms of readiness to change. On a given campus, there may be a lot of agreement that change is needed, but there may be differing opinions on what that change might look like. Alternatively, there may be a great diversity of opinion on whether anything even needs to change. How might a campus get on the same page? We see the greatest successes when there is collaboration across offices on campus that includes student input. When I look at the work your DCHIP team has been doing, that very much counts as a best practice.

Sexual assault on campuses is also an urgent national issue. Is there any connection between the work we do to reduce harm from high-risk drinking and combating the problems of gender violence and assault?This is a very complicated question, with the need for additional research to determine how to best serve our students. The hope is that anything we do to reduce the risks associated with alcohol use will impact sexual assault, relationship violence, and power-based violence; we also hope that the opposite is true. We have seen that alcohol can muddy the waters around communication and consent, so some programs try to clarify what consent and healthy communication look like while also highlighting how alcohol impacts these issues. We have seen bystander intervention programs for both alcohol and sexual assault, and the role a campus community can play in intervening on both of these issues is exceptionally important.