M. Dolores Cimini, Ph.D.
Assistant Director for Prevention & Program Evaluation
University at Albany, SUNY
“Mental Health on Campus: We all Play a Part!”
Ohio Program for Campus Safety and Mental Health Conference
May 20, 2014
Columbus State Community College Conference Center, Columbus, Ohio

Up to ninety percent of college
students drink alcohol

Twenty-five to fifty percent are
“heavy” episodic or “binge” drinkers

Students who abuse alcohol are at
high risk for a number of negative
consequences
Students who engage in heavy drinking are at risk for a
host of negative alcohol-related consequences…

Each year, among college students, alcohol use
contributes to:
 1,400 deaths (up to 1800)
 500,000 unintentional injuries
 600,000 assaults
 70,000 sexual assaults, acquaintance rapes
Source:
NIAAA Report on College Drinking,
April 2002

Percentage of students who reported specific
problems over the past year as a result of
their alcohol use (Wechsler et al., 2002)





Got into trouble with the authorities: 7%
Got hurt or injured: 13%
Forgot what you did: 27%
Done something later regretted: 35%
Numbers rise for those students who report
frequent “binge” drinking

Past year prevalence:




Alcohol abuse: 12.5%
Alcohol dependence: 8.1%
Any drug abuse: 2.3%
Any drug dependence: 5.6%

Only 3.9% of full-time college students with an alcohol
use disorder received any alcohol services in the past
year

Only 2.4% of those who screen positive and did not
receive services perceived a need for services
Wu, et al., (2007)
Any illicit drug
 35% report past year use
Marijuana
 32% report past year use
Any illicit drug other than marijuana






15% report past year use
6.7% Vicodin
6.5% Narcotics other than heroin
5.7% Amphetamines
5.1% Hallucinogens
5.0% Tranquilizers
Tobacco vs. Other Drugs
 More students reported past year use of any illicit
drug (35%) than did past year use of cigarettes
(30%)

Factors affecting academic performance as identified by students
(ACHA, 2011):
 24.7% Stress
 17.8% Sleep difficulties
 16.5% Anxiety
 13.8% Cold/Flu/Sore throat
 11.6% Internet use/computer games
 11.5% Work
 10.1% Concern for a troubled friend/family member
 10.0% Depression

Consider ways in which alcohol could contribute to, exacerbate, or cause
problems in each of the above factors








University Center within 64-campus
SUNY System
Urban Setting
Research University
NCAA Division I
Students:
 Undergraduates  Graduate Students -
13,457
5,177
 Undergraduate  Masters  Doctorate -
61
89
39
Faculty:
Employees:
Degree Programs:
967
4,197
Data from
National College Health Assessment,
American College Health Association
Spring 2000,2004 & 2006 In-Class Administrations
and Entering Student Questionnaire (ESQ)
Summer 2006 Administration
60%
54.0%
51.4%
50.1%
50%
40%
30%
29.9%
23.0%
23.0%
18.6%
26.6%
23.3%
20%
10%
0%
Spring 2000
Did not use
Spring 2004
Used 1-9 days
Spring 2006
Used 10+ days
60%
52.0%
50%
44.4%
40.7%
40%
29.3%
30%
20%
24.0%
16.0%
20.0%
10.1%
8.7%
10%
26.6%
21.8%
7.2%
0%
Spring 2000
0 Times
Spring 2004
1-2 Times
3-5 Times
Spring 2006
6+ Times
Percent (%)
Spring
2000
Spring
2004
Spring
2006
Being physically injured
22.0
28.2
26.3
Physically injured another person
8.9
8.5
10.1
Being involved in a fight
11.0
17.2
13.9
Doing something later regretted
45.0
49.7
44.5
Forgot where they were or what
they have done
40.0
43.3
43.2
Having someone use force or
threat of force to have sex
3.7
2.1
0.9
Having unprotected sex
20.0
21.5
20.1
UAlbany Nat’l UAlbany Nat’l UAlbany UAlbany
Spring 2004 Spring 2006 Spring
SPC
2000
2004
2006
2006
6.5
6.4
7.4
4.5
6.9
4.5
UAlbany NCHA data tell us that students who engage in high-risk drinking are also
more likely to report the following:
Broken bones
Chlamydia
Genital Warts
Gonorrhea
High Cholesterol
Mononucleosis
Repetitive Stress Injury
Strep
Depression
Other Substance Abuse
Source:
National College Health Assessment, American College Health Association
Coordinated by E. Rivero, M. D. Cimini, B. Freidenberg, et al.
http://www.collegedrinkingprevention.gov/

Individuals, Including At-Risk or
Alcohol-Dependent Drinkers

Student Body as a Whole

College and the Surrounding
Community
From: “A Call to Action: Changing the
Culture of Drinking at U.S. Colleges,” NIAAA
Task Force
Tier 1:
Evidence of effectiveness among
students
college
Tier 2:
Evidence of success with general populations
that could be applied to college environments
Tier 3:
Promising: Evidence of logical and theoretical
promise, but require more comprehensive
evaluation
Tier 4:
Ineffective: No Evidence of Effectiveness
From: “A Call to Action: Changing the Culture of Drinking at U.S. Colleges,” NIAAA Task Force
Components of UAlbany
Comprehensive AOD Prevention Program
Comprehensive Program
Presidential Leadership
Campus AOD Task Force
Student Involvement/Leadership
Social Norms Marketing
Campus-Community Coalitions
Inclusive Academic Excellence
Healthy Living Communities
Alcohol-Free Activities
Early Intervention
Restricting Alcohol Marketing/Promotion
Policy Evaluation/Enforcement
Parental Involvement
Treatment & Referral
Research and Program Evaluation - NCHIP
Spectrum of Intervention Response:
Alcohol Abuse Prevention
Reclaim
Health
Optimize
Health&
Wellbeing
Prevent
Problems
Treat
Problems
Specialized Treatment
•Outpatient Assessment,
Treatment, & Referral
Early Intervention
Health Promotion
•Social Norms Campaigns
•Peer Services
•Committee on University &
Community Relations
•Healthy Living Communities
•
•
•
•
•
BASICS
ASTP Groups
Interactive Education
with Social Norms
AA Meetings
Consistent Policy
Enforcement
2006: Committee on University
& Community Relations Social
2005: Project Norms Project
First STEPS
2009: Project
Greek STEPS
Present: Continued
Implementation &
Evaluation of Effective
Programs
STEPS (2005) and Social Norms Campaign (2006)
2006: Project
Healthy STEPS
2006: Project
Winning STEPS
2010: STEPS
Program Awards
2011: National
Registry of
Evidencebased
programs &
Practices
The STEPS Brief Screening and Intervention Model
Targeting Students at Risk
Sustaining Success
Preventing High-Risk Alcohol Use & Promoting Healthy Behaviors
Engaging High-Risk Drinkers in Brief Alcohol Interventions
Targeting High-Risk Drinkers
Screening At-Risk Students for Alcohol Use & Related Behaviors
Survey Instruments for Project Participants
 Alcohol Use Disorders Identification Test (AUDIT)
 GPRA Assessment Tool
 Center for Epidemiological Studies-Depression Scale (CES-D)
 Daily Drinking Questionnaire (DDQ)
 Brief Alcohol Expectancies Questionnaire (BAEQ)
 Drinking Norms Rating Form (DNRF)
 Protective Behaviors Strategies Scale (PBSS)
 Readiness to Change Scale (RTC)
 Rutgers Alcohol Problem Index (RAPI)
 Brief Drinker Profile
Campus-Wide Surveillance Data
 The National College Health Assessment, American College Health
Association (NCHA)












Typical Drinking Pattern
Blood Alcohol Levels
Drinking Norms
Biphasic Curve
Beliefs about Alcohol Effects
Alcohol-Related Problems
Calories consumed
Financial Costs of Drinking
Alcohol Use & Sex
Family History
Protective Factors
Athletic Performance

Combining cognitive-behavioral skills with
norms clarification and motivational
enhancement interventions.

Offering brief motivational enhancement
interventions.

Challenging alcohol expectancies
From: “A Call to Action: Changing the
Culture of Drinking at U.S. Colleges,” NIAAA
Task Force

Precontemplation

Contemplation

Preparation/Determination

Action

Maintenance
Stages of Change in Substance
Abuse and Dependence:
Intervention Strategies
Precontemplation
Stage
Contemplation
Stage
Action
Stage
Maintenance
of
Recovery
Stage
Relapse Stage
MOTIVATIONAL
ENHANCEMENT
STRATEGIES
ASSESSMENT
AND TREATMENT
MATCHING
RELAPSE
PREVENTION
& MANAGEMENT
Motivational Interviewing
Basic Principles
(Miller and Rollnick, 1991, 2002)
1. Express Empathy
2. Develop Discrepancy
3. Roll with Resistance
4. Support Self-Efficacy

Examines students’ perceptions
about:
 Acceptability of excessive drinking
behavior
 Perceptions about the drinking rates of
their peers
 Perception about the drinking prevalence
of their peers
 Moderate drinking skills
 Blood alcohol concentration discrimination
 Altering expectancies about alcohol’s effects
 Assertiveness skills (drink refusal)
 Relaxation/Stress Management skills
 Lifestyle balance skills
 “Alcohol specific skills”
Alcohol’s Biphasic Effect
Euphoria Up
+
Point of Diminishing
Returns
Feeling
Scale
Cultural
Myth
About
Alcohol
0
__
After
Tolerance
Develops
Dysphoria Down
Time
Male 185 lbs.
Hours
0
1 0.020
No. of 2 0.040
drinks 3 0.060
4 0.080
5 0.100
6 0.120
7 0.140
8 0.160
9 0.180
10 0.200
11 0.220
12 0.240
1
0.004
0.024
0.044
0.064
0.084
0.104
0.124
0.144
0.164
0.184
0.204
0.224
2
0.000
0.008
0.028
0.048
0.068
0.088
0.108
0.128
0.148
0.168
0.188
0.208
3
0.000
0.000
0.012
0.032
0.052
0.072
0.092
0.112
0.132
0.152
0.172
0.192
4
0.000
0.000
0.000
0.016
0.036
0.056
0.076
0.096
0.116
0.136
0.156
0.176
5
0.000
0.000
0.000
0.000
0.020
0.400
0.060
0.080
0.100
0.120
0.140
0.160
6
0.000
0.000
0.000
0.000
0.004
0.024
0.044
0.064
0.084
0.104
0.124
0.144
7
0.000
0.000
0.000
0.000
0.000
0.008
0.028
0.048
0.068
0.088
0.108
0.128
8
0.000
0.000
0.000
0.000
0.000
0.000
0.012
0.032
0.052
0.072
0.092
0.112
9
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.016
0.036
0.056
0.076
0.096
10
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.020
0.040
0.060
0.080

Set limits

Keep track of how much you drink

Space your drinks

Alternate alcoholic drinks w/non-alcoholic drinks

Drink for quality, not quantity

Avoid drinking games


If you choose to drink, drink slowly
Don’t leave your drink unattended

Don’t accept a drink when you don’t know
what’s in it








Academic Failure
Blackouts
Hangovers
Weight Gain
Tolerance
Decisions around sex
Impaired sleep
Sexual Assault







Finances
Family History
Alcohol-Related
Accidents
Time Spent Intoxicated
Relationships
Legal Problems
Work-Related
Problems










Use a designated driver.
Have a friend let you know when
you have had enough to drink.
Leave the bar/party at a
predetermined time.
Make sure that you go home
with a friend.
Know where your drink has been
at all times.
Drink only with close friends.
Avoid mixing different types of
alcohol.
Drink slowly, rather than gulp or
chug.
Avoid trying to "keep up" or
"outdrink" others.
Put extra ice in your drink.










Do not go to parties/bars alone.
Avoid drinks that contain
multiple shots of alcohol.
Avoid drinking when angry, sad,
or otherwise upset.
Eating before/during drinking.
Determine not to exceed a set
number of drinks.
Alternate alcoholic and nonalcoholic drinks.
Avoid drinking games.
Avoid drinking shots of liquor.
Stop drinking at a
predetermined time.
Drink water while drinking
alcohol.
EXPECT
Alcohol
No Alcohol
Service
Students Served to Date
Screening Only
19,879
Screening and Brief Intervention
2,813
TOTAL
22,813
19
18
18.1
19% decrease
17
16
15
14.6***
14
13
12
Baseline
11
6-month follow-up
10
Drinks per week
Significant
***p<.001
50
45
25.7%
decrease***
31.4%
decrease***
40
35
30
25
Baseline
6-month follow-up
20
Fought, Acted Bad, Did Mean
Things
Fight/Argument/Bad Feelings
with Friend
Significant
***p<.001
All Students
Student Athletes
1st Year Students
2012
2010
2008
2006
2004
2012
2010
2008
2006
2004
2012
2010
2008
2006
2004
60
49
Percent of students
50
46
4242
3837 *
40
30
23
20
29
*
25242425
19
2625
2004
2006
2008
2010
2012
2013
22
1717
10
*
7
5 5
*
2 2 2
0
Abstains
6+
10+
Number of Days per Month
20+
Significant
*p <.05
8
Drinks Consumed
7
7
6
6
6
5.5
5
5
4
5
4
4
5
U Albany
National
4
3
Significant
*p <.05
2
2004
2006
2008
2010
2012
2013
100
Percent of Students
95
90
91
91
85
85
*
87
85
82
80
75
U Albany
National
82
77
76
75
70
Significant
*p <.05
65
2004
2006
2008
2010
2012
2013
80
68
70
76
76*
70
Percent of students
60
50
43
42
38
38
39
39
40
30
23
U Albany
National
21
20
10
Significant
*p <.05
0
2004
2006
2008
2010
2012
2013
100
99
99 *
Percent of Students
98
98
97
96
97
97
98
97
96
U Albany
National
95
94
94
93
94
93
92
Significant
*p <.05
91
90
2004
2006
2008
2010
2013
2013
2004
*
7%
Think Typical
Students
Drink Daily
Think Typical
Students
Drink Daily
48%
52%
Does Not
Think Typical
Student
Drinks Daily
93%
Does Not
Think Typical
Student
Drinks Daily
Significant
*p <.05






11% increase in athletes practicing protective
behaviors
38% increase in athletes who avoid drinking
games
17% increase in athletes who do not allow alcohol
to negatively affect their academics
14% increase in athletes who choose to not drink
alcohol at parties
16% increase in non-smokers
8% increase in athletes who use a designated
driver
Assessing Proximal Risk Factors for Suicide
The STEPS Comprehensive Suicide
Prevention Program Model
Sustaining Student Success
Preventing Suicide Risk Behaviors & Promoting Healthy
Behaviors
Engaging Students, Faculty, Staff, & Families in Education
About Suicide Prevention
Training Potential Campus Responders & Strengthening a
Campus Comprehensive Care Network
Screening and Early Intervention for Students at Risk for Suicide and
Related Risk Factors
“Partnerships Working to Prevent Student Suicide… One Step at a Time”
Spectrum of Intervention Response:
Suicide Prevention
Thresholds
for Action
Specialized Interventions
Early Intervention
Universal Prevention
•Stigma Reduction Media
Campaign
•Peer Services (Peer
Education and Hotline
Services)
•Educational Brochures
•“Save-A-Life" Gatekeeper
Training Program for
Faculty, Staff, and Students
•PRISM (Proximate Risk
Index and Screening
Measure) Screenings
•Consultations with faculty,
staff, students, and parents
•CARE Net (Consultation and
Resource Evaluation) Program
•Treatment and Referral
•Response to Urgent or
Emergent Situations

Prevention-related, risk-factor focused screening measure (not a suicide
prediction tool)

Items selected for inclusion assess risk factors found in more than half
of the cases of serious suicide attempts1

Goal is to increase screening/self-selection and link at-risk students to
counseling services

Questions are responsive to needs of a variety of target populations (
students seeking health care, academic advisement, career services,
etc.)
1
Hall et al. (1999)
PRISM Scores
University at Albany, State University of New York
University Counseling Center Student Questionnaire
Dear Student: To provide you with the highest level of care, we ask your help in completing the questions
below. Please hand this form in to your provider during today’s visit. If you have completed this form within
the past month, please return the blank form to your provider. Information from this form that is discussed
with your provider will remain confidential and this form will remain in your confidential University
Counseling Center file. Thank You.
Instructions: These questions concern
how you have been feeling and doing
over the past 7 days. Check the choice
below each question that best describes
how you have been.
Name: _______________________________________
•SD = 4.8
Phone: _______________________________________
Age: ____
•Median = 11
•Mode = 14
Email: ________________________________________
Date:__________________
•Mean = 11.1
□ Male □ Female
1. Difficulties falling asleep or staying asleep?
0 □ No Days 1 □ One Day 2 □ Some Days 3 □ Most Days 4 □ Everyday
•Range = 0 to 21
2. Very anxious or nervous, unable to stop thinking, uncomfortably restless or physically agitated?
0 □ No Days 1 □ One Day 2 □ Some Days 3 □ Most Days 4 □ Everyday
•PRISM-AUDIT: r=.25*
3. Panic attacks, a sudden rush of intense fear, apprehension, or terror?
0 □ No Days 2 □ One Day
3 □ More Than One Day
4. Feeling sad or down for most of the day, like everything is an effort and/or very irritable and
unhappy?
0 □ No Days 1 □ One Day 2 □ Several Days 3 □ Nearly Everyday
5. Having no hope or expectation that things will get better?
0 □ No Days 1 □ Once in a While
2 □ Often
6. Feeling trapped, helpless or like a complete failure?
0 □ No Days
1 □ Once in a While
2 □ Often
7. A painful loss or crisis in a relationship, valued activity or
For Office Use Only
important goal?
Circle
One:
Decline
Accept
0 □ No Days 1 □ One Day 2 □ Several Days 3 □ Nearly Everyday
Circle One: Barr
8. Use of alcohol and/or substances?
0 □ No Days
1 □ One Day
2 □ Two or More Days
TOTAL SCORE (Questions 1—8) =
Add the numbers left of the checks.
Bernier
Dewitt-Parker Diaz-Myers
Heslin Pokat
Horner
Rivero
Rosin
N/A
Cimini
Freidenberg
Monserrat
Stanley
Intern _____________________________
Pilot PRISM, Fall 2006.

36% increase in number of clients seeking treatment
at University Counseling Center

79% increase in number of consultations from faculty,
staff, students, and parents

79 referrals to CARE Net Program

Completed gatekeeper training for 90% of
professional student services staff members

Buy-in at all university levels

Clear statements of protocols and procedures

Consistent implementation of stated procedures
with appropriate tracking

Training and communication with professional and
support staff

Process and outcome evaluation

Project Work Group and Steering Committee

President’s Advisory Council on the Prevention of
Alcohol Abuse and Related Risk Behaviors

Annual Reporting and Strategic Planning

Presentations and Publications

Consultation With Colleagues

Media Advocacy

Addictions Research Center

Infrastructure issues
 Staffing
 Space
 Incentives for student participation in
interventions

Alignment of University Counseling Center goals
and priorities with changing and increasingly
complex student needs

Develop, implement, and test the efficacy of drug-specific
screening and intervention methods for college student drug
use and comorbidity with mental health concerns

Develop technical assistance manuals for practitioners, outlining
effective elements of projects and offering templates for
implementation on other college campuses and communities on
a local, state, and national scale

Develop formal training/academic course curriculum in
screening and brief intervention theory and practice for
graduate and undergraduate students

Capitalize on opportunities to educate faculty, staff, students,
and the community, and professionals on a regional and
national level on our effective intervention strategies
Questions?
Our Funders:
 National Institute on Alcohol Abuse and Alcoholism
 New York State Office of Alcoholism and Substance Abuse Services
 Substance Abuse and Mental Health Services Administration-Center for Mental Health Services
 Substance Abuse and Mental Health Services Administration-Center for Substance Abuse
Treatment
 Substance Abuse and Mental Health Services Administration-Center for Substance Abuse
Prevention
 U. S. Department of Education
Our Interventionists:

University at Albany Counseling Center staff
Our University Colleagues:
 Department of Athletics
 Department of Residential Life
 Office of Conflict Resolution and Civic Responsibility
 University Health Center
Our Consultants:
 Drs. Mary Larimer and Jason Kilmer, University of Washington,
 Dr. H. Wesley Perkins, Hobart and William Smith Colleges
M. Dolores Cimini, Ph.D.
Assistant Director for Prevention
& Program Evaluation
dcimini@albany.edu
Brian M. Freidenberg, Ph.D.
Addictive Behaviors Specialist/Staff Psychologist
bfreidenberg@albany.edu
University Counseling Center
University at Albany, SUNY
400 Patroon Creek Boulevard
Suite 104
Albany, NY 12206
Phone:
Fax:
Website:
518-442-5800
518-442-3096
www.albany.edu/counseling_center/