The Comparative Effectiveness of Group and
Individual Brief Alcohol Screening and
Intervention for College Students (BASICS)
Suzanne Zeman, M.S., R.N.
The Pennsylvania State University
University Health Services
John Hustad, Ph.D.
Penn State University - College of Medicine
Milton S. Hershey Medical Center
Linda LaSalle, Ph.D.
Rachel Urwin, Ph.D.
The Pennsylvania State University
University Health Services
Outline
 Brief background on alcohol use by college students
nationally and at Penn State
 Summarize empirically supported techniques for college
students
 Discuss the BASICS program at Penn State
 Outcome data
 Summarize our findings
 Future directions
Objectives
 Describe the components of group and individual
BASICS
 Identify key behavior outcomes that are relevant to
assessing the efficacy of group and individual BASICS
 Discuss the differences in effectiveness between group
and individual delivery mode of BASICS
 Discuss the implications for college health professionals
and campus administrators
Background
• Alcohol use is the greatest single contributor to college
student morbidity and mortality (e.g., Hingson et al.,
2009).
• Individual (one-on-one) motivational interviewing (MI)
is efficacious (e.g., NIAAA, 2004).
• Group-delivered MI has limited evidence of efficacy
(LaChance et al., 2009) and can be delivered at a lower
cost than one-on-one interventions.
• Group-delivered MI has yet to be compared to a one-onone MI for alcohol use.
Alcohol Use by College Students
 59.8% of college students reported using alcohol in the
last 3o days according to the ACHA-NCHA Fall 2010
assessment
Snapshot of Annual High-Risk
College Drinking Consequences
 Death: 1,825 college students between the ages of 18
and 24 die from alcohol-related unintentional injuries,
including motor vehicle crashes.
 Injury: 599,000 students between the ages of 18 and
24 are unintentionally injured under the influence of
alcohol.
 Assault: 696,000 students between the ages of 18 and
24 are assaulted by another student who has been
drinking.
 Sexual Abuse: 97,000 students between the ages of 18
and 24 are victims of alcohol-related sexual assault or
date rape.
Source: Hingson et al., 2009
Consequences Continued
 Academic Problems: About 25 percent of college
students report academic consequences of their drinking
including missing class, falling behind, doing poorly on
exams or papers, and receiving lower grades overall
(Engs et al., 1996; Presley et al., 1996a, 1996b;
Wechsler et al., 2002).
 Health Problems/Suicide Attempts: More than
150,000 students develop an alcohol-related health
problem (Hingson et al., 2002), and between 1.2 and
1.5 percent of students indicate that they tried to
commit suicide within the past year due to drinking or
drug use (Presley et al., 1998).
Alcohol Abuse and Dependence
In the past 12 months, according to questionnaire based
self-reports about their drinking:
 31 percent of college students met criteria for a
diagnosis of alcohol abuse
 6 percent of college students met criteria for a diagnosis
of alcohol dependence
Source: Knight et al., 2002
Penn State Student Drinking Data
From the Student Affairs Research and Assessment,
PULSE Student Drinking Report 2011
High Risk Drinking at Penn State
 Penn State Pulse Student Drinking 2011 Data:
 47.5 % of students are high-risk drinkers
 18.6% of students are frequent high risk drinkers
 Male high risk drinking
 52.6% of high risk drinkers were male
 Female high risk drinking
 42.5% of high risk drinkers were female
Source: Penn State Student Affairs Research and Assessment, Student Drinking Report 2011
Alcohol Related Consequences
Within the past 12 months as a consequence of drinking…
Alcohol Related Consequence
ACHANCHA Fall
2010 Data
Penn State Pulse
Student Drinking
Report 2011
Did something they later regretted
32.4%
29.8%
Forgot where they were/what they did
29.7%
43%
Physically injured themselves
15.1%
12.3%
Source: American College Health Association, 2010
Source: Penn State Student Affairs Research and Assessment, Student Drinking Report 2011
Nightly Self Reported Alcohol Use During a
Typical Week-Penn State 2011
Variable
Wednesday
Thursday
Friday
Saturday
% of Students Drinking
14%
40%
70%
69%
Average # Drinks
0.42
1.69
3.86
3.95
Average # Hours Drinking
0.32
1.21
2.75
2.81
Average BAC
0.042
0.064
0.083
0.085
Source: Penn State Student Affairs Research and Assessment, Student Drinking Report 2011
Drinks Consumed/Hour During Peak
Drinking by Penn State Students
Number of Drinks
>0 to ≤ 1 drinks
% of Students
21%
>1 to ≤ 2 drinks
43%
> 2 to ≤ 3 drinks
22%
> 3 drinks
14%
Source: Penn State Student Affairs Research and Assessment, Student Drinking Report 2011
Self Reported Alcohol Consequences
Direct Consequences: Physical
% of Students
Had a hangover/headache the morning after drinking
60.5%
Felt sick to your stomach or thrown up
45.1%
Been unable to remember a part of the previous evening
43.1%
Been hurt or injured
12.3%
Gotten into a physical fight
5.8%
Source: Penn State Student Affairs Research and Assessment, Student Drinking Report 2011
Self Reported Alcohol Consequences
Direct Consequences: Academic
Missed class
% of
Students
25.2%
Gotten behind in schoolwork
22%
Had difficulty concentrating in class
9.8%
Performed poorly on an assignment or test
2.6%
Source: Penn State Student Affairs Research and Assessment, Student Drinking Report 2011
Self Reported Alcohol Consequences
Direct Consequences: Interpersonal
% of
Students
Done something you later regretted
29.8%
Become rude, obnoxious or insulting
28.5%
Felt guilty about your drinking
22.8%
Source: Penn State Student Affairs Research and Assessment, Student Drinking Report 2011
The NIAAA Report on College Drinking
What Colleges Need to Know Now An
Update on College Drinking Research.
(2007)
www.collegedrinkingprevention.gov/
4 Tiers of Effectiveness
Task Force members placed prevention strategies in descending tiers on the basis
on the evidence available to support or refute them.
 Tier 1:
Evidence of effectiveness among college students. BASICS fits here which is
why we are using it at Penn State in University Health Services.
 Tier 2:
Evidence of success with general populations that could be applied to college
environments.
 Tier 3:
Evidence of logical and theoretical promise, but require more comprehensive
evaluation.
 Tier 4:
Evidence of ineffectiveness. Source: “A Call to Action: Changing the Culture of
Drinking at U.S. Colleges,” NIAAA Task Force.
Nationally Recognized Program
 National Institutes of Health
 One of the most promising interventions for college
students regarding alcohol use
 Substance Abuse and Mental Health Services
Administration (SAMHSA)
 Model Program
 BASICS is a tier 1 strategy which is why we are using it at
Penn State in University Health Services
(Source: http://www.samhsa.gov )
BASICS Implementation at Penn State
 Alcohol intervention programs have been offered at UHS since the
mid-1980’s;components of BASICS have been used ~5 years now (AIP
I & II and PAUSE Blue & White)
 Expansion of BASICS has been a collaborative SA effort between UHS,
Judicial Affairs, Residence Life, CAPS and the VP of SA
 5 FT health educators were hired to facilitate the program in addition
to a PT graduate assistant
 1 new FT Addiction Specialist was also hired in CAPS to facilitate
referrals from BASICS
 Dr. John Hustad was hired to do a comprehensive evaluation of the
BASICS program
 National experts on BASICS and Motivational Interviewing were
brought in to do staff training
Policy Changes Affecting Referral to
BASICS
 Effective fall 2010:
 all students who have a first time alcohol violation (underage
possession or use, DUI, public drunkenness, supplying to minors,
party host, etc.) that occurs on or off campus have a mandated
referral to BASICS
 all students who go to Mt. Nittany Medical Center (local hospital)
or alcohol-related treatment have a mandated referral to BASICS
 students complete 2 or 4 mandated sessions based on their
screenings and experiences with alcohol
 program fee is $200
 We’ve seen ~ 1500 students so far in BASICS since August 2011
Referral Sources
 Judicial Affairs
 Residence Life
 Emergency Department (Mt. Nittany Medical Center)
 Types of policy or legal violations:
 Underage drinking/ underage possession or use
 DUI
 Public Drunkenness/ excessive consumption
 Alcohol-related emergency department treatment
 Furnishing to minors
BASICS Components
Assessment Session
Structured Interview
Self-Monitoring of Drinking
Self-Report questionnaire
Feedback Session
Individualized feedback
report (PNF sheet)
Referral
Traditional BASICS Delivery
 Every student spent two 1 hour individual sessions with a health
educator
 Students that screened ≥16 on the AUDIT (with an alcohol
policy/legal violation) were also mandated to two 1 hour sessions
with a clinician in CAPS
 Students participating in the research had their feedback session
audio recorded
 Non-mandatory referrals were also made for students screening
for symptoms of anxiety or depression
 Satisfaction surveys were also conducted at the end of the second
session
BASICS Session One: Assessment
 Confidentiality
 Discuss student’s referral event
 Review standard drinks
 Explain monitoring activity
 Screen for anxiety, depression and alcohol dependence
 Complete a comprehensive computer assessment (typical drinking
patterns, negative consequences, perceptions of alcohol use, risk
behaviors, etc.)
 Refer students to CAPS for anxiety and depression (if applicable)
 1-2 weeks between session one and session two
Anxiety Screening
 The Overall Anxiety Screening and Impairment Scale (OASIS) is
used to screen for anxiety
 A student scoring ≥8 on the screening is given a non-mandatory
referral to CAPS for further evaluation
Depression Screening
 The Patient Health Questionnaire-9 (PHQ-9) is used to screen for
depression
 Any student who screens positive for question #9 (self harm,
suicidal ideation) has a phone crisis consultation with a CAPS
clinician to determine appropriate course of action
 Any student who scores ≥ 10 is given a non-mandatory referral to
CAPS for further evaluation
Alcohol Abuse Screening
 The Alcohol Use Disorders Identification Test (AUDIT) from the
World Health Organization is used to screen for alcohol abuse
 Any student who scores a ≥16 with an alcohol violation is
mandated to two additional sessions in CAPS with one of the
Addiction Specialists
 Any student who scores a ≥ 16 who went to the ED but didn’t
have an alcohol violation is given a non-mandatory referral to
CAPS for two additional sessions
BASICS Session Two: Feedback
 Personalized normative feedback (PNF) sheets are given to





students based on the computerized assessment they completed
Health educators review the PNF sheets with the students and use
motivational interviewing techniques to assist with behavior
change
BAC cards and alcohol poisoning cards are given out
Change/action plans are completed (if applicable)
Referral to CAPS made for students with AUDIT scores ≥16 (if
alcohol violation)
Satisfaction survey
Sample PNF sheet for an Actual
Student
BASICS 3 and 4
 Extended BASICS (sessions 3 and 4) occurs in CAPS with the
Addiction Specialists
 BASICS 3 is an intake consultation
 BASICS 4 is tailored to the student needs
Follow-up Assessment
 All BASICS participants are required to complete a 1 month
follow-up assessment as part of their sanction requirement
 Research participants were asked to complete additional follow
ups
Key Behavior Outcomes
Relevant to Assessing the Efficacy of
Group and Individual BASICS
Behavior Outcomes of BASICS
 Decreased typical BAC
 Decreased peak BAC
 Decreased negative consequences associated with alcohol
 Increased use of protective behaviors while drinking
Research Background
 High risk drinking among college students is well documented
(Hingson, 2005; Johnson, et. al., 2008; Nelson, et. al., 2009)
 There is strong empirical evidence supporting the efficacy of oneon-one delivery of BASICS (Larimer, et. al., 2007)
 Recent research suggests that group delivered BASICS is
promising and cost-effective (LaChance, 2009).
 To date, no research has been conducted comparing the efficacy of
group delivered BASICS to individually delivered BASICS.
Hypothesis
 We hypothesized that participants who received individual MI
would report drinking at lower levels on a peak drinking occasion
and experience reduced levels of alcohol-related problems at
follow-up compared to the group MI condition.
Methods -Procedures
• Participants were recruited from a sample of college students (N
= 547) who were mandated to receive an alcohol intervention
following an alcohol-related offense (e.g., underage drinking,
arrested for driving, emergency department visit, driving under
the influence) during the fall semester of the 2010-2011 academic
year
• Eligibility criteria: Alcohol Use Disorder Identification Test
(AUDIT) score <16, no suicidal ideation, and an undergraduate
student between 18 and 22 years old
Study Procedure and Design
A= Assessment
R= Randomization
BMI= Brief Motivational Intervention
BMI
A
R
Group
BMI
Excluded High
Risk
Students
Follow up
Assessment at
1, 3, 6 Months
BASICS Components-Group Condition
Individual
Group
Assessment Session
Assessment Session
Individual BMI 2nd Session
Group BMI 2nd Session
Group BASICS Condition
 Session 1 of BASICS was done individually with a health educator
 Session 2 was conducted in a group setting
 Group characteristics:
 2-7 students per group
 Facilitated by a health educator
 A mixing board was used for recording and all participants had
individual microphones for the group sessions
 All group participants scored < 16 on the AUDIT and did not
endorse suicidal ideation on the PHQ-9, question #9
BASICS Components-Group Condition
Assessment Session
Feedback Session
Individual
Group
Structured Interview
Self-Monitoring of Drinking
Self-Report questionnaire
Individualized feedback
report (PNF sheet)
Method
Participants and Setting
 Students who were mandated to receive an intervention.
 Incentives:
 $15 gift card for the 30 day follow up survey
 $20 gift card for the 3 month follow up survey
 $25 gift card for the 6 month follow up survey
 Participation in this study fulfilled the campus requirement
Method
 Demographics
 Alcohol use (Past month):
 Typical Drinks and amount of time spent drinking
 Peak Drinks and amount of time spent drinking
 Estimated average and peak blood alcohol concentration (e.g.,
Hustad & Carey, 2005)
 Alcohol-related consequences:Young Adult Consequences
Questionnaire (YAACQ; Read et al., 2006; Kahler, Hustad et al.,
2008)
Participant Flow
Sample Characteristics
 Participants randomized to receive group-delivered BASICS
were more likely to be male than participants in the
individual BASICS condition
 There were no other significant differences between the two
conditions according to key demographic and baseline
characteristics.
Sample Characteristics
Variable
#
Percentage
Male
189
69%
Female
93
33%
Mean= 19.04
(SD=1.21)
-
White
229
81%
Asian
15
5%
Black/African American
10
4%
Hispanic
11
4%
Other
27
10%
Gender:
Age
Race:
Sample Characteristics
Variable
%
On-campus
64%
Off-campus
29%
With parents
0.7%
Fraternity house
3.2%
Sorority floor
1.42%
Residence:
Other
1%
Raw Means of Key Outcome Variables
Across Assessments
Variable
Individual
(N=133)
Group
(N=147)
Gender:
pValue
0.05
% male
72.30
61.19
-
% female
27.70
38.81
-
Ethnicity
(% White)
88.72
82.31
0.13
Year
(% Freshman)
52.63
50.34
0.92
Residence
(% on campus)
64.66
63.27
0.78
Greek status
(% non-Greek)
81.95
80.27
0.84
Raw Means of Key Outcome Variables
Across Assessments for Participants
Variable
Individual
(N=133)
Group
(N=147)
pValue
Age
18.98
19.11
0.39
Drinks/week
11.14
11.27
0.91
Drinks/
drinking day
5.10
5.04
0.85
Heavy drinking
frequency
1.24
1.18
0.78
Typical BAC
0.08
0.08
0.93
Peak BAC
0.14
0.13
0.57
YAACQ total
6.29
5.55
0.23
Participant Self Reported Alcohol
Related Consequences
I have had a blackout after drinking heavily
I often drank more than I originally had planned
I often have thought about needing to cut down or
to stop drinking
I have woken up in an unexpected place after heavy
drinking
No
Yes
I have felt badly about myself because of my
drinking
I have passed out from my drinking
I have felt guilty about my drinking
0
50
100
150
200
250
300
Participant Self Reported Alcohol
Related Consequences
Gotten in trouble with police
I have gotten into trouble at work or school because
of drinking
While drinking, I have said or done embarassing
things
I have said things while drinking that I later
regretted
No
I have had a hangover (headache, sick to the
stomach) the morning after drinking
Yes
I've not been able to remember large stretches of
time while drinking
I have felt very sick to my stomach or thrown up
after drinking
I have taken foolish risks when I have been drinking
0
50
100
150
200
250
Self Reported Referral Source
 Judicial Affairs
 Residence Life
 Emergency Department
 District Magistrate
 Other
Measures
 Demographics: Gender and weight (in pounds)
 Alcohol Use Disorder Identification (AUDIT; Saunders et al., 1993) was
used to screen students for alcohol dependence
 Alcohol use (past month): Self-reported number of peak drinks and
amount of time spent drinking. These variables were used to
estimate peak blood alcohol concentration (eBAC) (e.g., Hustad &
Carey, 2005)
 Alcohol-related consequences (past month):Young Adult Consequences
Questionnaire (YAACQ; Read et al., 2006; Kahler et al., 2008)
Analysis Plan
 Investigated differences by group over time using General estimating
equations (GEE)
 Investigated whether gender moderated the effect of the intervention
Primary Outcomes
Baseline Characteristics
• Conditions were not statistically different on key
demographics and variables
• Evaluate differences by group over time using two separate
general estimating equations (GEE) models for (1) peak eBAC and
(2) alcohol-related consequences after controlling for gender
Primary Outcomes
•The effect for time was significant for peak eBAC (z = -2.07, p
= .04) and alcohol-related consequences (z = -2.79, p = .005)
•There was a main effect for gender where female participants
had significantly higher peak eBACs than male participants (z =
4.86, p < .001)
•The main effect for gender was not statistically significant for
alcohol-related consequences (z = 0.57, p = .57)
•The condition X time interaction was not statistically
significant
Results: Estimated Typical Blood
Alcohol Concentration (BAC)
0.09
0.08
0.07
0.078
0.065
0.073
0.063
Mean
0.06
0.058
0.06
0.05
0.04
0.03
0.02
0.01
0
Baseline
30 Day Follow up
Individual
Group
3 Month Follow up
Results: Estimated Peak Blood
Alcohol Concentration (BAC)
0.16
0.14
0.12
0.140
0.131
0.101
0.101
Mean
0.1
0.08
0.095
0.096
0.06
0.04
0.02
0
Baseline
30 Day Follow up
Individual
3 Month Follow up
Group
Results: Alcohol Problems
7
6.3
6
Mean
5
5.6
4.7
4.3
4
3
4
3.1
2
1
0
Baseline
30 Day Follow up
Individual
3 Month Follow up
Group
Results: Number of Safer Drinking
Strategies
60
50
47.932
47.007
40
Mean
34.283
30
33.027
28.38
25.376
20
10
0
Baseline
30 Day Follow up
3 Month Follow up
Individual
Group
Discussion
• Participants decreased their alcohol use and associated harms after
they received a MI
• Group MI was not statistically different than individual MI
Summary of Main Study Outcomes
 Both Groups demonstrated decreases on key outcome variables
 No differences between the group versus individual conditions
 No gender by intervention effects
 Group motivational interviewing appears to be a cost effective method
 Participants decreased their alcohol use and related harms after
BASICS
 Despite the lack of a control group, the magnitude of these reductions
are similar to similar studies (e.g., Carey, et. al., 2006)
Limitations
• Results may not generalize to non-mandated students
• Lack of an assessment-only control group
• Fidelity of the interventionists has not been analyzed
Implications
 Results suggest that group MI is a cost-efficient intervention
strategy
Future Directions
 Evaluate mechanisms and active ingredients of behavioral change
 Look at mediators of change such as: alcohol norms, motivation to
change, self efficacy, alcohol beliefs and in-session talk
 Investigate the effect of time on outcomes
 Our 6 month follow up is in progress and will be finished soon
 Continue to evaluate the efficacy of BASICS
Thank You to Penn State Staff
Involved with BASICS
 Liz Barton-Staff assistant
 Alwyn Brittain-BASICS Health Educator
 Angel Goldian-Staff assistant
 Rochelle Holmes-BASICS Graudate Assistant
 John Hustad, Ph.D.-BASICS Researcher
 Linda LaSalle, Ph.D.-Associate Director of Educational Services
 David Mallen-BASICS Health Educator
 Jessica Nabozny-BASICS Health Educator
 Steve Shephard-BASICS Health Educator
 Katie Tenny-BASICS Health Educator
 Rachel Urwin, Ph.D.-Coordinator of Educational Services
THANK YOU 
Contact information:
Suzanne Zeman, M.S., R.N.
Coordinator of Educational Services
The Pennsylvania State University
University Health Services
slb227@sa.psu.edu
(814) 863-0461