Young adults — particularly college students — are more likely than any other group in the U.S. to engage in heavy drinking and experience alcohol-related consequences.
The consequences of heavy drinking — which is defined as four or more drinks per occasion for women and five or more for men — are felt throughout the college community. These include blackouts, academic underperformance and interpersonal problems. Then there are the secondhand consequences for students who don’t drink, such as interrupted study, aggression, assault and having to care for intoxicated peers.
In a new study, researchers from the Brown University School of Public Health developed and tested an intervention called Counter-Attitudinal Advocacy (CAA). CAA involves advocating for a position that contradicts a personally held attitude or behavior. In this context, CAA targets positive perceptions of heavy drinking and the belief that alcohol is an essential part of college life.
In randomized controlled trials at two sites with 585 college students, researchers compared CAA to the well-established Personalized Normative Feedback (PNF) to evaluate their effectiveness in decreasing drinks per week, peak blood alcohol concentration and alcohol-related consequences relative to a control group. Researchers focused on drinks per week, a standard measure given the irregular drinking patterns of college students, who often veer between heavy drinking and alcohol-free days.
Ultimately, they worked on answering two main questions:
- Does CAA effectively reduce alcohol-related risk compared to our control?
- How does CAA compare to PNF, which has proven to be an effective low-cost way of reducing alcohol consumption among high-risk students?
Here’s what they found: Participants who received PNF reported significantly fewer drinks per week than the control group, while those who received CAA reported significantly fewer consequences. CAA had a harm reduction effect on consequences — its intended focus — but not on consumption of alcohol, which it did not target.
“Both interventions take just 5-10 minutes, making them ideal for broad prevention efforts,” said Kate Carey, co-lead investigator of the study and professor of behavioral and social sciences at Brown. “Our results showed that PNF did reduce alcohol consumption, as expected. But CAA specifically reduced the number of problems participants reported due to drinking. So, while they had different effects, they were complementary — giving us another useful tool for harm reduction.”
Carey explained that PNFs show participants how their drinking habits stack up against those of their peers, often exposing a common misconception that others drink more than they actually do: an insight that can help them adjust their own behavior. In contrast, CAA encourages participants to reflect on why it is a good idea to avoid alcohol-related problems, such as passing out or taking excessive risks, and to identify specific actions they can take to minimize these risks.
“Instead of directly telling students what to do, we prompt them to generate their own strategies,” Carey said. “This makes the intervention personalized and non-confrontational. Unlike some interventions that make people feel defensive about their drinking, CAA frames the discussion more broadly: ‘Why is it good for young people to avoid problems?’ rather than ‘You personally need to change.'”
As participants responded to these prompts, a research assistant or peer asked them to explain their written responses. Carey noted that this act of verbal reinforcement likely strengthened the intervention’s effect, since we tend to feel more committed to our viewpoints when we share them publicly.
It’s important to have a variety of brief interventions, since no single approach works for everyone, Carey stressed. Offering multiple evidence-based options increases the chances of reaching more people who are undergoing a period of heightened risk.
The research team, which includes co-primary investigators Angelo DiBello associate professor of applied and professional psychology at Rutgers University and Clayton Neighbors, professor of social psychology at the University of Houston, are encouraged that CAA provides another effective tool — especially for those who may not respond to PNF.