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Tho effects of -efficacy training on types of alcohol drinker and their resisting drinking in unpleasant emotional situations

Fennig, John Patrick, Ph.D. The Ohio State University, 1989

Copyright ©1989 by Pennlg, John Patrick. All rights reserved.

UMI 300N.ZeebRd. Ann Arbor, MI 48106

THE EFFECTS OF SELF-EFFICACY TRAINING ON TYPES OF ALCOHOL DRINKER AND THEIR CONFIDENCE RESISTING DRINKING IN UNPLEASANT EMOTIONAL SITUATIONS

DISSERTATION

Presented in Partial Fulfillment of the Requirements for the Degree Doctor of in the Graduate School of the Ohio State University

by

John Patrick Fennig, B.A., M.A.

*****

The Ohio State University 1989

Dissertation Committee: Approved by Lyle D. Schmidt, Ph.D. Theodore J. Kaul, Ph.D. W. Bruce Walsh, Ph.D. J~(snL(- CP / Adviser --- Department of Psychology Copyright by John Patrick Fennig 1989 ACKNOWLEDGMENTS

A number of people have provided direct support of many kinds over the past two years to make this dissertation possible. In addition to learning how to do the science of psychology a little better, the people In this process have helped me to understand both what I can do well and, perhaps more importantly, what I cannot do so well. This of limits for me is also a wonderful discovery of the tremendous resources of others. I would like to thank Dr. Lyle Schmidt for taking me on as an advisee mid-stream and for continuing to support me long-distance for two years. He invested serious time and in helping me to research and to write more accurately and meaningfully. Dr. Bruce Walsh and Dr. Ted Kaul have been intriguing and inspiring for me throughout graduate school and other very helpful reading committees. Both have taught me how to ask better questions and to say what I mean, both in the assessment of and of research problems.

ii Father John Forliti and many at the College of St. Thomas made this study a reality. I greatly appreciate Fr. Forliti's provision of grant money from the alcohol fund to help pay many of the expenses involved in doing research. He also offered much needed moral support and mentoring. Brian Dusbiber and the Residence Life staff provided rather awesome computer facilities and a comfortable place to do some late-night work. I am thoroughly indebted to Dr. Lorman Lundsten and others at the St. Thomas computing center who spent long hours helping me to analyze such a volume of data on seven different computer programs and become considerably more computer literate in the process. Kris Nitti gets credit for help with the graphic embellishment in the text. Through two rather difficult and eventful years, many have offered personal support and encouragement. I especially want to thank Debbie Buss for this. Hy uncle and mentor, Fr. Tom Finucan offers unending inspiration and much needed guidance into what God wants for and from me. My brother Tom and his wife Patti helped with their concern and an emergency computer donation. Dan and Barb Keegan served the best bed and breakfast in Columbus through their own transition year and were very encouraging and caring to me in my own transitions. Mark Harris has been a dear friend and very wonderful

iii colleague who offered timely wit and timeless support. Micheal Robert Buss-Fennig was a big and blessing to me. The short time X knew him was during the final stages of this research. His presence helped me to finish what was important. Finally, deep love and thanks to the parents I have known my whole life and to those who I never did, but who gave roe the chance for life to begin with.

iv VITA

April 25, 1960...... Born - Milwaukee, Wisconsin 1982...... B.A., Saint John's University, Collegeville, Minnesota 1984-1985...... Management Consultant, Price Waterhouse, Columbus, Ohio 1985...... M.A., Counseling Psychology, The Ohio State University, Columbus, Ohio 1987-1988...... Doctoral Psychology Intern, The University of Minnesota, Minneapolis, Minnesota 1987-198 9 ...... Alcohol and Other Drug Counselor, College of Saint Thomas, Saint Paul, Minnesota 1988-198 9 ...... Adjunct Consultant, MDA Consulting Group, Inc., Minneapolis, Minnesota 1989-Presen t ...... Consultant/Trainer - Training and Development Division, Personnel Decisions Inc., Minneapolis, Minnesota

PUBLICATIONS/PRESENTATIONS

Fennig, J. P. (1989, February). Self-hvpnosis as an alcohol prevention strategy. Minnesota Association for Counseling and Development, Minneapolis. Jolkovski, M. P. & Fennig, J. P. (1988, February). Entering the system in the Big Tent A survey of counseling center intake proceduresT Big Ten Counseling Centers Annual Conference, Minneapolis. v Fennig, J. P. (1985). College students' expectations of self-efficacy and preferences seeking help. Unpublished Master's Thesis, chair: Harold B. Pepinsky, Ph.D.

FIELDS OF STUDY Major Field: Counseling Psychology

vi TABLE OF CONTENTS

ACKNOWLEDGEMENTS ...... ii VITA ...... v LIST OF TABLES ...... ix LIST OF FIGURES ...... xi CHAPTER PAGE I. INTRODUCTION ...... 1 II. REVIEW OF LITERATURE College-Based Alcohol Abuse Prevention Programs ...... 10 The Concept of Self-Efficacy...... 15 Applications of Self-Efficacy to ...... 19 Self-Efficacy and Alcohol Abuse ...... 20 Summary and Research Hypotheses ...... 25 III. METHOD Subjects ...... 28 Instruments...... 30 Design and Procedure ...... 38 IV. RESULTS Description of the S a m p l e ...... 43 Treatment Procedural Check ...... 53 Drinking-Related Self-Efficacy Expectations in Unpleasant Emotional Situations...... 56 Effects of Treatments ...... 62 Additional Findings ...... 70 V. DISCUSSION Summary of Findings...... 75 Assumptions and Limitations...... 81 vii Implications ...... 83 REFERENCES ...... 86 APPENDICES A. Survey of Health Activity ...... 93 B. Outline of the Training M o d u l e ...... 95 C. Manipulation Check Rating Sheet ...... 100

viii LIST OF TABLES

TABLE PAGE

1. Pre-Treatment Frequency of Characteristics 45 in the Three Treatment Groups 2. Pre-Treatment Quantity and Frequency 47 Percentages of the subjects' Alcohol Consumption 3. Pre-Treatment Gender Differences in Q-F 48 Drinking Level 4. Pre-Treatment Distribution of Q-F Drinking 51 Level by class Year 5. Pre-Treatment Distribution of Q-F Drinking 52 Level by Grade-Point Average 6. Pre-Treatment Percentage of Subjects 54 Experiencing Problems as a Result of Drinking 7. Pre-Treatment Problems Experienced in the 55 Last Two Months as a Result of Drinking That Were Significantly Higher for Heavy Drinkers Than Moderate or Lighter Drinkers 8. Procedure Check of Treatment Conditions 57 by Six Trained Student Raters 9. Pre-Treatment Ratings of Confidence 58 Resisting Drinking by Different Levels of Drinker in Eight Situations 10. Mean Pre-Treatment Ratings of Confidence 61 Resisting Drinking in Unpleasant Emotional Situations

ix TABLE PAGE 11. Significant Pre-Treatment Variation in 63 Different Drinker's Ratings of Confidence Resisting Drinking in Eight Situations 12. ANOVA: The Effects of Three Levels of 64 Self-Efficacy Training on Ratings of Confidence Resisting Drinking in Unpleasant Emotional Situations 13. Mean Post-Treatment Ratings of Confidence 65 Resisting Drinking in Unpleasant Emotional Situations 14. Effects of Self-Efficacy Training on 66 Confidence Resisting Drinking for Different Types of Drinker 15. Pearson's Correlation Between Pre-Treatment 68 About Alcohol and Ratings of Confidence Resisting Drinking in Eight Situations 16. Effects of Self-Efficacy Training on Gain 69 in Knowledge About Alcohol 17. Effects of Self-Efficacy Training on Gain 71 in Knowledge About Alcohol by Q-F Drinking Level 18. Effects of Problems Experienced as a 72 Result of Drinking on Pre-Treatment Ratings of Confidence Resisting Drinking in Eight Situations 19. Significant Differences in Pre-Treatment 73 Ratings of Confidence Resisting Drinking by Recency of Drinking-Related Problems Experienced

X LIST OF FIGURES

FIGURE PAGE

1. Quantitv-Frequency (Q-F) Drinking Level 33 Classification System 2 . How Different Drinkers Rate Their 60 Confidence Resisting Drinking in Eight Situations

xi CHAPTER I INTRODUCTION

Problems related to the consumption o£ alcohol are prevalent throughout society (Emboden, 1988). National Institute on.. Alcohol Abuse statistics from 1983 suggest that 68% of Americans twenty-one and older consume alcohol. Eight percent of those who drink develop a dependence on alcohol, with men six times more likely to do so than women. Only about 1% of those in need of help for alcohol dependency seek it. The estimated annual cost for alcoholism and alcohol abuse to the United States is about 116 billion dollars (Nace, 1987). Although societal problems with alcohol exist, a disproportionate share of these problems continue to be found on the college campus. With over 85% of American college students drinking beer, wine or distilled spirits, this population has a higher number of drinkers than any other single population in the United States. College students also report greater quantities and frequencies of alcohol use than the general population (Gonzalez & Broughton, 1986; Neidigh, Gesten & Shiffman, 1988). Extensive studies by Engs (1977) and Engs and

1 2 Hanson (1985r 1988) across a large number of colleges nationally reveal that although over-all drinking, and problems related to drinking, have decreased slightly in the past 10 years, the proportion of students classified as heavy drinkers (5 or more drinks at one occasion at least weekly) has remained constant at about 20%. They also found a significant increase over the past decade in women reporting heavy drinking and problems related to drinking. Their research and that of others (Bloch & Ungerleider, 1988) suggests that the consumption of alcohol by college students is significantly higher for men, Caucasians, first year students, those with lower grade-point averages, Roman Catholics (in comparison to those seeing religion as important), those for whom religion is not important (in comparison to those for whom it is), and those attending school in the North Central part of the United States. Heavy drinkers are those most likely to have drinking problems and to negative consequences as a result of alcohol use (Berkowitz & Perkins, 1986; Engs & Hanson, 1988). Despite greater efforts at alcohol education and counseling on college campuses in the last decade, student-affairs administrators see alcohol- related problems as increasing (35%) or remaining the same (41%) (Magner, 1988, November 9). Bloch and Ungerleider (1988) suggest that alcohol abuse prevention 3 programs with college students may not be reaching those students most in need of them. Most college-based programs of alcohol abuse prevention lack an empirically-tested theoretical base (Anderson, Maypole, & Norris-Henderson, 1987; Frankel & Gonzalez, 1984; Milgram, 1987; Woodward, 1986). In an extensive review of 14 alcohol education programs for college students, Goodstadt and Caleekal-John (1984) found some version of a knowledge-- model in all the programs. This review points to the current lack of about the relationships that exist between the three variables in this model. It also remains unclear what the underlying psychological mechanisms are that might influence these variables, due to the lack of a unifying theory. At the First National Conference on Campus Alcohol Policy Initiatives in 1986, Gerardo Gonzalez, one of the founders of the national college network BACCHUS (Boost Alcohol Consciousness Concerning the Health of University Students) called for the needed development of a theoretical base for alcohol education. Barnes (1984) sees the absence of theory as causing ambivalence and confusion in defining the desired outcomes of prevention programs. As an example, he points to the lack of clarity and multiple definitions of the term "responsible use", a term that serves as a basis for many programs on alcohol use. 4 A lack of clarity and direction appears to exist in application as well as theory. A recent survey (Dean, Dean & Kliener, 1987) of alcohol and drug treatment programs on college campuses describes a wide variety of treatment approaches and programs being implemented. The authors suggest that these variations may represent conceptual confusion and indecision in the delivery of alcohol and drug treatment services. Developers of the comprehensive alcohol education program HLAY (Here's Looking At You), based on the prevailing knowledge- •attitude-behavior model, suggest that their program's failure to change behavior related to alcohol could be due to the complexity of the "responsible use" (Hopkins, Mauss, Kearney & Weisheit, 1988). Efforts towards alcohol abuse prevention have been classified into three epidemiologic categories (Alden, 1980; Cellucci, 1984; Engstrom, 1984). Primary prevention refers to the removal or modification of the causes of a drinking disorder to prevent its occurrence. Secondary prevention means the early identification and treatment of a drinking disorder. Tertiary prevention refers to the treatment of a fully developed disorder. Alcohol abuse prevention efforts with college students are most typically at the primary and secondary levels. Despite the importance of primary and secondary preventipn interventions for this population and their 5 potential for alleviating the later need for tertiary programs, scientific data are extremely weak at both the primary (Engstrom, 1984) and secondary (Cellucci, 1984) prevention level. Nathan (1986) calls for a complete rethinking of prevention program strategy. Me identifies both social learning concepts and cognitive processes as playing important roles in drinking behaviors. Research on prevention is necessary to better define what Botvin (1983) calls the "active ingredients" of alcohol abuse. Identification of these ingredients would lead to better definition of the behaviors targeted by prevention interventions. Bandura's social cognitive model of behavior offers a potentially useful explanation of the underlying mechanisms of drinking behavior. The model suggests that self-efficacy expectations are an important mediating variable in the link between knowledge and behavior (Bandura, 1986). A self-efficacy expectation is defined as a belief in one's ability to perform a specific behavior in a specific situation (Bandura, 1977). Effective drinking-related behavior requires both the possession of necessary to engage in the behavior and the necessary expectations of self-efficacy to actually implement these skills. Marlatt and Gordon (1985) have developed a social learning model for the tertiary level of alcohol abuse 6 prevention, relapse prevention £or alcoholics, and an approach to assessing and changing drinking-related self- efficacy expectations. Their model is well established in the scientific literature and in therapeutic settings (Annis, 1986; Rist & Watzl, 1983). The role of self- efficacy expectations in decreasing the probability that alcoholics will drink has been clearly outlined (Clifford, 1983; Marlatt & Gordon, 1985). The Situational Confidence Questionnaire (SCQ) (Annis, 1987) was developed and shown to measure an alcoholic's efficacy expectations about resisting drinking in high- risk situations. Results from this instrument are used to monitor the progress of treatment and the potential for relapse. Marlatt and Gordon (1985) point to the SCQ and other applications of self-efficacy in developing health-related instruments (e.g. Condiotte & Lichtenstein, 1981; Lawrance & Rubinson, 1986; Litt, 1988a) as providing a general framework for the future development of additional drinking-related self-efficacy measures for different populations and applications. It would appear that Bandura's model provides testable constructs and established therapeutic and research methodologies that* could improve not only tertiary-level programs for identified alcoholics, but primary-level programs for college students who have not yet developed abusive drinking practices and secondary- 7 level interventions for those who are in earlier and perhaps more treatable stages of alcohol abuse or alcoholism. Barnes (1984) encourages the use of social learning theory in defining the of alcohol education and prevention programs. Bandura's (1986) social cognitive theory is an extension of social learning theory with an increased emphasis on the mediating role of cognition. No empirical research has been done on the application of self-efficacy to alcohol abuse prevention with young in college who engage in a wide range of drinking behaviors and experience different problems as a result of drinking. Botvin's (1983) highly effective Life Skills Training program for alcohol abuse prevention in high-school students is a "broad-spectrum" approach utilizing social learning strategies. Behavior- based skills training has been shown to reduce drug abuse among a Native American population (Gilchrist, Schinke, Trimble & Cvetkovich, 1987). While outcome measures for both these programs suggest their over-all effectiveness, no direct measures of skills training on self-efficacy were made. This study sought to demonstrate the usefulness of Bandura's (1977) conception of self-efficacy in describing alcohol consumption patterns and problems of college students and in providing a useful theoretical 8 basis for primary and secondary prevention programing. Specifically, this study examined the relationship between expectations of efficacy resisting drinking in high-risk situations, type of drinker and the number and kinds of drinking-related problems encountered. This study also tested the effectiveness of three levels of self-efficacy training, performance attainments ("mastery"), vicarious experience ("modeling") and verbal persuasion ("lecture"), on confidence resisting drinking in unpleasant emotional situations. Of the eight high- risk drinking situations measured by the Situational Confidence Questionnaire, Unpleasant Emotional situations was selected as the target for self-efficacy training. Due to the nature of this study as the first to apply the SCQ to a sample comprised of many types of drinkers, the selection of this particular behavioral situation was based both on the indications of previous studies and the recognition that the results of this study might indicate useful investigations with other situations as dependent variables. Marlatt (1978) identified the greatest chance of relapse for an alcoholic as occurring during unpleasant emotional situations. It was assumed this situation would provide the greatest possibility for changing cognition related to resisting drinking. Given the impact of unpleasant emotions on relapse, the focus of tertiary prevention interventions, it was seen as a 9 logically important focus for earlier prevention efforts at the primary and secondary levels. CHAPTER II REVIEW OF LITERATURE

College-Based Alcohol Abuse Prevention Programs Based on extensive research over the last 15 years, it appears that psychological factors an important role in concert with, and at times independent from the pharmacological effects of ethanol on drinking behavior (Christiansen, Smith, Roehling & Goldman, 1989). Additionally, the literature suggests the need for continued and improved research to develop alcohol abuse prevention programs (Cellucci, 1984; Goodstadt & Caleekal-John, 1984). One for this is that current programs have yet to demonstrate their effectiveness (Engstrom, 1984). Alden (1980) reports mixed results in the literature on primary prevention programs for alcohol education. He attributes this to the still unspecified etiology of alcohol abuse, with its complex and interrelated psychological and environmental determinants. Without an understanding of the mechanisms involved, programs to prevent abusive drinking lack the critical targets to be most effective. He encourages continued efforts to develop secondary-level prevention 10 11 programs, targeting identified nat risk" populations that may already be drinking, while these fundamental mechanisms are being identified. Others suggest continued research of prevention-level programs is necessary because there are more people in need of help than there are available treatment facilities, that the efficacy of alcohol abuse treatment is still in question and that wide-spread progress requires early efforts at the source of the problem (Nirenberg and Miller, 1984). Many authors have encouraged more focused investigations into the psychological mechanisms involved in the use and abuse of alcohol and the development of behavior-based skills training programs to teach the effective management of alcohol use. The First National Conference on Campus Alcohol Policy Initiatives' in 1986 recommended primary-level prevention research to develop programs in a cognitive and behavioral framework (Woodward, 1986). The recommended programs would facilitate skills development and decision-making competence. Cellucci (1984) reports that the research does not support a strong relationship between knowledge about alcohol and consequential attitude or behavior change. Rather, he sees the advent of skills-based curricula based on social learning theory that target measurable behavior changes as the most promising avenue for 12 research and programming. He recommends a six component approach to changing abusive drinking behavior: 1) self-monitoring and functional analysis of drinking behavior, 2) eliminating the problematic antecedents of drinking, 3) discriminating Blood Alcohol Content, 4) modifying drinking behavior directly, 5) generating alternatives to drinking, and 6) changing environments to support moderate drinking. These interventions involve both cognitive and behavioral dimensions. Engs and Fors (1988) see the key elements of a prevention curriculum including the skills for decision­ making, , reduction and generating alternative "highs", as well as cognition related to self-esteem and alcohol knowledge. They recommend these goals in response to both academic uncertainty and national-level political disagreement on desired outcomes of prevention education. They encourage the promotion of a "responsible use" rather than a "prohibitionistic" stance on the goals of alcohol education and that the students be included in the definition of what their program defines as "responsible". They see this as promoting better self-management and greater personal of healthy behavior. There are significant correlations between an 's exercising external and internal self-control strategies and both the amount of alcohol they consume and the problems they experience 13 as a result of drinking (Werch & Gorman# 1988). Multifaceted programs that cast a broad educational net may not be as successful reaching who need them most (Bloch & Ungerleider, 1988). This may be due in part to the nature of seeking and receiving help# where a must execute the skills necessary to recognize their current Inability to cope and identify resources they know how to access. College students are most likely to seek the help of resources that they are confident using, turning to a friend or family member for a personal problem with alcohol before turning to a college counselor or teacher (Fennig, 1985). It would appear that prevention efforts need to be focused to specific individuals and behaviors to be most effective (Bloch & Ungerleider# 1988), with the targeting process itself better ensuring those who need help can get it. This is important due to the discrepancy that can occur between self-identified and objectively defined problematic alcohol use. Berkowitz and Perkins (1986) found only 1% of their sample admitting having a problem with alcohol, in comparison with 25% that were objectively assessed to be experiencing alcohol-related problems. These authors suggest that the focus of alcohol abuse interventions should be on the current effects of a person's use and the inconsistencies with their immediate and long-term goals. This recommendation 14 for training in self-management and through a functional behavioral analysis matches the social learning approach to interventions for preventing abusive alcohol consumption. Applying these strategies that have been shown to work at the tertiary level of alcohol abuse prevention, enabling identified alcoholics to stay sober, would also appear to be beneficial at the secondary and primary prevention levels (Alden, 1980). A social learning approach to prevention emphasizes the development of self-management skills and cognition to cope with alcohol. The self-control approach assists individuals to define what their level of responsible use is, and helps them to acquire the necessary skills to maintain that level of consumption. This includes controlled drinking programs for those who have previously abused alcohol (Marlatt & Parks, 1982). This model stands in clear contrast to the abstinence-based model of prevention promoted by Alcoholics Anonymous, viewing alcohol abuse as a disease that the individual alone is powerless to overcome. The self-control approach to alcohol education and abuse prevention appears more useful for most college students for several . First, this approach defines specific and teachable behaviors that can be readily practiced and perhaps generalized to other situations and problems that students encounter. Second, a skills-oriented approach 15 to self-management and responsible alcohol use would be received more favorably by students than abstinence- oriented programs. Third, it actively involves the students in defining for themselves desired behaviors, and goals. The Concept of Self-Efficacy Extensive research has been done applying social learning theory to interventions that help identified and treated alcoholics remain sober, defined as tertiary- level or relapse prevention (Marlatt & Gordon, 1985). A critical component of their model and a target for treatment is Bandura's concept of self-efficacy. Self- efficacy is defined as a judgement of one's capability to accomplish a certain level of performance (Bandura, 1986). This cognition is seen as a mediating variable between knowledge and behavior. The importance of cognition for Bandura is reflected in his renaming the theory social cognitive rather than social learning in 1986. Effective behavior, then, requires not only the skills to perform, but also the belief or confidence in one's ability to perform. Individuals make two separate cognitive evaluations in the selection of their behavior, efficacy expectations and outcome expectations. Efficacy expectations are judgments of personal ability. Outcome expectations are estimations of the likelihood of a successful behavioral outcome, regardless of personal 16 competency to perform the behavior, that take into account environmental and situational contingencies that would promote or prohibit executing a given behavior. Efficacy expectations determine a person's choice of activity, level of effort and duration of persistence in the face of obstacles and aversive (Bandura, 1977) . Efficacy expectations are highly situation-specific evaluations. They are seen as developing out of the reciprocal interaction of three components, individuals themselves, their environment and their history of past behaviors (Bandura, 1978). This ongoing inter-relation of elements explains how dysfunctional behaviors are maintained and often further deteriorate on the same cyclical basis that functional behaviors are maintained and enhanced through the influences of the person, his or her environment and behavioral contingencies. Dimensions of self-efficacy include the strength, magnitude and generality of the perception. The strength of an efficacy expectation is the degree of confidence an individual has in his or her ability to perform a behavior, measured in percent of confidence. Magnitude refers to how difficult a task individuals see themselves as capable of performing. Generality refers to how situation-specific or general the sense of efficacy is. 17 The utility of the self-efficacy construct for modifying or changing behavior is in Bandura's (1977) specific reference to sources of efficacy information. The four sources of information that affect efficacy are mastery experiences, modeling experiences, verbal persuasion and emotional/physiological states. Mastery experiences refer to the in vivo exposure of the person to a behavior and opportunities to engage in it directly. These experiences are the most powerful at changing cognition and behavior through performance desensitization, participatory modeling, performance exposure and self-instructed performance. This is learning by doing. Vicarious experience or modeling is seen as the next most powerful source of efficacy information. It involves either live or symbolic modeling to demonstrate alternative behavior. This is learning by watching others doing. Verbal persuasion can occur through suggestion, exhortation, self-instruction or interpretation. It is seen as less powerful than either mastery or modeling and is learning by hearing how to do. Lastly, emotional and physiological states are instructive through attributions, biofeedback, symbolic desensitization or 'symbolic exposure. A growing body of literature suggests the predictive utility of self-efficacy expectations on behavior (Bandura, 1986; Morris & Altmaier, 1988; Schunk & 18 Carbonari, 1984). Self-efficacy has been applied to descriptions of the mechanisms of depression and potential therapeutic interventions (Ahrens, Zeiss & Kanfer, 1988). Cervone and Peake (1986) examined efficacy expectations in relation to task persistence. Their findings suggest that personal standards of behavior and persistence toward goals may be a function of perceived self-efficacy. Guidelines for facilitating self-efficacy are also well established in the literature. In order to effect lasting changes in a client's self-schemata, Goldfried and Robins (1982) suggest a four step approach that includes: 1) discriminating between past and present behavior, 2) viewing change from both objective and subjective vantage points, 3) helping the client to retrieve past successful experiences, and 4) aligning the client's expectancies, anticipated feelings, behaviors, objective consequences and subjective self-evaluations. Schunk and Carbonari (1984) suggest that conscious self- evaluations of perceived efficacy are more prominent during the modification of habits or in response to drastic changes in circumstances. Whereas low self- efficacy expectations require strong sources of efficacy information in order to change, strong expectations of personal efficacy are not easily destroyed by brief failures. Individual self-regulation, they point out, 19 involves self-monitoring, self-evaluation and self­ reinforcement. Although people employ these skills more commonly to maintain behavior rather than to change it, deep and lasting behavior change is possible. It is initiated and maintained through the interaction of self- regulatory skills and expectations of self-efficacy. Applications of Self-Efficacy to Health Behaviors Self-efficacy expectations have been applied and assessed in relation to a growing number of health- related behaviors. Its earliest and most tested application has been with smoking cessation. Condiotte and Lichtenstein (1981) found a strong relationship between self-efficacy and maintained abstinence from cigarettes. .Efficacy expectations were better predictors of sustained smoking cessation than past behavior. Similar findings related to smoking were found by other researchers (DiClemente, Prochaska & Gibertini, 1985; Godding & Glasgow, 1985; Lawrence & Rubinson, 1986). Devins and Edwards (1988) tested self-efficacy in relation to smoking behavior in chronic obstructive pulmonary disease patients. After controlling specific expectancies and cognition, they found that self-efficacy was the only significant predictor of reduced smoking, over other tested social cognitive theory constructs. They suggest the need to gauge habit-strength and level along with efficacy beliefs. 20 Efficacy expectations were found to be predictive of pain control and (Litt, 1988b), asthma control (Tobin, Wigal, Winder, Holroyd & Creer, 1987)and recovery from bulimia (Schneider, O'Leary & Agras, 1987). These studies demonstrated how efficacy expectations can be measured and altered to increase self-management and healthy behavior selection. Two recent articles review the growing range of health-related applications of self- efficacy in defining target populations, outcome criteria and change mechanisms (Lawrance & McLeroy, 1986; Strecher, DeVellis, Becker & Rosenstock, 1986). Self-Efficacy and Alcohol Abuse Despite the increasing in Bandura's social cognitive theory and the concept of self-efficacy in the research and treatment of health-related behaviors, few studies to date have applied them to the use of alcohol. The focus of studies currently present in the literature is on treating identified alcoholics and preventing their relapse into abusive drinking. It appears that there are few studies on alcohol-related efficacy expectations and interventions at the primary or secondary levels of alcohol abuse prevention. Berg and Skutle (1986) suggest early-stage problem drinkers have received little in the research and that there are still no standard screening instruments or procedures for identifying them. They used one of the first measures of 21 self-efficacy and drinking, the High-Risk Situations Questionnaire.(Chaney, O'Leary & Harlatt, 1978), to test four behavioral approaches to alcohol abuse treatment. Although they did not find significant differences between treatment groups, significant agreement was found on the lower confidence ratings for two specific high- risk situations. At intake, negative emotional states was reported by 42% of the subjects as their greatest risk scenario for .relapse. At 12 month follow-up, 45% of the subjects reported being least confident resisting drinking in positive emotional states with others. Rist and Watzl (1983) studied the self-assessment of relapse risk in relation to therapeutic outcomes with female alcoholics and found efficacy expectations were related to the patient's conviction to stay abstinent from alcohol. Interestingly, they found these expectations being stated by the subjects as early as the time of admission into treatment. Clifford (1983) describes the potency of efficacy expectations in reducing the risk of alcoholic relapse and defines therapeutic steps to increase self-efficacy. Most recently, Hansen et al. (1988) tested an alcohol abuse prevention program for adolescents based on self-efficacy expectations related to resisting peer pressure to drink. The study failed to demonstrate a change in the subject's confidence to "say no", even 22 though their behavioral repertoire to avoid drinking was increased. The most comprehensive linking of social cognitive theory and drinking behavior is Marlatt's work in the tertiary level of relapse prevention (Marlatt & Gordon, 1985). Self-efficacy expectations play an important mediating role in determining the probability of an alcoholic taking another drink. Increased confidence in one's ability to resist drinking leads to a decreased probability of drinking. This leads to consequences that are reinforcing of even stronger efficacy expectations through the execution of alternative coping strategies other than drinking. Alternatively, decreased confidence in one's ability to resist drinking combined with positive expectancies regarding the effects of alcohol often leads to its consumption. After taking a drink, the Abstinence Violation Effect or "once and for all rule" occurs. Due either to cognitive dissonance or negative self-attributions, the decision to drink is blamed on the alcohol itself or something external to the individual. In the face of external forces perceived as stronger than themselves, the individual experiences even more of a decrease in self-efficacy, viewed as a process that is reciprocally determined, the cycle is completed and the individual is even more likely to drink in the future. 23 Marlatt and Gordon (1985) outline a method for therapeutic interventions with alcoholics to prevent relapse. It involves defining explicit goals with the client's input, explicit intervention procedures and evaluation criteria based on the goals and treatments decided upon. They describe a functional behavior analysis that begins with the identification of risky drinking situations for the client and an assessment of their coping skills capacity. This serves as a basis for individually-tailored skills-training. The first skills taught are advanced planning and problem solving strategies to recognize cues as discriminating stimuli to perform coping responses. Successful experiences with advanced planning skills contribute to an increased sense of personal responsibility and self-efficacy with early decision-making. Following this, coping skills training is suggested using the strongest sources of efficacy information available. Instruction, modeling, behavioral rehearsal and coaching are used to teach both the actual behaviors being acquired and the cognitive processes needed to generate these behaviors. This cognitive- behavioral approach teaches relaxation, assertiveness, and self-control methods. This procedure may be applicable to drinkers in earlier Btages of problems with alcohol, at secondary prevention levels, or even in equipping individuals with 24 the skills and cognition to cope with alcohol before it becomes a problem at all, primary prevention. As applied to those already having problems with alcohol, the earlier one intervenes in the chain of events leading to high-risk drinking situations, the easier it is to prevent relapse (Marlatt & Gordon, 1985). In relation to alcohol, a healthy and effectively functioning individual in terms of social learning theory is one who has a rich and flexible repertoire of cognitive-behavioral skills to make informed decisions about whether to drink, how much to have and how to behave if drinking (Abrams & Niaura, 1987). In researching the cognitive capabilities of problem drinkers, Larson and Heppner (1989) found male alcoholics' problem-solving appraisal more similar to late adolescents than to adults to whom they were closer in age. It would seem that behavioral interventions could be developed and targeted for individuals along the range of drinking behaviors, from infrequent drinkers to alcoholics. Interventions with those in earlier stages of drinking might prevent their developing heavier drinking habits and problems. Abrams and Niura (1987) see future research into social learning-based prevention programs for younger individuals as promising and potentially leading to sorely needed programs of primary prevention. 25 Annis (1986) reports that treatment programs have been generally successful at Initiating behavior change but that the maintenance of therapeutic change over time continues to be a problem. She sees the self-efficacy construct as providing a testable and useful framework for conceptualizing alcoholic relapse and a potential basiB for designing relapse prevention strategies that are better at maintaining change. Her Situational Confidence Questionnaire (Annis, 1987) assesses self- efficacy in relation to a client's ability to cope effectively with alcohol. Specifically, it measures an individual's confidence resisting drinking heavily in eight high-risk situations. Reliability and validity testing suggest its soundness as a useful tool in the measurement of self-efficacy as it relates to alcohol consumption for populations of identified alcoholics. She sees additional research as needed to test the SCQ's usefulness with other populations seeking help for their alcohol use. Summary and Research Hypotheses It appears that college students' level of alcohol consumption and the problems they experience as a result of drinking could be related to their confidence in their ability to use or not use alcohol. Further, expectations of self-efficacy related to managing drinking have been measured and strengthened through rehabilitation programs 26 at tertiary levels of prevention for identified alcoholics (Annis, 1986). It appears possible and desirable to assist college students to better manage their drinking through strengthened expectations of self- efficacy. This study sought to extend Bandura's social cognitive construct of self-efficacy as lending theoretical support beyond tertiary rehabilitation efforts (Marlatt & Gordon, 1985) to primary and secondary level alcohol abuse prevention programming. Specifically, it was hypothesized that college students' level of alcohol use, as measured by the Student Alcohol Questionnaire (SAQ) (Engs, 1975), would be significantly related to their confidence in their ability to resist drinking. It was expected that across all eight high- risk drinking situations measured by the Situational Confidence Questionnaire (SCQ) (Annis, 1987), heavy drinkers would report the least confidence resisting drinking and light drinkers would report significantly greater confidence. No predictions about abstainers were made since drinking-related self-efficacy expectations have only been previously tested with alcoholics (Chaney, O'Leary & Marlatt, 1978; Rist & Watzl, 1983; Annis, 1986). In these treatment programs, effective self­ management of alcohol consumption was elicited by increasing efficacy expectations related to drinking. 27 The second hypothesis of this study was that self- efficacy expectations to resist drinking can be strengthened through alcohol abuse prevention programming based on social cognitive techniques. Specifically, those students receiving alcohol abuse prevention training based on mastery experiences would report significantly (p < .01) greater confidence to resist drinking in unpleasant emotional situations than those students receiving training based primarily on modeling or verbal persuasion. This hypothesis is based on research presented and summarized by Bandura (1986) suggesting that mastery experiences provide the strongest source of learning, followed by modeling and then verbal persuasion. Finally, it was hypothesized that students who have experienced the greatest number of problems and the most recent problems resulting from drinking alcohol would report significantly (p < .01) less confidence to resist drinking in unpleasant emotional situations than those students experiencing fewer and less recent problems. This hypothesis is based on the findings of Berkowitz and Perkins (1986) and Engs and Hanson (1988) that those students experiencing the most negative consequences of their drinking tended to be the heavier drinkers. CHAPTER III METHOD Subj ects Subjects for this study were 345 of the 374 students enrolled in a physical education course at a medium-sized Catholic college in the midwest. This . course is a graduation requirement taken by students in any semester in their freshman through senior year. Given that enrollment in this course is random (taken whenever a student's schedule permits) and that 10% of the population of this college takes this course in any given semester, this sample was seen as representative of the college's over-all undergraduate population. Survey courses such as this one, with the enrollment of students from all four college classes, are characteristic of the samples used in national studies on the drinking patterns and problems of college students (Engs & Hanson, 1985; Hanson, 1977). The present study was administered in the first week of spring semester as the "Responsible Alcohol Use" module of* the course. This study was conducted the way the course itself is presented, with the provision of information and training on health behaviors and the

28 29 administration of health-related assessments. The students enrolled into one of three sections of the course at either 9:20, 10:25 or 11:30 a.m. Students typically select the section that fits into their academic schedule. Given the size of each class and the reasonably random manner of enrollment, the composition of each class was assumed to be normally distributed (see Table 1 on page 44). Pre-treatment testing suggested no significant differences (p < .01) between sections by types of drinkers, gender, grade-point average or class standing. Pre-treatment testing also suggested no significant differences between treatment groups in their ratings of confidence resisting drinking in the eight situations (p = .987) prior to the administration of the three treatments. (See Chapter IV). Each section was randomly assigned a different type of self-efficacy training to enhance confidence resisting drinking in unpleasant emotional situations. Participation in the research component of the course was entirely voluntary. Subjects were instructed after both the pre- and post-testing that they were free to retain their response forms and not turn them in. Twenty-nine students chose to do this at pre-testing, resulting in 345 total responses out of 374. An additional seventeen did not return post-test 30 instruments, resulting in 328 responses at post-testing. The anonymity of individual subjects was ensured in that fake identifiers were created and only general demographic data were collected and associated with the instruments. The students' performance in class during the four days of this study had no bearing on their course grade. Attendance was the sole criterion used for grading in this semester-long course. Instruments This study used three instruments, the Student Alcohol Questionnaire (SAQ) (Engs, 1975), the Situational Confidence Questionnaire (SCQ) (Annis, 1987) and a survey of health activity (Appendix A) created by the investigator. The health survey was used only in the pre-test phase as a time-filler and not an actual research measure. This survey permitted the randomized presentation of six possible combinations of the SAQ and SCQ together or alone in a pre-treatment assessment: SAQ/SCQ, SAQ/survey, SCQ/SAQ, SCQ/survey, survey/SAQ, survey/SCQ. The pre-test was performed to assess the comparability of groups and to control for the possible effects due to testing on data measured at post-testing. The Student Alcohol Questionnaire (SAQ) was selected for this study due to its extensive use with college students and its ability to classify a full range of types of drinkers and negative consequences related to 31 drinking. Engs and Hanson (1988) report that hundreds of researchers over the past 15 years have used the SAQ and that its test-retest reliability over three years is .79. No measure of the instrument's validity appears to have been reported, however. The SAQ includes measures of the quantity and frequency of alcohol consumption, frequency of alcohol-related problems, knowledge about alcohol and demographic variables. Six items on the SAQ determine the quantity and frequency of alcohol consumption for each of three types of beverage: beer, wine and hard liquor. These items are worded to control for the relative amount of alcohol in each type of beverage. The quantity of consumption is defined as: (1) over six drinks, (2) five or six drinks, (3) three or four drinks, (4) one or two drinks, and (5) less than one drink. Frequency measures include: (1) every day, (2) at least once a week but not every day, (3) at least once a month but less than once a week, (4) more than once a year but less than once a month, and (5) once a year or less. From the subject's self-report to these six items, a quantity-frequency (Q-F) index is calculated using both the beverage most frequently used and the amount of that beverage typically consumed. This index is a classification that places the subject into one of six levels of alcohol consumption: (1) Abstainer (less than 32 once a year or not at all), (2) Infrequent (at least once a year but less than once a month), (3) Light (at least once a month but not more than two drinks in a sitting, (4) Moderate (at least once a month with no more than three or four drinks, or at least once a week with no more than one or two drinks, (5) Moderate-heavy (three to four drinks at least once a week, or five or more drinks at least once a month) and (6) Heavy (five or more drinks more than once a week). This matrix is presented in Figure 1. The SAQ also assesses the frequency of seventeen alcohol-related problems college students could encounter. These problems include: (1) Having a hangover, (2) Getting nauseated and vomiting from drinking, (3) Driving a car after having several drinks, (4) Driving a car when one knows they have had too much to drink, (5) Drinking while driving a car, (6) Coming to class after having several drinks, (7) Cutting a class after having several drinks, (8) Missing class because of a hangover, (9) Getting arrested for DWI (Driving While Intoxicated), (10) Being criticized by a date because of drinking, (11) Getting in trouble with the because of drinking, (12) Losing a job because of drinking, (13) Getting a lower grade because of drinking too much, (14) Getting into trouble with school administration because of behavior resulting from drinking too much, Frequency of Drinking (beer, wine or liquor/spirits)

At Least Once At Least Once At Least Quantity A Year (But A Month (But Once A of Less Than Less Than Less Than Week (But Drinkinq Once A Year Once a Month) Once a Week) Not Daily Daily Less I I I I I Than 1 I Abstainer I Infrequent I Light I Moderate I Moderate I I______I I I I ______I I I' "I" "I" T I 1 or 2 I Abstainer I Infrequent I Light I Moderate I Moderate I I______I I______I I ______I I I" "I "I" T I 3 or 4 I Abstainer I Infrequent I Moderate I Mod-Heavy I Mod-Heavy I I______I I______I I______I I I" 'I "I" 'I I 5 or More I Not Appl. I Infrequent I Mod-Heavy I Heavy I Heavy I I I I ______I I______I

Note: Not Appl. = No individuals located here. One drink = 12 oz. beer, 6 oz. wine or 1.5 oz. distilled spirits.

Figure 1 - Quantity-Frequency (Q-F) Drinkinq Level Classification System 34 (15) Getting into a fight after drinking, (16) Thinking one night have a problem with drinking, and (17) Danaging , pulling false fire alarm, or other such behavior after drinking. For each of these problems, the subjects rate how frequently they have experienced them. Possible responses are: (l) at least once during the past two months and at least one additional time during the past year, (2) at least once during the past two months but not during the rest of the past year, (3) not during the past two months but at least once during the past year, (4) at least once in my life but not during the past year, and (5) has not happened to me. The third section of the SAQ measures knowledge about alcohol through a thirty-six item test of basic alcohol information. Responses are given as True, False or "Do not know" for each item. Scoring is based on the number of correct answers. The three demographic variables from the SAQ used to describe the subjects in this study will be sex, year in school and grade point average. The Situational Confidence Questionnaire (SCQ) (Annis, 1987) assesses expectations of self-efficacy (confidence) resisting heavy drinking. The instrument appears to be the only one published and tested that measures Bandura's concept of self-efficacy and a 35 person's perceived ability to cope effectively with alcohol in high risk situations. Annis and Graham (1988) report both construct and criterion-related validity research and estimates in the SCQ user's guide. Construct validity was tested with correlations between subscale scores and reported measures of alcohol consumption by identified alcoholics at treatment intake. Although low, these correlations were significant in the predicted direction. Additional testing that correlated the SCQ with other established alcohol-related instruments on alcoholics entering treatment are also reported and found to be significant. Criterion-related validity was assessed through studies of the discriminant validity of the SCQ to discriminate between alcoholics in treatment and post-treatment abstainers. Predictive validity measures on post-treatment drinking levels suggest its usefulness in predicting the quantity of alcohol consumed on a given drinking day, despite its inability to predict the frequency of drinking episodes. Preliminary testing has addressed the relationship 4 between SCQ-identified risk situations and actual relapse situations occurring after treatment. Self-efficacy scores at intake successfully predicted instances of heavy drinking but not those of lighter drinking after treatment. They report good internal consistency reliability measures as currently between .81 to .97 for 36 the eight individual subscales of high-risk drinking situations. Construct and predictive validity evidence is reported as encouraging but still emerging in research. No time intervals on reliaiblity testing are reported in their manual. The SCQ is based on eight subscales divided into two classes of high-risk drinking situations, Personal States and Situations Involving Other People. "Personal States" is defined as drinking in response to an event that is primarily psychological or physical in nature. The five categories that comprise Personal States are: Unpleasant Emotions, Physical Discomfort, Pleasant Emotions, Testing Personal Control, and Urges and Temptations. "Situations Involving Other People" is defined as those drinking events influenced significantly by another person. The three categories that comprise "Situations Involving Other People" are: Conflict with Others, Social Pressure to Drink, and Pleasant Times with Others. Subjects rate their perceived level of confidence resisting the urge to drink heavily in each of the thirty-nine situations presented. The six point confidence measures include: 0% (no confidence), 20%, 40%, 60%, 80%, and 100% (very confident). From the responses to these thirty-nine items, confidence scores are calculated for each of the eight subscales. This is done by calculating a mean percentage from the specific 37 items that pertain to each subscale. The SCQ was developed initially for a population of identified alcoholics to monitor the progress of treatment and assist in the detection of high-risk relapse situations. Although previously applied to only these tertiary level prevention interventions and research projects, the application of the SCQ in a non- clinical setting to a general population of college students appears appropriate and merits testing (Graham, personal , November 18, ‘ 1988). Among college students, drinking behaviors and their problematic consequences vary greatly (Berkowitz & Perkins, 1986). This study intended to demonstrate that college students also vary in their levels of confidence resisting drinking in difficult situations, and that a relationship exists between drinking behavior, problems experienced as a result of drinking, and efficacy expectations related to drinking. Six of the eight subscales pertain to high-risk situations that most drinkers could encounter. Two scales, Testing Personal Control, and Urges and Temptations, may be least applicable to non-alcoholics. Also, some items address stressors in the workplace, but do not address stressors related to school. Expectations of self-efficacy are situation specific cognitions (Bandura, 1977) and specific SCQ subscales 38 needed to be used to assess the effectiveness of self- efficacy training. For this study, the three levels of training focused on developing confidence resisting drinking in unpleasant emotional situations. Therefore, although the entire SCQ was administered in post­ treatment testing, the subscale that addressed unpleasant emotional situations was used to determine any effects due to the treatments. Design and Procedure The Responsible Alcohol Use Module of Physical Education 100 was presented to three different sections of students over a four day period. In each section, a pre-test was given on the first day that would help control for the possible effects due to testing on data measured at post-testing. Pre-treatment testing was also performed to collect data on alcohol consumption, alcohol related problems, knowledge about alcohol and confidence resisting drinking that was not affected by the week-long treatment conditions. Students were not informed of the design of the study or the post-test. They were instructed to create a fictitious name and 6-digit number to serve as an anonymous identifier. They recorded their identifier both on the pre-test response forms and on a 5 X 7 card that they were instructed to bring back on the fourth and final day of the module. Their anonymous identifier permitted the matching of pre- and post-test 39 responses. Each section received a separate, randomly assigned type of self-efficacy training to enhance confidence resisting drinking in unpleasant emotional situations (Appendix B). The three treatment conditions were: 1) Performance Attainments ("Mastery"): experiential exercises to practice coping skills directly through written work, role playing, cognitive rehearsal/mental imagery; 2) Vicarious Experiences ("Modeling"): opportunities to observe different types of modeling of successful coping skills; and 3) Verbal Persuasion ("Lecture"): receiving third-party instruction and persuasion to perform successful coping skills. The strategies used in each treatment condition derive from social learning research on the application and assessment of self-efficacy for health behaviors (Abrams & Niura, 1987; Bandura, 1986; Marlatt & Gordon, 1985; Miller & Mastria, 1977). Over the four days, each section completed a pre- and post-test battery and received three 50-minute training sessions, one session for each targeted area. The three target skill areas that each type of self-efficacy training addressed were 1) advanced planning/problem solving skills, 2) self-monitoring/ self-control skills, and 3) relaxation/ assertiveness skills. See Appendix B for a more detailed description 40 of the three types of skill training as delivered through each of the three approaches to self-efficacy training. In the Mastery condition, subjects were taught and practiced the problem solving skills of brainstorming, generating alternatives, cost-benefit analysis and advanced planning through visualization. They engaged in the self-monitoring skills of attending to emotional states, measuring blood-alcohol-level and recognizing contributing factors of intoxication. Finally, they were taught the use of progressive muscle relaxation and imagery to induce their own relaxation and to cope with unpleasant emotions and to present themselves assertively to others. In the Modeling condition, the same skills as the Mastery condition taught were presented to the subjects through a live example and demonstration by the researcher. They were not given the opportunity to apply these skills themselves during the treatment. For the relaxation/assertion training demonstration, five volunteers from the group served as models. In the Lecture condition, the same skills as were presented in the Mastery and Modeling conditions were presented to the subjects. However, subjects were only encouraged to apply the coping skills that were described at some future time. The subjects were not given demonstrations or opportunities to practice the skills. 41 See Appendix B for a detailed outline of the treatments. To determine possible effects due to the three treatment conditions, post-treatment testing was administered on the fourth day, after presentation of the final segment of self-efficacy training. Reliance on the post-test comparisons was possible due to the assumption of comparable treatment sample groups. Tests of this assumption are presented in Chapter IV. Only the two instruments of interest in this study, the SCQ and SAQ were used in the post-treatment testing. The order of completion of these two instruments was randomized. Subjects were asked to refer to the 5 x 7 cards in their possession and to use the same anonymous identifier they had created for the pre-test. The response forms used both for pre- and post-testing permitted optical scanning and scoring (NCS, 1988) of data. As with the pre-test, subjects were instructed only to turn in their response forms if they wanted to participate in the study (see Chapter IV for specific data on the number responding). The entire training module was videotaped and subjected to a procedural check with 6 student raters, who were employed as peer counselors for students with problems relating to chemical use and abuse. Raters were given training in the rating procedure that included explanations of the three levels of social cognitive training presented, the three key skill areas addressed 42 within these three training approaches, and the bases for distinguishing between then. Because of availability and scheduling, the videotapes were shown to the raters in two separate groups of 2 and 4 raters each. Each of nine videotapes contained a recording of one hour of treatment in which one of the three types of self-efficacy training (nastery, modeling and lecture) was used to present one of three skill areas (planning/problem-solving, self- control, relaxation). The nine videotapes were shown to the raters in random order. Rather than showing the entire hour, four segments of three to four minutes each were randomly selected from each videotape. Raters were given a rating sheet (see Appendix C) on which to identify: l) which of the nine sets of treatment approach/skill target segments was presented, and 2) how distinct the segments were from the others. To accomplish this, the raters were asked after viewing the four segments of a tape, to identify which treatment/skill combination had been presented. To prevent the raters from using a process of elimination, they were told that they might be shown the same tape more than once. However, no duplicate segments were shown. Raters also rated (from 1 to 7) how clearly the stated skill objectives of each tape were presented by the trainer. Chapter IV discusses how these ratings were scored. CHAPTER IV RESULTS

Description of the Sample Each subject's response forms were optically scanned by ScanTools software (National Computer Systems, 1988) and the data from the two instruments down-loaded on an ASCII (American Standard code Information Interchange) file to Minitab (Digital Equipment Corporation) for calculations on SPSS-x (1988). As described in detail by Engs (1977), guantity-frequency (Q-F) level was used to determine each subject's drinking classification (See Figure 1). An SPSS-X computer program was created to classify the subjects' SAQ responses into one of six categories ranging from Abstainer to Heavy Drinker. Frequency descriptions for the research sample included gender, year in college, grade point average, type of drinking problem and quantity-frequency classification of drinking behavior. A score for correct answers to the test of alcohol knowledge also was calculated for each subject. Finally, the SCQ was scored through an SPSS-X program to determine levels of confidence resisting drinking in each of the eight high-risk drinking

43 44 situations for each subject. This was done by calculating the mean confidence percentage for each situation from the items that corresponded to them. The "unpleasant emotions" subscale of the SCQ was used as the target variable for the three types of self- efficacy training to determine treatment effects. In order to test the similarity of the three treatment groups with respect to the independent variables of this study, several chi-square and ANOVA tests were performed on the pre-test data. Table 1 presents the distribution of variables in the sample groups. Chi-square analysis yielded no significant differences between the three groups on the following characteristics: gender (p » .830), year in school (p = .325), grade-point average (p » .154), number or recency of problems experienced resulting from drinking (p « .769) or Quantity-Frequency level of drinker (p = .984). ANOVA (Table 10) demonstrated no significant differences between treatment groups on pre-treatment ratings of confidence resisting drinking in unpleasant emotional situations (p = .987). The relationship of the pre-treatment quantity- frequency level of alcohol consumption and the gender, college class and grade-point average of the subject were consistent with the findings of previous studies (Brown, 1983; Engs & Hanson, 1985; Berkowitz & Perkins, 1987). 45 Table 1 Pre-Treatment Frequency Of Characteristics In The Three Treatment Groups

Characteristic Mastery Modeling Lecture

Gender: Female 36 56 64 Male 45 57 61 Sample Total at Pre-Test 81 127 139 Sample Total at Post-Test 84 116 128 Q-F Drinking Level: Abstainer 12 17 25 Infrequent 12 18 14 Light 8 13 12 Moderate 13 16 22 Moderate-Heavy 17 26 30 Heavy 18 28 30 Class Year: Freshman 37 55 55 Sophomore 17 24 31 Junior 15 16 24 Senior 10 12 14 Grade-Point Average: 4.0 6 5 7 3.5 - 3.9 13 29 30 3.0 - 3.4 46 37 53 2.5 - 2.9 9 29 32 2.0 - 2.4 4 6 2 < 2.0 1 1 0 Alcohol-Related Problems: Never 8 8 10 Lifetime/not past year 7 13 8 Once in past year 62 94 108 Note: Some missing data due to incomplete reporting. Table 2 shows the distribution of quantity and frequency of drinking behaviors across three types of alcoholic beverage. Students drink beer more frequently than either wine or distilled alcohol, with 34.8% reporting weekly consumption. When they drink beer, 19% report having five to six in a sitting and 7.2% say they consume more than six drinks (defined as 12 ounces for beer). Either of these amounts of alcohol over a typicaj. three to four hour sitting would put most drinkers weighing an average 160 pounds into the impaired behavior range (.05 Blood Alcohol Level) and those weighing 120 pounds into the intoxicated range (.10 Blood Alcohol Level). Distilled alcohol is the second most consumed drink in amount and frequency. On a weekly basis, 10.4% of the subjects reported drinking hard liquor. In terms * of quantity, 5.6% say they have five or six drinks (1.5 ounces per drink) and 6.4% report consumption of greater than 6 drinks per typical three to four hour sitting. These findings are consistent with a previous survey at the school used in this study where 14.3% of the students reported getting drunk once a week and 5.7% more than once a week (ADEC, 1986). As shown in Table 3, significantly (p <.01) greater numbers of men (32.1%) than women (15.7%) were classified as Heavy drinkers on the pre-test. About 24.2% of the total sample received the Heavy Drinking classification. Table 2 Pre-Treatment Quantity and Frequency Percentages of the Subject's Reported Alcohol Consumption

Type of Alcohol

Quantity Beer Wine Spirits (per sitting) ( * ) ( % ) ( % )

More than 6 drinks 7.2 2.1 6.4 5 or 6 drinks 19.0 1.9 5.6 3 or 4 drinks 24.9 9.1 27.5 1 or 2 drinks 17.6 44.7 27.0 Less than 1 drink 8.0 10.2 8.8

Frequency

Every day 2.9 2.1 2.4 At least once a week 34.8 2.9 10.4 At least once a month 21.9 15.8 29.7 More than once a year 12.8 33.2 22.5 Once a year or less 4.5 14.4 10.4 Does not consume 11.2 19.8 12.5

Note; Totals do not equal 100% due to incomplete reporting by subjects (n = 330). 1 drink » 12 oz. beer, 6 oz. wine, 1.5 oz distilled alcohol 48

Table 3 Pre-Treatment Gender Differences in Q-F Drinking Level

Q-F Level n Male Female Total (*) (%> (%)

Abstainer 32 10.1 9.4 9.8 Infrequent 47 10.7 18.2* 14.4 Light 32 8.3 11.3'* 9.8 Moderate 56 15.5 18.9 17.1 Moderate-Heavy 81 23.2 26.4 24.9 Heavy 79 32.1* 15.7 24.2 Total 327

Note; Figures on the gender breakdown are shown In percent of the total for that sex. Chi- square analysis performed on raw frequency data.

* = Significant differences in the number of of types of drinker between males and females shown by chi-square (p = .0156).

Chi-Square D.F. Significance Min E.F. Cells E.F.<5

14.00477 5 0.0156 15.560 None 49 This is higher than the national average of 20.4% determined by Engs and Hanson (1988), but consistent with their research suggesting heavier drinking among college students from the North Central part of the country as well as among those who are Catholic, when compared to those for whom religion is important. There were no significant gender differences in the moderately heavy, moderate, light or abstainer drinker categories. Significantly (p < .01) more women than men were infrequent drinkers. significant differences in the drinking patterns of students by year in school were shown by Engs and Hanson (1985), who found the number of Heavy drinkers decreased significantly over the four years in college, from 22.6% of the freshmen to 17.1% of the seniors. The present study showed a steady and higher Heavy drinking level than did Engs and Hanson (1985) across all four years with 25.3% of freshmen to 26.8% of seniors reporting behaviors that are classified as Heavy drinker (Table 4). Prom a comparison of all possible class year and quantity-frequency drinking level combinations, two significant differences were found by chi-square analysis (p = .0388). More juniors appear to be light and moderate drinkers, perhaps due to becoming 21 years old and of legal age to drink. Second, more seniors appear to be moderate-heavy drinkers. This may be due to the 50 influences of a legal drinking cohort and a year of legal opportunity to drink. Further research is needed to study these increases, especially in light of previous research (Engs & Hanson, 1985). According to the findings of Engs and Hanson (1985) a significant (p <.01) inverse relationship would be expected between the number of students who drink and those who are Heavy, drinkers, in relation to their grade- point average. As shown in Table 5, no significant relationships were found by chi-square analysis (p = .9789) in overall composition of drinker type for each grade point average range. However, some individual variation is suggested with 35.7% of those earning a 2.0 (a "C" letter grade equivalent) reporting being Heavy drinkers and 27.8% of those earning a 4.0 (an "A11 letter grade equivalent) rated as Infrequent drinkers. Only two subjects reported earning less than a 2.0 grade point average, one was a moderately-heavy and one a heavy drinker. Table 6 shows the types and frequencies of problems students encounter as a result of their drinking. In comparison with previous research on these problems (Engs & Hanson, 1985), this sample reported more experiences with hangovers (71.8% vs. 56.2%), nausea and vomiting (51.4% vs. 37.3%), and driving after knowing they had too much to drink (34.8% vs. 29.9%). Despite this last 4

51

Table 4 Pre-Treatment Distribution*of Q-F Drinking Level bv class Year

Year in College

Q-F Level Freshman Sophomore Junior Senior

Abstainer 9.7 11.7 7.0 12.2 Infrequent 19.5 14.3 3.5 4.9 Light 5.8 10.4 17.5* 12.2 Moderate 16.9 15.6 26.3 7.3 Mode rate-Heavy 22.7 23.4 21.1 36.6* Heavy 25.3 24.7 24.6 26.8

Note: Figures are in percent. Significant difference shown by chi-square given an asterisk (*).

Chi-Square D.F. Significance Min E.F. Cells E.F.<5

25.92696 15 0.0388 3.988 2 of 24 (8.3%) 52

Table 5 Pre-Treatment Distribution of Q-F Drinking Level by Grade-Point Average

Grade Point Average (A - 4.0)

4.0 3.5 3.0 2.5 2.0 <2.0

Abstainer 11.1 6.4 10.8 12.3 14.3 Infrequent 27.8 14.1 14.2 9.6 21.4 Light 5.6 11.5 10.1 9.6 7.1 Moderate 11.1 16.7 18.9 15.1 14.3 Mod-Heavy 22.2 25.6 24.3 26.0 7.1 50.0 Heavy 22.2 25.6 21.6 27.4 35.7 50.0

Note; Figures are in percent. Totals do not equal 100% due to missing data. No significant differences in class year effects or GPA found (p c.Ol).

Chi-Square D.F. Significance Min E.F. Cells E.F.<5

12.79498 25 0.9789 0.198 18 of 36 (50%) 53 statistic, fewer subjects in the present sample said they drove after drinking (40.1% vs. 49.4%). Both of these percentages on drinking and driving are very high in light of alcohol-related automobile accidents being the single highest cause of among young adults 16 to 24 (Gonzalez & Broughton, 1986). The third column of Table 6 gives the percent of heavy or moderately-heavy drinkers comprising the total number of those reporting negative experiences in their lifetime. The four problems in Table 7 were found by chi- square to differ significantly (p < .01) by quantity- frequency type of drinker. Heavy drinkers reported experiencing significantly more of these negative results due to drinking in the past two months than moderate, light or infrequent drinkers or abstainers. Treatment Procedural Check Six raters evaluated randomly selected segments of videotapes of the treatments to assess whether the treatment conditions appeared as intended. Table 8 shows the results of this manipulation check. Although identification of the target skills was somewhat low (e.g. only 33% correct on 3 and 17% on 1), raters were able to identify the different treatment categories much more accurately (50% to 100% correct). Lastly, the raters provided a rating from 1 (not clear) to 7 (very clear) on how clearly they believed the skills for the 54 Table 6 Pre-Treatment Percentage of Subjects Experiencing Problems as a Result of Drinking

Drinking Problem AB C

Hangover 71.8 83.8 62. 2 Nausea/vomiting 51.4 78.1 54. 0 Driving after drinking 40.1 61.8 56. 1 Drinking while driving 20.3 33.3 61. 9 Damaged school property 18.6 35.3 70. 3 Fighting after drinking 14.1 33.0 61. 0 Had problems with law 8.5 19.0 63. 2 Missed class from hangover 19.2 29.2 61. 0 Driving after knowing drank too much 34.8 55.8 56. 6 Criticized by a date for drinking 17.2 23.9 49. 8 Thought you had a problem with alcohol 11.1 23.7 67. 1 Went to class after drinking 6.2 17.2 50. 6 Received lower grade 5.8 12.5 51. 2 Missed class after drinking 5.3 12.0 71. 7 Trouble with school administration 4.0 10.8 73. 1 Driving While Intoxicated Arrest 3.8 5.2 48. 0 Lost job because of drinking 1.9 2.9 17. 2 Note; n « 210. A) Percent of subjects experiencing the problem in past year. B) Percent of subjects experiencing the problem once in their lifetime. C) Percent of Column B made up of Moderately Heavy and Heavy drinkers. 55

Table 7 Pre-Treatment Problems Experienced In the Last Two Months as a Result of Drinking That Were Significantly Higher for Heavy Drinkers Than Moderate or Lighter Drinkers

Drinking Chi- Problem Square df P -

Hangover 83.308 20 0.001 Nausea/vomiting 55.044 20 0.001 Driving after drinking 53.619 20 0.001 Dr.inking while driving 47.940 20 0.001

Note: n « 210. 56 each segment were being taught. The scores suggest above average clarity (4.9 to 6.8) on all nine training tapes. This procedural check provides some support to the three treatment conditions appearing as they were intended. However, the specific skill areas were less distinct within treatment conditions. While it is possible that the brief segments of videotape did not adequately reflect the presentation, greater attention to well defined and controlled training within treatment approaches is necessary in further research. Drinking-Related Self-Efficacy Expectations in Unpleasant Emotional Situations Table 9 presents the pre-treatment ratings of confidence resisting drinking given by the six different quantity-frequency drinker types for each of the eight situations of the Situational Confidence Questionnaire. These ratings were based on 218 respondents who took the SCQ during pre-treatment testing. In seven of the eight situations, significant differences (p < .001) were found by ANOVA between the level of drinker and their reported confidence resisting drinking. Only the Physical Discomfort situation was not rated significantly different by different types of drinker. This result is not surprising in that a college-aged population would be less likely to drink to alleviate physical discomfort than the older alcoholic population on whom the SCQ was 57 Table 8 Procedure Check of Treatment Conditions bv Six Trained Student Raters

Percent Percent Correctly Correctly Identifying Mean Treatment Category & Identifying Treatment Clarity Skills-focus Skills Category Rating

Mastery Advanced Planning and 33% 100% 5.0 Problem Solving Self-Monitoring and 67% 83% 4.9 Self-Control Relaxation and 50% 100% 4.9 Assertiveness Modeling Advanced Planning and 33% 67% 5.0 Problem Solving Self-Monitoring and 33% 67% 5.7 Self-Control Relaxation and 100% 100% 6.1 Assertiveness Lecture Advanced Planning and 83% 100% 5.1 Problem Solving Self-Monitoring and 17% 50% 5.8 Self-Control Relaxation and 100% 100% 6.8 Assertiveness Note: Clarity rating is on scale from 1 (Not Clear) to 7 (Very Clear). Table 9

Pre-Treatment Mean Ratings of Confidence Resisting Drinking by

Different Levels of Drinker in Eight Situations

Quantity-Frequency (Q-F) Drinking Level ANOVA

Moderate Situation Abst. Infreq. Light Moderate Heavy Heavy F P - n - (39) (26) (23) (33) (50) (55)

Unpleasant Emotions 85.3 90.8 88.4 83.7 77.6 75.3 5.1 .000

Physical Discomfort 92.8 96.5 94.8 92.0 91.0 88.6 1.8 .117

Social Probs.-School 87.7 95.1 91.0 85.9 81.6 82.8 3.5 .004

Social Tension 84.5 90.2 85.3 82.5 73.5 74.4 6.1 .000

Pleasant Emotions 82.6 92.3 87.5 82.4 73.5 74.4 3.5 .005

Positive Social Sit. 61.5 73.8 68.7 59.0 52.4 45.3 7.9 .000

Urges and Tempt. 77.4 86.7 83.6 79.0 71.6 64.8 7.0 .000

Testing Personal Cntrl 81.5 92.5 87.8 80.1 76.7 73.2 5.2 .000

Note; df = 5,218 59 initially developed. The mean confidence ratings from Table 9 are graphically displayed in Figure 2. Across all eight high-risk situations, Infrequent drinkers appear to rate themselves as most confident resisting drinking. The next most confident type were the Light drinkers. Interestingly, Abstainers did not report the most confidence resisting drinking. Their responses were in the middle levels of reported confidence, similar to how moderate drinkers report. ANOVA was performed on the pre-treatment ratings of confidence for the situation selected as the dependent variable in this study, Unpleasant Emotional situations. As shown in Table 10, confidence ratings between treatment groups were not significant (p = .987) prior to administration of the treatments. As found in MANOVA testing of the pre-treatment confidence ratings of different quantity-frequency drinker types in each of the eight high-risk drinking situations of the SCQ (Table 9), significant differences (p < .001) were found in reported confidence between different types of drinkers in Unpleasant Emotional situations. Table 11 lists significant (p < .01) results from specific post-hoc testing with Duncan comparisons for each of the eight high-risk drinking situations. In general, across seven of the eight drinking situations, Moderate-Heavy and 100 ♦ © ♦ 4 + p 90 - 8 o © o © i e o + a a 0 a v © b X a B X □ ? BO - a a x □ x © ©

70 - H 8 □ Abstainer □ 60 - + Infrequent a ♦ Light u a Moderate L. SO - x Moderate-Heavy & ▼ Heavy

40

Risky O"irking Situations

1 - Unpleasant Emotions 5 - Pleasant Emotions 2 - Physical Discomfort 6 - Positive Social Situations 3 - Social Problems at School 7 - .Urges and Temptations 4 - Social Tension 8 - Testing Personal Control

Figure 2 Hoy Plffcrent Drinkers Rate Their Confidence Resisting ON Prinking in Eight Situations o 61

Table 10 Mean Pre-Treatment Ratings of Confidence Resisting Drinking In Unpleasant Emotional Situations

Analysis of Variance

Source SS df MS F P

Main Effects 6914.934 7 987.848 3.674 .001 Q-F Level 6871.246 5 1374.249 5.112 .001 Treatments 7.068 2 3.534 .013 .987

Q-F X Treatments 3232.026 10 323.203 1.202 .291

Explained 10146.960 17 596.880 2.220 .005 Residual 55919.009 208 268.841 Total 66065.968 225 293.627 62 Heavy drinkers report significantly less confidence resisting drinking than Infrequent and Light drinkers. In the Positive Social and the Urges and Temptations situations, Heavy drinkers reported significantly less confidence than four of the other types of drinkers. Effects of Treatments Effects of the three levels of self-efficacy training on ratings of confidence resisting drinking in Unpleasant Emotional situations (Table 12) were determined by ANOVA from post-test data. Contrary to expectations, no significant (p = .408) differences were found between the treatment conditions. As with the pre­ treatment results, confidence ratings following treatment were significantly (p < .001) different between quantity- frequency types of drinkers. However, no significant interaction (p «= .172) was found between type of treatment and type of drinker. In Table 13, the mean post-treatment confidence ratings are presented for the three treatment conditions and the six quantity-frequency types of drinker. Pre and post-test mean confidence ratings are presented in Table 14 for each type of drinker. The largest difference appears to be for Abstainers. Duncan tests on the increase from pre to post-treatments in the Abstainers' confidence ratings were not significant (p < .170). No significant effects of the self-efficacy 63 Table 11 Significant Pre-Treatment Variation In Different

Drinker* a Ratings of Confidence Resisting Drinking in Eight Situations

Significantly Different Comparisons of Mean Pre-Test Drinking Situation Confidence Ratings (p < .01)

Unpleasant Emotions Mod-Heavy (77.55) < Infrequent(90.77) Heavy (75.32) < Abstainer (85.26) Heavy (75.32) < Infrequent (90.77) Heavy (75.32) < Light (88.44) Physical Discomfort No differences in confidence. Social Problems Mod-Heavy(81.60) < Infrequent (95.12) Heavy (82.84) < Infrequent (95.12) Social Tension Mod-Heavy (73.49) < Abstainer (84.51) Mod-Heavy(73.49) < Infrequent (90.15) Mod-Heavy (73.49) < Light (85.30) Heavy (74.43) < Abstainer (84.51) Heavy (74.43) < Infrequent (90.15) Pleasant Emotions Heavy (75.37) < Infrequent (92.31) Positive Social Sit Mod-Heavy(52.41) < Infrequent (73.75) Mod-Heavy (52.41) < Light (68.67) Heavy (45.27) < Abstainer (61.47) Heavy (45.27) < Infrequent (73.75) Heavy (45.27) < Light (68.67) Heavy (45.27) < Moderate (58.94) Urges and Tempt Mod-Heavy(71.57) < Infrequent (86.73) Heavy (64.78) < Abstainer (77.39) Heavy (64.78) < Infrequent (86.73) Heavy (64.78) < Light (83.55) Heavy (64.78) < Moderate (78.99) Testing Pers Cntrl Mod-Heavy(76.67) < Infrequent (92.50) Heavy (73.15) < Infrequent (92.50) Heavy (73.15) < Light (87.83) Note: Results determined by Duncan post-hoc tests. 64 Table 12 ANOVA: The Effects of Three Levels of Self-Efficacy Training on Ratings of Confidence Resisting Drinking in Unpleasant Emotional Situations

Analysis of Variance

Source of Variation SS df MS F P -

Main Effects 12227.179 7 1746.740 6.750 .001 Q-F Level 11753.836 5 2350.767 9.084 .001 Treatments 466.108 2 233.054 .901 .408

Q-F X Treatments 3673.830 10 367.383 1.420 .172

Explained 15901.009 17 935.353 3.615 .001 Residual 64692.491 250 258.770 Total 80593.501 267 301.848 65

Table 13 Mean Post-Treatment Ratings of Confidence Resisting Drinking in Unpleasant Emotional Situations

Treatment Condition

Q-F Level Mastery Modeling Lecture Total

Abstainer 100.00 100.00 94.64 96.59 Infrequent 95.68 87.06 89.46 90.12 Light 97.81 82.92 80.68 85.97 Moderate 76.67 82.86 82.16 80.99 Mod-Heavy 75.00 78.81 75.94 76.60 Heavy 74.79 67.80 78.51 73.82

Total 82.34 78.96 81.15 80.69

Note: Figures are In percent. 66

Table 14 Effects of Self-Efficacy Training on Confidence Resisting Drinking for Different Types of Drinkers

Q-F Drinking Level

Test Abstainer Infrequent Light Moderate Mod-Heavy Heavy Means

Pre: 85.26 90.77 83.73 77.55 77.55 75.32 Post: 96.59 90.12 85.97 80.99 76.60 73.82

Multivariate Analysis of Variance - Repeated

Source of Variation SS df MS F p

Within Cells 42.19 7 6.03 Time 14.06 1 14.06 2.33 .170

Note: MANOVA performed for a Duncan post-hoc analysis of the post-test increase in confidence for Abstainers. Only eight of the thirty-two abstainers could be compared pre- and post-test. 67 treatments were found for any of the six types of drinkers (Table 14). In the prevailing Knowledge-Attitude-Behavior model of alcohol education programs, an increase in knowledge is believed to lead to a positive change in behavior (Goodstadt & Caleekal-John, 1984). In the present study, several analyses were performed to determine the effects of the three treatment conditions on the acquisition of knowledge about alcohol. Table 15 shows the Pearson correlations between pre-treatment knowledge about alcohol and ratings of confidence resisting drinking. For two of the eight situations given confidence ratings, small but significant correlations were found between confidence and knowledge about alcohol (p < .01). Table 16 shows the effects of self-efficacy training on the subjects' gain in knowledge about alcohol. Although no significant (p = .098) differences were found in gain in knowledge about alcohol for different types of self-efficacy training, a significant (p < .001) over-all increase in knowledge was found across the three treatment groups by repeated measures MANOVA. Repeated measures MANOVA tests (Table 17) were performed for possible interaction effects on alcohol knowledge gain due to treatment group assignment, quantity-frequency level, time or an interaction of these. No significant effects were found for treatment 68

Table 15 Pearson*s Correlation Between Pre-Treatment Knowledge About Alcohol and Ratings of Confidence Resisting Drinking In Eight Situations

Mean Alcohol Situation Knowledge Score

Physical Discomfort .16 (P .003) Unpleasant Emotions .14 (P .006) Testing Personal Control .11 (P as .032) Social Problems at Work .09 (P = .051)

Positive Social Situations .09 (P - .061) Social Tension .08 (P - .073) Urges and Temptations .08 (P .092) Pleasant Emotions .05 (P - .202)

Note: Correlation coefficient is pearson's r. 69 Table 16 Effects of Self-Efficacy Training on Gain In Knowledge About Alcohol

Treatment n Kean Gain Std Dev

Mastery 72 7.01 11.21 Modeling 111 3.56 12.11 Lecture 121 5.90 10.44 ■ ■ ...... = ^ ^ —-- --■--—^— —

Repeated Measures Analysis of Variance - Within Subjects

Source SS df MS P p

Within Cells 19071.58 301 63.36 Time 4354.11 1 4354.11 68.72 .000 Treatment x Time 295.88 2 147.94 2.33 .099

BBBBCCSBBBSSSSBSSBtSaSSBSSSS;SSSBSBBBb s b s b s b &b b &sssssibbssbsb

Repeated Measures Analysis of Variance - Between Subjects

Source SS df MS F p

Within Cells 31525.08 301 104.73 Constant 148135.96 1 148131.96 1414.40 .000 Treatment 218.91 2 109.46 1.05 .353 70 group (p < .199), quantity-frequency level (p < .487) or the interaction of these two. The "Time" variable refers to changes between pre- and post-treatment. As a whole sample, subjects scored significantly (p < .001) better on the alcohol knowledge test after the treatment. Additional Findings This study also investigated the possible effects of problems experienced as a result of drinking on ratings of confidence resisting drinking at pre-treatment testing (Table 18). Significant differences were found by MANOVA in the ratings of confidence in seven of the drinking situations at p < .01. As Table 19 shows, those reporting higher confidence ratings also report experiencing fewer problems due to drinking. Confidence ratings were significantly higher for subjects who never experienced problems due to drinking than those having experienced problems in the last year. In the Physical Discomfort category no differences in pre-treatment confidence ratings were found in relation to any measured characteristics of the subjects, including drinking problems. The effects of gender on pre-treatment confidence ratings was assessed by MANOVA. Consistent with Annis (1987), no gender differences were found for any of the eight drinking situations. The ANOVA comparison of gender and quantity-frequency drinking type on pre- 71

Table 17 Effects of Self-Efficacy Training on Gain in Knowledge About Alcohol by Q-F Drinking Level

Repeated Measures Analysis of Variance - Within Subjects

Source of Variation SS df MS F P

Within Cells 16204.95 270 60.02 Time 3527.24 1 3527.24 58.77 .001 Treatments x Time 194.89 2 97.44 1.62 .199 Q-F Level x Time 267.84 5 53.57 .89 .487 Treatm x Q-F x Time 499.54 10 49.95 .83 .598 SSBBSBBBSSI SSB&BB

Repeated Measures Analysis of Variance - Between Subjects

Source of Variation SS df MS F P

Within Cells 28496.37 270 105.54 Constant 82985.41 1 82985.41 786.28 .001 Treatments .61 2 .31 .00 .997 Q-F Level 211.43 5 42.29 .40 .848 Treatm x Q-F 553.01 10 55.30 .52 .873 Table 18 Effects of Problems Experienced as a Result of Drinking on Pre-Treatment Ratings of Confidence Resisting Drinking in Eight Situations

Problems Effect

Drinking Situation F P

Unpleasant Emotions 8.503 .001 Physical Discomfort 3.230 .054 Social Problems at Work 5.915 .003 Social Tension 8.978 .001 Pleasant Emotions 8.861 .001 Positive Social Situations 18.561 .001 Urges and Temptations 11.457 .001 Testing Personal Control 7.110 .001

Note; df = 2,202. Significant differences in problems experienced relating to drinking and confidence resisting drinking in seven of eight drinking situations shown by MANOVA. 73

Table 19 . Significant Differences in Pre-Treatment Ratings of Confidence Resisting Drinking by Recency of Drinking- Related Problems Experienced

Significantly Different Comparisons of Mean Pre-Test Confidence Ratings (p < .01) Drinking Situation by Recency of Problem

Unpleasant Emotions Last Year (79.42) < Never (94.58) Physical Discomfort No differences in confidence. Social Problems Last Year (84.25) < Never (95.93) Social Tension Last Year (77.53) < Never (93.33) Pleasant Emotions Last Year (80.08) < Never (95.19) Last Year (80.08) < Lifetime(93.33) Positive Social Sit. Last Year (53.90) < Never (84.58) Last Year (53.90) < Lifetime(70.14) Urges and Temptations Last Year (72.62) < Never (93.61) Testing Personal Cntrl Last Year (77.66) < Never (91.39)

Note: Results determined by Duncan post-hoc tests. 74 treatment ratings of confidence resisting drinking in unpleasant emotional situations yielded no significant differences for gender, drinker type or the interaction of these two variables. MANOVA yielded no significant effects of class year or grade-point average on differences in drinking-related confidence ratings prior to administration of the treatment conditions. CHAPTER V DISCUSSION

Summary of Findings It was anticipated that the results of this study would contribute empirical evidence to the utility of the self-efficacy concept in developing early and effective alcohol abuse prevention strategies for college students. This sample reported levels of alcohol consumption and problems resulting from drinking that were consistent with the literature, giving credibility to their responses and to the assessment itself. As a foundation for the treatment conditions, this study sought to demonstrate significant (p <.05) differences in the effects of level of alcohol consumed and frequency of drinking problems, on ratings of r confidence resisting drinking. It was predicted that those who drink less alcohol and have experienced fewer problems due to their drinking would report greater confidence resisting the urge to drink as assessed by the Situational Confidence Questionnaire (SCQ). A significant (p <.05) interaction effect between consumption level and drinking problems also was expected. These predictions are based on Marlatt and 75 76 Gordon's (1985) model of relapse prevention for alcoholics, where self-efficacy expectations arise from and mediate between available drinking coping responses and the probability of consuming alcohol. The results from this study support some of the pre­ treatment hypotheses. Efficacy expectations to resist drinking were reported at significantly different levels for different types of drinkers. Those reporting the most confidence were the Infrequent and Light drinkers across all eight drinking situations measured. Heavy drinkers reported significantly lower confidence to resist drinking than most of the other types of drinkers across the eight situations. Although Abstainers' ratings of confidence to resist drinking appeared to be lower than Infrequent or Light drinkers in each of the eight situations assessed, the differences were not significant. Further research is needed to determine possible distinctions between Abstainers and other Q-F types of drinkers. One possible hypothesis is that a lower sense of confidence managing alcohol is related to abstaining entirely. Another is that Abstainers have the least exposure to the experiences of drinking and perceive themselves as less efficacious in unfamiliar situations involving drinking. This appears to be an important area of additional research, especially in light of current 77 prevention models that promote abstention, but may not facilitate higher levels of self-efficacy to manage the consumption of alcohol. The subjects reporting the least confidence resisting drinking across all eight situations were the Heavy drinkers. A series of studies by Guralnik and Kaplan (Otten, 1989) suggest those who consume moderate amounts of alcohol in their early twenties were twice as likely to function effectively on daily behavioral tasks when elderly than abstainers, and one and one-half times more likely than heavy drinkers. These researchers suggest their findings indicate the beneficial outcomes of health interventions on the ability to function better for a longer time in later life. For the present sample of college students, all six types of drinkers saw Positive Social situations as the most challenging to resist drinking. This situation also elicited the widest range of ratings, the greatest differences in confidence between lighter and heavier drinkers. Within the alcohol-expectancy literature, the influence of positive social situations emerges as particularly salient. A recent study points to the repeated finding that "at-risk" adolescent drinkers hold strong expectancies that alcohol facilitates social functioning. Attributing successful social engagement to alcohol is seen as inaccurate. This is due to alcohol's 78 potential negative interpersonal impact and to the lack of internal attributions of the person's success or failure to enagage well socially (Christiansen; Smith, Roehling & Goldman, 1989). Additional study of self- efficacy expectations in positive social situations is needed. Further research also appears warranted on self- efficacy expectations in relation to alcohol-expectancies to expand a cognitive model inclusive of both personal and environmental determinants of drinking behavior. Training based on performance attainments (Mastery) was expected to be significantly more effective at increasing drinking-related self-efficacy for unpleasant emotional situations than training based on vicarious experiences (Modeling) or verbal persuasion (Lecture). This prediction was based on Bandura's (1977, 1986) demonstrations that experiential skills training for personal mastery is a more powerful source of self- efficacy information than modeling or verbal persuasion. Confidence levels for heavier (moderately-heavy and heavy) drinkers were predicted to increase most in Performance Attainment (Mastery) training and to not change significantly in either other training condition. Moderate (light and moderate) drinkers were predicted to report a significant increase in confidence in both performance Attainment (Mastery) and Vicarious Experience training (Modeling). No increases in confidence in any 79 of the three training conditions were predicted for abstaining or infrequent drinkers. These predictions also were based on the assumption of a relationship between level of drinking and drinking-related self- efficacy. For heavier drinkers, stronger levels of efficacy training were seen as needed to influence confidence levels. No significant differences between the types of self-efficacy training were found in the reported ratings of confidence to resist drinking following treatment. No significant effects of particular treatments on particular types of drinkers were found either. The overall effect of the Alcohol Education Module on the class appears to have been in their increased knowledge about alcohol. The three types of efficacy training that comprised each of the three treatment approaches did not affect knowledge gain differentially. Perhaps the common skills targets across the three treatments contributed to enhancing students knowledge about alcohol. This hypothesis is based on prior prevention programs using the Knowledge-Attitude- Behavior model, where similar information to the present study was delivered in lecture format only (the common dimension underlying all three self-efficacy training approaches used in the present study) and yielded an increase in alcohol knowledge (Goodstadt & Caleekal-John, 80 1984) . A significant (p <.05) positive relationship was expected between the pre-treatment level of alcohol consumption and the numbers and types of drinking problems reported. It also was predicted that significantly (p <.05) more severe consequences of drinking (e.g. sickness, drunk driving, property damage) would be reported by those who were Heavy drinkers. As predicted, those students experiencing the most recent problems most often resulting from their alcohol use were significantly less confident resisting drinking across all eight risky drinking situations (Table 22). Marlatt and Gordon (1985) see the cycle of negatively reinforcing factors and events as developing and maintaining lower drinking-related self-efficacy expectations. Matross and Hines (1982) identify the role of denial as maintaining self-perceptions in the face of increasing problems for heavier drinkers. For Marlatt and Gordon (1985), this denial process prevents a person from directly confronting and learning to manage their alcohol use. Without this, lower self-efficacy expectations relating to alcohol persist. These results appear to support Bandura's (1986) assertion that negative consequences to behavior, especially those more proximal in time, can diminish expectations of self-efficacy. Individuals with weaker 81 efficacy expectations to begin with, as Heavy drinkers in this study report in relation to resisting drinking, are more easily influenced by environmental events. For Nace (1987), one element of abusive drinking is continued use after recurring negative outcomes that are themselves caused by or exacerbated by the use of alcohol. The mutually determined interaction of person, behavior and environment is what Bandura refers to as reciprocal determinism (1978). Assumptions and Limitations Several limitations were present in implementing this study and interpreting its findings. The Situational Confidence Questionnaire (Annis & Graham, 1988) was developed and normed on samples of alcoholics with a mean age of 41.4 years. Some test items are not appropriate for college-aged individuals along the continuum of possible drinking behaviors. Additionally, some elements of college students' self-efficacy related to resisting drinking are probably not presented in the SCQ. For this reason, a subscale measuring more common experiences for college students, resisting drinking in unpleasant emotional situations, was selected to test the effects of the three types of self-efficacy training. Due to the obvious nature of the SCQ, some subjects may have faked responses. Other subjects might not have been able to accurately estimate their levels of 82 confidence in particular situations, despite to respond accurately. It also was possible that those having more difficulty managing their drinking could have had more distorted perceptions about their confidence resisting drinking and overestimated their actual levels. In light of this possibility, the significantly lower confidence ratings of the Heavy drinkers may be noteworthy. This study also had limitations relating to the treatment conditions. Three sessions of self-efficacy training might not have provided enough time for the training conditions to be effective, even with the situation-specific focus of the training on unpleasant emotions. It also was possible that the SCQ scale * "unpleasant emotions" chosen as the target situation for self-efficacy training is difficult to change in college students. The subjects reported higher and less differentiated pre-treatment confidence estimates in this situation, selected as the dependent variable for treatment, than in the Positive Social situation that was not selected a priori. Although a manipulation check was performed and the distinctness of the three different treatment conditions appeared supported, the raters were less accurate in identifying what specific target skills were being addressed. It is possible that the intended skills were 83 not presented or received clearly during treatment. There were constraints on delivering skills-based training to large lecture-hall type groups of over 100 people, especially in the Mastery condition that provides opportunities for individual behavioral rehearsal and feedback. Further research is needed on the effectiveness of treatment group size for different types of self-efficacy training for alcohol use. Relying on post-testing alone to determine the effects of the three treatments assumes the normal distribution of subjects through the three classes. Pre-treatment testing on selected variables of interest to this study suggested there were no significant differences between the three groups on the dimensions measured. Nevertheless it was possible that some important variables were not evenly represented in each treatment condition. Implications There are some potential implications of the results of this study for further research on the application of self-efficacy to the description and prediction of alcohol consumption patterns and problems of college students. The students' reactions to participating in this course module were very positive. Their expectation was that they would be lectured about, rather than involved 84 in the learning of the material* Even in the Verbal Persuasion group, the students seemed pleased to be receiving lectures geared at helping them define practical skills that they were responsible for implementing. Many also assumed a course in alcohol use for college students would take a more prohibitive, "this is what you can't/shouldn't do" stance. The students appeared surprised but pleased that they were taught constructive skills to make decisions for themselves as they related to alcohol use. It would seem that subject receptivity and belief in the source of information is a critical component to facilitating change. The purpose of this study was to investigate the i relationship between variables and treatments previously studied only with identified alcoholics at the relapse level of prevention. The demonstration of a relationship between pre-treatment drinking-related efficacy expectations and the types of college-aged drinkers lends evidence toward the usefulness of Bandura's Social Cognitive theory as a foundation for primary and secondary alcohol abuse prevention efforts. Goodstadt (1986) recommends alcohol education programs meet the following criteria: 1) target specific sub-populations who are determined to be "at risk" (secondary prevention), 2) have a strong theoretical basis, 3) be explicit and realistic in their goals, and 4) address 85 only well tested intervening variables. It would appear that a social cognitive approach offers such a theoretical basis. The construct of self-efficacy offers a potential avenue towards early identification of problem situations, thinking and skills deficits that could be addressed concretely in prevention interventions. Dean, Dean and Kleiner (1987) found that the majority (67%) of college counseling programs lacked uniform procedures to assess and manage the students' concerns with alcohol or other drugs. Their findings suggest the need for developing systematic and measurable approaches to identification and intervention planning. This might warrant the development of a new self-efficacy instrument that could assess more appropriate issues related to responsible drinking and expectations of self- efficacy in college-aged individuals. These measures could provide a theoretical framework to guide counselors in developing and monitoring alcohol abuse prevention interventions for different types of drinkers who have experienced different numbers and kinds of drinking- related problems. Jt also is possible that further research will demonstrate that self-efficacy expectations are descriptive of present or predictive of future alcohol abuse in college students. REFERENCES

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Ce!I oring, efficacy, and action: Tne influence of judgmental _ „ andi behavior. Journal of and Social Psychology. 50(3), 492-501. Chaney, E. F.. O'Leary, M. R.. & Marlatt, G. A. (1978). Skill training with alcoholics. Journal of Consulting and Clinical Psychology. 46. 1092-1104. Christiansen, B. A., Smith, G. T., Roehling, P. V., & Goldman, M. S. (1989). Using Alcohol Expectancies to Predict Adolescent Drinking Behavior After One Year. Journal of Consulting and Clinical Psychology. 57(1), 93-99. 88 Clifford. J. S. (1983). Self-efficacy counseling and the maintenance of sobriety. The Personnel and Guidance Journal. 111-114. Condiotte, M. M., & Lichtenstein, E. (1981). Self- efficacy and relapse in smoking cessation programs. Journal of Consulting and Clinical Psychology. 49(5), 648—658^ Dean, J. C., Dean, H. E., & Kleiner, D. L. (1987). Collegiate alcohol/drug treatment programs in the United States. The International Journal of the Addictions. 22(8), 767-778. Devins, G. M., & Edwards. P. J . .(1988). Self-efficacy and smoking reduction in chronic obstructive pulmonary disease. Behavior Research and Therapy. 26(2), 127-135. DiCleroente, C. C., Prochaska, J. 0., & Gibertini, M. (1985). Self-efficacy and the stages of self-change of smoking. Cognitive Therapy and Research. 9(2), 181-200. Emboden, W. A. (1988). Natural highs in an historical and biological context. Journal of Drug Education. 18(1), 33-47. Engs, R. C. (1975). Student Alcohol Questionnaire. Bloomington, IN. Engs, R. C. (1977). Drinking patterns and problems of college students. Journal of Studies on Alcohol. 38(11), 2144-2156. Engs, R. C., & Fors, S. W. (1988). Drug abuse hysteria: The challenge of keeping perspective. Journal of School Health. 58(1), 26-28. Engs, R. C., 6 Hanson, D. J. (1985). The drinking patterns and problems of college students: 1983. Journal of Alcohol and Drug Education. 31. 65-85. EngB, R. C., & Hanson, D. J. (1988). University students' drinking patterns and problems: Examining the effects of raising the purchase age. Public Health Reports. 106(6), 667-673. Engstrom, D. (1984). A psychological perspective of prevention in alcoholism. In J. Matarazzo, s. Weiss, J. A. Herd, N. E. Miller, & S. M. Weiss (Eds.), Behavioral Health: A Handbook of Health Enhancement and Disease Prevention. New York: John Wiley & Sons. 89

Fennig, J. P. (1985). College studentsf expectations of self-efficacy and preferences in seeking helpl Unpublished master's thesis, Columbus. Frankel, G.. & Gonzalez, D. H. (1984). Counseling.. services in the drug -field. Journal of Drug Education. 14(2), 161-174. Gilchrist. L. D., Schinke, S. P., Trimble, J. E., & Cvetkovich, G. T. (1987). Skills enhancement to prevent substance abuse among American Indian adolescents. The International Journal of the Addictions. 22(9), 869-8^9. Godding, P. R., & Glasgow, R. E. (1985). Self-Efficacy and outcome expectations as predictors of controlled smoking status. Cognitive Therapy and Research. 9(5), 583-590. Goldfried, M. R., & Robins, c. (1982). On the facilitation of self-efficacy. Cognitive Therapy and Research. 6(4), 361-380. Gonzalez, G. M.. & Broughton, E. A. (1986). Status of alcohol policies on campus: A national survey. NASPA Journal. 2 ± ( 2 ), 49-59. Goodstadt, M. S. (1986). Alcohol education research and practice: A logical analysis of the two realities. Journal of Drug Education. 16(4), 349-365. Goodstadt, M. S., & Caleekal-John, A. (1984). Alcohol education programs for university students: A review of their effectiveness. The International Journal of the Addictions. 19(7), 721-741. Hansen, W. B. (1977). Trends in drinking attitudes and behaviors among college students. Journal of Alcohol and Drug Education. 22(3.), 17-22. Hansen, W. B., Malotte, C. K., & Fielding, J. E. (1988). Evaluation of a tobacco and alcohol abuse prevention curiculum for adolescents. Health Education Quarterly. 15(1), 93-114. Hansen, W. B., Graham, J. W., Wolkenstein, B. H., Lundy, B. 2., Pearson, J.. Flay, B. R., & Johnson, C. A. (1988). Differential impact of three alcohol prevention curricula on hypothesized mediating variables. Journal of Drug Education. 18(2), 143- 153. 90

Hopkins, R. H., Mauss, A. L., Kearney, K. A.. & Weisheit, R. A. (1988). Study demonstrates ineffectiveness of model alcohol education curriculum. Observer. 10(4), 2 & 6. Larson, L. M., & Heppner, P. P. (1989). Problem-solving appraisal in an alcoholic population. Journal of Counseling Psychology. 36(1), 73-78. Lawrence, L., & McLeroy, K. R. (1986). Self-efficacy and health education. Journal of School Health. 56(8), 317-321. Lawrence, L., & Rubinson, L. (1986). Self-efficacy as a predictor of smoking behavior in young adolescents! Addictive Behaviors. 11. 367-382. Litt, M. D. (1988). Self-efficacy and perceived control: Cognitive mediators of pain tolerance. Journal of Personality and Social Psychology. 54(1), 149-160. Litt, M. D., (1988). Cognitive mediators of stressful experience: Self-efficacy and perceived control. Cognitive Therapy and Research. 12(3), 241-260. Magner, D. K. (1988, November 9). Alcohol-related problems have not decreased on most college campuses, survey indicates. Chronicle of Higher Education, pp. A35, A37. Marlatt, G. A. (1978). Behavioral Approaches to alcoholism. New Brunswick, N. *J. : Rutgers. Center of Alcohol Studies. Marlatt, G. A., & Gordon, J.R. (1985). Relapse Prevention. New York: The Guilford Press. Matross, R., & Hines, M. (1982). Behavioral definitions of problem drinking among college students. Journal of Studies on Alcohol. 43(7), 702-713. Miller, W., & Mastria, M. (1977). Alternatives to alcohol abuse: A social learning"model. Champaign: Research Press Co. Milgram, G. G. (1987). Alcohol and drug education programs. Journal of Drug Education. 17(1), 43-57. Morris, K. J., & Altmaier, E. M. (1988). On the Conceptualization and Measurement of Self-Efficacy. Paper presented at the American Psychological Association, Atlanta. Nace,-A. E. (1987). The treatment of alcoholism. N. Y.: Brunner/Mazel. Nathan, P. E. (1986). What do behavioral scientists know - and what can they do - about alcoholism? In R. A. Dienstbier & P. C. Rivers (Eds.), Nebraska Symposium on Motivation 1986: Alcohol and Addictive Behavior^ Lincoln: University of Nebraska Press. National Computer Systems. (1988). ScanTools. Minneapolis. Neidigh, L. W., Gesten, E.L., & Shiftman S. (1988). Coping with the temptation to drink. Addictive Behaviors, 13(1), 1-9. Nirenberg, T. D., & Miller, P. M. (1984). History and overview of the prevention of alcohol abuse. In P. M. Miller & T. D. Nirenberg (Eds.), Prevention of Alcohol Abuse. New York: Plenum Press. Otten, A. L. (1989, July 14). Moderate drinkers, nonsmokers age well. The Wall Street Journal, p. Bl. Rist, F., & Watzl, H. (1983). Self assessment of relapse risk and assertiveness in relation to treatment outcome of female alcoholics. Addictive Behaviors. 8, 121-127. Schneider, J. A., O'Leary, A., & Agras. W. S. (1987). The role of perceived self-efficacy in recovery from bulimia: A preliminary examination. Behavior Research and Therapy, 25(5), 429-432. Schunk, D. H., & carbonari, J. P. (1984). Self-efficacy models. In J. D. Matarazzo, S. M. Weiss, J. A. Herd, N. E. Miller, & S. M. Weiss (Eds.), Behavioral Health: A Handbook of Health Enhancement and Disease Prevention. New York: John Wiley & Sons. SPSS Inc. (1988). SPSS-X. Chicago. Strecher, V. J., McEvoy DeVellis, B. H., Becker, M. H., & Rosenstock, I. M. (1986). The role of self-efficacy in achieving helath behavior change. Health Education Quarterly, 13(1), 73-91. 92 Tobin, D. L., Wigal, J. K., Hinder, J. A., Holroyd, K. A., & Creer, T. L. (1987). The asthma self-efficacy scale. Annals of Allergy. 59, 273-277. Herch, C. E., & Gorman, D. R. (1987). Relationship between self-control and alcohol consumption patterns and problems of college students. Journal of Studies on Alcohol. 49, 30-37. Woodward, G. A. (1986). Campus alcohol policy: The case for alcohol education. In BACCHUS of the United States, Inc., First National Conference on Campus Alcohol Policy Initiatives. BACCHUS of the United states, Inc. APPENDIX A SURVEY OF HEALTH ACTIVITY »

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SURVEY OF HEALTH ACTIVITY This is a short answer survey. Please use this page to answer the questions, not the computer scoring sheet. Do not put your name on this, it is an anonymous survey.

1) Describe a few of the things you do now to stay healthy.

2) Rank order the three or four things you need to do to be even healthier than you are now. 1. 2 . 3. 4.

3) Are there things about becoming healthy that you would like to learn more about? If so, what are they?

4) What health issues would you like to see this college teach?

5) What are the most important health problems that society as a whole must address in the 1990's? APPENDIX B OUTLINE OF SELF-EFFICACY TRAINING MODULE

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Outline of the Training Module Physical Education 100 Responsible Alcohol Use Module February 6-10, 1989 Course Syllabus Goal of Module To enhance students' expectations of self-efficacy to resist drinking heavily (Blood Alcohol Level below .05) to cope with unpleasant emotional situations. The eight items of the Situational Confidence Questionnaire used to measure this type of situation are: o Letting myself down; o Fights at home; o Afraid things weren't going to work out; o Others interfering with my plans; o Angry at the way things turned out; o Treated unfairly by others; o Felt confused about what I should do; and o Felt under a lot of pressure from family members. Duration of Treatment Three 50-minute classes given on successive days to about 140 students each. Post-testing on the fourth day. Types of Class Interventions (Treatments) These will be assigned to the scheduled time slots randomly. These times and number currently enrolled are 9:20 am (91), 10:25 am (149), and 11:30 (143). I - Mastery Experiences II - Modeling III - Verbal Instruction and Persuasion Common Elements to Three Classes (Abrams & Niaura, 1987; Marlatt & Gordon, 1985; Miller & Masteria, 1977) I. Advanced Planning Training (Class 1) A. Identify high-risk antecedents 1. Cues for negative emotional situations. 2. Definition of heavy drinking for you. 97 3. Definition of contexts in which you drink. 4. Definition of available coping responses. 5. Rating of confidence to use available coping responses. B. Identify any self-efficacy enhancing effects of engaging In advanced planning. II. Problem-Solving Skills Training (Class 1) (Goldfried, 1971) A. Orienting to problem situation (negative emotions). B. Defining problem drinking in negative emotional situations. C. Generating alternative solutions to drinking in negative emotional situations. D. Evaluating the effectiveness (consequences) of chosen alternative coping responses. HOMEWORK: Depending on type of treatment, use these skills on a particular unpleasant emotional problem and write-up. III. Specific Coping Skills Training A. Self-monitoring and self-control training (Class 2) 1. Monitoring emotional experiences. 2. Monitoring drinking responses. 3. Monitoring reciprocal effect of 1 and 2. 4. Controlled drinking responses. 5. Generating alternative coping responses. HOMEWORK: Depending on type of treatment, apply these skills on a particular unpleasant emotional problem and write-up. B. Relaxation Training (Class 3) 1. Progressive muscle relaxation. 2. Imagery production for relaxation in unpleasant emotional situations. C. Assertion Training (Class 3) 1. Drinking refusal skills. 2. Coping with sources of unpleasant emotions. 3. Cognitive rehearsal to assist advanced planning and problem solving. HOMEWORK: Depending on type of treatment, apply these skills on a particular unpleasant emotional problem and write-up. 98

Specific Elements of Each Class (Treatment Condition) I. MASTERY EXPERIENCES A. Advanced Planning Training and Problem Solving Skills Training (Class 1) 1. Hands-on written exercise to define for self negative emotional situations, drinking behavior, and available coping responses. 2. Exercise to apply problem solving skills to generate behavioral alternatives to drinking in unpleasant emotional situations. 3. Homework to apply these skills to an anticipated unpleasant emotional situation. B. Self-Monitoring and Self-Control Training (Class 2) 1. Exercise in monitoring emotional states. 2. Exercise in monitoring drinking behavior. 3. Exercise in generating and applying alternative coping behaviors. 4. Homework to apply self-monitoring and control. C. Relaxation and Assertion Training (Class 3) 1. Training in inducing own PMR. 2. Training in inducing own imagery to deal with unpleasant emotions. 3. Homework to practice relaxation skills. D. Post-Testing and Debriefing (Class 4) II. MODELING EXPERIENCES A. Advanced Planning Training and Problem Solving Skills Training (Class l) 1. Modeling how to define for self negative emotional situations, drinking behavior, and available coping responses. 2. Model how to apply problem solving skills to generate behavioral alternatives to drinking in unpleasant emotional situations. 3. Homework to identify someone using these skills to an anticipated unpleasant emotional situation. B. Self-Monitoring and Self-Control Training (Class 2) 1. Model monitoring emotional states. 2. Model monitoring drinking behavior. 3. Model generating and applying alternative coping behaviors. 4. Homework to identify someone using self­ monitoring and control. 99 C. Relaxation and Assertion Training (Class 3) 1. Demonstrate inducing PMR. 2. Demonstrate inducing imagery to deal with unpleasant emotions. 3. Homework to reflect on presented relaxation skills. D. Post-Testing and Debriefing (Class 4)

III. VERBAL PERSUASION EXPERIENCES A. Advanced Planning Training and Problem Solving Skills Training (Class 1) 1. Encourage students to define for self . negative emotional situations, drinking behavior, and available coping responses. 2. Encourage students to apply problem solving skills to generate behavioral alternatives to drinking in unpleasant emotional situations. 3. Homework to review class notes about using these skills to an anticipated unpleasant emotional situation. B. Self-Monitoring and Self-Control Training (Class 2) 1. Description of importance of monitoring emotional states, drinking behavior and generating and applying alternative coping behaviors. 2. Homework to review class notes about applying self-monitoring and control. C. Relaxation and Assertion Training (Class 3) 1. Describe PMR for unpleasant emotional states. 2. Describe the use of imagery to deal with unpleasant emotions. 3. Homework to review class notes on relaxation skills. D. Post-Testing and Debriefing (Class 4) APPENDIX C MANIPULATION CHECK RATING SHEET

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Physical Education 100 Responsible Alcohol Use Module February 6-10, 1989 Rater Number ______

I. MASTERY EXPERIENCES - will include lecture and examples but focuses on hands-on practice exercises. Students supply own answers to questions, models in class. A. Advanced Planning Training and Problem Solving Skills Training 1. Hands-on written exercise to define for self negative emotional situations, drinking behavior, and available coping responses. 2. Exercise to apply problem solving skills to generate behavioral alternatives to drinking in unpleasant emotional situations. 3. Homework to apply these skills to an anticipated unpleasant emotional situations. B. Self-Monitoring and Self-Control Training 1. Exercise in monitoring emotional states. 2. Exercise in monitoring drinking behavior. 3. Exercise in generating and applying alternative coping behaviors. 4. Homework to apply self-monitoring and control. C. Relaxation and Assertion Training 1. Training in inducing o»*n PMR. 2. Training in inducing own imagery to deal with unpleasant emotions. 3. Homework to practice relaxation skills.

II. MODELING EXPERIENCES - will include lecture but focuses on giving clear examples, models or demonstrations to teach. A. Advanced Planning Training and Problem Solving Skills Training 1. Modeling how to define for self negative emotional situations, drinking behavior, and available 102

coping responses. 2. Model how to apply problem solving skills to generate behavioral alternatives to drinking in unpleasant emotional situations. 3. Homework to identify someone using these skills to an anticipated unpleasant emotional situation. B. Self-Monitoring and Self-Control Training 1. Model monitoring emotional states. 2. Model monitoring drinking behavior. 3. Model generating and applying alternative coping behaviors. 4. Homework to identify someone using self-monitoring and control. C. Relaxation and Assertion Training 1. Demonstrate inducing PMR. 2. Demonstrate inducing imagery to deal with unpleasant emotions. 3. Homework to reflect on presented relaxation skills.

III. VERBAL PERSUASION EXPERIENCES - lecture only, examples might be mentioned but not shown directly. A. Advanced Planning Training and Problem Solving Skills Training 1. Encourage students to define for self negative emotional situations, drinking behavior, and available coping responses. 2. Encourage students to apply problem solving skills to generate behavioral alternatives to drinking in unpleasant emotional situations. 3. Homework to review class notes about using these skills to an anticipated unpleasant emotional situation. B. Self-Monitoring and Self-Control Training 1. Description of importance of monitoring emotional states, drinking behavior ana generating and applying alternative coping behaviors. 2. Homework to review class notes about applying self-monitoring and control. C. Relaxation and Assertion Training 103

1. Describe PMR for unpleasant emotional states. 2. Describe the use of imagery to deal with unpleasant emotions. 3. Homework to review class notes on relaxation skills.

In the left margin, please identify which skill is being addressed and in what manner. Also, assign a number rating for how clearly you see that particular skill being taught in the manner it is described. Use the rating system presented below.

Not Clear Clear Very Clear 1 2 3 4 5 6 7 Thank you.