AlcoholEdu Partner Guide

William DeJong, PhD Boston University School of Public Health; Consultant, EverFi Elaine Albers, BS Robert Buelow, MS Helen Stubbs, MS Kimberley Timpf, MEd AlcoholEdu Partner Guide

Table of Contents

Preface 3 Introduction 4 An Orientation to the Guide Understanding AlcoholEdu 6 The Course’s Prevention Philosophy and Key Messages Revisiting AlcoholEdu 11 Recommendations for Additional Prevention Programming Part 1 Module 1: Getting Started 12 Module 2: Standard Drink 13 Survey 1: Pre-Intervention Survey 14 Module 3: Where Do You Stand? 14 Module 4: Goal Setting 18 Module 5: Drinking and Motivation 19 Module 6: Brain and Body 22 Module 7: My Action Plan 27 Module 8: Laws and Policies 28 Module 9: Helping Friends 29 Survey 2: Course Evaluation 32

Part 2 Module 1: Getting Started 32 Module 2: Standard Drink 33

Beyond AlcoholEdu 36 Implementing a Comprehensive Prevention Program

APPENDIX 1: AlcoholEdu Learning Objectives 42

APPENDIX 2: AlcoholEdu Course Map 52

APPENDIX 3: AlcoholEdu Evidence Base 57

APPENDIX 4: The Rape of Mr. Smith 62

APPENDIX 5: The Alcohol Use Disorders Identification Test 63

APPENDIX 6: Campus Alcohol Policy Survey 64

2 Preface College administrators have long recognized that students’ misuse of alcohol is a major problem on campuses, not only because of the consequences experienced by students who choose to drink heavily, but also because of the impact on the majority of students who abstain from alcohol or do not drink abusively. While the threat to students’ health and safety is a continual worry, there is also growing awareness that student alcohol use can compromise an institution’s ability to fulfill its educational mission. First, high-risk drinking and its consequences can tarnish a college’s reputation for academic excellence, which in turn can make it harder to recruit and retain gifted students, damage graduates’ employability in a competitive job market, and demoralize alumni who are supporting the school financially. When a college is named a top “party school” by noted publications and websites, administrators immediately take steps to protect the institution’s “brand” and avoid being singled out in future reports. Second, several studies have shown that students who drink heavily have lower grade- point averages and more often report missing classes or assignments, attending class unprepared, and having difficulty concentrating. It is unsurprising, then, that high- risk drinking is associated with an increased probability of academic failure and early departure from college. Lower graduation rates hurt an institution’s prestige. Third, alcohol problems on campus also drive up an institution’s operational costs due to the additional personnel needed for counseling services, judicial affairs, public safety, and buildings and grounds maintenance; non-billable property damage; and lost tuition and recruitment costs related to student attrition. Another concern is potential legal liability. Recent case law has established that campus officials must take reasonable protective measures to guard against foreseeable hazards and risks in the campus environment, meaning, in part, that they need to deal with dangerous situations on campus. Years of litigation over the concept of “reasonable care” in higher education law have shown that the courts will typically protect an institution that shows good faith by seeking to apply evidence-based prevention programs. AlcoholEdu for College, with rigorous evaluation studies demonstrating its effectiveness in reducing student drinking and negative alcohol-related consequences among first- year students, is one of those evidence-based programs. This online course provides students with both the information and motivation they need to protect their health and safety, while also helping set the stage for environmental management strategies that should be part of every college’s efforts to reduce alcohol problems on campus. From all of us on the EverFi team, we thank you for making AlcoholEdu the cornerstone of your institution’s alcohol prevention efforts. You have taken an important step to protect the health and safety of your students.

Regards, The EverFi Team

3 Introduction Educating and motivating AN ORIENTATION TO THE GUIDE students to The purpose of this guide is to support campuses that are implementing AlcoholEdu for continue College as part of a comprehensive alcohol prevention program. The course is designed primarily for first-year students, but other students who complete the course will also abstaining - or to benefit. Intervention prior to matriculation or shortly thereafter is critical, as the first use alcohol safely term in college often sets the stage for alcohol abuse patterns that persist throughout if they choose the college years. It is true that many students begin college with an established pattern to drink - must of high-risk drinking, but many others initiate excessive alcohol consumption shortly be supported after arriving on campus. by a campus AlcoholEdu’s development was guided by a theory-based intervention planning system environment that called Intervention Mapping, which has been used to design health communications campaigns, education programs, and other public health interventions. Moreover, reinforces and the course incorporates key elements found in successful intervention programs, as builds on the identified by recent reviews of the research literature. foundation of the It is important to remember, however, that an online education program is just one course. part of a comprehensive approach to addressing alcohol-related problems on campus. This guide is intended to provide a deeper understanding of the underlying framework and the student learning experience in AlcoholEdu so that campus practitioners can reinforce and build upon the course through ongoing programming during the academic year and thereby sustain its positive impact on student knowledge, attitudes, and behavior.

ORGANIZATION The AlcoholEdu Partner Guide is organized into three main sections:

Understanding AlcoholEdu: introduction to the course’s prevention philosophy and key messages Revisiting AlcoholEdu: overview of course content and recommendations for additional prevention programming Beyond AlcoholEdu: a comprehensive approach to reduce alcohol and other drug problems among first-year students

Assisted by this guide, campus practitioners will be able to develop continuing prevention efforts that build upon the course’s fundamental learning objectives, including both additional educational programming and environmental management strategies designed to change the environment in which students make decisions about their alcohol use. Effective prevention requires continuous effort.AlcoholEdu moves first-year students in the right direction—the research evidence on this point is definitive. Ultimately, however, AlcoholEdu’s success in educating and motivating students to continue abstaining—or to use alcohol safely, if they choose to drink—must be supported by a campus environment that reinforces and then builds on the foundation the course provides.

WHO SHOULD USE THIS GUIDE? This guide will be useful to anyone wanting to learn more about AlcoholEdu and how it fits into a comprehensive approach to campus alcohol prevention. It is important, however, for prevention programs to be developed and implemented by trained 4 professionals, and for that reason it would be inappropriate for the guide to be used by an untrained facilitator to develop a new or supplemental educational program. First-year students arrive on campus believing that they already know a lot about alcohol. Many of them have used alcohol previously, and they very often have firmly held beliefs and attitudes about student drinking, some of which are based on misinformation. As a result, talking about these issues with students can be challenging, and poorly delivered programs run the risk of building, rather than overcoming, student resistance to the college’s prevention messaging. Thus, the development of programs and workshops that build on AlcoholEdu is best done by trained professionals who have in-depth knowledge of the subject, understand student-centered approaches to learning, and therefore are best equipped to meet this challenge.

HOW SHOULD THE GUIDE BE USED? This guide was developed to provide practitioners with information they can use to build upon AlcoholEdu to create additional prevention programming for their students. Appendix 1 lists the course’s many learning objectives, plus a few that are not covered, all of which can be reinforced through subsequent workshops, seminars, courses, educational events, and public communication campaigns, as well as through campus policy and other environmental management strategies. On many campuses, there are limited opportunities to access all incoming students. This is an important concern for two reasons. Most importantly, new incoming students are at greatest risk for high-risk drinking and its negative consequences during their first six weeks on campus. In addition, with students having just recently taken AlcoholEdu, it is important to take advantage of immediate opportunities to reinforce the course’s key messages. One of the best ways to reach incoming students after they have completed AlcoholEdu, particularly at colleges that implement the course prior to matriculation, is in orientation programs and first-year seminars. Another option is a public communications campaign that uses posters, flyers, newspaper ads, email and text messages, and other media channels to convey key messages throughout the academic year. Stated simply, because this is a high-risk period, campus practitioners should talk early and often with their students, not only to extend what they learned in AlcoholEdu, but also to underscore the college’s expectations, outline the school’s alcohol policies, reinforce the students’ commitment to their educational goals, ensure that they are aware of the rich opportunities available to them, both academically and socially, and correct their misperceptions of campus drinking norms.

5 Understanding AlcoholEdu There is a sizeable uptick in students’ THE COURSE’S PREVENTION PHILOSOPHY AND KEY MESSAGES alcohol use once This section explains the prevention philosophy behind AlcoholEdu for College and some of they arrive on the course’s key messages, which together provided a guiding framework for the course’s campus, what we several educational modules. call the “college All First-Year Students Should Complete AlcoholEdu effect.” Incoming first-year students who abstain from alcohol or do not drink heavily may wonder why they are being required to take AlcoholEdu, rather than just the students who are problem drinkers. The main reason is that there is a sizeable uptick in students’ alcohol use once they arrive on campus, what we call the “college effect.” Students who have not been heavy drinkers may begin to consume greater amounts of alcohol. Those who have only occasionally had a drink may begin to drink more frequently, and those who have abstained may begin to experiment with alcohol for the first time. Some abstainers are committed to this choice and will continue not to drink, but it is hard to know, absent extensive questioning, who those students will be. In any case, even this group of abstainers can benefit from the course by learning more about alcohol, what their classmates may be experiencing, and how to intervene appropriately if another student appears to be in danger. The other reason to require universal education is the “prevention paradox.” It is true that frequent heavy drinkers put themselves at the greatest personal risk, but they are relatively small in number and therefore responsible for a relatively small proportion of total drinking-related consequences. There are a far larger number of occasional or moderate student drinkers who are at less personal risk, but collectively experience the majority of negative consequences. The key is to drive down population-level consumption, and that requires that the entire incoming class be required to take the course, not just the heaviest drinkers.

Education Works Best in a Supportive “Prevention Environment” AlcoholEdu has been proven to reduce drinking and negative alcohol-related consequences, but the course alone cannot be expected to sustain this positive effect in the long run without other prevention efforts in place, particularly environmental management strategies that address problematic factors in the campus and community environment. Importantly, AlcoholEdu helps set the stage for implementing such strategies, and reinforcing their application through supportive course content.

Environmental management entails five basic strategies: 1. Offer and promote social, recreational, extracurricular, and public service options that do not include alcohol and other drugs. Colleges are investing in creating substance-free events and activities; offering financial support to substance-free student organizations; opening or expanding the hours for a student center, gym, or other substance-free settings; and expanding student service learning or volunteer activities. AlcoholEdu asks students to indicate their interest in participating in and organizing each of several such activities. This information is available to the course administrator via a report in the Higher Ed Partner Center. Abstainers can connect with like-minded students, while drinkers receive notice that the campus community presents a wide array of attractive social options that do not involve alcohol.

6 2. Create a social, academic, and residential environment that supports health- promoting norms. Academic reform is one avenue: modifying the academic schedule to increase the number of early morning and Friday classes, increasing academic standards so that students will need to spend additional time studying out of class, requiring and tracking class attendance, increasing faculty-student contact, and improving faculty-student mentoring. Students tend to think that more of their peers drink heavily than is actually the case. Social norms marketing campaigns convey accurate information about student alcohol use in order to counter exaggerated misperceptions of campus drinking norms and thereby drive down consumption. Several institutions have launched successful campaigns, with subsequent student surveys revealing both an increase in accurate perceptions of actual drinking behavior on campus and decreases in reported heavy drinking.

AlcoholEdu surveys provide data on alcohol use that can be used in social norms messaging directed to future incoming classes.

3. Limit the availability of alcohol and other drugs both on and off campus.Campus officials can enforce policies that limit the times and places that alcohol is available to students who students of legal drinking age on campus. Key strategies include prohibiting delivery failed to take or use of kegs or other common containers, controlling or eliminating alcohol sales the course were at sporting events, and disseminating and enforcing guidelines for registered parties. Community-based strategies include limiting both the number of alcohol outlets near 4.64 times campus and the days or hours of alcohol sales, eliminating low-cost promotions, requiring keg registration, prohibiting home delivery of alcohol purchases, and more likely implementing responsible beverage service (RBS) training programs. than those who AlcoholEdu informs incoming students that a majority of college students support these kinds completed it to of measures by reporting the results of past surveys. experience an 4. Restrict marketing and promotion of alcohol and other drugs. Campus officials have alcohol-related wide latitude to ban or restrict alcohol advertising on campus and to limit the content event requiring of party or event announcements. Off-campus, campus-based, and community officials medical attention. can work together to eliminate alcohol promotions that offer low-priced drink specials or otherwise promote high-risk drinking. AlcoholEdu draws students’ attention to the fact that alcohol advertisers create messages and images that create unrealistic expectations about alcohol’s benefits while ignoring the problems that can arise if alcohol is misused. 5. Develop and enforce campus policies and local, state, and federal laws. Campus administrators should authorize and encourage campus police to work in partnership with local law enforcement agencies to uphold campus policies and local, state, and federal laws. Statutes of particular concern include laws that prohibit alcohol possession by minors, providing alcohol to minors, alcohol-impaired driving, and neighborhood disturbances. AlcoholEdu informs students about the laws in the state where they attend school, noting that they are enforced and that a violation can be financially costly and compromise their future. The course also asks students to indicate their interest in working on policies that would serve to improve campus life. A list of students who opt-in to be contacted for such opportunities is available to the course administrator via a report in the Higher Ed Partner Center.

7 1. Offer and promote social, recreational, extracurricular, and public service options that do not include alcohol and other drugs. Colleges are investing in creating substance-free events and activities; offering financial support to substance-free student organizations; opening or expanding the hours for a student center, gym, or other substance-free settings; and expanding student service learning or volunteer activities.

THEAl cCASEohol EFORdu a MANDATINGsks students ALCOHOLEDUto indicate their interest in participating in and organizing each of Researchersseveral satu ca hprivate activ universityities. Th iins ithenfo Northeastrmation irevieweds availab thele medicalto the crecordsourse administrator via a report in keptthe by Htheirighe studentr Ed P healthartne centerr Cen ttoe rinvestigate. Abstaine whetherrs can theconne failurect ofw iincomingth like-m inded students, while drinkers first-yearreceiv estudents notice to tha completet the cAlcoholEdu ampus c owouldmmun predictity p rfutureesen thigh-risks a wide drinking array thatof a ttractive options. required medical attention. The university encouraged students to take the course, 2. Create a social, academic, and residential environment that supports health-promoting but did not mandate its completion. norms. Academic reform is one avenue: modifying the academic schedule to increase the Thenu resultsmbe rshowed of ear lthaty m studentsorning andwho Ffailedrida toy ctakelass thees course, increa weresing 4.64 ac adetimesm ic standards so that students! more likely than those who completed it to experience an alcohol-related event will need to spend additional time studying out of class, increasing faculty-student contact, and requiring medical attention, while those who had partially completed the course were improving faculty-student mentoring. 1.52 times more likely.

There are two possible explanations. First, given AlcoholEdu’s demonstrated Megan Chiango 7/20/15 2:47 PM effectiveness, the course may have had a protective effect, making it less likely for Formatted: Check spelling and grammar studentsThe toC asedrink fheavily.or Ma ndating AlcoholEdu Rob Buelow 4/20/15 3:24 PM Second,Res studentsearche rfailings at a to p completerivate un theive coursersity i nmay the have No rbeenthea morest re vproneiewed initially the medical records kept by Formatted Table to engagethe s tinuden high-riskt hea drinkinglth cen andter thereforeto inves twereigate less whe interestedther the in f areceivingilure of incoming first-year students to educationcomp onlet thise A topic.lcoholEdu would predict future high-risk drinking that required medical attention. The university encouraged students to take the course, but did not mandate its completion. In either case, the study’s findings underscore the importance of imposing a firm mandateThe sore sthatult sall s incominghowed t studentshat studen takets the w hocourse. failed to take the course were 4.64 times more likely than those who completed it to experience an alcohol-related event requiring medical attention, while those who had partially completed the course were 1.52 times more likely. ! There are two possible Megan Chiango 7/20/15 2:47 PM Percentage of Students Having Requiring explanations. First, given Formatted: Font:(Default) +Theme Body, AlcoholEdu’s demonstrated Medical Attention with Elevated BAC 11 pt, Not Expanded by / Condensed by effectiveness, the course may have Megan Chiango 7/20/15 2:47 PM had a protective effect, making it Formatted: Normal less likely for students to drink heavily.

AlcoholEdu Second, students failing to complete Completed the course may have been more prone initially to engage in high-risk AlcoholEdu drinking and therefore were less Started interested in receiving education on this topic. AlcoholEdu Not Started In either case, the study’s findings underscore the importance of 0 10 20 30 40 imposing a firm mandate so that all incoming students take the course. Source: Abrams GB, Kolligian J, Mills DL, DeJong W. Failure of college students to complete an online alcohol education course as a predictor of high-risk drinking that requires medical attention . Am J Drug Alcohol Abuse. 2001;37:515-519.! Source: Abrams GB, Kolligian J, Mills DL, DeJong W. Failure of college students to complete an online alcohol education course as a predictor of high-risk drinking that requires medical attention. Am J Drug Alcohol Abuse. 2001;37:515-519. ) " !

8 MOST STUDENTS WANT THE LAWS ENFORCED A majority of A survey conducted at 32 four-year colleges and universities revealed that a majority students support of students supported several policy measures to reduce alcohol abuse on campus: policy measures to reduce alcohol PERCENTAGE OF STUDENTS IN SUPPORT OF ALCOHOL POLICY MEASURES abuse on campus 90.1%: Stricter disciplinary sanctions for students who engage in alcohol-related violence 72.6%: Stricter disciplinary sanctions for students who repeatedly violate campus alcohol policy 59.5%: Stricter penalties for the use of false IDs to purchase alcohol illegally 56.1%: Prohibit kegs on campus 52.1%: Restrict advertising that promotes alcohol consumption at on-campus parties or events

While a majority of students supported policies to reduce alcohol abuse, far lower percentages of students thought that other students attending their college would support these measures. This is another example of how students misperceive the norms on their campus. Student support for policy can be leveraged to introduce new environmental management strategies. A survey conducted at a large public university in the Northeast discovered that 83% of its undergraduates wanted to see tougher enforcement of the state’s drunk driving laws. Campus offi cials launched a media campaign announcing that information, then followed up with a series of measures in the local community to reduce alcohol- impaired driving and the use of fake IDs to make illegal purchases of alcohol. These measures were positioned as a response to student concerns. Intercept interviews conducted on campus throughout the school year consistently showed that the vast majority of students strongly endorsed the campaign.

Source: DeJong W, Towvim LG, Schneider SK. Support for alcohol control policies and enforcement strategies among U.S. college students at 4-year institutions. J Am Coll Health. 2008;56:231-236.

It Is Unrealistic to Push Students Who Drink to Begin Abstaining AlcoholEdu reminds students that the minimum legal drinking age in all 50 states is 21, and that violating this law by drinking underage or providing alcohol to minors can have serious legal and personal consequences. That said, the course accepts the fact that, despite the law, a number of incoming students have already made the choice to drink and instead focuses on motiving them to drink more safely. There are two primary behavioral objectives: 1) to reduce the number of occasions on which students choose to drink and 2) to reduce the amount of alcohol they consume per occasion. AlcoholEdu uses positive framing by emphasizing what students can gain by drinking less. Alcohol has biphasic eff ects. It is a depressant, so initially alcohol can reduce stress and create a feeling of well-being and relaxation. But once the blood alcohol concentration (BAC) exceeds 0.04%, drinkers begin to experience impairment of reasoning and memory and they become less cautious. In many countries, the per se limit that defi nes impaired driving is 0.05% BAC, versus 0.08% in the US. Higher BAC levels result in increasingly serious cognitive and physiological eff ects.

9 The course presents several strategies that students can use to moderate their drinking: 5-Step Cognitive Model for „„ Set a limit on the number of drinks Bystander Intervention

„„ Have 1 or fewer drinks per hour Take note of the situation „ „ Stop drinking at a predetermined time Identify situation as critical (warranting intervention) „„ Limit the amount of money on hand

„„ Choose a drink containing less alcohol Feel personal responsibility to intervene „„ Put extra ice in the drink Believe in ability to intervene „„ Eat food before or while drinking successfully

„„ Alternate non-alcoholic beverages with alcoholic drinks Consciously decide to help

„„ Avoid drinking from a shared source (e.g., punch bowl) Latane and Darley (1970) „„ Avoid drinking games, pregaming, and doing shots In short, students who choose to drink can enjoy their drinking experience more if they take steps to keep their BAC below 0.04%, and, of course, they can avoid the negative academic, social, and health consequences that often result from heavy drinking.

Students Need to Intervene When Other Students Are in Trouble AlcoholEdu underscores the importance of recognizing the warning signs of alcohol poisoning and other drinking-related problems and then reviews how best to intervene to help keep other students safe. Especially important is intervening to prevent someone from driving while impaired after drinking or using drugs. While alcohol poisoning Alcohol-impaired deaths are widely publicized, alcohol-impaired driving is the leading cause of drinking- related deaths and injuries among college students. Promoting bystander intervention is driving is the increasingly recognized as a vital harm reduction strategy to prevent students from driving leading cause of intoxicated as well as deter excessive alcohol use that can result in additional problematic drinking-related behaviors. deaths and Most students want to do the right thing but sometimes are afraid to act lest they or injuries among the student needing help will run afoul of the college’s alcohol policy and be severely college students disciplined. College officials need to make clear this is not the case. To reinforce this point, many schools have instituted a so-called Good Samaritan policy to assure students this will not happen. Students can be taught to recognize potential problems as they are emerging so that they can intervene earlier and more effectively. To do this, students need to be watchful, while also recognizing that others may privately be troubled about what is going but are not expressing their concerns. Being aware that other bystanders may react this way can help students assume personal responsibility to speak up or take other steps to avoid a tragic outcome.

10 Revisiting AlcoholEdu RECOMMENDATIONS FOR ADDITIONAL PREVENTION PROGRAMMING Because AlcoholEdu provides a solid foundation upon which to build a comprehensive alcohol prevention program, it is important for campus practitioners to become familiar with the specific content of the course—its learning objectives, the information conveyed, the pedagogical approaches used, the exercises designed to get students to act on what they have learned, and so forth. With this knowledge, staff will be prepared to answer student questions, engage in rich follow-up discussions about AlcoholEdu, and design additional programming consistent with the course’s philosophy.

AlcoholEdu for College is designed to provide students with the information they need to make informed choices about drinking.

This section reviews the content of AlcoholEdu’s several learning modules; suggests discussion questions for seminars, workshops, educational events, and communication campaigns; and describes recommended activities designed to promote student engagement, deepen learning, encourage self-reflection, and inspire each student’s personal commitment to make choices about drinking that are consistent with their longer term goals and aspirations.

PART 1 of AlcoholEdu includes the following instructional units: MODULE 1 Getting Started MODULE 2 Standard Drink SURVEY 1 Pre-Intervention Survey MODULE 3 Where Do You Stand? MODULE 4 Goal Setting MODULE 5 Drinking and Motivation MODULE 6 Brain and Body MODULE 7 My Action Plan MODULE 8 Laws and Policies MODULE 9 Helping Friends SURVEY 2 Course Evaluation

PART 2 includes one additional learning module: SURVEY 3 Post-Intervention Survey MODULE 10 Recognizing Problems

There are five appendices: Appendix 1 outlinesAlcoholEdu’s several learning objectives, while Appendix 2 presents a course map to illustrate how AlcoholEdu is organized. Appendix 3 summarizes the major research studies that establish AlcoholEdu as an evidence-based program. Appendices 4-6 have material related to specific recommended activities. Campus practitioners should keep in mind that the order in which AlcoholEdu covers this material may not be the best sequence to follow when designing new or revised programming. Moreover, a particular program might cover one, several, or all of these topic areas, depending on the type of audience, the length of the program, and the availability of other, complementary programming. With this in mind, practitioners should consider the discussion questions and recommended activities presented below as raw materials that they can bring together in whatever way best suits their needs and those of their students. Ideally, however, an institution’s set of prevention efforts would be designed to reinforce the entirety of AlcoholEdu’s curriculum. 11 We do recommend that practitioners use a diverse set of approaches to draw student interest, maximize engagement, and align with varying learning styles. There are many types of strategies that can be used—for example, online education, classroom demonstrations, plays and films, student debates, community forums, activity fairs, rallies, press events, and social marketing, including posters, flyers, table tents, email messages, screen savers, bulletin boards, social media, and other communication channels. Part 1 Module 1: Getting Started This introductory module begins by reminding students that college is a significant investment, but will pay off if they use their time wisely. This is the context in which students need to think about the choices they make about drinking. AlcoholEdu does not tell students what to do when it comes to drinking. Rather, it presents factual information that can help them make informed choices, and does so objectively, without resorting to scare tactics. Importantly, students are told that, although many people think that “everyone” drinks, they will learn that is not true. They will also learn when drinking can become dangerous, and students who drink are given personalized feedback on their current drinking behavior. While attending college, students are told they’ll be part of a caring community where people look out for one another. For its part, AlcoholEdu introduces strategies students can use to keep themselves and their friends safe, whether they drink or not.

Discussion Questions for Module 1:

„„ Why did you decide to attend college? What specific goals do you „„ As you began college, what did your parents or guardians say to have? you about alcohol? „„ What kind of career do you want to have after college? „„ Why do you think you’ve been asked to take AlcoholEdu? „„ What do you need to do to achieve your goals? „„ Do you think most students know everything they need to know about alcohol? „„ What are some things that might get in the way of your achieving these goals? „„ What would you want to see done to reduce alcohol-related problems among college students? „„ How might drinking or partying get in the way? „„ What are some ways you can balance your social life and what you need to do to achieve your goals?

Recommended Activities for Module 1:

„„ There is ample research showing that heavy drinkers do not sleep; h) experiencing poor health; i) anxiety, depression, or other perform as well academically in college and are less likely to behavioral health problems; and j) being injured or experiencing graduate. In a class or workshop, ask students to develop other severe alcohol-related consequences. hypotheses that might explain why students who drink heavily have lower grade-point averages and are less likely to finish „„ Implement a social marketing campaign—using posters, flyers, college. table tents, newspaper ads, emails, social media, and other communication channels—that makes the point that high-risk The Impact of Alcohol Use on Academic Performance drinking and its consequences can derail a student’s career Students who drink heavily are: aspirations. Some materials might focus on particular professions. • More likely to miss class and fall behind in their schoolwork For example, a career in the criminal justice field might not be • Less likely to spend time studying outside of class possible if a student has been arrested for driving under the • More likely to have a lower grade-point average influence or providing alcohol to a minor. • Less likely to graduate „„ Develop an educational module or presentation on how Possible explanations: a) poor life management skills; b) inappropriate postings on Facebook, Instagram, and other social inadequate academic preparation; c) ill-defined academic goals; media sites can come back to haunt students for years to come, d) missing class; e) failing to turn in assignments; f) not spending even if those postings were made by other people. enough time studying outside of class; g) failing to get enough

12 Module 2: Standard Drink A Look Inside AlcoholEdu The module begins with a multiple-choice test to assess students’ knowledge about alcohol, including the standard drink defi nition; factors that aff ect blood alcohol concentration; the short- and long-term eff ects of alcohol on the body; facts about negative alcohol consequences, including blackouts and hangovers; danger signs of alcohol poisoning; and prevalence rates for alcohol abstention, high-risk drinking, and alcohol-related sexual assaults. Next, the module provides a defi nition of a standard drink. Students complete this module just prior to fi lling out Survey 1, which asks about their recent drinking history and their alcohol-related attitudes and beliefs. Students need to report their alcohol consumption using the standard drink measure. A standard drink contains about 0.6 fl uid ounces of alcohol, which translates to 1.5 ounces of liquor, 5 ounces of wine, and 12 ounces of regular beer. Distilled spirits often contain approximately 40% alcohol, while most wine is approximately 12% alcohol. Beer varies, with most having about 6% alcohol, but others having as much as 15% alcohol. Flavored alcoholic beverages range between 4% to 12% or more. One way in which students can moderate their drinking is to count their drinks , pacing themselves to one drink per hour in and eff ort to limit their overall consumption. In practice, this can be diffi cult to do because of variations in the percentage volume of alcohol and container size. Keeping track is especially hard with punch or mixed drinks, when it is harder to know how much alcohol was poured. For this reason, the module includes exercises to help students learn how to keep track of the number of standard drinks that are actually contained in an alcoholic beverage.

Discussion Questions for Module 2:

„ Has learning about the defi nition of a standard drink led you to therefore in the number of standard drinks they contain; d) think diff erently about your own drinking? people pour drinks into diff erent sized cups and glasses; e) bartenders often serve mixed drinks that exceed one standard „ Why is it important for people who drink to keep track of how drink and do so by an unknown amount; and e) alcoholic many standard drinks they’ve had? beverages served in punch bowls usually do not follow a recipe. „ Possible answers: a) to pace their drinking; b) to keep to a plan to „ What strategies can people use to make sure they know exactly limit how much they’ll drink; c) to avoid reaching a high-risk BAC what they’re drinking? (blood alcohol concentration); and d) to avoid negative alcohol- related consequences. „ Possible answers: a) drink from standard-sized containers (e.g., 12-ounce can of beer); b) use the same sized cup or glass when „ What are some of the challenges that people face when trying to drinking, to help gauge how many standard drinks it has; c) ask keep track of how many standard drinks they’ve had? the bartender to measure out the drink; d) drinkers can mix their „ Possible answers: a) the percentage volume of alcohol diff ers own drinks; e) do not drink an alcoholic beverage served in a across types of alcohol and may diff er across brands within a punch bowl; f) do not put down a drink and keep track of it at all type; c) alcoholic beverage containers vary widely in size and times.

Recommended Activities for Module 2:

„ The National Institute on Alcohol Abuse and Alcoholism (NIAAA) „ For example, students might be told the percentage alcohol by has posted a “standard drink calculator.” Link the college’s website volume for a low-end fortifi ed wine and then asked to pour water to this online resource. On the website and through email and into a 16-ounce Solo® Cup or an 8-ounce wine glass until the other messaging, encourage students to explore how it works number of ounces poured is equivalent to one standard drink of and then use it to help them determine how much they can drink that beverage. without exceeding a safer number of standard drinks. Source: http://rethinkingdrinking.niaaa.nih.gov/toolsresources/ „ This exercise can involve several types of alcohol, including regular drinksizecalculator.asp beer, malt liquor, wine, fortifi ed wine, fl avored alcoholic beverages, alcoholic energy drinks, wine coolers, various types of distilled „ As part of a classroom or workshop presentation, have students spirits or hard liquor, cordials, and liqueurs. practice pouring one standard drink of diff erent types of alcohol by pouring water into various sized cups and glasses, and then „ Students can use the NIAAA’s standard drink calculator (see above) transferring the water to a measuring cup to gauge how accurate to determine how much they should pour. Over time, they should they were. strive to learn how to do the calculation in their head, as they would normally have to when drinking.

13 Survey 1: Pre-Intervention Survey Prior to Module 3, students complete a baseline survey to assess the following: 1) alcohol and other drug use in the past two weeks; 2) high-risk drinking behaviors (i.e., chugging, doing shots, pregaming); 3) protective drinking strategies they use when drinking; 4) negative drinking-related consequences in the past two weeks; 5) their reasons for drinking; 6) their reasons for choosing not to drink; and 7) future behavioral intentions related to alcohol use. Students also report their biological sex, race/ethnicity, age, full-time or part-time student status, college living arrangements, and participation in activities outside academics. They also state at what age they had their first drink, if any, and how many of their blood relatives have been a problem drinker or alcoholic, either now or in the past. Of note, the survey uses a calendar-based question for students to report how many drinks they had on each of the past 14 days. Their responses are used to create two variables: total number of drinks consumed in the past two weeks, and whether students reported one or more occasions of heavy, episodic drinking in the past two weeks, defined for men as having five or more drinks on a single occasion in the past two weeks, and defined for women as having four or more drinks. Module 3: Where Do You Stand? Students initiate this module after completing Survey 1. To begin, students are informed 38% of how their drinking habits and experiences compare to those of other first-year students incoming who have taken AlcoholEdu for College. freshmen did not Research conducted at hundreds of colleges has demonstrated that college drink in the past students greatly overestimate the percentage of their peers who drink heavily. That’s year, and that understandable, given the numerous alcohol ads, movies, television shows, pop songs, and news reports that depict or imply that high-risk drinking is the campus norm. 67% did not For this reason, the module informs students that, according to AlcoholEdu data, fully 38% do so in the past of incoming freshmen did not drink in the past year, and that 67% did not do so in the past two weeks two weeks. Moreover, the male students who drank in the past two weeks had an average of 4.39 drinks during that time period, while female students consumed an average of only 2.88 drinks. Students who have abstained from alcohol will see from these data that they are not alone. In fact, the percentage of students who choose not to drink has been steadily increasing over the past two and a half decades. Students who drink heavily will discover that their alcohol use exceeds the norm, even among drinkers, which is something they should consider in the future. At this point, students who are committed abstainers may wonder why they need to take AlcoholEdu. The course explains that they can benefit in several ways: they will learn more about alcohol, develop a deeper understanding of what their classmates may be experiencing, and receive guidance on how to intervene appropriately if another student appears to be in danger. The module then presents examples of activities on campus that all students can explore that do not involve alcohol. In addition, abstainers are given the opportunity to connect with other like-minded students.

14 REINFORCING POSITIVE CAMPUS NORMS Correcting misperceptions of campus drinking norms is a major focus of AlcoholEdu and among the reasons for its success in reducing drinking and alcohol-related problems among first-year students. Using the course as a foundation, campus administrators should use every opportunity to publicize the many ways in which the majority of students are making good decisions to protect their health and safety and that of their peers. It is critically important for administrators to avoid using images or descriptions of the problem that would reinforce these misperceptions, as well as to eliminate conflicting messages from the campus environment that state or even imply that frequent heavy drinking is the norm.

Students who drink are directed through different course pathway than those who do not drink. First, they compare the negative drinking-related consequences they reported in Survey 1 against those reported by other students. The module also asks them to estimate the highest BAC (blood alcohol concentration) level they reached when drinking during the past two weeks. Then, based on the data they provided in Survey 1, students calculate their true peak BAC. Most students, especially the heaviest drinkers, will underestimate their peak BAC, which likely means that until this time they have not been fully aware of the risks posed by their alcohol use. Next, having received all of this feedback, students who drink are asked to indicate how they currently feel about their drinking habits and presented with contact information for national resources that can provide assistance, plus a customized list of local campus resources provided by each college’s AlcoholEdu administrator. The course then presents a list of strategies that students who drink can use to moderate their alcohol use and keep their BAC in a safer range, specifically 0.04% or less. There is also a calculator activity that students can use to estimate how much money they would spend and how many empty calories they would consume if they were to drink in various ways. For all students, the module reviews factors that affect people’s risk of experiencing alcohol-related problems, including being male, being Caucasian (white), belonging or intending to belong to a fraternity or sorority, participating or intending to participate on an intercollegiate athletic team, having initiated drinking before age 15, and coming from a family that has experienced drinking problems. Of course, even if students have a high risk profile, they can choose to abstain or drink in a safer way in order to avoid negative consequences. The module then shifts to explore the reasons people choose to take a break from drinking alcohol or to abstain. The course asks students to indicate their own reasons from the The top five list shown in the following table, and then to reflect whether their reasons were similar or reasons students different from the top five reasons students in previous years have given for not drinking: 1) I’m going to drive. 2) I have other things to do. 3) I don’t want to lose control. 4) I don’t abstain from have to drink to have a good time; and 5) I don’t want to spend the money. drinking

15 POTENTIAL REASONS FOR CHOOSING NOT TO DRINK

Alcohol Characteristics Peer Influences Legal/Financial Concerns „„ I don’t like the taste. „„ My friends don’t drink. „„ I’m not old enough to drink legally. „„ Alcohol is fattening. „„ People I care about would „„ I am worried about being caught by disapprove. authorities. Lifestyle/Personal Values „„ I don’t like being around others who „„ I don’t want to spend the money. „„ Drinking is against my personal are drinking. values. „„ I want to fit in with a group I like. Negative Consequences „„ Drinking conflicts with my religious „„ I am worried about the negative beliefs. Behavioral Impacts effects on my health. „„ I’ve decided to cut down. „„ I don’t want to lose control. „„ I am not able to drink due to a „„ I don’t want the image of a drinker. „„ I don’t like the way I act when I’m medical condition. drinking. „„ Drinking interferes with my athletic Problem History „„ I’m going to drive activities. „„ People in my family have had alcohol „„ Drinking interferes with my school problems. Alternative Activities work. „„ I’ve had problems with alcohol use in „„ I have other things to do. the past. „„ I don’t have to drink to have a good time.

Discussion Questions for Module 3:

„„ In AlcoholEdu, you learned what percentage of incoming first- „„ Why do college students think more students drink heavily than is year college students drink and what percentage abstain from actually the case? alcohol. What do you remember about those data? What were „„ Possible answers: a) alcohol ads; b) movies, television shows, and you thinking when you learned this information? pop songs; c) news reports about student drinking; and d) people „„ Do you believe the AlcoholEdu data? If not, why? If you do believe are more likely to notice students who are drinking heavily, which the survey results, then explain your answer. distorts their perception of how many students do this. „„ Possible answers: a) students knew their survey responses would be kept in confidence and not reported to anyone; b) the survey questions were straightforward and easy to answer; c) other surveys ask these same questions about alcohol use; d) seen or heard about similar data from other surveys; and e) students who reported drinking a lot said they had experienced several negative consequences.

Recommended Activities for Module 3:

„„ As part of a classroom or workshop presentation, have students examine the following chart, which shows the percentage of US college students who reported consuming alcohol in their lifetime, in the past year, and in the past 30 days, as well as the percentage who had five or more drinks in a row at least once in the past two weeks. These are data reported by the University of Michigan’s Monitoring the Future study: Source: http://www.monitoringthefuture.org/pubs.html

Year Lifetime Use Use in Past Year Use in Past 30 Days 5+ Drinks in a Row in Past 2 Weeks

1990 93.1 89.0 74.5 41.0 1995 88.5 83.2 67.5 38.6 2000 86.6 83.2 67.4 39.3 2005 86.6 83.0 67.9 40.1 2010 82.3 78.6 65.0 37.0 2013 78.0 75.6 63.1 35.2

16

Through a website posting, or as part of a classroom or workshop presentation, ask students to guess the results of a survey of 2,801 students attending 18 colleges and „„ unAs partive rofs aiti classroomes acro orss workshop the U Spresentation,. Under chaveond studentsitions examine of anon they followingmity, schart,tuden whichts showsansw theer percentageed the of US college students who reported consuming alcohol in their lifetime, in the past year, and in the past 30 days, as well as the percentage who had five foro llmoreowi drinksng tw ino a querow ats leasttion onces: in the past two weeks. These are data reported by the University of Michigan’s Monitoring the Future study: Source: http://www.monitoringthefuture.org/pubs.html Ask students Pe rtoc describeeived Dtheri patternnking of: D results,uring moving the pafroms t1990 30 throughdays, 2013, on hoandw then m anyask the o followingccasion question:s do y Whatou does it mean thatth thein kdecrease the a inve therage percentage or ty pofi cstudentsal studen who havet at had[you fiver] orsc morehoo drinksl ha sin uthes edlast twoalc ohoweeksl is( beeso muchr, w lessine than, the percentageliquo decreasesr)? shown for the other consumption measures? Ask students to develop hypotheses that might explain why alcohol use among college students has decreased over time, and to outline what kind A ofc datatua lwould Drin theykin needg: D tou testring their the hypotheses. past 30 days, on how many occasions did you use „„ Through a websitelcoho lposting, (bee ror, was ipartne, of li qa classroomuor)? or workshop presentation, ask students to guess the results of a survey of 2,801 students attending 18 colleges and universities across the US. Under conditions of anonymity, students answered the following two Tquestions:he response options were: Never, 1-2 times, 3-5 times, 6-9 times, 10-19 times, 20-39 tPerceivedimes, and Drinking: 40+ Duringtimes the. past 30 days, on how many occasions do you think the average or typical student at [your] school has used alcohol (beer, wine, liquor)? AActualfter pDrinking:roviding During the the de pastsc r30ip days,tion on o fhow the many su roccasionsvey, a sdidk youstuden use alcoholts to (beer, esti wine,mat eliquor)? the percentage of sThetuden responsets fr optionsom the were: 18 Never, coll 1-2ege times,s and 3-5 times,unive 6-9r stimes,ities 10-19 who times, repo 20-39rted times, the andir o 40+wn times. drinking to be at tAfterhes providinge variou thes description levels. of the survey, ask students to estimate the percentage of students from the 18 colleges and universities who reported their own drinking to be at these various levels.

NNext,ex t,have ha theve students the st reportuden outts theirrepo estimatesrt out forthe “Never,”ir esti “1-2ma times,”tes f oandr ““10-19Neve times.”r,” “1 Ask-2 students times ,with” and especially “10- high19 or low estimates to explain their reasoning. times.” Ask students with especially high or low estimates to explain their reasoning. Following this discussion, show the students bar graph displayed below which depicts the actual survey results. Possible discussion Fquestions:ollowing a) What this do d theseiscu resultsssion demonstrate?, show the b) sAretuden they surprisedts bar gbyr aphthe results? disp c)la Whatyed accounts below for w discrepancyhich dep betweenicts what the survey respondents reported about their own drinking and the students’ estimates? d) Will this information change how students view ttheirhe aownct uadrinkingl su rbehavior?vey re sults.

40+X

20-39X

10-19X % Actual 6-9X % Perceived

3-5X

1-2X

Never

0 5 10 15 20 25 30 35

„„ Most college students believe their peers are drinking much more alcohol on average than is actually the case. Several studies have shown that a communications campaign that provides accurate information about student alcohol use will reduce these misperceptions and Ptherebyossib reducele di schigh-riskussi ondrinking. que Thissti ontypes of: a campaign) Wha tis doknown the ass sociale re normssults marketing. demon strate? b) Are they sSurveyurpr i1s providesed by campusthe re practitionerssults? c) withWha datat a oncc theoun alcohol-relatedts for disc attitudes,repan beliefs,cy be andtw eenbehaviors wha oft their the incoming surve yfirst-year students. This information can be used for a social norms marketing campaign directed to the next year’s freshman class. rThises pondencampaign cants rbeginepo evenrted before abou studentst thei rarrive ow non d campus.rinking The and start tofhe classes studen is a busyts’ time,esti manda there’stes? da risk) W thatill tthehis campaign’s imessagesnforma wouldtion cgethange lost in the ho floodw s tofuden informationts vie thatw tcomesheir otheirwn way.dr iInstead,nking bybehav communicatingior? in advance about the true campus norms, while also clarifying the college’s expectations for student conduct, the campaign can persuade students to make healthier choices from the moment they arrive on campus. For example, the campaign can capitalize on the students’ acceptance letter, perhaps the most memorable correspondence students will receive from their school. A companion letter to parents can reinforce the social norms message in the context of providing guidance on how to talk with their child about substance use. After students commit to attending, their college will send pre-enrollment information about fall orientation, housing, and course registration, which can also carry the campaign messages. This effort can then continue once students start classes and throughout the academic year. ##" !

17 Module 4: Goal Setting A Look Inside AlcoholEdu The module begins by reminding students that setting goals is an important part of college. It is important to specify what they hope to accomplish and to check their progress along the way, as the decisions they make each day will determine whether they achieve their goals. The students choose their priority goals for the coming academic year and to check off the specifi c reasons they have for those selections. This information is then used to create their personalized goal statement. Potential areas of focus include schoolwork, sports, relationships, extracurricular activities, health and fi tness, and community service. For each area they choose, the course lists fi ve or six reasons they might have for selecting that goal. If they pick community service, for example, the choices are: be a good role model, meet people who share my values, expand my social network, make a diff erence, feel good about my time in college, and get more experience. Consistent with AlcoholEdu’s prevention philosophy, the module reminds students that while they may choose to drink, they should consider whether their alcohol use might impede their ability to accomplish the goals they chose for themselves. Accordingly, students then select the specifi c goals they have regarding their use of alcohol. The options are: a) continue not to drink, b) take care of my body, c) stop drinking, d) stay safe, e) reduce my drinking, f) help others make better choices, and g) make good decisions. Of course, some students might be anticipating that they’ll start drinking or increase their alcohol consumption, but the course doesn’t off er those options. Next, students select the reasons they have for these goals, which are framed in terms of what they want to avoid: a) only focus on drinking, b) damage relationships, c) get in trouble, d) embarrass myself, e) disappoint others, f) put myself at risk, g) fall behind in school, h) put my friends at risk, i) develop health problems, and j) have regrets.

Discussion Questions for Module 4:

„ If students do choose to drink, what can they do to stay focused „ Some entering freshmen students may be anticipating that they’ll on their academic studies, do well in their classes, and graduate increase their alcohol consumption once they get to campus. It on time? might be possible to dissuade them from doing this, but if not what would you tell them to help them make healthy choices, stay Possible answers: a) drink less often, or not at all when the safe, and achieve their goals for attending college? schoolwork is most demanding; b) consume less alcohol to avoid „ In their eagerness to take maximum advantage of their college drinking-related negative consequences; c) fi nd healthy ways to career, some students take on too much and end up experiencing relieve stress and have fun; d) get involved in activities that don’t severe stress. What would you recommend that students in this involve drinking; and e) spend time with friends who are also situation do to alleviate their stress? What would you recommend committed to doing well in college. that they not do? What campus resources are available to help these students?

Recommended Activities for Module 4:

„ Interview seniors attending your college to ask the following „ In a classroom or workshop presentation, ask students to write three questions: a) What do you know now about going to college themselves a congratu-latory email message they will read again that you wish you had known when you fi rst arrived on campus when they earn their degree. The message should refl ect on as a freshman? b) What do you wish you had done diff erently what they accomplished while attending college and their post- to get more out of college? c) What advice would you give fi rst- graduation plans. Ask students to read their email message to year students about how to use their years in college to get the the rest of the group. Following that, discuss the common themes maximum benefi t? Compile this information, including quotations, that emerged, and ask the students what specifi c steps they will for freshman orientation, classroom or workshop presentations, take to stay on track to achieve their goals. website postings, and other educational venues. Consider posting video clips from the interviews.

18 Module 5: Drinking and Motivation This module explores what students know about alcohol and the factors that influence people’s decisions and attitudes about drinking. The first section begins by highlighting the following statistics:

„„ Only 11% of incoming college students who have taken AlcoholEdu were frequent heavy drinkers.

„„ While it might be easy to assume that “everyone” drinks, that actually isn’t true: 38% of incoming students reported not drinking alcohol in the past year.

„„ Fully 34% of incoming students who drank in the past year indicated that they were thinking about, ready to, or currently trying to drink alcohol in a safer way. The next section points out that people’s drinking is greatly influenced by what they think others attitudes are when it comes to alcohol and by how much they believe others drink. Students who believe that more heavy drinking is going on than is actually the case will be influenced by that misperception and may increase their own drinking in an attempt to “fit in.” The fact is, however, that many students don’t drink, and most students who do are consuming alcohol in a safe way. These misperceptions are driven by alcohol ads, movies, television shows, pop songs, and news reports about student drinking, which communicate or imply that college is a big party. In addition, it’s very easy to notice students who drink heavily while overlooking those who are having just a couple of drinks or are doing something else. Students are greatly influenced by their family’s attitudes about alcohol and the family members’ drinking patterns. Parental limits on alcohol and disapproval of alcohol use in high school can deter consumption in the first year of college. Children of alcoholics can be at great risk for alcohol-related problems, but they can avoid the same path if they make the choice to be a light or moderate drinker or not to drink at all. That said, students will need to make their own decisions about alcohol, regardless of their family’s attitudes and experiences. Peer influences are also a major factor. Going to college means being in a new place, meeting new people, and experiencing new things. AlcoholEdu points out that there is a big difference between having a few drinks with friends and drinking heavily in order to feel comfortable in a new social situation. In fact, relying on alcohol in that way can be a warning sign of current or future alcohol dependence.

If students feel they’re being judged by a friend for not drinking or for drinking in a responsible way, then they might want to reevaluate that friendship. A good friend will respect and support a student who makes healthy choices about drinking.

Although starting college means excitement and opportunity, the transition to college life also brings new pressures and uncertainties that can be stressful. There are healthy and unhealthy ways of managing stress. Drinking to reduce stress is an unwise choice and can often make things worse. Students who use alcohol to decrease stress may be at risk for alcohol dependence. The next section asks students to identify the top reasons why they think students drink. The reasons receiving the most votes were “they think drinking will help them fit in” (37.5%) and “they assume ‘that’s just what people do in college;’” (34.2%). These responses reinforce AlcoholEdu’s focus on students’ misperceptions of campus drinking norms and the resulting social pressure that such a belief can engender. Interestingly, the idea that students drink due to being “under a lot of stress” received very few votes (5.6%).

19 Students then try to identify the top reasons that their peers give for deciding not to A Look Inside AlcoholEdu drink or to drink in moderation. The reasons receiving the most votes were: “they don’t want alcohol to interfere with sports, academics, or their health” (34.7%), “they want to stay in control” (18.8%), and “they don’t want to get in trouble at school” (13.7%). The fact that students “are under 21 and don’t want to break the law” was seldom selected as an important reason (8.7%). This was also the case for not wanting “to disappoint their friends or family members” (8.0%). The module next turns to the subject of alcohol advertising. Studies have demonstrated that what people expect to experience when consuming alcohol has a huge infl uence on how they actually feel and act while drinking. Advertisers exploit this fact by presenting idealized images of drinkers who are relaxed, sociable, fun-loving, disinhibited, and look “cool.” Of course, the ads never go on to show what can happen when people drink too heavily or develop alcohol dependence. In recent years, alcohol advertising has increasingly targeted young women. Many of the ads use images and messaging that portray women who are confi dent, powerful, sexy, and seductive, implying that women who drink the advertised brand will be able to take on these same qualities. Ads that show groups of women drinking in a comfortable, safe setting draw upon other themes that resonate with women: friendship, togetherness, acceptance, and relaxation. Advertising directed to men attempt to associate the brand with feelings of brotherhood, camaraderie, acceptance, and relaxation, along with sports and the attention of sexy women. Pointing out that many people get annoyed by manipulative advertising, the course then asks students to identify their biggest concern about alcohol ads. Next, the students are shown what previous AlcoholEdu students had to say. The top three choices were: the ads “don’t show the negative side of drinking” (39.1%), “they send a false message that drinking is always fun and cool” (26.6%), and “they are common in places where younger kids can see them” (13.8%).

Discussion Questions for Module 5:

„ AlcoholEdu for College outlined how alcohol companies use „ What topics did your parents or guardians talk to you about? advertising to link their brands to what they think potential What did they say that was helpful to you? Was anything they said drinkers care about. What alcohol advertising have you seen on unhelpful? television or magazines recently that used some of the strategies „ If you were to advise the parents or guardians of next year’s discussed in the course? What themes, images, and slogans did freshman class, what would you tell them to say to their students the ads use? Do the ads target men and women diff erently? about campus life before they start college? What do you think „ Studies have shown that fi rst-year college students will make they should say about alcohol? About other drugs? Other topics? healthier decisions about drinking if their parents or guardians talk to them about campus life, including alcohol use, before they start college.

20 Recommended Activities for Module 5:

„„ Take photos of brand-specific alcohol advertisements appearing in If not, then consider using data on the high percentage of students magazines with large youth audiences (e.g., Cosmopolitan, ESPN, who take protective steps to avoid high-risk drinking or the low InStyle, People, Rolling Stone, Sports Illustrated, Us, and Vogue). percentage of students who experience negative consequences Display three or four of the ads and ask students to evaluate each due to their drinking. Alternatively, focus on their expressed beliefs ad on the listed dimensions, where: 1 = Strongly Disagree, 2 = and attitudes that would support healthier decisions regarding Disagree, 3 = Agree, and 4 = Strongly Agree. alcohol use. • This ad shows this product will make people popular. Next, have students develop draft messages (“mock-ups”) for the • This ad shows this product will make people cool. campaign. There are several communication channels they can • This ad shows this product will make people successful. consider: posters, flyers, newspaper ads, table tents, social media, and so forth. • This ad shows this product will make people look sexy. The messages should follow these guidelines: • This ad shows this product will make people look attractive. • Choose a message for all freshmen rather than a particular • This ad uses symbols, language, music, gestures, celebrities, or group (e.g., men or women, student athletes, fraternity and features that appeal primarily to persons below age 18. sorority members). Compare the ratings for the ads. What themes, images, and slogans • Frame the message so that it emphasizes the positive majority did the ads use to develop the products’ “brand identity”? What did rather than the minority of students who are making unhealthy they like or dislike about the ads? Do they find the ads effective? Do choices. they have any concerns about this type of advertising being used? • Have the message be a simple statement of fact. Avoid a „„ As part of a classroom or workshop presentation, have students judgmental or moralistic tone. design messages for a social norms marketing campaign for next • Identify the source of the data (e.g., AlcoholEdu for College, year’s entering freshmen. As noted, this type of campaign publicizes Survey of Entering First-Year Students, August 2014). accurate information about student alcohol use in order to reduce • When reporting drinking behavior, cite the definition of a exaggerated misperceptions of campus drinking norms. “standard drink,” as cited in AlcoholEdu and in the survey To start, provide students with selected data from the Survey instructions: 1.5 ounces of liquor, 5 ounces of wine, and 12 1 report for your institu-tion’s most recent administration of ounces of regular beer. AlcoholEdu. Choose data showing that a majority of the freshmen • For visual media, use eye-catching photographs that also reported making safe and healthy choices. Ideally, data on their convey a positive message. alcohol use will be suitable—e.g., the average number of drinks • Include a campaign logo (which the students themselves can consumed per week, the percentage of students who could be develop). classified as “heavy drinkers,” the percentage that did not drink in the past two weeks. • Cite the source of the campaign message (e.g., Student Health Services, Dean of Students Office). Have the students present the draft materials to receive constructive feedback from other students.

21 Module 6: Brain and Body This module examines risk and protective factors related to alcohol consumption and how the body and brain respond at various blood alcohol concentration (BAC) levels. Students learn that not everyone’s BAC increases at the same rate, even if they drink the same amount of alcohol over the same length of time.

„„ A key factor is biological sex. If a man and a woman consume the same number of drinks, the woman will reach a higher BAC level, even if they weigh the same. One reason for this difference is that women have less of the enzyme dehydrogenase that breaks down alcohol in the stomach. Women also tend to have a higher percentage of body fat and lower percentage of water. This is why it is dangerous for women to try to “keep up” with how much the men are drinking.

„„ The more a person weighs, the more mass and body water he or she has to absorb the alcohol, which means a lower BAC for a given amount of alcohol.

„„ Eating food before or while drinking can help slow the rate at which alcohol is absorbed. All of the alcohol consumed will eventually be absorbed, but it’s better if it’s absorbed more slowly because that will result in a lower BAC level.

„„ The carbonation in sodas used in mixed drinks can speed up the body’s absorption of alcohol. The course also explains that the faster a person drinks, the faster his or her BAC will rise. It explains that drinking games and doing shots generally lead to large amounts of alcohol being consumed in a short period of time, which can quickly bring their BAC to a dangerous level.

The notion that drinking coffee, taking a cold shower, or vomiting will help a person sober up is a myth. The only thing that lowers a person’s BAC is the passage of time.

It takes about two hours for the liver to eliminate one standard drink—that is, 0.6 fluid ounces of alcohol. That means that people should pace themselves to one or fewer drinks per hour. Sugary mixers can mask the taste of alcohol, which may lead people to consume a dangerous amount without realizing it. Additionally, the caffeine in energy drinks counteracts alcohol’s depressant effects, which may also induce people to drink to unsafe levels. The course emphasizes that the dangers of alcohol are intensified with the addition of other drugs, including allergy medications, anti-depressants, pain relievers, and prescription medications such as antibiotics. The combination of alcohol with aspirin or other nonnarcotic pain relievers such as acetaminophen or ibuprofen can cause stomach irritation. Additionally, the combination of acetaminophen and alcohol can cause liver damage. It is also dangerous to combine alcohol with antihistamines or any other drug that can cause drowsiness, as they magnify alcohol’s sedative effects. Combining alcohol with antidepressants can also be problematic. Skipping medications in order to drink is not the answer. Certain medications stay in people’s system long after they stop taking them and can still interact with alcohol. Moreover, discontinuing prescribed medications may come with side effects that may be magnified by use of alcohol or other drugs.

22 ALCOHOL INTERFERES WITH SLEEP When alcohol is consumed close to bedtime, the brain doesn’t complete its normal sleep cycle. REM (Rapid Eye Movement) sleep is disrupted, causing daytime fatigue and sleepiness.

The course presents students with a BAC Calculator. Students input values for sex, body weight, number of hours spent drinking, and number of drinks consumed, and the calculator estimates the maximum BAC that the specified person would reach during that drinking episode. Students are shown the estimated BAC and probable side effects in the chart format shown below. The key message is that if students choose to drink, they should plan to stay in the safer range of 0.02% to 0.04% BAC.

BAC Level Probable Side Effects

Slowed heart rate and breathing Greater than 0.35% Potential coma or death

Total mental confusion 0.21% to 0.35% Needs assistance walking Loss of consciousness

Confusion, dizziness, and slurred speech 0.11% to 0.20% Slower reaction time Lack of balance Vomiting, sleepiness, and blackouts may occur

Lack of muscle coordination (balance, speech, vision, 0.05% to 0.10% reaction time) Impaired judgment and memory

Warm feelings Less than 0.04% Lowered inhibitions Coordination and judgment may start to be affected

Next, the module uses a Q & A format to provide key information about marijuana and prescription drugs. Students learn that while some marijuana smokers report experiencing a state of euphoria or “high,” the drug makes others feel anxious, even panicky. Studies have also shown that tetrahydrocannabinol (THC), the key ingredient in marijuana, impairs learning, memory, and motivation; some research indicates that its effects on thinking and memory may last a long time or even be permanent. Marijuana can be addictive, especially for frequent users and people who began using the drug at early age. Importantly, students are cautioned that it is unsafe to drive after smoking marijuana. THC affects coordination, reaction times, and judgment, which can more than double a driver’s risk of being in a traffic accident. Combining marijuana and alcohol increases the risk. The module notes that while the vast majority of students do not abuse prescription drugs, using a medication other than as prescribed is both illegal and dangerous. The side effects can be severe: vomiting, mood changes, difficulty breathing, a slowed heartbeat, addiction, and even death. Combining non-prescribed medicines with alcohol or other substances compounds the risk.

23 Some students abuse stimulants such as Adderall and Ritalin, which are used to treat attention deficit/hyperactivity disorder (ADHD). They use these drugs because they believe it will help them stay up all night and study, but this is a dangerous practice. These drugs do not enhance learning or concentration, and studies show that students who abuse stimulants typically don’t do better in school. Street drugs are especially dangerous. For example: „„ MDMA (known as Ecstasy or Molly) can lead to a sharp increase in body temperature (hyperthermia), which may result in liver, kidney, or cardiovascular failure, and even death. Moreover, dealers who sell illegal drugs such as MDMA often contaminate it with other substances or lie about what the drug actually is, which means that users can’t even be sure of what they’re putting in their body.

„„ When taken as prescribed, opioids such as OxyContin and Vicodin can be used to manage pain effectively. When abused, however, opioids can be extremely dangerous, leading to potentially life-threatening respiratory problems and physical dependence or addiction.

MIND YOUR MEDS „„ Only take medications as directed. „„ Keep prescriptions in a secure location. Approximately „„ Do not share prescriptions with anyone, regardless of the reason. 70 to 80 percent „ „ Never mix alcohol with other drugs. of college sexual assaults involve The topic of sexual assault is also addressed in this module, making clear to students that it is a real issue on college campuses and one that is taken very seriously.. The course alcohol defines sexual assault as any form of sexual contact that occurs without consent. Consent exists when sexual partners communicate about what they want, respect each other’s boundaries, and expressly agree on what is going to happen between them. A person’s ability to give consent is compromised by the use of force, the threat of force, intimidation, coercion, or impairment due to alcohol or drugs. Approximately 70 to 80 percent of college sexual assaults involve alcohol. When alcohol is involved in a sexual assault, even when both people have been drinking, it is often used intentionally by one individual to incapacitate another, and not the less common situation where both individuals get drunk and don’t remember what happened. Alcohol can affect a potential victim in three ways: 1) decreasing the person’s ability to detect a risk situation; 2) impairing the person’s ability to resist an assault; and 3) interfering with the person’s ability to give true consent. It is difficult to identify potential sexual assault perpetrators, but possible warning signs include the following: 1) use of sexist language or statements that speak of sex as a “conquest,” 2) trying to encourage more alcohol consumption, 3) using coercive language, 4) invading another individual’s personal space or not respecting personal boundaries, 5) isolating the person from friends, 6) exhibiting angry or aggressive behavior, and 7) threatening a person with negative consequences if they don’t cooperate.

RAPE DRUGS Alcohol is the most commonly used rape drug. Sexual assault perpetrators may drink less so that they can stay “in control,” while using alcohol to disable their victims so that they have less control over what happens. Other rape drugs include GHB and Rohypnol (“roofies”). They are extremely dangerous and can cause unconsciousness; when combined with alcohol, they can be fatal. They can also cause severe sedation and amnesia, which can make a person highly vulnerable to assault. For that reason, it’s important for students to pour their own alcoholic beverages and to keep an eye on their drink to prevent anyone from slipping something into it. 24 If people notice a potentially dangerous situation, then they should act, recognizing A Look Inside AlcoholEdu that other people likely share their concern even if they don’t show it. Enlist others for support. Attempt to distract the potential perpetrator—ask questions, engage them in conversation—and help the potential victim get away from the situation. Alternatively, talk to the potential victim and ask if everything is okay or if they need help getting home. If the potential perpetrator is a friend, then consider confronting the situation directly, but in a caring way, to make clear that what is going on is not okay. The course notes that taking action to intervene is part of being a member of a caring community.

It is never a person’s fault for being taken advantage of sexually, no matter what they wear, how they act, or how intoxicated they are. Sexual assault is a crime, and the fault lies with the perpetrator and never the victim.

The module’s next section explains alcohol’s biphasic properties, which provides students with yet another reason for keeping their BAC below 0.04% if they choose to drink. Alcohol is a depressant, and after one or two drinks people will often feel more relaxed, perhaps even euphoric, and experience lowered inhibitions. That’s the fi rst phase. With those good feelings people may be led to drink even more, but once their BAC goes above 0.04%, the good feelings will be supplanted by a mix of negative eff ects, beginning with lack of muscle coordination and impaired judgment, which get progressively worse as they continue to drink. That’s the second phase. Referring to the interactive graphic shown below, students are advised to “stay on the left side of the curve.” The module concludes by reviewing how alcohol interferes with the central nervous system and disrupts normal functions of the brain and body. After drinking, people may feel clumsy because alcohol impacts the cerebellum, the part of the brain responsible for motor control and equilibrium, and causes the central nervous system to respond more slowly. Why do people get a hangover? Drinking alters activity in the hypothalamus, which can lead to dehydration, causing the brain to shrink away from the skull and resulting in a painful headache. Alcohol is a diuretic: it causes the pituitary to stop making vasopressin, causing the kidneys to send water directly to the bladder instead of reabsorbing it into the body, which means more trips to the bathroom. Why do people sometimes experience a blackout after drinking? Large amounts of alcohol can impair the hippocampus, which impairs the brain’s ability to store new memories. A “brownout” is distinguished from a blackout when people cannot initially recall something that happened but can eventually remember when they are prompted. If a person experiences frequent brownouts or blackouts, this could be a sign of alcohol dependency.

25 Discussion Questions for Module6:

„„ What are the problems that heavy-drinking students can cause for other students, including those who don’t drink in a high-risk way and those who choose not to drink? These problems are often referred to as the “secondhand effects” of alcohol just as cigarette smoke that aggravates other people— and can negatively affect their health—is called “secondhand smoke.” Possible answers appear in the chart below:

PROBLEMS THAT HEAVY DRINKERS CAN CAUSE FOR OTHER STUDENTS

• Had sleep interrupted • Got into a verbal argument • Had studying interrupted • Threatened with physical violence • Had classroom activities disrupted • Hit, pushed, or assaulted • Had on-campus event disrupted • Got into a physical fight • Found bottles, cans, and other litter in or around • Was made to feel unsafe residence • Harassed due to race/ethnicity, religion, sexual orientation, or gender • Found vomit in or around residence • Take advantage of sexually • Had personal property or residence damaged • Was a victim of sexual assault • Had to take care of intoxicated student • Had to call 911 for intoxicated student

„„ The federal government’s Dietary Guidelines for Americans „„ Rather than resorting to alcohol, what are healthier and more defines “moderate alcohol consumption” as no more than 1 drink effective ways to cope with stress? per day for women and no more than two drinks per day for „„ Possible answers: 1) do vigorous exercise; 2) meditate or do men. This refers to the amount consumed on a single day, not yoga; 3) get a good night’s sleep; 4) talk to a friend; 5) organize an an average number of drinks over several days. What is the basis activity with friends that doesn’t involve alcohol or other drugs; for this definition? Why do you think the definition for men and 6) do something positive for another person; 7) listen to music; women is different? 8) make a “To Do” list and develop a schedule; 9) break up major „„ Alcohol may help some people relax, but using alcohol to cope assignments into smaller, more manageable parts; and 10) see an with long-term stress is counter¬productive. In fact, the National advisor or counselor to get help. Institute on Alcohol Abuse and Alcoholism (NIAAA) states, “a long- „„ Alcohol is involved in the vast majority of sexual assaults that term heavy drinker may experience higher levels of anxiety when occur at American colleges and universities. Some victim faced with a stressful situation than someone who never drank advocates object to discussing the role that alcohol can play in or who drank only moderately.” Source: http://pubs.niaaa.nih.gov/ campus sexual assault, believing that doing so constitutes victim- publications/AA85/AA85.htm blaming. Do you agree or disagree with this position? Is there a „„ Do you think college students experience more stress than other way to talk about alcohol and sexual assault without appearing to people? Are you more stressed than when you were high school blame the person who was assaulted? or are you less stressed? What are the typical sources of stress for college students?

Recommended Activities for Module 6:

„„ The Rape of Mr. Smith is an imaginary script with a defense Reflection:We often hear people blame victims for their attorney cross-examining the male victim of a robbery (see misfortune, even in cases of natural disasters. Why does this Appendix 4). Have a male volunteer read for “Mr. Smith” and happen? Most people have an “optimism bias” and therefore another volunteer read for the attorney. Then raise the following believe they are at less risk of experiencing a negative event than questions for discussion: others are. This belief is challenged whenever they learn that • What are some other crimes where it would be absurd to blame something bad has happened to someone else. According to the the victim? “just world hypothesis,” people often respond to this challenge • Why is it easy to blame the victim of a sexual assault and not by asserting their belief in a just world where people get what other crimes? they deserve. Thus, when they hear about a sexual assault, they blame what happened on the victim’s dress or behavior. With that, • What messages does society send regarding victim-blaming for people can go on believing that they will never be the victim of crimes other than sexual assault? For sexual assault? such a crime because they feel they would know better than to act • What role does alcohol play in whether or not the victim of a in the same way. crime is blamed? Does it differ for victims of sexual assault versus The key message: Just because there are precautions that people other crimes? can take to avoid being the victim of a crime doesn’t mean they • What role does alcohol play in assigning fault to the perpetrator can’t be victimized or that it’s their fault if they are. of any crime? Does it differ for perpetrators of sexual assault versus other crimes? • How can we talk about the connection between alcohol use and sexual assault without victim-blaming?

26 „„ Students can be effective partners in building school-wide support Once the question set is complete, have the students go to for new policies and programs to improve the social climate on different high-traffic areas on campus and ask other students campus and reduce alcohol-related problems. One effective way to whom they don’t know to take a moment to fill out the survey. After do this is to ask a team of students to collect data that can be used students have answered the questions, they can fold their survey to make the case for change: in half and put it in a small box with the other completed surveys. When the team has gotten 200 or more surveys (and the more, the • Have students conduct an environmental scan of the campus better), have them compile the results. and surrounding community. This task involves the following: 1) recording the number and location of on-premises and off- Have the students brainstorm different ways of reporting the premises alcohol establishments; 2) doing a content analysis of results of the environmental scan and the survey—e.g., student the campus newspaper for stories, commentaries, or advertising newspaper article, campus email message, social media messaging, focused on alcohol; 3) examining campus bulletin boards for dining hall table tents, posters or flyers. From there, they can party notices, posters, or flyers that advertise or promote design and execute a communications campaign to publicize this alcohol-related activities, local bars, and drink specials; and information and build support for addressing alcohol problems on 4) documenting physical evidence of the “alcohol culture” on campus. campus—e.g., beer mugs and shot glasses being sold on campus, student posters, posters in student rooms, alcohol-related litter and trash. See the College Alcohol Risk Assessment Guide: Environmental Approaches to Prevention: http://files.eric.ed.gov/ fulltext/ED514315.pdf. • Have a team of students conduct a survey with questions designed to document how students at their school have been affected by other people’s drinking. See below for how a main question could read.

During the current academic year, approximately how many times have you experienced the following consequences due to other people’s alcohol use?

Consequences 1-2 3-5 6-9 10-19 20+ Had personal property or residence damaged

Was made to feel unsafe

The chart in the discussion questions for Module 6 lists additional consequences to ask about. Students can add to the list.

Module 7: My Action Plan With this module, students answer a series of questions to create a personalized plan to make—or continue to make—good decisions about alcohol. One set of questions is for students who drink, and a second set is for non-drinkers. Each question lists a behavioral objective and then presents a list of optional strategies that students can choose to become part of their plan. The goals for drinkers are: 1) setting a reasonable drink limit; 2) eating before and while drinking; 3) pacing their drinking; 4) keeping track of their drinking; 5) avoiding drinking quickly; 6) knowing exactly what’s in their drink; 7) making sure that no one adds anything to their drink; 8) helping keep their friends safe; and 9) finding other things to do. There are numerous strategy options from which students can customize their plan. For example, to be sure of exactly what is in their drink, students can choose from the following: avoid drinking from punch bowls and other communal sources; always pour their own drink; watch when someone else pours the drink to see exactly what’s in it; never accept a drink from a stranger or anyone else who might not be trustworthy; and only drink from standard-size cups or glasses. For finding other things to do, the presented options are: hosting a “game night” with computer games, board games, or other games; plan more off-campus activities (e.g., concerts, movies); do volunteer work in the community; and check out other campus activities or organize something on their own.

27 A Look Inside AlcoholEdu ACTIVITIES ON CAMPUS Students select what types of activities and events they are most interested in and indicate if they would like to be contacted to help plan or attend activities that don’t focus on alcohol. The objectives listed for non-drinkers are: 1) staying committed to not drinking; 2) knowing how to decline a drink; 3) knowing exactly what’s in their drink; 4) making sure that no one adds anything to their drink; 5) helping keep their friends safe; and 6) fi nding other things to do. Clearly, there are behavioral objectives that apply to drinkers and nondrinkers alike.

For example, for knowing how to decline a drink, students can fi ll out their plan by choosing from three options: 1) use a vague excuse (e.g., “I’m fi ne, thanks”); 2) if necessary, use a made- up excuse (e.g., “I’m trying to lose weight”); and 3) have a non-alcoholic drink so people won’t off er a drink. Module 8: Laws and Policies For keeping their friends safe, the options are: 1) off er assistance to a friend who has had too much to drink; 2) never let a friend drive under the infl uence of alcohol or other drugs; and 3) off er assistance to a friend who seems to be having a real problem with alcohol. This module reviews four basic alcohol-related laws that aff ect college students in all 50 states: „ The minimum legal drinking age is 21 years. „ It is illegal for anyone under 21 to drive a car after drinking alcohol. This is often referred to as the “zero tolerance law.” „ For people age 21 and older, it is illegal to drive with a blood alcohol concentration (BAC) of 0.08% BAC or higher. „ It is against the law to use a fake ID to purchase alcohol. Misrepresenting one’s identity is a serious crime. Many college freshmen have decided to drink despite the age 21 law, but a large percentage of students have decided to wait until they reach the legal age before they drink. Since the founding of Mothers Against Drunk Driving (MADD) in 1980, all 50 states have passed tougher laws and increased enforcement to combat driving under the infl uence (DUI). To avoid running afoul of the law, and to avoid risking harm to themselves or others, students can take several steps to prevent drunk driving, including making the choice not to drink or to drink less, selecting a designated driver ahead of time, using a “safe rides” program, chipping in to take a cab, or choosing to spend the night when the party’s over. There is no excuse for driving while impaired. The module also reminds students to do what they can to keep others from driving after drinking too much—convincing them to give up their keys, giving them a ride home, or having them spend the night. Campus policies and programs also play a role in keeping students safe. Students can indicate if they are interested in being contacted to get involved in setting campus policies or being involved in eff orts to improve the campus social climate.

28 Discussion Questions for Module 8:

„ According to the National Highway Traffi c Safety Administration „ Marijuana and other drugs are involved in nearly 20 percent (NHTSA), the number of Americans who died each year in of all fatal traffi c crashes, either in combination with alcohol or alcohol-related traffi c crashes in the early eighties reached more alone. Presently, police do not have a test as fast and accurate than 21,000. By 2013, that number had declined to 10,076, as the alcohol Breathalyzer to determine a person’s marijuana representing a 52% decrease over a 40-year period. What factors intoxication level. Given that, what laws, regulations, and account for this reduction? What more do you think could be programs should be put in place to discourage people from done to address this problem? driving after smoking marijuana? „ In the United States, it is illegal for people age 21 and older to drive with a blood alcohol concentration (BAC) of 0.08% or higher. In other countries, the BAC level that defi nes alcohol-impaired driving is far lower—e.g., 0.05% in Australia and several European countries; 0.02% in Norway, Russia, and Sweden. Why do you think other countries have stricter laws than the United States? Would you support or oppose a law that would lower the illegal limit from 0.08% to 0.05% BAC?

Recommended Activities for Module 8:

„ As part of a classroom or workshop presentation, have students Even so, some states now permit marijuana to be prescribed for debate the pros and cons of setting the minimum legal drinking medical purposes, and two states, Colorado and Washington, age (MLDA) at 18 years. have moved to legalize marijuana altogether even though the federal prohibition remains in place. There are several key factors that state lawmakers would take into account if they were to consider making this change: a) What might the benefi ts of legalizing marijuana be? What harms Would lowering the MLDA lead to more or fewer alcohol-related might result from legalization? Would legalizing marijuana lead to problems? b) Is it unfair to prohibit young people ages 18-20 from more health and safety-related problems? Do the anti-marijuana purchasing alcohol when they are otherwise legally considered laws represent government overreach? Are additional studies to be adults? c) Does the current MLDA represent government needed to help decide this issue? Have the students research overreach? d) Would the public support lowering the MLDA? Have these issues and present their case. the students research these issues and present their case. If marijuana were legalized nationwide, what laws, regulations, or For additional information: DeJong W, Blanchette J. Case closed: programs would be needed to minimize the potential negative Research evidence on the positive public health impact of the age consequences of marijuana use, including harms that might be 21 minimum legal drinking age in the U.S. J Stud Alcohol Drugs. experienced by non-users? What restrictions would college and 2014;17S:108-115. university administrators need to put in place? „ As part of a classroom or workshop presentation, have students debate the pros and cons of marijuana legalization. The federal government still classifi es marijuana as a Schedule 1 drug under the Controlled Substances Act, meaning that it is a dangerous drug that has no currently accepted medical use.

Module 9: Helping Friends A Look Inside AlcoholEdu This module opens with a video montage of current students off ering advice on what incoming fi rst-year students can do to stay safe. Importantly, several students who are depicted as older reinforce prevailing campus norms in favor of safer alcohol consumption and not pressuring others to drink: „ “I guess the biggest thing is just to not have the goal of my night be to get really drunk. I guess I’m more focused on who I’m with and not so much what I’m drinking.” „ “If you don’t enjoy alcohol, you don’t have to drink it.” „ “Don’t feel like you have to keep up with people around you.” „ “Don’t make it a big part of your life, because it’s not worth it.” „ “If you don’t feel comfortable, don’t do it.” „ “I personally don’t drink…You don’t have to drink to have fun.” The module then presents a series of scenario-driven exercises designed to help students know what to do if another student needs help. If a friend has already had too much to drink, students can intervene by putting the alcohol away and saying they’ve run out, pouring out the drink when the friend isn’t looking, or off ering water or a non-alcoholic beverage. 29 Students are asked to select one of five options as their top choice for how to help their friends stay safe, after which they see what previous AlcoholEdu students said. The top response was to make sure friends don’t drink and drive or ride with someone who has been drinking (47.9%), followed by looking out for and helping friends who might have had too much to drink (29.9%), reminding their friends to drink safely (16.2%), talking to their friends when they’ve had too much to drink (4.7%), and “something else” (1.4%). The next scenario-based exercise emphasizes that students can prevent others from driving under the influence by talking to them, getting their keys, giving them a safe ride home, calling for a cab, or having them stay overnight. The module reiterates that students can plan ahead to avoid impaired driving by choosing a designated driver, using a safe rides program, bringing the phone number for a local taxicab, or staying overnight until the morning. Students also receive instructions for what to do if they suspect that someone might have alcohol poisoning. Importantly, the course acknowledges that calling 911 may seem extreme, and there is a chance the person might be mad later. But so what? Making the call might save that person’s life. The module concludes by providing contact information for national resources that can provide assistance, plus a customized list of local campus resources provided by the college’s course administrator. The national resources include: „„ Adult Children of Alcoholics World Service Organization at http://www.adultchildren. org/. Adult Children of Alcoholics (ACA) is a program for women and men who grew up in an alcoholic or otherwise dysfunctional home. „„ Alcoholics Anonymous at http://www.aa.org/. Alcoholics Anonymous (AA) is an international fellowship whose primary purpose is to help alcoholics achieve sobriety. „„ Al-Anon/Alateen at http://www.al-anon.org/. Al-Anon is an independent fellowship that helps relatives and friends of alcoholics. Al-Anon holds the view that alcoholism is a family illness. „„ The Center on Addition and the Family at http://www.phoenixhouse.org/family/center- on-addiction-and-the-family/. A unit of Phoenix House, COAF is the nation’s leading provider of alcohol and drug abuse treatment and prevention services.

SIGNS OF ALCOHOL POISONING WHAT TO DO „„ Passed out or is semiconscious „„ Lay the person on his or her side „„ Unresponsive, even after vomiting „„ Do not put the person to bed to “sleep it off” „„ Trouble talking „„ Monitor the person’s breathing „„ Abnormally slow or irregular breathing „„ Call 911 or a campus emergency number „„ Cool, pale, bluish, or clammy skin „„ Continue to monitor until help arrives „„ Do not leave the person alone

In addition, the Substance Abuse and Mental Health Services Administration (SAMHSA), an agency within the U.S. Department of Health and Human Services, provides two services to help the public find substance abuse or mental health treatment facilities and programs around the country: 1) a website, the Substance Abuse Treatment Facility Locator, which calls up contact information for treatment options within a specified distance of the user’s Zip code location (https://findtreatment.samhsa.gov/TreatmentLocator/faces/quickSearch. jspx); and 2) the National Drug Treatment Referral Routing Service, a 24/7 toll-free telephone number for alcohol and drug information and local treatment referral assistance (1-800-622-HELP). Immediately following Module 9, students take an Exam to assess their knowledge related to the content covered in the course. 30 Discussion Questions for Module 9:

„ Student deaths from alcohol poisoning often result when other „ What provisions should the policy have? Possible answers: students fail to call for emergency help. One barrier is ignorance of • No students seeking medical attention for intoxication or the danger signs. But even when students recognize that a peer is overdose would be formally disciplined for illegal use or in distress, they may be afraid to take action for fear of getting the underage possession of alcohol or other drugs, provided that person in trouble or being disciplined themselves for violating the the sole reason their intoxication or overdose became known school’s alcohol policy. To address this challenge, some schools to schools offi cials was the result of seeking medical care for have adopted a “Good Samaritan” or “medical amnesty” policy to themselves or another student. promote bystander intervention and to encourage students to seek medical attention for themselves. • Immunity from disciplinary action for alcohol violations would extend to any individuals seeking help for the intoxicated „ Does your institution have this type of policy? If yes, what exactly student, but would not mitigate responsibility of a group or does the policy say? Is the policy adequate or should it be revised? organization for any policy violations. The fact that a group Are students actually more likely to call for emergency help because sought help for an intoxicated student would be considered in of the policy? If not, why is that the case? Do you know of any cases determining any sanctions relating to those violations. where someone did call for emergency help? What happened? • Students who would be immune from disciplinary action under „ If no, do you think your institution should have such a policy? What this policy would be required to complete evaluation counseling are the advantages of the policy? Are there any disadvantages? If and then treatment if indicated. Failure to complete the the policy were in place, would students be more likely to call for prescribed course of treatment would result in disciplinary action emergency help? Do you think the policy might have an eff ect on being taken. students’ drinking behavior? „ Designated driver and safe ride programs are sometimes criticized for encouraging or giving tacit approval to excessive drinking by the passengers. They are not driving, of course, but if they drink excessively then they could suff er other types of negative consequences, including severe injuries. What is your reaction to this criticism? Do you think designated driver and safe rides programs do more good than harm? Or more harm than good?

Recommended Activities for Module 9:

„ Before people will intervene in a high-risk drinking situation, they „ Using a designated driver is a simple strategy for avoiding driving must fi rst notice what is going on, recognize it as a problem, feel after drinking. Typically, this involves a couple or group of friends personally responsible to intervene, and know how to intervene plans ahead to select one person to abstain from alcohol and be properly and safely. One of the barriers that prevent people from responsible for driving, with the others free to drink or not as they taking action is their apprehension that others might not share choose. their concern or won’t respect someone who chooses to intervene. Have students design a campus-based media campaign to promote In fact, the vast majority of people do want to do the right thing, the use of designated drivers. Simple encouragement may not be but if they are uncertain whether others agree with them or will enough. Some people resist the idea of taking their turn as the appreciate someone stepping up, then they may fail to act. designated driver. And there is the risk that the driver’s passengers „ Have a team of students design a short survey with questions may drink more than usual, which may put them at risk of injury or designed to reveal the true campus norms regarding intervening in other negative consequences even though they are not driving. A diff erent high-risk drinking situations. To get the ball rolling, show successful campaign will need to hit these issues head-on. them this sample question: If marijuana were legalized nationwide, what laws, regulations, or • Imagine that you are at a party and saw someone passed out from programs would be needed to minimize the potential negative drinking too much. The person is unresponsive and feels cool consequences of marijuana use, including harms that might be to the touch. Another student expresses concern and calls 911. experienced by non-users? What restrictions would college and Would you support or not support the student’s decision to call university administrators need to put in place? for emergency help? Defi nitely not support ______Defi nitely support 1 2 3 4 5 The fi rst major eff ort to encourage the use of designated Once the question set is complete, have the students go to drivers was the Harvard Alcohol Project (HAP), a national media diff erent high-traffi c areas on campus and ask other students campaign launched in 1988 by the Harvard School of Public whom they don’t know to take a moment and fi ll out the survey. Health’s Center for Health Communication. After students have answered the questions, they can fold their Working with the cooperation of leading survey in half and put it in a small box with the other completed television networks and Hollywood surveys. production studios, the campaign sought to When the team has gotten 200 or more surveys (and the more, promote an emerging social norm that the the better), have them compile the results. Have the students driver should abstain from alcohol. brainstorm diff erent ways of reporting positive results from the survey—e.g., student newspaper article, campus email message, For additional information: http://www.hsph. social media messaging, dining hall table tents, posters or fl yers. harvard.edu/chc/harvard-alcohol-project/ From there, they can design and execute a communications campaign.

31 Survey 2: Course Evaluation After the Exam, students complete Survey 2, which provides a quick look at what students learned and whether they think taking AlcoholEdu will impact their future behavior. Students rate to what degree the course prepared them to: prevent an alcohol overdose; help someone who may have alcohol poisoning; and establish a plan ahead of time to make responsible decisions about drinking. Next, students report to what degree they plan to engage in each of five protective behaviors during the next 30 days: 1) reduce the number of times they drink per week; 2) reduce the number of drinks they have each time they drink; 3) pace their drinks to one or fewer per hours; 4) set a limit on how many drinks they’ll have; and 5) alternate non- alcoholic beverages with alcoholic beverages. Finally, using a 7-point Likert scale, students report how much they think their drinking- related behavior will change as a result of taking AlcoholEdu, where 1 = not at all and 7 = a great deal. Using the same scale, students report how much the course changed their perceptions of other students’ drinking-related behavior.

INTERSESSION This concludes Part 1 of AlcoholEdu for College. There is a four to six-week break before students are contacted once again, this time to completePart 2.

Part 2

One of the primary purposes of Part 2 is to have students complete Survey 3, which is the Post-Intervention Survey. Depending on when students are asked to initiate the course, this survey provides information on their alcohol-related behaviors and consequences after they have been on campus for some period of time. Thus, it is important for campus administrators to enforce completion of Part 2 as part of the students’ AlcoholEdu requirement.

Part 2 has two sections: Survey 3, plus Module 10: Recognizing Problems. Survey 3: Post-Intervention Survey Prior to Module 10, students complete a post-intervention survey that repeats the questions asked in Survey 1, the pre-intervention (baseline) survey. This survey does not repeat items asking about students’ background characteristics, but otherwise the two surveys are the same. Campus administrators should examine and work with their AlcoholEdu survey data, to monitor conditions and to gain important insights that can guide future prevention efforts. Can the survey data be used to evaluate whether AlcoholEdu is working on a particular campus? Unfortunately, the answer is no: „„ A comparison between Survey 1 and Survey 3 provides information about all of the college’s prevention efforts collectively,including but not limited to AlcoholEdu. „„ The Survey 3 data is impacted by the “college effect.” A college’s prevention efforts might dampen the increase in first-year student drinking but not reverse it. „„ There is no control group against which to compare the college’s results, which would be necessary to distill out the impact of the course itself. Conducting such a study is time-consuming and expensive.

32 Fortunately, randomized control studies that include a control have been done. The bottom line is that AlcoholEdu has been tested and found eff ective. Appendix 3 summarizes the major published studies that have been conducted.

USING THE ALCOHOLEDU SURVEY DATA Looking at your Survey 3 data across several years can help you assess whether your entire prevention eff ort is on the right track, including but not limited to AlcoholEdu. Ideally, there will be year-to-year improvements in the Survey 3 data on student attitudes, behaviors, and consequences. If not, then your prevention eff orts need to be expanded and revised. It’s very unlikely that the problem is with AlcoholEdu. Why? We have substantial data demonstrating the course’s eff ectiveness, as shown in Appendix 3. AlcoholEdu is a launch pad for your prevention eff orts, but there should be other evidence-based strategies in place to change the environment in which students make decisions about their drinking.

Module 10: Recognizing Problems The module provides guidance on how to talk to a roommate or friend who is drinking too much and therefore is at risk. A Look Inside AlcoholEdu The fi rst issue is how to know when a person’s drinking is becoming a real problem. The course lists the following signs: 1) missing classes and falling behind on schoolwork; 2) experiencing a blackout—that is, forgetting what happened while drinking; 3) lying to others or hiding their alcohol use; 4) noticeable changes in behavior; and other people expressing concern. Choosing the right time and place to talk to a friend about his or her alcohol use is critical. The course advises that the conversation occur in a quiet and convenient spot where there is privacy and minimal distractions, with cell phones, computers, and televisions turned off . In addition, both parties should be sober. How should the conversation proceed? Students are told the following: „ Admit that this is a hard discussion to have. „ Refer to what you’ve observed, including specifi c behaviors. “YOU ARE PART OF A COLLEGE „ Express the observations in an objective and nonjudgmental way. COMMUNITY AND IT’S „ Avoid making accusations or threats. IMPORTANT TO HELP KEEP „ Express how you feel about the behaviors you’re describing. EACH OTHER SAFE.” „ Listen attentively, and try to be compassionate, understanding, and patient. „ Don’t off er unsolicited advice. „ Off er to help if the person asks for it. „ Stay calm and keep the conversation focused on your concerns.

The course reminds students to be careful about promising confi dentiality to a friend who may have an alcohol problem since there may come a point when outside help is needed. Finally, students are cautioned not to expect things to change overnight, and it may be necessary to have the conversation again, perhaps even a few times. If other students share your concern, they should talk to the person themselves. Ultimately, it is up to the other person to acknowledge and fi x the problem.

33 CONCLUSION Students are reminded to review their goals periodically to assess their progress. And they should also review the strategies they selected to reach the goals set in their personal plan. If students have any questions, concerns, or comments, they can write to EverFi at the following email address: [email protected]

Discussion Questions for Module 10:

„„ No matter how appropriate, tactful, and helpful you are, having „„ If you were to give advice to a new first-year college student, an intervention with a friend who seems to have a dangerous what are the top three strategies that you would recommend drinking pattern isn’t always successful. Often, people who to help them avoid the negative consequences that can try to help feel guilty that they didn’t “fix” the problem, or they come from drinking alcohol? Why did you choose those three feel responsible for “making the problem worse.” What type particular suggestions? What makes certain plans “easy” or of advice would you give to someone who was struggling with “hard” to use or stick to? these concerns? „„ Now that you’ve spent more time at this institution, how „„ It has been a few weeks since you first started AlcoholEdu for important do you think alcohol is to student life here? What are College. What information or strategies have you found useful some of the benefits? What are some of the challenges? What in social situations you have experienced (or avoided) over advice would you give to the President of our institution or the last few weeks? What strategies have you applied? What organization to deal with the influence of alcohol on students’ strategies did you choose not to apply—and why? college experiences overall? „„ We know that a person’s social network can strongly influence his or her decision to drink or not. Are you comfortable with the new friends that you’ve made since starting college? Are they supportive of your decisions? Have you had opportunities where you looked out for each other while at parties or other social gatherings? Have you retained your personal goals and values, or changed them to be more in line with those of your new friends? How has this worked for you?

34 Recommended Activities for Module 10:

„„ As part of a classroom or workshop presentation, ask students to SCENARIO 1: Student 2 was a very good student in high school, think about a person they know who drinks alcohol on a regular but now in college, after midterm exams, Student 2 is in danger basis. Then instruct them fill out the Alcohol Use Disorders of failing one course and is barely getting by in three others. For Identification Test (AUDIT) as if they were that individual. For Student 2, every weekend begins on Thursday night with a blowout example, if students are thinking about their roommate, then they party somewhere off campus, after which Student 2 staggers back would fill out the AUDIT form with that person’s drinking patterns in to the residence hall, completed wasted. Fridays and Saturdays mind. mean pregaming and doing shots before heading out to the local bars. Three or four times, Student 1 had to clean up after Student The AUDIT questions and scoring instructions appear in Appendix 5. 2 vomited in their room and passed out. To make matters worse, In a follow-up discussion, ask students to describe their reaction to Student 2 got into a fight at a club after thinking that someone was the AUDIT. Make sure they understand that they are not to reveal flirting with Student 2’s date and got arrested. the name of the person they had in mind. Possible questions: SCENARIO 2: Student 1’s drinking is out of control. What’s really • What were your thoughts as you filled out the AUDIT? scary is what happens when Study 1 drinks. Normally, Student 1 is • If a student were a frequent heavy drinker, do you think that filling a terrific person—easy-going, funny, and great to be around. But out the AUDIT would get them to reconsider their drinking habits? after having several drinks Student 1 is like a completely different • A total score of 8 or more is commonly accepted as an indicator person—either loud, belligerent, and even a little paranoid or of “hazardous and harmful alcohol use, as well as possible alcohol just really quiet and morose. Student 1 fell a couple of times after dependence.” Does that seem like a reasonable threshold? Is it too drinking, once down a flight of stairs and Student 2 had to call 911, low? Too high? Where would they set the threshold? Why? and afterwards Student 1 couldn’t even remember what happened. That’s very often the case when Student 1 drinks. Another time • The AUDIT is a widely used alcohol screening tool published by the Student 1 woke up in the morning after a night of drinking—naked, World Health Organization. Do you think the AUDIT is appropriate in bed with another student—and had no idea what happened. for use by U.S. college students? • If you were to develop an alcohol screening tool for college Distribute the scenario. Instruct the students to read each scenario students, what additional questions would you want to ask? and think about how they will approach the two role-plays, in one case being the student who wants to have the conversation and • What programs or policies do you think campus administrators in the other being the student who has created the cause for their should put in place to get students to complete the AUDIT? friend’s concern. „„ As part of a classroom or workshop presentation, ask students Call on two students to come in front of the group and do the role- to role-play having a conversation with a friend whose drinking play for Scenario 1. Ask the group to give Student 1 feedback and concerns them. To start, have the students review and discuss the then offer your own. Call on two other students to do the role-play intervention guidelines presented in Module 10. Possible questions: for Scenario 2 and then provide feedback as before. 1) Is this something they’ve done before? If so, how did that go? 2) Do the guidelines make sense to them? 3) Would they add any Have all of the remaining pairs of students privately do the role-play additional advice? 4) Is this something they think they could do? 5) for Scenario 1, after which they talk about how it went. Next, they do What challenges would they expect to encounter, and how would the role-play for Scenario 2 and again talk about it. Allow about five they try to get past them? 6) How would they respond if the friend minutes for each scenario. rejected what they had to say? What would they do next? Bring the entire group back together to discuss the role-plays, Have the students find a partner, preferably someone they don’t focusing on the student who initiated the conversation. Possible know well. For Scenario A, Student 1 is the person who wants to questions: 1) What was the first thing they said? 2) What did they have a conversation with Student 2, and for Scenario B, Student 2 is say? 3) How did they feel about the conversation? 4) If the other the person who wants to have a conversation with Student 1. student denied having a problem, how did they respond? 5) Reflecting on the role-play, what might they have done differently?

35 Beyond AlcoholEdu IMPLEMENTING A COMPREHENSIVE PREVENTION PROGRAM AlcoholEdu for College provides students with both the information and motivation they need to make healthier decisions about drinking as they make the transition into college. Rigorous evaluation studies have demonstrated the course’s effectiveness in reducing drinking and its negative consequences among first-year students (see Appendix 3 for a review of the major studies). Even so, this online education program should be viewed as just one part of a comprehensive approach to reducing alcohol-related problems among first-year students. Ultimately, AlcoholEdu’s success in educating and motivating students to continue abstaining—or to use alcohol safely, if they choose to drink—must be supported by a campus environment that reinforces and then builds on the foundation the course provides. Addressing the alcohol environment is critically important. Many entering college students arrive on campus expecting to drink heavily while in college, and campus environments— often defined by easy access to alcohol, marketing and advertising that glorifies high-risk drinking, and weak enforcement of the institution’s rules and local and state laws—often facilitate that choice. Moreover, students are often on their own for the first time, without everyday accountability to their parents or guardians, and typically they have much more unscheduled time than when they were in high school. Clearly, as part of a comprehensive prevention effort, it is imperative for college officials to collaborate with local leaders to shape an environment that will discourage the misuse of alcohol and instead prompts freshmen—and upperclassmen as well—to make healthier choices. This section reviews a set of environmental management strategies that can be employed to achieve that goal.

ENVIRONMENTAL MANAGEMENT APPROACHES FOR SHAPING THE FIRST-YEAR EXPERIENCE Alcohol-related problems among first-year students are driven in part by environmental factors that increase both the availability and the appeal of alcohol, each of which can be addressed by a set of environmental management strategies: „„ Alcohol-Free Options: Many students, especially at residential colleges, have few adult responsibilities like jobs and family, a great deal of unstructured free time, and too few social and recreational options. The answer is to offer and promote social, recreational, extracurricular, and public service options that do not include alcohol and other drugs. „„ Normative Environment: Many people accept drinking, even heavy drinking, as a “normal” part of the college experience. The answer is to create a social, academic, and residential environment that supports health-promoting norms. „„ Alcohol Marketing and Promotion: Local bars, restaurants, and liquor stores may use aggressive promotions to target underage and other college drinkers. The answer is to restrict marketing and promotion of alcoholic beverages both on and off campus. „„ Alcohol Availability: Too often alcohol is abundantly available to students and is inexpensive. The answer is to limit alcohol availability both on and off campus. „„ Policy Development and Enforcement: Campus policies and local, state, and federal laws related to substance use may not be enforced consistently for the campus population. The answer is to develop and enforce campus policies and local, state, and federal laws. Enforcement efforts must be publicized. All of these approaches require town-gown collaboration. College officials may want to begin by focusing on what they can do address the campus environment, but working with local officials, while often time-consuming and sometimes frustrating, is absolutely essential.

36 There are several environmental management strategies that would help guide and support first-year students as they make the transition to college life and move them toward having a successful academic career. Entering students need to learn—and to experience—that they are part of a community that is value-centered, demanding in its expectations, yet highly supportive, and where academic focus, responsible and healthy decision making, and care for others are the norm. The chart below provides a list of specific program policy options that would help create that kind of campus community environment.

ENVIRONMENTAL MANAGEMENT: PROGRAM AND POLICY OPTIONS FOR HELPING STUDENTS MAKE A SUCCESSFUL TRANSITION TO COLLEGE

Provide Alcohol-Free Options Restrict Alcohol Availability „„ Create and promote alcohol-free events for first-year „„ Require all social events during orientation to be “dry” students „„ Require first-year students to live on campus „„ Provide financial support to small student groups to organize alcohol-free social events „„ Disseminate responsible host guidelines for both on- and off-campus parties „„ Support student clubs and organizations that are substance-free „„ Install a responsible beverage service program „„ Create and promote service learning and volunteer „„ Train alcohol servers and managers to stop service to opportunities underage or intoxicated students „„ Require community service work as part of the academic „„ Train alcohol servers and managers in the latest curriculum techniques and technologies for recognizing false IDs „„ Open or expand hours at a student center, recreation „„ Eliminate residence hall delivery of alcohol purchases facilities, and similar alcohol-free settings „„ Advertise food and activities such as dancing or sports „„ Promote consumption of nonalcoholic beverages and rather than drinking as the focus of the event food at events Strengthen Policy Development and Create a Healthy Normative Environment Enforcement

„„ Require on-campus living for first-year students „„ Review campus alcohol and other drug policies and „„ Provide segregated housing for first-year students strengthen where necessary „„ Offer a greater number of substance-free residence halls „„ Disseminate campus alcohol and other drug policies and publicize their enforcement „„ Promote faculty-student contact „„ Require on-campus functions to be registered „„ Require regular meetings with academic adviser „„ Impose tough penalties for possessing a fake ID „„ Require regular meetings with resident assistant „„ Enforce minimum legal drinking age laws „„ Employ older resident assistants • Increase ID checks at on-campus functions and parties „„ Prohibit fraternity and sorority rush for first-year students • Use decoy operations at campus pubs and on-campus functions „„ Require more morning and Friday classes • Increase ID checks at off-campus bars and liquor stores • Use decoy operations at retail alcohol outlets Restrict Marketing and Promotion of Alcohol • Enforce seller penalties for sale of liquor to minors „„ Ban alcohol promotions with special appeal to underage „„ Screen resident assistant applicants for those willing to drinkers enforce alcohol policies „„ Ban alcohol advertising on campus grounds „„ Support local and state enforcement in imposing driver’s „„ Ban advertising of high-risk promotions license penalties for minors violating alcohol laws and in changing driver’s licensing procedures and formats „„ Notify parents of rules violations

37 Research has shown that one of the key variables that predict whether students continue not to drink is having a close friend who also abstains. This suggests that administrators should initiate programs to help abstainers connect with one another as soon as possible after they arrive on campus. Providing students with these opportunities is not only important in supporting their own continued wellness, but also allows students who do choose to drink to see that there are lots of good options other than drinking heavily on weekends during free time. With this in mind, AlcoholEdu asks students who have not consumed alcohol in the past year if they would like to connect with other students who don’t care to develop a social life that centers on alcohol use. Thousands of students have responded positively to this feature, offering their e-mail addresses to be part of a group set up by their AlcoholEdu course administrator. EverFi partners have used this feature in a variety of low-effort ways, creating group e-mail lists where the students can create their own community and organize meet-ups and other events. Importantly, these kinds of efforts are different than establishing a recovery community on campus for students with a history of alcohol or other substance addiction. Many campuses have found an increasing proportion of students in recovery seeking out programs, services, and living accommodations that support their continued abstinence from alcohol and drugs.

THE ALCOHOL PREVENTION COMPASS Since 2008, The EverFi Coalition has been compiling and assessing the evidence base for numerous alcohol prevention approaches and then presenting the findings using a tool called the Alcohol Prevention Compass. EverFi staff evaluates the relative strength of more than 30 alcohol prevention policies and programs in terms of their effectiveness, cost, and reach. Our team has examined more than 400 efficacy studies, applying a standardized procedure to assign numeric values to the reported outcomes of these studies, and then averaging the values across the set of studies for each of the programs examined. We also note the characteristics of the study sample—whether these were a random sample of students, high-risk students, students mandated to receive the program, or other subsets of the student population. We annually update the evidence base supporting the Compass so that practitioners can rely on timely data to inform their prevention approach. The Compass and its supporting documentation can be found online at www.coalition.everfi.com.

REINFORCING ALCOHOLEDU’S LESSONS In order to sustain AlcoholEdu’s positive impact on students’ knowledge, attitudes, and behavior, campus practitioners should reinforce and build upon the course through ongoing programming during the academic year. There are several opportunities to do this, beginning well before students arrive on campus. Pre-Enrollment Messages. As noted previously, first-year students typically have exaggerated ideas about how much college students drink. Wanting to fit in and being free of parental control for the first time, these students can be led by this misperception into a pattern of heavy drinking that increases their risk of academic failure, serious injury, and even death. Social norms marketing campaigns try to counteract these false beliefs by conveying accurate survey data about student drinking norms. The idea is that once students learn that far fewer students are drinking heavily than they once thought, they will feel less social pressure to drink and therefore moderate their alcohol use.

38 To reach first-year students, a social norms campaign should begin well before their first week of college and then continue throughout the academic year. The start of the academic year is a hectic time, when most entering students are overwhelmed by new information and the stress of settling in, and there is a risk that the campaign’s message will be less impactful. In contrast, communicating in advance about the true drinking norms, while also clarifying the college’s expectations for student conduct, has the potential to help students make healthier choices from the moment they arrive on campus. To begin, colleges can capitalize on the April acceptance letter. A companion letter to parents can reinforce the social norms message in the context of providing guidance on how to talk with their child about substance use. After students commit to attending a college, the institution will send pre-enrollment information about fall orientation, housing, and course registration, which also can carry prevention messages. Open houses for accepted students and campus visits provide another opportunity to educate both students and parents about student alcohol and other use and campus policies and to dispel misperceptions about prevailing campus drinking norms. Upperclass students who serve as student hosts and allow accepted students to stay overnight in a campus residence hall also can be trained to reinforce the social norms message Orientation Week. Comprehensive orientation programs typically include information about the institution’s alcohol and other drug policies and enforcement. In that context, during general assemblies and in written support materials, the president, dean of freshmen, or other high-level official should deliver the social norms message and establish clear expectations for student conduct.

If the data are available, first-year students can also be shown survey findings that demonstrate widespread student support for strict enforcement of the institution’s alcohol policies. Appendix 6 provides a sample survey instrument.

Additional topics taken from AlcoholEdu can be covered, too—e.g., the dangers associated with elevated blood alcohol concentration (BAC); how alcohol and other drugs affect the brain; strategies for keeping BAC at 0.04% or less; the potential risks associated amphetamines, narcotics, MDMA (ecstasy), and misused prescription drugs; the role of alcohol in sexual assaults and the importance of obtaining consent; how to recognize and respond to potentially dangerous situations involving alcohol. Any concerns about being redundant with AlcoholEdu should be put aside in favor of driving these messages home. Orientation week programs might include other activities that help students connect with campus resources and programs that serve to direct them away from alcohol and other drug, such as a community service program or a sports competition. Having specific programming for first-year students reinforces the message that they have joined a healthy academic community. Academic Year. First-year students benefit from other structured opportunities to examine their own patterns of alcohol and other drug use and explore how substance use may affect their life goals. They then need to learn ways to reduce their alcohol and other drug use risk, including managing stress, tracking daily alcohol consumption, and deciding on a drinking limit before they go to social events. Some institutions meet this need by having first-year students attend a mandatory life- skills course, which also helps students identify their personal educational goals, plan their courses of study, enhance their academic skills, learn about available resources at the university, and explore career options. Additional lessons might focus on goal setting, time management, and learning strategies.

39 Fall semester is also a good time for first-year students to complete a personal risk assessment and receive feedback on their drinking. A brief motivational interview program called Brief Alcohol Screening and Intervention for College Students (BASICS) is one such program, which involves two sessions in which students fill out an assessment, receive feedback about their drinking behavior, and work with a trained counselor to develop a plan for change. Research data show that high-risk drinkers who participate in the BASICS program significantly reduce both their alcohol use and drinking-related problems. There are also computer-based brief intervention programs. In addition, some institutions have begun to administer routine alcohol screenings and provide brief interventions through their campus health center.

College first-year students are not the only new students at colleges and universities. Transfer students should also be included in alcohol prevention programs for students in transition.

Finally, throughout the fall semester and into the spring, alcohol and other drug abuse prevention information can be incorporated into already planned events. The fall parents’ weekend, for example, provides an opportunity to support parents in communicating their expectations to their children. Reminder messages also can be sent out to first-year students via e-mail, newspaper ads, residence hall presentations, social media, and other campus venues.

WORKING WITH STUDENTS AS PREVENTION PARTNERS Campus-based efforts to reduce alcohol and drug abuse are more successful if they involve a wide range of stakeholders—including students—who can contribute to the program’s design, implementation, and evaluation. First-year students, although new to campus, can be valuable partners in this effort because of their unique perspectives and insights. One opportunity is to participate in organizing events for students who do not drink or simply want to take a break from drinking. AlcoholEdu asks students to indicate their interest in doing this, and a list of these students is available to the course administrator via a report in the Higher Ed Partner Center. Likewise, the course also asks students to indicate their interest in working on policies that would serve to improve campus life. In working with students, campus administrators are advised to use a mentoring approach, with a focus on recruiting, training, and supervising a manageable number of qualified and committed students. It is especially important that students receive training on the mission, goals, and underlying rationale of the projects they will be working on so that they can make informed contributions to the work and also receive the greatest benefit. Such training should include information about evidence-based strategies and best practices in campus prevention.

INVOLVING PARENTS AS ALLIES IN PREVENTION EverFi’s research using data collected through AlcoholEdu revealed that the greater the number of specific alcohol-related topics that parents talked to their first-year students about prior to college, the less likely those students were to experience negative consequences due to drinking. This finding underscores the importance of parental involvement, even as their children are entering college and moving away from home. Strategies to involve parents as potential allies in combating campus substance use show great promise. One recent study found that first-year college students whose parents read a manual describing how to talk to their student about alcohol-related problems had lower drinking rates and experienced fewer alcohol-related consequences than students whose parents did not read the manual.

40 As noted previously, there are multiple opportunities for college administrators to reach out to parents and enlist their cooperation and help, both before and after their student arrives on campus to start their college experience. Parents can be encouraged and given guidance on how to discuss the following topics: „„ College students tend to think that others are drinking more than they actually are „„ Importance of not being pressured by others into drinking „„ How to be assertive about not drinking „„ Importance of keeping blood alcohol concentration below 0.04% BAC „„ Strategies for limiting drinking, such as counting drinks, not playing drinking games, and avoiding common containers (e.g., punch bowls, kegs) „„ College environments (e.g., fraternity/sorority events, parties) where social pressure to drink alcohol is likely to be higher „„ Avoiding environments where heavy drinking is likely to take place „„ Availability of activities in college that do not involve drinking „„ How to find fun things to do instead of drinking „„ Alternatives to drinking to celebrate special occasions „„ College policies about alcohol use and the consequences of violating them „„ Legal penalties for things like underage drinking, drinking and driving, using a fake ID, and public drinking or drunkenness „„ How alcohol works in the body „„ Ways alcohol can impair judgment „„ Alcohol is toxic and excessive consumption can lead to a fatal poisoning „„ How heavy drinking can lead to high-risk behavior and may play a role in accidents, injuries, sexual assaults, or arrests „„ Drunk driving and its consequences „„ Risks of riding in a car with a driver who has been drinking „„ Risks associated with mixing alcohol and sex „„ Expectations regarding academic performance in college „„ Importance of intervening when someone may be in trouble due to an alcohol overdose „„ Standing up for the right to a safe academic environment

THE EVERFI COALITION The EverFi Coalition provides institutional leaders with critical insights, tools, and support to reduce their students’ alcohol-related risk and promote a safe and healthy campus environment. Members of EverFi’s Partner Education team identify and share information about both innovative and evidence-based programs and policies, provide professional leadership training, and offer consultation and practical guidance for strategic planning and policy and program implementation. Contact your Partner Services Director regarding The EverFi Coalition’s advisory services. Information about the Coalition can also be found at www.everfi.com/the- everfi-coalition.

41 APPENDIX 1: AlcoholEdu Learning Objectives AlcoholEdu for College is designed to help achieve several behavioral outcomes: Abstainers: „„ Abstainers will continue to choose not to drink Drinkers: „„ Drinkers will more often choose not to drink any alcohol „„ When having alcohol, drinkers will take steps to keep their BAC in a safer range All Students: „„ Students will help protect another person who has had too much to drink „„ Students will try to help a friend who might have a problem with alcohol „„ Students will make informed decisions to avoid using marijuana and other drugs „„ Students will seek consent if and when they engage in sexual activity Each of these behavioral outcomes is supported by a set of learning objectives. The learning objectives are linked to individual-level factors that influence behavior, which can be grouped into eight categories derived from three seminal behavior change theories: the Health Belief Model, the Theory of Planned Behavior, and Social Cognitive Theory. Knowledge: Especially important points of knowledge include the seriousness of alcohol-related problems, including a focus on social, financial, and other consequences; personal risk factors; the existence of behavioral alternatives; and other key facts (e.g., factors that affect blood alcohol level, warning signs of alcohol poisoning). Attitudes: Positive or negative reactions and feelings about a new behavior are grounded in a set of supportive or non-supportive beliefs (e.g., “The minimum legal drinking age is unfair,” “Playing drinking games is dangerous”). Perceived Outcomes: In general, people will be more likely to engage in new behaviors that provide more benefits than costs. Potential benefits are more motivating when they are highly valued and likelier to occur. Personal Norms: People are more likely to engage in new behaviors that are consistent with their personal values or with their self-image. Social Norms: People are greatly influenced by the expectations of other persons or groups who approve or disapprove of a particular behavior. These perceived expectations, in turn, are informed by observations of what other people say or do in particular circumstances. Perceptions of social norms are highly prone to error. Behavioral Skills: People are more successful in changing their behavior if they have self-assessment and self-management skills. Certain behaviors may require more specific skills, such as knowing how to intervene when another student may be in trouble due to alcohol. Perceived Behavioral Control: People are more likely to engage in behaviors when they believe they are capable of doing so at particular times and places, and when they can call upon learned strategies to overcome possible barriers. Cues to Action: Internal or external cues can serve as reminders to engage in a new behavior. This is especially important when trying to change drinking habits. Listed below are the learning objectives for each of the behavioral outcomes above. With this information, campus practitioners can build upon AlcoholEdu to create additional programming for their students such as workshops, seminars, courses, educational events, and public communication campaigns, plus supportive campus policies and other environmental management strategies. 42 ABSTAINERS WILL CONTINUE TO CHOOSE NOT TO DRINK Knowledge • Describe the negative physical, mental, and social consequences associated with heavy drinking • List the negative effects that student drinking can have on a college community • Cite the laws and campus policies relevant to underage drinking • Cite the common reasons that abstainers give for choosing not to drink • Recall fun events on campus that don’t involve alcohol Attitudes and Beliefs • Agree: There are plenty of ways to have fun that don’t involve drinking • Agree: My academic performance might suffer if I start drinking • Agree: I will support other students who choose not to drink Perceived Outcomes • Agree: My decision not to drink will help me accomplish my personal goals while attending college • Agree: I will have a richer and more fulfilling college experience if I continue not to drink • Agree: I will continue to feel well physically if I continue not to drink • Agree: I will continue to have more energy if I continue not to drink Social Norms • Agree: I am part of a campus community where many students choose not to drink • Agree: Many college students take advantage of alcohol-free activities on the weekends • Agree: Students at my school will respect my decision not to drink • Agree: People I’m close to might be put off if I chose to start drinking • Agree: The media misrepresents alcohol as being central to the college experience Personal Norms • Agree: Drinking is not consistent with my academic or career goals • Agree: I will have greater respect for myself if I continue not to drink Behavioral Skills • By each Thursday, set aside time to plan weekend activities around alcohol-free events • Demonstrate how to use non-confrontational responses to turn down an invitation to go out drinking or attend a drinking-related event • Describe a system for setting personal goals, monitoring progress, and tracking their completion Perceived Behavioral Control • Agree: I can suggest events to my friends that do not involve drinking • Agree: I can successfully turn down a drink of alcohol • Agree: Everyone will be too busy to notice if I turn down a drink at a party • Agree: If I’m drinking a soda at a party, other people won’t know (or care) that I’m not drinking alcohol Cues to Action Note: These cues to action are not introduced in AlcoholEdu, but they can be introduced during other programming offered on campus. • Create a calendar reminder to check out upcoming local events that do not involve drinking • Create calendar reminders for alcohol-free events • Look ahead at my calendar to see what obligations and responsibilities I have coming up • Take notice of non-drinking activities that other students take advantage of during the evenings or on weekends

43 DRINKERS WILL MORE OFTEN CHOOSE NOT TO DRINK ANY ALCOHOL Knowledge • Describe the negative physical, mental, and social consequences associated with frequent drinking • List the negative effects that student drinking can have on a college community • Cite the laws and campus policies relevant to underage drinking • Cite the common reasons that drinkers give for choosing not to drink • Recall fun events on campus that don’t involve alcohol

Attitudes and Beliefs • Agree: There are plenty of ways to have fun that don’t involve drinking • Agree: Drinking is not a good stress reliever and can make things worse • Agree: My academic performance will suffer if I drink frequently • Agree: I will support other students who choose not to drink

Perceived Outcomes • Agree: My decision not to drink as often will help me accomplish my personal goals while in college • Agree: I will have a richer and more fulfilling college experience if I cut back on how often I drink • Agree: I will feel better physically if I drink less often • Agree: I will have more energy if I drink less often

Social Norms • Agree: Most college students abstain or avoid drinking heavily • Agree: Many college students take advantage of alcohol-free activities on the weekends • Agree: Students at my school will respect my decision not to drink • Agree: People I’m close to will be put off if I drink frequently • Agree: The media misrepresents alcohol as being central to the college experience

Personal Norms • Agree: Frequent drinking is not consistent with my academic or career goals • Agree: I will have greater respect for myself if I drink less often • Agree: Keeping track of how often I am drinking is consistent with being a responsible adult • Agree: I respect my fellow students, which includes whether or not they choose to drink

Behavioral Skills • Demonstrate how to use non-confrontational responses to turn down an invitation to go out drinking or attend a drinking-related event • Describe a system for setting personal goals, monitoring progress, and tracking their completion (e.g., schoolwork, post-graduation plans, career, community service, campus involvement, fitness and health)

Perceived Behavioral Control • Agree: Cutting back on how often I drink is not a big deal • Agree: I can go the whole weekend without drinking alcohol • Agree: I can suggest events to my friends that do not involve drinking • Agree: I can successfully turn down a drink of alcohol • Agree: Everyone will be too busy to notice if I turn down a drink at a party • Agree: If I’m drinking a soda at a party, other people won’t know (or care) that I’m not drinking alcohol

Cues to Action Note: These cues to action are not introduced in AlcoholEdu, but they can be introduced during other programming offered on campus. • Create a calendar reminder to check out upcoming local events that do not involve drinking • Create calendar reminders for alcohol-free events • Look ahead at my calendar to see what obligations and responsibilities I have coming up • Take notice of non-drinking activities that other students take advantage of during the evenings or on weekends • Display photos of being with friends and having fun without drinking

44 WHEN HAVING ALCOHOL, DRINKERS WILL TAKE STEPS TO KEEP THEIR BAC IN A SAFER RANGE

Knowledge • Describe the negative physical, mental, and social consequences associated with heavy drinking • Explain how heavy drinking impacts information processing and memory • Outline the risks posed at specific BAC levels above 0.04% BAC • List the negative effects that student drinking can have on a college community • List the strategies that drinkers can use to keep their BAC in a safer range • Cite the common reasons that drinkers give for drinking smaller amounts of alcohol when they have made the choice to drink • Explain the implications of alcohol’s biphasic properties • Explain the factors that affect BAC level (e.g., amount of alcohol consumed, pacing, food consumption, biological sex) • List the “standard drink” size for wine, beer, and liquor • Explain why college students think that more of their peers drink heavily than is actually the case

Attitudes and Beliefs • Agree: Alcohol is a drug that can have serious negative consequences when people drink heavily • Agree: No level of alcohol consumption is 100% safe • Agree: Advertising exaggerates alcohol’s benefits while ignoring the negative consequences that can result from heavy drinking • Agree: I don’t need to drink heavily to have fun • Agree: People I might be attracted to will be put off if I drink heavily • Agree: My academic performance will suffer if I drink heavily • Agree: Having a hangover can make paying attention in class difficult and unproductive • Agree: Drinking is not a good stress reliever and can make things worse • Agree: Potential employers won’t hire me when they do a background check and discover that I was a heavy drinker while in college through tagged photos, arrest records, and/or other documents

Perceived Outcomes • Outline the personal benefits of drinking less heavily (e.g., fewer hangovers, blackouts, injuries, fights) • Agree: My decision not to drink heavily will help me accomplish my personal goals and be more successful • Agree: I will have a richer and more fulfilling college experience if I drink less heavily when I chose to have alcohol • Agree: I can experience the benefits of drinking alcohol by drinking less, not more

Social Norms • Agree: Most college students abstain or avoid drinking heavily • Agree: Most college students support policies that can prevent dangerous alcohol use • Agree: Students at my school will respect my decision to drink less • Agree: People I’m close to will be put off if I drink heavily • Agree: My friends won’t want to see me put myself at risk by drinking heavily

Personal Norms • Agree: High-risk drinking is not consistent with my academic or career goals • Agree: I will have greater respect for myself if I control how much alcohol I drink and keep my BAC in a safer range • Agree: Keeping track of what and how much I am drinking is consistent with being a responsible adult • Agree: I do not want to be perceived as an out-of-control drinker

45 • Agree: I do not want embarrassing content about my drinking on the Internet

Behavioral Skills • Outline a personal plan for keeping BAC at a safer level when consuming alcohol • Demonstrate how to calculate the number of standard drinks in an alcoholic beverage • Explain how to monitor drinking behavior (e.g., using a smartphone, collecting bottle caps/tabs) • Demonstrate how to use non-confrontational responses to decline alcoholic drinks • Describe a system for setting personal goals, monitoring progress, and tracking their completion (e.g., schoolwork, post-graduation plans, career, community service, campus involvement, fitness and health)

Perceived Behavioral Control • Agree: Cutting back on how much I drink is not a big deal • Agree: I can control how much I drink by planning ahead • Agree: I can successfully turn down a drink of alcohol • Agree: Everyone will be too busy to notice if I turn down a drink at a party • Agree: If I’m drinking a soda at a party, other people won’t know (or care) that I’m not drinking alcohol

Cues to Action Note: This cue to action is not introduced in AlcoholEdu, but it can be introduced during other programming offered on campus. • Create an automatic text message reminder regarding strategies for keeping BAC at a safer level

STUDENTS WILL HELP PROTECT ANOTHER PERSON WHO HAS HAD TOO MUCH TO DRINK Knowledge • List the signs of a possible alcohol overdose (alcohol poisoning) • Describe the health and safety risks associated with alcohol overdose • Explain that impaired driving is the leading cause of alcohol-related deaths among college students • Explain why driving after consuming any amount of alcohol increases the risk of being in an accident • Cite the laws and campus policies relevant to alcohol-impaired driving • Itemize the legal, financial, academic, and social consequences that can result from an arrest for alcohol-impaired driving

Attitudes and Beliefs • Agree: Choosing to intervene with someone who has had too much to drink might save that person’s life • Agree: It is better to help someone and call 911 and not worry about getting into trouble with local or campus authorities • Agree: Getting into a car with a driver who has been drinking is never a good idea

Perceived Outcomes • Agree: A true friend will later thank me for cutting them off, taking their keys, or contacting the authorities in order to protect them from getting seriously hurt or killed • Agree: Local and campus authorities will care more about the fact that someone intervened to prevent another student from getting seriously hurt or killed than about punishing anyone for underage drinking • Agree: I will feel good about myself when I do the right thing and call 911 for help

Social Norms • Agree: My friends and family would want me to intervene to protect another person who has had too much to drink • Agree: Most students would do the right thing by calling the authorities when another person might be suffering an alcohol overdose

46 • Agree: Most students would intervene to keep another person from driving while impaired

Personal Norms • Agree: Intervening to help a person who has had too much to drink is consistent with my self- image as a caring person • Agree: Driving while impaired is unacceptable behavior • Agree: I would feel terrible about myself if I choose not to intervene and someone got seriously hurt or killed

Behavioral Skills • Demonstrate how to prevent another student from drinking too much by cutting off the alcohol • Demonstrate how to call 911 (or the appropriate campus authorities) to report a possible case of alcohol overdose • Demonstrate how to care properly for an intoxicated person while waiting for help to arrive • Describe different strategies to keep a person from driving after drinking • Explain how to negotiate with friends ahead of time about having a designated driver or calling for a safe ride (e.g., bus, taxi)

Perceived Behavioral Control • Agree: I have the ability to take control of a dangerous situation and call 911 for help • Agree: I can stand up to those who don’t want to call for help out of fear of getting into trouble • Agree: I will have done the right thing by calling 911 even if it turns out that my friend didn’t need to be transported to the hospital • Agree: By being persistent, I can overcome the resistance of an alcohol-impaired person when I cut them off or prevent them from driving • Agree: I can make plans ahead of time to avoid drinking and driving or riding in a car with someone who has been drinking

Cues to Action • Agree: If I’m concerned about someone’s well-being, then I should pay attention to my discomfort and call 911 • Agree: The fact that others are not intervening should prompt me to take action myself

STUDENTS WILL TRY TO HELP A FRIEND WHO MIGHT HAVE A PROBLEM WITH ALCOHOL Knowledge • List the signs that someone might have a problem with alcohol • Explain the difference between “normal” and “abnormal” drinking behaviors • Describe the physiological and psychological aspects of alcohol addiction • Describe the risks and negative consequences associated with alcohol addiction

Attitudes and Beliefs • Agree: Choosing to intervene with someone who might have a problem with alcohol could save that person’s life • Agree: People with an alcohol problem might be able to cope and function for a long time, but it will eventually create major problems in their life • Agree: It is my business if someone I’m close to has a problem with alcohol • Agree: If I had a family member who was a problem drinker, I wouldn’t think it was okay, and I should feel the same way about a friend who drinks too much or acts out after drinking

Perceived Outcomes • Agree: A true friend will thank me later if I express concerns about his or her drinking • Agree: Saying something to a friend who may have a problem with alcohol might be the very thing that prompts him or her to seek help • Agree: My intervention may not change my friend’s behavior, but it might make him or her more receptive when other people echo my concerns • Agree: I will feel good about doing the right thing if I talk to a friend about his or her drinking • Agree: I will feel relieved if I express my concerns rather than remain silent 47 Social Norms • Agree: My friends and family would want me to intervene to protect another person who might have an alcohol problem • Agree: Most students would do the right thing by saying something to a friend who might have a drinking problem

Personal Norms • Agree: Intervening to help a friend is consistent with my self-image as a caring person • Agree: I’m a good friend and that means looking out for my friends and being honest • Agree: I would feel terrible about myself if I choose not to say anything to my friend and he or she got seriously hurt or killed

Behavioral Skills • Demonstrate how to reach out to a friend who may have a problem with alcohol • Outline strategies for responding to a friend who is resistant or gets defensive

Perceived Behavioral Control • Agree: I will have done the right thing by saying something to a friend I’m concerned about • Agree: I will be able to cope with my friend’s resistance or defensiveness by being compassionate • Agree: I will have done the right thing by talking to my friend even if it turns out that he or she didn’t act on what I said

Cues to Action • Agree: If a friend talks about his or her habitual drinking, then I will take that as an opportunity to express my concerns • Agree: If I’m concerned about my friend’s well-being, then I should pay attention to my discomfort and express my concerns • Agree: The fact that others are not saying anything should prompt me to take action myself

STUDENTS WILL MAKE INFORMED DECISIONS TO AVOID USING MARIJUANA AND OTHER DRUGS Note: AlcoholEdu reviews frequently asked questions and answers regarding marijuana and other drug use, and then examines the risks related to the use of amphetamines, narcotics, MDMA (ecstasy), and prescription drugs in greater depth. Alcohol is by far the #1 drug used by college students, and that is the course’s primary focus. Accordingly, AlcoholEdu could not cover all of the learning objectives listed here, but we present them to guide any additional programming on this topic that a campus might wish to develop.

Knowledge • Explain the psychological aspects of marijuana addiction • Cite data showing that more people enter into treatment for marijuana than any other illegal drug • Cite the laws and campus policies relevant to marijuana and other drugs • Explain that marijuana is still illegal under federal law, even though a small number of states have recently changed their laws • Describe how prescription drugs affect the liver and other organs, especially when used in combination with alcohol • Recall fun events on campus that don’t involve using marijuana or other drugs

Attitudes and Beliefs • Agree: Using marijuana or other drugs can have serious negative healthy and safety, academic, and legal consequences • Agree: Using any drug involves risk • Agree: Using drugs is a dangerous way to relieve boredom • Agree: My academic performance might suffer if I smoke marijuana or use other drugs • Agree: Marijuana can impair alertness, coordination, and decision-making • Agree: Smoking marijuana is not a good stress reliever and can make things worse 48 • Agree: Smoking anything, including marijuana, can be harmful to my lungs • Agree: It’s dangerous to drive while under the influence of marijuana or other drugs • Agree: The risk of liver damage goes up when prescription drugs are used in combination with alcohol • Agree: The idea that Adderall or other stimulants help improve academic performance is a myth • Agree: Being alcohol-impaired will increase my risk of experimenting with dangerous drugs • Agree: I don’t need to get high to have a good time • Agree: There are plenty of ways to have fun that don’t involve using drugs • Agree: I will support other students who choose not to smoke marijuana or use other drugs

Perceived Outcomes • Agree: My decision not to smoke marijuana or use other drugs will help me accomplish my personal goals while in college • Agree: I will have a richer and more fulfilling college experience if I don’t smoke marijuana or use other drugs • Agree: I will feel better physically if I don’t smoke marijuana or use other drugs • Agree: I will have more energy if I don’t smoke marijuana or use other drugs

Social Norms • Agree: The majority of college students have never smoked marijuana or used other drugs in their lifetime • Agree: Students at my school will respect my decision not to smoke marijuana or use other drugs • Agree: People I’m close to will be put off if I smoke marijuana or use other drugs • Agree: Celebrities often misrepresent marijuana and other drugs as “safe”

Personal Norms • Agree: Using marijuana or other drugs is not consistent with my academic or career goals • Agree: I will have greater respect for myself if avoid using marijuana or other drugs • Agree: Avoiding drug use is consistent with being a responsible adult • Agree: I don’t want the image of a “drug user”

Behavioral Skills • Demonstrate how to use non-confrontational responses to turn down marijuana or other drugs • Describe a system for setting personal goals, monitoring progress, and tracking their completion (e.g., schoolwork, post-graduation plans, career, community service, campus involvement, fitness and health)

Perceived Behavioral Control • Agree: I can successfully turn down marijuana or other drugs • Agree: No amount of peer pressure will convince me to try marijuana or other drugs

Cues to Action Note: This cue to action is not introduced in AlcoholEdu, but it can be introduced during other programming offered on campus. • Look ahead at my calendar to see what obligations and responsibilities I have coming up

49 STUDENTS WILL SEEK CONSENT IF AND WHEN THEY ENGAGE IN SEXUAL ACTIVITY

Knowledge • Describe the critical elements of consent (i.e., verbal, explicit, free to act, no force or coercion, not incapacitated by alcohol or other drugs) • Explain the importance of seeking consent as a means of preventing sexual assault • Identify alcohol as the #1 rape drug (i.e., a tool used by people who commit sexual assault to increase another person’s vulnerability) • Explain how alcohol can negatively impact communication, decision-making, and perceptions of verbal and non-verbal cues, thereby increasing the risk of sexual assault • Describe the cognitive and physiological impact of alcohol as it relates to a person’s ability to recognize and respond to personal risk

Attitudes and Beliefs • Agree: Being drunk or high is not an excuse for illegal or unacceptable behavior • Agree: Just because a person is drinking does not mean he or she is more sexually available • Agree: Hooking up while intoxicated is risky • Agree: It’s best not to have sex if one or both persons are intoxicated or high • Agree: Sexual assault is very harmful to victims and has serious consequences for perpetrators • Agree: Using alcohol to get an otherwise unwilling person to have sex is sexual assault and a serious crime • Agree: Just like any other criminal, perpetrators of sexual assault are solely to blame for their criminal acts • Agree: Victims of sexual assault are never to blame, even if alcohol is involved • Agree: The media creates problematic misperceptions by conflating alcohol with sex

Perceived Outcomes • Agree: A true friend will thank me later if I intervene to prevent a possible sexual assault • Agree: I will feel good about doing the right thing if I intervene to prevent a sexual assault

Social Norms • Agree: Almost every new college student is anxious about how to fit in socially • Agree: My peers do not approve of using alcohol or other drugs to feel comfortable hooking up with someone • Agree: My friends will not respect me more if I hook up with someone who is intoxicated or high • Agree: Most students reject “rape myths” • Agree: Most students think that seeking consent is a very important part of engaging in sexual activity • Agree: Most college students would intervene if they thought a person was too impaired to give consent or was at risk for being sexually assaulted

Personal Norms • Agree: Taking advantage of someone who is impaired is inconsistent with being a caring person • Agree: I want to have healthy relationships • Agree: Intervening to prevent a sexual assault is consistent with being a caring person

Behavioral Skills • Explain how to make sure that consent has been obtained in a sexual situation • Explain the importance of knowing how much alcohol is in a drink • Explain the importance of keeping control of a drink to avoid someone adding a rape drug • Demonstrate how to use non-confrontational intervention strategies to prevent sexual assault (i.e., distract, delegate, direct, delay)

50 Perceived Behavioral Control • Agree: I don’t need to be under the influence of alcohol or other drugs to feel comfortable talking to someone I am attracted to • Agree: I can stop myself from engaging in sexual activity if my partner and/or I are under the influence of alcohol or other drugs • Agree: I can be more certain whether my partner is consenting to sexual activity if we are both sober • Agree: I know several different strategies for safely intervening to prevent a sexual assault • Agree: I will have done the right thing if I intervene to keep a friend from committing sexual assault or being sexually assaulted, even if he or she gets mad at me

Cues to Action • Agree: If I’m concerned about someone’s safety, then I should pay attention to my discomfort and say or do something to intervene • Agree: The fact that others are not intervening should prompt me to take action myself • Agree: When sexual activity is progressing, I will make sure my partner is okay with what’s going on • Agree: If I find myself asking “Am I too drunk?” or “Are they too drunk?” then it’s a good idea to avoid or disengage from any sexual activity

51 APPENDIX 2: AlcoholEdu Course Map

PART 1

MODULE 1: GETTING STARTED

Introductory Animated motion graphic that introduces students to the Video course and its content.

Custom Welcome Optional partner-provided text that is integrated into the Letter course (e.g., information regarding course deadlines, passing grade requirements, institutional objectives).

Custom Welcome Optional partner-provided video that is integrated into the Video course.

MODULE 2: STANDARD DRINK

Student Alcohol Montage of “person-on-the-street” video clips with students Knowledge answering questions related to alcohol. Demonstrates the Interviews range of knowledge—and misinformation—among today’s students.

Pre-Assessment Baseline assessment of students’ knowledge related to the (Quiz) specific content covered in the course.

Standard Drink Definition of a standard drink and why utilizing the standard Definition drink measurement is important and helpful.

Identifying Non- Examination of what constitutes a non-standard drink. Standard Drinks

Pouring Standard Interactive activity to practice pouring a standard drink of beer, Drinks wine, and liquor into a 16 oz. plastic cup.

My Notes End of module summary activity for students to identify which key points they would like to save to their digital portfolio.

SURVEY 1: PRE-INTERVENTION SURVEY

Survey 1 Assessment of students’ alcohol-related attitudes, behaviors, and consequences.

MODULE 3: WHERE DO YOU STAND?

Risk Factors Examination of risk factors that can increase the likelihood of experiencing alcohol-related problems.

Choices Review of the similarities between students’ top reasons for not drinking—or taking a break from drinking—and what past students indicated.

You Are Self-identified abstainers learn that they are not alone in Not Alone making the decision not to drink alcohol. (Abstainers)

52 MODULE 3: WHERE DO YOU STAND? continued

Your Drinking Self-identified drinkers examine how their drinking behaviors Profile (Drinkers) compare with their peers.

Your Peak BAC Self-identified drinkers identify the BAC range that they believe (Drinkers) best matches their peak BAC during the past two weeks.

Calculate BAC Self-identified drinkers calculate their actual peak BAC based (Drinkers) on the data they provided.

Reducing Your Self-identified drinkers review strategies for keeping their BAC BAC (Drinkers) in a safer range of 0.04% or less.

Drinking Self-identified drinkers compare the negative drinking-related Consequences consequences they reported experiencing with those most (Drinkers) often reported by past students.

Benefits of Not A series of brief testimonial voice-over segments with other Drinking students describing the benefits of deciding not to drink or to take a break from drinking.

Calories and Interactive calculator activity for determining the financial cost Cash and calorie burden associated with different alcohol consump- tion patterns.

Support for Abstainers review examples of activities they can explore Your Choice on campus to support their decision not to drink, and then (Abstainers) indicate whether they wish to be connected with other students who are non-drinkers.

Your Drinking Self-identified drinkers indicate how they currently feel about Habits (Drinkers) their drinking habits, and then receive contact information for national resources that can provide assistance, plus a custom- ized list of local campus resources.

My Notes End of module summary activity for students to identify which key points they would like to save to their digital portfolio.

MODULE 4: GOAL SETTING

What’s Important Students draft a statement about their goals for the next year to You? of college.

What Do You Students select objectives listed for different topic categories Want to Focus (e.g., schoolwork, relationships) that best reflect their personal on this Year and goals. Why?

My Choices Students indicate the choices they want to make related to alcohol use and identify why these choices are important to them.

53 MODULE 5: DRINKING AND MOTIVATION

What Do You Statistics related to college drinking, which make clear that it’s Think? easy to overestimate the number of students who drink and underestimate the number of students who want to drink in a safer way.

Factors That Information on factors that can influence the decisions Can Influence people make about drinking, including family background, Decisions assumptions, peer influence, and stress.

Why/Why Not Top reasons that past students indicated for why they choose Drink? Poll not to drink or to drink in moderation.

Expectancy How expectations concerning alcohol consumption can impact Theory and how students drink and how they feel and act when drinking. Advertising

Ads Appealing to How advertisements are used to influence perceptions and Men/Women portray an idealized image of alcohol consumption.

Alcohol and Top reasons that past students indicated for why they get Advertising Poll annoyed with manipulative alcohol advertising.

Write a Tagline Students view four pseudo-ads and develop their own tagline for an advertisement that conveys the truth about alcohol.

My Notes End of module summary activity for students to identify which key points they would like to save to their digital portfolio.

MODULE 6: BRAIN AND BODY

BAC Basics Motion graphic animation that provides an overview of BAC and common myths related to “sobering up.”

What Factors Exploratory activity to examine the broad range of factors Affect BAC that can influence BAC, including sex, weight, amount of food consumed, and more.

Risk/Protective Students categorize behaviors that can influence BAC as Factors “protective factors” or “risk factors.”

BAC Calculator Interactive calculator for estimating BAC based on inputted values for sex, weight, hours spent drinking, and number of drinks consumed.

Marijuana and Frequently asked questions and answers related to marijuana Drugs and other drug use, followed by an in-depth look at the potential risks associated amphetamines, narcotics, MDMA (ecstasy), and prescription drugs.

Sexual Information on the prevalence of sexual assault, the use of Assault and alcohol by sexual perpetrators, the importance of obtaining Understanding consent, and bystander intervention techniques. Consent

54 MODULE 6: BRAIN AND BODY continued

Biphasic Motion graphic animated video that provides an overview of Animation the biphasic effect of alcohol and encourages students who drink to keep their BAC at 0.04% or less.

Brain Science Interactive activity to explore how different areas of the brain are affected by alcohol.

Biphasic Effect An interactive exercise to explore alcohol’s biphasic effects and what students can experience at different BAC levels.

A BAC Story An unfolding story of two students on a date who fail to keep their BAC in check and the negative consequences they experience as a result.

My Notes End of module summary activity for students to identify which key points they would like to save to their digital portfolio.

MODULE 7: MY ACTION PLAN

Drinker/Non- Students create a personalized plan based on whether they Drinking Plan identify themselves as a non-drinker or drinker.

Choose Your Students flesh out their action plan by selecting the strategies Strategies they plan to use (e.g., setting a reasonable drink limit, pacing their drinking, knowing exactly what’s in their drink).

Activities on Students indicate what types of activities and events they are Campus interested in and whether they would like to be contacted to help plan and/or attend activities that don’t focus on drinking.

MODULE 8: LAWS AND POLICIES

Alcohol Related Exploration of the key alcohol laws in individual states and Laws territories.

Campus Policies Students indicate whether they are interested in being contacted about getting involved in setting campus policies or improving the campus social climate.

Drinking and Series of brief voice-over segments with students describing Driving the strategies they use to avoid drinking and driving.

My Notes End of module summary activity for students to identify which key points they would like to save to their digital portfolio.

MODULE 9: HELPING FRIENDS

Taking Care of Montage of “person-on-the-street” video clips of students Yourself and answering questions related to the strategies they use to stay Others safe and their advice for incoming freshmen.

Alcohol Scenario-based exercise involving a potential case of alcohol Poisoning poisoning at a party, with a range of provided options for intervening.

55 MODULE 9: HELPING FRIENDS continued

Helping Your Students indicate their top strategy for helping their friends Friends Poll stay safe and then examine the options that past students selected.

Drinking and Scenario-based exercise involving a potential drinking and Driving driving situation at a party, with a range of provided options for intervening.

Getting Help Contact information for national resources that can provide assistance, plus a customized list of local campus resources.

My Notes End of module summary activity for students to identify which key points they would like to save to their digital portfolio.

Post-Assessment Post-intervention assessment of student's knowledge related (Exam) to the specific content covered in the course.

SURVEY 2: COURSE EVALUATION

Survey 2 Assessment of what students think they learned and whether they believe taking AlcoholEdu will impact their future behavior.

PART 2

SURVEY 3: POST-INTERVENTION SURVEY

Survey 3 Assessment of students’ alcohol-related attitudes, behaviors, and consequences.

MODULE 10: RECOGNIZING PROBLEMS

Taking Care of Scenario-based exercise involving a friend whose drinking has Yourself and escalated to the point of being a serious concern, with a range Others of provided options for intervening.

My Notes End of module summary activity for students to identify which key points they would like to save to their digital portfolio.

56 APPENDIX 3: AlcoholEdu Evidence Base Several rigorous studies have demonstrated that AlcoholEdu for College has a positive impact on first-year students’ alcohol-related attitudes, behaviors, and consequences.

PACIFIC INSTITUTE FOR RESEARCH AND EVALUATION: MULTISITE RANDOMIZED CONTROL TRIAL The Pacific Institute for Research and Evaluation (PIRE), led by M. J. Paschall, secured a multi-million dollar grant from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) to evaluate AlcoholEdu. The PIRE team published its findings in 2011 (Paschall, Antin, Ringwalt, & Saltz, 2011a; Paschall, Antin, & Ringwalt, 2011b).

"Based on the findings, the online course appears to constitute a strategy for reducing hazardous drinking that is particularly appropriate for freshmen who are newly arrived on campus, at a time when they are at high risk for engaging in this behavior.” —Paschall et al., 2011a, p. 307)

The PIRE study was a multisite randomized control trial, with 15 colleges randomly assigned to have their first-year students take AlcoholEdu for College (treatment group) and 15 comparison schools (control group). AlcoholEdu is a population-level prevention strategy, intended to influence the student body as a whole. Accordingly, PIRE’s research design is the best possible design for evaluating the course’s impact. PIRE set up the strictest possible test of AlcoholEdu by conducting what is called an intent-to-treat analysis. This type of analysis is common in pharmaceutical studies, where patients are considered to be in the treatment group whether or not they have actually used the drug being tested. Following this model, PIRE included all of the colleges that had been randomly assigned to administer AlcoholEdu, even when they failed to administer the course properly and had a very small percentage of students complete it. This is an important aspect of the study to understand. According to PIRE, the course completion rates ranged from 4% to 100%, with a mean of 56%. In contrast, the colleges that implement AlcoholEdu typically report much higher course completion rates: colleges that use an implied mandate—meaning that freshmen are told they have to complete course, but no real consequences are assessed if they don’t—have an average course completion rate of 86%, while colleges that do impose consequences have rates of 91% to 98%, depending on the nature of the threatened sanction. Why were the PIRE completion rates so low? The colleges taking part in the PIRE study received AlcoholEdu free of charge, which apparently led some administrators to place far less value on implementing the course optimally than would have been the case had the colleges paid for the course. What implications does this have for this evaluation? According to the PIRE team (Paschall et al., 2011b, pp. 646, 648): “We used intent-to-treat analyses to test our primary hypothesis concerning the effectiveness of AlcoholEdu on alcohol- related problems at the campus level while recognizing that those results might underestimate the actual effectiveness of the course at the student level.” PIRE conducted a series of random-sample student surveys at each of the treatment group and control group colleges during: 1) the 2009 spring semester (baseline), 2) the 2009 fall semester (posttest survey, short term), and 3) the 2010 spring semester 57 (posttest survey, long term). Even though the treatment group included several colleges with poor completion rates, and the PIRE surveys therefore included many first-year students who had not taken AlcoholEdu, PIRE’s analysis showed that, during the 2009 fall semester that immediately followed course implementation, the treatment group colleges showed significant decreases in the following measures: „„ Frequency of past 30-day alcohol use (see Paschall et al., 2011a, p. 304; Table 3, p. 305; and Figure 2, p. 306). „„ Frequency of past 30-day “binge drinking,” here defined for men as five or more drinks in a row, and for women as four or more drinks in a row, within a 2-hour period (see Paschall et al., 2011a, p. 304; Table 3, p. 305; and Figure 2, p. 306). „„ Total number of past 30-day alcohol-related problems (see Paschall et al., 2011b, p. 648; Table 3, p. 647; and Figure 1, p. 648).

The results for the subsequent spring semester were more ambiguous, but given the pattern of results shown in the figures (Paschall et al., 2011a, Figure 2, p. 306; 2011b, Figure 1, p. 648), the study appears to have had inadequate statistical power to detect statistically significant differences between the treatment and control groups.

58 In sum, the PIRE evaluation provides strong empirical support for AlcoholEdu for College: „„ The research design—a multisite randomized control trial—represents the gold standard for evaluating a population-level prevention program like AlcoholEdu. „„ PIRE applied an intent-to-treat analysis, which Paschall and his colleagues admitted may have underestimated the actual effects of the course because of the low course completion rates at several of the treatment group colleges. „„ Even so, PIRE reported that AlcoholEdu significantly reduced heavy episodic (“binge”) drinking and alcohol-related problems during the fall semester after students took the course—a time that is known to be the riskiest period for new college students to drink heavily.

In the PIRE study, AlcoholEdu was far more effective for schools with the highest rates of course completion. Thus, mandating the course is likely to yield the greatest benefits.

ROGER WILLIAMS UNIVERSITY: RANDOMIZED CONTROL TRIAL John Hustad and his colleagues (2010) conducted a randomized control trial that compared the most recent version of AlcoholEdu for College and e-Chug (Electronic Check-Up to Go), a brief online alcohol screening and intervention program. Importantly, this investigation is the only published study that directly compares AlcoholEdu and e-Chug. Unlike the PIRE evaluation, this study was conducted at a single college. Individual students were randomly assigned to one of three groups: AlcoholEdu (n = 26), e-Chug (n = 31), or a no-intervention comparison group (n = 25). The researchers conducted an online baseline survey, followed by a posttest survey conducted one month later. Across the three groups, the students had similar demographic and drinking profiles. It is important to emphasize that this is a small-scale study with very low statistical power. This means that any significant findings are especially noteworthy, as only substantial differences between any two of the groups would be declared statistically significant. At one-month follow-up, AlcoholEdu produced a significant reduction in alcohol use and showed significantly fewer negative alcohol-related consequences (Section 3.3, p. 186; Table 1, p. 187). Note that only the AlcoholEdu group was significantly different than the comparison group for alcohol-related consequences. The AlcoholEdu group demonstrated a 37% decrease, while the e-Chug group demonstrated only an 11% decrease. The AlcoholEdu group also consumed fewer drinks per drinking occasion compared to the e-Chug group. Number of Negative Alcohol-Related Consequences at 1-Month Follow-Up

6 Baseline 1 Month 5

4

3

2

1

0 Baseline Post Intervention Follow-Up 59 COLLEGE OF CHARLESTON: TIME-SERIES ANALYSIS Randomized control trials have shown that AlcoholEdu impacts fi rst-year students’ alcohol-related attitudes, behaviors, and consequences. Wyatt, DeJong, and Dixon (2013) examined whether a college that used AlcoholEdu year after year would see sustained institutional-level changes in these outcomes. The College of Charleston fi rst implemented AlcoholEdu in 2004. The primary source of data was the Core Alcohol and Drug Survey that members of all four undergraduate classes completed each year from 1990 through 2009. ARIMA time-series analyses revealed that the year in which AlcoholEdu was fi rst implemented was associated with signifi cant decreases in alcohol use and substance use-related negative consequences. The fi gures shown below reveal that these positive changes were amplifi ed and sustained over time as succeeding fi rst-year students took the course. Note that the vertical dashed lines highlight the fact that in 2004, and in subsequent years, fi rst-year students took AlcoholEdu two or more months before the university administered its annual Core Survey. Thus, the data shown for 2004 and each subsequent year refl ect any changes that are associated with AlcoholEdu.

60 We also investigated several additional programs implemented during the same time period. Implementation of these programs was associated with a fraction of the decreases associated with the AlcoholEdu course. There were moderate downturns in alcohol use, plus some favorable changes in substance use-related consequences, but in general these interventions were associated with few signifi cant eff ects, either immediately or gradually over time. It is important to point out, however, that the decreases associated with AlcoholEdu may be at least partially due to the combined impact of the multiple, targeted programs already in place when the course was fi rst implemented in 2004.

REFERENCES Hustad, J. T. P., Barnett, N. P., Borsari, B., & Jackson, K. M. (2010). Web-based alcohol prevention for incoming college students: A randomized controlled trial. Addictive Behaviors, 2010; 35, 183-189. Paschall, M.J., Antin, T., Ringwalt, C.L., & Saltz, F. (2011a). Evaluation of an internet-based alcohol misuse prevention course for college freshmen: Findings of a randomized multi- campus trial. American Journal of Preventive Medicine, 41, 300-308. Paschall, M.J., Antin, T., & Ringwalt, C.L. (2011b). Eff ects of AlcoholEdu for College on alcohol-related problems among freshmen: A randomized multicampus trial. Journal of Studies on Alcohol and Drugs, 72, 642-650. Wyatt, T.M., DeJong, W., Dixon, E. (2013).The impact of a population-level administration of AlcoholEdu for College on student alcohol use: A time-series analysis. Journal of Health Communication, 18: 898-912.

61 APPENDIX 4: Legal Bias Against Rape Victims (The Rape of Mr. Smith) Unlike trials for other crimes, the complainant in a rape case will often find herself on trial to prove that she is not to blame for being victimized. Imagine how it might sound if a robbery victim were subjected to the kind of treatment that a rape victim usually undergoes in cross-examination A robbery victim is asked questions by a lawyer: Attorney: Mr. Smith, you were held up at gunpoint on the corner of First and Main? Mr. Smith: Yes. Attorney: Did you struggle with the robber? Mr. Smith: No. Attorney: Why not? Mr. Smith: He was armed. Attorney: Then you made a conscious decision to comply with his demands rather than resist? Mr. Smith: Yes. Attorney: Did you scream? Cry out? Mr. Smith: No, I was afraid. Attorney: I see. Have you ever been held up before? Mr. Smith: No. Attorney: Have you ever given money away? Mr. Smith: Yes, of course. Attorney: And you did so willingly? Mr. Smith: What are you getting at? Attorney: Well, let’s put it like this, Mr. Smith. You’ve given money away in the past. In fact, you have quite a reputation for philanthropy. How can we be sure that you weren’t contriving to have your money taken from you by force? Mr. Smith: Listen, if I wanted – Attorney: Never mind. What time did this holdup take place, Mr. Smith? Mr. Smith: About 11:00 P.M. Attorney: You were out on the street at 11:00 P.M.? Doing what? Mr. Smith: Just walking. Attorney: Just walking? You know that it’s dangerous being out on the street that late at night. Weren’t you aware that you could have been held up? Mr. Smith: I hadn’t thought about it. Attorney: What were you wearing at the time, Mr. Smith? Mr. Smith: Let’s see … a suit. Yes, a suit. Attorney: An expensive suit? Mr. Smith: Well – yes. I’m a successful lawyer, you know. Attorney: In other words, Mr. Smith, you were walking around the streets late at night in a suit that practically advertised the fact that you might be good target for some easy money, isn’t that so? I mean, if we didn’t know better, Mr. Smith, we might even think that you were asking for this to happen, mightn’t we?

62 APPENDIX 5: The Alcohol Use Disorders Identification

TestAppendix (AUDIT) 5: The Alcohol Use Disorders Identification Test (AUDIT)

Points Score Questions 0 1 2 3 4 1. How often do you have a drink Never Monthly 2 to 4 2 to3 4 or more containing alcohol? or less times a times a times a month week week

2. How many drinks containing alcohol 1 or 2 3 or 4 5 or 6 7 or 9 10 or do you have on a typical day when you more are drinking?

3. How often do you have 5 or more Never Less than Monthly Weekly Daily or drinks on one occasion? monthly almost daily

4. How often during the last year have Never Less than Monthly Weekly Daily or you found that you were not able to monthly almost stop drinking once you had started? daily

5. How often during the last year have Never Less than Monthly Weekly Daily or you failed to do what was normally monthly almost expected of you because of drinking? daily

6. How often during the last year have Never Less than Monthly Weekly Daily or you needed a first drink in the morning monthly almost to get yourself going after a heavy daily drinking session?

7. How often during the last year have Never Less than Monthly Weekly Daily or you had a feeling of guilt or remorse monthly almost after drinking? daily

8. How often during the last year have Never Less than Monthly Weekly Daily or you been unable to remember what monthly almost happened the night before because of daily your drinking?

9. Have you or someone else been No ------Yes, but ------Yes, injured because of your drinking? not in the during the last year last year

10. Has a relative, friend, doctor, or No ------Yes, but ------Yes, other health care worker been not in the during the concerned about your drinking or last year last year suggested you cut down?

TOTAL

INSTRUCTIONS Each question has a set of responses from which to choose. Select the response that best matches your answer, and then enter the point value for that response (0, 1, 2, 3, 87 or 4) in the right-most column labeled “Score.” After answering all 10 questions, add up the total number of points and enter that in the next to the box labeled “TOTAL.” A total score of 8 or more is commonly accepted as an indicator of “hazardous and harmful alcohol use, as well as possible alcohol dependence.” Scores of 20 or higher call for a diagnostic evaluation for alcohol dependence. Source: Babor, T.F., Higgins-Biddle, J.C., Saunders, J.B., and Monteiro, M.G. (2001). AUDIT: The Alcohol Use Disorders Identification Test—Guidelines for Use in Primary Care (Second Edition). Geneva, Switzerland: World Health Organization, Department of Mental Health and Substance Dependence.

63 APPENDIX 6: Campus Alcohol Policy Survey Using this survey instrument, national data collected through AlcoholEdu has demonstrated clear majority support among first-year students for numerous alcohol policy measures and institutional responses to alcohol policy violators. These data have also revealed a large discrepancy between perceived and actual support for these measures: across the board, the percentage of students who endorse these measures is far greater than the percentage who think that other students endorse them. Collecting these data at the campus level can inform policy conversations and also be reflected back to students in social norms marketing or other materials designed to support a campus policy initiative.

INSTRUCTIONS This survey is anonymous. None of the information you provide will be linked to you in any way. Your individual response to any question you’re asked in this course will never be identified with you or reported. If there are questions you would prefer not to answer, you can choose to leave them blank, but we hope you’ll answer all questions as completely as you can. 1. In general, what best represents your thoughts about:

Too Too Lenient Strict 1 2 3 4 5 6 7

Alcohol policies at my college

Enforcement of alcohol policies at my college

Alcohol policies in the local commun-ity near my college

Enforcement of alcohol policies in the local community near my college

2. To what extent do you support or oppose the following possible policies or procedures?

Strongly Strongly Oppose Support 1 2 3 4 5 6 7

Prohibit kegs on campus

Offer alcohol-free residence halls

64 Strongly Strongly Oppose Support 1 2 3 4 5 6 7

Make all residences on campus alco- hol-free

Use stricter disciplinary sanctions for students who engage in alcohol-related violence

Use stricter disciplinary sanctions for students who repeatedly violate cam- pus alcohol policies

Use stricter disciplinary sanctions for violations of underage drinking laws at residence hall room parties

Use suspension or expulsion as a sanc- tion for alcohol-related policy violations

Apply stricter penalties for the use of fake IDs to purchase alcohol illegally

Apply stricter penalties for the use of another person’s ID to purchase alcohol illegally

Notify parents of a first offense when underage students violate the college’s alcohol rules or local alcohol laws

Notify parents of a repeat offense when underage students violate the college’s alcohol rules or local alcohol laws

Conduct under-cover operations at bars, restaurants, and liquor stores to increase compliance with underage drinking laws

Restrict advertising that promotes alcohol consumption at on-campus parties or events

Eliminate happy hours and other low- price alcohol promotions targeted to college students

Ban alcohol industry sponsorship of school events

Limit the days or hours of sale for alco- hol outlets near campus

Prohibit “drinking games” on campus

Apply stricter disci-plinary sanctions for students who damage property after drinking

Require student parties to have a certified bartender

Apply stricter disci-plinary sanctions for students who disturb other people after drinking 65 Strongly Strongly Oppose Support 1 2 3 4 5 6 7

Age 21 minimum legal drinking age

“Zero tolerance” law, which specifies a maximum blood alcohol concentration (BAC) of .02% or less for drivers under age 21

Prohibit delivery of alcohol to campus

Eliminate “ladies drink free” alcohol promotions

Increase taxes on alcohol to help pay for programs to prevent minors from drinking Require more early morning and Friday classes to discourage alcohol use during the week

Ban sale of shot glasses and beer mugs with the college’s logo at the college book store

Enforce the under age 21 legal restrictions on alcohol use

Require non-alcoholic beverages be available when alcohol is served at campus events

Let students drink regardless of age

Put restrictions on the amount of alco-hol that can be served at a tail-gat- ing party

Increase enforcement of anti-drunk driving laws

Provide more alcohol-free recreational and cultural opportunities such as movies, dances, sports, lectures

Require all alcohol servers to be trained in responsible alcohol bever-age service

Hold social hosts responsible for problems arising from alcohol use

Require registration of all student par-ties where alcohol will be served

Organize designated driver program for students

Offer a “safe rides” program for stud- ents who drink at local bars and taverns 66 Strongly Strongly Oppose Support 1 2 3 4 5 6 7 Apply college disciplinary sanctions for off-campus violations of local or state law

Use stricter disci-plinary sanctions for students who are publicly intoxicated

Prohibit parties where alcohol will be served during freshman orientation period

Do not discipline a student for violating the college’s alcohol policy after seeking medical attention for intoxication

Do not discipline a student or organi- zation for violating the college’s alcohol policy after seeking assistance for another student who is intoxicated

Have no policies or procedures which attempt to control alcohol use

Note: The same list can be used in a question that asks whether other students support or oppose these policies: To what extent do you think other students at your college support or oppose the following possible policies or procedures?

3. Since attending school, have you read a copy of your school’s policy on alcohol? Yes No

4. Which of the following do you think should be your school’s approach to student drinking? The current alcohol policy A policy which imposes greater restrictions on alcohol use A policy which imposes fewer restrictions on alcohol use Don’t know current policy

5. In your opinion, how likely is it that students on your campus would be caught for violating the following policies on-campus?

Extremely Extremely Unlikely Likely 1 2 3 4 5 6 7

Persons under 21 years drinking anywhere on campus

Persons 21 years or older drinking alcohol in a student’s residence hall room when someone under 21 is present

Persons under 21 drinking alcohol from a central source (e.g., keg, beer balls, trash cans)

Persons under 21 playing drinking games

Persons under 21 years drinking alco-hol at university-sponsored events

67 6. Do the following statements describe what your school does about student drinking?

Yes No Don’t Know

Discourages or tries to prevent all student drinking

Tolerates drinking but tries to keep students from becoming drunk and disorderly

Encourages responsible drinking

Does little to discourage alcohol use or abuse

7. How do you think your school’s administration should deal with students in the following situations? (Please check all that apply in each row.)

Refer student to educational Take Do Talk with or counseling disciplinary nothing student program action

Student brings alcohol into area or event where prohibited

21 year old buys alcohol for underage friends

Student becomes drunk and disorderly at a campus party Student hosts an on-campus party at which others become drunk and disorderly

Student requires emergency medical treatment for alcohol overdose

Student is arrested for alcohol violation off campus

RA or roommate reports a student is drinking heavily

Student commits sexual assault while drunk

68