Article Review: Reducing Substance Abuse Among College Students

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[. . .] Their findings reveal that the experience of stimulation or sedation during the drinking event significantly predicted the prevalence of high BACs, blackouts, and hangovers. The authors of this study further concluded that the combined experiences of blackouts and hangovers, together with feelings of stimulation or sedation, may be valuable clinical predictors for the onset of chronic alcohol abuse problems. The authors also suggested that incorporating the subjective experience of alcohol-related feelings of stimulation or sedation into an intervention might increase the intervention's efficacy. The findings from this study and others seem relevant to the intervention used in the study by Kazemi et al. (2013), yet they were not incorporated into the literature review or elsewhere. In addition, there was no mention of studies revealing a lack of clinical efficacy for motivational interviewing.

Kazemi and colleagues (2013) attempted to recruit a large sample size and were successful. Out of the initial 300 college freshman contacted, 188 signed the consent form and participated in the study. The authors of this study were remarkably fortunate, because none of the 188 freshman participating in the study dropped out, thereby eliminating the possibility of an attrition bias. The inclusion criteria were age (18 to 20), freshman status, enrolled full-time, English fluency, interested in participating in the study, and consumption of alcohol in the last 30 days. This screening process eliminated 32% of the initial sample. The exclusion criteria included an inability to complete all four scheduled intervention sessions. These selection criteria are relatively broad; therefore the risk of limiting the generalizability of the findings to all freshmen who consume alcohol would probably be low. In addition, only 5% of the students meeting the inclusion criteria were excluded due to scheduling conflicts.

The predicted power of the study, given the number enrolled and completing the study, was above 99% or an alpha of .05; however, the authors decided to expose all of the participants to the intervention (Kazemi et al., 2013). No rationale was given for this decision, whether for statistical or ethical reasons. One possibility is that the researchers considered the withholding of the intervention from the controls unethical, given the past record of success for reducing substance abuse behaviors through motivational interviewing, but this rationale was not mentioned in the publication. In addition, the absence of a control group obviated the need to randomize participants to an intervention and control group. These limitations could potentially undermine the internal validity of the findings due to the effects of history, pretest, instruments, regression towards the mean, maturation, or an interaction between any of these factors (Dimitrov & Rumrill, 2003). For example, the freshman class as a whole could have viewed an online documentary about substance abuse during the study period, which could have had a significant impact on the outcome variables. This factor would fall under history. The improved outcome statistics could have been due to regression to the mean, which implies that the natural ebb and flow of substance abuse prevalence among all freshmen will generate overall improvements from time to time independent of the intervention. In addition, the freshman class as a whole could have matured during the six-month study period and began to reduce their abuse of alcohol and drugs independently of the intervention. These flaws are realistic possibilities and potential fatal flaws of this study.

To summarize, Kazemi and colleagues (2013) made an adaquate case for investigating the efficacy of motivational interviewing for reducing the prevalence of substance abuse among college freshmen, but the depth and comprehensiveness of the literature review is problematic. In particular, contrary findings were not presented or discussed and the discussion of the intervention's efficacy was anemic. The sample size was more than sufficient and calls into question why a control group was not utilized. The lack of a comparison control group is a fatal flaw, because the magnitude of outcome variable improvement could just as easily be due to regression to the mean, maturation, history, and/or other threats to internal validity.

Reviewer Recommendation

In the absence of a comparison group the findings of Kazemi and colleagues (2013) cannot be used as the sole justification for using motivational interviewing to reduce substance abuse problems among college freshmen. For this reason, this study should be shelved until its findings can be validated or invalidated by an independent research group using a control group, preferably a control group created through randomization. In addition, the internal validity of the study might be improved by recruiting freshmen and exposing them to the intervention on a rolling basis, thereby minimizing the impact of history and regression to the mean on the magnitude of the difference between pretest and posttest scores. The inherent value of the study conducted by Kazemi et al. (2013) is therefore severely limited and should not be used as source material for any researcher interested in learning more about this important health issue.

References

Barnett, E., Sussman, S., Smith, C., Rohrbach, L.A., & Pruijt-Metz, D. (2012). Motivational interviewing for adolescent substance use: A review of the literature. Addictive Behaviors, 37(12), 1325-34.

DiClemente, C.C. & Prochaska, J.O. (1982). Self-change and therapy change of smoking behavior: A comparison of processes of change in cessation and maintenance. Addictive Behaviors, 7(2), 133-42.

Dimitrov, D.M. & Rumrill, P.D. Jr. (2003). Pretest-posttest designs and measurement of change. Work, 20(2), 159-65.

Grucza, R.A., Norberg, K.E., & Bierut, L.J. (2009). Binge drinking among youths and young adults in the United States: 1979-2006. Journal of the American Academy of Child & Adolescent Psychiatry, 48(7), 692-702.

Jackson, H. (2013). Motivational interviewing and HIV drug adherence. Nursing Times,… [END OF PREVIEW]

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Reducing Substance Abuse Among College Students.  (2014, March 20).  Retrieved April 19, 2019, from https://www.essaytown.com/subjects/paper/reducing-substance-abuse-among-college/6144563

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"Reducing Substance Abuse Among College Students."  Essaytown.com.  March 20, 2014.  Accessed April 19, 2019.
https://www.essaytown.com/subjects/paper/reducing-substance-abuse-among-college/6144563.