Meeting the Standards of Practice in Alcohol Prevention: A Reflection
A Commentary by Dr. William DeJong
Because college student drinking continues to be a problem on our nation’s campuses, the central question on the minds of college administrators today is no different from what it was 20 years ago: What works? What has changed over time is our ability to answer that question. With hundreds of studies published, researchers now know much more today than we did in the past about which prevention strategies are most effective.
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related to the recently published research (Nelson et al., 2010) on implementation of recommendations from the 2002 NIAAA Report, "A Call to Action."
Making that information actionable for administrators, however, is a major undertaking. The first group to make this attempt was the Task Force on College Drinking sponsored by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), which issued its recommendations report in 2002, A Call to Action: Changing the Culture of Drinking at U.S. Colleges. The report summarized the research literature circa 2000, and it offered sound practice recommendations based on what was known at that time. I served on the Task Force, and contributing to this report was a career highlight for me.
Yet, a research article in the October 2010 issue of Alcoholism: Clinical and Experimental Research by Toben Nelson and his University of Minnesota colleagues shows that, eight years later, only a small percentage of colleges and universities have acted on the NIAAA recommendations. This brings two thoughts to mind. First, as a field, we need to redouble our efforts to put evidence-based programs and policies in place. Second, the NIAAA report reviewed research from a decade ago, and the Institute currently has no plans to update its recommendations to take into account the abundance of new research that’s been conducted. That’s a problem, because a lot has changed.
What we have learned about social norms marketing (SNM) illustrates this point. By 2002, no rigorous experiments of this approach had been conducted, only case studies. Accordingly, the NIAAA Task Force classified SNM as a “promising” strategy and assigned it to “Tier 3.” Since then, experimental and quasi-experimental research has shown that a large-scale, fully implemented SNM campaign can reduce student drinking significantly.
Consider also how we think about computer-based or online education programs. In 2002, the Task Force declared that alcohol education programs, along with other educational programs, should be classified as “Tier 4” strategies, meaning that there was no evidence of their effectiveness when used alone. The take-home message for many student affairs officials was simple: “Education, by itself, doesn’t work.”
Now, in 2010, the situation is very different. Two randomized control studies, one published in Addictive Behaviors and the other appearing in the Journal of Health Communication, show that Outside The Classroom’s AlcoholEdu for College, an online alcohol education program for first-year college students, significantly reduces student drinking and alcohol-related negative consequences.
If the NIAAA Task Force were to reconvene, online alcohol education (and perhaps AlcoholEdu itself) would be classified as a “Tier 1” strategy, meaning that it has a high level of empirical support. The criterion is simple: for a program or policy to be so classified, the Task Force required at least two “rigorous” studies showing that it worked. Some online education programs—but not all—have cleared that bar.
I mentioned before that NIAAA has no current plans to update A Call to Action. To move the field forward, we need a mechanism for reviewing the literature on an ongoing basis. That way, we will always have an up-to-date answer whenever a practitioner asks that familiar question: What works?
This is why my colleagues at Outside The Classroom and I developed The Alcohol Prevention Compass. This analysis, updated annually and available to the company’s partners in the Alcohol Prevention Coalition, uses a rapid scoring system to assess the relative strength of alcohol prevention programs and policies, taking into account both the degree of positive change they produce and the quality of the research evidence. I believe this rubric will change how we identify and then promote the best evidence-based strategies.
The Nelson et al. article is a welcomed reminder that student affairs officials should be guided by the research evidence when putting together their alcohol prevention program. Let’s do what we can to make sure this happens—but let’s also make sure that the field aspires to a standard of practice that is based on the newest research.