Surveys of drinking in national samples of college campuses revealed that between 34 to 44% of students met criteria for heavy drinking (Douglas et al., 1997
; Wechsler et al., 2002
). Heavy drinking can lead to health risks (e.g., blackouts, personal injuries, physical illnesses, and unprotected sexual activity), in addition to academic, interpersonal, and legal problems (Hingson, Heeren, Winter, & Wechsler, 2005
; Perkins, 2002
; Aertgeerts & Buntinx, 2002
). Due to the substantial risks associated with heavy college drinking, innovative risk reduction strategies are needed. Effective intervention programs have combined information, normative feedback and values clarification within a context of teaching college students skills to moderate risky drinking behaviors (Larimer & Cronce, 2002
Skills-based interventions are designed to modify high risk drinking behaviors in two ways: (a) teaching how to cope with life stresses in ways other than alcohol use (e.g., building alternative stress management, relaxation, and social skills), and (b) teaching alcohol-specific harm reduction skills (e.g., drinking in ways to avoid extreme intoxication and negative consequences). These intervention components evolved from self-management approaches for controlled drinking. For example, Miller and Muñoz (2005)
developed a manual titled Controlling Your Drinking
which outlines self-control strategies in three domains: while you drink, before you drink, and instead of drinking. The ‘while you drink’ strategies focus on slowing down drinking. The ‘before you drink’ strategies focus on teaching ways to gain control over drinking by understanding and changing antecedents that lead to heavy drinking. Lastly, the ‘instead of drinking’ strategies focus on gaining understanding of the reinforcers of alcohol use and teaching alternate ways to achieve these reinforcing effects without alcohol use.
Many skills-based interventions designed for college students offer a menu of strategies or tips to students to help them moderate their drinking. However, little is known about the relationship between recommended strategies and college alcohol consumption. Some strategies developed for use by adult problem drinkers may not be as relevant for students in a college drinking environment as other strategies. For example, “alternating alcoholic and non-alcoholic drinks” may be more challenging for an underage college student than for an adult of legal drinking age who has more control over access to alcoholic and non-alcoholic beverages. It is possible that some strategies may be more effective than others in moderating college drinking patterns. A limited number of studies have explored the relationship of drinking control strategies to alcohol consumption in college student samples. A brief literature review will summarize studies that have examined the use of drinking control strategies by college students.
To determine if college students employ self-control strategies on their own to moderate their alcohol consumption, Werch and Gorman (1986)
developed a Self-Control Questionnaire comprised of a list of 37 external self-control strategies and 14 internal self-control standards. These items were derived from behavioral self-control program manuals. External strategies referred to goal setting, self-monitoring, self-reinforcement, and self-punishment. Internal self-control standards focused on noticing physiological sensations and mood alterations that occur with alcohol consumption. Factor analysis of the Self-Control Questionnaire revealed seven factors for external self-control strategies: Rate Control, Self-reinforcement and Punishment, Alternatives, Avoidance, Limiting Driving and Cash, Controlling Time and Food, and Awareness. In addition, three factors for internal self-control were identified: Impairment, Relaxation, and Anxiousness (Werch & Gorman, 1986
Significant relationships emerged between the frequency of use of external and internal self-control strategies with most alcohol-related problems (Werch & Gorman, 1988
). However, the direction of these relationships is not clear based on the data available in this report. In addition, significant group differences emerged across quantity-frequency levels for six of the seven external control factors (the exception was “Alternatives”). An inverted-U shaped pattern between strategy use and alcohol consumption emerged for the six factors. Abstainers used the least number of strategies, with each successive category using more strategies than the next up to moderate drinkers (defined as drinking at least once a month with no more than 3–4 drinks, or at least once a week with no more than 1–2 drinks at any one sitting) using the greatest number of strategies. Strategy use declined successively in the moderate-heavy and heavy categories. The results of this study indicate that moderate drinkers use strategies most frequently, with abstainers and heavy drinkers using strategies at lower frequencies.
Using a briefer version of the Self-Control Questionnaire, Werch (1990)
investigated the relationship of strategy use to consumption. Drinkers in this sample were categorized by the degree of self-control (low, moderate, and high) based on frequency of self-control strategy use. In this study, participants in the moderate self-control category reported the greatest mean alcohol consumption (number of drinking days last month and number of drinks per occasion). Participants who rarely used strategies and participants who often used strategies reported lower alcohol consumption than participants who sometimes used strategies.
This series of studies (Werch, 1990
; Werch & Gorman, 1986
) established the relevance of drinking control strategies for college drinkers and suggested that strategy use was related to alcohol consumption in somewhat complex ways. However, drinking control strategies were identified in these studies as a heterogeneous set of internal cues, avoidance behaviors, and self-management strategies.
Drinking control strategies have also been construed as protective behaviors. The concept of protective behaviors derives from problem-behavior theory (PBT), which was developed as a framework for understanding alcohol abuse and other problem behaviors (Jessor & Jessor, 1977
). PBT focuses on three systems of psychosocial influence in the development of problem behaviors: (1) the personality system, (2) the perceived environment system, and (3) the behavior system. Protective behaviors are included in the third system and are hypothesized to decrease the likelihood of involvement in problem behaviors (Jessor, Costa, Krueger, & Turbin, 2006
). Given this framework, protective behaviors have been examined in association with alcohol-related consequences and heavy drinking.
Cross-sectional survey data from a large random sample of undergraduate students found a dose-response relationship between protective behaviors (e.g. eat before or during drinking, avoid drinking games, use a designated driver) and alcohol-related consequences, such that students reporting the highest use of protective behaviors also reported the lowest number of consequences (Delva et al., 2004
). This association was stronger for women than for men. Further support for this relationship was found in another study investigating the relationship of protective behavioral strategies (PBS) to alcohol-related consequences in a college student sample (Martens et al., 2004
). In this study, the authors defined PBS as “behaviors that individuals can engage in while drinking alcohol in order to limit negative alcohol related consequences” (emphasis added). Martens et al. (2004)
demonstrated that less frequent use of protective behavioral strategies was related to greater numbers of negative alcohol-related consequences.
Although some evidence links the use of self-control and/or protective strategies to alcohol-related consequences and heavy drinking, several limitations exist in the research on strategy use and college student drinking. First, the measures used in each of the reviewed studies varied in number and type of strategies. Limited information on the psychometric properties of the more comprehensive Werch and Gorman (1986)
scales is available and a more recent measure with good psychometric properties addresses only a subset of strategies that can be employed while drinking (Martens et al., 2004
). A comprehensive list of strategies that are appropriate and relevant to college students, with good psychometric properties, would help inform interventions designed for this population. Second, substantial percentages of students studied by Werch and colleagues (1988
were seniors and graduate students. Since alcohol use has been shown to decline throughout the college years (Schulenberg, O’Malley, Bachman, Wadsworth, & Johnston, 1996
), the functional relationships between strategy use and consumption in underclassmen cannot be determined from these studies. Strategies employed by older students may differ or not have the same level of effectiveness for all college students.
The relationship of drinking control strategy use and alcohol consumption needs to be explored. A key element that is missing from the current literature is the effect of strategy use on blood alcohol content (BAC). A number of the strategies focus on maintaining low BACs (i.e. space out drinks, drink slowly, eat before drinking). Therefore, it may be that strategy use is more related to BACs than number of drinks consumed. This study will examine the effect of strategy use on students’ average and peak BACs.
Our goals in the present study are threefold. First, we extend previous cross-sectional research by developing and pilot testing an expanded and revised list of strategies generated from a review of the literature. Second, we investigate the factor structure of the Strategy Questionnaire in a sample of college student drinkers. Third, we investigate the relationship of reported strategy use frequency with alcohol consumption (average number of drinks per week) and level of intoxication (an average BAC and peak BAC). It is hypothesized that strategy use frequency is negatively related to alcohol consumption and BAC.