Doing a Better Job of Keeping Kids Off Drugs: A Critique of Drug Abuse Resistance Education (D.A.R.E.)

– Sara O’Brien

I. Introduction
Drug Abuse Resistance Education, known by its acronym D.A.R.E, has been implemented in seventy five percent of all schools in the United States and is currently in 43 countries (1). D.A.R.E. was the result of the collaboration of the L.A. Police Department and the L.A. Unified School District that came out of the federal government’s proclamation of a “War on Drugs” in 1983 (2). The main objective of the D.A.R.E. curriculum is to impart to students in the fifth or sixth grade the knowledge and skills about how to abstain from drugs (2). The D.A.R.E. program involves anti-drug lessons taught in the classroom by a trained uniformed D.A.R.E. police officer for one hour a week for 10 consecutive weeks (1).

With the high percentage of program implementation nationwide, D.A.R.E. would appear to be an effective program. However, studies have shown that D.A.R.E. at 1 year, 5 years, and 10 years after completion of the program is not effective in decreasing drug use (3-8). There are three main reasons D.A.R.E. is ineffective. First, D.A.R.E. assumes that children behave rationally. Second, D.A.R.E. violates marketing theory by misunderstanding the target audience and offering a bad promise. Finally, D.A.R.E. is ineffective because it was developed at the individual level and does not take into account social and environmental factors that affect a student’s ability to stay off drugs. The development of an anti-drug intervention that takes into account that children behave predictably irrational, utilizes marketing theory, understands its target audience, and functions on the group level will be presented in contrast to the D.A.R.E. program.

II. Critique of the D.A.R.E. Program

II a. The D.A.R.E. Program assumes rational behavior
A main objective of the D.A.R.E. program was to increase the knowledge of the consequences of drug abuse (2). The theory that D.A.R.E. applied was that the increase in knowledge of drug consequences would lead to attitudinal changes about drugs that would lead to an increased resistance to drug use (9). The set up of the D.A.R.E. program assumes that a barrier to anti-drug behavior is a lack of knowledge. Assuming that this path from knowledge to behavior occurs demonstrates that the D.A.R.E. program was designed based on the belief that rational behavior would occur.

Study results show that D.A.R.E. did cause an increase in drug consequence knowledge in students, but did not have any significant effect on drug use demonstrating that rational behavior did not occur. At one year post completion of the D.A.R.E. program, no significant impact on students’ drug use was found (3). D.A.R.E. students one year after completion were significantly better able to identify the media portrayal of beer drinking, but no significant effect on alcohol use was found (3). Five years after the completion of the D.A.R.E. program it was found that there was a 42% increase in knowledge, 19% increase in social sills, 13% increase in positive attitudes toward police, 11% increase in negative attitudes about drug use, and a 6% increase in self esteem (4). However, the rate of drug use at 5 years was not statistically significant and all significant results for D.A.R.E. were found to be statistically less than interactive drug programs they were compared with (4).
D.A.R.E. participants were monitored for 10 years and it was found that the pre-D.A.R.E. levels of drug use and belief of negative effects of drugs were significantly related to student drug us at 10 years, but not their D.A.R.E. status (5). This effect was found to be true for cigarettes, alcohol, marijuana, and other illicit drugs (5).

Further evidence that drug consequence knowledge does not affect individual behavior was found using a meta analysis. The overall weighted effect size for the D.A.R.E. program creating better outcomes for D.A.R.E. participants in relation to drug use was 0.011 (6). This overall effect was not significant and would need to be 20 times larger to mathematically be considered small (6, 7).

The D.A.R.E. scale is an assessment tool developed by D.A.R.E. to demonstrate the effect the program is having on the students. The D.A.R.E. scale involves 19 questions about drug knowledge and attitudes. The scale was given to a group of D.A.R.E. and non-D.A.R.E. participants at the completion of the seventh grade and again at the end of their senior year of high school. It was found that both groups had the same average response at both testing points (8). It was shown that in both groups of seniors who gave the average (which was the correct) responses to the majority of the items on the scale were also reported to be using various drugs (8). The D.A.R.E. scale is a flawed assessment tool of how well the D.A.R.E. program is functioning as it is only showing the ability of students to regurgitate information, not their ability to abstain from drugs (8). Using the D.A.R.E. scale will give schools the incorrect belief that the program is keeping their students off drugs.

II b. The D.A.R.E. program violates marketing theory
The D.A.R.E. program was set up using the public health paradigm, which violates marketing theory (10). D.A.R.E. started with a product that the police officers and school administrators wanted the students to want, not a product that the students had a desire for. The D.A.R.E. program tried to sell the program to the students by appealing to the students’ desire for health (10). Marketing theory demonstrates that health is not a core value that people respond to, let alone children who have the majority of their lives ahead of them (10).

The soul of any campaign is the promise and for the D.A.R.E. program the promise is an expected message from an authority figure (11). The D.A.R.E. promise is that only total abstinence on all types and forms of drugs legal or illegal is acceptable (8). The D.A.R.E. program equates drug experimentation with drug abuse and has a zero tolerance rule. This promise is not going to appeal to the curious nature of children as they grow. Telling children to squash any curiosity is unrealistic, especially when some of the drugs are legal and possibly being used by people they know. Research on the adolescent market found that adolescents want any message besides “don’t”, and the main message being sent from the D.A.R.E. program is “don’t” (12). D.A.R.E. is set up with the promise of “don’t” and uses teaching of the negative consequences that occur with drug use as support. The D.A.R.E. program uses the promise of not trying drugs to not get addicted to drugs to not become sick. This again is a negative message. The key word in the D.A.R.E. program is “no” and D.A.R.E. teaches eight ways to say “no” (2). The D.A.R.E. program’s support for its promise is the continued use of the word “no”. D.A.R.E. uses stories and examples for support and then offers interactive sessions for students to demonstrate how to say “no” in the specific situation (1). A negative promise with negative support will have a hard time finding any audience (13).

A main characteristic of the D.A.R.E. program’s target audience, individuals approaching or in adolescence, is their need for independence and rebellion (12). The choice of a police officer, an ultimate authority figure, as the individual to deliver the message of “don’t” would cause the audience to tune out the message. A qualitative assessment of D.A.R.E. revealed that the choice of police officer to teach the D.A.R.E. program made the students feel as if their perceptions had been ignored (8). The general feeling of the D.A.R.E. participants was that it was not important what they thought, that the D.A.R.E. police office just wanted the participants to do what they were told (8). The D.A.R.E. participants felt as if the officer was unable to bring themselves to the level of the students (8). These feelings often led to students undermining the teachings of the D.A.R.E. officer, which would be expected because of reactance theory (14). In reactance theory it is expected that students would hear the message and then do the exact opposite of the message (14). For D.A.R.E. found to be true because reactance led to a significant increase in hallucinogenic drug use and an increase in crimes committed by the D.A.R.E. participants (8, 15).

The D.A.R.E. program targets children of all genders, but was set up using the male treatment model (16). It was assumed that sufficient similarities exist between the genders that using this model would be appropriate (16). Improving drug specific refusal skills is more useful for adolescent males because of the different ways in which males and females assess peer pressure; therefore sexism is built into D.A.R.E. (16). Among boys, those who participated in D.A.R.E. were less likely to show an increase in alcohol behavior and intentions, alcohol use, smoking and victimization (17). There was no significant difference in behaviors between girls who did and did not participate in D.A.R.E. (17).

II c. The D.A.R.E. program was developed at the individual level
The D.A.R.E. program was designed to develop an individual’s resistance skills and their self esteem (2). However, by focusing the program at an individual level the D.A.R.E. program did not take into account environmental and social factors. The D.A.R.E. program was designed by the L.A. Police Department and the L.A. Unified School District, which is an urban area and the program does not account for different environmental settings. For example, D.A.R.E. was more successful with urban students then rural students in teaching them to understand the media influence regarding beer and cigarettes (3). Urban students had 13% greater odds of identifying the media influence then those enrolled in rural D.A.R.E. programs (3). When cigarette use and frequency was compared from Montana, a predominately rural state, to the city of L.A., 8.1% of students from Montana compared with 2.6% from L.A. students were found to have used cigarettes at least 20 of the last 30 days. (18). In Montana a significantly greater number of students were found to have tried alcohol (77.8% vs. 71.2%) and to have consumed more than 5 drinks in a row in the past 30 days (32.4 % vs. 24.6%) then students in Los Angeles (18). These significant differences in drug use between the two communities demonstrate the need for a difference in the method the lessons are presented as well as the type of drug presented.

The D.A.R.E. curriculum which is used in seventy five percent of the schools in the United States is written very specifically with examples to use during role play and games. However, some of the examples that are given are specific to urban areas. For example, asking students for a response when friends are “huffing glue behind the quik-e-mart” or what do when “walking home in the alley behind your house” (19). These lessons lose some of their effect because they are unidentifiable to non-urban students and students may feel that the program does not understand where they are coming from (8).

Drug use, particularly inhalants, is strongly influenced by proximal social contacts and children with friends or siblings who used inhalants were 3.33 times more likely to report a higher likelihood of future inhalant use (20). These findings demonstrate that drug use spreads through groups and therefore focusing on the individual level, and teaching an individual ways to say no, would be ineffective. Because drug use moves through a social network, this means drug resistance is a group decision and not an individual’s choice (21). D.A.R.E. tries to create a vacuum for individuals and teach them how to resist against outside forces. By ignoring the outside forces and the fact that drugs move through a social network makes D.A.R.E. an ineffective anti-drug program.

III. The Freestyle program is an improved D.A.R.E. program
The Freestyle program is a school based drug resistance program that is based on the group level, assumes irrational behavior from participants and uses marketing theory to increase buy-in to the program. Freestyle draws upon children’s preexisting interests and social groupings and partners with the town’s recreation department to create activities for children to experience in drug free environments. Freestyle will involve sports teams, art groups, music groups and other group based activities. Each group will be identified and these groups will have anti-drug lessons and activities intertwined with their recreation activity. Each group will be age based so there will be a built in peer group in the activity group. Once a month a classroom based activity will occur to foster identity as drug free individuals and to continue the effective teachings of media influence from D.A.R.E..
Each student, from elementary school through middle school, will enroll in a club for a semester and these clubs will then take their anti-drug lesson classes together. Each club will have a coach or director, who will be an adult within the community. The coaches and directors will receive training on being a positive adult role model as well as how to deliver the anti-drug lessons. The anti drug lessons are much more focused on building a group identity of non-drug users than giving drug use consequence knowledge. However, within each lesson some information about drug consequences will be given. The knowledge will be presented within the context of the lesson and the type of drug presented will depend on the regional drug use statistics.

III a. Freestyle uses predictably irrational behavior
Freestyle is not based on the principle that knowledge leads to behavior, instead it will use predictably irrational behavior in the form of expectations, ownership and self control to establish an effective anti-drug program. A main goal of Freestyle is getting students to label themselves as non-drug users, and to affiliate it with the club they have chosen to be involved with. For example, someone enrolled in the soccer program would see themselves as a non-drug using athlete or someone else in a painting program as a non-drug using painter. Labels are effective tools, as when someone is labeled by themselves or others they will fulfill the expectation that the label has given them (22). The student’s clubs will be labeled in an effort to foster the group identity. For example, a football club in the town of Fairview might be labeled as Fairview’s Freestyle Fifth Grade Footballers. It will be expected that other clubs will identify the clubs by their given labels. Also, for competitions, presentations or other club activities group members will be expected to wear their club’s t-shirt that is adorned with their group label. The clothing will help the student to connect with their label.

Predictably irrational behavior involves ownership of a behavior (23). The Freestyle program with labeling students as drug free athletes or drug free painters is helping them own this behavior. Involving students at an age that they are able to partake in recreation activities builds the behavior over time and will help student to feel as if they own the behavior. Also, the use of t-shirts for club activities is another way to build ownership of the label by giving students a tangible object (23). With ownership comes a strong aversion to loss (23). The goal of the Freestyle program is to ingrain the behavior as a non-drug user in order to decrease drug use from occurring later in life.
D.A.R.E. understood that people have little self control, but taught lessons on resistance behavior that were found to be ineffective for stopping drug use (3-8). Contracts have been found to be effective methods to help individuals accomplish goals (24). Contracts will be done at both individual and group level. This will be used in the Freestyle program for individual contracts starting in the third grade (when students can sign their own name) to state their goals for enrolling in the program at the beginning of every school year. The group contracts will set goals for accomplishment by the entire group. For example, the art club could have a goal of getting a collaborative mural entered into the state art show. Upon completion of the school year it will be evaluated how many students and clubs have met their goals and these along with a drug use survey will be used as the assessment tool for the Freestyle program. This outcome measurement system is in contrast to the D.A.R.E. scale which measured regurgitation of facts.

III b. Freestyle utilizes Marketing Theory
The D.A.R.E. program was set up using the public health paradigm for marketing, but the Freestyle program follows the marketing theory paradigm. Using the marketing theory paradigm a benefit being sought must be provided by the program (10). This benefit must be found through comprehensive research of the market and the public health intervention can then be repackaged, reframed and reposition in order to offer the benefit that is sought (10). The Freestyle program uses the research done by the Centers for Disease Control for prevention of smoking initiation and uses the five identified core values: freedom, independence, rebellion, control and identity and sells these values as the product of the program (10). These core values are then used to develop the lessons and goals of the program.

The overall promise of the Freestyle program is freedom from addiction to drugs. The brand of the program includes the word “free” in order to position itself as promoting freedom first and foremost and then the fact that it is freedom from addiction second (13). Freedom has a much more positive connotation than the “no” or “don’t” promise that D.A.R.E. put forth. Individuals are more responsive to a positive promise (11).

Lessons based on core values will include independence; independence from media manipulation through the portrayal of alcohol, cigarettes and illegal drugs in print, movies, websites and other media forms. The independence lesson will build off the work that the D.A.R.E. program had successfully executed for the urban schools and will be tweaked to fit into a rural setting. The rebellion lessons will build on the independence lessons, as well as the work already done by the Truth campaign. The rebellion lessons will teach students to rebel against drug dealers, cigarette and alcohol companies that have manipulated the students with misrepresentations of their products and have tried to get them addicted (10, 12). Control, which will be another lesson, will focus on the control the student has over the way other people see themselves and the club they belong to. Students can control if their club is seen as non-drug users or as phonies who are not really true to the premise of the club. The final lesson will revolve around identity. The identity lesson ties into having students label themselves as non-drug users. The identity lessons emphasize that individuals who are the best at their club activity are those who abstain from drug use. Also, the identity of the club as the best club is dependent on the amount of individuals who remain non-drug users.

As seen in D.A.R.E. a carefully crafted message can be ineffective because of who is delivering the message. In D.A.R.E. the message was viewed as ineffective because of reactance theory and the use of a police officer to deliver the message. Freestyle was set up understanding that less reactance occurs when the individual delivering the message shares a great deal of sameness with the audience (14). This is one of the main reasons that the adult who is the leader of the club is the individual who is doing the school based lessons. This adult has already built in the same interests and values in the views of the students and they will be more receptive to the message because of it (14).

Freestyle is not built upon the male treatment model, like D.A.R.E. is. Freestyle was developed based on overlapping principles shared by both genders, the core values of independence, freedom, rebellion and control. These values are gender neutral. A main goal of the Freestyle program was to not separate genders. This is because separation would create too little interaction between genders and the student will experience peer group situations in which both genders are present and need to be capable of handling these situations.

III c. Freestyle is a group level program
It has been shown that drug use moves through a social network (20). The Freestyle program teaches kids in their preexisting social networks; their sports teams, theater groups or other activity grouping. These social groups are most likely to contain their friends. Friends have a significant influence on thoughts and behavior because they are within an individual’s network (25). Teaching students anti-drug behaviors while they are in their social network will help to introduce the behavior at one time to the entire group (25). Behaviors move from the center of the social network out to the perimeter of the networks (25). In order to identify from year to year the center of the networks each club will vote for two captains. The captains can then be monitored for behaviors for the entire group. Once the captains buy into an idea or piece of the program the rest of the group will follow. The captains are also a good resource of feedback for the coach or director who can check in to make sure that they are still on the same page with students as far as interests and influencing factors. For example, the coach of the baseball club maybe able to find out who the current favorite baseball player is and use stories about this player as support for the lessons that are given.

The Freestyle program will take into account the environment in which the program is taking place, unlike D.A.R.E.. With Freestyle there will be a minimum of three versions: urban schools, suburban schools and rural schools. Each will take into account the different communities in these environments and the language and content in some of the lessons will be changed. For example, for urban schools it was shown that students have a greater variety of drugs that they experiment with and have higher rates of cocaine, marijuana and methamphetamine use (18). Students in the rural schools have higher uses of tobacco in the form of cigarettes, chew, and cigars and binge drinking (18). The type of drug that will be part of each the lesson will be different depending on regional drug use. Examples and stories used for support in rural towns would be different from those in the suburban and urban areas. For example, discussion about situations in apartment complexes might be relevant to urban students, but would not have the same effect on rural students living in houses and therefore would not be included in the rural program.

IV. Conclusion
After 26 years of the D.A.R.E. program, it is clear that in its original form the goal of drug abuse resistance education was achieved, but this education did not correlate to decreased drug use. D.A.R.E.’s failures were results of setting the program up to assume that children would behave rationally, violating marketing theory, and focusing on the individual level. The Freestyle program takes the school based anti-drug intervention a couple of steps further by assuming irrational behavior, utilizing marketing theory, and implementing a group level program. The Freestyle program uses the natural social networks that are formed when students join clubs and teams and uses them to diffuse anti-drug behaviors and ideas. The Freestyle program still has its limitations, but is step in the right direction for school based anti-drug programs.

REFERENCES:

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Too Many Flaws in “After Too Many” Binge Drinking Intervention – Daniel Amante

I. Introduction

Despite an increase in intervention campaigns, the prevalence of binge drinking among college students has continued to increase over the past few years (1). While various studies have found that some interventions yield positive results, several campaigns have failed to connect with students effectively (2-5). Although the appropriate research studies needed to support my claim have yet to be conducted, I believe the After Too Many anti-binge drinking campaign is not only failing to appropriately connect with its targeted audience, but may actually be doing more harm than good.

The After Too Many campaign was started in 2006 in Northern California by the Youth Leadership Institute. It attempts to influence students to stop binge drinking by highlighting embarrassing things students do when intoxicated. It does so through various media advertisements such as posters, videos, and an interactive website. All three of these methods will most likely end up as failed attempts for reasons that will be discussed over the next several paragraphs.

II. Critique of the After Too Many anti-binge drinking campaign

This section is dedicated to explaining why the After Too Many campaign will ultimately result in failure. First, the campaign fails to deliver a realistic message that makes students think about the actual benefits and risks of not binge drinking. Secondly, the campaign not only fails to de-emphasize the prevalence of binge drinking among college students, I believe it makes students believe that binge drinking is even more common than it really is. Lastly, the campaign fails to make an appropriate promise that is necessary to produce a change in behavior. In order to accurately explain the deficiencies of this campaign, a description of each type of advertisement is required.

After Too Many created five different posters which have been displayed around 12 universities in California. All of the posters have the same general layout and attempt to deliver the same message. The message portrayed is that a student’s “Beer” tells the drinker to do embarrassing things. The five posters read; My Beer Told Me To Puke On My Girlfriend, My Beer Told Me To Drive Into a Tree, My Beer Told Me to Punch My Best Friend, My Beer Told Me To Piss My Pants, and My Beer Told Me to Blow the Football Team.

The two videos that the campaign created are of similar nature to the posters in that they talk about poor decisions that will be made after consuming too much alcohol. Both of the videos, which can be found online and have been aired on TV, feature two friends talking about their plans to go to a party. The first video features two girls talking in the bathroom about a party one of them plans on attending. Both girls are attractive, happy, and excited about the party. The party is described as the one that “all the cute boys go to.” The girl who is attending the party says that she will probably mess around with a few of the players. She then says, while laughing, that she is going to sleep with the whole team. The last thing she says is, “Yeah, I bet I’m going to get pregnant.” The commercial ends with the other girl shrugging off the “getting pregnant” comment with a nonchalant, “Eh, what can you do?”

The second video features two athletic looking guys walking down the street. They are talking about a party at their friend’s parents’ house that is described as being “so cool.” Similar to the first video, one of the guys is talking about his plans for the night. He says that he can’t wait to mess up the house, kick his foot through his friend’s big screen TV and “piss” all over the favorite rug of his friend’s mother. They then talk about a pretty girl who is attending the party. The ad finishes with the guy saying that he is going to rape the pretty girl and that it is going to be “so much fun.” Both videos end with the phrase “AFTER TOO MANY DRINKS THIS ISN’T JUST TALK.”

The website is called “Unhappy Hour” and upon entering, four options are displayed on the backdrop of a run-down, abandoned house. The first option, Binge 101, gives a description of what binge drinking is. The second option, Under the Label, presents facts about alcohol consumption as you scroll over various empty bottles. The third option, The Hard Stuff, is where you can find the posters and the videos described above. The last option, Crashing the Party, gives instructions to students, parents, teachers, and researchers about how they can help reduce binge drinking (although the researchers section has yet to be completed).

Criticism A. Failure to Deliver a Realistic Message that Discourages Behavior

The most obvious fault of the campaign is that all three types of advertisements fail to deliver a realistic message that would discourage students from engaging in binge drinking. College-aged students are known to participate and even seek out risky behaviors (6-8). The messages found in the posters about puking, pissing, getting into fights, hitting a tree, or hooking up with people while intoxicated are intended to deter students from binge drinking. The problem is that these “negative” activities are often the most important part of the many stories told by students after a drunken weekend of binge drinking. In many cases, these stories are even exaggerated and glorified by the guilty party in attempt to impress peers. The fact that their beer “told” them to do such foolish acts makes the posters more comical than effective, as students are fully aware that a beer is unable to talk.

Similar to the posters, the majority of each video highlights the risky behaviors that many students pursue. Unlike the posters, the videos go from fairly normal risky behaviors immediately followed by incredibly serious situations, such as intending to get pregnant or raping a girl. While both pregnancies and sexual assault have been highly associated with alcohol use (9,10), to portray either of these events as being desirable due to consumption of alcohol comes across as ridiculous and unrealistic. It is extremely unlikely that students would ever plan on making such terrible decisions before drinking. While the intent of the ad is to emphasize poor decision-making when under the influence of alcohol, the message is lost as they attempt to make light of such unfortunate and horrific situations. Further more, especially considering the particular target audience, there will be a fair amount of optimistic bias associated with events of such magnitude (11,12). Optimistic bias occurs when a person believes that an undesirable outcome is less likely to happen to them than to others (12).

The website also fails to connect to students in a realistic manner. The backdrop image of a rundown, abandoned house with eerie sound effects in the background suggests that the purpose of the website is to scare students away from drinking. Creating the website to look depressing and scary is a type of fear tactic intended to make the students associate drinking with falling on rough times. In reality, however, the majority of college students cannot relate to such a morose scene. A better way to get the message across to students is to frame it in a way that will elicit a desired response from the student. Framing is the process of packaging a program or policy so that it reinforces the public’s core values (13). An example of a better way to frame an anti-binge drinking intervention would be to address a core value such as the ability to make one’s own choices. This could be done by having the different choices on the website be depicted as roads on a map, emphasizing that the student can “choose” which direction they wish to go.

Criticism B. Failure to De-Emphasize the Prevalence of Binge Drinking

Another point of failure in this campaign is that it neglects to de-emphasize the prevalence of binge drinking. While binge drinking is obviously a topic of serious concern, several studies show that students will consistently overestimate the amount of students that are actually binge drinking (14). Instead of presenting facts to students about the true numbers of students who binge drink, the campaign focuses only on presenting information about those students who do drink excessively. When students hear friends talking about embarrassing stories of when they were drunk and then see posters with beer telling them to do embarrassing things, it will increase the perception that everyone else in their social network is already drinking.

The same effect will occur after watching the videos presented by the campaign. In both videos, young and attractive students are talking about their plans to drink that night. Both of the parties that the students are planning on attending are described as being “cool” places where attractive people are going to be partying. A vulnerable, young person watching these videos will most likely see how happy and excited the actors are. This will influence those students who are already participating in binge drinking to continue such behavior and intrigue those students who previously chose not to drink excessively. By the time the video delivers its final message, which in this case deals with either getting pregnant or raping a girl, the students are unlikely to relate to it as much as they are able to relate to the previous risky behaviors that aren’t nearly as serious in nature. The message that students will take away from the videos is that drinking at parties and acting irresponsible is cool and fun. Since they would never go to a party with the intention of raping or getting pregnant, it is highly unlikely that those situations would have a large effect on the students.

The website also fails to take advantage of an opportunity to educate students about the true prevalence of binge drinking. In the “Under the Label” section, which presents facts about alcohol and student drinking, the website focuses exclusively on negative statistics about alcohol. Examples of some of the facts presented are; Each year college students spend 5.5 billion dollars on alcohol, Binge drinking has increased 125% at women’s colleges since 1993, Alcohol is the #1 choice of drug among our nation’s youth, 60% of students begin binge drinking in 9th grade, On college campuses, 70% or more of the students binge drink, and Two-thirds of 12th graders report having been drunk. All of these statistics are intended to stress the severity of the alcohol problem our society is facing. The point students will take away from all these statistics, however, is that it is normal to binge drink and that if they don’t then they are in the minority of college students out there. According to the Social Norms Marketing Theory, the better way to present data regarding binge drinking is to show students that drinking isn’t as prevalent as they may think (14).

Criticism C. Failure to Make a Significant Promise

A major problem of the campaign is that it focuses solely on the allegedly negative aspects of binge drinking and makes no attempt to focus on any positive features associated with choosing NOT to drink. A key to Social Advertising Theory is to make a promise that is significant enough that it will be able to alter the target audience’s behavior. Generally speaking, the greater a promise is, the greater potential for behavioral change (16). In this campaign, there is no reference to any direct benefits the students will enjoy if they abstain from binge drinking. It is thus important to step back and consider the benefits and barriers students will consider after seeing the advertisements of this campaign.

Let’s first consider the perceived benefits and barriers of binge drinking that would come to mind after viewing this campaign’s advertisements. As mentioned before, students will naturally overestimate the amount of students who actually binge drink. This implies that by binge drinking, they believe they are performing “normal” behavior. This belief would enable them to feel like they fit in with the rest of their peers. Binge drinking may also appear as an opportunity to socialize, to release great amounts of stress, and to enable them to participate in risky behaviors that they normally might not be inclined to do. The barriers presented in the advertisements consist of embarrassing themselves in front of peers, engaging in risky sexual behavior, becoming violent and abusive, raping an individual and getting pregnant.

Now let’s consider what students will think the perceived barriers and benefits of NOT participating in binge drinking are upon seeing these advertisements. The barriers may include isolating themselves from the majority of their peers, not attending “cool” parties where “cute” members of the opposite sex will be and not engaging in desirable risky behaviors, including risky sexual behaviors. The perceived benefits of not binge drinking would consist of not embarrassing themselves, not raping an individual and not getting pregnant.

When considering these perceived benefits and barriers through one of the most basic theories of individual health behavior, the Health Belief Model (HBM), it is likely that students would continue to binge drink, as well as begin to binge drink if they hadn’t done so in the past. The HBM weighs perceived barriers against perceived benefits in order to determine a resulting intention that will lead to behavior. Critical to the HBM is that the perceived benefits of a behavior are influenced by both perceived susceptibility and perceived severity of the problems the behavior will prevent (17). When considering the behavior of choosing to binge drink, the perceived severity of becoming isolated from one’s peers by not participating in “normal” behavior is incredibly high for students. The perceived susceptibility of this occurring if they don’t participate in the common behavior is also very high. Both of these factors will increase the effect of the perceived benefits, which greatly outweigh the perceived barriers in this case and will result in the students deciding to binge drink.

When considering the effects of the campaign’s advertisements, the opposite effect would be seen when looking at the behavior of not participating in binge drinking. While the perceived severity of raping a girl or getting pregnant is very high, the perceived susceptibility that these problems will actually occur is very low. This will cause the influence of the two to cancel each other out to some degree. Meanwhile, the perceived susceptibility of embarrassing yourself among friends who are also drinking is very high but the perceived severity of this problem is very low, because such behavior while drinking has become tolerated, expected, and often glorified. Therefore, neither of these situations will significantly influence the perceived benefits of not drinking, which were already greatly outweighed by the perceived barriers mentioned above. Since the campaign never makes a promise of a significant benefit, there is little to no incentive for students to decide not to binge drink.

III. A Proposal For Effective Intervention Against College Binge Drinking

In order to create an effective campaign intended to reduce college binge drinking, several important elements must be present, and therefore must require a multi-faceted approach. The very first thing that must occur is that the intervention must be able to relate to the target audience in a way that is realistic yet influential. Secondly, the intervention must abolish false presumptions by educating the audience about the realities of binge drinking. And lastly, a powerful promise that abstaining from binge drinking will result in meaningful benefits must be made and well supported.

Proposal A. Relating To The Audience

Excessive consumption of alcohol has long been established as being a significant part of the college experience. Denying such a fact would instantly alienate the target audience. In order to successfully relate to students, we must take a step back and focus on other established aspects of college life that students value more than binge drinking. By focusing on important core values tailored specifically for college students such as sex, independence, control, health, athletics, happiness or academic success, we can design an approach that will not only grab the attention of students but also force them into a “hot state” as they take how much they actually value binge drinking into consideration.

This use of one’s core values in order to prevent binge drinking is a good way to eliminate restraint bias. The idea of restraint bias is that people will tend to overestimate their ability of self-control (15). Often, when a targeted audience sees an ad that is trying to influence a certain behavioral change, they may believe that they have the ability to resist the impulse associated with that behavior. Ultimately, this leads to people overexposing themselves to temptation, which leads to giving in and performing the behavior, resulting in a failed intervention (15). By introducing core values that are very important to the student, it will put them into a “hot state” and enable them to look past the restraint bias associated with binge drinking. By doing so, they may be more open to the message that an intervention is trying to get across.

Proposal B. Exposing The Truth

Many interventions, like After Too Many, ultimately fail because they choose to focus solely on the negative consequences that may result from a risky behavior. The problem with this technique is that in most cases students are already aware of the associated risks and possibly even further attracted to the behavior because of them (2). This is especially true if they believe pursuing a risky behavior is normal, expected, and valued among their peers. A critical aspect of my proposed intervention is to expose the truth about binge drinking prevalence to students. Several studies have shown that students often greatly overestimate the degree to which their peers are binge drinking (14). This leads to a false perception of binge drinking being the norm and a perceived increase of social pressures to perform the behavior.

As the Theory of Reasoned Action suggests, people will adhere to a particular behavior if they believe they should be performing it (17). Whether they believe they should perform the behavior is a function of two things. The first thing is their personal beliefs towards the action. The second is their perception of social pressures to perform the behavior. If we can successfully alter the student’s beliefs about binge drinking by contrasting it against their core values, and if we are simultaneously able to change their perception of the social pressures associated with binge drinking, then according to the TRA, there is a good chance we will be able to reduce the amount of people who binge drink.

Proposal C. Delivering a Powerful Promise

Although the TRA would suggest we have done enough to change behavior, a flaw of the model is that it assumes rational behavior of the audience. When addressing the issue of college students and binge drinking, we face a problem in that people, and students in particular, often act irrationally. Furthermore, we are dealing with a certain behavior, binge drinking, which promotes irrational behavior in itself. That being said, it is important that we deliver a promise that is so powerful, even the most irrational of people will want to change their behavior in order to obtain it.

David Ogilvy, in the book Confessions of an Advertising Man, references a comment made by Dr. Samuel Johnson hundreds of years ago. He said, “Promise, large promise is the soul of an advertisement” (16). The promise that is to be made must be more than just good. The promise must be so great that it is able to excite the students. In order to do so, one must incorporate the core values talked about previously into the promise. The bigger the promise is, the more influential the ad will be in altering the behavior. In order for the promise to be successful, however, it must be supported with effective imagery and factual information (13).

Conclusion – The Final Product

When developing the final product of the proposed intervention, several additional things should be taken into consideration. Such things consist of what types of advertisements will be used, their appearance, and how they will be delivered to the students. The use of poster advertisements around college campuses is a very effective way to deliver an intervention method. The posters should be placed in areas where students spend most of their time, such as campus centers, cafeterias, and dormitories. An interactive website is also a very effective way of relaying messages to students. The appearance of the website, however, should resemble something that students are familiar with and can relate to, such as a dormitory hallway. It should also be framed in such a manner that it evokes a positive association. It should contain all of our advertisements, as well as several facts that will educate students about the true extent of binge drinking that goes on.

When considering the design of the posters, we must be sure that our previously defined goals are met. This means that the poster must be able to relate to students by referring to their core values, expose the truth about false presumptions, and deliver a powerful promise. To do so, we can incorporate a core value into the promise so that there is a direct, negative relationship between that value and binge drinking. This will be our primary message we are trying to get across. We should then reinforce our promise with facts and strong imagery in order to increase excitement about the promise. Finally, we should include facts that de-emphasize the prevalence of drinking so that it makes the decision of choosing not to binge drink easier for the student.

In conclusion, I believe if we take our promise that by not binge drinking a core value will benefit, support that promise with hard facts, surround it with effective imagery and supplement it with information that alters the student’s perceptions of social norms, the proposed intervention will be able to successfully modify behavior and reduce binge drinking across college campuses.

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The Failures of College Drinking Interventions: Learning from the Past and Moving Forward – Nick McNeill

Introduction

Misuse of alcohol has been documented to be a critical public health issue for many years. Problematic drinking has specifically been seen to occur in young adulthood (1), with the highest prevalence rates of abuse and dependence arising in individuals ages 18-29 (2). Given 90% of college students fall between those ages (3) - and that national surveys have shown 40% of college students report heavy-episode drinking (usually defined as four or five drinks in one sitting for women and men, respectively) (4) and 18% suffer from clinically significant alcohol-related problems (5) – alcohol use among college students represents a serious public health threat.

College drinking’s salience as an emerging public health crisis is exemplified in the numbers, as approximately 1,700 unintentional deaths, 97,000 sexual assaults, and 500,000 injuries that occur each year to college students can be attributed to alcohol use (6). Furthermore, problematic drinking among college students is also associated with a myriad of other direct and indirect consequences, such as unplanned sexual activity, vandalism, blackouts, suicide attempts, poor class attendance, stealing, trouble with authorities, physical illness, and relationship issues (7). Most disconcerting, however, is that alcohol-related deaths, heavy drinking episodes and drunk driving have all been on the rise on college campuses over the past decade (8).

Drinking-related accidental deaths among 18- to 24-year-old students have increased from 1,440 in 1998 to 1,825 in 2005. In addition, the proportion of students who reported recent heavy episodic drinking rose from roughly 42% to 45%. Finally, the proportion who admitted to drinking and driving in the past year increased from 26.5 % to 29%. So, given college drinking is not going away, but actually getting worse, the question remains: why are interventions aimed at decreasing college drinking failing? While there are a number of different explanations as to why these public health interventions have been unsuccessful, I will discuss what I believe are three of the most critical mistakes these interventions have committed.

First, the majority of alcohol education programs for students have been individually focused and abstinence-based “browbeating” sessions, which ignore the idea that harm reduction exists on a continuum that begins with abstinence and ranges to practices that minimize the likelihood of negative consequences, such as moderating the amount of alcohol consumed. Second, many schools have focused their efforts primarily on the students, largely ignoring the broader environmental context in which college drinking occurs. Finally, although research has found social norms to be among the best predictors of college drinking (9), public health interventions have not done enough to correct inaccurate perceptions of norms and attitudes regarding college drinking, leading to the reinforcement and perpetuation of abusive drinking patterns. In turn, I will propose a comprehensive intervention that I believe can address these three errors and succeed where others in the past have failed.

The Folly of Promoting Alcohol Abstinence Programs

Though the minimum drinking age in the U.S. stands at twenty-one, its common knowledge that many adolescents and young adults who are underage consume alcohol, including those who are in college. Yet, many drinking prevention strategies - such as those in high school or college - virtually ignore this fact, unrealistically and irresponsibly setting out to achieve zero tolerance via the stigmatization of alcohol (10). In addition, by attempting to scare college students into alcohol abstinence, we run the risk of causing the very thing we’re trying to prevent – the misuse of alcohol.

The phenomenon of the “boomerang effect” in public health interventions has been well documented (11) and has principally come out of psychological reactance theory (PRT) (12-14). Developed by a psychologist by the name of Brehm, PRT basically espouses the concept of reverse psychology, which argues that people react against threats to their freedom of choice by experiencing and yielding to pressure to reestablish that freedom, including pressure to engage in the prohibited behavior. The argument follows that college students who are exposed to anti-drinking messages may react against them by not only expressing pro-drinking sentiments, but also more dangerously, by engaging in problematic drinking behavior.

In addition to looking at the possible consequences of “boomerang effects,” research studies have also examined the effectiveness of college alcohol education programs, comparing those that present an abstinence-only message with those that present drinking in moderation as an option. The results are clear: programs accepting responsible use of alcohol are demonstrably more successful than are abstinence programs (15). Despite good intentions and the spending of massive amounts of money and energy, the best research shows that our current abstinence-oriented alcohol education is ineffective. Therefore, http://www2.potsdam.edu/hansondj/references/UnderageDrinking.html - 27instead of stigmatizing alcohol and trying to scare people into abstinence, we need to recognize that it is not alcohol itself but rather the abuse of alcohol (i.e. binge drinking) that is the problem.

Clearly, the most effective way to avoid negative consequences is not to drink. However, despite the minimum legal drinking age of twenty-one, that's not the reality for the overwhelming majority of college students. Therefore, harm-reduction approaches logically opine that it's ultimately more realistic and effective to try and meet someone where their currently at and work together to reduce risks and negative consequences rather than to recommend complete abstinence from alcohol.

Environmental Context: Looking Past the Individual

Many schools have primarily focused their efforts on students - for example, offering counseling to those who've been found to have a potential drinking problem. While it’s clear that I don’t ascribe to interventions that emphasize an abstinence approach to alcohol, I do believe there is merit in having programs and policies in place that are geared towards students. With that being said, another problem with most college drinking interventions is that they have solely emphasized the individual student, and by doing so, have largely ignored the broader environmental context in which college drinking occurs (16). This is a critical failure for a number of reasons.

The idea that individual beliefs, attitudes, and behaviors occur in a social context has been a staple of a number of social sciences theories, most notably the Behavioral Ecological Model (BEM), a multi-faceted expansion of social cognitive theories (17). The BEM states that health promotion, such as curbing the prevalence of college drinking, can be more successfully accomplished through changing one’s social environment (18). As a result, it emphasizes the importance of considering multiple levels of influence and the role of the environment on behavior (19, 20). The five levels of influence which make up the BEM are: intrapersonal or individual factors; interpersonal factors; institutional or organizational factors; community factors; and public policy factors (21). What the majority of college drinking interventions most lack is a broader focus on communal and institutional factors.

Community factors, such as social networks, can have a detrimental impact on students and their drinking habits. A social network that doesn’t deem college drinking to be an issue (i.e. the school, the student’s peers, and people in the community) will probably lead to the student themselves also not seeing their drinking or others drinking as a problem (22). Similarly, the mass media can also harmfully contribute to college drinking, via beer or liquor commercials that glamorize partying or anti-drinking commercials which stigmatize the use of alcohol, which in turn unintentionally cause students to misuse alcohol. Finally, the availability and accessibility of bars and liquor stores can also have a significant effect on students’ drinking habits, as increased alcohol availability is associated with increased alcohol consumption (23).

Institutional factors - such as a school’s policies, culture, or living arrangements - can also have a significant effect on students’ drinking habits. Studies have shown that heavy drinking behavior of students is more common in college environments that have: a strong drinking culture; few alcohol control policies on campus or in the surrounding community; and weak enforcement of existing policies (24). In addition, students’ drinking behaviors also differ as a function of living arrangement (25). On-campus living is usually associated with heavier drinking than off-campus living, especially if a student lives with their parents (26). Finally, among on-campus living types, students living in Greek houses (fraternities/sororities) have a greater level of alcohol use and misuse as compared to those living in dorms (27).

Given that drinking, and specifically binge drinking, among college students has been tied to conditions in the environment, current and future interventions must re-think their approaches to the problem. Rather than narrowly focused on the individual student, interventions will have to be aware of and account for the many different influences on college students’ drinking behavior.

Inaccurate Social Norms & Unrealistic Optimism: A Recipe for Disaster

Though many college interventions incorrectly focus on abstinence education and for the most part disregard the influence a student’s environment has on their drinking, perhaps the biggest failure of these public health interventions is their inability to correct inaccurate perceptions of social norms and attitudes regarding college drinking. In turn, this leads to the reinforcement and perpetuation of abusive drinking patterns.

Social norms can be categorized into two main categories: descriptive norms (perceptions of what others do) and injunctive norms (perceived opinions of relevant others) (28). Perceived descriptive drinking norms refer to the perceived prevalence of drinking, such as the perceived quantity and frequency of alcohol consumption (29). Studies have shown that college students have a generalized tendency to overestimate descriptive norms (30). Furthermore, students who reported higher perceived descriptive norms for alcohol use of their peers have also been shown to report heavier drinking themselves.

Perceived injunctive norms refer to the perceptions of how much others approve of a particular behavior, and are tantamount with subjective norms, a crucial aspect of both the Theory of Reasoned Action (TRA) (31) and the Theory of Planned Behavior (TPB) (32). Similar to research on descriptive norms, studies have shown that college students usually perceive their student peers as more approving of drinking behavior than they actually are (33). In addition, students who reported higher perceived injunctive norms, such as overestimating their student peers’ approval of their drinking, was also associated with heavier alcohol use (34). Misconceptions regarding both descriptive and injunctive norms must be corrected if we hope to reduce alcohol use among students, especially given they lead to college student drinkers being overly optimistic about the likelihood of experiencing future problems with alcohol.

Unrealistic optimism or optimistic bias about future life events has also been well documented in the literature (35-37). Optimism bias refers to the demonstrated systematic tendency for people to be over-optimistic about the outcome of planned actions, i.e. more optimistic that good things will happen to them and more optimistic that bad things are less likely to happen to them. This includes over-estimating the likelihood of positive events, such as owning your own home, living past 80, and traveling to Europe, and under-estimating the likelihood of negative events, such as having a drinking problem, attempting suicide, and being injured in a car accident. It is one kind of positive illusion – people’s beliefs about themselves, the world, and the future which are more positive than reality can sustain - to which people are susceptible.

This distorted perception of risk has important implications for public health interventions aimed at decreasing the prevalence of college drinking. If students don’t perceive themselves or their peers to have a drinking problem, and they actually do, such unrealistic optimism about their future can prompt risky behaviors and unfortunate consequences (38). As a result, we must come up with strategies and interventions that can help to curb unrealistically optimistic perceptions and ultimately reduce risky health behaviors.

Proposed Intervention: Harm Reduction, Environmental Context, and Correcting Social Norms

A comprehensive intervention that I will propose has the ability to address these three flaws of public health interventions aimed at reducing the prevalence of college drinking. First, my alternative intervention will move away from ineffective alcohol abstinence education programs for students and instead emphasize a more realistic and effective harm reduction strategy that will account for possible boomerang effects. Second, this alternative intervention will not only focus on the individual student, but also incorporate the broader environmental context in which college drinking occurs, including communal and institutional strategies to help reduce the prevalence of college drinking. Finally, this proposal will include strategies to correct inaccurate perceptions of social norms and unrealistic optimism regarding college drinking.

A Harm Reduction Continuum: Combating Reactance via BMI

Rather than employing an abstinence-based program towards reducing college drinking that stigmatizes the use of alcohol, I would instead opt for a program utilizing Brief Motivational Interventions (BMI). Studies have shown that students are particularly receptive to BMI, responding favorably to the concept of harm reduction rather than abstinence (39). For example, at the University of Central Florida, researchers found that BMI were effective in reducing alcohol consumption and drinking-related problems (40), which suggests that providing an opportunity to discuss alcohol-related information in a non-judgmental format can influence drinking behaviors (41). Furthermore, research has shown that BMI-based interventions have been more successful than alternative interventions at reducing alcohol use and problems, such as alcohol-education (AE) classes which promote abstinence (42).

BMI approaches generally work well in college populations and especially work well with students mandated to go for alcohol counseling for a number of reasons (43, 44). First, harm reduction through BMI exists on a continuum that starts with abstinence and ranges to practices which diminish the likelihood of harmful consequences, such as moderating consumption or using designated drivers. This is a much more realistic way of attempting to reduce drinking compared to abstinence.

Second, BMI is a collaborative, non-confrontational way of addressing behaviors like drinking. It is quite suitable for use with college students who consider themselves “emerging adults,” as they are a group very likely to resist authoritarian figures, because students’ peers are often the ones who conduct the sessions. The importance of using trained peer facilitators is especially relevant given our discussion of PRT earlier. PRT states that similarity is the most important factor one can use to decrease reactance (and in turn, possible boomerang effects) and increase compliance regarding a certain behavior. Therefore, using peers to conduct BMI sessions to reduce college drinking ensures a less threatening and more similar message to the student, as compared to using individuals who are older or more aggressive.

Third, BMI approaches also make a point of seeing where a student is currently at motivationally and trying to modify the intervention accordingly. In a BMI session, for example, if there is a student who is drinking heavily and experiencing negative consequences as a result of their behavior, but has given little thought to changing this behavior, the intervention would focus on increasing awareness of these negative consequences and both current and future risks related to those results.

Finally, BMI is cost effective, can be implemented by trained peer facilitators, and may lead to an increase in the likelihood of additional help seeking. These benefits are especially important when you consider mandated students, as they are far more likely to enter alcohol sessions more hesitantly.

No matter what we do, some college students are still likely to drink. The quicker we realize this fact the better the chance we have at mitigating the problem. As a result, we must make use of interventions such as BMI that utilize harm-reduction approaches, as not only are they more realistic than recommending complete abstinence from alcohol, but they are also more effective, particularly when they make use of trained peer facilitators who can decrease student reactance to such programs.

Broadening Our Perspective

College drinking doesn’t occur within a vacuum and is in fact influenced by a number of factors, such as environmental context. Recent studies have shown that there are effective ways to curb college drinking via changing students’ social environment. For example, two studies at the Universities of Rhode Island and Washington found that programs in which colleges worked with surrounding communities to target student drinking were effective in reducing heavy drinking and off-campus alcohol-related incidents (45). Therefore, one effective strategy to reduce college drinking seems to be getting the wider community at large to collaborate more with colleges, which can be done in a few different ways.

First, college environments that have a number of liquor stores and bars where students can buy alcohol, and may be influenced to do so by heavy marketing, low prices and special promotions, create conditions for not only college drinking, but more seriously, binge drinking. To change these types of conditions, colleges and local communities must work hand-in-hand and attempt to include more controls on the supply of alcohol, such as limiting the numbers of liquor stores and bars surrounding the college campus (46). Second, colleges must ensure that they work with the community to better enforce laws against underage drinking, fake identification (ID) cards, and alcohol-related violations, such as drinking and driving.

Third, colleges can collaborate with local media outlets (T.V., internet, radio) to put together more effective and realistic messages regarding college drinking. Finally, colleges can also work together with their local communities and implement measures like increased police patrols in problem neighborhoods and efforts to make students more aware of their responsibilities as community residents (47).

Another way in which colleges can reduce the prevalence of college drinking is by making changes to the actual institution. As we have seen, students’ drinking behaviors also differ as a function of living arrangement, i.e. on-campus living is usually associated with heavier drinking than off-campus living, students living in fraternities or sororities usually drink more than those living in dorms. In turn, creating alcohol-free or substance-free dormitories would be one possible intervention that could lessen the amount of college drinking.

Some research has already shown that substance-free college dorms can help to reduce heavy drinking (48). One study found that students who live in substance-free college dorms were 60% less likely to engage in heavy episodic drinking as compared to students living in unrestricted dorms. Furthermore, such students also experienced fewer alcohol-related problems. Finally, these students also experienced fewer secondhand effects of alcohol use by other students than students in unrestricted dorms, such as their property being vandalized or their possessions stolen.

Studies have also shown that college drinking, and specifically heavy drinking behavior of students, is more common in college environments that have few alcohol control policies on campus or in the surrounding community and weak enforcement of existing policies (49). As such, colleges must make a concerted effort to actually “walk the talk” and implement policies that no longer provide students with a simple slap on the wrist. Rather, institutions must deal with alcohol-related misconduct and incidents seriously and openly, appropriately punishing students for their transgressions but also giving them the counseling they need to get better.

Effective interventions must target multifaceted environments, including communal and institutional factors, if we are to reduce the prevalence of college drinking. By acknowledging that such alcohol use occurs in a broader context of influence, we have the ability to focus on multiple areas of need, giving us a better chance of succeeding where public health interventions have failed in the past.

Changing Normative Misperceptions

Social norms are among the best predictors of college student drinking, and given college students have a generalized tendency to overestimate both descriptive and injunctive norms, interventions must correct the disconnect between perception and reality (50). This can be specifically done by implementing interventions which take advantage of theories that espouse the power of group behavior, such as Social Network Theory (SNT) (51).

SNT is a group-level model which states that what determines behavior is social norms, and that these social norms are actually quite malleable if you understand the behavior that drives them. Specifically, the theory states that people within a respective network have the ability to directly influence and change each other’s behavior, i.e. the effect friends, family, co-workers, etc., can have on one another.

This theory has been shown to have validity, as research has shown that network phenomena are relevant to smoking behavior and obesity, as both have been shown to spread through close and distant social ties over time, described as “clusters” of behavior (52, 53). In addition, another study found that peers had an impact on grade point average and on decisions to join social groups such as fraternities, which is especially relevant given the topic of problematic college drinking (54). Furthermore, given our discussion earlier of how students’ unrealistic optimism regarding their future can prompt risky behaviors and unfortunate consequences, targeting the social network of students - especially those who have already gotten into trouble as a result of alcohol misuse - may be an effective strategy for changing drinking perceptions and behaviors.

Let’s take, for example, those college students who have been mandated to receive alcohol counseling, usually because of an alcohol-related transgression of a law or college policy. Evidence has shown that mandated students typically drink on average more than students who are not mandated (55). However, mandated students usually state that their friends drink as much, or even more, than they do. So, their perceptions about what constitutes normal drinking are clearly influenced by their peers, who also just so happen to drink heavily. Therefore, if we can effect changes in these perceptions as well as in the student's social network, by possibly offering an intervention to their peers who are binge drinkers, such as BMI, we might end up seeing better outcomes.

Conclusion

A significant proportion of college students are going to drink, despite whatever interventions or strategies we attempt to implement. In addition, problematic college drinking hasn’t gone away but has actually gotten worse, as alcohol-related deaths, heavy drinking episodes and drunk driving have all been on the rise on college campuses over the past decade.
As a result, an alternative strategy is needed to combat the misuse of alcohol among college students. First, ineffective alcohol abstinence education programs must be thrown by the wayside and instead be replaced by more realistic and effective harm reduction strategies, such as BMI, that increase compliance and learning among college students. Second, incorporating the broader environmental context in which college drinking occurs will also help to reduce the prevalence of college drinking. Finally, correcting inaccurate perceptions of the frequency of alcohol consumption, the approval of such activities, and unrealistic optimism regarding alcohol use, will be paramount to the success of new public health interventions regarding college drinking.

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