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Health Centers' Role Critical In Screening Students For High-Risk Drinking

Apr 17, 2008
For most students, college is a learning experience that goes well beyond the classroom. More freedom and responsibility means more risk, which is borne out in the statistics surroundings students' use of alcohol. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), one in three 18 to 24 year olds admitted to the emergency room is intoxicated, and about half of all fatal traffic crashes amongst this age group involve alcohol.

College health professionals are charged with a duty of care for students' health and wellbeing; the somewhat daunting task of keeping them safe from alcohol-related injury and death can be seen as part of that responsibility. The question is, how can an already-stretched college health center best tackle the continuing problem of harm related to binge drinking?

An increasing number of health professionals, including Dr. James Schaus, assistant director for clinical services at the University of Central Florida, and principal investigator in the NIAAA-funded study entititled "Alcohol Screening and Intervention in a College Clinic", believe the answer lies in a well-implemented program of alcohol screening followed by brief interventions for high-risk students. The goal of a brief intervention is to reduce harm and effect a change in behavior. This is particularly important for this age group, explains Schaus.

"Students are at a pivotal time in their life," he said. "If you can connect with a college student on the topic of alcohol and other social and preventative health issues, and get them to recognize that there is a problem and maybe even do something to change it, you're likely to be affecting their behavior for life."

The first step, however, is to screen students for high-risk drinking. There are several ways to do this. The AUDIT or Alcohol Use Disorders Identification Test is a 10 question screen developed and validated by the World Health Organization, but there are other, even simpler screens also available. Schaus recommends a single question screen that includes the "5/4" definition of high-risk drinking. "If the student is male, the question is 'In the last two weeks, have you had five or more drinks in a row?' If the student is female, the figure changes to four or more drinks in a row."

Schaus believes that the key to successful screening is to take a non-judgmental, student-centered approach. "Alcohol can be a sensitive topic with students. If you ask them straight out about their consumption of alcohol or drugs, you're not likely to get an honest answer," he said. "But if you use a motivational interview style and approach the subject on their terms, making sure you're non-judgmental in the way you deal with it, they feel more comfortable."

This style of interviewing can be applied to substance abuse, eating disorders and a range of other problems. In fact, claims Schaus, when you use this approach, you can often end up discussing other important problems that the student didn't initially plan on broaching. If the student has a positive experience talking about these sensitive topics, it also makes it more likely that they will return to the health center if they have a problem in the future.

Once you've identified the high-risk students, the next step is to conduct a brief intervention. As the name suggests, it doesn't have to be time consuming. There have been a number of studies delivered by counselors suggesting that even very brief sessions - as little as five minutes - can reduce harm. Schaus suggests, if possible, scheduling two 20-minute sessions and using a behavioral change counseling approach. This type of counseling is based on motivational interviewing but requires less time to be effective.

Most students fall into the category of at-risk consumption, which brief interventions are effective at tackling. According to Schaus, traditional, longer-term counseling is more appropriate for alcohol use disorders, alcohol abuse or alcohol dependency. However, usually only five to 10 percent of college students fall into these categories.

The challenge, of course, is to incorporate this into the schedule of a busy student health center. One tactic for doing this is known as the "teachable moment". Schaus explains, "If a student presents with a sprained ankle because they fell over when drunk, or if they're being tested for an STD because they had a high-risk sexual encounter while intoxicated, you can use these incidents as a starting point to talk about alcohol."

Additionally, Schaus advises that there should be a dedicated formal screen at initial patient registration at the health center. Making sure that all students have participated can be a simple process if your health center has a practice management system such as Nuesoft Xpress™. With the click of a button, a list can be compiled of all students who have not yet been screened, and a follow up letter sent to each one. Students can even schedule their own screenings via Nuesoft Xpress' student Web portal.

Schaus' screening and intervention recommendations seem to be practical ones. Yet a 2004 article by Foote in Journal of American College Health indicated that only 32 percent of college health centers routinely screen and only 12 percent use a standardized, approved screen. What's more, says Schaus, the majority of these health centers use the CAGE screen (so called because it is a mnemonic of the key words from each question) which is a screen primarily used to detect alcohol dependency rather than at-risk consumption.

"Apart from the lack of time and money, many college health centers feel their staff hasn't had adequate training to deliver an intervention," says Schaus. "But only eight hours of training are required for staff to be able to deliver an effective brief intervention." Educational resources are accessible either through the BASICS program or the College Drinking Prevention Curriculum developed by the NIAAA.

This combination of screening and brief interventions appears to be effective at identifying at-risk students and changing their behavior significantly.

"At 12 months out from our initial study, we're seeing a lasting effect," said Schaus.

Not only did the study show statistically significant reductions in all eight alcohol consumption outcomes (including peak blood alcohol count and number of drinks consumed in one sitting); it also showed reductions in alcohol related harms including driving after three or more drinks, taking foolish risks and physical injuries.

Those college health centers with Nuesoft Xpress can use the clinical study feature to track the effectiveness of their own alcohol prevention program over time. As the results of studies such as Schaus' become publicized, more college health centers will find a way to implement these types of screenings and brief interventions, making high-risk drinking on campus less prevalent and helping to safeguard students.
About the Author
Cassie Harman writes for NueMD (http://www.nuemd.com ), a provider of medical billing software. This article previously appeared in the Nuesoft Xpress e-nues .
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