University of California Santa Barbara

Debbie Fleming, M.P.H. Associate Dean of Students

Ian Kaminsky, Ph.D.Director, Alcohol and Drug Program

UCSB ContextUCSB Context

High rates of binge drinking (51% per High rates of binge drinking (51% per 2005 California Safer Universities study)2005 California Safer Universities study)Unique influence of Isla VistaUnique influence of Isla VistaAlcohol and Drug Program embedded in Alcohol and Drug Program embedded in Student Health ServiceStudent Health ServiceAggressive adoption of best practices in Aggressive adoption of best practices in alcohol and drug preventionalcohol and drug preventionStrong support from Vice Chancellor for Strong support from Vice Chancellor for Student AffairsStudent Affairs

Early Intervention StrategiesEarly Intervention Strategiesfor AOD at UCSBfor AOD at UCSB

- AOD Counseling and Assessment- AOD Counseling and Assessment - Parent Notification- Parent Notification

- Resident Assistant Training- Resident Assistant Training - Monthly E-- Monthly E-NewslettersNewsletters

- On-Line Assessment/Feedback- On-Line Assessment/Feedback - 21- 21stst Birthday E-Mails Birthday E-Mails

(MyStudentBody.com(MyStudentBody.com, E-Chug, E-Toke, E-Chug, E-Toke)) - Social Worker- Social Worker

- Brief Motivational Interviewing- Brief Motivational Interviewing - Parent Education - Parent Education

- Emergency Room Referrals- Emergency Room Referrals

- On Call AOD Counseling (SBIRT)- On Call AOD Counseling (SBIRT)

Development of CASEDevelopment of CASEGOALS:GOALS:

Increased accountability and heightened Increased accountability and heightened consequences for alcohol/drug policy violations in consequences for alcohol/drug policy violations in the residence hallsthe residence halls

Partnership between multiple departmentsPartnership between multiple departments Housing and Residential ServicesHousing and Residential ServicesAlcohol and Drug ProgramAlcohol and Drug ProgramDean of Students/Office of Student LifeDean of Students/Office of Student LifeOffice of Judicial AffairsOffice of Judicial AffairsGevirtz Graduate School of EducationGevirtz Graduate School of Education

Harm-reduction and skills-development approach Harm-reduction and skills-development approach using evidenced-based strategiesusing evidenced-based strategies

CASE Program OverviewCASE Program Overview

Referral to CASE by Resident DirectorReferral to CASE by Resident Director

Intake Assessment and Personalized ProgrammingIntake Assessment and Personalized Programming

5 Weekly Group Meetings (75 minutes each)5 Weekly Group Meetings (75 minutes each)

Follow-up Session (2-3 weeks later)Follow-up Session (2-3 weeks later)

Appropriate Referrals to On-Campus and Appropriate Referrals to On-Campus and Community ResourcesCommunity Resources

CASE Behavior Change GoalsCASE Behavior Change GoalsReduce frequency of use Reduce frequency of use

Reduce amountReduce amount

Reduce negative consequencesReduce negative consequences

Eliminate blackoutsEliminate blackouts

Increase responsible drinking strategiesIncrease responsible drinking strategies

Change style of drinkingChange style of drinking

““CASE made me realize that the way I was CASE made me realize that the way I was drinking was the cause of my blackouts, and drinking was the cause of my blackouts, and decisions that I would not have made sober.”decisions that I would not have made sober.”

Evidence-Based StrategiesEvidence-Based Strategies

Brief Motivational InterviewingBrief Motivational Interviewing

Alcohol Skills Training Program (ASTP)Alcohol Skills Training Program (ASTP)

NIAAA Clinical Protocols to Reduce High Risk NIAAA Clinical Protocols to Reduce High Risk Drinking in College StudentsDrinking in College Students

Behavior ModificationBehavior Modification

Life SkillsLife Skills

CASE incorporates strategies proven to be CASE incorporates strategies proven to be effective with college studentseffective with college students

Abstinence vs. Harm Abstinence vs. Harm ReductionReduction

Abstinence from alcohol is theAbstinence from alcohol is the only no-risk alternativeonly no-risk alternative and the and the only legal optiononly legal option for those under 21 years of for those under 21 years of age. age.

College students who choose to drink should learn to do College students who choose to drink should learn to do so with the so with the least risk and harmleast risk and harm possible. possible.

““My group leader was not judgmental, but open and honest. My group leader was not judgmental, but open and honest. She seemed to care, not condemn.”She seemed to care, not condemn.”

““They didn’t judge my use, but helped me to use They didn’t judge my use, but helped me to use responsibly.”responsibly.”

How CASE WorksHow CASE Works

Through in-class discussion and out-of-class Through in-class discussion and out-of-class assignments and exercises students:assignments and exercises students:

– Receive individualized feedback on their drinking Receive individualized feedback on their drinking behaviorbehavior

– Examine how their behavior affects their goalsExamine how their behavior affects their goals– Discuss the pros and cons of their useDiscuss the pros and cons of their use– Develop a plan for changeDevelop a plan for change– Test their skills and review results weeklyTest their skills and review results weekly

CASE CurriculumCASE Curriculum

Day 1Day 1:: Program Description and RequirementsProgram Description and RequirementsPsychology of Substance UsePsychology of Substance UseWhat is Alcohol?What is Alcohol?What is One Drink?What is One Drink?Alcohol and Women Alcohol and Women BAC/ Self-Monitoring FormBAC/ Self-Monitoring FormAOD Emergency/ Alcohol PoisoningAOD Emergency/ Alcohol Poisoning

Day 2Day 2:: Alcohol and the BodyAlcohol and the BodySobering UpSobering UpUse-Abuse Use-Abuse

ContinuumContinuumToleranceToleranceBi-Phasic ResponseBi-Phasic Response

CASE CurriculumCASE Curriculum

Day 3Day 3:: Alcohol/Marijuana and the BrainAlcohol/Marijuana and the BrainAlcohol/Marijuana and MemoryAlcohol/Marijuana and MemoryBinge DrinkingBinge DrinkingDrinking GamesDrinking GamesBlackoutsBlackouts

Day 4:Day 4:Pros and Cons of MarijuanaPros and Cons of MarijuanaBrain ScansBrain ScansAlcohol and SexAlcohol and SexSexual AssaultSexual Assault

CASE CurriculumCASE Curriculum

Day 5:Day 5: AddictionAddictionDependenceDependenceUppersUppersDownersDownersAll-AroundersAll-Arounders

Characteristics of CASE Characteristics of CASE Participants in Evaluation StudyParticipants in Evaluation Study

2005-2006 (2005-2006 (NN=481)=481)

GenderGenderMaleMale 62%62%FemaleFemale 38%38%

EthnicityEthnicityEuropean-AmericanEuropean-American 73%73%Latino/aLatino/a 8% 8%Asian-American Asian-American 7% 7%African-AmericanAfrican-American 1% 1%Other/BiculturalOther/Bicultural 11%11%

2006-2007 (2006-2007 (NN= 238)= 238)

GenderGenderMaleMale 66%66%FemaleFemale 34%34%

EthnicityEthnicityEuropean-AmericanEuropean-American 61%61%Latino/aLatino/a 7%7%Asian-American Asian-American 13%13%African-AmericanAfrican-American 1%1%Other/BiculturalOther/Bicultural 18%18%

CASE Evaluation ResultsCASE Evaluation ResultsLess dangerous drinkingLess dangerous drinking– Statistically significant reductions in amount and frequency of Statistically significant reductions in amount and frequency of

drinks per weekdrinks per week– increase in use of behavioral harm reduction strategiesincrease in use of behavioral harm reduction strategies

75% participant satisfaction with program despite 75% participant satisfaction with program despite mandatory nature and $75 feemandatory nature and $75 fee

Program more helpful for some students than othersProgram more helpful for some students than others

““I liked the small groups, familiar faces, instructor, and safe I liked the small groups, familiar faces, instructor, and safe environment. I liked how casual it was, but at the same environment. I liked how casual it was, but at the same

time we were able to learn a lot, get resources, and time we were able to learn a lot, get resources, and share openly.”share openly.”

Changes in Drinks in a Typical WeekChanges in Drinks in a Typical Week

2005-2006 (2005-2006 (NN=172)=172) 2006-2007 (2006-2007 (NN=238)=238)

Changes in Drinks in a Typical Week Changes in Drinks in a Typical Week for Students with and without Blackoutsfor Students with and without Blackouts

2005-2006 (2005-2006 (NN=172)=172) 2006-2007 (2006-2007 (NN=238)=238)

Changes in Drinks in a Typical Changes in Drinks in a Typical Week by GroupWeek by Group

High School HistoryHigh School History– 2006-2007 (2006-2007 (NN=234)=234)

Family HistoryFamily History– 2006-2007 (2006-2007 (NN=234)=234)

Harm-Reduction Strategies Harm-Reduction Strategies Reported at Follow-UpReported at Follow-Up

StrategiesStrategies 2005-062005-06 2006-072006-07

NN=297=297 NN=237=237

Eating before/while drinkingEating before/while drinking 75%75% 61%61%Monitoring drinkingMonitoring drinking 68%68% 53%53%Pacing drinks over timePacing drinks over time 67%67% 52%52%Counting drinksCounting drinks 66%66% 57%57%Talking about their drinking Talking about their drinking 61%61% 54%54%Talking about others’ drinkingTalking about others’ drinking54%54% 47%47%Pacing drinks with waterPacing drinks with water 53%53% 31%31%Calculating BACCalculating BAC 33%33% 26%26%Pre-partying lessPre-partying less 21%21% 16%16%Playing fewer drinking gamesPlaying fewer drinking games17%17% 9% 9%

Unexpected Consequences of Unexpected Consequences of CASECASE

CASE has become a tool for CASE has become a tool for early identificationearly identification of mental health issuesof mental health issues

CASE has become an CASE has become an effective mechanismeffective mechanism for for getting students the care they needgetting students the care they need

Managing high risk students in CASE has Managing high risk students in CASE has created the need for development of created the need for development of new new protocols and increased communicationprotocols and increased communication and and collaborationcollaboration

Identification of High-Risk StudentsIdentification of High-Risk Students

Intake process (evaluations, questionnaires) andIntake process (evaluations, questionnaires) andweekly small group participation allows for weekly small group participation allows for

assessment of risk indicators such as:assessment of risk indicators such as:

Stress/AnxietyStress/AnxietyDepressionDepressionSuicideSuicideFamily History of AOD UseFamily History of AOD UseAcademic/ Social/ Financial/ Health-Related Academic/ Social/ Financial/ Health-Related Pressures Pressures

Consent forms allow CASE staff Consent forms allow CASE staff to contact students if appropriateto contact students if appropriate

Screening, Identification, TrackingScreening, Identification, TrackingIndividual AOD screens for each studentIndividual AOD screens for each student

Classification of each student based on level of Classification of each student based on level of riskrisk

High levels of AOD severity are often an High levels of AOD severity are often an indicator of underlying mental health issuesindicator of underlying mental health issues

System in place to help counselors keep track of System in place to help counselors keep track of at risk students (e.g., suicide, depression, sexual at risk students (e.g., suicide, depression, sexual assault)assault)

Confidentiality issuesConfidentiality issues

Participant HistoryParticipant History 2005-062005-06 2006-2006-

0707

NN=481=481 NN=238=238

Family history of AOD problemsFamily history of AOD problems 31%31% 43%43%

Saw counselor before collegeSaw counselor before college 5%5% 11%11%

AOD treatment before collegeAOD treatment before college 4%4% 15%15%

Diagnosed with learning disabilityDiagnosed with learning disability 3%3% 3%3%

History of physical abuseHistory of physical abuse 2%2% 4%4%

Additional IssuesAdditional Issues

DepressionDepressionAnxiety Anxiety StressStressBlackoutsBlackoutsPassing OutPassing OutDrinking GamesDrinking GamesCompetitive DrinkingCompetitive DrinkingGreek/Athlete Community Greek/Athlete Community RitualsRitualsUse of Study DrugsUse of Study DrugsIntense Peer Pressure to Drink Intense Peer Pressure to Drink and Useand UseHazingHazing

Arguments and FightsArguments and FightsTrouble with PoliceTrouble with PoliceSleep DifficultiesSleep DifficultiesSelf MedicationSelf MedicationAbuse of Prescription Abuse of Prescription Medication Medication Fear for Personal Safety Fear for Personal Safety Disgust with Friends and Disgust with Friends and PeersPeersRelationship ProblemsRelationship ProblemsRoommate ProblemsRoommate ProblemsAcademic ProblemsAcademic Problems

How We Know Who Needs HelpHow We Know Who Needs HelpStandardized assessmentsStandardized assessments

Small groups over multiple weeksSmall groups over multiple weeks

Counselors make time after groups to chatCounselors make time after groups to chat

CASE counselors are trained to look for students who CASE counselors are trained to look for students who have more than an AOD issue (e.g., we look at body have more than an AOD issue (e.g., we look at body posture, clothing, hygiene, eye contact)posture, clothing, hygiene, eye contact)

Homework -- Students write one journal at the end of the Homework -- Students write one journal at the end of the program (often this is when students feel safe to discuss program (often this is when students feel safe to discuss their mental health challenges)their mental health challenges)

Follow up appointmentsFollow up appointments

Clinical SupervisionClinical SupervisionHeld weeklyHeld weekly

Digital picture of each studentDigital picture of each student

Discussion/review of 1:1 treatment plansDiscussion/review of 1:1 treatment plans

Discussion of group techniqueDiscussion of group technique

Role play motivational interviewing and challenging Role play motivational interviewing and challenging casescases

Audiotape of some sessionsAudiotape of some sessions

Summary of CASE ImpactsSummary of CASE Impacts600+ students x 7 visits = 4,200 visits/clinical contacts 600+ students x 7 visits = 4,200 visits/clinical contacts absorbed into Student Health each yearabsorbed into Student Health each year

Increase in staffing and student contact = need for Increase in staffing and student contact = need for additional space and fundingadditional space and funding

Need for increased collaboration and communication Need for increased collaboration and communication between departments serving mental health needs of between departments serving mental health needs of studentsstudents

Increase in number of students referred by others and self-Increase in number of students referred by others and self-referred for AOD counseling and assessmentreferred for AOD counseling and assessment

Reduction in number of repeat AOD violations in residence Reduction in number of repeat AOD violations in residence hallshalls

UCSB Contact InformationUCSB Contact Information

Debbie Fleming, M.P.H.Debbie Fleming, M.P.H.– Associate Dean of Students, Associate Dean of Students,

debbie.fleming@sa.ucsb.edudebbie.fleming@sa.ucsb.edu

Ian Kaminsky, Ph.D.Ian Kaminsky, Ph.D.– Director, Alcohol and Drug Program, Director, Alcohol and Drug Program,

ian.kaminsky@sa.ucsb.eduian.kaminsky@sa.ucsb.edu

Merith Cosden, ProfessorMerith Cosden, Professor– Dept. of Counseling, Clinical & School Psychology, Dept. of Counseling, Clinical & School Psychology,

cosden@education.ucsb.educosden@education.ucsb.edu