Harm Reduction With High School Students
Dr. Larimer's approach is based on cognitive–behavioral, social learning, and motivational models of behavior and behavior change, including motivational interviewing (Miller & Rollnick, 2002) and motivational enhancement therapy (Project MATCH Research Group, 1997), stages of change (Prochaska & DiClemente, 1986), relapse prevention (Marlatt & Gordon, 1985), and multiple theories regarding normative and social influences on behavior (Asch, 1952; Bandura, 1986, 1999; Festinger, 1954). Specifically, the approach uses many of the common elements of brief intervention summarized in the FRAMES acronym (Bien, Miller, & Tonigan, 1993): Feedback regarding the person's behavior, experienced consequences, risks, and comparison to population norms is offered; Responsibility for change rests with the individual; Advice to change is offered; a Menu of options for change is provided; Empathy is expressed through strategic use of reflective listening; and Self-Efficacy is supported. These elements are integrated into the BASICS (Brief Alcohol Screening and Intervention for College Students; Dimeff, Baer, Kivlahan, & Marlatt, 1999) intervention, which typically consists of a 1-hour feedback session based on either interview or self-report information provided previously.
The BASICS and similar interventions have been adapted to be used with other populations, including high school students, as is illustrated in the video. Interventions illustrated in the video consistent with these theoretical approaches include emphasizing the client's personal choice regarding his drinking; asking open-ended questions and using strategic reflections to elicit personally relevant reasons to consider changing his drinking; providing normative feedback, indicating that typical students drink less than he does and less than he believes them to drink; providing information with permission that might be useful to the client in making decisions about his drinking; and providing a menu of options that he might consider using if he decides to make a change. Throughout the session, Dr. Larimer focuses on meeting the client at his level of readiness to change; building discrepancy between his current behavior and his personal goals, values, and beliefs; and affirming the client and his ability to make good choices and to change his behavior if he chooses to do so.
The "typical" client is an older adolescent or adult who is engaging in high-risk alcohol use that he or she views as normative. The typical client may view his or her drinking as heavy but not problematic, or may think he or she actually drinks less than others, but in most cases clients will not be aware of the extent to which they are drinking more than peers, nor have they typically given much consideration to changing their drinking. Though Dr. Larimer's work has primarily focused on adolescents and young adults in college settings, this same or similar approach has been used in workplace settings (Anderson & Larimer, 2002) and with other populations including those meeting criteria for alcohol dependence (Project MATCH Research Group, 1997).
In some cases, the brief intervention is an initial session, designed to build commitment to change and to facilitate referral for more intensive interventions as needed. In other cases, the brief intervention alone is sufficient to promote changes in behavior.
Dr. Larimer would be less likely to use this approach with individuals who present as already very motivated to change their behavior and ready to engage in problem-solving and behavior change strategies. In that case, she suggests using some elements of this approach but relying more on cognitive–behavioral skills training and relapse prevention strategies. Nonetheless, she would continue to use elements of the motivational counseling style, especially to build support for using the skills-based strategies, to encourage compliance with homework and practice, and to attend to fluctuations in motivation posed by setbacks in the change process.
Mary E. Larimer, PhD, is associate director of the University of Washington's Addictive Behaviors Research Center, associate professor of psychiatry and behavioral sciences, and adjunct associate professor of psychology. Dr. Larimer received her doctorate from the University of Washington in 1992 and joined the faculty in 1995.
Dr. Larimer's research and clinical interests include (a) prevention and treatment of alcohol problems among adolescents and college students; (b) prediction of initiation of drinking and maintenance of low- or high-risk drinking patterns during college; (c) comorbidity of substance use with depression, disordered eating, and gambling problems; and (d) dissemination of evidence-based prevention and treatment approaches into clinical, school, and workplace settings.
Dr. Larimer is the author and coauthor of numerous journal articles and book chapters on alcohol-related topics. She is principal investigator or coinvestigator of four longitudinal outcome trials of prevention strategies for high-risk drinking funded by the National Institute on Alcohol Abuse and Alcoholism.
- Anderson, B. K., & Larimer, M. E. (2002). Problem drinking and the workplace: An individualized approach to prevention and treatment. Psychology of Addictive Behaviors, 16, 243–251.
- Asch, S.E. (1952). Social psychology. Englewood Cliffs, NJ: Prentice-Hall.
- Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Englewood Cliffs, NJ: Prentice Hall.
- Bandura, A. (1999). A sociocognitive analysis of substance abuse: An agentic perspective. Psychological Science, 10, 214–217.
- Bien, T. H., Miller, W. R., & Tonigan, J. S. (1993). Brief interventions for alcohol problems: A review. Addiction, 88, 315–335.
- Dimeff, L. A., Baer, J. S., Kivlahan, D. R., & Marlatt, G. A. (1999). Brief alcohol screening and intervention for college students (BASICS): A harm reduction approach. New York: Guilford Press.
- Festinger, L. (1954). A theory of social comparison processes. Human Relations, 7, 117–140.
- Marlatt, G. A. (1998). Harm reduction: Pragmatic strategies for managing high-risk behaviors. New York: Guilford Press.
- Marlatt, G. A., & Gordon, J. R. (1985). Relapse prevention: Maintenance strategies in the treatment of addictive behaviors. New York: Guilford Press.
- Miller, E., Kilmer, J. R., Kim, E. L., Weingardt, K. R., & Marlatt, G. A. (2001). Alcohol skills training for college students. In P. M. Monti, S. M. Colby, & T. A. O'Leary (Eds.), Adolescents, alcohol and substance abuse: Reaching teens through brief intervention (pp.183–215). New York: Guilford Press.
- Miller, W. R., & Rollnick, S. (2002). Motivational interviewing: Preparing people for change (2nd ed.). New York: Guilford Press.
- Prochaska, J. O., & DiClemente, C. C. (1986). Toward a comprehensive model of change. In W. R. Miller & N. Heather (Eds.), Treating addictive behaviors: Processes of change (pp. 3–27). New York: Plenum Press.
- Project MATCH Research Group. (1997). Matching alcoholism treatment to client heterogeneity: Project MATCH post-treatment drinking outcomes. Journal of Studies on Alcohol, 48, 7–29.
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