Cognitive Behaviour Therapy for College Drinking Interventions

CBT and College Drinking

     This study would like to identify the dynamics of college drinking and identify the best therapy for intervention as Cognitive Behavior Therapy (CBT).  The purpose is to identify students who drink from Freshman through Senior year and promote a therapy like approach.  Transition to college from high school can be a challenging phase.  Higher expectations for schoolwork, making new friends and being without the parents may increase anxiety, which could present a difficult transition period during freshman year (Budny, 2004).  This kind of transition is often associated with risky behavior such as excessive alcohol consumption (Lorant, 2013).  CBT may be helpful to treat substance abuse and addiction (Davies, 2018).  Alcohol Use Disorder (AUD) is defined by alcohol often taken in larger amounts or over a longer period than was intended (American Psychiatric Association, [APA], 2013).

  Literature Review       

Drinking Habits

Studies have investigated the factors that influenced the onset of binge drinking in college (Weitzman, Nelson, & Wechsler, 2003).   The research, which was based on self-reported responses from students, revealed that most college students are influenced by their environment to start drinking (Weitzman, 2003). Students reported they drink when they are in social surroundings where alcohol is cheap and easily accessible (Weitzman, 2003).  The study also showed people who start binge drinking in college reported inflated definitions of binge drinking (Weitzman, 2003).  Creating a substance-free environment is ideal for limiting the adoption of binge drinking activities (Weitzman, 2003).

Freshman Year Drinking

     The first 6 weeks of freshman year are a vulnerable time for underage college drinking and alcohol-related consequences because of student expectations and social pressures at the start of the academic year (National, 2019).  A study explored the possibility of students starting to binge drink before going to college (White and Swartzwelder, 2009).   Most students bring unhealthy drinking habits to college (White, 2009).  Coping with a stressful event is a result that 88.5% of students are using alcohol in Freshman year (American Addictions Centers, 2019).  Alcohol education and prevention programs should target students prior to their arrival on college campuses (White, 2009).  Many students are now required to attend brief alcohol interventions incorporated into freshman orientation (Taylor, 2015).  A study examined the motivations for binge drinking among college students as they transition from the first year to their final year (Wolburg, J.M., 2016).  The study revealed that the need for social validation motivated students to engage in binge drinking (Wolburg, 2016).  Other drinkers use it as a method to enhance transformation from childhood to adulthood (Wolburg, 2016).  Avocation is needed for increased behavioral therapies during freshmen and sophomore years (Wolburg, 2016).

Sophomore Year Drinking

Heavy consumption during the earlier years is consistent with pregaming and other binge styles of drinking that are more typical of underage drinkers. (Wolburg, 2016).  Sophomore year students may mature slightly stating it's more about bonding with your group of friends (Wolburg, 2016).  Compared to Freshman year drinking to cope with a stressful event decreased (-3.9%) as a Sophomore to 84.6% (American, 2019).  Sophomores are more confident now that they have experienced one full year of college life.  Some Sophomores will transition from drinking in the dorms to bars because students have fake IDs by the time they became sophomores (Wolburg, 2016).

Junior Year Drinking

Students generally reach the legal drinking age as a Junior.  After students turn 21, they have easier access to alcohol and they may not feel as compelled to pre-party as when they had more limited, illegal access (Wolburg, 2016).   Junior year provides the move from dorms to apartments or houses and changes the ordering function of drinking, freedom from rules and the ability for juniors to host the house parties that freshmen attend seeking easy access to alcohol (Wolburg, 2016).  Junior year found an increase (93.3%) in alcohol to cope with a stressful event (American, 2019).  This may be due to new pressures to cope with internships, job searches and advanced classes, etc. (Rabalais, 2015)

Senior Year Drinking

The transition from Junior to Senior year is more subtle than other transitions. (Wolburg, 2016).  The transformation reflects students' awareness that they will soon graduate and move into the world beyond college (Wolburg, 2016).  Many students agreed that by their Senior year they drank less, this is my last year of college, drinking is not one of my priorities (Wolburg, 2016).  The maturity factor brings about reduced drinking for many students, the need to make the most of the remaining time with friends before graduation and taking graduate student test like the Dental Admission Test (DAT) is important (Wolburg, 2016).  Drinking to cope with a stressful event decreased slightly in Senior year to 87.3% (American, 2019). 

Recommended Therapy

Cognitive Behavior Therapy (CBT)

     Cognitive Behavioral Therapy (CBT) is a form of psychological treatment that has been demonstrated to be effective for a range of problems including depression, anxiety disorders, alcohol and drug use problems (American, 2019).  CBT is preferred over other forms of psychotherapy, it is performed in a structed way, it generally requires fewer sessions (Mayo, 2019).  CBT, is a short-term therapy technique that can help people find new ways to behave by changing their thought patterns (Davies, 2018).  During CBT therapy the client will learn and practice techniques such as relaxation, coping, resilience, stress management and assertiveness (Mayo, 2019).  A study explored the outcome of treatment through, CBT illustrated that self-efficacy, a factor reinforced in CBT played a significant role in long-term outcome of the prevention program: Increased self-efficacy led to a successful treatment (Litt, 2018).  Improvement in awareness to young adults, CBT may be beneficial to develop coping skills around alcohol (Wolburg, 2016). The goals of CBT are to decrease the reinforcing properties of alcohol, to teach people new behaviors inconsistent with alcohol abuse, and to modify the environment to include reinforcements for activities that do not involve alcohol (Taylor, 2015).  CBT is a problem-specific, goal-oriented approach that needs the individual's active involvement to succeed.  It focuses on their present-day challenges, thoughts, and behaviors (Davies, 2018).  Learning coping techniques for dealing with stress and relapse prevention skills enhance the prospects for long-term maintenance (Taylor, 2015).  A study concluded that CBT intervention on average had fewer days of alcohol use during the 6-month follow-up period (Deas, 2009).  Overall, the evidence shows that CBT to treat alcohol disorders are successful across a broad range of people and situations (Taylor, 2015).  Interventions with heavy-drinking college students have made use of these approaches (Taylor, 2015). 

Current Study

 Previous studies have not conducted research specifically like this study.  This study focuses on the treatment of CBT across the four-year college experience.  Previous studies did not focus on each specific Freshman through Senior year experience.  CBT is becoming more of a direct treatment approach to college age alcohol intervention.  Today, colleges and universities are starting to understand that success of students and alcohol use may be in self-efficacy and helping students to obtain self-control with alcohol instead of trying to eliminate it.  Students who become aware of CBT as a method to reduce alcohol consumption may not misuse alcohol while in the college environment.  With the use of CBT, self-efficacy is interwoven into therapy, which seems to increase self-awareness and decrease the amount of alcohol consumption.  Using CBT brings awareness and real life skills to help the student navigate, by their choice, situations where there will be alcohol. 

References

• American Psychological Association, [APA], (2019). What Is Cognitive Behavioral Therapy? Clinical Pratice Guideline for the Treatment of Posttraumatic Stress Disorder.
• American Psychological Association, [APA], (2013), The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).     
• American Addiction Centers, (2019). Coping With College Stress. Brentwood
• Budny, D. D. (2004). Working With Students And Parents To Improve The Freshman Retention. Pittsburgh.
• Davies, K. (2018). How does cognitive behavioral therapy work? Medical News Today.
• Deas, D. C. (2009). Current state of treatment for alcohol and other drug use disorders in adolescents. Alcohol Research & Health.
• Litt, M. D., Kadden, R.M. & Tennen, H. (2018). Treatment Response and Non-Response in CBT and Network Support for Alcohol Disorders: Targeted Mechanisms and Common Factors. Addiction Behavior, 1407-1417.
• Lorant, V. N., Nicaise, P., Soto, V.W. & d'Hoore, W. (2013). Alcohol drinking among college students: college responsibility for personal troubles. BMC Public Health, 615.
• Mayo Clinic, (2019). Cognitive behavioral therapy. Rochester
• National Institute on Alcohol Abuse and Alcoholism, (2019) Fall Semester -A Time for Parents to Discuss the Risks of College Drinking
• Rabalais, E. (2015). 10 Reasons Why Your Junior Year Of College Is The Most Stressful. Louisville: Odyssey.
• Taylor, S. E. (2015). Health Psychology. Los Angeles: McGraw-Hill Education.
• Weitzman, E. R., Nelson, T.F., & Wechsler, H. (2003). Taking up binge drinking in college: the influences of person, social group, and environment. Journal of Adolescent Health, 26-35.
• White, A., Swartzwelder, S.H. (2009). Inbound College Students Drink Heavily during the Summer before Their Freshman Year. American Journal of Health Education , 90-96.
• Wolburg, J.M. (2016). Insights for Prevention Campaigns: The power of drinking rituals in the college student experience from freshman to senior year. Journal of Current Issues & Research in Advertising, 80-94.