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. Author manuscript; available in PMC: 2025 Jan 25.
Published in final edited form as: Subst Use Misuse. 2024 Jan 25;59(3):421–424. doi: 10.1080/10826084.2023.2275565

Initial Results from a New College Substance Use Prevention Program Targeting Externalizing and Internalizing Traits

Maia Choi 1,*, Morgan N Driver 2,*, Emily Balcke 3, Trisha Saunders 4, Joshua M Langberg 5, Danielle M Dick 3
PMCID: PMC10873059  NIHMSID: NIHMS1941615  PMID: 37897057

Abstract

Objective:

College students engage in high rates of risky substance use. Standard college prevention strategies focus on providing feedback about current substance use behaviors and harm reduction strategies but do not address the underlying genetically-influenced risk factors impacting these behaviors. We created an online Personalized Feedback Program (PFP) for college students that targets genetically-influenced externalizing and internalizing risk pathways and provides personalized recommendations and campus resources. College students received personalized feedback on four risk domains (Sensation Seeking, Impulsivity, Extraversion, and Neuroticism).

Methods:

An open trial (n=300) was conducted at a large public university in spring of 2021 to assess initial responses to the PFP and evaluate intentions related to future substance use and campus resource use.

Results:

81% of students in the open trial reported they enjoyed the Personalized Feedback Program. Participants reported intending to use significantly more campus resources after completing the PFP. Among participants that drank, 39% reported they intended to decrease their alcohol consumption and 41% reported they intended to decrease the number of times they get drunk after completing the PFP; these intentions to reduce use after completing the PFP are higher than rates found in previous studies.

Conclusion:

Preliminary data indicate that the Personalized Feedback Program may be a complementary method to enhance current college substance use prevention programs.

Introduction

Alcohol use is prevalent in college students (SAMHSA, 2020) and associated with numerous adverse consequences (Foster et al., 2013; White & Hingson, 2013). The transition from high school to college is associated with a significant increase in alcohol use (Sher & Rutledge, 2007). Thus, prevention programs are important to mitigate escalation of substance use.

Current alcohol interventions for college students are primarily based on a brief motivational intervention (BMI) framework, which provides education on the harmful effects of alcohol use and uses motivational interviewing strategies to change beliefs, expectations, and behaviors surrounding alcohol use (Tevyaw & Monti, 2004). Despite their widespread use, BMIs show modest effects in reducing and preventing alcohol use (Paschall et al., 2011). Additional prevention programs are needed that incorporate novel strategies for reducing college substance use.

One such strategy is the incorporation of information about etiological factors that contribute to risk for substance use disorders into prevention programming. In the literature, risk is discussed in the context of two primary pathways: externalizing and internalizing (Trucco & Hartmann, 2021). The externalizing pathway is characterized by traits such as sensation seeking, impulsivity, and extraversion, which are among the strongest predictors of substance use initiation and problems in emerging adults (Dick et al., 2010; Zucker et al., 2011). Internalizing symptomology has also been related to substance use problems (Hussong et al., 2011). Providing individuals with specific information about their risk profiles, accompanied by personalized recommendations for reducing risk, has the potential to motivate individuals to better self-regulate their health behaviors.

Early work in this area was led by Conrod and colleagues, who developed a school-based prevention program for adolescent alcohol use focused on internalizing and externalizing characteristics. High-risk students with elevations on a particular dimension received interventions that incorporated aspects of cognitive behavioral therapy and motivational enhancement therapy focused on that particular risk factor (e.g., sensation-seeking). This intervention has been associated with reduced substance use in short and long-term follow-ups (Conrod et al., 2013; Debenham et al., 2021; Newton et al., 2022; O’Leary-Barrett et al., 2013). However, this prevention program is limited in that it was developed for delivery in a school-based setting, and only targets one risk factor at a time, whereas many individuals have elevated risk across multiple dimensions (Colder et al., 2013; King et al., 2004).

Present Study

The present study sought to expand on this literature by designing an online program for college students that gives feedback across internalizing and externalizing risk domains previously shown to be associated with college substance use. We conducted an open trial to assess initial responses to the Personalized Feedback Program (PFP).

Methods

Participants and Recruitment

Participants at a public, urban university were recruited from two sources: PsychSONA, a database of university research studies actively recruiting participants, and Spit for Science, a university-wide research registry open to all incoming first-time college students (Dick et al., 2014). Participants were provided with a link to the consent form for the study in REDCap (Harris et al., 2009). Inclusion criteria required that individuals were full-time college students aged 18 or older.

Study Design

Data collection

Participants completed a baseline survey assessing demographic information and campus resource use. Next, the students were directed to the PFP using an embedded link in the survey. Immediately following completion of the PFP, participants answered survey questions that assessed satisfaction with the PFP and future intentions regarding campus resource use and alcohol and drug use. REDCap was used to administer the surveys.

The Personalized Feedback Program

The PFP provided feedback to participants about their underlying genetically-influenced externalizing and internalizing risk factors (Sensation-seeking, Impulsivity, Extraversion, and Neuroticism) for substance use. Participants also received recommendations and campus resources intended to help them succeed during college, tailored to their individual personality profile. Further interactive elements of the program prompted participants to explore their goals and make decisions in a series of hypothetical scenarios. The PFP is intended as a universal prevention program for college students. Details about the development and content of the PFP can be found in Dick et al. (2022). Participation took 15–30 minutes. All study procedures were approved by the university’s Institutional Review Board.

Measures

Items were included to assess demographic characteristics, satisfaction with the PFP, campus resource use, and future substance use. Age, sex assigned at birth, gender identity, race/ethnicity, class designation, and current living situation were assessed. Ten items were used to assess satisfaction with the PFP. Additionally, participants were presented with a list of all campus resources included in the PFP and asked to indicate which resources they intended to use in the next 30 days. Items were also included to assess intentions regarding drinking, getting drunk, and using other drugs.

Analysis Plan

Descriptive analyses were used to summarize participant demographic information and other variables of interest. Paired t-tests were used to compare the number of resources participants endorsed using at baseline and the number of resources participants endorsed intending to use after completing the PFP. All analyses were completed using R version 4.1.1.

Results

Sample Characteristics

286 individuals were included in the analyses. Most of the sample was between the ages of 18 and 22 (95%) and self-reported biological sex as female (72%). 41% of the sample self-identified as White, 25% self-identified as Black/African American, and 18% self-identified as Asian. 34% of students were freshmen, 24% were sophomores, 16% were juniors, and 27% were seniors in college.

Satisfaction with the PFP

Overall, students were highly satisfied with the PFP. Figure 1 shows agreement levels across all items. A majority of participants agreed or strongly agreed with each statement that assessed satisfaction with the PFP.

Figure 1.

Figure 1.

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Participant responses to items assessing satisfaction with the Personalized Feedback Program.

Intentions to Use Campus Resources

On average, participants endorsed using 1.01 (SD = 1.53) resources in the past 30 days at baseline. After completing the PFP, participants reported intending to use an average of 2.29 (SD = 2.52) resources, a mean difference of 1.24 (SD = 2.25) more resources, t (259) = −9.17, p <.001.

Intentions Regarding Substance Use

After completing the PFP, 39% of participants reported they plan to drink less than last month, 55% reported they would drink the same as last month, and 5% reported they intended to drink more than last month. 41% of participants reported they plan to get drunk less than last month, 64% reported the same as last month, and 9% reported more than last month. 46% of participants reported they plan to use drugs less than last month, 50% reported the same as last month, and 4% reported more than last month. We note that past 30-day substance use was relatively low in this sample, with 49% of students reporting that they did not drink alcohol and 60% of students reporting they did not use other drugs, so maintaining “the same” levels of substance use is a favorable outcome.

Discussion

The two main goals of the open trial were to assess the acceptability of the PFP and to test for preliminary effects on students’ intentions to use recommended resources and reduce substance use. Results indicate high acceptance of the program. Most students reported enjoying the program content, found the delivery method acceptable, and learned from the information provided. Students reported intending to use more university resources in the future after completing the program, which has been associated with student well-being and success (Ketchen Lipson et al., 2015; Zegre et al., 2022). Although we only assessed intentions to use substances after completing the PFP, and thus do not have a pre-program reference, the substance use intention data can be considered in the context of pre-intervention data collected as part of a RCT on college drinking conducted on the campus that same academic year, using similar recruitment methods (Choi et al., 2023). In this sample of students who had not received any intervention, 22% of participants reported they planned to drink less than last month (compared to 39% in this study); 35% of participants indicated they planned to get drunk less than last month (compared to 41% in this study); and 42% of participants indicated they planned to use drugs less than last month (compared to 46% in this study). Thus, our results suggest that students intend to use less alcohol, and potentially get drunk and use drugs less frequently, after completing the PFP.

Limitations

These findings should be interpreted in the context of the following limitations. First, future substance use intentions were only collected after completion of the PFP, so our comparison point is data collected prior to receiving any intervention from a similar sample of students (Choi et al., 2023). The sample is majority female (72%) which is similar to other drinking interventions conducted at university (Choi et al., 2023; Neale et al., 2018; Savage et al., 2015). Additionally, data collection occurred during Spring 2021 during the COVID-19 pandemic, which substantially affected students’ college experience. Substance use behaviors and endorsement of mental health symptoms may differ from college student data collected at other times.

Conclusions

In conclusion, our findings indicate that the PFP may be a complementary method to enhancing college substance use prevention programs. Next steps include a randomized clinical trial to compare the PFP to the more widely used online BMIs and collect longitudinal data on substance use to test the efficacy of the PFP.

Acknowledgments

This project is supported by R34AA027347 (DMD, JML) from the National Institute on Alcohol Abuse and Alcoholism (NIAAA). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIAAA. This research was further made possible by Spit for Science. Spit for Science has been supported by Virginia Commonwealth University, P20 AA017828, R37AA011408, K02AA018755, P50 AA022537, and K01AA024152 from the National Institute on Alcohol Abuse and Alcoholism, and UL1RR031990 from the National Center for Research Resources and National Institutes of Health Roadmap for Medical Research. Spit for Science was also supported by the National Institute on Drug Abuse of the National Institutes of Health under Award Number U54DA036105 and the Center for Tobacco Products of the U.S. Food and Drug Administration. The content is solely the responsibility of the authors and does not necessarily represent the views of the NIH or the FDA. Data from this study are available to qualified researchers via dbGaP (phs001754.v2.p1).

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