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. Author manuscript; available in PMC: 2014 Sep 4.
Published in final edited form as: J Subst Abuse Treat. 2013 Sep 14;46(1):22–28. doi: 10.1016/j.jsat.2013.08.011

A computer-based feedback only intervention with and without a moderation skills component

Cameron C Weaver a,*, Thad R Leffingwell b, Nathaniel J Lombardi b, Kasey R Claborn b, Mary E Miller b, Matthew P Martens c
PMCID: PMC4154817  NIHMSID: NIHMS559436  PMID: 24041748

Abstract

Research on the efficacy of computer-delivered feedback-only interventions (FOIs) for college alcohol misuse has been mixed. Limitations to these FOIs include participant engagement and variation in the use of a moderation skills component. The current investigation sought to address these limitations using a novel computer-delivered FOI, the Drinkers Assessment and Feedback Tool for College Students (DrAFT-CS). Heavy drinking college students (N = 176) were randomly assigned to DrAFT-CS, DrAFT-CS plus moderation skills (DrAFT-CS+), moderation skills only (MSO), or assessment only (AO) group, and were assessed at 1-month follow-up (N = 157). Participants in the DrAFT-CS and DrAFT-CS + groups reported significantly lower estimated blood alcohol concentrations (eBACs) on typical heaviest drinking day than participants in the AO group. The data also supported the incorporation of a moderation skills component within FOIs, such that participants in DrAFT-CS + group reported significantly fewer drinks per week and drinks per heaviest drinking occasion than participants in the AO group.

Keywords: Personalized feedback, Moderation skills, Computer delivery, Alcohol use, College students

1. Introduction

Alcohol misuse by college students is a significant problem on many college campuses (Johnston, O’Malley, Bachman, & Schulenberg, 2010). Wechsler and colleagues, (2002) found that over 40% of a large national sample of college students reported having engaged in heavy episodic alcohol consumption within the previous 2 weeks. Alcohol misuse by college students has been associated with a number of related problems including driving after drinking, damaging property, sustaining injury, experiencing/perpetrating a sexual assault, and death (Hingson, Zha, & Weitzman, 2009; Wechsler et al., 2002). Given the associated consequences of heavy alcohol consumption on college campuses, researchers have examined a variety of intervention and prevention strategies aimed at reducing alcohol consumption and related problems (Larimer & Cronce, 2007).

Among these strategies are personalized feedback interventions (PFI). PFIs are designed to enhance motivation for change by highlighting discrepancies regarding one’s current alcohol use behaviors through the use of personalized drinking feedback and motivational enhancement strategies (Miller & Rollnick, 2002; Miller, Sovereign, & Krege, 1988; Walters & Neighbors, 2005). Content of the alcohol-related feedback varies, but PFIs typically include personalized feedback regarding quantity/frequency of alcohol use, perceived drinking norms, and alcohol-related problems (Miller et al., 2012). Research has also begun to examine PFIs without the use of an in-person interview.

1.1. Feedback-Only Interventions

Research has examined the use of personalized feedback in the absence of a one-on-one session with a clinician. These feedback-only interventions (FOI) include similar feedback to that provided in PFIs that utilize an in-person meeting plus feedback, but students are asked to review their feedback independently. FOIs have been delivered in a variety of formats including mailed, computer-delivered, and in-person during which the participant receives printed feedback following assessment that is reviewed privately without the assistance of a clinician (e.g., Agostinelli, Brown, & Miller, 1995; Neighbors, Larimer, & Lewis, 2004; White, Mun, Pugh, & Morgan, 2007). Beyond the personalized feedback, there exist important variations in additional content, and the delivery of BMIs. Two sources of variation that are relevant to the current investigation are the method of delivery of these interventions and the use of moderation skills training designed to provide students with strategies for promoting more responsible drinking.

Research examining the efficacy of FOIs is somewhat mixed. Some studies have found them to be efficacious when compared to control conditions (Agostinelli et al., 1995; Collins, Carey, & Sliwinski, 2002; Walters, Vader, & Harris, 2007), whereas others have not (e.g., Murphy, Dennhardt, Skidmore, Martens, & McDevitt-Murphy, 2010; Walters, Vader, Harris, Field, & Jouriles, 2009). Research that has directly compared FOIs to in-person BMIs has also been mixed. Some studies have found FOIs to be as effective as in-person interventions (e.g., Butler & Correia, 2009; Murphy et al., 2004; Juarez, Walters, & Daugherty, 2006), whereas others found superior effects for in-person interventions (Carey, Henson, Carey, & Maisto, 2009; Murphy et al., 2010; Wagener et al., 2012; Walters et al., 2009). This variability in findings regarding the effects of FOIs may be due to a limitation of the intervention format. In-person feedback includes an interaction between the participant and the clinician that may promote engagement in the personalized information. In contrast, there may be a variety of reasons (e.g., disinterest, confusion) for which many participants may not adequately engage in the feedback material presented in FOIs.

In an attempt to address these limitations, Leffingwell et al. (2007) developed the Drinking Assessment and Feedback Tool for College Students (DrAFT-CS). The DrAFT-CS was developed to provide a computer-delivered personalized feedback experience that is more similar to in-person interventions. Like other computerized FOIs, assessment and feedback are completed via computer without any face-to-face interaction with an interviewer. Unique to the DrAFT-CS, though, participants’ feedback is provided and explained by an on-screen virtual interviewer who introduces the feedback as it is presented on the computer screen. No printed feedback is provided. Modeled to reflect feedback from the Brief Alcohol Screening and Intervention for College Students (BASICS; Dimeff, Baer, Kivlahan, & Marlatt, 1999), the DrAFT-CS takes approximately 45 minutes to complete and consists of assessment and feedback for drinking-related variables in a multimedia format. Participants are asked a number of questions related to their current drinking behavior with the guide of a video “interviewer” that introduces the assessment content. The measures used to generate feedback include measures of quantity and frequency of drinking (using items adapted from the Daily Drinking Questionnaire; Collins, Parks, & Marlatt, 1985; and Frequency-Quantity Questionnaire; adapted from Cahalan & Cisin, 1968 and reported in Dimeff et al., 1999), alcohol-related problems (Rutgers Alcohol Problem Index; White & Labouvie, 1989), alcohol dependence (Alcohol Dependence Scale; Skinner & Horn, 1984), perceptions of drinking norms (Drinking Norms Rating Form; Baer, Stacy, & Larimer, 1991), psychological distress (Behavioral Health Screener; Zygowicz & Saunders, 2003), and motivation for change (Readiness to Change Questionnaire; Rollnick, Heather, Gold, & Hall, 1992). Following the assessment phase, the DrAFT-CS video interviewer appears adjacent to the feedback information presented on the computer screen and interprets computer-generated graphs that compare the participant’s drinking behavior to that of a normative college sample and personal risk associated with current use (e.g., risk of alcohol use disorder, estimated blood alcohol concentration and associated risk, money spent, calories consumed). The video interviewer is a 25-year-old Caucasian male graduate student with extensive training in MI. Assessment instructions and feedback information provided by the video interviewer are pre-recorded and all instruction and information provided by the interviewer is the same for every participant. The data presented in the feedback is personalized to the participant; however, all instructions and information provided by the video interviewer is the same for every participant. The script for the pre-recorded responses was developed by a member of the Motivational Interviewing Network of Trainers (MINT) and was designed to be non-confrontational and empathic and emphasized the autonomy of the participant in regard to decisions about any necessary behavior changes. Participant ratings in earlier trials confirmed that this is how participants perceived the intervention (Leffingwell et al., 2007; Wagener et al., 2012).

There has been one unpublished trial (Leffingwell et al., 2007) and one published trial (Wagener et al., 2012) of the DrAFT-CS program. Leffingwell and colleagues (2007) found DrAFT-CS to produce significantly greater reductions in alcohol outcomes than assessment only control. In contrast, Wagener and colleagues (2012) compared DrAFT-CS to in-person feedback, assessment plus DrAFT-CS assessment without feedback, and assessment only conditions. Results indicated that in-person feedback produced significantly greater reductions in alcohol outcomes than assessment only and significantly greater reductions in peak estimated blood alcohol levels (eBAC) than those in the DrAFT-CS and assessment only conditions. While DrAFT-CS produced greater reductions in alcohol use than assessment only conditions, these differences were not significant. Given the inconsistent findings of the two aforementioned studies, more work examining the efficacy of the DrAFT-CS as a stand-alone intervention is necessary.

1.2. Moderation Skills Modules

Another issue associated with evaluating the efficacy of FOIs is that there is variability in content areas covered (Miller et al., 2012). One such area is the use of moderation skills components (MSCs) where students are provided with specific skills designed to decrease risky drinking and subsequent alcohol-related harms (e.g., using a designated driver, alternating between alcoholic and non-alcoholic drinks, how to calculate eBAC). Several FOIs have utilized MSCs (e.g., Butler & Correia, 2009; Hester, Squires, & Delaney, 2005; Murphy et al., 2004; Walters et al., 2007), but these components are not universal (e.g., Juarez et al., 2006; Kypri et al., 2004; Leffingwell et al., 2007; Walters et al., 2009). MSCs may add incrementally to the efficacy of FOIs. FOIs without instruction on moderation focus on developing motivation to change one’s alcohol use behavior. Some participants may be sufficiently motivated to change their behavior as a result of an FOI but lack sufficient knowledge or skills to implement that change. For these individuals, adding an MSC could address this deficiency and improve the efficacy of the FOI alone. To date, no one study has systematically examined the unique contribution of MSC to these interventions using a dismantling design.

1.3. The Present Study

The purpose of the present study was to examine the efficacy of a novel computer-based FOI, the DrAFT-CS. We hypothesized that participants in the DrAFT-CS conditions would experience greater reductions in alcohol use than those in an assessment only (AO) control condition. A second goal of the current investigation was to examine the unique effect of adding an MSC to an FOI. Since previous research has found FOIs to be effective in reducing alcohol use compared to control conditions regardless of the use of MSC, we hypothesized that participants in both the DrAFT-CS and DrAFT-CS plus a computer-based MSC module (DrAFT-CS+) condition would experience greater reduction in alcohol use than those in the AO and the moderation skills only (MSO) conditions. Given the possible incremental additive effect of an MSC, we also hypothesized that participants in the DrAFT-CS + condition would experience greater reduction in alcohol use than those in the DrAFT-CS condition.

2. Methods

2.1. Participants

2.1.1. Initial screening

Participants were recruited from undergraduate psychology courses at a large midwestern university. Potentially eligible participants were initially identified by their response to a question on a universal screening questionnaire completed by all individuals in the departmental research subject pool. Those who answered “yes” to a question assessing whether or not they consumed alcohol were eligible for the study. Eligible students were then contacted via email through the online research system utilized by the university in order to assess their desire for participation in the current investigation. Those interested in participating provided both their name and phone number.

2.1.2. Secondary Screening

Interested students were contacted via phone and assessed to determine if they met secondary inclusion criteria: (a) currently enrolled in college, (b) between 18 and 25 years of age, (c) at least one heavy episodic drinking in the past month (defined as 5 drinks or more in one sitting for males and 4 drinks or more in one sitting for females), (d) drinking at least 20 drinks per month on average, and (e) at least one negative consequence related to alcohol use within the past month. Those who endorsed current treatment for an alcohol use disorder or were currently being treated for a psychological disorder were ineligible for the study. Participants were randomly assigned to one of four conditions: an AO control group, an MSO group, a DrAFT-CS group, or a DrAFT-CS + group.

Initially 7,914 students completed the departmental prescreener, 1,499 of whom received a recruitment email. Two hundred and ninety-nine students responded to this recruitment email expressing interest in the study. Twenty-nine did not respond to phone calls to determine eligibility. Sixty-nine students did not meet criteria for inclusion and twelve students stated that they were no longer interested in participating in the study. One hundred and eighty-nine students were enrolled in the study. Thirteen students failed to keep their appointment and were unable to be reached for rescheduling. The remaining 176 participants were randomly assigned to one of four experimental conditions prior to their arrival at the laboratory. Upon arrival, all participants were consented to treatment and completed the protocol with knowledge that they could discontinue at any time. See Fig. 1 for a participant flow diagram.

Fig. 1.

Fig. 1

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Participant flow chart describing recruitment, consent, and retention rates on the total sample. DrAFT-CS = Drinking Assessment Feedback Tool for College Students; DrAFT-CS + = DrAFT-CS plus moderation skills training.

2.2. Measures

2.2.1. Demographic Questionnaire

Participants completed a questionnaire assessing demographic variables such as age, sex, ethnicity, year in school, and association with Greek organizations.

2.2.2. Daily Drinking Questionnaire (DDQ)

Participants’ daily alcohol consumption was assessed using a modified version of the DDQ (Collins et al., 1985). The DDQ is a self-report instrument that measures daily alcohol consumption by assessing the typical number of drinks and the number of hours spent drinking on each day of a typical week in the past month. For the purposes of this study we calculated average number of drinks per week (DPW) and eBAC on the reported heaviest typical drinking day. eBAC was calculated using the following formula: [(number of standard drinks/2) × (gender constant/weight)] − (.016 × number of hours of drinking episode), where gender constant equals 9.0 for women and 7.5 for men (Matthews & Miller, 1979). This formula has been shown as a valid estimate of eBAC as other eBAC calculators (Hustad & Carey, 2005).

2.2.3. Frequency-Quantity Questionnaire (FQQ)

Frequency and amount of alcohol consumed over the past month was assessed using the FQQ (Dimeff et al., 1999). The FQQ is a four-item questionnaire designed to assess the largest number of drinks consumed in a single sitting over the past month, the typical number of drinks consumed on a single weekend evening, the frequency of drinking occasions over the past month, and the number drinking occasions where participants drank with the intention of getting drunk. For the purposes of this paper, the FQQ was used to assess for heaviest drinking occasion in the past month.

2.2.4. Procedures

Upon arrival in the lab, participants provided consent to participate. They were informed that they were participating in a study examining alcohol use among college students, and would be receiving course research credit for their participation in the baseline data collection. Participants were also informed that upon completion of follow-up measures they would be placed in a drawing to win one of two prizes: a portable DVD player or an iPod Nano. Following the consent process, all participants were seated at a computer by a research assistant where the baseline measures outlined above were completed online. Following completion of these measures, the participant received a prompt to signal a research assistant for further instruction. Study protocol was approved by the institutional review board.

2.2.5. Intervention condition

2.2.5.1. DrAFT-CS

Following completion of baseline measures, participants in the DRAFT-CS condition signaled a research assistant who initiated the computer program. Upon starting DrAFT-CS, participants were greeted by a video clinician who explained the intent of the program. After the introduction, participants were guided by the video clinician through questions that assessed a variety of variables necessary for personalized feedback. Participants answered questions that assessed quantity and frequency of alcohol use, alcohol-related problems, alcohol dependence symptoms, perceptions of drinking norms, psychological distress, and motivation to change drinking behavior. Once participants completed the assessment phase of the DrAFT-CS, the video clinician introduced the feedback section of the intervention and provided personalized feedback regarding their alcohol use, alcohol-related problems, risk for developing an alcohol use disorder, normative feedback on drinking behavior, money spent on alcohol, and calories consumed. Unique to DrAFT-CS, participants received this information via the video clinician who explained each piece of feedback as it was presented. Consistent with the style of motivational interviewing (Miller & Rollnick, 2002), the video clinician presented information without suggesting a need for change in order to reduce the risk of resistance from the participant. Once the feedback was completed, the research assistant closed the program and informed the participant that they would be contacted via email with a link to complete follow-up assessments. The DrAFT-CS took approximately 45-minutes to complete.

2.2.5.2. DrAFT-CS+

Participants in the DrAFT-CS + condition followed the same procedure as those in the DrAFT-CS condition; however, upon completion of the DrAFT-CS program a research assistant assisted the participant in starting an MSC module. The module was a slide presentation with audio instruction from a professor of clinical psychology who provided education regarding the nature and effects of alcohol and specific skills helpful for moderating its use. Topics covered included: facts regarding alcohol use on college campuses, biphasic effects of alcohol, calculating eBAC, and skills that foster moderate use of alcohol (e.g., alternating between alcoholic and non-alcoholic drinks, switching to light beer, eating before and during a drinking episode, and picking quality drinks that are enjoyed over sheer quantity of drinks consumed). The MSC took approximately 30 minutes to complete.

2.2.5.3. MSO

Following completion of baseline assessment measures, participants in the MSO condition were assisted by a research assistant to begin the MSC module described above. They were not provided with any feedback regarding their drinking behavior.

2.2.5.4. AO

Participants in the assessment only condition completed the computer-based baseline assessment measures described above, but received no personalized feedback regarding their drinking habits or information on moderation skills training.

2.2.6. Follow-up assessment

Participants in all conditions were contacted to complete follow-up assessments at 4 weeks post-intervention. All assessment measures were available online and did not require the participants to return to the lab. Follow-up measures included those administered during baseline.

2.3. Data analytic plan

All alcohol use variables were examined using separate univariate analysis of covariance (ANCOVA). All analyses were conducted on follow-up alcohol use variables, controlling for baseline alcohol use and gender. Effect size was calculated using partial η2 (small = .01, medium = .06, large = .14; Cohen, 1988). After examining intervention main effects, follow-up pairwise comparisons of the estimated marginal mean group differences were examined for specific between group contrasts.

3. Results

3.1. Sample characteristics

One hundred and seventy-six participants completed baseline measures, 88% of whom completed the one-month follow-up. There was an approximately equal number of men (n = 89) and women (n = 87) in the study. Participants were mostly White (83.1%), underclassmen (freshmen 41.2%, sophomores 20.5%), and half were affiliated with Greek organizations (50.3%). Chi square tests of association were conducted to examine frequency of group membership across a variety of demographic variables. Frequency of intervention condition membership was non-significant for sex (χ2 = 3.35, p = .34), ethnicity (χ2 = 20.56, p = .49), age (χ2 = 26.33, p = .34), and Greek affiliation (χ2 = 8.42, p = .21). A one-way analysis of variance (ANOVA) revealed no significant differences among groups at baseline for DPW (F(3,170) = 1.04, p = .34), eBAC (F(3, 175 = .64, p = .59), or peak drinking occasion (F(3, 174) = .63, p = .60). There were significant differences between completers and non-completers with completers reporting significantly (p < .05) greater DPW (M = 23.74, SD = 12.88; M = 13.1, SD = 6.93, respectively), eBAC (M = .18, SD = .10; M = .11, SD = .07, respectively), and quantity during their peak drinking episode (M = 7.45, SD = 2.37; M = 6.22, SD = 1.52, respectively).

3.2. Intervention effects

3.2.1. eBAC

Significant group differences occurred after controlling for baseline eBAC and gender, F(3, 152) = 3.06, p = .03, η2 = .06, observed power = .71. Pairwise comparisons indicated that participants in both DrAFT-CS (M = .13, SE = .02) and DrAFT-CS + (M = .12, SE = .01) displayed significantly lower BACs than participants in the AO (M = .17, SE = .01) condition (p = .03; p = .004, respectively). There was no significant difference in follow-up eBAC between participants in the MSO and the AO conditions. Finally, no significant differences in follow-up eBAC were observed among the DrAFT-CS, DrAFT-CS+, and MSO conditions (see Fig. 2).

Fig. 2.

Fig. 2

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Estimated marginal means of follow-up eBAC on largest typical drinking day derived from the Daily Drinking Questionnaire controlling for gender and baseline eBAC. eBAC = estimated blood alcohol concentration; AO = assessment only control condition; MSO = moderation skills only; DrAFT-CS = DrAFT-CS alone; DrAFT-CS + = DrAFT-CS plus moderations skills. Only significant differences were between both DrAFT-CS conditions and AO control (p < .05).

3.2.2. DPW

There was no significant omnibus intervention effect when controlling for baseline DPW and gender, F(3, 148) = 2.19, p = .09, partial η2 = .04, observed power = .56. However, examination of pairwise comparisons indicated a significant difference between participants in the DrAFT-CS + (M = 16.19, SE = 1.56) and the AO (M = 21.61, SE = 1.57) conditions, p = .02 (see Fig. 3).

Fig. 3.

Fig. 3

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Estimated marginal means of DPW at follow-up controlling for gender and baseline DPW. DPW = Drinks per week derived from the Daily Drinking Questionnaire; AO = assessment only control condition; MSO = moderation skills only; DrAFT-CS = DrAFT-CS alone; DrAFT-CS + = DrAFT-CS plus moderations skills. Only significant differences were between the DrAFT-CS + and AO control conditions (p < .05).

3.2.3. Peak drinking episode

There was no significant intervention main effect when controlling for baseline peak drinking episode and gender, F(3, 153) = 2.12, p = .10, partial η2 = .04, observed power = .53; however, examination of pairwise comparisons of the marginal means found a significant difference between participants in the DrAFT-CS + (M = 6.03, SE = .34) and the AO (M = 7.22, SE = .34) conditions, p = .02 (see Fig. 4).

Fig. 4.

Fig. 4

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Estimated marginal means of follow-up peak drinking episode controlling for gender and baseline peak drinking occasion. Peak = peak drinking episode reported in the past 30 days; AO = assessment only control condition; MSO = moderation skills only; DrAFT-CS = DrAFT-CS alone; DrAFT-CS + = DrAFT-CS plus moderations skills. Only significant differences were between DrAFT-CS + and AO control conditions (p < .05).

4. Discussion

The purpose of this investigation was to examine the efficacy of a novel computer-based feedback only intervention (DrAFT-CS) for at-risk college drinkers. Findings from this study support the use of DrAFT-CS as a computer-based FOI to reduce alcohol consumption among college students, as participants in the DrAFT-CS and DrAFT-CS + conditions reported significantly lower follow-up BACs than participants in the AO condition. A second objective of this investigation was to examine the unique, and possibly additive, contribution of including a moderation skills component to an existing FOI (DrAFT-CS+). Participants in the DrAFT-CS + condition reported significantly fewer DPW and drinks during their peak drinking occasion at follow-up compared to AO participants, even though overall omnibus tests of all four conditions were not statistically significant. In contrast, participants in the MSO condition did not report alcohol outcomes that significantly differed from the AO participants.

The primary finding from the current investigation was that participants in the DrAFT-CS and DrAFT-CS + conditions reported significantly lower BACs at follow-up than those in the AO condition. This finding is consistent with previous research that has found computer-based FOIs to be effective in reducing alcohol use and provides additional support for this novel computer-based FOI that is designed to more closely simulate in-person feedback. Although participants in both DrAFT-CS conditions reported lower BACs than those in the AO condition, there were no significant differences between the DrAFT-CS and DrAFT-CS + conditions. These findings suggest that with regard to impacting heaviest drinking occasion, DrAFT-CS was effective regardless of whether an MSC was utilized.

Some support for the efficacy of incorporating moderation skills within FOIs was found when examining pairwise comparisons of the estimated marginal means for both DPW and peak drinking occasion. For both DPW and peak drinking occasion, participants in the DrAFT-CS + condition reported significantly fewer DPW and drinks on their peak drinking occasion than participants in the AO condition. In contrast, those in DrAFT-CS, MSO, and AO did not significantly differ from each other. Taken together, the current study provides initial evidence that the DrAFT-CS + is an efficacious intervention for reducing alcohol use among at-risk college students. Further, this study provides additional evidence that DrAFT-CS alone may be effective in reducing alcohol use on heaviest typical drinking day.

The MSO intervention did not significantly differ from AO on all alcohol use variables despite using a more comprehensive MSC than the tip sheet typically included in FOIs (e.g., Butler & Correia, 2009; Murphy et al., 2004; Walters et al., 2007). This finding is similar to another recent examination of a skills training intervention that found that personalized normative feedback produced reductions in alcohol use, while an intervention designed to discuss protective behavioral strategies did not (Martens, Smith, & Murphy, 2013). Given previous research on alcohol skills training interventions (e.g., Kivlahan, Marlatt, Fromme, Coppel, & Williams, 1990), it may be that for MSCs to be an effective stand-alone intervention, it needs to be delivered in a more intensive intervention administered over multiple sessions and not in a brief format.

These findings, though, do not suggest that brief MSC should be abandoned entirely. The results of the current investigation found some additive effects for including an MSC module with an FOI, while providing no evidence that MSC decreased the efficacy of the FOI alone. One explanation for these findings is that brief MSC may be effective in reducing alcohol use when used following motivational enhancement. Consistent with MI theory, motivation for change occurs when an intervention is able to evoke a discrepancy between current behavior and one’s beliefs or values (Miller & Rollnick, 2002). Providing social norm’s comparisons and information on personal risk may evoke distress related to these discrepancies, thereby decreasing resistance to change and increasing one’s willingness to engage in more protective behavior strategies that have been shown to mediate the relationship between feedback interventions and alcohol outcomes (Barnett, Murphy, Colby, & Monti, 2007; Larimer et al., 2007). Future research may more effectively test this hypothesis by focusing on designs that would adequately test the direction of this relationship.

4.1. Limitations

Although the results from this study provide an important addition to the literature regarding FOIs, there are limitations to the study. First, the overall omnibus F-tests for DPW and peak drinking occasion were not significant. Despite this limitation, examination of the pairwise comparisons found significant differences between the DrAFT-CS + and AO groups. Further, observed effect sizes were similar to those found in previous research examining feedback interventions (e.g., Collins et al., 2002; Neighbors et al., 2004). The sample size used in this four-group randomized controlled trial was relatively small compared to similar feedback intervention trials that found statistically significant intervention effects. Future trials with larger sample sizes may provide more adequate power for detecting intervention effects. Second, there was only one follow-up time point for this study. Given the unique nature of the DrAFT-CS, it would be beneficial to have multiple follow-up time points in order to determine retention of treatment gains experienced by participants who receive the DrAFT-CS intervention. In addition, measures of participant satisfaction where not used in this trial. Such ratings would provide further evidence of the satisfaction and acceptance of the DrAFT-CS format; however, past trials have utilized such measures and have found the DrAFT-CS to be acceptable and helpful (Leffingwell et al., 2007; Wagener et al., 2012). Further, the criteria for at-risk drinkers were less conservative (i.e., 20+ drinks in 30 days). Utilizing a sample of heavier drinkers may provide better evidence for the effectiveness of the DrAFT-CS for students at greater risk. Also, the current investigation did not include a measure of protective behavioral strategies (e.g., Protective Behavioral Strategies Scale; Martens et al., 2005). Future trials should incorporate a measure of protective behavioral strategy use in order to assess if intervention effects are mediated by increases in the use of such strategies in groups that receive MSCs. Finally, the current investigation focused on alcohol use variables and not measures of alcohol-related problems. Examining intervention effects on alcohol-related problems would provide a more comprehensive test of the intervention’s effectiveness.

4.2. Conclusions

Regardless of the aforementioned limitations, the current investigation contributed two important additions to the FOI literature. First, this study provided additional support for the efficacy of the DrAFT-CS as a novel computer-based FOI for at-risk college drinkers, delivering personalized feedback without clinician contact while still explaining the feedback with assistance of a video interviewer. In addition, this study is the first study to use a dismantling design to examine the unique contribution of an MSC added to an FOI in dismantling design. Results from the current investigation provide some support for incorporating an MSC into a computer-based FOI. Future research should focus on larger sample sizes, including more follow-up time points, measuring changes in protective behavioral strategies, and examining a larger variety of alcohol outcomes.

Acknowledgments

The project was in part supported by an NIH Ruth L. Kirschstein National Research Service Award (T32 AA013526 - 10) to Kenneth J. Sher, Ph.D.

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