Implementation of a Brief Motivational Intervention for Alcohol and Other Drug Using Latinx College Students

Abstract

Alcohol and other drug (AOD) use problems among college students continue to represent a public health epidemic. In 2019, historically high rates of binge-drinking and marijuana use were reported among college-age adults, and the detrimental effects of excessive AOD use in college, such as poorer academic performance, sexual assault, injury or overdoses, and a range of other negative consequences, have been well-documented. Thus, there is a continued need for effective implementation of evidence-based, cost-effective interventions aimed at reducing risks associated with collegiate AOD use. Guided Self Change (GSC) is a brief intervention involving motivational enhancement and cognitive-behavioral strategies and has demonstrated effectiveness in reducing AOD use problems. Its brevity, client-driven style, and concrete here-and-now focus are appealing to individuals struggling with mild to moderate AOD use problems. In order to successfully intervene with collegians with AOD use problems attending minority-serving institutions, GSC requires developmental and cultural tailoring. The current report describes the developmental and cultural tailoring of GSC for emerging adult Latinx collegians, as well as our consumer-driven addition of mindfulness content. Key components of our GSC program are documented through qualitative feedback, quantitative results, and case vignettes.

Background

Alcohol and marijuana remain the most widely used substances in the United States. Among all age cohorts in the U.S., emerging adults (defined as late teens through the twenties, with a focus on ages 18–25)^1,2 have the highest prevalence of alcohol use (81% past year drinking, 67% past month, and 5.2% daily drinking) and approximately one-third (32%) engage in binge drinking -- at least one heavy episodic drinking (HED) episode (4/5 drinks in two hours females/males) during the previous two weeks.¹ Additionally, those aged 18–25 have the highest reported past year rates of cocaine, heroin, methamphetamines, prescription stimulants and sedatives, benzodiazepines, pain relievers, and opioids.³ The developmental stage of emerging adulthood (ages 18–25 years old) is characterized by identity exploration and shifting of roles from a dependent to an independent adult. The dramatic brain maturation characterizing adolescence and emerging adulthood, coinciding with the time that most individuals initiate and increase their consumption of alcohol and other drugs, further exacerbates risks.⁴ AOD use during emerging adulthood is strongly and directly associated with negative and life-threatening consequences, including ER visits, alcohol use disorders, alcohol-related injuries, alcohol-related arrests and/or legal problems, alcohol-related car accidents, physical assault, sexual assault, and death.^5,6 AOD use also increases the chances of unprotected sex and the transmission of HIV and other sexually transmitted infections.⁷

College attending emerging adults binge drink at a higher rate (78% annual use, 62% past 30-day use) than their non-college attending peers (67% annual use, 50% past 30-day use).¹ One conceptualization of the elevated risk of HED during emerging adulthood is that it reflects the exploration and shift from dependence to independence characteristic of this stage of life.⁸ Key defining domains of the emerging adulthood include (A) identity exploration, (B) instability, (C) focusing on the self, (D) feeling in-between, and (E) exploration of life’s possibilities.^8,9 However, continuing brain maturation may impede an emerging adult to control the impulse to drink alcohol, or to know when to stop drinking.⁴ These developmental tasks, combined with the freedom of being on a college campus and attending events typically associated with college (i.e., tailgating, parties), elevates opportunities for AOD use, especially HED.

Latinx emerging adults in the United States are at elevated risk for problematic drinking and related negative consequences compared to their non-Latinx peers due to the added socially-determined obstacles of acculturative stress, discrimination, ethnic identity, and limited access due to lack of attention to unique cultural issues.^10–14 Compared to their non-Hispanic counterparts, Latinx emerging adult drinkers are at greater risk for transitioning to alcohol and other drug use disorders (e.g., Alcohol Use Disorder, AUD ¹⁵) and experience more severe negative consequences, (e.g., liver cirrhosis, alcohol use-related contact with the criminal justice system; ¹⁶). In particular, Latinx emerging adults disproportionately experience severe negative consequences from HED (e.g., alcohol related violence, unprotected sex) and are considered a high priority group for binge drinking prevention and intervention.¹⁷

Additionally, Latinx emerging adult drinkers are less likely to seek treatment and have less access to culturally appropriate evidence-based health promotion and disease prevention programs, exacerbating health inequities.^18–23 Even if they can access treatment, members of Latinx and other minority populations are 3.5 – 8.1% less likely to complete treatment than are members of majority populations.^22,24,25 As many as 1 in 5 Latinx individuals report avoiding health care for fear of racial/ethnic discrimination.²⁶

Moreover, Latinx college students are less likely than their non-Hispanic counterparts to seek mental health services (including help for AOD use problems). Between 2012 and 2015, the past-year prevalence of Latinx college students attending treatment was 23.7%, compared to 33.3% non-Latinx White and 30.2% overall,²⁷ possibly influenced by stigma, culture,^28,29 or beliefs about the need for, and efficacy of, treatment.²² These barriers highlight the need to disseminate novel, easily accessible interventions that can ameliorate hazardous AOD use, and consider Latinx cultural issues.

Implementation of a Brief Motivational Intervention for Substance Using Latinx College Students

The current project aimed to implement a culturally and developmentally tailored, on-campus Guided Self-Change program (GSC; ³⁰) for Latinx collegians. The foundation of GSC is Cognitive Behavioral Therapy (CBT) and GSC includes both cognitive aspects (e.g., relapse prevention) and behavioral aspects (e.g., goal setting, stress reduction). GSC also incorporates Motivational Interviewing (MI; ³¹), a directive, client-centered, collaborative counseling style that enhances motivation for change by helping the client clarify and resolve ambivalence about behavior change.

For our Latinx collegian GSC program, the research team tailored a manualized GSC intervention that we previously developed for (a) Latinx adolescent alcohol and other drug users court mandated to AOD treatment ³² and (b) Latinx high school students.³³ Prior to implementation, focus groups were conducted to tailor project materials to match the key values and beliefs of the target population (see ³⁴ for details on focus groups in the context of a larger study). Key focus group results were: (a) harm-reduction would be well-received and fear-based programming should be avoided; (b) materials should be in English, although Spanish words could be added in certain situations; (c) stereotypical references should be avoided; (d) stigma and shame should be reduced, which would be bolstered by providing services at a location separate from traditional counseling services; (e) no-cost, confidential, private services should be highlighted, especially since many Latinx college students live with family; and, (f) the intervention would be more appealing and impactful if it included attention to mindfulness. To address consumer interest in mindfulness, an introduction to mindfulness was added to our GSC intervention. Mindfulness-based interventions potentially can diminish stress-induced alcohol misuse, and therefore may effectively reduce alcohol misuse among non-clinical emerging adult populations.^35,36

Methods

Participants

Participants were referred directly to the program through student services (i.e., Student Conduct and Student Counseling Services) for intervention for AOD use problems. Eligible participants were emerging adults with substance use concerns who were undergraduate or graduate students at a large urban minority serving institution (see Table 1 for participant demographics). Participants who reported co-occurring primary psychopathology, or severe AOD use problems, were provided with the appropriate referral through the Student Counseling Services Center. All study procedures, including informed consent, were reviewed and approved by our university’s Institutional Review Board.

Table 1.

Demographics of the participant sample (N = 73).

Age: M (SD)	24 (4.8)
Range	18 – 39
Gender Count (%)
Female	38 (52.1%)
Male	35 (47.9%)
Race Count (%)
White	53 (75.7%)*
Black/African American	16 (22.9%)*
Asian	2 (2.9%)*
American Indian or Alaskan Native	1 (1.4%)*
Ethnicity Count (%)
Hispanic/Latinx	43 (58.9%)
Not Hispanic/Latinx	30 (41.1%)
Race & Ethnicity: Count (%)
Hispanic/Latinx and White	38 (54.3%)*
Hispanic/Latinx and Black/African American	2 (2.9%)*
Sexual orientation: Count (%)
Heterosexual	53 (77.9%)*
Bisexual	14 (20.6%)*
Gay/Lesbian	1 (1.5%)*
Living situation: Count (%)
In own home/apartment/condo	36 (50%)*
In relative’s home	17 (23.6%)*
On campus/in dormitory housing	15 (20.8%)*
In a group home	3 (4.2%)*
Other	1 (1.4%)*
Primary substance1: Count (%)
Alcohol	33 (45.2%)*
Marijuana	41 (56.2%)*
Both	6 (8.2%)*
Other	10 (13.7%)

Note: the demographics of the total sample are based on participants who completed a baseline survey and at least one session.

^*The percentages are excluding missing values, based on valid counts and percentages.

¹Primary substance as indicated at baseline. Clients may use multiple substances.

Of the 73 participants initially enrolled in GSC, 47 (64.4%) completed the program; there were no systematic differences between clients who completed the program and those who dropped out with regard to gender, age, Hispanic/Latinx self-identification, or Black/African American self-identification. Completion rates for alcohol and other drug treatment programs vary widely and have been cited to range from as low as 33% to as high as 81% ³⁷. While the current completion rate falls within that range it is important to contextualize this; as noted earlier, Latinx and other minority populations are 3.5 – 8.1% less likely to complete treatment than are members of majority populations.^22,24,25 However, there were statistically significant differences in tobacco used (p = .01) and marijuana use (p = .03); participants who dropped out of GSC used tobacco (M = 7, SD = 10.7) and marijuana products (M = 18.5, SD = 11.8) on more days at baseline than participants who completed GSC (marijuana: M = 12.6, SD = 13; tobacco: M = 1.2, SD = 4.6).

Procedures

Our GSC program consisted of 4 individual face-to-face sessions with an overall goal of reducing AOD use problems. An overview of the program is presented in Figure 1 (GSC Program: 4 session overview). Participants completed a survey prior to the first session and immediately after session 4. A description of each session follows.

Figure 1.

GSC Program: 4 session overviews

Session 1

The initial session began with introductions and an orientation regarding what can be expected, including limits of confidentiality. Clients are told, “You are here to identify, explore, and work on problems related to your alcohol/other drug use.” The therapist emphasizes that the overall goal is to help the client understand and learn about their AOD use, learn what is important to them, and how this is impacted by their AOD use. Session content focuses on getting to know the client and what led to the presentation for treatment.

Session 1 exercises (explained in greater detail below) include: (1) Decision to change: the client’s self-described pros and cons for using alcohol and any other drugs (as applicable); (2) Goals for change: motivation, confidence, and readiness to change; (3) Identifying triggers and high-risk situations; (4) Options and actions: generating alternatives to AOD use; (5) Weekly session check-in; and (6) Session wrap-up.

1. Decision to change: the client’s self-described pros and cons for using alcohol and any other drugs (as applicable);

   The therapist elicits from the client the pros and cons of (a) using alcohol and/or other drugs, as well as (b) reducing or stopping use of alcohol and/or other drugs. Clients tend to be pleasantly surprised that the therapist is asking about “good things about using” and “negatives about reducing or stopping use.” This balanced approach facilitates the client joining with the therapist, reduces resistance, and increases motivation to participate. The therapist reflects back what the client indicates is important to them using motivational techniques (e.g., “It sounds like using has been a way to deal with social anxiety”) and to highlight ambivalence in a curious, non-judgmental manner (e.g., “On the one hand, you mention that alcohol makes you feel more comfortable in social situations, but then you also mentioned that you end up worrying more about your safety when you were drinking than about being uncomfortable in a group”). An additional useful technique regarding the cons of using is for the therapist to ask, “How much do you typically spend on alcohol/drugs per week?” and to verbally calculate the cost per month (x4) and per year (x52); this is followed up by asking, “What else could you buy or do with this money?” The therapist summarizes the pros and cons, highlights the positives and the client’s statements regarding motivation to change (e.g., “It seems like the positive things about reducing your use are outweighing the downside of reducing your use”) and asks the clients to weigh the pros and cons.

2. Goals for change: motivation, confidence, and readiness to change

   Goal setting is introduced, and the therapist and client explore how the likelihood of achieving goals changes by continuing AOD use as opposed to reducing or discontinuing AOD use. The client is asked to rate and elaborate on: (a) importance to change AOD use [not at all important (0) - the most important thing in my life (4)]; (b) confidence to change AOD use [not confident at all (0) - extremely confident (4)]; and (c) readiness to change [not ready at all (0) - extremely ready (4)]. Most importantly, the therapist concludes the exercise by asking, “What can you do to increase each rating?” This implies that not only can something be done, but that the client has the ability to accomplish the necessary steps.

3. Identifying triggers and high-risk situations

   The concept of triggers for AOD use is introduced. “A trigger can be a place, object, person, situation, thought, feeling, time of day, etc. that makes it more likely for you to use (AOD).” For many clients, a clear pattern of negative (e.g., sadness) or positive (e.g., social situations) triggers will emerge. The therapist then asks the client to describe the behaviors that follow the urge to use. This often allows the client to slow the process down and think before automatically acting on the thought (e.g., reacting versus responding). Positive consequences of using (alcohol and other drugs) in trigger, or high-risk, situations can be tied back to the pros and cons elicited earlier in the session. Negative consequences will be discussed in the context of the client’s self-described goals at the end of the session. This is followed by brainstorming alternatives to AOD use and the respective positive and negative consequences.

4. Options and Actions Plan: generating alternatives to AOD use

   The therapist asks the client to select one of their triggers and to generate a list of alternative behaviors to AOD use (e.g., “go for a run”). This leads to the development of a step-by-step action plan (e.g., “change into workout clothes, get water, set a timer on my phone, and run”). The client is reminded that taking this one step at a time makes it more manageable to accomplish when faced with a trigger situation. The client is asked to consider the consequences of employing the alternative plan and contrast this with the consequences of AOD use in response to the trigger. The presentation of a healthy coping behavior is introduced as a tool to add to their “toolbox;” this toolbox will continue to be filled throughout the four sessions. As referred to earlier, the toolbox is aimed at increasing resilience and foster adaptive emotion regulation.

5. Weekly session check-in

   The first session concludes with a Weekly Session Check-In, which will also be completed at the beginning of each subsequent session. It allows the client to look back at the past week in terms of AOD use and goal setting and to set a new goal for following week. The weekly reflection on AOD use assists the client to quantify AOD use and identify patterns of use. Clients are asked: (a) whether they thought about using (alcohol and other drugs) or used on each day of the past week; clients are often surprised to learn that thinking about using (alcohol and other drugs) and actually using (alcohol and other drugs) are independent behaviors (e.g., one can think about AOD but refrain from using (alcohol and other drugs), use without thinking about it, etc.); (b) to identify their reasons for use; (c) to state what they did when they thought about using (alcohol and other drugs); and (d) to set a reasonable risk-reduction goal for the next week (i.e., “no AOD use while driving, use lesser amounts, using only one substance at a time”). The goal can be general (i.e., “use fewer days”) or more specific (i.e., “use only twice this week”). The client may also set any other goal that is related with substance use (i.e., “I want to take a walk [previously identified option] when I think about using (alcohol and other drugs).” The session-check in concludes with the client giving a numeric rating of the past week [lousy (0) – fantastic (4)]. The therapist asks the client to consider the factors that contributed to this rating, reflecting on the positive factors and asking the client what they could have done to have made that rating higher. This is asked in the same manner and with the same intention as the question asked earlier with the Goals for Change exercise; it send a message to the client that this is an active process and that he/she has the ability to improve their week.

6. Session wrap-up

   The therapist distributes a resource directory, further strengthening the message that the client has the ability to make changes and has support when needed, and ends the session with a brief summary, asking the client for one or two things that stood out the most in the session. The therapist elicits any questions or concerns, and the next appointment is set. The session concludes with the therapist thanking the client for their hard work (i.e., bravery, achievements, etc.) and reminding them to keep their goal (or something else from the session that stood out) in mind between sessions.

Session 2

Session 2 included: (1) Weekly session check-in; (2) A discussion of slips (lapses) and the “slip back effect” (abstinence violation effect; ³⁸); (3) Communication and refusal skills; (4) Change plan worksheet; and (5) Session wrap-up.

1. Weekly session check-in

   The therapist welcomes the client back and begins with a weekly session check-in (as described in Session 1 above).

2. A discussion of slips and the “slip back effect”:

   The therapist introduces the concept of a “slip,” explaining that it is important to prepare for what happens when you slip (lapse in abstinence and return to AOD use). This normalizes slips as a common part of behavior change and helps the client get back on track rather than continuing to use. The therapist discusses the “slip back effect,” the cycle of feeling guilty (or having other negative emotions) following an unintentional slip and being likely to repeat old use patterns. The therapist explains to the client that this can be part of change as it is a non-linear process and follows up with a discussion about how to think of slips as mistakes, being kind to oneself, and realizing that slips can be contained and prevented from becoming relapses. This is taken as a learning experience and is an opportunity for the therapist to remind the client about triggers, options, and coping skills from session 1.

Communication and refusal skills

The therapist introduces and describes communication skills, particularly in relation to refusal skills and triggers. Since effective communication includes both expressing and listening, the therapist elicits from the client an example of a situation in which they have had trouble communicating; this can be related to AOD use, but is not necessary. The therapist and client then engage in a role play about that situation, trying out newly learned communication skills; the therapist and client can also switch roles. The therapist takes this opportunity to relate communication skills back to a situation in which the client had trouble refusing AOD use. After a brief discussion about the benefits and challenges of using these communication skills, the therapist suggests these skills be added to the client’s “toolbox.”

1. Change plan worksheet

   The therapist asks the client to identify and write down 1–2 changes they would like to make; these can be AOD-related, but is not necessary. The client is also asked to consider why these changes are important, the steps required to make these changes, and the people who can provide support. The client is also asked to consider how they will evaluate success of making the changes and to anticipate, and prepare for, what may get in the way of their change plan.

2. Session wrap-up

   The session concludes in a similar manner to that previously described in Session 1 above.

Session 3

Session 3 included: (1) Weekly session check-in; (2) Future goals (1-month, 1-year, and 5-years); (3) What stresses you out? —preventing and coping with stress; (4) An introduction to mindfulness with a 5-minute guided mindfulness practice; and (5) Session wrap-up.

1. Weekly session check-in

   The therapist welcomes the client back and begins with a weekly session check-in (as described in Session 1 above).

2. Future goals (1-month, 1-year, and 5-years)

   Goal setting has been associated with positive behavior change³⁹ and was found to be related to effective substance use reduction.⁴⁰ The aim of this exercise is to help the client gain perspective on their long-term goals, regarding AOD use and other areas of life. The therapist asks the client to set goals for 1 month, 1 year, and 5 years from now, guiding the client to make connections between their AOD goals and other life goals.

3. What stresses you out? —preventing and coping with stress

   Stress is often something that can be a barrier to achieving goals. Although the term is frequently used in general terms, clients often cannot identify what stress is to them or how they know when they under stress. Stress is also presented as an expected part of life, and strategies for preventing, dealing with, and minimizing stresses, or the negative effects of stress, are discussed. After identifying the client’s stressors, the therapist and client explore how the experience of stress may be related to their AOD use. This gets linked back to triggers and the client’s toolbox, referred to in earlier sessions, and the mindfulness practice that follows.

4. Introduction to mindfulness and 5-minute guided practice

   The therapist asks the client to share what they know about mindfulness and can elaborate as needed. The therapist shares that key aspects of mindfulness include focusing on the here and now/anchoring in the present and being non-judgmental and approaching oneself with kindness and curiosity.⁴¹ The reported benefits of mindfulness practice are vast and can include decreases in stress, anxiety, hostility, and impulsivity, as well as increases in well-being, self-awareness, calmness, and empathy. The therapist asks the client permission to demonstrate this with a brief, guided 5-minute mindfulness exercise. Clients who demonstrate reluctance to attempt the mindfulness practice are invited to try this as an experiment and can, of course, stop whenever they choose to do so. Participation is voluntary so a client can decline participation. As a precaution, clients are asked if they have any medical conditions that may cause sitting with their eyes closed to be potentially harmful in any way. The therapist walks the client through the mindfulness meditation for up to 5 minutes, asking the client to: (a) Focus on breath; (b) Focus on the present moment; (c) Focus on physical sensations; (d) Focus on thoughts or emotions; and (e) Let go of any judgments. The therapist asks the client to transition from the mindfulness exercise back to the session slowly, allowing time for them to re-acclimate to the room. After the mindfulness exercise, the therapist asks the client about their experience (i.e., “What was your experience like?”, “What did you notice?”), highlighting the difference between reacting and responding. This is followed up letting the client know that they can train themselves to be more responsive and think first before acting. This can easily be linked back to the weekly check-ins, triggers, and options and actions plan from earlier sessions, differentiating the act of thinking about AOD use and actually using. The therapist then presents the client with a list of mindfulness resources.

5. Session wrap-up

   The session concludes in a similar manner to that previously described in Session 1 above.

Session 4

The final session served as a review and reflection in preparation for termination and continued independent application by the client of newly developed skills. Several exercises from previous sessions are repeated and compared to earlier in treatment. Session 4 includes: (1) Weekly session check-in; (2) Decision to change: the client’s self-described pros and cons for using alcohol and any other drugs (as applicable); (3) Goals for change: motivation, confidence, and readiness to change; (4) Identifying triggers and high risk situations; (5) Options and actions: generating alternatives to AOD use; (6) Support systems; (7) Resource directories; and (8) Session/program wrap up.

1. Weekly session check-in

   The therapist welcomes the client back and begins with a weekly session check-in (as described in Session 1 above). The added component in this final session is that clients are encouraged to continue this on their own and are offered additional copies of the form upon request.

2. Decision to change: the client’s self-described pros and cons for using alcohol and any other drugs (as applicable);

   The Decision to Change exercise is completed (as described in Session 1 above) and current pros and cons are compared and contrasted with those from the first session. Clients are often surprised to see a shift in their views from the beginning of the program.

3. Goals for change: motivation, confidence, and readiness to change

   The Goals for Change exercise is completed (as described in Session 1 above) and current ratings on motivation, confidence, and readiness to change AOD use are compared and contrasted with those from the first session. Once again, clients are often surprised to see a shift in their ratings since the beginning of the program. It is important to note that clients often report a decrease in their rating of importance to change AOD use while confidence and readiness to change increase; an exploration with the client often reveals that this may be due to other things in their life taking on higher priorities as a consequence of reduced AOD use.

4. Identifying triggers and high-risk situations

   The Triggers and High-Risk exercise is completed (as described in Session 1 above) and current triggers are compared and contrasted with those from the first session.

5. Options and actions: generating alternatives to AOD use

   A current Options and Action Plan for managing risky situations is completed (as described in Session 1 above). The current plan, as well as the use of newly learned tools, are compared and contrasted with those from the first session.

6. Support systems

   As a final exercise, the therapist assists the client to assess their support system, specifically exploring how their network can support continued change and/or maintenance of behavior changes. The client is asked to name people they can depend on to provide support (family, friends, doctors, therapists, etc.), about whether each person is aware of their AOD use, and their attitudes towards their AOD use and goals. The therapist can help the client evaluate their support system and how this can be relied upon going forward.

7. Resource directories

   As the session draws to a close, the therapist reviews the resource directories (mental health, AOD use, and mindfulness/yoga) previously distributed in sessions 1 and 3, reminding the client that he/she has the skills to continue making progress towards their stated goals and that there are resources if and when they are needed.

8. Session/program wrap up

   The therapist concludes the session with a wrap-up (as described in Session 1 above) and extends the discussion to the entire program, asking the client for one or two things that stood out the most from the whole program. The therapist reflects on the client’s commentary and progress, reinforce change efforts and behavior changes, and exploring what has changed since the beginning of the program. The therapist thanks the client for persisting, acknowledging that change can be challenging, and reminding them about their stated goals, new skills, and their toolbox of coping strategies. The therapist encourages the client to take their completed manual home and continue their independent behavior changes. The therapist elicits any final questions or comments and congratulates the client as they leave session.

Data Analysis and Measures

Participants completed a survey at baseline (before session 1) and at exit (immediately after session 4). The survey included quantitative items, that included questions about demographics, substance use, attitudes toward substance use risk, and sexual behavior, (see Results section) developed by SAMSHA.⁴² and was mostly identical at baseline and exit. In the present study, we analyzed past 30-day use (at both baseline and exit), measured by items asking for the number of days on which the participant drank alcohol, engaged in HED, and/or used marijuana (see Table 2: Descriptive statistics and correlations of the goals for change constructs and substance use outcomes for sample sizes by substance). Exit questionnaires also included a qualitative survey, aimed at gauging the participants’ perspectives on the program as a developmentally and culturally tailored intervention. During sessions 1 and 4, three Goals for Change constructs were measured on a 0–4 rating scale, including importance to change, confidence to change, readiness to change, and the preferred substance(s) of use.

Table 2.

Descriptive statistics and correlations of the goals for change constructs and substance use outcomes.

		Baseline		Exit
	n	M	SD	M	SD	Effect size1
Confidence to change	47	2.3	1	3.2	.6	.97**
Readiness to Change	47	2.8	1	3.3	.8	.32**
Importance to change	47	2.9	.8	3	.8	.12
Alcohol Use	21	9.4	5.2	7.4	4.2	.27
Binge Drinking	22	6.1	5	2.7	3.6	.38*
Marijuana Use	22	20.9	11.5	15.8	9.4	.33*

Note: the sample sizes reflect either the total sample size (n = 47) or based on indicated preferred substance at baseline (n = 21, n = 22, n = 22). All bolded means indicate a statistically significant change.

^*Significant at the < .05 level

^**Significant at the < .01 level

¹Effect size refers to Cohen’s d for paired samples t-tests and r for Wilcoxon Rank Order tests.

To evaluate pre-post change from session 1 to 4, we conducted paired samples t-tests using SPSS version 25.⁴³ SPSS version 25 was also used to conduct all other explorative data-analyses and data cleaning. Several normality tests were conducted on change constructs and substance use measures. Non-normal distributions were found for binge drinking at exit, marijuana use at baseline, combined binge drinking and marijuana use at baseline, and readiness to change at exit. We therefore chose to conduct paired samples t-test for the normally distributed variables (alcohol use, importance to change, confidence to change) and Wilcoxon Signed Rank Tests for the non-normally distributed variables (binge drinking, marijuana use and readiness to change). Finally, SPSS version 25 was used for linear regression analyses.

Results

Quantitative Outcomes

Descriptive statistics are provided in Table 2: Descriptive statistics and correlations of the goals for change constructs and substance use outcomes. Using paired samples t-tests and Wilcoxon Rank Order Tests, we found statistically significant increases in confidence to change (t (1,46) = −6.64, p < .001, d = .97) and readiness to change (Z = −3.1, p = .002) from baseline to exit. Importance to change also increased from baseline to exit, but this increase was not statistically significant (t (1,46) = −0.79, p = .43, d = .12).

Regarding the statistical testing of past 30-day substances used, results of the Wilcoxon Rank Order Tests indicated a non-significant decrease in alcohol use (Z = −1.77, p = .08) and a significant decrease in days of and a statistically significant decrease in binge drinking (Z = −2.51, p = .01) between baseline and exit. With regard to past 30-day marijuana use, the results indicated a significant decrease in marijuana use (Z = −2.18, p = .03) between baseline and exit.

Finally, results of the linear regression analyses indicated change in readiness to change predicted the pre-post reduction in binge drinking and marijuana use (F (3,39) = 34.49, p < .001, R² =.74), controlling for baseline readiness to change. As the change in readiness to change increased, combined binge drinking and marijuana use decreased by 4.6 units from pre to post. Confidence to change and importance to change did not significantly predict this change.

Qualitative Outcomes

Our GSC program was well-received based on the qualitative responses from treatment completers. Common themes included (1) the appeal and appropriateness of our GSC program to emerging adults and Latinx and other minority individuals, and (2) the program’s interactive, hands-on nature. Participants made specific comments regarding: (1) coping mechanisms and mindfulness (e.g., “I have tools that can help with coping and more motivation to use these tools;” “I liked how the program taught me things that I already knew but never implemented in my life! Gave me tools to help myself;” and “I was able to mindful for a moment and I hope that remains with me.”); (2) identifying triggers, setting goals, and weighing pros and cons (e.g., “Identifying triggers, stressors, and setting small achievable goals to progress;” “How it helped me realize the pros and cons of my habit and made me more conscious about my drug use;” and “Help me reflect and decide what is good and bad for myself, very structured.”); and (3) program and therapist characteristics (e.g., “I liked that the program was geared towards the individual’s goal and was reflective on the previous goal set forth in the earlier sessions;” “Creating a weekly plan I could visualize and adhere to;” and “My program counselor was particularly supportive and genuinely cared about helping me reach my goals in a very non-judgmental way.”).

Discussion

Implications

Our culturally and developmentally tailored GSC program was developed as part of a SAMHSA-funded project devoted to on-campus intervention for AOD use problems among Latinx emerging adults attending a minority-serving institution. The adaptation and implementation of the 4-session Guided-Self Change (GSC) intervention was informed by focus groups, which addressed cultural assumptions and community needs among Latinx emerging adult college students. Our GSC program was implemented (a) as a harm-reduction intervention, (b) in English, (c) avoiding stereotypical Latinx references, (d) reducing stigma and shame, and (e) in a discrete location, free of charge. Additionally, as per consumer demand, a mindfulness component was added.

Limitations

Although the sample was somewhat small, the intervention proved to be successful on several qualitative and quantitative outcomes. Attrition may have been based on the nature of the institution, since our students predominantly are commuter-students, which may have exacerbated logistical barriers to attending sessions.⁴⁴ Further analysis of dropouts, including the nature and extent of the initial AOD problem, might shed additional light on appropriate treatment length (as those with minor AOD problems might have benefitted from less sessions) and retention rates; however, this type of analysis was not included in the informed consent process. Analyses revealed that over the course of the intervention, there was a significant reduction in combined binge drinking and past 30-day marijuana use; furthermore, past 30-day alcohol use showed a decreasing trend.

Summary

Our culturally and developmentally tailored GSC program resulted in significant decreases in binge drinking and marijuana use among Latinx emerging adult college students with AOD problems. Moreover, GSC led to increased confidence to reduce AOD use and increase readiness to reduce AOD use. Qualitative surveys indicated our program was well-liked and well-received. Participants reported appreciation for the interactive, hands-on nature of the program, the brief harm reduction nature of the program, and the warm and non-judgmental nature of the clinicians. Many participants also noted that the coping strategies learned through GSC generalized beyond substance use to the participants’ daily life and overall coping. Finally, several participants referenced our novel mindfulness component as appealing, helpful, and memorable.

Conclusions

Culturally and developmentally tailored GSC holds promise for widespread implementation across the campuses of minority serving institutions. Implementation of tailored programs and services has the potential to mitigate health disparities among Latinx emerging adult drinkers, who are less likely to seek treatment and have less access than their non-Hispanic counterparts to culturally appropriate and accessible evidence-based services. This is especially salient in current times as the unique needs of racial/ethnic minority groups are universally forefront. Given the high rates and risks associated with collegiate binge drinking, and specifically among Latinx emerging adults ^10–14,45 there is an urgent need for culturally and developmentally tailored interventions on college campuses. Our success with adapting and implementing GSC for Latinx collegians represents early progress in this area.

Figure 2.

Weekly Check-In Sheet

Glossary

binge drinking/heavy episodic drinking

4 drinks in two hours for females/5 drinks in two hours for males

brief motivational intervention

engaging a client in 1 or more (maximum number of sessions differs according to the literature) sessions with the intention of increasing the likelihood of behavior change and/or retention in treatment

change-talk

client statements indicating behavior change

emerging adult

developmental period between adolescence and adulthood defined as late teens through the twenties, with a focus on ages 18–25

Guided Self-Change (GSC)

brief intervention that utilizes motivational and cognitive behavioral strategies with the goal of harm reduction

Latinx

a person of Latin American origin or descent

mindfulness

a present-focused mental state characterized by heightened awareness and acceptance

minority-serving institution (MSI)

an institution of higher learning that serves a mostly minority population

Data Availability Statement:

The data reported on in this manuscript are not open and not available for sharing.