Intervention Summary

College Drinker's Check-up (CDCU)

College Drinker's Check-up (CDCU) is a computer-based, brief motivational interviewing intervention designed to help reduce the use of alcohol by college students (ages 18-24) who are heavy, episodic drinkers (defined as having four or more drinks per occasion for women and five or more drinks per occasion for men at least once in the past 2 weeks with an estimated peak blood alcohol concentration of 0.08 gram-percent or above). CDCU consists of an integrated set of screening, assessment, personalized feedback, and decisionmaking modules and is based on Drinker's Check-up for heavy-drinking adults. (Drinker's Check-up was reviewed separately by NREPP.) CDCU is delivered using the stepwise FRAMES core elements that constitute a brief motivational interviewing session within the context of an individual's readiness to change:

F--Feedback is personalized.
R--Responsibility for changing is left with the individual.
A--Advice to change is given.
M--Menu of options for changing is offered.
E--Empathic style of information delivery.
S--Self-efficacy is emphasized.

The feedback module of CDCU is tailored to college-age participants with gender- and university-specific norms. As a one-time, 35- to 45-minute intervention with optional, 15- to 20-minute follow-up sessions, CDCU can be used as a stand-alone intervention or as a precursor to more intensive alcohol use treatment interventions.

CDCU is available as a Web application (with a MySQL database) and as a Windows program for use in colleges and universities. The program includes an administrator's module, which can be used to conduct follow-up data collection and generate outcomes reports.

Descriptive Information

Areas of Interest	Substance use disorder treatment
Outcomes	1: Alcohol use
Outcome Categories	Alcohol
Ages	18-25 (Young adult)
Genders	Male Female
Races/Ethnicities	American Indian or Alaska Native Asian Black or African American Hispanic or Latino Native Hawaiian or other Pacific Islander White Race/ethnicity unspecified
Settings	School
Geographic Locations	Urban Suburban
Implementation History	College Drinker's Check-up is an adaptation of Drinker's Check-up. CDCU was first implemented and evaluated And 226 college students participated in two clinical trials. CDCU was made available to college and universities. The College of Social Work at the University of Tennessee, Knoxville, has incorporated CDCU into an online suite of programs for young adults and returning veterans ages 18-24 who live in rural areas of east Tennessee. The University of Oklahoma also has begun implementation of CDCU.
NIH Funding/CER Studies	Partially/fully funded by National Institutes of Health: Yes Evaluated in comparative effectiveness research studies: No
Adaptations	No population- or culture-specific adaptations of the intervention were identified by the developer.
Adverse Effects	No adverse effects, concerns, or unintended consequences were identified by the developer.
IOM Prevention Categories	IOM prevention categories are not applicable.

Quality of Research

Documents Reviewed

The documents below were reviewed for Quality of Research. The research point of contact can provide information regarding the studies reviewed and the availability of additional materials, including those from more recent studies that may have been conducted.

Outcomes

Outcome 1: Alcohol use
Description of Measures	Alcohol use was assessed for the prior 1-month period using four measures from a self-administered, online version of the Brief Drinker Profile (BDP): (1) drinks per week, (2) estimated peak blood alcohol concentration (BAC) in a typical week, (3) average number of drinks during two heavy drinking episodes, and (4) average estimated peak BAC in the two heavy drinking episodes. The BDP, derived from the Comprehensive Drinker Profile, is a 50-minute structured interview that measures the quantity and frequency of current drinking and the severity of risk factors across eight life domains: demographics, family and employment status, history of problem development, alcohol-related problems, severity of dependence, other drug use, additional life problems, and motivation for treatment.
Key Findings	In a 12-month clinical trial, heavy-drinking college students (ages 18-24) from a 4-year public university and a community college were randomly assigned to the intervention group, which received CDCU, or an assessment-only control group. Heavy drinking was defined according to the National Institute on Alcohol Abuse and Alcoholism (NIAAA) criteria for heavy, episodic drinking (i.e., having four or more drinks per occasion for women and five or more drinks per occasion for men at least once in the past 2 weeks with an estimated peak BAC of 0.08 gram-percent or above). Assessments occurred at baseline and at 1 and 12 months after baseline (follow-ups). Findings included the following: At the 1-month follow-up, participants in the intervention group had a lower peak BAC during a typical week (p = .017), a lower average number of drinks during two heavy drinking episodes (p = .017), and a lower average BAC during the two heavy drinking episodes (p = .010) compared with participants in the control group, after controlling for baseline assessments. These group differences were associated with small effect sizes (Cohen's d = 0.41, 0.41, and 0.44, respectively). At the 12-month follow-up, participants in the intervention group had fewer drinks per week (p = .044), a lower average number of drinks during two heavy drinking episodes (p = .021), and a lower average estimated BAC in the two heavy drinking episodes (p = .024) compared with participants in the control group, after controlling for baseline assessments. These group differences were associated with small effect sizes (Cohen's d = 0.36, 0.41, and 0.40, respectively). In a 1-month clinical trial, heavy-drinking college students (ages 18-24) from a 4-year public university and a community college were randomly assigned to the intervention group, which received CDCU, or a delayed-assessment control group. Heavy drinking was defined according to the NIAAA criteria for heavy, episodic drinking. Assessments occurred at baseline and at 1 month after baseline (follow-up) for participants in the intervention group and at 1-month follow-up for participants in the delayed-assessment control group, who completed a retrospective baseline assessment. At the 1-month follow-up, participants in the intervention group had fewer drinks per week (p = .008), a lower estimated peak BAC in a typical week (p = .001), a lower average number of drinks during two heavy drinking episodes (p = .001), and a lower average estimated peak BAC in the two heavy drinking episodes (p = .001) compared with participants in the control group, after controlling for baseline assessments. These group differences were associated with medium and large effect sizes (Cohen's d = 0.60, 0.80, 0.91, and 0.97, respectively).
Studies Measuring Outcome	Study 1, Study 2
Study Designs	Experimental
Quality of Research Rating	3.1 (0.0-4.0 scale)

Study Populations

The following populations were identified in the studies reviewed for Quality of Research.

Study	Age	Gender	Race/Ethnicity
Study 1	18-25 (Young adult)	62.5% Male 37.5% Female	55.6% White 28.5% Hispanic or Latino 6.9% Race/ethnicity unspecified 5.6% Black or African American 2.1% American Indian or Alaska Native 0.7% Asian 0.7% Native Hawaiian or other Pacific Islander
Study 2	18-25 (Young adult)	56.1% Male 43.9% Female	46.3% White 37.8% Hispanic or Latino 9.8% Race/ethnicity unspecified 2.4% American Indian or Alaska Native 2.4% Black or African American 1.2% Asian

Quality of Research Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the Quality of Research for an intervention's reported results using six criteria:

Reliability of measures
Validity of measures
Intervention fidelity
Missing data and attrition
Potential confounding variables
Appropriateness of analysis

For more information about these criteria and the meaning of the ratings, see Quality of Research.

Outcome	Reliability of Measures	Validity of Measures	Fidelity	Missing Data/Attrition	Confounding Variables	Data Analysis	Overall Rating
1: Alcohol use	2.8	2.9	3.3	3.0	2.9	3.5	3.1

Study Strengths

The Brief Drinker Profile (BDP), a well-known assessment instrument, is supported by acceptable reliability and validity in the field, and its adaptation from an interview to an online self-report for use by a college student population was supported by sample test-retest reliability estimates from the second study. Breathalyzer tests and a collateral informant option improved reliability and validity of the assessments in both studies. Intervention fidelity was strengthened by a stand-alone computer delivery system, feedback norms that were appropriately tailored for college students, and the placement of research assistants in the computer room to answer questions while participants accessed the intervention. Attrition was low in both studies (3% and 10% at the 1- and 12-month follow-ups, respectively, in one study and 2% at the 1-month follow-up in another study). The use of a stratified, randomized study and the implementation of a delayed-assessment control (using a retrospective pretest methodology) in one study minimized potential confounding variables. The analysis of covariance modeling of the data in both studies was appropriate and used an adequate sample size on the basis of a prospective power analysis, resulting in excellent control of type I and type II error rates. The use of Bonferroni corrections, the 95% confidence interval, and effect sizes for condition contrasts in addition to the traditional alpha tests of significance added to the overall strength of data modeling and control of type I and type II errors.

Study Weaknesses

Reliability of the peak BAC estimates may have been compromised because participants estimated their weight and amount of time spent drinking, a potential reliability issue also noted in the BDP manual. Psychometrics for the self-report drinking measures were provided by the BDP manual; however, criterion validity correlations between self-reports and collateral reports for estimated peak BAC were substantially lower for steady and per episode drinking (0.39 and 0.36, respectively) than for drinks per week (0.76). The convergent validity provided for the online self-report form of the BDP with the well-established Form 90 was based on an adult community sample, and it is unclear whether generalization to a college student population is justified. There was no direct measurement of implementation fidelity during interactions of participants and research assistants (i.e., when research assistants conducted in-person screenings of participants, when participants accessed the intervention while research assistants were in the computer room). Although attrition at the 12-month follow-up in one study was low (10%), no data comparing noncompleters and completers were reported. As the investigators noted, general maturation, regression to the mean, and a Hawthorne effect on the outcomes cannot be ruled out in both studies. An intent-to-treat approach was not used, and participants with incomplete assessment data were excluded from the statistical analyses in both studies.

Readiness for Dissemination

Materials Reviewed

The materials below were reviewed for Readiness for Dissemination. The implementation point of contact can provide information regarding implementation of the intervention and the availability of additional, updated, or new materials.

The College Drinker's Checkup: Instructions for Customizing the Program for Your Institution and Generating Program Evaluation Outcome Reports

Installation Notes for the Internet Version of the College Drinker's Check-up (CDCU)

Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the intervention's Readiness for Dissemination using three criteria:

Availability of implementation materials
Availability of training and support resources
Availability of quality assurance procedures

For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.

Implementation Materials	Training and Support Resources	Quality Assurance Procedures	Overall Rating
2.8	1.5	2.5	2.3

Dissemination Strengths

The program Web site clearly describes the target population and the purpose of the program. The Web site includes an easy-to-navigate administrator's module, which has features for customizing the program for a specific institution. Students receive individual feedback throughout the process of using the program and can create customized action plans. Several outcome measures are available (including student follow-up surveys), as well as customized individual reports and detailed aggregated reports.

Dissemination Weaknesses

Instructions for setting up and implementing the program are provided through a brief document, not a thorough implementation guide. Although implementation support and technical assistance are available, no information is provided for accessing this support; in addition, no training materials are available for implementers. Minimal guidance is provided for customizing the data collection and creating reports with the administrator's module.

Costs

The cost information below was provided by the developer. Although this cost information may have been updated by the developer since the time of review, it may not reflect the current costs or availability of items (including newly developed or discontinued items). The implementation point of contact can provide current information and discuss implementation requirements.

Item Description	Cost	Required by Developer
Program license (includes the Web application and Windows program)	$2,500 for colleges with fewer than 15,000 students $4,500 for colleges with more than 15,000 students	Yes
Administrator's module	Included with license	Yes
Installation notes for the Web application and instructions for setting up a MySQL database	Included with license	Yes
Phone technical assistance and consultation	$125 per hour	No

Additional Information

The program license is a one-time purchase; there are no annual renewal fees or fees for each user.