Dr. Michael Madson is a professor in the Counseling Psychology Program at Southern Miss. Madson joined the USM faculty in 2005 and his research involves college student substance use, harm reduction, and motivational interviewing (MI). He directs the Department of Psychology’s Behavior and Alcohol Research Laboratory and its Brief Alcohol Screening and Intervention for College Students (BASICS) program. BASICS provides students at-risk for developing a detectable alcohol use problem with information and strategies to protect themselves and others from the harmful effects of alcohol abuse. BASICS is funded in part by a grant from the American Psychological Foundation and housed in the department’s Community Counseling and Assessment Clinic. Dr. Madson recently took time to discuss the BASICS program, now in its eighth year.
Q: What are the goals of BASICS?
A: The goals of BASICS are to help students become more aware of their alcohol use patterns, how those patterns relate to harm/negative consequences, and to have a conversation about how a student may choose to behave differently when drinking to reduce harm. BASICS is not an abstinence-focused program, but emphasizes harm reduction because that is the approach that seems to be most effective with college students.
Q: What was the inspiration for this program, and what are the desired outcomes?
A: The inspiration nationally for the program came from findings that traditional age college students (18-25) have some of the highest levels of harmful drinking, including binge drinking, even when compared to their non-college peers. However, most of these students tend to change their drinking behavior when leaving college. So, there is something unique about the college environment that facilitates harmful drinking. Traditional approaches, such as education, abstinence-based approaches and even dry campus policies tend not to reduce this problem. In the past, students who got into troubled were labeled as “alcoholic” when most often they did not meet those diagnostic criteria nor truly had an addiction. Thus, BASICS was developed as a means to build students’ internal motivation to change their behavior to keep safe.
At Southern Miss, my goal was to implement the program to combine my research on motivational interviewing and college student alcohol use, train my students in substance use counseling and provide a much-needed service to campus. At that time many traditional university prevention and intervention approaches were used here. BASICS filled a void by adding an evidence-based harm reduction approach to help USM students succeed.
Our desired outcomes include reductions in the amount of harmful alcohol use and associated negative consequences. Over the past seven years we have found that, in fact, students who went through the program have reduced their harmful alcohol use and negative consequences experienced after completing the program, and that these outcomes have been maintained at least one month following program completion.
Some ancillary outcomes we hope for are that students will improve their academic performance and retention at USM. Further, we hope that their experience will increase their likelihood to seek help for other difficulties based on their experience in BASICS. Of course, a long-term outcome is to prevent students’ alcohol use from becoming problematic, which would require more intensive treatment.
Q: What is a working definition of alcoholism? What do we know now about it, based on research, that we did or didn’t know in the past? Are there myths about alcohol use disorder that you have found to be generally held by students and the broader public?
A: Recently the definition of what we often think of as “alcoholism” has changed. In the past we used to refer to it as alcohol dependence. More recently we have conceptualized alcohol use - and what we now call alcohol use disorder - along a continuum ranging from a mild problem to a severe problem depending on the number of symptoms an individual has experienced in the past year. This change better reflects the nature of an alcohol use problem and also matches how alcohol use problems should be treated. Specifically, the general thinking is that somebody with an alcohol problem needs to attend 28 days of rehab in a treatment facility. In fact, that is not the case; many individuals can change their behavior by brief interventions or outpatient counseling. In fact, psychologists at the University of Mississippi Medical Center and I are involved in a program to train medical students on how to screen and provide a brief intervention for patients with a range of alcohol use behaviors. The research shows that for many of those individuals, an intervention such as this is sufficient.
With increasing technology and methods to observe the brain functioning, we are learning more about how alcohol use disorders, and many addictions, can in fact be considered a brain disease. We are learning how after prolonged use of substances, they actually hijack the brain and change its functioning in such a way that the individual actually needs the substance to feel normal. This is hard for friends and family to appreciate as they see alcohol and drug use as a behavior – and it definitely is – but it meets the accepted definition of disease. At the same time, many chronic illnesses such as hypertension also involve behaviors. We can see hypertension improve when a person makes behavioral changes such as eating healthy and exercising. Similarly, we can see physiological and brain changes in individuals when they stop using. As we become more technologically advanced, I’m certain we will learn more about this.
Most college students tend to think that their alcohol use is normative, and that they use alcohol about as much as the average college student. Oftentimes, the students we see are shocked to learn that they are drinking more than about 80-90% of college students their same sex nationwide. In other words, they assume that everybody in college drinks alcohol when in fact it is roughly about 60-65% and just less than half, about 40%, engage in binge drinking. Similarly, their drinking at these levels make them susceptible to developing an alcohol use disorder and to experience a plethora of problems. One of the reasons many traditional approaches to alcohol prevention do not work is because students often have what we call an ‘optimistic bias’ – the belief that they are at a low risk of experiencing negative consequences or developing alcohol use disorder. Providing feedback on this, in a non-judgmental fashion, is a key component of BASICS.
Q: What are the impacts/benefits for you as a researcher, your students and the Department of Psychology?
A: Because psychology is the scientific study of behavior there are many benefits. As a Licensed Psychologist who focuses on prevention and intervention for behavioral problems, the BASICS program provides me a great opportunity to study the BASICS intervention, train graduate students as scientists and practitioners, and most importantly provide an effective service to Southern Miss free of charge to students.
Our graduate students learn that their research has practical implications for helping the lives of college students throughout the world. Many students choose psychology because they want to be practicing psychologists providing psychological services versus conducting research. This applied research program helps them learn how to collect practice-based data that can inform and improve the psychological services they provide.
Q: Describe the relationship(s) between the research component of BASICS and how it is applied in terms of interaction with students who can benefit.
A: As a prevention for harmful drinking, BASICS is appropriate for any traditional-age college student who has concerns or wants to learn about her or his alcohol use. We receive referrals from several departments on campus but also faculty and self-referrals. Because BASICS is individualized to each student, different components may be meaningful for different students. Essentially, BASICS includes two meetings with a counselor. At the first meeting we outline the program and talk with students about their use and other health behaviors. At the second meeting we engage in a conversation with the student providing feedback on the results from the first session and explore what, if anything, a student may want to change. We also provide some information on evidence-based protective behaviors students can use to reduce their harm and discuss how students may want to implement these behaviors. We never force students to do one thing or another – ultimately it is their choice what to do.
Q: What would you say are the highlights of the program in terms of research and outcomes during that time? What have you and your students learned that you didn’t know before, or confirmed previous research/theories/assessments?
A: The major highlight is that our outcomes match those published from programs implemented at other universities nationwide, so that is exciting. Similarly, we are finding that our program does increase students’ use of safe drinking behaviors. We also have found that the BASICS program has increased students’ willingness to seek other services on campus that may help them with non-academic difficulties.
Q: What have you and your students learned about student alcohol use during this time that is useful both for research purposes and for managing alcohol use, and/or treatment of alcoholism?
A: One thing we are seeing in our research is the co-existence of mental health problems and alcohol use. This certainly mirrors what we see in the general population – this high prevalence of psychological problems and substance use. Thus, part of what we suggest in our research is the increased importance of services on college campuses, including BASICS, to screen and potentially address how mental health factors may influence a student’s use of substances. Addressing these issues briefly in BASICS can help students appreciate why they may be drinking at harmful levels – say, to cope – and help facilitate a referral for counseling. This also highlights the importance of mental health professionals appropriately addressing alcohol and other substances as part of their treatment.