The Value of Advocating for Safer Substance Use

The Value of Advocating for Safer (But Not Reduced) Substance Use

By Tom Horvath, PhD

In a study recently published online, researchers at Brown University (a major US addiction research site) compared an intervention to reduce the drinking of heavy drinking college students (without focusing on the consequences of drinking), with an intervention to reduce the negative consequences from drinking (without focusing on the amount of drinking).

Both interventions worked as predicted. The first group (PNF; Personalized Normative Feedback) reduced drinking (without reducing consequences) and the second group (CAA; Counter-Attitudinal Advocacy) reduced consequences (without reducing drinking). The subjects were 585 students who by self-report engaged in episodes of heavy drinking and had experienced at least two significant negative consequences from drinking. After the brief intervention (lasting 5-10 minutes), subjects were assessed at one month, three months, and six months to determine if their drinks per week, typical drinks per day, peak blood alcohol concentration, and alcohol negative consequences had diminished, relative to the control group (which got neither intervention).

PNF is a common method for showing heavy drinking college students that they are heavy drinkers compared to their peers. Their belief that “everyone drinks this way” is typically exaggerated. With PNF the drinker may take on a different view of their drinking and its place in their peer culture. CAA focuses on the perceived benefits of drinking, the belief that drinking is a very important part of the college experience, the value of avoiding alcohol harms, and what specific actions might be taken to minimize risks. This intervention encourages students to come up with their own plans, rather than telling them what to do. (This personalized and non-confrontational approach should be universal!)

The study is significant for several reasons. College students are perhaps the heaviest drinking group in the country. The negative consequences they experience from heavy drinking are substantial. These consequences effect the entire community. Low-cost interventions such as PNF and CAA are highly desirable. Because no approach works with everyone having a wide range of options is valuable. This study demonstrated that focusing specifically on preventing harm in a non-judgmental way can reduce harm. The CAA intervention does not suggest anything like “you drink too much.” Instead, the focus is on “how can we keep you safe?” Even among heavy drinkers that approach is perceived as helpful, and they change accordingly.

Efficacy of counter-attitudinal advocacy and personalized feedback for heavy-drinking college students. Carey, K. B., DiBello, A. M., Hatch, M. R., Weinstein, A. P., & Neighbors, C. (2025). Efficacy of counter-attitudinal advocacy and personalized feedback for heavy-drinking college students. Journal of Consulting and Clinical Psychology. Advance online publication. https://doi.org/10.1037/ccp0000949

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