International Journal of Drug Policy 17 (2006) 310–319

Review

Reduction of alcohol-related harm on United States college campuses:

The use of personal feedback interventions
Helene Raskin White ∗
Rutgers Center of Alcohol Studies, 607 Allison Road, Piscataway, NJ 08854-8001, USA

Received 7 June 2005; received in revised form 11 October 2005; accepted 6 February 2006

Abstract

This paper reviews research evaluating personalised feedback interventions (PFIs) for reducing the harms associated with alcohol abuse
among US college students. PFIs provide students with feedback about their own alcohol use relative to college norms, as well as information
about other aspects of their drinking behaviours, related problems and/or perceived risks. Studies conducted in the United States using
randomised designs indicate that PFIs are efficacious for reducing various aspects of alcohol use and/or related negative consequences for
both high-risk volunteer and mandated college students. To date, these studies have demonstrated that written-feedback-only PFIs are as
efficacious as brief in-person PFIs, at least on a short-term duration. Therefore, college administrators should be encouraged to develop
interventions to screen students and provide written personal feedback in order to reduce high-risk drinking patterns among college students.
Web-based approaches might prove to be a very cost-effective strategy, although more research is needed to determine their efficacy, as well
as what aspects of the feedback are the most effective.
© 2006 Elsevier B.V. All rights reserved.

Keywords: Drinking; Alcohol; College students; Interventions; Feedback

Introduction
In the United States (US), significant increases in the
frequency and quantity of alcohol use occur during the tran-
sition from high school to college (Bachman, Wadsworth,
O’Malley, Johnston, & Schulenberg, 1997). Many young
people leave their homes, parents, and old friends when they
enter college. These changes lead to new freedoms and reduc-
tions of informal social controls. In addition, first-year college
students have more free time than they did while attend-
ing high school. All of these new freedoms contribute to
an increase in alcohol use among first-year college students
(Arnett, 2005; Maggs, 1997; White & Jackson, 2004/2005).
Young people also face more challenges during their first
year of college than they did in high school, such as pay-
ing for school and balancing social pressures with academic
demands, new roles and the need to develop new friendships,
all of which may create stress. Some students may turn to
∗ Tel.: +1 732 445 3579; fax: +1 732 445 3500.
E-mail address: hewhite@rci.rutgers.edu.
alcohol to cope with this stress and associate with peers who
also use alcohol to cope and who reinforce such behaviour
(Paschall & Flewelling, 2002). In addition, first-year stu-
dents may perceive heavy drinking as normative behaviour
among their peers and may come to college with positive
alcohol expectancies (Maggs, 1997; Paschall & Flewelling,
2002). Finally, alcohol use may facilitate the making of new
friendships (Schulenburg & Maggs, 2002; White & Jackson,
2004/2005). Therefore, increases in drinking as young peo-
ple enter college may be for positive reasons (for example,
to be social) and for negative reasons (to cope with stress
or to conform to misperceived norms). Cooper, Agocha, and
Sheldon (2000) found that drinking to cope with negative
circumstances predicted heavy drinking among college stu-
dents. However, research suggests that college students are
more likely to drink for positive or celebratory reasons than to
cope with negative feelings (Read, Wood, Kahler, Maddock,
& Palfai, 2003).
Whereas there may be some benefits of drinking for
college students (such as socialising), excessive drinking
among this group is associated with negative consequences

0955-3959/$ – see front matter © 2006 Elsevier B.V. All rights reserved.
doi:10.1016/j.drugpo.2006.02.006
 H.R. White / International Journal of Drug Policy 17 (2006) 310–319
that can have long-term repercussions (White & Jackson,
2004/2005). In 2001, more than 1700 US college student
deaths and over 500,000 unintentional injuries were alcohol-
related (Hingson, Heeren, Winter, & Wechsler, 2005). Exces-
sive drinking by college students increases the risks of fatal
and non-fatal injuries, academic failure, violence and other
crime and unsafe sexual behaviour (Goldman, 2002; Presley,
Meilman, & Cashin, 1996; Wechsler, Lee, Kuo, & Lee,
2000; Wechsler, Lee, Nelson, & Lee, 2001). In addition,
there are second-hand negative consequences from exces-
sive drinking by students that are experienced by others on
campus and in local neighbourhoods (for example, physical
and sexual assaults, vandalism, insults and humiliation, sleep
disturbances and so on) (Wechsler et al., 2001). Therefore,
interventions are needed to reduce the harms associated with
excessive drinking among college students.
Although 31% of US college students report symptoms
of alcohol abuse and 6% report symptoms of dependence
(Knight et al., 2002), most will outgrow heavy drinking and
alcohol problems on their own and without treatment (Marlatt
et al., 1998; Schulenberg, O’Malley, Bachman, Wadsworth,
& Johnston, 1996; Weingardt et al., 1998). However, young
people are still vulnerable to harmful consequences during
their peak using years. Therefore, more effective prevention
programs are needed to help students safely move through
this risky developmental period (Dimeff, Baer, Kivlahan, &
Marlatt, 1999). Furthermore, although most heavy drinkers
mature out, there exists a subset that maintains heavy drinking
and goes on to develop more serious problems with alcohol
after college (O’Neill, Parra, & Sher, 2001). Unfortunately,
it is difficult to predict in advance who will and who will
not mature out. Therefore, heavy-drinking college students
represent an important target group for prevention efforts.
It is especially important to reach at-risk students who do
not typically seek help. College campuses are settings where
young people with problems can be identified and treated
(Barnett, Monti, & Wood, 2001). Campuses need to imple-
ment new strategies for screening and early identification of
high-risk youths and ensure that treatment is readily available
to those in need (Knight et al., 2002, p. 263).
Over the last decade, and especially the last several years,
there has been massive growth in college prevention pro-
grams, although few have been evaluated properly (Anderson
& Milgram, 1996, 2001). Furthermore, the proliferation of
college prevention programs has not led to a reduction in
problems related to alcohol use among college students
(Wechsler et al., 2002). For the most part, universal programs
have been the least successful (Chiauzzi, Green, Lord, Thum,
& Goldstein, 2005; Moskowitz, 1989). Targeted and indi-
cated programs may be especially cost-effective because they
reach students who could potentially benefit the most from
the intervention (Larimer et al., 2001). A thorough review
of individually oriented interventions with adequate evalu-
ation designs was conducted for the US National Institute
on Alcohol Abuse and Alcoholism Task Force on College
Drinking (Task Force of the National Advisory Council on
311
Alcohol Abuse and Alcoholism, 2002). The authors con-
cluded that the most effective individual approaches for alco-
hol prevention on college campuses were: (1) interventions
that combined brief cognitive-behavioural skills with norms
clarification and motivational enhancement; (2) brief motiva-
tional enhancement interventions; and (3) alcohol expectancy
challenges (Larimer & Cronce, 2002). Brief interventions
are needed because most multi-component programs are
resource-intensive, making them difficult to implement on
a large scale (Boyd & Faden, 2002).
Brief interventions have been used in a variety
of settings—including college health centres, emergency
rooms, crisis centres and physicians’ offices—and are usu-
ally defined as minimal contact with a medical or mental
health professional that ranges from several minutes to sev-
eral sessions in length (usually one or two sessions, but almost
always less than four) (Barnett et al., 2001; Bien, Miller, &
Tonigan, 1993; Dimeff et al., 1999). Brief and inexpensive
interventions have demonstrated effectiveness with individ-
uals who are not seeking help (Heather, 1998). Studies have
also shown a positive effect of brief interventions in health
care settings with adult problem drinkers (Babor & Grant,
1992; Ballesteros, Duffy, Querejeta, Ariño, & González-
Pinto, 2004; Barnett et al., 2001). A major advantage of
brief interventions is that they are cost-effective and, thus,
can reach large numbers of people. Therefore, even pro-
grams with small individual effects can have an overall large
effect on society. The purpose of this paper is to describe the
rationale for brief personal feedback interventions for college
students and to summarise evaluations of these interventions.
Brief personal feedback interventions
One type of brief intervention that has been particularly
effective with college students is brief personal feedback
interventions (PFIs). PFIs assume that by receiving infor-
mation about one’s own drinking patterns in relation to peers
and personal risk factors, the individual will be motivated
to change, develop a strategy for change and implement
change (Miller, Toscova, Miller, & Sanchez, 2000). PFIs are
designed, therefore, to heighten the participant’s awareness
of personal patterns of use, peer norms, risks related to use
and the experience of negative consequences under certain
drinking conditions. The increased awareness and salience
of personal risk factors is a key component of theories of
behavioural change (Larimer et al., 2001, p. 372). Further-
more, because students tend to over-estimate the acceptability
of heavy drinking by peers and the amounts of alcohol that
other students drink (Borsari & Carey, 2001, 2003; Perkins,
2002), individualised feedback to counteract these misper-
ceptions is hypothesised to reduce harmful drinking.
PFIs are recommended for people who do not exhibit
severe substance use dependence but, rather, have mild to
moderate problems or who use substances in harmful ways
(Dimeff et al., 1999). Such interventions seem particularly
312 H.R. White / International Journal of Drug Policy 17 (2006) 310–319
appropriate with college students who often demonstrate
risky use of substances or who use in combination with at-risk
situations (for example, alcohol-impaired driving). PFIs are
often conducted in person within the context of a brief motiva-
tional interview (BMI), a technique that focuses on increasing
clients’ motivations to change (Miller & Rollnick, 2002). A
major goal of BMIs is to make clients aware of the discrep-
ancy between their actual and desired behaviour. BMIs have
the potential to be especially effective with young people
because they are tailored for individuals who may not be inter-
ested in changing their behaviour and utilise strategies that are
appropriate to individuals’ readiness to change (Barnett et al.,
2001). Marlatt, Larimer, Baer, & Quigley (1993) identified
numerous advantages of BMIs for college students. First, the
non-confrontational and non-judgemental style of a BMI is
appropriate for college students who are generally defensive
about their drinking and do not respond positively to being
lectured. Second, this technique avoids labelling young peo-
ple as having a problem or as being a substance abuser. Third,
the technique is based on each individual’s specific history
and risk factors. Therefore, it addresses the highly variable
nature of college drinking behaviour. Finally, because BMIs
put the responsibility on the individual to recognise his or her
own need to change, the student is treated as a ‘thoughtful
adult’.
Many PFIs for college students have been modelled on the
Brief Alcohol Screening and Intervention for College Stu-
dents (BASICS) model, which was designed as a model BMI
for alcohol prevention among this population (Dimeff et al.,
1999). The BASICS program combines Miller & Rollnick’s
(2002) concept of motivational enhancement with cognitive-
behavioural skills training (Baer et al., 1992) within a harm
reduction perspective (Marlatt, Baer, & Larimer, 1995). The
primary goal is to move students to reduce risky behaviours
and avoid the harmful effects from drinking rather than focus
on a specific drinking target, such as abstinence (Dimeff et al.,
1999, p. 5). BASICS is conducted in two sessions. In the first
session, assessments of drinking are made, and information
is presented about alcohol use, such as the effects of varying
blood alcohol concentrations (BACs). In the second session,
the student is given feedback about his or her drinking in
relation to other students, and then strategies to reduce risk
are discussed. The feedback sheet contains information on a
student’s drinking pattern relative to other college students,
his or her peak BAC level, alcohol-related problems and per-
sonal risk factors (for example, dependence symptoms and
family history of alcoholism; see Dimeff et al., 1999; Murphy
et al., 2001).
The theoretical model for BASICS assumes that, upon
receiving feedback on the extent of one’s personal risk, alco-
hol use and expectancies in relation to peers, the student
will increase his or her readiness to change his or her drink-
ing behaviours (Miller & Rollnick, 2002). In addition, the
students’ perceptions about risk, peer use and alcohol/drug
expectancies will change (Dimeff et al., 1999). These changes
will lead to reduced drinking, which in turn should reduce
negative consequences of use. The BASICS model, thus,
relies on motivational enhancement techniques to increase
clients’ readiness for change and to help guide them through
the change process (Dimeff et al., 1999). BASICS has been
tested on several college campuses throughout the United
States. Below, results from these studies, as well as other stud-
ies that have evaluated PFIs for college students, are reviewed.
Evaluations of personal feedback interventions
Some of the studies evaluating PFIs with college students
have incorporated a PFI within the context of an in-person
intervention, and others have used written feedback only.
Most of the evaluations have used samples of student vol-
unteers, generally screened for high risk, and most of these
studies were included in a recent review by Walters and
Neighbors (2005). A few studies have also evaluated PFIs for
mandated students. This paper extends Walters and Neigh-
bors’ review by adding four studies of mandated students
(Barnett, Colby, & Monti, 2004; Borsari & Carey, 2005;
Fromme & Corbin, 2004; White et al., 2006), which were
not published at the time that the authors wrote their review,
as well as one new Web-based study (Chiauzzi et al., 2005)
and another study that was not included in their review (Nye,
Agnostinelli, & Smith, 1999). Two studies included in the
Walters and Neighbors’ review (Dimeff & McNeely, 2000;
Walters, 2000) are not summarised here, because the cited
references did not provide enough information about their
design and/or findings to be able to adequately summarise
them. Only studies that have used randomised designs are
included in this review.
Interventions with student volunteers
Baer et al. (1992) randomised students to either a class-
room format, which entailed six 90-min weekly meetings
including an alcohol challenge, or to an individualised feed-
back and advice format, which included an assessment and
1 h of personalised feedback in the context of a motiva-
tional interview. Follow-ups were conducted at 3, 6, 12 and
24 months. Both groups (approximate N = 69 at follow-up)
reduced their frequency and volume of drinking by about 40%
from baseline to follow-up, and reductions were maintained
over time. There were no significant differences between
individuals who attended the classes and those who received
the brief feedback intervention, although students were more
favourable about the classroom intervention. This study was
one of the earliest to demonstrate that a brief intervention for
college students could be successful in modifying drinking
behaviours. However, the relatively small N and lack of a
no-treatment control group were limitations.
Marlatt et al. (1998) evaluated the efficacy of the BASICS
model with 348 high-risk student volunteers who were
randomly assigned to the intervention condition or to an
assessment-only control group. During the winter of their
 H.R. White / International Journal of Drug Policy 17 (2006) 310–319
freshman year, students in the PFI met with an interviewer and
received personal feedback about their drinking in relation to
college averages, risk behaviours, personal risks for problems
and beliefs about alcohol effects. Each student was given
a written personalised feedback profile along with generic
information about alcohol and strategies for reducing risk.
At the 6-month follow-up, those in the PFI reported less fre-
quent drinking, lower quantities and lower peak quantities
over time compared to the controls. Effect sizes were rel-
atively small (standardised effect sizes of about 0.15). The
following year, members of the PFI group were sent written
feedback regarding their responses to the baseline, 6-month
and 12-month assessments and some (especially those at risk)
received a second BMI in person or over the telephone. At the
2-year follow-up, there were significant reductions in drink-
ing and related problems for all students; however, those in the
PFI group displayed significantly greater reduction in drink-
ing rates (effect sizes ranged from 0.14 to 0.20) and problems
(effect size of 0.32) than those in the control group (Marlatt et
al., 1998). The results were maintained when outcomes were
compared by gender, parental history of alcoholism, conduct
problems and whether or not students lived in fraternities or
sororities. A 4-year follow-up indicated that these PFI effects
were sustained over time (Baer, Kivlahan, Blume, McKnight,
& Marlatt, 2001).
At the same school, Larimer et al. (2001) administered a
similar intervention to fraternity members. Fraternities were
randomly assigned to a PFI (N = 77) or an assessment-only
control group (N = 82). Students in the PFI received a 1-h indi-
vidually tailored feedback session, presented according to the
principles of motivational interviewing. PFI students reported
greater reductions in the number of drinks per week (effect
size = 0.42) and typical peak BAC (effect size = 0.38) com-
pared to controls. There were no significant group differences
in volume of alcohol consumed per occasion, frequency of
drinking or alcohol-related problems. Students who received
their intervention from peers (trained undergraduates) rather
than from professionals (trained psychology graduate stu-
dents) reported significantly greater reductions in peak BAC
(effect size = 0.58).
At another university, Borsari and Carey (2000) evaluated
the efficacy of a PFI within a BMI, based on the BASICS
model. They randomly assigned 29 students to the PFI and
31 students to a no-treatment control group. At the 6-week
follow-up, the brief intervention group reported significantly
greater reductions in frequency of overall drinking (effect
size = 0.28), frequency of heavy drinking (effect size = 0.12)
and number of drinks per week (effect size = 0.21) compared
to controls. There were no group differences in alcohol-
related problems. The authors found that perceptions of typi-
cal student drinking mediated the effects of the intervention.
Results should be interpreted with caution, given the rela-
tively small sample size.
Murphy et al. (2001) also evaluated the BASICS model.
High-risk student volunteers were randomly assigned to: (1)
a 50-min session, in which the student met individually with
313
a clinician and discussed his or her personal feedback sheet
(N = 30); (2) an alcohol education condition, consisting of a
30-min video on consequences of drinking and then a 20-
min individual session with a clinician to discuss the video,
as well as a generic information sheet on risks of drinking
for college students (N = 29); or (3) a no-treatment control
group (N = 25). Students were followed up at 3 and 9 months
after the intervention. Given the small sample size, there were
no statistically significant differences among the groups on
the drinking variables. However, at the 3-month follow-up,
effect sizes indicated that BASICS students reported greater
reductions in frequency of drinking than the participants of
the education (between group effect size = 0.46) and control
(between group effect size = 0.46) groups and greater reduc-
tions in alcohol problems than the control students (between
group effect size = 0.33). At the 9-month follow-up, there
were no significant differences among groups for the drinking
variables. The study also found that the PFI was more effi-
cacious with heavier than lighter drinkers. Finally, students
in the BASICS group rated the intervention more favourably
than those in the education group.
Using a small sample of 72 high-risk drinker volunteers,
Nye et al. (1999) evaluated the efficacy of two types of writ-
ten personal feedback (self-focusing and normative) deliv-
ered in person. The self-focusing feedback provided students
with information about their own drinking patterns, whereas
the normative feedback provided students with information
about drinking patterns of college students of their same
sex. Study participants were randomly assigned to one of
four groups (self-focusing-only, normative-only, both self-
focusing and normative, and a control group that received
printed material on a health issue unrelated to alcohol); group
sample sizes for this study were relatively small. Students
who received either the normative information alone or the
self-focusing information alone perceived the greatest per-
sonal alcohol problem recognition and provided the most
negative evaluations of their own drinking. The group that
received both types of feedback decreased problem recogni-
tion, possibly because the combined feedback created more
defensiveness. Effects sizes were not presented.
Neal and Carey (2004) compared two types of feedback
interventions delivered in a small group context for the major-
ity of participants (five students received the session indi-
vidually). High-risk volunteers were randomly assigned to
a PFI delivered in a small group (N = 31), a personal striv-
ing assessment (PSA) group (N = 31) or an attention control
group (N = 30). Students in the PFI received personal feed-
back on their own drinking and normative comparison data, as
well as feedback on their frequency of alcohol-related prob-
lems. Students in the PSA group participated in an exercise
in which they rated how each of their 10 most important
personal strivings (presented to them on a form) would be
affected by various levels of alcohol consumption. The atten-
tion control group received a handout on alcohol absorption
and metabolism, which was explained in a lecture format. Fol-
lowing the intervention, PFI students showed a significantly
314 H.R. White / International Journal of Drug Policy 17 (2006) 310–319
higher intention to reduce their drinking than the PSA and
control groups and higher discrepancy compared to the con-
trol group, although the authors provided no effect sizes. The
three groups did not differ in terms of reported negative affect
or any drinking outcome measured the week following the
intervention.
Murphy et al. (2004) randomly assigned high-risk stu-
dent volunteers to either receive written personal feedback
and a harm reduction sheet only (N = 28) or to receive writ-
ten personal feedback and a harm reduction sheet within the
context of a BMI (N = 26). At the 6-month follow-up, stu-
dents in both conditions reduced their frequency of drinking,
number of drinks per week and frequency of heavy drinking
with medium effects sizes (mean within group effect size was
0.42 for the feedback-only group and 0.48 for the feedback
plus BMI group), although there were no significant reduc-
tions in alcohol-related problems. There were no significant
differences between intervention conditions, demonstrating
that written PFIs can be as efficacious as in-person PFIs.
The small sample size may have contributed to the inabil-
ity to detect group differences. Furthermore, there was no
no-treatment control group.
A few studies have evaluated mailed PFIs. Agostinelli,
Brown, and Miller (1995) evaluated the efficacy of a mailed
PFI with a very small sample of high-risk student volunteers
(N = 26). After completing a baseline assessment, students
were randomly assigned to receive written feedback by mail
or to a no-contact control group. Six weeks later, those in the
PFI significantly reduced their alcohol consumption (effect
size of 1.14) and average BAC (effect size = 1.00) compared
to the control group, but not their peak BAC.
Using a small sample of high-risk volunteers (N = 37),
Walters, Bennett, and Miller (2000) also compared a 2-h
small group intervention with mailed personal feedback to
a mailed PFI-only condition and a no-contact control condi-
tion. At the 6-week follow-up, the mailed PFI significantly
decreased the number of drinks per month (within group
effect size = 1.01) relative to controls (within group effect
size = 0.04). The group intervention plus feedback group did
not differ significantly from the other two groups (within
group effect size = 0.60). There were no significant differ-
ences among groups in terms of peak BAC, alcohol-related
consequences and alcohol expectancies, although the small
sample size may have affected these results. Overall, the
results indicated that a feedback-only intervention was as effi-
cacious as a more intense in-person intervention in reducing
drinking behaviour over a short time period.
Collins, Carey, and Sliwinski (2002) expanded upon these
studies of mailed feedback and evaluated the efficacy of
a mailed PFI for at-risk college student volunteers. Stu-
dents were randomly assigned to the PFI group (N = 47)
or an attention-control group (which received a psycho-
educational brochure about alcohol, N = 48). At the 6-week
follow-up, students in the PFI reported fewer drinks per
heaviest drinking week (between group effect size = 0.28)
and fewer heavy-drinking episodes (between group effect
size = 0.33) than controls; however, these significant differ-
ences disappeared at the 6-month follow-up. The intervention
did not affect peak BAC or alcohol-related consequences. The
researchers suggested that future PFIs should include infor-
mation about negative consequences on the feedback sheet.
Although the sample for this study was larger than the pre-
vious two evaluations of mailed interventions, the follow-up
sample was still relatively small.
In addition to mailed feedback, a couple of recent studies
have evaluated computer-delivered feedback. In a study by
Neighbors, Larimer, and Lewis (2004), heavy drinkers (based
on a large screening) completed a baseline assessment and
were randomly assigned to receive a PFI delivered imme-
diately by computer and then printed out (N = 126) or to a
no-treatment control group (N = 126). The feedback profile
included only information about the amount the participant
consumed, his or her perceptions about other students’ drink-
ing, and other students’ actual drinking. The results indicated
that there were significant reductions in drinking behaviour
for the intervention group relative to the control group at
both the 3- and 6-month follow-ups (effect sizes = 0.35 and
0.36, respectively). In addition, at both follow-ups, there were
significant differences in perception of peer norms (effect
sizes = 0.61 and 0.63, respectively). Consistent with the find-
ings of the Borsari and Carey (2000) study, the reduction in
drinking was mediated by the reduction in perceptions of peer
use.
In another study, Chiauzzi et al. (2005) evaluated the effi-
cacy of a Web-based PFI. Heavy drinking college students
were randomised by sex to either an interactive Web site that
offered motivational feedback (known as ‘My Student Body:
Alcohol’) (N = 105) or to a control group that received alcohol
education on a Web site (N = 110). Both groups were expected
to access the Web site for four weekly 20-min sessions. Stu-
dents were followed up approximately 1 month after baseline
and 3 months post-intervention. Both groups showed signifi-
cant decreases in alcohol frequency, occasions of binge drink-
ing and alcohol quantity over time. At the 1-month follow-up,
PFI students decreased their maximum number of drinks con-
sumed on a drinking day more quickly (from logged 2.0 to
1.56) than controls (from logged 1.8 to 1.6) and decreased
their overall drinking composite measure (from z-score −.09
to −.32), whereas controls increased their overall drinking
(from z-score .23 to .39). At the 3-month follow-up, there
were no significant differences between groups on any alco-
hol use measure. However, significant differences between
the PFI and control groups were found for women, persistent
heavy drinkers and drinkers with low motivation to change.
Within each of these subgroups, students in the PFI condi-
tion reduced their alcohol consumption rates faster than those
in the control condition. Furthermore, non-White students
reduced their drinking more quickly than White students.
Finally, PFI students reported more favourable evaluations
of the intervention site than education students. The PFI con-
dition included educational, motivational and skill building
components, and it is not possible, therefore, to attribute the
 H.R. White / International Journal of Drug Policy 17 (2006) 310–319
positive effects of the intervention specifically to the feedback
component.
In sum, the above studies have demonstrated that in-
person, mailed and computer-generated PFIs are effective in
reducing alcohol use and/or related problems among heavy
drinking college student volunteers. Nevertheless, the results
should be interpreted cautiously due to the small sample sizes
and short-term follow-ups in many of the studies.
Interventions with mandated students
A few recent studies have evaluated PFIs for students
mandated to receive an intervention because of infractions
of university rules concerning alcohol use. Such students
are an important target group for interventions (Larimer &
Cronce, 2002) and generally report higher drinking rates,
more alcohol-related problems and lower grades than other
students (Fromme & Corbin, 2004; Tevyaw, Monti, & Colby,
2004).
Borsari and Carey (2005) compared high-risk mandated
students in an in-person PFI (N = 34) to those receiving an
alcohol education intervention (N = 30). Both interventions
were conducted one-on-one. The PFI was provided within the
context of a BMI, using the principles of motivational inter-
viewing (Miller & Rollnick, 2002). At the 6-month follow-
up, both groups significantly reduced their heavy drinking
episodes (PFI within group effect size = 0.39; alcohol educa-
tion group = 0.52). The PFI intervention group (within group
effect size = 1.11) showed significantly greater reductions
in the alcohol-related problems than the alcohol education
group (within group effect size = 0.07) (between group effect
size = 0.39). Although there was no significant time by group
interaction effect for typical BAC, the reduction was larger
for the PFI (within group effect size = 0.67) than for the alco-
hol education group (within group effect size = 0.19).
White et al. (2006) (see also White, Labouvie, Morgan,
Pugh, & Celinska, 2005) evaluated a brief PFI for mandated
college students. The program was modelled after BASICS.
After the initial assessment session, students were randomly
assigned to either receive a written personal feedback pro-
file only (N = 104) or to go over their personal profile with
a counselor within the context of a BMI (N = 118). At the
3-month follow-up, students in both conditions significantly
reduced their number of drinks per week (effect size = 0.32),
peak BAC in a typical week (effect size = 0.46), occasions of
high-volume drinking (effect size = 0.14) and alcohol-related
problems (effect size = 0.58). In addition, there was a sig-
nificant decrease in the percent of students who smoked
cigarettes (24% decrease) and used cannabis (20% decrease),
as well as in the number of drug-related problems (effect
size = 0.19). The authors also found that both PFIs had a sig-
nificant effect on proposed mediators; participants in both
conditions significantly reduced their perception of the num-
ber of students who use cannabis (effect size = 0.26) and
other drugs (effect size = 0.27) and increased their readiness
to change (effect size = 0.19), although there was no differ-
315
ence between intervention groups. As found in the Murphy
et al. (2004) study, there were no significant differences in
any outcome (or mediator) between those who received the
in-person intervention and those who received only written
feedback.
Barnett et al. (2004) compared a one-session BMI with
personal feedback to a standard alcohol education interven-
tion (using the CD-ROM, Alcohol 101). After the interven-
tion, students were randomly assigned to receive a booster
session 1 month later. The booster session was the same for-
mat as their original intervention, although somewhat shorter.
Students with and without the booster were followed up 3
months after the baseline intervention. Preliminary findings
for 117 students indicated that both intervention groups (BMI
and education) significantly reduced their frequency of drink-
ing, frequency of heavy drinking and the number of drinks
per week, although no between group differences were found
for these outcomes (effect sizes were not presented). Students
in the alcohol education group reduced their typical BAC sig-
nificantly more than those in the BMI (possibly because the
CD-ROM focused on BAC levels). There were no changes
in the number of alcohol-related negative consequences. Stu-
dents in the BMI group with the booster session were more
likely to seek further counseling compared to those in the
other three groups.
Fromme and Corbin (2004) evaluated the Lifestyle Man-
agement Class (LMC) using 403 high-risk volunteers and 113
mandated college students. Students were randomly assigned
to either a peer-led LMC (N = 193), a professionally led LMC
(N = 159) or to a control group (wait-list control group for
mandated students or assessment-only control group for vol-
unteers) (N = 164). The LMC involved two 2-h classes with
about 10 students in each group. In the first session, students
completed an assessment of their drinking behaviour and then
discussed alcohol use, behavioural change, self-management
and moderation. In the second session they were provided
with graphic feedback about their drinking in comparison to
peer use and there was more discussion about alcohol use,
peer norms and harm reduction strategies. Students were
followed up approximately 6 weeks after the pre-test and
6 months post-intervention. All groups, including the con-
trol group, reduced their drinking over time. At the 6 week
post-test, the only alcohol-related outcome that differentiated
between treatment and control groups was that the treatment
groups reported a greater decrease in instances of alcohol-
impaired driving (within group effect sizes for mandated
students ranged from 0.03 to 0.22 and for volunteer students
from 0.17 to 0.20) than controls (within group effect size
ranged from −0.09 to 0.00). At the 6-month follow-up, there
were no significant effects involving treatment condition. The
results indicated that there were no differences in alcohol use
outcomes among students in the peer-led and professionally
led LMCs.
In sum, all studies evaluating the efficacy of interventions
with mandated students showed declines in alcohol use out-
comes, although the type of intervention did not appear to
316 H.R. White / International Journal of Drug Policy 17 (2006) 310–319
affect most outcomes. Because of ethical reasons, it is often
difficult to assign mandated students to a no-treatment con-
trol group. Therefore, only the Fromme and Corbin (2004)
study had a no-treatment (wait list) control group, and for
most of the drinking variables, these students improved sim-
ilarly to those receiving the intervention. The absence of a
no-treatment control group in the other three studies of man-
dated students makes it difficult to determine the specific
effects of the intervention relative to being reprimanded or
simply being assessed.
Discussion
The results of rigorous evaluations of PFIs with US college
students have been quite promising. Students receiving per-
sonal feedback regarding their own drinking and peer norms
reduce drinking and related problems more than those who
do not receive feedback, and, thus far, this finding holds
regardless of whether the feedback is presented in person or
not. Similar findings have been reported outside the United
States. For example, university students in New Zealand
were randomly assigned to a computerised assessment and
PFI in the context of a BMI or to a leaflet-only control
condition. Students in the PFI significantly reduced their
drinking and related problems relative to controls (Kypri,
2004).
Therefore, the efficacy of BMIs for college students may
not depend on personal contact, but instead may be the result
of the feedback provided (Larimer & Cronce, 2002). In fact,
both Murphy et al. (2004) and White et al. (2006) compared
in-person to written feedback-only PFIs and demonstrated
that written feedback alone was as effective as in-person
feedback to reduce harmful drinking behaviours, at least on a
short-term basis. The former study used high-risk college stu-
dent volunteers and the latter was conducted with mandated
students. However, the first study was based on a relatively
small sample and neither study utilised a no-treatment con-
trol group. Therefore, it is possible that assessment alone may
have had a positive effect on reducing drinking behaviour
(Fromme & Corbin, 2004; White et al., 2006). However,
White et al. (2006) compared their mandated students to a
representative sample of college students who were assessed
twice—2 months apart—as a control group for a different
study (i.e., they served as a quasi-control group for the PFI
students). The analyses indicated that the observed changes
from baseline to follow-up among the mandated students
receiving the PFI were not due to normal developmental
reductions in substance use over the course of a college
year. White et al. (2006) found that the quasi-control group
increased some aspects of their drinking (such as the num-
ber of drinks per week and peak BAC) after a baseline
assessment, whereas the mandated students receiving the PFI
decreased in these same drinking measures. Furthermore,
several short-term follow-up studies have demonstrated that
mailed PFIs lead to reductions in drinking compared to no-
treatment controls (for example, Agostinelli et al., 1995;
Collins et al., 2002; Walters et al., 2000), and in all of these
studies, the control group completed a baseline assessment.
Therefore, to date, no studies have demonstrated that in-
person PFIs are superior to written feedback alone (mailed
or off the Web), and existing studies have suggested that
feedback-alone is associated with reductions in drinking
compared to assessment-only. Group formats for providing
feedback have not proven to be as efficacious as these other
modes (Walters & Neighbors, 2005). Longer term follow-ups
are needed to demonstrate that these reductions are sustained
over time. Given the existing evidence, however, it is reason-
able to hypothesise that written feedback can be an efficacious
approach for reducing the harms related to alcohol use among
college students. Murphy et al. (2004) suggested that written
PFIs may be particularly effective with ambivalent students
who might increase resistance in the presence of a counselor.
Electronic assessment and feedback may be an especially
cost-effective strategy for providing PFIs to college students.
In focus groups conducted in New Zealand, high-risk college
student drinkers expressed an interest in electronic assess-
ment and feedback in contrast to a reluctance to discuss
their drinking with a doctor or another health professional
(Kypri, 2004). Furthermore, an anonymous survey of New
Zealand university students found that electronic screening
and brief intervention was the most popular intervention
strategy endorsed by students (Kypri, 2004). Students in the
US also prefer unassisted, self-directed or minimal-contact
alcohol use interventions over other types of interventions
(Chiauzzi et al., 2005).
Furthermore, personal computer (for example, Neighbors
et al., 2004) and Web-based (for example, Chiauzzi et al.,
2005) feedbacks have been shown to be efficacious in reduc-
ing alcohol consumption among heavy-drinking college stu-
dents when compared to no intervention and an alternative
intervention, respectively. Thus, recent research supports
the feasibility of providing motivational interventions on a
large-scale anonymous basis using computerised technolo-
gies (Chiauzzi et al., 2005, p. 272). In other words, Web-
based approaches offer a promising non-intrusive way to
provide incentive to change risky drinking among college stu-
dents (Koski-Jannes & Cunningham, 2001), although more
research is needed with larger samples to establish the effi-
cacy of such interventions.
It is, therefore, reasonable to recommend that college
administrators begin to implement screening and feedback
interventions for incoming students. In a recent review arti-
cle, Larimer, Cronce, Lee, and Kilmer (2004/2005) identified
several opportunities to screen young people for high-risk
drinking on college campuses. They also discussed the ben-
efits and costs of universal screening compared to screening
students in local emergency rooms or student health centres,
and to screening mandated students. The authors identified
several issues that must be considered when initiating a large-
scale screening and intervention program, including who
should deliver the intervention, how to encourage students to
 H.R. White / International Journal of Drug Policy 17 (2006) 310–319
participate in these programs, how to increase student trust
and accuracy of responses, institutional liability and con-
fidentiality of the data (see Larimer et al., 2004/2005, for
greater details on recommendations for college administra-
tors). Larimer et al. concluded, and I agree, that regardless of
how measures are implemented, the intervention content and
process should be based on interventions that have already
been proven to be efficacious.Although a large amount of
evidence supports the efficacy of PFIs, more research is still
needed before universal screening and feedback interven-
tions are initiated. Walters and Neighbors (2005) highlighted
several gaps in the existing literature. First, it is necessary
to identify what components of feedback intervention are
necessary and sufficient, as well as whether there are addi-
tive effects of various feedback components. Furthermore,
research is needed to determine which components are effec-
tive for which types of students. There is also a need to
determine the appropriate reference group when providing
normative feedback to various groups of students. Finally,
more research is needed to evaluate potential mechanisms of
intervention efficacy.
Given that most college students, at least in the US, have
access to the Internet (Chiauzzi et al., 2005), it would be
possible to deliver Web-based interventions to the entire stu-
dent body and, thereby, to provide much needed screening
and intervention services (Knight et al., 2002). Several of the
studies reviewed above demonstrated that PFIs were more
efficacious with higher than lower risk students (for example,
Chiauzzi et al., 2005; Murphy et al., 2001). Therefore, Web-
based PFIs potentially might be used to supplement or replace
more labour-intensive, in-person interventions for high-risk
students. More research is needed to determine what com-
ponents of Web-based feedback are beneficial and for what
types of college students Web-based PFIs are and are not
effective.
Acknowledgements
The writing of this paper was supported by the National
Institute on Drug Abuse (DA 17552) as part of the Rutgers
Transdisciplinary Prevention Research Center. An earlier ver-
sion of the paper was presented at the 16th International
Conference on the Reduction of Drug Related Harm, Jan-
uary 25, 2005, in Belfast, Ireland. The author thanks Valerie
Johnson, Erich Labouvie, Mary Larimer, Thomas Morgan,
Robert Pandina, Lisa Pugh and two anonymous reviewers
for their comments and contributions and Lisa Metzger and
Grace Yan for assistance with manuscript preparation.
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