Mechanisms of Behavior Change Within Peer-Implemented Alcohol Interventions

Abstract

Objective: Colleges continue to experience a high number of referred students because of campus alcohol violations. Subsequently, there has been a trend to use peer-implemented minimal interventions (PMIs), often using motivational interviewing (MI). However, little is known about how PMIs facilitate behavior change. This study aims to examine the mechanisms of behavior change within PMIs and their influence on alcohol reduction among mandated students.

Method: Participants (N = 146; mean age = 18.7 years; 67% male; 94% White) were college students who violated campus alcohol policy at a Northeastern liberal arts college who received a 15-minute PMI addressing their alcohol use. The Motivational Interviewing Skill Code (Miller et al., 2003) was used to identify peer counselor behaviors that were MI consistent (MICO), client change talk (CT), and client self-exploration.

Results: MICO behaviors were positively associated with CT and self-exploration. Client CT and self-exploration were negatively associated with alcohol-related outcomes. Furthermore, mediational models examining MICO behaviors revealed effects for two paths: (a) from MICO to client CT to reduced alcohol use; and (b) from MICO to client self-exploration to reduced alcohol-related consequences and use.

Conclusions: These data support the primary causal chain examining the influence of MICO on in-session client behaviors and related post-session behavior change in PMIs among at-risk students.

Figure 1.

Overall mediation model for peer therapist behaviors, client behaviors, and drinking outcomes. MICO = motivational interviewing–consistent.

Figure 2.

Regression coefficients: Assessing the mediating effect of client behaviors between motivational interviewing-consistent (MICO) and alcohol outcomes at 6 weeks after peer-implemented minimal interventions. Notes: HED = heavy episodic drinking; BAC = blood alcohol concentration. All regression models were run with the baseline value of the dependent variable included as covariates. Solid lines = mediating effect of CT between MICO and alcohol outcomes; dashed lines = mediating effect of self-exploration between MICO and alcohol outcomes. *p < .05, two tailed; **p < .01, two tailed.