Alcohol related social norm perceptions in university students: a review of effective interventions for change

Alcohol Insight Number 72

Research and Development Grant

Introduction

There is growing recognition that students’ alcohol consumption is impacting on many aspects of university life, such as health, attrition rates and academic achievement. In the U.K, around 50% of young people now attend university and thus become exposed to this high alcohol consuming culture. Recent trends suggest that excessive drinking patterns that begin during student years are now continuing throughout adulthood (e.g. Newbury-Birch et al, 2002). Further evidence to this effect comes from liver experts reporting worrying changes in the age of onset of alcohol related liver disease (Smith et al, 2006). A recent survey conducted by the current researchers suggests that consumption levels are probably significantly underestimated in many studies, with 88% of students drinking 6 or more units on any one occasion, with an average of 20 for males, and 17 for females (John & Alwyn, 2009).

It is thus increasingly apposite for health professionals and policy makers to identify effective ways of influencing this traditionally hard to reach population in terms of reducing alcohol consumption. ‘Social norms theory’ was first proposed by Perkins and Berkowitz in 1986, after their investigation into student drinking behaviour appeared to demonstrate a ‘pluralistic ignorance effect’ (where everyone assesses a situation by observing what other people do, and which is a major influence on normative social behaviour) in relation to misperceptions of behavioural drinking norms. Studies conducted on American college campuses consistently demonstrate that students overestimate both the alcohol use and approval of drinking of others, thus producing elevated norms, which make excessive alcohol consumption seem common and acceptable (e.g. Borsari and Carey, 2001). The approach suggests that changing these mis-perceptions through normative feedback should lead individual students to reduce their personal levels of drinking, and social normative approaches have been increasingly applied to interventions to attempt to change undergraduate drinking behaviour. This trend developed in the United States and appears to be increasing in popularity in the United Kingdom.

Method

The current review evaluated the national and international evidence for effectiveness of such interventions in changing student drinking patterns. This was achieved through:

  • An international review of the literature on social normative interventions;
  • A scoping and mapping exercise of social normative interventions and initiatives currently being implemented in the United Kingdom;
  • A consultation exercise with experts in the field and university stakeholders.
  • The fourth task was to synthesise the findings from tasks 1 to 3 to produce an evidence based account of social normative interventions in student populations.

Findings

  • There is a consensus amongst the experts consulted that students appear to misperceive drinking norms in their survey responses to campus alcohol consumption. However, they do not believe that simply changing these misperceptions will necessarily result in positive changes in student drinking behaviour. Further, there is some concern from experts in the field about the possible faddish nature of social normative interventions, and that the enthusiasm for the approach may be to some degree ‘outstripping its evidence base’.
  • The evidence for effectiveness of social normative interventions is mixed to date. The majority of this evidence stems from the United States with some additional studies in New Zealand, and due to differences in cultural drinking norms and legal drinking age, its transferability to UK undergraduates is questionable. Further, weaknesses in methodological rigour in many of these studies makes it difficult to draw clear conclusions about outcomes. Problems include lack of randomisation, little or no follow up data, and inappropriate screening and outcome measures. There are also inconsistencies in definitions of terms and classification of drinker ‘type’ (for example, heavy drinking, binge drinking, harmful drinking), which is key to the notion of normative feedback.
  • There is very little current evidence of social normative work in the UK relating to reducing student drinking. There is only one published web-based social normative intervention with UK participants (although there are others currently in preparation), and even though the immediate outcomes may be promising, the study has limited ecological validity in that student participation and take up is poor.
  • Social normative interventions need to be rigorously evaluated for effectiveness over time in a UK context. Further, they should not be delivered in isolation but rather should be an element in a multi-dimensional approach that has a clear evidence base for the UK population. The strongest evidence is demonstrated through interventions incorporating a number of social cognition components such as personal feedback of drinking effects, efficacy training and drinker prototype identity. They also need to target different levels of drinking behaviour and employ evidence based methods of delivery. For example, brief motivational interventions demonstrate effectiveness over time.
  • Young people in the U.K. come to university with pre-existing perceptions and expectations of student drinking behaviour, and often start university with an already established habit of consuming high levels of alcohol, and there is pressure on students to conform to the stereotype (peers, student union).
  • People working in the higher education sector recognise that student drinking is a problem but universities do not have alcohol–specific policies for students. Cultural norms dictate attitudes to alcohol consumption across the university, including at senior management level. Successful intervention will rely on university commitment to deliver interventions and combat mixed messages.
  • Students’ unions have a pivotal role, in both the problem and the potential solutions for excessive student drinking. Commercial issues for students’ unions are perceived as a driver for maintaining high campus alcohol sales, and alternative funding streams should be identified. Initiatives that have the support of the unions, where they are involved in both the development and delivery of interventions are more likely to succeed.

Implications

  1. The social normative approach to excessive undergraduate drinking has been ‘somewhat oversold,’ almost as a universal solution. However, there are promising elements that should be further tested in the U.K cultural context. Further research need to be undertaken, with methodologically rigorous evaluation of the usefulness of social normative feedback over time, before it can be said with confidence that this is an effective approach.
  2. Interventions need to be developed to address the broad spectrum of student drinking problems (from universal to more targeted interventions for heavy and harmful drinking)
  3. Universal web-based interventions that are informed by evidence (for example addressing expectancy effects and self-efficacy skills training) should be developed and administered at strategic times through high school to graduation (e.g. UCAS application, open days, induction days, enrolment and re-enrolment).
  4. Interventions should be multi-component, reflecting current evidence and should be delivered through an evidence-based approach (such as brief motivational interventions).
  5. There must be specific alcohol-related policy and strategy development within universities that is supported across the institution from directorate level to student representation.
  6. Training initiatives should be implemented to challenge and change the prevailing attitudes regarding alcohol consumption as a cultural norm across the institution, to include senior management and key university stakeholders
  7. Student representatives should be involved in the content development and delivery of interventions.
  8. This report was commissioned by policy makers, and we therefore include a more general recommendation that has emerged from the research, namely that to encourage overseas students and reduce student attrition rates, universities should be supported by government in developing and implementing effective safe drinking initiatives.

References

Borsari, B. & Carey, K.B. (2001) Peer influences in college drinking: a review of the research. Journal of Substance Abuse, 13, 391-424

John, B. & Alwyn, T. (2009) Mapping student alcohol consumption & drinking patterns, and the factors influencing this behaviour in students at Higher Education Institutions in Wales. A report to the Wales Assembly Government

Newbury-Birch, D., Lowry, R. & Kamali, F. (2002) The changing patterns of drinking, illicit drug use, stress, anxiety and depression in dental students in a UK dental school: a longitudinal study. British Dental Journal 192 (11): 646-9

Perkins, H.W & Berkowitz, A. (1986). Perceiving the community norms of alcohol use among students. International Journal of the Addictions 21, 961-976

Smith. S, White, J., Nelson, C., Davies, M., Lavers J. and Sheron, N. (2006) Severe alcohol-induced liver disease and the alcohol dependence syndrome. Alcohol and Alcoholism 41(3):274-277

Research Team

Dr Bev John, Reader in Psychology, University of Glamorgan

Dr Tina Alwyn, Reader in Psychology, University of Wales Institute Cardiff

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