摘要：Objectives. This study examined long-term response to an individual preventive intervention for high-risk college drinkers relative to the natural history of college drinking. Methods. A single-session, individualized preventive intervention was evaluated within a randomized controlled trial with college freshmen who reported drinking heavily while in high school. An additional group randomly selected from the entire screening pool provided a normative comparison. Participant self-report was assessed annually for 4 years. Results. High-risk controls showed secular trends for reduced drinking quantity and negative consequences without changes in drinking frequency. Those receiving the brief preventive intervention reported significant additional reductions, particularly with respect to negative consequences. Categorical individual change analyses show that remission is normative, and they suggest that participants receiving the brief intervention are more likely to improve and less likely to worsen regarding negative drinking consequences. Conclusions. Brief individual preventive interventions for high-risk college drinkers can achieve long-term benefits even in the context of maturational trends. Lifetime consumption of alcohol typically reaches its highest levels during an individual's late teens and early 20s. 1 Numerous studies document a range of negative consequences of high levels of alcohol consumption, including violence, date rape, accidents, academic problems, and family conflict. 1 , 2 The college campus is one setting where the pattern of youthful heavy drinking is felt acutely. College students, on average, drink more than their noncollege peers of the same age 3 and routinely report negative consequences from both their own and others' drinking. 4 While heavy drinking in college is associated with personality factors such as impulsivity, 5 noncomformity, 6 and depression, 5 , 7 , 8 contextual factors such as distance from parents, close association with peers, dormitory residence, association with fraternities and sororities, large-group social events, and athletics appear to support and exacerbate heavy drinking as well. 9 – 13 Heavy drinking in college should not be confused with dependent drinking in later life, however. Several studies note significant reductions in heavy drinking in the 20s. 14 – 16 At the individual level, Schulenberg and colleagues 17 followed the drinking patterns of high school seniors for at least 6 years and noted that a subset of individuals (17%) reported more than isolated patterns of heavy drinking over time. Thus, college administration and health officials, who are under increasing pressure to provide both preventive and treatment services as a public health service for college students, are faced with a multifaceted social problem that is common, risky, and limited in time for most but chronic for some. Unfortunately, few interventions have a documented positive impact in changing college drinking behavior. In particular, commonly offered educational programs have little impact. 18 We recently reported on one model of indicated prevention, which involves personalized individual feedback and brief motivational interventions for high-risk students during a single brief, nonconfrontational counseling session. 19 – 21 Students who received this preventive intervention reported significantly greater reductions in alcohol-related problems at the 2-year follow-up compared with a randomly assigned control group. 21 , 22 In the current analysis, we examine the natural history of drinking patterns and related problems over 4 years, within both high-risk and normative samples. The preventive intervention is evaluated over this extended period of time. Finally, using individual classification of reliable change, 22 we describe developmental trajectories of drinking among college students who drank heavily in high school and describe rates of clinically significant change.
