The role of social anxiety in a brief alcohol intervention for heavy-drinking college students

The Brief Alcohol Screening and Intervention for College Students (BASICS) reduces alcohol use and alcohol-related problems among undergraduates, yet variability in outcomes exists. Identifying individual difference variables related to outcomes could inform efforts to improve treatment protocols. The current study evaluated the role of social anxiety during BASICS. High socially anxious (HSA; n 5 26) and low socially anxious (LSA; n 5 44) heavy-drinking undergraduates were randomly assigned to BASICS (n 5 38) or an assessment-only control (n 5 32). HSA patients reported higher baseline alcohol consumption (typical drinks, weekly quantity, and frequency). BASICS significantly decreased weekly alcohol consumption and alcohol-related problems relative to the control group. Social anxiety moderated outcomes such that in the BASICS condition; HSA patients reported heavier typical drinks at posttest, even after controlling for referral status, baseline typical drinks, and trait anxiety. This was not the case in the control group. HSA patients may benefit from social anxiety-specific interventions during BASICS. Keywords: alcohol; social anxiety; treatment outcome; treatment moderator; brief motivational intervention; college student Heavy drinking on college campuses remains an important public health concern, with one-third of college students meeting the diagnostic criteria for alcohol abuse during their college years (Knight et al., 2002) compared to 6% to 13% in the general population (Kessler et al., 1994). Heavy alcohol use among college students has been consistently associated with high-risk and illegal behaviors including physical and sexual assault, property damage, and personal injury (Hingston, Winter, Wechsler, 2005; Johnston, O'Malley, Bachman, & Schulenberg, 2004; Wechsler, Davenport, Dowall, Moeykens, & Castillo, 1994). However, fewer than 4% of students meeting diagnostic criteria for an alcohol use disorder (AUD) will seek treatment while enrolled in school (Clements, 1999; U.S. Department of Health and Human Services [USDHHS], 2002). This fact is concerning because, for some students, heavy alcohol use during college marks the initiation of a severe, chronic alcohol use pattern leading to alcohol dependence and/or serious alcohol-related health problems (e.g., liver damage; Jackson, Sher, Gotham, & Wood, 2001; Merline, O'Malley, Schulenberg, Bachman, & Johnston, 2004). The National Institute on Alcohol Abuse and Alcoholism Task Force on College Drinking recommends the use of brief motivational interventions (BMI) to reduce heavy alcohol use and alcoholrelated problems in college student populations (USDHHS, 2002). The Brief Alcohol Screening and Intervention for College Students (BASICS; Dimeff, Baer, Kivlahan, & Marlatt, 1999) is a specialized BMI designed for college students. BASICS appears efficacious in reducing alcohol consumption and alcohol-related problems among heavy-drinking college students who undergo treatment voluntarily (Baer, Kivlahan, Blume, McKnight, & Marlatt, 2001; Borsari & Carey, 2001; Dimeff et al., 1999; Larimer et al., 2001; Marlatt et al., 1998; Murphy et al., 2001, 2004) and among college students who are required to attend the intervention as part of the disciplinary procedures following the violation of a campus alcohol policy (Barnett & Read, 2005; Borsari & Carey, 2005; Fromme & Corbin, 2004; Larimer & Cronce, 2002, 2007; Terlecki, Larimer, & Copeland, 2010; White et al., 2006). Despite the efficacy of BASICS to reduce heavy-drinking and alcohol-related problems among college students, variability in outcomes remains. Identification of individual difference variables associated with poorer outcomes may help inform efforts to refine BASICS protocols and help improve outcomes among vulnerable patients. Social anxiety (SA) is one variable that appears particularly relevant. At clinical levels (i.e., social anxiety disorder or SAD), SA is characterized by intense and/or persistent fear or avoidance of social scrutiny (American Psychiatric Association, 1994). …