Clinicians Digest Sept/Oct 2008 - Page 5

A True Alcohol Buzz

In an old Honeymooners episode, Alice Kramden, learning that her husband, Ralph, and his best friend, Ed Norton, are planning to get drunk in the kitchen that night, empties the wine bottle and pours in grape juice. Later, Ralph and Ed, thinking they're drunk, have a great time acting silly and uninhibited.

Alice's strategy may help explain why the Expectancy Challenge (EC) is one of only three alcohol-prevention treatments for college students that the National Institute on Alcohol Abuse and Alcoholism (NIAAA) designates as effective. Expectancy Challenges help drinkers cut down by proving to them that many of the desirable effects they seek through drinking, like affability, extraversion, social confidence, and hearty partying, have more to do with how they expect the alcohol to influence them than with the alcohol itself.

But you can't just tell people this is true. So EC gets this surprising message across by proving it. Facilitators set up a room with a bar and invite college students in for drinks and party games. They inform participants that half the group will get alcoholic drinks and the other half non-alcoholic drinks that taste like the real thing. After some socializing and games, everyone guesses who drank alcohol and who drank the placebo. People invariably mistake themselves and others for alcohol or placebo drinkers.

Once students realize that their own expectations, not drinking, have freed them to behave as they'd like, many drink less frequently. When they do drink, they usually consume fewer drinks. Most encouraging, EC seems to be most effective with heavier drinkers.

EC shares some features with the other two NIAAA-recommended prevention treatments: Motivational Enhancement Training (MET), and a combination of cognitive-behavioral skills training, values clarification, and MET. None of the treatments has complete abstinence as the goal. Instead, each one helps clients identify their life goals, discuss ways to meet these goals, and link alcohol reduction with achieving them.

Despite its proven effectiveness, EC has been slow to catch on. University of Buffalo research associate Cathy Lau-Barraco, whose latest EC study appears in the June Psychology of Addictive Behaviors, thinks that's because many colleges are reluctant to provide real alcohol as part of a treatment program. A more fundamental problem may be the traditional bias of substance-abuse prevention programs: an entrenched desire to fund "just-say-no" programs, instead of empirically supported prevention strategies.

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