TREATMENT AVolitional Help Sheet to Reduce Binge Drinking in Students: A Randomized Exploratory Trial

Aims: This study tested the ability of a volitional help sheet (VHS) to decrease binge drinking in UK students. Methods: Fifty-six participants were randomly allocated to one of three conditions: control, active control or VHS as part of a questionnaire-based study. Results: There were significant decreases in units of alcohol consumed and self-reported binge drinking frequency in the VHS condition, but not in either of the control conditions. Conclusions: The findings support use of the VHS to help people to reduce their alcohol consumption and binge drinking. Alcohol-related morbidity and mortality are increasing problems across the UK, particularly among young people (16– 24 years) with 25% of young women and 32% of young men binge drinking at least once a week (Health and Social Care Information Centre, 2009). Despite government campaigns designed to reduce harmful drinking (Cabinet Office Strategy Unit, 2004), the prevalence of harmful drinking continues to be a concern. The principal aim of the present study was to test a tool [the volitional help sheet (VHS)] designed to facilitate the formation of implementation intentions (Gollwitzer, 1999) to reduce binge drinking in young people. Implementation intentions are if-then plans that link in memory a critical situation with an appropriate behavioural response. When the critical situation is encountered, the linked behavioural response is activated automatically (Gollwitzer and Sheeran, 2006). Implementation intentions have been shown to be an effective means of changing behaviour, with an average effect size of d = 0.65 reported in Gollwitzer and Sheeran’s (2006) meta-analysis. Although only 1 of the 94 studies reported in Gollwitzer and Sheeran’s (2006) meta-analysis investigated alcohol consumption (Murgraff et al., 1996), implementation intentions have successfully reduced alcohol consumption in four more recent studies (Murgraff et al., 2007; Gebhardt et al., 2008; Armitage, 2009; Armitage et al., 2011). The VHS (Armitage, 2008) is a tool designed to enable the construction of effective implementation intentions in which participants are asked to link in memory temptations (difficult situations that result in urges to engage in a specific behaviour) or (‘critical situations’) with processes of change (means by which behaviour is changed/sustained or ‘appropriate behavioural responses’) from the transtheoretical model (Prochaska and DiClemente, 1983). Armitage (2008) tested the ability of a VHS to encourage quitting in a sample representative of smokers. The results showed that significantly more people quit in the experimental group (P < 0.01, 19%, n = 9) when they were asked to form implementation intentions by linking critical situations (e.g. ‘If I am tempted to smoke at a bar or pub while having a drink’ adapted from Velicer et al., 1990) with appropriate behavioural responses (e.g. ‘then I will remember that I get upset when I think about my smoking’ adapted from Prochaska et al., 1988) compared with the equivalently active control group (2%, n = 1), who were asked simply to identify critical situations and appropriate behavioural responses that might be useful to them without linking them together in memory. No studies to date have utilized a VHS in relation to binge drinking, although evidence-based drinking temptation scales and processes of change for drinking scales exist that could be used to create a binge drinking VHS. A binge drinking VHS could be a very simple, cost-effective and easy to use intervention to reduce drinking because VHSs are self-directed and take fewer than 5 min to complete. Therefore, the present study aimed to pilot an alcohol-reduction VHS in a population at risk of high levels of binge drinking. It was hypothesized that: (a) planning to reduce binge drinking using the VHS (linking critical situations and appropriate behavioural responses in a VHS condition) would reduce binge drinking over and above being asked simply to form a plan (control condition) or being asked to tick critical situations and solutions (active control condition), and (b) there will be no difference between being asked to form a plan (control condition) and being asked to tick critical situations and solutions (active control condition).