Journal

of Substance

Pergamon

Abuse Treatment, Vol. 11, No. 6, pp. 569-581, 1994

Copyright 0 1994 Elsevier Science Ltd
Printed in the USA. All rights reserved
0740-5472/94 $6.00 + .OO

0740-5472(94)00056-S

IN THE SPOTLIGHT

Treating College Substance Abusers

The New Jersey Collegiate

Substance Abuse Program

NEW BRUNSWICK, NEW JERSEY

Abstract - University students with serious substance use disorders may require specialized treat-

ment. The New Jersey Collegiate Substance Abuse Program (NJCSAP) was a treatment center
developed for this population that allowed students to receive treatment while remaining in the
university environment and continuing school. NJCSAP was structured into three levels of care
so that clients could be matched to treatment of appropriate intensity. In addition, NJCSAP helped
students develop a network of supportive recovering peers and activities on the Rutgers University
campus. An evaluation of the client population revealed a group of students with a history of severe
substance use and related problems. Implications of the evaluation results are discussed.
Keywords-student;

college;

treatment;

alcohol;

abuse.

has increased in recent years (Saltz & Elandt, 1986).

College administrators, clinicians, and researchers
alike have become concerned that a percentage of this
population may have developed, or be at risk to develop, psychoactive substance-use disorders (Anderson
& Gadeleto, 1984; Dean, Dean, & Kleiner, 1986).
This wariness is supported by research that estimates
heavy or problem drinking in lo%-25% of college students (Baer, Kivlahan, Barrett, & Marlatt,
1991; Berkowitz & Perkins, 1986; Cook, 1987).
Since the mid-1970s, and more frequently in the
198Os,American colleges and universities have offered
a variety of substance-abuse education and prevention
programs both to combat widespread substance use

INTRODUCTION
OVER THE PAST FOUR DECADES, it has been well established that consumption of alcohol and other drugs
among university students is frequent (Blane & Hewitt,
1977; Saltz & Elandt, 1986; Straus 8z Bacon, 1953) and

In addition to the authors, the personnel responsible for the design

and implementation of the clinical program at NJCSAP included
Robert Bierman, MD, William David Burns, AB, and Lisa A. Laitman, MSEd.
Requests for reprints should be addressed to Dr. Daniel S. Keller,
Department of Psychiatry, Division of Alcoholism and Drug Abuse,
New York University School of Medicine, 550 First Avenue, New
York, NY 10016.

Received October 26, 1993; Accepted May 20, 1994.

569

570

among students in general and to address the needs of

those with potential or actual substance-abuse
patterns. Berkowitz and Perkins (1986) reported that, by
the early 198Os, 88% of a representative
sample of
American colleges and universities offered some form
of an alcohol prevention program. These authors suggested that such programs exist along a continuum
of
increasingly
more intensive activities. Such activities
range from primary preventive efforts, such as the dissemination
of information
on the deleterious effects
of alcohol and other drug abuse, to secondary prevention, which includes the training of students, residence
life counselors,
and other staff to detect and refer
problem users to peer counseling groups and/or student assistance programs. Finally, the most intensive
programs involve alcohol and other drug treatment
either in an on-campus
facility such as a university
counseling center or in traditional
community-based
substance-abuse
treatment
programs
(Berkowitz
&
Perkins, 1986). Although there is debate as to the effectiveness of college alcohol education programs (cf.
Berkowitz & Perkins, 1986, pp. 109-l lo), several reports suggest that well-designed programs can produce
significant behavior change in students exposed to primary and, to some degree, secondary preventative efforts (e.g., Goodstadt & Caleekal-John,
1984). It has
been suggested, however, that students who exhibit
such positive change are low risk for substance abuse
(Duthie, Baer, & Marlatt, 1991).
Although university-based
prevention programs display some efficacy, Dean et al. (1986) suggested that
some students require treatment that exceeds the resources and capabilities of prevention programs. Similar to Berkowitz and Perkins (1986), Dean et al. (1986)
developed a model that conceptualizes
college student
substance-abuse
treatment along a continuum
of intensity including
(a) zero or minimal preventative
efforts, (b) on-campus assessment and referral to offcampus treatment, and (c) on-campus assessment and
referral to on-campus
treatment.
In this model, oncampus treatment
would include student assistance
programs as well as outpatient substance-abuse
treatment located in student health and counseling centers.
Theoretically, this model could include a university,
hospital-based
inpatient
substance
program as the
most intensive form of treatment.
However, Dean
et al. (1986) suggested that the majority of on-campus
substance-abuse
treatment in the United States occurs
on an outpatient
basis in counseling centers and less
frequently in student assistance programs. Students requiring more intensive treatment are typically referred
to off-campus, community-based,
inpatient programs,
yet there are several disadvantages
to this approach.
First, such inpatient
units teach relapse prevention
skills and other abstinence-enhancing
strategies in an
artificial
environment,
and it is unclear how well
these carry over into the real world. Second, recent
reports indicate that outpatient (Miller & Hester, 1986)

D.S. Keller et al.

and partial-residential
(McCrady, Dean, Dubreuil, &
Swanson, 1985) treatments may be at least as, if not
more, effective than traditional inpatient treatment of
substance-abuse
disorders. Third, college students are
exposed to university-specific
alcohol and drug highrisk situations (Schall, Kemeny, & Maltzman,
1992),
which may require specialized adaptation
of skills
training.
Fourth,
students referred to communitybased inpatient programs often have to interrupt or
discontinue
school. Fifth, it is less likely that students
in traditional
inpatient programs are able to develop
recovery-enhancing
peer support networks because
treatment does not occur among peers. Finally, there
is little well-controlled
empirical support for the efficacy of traditional,
community-based
programs (Institute of Medicine,
1989, pp. 185-187).
This study describes The New Jersey Collegiate
Substance Abuse Program (NJCSAP), a 5-year, campusbased alcohol and other drug rehabilitation
demonstration project at Rutgers, the State University
of
New Jersey. NJCSAP provided residential,
partialresidential,
and intensive
outpatient
treatment
to
student substance abusers requiring more intense interventions
than those generally found at universities
and colleges. NJCSAP was jointly sponsored by the
Center of Alcohol Studies, the Student Health Service,
and the Office of Student Life Policy at Rutgers. It
was located in a wing of the Student Health Center of
the New Brunswick campus and was, to our knowledge, the only rehabilitation
program in the United
States situated on a university campus and dedicated
exclusively to the treatment
of college student substance abusers.
The rationale for locating an intensive substanceabuse treatment program on a university campus was
guided by several considerations.
Prior to the inception of NJCSAP, Rutgers offered an impressive array
of substance-abuse
services to students.
These included educational
prevention programs, weekly student assistance counseling, a substance-free recovery
housing program, and a well-coordinated
network of
self-help meetings and related recovery activities. Nevertheless, these services did not appear to meet the
needs of a more severely impaired subgroup of student
substance abusers. In keeping with the suggestions of
Dean et al. (1986), such students were typically referred
to community-based,
inpatient programs.
However,
anecdotal evidence suggested a high rate of negative
outcomes among these students, such as failure to follow through on referrals, dropping out of school, or
relapse upon reentering the university following the
completion of inpatient treatment.
NJCSAP was created as an alternative
treatment
option to meet the
unique needs of this group of students.
NJCSAP also contained
several advantages
over
community
programs. First, students would be more
likely to receive appropriate
treatment because most
referrals would originate within the system. Second,

571

Treating College Substance Abusers

sobriety-inducing
and sobriety-maintaining
skills would
be acquired in the environment
within which they
needed to be practiced and utilized. Third, by providing addictions treatment along a continuum
of intensity and structure (i.e., residential to partial-residential
to intensive outpatient),
students could be exposed in
properly dosed amounts to university life with all of
its attendant hazards and opportunities.
Fourth, students would not need to discontinue
or interrupt their
educations.
Fifth, students would receive treatment
with peers undergoing similar difficulties, thereby enhancing the feeling of being understood
as well as
forming the nexus for peer support networks.
The purpose of this study is to provide a detailed
description of NJCSAP, an innovative model for treating college student substance abusers with serious alcohol and other drug-abuse problems. First, we present
a description
of the types of students for whom the
program was initially intended and a detailed outline
of the structure and functioning of the clinical services
developed to treat such students. Second, we present
preliminary
program evaluation
data that describe
characteristics
of the clinical population
served over
the past 3 years and how program services were utilized. Finally, we discuss the issue of on-campus intensive addictions treatment based on both the program
evaluation findings and our experience in creating the
program.

PROGRAM
Description

of Intended

DESCRIPTION
Client Population

NJCSAP was developed as a demonstration

project to
provide intensive substance-abuse
treatment for college students with moderate to severe substance-use
disorders. It was anticipated that this group of students
would include (a) students with multiple treatment failures, particularly
those for whom student assistance
counseling was inadequate;
(b) recovering students at
high risk for relapse or who had actually relapsed; (c)
students mandated to treatment by university administrators or on-campus law enforcement
agencies; (d)
students whose clinical presentation
included severe
cravings, signs and symptoms of tolerance and withdrawal, and substance use patterns that seriously interfered with important responsibilities
such as school
or work; (e) student substance abusers who lived in
high-risk environments
(e.g., fraternities,
dorms, offcampus apartments)
with other heavy or problem
users; and (f) students from neighboring
colleges and
universities that did not offer substance-abuse
treatment or counseling. In addition, it was anticipated that
some percentage of these students would present with
co-morbid psychopathology
that counselors in prevention and student assistance programs were not adequately trained to address.

Description

of Program

Elements

Program Structure. NJCSAP was designed to integrate

treatment of appropriate
intensity and duration with
the students academic responsibilities.
It attempted to
achieve this in three ways: (a) multiple levels of care;
(b) creation of off-unit, substance-free
environments
and extra program support networks; and (c) integration of treatment and academic schedules.
NJCSAP offered three levels of care: residential,
partial-residential,
and intensive outpatient treatment.
It had a bed capacity for 12 full and partial residents
as well as 35-40 outpatient
treatment slots. The residential track was used briefly to stabilize only the most
severely impaired students. Typically, such students
had recently experienced uncontrolled
drinking,
reported intense cravings, had multiple treatment
failures, and had a lack appropriate
social supports.
Students were expected to stay in residential treatment
for 2 or 3 days. Residents participated
only in unitscheduled activities and were proscribed from leaving
the unit. The principal goal of residential treatment
was to stabilize students and transfer them to partialresidential status as soon as possible.
The partial-residential
track was the most unique
component
of NJCSAP. Students in this track were
sufficiently impaired to require a highly structured environment.
However, these students were permitted to
leave the unit to attend classes, self-help meetings
accompanied
by peers with longer periods of abstinence, and other low-risk activities. Typically, partialresidents might have experienced a moderate relapse
during outpatient
treatment
and may have lacked a
supportive living environment.
Often a central goal of
the partial-residential
track was securing appropriate
postresidential
living arrangements.
Clients were expected to stay in partial-residential
treatment for l-3
weeks.
The intensive outpatient track was for students who
needed less structure than partial-residents,
yet required more intensive treatment
than a student assistance program.
Initially these students attended
treatment for several hours each day, 3 or 4 days each
week. Students were expected to remain in intensive
outpatient treatment for one or two semesters, with the
intensity of treatment gradually reduced over time.
The second way that NJCSAP met the needs of a
student population
was by fostering a supportive network within the students natural environment.
This
goal was achieved in two ways. First, a primary focus
of NJCSAP was securing off-unit, substance-free
environments
for students.
Effective substance-abuse
treatment can require significant modification of a students lifestyle (Marlatt, 1985). Given the prevalence
of substance use within the university setting, it was
considered
vital that recovering
students
obtain
substance-free
living environments.
NJCSAP counselors helped students analyze their living environments

572
and make the changes necessary to keep the setting
substance free. For example, if a student lived with
three roommates who used substances, the counselor
would work with the student to find new living arrangements with nonusing peers (e.g., other NJCSAP
clients or former NJCSAP clients). For students lacking adequate living arrangements, NJCSAP assisted
in securing recovery housing- dormitory rooms and
apartments owned by the university that are allocated
for use by recovering students. NJCSAP also helped
students create substance-free living environments on
their own.
NJCSAP also provided the student with a network
of supportive recovering peers and activities. This network included other students in the program as well
as engagement in university-based, self-help meetings.
Additionally, NJCSAP had a group of alumni who
accompanied new students to self-help meetings and
introduced them to the larger recovery community
within the university.
The third unique feature of NJCSAP was the integration of treatment and academic schedules. Therapy
groups were scheduled at times during which most students were not in class. In addition, group sessions
were not held to the traditional 60- or 90-min time periods, but adapted to the academic class schedule of
1 hr and 20 min, enabling a student to fit group sessions into an academic schedule. The location of
NJCSAP in the on-campus student health center enabled students to attend their therapy sessions and activities without leaving campus. Moreover, the unit
was open days, evenings, and weekends, providing a
place for clients to come between classes, during evenings to study or to meet with peers, or at times of
crisis.
Clinical Services. Treatment at NJCSAP combined individual, group, family, and psychoeducational counseling tailored to the individual needs of each student.
Treatment focused on cognitive-behavioral skills building (Marlatt & Gordon, 1985; Monti, Rohsenow,
Abrams, & Binkoff, 1988) and integration into the network of university and community-based 1Zstep programs. Treatment was delivered by a multidisciplinary
team of psychologists, social workers, nurses, alcoholism counselors, clinical psychology practicum students,
and social work graduate student interns. All treatment
was supervised by faculty members of the Center of
Alcohol Studies and Graduate School of Social Work.
NJCSAP provided a range of clinical services. Table 1 lists three categories of group therapies and
activities provided at NJCSAP. Category 1 groups
focused on building the cognitive and behavioral skills
necessary for inducing and maintaining abstinence.
Skills included identification and development of strategies for dealing with high-risk situations, conditioned
cues, irrational thoughts, and apparently irrelevant de-

D. S. Keller et al.
TABLE 1
Types of Groups and Activities Offered at NJCSAP

Category
1. Recovery

Type of Group
groups

2. Interpersonal

groups

3. Health/education/social

Relapse prevention
Social skills
Collegiate issues
Open group
Open group
Menslwomens
issues
Family issues
Multiple family therapy
Residents issues
Recreational activities
Sociology of Alcoholism
Weekend social

cisions. Drink refusal, anger management, and assertiveness training were also taught. Category 2 groups
provided students with the opportunity to explore a variety of interpersonal problems of a more specific nature. Students were assigned to such groups based on
an assessment of their individual needs. For instance,
a student having difficulty telling his or her parents of
his or her substance abuse might become involved in
the Family Issues Group. Students with gender-specific
concerns might elect either the Mens or the Womens
Group. Category 3 groups reflected ancillary activities
provided at the NJCSAP such as recreational and social activities and a for-credit course entitled Sociology of Alcohol, which is presented in videotaped
lecture format.
Assessment of Need. Upon presentation to NJCSAP,
a student was assessed to determine if intensive addictions treatment was required and which level of care
is most appropriate. Once admitted to the program,
the student was assigned a primary therapist who acted
as the students individual therapist and coordinated all
therapeutic activities. The primary therapist conducted
an extensive evaluation of the students substance-use
history and current abuse patterns. A biopsychosocial
assessment in which life areas likely to be affected by
substance abuse/dependence was evaluated viewing
topics such as psychiatric status, family/social relationships, legal status, and educational/vocational
status.
Based on this information, the primary therapist
and the patient jointly established a problem list and
negotiated a master treatment plan. The master treatment plan identified which groups would be most appropriate for the student, goals for individual therapy,
what needed to be altered in the patients environment,
and specified which adjunctive treatments (e.g., medical, psychiatric) were required. The primary therapist
also coordinated the students treatment plan with his
or her academic schedule and acted as a liaison between the student and other university programs such

573

Treating College Substance Abusers

as the medical unit, recovery housing program, and academic deans.
Group assignments and master treatment plans were
reviewed in the treatment team case conference.
An
important
feature of NJCSAP included requiring the
student to attend the case conference on a regular basis to receive feedback from team members regarding
progress made, suggestions for further work, and alterations of treatment
goals.

Course of Treatment. Although treatment at NJCSAP

was individually
tailored to students particular needs,
there were several general phases that applied to most
students. The early phase of treatment focused on the
establishment
and maintenance
of abstinence through
cognitive-behavioral
skills building, securing supportive peer networks and sober living environments,
and
working through resistances to these goals. As abstinence was achieved and became more solidly based
within the students life, the focus of treatment tended
to shift toward an examination
of emotional and psychological
issues, the establishment
of meaningful
interpersonal
relationships,
and the execution of academic and vocational responsibilities
without using alcohol and/or other drugs, especially during times of
stress. Attainment
of these goals generally required
6-12 months in the program. When these goals were
judged to have been adequately achieved by the student, the primary therapist, and the NJCSAP treatment team, a termination
and referral stage ensued.
In almost all cases, prior to discharge, NJCSAP assisted the student in obtaining
appropriate
aftercare
treatment such as weekly student assistance counseling, continuation
in recovery housing or other sober
living arrangements,
and appropriate psychological or
psychiatric care when necessary.
PROGRAM

EVALUATION

NJCSAP was designed to treat college student substance abusers with serious abuse problems.
It was
anticipated
that such students would require a fairly
rigorous program and a relatively lengthy course of
treatment
as described before. However, at the outset, the degree of substance abuse and other problem
severity was not precisely known, and it was not possible to fully predict how NJCSAP services would be
utilized by this population.
We now turn to preliminary data from our program evaluation
to address
these questions.
METHOD
Description of Subjects Involved
in the Program Evaluation
Information
was collected on 128 individuals who had
received services at NJCSAP over the past 3 years. An-

other four individuals,

who were evaluated for treatment at NJCSAP but were not formally admitted to
the program, were included in the assessment of demographic characteristics.
More specific information
regarding patterns of
substance use was collected for a subsample of clients
(n = 62) who participated in a separate research project
at NJCSAP. These data provide a more detailed description of the different alcohol and drug problems
that NJCSAP clients experienced,
as well as an indication of lifetime severity of substance use. All clients
who were formally admitted to NJCSAP were invited
to participate in the research project. Those subjects
who did participate in the research project (n = 62)
were compared with those who did not (n = 72). The
two groups did not differ in terms of age at admission
to NJCSAP, age of first use of alcohol, age of first use
of other drugs, academic class, overall grade point average, academic standing,
past inpatient psychiatric
treatment,
past outpatient
psychiatric treatment,
or
past inpatient substance-abuse
treatment. Two trends
emerged: Females were more likely than males to participate in the research (x2 = 3.682, p = .06), and
clients who had past outpatient substance-abuse
treatment were less likely to participate
in the research
(x2 = 3.571, p = .06).
Description

of Program Evaluation

Measures. Two data collection

Measures

forms were developed

for collecting
information
from subjects medical
records. A Descriptive Information
Form (DIF) was
used to collect descriptive data in six areas: demographic information,
academics, living arrangements,
substance use history, family history, and psychiatric
history. A Treatment
Information
Form (TIF) was
used to collect treatment data in three areas: inpatient
treatment utilization, outpatient treatment utilization,
and discharge information.
Subjects who participated
in the research project
(n = 62) also completed the Addiction Severity Index
(ASI; McLellan, Luborsky, Woody, & OBrien, 1980).
The AS1 is a structured interview to assess substance
use and related experiences. This study used the Alcohol Problems and Drug Problems sections of the
AS1 to assess several variables. Lifetime regular use of
alcohol and drugs was assessed, with regular use defined as drinking or using drugs on three or more occasions per week. Subjects rated their level of distress
over drug and alcohol problems in the past 30 days,
ranging from not at all troubled (0) to extremely troubled (4). Subjects rated the importance of treatment
for alcohol and drug abuse, ranging from not at all
important (0) to extremely important (4). In addition,
subjects reported the amount of money spent on alcohol and drugs in the past 30 days, the number of
days experiencing alcohol problems in the past 30 days,

D.S. Keller et al.

574

and the number of days experiencing drug problems

in the past 30 days.
Reliability. The reliability of the data extracted from
the medical records for the treatment variables was
determined by calculating interrater agreement using
a subset of the medical records that were reviewed.
Thirty (23.7%) medical records were read by two reviewers, and correlation coefficients were calculated
for each of the treatment variables. Table 2 lists results
of the reliability assessment.
Reliability coefficients were not calculated for the
descriptive variables. As this information was part of
the standard program assessment, there were no discrepancies between data collected by the two reviewers.
High reliability and validity of the AS1 with populations of substance abusers seeking treatment has been
demonstrated (Kosten, Rounsaville, 8z Kleber, 1983;
McLellan, Luborsky, Woody, Jz OBrien, 1980).

Description

of Program Evaluation

Procedures

Review of Medical Records. Two trained reviewers collected data from the medical records of 132 clients who
received services at NJCSAP over the past 3 years. One
reviewer read the medical record and recorded the descriptive information using the DIF. Any descriptive
information not found in the medical record was coded
as missing. A reviewer then counted each treatment
event recorded in the medical record using the TIE Clinicians at NJCSAP wrote a progress note for each
treatment event that a client was scheduled to attend,
whether or not the client attended. Thus it was possible to tally all group, individual, and family sessions
that the client attended, as well as those that he or she
missed.

TABLE 2
Correlation Coefficients Assessing Interrater Agreement
for Treatment Variables
Variable
Inpatient Treatment
Length of inpatient treatment
Individual sessions attended
Individual sessions misseda
Groups attended
Groups missed
Family sessions attended
Outpatient treatment
Individual sessions attended
Individual sessions missed
Groups attended
Groups missed
Family sessions attended

r
0.994
0.984
0.998
1 .ooo
1.000
0.993
0.992
0.941
0.999
0.995
0.895

Walue could not be calculated because of insufficient observations.

In addition, data on outpatient treatment were collected by month for a subset of 99 subjects. These
subjects consisted of students who either entered
outpatient treatment directly or were transferred to
outpatient status after an initial inpatient stay. This
subset was created to analyze separately how outpatient services were utilized over time. For this subset,
the total number of months in treatment was determined, and subjects were divided into two groups: (a)
subjects who received between 1 week and 3 months
of intensive outpatient treatment (n = 28) and (b) subjects who received 4 months or more of intensive
outpatient treatment (n = 71). These groups were compared in terms of total number of groups and individual sessions attended.
For a subset of subjects who received 4 or more
months of outpatient treatment, the number of group
and individual sessions for each subjects first full
month, middle full month, and last full month in treatment were recorded to determine if there were any patterns to treatment utilization throughout the time spent
in treatment (n = 56, only those subjects with complete
first, middle, and last month data were included). A
full month of treatment was defined as a month in
which there were at least 19 days available for treatment (excluding weekends and holidays). Because clients entered treatment during different months and
received varying amounts of treatment per month, clients differed in terms of which month was their first
full month, middle full month, and last full month.
Discharge Information. Information was collected
about a clients final discharge from the program.
Thus, a clients discharge from the inpatient level of
care was not included if he or she was continuing in
the outpatient segment of the program.
A discharge against medical advice (AMA) was defined as leaving residential or partial-residential treatment before meeting the units criteria for discharge.
A premature discharge was defined as discontinuing
of intensive outpatient treatment after initially engaging in treatment.
Missing Data. Some descriptive variables were not
available from all medical records. The number of subjects assessed for each variable is listed with the results.
Assessment of Research Subsample With the ASI. Informed consent to participate in the separate research
project was obtained within the first week of treatment, and the AS1 was administered in the second or
third week of treatment. Data were collected by four
advanced graduate students in clinical psychology.
RESULTS

Three sets of analyses were conducted: (a) descriptive

characteristics of the sample were evaluated, along

575

Treating College Substance Abusers

with the more specific substance-use experiences of the
research subsample;
(b) treatment variables were assessed; and (c) interactions
between descriptive and
treatment variables were assessed.

TABLE 4
Academic Characteristics

of the Sample

Number (Perceni

Variable

102

Descriptive

Characteristics

of the Sample

Demographic Variables. Table 3 summarizes the demographic

characteristics
of the sample. Subjects
ranged in age from 17-41 years, with an average age
of 22.51 years (SD = 4.76 years). Eighty subjects were
male, whereas 52 were female. The subjects were distributed across all grade levels, with 38.7% freshman
and sophomores, 49.1% juniors and seniors, and 11.9%
postgraduate
or nonmatriculated.
Most of the sample
was White and unmarried.
Academic Variables. Table 4 lists the academic characteristics of the sample. Subjects overall grade point
average (GPA) was assessed. Half the clients had a
C average, some had below a C average, and about
one third had an A or B average. Results changed
slightly for last-term GPA: More clients had below a
C average, and about equal proportions
had an A or
B average. Most subjects were in satisfactory academic
standing, although one quarter were on academic probation. About 20% were members of a Greek letter
organization.
Living Arrangements at Intake. A summary of the living arrangements
of students is provided in Table 5.
At the start of treatment,
one third lived in a dormi-

TABLE 3
Demographic Characteristics

n
132
124

130

132

Variable
Percent male
Grade level
Freshman
Sophomore
Junior
Senior
Postgraduate
Nonmatriculated
Race
White
African-American
Asian
Hispanic
Other
Marital status
Single
Married
Cohabitating
Divorced
Other

of the Sample

Number (Percent)
80

(60.6)

20
28
38
23
9
6

(16.1)
(22.6)
(30.6)
(18.5)
(7.3)
(4.8)

111
8
2
6
3

(85.4)
(6.2)
(1.5)
(4.6)
(2.3)

123
2
2
3
2

(93.2)
(1.5)
(1.5)
(2.3)
(1.5)

Overall GPA
0.00-0.99
1.00-l .99
2.00-2.99
3.00-3.99
4.0
68 Last-term GPA
0.00-0.99
1.00-l .99
2.00-2.99
3.00-3.99
4.0
1 17 Academic standing
Satisfactory
Probation
Other
125 Member of a Greek organization
Yes
No

2
13
51
33
3

(2.0)
(12.7)
(50.0)
(32.4)
(2.9)

4
11
24
26
3

(5.9)
(16.2)
(35.3)
(38.2)
(4.4)

74 (63.2)
30 (25.6)
13 (11.1)
26 (20.8)
99 (79.2)

tory and another one third lived in an off-campus

apartment. Fewer clients resided in their familys home
or in University Recovery Housing.
Substance Use History. Table 6 summarizes subjects
past substance-use
characteristics.
On average, clients
began using alcohol at age 11 and began drug use at
approximately
age 14. Most clients endorsed alcohol
as their drug of choice, although smaller proportions
preferred marijuana or cocaine, and few endorsed hallucinogens as their preferred substance. About 20%
reported a combination
of alcohol with either marijuana or cocaine as their drugs of choice.
Almost one quarter of the sample reported a previous history of inpatient
substance-use
treatment,
whereas more than one third reported a history of outpatient substance-use treatment. Most subjects (70.2%)
had past experience with AA or NA.
A subsample of subjects (n = 60) was assessed with
the ASI on the remaining substance-use
variables. On

TABLE 5
Living Arrangements

n
130

at Intake

Variable
Living arrangements at intake
Dormitory
Apartment off campus
Family home
Recovery housing
Other

Number (Percent)

42
46
24
13
5

(32.3)
(35.4)
(18.5)
(10.0)
(3.8)

576

D.S. Keller et al.

TABLE 6

Substance Use Characteristics of the Sample

n
114
114
79

120
120
114
62
62
62
62
62
62

62

61

61

62
62
62
62

Variable

Number (% or SD)

Mean age of first use of alcohol (SD)

Mean age of first use of drugs (SD)
Drug of choice
Alcohol
Marijuana
Cocaine
Hallucinogens
Combination
Past inpatient substance-use treatment
Past outpatient substance-use treatment
Past experience with AAINA
Mean months of regular use of alcohol (SD)
Mean months of regular use of alcohol to intoxication (SD)
Mean months of regular use of marijuana (SD)
Mean months of regular use of cocaine (SD)
Mean months of regular use of two or more substances (SD)
Ratings of distress over alcohol problems in the past month
Not at all distressed
Slightly distressed
Moderately distressed
Considerably distressed
Extremely distressed
Ratings of distress over drug problems in the past month
Not at all distressed
Slightly distressed
Moderately distressed
Considerably distressed
Extremely distressed
Ratings of importance of additional alcohol treatment
Not at all important
Slightly important
Moderately important
Considerably important
Extremely important
Ratings of importance of additional drug treatment
Not at all important
Slightly important
Moderately important
Considerably important
Extremely important
Mean dollars spent on alcohol in past month (SD)
Mean dollars spent on drugs in past month (SD)
Mean days experiencing alcohol problems in the past month (SD)
Mean days experiencing drug problems in the past month (SD)

average, these subjects had used alcohol regularly for

over 6 years and used it to the point of intoxication
for almost 4 years. In addition,
subjects engaged in
regular use of marijuana
for almost 3 years and regular use of cocaine for less than 6 months. Subjects engaged in regular use of two or more substances for
almost 2.5 years.
Of the subsample,
almost two thirds reported being moderately,
considerably,
or extremely bothered
by alcohol problems during the past month, and half
reported similar levels of distress regarding drug problems in the past month. Almost two thirds rated additional treatment for alcohol problems as moderately,
considerably,
or extremely important,
whereas almost

11.60
14.44

(3.80)
(3.33)

42
10
8
2
17
29
45

(53.2%)
(12.7%)
(10.1%)
(2.5%)
(21.5%)
(24.2%)
(37.5%)

z.94
47.15
33.84
5.60
29.63

;;::z;)
(45.13)
(46.43)
(13.81)
(40.14)

16
8
9
17
12

(25.8%)
(12.9%)
(14.5%)
(27.4%)
(19.4%)

25
7
9
11
10

(40.3%)
(11.3%)
(14.5%)
(17.7%)
(16.1%)

16
6
6
9
24

(25.8%)
(9.7%)
(9.7%)
(14.5%)
(38.7%)

25
7
4
6
19
42.82
52.18
7.52
6.15

(40.3%)
(11.3%)
(6.5%)
(9.7%)
(30.6%)
(102.02)
(155.70)
(10.39)
(9.59)

half rated additional treatment for drug problems as

moderately,
considerably,
or extremely important.
On average, subjects in the subsample spent over
$40 on alcohol and over $50 on drugs in the month
prior to the interview. They had experienced alcohol
problems for more than 1 week of the past month and
drug problems
for almost 1 week out of the past
month.
Family History. Family history variables are summarized in Table 7. Almost half of the sample had a father
who experienced problem alcohol use either currently
or in the past. Few clients had a father who had ever
experienced problem use of other drugs. Smaller num-

577

Treating College Substance Abusers

TABLE 7
Family History of Substance Use
Variable

n
119
122
119
123
111
108

Father with problem use of

alcohol
Father with problem use of
drugs
Mother with problem use of
alcohol
Mother with problem use of
drugs
Previous physical abuse
Previous sexual abuse

Number (Percent)

50 (42.0)
6 (4.9)
18 (15.1)
11 (8.9)
18 (16.2)
22 (20.4)

bers had a mother with either current or past problem

with alcohol or drugs. In addition,
16.2% reported
previous physical abuse, and 20.4% reported past sexual abuse.
Psychiatric History. Table 8 lists psychiatric characteristics of the sample. Overall, 19.2% had a history
of previous inpatient psychiatric treatment,
whereas
75 % reported past outpatient
psychiatric treatment.
At the start of treatment at NJCSAP, 15% were taking medication for a psychological problem. One quarter of the sample reported previous symptoms of an
eating disorder, and almost as many reported at least
one past suicide attempt.
Treatment

Utilization

Table 9 summarizes the ways that clients utilized treatment, Almost one quarter of students received first
inpatient then outpatient services at NJCSAP, whereas
almost one half received outpatient
services only.
Another 10.6% attended NJCSAP only as inpatients,
and 13.6% had multiple
inpatient
and outpatient
admissions.
Residential and Partial-Residential
Treatment.
The
length of residential and partial-residential
treatment

TABLE 8
Psychiatric Characteristics of the Sample

n
130
124
127
125
1 19

Variable
Past inpatient psychiatric
treatment
Past outpatient psychiatric
treatment
Current use of psychotropic
medication
Current or past eating disorder
symptoms
Past suicide attempt

Number (Percent)

25 (19.2)

ranged from l-73 days, with a mean of 26.07 days.

On average, clients attended more than five individual sessions during residential and partial-residential
treatment:
they missed very few individual
sessions.
Clients attended an average of almost 22 group sessions as inpatients.
Intensive Outpatient Treatment. The length of outpatient treatment ranged from 12-524 days, with a mean
of 185.97 days. On average, clients attended 16 individual sessions during outpatient treatment,
and they
missed just over two individual
sessions. Clients attended an average of almost 28 group sessions as outpatients and missed an average of eight groups.
Clients who received less than 4 months of outpatient treatment
(n = 28) averaged 3.41 individual
sessions and 5.59 group sessions over the course of
treatment.
Clients who received more than 4 months
of treatment (n = 71) averaged 20.41 individual
sessions and 41.23 group sessions over the course of
treatment.
A subset of clients who received more than 4 months
of outpatient treatment (n = 56) was then assessed in
terms of their first, middle, and last full months of
treatment in order to determine if there were any patterns to treatment utilization.
In their first full month
of outpatient
treatment,
clients averaged 8.00 (SD =
4.48) group sessions and 3.41 (SD = 1.92) individual
sessions. In their middle full month of outpatient treatment, clients averaged 7.05 (SD = 3.15) group sessions
and 2.91 (SD = 1.47) individual sessions. In their last
full month of outpatient
treatment,
clients averaged
4.43 (SD = 3.01) group sessions and 2.59 (SD = 1.49)
individual
sessions.
Repeated measures analysis of variance (ANOVA)
was used to assess the significance
of these changes
over time and showed an overall significant time effect (F = 6.758, p < .002). Paired t tests were used to
assess the significance of these individual differences.
Clients attended a greater number of group sessions
during both the first and the middle full months of outpatient treatment than during the last full month (t =
4.98,~ < .OOOl and t = -4.85,~ < .OOOl, respectively).
Clients attended a greater number of individual
sessions during the first full month of outpatient
treatment than during the last full month (t = 2.45, p <
.02). These results indicate that outpatient treatment
followed a pattern of utilization wherein patients attended twice as many group sessions during the beginning and middle of treatment
as at the end and
attended twice as many individual sessions during the
beginning of treatment as at the end of treatment.

93 (75.0)
19 (15.0)
32 (25.6)
28 (23.5)

Discharge Information. Of the subjects who had been

discharged from NJCSAP, 63.47% completed a regular discharge, 9.5% had an AMA discharge, 6.0%
were transferred
to other treatment
facilities, and
20.8% had a premature
discharge.

578

D.S. Keller

et al.

TABLE 9
Treatment Utilization

Variable

132

67

99

28

71

56

115

Number (% or SD)

Order of services
Inpatient to outpatient
Outpatient only
inpatient only
Multiple admissions
Not admitted
Inpatient treatment (M + SD)
Length of inpatient stay in days
Individual sessions attended
Individual sessions missed
Groups attended
Groups missed
Outpatient treatment (M * SD)
Length of outpatient stay in days
Individual sessions attended
Individual sessions missed
Groups attended
Groups missed
Outpatient treatment: clients who received less than
4 months outpatient treatment (M f SD)
Individual sessions attended
Groups attended
Outpatient treatment: clients who received more than
4 months outpatient treatment (M k SD)
Individual sessions attended
Groups attended
Outpatient treatment: Clients who received more than
4 months outpatient treatment (IU f SD)
Individual sessions attended in first full month
Individual sessions attended in middle full month
Individual sessions attended in last full month
Groups attended in first full month
Groups attended in middle full month
Groups attended in last full month
Discharge information
Regular discharge
AMA discharge
Transferred to other facilities
Premature discharge

Interactions Between Descriptive

and Treatment Variables
Among those who received residential
treatment,
females remained
in treatment
longer than males,
t(64) = -2.51, p c .05. Females attended
more
group sessions, t(64) = -2.93, p < .Ol, and a trend
towards more individual sessions, t (64) = - 1.87, p =
.067, as residents than males. There were no differences between males and females on any of the outpatient treatment
variables.
No other comparisons
were significant.

DISCUSSION
NJCSAP was designed to meet the substance-abuse
treatment needs that were assumed to exist among Rutgers University students. To assess the previously pre-

36
60
14
18
4

(27.3%)
(45.5%)
(10.6%)
(13.6%)
(3.0%)

26.08
5.72
0.04
21.56
0.25

(19.38)
(4.73)
(0.37)
(17.06)
(0.61)

185.97
16.26
2.38
27.80
8.03

(121.27)
(11.82)
(3.01)
(24.70)
(6.67)

3.41 (2.41)
5.59 (6.10)

20.41
41.23

3.41
2.91
2.59
8.00
7.05
4.43
73
11
7
24

(12.07)
(25.80)

(1.92)
(1.47)
(1.49)
(4.48)
(3.15)
(3.01)
(63.5%)
(9.5%)
(6.0%)
(20.8%)

sented program evaluation

data, we organized the
discussion with respect to our initial assumptions:
(a)
a seriously impaired population of college student substance abusers exists; (b) this population requires more
intensive substance-abuse
treatment than what traditionally can be found on a university campus; and (c)
this population could be attracted to an on-campus residential and intensive outpatient substance-abuse
treatment program.
First, we thought that a population of students with
serious substance use problems existed within the university whose treatment needs exceeded the capacities
of prevention and student assistance programs. This
assumption
was based upon the growing frequency
with which students entering the student assistance
program required referral to more intensive communitybased treatment
centers. It was also supported
by
reports in the literature which suggested that more

Treating College Substance Abusers

intensive treatment models might become necessary for
adequate
treatment
of some college students with
substance-abuse
problems (Berkowitz & Perkins, 1986;
Dean et al., 1986). Clearly, the present program evaluation suggests that such an impaired population
exists at Rutgers. Students utilizing NJCSAP reported
an early onset of substance use, substantial
prior utilization of both inpatient and outpatient
substanceabuse treatment, extensive prior utilization of self-help
programs, and high rates of family alcohol problems.
Moreover, data from the research subsample suggest
that students treated at NJCSAP had utilized substances on a regular basis and to the point of intoxication over long periods of time prior to entering the
program or the university. This latter finding suggests
that substance abuse in this population
may not be
simply a function of the widespread availability
and
acceptability of substance use on American university
campuses but that these students may bring substanceuse disorders with them to the university. Furthermore,
a significant number of these students reported fairly
high levels of distress over their use of substances in
the month prior to entering treatment and regarded
treatment
as moderately to extremely important.
Finally, the program evaluation data revealed that many
of the students had experienced, or were experiencing,
a host of other psychological,
emotional,
and traumatic difficulties such as eating disorders, physical and
sexual abuse, and suicide attempts. A full 75% reported past outpatient psychiatric treatment, and nearly
20% had required a past psychiatric hospitalization.
Moreover, many, if not the majority, of these students
met diagnostic criteria for one or more comorbid psychiatric disorders (Bennett & McCrady, 1993). Given
these histories of extensive substance abuse, previous
substance-abuse
treatment, high rates of other psychological/emotional
problems, and frequent prior psychiatric treatment,
it appears reasonable to conclude
that our first assumption
was confirmed: There exists
a population
of students with serious substance-use
problems.
Second, when the program initially was conceived,
it was assumed that students would require interventions of significant intensity and duration. Specifically,
we anticipated
that (a) many students would require
residential or partial-residential
treatment,
similar to
that provided by community-based
rehabilitation
programs, followed by intensive outpatient treatment; (b)
intensive outpatient treatment for students entering either directly or transferring from residential care would
involve multiple treatment hours per day, several days
per week over the initial 3-6 months, devolving into
progressively
less intensive treatment thereafter;
and
(c) the length of treatment
would probably be 6-12
months. Based on our program evaluation data, several interesting findings emerge. About half of the students treated at NJCSAP required some residential
treatment at one time or another. The duration of such

579
treatment (mean = 26.08 days) parallels that provided
in community-based
settings, which typically lasts 2128 days. During this period, students received approximately 1.5 individual sessions per week and just under
one group therapy hour per day. Additionally,
students engaged in a variety of related activities such as
self-help meetings, execution of treatment plan assignments, psychoeducational
films and lectures, and the
Sociology of Alcohol course. Although this level of intensity is what we anticipated, it is probably somewhat
lower than treatment intensity in typical inpatient programs in the community.
This possible disparity may
reflect that the vast majority of inpatient treatment
provided at NJCSAP was partial-residential,
with students at this level of care regularly leaving the unit for
large parts of the day.
However, it appears that students receiving intensive outpatient treatment required a treatment course
of far less intensity and duration than was initially anticipated. Overall, these students received approximately
two treatment
hours per week for about 6 months.
Even when early dropouts are eliminated (students with
less than 4 months of treatment) from the analyses, the
data reveal that longer term outpatients
(greater than
4 mopths of treatment) received approximately
3 hr of
treatment per week in their first month, about 2.5 hr
of treatment per week in the middle month, and 1.75 hr
of treatment per week in the month prior to discharge.
These program evaluation data for both inpatients and
outpatients
suggest the intensity of substance-abuse
treatment
for a seriously impaired
college student
population
may not need to be as intensive as many
community-based
programs
prescribe or as we assumed to be necessary. Of course, the more crucial
question is how effective treatment actually has been.
The program evaluation data reported in this study do
not permit an estimate of clinical outcomes at NJCSAP,
which will be the subject of a future communication.
However, the data do provide several indices related
to outcome. First, nearly 64% of all students in the
program evaluation completed treatment with regular
discharges, suggesting that such students may be retained at a relatively high rate. Second, students appear to have adhered extremely well to treatment plans:
Attendance
for scheduled treatment
sessions ranged
from 77%-99%
across levels of care.
It is appropriate
to speculate on the importance
of
nonspecific
factors such as recovery housing and
peer support networks in the treatment
of NJCSAP
students. Although the program evaluation
does not
contain data on these variables, it is probable that aggressive use of such supports both facilitated positive
outcomes and decreased the need for more frequent
utilization
of on-unit therapies per se.
A third assumption
underlying
the creation
of
NJCSAP was that a sufficient client base existed within
the university and that these students could be attracted
to the program. Although it is clear from the present

580
data that there are students with severe substance abuse
and related disorders who require intensive treatment,
it remains unclear whether this population is sufficiently large enough to support the existence of a program such as ours. Perhaps this issue can be illustrated
best by reviewing some of the common impediments
and obstacles NJCSAP experienced in attracting students in need into the program.
First and foremost is the issue of referral sources.
Referrals to NJCSAP came from both within and outside the university. Within-university referrals originated from a variety of sources, but most came from
other treatment providers at Rutgers, such as the student assistance program and the student counseling
centers. In theory, substance-abuse treatment within
the university existed along a continuum from preventive education to student assistance to intensive treatment. In practice, however, this continuum of services
was not as integrated and coordinated as it might have
been. Thus, each of these programs remained fairly autonomous from one another, and it was not always
clear whether appropriate referrals were made or if
they were made in a timely manner. It is our view that
one unified integrated system of services would vastly
facilitate the referral process and ensure that students
would be referred to the appropriate level of care upon
presentation for treatment.
With respect to referrals originating outside the university, we initially believed that impaired students
from other colleges and universities in New Jersey and
surrounding states would utilize NJCSAP. Mechanisms were devised to enroll such students on a nonmatriculated basis so that they could remain in school
and return to their home universities with transfer
credits accumulated at Rutgers. Success in recruiting
these students was modest at best. One significant obstacle was the lack of adequate marketing funds and
other resources to maintain active liaisons with other
schools. In addition, it was difficult for students from
other schools to interrupt their school work midsemester to enroll in treatment.
A second impediment in recruiting students was financial. In contrast to prevention and student assistance programs, NJCSAP relied on fee-for-service
revenues as a major funding source. Initially, we expected that students would be able to afford treatment
either through parental insurance, student insurance,
or some combination. Nevertheless, a number of difficulties arose in this area including the increasing reluctance of third-party payers to authorize inpatient
substance-abuse treatment, the somewhat ironic fact
that Rutgers own student insurance policy does not
pay for outpatient treatment, and the reluctance among
many students to utilize parental insurance policies under which they were covered in order to avoid disclosing their substance abuse problems to parents.
Finally, there appeared to exist a small number of
students with severe substance-use disorders who were

D.S. Keller et al.

not appropriate for our program. Typically, such students presented with either severe thought disorder or
were too overtly aggressive. The former are most appropriately treated in a hospital-based dual diagnosis
program, the latter in more conventional community
programs. In either case, such students are simply too
disruptive to others in the program.
CONCLUSIONS

Several conclusions may be drawn from our experiences in treating this population of substance abusers
and the data from the program evaluation. First, a
population of severely impaired substance-abusing college students exists within the university. These
students typically present with fairly longstanding
substance-abuse problems, previous substance-abuse
treatment, and often complicating psychiatric/emotional disorders. Whether this population is characteristic of American universities at large is a question that
deserves further scrutiny but is not possible to answer
based on the data of this study. However, reports
in the literature (Berkowitz & Perkins, 1986; Dean
et al., 1986) suggest that the problem of college students with severe substance-use disorders is not a
localized phenomenon.
Second, an intensive on-campus treatment program
can be developed and implemented to provide treatments of appropriate intensity and duration to such
students while simultaneously permitting them to remain in school. The intensity and duration of such
treatment, although exceeding treatment typically provided by prevention and student assistance programs,
may be less than is usually provided at communitybased centers. The degree to which such treatment is
effective will be reported in a future communication.
Third, for such a program to achieve maximum
productivity and efficiency in accessing and treating
this population, it should be part of an integrated and
cohesive continuum of substance-abuse services. Furthermore, it may require university-committed funding for adequate staffing and marketing (Dean et al.,
1986).
Daniel S. Keller, PhD, *
Melanie E. Bennett, MS,t
Barbara S. McCrady, PhD,t
Michael D. Paulus, MSKt and
William Frankenstein, PhD $
*Department of Psychiatry
Division of Alcoholism and Drug Abuse
New York University School of Medicine
New York, New York
iCenter of Alcohol Studies,
Rutgers-The
State University of New Jersey,
New Brunswick, New Jersey
SPrivate Practice, Red Bank, New Jersey

Treating

CoIlege

Substance

Abusers

REFERENCES
Anderson, D.S., & Gadeleto, A.F. (1984). Progress on illusion: The
1979 and 1982 college surveys. Journal of College Student Personnel, 25, 332-337.
Baer, J.S., Kivlahan, D., Barrett, K., & Marlatt, G.A. (1991, November). Prediction
of college student drinking from individual difference and social influence processes. Poster presented
at the 25th annual convention
for the Association
for the Advancement of Behavior Therapy, New York.
Bennett, M.E., & McCrady, B.S. (1993). Subtype by comorbidity
in young adult substance abusers. Journal of Substance Abuse,
5, 365-378.
Berkowitz, A.D., & Perkins, H.W. (1986). Current issues in effective alcohol education programming.
In J.S. Sherwood (Ed.),
Alcohol abuseproblems among college students (NASPA Monograph Series). Columbus, OH: National Association of Student
Personnel Administrators.
Blane, H.T., &Hewitt, L.E. (1977). Alcoholandyouth:
An analysis
of the literature: 1960-1975. Prepared for the National Institute
on Alcohol Abuse and Alcoholism
(Reprint No. PB-268-698,
NIAAA/NCALl-770107).
Springfield, VA: U.S. National Technical Information
Service.
Cook, D.R. (1987). Self-identified addictions and emotional disturbances in a sample of college students. Psychology of Addictive Behaviors, 1, 55-61.
Dean, J.C., Dean, H.E., & Kleiner, D.L. (1986). Alcohol and drug
collegiate treatment programs: A proposal. Journal of Substance
Abuse Treatment, 3, 95-101.
Duthie, L.A., Baer, J.S., & Marlatt, G.A. (1991, November). High
risk status and personal risk perception
for alcohol problems
among college students. Poster presented at the 25th annual convention for the Association
for the Advancement
of Behavior
Therapy, New York.
Goodstadt,
MS., & Caleekal-John,
A. (1984). Alcohol education
programs for university students: A review of their effectiveness.
International Journal of the Addictions,
19(7), 721-741.

581
Institute of Medicine. (1989). Prevention and treatment of alcohol
problems: Research opportunities.
Washington,
DC: National
Academy Press.
Kosten, T.R., Rounsaville,
B.J., & Kleber, H.D. (1983). Concurrent validity of the Addiction Severity Index. Journal of Nervous and Mental Disease, 171, 606-610.
Marlatt, G.A. (1985). Lifestyle modification.
In G.A. Marlatt & J.R.
Gordon (Eds.), Relapse prevention: Maintenance strategies in
the treatment of addictive disorders (pp. 280-348). New York:
Guilford.
Marlatt, G.A., &Gordon,
J.R. (1985). (Eds.). Relapseprevention:
Maintenance strategies in the treatment of addictive disorders.
New York: Guilford.
McCrady, B.S., Dean, L., Dubreuil, E., & Swanson, S. (1985). The
problem drinkers project: A programmatic
application of sociallearning-based treatment. In G.A. Marlatt & J.R. Gordon (Eds.),
Relapse prevention: Maintenance strategies in the treatment of
addictive disorders (pp. 417-471). New York: Guilford.
McLellan,
A.T., Luborsky,
L., Woody, G.E., & OBrien, C.P.
(1980). An improved diagnostic instrument for substance abuse
patients: The Addiction Severity Index. Journal of Nervous and
Mental Disease, 168, 26-33.
Miller, W.R., & Hester, R.K. (1986). Inpatient alcoholism treatment:
Who benefits? American Psychologist,
41, 794-805.
Monti, P.M., Rohsenow,
D.J., Abrams,
D.B., & Binkoff,
J.A.
(1988). Social learning approaches
to alcohol relapse: Selected
illustrations and implications. National Institute on Drug Abuse
Research Monograph Series, 84, 141-160.
Saltz, R., & Elandt, D. (1986). College student drinking studies 19761985. Contemporary
Drug Problems, 13(l), 117-159.
Schall, M., Kemeny, A., & Maltzman, I. (1992). Factors associated
with alcohol use in university students. Journal of Studies on
Alcohol, 53(2), 122-136.
Straus, R., &Bacon, S.D. (1953). Drinking in college. New Haven,
CT: Yale University Press.