Alcohol misuse is a serious issue among college students in the U.S., and American Indian and Alaska Native (AI/AN) students in Alaska, in particular, experience more alcohol-related consequences despite reporting drinking rates comparable to non-Native students. To address these issues, abstinence-only (AO) and harm reduction (HR) approaches are commonly employed. AO emphasizes complete elimination of alcohol use to prevent negative outcomes and is often preferred in prior research by individuals with more severe alcohol-related issues. In contrast, HR aims to reduce the risks and harms associated with drinking without requiring abstinence, and has been shown to be particularly effective among general college populations. However, the higher abstinence rates, negative attitudes toward alcohol use, and collectivist values prevalent in AI/AN communities complicate the direct application of these strategies, and little is known about AI/AN college students’ specific attitudes toward AO and HR. Therefore, this study aims to examine AI/AN students’ perspectives on AO and HR interventions, including perceived social support.
The study involved 159 AI/AN college students recruited from two large open-enrollment universities in distinct regions of Alaska. Participants completed a single in-person data collection session, during which they provided demographic information and responded to a 25-item AO measure and a 21-item HR measure—collectively referred to as the Treatment Attitude Scale, capturing perceived effectiveness, self-efficacy to engage in each strategy, and perceived social support from friends and family. To assess hazardous drinking behaviors, the students also completed the three-item Alcohol Use Disorders Identification Test–Consumption (AUDIT-C). The collected data were then analyzed using 2×2 mixed (between- and within-subjects) analyses of covariance (ANCOVAs) to compare perceived effectiveness, self-efficacy, and perceived social support for AO versus HR interventions.
According to the study findings, there was no significant difference in perceived effectiveness between the two intervention strategies. However, a notable difference emerged in terms of self-efficacy, such that participants reported higher self-efficacy when employing the HR strategy compared to AO. Additionally, individuals with lower levels of hazardous drinking reported higher self-efficacy overall. Regarding perceived social support from friends, there was no difference attributable to participants’ own drinking status. Nonetheless, the friends’ drinking status and the intervention strategy both showed significant effects, as did their interaction. Specifically, participants received notably greater support when using the HR strategy, regardless of whether their friends drank. For perceived social support from family, there was a small but significant difference related to participants’ hazardous drinking status: those who engaged in hazardous drinking tended to perceive lower levels of family support than did non-hazardous drinkers. Furthermore, a significant interaction was found between family drinking status and the intervention strategy, indicating that even if family members drank, support for HR was still significantly higher than for AO. These findings highlight that HR strategies appear to represent a socially and culturally valid approach for addressing the needs of AI/AN college students.
Takeaway: Compared to AO approaches, HR strategies tended to elicit higher levels of self-efficacy and perceived social support from both friends and family among AI/AN college students.