A Randomized Controlled Trial of Counterfactual and Personalized Normative Feedback Interventions to Increase Safe Drinking Strategies

<i>Objective:</i> A variety of interventions have been developed to target problematic college student drinking, with minimal long-term effects. Several interventions incorporate alcohol protective behavioral strategies (PBS); however, these remain underdeveloped and underused. Counterfactuals (thoughts about what might have been) can strengthen causal links between behavior and outcome. Recent research has demonstrated counterfactual's effectiveness to increase PBS use. This study examines the effects of brief counterfactual and personalized normative feedback (PNF) interventions to increase PBS use. <i>Method:</i> Undergraduates (<i>N</i> = 239) completed an online 6-week intervention. Participants completed baseline demographics, PBS and alcohol use, and alcohol consequences measures. Participants were randomly assigned to condition: negative event only (Control), negative event with details (Sham), negative event with counterfactuals (CF), and PNF (PBS-PNF). They reported alcohol use, alcohol consequences, and PBS use weekly for 6 wk. <i>Results:</i> PBS use declined in both Control and Sham conditions. By the study's conclusion, CF (<i>d</i> = 0.54) and PBS-PNF (<i>d</i> = 0.46) conditions reported significantly higher PBS use (vs. Control). The Control, Sham, and PBS-PNF (but not CF) conditions had increases in alcohol use across time. In the final week there were indirect associations between alcohol consequences and both CF and PBS-PNF conditions from five weeks prior. <i>Conclusions:</i> This study provides some support for the use of both personalized normative feedback and counterfactual interventions to increase PBS use in college students. The personal relevance of the counterfactual intervention may produce sustained positive outcomes.