Normative Feedback for Adult Drinkers: Intervention through Developing Discrepancy or By Validating Pre-Existing Worries?

Background and Purpose: Normative feedback (NF) is a highly effective brief intervention for many health behaviors, including problem drinking. It is currently being utilized across health care systems and community based organizations by social workers as a first point of prevention and intervention among problem drinkers. Despite its widespread utilization, its mechanisms of action remain largely unknown and unexplored in an adult drinker population—preventing discovery of the most efficient and cost effective form of NF. It is theorized that NF works primarily by developing discrepancy between one’s own drinking and that of his or her peers (normative discrepancy) or between one’s ideal image of oneself and one’s actual drinking (self-ideal discrepancy). This exploratory study examined the role of discrepancy as a potential mechanism of action of NF among a sample of adult drinkers.

Method: Using Amazon’s Mechanical Turk, 87 men (n=56) and women (n=31) completed an online survey during which they were asked about their perceptions of their drinking compared to peers and the quantity and frequency of drinking. They were then provided NF on their drinking and were immediately evaluated for their reactions (e.g., “Does this worry you?”, “Are you surprised by this?”, “Is this new information for you?”). NF was provided based on actual drinking. Discrepancy was measured by the difference between one’s estimated percentile ranking and actual percentile ranking of drinking related to a general population of their same gender. Plan to change drinking was a proxy for behavioral outcome.

Results: Participants generally estimated that others drank more than they did. Most participants did not identify their alcohol use as excessive (M=1.9, SD=1.5) or problematic (M=1.6, SD=1.3; range 1-8, 8 = extremely excessive or problematic). Only 6.4% reported drinking beyond safety guidelines defined by the National Institute for Alcohol Abuse and Alcoholism. Generally, participants were quite surprised by NF (M=6.1, SD=2.2) but not worried (M=2.6, SD=2.1). After receipt of NF, 26% planned to decrease drinking. The greater the participant rated their drinking as problematic pre-NF (B=-.236, p <.001), the greater the worry (B=-.165, p <.001) and the greater the perceived accuracy of NF (B=-.150, p <.01), the more drastic the plan to cut back drinking (R²=.416). Discrepancy was not related to planning or to worry.

Conclusion: Findings suggest drinkers who believe NF and plan to change may already be aware that drinking may be a problem. All indicators of developed discrepancy, including the discrepancy variable, surprise or whether this was new information, were not predictive of planned behavior change. This is consistent with the three other studies that have investigated the role of discrepancy in NF, though each study operationalized discrepancy differently. These findings suggest it may be that NF works by validating a preexisting notion that drinking may be excessive compared to norms—instead of creating worry where none existed (i.e., developed discrepancy). Limitations are discussed.