Session Components

Although the Facilitator Handbook provides step-by-step instructions and details for facilitating an IMAGE session, an overview of each session component is included here. To request a Facilitator Handbook, contact UH Wellness directly.


In order to provide normative feedback for the cohort’s alcohol use behavior, a pre-test must be obtained. If you are utilizing an Audience Response System (i.e. “Clickers”), the pre-test questions can be asked during the course of the session itself. If not, it is important to obtain the data ahead of time so that the cohort’s perceptions and self-reported drinking can be determined.

Defining High-Risk Drinking

IMAGE focuses on the concept of “high-risk drinking” rather than the commonly used term, “binge drinking”; as a result, a discussion is held clarifying the two terms.  The facilitator explains that high-risk drinking is a broader term which, for IMAGE purposes, is defined as alcohol-use behavior that can result in negative consequences.

High-Risk Drinking Discussion

The facilitator then leads a discussion with the students examining high-risk drinking examples.  For each example, it is important to be sure to discuss why it is high-risk or what the potential negative consequence would be. This allows the students to recognize the benefits of the self-protective behaviors which are discussed next in the section.

Self-protective Behavior Discussion: Having generated a list of high-risk drinking examples, the students are then asked to discuss examples of self-protective behaviors, which are defined as those behaviors that reduce the likelihood of negative alcohol-related consequences. Both abstinence-supporting (such as “making academics a priority over alcohol”) and harm-reduction behaviors (“staying hydrated”) are included in the discussion.

Alcohol Poisoning

A brief discussion of alcohol poisoning is included, which details symptoms as well as actions to take in the event of that situation. To increase students’ knowledge of available campus resources, and reduce the likelihood of student inaction in cases of alcohol poisoning, UH Wellness developed a plastic, wallet-sized card for distribution to students.  The card details signs of alcohol poisoning (using a novel acronym PUBS—Puking, Unconscious, Breathing, Skin) on one side with campus resources and when to call “911” on the other. Request a Facilitator Handbook for additional details about the PUBS card.

Normative Feedback

The most crucial component of IMAGE is the provision of normative feedback based upon both campus and cohort norms.  The facilitator asks the students to estimate campus-wide alcohol frequencies and quantities in order to demonstrate the overestimation that often occurs. Then, the student cohort’s self-reported alcohol frequency and quantity are revealed and compared to the campus-wide norms. If ARS technology is being utilized, the software generates bar charts to visually represent the student responses and campus-wide norms.  If ARS is not available, the facilitator uses a physical representation of the normative information which can be hard-copy bar charts, groupings of root beer bottles, or other graphic representations.  For additional details, contact UH Wellness to obtain the Facilitator Handbook.

Regardless of the specific representation method, the facilitator then leads a discussion (using Motivational Interviewing skills), about what risks the cohort faces as result of members who may be choosing to drink frequently and/or in excess. Student participants are able to privately compare their drinking patterns with both campus-wide norms and their cohort – students to whom they see themselves as being similar. The discussion of risks can be quite impactful to cohorts, and is designed to motivate students to make changes in their own drinking patterns but sometimes simply hearing the normative feedback  alone is enough to encourage changes in behavior.


Finally, students complete a post-test during which they identify one self-protective behavior that they plan on implementing into their lifestyle, consistent with the Theory of Reasoned Action. They also provide their perception of campus-wide norms, to test their recall from the session.