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Colleges are using new simulation-based programs to help train freshmen about important topics, such as substance use and sexual misconduct prevention. Ariel Skelley/Getty Images
  • Kognito is a “health simulation company” that offers computer simulations to help educate college students about substance use and sexual misconduct prevention.
  • The creators of these programs say being able to participate in the trainings from the privacy of one’s home rather than in a classroom or school auditorium is a lot less intimidating, allowing students to get more out of the training from the beginning.
  • These programs may also help students develop effective “bystander skills,” or ways students can intervene if they see a situation as potentially dangerous for others around them.

This fall, millions of students started college programs as the new school year began.

Many were returning to in-person classes on campus for the first time in a year and a half, following the move to virtual learning during the height of the COVID-19 pandemic.

For many, it has been a disorienting time to return to school amid shifting norms of life during a pandemic.

With a return to studying and living on physical campuses comes efforts by college administrators, counselors, and peer support staff to help students — especially freshmen and transfer students who are new to their college communities — navigate some of the challenges they may face.

Two of those include substance misuse issues and the epidemic of sexual assault on U.S. campuses.

Right now, one company is turning to avatar-based computer simulations to help students prepare for some of these most challenging, traumatizing situations that are all too familiar in college life.

Is modern technology effective at helping students navigate these problems? How has the pandemic further exacerbated and complicated these issues?

To find answers, Healthline spoke with several experts to weigh in on where we are today with raising awareness and providing training to deal with substance use disorders and sexual assault on college campuses.

The statistics are often troubling.

The Association of American Universities reports that 13 percent of all college students experience sexual assault by way of physical force, incapacitation, or violence. This includes 26.4 percent of undergraduate women and 6.9 percent of undergraduate men.

When it comes to issues surrounding substance use, the Substance Abuse and Mental Health Services Administration (SAMHSA), a branch of the Department of Health and Human Services, reports that full-time college students drink more than other people in their age group.

According to 2019 statistics from SAMHSA, 53 percent of these full-time students reported drinking “alcohol in the past month,” with 33 percent of them saying they engaged in binge drinking. About 8 percent said they engaged in “heavy drinking.”

Additionally, 2018 numbers reveal 45 percent of college students reported using recreational drugs of some kind on campus, with 18 percent reporting that drug use extended beyond cannabis.

In general, when it comes to providing training for how to navigate college life, in-person workshops and instruction are the norm.

Kenneth Leonard, PhD, director of the University at Buffalo Clinical and Research Institute on Addictions, told Healthline that the “vast majority” of alcohol education programs, for example, usually “provide classroom instruction about how alcohol is metabolized, the amount of ethanol, or alcohol, in usual alcohol beverages, and the consequences of excessive drinking.”

But he said there’s “no evidence” that this kind of education “has any influence on drinking.”

“Education can be effective if it is combined with skill training directed at reducing risky drinking behavior. There are also some programs called personalized feedback interventions that assess a student’s drinking pattern and provides information about [how] the student’s drinking compares to the average student,” he explained. “Education can be effective if it is combined with these interventions.”

When it comes to what makes an effective training, education, and awareness program for incoming college students centered on sexual assault and violence prevention, Clara Kim, vice president of consulting services for RAINN, explained that the program has to be tailored specifically group by group.

There’s not necessarily a one-size-fits-all approach for discussing and destigmatizing conversations around sexual violence and sexual assault across different kinds of communities.

“Relevance is critical for engagement, and engagement is necessary for positive outcomes,” she wrote in an email to Healthline.

Kim said that RAINN uses a combination of methods, which include lectures, facilitated discussions, breakout sessions, activities, and even multimedia presentations, like short videos and podcasts.

“The education and awareness opportunities need to be provided in an ongoing way,” she wrote. “No single training session no matter how thoughtfully designed, is enough. This is a topic that requires more conversation, not less.”

She added, “It’s critical to create a sense of safety when discussing this enormously difficult topic. Given the prevalence of sexual violence, it is likely that there will be survivors among the participants, as well as individuals who have loved ones who are survivors, and trainers must be highly skilled in trauma-informed communication.”

In an era when technology is so embedded in the lives of students — especially after a year of lockdowns and studying from home — Kognito is hoping that research-backed, computer simulations can help students tackle these important issues.

The New York City-based Kognito bills itself as a “health simulation company,” and is betting on these simulations, which walk participants through hypothetical situations, as being more effective and accessible than in-person workshops.

Kognito offers programs and services designed for a range of groups, from pre-kindergarten to high school students and government to nonprofit workers.

Simulation-based trainings include bullying prevention, cancer, and trauma-informed teaching.

For incoming college students, the company’s “Alcohol & Other Drugs” and “Sexual Misconduct Prevention for Students” programs walk participants through detailed scenarios. You eventually “graduate” once you’ve mastered the discussions needed to work your way through these real-life scenarios.

Kimberly Wieland, MPH, Kognito’s head of product and education, told Healthline that the company had been working with university and college clients for a long time with simulations around mental health scenarios.

She said the feedback the company kept hearing was that schools wanted their students to feel “more comfortable using skills in the moment,” and were looking for programs about sexual assault and substance use prevention that could be accessible for incoming freshmen and transfer students.

“Those first 6 months when you transition to college is a very important time,” she said. “That’s actually when a lot of things, when the worst outcomes happen. They really wanted to make sure that students coming in felt prepared for what they would expect, a program that was also accurate to their expectations of what college would be like.”

Wieland added that in developing these simulations, the goal was not to pander to students. Instead, it was to reflect just how complicated these scenarios can be in real life.

“One of the scenarios in the Alcohol & Other Drugs program is around ‘refusal skills,’ either during pregaming or at a party with drinking games. They feel they want to fit in, so how do we navigate those situations? We took their very specific scenarios and made it very real,” she said.

Glenn Albright, PhD, Kognito’s co-founder and director of research, told Healthline that participating in trainings with “virtual humans” has “many advantages over real face-to-face role plays.”

“In a role play with a virtual human, we are much less likely to feel judged, we open up more, we are much more apt to be curious in terms of exploring different conversation avenues to take with a virtual human,” he said.

“There is less of what we refer to as ‘social evaluative threat,’ the anxiety we feel when we do live role plays with an instructor and other students — that anxiety interferes with your ability to drive the role play,” explained Albright, who is also an associate professor at Baruch College.

Being able to participate in these trainings from the privacy of one’s home rather than in a classroom or a school auditorium is a lot less intimidating.

He also explained that the virtual humans Kognito uses have a “neutral appearance” that can reach a range of people from various backgrounds, races, and cultures.

“The virtual humans are not going to be fatigued. They will be armed with the correct information, they will respond in a way that is most efficacious for the learner,” he added.

Wieland said one example of how helpful these programs are is in the responses she’s received from students discussing “bystander skills.”

“We know students want to intervene if they see a situation as potentially dangerous. Just one example, a student said ‘I saw X happening, but I didn’t know what to do.’ With the program, they are able to try out different things, develop bystander skills. They are given actual language to use in these situations that feels realistic to them,” she said.

For example, in the situation of not knowing how to help a friend who drank too much without seeming judgmental, Wieland said the virtual training might help them de-escalate a potentially charged situation.

Instead of putting the friend on the defense, they can offer a distraction and say, “Let’s go get food.” It sounds like a simple solution, but it might have averted a negative outcome.

“This type of training is highly scalable. You can saturate an entire freshman class with this type of training very easily,” Albright added of the appeal of this kind of program to colleges and universities.

“It can be very cost-effective as opposed to face-to-face training,” he added.

So far, Wieland said positive feedback from students has been “off the charts.”

Generally, training programs carried out before or at the start of an academic year might be greeted by students with a shrug, just one more “compliance thing they have to carry out to complete registration.”

As a result, she said they tried to make the Kognito simulations as engaging as possible.

“We’ve given them open-ended questions to gain their feedback, and they say they liked that it was skills-based, that it was respectful of their time, and gave them something actionable that they can go and do and use it,” she added.

When asked how effective technology-centric approaches to substance use and sexual misconduct and assault trainings might be on college campuses, Leonard of the University at Buffalo said there’s a lot of interest and research right now in leveraging technology to “provide interventions to reduce excessive drinking and prevent adverse consequences from drinking.”

“Interactive video simulations addressing these concerns is currently of great interest. In addition, there is considerable research that utilizes cellphones and real-time monitoring and assessments to identify high-risk drinking situations and to intervene in the moment to reduce the risk,” he added. “These are largely still in the research phase, but are not widely utilized at this point.”

Beyond this, Leonard said social media is a key tool that more colleges and universities are attempting to utilize to reach students.

“As each new technological intervention that provides a way of directly or indirectly interacting with someone is developed, many researchers very quickly begin to develop and test the usefulness of these technologies in reducing drinking and drinking problems,” Leonard explained.

“It takes several years to work out the interventions, test them, and then refine and test again. Then, if successful, it takes time to let people know about these and convince them to use them. So, interventions based on technological innovations are rapidly developed and tested, but it takes a fairly long time before they are widely used,” he added.

Kim, of RAINN, echoed Leonard, writing that “using different technology as a means to create awareness and opportunities to engage with the topic” can be “very effective.”

“But it’s less about the technology and far more about the approach to the topic. This topic needs to be addressed with both sensitivity and sophistication to best surface the complexities of sexual violence and how it can present with a given community.

“Are the scenarios depicted reflective of an audience’s experiences without crossing the line into content that can, itself, create a sense of fear and lack of safety? Is the approach inclusive?” she wrote.

She said that from RAINN’s own research and experience operating the National Sexual Assault Hotline since 1994, “sexual violence can affect anyone, regardless of age, race, gender identity, sexual orientation, and background.”

“For example, a narrative that focuses exclusively on female survivors leaves male survivors out of the conversation (1 in 33 men have experienced an attempted or completed rape in their lifetime),” Kim added.

As with many things — if not everything — COVID-19 immeasurably changed education, the college experience, and some of the issues these simulations and trainings aim to address.

“With college students now returning to campuses, it’s hard to quantify an increase in prevalence rates, data typically lags by several years. But this is what we know: it will continue to be an issue that requires prioritized attention from educational institutions,” Kim wrote of sexual assault and violence on college campuses.

“And we also need to take into consideration the effect of the pandemic on domestic violence and child sexual abuse. Quarantine conditions cut people off from support systems and allies from whom they might otherwise seek support. Educational institutions need to be prepared for the likelihood that some of their students will require more support,” she added.

Leonard echoed Kim that it’s nearly impossible to assess right now how COVID-19 has affected the state or prevalence of substance use and substance use disorders at colleges.

It’s something we’ll need to monitor and have some distance from to better put in context.

“Over the past year, there was some increase in drinking, but some of the research suggests that drinking may have increased in people who were already at risk for drinking for other reasons, but that many others did not change their drinking behavior,” Leonard said.

“It is important to understand that not every college student was impacted in the same way by the pandemic,” he said. “Some may have remained on campus while taking most of the classes remotely, while others returned home and took all of their classes remotely.”

Leonard added that leaving campuses and returning home during COVID-19 lockdowns most likely led to less heavy drinking.

“Similarly, not all students were in areas that were locked down. As we move into the next year, will there be some kind of rebound effect in which those who drank less increase their drinking, or will it return to the typical level?” he said.

For their parts, both Wieland and Albright said the skills that can be gained from dealing with the scenarios in Kognito’s training videos can be applied to managing ever-evolving changes brought to daily life and society by the pandemic.

“I am so pleased how students have related the skills they learned [through the simulations] in dealing with the stress of COVID-19. During quarantine, there is the potential increase in use of drugs and even violence in the home in some cases,” Albright said.

“You have students learning online in the closet of their home because it’s the only place they can be secure. You have all types of stressors, and, relating back to the skills learned in the simulations, they can better handle those stressors and identify them,” he said.

Wieland said it’s also important to emphasize that no single program — whether it be virtual or in person — can be a substitute for engaging with all the resources a college student has at their disposal.

It’s important to take something of a holistic approach to handling the challenges of college life.

“We work closely with every university we deal with as we roll this out. Throughout the program we make clear there are resources available to you through your campus. None of this is done separate from those resources. It’s not just mental health resources, but all types of resources,” she added.

Kognito offers trainings for faculty and staff to help respond effectively to student concerns, too.

If a student confides in staff about something that might have occurred over the weekend, they will know how to direct that student to the appropriate services on campus.

“It’s all about making sure that everyone knows what’s available and what they are able to access to help them support each other,” Wieland said. “It’s not just coping skills to work it out for themselves, but ways to tap into other resources.”