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Objective: Most states prohibit sales of alcohol to customers who are apparently intoxicated, and many require training in responsible beverage service (RBS), with the aim of reducing driving while intoxicated (DWI) and other harms. Sales to apparently intoxicated patrons were assessed in onsite alcohol sales establishments and compared across three states., Method: A sample of 180 licensed onsite alcohol establishments was selected in California ( n = 60), New Mexico ( n = 60), and Washington State ( n = 60). States had different RBS training histories, content, and procedures. Research confederates, trained to feign cues of intoxication, visited each establishment twice. The pseudo-intoxicated patron (PP) ordered an alcoholic beverage while displaying intoxication cues. Sale of alcohol was the primary outcome., Results: At 179 establishments assessed, PPs were served alcohol during 56.5% of 356 visits (35.6% of establishments served and 22.6% did not serve at both visits). Alcohol sales were less frequent in New Mexico (47.9% of visits; odds ratio [OR] = 0.374, p = .008) and Washington State (49.6%; OR = 0.387, p = .012) than in California (72.0%). Servers less consistently refused service at both visits (6.8%) in California than New Mexico (33.9%) or Washington (27.1%), χ 2 (4, n = 177) = 16.72, p = .002. Alcohol sales were higher when intoxication cues were less obvious ( p < .001)., Conclusions: Overservice of alcohol to apparently intoxicated customers was frequent and likely elevated risk of DWI and other harms. The lower sales in New Mexico and Washington than California may show that a policy approach prohibiting sales to intoxicated customers combined with well-established RBS training can reduce overservice. Further efforts are needed to reduce overservice., Competing Interests: Dr. Buller, Dr. Woodall, Ms. Martinez, Ms. Small, and Mr. Chirico receive a salary from Klein Buendel, Inc. Dr. Buller's spouse is an owner of Klein Buendel Inc. Dr. Buller and Dr. Woodall are owners of Wedge Communications LLC, the distributor of the WayToServe online responsible beverage service training. An active management plan is in place at Klein Buendel to manage this conflict of interest. Dr. Cutter is employed by the University of Alabama at Birmingham and reports personal fees from Pythagoras Board membership; advisory board fees from Alexion, Antisense Therapeutics, Avotres, Biogen, Clene Nanomedicine, Clinical Trial Solutions LLC, Entelexo Biotherapeutics, Inc., Genzyme, Genentech, GW Pharmaceuticals, Hoya Corporation, Immunic, Immunosis Pty Ltd, Klein-Buendel Incorporated, Linical, Merck/Serono, Novartis, Perception Neurosciences, Protalix Biotherapeutics, Regeneron, Roche, SAB Biotherapeutics; and data and safety monitoring board fees from Applied Therapeutics, AI therapeutics, AMO Pharma, Astra-Zeneca, Avexis Pharmaceuticals, Bristol Meyers Squibb/Celgene, CSL Behring, Horizon Pharmaceuticals, Immunic, Karuna Therapeutics, Kezar Life Sciences, Mapi Pharmaceuticals Ltd, Merck, Mitsubishi Tanabe Pharma Holdings, Opko Biologics, Prothena Biosciences, Novartis, Regeneron, Sanofi-Aventis, Reata Pharmaceuticals, Teva Pharmaceuticals, NHLBI (Protocol Review Committee), University of Texas Southwestern, University of Pennsylvania, Visioneering Technologies Inc. outside the submitted work. Dr. Saltz has no conflicts.

Objective: Governments generate substantial revenue from the distribution and sale of alcoholic beverages. However, the use of this alcohol results in considerable public costs for health care, criminal justice, and economic loss of production. Because comparisons of these two sides of the same coin are limited, this study aims to estimate this net alcohol surplus or deficit in Canada and each province/territory for a 14-year study period., Method: Net government revenue from alcohol sales and net social costs of alcohol use were estimated for Canada and each province/territory for all years of study from 2007 to 2020, and all dollar figures were Consumer Price Index-adjusted to 2020 Canadian dollars (CAD). The net alcohol surplus/deficit was estimated as the difference. Per capita recorded alcohol sold was from administrative sources and used as proxy to calculate alcohol used by adding an estimate of unrecorded use and converting to Canadian standard drinks (CSDs). The per-drink net deficit was the net deficit divided by CSDs., Results: In Canada in 2020, governments generated CAD $13.3 billion in revenue from alcohol sales, but this was offset by $19.7 billion in social costs attributable to alcohol use. This "alcohol deficit" increased by 122.0% in real-dollar terms over the study period and reached a high of $6.4 billion in 2020. In 2020, the magnitude of the alcohol used in Canada was 16.8 billion CSDs. Each of these drinks resulted in a public net deficit of $0.379., Conclusions: Both alcohol use and the resulting public alcohol deficit are high in Canada. To mitigate these losses to the well-being of Canadians and their economy, government planners, regulators, and policymakers must urgently deploy evidence-based alcohol policies toward reducing the magnitude of alcohol used in Canada.

Objective: Excessive alcohol use is very prevalent among young adults, and consequences of drinking are often observed by witnesses. Understanding the circumstances under which witnesses of risky alcohol use help others and whether they perceive these circumstances as an opportunity to engage in bystander intervention are important, but valid measures of these constructs are needed. The current study is a psychometric evaluation of the Exposure to Hazardous Drinking in Others (EHDO) scale and a single-item indicator of Perceived Alcohol-Related Bystander Opportunity (PARBO)., Method: Young adults ( N = 1,011; 46.0% women) who reported being around someone who showed signs of alcohol intoxication in the past 3 months were recruited via Qualtrics Panels. The initial item set for the EHDO was developed through qualitative methods and reflected observed or reported risks or consequences. Factor analyses and Item Response Theory analyses were used to reduce and categorize EHDO items, and construct validity was assessed for the EHDO and the PARBO item., Results: An initial set of 33 EHDO items was reduced to 21, representing two factors: Situational Risk Signs and Problematic Pattern. Both factors demonstrated good model fit, internal consistency, and evidence of convergent validity. The PARBO item showed good construct validity but was distinct from the EHDO., Conclusions: These instruments are useful for measuring secondhand alcohol risks in a community and are particularly applicable for evaluating bystander intervention for alcohol risk.

Objective: Prior studies have linked fall-related emergency department (ED) visits among older adults to alcohol use. Characteristics related to falls in the working age population (WAP; 15-64 years) may vary with alcohol and substance use. This study aimed to identify factors associated with fall-related ED visits related to alcohol and substance use in the WAP., Method: Using nationally representative 2019-2020 National Hospital Ambulatory Medical Care Survey data, fall-related ED visits within 72 hours were stratified by indication of alcohol use, substance use, and concurrent alcohol and substance use. Descriptive statistics accounting for the survey's complex design were used along with multivariable logistic regression to identify associated factors., Results: Between 2019 and 2020, an estimated 10,800,000 fall-related ED visits occurred among the WAP, with 51.7% related to alcohol use, substance use, or both. Multivariable logistic regression analysis revealed that the WAP with fall-injury ED visits were associated with alcohol use (adjusted odds ratio [AOR] = 2.3, 95% CI [1.0, 5.9]) or concurrent alcohol and substance use (AOR = 8.5, 95% CI [1.6, 43.0]), and individuals with alcohol and substance use with a depression diagnosis are twice as likely to visit EDs with fall injuries., Conclusions: Individuals with alcohol and substance use with depression were twice as likely to visit EDs for fall injuries. Higher fall-related ED visits in the WAP were attributed to alcohol and substance use. Identified factors could improve injury prevention and timely intervention among the WAP in the United States.

Objective: Among college students, student-athletes are at increased risk for heavy alcohol consumption, participation in risky drinking practices (e.g., playing drinking games [DG]), and adverse alcohol-related consequences relative to non-student-athletes. Within the student-athlete population, level of sports participation (e.g., recreational or varsity sports) can affect alcohol use behaviors and consequences, but our understanding of the extent to which level of sports participation influences engagement in DG is limited. Thus, in the present study, we examined differences in frequency of participation in DG, typical drink consumption while playing DG, negative DG consequences, and motives for playing DG among varsity, recreational, and non-student-athletes., Method: College students ( n = 7,901 across 12 U.S. colleges/universities) completed questionnaires on alcohol use attitudes, behaviors, and consequences., Results: Student-athletes (recreational or varsity sports) were more likely to have participated in DG within the past month than non-student-athletes. Among students who reported past-month DG play, recreational athletes played more often and endorsed more enhancement/thrills motives for playing DG than non-student-athletes, and student-athletes (recreational or varsity) endorsed higher levels of competition motives for playing DG than non-student-athletes., Conclusions: These findings shed light on some risky drinking patterns and motives of recreational athletes who are often overlooked and under-resourced in health research and clinical practice. Recreational and varsity student-athletes could benefit from alcohol screening and prevention efforts, which can include provision of competitive and alcohol-free social activities and promotion of alcohol protective behavioral strategies to help reduce recreational athletes' risk for harm while playing DG.

Objective: Bystander intervention (BI) is a promising approach for promoting collective behavior change that has been applied to several domains, including sexual assault, bullying, and more recently, problematic alcohol use. Accurately measuring the strategies that bystanders use to reduce others' alcohol-related risk is an essential step toward improving bystanders' ability to reduce alcohol-related harm in their communities, but current measures of BI are not easily modifiable and applicable for alcohol-related BI. The current study aimed to develop a valid and reliable measure of the bystander construct most proximal to the reduction of risk: bystander strategies., Method: Young adults ( N = 1,011) who reported being around someone who showed signs of alcohol intoxication in the past 3 months were recruited via Qualtrics Panels to participate in an online survey; a subsample ( n = 345) completed a 2-week follow-up. Psychometric evaluation included exploratory and confirmatory factor analyses, item response theory analyses, convergent validity, and test-retest reliability., Results: An initial set of 52 items was reduced to 17 items, representing two different factors. The first factor, Level 1, reflected strategies used during circumstances of acute risk. The second factor, Level 2, reflected strategies used to reduce risk for more longstanding problems with alcohol. Both factors demonstrated good model fit, strong internal consistency, evidence of convergent validity, and moderate test-retest reliability., Conclusions: This novel measure can contribute to the production of knowledge about the use and efficacy of peer-focused strategies and the value of BI training for alcohol use.

Objective: Few studies have investigated the persistence over time of experiences of harm from a known person's drinking. The aim of this study was to describe 1-year persistence and investigate its predictors at baseline. Potential predictors included the harmed person's sociodemographic factors, their own drinking habits, their relationship to the person causing harm, and the type of negative experience., Method: The sample included respondents who reported experiencing harm from a known person's drinking in a general population survey in 2013 and participated in a follow-up survey in 2014 ( n = 1,203). One-year persistence of experienced harm was defined as reporting any harm in both surveys. We investigated potential baseline predictors of persistence by estimating relative risks and 95% confidence intervals through modified binary Poisson regression analyses with robust error variance., Results: One-year persistence of experiencing any type of harm from a known person's drinking was seen in 52.5% of those reporting harm at baseline and was higher among women (56.7%) than men (43.3%). Reporting harm from a partner, parent, or other household member significantly predicted 1-year persistence, as did severity of overall perceived harm at baseline., Conclusions: In Sweden, 1-year persistence of experienced harm from a known person's drinking is common in most individuals. The risk of experiencing such harm is higher among women, when harm occurs within close relationships, and when it is experienced as severe at baseline. Support to individuals in these situations is crucial.

Objective: Alcohol overservice at on-premises establishments is associated with driving while intoxicated, violence, and other harms. This study examined rates of alcohol overservice and service refusal among licensed on-premises establishments in northern California and characteristics of establishments, servers, and pseudo-patrons (PPs) that may be associated with service refusal., Method: In 2022, 300 licensed on-premises establishments were sampled in nine counties representing the San Francisco Bay Area. From July 2022 to January 2023, PP and observer teams visited each establishment, and PPs attempted to buy alcohol while displaying obvious signs of intoxication. The outcome of each purchase attempt; characteristics of establishments, servers, and PPs; and month, day, and time were recorded. Descriptive and regression analyses were conducted to address study objectives., Results: Twenty-one percent of the establishments refused alcohol service to PPs. No establishment or server characteristics were significantly associated with service refusal in logistic regression analysis, nor were month, day, or time. However, service refusal was significantly more likely among female PPs (odds ratio = 3.71, 95% CI [1.67, 8.24], p < .01) and PPs displaying obvious or very obvious signs of intoxication (odds ratio = 9.28, 95% CI [1.99, 43.40], p < .01). There was no significant interaction effect of PP × Server Gender on the likelihood of service refusal., Conclusions: This study indicates that alcohol overservice to obviously intoxicated patrons remains common at licensed on-premises establishments. Mandatory responsible beverage service training of servers and enforcement of alcohol overservice laws are needed to reduce overservice and related harms., Competing Interests: Dr. Saltz, Dr. Paschall, and Dr. O'Hara have no conflicts. Dr. Buller, Dr. Woodall, and Ms. Martinez receive a salary from Klein Buendel, Inc. Dr. Buller's spouse is an owner of Klein Buendel, Inc. Dr. Buller and Dr. Woodall are owners of Wedge Communications, LLC, the distributor of the WayToServe online training. An active management plan is in place at Klein Buendel to manage this conflict of interest. The management plan includes offering the WayToServe free to project participants; having results reviewed by project investigators outside Klein Buendel who are free of conflicts of interest; publicly disclosing the conflicts of interest; reporting results faithfully, accurately, and completely; and monitoring and auditing of the conflict of interest.

Objective: A crucial question regarding the public health impacts of cannabis legalization is its impact on alcohol consumption and alcohol-related harm. However, little is known about whether these changing cannabis policies are occurring in liberal or in restrictive alcohol policy environments, either of which likely affect public health outcomes. We constructed comprehensive state-level alcohol and cannabis policy indices and explored relationships between them., Method: We assessed relationships between the Alcohol Policy Scale (APS) and the Cannabis Policy Scale (CPS) from 1999 to 2019. The APS and CPS were based on 29 and 17 state-level policies, respectively, and each policy was weighted for its relative efficacy and degree of state-year implementation., Results: From 1999 to 2019, average state APS scores increased modestly (became more restrictive) by 4.11 points (2019 M = 43.23, range: 24.44-66.31) and average CPS scores decreased (became less restrictive) by 15.33 points (2019 M = 76.40, range: 29.40-95.74) on a 100-point scale. In 2019, average APS scores were similar among states that prohibited (criminalized) possession of cannabis (42.00), decriminalized possession (41.33), legalized medical cannabis (44.36), and legalized recreational cannabis (43.32). Across states, there was no correlation between the restrictiveness of state-level alcohol and cannabis policies ( r = .03, p = .37) in unadjusted models, although there was some variation by time, geographic region, and political party, with a weak negative correlation in state fixed-effects models., Conclusions: Although cannabis policies liberalized rapidly from 1999 to 2019, alcohol policies stayed relatively stable and did not differ by degree of cannabis policy liberalization. In general, there were weak associations between cannabis and alcohol policies among states; however, there was some temporal, regional, and political variation.

Objective: Epidemiological research has repeatedly found that alcohol-impaired driving is associated with elevated risk of crash involvement in a dose-response fashion. Although experimental studies show that alcohol impairment of cognitive and psychomotor driving skills is exacerbated by sleep deprivation, there is less evidence that the combination of drowsiness and alcohol predicts actual motor vehicle crashes., Method: We explored this by reanalyzing data from the National Highway Traffic Safety Administration Drug and Alcohol Crash Risk Study, constructing separate risk curves for daytime and nighttime hours., Results: Controlling for driver demographics and driving exposure, and excluding other impairing drugs, we observed significantly greater risk of crash during the night versus the day at blood alcohol concentrations (BACs) between approximately .04 and .12 g/dl. Based on fitted point estimates, at .08 g/dl, the risk of crash at night was three times the risk of crash during the day., Conclusions: The association between BACs and crash risk was markedly different during daytime versus nighttime hours. Increased daytime risk was not observed until BACs exceeded the .08 g/dl per se legal limit. Results are interpreted as emphasizing the sedating role of alcohol. Implications are discussed.

Objective: Thus far, behavioral health research in the United States has not explored the prevalence or correlates of sober curiosity (SC; exploratory or experimental abstinence or moderation) or temporary alcohol abstinence challenges (TAACs; e.g., "Dry January"), despite significant attention in media and popular discourse. We explored these activities in a sample of U.S. emerging adults (e.g., ages 18-29), a population with higher-risk drinking behavior yet some of the lowest rates of treatment engagement for alcohol use problems., Method: Survey data were collected in 2021-2022 among participants ( n = 1,659; M age = 24.7 years). We assessed SC awareness/engagement and past-year TAAC participation, and differences across demographics and behavioral characteristics., Results: Overall, 9% of emerging adults were familiar with SC and 7% had participated in a TAAC in the past year. Half of TAAC participants reported drinking less after the TAAC, and 15% remained abstinent after the TAAC ended. SC familiarity and TAAC were both associated with past-month heavy drinking, cannabis use, higher Alcohol Use Disorders Identification Test (AUDIT) scores, more past-year alcohol and cannabis consequences, past-year substance use treatment, and greater readiness to quit alcohol., Conclusions: Both SC and TAACs may have potential to engage young people with a desire to moderate or eliminate their alcohol consumption. This may occur directly through use of these strategies or by helping them connect to additional services. Future research can help the field understand the uptake of SC and TAACs, gauge efficacy, and identify avenues to link young people to resources and interventions.

Objective: Assessment reactivity research has contributed substantially to our understanding of alcohol treatment research protocols influencing clinical outcomes. The state of the science is such that relatively little is known about how alcohol treatment research participation influences behavior. The purpose of this study was twofold: (a) to determine the distribution of FRAMES elements (i.e., Feedback, personal Responsibility, Advice, a Menu of options, Empathic style of interaction, and support for Self-efficacy) contained in alcohol treatment research assessment interviews; and (b) to examine their association with subsequent alcohol use among a sample of clients presenting for alcohol use disorder treatment., Method: Audiotaped recordings of participant ( n = 189) research assessment interviews were converted to digital recordings and reviewed for FRAMES elements using the FRAMES Checklist Instrument., Results: Feedback, personal responsibility, empathic style of interaction, and support for self-efficacy were the more frequently occurring elements across follow-up periods. Alternatively, menu of options and advice occurred infrequently. Feedback and support for self-efficacy predicted subsequent alcohol use, although the association between feedback and alcohol use was unexpectedly positive., Conclusions: As part of the assessment interview process, alcohol treatment research participants receive multiple instances of feedback and support for self-efficacy specific to their alcohol use that are predictive of changes in alcohol use.

Objective: Heavy drinking poses serious risks to individuals with HIV, hepatitis C virus (HCV), and especially HIV/HCV coinfection. We adapted the National Institute on Alcohol Abuse and Alcoholism Clinician's Guide to address HIV/HCV coinfection and paired this with the "HealthCall" smartphone app to create an intervention tailored to HIV/HCV. After formative work and pretesting with HIV/HCV coinfected heavy drinkers, we conducted a pilot trial to determine potential of this new intervention for decreasing drinking., Method: A sample of 31 HIV/HCV coinfected heavy drinkers were randomly assigned to either intervention ( n = 16) or control ( n = 15; psychoeducation and brief advice) conditions. All participants completed a 60-day program consisting of approximately 25-minute-long baseline sessions and brief 5-10-minute booster sessions at 30 and 60 days, as well as an assessment-only follow-up at 90 days. Outcomes were measured using the Timeline Followback at baseline, 30, 60, and 90 days. Generalized linear models were used for analysis., Results: Intervention participants drank fewer mean drinks per drinking day at 60 days (incidence rate ratio [IRR] = 0.43, p = .03) and 90 days (IRR = 0.34, p < .01). Intervention participants also reported fewer drinking days at 90 days (mean difference = 34.5%; p < .01). Self-efficacy differed between groups during intervention ( p < .05)., Conclusions: Although our sample was small, our results suggested lower drinking among participants who received a modified Clinician's Guide intervention plus use of the smartphone app HealthCall, in comparison with education and advice alone. A larger study is indicated to further examine this brief, disseminable intervention for HIV/HCV coinfected drinkers.

Competing Interests: Creina S. Stockley reports previous grants from the Australian wine industry including the National Wine Foundation; Australian government bodies such as Wine Australia, Cancer Australia, [Australian] National Health & Medical Research Council, Commonwealth Scientific and Industrial Research Organisation, DrinkWise Australia, and Alcohol Education and Rehabilitation Foundation; and the Friedreich Ataxia Research Alliance, The University of Adelaide, The University of Melbourne, [Australian] The University of Newcastle, The University of Alabama, University Victor Segalen Bordeaux, Universidad Catolica de Chile, and the State Government of South Australia. Dr. Stockley was employed from 1991 to 2017 by the not-for-profit The Australian Wine Research Institute and had paid consultancies from Alcohol Beverages Australia, International Centre for Alcohol Policies, Wine in Moderation, and Alcohol in Moderation. Henk F. J. Hendriks reports previous grants from various Dutch governmental bodies such as OostNL, TIFN, and ZonMW as well as personal fees for lectures from Brewers of Europe, Belgium; Fundación Cerveza y Salud, Spain; CNRIFFI China; Dutch Oenologists Academy, The Netherlands; and Brewers of Europe, Brussels. Dr. Hendriks also had paid consultancies from Carlsberg, Heineken, Danone, IARD, 73100, Geosilica, AIM, and TNO and an educational grant from Diageo plc. Professor R.C. Ellison serves as voluntary Chair of the International Scientific Forum on Alcohol Research (ISFAR). Until 2013, when it ceased operations, he was the director of the Institute on Lifestyle & Health at Boston University School of Medicine, which received support from individuals, groups, associations, and companies including from the wine or beverage alcohol industry. These were unrestricted donations to Boston University to support the work of the Institute in monitoring the scientific literature on alcohol and health and providing commentaries; donations were not for funding specific research. Donors had no input into which articles were reviewed by the Institute, the discussions among scientists of the articles, or the conclusions expressed in the commentaries; donors did not know the content of commentaries until they were published for the public. According to records, unrestricted donations from the following three organizations were received between 2007 and 2013: the New York Wine & Grape Foundation, Canandaigua, NY; Diageo, Inc., New York City; and Brown-Forman Corporation, Louisville, KY. No funds have been received since then, and the Institute ceased operation in 2013. In 2010, he became a founder and remains scientific co-director of ISFAR. Over the past 40 years, invited presentations have been made at more than 100 local, regional, national, or international scientific meetings, for which travel expenses were paid as follows: 1. WineHealth, 2013, International Wine & Health Conference, Sydney, Australia, July 18–20, 2013, for which the official sponsor was the government agency International Organisation of Vine and Wine; 2. the 37th Annual Conference of the Association for Medical Education and Research in Substance Abuse (AMERSA), Bethesda, MD, November 7–9, 2013; 3. the 10th International Congress on Coronary Artery Disease, Florence, Italy, October 12–16, 2013, sponsored by the International Congress on Coronary Artery Disease; 4. Science Committee Meeting of DISCUS, Washington, DC, May 21, 2013; 5. Macrowine2012, Bordeaux, France, on June 16–20, 2012, sponsored by the Institut National de la Recherche Agronomique of France; 6. the 6th International Wine and Heart Health Summit, in Newberg, OR, November 3–6, 2011; 7. Washington State Grape Society Meeting, Grandview, WA, November 19, 2010; 8. World Wine Symposium, Lago di Como, Italy, on October 28–31, 2010; and 9. WineHealth, 2010, International Wine & Health Conference, Italy, October 3–6, 2010. In addition, in 2016 and 2017 Prof. Ellison received funding from the New York Wine and Grape Foundation to review wine and health research and reports. No funding has been received from alcohol industry sources since that time. ISFAR critiques are prepared by a group of scientists, physicians, and specialists who carry out research in fields related to alcohol and its effects on the human body and disease, and they do not receive any remuneration for their contributions. The discussions of emerging research and critiques are closed to all but the scientific members of ISFAR until they are released to the public through posting on the website: www.alcoholresearchforum. org. The distribution of ISFAR press releases to health editors, the medical community, public health agencies, and relevant policy makers describing new critiques on the ISFAR website is carried out by Alcohol in Moderation (AIM) in the United Kingdom. AIM is a nonprofit organization that publishes a journal (www.aim-digest.com) 10 times per year that summarizes new information related to the use and abuse of alcohol originating from scientists, governmental organizations, the World Health Organization, and nongovernmental organization (NGO) groups. The AIM journal is funded by subscriptions to the journal; subscribers do include some companies and associations in the beverage industry as well as NGO and governmental organizations, researchers, and institutions. None of the professors, physicians, and specialists who are on the AIM Council and/or also on the ISFAR board receive any remuneration for their reviews and analysis published in AIM and on the ISFAR website, and the two co-directors receive an honorarium for time spent in coordinating the critiques. It needs to be documented that ISFAR members are independent, peer-review-published, and respected scientists and medical specialists funded principally by government and not-for-profit organizations.

Objective: Most young people start to drink alcohol in adolescence and increase their consumption until their early 20s. The present study meta-analyzed results of longitudinal studies across the age range of 10 to 25 years., Method: A systematic search in the PsycINFO, PSYNDEX, and Web of Science databases resulted in 513 studies that were included in multilevel meta-analysis., Results: On average, alcohol consumption increased by .21 standard deviation units per year, with the strongest increase at age 12 to 13 years. Regarding cumulative change, drinking peaked around 22 years. Drinking started to decline at age 24, with minor changes being observed in 24- and 25-year-olds. Female participants increased their consumption less than their male peers, but gender differences were very small. Weaker increases in drinking were found in countries with higher minimum legal age of buying alcohol. Passing the minimum legal age of 16 years was associated with a stronger immediate increase in drinking compared with countries with higher minimum legal age, whereas passing higher minimum legal ages had no effect on alcohol consumption. In U.S. samples, smaller increases in drinking were observed in more recent studies., Conclusions: Prevention must start before age 12. Passing a low minimum legal drinking age only seems to have a short-term effect on alcohol consumption.

Objective: From 2015 to 2019, the Government of Ontario expanded privatized sales of alcohol, licensing 450 grocery stores to sell beer, cider, and wine. The impacts of a nearby grocery store gaining an alcohol license on adults' alcohol use in Ontario are examined, including whether impacts differed by gender., Method: Data from 2015-2019 Canadian Community Health Survey participants in Ontario (age ≥ 20 years), living within 1,000 m and 1,500 m of grocery stores that gained a license to sell alcohol and propensity-matched controls were included (1,000 m n = 14,052, 1,500 m n = 30,486). Alcohol use outcomes included past-7-day number of standard drinks consumed, near-daily drinking (≥4 days/week), and heavy drinking (5+ drinks in men/4+ in women, at least once/month). Gender-specific difference-in-differences (DiD) analyses compared changes in alcohol use before and after intervention in intervention and control populations., Results: Decreases in past-7-day drinks, near-daily drinking, and heavy drinking were observed after intervention in both intervention and control populations. At the 1,000 m level, adjusted DiD analyses showed past-7-day drinking in women (risk ratio = 1.21, 95% CI [0.88, 1.60]) and heavy drinking in men (odds ratio = 1.38, 95% CI [0.92, 2.08]) had effect sizes above 1, a relative increase over controls, although confidence intervals crossed 1. Findings did not indicate significant differences in alcohol use in intervention relative to controls for other alcohol use measures and at 1,500 m., Conclusions: Findings suggest no association between a partial alcohol deregulation initiative in Ontario and alcohol use from 2015 to 2019. It is important to monitor the impacts on alcohol use over time as further alcohol deregulation plans in Ontario and other jurisdictions are considered.

Objective: The purpose of this study was to use a dual-process decision-making model to examine the longitudinal associations between alcohol-induced blackouts (blackouts) and alcohol use disorder (AUD) risk symptoms among college student drinkers., Method: Undergraduate drinkers ( N = 2,024; 56% female; 87% White; 5% Hispanic) at a large northeastern university completed online surveys each semester during their first (Time [T] 1, T2), second (T3, T4), third (T5, T6), and fourth (T7, T8) years of college (87% retention across the study). Path analyses were examined testing the longitudinal associations between T1 willingness to experience a blackout, T1 intentions to avoid a blackout, T2-T8 drinking, T2-T8 blackouts, and T8 AUD risk symptoms. Hypotheses 1 and 2 tested the associations between T1 willingness, T1 intentions, T2-T8 drinking, and T2-T8 blackouts. Hypothesis 3 tested the associations between T2-T8 drinking, T2-T8 blackouts, and T8 AUD risk symptoms., Results: Students experienced an average of 8 ( SD = 8) blackouts during college. Approximately 1,514 (88.8%) participants reported experiencing 1 of 8 AUD risk symptoms. T1 willingness was positively associated with T2-T8 blackouts. T2-T8 drinking and T2-T8 blackouts were positively associated with T8 AUD risk symptoms. T1 willingness significantly indirectly affected T8 AUD risk symptoms through its association with T2-T8 blackouts., Conclusions: Results estimated that, on average, college student drinkers experienced eight blackouts across 4 years of college, and 88% of participants reported experiencing at least one symptom of AUD in the last semester of college. Willingness to experience a blackout influenced students' AUD risk symptoms through the number of blackouts they experienced throughout college.

Objective: Alcohol-related problems (e.g., physical, interpersonal, intrapersonal, impulse control, social responsibility) can have an impact on posttraumatic stress disorder (PTSD) symptoms during treatment. Evidence-based online self-help tools exist to target alcohol use and related problems and co-occurring PTSD symptoms. It is unknown to what degree individuals with varying alcohol-related problems respond differently to web-based interventions for hazardous alcohol use and PTSD. The current study evaluated specific alcohol-related problems as potential moderators of PTSD symptom changes during the VetChange online intervention while controlling for average daily alcohol use, gender, race, and age., Method: We conducted a secondary analysis of a randomized controlled trial that included 600 post-9/11 veterans (518 men and 82 women). Mixed-effects regression models of alcohol-related problems on PTSD severity scores over time were performed separately in an initial intervention group (IIG; n = 404) and a delayed intervention group (DIG; n = 196) that was used as a comparison condition., Results: Interpersonal problems emerged as a moderator of PTSD symptom changes in IIG such that veterans endorsing greater interpersonal problems demonstrated larger reductions in PTSD symptoms throughout VetChange. There were no significant moderation effects in DIG. Non-White veterans reported significantly higher PTSD symptoms during VetChange. Post hoc analyses indicated that veterans with higher interpersonal problems were more likely to engage in online intervention content focused on identifying high-risk drinking situations and coping with symptoms., Conclusions: Findings imply that veterans reporting alcohol-related interpersonal problems may benefit the most from, and be more motivated to use, online interventions for hazardous alcohol use and PTSD symptoms.

Objective: Excessive alcohol consumption and its consequences among college women continues despite prevention efforts. One common consequence, alcohol-related blackouts (ARBs), are periods of alcohol-activated anterograde amnesia. The purpose of the current project is to extend the ARB and drinking motive literature by examining their relationship over time., Method: A sample of 424 women (88.9% White) completed online surveys assessing their ARBs and drinking motives weekly for 10 weeks. A series of hierarchical generalized linear models were estimated to examine the between-person and within-person effects of each drinking motive on repeated measures of experiencing a blackout across the time points., Results: Women who report higher levels of drinking motives compared with others were more likely to report having blackout experiences. College women who reported higher levels of conformity motives did not have increased odds of experiencing a blackout. In weeks when they reported elevated levels of drinking motives, they were also more likely to experience an ARB., Conclusions: In general, college women who reported higher levels of social, coping, or enhancement motives experienced more blackouts than students who reported lower levels of these motives. Women who were underage were more likely to experience a blackout compared with women who were 21 or older. In a given week, 52.6% to 70.7% of the students consumed alcohol, and among women who drank in a given week, the prevalence of blackouts ranged from 8.5% to 14.6%. The results suggest that changes in motivational levels might provide a possible intervention point for ARBs risk.

Objective: Alcohol minimum unit pricing (MUP) policies establish a floor price beneath which alcohol cannot be sold. The potential effectiveness of MUP policies for reducing alcohol-attributable deaths in the United States has not been quantitatively assessed. Therefore, this study estimated the effects of two hypothetical distilled spirits MUP policies on alcohol sales, consumption, and alcohol-attributable deaths in one state., Method: The International Model of Alcohol Harms and Policies tool was used to estimate the effects of two hypothetical MUP per standard drink policies (40-cent and 45-cent) pertaining to distilled spirits products at off-premises alcohol outlets in Michigan during 2020. Prevalence estimates on drinking patterns among Michigan adults were calculated by sex and age group. Prices per standard drink and sales of 9,747 spirits products were analyzed using National Alcohol Beverage Control Association data. Analyses accounted for other alcoholic beverage type sales using cross-price elasticities., Results: Increasing the MUP of the 3.5% of spirits with the lowest prices per standard drink to 40 cents could reduce total alcohol per capita consumption in Michigan by 2.6% and prevent 232 (5.3%) alcohol-attributable deaths annually. A 45-cent MUP would affect 8.0% of the spirits and reduce total alcohol per capita consumption by 3.9%, preventing 354 (8.1%) deaths., Conclusions: Modestly increasing the prices of the lowest-priced spirits with an MUP policy in a single state could save hundreds of lives annually. This suggests that alcohol MUP policies could be an effective strategy for improving public health in the United States, consistent with the World Health Organization's recommendation.

Objective: Young adults who engage in simultaneous alcohol and cannabis use report heavy use of both substances. Event-level studies examining differences between consequences experienced on simultaneous use compared with single substance use days have been mixed. Although studies often control for alcohol use levels, few have examined how quantity of alcohol may influence consequences experienced on simultaneous use days. Furthermore, little research has examined the relationship between simultaneous use and positive consequences or explored individual consequences. This study examined differences in consequences experienced on simultaneous use versus single substance use days (alcohol-only, cannabis-only) including endorsement of specific consequences and examined the relationship among simultaneous use, consequences, and alcohol consumption., Method: Young adults who engage in simultaneous use ( N = 86) completed 30 days of daily surveys reporting substance use and positive and negative consequences., Results: Simultaneous use days were associated with more negative and positive consequences than single substance use (alcohol-only and cannabis-only) days. We also examined endorsement of specific positive and negative consequences on alcohol-only, cannabis-only, and simultaneous use days. The effect of day type (simultaneous use vs. alcohol-only) on consequences was moderated by alcohol quantity. On lighter drinking days, more positive and negative consequences were endorsed if it was a simultaneous use versus alcohol-only day. On heavier drinking days, number of consequences did not differ between simultaneous use and alcohol-only days., Conclusions: Findings from this study point to simultaneous use as both reinforcing and high risk and highlight the importance of intervening even on lighter drinking simultaneous use occasions to reduce harms.

Objective: Differences in the subjective effects of alcohol in different social contexts have been well documented, but little research examines affect during drinking in real-world social contexts. This study examined differences by social context in negative affect and positive affect during alcohol consumption. We hypothesized that negative affect and positive affect with drinking would vary as a function of social context (alone or with others)., Method: A total of 257 young adults ( M age = 21.3, 53.3% female) who were enrolled in a longitudinal, observational study assessing risk for smoking completed 7 days of ecological momentary assessment assessing alcohol use, affect, and social context at two time points of the study. Mixed-effects location scale analyses examined effects of being alone versus with others on positive affect and negative affect after drinking and compared with nondrinking times., Results: Positive affect was higher when drinking with others versus alone, and negative affect was higher when drinking alone versus with others. Both negative affect and positive affect variability were higher when participants were drinking alone compared to with others, and negative affect variability was higher at low amounts of alcohol but decreased with increased drinking., Conclusions: These findings demonstrate that solitary drinking is less consistently reinforcing because of greater and more variable negative affect, as well as more variable positive affect. When drinking with others, increased and less variable positive affect suggests that social drinking may be particularly reinforcing in young adulthood.

Objective: The association of many chronic disease conditions with alcohol consumption is well established, and research on drinking patterns following diagnosis suggests that those with a chronic condition drink less than their healthy counterparts. However, these studies have not controlled for confounding influences on this relationship. This article reports current drinking patterns of those with one of four chronic disease conditions (hypertension, diabetes, heart disease, cancer) compared to those without, controlling for covariates., Method: Data were analyzed from a merged sample of the two National Alcohol Surveys of the U.S. adult population (2014-2015 and 2019-2020; n = 9,597). Those reporting any one of the four disease conditions were matched to healthy control respondents on demographic characteristics and history of drinking using propensity score weighting (PSW)., Results: Those with hypertension and heart disease appeared to drink less than controls during the last year, but after models were adjusted for covariates or PSW, no significant differences were found. For diabetes, only the PSW models showed no significant difference in drinking from controls, whereas both unadjusted and adjusted models for cancer showed no differences from controls., Conclusions: Controlling for covariates and PSW appeared to make cases and their healthy controls more similar in past-year drinking patterns. Observed similarity in drinking patterns of those with and without a chronic disease may serve as an impetus for a greater focus on screening and identification of those with chronic conditions who would benefit from focused harm-reduction messages and implementation of effective alcohol interventions.

Objective: Alcohol-impaired driving is a major contributor to motor vehicle crash deaths and injury. Many survey studies include self-report measures of alcohol-impaired driving, but no guidance is available to help researchers select from among available measures. The aims of this systematic review were to compile a list of measures that researchers have used previously, to compare performance between measures, and to identify the measures with highest validity and reliability., Method: Literature searches of PubMed, Scopus, and Web of Science identified studies that assessed alcohol-impaired driving behavior through self-report. The measures from each study and, if available, indices of reliability or validity were extracted. Using the measures' text, we developed 10 codes to group similar measures and compare them. For example, the "alcohol effects" code refers to driving while feeling dizzy or lightheaded after drinking, and the "drink count" code pertains to the number of drinks someone consumed before driving. For measures with multiple items, each item was categorized separately., Results: After screening according to the eligibility criteria, 41 articles were included in the review. Thirteen articles reported on reliability. No articles reported on validity. The self-report measures with the highest reliability coefficients contained items from multiple codes, namely alcohol effects and drink count., Conclusions: Self-report alcohol-impaired driving measures with multiple items evaluating distinct aspects of alcohol-impaired driving show better reliability than measures using a single item. Future work investigating the validity of these measures is needed to determine the best approach for conducting self-report research in this area.

Objective: Experimental research has demonstrated that when alcohol-related content is viewed on social media, adolescents and young adults tend to have favorable attitudes toward alcohol use. However, limited research focuses on social media norms for abstaining from alcohol use. The current study examined the role of descriptive and injunctive alcohol-abstaining-and-drinking norms via experimentally manipulated social media profiles. Experimental effects on descriptive and injunctive normative perceptions and subsequent behavior were tested., Method: Participants ( N = 306; ages 15-20 years) were recruited from the Seattle metropolitan area to complete a baseline survey and view researcher-fabricated social media profiles. Using stratified random assignment (birth sex and age), participants were randomized into one of three conditions: (a) alcohol abstaining and drinking, (b) alcohol abstaining, and (c) attention control., Results: The alcohol-abstaining-and-drinking condition reported greater drinking descriptive norms compared with participants in either the alcohol-abstaining or the attention-control conditions at post-experiment and 1-month follow-up. The alcohol-abstaining-and-drinking condition reported lower abstaining descriptive norms (i.e., perceiving fewer peers abstain) compared with those in the alcohol-abstaining condition at post-experiment and lower abstaining injunctive norms compared with those in the attention-control condition at 1-month follow-up., Conclusions: Exposure to social media profiles containing both alcohol-drinking and alcohol-abstaining messages was respectively associated with individuals perceiving that peers were consuming alcohol more often and that fewer peers were abstaining. The present findings are consistent with prior experimental research that indicates alcohol displays on social media are associated with riskier drinking cognitions.

Objective: From October 1, 2018, the Northern Territory (NT) of Australia introduced a minimum unit price (MUP) for alcohol of AU$1.30 per standard drink. The MUP was introduced to address the high alcohol consumption rates and harms within the NT. This study aimed to investigate the unique short-term impact of the MUP on alcohol-related assaults across the NT, for the NT overall and separately for four key regions (Darwin and Palmerston, Alice Springs, Katherine, and Tennant Creek); which allowed for the consideration of differences in concurrent alcohol interventions and population (e.g., Alice Springs had Police Auxiliary Liquor Inspectors (PALIs) introduced on October 1, 2018, whereas Darwin and Palmerston only had the MUP introduced in this period). PALIs effectively equate to a police officer being stationed in every off-premise liquor vendor., Method: Using data from January 2013 to September 2019, interrupted time series (ITS) analyses assessed the short-term impact of the MUP on the monthly rate of police-recorded alcohol-related assaults., Results: A 14% reduction ( B = -3.07 [-5.40, -0.74], p < .010) was found for alcohol-related assault offenses per 10,000 in Darwin/Palmerston. Significant reductions were also noted in Alice Springs and the NT overall, although PALIs are likely to have contributed to these reductions in addition to the MUP., Conclusions: This short-term impact warrants longer-term follow-up to determine whether the reductions in alcohol-related assaults following the introduction of MUP are maintained, and the extent to which assault rates are influenced by other alcohol-policy interventions in the NT.

Objective: Specific events are associated with heavier and riskier substance use behaviors among college students, including holidays like Halloween, which may include several days of themed parties/events ("Halloweekend"). The current study compared drinking, pregaming (i.e., fast-paced drinking before going out for the night), cannabis use, same-day alcohol and cannabis co-use, and negative alcohol-related consequences over Halloweekend compared with two adjacent non-Halloween weekends among a sample of heavy-drinking university students., Method: Participants ( N = 228; 65% female) provided 28 days of daily diary data. We used a three-level generalized linear mixed model (GLMM) approach estimating zero-inflated Conway-Maxwell Poisson regressions to assess the effect of weekend and specific weekend day on number of overall drinks, number of pregaming drinks, and negative alcohol-related consequences. Proportions tests assessed for differences in any cannabis use and daily co-use between Halloweekend and non-Halloween weekends., Results: Zero-inflated portions of the GLMMs indicated that general drinking, pregaming, and negative consequences were most prevalent on Halloweekend and Fridays and Saturdays. Count portions of the models indicated that general drinking quantity was highest during these periods, and participants experienced a greater number of negative consequences on Halloweekend compared with the weekend before; no differences were observed in the quantity of pregaming drinks consumed across weekends or days. No significant differences in cannabis use or co-use were observed between weekends., Conclusions: Given risk associated with Halloweekend compared with weekends immediately before and after, interventions targeting alcohol use and pregaming on Halloweekend may be beneficial to reduce related harm for heavy-drinking students.

Objective: There has been concern regarding increased substance use during the COVID-19 pandemic, particularly among young adults, but much of this concern stemmed from cross-sectional or short-term data collected early in the pandemic. This study followed a young adult community cohort throughout the first 1.5 years of the pandemic to examine longer-term trends/trajectories in alcohol and cannabis use behaviors., Method: Beginning before the COVID-19 pandemic (January 2020), 656 young adults completed up to eight surveys on substance use and other behaviors, which extended through August 2021. Multilevel spline growth models estimated changes in alcohol/cannabis use in three segments: (a) from pre-pandemic to April 2020, (b) from April 2020 to September/October 2020, and (c) from September/October 2020 to July/August 2021. Abstainers were removed from the analyses, yielding subsamples for alcohol models ( n = 545; M age = 25.6 years; 59.8% female) and cannabis models ( n = 303; M age = 25.6; 61.4% female)., Results: Drinking frequency initially increased (3% per month), decreased in the second segment (4% per month), and plateaued in the final segment. Drinking quantity significantly decreased in all three segments: 4% per month in segment one, 3% per month in segment two, and 1% per month in the final segment. Cannabis frequency and quantity showed no significant changes across the first two segments, then significantly decreased in the final segment (3% and 6% per month, respectively). The significant changes for cannabis frequency/quantity were moderated by age, such that older participants had steeper decreases in the final segment., Conclusions: Findings highlight that young adult alcohol and cannabis use generally declined across the first 1.5 years of the COVID-19 pandemic, contrary to widespread concerns., Competing Interests: The authors have no conflicts of interest to disclose.

Objective: Chronic substance use and its effects on brain function and structure has long been of interest to clinicians and researchers. Prior cross-sectional comparisons of diffusion tensor imaging (DTI) metrics have suggested deleterious effects of chronic substance use (i.e., cocaine use) on white matter coherence. However, it is unclear how these effects may replicate across geographic regions when examined with similar technologies. In this study, we sought to conduct a replication of previous work in this area and determine whether there are any patterns of persistent differences in white matter microstructure between individuals with a history of cocaine use disorder (CocUD, according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition ) and healthy controls., Method: A total of 46 participants (21 healthy controls, 25 chronic cocaine users) were recruited from the Richmond, Virginia metropolitan area. Information regarding past and current substance use was collected from all participants. Participants also completed structural and DTI scans., Results: Consistent with previous DTI studies, significant differences were found between fractional anisotropy (FA) and axial diffusivity (AD) CocUD and controls, with CocUD showing lower FA and AD in the right inferior and superior longitudinal fasciculus, the genu, body, and splenium of the corpus callosum, and the anterior, posterior, and superior corona radiata, among several other regions. These differences were not significant for other diffusivity metrics. Lifetime alcohol consumption was greater in the CocUD group, but lifetime alcohol consumption did not show a significant linear relationship with any of the DTI metrics in within-group regression analyses., Conclusions: These data align with previously reported declines in white matter coherence in chronic cocaine users. However, it is less clear whether comorbid alcohol consumption results in an additive deleterious effect on white matter microstructure.

Objective: Given social media's reach and potential, a systematic review is needed to assess their effectiveness in influencing alcohol consumption and related harms, attitudes, and awareness., Method: We searched 12 databases from inception to December 2022, along with reference lists of eligible studies. We included studies of any design conducted in any country, reported in English, evaluating campaigns using social media alone or in combination with other media. We assessed study quality, extracted data, and completed a narrative synthesis., Results: Eleven of 6,442 unique studies met inclusion criteria, spanning 17 countries, targeting diverse populations, and predominantly using repeated cross-sectional study designs. Most were of weak quality. Only three studies evaluated campaigns relying solely or primarily on social media. Two drink-driving campaigns had no behavioral impact, whereas two others found behavior change. Two of three studies targeting college student drinking found significant reductions in drinking after the campaign, but a third detected no differences in quality or duration of drinking. Only one study measured changes in attitudes, finding that the campaign significantly increased policy support for key alcohol policies. All studies noted awareness, but only six quantified short-term measures, showing increased campaign awareness., Conclusions: It is unclear from the peer-reviewed literature whether public health-oriented social media campaigns can influence alcohol consumption and related harms, attitudes, and/or awareness. Our review nevertheless indicates that social media campaigns offer potential in some populations to influence these outcomes. There is an urgent need for the public health field to test and rigorously evaluate social media's utility as a vehicle for influencing population-level alcohol consumption and related problems, attitudes, and awareness.

Objective: Individuals in the United States with opioid use disorder (OUD) have high rates of co-occurring alcohol use disorder. However, there is limited research on co-use patterns among opioid and alcohol use. The present study examined the relationship between alcohol and opioid use in treatment-seeking individuals with an OUD., Method: The study used baseline assessment data from a multisite, comparative effectiveness trial. Participants with an OUD who had used nonprescribed opioids in the last 30 days ( n = 567) reported on their alcohol and opioid use during the past 30 days using the Timeline Followback. Two mixed-effects logistic regression models were used to assess the effect of alcohol use and binge alcohol use (≥4 drinks/day for women and ≥5 drinks/day for men) on opioid use., Results: The likelihood of same-day opioid use was significantly lower on days in which participants drank any alcohol ( p < .001) as well as on days in which participants reported binge drinking ( p = .01), controlling for age, gender, ethnicity, and years of education., Conclusions: These findings suggest that alcohol or binge alcohol use is associated with significantly lower odds of opioid use on a given day, which was not related to gender or age. The prevalence of opioid use remained high on both alcohol use and non-alcohol use days. In line with a substitution model of alcohol and opioid co-use, alcohol may be used to treat symptoms of opioid withdrawal and possibly play a secondary and substitutive role in individuals with OUD substance use patterns.

Objective: Binge drinking is characterized by excessive alcohol use and is widespread in youth. We explore the relationship between binge drinking's risk factors by considering (a) aggregate genetic liability (polygenic risk score [PGS]) for alcohol use and problems and (b) impulsivity-related processes. We examined whether the associations between PGS and binge drinking were mediated by impulsivity, with a possible shared genetic liability between alcohol phenotypes and impulsivity., Method: Participants were from the Avon Longitudinal Study of Parents and Children ( N = 2,545). We evaluated PGS for alcohol use and problems and impulsivity-related processes (sensation seeking at age 18 and inhibition at age 24) and measured binge drinking frequency (24 years old) as the outcome. Correlations and structural equation models were used to test a hypothesized model of the relationships among these variables., Results: Higher binge drinking frequency was related to higher aggregate genetic liability for alcohol use and problems in both models (standardized betas = .055-.064, all ps < .009). We found an association between binge drinking and sensation seeking (standardized beta = .224, p < .0001) but not inhibition (standardized beta = -.015, p = .437). Although the association between binge drinking and PGS for alcohol use and problems was mainly direct, a proportion of the association with alcohol problems was mediated by sensation seeking (14.61%)., Conclusions: Targeting sensation seeking at the end of adolescence may be means to prevent binge drinking in adulthood, whereas considering the role of genetic factors may improve our understanding of at-risk youth.

Objective: Government alcohol sales data were used to investigate associations between estimates of per capita age 15+ alcohol consumption, policy restrictiveness, and area-level deprivation., Method: We analyzed weekly consumption data (expressed as per capita age 15+ Canadian standard drinks [13.45 g of pure ethanol]) collected from all 89 local health areas in British Columbia, Canada, between April 2017 and April 2021. Our analyses were stratified by outlet type (total, on-premise, and off-premise). Our intervention was alcohol policy restrictiveness (operationalized by the Restrictiveness of Alcohol Policy Index), and our moderator was area-level deprivation (Canadian Index of Multiple Deprivation). The Restrictiveness of Alcohol Policy Index included hours of trading, the number of people permitted on site for on-premise venues, the proportion of outlets in operation, and the extent of permissible home delivery., Results: Higher policy restrictiveness was associated with decreased consumption across all outlet types ( ps < .001): when the most restrictive policies were implemented, consumption was reduced by 9% and 100% in off- and on-premise outlets, respectively. Area-based deprivation level modified the effect of policy restriction on per capita alcohol consumption ( ps < .007): for total and off-premise consumption, the decrease was greatest among more economically deprived areas ( ps < .001); for on-premise outlets, areas with a high proportion of racial and ethnic minorities increased their consumption ( ps < .001)., Conclusions: Alcohol-specific policy restrictions implemented in response to the COVID-19 pandemic were associated with reduced consumption. However, the magnitude and direction of change was moderated by area-based deprivation level, albeit inconsistently across various deprivation measures.

Objective: Simultaneous alcohol and marijuana (SAM) use is reported to be associated with heavier alcohol and marijuana use and more negative consequences, but less is known about the social, physical, and temporal contexts of SAM use., Method: Young adults ( N = 326, 51.2% male, 49.1% White non-Hispanic) who reported past-month SAM use completed up to 14 daily surveys across five bursts that assessed SAM use and negative consequences and social, physical, and temporal contexts. We used multilevel models to examine SAM use contexts' associations with alcohol/marijuana quantity and consequences., Results: The social context of alone only (vs. with others only) was associated with consuming fewer drinks. Physical contexts that included using both at home and outside the home (vs. only at home) were associated with greater alcohol and marijuana quantity and negative consequences (but not after controlling for alcohol quantity); use outside the home only (vs. only at home) was associated with more alcohol use, more alcohol consequences (but not after controlling for alcohol quantity), and fewer marijuana consequences (even after controlling for marijuana quantity). The temporal context of first engaging in SAM use before 6 P.M. (vs. after 9 P.M.) was associated with greater alcohol and marijuana quantity and more marijuana consequences (but not after controlling for number of hours high), and first engaging in SAM use between 6 and 9 P.M. was associated with more hours high., Conclusions: SAM use contexts such as using with others, using outside the home, and using earlier in the evening are typically associated with greater alcohol/marijuana quantity and consequences.

Objective: Research links approval-contingent self-worth to college drinking but has not differentiated social and solitary consumption. High approval-contingent self-worth individuals might drink socially to derive approval., Method: In a sample of 832 undergraduates, approval-contingent self-worth and drinking motives were measured in an initial questionnaire, and social and solitary consumption were reported daily for 30 days., Results: Results indicated an overall positive association between approval-contingent self-worth and social consumption and positive indirect effects via social and enhancement motivations, but a negative indirect effect via conformity motivation. The association between approval-contingent self-worth and solitary alcohol consumption was nonsignificant because of a negative direct effect counteracted by a positive total indirect effect., Conclusions: Results highlight the importance of drinking motives and of distinguishing between social and solitary consumption.

Objective: We studied the factorial structure and diagnostic performance in primary care of a digital version of the Alcohol Use Disorders Identification Test (d-AUDIT) for screening for excessive drinking., Method: In two primary care centers in Santiago, Chile, we conducted a cross-sectional study involving 330 people 18 years of age or older who had drunk alcohol six or more times in the last year. The d-AUDIT was developed from the paper version validated in Chile and was self-administered on 7-inch tablets. Trained psychologists evaluated the participants using a 1-year Timeline Followback and the alcohol use disorders section from the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition . We used confirmatory factorial analysis to examine the structure of the d-AUDIT and areas under the receiver operating characteristic curves (AUCs) to examine the diagnostic performance of the d-AUDIT., Results: A two-factor model presented good overall fit, with item loads in the 0.53-0.88 range. The correlation among factors was .74, reflecting a good discriminant validity. The total score and the Fast Alcohol Screening Test (FAST) score (i.e., bingeing, role failure, blackouts, and others' concern items) obtained the best diagnostic performance for problematic drinking, with AUCs of 0.94 (CI [0.91, 0.97]) and 0.92 (CI [0.88, 0.96]), respectively. The FAST could differentiate hazardous drinking (cut point three in men and one in women) from problematic drinking (cut point four in men and two in women)., Conclusions: We replicated prior factor analysis findings of a two-factor structure for the d-AUDIT with a good discriminant validity. The FAST obtained excellent diagnostic performance and retained some ability to discriminate between hazardous and problematic drinking.

Objective: More than 270,000 people across the world die every year from alcohol-related crashes. Introducing alcohol per se laws (APL) based on a blood alcohol concentration (BAC) threshold of .05% could save at least 16,000 lives annually. Nevertheless, little is known about the evolution of APL adoptions at this BAC threshold. This study organizes the available data to chart the evolution of APLs across 183 countries from 1936 to 2021., Method: A review to identify relevant policies involved (a) probing multiple data sources, including legislation archives, international and national reports, and peer-review articles; and (b) an iterative record search and screening by two independent researchers, data collection, and expert consultations., Results: Data for 183 countries were organized and integrated to form a new global data set. A global diffusion process framework describes the evolution of APLs based on the data set. In the first period of analysis (1936-1968), APLs emerged in Nordic countries as well as in England, Australia, and the United States. APLs then spread to other parts of continental Europe and to Canada. By 2021, more than 140 countries had adopted an APL with a BAC threshold of at least .05%., Conclusions: The present study offers a methodology for tracing alcohol-related policies from a cross-national and historic perspective. Future studies could integrate other variables into this data set to chart the speed of adoption of APLs and to test how changes in APLs correlate with alcohol-related crashes over time between and within jurisdictions.

Objective: Despite the important role of enforcement in reducing alcohol-related harms, few studies have assessed alcohol enforcement efforts, particularly over time. We assessed the prevalence of alcohol law enforcement strategies at two time points., Method: Of a random sample of U.S. local law enforcement agencies (i.e., police, sheriff) surveyed in 2010, 1,028 were resurveyed in 2019 (742/1,028 [72%] response rate). We assessed changes in alcohol enforcement strategies and priorities within three domains: (a) alcohol-impaired driving, (b) alcohol sales to obviously intoxicated patrons (i.e., overservice), and (c) underage drinking., Results: Agencies reported placing higher priority on enforcement of alcohol-impaired driving and overservice in 2019 versus 2010. For alcohol-impaired driving enforcement strategies, we found increases over time in use of saturation patrols and in enforcing laws prohibiting open containers of alcohol in motor vehicles, but not in use of sobriety checkpoints. Approximately 25% of agencies conducted overservice enforcement in both years. For all strategies directed at underage drinking, enforcement decreased over time with more agencies using strategies aimed at underage drinkers versus alcohol suppliers (alcohol outlets, adults) in both years., Conclusions: Agencies reported continued low levels or declines in enforcement across most strategies despite reported increases in prioritizing alcohol enforcement. More agencies could adopt alcohol control enforcement strategies, including an increased focus on suppliers of alcohol to youth rather than on underage drinkers, and increased awareness and enforcement of selling alcohol to obviously intoxicated patrons. Use of these strategies has the potential to reduce health and safety consequences of excessive alcohol use.

Objective: Romantic relationship dysfunction is a risk for subsequent alcohol use, with some research suggesting gender differences in this link. We evaluated how different aspects of relationship dysfunction are related to different drinking behaviors and whether these associations vary by gender. We further examined the role of age as a potential moderator of this gender difference., Method: Qualtrics Panelists ( N = 1,470; 50% women) who were in a romantic relationship and regularly consumed alcohol completed an online survey. The sample was wide-ranging in age (range: 18-85 years old; M = 46.64, SD = 11.95). Participants reported drinking about 10 drinks per week, on average ( SD = 11.01)., Results: Five factor scores were constructed from relationship predictors (relationship distress, intrusion/jealousy, and disagreements) and drinking outcomes (consumption and coping motives). Moderation analyses indicated several significant two-way interactions between relationship dysfunction, gender, and age when predicting alcohol outcomes. Of note, the positive associations between relationship distress and both consumption and coping motives were stronger among younger than older individuals and among men than women (consistent with an externalizing stress perspective). A significant three-way interaction suggested that, for women, associations between intrusion/jealousy and coping motives were strongest at younger ages, consistent with an interpersonal sensitivity perspective. Conversely, for men, these associations were stronger at older ages, consistent with an externalizing stress perspective., Conclusions: Men and younger individuals should be of particular focus when designing and testing interventions for drinking in response to relationship distress and disagreements. Younger women and older men may benefit from interventions focused on drinking to cope with relationship jealousy and electronic intrusions.

Objective: In the United Kingdom, some public health teams (PHTs) routinely engage with local alcohol premises licensing systems, through which licenses to sell alcohol are granted. We aimed to categorize PHT efforts and to develop and apply a measure of their efforts over time., Method: Preliminary categories of PHT activity were developed based on prior literature and were used to guide data collection with PHTs in 39 local government areas (27 in England; 12 in Scotland), sampled purposively. Relevant activity from April 2012 to March 2019 was identified through structured interviews ( N = 62), documentation analysis, and follow-up checks, and a grading system was developed. The measure was refined based on expert consultation and used to grade relevant PHT activity for the 39 areas in 6-month periods., Results: The Public Health engagement In Alcohol Licensing (PHIAL) Measure includes 19 activities in six categories: (a) staffing; (b) reviewing license applications; (c) responding to license applications; (d) data usage; (e) influencing licensing stakeholders or policy; and (f) public involvement. PHIAL scores for each area demonstrate fluctuation in type and level of activity between and within areas over time. Participating PHTs in Scotland were more active on average, particularly on senior leadership, policy development, and working with the public. In England, activity to influence license applications before decision was more common, and a clear increase in activity is apparent from 2014 onward., Conclusions: The novel PHIAL Measure successfully assessed diverse and fluctuating PHT engagement in alcohol licensing systems over time and will have practice, policy, and research applications., Competing Interests: Colin Angus has received funding related to commissioned research from Systembolaget and Alko, the Swedish and Finnish government-owned alcohol retail monopolies. All other authors declare that they have no competing interests.

Objective: Alcohol-induced blackouts are a marker of risk such that they are strong independent predictors of experiencing other adverse alcohol-related social and health effects. Existing work informed by the Theory of Planned Behavior suggests that several of the constructs contained within it, such as perceived norms, personal attitudes toward consumption, and drinking intentions, are reliable predictors of alcohol use, related problems, and blackout experiences. However, research to date has not examined these theoretical antecedents as predictors of change in the occurrence of alcohol-induced blackout. The current work aimed to evaluate descriptive (the rate a behavior occurs) and injunctive (the approval of a behavior) norms, attitudes toward heavy drinking, and drinking intentions as predictors of the prospective change in experiencing a blackout., Method: Using existing data from two samples (Sample 1: N = 431, 68% male; Sample 2: N = 479, 52% male), students mandated to complete an alcohol intervention completed surveys at baseline and 1- and 3-month follow-ups. Latent growth curve models evaluated perceived norms, positive attitude toward heavy drinking, and drinking intention as prospective predictors of the change in blackout over 3 months., Results: Across both samples, descriptive and injunctive norms and drinking intentions were not significantly predictive of the change in blackout. Only attitude toward heavy drinking significantly predicted prospective change (the slope factor) in blackout in both samples., Conclusions: Given the strong association between heavy drinking attitudes and change in blackout, attitudes may represent an important and novel target for prevention and intervention efforts.

Objective: A growing body of research implicates Fear of Missing Out (FoMO) as a risk factor for collegiate alcohol use. However, little research has explored the causal mechanisms of this association, which may depend on examining FoMO at both trait and state levels. We therefore examined how predispositions toward experiencing FoMO (i.e., trait-FoMO) interacted with state-level cues indicating that one was "missing out" (i.e., state-FoMO) and cues indicating the presence or absence of alcohol., Method: College students ( n = 544) participating in an online experiment completed a measure of trait-FoMO and were then randomly assigned to one of four guided-imagery script conditions (FoMO/Alcohol cue, FoMO/No Alcohol cue, No FoMO/Alcohol cue, No FoMO/No Alcohol cue). Participants then completed measures of alcohol craving and drinking likelihood for the given scenario., Results: Two hierarchical regressions (one per dependent variable) revealed significant two-way interactions. Greater trait-FoMO demonstrated the strongest, positive associations with alcohol craving following scenarios with FoMO cues present. Reported drinking likelihood was strongest when state-level cues for FoMO and alcohol were both present, moderate when either cue was independently present, and lowest when both cues were absent., Conclusions: FoMO's impact on alcohol craving and drinking likelihood varied across trait/state levels. Although trait-FoMO was associated with alcohol craving, state-level cues indicating "missing out" affected both alcohol-related variables and interacted with alcohol cues in imagery scenarios to predict drinking likelihood. Although additional research is needed, targeting psychological variables related to meaningful social connection may reduce collegiate alcohol use with respect to FoMO.

Objective: Whether college students' reports of their parents' behaviors are as reliable a predictor of student drinking as their parents' own reports remains an open question and a point of contention in the literature. To address this, the current study examined concordance between college student and mother/father reports of the same parenting behaviors relevant to parent-based college drinking interventions (relationship quality, monitoring, and permissiveness), and the extent to which student and parental reports differed in their relation to college drinking and consequences., Method: The sample consisted of 1,429 students and 1,761 parents recruited from three large public universities in the United States (814 mother-daughter, 563 mother-son, 233 father-daughter, and 151 father-son dyads). Students and their parents were each invited to complete four surveys over the course of the students' first 4 years of college (one survey per year)., Results: Paired samples t tests revealed that parental reports of parenting constructs were typically more conservative than student reports. Intraclass correlations revealed moderate associations between parental and student reports on relationship quality, general monitoring, and permissiveness. The associations between parenting constructs and drinking and consequences were also consistent when using parental and student reports of permissiveness. Results were generally consistent for all four types of dyads, and at each of the four time points., Conclusions: Taken together, these findings provide additional support for the use of student reports of parental behaviors as a valid proxy of parents' actual reports and as a reliable predictor of college student drinking and consequences.

Objective: Co-use of alcohol and cannabis has been associated with more total negative consequences than single-substance use, but results have been mixed depending on whether the single substance was alcohol or cannabis. The present study used within-person analyses to examine whether co-use increased the risk for experiencing specific acute negative consequences., Method: College students who were co-users of alcohol and cannabis ( N = 341; M age = 19.8 years; 51.3% female; 74.8% White) completed 56 days of five daily surveys across two bursts. We used generalized linear mixed effects models to examine the effects of type of substance use day on specific negative consequences, controlling for consumption and covariates., Results: Relative to both alcohol-only and co-use days, cannabis-only days were associated with decreased likelihood of experiencing hangover, blackout, nausea/vomiting, injury, rude/aggressive behavior, and unwanted sex. Relative to alcohol-only days, cannabis-only and co-use days were associated with an increased likelihood of driving high/drunk. Finally, there was an increased likelihood of hangovers on alcohol-only days compared with co-use days., Conclusions: Days with different types of substance use differed in specific consequences. Most of the negative co-use consequences investigated here appear to be driven by alcohol consumption rather than cannabis use. The results also indicated that these young adults were more likely to endorse driving under the influence of cannabis than alcohol. Interventions for co-use should target alcohol consumption to reduce negative consequences such as blackout, injury, rude/aggressive behavior, and unwanted sex and highlight the dangers of driving under the influence of cannabis.