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IntroductionAs many as 74% of veterans with alcohol use disorders (AUDS) report symptoms of insomnia. Insomnia represents a barrier to alcohol treatment because insomnia symptoms (1) may lead to relapse among those who use alcohol to help them sleep and may negatively impact (2) executive functions and (3) emotion regulation skills. Cognitive-behavioural therapy for insomnia (CBT-I) is an efficacious first-line treatment for insomnia; however, no research has examined the impact of CBT-I on individuals' response to alcohol treatment. In the Sleep and Alcohol for Veterans (Project SAVE) randomised controlled trial, we hypothesise that CBT-I will enhance the efficacy of alcohol treatment among Veterans with insomnia by enhancing their abilities to attend to treatment, regulate emotions and initiate sleep without alcohol.Methods and analysisEighty Veterans enrolled in alcohol treatment at the Veterans Administration (VA) hospital will be randomly assigned to receive either CBT-I or single-session sleep hygiene (SH) education. Individuals will be eligible to participate if they meet Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for moderate to severe AUD and Insomnia Disorder of at least 1-month duration. Participants will complete assessments at baseline, post-treatment and 6-week follow-up. Preliminary process outcomes include retention/recruitment rates and treatment satisfaction (feasibility and acceptability, respectively). Primary outcomes are insomnia severity, percentage of heavy-drinking days and alcohol-related problems. We will assess a variety of secondary clinical and mechanistic outcomes (eg, post-traumatic stress disorder (PTSD) symptoms, attention and working memory).Ethics and disseminationEthics approval was obtained in October 2018. Data collection began in July 2019 and is planned for completion by July 2021. Trial results will be disseminated at local and national conferences, in peer-reviewed publications and

IntroductionAs many as 74% of veterans with alcohol use disorders (AUDS) report symptoms of insomnia. Insomnia represents a barrier to alcohol treatment because insomnia symptoms (1) may lead to relapse among those who use alcohol to help them sleep and may negatively impact (2) executive functions and (3) emotion regulation skills. Cognitive-behavioural therapy for insomnia (CBT-I) is an efficacious first-line treatment for insomnia; however, no research has examined the impact of CBT-I on individuals' response to alcohol treatment. In the Sleep and Alcohol for Veterans (Project SAVE) randomised controlled trial, we hypothesise that CBT-I will enhance the efficacy of alcohol treatment among Veterans with insomnia by enhancing their abilities to attend to treatment, regulate emotions and initiate sleep without alcohol.Methods and analysisEighty Veterans enrolled in alcohol treatment at the Veterans Administration (VA) hospital will be randomly assigned to receive either CBT-I or single-session sleep hygiene (SH) education. Individuals will be eligible to participate if they meet Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for moderate to severe AUD and Insomnia Disorder of at least 1-month duration. Participants will complete assessments at baseline, post-treatment and 6-week follow-up. Preliminary process outcomes include retention/recruitment rates and treatment satisfaction (feasibility and acceptability, respectively). Primary outcomes are insomnia severity, percentage of heavy-drinking days and alcohol-related problems. We will assess a variety of secondary clinical and mechanistic outcomes (eg, post-traumatic stress disorder (PTSD) symptoms, attention and working memory).Ethics and disseminationEthics approval was obtained in October 2018. Data collection began in July 2019 and is planned for completion by July 2021. Trial results will be disseminated at local and national conferences, in peer-reviewed publications and

Brief motivational interventions (BMIs) are widely used and efficacious interventions that address alcohol misuse in mandated college students. Consistent with motivational interviewing (MI; Miller & Rollnick, 2013) theory, within-therapist improvements in MI-consistent (MICO) skills over time-that is, as a therapist gains skill through repeated practice-may be associated with concurrent increases in client change language and subsequent changes in behavior. This study examined how therapist skill changed over time and whether within-therapist improvement in MICO skills impacted in-session client change language and subsequent alcohol-related outcomes. BMI sessions (N = 228) from 2 randomized clinical trials that had led to significant reductions in alcohol use and alcohol-related problems in mandated student drinkers were coded using the Motivational Interviewing Skills Code 2.0 (Miller, Moyers, Ernst, & Amrhein, 2003). In both studies, the BMI consisted of a single 45- to 60-min session. Analyses examined session-by-session changes in therapist MICO skills, client change language, and alcohol use outcomes. Therapist MICO skills improved over time, and there were significant increases in client change language and decreases in client discussion of topics other than personal alcohol use. Among relatively heavy-drinking clients, those treated by a more experienced therapist demonstrated greater reductions in alcohol use; however, this association was not mediated by client change language. Increased experience conducting BMIs improved therapist MICO skills over time, which in turn increased the focus on personal alcohol use during the session. However, it remains unclear how client language predicts behavior change following a BMI. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Brief motivational interventions (BMIs) are widely used and efficacious interventions that address alcohol misuse in mandated college students. Consistent with motivational interviewing (MI; Miller & Rollnick, 2013) theory, within-therapist improvements in MI-consistent (MICO) skills over time-that is, as a therapist gains skill through repeated practice-may be associated with concurrent increases in client change language and subsequent changes in behavior. This study examined how therapist skill changed over time and whether within-therapist improvement in MICO skills impacted in-session client change language and subsequent alcohol-related outcomes. BMI sessions (N = 228) from 2 randomized clinical trials that had led to significant reductions in alcohol use and alcohol-related problems in mandated student drinkers were coded using the Motivational Interviewing Skills Code 2.0 (Miller, Moyers, Ernst, & Amrhein, 2003). In both studies, the BMI consisted of a single 45- to 60-min session. Analyses examined session-by-session changes in therapist MICO skills, client change language, and alcohol use outcomes. Therapist MICO skills improved over time, and there were significant increases in client change language and decreases in client discussion of topics other than personal alcohol use. Among relatively heavy-drinking clients, those treated by a more experienced therapist demonstrated greater reductions in alcohol use; however, this association was not mediated by client change language. Increased experience conducting BMIs improved therapist MICO skills over time, which in turn increased the focus on personal alcohol use during the session. However, it remains unclear how client language predicts behavior change following a BMI. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

OBJECTIVE:Brief motivational interventions (BMIs) are currently the most efficacious individual intervention for mandated college students. However, little is known about how BMIs facilitate client language in relation to subsequent changes in alcohol use and problems in mandated student samples. METHOD:The current study used the Motivational Interviewing Skills Code (MISC 2.0; Miller, Moyers, Ernst, & Amrhein, 2003) to code BMI sessions (N = 252) from 2 randomized clinical trials that led to significant reductions in alcohol use and alcohol-related problems in mandated student drinkers. A proportion of change language was calculated for each decile (1st to 10th) of the BMI sessions. RESULTS:Latent class analyses of in-session speech indicated that there were 3 distinct trajectories of change language over the course of the session: high (n = 59), increasing (n = 122), and low (n = 71). Members of the high trajectory group showed higher rates of alcohol-related problems prior to the BMI and members of the low trajectory group were more likely to be male. Six months following the BMI, members of the high and low trajectory groups demonstrated significant reductions in alcohol use and problems, and members of the increasing trajectory group only reduced alcohol-related problems. CONCLUSIONS:Associations among the 3 trajectories of client change language and subsequent reductions in alcohol use and problems partially supported the technical hypothesis of MI efficacy. Client factors as well as the nature of the discussion of personalized feedback may determine the link between in-session client language and subsequent behavior change. (PsycINFO Database Record

Many returning OIF/OEF/OND Veterans are seeking higher education in an effort to develop a meaningful career and financial stability. Evidence suggests that student service members/veterans (SSM/Vs) are experiencing less academic success than other students. The purpose of this review is to identify the unique challenges of SSM/Vs and evaluate current campus efforts to facilitate their retention and academic performance. With a focus on SSM/Vs attending colleges and universities, we obtained 57 peer-reviewed and 73 gray literature records published between 2001 and 2015. The current SSM/V literature contains an abundance of gray literature, and the empirical research tends to be limited by cross-sectional design and small sample sizes. SSM/Vs encounter significant personal and environmental challenges when transitioning from the military to college campuses. A variety of services have been developed to address the needs of the SSM/V population, but the efficacy of these services remains largely unknown. In conclusion, there is a clear need to provide education to faculty, students, and staff regarding the experiences of SSM/Vs. Efforts to enhance screening for, availability of, and SSM/V engagement in mental health services would also be beneficial, as would improved availability of and SSM/V access to academic support. All future programs designed to address the unique challenges of SSM/Vs in the academic environment should also be systematically implemented and evaluated. (PsycINFO Database Record

PurposePrior research has documented associations between mental health and alcohol use, mental health and insomnia, and insomnia and alcohol use. This study examined insomnia severity as a mediator of the association between mental health and alcohol-related outcomes in young adult veterans.ProceduresVeterans aged 18-34 years (N=622, 83% male) who reported drinking in the past year completed assessments at baseline and one-month follow-up as part of a larger intervention trial. Participants reported symptoms of depression and posttraumatic stress disorder (PTSD) at baseline, insomnia severity at one month, and alcohol use and related consequences at baseline and one month. Mediation analyses using bootstrapped confidence intervals were used to examine the indirect effects of baseline mental health symptoms on alcohol-related outcomes at one month via insomnia severity.Main findingsInsomnia severity was associated with both drinking quantity and alcohol-related consequences. Greater depressive (but not PTSD) symptoms were associated directly with more alcohol-related consequences. Neither depressive nor PTSD symptoms had direct effects on drinking quantity when controlling for the other mental health symptoms (e.g., depressive symptoms did not predict drinking quantity when controlling for symptoms of PTSD). However, symptoms of depression and PTSD predicted drinks per week and alcohol-related consequences indirectly through insomnia severity.ConclusionsSymptoms of depression and PTSD increase risk for alcohol use and related consequences in part by increasing symptoms of insomnia. Findings suggest that insomnia may be an appropriate target for prevention and intervention efforts among heavy-drinking Veterans reporting symptoms of depression or PTSD.

College students frequently engage in drinking games (DGs) and experience a variety of consequences as a result. It is currently unknown whether brief motivational interventions (BMIs) that provide feedback on DG participation can reduce this high risk behavior. This study examined outcome data from 2 randomized clinical trials to examine whether BMIs facilitate change in DG frequency and how these changes may occur. Mandated college students (Trial 1, N = 198, 46% female; Trial 2, N = 412; 32% female) were randomized to BMI or comparison control conditions. Hierarchical linear modeling (HLM) was used to compare the BMI and comparison groups to determine whether the BMI reduced DG participation over time. Percent change talk (PCT) during the discussion of DG during the session was examined as a predictor of change in DG frequency, and gender was examined as a moderator of treatment effects. Controlling for regular drinking frequency, participants who received a BMI did not significantly reduce their DG frequency relative to the comparison group in either sample, and the BMI was equally ineffective at reducing DG behavior for men and women. DG-related PCT during the BMI was associated with lower DG frequency at the second follow-up in both trials. In Trial 1, PCT during the BMI was associated with less steep increases in DG frequency across the course of all follow-ups. Effects of PCT on DG behavior were not moderated by gender. Findings did not support hypothesized reductions in DG participation following a BMI. Future research should explore whether targeted DG-specific interventions could reduce DG participation and the role of in-session client language in facilitating such change. (PsycINFO Database Record

Many returning OIF/OEF/OND Veterans are seeking higher education in an effort to develop a meaningful career and financial stability. Evidence suggests that student service members/veterans (SSM/Vs) are experiencing less academic success than other students. The purpose of this review is to identify the unique challenges of SSM/Vs and evaluate current campus efforts to facilitate their retention and academic performance. With a focus on SSM/Vs attending colleges and universities, we obtained 57 peer-reviewed and 73 gray literature records published between 2001 and 2015. The current SSM/V literature contains an abundance of gray literature, and the empirical research tends to be limited by cross-sectional design and small sample sizes. SSM/Vs encounter significant personal and environmental challenges when transitioning from the military to college campuses. A variety of services have been developed to address the needs of the SSM/V population, but the efficacy of these services remains largely unknown. In conclusion, there is a clear need to provide education to faculty, students, and staff regarding the experiences of SSM/Vs. Efforts to enhance screening for, availability of, and SSM/V engagement in mental health services would also be beneficial, as would improved availability of and SSM/V access to academic support. All future programs designed to address the unique challenges of SSM/Vs in the academic environment should also be systematically implemented and evaluated. (PsycINFO Database Record

College students frequently engage in drinking games (DGs) and experience a variety of consequences as a result. It is currently unknown whether brief motivational interventions (BMIs) that provide feedback on DG participation can reduce this high risk behavior. This study examined outcome data from 2 randomized clinical trials to examine whether BMIs facilitate change in DG frequency and how these changes may occur. Mandated college students (Trial 1, N = 198, 46% female; Trial 2, N = 412; 32% female) were randomized to BMI or comparison control conditions. Hierarchical linear modeling (HLM) was used to compare the BMI and comparison groups to determine whether the BMI reduced DG participation over time. Percent change talk (PCT) during the discussion of DG during the session was examined as a predictor of change in DG frequency, and gender was examined as a moderator of treatment effects. Controlling for regular drinking frequency, participants who received a BMI did not significantly reduce their DG frequency relative to the comparison group in either sample, and the BMI was equally ineffective at reducing DG behavior for men and women. DG-related PCT during the BMI was associated with lower DG frequency at the second follow-up in both trials. In Trial 1, PCT during the BMI was associated with less steep increases in DG frequency across the course of all follow-ups. Effects of PCT on DG behavior were not moderated by gender. Findings did not support hypothesized reductions in DG participation following a BMI. Future research should explore whether targeted DG-specific interventions could reduce DG participation and the role of in-session client language in facilitating such change. (PsycINFO Database Record

PurposePrior research has documented associations between mental health and alcohol use, mental health and insomnia, and insomnia and alcohol use. This study examined insomnia severity as a mediator of the association between mental health and alcohol-related outcomes in young adult veterans.ProceduresVeterans aged 18-34 years (N=622, 83% male) who reported drinking in the past year completed assessments at baseline and one-month follow-up as part of a larger intervention trial. Participants reported symptoms of depression and posttraumatic stress disorder (PTSD) at baseline, insomnia severity at one month, and alcohol use and related consequences at baseline and one month. Mediation analyses using bootstrapped confidence intervals were used to examine the indirect effects of baseline mental health symptoms on alcohol-related outcomes at one month via insomnia severity.Main findingsInsomnia severity was associated with both drinking quantity and alcohol-related consequences. Greater depressive (but not PTSD) symptoms were associated directly with more alcohol-related consequences. Neither depressive nor PTSD symptoms had direct effects on drinking quantity when controlling for the other mental health symptoms (e.g., depressive symptoms did not predict drinking quantity when controlling for symptoms of PTSD). However, symptoms of depression and PTSD predicted drinks per week and alcohol-related consequences indirectly through insomnia severity.ConclusionsSymptoms of depression and PTSD increase risk for alcohol use and related consequences in part by increasing symptoms of insomnia. Findings suggest that insomnia may be an appropriate target for prevention and intervention efforts among heavy-drinking Veterans reporting symptoms of depression or PTSD.

BackgroundPregaming, also known as frontloading or predrinking, is a common but risky drinking behavior among college students. However, little is known about the way in which a brief motivational intervention (BMI) addressing general alcohol use and consequences may impact pregaming frequency.ObjectivesThis study examined whether mandated students reduced frequency of pregaming following a BMI when pregaming was spontaneously discussed and whether gender moderated these effects.MethodsParticipants (n = 269, 32% female) were mandated college students who had received a campus-based alcohol citation and continued to exhibit risky alcohol use six weeks after receiving a brief advice session. Participants were randomized to a brief motivational intervention (BMI, n = 145) or assessment only (AO, n = 124) and completed follow-up assessments at 3, 6, and 9 months postintervention. Hierarchical Linear Modeling (HLM) was used to examine both between-person (Level 2) effects (i.e., condition) and within-person (Level 1) effects (i.e., time) on pregaming frequency. Analyses examining discussions of pregaming within the BMI were conducted using a subsample of the BMI sessions which had been transcribed (n = 121).ResultsParticipants in the BMI group did not significantly reduce the frequency of pregaming compared to those in the AO group, even when pregaming was explicitly discussed during the BMI. Moreover, the BMI was equally ineffective at reducing pregaming frequency for both males and females. Conclusion/Importance: Pregaming frequency appears to be resistant to conventional intervention efforts, but recent research suggests several innovative strategies for addressing pregaming in the college student population.

ObjectiveEach year, thousands of college students receive mandated intervention as a sanction for alcohol use or alcohol-related behavior. For these mandated students, brief motivational interventions (BMIs) are currently the most efficacious individual intervention. However, little is known about how the technical (therapist behaviors) and relational (e.g., global ratings of therapist empathy) components of BMIs influence client language as well as subsequent change in alcohol use and consequences.MethodThis study used the Motivational Interviewing Skills Code (MISC 2.0; Miller, Moyers, Ernst, & Amrhein, 2003) to code BMI sessions from 2 randomized clinical trials that facilitated significant reductions in alcohol use (Study 1, n = 91) and alcohol-related consequences (Study 2, n = 158) in mandated students.ResultsThere were significant relationships among therapist behaviors, global scores, and client language both for and against change, yet there were no links between in-session client language and subsequent changes in alcohol use or problems. In contrast, relational aspects of motivational interviewing (MI; global ratings of therapist MI Spirit and client self-exploration) were most predictive of postsession alcohol use. Mediation models incorporating both technical and relational components revealed that higher levels of client self-exploration mediated the relationship between higher therapist ratings of MI Spirit and reduced drinking at follow-up.ConclusionsFindings highlight the importance of considering how both technical and relational components of MI may influence alcohol use in mandated college students and also suggest more exact analyses to better understand this complex relationship.

Alcohol expectancies, defined as a person's beliefs about the effects of drinking, can influence alcohol consumption and help predict problem drinking in college students. However, there are concerns that current expectancy measures do not adequately capture mandated student expectations about alcohol use. This study examined the correspondence of 412 self-generated expectancies from mandated students (n=64) to items on the Brief Comprehensive Effects of Alcohol (B-CEOA; Ham, Stewart, Norton, & Hope, 2005). Self-generated expectancies were reviewed by raters who attempted to match each expectancy with a single B-CEOA item based on the qualitative essence of each statement. Most mandated student expectancies were not represented by the B-CEOA. All expectancies were then classified into 6 categories based on themes and categories from the alcohol expectancy literature. Mandated student expectancies emphasized the physiological aspects of drinking, whereas the B-CEOA assesses expectancies about intrapersonal factors. The findings suggest the B-CEOA may exclude alcohol expectancies that are important and relevant to this population. Self-generated alcohol expectancies from the target population should be considered when developing or administering expectancy questionnaires.