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Aims: To test differential outcomes between three 6‐month text‐messaging interventions to reduce at‐risk drinking in help‐seeking adults. Design: A three‐arm single‐blind randomized controlled trial with 1‐, 3‐, 6‐ and 12‐month follow‐ups. Setting: United States. A fully remote trial without human contact, with participants recruited primarily via social media outlets. Participants: Seven hundred and twenty‐three adults (mean = 39.9 years, standard deviation = 10.0; 62.5% female) seeking to reduce their drinking were allocated to 6 months of baseline 'tailored statically' messaging (TS; n = 240), 'tailored adaptive' messaging (TA; n = 239) or 'drink tracking' messaging (DT; n = 244). Interventions: TS consisted of daily text messages to reduce harmful drinking that were tailored to demographics and alcohol use. TA consisted of daily, tailored text messages that were also adapted based on goal achievement and proactive prompts. DT consisted of a weekly assessment for self‐reported drinking over the past 7 days. Measurements The primary outcome measure was weekly sum of standard drinks (SSD) at 6‐month follow‐up. Secondary outcome measures included drinks per drinking day (DDD), number of drinking days (NDD) per week and heavy drinking days (HDD) at 1‐, 3‐, 6‐ and 12‐month follow‐ups. Findings At 6 months, compared with DT, TA resulted in significant SSD reductions of 16.2 (from 28.7 to 12.5) drinks [adjusted risk ratio (aRR) = 0.80, 95% confidence interval (CI) = 0.71, 0.91] using intent‐to‐treat analysis. TA also resulted in significant improvements in DDD (aRR = 0.84; 95% CI = 0.77–0.92) and drinking days per week (b = −0.39; 95% CI = −0.67, –0.10), but not HDD compared with DT at 6 months. TA was not significantly different from TS at any time‐point, except DDD at 6 months. All groups made improvements in SSD at 12‐month follow‐up compared with baseline with an average reduction of 12.9 drinks per week across groups. Conclusions: Automated tailored mobile messaging interventions are scalable solutions that can reduce weekly alcohol consumption in remote help‐seeking drinkers over time. [ABSTRACT FROM AUTHOR]

Aims: Alcohol biosensors, including the BACtrack Skyn, provide an objective and passive method of continuously assessing alcohol consumption in the natural environment. Despite the many strengths of the Skyn, six key challenges in the collection and processing of data include (1) identifying consumed alcohol; (2) identifying environmental alcohol; (3) identifying and determining the source of missing or invalid data; (4) achieving high participant adherence; (5) integrating Skyn and self‐report data; and (6) implications for statistical inference. In this report we outline these challenges, provide recommendations to address them and identify future needs. Design and settings: Procedures from several laboratory and field‐based pilot studies are presented to demonstrate practical recommendations for Skyn use. Data from a pilot study including a 7‐day ecological momentary assessment period are also presented to evaluate effects of environmental alcohol on BACtrack Skyn readings. Conclusions: To address challenges in the collection and processing of data from the BACtrack Skyn alcohol biosensor, researchers should identify goals in advance of data collection to anticipate the processing necessary to interpret Skyn data. The Transdermal Alcohol Sensor Data Macro (TASMAC) version 2.0 software can help to process data rapidly; identify drinking events, missing data and environmental alcohol; and integrate the sensor with self‐report data. Thorough participant orientation and regular contact in field studies can reduce missing data and enhance adherence. Many recommended methods for Skyn use are applicable to other alcohol sensors and wearable devices. [ABSTRACT FROM AUTHOR]

Background: Transdermal alcohol biosensors measure alcohol use continuously, passively, and non‐invasively. There is little field research on the Skyn biosensor, a new‐generation, wrist‐worn transdermal alcohol biosensor, and little evaluation of its sensitivity and specificity and the day‐level correspondence between transdermal alcohol concentration (TAC) and number of self‐reported drinks. Methods: Participants (N = 36; 61% male, Mage = 34.3) wore the Skyn biosensor and completed ecological momentary assessment (EMA) surveys about their alcohol use over 2 weeks. A total of 497 days of biosensor and EMA data were collected. Skyn‐measured drinking episodes were defined by TAC > 5 μg/L. Skyn data were compared to self‐reported drinking to calculate sensitivity and specificity (for drinking day vs. nondrinking day). Generalized estimating equations models were used to evaluate the correspondence between TAC features (peak TAC and TAC‐area under the curve (AUC)) and number of drinks. Individual‐level factors (sex, age, race/ethnicity, body mass index, human immunodeficiency virus status, and hazardous drinking) were examined to explore associations with TAC controlling for number of drinks. Results: Using a minimum TAC threshold of 5 μg/L plus coder review, the biosensor had sensitivity of 54.7% and specificity of 94.6% for distinguishing drinking from nondrinking days. Without coder review, the sensitivity was 78.1% and the specificity was 55.2%. Peak TAC (β = 0.92, p < 0.0001) and TAC‐AUC (β = 1.60, p < 0.0001) were significantly associated with number of drinks. Females had significantly higher TAC levels than males for the same number of drinks. Conclusions: Skyn‐derived TAC can be used to measure alcohol use under naturalistic drinking conditions, additional research is needed to accurately identify drinking episodes based on Skyn TAC readings. [ABSTRACT FROM AUTHOR]

Impulsivity's relationships to addictive and sexual behaviours raise questions regarding the extent impulsivity may constitute a vulnerability factor for subsequent addictive and sexual behaviours and/or results from each of these. Here, we systematically reviewed empirical support for impulsivity as a precipitating factor or a consequence of addictive or sexual behaviours. We restricted ourselves to recent, human studies with assessments over time, including at least one measure of impulsivity, addictive and sexual behaviours, yielding a review including 29 published reports from 28 studies. Findings point to generalized, self-reported impulsivity as a predictor of addictive and sexual behaviours at a wide range of severity, with elements of both impulsivity and compulsivity to these acts. Alcohol consumption often increases impulsive behaviour, including inclinations towards impulsive and potentially compulsive sexual acts. Research using the Sexual Delay Discounting Task has yielded findings linking impulsivity, addictive and sexual behaviour and as such is a valuable research tool that should be used more extensively. The present review identified gaps to be addressed in further research that concurrently examines facets of impulsivity, addictive and sexual behaviours, especially because criteria for compulsive sexual behaviour disorder have been included in the eleventh edition of the International Classification of Diseases. This article is part of the theme issue 'Risk taking and impulsive behaviour: fundamental discoveries, theoretical perspectives and clinical implications'. [ABSTRACT FROM AUTHOR]

Objective: Drinking goals set at treatment onset predict treatment outcome in patients with alcohol use disorders. Yet the cognitive constructs of goal setting and goal attainment are understudied in young adult drinkers. This study sought to examine how the interplay of goal setting and goal attainment during treatment impacts treatment outcome in a sample of young adult heavy drinkers. Method: Participants were 128 young adult heavy drinkers (Mage = 21.5 years) who participated in a double-blind, placebo-controlled, 8-week efficacy trial of naltrexone plus brief counseling. Participants were not required to be interested in changing their drinking for inclusion. Drinking goals were assessed at baseline, midtreatment, and end of treatment. Outcomes were peak drinking, typical drinking, and drinking frequency. Results: Results from PROCESS serial, multiple mediator models showed that midtreatment goal setting and goal attainment collectively predicted peak drinking (b = 0.87, 95% CI [0.40, 1.37]) and drinking frequency (b = 0.66, 95% CI [0.37, 1.06]). Only midtreatment goal setting mediated the relationship between baseline goal setting and typical drinking (b = 0.35, 95% CI [0.10, 0.85]). Participants who set more ambitious drinking goals at baseline were more likely to set subsequent, ambitious goals; more ambitious goals at midtreatment were associated with better treatment outcomes. Conclusion: Setting initial, ambitious goals led to further ambitious goals, which ultimately contributed to lower levels of drinking. Thus, cognitive processes during treatment may be an important target of intervention efforts. For example, the inclusion of goal-setting exercises during treatment could serve to improve intervention effects. [ABSTRACT FROM AUTHOR]

Individuals with posttraumatic stress disorder (PTSD) are more than four times as likely as those without PTSD to have substance use disorder (SUD), making it critical to understand the interaction of substance use status and PTSD outcomes. Using the broader treatment literature, we examined PTSD treatment effects, with and without co-morbid SUD, by extending a published meta-analysis to include recent studies. From reports of 156 Randomized Controlled Trials (RCTs), we extracted exclusion criteria based on substance use and findings involving substance use as a predictor or outcome. Almost three-quarters of RCT designs excluded participants based on substance use status. Only 29.5% reported descriptive statistics characterizing substance use within the study sample and only 7.7% reported substance use-related outcomes. There was no clear relationship between exclusion criteria based on substance use and PTSD outcome or participant retention, suggesting either that SUD does not impede treatment effects, or that available studies lack sufficient data for these analyses. Importantly, no studies reported significant increases in substance use in the course of PTSD treatment. We conclude that patients with PTSD and co-morbid SUD have been largely neglected in PTSD RCTs; thus findings may not be fully applicable to those meeting criteria for both conditions. [ABSTRACT FROM AUTHOR]

Objective: Behavioral interventions for young adults show limited effects 1-year posttreatment. Few studies have examined the longitudinal outcomes of pharmacotherapy trials to reduce heavy drinking. This study examined the posttreatment. longitudinal effects of the first placebo-controlled trial of naltrexone in young adult heavy drinkers. Method: Randomized, double-blind, placebo-controlled, 8-week trial. Follow-up assessments at posttreatment (8 weeks [8W]), 3 months [3M], 6 months [6M], and 12 months [12M]). Participants were young adults ages 18-25 (N = 118) who reported ≥4 heavy drinking days in the prior 4 weeks. Outcomes were percent days heavy drinking (PHDD), percent days abstinent (PDA), and drinks per drinking day (DPDD). Results: There were no time effects on PHDD. Treatment improvements were maintained posttreatment. A main effect of time was found for PDA. Both conditions continued to increase PDA posttreatment. For DPDD, a Treatment XTime interaction emerged. In the naltrexone condition. DPDD increased from 8W to 6M and decreased from 6M to 12M, resulting in no net change posttreatment. The placebo group had a nonsignificant decrease in DPDD. The result was a significant benefit of naltrexone at 8W but not 12M. Conclusions: Participants showed improvements or no change on most outcomes over 1 year posttreatment. Naltrexone had significant benefits over placebo at 8W. Although differences among groups diminished during follow-up, overall effects were maintained. Behavioral monitoring during treatment may impact long-term outcomes more than a single intervention following discontinuation of active medication. [ABSTRACT FROM AUTHOR]

Background and aims: Perceived parental permissiveness toward gambling may relate to adolescents’ engagement in various risky behaviors. To examine this possibility, we analyzed data from a high-school based risk-behavior survey to assess relationships between perceived parental permissiveness toward gambling and adolescent gambling behavior, substance use and related problems. We also evaluated predictions that relationships between perceived parental permissiveness toward gambling and risky behaviors would be particularly strong amongst adolescents reporting high sensation-seeking or impulsivity. Methods: High-school students (n = 2,805) provided data on risky behaviors, perceived parental permissiveness toward gambling, impulsivity and sensation-seeking. Bivariate and logistic regression analyses were conducted to examine relationships with gambling and alcohol, cigarette and marijuana use. Results: Perceived parental permissiveness toward gambling related significantly to adolescent gambling, all substance-use behaviors as well as alcohol and drug problems. There were significant parental-permissiveness-by-sensation-seeking interactions in multiple models. Relationships between perceived parental permissiveness toward gambling and alcohol-use frequency were particularly strong among those with high sensation-seeking. This relationship also applied to gambling and heavy cigarette smoking, albeit to a lesser extent. Impulsivity related strongly to drug problems among those who perceived their parents to be more and less permissive toward gambling. Discussion and conclusions: These findings support the relevance of perceived parental permissiveness toward gambling to adolescent risky behaviors. Parenting perceived as less permissive toward gambling appeared to have protective effects on gambling, alcohol and cigarette use, even among those with high sensation-seeking. Reducing parental permissiveness toward gambling may be a valuable intervention goal, particularly for parents of sensation-seeking adolescents. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: Although impulsivity, sensation-seeking, and part-time employment have each been linked to risky behaviors in adolescents, their inter-relationships are less well-understood. We examined data from adolescents to assess the following predictions: (1) sensation-seeking would relate closely to substance use and gambling; (2) impulsivity would relate closely to alcohol, drug, and gambling problems; and (3) these relationships would be particularly strong among those holding part-time jobs. Method: High-school students (N = 3,106) were surveyed to provide data on impulsivity, sensation-seeking, and part-time job status. Bivariate and logistic regression analyses were conducted to examine relationships with gambling, substance use (i.e., alcohol, cigarettes, and marijuana) and related problems. Results: Both impulsivity and sensation-seeking related significantly to substance use and impulsivity to gambling. Impulsivity had stronger associations with drug and gambling problems than sensation-seeking did. Students with paid part-time jobs were more likely to drink alcohol, binge drink, and use marijuana. Sensation-seeking had a particularly strong relationship to heavy cigarette smoking among students with part-time jobs. Conversely, there was little relationship between part-time job status and smoking among low sensation-seekers. Conclusions: These findings further support the relevance of sensation-seeking, impulsivity, and part-time job status to risky behaviors among adolescents. Sensation-seeking and impulsivity had unique relationships to risky behaviors, in accordance with theory and prior evidence. Impulsive adolescents may be in particular need for interventions to reduce drug use and gambling. Although part-time jobs can be beneficial, parents and caregivers should be mindful of potential negative ramifications of paid work outside the home. [Copyright &y& Elsevier]

Few studies have examined the co-occurrence of alcohol and marijuana use in clinical samples of young adults. The present study investigated whether co-occurring marijuana use is associated with characteristics indicative of a high level of risk in young adult heavy drinkers. Individuals between the ages of 18 and 25 years (N =122) participated in an ongoing 8-week randomized clinical trial that tested the efficacy of placebo-controlled naltrexone plus brief individual counseling to reduce heavy drinking. At intake participants completed self-report assessments on alcohol consumption, alcohol-related negative consequences, motivation to reduce drinking, trait impulsivity, expectancies for alcohol-induced disinhibition, use of cigarettes, and history of medication nonadherence. In univariate tests heavy drinkers with and without co-occurring marijuana use did not differ on alcohol consumption, most alcohol-related negative consequences, and motivation to reduce drinking. In multivariate tests controlling for demographic characteristics, co-occurring heavy alcohol and marijuana use was significantly associated with nonplanning impulsivity (β=2.95) and a history of both unintentional (adjusted odds ratio [aOR]=3.30) and purposeful (aOR=3.98) nonadherence to medication. Findings suggest that young adult heavy drinkers with co-occurring marijuana use exhibit a high-risk clinical profile and may benefit from interventions that increase adherence to medications. [Copyright &y& Elsevier]

There is only modest overlap in the most common alcohol consumption phenotypes measured in animal studies and those typically studied in humans. To address this issue, we identified a number of alcohol consumption phenotypes of importance to the field that have potential for consilience between human and animal models. These phenotypes can be broken down into three categories: (1) abstinence/the decision to drink or abstain; (2) the actual amount of alcohol consumed; and (3) heavy drinking. A number of suggestions for human and animal researchers are made in order to address these phenotypes and enhance consilience. Laboratory studies of the decision to drink or to abstain are needed in both human and animal research. In human laboratory studies, heavy or binge drinking that meets cut-offs used in epidemiological and clinical studies should be reported. Greater attention to patterns of drinking over time is needed in both animal and human studies. Individual differences pertaining to all consumption phenotypes should be addressed in animal research. Lastly, improved biomarkers need to be developed in future research for use with both humans and animals. Greater precision in estimating blood alcohol levels in the field, together with consistent measurement of breath/blood alcohol levels in human laboratory and animal studies, provides one means of achieving greater consilience of alcohol consumption phenotypes. [ABSTRACT FROM AUTHOR]

The article presents a study on the role of alcohol-induced disinhibition expectancies and impaired control as predictors of problem drinking among college undergraduates. It says that trait disinhibition can be associated with problem drinking and alcohol drinking can cause a state of disinhibition. The study utilized the data from a prospective survey on freshman and senior years of college students. Results reveal that expectancies of alcohol inhibition show variance in problem drinking.

Abstract: cognitive processing model postulates that craving will only occur when access to alcohol is blocked. To test a hypothesis based on this model, we analyzed data from a naturalistic laboratory alcohol challenge study involving moderate-to-heavy drinking young adults (N =174) with a focus on the placebo beverage condition of this study. Our hypothesis was that self-reports of “wanting more alcohol” (i.e., craving) in the lab, following placebo, would predict subsequent ad libitum consumption because placebo administration would constitute partial blocking of access to alcohol. We also tested the possibility that craving might mediate associations between personality traits and ad libitum consumption. Both trait disinhibition and reports of craving following the placebo beverage significantly predicted ad libitum consumption. Further, craving partially mediated the association between trait disinhibition and ad libitum consumption. Potential implications of these findings are discussed. [Copyright &y& Elsevier]

ABSTRACT: Accruing evidence of an association between drinking and smoking relapse suggests that it is important to measure alcohol use in smoking cessation studies. However, most studies do not do so, often because of the extra time burden required for these assessments. Data from participants (N =634) in two smoking cessation clinical trials were used to examine the relationship between short and longer periods of monitoring for a number of Timeline Followback (TLFB) drinking metrics at baseline and during treatment. High intercorrelations were found between short (7 and 14 days) and longer (30 and 60 days) time windows for baseline drinking data. Intercorrelations between short (last 7 days of treatment) and longer (entire treatment period) time windows of drinking data during the smoking cessation treatment period were also mostly in the high range. Although total abstinence was significantly overestimated with shorter time windows, for those who were misclassified, percentage of days abstinent was high and percentage of heavy drinking days and number of drinks per drinking day were low during the longer period. Thus, a brief estimate of alcohol use over 7 days at baseline is likely to provide a representative assessment of percentage of days abstinent, percentage of heavy drinking days, and number of drinks per drinking day. To estimate abstinence at baseline and during treatment, however, a more comprehensive period of monitoring may be required. [Copyright &y& Elsevier]

Abstract: Links between trait disinhibition and high-risk drinking are well established. It is also known that alcohol has disinhibiting effects. Nonetheless, there is no measure in the literature devoted exclusively to assessing disinhibiting effects of alcohol. The multidimensional Drinking-Induced Disinhibition Scale (DIDS) was developed as part of Study I, a prospective survey conducted with undergraduates (N =337). Study II, a cross-sectional survey (N =260), allowed for a confirmatory factor analysis and further validation of the measure through comparisons with an expectancies scale. The nine-item DIDS is comprised of three subscales assessing euphoric/social, dysphoric and sexual disinhibition. All three subscales had good internal consistency and adequate test–retest reliability. Convergent and discriminant validity were established in both studies. The subscales had different associations with high-risk drinking: sexual disinhibition predicted heavy episodic drinking; dysphoric disinhibition predicted alcohol-related problems and euphoric/social had associations with both. A cluster analysis revealed four distinct disinhibition profiles (i.e., low effect drinker; high euphoric/social only; high euphoric social and dysphoric; high euphoric/social and sexual), which predicted likelihood of high-risk drinking. [Copyright &y& Elsevier]

Aims: We conducted a review of published reports of smoking cessation pharmacotherapy trials in order to address the following: (i) the generalizability of findings to smokers with a history of alcohol problems; (ii) the extent to which alcohol use affects smoking cessation overall and the efficacy of pharmacotherapy specifically and (iii) the effect of smoking cessation on alcohol use. Methods: We located published reports of nicotine replacement therapy (NRT), bupropion sustained release (SR) and varenicline clinical trials using an approach based on prior Cochrane reviews. The reports were searched for alcohol-related inclusion exclusion criteria and for findings related to alcohol. Results: The present review included 212 published reports from 149 trials. Alcohol-related exclusion criteria appeared frequently (41.6% of trials)—45/125 NRT trials (36%), 15/22 bupropion SR trials (68.2%) and 3/3 varenicline trials—and most commonly involved exclusion of participants with either current or recent alcohol problems. Most studies failed to provide any baseline alcohol-related characteristics. Eleven trials reported on the relationship between alcohol history and likelihood of smoking cessation. In the majority of these studies, smokers with a past history of alcohol problems were not at a disadvantage, although contrary findings exist. Only two studies examined the potential influence of smoking cessation on alcohol use. Conclusions: Smokers with alcohol problems, particularly those with current or recent problems, are underrepresented in studies of approved pharmacotherapy for smoking cessation. Future trials should assess alcohol use at baseline and during treatment and examine reciprocal influences between alcohol consumption and smoking cessation. [ABSTRACT FROM AUTHOR]

Wearable alcohol biosensors have emerged as a valuable tool for noninvasive, objective, and continuous monitoring of alcohol consumption. However, to date their research and clinical applications have been limited by several factors including large size, high cost, and social stigma. In contrast, recently developed wrist-worn alcohol biosensors are smaller, less expensive, and may be more acceptable for daily use. However, these devices are at the prototype phase and have just begun to be tested for research applications. In this paper, we describe our experiences with two prototypes of these new wrist-worn alcohol biosensors (i.e., Quantac Tally and BACtrack Skyn) and their associated smartphone applications in both a controlled laboratory setting and the real-world environment. Our preliminary experiences with these devices highlight their advantages including comfort, high participant acceptability, and good compliance. However, there are various limitations that should be addressed prior to future research applications of these biosensors, including large interpersonal variations in transdermal alcohol readings, lack of immediately applicable data analysis/interpretation software, and poor battery life after a few months. More research is also needed to further validate the new biosensors, and investigate individual (e.g., skin thickness, gender differences) and environmental factors (e.g., humidity, temperature) contributing to the variations in transdermal alcohol readings measured by wrist-worn alcohol biosensors. • Wrist-worn alcohol biosensors may be a powerful tool for real-life alcohol monitoring. • Advantages include small size, low cost, power efficiency, and high acceptability. • Limitations include variable data quality due to personal and environmental factors. • Future directions include validation research and development of analysis software. [ABSTRACT FROM AUTHOR]

Wrist-worn alcohol biosensor technology has developed rapidly in recent years. These devices are light, easy to wear, relatively inexpensive, and resemble commercial fitness trackers. As a result, they may be more suitable for a wide range of clinical and research applications. In this paper, we describe three pilot projects examining the associations between reported drinking behavior and transdermal alcohol concentration (TAC) derived from a new, wrist-worn alcohol biosensor (BACtrack Skyn) in diverse participant groups and settings. Study 1 (N = 3) compared Skyn-derived TAC with that from an ankle-worn alcohol sensor (SCRAM CAM) and breath alcohol concentration (BrAC) in a laboratory setting. Study 2 (N = 10) compared Skyn TAC with BrAC during a naturalistic drinking episode in the field. Study 3 (N = 12) used the Skyn to monitor alcohol use in the field for 2 weeks. Studies 2 and 3 also collected usability and acceptability data from participants. The results of Study 1 showed that the Skyn produced a TAC curve that closely resembled that of the validated SCRAM CAM anklet. In Study 2, Skyn detected drinking for all 10 participants (peak BrAC range: 0.02-0.21) with an average delay of 35.6 ± 10.2 min after the start of self-reported drinking. In Study 3, Skyn reliably recorded continuous TAC data showing multiple drinking episodes over the monitoring period. Participants in Studies 2 and 3 both reported Skyn as highly acceptable. Collectively, the results of these pilot studies show that the Skyn was able to reliably detect drinking events in the laboratory and natural environments. We offer suggestions for further refinements of alcohol biosensors and accompanying analytic software that may facilitate adoption of these devices as cost-effective, user-friendly, and reliable tools to passively and accurately assess alcohol use in the field. [ABSTRACT FROM AUTHOR]

Background: Young adults with higher trait urgency (i.e., a tendency to act rashly in response to heightened affect) may be especially vulnerable to heavy drinking. The current study examined 1) the influence of urgency on daily relations between affect and drinking to intoxication, and 2) whether urgency influenced the effectiveness of naltrexone (vs. placebo) for reducing alcohol use.Methods: This study is a secondary analysis of data from 126 (n=40 female) heavy drinking young adults, ages 18-25, enrolled in a double-blind, 8-week clinical trial comparing brief motivational intervention and either naltrexone or placebo. Multilevel models examined whether trait urgency moderated daily relations between positive and negative affect and drinking to intoxication, measured by an estimated blood-alcohol concentration (eBAC) at or above the legal limit (≥0.08g%). Person-level interactions examined whether naltrexone was more effective than placebo at reducing the odds of eBAC≥0.08g% for individuals with higher vs. lower trait urgency.Results: On days of greater within-person positive or negative affect, young adults with higher urgency were more likely to drink to intoxication than those with lower urgency. Naltrexone reduced the odds of drinking to intoxication significantly more than placebo, independent of positive or negative urgency.Conclusions: Although naltrexone treatment reduced drinking overall, young adults with higher trait urgency were still at increased risk for hazardous drinking following times of strong positive or negative mood. Targeted interventions are needed to reduce the risk of heavy drinking among young adults with high trait urgency. [ABSTRACT FROM AUTHOR]