Search

Background: It is important to identify students who would benefit from early interventions to reduce harmful drinking patterns and associated consequences. the Brief Young Adult Alcohol Consequences Questionnaire (B-YAACQ) could be particularly useful as a screening tool in university settings. Objectives. The present study examined the utility of the B-YAACQ to distinguish among students at-risk for problematic alcohol use as measured by the AUDIT. Objectives: The present study examined the utility of the B-YAACQ to distinguish among students at-risk for problematic alcohol use as measured by the AUDIT. Methods: A sample of 6382 students (mean age=20.28, SD=3.75, 72.2% females) from seven countries (i.e., U.S., Canada, South-Africa, Spain, Argentina, Uruguay, England) completed the B-YAACQ, the AUDIT and different measures of alcohol use. Results: ROC analyses suggested that a cutoff score of 5 maximized the YAACQ's discrimination utility to differentiate between students at low versus moderate/high risk in the total sample and across countries (except in Canada, where the cutoff was 4). In addition, a cutoff of 7 differentiated between students at low/moderate versus high risk in the total sample, while cutoffs of 10, 9, 8 and 7 differentiate between students at low/moderate versus high risk in Uruguay, U.S and Spain (10), Argentina (9), England (8), and Canada and South-Africa (7), respectively. Students classified at the three risk levels (i.e., low, moderate and high) differed in age (i.e., a younger age was associated with higher risk) and drinking patters (i.e., higher drinking frequency, quantity, binge drinking and AUDIT and B-YAACQ scores in the higher risk groups). Conclusions: This study suggest that the B-YAACQ is a useful tool to identify college students at-risk for experiencing problematic patterns of alcohol use. [ABSTRACT FROM AUTHOR]

The aim of this study was to conduct a preliminary investigation of the associations between facets of impulsivity and alcohol outcomes through motives for drinking responsibly described by self-determination theory (SDT) among college students. Participants (N = 2808) were part of a multisite investigation of college student drinking across 10 universities in 8 states in the USA who reported past-month drinking. Results of a structural equation model testing all possible indirect associations simultaneously indicated that one-third (20 out of 60) of the indirect associations were statistically significant (p<.01). Facets with higher scores representing higher impulsivity (negative/positive urgency) were negatively associated with more internalized motives (autonomous motivation and introjected regulation) and positively associated with less internalized motives (external regulation and amotivation) for drinking responsibly. Facets with higher scores representing lower impulsivity (perseverance and premeditation) demonstrated opposite patterns of associations with motives for drinking responsibly. In turn, more internalized motives were related to higher frequency of protective behavioral strategies use, lower alcohol use severity, and fewer negative alcohol-related consequences; less internalized motives demonstrated an opposite pattern of associations with these alcohol outcomes. The present findings should be replicated using experimental and longitudinal studies for appropriately testing mediation but offer support for a novel hypothesis for motivational pathways from impulsivity to alcohol outcomes that may provide insight into intervention targets, if further supported by future research. [ABSTRACT FROM AUTHOR]

Background: Progression through the stages of change is a proposed mechanism underlying the effects of treatment for alcohol use disorder (AUD). However, examining stages of change as a mechanism of treatment effects requires that the measure be invariant across patient subgroups, treatment conditions, and time. In this study, we examined measurement invariance of the University of Rhode Island Change Assessment Scale (URICA) in Project MATCH using an exploratory structural equation modeling (ESEM) approach. Methods: We conducted a secondary analysis of data from Project MATCH (N = 1726; Mage = 40.2, SD = 10.9; 75.7% male; 80% non‐Hispanic white), a multisite randomized clinical trial that tested three AUD treatments: Motivational Enhancement Therapy, Cognitive‐Behavioral Therapy, or Twelve‐Step Facilitation. Participants completed the 24‐item URICA for assessing the stages of change in relation to drinking at baseline and post‐treatment (3 months after baseline). Results: A 4‐factor ESEM provided a good fit to the data and a better fit to the data than a conventional 4‐factor confirmatory factor analysis model. Further, the URICA demonstrated scalar invariance across each patient subgroup at baseline (sex, ethnicity, marital status, education, and parental history of AUD) and treatment condition at follow‐up. However, the URICA was not longitudinally invariant as the metric model resulted in a significant decrement in model fit. Conclusions: Measurement invariance of the URICA over time was not supported. Longitudinally invariant measures of the stages of change are needed to test the proposal that progression through the stages explains treatment effects. [ABSTRACT FROM AUTHOR]

Use of protective behavioral strategies (PBS) has been associated with reduced alcohol-related harms among college students. However, most of this research has been conducted among U.S. samples. The present study examines the use of PBS in an international context. Participants (n = 1512) were recruited from universities in Spain (n = 298), Argentina (n = 439), and the U.S. (n = 775) to determine if there are differences in PBS use across countries and/or across sex. Further, we examined whether the association between PBS use and negative consequences differ across country and sex. We found that U.S. students reported the most frequent use of Stopping/Limiting Drinking PBS (M = 3.32, SD = 1.23) compared to Argentine (M = 2.89, SD = 0.97) and Spanish (M = 2.83, SD = 0.94) students. Argentine students reported the least frequent use of Serious Harm Reduction PBS (M = 4.57, SD = 0.99) compared to U.S. (M = 5.09, SD = 0.98) and Spanish (M = 5.03, SD = 0.78) students. Elastic net regression analyses stratified by country indicated most individual PBS predicted decreased negative alcohol-related consequences, although two items consistently predicted increased consequences and we observed some variability in the most predictive specific strategies in each country. Across each subscale and for 32 of 40 individual items, females reported more frequent use of PBS than males (ps<.05). From the perspective of developing and adapting interventions, we recommend the cultural context in which PBS are used is taken into account. Although future work is needed to delineate cultural factors underlying the country-level differences we found, these findings have implications for the most promising PBS to target for college students in each country. [ABSTRACT FROM AUTHOR]

Background: Recent research indicates some individuals who engage in heavy drinking following treatment for alcohol use disorder fare as well as those who abstain with respect to psychosocial functioning, employment, life satisfaction, and mental health. The current study evaluated whether these findings replicated in an independent sample and examined associations between recovery profiles and functioning up to 6 years later. Methods: Data were from the 3‐year and 7‐ to 9‐year follow‐ups of subsamples initially recruited for the COMBINE study (3‐year follow‐up: n = 694; 30.1% female, 21.0% non‐White; 7‐ to 9‐year follow‐up: n = 127; 38.9% female, 27.8% non‐White). Recovery at 3 years was defined by latent profile analyses including measures of health functioning, quality of life, employment, alcohol consumption, and cannabis and other drug use. Functioning at the 7‐ to 9‐year follow‐up was assessed using single items of self‐rated general health, hospitalizations, and alcohol consumption. Results: We identified 4 profiles at the 3‐year follow‐up: (i) low‐functioning frequent heavy drinkers (13.9%), (ii) low‐functioning infrequent heavy drinkers (15.8%), (iii) high‐functioning heavy drinkers (19.4%), and (iv) high‐functioning infrequent drinkers (50.9%). At the 7‐ to 9‐year follow‐up, the 2 high‐functioning profiles had the best self‐rated health, and the high‐functioning heavy drinking profile had significantly fewer hospitalizations than the low‐functioning frequent heavy drinking profile. Conclusions: Previous findings showing heterogeneity in recovery outcomes were replicated. Most treatment recipients functioned well for years after treatment, and a subset who achieved stable recovery engaged in heavy drinking and reported good health outcomes up to 9 years after treatment. Results question the long‐standing emphasis on drinking practices as a primary outcome, as well as abstinence as a recovery criterion in epidemiologic and treatment outcome research and among stakeholder groups and funding/regulatory agencies. Findings support an expanded recovery research agenda that considers drinking patterns, health, life satisfaction, and functioning. [ABSTRACT FROM AUTHOR]

Background: College students with more social anxiety symptoms are particularly vulnerable to problematic alcohol and marijuana use given their susceptibility for elevated anxiety symptoms in social settings combined with the normative nature of substance use. Existing research has established substance use as coping motivated for these students when examining alcohol and marijuana use problems separately. The next step is to determine whether students with more social anxiety who use both substances do so for similar or different reasons. The current study tested a comprehensive (i.e., all variables in the same model) motivational model of alcohol/marijuana use in a sample of college students from 10 universities across the United States who endorsed both past‐month alcohol and marijuana use. Methods: College students were recruited through psychology department participant pools and completed an online survey assessing mental health symptoms, substance use motives, and substances use behaviors. Current sample comprised concurrent alcohol/marijuana users (n = 2,034), 29.6% of whom endorsed clinically indicated levels of social anxiety and nearly one‐fourth exceeded the cutoff for hazardous drinking (23.2%) and hazardous marijuana use (21.9%). Results: Across both substances, coping motives significantly mediated the positive relationship between social anxiety symptoms and substance use problems. Unique to alcohol, conformity motives mediated the association between social anxiety symptoms and alcohol‐related problems. Conclusions: Taken together, students with more social anxiety who are focused on anxiety management may use either alcohol or marijuana; however, these students may experience more alcohol‐related problems when drinking to fit in with peers. Students with higher social anxiety who are focused on anxiety management may experience more problems from using either alcohol or marijuana. Yet, for these students, drinking as a means to fit in with others may be more likely to lead to alcohol‐related problems. Expanding investigations to the determinants and consequences of students using multiple substances is critical to facilitate adaptive functioning and prevent clinical‐levels of impairment across the spectrum of mental health issues. [ABSTRACT FROM AUTHOR]

Background and Aims: Recovery from alcohol use disorder (AUD) is often narrowly defined by abstinence from alcohol and improvements in functioning (e.g. mental health, social functioning, employment). This study used latent profile analysis to examine variability in recovery outcomes, defined by alcohol use, alcohol‐related problems and psychosocial functioning at 3 years following treatment. Secondary analysis investigated pre‐treatment, post‐treatment and 1‐ and 3‐year post‐treatment covariate predictors of the latent profiles. Design Secondary analysis of data from a randomized clinical trial. Setting: United States. Participants: We used data from the out‐patient arm of Project MATCH (n = 806; 29.7% female, 22.2% non‐white). Measurements Recovery was defined by latent profile analyses including measures of psychosocial functioning and life satisfaction (Psychosocial Functioning Inventory), unemployment and mental health (Addiction Severity Index), alcohol and other drug use (Form 90) and alcohol‐related consequences (Drinker Inventory of Consequences) 3 years following treatment. Mixture modeling was used to examine correlates of profiles. Findings We identified four profiles at 3 years following treatment: (1) poor functioning frequent heavy drinkers, (2) poor functioning infrequent heavy drinkers, (3) high functioning occasional heavy drinkers and (4) high‐functioning infrequent non‐heavy drinkers. There were relatively few differences on indicators of functioning and treatment‐related variables between the high functioning infrequent non‐heavy drinkers and the high‐functioning occasional heavy drinkers, other than high‐functioning occasional heavy drinkers having lower alcohol dependence severity [odds ratio (OR) = 0.94, 95% confidence interval (CI) = 0.90, 0.98], fewer post‐treatment coping skills (OR = 0.54, 95% CI = 0.32, 0.90) and lower 3‐year post‐treatment abstinence self‐efficacy (OR = 0.37, 95% CI = 0.28, 0.49) and Alcoholics Anonymous (AA) involvement (OR = 0.87, 95% CI = 0.85, 0.99). The two high‐functioning profiles showed the greatest improvements in functioning from baseline through the 3‐year follow‐up, whereas the low‐functioning profiles showed the least amount of improvement. High‐functioning occasional heavy drinkers had higher purpose in life than the poor‐functioning profiles. Conclusions: Some individuals who engage in heavy drinking following treatment for alcohol use disorder may function as well as those who are mostly abstinent with respect to psychosocial functioning, employment, life satisfaction and mental health. [ABSTRACT FROM AUTHOR]

Background and Aims: There is consensus that best clinical practice for dual diagnosis (DD) is integrated mental health and substance use treatment augmented with Alcoholics Anonymous (AA) attendance. This is the first quantitative review of the direction and magnitude of the association between AA attendance and alcohol abstinence for DD patients. Method: A systematic literature search (1993–2017) identified 22 studies yielding 24 effect sizes that met our inclusion criteria (8075 patients). Inverse‐variance weighting of correlation coefficients (r) was used to aggregate sample‐level findings and study aims were addressed using random‐ and mixed‐effect models. Sensitivity and publication bias analyses were conducted to assess the likelihood of bias in the overall estimate of AA‐related benefit. Results: AA exposure and abstinence for DD patients were associated significantly and positively [rw = 0.249; 95% confidence interval (CI) = 0.203–0.293; tau = 0.097). There was also significant heterogeneity in the distribution of effect sizes and high between‐sample variance (I2 = 74.6, P < 0.001). Subgroup analyses indicated that the magnitude of AA‐related benefit did not differ between 6‐ (k = 7) and 12‐ (k = 12) month follow‐up (Q = 0.068, P = 0.794), type of treatment received (in‐patient k = 9; intensive out‐patient, out‐patient, community k = 15; Q = 2.057, P = 0.152), and whether a majority of patients in a sample had (k = 11) or did not have (k = 13) major depression (Q = 0.563, P = 0.453). Sensitivity analyses indicated that the overall meta‐analytical estimate of AA benefit was not impacted adversely or substantively by pooling randomized controlled trial (RCT) and observational samples (Q = 0.763, P = 0.382), pooling count, binary and ordinal‐based AA (Q = 0.023, P = 0.879) and outcome data (Q = 1.906, P = 0.167) and reversing direction of correlations extracted from studies (Q = 0.006, P = 0.937). No support was found for publication bias. Conclusions: Clinical referral of dual diagnosis patients to Alcoholics Anonymous is common and, in many cases, dual diagnosis patients who attend Alcoholics Anonymous will report higher rates of alcohol abstinence relative to dual diagnosis patients who do not attend Alcoholics Anonymous. [ABSTRACT FROM AUTHOR]

Background: Alcohol protective behavioral strategies (PBS) are behaviors engaged in immediately prior to, during, after, or instead of drinking with the explicit goal of reducing alcohol use, intoxication, and/or alcohol-related harms. Despite the quantitative support for alcohol PBS as a protective factor among college student drinkers, we know of no qualitative research aimed at determining college student drinkers' perceptions regarding the advantages and disadvantages of using PBS. Objectives: In the style of a decisional balance exercise, we asked college student drinkers (analytic n = 113) to identify 5 reasons they would not use PBS (cons) and 5 reasons they would use PBS (pros). Method: Participants (majority female, 77.0%) were recruited from a psychology department participant pool at a large, southeastern university in the United States. Within our analytic sample, participants on average consumed 6.38 (SD = 8.16) drinks per typical week of drinking and reported consuming alcohol on average 7.5 days (SD = 5.83) in the last 30 days. Results: Using a descriptive phenomenological approach, we identified 2 themes for pros (prevention of specific negative alcohol-related consequences and general safety) and 4 themes for cons (goal conflict, ineffectiveness, difficulty of implementation, and negative peer/social repercussions). Overall, participants reported more pros than cons and this discrepancy (i.e., number of PBS pros minus number of PBS cons) was positively related to self-reported frequency of PBS use. Conclusions/Importance: Taken together, we hope that clinicians/researchers will probe individual's reasons for choosing to use (or not use) PBS in order to tailor or improve existing PBS-based interventions. [ABSTRACT FROM AUTHOR]

The present study sought to address an issue in the drinking to cope (DTC) motives literature, namely the inconsistent application of treating DTC motives as a single construct and splitting it into DTC-depression and DTC-anxiety motives. Specifically, we aimed to determine if the effects of anxiety and depression on alcohol-related problems are best explained via their associations with DTC with specific affects or via their associations with a more global measure of DTC by testing four distinct models: the effects of anxiety/depression on alcohol-related problems mediated by DTC-anxiety only (Model 1), these effects mediated by DTC-depression only (Model 2), these effects mediated by a combined, global DTC factor (Model 3), and these effects mediated by both DTC-anxiety and DTC-depression (Model 4). Using path analysis/structural equation modeling across two independent samples, we found that there was a significant total indirect effect of both anxiety and depressive symptoms on alcohol-related problems in every model. However, there was a slightly larger indirect effect in all models using the global DTC motives factor compared to even the model that included the two distinct DTC motives. Our results provide some preliminary evidence that at least at the between-subjects level, a global DTC motives factor may have more predictive validity than separate DTC motives. Additional research is needed to examine how to best operationalize DTC motives at different levels of analysis (e.g., within-subjects vs. between subjects) and in different populations (e.g., college students vs. individuals with alcohol use disorder). [ABSTRACT FROM AUTHOR]

Background: To examine whether a clinically meaningful alcohol consumption cutoff can be created for clinical samples, we used receiver operator characteristic (ROC) curves to derive gender-specific consumption cutoffs that maximized sensitivity and specificity in the prediction of a wide range of negative consequences from drinking.Methods: We conducted secondary data analyses using data from two large clinical trials targeting alcohol use disorders: Project MATCH (n=1726) and COMBINE (n=1383).Results: In both studies, we found that the ideal cutoff for men and women that maximized sensitivity/specificity varied substantially both across different alcohol consumption variables and alcohol consequence outcomes. Further, the levels of sensitivity/specificity were poor across all consequences.Conclusions: These results fail to provide support for a clinically meaningful alcohol consumption cutoff and suggest that binary classification of levels of alcohol consumption is a poor proxy for maximizing sensitivity/specificity in the prediction of negative consequences from drinking. Future research examining consumption-consequence associations should take advantage of continuous measures of alcohol consumption and alternative approaches for assessing the link between levels of consumption and consequences (e.g., ecological momentary assessment). Clinical researchers should consider focusing more directly on the consequences they aim to reduce instead of relying on consumption as a proxy for more clinically meaningful outcomes. [ABSTRACT FROM AUTHOR]

Background: Self-report measures of alcohol problems are commonly included in studies evaluating treatment and recovery from alcohol use disorder (AUD), but no prior study has examined the replicability of the measurement of alcohol problems across studies with various measures and diverse samples. Further, it is unclear which items may be better indicators of alcohol problems for patient subgroups. In the present study, we integrated data from four large alcohol treatment studies to develop a commensurate measure of alcohol problems using moderated nonlinear factor analysis (MNLFA).Methods: Data were from the COMBINE study, Project MATCH, the Relapse Replication and Extension Project (RREP), and the United Kingdom Alcohol Treatment Trial (UKATT), yielding a total sample size of 4414. MNLFA was carried out on the Drinker Inventory of Consequences (COMBINE, MATCH, RREP) and Alcohol Problems Questionnaire (UKATT).Results: We successfully created a 78-item commensurate measure of alcohol problems and examined differential item functioning (DIF) by study membership, time, and socio-demographic characteristics. Sixty-two items demonstrated intercept DIF, suggesting differences in rates of item endorsement for clients with the same underlying levels of alcohol problems across patient subgroups. Six items demonstrated loading DIF, suggesting differences in the extent to which the items were indicative of alcohol problems across patient subgroups.Conclusions: The self-reported measurement of alcohol problems replicates across measures and diverse samples. Items with DIF have clinical implications for the treatment of AUD. Finally, MNLFA scores can be used to test substantive research questions across these studies. [ABSTRACT FROM AUTHOR]

Background: Research has linked tonic and variable mood to problematic alcohol use, both between- and within-subjects. Indices of behavioral control have moderated these links, at least at the between-subjects level. The current study examines daily associations between indices of emotional functioning and alcohol involvement as a function of response inhibition.Methods: College student drinkers (n=74; 58.11% female) were enrolled in a study on emotion and alcohol use. Participants completed a stop-signal task as an index of response inhibition. They then carried a personal data device for 21 days, reporting daily on mood, alcohol use, and acute alcohol use disorder symptoms. Mood instability was the mean square of successive differences from daily mood assessments.Results: There were 1309 person days (622 drinking days) available for analysis. Pre-drinking mood instability was positively associated the likelihood of drinking and drinks consumed on drinking days. The former association was diminished among women with high response inhibition. Pre-drinking positive mood was positively associated the likelihood of drinking and drinks consumed on drinking days. The latter association was diminished among women with high response inhibition. Pre-drinking negative mood was positively associated with drinks consumed on drinking days among women with low response inhibition. Finally, pre-drinking positive mood was associated with acute alcohol use disorder symptoms among those with low response inhibition.Conclusions: These results suggest that interventions targeting positive mood may be particularly important. Further, developing ways to improve response inhibition control may broadly influence negative drinking outcomes by affecting multiple mood-drinking associations. [ABSTRACT FROM AUTHOR]

The purpose of the present study was to examine interaction effects between alcohol protective behavioral strategies (PBS) and a variety of risk and protective factors for experiencing negative alcohol-related consequences using data from a large, multi-site sample of college students. We recruited 5090 college students (71.2% female; 77.4% White; Mean Age = 20.89, SD = 4.44) who reported any alcohol use in the past month from psychology department participant pools at 10 universities across the U.S. to complete an online survey. Alcohol PBS use was a statistically significant negative predictor of alcohol-related problems while controlling for each antecedent variable individually. In terms of moderation effects, 26 out of 35 interactions (74.3%) were statistically significant in the models controlling only for sex. When controlling for frequency and quantity of alcohol use, 24 of 33 interactions (72.7%) were statistically significant. The nature of these interaction effects was largely the same: more frequent alcohol PBS use reduced the positive associations between risk factors and alcohol-related problems. The lack of specificity of these interaction effects calls into question the limited contributions of tests of interaction effects between alcohol PBS and individual antecedent variables. Comprehensive tests of interaction effects between alcohol PBS and antecedent variables with large samples are needed to move the field forward, especially replication attempts of interactions effects reported in single studies. [ABSTRACT FROM AUTHOR]