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Purchase tasks are used to measure the value, or demand, for various substances by assessing the amount of a substance individuals would purchase across a series of escalating prices. Marijuana purchase task (MPT) has been previously developed; however, cannabis can be consumed in various forms and measurements, thus raising questions about the applicability of the MPT across cannabis users. An adaptive MPT was developed to allow participants to select their preferred product (e.g., herbal, dabs) and division (e.g., hits, grams). Little research has been done to assess the temporal stability of these measures. Participants (

Hypothetical purchase tasks assess substance demand, but the length of purchase tasks makes repeated assessment of state-dependent changes in demand difficult, often limiting clinical utility. Although brief assessments of alcohol and cigarette demand exist, brief measures of cannabis demand do not. College students (

Motives for alcohol use and behavioral economic measures of demand are associated with alcohol consumption and alcohol-related problems. However, it is unclear how differences in reasons for alcohol use may affect alcohol demand. Additionally, although alcohol is commonly used to self-manage conditions such as pain and sleep problems, the impact of these reasons for alcohol use on alcohol demand is not well characterized. The present study addressed this gap. Participants were adults recruited via Amazon Mechanical Turk as part of a larger study investigating health behaviors. Analyses included participants who reported alcohol use in the past year (

Behavioral economics suggests that individuals are likely to engage in a behavior if it is more reinforcing and readily available than other possible options. In real-world environments, sedentary behaviors are often more reinforcing and easily available than physical activities. In order to promote regular physical activity in an environment with sedentary alternatives, it is important to understand the proportion of overall reinforcement that is derived from physical activity (i.e., relative reinforcement, RR). Conceptually similar laboratory-research supports this notion, but applications to individual, real-world environments remain understudied. The current study used a novel survey-based approach to estimate the RR of common physical activities. Healthy adults (N = 348, M age = 39.0 ± 8.7) from the United States completed an online survey between April-May 2020, including a modified activity survey with ten physically active and ten sedentary activities. Regression analysis showed that total RR of physical activity was related to greater physical activity levels when controlling for enjoyment and other covariates. Four factors were identified (household, conditioning, sports, and outdoor activities) using exploratory structural equation modeling, but internal consistency was limited when items were constrained to each factor in the structural equation model. Previous laboratory findings on overall RR of physical activity were replicated with the survey-based measure, but further improvement for relative reinforcement of different sub-domains of physical activity is needed. Researchers and practitioners can use this survey to determine attractive physical activities on the individual level that can compete with sedentary leisure activities.

STUDY OBJECTIVES: Cannabis use is common among young adults and has been proposed as a potential treatment for insomnia. However, controlled studies examining the impact of cannabis use on insomnia symptoms are rare. This secondary analysis of published trial data tested cannabis use during cognitive behavioral treatment for insomnia (CBT-I) as a moderator of treatment efficacy. METHODS: Young adults (ages 18–30 years) who reported past-month binge drinking (4/5+ drinks for women/men) and met diagnostic criteria for insomnia disorder were randomized to CBT-I (n = 28) or sleep hygiene (n = 28) groups. Interaction effects were tested using multilevel models. Outcomes included insomnia severity, actigraphy-assessed sleep efficiency, diary-assessed sleep quality, drinking quantity, and alcohol-related consequences. RESULTS: Twenty-six participants (46%; 12 in the sleep hygiene group and 14 in the CBT-I group) reported using cannabis during the treatment phase of the study, on an average of 23% of treatment days (range, 3%–100%). Relative to those who did not use cannabis, participants who used cannabis during treatment reported heavier drinking and more frequent cigarette use. Approximately 1 in 4 cannabis users (27%) reported using cannabis to help with sleep; however, cannabis users and nonusers did not differ in the use of alcohol as a sleep aid. Controlling for sex, race, drinking quantity, cigarette use, symptoms of depression, and symptoms of anxiety, use of cannabis during treatment did not moderate CBT-I effects on insomnia severity (b, –.002; p = .99) or other outcomes (all p > .20). CONCLUSIONS: CBT-I is effective in reducing insomnia symptoms among young adult drinkers with insomnia, regardless of cannabis use. CLINICAL TRIAL REGISTRATION: Registry: ClinicalTrials.gov; Name: The Insomnia Treatment and Problems (iTAP) Study; URL: https://clinicaltrials.gov/ct2/show/NCT03627832; Identifier: NCT03627832. CITATION: Miller MB, Carpenter RW, Freeman LK, Curtis AF, Yurasek AM, McCrae CS. Cannabis use as a moderator of cognitive behavioral therapy for insomnia. J Clin Sleep Med. 2022;18(4):1047–1054.

Youth involved in the juvenile justice system are at elevated risk for suicide and co-occurring mental health symptoms. This study aims to examine the suicide risk and treatment needs of court-involved, non-incarcerated (CINI) youth, and to understand the acceptability and effectiveness of implementing a mental health screening procedure at time of first court contact. By embedding a forensic mental health screening tool into the intake process of a family court diversionary program, a total of 891 youth (aged 12-18) were assessed using the Massachusetts Youth Screening Instrument-2 (MAYSI-2). Analysis of screening responses revealed 12.5% of youth indicated risk for suicide with risk levels differentiated by youth sex, race and ethnicity. Suicide ideation was also significantly associated with flagging, an indication of clinical risk, on all other scales of the MAYSI-2, as well as subsequent referrals to treatment. Screening for suicide at first point of court contact within an existing diversionary program may serve as a critical and effective point of intervention for youth in need.

Supersized alcopops are sugar-sweetened beverages with extraordinarily high alcohol content; consumption is highly prevalent among college students and is associated with a variety of negative alcohol-related consequences. However, few studies have examined risk factors for consumption of these products. The objective of this study was to examine, among a college student sample, whether the behavioral economic principle of alcohol demand was associated with self-reported lifetime consumption of Four Loko-the most popular brand of supersized alcopop among underage drinkers. Participants were 170 undergraduate students who were at least 18 years of age and reported at least 1 day of alcohol consumption within the past month. Study participants completed a self-administered questionnaire assessing demographics, Four Loko consumption and associated problems, and alcohol demand (using the Brief Assessment of Alcohol Demand). Hierarchical logistic regression analyses revealed that intensity (drinks they would consume if free) significantly predicted Four Loko consumption but not breakpoint (maximum expenditure per drink) or Omax (maximum expenditure for all drinks). Findings support that students who prefer consuming large quantities of alcohol when it is free are more likely to have consumed Four Loko. Interventions increasing price or reducing the availability of Four Loko may be especially protective for this at-risk population. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

OBJECTIVE: To examine the Acquired Preparedness Model using a behavioral impulsivity facet and positive marijuana expectancies to examine direct and indirect effects on marijuana use and related problems. PARTICIPANTS: 250 college students (61.7% female, 54% white) recruited from a southeastern university. METHODS: Participants completed an online survey of delay reward discounting, marijuana expectancies, consideration of future consequences, and marijuana-related outcomes. RESULTS: Delay reward discounting and consideration of future consequences related to marijuana-related problems, but not marijuana use. However, positive marijuana expectancies did not mediate the relation between impulsivity and marijuana outcomes. CONCLUSIONS: These results emphasize delay reward discounting and consideration of future consequences as important factors associated with marijuana-related problems. Interventions aimed at decreasing delay reward discounting and augmenting future orientation may be effective in college students who report light to moderate marijuana use. Future studies would benefit from longitudinal study designs using multiple impulsivity measures among light and heavy users.

BACKGROUND. Deaf and hard-of-hearing (DHH) patients are an underserved priority population. Existing, although contextually limited, findings indicate that DHH patients are more likely to use the emergency department (ED) than non-DHH patients. However, little attention has been given to the differences in ED utilization by patients’ language modality. OBJECTIVE/HYPOTHESIS: We hypothesized that DHH ASL-users and DHH English-speakers would have higher rates of ED utilization in the past 36 months, than non-DHH English-speakers. METHODS. We used a retrospective chart review design using data from a large academic medical center in the southeastern United States. In total, 277 DHH ASL-users, 1,000 DHH English-speakers, and 1,000 non-DHH English-speakers were included. We used logistic regression and zero-inflated modeling to assess relations between patient segment and ED utilization in the past 12- and 36-months. We describe primary ED visit diagnosis codes using AHRQ Clinical Classifications Software. RESULTS. DHH ASL-users and DHH English-speakers had higher adjusted odds ratios of using the ED in the past 36-months than non-DHH English-speakers (aORs = 1.790 and 1.644, respectively). Both DHH ASL-users and DHH English-speakers had higher frequency of ED visits, among patients who used the ED in the past 36-months (61.0% and 70.1%, respectively). The most common principal diagnosis code was for abdominal pain, with DHH English-speakers making up over half of all abdominal pain encounters. CONCLUSIONS. DHH ASL-users and DHH English-speakers are at higher risk of using the ED compared to non-DHH English-speakers. We call for additional attention on DHH patients in health services and ED utilization research.

Background The marijuana purchase task (MPT) is a commonly used behavioral economic measure of relative cannabis value (i.e. demand) that presents specific methodological concerns due to non-standardized measurement, variability in modality of use, and evolving legalization policies. Refinement of the task is critical to improve task ecological validity and accurate measurement of cannabis demand. The present study examined the construct validity of an adaptive MPT that allowed for participant selection of their preferred cannabis-based product and unit of measurement and the effect of next-day responsibilities on demand. Methods Participants reporting at least monthly cannabis use (N = 186, 40.3 % women, Mage = 33.59) were recruited via Amazon Mechanical Turk and completed the original MPT and our adaptive form with 2 next-day responsibilities scenarios (no responsibilities vs. morning job interview) for each MPT. Cannabis use motives, problems, and risk for cannabis use disorder were also assessed. Results Cannabis demand was sensitive to next-day responsibility, with higher hypothetical consumption observed in the no responsibilities condition. Responsibility-related decreases in Omax (F(1,185) = 4.83, p = .029, η2p = .03) were significantly greater on the adaptive MPT than the original MPT. Demand indices derived from the adaptive MPT were significantly correlated with cannabis problems (rbreakpoint = .19, rPmax = 0.18, relasticity=-0.18) and motives (rrange=-.32−.25), and demand metrics from the original MPT. Conclusions Results provide preliminary support for the construct validity of an adaptive MPT and suggest that early-morning work responsibilities may reduce cannabis demand. Continued research is needed to further refine this task and determine implications for cannabis use disorder intervention and prevention approaches.

PURPOSE OF REVIEW: The purpose of this review is to provide an overview of the existing literature on the relationship between the co-use of cannabis and alcohol including (1) epidemiology, comorbidity, and associated consequences of cannabis and alcohol use disorders; (2) preclinical and clinical laboratory studies examining behavioral pharmacology of cannabis and alcohol co-use; and (3) clinical outcomes related to co-use. RECENT FINDINGS: Findings from the literature reviewed suggest that the co-use of alcohol and cannabis is associated with additive performance impairment effects, higher and more frequent consumption levels, increased social and behavioral consequences such as driving while impaired, and greater likelihood of the experiencing comorbid substance use and mental health disorders. Furthermore, co-use may be associated with worse clinical outcomes, yet there are few studies examining the development and evaluation of interventions on reducing the co-use of cannabis and alcohol. SUMMARY: There is a need for more rigorous and longitudinal research studies on the co-use of cannabis and alcohol to glean a more complete understanding of the relationship between the two substances. Findings can be used to develop and refine intervention strategies to successfully reduce cannabis and alcohol co-use.

The demand for opioid medication to effectively treat pain has contributed to the surging opioid crisis, which is a major source of morbidity and mortality in the U.S. More than 100,000 people begin opioid maintenance treatment (OMT) annually, the standard pharmacotherapy for opioid use disorder (OUD). Although OMT is the standard care for OUD, patients often experience or develop a heightened sensitivity to pain (hyperalgesia) as a result of the opioid medication, and also have high rates of stress, affective, and anxiety-related conditions. These conditions are interactive with other behavioral and environmental correlates of opioid and other substance use disorders including impulsive decision-making (e.g., harmful opioid use associated with increased delay discounting), and a lack of alternative (i.e., substance-free) and social reinforcement. Collectively these complex and multifaceted factors constitute significant predictors of lack of adherence to OMT (and other pharmacotherapies) and relapse. There is an urgent need, therefore, to develop novel adjunctive treatments that preserve the benefits of OMT and various pharmacotherapies, and simultaneously diminish continued pain and hyperalgesia, reduce stress and anxiety-related conditions, target relevant behavioral mechanism such as impulsive choice, and also serve to enhance the value of alternative and substance free activities. Here, we discuss evidence that an environmental manipulation – access to greenspace and nature – could serve as a potential adjunctive treatment to standard pharmacotherapies by targeting multiple biological and behavioral mechanisms that standard pharmacotherapies do not address.

Insomnia symptoms have been linked to problematic marijuana use among young adults, but the mechanism underlying this association and whether sex differences exist, remains unclear. Using cross-sectional data, this study examined negative mood as a mediator of the association between insomnia and marijuana problems among male and female college students. Undergraduate students (n = 267; 61% female) reporting marijuana use in the past month completed an online survey assessing insomnia symptoms, negative mood and marijuana problems. Controlling for relevant covariates, negative mood was examined as a mediator of the association between insomnia and marijuana problems using bootstrapped significance tests for indirect effects (n-boot = 1,000). Results indicated that higher levels of insomnia were associated with greater levels of negative mood (regardless of sex), which in turn were associated with greater marijuana-related problems. In conclusion, insomnia symptoms are associated with more negative mood among college students who use marijuana, and this effect on negative mood accounts for a large part of the association of insomnia symptoms with marijuana-related problems. Research is needed to determine if these associations are maintained prospectively.

Purpose: Twenty-nine states have bypassed federal regulations by legalizing marijuana (MJ) either medicinally, recreationally or both. The FDA states that there is no empirical evidence that MJ is effective to treat these disorders. With over a billion individuals living with a disability across the globe, it is crucial to fully research the efficaciousness and safety of medical MJ to treat this population. The purpose to present the results of a scoping review of studies focused on the levels of evidence currently available on medical MJ's efficacy in treatment across a large range of disabilities.Methods: Databases were searched for research articles on the current level of evidence to support medical MJ use among people with disabilities.Results: Forty-one peer reviewed articles met the inclusion criteria. Articles focused on attention deficit hyperactivity disorder, post-traumatic stress disorder, depression, schizophrenia, spinal cord injury, multiple sclerosis/movement disorders, fibromyalgia, epilepsy, with some that focused on multiple disabilities.Conclusions: The level of evidence for the use of medical MJ among people with disabilities varies greatly, and has a clear lack of methodologically sound studies. Overall, medical MJ does not improve the level of functioning, but it may improve the overall quality of life for people with disabilities.Implications for RehabilitationEpilepsy can be a disabling chronic disorder which not only impacts physically but can restricts quality of life.Quality of life is diminished even more with treatment resistant epilepsy.Chronic pain is the leading cause of disability and is the most common cause of long-term disability.There is sufficient evidence that medical marijuana is effective in treating epileptic seizures and chronic pain.Medical marijuana may improve the level of functioning and quality of life for individuals with certain disabilities.

Understanding influences and predictors of adolescent alcohol use is necessary for treatment and prevention efforts. Although parent, sibling, and peer substance use have demonstrated associations with adolescent drinking, there is a need to examine the unique predictive role of each variable across time. The purpose of the current study was to longitudinally examine the varying influences of parent, sibling, and peer substance use on adolescent drinking. Participants were 102 at-risk adolescents referred to a randomized intervention trial. Hierarchical multiple regressions were conducted to assess the utility of parent alcohol use, sibling alcohol use, and peer substance use to predict drinking outcomes in the referred adolescent at 3-, 6-, and 12-month follow-up assessments. Results indicated that sibling and peer substance use significantly predicted adolescent drinking frequency above and beyond parent alcohol use at all three time points and drinking quantity and frequency of intoxication at the 12-month follow-up. Peer substance use predicted high volume drinking episodes at all follow-ups and frequency of intoxication at the 3- and 6-month follow-up, whereas only sibling alcohol use predicted drinking quantity at the 3-month follow-up. Parent alcohol use was not a significant predictor of drinking outcomes at any time point. Both sibling and peer substance use were better predictors of adolescent drinking typology at different assessment time points compared to parent alcohol use. These findings highlight the importance of assessing and targeting sibling and peer substance use in intervention and prevention programs.

Background Justice-involved youth report high rates of substance use and related problems that are associated with treatment needs; however, data on screening and linkage to treatment within the justice system is lacking. To further inform the juvenile justice behavioral health cascade of care, this study examined factors associated with identified problematic substance use and treatment referral using two screening tools. Method As part of a family court intake process, 348 justice-involved youth received two screening measures, the MAYSI-2 alcohol/drug use subscale and the CRAFFT. Both tools are designed to indicate early warning signs of substance use problems and signal referral for further clinical evaluation or treatment. Chart review analysis examined whether demographic variables (sex & race), severity of use, and type of substance used were associated with positive screens on either or both measures and subsequent treatment referral. Results Half (51.2%) of youth were identified as having problematic substance use (a positive screen) on at least one of the screeners. Overall, 38.5% positively screened on the CRAFFT with only 0.3% positively screening on just the MAYSI-2 alcohol/drug scale. Cannabis only users were less likely to positively screen on the MAYSI-2 compared to youth who reported use of both alcohol and cannabis. Positively screening on one versus both screeners was not associated with referral, yet many (28%) who positively screened were not referred for services. Conclusions The CRAFFT may be more accurate at identifying youth specifically at risk for problematic cannabis use compared to the MAYSI-2 alcohol/drug subscale. Regardless of tool used, treatment referral was low, highlighting the need for accurate identification of treatment needs of substance-using, justice-involved youth. Interventions to facilitate referrals for youth with problematic substance use are needed.

Four Loko, the leading supersized alcopop brand, is a pre-mixed alcoholic beverage containing up to 5.5 standard alcoholic drinks in a can. In 2013, the Federal Trade Commission (FTC) mandated the addition to Four Loko cans of a label indicating its alcohol content in standard drinks, presented as "alcohol per serving" and "servings per container."The current study investigated whether college students accurately estimate the alcohol content in cans of Four Loko bearing the FTC mandated labels.Undergraduate student drinkers (More than 60% of Florida students and more than 70% of Virginia students underestimated Four Loko's alcohol content by one or more standard drinks, compared to 45% of Montana students. Multivariable logistic regression analysis found the following variables were associated with greater odds of underestimating Four Loko's alcohol content by one or more standard alcoholic drinks: being female (AOR = 2.2), having never seen nor heard of Four Loko (AOR = 1.9), and residing in Florida (AOR = 1.7) or Virginia (AOR = 2.8) versus Montana.Students were far less likely to underestimate alcohol content for 8% alcohol-by-volume (abv) cans compared to those with higher alcohol concentrations. Thus, policies restricting supersized alcopops' abv may help consumers better estimate their alcohol content.

Supersized alcopops are sugar sweetened beverages with high alcohol concentration; Four Loko is the most commonly consumed brand among underage drinkers.The current study examined the prevalence and correlates of Four Loko consumption, as well as drinking location, beverage source, quantity consumed, and alcohol-related consequences among students who consumed the product before age 21.Undergraduate drinkers (Among drinkers, 46% had consumed Four Loko. The vast majority (93%) drank the product before age 21. During their first Four Loko drinking episode, 57% consumed at least one can and 10% drank two or more cans. Among underage drinkers, being male (AOR = 6.8), paying for the Four Loko (AOR = 3.1), and earlier age of alcohol initiation (AOR = 0.8) were associated with greater odds of drinking at least one can. Among underage drinkers who finished at least one can, 36% blacked out and 21% vomited. The odds of blacking out and vomiting were greater if the participant drank at least one can (AOR = 6.0, AOR = 4.0). Students in states that sold Four Loko with higher alcohol-by-volume were more likely to blackout (AOR = 2.0) and vomit (AOR = 2.5).Delaying the age of first alcohol use may have protective effects on supersized alcopop consumption. Increased enforcement of existing laws is needed to prevent underage access to Four Loko. Further, laws that reduce the alcohol content of Four Loko may reduce negative consequences associated with its consumption.

Behavioral economics states that alcohol misuse is inversely related with reinforcement from alternative sources, as operationalized by Herrnstein’s matching law. Thus, alcohol misuse is influenced by environmental constrains and is promulgated by deprivation of reward from alternative (nonalcohol) sources. This chapter briefly describes the history of research on reward deprivation before describing currently available approaches for the measurement of reward deprivation. Next, the current research using these measurement approaches is reviewed, including cross-sectional and longitudinal relations. The chapter ends by describing intervention approaches that embody the spirit of behavioral economics by purposefully targeting engagement in alternative activities.

Delay discounting (DD) refers to the decrease in the subjective value of a reward as the delay to its receipt increases. As high rates of DD are consistently associated with measures of substance misuse, DD is an important construct in current conceptualizations of addiction. High rates of DD appear to model preference for the immediate rewards provided by substance use, resulting in the interpretation that individuals with substance use disorder are generally unable or unwilling to delay gratification to obtain larger but delayed rewards. This interpretation is largely based on literature implementing binary choice tasks using differing amounts of the same commodity (i.e., single-commodity), in which high rates of DD can result from relative preference for the immediate outcome or relative dispreference for the delayed outcome. We propose that tasks using different commodities (i.e., cross-commodity) for the immediate and delayed outcomes offer potential in disentangling these dissociable and consequentially distinct interpretations. Our review suggests that cross-commodity DD tasks provide unique insights into understanding addiction not captured by single-commodity designs. We conclude that more research implementing cross-commodity DD tasks is needed to better understand the role of intertemporal choice in addiction and recovery.

BackgroundBoth drinking location and pregaming have been associated with heavy alcohol use among college students, yet the manner by which they uniquely contribute to alcohol intoxication remains unclear.ObjectiveThe current study examined the unique utility of drinking location and pregaming in predicting alcohol intoxication among college students who violated campus alcohol policy.MethodBetween 2011 and 2012, mandated college students who reported drinking prior to their referral events (N = 212, 41% female, 80% White, Mage = 19.4 y) completed a computerized assessment of drinking location and related behaviors as part of larger research trial. Chi-squared statistics, t-tests, one-way analyses of covariance, and regression were used to examine study aims.ResultsParticipants were most likely (44%) to report drinking in off-campus housing prior to the referral event, and approximately half (47%) reported pregaming. Alcohol intoxication on the night of the referral event differed significantly as a function of both drinking location and pregaming, but pregaming did not moderate the association between drinking location and alcohol intoxication among mandated students. Female birth sex, pregaming, and drinking at either fraternities or off-campus housing predicted greater levels of alcohol intoxication on the night of the referral incident, while drinking in a residence hall/dorm predicted lower intoxication.Conclusions/importanceDrinking location and pregaming are distinct predictors of alcohol intoxication among mandated college students. Future interventions may benefit from targeting both where and how college students consume alcohol.

Longitudinal research examining college students' alcohol use during the summer months, especially in at-risk individuals, is limited. The current study evaluated changes in mandated college students' alcohol use and related consequences over the summer.Participants (n = 305, 67% male) who had violated campus alcohol policy and were subsequently mandated to treatment completed follow-up assessments at 3, 6, and 9 months. For the majority of students, one of these follow-up assessments occurred over the summer. Hierarchical linear modeling was used to examine changes in alcohol use and related consequences during the school year and summer.Participants reported consuming significantly fewer drinks per occasion, reaching lower peak blood alcohol concentrations, and experiencing fewer alcohol-related consequences during the summer months. All outcomes were mediated by summer housing, indicating that summer influenced alcohol use indirectly through participants' tendency to live at home.Despite small but significant decreases in alcohol consumption and related consequences when living with a parent/guardian, mandated college students continue to exhibit risky drinking and consequences during the summer months. Given these findings, summer may be an appropriate time to implement prevention and intervention strategies with mandated and other at-risk populations.

A recent study demonstrated that a single 50-min supplemental session that targeted the behavioral economic mechanisms of substance-free reinforcement and delayed reward discounting (Substance-Free Activity Session: SFAS) enhanced the efficacy of a standard alcohol brief motivational intervention (BMI) for college drinkers. The purpose of the current study was to conduct a randomized controlled trial intended to replicate and extend the aforementioned study by focusing on both drug and alcohol misuse and reducing session length in order to enhance dissemination potential. Participants were 97 college students (58.8% women; 59.8% White/Caucasian, and 30.9% African American; M age = 20.01, SD = 2.23) who reported at least 1 heavy drinking episode in the past month (M = 4.01 episodes). Most participants (62%) reported recent marijuana use (M = 12.22 days of past-month use). After completing a baseline assessment and an individual 30-min alcohol-focused BMI, participants were randomized to either the 30-min SFAS session or an education control session. A series of mixed model intent-to-treat analyses revealed that both groups reported drinking reductions and that participants in the BMI + SFAS group reported fewer days using marijuana at the 6-month follow-up. These results do not support the incremental efficacy of the briefer SFAS for reducing drinking but suggest that it may improve marijuana outcomes. Future research is needed to identify the ideal length and timing of the SFAS supplement to BMIs. (PsycINFO Database Record Language: en

OBJECTIVE: The purpose of this commentary was to briefly summarize the literature on the relationship between adolescent marijuana use and mental health and how policy changes surrounding marijuana decriminalization and legalization might impact this relationship. METHODS: A comprehensive literature search on adolescent marijuana use, mental health, and the impact of decriminalization and legalization was conducted. Findings are briefly summarized and discussed. RESULTS: Although there is a great deal of ambiguity regarding the causal direction of marijuana use and mental health problems, what can safely be gleaned from this body of research is that early and frequent use of marijuana during adolescence is associated with the development of more psychiatric-related problems than occasional use or nonuse. CONCLUSIONS: Until there is greater clarity in this domain, clinicians should continue to screen adolescent patients for marijuana use as well as mental health difficulties, but may need to be more thoughtful about screening among early adolescents, if in fact a shift in the age of marijuana uptake occurs amidst policy changes. Language: en

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

The present study examined (1) the impact of a brief substance use intervention on delay discounting and indices of substance reward value (RV), and (2) whether baseline values and posttreatment change in these behavioral economic variables predict substance use outcomes. Participants were 97 heavy drinking college students (58.8% female, 41.2% male) who completed a brief motivational intervention (BMI) and then were randomized to one of two conditions: a supplemental behavioral economic intervention that attempted to increase engagement in substance-free activities associated with delayed rewards (SFAS) or an Education control (EDU). Demand intensity, and Omax, decreased and elasticity significantly increased after treatment, but there was no effect for condition. Both baseline values and change in RV, but not discounting, predicted substance use outcomes at 6-month follow-up. Students with high RV who used marijuana were more likely to reduce their use after the SFAS intervention. These results suggest that brief interventions may reduce substance reward value, and that changes in reward value are associated with subsequent drinking and drug use reductions. High RV marijuana users may benefit from intervention elements that enhance future time orientation and substance-free activity participation.

Behavioral economic demand curves measure alcohol consumption as a function of price and may capture clinically relevant individual differences in alcohol-reinforcing efficacy. This study used a novel, behavioral-economic, hypothetical demand-curve paradigm to examine the association between family history of alcohol misuse and individual differences in both alcohol demand and the relative sensitivity of alcohol demand to next-day responsibilities.Participants were 207 college students (47% male, 68.5% White, 27.4% African American, Mage = 19.5 years) who reported at least one heavy drinking episode (5/4 or more drinks on one occasion for a man/woman) in the past month and completed two versions of an alcohol purchase task (APT) that assessed hypothetical alcohol consumption across 17 drink prices. In one APT (standard), students imagined they had no next-day responsibilities, and in the other, they imagined having a 10:00 a.m. test the next day.A series of analyses of covariance indicated that participants with at least one biological parent or grandparent who had misused alcohol reported similar levels of alcohol demand on the standard APT but significantly less sensitivity to the next-day academic responsibility as measured by the percentage of reduction in demand intensity and breakpoint across the no-responsibility and next-day-test conditions.These findings provide initial evidence that APTs might clarify one potential mechanism of risk conferred by family history. Young adult heavy drinkers with a family history of problematic drinking may be less sensitive to next-day responsibilities that might modulate drinking in drinkers without a family history of alcohol problems.

Few adolescent smoking cessation programs have been able to match the success rate found in adult programs. The current study identified smoking cessation strategies used by adolescents and whether strategies differed as a function of ethnic, gender, or individual smoking level. Participants were 136 high school students who made an attempt to quit or reduce their smoking. Logistic regressions revealed that individuals making an actual quit attempt and African-American adolescents used cessation strategies presumed to be more effective. Adolescents are more likely to use informal cessation methods and may need to be provided with more information on effective quit strategies.

BackgroundPregaming is a common phenomenon among college students and is associated with increased risks such as heavy drinking, alcohol-related consequences, and violating campus alcohol policies. However, the mechanism by which pregaming increases student risk is unclear.ObjectivesThe current study aimed to delineate the role of personal endorsement of pregaming, duration of an entire drinking episode on the night of an alcohol violation, and movement from one location to another in predicting alcohol use and violation-related cognitions.MethodsParticipants (N = 113) were college students who had received an alcohol violation. Hierarchical multiple regressions were conducted to investigate the predictive value of pregaming endorsement, duration of drinking, and movement on drinking behaviors [number of drinks consumed and estimated blood alcohol content (eBAC)] on the night of the alcohol violation as well as violation-related cognitions (responsibility, aversiveness).ResultsPregaming and duration of drinking were significant predictors of alcohol consumption and eBAC on the night of the violation, whereas movement was not. Duration of the drinking episode was significantly related to increased perceived responsibility for the alcohol violation.Conclusions/importanceSelf-reported pregaming and the duration of the drinking episode appear to be better targets than movement for prevention and intervention efforts addressing pregaming on college campuses. Interventions should continue focusing on reducing pregaming and its associated consequences, especially for those who report a longer duration of drinking following a pregaming episode.

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.

Motivational interviewing (MI) is often incorporated into screening, brief intervention, and referral to treatment (SBIRT) interventions in critical care settings to address alcohol and other drug use. However, cognitive status has been linked to differential response to MI sessions in emergency department (ED) settings. The current study examined one possible explanation for this differential response: whether higher versus lower mental status impacts patient response to clinician statements during MI sessions conducted in an ED. Participants were 126 patients receiving an MI-based single-session alcohol brief intervention, and 13 therapists who provided treatment. Participants completed a mental status exam (MSE) as part of the screening process, and intervention sessions were audio-taped, and transcribed and coded using the Motivational Interviewing Skills Code (MISC 2.0; Miller, Moyers, Ernst, & Amrhein, 2003). The MISC 2.0 coded therapist behaviors that are related to the use of motivational interviewing, and patient language reflecting movement toward (change talk) or away from (sustain talk) changing personal alcohol use. Overall, patients responded in a similar manner to therapist MI behaviors regardless of high versus low level of mental functioning at the time of the intervention. Group differences emerged on patient response to only three specific therapist skills: giving information, open questions, and complex reflection. Thus, the differential effects of SBIRT in critical care settings do not appear to be a result of differences in the therapist and patient communication process.

Several studies have shown that demand curve indices of the reinforcing efficacy of alcohol (i.e., reports of hypothetical alcohol consumption and expenditures across a range of drink prices) are associated with alcohol-related outcomes. A next logical step in this area of research is to examine potential mediators of this direct relationship. It is possible that enhancement and coping drinking motives serve as an intermediary of the reinforcing efficacy-alcohol use relationship, such that higher reinforcing efficacy is associated with increased motivation to drink, which is then associated with greater alcohol use and problems.Data were collected from 215 college undergraduates who reported drinking in the past 30 days.The demand curve reinforcing efficacy indices O(max) (maximum alcohol expenditure) and intensity (consumption level when drinks were free) demonstrated the strongest and most consistent associations with alcohol use, problems, and motives. Results from two structural equation models indicated that enhancement and coping motives mediated the relationship between reinforcing efficacy and alcohol use and alcohol-related problems.These results suggest that the motivational effects of the behavioral economic variable reinforcing efficacy on problematic alcohol use are in part mediated by increases in enhancement and coping motives for drinking.

What is already known about this subject • Brief motivational interventions have been found to be efficacious for obesity in older adult populations. • Brief motivational interventions including delivery of personalized feedback have been found to be efficacious for reducing college student drinking. What this study adds • First study to test the efficacy of a one-session, brief motivational intervention for obesity among college students. • One session brief motivational interventions may have an impact on the reduction of calorie-dense foods and beverages. • A brief, one-session motivational interview with personalized feedback may not be an intensive enough intervention for obesity treatment among college students. Summary Young adults are at an increased risk for weight gain as they begin college and this has implications for the onset of future health consequences. Brief motivational interventions (BMIs) have been found to be effective with college students for reducing risky health behaviours such as alcohol consumption, but have not been developed and tested with a primary goal of reducing obesity. BMIs have been developed and tested for the treatment of obesity and weight-related health behaviours (WRHB) in other populations, such as adults and adolescents, with promising results. The purpose of the following study was to develop and test the efficacy of a BMI for weight loss among overweight and obese college students. Seventy undergraduate students (85.7% female, 57.1% African–American) completed an assessment about WRHBs and then were randomized to either receive a single 60-min BMI plus a booster phone call or to assessment only. At 3 months post-intervention, effect sizes within the intervention group were twice as large as within the assessment-only group on reductions in high-calorie foods and beverages. However, there were no statistically significant differences between groups on body mass index or WRHBs. The one-session nature of the session might not have been enough to produce significant change in weight.

Stepped care approaches for mandated college students provide individual brief motivational interventions (BMI) only for individuals who do not respond to an initial, low-intensity level of treatment such as Brief Advice (BA). However, how BMIs facilitate change in this higher-risk group of mandated students remains unclear. Perceived descriptive norms and alcohol-related expectancies are the most commonly examined mediators of BMI efficacy but have yet to be examined in the context of stepped care. Participants were mandated college students (N = 598) participating in a stepped care trial in which mandated students first received BA. Those who reported continued risky drinking 6 weeks following a BA session were randomized to either a single-session BMI (N = 163) or an assessment-only comparison condition (AO; N = 165). BMI participants reduced alcohol-related problems at the 9 month follow up significantly more than AO participants. Multiple mediation analyses using bootstrapping techniques examined whether perceived descriptive norms and alcohol-related expectancies mediated the observed outcomes. Reductions in perceptions of average student drinking (B = -.24; 95% CI [-.61, -.04]) and negative expectancies (B = -.13; 95% CI [-.38, -.01]) mediated the BMI effects. Furthermore, perceived average student norms were reduced after the BMI to levels approximating those of students who had exhibited lower risk drinking following the BA session. Findings highlight the utility of addressing perceived norms and expectancies in BMIs, especially for students who have not responded to less intensive prevention efforts.

The present study attempted to determine whether behavioral economic indices of elevated alcohol reward value, measured before and immediately after a brief alcohol intervention, predict treatment response.Participants were 133 heavy drinking college students (49.6% female, 51.4% male; 64.3% Caucasian, 29.5% African American) who were randomized to 1 of 3 conditions: motivational interviewing plus personalized feedback (brief motivational interventions; BMI), computerized personalized feedback intervention (electronic check-up to go; e-CHUG), and assessment only.Baseline level of alcohol demand intensity (maximum consumption) significantly predicted drinks per week and alcohol problems at 1-month follow-up and baseline relative discretionary expenditures on alcohol significantly predicted drinks per week and alcohol problems at 6-month follow-up. BMI and e-CHUG were associated with an immediate postsession reduction in alcohol demand (p.001, ηp2 = .29) that persisted at the 1-month follow-up, with greater postsession reductions in the BMI condition (p = .02, ηp2 = .06). Reductions in demand intensity and Omax (maximum expenditure) immediately postintervention significantly predicted drinking reductions at 1-month follow up (p = .04, ΔR2 = .02, and p = .01, ΔR2 = .03, respectively). Reductions in relative discretionary expenditures on alcohol at 1-month significantly predicted drinking (p = .002, ΔR2 = .06,) and alcohol problem (p.001, ΔR2 = .13) reductions at the 6-month follow-up.These results suggest that behavioral economic reward value indices may function as risk factors for poor intervention response and as clinically relevant markers of change in heavy drinkers.

Cigarette smokers have higher levels of alcohol consumption than nonsmokers and poorer response to alcohol treatment. It is possible that the greater severity of alcohol problems observed in smokers reflects a greater susceptibility to alcohol-related reinforcement. The present study used a behavioral economic purchase task to investigate whether heavy drinking smokers would have greater demand for alcohol than heavy drinking nonsmokers.Participants were 207 college students who reported at least one heavy drinking episode in the past month. Of the 207 participants, 33.2% (n = 67) reported smoking cigarettes at least 1 day in the past month. Participants completed the hypothetical alcohol purchase task, a simulation task that asked them to report how many drinks they would purchase at varying price increments.After the participants' reported alcohol consumption, gender, alcohol problems, and depression were controlled for, analyses of covariance revealed that heavy drinking smokers had significantly greater reported maximum alcohol expenditures (Omax), greater maximum inelastic price (Pmax), and higher breakpoint values (first price suppressing consumption to zero).College student heavy drinkers who also smoke cigarettes exhibit increased demand for alcohol. Smokers in this high-risk developmental stage may thus be less sensitive to price and other contingencies that would otherwise serve to modulate drinking and may require more intensive intervention approaches.

Background Behavioral economic demand curves measure individual differences in motivation for alcohol and have been associated with problematic patterns of alcohol use, but little is known about the variables that may contribute to elevated demand. Negative visceral states have been theorized to increase demand for alcohol and to contribute to excessive drinking patterns, but little empirical research has evaluated this possibility. The present study tested the hypothesis that symptoms of depression and PTSD would be uniquely associated with elevated alcohol demand even after taking into account differences in typical drinking levels. Method An Alcohol Purchase Task (APT) was used to generate a demand curve measure of alcohol reinforcement in a sample of 133 college students (50.4% male, 64.4% Caucasian, 29.5% African-American) who reported at least one heavy drinking episode (5/4 or more drinks in one occasion for a man/woman) in the past month. Participants also completed standard measures of alcohol consumption and symptoms of depression and PTSD. Results Regression analyses indicated that symptoms of depression were associated with higher demand intensity (alcohol consumption when price = 0; Δ R 2 = .05, p = .002) and lower elasticity (Δ R 2 = .04, p = .03), and that PTSD symptoms were associated with all five demand curve metrics (Δ R 2 = .04–.07, p s Conclusions These findings provide support for behavioral economic models of addiction that highlight the role of aversive visceral states in increasing the reward value of alcohol and provide an additional theoretical model to explain the association between negative affect and problematic drinking patterns.

Studies have shown that impulsivity-related traits are associated with alcohol use among college students. It is possible that individual differences in susceptibility to reinforcement from alcohol, which reflects the extent to which an individual values alcohol, moderates this relationship. Data were collected from 255 college students at a large, urban university who reported consuming alcohol at least once in the past 30 days. Two impulsivity-related-traits, Urgency and Sensation Seeking, were examined, as well as the reinforcing efficacy indices of Omax (maximum alcohol expenditure) and Demand Intensity (consumption when price = zero). Findings indicated that Omax moderated the relationship between both impulsivity-related traits and alcohol consumption, and between Urgency and alcohol-related problems. Demand Intensity also moderated the relationship between both impulsivity-related traits and alcohol use, but did not moderate the relationship between either trait and alcohol-related problems. Results from this study suggest that college students high in certain impulsivity-related traits and for whom alcohol is a highly valued reinforcer have a high risk for excessive alcohol consumption and an increased probability of experiencing negative alcohol-related problems.