Predicting Alcohol Patterns in First-Year College Students Through Motivational Systems and Reasons for Drinking

Clarifying the measurement and the role of the behavioral inhibition system in alcohol misuse

BACKGROUND

In response to conflicting reward (Behavioral Approach System [BAS]) and/or punishment cues (Fight-Flight-Freeze System [FFFS]) the Behavioral Inhibition System (BIS) inhibits behavior, leading to increased attention to threat, high anxiety, and behavioral ambivalence. The role of BIS in alcohol misuse is complex, as anxiety promotes self-medication drinking, while attention to threat (e.g., negative outcomes of heavy drinking) may reduce risk. Theory suggests that a concurrent strong BAS may bias BIS-conflict in favor of alcohol approach, while a concurrent strong FFFS may increase the likelihood of alcohol avoidance. However, few studies measure BIS as a conflict system, and no studies incorporate such a measure into examinations of alcohol misuse. Our study goals were to (i) test the Motivational Flanker Task (MFT) as a new laboratory measure of the BIS, BAS, and FFFS; and (ii) use the MFT, in conjunction with self-report measures, to test BAS and FFFS as moderators of the BIS-alcohol misuse relation. We hypothesized that an elevated BIS would predict heavy drinking and alcohol-related problems, but only when BAS was high. Further, we expected an elevated BIS to be associated with reduced alcohol misuse, but only when FFFS was high.

METHODS

Students (N = 198) completed self-reports of BIS/BAS/FFFS and drinking behavior, and 2 reaction time tasks: MFT and Point Scoring Reaction Time Task (PSRTT). The PSRTT is a published measure of the revised BIS.

RESULTS

MFT BIS conflict was associated with self-report and PSRTT measures. MFT BAS, but not FFFS, was associated with self-reports. As expected, elevated BIS was associated with heavy drinking, but only when BAS-Drive and BAS-Fun Seeking was also high. FFFS was not supported as a moderator of the BIS-alcohol misuse association.

CONCLUSIONS

Results support the MFT as a promising measure of the revised BIS. Considering the joint effects of BIS and BAS clarified risk for alcohol misuse.

Posttraumatic stress symptoms and alcohol problems: self-medication or trait vulnerability?

BACKGROUND AND OBJECTIVES

Posttraumatic stress symptoms (PTSD) and problem alcohol use (ALC) commonly co-occur, but the nature of this co-occurrence is unclear. Self-medication explanations have been forwarded, yet traits such as tendency toward negative emotionality and behavioral disconstraint also have been implicated. In this study we test three competing models (Self-Medication, Trait Vulnerability, Combined Dual Pathway) of PTSD-ALC prospectively in a college sample.

METHOD

Participants (N=659; 73% female, M age=18) provided data at college matriculation (Time 1) and 1 year later (Time 2).

RESULTS

Structural equation models showed disconstraint to meditate the path from PTSD symptoms to alcohol problems, supporting a trait vulnerability conceptualization. Findings regarding negative emotionality and self-medication were more mixed. Negative emotionality played a stronger role in cross-sectional than in prospective analyses, suggesting the importance of temporal proximity.

CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE

Self-regulation skills may be an important focus for clinicians treating PTSD symptoms and alcohol misuse disorders concurrently.

Effects of reward sensitivity and regional brain volumes on substance use initiation in adolescence

This longitudinal study examines associations between baseline individual differences and developmental changes in reward [i.e. behavioral approach system (BAS)] sensitivity and relevant brain structures' volumes to prospective substance use initiation during adolescence. A community sample of adolescents ages 15-18 with no prior substance use was assessed for substance use initiation (i.e. initiation of regular alcohol use and/or any use of other substances) during a 2-year follow-up period and for alcohol use frequency in the last year of the follow-up. Longitudinal 'increases' in BAS sensitivity were associated with substance use initiation and increased alcohol use frequency during the follow-up. Moreover, adolescents with smaller left nucleus accumbens at baseline were more likely to initiate substance use during the follow-up period. This study provides support for the link between developmental increases in reward sensitivity and substance use initiation in adolescence. The study also emphasizes the potential importance of individual differences in volumes of subcortical regions and their structural development for substance use initiation during adolescence.

A person-centered approach to understanding negative reinforcement drinking among first year college students

The current study used a person-centered approach (i.e. latent profile analysis) to identify distinct types of college student drinkers based on the predictions of motivational, social learning, and stress and coping theories of maladaptive drinking. A large sample (N=844; 53% female) of first-year undergraduates from two institutions, public and private, who reported consuming one or more drinks in the last three months completed measures of depressive and anxiety symptoms, positive alcohol-outcome expectancies, negative life events, social support, drinking motives, drinking level and drinking-related problems. Latent profile analysis revealed a small subgroup of individuals (n=81, 9%) who conformed to the anticipated high-risk profile; specifically, this group demonstrated high levels of negative affect, coping motives, drinks per week, and drinking-related problems. However, additional groups emerged that showed patterns inconsistent with the proposed vulnerability profile (e.g., high negative affect, positive expectancies, and negative life events, but relatively low drinking levels). Findings from our person-centered approach showing the presence of groups both consistent and inconsistent with the predictions of motivational, social learning, and stress and coping theories highlight the need to identify and target certain college students for prevention and intervention of negative affect-related drinking.

Recent sexual victimization and drinking behavior in newly matriculated college students: a latent growth analysis

College matriculation is a time of developmental and social change and is often a time of heavy drinking. Sexual victimization (SV) is prevalent in late adolescence and poses additional risk for problem drinking behavior. Thus, matriculating students with a SV history may be at heightened risk for maladaptive alcohol use while transitioning through the first year of college. Furthermore, victimization that has occurred close to college matriculation may confer particular risk for problem alcohol use, because the added stressor of coping with a SV while negotiating the transition into college may lead to risky drinking behavior. Therefore, examining the influence of SV timing (i.e., recency) on drinking patterns in freshman year was the aim of the present study. Matriculating undergraduates with a history of SV were assessed at six points during freshman year. Using latent growth curve modeling, we tested differences in trajectories of drinking behavior (i.e., alcohol use, binge drinking) between students who reported a recent SV and those who reported a more distal SV. Students endorsing a recent SV evidenced greater overall levels of alcohol use and higher levels of binge drinking than individuals with SV that was less recent. Moreover, the recent SV group showed significantly more variability in drinking outcomes over freshman year, with escalations mapping onto more salient periods of transition over the first college year. SV that occurs close to college entry is associated with specific and persistent risk for maladaptive drinking behavior in newly matriculated college students.

The role of behavioral inhibition and behavioral approach systems in the associations between mood and alcohol consequences in college: a longitudinal multilevel analysis

The behavioral inhibition system (BIS) and behavioral approach system (BAS) are thought to influence sensitivity to reinforcement and punishment, making them useful for predicting mood-related drinking outcomes. This study provided the first examination of BIS and BAS as moderators of longitudinal within-person associations between mood and alcohol-related consequences in college student drinkers. Participants (N = 637) at two public U.S. universities completed up to 14 online surveys over the first three years of college assessing past-month general positive and negative moods, as well as past-month alcohol use and consequences. BIS and BAS were assessed at baseline. Using multilevel regression, we found that BIS and BAS moderated the within-person associations between negative mood and alcohol consequences. For students high on BIS only, high on BAS only, or high on both BIS and BAS, within-person increases in negative mood were associated with greater alcohol consequences in the first year of college. However, these negative mood-alcohol consequence associations diminished over time for students high on BIS and low on BAS, but remained strong for students high on both BIS and BAS. Within-person associations between positive mood and alcohol consequences changed from slightly positive to slightly negative over time, but were not moderated by BIS or BAS. Findings suggest that BIS and BAS impact the within-person association between general changes in negative mood and negative alcohol consequences, working jointly to maintain this relationship over time.

What are other parents saying? Perceived parental communication norms and the relationship between alcohol-specific parental communication and college student drinking

This study examined parents' normative perceptions of other college parents' alcohol-specific communication, and how parents' perceived communication norms and alcohol-specific communication relate to student drinking outcomes. A sample of 457 student-parent dyads were recruited from a midsize university. Students completed Web-based assessments of alcohol-related attitudes and behaviors. Parents completed alcohol-specific measures of communication norms and parent-child communication, including communication content (i.e., targeted communication) and frequency of communication. Results indicated that parents overestimated how much other parents talked to their college students about the frequency and quantity of alcohol use, but underestimated how often parents initiated conversations about alcohol. In a path model, perceived communication norms positively predicted both targeted communication and frequency of communication. Perceived communication norms and targeted communication negatively predicted students' attitude toward alcohol use. In contrast, more frequent communication predicted students holding more approving attitudes toward alcohol. The relationship between parents' perceived communication norms and students' drinking behaviors was mediated by the parental communication variables and student attitudes. Tests of indirect effects were undertaken to examine meditational processes. The findings underscore relations involving parental perceived communication norms and parents' own alcohol communication and their children's drinking outcomes. The complex relationships of different types of parental communication and student outcomes warrant further research.

A machine learning approach to college drinking prediction and risk factor identification

Alcohol misuse is one of the most serious public health problems facing adolescents and young adults in the United States. National statistics shows that nearly 90% of alcohol consumed by youth under 21 years of age involves binge drinking and 44% of college students engage in high-risk drinking activities. Conventional alcohol intervention programs, which aim at installing either an alcohol reduction norm or prohibition against underage drinking, have yielded little progress in controlling college binge drinking over the years. Existing alcohol studies are deductive where data are collected to investigate a psychological/behavioral hypothesis, and statistical analysis is applied to the data to confirm the hypothesis. Due to this confirmatory manner of analysis, the resulting statistical models are cohort-specific and typically fail to replicate on a different sample. This article presents two machine learning approaches for a secondary analysis of longitudinal data collected in college alcohol studies sponsored by the National Institute on Alcohol Abuse and Alcoholism. Our approach aims to discover knowledge, from multiwave cohort-sequential daily data, which may or may not align with the original hypothesis but quantifies predictive models with higher likelihood to generalize to new samples. We first propose a so-called temporally-correlated support vector machine to construct a classifier as a function of daily moods, stress, and drinking expectancies to distinguish days with nighttime binge drinking from days without for individual students. We then propose a combination of cluster analysis and feature selection, where cluster analysis is used to identify drinking patterns based on averaged daily drinking behavior and feature selection is used to identify risk factors associated with each pattern. We evaluate our methods on two cohorts of 530 total college students recruited during the Spring and Fall semesters, respectively. Cross validation on these two cohorts and further on 100 random partitions of the total students demonstrate that our methods improve the model generalizability in comparison with traditional multilevel logistic regression. The discovered risk factors and the interaction of these factors delineated in our models can set a potential basis and offer insights to a new design of more effective college alcohol interventions.

Pre-college matriculation risk profiles and alcohol consumption patterns during the first semesters of college

Excessive alcohol consumption represents a significant concern on U.S. college campuses, and there is a need to identify students who may be at risk for engaging in risky alcohol use. The current study examined how variables measured prior to college matriculation, specifically alcohol-related decision-making variables drawn from the Theory of Reasoned Action (i.e., alcohol expectancies, attitudes, and normative beliefs), were associated with patterns of alcohol use prior to and throughout the first semesters of college. Participants were 392 undergraduate students (56% female) from a large Northeastern U.S. university. Decision-making variables were assessed prior to college matriculation, and alcohol use was measured with five assessments before and throughout freshman and sophomore semesters. Latent profile analysis was used to identify types of students with distinct patterns of decision-making variables. These decision-making profiles were subsequently linked to distinct patterns of alcohol use using latent transition analysis. Four distinct decision-making profiles were found and were labeled "Anti-Drinking," "Unfavorable," "Mixed," and "Risky." Five drinking patterns were observed and included participants who reported consistently low, moderate, or high rates of alcohol use. Two patterns described low or non-drinking at the pre-college baseline with drinking escalation during the measurement period. Students' likelihood of following the various drinking patterns varied according to their decision-making. Findings suggest the early identification of at-risk students may be improved by assessing decision-making variables in addition to alcohol use. The findings also have implications for the design of early identification assessments to identify at-risk college students and for the targeting of alcohol prevention efforts to students based on their alcohol-related attitudes and beliefs.

Trajectories of Reinforcement Sensitivity During Adolescence and Risk for Substance Use

Developmental neuroscience models suggest that changes in responsiveness to incentives contribute to increases in adolescent risk behavior, including substance use. Trajectories of sensitivity to reward (SR) and sensitivity to punishment (SP) were examined and tested as predictors of escalation of early substance use in a community sample of adolescents (N=765, mean baseline age 11.8 years, 54% female). SR and SP were assessed using a laboratory task. Across three annual assessments, SR increased, and rapid escalation was associated with increases in substance use. SP declined and was unrelated to substance use. Findings support contemporary views of adolescent brain development, and suggest that early adolescent substance use is motivated by approach responses to reward, rather than failure to avoid potential aversive consequences.

Patterns of alcohol use and related consequences in non-college-attending emerging adults

OBJECTIVE

Among emerging adults, those who do not attain postsecondary education are at highest risk for experiencing longterm problems related to alcohol use, including alcohol dependence. The purpose of the current study was to identify latent classes of alcohol users among non-college-attending youth and examine correlates of class membership.

METHOD

Screening criteria were used to select emerging adults between ages 18 and 22 years with no postsecondary education (N = 264) from a prerecruited probability-based Web panel. Latent class analysis (LCA) was used to identify common patterns of alcohol use. Grouping variables and demographic variables were added to the LCA model, and rates of alcohol-related consequences across the LCA classes were compared.

RESULTS

Four classes of drinking patterns were identified: (a) current nondrinkers (34%), (b) weekend light drinkers (38%), (c) weekend risky drinkers (23%), and (d) daily drinkers (5%). Class membership was associated with early onset of alcohol use (age 14 or younger), marital status, employment status, and urban residency (area populated by 50,000 or more people). The number of latent classes did not differ across sex and legal drinking age status, although proportions of subjects within classes varied by age. Weekend risky drinkers were most likely to report sickness and feelings of guilt because of drinking, whereas daily drinkers were most likely to report getting into fights, driving a car after drinking, and missing work.

CONCLUSIONS

Similar to college samples of emerging adults, most of this noncollege sample belonged to latent classes defined by rare or moderate alcohol use. Nevertheless, nearly a quarter of the sample reported high-risk drinking behaviors, and a small number reported drinking alcohol on a daily basis. Both of these classes were at elevated risk for experiencing a number of alcohol-related consequences.

Sociocultural and Mental Health Adjustment of Black Student-Athletes: Within-Group Differences and Institutional Setting

Research has shown that African American college students have a difficult time adjusting at predominately White institutions (PWIs) in comparison with historically Black colleges and universities (HBCUs) with regard to both general and race-related stressors (Neville, Heppner, Ji, & Thye, 2004; Prillerman, Myers, & Smedley, 1989; Sedlacek, 1999). For college student-athletes, the campus environment can challenge their capacity to ft in and adhere to academic and social expectations, perhaps especially for Black student-athletes (BSA). The current study therefore examined the sociocultural and mental health adjustment of 98 BSA based on their perceived social support, perceived campus racial climate, team cohesion, and life events using latent profle analysis (LPA). Results indicated three distinct profile groups: Low Social Support/Cohesion, High Minority Stress, and High Social Support/Cohesion. Profiles were predictive of adjustment concerns and campus setting (PWIs vs. HBCUs), highlighting within-group differences among BSA. Implications for interventions to facilitate and support healthy adjustment and success for BSA are discussed.

The Disparity between Social Drinking Motives and Social Outcomes: A New Perspective on College Student Drinking

Students report drinking for social reasons, yet the social benefits of alcohol use are less understood. Associations between social drinking motives, drinking behaviors, and college friendships were examined via in-person interviews with 72 college freshmen from a large Midwestern University. Social drinking motives were significantly associated with drinking behaviors; however, drinking behaviors were not associated with the number of new casual or close friends students made at college. Consistent with previous research, social motives predicted drinking behaviors; however drinking behaviors were unrelated to friendship outcomes. Drinking prevention campaigns might incorporate these findings in an effort to alter college freshmen's social alcohol expectancies.

Improving control over the impulse for reward: sensitivity of harmful alcohol drinkers to delayed reward but not immediate punishment

BACKGROUND

Cognitive control dysfunction has been identified in dependent alcohol users and implicated in the transition from abuse to dependence, although evidence of dyscontrol in chronic but non-dependent 'harmful' alcohol abusers is mixed. The current study examined harmful alcohol users response inhibition over rewarding stimuli in the presence of monetary reward and punishment, to determine whether changes in sensitivity to these factors, noted in imaging studies of dependent users, influences impulse control.

METHOD

Harmful (n=30) and non-hazardous (n=55) alcohol users were administered a Monetary Incentive Go/No-go task that required participants to inhibit a prepotent motor response associated with reward.

RESULTS

Harmful alcohol users showed a significantly poorer ability to withhold their impulse for a rewarding stimulus in the presence of immediate monetary punishment for failure, while retaining equivalent response inhibition performance under neutral conditions (associated with neither monetary loss or gain), and significantly better performance under delayed reward conditions.

CONCLUSIONS

The results of the present study suggest that non-dependent alcohol abusers have altered sensitivity to reward and punishment that influences their impulse control for reward, in the absence of gross dyscontrol that is consistent with past findings in which such performance contingencies were not used. The ability of delayed monetary reward, but not punishment, to increase sustained impulse control in this sample has implications for the mechanism that might underlie the transition from alcohol abuse to dependence, as well as intervention strategies aimed at preventing this transition.

The association between drinking motives and alcohol-related consequences - room for biases and measurement issues?

AIMS

To investigate whether the predominant finding of generalized positive associations between self-rated motives for drinking alcohol and negative consequences of drinking alcohol are influenced by (i) using raw scores of motives that may weight inter-individual response behaviours too strongly, and (ii) predictor-criterion contamination by using consequence items where respondents attribute alcohol use as the cause.

DESIGN

Cross-sectional study within the European School Survey Project on Alcohol and other Drugs (ESPAD).

SETTING

School classes.

PARTICIPANTS

Students, aged 13-16 (n = 5633).

MEASUREMENTS

Raw, rank and mean-variance standardized scores of the Drinking Motives Questionnaire--Revised (DMQ-R); four consequences: serious problems with friends, sexual intercourse regretted the next day, physical fights and troubles with the police, each itemized with attribution ('because of your alcohol use') and without.

FINDINGS

As found previously in the literature, raw scores for all drinking motives had positive associations with negative consequences of drinking, while transformed (rank or Z) scores showed a more specific pattern: external reinforcing motives (social, conformity) had negative and internal reinforcing motives (enhancement, coping) had non-significant or positive associations with negative consequences. Attributed consequences showed stronger associations with motives than non-attributed ones.

CONCLUSION

Standard scoring of the Drinking Motives Questionnaire (Revised) fails to capture motives in a way that permits specific associations with different negative consequences to be identified, whereas use of rank or Z-scores does permit this. Use of attributed consequences overestimates the association with drinking motives.

Personality mediators of psychopathy and substance dependence in male offenders

Psychopathy and substance dependence (SUD) is highly prevalent in incarcerated populations and tends to co-occur in the same individuals. The factors underlying this relationship are not clearly understood. The primary purpose of this study was to investigate whether two personality models mediate the relationship between psychopathy and substance misuse in male offenders. Ninety-two inmates in provincial correctional centers in New Brunswick completed questionnaires, including the Sensitivity to Reward Sensitivity to Punishment Questionnaire to measure behavioral activation and behavioral inhibition, the Substance Use Risk Profile Scale to measure anxiety sensitivity, introversion/hopelessness, sensation seeking and impulsivity, and the Psychopathic Personality Inventory-Revised to assess psychopathy levels. Results revealed that high impulsivity indirectly mediated the relationship between psychopathy and stimulant dependence. In addition, low anxiety sensitivity indirectly mediated the relationship between psychopathy and opioid dependence. Finally, impulsivity indirectly and inconsistently mediated the relationship between psychopathy and alcohol dependence. These results suggest that individuals with psychopathic traits are at increased risk of misusing certain drugs due to underlying personality-based differences.

Rash impulsiveness and reward sensitivity in relation to risky drinking by university students: potential roles of frontal systems

BACKGROUND

Two forms of impulsivity, rash impulsiveness and reward sensitivity, have been proposed to reflect aspects of frontal lobe functioning and promote substance use. The present study examined these two forms of impulsivity as well as frontal lobe symptoms in relation to risky drinking by university students.

METHODS

University undergraduates aged 18-26years completed the Alcohol Use Disorders Identification Test (AUDIT), Barratt Impulsiveness Scale (BIS-11), Sensitivity to Punishment and Sensitivity to Reward Questionnaire (SPSRQ), Frontal Systems Behavior Scale (FrSBe), and a demographics questionnaire assessing age, gender, and age of onset of weekly drinking (AOD).

RESULTS

AUDIT-defined harmful drinkers reported earlier AOD and scored higher on BIS-11, the Sensitivity to Reward (SR) scale of the SPSRQ, and the Disinhibition and Executive Dysfunction scales of the FrSBe compared to lower risk groups. Differences remained significant after controlling for duration of alcohol exposure. Path analyses indicated that the influence of SR on AUDIT was mediated by FrSBe Disinhibition, whereas the influence of BIS-11 on AUDIT was mediated by both Disinhibition and Executive Dysfunction scales of the FrSBe.

CONCLUSIONS

Findings tentatively suggest that the influence of rash impulsiveness on drinking may reflect dysfunction in dorsolateral prefrontal and orbitofrontal systems, whereas the influence of reward sensitivity on drinking may primarily reflect orbitofrontal dysfunction. Irrespective of the underlying functional brain systems involved, results appear to be more consistent with a pre-drinking trait interpretation than effects of alcohol exposure.

Using parental profiles to predict membership in a subset of college students experiencing excessive alcohol consequences: findings from a longitudinal study

OBJECTIVE

Previous research identified a high-risk subset of college students experiencing a disproportionate number of alcohol-related consequences at the end of their first year. With the goal of identifying pre-college predictors of membership in this high-risk subset, the present study used a prospective design to identify latent profiles of student-reported maternal and paternal parenting styles and alcohol-specific behaviors and to determine whether these profiles were associated with membership in the high-risk consequences subset.

METHOD

A sample of randomly selected 370 incoming first-year students at a large public university reported on their mothers' and fathers' communication quality, monitoring, approval of alcohol use, and modeling of drinking behaviors and on consequences experienced across the first year of college.

RESULTS

Students in the high-risk subset comprised 15.5% of the sample but accounted for almost half (46.6%) of the total consequences reported by the entire sample. Latent profile analyses identified four parental profiles: positive pro-alcohol, positive anti-alcohol, negative mother, and negative father. Logistic regression analyses revealed that students in the negative-father profile were at greatest odds of being in the high-risk consequences subset at a follow-up assessment 1 year later, even after drinking at baseline was controlled for. Students in the positive pro-alcohol profile also were at increased odds of being in the high-risk subset, although this association was attenuated after baseline drinking was controlled for.

CONCLUSIONS

These findings have important implications for the improvement of existing parent- and individual-based college student drinking interventions designed to reduce alcohol-related consequences.

Development and preliminary validation of a behavioral task of negative reinforcement underlying risk-taking and its relation to problem alcohol use in college freshmen

BACKGROUND

A long line of theoretical and empirical evidence implicates negative reinforcement as a process underlying the etiology and maintenance of risky alcohol use behaviors from adolescence through emerging adulthood. However, the bulk of this literature has relied on self-report measures, and there is a notable absence of behavioral modes of assessments of negative reinforcement-based alcohol-related risk-taking. To address this clear gap in the literature, the current study presents the first published data on the reliability and validity of the Maryland Resource for the Behavioral Utilization of the Reinforcement of Negative Stimuli (MRBURNS), which is a modified version of the positive reinforcement-based Balloon Analogue Risk Task (BART).

METHODS

Participants included a convenience sample of 116 college freshmen ever regular drinkers (aged 18 to 19) who completed both behavioral tasks; self-report measures of negative reinforcement/avoidance constructs and of positive reinforcement/appetitive constructs to examine convergent validity and discriminant validity, respectively; and self-report measures of alcohol use, problems, and motives to examine criterion validity.

RESULTS

The MRBURNS evidenced sound experimental properties and reliability across task trials. In support of convergent validity, risk-taking on the MRBURNS correlated significantly with negative urgency, difficulties in emotion regulation, and depressive and anxiety-related symptoms. In support of discriminant validity, performance on the MRBURNS was unrelated to risk-taking on the BART, sensation seeking, and trait impulsivity. Finally, pertaining to criterion validity, risk-taking on the MRBURNS was related to alcohol-related problems but not heavy episodic alcohol use. Notably, risk-taking on the MRBURNS was associated with negative reinforcement-based but not with positive reinforcement-based drinking motives.

CONCLUSIONS

Data from this initial investigation suggest the utility of the MRBURNS as a behavioral measure of negative reinforcement-based risk-taking that can provide a useful complement to existing self-report measures to improve our understanding of the relationship between avoidant reinforcement processes and risky alcohol use.

Positive alcohol expectancies mediate the influence of the behavioral activation system on alcohol use: a prospective path analysis

Gray's (1975, 1987) behavioral activation (BAS) and behavioral inhibition systems (BIS) are thought to underlie sensitivity to reinforcement and punishment, respectively. Consistent with Gray's theory and the Acquired Preparedness model, BAS may facilitate the learning of positive alcohol expectancies (PAEs) over time, leading to increases in drinking. Yet, no prospective tests of this pathway have been reported. The present study investigated whether BAS prospectively predicted PAEs and whether PAEs mediated the association between BAS and subsequent alcohol use. We hypothesized that BAS would influence drinking specifically via enhancement-related PAEs. We also explored the role of BIS in PAEs and drinking. College students (N=557) completed online BAS, PAE, and alcohol use measures in September of their first (T1), second (T2), and third (T3) years of college. We conducted autoregressive path analyses with three BAS subscales and BIS (T1) as predictors, four PAE types (T2) as mediators, and quantity and frequency of drinking (T3) as outcomes. The BAS Fun-Seeking scale was prospectively associated with PAEs, and there was a significant indirect path from Fun-Seeking to alcohol use mediated specifically through activity enhancement PAEs. BIS was positively associated with some PAE types, but did not have indirect effects on drinking. Findings are consistent with both the theory of the BAS and the Acquired Preparedness model, as individuals high on BAS Fun-Seeking may find the rewarding properties of alcohol more reinforcing, leading to stronger enhancement PAEs and increased drinking over time. The prospective design helps establish the temporal association between BAS and alcohol-related learning, and points to the need for prevention efforts that target these at-risk students.

Patterns of drinking-related protective and risk behaviors in college student drinkers

Drinking-related protective (e.g., pacing consumption) and risk (e.g., participating in drinking games) behaviors influence both the amount of alcohol consumed and the consequences experienced by college students. Previous studies of these behaviors have typically examined use and predictors of these constructs separately. In the current study, latent profile analysis (LPA) was used to identify latent subgroups of drinkers with distinct patterns of use of both drinking-related protective and risk behaviors in a sample of college students. A random sample of first year student drinkers (N=229, 59.4% female) at a large, public university in the Northeastern United States completed a web-based assessment of drinking-related protective and risk behaviors, alcohol use, and related consequences. Three patterns of use were identified, including: 1) students who used protective behaviors frequently and seldom engaged in risk behaviors (10%), 2) students who used risk behaviors more frequently and used protective behaviors less often (30%), and 3) students who used both risk and protective behaviors at similar frequencies (60%). Significant differences in the distribution of profiles were observed when considering gender, age of onset of alcohol use, and recent drinking outcomes including weekend alcohol use, heavy-episodic drinking, and alcohol-related problems. Prevention and intervention programs may benefit from a focus on not only increasing protective actions, but on also reducing risk behaviors beyond that of quantity and frequency of alcohol use alone.

Behavioral approach system moderates the prospective association between the behavioral inhibition system and alcohol outcomes in college students

OBJECTIVE

Reinforcement sensitivity theory (RST) is a useful framework for understanding alcohol use, including problematic drinking among college students. Although the link between the behavioral approach system (BAS) and drinking is well established, the role of the behavioral inhibition system (BIS) is less well studied, and findings have been mixed. Consistent with RST, the relationship between BIS and problematic drinking may be moderated by BAS, but tests of the BIS × BAS interaction have been scarce. We hypothesized that high BIS would be a risk factor for subsequent problematic drinking in combination with an elevated BAS, whereas BIS would protect against subsequent problematic drinking in the context of low levels of BAS.

METHOD

College student drinkers (N = 638; 66% women) at two universities completed online measures of BIS, BAS, alcohol use, and alcohol problems at matriculation (Time 1 [T1]) and again 1 year later (Time 2 [T2]).

RESULTS

Regression analyses of alcohol use and problems were performed with BIS, BAS, and the BIS × BAS interaction as predictors. The interaction was not statistically significant in cross-sectional models (T1 alcohol outcomes), but it was a significant prospective predictor of T2 alcohol use (marginal) and T2 alcohol problems. Simple slopes analyses revealed that BIS was a positive predictor of T2 alcohol use and problems at high but not low levels of BAS, albeit this effect was less reliable for use.

CONCLUSIONS

Our findings enhance interpretation of RST, demonstrating a complex link between BIS and problematic drinking risk, one that is moderated by BAS. The prospective nature of these associations suggests that, together, BIS and BAS may promote increases in problematic drinking over time, highlighting the need for targeted interventions during the first year of college.

Reinforcement sensitivity theory and alcohol outcome expectancies in early adolescence

BACKGROUND

Little research has examined the development of alcohol expectancies in childhood, a notable omission as expectancies are viable targets for prevention programs. Moreover, limited alcohol expectancies research has been conducted from the perspective of psychobiological models of motivation despite the strong conceptual links between such models and cognitive models of alcohol use.

OBJECTIVE

To examine if the associations between individual differences from the revised reinforcement sensitivity theory (Gray JA, McNaughton N. The Neuropsychology of Anxiety: An Enquiry into the Functions of the Septo-hippocampal System (2nd ed.). Oxford, UK: Oxford University Press, 2000) and alcohol use is mediated by alcohol expectancies in a large community sample of early adolescents using a prospective design.

METHODS

378 families (1 caregiver; 1 child) were recruited via random digit phone call using a prospective design.

RESULTS

Our findings suggest that both a strong behavioral approach system and fight-flight or freeze system were associated with high levels of positive outcome expectancies, which subsequently predicted an increase in likelihood of alcohol use. There was also some evidence that drive (an aspect of behavioral approach system) was also positively associated with negative expectancies, which subsequently predicted a low probability of alcohol use.

CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE

Individual differences in reinforcement sensitivity may influence the acquisition of positive and negative outcome expectancies, thereby potentially influencing the likelihood of alcohol use in early adolescence. Thus, reinforcement sensitivity theory is a promising theory to account for the link between neural models of addiction and early acquisition of alcohol use in humans.

Validation of a nine-dimensional measure of drinking motives for use in clinical applications: the desired effects of drinking scale

The Desired Effects of Drinking (DEOD) is a 36-item, 9-subscale, self-report measure assessing reasons for drinking, concerning three general motives for alcohol use: Coping, Social, and Enhancement. These subscales include Negative Feelings, Self-esteem, Relief, Positive Feelings, Social Facilitation, Assertion, Drug Effects, Sexual Enhancement, and Mental effects. As part of the COMBINE study, scores from the nine DEOD subscales, along with additional information about alcohol consumption and consequences, were incorporated into personalized client feedback as part of a motivational enhancement intervention and as a guide for the development of a plan for treatment and change. With responses from a clinical sample of 572 individuals seeking alcohol treatment, the 9-subscale structure of the instrument was substantiated through a second-order confirmatory factor analysis, revealing moderately large to large factor loadings and good indices of model fit. A third-order factor analysis indicated these nine subscales adequately represented the three drinking motives. It is suggested these three general motives for alcohol use, which may be more distinctly delineated into the nine dimensions reflected in the DEOD structure, can be used clinically to help plan appropriate interventions and facilitate behavior change.

Alcohol-related infractions among college students: associations with subsequent drinking as a function of sensitivity to punishment

Problematic alcohol use on college campuses is a significant concern. Violations of campus alcohol policies can lead to disciplinary action from the university. These and other alcohol-related legal infractions may be a sign of significant alcohol-related problems. However, few studies have focused on determining predictors of alcohol-related infractions among college students. Likewise, the role of infractions in reducing future use is unclear. In the present study, we tested whether alcohol-related infractions were associated with decreased alcohol use, and whether the effect of the infraction varied as a function of initial drinking levels, sensitivity to punishment (SP), and sensitivity to reward (SR) in a 6-month prospective design. Alcohol use, grade point average, and SR were significantly associated with receiving an alcohol-related infraction. For heavier drinkers, receiving an infraction was associated with decreased drinking at follow-up, and this decrease was most pronounced among those with higher sensitivity to punishment. SP appeared to increase responsiveness to the infraction, resulting in greater attenuation of drinking at follow-up.

Selected impulsivity facets with alcohol use/problems: the mediating role of drinking motives

Impulsivity is associated with alcohol use and related problems, yet limited research has examined the different facets of impulsivity with these outcomes. This study aimed to examine whether sensation seeking, positive urgency, and negative urgency, as separate constructs, would differentially predict alcohol use/problems, and to investigate whether specific drinking motives would mediate these relationships. Self-reported data from an online survey of undergraduate drinkers (n=317) was used in the current study. Findings indicate that sensation seeking and the urgency traits represent unique personality constructs in the prediction of alcohol use/problems, and should be considered separately in future research and when designing prevention and intervention strategies.

Avoidance orientation moderates the effect of threatening messages

This study investigated the influence of individual differences in people's dispositional avoidance orientation on the persuasive effects of low- and high-threat messages promoting moderate drinking. First, participents (N = 99) individual differences in avoidance orientation were assessed, after which they were provided with either high- or low-threat messages about the consequences of drinking too much alcohol. The primary outcome measures were information acceptance, attitude and intention. Results showed that participants low in avoidance orientation were more likely to be persuaded by the low-threat message, whereas participants high in avoidance orientation were more likely to be persuaded by the high-threat message.

Characterizing binge drinking among U.S. military Veterans receiving a brief alcohol intervention

BACKGROUND

Brief web-based alcohol interventions (BAIs) are effective for reducing binge drinking in college students and civilian adults, and are increasingly being applied to U.S. military populations. However, little is known about factors associated with binge drinking in Veteran populations and therefore some concern remains on the generalizability of studies supporting BAIs for addressing binge drinking in this population. This study sought to better understand the characteristics (e.g., demographic, coping related mental health factors, prior exposure to traumatic events, and factors assessing motivation to change alcohol use) of a predominantly male sample of binge drinking Veterans receiving a BAI from a VA provider.

METHODS

A primarily male (93.5%) sample (N=554) of Veterans completed a BAI consisting of brief assessment and personalized feedback.

RESULTS

We found that Veterans who were younger, used drugs/alcohol to cope with symptoms of PTSD and depression (e.g., nightmares and flashbacks and sleep difficulties), and had experienced sexual assault, had higher self-reported peak blood alcohol concentration and a higher likelihood for a binge drinking episode in the last 90days.

CONCLUSIONS

BAIs may be a promising approach for addressing binge drinking in Veterans. However, binge drinking among a sample of mostly male Veterans receiving a BAI may be associated with a complex set of factors that are less prevalent in the college student population and thus studies demonstrating the efficacy of BAIs with Veterans are needed.

Response inhibition and reward response bias mediate the predictive relationships between impulsivity and sensation seeking and common and unique variance in conduct disorder and substance misuse

BACKGROUND

Disinhibited traits, assessed both at the self-report and at the cognitive/behavioral levels, have been frequently implicated in externalizing behaviors, such as conduct disorder (CD), binge drinking, and drug use. However, self-report measures of disinhibition, such as impulsivity (IMP) and sensation seeking (SS), and cognitive measures of disinhibition are not often studied together in the same participants. Thus, it is still unclear how cognitive measures such as response inhibition and reward response bias relate to self-report measures of IMP and SS, and whether they can explain some of the association found between these self-report measures and specific facets of externalizing problems.

METHODS

The aim of this study was to assess whether cognitive measures of disinhibition relate to self-report measures of disinhibition and can mediate the specific relationships between self-report measures of disinhibition and CD symptoms, binge drinking and drug use in adolescence. Seventy-six adolescents were assessed on personality, substance use, and conduct problems every 6 months from 14 to 16 years of age and completed a test battery that included a Stop task, rewarded go/no-go task, digit span, and intelligence quotient tests at 16 years of age.

RESULTS

Multiple regression analyses showed that self-report IMP at 14 and deficits in response inhibition were associated with a 2-year average CD symptoms score and that deficits in response inhibition partially mediated the association between self-report IMP and CD symptoms (ab = 0.018 CI: 0.00002 to 0.04827). In contrast, SS and reward response bias were significantly associated with the unique variance in binge drinking, and that part of the overlap between SS and binge drinking was mediated by reward response bias (ab = 0.019, CI: 0.00131 to 0.04662).

CONCLUSIONS

Findings show a dissociation between inhibitory measures associated with CD symptoms and those associated with binge drinking, with "cool" inhibitory and executive functions being associated with CD but "hot," reward-related disinhibition measures being specific mediators between SS and binge drinking. The findings support the theoretical conceptualization for dual cognitive/motivational pathways of disinhibition, in this case IMP and SS, and their unique association with externalizing behavior in adolescence.

A motivational model of alcohol misuse in emerging adulthood

Many emerging adults who have dropped out of high school are known to misuse alcohol. Expectancies and motives for drinking are pivotal in shaping the drinking behavior of emerging adults, especially those related to social influences. We tested a motivational model of problematic alcohol use using drinking motives (enhancement, social, conformity, coping) as multiple mediators to explain the association between social alcohol expectancies and alcohol misuse. A community sample of 104 individuals between ages 16 and 21 attending a General Educational Development (GED) program completed self-report measures of alcohol expectancies, drinking motives, quantity and frequency of drinking, and a structured interview that assessed the symptoms of alcohol use disorders. Results of multiple regression analysis testing multiple mediators indicated that social alcohol expectancies were associated with alcohol misuse through the mediated pathways of enhancement drinking motives.

Person-environment interaction in the prediction of alcohol abuse and alcohol dependence in adulthood

BACKGROUND

Behavioral disinhibition (externalizing/impulsivity) and behavioral inhibition (internalizing/anxiety) may contribute to the development of alcohol abuse and dependence. But tests of person-by-environment interactions in predicting alcohol use disorders are needed. This study examined the extent to which interactions between behavioral disinhibition, behavioral inhibition and family management during adolescence predict alcohol abuse and alcohol dependence at age 27.

METHODS

This study used longitudinal data from a community sample of 808 men and women interviewed from ages 10 to 27 in the Seattle Social Development Project. Zero-order correlations followed by a series of nested regressions examined the relationships between individual characteristics (behavioral disinhibition and behavioral inhibition/anxiety) and environment (good vs. poor family management practices during adolescence) in predicting alcohol abuse and dependence criterion counts at age 27.

RESULTS

Behavioral disinhibition and poor family management predicted increased likelihood of both alcohol abuse and alcohol dependence at age 27. Behavioral inhibition/anxiety was unrelated to both outcomes. Youths high in behavioral disinhibition were at increased risk for later alcohol abuse and dependence only in consistently poorly managed family environments. In consistently well-managed families, high levels of behavioral disinhibition did not increase risk for later alcohol abuse or dependence.

CONCLUSIONS

Behavioral disinhibition increases risk for alcohol abuse and dependence in early adulthood only for individuals who experience poor family management during adolescence. Interventions seeking to reduce environmental risks by strengthening consistent positive family management practices may prevent later alcohol abuse and dependence among individuals at risk due to behavioral disinhibition.

Interpersonal problems and negative mood as predictors of within-day time to drinking

Using data collected via handheld electronic diaries (EDs), we examined within-day associations between early-day negative moods and stress and subsequent time to drinking. A sample of 97 (n=48 women) adults recruited to participate in a drinking-reduction intervention study used EDs to record mood and interpersonal problems at randomly selected times during each of 3 reporting intervals and drinking as it occurred each day for 21 days. Using multilevel hazard models, we tested associations between early-day stress/negative mood ratings and time to drinking as well as potential moderating effects of drinking to cope (DTC) motives on these associations. Whereas previous analyses of these data showed no associations between early-day negative moods and number of drinks consumed later in the day, here we found significant associations between negative moods and time to drinking. Associations involving negative moods, DTC, and hazard for drinking varied depending on time of day, and some mood effects were moderated by DTC. These findings suggest that time to drinking may be more sensitive to the effects of acute negative mood states than is drinking quantity.

Behavioral inhibition and activation systems: differences in substance use expectancy organization and activation in memory

We used multidimensional scaling to model the semantic network of alcohol and marijuana expectancies (N=897). Preference mapping was used to estimate vectors representing patterns of activation through the network as a function of levels of behavioral inhibition (BIS) and behavioral activation (BAS). Individuals with low BIS combined with high BAS levels exhibited patterns of activation emphasizing behavioral activation similar to heavier drug users in previous research. High BIS, low BAS individuals exhibited activation patterns with greater emphasis on inhibitory expectancies similar to low-level users. Differences in expectancy activation patterns were maintained after controlling for substance use and gender. Individual differences in BIS/BAS are associated with the organization of semantic networks and patterns of activation of expectancies contributing to differences in substance use behavior.

Trial of the university assistance program for alcohol use among mandated students

OBJECTIVE

The aim of this study was to investigate the effectiveness of a brief intervention for mandated students in the context of the University Assistance Program, a Student Assistance Program developed and modeled after workplace Employee Assistance Programs.

METHOD

Participants were 265 (196 males and 69 females) judicially mandated college students enrolled in a large, urban university in the northeast United States. All participants were sanctioned by the university's judicial office for an alcohol- or drug-related violation. Participants were randomized to one of two intervention conditions (the University Assistance Program or services as usual) and were assessed at baseline and 3 and 6 months after intervention.

RESULTS

Growth curve analyses showed that, relative to services as usual, the University Assistance Program was more efficacious in reducing past-90-day weekday alcohol consumption and the number of alcohol-related consequences while increasing past-90-day use of protective behaviors and coping skills. No significant differences in growth trajectories were found between the two intervention conditions on past-90-day blood alcohol concentration, total alcohol consumption, or weekend consumption.

CONCLUSIONS

The University Assistance Program may have a possible advantage over services as usual for mandated students.

Should personality traits be considered when refining substance misuse treatment programs?

The interplay between stable personality characteristics and environmental factors is emphasised in most contemporary approaches to individual differences. This interaction appears to be important in understanding the development of substance use and misuse. Impulsivity related personality traits such as sensation-seeking, novelty seeking, reward-sensitivity and behavioural disinhibition, are strongly linked to adolescent and adult substance use and misuse. The role of anxiety-related traits, in the development of substance misuse is less clear. Nonetheless, anxiety disorders are very common amongst adult substance misusers and almost certainly play a critical role in the maintenance of a substance use disorder and influence treatment effectiveness. The data suggest that personality influences treatment outcomes and yet these individual differences are generally not addressed in treatment. We argue in this review that interventions which are matched to these relevant personality traits may improve treatment outcomes for substance misusers.

Influence of alcohol use experience and motivational drive on college students' alcohol-related cognition

BACKGROUND

Cognitive processes are thought to be pivotal to risk for heavy drinking. However, few studies have examined the alcohol cue-activated positive and negative semantic memory networks that may be pivotal to drinking behavior. Moreover, much is to be understood about the influences of cognitive processes, particularly in high-risk drinking samples such as college students. The current study examines the sequential process of alcohol cues activating valenced semantic memory networks, and the influences of prior drinking experience and individual differences in motivational drive on this automatic (implicit) cognitive process.

METHODS

Participants (N = 138, 52% women) were college freshmen prescreened to represent the full range of drinking experience (i.e., current abstainers, light and heavy drinkers). Participants completed self-reports of past month alcohol use, and individual differences in behavioral inhibition system (BIS) and behavioral approach/activation system (BAS). Alcohol cue-elicited positive and negative semantic memory networks were assessed using a priming task.

RESULTS

Results from the priming task revealed that for light drinkers alcohol cues were equally as likely to activate positive and negative semantic memory networks, suggesting relatively neutral cue-elicited alcohol attitudes. Conversely, for heavy drinkers, alcohol cues more readily activated positive relative to negative semantic memory networks, suggesting relatively positive cue-elicited alcohol attitudes. Furthermore, positive alcohol cue-elicited semantic memory networks (positive attitudes) were evident for individuals characterized by a strong BAS and weak BIS (as hypothesized) and those characterized by a weak BAS and weak BIS.

CONCLUSIONS

The findings suggest that alcohol-cue elicited positive semantic memory networks may be pivotal to risk for heavy drinking. Specifically, it is via the influence on this cognitive process that prior drinking experience and individual differences in motivational drive, respectively, may maintain and predispose individuals to risk for heavy alcohol use.

Patterns of alcohol consumption and related behaviour in Great Britain: a latent class analysis of the alcohol use disorder identification test (AUDIT)

AIMS

Attempts have been made to develop typologies to classify different types of alcoholism. However, limited research has focused on classifications to describe general patterns of alcohol use in general population samples.

METHODS

Latent class analysis was used to create empirically derived behaviour clusters of alcohol consumption and related problems from the Alcohol Use Disorder Identification Test (AUDIT) based on data from a large stratified multi-stage random sample of the population of Great Britain. Multinomial logistic regression was performed to describe these resultant classes using both demographic variables and mental health outcomes.

RESULTS

Six classes best described responses in the sample data. Three were heavy consumption groups, one with multiple negative consequences, one experiencing alcohol-related injury and social pressures to cut down and an additional class with memory loss. There was one moderate class with few negative consequences, and finally two mild consumption groups, one with alcohol-related injury and social pressure to cut down and one with no associated problems.

CONCLUSIONS

Alcohol use in Great Britain can be hypothesized as reflecting six distinct classes, four of which follow a continuum of increased consumption leading to increased dependence and related problems and two that do not. Differences between alcohol use classes are apparent with reduced risk of depressive episode in moderate classes and an increased risk of anxiety disorders for the highest consumers of alcohol.

Alcohol and drug use among university students: gender differences

OBJECTIVE

This study compared the pattern of alcohol, legal and illegal drugs use among students of the Universidade de São Paulo (Brazil) in 1996 and 2001.

METHOD

Samples of 2.564 (1996) and 2.837 (2001) students answered a questionnaire proposed by the World Health Organization, which characterizes the consumption of alcohol, legal and illegal drugs in lifetime, in the last 12 months and in the last 30 days.

RESULTS

Men showed a significant increase in lifetime use of tobacco (44.8% to 50.9%), marijuana (33.7% to 39.5%) and hallucinogens (6.6% to 14.1%) between 1996 and 2001. No significant change was observed among women between 1996 and 2001 in tranquilizer use. Concerning the consumption reported in the last 12 months, both genders displayed significant increases in the consumption of marijuana (22.3% to 27.1% for men and 12.9% to 16.9% for women), amphetamines (1.9% to 5.0% for men and 3.4% to 5.6% for women), and inhalants (9.8% to 15.7% for men and 5.4% to 10.6% for women). The greatest gender difference was observed in consumption reported in the last 30 days with significant increases in male use of tobacco (19.6% to 23.5%), marijuana (15.8% to 20.5%), amphetamines (1.1% to 3.2%), and inhalants (4.0% to 7.9%). Substance use reported in the last 30 days remained stable among women between the 2 surveys.

CONCLUSION

Rates of substance use among university students increased. These gender differences in substance consumption should be taken into account in the development of preventive and treatment strategies for undergraduate university students.

Alcohol use as a behavioural sign of disinhibition: evidence from J.A. Gray's model of personality

Based on Gray's Reinforcement Sensitivity Theory, the influence of behavioural disinhibition upon alcohol consumption was studied. A sample of undergraduates answered different questionnaires related to the Behavioural Inhibition System and Behavioural Activation System. In relation to alcohol use, three aspects of alcohol consumption were assessed: frequency, quantity of alcohol intake and the age at first drink. From a series of correlation and regression analyses, we found that both high scores on BAS-related scales and low scores on those scales related to the BIS were jointly associated with current alcohol-taking habits. Additionally, the Sensitivity to Reward (SR) scale (BAS) was negatively correlated with, and a predictor of, the onset age of alcohol use. We conclude by proposing that research on alcohol use can benefit from this well-grounded theory of the neuropsychology of the individual differences.

Predictors of alcohol use during the first year of college: implications for prevention

The first year of college is a unique transition period, in which the student establishes a college identity and social network. Alcohol use is often part of this process, and many first-year college students develop a pattern of heavy drinking that puts them at risk for adverse consequences during their college years and into young adulthood. To better understand the development of risky alcohol use during this transition, we reviewed the literature on influences on college drinking and identified moderators and mediators that were particularly relevant for first-year alcohol use. As the transition from high school to college presents a unique opportunity for intervention, we discuss how these moderators and mediators can inform alcohol abuse prevention programs. We also identify approaches aimed at changing the culture of alcohol use on campus. Limitations of the reviewed research are highlighted in the context of promising directions for future research.

Behavioral Activation System (BAS) sensitivity and reactivity to alcohol cues among hazardous drinkers

Previous research has suggested that Behavioral Activation System (BAS) sensitivity may be associated with stronger appetitive responses to alcohol cues. This study was conducted to explore whether those with higher BAS sensitivity showed greater urge and affective responses to alcohol cues and whether different types of appetitive cues moderated the magnitude of these associations. One hundred eighty-eight hazardous drinkers (90 women) were exposed to the sight and smell of their favorite alcoholic beverage during a cue exposure procedure. Participants were asked to either lean towards the beverage (Cue Only) when signaled by tones, or lift the beverage towards them (Cue+Action). BAS sensitivity was significantly associated with baseline ratings of urge and affect, and was found to be a significant predictor of urge and affect reactivity; however significant interaction effects with cue type were not observed. Results provide further evidence for the influence of individual differences in reward responsiveness on alcohol use and abuse.

Patterns of responses on health-related quality of life questionnaires among patients with HIV/AIDS

BACKGROUND

Health-related quality of life (HRQoL) has become an important facet of HIV/AIDS research. Typically, the unit of analysis is either the total instrument score or subscale score. Developing a typology of responses across various HRQoL measures, however, may advance understating of patients' perspectives.

METHODS

In a multicenter study, we categorized 443 patients' responses on utility measures (time-tradeoff, standard gamble, and rating scale) and the HIV/AIDS-Targeted Quality of Life (HAT-QoL) scale by using latent profile analysis to empirically derive classes of respondents. We then used linear regressions to identify whether class membership is associated with clinical measures (viral load, CD4, time since diagnosis, highly active antiretroviral therapy [HAART]) and psychosocial function (depressed mood, alcohol use, religious coping).

RESULTS

Six classes were identified. Responses across the HAT-QoL subscales tended to fall into 3 groupings--high functioning (Class 1), moderate functioning (Classes 2 and 3), and low functioning (Classes 4 to 6); utility measures further distinguished individuals among classes. Regression analyses comparing those in Class 1 with those in the other 5 found significantly more symptoms of depression, negative religious coping strategies, and lower CD4 counts among subjects in Class 1. Those in Class 5 had been diagnosed with HIV longer, and members of Class 6 reported significantly less alcohol consumption, had higher viral loads, and were more likely to receive HAART.

CONCLUSION

Patients with HIV respond differentially to various types of HRQoL measures. Health status and utility measures are thus complementary approaches to measuring HRQoL in patients with HIV.