Mediation-moderation analysis of problematic alcohol use: the roles of urgency, drinking motives, and risk/benefit perception

Alcohol use disorder among Whites and Hispanics on and off the U.S./Mexico border in California

This paper examines whether U.S./Mexico border residence in California is related to the prevalence of DSM-5 alcohol use disorder (AUD) among Whites and Hispanics. Household survey data were obtained from 1,209 adults (59.7% female) 18 to 39 years of age resident in four counties in California: Imperial on the U.S./Mexico border; and Kern, Tulare, and Madera in California's Central Valley. Households were selected using a list assisted sample, with data collected on the phone or online. Results show that AUD rates were not different between border and non-border location and between Whites and Hispanics. AUD was negatively associated with higher income ($20,000 to $60,000: AOR=.38; 95%CI=.17-.86; p<.01-more than $60,000: AOR=.27; 95%CI: .09-.81; p<.01) and poor risk perception (AOR=.86; 95%CI=.78-.94; p<.01). AUD was positively associated with continued volume of drinking (AOR = 1.05; 95%CI = 1.01-1.09; p<.01), drinking in Mexico (AOR = 4.28; 95%CI = 1.61-11.36; p<.01), marijuana use (AOR = 4.11; 95%CI = 1.73-9.77; p<.01), and impulsivity (AOR = 1.55; 95%CI = 1.23-1.94). Efforts to prevent AUD in the population in California, and especially among those who live close to the border with Mexico, should take into consideration factors such as impulsivity, marijuana use, border crossing to drink in Mexico, all of which increased risk of AUD.

Predicting Reasons for Drinking in a Dually-Diagnosed Sample with PTSD and Substance Use Disorders

Objective: Using the negative reinforcement and common factors frameworks, this work assessed whether and how anxiety sensitivity, distress tolerance, and impulsivity relate to reasons for drinking (RFD) in a residential treatment sample with co-occurring alcohol use disorder and posttraumatic stress disorder (AUD-PTSD). Demographic differences were also examined. Method: Participants were 75 (52.0% male, 78.7% white) adults at a residential substance use treatment facility who met criteria for AUD-PTSD with 98.67% meeting criteria for one or more substance use disorders in addition to AUD. Participants completed measures of anxiety sensitivity, distress tolerance, impulsivity, RFD, and AUD-PTSD symptoms. Univariate and multivariate linear regression was used with and without controlling for demographic variables (i.e., age, race, and sex). Results: The positive and negative urgency facets of impulsivity were positively related to both negative affect and cue/craving response RFD with relations maintained after controlling for demographic variables and including PTSD symptom severity (βs .30-.51). There were no significant relations between impulsivity and social RFD. No facets of anxiety sensitivity or distress tolerance were significantly related to RFD domains. Conclusions: Findings suggest that the urgency facets of impulsivity are crucial in understanding negative affect and cue/craving RFD. However, anxiety sensitivity and distress tolerance are not related to RFD in this dually diagnosed AUD-PTSD sample. Treatment considerations and future directions are discussed.

Pathways of personality and learning risk for addictive behaviors: A systematic review of mediational research on the Acquired Preparedness model

OBJECTIVE

The Acquired Preparedness (AP) model proposes that impulsive personality traits predispose some individuals to learn certain behavior-outcome associations (expectancies), and that these expectancies in turn influence the escalation of risky behaviors. This theory has been applied to the development of behaviors such as drinking, drug use, gambling, and disordered eating. In the current study, we aimed to summarize empirical tests of this model over the 20 years since it was proposed.

METHOD

We used a descriptive approach to summarize tests of mediation across 50 studies involving n=21,715 total participants.

RESULTS

We observed a consistent effect of personality on expectancies (median effect size = .22), of expectancies on behavior (.24), and a small mediated effect (.05) of personality on behavior via expectancies. Impulsive traits that involve positive or negative affect showed the most consistent support for AP, as did positive expectancies. Most studies testing AP focused on alcohol, but research on other behaviors also showed support for AP.

CONCLUSIONS

The literature appears to support a small mediated effect consistent with the AP model. Future research should continue to clarify which AP pathways are most influential in explaining risky behaviors, and supplement correlational research with experimental and quasi-experimental designs.

Self-control and problematic use of social networking sites: Examining distress tolerance as a mediator among Argentinian college students

Introduction

Use of Social networking sites (SNSs) is a highly prevalent behavior worldwide and, for some individuals, its use can turn maladaptive. There has been growing interest to identify which variables are associated with problematic use of SNSs.

Aim

The present study cross-sectionally examined whether the associations between different features of self-control (i.e., impulsivity-like traits, self-regulation and emotion regulation) indirectly relate to two outcomes of SNSs (hours of use and problematic use) via distress tolerance.

Methods

A sample of 509 Argentinean college students (70.3% female; Mean age = 21.15 ± 5.15) completed an online survey.

Results

Two significant indirect effects were found: a) higher negative urgency was associated with higher problematic use of SNSs via lower distress tolerance and b) higher self-regulation was associated with lower problematic use of SNSs via higher distress tolerance. Positive urgency, negative urgency and self-regulation had significant direct associations with problematic use of SNSs while neither component of emotion regulation was significantly associated with SNSs outcomes. No significant direct or indirect effects were found between any of the self-control features and time spent using SNSs.

Conclusions

The results highlight dysfunctional self-control, particularly emotion-driven impulsivity and low self-regulation, as relevant components of maladaptive SNSs that seem to operate by decreasing the perceived capacity to tolerate negative affect. In this context, interventions targeting the development and improvement of distress tolerance abilities might have a positive impact on problematic use of SNS.

Drinking in Mexico by Whites and Hispanics on and off the US/Mexico border in California

This paper compares drinking patterns of Whites and Hispanics who after crossing the U.S./Mexico border drink and do not drink in Mexico. Data came from a household survey of 1,209 adults 18 to 39 years of age in California. Residence near the US/Mexico border increases the likelihood of drinking in Mexico (AOR = 4.57; 95%CI = 2.45-8.52; p < .001). Hispanics (AOR = 1.91; 95%CI = 1.26-2.90; p < .01), those who drink more frequently (AOR = 1.05; 95%CI = 1.02-1.09; p < .01) and those who drink six or more drinks in day (AOR = 1.91; 95%CI = 1.26-2.29; p < .01) are more likely than Whites and lighter drinkers to report this behavior. Crossing the U.S./Mexico border to drink is influenced by living close to the border, Hispanic ethnicity, and drinking many drinks in a day.

Drinking motives mediate the associations between urgency and hazardous/harmful alcohol use among moderate-to-heavy drinking men who have sex with men (MSM)

Urgency, the tendency to act rashly under extreme emotions, has been associated with higher rates of hazardous/harmful drinking. Moreover, previous work suggests that the association between urgency and hazardous/harmful drinking may be mediated by drinking motives. The current study sought to replicate and extend this research to men who have sex with men (MSM), a population that has shown increased alcohol-related health risk behavior.

METHODS

Two-hundred-and-fifty-six moderate-to-heavy drinking MSM completed questionnaires assessing urgency, drinking motives, and hazardous/harmful drinking. Regression models were conducted to examine the direct effect of Urgency on heavy episodic drinking and alcohol-related consequences and its indirect effects on these outcomes through drinking motives.

RESULTS

Urgency was significantly associated with heavy episodic drinking and alcohol-related consequences. Bootstrapping procedures indicated significant indirect effects through coping and enhancement motives for both outcomes and also conformity for consequences.

CONCLUSIONS

These results indicate urgency may be an important risk factor for hazardous/harmful drinking among adult MSM that may operate in part through its effects on coping and enhancement motives.

Positive urgency worsens the impact of normative feedback on 21st birthday drinking

BACKGROUND

The 21st birthday is associated with more alcohol consumption and negative consequences than any other occasion. The current study investigated how positive urgency, the tendency to act rashly in response to positive emotions, influences 21st birthday drinking and the effectiveness of a single event text message intervention designed to reduce 21st birthday drinking and related negative consequences.

METHODS

Participants were 183 undergraduate students (69% female, 86% white) about to turn 21. Participants were randomly assigned to either a text message intervention or control condition. Those in the intervention condition received one text message the day before their 21st birthday that provided personalized normative feedback and one text message on the day of their 21st birthday. Participants reported actual alcohol consumption the day after their 21st birthday celebration.

RESULTS

Hierarchical linear regression found that, after controlling for sex, intervention condition, and planned drinking, positive urgency was associated with greater number of drinks (β = .15, p = .031) and drinking problems (β = .25, p = .001). A moderated-mediation model was significant (B = 0.42, CI95 [.10, .76]): At high levels of positive urgency, the intervention condition was associated with drinking more than planned, which significantly mediated the relationship between intervention and alcohol-related consequences; the mediation was not significant at mean or low levels of positive urgency.

CONCLUSIONS

These findings are the first to link positive urgency with 21st birthday drinking and to empirically demonstrate that positive urgency negatively impacts the effectiveness of an intervention aimed at reducing alcohol consumption.

Understanding profiles of student binge drinking and eating: The importance of motives

Binge drinking and binge eating occur frequently in undergraduates; however, the mechanism driving their co-occurrence is not well-understood. Several theories support the role of motives in driving drinking and eating behavior, especially motivations related to affect regulation (i.e., enhancement/pleasure and coping). This study used a person-centered approach to identify classes of students based on eating and drinking motives and past-month binge behavior and examined class differences in psychopathology, emotion regulation, and impulsivity. Undergraduates (N = 776) completed a drinking timeline follow-back and surveys assessing motives, binge eating, psychopathology, emotion regulation, impulsivity, and quality of life. Mixture modeling was used to group students based on presence/absence of past-month binge eating, binge drinking, and motives for eating and drinking. The analysis resulted in 4 classes: Binge Drinking (with relatively high social and enhancement drinking motives), Binge Eating (with overall high eating motives), Both Bingeing (with high drinking motives, especially coping, and high eating motives), and Low Bingeing (with low motives for both behaviors). ANOVA and post-hoc analyses suggested that the Binge Eating and Both Bingeing groups were most impaired, while the Binge Drinking class rarely differed from the Low Bingeing group across measures of psychological distress. Notably, classes with high eating/drinking motives displayed significant impairment despite not all class members endorsing binge behavior. Findings suggest that binge drinking in addition to binge eating may not imply more psychological impairment and support the importance of assessing motives for eating/drinking among undergraduates and potentially trying to challenge these motives through early intervention.

The Sequential Indirect Effect of Negative Urgency on Drinking Consequences Through Distress Intolerance and Drinking Motives: Initial Examination in College Students Reporting Past Month Alcohol Use

Identification of cognitive and affective vulnerabilities among college drinkers may aid in developing focused interventions that promote a reduction in the prevalence of alcohol use. Negative urgency (NU) and distress intolerance (DI) evidence concurrent, unique, and synergistic relations with drinking motives and negative consequences of alcohol use. Utilizing a sequential multiple mediation framework to investigate a comprehensive model of these variables, we examined NU as a behavioral risk factor that potentiates the development of DI, thereby contributing to drinking motives that increase the risk of problematic use in young adults. A diverse sample of undergraduate students (N = 616; M _age= 19.1, SD=1.4, range=18-25; 50.6% female; 60.6% Caucasian; recruited between September 2015 and Spring 2017) reporting past month alcohol use completed an online questionnaire battery. The results suggested that NU may contribute to negative alcohol use outcomes via its relation to DI and the motivation to drink in order to cope with negative emotional states and conform to social pressure. These findings suggest that NU may be a primary intervention target in young adults.

The Roles of Prevention Messages, Risk Perception, and Benefit Perception in Predicting Binge Drinking among College Students

To account for the effect of prevention-message exposure on binge drinking among college students, I hypothesized a conceptual model outlining potential mechanisms including perceived probability of negative consequences (PPNC), perceived severity of negative consequences (PSNC), perceived probability of positive consequences (PPPC), and perceived beneficiality of positive consequences (PBPC) from binge drinking, based on the two-step process model. I conducted an online survey at a public university in the US (N = 278). Findings suggested only PBPC was significantly related to binge drinking and the relationship was positive; prevention-message exposure was not directly associated with binge drinking, but was positively associated with PPNC, PSNC, PPPC, and PBPC; none of the mediational paths was significant; higher risk perception (interaction between PPNC and PSNC) was significantly related to less binge drinking, while benefit perception (interaction between PPPC and PBPC) was not predictive of binge drinking. Implications of findings were discussed.

The Role of Impulsivity in the Relation Between Negative Affect and Risky Sexual Behaviors

While risky sexual behavior associates with negative affect, and impulsivity often increases during negative affective states, little is known about the interrelations of these factors. This study examined whether impulsivity explained the relation between negative affect and risky sex among college students. Negative affect exhibited an indirect effect via impulsivity on number of sexual partners for both males and females, and on inconsistent condom use for females, but not males. Results suggest risky sex may serve to regulate negative affect, proposing the importance of negative affect in future strategies to reduce risky sex among young adults.

Binging at the campus: Motivations and impulsivity influence binge drinking profiles in university students

This study explored the involvement of two key psychological factors, drinking motives and impulsivity traits, in binge drinking. On the basis of a large screening phase (N=4424), 867 binge drinkers were selected and were first compared with 924 non-binge drinkers. Then, a cluster analysis was performed, focusing on the binge drinker sample, to explore the respective involvement of four drinking motives (DMQ-R model) and four impulsivity facets (UPPS model) in this habit. Centrally, the cluster analysis identified three clusters of binge drinkers presenting distinct psychological characteristics and alcohol consumption patterns: emotional, recreational, and hazardous binge drinkers. Hazardous binge drinkers were characterized by strong drinking motives but moderate impulsivity. Binge drinking should thus no more be considered as a unitary drinking pattern but rather as a habit encompassing a variety of psychological profiles. Moreover, risky drinking habits in young people might be mainly related to disproportionate drinking motives. Future studies should thus consider binge drinking heterogeneity, and prevention programs focusing on drinking motivations should be developed.

Drinking motives and alcohol outcome expectancies as mediators of the association between negative urgency and alcohol consumption

OBJECTIVE

To determine whether the effects of negative urgency, a unique facet of impulsivity marked by engaging in potentially unhealthy and rash behaviors in order to cope with anxiety or negative moods, on drinking behavior can be explained by positive and negative alcohol outcome expectancies and specific drinking motives (i.e., coping and enhancement).

METHODS

College students (N=194) completed web-based surveys in exchange for course credit. Students completed measures of negative urgency, comprehensive effects of alcohol, drinking motives, and alcohol use behaviors.

RESULTS

Results of path analysis indicated significant indirect effects of negative urgency and alcohol use through both alcohol outcome expectancies and enhancement motives. The effects of enhancement motives on drinking were mediated by positive alcohol outcome expectancies. The effects of coping motives on drinking were not attributable to negative expectancies.

CONCLUSIONS

Individuals high on negative urgency may consume alcohol in order to ameliorate their emotional distress due to strong desires to increase positive and decrease negative experiences associated with drinking. Emotion-focused impulsivity's influence on drinking outcomes can be ascribed to enhancement motives for drinking as well as positive and negative alcohol outcome expectancies. Prevention efforts should target drinking motives and alcohol outcome expectancies among those higher in negative urgency.

[Risk factors and psychological vulnerabilities to binge-drinking in youth]

For years, a large number of studies have demonstrated the harmful effects of alcohol consumption on the brain and therefore on behavior and cognition. These studies first aimed at identifying the consequences of alcohol abuse consumption, more specifically in pathologies such as alcohol-dependence or Korsakoff syndrome. Researchers then also started to focus on vulnerabilities to alcohol consumption, especially in hyper fast alcohol consumption called binge-drinking (BD). Indeed BD, which is a particularly dangerous form of alcohol consumption, is usually observed in adolescents and young adults. Typically, young people tend to adopt this way of drinking in order to reach a massive and expeditious intoxication. The aim of this paper is to present the bibliographic data available on the main risk factors to BD and to describe the main measurement tools for investigating these factors in clinical researches. The interaction between psychological dysfunctions and BD is not well understood. For a better understanding of the links between binge-drinking and psychological and personality factors in terms of vulnerability or risk, studies have investigated on affective factors (depression and anxiety), personality characteristics (impulsivity and sensation seeking) and drinking motives (coping, improvement, compliance and wellness). Although different factors are often associated with BD in adolescents and young adults, it is still not clear whether these factors are the consequences of alcohol consumption or a reflection of pre-morbid abnormalities predisposing individuals to excessive alcohol consumption. Furthermore, results are not unequivocal and various distinct personality profiles seem to emerge. Thus, these questions are still not fully resolved and further studies are needed to understand the complex relationships between BD and the various psychological or personality factors. The need for investigating these factors in clinical studies is nevertheless important with regard to therapeutic interventions. Indeed, the identification of specific profiles involved in a binge-drinking type of consumption could allow an adaptation of the contents of therapeutic programs by targeting a specific mechanism. For example, recent findings have revealed that when factors such as impulsivity are considered, therapeutic intervention is more effective.

Combining Trait Models of Impulsivity to Improve Explanation of Substance Use Behaviour

The UPPS–P model of impulsivity is gaining popularity among personality and substance use researchers, but questions remain as to whether its five facets have incremental validity in explaining substance use over a more parsimonious model specifying only two facets: reward drive and rash impulsiveness. In three cross–sectional studies (total N = 486), we investigated whether the novel components of the UPPS–P model (negative Urgency, Premeditation, Perseverance, Sensation seeking, Positive urgency) predicted typical and problematic alcohol and cannabis use after accounting for reward drive, rash impulsiveness and trait neuroticism (assessed with the Eysenck Personality Questionnaire). Reward drive and rash impulsiveness scores were calculated using principal components analysis of multiple scales, including UPPS–P premeditation and sensation seeking. Results showed that rash impulsiveness was a robust predictor of typical and problematic substance use. The novel facets of the UPPS–P did not improve prediction of typical substance use. The urgency scales inconsistently predicted problematic use. Specifically, negative urgency predicted one of three measures of negative consequences from alcohol use, and positive urgency only predicted negative consequences from cannabis use. Results suggest that the three novel facets of the UPPS–P model add little over a two component model in explaining substance use, although may provide preliminary evidence for the utility of a revised global urgency construct in explaining problematic substance use. Copyright © 2017 European Association of Personality Psychology

Interactive and Indirect Effects of Anxiety and Negative Urgency on Alcohol-Related Problems

BACKGROUND

Although drinking for tension reduction has long been posited as a risk factor for alcohol-related problems, studies investigating anxiety in relation to risk for alcohol problems have returned inconsistent results, leading researchers to search for potential moderators. Negative urgency (the tendency to become behaviorally dysregulated when experiencing negative affect) is a potential moderator of theoretical interest because it may increase risk for alcohol problems among those high in negative affect. This study tested a cross-sectional mediated moderation hypothesis whereby an interactive effect of anxiety and negative urgency on alcohol problems is mediated through coping-related drinking motives.

METHODS

The study utilized baseline data from a hazardously drinking sample of young adults (N = 193) evaluated for participation in a randomized controlled trial of naltrexone and motivational interviewing for drinking reduction.

RESULTS

The direct effect of anxiety on physiological dependence symptoms was moderated by negative urgency such that the positive association between anxiety and physiological dependence symptoms became stronger as negative urgency increased. Indirect effects of anxiety and negative urgency on alcohol problems (operating through coping motives) were also observed.

CONCLUSIONS

Although results of the current cross-sectional study require replication using longitudinal data, the findings suggest that the simultaneous presence of anxiety and negative urgency may be an important indicator of risk for alcohol use disorders via both direct interactive effects and indirect additive effects operating through coping motives. These findings have potentially important implications for prevention/intervention efforts for individuals who become disinhibited in the context of negative emotional states.

Depressive symptoms, negative urgency and substance use initiation in adolescents

BACKGROUND

Studies show depressive symptoms are associated with substance use in adolescents, but the mechanism underlying this association is still unclear. This study investigated negative urgency - the disposition to rash action during emotional states - as a factor explaining relations between depressive symptoms and use of several substances.

METHODS

In this cross-sectional study, 476 adolescents (mean age 14.5 years) completed self-report surveys. Regression models and products of coefficient analyses examined the overall relation of depressive symptoms to substance use and negative urgency as a statistical mediator of this association.

RESULTS

Depression levels associated with increased likelihood of lifetime use of cigarettes, other forms of tobacco, marijuana, alcohol, inhalants, prescription painkillers, and any substance. Relations between depression levels and lifetime use of alcohol, inhalants, and any substance were accounted for (i.e., statistically mediated) by negative urgency. In adolescents endorsing lifetime use, depression levels associated with younger age of first use of other forms of tobacco and alcohol as well as use frequency of cigarette, alcohol, and composite frequency. Negative urgency accounted for the covariance between depression level and age of first use of alcohol, but did not for other forms of tobacco or frequency of use of any substances.

CONCLUSIONS

Depression levels are associated with lifetime use of a variety of substances in early adolescence and targeting this risk factor with preventive efforts may be useful in reducing risk. Negative urgency may be an important target for interventions aimed at alcohol and inhalant use.