Moderators of implicit and explicit drinking identity in a large US adult sample

'I am a Drinker': A Content, Correlational, and Factor Analytic Study of Measures of Drinker Identity Among College Students

ABSTRACT Background: Drinker identity research has proliferated over the last decade, resulting in 10 self-report questionnaire measures of this construct. However, it is unknown to what extent these measures accurately reflect the theorized multi-dimensional conceptualization of drinker identity.

OBJECTIVES

The current study set out to investigate and compare these different measures using content, correlational, and factor analyses. A content analysis is conducted to investigate dimensions captured within the 10 measures of drinker identity. Correlational and exploratory factor analyses on the items is conducted within a young adult sample (n = 1006). Descriptions of the measures, items, and factors within the measures are discussed.

RESULTS

Across the 10 measures, seven distinct factors were identified by the content analysis, and multi-dimensionality was confirmed by both the correlational and factor analyses. Factor analysis on all items yielded four interpretable factors representing generalized identity, relative identity importance, identity value/affect, and social identification.

CONCLUSIONS

The results are discussed in terms of the multi-dimensional nature of drinker identity, the psychometric equivalence of the included measures, and further issues in defining and measuring drinker identity.

Components of identity expression in problem and non-problem gamblers

Few studies have examined whether specific aspects of group identification predict problematic and non-problematic addictive behaviours and none have focused on gambling. Applying Leach et al.'s (2008) hierarchical model of in-group identification, we tested the associations between components of self-investment (satisfaction, solidarity, and centrality) and components of self-definition (individual self-stereotyping, in-group homogeneity) on distinguishing between problem and non-problem gambling (n = 10,157) and on the severity of problematic gambling behaviour (n = 2,568). Results showed that (i) in-group-based identities are important in predicting problematic vs. non-problematic gambling behaviours; (ii) in-group-based identities are important in predicting the severity of problematic gambling; (iii) how self-invested an individual is with their in-group and aspects associated with self-definition processes are both important predictors; (iv) perceptions related to how chronically salient one's group membership is for the self (centrality) are essential features of the self-investment mechanism; and (v) self-stereotypical beliefs about one's essential similarities to the prototypical gambling group member norm are fundamental for the defining oneself as a gambler.

The nomological network of drinker identity: A scoping review

BACKGROUND

Despite the growing interest in the construct of drinker identity and empirical evidence for its role in drinking behavior, there is a paucity of papers that evaluate and integrate the results of studies on drinker identity, leaving a gap in our knowledge of the importance of the drinker identity construct. The current paper addresses this gap by reviewing and integrating the results of the studies of drinker identity.

METHODS

The scoping review identified, retrieved, and evaluated the existing literature regarding drinker identity. English language studies from EBSCOHost, PubMed, ScienceDirect, and Scopus databases were reviewed. Studies were included in the review if they were data-based studies or theoretical publications with drinker identity as the primary topic published in peer-reviewed journals. Studies were reviewed and coded based on their reported methodology and findings and codes were used to integrate and present findings.

RESULTS

This review advances this line of research in four ways. First, the operationalization of drinker identity is evaluated by examining the theoretical frameworks defining the construct. Second, the conceptualization and measurement of drinker identity is assessed, with suggestions for future measurement research. Third, an integrated framework of predictors, outcomes, moderators, and mediators is presented. Finally, the research gaps, future recommendations, and clinical implications are discussed.

CONCLUSIONS

There is a need for continued research, specifically research which aims to standardize and improve measurement of drinker identity, considers longitudinal and developmental processes, and broadens the research samples and settings.

Association of Cannabis Use and At-Risk Alcohol Use With Intimate Partner Violence in an Urban ED Sample

INTRODUCTION

Urban ED patients have elevated rates of substance use and intimate partner violence. The purpose of this study is to describe the risk profiles for intimate partner violence among urban ED patients who report at-risk alcohol use only, cannabis use only, or both types of substance use.

METHODS

Cross-sectional survey data were collected from study participants (N = 1037; 53% female; ages 18-50) following informed consent. We measured participants' past-year at-risk drinking (women/men who had 4+/5+ drinks in a day), cannabis use, psychosocial and demographic characteristics, and past-year physical intimate partner violence (assessed with the Revised Conflict Tactics Scale). We used bivariate analysis to assess whether rates of intimate partner violence perpetration and victimization differed by type of substance use behavior. Multivariate logistic regression models were estimated for each intimate partner violence outcome. All analyses were stratified by gender.

RESULTS

Rates of intimate partner violence differed significantly by type of substance use behavior and were highest among those who reported both at-risk drinking and cannabis use. Multivariate analysis showed that women who reported at-risk drinking only, cannabis use only, or both types of substance use had increased odds for intimate partner violence perpetration and victimization compared with women who reported neither type of substance use. Men's at-risk drinking and cannabis use were not associated with elevated odds of intimate partner violence perpetration or victimization.

DISCUSSION

Brief screening of patients' at-risk drinking and cannabis use behaviors may help identify those at greater risk for intimate partner violence and those in need of referral to treatment.

Implicit and Explicit Self-Identification as a Drug User in People Who Used Heroin and Methamphetamine

Implicit and explicit self-identification as a drug user specific to the substance used (e.g., viewing oneself as a drinker) have been examined, as they relate to that drug use. However, studies have rarely explored whether identifying as a "drug user" differs implicitly and explicitly for people who use different drugs and how this identification relates to drug-use behaviors or abstinence. This study examined implicit and explicit self-identification as a "drug user" and their associations with drug-use behaviors and abstinence in people who used heroin (PWUH) and people who used methamphetamine (PWUM). Forty PWUH and 35 PWUM in a rehabilitation facility completed the single category implicit association test (SC-IAT), which evaluated implicit associations of a "drug user" with "self," and a measure of explicit self-identification as a "drug user." Prior drug-use behaviors and current abstinence duration of the participants were assessed. PWUH demonstrated stronger implicit "self + drug user" associations and higher levels of explicit self-identification as a "drug user" than PWUM. A higher frequency of drug use was associated with higher levels of explicit drug-user self-identity, and longer abstinence duration was positively related to stronger implicit "self + drug user" associations in PWUH. The drug type of heroin (vs. methamphetamine) participants used was associated with a higher frequency of use, which, in turn, predicted higher levels of explicit drug-user self-identity. Given that the PWUH group differs from the PWUM group in terms of implicit and explicit self-identification as "drug users," it would be more appropriate to address drug-user self-identity of individuals according to the substance they use rather than as a collective group.

I am what I am: A meta-analysis of the association between substance user identities and substance use-related outcomes

OBJECTIVE

Research indicates that a substance user identity (i.e., drinking, smoking, and marijuana identity) is positively correlated with substance use-related outcomes (e.g., frequency, quantity, consequences, and disorder symptoms). The current study aimed to meta-analytically derive single, weighted effect size estimates of the identity-outcome association as well as to examine moderators (e.g., substance use type, explicit/implicit assessment, demographic characteristics, and research design) of this association.

METHOD

Random effects meta-analysis was conducted on 70 unique samples that assessed substance user identity and at least one substance use-related outcome (frequency, quantity, consequences, and/or disorder symptoms), and provided the necessary information for effect size calculations.

RESULTS

Substance user identity was found to be a statistically significant moderate-to-large correlate of all substance use-related outcomes examined in the current study (r _w = .365, p < .001, r_w² = .133). The strongest associations were observed between identity and disorder symptoms (alcohol) and frequency of substance use (tobacco or marijuana). In terms of moderators of the identity-outcome association, the link between explicit drinking identity and alcohol use-related outcomes appeared to be stronger in magnitude than the relationship between implicit drinking identity and alcohol use-related outcomes; however, this difference appears to be largely due to the finding that implicit measures have lower reliability. The strongest identity-outcome association was observed among younger individuals.

CONCLUSIONS

Substance user identity is clearly an important correlate of substance use-related outcomes and this association is stronger among younger individuals. Additional theoretical, empirical, and intervention research is needed to utilize knowledge gleaned from the current study on the identity-outcome association. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Alcohol and marijuana protective behavioral strategies mediate the relationship between substance use identity and use-related outcomes: A multi-sample examination

Substance use identity has been consistently associated with problematic substance use. Limited attention has considered mechanisms of this association. This research examined whether greater identification as a drinker or marijuana user would be associated with the use of fewer alcohol/marijuana protective behavioral strategies (PBS; e.g., avoiding drinking games/avoiding using marijuana in public places). Further, PBS have been associated with lower levels of negative alcohol/marijuana-related outcomes (i.e., frequency, quantity, consequences). In the current multi-sample study, PBS were examined as a mediator of the relationship between drinking/marijuana identity and alcohol/marijuana-related outcomes across three studies. Study 1 was an intervention study with heavy drinking college students (N = 605), Study 2 was a multisite study of marijuana outcomes among college students (N = 2,077), and Study 3 was a study of substance use in a community sample (n = 369_alcohol; n = 146_marijuana). Cross-sectional and/or longitudinal data were collected across studies. Substance use identity, PBS, and use-related outcomes were measured across the three studies. Indirect effects were evaluated by Monte Carlo confidence intervals. Manner of Drinking PBS were found to be the only statistically significant mediator of the relationship between drinking identity and alcohol-related outcomes (i.e., quantity and consequences) cross-sectionally. These significant cross-sectional mediation effects for alcohol were replicated in one of three longitudinal models. Marijuana PBS were also found to mediate the relationship between marijuana identity and all marijuana-related outcomes examined in the current study. Study findings may help to inform the development of identity-based and PBS-based interventions that aim to reduce negative alcohol/marijuana-related outcomes.

On the role of (implicit) drinking self-identity in alcohol use and problematic drinking: A comparison of five measures

Objective: Implicit and explicit drinking self-identity appear to be useful in predicting alcohol-related outcomes. However, there are several different implicit and explicit measures which can be used to assess drinking self-identity. Some of these implicit measures can also capture relational information (e.g., I am a drinker, I should be a drinker), which might provide unique advantages. Despite the importance of having good measures of drinking self-identity, to date there has been little direct comparison of these measures. Method: This study (N = 358) systematically compared two commonly used measures of drinking self-identity (one implicit and one explicit: the Implicit Association Test [IAT] and the Alcohol Self-Concept Scale [ASCS]) with three relational measures of implicit self-identity (the autobiographical IAT [aIAT], the Relational Responding Task [RRT], and the Propositional Concealed Information Test [pCIT]) on a range of criteria relevant to experimental and clinical alcohol researchers. Results: Overall, we found mixed performances on the implicit measures. Interestingly, the aIAT, which probed should-based drinking identity, performed better than the standard IAT. However, the explicit measure exhibited superior performance to all other measures across all criteria. Conclusions: Our results suggest that researchers who wish to assess drinking-related self-identity and to predict alcohol-related outcomes cross-sectionally should set their focus primarily on the use (and further development) of the ASCS, rather than any of the implicit measures. Future research focusing on the ASCS should seek to investigate the generalizability of our findings to patient populations, and incorporate relational information within that procedure to further improve upon its already-strong utility. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Growth Mindsets of Alcoholism Buffer Against Deleterious Effects of Drinking Identity on Problem Drinking Over Time

BACKGROUND

Explicit (self-report) and implicit (indirect) measures of identification with drinking alcohol-drinking identity-are associated with drinking outcomes cross-sectionally and longitudinally. A key next step is to identify moderators. The current study evaluated a promising moderator: mindsets of alcoholism. Believing people can change (growth mindset) is associated with adaptive outcomes in domains such as mental health, but research is scant regarding mindsets related to problematic drinking. We evaluated whether individuals' alcoholism mindsets moderated the drinking identity to drinking relation as part of a larger, longitudinal web-based study of heavy drinkers.

METHODS

A total of 422 US college graduates (59% women) who were heavy drinkers completed measures assessing drinking identity, mindsets, and drinking outcomes (consumption, problems, and risk of alcohol use disorder). Drinking outcomes were assessed at 2 subsequent assessments occurring 4 and 8 months after the initial assessment.

RESULTS

Drinking identity was positively associated with drinking outcomes, and drinking outcomes reduced following college graduation. Alcoholism mindsets were significantly and negatively correlated with all drinking outcomes. Mindsets were only conditionally associated with drinking behaviors over time in models that evaluated mindsets, drinking identity measures, and their interaction. Mindsets moderated the relationship between drinking identity and changes in drinking behaviors, but the relation was specific to explicit drinking identity and consumption. Among participants with stronger drinking identity, those who had stronger (vs. weaker) growth mindsets reported reduction in consumption over time.

CONCLUSIONS

Growth mindsets of alcoholism appear adaptive for college graduate heavy drinkers with a stronger drinking identity. Mindsets are amenable to interventions; targeting them may be useful in heavy-drinking college graduates.

Identification with drug use among young adults who are at risk of transitioning to more serious use

Understanding the drug use trajectories for at risk young adults can help reduce harms associated with serious drug use. This longitudinal study tracked young people to assess whether implicit and explicit identification with substance use predicts changes in use over time and whether patterns of use impacts identification with drugs. Two hundred and twenty-eight participants were initially recruited from homeless shelters, youth centers, drug health services, and parks where young people who use drugs are known to frequent. Over a 20-month period, 78 of these original participants were successfully recontacted and surveyed again. The survey assessed implicit and explicit identification with drug use, along with known risk factors, to determine if identification predicts changes in drug use over time as assessed by frequency, recency, and multiple drug use. Results revealed that implicit and explicit identification with drug use were stronger among participants who used more frequently, more recently, and used multiple drugs, although this finding only emerged cross-sectionally and not longitudinally. Overall, these results suggest that patterns of drug use are associated with the identity of the individual and that identification with drug use is a marker of drug-using behavior, but identification with drug use does not appear to be predictive of future behavior nor an outcome of prior drug use.

Implicit Cognition and Psychopathology: Looking Back and Looking Forward

Implicit cognitive processing is theorized to have a central role in many forms of psychopathology. In the current review, we focus on implicit associations, by which we mean evaluative representations in memory that are difficult to control and do not require conscious reflection to influence affect, cognition, or behavior. We consider definitional and measurement challenges before examining recent empirical evidence for these associations in anxiety, obsessive–compulsive, posttraumatic stress, depressive, and alcohol use disorders. This examination is framed by a brief review of the ways that prominent models of psychopathology represent biased implicit processing of disorder-relevant information. We consider to what extent models reflect more traditional automatic/implicit versus strategic/explicit dual-process perspectives or reflect more recent dynamical systems perspectives in which mental representations are iteratively reprocessed, evolving continuously. Finally, we consider the future research needed to better understand the interactive and temporal dynamics of implicit cognition in psychopathology.

Hazardous drinking has unique relationships with implicit and explicit drinking identity

Measures of drinking identity are predictive of hazardous drinking. The extent to which hazardous drinking is differentially related to implicit compared to explicit drinking identity is not well understood. Neurocognitive models of addiction indicate that chronic alcohol use is associated with deficits in self-awareness which could limit the growth or recognition of drinking identity for individuals engaging in hazardous drinking. This might be particularly true for more reflective explicit measures of identity because their assessment and underlying cognitive processes rely more on self-awareness and conscious introspection. We predicted there would be different patterns of relationships between hazardous drinking and implicit/explicit drinking identity measures. A linear model was predicted to better fit the hazardous drinking and implicit identity relationship whereas a non-linear model was predicted to better fit the hazardous drinking and explicit identity relationship due to decreased ability to reflect on changes in identity at high levels of hazardous drinking. The present study is a re-analysis of a large secondary dataset (Project Implicit Mental Health; N = 11,320) which included measures of hazardous drinking (e.g., Alcohol Use Disorder Identification Test) and implicit/explicit identity. Results were consistent with predictions. The relationship between hazardous drinking and implicit drinking identity was best modeled by a linear function whereas the relationship between hazardous drinking and explicit drinking identity was best modeled by a non-linear cubit spline function. These findings are consistent not only with neurocognitive models but also with dual process formulations that implicit and explicit drinking identity are somewhat related but also quite distinct.

Women's Self-Perceived Similarity to Their Mother and Associations with Patterns of Alcohol Misuse over 20 Years

AIMS

This study examined transgenerational transmission of risk for female alcohol misuse. Women's perceived similarity to their mother/father in adulthood was examined in terms of its influence on the expected association between perceived maternal alcohol use and female offsprings' trajectories of alcohol misuse. We hypothesized that a daughter's self-perceived similarity to her mother, in instances where her mother was perceived to be a frequent- or problem-drinker, would be associated with an increase in the daughter's count of negative consequences from alcohol use and potential symptoms of alcohol dependence across adulthood.

SHORT SUMMARY

Women's perceived similarity to their mother/father was examined as a factor influencing associations between perceived parental alcohol use during childhood and patterns of alcohol misuse in adulthood. Women's self-perceived similarity to their frequent- or problem-drinking mothers increased the risk of negative consequences from drinking over time as well as potential symptoms of alcohol dependence over time.

METHODS

Analyses utilized data from a survey of women (N = 911) who were followed over a 20-year period, beginning in 1981. Women, ages 21 or older and living in households in the contiguous USA, were eligible, and women who consumed four or more alcoholic drinks per week were oversampled. Model estimates were weighted to adjust for the oversampling of heavier drinking women and to reflect national demographics. Latent growth mixture models estimated regression parameters that captured variation in participants' alcohol misuse over time.

RESULTS

Women who reported that their mother was a frequent- or problem-drinker and who perceived themselves to be similar to their mother, in general, showed increases in alcohol misuse. The same pattern of results was not shown for fathers.

CONCLUSIONS

Results support that interventions seeking to reduce female alcohol misuse should address the role of perceived similarity to heavy-drinking female role models or 'female-drinker' prototypes to reduce problem-drinking behavior among female drinkers.

Identity as a cannabis user is related to problematic patterns of consumption among emerging adults

INTRODUCTION

Cannabis use has become a more normative, socially-acceptable behavior in the United States, despite research indicating that frequent use may become problematic for some individuals. Emerging adulthood, a time of identity development, is the most common time for cannabis use. Cannabis self-concept, or one's identification with cannabis as part of their personality or identity, is one factor that may influence use behavior. This study extends previous research that reported a link between self-concept, motivational factors, and normative beliefs by evaluating relationships between cannabis self-concept, motives for use, motivation to change, perceived descriptive norms, as well as cannabis-related outcomes (use, using alone, and cannabis-related problems).

METHODS

Emerging adults who used cannabis in the previous month (n=345, 53.9% male, mean age 21.0, 67.5% Non-Latino White) were recruited from a community sample for a health behaviors study. Participants were assessed for explicit cannabis self-concept, frequency of use, problems associated with use, motives for use, motivation to change, and normative beliefs about others' use.

RESULTS

Participants reported using cannabis on an average of 17.9 (SD=11.1) days of the previous month. Correlational analyses revealed that cannabis self-concept was positively associated with frequency of use, use-related problems, several motives for use, descriptive norms, and with using cannabis alone. Multivariate analyses revealed that rates of use, problems, and social and enhancement motives were independently and positively associated (p<0.05) with cannabis self-concept, while self-concept was negatively associated with desire to reduce cannabis use.

CONCLUSIONS

Cannabis self-concept may be a marker for more problematic patterns of use.

Drinker Identity: Key Risk Factor for Adolescent Alcohol Use

BACKGROUND

Adolescent alcohol use continues to be a critical public health problem with both short- and long-term negative health consequences. Defining oneself in terms of alcohol, a drinking-related identity, has been shown to predict high levels of alcohol use. Because adolescence is the developmental period during which identity development is most salient, preventing the development of the drinker identity and early identification of youth who have a developing drinker identity may be important for prevention and early intervention.

METHODS

We review the theory- and evidence-based literature about identity development and the effects of a drinker identity on alcohol use behaviors in adolescents, discuss potential determinants of the drinker identity, and discuss future implications for practice and research.

RESULTS

There is some evidence that the drinker identity forms in early adolescence and becomes more well-developed during adolescence. The drinker identity predicts alcohol use behaviors both concurrently and over time in adolescence and young adulthood. There is also some evidence that early exposure to alcohol may contribute to formation of the drinker identity.

CONCLUSIONS

Identity-based approaches may be promising strategies to identify adolescents who are at risk for alcohol use and to intervene with early prevention or treatment within the school setting.

Does change in self-perceived problem drinker identity relate to change in alcohol use? An examination of nontreatment seeking hazardous drinkers

Identity change is related to reductions in alcohol use among treatment seekers, but it is unclear the extent to which identity change is associated with reductions in alcohol use among nontreatment seeking hazardous drinkers. The goal of the current study was to examine whether change in problem drinker identity (i.e., self-reported identification as a problem or nonproblem drinker) was associated with reductions in heavy drinking among nontreatment seeking hazardous drinkers. Participants (n = 149) completed measures to assess alcohol use and were asked if they identified as a problem drinker at baseline and at 6-, 12-, 18-, and 24-month follow-ups. Two groups were compared: (a) those who identified as a problem drinker at baseline but identified as a nonproblem drinker at 12 months and (b) those who did not make the same transition. Latent mixture modeling was conducted to examine whether change in problem drinker identity was predictive of heavy drinking latent class growth trajectories. The results indicated that a self-reported transition from identification as a problem drinker to identification as a nonproblem drinker was associated with greater reductions in heavy drinking over the assessment period and a 7 times greater likelihood of being in a rapidly decreasing heavy drinking latent trajectory class compared with participants who did not make the same transition. Self-reported transitions in identity appear to be a good predictor of heavy drinking trajectories among nontreatment seekers. A better understanding of what predicts transitions in drinking identity among non-treatment and treatment seekers is needed. (PsycINFO Database Record

Evaluating the Relationship between Explicit and Implicit Drinking Identity Centrality and Hazardous Drinking

INTRODUCTION

Drinking identity strength (how strongly one views oneself as a drinker) is a promising risk factor for hazardous drinking. A critical next step is to investigate whether the centrality of drinking identity (i.e., the relative importance of drinking vs. other identity domains, like well-being, relationships, education) also plays a role. Thus, we developed explicit and implicit measures of drinking identity centrality and evaluated them as predictors of hazardous drinking after controlling for explicit drinking identity strength.

METHODS

Two studies were conducted (Ns = 360 and 450, respectively). Participants, who self-identified as full-time students, completed measures of explicit identity strength, explicit and implicit centrality, and the Alcohol Use Disorders Identification Test (AUDIT). Study 1a evaluated two variants of the implicit measure (short- vs. long-format of the Multi-category Implicit Association Test); Study 1b only included the long form and also assessed alcohol consumption.

RESULTS

In Study 1a, implicit and explicit centrality measures were positively and significantly associated with AUDIT scores after controlling for explicit drinking identity strength. There were no significant differences in the implicit measure variants, but the long format had slightly higher internal consistency. In Study 1b, results replicated for explicit, but not implicit, centrality.

CONCLUSIONS

These studies provide preliminary evidence that drinking identity centrality may be an important factor for predicting hazardous drinking. Future research should improve its measurement and evaluate implicit and explicit centrality in experimental and longitudinal studies.

A review of implicit and explicit substance self-concept as a predictor of alcohol and tobacco use and misuse

BACKGROUND

This paper provides an overview of the self-concept as it relates to substance use. Self-concept has a long history in psychological theory and research; however, substance self-concept (e.g., viewing one's self as a drinker or smoker) is an understudied area of research with the potential to expand existing conceptualizations of substance use, addiction, and prevention and treatment efforts, and should receive greater research attention.

OBJECTIVES

First, we review and provide a theoretical framework of substance self-concept that draws from dual process models and distinguishes between implicit and explicit self-concept. Next, we summarize key findings related to substance use in the extant literature, focusing on alcohol and tobacco (smoking).

RESULTS

Across both substances, there is converging evidence that substance self-concept is associated with substance use outcomes, including quantity and frequency of use and problems associated with use, and that change in substance self-concept is associated with recovery from substance misuse. Recommendations for the substance self-concept research agenda include routine assessment of substance self-concept, expanded use of implicit measures, investigation of moderators of substance self-concept, and targeting substance self-concept directly in prevention and intervention efforts.

CONCLUSION

Ultimately, we suggest that substance self-concept is a promising, but understudied, construct. Greater research attention to substance self-concept could clarify its potential as an important risk factor for hazardous use and addiction as well as its utility as a prevention and treatment target.