A latent profile analysis of drinking patterns among nonstudent emerging adults

Cognitive impairment among alcohol treatment service users in South Wales: an exploratory examination of typologies of behaviour, impairment, and service attendance

Introduction

Alcohol dependence is a global issue with many negative consequences, including alcohol-related brain damage (ARBD). Assessment of the sociodemographic and cognitive characteristics of individuals with confirmed or suspected ARBD presenting to alcohol services warrants further investigation.

Methods

This study retrospectively examined rates of cognitive impairment using Montreal Cognitive Assessment (MoCA) data from 300 adults who visited three alcohol support services. We demonstrate that 55.3% of the sample had significant levels of cognitive impairment. Females' cognitive performance was disproportionately negatively affected by historical alcohol use relative to males.

Results

The analysis identified four categories of participants, and the majority had a long history (+10 years) of alcohol use and were still actively drinking. Those taking part in active treatment for ARBD or practising abstinence demonstrated lower levels of cognitive impairment. Additionally, prior access to specialised ARBD care was associated with higher MoCA scores.

Discussion

This research has identified a range of key service engagement, sociodemographic and cognitive characteristics that could be used to optimise support for those with alcohol dependence, whilst also highlighting some critical questions to be addressed in future research.

Latent classes of alcohol and cannabis use among adults with binge-spectrum eating disorders: Associations with eating disorder symptom severity and personality features

OBJECTIVE

Alcohol and cannabis use are prevalent among individuals with binge-spectrum eating disorders (B-ED) and vary in terms of frequency and associated problems. The current study aimed to identify latent classes of alcohol and cannabis use patterns among B-ED and examine associations between latent classes and demographic characteristics, eating disorder symptoms, and personality features.

METHODS

Participants (N = 236) were treatment-seeking adults with B-ED who completed a clinical interview of eating pathology and self-report measures of alcohol and cannabis use in the past 3 months, alcohol and cannabis-related problems, and personality features (i.e., impulsivity, affect lability).

RESULTS

Latent class analysis identified three heterogeneous classes, labelled as (a) Low Alcohol, (b) Moderate Drinking and Problems with Occasional Cannabis Use, and (c) No Alcohol and Cannabis Use. Latent classes significantly differed in terms of substance use engagement and problems, demographic characteristics, dietary restraint, impulsive personality features, and affect lability.

CONCLUSIONS

Study findings support heterogeneity in alcohol and cannabis use among B-ED and suggest patient characteristics and clinical severity associated with specific substance use presentations. Future research should replicate results using larger, diverse samples engaging in a broader range of alcohol and cannabis use symptoms.

Daily Stress, Drinking Motives and Alcohol Co-Use with Other Drugs

Background: Recent evidence indicates that alcohol and other substance co-use, compared to alcohol-only use, might be more closely associated with negative reinforcement processes, and thus more likely during periods of increased stress. The present study examined this possibility by using data from an intensive longitudinal (daily) study of college student drinkers (N = 1461, 54% women). We also examined individual differences in coping and enhancement drinking motives as predictors of alcohol and other substance co-use. Results: We used multilevel multinomial logistic regression to predict, relative to alcohol-only days, the likelihood of alcohol co-use with either cigarettes or marijuana, along with alcohol use with multiple substances and other substance-only use from daily interpersonal and academic stress, day-of-the-week, sex, and individual differences in coping and enhancement drinking motives. We found that, relative to alcohol-only, alcohol and marijuana co-use was more likely, and non-alcohol related substance use was less likely, on weekends. Alcohol and marijuana co-use was less likely, and other substance-only use was more likely, on days characterized by greater academic stress, whereas alcohol and cigarette co-use was more likely on days characterized by greater interpersonal stress. Individuals with higher levels of drinking to cope motivation were more likely to engage in alcohol and cigarette co-use, other substance-only use, and alcohol plus multiple substances, relative to alcohol-only. Individuals with higher levels of enhancement motives were more likely to engage in all types of alcohol and other substance co-use and other substance-only use relative to alcohol-only. Conclusions: Findings are discussed in terms of the complex nature of different patterns of co-use patterns when evaluating indicators of positive- and negative-reinforcement processes.

Examining Subtypes of Emerging Adult Situational Drinking: A Replication and Extension Study

Background: Emerging adulthood is associated with heavy drinking. Despite overall heavy use, studies show considerable heterogeneity in emerging adult drinking habits. Lau-Barraco and colleagues (2016 b) identified three subtypes (high, moderate, low) of emerging adult heavy drinkers based on patterns of use across common drinking situations. Heavy situational drinkers had more alcohol problems, mental health symptoms, and coping/conformity motives for alcohol use.Objective: Our goal was to replicate and extend the aforementioned study, expecting to find the same subgroups, then examining whether certain risk factors predicted subgroup membership.Methods/Results: Undergraduates (N = 497) completed online self-report measures and a latent profile analysis (LPA) found support for three similar subtypes; low, "moderate" (higher endorsement of pleasant emotion/social pressure situations, relative to the low group), and high. Univariate ANOVAs, followed by pairwise comparisons, found that heavy situational drinkers scored highest on measures of alcohol problems, problem gambling, drug use, depression, and anxiety compared to the other two groups, and consistent with previous findings.Conclusions: This study showed that emerging adults who drink heavily across various situations are likely to engage in other addictive behaviors and struggle with mental health symptoms. Identifying one's personal risk factors and their riskiest drinking situations is critical for developing targeted intervention programs and increasing the understanding of the heterogeneous nature of drinking behaviors in emerging adults in Canada.

The Clinical Course of Alcohol Use Disorder Depicted by Digital Biomarkers

Aims: This study introduces new digital biomarkers to be used as precise, objective tools to measure and describe the clinical course of patients with alcohol use disorder (AUD).

Methods: An algorithm is outlined for the calculation of a new digital biomarker, the recovery and exacerbation index (REI), which describes the current trend in a patient's clinical course of AUD. A threshold applied to the REI identifies the starting point and the length of an exacerbation event (EE). The disease patterns and periodicity are described by the number, length, and distance between EEs. The algorithms were tested on data from patients from previous clinical trials (n = 51) and clinical practice (n = 1,717).

Results: Our study indicates that the digital biomarker-based description of the clinical course of AUD might be superior to the traditional self-reported relapse/remission concept and conventional biomarkers due to higher data quality (alcohol measured) and time resolution. We found that EEs and the REI introduce distinct tools to identify qualitative and quantitative differences in drinking patterns (drinks per drinking day, phosphatidyl ethanol levels, weekday and holiday patterns) and effect of treatment time.

Conclusions: This study indicates that the disease state—level, trend and periodicity—can be mathematically described and visualized with digital biomarkers, thereby improving knowledge about the clinical course of AUD and enabling clinical decision-making and adaptive care. The algorithms provide a basis for machine-learning-driven research that might also be applied for other disorders where daily data are available from digital health systems.

Characterising patterns of alcohol use among heavy drinkers: A cluster analysis utilising alcohol biosensor data

INTRODUCTION

Previous research has predominately relied on person-level or single characteristics of drinking episodes to characterise patterns of drinking that may confer risk. This research often relies on self-report measures. Advancements in wearable alcohol biosensors provide a multi-faceted objective measure of drinking. The current study aimed to characterise drinking episodes using data derived from a wearable alcohol biosensor.

METHODS

Participants (n = 45) were adult heavy drinkers who wore the Secure Continuous Remote Alcohol Monitoring (SCRAM) bracelet and reported on their drinking behaviours. Cluster analysis was used to evaluate unique combinations of alcohol episode characteristics. Associations between clusters and self-reported person and event-level factors were also examined in univariable and multivariable models.

RESULTS

Results suggested three unique clusters: Cluster 1 (most common, slowest rate of rise to and decline from peak), Cluster 2 (highest peak transdermal alcohol concentration and area under the curve) and Cluster 3 (fastest rate of decline from peak). Univariable analyses distinguished Cluster 1 as having fewer self-reported drinks and fewer episodes that occurred on weekends relative to Cluster 2. The effect for number of drinks remained in multivariable analyses.

DISCUSSION AND CONCLUSIONS

This is the first study to characterise drinking patterns at the event-level using objective data. Results suggest that it is possible to distinguish drinking episodes based on several characteristics derived from wearable alcohol biosensors. This examination lays the groundwork for future studies to characterise patterns of drinking and their association with consequences of drinking behaviour.

Personalized feedback tempers weekend increases in alcohol use among nonstudent emerging adult drinkers

A common pattern of problematic alcohol consumption among emerging adults consists of little to no drinking during the week, with heavy drinking episodes on the weekend. However, little is known about whether brief alcohol interventions exert impact on decreasing weekend drinking escalations or simply overall consumption throughout the week. A recent randomized controlled trial of heavy drinking emerging adult nonstudents (N = 164) demonstrated the efficacy of a personalized feedback intervention (PFI). Specifically, the PFI was associated with reduced overall alcohol consumption relative to assessment-only controls. However, it is not clear if patterns of weekend drinking escalation may have been disrupted by the intervention. The current study was a follow-up analysis of the parent trial. Using retrospective daily drinking data provided at each timepoint (up to 9-months), data were coded to reflect condition, time (coded to capture initial changes post-intervention as well as long-term maintenance), and day of the week (coded to capture weekend versus weekday). A multilevel negative binomial hurdle analysis was conducted, yielding two sets of results: 1) predicting the probability of a non-drinking day, and 2) predicting number of drinks consumed. Although the three-way interaction was not significant, 2 two-way interactions indicated that weekend increases in drinking were less steep over time for both groups, and less steep for PFI participants. In addition, the higher weekend likelihood of drinking was decreased over time for both groups. Steep weekend increases in drinking were disrupted over time, particularly among PFI recipients. Personalized feedback may be effective at helping nonstudent emerging adults avoid high risk drinking situations.

Predictors of Daily Adherence to Naltrexone for Alcohol Use Disorder Treatment During a Mobile Health Intervention

Background

Adherence to medications for treating alcohol use disorder (AUD) is poor. To identify predictors of daily naltrexone adherence over time, a secondary data analysis was conducted of a trial evaluating a mobile health intervention to improve adherence.

Methods

Participants seeking treatment for AUD (n = 58; Mage = 38 years; 71% male) were prescribed naltrexone for 8 weeks. Adherence was tracked using the Medication Event Monitoring System (MEMS). In response to daily text messages, participants reported the previous day's alcohol use, craving, and naltrexone side effects. Using multilevel structural equation modeling (MSEM), we examined baseline dispositional factors and within-person, time-varying factors as predictors of daily adherence.

Results

Naltrexone adherence decreased over time. Adherence was higher on days when individuals completed daily mobile assessments relative to days when they did not (odds ratio [OR] = 2.53, 95% confidence interval [CI] 1.61 to 3.98), irrespective of intervention condition. Days when individuals drank more than their typical amount were related to lower next-day adherence (OR = 0.93, 95% CI 0.88 to 0.99). A similar pattern was supported for craving (OR = 0.88, 95% CI 0.79 to 0.98). Weekend days were associated with lower adherence than weekdays (OR = 0.71, 95% CI 0.58 to 0.86); this effect was partly mediated by heavier daily drinking (indirect effect = -0.02, 95% CI -0.04 to -0.003) and stronger-than-usual craving (indirect effect = -0.01, 95% CI -0.02 to 0.00) on weekend days.

Conclusions

The results further demonstrate the need to improve adherence to AUD pharmacotherapy. The present findings also support developing interventions that target daily-level risk factors for nonadherence. Mobile health interventions may be one means of developing tailored and adaptive adherence interventions.

In-the-Moment Drinking Characteristics: An Examination Across Attention-Deficit/Hyperactivity Disorder History and Race

BACKGROUND

Adults with a history of childhood attention-deficit/hyperactivity disorder (ADHD) and Black drinkers are at elevated risk for alcohol problems and alcohol use disorder. Processes that increase risk for these distinct populations have not focused on in-the-moment behaviors that occur while drinking. The present study examined in-the-moment drinking characteristics (i.e., location, social context, day, time, drink type, speed of consumption) that may differ for individuals with and without ADHD histories or for Black and White drinkers. We also examined the interplay among these in-the-moment drinking characteristics to further understanding of contexts when risk may be momentarily increased.

METHODS

As part of a larger study, 135 individuals (M_age  = 27.81, 69.6% male, 45.9% ADHD, 69.6% White) completed a 10-day ecological momentary assessment protocol that included self-initiated reports following consumption of an alcoholic drink. Hypotheses were tested using multilevel modeling.

RESULTS

Controlling for multiple demographic covariates, Black drinkers drank significantly more quickly than White drinkers and were more likely to consume hard liquor-containing beverages. Differences in drinking speed remained significant when adjusting for Black drinkers' greater likelihood to consume liquor-containing beverages and momentary experience of discrimination; however, Black drinkers' increased likelihood to consume liquor-containing beverages was no longer significant when adjusting for momentary experience of discrimination. Individuals with ADHD histories did not differ from those without ADHD histories in any in-the-moment drinking characteristics. ADHD and race did not interact to predict any drinking characteristic.

CONCLUSIONS

Differences in speed of alcohol consumption and propensity to consume liquor-containing beverages may contribute to increased risk for alcohol problems experienced by Black drinkers compared to White drinkers.

Associations between young adult men's patterns of alcohol use and sexual behavior: A latent profile analysis of two independent samples

Men's alcohol consumption and casual sexual behavior peak in early adulthood. Although there is a strong positive association between these behaviors, most studies have utilized a between-subjects approach rather than a person-centered approach to assess this relationship. A person-centered approach allows for an examination of subgroups of drinkers that may differ in their casual sexual behaviors. To address this gap, secondary data analyses were conducted with two independent samples totaling 906 men between the ages of 18 and 29 from the Midwestern United States. In both studies, participants reported their alcohol expectancies and consumption, sexual behaviors, and sexual attitudes. Multiple group latent profile similarity analyses were conducted using the alcohol-related variables. Four similar profiles emerged in both samples; thus, the data were combined. Casual sex-related variables were then examined in relation to the profiles. The two lighter drinking groups differed from one another in their alcohol consumption and sexual attitudes; however, they did not differ in their alcohol expectancies or number of sex partners. The two heavier drinking groups differed from one another in their liquid courage expectancies, alcohol consumption, one-time-only partners, and sexual attitudes; however, they did not differ from each other in their sex-drive expectancies or lifetime partners. Person-centered approaches can be used to develop more tailored interventions, particularly for those at greater risk for the negative health consequences of engaging in sexual behavior with multiple one-time-only partners.

The Influence of a Brief Alcohol Intervention on Alcohol Use Trajectories in Nonstudent Emerging Adult Drinkers

Background: This study sought to inform research with noncollege-attending emerging adults, an at-risk, and understudied population, by identifying patterns of response following a brief alcohol intervention. This study was a reanalysis of data from a randomized controlled intervention trial testing a brief, personalized feedback alcohol intervention targeting nonstudent emerging adult drinkers. Objectives: The study aims were to (1) model intervention response by identifying subgroups characterized by changes in heavy drinking (i.e. peak use, number of binges during a typical week, proportion of binge days, peak estimated blood alcohol concentration [eBAC]) following the alcohol intervention, and (2) distinguish subgroups on factors related to intervention response (i.e. perceived norms regarding how much peers drink, alcohol use severity, mental health symptoms, and readiness to change). Methods: Participants were 81 (64.2% men) nonstudent heavy drinkers between ages 18-25 years (average age = 22.04) recruited from the community. Results: Findings revealed two latent subgroups that exhibited differential response to the intervention (i.e. intervention "responders" and "nonresponders"). Further, responders reported higher pre-intervention descriptive normative perceptions and alcohol use severity. Conclusions/Importance: The current investigation contributed to knowledge regarding for whom brief alcohol interventions work in the short term within nonstudent emerging adults and could inform future research to facilitate behavior change in those unresponsive to intervention efforts.

A Daily Diary Study of Drinking and Nondrinking Days in Nonstudent Alcohol Users

BACKGROUND

Emerging adults with lower educational attainment are at higher long-term risk for problematic drinking and alcohol use disorders. Efforts to gain a more in-depth understanding of the drinking habits of nonstudent emerging adults are critical to reduce disparities and to shed light on targets of intervention for this vulnerable group.

OBJECTIVES

The current investigation aimed to: (1) provide a description of the daily drinking habits of nonstudent emerging adult drinkers using a 14-day diary method, and (2) examine nondrinking days by assessing their reasons for not drinking as well as strategies used to avoid drinking.

METHODS

Participants were 27 (55.5% women) emerging adult drinkers recruited from the community.

RESULTS

On drinking days, multilevel results indicated that heavier alcohol use was positively associated with level of subjective intoxication and alcohol-related problems. Men reported higher alcohol use outcomes than women across all alcohol use indicators. Regarding nonconsumptive days, the most frequently endorsed reasons for not drinking largely reflected an internal motivation, while the least endorsed reasons were related to external constraints. Pertaining to strategies used to avoid drinking, the most frequently endorsed response related to choosing alternative enjoyable activities. Diary compliance with the 14-day protocol was 90.9% for at least one daily survey. Conclusion/Importance: The present investigation represents one of the first to examine drinking behaviors using a daily diary approach with nonstudent emerging adult drinkers. Study findings filled an important gap regarding our understanding of the context of drinking of an at-risk and understudied group of drinkers.

Drinking Patterns of College- and Non-College-Attending Young Adults: Is High-Intensity Drinking Only a College Phenomenon?

BACKGROUND

Young adults report the heaviest drinking of any age group, and many are at risk for experiencing an alcohol use disorder. Most research investigating young adult drinking has focused on single indicators of use. Using multiple dimensions of consumption, such as federal guidelines for daily/weekly drinking and engagement in drinking at twice the binge threshold ("high-intensity drinking") to characterize drinking behavior could illuminate drinking patterns linked with harms.

OBJECTIVES

We used a person-centered approach to examine latent classes of drinkers from a national sample of young adults. Further, we compared classes on college status.

METHODS

We used 2012-2013 data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)-III. We included past-year drinkers aged 18-22 years (n = 2213). Latent classes were estimated based on drinking frequency, daily/weekly drinking, frequency of heavy episodic drinking (4+/5+ drinks for women/men), frequency of high-intensity drinking (8+/10+ drinks), and intoxication frequency.

RESULTS

Five latent classes were identified: Occasional, Light Drinkers (30%), Regular Drinkers (6%), Infrequent Drinkers with Occasional Binging (10%), Frequent Drinkers with Occasional Binging (22%), and High-Intensity Drinkers (32%). Although membership in the two riskiest classes were more common among college-attenders, odds of being a High-Intensity Drinker relative to the second riskiest class was not significantly different for college- and non-college-attending young adults. Conclusions/Importance: As high-intensity drinking does not appear to be a drinking pattern unique to college-attenders and non-college-attenders are less likely to mature out of heavy drinking patterns, intervention efforts are needed for this at-risk age group.

Short-term stability of different drinking patterns over the course of four weeks among adults. A latent transition analysis

OBJECTIVE

The purpose of the present study was to identify drinking patterns and determine their intraindividual stability over the course of four weeks among a sample of adults from the general population.

METHODS

The sample comprised 288 adults who reported drinking alcohol at least once per month (49% female; mean age = 33.1 years, SD = 12.8 years). Participants were recruited in the waiting area of a local registration office in northeastern Germany. Data were collected four times over four consecutive weeks by interview (once in the registration office and thrice by telephone). To assess alcohol consumption in the past seven days, timeline follow-back questions were administered each time. For data analysis, latent profile and latent transition analyses were applied. Indicators for latent classes were total number of drinks per seven days, number of drinking days, and number of days with heavy episodic drinking.

RESULTS

Three classes of seven-day drinking patterns were identified at baseline: (a) light drinkers (77%), (b) moderate drinkers (18%), and (c) heavy drinkers (5%). Approximately one-fifth (21%) of baseline light drinkers and 94% of baseline moderate drinkers changed their drinking pattern at least once during the four weeks. The majority (81%) of baseline moderate drinkers also reported light drinking in at least one of the three subsequent weeks.

CONCLUSIONS

Our findings suggest intraindividual changes in drinking patterns even during a short period of time. Instability of drinking patterns may potentially impair the assessment of light to moderate alcohol consumption when a quantity-frequency approach is applied.

Insomnia moderates the association between alcohol use and consequences among young adult veterans

OBJECTIVE

Symptoms of insomnia and heavy alcohol use tend to co-occur among military and veteran samples. The current study examined insomnia as a moderator of the association between alcohol use and related consequences among young adult veterans in an effort to extend and replicate findings observed in samples of civilian young adults.

METHOD

Young adult veterans (N=622; 83% male; age M=29.0, SD=3.4) reporting alcohol use in the past year completed measures of insomnia severity, alcohol use, and alcohol-related consequences as part of a larger intervention trial. Participants were classified as screening 'positive' (n=383, 62%) or 'negative' (n=239, 38%) for insomnia using the Insomnia Severity Index. Hierarchical regression was used to examine the interaction between drinking quantity and insomnia on alcohol-related consequences. Predictor and outcome variables were measured concurrently.

RESULTS

Both a greater number of drinks per week and a positive insomnia screen were associated with more alcohol-related consequences. Drinks per week and insomnia screen interacted to predict alcohol-related consequences, such that the effect of drinking on alcohol-related consequences was stronger in the context of a positive versus negative insomnia screen.

CONCLUSION

Drinking is associated with more alcohol-related consequences in the presence of clinically significant insomnia symptoms. These findings replicate those documented in civilian young adults and indicate that insomnia may be an appropriate target for alcohol prevention and intervention efforts among young adult veterans.