How do college students subjectively evaluate "blackouts"?

An Expanded Daily Alcohol Expectancies Measure: Results on the Multilevel Factor Structure and Psychometric Properties

OBJECTIVE

Alcohol expectancies are beliefs people have about the likelihood of experiencing various positive or negative consequences related to alcohol use. Expectancies have most commonly been treated as traitlike characteristics of individuals, but some researchers have assessed expectancies as state-level characteristics that vary within persons across days. Previous work developed a 13-item daily alcohol expectancies measure. This study evaluated an expanded version of that measure that includes 10 additional expectancy items.

METHOD

Participants were 2- and 4-year college students (N = 201; 63.7% female; 55.2% White non-Hispanic; 75.1% 4-year students) randomized to the control group of a longitudinal study designed to test the efficacy of a just-in-time adaptive intervention delivered via mobile app to reduce high-risk alcohol use. Multilevel exploratory factor analysis was used to determine the factor structure at the daily and person levels. Multilevel models were used to evaluate the convergent validity of the resulting subscales.

RESULTS

Two factors, broadly representing positive and negative alcohol expectancies, were retained at the daily and person levels. Composite reliability (omega) estimates ranged from .85 to .96 and suggested that the reliability of the resulting subscales was good to strong. Associations between the daily expectancy subscales and baseline scores on an established expectancies measure provided preliminary evidence of convergent validity.

CONCLUSIONS

Findings indicate that this expanded 23-item daily alcohol expectancies measure is psychometrically sound. This measure is appropriate for use in daily or just-in-time expectancy challenge interventions. It is suitable for use among 2- and 4-year college students who drink alcohol regularly and occasionally in heavy quantities and who experience alcohol-related negative consequences.

Examining alcohol-related social norms among international and domestic students in the United States

OBJECTIVES

The purpose of the current study is to examine college student status (international vs. domestic) across alcohol social norms perception.

METHODS

Undergraduates (n = 3081) were recruited for the study. Most participants were female (69.9%) and White (98.2%), with the average age of participants was 19.97 (SD = 1.61). Approximately 17.3% (n = 534) of the students were international (i.e., nonresident alien who are in the US for a bachelor's degree). It is a cross-sectional study.

RESULTS

International students reported significantly lower social norms than domestic students. International students in later college years reported norms closer to domestic students. International women endorsed social norms at a higher level than international men.

CONCLUSIONS

Assimilation into U.S. drinking culture may be linked with increased support of drinking norms among International students. This study shows the importance of incorporating drinking norms prevention strategy and cultural diversity awareness training to increase international students' knowledge and prevent misconceptions. International students' social norms should be examined for future drinking interventions. Interventions for college drinking should target specific events and context with short-term increase in hazardous drinking behavior but long-lasting effects.

Effects of social drinking context on subjective effects, affect, and next-day appraisals in the natural environment

BACKGROUND

Drinking commonly occurs in social settings and may bolster social reinforcement. Laboratory studies suggest that subjective effects and mood are mechanisms through which the social context influences alcohol consumption. Ecological momentary assessment (EMA) may be useful for extending these findings to the natural environment. This pre-registered secondary analysis of EMA data investigated the influence of the social environment on: (1) stimulating and sedating subjective effects of alcohol, (2) contentedness and negative affect, and (3) next-day evaluations of the drinking occasion.

METHODS

Nontreatment seeking adults reporting past-month heavy drinking (N = 131; Mage = 28.09; 42% female) completed 7 days of EMA (in the morning, at random, and following drinking prompts), which included questions on their social context (drinking in the presence of known others or alone), contemporaneous stimulating and sedating effects, contentedness and negative affect, alcohol consumption, and next-day evaluations of a prior day's drinking event (how satisfying/pleasant was drinking). We used multi-level models in SAS 9.4 M7 software to examine relations among the variables.

RESULTS

Contemporaneous subjective effects (stimulating or sedating), negative affect, and contentedness did not significantly depend on the social context. For next-day evaluations of pleasure/satisfaction from drinking, context effects were dependent on consumption totals. As the total number of standard drinks consumed increased, recollections of pleasure/satisfaction were higher when drinking had occurred with others, relative to alone. At lower consumption totals, next-day evaluations did not appear to depend on social context.

CONCLUSIONS

When reported contemporaneously, subjective effects and affect do not appear dependent upon the presence of known others. However, heavier drinking events, relative to lighter drinking events, are appraised more favorably the following day when occurring within social contexts.

Recent alcohol-induced blackouts among heavy drinking college students: A qualitative examination of intentions, willingness, and social context

One-third to half of emerging adult drinkers report experiencing alcohol-induced blackouts in the past year, and blackouts increase the risk for negative consequences. Qualitative methods provide valuable tools for scientific inquiry, allowing for in-depth understanding of lived experiences. The goal of the present study was to gain insight into emerging adults' recent blackout experiences. One hundred heavy drinking college students (age 18-20) completed a baseline survey, 28 days of ecological momentary assessment (EMA) of their alcohol use and consequences, and a follow-up interview. A subset of 37 (46% female, 13.5% Hispanic/Latinx, 54% non-Hispanic ethnicity/White race) endorsed a blackout (forgot what they did during or after drinking) and were interviewed regarding their recent blackout experience. A semi-structured interview guide focused on several key questions regarding intentions and/or willingness to black out, how friends reacted to their blackout, and social norms for blacking out. A priori as well as emergent themes were generated from review of coded data. Qualitative themes included: blackouts are often unintentional, heavy drinking young adults express willingness to black out, friends react in a variety of ways to blackouts, and blackouts are perceived as common and acceptable. Data provide insight into the phenomenology of blackouts among college students, revealing that although college students may not intend to, they are often willing to black out. Future qualitative studies on blackouts among non-college-attending emerging adults are warranted. Such work can inform theory and future survey studies to better understand this high-risk behavior. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A Longitudinal Examination of Alcohol-Related Blackouts as a Predictor of Changes in Learning, Memory, and Executive Function in Adolescents

INTRODUCTION

In adolescents, the relationship between alcohol-related blackouts (ARBs) and distinct cognitive changes lasting beyond intoxication is unclear. We examined ARBs as a predictor of persistent changes in the development of learning, memory, and executive function in participants from the National Consortium on Alcohol and Neurodevelopment in Adolescence (NCANDA) study.

METHODS

Descriptive analyses of the NCANDA sample (N = 831, 50.9% female, 12-21 years at baseline) identified ARB patterns within participants with an ARB history (n = 106). Latent growth curve modeling evaluated ARB-related performance changes on four neuropsychological measures across five years, excluding baseline data to reduce the magnitude of practice effects over time (n = 790). Measures included the Penn Conditional Exclusion Test (PCET), Penn Letter N-back Test (PLBT), Penn Facial Memory Test immediate (PFMT_i), and delayed (PFMT_d) recognition trials, and the Rey Complex Figure Test copy (RCFT_c), immediate recall (RCFT_i), and delayed recall (RCFT_d) trials. Multivariate models were fit for raw accuracy scores from each measure, with ARB history (i.e., presence of past-year ARBs) as the main independent variable. Age, sex, race, socioeconomic status, assessment site, and alcohol use (i.e., past-year frequency) were included as covariates. Interaction effects between ARB history and alcohol use frequency were tested.

RESULTS

By year five, 16% of participants had experienced at least one ARB (59% of whom reported > 1 ARB and 57% of whom had an ARB lasting > 1 h). After controlling for demographics and alcohol use, ARB history predicted attenuated PFMT_d performance growth at year one. Interaction effects between ARB history and alcohol use frequency predicted attenuated PFMT_d performance growth at years one and two. ARB history predicted attenuated RCFT_i and RCFT_d performance growth by year four, but not PCET or PLBT performance over time. By contrast, greater past-year alcohol use predicted attenuated PFMT_i and PFMT_d performance growth between years two and four in adolescents without an ARB history.

CONCLUSION

We found that ARBs predict distinct, lasting changes in learning and memory for visual information, with results suggesting that the developing brain is vulnerable to ARBs during adolescence and emerging adulthood.

Do Alcohol Consequences Serve as Teachable Moments? A Test of Between- and Within-Person Reciprocal Effects From College Age to Adulthood

OBJECTIVE

Several studies find between-person reciprocal relations between adolescent/college drinking and positive expectancies. However, drinking and expectancies from college into adulthood are largely unstudied, as are within-person associations. During these age periods, negative alcohol consequences may represent "teachable moments" via expectancy change. The current study tested the reciprocal effects of drinking, negative consequences, and expectancies from college age to adulthood.

METHOD

Using data from a longitudinal study focused on familial alcohol disorder, age bands were created to model effects from college age (18-22) to young adulthood (23-28) and adulthood (29-34). Participants (N = 420) reported on their drinking, negative consequences, and expectancies across three waves (1995-2010).

RESULTS

Negative consequences did not predict negative expectancies, but the random intercepts of the two were highly related. Young adult negative consequences predicted a within-person increase in adult heavy drinking. A within-person increase in college age negative expectancies indirectly predicted a within-person decrease in adult negative consequences through reduced young adult drinking, whereas within-person increases in college age positive expectancies indirectly predicted a within-person increase in adult negative consequences through heavier young adult drinking.

CONCLUSIONS

Findings suggest that negative consequences were related to trait-level negative expectancies, even though prospective effects were not observed. Findings also suggest that college age negative expectancies were protective against future use and consequences, and this effect was unique to college age.

Context-specific drinking and social anxiety: The roles of anticipatory anxiety and post-event processing

Individuals with clinically elevated social anxiety are especially vulnerable to alcohol-related problems, despite not drinking more than those with less anxiety. It is therefore important to identify contexts in which socially anxious persons drink more to inform intervention efforts. This study tested whether social anxiety was related to greater drinking before, during, or after a social event and whether such drinking was related to the psychosocial factors anticipatory anxiety or post-event processing (PEP; review of the social event). Among past-month drinkers, those with clinically elevated or higher social anxiety (HSA; n = 212) reported more anticipatory anxiety, more pre-event drinking to manage anxiety, and PEP than those with normative or lower social anxiety (LSA; n = 365). There was a significant indirect effect of social anxiety on pre-drinking via anticipatory anxiety. Social anxiety was related to more drinking during the event indirectly via the serial effects of anticipatory anxiety and pre-drinking. Unexpectedly, PEP did not mediate or moderate the relation between social anxiety and post-event drinking. In sum, anticipatory anxiety was related to more drinking before, during, and after a social event and HSA drinkers were especially vulnerable to drinking more to manage this anxiety, which increased drinking before and during the event. This effect was specific to anticipatory anxiety and not evident for another social anxiety-specific risk factor, PEP. Thus, anticipatory anxiety may be an important therapeutic target for drinkers generally and may be especially important among HSA drinkers.

Posting Post-Blackout: A Qualitative Examination of the Positive and Negative Valence of Tweets Posted after "Blackout" Drinking

Alcohol-induced memory loss (i.e., blackout) is a consequence of drinking that is both common and associated with additional negative outcomes. The goal of the present study was to use publicly available Twitter data to better understand cognitions and emotions following blackouts. Tweets containing key terms (e.g., "black out") were collected over 4 days in 2018. Using NVivo software, we coded all post-blackout Tweets for valence (positive, negative, neutral). Within each valence category, we reviewed Tweets to identify themes. Among Tweets coded with a positive valence, themes included pride in blacking out, pride in ability to function despite blackouts, blackouts as a shared social experience, and overall positive views of a drinking experience despite blackouts. Among Tweets coded with a negative valence, themes included the experience of other negative consequences on blackout nights, blackouts as unexpected/unplanned, blackouts as motivator of change, and blackout-related negative emotions. Additionally, Tweeters expressed pride in avoiding blackouts during drinking events. Findings provide insight into why not all individuals describe blackouts negatively, by analyzing specific statements made in a public forum following a blackout. Such insight may inform interventions targeting those who report this risky outcome of drinking, including those that could be delivered via social media.

A qualitative study of the perceived effects of alcohol on depressive symptoms among undergraduates who drink to cope with depression

INTRODUCTION AND AIMS

Heavy drinking is prevalent among undergraduate students and is linked with drinking to cope with depression motives for drinking. Drinking to cope with depression remains poorly understood given that alcohol has been shown to have adverse effects on mood when consumed at high doses. Using semi-structured qualitative interviews, the present study examined the perceived effects of alcohol on depressive symptoms as reported by undergraduate students who endorse high levels of drinking to cope with depression.

DESIGN AND METHODS

Sixteen undergraduate coping-with-depression-motivated (CWDM) drinkers (nine women, seven men), identified using the Modified Drinking Motives Questionnaire-Revised [1], reported on their experiences of drinking to cope with depression. Thematic analysis was conducted to identify themes and subthemes in the data.

RESULTS

Undergraduate students reported several effects of alcohol on affective, cognitive and behavioural depressive symptoms. While most of the perceived alcohol effects they described involved relief from depressive symptoms, some perceived effects involved worsening depressive symptoms.

DISCUSSION AND CONCLUSIONS

The study generated several hypotheses to explain drinking to cope with depression, some of which might be testable in future experimental work. Overall, findings suggest the mood-altering effects of alcohol do not fully explain why depression and alcohol use are frequently co-morbid. Indeed, effects of alcohol on cognitive and behavioural depressive symptoms might be particularly reinforcing for CWDM drinkers. Interventions that target co-morbid depression and alcohol use might be improved by teaching CWDM drinkers skills to reduce depressive cognitions and to improve interpersonal interactions outside of drinking contexts.

A Test of the Theory of Planned Behavior in the Prediction of Alcohol-Induced Blackout Intention and Frequency

BACKGROUND

This study examined the theory of planned behavior (TPB) as an explanatory model for alcohol-induced blackouts among college students. Blackouts are periods of time wherein individuals continue to function and engage in their social environment but do not remember it as a result of consuming large quantities of alcohol. Social cognitive factors posited within TPB, such as perceived norms and personal attitudes toward alcohol consumption, are reliable predictors of alcohol use and related problems. However, research to date has not examined these theoretical antecedents as predictors of alcohol-induced blackout.

METHODS

College students with a history of blackout (N = 384) completed a baseline survey, and a subsample (N = 120) completed a 1-month follow-up survey. Negative binomial mediation models were used to evaluate intentions to blackout as a mediator of the norms, attitudes, and self-efficacy to avoid blackout-blackout frequency association at baseline and 1-month follow-up.

RESULTS

Norms, attitudes, and self-efficacy to avoid blackout all significantly predicted blackout intentions at baseline, which in turn predicted more frequent blackouts both at baseline and at 1-month follow-up. Notably, blackout attitudes demonstrated both direct and indirect associations with blackout frequency.

CONCLUSIONS

Prospective analyses provided partial support for the TPB, with only attitudes and intentions demonstrating prospective associations with actual blackout frequency. Given the particularly strong association between blackout attitudes and frequency of blackouts, attitudes may represent an important and novel target for prevention and intervention efforts.

Event-Level Correlates of Drinking Events Characterized by Alcohol-Induced Blackouts

BACKGROUND

Prior research identifies a range of potential predictors of blackouts and suggests that blackouts increase risk for additional negative consequences. However, these studies are based on epidemiological work that allows us to draw conclusions about groups of people but not within-person processes. The present study examined within-person, event-level correlates of blackouts.

METHODS

Ninety-six heavy drinking college students (52% female) completed 28 days of daily reports of alcohol use and consequences, including blackouts. Thirty-three participants reported 56 blackouts. Hierarchical linear modeling compared morning reports of drinking events on which participants did versus did not report a blackout, controlling for total drinks at the event.

RESULTS

Blackout likelihood increased as a function of total drinks consumed and of crossing thresholds for heavy episodic drinking (4+/5+ drinks for women/men) and high-intensity drinking (8+/10+). Participants reported a higher total number of additional negative consequences on blackout events. Specific consequences that were more likely included embarrassing oneself and hangover. Blackouts were associated with morning ratings of less positive mood and a less favorable drinking event. Motives for drinking and simultaneous use of marijuana were not associated with blackouts.

CONCLUSIONS

Event-level findings of this study document that events leading to alcohol-induced memory loss are associated with other adverse experiences relative to drinking events that do not result in blackout, and offer potentially motivational levers for preventive interventions.

Replication of factors related to blackout incidence in U.S. high school students: A brief report

Alcohol-related blackouts are a common, yet serious consequence that can result from heavy alcohol intake. This study tested a model examining whether factors identified in related samples (i.e., adolescents residing in the U.K. and U.S. college students) predicted blackouts in community-dwelling U.S. high school youth. Participants from a Northeastern U.S. high school with prior alcohol use (M_age = 16.0 years; 48.2% male, 78.0% White) completed a paper-and-pencil assessment including measures of demographics, alcohol and other substance use, externalizing behaviors, and injunctive norms about risky drinking behaviors. Hierarchical logistic regression examined which factors identified for U.K. residing adolescents (Block 1) replicated in the U.S. sample, and whether factors identified in samples of U.S. college students added additional explained variance (Block 2). Blackouts were reported by 35.6% of students. Regression results indicated that two variables previously identified in adolescents, female gender (OR = 3.26) and increased alcohol use (OR = 1.27) were associated with blackouts. College student risk factors of drinking game (DG) participation and, to a lesser degree injunctive norms for passing out, emerged as additional risk factors (ORs = 2.85 and 1.32, respectively), with the final model explaining 39% of the variance in blackouts. This study advances our understanding of blackouts in younger drinkers and identifies the importance of addressing blackouts within the context of intervention programming that addresses cognitions and high risk drinking practices like DGs.

Brief Motivational Interventions Are Associated with Reductions in Alcohol-Induced Blackouts Among Heavy Drinking College Students

BACKGROUND

Alcohol-induced blackouts, a form of anterograde amnesia that restricts the encoding of short-term memories into long-term ones, are among the most severe alcohol-related consequences. College students are at high risk of experiencing alcohol-induced blackouts, and there is a need to determine whether alcohol interventions can effectively reduce blackouts in this population. The current study uses data from 3 randomized clinical trials to examine the effect of various intervention approaches on alcohol-induced blackouts.

METHODS

Four interventions were compared over 3 studies: (i) a computerized feedback intervention (electronic Check-Up To Go [e-Chug]; Study 1); (ii) a single-session brief motivational intervention (BMI; Study 1); (iii) a BMI plus behavioral economic session focused on increasing substance-free activities (BMI + Substance-Free Activity Session [SFAS]; Studies 2 and 3); and (iv) a BMI plus supplemental Relaxation Training session (BMI + Relaxation Training; Studies 2 and 3). Studies 1 and 3 also included an assessment-only control condition. For each study, participants reported whether they had experienced an alcohol-induced blackout at each time point; binary logistic regressions examined differential likelihood of experiencing an alcohol-induced blackout over time.

RESULTS

Neither the single-session BMI nor e-Chug reduced alcohol-induced blackouts over assessment only; however, participants in the BMI + SFAS or BMI + Relaxation Training condition were significantly less likely to experience an alcohol-induced blackout compared to assessment only at 1-month (Wald = 4.77, odds ratio [OR] = 0.53, p = 0.03) and 6-month follow-ups (Wald = 5.72, OR = 0.52, p = 0.02). Study 2 also revealed a larger effect for the BMI + SFAS over the BMI + Relaxation Training condition at 6 months (Wald = 4.11 OR = 0.22, p = 0.043), although this was not replicated in Study 3. The effects for the 2-session BMIs lasted 6 months, at which point maturation effects diminished differences between assessment-only and intervention conditions.

CONCLUSIONS

Two sessions of BMI are a substantial enough dose to result in reductions in alcohol-induced blackouts among college student heavy drinkers.