Integrating field methodology and web-based data collection to assess the reliability of the Alcohol Use Disorders Identification Test (AUDIT)

The Relationship between Mindfulness and Readiness to Change in Alcohol Drinkers

Mindfulness is a multi-faceted construct that involves paying attention to thoughts and emotions without automatically reacting and being critical of them. Recent research has suggested that mindfulness might play an important role in reducing problematic alcohol use. Further, Readiness to Change (RTC) is related to motivation to change drinking behaviours. The RTC scale identifies motivation to change drinking behaviours including Precontemplation, Contemplation, and Action stages. The current study investigated, for the first time, the relationship between mindfulness (and its facets) and RTC in relation to drinking behaviours. Undergraduate students from Western Sydney University (N = 279) were screened for drinking levels using the Alcohol Use Disorder Identification Test (AUDIT) and then completed the Readiness to Change Questionnaire (RCT) and the Five Facets Mindfulness Questionnaire (FFMQ), which includes the following facets: Acting with Awareness, Non-Judging of Inner Experience, Non-Reactivity to Inner Experience, Describing, and Observing. Results show that overall, mindfulness and its facets negatively correlated with RTC. Multiple regression analysis further showed that Awareness and Non-Judgement facets negatively predicted RTC. These findings provide insight into how the facets of mindfulness interact with the drinking motives of individuals and their intentions to change drinking behaviours. Based on these findings, we recommend the incorporation of mindfulness techniques in interventions targeting problematic drinking.

Pregaming: A Field-Based Investigation of Alcohol Quantities Consumed Prior to Visiting a Bar and Restaurant District

BACKGROUND

Investigations examining the association between pregaming, or the consumption of alcohol prior to attending a social gathering or drinking establishment, and blood alcohol concentrations have primarily relied on estimations (i.e., Widmark equation), rather than objective biologic samples, such as breath alcohol concentration (BrAC).

OBJECTIVES

The current study assessed: (1) pregaming, using quantity-based measures, among a sample of college and non-college affiliated bar patrons, (2) associations between pregaming intensity/status and participant intoxication (BrAC), and (3) whether participants who pregamed were more likely to identify as a hazardous drinker.

METHODS

548 bar patrons provided data on the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) and a single pregaming item assessing quantity of alcohol consumed prior to visiting a bar/restaurant district in 2015. BrAC samples were collected post interview. We used hierarchical linear regression models, respectively, to assess whether pregaming significantly impacted BrAC and whether presence of hazardous drinking predicted pregaming behavior.

RESULTS

After controlling for sex, race/ethnicity, age, student status, and Greek affiliation, the linear regression model explained 32.3% (R² = .323) of the variance of BrAC levels (F(12) = 21.162, p < .001), with 4.30% of the variance explained solely by pregaming (β = 0.014; p < .001). The linear regression model to assess if harzardous drinking behavior (AUDIT-C) significantly predicted pregaming explained 31.2% (R² = .312) of the variance of pregaming behavior (F(18) = 13.276, p < .001), with 4.2% of the variance explained solely by AUDIT-C scores (β = 0.280; p < .001).

CONCLUSION

Findings further highlight pregaming as a harmful risk behavior linked to elevated levels of hazardous drinking and intoxication.

Factors Associated with Self-Estimated Breath Alcohol Concentration Among Bar Patrons

BACKGROUND

Few studies have examined the context in which drinkers underestimate their breath alcohol concentration (BrAC) in natural drinking environments. This study examined factors associated with bar patrons' self-estimated BrAC in high-risk college town settings.

METHODS

Guided interview and BrAC data were collected from 510 participants recruited as they exited bars located close to large universities: 1 in Florida and 1 in Texas.

RESULTS

Participants with the highest measured BrACs underestimated their BrAC levels the most. Findings from multivariable linear regression analysis indicated that BrAC (std β = 0.014, p < 0.001), number of alcoholic drinks consumed (std β = 0.006, p < 0.01), and perceived drunkenness (std β = 0.024, p < 0.001) had significant positive associations with BrAC self-estimates, where the regression coefficients were scaled by values approximately equal to each variable's interquartile range. Among the 321 participants with BrAC levels ≥ 0.08 g/dl, 21.2% believed their BrAC was below the legal per se driving limit of 0.08 g/dl. Results from a logistic regression analysis indicated that higher levels of perceived drunkenness were associated with better self-recognition that one's BrAC level exceeded the legal driving threshold (OR = 3.312, p < 0.001). Further, participants under 26 years of age had reduced odds of recognizing that their BrAC was greater than 0.079 g/dl (OR = 0.245, p < 0.05).

CONCLUSIONS

These findings highlight the inaccuracy of self-estimated BrAC when drinking, particularly among younger drinkers. Adjusting for BrAC, situational factors were strongly associated with self-estimated BrAC. Future research is needed to better understand how altering drinking environments may improve accuracy of BrAC self-estimates and deter driving after drinking.

Alcohol use, risky sexual behavior, and condom possession among bar patrons

PURPOSE

The current study seeks to: 1) assess the relationship between alcohol consumption and intentions to engage in unprotected sex in an uncontrolled environment, and 2) to identify if covariates (race, age, sex, breath alcohol content (BrAC), intentions to engage in sex, hazardous drinking rates) are significant predictors of condom possession during time of uncontrolled alcohol consumption.

METHODS

Data were collected from 917 bar patrons to assess alcohol use using the Alcohol Use Disorders Identification Test (AUDIT-C), BrAC levels, intentions to engage in risky sex, and condom possession. Correlational analysis and hierarchical binary logistic regression was conducted using SPSS.

RESULTS

Correlational analyses indicated a negative relationship between AUDIT-C scores (r=-0.115, p=0.001), BrAC (r=-0.08, p=0.015), and intentions to use a condom. Over 70% of participants intended to use a condom if they engaged in sex; however, only 28.4% had a condom to use. The regression analysis indicated the predictive model (χ(2)=114.5, df=8, p<0.001) was statistically significant, and correctly classified 72.9% of those in possession of a condom.

CONCLUSIONS

Alcohol consumption was associated with intentions to have unprotected sex; however, intentions to engage in protected sex and condom possession were higher for males and those with higher BrAC levels.

Alcohol mixed with energy drink: Use may be a consequence of heavy drinking

AIMS

In recent years, studies have indicated that consumers of alcohol mixed with energy drink (AmED) are more likely to drink heavily and experience more negative consequences than consumers who avoid these beverages. Although researchers have identified a number of plausible hypotheses that explain how alcohol-energy drink co-ingestion could cause greater alcohol consumption, there has been no postulation about reverse causal relations. This paper identifies several plausible hypotheses for the observed associations between AmED consumption and greater alcohol consumption, and provides initial evidence for one such hypothesis suggesting that heavy drinking may be a determinant of AmED use.

METHOD

Data collected from 511bar patrons were used to examine the plausibility of one of the proposed hypotheses, i.e., AmED is an artifact of heavy drinking. Associations between the consumption of an assortment of alcoholic beverage types and total alcohol consumption were examined at the event-level, to assess whether AmED is uniquely related with greater alcohol consumption.

RESULTS

Increased alcohol consumption was associated with greater odds of consuming most alcoholic beverage types; this association was not unique to AmED.

CONCLUSIONS

Results support the overlooked hypothesis that AmED use is an artifact of heavy drinking. Thus, AmED consumption may be a consequence or marker of heavier drinking. Much of the existing research on alcoholic beverage types is limited in its ability to implicate any specific type of drink, including AmED, as a cause of increased alcohol consumption and related harm. More rigorous study designs are needed to examine causal relationships.

A field-based community assessment of intoxication levels across college football weekends: does it matter who's playing?

While alcohol consumption has been consistently linked to college football games in the United States, this literature lacks (a) field-based event-level analyses; (b) assessments of the context of drinking, such as days leading to an event, that occurs in conjunction with a contest; (c) investigations of non-student drinking; and (d) objective assessments of opponent rating. Therefore, the present study: (1) examines the extent to which breath alcohol concentrations (BrAC) among restaurant and bar district patrons differ for low- and high-profile games and (2) explores the relationship between an objective rating of a team's opponent and BrAC levels. Data were collected throughout the fall 2011 football season via six anonymous field studies in a bar district within a southeastern college community. During low-profile game weekends, respondents recorded significantly lower BrAC levels than those during high-profile game weekends. Additionally, there was a positive correlation between opponent rating and BrAC levels, such that mean BrAC readings were highest prior to the game featuring the highest rated opponent. Overall, participants exhibited significantly higher BrACs when a higher-rated opponent was playing that weekend. When resources (money, manpower) are limited, community-based prevention and enforcement efforts should occur during the weekends surrounding higher-profile games.

Emerging adults' use of alcohol and social networking sites during a large street festival: A real-time interview study

Background

Emerging adults have high rates of heavy episodic drinking (binge drinking) and related risks including alcohol-impaired driving. To understand whether social networking sites (SNSs) used on mobile devices represent a viable platform for real-time interventions, this study measured emerging adults’ use of two popular SNSs (Facebook and Twitter) during the Mifflin Street Block Party. This annual festival is held in Madison, Wisconsin and is known for high alcohol consumption.

Findings

Event attendees ages 18–23 years were recruited by young adult research assistants (>21 years). Participants completed a brief in-person interview assessing drinking intensity, use of SNSs, and use of SNSs to plan transportation. Analyses included t-tests, chi-squared tests, and Fisher’s exact tests. At the event, nearly all of the 200 participants (97 %) consumed alcohol and 18 % met criteria for heavy episodic drinking. Approximately one-third of participants had used Facebook or Twitter on the day of the event. Facebook use (23 %) was more prevalent than Twitter use (18 %), especially among heavy episodic drinkers. Use of either SNS was 41 % among females and 24 % among males (χ² = 6.01; df = 1; p = 0.01). Plans to use a SNS to arrange transportation were relatively uncommon (4 %), but this was more frequent among heavy episodic drinkers (11 %) compared to non-heavy episodic drinkers (2 %) (Fisher’s exact p = 0.02).

Conclusions

These results indicate that SNSs are used during alcohol consumption and warrant exploration as a way to facilitate connections to resources like safe ride services.

A field investigation of the effects of drinking consequences on young adults' readiness to change

In the research on readiness to change (RTC) one's drinking, there has been little assessment of the influence of positive drinking consequences or other potential moderating variables. To address these limitations, we examined how young adults' RTC their alcohol consumption shortly following a drinking episode was associated with self-reported drinking consequences, as well as any potential moderating effects of gender and Breath Alcohol Concentration (BrAC). In street interviews outside bars, 238 young adults were administered questionnaires about their drinking, including a measure examining participants' current readiness to reduce their alcohol consumption. Within 72h of their drinking episode, 67 participants (36 males; entire sample Mage=20.90years, Range=18-26years) completed an online survey, once again measuring RTC as well as positive and negative drinking consequences. Consistent with our hypothesis, positive drinking consequences were negatively associated with participants' changes in RTC. Additionally, a three-way interaction of gender×BrAC×positive drinking consequences on RTC showed that females with low BrACs reported higher RTC scores when they had endorsed fewer positive drinking consequences. Interestingly, negative drinking consequences alone did not impact individuals' RTC. Because positive drinking consequences were a significantly better predictor of RTC than were negative drinking consequences, researchers are advised to examine both types of consequences in future studies. Finally, effective alcohol education programs for those who have never consumed alcohol as well as social drinkers should include consideration of the experience of positive outcomes.

Readiness to change and reasons for intended reduction of alcohol consumption in emergency department versus trauma population

Introduction

The primary objective was to identify the most common reasons for intending to cut back on alcohol use, in emergency department (ED) and trauma patient populations. The secondary objective was to determine the association between reason to cut back on alcohol and education level.

Methods

We conducted the study at a level one trauma center in California between 2008 and 2012. This was a retrospective analysis of data collected from computerized alcohol screening and intervention (CASI). We excluded patients who drank too little, and those whose scores were consistent with dependency (Alcohol Use Disorders Identification Test [AUDIT]>19). The CASI database includes the patient’s age, gender, language, education level, an AUDIT score (1–40 scale), a readiness to change score (1–10), and the option to choose any of 10 “reasons to cut back” on their alcohol consumption.

Results

From 10,537 patients, 1,202 met criteria for the study (848 ED, 354 trauma). Overall, the most common reasons cited for cutting back on alcohol were “To avoid health problems” (68.5%), “To avoid getting a DUI” (43.6%), “It could save me money” (42.0%), and “To avoid situations where I could get hurt” (41.0%). Trauma patients cited the following reasons significantly more than ED patients: “To avoid situations where I could get hurt” (46.3% versus 38.8%, respectively), “So I can be in control of my behavior” (40.7% versus 32.2%), and “My partner or spouse wants me to stop” (20.1% versus 15.0%). Additionally, those patients who cited “To avoid health problems” reported 1.2 points higher than average (p<0.001) on the 10-point readiness to change scale. Those who have completed some college or an associate degree cited “To avoid health problems” less often than high school graduates (odds ratio [OR] 0.45), while they cited “To avoid situations where I could get hurt” (OR 2.5) and “To avoid being in a car crash caused by alcohol use” (OR 3.8) more often than high school graduates.

Conclusion

Health, injury, finances, and legal issues remain top concerns for patients, while trauma patients specifically had proportionately more concerns with situations where they could get hurt.

Acute and chronic effects of alcohol on trail making test performance among underage drinkers in a field setting

OBJECTIVE

Alcohol's effects on executive functioning are well documented. Research in this area has provided much information on both the acute and chronic effects of alcohol on processes such as working memory and mental flexibility. However, most research on the acute effects of alcohol is conducted with individuals older than 21 years of age. Using field recruitment methods can provide unique empirical data on the acute effects of alcohol on an underage population.

METHOD

The current study examined the independent effects of acute alcohol intoxication (measured by breath alcohol content) and chronic alcohol use (measured by years drinking) on a test of visuomotor performance and mental flexibility (Trail Making Test) among 91 drinkers ages 18-20 years recruited from a field setting.

RESULTS

Results show that breath alcohol predicts performance on Trails B, but not on Trails A, and that years drinking, above and beyond acute intoxication, predicts poorer performance on both Trails A and B.

CONCLUSIONS

These data suggest that, independent of the acute effects of alcohol, chronic alcohol consumption has deleterious effects on executive functioning processes among underage drinkers. Our discussion focuses on the importance of these data in describing the effect of alcohol on adolescents and the potential for engaging in risky behavior while intoxicated.

Gender, history of alcohol use and number of drinks consumed predict craving among drinkers in a field setting

To the extent that craving serves to compel excessive drinking, it would be important to predict the intensity of an individual's craving over the course of a drinking episode. Previous research indicates that regular alcohol use (measured by the AUDIT) and the number of drinks individuals have already consumed that evening independently predict craving to drink (Schoenmakers & Wiers, 2010). The current study aims to replicate those findings by testing whether these same variables predict craving to drink in a sample of 1320 bar patrons in a naturalistic setting. In addition, we extend those findings by testing whether regular alcohol use and self-reported number of drinks consumed interact to predict craving, and whether gender independently predicts craving or interacts with other variables to predict craving. Results indicate that for men, AUDIT score alone predicted craving, whereas for women, AUDIT score and number of drinks consumed interacted to predict craving, with craving highest among women with either high AUDIT scores or relatively high consumption levels. Our findings have implications for targeted intervention and prevention efforts, as women who have a history of harmful alcohol use and consume several drinks in an evening might be at the greatest risk for continued alcohol consumption.

Are we drunk yet? Motor versus cognitive cues of subjective intoxication

BACKGROUND

Perception of alcohol intoxication presumably plays an important role in guiding behavior during a current drinking episode. Yet, there has been surprisingly little investigation of what aspects associated with intoxication are used by individuals to attribute their level of intoxication.

METHODS

Building on recent laboratory-based findings, this study employed a complex field-based design to explore the relative contributions of motor performance versus cognitive performance-specifically executive control-on self-attributions of intoxication. Individuals recruited outside of bars (N = 280; mean age = 22; range: 18 to 32) completed a structured interview, self-report questionnaire, and neuropsychological testing battery, and provided a breath alcohol concentration (BrAC) sample.

RESULTS

Results of a multiple linear regression analysis demonstrated that current level of subjective intoxication was associated with current alcohol-related stimulant effects, current sedative effects, and current BrAC. After controlling for the unique variance accounted for by these factors, subjective intoxication was better predicted by simple motor speed, as indexed by performance on the Finger Tapping Test, than by executive control, as indexed by performance on the Trail Making Test.

CONCLUSIONS

These results-generated from data collected in a naturally occurring setting-support previous findings from a more traditional laboratory-based investigation, thus illustrating the iterative process of linking field methodology and controlled laboratory experimentation.

Validating the ability of a single-item assessing drunkenness to detect hazardous drinking

BACKGROUND

To simplify the screening process to identify problem drinking, researchers have developed single-item, quantity-based instruments. Quantity-based items, however, suffer from several limitations.

OBJECTIVE

Determine whether a non-quantity-based single item assessing drunkenness would be able to identify those who exhibited signs of hazardous alcohol use, as determined by Alcohol Use Disorders Identification Test (AUDIT)-C scores.

METHODS

Between September and November of 2011, the alcohol-related behaviors of 1062 self-identified current drinkers were assessed with self-report measures (i.e. AUDIT-C and one item assessing frequency of drunkenness) in addition to corresponding biologic samples (i.e. breath alcohol concentration (BrAC) samples). We assessed the concurrent validity of the single item to identify hazardous alcohol use established via gender-based AUDIT-C thresholds. Convergent validity of the single-item was assessed by determining its relationship to BrAC levels.

RESULTS

The single item accounted for 0.791 of the area under the received operating characteristics curve for hazardous alcohol use (p < 0.001). When employing a cut-off of 1, the single-item question was 95.9% sensitive in identifying hazardous alcohol use.

CONCLUSION

The results reported herein highlight the validity (both concurrent and convergent) and potential utility of a non-quantity-based single-item alcohol screen for assessing drunkenness. Additional research is warranted to confirm the utility of this one-item drunkenness measure to capture risk of injury and hazardous drinking.

ADOLESCENTS AND ALCOHOL

The high levels of alcohol consumption characteristic of adolescence may be in part biologically based, given that elevated consumption levels are also evident during this developmental transition in other mammalian species as well. Studies conducted using a simple animal model of adolescence in the rat has shown adolescents to be more sensitive than adults to social facilitatory and rewarding effects of alcohol, but less sensitive to numerous alcohol effects that may serve as cues to limit intake. These age-specific alcohol sensitivities appear related to differential rates of development of neural systems underlying different alcohol effects as well as to an ontogenetic decline in rapid brain compensations to alcohol, termed "acute tolerance". In contrast, these adolescent-typical sensitivities to alcohol do not appear to be notably influenced by pubertally-related increases in gonadal hormones. Although data are sparse, there are hints that similar alcohol sensitivities may also be seen in human adolescents, with this developmentally decreased sensitivity to alcohol's intoxicating effects possibly exacerbated by genetic vulnerabilities also characterized by an insensitivity to alcohol intoxication, thereby perhaps permitting especially high levels of alcohol consumption among vulnerable youth.