Brief motivational interventions for heavy college drinkers: A randomized controlled trial

"Letter to my future self" as a device for assessing health education effectiveness

OBJECTIVE

To examine whether a "letter to my future self" analyzed using structural topic modeling (STM) represents a useful technique in revealing how participants integrate educational content into planned future behaviors.

METHODS

453 club-sports athletes in a concussion-education randomized control study wrote two-paragraph letters describing what they hoped to remember after viewing one of three randomly assigned educational interventions.

RESULTS

A six-topic solution revealed three topics related to the content of the education and three topics related to the participant behavioral takeaways. The content-related topics reflected the educational content viewed. The behavioral takeaway topics indicated that the Consequence-based education was more likely to generate the Concussion Seriousness[CS:23%] topic while Traditional(24%) and Consequence-based(20%) interventions were more likely to generate the Responsibility for Brain Health[BH] topic. Traditional(21%) and Revised-symptom(17%) interventions were more likely to generate the Awareness and Action topics.

CONCLUSION

Unstructured user-generated data in the form of a "letter to my future self" analyzed using structural topic modeling provides a novel evaluation of the present and likely future impact of educational interventions.

PRACTICE IMPLICATIONS

Patient educators can enhance the effectiveness of education through the application of these methods to the evaluation of and innovation in programs.

Writing about the future self to shift drinking identity: An experimental investigation

College student drinking is prevalent and costly to public and personal health, leading to calls to identify and target novel mechanisms of behavior change. We aimed to manipulate drinking identity (a cognitive risk factor for hazardous drinking) via three sessions of narrative writing about a future self. We tested whether writing could shift drinking identity and would be accompanied by changes in alcohol consumption and problems. Participants were college students meeting hazardous drinking criteria (N = 328; Mage = 20.15; 59% women, 40% men, 1% gender-diverse; 60% white; 23% Asian; 12% multiple races; 2% other racial groups; 8% identified as Hispanic/Latino/a/x). The study had a 2 [narrative writing topic: low-risk drinker vs. reduced smartphone use] × 2 [writing perspective: first person vs. non-first-person] × 2 [social network instruction: instructed to include vs. not] factorial design. Outcomes were drinking identity, drinking refusal self-efficacy, alcohol consumption, alcohol-related problems, and craving. Participants completed three writing sessions and online follow-up assessments at 2, 4, and 12 weeks. The study is a registered clinical trial; hypotheses and analyses were preregistered (https://osf.io/vy2ep/). Contrary to predictions, narrative writing about a future self as a low-risk drinker did not significantly impact outcomes. Null results extended to expected interactions with writing perspective and social network instructions. The narrative writing task did not shift drinking or alcohol-related outcomes. Future experimental work may benefit from greater flexibility in conceptualizing a future self, recruiting individuals interested in behavior change, and more sensitive measures of drinking identity.

Motivational interviewing for substance use reduction

BACKGROUND

Substance use is a global issue, with around 30 to 35 million individuals estimated to have a substance-use disorder. Motivational interviewing (MI) is a client-centred method that aims to strengthen a person's motivation and commitment to a specific goal by exploring their reasons for change and resolving ambivalence, in an atmosphere of acceptance and compassion. This review updates the 2011 version by Smedslund and colleagues.

OBJECTIVES

To assess the effectiveness of motivational interviewing for substance use on the extent of substance use, readiness to change, and retention in treatment.

SEARCH METHODS

We searched 18 electronic databases, six websites, four mailing lists, and the reference lists of included studies and reviews. The last search dates were in February 2021 and November 2022.

SELECTION CRITERIA

We included randomised controlled trials with individuals using drugs, alcohol, or both. Interventions were MI or motivational enhancement therapy (MET), delivered individually and face to face. Eligible control interventions were no intervention, treatment as usual, assessment and feedback, or other active intervention.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane, and assessed the certainty of evidence with GRADE. We conducted meta-analyses for the three outcomes (extent of substance use, readiness to change, retention in treatment) at four time points (post-intervention, short-, medium-, and long-term follow-up).

MAIN RESULTS

We included 93 studies with 22,776 participants. MI was delivered in one to nine sessions. Session durations varied, from as little as 10 minutes to as long as 148 minutes per session, across included studies. Study settings included inpatient and outpatient clinics, universities, army recruitment centres, veterans' health centres, and prisons. We judged 69 studies to be at high risk of bias in at least one domain and 24 studies to be at low or unclear risk. Comparing MI to no intervention revealed a small to moderate effect of MI in substance use post-intervention (standardised mean difference (SMD) 0.48, 95% confidence interval (CI) 0.07 to 0.89; I2 = 75%; 6 studies, 471 participants; low-certainty evidence). The effect was weaker at short-term follow-up (SMD 0.20, 95% CI 0.12 to 0.28; 19 studies, 3351 participants; very low-certainty evidence). This comparison revealed a difference in favour of MI at medium-term follow-up (SMD 0.12, 95% CI 0.05 to 0.20; 16 studies, 3137 participants; low-certainty evidence) and no difference at long-term follow-up (SMD 0.12, 95% CI -0.00 to 0.25; 9 studies, 1525 participants; very low-certainty evidence). There was no difference in readiness to change (SMD 0.05, 95% CI -0.11 to 0.22; 5 studies, 1495 participants; very low-certainty evidence). Retention in treatment was slightly higher with MI (SMD 0.26, 95% CI -0.00 to 0.52; 2 studies, 427 participants; very low-certainty evidence). Comparing MI to treatment as usual revealed a very small negative effect in substance use post-intervention (SMD -0.14, 95% CI -0.27 to -0.02; 5 studies, 976 participants; very low-certainty evidence). There was no difference at short-term follow-up (SMD 0.07, 95% CI -0.03 to 0.17; 14 studies, 3066 participants), a very small benefit of MI at medium-term follow-up (SMD 0.12, 95% CI 0.02 to 0.22; 9 studies, 1624 participants), and no difference at long-term follow-up (SMD 0.06, 95% CI -0.05 to 0.17; 8 studies, 1449 participants), all with low-certainty evidence. There was no difference in readiness to change (SMD 0.06, 95% CI -0.27 to 0.39; 2 studies, 150 participants) and retention in treatment (SMD -0.09, 95% CI -0.34 to 0.16; 5 studies, 1295 participants), both with very low-certainty evidence. Comparing MI to assessment and feedback revealed no difference in substance use at short-term follow-up (SMD 0.09, 95% CI -0.05 to 0.23; 7 studies, 854 participants; low-certainty evidence). A small benefit for MI was shown at medium-term (SMD 0.24, 95% CI 0.08 to 0.40; 6 studies, 688 participants) and long-term follow-up (SMD 0.24, 95% CI 0.07 to 0.41; 3 studies, 448 participants), both with moderate-certainty evidence. None of the studies in this comparison measured substance use at the post-intervention time point, readiness to change, and retention in treatment. Comparing MI to another active intervention revealed no difference in substance use at any follow-up time point, all with low-certainty evidence: post-intervention (SMD 0.07, 95% CI -0.15 to 0.29; 3 studies, 338 participants); short-term (SMD 0.05, 95% CI -0.03 to 0.13; 18 studies, 2795 participants); medium-term (SMD 0.08, 95% CI -0.01 to 0.17; 15 studies, 2352 participants); and long-term follow-up (SMD 0.03, 95% CI -0.07 to 0.13; 10 studies, 1908 participants). There was no difference in readiness to change (SMD 0.15, 95% CI -0.00 to 0.30; 5 studies, 988 participants; low-certainty evidence) and retention in treatment (SMD -0.04, 95% CI -0.23 to 0.14; 12 studies, 1945 participants; moderate-certainty evidence). We downgraded the certainty of evidence due to inconsistency, study limitations, publication bias, and imprecision.

AUTHORS' CONCLUSIONS

Motivational interviewing may reduce substance use compared with no intervention up to a short follow-up period. MI probably reduces substance use slightly compared with assessment and feedback over medium- and long-term periods. MI may make little to no difference to substance use compared to treatment as usual and another active intervention. It is unclear if MI has an effect on readiness to change and retention in treatment. The studies included in this review were heterogeneous in many respects, including the characteristics of participants, substance(s) used, and interventions. Given the widespread use of MI and the many studies examining MI, it is very important that counsellors adhere to and report quality conditions so that only studies in which the intervention implemented was actually MI are included in evidence syntheses and systematic reviews. Overall, we have moderate to no confidence in the evidence, which forces us to be careful about our conclusions. Consequently, future studies are likely to change the findings and conclusions of this review.

Do brief motivational interventions increase motivation for change in drinking among college students? A two-step meta-analysis of individual participant data

BACKGROUND

Brief motivational interventions (BMIs) are one of the most effective individually focused alcohol intervention strategies for college students. Despite the central theoretical role of motivation for change in BMIs, it is unclear whether BMIs increase motivation to change drinking behavior. We conducted a two-step meta-analysis of individual participant data (IPD) to examine whether BMIs increase motivation for change. N = 5903;59% women, 72% White) from Project INTEGRATE. The BMIs included individually delivered motivational interviewing with personalized feedback (MI + PF), stand-alone personalized feedback (PF), and group-based motivational interviewing (GMI).

METHODS

We included 15 trials of BMI (N = 5903;59% women, 72% White) from Project INTEGRATE. The BMIs included individually-delivered motivational interviewing with personalized feedback (MI + PF), stand-alone personalized feedback (PF), and group-based motivational interviewing (GMI). Different measures and responses used in the original trials were harmonized. Effect size estimates were derived from a model that adjusted for baseline motivation and demographic variables for each trial (step 1) and subsequently combined in a random-effects meta-analysis (step 2).

RESULTS

The overall intervention effect of BMIs on motivation for change was not statistically significant (standard mean difference [SMD]: 0.026, 95% CI: [-0.001, 0.053], p = 0.06, k = 19 comparisons). Of the three subtypes of BMIs, GMI, which tended to provide motivation-targeted content, had a statistically significant intervention effect on motivation, compared with controls (SMD: 0.055, 95% CI: [0.007, 0.103], p = 0.025, k = 5). By contrast, there was no evidence that MI + PF (SMD = 0.04, 95% CI: [-0.02, 0.10], k = 6, p = 0.20) nor PF increased motivation (SMD = 0.005, 95% CI: [-0.028, 0.039], k = 8, p = 0.75), compared with controls. Post hoc meta-regression analysis suggested that motivation sharply decreased each month within the first 3 months postintervention (b = -0.050, z = -2.80, p = 0.005 for k = 14).

CONCLUSIONS

Although BMIs provide motivational content and normative feedback and are assumed to motivate behavior change, the results do not wholly support the hypothesis that BMIs improve motivation for change. Changing motivation is difficult to assess during and following interventions, but it is still a theoretically important clinical endpoint. Further, the evidence cautiously suggests that changing motivation may be achievable, especially if motivation-targeted content components are provided.

Enhancing distress tolerance to uplift motivation in recovery: Results from an open development trial

Objective

This open pilot study examines the feasibility, acceptability, and qualitative outcomes of an interactive web- and text message-delivered personalized feedback intervention aimed at cultivating motivation and tolerance of distress for adults initiating outpatient buprenorphine treatment.

Methods

Patients (n = 10) initiating buprenorphine within the past 8 weeks first completed a web-based intervention focused on enhancing motivation and providing psychoeducation on distress tolerance skills. Participants then received 8 weeks of daily personalized text messages that provided reminders of salient motivational factors and recommended distress tolerance-oriented coping skills. Participants completed self-report measures to assess intervention satisfaction, perceived usability, and preliminary efficacy. Additional perspectives were captured via qualitative exit interviews.

Results

In total, 100% of retained participants (n = 9) engaged with the text messages throughout the entire 8-week period. Mean scores of 27 (SD = 5.05) on the Client Satisfaction Questionnaire at the end of 8-week period indicated a high degree of satisfaction with the text-based intervention. The average rating on the System Usability Scale was 65.3 at the end of the 8-week program, suggesting that the intervention was relatively easy to use. Participants also endorsed positive experiences with the intervention during qualitative interviews. Clinical improvements were observed across the intervention period.

Conclusions

Preliminary findings from this pilot suggest that the content and delivery method of this combined web- and text message-based personalized feedback intervention is perceived by patients as feasible and acceptable. Leveraging digital health platforms to augment buprenorphine has potential for high scalability and impact to reduce opioid use, increase adherence/retention to treatment, and prevent future incidence of overdose. Future work will evaluate the efficacy of the intervention in a randomized clinical trial design.

What Predicts Willingness to Experience Negative Consequences in College Student Drinkers?

OBJECTIVE

Research has shown that students who were more willing to experience consequences reported higher rates of alcohol consumption and negative consequences. The present study used a longitudinal design to examine intra- and interpersonal consequence-specific predictors of willingness to experience negative consequences.

METHOD

Students (N = 2,024) were assessed in the fall (Time [T] 1) and spring (T2) semesters of their first year in college. Intrapersonal constructs (i.e., expectancies, subjective evaluations, self-efficacy), interpersonal constructs (i.e., peer descriptive, injunctive norms), and personality constructs (i.e., self-regulation, impulsivity, sensation seeking) were assessed at T1 and willingness to experience negative alcohol-related consequences was assessed 6 months later. A structural path model examined the relationship between T1 predictors and T2 willingness. T1 drinking and sex were included as covariates.

RESULTS

These results demonstrated significant positive relationships between T1 participants' subjective evaluations of consequences, expectancies of experiencing consequences, and T2 willingness to experience negative consequences. Further, impulsivity, sensation seeking, and T1 drinking showed significant, positive associations with willingness, whereas higher self-regulation was significantly associated with lower willingness. Men were significantly more willing to experience negative consequences than women. No significant associations were observed between normative perceptions and willingness.

CONCLUSIONS

Intrapersonal and personality constructs, as well as previous drinking, were significantly associated with willingness to experience consequences whereas interpersonal constructs were not. Men were significantly more willing to experience negative consequences. College student interventions may benefit from focusing on significant constructs identified in the current study (e.g., enhancing self-regulation) and focusing on students with higher willingness to experience negative consequences.

Repeated Assessment of Alcohol Use and Perceived Norms Among College Students Who Drink: Comparisons to a Minimal Assessment at 12-Month Follow-Up

OBJECTIVE

Clinical trials assessing efficacy of alcohol use interventions often aim to test differences between treatment and control conditions at several follow-up time points, requiring repeated assessment of outcomes (e.g., weekly number of drinks). There has been concern that repeated assessment may elicit assessment reactivity in which participants, even those who did not receive treatment, reduce their alcohol use, but findings in the literature have been mixed. The current study of assessment reactivity compared two control conditions that were part of a larger randomized controlled trial: (a) repeated assessment that completed surveys at baseline, 3-, 6-, and 12-month follow-ups, and (b) minimal assessment that only completed surveys at baseline and 12-month follow-up. Outcomes assessed at 12-month follow-up included (a) changes in alcohol use behavior and negative consequences, (b) changes in perceived descriptive and injunctive norms, and (c) participant attrition/retention.

METHOD

Participants were undergraduate students who reported at least one heavy drinking occasion (4+/5+ drinks for women/men) in the past month (N = 456; 63.3% female; mean age = 20.11 years).

RESULTS

Multiple regression models indicated no significant differences between the repeated and minimal assessment control conditions on any indices of alcohol use (p values ranged from .42 to .97), negative consequences (p = .39), or on perceived descriptive/injunctive norms (p = .60 and .23, respectively). Attrition at 12-month follow-up was low in both groups, but significantly higher (p = .006) in the repeated assessment condition (16.49%) than the minimal assessment condition (8.55%).

CONCLUSIONS

Repeated assessment did not elicit changes in alcohol use, negative consequences, or perceived norms. A minimal assessment control condition may not be necessary when assessing intervention efficacy across longitudinal follow-ups. However, when attrition at 12-month follow-up is a salient concern, a minimal assessment control may retain more participants than repeated assessment.

Using administrative data to uncover how often and why supervisory neglect happens: Implications for child maltreatment prevention

BACKGROUND

Despite supervisory neglect being the most prevalent and fatal neglect sub-type, the most common reasons why caregivers are substantiated for this type of maltreatment remains unknown.

OBJECTIVE

Our study describes cases substantiated for supervisory neglect in a Midwestern state in an effort to inform prevention strategies against supervisory neglect.

PARTICIPANTS AND SETTING

This study utilized state administrative data from substantiated child maltreatment investigations conducted between May 1st and October 31st, 2019 (N = 11,208).

METHODS

We first identified the substantiated investigations where supervisory neglect was present and established investigation-level correlates for these cases. We then selected a random sample of investigations with a substantiated allegation of supervisory neglect (n = 150) for a qualitative review of written investigative narratives to uncover the contextual factors of supervisory neglect and identify which factors frequently co-occur.

RESULTS

Supervisory neglect was the most common maltreatment type, present in 71% (n = 7945) of substantiated child welfare investigations. Our qualitative review of 150 randomly selected cases identified ten distinct, non-mutually exclusive contextual factors of supervisory neglect. Child exposure to domestic violence was the most prevalent contextual factor (45%), followed by caregiver's substance-related problems (42%). Childhood exposure to domestic violence and caregiver's substance-related problems was the most common co-occurrence of factors, present in 18% of cases.

CONCLUSIONS

Supervisory neglect accounts for the vast majority of child maltreatment incidents. To prevent the largest share of supervisory neglect cases, policy and programs are needed to address domestic violence and substance-related problems among caregivers.

Insight into Selecting Adolescents for Drinking Intervention Programs: a Simulation Based on Stochastic Actor-Oriented Models

Adolescent drinking remains a prominent public health and socioeconomic issue in the USA with costly consequences. While numerous drinking intervention programs have been developed, there is little guidance whether certain strategies of participant recruitment are more effective than others. The current study aims at addressing this gap in the literature using a computer simulation approach, a more cost-effective method than employing actual interventions. We first estimate stochastic actor-oriented models for two schools from the National Longitudinal Study of Adolescent to Adult Health (Add Health). We then employ different strategies for selecting adolescents for the intervention (either based on their drinking levels or their positions in the school network) and simulate the estimated model forward in time to assess the aggregated level of drinking in the school at a later time point. The results suggest that selecting moderate or heavy drinkers for the intervention produces better results compared to selecting casual or light drinkers. The intervention results are improved further if network position information is taken into account, as selecting drinking adolescents with higher in-degree or higher eigenvector centrality values for intervention yields the best results. Results from this study help elucidate participant selection criteria and targeted network intervention strategies for drinking intervention programs in the USA.

What really matters in binge drinking: A dominance analysis of binge drinking psychological determinants among University students

Introduction

Binge drinking (BD) is a public health concern, especially in young people. Multiple individual factors referring to different level of analyses - positional, inter-individual and intra-individual - are associated to BD. As they have mainly been explored separately, little is known about the psychological variables most associated with BD. This study, based on an integrative model considering a large number of variables, aims to estimate these associations and possible dominance of some variables in BD.

Methods

A sample of university students (N = 2851) participated in an internet survey-based study. They provided information on alcohol related variables (AUDIT, BD score), positional factors (sex, age), inter-individual factors (subjective norm, social identity, external motivations), and intra-individual factors (internal motivations, meta-cognitions, impulsivity and personality traits). The data were processed via a backward regression analysis including all variables and completed with a dominance analysis on variables that are significantly associated with BD intensity.

Results

The strongest variables associated with BD intensity were enhancement motives and drinking identity (average ΔR ² = 21.81%), followed by alcohol subjective norm and social motives (average ΔR ² = 13.99%). Other associated variables (average ΔR ² = 2,84%) were negative metacognition on uncontrollability, sex, coping motives, lack of premeditation, positive metacognition on cognitive self-regulation, positive urgency, lack of perseverance, age, conformity motives and loneliness.

Conclusion

Results offer new avenues at the empirical level, by spotting particularly inter-individual psychological variables that should be more thoroughly explored, but also at the clinical level, to elaborate new prevention strategies focusing on these specific factors.

Changes in Young Adults' Alcohol and Marijuana Use, Norms, and Motives From Before to During the COVID-19 Pandemic

PURPOSE

Alongside the SARS-CoV-2 virus, the COVID-19 pandemic is associated with several secondary health effects. There is concern for increased substance use motivated by coping with stress, anxiety, depression, and boredom-all of which may be elevated during the pandemic. The current study examined intraindividual changes (from pre-COVID to during COVID) in young adults' alcohol and marijuana use, perceptions of peers' use (i.e., norms), and motives for use.

METHODS

A community sample of young adults (N = 572; Mage= 25.14; 60.8% women) was recruited in Washington State. By using a repeated-measures design, data were collected prior to the COVID-19 pandemic (January 2020) and again during the initial acute phase of the pandemic (April/May of 2020).

RESULTS

Young adults, on average, increased alcohol use frequency but decreased the amount consumed per drinking occasion. No changes in marijuana use were identified. Young adults (on average) perceived that peers had increased the frequency and total amount of alcohol use and perceived that peers were engaging in heavier marijuana use than prior to COVID-19. For alcohol use motives, there was a significant increase in depression coping motives and significant decreases in social, enhancement, and conformity motives. Boredom motives for marijuana use significantly increased, while celebration motives decreased.

CONCLUSIONS

Using a prospective design with a sample initially recruited in Washington State, these data indicate that (a) young adults' patterns of alcohol use may have changed, (b) young adults tend to think that peers are engaging in heavier alcohol/marijuana use than before the pandemic, and (c) motives for using alcohol/marijuana may have changed during the pandemic.

The effects of pre-intervention mindset induction on a brief intervention to increase risk perception and reduce alcohol use among university students: A pilot randomized controlled trial

Objective

Brief interventions based on personalized feedback have shown promising results in reducing risky alcohol use among university students. We investigated the effects of activating deliberative (predecisional) or implemental (postdecisional) mindsets on the effectiveness of a standardized brief intervention, the ASSIST-linked Brief Intervention. This intervention comprises a personalized feedback and a decisional balance exercise. We hypothesized that participants in a deliberative mindset should show better outcomes related to risk perception and behavior than participants in an implemental mindset.

Methods

A sample of 257 students provided baseline measures on risk perception, readiness to change, and alcohol use. Of those, 64 students with risky alcohol use were randomly allocated to one of two mindset induction conditions–deliberative or implemental mindset. Thereafter, they received the ASSIST-linked Brief Intervention and completed self-report questionnaires on changes in risk perception, alcohol use, and readiness to change at post-intervention and four-week follow-up.

Results

In contrast to our hypotheses, the four-weeks follow-up revealed that participants in the implemental mindset consumed significantly less alcohol than participants in a deliberative mindset did. The former decreased and the latter increased their alcohol intake; resistance to the brief intervention was stronger in the latter condition. However, neither deliberative nor implemental mindset participants showed any changes in risk perceptions or in their readiness to change alcohol consumption.

Conclusions

These findings suggest that mindset induction is a powerful moderator of the effects of the ASSIST-linked Brief Intervention. We argue that systematic research on mindset effects on brief intervention techniques aimed to reduce risky alcohol use is highly needed in order to identify the processes involved with commitment and resistance being the main candidates.

Using motivational interviewing to enhance emerging adults' engagement in weight loss: The Live Well RVA pilot randomized clinical trial

Background

Emerging adults (ages 18–25) are at high risk for overweight/obesity, yet traditional adult behavioural weight loss (BWL) interventions do not meet the needs of individuals at this developmental stage. Motivational interviewing (MI) is an evidence‐based approach to promote behaviour change but has not been tested for weight loss in this population. The study aimed to test the feasibility and preliminary efficacy of an MI‐enhanced weight loss programme to promote engagement, retention and weight loss in emerging adults.

Methods

Emerging adults with overweight/obesity (N = 47, 81% female, 47% racial/ethnic minority, body mass index [BMI] = 33.2 ± 4.6 kg/m²) were randomized to either standard BWL or MI‐enhanced BWL (MIBWL). Weight was assessed objectively at baseline and posttreatment (3 months). Engagement (in‐person session attendance [weeks 1 and 2], online self‐monitoring [weeks 3–12] and online content viewing [weeks 3–12]) was tracked throughout the program.

Results

Though results did not reach the level of statistical significance, participants in MIBWL demonstrated greater programme engagement (77% vs. 61.0%, p = .11; Cohen d = .48), retention (71% vs. 48.0%, p = .10; Cohen h = .47) and intent‐to‐treat weight loss (−3.3% vs. −2.2%, p = .37; Cohen d = .26) compared with those in BWL.

Conclusions

Effect sizes suggest that MI might be a viable approach to enhance engagement and retention in weight loss programmes targeting emerging adults. This finding is meaningful, given the documented challenges with engagement and retention in this vulnerable population and the relationship between engagement and better weight loss outcomes. The results of this small pilot study support efforts to replicate these findings within the context of a fully powered trial.

A Brief Clinic-Based Intervention to Reduce Alcohol Misuse and Sexual Risk Behavior in Young Women: Results from an Exploratory Clinical Trial

This exploratory trial determined the feasibility, acceptability, and preliminary efficacy of a brief intervention (BI), supplemented with text messaging and a curated Web site, on alcohol use and sexual risk behavior among young women. Young women seeking care at a reproductive health clinic were screened for alcohol misuse and sexual risk behavior. Those who screened positive and who agreed to participate (N = 48; M = 22.67 years) were randomized to either (a) a brief in-person session during which personalized feedback regarding alcohol use and sexual risk taking was provided and discussed, or (b) a control condition. Feasibility was assessed by recruitment and retention rates. Acceptability was assessed with participant ratings of their intervention. Efficacy was measured using self-reported alcohol use and sexual behavior at baseline and during a 3-month follow-up. We supplemented the quantitative data with qualitative data from semi-structured interviews. Feasibility data indicated that 64% of eligible women agreed to participate, 74% of eligible women were enrolled, and 86% of enrolled women were retained through follow-up. Acceptability data showed that women who received the BI reported strong satisfaction with their intervention (M = 4.65 vs. 3.98 on a five-point scale) and also reported that text messaging was helpful (M = 4.73 on a seven-point scale) and acceptable (M = 5.27 on a seven-point scale). Qualitative data provided additional support for BI feasibility and acceptability. Efficacy data showed that women in both conditions reduced alcohol use and sexual risk behavior over time; women who received the BI reduced their maximum daily alcohol intake more than controls (BI from 7.68 to 4.82 standard drinks vs. control from 6.48 to 5.65; Wald χ² = 4.93, p < .05). Women in the BI reported fewer occasions of condomless sex (median = 2.50) than controls (median = 5.00) at the follow-up, but this difference was not statistically significant (OR = 0.61, 95% CI [0.32, 1.15]). A brief intervention, supplemented with text messaging and a Web site, that targeted alcohol use and sexual behavior was feasible and acceptable to young women and led to lower levels of alcohol misuse and sexual risk behavior.

Vida PURA: results from a pilot randomized trial of a culturally adapted screening and brief intervention to reduce unhealthy alcohol use among Latino day laborers

Latino immigrant men are at increased risk for unhealthy alcohol use. Vida PURA is a culturally adapted evidence-based intervention that consists of promotores providing screening and brief intervention to reduce unhealthy alcohol use among Latino immigrant men. The purpose was to assess the efficacy of Vida PURA in a pilot randomized control trial. Participants were screened for eligibility at a day labor worker center using the Alcohol Use Disorders Identification Test (AUDIT). Those with an AUDIT score ≥ 6 (N = 121) were randomized into an intervention (N = 77) or control group (N = 44). Participants in the intervention group received a brief intervention from a promotor including personalized feedback, motivational interviewing to assess their readiness to change, and referral to services. Participants in the control group received information about local substance use treatment services. We assessed changes in AUDIT scores, drinks per drinking day, drinking days, and frequency of heavy episodic drinking at 2 and 8 weeks following the baseline survey using a mixed-effects regression model. Many men had high AUDIT scores, indicating dependence. Both the intervention and control groups reduced their alcohol-related behaviors over time, but there were no significant differences between the groups. A culturally adapted brief intervention may not be enough to significantly reduce alcohol use among Latino day laborers, especially among those that are dependent. We discuss lessons learned from this trial, including the value of community-based approaches to reaching high-risk and underserved populations.

Testing the efficacy of motivational strategies, empathic reflections, and lifelike features in a computerized intervention for alcohol use: A factorial trial

Although computer delivered brief interventions (CDBIs) have been effective in reducing alcohol use, few studies have examined which components of CDBIs are most associated with drinking reductions. The current factorial trial deconstructed a brief alcohol intervention into component parts to identify main and interaction effects on drinking outcomes. Participants (N = 352) were randomly assigned to 1 of 16 possible combinations of four dichotomous (present vs. absent) CDBI components for which theoretical and empirical support was available: empathic reflections, motivational strategies, a spoken voice, and an animated narrator. We measured main and interaction effects of these components on the primary outcome of self-reported mean drinks per day at 1- and 3-month follow-up, as well as on secondary outcomes, including binge drinking, intentions to reduce drinking, and alcohol consequences. Participants reduced drinking across all alcohol use indices over the 3-month assessment period. These effects were stronger for participants who were exposed to motivational strategies, F = 7.7, p < .001. Empathic reflections, use of a spoken voice, and use of an animated narrator were not associated with reductions in alcohol use, either as main effects or in interaction with other factors. Results suggest that CDBIs using motivational strategies are effective in reducing alcohol use. However, empathic reflections and lifelike characteristics (e.g., narrator, voice) may operate differently in CDBIs than they do in person-delivered interventions. More research is needed to better understand how these (or other factors) may influence efficacy. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Group Cohesion and Climate in Cognitive Behavioral Therapy for Individuals with a First-Time DUI

Few studies have examined group cohesion and climate in the substance use disorder treatment literature. We examined whether group cohesion and climate are associated with increased self-efficacy outcomes and reduced drinks per week, binge drinking and DUI behaviors, in a sample of individuals with a first-time DUI receiving either cognitive behavioral therapy (CBT) or usual care. Additionally, we examined whether CBT moderates these relationships. Group measures and drinking outcomes were not significantly associated. This study is the first to provide an in-depth analysis on group processes in DUI settings, and as such, provides important insights into how group processes may differ in a mandated DUI context.

A Smartphone App to Assess Alcohol Consumption Behavior: Development, Compliance, and Reactivity

BACKGROUND

There are disadvantages-largely related to cost, participant burden, and missing data-associated with traditional electronic methods of assessing drinking behavior in real time. This potentially diminishes some of the advantages-namely, enhanced sample size and diversity-typically attributed to these methods. Download of smartphone apps to participants' own phones might preserve these advantages. However, to date, few researchers have detailed the process involved in developing custom-built apps for use in the experimental arena or explored methodological concerns regarding compliance and reactivity.

OBJECTIVE

The aim of this study was to describe the process used to guide the development of a custom-built smartphone app designed to capture alcohol intake behavior in the healthy population. Methodological issues related to compliance with and reactivity to app study protocols were examined. Specifically, we sought to investigate whether hazard and nonhazard drinkers would be equally compliant. We also explored whether reactivity in the form of a decrease in drinking or reduced responding ("yes") to drinking behavior would emerge as a function of hazard or nonhazard group status.

METHODS

An iterative development process that included elements typical of agile software design guided the creation of the CNLab-A app. Healthy individuals used the app to record alcohol consumption behavior each day for 21 days. Submissions were either event- or notification-contingent. We considered the size and diversity of the sample, and assessed the data for evidence of app protocol compliance and reactivity as a function of hazard and nonhazard drinker status.

RESULTS

CNLab-A yielded a large and diverse sample (N=671, mean age 23.12). On average, participants submitted data on 20.27 (SD 1.88) out of 21 days (96.5%, 20.27/21). Both hazard and nonhazard drinkers were highly compliant with app protocols. There were no differences between groups in terms of number of days of app use (P=.49) or average number of app responses (P=.54). Linear growth analyses revealed hazardous drinkers decreased their alcohol intake by 0.80 standard drinks over the 21-day experimental period. There was no change to the drinking of nonhazard individuals. Both hazard and nonhazard drinkers showed a slight decrease in responding ("yes") to drinking behavior over the same period.

CONCLUSIONS

Smartphone apps participants download to their own phones are effective and methodologically sound means of obtaining alcohol consumption information for research purposes. Although further investigation is required, such apps might, in future, allow for a more thorough examination of the antecedents and consequences of drinking behavior.

Elucidating the Effect of a Brief Drinking Intervention Using Neuroimaging: A Preliminary Study

BACKGROUND

Brief interventions have empirical support for acutely reducing alcohol use among non-treatment-seeking heavy drinkers. Neuroimaging techniques allow for the examination of the neurobiological effect of behavioral interventions, probing brain systems putatively involved in clinical response to treatment. Few studies have prospectively evaluated whether psychosocial interventions attenuate neural cue reactivity that in turn reduces drinking in the same population. This study aimed to examine the effect of a brief intervention on drinking outcomes, neural alcohol cue reactivity, and the ability of neural alcohol cue reactivity to prospectively predict drinking outcomes.

METHODS

Non-treatment-seeking heavy drinking participants were randomized to receive a brief interview intervention (n = 22) or an attention-matched control (n = 24). Immediately following the intervention or control, participants underwent a functional magnetic resonance imaging scan comprised of the alcohol taste cues paradigm. Four weeks after the intervention (or control), participants completed a follow-up visit to report on their past-month drinking. Baseline and follow-up percent heavy drinking days (PHDD) were calculated for each participant.

RESULTS

There was no significant effect of the brief intervention on PHDD at follow-up or on modulating neural activation to alcohol relative to water taste cues. There was a significant association between neural response to alcohol taste cues and PHDD across groups (Z > 2.3, p < 0.05), such that individuals who had greater neural reactivity to alcohol taste cues in the precuneus and prefrontal cortex (PFC) had fewer PHDD at follow-up.

CONCLUSIONS

This study did not find an effect of the brief intervention on alcohol use in this sample, and the intervention was not associated with differential neural alcohol cue reactivity. Nevertheless, greater activation of the precuneus and PFC during alcohol cue exposure predicted less alcohol use prospectively suggesting that these neural substrates subserve the effects of alcohol cues on drinking behavior.

Enrollment and assessment of a first-year college class social network for a controlled trial of the indirect effect of a brief motivational intervention

Heavy drinking and its consequences among college students represent a serious public health problem, and peer social networks are a robust predictor of drinking-related risk behaviors. In a recent trial, we administered a Brief Motivational Intervention (BMI) to a small number of first-year college students to assess the indirect effects of the intervention on peers not receiving the intervention.

OBJECTIVES

To present the research design, describe the methods used to successfully enroll a high proportion of a first-year college class network, and document participant characteristics.

METHODS

Prior to study enrollment, we consulted with a student advisory group and campus stakeholders to aid in the development of study-related procedures. Enrollment and baseline procedures were completed in the first six weeks of the academic semester. Surveys assessed demographics, alcohol use, and social network ties. Individuals were assigned to a BMI or control group according to their dormitory location.

RESULTS

The majority of incoming first-year students (1342/1660; 81%) were enrolled (55% female, 52% nonwhite, mean age 18.6 [SD = 0.51]). Differences between the intervention and control group were noted in alcohol use, but were in large part a function of there being more substance-free dormitory floors in the control group.

CONCLUSIONS

The current study was successful in enrolling a large proportion of a first-year college class and can serve as a template for social network investigations.

Efficacy of interventions targeting alcohol, drug and smoking behaviors in university and college students: A review of randomized controlled trials

OBJECTIVE

To evaluate the effectiveness of interventions targeting alcohol consumption, drug use and smoking for college/university students.

PARTICIPANTS

College/University students.

METHODS

Studies were eligible if: (1)included students attending universities/colleges; (2)implemented in a university/college setting; (3)aimed to improve at least one of the following behaviors: alcohol and/or drug use and/or smoking; (4)were RCTs. The effect of the interventions on behaviors was determined by the percentage of studies that reported an effect. Due to the heterogeneity of outcomes meta-analysis was not conducted.

RESULTS

88 studies met criteria. University-based interventions were effective for reducing alcohol-related outcomes (drinking patterns, BAC, consequences, problem drinking). Inconsistent findings for drug and smoking were observed.

CONCLUSIONS

University-based interventions have the potential to improve health for students. While there is a breadth of research examining the efficacy of interventions to reduce alcohol consumption, further research is needed to determine the best approach for addressing smoking and drug use among students.

Screening and Behavioral Counseling Interventions to Reduce Unhealthy Alcohol Use in Adolescents and Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force

IMPORTANCE

Unhealthy alcohol use is common, increasing, and a leading cause of premature mortality.

OBJECTIVE

To review literature on the effectiveness and harms of screening and counseling for unhealthy alcohol use to inform the US Preventive Services Task Force.

DATA SOURCES

MEDLINE, PubMed, PsycINFO, and the Cochrane Central Register of Controlled Trials through October 12, 2017; literature surveillance through August 1, 2018.

STUDY SELECTION

Test accuracy studies and randomized clinical trials of screening and counseling to reduce unhealthy alcohol use.

DATA EXTRACTION AND SYNTHESIS

Independent critical appraisal and data abstraction by 2 reviewers. Counseling trials were pooled using random-effects meta-analyses.

MAIN OUTCOMES AND MEASURES

Sensitivity, specificity, drinks per week, exceeding recommended limits, heavy use episodes, abstinence (for pregnant women), and other health, family, social, and legal outcomes.

RESULTS

One hundred thirteen studies (N = 314 466) were included. No studies examined benefits or harms of screening programs to reduce unhealthy alcohol use. For adolescents (10 studies [n = 171 363]), 1 study (n = 225) reported a sensitivity of 0.73 (95% CI, 0.60 to 0.83) and specificity of 0.81 (95% CI, 0.74 to 0.86) using the AUDIT-C (Alcohol Use Disorders Identification Test-Consumption) to detect the full spectrum of unhealthy alcohol use. For adults (35 studies [n = 114 182]), brief screening instruments commonly reported sensitivity and specificity between 0.70 and 0.85. Two trials of the effects of interventions to reduce unhealthy alcohol use in adolescents (n = 588) found mixed results: one reported a benefit in high-risk but not moderate-risk drinkers, and the other reported a statistically significant reduction in drinking frequency for boys but not girls; neither reported health or related outcomes. Across all populations (68 studies [n = 36 528]), counseling interventions were associated with a decrease in drinks per week (weighted mean difference, -1.6 [95% CI, -2.2 to -1.0]; 32 studies [37 effects; n = 15 974]), the proportion exceeding recommended drinking limits (odds ratio [OR], 0.60 [95% CI, 0.53 to 0.67]; 15 studies [16 effects; n = 9760]), and the proportion reporting a heavy use episode (OR, 0.67 [95% CI, 0.58 to 0.77]; 12 studies [14 effects; n = 8108]), and an increase in the proportion of pregnant women reporting abstinence (OR, 2.26 [95% CI, 1.43 to 3.56]; 5 studies [n = 796]) after 6 to 12 months. Health outcomes were sparsely reported and generally did not demonstrate group differences in effect. There was no evidence that these interventions could be harmful.

CONCLUSIONS AND RELEVANCE

Among adults, screening instruments feasible for use in primary care are available that can effectively identify people with unhealthy alcohol use, and counseling interventions in those who screen positive are associated with reductions in unhealthy alcohol use. There was no evidence that these interventions have unintended harmful effects.

An Evaluation of e-CHECKUP TO GO in Canada: The Mediating Role of Changes in Social Norm Misperceptions

BACKGROUND

Alcohol use and related problems are key concerns among colleges, and web-based interventions to mitigate these issues are increasingly popular across campuses. A variety of programs are commercially available and have demonstrated efficacy in reducing alcohol use and consequences; however, little is known about how these programs reduce alcohol outcomes.

OBJECTIVES

The e-CHECKUP TO GO program (e-CHUG) is the briefest electronic intervention available and over 600 institutions are using it internationally. The present study evaluates the impact of the e-CHUG program on drinking outcomes and examines changes in perceived norms as a potential mediator of intervention efficacy in a sample of first-year Canadian university residence students. This is the first Canadian evaluation of e-CHUG.

METHODS

First year Canadian university students (N = 245) living in residence in August 2014 participated in a randomized control trial to evaluate the efficacy of e-CHUG program compared to an assessment-only control condition. Follow-up assessments were completed at 3-months and 5-months. Norm misperceptions and drinking outcomes were measured.

RESULTS

At 3-month and 5-month follow-up assessments program participants had lower norm misperceptions about peers drinking compared to control participants. Changes in norm misperceptions at 3-months mediated the effect of the program on drinking outcomes at 5-months. There were no sex differences in the associations. Conclusions/Importance: Findings suggest that e-CHECKUP TO GO may be a promising strategy for addressing norm misperceptions and subsequently drinking for Canadian students.

The Impact of University Sanctions on Cannabis Use: Individual Difference Factors that Predict Change in Cannabis Use

Over one-third of college students use cannabis, yet the majority of students experiencing cannabis-use problems are not interested in seeking treatment. Therefore, the campus judicial process following a violation of university cannabis policies may be an important point of intervention. This study examined whether cannabis use decreased following being sanctioned by the university for violation of campus drug policy. We also identified individual difference factors related to changes in post-infraction use. University students (N = 98, 73.1% White, 88.2% Male) were referred to participate in a brief motivational intervention study as a component of their sanctions following violation of campus cannabis policies. Data were collected during the intake appointment. Approximately 91% of participants reported decreased post-infraction cannabis use and 58% of the sample reported abstinence in the month prior to intake. The following variables were significantly related to both abstinence or to reducing frequent use (from at least four times per month to less frequently): using less frequently prior to their infraction, descriptive friend norms, and enhancement motives. The following variables were significantly related only to reducing frequent use: injunctive norms regarding parents and expansion motives. Students sanctioned for cannabis violations appear to decrease cannabis use post-infraction. Thus, results support campus efforts to sanction students for violation of campus cannabis use policies. Identification of individual difference variables that predict post-infraction change in cannabis use can inform treatment and prevention efforts.

A quantification of the alcohol use-consequences association in college student and clinical populations: A large, multi-sample study

BACKGROUND

The present study sought to quantify the relationship between alcohol use and alcohol-related consequences in both college student and clinical samples.

METHODS

We gathered 33 college student datasets comprising of 15,618 participants and nine clinical sample datasets comprising of 4,527 participants to determine the effect size of the relationship between alcohol use and alcohol-related consequences. We used random-effects meta-analytic techniques, separately in college and clinical samples, to account for a distribution of true effects and to assess for heterogeneity in effect sizes.

RESULTS

Results demonstrated that the clear majority of the variability in alcohol-related consequences is not explained by alcohol use (ie, >77% in college samples; >86% in clinical samples), and that there was significant heterogeneity in all effect sizes.

CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE

Experiencing alcohol-related consequences results from factors that extend beyond frequency and quantity of alcohol consumed suggesting a need to examine other predictors of alcohol-related consequences beyond alcohol use. (Am J Addict 2018;27:116-123).

Exploration of treatment matching of problem drinker characteristics to motivational interviewing and non-directive client-centered psychotherapy

Motivational Interviewing (MI) is a known effective intervention for alcohol use disorder (AUD). MI's mechanisms of action remain inconsistently substantiated, and research in this area has been reliant on identifying relationships through strength of association rather than experimental manipulation of active ingredients. In two previous studies, a pilot and a larger replication study, we disaggregated MI into its hypothesized active ingredients by creating three conditions: MI, Spirit Only MI (SOMI, in which evocation of change talk was proscribed), and a non-therapy condition (NTC). Results from both studies yielded equivalent findings across all three conditions. In the current analyses, data from both studies were combined to test five participant characteristics as moderators of MI's component parts: 1) severity of baseline drinking, 2) severe AUD (met 6 or more criteria), 3) baseline self-efficacy to moderate drinking, 4) mean daily confidence to resist heavy drinking in the week prior to treatment initiation, and 5) depression. There were no significant findings related to baseline drinking, severe AUD, or baseline self-efficacy. Confidence yielded a significant interaction effect. When participants had high baseline confidence, drinking for those in MI increased compared to those in SOMI. Depression also yielded a significant moderating effect such that in the context of higher depressive symptoms, receipt of either therapy reduced drinking relative to NTC. Results are discussed in light of existing literature on MOBC with MI and the potential role exploring ambivalence may play for participants with particular characteristics.

Predictors of short-term change after a brief alcohol intervention for mandated college drinkers

OBJECTIVE

Brief motivational interventions (BMIs) reduce problematic drinking for some, but not all, college students. Identifying those students who are less responsive can help to guide intervention refinement. Therefore, we examined demographic, personality, and cognitive factors hypothesized to influence change after a BMI.

METHOD

Students mandated for intervention following a campus alcohol violation (N=568; 28% female, 38% freshmen) completed a baseline assessment, then received a BMI, and then completed a 1-month follow-up. At both assessments, alcohol use (i.e., drinks per week, typical BAC, binge frequency) and alcohol-related problems were measured.

RESULTS

Latent change score analyses revealed significant decrease in both alcohol use and problems 1month after the BMI. In the final model that predicted change in alcohol use, four factors (male sex, a "fun seeking" disposition, more perceived costs and fewer perceived benefits of change) predicted smaller decreases in alcohol use over time. In the final model that predicted change in alcohol-related problems, three factors (stronger beliefs about the centrality of alcohol to college life, more perceived costs and fewer perceived benefits of change) predicted smaller decreases in problems over time.

CONCLUSIONS

Participation in a BMI reduced alcohol use and problems among mandated college students at 1-month follow-up. We identified predictors of these outcomes, which suggest the need to tailor the BMI to improve its efficacy among males and those students expressing motives (pro and cons, and fun seeking) and beliefs about the centrality of drinking in college.

A Novel Approach for Streamlining Delivery of Brief Motivational Interventions to Mandated College Students: Using Group and Individual Sessions Matched to Level of Risk

BACKGROUND

Mandated college students (those in violation of a campus alcohol policy) are heterogenous with respect to alcohol consumption. Thus, when universities consider required treatment for mandated students, one promising option is to match treatment intensity according to level of alcohol involvement. The present study evaluates such an approach with minimal resources.

METHODS

Mandated students (N = 285) were required to complete a baseline assessment. Participants identified as high-risk (5+ past month alcohol problems AND 2+ past month heavy drinking episodes) received a one session individual Brief Motivational Intervention (I-BMI) whereas those identified as low-risk (all others) received a one session group Brief Motivational Intervention (G-BMI). I-BMI and G-BMI sessions were delivered by doctoral students in Clinical Psychology. Follow-up assessments were collected 1 month post-intervention (response rate = 73%).

RESULTS

The vast majority of students complied with their requirement. Participants assigned to I-BMI reported an 82% reduction in drinks per week, a 58% reduction in heavy episodic drinking, and a 74% reduction in alcohol-related problems at a 1 month follow-up. Participants assigned to G-BMI reported a 61% reduction in drinks per week and a 42% reduction in alcohol-related problems at follow-up relative to baseline. Conclusion/Importance: We demonstrate that matching intervention intensity on baseline alcohol involvement with mandated students is feasible and associated with short-term reductions in alcohol use and consequences. Universities may wish to consider the procedure outlined here as a way of allocating more resources to those who drink at problematic levels.

Interaction between the ADH1B*3 allele and drinking motives on alcohol use among Black college students

BACKGROUND

Black young adults have lower rates of alcohol use than other racial groups. Genetic factors may protect against drinking. Specifically, the ADH1B*3 allele is present almost exclusively in Black populations and has been protective against alcohol use and alcohol use disorder. The protective effects of the ADH1B*3 allele, however, may differ as a function of alcohol-promoting cognitions.

OBJECTIVES

The current study examined whether ADH1B*3 moderated relations of drinking motives with alcohol consumption among Black college drinkers.

METHODS

Participants were 241 undergraduate students of self-identified Black race (mean age = 20 years; 66% female) who reported consuming alcohol at least once in the past 30 days.

RESULTS

ADH1B*3 was not significantly associated with drinking motives or drinking behaviors. However, significant, albeit small, interaction effects of ADH1B*3 with drinking motives on drinking behavior were found; the presence of an ADH1B*3 allele protected against greater drinking quantity among students with high social motives (incidence rate ratio [IRR] = 0.95, 95% CI [0.92, 0.99]) and against frequent drinking among students with low coping motives (IRR = 1.06, 95% CI [1.01, 1.11]).

CONCLUSION

These findings represent a novel demonstration of genetic modulation of alcohol-related cognitions within Black college drinkers, although replication is needed. Results represent an initial step toward better characterizing individual differences in associations of drinking motives with drinking behavior, with potential implications for interventions aimed at motivational processes in alcohol use.

Using Sleep Interventions to Engage and Treat Heavy-Drinking College Students: A Randomized Pilot Study

BACKGROUND

Continued high alcohol consumption levels by college students highlight the need for more effective alcohol interventions and novel treatment engagement strategies. The purpose of this study was to investigate a behavioral sleep intervention as a means to engage heavy-drinking college students in treatment and reduce alcohol use and alcohol-related consequences.

METHODS

Heavy-drinking college students (N = 42) were assigned to 1 of 2 web-based interventions comprised of 4 modules delivered over 4 weeks. The experimental intervention focused primarily on sleep and included evidence-based sleep content (i.e., stimulus control instructions, sleep scheduling [consistent bed/rise times; ideal sleep duration for adolescents/young adults], sleep hygiene advice, relaxation training, cognitive strategies to target sleep-disruptive beliefs), and alcohol content (i.e., normative and blood alcohol level feedback, moderate drinking guidelines, controlled drinking strategies, effects of alcohol on sleep and the body, advice to moderate drinking for improved sleep) in young adults. The control condition Healthy Behaviors provided basic advice about nutrition, exercise, sleep (i.e., good sleep hygiene only), and drinking (i.e., effects of alcohol on the body, moderate drinking guidelines, advice to moderate drinking for sleep). Participants in both conditions monitored their sleep using daily web-based diaries and a wrist-worn sleep tracker.

RESULTS

Recruitment ads targeting college students with sleep concerns effectively identified heavy-drinking students. The program generated a high number of inquiries and treatment completion rates were high. Both interventions significantly reduced typical week drinking and alcohol-related consequences and improved sleep quality and sleep-related impairment ratings. The control condition yielded greater reductions in total drinks in a heaviest drinking week. The effects on drinking were larger than those observed in typical brief alcohol intervention studies for college students. Greater sleep improvement tended to predict better subsequent drinking outcomes.

CONCLUSIONS

The results suggest that sleep treatment may be a promising strategy for targeting and treating heavy-drinking college students.

Drinking motives and PTSD-related alcohol expectancies among combat veterans

INTRODUCTION

Combat veterans are at increased risk for PTSD and alcohol misuse, and expectancies and motives for drinking may help explain the link between these comorbid issues. This investigation explored the relationships between PTSD symptoms, PTSD-related alcohol expectancies, motives for drinking, and alcohol consumption/misuse.

METHOD

67 veterans of Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) participated in this project. We examined correlations between PTSD severity, alcohol misuse, drinking motives, PTSD alcohol expectancies, and tested models of mediation and moderation.

RESULTS

Coping-anxiety drinking motives and positive PTSD-related alcohol expectancies were associated with alcohol misuse and alcohol-related consequences, but not with consumption. Each PTSD symptom cluster was associated with positive and negative PTSD alcohol expectancies, and coping-anxiety was specifically related to reexperiencing and avoidance. Drinking to cope mediated the relationship between PTSD symptoms and hazardous drinking. Moderation analyses showed that a positive relationship between PTSD severity and hazardous drinking existed among those with moderate and higher levels of positive PTSD-alcohol expectancies.

DISCUSSION

Our findings point to surprising, and in some cases complex, relationships between PTSD and alcohol use. Although related, PTSD alcohol expectancies and drinking motives seem to function differently in the relationship between PTSD and alcohol misuse.

Motivational interviewing and the decisional balance procedure for cessation induction in smokers not intending to quit

INTRODUCTION

The decisional balance (DB) procedure examines the pros and cons of behavior change and was considered a component in early formulations of Motivational Interviewing (MI). However, there is controversy and conflicting findings regarding the use of a DB exercise within the treatment of addictions and a need to clarify the role of DB as a component of MI.

METHODS

College tobacco smokers (N=82) with no intentions on quitting were randomly assigned to receive a single counseling session of either Motivational Interviewing using only the decisional balance component (MIDB), or health education around smoking cessation (HE). Assessments were obtained at baseline, immediately post-treatment, 1week, and 4weeks.

RESULTS

Compared to HE, the MIDB sessions scored significantly higher on the Motivational Interviewing Treatment Integrity (MITI) scale (all standardized differences d>1, p<0.001). Unexpectedly, self-report Pros of smoking scores increased for MIDB but decreased for HE (MIDB vs HE standardized difference d=0.5; 95%CI 0.1 to 1.0, p=0.021). Both groups showed significant reductions in smoking rates and increases in motivation to quit, quit attempts, and self-reported abstinence, with no significant group differences. Changes in the Pros of smoking were correlated with MITI scores, but not with cessation outcomes. In contrast, increases in the Cons of smoking and therapeutic alliance were predictive of better cessation outcomes.

CONCLUSIONS

The decisional balance exercise as formulated by earlier versions of MI may be counter-productive and cautions around its use are warranted. Instead, improved cessation outcomes appear associated with increasing perceived benefits of quitting and positive therapeutic alliance.

Do brief motivational interventions reduce drinking game frequency in mandated students? An analysis of data from two randomized controlled trials

College students frequently engage in drinking games (DGs) and experience a variety of consequences as a result. It is currently unknown whether brief motivational interventions (BMIs) that provide feedback on DG participation can reduce this high risk behavior. This study examined outcome data from 2 randomized clinical trials to examine whether BMIs facilitate change in DG frequency and how these changes may occur. Mandated college students (Trial 1, N = 198, 46% female; Trial 2, N = 412; 32% female) were randomized to BMI or comparison control conditions. Hierarchical linear modeling (HLM) was used to compare the BMI and comparison groups to determine whether the BMI reduced DG participation over time. Percent change talk (PCT) during the discussion of DG during the session was examined as a predictor of change in DG frequency, and gender was examined as a moderator of treatment effects. Controlling for regular drinking frequency, participants who received a BMI did not significantly reduce their DG frequency relative to the comparison group in either sample, and the BMI was equally ineffective at reducing DG behavior for men and women. DG-related PCT during the BMI was associated with lower DG frequency at the second follow-up in both trials. In Trial 1, PCT during the BMI was associated with less steep increases in DG frequency across the course of all follow-ups. Effects of PCT on DG behavior were not moderated by gender. Findings did not support hypothesized reductions in DG participation following a BMI. Future research should explore whether targeted DG-specific interventions could reduce DG participation and the role of in-session client language in facilitating such change. (PsycINFO Database Record

Pathways to romantic relational aggression through adolescent peer aggression and heavy episodic drinking

Adolescent peer aggression is a well-established correlate of romantic relational aggression; however, the mechanisms underlying this association are unclear. Heavy episodic drinking (or "binge" alcohol use) was examined as both a prior and concurrent mediator of this link in a sample of 282 12-18 year old interviewed four times over 6 years. Path analyses indicated that early peer relational and physical aggression each uniquely predicted later romantic relational aggression. Concurrent heavy episodic drinking fully mediated this effect for peer physical aggression only. These findings highlight two important mechanisms by which peer aggression may increase the risk of later romantic relational aggression: a direct pathway from peer relational aggression to romantic relational aggression and an indirect pathway through peer physical aggression and concurrent heavy episodic drinking. Prevention programs targeting romantic relational aggression in adolescence and young adulthood may benefit from interventions that target multiple domains of risky behavior, including the heavy concurrent use of alcohol. Aggr. Behav. 42:563-576, 2016. © 2016 Wiley Periodicals, Inc.

[Influence of Counsellor- and Intervention Variables on Motivation to Change Following a Brief Motivational Intervention to Reduce Risky Alcohol Use]

Influence of Counsellor- and Intervention Variables on Motivation to Change Following a Brief Motivational Intervention to Reduce Risky Alcohol Use Brief interventions are recommended for prevention and early intervention of risky alcohol use. However, evidence of their effectiveness, in particular for children and adolescents, is heterogeneous. Analysis of counsellor and intervention variables may provide insights into mechanisms of action in brief interventions and thereby contribute to an enhanced effectiveness. We analyzed data of N = 141 children and adolescents who were treated for acute alcohol intoxication in the emergency department. Study participants received a brief motivational intervention to reduce risky alcohol use during hospitalization. We applied multiple regression analysis to examine counsellor variables (empathy, affirmation, competence, congruence) and intervention variables (readiness and confidence ruler, decisional balance, goal agreement) as predictors of motivation to change. Higher scores on the basic therapeutic skill "positive affirmation" (R2 = 7.1 %; p < .01), finishing the intervention with a written goal agreement (R2 = 2.9 %; p < .05) and younger age were associated with greater readiness to change (R2 = 10.2 %; p < .01). Therefore, a special focus should be put on the counsellor skill "positive affirmation" when training new counsellors. Results also indicate that younger patients respond stronger to a brief intervention in this context.

Do drinking motives distinguish extreme drinking college students from their peers?

OBJECTIVE

The literature highlights the need to move beyond the traditional heavy episodic ("binge") drinking criteria when trying to identify at-risk college drinkers. Thus, recent attention has focused on more extreme levels of drinking. This study examines whether drinking motives can distinguish college student extreme drinkers from lighter drinkers.

METHOD

We used data from 3518 college student current drinkers (63.4% women) who participated in eight different studies at five different college campuses across the United States; a subsample of these students was followed up at 6months post-baseline. At baseline and follow-up, drinkers were divided into three groups: nonbinge drinkers (<4 drinks for women and 5 for men on their maximum drinking occasion), binge drinkers (4-7 drinks for women; 5-9 for men), and extreme drinkers (8+ for women and 10+ for men).

RESULTS

At baseline, extreme drinkers, compared to nonbinge and binge drinkers, reported greater social, enhancement, and coping motives, as well as greater quantity and frequency of drinking per week and more alcohol-related problems. Those who were not extreme drinkers at baseline and later became extreme drinkers at follow-up reported significantly greater increases in social and enhancement motives, compared to those who remained nonextreme drinkers. Those who were extreme drinkers at baseline and reduced their drinking 6months later, compared to those who remained extreme drinkers, reported greater reductions in enhancement and coping motives.

CONCLUSIONS

Focusing on drinking motives might be an efficacious target for preventive intervention programs to reduce extreme drinking among college students.

QuikFix: enhanced motivational interviewing interventions for youth substance use

Purpose

This paper explores the background principles, theories, and components of the QuikFix intervention for primary and comorbid substance use in young people.

Design/methodology/approach

QuikFix is a brief Motivational Interviewing (MI) intervention utilising cognitive-behavioural coping skills training to reduce vulnerability to substance use and comorbid mental health problems in young people. It is delivered in two to three brief sessions including an assessment. A new version, QuikFix PI (Personality Intervention) which incorporates coping skills training targeting, sensation seeking, impulsive, depressive and anxiety personality styles that may underlie primary and comorbid substance use problems is presented.

Findings

The original QuikFix intervention has demonstrated efficacy in young alcohol and cannabis users with comorbid depression and anxiety symptoms. The efficacy of the new personality targeted version of QuikFix is currently being tested in a large randomized controlled trial among young people with alcohol related injuries/illnesses. Future research is required to determine the efficacy of QuikFix PI in comorbid populations including those with behavioural disorders.

Practical implications

QuikFix interventions can be delivered via telephone or face-to-face in clinical settings for clients with primary substance use and comorbid depression and anxiety symptoms.

Originality/value

This paper describes a novel two to three session manualised personality targeted substance use intervention. The full original QuikFix treatment manual is available online (Hides and Carroll 2010).

How effective are brief interventions in reducing alcohol consumption: do the setting, practitioner group and content matter? Findings from a systematic review and metaregression analysis

BACKGROUND

While the efficacy and effectiveness of brief interventions for alcohol (ABI) have been demonstrated in primary care, there is weaker evidence in other settings and reviews do not consider differences in content. We conducted a systematic review to measure the effect of ABIs on alcohol consumption and how it differs by the setting, practitioner group and content of intervention.

METHODS

We searched MEDLINE, EMBASE, PsycINFO; CINAHL, Social Science Citation Index, Cochrane Library and Global Health up to January 2015 for randomised controlled trials that measured effectiveness of ABIs on alcohol consumption. We grouped outcomes into measures of quantity and frequency indices. We used multilevel meta-analysis to estimate pooled effect sizes and tested for the effect of moderators through a multiparameter Wald test. Stratified analysis of a subset of quantity and frequency outcomes was conducted as a sensitivity check.

RESULTS

52 trials were included contributing data on 29 891 individuals. ABIs reduced the quantity of alcohol consumed by 0.15 SDs. While neither the setting nor content appeared to significantly moderate intervention effectiveness, the provider did in some analyses. Interventions delivered by nurses had the most effect in reducing quantity (d=-0.23, 95% CI (-0.33 to -0.13)) but not frequency of alcohol consumption. All content groups had statistically significant mean effects, brief advice was the most effective in reducing quantity consumed (d=-0.20, 95% CI (-0.30 to -0.09)). Effects were maintained in the stratified sensitivity analysis at the first and last assessment time.

CONCLUSIONS

ABIs play a small but significant role in reducing alcohol consumption. Findings show the positive role of nurses in delivering interventions. The lack of evidence on the impact of content of intervention reinforces advice that services should select the ABI tool that best suits their needs.

Motivational interviewing for the prevention of alcohol misuse in young adults

BACKGROUND

Alcohol use and misuse in young people is a major risk behaviour for mortality and morbidity. Motivational interviewing (MI) is a popular technique for addressing excessive drinking in young adults.

OBJECTIVES

To assess the effects of motivational interviewing (MI) interventions for preventing alcohol misuse and alcohol-related problems in young adults.

SEARCH METHODS

We identified relevant evidence from the Cochrane Central Register of Controlled Trials (CENTRAL) (2015, Issue 12), MEDLINE (January 1966 to July 2015), EMBASE (January 1988 to July 2015), and PsycINFO (1985 to July 2015). We also searched clinical trial registers and handsearched references of topic-related systematic reviews and the included studies.

SELECTION CRITERIA

We included randomised controlled trials in young adults up to the age of 25 years comparing MIs for prevention of alcohol misuse and alcohol-related problems with no intervention, assessment only or alternative interventions for preventing alcohol misuse and alcohol-related problems.

DATA COLLECTION AND ANALYSIS

We used the standard methodological procedures expected by Cochrane.

MAIN RESULTS

We included a total of 84 trials (22,872 participants), with 70/84 studies reporting interventions in higher risk individuals or settings. Studies with follow-up periods of at least four months were of more interest in assessing the sustainability of intervention effects and were also less susceptible to short-term reporting or publication bias. Overall, the risk of bias assessment showed that these studies provided moderate or low quality evidence.At four or more months follow-up, we found effects in favour of MI for the quantity of alcohol consumed (standardised mean difference (SMD) -0.11, 95% confidence interval (CI) -0.15 to -0.06 or a reduction from 13.7 drinks/week to 12.5 drinks/week; moderate quality evidence); frequency of alcohol consumption (SMD -0.14, 95% CI -0.21 to -0.07 or a reduction in the number of days/week alcohol was consumed from 2.74 days to 2.52 days; moderate quality evidence); and peak blood alcohol concentration, or BAC (SMD -0.12, 95% CI -0.20 to 0.05, or a reduction from 0.144% to 0.131%; moderate quality evidence).We found a marginal effect in favour of MI for alcohol problems (SMD -0.08, 95% CI -0.17 to 0.00 or a reduction in an alcohol problems scale score from 8.91 to 8.18; low quality evidence) and no effects for binge drinking (SMD -0.04, 95% CI -0.09 to 0.02, moderate quality evidence) or for average BAC (SMD -0.05, 95% CI -0.18 to 0.08; moderate quality evidence). We also considered other alcohol-related behavioural outcomes, and at four or more months follow-up, we found no effects on drink-driving (SMD -0.13, 95% CI -0.36 to 0.10; moderate quality of evidence) or other alcohol-related risky behaviour (SMD -0.15, 95% CI -0.31 to 0.01; moderate quality evidence).Further analyses showed that there was no clear relationship between the duration of the MI intervention (in minutes) and effect size. Subgroup analyses revealed no clear subgroup effects for longer-term outcomes (four or more months) for assessment only versus alternative intervention controls; for university/college vs other settings; or for higher risk vs all/low risk participants.None of the studies reported harms related to MI.

AUTHORS' CONCLUSIONS

The results of this review indicate that there are no substantive, meaningful benefits of MI interventions for preventing alcohol use, misuse or alcohol-related problems. Although we found some statistically significant effects, the effect sizes were too small, given the measurement scales used in the included studies, to be of relevance to policy or practice. Moreover, the statistically significant effects are not consistent for all misuse measures, and the quality of evidence is not strong, implying that any effects could be inflated by risk of bias.

Short-term effects of a brief intervention to reduce alcohol use and sexual risk among homeless young adults: Results from a randomized controlled trial

BACKGROUND

Homeless young adults are more likely than their never-homeless counterparts to abuse alcohol and engage in risky sexual behaviors, yet no interventions to simultaneously reduce both these behaviors among this vulnerable population have been systematically designed and evaluated. We therefore developed a brief intervention (BI) to reduce both alcohol use and sexual risk behaviors among homeless young adults. The results of a randomized trial testing the BI against an education comparison (EC) are presented.

METHOD

Young adults (N=61; age 17-22 years) from an urban, Northeastern crisis shelter were randomly assigned to either the 2-session, individual-level BI or a time-matched, 2-session, individual-level EC. Generalized linear mixed models for repeated measures determined effects of treatment condition on outcomes.

RESULTS

The BI significantly increased participant readiness to change alcohol use. However, it did not significantly decrease primary alcohol or HIV sexual risk outcomes, independently or relative to EC (all ps>.05). Participants in the EC reduced times engaged in unprotected sex between baseline and post-intervention to a significantly greater extent (p<.01) than those in the BI condition. Participants in both conditions reported satisfaction with respective interventions.

CONCLUSIONS

Findings suggest that the BI was acceptable and successful in getting participants to consider changing their drinking. However, lack of change in alcohol and sexual behavior outcomes indicates the need for further research to determine how to translate readiness to change into actual behavioral change among homeless young adults.

Effects of normative feedback for drinkers who consume less than the norm: Dodging the boomerang

Several alcohol interventions designed for college students attempt to correct exaggerated perceptions of alcohol use on college campuses through the use of personalized normative feedback. Personalized normative feedback has been shown to be effective in reducing drinking as a stand-alone intervention and as a part of a multicomponent intervention. This feedback is typically targeted to heavier drinkers to create a discrepancy between their personal beliefs and behavior and the actual lower levels of use on campus. However, little is known about how this form of normative feedback might affect lighter drinkers who learn that they are drinking less than the typical student at their school. The risk is a potential boomerang effect, or an increase in drinking among lighter drinkers receiving personalized feedback. The current study examined four samples from three geographic locations: two using computer-delivered personalized normative feedback alone and two delivering personalized feedback in the context of a brief motivational intervention. We found no evidence for a boomerang effect among lighter drinkers receiving personalized normative feedback in any of the four samples. These findings help to assuage fears of increasing drinking among lighter drinkers through widespread implementation of normative interventions for college students in the absence of screening for current drinking status.

The moderating role of dysphoria in the relationship between intrusions and alcohol use

Posttraumatic Stress Disorder (PTSD) is frequently comorbid with alcohol use disorders (AUD; Calabrese et al., 2011; McFall, Mackay, & Donovan, 1992). Among several explanations for this comorbidity, the most empirically supported is the self-medication theory which postulates that substances are used to medicate PTSD-related distress (Keane & Wolfe, 1990; Khantzian, 1985; Stewart, 1996). The current study examines the effects of trauma-related distress on alcohol use (total drinking days, drinks per drinking day, heavy drinking days) in a sample of 127 trauma-exposed Veterans following deployment to Iraq or Afghanistan. The dysphoria symptoms of PTSD were used as an indicator of distress, and examined as a moderator in the relationship between intrusion symptoms of PTSD and alcohol use. The proposed moderation model was tested using cross-sectional data from the first month following return from deployment, and at 6 months and at 12 months post-deployment. Results showed that dysphoria symptoms significantly moderated relations between intrusions and total drinking days and heavy drinking days at one month post-deployment; however, a significant pattern was not demonstrated at 6 months and 12 months. Further, dysphoria did not moderate the relation between intrusion symptoms and drinks per drinking day at the three time points. Theoretical and clinical implications are subsequently discussed.

Development and evaluation of the efficacy of a web-based 'social norms'-intervention for the prevention and reduction of substance use in a cluster-controlled trial conducted at eight German universities

BACKGROUND

Previous research suggests that perceptions of peer substance use are associated with personal use. Specifically, overestimating use in the peer group is predictive of higher rates of personal substance use. 'Social norms'-interventions are based on the premise that changing these misperceived social norms regarding substance use by providing feedback on actual norms is associated with a reduction in personal substance use. Studies conducted in the U.S.A. suggest that 'social norms'-feedback is an effective strategy for reducing substance use among university students. It is unknown whether the effects of a 'social norms'-feedback on substance use can be replicated in a sample of German university students. The objective of this article is to describe the study design and aims of the 'INternet-based Social norms-Intervention for the prevention of substance use among Students' (INSIST)-study, a cluster-controlled trial examining the effects of a web-based 'social norms'- intervention in students enrolled at four intervention universities with those enrolled at four delayed intervention control universities. The INSIST-study is funded by the German Federal Ministry of Health.

METHODS/DESIGN

Eight universities in four regions in Germany will take part in the study, four serving as intervention and four as delayed intervention control universities (randomly selected within a geographic region). Six hundred students will be recruited at each university and will be asked to complete a web-based survey assessing personal and perceived substance use/attitudes towards substance use at baseline. These data will be used to develop the web-based 'social norms'-feedback tailored to gender and university. Three months after the baseline survey, students at intervention universities will receive the intervention. Two months after the launch of the intervention, students of all eight universities will be asked to complete the follow-up questionnaires to assess changes in perceptions of/attitudes toward peer substance use and rates of personal substance use.

DISCUSSION

This study is the first German cluster-controlled trial investigating the influence of a web-based 'social norms'-intervention on perceptions of/attitudes towards substance use and substance use behavior in a large university student sample. This study will provide new information on the efficacy of this intervention strategy in the German university context.

TRIAL REGISTRATION

DRKS00007635 at the 'German Clinical Trials Register' (17.12.2014).

Randomized controlled trial of brief alcohol screening and intervention for college students for heavy-drinking mandated and volunteer undergraduates: 12-month outcomes

This is the first randomized trial testing whether heavy-drinking undergraduates mandated to the Brief Alcohol Screening and Intervention for College Students (BASICS) program following a campus alcohol violation would benefit as much as heavy-drinking volunteers up to 1 year postintervention using control groups with high-risk drinkers to model disciplinary-related and naturalistic changes in drinking. Participants (61% male; 51% mandated; 84% Caucasian; M age = 20.14 years) were screened for heavy drinking and randomized to BASICS (n = 115) or assessment-only control (n = 110). Outcome measures (drinking, alcohol problems) were collected at baseline, 4 weeks, 3, 6, and 12 months postintervention. At 4 weeks postintervention, intent-to-treat multilevel longitudinal models showed that regardless of referral group (mandated or volunteer), BASICS significantly decreased weekly drinking, typical drinks, and peak drinks relative to controls (ds = .41-.92). BASICS had a large effect on decreases in alcohol problems (d = .87). At 12 months postintervention, BASICS participants (regardless of referral group) reported significantly fewer alcohol problems (d = .56) compared with controls. Significant long-term intervention gains for peak and typical drinks were sustained in both referral groups relative to controls (ds = .42; .11). Referral group had no significant main effect and did not interact with intervention condition to predict outcomes. Given that BASICS was associated with less drinking and fewer alcohol problems (even among heavier drinking mandated students up to 1 year postintervention), provision of BASICS-style programs within disciplinary settings may help reduce heavy and problematic drinking among at-risk students. (PsycINFO Database Record

Emotion Regulation Difficulties Moderate the Association Between Heavy Episodic Drinking and Dating Violence Perpetration Among College Men

Because of high rates of heavy drinking and dating violence (psychological or physical aggression toward a dating partner) among college men, we examined whether emotion regulation difficulties moderated the association between heavy drinking and dating violence perpetration. One hundred and fifty-eight men were recruited from a large northwestern US university between April 2014 and August 2014. Participants completed an online survey that assessed their emotion regulation difficulties as well as their past year history of heavy episodic drinking (HED; consuming 5+ drinks in 2 hours) and dating violence perpetration. Generalized linear models revealed that the positive association between HED and dating violence perpetration was stronger for men with greater impulse control difficulties and for those who reported limited access to emotion regulation strategies. In addition to continued efforts to reduce heavy drinking among college men, interventions targeting emotion regulation difficulties should be incorporated into standard dating violence intervention and prevention efforts to further reduce the likelihood of dating violence perpetration in this population.

Patient-centered care interventions for the management of alcohol use disorders: a systematic review of randomized controlled trials

ISSUES

Patient-centered care (PCC) is increasingly accepted as an integral component of good health care, including addiction medicine. However, its implementation has been controversial in people with alcohol use disorders.

APPROACH

A systematic search strategy was devised to find completed randomized controlled trials enrolling adults (>18 years) with alcohol use disorders. Studies had to use a PCC approach such that they should have been individualized, respectful to the patients' own goals, and empowering. Studies until September 2015 were searched using PubMed, Scopus, the Cochrane Library, PsychINFO, and Web of Knowledge.

KEY FINDINGS

In total, 40 studies enrolling 16,020 patients met the inclusion criteria. Assessment revealed two main categories of study: psychosocial (n=35 based on motivational interviewing) and pharmacological (n=5 based on an as needed dosing regimen). Psychosocial interventions were further classified according to the presence or absence of an active comparator. When no active comparator was present, studies were classified according to the number of sessions (≥1). Results from single sessions of motivational interviewing showed no clear benefit on alcohol consumption outcomes, with few studies indicating benefit of PCC versus control. Although the results for studies of multiple sessions of counseling were also mixed, many did show a significant benefit of the PCC intervention. By contrast, studies consistently demonstrated a benefit of pharmacologically supported PCC interventions, with most of the differences reaching statistical significance.

IMPLICATIONS

PCC-based interventions may be beneficial for reducing alcohol consumption in people with alcohol use disorders.

Drinking norms, readiness to change, and gender as moderators of a combined alcohol intervention for first-year college students

INTRODUCTION

Alcohol interventions targeting college students and their parents have been shown to be efficacious. Little research has examined moderators of intervention efficacy to help tailor interventions for subgroups of students.

METHOD

This study is a secondary data analysis of readiness to change, drinking norms, and gender as moderators of an efficacious peer- and parent-based intervention (Turrisi et al., 2009). Students (n=680) were randomized to the combined peer and parent intervention (n=342) or assessment-only control (n=338).

RESULTS

The combined intervention reduced peak blood alcohol content (BAC) compared to control. Gender and norms did not moderate the relationship between the intervention and drinking. Significant interactions were found between gender, precontemplation, and intervention. Students in the combined condition with higher precontemplation had lower weekly drinking compared to those with lower precontemplation. This pattern was also found among men for peak BAC and alcohol-related consequences but not among women, indicating a three-way interaction.

CONCLUSION

Interventions may need to consider readiness to change and gender to optimize effectiveness.

An experimental test of assessment reactivity within a web-based brief alcohol intervention study for college students

OBJECTIVE

Web-based brief alcohol intervention (WBI) programs have efficacy in a wide range of college students and have been widely disseminated to universities to address heavy alcohol use. In the majority of efficacy studies, web-based research assessments were conducted before the intervention. Web-based research assessments may elicit reactivity, which could inflate estimates of WBI efficacy. The current study tested whether web-based research assessments conducted in combination with a WBI had additive effects on alcohol use outcomes, compared to a WBI only.

METHODS

Undergraduate students (n=856) from universities in the United States and Canada participated in this online study. Eligible individuals were randomized to complete 1) research assessments+WBI or 2) WBI-only. Alcohol consumption, alcohol-related problems, and protective behaviors were assessed at one-month follow up.

RESULTS

Multiple regression using 20 multiply imputed datasets indicated that there were no significant differences at follow up in alcohol use, alcohol-related problems, or protective behaviors used when controlling for variables with theoretical and statistical relevance. A repeated measures analysis of covariance revealed a significant decrease in peak estimated blood alcohol concentration in both groups, but no differential effects by randomized group. There were no significant moderating effects from gender, hazardous alcohol use, or motivation to change drinking.

CONCLUSIONS

Web-based research assessments combined with a web-based alcohol intervention did not inflate estimates of intervention efficacy when measured within-subjects. Our findings suggest universities may be observing intervention effects similar to those cited in efficacy studies, although effectiveness trials are needed.

Alcohol expectancies and drinking behaviors among college students with disordered eating

OBJECTIVE

The authors investigated binge drinking, alcohol expectancies, and risky and protective drinking behaviors in relation to disordered eating behaviors in male and female college students.

PARTICIPANTS

The full sample consisted of 7,720 undergraduate students, 18 to 22 years of age. Drinking behaviors were analyzed in 4,592 recent drinkers.

METHODS

Participants anonymously completed a survey as part of a universal alcohol abuse prevention program between September 2007 and April 2008.

RESULTS

Co-occurring disordered eating behaviors and binge drinking characterized 17.1% of males and 19.0% of females. Rates of binge drinking were higher in those with disordered eating behaviors. Students with disordered eating behaviors also had more positive and negative alcohol expectancies and engaged in more risky and fewer protective drinking behaviors than their counterparts.

CONCLUSIONS

Students with disordered eating behaviors have outcome expectancies and behavior patterns associated with problematic drinking. These findings may enhance prevention and intervention programs.