An examination of college students' willingness to experience consequences as a unique predictor of alcohol problems

Transdermal alcohol concentration features predict alcohol-induced blackouts in college students

BACKGROUND

Alcohol-induced blackouts (AIBs) are common in college students. Individuals with AIBs also experience acute and chronic alcohol-related consequences. Research suggests that how students drink is an important predictor of AIBs. We used transdermal alcohol concentration (TAC) sensors to measure biomarkers of increasing alcohol intoxication (rise rate, peak, and rise duration) in a sample of college students. We hypothesized that the TAC biomarkers would be positively associated with AIBs.

METHODS

Students were eligible to participate if they were aged 18-22 years, in their second or third year of college, reported drinking 4+ drinks on a typical Friday or Saturday, experienced ≥1 AIB in the past semester, owned an iPhone, and were willing to wear a sensor for 3 days each weekend. Students (N = 79, 55.7% female, 86.1% White, Mage = 20.1) wore TAC sensors and completed daily diaries over four consecutive weekends (89.9% completion rate). AIBs were assessed using the Alcohol-Induced Blackout Measure-2. Logistic multilevel models were conducted to test for main effects.

RESULTS

Days with faster TAC rise rates (OR = 2.69, 95% CI: 1.56, 5.90), higher peak TACs (OR = 2.93, 95% CI: 1.64, 7.11), and longer rise TAC durations (OR = 4.16, 95% CI: 2.08, 10.62) were associated with greater odds of experiencing an AIB.

CONCLUSIONS

In a sample of "risky" drinking college students, three TAC drinking features identified as being related to rising intoxication independently predicted the risk for daily AIBs. Our findings suggest that considering how an individual drinks (assessed using TAC biomarkers), rather than quantity alone, is important for assessing risk and has implications for efforts to reduce risk. Not only is speed of intoxication important for predicting AIBs, but the height of the peak intoxication and the time spent reaching the peak are important predictors, each with different implications for prevention.

Effects of the FITSTART + PBI on drinking and negative alcohol-related consequences during the first year of college

Objective: This study evaluated FITSTART+, a parent-based intervention (PBI), for preventing risky drinking among first-year college students. Participants: Participants were traditional first-year students aged between 17 and 20. Method: In total, 391 eligible students completed a baseline survey and their parents were then invited to use the FITSTART+ PBI or Control web-applications. 266 students had a parent who created a profile in the app (FITSTART+ PBI, n = 134; FITSTART+ Control, n = 132). Additionally, 58 parents randomized to the FITSTART+ PBI did not complete the personalized normative feedback (PNF) component of the intervention. Results: No significant effect on drinking or related consequences was detected between Intervention and Control groups. However, exploratory analyses revealed that completing PNF in the FITSTART+ PBI condition was associated with a greater likelihood of remaining zero on consequences at follow-ups. Conclusion: The PNF component of the FITSTART+ PBI showed potential in preventing risky drinking, warranting further research.

A Dual-Process Decision-Making Model Examining the Longitudinal Associations Between Alcohol-Induced Blackouts and Alcohol Use Disorder Risk Among College Student Drinkers

OBJECTIVE

The purpose of this study was to use a dual-process decision-making model to examine the longitudinal associations between alcohol-induced blackouts (blackouts) and alcohol use disorder (AUD) risk symptoms among college student drinkers.

METHOD

Undergraduate drinkers (N = 2,024; 56% female; 87% White; 5% Hispanic) at a large northeastern university completed online surveys each semester during their first (Time [T] 1, T2), second (T3, T4), third (T5, T6), and fourth (T7, T8) years of college (87% retention across the study). Path analyses were examined testing the longitudinal associations between T1 willingness to experience a blackout, T1 intentions to avoid a blackout, T2-T8 drinking, T2-T8 blackouts, and T8 AUD risk symptoms. Hypotheses 1 and 2 tested the associations between T1 willingness, T1 intentions, T2-T8 drinking, and T2-T8 blackouts. Hypothesis 3 tested the associations between T2-T8 drinking, T2-T8 blackouts, and T8 AUD risk symptoms.

RESULTS

Students experienced an average of 8 (SD = 8) blackouts during college. Approximately 1,514 (88.8%) participants reported experiencing 1 of 8 AUD risk symptoms. T1 willingness was positively associated with T2-T8 blackouts. T2-T8 drinking and T2-T8 blackouts were positively associated with T8 AUD risk symptoms. T1 willingness significantly indirectly affected T8 AUD risk symptoms through its association with T2-T8 blackouts.

CONCLUSIONS

Results estimated that, on average, college student drinkers experienced eight blackouts across 4 years of college, and 88% of participants reported experiencing at least one symptom of AUD in the last semester of college. Willingness to experience a blackout influenced students' AUD risk symptoms through the number of blackouts they experienced throughout college.

Alcohol-induced blackouts among college student drinkers: A multilevel analysis

OBJECTIVE

To identify factors (manner of drinking, combined alcohol and other substance use, physiology) that are associated with alcohol-induced blackouts (AIBs) over and above estimated blood alcohol concentration (eBAC).

METHODS

Students (N = 462, 51.7 % female, 87.7 % White, Mage = 20.1) were assessed across 6 weekends via e-surveys (80-97 % response rate). eBAC was calculated using standard number of drinks, drinking duration, sex, and weight. Three-level multilevel models (days, weeks, persons) were conducted to test for main effects, controlling for eBAC.

RESULTS

Protective behavioral strategies (PBS) were associated with decreased odds of AIBs on the daily (OR = 0.64, 95 % CI: 0.53, 0.77), weekly (OR = 0.84, 95 % CI: 0.72, 0.98), and person-levels (OR = 0.62, 95 % CI: 0.51, 0.74). Combined cannabis with alcohol was associated with increased odds of AIBs on the weekly (OR = 2.13, 95 % CI 1.13, 4.07) and person-levels (OR = 3.56, 95 % CI 1.60, 7.93). People who more frequently played drinking games (OR = 1.41, 95 % CI: 1.12, 1.77), pregamed (OR = 1.55, 95 % CI: 1.19, 2.03), and showed higher tolerance (OR = 1.22, 95 % CI: 1.08, 1.37) showed increased risk of AIBs, over and above eBAC levels.

CONCLUSION

We identified a number of daily-, weekly-, and person-level factors that uniquely contribute to the prediction of AIBs even at equivalent eBACs. Many of these factors were behavioral, suggesting that they may serve as malleable prevention targets for AIBs in college student drinkers.

An examination of the associations between depressive symptoms, perceived parental discipline, alcohol use, and drinking-related consequences during the first year of college: A moderated mediation model

Background

Depression is prevalent among adolescents and young adults and is associated with experiencing increased negative alcohol-related consequences; thus, it is imperative to identify malleable protective factors for alcohol risks in young adults experiencing elevated depressive symptoms. The current study longitudinally explored the effects of perceived parental alcohol-related discipline on the relationship between depressive symptoms, alcohol use, and negative drinking consequences during the transition into college.

Methods

Incoming college students (N = 272, 63.2% female) completed web-based surveys before (July, T1) and after (October, T2) the transition into college and reported depressive symptoms, perceived alcohol-related discipline, alcohol use, and consequences of drinking experienced in the past 30 days.

Results

The moderated mediation model revealed that at above average perceptions of alcohol-related discipline, depressive symptoms were negatively associated with alcohol use, which in turn was associated with experiencing fewer negative consequences of drinking.

Limitations

The current study did not measure a diagnosis of major depressive disorder, and therefore our results may differ among clinical populations. In addition, we did not measure other parenting constructs shown to protect students with elevated levels of depressive symptoms from experiencing consequences (i.e., monitoring).

Conclusions

The present findings suggest perceptions of parental alcohol-related discipline measured here (e.g., having a privilege taken away, being scolded or grounded) can be protective against alcohol risks among college students experiencing above average depressive symptoms. Parent-based alcohol interventions administered prior to matriculation should encourage parents of depressed students to clearly communicate consequences for drinking to their child.

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.

Examining the Moderating Role of Behavioral Willingness on Indirect Relations Between Alcohol Expectancies and Negative Consequences

AIMS

Alcohol expectancies are directly linked to alcohol misuse and indirectly linked to negative consequences via use. Likewise, willingness to experience negative consequences imparts direct risk for negative consequences and may represent an important individual difference when predicting risky alcohol use. To date, no studies have examined how willingness to experience consequences may moderate relations between expectancies and alcohol use in the prediction of negative consequences. It is possible that those who expect appetitive effects and are high in willingness may discount the severity of negative consequences and drink more to realize positive expectations. Alternatively, those who expect aversive alcohol-related effects and are high in willingness may drink more to overcome negative experiences.

METHODS

The current study tested these hypotheses in a sample of undergraduate students (N = 657) from a larger study focused on alcohol and cannabis co-use.

RESULTS

Findings suggested that high-arousal positive expectancies (e.g. sociable, lively, talkative) function as a risk factor for negative consequences indirectly through heavier drinking, whereas low-arousal positive (e.g. mellow, relaxed) expectancies served as an indirect protective factor against negative consequences through lighter drinking. Willingness to experience negative consequences had direct and indirect effects on negative consequences through drinking but did not interact with alcohol expectancies.

CONCLUSIONS

The present study demonstrates the utility of assessing the full range of alcohol expectancies and behavioral willingness in continued research into the dynamic nature of antecedents to alcohol misuse and negative consequences.

Examining the impact of early college experiences on the cumulative number of alcohol-related consequences

OBJECTIVE

To estimate the total number of alcohol-related consequences students experience during 4 years of college and examine early college indicators that result in higher rates of consequences.

METHOD

Undergraduate drinkers (N = 1,744; 58% female; 87% White; 5% Hispanic) at a large northeastern university completed an online survey at the end of the fall and spring semesters during their first (T1, T2), second (T3, T4), third (T5, T6), and fourth (T7, T8) years of college (87% retention across the study). First, descriptive statistics were calculated to estimate the total number of alcohol-related consequences students experienced across all 4 years of college. Second, a structural equation model was examined to identify early college indicators that influence individuals experiencing more cumulative consequences.

RESULTS

Students experienced an average of 102 (SD = 89.91) alcohol-related consequences during 4 years of college. Next, early parental approval of consequences, but not peer drinking norms, were positively associated with students' willingness to experience consequences, which in turn, were positively associated with higher alcohol consumption and greater total consequences.

CONCLUSIONS

Results estimated that, on average, students experienced 102 alcohol-related consequences across all 4 years of college. Parental approval of consequences influenced students' total consequences through their willingness to experience consequences and drinking behaviors. Findings from the current study have several important implications for interventions.

Day drinking among college students and its association with risky substance use behaviors

BACKGROUND

Day drinking, or drinking during the daytime, is a term used colloquially in the media and among college students based on anecdotal evidence. Drinking at tailgate parties, generally thought to be a type of day drinking, tends to be particularly heavy and to achieve levels comparable to drinking on holidays and special occasions. The objective of this study was to assess how many and how often students day drink and whether day drinking days (i.e., days drinking began before 4:00 p.m.) were associated with heavy drinking, legal intoxication, negative alcohol-related consequences, and three risky substance use behaviors.

METHODS

We conducted a longitudinal daily diary study of college students who were followed for their first seven semesters of college. The analytic sample includes 7,633 drinking days nested with 619 student drinkers. We used logistic and Poisson multilevel models to test associations between day drinking days and substance use outcomes and negative consequences.

RESULTS

Approximately 50% of drinkers drank durinng the day at least once, and day drinking occurred on 9% of drinking days. Greek organization participants reported significantly more day drinking days than non-participants. Day drinking days were characterized by heavy drinking as evidenced by strong, positive associations between day drinking and drinking to heavy episodic drinking (HED) and high-intensity drinking (HID) thresholds on a given day. In contrast, students were less likely to reach legal intoxication and experienced fewer negative alcohol-related consequences on day drinking days than days on which drinking began in the evening or nighttime. Students who reported day drinking more often throughout the study also reported having more days of drinking at the HED and HID thresholds and playing drinking games and mixed alcohol with energy drinks more frequently.

CONCLUSIONS

Day drinking was common among this sample of college students. Findings suggest that day drinking days may be characterized by heavy drinking and may be a behavior most typically engaged in by heavy drinkers, including members of Greek organizations.

Psychoeducational Messaging to Reduce Alcohol Use for College Students With Type 1 Diabetes: Internet-Delivered Pilot Trial

Background

College environments promote high-volume or binge alcohol consumption among youth, which may be especially harmful to those with type 1 diabetes (T1D). Little is known about the acceptability and effectiveness of interventions targeting reduced alcohol use by college students with T1D, and it is unclear whether intervention framing (specifically, the narrator of intervention messages) matters with respect to affecting behavior change. Interventions promoted by peer educators may be highly relatable and socially persuasive, whereas those delivered by clinical providers may be highly credible and motivating.

Objective

The aim of this study is to determine the acceptability and impacts of an alcohol use psychoeducational intervention delivered asynchronously through web-based channels to college students with T1D. The secondary aim is to compare the impacts of two competing versions of the intervention that differed by narrator (peer vs clinician).

Methods

We recruited 138 college students (aged 17-25 years) with T1D through web-based channels and delivered a brief intervention to participants randomly assigned to 1 of 2 versions that differed only with respect to the audiovisually recorded narrator. We assessed the impacts of the exposure to the intervention overall and by group, comparing the levels of alcohol- and diabetes-related knowledge, perceptions, and use among baseline, immediately after the intervention, and 2 weeks after intervention delivery.

Results

Of the 138 enrolled participants, 122 (88.4%) completed all follow-up assessments; the participants were predominantly women (98/122, 80.3%), were White non-Hispanic (102/122, 83.6%), and had consumed alcohol in the past year (101/122, 82.8%). Both arms saw significant postintervention gains in the knowledge of alcohol’s impacts on diabetes-related factors, health-protecting attitudes toward drinking, and concerns about drinking. All participants reported significant decreases in binge drinking 2 weeks after the intervention (21.3%; odds ratio 0.48, 95% CI 0.31-0.75) compared with the 2 weeks before the intervention (43/122, 35.2%). Changes in binge drinking after the intervention were affected by changes in concerns about alcohol use and T1D. Those who viewed the provider narrator were significantly more likely to rate their narrator as knowledgeable and trustworthy; there were no other significant differences in intervention effects by the narrator.

Conclusions

The intervention model was highly acceptable and effective at reducing self-reported binge drinking at follow-up, offering the potential for broad dissemination and reach given the web-based format and contactless, on-demand content. Both intervention narrators increased knowledge, improved health-protecting attitudes, and increased concerns regarding alcohol use. The participants’ perceptions of expertise and credibility differed by narrator.

Trial Registration

ClinicalTrials.gov NCT02883829; https://clinicaltrials.gov/ct2/show/NCT02883829

International Registered Report Identifier (IRRID)

RR2-10.1177/1932296819839503

Are Co-users of Alcohol and Marijuana More Willing to Experience Consequences From Drinking? A Longitudinal Examination Among First-Year College Students

BACKGROUND

Alcohol and marijuana co-users are at heightened vulnerability for experiencing a variety of negative alcohol use outcomes including heavier alcohol use and driving under the influence. The current study explored willingness to experience negative consequences as a potential factor underlying the association between co-user status and negative consequences in an effort to guide future intervention work. From a longitudinal study of first-year college students, we examined willingness to experience consequences at Time 2 as a mediator of co-user status at Time 1 and experience of negative consequences at Time 3.

METHODS

First-year college student drinkers (n = 1,914) at a large university completed surveys in the fall and spring of their freshman year and the fall of their sophomore year.

RESULTS

Alcohol and marijuana co-users reported higher willingness to experience consequences than alcohol-only users. Willingness to experience consequences partially explained the association between alcohol and marijuana couse and consequences.

CONCLUSIONS

The current study was the first to compare co-users of alcohol and marijuana to alcohol-only users on willingness to experience consequences, and examine the role of willingness as a mediator between co-user status and consequences experienced. Co-users were more willing to experience adverse effects from drinking, in turn predicting more consequences. Intervention work targeting consequences may be less effective for co-users; thus, additional work is needed to identify other potential mechanisms for change for this at-risk group.

Willingness as a mediator of the effects of personality on alcohol-related consequences between the first and second years of college: A longitudinal prospective study

The present study used a prospective longitudinal design to examine whether willingness to experience negative alcohol-related consequences mediated the effects of personality on consequences (e.g., blacking out, getting into a fight, and regretted sex). Students (N = 2024) were assessed at three time points: fall semester of the students' first year in college (baseline), 6-months post-baseline, and one-year post-baseline. Personality constructs were assessed at baseline (i.e., impulsivity, sensation seeking, self-regulation), willingness to experience negative alcohol-related consequences was assessed at baseline and 6-months, and negative alcohol-related consequences were examined at baseline and one-year post-baseline. A structural path model was used to examine if willingness mediated the effects of personality on consequences. Baseline drinking was included as a covariate in the model. Results demonstrated willingness to experience consequences significantly mediated the effects of impulsivity, sensation seeking, and self-regulation on consequences. Findings from this study support the idea that consequence-specific cognitions, such as willingness, can explain changes in consequences associated with personality. This suggests that intervention efforts aimed at reducing negative alcohol-related consequences could benefit from the inclusion of consequence-specific cognitions, personality (e.g., impulsivity, sensation seeking, and self-regulation), and drinking.

College alcohol beliefs and drinking consequences: A multiple mediation analysis of norms, expectancies, and willingness to experience drinking consequences

OBJECTIVE

We explored the potential mediating role of willingness to experience drinking consequences and other traditional alcohol outcome predictors (descriptive norms, injunctive norms, positive alcohol expectancies) in explaining the association between college alcohol beliefs ¹ (CABs) and the actual experience of drinking consequences among college students.

PARTICIPANTS

The sample consisted of 415 college students tested in October 2014.

METHODS

Participants responded to an online survey.

RESULTS

When compared to both types of norms and positive alcohol expectancies, CABs demonstrated the strongest associations to both willingness to experience drinking consequences and actual drinking consequences among college students. A multiple mediation analysis revealed that the impact of CABs on students' actual drinking consequences was mediated only through their willingness to experience drinking consequences.

CONCLUSIONS

Students' college alcohol beliefs and their corresponding willingness to experience drinking consequences should be targeted in prevention and intervention programs designed to address the problem of college student drinking.

Adolescents who experienced negative alcohol-related consequences are willing to experience these consequences again in the future

Alcohol use and risky single occasion drinking are common among adolescents and are associated with a higher risk of various negative social, physical, academic, or sexual consequences. Studies have shown that among college students, willingness to experience negative consequences is associated with a higher likelihood of experiencing these consequences in the future. However, it remains unclear how experiencing negative consequences influences adolescents' willingness to experience them again. Based on a representative sample of 1,333 alcohol-using 14- to 15-year-olds (47.9% female), a path model was used to examine the associations between risky drinking, negative social and physical consequences, and willingness to experience the specific consequence in the future. As hypothesized, more frequent risky drinking was positively associated with experiencing negative consequences (i.e., saying or doing embarrassing things, regretted sexual experiences, impairment of schoolwork, problems with parents/friends, accident or injury, hangover, vomiting, memory lapses). Contrary to our second hypothesis, adolescents who experienced a negative consequence were also consistently willing to experience it in the future. Findings suggest that adolescents may see the experience of negative consequences as a necessary evil to attain the positive consequences. Prevention efforts may benefit from focusing on ways of attaining positive consequences by promoting alternatives to engaging in risky drinking practices, as well as reducing negative consequences (e.g., by promoting protective behavioral strategies). (PsycINFO Database Record

The 7-factor hybrid model of DSM-5 PTSD symptoms and alcohol consumption and consequences in a national sample of trauma-exposed veterans

The purpose of the present study was to investigate associations between the 7-factor hybrid model of DSM-5 posttraumatic stress disorder (PTSD) symptoms, which includes intrusions, avoidance, negative affect, anhedonia, externalizing behaviors, anxious arousal, and dysphoric arousal symptoms, and alcohol consumption and consequences. A nationally representative sample of 916 trauma-exposed U.S. military veterans were administered the Trauma History Screen, PTSD Checklist-5, and Alcohol Use Disorders Identification Test. Confirmatory factor analyses were conducted to determine associations between the 7-factor hybrid model of PTSD symptoms, and alcohol consumption and consequences. Results revealed that lifetime dysphoric arousal (r=0.31), negative affect (r=0.30), and anhedonia (r=0.29) symptom clusters were most strongly associated with past-year alcohol consequences. No significant associations were observed for alcohol consumption. While the cross-sectional study design does not allow one to ascertain causative associations between PTSD factors and alcohol consumption and consequences, results generally align with the self-medication hypothesis, as PTSD factors reflecting internalizing were most strongly related to alcohol-related consequences. These results underscore the importance of assessing for alcohol use problems in veterans who score highly on PTSD symptoms reflecting internalizing symptomatology.

Promoting healthy transition to college through mindfulness training with first-year college students: Pilot randomized controlled trial

OBJECTIVE

Given the importance of developmental transitions on young adults' lives and the high rates of mental health issues among U.S. college students, first-year college students can be particularly vulnerable to stress and adversity. This pilot study evaluated the effectiveness and feasibility of mindfulness training aiming to promote first-year college students' health and wellbeing.

PARTICIPANTS

109 freshmen were recruited from residential halls (50% Caucasian, 66% female). Data collection was completed in November 2014.

METHODS

A randomized control trial was conducted utilizing the Learning to BREATHE (L2B) program, a universal mindfulness program adapted to match the developmental tasks of college transition.

RESULTS

Participation in the pilot intervention was associated with significant increase in students' life satisfaction, and significant decrease in depression and anxiety. Marginally significant decrease was found for sleep issues and alcohol consequences.

CONCLUSIONS

Mindfulness-based programs may be an effective strategy to enhance a healthy transition into college.

Evaluations and Perceptions of Others' Evaluations of Negative Alcohol-Related Consequences Predict Negative Alcohol-Related Consequences Among College Drinkers

OBJECTIVE

A key assumption when assessing alcohol-related problems is that these problems are considered negative. A growing literature suggests that college drinkers do not perceive all measured consequences to be negative. Research has established the impact of others' beliefs on personal beliefs and behaviors. The purpose of this study was to assess the effect of perceptions of others' evaluations (POE) of consequences on one's own evaluations and subsequent experiences of consequences.

METHOD

A sample of 885 heavy drinking college students participated in a longitudinal study. Participants reported the number of alcoholic drinks consumed per week, experiences of alcohol-related problems, evaluations of those consequences, and perceptions of how typical university students evaluate those consequences. A moderated mediation of POE on negative alcohol-related consequences via evaluations of consequences at differing levels of alcohol consumption was conducted, with gender, baseline consequences, and intervention effects being controlled for.

RESULTS

Results indicated that POE had no direct effect on subsequent consequences. However, an indirect effect was found through evaluations of consequences, such that there was a positive association between both POE and evaluations of consequences, and evaluations of consequences and subsequent consequences. Average weekly drinking moderated the association between POE and evaluations of consequences, such that the association between POE and evaluations of consequences was stronger for those who drank more heavily.

CONCLUSIONS

Results are consistent with social cognition processes, such as pluralistic ignorance, and suggest that POE and evaluations of consequences should be considered in the construction of interventions targeting heavy-drinking college students.

When alcohol is only part of the problem: An event-level analysis of negative consequences related to alcohol and other substance use

While alcohol remains the drug of choice for most college students, national data show that 40% of college students also use other substances (e.g., marijuana, cocaine, etc.). Longitudinal studies indicate that students who report use of both alcohol and other substances experience more consequences (e.g., blackout, arrests). The current study expands upon this research by using a multilevel approach to examine average and event-level alcohol combined with other substance use (ALC+) and its role on consequences experienced. In addition, the research examined which substance combined with alcohol posed the most risk. A total of 461 students reported on alcohol use, substance use, and consequences experienced (e.g., Young Adult Alcohol Consequences Questionnaire [YAACQ]) on 12 weekend nights (Thursday, Friday, Saturday) across 4 weekends in an academic year. Multilevel model analyses revealed a positive association between both average and event-level ALC+ use and the number of consequences experienced. A significant cross-level interaction was also revealed indicating students who typically combine alcohol and other substances experienced more consequences on occasions when they use more substances relative to students who typically use alcohol only. Finally, alcohol plus nicotine, or marijuana, or attention-deficit/hyperactivity disorder (ADHD) medications, or cocaine were all significantly positively related to increased consequences. These findings provide consistent evidence that ALC+ use is a highly prevalent behavior among college students that increases risk of problematic consequences. (PsycINFO Database Record

Is the deliberate self-induction of alcohol tolerance associated with negative alcohol outcomes?

Research indicates 10% of college student drinkers report deliberately training to increase alcohol tolerance (a diagnostic criterion for alcohol use disorder) to avoid passing out early or to keep up with peers. Given that tolerance training may be considered a harm reduction technique designed to reduce acute aversive consequences, we examined the associations between tolerance training and the use of protective behavioral strategies (PBS) more generally. A cross-sectional survey of 1080 lifetime drinkers was conducted at a large Midwestern university. Of this sample, 5.6% (n=60) reported training to increase their tolerance. Drinkers who endorsed having trained to increase tolerance reported notably more alcohol-related problems than those who reported never training (M_adj=51.80 versus M_adj=39.30; p<0.0001). Further, participants who endorsed tolerance training reported utilizing significantly fewer PBS (e.g., avoid drinking games) on the Protective Behavioral Strategies Scale (PBSS, Martens et al., 2005) than participants who had never trained (M_adj=16.89 versus M_adj=18.90; p<0.01). An exception was that drinkers who trained to avoid passing out early used significantly more PBS (e.g., using a designated driver, knowing where your drink is at all times). Despite this, these trainers consumed more alcohol and experienced more alcohol-related harms. The present findings support previous research demonstrating that trainers consume more alcohol than non-trainers, and provide further evidence that deliberately training to increase tolerance is indicative of problematic drinking behavior. Prevention efforts might aim to inform drinkers of the problems associated with deliberately inducing alcohol tolerance, and focus on developing alternative strategies for minimizing acute harm from drinking.

Evaluations of alcohol consequences moderate social anxiety risk for problematic drinking

The link between social anxiety (SA) and problematic drinking is complex; this seems predominantly true among young adults. Individuals high on SA are thought to be particularly sensitive to the negative effects of alcohol, which should deter them from drinking. Yet, some evidence suggests that those high on SA continue to drink despite experiencing negative alcohol-related consequences (NACs) (Morris, Stewart, & Ham, 2005). Although traditionally, researchers assume NACs are perceived as averse, emerging evidence suggests these are not categorically viewed as negative by undergraduates. The study goal was to test whether evaluations of NACs moderate the effect of SA on problematic drinking. It was hypothesized that high SA would predict elevated alcohol use and number of NACs experienced, but only for those who evaluate NACs as less negative. Undergraduate drinkers (N=130, 80 women) completed self-reports of social anxiety, NAC evaluations (ratings of how 'bad' experiencing each alcohol-related consequence would be), alcohol use, and NACs experienced. Regression analyses revealed that NAC evaluations moderated the effect of SA on number of NACs experienced, but not the effect of SA on weekly alcohol use. Simple slopes analyses showed that high SA was associated with elevated NACs experienced for those with weak negative NAC evaluations, controlling for alcohol use. These findings help explain the mixed SA-problematic drinking literature by identifying perceptions of NACs as an important moderator of SA risk for experiencing NACs. Moreover, clinical interventions aimed at reducing SA risk for undergraduate problematic drinking may benefit from targeting NAC evaluations.

Dangerous Beliefs: College Alcohol Beliefs Are Associated With Increased Risk of Regretted Sexual Encounters

This study explored the relative impact of college alcohol beliefs (CABs; i.e., the extent to which the student views alcohol as part of the fabric of college life), descriptive norms, injunctive norms, positive alcohol expectancies, and sensation seeking on college students' (N = 415) risk for engaging in regretted sexual encounters (RSE). Overall, 12% of our sample reported having experienced RSE within the past 30 days. When pitted against the other traditional predictors of college student drinking and its consequences, such as positive alcohol expectancies, descriptive and injunctive norms, and sensation seeking, CABs emerged as the strongest correlate of RSE other than drinking itself, and explained significant additional variance in RSE beyond these other predictors. Mediation analyses revealed that CABs had a significant indirect effect on RSE through typical weekly drinking. This pattern of findings indicates that college alcohol beliefs are, from a public health perspective, dangerous beliefs, that warrant serious consideration in the development of new approaches to college student drinking and its consequences.

Day-to-day variations in high-intensity drinking, expectancies, and positive and negative alcohol-related consequences

High-intensity drinking (i.e., women/men consuming 8+/10+ drinks in a day) is prevalent and associated with negative consequences. Occasions of high-intensity drinking have markedly high risk; however, previous research has not examined the predictors of these high-risk drinking days. The current study was designed to examine to what extent positive and negative alcohol expectancies predict high-intensity drinking and whether high-intensity drinking on a given day was associated with drinking consequences and their evaluations that day. Frequently drinking college students (N=342) participated in an intensive longitudinal study of drinking behaviors (N=4645 drinking days). Days with greater positive and negative expectancies were associated with high-intensity drinking. Days with high-intensity drinking were associated with reporting more positive and negative consequences and with evaluating positive consequences more favorably and evaluating negative consequences less favorably, compared to drinking days without high-intensity drinking. Given this, prevention and intervention efforts may consider specifically targeting high-intensity drinking events as a unique phenomenon.

A Dual-Process Examination of Alcohol-Related Consequences Among First-Year College Students

OBJECTIVE

Despite showing reductions in college student drinking, interventions have shown some inconsistency in their ability to successfully decrease consequences. With the goal of improving prevention efforts, the purpose of this study was to examine the role of consequence-specific constructs, in addition to drinking, that influence students' experiences with alcohol-related problems. The study examined how drinking and protective behaviors mediated the relationships between students' willingness to experience consequences, intentions to avoid them, and four categories of alcohol-related problems (physiological, social, sexual, and academic).

METHOD

First-year college student drinkers (n = 2,024) at a large northeastern university completed surveys during the fall and spring of their freshman year.

RESULTS

As expected, different patterns of associations emerged for physiological and nonphysiological consequences. When physiological consequences (e.g., hangover, vomiting) were examined, drinking significantly mediated the effect of willingness on the consequences. Drinking-specific protective behaviors indirectly influenced consequences through drinking behaviors whereas general protective behaviors did not. When nonphysiological (e.g., social, sexual, academic) consequences were examined, drinking and general protective behaviors emerged as significant mediators of the effects of willingness and intentions on the consequences, whereas drinking-specific protective behaviors did not.

CONCLUSIONS

The results suggest that prevention efforts (e.g., personalized feedback) could be tailored to address specific types of protective behaviors as well as specific types of consequences frequently experienced by college students.

Drinking consequences and subsequent drinking in college students over 4 years

There is some evidence that college student drinkers may continue drinking in the face of adverse consequences. We examined 2 hypotheses: (a) that this seemingly pathological behavior is a phenomenon of university life, occurring with consistency throughout the entirety of college, and (b) that individuals accumulate these consequences over multiple semesters in college. A sample of 3,720 students from a large Midwestern university was asked to complete surveys the summer before college and every semester thereafter for 4 years. Results showed that certain drinking-related consequences (e.g., blackouts, regretted sexual experiences) consistently predicted continued frequent heavy drinking in the following semester, even after controlling for sex, race, age, and previous-semester frequent heavy drinking (range of odds ratio = 1.17 to 1.45 across semesters, p < .01). Such potent consequences may predict subsequent drinking for a number of possible reasons that may be examined and addressed as they would pertain to specific protective behavioral strategy-related and cognitive interventions. Furthermore, consequences were accumulated over multiple semesters by notable proportions of students. For example, 13.8% of students reported blacking out 5 time-points or more--describing a full half or more of their college careers. Experimental studies which aim to modify students' perceptions of norms associated with these consequences may aid in developing interventions to reduce the burden of harm to students. In the broader context, and given the prevalence of students' accumulation of consequences, future study might aim to determine how and in what ways these findings describe either pathological or normative processes.

First- and second-hand consequences of alcohol in college: Differential associations with later alcohol use

INTRODUCTION

College students are at increased risk of experiencing a variety of consequences as result of their own as well as others' alcohol consumption. The current study examined the differential associations between both first-hand consequences (resulting from one's own drinking) and second-hand consequences (resulting in victimization as a result of others' drinking) and subsequent alcohol consumption across the first year of college.

METHOD

First year students (n = 253) from a large northeastern U.S. university were randomly selected to participate and surveyed at the end of the first semester of college (time 1) and during the first semester of the second year of college (time 2).

RESULTS

Results showed a significant, positive relationship between first-hand consequences and subsequent weekend drinking (β = .16, p < .05) and heavy episodic drinking (β = .49, p < .01), after controlling for individual and friend drinking. A negative association between second-hand consequences and later heavy episodic drinking was also observed (β = -.16, p < .05).

DISCUSSION AND CONCLUSIONS

The findings provided partial support for both a positive association hypothesis and a negative association hypothesis. The importance of personal alcohol consumption and peers' drinking in relation to first- and second-hand consequences are discussed.

Who Will Experience the Most Alcohol Problems in College? The Roles of Middle and High School Drinking Tendencies

BACKGROUND

Previous work examining college drinking tendencies has identified a disproportionately small (20%), but uniquely high-risk group of students who experience nearly 50% of the reported alcohol-related consequences (i.e., the multiple repeated consequences, or MRC, group). With the goal of reducing drinking-related consequences later in college, this study sought to identify potential MRC group members in their first semester by examining: (i) early-risk subgroups based on analysis of early-risk screening constructs (e.g., age of drinking onset, middle school alcohol exposure, high school drinking, and consequences); and (ii) their association with MRC criteria early in the first semester of college.

METHODS

A random sample of 2,021 first-year college student drinkers (56% female) completed a web-based drinking survey in their first semester on campus.

RESULTS

Latent class analysis revealed 4 early-risk subgroups: (i) an early-onset risk group who endorsed early age of drinking onset and engaged in heavy middle and high school drinking (10%); (ii) a late-onset risk group who engaged in weekend drinking and drunkenness and experienced 6 or more unique consequences as seniors in high school (32%); (iii) an early-onset limited risk group who only endorsed early age of onset and middle school drinking (3%); and (iv) a minimal risk group who did not engage in any early-risk behaviors (55%). Members of both the early- and late-onset risk groups had significantly higher odds of MRC membership in their first semester of college (9.85 and 6.79 greater, respectively).

CONCLUSIONS

Results suggest age of onset, middle and high school drinking and drunkenness, and frequency of unique consequences could be particularly useful in brief screening tools. Further, findings support early screening and prevention efforts for MRC membership prior to college matriculation.

Examination of a dual-process model predicting riding with drinking drivers

BACKGROUND

Nearly 1 in 5 of the fatalities in alcohol-related crashes are passengers. Few studies have utilized theory to examine modifiable psychosocial predictors of individuals' tendencies to be a passenger in a vehicle operated by a driver who has consumed alcohol. This study used a prospective design to test a dual-process model featuring reasoned and reactive psychological influences and psychosocial constructs as predictors of riding with drinking drivers (RWDD) in a sample of individuals aged 18 to 21.

METHODS

College students (N = 508) completed web-based questionnaires assessing RWDD, psychosocial constructs (attitudes, expectancies, and norms), and reasoned and reactive influences (intentions and willingness) at baseline (the middle of the spring semester) and again 1 and 6 months later. Regression was used to analyze reasoned and reactive influences as proximal predictors of RWDD at the 6-month follow-up. Subsequent analyses examined the relationship between the psychosocial constructs as distal predictors of RWDD and the mediation effects of reasoned and reactive influences.

RESULTS

Both reasoned and reactive influences predicted RWDD, while only the reactive influence had a significant unique effect. Reactive influences significantly mediated the effects of peer norms, attitudes, and drinking influences on RWDD. Nearly all effects were constant across gender except parental norms (significant for females).

CONCLUSIONS

Findings highlight that the important precursors of RWDD were reactive influences, attitudes, and peer and parent norms. These findings suggest several intervention methods, specifically normative feedback interventions, parent-based interventions, and brief motivational interviewing, may be particularly beneficial in reducing RWDD.

Does hangover influence the time to next drink? An investigation using ecological momentary assessment

BACKGROUND

Measures of hangover are associated with current and future problematic alcohol use. At present, it is not known whether these associations reflect any direct influence of hangover events on near-term drinking behaviors. The current study aimed to determine whether hangover following a drinking episode influences time to next drink (TTND) and, if so, to determine the direction of this effect and identify any moderating personal or contextual factors.

METHODS

Community-recruited, frequent drinkers oversampled for current smoking (N = 386) carried electronic diaries for 21 days, reporting on drinking behaviors and other experiences. Survival analysis was used to model data from 2,276 drinking episodes, including 463 episodes that were followed by self-reported hangover in morning diary entries.

RESULTS

When tested as the sole predictor in a survival model, hangover was associated with increased TTND. The median survival time was approximately 6 hours longer after episodes with hangovers compared to those without. In a multivariate model, hangover was only significant in the presence of interaction effects involving craving at the end of the index drinking episode and the occurrence of financial stressors. Additional predictors of TTND in the final multivariate model included age, lifetime alcohol use disorder diagnosis, typical drinking frequency, day of the week, and morning reports of craving, negative affect, and stressors after the index episode. There was no association between morning reports of hangover and contemporaneous diary ratings of likelihood of drinking later the same day.

CONCLUSIONS

The findings suggest that hangover has, at best, a modest or inconsistent influence on the timing of subsequent alcohol use among frequent drinkers.

Are certain college students prone to experiencing excessive alcohol-related consequences? Predicting membership in a high-risk subgroup using pre-college profiles

OBJECTIVE

Previous research identified a high-risk subgroup of students who experience high levels of multiple and repeated alcohol-related consequences (MRC group). Although they consist of 20% of the population and account for nearly 50% of the consequences, the MRC group has not been the focus of etiological or prevention research. The present study identified pre-college profiles of psychosocial and behavioral characteristics and examined the association between these profiles and membership in the MRC group.

METHOD

The sample consisted of 370 first-year college students (57% female) recruited in the summer before college. Participants reported on typical drinking, alcohol-related risky and protective drinking behaviors, alcohol beliefs, descriptive and injunctive norms, and alcohol-related consequences at three time points over 15 months.

RESULTS

Latent profile analysis identified four baseline student profiles: extreme-consequence drinkers, high-risk drinkers, protective drinkers, and nondrinkers. Logistic regression revealed that, when the high-risk drinkers were used as the reference group, both the protective drinkers and the nondrinkers were significantly less likely to be members of the MRC group, whereas the extreme-consequence drinkers were at increased odds of being in the MRC group, even after first-year drinking was controlled for. Student profiles and previously identified parental profiles both had unique main effects on MRC group membership, but there was no significant interaction between parental and student profiles.

CONCLUSIONS

Findings suggest ways that brief interventions can be tailored for students and parents in relation to the MRC group.

An update of research examining college student alcohol-related consequences: new perspectives and implications for interventions

The objective of this review is to provide an update on existing research examining alcohol-related consequences among college students with relevance for individual-based interventions. While alcohol-related consequences have been a focus of study for several decades, the literature has evolved into an increasingly nuanced understanding of individual and environmental circumstances that contribute to risk of experiencing consequences. A number of risk factors for experiencing alcohol-related consequences have been identified, including belonging to specific student subgroups (e.g., Greek organizations) or drinking during high-risk periods, such as spring break. In addition, the relationship between students' evaluations of both negative and positive consequences and their future drinking behavior has become a focus of research. The current review provides an overview of high-risk student subpopulations, high-risk windows and activities, and college students' subjective evaluations of alcohol-related consequences. Future directions for research are discussed and include determining how students' orientations toward consequences change over time, identifying predictors of membership in high-risk consequence subgroups and refining existing measures of consequences to address evolving research questions.

Using parental profiles to predict membership in a subset of college students experiencing excessive alcohol consequences: findings from a longitudinal study

OBJECTIVE

Previous research identified a high-risk subset of college students experiencing a disproportionate number of alcohol-related consequences at the end of their first year. With the goal of identifying pre-college predictors of membership in this high-risk subset, the present study used a prospective design to identify latent profiles of student-reported maternal and paternal parenting styles and alcohol-specific behaviors and to determine whether these profiles were associated with membership in the high-risk consequences subset.

METHOD

A sample of randomly selected 370 incoming first-year students at a large public university reported on their mothers' and fathers' communication quality, monitoring, approval of alcohol use, and modeling of drinking behaviors and on consequences experienced across the first year of college.

RESULTS

Students in the high-risk subset comprised 15.5% of the sample but accounted for almost half (46.6%) of the total consequences reported by the entire sample. Latent profile analyses identified four parental profiles: positive pro-alcohol, positive anti-alcohol, negative mother, and negative father. Logistic regression analyses revealed that students in the negative-father profile were at greatest odds of being in the high-risk consequences subset at a follow-up assessment 1 year later, even after drinking at baseline was controlled for. Students in the positive pro-alcohol profile also were at increased odds of being in the high-risk subset, although this association was attenuated after baseline drinking was controlled for.

CONCLUSIONS

These findings have important implications for the improvement of existing parent- and individual-based college student drinking interventions designed to reduce alcohol-related consequences.

Rose-colored beer goggles: the relation between experiencing alcohol consequences and perceived likelihood and valence

Although experiencing alcohol-related consequences has some influence on future drinking, this effect may be stronger based on the degree to which the consequence is viewed as positive versus negative, either by the individual or predefined by researchers. This study explored the relationship between experiencing positive and negative alcohol-related consequences and college students' perceptions of how likely those consequences were to occur in the future (i.e., likelihood), and their view of how positive or negative experiencing those consequences would be if they did experience them as a result of drinking (i.e., valence). Data were collected from 491 college students (mean age = 19.26; 56.4% female; 55.0% Caucasian; 33.2% Asian/Pacific Islander) through a computerized survey. Results indicated that experiencing more positive consequences in the past year was associated with viewing those consequences as both more likely to occur and more positive, while experiencing more negative consequences was associated with viewing them as less negative and no more likely to occur, except for those who had experienced the highest levels of negative consequences. These findings suggest that finding ways to reduce both perceptions as well as consequences themselves may be effective intervention tools.