Characterizing subjective responses to alcohol among adolescent problem drinkers

Understanding alcohol use and alcohol use disorders from a developmental psychopathology perspective: Research advances, challenges, and future directions

As part of the special issue of Development and Psychopathology honoring the remarkable contributions of Dr Dante Cicchetti, the current paper attempts to describe the recent contributions that a developmental psychopathology perspective has made in understanding the development of alcohol use and alcohol-related problems over the lifespan. The paper also identifies some of the future challenges and research directions. Because the scope of this task far exceeds the confines of a journal length article this paper does not attempt a comprehensive review. Rather, it builds on an earlier review and commentary that was published in Development and Psychopathology in 2013, with a similar goal.)Building on that work and updating its conclusions and suggestions for future directions, the current paper emphasizes findings from the research areas that were identified for further study in 2013 and the findings that have been published since that time.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Sleep-Related Predictors of Risk for Alcohol Use and Related Problems in Adolescents and Young Adults

PURPOSE

Growing evidence supports sleep and circadian rhythms as influencing alcohol use and the course of alcohol use disorder (AUD). Studying sleep/circadian-alcohol associations during adolescence and young adulthood may be valuable for identifying sleep/circadian-related approaches to preventing and/or treating AUD. This paper reviews current evidence for prospective associations between sleep/circadian factors and alcohol involvement during adolescence and young adulthood with an emphasis on the effects of sleep/circadian factors on alcohol use.

SEARCH METHODS

The authors conducted a literature search in PsycInfo, PubMed, and Web of Science using the search terms "sleep" and "alcohol" paired with "adolescent" or "adolescence" or "young adult" or "emerging adult," focusing on the title/abstract fields, and restricting to English-language articles. Next, the search was narrowed to articles with a prospective/longitudinal or experimental design, a sleep-related measure as a predictor, an alcohol-related measure as an outcome, and confirming a primarily adolescent and/or young adult sample. This step was completed by a joint review of candidate article abstracts by two of the authors.

SEARCH RESULTS

The initial search resulted in 720 articles. After review of the abstracts, the list was narrowed to 27 articles reporting on observational longitudinal studies and three articles reporting on intervention trials. Noted for potential inclusion were 35 additional articles that reported on studies with alcohol-related predictors and sleep-related outcomes, and/or reported on candidate moderators or mediators of sleep-alcohol associations. Additional articles were identified via review of relevant article reference lists and prior exposure based on the authors' previous work in this area.

DISCUSSION AND CONCLUSIONS

Overall, the review supports a range of sleep/circadian characteristics during adolescence and young adulthood predicting the development of alcohol use and/or alcohol-related problems. Although sleep treatment studies in adolescents and young adults engaging in regular and/or heavy drinking show that sleep can be improved in those individuals, as well as potentially reducing alcohol craving and alcohol-related consequences, no studies in any age group have yet demonstrated that improving sleep reduces drinking behavior. Notable limitations include relatively few longitudinal studies and only two experimental studies, insufficient consideration of different assessment timescales (e.g., day-to-day vs. years), insufficient consideration of the multidimensional nature of sleep, a paucity of objective measures of sleep and circadian rhythms, and insufficient consideration of how demographic variables may influence sleep/circadian-alcohol associations. Examining such moderators, particularly those related to minoritized identities, as well as further investigation of putative mechanistic pathways linking sleep/circadian characteristics to alcohol outcomes, are important next steps.

Effects of emerging alcohol use on developmental trajectories of functional sleep measures in adolescents

STUDY OBJECTIVES

Adolescence is characterized by significant brain development, accompanied by changes in sleep timing and architecture. It also is a period of profound psychosocial changes, including the initiation of alcohol use; however, it is unknown how alcohol use affects sleep architecture in the context of adolescent development. We tracked developmental changes in polysomnographic (PSG) and electroencephalographic (EEG) sleep measures and their relationship with emergent alcohol use in adolescents considering confounding effects (e.g. cannabis use).

METHODS

Adolescents (n = 94, 43% female, age: 12-21 years) in the National Consortium on Alcohol and Neurodevelopment in Adolescence (NCANDA) study had annual laboratory PSG recordings across 4-years. Participants were no/low drinkers at baseline.

RESULTS

Linear mixed effect models showed developmental changes in sleep macrostructure and EEG, including a decrease in slow wave sleep and slow wave (delta) EEG activity with advancing age. Emergent moderate/heavy alcohol use across three follow-up years was associated with a decline in percentage rapid eye movement (REM) sleep over time, a longer sleep onset latency (SOL) and shorter total sleep time (TST) in older adolescents, and lower non-REM delta and theta power in males.

CONCLUSIONS

These longitudinal data show substantial developmental changes in sleep architecture. Emergent alcohol use during this period was associated with altered sleep continuity, architecture, and EEG measures, with some effects dependent on age and sex. These effects, in part, could be attributed to the effects of alcohol on underlying brain maturation processes involved in sleep-wake regulation.

Assessing real-time positive subjective effects of alcohol using high-resolution ecological momentary assessment in risky versus light drinkers

BACKGROUND

High-resolution ecological momentary assessment (HR-EMA) can assess acute alcohol responses during naturalistic heavy drinking episodes. The goal of this study was to use HR-EMA to examine drinking behavior and subjective responses to alcohol in risky drinkers (moderate-severe alcohol use disorder [MS-AUD], heavy social drinkers [HD]) and light drinkers (LD). We expected that risky drinkers would endorse greater alcohol stimulation and reward, with lower sedation, than LD, even when controlling for amount of alcohol consumed.

METHODS

Participants (N = 112; 54% male, M ± SD age = 27.2 ± 4.2 years) completed smartphone-based HR-EMA during one typical alcohol drinking occasion and one non-alcohol-drinking occasion in their natural environment. Participants were prompted to complete next-day surveys that assessed drinking-related outcomes, study acceptability, and safety.

RESULTS

HR-EMA prompt completion rates were excellent (92% and 89% for the alcohol and nonalcohol episodes, respectively). The MS-AUD group consumed the most alcohol with the highest estimated blood alcohol concentration (eBAC) by the end of the alcohol drinking episode (0.14 g/dL) versus LD (0.02 g/dL), with HD intermediate (0.10 g/dL). Relative to LD, MS-AUD and HD endorsed greater positive effects of alcohol (stimulation, liking, and wanting).

CONCLUSIONS

This study is the first to use HR-EMA to measure and compare real-world acute alcohol responses across diverse drinker subgroups, including persons with MS-AUD. Results demonstrate that risky drinkers experience heightened pleasurable effects measured in real-time during natural-environment alcohol responses. Rather than drinking excessively to eventually achieve desirable subjective effects, risky drinkers show sensitivity to positive alcohol effects throughout a heavy drinking episode.

Leveraging Ecological Momentary Assessment to Examine Bi-directional Associations Between Sleep Quality, Adolescent/Young Adult Alcohol Craving and Use

BACKGROUND

Alcohol use is common among adolescents and young adults (AYA) and linked to poor sleep quality. Poor sleep quality may also increase alcohol use and alcohol craving, yet bi-directional relations between sleep quality and AYA alcohol use are poorly understood.

PURPOSE

This study examined bi-directional associations between sleep quality, alcohol craving, and alcohol use in AYA using ecological momentary assessment (EMA) and explored if biological sex, age, or race moderated these associations.

METHODS

This pre-registered secondary analysis pooled EMA data from the baseline, pre-randomization period (M = 8.18 days, range = 1-17) in two double-blind randomized placebo-controlled clinical trials examining medication effects on alcohol use in AYA (N = 115). Each morning, participants reported sleep quality and alcohol consumption (i.e., number of standard drinks) from the previous day, and craving was rated at several random points each day.

RESULTS

Multilevel modeling showed that poorer average sleep quality was associated with higher levels of alcohol craving for females but not for males, and better overall levels of sleep quality were associated with decreased likelihood of engaging in alcohol use. No other person- or day-level associations between sleep and alcohol use emerged.

CONCLUSIONS

Better sleep quality may be protective against alcohol use in AYA, and female AYA who report poorer sleep quality may experience higher levels of alcohol craving. Research and clinical assessment of AYA sleep quality can contribute to understanding of factors promoting alcohol craving and use.

Momentary subjective responses to alcohol as predictors of continuing to drink during daily-life drinking episodes

PURPOSE

Subjective response to alcohol's stimulating and sedating effects is a person-level risk factor for heavy drinking and alcohol use disorder. Longitudinal and laboratory studies have demonstrated that at-risk individuals experience greater stimulation and lower sedation while drinking. While between-person subjective responses inform risk and etiology, in-the-moment assessments during daily-life drinking may elucidate the within-person processes by which stimulation and sedation may lead to heavier drinking. We aimed to characterize these momentary processes by testing momentary stimulation and sedation during drinking as predictors of subsequently continuing to drink during densely sampled, daily-life drinking episodes.

PROCEDURES

113 adults (54 with borderline personality disorder and 59 community participants; 77.9% female) completed ecological momentary assessment for 21 days, reporting momentary subjective stimulation and sedation throughout drinking episodes and momentary alcohol use after drink initiation (i.e., continued drinking).

FINDINGS

GLMMs demonstrated that greater day-level stimulation (OR=1.48, 95% CI=[1.20, 1.82], p<.001), greater person-level stimulation (OR=1.63, 95% CI=[1.05, 2.53], p=.031), and lower momentary sedation (OR=0.54, 95% CI=[0.41, 0.71], p<.001) predicted continued drinking.

CONCLUSIONS

Although greater stimulation and lower sedation have been conceptualized as individual-level risk factors for heavy drinking, our findings suggest that these associations are accompanied by processes that operate within person. Our results suggest that greater stimulation may confer risk for heavy drinking at the level of the drinking episode, possibly acting as positive reinforcement that may contribute to heavier drinking during future episodes. In contrast, lower sedation may primarily confer in-the-moment risk by contributing to momentary decisions to keep drinking within an episode.

Underage access to alcohol and its impact on teenage drinking and crime

Does underage access to alcohol increase teenage drinking and crime? To address this question, I leverage a discontinuity in legal access to alcohol at age 16 in Germany, a country with high consumption levels and a particularly early access regulation. Using detailed survey data and administrative crime records from 2005 to 2015, I detect considerable increases in drinking participation, frequency, and intensity at the legal cutoff along the middle and lower end of the distribution. These increases coincide with discrete jumps in criminal engagement under the influence of alcohol, mostly due to violent and property crimes. My findings suggest that changes in drinking intensity induce these crimes, implying a drinking-crime elasticity of 0.4 at age 16.

Incubation of alcohol craving as it naturally occurs in a developmentally diverse sample of dependent and nondependent drinkers

Longer periods of abstinence are shown to enhance response to alcohol cues among alcohol-dependent animals and humans, a phenomenon described as "incubation of craving." The present work examined the effects of days since last drink on general craving and alcohol-cued craving as it occurs in daily life and explored whether effects were influenced by age and dependence. Three samples were combined to include 266 drinkers ranging in age from 14 to 67 years recruited from the community; about half (59.4%) met criteria for alcohol dependence. Drinkers used handheld electronic devices to rate their subjective alcohol craving (assessed as "urge to drink") and situational context (e.g., presence of visible alcohol cues) at nondrinking times in daily life, with days since last alcohol use culled from timeline follow-back interviews and real-world reports. Drinkers at the lower end of the age range in this sample reported greater intensification of craving with more days of continuous abstinence than drinkers at the upper end of the age range. Age was not related to incubation of cue-elicited craving, in specific, however. For drinkers with dependence, craving when in the presence of visible alcohol cues intensified with more days of continuous abstinence, suggesting craving incubation. This study builds from important foundational work to demonstrate that incubation of cue-elicited craving occurs in dependent drinkers and applies regardless of age. Inasmuch as craving is a motivational drive that maintains alcohol use, understanding factors that influence craving in daily life holds promise for improving clinical care.

Alcohol subjective responses in heavy drinkers: Measuring acute effects in the natural environment versus the controlled laboratory setting

BACKGROUND

For decades, laboratory alcohol challenges have been the "gold standard" for measuring individual differences in alcohol's subjective effects. However, these approaches are expensive and labor-intensive, making them impractical for large-scale use. This study examined the reliability and validity of a new high-resolution EMA (HR-EMA) ambulatory approach to assessing alcohol use and subjective responses in drinkers' natural environments.

METHODS

Participants were 83 young adult heavy social drinkers (58% male; mean ± SD age = 25.4 ± 2.6 years) who completed up to two smartphone-based, 3-h HR-EMA assessments of alcohol use and related subjective responses in their typical drinking environments. Reported alcohol consumption during the HR-EMA periods was used to calculate estimated blood alcohol concentration (eBAC). Subjective effects were measured using the Brief Biphasic Alcohol Effects Scale (B-BAES) and Drug Effects Questionnaire (DEQ). All participants also completed identical measures during a separate, 4 to 5-h laboratory session in which they received a 0.8 g/kg alcohol challenge.

RESULTS

Most natural environment drinking episodes (87%) met or exceeded the threshold for binge drinking (final mean eBAC = 0.12 g/dl). Associations between reported alcohol use and subjective responses on the B-BAES and DEQ were strongest earlier in the drinking events, with fair reliability of reported subjective effects across two HR-EMA episodes (intraclass correlation [ICC] range = 0.46-0.49). There was fair-to-good correspondence between HR-EMA- and laboratory-derived subjective responses (ICC range = 0.49-0.74), even after accounting for differences in alcohol consumption and drinking context. Reported stimulating and rewarding alcohol effects were higher in the ambulatory than laboratory setting, and vice versa for sedating effects.

CONCLUSIONS

This study supports the reliability and validity of smartphone-based HR-EMA to measure alcohol use and subjective responses in heavy drinkers' natural environments. These findings lend support to the use of ambulatory HR-EMA as a measure of alcohol subjective responses in risky drinkers when a laboratory protocol is not practical, feasible, or safe.

Parental drinking according to parental composition and adolescent binge drinking: findings from a nationwide high school survey in Japan

Background

Alcohol problems in parents have been revealed to affect adolescent alcohol misuse. However, few studies examine the effects of parental drinking on adolescent risky drinking (including binge drinking) in the general population. In particular, previous study findings are inconsistent regarding the influence of parental drinking according to parental composition. In this study, we aimed to examine the relationship between parental drinking, according to parental composition, and binge drinking among high school students in Japan.

Methods

We performed a secondary analysis of the Nationwide High School Survey on Drug Use and Lifestyle 2018, Japan. A total of 46,848 valid surveys from high school students of 78 schools were included for analysis. Logistic regression analysis with a generalized linear mixed model was conducted with binge drinking as the dependent variable and “parental drinking according to parental composition” (e.g., father’s drinking, mother’s drinking, father’s absence, mother’s absence, both parents drinking, and neither parent at home) as the independent variable, after adjusting with covariates. Binge drinking was defined as five or more alcoholic drinks for male adolescents or four or more alcoholic drinks for females on the same occasion within two hours.

Results

In the fully adjusted models, adolescents whose mothers drink (adjusted odds ratio (AOR): 1.50, 95% confidence interval (CI): 1.06–2.12) were significantly associated with adolescent binge drinking. This risk was significantly higher among students with neither parent living at home (AOR: 4.35, 95% CI: 2.10–9.02).

Conclusion

Parental drinking and absence do affect adolescent binge drinking; our findings show that adolescents are more likely to engage in binge drinking if their mothers drink or if they are not living with either parent. Therefore, it is important to engage parents and non-parental family members in future programs and interventions to prevent adolescent binge drinking.

Annual Research Review: Ecological momentary assessment studies in child psychology and psychiatry

BACKGROUND

Enhancements in mobile phone technology allow the study of children and adolescents' everyday lives like never before. Ecological momentary assessment (EMA) uses these advancements to allow in-depth measurements of links between context, behavior, and physiology in youths' everyday lives.

FINDINGS

A large and diverse literature now exists on using EMA to study mental and behavioral health among youth. Modern EMA methods are built on a rich tradition of idiographic inquiry focused on the intensive study of individuals. Studies of child and adolescent mental and behavioral health have used EMA to characterize lived experience, document naturalistic within-person processes and individual differences in these processes, measure familiar constructs in novel ways, and examine temporal order and dynamics in youths' everyday lives.

CONCLUSIONS

Ecological momentary assessment is feasible and reliable for studying the daily lives of youth. EMA can inform the development and augmentation of traditional and momentary intervention. Continued research and technological development in mobile intervention design and implementation, EMA-sensor integration, and complex real-time data analysis are needed to realize the potential of just-in-time adaptive intervention, which may allow researchers to reach high-risk youth with intervention content when and where it is needed most.

Why don't they stop? Understanding unplanned marijuana use among adolescents and young adults

Difficulty regulating substance use is a core feature of addiction that can manifest as unplanned use. This study sought to identify internal and situational influences on unplanned marijuana use among youth ages 15 to 24 years (N = 85; 48% female; 27% age <18 years). Additionally, we disentangled person-level associations from within-person day-to-day influences. Ecological momentary assessment methods captured affective (positive: energized, excited, sociable, happy, relaxed; negative: bored, tense, sad, stressed) and situational factors in real-world settings during a 1-week monitoring period. Participants reported no plan to use on 51% of days (269/527), and youth ultimately used marijuana on 35% of these unplanned days. At the day level, on days when youth spent more time in the presence of marijuana-related cues than they typically do, they used more grams on planned days and less on unplanned days. Regardless of use plans, youth were more likely to use on days when they spent more time with using friends and if they reported greater availability of marijuana in general across the monitoring period. At the person level, youth who generally reported higher positive affect, relative to other participants, used more on planned days and less on unplanned days. Regardless of use plans, youth who generally reported greater craving and time in the presence of marijuana-related cues used more grams, whereas youth who generally reported greater negative affect used less. Together, findings revealed several factors, with clear clinical relevance, which may explain why some youth struggle to control their marijuana use. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Rate of alcohol consumption in the daily life of adolescents and emerging adults

RATIONALE

Alcohol consumption in adolescents and emerging adults is a significant issue. However, our understanding of the topography of alcohol use within drinking episodes in this population is at a nascent stage.

OBJECTIVES

This study characterized rate of alcohol consumption in the daily lives of problem drinkers ages 16-24 years (N = 75). We examined whether AUD symptoms and the presence of peers, factors relevant to alcohol consumption in youth, were associated with rate of consumption.

METHODS

Ecological momentary assessment (EMA) was used (N_observations = 799). Rate of consumption was defined as change in estimated blood alcohol concentration (eBAC) relative to the start of the drinking episode. Piecewise multi-level modeling was used to test hypotheses. As a comparison, we examined whether indicators of quantity and frequency (Q-F) were associated with AUD symptoms and presence of peers.

RESULTS

For all participants, eBAC increased sharply early in the episode, then plateaued. Participants with more AUD symptoms or who were in the presence of peers had significantly steeper increases in eBAC over the early part of the episode. Participants with more AUD symptoms were also more likely to engage in binge-like behavior. For Q-F, only peak eBAC and peak number of standard drinks were associated with AUD symptoms, and not presence of peers.

CONCLUSIONS

Findings highlight the value of rate of consumption as an indicator of use in youth, one sensitive to the influence of relevant person-level and situational factors. Intervention efforts may benefit from targeting the speed at which youth drink.

Assessment of Alcohol Use in the Natural Environment

The current article critically reviews 3 methodological options for assessing drinking episodes in the natural environment. Ecological momentary assessment (EMA) typically involves using mobile devices to collect self-report data from participants in daily life. This technique is now widely used in alcohol research, but investigators have implemented diverse assessment strategies. This article focuses on "high-resolution" EMA protocols that oversample experiences and behaviors within individual drinking episodes. A number of approaches have been used to accomplish this, including using signaled follow-ups tied to drinking initiation, asking participants to log entries before and after individual drinks or drinking episodes, and delivering frequent signaled assessments during periods of the day when alcohol use is most common. Transdermal alcohol sensors (TAS) are devices that are worn continuously and are capable of detecting alcohol eliminated through the skin. These methods are appealing because they do not rely upon drinkers' self-report. Studies using TAS have been appearing with greater frequency over the past several years. New methods are making the use of TAS more tractable by permitting back-translation of transdermal alcohol concentration data to more familiar estimates of blood alcohol concentration or breath alcohol concentration. However, the current generation of devices can have problems with missing data and tend to be relatively insensitive to low-level drinking. An emerging area of research investigates the possibility of using mobile device data and machine learning to passively detect the user's drinking, with promising early findings. EMA, TAS, and sensor-based approaches are all valid, and tend to produce convergent information when used in conjunction with one another. Each has a unique profile of advantages, disadvantages, and threats to validity. Therefore, the nature of the underlying research question must dictate the method(s) investigators select.

Subjective cannabis effects as part of a developing disorder in adolescents and emerging adults

In light of expanding legalization of cannabis and swelling debate about the potential risks, particularly for younger users, understanding acute cannabis effects among adolescents and emerging adults is more important than ever. Contemporary models of addiction development identify subjective drug responses as central to the developmental unfolding of drug use disorders. Despite this, surprisingly little is known about cannabis's acute subjective effects in human youths. This research utilized ecological momentary assessment (EMA) in the natural environment to identify the typical situational context of cannabis use among 85 frequent cannabis users, ages 15-24 years (M = 19.8, SD = 2.0; 48.2% female). Study aims were to (a) characterize momentary changes in several subjective states (i.e., stimulation, sedation, tension, craving, and high) when not using, just before cannabis use, and after use, and (b) evaluate whether cannabis responses varied with cannabis use disorder (CUD) severity or across the transition from adolescence to emerging adulthood in a correlational manner. Use of cannabis produced measurable reductions in craving and tension, as well as increases in stimulation, sedation, and "high." Participants with more CUD symptoms reported greater relief of craving and increased stimulatory response and high following use. In contrast, emerging adults reported diminished stimulatory response and high following use, relative to adolescents. Results highlight the utility of EMA for characterizing cannabis response as this behavior unfolds in daily life, during a key developmental timeframe in the pathogenesis of cannabis-use pathology. (PsycINFO Database Record

A multimodal investigation of contextual effects on alcohol's emotional rewards

Regular alcohol consumption in unfamiliar social settings has been linked to problematic drinking. A large body of indirect evidence has accumulated to suggest that alcohol's rewarding emotional effects-both negative-mood relieving and positive-mood enhancing-will be magnified when alcohol is consumed within unfamiliar versus familiar social contexts. But empirical research has never directly examined links between contextual familiarity and alcohol reward. In the current study, we mobilized novel ambulatory technology to examine the effect of social familiarity on alcohol reward in everyday drinking contexts while also examining how alcohol reward observed in these field contexts corresponds to reward observed in the laboratory. Heavy social drinking participants (N = 48, 50% male) engaged in an intensive week of ambulatory assessment. Participants wore transdermal alcohol sensors while they reported on their mood and took photographs of their social contexts in response to random prompts. Participants also attended 2 laboratory beverage-administration sessions, during which their emotional responses were assessed and transdermal sensors were calibrated to estimate breathalyzer readings (eBrACs). Results indicated a significant interaction between social familiarity and alcohol episode in everyday drinking settings, with alcohol enhancing mood to a greater extent in relatively unfamiliar versus familiar social contexts. Findings also indicated that drinking in relatively unfamiliar social settings was associated with higher eBrACs. Finally, results indicated a correspondence between some mood effects of alcohol experienced inside and outside the laboratory. This study presents a novel methodology for examining alcohol reward and indicates social familiarity as a promising direction for research seeking to explain problematic drinking. (PsycINFO Database Record

Risk-Taking Propensity, Affect, and Alcohol Craving in Adolescents' Daily Lives

Background: Alcohol craving is common among adolescents, stronger among those with more alcohol-related problems, and predicts drinking levels in their daily lives. Yet, the conditions that predict momentary changes in craving in real time among adolescents remain unclear. Objectives: This study examined the interactive effects of momentary risk-taking propensity and affect on adolescents' alcohol craving by leveraging ecological momentary assessment (EMA) methods. Methods: Participants were 29 adolescents ages 15-19 years (55% female; 69% White; 10% Black; 17% Hispanic); 45% met criteria for alcohol dependence. Following a laboratory session that captured self-report and behavioral assessments, including the well-established Balloon Analog Risk Task (BART), participants completed multiple daily assessments of alcohol craving, positive and negative affect, and risk propensity for approximately one week. Momentary risk propensity was captured in real-world settings via an EMA behavioral task ("Balloon Game"). Results: Mixed-effects models with EMA reports (Level 1) nested within participants (Level 2) revealed the majority (74%) of variability in "Balloon Game" performance was due to within-person, momentary, fluctuations. Greater momentary positive affect predicted increased alcohol craving, but only when participants exhibited heightened risk-taking propensity. Negative affect did not influence the relation between momentary risk-taking and craving. Conclusions/Importance: Momentary fluctuations in positive affect predicted acute increases in craving but only in moments when adolescents demonstrated higher levels of risk-taking propensity, as captured with an EMA-delivered behavioral task. Momentary risk-taking assessments offer new avenues to substantiate dominant theories on the driving mechanisms of craving and alcohol use among adolescents.

Lower Blood Alcohol Concentration Among HIV-Positive Versus HIV-Negative Individuals Following Controlled Alcohol Administration

BACKGROUND

Although it has been purported that HIV-positive individuals may experience a greater degree of intoxication than HIV-negative individuals following acute alcohol consumption, no research to date has empirically tested this supposition. The present investigation entailed a randomized controlled experiment to identify whether the administration of a weight-specified dose of alcohol would lead to differential blood alcohol concentrations (BACs) among HIV-positive versus HIV-negative men.

METHODS

In a specialized barroom laboratory, 143 men (n = 76 HIV-positive and n = 67 HIV-negative; mean age = 42.9) consumed beverages based on a formulation of 0.7 g alcohol/kg body weight over a 15-minute time frame. BAC was assessed via breathalyzer at 2 set time points (10 and 13 minutes postconsumption) and then periodically until detoxification (BAC < 0.040%). Primary outcomes included (i) area under the curve (AUC), calculated based on all of one's BAC readings, (ii) "BAC-EXP," defined as one's BAC reading 13 minutes postconsumption, and (iii) BAC-PEAK, defined as one's highest recorded BAC reading.

RESULTS

Contrary to predictions, AUC (t(141) = 2.23, p = 0.027), BAC-EXP (t(141) = 2.68, p = 0.008), and BAC-PEAK (t(141) = 2.29, p = 0.023) were significantly lower among HIV-positive versus HIV-negative participants. These effects were sustained in multivariable models controlling for age, race, and AUDIT-based hazardous drinking classification. Among the HIV-positive sample, outcomes did not significantly differ based on HIV viral load detectability, antiretroviral therapy (ART) status, or ART adherence.

CONCLUSIONS

The administration of a controlled, weight-specified dose of alcohol led to lower BACs among HIV-positive versus HIV-negative participants. These differences might derive from decreased body fat percentage and delayed gastric emptying associated with HIV seropositivity; however, additional research is necessary to verify these mechanisms. Unique alcohol dosing formulas based on HIV serostatus may be required in future alcohol administration experiments involving HIV-positive samples.

Cognitive effects of labeled addictolytic medications

INTRODUCTION

Alcohol, tobacco, and illegal drug usage is pervasive throughout the world, and abuse of these substances is a major contributor to the global disease burden. Many pharmacotherapies have been developed over the last 50years to target addictive disorders. While the efficacy of these pharmacotherapies is largely recognized, their cognitive impact is less known. However, all substance abuse disorders are known to promote cognitive disorders like executive dysfunction and memory impairment. These impairments are critical for the maintenance of addictive behaviors and impede cognitive behavioral therapies that are regularly administered in association with pharmacotherapies. It is also unknown if addictolytic medications have an impact on preexisting cognitive disorders, and if this impact is modulated by the indication of prescription, i.e. abstinence, reduction or substitution, or by the specific action of the medication.

METHOD

We reviewed the cognitive effects of labeled medications for tobacco addiction (varenicline, bupropion, nicotine patch and nicotine gums), alcohol addiction (naltrexone, nalmefene, baclofen, disulfiram, sodium oxybate, acamprosate), and opioid addiction (methadone, buprenorphine) in human studies. Studies were selected following MOOSE guidelines for systematic reviews of observational studies, using the keywords [Cognition] and [Cognitive disorders] and [treatment] for each medication.

RESULTS

971 articles were screened and 77 studies met the inclusion criteria and were reported in this review (for alcohol abuse, n=21, for tobacco n=22, for opioid n=34. However, very few comparative clinical trials have explored the chronic effects of addictolytic medications on cognition in addictive behaviors, and there are no clinical trials on the cognitive impact of nalmefene in patients suffering from alcohol use disorders.

DISCUSSION

Although some medications seem to enhance cognition in patients suffering from cognitive disorders, others could promote cognitive impairments, and our work highlights a lack of literature on this subject. In conclusion, more comparative clinical trials are needed to better understand the cognitive impact of addictolytic medications.

Adolescent Binge Drinking

Binge drinking, commonly defined as consuming five or more standard drinks per occasion for men and four or more drinks for women, typically begins in adolescence. Adolescents, although they may drink less often, tend to consume higher quantities of alcohol per occasion compared with adults. This developmental difference in pattern of alcohol consumption may result, in part, from maturational changes that involve an adolescent-specific sensitivity to certain alcohol effects and greater propensity for risk-taking behaviors, such as binge drinking. Adolescent binge drinking is associated with a range of acute alcohol-related harms, some of which may persist into adulthood. The prevalence of binge drinking, including high-intensity drinking (i.e., 10 or more and 15 or more drinks per occasion), has declined among adolescents in recent years. Overall, however, the proportion of youth who engage in binge drinking remains high. This article reviews the definition and prevalence of binge drinking in adolescence, trajectories of binge drinking and their correlates, and implications for prevention.

A Review of Developmental Considerations in Human Laboratory Alcohol Research

PURPOSE OF REVIEW

Human laboratory studies involving alcohol administration have generated critical knowledge about individual differences in risk for alcohol use disorder (AUD), but have primarily involved adult populations and cross-sectional research designs. Ethical constraints have largely precluded human laboratory alcohol research in adolescence, and prospective studies have been rare. This paper provides an overview of developmental considerations in human laboratory alcohol research, with a focus on studies conducted with youth.

RECENT FINDINGS

Recent human laboratory studies from Europe and Canada have examined aspects of alcohol response during late adolescence, while recent survey studies from the United States have highlighted methods for circumventing alcohol administration in studies of adolescents.

SUMMARY

Across several decades of research, exceedingly few laboratory studies have examined developmental differences in alcohol responses or utilized prospective designs. Efforts to prioritize prospective research would further clarify the role of alcohol sensitivity traits as predictors or markers of AUD onset and progression.

A prospective study of genetic factors, human laboratory phenotypes, and heavy drinking in late adolescence

Subjective responses to alcohol are considered candidate endophenotypes for alcohol use disorder and appear to anticipate future consumption. However, prospective studies have been rare, and laboratory research has typically examined subjective responses absent measures of self-administration. This study examined the association of subjective responses with subsequent laboratory self-administration, also evaluating laboratory phenotypes in relation to putative genetic risk factors [family history (FH) of alcohol dependence and OPRM1 genotype] and subsequent heavy drinking. Participants (N = 61, M = 19.89 years, SD = 0.86) completed laboratory sessions involving intravenous alcohol challenge (Session 1) and free-access intravenous self-administration (Session 2), followed by prospective assessments. Multilevel modeling showed that higher reported stimulation and lower sedation during Session 1 independently predicted greater alcohol self-administration during Session 2. Although self-administration did not differ by FH group, participants with the OPRM1 118G allele evidenced steeper breath alcohol concentration (BrAC) trajectories and greater peak BrAC relative to 118A homozygous participants. Prospective analyses supported significant indirect associations between Session 1 subjective responses and 6-month heavy drinking via peak BrAC in Session 2. Additionally, significant indirect associations of FH (via Session 1 stimulation and Session 2 peak BrAC) and OPRM1 (via peak BrAC) with follow-up heavy drinking were observed. These results further support the utility of human laboratory phenotypes in prospective studies of alcohol use disorder risk and highlight the potential role of self-administration phenotypes in longitudinal research.

Craving and acute effects of alcohol in youths' daily lives: Associations with alcohol use disorder severity

Identifying factors associated with the progression from recreational to pathological drinking in youth holds high clinical and theoretical importance. The present study tested cross-sectional associations of alcohol use disorder (AUD) severity with putative mechanisms of AUD progression among youth ages 15-24 years, namely acute subjective effects of alcohol and craving. Male (n = 44) and female (n = 42) youth completed ecological momentary assessments when not drinking, just before drinking, and while drinking in the natural environment via handheld wireless devices. Youth were recruited from the community and were frequent and heavy drinkers, the majority (93%) with at least 1 AUD symptom (M = 3.4, SD = 2.4). Findings from youths' daily lives suggested that how youth feel while they drink depends, in part, on their severity of AUD pathology. In support of hypotheses, youths with more progressed drinking pathology (i.e., those with more symptoms of AUD) reported greater reductions in craving and tension while drinking, relative to nondrinking times. In partial support of hypotheses, males with greater AUD symptomatology reported marginally attenuated increases in stimulatory states while drinking; however, contrary to hypotheses, females with greater AUD symptomatology reported enhanced increases in stimulation while drinking. This research leveraged ecological momentary assessment methods to study subjective responses to alcohol and craving in youths' daily lives and to cross-sectionally test putative associations with AUD etiology. This work adds to literature supporting subjective responses to alcohol in the pathogenesis of alcoholism, specifically by highlighting their importance during the period in life when alcohol problems typically first emerge. (PsycINFO Database Record

Association of Anticipated and Laboratory-Derived Alcohol Stimulation, Sedation, and Reward

BACKGROUND

Laboratory alcohol challenges are the "gold standard" for obtaining accurate measurements of subjective alcohol stimulation, sedation, and reward. However, these approaches are time and resource intensive. This study examined the extent to which self-reported anticipated alcohol stimulation, sedation, and reward corresponded with those same responses measured with the Biphasic Alcohol Effects Scale (BAES), Brief-BAES (B-BAES), and Drug Effects Questionnaire (DEQ) during a controlled laboratory alcohol challenge.

METHODS

Participants were 106 light-to-heavy social drinkers (58.5% male; mean ± SD age = 35.8 ± 3.2 years) who completed the Anticipated BAES and DEQ, as well as laboratory-derived versions of these scales 30 and 60 minutes after consuming placebo and 0.8 g/kg alcohol on separate days as part of laboratory sessions in the Chicago Social Drinking Project.

RESULTS

Anticipated BAES/B-BAES and Anticipated DEQ alcohol effects were strong predictors of their corresponding laboratory-derived responses during both the rising limb and at peak breath alcohol concentrations. Effects were significant even when accounting for age, sex, past-month heavy drinking frequency, and laboratory session order (placebo or alcohol first).

CONCLUSIONS

This study provides strong preliminary support for measuring anticipated alcohol effects with the Anticipated BAES/B-BAES and Anticipated DEQ as a proxy of subjective responses experienced during a controlled laboratory alcohol challenge. The findings lend support for these measures as viable alternatives to other anticipatory scales when laboratory-derived alcohol response measurement is not feasible.

Compliance With Mobile Ecological Momentary Assessment Protocols in Children and Adolescents: A Systematic Review and Meta-Analysis

BACKGROUND

Mobile device-based ecological momentary assessment (mobile-EMA) is increasingly used to collect participants' data in real-time and in context. Although EMA offers methodological advantages, these advantages can be diminished by participant noncompliance. However, evidence on how well participants comply with mobile-EMA protocols and how study design factors associated with participant compliance is limited, especially in the youth literature.

OBJECTIVE

To systematically and meta-analytically examine youth's compliance to mobile-EMA protocols and moderators of participant compliance in clinical and nonclinical settings.

METHODS

Studies using mobile devices to collect EMA data among youth (age ≤18 years old) were identified. A systematic review was conducted to describe the characteristics of mobile-EMA protocols and author-reported factors associated with compliance. Random effects meta-analyses were conducted to estimate the overall compliance across studies and to explore factors associated with differences in youths' compliance.

RESULTS

This review included 42 unique studies that assessed behaviors, subjective experiences, and contextual information. Mobile phones were used as the primary mode of EMA data collection in 48% (20/42) of the reviewed studies. In total, 12% (5/42) of the studies used wearable devices in addition to the EMA data collection platforms. About half of the studies (62%, 24/42) recruited youth from nonclinical settings. Most (98%, 41/42) studies used a time-based sampling protocol. Among these studies, most (95%, 39/41) prompted youth 2-9 times daily, for a study length ranging from 2-42 days. Sampling frequency and study length did not differ between studies with participants from clinical versus nonclinical settings. Most (88%, 36/41) studies with a time-based sampling protocol defined compliance as the proportion of prompts to which participants responded. In these studies, the weighted average compliance rate was 78.3%. The average compliance rates were not different between studies with clinical (76.9%) and nonclinical (79.2%; P=.29) and studies that used only a mobile-EMA platform (77.4%) and mobile platform plus additional wearable devices (73.0%, P=.36). Among clinical studies, the mean compliance rate was significantly lower in studies that prompted participants 2-3 times (73.5%) or 4-5 times (66.9%) compared with studies with a higher sampling frequency (6+ times: 89.3%). Among nonclinical studies, a higher average compliance rate was observed in studies that prompted participants 2-3 times daily (91.7%) compared with those that prompted participants more frequently (4-5 times: 77.4%; 6+ times: 75.0%). The reported compliance rates did not differ by duration of EMA period among studies from either clinical or nonclinical settings.

CONCLUSIONS

The compliance rate among mobile-EMA studies in youth is moderate but suboptimal. Study design may affect protocol compliance differently between clinical and nonclinical participants; including additional wearable devices did not affect participant compliance. A more consistent compliance-related result reporting practices can facilitate understanding and improvement of participant compliance with EMA data collection among youth.

Subjective alcohol responses in a cross-sectional, field-based study of adolescents and young adults: Effects of age, drinking level, and dependence/consequences

BACKGROUND

Adolescents are physically, cognitively, socially, and emotionally different than adults in ways that may partially explain why alcohol misuse typically develops during this period. Ample animal-science evidence and nascent ecological evidence points toward developmentally limited differences in sensitivity to alcohol's stimulatory and sedative effects. Field-based research methods were used to test for such age-related differences in a sample of adolescents through young adults. Potential moderating influences of estimated blood alcohol content (eBAC), as well as typical consumption and level of dependence/consequences were explored.

METHODS

Subjective alcohol responses were collected from 1,364 participants, aged 17 to 32 years, recruited outside of venues where drinking takes place in a small metropolitan bar district.

RESULTS

Self-reports of stimulatory response to alcohol were age-related, such that younger participants reported increased subjective stimulation at the time of data collection relative to older participants. Age-related differences in stimulatory responses were more pronounced at lower eBACs and among younger participants who typically drank more heavily. Stimulatory responses generally diminished among older than younger participants, although individuals with greater dependence/consequences consistently reported greater stimulation from drinking. Contrastingly, age, typical consumption, and dependence/consequences were not related to sedation in this sample.

CONCLUSIONS

This research provides cross-sectional evidence to support age-, consumption-, and dependence/consequences-related differences in stimulatory alcohol responses among adolescents and young adults assessed within a bar-area context. While cross-sectional, the results of this field-based study provide support for the theory that addiction liability is developmentally linked and associated, in part, with age-related differences in subjective alcohol responses.

Emerging Pharmacologic Treatments for Adolescent Substance Use: Challenges and New Directions

Adolescence is a key period in the development of substance use and misuse. Substance use typically begins during adolescence and prevalence rates for many substance use disorders peak before age 21 years. Yet, despite clinical demand, treatments for youth rely almost entirely on psychosocial interventions that yield only modest benefit. One potential way to improve treatment effects is to augment the best available psychosocial interventions with pharmacotherapy. Although pharmacotherapy research has advanced care for adults with substance use disorders, no medication is indicated for adolescents and controlled trials with teenagers are scant. Optimizing treatments for youth will require closing this important gap in medication development research. In this paper we review the paucity of pharmacotherapy research for adolescent substance misuse, and we discuss how we can leverage human laboratory paradigms and technology to advance our understanding regarding if and how medications may improve treatment options for youths.

Biobehavioral mechanisms of topiramate's effects on alcohol use: an investigation pairing laboratory and ecological momentary assessments

Topiramate reduces drinking, but little is known about the mechanisms that precipitate this effect. This double-blind randomized placebo-controlled study assessed the putative mechanisms by which topiramate reduces alcohol use among 96 adult non-treatment-seeking heavy drinkers in a laboratory-based alcohol cue reactivity assessment and in the natural environment using ecological momentary assessment methods. Topiramate reduced the quantity of alcohol heavy drinkers consumed on drinking days and reduced craving while participants were drinking but did not affect craving outside of drinking episodes in either the laboratory or in the natural environment. Topiramate did not alter the stimulant or sedative effects of alcohol ingestion during the ascending limb of the blood alcohol curve. A direct test of putative mechanisms of action using multilevel structural equation mediation models showed that topiramate reduced drinking indirectly by blunting alcohol-induced craving. These findings provide the first real-time prospective evidence that topiramate reduces drinking by reducing alcohol's priming effects on craving and highlight the importance of craving as an important treatment target of pharmacotherapy for alcoholism.

A multilevel structural equation model of within- and between-person associations among subjective responses to alcohol, craving, and laboratory alcohol self-administration

Subjective responses to alcohol are important determinants of drinking behavior and have been linked with risk for alcohol use disorders. However, few attempts have been made to examine proximal within-person associations among state changes in subjective responses and ongoing alcohol self-administration in the laboratory. This study disaggregated within- and between-person associations among subjective responses and alcohol self-administration, while also examining the mediating role of craving and the moderating role of trait impaired control over alcohol. Sixty young heavy drinkers (mean age = 19.90, SD = 0.86) completed self-report measures including the Impaired Control Scale, then participated in a 2-hr intravenous alcohol self-administration session using the Computer-Assisted Self-infusion of Ethanol (CASE) paradigm. Repeated assessments of subjective stimulation, subjective sedation, and craving were examined in relation to ongoing in-session self-administration, as indexed by breath alcohol concentration (BrAC) assessed 15 min later. Multilevel structural equation modeling was used to isolate within-person and between-person associations. The results showed few significant associations at the between-person level, except for a direct negative association between sedation and BrAC. At the within-person level, state fluctuations in stimulation were positively associated with both craving and subsequent BrAC, whereas state changes in sedation were negatively associated with craving and positively associated with BrAC. Within-person indirect associations from subjective stimulation and sedation to subsequent BrAC mediated via craving were statistically significant. Also, participants higher on impaired control showed stronger within-person associations between craving and greater subsequent BrAC. The results suggest that subjective responses to alcohol and craving have proximal associations with self-administration behavior, the strength of which is linked with trait impaired control over alcohol.

Application of an alcohol clamp paradigm to examine inhibitory control, subjective responses, and acute tolerance in late adolescence

Individual differences in acute alcohol effects on cognitive control and subjective responses--and acute tolerance to these effects--are implicated in the risk for heavy drinking and alcohol-related harms. Few studies have examined these effects in drinkers under age 21. Additionally, studies of acute tolerance typically involve bolus oral alcohol administration, such that estimates of tolerance are confounded with blood alcohol concentration (BAC) limb. The current study examined cognitive control and subjective responses in young heavy drinkers (n = 88; M = 19.8 years old, SD = 0.8) during a single-session alcohol clamp protocol. Participants completed an intravenous alcohol session comprising an ascending limb (0 to 80 mg% in 20 min) and a BAC plateau (80 mg% for 80 min). Serial assessments included a cued go/no-go task and measures of stimulation, sedation, and craving. Relevant individual difference factors (attention-deficit hyperactivity disorder [ADHD] symptoms and sensation seeking) were examined as moderators. Multilevel modeling demonstrated that response inhibition worsened following initial rise in BAC and showed increasing impairment during the BAC plateau. ADHD symptoms and sensation seeking moderated this effect. Significant within-person associations between stimulation and craving were evident on the ascending limb only. Participants with higher ADHD symptoms reported steeper increases in stimulation during the ascending limb. These findings provide initial information about subjective and behavioral responses during pseudoconstant BAC, and potential moderators of these outcomes, in late adolescence. Additional studies with placebo-controlled designs are necessary to confirm these findings.

Using Ecological Momentary Assessment (EMA) to Assess Situation-Level Predictors of Alcohol Use and Alcohol-Related Consequences

Ecological momentary assessment (EMA) has afforded several important advances in the field of alcohol research, including testing prominent models of alcohol abuse etiology in "high resolution." Using high-tech methods for signaling and/or assessment, such as mobile electronic diaries, personal data assistants, and smartphones, EMA approaches potentially can improve understanding of precipitants of drinking, drinking patterns, and consequences. For example, EMA has been used to study complex drinking patterns and dynamic predictors of drinking in near-real time. Compared with other methods, EMA can better sample and capture changes in these phenomena that occur in relatively short time frames. EMA also has several potential applications in studying the consequences of alcohol use, including physical, interpersonal, behavioral, and legal problems. However, even with all these potential capabilities, EMA research in the alcohol field still is associated with some limitations, including the potential for measurement reactivity and problems with acceptability and compliance. Despite these limitations, electronically based EMA methods are versatile and are capable of capturing data relevant to a variety of momentary influences on both alcohol use and consequences. Therefore, it will be exciting to fully realize the potential of future applications of EMA technologies, particularly if the associated costs can be reduced.