Drinking to cope moderates the efficacy of changing veteran drinking norms as a strategy for reducing drinking and alcohol-related problems among U.S. veterans

A Gamified Personalized Normative Feedback App to Reduce Drinking Among Sexual Minority Women: Randomized Controlled Trial and Feasibility Study

BACKGROUND

Sexual minority women disproportionately engage in heavy drinking and shoulder the burden of alcohol dependence. Although several intensive interventions are being developed to meet the needs of treatment-seeking sexual minority women, there remains a lack of preventive interventions to reduce drinking and its consequences among women not yet motivated to reduce their alcohol consumption.

OBJECTIVE

We aimed to examine the feasibility and efficacy of reducing alcohol-related risks via personalized normative feedback (PNF) on alcohol use and coping delivered within LezParlay, a social media-inspired digital competition designed to challenge negative stereotypes about lesbian, bisexual, and queer (LBQ)-identified sexual minority women.

METHODS

Feasibility was assessed by examining engagement with LezParlay outside the context of an incentivized research study, assessing the characteristics of the LBQ women taking part, and examining the competition's ability to derive risk-reducing actual norms as well as levels of acceptability and perceived benefits reported by participants. Intervention efficacy was examined by randomizing a subsample of 499 LBQ alcohol consumers (ie, drinkers) already taking part in the competition to receive sexual identity-specific PNF on alcohol use and coping, alcohol use only, or control topics over only 2 rounds of play. Changes in alcohol use and negative consequences were examined 2 and 4 months after the delivery of treatment PNF.

RESULTS

A total of 2667 diverse LBQ women played ≥1 round of LezParlay. The competition attracted large numbers of moderate and heavy drinkers; however, risk-reducing actual norms could still be derived from competition rounds and featured in PNF. Efficacy results revealed that drinkers who received PNF on alcohol use and both alcohol use and coping had similar reductions in their weekly drinks (P=.003; P<.001), peak drinks (P<.001; P<.001), and negative consequences (P<.001; P<.001) relative to those who received PNF on control topics at the 2-month follow-up. However, at the 4-month follow-up, reductions in alcohol consumption outcomes faded among those who received alcohol PNF only (weekly: P=.06; peak: P=.11), whereas they remained relatively robust among those who received PNF on both alcohol use and coping (weekly: P=.02; peak: P=.03). Finally, participants found the competition highly acceptable and psychologically beneficial as a whole.

CONCLUSIONS

The LezParlay competition was found to be a feasible and efficacious means of reducing alcohol-related risks in this population. Our findings demonstrate the utility of correcting sexual identity-specific drinking and coping norms to reduce alcohol-related risks among LBQ women and suggest that this approach may also prove fruitful in other stigmatized health disparity populations. To engage these populations in the real world and expand the psychological benefits associated with PNF, our findings also point to packaging PNF within a broader, culturally tailored competition designed to challenge negative group stereotypes.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03884478; https://clinicaltrials.gov/ct2/show/NCT03884478.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/24647.

The global prevalence of depression, suicide ideation, and attempts in the military forces: a systematic review and Meta-analysis of cross sectional studies

BACKGROUND

Given the wide range of depressive disorders, suicidal ideation and suicide attempts in various military studies around the world, determining the exact prevalence of these disorders in line with health planning as well as care and treatment service designing for military forces can be useful. The aim of the present meta-analysis was to determine the pooled prevalence of depressive disorders, suicide thoughts, and attempts in the military.

METHODS

The present systematic review and meta-analysis study was performed based on PRISMA criteria in 5 steps of the search strategy, screening and selection of articles, data extraction, evaluation of article quality and meta-analysis. International databases (PubMed (Medline), Scopus, Web of science, Embase (Elsevier), PsycInfo (Ovid), Cochrane CENTRAL (Ovid)) were searched using related keywords extracted from Mesh and Emtree. After screening and final selection of articles, data were extracted and qualitative evaluation was performed using the NOS checklist.

RESULTS

The results of meta-analysis showed that the prevalence of depression in active military forces and veterans was 23% (%95 CI: 20-26%) and 20% (%95 CI: 18-22%), respectively. In addition, the prevalence of suicidal ideation and attempts in the military was 11% (%95 CI: 10-13%) and 11% (%95 CI: 9-13%), respectively. The prevalence of suicide ideation and attempts in drug-using military was 18% (%95 CI: 7-33%) and 30% (%95 CI: 23-36%), respectively. The prevalence of suicidal ideation and attempts in military consuming alcohol were 9% (%95 CI: 4-13%) and 8% (%95 CI: 7-10%), respectively. In militaries with AIDS / HIV, the prevalence of suicide attempts was 5% (%95 CI: 4-8%).

CONCLUSION

Therefore, it is necessary to develop and design training and intervention programs in order to increase the awareness of the military, especially veterans, to prevent the occurrence of suicide and depression.

Risk and protective effects of social networks on alcohol use problems among Army Reserve and National Guard soldiers

BACKGROUND

Military personnel engage in alcohol-related behaviors for a variety of reasons, some of which may be socially-motivated. Although civilian-based research has established that peers' drinking behaviors are correlated with individuals' own drinking behaviors, military work has not yet examined the influence of social network characteristics on soldier drinking behaviors. This study describes characteristics of soldiers' social networks in association with soldier alcohol use problems.

METHODS

This study includes data on 353 U.S. Reserve and National Guard (R/NG) soldiers and their 2154 past-year social ties. Descriptive analyses examined social tie characteristics (e.g., military affiliation, substance misuse, and drinking influence). Negative binomial regression models examined relationships between social network characteristics and soldier alcohol use problems.

RESULTS

On average, 14% of a R/NG soldier's social network was comprised of military-affiliated ties. Further, an average of 14% of ties in a soldier's network were considered drinking buddies, and 8% of ties were heavy-drinkers. More drinking buddies and heavy-drinking ties in a soldier's social network and greater average number of past-month days drinking with ties were associated with increases in soldier alcohol problems. For deployed soldiers, larger military-affiliated social networks were protective against alcohol problems.

CONCLUSIONS

Drinking-related social network characteristics are associated with increased alcohol problems among soldiers, while military-affiliated ties are protective specifically for deployed soldiers. Interventions to reduce alcohol use problems may focus on enhancing social connections between R/NG soldiers and providing opportunities to connect deployed R/NG soldiers with one another during and after reintegration.

The Coping Self-Efficacy Scale: Psychometric properties in an outpatient sample of active duty military personnel

Active duty military service members endure a unique constellation of stressors while deployed or at home. Yet, assessment of protective factors against these stressors among active duty service members represents an under studied area. The present study advances the assessment of protective factors through the psychometric evaluation of the Coping Self-Efficacy Scale (CSES) in a clinical sample of military service members in mental health or substance abuse treatment (n = 200). Cross-sectional data were drawn from military medical records and a supplemental self-report questionnaire. Data extracted included demographic (e.g., sex, age), military characteristics (e.g., rank, years in service), physical health and mental health (e.g., anxiety, depression), and coping self-efficacy. Findings suggest a 3-factor (i.e., problem-focused coping, thought-stopping, and getting social support) CSES structure with acceptable internal consistency. Further, there were small-to-moderate associations with physical and mental health outcomes, providing evidence of construct validity. There were few significant associations with military-related characteristics. Finally, controlling for covariates, thought-stopping beliefs explained unique variance in suicide-related behaviors. Together, findings support the use of the CSES to measure coping-related beliefs in military service members. Recommendations are offered for future research and practice with active duty service members.

Cognitive factors and addiction

The present paper provides a brief review of cognitive factors related to addiction. Five representative cognitive constructs were selected from the current literature. These include the distinction between implicit and explicit cognitions; metacognitions; expectancies; motives; and social norms. For each of these a general overview is provided along with specific findings from selected recent studies. The intention is to provide the reader with a succinct but reasonable view of how each construct is currently studied in relation to the use of alcohol and other substances and to become aware of some of the strengths and limitations corresponding to the study of these constructs.

Does providing a brief internet intervention for hazardous alcohol use to people seeking online help for depression reduce both alcohol use and depression symptoms among participants with these co-occurring disorders? Study protocol for a randomised controlled trial

INTRODUCTION

Hazardous alcohol consumption is common among people experiencing depression, often acting to exacerbate depressive symptoms. While many people with these co-occurring disorders do not seek face-to-face treatment, they do seek help online. There are effective internet interventions that target hazardous alcohol consumption or depression separately but none that combine these online interventions without the involvement of a therapist. In order to realise the potential of internet interventions, we need to develop an evidence base supporting the efficacy of internet interventions for co-occurring depression and hazardous alcohol use without any therapist involvement. This study aims to evaluate the effects on drinking, and on depressive symptoms, of combining an internet intervention targeting hazardous alcohol consumption with one for depression.

METHODS AND ANALYSIS

A double blinded, parallel group randomised controlled trial will be used. Participants with current depression who also drink in a hazardous fashion (n=986) will be recruited for a study to 'help improve an online intervention for depression'. Participants will be randomised either to receive an established online intervention for depression (MoodGYM) or to receive MoodGYM plus a brief internet intervention for hazardous alcohol consumption (Check Your Drinking; CYD). Participants will be contacted 3 and 6 months after receiving the interventions to assess changes in drinking and depression symptoms. It is predicted that participants receiving the CYD intervention in addition to MoodGYM will report greater postintervention reductions in alcohol consumption and depressive symptoms compared with those who received MoodGYM only. Hypothesised mediation and moderation effects will also be investigated. Using an intention-to-treat basis for the analyses, the hypotheses will be tested using a generalised linear hypothesis framework, and longitudinal analyses will use either generalised linear mixed modelling or generalised estimating equation approach where appropriate.

ETHICS AND DISSEMINATION

This research comprises the crucial first steps in developing lower-cost and efficacious internet interventions for people suffering from depression who also drink in a hazardous fashion-promoting the widespread availability of care for those in need. This study has been approved by the standing ethics review committee of the Centre for Addiction and Mental Health, and findings will be disseminated in the form of at least one peer-reviewed article and presentations at conferences.

TRIAL REGISTRATION NUMBER

NCT03421080; Pre-results.

Mediators and Moderators of a Personalized Feedback Alcohol Intervention for Nonstudent Emerging Adult Drinkers

BACKGROUND

The main objective of this study was to test proposed mediators and moderators of a personalized feedback alcohol intervention (PFI) on alcohol use. Data for the current investigation came from an earlier randomized controlled trial of a PFI targeted for nonstudent heavy drinkers between 18 and 25 years.

METHODS

Participants were 164 (65.9% men) drinkers recruited from the community. They were randomly assigned to either a single-session PFI or an assessment-only (AO) control group. Follow-up assessments at 1 and 3 months were included for analysis.

RESULTS

Perceived drinking norms mediated the intervention effect on quantity, frequency, and peak drinking; 2 dimensions of protective behavioral strategies (PBS) mediated the intervention effect on peak drinking; and drinking to cope motives did not mediate any drinking outcomes. Of the moderating factors examined (i.e., norms, PBS, drink to cope motives, age, gender), only PBS related to serious harm reduction moderated intervention impact. Specifically, for those high in serious harm reduction PBS at baseline, postintervention reductions in drinking were stronger for the PFI group compared to AO.

CONCLUSIONS

Overall, findings highlight the importance of correcting misperceived drinking norms and addressing the use of specific PBS in brief interventions. The knowledge gained from this study represents an important step toward minimizing drinking-related harms that are disproportionately experienced by those with lower educational attainment.