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Cox MJ, DiBello AM, Jones EP, Gette J, Godbole A, Barcenas L, Roudebush M, Simensky J, Mancini L, Gheewalla A, Pannu K. A systematic review of the associations between protective behavioral strategies and heavy alcohol consumption and consequences among young adults. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2024; 38:488-506. [PMID: 38573700 PMCID: PMC11116058 DOI: 10.1037/adb0001002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
OBJECTIVE We systematically reviewed the literature to assess the association between use of alcohol protective behavioral strategies (PBS) and young adult heavy drinking and alcohol-related consequences. METHOD We followed the preferred reporting items for systematic review and meta-analysis guidelines to select and review research studies that were comprised of a sample of young adults ages 18-26, included PBS derived from one of 10 validated scales as an independent variable, measured heavy alcohol use or alcohol consequences as the dependent variable, and tested the direct association between the two. Studies were gathered via PubMed, Scopus, Cumulative Index to Nursing and Allied Health Literature, APA PsycInfo, and Global Health. All identified study records underwent a two-step screening process and risk of bias assessment. RESULTS Data were extracted from 94 studies that met inclusion criteria; 16 studies (17%) examined associations with heavy alcohol use and 91 studies (97%) tested effects of PBS on alcohol consequences. All studies that measured a total effect of PBS use (summations across all strategies) found significant negative associations with heavy alcohol use and 91% were negatively associated with alcohol consequences. Most studies that examined subscales of PBS found at least one significant, negative relation with heavy alcohol use (73%) and alcohol-related consequences (78%), though effects varied across type of subscale (e.g., manner of drinking). CONCLUSIONS Our results support the use of PBS to address heavy alcohol consumption and related harms among young adults. Opportunities for refinement of current PBS in preventive interventions are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Melissa J Cox
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | | | - Emily P Jones
- Health Sciences Library, University of North Carolina at Chapel Hill
| | - Jordan Gette
- Center of Alcohol and Substance Use Studies, Rutgers University
| | - Avanti Godbole
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Loren Barcenas
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - McKenna Roudebush
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Josh Simensky
- Center of Alcohol and Substance Use Studies, Rutgers University
| | - Lindsay Mancini
- Center of Alcohol and Substance Use Studies, Rutgers University
| | | | - Karman Pannu
- Center of Alcohol and Substance Use Studies, Rutgers University
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2
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Peterson R, Dvorak RD, Burr EK, De Leon AN, Klaver SJ, Maynard MH, Hayden ER, Aguilar B. Revised Alcohol Protective Behavioral Strategies Scale-20 (PBSS-20) Sub-Types: An Analysis of Direct/Controlled Consumption and Indirect/Harm Reduction PBS. JOURNAL OF DRUG EDUCATION 2024:472379241246367. [PMID: 38591951 DOI: 10.1177/00472379241246367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
Alcohol protective behavioral strategies (PBS) are commonly conceptualized with a three-factor model, as used in the Protective Behavioral Strategies Scale-20 (PBSS-20). However, inconsistencies exist between factors and drinking outcomes. The current study used factor analysis to test a two-factor structure directly via controlled consumption (Direct/CC) and indirectly via harm reduction (Indirect/HR) using the PBSS-20 among a combined sample of n = 4,883 drinkers. Both the two- and three-factor structures evince similar model fit. A two-factor model yielded more concise PBS measurement. Negative associations were observed with consumption (Direct/CC PBS) and problems (Indirect/HR). A condensed, eight-item, two-factor model accounted for less variance in alcohol consumption, however more variance in alcohol-related problems. A more consistent framework for understanding the impact of PBS on alcohol-related outcomes is provided.
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Affiliation(s)
| | - Robert D Dvorak
- Department of Psychology, University of Central Florida, USA
| | - Emily K Burr
- Department of Psychology, University of Central Florida, USA
| | | | | | | | - Emma R Hayden
- Department of Psychology, University of Central Florida, USA
| | - Bradley Aguilar
- Department of Psychology, University of Central Florida, USA
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3
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Tucker JA, Cheong J, Stinson LA, Chandler SD. Relationship between drinking risk and preferences for helping resources among emerging adults living in disadvantaged communities in the Southeastern United States. Alcohol Alcohol 2023; 58:539-546. [PMID: 37565459 DOI: 10.1093/alcalc/agad054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/23/2023] [Accepted: 07/21/2023] [Indexed: 08/12/2023] Open
Abstract
Compared to campus-based alcohol interventions for college students, services for emerging adult (EA) risky drinkers who reside off-campus in disadvantaged communities are not well established. This web survey assessed drinking practices, problems, and preferences for professional and lay helping resources spanning digital and in-person formats among community-dwelling EAs to guide services for them and determine whether drinking risk levels varied by preferences for help. Digital respondent-driven sampling recruited EA risky drinkers from disadvantaged communities (N = 356; M age = 23.6 years, 64.0% women, 77.4% employed, 64.9% residing in impoverished areas above the US average, 53.5% income < $20k/year). A web survey assessed participants' drinking practices and problems, including alcohol use disorder symptoms, and help-seeking preferences for smartphone apps; online help; in-person help from doctors, clinics, teachers, and school programs; mutual help groups; and help from friends and family. Preferences were related to participant drinking risks using generalized linear modeling. Modeling results showed that risk levels were related to help-seeking preferences. EAs reporting more negative consequences preferred smartphone apps and help from friends, whereas EAs reporting fewer negative consequences and drinking days preferred professional in-person help (Ps < 0.05). Although >90% fulfilled alcohol use disorder diagnostic criteria, <4% had received an alcohol-related intervention. EAs who are riskier drinkers appear less likely to use professional resources in favor of informal and online resources that allow greater anonymity. Findings can guide services for this underserved population that are responsive to drinker risk levels.
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Affiliation(s)
- Jalie A Tucker
- Center for Behavioral Economic Health Research, University of Florida, Gainesville, FL, United States
| | - JeeWon Cheong
- Center for Behavioral Economic Health Research, University of Florida, Gainesville, FL, United States
| | - Lesleigh A Stinson
- Center for Behavioral Economic Health Research, University of Florida, Gainesville, FL, United States
| | - Susan D Chandler
- Center for Behavioral Economic Health Research, University of Florida, Gainesville, FL, United States
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4
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D’Adamo L, Paraboschi L, Grammer AC, Fennig M, Graham AK, Yaeger LH, Newman MG, Wilfley DE, Taylor CB, Eisenberg D, Fitzsimmons-Craft EE. Reach and uptake of digital mental health interventions based on cognitive-behavioral therapy for college students: A systematic review. JOURNAL OF BEHAVIORAL AND COGNITIVE THERAPY 2023; 33:97-117. [PMID: 37724304 PMCID: PMC10506850 DOI: 10.1016/j.jbct.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
Background Mental health problems are increasing in prevalence among college students, yet few students receive treatment due to barriers such as insufficient resources in college counseling centers. Digital mental health interventions (DMHIs) have potential to overcome barriers and offer accessible, evidence-based care to college students. However, to evaluate the true public health impact of evidence-based DMHIs, it is important to assess the reach and uptake rates of DMHIs on college campuses. Objectives We conducted a systematic review to examine the reach (i.e., % of invited students who express interest) and uptake (i.e., % of enrolled participants who initiate an intervention) of DMHIs based on cognitive-behavioral therapy (CBT) for college students. Methods Eight databases were searched. Inclusion criteria included: (1) college population; (2) experimental design; (3) CBT-based intervention; (4) intervention targeting specific mental health conditions; and (5) digital intervention. Reach and uptake rates were calculated from data reported. A systematic narrative review framework was used to synthesize results. Results Of 10,315 articles screened, 90 were included. Seventeen studies (19%) reported sufficient data to calculate reach; 35 studies (39%) reported uptake rates. Of studies that reported reach or uptake, most evaluated unguided (n = 20) or guided (n = 16) self-help programs. Measurement methods varied widely. Overall reach was low, whereas uptake was high among enrolled participants. Discussion Despite evidence that improving reach and uptake can increase the public health impact of DMHIs, most studies did not report on either outcome. Suggested practices to improve these outcomes, and their reporting, are discussed.
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Affiliation(s)
- Laura D’Adamo
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Ave., St. Louis, MO 63110, USA
- Department of Psychological and Brain Sciences and Center for Weight, Eating, and Lifestyle Science (WELL Center), Drexel University, 3201 Chestnut St. Philadelphia, PA 19104, USA
| | - Layna Paraboschi
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Ave., St. Louis, MO 63110, USA
| | - Anne Claire Grammer
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Ave., St. Louis, MO 63110, USA
| | - Molly Fennig
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Ave., St. Louis, MO 63110, USA
| | - Andrea K. Graham
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 633 N St Clair St, Chicago, IL 60611, USA
| | - Lauren H. Yaeger
- Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO 63110, USA
| | - Michelle G. Newman
- Department of Psychology, The Pennsylvania State University, 371 Moore Building, University Park, PA 16801, USA
| | - Denise E. Wilfley
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Ave., St. Louis, MO 63110, USA
| | - C. Barr Taylor
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305, USA
- Center for m Health, Palo Alto University, 5150 El Camino Real, Los Altos, CA 94022, USA
| | - Daniel Eisenberg
- Department of Health Policy and Management, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Ellen E. Fitzsimmons-Craft
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Ave., St. Louis, MO 63110, USA
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Pritschmann RK, Gebru NM, Litt DM, Zhou Z, Lewis MA. Are Drinking Cognitions Associated with Marijuana and Concurrent Alcohol and Marijuana Use among Adolescents and Young Adults? CANNABIS (ALBUQUERQUE, N.M.) 2022; 5:59-74. [PMID: 36937543 PMCID: PMC10021335 DOI: 10.26828/cannabis/2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Concurrent use of alcohol and marijuana (i.e., CAM use) is the most common poly-drug use pattern among adolescents and young adults and is associated with negative outcomes. Research indicates that Prototype Willingness Model (PWM) drinking cognitions are associated with alcohol use. This secondary analysis was conducted to explore cross-sectional associations between PWM drinking cognitions, alcohol, marijuana, and CAM use. Methods Adolescents and young adults between 15-25 years (N = 124, M age = 18.7) completed a baseline assessment as part of a larger study, including questions on alcohol and marijuana use, and PWM drinking cognitions. Results In the social reaction pathway, descriptive norms, perceived vulnerability, and prototype favorability, but not willingness were associated with greater alcohol use, whereas in the reasoned pathway attitudes and intentions were associated with frequency of drinking whereas injunctive norms were not. Both willingness and intention to drink were related to marijuana and CAM use when controlling for alcohol use frequency. Greater willingness to drink was the only significant predictor of marijuana use, and only descriptive norms predicted CAM use. However, of the cognitions within the reasoned pathway, greater attitudes toward drinking and drinking intention were related to greater marijuana and CAM use. Results also indicated that CAM users displayed higher levels of certain risk cognitions than non-users or single substance users. Conclusions Findings support and extend the utility of the PWM by indicating that specific alcohol cognitions are associated with alcohol, marijuana, and CAM use in adolescents and young adults.
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Affiliation(s)
- Ricarda K. Pritschmann
- University of Florida, Department of Health Education & Behavior, Gainesville FL
- University of Florida Center for Addiction Research and Education, Gainesville FL
- University of Florida Center for Behavioral Economic Health Research, Gainesville FL
| | - Nioud Mulugeta Gebru
- University of Florida, Department of Health Education & Behavior, Gainesville FL
- University of Florida Center for Addiction Research and Education, Gainesville FL
- University of Florida Center for Behavioral Economic Health Research, Gainesville FL
- University of Florida Clinical and Translational Science Institute, Gainesville FL
| | - Dana M. Litt
- University of North Texas Health Science Center, Department of Health Behavior and Health Systems, School of Public Health, Fort Worth, TX
| | - Zhengyang Zhou
- University of North Texas Health Science Center, Department of Biostatistics and Epidemiology, School of Public Health, Fort Worth, TX
| | - Melissa A. Lewis
- University of North Texas Health Science Center, Department of Health Behavior and Health Systems, School of Public Health, Fort Worth, TX
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Witkiewitz K, Pfund RA, Tucker JA. Mechanisms of Behavior Change in Substance Use Disorder With and Without Formal Treatment. Annu Rev Clin Psychol 2022; 18:497-525. [PMID: 35138868 DOI: 10.1146/annurev-clinpsy-072720-014802] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This article provides a narrative review of studies that examined mechanisms of behavior change in substance use disorder. Several mechanisms have some support, including self-efficacy, craving, protective behavioral strategies, and increasing substance-free rewards, whereas others have minimal support (e.g., motivation, identity). The review provides recommendations for expanding the research agenda for studying mechanisms of change, including designs to manipulate putative change mechanisms, measurement approaches that expand the temporal units of analysis during change efforts, more studies of change outside of treatment, and analytic approaches that move beyond mediation tests. The dominant causal inference approach that focuses on treatment and individuals as change agents could be expanded to include a molar behavioral approach that focuses on patterns of behavior in temporally extended environmental contexts. Molar behavioral approaches may advance understanding of how recovery from substance use disorder is influenced by broader contextual features, community-level variables, and social determinants of health. Expected final online publication date for the Annual Review of Clinical Psychology, Volume 18 is May 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Katie Witkiewitz
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico, USA; .,Center on Alcohol, Substance Use and Addictions, University of New Mexico, Albuquerque, New Mexico, USA
| | - Rory A Pfund
- Center on Alcohol, Substance Use and Addictions, University of New Mexico, Albuquerque, New Mexico, USA
| | - Jalie A Tucker
- Department of Health Education & Behavior and Center for Behavioral Economic Health Research, University of Florida, Gainesville, Florida, USA
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7
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Social Network Drinking Feedback is Associated with Use of Protective Behavioral Strategies and Drinking-Related Outcomes in Emerging Adult Risky Drinkers. J Stud Alcohol Drugs 2022; 83:64-73. [PMID: 35040761 PMCID: PMC8819894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE Although emerging adult risky drinkers are generally unmotivated to change their drinking, use of protective behavioral strategies (PBS) to minimize drinking risks is associated with decreased alcohol-related harms. However, research on social influences on PBS use and associations with drinking outcomes is limited and relevant to informing interventions for this priority population. This study investigated whether emerging adults' drinking-related behaviors were associated with social network encouragement, discouragement, or mixed messages about their drinking and with PBS use. METHOD Risky drinkers ages 21-29 years (N = 356; 228 women; mean age = 23.6 years) were recruited from the community using digitally implemented respondent-driven sampling. A web-based survey assessed social network drinking feedback, PBS use, drinking practices and problems, and behavioral allocation of time and money to drinking. RESULTS Negative binomial generalized linear models indicated that friend and spouse/ partner discouragement of drinking was associated with greater PBS use, whereas mixed messages were associated with lower use (ps < .05). Greater PBS use was associated with fewer alcohol-related negative consequences and lower behavioral allocation to drinking (ps < .05); the latter association was most consistent for serious harm reduction PBS (e.g., use of a designated driver). Mixed drinking messages from all relationship types had direct negative associations with drinking outcomes, particularly time and money allocated to drinking. CONCLUSIONS Assessing social network features may guide interventions to increase PBS use and reduce drinking-related harms among emerging adult risky drinkers.
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Lipperman-Kreda S, Mair C, Gruenewald PJ. Ecological momentary assessments of night-time drinking among California adolescents: bases for informing night-time preventive interventions. Addiction 2021; 116:3408-3421. [PMID: 34159671 PMCID: PMC8578195 DOI: 10.1111/add.15623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/30/2020] [Accepted: 06/09/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND AIM To inform the development of effective night-time preventive interventions, our goal was to assess adolescents' residence (i.e. being at) and transitions across contexts during evening hours and risks for drinking and drinking-related problems in relation to contexts and to these transitions. DESIGN Ecological momentary assessment and survey methods. SETTING Twelve mid-sized cities (50 000-500 000 population) in California, USA from December 2014 to September 2015. ANALYTICAL SAMPLE A total of 153 adolescents (mean age = 16.4, 46.2% female). MEASUREMENT Initial conditions (e.g. past-year heavy drinking, gender, best friend's approval of drinking); adolescents' residence (i.e. being at) and transitions between (a) their own homes, (b) others' homes and (c) public spaces (e.g. restaurants, parks, concert venues) at early, middle and late evening hours; drinking in these contexts at early, middle and late evening hours; and drinking-related problems across evening hours. FINDINGS Risks for drinking were 23.5 times greater in others' homes (P < 0.01) and somewhat less in public spaces [odds ratio (OR) = 6.01, P < 0.01], compared with own home. Risks for problems in any evening time were elevated in relation to being in others' homes (OR = 2.37, P < 0.05) and public spaces (OR = 2.71, P < 0.01) versus at own home. Drinking in others' homes was related to 5.9 times increase in odds of transitioning back to own home (OR = 5.93, P < 0.05), 11.9 times increase in odds of remaining in others' homes (OR = 11.86, P < 0.01) or 7.3 times increase in odds of transitioning from others' homes to public spaces (OR = 7.3, P < 0.05). Initial conditions were associated with being in states, drinking and problems during evening hours and transitions across states. CONCLUSIONS In California, adolescents who are older, female, Hispanic or have greater spending money may be more likely to be outside their own home during evening hours than adolescents who do not match those criteria. In turn, being outside one's home during evening hours appears to be related to greater risks for drinking and drinking-related problems. Finally, transitions between contexts increased differential risks for drinking such that, for example, drinking in others' homes was highly related to transitioning to public spaces and less to returning to own home.
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Affiliation(s)
- Sharon Lipperman-Kreda
- Prevention Research Center, Pacific Institute for Research and Evaluation, 2150 Shattuck Avenue, Suite 601, Berkeley, CA 94704 USA
| | - Christina Mair
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, 130 De Soto Street Pittsburgh, PA 15261 USA
| | - Paul J. Gruenewald
- Prevention Research Center, Pacific Institute for Research and Evaluation, 2150 Shattuck Avenue, Suite 601, Berkeley, CA 94704 USA
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Pettigrew S, Booth L, Jongenelis MI, Brennan E, Chikritzhs T, Hasking P, Miller P, Hastings G, Wakefield M. A randomized controlled trial of the effectiveness of combinations of 'why to reduce' and 'how to reduce' alcohol harm-reduction communications. Addict Behav 2021; 121:107004. [PMID: 34102583 DOI: 10.1016/j.addbeh.2021.107004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 05/26/2021] [Accepted: 05/31/2021] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Alcohol is a major source of harm worldwide. The aim of this study was to experimentally assess the effects of exposing Australian adult drinkers to combinations of 'why to reduce' and 'how to reduce' alcohol harm-reduction messages. METHODS Three online surveys were administered over six weeks: Time 1 at baseline (n = 7,995), Time 2 at three weeks post-baseline (n = 4,588), and Time 3 at six weeks post-baseline (n = 2,687). Participants were randomly assigned to one of eight conditions: (1) a control condition; (2) a 'why to reduce' television advertisement; (3-5) one of three 'how to reduce' messages referring to the following protective behavioral strategies (PBSs): Keep count of your drinks, Decide how many drinks and stick to it, It's okay to say no; and (6-8) the television advertisement combined with each PBS message individually. Intention-to-treat analyses were conducted to determine effects of condition assignment on changes over time in attempts to reduce alcohol consumption and amount of alcohol consumed. RESULTS Participants assigned to the 'TV ad' and 'TV ad + Keep count of your drinks PBS' conditions reported significant increases in attempts to reduce alcohol consumption. Only participants assigned to the 'TV ad + Keep count of your drinks PBS' condition exhibited a significant reduction in alcohol consumed (-0.87 drinks per person per week). CONCLUSIONS Well-executed 'why to reduce' alcohol harm-reduction advertisements can encourage drinkers to attempt to reduce their alcohol consumption. These ads may be effectively supplemented by specific 'how to reduce' messages designed to encourage drinkers to monitor their intake.
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Affiliation(s)
- Simone Pettigrew
- The George Institute for Global Health, University of New South Wales, 1 King St, Newtown, NSW, Australia; National Drug Research Institute, Curtin University, Kent St Bentley, WA, Australia.
| | - Leon Booth
- The George Institute for Global Health, University of New South Wales, 1 King St, Newtown, NSW, Australia; School of Population Health, Curtin University, Kent St Bentley, WA, Australia.
| | - Michelle I Jongenelis
- Melbourne Centre for Behaviour Change, Melbourne School of Psychological Sciences, University of Melbourne, Barry St, Melbourne, VIC, Australia.
| | - Emily Brennan
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, 615 St Kilda Rd, Melbourne, VIC, Australia.
| | - Tanya Chikritzhs
- National Drug Research Institute, Curtin University, Kent St Bentley, WA, Australia.
| | - Penelope Hasking
- School of Population Health, Curtin University, Kent St Bentley, WA, Australia
| | - Peter Miller
- School of Psychology, Deakin University, Geelong Waterfront Campus, VIC, Australia.
| | - Gerard Hastings
- Institute for Social Marketing and Health, Stirling University, Stirling, Scotland, UK.
| | - Melanie Wakefield
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, 615 St Kilda Rd, Melbourne, VIC, Australia.
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Cucciare MA, Combs AS, Joshi G, Han X, Humphreys K. Computer-delivered brief alcohol intervention for patients with liver disease: a randomized controlled trial. Addiction 2021; 116:1076-1087. [PMID: 32924207 DOI: 10.1111/add.15263] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 12/24/2019] [Accepted: 09/07/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Reducing alcohol consumption by liver disease patients can reduce morbidity and mortality. This study compared a computer-delivered brief alcohol intervention (cBAI) with standard care in a sample of US military veterans with liver disease. DESIGN Multi-site, randomized controlled trial of a cBAI plus standard care (n = 67) versus standard care only (n = 71). Participants were assessed at baseline and 3- and 6-month follow-up. SETTING US Veterans Health Administration liver clinics. PARTICIPANTS Participants were mostly male and diagnosed with hepatitis C. INTERVENTIONS AND COMPARATORS A cBAI tailored to veterans with liver disease and consisting of assessment and personalized feedback. Standard care was brief education and advice about alcohol and liver disease. MEASUREMENT Primary outcomes were self-reported number of drinking days and unhealthy drinking days (defined as more than two drinks for men and more than one for women) in the past 30 days at 6-month follow-up. Secondary outcomes were these two variables at 3-month follow-up, and drinks consumed per drinking day, depression and overall health at 3- and 6-month follow-ups. Missing data were imputed using multiple imputation. FINDINGS Compared with standard care, cBAI participants reported significantly fewer drinking days at 6-month follow-up and fewer unhealthy drinking days at both 3- and 6-month follow-ups. Least square means (LS-means) for number of drinking days were 3.78 for the cBAI condition and 6.89 for the standard care condition at 6 months [LS-mean ratio = 3.78/6.89 = 0.55, 95% confidence interval (CI) = 0.34, 0.89]. LS-means for number of unhealthy drinking days were 1.04 for the cBAI condition and 2.57 for the standard care condition at 3-month follow-up (LS-mean ratio = 1.04/2.57 = 0.41, 95% CI = 0.19, 0.85). At 6-months follow-up, LS-means were 1.18 for the cBAI condition and 2.75 for the standard care condition (LS-mean ratio = 1.18/2.75 = 0.43, 95% CI = 0.20, 0.91). CONCLUSIONS A computer-delivered brief alcohol intervention reduced drinking days and unhealthy drinking days at 6-month follow up in military veterans with liver disease compared with brief education and advice to reduce consumption.
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Affiliation(s)
- Michael A Cucciare
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR, USA.,Veterans Affairs South Central Mental Illness Research, Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA.,Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ann S Combs
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, USA
| | - Gauri Joshi
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, USA
| | - Xiaotong Han
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR, USA.,Veterans Affairs South Central Mental Illness Research, Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA.,Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Keith Humphreys
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, USA.,Department of Psychiatry, Stanford University, Stanford, CA, USA
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11
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Tucker JA, Lindstrom K, Chandler SD, Bacon JP, Cheong J. Behavioral economic indicators of risky drinking among community-dwelling emerging adults. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2021; 35:415-423. [PMID: 33630617 DOI: 10.1037/adb0000686] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objective: Behavioral economic (BE) approaches to understanding and reducing risky drinking among college students are well established, but little is known about the generalizability of prior findings to peers who currently are not traditional college students and are more difficult to reach for assessment and intervention. This cross-sectional survey investigated whether drinking practices and negative consequences were associated with greater alcohol demand, alcohol reward value, and delay discounting in this target population. Method: Community-dwelling emerging adult drinkers aged 21 to 29 (N = 357) were recruited using Respondent-Driven Sampling adapted to a digital platform (Mage = 23.6 years, 64% women). Peers recruited peers in an iterative fashion. Participants completed a web-based survey of drinking practices, negative alcohol-related consequences, and BE measures of alcohol demand, alcohol reward value, and delay discounting. Results: Regression analyses supported the study hypotheses. Higher alcohol demand (intensity and elasticity) predicted higher drinks per drinking day, more past-month drinking days, and more negative consequences. Higher alcohol reward value (discretionary alcohol spending and alcohol-involved activities) and stronger preference for sooner smaller versus later larger rewards predicted select drinking risk variables in the hypothesized direction (p < .05). Conclusions: BE risk characteristics were generalized to community-dwelling emerging adult risky drinkers, with the most consistent associations found between alcohol demand and drinking risk measures. The findings lay a foundation for extending successful BE interventions with college drinkers to this underserved population. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Jalie A Tucker
- Center for Behavioral Economic Health Research, University of Florida
| | - Katie Lindstrom
- Center for Behavioral Economic Health Research, University of Florida
| | - Susan D Chandler
- Center for Behavioral Economic Health Research, University of Florida
| | - Joseph P Bacon
- Center for Behavioral Economic Health Research, University of Florida
| | - JeeWon Cheong
- Center for Behavioral Economic Health Research, University of Florida
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12
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Cheong J, Lindstrom K, Chandler SD, Bacon JP, Tucker JA. Social Network Feedback and Drinking Outcomes among Emerging Adult Risky Drinkers Living in Urban Communities. Subst Use Misuse 2021; 56:1989-1996. [PMID: 34429032 PMCID: PMC8935916 DOI: 10.1080/10826084.2021.1963985] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
UNLABELLED Alcohol use and related problems often increase during emerging adulthood and are influenced by social networks. Investigating alcohol-specific feedback from network members may be useful for understanding social influences and designing interventions to reduce risky drinking among emerging adults.Purpose/Objectives: This study examined whether drinking practices and consequences among emerging adult risky drinkers living in disadvantaged urban communities were influenced by receipt of encouragement, discouragement, or mixed messages about drinking from network members. METHODS Risky drinkers ages 21-29 (N = 356; 228 females; mean age = 23.6 years) residing in the community were recruited using digitally implemented Respondent Driven Sampling, a peer-driven chain referral method. A web-based survey assessed drinking practices, negative alcohol-related consequences, and drinking feedback from social network members including friends, spouse/partner, and other family members. RESULTS Negative binomial generalized linear modeling showed that discouragement of drinking by friends was associated with fewer drinking days and negative consequences, whereas discouragement by family members (excluding spouse/partner) was associated with more drinks per drinking day. Mixed feedback (sometimes encouraging, sometimes discouraging drinking) from friends and spouse/partner was associated with more drinking days and negative consequences.Conclusions/Importance: Social network feedback had both risk and protective associations with drinking practices and problems among emerging adults, with discouragement to drink by friends appearing to serve a protective function. The findings suggest the utility of interventions delivered through social networks that amplify the natural protective function of friend discouragement of drinking, in addition to addressing established risks associated with peers.
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Affiliation(s)
- JeeWon Cheong
- Department of Health Education and Behavior and Center for Behavioral Economic Health Research, University of Florida, Gainesville, Florida, USA
| | - Katie Lindstrom
- Department of Health Education and Behavior and Center for Behavioral Economic Health Research, University of Florida, Gainesville, Florida, USA
| | - Susan D Chandler
- Department of Health Education and Behavior and Center for Behavioral Economic Health Research, University of Florida, Gainesville, Florida, USA
| | - Joseph P Bacon
- Department of Health Education and Behavior and Center for Behavioral Economic Health Research, University of Florida, Gainesville, Florida, USA
| | - Jalie A Tucker
- Department of Health Education and Behavior and Center for Behavioral Economic Health Research, University of Florida, Gainesville, Florida, USA
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13
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Neurochemical and Behavioral Characterization after Acute and Repeated Exposure to Novel Synthetic Cannabinoid Agonist 5-MDMB-PICA. Brain Sci 2020; 10:brainsci10121011. [PMID: 33353194 PMCID: PMC7766979 DOI: 10.3390/brainsci10121011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/06/2020] [Accepted: 12/14/2020] [Indexed: 01/21/2023] Open
Abstract
Since the early 2000s, herbal mixtures containing synthetic cannabinoids (SCs), broadly known as Spice/K2, have been marketed as a legal marijuana surrogate and have become very popular among adolescents. Adolescence is a critical period of development, which is associated with an increased vulnerability to the central effects of drugs. Despite growing concerns about the negative effects of the use of SCs, newly synthetized compounds are increasingly detected in drugs seized by the authorities, posing a serious threat to public health. 5F-MDMB-PICA has been recently detected and classified as a highly potent agonist of CB1 and CB2 cannabinoid receptors. Here, we first investigated the rewarding properties of 5F-MDMB-PICA in C57BL/6 adolescent and adult mice by in vivo brain microdialysis. Data showed that acute administration of a selected dose of 5F-MDMB-PICA (0.01 mg/kg i.p.) stimulates the release of dopamine in the nucleus accumbens shell of adolescent, but not of adult, mice. To further investigate the consequences of repeated exposure to this dose of 5F-MDMB-PICA, a separate group of adolescent mice was treated for 14 consecutive days and evaluated for behavioral abnormalities at adulthood, starting from 7 days after drug discontinuation. Data showed that this group of adult mice displayed an anxiety-like and compulsive-like state as revealed by an altered performance in the marble burying test. Our study suggests an alarming vulnerability of adolescent mice to the effects of 5F-MDMB-PICA. These findings provide a useful basis for understanding and evaluating both early and late detrimental effects that may derive from the use of SCs during adolescence.
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14
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Tucker JA, Bacon JP, Chandler SD, Lindstrom K, Cheong J. Utility of digital Respondent Driven Sampling to recruit community-dwelling emerging adults for assessment of drinking and related risks. Addict Behav 2020; 110:106536. [PMID: 32711287 PMCID: PMC7329684 DOI: 10.1016/j.addbeh.2020.106536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/17/2020] [Accepted: 06/29/2020] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Emerging adulthood often entails heightened risk-taking, including risky drinking, and research is needed to guide intervention development and delivery. This study adapted Respondent Driven Sampling, a peer-driven recruitment method, to a digital platform (d-RDS) and evaluated its utility to recruit community-dwelling emerging adult (EA) risky drinkers, who are under-served and more difficult to reach for assessment and intervention than their college student peers. MATERIALS AND METHODS Community-dwelling EA risky drinkers (N = 357) were recruited using d-RDS (M age = 23.6 years, 64.0% women). Peers recruited peers in an iterative fashion. Participants completed a web-based cross-sectional survey of drinking practices and problems and associated risk and protective factors. RESULTS d-RDS successfully recruited EA risky drinkers. On average, the sample reported recent drinking exceeding low-risk drinking guidelines and 8.80 negative consequences in the past three months. Compared to age-matched respondents from the representative U.S. National Survey on Drug Use and Health, the sample reported more past month drinking days and more drinks consumed per drinking day (ps < 0.001). At higher consumption levels, predicted positive associations were found with lower education and receipt of public assistance. CONCLUSIONS Results supported the utility of d-RDS as a sampling method and grassroots platform for research and intervention with community-dwelling EA drinkers who are harder to reach than traditional college students. The study provides a method and lays an empirical foundation for extending efficacious alcohol brief interventions with college drinkers to this underserved population.
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Affiliation(s)
- Jalie A Tucker
- University of Florida and Center for Behavioral Economic Health Research, Gainesville, FL, United States.
| | - Joseph P Bacon
- University of Florida and Center for Behavioral Economic Health Research, Gainesville, FL, United States
| | - Susan D Chandler
- University of Florida and Center for Behavioral Economic Health Research, Gainesville, FL, United States
| | - Katie Lindstrom
- University of Florida and Center for Behavioral Economic Health Research, Gainesville, FL, United States
| | - JeeWon Cheong
- University of Florida and Center for Behavioral Economic Health Research, Gainesville, FL, United States
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15
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Esmaeili A, Yu W, Cucciare MA, Combs AS, Joshi G, Humphreys K. Budget Impact Analysis of a Computer-Delivered Brief Alcohol Intervention in Veterans Affairs (VA) Liver Clinics: A Randomized Controlled Trial. ALCOHOLISM TREATMENT QUARTERLY 2020. [DOI: 10.1080/07347324.2020.1760755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Aryan Esmaeili
- U.S. Department of Veterans Affairs, Health Economics Resource Center, Menlo Park, California, USA
| | - Wei Yu
- U.S. Department of Veterans Affairs, Health Economics Resource Center, Menlo Park, California, USA
| | - Michael A. Cucciare
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, Arkansas, USA
- Veterans Affairs South Central Mental Illness Research, Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, USA
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Ann S. Combs
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California, USA
| | - Gauri Joshi
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California, USA
| | - Keith Humphreys
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California, USA
- Department of Psychiatry, Stanford University, Stanford, California, USA
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16
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Leavens ELS, Miller MB, Brett EI, Baraldi A, Leffingwell TR. Influencing college students' normative perceptions of protective behavioral strategies: A pilot randomized trial. Addict Behav 2020; 104:106256. [PMID: 31927219 DOI: 10.1016/j.addbeh.2019.106256] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 11/05/2019] [Accepted: 12/10/2019] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Personalized feedback interventions (PFIs) are associated with small but reliable decreases in alcohol consumption among college students. While they often include information regarding protective behavioral strategies (PBS), PFIs do not typically include feedback aimed to modify normative perceptions of PBS. This study aimed to enhance the efficacy of existing PFIs among college students by incorporating normative feedback on participants' use of PBS. METHODS Students enrolled in undergraduate courses (N = 268) completed baseline and 1-month follow-up assessments of past-month use of PBS, normative perceptions of PBS use, alcohol consumption, and alcohol-related consequences. Participants were randomized to one of three conditions: typical feedback on PBS (typical strategies PFI), descriptive normative feedback on PBS (strategy norms PFI), or assessment-only control (AOC). Participants in the typical strategies PFI and strategy norms PFI conditions received web-based personalized feedback profiles. RESULTS Compared to AOC, both the strategy norms PFI and typical strategies PFI were effective in correcting participants' perceptions of other students' engagement in PBS (p = .01) but did not differ significantly from one another. No statistically significant differences were observed between conditions in terms of actual PBS use, alcohol consumption, or alcohol-related consequences at 1-month follow-up (p > .05). DISCUSSION The strategy norms and typical strategies PFIs were both successful in increasing normative perceptions of PBS use, indicating that general (rather than normative) feedback regarding PBS use may be sufficient for changing perceptions of PBS use.
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Affiliation(s)
- Eleanor L S Leavens
- Department of Psychology, Oklahoma State University, Stillwater, OK, United States
| | - Mary Beth Miller
- Department of Psychiatry, University of Missouri, Columbia, MO, United States
| | - Emma I Brett
- Department of Psychology, Oklahoma State University, Stillwater, OK, United States
| | - Amanda Baraldi
- Department of Psychology, Oklahoma State University, Stillwater, OK, United States
| | - Thad R Leffingwell
- Department of Psychology, Oklahoma State University, Stillwater, OK, United States.
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17
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Pedersen ER, Davis JP, Hummer JF, DiGuiseppi G, Sedano A, Rodriguez A, Clapp JD. Development of a Measure to Assess Protective Behavioral Strategies for Pregaming among Young Adults. Subst Use Misuse 2020; 55:534-545. [PMID: 31847662 PMCID: PMC7310598 DOI: 10.1080/10826084.2019.1686025] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Although most young adults drink alcohol, there are specific drinking contexts that are associated with increased risk for alcohol-related consequences. One such drinking context is pregaming, which typically involves heavy drinking in brief periods of time and has consistently been linked to consequences within the pregaming event itself, on a night after pregaming, and in the long-term. Intervention efforts that specifically target this risky behavior are needed, but these efforts need to be informed by empirical work to better understand what behaviors young people engage in that can protect them from pregaming-related harms. Purpose: We designed this study to create a measure of protective behavioral strategies that young people use before, during, and after pregaming to inform future intervention work. Methods: We tested an item pool with 363 young adult college students who engaged in pregaming in the past year and conducted exploratory factor analysis to develop a 19-item Protective Behavioral Strategies for Pregaming (PBSP) scale, which featured four subscales of safety and familiarity, setting drink limits, pacing strategies, and minimizing intoxication. Results: Each subscale negatively and significantly correlated with measures of alcohol use and consequences, though subscales differed in their associations with specific pregaming outcomes and by sex. Conclusion: This initial exploratory examination of the PBSP scale's psychometric properties suggests that use of protective behavioral strategies used specifically during pregaming events may protect young people from heavy drinking and harms. More research with the PBSP scale is encouraged to determine its practical utility as a clinical and assessment tool with young people.
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Affiliation(s)
| | - Jordan P Davis
- University of Southern California, Suzanne Dworak-Peck School of Social Work; USC Institute for Addiction Science, Los Angeles, California, USA
| | | | - Graham DiGuiseppi
- University of Southern California, Suzanne Dworak-Peck School of Social Work; USC Institute for Addiction Science, Los Angeles, California, USA
| | - Angeles Sedano
- University of Southern California, Suzanne Dworak-Peck School of Social Work; USC Institute for Addiction Science, Los Angeles, California, USA
| | | | - John D Clapp
- University of Southern California, Suzanne Dworak-Peck School of Social Work; Department of Preventive Medicine, Keck School of Medicine; USC Institute for Addiction Science, Los Angeles, California, USA
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18
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Lee CM, Fairlie AM, Ramirez JJ, Patrick ME, Luk JW, Lewis MA. Self-fulfilling prophecies: Documentation of real-world daily alcohol expectancy effects on the experience of specific positive and negative alcohol-related consequences. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2019; 34:327-334. [PMID: 31804099 DOI: 10.1037/adb0000537] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Alcohol expectancies are consistently associated with alcohol use in cross-sectional and longitudinal studies. However, little research has examined whether alcohol expectancies on specific drinking occasions are associated with reported consequences on those days, particularly when controlling for the amount of alcohol consumed, thus differentiating the extent to which reported consequences may have resulted from alcohol or an "expectancy effect." This study examined consequence-specific daily expectancy effects. College students (N = 342; mean age 19.7 [standard deviation (SD) = 1.25], 52.9% female) participated in a longitudinal measurement burst study. During four 2-week intervals, participants used mobile phones to respond to 3 surveys per day via automated telephone interviews. The results showed that on days when college students had higher-than-average expectancies for specific subjective positive consequences (e.g., feeling more relaxed, being in a better mood), they were more likely to report experiencing those same consequences as a result of their alcohol use that day, even after controlling for how much they actually drank on that day. The same held true for subjective interpersonal negative consequences (e.g., becoming aggressive, rude, or obnoxious; embarrassing oneself), but not for less subjective physical/cognitive negative consequences (e.g., having a hangover, vomiting, getting hurt/injured, forgetting). The results suggest that one's expectations about the particular effects of alcohol tend to be self-fulfilling for subjective effects of alcohol even when they are not directly tied to the physiological effects of alcohol. The findings underscore the important role of alcohol expectancies, particularly the expectation of subjective positive social and tension-reduction/relaxation effects, in understanding problematic alcohol use. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | | | | | - Megan E Patrick
- Institute for Translational Research in Children's Mental Health
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19
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Kiluk BD, Ray LA, Walthers J, Bernstein M, Tonigan JS, Magill M. Technology-Delivered Cognitive-Behavioral Interventions for Alcohol Use: A Meta-Analysis. Alcohol Clin Exp Res 2019; 43:2285-2295. [PMID: 31566787 PMCID: PMC6824956 DOI: 10.1111/acer.14189] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 08/28/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cognitive-behavioral therapy (CBT) has long-standing evidence for efficacy in the treatment of alcohol use, yet implementation in clinical practice has been challenging. Delivery of CBT through technology-based platforms, such as web-based programs and mobile applications, has the potential to provide widespread access to this evidence-based intervention. While there have been reviews indicating the efficacy of technology-based delivery of CBT for various psychiatric conditions, none have focused on efficacy for alcohol use. The current meta-analysis was conducted to fill this research gap. METHODS Descriptive data were used to characterize the nature of the literature on technology-delivered, CBT-based interventions for alcohol use ("CBT Tech"). Inverse-variance-weighted effect sizes were calculated, and random effects, effect sizes were pooled in 4 subgroups. RESULTS Fifteen published trials conducted primarily with at-risk or heavy drinkers were identified. Of these studies, 60% explicitly targeted alcohol use moderation. The content of CBT Tech programs varied, ranging from 4 to 62 sessions/exercises, with many programs combining elements of motivational interviewing (47%). With respect to efficacy, CBT Tech as a stand-alone treatment in contrast to a minimal treatment control showed a positive and statistically significant, albeit small effect (g = 0.20: 95% CI = 0.22, 0.38, kes = 5). When CBT Tech was compared to treatment as usual (TAU), effects were nonsignificant. However, when CBT Tech was tested as an addition to TAU, in contrast to TAU only, the effect size was positive, significant (g = 0.30: 95% CI = 0.10, 0.50, kes = 7), and stable over 12-month follow-up. Only 2 studies compared CBT Tech to in-person CBT, and this pooled effect size did not suggest superior efficacy. CONCLUSIONS These results show a benefit for technology-delivered, CBT-based interventions as a stand-alone therapy for heavy drinking or as an addition to usual care in specialty substance use settings.
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Affiliation(s)
| | - Lara A. Ray
- University of California at Los Angeles, Los Angeles, CA
| | - Justin Walthers
- Brown University, Center for Alcohol and Addiction Studies, Providence, RI
| | - Michael Bernstein
- Brown University, Center for Alcohol and Addiction Studies, Providence, RI
| | | | - Molly Magill
- Brown University, Center for Alcohol and Addiction Studies, Providence, RI
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O'Connor EA, Perdue LA, Senger CA, Rushkin M, Patnode CD, Bean SI, Jonas DE. Screening and Behavioral Counseling Interventions to Reduce Unhealthy Alcohol Use in Adolescents and Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2018; 320:1910-1928. [PMID: 30422198 DOI: 10.1001/jama.2018.12086] [Citation(s) in RCA: 126] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE Unhealthy alcohol use is common, increasing, and a leading cause of premature mortality. OBJECTIVE To review literature on the effectiveness and harms of screening and counseling for unhealthy alcohol use to inform the US Preventive Services Task Force. DATA SOURCES MEDLINE, PubMed, PsycINFO, and the Cochrane Central Register of Controlled Trials through October 12, 2017; literature surveillance through August 1, 2018. STUDY SELECTION Test accuracy studies and randomized clinical trials of screening and counseling to reduce unhealthy alcohol use. DATA EXTRACTION AND SYNTHESIS Independent critical appraisal and data abstraction by 2 reviewers. Counseling trials were pooled using random-effects meta-analyses. MAIN OUTCOMES AND MEASURES Sensitivity, specificity, drinks per week, exceeding recommended limits, heavy use episodes, abstinence (for pregnant women), and other health, family, social, and legal outcomes. RESULTS One hundred thirteen studies (N = 314 466) were included. No studies examined benefits or harms of screening programs to reduce unhealthy alcohol use. For adolescents (10 studies [n = 171 363]), 1 study (n = 225) reported a sensitivity of 0.73 (95% CI, 0.60 to 0.83) and specificity of 0.81 (95% CI, 0.74 to 0.86) using the AUDIT-C (Alcohol Use Disorders Identification Test-Consumption) to detect the full spectrum of unhealthy alcohol use. For adults (35 studies [n = 114 182]), brief screening instruments commonly reported sensitivity and specificity between 0.70 and 0.85. Two trials of the effects of interventions to reduce unhealthy alcohol use in adolescents (n = 588) found mixed results: one reported a benefit in high-risk but not moderate-risk drinkers, and the other reported a statistically significant reduction in drinking frequency for boys but not girls; neither reported health or related outcomes. Across all populations (68 studies [n = 36 528]), counseling interventions were associated with a decrease in drinks per week (weighted mean difference, -1.6 [95% CI, -2.2 to -1.0]; 32 studies [37 effects; n = 15 974]), the proportion exceeding recommended drinking limits (odds ratio [OR], 0.60 [95% CI, 0.53 to 0.67]; 15 studies [16 effects; n = 9760]), and the proportion reporting a heavy use episode (OR, 0.67 [95% CI, 0.58 to 0.77]; 12 studies [14 effects; n = 8108]), and an increase in the proportion of pregnant women reporting abstinence (OR, 2.26 [95% CI, 1.43 to 3.56]; 5 studies [n = 796]) after 6 to 12 months. Health outcomes were sparsely reported and generally did not demonstrate group differences in effect. There was no evidence that these interventions could be harmful. CONCLUSIONS AND RELEVANCE Among adults, screening instruments feasible for use in primary care are available that can effectively identify people with unhealthy alcohol use, and counseling interventions in those who screen positive are associated with reductions in unhealthy alcohol use. There was no evidence that these interventions have unintended harmful effects.
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Affiliation(s)
- Elizabeth A O'Connor
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Leslie A Perdue
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Caitlyn A Senger
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Megan Rushkin
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Carrie D Patnode
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Sarah I Bean
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
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Prosser T, Gee KA, Jones F. A meta-analysis of effectiveness of E-interventions to reduce alcohol consumption in college and university students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2018; 66:292-301. [PMID: 29452058 DOI: 10.1080/07448481.2018.1440579] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To evaluate the effectiveness and moderators of E-Interventions versus assessment only (AO) controls in the reduction of alcoholic drinks per week (DPW) in university students. STUDY DESIGN AND METHODS Cochrane library, CINAEL, ERIC, MEDLINE, PsycINFO, PubMed, and Web of Science were searched up to June 2017. Studies were included if they were: an RCT, assessed the effectiveness of E-Interventions at reducing DPW, and employed university/college students. 23 studies (N = 7,614) were included and quality was assessed using the JADAD scale. RESULTS Weighted mean effect sizes were calculated using random-effects models. These showed a small, significant effect of E-Interventions at reducing the number of alcoholic DPW. Moderator analysis found a significant advantage for web-based personalised feedback interventions compared to other E-Interventions. CONCLUSIONS E-Interventions show a small, significant effect at reducing mean alcoholic DPW. Personalised feedback E-Interventions showed the strongest effect.
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Affiliation(s)
- Tom Prosser
- a Canterbury Christ Church University, School of Psychology , Canterbury , UK
| | - Kate Ann Gee
- a Canterbury Christ Church University, School of Psychology , Canterbury , UK
| | - Fergal Jones
- b Canterbury Christ Church University, Salomons Centre for Applied Psychology , Tunbridge Wells , UK
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Lau-Barraco C, Braitman AL, Stamates AL. A Randomized Trial of a Personalized Feedback Intervention for Nonstudent Emerging Adult At-Risk Drinkers. Alcohol Clin Exp Res 2018; 42:781-794. [PMID: 29485676 DOI: 10.1111/acer.13606] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 01/30/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Emerging adulthood is a period of heightened vulnerability for problematic alcohol use. Considerable research has been devoted to reducing alcohol risks in college student populations, although far less effort has focused on their noncollege-attending peers. Research targeting nonstudent emerging adults is critical as this group is at risk of experiencing alcohol-related harms. Consequently, the main objective of the present randomized study was to examine the preliminary efficacy of a brief personalized feedback intervention (PFI) tailored for nonstudent at-risk drinkers. We also examined the influence of gender on intervention outcomes. Finally, we explored participant acceptability of the intervention. METHODS Participants were 164 (65.9% men) emerging adults (M age = 21.98, SD = 2.02) recruited from the community. They were randomly assigned to either a 50-minute, in-person PFI or an assessment-only control group and were assessed over 9 months postintervention. RESULTS Results showed that for short-term change (1 month), the PFI condition reduced drinking significantly more than controls. For longer-term change (1 to 9 months), both conditions continued to show gradual decline in consumption. The groups did not differ in alcohol-related problems, and the intervention was equally effective for both women and men. Regarding acceptability, participants were extremely satisfied with the intervention, perceived the information to be personally relevant, and thought it provided them a new way of looking at their own drinking. CONCLUSIONS Overall, the present research advanced knowledge regarding an understudied and at-risk group of drinkers. This is among one of the first randomized studies to evaluate a brief intervention tailored to the needs of nonstudent emerging adults based on prior formative research with this group. Our data support PFI as a promising intervention approach for nonstudent drinkers in the community. Ultimately, this line of research aims to reduce alcohol-related health disparities associated with inequities in education.
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Affiliation(s)
- Cathy Lau-Barraco
- Department of Psychology, Old Dominion University, Norfolk, Virginia.,Virginia Consortium Program in Clinical Psychology, Norfolk, Virginia
| | - Abby L Braitman
- Department of Psychology, Old Dominion University, Norfolk, Virginia
| | - Amy L Stamates
- Department of Psychology, Old Dominion University, Norfolk, Virginia
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Kaner EFS, Beyer FR, Garnett C, Crane D, Brown J, Muirhead C, Redmore J, O'Donnell A, Newham JJ, de Vocht F, Hickman M, Brown H, Maniatopoulos G, Michie S. Personalised digital interventions for reducing hazardous and harmful alcohol consumption in community-dwelling populations. Cochrane Database Syst Rev 2017; 9:CD011479. [PMID: 28944453 PMCID: PMC6483779 DOI: 10.1002/14651858.cd011479.pub2] [Citation(s) in RCA: 149] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Excessive alcohol use contributes significantly to physical and psychological illness, injury and death, and a wide array of social harm in all age groups. A proven strategy for reducing excessive alcohol consumption levels is to offer a brief conversation-based intervention in primary care settings, but more recent technological innovations have enabled people to interact directly via computer, mobile device or smartphone with digital interventions designed to address problem alcohol consumption. OBJECTIVES To assess the effectiveness and cost-effectiveness of digital interventions for reducing hazardous and harmful alcohol consumption, alcohol-related problems, or both, in people living in the community, specifically: (i) Are digital interventions more effective and cost-effective than no intervention (or minimal input) controls? (ii) Are digital interventions at least equally effective as face-to-face brief alcohol interventions? (iii) What are the effective component behaviour change techniques (BCTs) of such interventions and their mechanisms of action? (iv) What theories or models have been used in the development and/or evaluation of the intervention? Secondary objectives were (i) to assess whether outcomes differ between trials where the digital intervention targets participants attending health, social care, education or other community-based settings and those where it is offered remotely via the internet or mobile phone platforms; (ii) to specify interventions according to their mode of delivery (e.g. functionality features) and assess the impact of mode of delivery on outcomes. SEARCH METHODS We searched CENTRAL, MEDLINE, PsycINFO, CINAHL, ERIC, HTA and Web of Knowledge databases; ClinicalTrials.com and WHO ICTRP trials registers and relevant websites to April 2017. We also checked the reference lists of included trials and relevant systematic reviews. SELECTION CRITERIA We included randomised controlled trials (RCTs) that evaluated the effectiveness of digital interventions compared with no intervention or with face-to-face interventions for reducing hazardous or harmful alcohol consumption in people living in the community and reported a measure of alcohol consumption. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by The Cochrane Collaboration. MAIN RESULTS We included 57 studies which randomised a total of 34,390 participants. The main sources of bias were from attrition and participant blinding (36% and 21% of studies respectively, high risk of bias). Forty one studies (42 comparisons, 19,241 participants) provided data for the primary meta-analysis, which demonstrated that participants using a digital intervention drank approximately 23 g alcohol weekly (95% CI 15 to 30) (about 3 UK units) less than participants who received no or minimal interventions at end of follow up (moderate-quality evidence).Fifteen studies (16 comparisons, 10,862 participants) demonstrated that participants who engaged with digital interventions had less than one drinking day per month fewer than no intervention controls (moderate-quality evidence), 15 studies (3587 participants) showed about one binge drinking session less per month in the intervention group compared to no intervention controls (moderate-quality evidence), and in 15 studies (9791 participants) intervention participants drank one unit per occasion less than no intervention control participants (moderate-quality evidence).Only five small studies (390 participants) compared digital and face-to-face interventions. There was no difference in alcohol consumption at end of follow up (MD 0.52 g/week, 95% CI -24.59 to 25.63; low-quality evidence). Thus, digital alcohol interventions produced broadly similar outcomes in these studies. No studies reported whether any adverse effects resulted from the interventions.A median of nine BCTs were used in experimental arms (range = 1 to 22). 'B' is an estimate of effect (MD in quantity of drinking, expressed in g/week) per unit increase in the BCT, and is a way to report whether individual BCTs are linked to the effect of the intervention. The BCTs of goal setting (B -43.94, 95% CI -78.59 to -9.30), problem solving (B -48.03, 95% CI -77.79 to -18.27), information about antecedents (B -74.20, 95% CI -117.72 to -30.68), behaviour substitution (B -123.71, 95% CI -184.63 to -62.80) and credible source (B -39.89, 95% CI -72.66 to -7.11) were significantly associated with reduced alcohol consumption in unadjusted models. In a multivariable model that included BCTs with B > 23 in the unadjusted model, the BCTs of behaviour substitution (B -95.12, 95% CI -162.90 to -27.34), problem solving (B -45.92, 95% CI -90.97 to -0.87), and credible source (B -32.09, 95% CI -60.64 to -3.55) were associated with reduced alcohol consumption.The most frequently mentioned theories or models in the included studies were Motivational Interviewing Theory (7/20), Transtheoretical Model (6/20) and Social Norms Theory (6/20). Over half of the interventions (n = 21, 51%) made no mention of theory. Only two studies used theory to select participants or tailor the intervention. There was no evidence of an association between reporting theory use and intervention effectiveness. AUTHORS' CONCLUSIONS There is moderate-quality evidence that digital interventions may lower alcohol consumption, with an average reduction of up to three (UK) standard drinks per week compared to control participants. Substantial heterogeneity and risk of performance and publication bias may mean the reduction was lower. Low-quality evidence from fewer studies suggested there may be little or no difference in impact on alcohol consumption between digital and face-to-face interventions.The BCTs of behaviour substitution, problem solving and credible source were associated with the effectiveness of digital interventions to reduce alcohol consumption and warrant further investigation in an experimental context.Reporting of theory use was very limited and often unclear when present. Over half of the interventions made no reference to any theories. Limited reporting of theory use was unrelated to heterogeneity in intervention effectiveness.
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Affiliation(s)
- Eileen FS Kaner
- Newcastle UniversityInstitute of Health and SocietyRichardson RoadNewcastle upon TyneUKNE2 4AX
| | - Fiona R Beyer
- Newcastle UniversityInstitute of Health and SocietyRichardson RoadNewcastle upon TyneUKNE2 4AX
| | - Claire Garnett
- University College LondonResearch Department of Clinical, Educational and Health Psychology1‐19 Torrington PlaceLondonUKWC1E 7HB
| | - David Crane
- University College LondonResearch Department of Clinical, Educational and Health Psychology1‐19 Torrington PlaceLondonUKWC1E 7HB
| | - Jamie Brown
- University College LondonResearch Department of Clinical, Educational and Health Psychology1‐19 Torrington PlaceLondonUKWC1E 7HB
| | - Colin Muirhead
- Newcastle UniversityInstitute of Health and SocietyRichardson RoadNewcastle upon TyneUKNE2 4AX
| | - James Redmore
- University of BristolPopulation Health Sciences, Bristol Medical School39 Whatley RoadBristolUKBS8 2PS
| | - Amy O'Donnell
- Newcastle UniversityInstitute of Health and SocietyRichardson RoadNewcastle upon TyneUKNE2 4AX
| | - James J Newham
- King's College LondonPrimary Care & Public Health SciencesAddison House, Guy's campusLondonUKSE1 1UL
| | - Frank de Vocht
- University of BristolSchool of Social and Community Medicine39 Whatley RoadBristolUKBS8 2PS
| | - Matthew Hickman
- University of BristolSchool of Social and Community Medicine39 Whatley RoadBristolUKBS8 2PS
| | - Heather Brown
- Newcastle UniversityInstitute of Health and SocietyRichardson RoadNewcastle upon TyneUKNE2 4AX
| | - Gregory Maniatopoulos
- Newcastle UniversityInstitute of Health and SocietyRichardson RoadNewcastle upon TyneUKNE2 4AX
| | - Susan Michie
- University College LondonResearch Department of Clinical, Educational and Health Psychology1‐19 Torrington PlaceLondonUKWC1E 7HB
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Muench F, van Stolk-Cooke K, Kuerbis A, Stadler G, Baumel A, Shao S, McKay JR, Morgenstern J. A Randomized Controlled Pilot Trial of Different Mobile Messaging Interventions for Problem Drinking Compared to Weekly Drink Tracking. PLoS One 2017; 12:e0167900. [PMID: 28146560 PMCID: PMC5287456 DOI: 10.1371/journal.pone.0167900] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 11/18/2016] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Recent evidence suggests that text messaging may help to reduce problem drinking as an extension to in-person services, but very little is known about the effectiveness of remote messaging on problem drinking as a stand-alone intervention, or how different types of messages may improve drinking outcomes in those seeking to moderate their alcohol consumption. METHODS We conducted an exploratory, single-blind randomized controlled pilot study comparing four different types of alcohol reduction-themed text messages sent daily to weekly drink self-tracking texts in order to determine their impact on drinking outcomes over a 12-week period in 152 participants (≈ 30 per group) seeking to reduce their drinking on the internet. Messaging interventions included: weekly drink self-tracking mobile assessment texts (MA), loss-framed texts (LF), gain-framed texts (GF), static tailored texts (ST), and adaptive tailored texts (TA). Poisson and least squares regressions were used to compare differences between each active messaging group and the MA control. RESULTS When adjusting for baseline drinking, participants in all messaging groups except GF significantly reduced the number of drinks consumed per week and the number of heavy drinking days compared to MA. Only the TA and GF groups were significantly different from MA in reducing the number of drinking days. While the TA group yielded the largest effect sizes on all outcome measures, there were no significant differences between active messaging groups on any outcome measure. 79.6% of individuals enrolled in the study wanted to continue receiving messages for an additional 12 weeks at the end of the study. DISCUSSION Results of this pilot study indicate that remote automated text messages delivered daily can help adult problem drinkers reduce drinking frequency and quantity significantly more than once-a-week self-tracking messages only, and that tailored adaptive texts yield the largest effect sizes across outcomes compared to MA. Larger samples are needed to understand differences between messaging interventions and to target their mechanisms of efficacy.
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Affiliation(s)
- Frederick Muench
- Feinstein Institute for Medical Research, Department of Psychiatry, Northwell Health Great Neck, New York, United States of America
| | - Katherine van Stolk-Cooke
- Feinstein Institute for Medical Research, Department of Psychiatry, Northwell Health Great Neck, New York, United States of America
| | - Alexis Kuerbis
- Silberman School of Social Work, Hunter College at the City University of New York, New York, United States of America
| | - Gertraud Stadler
- Department of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, United Kingdom
| | - Amit Baumel
- Feinstein Institute for Medical Research, Department of Psychiatry, Northwell Health Great Neck, New York, United States of America
| | - Sijing Shao
- Feinstein Institute for Medical Research, Department of Psychiatry, Northwell Health Great Neck, New York, United States of America
| | - James R. McKay
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Jon Morgenstern
- Feinstein Institute for Medical Research, Department of Psychiatry, Northwell Health Great Neck, New York, United States of America
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