Correlates of AUDIT risk status for male and female college students

Brief online negative affect focused functional imagery training (FIT) improves four-week drinking outcomes in hazardous student drinkers: A pilot randomised controlled trial replication in South Africa

Background

Previous study has shown that functional imagery training (FIT) to utilise positive mental imagery in response to negative affect could improve alcohol-related outcomes. The current study aimed to replicate whether this negative affect focused FIT would improve alcohol-related outcomes in hazardous student drinkers in South Africa at four-week follow-up.

Methods

50 hazardous student drinkers who reported drinking to cope with negative affect were randomised into two groups. The active group (n = 25) was trained online over two weeks to respond to personalised negative drinking triggers by retrieving a personalised adaptive strategy they might use to mitigate negative affect, whereas the control group (n = 25) received standard risk information about binge drinking. Outcome measures including alcohol consumption, drinking motives, anxiety and depression, self-efficacy and use of protective behavioural strategies were obtained at baseline and four-week follow-up.

Results

FIT effects were revealed by three significant group-by-timepoint interactions in a per-protocol analysis: there was a significant decrease in depressive symptoms, drinking to cope and drinking for social reasons from baseline to follow-up in the active group, but not the control group. No effects were observed on alcohol consumption, self-efficacy, protective behaviour strategies and anxiety.

Conclusions

Preliminary evidence supports that online negative affect focused FIT can improve depression as well as coping and social drinking motives in South African hazardous student drinkers who drank to cope, at four-week follow-up, suggesting that the principles of this FIT approach might be adapted and incorporated into a clinical intervention to test for efficacy in mitigating substance use problems.

Leveraging Natural Language Processing to Evaluate Young Adults' User Experiences with a Digital Sleep Intervention for Alcohol Use

Evaluating user experiences with digital interventions is critical to increase uptake and adherence, but traditional methods have limitations. We incorporated natural language processing (NLP) with convergent mixed methods to evaluate a personalized feedback and coaching digital sleep intervention for alcohol risk reduction: 'Call it a Night' (CIAN; N = 120). In this randomized clinical trial with young adults with heavy drinking, control conditions were A + SM: web-based advice + active and passive monitoring; and A: advice + passive monitoring. Findings converged to show that the CIAN treatment condition group found feedback and coaching most helpful, whereas participants across conditions generally found advice helpful. Further, most participants across groups were interested in varied whole-health sleep-related factors besides alcohol use (e.g., physical activity), and many appreciated increased awareness through monitoring with digital tools. All groups had high adherence, satisfaction, and reported feasibility, but participants in CIAN and A + SM reported significantly higher effectiveness than those in A. NLP corroborated positive sentiments across groups and added critical insight that sleep, not alcohol use, was a main participant motivator. Digital sleep interventions are an acceptable, novel alcohol treatment strategy, and improving sleep and overall wellness may be important motivations for young adults. Further, NLP provides an efficient convergent method for evaluating experiences with digital interventions.

Maximizing the use of the Alcohol Use Disorders Identification Test (AUDIT) as a two-step screening tool

Few studies have examined Alcohol Use Disorders Identification Test (AUDIT) measurement invariance and no study has done so across clinically relevant drinking subgroups (e.g., unhealthy drinkers [UHDs] and those drinking below unhealthy drinking thresholds [non-UHDs]). Study 1 evaluated the factor structure and measurement invariance of the AUDIT across UHDs/non-UHDs (n = 1,350, 79.3 % female, 31.2 % UHDs). Study 2 validated a statistically derived 8-item AUDIT (AUDIT-8) in an independent sample of UHDs (n = 238, 49.2 % female). Confirmatory factor analysis examined factor structure and measurement invariance between UHDs/non-UHDs. Item response theory and differential item functioning evaluated sources of variance and removed problematic items, yielding the AUDIT-8. Predictive validity and test-retest reliability of the AUDIT-8 were examined. In study 2, convergent validity and factor structure of the AUDIT-8 were examined. A unidimensional AUDIT model fit best. Invariance models suggested differences across UHDs/non-UHDs. Items 1-3 (consumption) were most relevant for the non-UHDs. Items 4-8 (problems) were most relevant for UHDs; however, items 4-8 were not relevant and rarely endorsed among non-UHDs. Items 9-10 performed poorly in both groups. Test-retest reliability and predictive validity of AUDIT-8 was acceptable. In a second sample of UHDs, AUDIT-8 had a unidimensional structure and acceptable convergent validity with measures of consumption, affect and drinking motives. Results suggest that only items 1-3 of the AUDIT should be administered in screenings for UHD among university students, with items 4-8 administered among positive screens to confirm UHD. Items 9-10 should be removed. Implications for AUDIT-8 as a two-part screening tool are discussed.

Risk Factors for Substance Use across the Lifespan

Substance use is a perennial public health concern with associated health risks and economic impacts on society. In this article, we present a selective review of the epidemiological and clinical literatures on alcohol and substance use from a lifespan developmental perspective. We compare and contrast risk factors for the initiation of use and the development of a substance use disorder in adolescence, young adulthood, middle-age and later life. During adolescence, alcohol use experimentation is at its peak. Specific risk factors have been identified including trauma and parenting style that can increase the risk of substance use for teenagers. Emerging adults and college students are likely to experiment with other substances in addition to alcohol such as nicotine, marijuana, cocaine, and prescription medication such as Adderall. Middle-age and older adults with alcohol and substance use in their developmental histories may have an undiagnosed alcohol use disorder. Others will develop a late-onset substance use disorder in older age, possibly due to a dearth of social support, coping with bereavement, and medical complication. Based on Social Cognitive Theory, the roles of expectancies and self-efficacy are hypothesized to impact substance use and the risk of substance use disorder across the lifespan. Implications of the present review for future research on age-specific risk factors in alcohol use in relation to underlying developmental processes are considered.

Brief Online Negative Affect Focused Functional Imagery Training Improves 2-Week Drinking Outcomes in Hazardous Student Drinkers: a Pilot Randomised Controlled Trial

BACKGROUND

Negative affect plays an important role in motivating problematic alcohol use. Consequently, training imagery-based adaptive responses to negative affect could reduce problematic alcohol use. The current study tested whether personalised online functional imagery training (FIT) to utilise positive mental imagery in response to negative affect would improve drinking outcomes in hazardous negative affect drinking students.

METHOD

Participants were 52 hazardous student drinkers who drink to cope with negative affect. Participants in the active group (n = 24) were trained online over 2 weeks to respond to personalised negative drinking triggers by retrieving a personalised adaptive strategy they might use to mitigate negative affect, whereas participants in the control group (n = 28) received standard risk information about binge drinking at university. Measures of daily drinking quantity, drinking motives, self-efficacy and use of protective behavioural strategies were obtained at baseline and 2 weeks follow-up.

RESULTS

There were three significant interactions between group and time in a per-protocol analysis: the active intervention group showed increased self-efficacy of control over negative affect drinking and control over alcohol consumption and decreased social drinking motives from baseline to 2-week follow-up, relative to the control intervention group. There were no effects on drinking frequency.

CONCLUSION

These findings provide initial evidence that online training to respond to negative affect drinking triggers by retrieving mental imagery of adaptive strategies can improve drinking-related outcomes in hazardous, student, negative affect drinkers. The findings support the utility of FIT interventions for substance use.

Positive Urgency, Drinking Preoccupation, and Alcohol Problems in College Students

OBJECTIVE

Individuals high in positive urgency (i.e., impulsiveness stemming from high positive mood) may be more preoccupied with alcohol-related cognitions. Our aim was to examine how positive urgency, drinking preoccupation, and consumption patterns concurrently influence the endorsement of alcohol-related problems.

METHOD

We sampled 756 students enrolled in a large, public U.S. university, who completed a cross-sectional survey online. Their mean age was 19.6 (SD = 1.72), 71.3% identified as female, and participants largely identified as Caucasian (65.5%) and Hispanic/Latinx (22.1%). Self-report measurements of trait positive urgency and drinking preoccupation and retrospective data of alcohol use and alcohol-related problems were collected. A series of linear regressions tested for a hypothesized indirect effect between variables.

RESULTS

We discovered an indirect effect in the relationship between positive urgency and alcohol-related problems via drinking preoccupation. A significant conditional effect showed that this relationship was influenced by past 30-day alcohol consumption, with the effect gaining strength as consumption days increased.

CONCLUSIONS

Students with high positive urgency may be more engrossed with alcohol-related drinking cognitions, leading to negative consequences as their alcohol consumption increases. This potential association can inform tailored intervention plans for college student alcohol control, such as successfully managing intense positive moods and alcohol-related cognitions and triggers.

Psychopathy and Protective Behavioral Strategies: PBS Mediates the Relationships between Primary and Secondary Psychopathy and Alcohol Consumption and Problems

Objective: The most common conceptualization of psychopathy is a two-factor model of primary psychopathy and secondary psychopathy. Primary psychopathy consists of interpersonally abusive behavior, and callousness. Secondary psychopathy includes impulsive and risky decision making. Past research has found that psychopathy is related to negative outcomes, including increased alcohol consumption and problems, and is inversely related to harm reduction behaviors. Protective behavioral strategies (PBS), behaviors designed to reduce alcohol consumption and associated problems, may mediate the relationship between psychopathy and alcohol pathology. The current study examined the relationship between psychopathy, each subtype of PBS use (serious harm reduction (SHR), manner of drinking (MD) and stopping/limiting drinking (SLD)), alcohol consumption, and alcohol problems.Method: Participants were n = 967 (61.22% female) college students. Participants completed measures assessing psychopathy, PBS use, alcohol consumption, and alcohol problems. A path analysis was conducted to examine the relationships between psychopathy, subtypes of PBS, and alcohol consumption and problems.Results: Results indicated an inverse relationship between primary psychopathy and both SHR PBS and MD PBS, while secondary psychopathy was inversely associated with all three PBS subtypes. SHR PBS was inversely associated with alcohol problems while MD PBS was inversely associated with alcohol consumption.Conclusion: These findings suggest specific PBS subtypes mediate the relationship between primary and secondary psychopathy and alcohol consumption and problems. It may be clinically pertinent to consider targeting PBS use, such as with motivational interviewing, when working with patients exhibiting psychopathy traits. Future research should consider these findings when examining alcohol use.

Changes in Alcohol Use during the COVID-19 Pandemic among Young Adults: The Prospective Effect of Anxiety and Depression

Health measures instantiated to reduce the spread of COVID-19 have imposed significant constraints for the population and impacted on drinking habits and mental health. This study longitudinally compared changes in alcohol consumption before and after the COVID-19 outbreak and the impact of sociodemographic and mental health variables on such changes among a community sample of young adults. Data were collected in the context of a larger, ongoing longitudinal study. The sample consisted of 305 young adults from Spain aged between 18 and 26 years (mean age = 21.27, (SD = 2.21), female = 53.4%; college students = 61.6%) who completed first (November-2019 and February-2020; i.e., before the outbreak of COVID-19) and second follow-up questionnaires (March 2021, a year after the COVID-19 outbreak). Alcohol use (quantity and drinking frequency), depression and anxiety symptoms were measured. Quantity and frequency of alcohol use decreased from the pre- to post-COVID-19 period. A decrease in drinking frequency was observed among college students, but not in noncollege peers. Although we found no effect of pre-COVID-19 anxiety on alcohol use changes, those with more depressive symptoms at the pre-COVID assessment were more resistant to decreasing their drinking quantity and frequency after the COVID-19 outbreak. This information will be of value when designing interventions aimed at reducing harmful alcohol use and highlights the role of mental health status when identifying high risk populations of young-adults during this, and future, public health crises.

Computer-delivered personalized feedback intervention for hazardous drinkers with elevated anxiety sensitivity: A pilot randomized controlled trial

Hazardous drinkers with emotional vulnerabilities (e.g., elevated anxiety sensitivity) remain an underserved group. This study aimed to evaluate the feasibility, acceptability, and initial efficacy of a single session remotely-delivered personalized feedback intervention (PFI) targeting alcohol (mis)use and anxiety sensitivity among college students. Hazardous drinkers with elevated anxiety sensitivity (N = 125; 76.8% female; M_age = 22.14; 66.4% racial/ethnic minorities) were randomized to receive the integrated PFI (n = 63) or attention control (n = 62). Follow-up assessments were conducted one-week, one-month and three-months post-intervention. Latent growth curve modeling was used to test pilot outcomes. It was feasible to recruit and retain hazardous drinking students with elevated anxiety sensitivity through follow-up with no group differences in retention. The integrated PFI was rated as more acceptable than the control with medium/large differences (p's < 0.004; d's = 0.54-0.80). The integrated PFI group had statistically significantly greater change in primary outcomes: motivation, hazardous alcohol use, and anxiety sensitivity (p's < 0.05; d's = 0.08-0.37) with larger within-group effect sizes (d's = 0.48-0.61) than in control (d's = 0.26-0.54). Despite a small sample size, this one-session intervention offers promise among a high-risk group of drinkers with emotional vulnerabilities. The computer-based format may allow for mass distribution of a low-cost intervention in the future; however, follow-up testing in larger samples is needed.

A Multimodal Mobile Sleep Intervention for Young Adults Engaged in Risky Drinking: Protocol for a Randomized Controlled Trial

Background

This paper describes the research protocol for a randomized controlled trial of a multimodal mobile sleep intervention for heavy-drinking young adults. Young adults report the highest rates of heavy, risky alcohol consumption and are a priority population for alcohol prevention and intervention efforts. Alcohol strategies that leverage other health concerns and use technology may offer an innovative solution. Poor sleep is common among young adults and is a risk factor for developing an alcohol use disorder. Moreover, young adults are interested in information to help them sleep better, and behavioral sleep interventions address alcohol use as a standard practice.

Objective

The primary aim of this study is to assess the effectiveness of a 2-week multimodal mobile sleep intervention for reducing drinks consumed per week among heavy-drinking young adults. We will explore the effects on alcohol-related consequences, assessing quantitative and qualitative sleep characteristics as secondary aims. The study’s goals are to identify the optimal combination of sleep intervention components for improving drinking outcomes, the feasibility and acceptability of these components, and the potential mechanisms by which these components may promote alcohol behavior change.

Methods

Young adults (aged 18-25 years) who report recent heavy drinking will be randomly assigned to one of three conditions: mobile sleep hygiene advice (n=30), mobile sleep hygiene advice and sleep and alcohol diary self-monitoring (n=30), or mobile sleep hygiene advice, sleep and alcohol diary self-monitoring, and sleep and alcohol data feedback (n=60). For the feedback component, participants will complete two web-based sessions with a health coach during which they will receive summaries of their sleep and alcohol data, and the potential association between them along with brief advice tailored to their data. All participants will wear sleep and alcohol biosensors daily for 2 weeks for objective assessments of these outcomes.

Results

The study was funded by the National Institutes of Health in May 2018. Recruitment began in December 2018 and will be concluded in Spring 2021. As of February 4, 2021, we have enrolled 110 participants.

Conclusions

Ultimately, this research could result in an efficacious, low-cost intervention with broad population reach through the use of technology. In addition, this intervention may substantially impact public health by reducing alcohol use disorder risk at a crucial developmental stage.

Trial Registration

ClinicalTrials.gov NCT03658954; https://clinicaltrials.gov/ct2/show/NCT03658954

International Registered Report Identifier (IRRID)

DERR1-10.2196/26557

Daily Patterns of Emotional Functioning on Drinking and Nondrinking Days

BACKGROUND

Alcohol misuse continues to be a significant public health problem. Understanding the factors that may contribute to the harmful progression in drinking is an important aspect of public health. Previous research has shown that affect regulation is associated with problematic alcohol use. Additionally, emotion instability has been found as a predictor of alcohol-related problems and may be linked to reinforcement mechanisms.

METHODS

The current study examined positive mood, negative mood, and mood instability in real time across drinking and nondrinking days utilizing ecological momentary assessment (EMA). Current drinkers (n = 74) were recruited for a 21-day EMA study. Participants completed up to 10 random assessments of positive mood, negative mood, and alcohol use per day. Mood instability was assessed as the squared difference in current mood from mood in the previous assessment. Data were analyzed using piecewise multilevel regression to examine mood trajectories across drinking and nondrinking days.

RESULTS

Positive emotion across the day was higher on drinking days than nondrinking days and continued to increase after drinking initiation. In contrast, negative emotion across the day was lower on drinking days than nondrinking days and continued to decrease after drinking initiation. Emotional functioning was stable across the day on nondrinking days. However, on drinking days there was a steady increase in emotional instability leading up to drinking initiation, followed by a rapid stabilization after initiation.

CONCLUSIONS

This study highlights the potentially reinforcing impact of alcohol via emotional stability. Overall, these findings highlight the importance of mood dynamics when examining the reinforcing effects of alcohol consumption.

The prevalence and impact of elevated anxiety sensitivity among hazardous drinking college students

Hazardous drinking is prevalent among college students, yet few seek treatment. Anxiety sensitivity AS is one factor with relevance to drinking. Yet, there are no known estimates of the prevalence of elevated AS among hazardous drinkers. The current study sought to estimate the prevalence of elevated AS among hazardous drinking college students and to examine relations between AS and hazardous drinking. Data from 1257 students Mage = 22.08; 80.4 % female; 76.8 % racial/ethnic minorities was employed. Approximately one third (30.7 %) of the sample met criteria for hazardous drinking. Among hazardous drinkers, 77.5 % had clinically elevated AS; similar rates were evidenced across sex and race/ethnicity. Hazardous drinkers reported significantly greater AS scores than moderate drinkers and non-drinkers (p < 0.001; η2 = 0.09). Those with elevated AS were more than three times more likely to be hazardous drinkers (p < 0.001). Among hazardous drinkers, those with elevated AS had more severe drinking levels (p < 0.001; Cohen's d=0.07) as well as greater likelihood, number, and disturbance related to use of other substances (p's from <0.001-0.005; Cohen's d's from 0.01 to 0.02). Findings from this study suggest that most hazardous drinkers have elevated AS, and that elevated AS is associated with a substantially higher likelihood of being a hazardous drinker. Hazardous drinkers with elevated AS report more severe drinking and other substance use than those with normative AS. There may be practical clinical benefit of implementing focus on AS to reduce hazardous drinking in college settings.

Breath alcohol concentration, hazardous drinking and preloading among Swedish university students

BACKGROUND

Approximately half of all young adults in Sweden are university students, and alcohol consumption is often a central part of students' social lives. Heavy drinking is associated with negative consequences, such as poor study skills, sexual risk-taking, violence and accidents. The aim of the present study is to assess the levels of alcohol intoxication as well as hazardous alcohol use among students at Swedish universities.

METHODS

In an alcohol field study, students (≥18 years old) were randomly selected and invited to participate. The settings were eight different parties at four universities in Sweden. Alcohol intoxication was measured using a breath analyser for breath alcohol concentration (BrAC). Demographic data (i.e., sex, age, number of years at the university) and responses to the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) were gathered through face-to-face interviews for the assessment of hazardous alcohol use.

RESULTS

In total, 723 students were invited to participate, 605 of whom consented (84% response rate). The mean age of the respondents was 22.2 years, and the proportion of women was 37%. A majority of the respondents (91%) reported drinking before arriving at the parties. Among those who had consumed alcohol before arriving, the average BrAC was 0.086%, and 36% had BrACs of 0.100% or more. The proportion of students reporting hazardous use was 86% for women and 87% for men.

CONCLUSIONS

This study provides the actual levels of intoxication among university students in four different cities. Alcohol intoxication and hazardous use among Swedish university students is a concern, and the university setting is an important arena for implementation of alcohol prevention strategies.

High levels of alcohol intoxication and strong support for restrictive alcohol policies among music festival visitors

Background

Alcohol intoxication is associated with problems such as violence, injuries, drunk driving and sexual risk-taking, and music festivals are considered a high-risk setting for high levels of alcohol consumption. This study investigates intoxication levels, drinking habits, and opinions on alcohol use and alcohol policies among visitors at one of the largest music festivals in Sweden in 2017.

Methods

A cross-sectional study assessing alcohol intoxication levels was conducted at a music festival (~ 50,000 attendees). Two research teams collected data at the two festival entrances during two nights, from approximately 6:00 pm to 01:30 am. Blood alcohol concentration (BAC) levels were measured using breath analyzers. A face-to-face questionnaire was used to interview attendees about their alcohol use in the past 12 months using the Alcohol Use Disorder Identification Test-Consumption (AUDIT-C), as well as about their personal opinions on alcohol use and alcohol policies (statement). BAC levels were compared between categories of various factors using Mann-Whitney U test and Kruskal-Wallis test. The distributions of BAC, AUDIT-C and statement category across gender was analyzed using Pearson’s Chi-square tests. Associations of BAC levels with different factors were analyzed using Spearman rank correlation and multinomial logistic regression.

Results

A total of 1663 attendees were randomly selected and invited to participate, and 1410 consented (63.7% men, 34.9% women, age 16–64 years). The proportion of drinkers was 81%. Among the drinkers, the median BAC level was 0.082%. Thirty-one percent of the participants had a BAC level above 0.10%. Forty-two percent of the participants reported binge drinking monthly, and 20% said that they binge drank weekly. Sixty-three percent of participants reported risky drinking habits. A self-reported risky alcohol habit increased the risk of a high alcohol intoxication level at the festival. Respondents were supportive of restrictive alcohol policies. Men had significantly higher BAC levels, reported more often risky alcohol habits and were less supportive of restrictive alcohol policies than women.

Conclusions

The results indicate that participants at music festivals in Sweden have high levels of alcohol intoxication and largely support restrictive alcohol policies. Thus, there is both a need and support for the implementation of alcohol prevention strategies at festivals.

A randomized control trial of a deviance regulation theory intervention to increase alcohol protective strategies

OBJECTIVE

Normative feedback remains an effective approach to reducing alcohol use among college students. However, this approach is difficult to extend to protective behavioral strategies (PBS), which are proximal to alcohol-related problems. Deviance regulation theory (DRT) is a social psychology theory that posits individuals engage in behaviors to standout out in positive ways or avoid standing out in negative ways. The current study tests a DRT-based randomized control trial.

METHOD

College student drinkers (n = 130) reported on PBS norm frequency, alcohol use, and PBS use. They were then randomly assigned to receive a positive message about PBS users, a negative message about non-PBS users, or a control. They reported on weekly PBS use, alcohol use, and alcohol problems for 10 weeks.

RESULTS

Consistent with DRT, there were immediate postintervention effects on PBS use for individuals who believed PBS was uncommon and who also received a positive message. This remained stable across time. There was significant growth in PBS use among individuals who received a negative message and who believed PBS use was common. The intervention was not directly associated with alcohol use or problems. However, PBS use was associated with average alcohol use and lower weekly and global alcohol problems.

CONCLUSIONS

This study shows that a DRT intervention may increase PBS use. This may translate into lower alcohol use and fewer alcohol-related problems. The results also identify conditions under which positive and negative messages are indicated. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Protective Behavioral Strategies Moderate the Association between Narcissistic Traits and Alcohol Pathology in College Student Drinkers

BACKGROUND

Personality traits found in Cluster B personality disorders have garnered considerable empirical attention and have been linked to a litany of issues, such as alcohol-related problems. While psychopathic traits have been linked to alcohol-use consequences, narcissistic traits remain understudied.

OBJECTIVES

The current study examines the relationship between narcissistic traits and alcohol use and consequences as a function of Protective Behavioral Strategies (PBS) in a sample of college students.

METHOD

Participants (n = 387 college student drinkers; 69.25% female) completed a series of questionnaires assessing alcohol use and consequences, PBS use, and narcissistic traits.

RESULTS

There was a significant positive association between narcissistic traits and alcohol use and consequences. The interaction of PBS and narcissistic traits was also statistically significant. Simple slopes revealed that at high levels of PBS (+1SD), the relationship between narcissistic traits and alcohol-use consequences was attenuated and not significant, while at low levels of PBS (-1SD), this association was potentiated.

CONCLUSION

These findings suggest that interventions targeting PBS use may be one way to reduce alcohol problems among those with higher levels of narcissistic traits.

Using e-mail boosters to maintain change after brief alcohol interventions for mandated college students: A randomized controlled trial

OBJECTIVE

Brief motivational interventions (BMIs) reduce drinking in the short term, but these initial effects often decay. We tested the hypothesis that theory-based e-mail boosters would promote maintenance of change after a BMI.

METHOD

Participants were students (N = 568; 72% male) who violated campus alcohol policy and were mandated to participate in an alcohol-risk-reduction program. Participants provided baseline data, received a BMI, and then completed a 1-month post-BMI survey. Next, they were randomized to receive 12 booster e-mails that contained either (a) alcohol norms or (b) structurally equivalent general health information (control). Alcohol consumption and alcohol-related consequences were assessed at baseline, 1, 3, 5, 8, and 12 months.

RESULTS

As expected, we observed significant reductions in both consumption and consequences after the BMI (ps < .01), and groups were equivalent at baseline and at 1-month post-BMI, prior to randomization (ps > .05). Latent growth curve models revealed no condition effects on changes in the latent consumption variable from 1- to 12-month follow-ups (b = .01, SE = .01, p > .05). Unexpectedly, a main effect of the condition emerged for self-reported consequences (b = .03, SE = .01, p = .01); we observed more consequences after boosters containing alcohol norms than general health information. Outcomes were not moderated by sex, consumption at baseline or 1 month, or e-mail exposure, and there was no mediation by descriptive norms, injunctive norms, or peer communication.

CONCLUSIONS

Contrary to predictions, e-mail boosters with corrective norms content did not improve outcomes after a BMI. (PsycINFO Database Record

Efficacy of the College Drinkers Check-Up for Student Drinkers Living Off Campus

OBJECTIVE

Students living in off-campus housing consume more alcohol and experience more alcohol-related consequences than those living on campus, yet prevention efforts have not targeted this high-risk group specifically. The present study evaluated the efficacy of a brief, computer-delivered, alcohol intervention (the College Drinkers Check-Up [CDCU]) in reducing alcohol use and related consequences in a sample of college students living off campus.

METHOD

Students who lived off campus and reported at least one heavy drinking episode (4+/5+ drinks for females/males in one occasion) in the past 30 days completed the CDCU or assessment only during the first month of the school year (n = 326; 61% female). Participants in both conditions completed follow-up assessments at 1, 3, and 6 months. We hypothesized that participants who completed the CDCU would report fewer drinks per week and heavy drinking episodes, lower peak drinking quantities, and fewer alcohol-related consequences than those in the control group.

RESULTS

Hierarchical linear modeling was used to examine changes in drinking outcomes across groups from baseline to 1-, 3-, and 6-month follow-ups. Significant effects of time indicated less drinking and fewer consequences at each follow-up relative to baseline. Compared with those in the control group, participants who received the CDCU reported significantly fewer heavy drinking episodes at 1 month, lower peak drinking quantities at 3 months, and fewer alcohol-related consequences at 1 and 3 months. Neither sex nor baseline drinking severity moderated intervention effects.

CONCLUSIONS

The brief, online CDCU reduces heavy drinking and alcohol consequences in the short term among atrisk college students living off campus.

Solitary drinking is associated with specific alcohol problems in emerging adults

Hazardous drinking in emerging adulthood is associated with multiple domains of alcohol problems, which range in type and severity. Alcohol problems at the severe end of the spectrum (e.g., impaired control) may be early warning signs of alcohol use disorders (AUDs) among emerging adults. However, given the emphasis in the literature on predictors of overall problem risk, we still know very little about predictors of these specific (and severe) domains of alcohol problems in emerging adults. Many emerging adults drink at social events (e.g., parties), but an estimated 15% engage in solitary drinking. Solitary drinking - a developmentally atypical behavior in emerging adulthood - may be especially risky. Data suggests that frequent solitary drinking may reflect a loss of control over drinking, leading to hazardous use and subsequent problems. Accordingly, we expected that frequent solitary drinking among emerging adults would predict severe alcohol problems that map onto diagnostic criteria for AUDs and these effects would be mediated by hazardous alcohol use. Undergraduates (N=118) completed self-report measures as a part of a larger study on motivation and alcohol use. As predicted, path analysis showed that solitary drinking positively predicted hazardous alcohol use, and this in turn predicted severe alcohol problems associated with diagnostic criteria for AUDs, particularly risky behaviors and blackout drinking. Solitary drinking also positively predicted less severe problems of diminished self-perception and poor self-care through hazardous use. Though comparatively smaller, some indirect effects were observed from social drinking (at parties, but not at bars) to alcohol problems, via hazardous alcohol use. Overall, our results suggest that solitary drinking is particularly harmful in emerging adulthood.

Examining the social ecology of a bar-crawl: An exploratory pilot study

Many of the problems associated with alcohol occur after a single drinking event (e.g. drink driving, assault). These acute alcohol problems have a huge global impact and account for a large percentage of unintentional and intentional injuries in the world. Nonetheless, alcohol research and preventive interventions rarely focus on drinking at the event-level since drinking events are complex, dynamic, and methodologically challenging to observe. This exploratory study provides an example of how event-level data may be collected, analyzed, and interpreted. The drinking behavior of twenty undergraduate students enrolled at a large Midwestern public university was observed during a single bar crawl event that is organized by students annually. Alcohol use was monitored with transdermal alcohol devices coupled with ecological momentary assessments and geospatial data. “Small N, Big Data” studies have the potential to advance health behavior theory and to guide real-time interventions. However, such studies generate large amounts of within subject data that can be challenging to analyze and present. This study examined how to visually display event-level data and also explored the relationship between some basic indicators and alcohol consumption.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Impulsive personality traits and alcohol use: Does sleeping help with thinking?

Both impulsivity and sleep disturbance have been associated with heavy alcohol use among young adults; yet studies to date have not examined their interactive effects. The current study aimed to determine if adequate sleep moderates the association between impulsive personality traits and alcohol use among young adults. College students (N = 568) who had been mandated to alcohol treatment following violation of campus alcohol policy provided information regarding alcohol use and related consequences, impulsive personality traits (measured using the UPPS Impulsive Behavior Scale), and perception of sleep adequacy as part of a larger intervention trial. Higher urgency, lower premeditation, and higher sensation-seeking predicted greater levels of alcohol consumption, while higher urgency predicted more alcohol-related consequences. As hypothesized, there was a significant interaction between premeditation and sleep adequacy in the prediction of drinks per week; in contrast to hypotheses, however, premeditation was associated with drinking only among those reporting adequate (rather than inadequate) sleep. Specifically, the tendency to premeditate was associated with less drinking among those who reported adequate sleep and was not associated with drinking among those reporting inadequate sleep. Sensation-seeking and urgency are associated with greater alcohol involvement among young adults, regardless of sleep adequacy. Conversely, the ability to plan ahead and anticipate the consequences of one's behaviors (premeditation) is only protective against heavy drinking among individuals receiving adequate sleep. With replication, these findings may inform alcohol prevention and intervention efforts. (PsycINFO Database Record

Students worry about the impact of alcohol on quality of life: Roles of frequency of binge drinking and drinker self-concept

INTRODUCTION

The aim of this study was to clarify the impact of binge drinking, its intensity and frequency, and drinker self-concept on health-related quality-of-life (HRQOL) in students.

METHODS

This cross-sectional online survey included 16,930 students. We collected sociodemographics, environmental data, and drinking behaviors. We assessed HRQOL using the Alcohol Quality-of-Life scale, which explicitly explores the subjective negative impact on quality of life one attributes to his relationship with alcohol and the degree to which drinking is a part of an individual's self-concept. Data analyses were performed in 2015 and 2016. We described and compared binge drinkers and non-binge drinkers. Using a regression model we identified the independent factors associated with HRQOL.

RESULTS

The impact on HRQOL attributed to alcohol was significantly greater among binge drinkers. Factors of impact on HRQOL subjectively attributed to alcohol by students were: AUDIT-C score, interaction between gender and AUDIT-C score, strong individual identity as a drinker, binge-drinking frequency, financial difficulties, being a foreigner, fewer years since diploma, chronic condition, recent use of cannabis, psychostimulant, poppers or gambling. Sleep quality, ability to work, expenditure on alcohol, shame, and health-related concerns were the most strongly impacted quality of life areas.

CONCLUSIONS

Binge-drinking frequency should be considered as an important target in prevention programs. In addition, integrating findings on students' subjective perceptions of impairment of HRQOL by alcohol could enable the development of more acceptable and more relevant prevention messages.

Profiles of College Drinkers Defined by Alcohol Behaviors at the Week Level: Replication Across Semesters and Prospective Associations With Hazardous Drinking and Dependence-Related Symptoms

OBJECTIVE

Types of college drinkers have been identified using traditional measures (e.g., 12-month drinking frequency). We used an alternative multidimensional approach based on daily reports of alcohol behaviors to identify college drinker statuses, each with a unique behavioral profile. The current study aimed to (a) identify drinker statuses at the week level across four semesters, (b) examine the predictive utility of drinker status by testing associations with senior-year hazardous drinking and dependence symptoms, and (c) identify concurrent predictors (gender, drinking motivations, hazardous drinking, any dependence symptoms) of senior-year drinker status. We also compared the week-level drinker statuses with drinker statuses identified using traditional measures.

METHOD

A multi-ethnic sample of U.S. college students completed 14-day bursts of daily web surveys across college (91%-96% completed ≥6 daily reports of the sampled week). Analyses focus on nine alcohol-related behaviors (including estimated blood alcohol concentration, pregaming, and drinking games) assessed daily in spring/sophomore year to fall/senior year and drinking motivations, hazardous drinking, and dependence symptoms assessed fall/senior year (n = 569; 56% women).

RESULTS

Four week-level drinker statuses were replicated across semesters: Nondrinker, Light Weekend, Heavy Weekend, and Heavy Frequent. Across semesters, drinker status was associated with senior-year hazardous drinking and any dependence symptoms. Senior-year fun/social motivations were also associated with senior-year drinker status. Differences in behavioral profiles between week-level drinker statuses and those identified using traditional measures were found.

CONCLUSIONS

Replicable week-level drinker statuses were identified, suggesting consistency in possible types of drinking weeks. Drinker statuses were predictive of senior-year hazardous drinking and dependence symptoms.

Do my peers approve? Interest in injunctive norms feedback delivered online to college student drinkers

Injunctive norms feedback is promising but understudied as a component of college drinking interventions. The aim of the present study was to demonstrate acceptability of injunctive norms feedback delivered to college drinkers via the web. We examined subjective interest in information reflecting peer approval of four sets of drinking behaviors and outcomes, and correlates of interest in the normative feedback. A sample of 221 young adults enrolled in a 2- or 4-year college or university (ages 18-25 years; 52% female) completed online surveys in which they were asked to rate their interest in each of 11 injunctive norms statements. Participants were randomly assigned to one of four sets of statements regarding peer approval of (a) intoxicated behaviors, (b) safe drinking strategies, (c) drinking-related consequences, and (d) drinking behaviors of potential partners. All items were framed to reflect disapproval of risky behaviors and approval of protective behaviors. Across norm sets, participants found the items to be moderately interesting and interest ratings did not differ across sets. Higher scores on the Alcohol Use Disorders Identification Test (AUDIT), stronger perceived approval of drinking in general (injunctive norms), stronger perceptions of drinking among peers (descriptive norms), and female gender were bivariately correlated with more interest. In a multiple regression, female gender, higher AUDIT (consequence subscale), and stronger general drinking injunctive norms remained significantly associated with interest in the pro-moderation statements. An important future direction is to determine whether the presentation of specific types of injunctive norms feedback can result in downward changes in drinking behavior.

Are drinking motives associated with sexual "hookups" among college student drinkers?

OBJECTIVE

This study examined associations between drinking motivation, alcohol use, and sexual hookups among college students.

PARTICIPANTS

Participants (n = 755 Midwest college student drinkers; 61% female) ranged in age from 18 to 24.

METHODS

Participants completed online measures of alcohol involvement (use and motives) and sexual activity.

RESULTS

Alcohol use was positively linked to sexual hookups. Social and enhancement motives were positively and indirectly associated with sexual hookups via alcohol use. Drinking to cope had a direct association with sexual hookups. Social drinking was more strongly associated with hookups in men than in women, but both groups exhibited a positive association.

CONCLUSIONS

This study is the first to highlight the relationships between distinct drinking motives and sexual risk behavior. The results indicate that specific motives may increase risk of sexual hookups both indirectly via alcohol use, as well as directly, at least among those that drink to cope with negative mood.

Psychosocial Correlates of AUDIT-C Hazardous Drinking Risk Status: Implications for Screening and Brief Intervention in College Settings

The current study identified psychosocial variables associated with AUDIT-C hazardous drinking risk status for male and female college students. Logistic regression analysis revealed that AUDIT-C risk status was associated with alcohol-related negative consequences, injunctive norms, and descriptive norms for both male and female participants. Sociability and self-perception outcome expectancies predicted risk status for females. Cognitive and behavioral impairment expectancies predicted risk status for men in the sample. Implications for screening and brief intervention programming efforts are discussed.

The relation between alcohol use and psychological, physical, and sexual dating violence perpetration among male college students

The prevalence of alcohol use and dating violence are shockingly high among male college students, making this a particularly high-risk group for alcohol-related aggression. Expanding upon previous research, the current study examined the relations between three indicators of alcohol use and three types of dating violence among 204 male college students. We also examined whether hazardous drinkers reported more violence perpetration than non-hazardous drinkers. Results demonstrated that alcohol use was related to all types of aggression, and hazardous drinkers are at greater risk of violence perpetration than non-hazardous drinkers. Implications for dating violence prevention programs and future research are discussed.

Student and Nonstudent National Guard Service Members/Veterans and Their Use of Services for Mental Health Symptoms

OBJECTIVE

To compare mental health symptoms and service utilization among returning student and nonstudent service members/veterans (SM/Vs).

PARTICIPANTS

SM/Vs (N = 1,439) were predominately white (83%) men (92%), half were over age 30 (48%), and 24% were students.

METHODS

SM/Vs completed surveys 6 months post deployment (October 2011-July 2013).

RESULTS

Students and nonstudent SM/Vs did not differ in positive screens for depression, anxiety, hazardous drinking, or posttraumatic stress disorder. Students (n = 81) and nonstudents (n = 265) with mental health symptoms had low levels of mental health service use (eg, Department of Veterans Affairs [VA], civilian, or military facilities), at 47% and 57%. respectively. Fewer students used VA mental health services. Common barriers to treatment seeking included not wanting treatment on military records and embarrassment.

CONCLUSIONS

Like other returning SM/Vs, student SM/Vs have unmet mental health needs. The discrepancy between potential need and treatment seeking suggests that colleges might be helpful in further facilitating mental health service use for student SM/Vs.

Variations in sleep characteristics and sleep-related impairment in at-risk college drinkers: a latent profile analysis

OBJECTIVE

Sleep disturbance and heavy drinking increase risk of negative consequences in college students. Limited research exists on how they act synergistically, and the overall nature of sleep and sleep-related impairment in college student drinkers is poorly understood. A latent profile analysis was conducted on the sleep characteristics and daytime sleep-related consequences of college student drinkers who were at-risk based on Alcohol Use Disorders Identification Test-Consumption scores.

METHODS

Participants (N = 312, mean age = 18.90 (0.97) years) consumed a mean (SD) of 20.93 (13.04) drinks per week. Scores on the 10 items of the Sleep/Wake Behavior Problems Scale (SWPS) were the class indicators.

RESULTS

Four classes best described the sleep and sleep-related consequences of at-risk college drinkers. Classes represented different gradients and types of sleep patterns and sleep-related impairment; nearly half the sample reported late bedtimes and daytime consequences of insufficient sleep. Subsequent validation analyses indicated that these classes were directly correspondent with severity of alcohol consumption, alcohol-related consequences illicit substance use, and perceived health.

CONCLUSIONS

These findings indicate the presence of significant heterogeneity in college drinkers' sleep patterns and experiences of sleep-related impairment. Class differences significantly impact the level of alcohol and drug use and the consequences members experience. Greater alcohol use and sleep/wake problems are associated with increased risk for negative consequences for certain classes. These results suggest that college drinking interventions could benefit from the incorporation of sleep-related content and the value in adding brief alcohol assessments and interventions to other college health treatments.

Ecological momentary assessment of acute alcohol use disorder symptoms: associations with mood, motives, and use on planned drinking days

Several theories posit that alcohol is consumed both in relation to one's mood and in relation to different motives for drinking. However, there are mixed findings regarding the role of mood and motives in predicting drinking. Ecological momentary assessment (EMA) methods provide an opportunity to evaluate near real-time changes in mood and motives within individuals to predict alcohol use. In addition, endorsement of criteria of an alcohol use disorder (AUD) may also be sensitive to changes within subjects. The current study used EMA with 74 moderate drinkers who responded to fixed and random mood, motive, alcohol use, and AUD criteria prompts over a 21-day assessment period. A temporal pattern of daytime mood, evening drinking motivation, and nighttime alcohol use and acute AUD symptoms on planned drinking days was modeled to examine how these associations unfold throughout the day. The results suggest considerable heterogeneity in drinking motivation across drinking days. Additionally, an affect regulation model of drinking to cope with negative mood was observed. Specifically, on planned drinking days, the temporal association between daytime negative mood and the experience of acute AUD symptoms was mediated via coping motives and alcohol use. The current study found that motives are dynamic, and that changes in motives may predict differential drinking patterns across days. Further, the study provides evidence that emotion-regulation-driven alcohol involvement may need to be examined at the event level to fully capture the ebb and flow of negative affect motivated drinking.

Sleep quality and alcohol risk in college students: examining the moderating effects of drinking motives

OBJECTIVE

Sleep problems and alcohol misuse are common issues experienced by college students that can have detrimental effects on overall health. Previous work indicates a strong relationship between poor sleep quality and alcohol risk in this population. This study explored the moderating effect of drinking motives in the relationship between global sleep quality and experience of alcohol-related negative consequences.

PARTICIPANTS

College students (N = 1,878) who reported past-month drinking.

METHODS

Participants completed online surveys assessing sleep and alcohol-related behaviors.

RESULTS

Poorer sleep quality and higher drinking motives (coping, conformity, and enhancement) predicted greater alcohol-related consequences, controlling for drinking. Further, coping motives moderated the relationship between sleep quality and consequences such that participants reporting poor sleep and high coping motives experienced heightened levels of consequences.

CONCLUSIONS

These findings advance the understanding of the relationship between sleep problems and alcohol-related risk and provide implications for targeted campus-based health promotion interventions.

Comparing short versions of the AUDIT in a community-based survey of young people

Background

The 10-item Alcohol Use Disorders Identification Test (AUDIT-10) is commonly used to monitor harmful alcohol consumption among high-risk groups, including young people. However, time and space constraints have generated interest for shortened versions. Commonly used variations are the AUDIT-C (three questions) and the Fast Alcohol Screening Test (FAST) (four questions), but their utility in screening young people in non-clinical settings has received little attention.

Methods

We examined the performance of established and novel shortened versions of the AUDIT in relation to the full AUDIT-10 in a community-based survey of young people (16–29 years) attending a music festival in Melbourne, Australia (January 2010).

Among those reporting drinking alcohol in the previous 12 months, the following statistics were systematically assessed for all possible combinations of three or four AUDIT items and established AUDIT variations: Cronbach’s alpha (internal consistency), variance explained (R²) and Pearson’s correlation coefficient (concurrent validity). For our purposes, novel shortened AUDIT versions considered were required to represent all three AUDIT domains and include item 9 on alcohol-related injury.

Results

We recruited 640 participants (68% female) reporting drinking in the previous 12 months. Median AUDIT-10 score was 10 in males and 9 in females, and 127 (20%) were classified as having at least high-level alcohol problems according to WHO classification.

The FAST scored consistently high across statistical measures; it explained 85.6% of variance in AUDIT-10, correlation with AUDIT-10 was 0.92, and Cronbach’s alpha was 0.66. A number of novel four-item AUDIT variations scored similarly high. Comparatively, the AUDIT-C scored substantially lower on all measures except internal consistency.

Conclusions

Numerous abbreviated variations of the AUDIT may be a suitable alternative to the AUDIT-10 for classifying high-level alcohol problems in a community-based population of young Australians. Four-item AUDIT variations scored more consistently high across all evaluated statistics compared to three-item combinations. Novel AUDIT versions may be more effective than many established shortened versions as an alternative screening tool to the AUDIT-10 to measure hazardous or harmful alcohol consumption in this population.

Optimizing the use of the AUDIT for alcohol screening in college students

The screening and brief intervention modality of treatment for at-risk college drinking is becoming increasingly popular. A key to effective implementation is use of validated screening tools. Although the Alcohol Use Disorders Identification Test (AUDIT) has been validated in adult samples and is often used with college students, research has not yet established optimal cutoff scores to screen for at-risk drinking. Four hundred and one current drinkers completed computerized assessments of demographics, family history of alcohol use disorders, alcohol use history, alcohol-related problems, and general health. Of the 401 drinkers, 207 met criteria for at-risk drinking. Receiver operating characteristic (ROC) curve analysis revealed that the area under the ROC (AUROC) of the AUDIT was .86 (95% CI [.83, .90]). The first 3 consumption items of the AUDIT (AUDIT-C; AUROC = .89, 95% CI [.86, .92]) performed significantly better than the AUDIT in the detection of at-risk drinking in the whole sample, and specifically for females. Gender differences emerged in the optimal cutoff scores for the AUDIT-C. A total score of 7 should be used for males, and a score of 5 should be used for females. These empirical guidelines may enhance identification of at-risk drinkers in college settings.

Alcohol misuse in patients with psoriasis: identification and relationship to disease severity and psychological distress

BACKGROUND

Moderate to severe psoriasis is associated with increased alcohol intake and excessive mortality from alcohol-related causes. Alcohol biomarkers provide an objective measure of alcohol consumption. Carbohydrate-deficient transferrin (CDT) is the single most sensitive and specific alcohol biomarker.

OBJECTIVES

To assess alcohol consumption in a cohort of patients with moderate to severe psoriasis using standard alcohol screening questionnaires and biomarkers. We investigated whether there was an association between alcohol intake, anxiety, depression and disease severity.

METHODS

Consecutive patients with chronic plaque psoriasis were recruited and completed a range of anonymized assessments. Psoriasis severity, anxiety and depression, and the impact of psoriasis on quality of life were assessed. Alcohol screening questionnaires were administered. Blood specimens were taken and γ-glutamyltransferase (γGT) and CDT were measured.

RESULTS

A total of 135 patients completed the study. Using validated questionnaires, between 22% and 32% had difficulties with alcohol. Seven per cent had CDT > 1·6% indicating a heavy alcohol intake. The Alcohol Use Disorders Identification Test (AUDIT) questionnaire was superior to other validated questionnaires in detecting alcohol misuse. There were no significant associations between measures of excessive alcohol consumption and disease severity. Excessive alcohol intake as measured by the CAGE questionnaire was associated with increased depression (P = 0·001) but other measures of alcohol excess did not correlate with psychological distress. Men had significantly more difficulties with alcohol than women (P < 0·001).

CONCLUSION

Alcohol misuse is common in patients with moderate to severe psoriasis. Screening with the AUDIT questionnaire and CDT may allow the identification of patients who are misusing alcohol and allow appropriate intervention.

Alcohol use and negative consequences among active duty military personnel

AIMS

An examination of alcohol use patterns in the active duty military to determine the relations of drinking levels and self-reported negative outcomes.

DESIGN

A population-based cross-sectional study design using two-stage complex sampling methodology.

SETTING

Paper and pencil surveys were administered anonymously in groups at 64 U.S. military installations worldwide.

PARTICIPANTS

Randomly selected active duty members (28,546) at major military installations representing the total active force, with the exception of recruits, cadets, and incarcerated personnel.

MEASURES

Personnel were classified into five drinking levels ranging from abstainer to heavy drinker based on quantity and frequency of alcohol intake. Negative outcomes were measured as self-reported serious consequences of alcohol use and alcohol-related productivity loss. Risk for other alcohol related problems was assessed by the Alcohol Use Disorders Identification Test (AUDIT).

FINDINGS

Alcohol negative outcomes showed a curvilinear dose-response relationship with drinking levels. Higher levels of drinking were associated with higher rates of alcohol problems, but problem rates were notably higher for heavy drinkers. Heavy alcohol users showed nearly three times the rate of self-reported serious consequences and over twice the rate of self-reported productivity loss than moderate/heavy drinkers. Heavy drinkers also had the highest risk for alcohol problems on the AUDIT. One fifth of military personnel were heavy drinkers and were most likely aged 18 to 35.

CONCLUSIONS

Prevention and clinical interventions should include a major focus on heavy drinkers. Commanders and peers should be trained in recognizing signs of heavy alcohol use and in approaching heavy alcohol users in a way that will foster positive attitudes as opposed to defensiveness and stigma.