Associations between abstainer, moderate and heavy drinker prototypes and drinking behaviour in young adults

Drinker's own drinking, experience of alcohol-related harms, and concern for drinking predict drinker's attitudes towards non-drinkers

OBJECTIVE

While the stigma experienced by non-drinkers is well-documented, little is known about the factors that influence it. This study aims to test a sequential mediation model in which the amount of alcohol consumed by a drinker, predicts their experienced alcohol-related harm, which in turn predicts the concern they have for drinking and their negative attitudes towards non-drinkers.

METHODS

A sample of 787 Australian drinkers (Mage = 38.4 years, SD = 11.4) completed online measures of alcohol consumption, alcohol-related harms, concern for drinking and the Cheers Attitudes towards Non-drinker Scale (CANS): a scale that measures the negative attitudes toward non-drinkers via three threats non-drinkers are perceived to pose to drinkers (Threat to Fun, Connection, and Self).

RESULTS

The model was shown to be a good fit and demonstrated a sequential mediation with significant indirect effects from alcohol consumption via experienced alcohol-related harms and concern, to each CANS subscale: Threat to Self (β = 0.402, p < 0.001), Fun (β = 0.096, p = 0.006) and Connection (β = 0.165, p < 0.001).

CONCLUSION

The findings suggest that the stigma directed at non-drinkers may be enacted as a defence against an unwanted self-reflection from a drinker's concern for their own drinking.

Development and Validation of the Cheers Attitudes towards Non-drinkers Scale (CANS)

Non-drinkers report experiencing stigma, which can act as a barrier to non-drinking. Two studies were undertaken to develop and test a new scale to measure attitudes towards non-drinkers. In Study 1, 29 items were presented to 426 Australian drinkers. In Study 2, the refined 12-item Cheers Attitudes to Non-drinkers Scale (CANS) was presented to 389 drinkers. Alcohol consumption, Harm and the Regan Attitudes towards Non-drinkers Scale (RANDS) were presented for scale validation. Exploratory factor analysis revealed three factors representing the Threats to Fun, Connection and Self that drinkers perceive non-drinkers to pose. Confirmatory factor analysis showed that the scale meets the required fit indices and had good reliability (α = 0.842). Evidence of validity was shown through significant correlations with Alcohol Consumption, Harm and the RANDS. These studies show the CANS to be a reliable and valid measure that could be utilised to understand and modify the stigma experienced by non-drinkers.

Look away now! Defensive processing and unrealistic optimism by level of alcohol consumption

OBJECTIVE

Health risk information is insufficient as a means of reducing alcohol use, particularly when it evokes negative emotional states amongst those for whom it is most personally relevant. Appraisal biases, or 'defensive processing', may be employed to mitigate the psychological discomfort posed by such information. Few studies have evaluated the role of defensive processing in people with different levels of alcohol consumption.

DESIGN

Online participants (n = 597) completed measures of defensive processing of a health risk infographic, perceived susceptibility and severity of alcohol use, efficacy for resisting alcohol use, unrealistic optimism, the Alcohol Use Disorder Identification Test - Consumption (AUDIT-C) and demographics.

RESULTS

AUDIT-C scores were positively and linearly associated with all defensive processing measures (Pearson's correlation r from.16 to .36), threat and susceptibility (r = .16) and unrealistic optimism (r = .50). AUDIT-C scores were also negatively associated with efficacy for controlling alcohol use (r = -0.48).

CONCLUSION

People with alcohol use disorder (AUD) engaged in much more defensive processing of alcohol-related messages, offering an explanation for why such messages are limited at eliciting behaviour change. High levels of unrealistic optimism in people with alcohol use disorder may reflect low problem recognition in order to maintain a problem-free drinking identity.

An integrated smoking cessation and alcohol intervention among Hong Kong Chinese young people: Study protocol for a feasibility randomized controlled trial

INTRODUCTION

Young smokers always partake in both smoking and drinking. However, drinking undermines their likelihood to attempt quitting smoking or to successfully abstain from smoking. Hence, this trial will examine the feasibility of implementing an integrated smoking cessation and alcohol intervention in young Hong Kong Chinese people. Effect sizes of the integrated intervention (II) on self-reported and biochemically validated quit rates will also be calculated.

METHODS

The study will be a three-arm randomized controlled trial in a convenience sample of 150 smokers aged 18-25 years with alcohol drinking. Participants will be randomized into a standard treatment (ST), II, or control arm. The ST group will receive a brief smoking cessation intervention based on the 5A (Ask, Assess, Advice, Assist, Arrange) and 5R (Relevance, Risks, Rewards, Roadblocks, Repetition) models. The II group will receive brief advice on alcohol use based on the FRAMES (Feedback, Responsibility, Advice, Menu, Empathy, Efficacy) model in addition to the brief smoking cessation intervention. Both the ST and II groups will receive booster interventions at 1-week, 1-month, 3-month, and 6-month follow-up. The control group will receive leaflets on smoking cessation and alcohol reduction. Self-reported quitters at 6-month follow-up will be invited for biochemical validation. The primary outcomes are feasibility measures. The secondary outcomes are effect size of II on self-reported and biochemically validated quit rates at 6 months relative to control and ST. Outcomes will be assessed at baseline and at 1-week, 1-month, 3-month, and 6-month follow-ups.

ANALYSIS

Descriptive statistics will be used to calculate the feasibility measures. The three arms will be compared using analysis of variance for continuous variables and chi-square test for categorical variables. Effect sizes of II for self-reported and biochemically validated quit rates at 6 months will be determined using the generalized estimating equation model.

Should we promote alcohol problems as a continuum? Implications for policy and practice

The highly heterogeneous nature of alcohol use and problems has presented significant challenges to those attempting to understand, treat or prevent what is commonly termed alcohol use disorder (AUD). However, any attempts to capture this complex phenomenon, including the various current criterion of AUD, come with a number of limitations. One particular limitation has been how alcohol problems are represented or understood in ways which do not capture the broad spectrum of alcohol use and harms and the many potential routes to prevention, treatment, and recovery. One possible response to this has been proposed as more explicitly framing or conceptualizing a continuum model of alcohol use and harms. In this commentary, we attempt to identify the key implications of a continuum model for policy and practice, examining the historical and current context of alcohol problem classifications and models. We argue a continuum model of alcohol use and problems holds a number of advantages for advancing public health goals, but also some potential limitations, both of which require further examination.

Perceptions of two different alcohol use behaviours in pregnancy: an application of the prototype/willingness model

Objective:

This study explored whether exposure to either an ‘ambiguous consumption’ prototype (no amount of alcohol specified) or a ‘small consumption’ prototype (‘small’ amount of alcohol specified) had an impact on prototype perceptions of, and willingness to use, small amounts of alcohol during pregnancy.

Method:

Participants were 140 women living in the UK, aged 20–45 years old, of whom 92% had previously been, or intended to become, pregnant. Participants completed measures to assess how favourably they viewed alcohol use in pregnancy, how similar they felt to those who would use alcohol in pregnancy and how responsible they perceived those who would use alcohol in pregnancy to be. Participant’s own willingness to use small amounts of alcohol during pregnancy was also assessed.

Results:

Having at least one child was positively correlated with being willing to accept an alcoholic drink while pregnant for those exposed to the ‘ambiguous consumption’ prototype only. Although perceptions of favourability, similarity and responsibility were consistently higher for those exposed to a ‘small consumption’ condition, there were no differences in willingness to drink according to exposure.

Conclusion:

This research suggests that women’s perceptions of those who drink alcohol while pregnant differ according to the amount of alcohol that they perceive as typical. This may have implications for how alcohol use in pregnancy is portrayed in public health messaging, particularly regarding the level of acceptance that may be associated with low to moderate alcohol use.

The 'sober eye': examining attitudes towards non-drinkers in Australia

BACKGROUND

The proportion of Australians who choose not to drink alcohol has increased in recent years; yet, non-drinkers report experiences of stigma and judgement from peers for this choice. This study aimed to explore the attitudes that exist towards non-drinkers and examine what drives this stigma.

METHOD

Thematic analysis of four focus groups was undertaken, comprising 37 drinking and non-drinking Australian adults.

RESULTS

Three themes were identified that elucidate the stigma, with non-drinkers being perceived as a: (1) threat to fun, a judgemental 'sober eye' disrupting the desired hedonistic environment created by alcohol, (2) threat to connection, described as difficult to initiate and maintain a social connection with and (3) threat to self, with the presence of a non-drinker described by drinkers as encouraging an unwanted reflection on the problematic aspects of their own drinking. Participant responses also suggested that the gender of the non-drinker influenced these perceptions.

CONCLUSION

Through the lens of Integrated Threat Theory, this study proposes that the stigma experienced by non-drinkers may be understood as a response to threats non-drinkers are perceived to pose to drinkers' group values (e.g. hedonism) and self-esteem. This study offers new direction for health promotion efforts to challenge negative perceptions of non-drinkers.

Personalized normative feedback for heavy drinking: An application of deviance regulation theory

Deviance Regulation Theory (DRT) proposes that individuals regulate their behavior to be in line with the behaviors of others. Specifically, individuals desire to stand out in positive way and not stand out in a negative way. DRT has been successfully applied to encourage other health behaviors and offers a unique method to utilize both injunctive norms in combination with descriptive norms in brief alcohol interventions. This randomized controlled trial evaluated a computer-delivered, norms-based personalized feedback intervention which systematically varied the focus on whether specific drinking behaviors were described as common or uncommon (a descriptive norm), whether the drinking behaviors were healthy versus unhealthy, and whether the drinking behaviors were positively or negatively framed (an injunctive norm). Nine-hundred and fifty-nine college drinkers completed baseline, three-month, and six-month follow-up assessments. Results indicated messages focusing on unhealthy drinking behaviors, particularly when described as uncommon, were most effective in reducing drinking and alcohol-related problems over time. This research utilizes deviance regulation theory as a way of improving personalized normative feedback by elucidating how to construct messages for brief interventions based on descriptive characteristics associated with specific target drinking behaviors in combination with perceptions of prevalence and acceptability of such drinking behaviors (an injunctive norm).

Similarity to prototypical heavy drinkers and non-drinkers predicts AUDIT-C and risky drinking in young adults: prospective study

OBJECTIVE

The aim of the present study was to explore whether constructs within the Prototype Willingness Model (PWM) predicted risky drinking as measured by AUDIT-C, drinking harms and unplanned drunkenness in a sample of UK young adults. Previous studies exploring the PWM often do not use validated measures of alcohol consumption, and the outcomes of risky drinking are underexplored.

DESIGN

An online prospective study design with 4 week follow-up was employed and 385 young adults completed the study (M age = 21.76, SD = 3.39, 69.6% female; 85.2% students).

MAIN OUTCOME MEASURES

Intentions to get drunk, AUDIT-C, drinking harms experienced in the last 4 weeks, and unplanned drunkenness in the last 4 weeks.

RESULTS

Heavy and non-drinker prototype similarity predicted AUDIT-C, drinking harms and unplanned drunkenness when controlling for past behaviour and reasoned action pathway constructs. Intentions and willingness both mediated the relationship between prototype perceptions and AUDIT-C.

CONCLUSION

This study supports the use of the PWM in the prediction of AUDIT-C, drinking harms and unplanned drinking in a UK sample. Prototype perceptions influenced behaviour via both reasoned and reactive cognitions. Targeting similarity to heavy and non-drinker prototypes should be the focus of future interventions in this population.

Positive excessive drinker prototypes predict greater drinking and alcohol problems

OBJECTIVES

According to the prototype willingness model, risky behaviours such as heavy drinking may be influenced by images of others who engage in this behaviour. In this study, we examined whether college students' prototypes of an individual who frequently drinks "over the limit" were associated with their own alcohol consumption and experience of alcohol-related problems during their first 2 years in college.

METHODS

We assessed students' (N = 340) prototypes of excessive drinkers and their own alcohol consumption and problems at four time points, across their first 2 years in college. Along with examining the trajectory of prototypes, consumption, and problems, we tested whether prototypes significantly predicted consumption and problems across the 2 years. Additional analyses examined whether the predictive value of prototypes was unique from related variables including perceived descriptive norms, perceived injunctive norms, and peer pressure to drink alcohol.

RESULTS

Primary analyses indicated that more positive prototypes of an excessive drinker were significantly associated with greater alcohol consumption in both year 1 and year 2. More positive prototypes were also significantly associated with experiencing more alcohol-related problems in year 2. These findings held when controlling for perceived descriptive and injunctive norms, and peer pressure.

CONCLUSIONS

Findings further support the importance of drinker prototypes to one's own drinking behaviour. By examining prototypes over time and their relationship to alcohol-related problems, this study makes a novel contribution to the existing research. Statement of contribution What is already known on this subject? Perceived norms (beliefs about how much others drink and what they approve of) are associated with own drinking. Individuals construct "risk prototypes," or images of people who engage in risky behaviours like drinking alcohol. Positive risk prototypes of drinkers have been associated with own willingness to drink and subsequent drinking. What does this study add? This study shows the trajectory of drinker prototypes across the first 2 years of college. Findings highlight consistent patterns of positive associations between drinker prototypes and own drinking. More positive drinker prototypes are associated with a greater number of problems with alcohol.

Cool or Fool? The Association Between Drinker Prototypes and Alcohol Consumption Using Multiple Time-Point Diary Assessments in Adolescent Males

OBJECTIVES

There is still limited understanding of how different kinds of drinker prototypes are associated with adolescent drinking. This study uses the strengths of multiple time-point diary measures (enhanced validity of alcohol use measurement) to test the predictive value of abstainer, moderate and heavy drinker prototypes in social situations. We examined whether the favorability of these prototypes (i.e., "prototype evaluation"), the perceived similarity of these prototypes to one's self-image (i.e., "prototype similarity") assessed at baseline, and their interaction predict alcohol use assessed in social situations.

METHODS

Drinker prototypes were assessed in a baseline sample of 599 adolescents. Subsequently, a sample of 77 alcohol-using 16 to 18-year-old males reported their Friday and Saturday evening drinking behavior the next day during eight weeks (resulting in 495 daily measures). Alcohol use was assessed in the company of peers.

RESULTS

The more adolescents perceived themselves as similar to heavy drinker prototypes the higher their alcohol consumption in social situations. The more adolescents held favorable abstainer prototypes, the lower their alcohol consumption. The interaction between prototype evaluation and similarity was not significant.

CONCLUSIONS

By using a more reliable and valid method to assess adolescents' alcohol use, the present study showed that more "extreme" drinker prototypes (i.e., heavy drinker and abstainer prototypes) are most predictive of adolescent alcohol use in social situations. Increasing the perceived dissimilarity to heavy drinker prototypes and the favorability of abstainer prototypes may therefore be important targets in interventions aimed at reducing adolescents' alcohol consumption.

Drinkers' identification with varying alcohol consumption prototypes

INTRODUCTION AND AIMS

Efforts to reduce excessive alcohol consumption need to take into account drinkers' perceptions of their risk of alcohol-related harm. The aim of the present study was to profile adult Australian drinkers according to their self-identification with various drinker prototypes to determine the extent to which these prototypes are associated with perceived and actual risk of alcohol-related harm.

DESIGN AND METHODS

A large web panel provider disseminated an online survey to a national sample of 2168 drinkers aged 18+ years who consumed alcohol at least twice per month. Respondents reported whether they considered themselves to be a light, occasional, social, heavy or binge drinker. The nominated category was compared with perceived and actual risk of alcohol-related harm.

RESULTS

The prototype most commonly nominated by respondents was 'social drinker' (45%), and the least common was 'binge drinker' (7%). Although the heaviest drinkers in terms of actual reported consumption typically selected prototypes indicative of harmful consumption, many of those selecting prototypes indicative of moderate consumption were at risk of alcohol-related harm.

DISCUSSION AND CONCLUSIONS

Many adult drinkers may be unaware of their risk of alcohol-related harm. The results suggest that there may be a need to recalibrate Australian drinkers' perceptions of high-risk drinking. [Pettigrew S, Jongenelis MI, Pratt IS, Slevin T, Chikritzhs T. Drinkers' identification with varying alcohol consumption prototypes. Drug Alcohol Rev 2017;36:464-467].

I like people who drink like me: Perceived appeal as a function of drinking status

INTRODUCTION

Individuals rate opposite sex faces as more attractive after consuming or being primed with alcohol. However, other traits such as intelligence and likeability have not been examined and might vary as a function of information about one's drinking habits. We expected social drinkers to be rated more positively than heavy drinkers, abstainers, or recovering alcoholics. We further hypothesized that faces with similar drinking habits to participants would be rated as more appealing.

METHODS

Five hundred ninety-four undergraduates viewed 25 opposite sex faces randomly paired with drinking information, and rated each face on perceived appeal.

RESULTS

Hierarchical linear models revealed that social drinkers were rated as most appealing, as expected. Unexpectedly, recovering alcoholics were rated as the next most appealing, followed by abstainers, then heavy drinkers. The interaction between drinker type and participants' own drinking predicting ratings indicated that the heavier the participant drinks, the more favorably they rated heavy drinkers compared to other types of drinkers. Thus, as expected, ratings varied as a function of participants' own drinking; however, ratings did not vary as a function of participants' alcohol-related problems.

CONCLUSIONS

Findings support hypotheses in that social drinkers were generally perceived as appealing compared to other drinker types, and ratings tended to be influenced by participants' own drinking. Individuals' prototypes and norms regarding drinking may influence how they perceive others when others' drinking habits are known. This might be especially important to consider with heavy drinkers who may seek out others who drink similarly, which could reinforce problematic drinking.

Development and Acceptability of a Co-Produced Online Intervention to Prevent Alcohol Misuse in Adolescents: A Think Aloud Study

Background

The prototype willingness model (PWM) may offer an appropriate basis for explaining and preventing adolescent alcohol misuse. An intervention was developed using a co-production approach, and consisted of an online quiz featuring 10 questions linked to the PWM.

Objective

This study sought to determine the acceptability and relevance of the intervention content to young people, to incorporate their feedback into a final version.

Methods

A qualitative think aloud study with follow-up semistructured interviews was undertaken with 16 young people aged 11-15 (50%). Transcripts were analyzed using thematic analysis.

Results

The following 3 main themes relating the acceptability of the intervention were identified: “challenging expectations of alcohol education”; “motivations for drinking or not drinking,” and “the inevitability of drinking.” Participants found the intervention appealing because it was counter to their expectations. The content appeared to reflect their experiences of social pressure and drinking encounters. There was evidence that a focus on drinker/nondrinker prototypes was too narrow and that because adolescents perceived drinking as inevitable, it would be challenging to enact any plans to resist pressure to drink.

Conclusions

An online intervention based on the PWM has the potential to engage and interest adolescents. A wide range of alcohol prototypes should be targeted and a focus on short-term harms should ensure that the intervention is credible to young people.

Drinker prototype alteration and cue reminders as strategies in a tailored web-based intervention reducing adults' alcohol consumption: randomized controlled trial

BACKGROUND

Excessive alcohol use is a prevalent and worldwide problem. Excessive drinking causes a significant burden of disease and is associated with both morbidity and excess mortality. Prototype alteration and provision of a cue reminder could be useful strategies to enhance the effectiveness of online tailored interventions for excessive drinking.

OBJECTIVE

Through a Web-based randomized controlled trial, 2 strategies (ie, prototype alteration and cue reminders) within an existing online personalized feedback intervention (Drinktest) aimed to reduce adults' excessive drinking. It was expected that both strategies would add to Drinktest and would result in reductions in alcohol consumption by intrinsic motivation and the seizure of opportunities to act.

METHODS

Participants were recruited online and through printed materials. Excessive drinking adults (N=2634) were randomly assigned to 4 conditions: original Drinktest, Drinktest plus prototype alteration, Drinktest plus cue reminder, and Drinktest plus prototype alteration and cue reminder. Evaluation took place at 1-month posttest and 6-month follow-up. Differences in drinking behavior, intentions, and behavioral willingness (ie, primary outcomes) were assessed by means of longitudinal multilevel analyses using a last observation carried forward method. Measures were based on self-reports.

RESULTS

All conditions showed reductions in drinking behavior and willingness to drink, and increased intentions to reduce drinking. Prototype alteration (B=-0.15, P<.05) and cue reminder usage (B=-0.15, P<.05) were both more effective in reducing alcohol consumption than when these strategies were not provided. Combining the strategies did not produce a synergistic effect. No differences across conditions were found regarding intentions or willingness.

CONCLUSIONS

Although individuals' awareness of their cue was reasonable, their reported alcohol consumption was nevertheless reduced. Individuals appeared to distance their self-image from heavier drinking prototypes. Thus, prototype alteration and cue reminder usage may be feasible and simple intervention strategies to promote reductions in alcohol consumption among adults, with an effect up to 6 months.

TRIAL REGISTRATION

Nederlands Trial Register (NTR): 4169; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4169 (Archived by WebCite at http://www.webcitation.org/6VD2jnxmB).