Comparisons of Alcohol Consumption by Time-Line Follow Back vs. Smartphone-Based Daily Interviews

Exploratory analysis of blood alcohol concentration-related technology use and drinking outcomes among young adults

BACKGROUND

Mobile health (mHealth) technology use may reduce alcohol use and related negative consequences; however, little is known about its efficacy without prompting from researchers or pay-per-use. This exploratory analysis assessed relationships between mHealth technology use frequency and alcohol-use outcomes.

METHODS

Young adults who drink heavily (N = 97, Mage = 23, 51% male, 64% non-Hispanic White, Mdrinks/week = 21) had the option to use three mHealth technologies (breathalyzer device/app, blood alcohol content estimator app, drink counting via text message) while drinking for 2 weeks. Relationships between alcohol-related outcomes and any, multiple, and specific mHealth technology use across study days and drinking days were evaluated via bivariate correlations and multiple regressions.

RESULTS

Participants used one or more mHealth technologies on approximately 68% of drinking days (33% of field days), with multiple technologies used on 34% of drinking days. Bivariate correlations revealed that a higher percentage of study days with any mHealth technology use was related to higher mean weekly drinks. However, a higher percentage of drinking days with any mHealth technology use was related to lower mean weekly drinks, percent of heavy and high-intensity drinking days, and negative consequences. There were several significant, inverse correlations between alcohol variables and using the mHealth technologies that provided personalized feedback. Multiple regression analyses (holding sex and baseline alcohol variables constant) indicated that a higher percentage of drinking days with any mHealth technology use was related to lower mean weekly drinks and lower percentage of heavy drinking days.

CONCLUSIONS

Using mHealth technologies to moderate drinking without direct prompting from the research team or per-use incentives was related to less overall alcohol use and heavy drinking. This indicates potential real-world engagement with mHealth apps to assist with in-the-moment drinking. Normalizing mHealth technology use during drinking could help curb the public health crisis around harmful alcohol use in young adult populations.

Examining early adherence measures as predictors of subsequent adherence in an intensive longitudinal study of individuals in mutual help groups: One day at a time

BACKGROUND

Individuals with a substance use disorder complete ecological momentary assessments (EMA) at lower rates than community samples. Previous research in tobacco users indicates that early log-in counts to smoking cessation websites predicted subsequent smoking cessation website usage. We extended this line of research to examine individuals who are seeking to change their drinking behaviors through mutual support groups. We examined whether adherence in the first 7 days (1487 observations) of an intensive longitudinal study design could predict subsequent EMA protocol adherence (50% and 80% adherence separately) at 30 (5700 observations) and 60 days (10,750 observations).

METHODS

Participants (n = 132) attending mutual-help groups for alcohol use completed two assessments per day for 6 months. We trained four classification models (logistic regression, recursive partitioning, support vector machines, and neural networks) using a training dataset (80% of the data) with each of the first 7 days' cumulative EMA assessment completion. We then tested these models to predict the remaining 20% of the data and evaluated model classification accuracy. We also used univariate receiver operating characteristic curves to examine the minimal combination of days and completion percentage to best predict subsequent adherence.

RESULTS

Different modeling techniques can be used with early assessment completion as predictors to accurately classify individuals that will meet minimal and optimal adherence rates later in the study. Models ranged in their performance from poor to outstanding classification, with no single model clearly outperforming other models.

CONCLUSIONS

Traditional and machine learning approaches can be used concurrently to examine several methods of predicting EMA adherence based on early assessment completion. Future studies could investigate the use of several algorithms in real time to help improve participant adherence rates by monitoring early adherence and using early assessment completion as features in predictive modeling.

Endpoints for Pharmacotherapy Trials for Alcohol Use Disorder

Alcohol use disorder (AUD) is a debilitating disorder, yet currently approved pharmacotherapies to treat AUD are under-utilized. The three medications approved by the US Food and Drug Administration (FDA) for the indication of AUD are disulfiram, acamprosate, and naltrexone. The current landscape of pharmacotherapies for AUD suggests opportunities for improvement. Clinical trials investigating novel pharmacotherapies for AUD traditionally use abstinence-based drinking outcomes or no heavy drinking days as trial endpoints to determine the efficacy of pharmacotherapies. These outcomes are typically measured through patient self-report endorsements of their drinking. Apart from these traditional outcomes, there have been recent developments in novel endpoints for AUD pharmacotherapies. These novel endpoints include utilizing the World Health Organization (WHO) risk drinking level reductions to promote a harm-reduction endpoint rather than an abstinence-based endpoint. Additionally, in contrast to patient self-report measurements, biological markers of alcohol use may serve as objective endpoints in AUD pharmacotherapy trials. Lastly, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) definition of recovery from AUD and patient-oriented outcomes offer new frameworks to consider endpoints associated with more than alcohol consumption itself, such as the provider-patient experiences with novel pharmacotherapies. These recent developments in new endpoints for AUD pharmacotherapies offer promising future opportunities for pharmacotherapy development, so long as validity and reliability measures are demonstrated for the endpoints. A greater breadth of endpoint utilization may better capture the complexity of AUD symptomatology.

Detecting and Understanding Social Influence During Drinking Situations: Protocol for a Bluetooth-Based Sensor Feasibility and Acceptability Study

BACKGROUND

High-risk alcohol consumption among young adults frequently occurs in the presence of peers who are also drinking. A high-risk drinking situation may consist of particular social network members who have a primary association with drinking. Fine-grained approaches such as ecological momentary assessment (EMA) are growing in popularity for studying real-time social influence, but studies using these approaches exclusively rely on participant self-report. Passive indicators of peer presence using Bluetooth-based technology to detect real-time interactions have the potential to assist in the development of just-in-time interventions.

OBJECTIVE

This study seeks to examine the feasibility and acceptability of using a Bluetooth-based sensor and smartphone app to measure social contact in real-world drinking situations.

METHODS

Young adults (N=20) who drink heavily and report social drinking will be recruited from the community to participate in a 3-week EMA study. Using a social network interview, index participants will identify and recruit 3 of their friends to carry a Bluetooth beacon. Participants will complete a series of EMA reports on their own personal Android devices including random reports; morning reports; first-drink reports; and signal-contingent reports, which are triggered following the detection of a beacon carried by a peer participant. EMA will assess alcohol use and characteristics of the social environment, including who is nearby and who is drinking. For items about peer proximity and peer drinking, a customized peer list will be presented to participants. Feedback about the study protocol will be ascertained through weekly contact with both index and peer participants, followed by a qualitative interview at the end of the study. We will examine the feasibility and acceptability of recruitment, enrollment of participants and peers, and retention. Feasibility will be determined using indexes of eligibility, enrollment, and recruitment. Acceptability will be determined through participant enrollment and retention, protocol compliance, and participant-reported measures of acceptability. Feasibility and acceptability for peer participants will be informed by enrollment rates, latency to enrollment, compliance with carrying the beacon, and self-reported reasons for compliance or noncompliance with beacon procedures. Finally, EMA data about peer proximity and peer drinking will support the validity of the peer selection process.

RESULTS

Participant recruitment began in February 2023, and enrollment was completed in December 2023. Results will be reported in 2025.

CONCLUSIONS

The protocol allows us to examine the feasibility and acceptability of a Bluetooth-based sensor for the detection of social contact between index participants and their friends, including social interactions during real-world drinking situations. Data from this study will inform just-in-time adaptive interventions seeking to address drinking in the natural environment by providing personalized feedback about a high-risk social context and alerting an individual that they are in a potentially unsafe situation.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/50650.

Relationship between alcohol intake based on daily smartphone-reported consumption and PEth concentrations in healthy volunteers

AIMS

To investigate the association between alcohol consumption registered daily with a digital smartphone-based diary and concentration of phosphatidylethanol (PEth) 16:0/18:1 in a population without a known alcohol use disorder (AUD), and evaluate whether prospective registration of alcohol consumption is better than retrospective registration and if the association between alcohol intake and PEth was affected by sex or body mass index (BMI).

METHODS

A total of 41 women and 21 men without AUD-diagnosis registered their alcohol consumption prospectively with a digital diary for 14 days, and retrospectively with the Timeline Followback method in the same time interval. PEth was measured before and after the registration period.

RESULTS

The correlation between alcohol consumption and PEth varied from 0.65 to 0.87. It did not depend significantly on the reporting method, and was not influenced by sex or BMI. Based on the regression coefficient, a reduction of alcohol consumption by two alcohol units (26 g of pure ethanol) per day would lead to a reduction of the PEth concentration of about 0.1 μmol/l, and vice versa.

CONCLUSIONS

There was a good correlation between PEth concentration and alcohol consumption, both when alcohol consumption was reported prospectively and retrospectively. The preferred cut-off for PEth should be adjusted to the level of alcohol consumption considered harmful and a purposeful trade-off between sensitivity and specificity. In order to identify persons with a daily alcohol consumption of more than two or three units of alcohol with a sensitivity of 80% or 90%, we suggest a cut-off of around 0.1 μmol/l.

A comparison of retrospectively reported and ecological momentary assessment-reported perceived social support in predicting ecological momentary assessment-reported non-suicidal self-injury

INTRODUCTION

Non-suicidal self-injury (NSSI) urges and behaviors are associated with lower perceived social support and related constructs (e.g., perceived rejection). However, no studies have examined the concordance of retrospective (baseline) and ecological momentary assessment (EMA) perceived social support assessments. Retrospective and EMA reports are often only weakly to moderately correlated; measurement approaches may, therefore, impact observed associations between variables. We tested whether average EMA-reported perceived emotional social support uniquely predicts EMA-reported NSSI urges and behaviors above baseline-reported retrospective self-report of perceived emotional social support alone.

METHODS

93 young adults (ages 18-34) with past-month NSSI urges or behaviors and lifetime NSSI behaviors completed a semi-structured interview, self-report surveys, and a 2-week EMA protocol.

RESULTS

Baseline- and EMA-reported perceived emotional social support were positively correlated (Kendall's tau-b = 0.51). Average EMA-reported social support was uniquely associated with EMA-reported NSSI urges but not NSSI behaviors.

CONCLUSIONS

EMA-reported perceived emotional social support captured information not represented by baseline reports alone, but improvement in model fit was modest. EMA-reported social support may further improve the estimation of EMA-reported NSSI urges if modeled as a proximal predictor of NSSI. Further work is needed to clarify temporal directions between social support and NSSI urges. Limitations are discussed.

Validity of an online, self-administered Timeline Followback for alcohol use with adolescents

Objective

The Timeline Followback (TLFB) is a widely used and well-validated interview-based tool for assessing patterns of recent health risk behavior. There is some evidence of the validity of the TLFB as a self-administered online tool for assessing alcohol use, but further research is needed to establish its validity in younger populations and populations outside the United States. Further, it is unknown how self-administered online TLFB formats compare to more timesaving and commonly used single-item alcohol questions. The primary aim of the current study was to validate a new online, self-administered TLFB for alcohol use against the TLFB interview in a sample of European (Danish) adolescents aged 16-18 years (N = 30).

Methods

Participants completed a TLFB telephone interview, a self-administered online version of the TLFB, and single-item alcohol questions. Assessments were administered using a within-subject, counter-balanced design. Estimates of number of drinking days, binge-drinking days, maximum drinks consumed on one occasion, total drinks, and drinks per drinking day were compared across metrics.

Results

All correlations between the drinking outcomes assessed via the TLFB interview and the TLFB online were positive, and statistically significant (rss = 0.86-0.94, p < 0.01). Wilcoxon signed-rank tests showed no significant differences between the TLFB interview and the TLFB online on drinking days, binge drinking days, max drinks, and total drinks. Participants reported drinking significantly more drinks per drinking day on the TLFB online (M = 4.66) compared to on the TLFB interview (M = 4.12; p = 0.009).

Conclusion

Overall, the results support the validity of the online, self-administered TLFB in a sample of European (Danish) adolescents.

Predicting discretionary food consumption using temporal self-regulation theory and food reward sensitivity

Discretionary foods account for over a third of the average adult's total daily energy intake. But its excess consumption is a risk factor for obesity, Type 2 diabetes, and other diet-related diseases. This study aimed to use temporal self-regulation theory (intention, past behaviour, habit, self-regulatory capacity) and food reward sensitivity to identify predictors of discretionary food consumption. Two hundred and seventy-three participants aged between 18 and 80 (M = 42.55, SD = 17.07) comprising of mostly females (79.5%) and those residing in Australia (93.4%), completed a two-part online survey, one week apart. Participants completed measures of intention, past behaviour, habit, self-regulatory capacity, food reward sensitivity and demographic information at time one, and discretionary food consumption at time two. Data was analysed using a hierarchical multiple regression analysis. All variables in combination accounted for a significant 40.3% of the variance in discretionary food consumption (R2 = 0.40, p < .001). However, past behaviour and intention were the only unique significant predictors of discretionary food consumption. No significant moderation effects found. Findings offer insight into the motivators of discretionary food consumption, which can inform the development of effective interventions to reduce discretionary food consumption. Past behaviour should be considered, and intention targeted in interventions to reduce discretionary food consumption.

Delivery of a Prevention Program in Large College Classes: Effectiveness of the Expectancy Challenge Alcohol Literacy Curriculum

Background: Despite modest reductions in alcohol use among college students, drinking-related harms continue to be prevalent. Group-delivered programs have had little impact on drinking except for experiential expectancy challenge interventions that are impractical because they rely on alcohol administration. Expectancy Challenge Alcohol Literacy Curriculum (ECALC), however, offers a non-experiential alternative suitable for widespread implementation for universal, selective, or indicated prevention. Objectives: ECALC has been effective with mandated students, fraternity members, and small classes of 30 or fewer first-year college students. Larger universities, however, typically have classes with 100 students or more, and ECALC has not yet been tested with groups of this size. To fill this gap, we conducted a group randomized trial in which five class sections with over 100 college students received either ECALC or an attention-matched control presentation and completed follow-up at four weeks. Results: ECALC was associated with significant changes on six subscales of the Comprehensive Effects of Alcohol Scale (CEOA), post-intervention expectancies predicted drinking at four-week follow-up, and there were significant expectancy differences between groups. Compared to the control group, students who received ECALC demonstrated significant expectancy changes and reported less alcohol use at follow-up. Conclusions: Findings suggest ECALC is an effective, single session group-delivered intervention program that can be successfully implemented in large classes.

Agreement between momentary and retrospective reports of cannabis use and alcohol use: Comparison of ecological momentary assessment and timeline followback indices

OBJECTIVE

This study compares three methods of cannabis and of alcohol use assessment in a sample of regular cannabis users: (a) ecological momentary assessment (EMA) repeated momentary surveys aggregated to the daily level, (b) EMA morning reports (MR) where participants reported on their total use from the previous day, and (c) retrospective timeline followback (TLFB) interviews covering the same period of time as the EMA portion of the study. We assessed the overall correspondence between these methods in terms of cannabis and alcohol use occasions and also investigated predictors of agreement between methods.

METHOD

Forty-nine individuals aged 18-50 (Mage = 24.49, 49% female, 84% White) who reported regular cannabis use completed a 14-day EMA study. At the end of the EMA period, participants returned to the laboratory to complete a TLFB (administered via computer) corresponding to the same dates of the EMA period.

RESULTS

Daily aggregated EMA and TLFB reports showed a low to modest agreement for both alcohol and cannabis use. Overall, agreement between EMA and MR was better than agreement between EMA and TLFB, likely because less retrospection is required when only reporting on behavior from the previous day. Quantity and frequency of use differentially predicted agreement across reporting methods when assessing alcohol compared to cannabis. When reporting cannabis use, but not alcohol use, individuals who used more demonstrated higher agreement between EMA and TLFB.

CONCLUSIONS

Results suggest that retrospective reporting methods assessing alcohol and cannabis should not be considered a direct "substitute" for momentary or daily assessments. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Pregame Heavy Episodic Drinking and Its Association With Negative Consequences and Other Risky Substance Use Behaviors

OBJECTIVE

Pregaming, or drinking before going out, is common among college students and has been linked with greater alcohol use and experiencing more negative consequences. This study tested within- and between-person associations between pregame heavy episodic drinking (Pregame HED; 4+/5+ drinks for women/men while pregaming) and high-intensity drinking (8+/10+ drinks), negative consequences, and three risky behaviors.

METHOD

College students at a large, public university in the Northeast United States who participated in a longitudinal measurement-burst design study completed a longer survey and up to 14 daily surveys in up to four consecutive semesters (n days = 4,706; n persons = 547). Hypotheses were primarily tested using logistic and Poisson multilevel models.

RESULTS

Pregame HED was reported by 41% of drinkers and on 15% of drinking days and 38% of pregaming days. Students were more likely to engage in high-intensity drinking on Pregame HED days than on moderate pregaming (1-3 and 1-4 pregaming drinks for women and men, respectively) or no pregaming drinking days. Students experienced more negative consequences on Pregame HED days than moderate or no pregaming drinking days, but there was no unique daily-level association between Pregame HED and negative consequences after alcohol intake was controlled. Students were more likely to use marijuana on Pregame HED days than on moderate and no pregaming drinking days.

CONCLUSIONS

Pregame HED appears to be a characteristic of extremely heavy drinking days and fundamentally different from moderate pregaming and no pregaming drinking days. Findings highlight the importance of accounting for amounts of alcohol consumed while pregaming and the notion that drinking episodes can be dynamic.

Effective prevention programming for reducing alcohol-related harms experienced by first year college students: Evaluation of the expectancy challenge alcohol literacy curriculum (ECALC)

Prevention programs may have contributed to modest declines in alcohol use among college students in recent years, but negative consequences continue to be pervasive. First year college students (FYCS) are particularly vulnerable, and there is clearly a need for more effective methods to reduce risk. Meta-analyses focused on expectancy challenge (EC) have found this approach to be effective, but "experiential" EC that includes a drinking exercise is not suitable for most FYCS, many of whom are underage. A non-experiential alternative, the Expectancy Challenge Alcohol Literacy Curriculum (ECALC), is practical for widespread implementation. ECALC has been effective with mandated students and members of fraternities, and in the present study, we focused on evaluating effects with FYCS. In a group randomized trial, 48 class sections of a course designed for FYCS received either ECALC or an attention-matched control presentation. ECALC was associated with significant changes on six expectancy subscales of the Comprehensive Effects of Alcohol Scale (CEOA). Structural equation modeling was used to examine the mediated effects of the intervention on alcohol-related harms via alcohol expectancies. There were significant indirect effects from condition to alcohol use (IND = -0.04, p <.001) and alcohol harms (IND = -0.07, p <.001). This model accounted for 54% of the variance in alcohol use and 46% of the variance in alcohol-related harms. These findings suggest ECALC is an effective, single session group-delivered program that can be incorporated into classroom curricula.

Targeting Unmet Clinical Needs in the Treatment of Alcohol Use Disorder

Alcohol Use Disorder (AUD) is a chronic psychiatric disorder marked by impaired control over drinking behavior that poses a significant challenge to the individual, their community, the healthcare system and economy. While the negative consequences of chronic excessive alcohol consumption are well-documented, effective treatment for AUD and alcohol-associated diseases remains challenging. Cognitive and behavioral treatment, with or without pharmaceutical interventions, remain the most commonly used methods; however, their efficacy is limited. The development of new treatment protocols for AUD is challenged by difficulty in accurately measuring patterns of alcohol consumption in AUD patients, a lack of a clear understanding of the neuropsychological basis of the disorder, the high likelihood of AUD patients relapsing after receiving treatment, and the numerous end-organ comorbidities associated with excessive alcohol use. Identification and prediction of patients who may respond well to a certain treatment mechanism as well as clinical measurement of a patient's alcohol exposure are bottlenecks in AUD research which should be further addressed. In addition, greater focus must be placed on the development of novel strategies of drug design aimed at targeting the integrated neural pathways implicated in AUD pathogenesis, so that next-generation AUD treatment protocols can address the broad and systemic effects of AUD and its comorbid conditions.

The Complex Dynamics of Resources and Maintaining Factors in Social Networks for Alcohol-Use Disorders: A Cross-Sectional Study

Systemic therapy considers the complex dynamics of relational factors and resources contributing to psychological symptoms. Negative maintaining factors have been well researched for people suffering from Alcohol-use Disorders (AUD). However, we know little about the complex dynamics of these negative factors and resources. We interviewed fifty-five participants suffering or fully remitted from Alcohol-use disorders in this cross-sectional study (M = 52 years; 33% female). The interviews focused on relational factors (e.g., social support and social negativity) referring to a Support Social Network and a Craving Social Network (CSN). The CSN included all significant others who were associated with craving situations. We compared the network characteristics of the group suffering from Alcohol-use Disorders (n = 38) to a fully remitted control group (n = 17). The abstinent group with full remission named on average fewer individuals in the CSNs. They had lower social negativity mean scores in the Support Social Network compared to the non-remitted group (d = 0.74). In the CSN, the mean scores of social support were significantly higher than the median for both groups (d = 2.50). These findings reveal the complex interplay of relational patterns contributing to the etiology, maintenance, and recovery from Alcohol-use disorders. A successful recovery can be linked to increased social resources and reduced relations associated with craving. However, craving-associated relations represent an important source of social support. Future research should investigate this ambivalence for the systemic perspective on the explanation and treatment of Alcohol-use disorders.

Measurement Properties of Smartphone Approaches to Assess Diet, Alcohol Use, and Tobacco Use: Systematic Review

BACKGROUND

Poor diet, alcohol use, and tobacco smoking have been identified as strong determinants of chronic diseases, such as cardiovascular disease, diabetes, and cancer. Smartphones have the potential to provide a real-time, pervasive, unobtrusive, and cost-effective way to measure these health behaviors and deliver instant feedback to users. Despite this, the validity of using smartphones to measure these behaviors is largely unknown.

OBJECTIVE

The aim of our review is to identify existing smartphone-based approaches to measure these health behaviors and critically appraise the quality of their measurement properties.

METHODS

We conducted a systematic search of the Ovid MEDLINE, Embase (Elsevier), Cochrane Library (Wiley), PsycINFO (EBSCOhost), CINAHL (EBSCOHost), Web of Science (Clarivate), SPORTDiscus (EBSCOhost), and IEEE Xplore Digital Library databases in March 2020. Articles that were written in English; reported measuring diet, alcohol use, or tobacco use via a smartphone; and reported on at least one measurement property (eg, validity, reliability, and responsiveness) were eligible. The methodological quality of the included studies was assessed using the Consensus-Based Standards for the Selection of Health Measurement Instruments Risk of Bias checklist. Outcomes were summarized in a narrative synthesis. This systematic review was registered with PROSPERO, identifier CRD42019122242.

RESULTS

Of 12,261 records, 72 studies describing the measurement properties of smartphone-based approaches to measure diet (48/72, 67%), alcohol use (16/72, 22%), and tobacco use (8/72, 11%) were identified and included in this review. Across the health behaviors, 18 different measurement techniques were used in smartphones. The measurement properties most commonly examined were construct validity, measurement error, and criterion validity. The results varied by behavior and measurement approach, and the methodological quality of the studies varied widely. Most studies investigating the measurement of diet and alcohol received very good or adequate methodological quality ratings, that is, 73% (35/48) and 69% (11/16), respectively, whereas only 13% (1/8) investigating the measurement of tobacco use received a very good or adequate rating.

CONCLUSIONS

This review is the first to provide evidence regarding the different types of smartphone-based approaches currently used to measure key behavioral risk factors for chronic diseases (diet, alcohol use, and tobacco use) and the quality of their measurement properties. A total of 19 measurement techniques were identified, most of which assessed dietary behaviors (48/72, 67%). Some evidence exists to support the reliability and validity of using smartphones to assess these behaviors; however, the results varied by behavior and measurement approach. The methodological quality of the included studies also varied. Overall, more high-quality studies validating smartphone-based approaches against criterion measures are needed. Further research investigating the use of smartphones to assess alcohol and tobacco use and objective measurement approaches is also needed.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-https://doi.org/10.1186/s13643-020-01375-w.

A Comparison Between Ecological Momentary Assessment and the Adapted-Quick Drinking Screen: Alcohol Mixed With Energy Drinks

Aims

To compare alcohol consumption and risk-taking behaviours on alcohol mixed with energy drink (AMED) and alcohol-only (AO) drinking occasions collected via ecological momentary assessment (EMA) versus retrospective survey methods (adapted-Quick Drinking Screen: a-QDS).

Methods

Completing participants were 52 university students who reported AMED consumption during the 30-day data collection period. Alcohol consumption and risk-taking behaviours were captured for recreational AMED and AO consumption occasions using a smartphone-based app across 30 days. Data were aggregated for comparison with the a-QDS conducted at the end of data collection.

Results

Irrespective of data collection method, alcohol was consumed more frequently and at higher quantities on the heaviest drinking occasions when consumed alone compared with when it was mixed with energy drinks. Consistent with this finding, more risk-taking behaviours were experienced on AO occasions compared with AMED occasions. Compared with the a-QDS, the quantity of alcohol consumed on the average and heaviest drinking occasion was significantly higher when reported via EMA. This was consistent across both AO and AMED drinking occasions.

Conclusion

EMA provides a more valid measure of consumption quantity compared with retrospective recall, which was susceptible to under-reporting, although this was not differentially affected across consumption occasions. In line with previous research, this study demonstrated that mixing alcohol with energy drinks does not increase alcohol consumption or risk-taking behaviours.

Smartphone-based alcohol interventions: A systematic review on the role of notifications in changing behaviors toward alcohol

Background: Smartphone-based interventions are increasingly being used to facilitate positive behavior change, including reducing alcohol consumption. However, less is known about the effects of notifications to support this change, including intervention engagement and adherence. The aim of this review was to assess the role of notifications in smartphone-based interventions designed to support, manage, or reduce alcohol consumption. Methods: Five electronic databases were searched to identify studies meeting inclusion criteria: (1) studies using a smartphone-based alcohol intervention, (2) the intervention used notifications, and (3) published between 1st January 2007 and 30th April 2021 in English. PROSPERO was searched to identify any completed, ongoing, or planned systematic reviews and meta-analyses of relevance. The reference lists of all included studies were searched. Results: Overall, 14 papers were identified, reporting on 10 different interventions. The strength of the evidence regarding the role and utility of notifications in changing behavior toward alcohol of the reviewed interventions was inconclusive. Only one study drew distinct conclusions about the relationships between notifications and app engagement, and notifications and behavior change. Conclusions: Although there are many smartphone-based interventions to support alcohol reduction, this review highlights a lack of evidence to support the use of notifications (such as push notifications, alerts, prompts, and nudges) used within smartphone interventions for alcohol management aiming to promote positive behavior change. Included studies were limited due to small sample sizes and insufficient follow-up. Evidence for the benefits of smartphone-based alcohol interventions remains promising, but the efficacy of using notifications, especially personalized notifications, within these interventions remain unproven.

Digital Public Health Surveillance Tools for Alcohol Use and HIV Risk Behaviors

There is a need for real-time and predictive data on alcohol use both broadly and specific to HIV. However, substance use and HIV data often suffer from lag times in reporting as they are typically measured from surveys, clinical case visits and other methods requiring extensive time for collection and analysis. Social big data might help to address this problem and be used to provide near real-time assessments of people's alcohol use and/or alcohol. This manuscript describes three types of social data sources (i.e., social media data, internet search data, and wearable device data) that might be used in surveillance of alcohol and HIV, and then discusses the implications and potential of implementing them as additional tools for public health surveillance.

Belief in the myth of an American Indian/Alaska Native biological vulnerability to alcohol problems among reservation-dwelling participants with a substance use problem

BACKGROUND

Belief in the myth of an American Indian/Alaska Native (AIAN)-specific biological vulnerability (BV) to alcohol problems is associated with worse alcohol outcomes among AIAN college students who drink, despite also being associated with greater attempts to reduce drinking. This study examined the association of belief in a BV with alcohol use among reservation-dwelling AI adults with a substance use problem.

METHODS

Participants (n = 141) who drank alcohol in the past 90 days were selected from a larger AI sample who self-identified as having a substance use problem. Moderated-mediation analyses examined whether belief in a BV was positively associated with alcohol- and substance use-related consequences and whether self-efficacy and craving mediated the association of belief in a BV with alcohol use.

RESULTS

Among participants who reported using alcohol but not hard drugs (e.g., methamphetamine, opioids), greater belief in a BV was associated with more drinking days, which in turn was associated with greater alcohol-related consequences. Among participants who used alcohol only, belief in a BV was also significantly associated with greater craving, and in turn with more drinking days. Among individuals who used both alcohol and hard drugs, greater belief in a BV was associated with fewer drinking days, but was not significantly associated with substance use-related consequences. No association was found between belief in a BV and self-efficacy to avoid alcohol or drug use.

CONCLUSIONS

Among individuals who use only alcohol, belief in a BV may contribute to more drinking days and greater alcohol-related consequences through its association with greater craving. This study provides further evidence of the potential harm of internalizing the belief that being AIAN contributes to the risk for alcohol problems, a notion that lacks scientific evidence despite decades of research. The findings highlight the importance of combating societal myths regarding AIAN peoples and the internalization of these stereotypes.

Toward a Just-in-Time Adaptive Intervention to Reduce Emerging Adult Alcohol Use: Testing Approaches for Identifying When to Intervene

ABBREVIATIONS

JITAI: Just-in-time adaptive intervention; ROC: receiver operating characteristic; AUC: area under the curve; MRT: micro-randomized trial.

Longitudinal associations with alcohol consumption during the first COVID-19 lockdown: Associations with mood, drinking motives, context of drinking, and mental health

BACKGROUND

Coronavirus (COVID-19) resulted in lockdown measures in the UK, which has impacted alcohol use. Alcohol is often used as a coping mechanism and there are public health concerns regarding excessive consumption due to the pandemic. We aimed to longitudinally assess drinking behaviors, and associated factors, during the first UK government-mandated lockdown.

METHODS

An online survey was distributed through social media (8^th April 2020, onwards). Fortnightly follow up surveys were emailed to participants. The primary outcome measure was 'weekly unit consumption' and data was collected on a range of potentially related factors: demographics, factors relating to COVID-19 (e.g., health, work status), drinking motives, context of drinking, drinking intentions, mood, depression and anxiety.

FINDINGS

A total of 539 self-selected participants completed the baseline survey, with 186 completing at least 3 follow up surveys for multilevel modelling analysis. Personal coping motives, anxiety, drinking at home alone, and drinking at home with others were positively associated with alcohol consumption during lockdown. The following baseline measures also predicted increased consumption: male gender, lower education, and higher AUDIT scores (based on behavior prior to lockdown). Findings were consistent when utilizing an inverse probability weight to account for predictors of attrition (female, younger age, higher baseline AUDIT scores).

CONCLUSIONS

Those already drinking at hazardous levels were more likely to increase their consumption, as were those who were drinking to cope. As we recover from the pandemic, there is a need for widespread alcohol support, and certain groups may need targeted support.

Contrasting a Mobile App with a Conversational Chatbot for Reducing Alcohol Consumption: A Pilot Trial (Preprint)

Background

Mobile apps have shown considerable promise for reducing alcohol consumption among problem drinkers, but like many mobile health apps, they frequently report low utilization, which is an important limitation, as research suggests that effectiveness is related to higher utilization. Interactive chatbots have the ability to provide a conversational interface with users and may be more engaging and result in higher utilization and effectiveness, but there is limited research into this possibility.

Objective

This study aimed to develop a chatbot alcohol intervention based on an empirically supported app (Step Away) for reducing drinking and to conduct a pilot trial of the 2 interventions. Included participants met the criteria for hazardous drinking and were interested in reducing alcohol consumption. The study assessed utilization patterns and alcohol outcomes across the 2 technology conditions, and a waitlist control group.

Methods

Participants were recruited using Facebook advertisements. Those who met the criteria for hazardous consumption and expressed an interest in changing their drinking habits were randomly assigned to three conditions: the Step Away app, Step Away chatbot, and waitlist control condition. Participants were assessed on the web using the Alcohol Use Disorders Identification Test, Adapted for Use in the United States, Readiness to Change Questionnaire, Short Inventory of Problems-Revised, and Timeline Followback at baseline and at 12 weeks follow-up.

Results

A total of 150 participants who completed the baseline and follow-up assessments were included in the final analysis. ANOVA results indicated that participants in the 3 conditions changed their drinking from baseline to follow-up, with large effect sizes noted (ie, η²=0.34 for change in drinks per day across conditions). However, the differences between groups were not significant across the alcohol outcome variables. The only significant difference between conditions was in the readiness to change variable, with the bot group showing the greatest improvement in readiness (F_2,147=5.6; P=.004; η²=0.07). The results suggested that the app group used the app for a longer duration (mean 50.71, SD 49.02 days) than the bot group (mean 27.16, SD 30.54 days; P=.02). Use of the interventions was shown to predict reduced drinking in a multiple regression analysis (β=.25, 95% CI 0.00-0.01; P=.04).

Conclusions

Results indicated that all groups in this study reduced their drinking considerably from baseline to the 12-week follow-up, but no differences were found in the alcohol outcome variables between the groups, possibly because of a combination of small sample size and methodological issues. The app group reported greater use and slightly higher usability scores than the bot group, but the bot group demonstrated improved readiness to change scores over the app group. The strengths and limitations of the app and bot interventions as well as directions for future research are discussed.

Trial Registration

ClinicalTrials.gov NCT04447794; https://clinicaltrials.gov/ct2/show/NCT04447794

Drunkorexia: is it really "just" a university lifestyle choice?

PURPOSE

The current study investigated the prevalence of compensatory behaviours (caloric restriction, increased exercise and bulimic tendencies) in response to alcohol consumption (also known as Drunkorexia) in students, non-students and previous students, as well as beginning to understand the presence of possible predictors of these behaviours (body esteem, sensation seeking).

METHODS

A volunteer sample of students, non-students and previous students (n = 95) completed the Compensatory Eating and Behaviours in Response to Alcohol Consumption Scale, a questionnaire which measures overall Drunkorexia engagement. The participants also completed the Body Esteem Scale for Adolescents and Adults Scale (BESAA) and the Brief Sensation Seeking Scale (BSSS) to investigate predictors of Drunkorexia.

RESULTS

The results indicated that there was no significant difference in Drunkorexia engagement and behaviours between students, non-students and previous students. It was also found that both low body esteem and high sensation seeking tendencies were significant predictors of Drunkorexia; specifically, the appearance esteem factor of the BESAA and the disinhibition factor of the BSSS.

CONCLUSIONS

Findings suggest that Drunkorexia is also present outside of student populations, and therefore, future interventions and research should include non-students in samples. In addition, findings support the idea that Drunkorexia cannot be classified solely as an eating disorder or a substance abuse disorder. As a result of this, further research should be conducted to fully understand why this complex behaviour exists.

EVIDENCE-BASED MEDICINE LEVEL

III (Evidence obtained from case-control analytic study).

What We Talk About When We Talk About Binge Drinking: Towards an Integrated Conceptualization and Evaluation

RATIONALE

Binge drinking (BD), characterized by recurring alternations between intense intoxication episodes and abstinence periods, is the most frequent alcohol consumption pattern in youth and is growing in prevalence among older adults. Many studies have underlined the specific harmful impact of this habit by showing impaired abilities in a wide range of cognitive functions among binge drinkers, as well as modifications of brain structure and function.

AIMS

Several controversies and inconsistencies currently hamper the harmonious development of the field and the recognition of BD as a specific alcohol consumption pattern. The main concern is the absence of consensual BD conceptualization, leading to variability in experimental group selection and alcohol consumption evaluation. The present paper aims at overcoming this key issue through a two-step approach.

METHODS AND CONCLUSIONS

First, a literature review allows proposing an integrated BD conceptualization, distinguishing it from other subclinical alcohol consumption patterns. Six specific characteristics of BD are identified, namely, (1) the presence of physiological symptoms related to BD episodes, (2) the presence of psychological symptoms related to BD episodes, (3) the ratio of BD episodes compared to all alcohol drinking occasions, (4) the frequency of BD episodes, (5) the consumption speed and (6) the alternation between BD episodes and soberness periods. Second, capitalizing on this conceptual clarification, we propose an evaluation protocol jointly measuring these six BD characteristics. Finally, several research perspectives are presented to refine the proposed conceptualization.

Ecological Momentary Assessment of Alcohol Consumption and Its Concordance with Transdermal Alcohol Detection and Timeline Follow-Back Self-report Among Adults Experiencing Homelessness

Background

Studies of alcohol use presume valid assessment measures. To evaluate this presumption, we examined the concordance of alcohol use as measured by ecological momentary assessment (EMA) self‐reports, transdermal alcohol concentration readings via the Secure Continuous Remote Alcohol Monitor (SCRAM), and retrospective self‐reports via the Timeline Follow‐Back (TLFB) among adults experiencing homelessness.

Methods

Forty‐nine adults who reported alcohol misuse (mean age = 47, SD = 9; 57% Black; 82% men) were recruited from a homeless shelter. For 4 weeks, alcohol use was assessed: (i) 5 times or more per day by EMA, (ii) every 30 minutes by a SCRAM device worn on the ankle, and (iii) by TLFB for the past month at the end of the study period. There were 1,389 days of observations of alcohol use and alcohol use intensity for 49 participants.

Results

EMA and SCRAM alcohol use data agreed on 73% of days, with an interrater agreement Kappa = 0.46. A multilevel analysis of concordance of 3 measures for alcohol use yielded statistically significant correlations of 0.40 (day level) and 0.63 (person level) between EMA and SCRAM. Alcohol use was detected on 49, 38, and 33% of days by EMA, SCRAM, and TLFB, respectively. For alcohol use intensity, EMA and SCRAM resulted in statistically significant correlations of 0.46 (day level) and 0.78 (person level). The concordance of TLFB with either EMA or SCRAM was weak, especially at the day level.

Conclusions

This is the first study to examine concordance of alcohol use estimates using EMA, SCRAM, and TLFB methods in adults experiencing homelessness. EMA is a valid approach to quantifying alcohol use, especially given its relatively low cost, low participant burden, and ease of use. Furthermore, any stigma associated with wearing the SCRAM or reporting alcohol use in person may be attenuated by using EMA, which may be appealing for use in studies of stigmatized and underserved populations.

Fun/intoxication pre-drinking motives lead indirectly to more alcohol-related consequences via increased alcohol consumption on a given night

INTRODUCTION

Pre-drinking increases alcohol use on drinking nights, which is associated with various adverse alcohol-related consequences but what motivates people to do so, i.e. the role of pre-drinking motives (PDM) in this link, is unclear. The current study examined a) the association of three PDM factors (fun/intoxication, facilitation, and conviviality) with average night-level alcohol use, b) whether PDM are associated with adverse alcohol-related consequences (hangover, drunk driving, blackout, risky sex, injury, and fights) and c) whether PDM mediates the link between night-level alcohol use and negative consequences.

METHODS

A sample of 204 young adult nightlife goers (48.8% males, M_age = 19 SD = 2.4) from Switzerland reported PDM at baseline, and subsequently participated in a 2-month event-level study. Regressions models assessed direct and mediated associations.

RESULTS

Fun/intoxication PDM predicted alcohol use in subsequent drinking nights (11.3 nights per participant on average), but not the two other PDM. No direct link between PDM and consequences was found. However, fun/intoxication PDM lead indirectly to more adverse consequences through higher alcohol use.

CONCLUSION

This study shows that predominantly 'fun/intoxication' predrinkers are at increased risk for alcohol consumption and consequences, but not those who predrink for conviviality or facilitation motives. The outcomes thus suggest the importance of specific PDM in preventing alcohol use for instance by tailoring interventions based on individuals' PDM in order to curb drinking and its associated consequences among young adults on weekend nights out.

Shooting shots: Estimating alcoholic drink sizes in real life using event-level reports and annotations of close-up pictures

INTRODUCTION AND AIMS

Drinks consumed in real life are diverse, in terms of beverage type, container size and alcohol by volume. To date, most ecological momentary assessment studies have assessed drinking amounts with 'standard' drinks, although their event-level design allows for more advanced assessment schemes. The purpose of this empirical study is to compare participants' estimates of alcoholic drink characteristics, assessed using drink-specific questions, with estimates generated by annotators based on pictures of the same drinks.

DESIGN AND METHODS

On weekend nights, 186 young adults took 1484 close-up pictures of their drinks using a custom-built smartphone application. Participants reported the beverage type, drink size and alcohol by volume. Annotators described the beverage type, container size and filling level. Correspondence between participants' and annotators' estimates was explored using descriptive statistics, difference tests and correlations.

RESULTS

Annotators were unable to precisely identify the beverage types in most pictures of liqueurs, spirits and mixed drinks. Participants' drink size estimates converged with annotators' estimates of the container size for beer (41 cl corresponding to 16 g of pure alcohol) and mixed drinks (28 cl/35 g), and of the content size for wine (10 cl/9 g). However, annotators estimated larger sizes for liqueur/fortified wine (12 cl/14 g vs. 7 cl/9 g) and spirits (8 cl/26 g vs. 4 cl/10 g) than participants.

DISCUSSION AND CONCLUSIONS

Annotations of pictures should be considered as a complement to participants' reports rather than a substitute. Except for wine, real-life drinks vary largely and often exceed 10 g 'standard' drinks.

Assessment of Alcohol Use and Consequences: Comparison of Data Collected Via Timeline Followback Interview and Daily Reports

OBJECTIVE

The aim of this study was to compare data on both alcohol use and alcohol-related consequences between intensive longitudinal data collection and the retrospective Timeline Followback (TLFB) interview.

METHOD

Heavy drinking college students (n = 96; 52% women) completed daily reports across a 28-day period to assess alcohol use and positive and negative consequences of drinking. They returned to the lab at the end of this period to complete a TLFB assessing behavior over those same 28 days. First, t tests were used to compare variables aggregated across the full 28 days at the between-person level. Next, hierarchical linear modeling was used to examine within-person differences between methods for each variable in weekly and daily increments.

RESULTS

Many alcohol use and consequence variables were significantly different when derived from self-reports during TLFB versus daily reports. In contrast to prior work, we found that higher estimates of drinking were reported retrospectively on the TLFB than on the daily reports. In addition, discrepancies were greater on some variables for heavier drinkers and when more time had elapsed between the end of the daily reporting period and TLFB collection.

CONCLUSIONS

Recall of drinking behavior during TLFB and daily reports may differ in systematic ways, with discrepancies varying based on participant and methodological characteristics.

Heaviness of Alcohol Use, Alcohol Problems, and Subjective Intoxication Predict Discrepant Drinking Reports in Daily Life

BACKGROUND

Self-reported consumption is pervasive in alcohol research, though retrospective recall bias is a concern. Fine-grained methods are designed to limit retrospection; yet, discrepancies can arise when comparing responses on fine-grained surveys with responses to retrospective surveys across weeks or months. Many fine-grained studies use both repeated daily surveys (RDS) and end-of-day (EOD) summaries, but little research has examined whether these survey types are consistent. The purpose of this study was to quantify the magnitude and directionality of discrepancy between EOD summaries and RDS and identify alcohol-related predictors of discrepancy.

METHODS

As a part of a larger study, college student alcohol and cannabis users (N = 341; 53% women; Mage  = 19.79 years) were recruited to complete 56 days of data collection, including 5 daily assessments of their substance use and related constructs, one of which included an EOD summary of the previous day. Generalized linear mixed-effects models were used to examine between- and within-person predictors of a 5-category, discrepancy outcome: no discrepancy, low discrepancy where RDS < EOD, low discrepancy where EOD < RDS, high discrepancy where RDS < EOD, and high discrepancy where EOD < RDS.

RESULTS

Discrepancies between EOD and RDS were observed in both directions. Alcohol problems predicted more alcohol consumption reported on the EOD survey than across RDS. Within-person alcohol quantity and hourly rate of consumption were most strongly related to less alcohol consumption reported on the EOD survey. Between- and within-person peak subjective intoxication and within-person liquor consumption were associated with discrepancies in both directions.

CONCLUSIONS

Surveys requiring more retrospection may overestimate alcohol consumption in problematic drinkers and underestimate consumption on days where more alcohol is consumed than typical. Evidence also suggests that greater day-to-day instability in alcohol behavior is linked to less consistent reporting overall. More research is needed to discern factors contributing to inconsistent reporting on fine-grained surveys to maximize the validity of reports.

Using the Internet to access key populations in ecological momentary assessment research: Comparing adherence, reactivity, and erratic responding across those enrolled remotely versus in-person

Ecological momentary assessment (EMA) is a set of longitudinal methods that researchers can use to understand complex processes (e.g., health, behavior, emotion) in "high resolution." Although technology has made EMA data collection easier, concerns remain about the consistency and quality of data collected from participants who are enrolled and followed online. In this study, we used EMA data from a larger study on HIV-risk behavior among men who have sex with men (MSM) to explore whether several indicators of data consistency/quality differed across those who elected to enroll in-person and those enrolled online. One hundred MSM (age 18-54) completed a 30-day EMA study. Forty-five of these participants chose to enroll online. There were no statistically significant differences in response rates for any survey type (e.g., daily diary [DD], experience sampling [ES], event-contingent [EC]) across participants who enrolled in-person versus online. DD and ES survey response rates were consistent across the study and did not differ between groups. EC response rates fell sharply across the study, but this pattern was also consistent across groups. Participants' responses on the DD were generally consistent with a poststudy follow-up Timeline Followback (TLFB) with some underreporting on the TLFB, but this pattern was consistent across both groups. In this sample of well-educated, mostly White MSM recruited from urban areas, EMA data collected from participants followed online was as consistent, reliable, and valid as data collected from participants followed in-person. These findings yield important insights about best practices for EMA studies with cautions regarding generalizability. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Daily physical activity and alcohol use among young adults

Evidence suggests that physical activity and alcohol use are positively related among young adults. Two studies have examined daily relations, and results have shown conflicting findings. We examined relations between physical activity and alcohol use at both within- and between-individual levels and investigated moderators of the relation at both levels. 269 college students wore accelerometers to collect physical activity data over a 2-week period. At the end of each day, they indicated whether or not they drank alcohol. Multilevel logistic regression indicated neither within- nor between-subject relations were statistically significant. Positive affect, negative affect, and drinking motives moderated these relations at the between-subject level. Contrary to previous research, we did not observe a relation between physical activity and alcohol use at the daily level. Unique features of the current study suggest next steps for future research examining the perplexing PA-alcohol relation in this population.

Alcohol Avoidance Training as a Mobile App for Problem Drinkers: Longitudinal Feasibility Study

Background

Alcohol use is associated with an automatic tendency to approach alcohol, and the retraining of this tendency (cognitive bias modification [CBM]) shows therapeutic promise in clinical settings. To improve access to training and to enhance participant engagement, a mobile version of alcohol avoidance training was developed.

Objective

The aims of this pilot study were to assess (1) adherence to a mobile health (mHealth) app; (2) changes in weekly alcohol use from before to after training; and (3) user experience with regard to the mHealth app.

Methods

A self-selected nonclinical sample of 1082 participants, who were experiencing problems associated with alcohol, signed up to use the alcohol avoidance training app Breindebaas for 3 weeks with at least two training sessions per week. In each training session, 100 pictures (50 of alcoholic beverages and 50 of nonalcoholic beverages) were presented consecutively in a random order at the center of a touchscreen. Alcoholic beverages were swiped upward (away from the body), whereas nonalcoholic beverages were swiped downward (toward the body). During approach responses, the picture size increased to mimic an approach movement, and conversely, during avoidance responses, the picture size decreased to mimic avoidance. At baseline, we assessed sociodemographic characteristics, alcohol consumption, alcohol-related problems, use of other substances, self-efficacy, and craving. After 3 weeks, 37.89% (410/1082) of the participants (posttest responders) completed an online questionnaire evaluating adherence, alcohol consumption, and user satisfaction. Three months later, 19.03% (206/1082) of the participants (follow-up responders) filled in a follow-up questionnaire examining adherence and alcohol consumption.

Results

The 410 posttest responders were older, were more commonly female, and had a higher education as compared with posttest dropouts. Among those who completed the study, 79.0% (324/410) were considered adherent as they completed four or more sessions, whereas 58.0% (238/410) performed the advised six or more training sessions. The study identified a significant reduction in alcohol consumption of 7.8 units per week after 3 weeks (95% CI 6.2-9.4, P<.001; n=410) and another reduction of 6.2 units at 3 months for follow-up responders (95% CI 3.7-8.7, P<.001; n=206). Posttest responders provided positive feedback regarding the fast-working, simple, and user-friendly design of the app. Almost half of the posttest responders reported gaining more control over their alcohol use. The repetitious and nonpersonalized nature of the intervention was suggested as a point for improvement.

Conclusions

This is one of the first studies to employ alcohol avoidance training in a mobile app for problem drinkers. Preliminary findings suggest that a mobile CBM app fulfils a need for problem drinkers and may contribute to a reduction in alcohol use. Replicating these findings in a controlled study is warranted.

Capturing habitualness of drinking and smoking behavior in humans

BACKGROUND

Recent findings suggest that overreliance on habit may be common in individuals diagnosed with addiction. To advance our understanding of habit in clinical samples and from behavioral measures, this study examines the interrelations between self-reported habit index for smoking and drinking as well as behavioral measures of intraindividual variability in smoking and drinking.

METHODS

Treatment-seeking heavy drinking smokers (N = 416) completed the Self-Report Habit Index (SRHI) adapted for both smoking and drinking. "Behavioral habitualness" was computed from the degree of intraindividual variability in patterns of smoking and drinking over the past month. Using the 28-day Timeline-Follow Back (TLFB) interview, we derived two measures of intraindividual variability: interclass correlation (ICC) and autocorrelation [AR(7) coefficients].

RESULTS

Self-report measures of habit were robustly associated with clinical severity of drinking and smoking with higher habit scores indicating greater severity of drinking and smoking, respectively. ICC and AR(7) coefficients, the behavioral measure of "patterness" and putative habit, were not associated with SRHI scores. While ICC for smoking was associated with higher nicotine dependence scores, this pattern was not found for drinking ICC and alcohol problem severity.

CONCLUSIONS

These results support the construct validity of the self-report measures of habit for smoking and drinking, as well an initial evaluation of behavioral measure of smoking "patterness" as a potential proxy for habit smoking. Because habit represents a complex phenotype with limited clinical translation, additional studies capturing a wider range of substance use severity and coupled with brain-based validation methods are warranted.

Item Responses in Quantity-Frequency Questionnaires: Implications for Data Generalizability

Alcohol consumption is an important predictor of a variety of negative outcomes. There is an extensive literature that examines the differences in the estimated level of alcohol consumption between types of assessments (e.g., quantity-frequency [QF] questionnaires, daily diaries). However, it is typically assumed that all QF-based measures are nearly identical in their assessment of the volume of alcohol consumption in a population. Using timeline follow-back data and constructing common QF consumption measures, we examined differences among survey instruments to assess alcohol consumption and heavy drinking. Using three data sets, including clinical to community samples, we demonstrate how scale-specific item characteristics (i.e., number of response options and ranges of consumption assessed by each option) can substantially affect the estimated mean level of consumption and estimated prevalence of binge drinking. Our analyses suggest that problems can be mitigated by employing more resolved measures of quantity and frequency in consumption questionnaires.

Sleep after Heavy Alcohol Consumption and Physical Activity Levels during Alcohol Hangover

Alcohol consumption can negatively affect sleep quality. The current study examined the impact of an evening of alcohol consumption on sleep, and next day activity levels and alcohol hangover. n = 25 healthy social drinkers participated in a naturalistic study, consisting of an alcohol and alcohol-free test day. On both days, a GENEactiv watch recorded sleep and wake, and corresponding activity levels. In addition, subjective assessments of sleep duration and quality were made, and hangover severity, and the amount of consumed alcoholic beverages were assessed. Alcohol consumption was also assessed in real-time during the drinking session, using smartphone technology. The results confirmed, by using both objective and subjective assessments, that consuming a large amount of alcohol has a negative impact on sleep, including a significant reduction in objective sleep efficiency and significantly lower self-reported sleep quality. Activity levels during the hangover day were significantly reduced compared to the alcohol-free control day. Of note, next-morning retrospective alcohol consumption assessments underestimated real-time beverage recordings. In conclusion, heavy alcohol consumption impairs sleep quality, which is associated with increased next day hangover severity and reduced activity levels. The outcome of this study underlines that, in addition to retrospectively reported data, real-time objective assessments are needed to fully understand the effects of heavy drinking.

Compliance with ecological momentary assessment protocols in substance users: a meta-analysis

BACKGROUND AND AIMS

While there are considerable benefits to Ecological Momentary Assessment (EMA), poor compliance with assessment protocols has been identified as a limitation, particularly in substance users. Our aim was to identify the pooled compliance rate of EMA studies in substance users and examine variables that may influence compliance with EMA protocols, such as the length and frequency of assessments.

DESIGN

A meta-analysis and meta-regression of all possible studies (randomized controlled trials and longitudinal) which incorporated EMA protocols, examining substance use.

SETTING

Studies took place from 1998 to 2017, in numerous countries world-wide.

PARTICIPANTS

One hundred and twenty-six studies were identified, contributing a total of 19 431 participants (52.32% male, mean age = 28.86).

MEASUREMENTS

Compliance data, the proportion of responses to the study protocol, were extracted from each study alongside prompt frequency, total length of assessment period, substance use population and device used to administer EMA prompts.

FINDINGS

The pooled compliance rate across all studies was 75.06% [95% confidence interval (CI) = 72.37%, 77.65%]. There was no evidence that compliance rates were significantly associated with prompt frequency [Q(3) = 7.35, P = 0.061], length of assessment period [Q(2) = 2.40, P = 0.301], substance type [Q(3) = 6.30, P = 0.098] or device administration [Q(4) = 4.28, P = 0.369]. However, dependent samples (69.80%) had lower compliance rates than non-dependent samples [76.02%; Q(1) = 4.13, P = 0.042].

CONCLUSIONS

The pooled compliance rate for Ecological Momentary Assessment studies in substance-using populations from 1998 to 2017 was lower than the recommended rate of 80%, and was not associated with frequency or duration of assessments.

A Smartphone App to Assess Alcohol Consumption Behavior: Development, Compliance, and Reactivity

BACKGROUND

There are disadvantages-largely related to cost, participant burden, and missing data-associated with traditional electronic methods of assessing drinking behavior in real time. This potentially diminishes some of the advantages-namely, enhanced sample size and diversity-typically attributed to these methods. Download of smartphone apps to participants' own phones might preserve these advantages. However, to date, few researchers have detailed the process involved in developing custom-built apps for use in the experimental arena or explored methodological concerns regarding compliance and reactivity.

OBJECTIVE

The aim of this study was to describe the process used to guide the development of a custom-built smartphone app designed to capture alcohol intake behavior in the healthy population. Methodological issues related to compliance with and reactivity to app study protocols were examined. Specifically, we sought to investigate whether hazard and nonhazard drinkers would be equally compliant. We also explored whether reactivity in the form of a decrease in drinking or reduced responding ("yes") to drinking behavior would emerge as a function of hazard or nonhazard group status.

METHODS

An iterative development process that included elements typical of agile software design guided the creation of the CNLab-A app. Healthy individuals used the app to record alcohol consumption behavior each day for 21 days. Submissions were either event- or notification-contingent. We considered the size and diversity of the sample, and assessed the data for evidence of app protocol compliance and reactivity as a function of hazard and nonhazard drinker status.

RESULTS

CNLab-A yielded a large and diverse sample (N=671, mean age 23.12). On average, participants submitted data on 20.27 (SD 1.88) out of 21 days (96.5%, 20.27/21). Both hazard and nonhazard drinkers were highly compliant with app protocols. There were no differences between groups in terms of number of days of app use (P=.49) or average number of app responses (P=.54). Linear growth analyses revealed hazardous drinkers decreased their alcohol intake by 0.80 standard drinks over the 21-day experimental period. There was no change to the drinking of nonhazard individuals. Both hazard and nonhazard drinkers showed a slight decrease in responding ("yes") to drinking behavior over the same period.

CONCLUSIONS

Smartphone apps participants download to their own phones are effective and methodologically sound means of obtaining alcohol consumption information for research purposes. Although further investigation is required, such apps might, in future, allow for a more thorough examination of the antecedents and consequences of drinking behavior.

Predictors of Adverse Alcohol Use Consequences Among Tertiary Students

BACKGROUND

The alcohol consumption patterns of young adults are of concern. Critically, tertiary students consume greater quantities of alcohol, are at increased risk of injury/harm, and have higher rates of alcohol use disorders as compared to their nonuniversity enrolled peers. The Brief Young Adult Alcohol Consequences Questionnaire (BYAACQ) is one of several tools utilized to explore adverse alcohol-related outcomes among tertiary students. Alcohol intake behavior, assessed via retrospective summary measures, has been linked to BYAACQ score. It is unclear, however, how drinking assessed in real time, in conjunction with variables such as age of drinking onset, might predict severity of adverse alcohol consequences as captured by the BYAACQ.

METHODS

The psychometric properties of the BYAACQ were explored using a large Australian sample of tertiary students (N = 893). A subsample (n = 504) provided alcohol intake information in real time (21 days; event and notification contingent) via a smartphone app (CNLab-A) plus details related to age of drinking onset, drug use, parental alcohol/drug use, and anxiety/depression symptomology.

RESULTS

Average BYAACQ score was 7.53 (SD = 5.37). Classical and item response theory analyses revealed inconsistencies related to dimensionality, progressive item severity, and male/female differential item functioning. Current drinking-namely, frequency of intake and quantity per drinking occasion-plus age of drinking onset predicted BYAACQ score after controlling for age, other drug use, and depression symptomology.

CONCLUSIONS

The BYAACQ is a sound tool for use with Australian samples. Information related to current drinking, age of drinking onset, and drug use is useful for predicting severity of alcohol use consequences. These markers might enable tertiary institutions to better target students who could benefit from prevention/intervention programs.

To drink or to drink less? Distinguishing between effects of implementation intentions on decisions to drink and how much to drink in treatment-seeking individuals with alcohol use disorder

INTRODUCTION

For many people with alcohol use disorders, alcohol drinking is a highly ingrained and automatized behavior with negative long-term health consequences. Implementation intentions, a behavioral intervention that links high-risk drinking situations with alternative, healthier responses, provide a means to intervene on habitual drinking behaviors. Here, a pilot treatment using implementation intentions was assessed with remote assessments and treatment prompts.

METHODS

Treatment-seeking individuals with alcohol use disorder between the ages of 18 and 65 were recruited from the community from October 2014 to November 2016. Participants (N=35) were quasi-randomly assigned to complete either active (n=18) or control (n=17) two-week implementation intention interventions. Active implementation intentions linked high-risk situations with alternative responses whereas the control condition selected situations and responses but did not link these together. Daily ecological momentary interventions of participant-tailored implementation intentions were delivered via text message. Alcohol consumption was assessed once daily with self-reported ecological momentary assessments (EMAs) of drinks consumed the previous day and thrice daily remotely submitted breathalyzer samples to assess reliability of self-reports.

RESULTS

On drinking days (80% of days), the active implementation intentions group reduced alcohol consumption during the intervention period compared to the control condition; however the difference between consumption was not observed at one-month follow-up.

DISCUSSION

The implementation intention intervention was associated with a 1.09 drink per day decrease in alcohol consumption on drinking days compared to a decrease of 0.29 drinks per day in the control condition. Future studies may combine implementation intentions with other treatments to help individuals to reduce alcohol consumption.

Assessment of alcohol intake: Retrospective measures versus a smartphone application

INTRODUCTION

Research investigating problem drinking often relies on retrospective measures to assess alcohol consumption behaviour. Limitations associated with such instruments can, however, distort actual consumption levels and patterns. We developed the smartphone application (app), CNLab-A, to assess alcohol intake behaviour in real-time.

METHODS

Healthy individuals (N=671, M age 23.12) completed demographic questions plus the Alcohol Use Questionnaire and a 21-day Timeline Followback before using CNLab-A for 21days. The app asked participants to record alcohol consumption details in real time. We compared data reported via retrospective measures with that captured using CNLab-A.

RESULTS

On average, participants submitted data on 20.27days using CNLab-A. Compared to Timeline Followback, a significantly greater percentage of drinking days (24.79% vs. 26.44%) and significantly higher total intake (20.30 vs. 24.26 standard drinks) was recorded via the app. CNLab-A captured a substantially greater number of high intake occasions at all levels from 8 or more drinks than Timeline Followback. Additionally, relative to the Alcohol Use Questionnaire, a significantly faster rate of consumption was recorded via the app.

CONCLUSIONS

CNLab-A provided more nuanced information regarding quantity and pattern of alcohol intake than the retrospective measures. In particular, it revealed higher levels of drinking than retrospective reporting. This will have implications for how particular at-risk alcohol consumption patterns are identified in future and might enable a more sophisticated exploration of the causes and consequences of drinking behaviour.

Alcohol, Diet and Drug Use Preceding Alcoholic Hepatitis

BACKGROUND

Alcoholic hepatitis (AH) is a severe manifestation of alcohol-related liver disease characterised by jaundice and liver failure. It is not known what might trigger an episode of AH. We interviewed patients to investigate changes in behaviour before the onset of AH.

METHODS

Structured interviews were performed with patients with AH to examine their alcohol use, diet, drug use and smoking habit. Clinical and laboratory results were noted. Patients were followed up for 12 months after interview.

RESULTS

Data from 39 patients was analysed. No single behavioural change occurred before the onset of jaundice, although reductions in alcohol and/or dietary intake were common. Reduction in alcohol use was seen to occur approximately 14 days before the onset of jaundice. Increased alcohol intake was not common. Clinical and laboratory data varied between types of behaviour changes, although these were not statistically significant. No changes in drug use or tobacco were reported before AH. Those who had not reduced alcohol intake or had increased their drinking had better survival.

CONCLUSIONS

No single type of behaviour change is associated with AH. Contrary to previous assertions, increased alcohol intake was not common; in fact, participants were much more likely to have reduced their alcohol intake.

Identifying the Intersection of Alcohol, Adherence and Sex in HIV Positive Men on ART Treatment in India Using an Adapted Timeline Followback Procedure

People living with HIV (PLHIV) on anti-retroviral treatment (ART) who drink are less adherent and more likely to engage in unprotected sex but the connections among these events are correlational. Using an adapted Timeline Follow-Back (A-TLFB) procedure, this paper examines the day by day interface of alcohol, medication adherence and sex to provide a fine grained understanding of how multiple behavioral risks coincide in time and space, explores concordance/discordance of measures with survey data and identifies potential recall bias. Data are drawn from a survey of behavior, knowledge and attitudes, and a 30 day TLFB assessment of multiple risk behaviors adapted for the Indian PLHIV context, administered to 940 alcohol-consuming, HIV positive men on ART at the baseline evaluation stage of a multilevel, multi-centric intervention study. On days participants drank they were significantly more likely to be medication non-adherent and to have unprotected sex. In the first day after their alcohol consuming day, the pattern of nonadherence persisted. Binge and regular drinking days were associated with nonadherence but only binge drinking co-occurred with unprotected sex. Asking about specific "drinking days" improved recall for drinking days and number of drinks consumed. Recall declined for both drinking days and nonadherence from the first week to subsequent weeks but varied randomly for sex risk. There was high concordance and low discordance between A-TLFB drinking and nonadherence but these results were reversed for unprotected sex. Moving beyond simple drinking-adherence correlational analysis, the A-TLFB offers improved recall probes and provides researchers and interventionists with the opportunity to identify types of risky days and tailor behavioral modification to reduce alcohol consumption, nonadherence and risky sex on those days.

The Going Out In Sydney App: Evaluating the Utility of a Smartphone App for Monitoring Real-World Illicit Drug Use and Police Encounters Among Festival and Club Goers

Gaining accurate information on illicit drug use and policing in real-world settings is a challenge. This study examines the utility of a smartphone app ('Going Out In Sydney') to prospectively follow up illicit drug use and policing encounters at music festivals and licensed entertainment precincts in Sydney, Australia. In all, 38 regular festival and licensed entertainment venue attendees used the app to log nights out over a 3-month period, including (1) where they went (eg, festival, nightclub), (2) the prevalence of illicit drug use, and (3) the incidence and nature of police encounters. A survey and interview were then conducted about the utility of the app. The app enabled rich data collection (n = 353 entries) about illicit drug use and policing at both target settings. Follow-up surveys indicated that most participants were extremely satisfied with the ease of use of the app and privacy afforded, and compared with other data collection modes, such as paper-based logs and online surveys, rated the app the most desirable method of data collection. This suggests smartphone apps may be a viable option for future studies on illicit drug use and policing of drugs.