Understanding alcohol harm reduction behaviors from the perspective of self-determination theory: A research agenda

Critical misconceptions and knowledge gaps regarding alcohol cessation and risk of relapse in alcohol-related liver disease patients: A qualitative mental models study

INTRODUCTION

Despite the mortality benefits of alcohol cessation and alcohol treatment, few patients with alcohol-related liver disease (ALD) get such treatment. To understand reasons for low treatment rates, we performed a qualitative mental models study to explore how ALD patients understand factors influencing alcohol cessation, relapse and their liver health.

METHODS

Using a mental models framework, we interviewed experts in alcohol use disorder (AUD) and ALD to determine factors influencing alcohol cessation, risk of relapse and liver health. An expert influence diagram was constructed and used to develop a patient interview guide. We recruited participants with ALD enrolled in hepatology or transplant clinics at a single tertiary-care center. We conducted interviews either face-to-face or by phone, per participant preference. We transcribed all interviews verbatim and analyzed them using combined deductive coding schema based on both the interview guide and emergent coding.

RESULTS

25 (10 women, 15 men) participants with a mean age of 57 years completed interviews. 68 % had decompensated cirrhosis. Major omissions included gender (as a factor in alcohol use or liver disease) and the influence of benzodiazepines/opioids on relapse. Misconceptions were common, in particular the idea that the absence of urges to drink meant participants were safe from relapse. Conceptual differences from the expert model emerged as well. Participants tended to view the self as primary and the only thing that could influence relapse in many cases, resulting in a linear mental model with few nodes influencing alcohol cessation. Participants' risky drinking signals (i.e., elevated liver enzymes) differed from known definitions of hazardous or high-risk drinking, which largely emphasize dose of alcohol consumed irrespective of consequences. Finally, participants sometimes viewed stopping on one's own as the primary means of stopping alcohol use, not recognizing the many other nodes in the influence diagram impacting ability to stop alcohol.

CONCLUSION

Patients with ALD had critical misconceptions, omissions, and conceptual reorganizations in their mental models of the ability to stop alcohol use. Attention to these differences may allow clinicians and researchers to craft more impactful interventions to improve rates of alcohol abstinence and AUD treatment engagement.

Understanding the Effect of External and Internal Assets on Hazardous/Harmful Drinking Among Chinese College Students: A Serial Mediation Model

Hazardous/harmful drinking among college students is increasingly becoming a global health concern. Previous studies have mostly paid more attention to the prevalence and risk factors of alcohol use disorder based on the public health approach, and less is understood about psychological mechanisms and protective factors of problem drinking behavior. Grounded in the framework of developmental assets, this study explored the predictive effect of external assets (i.e., social connectedness) and internal assets (i.e., self-concept clarity and drinking refusal self-efficacy) on hazardous/harmful drinking among Chinese college students. Participants were 598 college students with a mean age of 19.41 (SD = 1.21) years. The results of structural equation modeling showed that social connectedness negatively predicted college students' hazardous/harmful drinking. Moreover, our path analyses revealed a serial mediation among these variables: students with high social connectedness tended to report high self-concept clarity, which in turn increased drinking refusal self-efficacy, and consequently decreased the level of hazardous/harmful drinking. This study revealed the mechanisms underlying how external and internal assets predict risky drinking among college students. These findings made significant contributions to prevention and precision interventions for college-aged youth with drinking problems.

Application of Self-Determination Theory to Substance Use and Its Treatment: A Scoping Review of the Literature

Background: Self-determination theory (SDT) may provide important insights for understanding substance misuse and treatment outcomes. However, to date, the literature applying SDT to substance use and its treatment is varied and difficult to integrate. Methods: The authors searched psycINFO and PubMed on October 26th, 2021 to identify articles applying SDT to substance use and its treatment. Eligible studies were published in peer-reviewed articles in English, on adult populations (18+), and explicitly applied SDT to the context of substance use or its treatment. Results were categorized as studies applying SDT in non-treatment or treatment settings and were synthesized within these categories by substance(s) of focus, primary outcome(s), component(s) of SDT utilized, and relevant findings. Results: The search revealed 38 articles applying SDT in non-treatment (k = 16) and treatment (k = 22) settings. Causality orientations and the basic psychological needs were the most frequently studied components of SDT. Studies that applied SDT in non-treatment settings placed a greater emphasis on causality orientations, whereas treatment studies more frequently targeted or measured basic psychological needs. Conclusions: SDT constructs consistently predicted both substance misuse and treatment outcomes in a theoretically consistent manner, however, several important gaps remain and opportunities for future research are discussed.

A comprehensive examination of motivational profiles for alcohol-related behaviors among college students

Recent research demonstrates unique relations of types of motivation for drinking responsibly based on self-determination theory and drinking motives with alcohol-related outcomes among college students. In the present study, we sought to extend prior research by using a person-centered approach to simultaneously consider types of motivation within and across these motivational constructs as well as their synergistic relations with alcohol-related outcomes. We used cross-sectional survey data from 2,808 college students at 10 universities in eight states across the United States who reported past-month alcohol use (Mage = 20.59, SD = 4.18; 72.9% female; 58.2% non-Hispanic White). A series of latent profile analyses were conducted using types of motivation for drinking responsibly and drinking motives as indicators. A five-profile solution was selected as optimal. Mean comparisons indicated that profiles defined by high endorsement of higher quality motivations for drinking responsibly (i.e., more self-determined) and low endorsement of drinking motives in combination were related to the most frequent protective behavioral strategies use, least alcohol use, and fewest negative alcohol-related consequences. Additionally, these profiles were higher on dispositional autonomy and psychological need satisfaction and lower on psychological need frustration. These findings provide initial insight into simultaneously considering motivational profiles for the interrelated behaviors of drinking responsibly and drinking that can be leveraged in college drinking interventions. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Indirect Associations between Impulsivity and Alcohol Outcomes through Motives for Drinking Responsibly among U.S. College Students: An Integration of Self-Determination Theory and the Acquired Preparedness Model

The aim of the present study was to conduct a preliminary investigation of the associations between facets of impulsivity and alcohol outcomes through motives for drinking responsibly described by self-determination theory among college students. Participants (N=2,808) were part of a multisite investigation of college student drinking across 10 universities in 8 states in the U.S. who reported past-month drinking. Results of a structural equation model testing all possible indirect associations simultaneously indicated that one-third (20 out of 60) of the indirect associations were statistically significant (p<.01). Facets with higher scores representing higher impulsivity (negative/positive urgency) were negatively associated with more internalized motives (autonomous motivation and introjected regulation) and positively associated with less internalized motives (external regulation and amotivation) for drinking responsibly. Facets with higher scores representing lower impulsivity (perseverance and premeditation) demonstrated opposite patterns of associations with motives for drinking responsibly. In turn, more internalized motives were related to higher frequency of protective behavioral strategies use, lower alcohol use severity, and fewer negative alcohol-related consequences; less internalized motives demonstrated an opposite pattern of associations with these alcohol outcomes. The present findings should be replicated using experimental and longitudinal studies for appropriately testing mediation but offer support for a novel hypothesis for motivational pathways from impulsivity to alcohol outcomes that may provide insight into intervention targets.

A comprehensive examination of alcohol-related motivations among college students: Unique relations of drinking motives and motivations for drinking responsibly

Drinking motives, or reasons people choose to drink, are well-established risk factors for alcohol use and related negative consequences. Recent research has shown utility in a self-determination theory (SDT) approach for describing motivation for engaging in behaviors that reduce the harms associated with alcohol use (i.e., drinking responsibly). In the present study, we examined the relationship between drinking motives and motivations for drinking responsibly as well as their unique and incremental associations with alcohol-related outcomes (protective behavioral strategies [PBS], consumption, and negative consequences) in two samples of college student drinkers: (a) a random sample (n = 507) recruited from a Hispanic-Serving Institution on the U.S. border with Mexico (Mage = 22.84, SD = 5.84; 67.3% female; 90.9% Hispanic) and (b) a convenience sample (n = 2,808) from Psychology Department research participation pools at 10 universities in 8 U.S. states (Mage = 20.59, SD = 4.18; 72.9% female; 58.2% non-Hispanic White). Autonomous motivations (experience of volition and choice) for drinking responsibly were negatively correlated with drinking motives, but these correlations were small-to-medium in magnitude suggesting nonredundancy between the constructs. Drinking motives were risk factors for alcohol-related outcomes, especially alcohol-related problems, and autonomous motivations for drinking responsibly were protective factors for alcohol-related outcomes, especially PBS. Both motivational constructs predicted alcohol-related outcomes beyond the other, but drinking motives generally accounted for more variance. These findings suggest that integrating motivation in relation to both drinking and drinking responsibly may lead to a better understanding of alcohol-related behaviors and the associated negative consequences among college students. Implications for college drinking interventions are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Measurement invariance of the University of Rhode Island Change Assessment Scale in Project MATCH: An exploratory structural equation modeling approach

BACKGROUND

Progression through the stages of change is a proposed mechanism underlying the effects of treatment for alcohol use disorder (AUD). However, examining stages of change as a mechanism of treatment effects requires that the measure be invariant across patient subgroups, treatment conditions, and time. In this study, we examined measurement invariance of the University of Rhode Island Change Assessment Scale (URICA) in Project MATCH using an exploratory structural equation modeling (ESEM) approach.

METHODS

We conducted a secondary analysis of data from Project MATCH (N = 1726; M_age  = 40.2, SD = 10.9; 75.7% male; 80% non-Hispanic white), a multisite randomized clinical trial that tested three AUD treatments: Motivational Enhancement Therapy, Cognitive-Behavioral Therapy, or Twelve-Step Facilitation. Participants completed the 24-item URICA for assessing the stages of change in relation to drinking at baseline and post-treatment (3 months after baseline).

RESULTS

A 4-factor ESEM provided a good fit to the data and a better fit to the data than a conventional 4-factor confirmatory factor analysis model. Further, the URICA demonstrated scalar invariance across each patient subgroup at baseline (sex, ethnicity, marital status, education, and parental history of AUD) and treatment condition at follow-up. However, the URICA was not longitudinally invariant as the metric model resulted in a significant decrement in model fit.

CONCLUSIONS

Measurement invariance of the URICA over time was not supported. Longitudinally invariant measures of the stages of change are needed to test the proposal that progression through the stages explains treatment effects.

Psychometric evaluation of the treatment entry questionnaire to assess extrinsic motivation for inpatient addiction treatment

INTRODUCTION

Valid multi-faceted measurement of motivation for substance use disorder (SUD) treatment is needed to help inform treatment approaches and predict outcomes. This study examined evidence of validity for the Treatment Entry Questionnaire (TEQ-9).

METHODS

Data represented individuals entering inpatient SUD treatment (n = 1455). We used confirmatory factor analysis (CFA) to assess the three-factor structure of the TEQ-9 [identified (i.e., values/personally chooses treatment), introjected (i.e., internally controlled by guilt/shame) and external motivations (i.e., external pressure/demands)], and examined measurement invariance across gender, age, and ethno-racial identity. Correlation with readiness and confidence assessed convergent validity, while correlations with substance use problem severity and previous substance use treatment assessed meaningful group differences.

RESULTS

A three-factor structure was confirmed with all items loading significantly onto their respective factors (ps < 0.001). Each subscale demonstrated high internal consistency (Identified α = 0.90; Introjected α = 0.79; External α = 0.85). Each subscale demonstrated measurement invariance up to the scalar level across all sub-groups. Readiness, confidence, and substance use problem severity correlated as expected across various substances with the identified (rs = 0.098 - 0.262, ps < 0.05), and external (rs = -0.096 - -0.178, ps < 0.05) subscales. Additionally, the mean Identified subscale score was significantly higher among those who previously engaged in SUD treatment (p < 0.001). Findings for the Introjected subscale were more ambiguous.

CONCLUSIONS

Findings provide evidence for factorial validity, measurement invariance, convergent validity and group differences of the TEQ-9 in a large clinically mixed inpatient SUD treatment population, providing further support of its clinical and research utility.

Role of Causality Orientations in Predicting Alcohol Use and Abstinence Self-Efficacy

In the present study, we examined the ability of Self-Determination Theory's causality orientations to predict alcohol use and abstinence self-efficacy. We also provided suggestions for counselors supporting client and student autonomy in clinical practice. Objectives: This study sought to answer the following questions: (a) Does a person's causality orientation (autonomy, control, and impersonal) predict their alcohol use? (2) Does a person's causality orientation (autonomy, control, and impersonal) predict their temptation to use drugs and alcohol? (3) Does a person's causality orientation (autonomy, control, and impersonal) predict their confidence to use drugs and alcohol? Method: We utilized Amazon's Mechanical Turk (MTurk), a crowdsourced online labor market approach to collect data from a community sample. Results: The results suggest heightened impersonal orientation was predictive of increased alcohol use and increased temptation to use while control orientation was also predictive of increased temptation. Higher autonomous orientation was predictive of increased confidence to not use while impersonal and controlled were not. Conclusion: This study's findings underline the importance of SDT in substance use prevention, initiation, and treatment, and open the door to more empowering interventions. Through the intentional use of SDT, individuals may feel more empowered to set and achieve goals, feel a greater sense of control in their lives, strengthening their overall autonomy.

Investigating the experiences of individuals in recovery from problem substance use and their perceptions of the COVID-19 pandemic

Purpose

This paper aims to explore how enforced forms of social isolation arising from the first COVID-19 lockdown influenced experiences of problem substance use, relapse and coping strategies for recovery in individuals engaging with harm reduction recovery services.

Design/methodology/approach

A qualitative semi-structured interview design was adopted for this research. Seven participants were recruited from a harm reduction recovery organisation. During their initial interview, participants volunteered information regarding their experience of the first lockdown due to emerging concerns of the COVID-19 pandemic. Participants completed a second semi-structured interview at the end of the first lockdown regarding their experience of enforced isolation during this time.

Findings

Three themes identified from the analysis were isolation resulting in hindered human capabilities; adjusting to a new normal: an individual experience; and unexpected benefits to recovery resulting from isolation. While some participants reported boredom, loneliness and relapse events, others reported that the national response to the virus did not adversely affect them as they had already adjusted to living in a state of anxiety, isolation and uncertainty. These findings illuminate negative, neutral and positive aspects of substance use recovery throughout the COVID-19 lockdown as well as highlighting the complex and individualised role that social connectedness plays in relapse occurrence.

Originality/value

Participants reported differences in how they were affected by the pandemic, leading to theoretical implications for the effect of social isolation on recovery. For this reason, individuals with a history of dependency should be considered potentially vulnerable to the effects of enforced isolation and should be supported accordingly.