The Role of Social Support in Motivating Reductions in Alcohol Use: A Test of Three Models of Social Support in Alcohol-Impaired Drivers

Risk and Protective Factors for Parental Involvement and Early Indicators of School Achievement in Alaska

OBJECTIVES

Parental involvement can affect child school readiness, which in turn influences subsequent child learning outcomes. While social support, stress, caregiver psychological distress, and drinking could affect parental involvement, it is unknown whether and how these factors influence downstream child learning outcomes through parental involvement and child school readiness. This study tests those associations.

METHODS

Using de-identified data provided by the Alaska Longitudinal Child Abuse and Neglect Linkage project (N = 683), we use Structural Equation Modeling to assess direct and indirect effects of paths embedded in the proposed model.

RESULTS

This study found statistically significant indirect effects: (1) path linking stress faced by caregivers to child reading proficiency through caregiver psychological distress, parental involvement, and child school readiness, (2) path linking stress faced by caregivers to child reading proficiency through caregiver drinking, parental involvement, and child school readiness, and (3) path linking social support for caregivers to child reading proficiency through caregiver psychological distress, parental involvement, and child school readiness. Post-estimation showed that the sum of the magnitude of total effects of stress and the magnitude of total effects of support is significantly larger than either alone.

CONCLUSIONS FOR PRACTICE

Findings suggest that reducing caregiver stress and offering social support could not only benefit caregivers but learning outcomes of their children as well. For child learning outcomes, simultaneously reducing stress and offering social support for caregivers, rather than just one of them alone, is suggested. These results are important for children, particularly for those raised by caregivers experiencing psychological distress or drinking issues.

The indirect effects of self-regulation on the association of social support with increased protective drinking behavior and decreased alcohol problems in a predominantly Hispanic college student sample

BACKGROUND

Research suggests that self-regulation, which refers to one's ability to manage a behavior, and social support are related to alcohol use. Other research suggests that social support may serve as a precursor to self-regulation and health-promoting behaviors. We examined whether self-regulation has an indirect effect on the association between social support and both protective drinking behaviors and alcohol problems.

METHODS

A random sample of students at a Hispanic Serving Institution completed an online survey, which included sociodemographic questions, the Multidimensional Perceived Social Support Scale, the Short Self-Regulation Questionnaire, the Protective Behavioral Strategies (PBS) Scale, and the Rutgers Alcohol Problem Index. Undergraduate students (n = 192) who reported drinking in the last month were included in the analysis. A path analysis using Mplus8 was conducted to investigate the relationships among social support, self-regulation, PBS, and alcohol-related problems.

RESULTS

The sample was mostly female (58.9) and of Hispanic ethnicity (89.6). Analyses showed that social support had a significant positive association with PBS and a significant negative association with alcohol-related problems. When self-regulation was added to the models, these associations were no longer significant, and self-regulation had a significant indirect effect on the relationship between social support and both PBS and alcohol-related problems.

CONCLUSIONS

The results of the current cross-sectional study suggest that a viable hypothesis in future longitudinal studies is that self-regulation is a mechanism by which social support increases PBS and reduces alcohol problems. Future research should assess longitudinally both the mediating effects of self-regulation between social support and drinking outcomes and potential moderators, such as ethnicity.

Closing the Care Gap: Management of Alcohol Use Disorder in Patients with Alcohol-associated Liver Disease

Alcohol-associated liver disease (ALD)-related morbidity and mortality are rising in the United States. Although effective medications and behavioral interventions are available for the treatment of patients with alcohol use disorder (AUD), patients with ALD are profoundly undertreated for AUD. This article reviews the management of AUD in patients with ALD, with a focus on appropriate screening and diagnosis, management of alcohol withdrawal syndrome, pharmacotherapy for AUD, alcohol biomarkers, and behavioral interventions. Expanding access to AUD treatment is imperative for improving health outcomes in patients with ALD.

Alcohol consumption and associated factors among pregnant women attending antenatal care at governmental hospitals in Harari regional state, Eastern, Ethiopia

BACKGROUND

Alcohol consumption during the pregnancy period is high despite the well-established evidence of its harmful effects on pregnancy and infant development. Early identification and behavioral modification are of great significance. This study aimed to assess the prevalence and associated factors of alcohol consumption among pregnant women attending antenatal care at governmental hospitals in the Harari regional state, Eastern Ethiopia.

METHOD

From April 1/2022-May 1/2022, an institutional-based cross-sectional survey was conducted among 589 pregnant women attending antenatal care governmental hospitals in Harari regional state. A systematic random sampling technique was used to select study participants during the study period. Data were collected through face-to-face interview methods using AUDIT-C. The collected data were coded, entered into Epi-data data version 3.1, and analyzed by SPSS Version 26. Binary logistic regression was carried out to identify independent predictors of alcohol consumption at a 95% confidence level.

RESULTS

From a total of 617 eligible participants, 589 participated in the study with a response rate of 95.46%. The overall prevalence of alcohol consumption among pregnant women in Harari regional state governmental hospitals was 21.2% (95% CI:17.8, 24.4). In multivariate analysis, single marital status (AOR = 5.18;95% CI (2.66,10.11), previous history of abortion(AOR = 4.07;95% CI(2.06,8.04), family history of mental illness (AOR = 4.79;95% CI (1.94,11.83), depression (AOR 2.79; 95%CI(1.35,5.76), and anxiety(AOR = 2.51; 95% CI (1.23, 5.12) were variables found to have a statistically significant association with alcohol consumption during pregnancy in Harari regional state governmental hospitals.

CONCLUSION

In comparison to the majority of other research, the prevalence of alcohol usage during pregnancy was high in this study. This study observed that single marital status, previous history of abortion, family history of mental illness, depression, and anxiety were highly associated with alcohol consumption during pregnancy. Hence, responsible bodies working on mother and child health should try to mitigate or remove the above-mentioned risks when developing interventions.

Gender Differences in the Psychosocial Determinants Underlying the Onset and Maintenance of Alcohol Use Disorder

A large number of different mechanisms have been linked to Alcohol Use Disorder (AUD), including psychosocial, neurocognitive, affective, and neurobiological factors. Gender has been shown to impact the presentation and progression of AUD; yet, little work has been done to parse the different mechanisms underlying AUD within the lens of gender differences. A review of the literature on adolescence revealed that psychosocial factors, in particular lack of family social support and interactions with peers, drive the onset of alcohol use more strongly in girls relative to boys. However, research done on gender differences in disease progression in adults remains limited. Our gender-specific analysis of the mechanisms underlying AUD in adults revealed that lack of social support was causally linked to negative affect, mental health symptoms, and AUD symptom severity in women, but not men. These novel results suggest that psychosocial factors may play a gender-specific role not only in the onset of use in adolescence, but also in the maintenance of addiction in adults. If confirmed, this suggests the need for investigating gender-specific recovery trajectories. In this perspective piece, we review the literature regarding gender differences in the onset and maintenance of AUD and present original data that support unique risk factors in women.

An Assessment of the Psychosocial Evaluation for Early Liver Transplantation in Patients With Acute Alcoholic Hepatitis in the Context of Alcohol Use Disorder, a Case-Control Study

Background:

Severe acute alcoholic hepatitis (AAH) has an extremely poor prognosis with a high short term mortality rate. As a result, many centers, including our own, have allowed transplant patients to be listed for transplantation prior to achieving 6-months of sobriety. Several scoring systems, designed to target patients with a minimal period of sobriety, have been proposed to identify patients with alcohol use disorder (AUD), who would be predisposed to relapse after liver transplantation. We investigated whether these scoring systems corroborated the results of the non-structured selection criteria used by our center regarding decision to list for transplant.

Methods:

We conducted a retrospective case-control study of 11 patients who underwent early liver transplantation for AAH matched with 11 controls who were declined secondary to low insight into AUD. Blinded raters confirmed the severity of the diagnosis of DSM-5 and scored the patients on a variety of structured psychometric scales used to predict alcohol relapse. These included the High Risk for Alcohol Relapse Scale (HRAR), Stanford Integrated Psychosocial Assessment Tool (SIPAT), Alcohol Relapse Risk Assessment (ARRA), Hopkins Psychosocial Scale (HPSS), Michigan Alcoholism Prognosis Score (MAPS), Alcohol Use Disorders Identification Test -Consumption (AUDIT-C), and Sustained Alcohol Use Post-Liver Transplant (SALT) scales. All patients who underwent transplantation were followed for harmful and non-harmful drinking until the end of the study period.

Results:

The transplant recipients had significantly favorable MAPS, HRAR, SIPAT, ARRA, and HPSS scores with cutoffs that matched their previous research. The SALT and AUDIT-C scores were not predictive of our selection of patients for transplantation. Despite an expedited evaluation and no significant period of sobriety, our case cohort had a 30% relapse to harmful drinking after an average of 6.6 years (5-8.5 years) of follow-up.

Discussion:

Despite the rapid assessment and the short to no period of sobriety, the patient cohort demonstrated a 30% relapse to harmful drinking, consistent with the 20% to 30% relapse to drinking rate reported after liver transplantation for all forms of alcoholic liver disease. Average scores from MAPS, HRAR, SIPAT, ARRA, and HPSS corroborated our current stratification procedures, with lower mean risk scores found in the transplanted group.

Conclusion:

Patients with AUD and severe AAH who obtain new insight into their disease and posses other favorable psychosocial factors have low rates of AUD relapse post-liver-transplantation. The psychosocial selection criteria for patients with alcoholic hepatitis in our institution are consistent with 4 of the 5 scoring systems investigated in their prediction of sobriety post-transplant.

Social Support Effects on Neural Stress and Alcohol Reward Responses

Social support (SS), or having people to depend on during times of stress, may offer an emotional and neurological buffer to problem drinking. Specifically, SS may modulate reward and stress-related brain responses to mitigate perceptions of alcohol reward and stress. There is limited evidence, however, on this topic and specifically on brain networks that may modulate SS effects on stress and alcohol reward. Here we present a review of the current literature on this topic as well as data from a large community sample of 115 social drinkers. Findings from a novel fMRI task viewing alcohol cue, stress, and neutral images, in separate blocks, while providing ratings on subjective feelings of alcohol craving, stress, and arousal are included. Lower SS significantly predicted greater alcohol craving during alcohol cue and stress conditions, higher baseline levels of stress, and greater arousal in the alcohol cue, relative to neutral condition. Remarkably, individuals with low SS showed greater reward activation (ventral medial prefrontal cortex (VmPFC) and ventral striatum) during alcohol cue exposure, while those with high SS showed no such activation (p < 0.001, family wise error corrected at 0.05). Furthermore, individuals with lower SS showed greater stress circuit (VmPFC, dorsal striatum, and periaqueductal gray) activation not observed in the high SS groups. Both groups showed increased amygdala activation under stress condition. The findings support the notion that SS is a powerful modulator of stress response and reward motivation. High SS buffers neural and subjective stress responses, while low SS potentiates greater reward seeking with higher alcohol craving and greater brain activation during alcohol cue exposure. Previous research and current results suggest the need to further explore the role of SS in those at risk of developing alcohol use disorder and assess novel prevention strategies to boost SS in at-risk drinkers.

Social Support and the Rehabilitation of Alcohol-Impaired Drivers: Drinking Motives as Moderators

Alcohol-impaired driving is a common and costly public health problem associated with alcohol misuse. This investigation aims to understand the role of social support and drinking motives in motivating alcohol-impaired drivers to reduce alcohol use. One hundred nineteen participants with a history of driving-while-intoxicated arrest were recruited from either a correctional treatment facility (n = 59) or the community (n = 60) and asked about their motivation to change alcohol use. Motivation to change was tested in relationships with two types of social support (i.e. Abstinence-Specific Social Support and General Social Support) and drinking motives (Coping, Enhancement, and Social Motives). The results showed: (1) only Abstinence-Specific Social Support was positively associated with motivation to change; (2) Coping and Social Motives had a negative association with motivation to change; (3) the impact of Abstinence-Specific Social Support on motivation to change was greater among those with a stronger Enhancement Motives. In other words, those who drink primarily for pleasure showed a greater increase in motivation to change when more Abstinence-Specific Social Support is available, compared to those with lower Enhancement Motives. The findings of this investigation contribute to our knowledge of the roles of communication in the rehabilitation of alcohol-impaired drivers.

The Double Mediating Effect of Social Isolation and Emotional Support on Feelings of Entrapment and Motivation for Recovery among Korean Alcoholic Inpatients

This study identified the relationship between feeling of entrapment and motivation for change among hospitalized alcoholic patients and examined the double mediating effect model of social isolation and emotional support on this relationship. The study participants were 101 male and female alcoholic patients hospitalized at C hospital, which specializes in alcohol treatment at I city in Korea. PROCESS Macro 3.5 Model 6 was used for analyses of double mediating effects. The results revealed that entrapment and social isolation were negatively correlated with motivation for recovery of alcoholic inpatients, whereas emotional support was positively correlated with it. In a sequential double mediation model for motivation to change in alcoholic inpatients, the direct effects of social isolation and entrapment were not significant. However, the sequential indirect effect of social isolation and emotional support on entrapment and motivation for recovery among alcoholic inpatients was significant. These results suggest that making alcoholic inpatients not feel socially isolated by providing them with emotional support or through other means of assistance by practitioners or family members is important for their recovery from alcohol use disorder.

Social support modifies the association between hazardous drinking and depression symptoms among ART clients in Vietnam

INTRODUCTION

Hazardous drinking is widespread among people with HIV (PWH). PWH are also vulnerable to depression due to HIV-related social stigma, and social support can play an important role in improving mental health for this population. No studies have explored whether social support modifies the association of hazardous drinking and depressive symptoms among PWH.

METHODS

We used baseline data from a randomized controlled trial of two evidence-based alcohol reduction interventions among antiretroviral therapy clients in Vietnam. Hazardous alcohol use was defined as having a score ≥8 for men and ≥ 7 for women on the Alcohol Use Disorders Identification Test. The presence of depression symptoms was defined as a score ≥ 5 on the Patient Health Questionnaire-9. Social support was measured with a 5-question modified version of the Medical Outcomes Study Social Support Instrument. Crude (CPRs) and adjusted prevalence ratios (aPRs) of the association were presented.

RESULTS

Hazardous drinking was significantly associated with increased likelihood of having depressive symptoms (aPR = 1.26;95%CI 1.04-1.52). Hazardous drinking and depression symptoms were not associated among those with high social support (aPR = 1.01;95%CI 0.76-1.35), but were associated among those with medium (aPR = 1.24;95%CI 0.92-1.69) and low social support (aPR = 1.71;95%CI 1.25-2.34).

CONCLUSIONS

Social support significantly modified the association between hazardous drinking and depression symptoms among ART clients in Vietnam. Interventions to decrease hazardous alcohol use are broadly indicated for PWH in Vietnam and other low-resource settings, but special attention or modifications may be needed to support mental health among those with lower levels of social support.