Brief Motivational Interventions Are Associated with Reductions in Alcohol-Induced Blackouts Among Heavy Drinking College Students

Motivational interviewing for substance use reduction

BACKGROUND

Substance use is a global issue, with around 30 to 35 million individuals estimated to have a substance-use disorder. Motivational interviewing (MI) is a client-centred method that aims to strengthen a person's motivation and commitment to a specific goal by exploring their reasons for change and resolving ambivalence, in an atmosphere of acceptance and compassion. This review updates the 2011 version by Smedslund and colleagues.

OBJECTIVES

To assess the effectiveness of motivational interviewing for substance use on the extent of substance use, readiness to change, and retention in treatment.

SEARCH METHODS

We searched 18 electronic databases, six websites, four mailing lists, and the reference lists of included studies and reviews. The last search dates were in February 2021 and November 2022.

SELECTION CRITERIA

We included randomised controlled trials with individuals using drugs, alcohol, or both. Interventions were MI or motivational enhancement therapy (MET), delivered individually and face to face. Eligible control interventions were no intervention, treatment as usual, assessment and feedback, or other active intervention.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane, and assessed the certainty of evidence with GRADE. We conducted meta-analyses for the three outcomes (extent of substance use, readiness to change, retention in treatment) at four time points (post-intervention, short-, medium-, and long-term follow-up).

MAIN RESULTS

We included 93 studies with 22,776 participants. MI was delivered in one to nine sessions. Session durations varied, from as little as 10 minutes to as long as 148 minutes per session, across included studies. Study settings included inpatient and outpatient clinics, universities, army recruitment centres, veterans' health centres, and prisons. We judged 69 studies to be at high risk of bias in at least one domain and 24 studies to be at low or unclear risk. Comparing MI to no intervention revealed a small to moderate effect of MI in substance use post-intervention (standardised mean difference (SMD) 0.48, 95% confidence interval (CI) 0.07 to 0.89; I2 = 75%; 6 studies, 471 participants; low-certainty evidence). The effect was weaker at short-term follow-up (SMD 0.20, 95% CI 0.12 to 0.28; 19 studies, 3351 participants; very low-certainty evidence). This comparison revealed a difference in favour of MI at medium-term follow-up (SMD 0.12, 95% CI 0.05 to 0.20; 16 studies, 3137 participants; low-certainty evidence) and no difference at long-term follow-up (SMD 0.12, 95% CI -0.00 to 0.25; 9 studies, 1525 participants; very low-certainty evidence). There was no difference in readiness to change (SMD 0.05, 95% CI -0.11 to 0.22; 5 studies, 1495 participants; very low-certainty evidence). Retention in treatment was slightly higher with MI (SMD 0.26, 95% CI -0.00 to 0.52; 2 studies, 427 participants; very low-certainty evidence). Comparing MI to treatment as usual revealed a very small negative effect in substance use post-intervention (SMD -0.14, 95% CI -0.27 to -0.02; 5 studies, 976 participants; very low-certainty evidence). There was no difference at short-term follow-up (SMD 0.07, 95% CI -0.03 to 0.17; 14 studies, 3066 participants), a very small benefit of MI at medium-term follow-up (SMD 0.12, 95% CI 0.02 to 0.22; 9 studies, 1624 participants), and no difference at long-term follow-up (SMD 0.06, 95% CI -0.05 to 0.17; 8 studies, 1449 participants), all with low-certainty evidence. There was no difference in readiness to change (SMD 0.06, 95% CI -0.27 to 0.39; 2 studies, 150 participants) and retention in treatment (SMD -0.09, 95% CI -0.34 to 0.16; 5 studies, 1295 participants), both with very low-certainty evidence. Comparing MI to assessment and feedback revealed no difference in substance use at short-term follow-up (SMD 0.09, 95% CI -0.05 to 0.23; 7 studies, 854 participants; low-certainty evidence). A small benefit for MI was shown at medium-term (SMD 0.24, 95% CI 0.08 to 0.40; 6 studies, 688 participants) and long-term follow-up (SMD 0.24, 95% CI 0.07 to 0.41; 3 studies, 448 participants), both with moderate-certainty evidence. None of the studies in this comparison measured substance use at the post-intervention time point, readiness to change, and retention in treatment. Comparing MI to another active intervention revealed no difference in substance use at any follow-up time point, all with low-certainty evidence: post-intervention (SMD 0.07, 95% CI -0.15 to 0.29; 3 studies, 338 participants); short-term (SMD 0.05, 95% CI -0.03 to 0.13; 18 studies, 2795 participants); medium-term (SMD 0.08, 95% CI -0.01 to 0.17; 15 studies, 2352 participants); and long-term follow-up (SMD 0.03, 95% CI -0.07 to 0.13; 10 studies, 1908 participants). There was no difference in readiness to change (SMD 0.15, 95% CI -0.00 to 0.30; 5 studies, 988 participants; low-certainty evidence) and retention in treatment (SMD -0.04, 95% CI -0.23 to 0.14; 12 studies, 1945 participants; moderate-certainty evidence). We downgraded the certainty of evidence due to inconsistency, study limitations, publication bias, and imprecision.

AUTHORS' CONCLUSIONS

Motivational interviewing may reduce substance use compared with no intervention up to a short follow-up period. MI probably reduces substance use slightly compared with assessment and feedback over medium- and long-term periods. MI may make little to no difference to substance use compared to treatment as usual and another active intervention. It is unclear if MI has an effect on readiness to change and retention in treatment. The studies included in this review were heterogeneous in many respects, including the characteristics of participants, substance(s) used, and interventions. Given the widespread use of MI and the many studies examining MI, it is very important that counsellors adhere to and report quality conditions so that only studies in which the intervention implemented was actually MI are included in evidence syntheses and systematic reviews. Overall, we have moderate to no confidence in the evidence, which forces us to be careful about our conclusions. Consequently, future studies are likely to change the findings and conclusions of this review.

The effect of alcohol use disorder symptom and recovery narratives on problem-recognition: A randomized online trial

BACKGROUND

Low problem recognition is a barrier to seeking treatment for alcohol use disorder ("AUD"). Promoting continuum belief narratives, which conceptualize AUD as a spectrum, together with narratives that promote non-abstinence recovery may boost self-recognition of risky drinking. This experimental study examines the effect of dichotomous vs continuous symptom narratives and non-abstinence vs abstinence recovery narratives on self-recognition of risky drinking among students.

METHODS

N = 489 participants were randomized to one of four interventions combining a continuous vs dichotomous AUD symptom narrative with an abstinence vs moderated drinking AUD recovery narrative in a 2×2 design. Participants completed demographic and alcohol use (AUDIT-C) preintervention measures and postintervention measures assessing self-recognition of risky drinking and endorsement of continuum beliefs.

RESULTS

Moderate drinking recovery narratives resulted in higher endorsement of continuum beliefs (F (1, 485) = 16.27, p <.001, η2p =.032 90 % CI [0.01, 0.06]). Recognizing own risky drinking behavior was unaffected by the interventions. However, in a subgroup of participants without prior AUD experience who met AUDIT-C criteria for risky drinking, the combination of a continuous symptom narrative and moderated drinking recovery narrative resulted in higher problem recognition (F (1, 48) = 5.79, p =.020, η2p =.10, 90 % CI [0.01, 0.25]).

CONCLUSIONS

Exposure to moderated drinking recovery narratives may help develop an awareness in young adults that problematic alcohol use exists on a spectrum. Among those at increased risk for AUD, exposure to narratives that promote a continuous model of AUD and non-abstinence recovery may increase problem recognition.

A mixed-methods approach to improve the measurement of alcohol-induced blackouts: ABOM-2

BACKGROUND

Alcohol-induced blackouts describe memory loss resulting from alcohol consumption. Approximately half of college students report experiencing a blackout in their lifetime. Blackouts are associated with an increased risk for negative consequences, including serious injury. Research has documented two types of blackouts, en bloc (EB) and fragmentary (FB). However, research is limited by the lack of a validated measure that differentiates between these two forms of blackout. This study used a mixed-methods approach to improve the assessment of FB and EB among young adults. Specifically, we sought to improve the existing Alcohol-Induced Blackout Measure (ABOM), which was derived from a relatively small pool of items that did not distinguish FB from EB.

METHODS

Study 1 used three rounds of cognitive interviewing with U.S. college students (N = 31) to refine existing assessment items. Nineteen refined blackout items were retained for Study 2. Study 2 used face validity, factor analysis, item response theory, and external validation analyses to test the two-factor blackout model among U.S. heavy-drinking college students (N = 474) and to develop and validate a new blackout measure (ABOM-2).

RESULTS

Iterative factor analyses demonstrated that the items were well represented by correlated EB and FB factors, consistent with our hypothesis. External validation analyses demonstrated convergent and discriminant validity. These analyses also provided preliminary evidence for the two factors having differential predictive validity (e.g., FB correlated with enhancement drinking motives, while EB correlated with coping and conformity motives).

CONCLUSIONS

The Alcohol-Induced Blackout Measure-2 (ABOM-2) improves the measurement of blackout experiences among college students. Its use could facilitate the examination of EB and FB as differential predictors of alcohol-related outcomes in future studies.

Gender and Childhood Victimization: A Longitudinal Study of Heavy Drinking in Young Adulthood

The present longitudinal study, for 12 years, followed a group of young adults, examining (1) whether/how victimization in childhood increased the likelihood of heavy drinking; (2) whether depression mediated the strain-heavy drinking relationship; and (3) whether/how relationships among strain, depression, and heavy drinking differed across two gender groups. Data came from the National Longitudinal Survey of Youth 1997 cohort, dating 2004-2015 (5 interview waves and 22,549 person-wave measurements total). We linked consumption of 5+ drinks (during the month prior) to four discrete measures of violent victimization, to one measure of stressful events, and to depression. We needed to consider repeat measures of the same variables over time, so we used generalized estimating equations (GEE) to analyze data. Depression was found to increase heavy drinking uniformly. Empirical evidence confirmed that in the strain-heavy drinking relationship, depression plays a minor mediating role. Gender moderated heavy drinking's associations. Specifically, bullying in childhood raised risk for female respondents. The current strain was associated with a higher risk of heavy drinking among male respondents. Childhood victimization, as well as current life stress, play an important role in depression and heavy drinking. Future research should focus on the development of specific, targeted care to reduce heavy drinking's harm and promote equity among Americans.

Intentions and motives to experience alcohol-induced blackout among young adults in college

Blackouts are typically considered a negative consequence of alcohol use. Yet some college students report consuming alcohol with the intention of blacking out. This study examined intentions and motives for blackout drinking among young adults in college. College students with a past-year history of blackout (N = 350, 56% female, 73% White) completed an anonymous online survey. Descriptive statistics were used to examine the incidence of blackout intentions, and individuals who did and did not report future blackout intentions were then compared on drinking patterns, depressive symptoms, social norms, and outcome expectancies. Overall, 135 participants (39%) reported consuming alcohol in the past 30 days with the intention of losing memory of the night's events, and 107 (31%) reported blackout intentions in the next 30 days. When asked (via open text box) to indicate their motives for past blackout intentions, the majority of participants provided responses that fit with coping, social, or enhancement drinking motives. A larger proportion of men than women reported blackout intentions. As a group, those reporting future blackout intentions reported heavier, more frequent, and more problematic drinking, as well as more symptoms of depression and more positive (but not negative) outcome expectancies. A substantial subset of college students reporting a blackout in the past year also endorsed intentions to experience a blackout in the next 30 days. Given strong associations between intentions and subsequent behavior, interventions targeting blackout styles of drinking are warranted. The extent to which "blackout" drinking motives differ from traditional drinking motives is unclear. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The role of alcohol-induced blackouts in symptoms of depression among young adults

OBJECTIVE

Blackouts are associated with other alcohol-related consequences and depression among young adults, but the mechanisms underlying these associations are unclear. Using two separate samples, we tested the hypothesis that blackouts would be linked to symptoms of depression due in part to their association with other alcohol-related consequences.

METHOD

Young adults who use alcohol completed assessments at baseline in Sample 1 (N₁ = 381, 58% female) and baseline, 3 months, and 6 months in Sample 2 (N₂ = 603, 53 % female). Bootstrapped confidence intervals were used to examine the direct and indirect effects of blackouts on depressive symptoms, using cross-sectional mediation analysis in Sample 1 and a counterfactual approach with longitudinal data in Sample 2.

RESULTS

In both samples, alcohol-induced blackouts were associated with alcohol-related consequences, which in turn were associated with symptoms of depression. In Sample 1, blackouts had both direct and indirect (mediated) effects on depressive symptoms. In Sample 2, blackouts measured at baseline only had an indirect effect on depressive symptoms six months later through other alcohol-related consequences at three months.

CONCLUSIONS

Among heavy-drinking college students, the majority of whom reported minimal symptoms of depression, blackouts were associated with increases in other alcohol-related consequences, which in turn were associated with increases in symptoms of depression. These findings suggest that prevention and intervention efforts targeting blackouts may help reduce other alcohol-related consequences among young adults.