Two-year outcome of an intervention program for university students who have parents with alcohol problems: a randomized controlled trial

Effectiveness of a Web-Based Individual Coping and Alcohol Intervention Program for Children of Parents With Alcohol Use Problems: Randomized Controlled Trial

BACKGROUND

Children whose parents have alcohol use problems are at an increased risk of several negative consequences, such as poor school performance, an earlier onset of substance use, and poor mental health. Many would benefit from support programs, but the figures reveal that only a small proportion is reached by existing support. Digital interventions can provide readily accessible support and potentially reach a large number of children. Research on digital interventions aimed at this target group is scarce. We have developed a novel digital therapist-assisted self-management intervention targeting adolescents whose parents had alcohol use problems. This program aims to strengthen coping behaviors, improve mental health, and decrease alcohol consumption in adolescents.

OBJECTIVE

This study aims to examine the effectiveness of a novel web-based therapist-assisted self-management intervention for adolescents whose parents have alcohol use problems.

METHODS

Participants were recruited on the internet from social media and websites containing health-related information about adolescents. Possible participants were screened using the short version of the Children of Alcoholics Screening Test-6. Eligible participants were randomly allocated to either the intervention group (n=101) or the waitlist control group (n=103), and they were unblinded to the condition. The assessments, all self-assessed, consisted of a baseline and 2 follow-ups after 2 and 6 months. The primary outcome was the Coping With Parents Abuse Questionnaire (CPAQ), and secondary outcomes were the Center for Epidemiological Studies Depression Scale, Alcohol Use Disorders Identification Test (AUDIT-C), and Ladder of Life (LoL).

RESULTS

For the primary outcome, CPAQ, a small but inconclusive treatment effect was observed (Cohen d=-0.05 at both follow-up time points). The intervention group scored 38% and 46% lower than the control group on the continuous part of the AUDIT-C at the 2- and 6-month follow-up, respectively. All other between-group comparisons were inconclusive at either follow-up time point. Adherence was low, as only 24% (24/101) of the participants in the intervention group completed the intervention.

CONCLUSIONS

The findings were inconclusive for the primary outcome but demonstrate that a digital therapist-assisted self-management intervention may contribute to a reduction in alcohol consumption. These results highlight the potential for digital interventions to reach a vulnerable, hard-to-reach group of adolescents but underscore the need to develop more engaging support interventions to increase adherence.

TRIAL REGISTRATION

ISRCTN Registry ISRCTN41545712; https://www.isrctn.com/ISRCTN41545712?q=ISRCTN41545712.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1186/1471-2458-12-35.

Effective behaviour change techniques for family and close friends: A systematic review and meta-analysis across the addictions

This systematic review aimed to determine whether the use of specific behaviour change technique (BCT) groups are associated with greater effectiveness for psychosocial interventions delivered to family and close friends (FCFs) impacted by addiction. A systematic search of peer-reviewed and grey literature published until August 2021 identified 32 studies in 38 articles. An established BCT taxonomy (93 BCTs clustered into 16 groups) was adapted (inclusion of seven additional BCT groups) and applied to 57 interventions. The meta-analyses indicated that some, but not all, FCF outcomes were improved by the exclusion of BCTs within several groups (Reward and Threat, Scheduled Consequences, Confrontation of the Addicted Person to Engage in Treatment, and Goals and Planning) and inclusion of BCTs within the Restoring a Balanced Lifestyle group. Addicted person outcomes were improved by the inclusion of some BCTs within several groups (Repetition and Substitution, Reward and Threat, Scheduled Consequences, and Restoring a Balanced Lifestyle). Relationship functioning outcomes were improved by the inclusion of BCTs within the Confrontation of the Addicted Person to Engage in Treatment group. Future research involving the development and evaluation of numerous interventions or comprehensive multi-component interventions that can address the various needs of FCFs, without counteracting them, is required.

Associations Among Attention Problems, Learning Strategies, and Hazardous Drinking Behavior in a College Student Sample: A Pilot Study

Despite research linking substance use/abuse to pejorative academic outcomes, the underlying behavior and cognitive mechanisms responsible for this association are largely unknown. This study addresses a specific call for understanding learning strategies and skills associated with substance alcohol use/abuse. Four hundred fifty undergraduates (59.6% female) completed measures of hazardous drinking behavior and student learning strategies. Approximately 35.3% of the sample reported hazardous drinking scores in the clinical range. Bivariate correlations and a regression framework were utilized to understand the associations among hazardous drinking behavior, academic skills/strategies, and student liabilities. In the present study, hazardous drinking behavior was associated with 4 learning strategies: note-taking/listening skills, test-taking strategies, organizational techniques, and time management. Moreover, hazardous drinking behavior was associated with 2 student liabilities: low academic motivation and concentration/attention difficulties. Results from follow-up analyses suggest that only organizational techniques and concentration/attention difficulties predicted hazardous drinking behavior. Promising areas for future research and potential intervention targets are discussed.

Drinking to cope mediates the relationship between depression and alcohol risk: Different pathways for college and non-college young adults

BACKGROUND

It is well-established that drinking to cope with negative affective states mediates the relationship between depressed mood and alcohol risk outcomes among college students. Whether non-college emerging adults exhibit a similar pathway remains unknown. In the current study, we compared the mediating role of coping motives in the relationship between depressive symptoms and drinking risk outcomes (heavy episodic drinking and alcohol problems) in college and non-college emerging adult subgroups.

METHODS

Participants were three hundred forty-one community-recruited 18-25year olds reporting past month alcohol use. We used a structural equation modeling (SEM) for our primary mediation analysis and bias-corrected bootstrap resampling for testing the statistical significance of mediation.

RESULTS

Participants averaged 20.8 (±1.97) years of age, 49% were female, 67.7% were White, 34.6% were college students, and 65.4% were non-college emerging adults. College and non-college emerging adults reported similar levels of drinking, alcohol problems, and drinking to cope with negative affect, and drinking to cope was associated with alcohol-related problems in both samples. However, while drinking to cope mediated the relationship between depressed mood and alcohol problems among students, it did not mediate the pathway among non-college emerging adults.

CONCLUSIONS

These findings caution against extending college-based findings to non-college populations and underscore the need to better understand the role of coping motives and other intervening factors in pathways linking depressed mood and alcohol-related risk in non-college emerging adults.

Effectiveness of brief alcohol interventions in primary care populations

BACKGROUND

Excessive drinking is a significant cause of mortality, morbidity and social problems in many countries. Brief interventions aim to reduce alcohol consumption and related harm in hazardous and harmful drinkers who are not actively seeking help for alcohol problems. Interventions usually take the form of a conversation with a primary care provider and may include feedback on the person's alcohol use, information about potential harms and benefits of reducing intake, and advice on how to reduce consumption. Discussion informs the development of a personal plan to help reduce consumption. Brief interventions can also include behaviour change or motivationally-focused counselling.This is an update of a Cochrane Review published in 2007.

OBJECTIVES

To assess the effectiveness of screening and brief alcohol intervention to reduce excessive alcohol consumption in hazardous or harmful drinkers in general practice or emergency care settings.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and 12 other bibliographic databases to September 2017. We searched Alcohol and Alcohol Problems Science Database (to December 2003, after which the database was discontinued), trials registries, and websites. We carried out handsearching and checked reference lists of included studies and relevant reviews.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) of brief interventions to reduce hazardous or harmful alcohol consumption in people attending general practice, emergency care or other primary care settings for reasons other than alcohol treatment. The comparison group was no or minimal intervention, where a measure of alcohol consumption was reported. 'Brief intervention' was defined as a conversation comprising five or fewer sessions of brief advice or brief lifestyle counselling and a total duration of less than 60 minutes. Any more was considered an extended intervention. Digital interventions were not included in this review.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane. We carried out subgroup analyses where possible to investigate the impact of factors such as gender, age, setting (general practice versus emergency care), treatment exposure and baseline consumption.

MAIN RESULTS

We included 69 studies that randomised a total of 33,642 participants. Of these, 42 studies were added for this update (24,057 participants). Most interventions were delivered in general practice (38 studies, 55%) or emergency care (27 studies, 39%) settings. Most studies (61 studies, 88%) compared brief intervention to minimal or no intervention. Extended interventions were compared with brief (4 studies, 6%), minimal or no intervention (7 studies, 10%). Few studies targeted particular age groups: adolescents or young adults (6 studies, 9%) and older adults (4 studies, 6%). Mean baseline alcohol consumption was 244 g/week (30.5 standard UK units) among the studies that reported these data. Main sources of bias were attrition and lack of provider or participant blinding. The primary meta-analysis included 34 studies (15,197 participants) and provided moderate-quality evidence that participants who received brief intervention consumed less alcohol than minimal or no intervention participants after one year (mean difference (MD) -20 g/week, 95% confidence interval (CI) -28 to -12). There was substantial heterogeneity among studies (I² = 73%). A subgroup analysis by gender demonstrated that both men and women reduced alcohol consumption after receiving a brief intervention.We found moderate-quality evidence that brief alcohol interventions have little impact on frequency of binges per week (MD -0.08, 95% CI -0.14 to -0.02; 15 studies, 6946 participants); drinking days per week (MD -0.13, 95% CI -0.23 to -0.04; 11 studies, 5469 participants); or drinking intensity (-0.2 g/drinking day, 95% CI -3.1 to 2.7; 10 studies, 3128 participants).We found moderate-quality evidence of little difference in quantity of alcohol consumed when extended and no or minimal interventions were compared (-14 g/week, 95% CI -37 to 9; 6 studies, 1296 participants). There was little difference in binges per week (-0.08, 95% CI -0.28 to 0.12; 2 studies, 456 participants; moderate-quality evidence) or difference in days drinking per week (-0.45, 95% CI -0.81 to -0.09; 2 studies, 319 participants; moderate-quality evidence). Extended versus no or minimal intervention provided little impact on drinking intensity (9 g/drinking day, 95% CI -26 to 9; 1 study, 158 participants; low-quality evidence).Extended intervention had no greater impact than brief intervention on alcohol consumption, although findings were imprecise (MD 2 g/week, 95% CI -42 to 45; 3 studies, 552 participants; low-quality evidence). Numbers of binges were not reported for this comparison, but one trial suggested a possible drop in days drinking per week (-0.5, 95% CI -1.2 to 0.2; 147 participants; low-quality evidence). Results from this trial also suggested very little impact on drinking intensity (-1.7 g/drinking day, 95% CI -18.9 to 15.5; 147 participants; very low-quality evidence).Only five studies reported adverse effects (very low-quality evidence). No participants experienced any adverse effects in two studies; one study reported that the intervention increased binge drinking for women and two studies reported adverse events related to driving outcomes but concluded they were equivalent in both study arms.Sources of funding were reported by 67 studies (87%). With two exceptions, studies were funded by government institutes, research bodies or charitable foundations. One study was partly funded by a pharmaceutical company and a brewers association, another by a company developing diagnostic testing equipment.

AUTHORS' CONCLUSIONS

We found moderate-quality evidence that brief interventions can reduce alcohol consumption in hazardous and harmful drinkers compared to minimal or no intervention. Longer counselling duration probably has little additional effect. Future studies should focus on identifying the components of interventions which are most closely associated with effectiveness.

Effects of depressive symptoms and coping motives on naturalistic trends in negative and positive alcohol-related consequences

OBJECTIVE

Depressive symptoms and drinking to cope with negative affect increase the likelihood for drinking-related negative consequences among college students. However, less is known about their influence on the naturalistic trajectories of alcohol-related consequences. In the current study, we examined how positive and negative drinking-related consequences changed as a function of depressive symptoms and drinking motives (coping, conformity, social, enhancement).

METHOD

Participants (N=652; 58% female) were college student drinkers assessed biweekly during the first two years of college. We used hierarchical linear modeling to examine means of and linear change in positive and negative consequences related to depression and motives, controlling for level of drinking.

RESULTS

Consistent with hypotheses, negative and positive consequences decreased over the course of freshman and sophomore years. Higher levels of depression were associated with a faster decline in negative consequences during freshman year. Coping motives predicted average levels of negative and positive consequences across all years, with the effects of coping motives on consequences most pronounced at low levels of depression during sophomore year.

CONCLUSIONS

These findings indicate that screening students for depression and drinking to cope, independent of alcohol consumption, may help identify students at risk for experiencing negative alcohol consequences and that these factors should be addressed in targeted alcohol interventions.

Gender Differences in the Effect of Depressive Symptoms on Prospective Alcohol Expectancies, Coping Motives, and Alcohol Outcomes in the First Year of College

Problematic alcohol use and risk for dependence peak during late adolescence, particularly among first-year college students. Although students matriculating into college with depressive symptoms experience elevated risk for alcohol problems, few studies have examined the intervening mechanisms of risk. In this study, we examined depressed mood at college entry on prospective alcohol expectancies, drinking motives, and alcohol outcomes during the first year of college, adjusting for pre-college factors. Participants (N = 614; 59% female, 33% non-White) were incoming college students from three universities who completed online self-report surveys prior to matriculating into college and at the end of their first year in college. We utilized path analysis to test our hypotheses. In women, the path that linked depressive symptoms to consequences was primarily attributable to the effect of pre-college drinking to cope on drinking to cope in college, which in turn was associated with alcohol consequences. In men, the effect of depressive symptoms on alcohol consequences in college was independent of pre-college and college factors, thus indicating the need for research that identifies mechanisms of risk in males. Interventions that address coping deficits and motivations for drinking may be particularly beneficial for depressed adolescent females during this high-risk developmental period.

Design of a Web-based individual coping and alcohol-intervention program (web-ICAIP) for children of parents with alcohol problems: study protocol for a randomized controlled trial

Background

It has been estimated that approximately 20% of all Swedish children grow up with parents having alcohol problems, which may result in negative outcomes among these children. Therefore, most Swedish municipalities provide resources for support, but at the same time figures reveal that not even 2% receive support, mainly due to difficulties in identifying and recruiting these children into support programs. Delivering intervention programs to children and adolescents via the Internet seems a promising strategy, but to date, the number of web-based interventions aimed at this target group is very scarce. We have therefore developed a novel internet-delivered therapist assisted self-management intervention called the web-ICAIP (Individual Coping and Alcohol Intervention Program) for adolescents having parents with alcohol problems. The purpose of the program is to strengthen adolescents' coping behavior, improve their mental health, and postponing the onset or decreasing risky alcohol consumption. This paper describes the web-ICAIP and the design of a randomized controlled trial (RCT) to measure the efficacy of this intervention.

Methods/Design

The RCT will include at least 183 adolescents (15-19 year old) who will be randomly allocated to two conditions where one group has access to the web-ICAIP and the other is a waiting list control group. Participants will be recruited from websites containing information and facts for adolescents about alcohol and other drugs. Possible participants will be screened using the short version of the Children of Alcoholics Screening Test (CAST-6). The assessment consists of a baseline and two follow-up measurements taking place after two and six months, respectively. The primary outcomes include the Center for Epidemiological Studies Depression Scale (CES-DC), a coping behavior scale, and also the short version of the Alcohol Use Disorders Identification Test (AUDIT-C). Additional outcomes include the "Ladder of life" which measures overall life satisfaction and questions concerning program adherence.

Discussion

There is an urgent need for developing and evaluating web-based intervention programs which target children having parents with alcohol problems. This study will therefore make an important contribution to this novel field of research.

Trial registration

ISRCTN41545712

Predictors of error in estimates of blood alcohol concentration: a replication

OBJECTIVE

To identify predictors of error in estimated blood alcohol concentration (eBAC) in a sample of bar patrons.

METHOD

Six hundred sixty-six patrons (43.6% female) were randomly sampled from 32 bars. Patrons were asked to provide a breath sample into a handheld breath alcohol concentration test unit upon entrance and exit from the bar. Patrons also completed a brief survey at entrance and exit. For analyses, this sample was stratified by whether patrons consumed alcohol before attending the bar. Estimates of BAC were calculated using Matthews and Miller's formula (1979). A three-category dependent variable was created based on the estimation accuracy of eBAC relative to breath alcohol concentration: accurate (within .02), underestimate of BAC, and overestimate of BAC.

RESULTS

Of those that drank before arriving at the bar, 29% of eBACs were accurate, 32.3% were underestimates, and 38.8% were overestimates. For those who drank only at the bar, 42.0% were accurate, 20.8% were underestimates, and 37.7% were overestimates. Among those who drank before attending the bar, the number of drinks consumed before attending the bar was significantly related to eBAC underestimate. Among those who drank only at the bar, predictors of overestimate included being female, drinking more, and drinking longer.

CONCLUSIONS

The accuracy of eBAC is poor at best. In an earlier study of parties, eBACs were often underestimated; in the bar setting, eBACs were often overestimated. More research is needed to understand the role of setting on eBAC calculations.

Intervention for hazardous alcohol use and high level of stress in university freshmen: a comparison between an intervention and a control university

BACKGROUND

The first year of university studies is associated with increased levels of alcohol drinking and stress. This study examines the one-year outcome of both primary and secondary interventions of one alcohol programme and one stress intervention programme at an intervention university in comparison with a control university.

METHODS

At the intervention university all freshmen were offered a primary prevention programme for hazardous alcohol use and stress management and, in addition, those who had high ratings for stress and/or hazardous alcohol use were offered a secondary intervention programme for alcohol consumption and/or stress management. Freshmen still attending the two universities one year later responded to follow-up questionnaires.

RESULTS

The primary alcohol and stress interventions were associated with lower alcohol expectancies and mental symptoms, but no differences in AUDIT scores (-0.2, CI 95% -0.5 to 0.1), estimated blood alcohol concentrations or stress in comparison to freshmen at the control university. The secondary alcohol interventions were associated with decreased AUDIT (-1.1, CI 95% -2.0 to -0.2) as well as alcohol expectancies, blood alcohol concentrations, stress and mental symptoms in comparison to high-risk freshmen at the control university. The secondary stress interventions were associated with decreased mental symptoms and alcohol expectancies, but not stress, AUDIT scores (-0.6, CI 95% -1.4 to 0.2) and blood alcohol concentrations in comparison to high-risk freshmen at the control university.

CONCLUSION

This study suggests that both primary and secondary alcohol and stress interventions have 1-year effects in university freshmen and could be implemented in university settings.