The RT-18: a new screening tool to assess young adult risk-taking behavior

Impulsivity and Risk-Taking Behavior in School-Going Adolescents

Introduction Impulsivity (or impulsiveness) and risk-taking behavior are significant concerns as the adolescent population is at a higher risk of injuries and violence, unhealthy sexual behaviors, and drug- and alcohol-related problems. The early identification of these traits in adolescents can prove beneficial through timely interventions. This study was conducted to assess impulsive behavior and risk-taking behavior among school-going adolescents in New Delhi, India, and to study the association, if any, between the two. Methodology A cross-sectional study was conducted among 571 students of classes 9th-10th in three randomly selected schools in a part of Delhi, India. Barratt Impulsiveness Scale - Brief (BIS-Brief) was used to evaluate impulsivity, and risk-taking behavior was assessed using the RT-18 tool. Results The majority (72.3%) of the 571 students were aged 14-15 years. Among the students, 56.0% were males. The impulsivity score obtained ranged from 8 to 30, with a mean score of 15.7 (SD ±4.1). The risk-taking score ranged from 2 to 18, with a mean score of 9.9 (SD ±2.9). Impulsivity was seen to be significantly higher among the female students (p=0.004). The risk-taking behavior was significantly higher among the students from government schools, among the females, and among those who used the internet more. There was a significant direct association between impulsivity and risk-taking behavior among the students (correlation coefficient 0.301, p<0.001). Conclusion The study results showed that the mean impulsivity and risk-taking scores were comparable to other studies in adolescent age groups done internationally using the same tools. Impulsivity and risk-taking behavior were both found to be higher among females. There was a significant direct association between impulsivity and risk-taking.

Risk-Taking Behavior among Suicide Attempters

Background: Suicidal behavior is a major mental health concern both for the individual and for the public health. Among others, suicidal behavior is associated with impulsivity, risk taking, pain tolerance, and a state of overarousal. In the present study, we investigated if suicide attempters (SAs) reported higher scores for risk-taking when compared with healthy controls (HC) of the general population. Methods: A total of 616 individuals (mean age: 27.07 years; 51.5% females) took part in the study; of those, 240 (39%) were individuals with a suicide attempt (SA) within a time lapse of one to three months, and 376 (61%) were healthy controls (HC). Participants completed a series of self-rating questionnaires covering sociodemographic information, risk-taking (Risk-Taking Questionnaire 18; RT-18), and suicidal behavior (Suicide Behaviors Questionnaire-Revised; SBQ-R). Results: Compared with HCs, individuals with SA reported higher risk-taking and suicidal behavior scores. The risk-taking questionnaire yielded a four-factor solution: Thrill and sensation seeking; Cautious procedure; Cautious decision making; Impulsive behavior. Compared with HCs, SAs showed the highest scores for thrill and sensation seeking and impulsive behavior. Conclusions: Compared with healthy controls, individuals reporting a recent suicide attempt also reported a higher propensity to thrill and sensation seeking and impulsive behavior as a proxy of risk-taking behavior. The present results corroborate the notion that, among others, suicide attempts appeared to be less related to premeditation, but rather to impulsive and thus spontaneous behavior.

The CannTeen study: verbal episodic memory, spatial working memory, and response inhibition in adolescent and adult cannabis users and age-matched controls

BACKGROUND

Preclinical and human studies suggest that adolescent cannabis use may be associated with worse cognitive outcomes than adult cannabis use. We investigated the associations between chronic cannabis use and cognitive function in adolescent and adult cannabis users and controls. We hypothesised user-status would be negatively associated with cognitive function and this relationship would be stronger in adolescents than adults.

METHODS

As part of the 'CannTeen' project, this cross-sectional study assessed cognitive performance in adolescent cannabis users (n = 76; 16-17-year-olds), adolescent controls (n = 63), adult cannabis users (n = 71; 26-29-year-olds) and adult controls (n = 64). Users used cannabis 1-7 days/week. Adolescent and adult cannabis users were matched on cannabis use frequency (4 days/week) and time since last use (2.5 days). Verbal episodic memory (VEM) was assessed using the prose recall task, spatial working memory (SWM) was assessed using the spatial n-back task, and response inhibition was assessed with the stop-signal task. Primary outcome variables were: delayed recall, 3-back discriminability, and stop signal reaction time, respectively.

RESULTS

Users had worse VEM than controls (F(1,268) = 7.423, p = 0.007). There were no significant differences between user-groups on SWM or response inhibition. Null differences were supported by Bayesian analyses. No significant interactions between age-group and user-group were found for VEM, SWM, or response inhibition.

CONCLUSIONS

Consistent with previous research, there was an association between chronic cannabis use and poorer VEM, but chronic cannabis use was not associated with SWM or response inhibition. We did not find evidence for heightened adolescent vulnerability to cannabis-related cognitive impairment.

A Cross-Cultural Comparison of the Effects of Alcohol Mixed with Energy Drink (AMED) Consumption on Overall Alcohol Consumption and Related Consequences

There is a growing body of scientific literature examining the effects of alcohol mixed with energy drink (AMED) on alcohol consumption and related negative consequences, such as risky behavior or negative health effects. It is unknown whether differences in cultural context may influence these AMED effects. The current cross-cultural study compared the data of N = 6881 students from The Netherlands (N = 4424), UK (N = 1594), and Australia (N = 863). Demographics, alcohol consumption, its consequences, and motives for AMED consumption were assessed. Analyses included (a) between-groups comparison of AMED and alcohol only (AO) consumers, (b) within-subjects comparison of AMED and AO occasions among AMED consumers only, and (c) comparisons between the three countries. The between-groups analysis revealed that AMED consumers drink more alcohol than AO consumers (p < 0.001). AMED consumers differed from AO consumers in many other aspects. For example, AMED consumers were significantly more often a smoker and had higher risk-taking scores. Within subject analysis among AMED consumers showed that significantly less alcohol was consumed on AMED, compared to AO occasions (p < 0.001). These findings were observed for both typical drinking occasions and the past month's heaviest drinking occasion, and were consistent across the three countries. Comparisons between countries revealed that on both AMED and AO occasions, the UK sample consumed significantly more alcohol than the Australian and Dutch samples. Across countries, neutral motives such as 'I like the taste' and 'I wanted to drink something else' were the most frequently reported motives for consuming AMED. The most notable difference between the countries was the finding that consuming AMED 'To get drunk' was endorsed significantly more often among the UK sample (45.6%) than the Australian (31.2%) and Dutch (8.0%) samples. Negative alcohol-related consequences were significantly less frequently reported for AMED occasions compared to AO occasions. Some country-specific consequences of AMED consumption were observed, but these were more likely related to characteristics of the country and their drinking culture (e.g., the Australian sample reported more often driving a car after AMED consumption compared to the other countries, and this pattern of results was also found for AO occasions). In conclusion, there were limited differences between countries with regard to demographics of consumers and motives for AMED consumption, but the UK sample consumed significantly more alcohol and reported the highest frequency of negative alcohol related consequences. Consistent across countries was the observation that AMED consumers consume significantly less alcohol on their past month heaviest AMED drinking occasion, compared to their past month heaviest AO drinking occasion.

Dopamine-related striatal neurophysiology is associated with specialization of frontostriatal reward circuitry through adolescence

Characterizing developmental changes in frontostriatal circuitry is critical to understanding adolescent development and can clarify neurobiological mechanisms underlying increased reward sensitivity and risk-taking and the emergence of psychopathology during this period. However, the role of striatal neurobiology in the development of frontostriatal circuitry through human adolescence remains largely unknown. We examined background connectivity during a reward-guided decision-making task ("reward-state"), in addition to resting-state, and assessed the association between age-related changes in frontostriatal connectivity and age-related changes in reward learning and risk-taking through adolescence. Further, we examined the contribution of dopaminergic processes to changes in frontostriatal circuitry and decision-making using MR-based assessments of striatal tissue-iron as a correlate of dopamine-related neurobiology. Connectivity between the nucleus accumbens (NAcc) and ventral anterior cingulate, subgenual cingulate, and orbitofrontal cortices decreased through adolescence into adulthood, and decreases in reward-state connectivity were associated with improvements reward-guided decision-making as well as with decreases in risk-taking. Finally, NAcc tissue-iron mediated age-related changes and was associated with variability in connectivity, and developmental increases in NAcc R2' corresponded with developmental decreases in connectivity. Our results provide evidence that dopamine-related striatal properties contribute to the specialization of frontostriatal circuitry, potentially underlying changes in risk-taking and reward sensitivity into adulthood.

Risk-Taking Behavior and the Consumption of Alcohol Mixed with Energy Drink among Australian, Dutch and UK Students

The relationship between risk-taking behavior, alcohol consumption and negative alcohol-related consequences is well known. The current analyses were conducted to investigate whether alcohol mixed with energy drink (AMED) is related to risk-taking behavior and if there is a relationship between the amount of energy drink mixed with alcohol consumed, risk-taking behavior and negative alcohol-related consequences. Data from N = 1276 AMED consuming students from the Netherlands, UK and Australia who completed the same survey were evaluated. The analysis revealed that, compared to AMED occasions, on alcohol only (AO) occasions significantly more alcohol was consumed and significantly more negative alcohol-related consequences were reported. On both AO and AMED occasions, there was a strong and positive relationship between amount of alcohol consumed, level of risk-taking behavior and number of reported negative alcohol-related consequences. In contrast, the level of risk-taking behavior was not clearly related to energy drink consumption. Across risk-taking levels, differences in the amount of energy drink consumed on AMED occasions did not exceed one 250 mL serving of energy drink. When correcting for the amount of alcohol consumed, there were no statistically significant differences in the number of energy drinks consumed on AMED occasions between the risk-taking groups. In conclusion, alcohol consumption is clearly related to risk-taking behavior and experiencing negative alcohol-related consequences. In contrast, energy drink intake was not related to level of risk-taking behavior and only weakly related to the number of experienced negative alcohol-related consequences.

The Effects of Alcohol Hangover on Response Inhibition and Attentional Bias towards Alcohol-Related Stimuli

Alcohol hangover is associated with the development of alcohol use disorders, yet few studies have examined the influence of hangover on cognitive processes that may contribute towards future alcohol consumption such as response inhibition and attentional bias towards alcohol-related stimuli. Therefore, the current study aimed to explore the effects of hangover on these processes. In total, 37 adult drinkers who reported regularly engaging in heavy episodic drinking and experiencing a hangover at least once in the previous month took part in this within-subjects, "naturalistic" crossover study. Participants completed Go/No-Go (assessing response inhibition) and Visual Dot Probe (attentional bias) tasks in a hangover condition (morning following alcohol consumption) and a no-hangover condition (no alcohol consumption for at least 24 h). Participants also completed measures of hangover severity, mood, and perceived mental effort. Results indicated impaired response inhibition during hangover compared to the no-hangover condition (p < 0.001, d = 0.89), but no difference in attentional bias scores between conditions. Participants reported expending greater mental effort to complete tasks (p < 0.001, d = 1.65), decreased alertness (p < 0.001, d = 3.19), and reduced feelings of tranquillity (p < 0.001, d = 1.49) in the hangover versus no-hangover condition. Together, these findings suggest that alcohol hangover is associated with impaired response inhibition and lower mood. However, problems with recording eye-tracking data on the Visual Dot Probe task used in the present study may limit the reliability of our attentional bias findings.

Sensitivity to Experiencing Alcohol Hangovers: Reconsideration of the 0.11% Blood Alcohol Concentration (BAC) Threshold for Having a Hangover

The 2010 Alcohol Hangover Research Group consensus paper defined a cutoff blood alcohol concentration (BAC) of 0.11% as a toxicological threshold indicating that sufficient alcohol had been consumed to develop a hangover. The cutoff was based on previous research and applied mostly in studies comprising student samples. Previously, we showed that sensitivity to hangovers depends on (estimated) BAC during acute intoxication, with a greater percentage of drinkers reporting hangovers at higher BAC levels. However, a substantial number of participants also reported hangovers at comparatively lower BAC levels. This calls the suitability of the 0.11% threshold into question. Recent research has shown that subjective intoxication, i.e., the level of severity of reported drunkenness, and not BAC, is the most important determinant of hangover severity. Non-student samples often have a much lower alcohol intake compared to student samples, and overall BACs often remain below 0.11%. Despite these lower BACs, many non-student participants report having a hangover, especially when their subjective intoxication levels are high. This may be the case when alcohol consumption on the drinking occasion that results in a hangover significantly exceeds their "normal" drinking level, irrespective of whether they meet the 0.11% threshold in any of these conditions. Whereas consumers may have relative tolerance to the adverse effects at their "regular" drinking level, considerably higher alcohol intake-irrespective of the absolute amount-may consequentially result in a next-day hangover. Taken together, these findings suggest that the 0.11% threshold value as a criterion for having a hangover should be abandoned.

The Association between Alcohol Hangover Frequency and Severity: Evidence for Reverse Tolerance?

Although hangover is a common consequence of heavy alcohol consumption, the area is heavily under-researched. Hangover frequency is a potential predictor of future alcohol use disorder that may be affected by hangover severity, yet the relationship between hangover frequency and severity has not been investigated. Using different methodologies and assessment instruments, two surveys, and one naturalistic study collected data on hangover frequency, hangover severity, and alcohol consumption. The relationship between hangover frequency and severity was investigated via correlational analysis, considering potentially moderating variables including alcohol intake, estimated blood alcohol concentration, demographics, and personality characteristics. In all the three studies, a positive and significant association between hangover frequency and severity was found, which remained significant after correcting for alcohol intake and other moderating factors. These findings suggest that hangover severity increases when hangovers are experienced more frequently and may be driven by sensitization or reverse tolerance to this aspect of alcohol consumption. Future research should further investigate the relationship between hangover frequency and severity and alcohol use disorder and its implications for prevention.

Depressive and socially anxious symptoms, psychosocial maturity, and risk perception: Associations with risk-taking behaviour

Risk-taking behaviour and onset of mental illness peak in adolescence and young adulthood. This study evaluated the interconnectedness of the domains of risk-taking behaviour, mental health (symptoms of depression and social anxiety), psychosocial maturity, risk perception, age, and gender in a sample of 306 adolescents and young adults. Participants between the ages of 16 and 35 completed online self-report measures assessing risk-taking behaviour, depressive symptoms, socially anxious symptoms, psychosocial maturity and risk perception. Socially anxious symptoms, psychosocial maturity, and risk perception were directly associated with risk-taking behaviour. Correlations between depressive symptoms, socially anxious symptoms, and psychosocial maturity were found. Psychosocial maturity proved a better predictor of risk-taking behaviour than age in this cohort. The findings indicate that mental health impacts upon risk-taking behaviour and that consideration should be given to psychosocial maturity in attempts to reduce adolescent and young adult risk-taking behaviour.

Effects of Consuming a Low Dose of Alcohol with Mixers Containing Carbohydrate or Artificial Sweetener on Simulated Driving Performance

The Australian National Drug and Alcohol Research Centre (NDARC) devised gender-based drinking recommendations to ensure blood or equivalized breath alcohol concentrations (BrAC) remain <0.050%. However, these may be inappropriate for individuals consuming alcohol without carbohydrate (CHO), which results in higher BrACs. This study investigated the effects of ingesting alcohol with and without CHO on BrACs and simulated driving performance. Thirty-two participants (16 males; age: 23 ± 6 years) completed two randomized single-blinded trials. Participants performed a baseline drive (Drive 1), then an experimental drive (Drive 2), following alcohol consumption (males: 20 g; females: 10 g). Alcoholic beverages contained either 25 g sucrose or aspartame (AS). Driving performance was assessed using lateral control (standard deviation of lane position [SDLP] and number of lane departures) and risk-taking (number of overtaking maneuvers and maximum overtaking speed). BrAC and subjective ratings (e.g., intoxication) were also assessed. BrAC was significantly lower as Drive 2 commenced with CHO compared to AS (0.022 ± 0.008% vs. 0.030 ± 0.011%). Two males provided BrACs >0.050% with AS. Neither beverage influenced changes to simulated driving performance. Ingesting alcohol in quantities advised by the NDARC results in no detectable simulated driving impairment. However, the likelihood of exceeding the legal drink-driving BrAC is increased when alcohol is consumed with artificially-sweetened mixers.

Development of Risk-Taking Tendency Tool for High School Students

BACKGROUND

Adolescence is the age of increased sensation-seeking and risk-taking. To prevent such behaviors, the adolescent tendency to engage in high-risk behaviors must be measureable. This study aimed to develop a questionnaire about risk-taking tendencies among Iranian students.

METHODS

This study was conducted using cluster sampling of the tenth-grade students in three cities in Kerman province, Iran. The students were assured that the questionnaires would remain anonymous and unlinked. Construct validity was assessed using exploratory factor analysis (EFA) and comparison of known groups. Corrected item-scale correlation and Cronbach's alpha were calculated to evaluate reliability.

FINDINGS

A total of 551 high school students participated in this study. Of these, 57 were excluded after checking the "non-existent drug" item (10.3%). Girls accounted for 49.2% of the sample. Of the 33 initial questions, 13 were removed due to factor loading of less than 0.5. Two factors were extracted using the scree plot ("drug abuse tendency" and "other risky behavior tendency"). The tendency toward high-risk behavior was significantly higher in male students than in female ones (P < 0.001). This indicates the known group validity of the questionnaire. The Cronbach's alpha of the above-mentioned factors were 0.93 and 0.83, respectively.

CONCLUSION

The questionnaire measuring the tendency toward high-risk behavior among students showed acceptable validity and reliability.

Effects of consuming alcohol mixed with energy drinks versus consuming alcohol only on overall alcohol consumption and negative alcohol-related consequences

BACKGROUND

The aim of this study was to examine differences in alcohol consumption and its consequences when consumed alone and when mixed with energy drinks.

METHODS

A survey was conducted among Dutch students at Utrecht University and the College of Utrecht. We collected data on alcohol consumption and alcohol-related consequences of alcohol consumed alone and/or alcohol mixed with energy drinks (AMED). The data were analyzed using a retrospective within-subject design, comparing occasions when subjects consumed AMED with those when they consumed alcohol only in the past 30 days.

RESULTS

A representative sample of 6002 students completed the survey, including 1239 who consumed AMED. Compared with consuming alcohol only, when consuming AMED, students consumed significantly fewer alcoholic drinks on an average drinking day (6.0 versus 5.4, respectively), and reported significantly fewer drinking days in the previous month (9.2 versus 1.4), significantly fewer days being drunk (1.9 versus 0.5), and significantly fewer occasions of consuming more than four (female)/five (male) alcoholic drinks (4.7 versus 0.9). The maximum number of mixed alcoholic drinks (4.5) in the previous month was significantly lower when compared with occasions when they consumed alcohol only (10.7). Accordingly, the mean duration of a drinking session was significantly shorter when mixing alcoholic drinks (4.0 versus 6.0 hours). Finally, when consuming AMED, significantly fewer alcohol-related consequences were reported (2.6) for the previous year, including driving a car while intoxicated, taking foolish risks, or being injured or hurt, as compared with alcohol-related consequences when consuming alcohol only (4.9).

CONCLUSION

Mixing alcohol with energy drinks decreases overall alcohol consumption, and decreases the likelihood of experiencing negative alcohol-related consequences.

Alcohol mixed with energy drinks: methodology and design of the Utrecht Student Survey

This paper describes the methodology of the Utrecht Student Survey. This online survey was conducted in June 2011 by 6002 students living in Utrecht, The Netherlands. The aim of the survey was to determine the potential impact of mixing alcoholic beverages with energy drinks on overall alcohol consumption and alcohol-related consequences. In contrast to most previous surveys conducted on this topic, the current survey used a more appropriate within-subject design, comparing the alcohol consumption of individuals who consume alcohol mixed with energy drinks on occasions. Specifically, a comparison was conducted to examine the occasions during which these individuals consume this mixture versus occasions during which they consume alcohol alone. In addition to energy drinks, the consumption of other non-alcoholic mixers was also assessed when combined with alcoholic beverages. Furthermore, the reasons for consuming energy drinks alone or in combination with alcohol were investigated, and were compared to reasons for mixing alcohol with other non-alcoholic beverages. Finally, personality characteristics and the level of risk-taking behavior among the individuals were also assessed to explore their relationship with alcohol consumption. The Utrecht Student Survey will be replicated in the USA, Australia, and the UK. Results will be pooled, but also examined for possible cross-cultural differences.

Energy drinks mixed with alcohol: misconceptions, myths, and facts

Background

Whilst energy drinks improve performance and feelings of alertness, recent articles suggest that energy drink consumption combined with alcohol may reduce perception of alcohol intoxication, or lead to increased alcohol or drug use. This review discusses the available scientific evidence on the effects of mixing energy drinks with alcohol.

Methods

A literature search was performed using the keywords “energy drink and Red Bull^®” and consulting Medline/Pubmed, PsycINFO, and Embase.

Results

There is little evidence that energy drinks antagonize the behavioral effects of alcohol, and there is no consistent evidence that energy drinks alter the perceived level of intoxication of people who mix energy drinks with alcohol. No clinically relevant cardiovascular or other adverse effects have been reported for healthy subjects combining energy drinks with alcohol, although there are no long-term investigations currently available. Finally, whilst several surveys have shown associations, there is no direct evidence that coadministration of energy drinks increases alcohol consumption, or initiates drug and alcohol dependence or abuse.

Conclusion

Although some reports suggest that energy drinks lead to reduced awareness of intoxication and increased alcohol consumption, a review of the available literature shows that these views are not supported by direct or reliable scientific evidence. A personality with higher levels of risk-taking behavior may be the primary reason for increased alcohol and drug abuse per se. The coconsumption of energy drinks being one of the many expressions of that type of lifestyle and personality.