A pilot study of naltrexone and BASICS for heavy drinking young adults

Heavy drinking young adults often have limited motivation to change their drinking behavior. Adding pharmacotherapy to brief counseling is a novel approach to treating this population. A small open-label pilot study was conducted to assess the feasibility of offering eight weeks of daily and targeted (i.e., taken as needed in anticipation of drinking) naltrexone with BASICS (brief motivational) counseling to heavy drinking young adults; to assess the tolerability of the medication in this population and to obtain preliminary efficacy data. The sample (N=14) showed strong adherence to study appointments and medication taking, supporting the feasibility of this approach. Overall, the medication was well-tolerated. Significant reductions from baseline were observed in drinks per drinking day and in percent heavy drinking days and these gains were maintained one month after treatment ended. A significant decrease in alcohol-related consequences was also observed. Findings from this small pilot study suggest that naltrexone in combination with BASICS represents a promising strategy to reduce heavy drinking among young adults.     

Protective behavioral strategies mediate the effect of drinking motives on alcohol use among heavy drinking college students: gender and race differences

Objective

This study examined the extent to which protective behavioral strategies (PBS) mediated the influence of drinking motives on alcohol consumption, and if these hypothesized relationships were corroborated across subsamples of gender and race.

Method

Online surveys were completed by 1592 heavy drinking college undergraduates from two universities (49.9% male and 50.1% female; 76.9% Caucasian and 23.1% Asian). Independent samples t-tests compared males and females as well as Caucasians and Asians on measures of drinking motives, PBS use, and alcohol consumption, and structural equation models examined the mediating role of PBS.

Results

Consistent with predictions, t-tests revealed that males reported greater levels of consumption than females, but females reported greater use of PBS than males. Caucasians reported greater consumption levels, endorsed higher enhancement motives, and higher PBS related to serious harm reduction, but Asians endorsed higher coping and conformity motives, and PBS focused on stopping/limiting drinking. In multiple-sample SEM analyses, PBS were shown to largely mediate the relationship between motives and consumption in all demographic subsamples.

Conclusions

Findings indicate that PBS use leads to reductions in drinking despite pre-established drinking motives, hence pointing to the potential value of standalone PBS skills training interventions in lowering alcohol use among diverse groups of heavy drinking college students.     

Drinking motives,drinking restraint and drinking behaviour among young adults

Motives to drink alcohol are widely thought to be the proximal cognitive factors involved in the decision to consume alcohol beverages. However it has also been argued that the ability to restrain drinking may be a more proximal predictor of drinking behaviour. The current study aimed to examine the relationships between drinking motives, drinking restraint and both alcohol consumption and alcohol-related problems in a sample of young adults. A sample of 221 young adults (aged 17–34 years) completed self-report measures assessing drinking behaviour, motives for drinking and drinking restraint. Multiple regression analyses revealed that coping, enhancement and social motives were related to alcohol consumption and alcohol-related problems, while Cognitive and Emotional Preoccupation with drinking was related to all criterion variables. Further, the relationship between coping motives and drinking behaviour was mediated by preoccupation with drinking. The results are discussed in light of the roles of drinking motives and drinking restraint in risky drinking among young people, and implications for prevention and early intervention are presented.     

Re-configured pleasures: How young people feel good through abstaining or moderating their drinking

BackgroundAlcohol use has strong associations with the pursuit of pleasure, yet trends in young people's drinking have been declining in Australia for more than 15 years. Therefore, it is important to examine how the increasing number of young people who drink lightly or abstain think about pleasure and alcohol, and how this might reflect changing practices around drinking for pleasure.MethodsSemi-structured interviews were conducted with 50 young people aged 16–19 from Melbourne who abstained from alcohol or drank within Australian guidelines for risky drinking. Participants reflected on how they socialised whilst drinking lightly or without drinking at all, and how they experienced pleasure in this context. These responses were analysed thematically.ResultsFour key themes emerged; authenticity, intimacy, control, and vicarious pleasure. Some participants felt that by not drinking, they were enacting authentic or better versions of themselves, whilst developing a stronger sense of intimacy with their sober friends. Others described the displeasure of potentially losing control of their emotions and bodies in social situations and were able to instead experience enjoyment vicariously through their friends’ drinking.ConclusionDrinking has long been regarded as a way to build a connection with others, relax and feel a sense of pleasure. However, it is important to recognise that avoiding drinking and drunkenness provides an alternative means by which some young people pursue feelings of pleasure and enjoyment. In a time of declining drinking rates, participants here drew on notions of authenticity, intimacy, self-control, and vicarious enjoyment to construct light or non-drinking as a pleasurable pursuit, and a positive part of selfhood.     

Negative mood,implicit alcohol-related memory,and alcohol use in young adults: The moderating effect of alcohol expectancy

ObjectiveAlcohol-related implicit (preconscious) cognitive processes are established and unique predictors of alcohol use, but most research in this area has focused on alcohol-related implicit cognition and anxiety. This study extends this work into the area of depressed mood by testing a cognitive model that combines traditional explicit (conscious and considered) beliefs, implicit alcohol-related memory associations (AMAs), and self-reported drinking behavior.MethodUsing a sample of 106 university students, depressed mood was manipulated using a musical mood induction procedure immediately prior to completion of implicit then explicit alcohol-related cognition measures. A bootstrapped two-group (weak/strong expectancies of negative affect and tension reduction) structural equation model was used to examine how mood changes and alcohol-related memory associations varied across groups.ResultsExpectancies of negative affect moderated the association of depressed mood and AMAs, but there was no such association for tension reduction expectancy.ConclusionSubtle mood changes may unconsciously trigger alcohol-related memories in vulnerable individuals. Results have implications for addressing subtle fluctuations in depressed mood among young adults at risk of alcohol problems.     

Adolescent heavy episodic drinking trajectories and health in young adulthood

OBJECTIVE: This study examined the association of trajectories of heavy episodic drinking (at least five alcoholic drinks on one occasion) during adolescence with health status and practices at age 24. METHOD: Semiparametric group-based modeling and logistic regressions were used to analyze data from a longitudinal panel of 808 youths interviewed between 10 and 24 years of age. RESULTS: Four distinct trajectories of adolescent heavy episodic drinking were identified: nonheavy drinkers, late onsetters, escalators and chronic heavy drinkers. Overall, young adults who did not engage in heavy episodic drinking during adolescence had the lowest occurrence of health problems and were most likely to engage in safe health behaviors at age 24. Chronic and late-onset heavy episodic drinking during adolescence had negative effects on health status and practices at age 24. Adolescent chronic heavy drinkers were more likely to be overweight or obese and to have high blood pressure at age 24 than those who did not drink heavily in adolescence. Late-onset heavy drinkers were less likely to engage in safe driving practices at age 24 and were more likely to have been ill in the past year than adolescents who did not drink heavily. These health disparities remained even after current frequency of heavy episodic drinking at age 24, other adolescent drug use, ethnicity, gender and family poverty were controlled. CONCLUSIONS: Heavy episodic alcohol use during adolescence has long-term, negative health consequences. Distinct patterns of adolescent heavy drinking affect health status and practices in young adulthood differently.     

Acculturative stress as a moderator of the effect of drinking motives on alcohol use and problems among young adults

BackgroundResearch has demonstrated a strong relationship between drinking motives and alcohol use among young adult populations. Further, there is substantial evidence of the association between psychosocial stressors and greater alcohol consumption. In the present study, we examined whether acculturative stress would moderate the relationship between major drinking motives and alcohol use behaviors and alcohol-related problems, and whether this relationship differs by racial/ethnic group.MethodSix hundred diverse undergraduate students (mean age = 21.50, SD = 2.46; 82.8% female; 40.2% White/Caucasian) completed a series of measures, including demographic information, alcohol use/alcohol problems, and acculturative stress.ResultsFindings showed varying patterns in the moderating effect of acculturative stress on the relationship between drinking motives and alcohol consumption and alcohol-related problems, particularly for self-identified Hispanic, Black, and Asian students. Stronger drinking motives were associated with greater alcohol consumption and alcohol-related problems, and this relationship was stronger among Asian and Hispanic students who reported higher levels of acculturative stress. For Black students, greater acculturative stress was observed to weaken the relationship between coping, enhancement, and conformity motives and alcohol drinking frequency.ConclusionsResults are discussed in terms of incorporating acculturative stress in the development of tailored alcohol use interventions for vulnerable young adults, such as certain ethnic minority and immigrant groups. Clinical implications include screening for acculturative stress in primary care and counseling centers and early intervention programs to identify young adults who may be at-risk for or currently experiencing alcohol problems.     

Associations between binge drinking frequency and tobacco use among young adults

Tobacco use is greater among young adults who binge drink; yet there is limited research on tobacco use characteristics among different types of binge drinkers based on frequency. We aimed to characterize this relationship among young adults (18–25 years old) who used both substances in the past month (smoked ≥ 1 cigarette, and drank ≥ 1 alcoholic beverage) using an anonymous online survey. Participants (N = 1405, 65.0% male) were grouped based on binge drinking frequency and compared for tobacco use characteristics and demographics using bivariate analyses and multinomial logistic regression. Binge drinking frequency groups were: non-binge drinkers who consumed alcohol (0 days; 27.5%); occasional (1–3 days; 37.9%); intermediate (4–8 days; 21.9%); and frequent (9 + days; 12.7%) binge drinkers. Comparing each binge drinking group to non-binge drinkers: Both occasional and frequent binge drinkers smoked more cigarettes per day (p = 0.001; p = 0.002); frequent binge drinkers reported greater temptations to smoke in positive affective/social situations (p = 0.02); intermediate binge drinkers were less likely to have a tobacco abstinence goal (p = 0.03) but more likely to have made a serious tobacco quit attempt; all of the binge groups were more likely to be social smokers (all p < 0.01). Overall, we also found a high rate of smoking on binge drinking days. Individuals smoked cigarettes on 85.7% ± 32.9% of days they binge drank. Extent of binge drinking (not just prevalence) is an important factor influencing smoking characteristics in young adults.     

Social cognitive determinants of drinking in young adults: beyond the alcohol expectancies paradigm.

In prior investigations of the psychology of drinking behavior, drinkers' positive expectancies regarding the effects of alcohol have been studied extensively. From a social cognitive point of view, however, several additional psychological factors also deserve attention, namely negative expectancies, social influence, and self-efficacy expectations. In a representative sample of 161 university students, this study examined to what extent inclusion of these additional social cognitive factors enhanced the predictive power of the predominant alcohol-expectancies model of drinking behavior, and to what extent all four social cognitive factors were related to the uptake and cessation of drinking behavior. The three additional social cognitive factors contributed 17% to the explained variance in drinking behavior, in addition to the 18% accounted for by positive expectancies. The constructs with the greatest predictive strength all pertained to the social effects and social context of drinking. The most important predictors of drinking behavior were found to differ for male versus female students, and for students living with their parents versus those living on their own. The data on drinking acquisition and cessation suggest that in this sample little change in drinking behavior could be expected. The social cognitive factors were strongly related to acquisition stages but only weakly to cessation stages. Recommendations for interventions aimed at lowering alcohol intake are given.     

Changing drinking styles in Denmark and Finland. Fragmentation of male and female drinking among young adults

A traditional heavy intoxication-oriented drinking style, "heroic drinking," is a central drinking practice in Denmark and Finland, especially among men. However, it seems that another drinking style leading to intoxication, "playful drinking," has become more prevalent in Denmark as well as in Finland. Playful drinking is characterized by self-presentations in diverse forms of game situations in which you need to play with different aspects of social and bodily styles. We approach the positions of heroic drinking and playful drinking among young adults (between 17 and 23 years) in Denmark and Finland by analyzing how they discuss these two drinking styles in focus groups (N = 16).     

Country of origin, age of drinking onset, and drinking patterns among Mexican American young adults

This study examines relationships between country of origin, age of drinking onset, and adverse drinking outcomes among young adult Mexican Americans in the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Logistic regression models estimate associations between age of drinking onset, age of onset in relation to age at immigration, and adverse drinking outcomes, controlling for sex, age, employment, education, marital status, and income. Adjusted analyses indicate the odds of adverse drinking outcomes decreased as age of drinking onset increased. Mexican Americans who initiated drinking in Mexico had significantly lower odds of current or lifetime harmful drinking than U.S. born but the odds were not significantly different between foreign-born Mexican Americans who initiated drinking in the U.S. and U.S. born. Irrespective of whether drinking onset was in Mexico or the U.S., foreign-born Mexican Americans had lower odds of alcohol abuse than U.S. born. However, odds of dependence were not significantly different between foreign-born and U.S.-born Mexican Americans. While findings suggest that being foreign born may be protective, further research on social and cultural factors impacting drinking onset and related outcomes among young Mexican Americans may help inform prevention efforts.     

Trajectories of positive alcohol expectancies and drinking: An examination of young adults in the US and Sweden

Positive alcohol expectancies and alcohol use tend to increase from adolescence to young adulthood, yet little is known about the associations between these constructs across cultures. The current study adds to the extant literature by examining the growth trajectories of positive alcohol expectancies and drinking behavior among United States (US) and Swedish participants during a critical period where significant change in these outcomes may be expected to occur. A total of 870 (US, N = 362; Sweden, N = 508) high school seniors completed baseline, 6-month, and 12-month assessments of alcohol expectancies and drinking (i.e., drinks per week). Changes in positive alcohol expectancies and drinking behavior were examined using a parallel process latent growth model. In both samples, higher baseline levels of positive alcohol expectancies were associated with a higher number of drinks consumed per week at baseline. In the US sample, lower baseline levels of positive alcohol expectancies were associated with a greater increase in positive alcohol expectancies at 12-month follow-up, and lower baseline levels of drinks per week were associated with a greater increase in drinks consumed per week at 12-month follow-up. In the Swedish sample, an increase in positive alcohol expectancies over time was associated with an increase in drinks consumed per week over the same period of time. Additional research is needed to examine when and for whom expectancy-based alcohol interventions are most efficacious.     

The effect of past-year heavy drinking on alcohol-related aggression

OBJECTIVE: The primary goal of this study was to determine the moderating effect of a history of heavy episodic drinking on the alcohol-aggression relation in men and women. METHOD: Participants were 310 (152 men and 158 women) healthy social drinkers between 21 and 35 years of age. Drinking history was operationalized as participants' average number of alcoholic drinks consumed per drinking occasion during the past year. Following the consumption of either an alcohol or a placebo beverage, participants were tested on a modified version of the Taylor Aggression Paradigm in which mild electric shocks were received from, and administered to, a fictitious opponent during a competitive task. Aggressive behavior was operationalized as the shock intensities administered to the fictitious opponent under conditions of low and high provocation. RESULTS: Alcohol increased aggression only among highly provoked men who reported a history of heavy episodic drinking. A history of high-frequency drinking did not moderate the alcohol-aggression relation. CONCLUSIONS: These findings highlight the importance of considering a history of heavy episodic drinking in the prediction of intoxicated aggression.     

Parental problem drinking predicts implicit alcohol expectancy in adolescents and young adults

The present study aimed to investigate the influence of parental problem drinking on implicit and explicit alcohol expectancy of adolescents and young adults (12-24 years). The study was conducted via the Internet, employing a between-subjects design. We measured alcohol expectancy by means of an Implicit Association Test (IAT) and a self-report questionnaire. A short version of the Children of Alcoholics Screening Test (CAST) was used to measure alcohol-related parental problem behavior. Our results showed that increased CAST-scores were correlated with a stronger implicit association between the concepts alcohol and arousal. In contrast, no such relationship was observed between parental problem drinking and self-reported expectancy of alcohol arousal. These findings provide tentative evidence that an implicit cognitive processing bias is implicated in the intergenerational transmission of addictive behaviors.     

Integrated smoking cessation and binge drinking intervention for young adults: A pilot efficacy trial

Alcohol consumption is strongly associated with cigarette smoking in young adults. The primary aim of this investigation was to complete a pilot evaluation of the efficacy of an integrated intervention that targets both cigarette smoking and binge drinking on the cigarette smoking and binge behavior of young adults at 6-month follow-up. Participants were 95 young adult (M = 24.3; SD = 3.5 years) smokers (≥ 1 cigarettes per day) who binge drink (≥ 1 time per month) and who were randomly assigned to standard treatment (n = 47) involving six individual treatment visits plus eight weeks of nicotine patch therapy or the identical smoking cessation treatment integrated with a binge drinking intervention (integrated intervention; n = 48). Using an intent-to-treat analysis for tobacco abstinence, at both 3 month end of treatment and 6 month follow-up, more participants who received integrated intervention were biochemically confirmed abstinent from tobacco than those who received standard treatment at 3 months (19% vs. 9%, p = 0.06) and 6 months (21% vs. 9%, p = 0.05). At 6 months, participants who completed the study and who received integrated intervention consumed fewer drinks per month (p < 0.05) and number of binge drinking episodes per month (p < 0.05) than those who received standard treatment. Preliminary data supports that integrated intervention enhances smoking cessation and reduces binge drinking compared to standard treatment.     

Moderating effects of race in clinical trial participation and outcomes among marijuana-dependent young adults

Background

Few studies have examined clinical trial participation rates and treatment outcomes among underserved young adults who are dependent on marijuana, the most commonly abused illicit drug.

Method

The present study was a secondary analysis of a trial of court-referred marijuana-dependent young adults (ages 18–25) randomized to one of four treatment conditions: Motivational Enhancement Therapy/Cognitive Behavioral Therapy (MET/CBT), MET/CBT + Contingency Management (CM), Drug Counseling (DC) or DC + CM. African American (N = 81) participants were compared to White (N = 31) participants with respect to rates of participation in phases of treatment and substance use outcomes. In addition, the interaction of race and treatment condition was examined to ascertain if the interventions yielded different effects based on race.

Results

Among those who started treatment, African American young adults were significantly less likely to complete the treatment and posttreatment phases of the clinical trial than their White counterparts. Irrespective of treatment type, substance use outcomes (i.e., percentage of marijuana-negative specimens and longest duration of continuous abstinence) did not vary by race. However, there was a significant interaction effect between treatment type and race; African American young adults did not benefit differentially from any specific type of treatment, but CM was effective in reducing proportion of marijuana positive samples among White young adults.

Conclusions

Findings suggest that clinical trial treatment and posttreatment completion rates vary by race in this population, as does response to specific treatment types. More treatment research focusing specifically on African American marijuana-dependent young adults is warranted.     

Bottoming out experiences: factor analyses and moderating effects of gender and race

The Bottoming Out Experience (BOE) is thought to be the accumulation of negative experiences for those with Substance Use Disorders (SUDs). This study aimed to bridge research and the narrative utilized in 12-step programs by quantifying the construct of the BOE. To do this, we examined the factor structure of the BOE using negative experiences that have been associated with change for individuals at the intake level. We also tested for variances in factor loadings of the BOE between gender and ethnicity to understand moderating effects. Archival data from the Center from Substance Abuse Treatment (CSAT) was used, specifically data from the Global Appraisal of Individual Needs (GAIN). We hypothesized that identified negative experiences would load into a unidimensional model. Hypothesis one was rejected, due to exploratory factor analysis results. Thus, we created five subfactors (F1: mental distress and trauma; F2: stress; F3: substance use levels; F4: risky behaviors, and F5: financial problems) and confirmed the model with the second half of the dataset. Hypothesis two stated that differences would exist within the models based on both gender and ethnicity, and this hypothesis was supported. The overarching BOE model remained the same for all gender and ethnic groups, but factor loadings within the models differed based on both gender and ethnicity. Although previous theory supported the idea of the BOE, no research had been conducted on the multivariate relationships between these negative experiences. The BOE model and the gender and ethnic differences have significant implications for SUD treatment.     

Effects of tobacco deprivation on alcohol cue reactivity and drinking among young adults

Nicotine and alcohol may have common neurobiological mechanisms of reinforcement. Therefore, withholding one substance might result in compensatory increases in self-administration of the other. This laboratory study investigated the effects of brief tobacco deprivation on alcohol cue-elicited urges to drink, corresponding psychophysiological reactions, and alcohol consumption. Young adults (N=78) who were moderate to heavy smokers and drinkers were stratified and randomized to a 2 x 2 design. Participants were either deprived of tobacco for 5 h or not deprived and then exposed to in vivo alcohol or control beverage cues. Subsequently, participants engaged in a taste-rating task as an unobtrusive measure of alcohol consumption. Tobacco deprivation resulted in increased urge to smoke and decreased cardiovascular responses but did not increase alcohol urges or alcohol consumption. Results indicate that brief tobacco deprivation does not result in compensatory increases in alcohol consumption among young moderate to heavy drinkers.