The role of alcohol expectancy and drinking refusal self-efficacy beliefs in university student drinking

The relationship between cannabis outcome expectancies and cannabis refusal self-efficacy in a treatment population

BACKGROUND AND AIMS

Self-efficacy beliefs and outcome expectancies are central to Social Cognitive Theory (SCT). Alcohol studies demonstrate the theoretical and clinical utility of applying both SCT constructs. This study examined the relationship between refusal self-efficacy and outcome expectancies in a sample of cannabis users, and tested formal mediational models.

DESIGN

Patients referred for cannabis treatment completed a comprehensive clinical assessment, including recently validated cannabis expectancy and refusal self-efficacy scales.

SETTING

A hospital alcohol and drug out-patient clinic.

PARTICIPANTS

Patients referred for a cannabis treatment [n = 1115, mean age 26.29, standard deviation (SD) 9.39].

MEASUREMENTS

The Cannabis Expectancy Questionnaire (CEQ) and Cannabis Refusal Self-Efficacy Questionnaire (CRSEQ) were completed, along with measures of cannabis severity [Severity of Dependence Scale (SDS)] and cannabis consumption.

FINDINGS

Positive (β = -0.29, P < 0.001) and negative (β = -0.19, P < 0.001) cannabis outcome expectancies were associated significantly with refusal self-efficacy. Refusal self-efficacy, in turn, fully mediated the association between negative expectancy and weekly consumption [95% confidence interval (CI) = 0.03, 0.17] and partially mediated the effect of positive expectancy on weekly consumption (95% CI = 0.06, 0.17).

CONCLUSIONS

Consistent with Social Cognitive Theory, refusal self-efficacy (a person's belief that he or she can abstain from cannabis use) mediates part of the association between cannabis outcome expectancies (perceived consequences of cannabis use) and cannabis use.

Personality, cognition and hazardous drinking: Support for the 2-Component Approach to Reinforcing Substances Model

Personality and cognitive processes are both related to alcohol use and misuse. A recent model of hazardous drinking referred, the 2-CARS model, postulates two major pathways to hazardous drinking. One pathway primarily involves the association between Reward Drive and Positive Outcome Expectancies, the second involves the association between Rash Impulsiveness and Drinking Refusal Self-Efficacy. In previous tests of the model, Drinking Refusal Self-Efficacy was found to have the most proximal impact on drinking, being directly influenced by Rash Impulsiveness, and indirectly influenced by Reward Drive through Positive Outcome Expectancies. The aim of the current study was to test the 2-CARS model in a larger independent sample. Results found that individuals with a strong Reward Drive showed higher Positive Outcome Expectancies, while individuals high in Rash Impulsiveness were more likely to report reduced Drinking Refusal Self-Efficacy. The present results also showed a theoretically unexpected pathway with a direct association between Rash Impulsiveness and Positive Outcome Expectancies. However, overall the results support the view that a greater understanding of hazardous drinking can be achieved by investigating the relationship between these personality and cognitive variables.

Reducing alcohol-related harm in disadvantaged men: development and feasibility assessment of a brief intervention delivered by mobile telephone

Background

Socially disadvantaged men suffer substantial harm from heavy drinking. Brief alcohol interventions are effective in reducing consumption when delivered via health care. There is a need for tailored brief interventions for disadvantaged men who seldom attend health care.

Objectives

(1) To investigate the best ways to recruit and retain disadvantaged men in a study aimed at reducing the frequency of heavy drinking. (2) To identify the type of content and timing of the delivery that is most likely to engage disadvantaged young to middle-aged men in an intervention delivered by text messages. (3) To determine whether or not the intervention is likely to be an acceptable way to influence the frequency of heavy drinking.

Design

A three-phase study involving the development of the recruitment strategy and the intervention, an assessment of the feasibility of a randomised controlled trial, and a post-study evaluation.

Setting

Community-based study, conducted in Dundee, UK.

Participants

Disadvantaged men aged 25–44 years who had two or more episodes of heavy drinking (≥ 8 units in a single session) in the preceding month. Two recruitment strategies were employed: recruitment through general practice (GP) registers and recruitment through a community outreach strategy.

Interventions

Focus groups explored drinking motives and behaviours of the target group. The intervention also drew on reviews of the literature on: alcohol brief interventions, text message studies, communication theory and behaviour change theories and techniques. The intervention group received 36 text messages with images sent over a 28-day period.

Main outcome measures

The outcome measures evaluated the likely success of a full trial: recruitment of the participants; construction and delivery of a theoretically and empirically based intervention that successfully engages disadvantaged men; potential for the intervention to influence binge drinking.

Results

The focus group analyses identified that personal experience and knowledge of the harmful effects of alcohol was widespread. Furthermore, there was a discrepancy between frequent binge drinking and perceived social expectations and duties. This could usefully be targeted in the intervention. Theoretically and empirically based behaviour change strategies were successfully rendered in attractive, colourful, brief text messages. Both recruitment strategies (GP registers and community outreach) proved successful and a total of 67 men were recruited, exceeding the target of 60. The participants were at high risk of harm because of frequent episodes of heavy binge drinking. Baseline interviews established that those recruited through community outreach drank substantially more and had more frequent binge drinking sessions than those recruited through GP registers. Retention at follow-up was 96%. Extensive process evaluation was conducted. The evaluation showed that 95% of text messages were successfully delivered to participants' telephones. Furthermore, there was a high level of engagement with text messages which sought responses. Most men replied to these texts, often giving carefully structured personal responses. Analyses of the responses indicated a high level of engagement with key components of the behaviour change strategy. Post-trial evaluation showed high levels of satisfaction with the intervention.

Conclusions

This study has shown that disadvantaged men can be recruited and retained in an alcohol intervention trial. A theoretically and empirically based intervention was successfully delivered by text message. Furthermore, the messages were well received and elicited the types of response intended. A full trial of the intervention, incorporating a cost-effectiveness study, should be carried out.

Study registration

This study is registered as ISRCTN10515845.

Funding

The National Institute for Health Research Public Health Research programme.

Can you say no? Examining the relationship between drinking refusal self-efficacy and protective behavioral strategy use on alcohol outcomes

Preliminary research has demonstrated reductions in alcohol-related harm associated with increased use of protective behavioral strategies (PBS) and higher levels of drinking refusal self-efficacy (DRSE). To extend research that has evaluated these protective factors independently of one another, the present study examined the interactive effects of PBS use and DRSE in predicting alcohol outcomes. Participants were 1084 college students (63% female) who completed online surveys. Two hierarchical linear regression models revealed that both DRSE and PBS use predicted alcohol use and consequences. Additionally, DRSE moderated the relationship between PBS use and both typical weekly drinking and negative alcohol-related consequences, such that participants who reported lower levels of PBS use and DRSE in the social pressure or emotional regulation dimensions were at greatest risk for heavy drinking and consequences respectively. Interestingly, for those who reported higher levels of social and emotional DRSE, levels of PBS use had no impact on alcohol use or alcohol consequences respectively. These findings demonstrate that DRSE and PBS use differentially reduce risk, suggesting the utility of collegiate, alcohol harm reduction interventions that aim to both increase PBS use and bolster self-efficacy for greater harm reduction.

The development of a web-based brief alcohol intervention in reducing heavy drinking among college students: an Intervention Mapping approach

In the Netherlands, young adults' drinking practices have become an issue of public concern since their drinking levels are high. Heavy drinking can place young adults at an increased risk for developing short- and long-term health-related problems. Current national alcohol prevention programmes focus mainly on adolescents and their parents and paying less systematic attention to young adults. The present study describes the theory and evidence-based development of a web-based brief alcohol intervention entitled What Do You Drink (WDYD). We applied the Intervention Mapping (IM) protocol to combine theory and evidence in the development and implementation of WDYD. The WDYD intervention aims to detect and reduce heavy drinking of young adults who are willing to decrease their alcohol consumption, preferably below the Dutch guidelines of low-risk drinking. According to the IM protocol, the development of WDYD resulted in a structured intervention. Reducing heavy drinking to low-risk drinking was proposed as the behavioural outcome. Motivational interviewing principles and parts of the I-Change Model were used as methods in the development of WDYD, whereas computer tailoring was selected as main strategy. An effect and a process evaluation of the intervention will be conducted. IM was found to be a practical instrument for developing the WDYD intervention tailored to a specific target population in the area of alcohol prevention.

Heavy episodic drinking in college females: an exploration of expectancies, consequences, and self-efficacy

Differences on expectancies and self-efficacy between college females who engage in heavy episodic drinking (HED) and non-HED were examined. Students (N = 95) from Southern California filled out the Comprehensive Effects of Alcohol, Cognitive Appraisal of Risky Events, and Drinking Context Convivial Drinking scales as well as self-efficacy, alcohol use, and demographic items in the fall semester of 2008. Logistic and linear regression showed that greater positive expectancies and lower self-efficacy were predictive of categorization as HED and greater convivial drinking. Implications, limitations, and directions for future research are discussed.

Development and validation of the cannabis refusal self-efficacy questionnaire (CRSEQ) in adult cannabis users in treatment

BACKGROUND

There are few valid clinical assessment instruments for cannabis. Self-efficacy, or the ability of users to resist temptation, is a central feature of social cognitive theory. This study outlines the development and validation of the cannabis refusal self-efficacy questionnaire (CRSEQ), which measures the situational confidence to refuse cannabis.

METHOD

One thousand two hundred and forty-six patients referred for cannabis assessment completed the CRSEQ including measures of cannabis consumption and dependence severity (severity of dependence scale-cannabis, SDS-C). The CRSEQ was subject to independent exploratory (n=621, mean age 26.88, 78.6% male) and confirmatory (n=625, mean age 27.51, 76.8% male) factor analysis.

RESULTS

Three factors: Emotional Relief, Opportunistic and Social Facilitation were identified. They provided a good statistical and conceptual fit for the data. Emotional relief cannabis refusal self-efficacy was identified as most predictive of cannabis dependence, after controlling for cannabis consumption.

CONCLUSIONS

The CRSEQ is recommended as a psychometrically sound and clinically useful measure for cannabis misuse treatment planning and assessment.

Using the Drinking Expectancy Questionnaire (revised scoring method) in clinical practice

The Drinking Expectancy Questionnaire (Young & Knight, 1989; Young & Oei, 1996) has been widely used in clinical and research settings over the past 20 years. A revised scoring method with a five-factor structure has been proposed but no norms for this method are available (Lee, Oei, Greeley, & Baglioni, 2003). The aim of this study is to establish sample means for the five expectancy subscales (Social Confidence; Sexual Interest; Cognitive Enhancement; Tension Reduction; and Negative Consequences) in a sample of adults entering hospital treatment for alcohol dependence (N=163) and a sample of university undergraduate students (N=110). Clinical sample means on the expectancy subscales tended to be substantially higher than the means for the student sample, with the exception of Sexual Interest (which was higher in the students). Interestingly, the Negative Consequences subscale mean was more than two standard deviations higher in the clinical sample, and was strongly correlated with measures of depression, anxiety and stress. The Negative Consequences scores were strongly associated with drinking risk in the student sample but were not related to drinking measures in the clinical sample. A ROC analysis established a cut-off on the DEQ total of 107 that distinguished dependent drinkers from student drinkers with high sensitivity and specificity. The clinical utility of the DEQ in general will be discussed.

Path of socialization and cognitive factors' effects on adolescents' alcohol use in Taiwan

OBJECTIVES

The purpose of this study was to explore the direct and indirect effects of alcohol-related socialization factors and cognitive factors on adolescent alcohol use in a country with a low prevalence of drinking.

METHODS

Data were obtained from the 2006 phase of the Child and Adolescent Behaviors in Long-term Evolution (CABLE) project, at which time the study participants were in grade nine (aged 14-15 years). Data from 1940 participants were analyzed. The main study variables included the current alcohol use of each adolescent, alcohol expectations, alcohol refusal efficacy, alcohol use among parents and peers, attitudes of the parents toward underage drinking, and peer encouragement of drinking. Path analysis was conducted to examine whether parental and peer socialization factors had direct effects on adolescent alcohol use, or whether they acted indirectly via cognitive factors.

RESULTS

Among the participants, 19.54% had used alcohol in the previous month. Path analysis demonstrated that father, mother and peer alcohol use directly influenced alcohol use in adolescents. Attitudes of mothers toward underage drinking, peer drinking and peer encouragement of drinking had indirect effects on adolescent alcohol use that were mediated by cognitive factors.

CONCLUSIONS

This study demonstrated that alcohol-related socialization factors could directly influence adolescent drinking behavior and had indirect effects on alcohol use that were mediated by cognitive factors partially. Parents and peers play important roles in preventing adolescent alcohol use. Establishing appropriate alcohol expectations and strengthening alcohol refusal skills could aid in decreasing alcohol use in adolescents.

Factor Structure Validation of the Alcohol Dependence Scale in a Heavy Drinking College Sample

The prevalence of alcohol use disorders in college students necessitates that adequate measures exist to assess students for abuse and dependence. The Alcohol Dependence Scale (ADS) is a continuous measure of the severity of alcohol involvement found to have a unidimensional factor structure in clinical samples. The latent factor structure of the ADS in college drinkers has not been examined and this study sought to replicate unidimensionality. Heavy college drinkers (N=343) completed the ADS. Performance was examined using confirmatory factor analysis (CFA) and exploratory factor analysis (EFA). The CFA did not support a single factor solution. Follow-up EFA revealed a two factor structure. The first, termed "Acute Excessive Drinking" consisted of relatively commonly endorsed items relating to loss of behavioral control, blackouts, and obsessive/compulsive drinking. The second, termed "Severe Withdrawal Symptoms," consisted of relatively infrequently endorsed items relating to withdrawal symptoms. The ADS does not appear to have the same factor structure in college and clinical samples, making it inadvisable as a linear measure of alcohol problems within a college population.

Alexithymia in alcohol dependent patients is partially mediated by alcohol expectancy

BACKGROUND

Up to fifty percent of alcohol dependent individuals have alexithymia, a personality trait characterised by difficulties identifying and describing feelings, a lack of imagination and an externalised cognitive style. Although studies have examined alexithymia in relation to alcohol dependence, no research exists on mechanisms underlying this relationship. The present study examined the mediational effect of alcohol expectancies on alexithymia and alcohol dependence.

METHODS

230 outpatients completed the Toronto Alexithymia Scale (TAS-20), the Drinking Expectancy Questionnaire (DEQ) and the Alcohol Use Disorder Identification Test (AUDIT).

RESULTS

Regression analysis showed that alexithymia and alcohol dependence was, in two of three cases, partially mediated through alcohol expectancy.

CONCLUSIONS

Alcohol expectancies of assertion and affective change show promise as mediators of alcohol dependence in individuals with alexithymia.

Validation of the Cannabis Expectancy Questionnaire (CEQ) in adult cannabis users in treatment

BACKGROUND

Outcome expectancies are a key cognitive construct in the etiology, assessment and treatment of Substance Use Disorders. There is a research and clinical need for a cannabis expectancy measure validated in a clinical sample of cannabis users.

METHOD

The Cannabis Expectancy Questionnaire (CEQ) was subjected to exploratory (n=501, mean age 27.45, 78% male) and confirmatory (n=505, mean age 27.69, 78% male) factor analysis in two separate samples of cannabis users attending an outpatient cannabis treatment program. Weekly cannabis consumption was clinically assessed and patients completed the Severity of Dependence Scale-Cannabis (SDS-C) and the General Health Questionnaire (GHQ-28).

RESULTS

Two factors representing Negative Cannabis Expectancies and Positive Cannabis Expectancies were identified. These provided a robust statistical and conceptual fit for the data. Internal reliabilities were high. Negative expectancies were associated with greater dependence severity (as measured by the SDS) and positive expectancies with higher consumption. The interaction of positive and negative expectancies was consistently significantly associated with self-reported functioning across all four GHQ-28 scales (Somatic Concerns, Anxiety, Social Dysfunction and Depression). Specifically, within the context of high positive cannabis expectancy, higher negative expectancy was predictive of more impaired functioning. By contrast, within the context of low positive cannabis expectancy, higher negative expectancy was predictive of better functioning.

CONCLUSIONS

The CEQ is the first cannabis expectancy measure to be validated in a sample of cannabis users in treatment. Negative and positive cannabis expectancy domains were uniquely associated with consumption, dependence severity and self-reported mental health functioning.

Targeting young drinkers online: the effectiveness of a web-based brief alcohol intervention in reducing heavy drinking among college students: study protocol of a two-arm parallel group randomized controlled trial

Background

The prevalence of heavy drinking among college students and its associated health related consequences highlights an urgent need for alcohol prevention programs targeting 18 to 24 year olds. Nevertheless, current alcohol prevention programs in the Netherlands pay surprisingly little attention to the drinking patterns of this specific age group. The study described in this protocol will test the effectiveness of a web-based brief alcohol intervention that is aimed at reducing alcohol use among heavy drinking college students aged 18 to 24 years old.

Methods/Design

The effectiveness of the What Do You Drink web-based brief alcohol intervention will be tested among 908 heavy drinking college students in a two-arm parallel group randomized controlled trial. Participants will be allocated at random to either the experimental (N = 454: web-based brief alcohol intervention) or control condition (N = 454: no intervention). The primary outcome measure will be the percentage of participants who drink within the normative limits of the Dutch National Health Council for low-risk drinking. These limits specify that, for heavy alcohol use, the mean consumption cannot exceed 14 or 21 glasses of standard alcohol units per week for females and males, respectively, while for binge drinking, the consumption cannot exceed five or more glasses of standard alcohol units on one drinking occasion at least once per week within one month and six months after the intervention. Reductions in mean weekly alcohol consumption and frequency of binge drinking are also primary outcome measures. Weekly Ecological Momentary Assessment will measure alcohol-related cognitions, that is, attitudes, self-efficacy, subjective norms and alcohol expectancies, which will be included as the secondary outcome measures.

Discussion

This study protocol describes the two-arm parallel group randomized controlled trial developed to evaluate the effectiveness of a web-based brief alcohol intervention. We expect a reduction of mean weekly alcohol consumption and frequency of binge drinking in the experimental condition compared to the control condition as a direct result of the intervention. If the website is effective, it will be implemented in alcohol prevention initiatives, which will facilitate the implementation of the protocol.

Trial registration

Netherlands Trial Register NTR2665.

A dual process account of adolescent and adult binge drinking

This study adopted a dual process perspective to investigate the relative contributions of implicit and explicit cognitions to predicting binge drinking in adolescents and adults. Two hundred and seventy-two participants (136 teen-parent pairs) completed measures of alcohol memory associations (reflecting implicit cognition), expectancies about potential costs and benefits of alcohol use (reflecting explicit cognition), and self-reported binge drinking. Adolescents had stronger alcohol memory associations and perceived drinking benefits to be more probable than did adults. In turn, higher scores on the memory association and expected benefit measures were both associated with significantly higher levels of binge drinking. Moderation analyses revealed that alcohol memory associations and expected benefits of drinking were stronger predictors of binge drinking for adolescents than for adults. The findings suggest that both implicit and explicit cognitions may play important roles in alcohol use decisions, and these roles may differ for adolescents and adults.

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

OBJECTIVE

Alcohol-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.

METHOD

Using 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.

RESULTS

Expectancies of negative affect moderated the association of depressed mood and AMAs, but there was no such association for tension reduction expectancy.

CONCLUSION

Subtle 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.

The comprehensive alcohol expectancy questionnaire: confirmatory factor analysis, scale refinement, and further validation

The Comprehensive Alcohol Expectancy Questionnaire (CAEQ; Demmel & Hagen, 2003a, 2003b) is a self-report measure designed to assess an individual's alcohol expectancies. In this study, we examined the CAEQ in a student sample (N= 932) and in a clinical sample of alcohol-dependent inpatients (N= 744). The Five-factor structure was confirmed by means of confirmatory factor analysis. Convergent validity of the revised CAEQ was supported by showing significant relationships to quantity and frequency of drinking. The results of this study suggest that the revised CAEQ appears to be a psychometrically sound tool for the assessment of alcohol expectancies among both students and alcohol-dependent inpatients.

A motivational model of alcohol misuse in emerging adulthood

Many emerging adults who have dropped out of high school are known to misuse alcohol. Expectancies and motives for drinking are pivotal in shaping the drinking behavior of emerging adults, especially those related to social influences. We tested a motivational model of problematic alcohol use using drinking motives (enhancement, social, conformity, coping) as multiple mediators to explain the association between social alcohol expectancies and alcohol misuse. A community sample of 104 individuals between ages 16 and 21 attending a General Educational Development (GED) program completed self-report measures of alcohol expectancies, drinking motives, quantity and frequency of drinking, and a structured interview that assessed the symptoms of alcohol use disorders. Results of multiple regression analysis testing multiple mediators indicated that social alcohol expectancies were associated with alcohol misuse through the mediated pathways of enhancement drinking motives.

Alcohol expectancies and drinking refusal self-efficacy mediate the association of impulsivity with alcohol misuse

BACKGROUND

Recent work suggests that 2 biologically based traits convey risk for alcohol misuse: reward sensitivity/drive and (rash) impulsiveness. However, the cognitive mechanisms through which these traits convey risk are unclear. This study tested a model predicting that the risk conveyed by reward sensitivity is mediated by a learning bias for the reinforcing outcomes of alcohol consumption (i.e., positive alcohol expectancy). The model also proposed that the risk conveyed by rash impulsiveness (RI) is mediated by drinkers' perceived ability to resist alcohol (i.e., drinking refusal self-efficacy).

METHODS

Study 1 tested the model in a sample of young adults (n = 342). Study 2 tested the model in a sample of treatment-seeking substance abusers (n = 121). All participants completed a battery of personality, cognitive, and alcohol use questionnaires and models were tested using structural equation modeling.

RESULTS

In both studies, the hypothesized model was found to provide a good fit to the data, and a better fit than alternative models. In both young adults and treatment-seeking individuals, positive alcohol expectancy fully mediated the association between reward sensitivity and hazardous alcohol use. For treatment seekers, drinking refusal self-efficacy fully mediated the association between RI and hazardous drinking. However, there was partial mediation in the young adult sample. Furthermore, neither trait was directly associated with the other cognitive mediator.

CONCLUSIONS

The hypothesized model was confirmed on a large sample of young adults and replicated on a sample of treatment-seeking substance abusers. Taken together, these findings shed further light on the mechanisms through which an impulsive temperament may convey risk for alcohol misuse.

Alcohol-induced disinhibition expectancies and impaired control as prospective predictors of problem drinking in undergraduates

Trait disinhibition is associated with problem drinking and alcohol drinking can bring about a state of disinhibition. It is unclear however, if expectancies of alcohol-induced disinhibition are unique predictors of problem drinking. Impaired control (i.e., difficulty in limiting alcohol consumption) may be related to disinhibition expectancies in that both involve issues of control related to alcohol use. Data from a prospective survey of undergraduates assessed during freshman (N = 337) and senior year (N = 201) were analyzed to determine whether subscales of the Drinking-Induced Disinhibition Scale (Leeman, Toll, & Volpicelli, 2007) and the Impaired Control Scale (Heather et al., 1993) predicted unique variance in heavy episodic drinking and alcohol-related problems. In Time 1 cross-sectional models, Dysphoric disinhibition expectancies predicted alcohol-related problems and impaired control predicted both alcohol-related problems and heavy episodic drinking. In prospective models, Time 1 impaired control predicted Time 2 alcohol-related problems and Time 1 Euphoric/social Disinhibition expectancies predicted Time 2 heavy episodic drinking. These findings suggest that expectancies of alcohol-induced disinhibition and impaired control predict unique variance in problem drinking cross-sectionally and prospectively, and that these phenomena should be targeted in early intervention efforts.

Alexithymia and alcohol use disorders: a critical review

All human beings experience emotion. However a number of individuals have difficulties recognising, processing and regulating their emotions. This set of emotional "deficits' is classified as alexithymia. The prevalence rate of alexithymia in alcohol use disorders is between 45 and 67%. The objective of this paper is to review the published research on alexithymia and alcohol use, assess the methodological quality of this evidence, and draw the findings together to present a critical update on the relationship between alexithymia and alcohol use disorders. Yet, few research studies have comprehensively investigated alexithymia in alcohol use disorders, and a number of key issues still remain to be addressed in exploring the veracity of the link between alexithymia and alcohol use. For example, limited evidence exists regarding the association between alexithymia, alcohol consumption and severity of alcohol dependence. Furthermore, there is no current knowledge about the predictive utility of alexithymia in relation to more well researched and established psychological drinking constructs. Although alexithymia is often considered a risk factor for the development of alcohol use disorders, there is little evidence to support this notion. Given that alexithymia may have the potential to interfere with treatment outcomes, a better understanding of the role of alexithymia in alcohol use is needed.

The A1 allele of the D2 dopamine receptor gene region, alcohol expectancies and drinking refusal self-efficacy are associated with alcohol dependence severity

Psychological risk and genetic risk for alcohol dependence are rarely examined in concert. The current study used path analysis (via structural equation modelling) to explore the relationship between the A(1) allele of the D2 dopamine receptor DRD2 gene region, age of problem drinking onset, alcohol expectancy and drinking refusal self-efficacy towards alcohol consumption and dependence severity. One hundred and forty-three (93 male, 50 female) alcohol dependent inpatients provided an extensive clinical history, including age of onset of problem drinking and quantity and frequency of alcohol consumption. The Drinking Expectancy Profile and the Alcohol Dependence Scale were completed, and 10 milliliters of blood were obtained for genetic analysis. The results showed that the posited model fitted the data set well and support the pattern of direct (allele status to drinking) and indirect (allele status influenced by psychosocial variables) relationships hypothesised for the model. A formal test of mediation showed some support for a psychosocial mediational model. The results are discussed in terms of a possible developmental trajectory that involves both genetic risk that influences brain dopamine activity and reinforcement expectancies that both operate via diminished drinking refusal self-efficacy. The prevention and treatment possibilities that arise from understanding this trajectory are examined.

University students' perceptions of the alcohol campaign: "Is Getting Pissed Getting Pathetic? (Just Ask Your Friends)"

The present study examined students' understanding and perceived effectiveness of a recent Australian alcohol campaign designed to increase students' awareness of excessive and harmful drinking. Six hundred and seventy one university students (51% females), who had seen the campaign posters, with the tagline "Is Getting Pissed Getting Pathetic? (Just Ask You Friends)", were asked to comment on the messages that the campaign was communicating and how informative, relevant, and effective they perceived the campaign. Many students were positive in their evaluations and described the messages as "truth and realistic", "clear and to the point", and that the campaign made them think about their own drinking. However, other views were more negative and indicative of psychological reactance. These included concerns that students "won't listen" or "don't care" about media campaigns, and that "they don't what to be told what to do". The findings highlight how media campaigns can help an audience contemplate behavioral change, however, they can also alienate students and promote counterproductive attitudes.

The theory of planned behavior as a model of heavy episodic drinking among college students

This study provided a simultaneous confirmatory test of the theory of planned behavior (TPB) in predicting heavy episodic drinking (HED) among college students. It was hypothesized that past HED, drinking attitudes, subjective norms, and drinking refusal self-efficacy would predict intention, which would, in turn, predict future HED. Participants consisted of 131 college drinkers (63% women) who reported having engaged in HED in the previous 2 weeks. Participants were recruited and completed questionnaires within the context of a larger intervention study (see Collins & Carey, 2005). Latent factor structural equation modeling was used to test the ability of the TPB to predict HED. Chi-square tests and fit indices indicated good fit for the final structural models. Self-efficacy and attitudes but not subjective norms significantly predicted baseline intention, and intention and past HED predicted future HED. Contrary to hypotheses, however, a structural model excluding past HED provided a better fit than a model including it. Although further studies must be conducted before a definitive conclusion is reached, a TPB model excluding past behavior, which is arguably more parsimonious and theory driven, may predict HED among college drinkers better than a model including past behavior.

The relationship between alcohol expectancies and drinking restraint in treatment seeking alcohol dependent patients

The allied psychological drinking constructs of alcohol expectancy and drinking restraint have shown considerable promise, both independently and in combination, in understanding problematic drinking. However, previous research examining the relationship between these two constructs has only occurred in pre-dependent, convenience samples. This study examined the role of both alcohol expectancies and drinking restraint in an alcohol dependent sample. 143 DSM-IV alcohol dependent participants (93 males, 50 females) completed measures of drinking restraint (Temptation and Restraint Inventory, TRI) and alcohol expectancy (Drinking Expectancy Profile, DEP), along with quantity and frequency of consumption and dependence severity (Alcohol Dependence Scale, ADS). The results showed that although alcohol expectancy and drinking restraint do share common underlying properties, there was unique variance attributed to the prediction of dependence severity and consumption. The results also failed to replicate the drinking restraint model observed in non-clinical samples. It was concluded that alcohol expectancy and drinking restraint models appear to show superior utility in pre-dependent populations. The implications of these findings in refining social cognitive models of alcohol misuse are discussed, with a particular focus on prevention.