Alcohol-induced blackouts and maternal family history of problematic alcohol use

Factors that increase risk for alcohol-induced blackouts in high-intensity drinking young adults

BACKGROUND

Alcohol-induced blackouts are prospectively associated with negative drinking outcomes. While typically requiring heavy drinking, blackouts are not reported on all heavy drinking events or by all individuals who drink heavily. This study extends previous research by identifying the young adults most likely to experience blackouts assessed prospectively. Hypotheses focused on previously supported (female sex, White race, younger age, family history of alcohol problems, lower subjective response to alcohol, and higher tolerance) and novel predictors (possible traumatic brain injury; TBI) of alcohol-induced blackouts.

METHODS

Young adults (n = 203, 57% female, Mage = 22.07) recruited for high-intensity drinking (8/10+ drinks/occasion for females/males) completed a baseline survey and a 28-day ecological momentary assessment protocol. Hierarchical linear modeling was used to test between-person predictors of fragmentary (temporary) or en bloc (permanent) blackout likelihood during the 28 days, and moderators of the effect of day-level estimated blood alcohol concentration (eBAC) on blackout likelihood.

RESULTS

Controlling for event-level and average eBAC, both types of blackouts were more likely among those with higher subjective response to alcohol. Fragmentary blackouts were more likely among younger participants and those with possible prior TBI. Day-level eBAC was more strongly associated with both types of blackouts among non-Hispanic White participants and those with lower mean eBACs. Day-level eBAC was most strongly associated with fragmentary blackouts among those with a first-order family history of alcohol problems.

CONCLUSIONS

Younger age and greater sensitivity to alcohol may confer risk for blackouts above and beyond intoxication levels. Future work is needed to understand mechanisms that explain why these factors confer risk for blackouts.

Rate of alcohol-induced blackout experience and its negative consequences among Korean university students

An alcohol-induced blackout suggested to be related to a rapid increase in blood alcohol concentration and it is closely related to long-term memory creation. Blackout has been experienced by 35% of the general population and over 50% of university student population. In addition, it has been shown that blackout could be a precursor of injury risk. However, the rate of blackout and blackout related negative consequences in Korean university students have rarely been studied. Therefore, the objective of this study was to determine the blackout experience rate and its negative consequences among students from four universities in Korea. A survey was conducted among university students located in Pusan, Korea in 2013. Demographic and blackout related information were collected through self-report questionnaire, including blackout experience, age of first blackout, and negative consequences of blackout. Descriptive statistical analysis was performed for collected data. Of a total of 470 subjects (Male = 217, Female = 253) surveyed, 190 (40.4%) subjects had experienced a blackout at some points in their lives. The majority (86.3%) of them experienced the first blackout between 20-25 years old. Among those who had experienced a blackout, 57.0% reported that they could not remember how they went home at the end of the night, 8.1%, 7.6%, 3.1%, and 2.2% reported that they had bodily injuries, argument, physical or personal fight, and sexual-related incidences, respectively. This study shows that many Korean university students have experienced blackouts and related negative events. These results suggest that more systematic drinking control strategy is required for Korean university students.

The Relationship Between Men's Sociosexuality, Drinking Intake, and Blackouts

Background: Sociosexuality-attitudes, behaviors, and desires related to casual sex-partly predicts drinking behavior in both men and women because drinking is thought to facilitate interactions that lead to casual sex. It follows that sociosexuality would predict drinking intake (e.g., quantity consumed)-but perhaps not drinking consequences (e.g., blacking out)-on the premise that drinking large quantities with high frequency (but not to such high degrees/levels of intoxication that negative consequences occur) would facilitate casual sex. Objectives: This set of studies evaluated whether baseline measures of sociosexuality predict drinking intake (i.e., frequency, quantity, and binge drinking) but not experiencing blacking out at follow-up in two samples (Study 1, N = 172; Study 2, N = 1,038) of college-aged men. Results: As predicted, men's sociosexuality prospectively predicted drinking frequency, quantity, and binge drinking. Contrary to our predictions, men's sociosexuality also predicted blacking out. Conclusions: College men's drinking interventions should be tailored to high-risk groups and consider individual differences like sociosexuality.

A Dual-Process Decision-Making Model Examining the Longitudinal Associations Between Alcohol-Induced Blackouts and Alcohol Use Disorder Risk Among College Student Drinkers

OBJECTIVE

The purpose of this study was to use a dual-process decision-making model to examine the longitudinal associations between alcohol-induced blackouts (blackouts) and alcohol use disorder (AUD) risk symptoms among college student drinkers.

METHOD

Undergraduate drinkers (N = 2,024; 56% female; 87% White; 5% Hispanic) at a large northeastern university completed online surveys each semester during their first (Time [T] 1, T2), second (T3, T4), third (T5, T6), and fourth (T7, T8) years of college (87% retention across the study). Path analyses were examined testing the longitudinal associations between T1 willingness to experience a blackout, T1 intentions to avoid a blackout, T2-T8 drinking, T2-T8 blackouts, and T8 AUD risk symptoms. Hypotheses 1 and 2 tested the associations between T1 willingness, T1 intentions, T2-T8 drinking, and T2-T8 blackouts. Hypothesis 3 tested the associations between T2-T8 drinking, T2-T8 blackouts, and T8 AUD risk symptoms.

RESULTS

Students experienced an average of 8 (SD = 8) blackouts during college. Approximately 1,514 (88.8%) participants reported experiencing 1 of 8 AUD risk symptoms. T1 willingness was positively associated with T2-T8 blackouts. T2-T8 drinking and T2-T8 blackouts were positively associated with T8 AUD risk symptoms. T1 willingness significantly indirectly affected T8 AUD risk symptoms through its association with T2-T8 blackouts.

CONCLUSIONS

Results estimated that, on average, college student drinkers experienced eight blackouts across 4 years of college, and 88% of participants reported experiencing at least one symptom of AUD in the last semester of college. Willingness to experience a blackout influenced students' AUD risk symptoms through the number of blackouts they experienced throughout college.

The Relationship between Drunkorexia, Alcohol, and Blackouts Among College Students: An Exploratory Study

College drinkers commonly report blacking out (i.e., alcohol-induced amnesia), and those who drink with the intention to blackout are at risk for harmful consequences. Drunkorexia (i.e., restriction of calories on planned drinking days) is a high-risk behavior potentially associated with blacking out. Informed by the Theory of Planned Behavior (TPB), this study explores blackout experiences and intentions to blackout association with drunkorexia. College students (n=2335) who primarily identified as female and White participated via an online survey. Participants received a $3 coupon for completion of the study. Consistent with the literature, 40% and 60.7% participants reported experiencing blackouts and drunkorexia respectively in the last year. Informed by the TPB, a structural equation model assessed if more frequency blackout experiences (IV) related to drunkorexia behaviors (DV1) and alcohol behaviors (DV2), and if there was a significant indirect effect through blackout intention. The model fit the data well (CFI=.98, TLI=.95) and suggests that more frequent blackout experiences relate to more drunkorexia experiences (R²=.04) and higher levels of alcohol consumption (R²=.44). In addition, the relationship between blackout experiences and drunkorexia flows through intentions to blackout (i.e., a significant indirect effect). Findings are consistent with TPB, which suggests intentions predict health behavior. Future interventions should consider modifying intentions and other possible TPB constructs to minimize high risk alcohol consumption and drunkorexia behaviors.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Mortality in adult children of parents with alcohol use disorder: a nationwide register study

Research suggests that adult children of parents with harmful alcohol use are at increased risk for premature death. This national cohort study investigated mortality in adult children of parents with alcohol use disorder (AUD), adjusting for sociodemographic variables. The study used 1973 to 2018 data from Swedish national registers to compare mortality risk in children who had ≥ 1 parent with AUD (ICD-10 code F10 and its ICD-8 and ICD-9 equivalents) (n = 122,947) and those who did not (n = 2,298,532). A Cox regression model adjusted for year of birth, sex, parental education, and childhood loss of a parent was used. Before the age of 18 years, about 5% of children born in Sweden lived with ≥ 1 parent who had a clinical diagnosis of AUD. Overall mortality was higher in adult children of parents with AUD: hazard ratio (HR) 1.76, 95% confidence interval (CI) 1.71-1.82. Mortality remained elevated after adjustments for sociodemographic factors (HR 1.45, 95% CI 1.40-1.50). Children of parents with AUD had increased mortality from all investigated causes. The highest excess risk was for death from drug-related causes (excluding accidental poisonings) (HR 3.08, 95% CI 2.74-3.46). For most causes, mortality was higher if the mother had AUD than if the father had AUD. Patterns of mortality were similar in both sexes. This study provides evidence that parental AUD raises the risk of offspring mortality from preventable causes such as drug use, suicide (HR 2.16, 95% CI 1.98-2.36), accident (HR 2.00, 95% CI 1.87-2.13), and assault (HR 1.76, 95% CI 1.38-2.24).

The morning after the night before: Alcohol-induced blackouts impair next day recall in sober young adults

Binge-drinking in adolescents and young adults is a widespread problem, however, an often unreported consequence of binge-drinking behaviour is an alcohol-induced memory blackout (MBO). An MBO is a transient amnesic event resulting from rapid, excessive alcohol consumption. Here, we examine the short-term impact of an alcohol-induced MBO event (testing < 20 hours after blackout) on memory performance in people who have experienced a high volume of MBOs. In addition, we aimed to test the hypothesis that people who experience a high volume of MBOs may have poorer recall than non-blackout controls in either sober or intoxicated states. Three episodic memory paradigms consisting of free recall, serial recall, and depth of encoding tasks, were conducted by a group of alcohol drinkers who had never experienced a memory blackout, and those who reported at least 9 in the preceding 12-months. Studies were completed sober and after alcohol by all participants, and sober but after blackout by the experimental group. Accuracy of recall was assessed with linear mixed effects modelling for all experiments and conditions. Recall rate both before and after alcohol consumption was similar between groups, with poorer recall after drinking alcohol by all participants in all three studies. After blackout, MBO participants showed no significant improvement from their intoxicated state in serial recall and depth of encoding tasks, but an improvement in free recall. Further analysis of these findings revealed that 10 out of 23 participants showed significantly impaired performance after blackout during free recall, extending up to 17 participants in serial recall. In general, alcohol reduced recall rate in both blackout and control participants similarly, but recall following MBO remained poor. Our evidence suggests that alcohol-induced blackouts impair memory functioning the next day, and future research should establish the duration of deficits after an acute alcohol-induced blackout episode.

Pain severity and anxiety sensitivity interact to predict drinking severity among hazardous drinking college students

Background: Hazardous alcohol use among college students is a growing problem. Alcohol is commonly used in the context of pain due to acute analgesic effects, although the role of pain among hazardous drinkers has not been examined. Little is known regarding factors that may moderate pain-alcohol relations. One factor is anxiety sensitivity, which reflects the fear of physiological sensations. Pain severity and anxiety sensitivity may interact such that those with high anxiety sensitivity may have stronger pain-alcohol relations.Objectives: The current study examined interactive associations of pain severity and anxiety sensitivity in relation to hazardous drinking severity, alcohol consumption, and alcohol problems among hazardous drinking college students (n = 370; 78.1% female).Methods: Self report measures of alcohol use, pain severity, and anxiety sensitivity were collected and moderation analyses were conducted.Results: There was a significant interaction of pain severity and anxiety sensitivity in relation to hazardous drinking severity (β = 0.25, p = .037); pain severity was significantly related to hazardous drinking for high (β = 0.28, p < .001) but not low (β = 0.09, p = .202) anxiety sensitivity. There was a similar interaction for alcohol consumption (β = 0.35, p = .008). For alcohol problems, there was no significant interaction, but there were unique main effects of both pain severity (β = 0.23, p < .001) and anxiety sensitivity (β = 0.34, p < .001).Conclusions: These findings suggest that drinkers with high anxiety sensitivity may use alcohol hazardously (and in greater quantities) in the context of pain. If replicated with longitudinal samples, the findings may inform clinical practice in terms of screening for and treatment of anxiety sensitivity.

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

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

Investigation of tobacco and alcohol co-consumption in Thailand: A joint estimation approach

INTRODUCTION AND AIMS

Most studies on tobacco and alcohol consumption empirically model the two behaviours separately. The primary aim of this study was to investigate the patterns of tobacco and alcohol co-consumption in Thailand, modelling the two behaviours jointly and identifying whether they complemented or substituted each other.

DESIGN AND METHODS

Data were extracted from the 2007, 2011, 2014 and 2017 waves of the nationally representative Tobacco and Alcohol Consumption Survey in Thailand. A bivariate ordered probit model, under which the frequencies of tobacco and alcohol consumption were jointly estimated, was performed on the repeated cross-sectional sample as well as each of the cross-sectional samples.

RESULTS

Based on the repeated cross-sectional sample (n = 411 981), the analyses suggested that tobacco and alcohol consumption were complementary behaviours. The predicted conditional probabilities revealed that the more frequently one drank, the higher the likelihood that he/she also smoked at a higher frequency, and vice versa.

DISCUSSION AND CONCLUSIONS

Given the complementary nature of tobacco and alcohol consumption in Thailand, tobacco- and alcohol-prevention strategies should be realigned and better co-ordinated for greater efficiency. The net impacts of a given tobacco or alcohol policy should be incorporated into the optimal policy design to avoid duplication of efforts. Also, future studies of tobacco and alcohol consumption should consider modelling the two behaviours together using a joint estimation approach.

The prevalence and impact of elevated anxiety sensitivity among hazardous drinking college students

Hazardous drinking is prevalent among college students, yet few seek treatment. Anxiety sensitivity AS is one factor with relevance to drinking. Yet, there are no known estimates of the prevalence of elevated AS among hazardous drinkers. The current study sought to estimate the prevalence of elevated AS among hazardous drinking college students and to examine relations between AS and hazardous drinking. Data from 1257 students Mage = 22.08; 80.4 % female; 76.8 % racial/ethnic minorities was employed. Approximately one third (30.7 %) of the sample met criteria for hazardous drinking. Among hazardous drinkers, 77.5 % had clinically elevated AS; similar rates were evidenced across sex and race/ethnicity. Hazardous drinkers reported significantly greater AS scores than moderate drinkers and non-drinkers (p < 0.001; η2 = 0.09). Those with elevated AS were more than three times more likely to be hazardous drinkers (p < 0.001). Among hazardous drinkers, those with elevated AS had more severe drinking levels (p < 0.001; Cohen's d=0.07) as well as greater likelihood, number, and disturbance related to use of other substances (p's from <0.001-0.005; Cohen's d's from 0.01 to 0.02). Findings from this study suggest that most hazardous drinkers have elevated AS, and that elevated AS is associated with a substantially higher likelihood of being a hazardous drinker. Hazardous drinkers with elevated AS report more severe drinking and other substance use than those with normative AS. There may be practical clinical benefit of implementing focus on AS to reduce hazardous drinking in college settings.

Computer-delivered personalized feedback intervention for hazardous drinkers with elevated anxiety sensitivity: Study protocol for a randomized controlled trial

Integrated treatments for hazardous drinking and anxiety/depression are virtually nonexistent. Anxiety sensitivity is a common mechanism for both anxiety/depression and hazardous drinking. This article presents a study protocol for the development and testing of an integrated remotely delivered anxiety sensitivity/hazardous drinking personalized feedback intervention. Hazardous drinking college students with elevated anxiety sensitivity (n = 130) will be randomly assigned to a single session of a novel integrated personalized feedback intervention for anxiety sensitivity/hazardous drinking or control condition. Follow-ups will occur at 1 week, 1 month, and 3 months. This study will serve as an initial test and proof of concept for an integrated anxiety sensitivity/hazardous drinking personalized feedback intervention.

Event-Level Correlates of Drinking Events Characterized by Alcohol-Induced Blackouts

BACKGROUND

Prior research identifies a range of potential predictors of blackouts and suggests that blackouts increase risk for additional negative consequences. However, these studies are based on epidemiological work that allows us to draw conclusions about groups of people but not within-person processes. The present study examined within-person, event-level correlates of blackouts.

METHODS

Ninety-six heavy drinking college students (52% female) completed 28 days of daily reports of alcohol use and consequences, including blackouts. Thirty-three participants reported 56 blackouts. Hierarchical linear modeling compared morning reports of drinking events on which participants did versus did not report a blackout, controlling for total drinks at the event.

RESULTS

Blackout likelihood increased as a function of total drinks consumed and of crossing thresholds for heavy episodic drinking (4+/5+ drinks for women/men) and high-intensity drinking (8+/10+). Participants reported a higher total number of additional negative consequences on blackout events. Specific consequences that were more likely included embarrassing oneself and hangover. Blackouts were associated with morning ratings of less positive mood and a less favorable drinking event. Motives for drinking and simultaneous use of marijuana were not associated with blackouts.

CONCLUSIONS

Event-level findings of this study document that events leading to alcohol-induced memory loss are associated with other adverse experiences relative to drinking events that do not result in blackout, and offer potentially motivational levers for preventive interventions.

Alcohol-Induced Amnesia and Personalized Drinking Feedback: Blackouts Predict Intervention Response

Alcohol-induced amnesia ("blackout") is a reliable predictor of alcohol-related harm. Given its association with other negative consequences, experience of alcohol-induced amnesia may serve as a teachable moment, after which individuals are more likely to respond to intervention. To test this hypothesis, alcohol-induced amnesia was evaluated as a moderator of brief intervention effect on (a) alcohol-related consequences and (b) the proposed intervention mediators, protective behavioral strategies and peak blood alcohol concentration (BAC). Baseline alcohol risk measured using the Alcohol Use Disorders Identification Test (AUDIT) was also evaluated as a moderator to rule out the possibility that amnesia is simply an indicator of more general alcohol risk. College students (N = 198) reporting alcohol use in a typical week completed assessments at baseline and 1-month follow-up as part of a larger intervention trial. Participants were randomized to assessment only (AO; n = 58) or personalized feedback intervention (PFI; n = 140). Hierarchical regression was used to examine direct and indirect intervention effects. A significant group-by-amnesia interaction revealed that only PFI participants who had experienced alcohol-induced amnesia in the past month reported decreases in alcohol consequences at 1-month follow-up. The PFI reduced alcohol-related consequences indirectly through changes in peak BAC, but only among those who had experienced amnesia at baseline. In contrast, baseline alcohol risk (AUDIT) did not moderate intervention effects, and use of protective behavioral strategies did not statistically mediate intervention effects. Findings suggest that loss of memory for drinking events is a unique determinant of young adult response to brief alcohol intervention. Normative feedback interventions may be particularly effective for individuals who have experienced alcohol-induced amnesia in the past 30 days.

The role of parent and offspring sex on risk for externalizing psychopathology in offspring with parental alcohol use disorder: a national Swedish study

PURPOSE

The substantial literature showing that offspring of parents with alcohol use disorder (AUD) is at increased risk for externalizing psychopathology rarely examines the differential effects of parental and offspring sex. This literature also has other important limitations, such as modest sample sizes and use of unrepresentative samples. Using a large, nationwide Swedish sample, we aim to investigate the roles of parental and offspring sex in externalizing psychopathology among offspring with parental AUD.

METHODS

AUD diagnosis and externalizing measures were obtained from national registries. Associations between outcomes and parental AUD were examined using logistic regressions. Parental and offspring sex effects were examined with interaction terms.

RESULTS

Risks for externalizing disorders were increased in sons and daughters with parental AUD, with significant differences between sons and daughters for criminal behavior; maternal AUD had a greater impact than paternal AUD (regardless of offspring sex), but having two parents with AUD increased risk for all outcomes substantially more than having one parent; and maternal AUD increased risk of drug abuse for daughters more than sons, while paternal AUD increased risk of AUD and criminal behavior for sons more than daughters.

CONCLUSIONS

Offspring of parents with AUD are at increased risk for externalizing psychopathology. Maternal and paternal AUD differentially affected sons' vs. daughters' risks for AUD, drug abuse, and criminal behavior. The transmission of psychopathology within the externalizing spectrum appears to have sex-specific elements.

Alcohol-induced blackouts, subjective intoxication, and motivation to decrease drinking: Prospective examination of the transition out of college

OBJECTIVE

We prospectively examined whether subjective intoxication serves as a risk factor for experiencing alcohol-induced blackouts. We then examined whether subjective intoxication and/or blackouts predicted motivation to decrease their drinking, and whether this motivation to change would promote future changes in drinking behavior.

METHOD

Participants (N=1854, 62.1% female, 53.2% Caucasian, M_age=21.8) were recruited the summer prior to matriculating into a large, public university to complete a 6-year longitudinal study. Self-reported motivation to decrease their drinking behavior, their frequency of blackouts, quantity of alcohol consumption, and subjective intoxication (i.e., feeling drunk) were assessed annually during the transition out of college (Years 4-6).

RESULTS

In a cross-lagged model, subjective intoxication (i.e., feeling drunk) prospectively predicted experiencing blackouts (p<0.001). Controlling for both objective (e.g., quantity) and subjective intoxication, blackouts at Year 4 predicted greater motivation to decrease drinking behavior at Year 5 (p<0.01), but this motivation did not predict less quantity of alcohol use by Year 6 (p=0.076).

CONCLUSIONS

Subjective intoxication is a robust predictor of blackouts across time. Additionally, blackouts are modest, developmentally-limited predictors of motivation to change drinking behavior, but blackouts do not predict future behavior change.

Blackouts as a Moderator of Young Adult Veteran Response to Personalized Normative Feedback for Heavy Drinking

BACKGROUND

Blackouts-or periods of alcohol-induced amnesia for all or part of a drinking event-have been identified as independent predictors of alcohol-related harm that may be used to identify individuals who would benefit from intervention. However, little is known about the prevalence and impact of blackouts among Veterans. This study examined blackouts as a moderator of young adult veteran response to a brief, online personalized normative feedback (PNF) intervention for heavy drinking.

METHODS

Veterans scoring ≥3/4 (women/men) on the Alcohol Use Disorders Identification Test completed a baseline and 1-month assessment as part of a larger intervention trial (N = 571; 83% male; age M = 28.9, SD = 3.3). Participants were randomized to alcohol PNF (n = 285) or a video game attention control (n = 286). Hierarchical regression was used to examine the interaction between intervention condition and blackouts on alcohol-related outcomes at 1-month follow-up.

RESULTS

At baseline, 26% of participants reported loss of memory for drinking events in the past 30 days. The interaction between condition and blackouts was significant, such that PNF participants who had experienced blackouts at baseline reported greater decreases in drinking quantity at 1 month than those who had not, and only PNF participants who had experienced baseline blackouts reported a decrease in alcohol problems at follow-up.

CONCLUSIONS

PNF appears to be particularly effective for individuals who have experienced alcohol-induced blackout, perhaps because blackouts prime them for feedback on their alcohol use. While other negative consequences may also prime individuals for behavior change, blackouts are posited as a particularly useful screening tool because they are prevalent among young adults, have a strong association with alcohol-related harm, and are assessed in widely used clinical measures.

Predictors of Patterns of Alcohol-Related Blackouts Over Time in Youth From the Collaborative Study of the Genetics of Alcoholism: The Roles of Genetics and Cannabis

OBJECTIVE

Alcohol-related blackouts (ARBs) are anterograde amnesias related to heavy alcohol intake seen in about 50% of drinkers. Although a major determinant of ARBs relates to blood alcohol concentrations, additional contributions come from genetic vulnerabilities and possible impacts of cannabis use disorders (CUDs). We evaluated relationships of genetics and cannabis use to latent class trajectories of ARBs in 829 subjects from the Collaborative Study of the Genetics of Alcoholism (COGA).

METHOD

The number of ARBs experienced every 2 years from subjects with average ages of 18 to 25 were entered into a latent class growth analysis in Mplus, and resulting class membership was evaluated in light of baseline characteristics, including CUDs. Correlations of number of ARBs across assessments were also compared for sibling pairs versus unrelated subjects.

RESULTS

Latent class growth analysis identified ARB-based Classes 1 (consistent low = 42.5%), 2 (moderate low = 28.3%), 3 (moderate high = 22.9%), and 4 (consistent high = 6.3%). A multinomial logistic regression analysis within latent class growth analysis revealed that baseline CUDs related most closely to Classes 3 and 4. The number of ARBs across time correlated .23 for sibling pairs and -.10 for unrelated subjects.

CONCLUSIONS

Baseline CUDs related to the most severe latent ARB course over time, even when considered along with other trajectory predictors, including baseline alcohol use disorders and maximum number of drinks. Data indicated significant roles for genetic factors for alcohol use disorder patterns over time. Future research is needed to improve understanding of how cannabis adds to the ARB risk and to find genes that contribute to risks for ARBs among drinkers.

Sex and Drugs and Starting School: Differences in Precollege Alcohol-Related Sexual Risk Taking by Gender and Recent Blackout Activity

Research has demonstrated a link between alcohol use and multiple forms of risky sexual behavior, particularly among college-age individuals. Studies have also linked heavy alcohol use to other problems, such as impaired consciousness resulting from an alcohol-induced blackout, which may impact sexual decision making. However, research has rarely examined sexual risk taking (SRT) in relation to blackouts, nor has it examined this construct during the precollege transition (i.e., the interval of time between high school graduation and college matriculation). This study examined the intersection between alcohol-involved SRT, blackouts, and gender in a sample of precollege individuals with prior alcohol use (N = 229; 54% male, 63% White). Results indicated that, despite drinking less per occasion, women reporting recent blackouts were at increased risk for experiencing unwanted, unsafe, and regretted sexual behaviors compared to men with recent blackouts and their peers with no recent blackouts. Women with recent blackouts also reported differences in alcohol expectancies that may increase their risk for experiencing negative consequences while drinking, including higher social expectancies and lower negative expectancies of danger. Future directions for research and implications for precollege interventions are discussed.

Alcohol-related blackouts across 55 weeks of college: Effects of European-American ethnicity, female sex, and low level of response to alcohol

BACKGROUND

While high blood alcohol concentrations (BACs) are required for alcohol-related blackouts (ARBs), additional characteristics also contribute to the risk, including a person's ethnicity, sex, and phenotypes relating to heavier drinking. Few prospective studies of ARBs have evaluated how these additional characteristics interact.

METHOD

Data regarding 398 European American (EA), Asian and Hispanic students were extracted from a 55-week prospective study of different approaches to decrease heavy drinking among college freshmen. Information on past month ARB frequency was determined at 8 assessments. While controlling for the prior month maximum BAC and active education vs. control group assignment, the patterns and intensities of ARBs over time across ethnic groups were evaluated with ANOVA at each follow-up for the full sample, and then separately by sex and then by low vs. high levels of response to alcohol status (LR). The overall pattern of ARBs over time was evaluated with a 3 ethnic groups by 2 sexes by 2 LR status by 8 time points mixed-design ANOVA.

RESULTS

Higher rates of ARBs over time were associated with EA ethnicity, female sex and a low LR to alcohol, with the ethnic differences in ARBs most robust in females and drinkers with high LRs. Participation in education programs aimed at heavy drinking was associated with decreases in ARBs.

CONCLUSIONS

The data indicate that in addition to BACs achieved, propensities toward ARBs relate to complex interactions between additional risk factors, including ethnicity, sex, and LR status.

Latent growth classes of alcohol-related blackouts over the first 2 years of college

Alcohol-related blackouts are common among college student drinkers. The present study extends prior work by examining latent growth classes of blackouts and several predictors of class membership. Participants (N = 709 college drinkers) completed a baseline survey at college entry and biweekly online assessments throughout freshman and sophomore years. Results revealed 5 latent growth class trajectories, reflecting varying experiences of blackouts at the beginning of college and differential change in blackouts over time. The largest class represented a relatively low-risk group (low decrease; 47.3%) characterized by endorsement of no or very low likelihood of blackouts, and decreasing likelihood of blackouts over time. Another decreasing risk group (high decrease; 11.1%) initially reported a high proportion of blackouts and had the steepest decrease in blackout risk over time. A small percentage showed consistently high likelihood of blackouts over time (high stable; 4.1%). The remaining 2 groups were distinguished by relatively moderate (moderate stable; 14.9%) and lower (low stable; 22.6%) likelihood of blackouts, which remained stable over time. Comparisons between classes revealed that students with greater perceived peer drinking, perceived peer approval of drinking, and enhancement motives upon entry to college tended to be in higher risk groups with consistent experiences of blackouts over time, whereas blackout likelihood decreased over time for students with greater conformity motives. Findings suggest that precollege preventive interventions may be strengthened by considering not only factors related to current risk for blackouts and other alcohol-related consequences, but also those factors related to persistence of these behaviors over time. (PsycINFO Database Record

Alcohol-Induced Blackouts: A Review of Recent Clinical Research with Practical Implications and Recommendations for Future Studies

BACKGROUND

Alcohol-induced blackouts, or memory loss for all or portions of events that occurred during a drinking episode, are reported by approximately 50% of drinkers and are associated with a wide range of negative consequences, including injury and death. As such, identifying the factors that contribute to and result from alcohol-induced blackouts is critical in developing effective prevention programs. Here, we provide an updated review (2010 to 2015) of clinical research focused on alcohol-induced blackouts, outline practical and clinical implications, and provide recommendations for future research.

METHODS

A comprehensive, systematic literature review was conducted to examine all articles published between January 2010 through August 2015 that focused on vulnerabilities, consequences, and possible mechanisms for alcohol-induced blackouts.

RESULTS

Twenty-six studies reported on alcohol-induced blackouts. Fifteen studies examined prevalence and/or predictors of alcohol-induced blackouts. Six publications described the consequences of alcohol-induced blackouts, and 5 studies explored potential cognitive and neurobiological mechanisms underlying alcohol-induced blackouts.

CONCLUSIONS

Recent research on alcohol-induced blackouts suggests that individual differences, not just alcohol consumption, increase the likelihood of experiencing an alcohol-induced blackout, and the consequences of alcohol-induced blackouts extend beyond the consequences related to the drinking episode to include psychiatric symptoms and neurobiological abnormalities. Prospective studies and a standardized assessment of alcohol-induced blackouts are needed to fully characterize factors associated with alcohol-induced blackouts and to improve prevention strategies.

Alcohol-Induced Blackouts as Predictors of Other Drinking Related Harms Among Emerging Young Adults

BACKGROUND

Alcohol-related blackouts are periods of amnesia that reflect the failure of the brain to record memories of what transpires while drinking. This paper examined the incidence, predictors, and behavioral correlates of blackouts among emerging adults and examined whether questions about blackouts could serve as better markers of risk for other alcohol related harms than questions about levels of consumption.

METHODS

In 2012 to 2013, 1,463 (68%) of 2,140 respondents 1-year past high school reported having consumed alcohol. They were asked whether, in the past 6 months because of drinking, they forgot where they were or what they did. The survey also explored demographics, substance use behaviors, and other alcohol-related problems in the past 6 months. Chi-square and logistic regression analyses explored bivariate and multivariate predictors of blackouts and other alcohol-related problems.

RESULTS

Twenty percent of respondents who ever drank alcohol reported a blackout in the past 6 months. Blackouts were more prevalent among females and those who, in the past 30 days, used multiple drugs, more frequently binged, were drunk, smoked, had lower body weight, and lived in college dorms. After controlling for drinking levels, having a blackout was the strongest independent predictor of most other alcohol problems examined, including in the past 6 months because of drinking, missing class or work, getting behind in work or school, doing something respondents later regretted, arguing with friends, experiencing an overdose, and total number of alcohol problems reported. It was also an independent predictor of hangovers, damaging property, getting hurt, and trouble with police.

CONCLUSIONS

Because blackouts indicate drinking at levels that result in significant cognitive and behavioral impairment, questions about blackouts could serve as important, simple screeners for the risk of experiencing other alcohol related harms. Additional work on this subject is warranted.

Early Onset Drinking Predicts Greater Level But Not Growth of Alcohol-Induced Blackouts Beyond the Effect of Binge Drinking During Emerging Adulthood

BACKGROUND

Early onset drinking is associated with later heavy drinking and related consequences. Early drinking onset and binge drinking are also independently associated with blackouts, which are periods of amnesia for events during a drinking episode. The objective of this study was to examine how early onset drinking relates to changes in the frequency of experiencing blackouts across 3 years controlling for year-specific binge drinking.

METHODS

Participants (N = 1,145; 67.9% female) from a 6-year, longitudinal study are included in these analyses. Measures of self-reported age at drinking onset included ages at first drink, first high, and first drunk, which were used to create a latent early onset drinking factor. Frequency of binge drinking and blackouts were assessed annually during Years 4 to 6.

RESULTS

Overall, 69.2% of participants reported experiencing blackouts. After controlling for year-specific binge drinking, a growth curve model indicated that early onset drinkers reported more frequent blackouts at Year 4. There were, however, no significant effects of acceleration or deceleration in the frequency of blackouts across the 3 years. Early onset drinkers continued to experience more frequent blackouts compared with those who initiated alcohol use later, despite decreases in binge drinking over time.

CONCLUSIONS

Early onset drinkers reported more frequent blackouts across all 3 years, indicating that early alcohol initiation predisposes those individuals to continue to experience more frequent blackouts, despite a decrease in their binge drinking. This may be due to various factors, such as altered hippocampal development and functioning resulting from early alcohol exposure.

Alcohol-Induced Blackouts and Other Negative Outcomes During the Transition Out of College

OBJECTIVE

There is considerable debate about the prospective association between alcohol-dependence symptoms and alcohol-related blackouts. The goal of this study was to examine the associations among alcohol-dependence symptoms, blackouts, and social and emotional consequences during the transition out of college.

METHOD

Participants (N = 829; 66% female) were part of a 6-year longitudinal study designed to explore alcohol use and risky behaviors during and after college. Data for these analyses were from Years 4 and 5 of data collection, which most closely corresponded to the transition out of college. Using cross-lagged models, we tested the prospective associations of alcohol-dependence symptoms, blackout frequency, and social and emotional consequences.

RESULTS

Alcohol-dependence symptoms in Year 4 predicted increased frequency of blackouts and social and emotional consequences during the subsequent year. Blackouts during Year 4 also significantly predicted increased alcohol-related social and emotional consequences, but not dependence symptoms, in Year 5.

CONCLUSIONS

Although blackouts do not predict the development of alcohol-dependence symptoms, they increase the risk for less severe alcohol-related consequences during the transition out of college. This may result from the cognitive reconciliation of negative behaviors that occur during these episodes of amnesia.