Alcohol expectancies: integrating cognitive science and psychometric approaches

Positive alcohol expectancy and resting-state functional connectivity of the insula in problem drinking

Positive alcohol expectancy (AE), a significant predictor of excessive alcohol consumption, is associated with heightened drinking motivation and reduced control. As the insula interacts with the limbic and prefrontal structures to integrate stimulus saliency, interoception, and cognitive control, the region may play a unique role in modulating AE. Here, we examined resting-state functional connectivity of the right and left insula in relation to AE in 180 adult drinkers. Whole-brain multiple regressions and path analysis were performed to delineate the inter-relationship between AE, insular connectivity, and drinking severity. We found that heightened AE was associated with diminished right insular connectivity with regions involved in negative emotion processing and self-control, including the amygdala, putamen, and ventromedial prefrontal cortex. In contrast, there was a positive relationship between AE and right insular connectivity with regions implicated in motivated responses to alcohol stimuli, including the superior parietal lobule, postcentral and superior frontal gyri. Path analysis showed that the two sets of right insular connectivity exhibited opposing associations with AE and that their net strength (i.e., "control minus motivation") was negatively correlated with AE and drinking severity. Analyses of the left insula seed, in contrast, did not yield regional connectivity in significant correlation with AE. These findings highlight the roles of right insula connectivity in motivational and regulatory processes that may differentially modulate drinking behavior. Recruitment of the motivational circuit and/or disengagement of the affective control circuit would be associated with heightened AE and heavier alcohol consumption.

Mediators of behavior change resulting from a sexual risk reduction intervention for STI patients, Cape Town, South Africa

Theory-based sexual risk reduction interventions are often demonstrated effective, but few studies have examined the mechanisms that mediate their behavior changes. In addition, critical contextual factors, such as alcohol use, are often not accounted for by social cognitive theories and may add to the explanatory value of intervention effects. The purpose of this study is to examine the underlying mechanisms driving condom use following a brief sexual risk reduction intervention grounded in the information, motivation, behavioral skills (IMB) model of behavior change. We examined IMB theoretical constructs and alcohol-related contextual factors as potential mediators in separate models. Patients (n = 617) from an STI clinic in Cape Town, South Africa were randomly assigned to either a brief risk reduction intervention or an education-only control condition. We assessed IMB, and alcohol-related variables at baseline, 3, 6, 9, and 12 months and modeled IMB constructs and alcohol-related factors as mediators of behavior change. Results of growth-curve mediational modeling showed that 1 year after counseling, the intervention indirectly affected sexual risk behavior through alcohol-related constructs, but not IMB constructs. Alcohol use and related factors play critical roles in explaining HIV and STI risk reduction intervention effects. Interventions that directly address alcohol use as a factor in sexual risk behavior and behavior change should be the focus of future research.

Item banks for alcohol use from the Patient-Reported Outcomes Measurement Information System (PROMIS): use, consequences, and expectancies

BACKGROUND

We report on the development and calibration of item banks for alcohol use, negative and positive consequences of alcohol use, and negative and positive expectancies regarding drinking as part of the Patient-Reported Outcomes Measurement Information System (PROMIS).

METHODS

Comprehensive literature searches yielded an initial bank of more than 5000 items from over 200 instruments. After qualitative item analysis (including focus groups and cognitive interviewing), 141 items were included in field testing. Items for alcohol use and consequences were written in a first-person, past-tense format with a 30-day time frame and 5 response options reflecting frequency. Items for expectancies were written in a third-person, present-tense format with no time frame specified and 5 response options reflecting intensity. The calibration sample included 1407 respondents, 1000 from the general population (ascertained through an internet panel) and 407 from community treatment programs participating in the National Institute on Drug Abuse (NIDA) Clinical Trials Network (CTN).

RESULTS

Final banks of 37, 31, 20, 11, and 9 items (108 total items) were calibrated for alcohol use, negative consequences, positive consequences, negative expectancies, and positive expectancies, respectively, using item response theory (IRT). Seven-item static short forms were also developed from each item bank.

CONCLUSIONS

Test information curves showed that the PROMIS item banks provided substantial information in a broad range of severity, making them suitable for treatment, observational, and epidemiological research.

Suicidal behaviour among youths associated with psychopathology in both parents and youths attending outpatient psychiatric clinic in Kenya

BACKGROUND

Suicide is a major cause of death among youths particularly with psychiatric, alcohol abuse and substance abuse disorders. There are relatively few studies on the relationship between psychiatric and substance abuse disorders with suicidal behaviour from low-income countries. This study examines the relationship between suicidal behaviour and co-existing psychiatric or substance disorders among youths and depressive and alcohol use disorders in their parents.

METHOD

The study sample had 678 respondents: 250 youths and 226 and 202 biological mothers and fathers, respectively.

RESULTS

This study found a significant statistical association between depressive (p < 0.001), alcohol abuse (p <0.001) and substance abuse (p < 0.001) disorders and suicidal behaviour in youths. There was a significant relationship between maternal depressive disorder (p < 0.001) and perceived maternal rejecting parenting behaviour (p < 0.001) with suicidal behaviour in youths. There was a greater odds of a youth with two to three (odds ratio (OR) = 3.63; p = 0.009) and four or more (OR = 8.23; p < 0.001) co-existing psychiatric disorders to have suicidal behaviour than a youth with only one psychiatric disorder. The results also indicate that a higher proportion of youths between ages 16-18 years had suicidal behaviour than youths below 16 years or above 18 years of age (p = 0.004).

CONCLUSION

These findings suggest that youths with psychiatric and substance abuse disorders have mothers living with a depressive disorder. Also, perceived maternal rejecting parenting behaviour contributes significantly to the development of suicidal behaviour later in adolescent years.

What You are Feeling and Why: Two Distinct Types of Emotional Clarity

Individual difference approaches have typically treated emotional clarity (i.e., one's understanding of one's own emotions) as a unitary construct. Based on strong theoretical reasons, in this study we explored two related aspects of emotional clarity in a student sample. The first, type awareness, refers to the extent to which people typically can identify and distinguish the types of emotions they experience. The second, source awareness, refers to the extent to which people typically know the causes of their emotions. We psychometrically distinguished self-report items of source and type awareness. Items measuring type awareness were obtained from traditional measures of the construct, clarity of emotions. As no existing measures assess individual differences in source awareness, we developed a set of items with strong face validity. Our results provide initial evidence that one can measure source and type awareness separately.

Randomized clinical trial of brief risk reduction counseling for sexually transmitted infection clinic patients in Cape Town, South Africa

OBJECTIVES

We examined the effects of a brief counseling intervention designed to reduce HIV risk behaviors and sexually transmitted infections (STIs) among patients receiving STI services in Cape Town, South Africa.

METHODS

After randomization to either a 60-minute risk reduction counseling session or a 20-minute HIV-STI educational session, patients completed computerized sexual behavior assessments. More than 85% of the participants were retained at the 12-month follow-up.

RESULTS

There were 24% fewer incident STIs and significant reductions in unprotected vaginal and anal intercourse among participants who received risk reduction counseling relative to members of the control condition. Moderator analyses showed shorter lived outcomes for heavy alcohol drinkers than for lighter drinkers. The results were not moderated by gender.

CONCLUSIONS

Brief single-session HIV prevention counseling delivered to STI clinic patients has the potential to reduce HIV infections. Counseling should be enhanced for heavier drinkers, and sustained outcomes will require relapse prevention techniques. Disseminating effective, brief, and feasible behavioral interventions to those at highest risk for HIV infection should remain a public health priority.

The Amyl Nitrite Expectancy Questionnaire for Men who have Sex with Men (AEQ-MSM): a measure of substance-related beliefs

A measure of perceived reinforcement associated with amyl nitrite was developed and evaluated among gay and bisexual men. This is the first known expectancy measure to date for this drug class. The Amyl Nitrite Expectancy Questionnaire for Men who have Sex with Men (AEQ-MSM) was completed online by 102 gay and bisexual men, between 2006 and 2008 in Queensland, Australia. The AEQ-MSM demonstrated good psychometric properties and was associated with consumption patterns. Factor analysis revealed three distinct reinforcement domains: "Enhanced sexual desire and pleasure," "Disorientation," and "Sexual negotiation." Limitations include sampling via self-selection, recruitment through health centers and self-report data. Implications for sexual activity and risk-taking, including reducing associated harm (e.g., HIV transmission), and future directions are discussed.

The Drinking Expectancy Questionnaire for Men who have Sex with Men (DEQ-MSM): a measure of substance-related beliefs

INTRODUCTION AND AIMS

Alcohol expectancies are associated with drinking behaviour and post-drinking use thoughts, feelings and behaviours. The expectancies held by specific cultural or sub-cultural groups have rarely been investigated. This research maps expectancies specific to gay and other men who have sex with men (MSM) and their relationship with substance use. This study describes the specific development of a measure of such beliefs for alcohol, the Drinking Expectancy Questionnaire for Men who have Sex with Men (DEQ-MSM).

DESIGN AND METHODS

Items selected through a focus group and interviews were piloted on 220 self-identified gay or other MSM via an online questionnaire.

RESULTS

Factor analysis revealed three distinct substance reinforcement domains ('Cognitive impairment', 'Sexual activity' and 'Social and emotional facilitation'). These factors were associated with consumption patterns of alcohol, and in a crucial test of discriminant validity were not associated with the consumption of cannabis or stimulants. Similarities and differences with existing measures will also be discussed.

DISCUSSION AND CONCLUSIONS

The DEQ-MSM represents a reliable and valid measure of outcome expectancies, related to alcohol use among MSM, and represents an important advance as no known existing alcohol expectancy measure, to date, has been developed and/or normed for use among this group. Future applications of the DEQ-MSM in health promotion, clinical settings and research may contribute to reducing harm associated with alcohol use among MSM, including the development of alcohol use among young gay men.

The Cannabis Expectancy Questionnaire for Men who have Sex with Men (CEQ-MSM): A measure of substance-related beliefs

OBJECTIVE

Substance-related expectancies are associated with substance use and post-substance use thoughts, feelings and behaviours. The expectancies held by specific cultural or sub-cultural groups have rarely been investigated. This research maps expectancies specific to gay and other men who have sex with men (MSM) and their relationship with substance patterns and behaviours following use, including sexual practices (e.g., unprotected anal intercourse). This study describes the development of a measure of such beliefs for cannabis, the Cannabis Expectancy Questionnaire for Men who have Sex with Men (CEQ-MSM).

METHOD

Items selected through a focus group and interviews were piloted on 180 self-identified gay or other MSM via an online questionnaire.

RESULTS

Factor analysis revealed six distinct substance reinforcement domains ("Enhanced sexual experience", "Sexual negotiation", "Cognitive impairment", "Social and emotional facilitation", "Enhanced sexual desire", and "Sexual inhibition"). The scale was associated with consumption patterns of cannabis, and in a crucial test of discriminant validity not with the consumption of alcohol or stimulants.

CONCLUSIONS

The CEQ-MSM represents a reliable and valid measure of outcome expectancies, related to cannabis among MSM. Future applications of the CEQ-MSM in health promotion, clinical settings and research may contribute to reducing harm associated with substance use among MSM, including HIV transmission.

Measuring clarity of and attention to emotions

Previous research has found that understanding one's emotions and attending to them are 2 dimensions of emotional awareness. In this research, we examined whether improved subscales for measuring clarity of and attention to emotions could be developed by selecting the best items from 2 frequently used measures of emotional awareness. Using multidimensional scaling and confirmatory factor analysis, we analyzed the Toronto Alexithymia Scale-20 (Bagby, Parker, & Taylor, 1994) and the Trait Meta-Mood Scale (Salovey, Mayer, Goldman, Turvey, & Palfai, 1995) data from 867 college students. Results supported distinct clarity and attention constructs. New subscales were internally consistent and fared as well as or better than previous versions in terms of internal consistency and convergent validity.

Implementing evidence-based practice in community mental health agencies: a multiple stakeholder analysis

OBJECTIVES

We sought to identify factors believed to facilitate or hinder evidence-based practice (EBP) implementation in public mental health service systems as a step in developing theory to be tested in future studies.

METHODS

Focusing across levels of an entire large public sector mental health service system for youths, we engaged participants from 6 stakeholder groups: county officials, agency directors, program managers, clinical staff, administrative staff, and consumers.

RESULTS

Participants generated 105 unique statements identifying implementation barriers and facilitators. Participants rated each statement on importance and changeability (i.e., the degree to which each barrier or facilitator is considered changeable). Data analyses distilled statements into 14 factors or dimensions. Descriptive analyses suggest that perceptions of importance and changeability varied across stakeholder groups.

CONCLUSIONS

Implementation of EBP is a complex process. Cross-system-level approaches are needed to bring divergent and convergent perspectives to light. Examples include agency and program directors facilitating EBP implementation by supporting staff, actively sharing information with policymakers and administrators about EBP effectiveness and fit with clients' needs and preferences, and helping clinicians to present and deliver EBPs and address consumer concerns.

Behavioral inhibition and activation systems: differences in substance use expectancy organization and activation in memory

We used multidimensional scaling to model the semantic network of alcohol and marijuana expectancies (N=897). Preference mapping was used to estimate vectors representing patterns of activation through the network as a function of levels of behavioral inhibition (BIS) and behavioral activation (BAS). Individuals with low BIS combined with high BAS levels exhibited patterns of activation emphasizing behavioral activation similar to heavier drug users in previous research. High BIS, low BAS individuals exhibited activation patterns with greater emphasis on inhibitory expectancies similar to low-level users. Differences in expectancy activation patterns were maintained after controlling for substance use and gender. Individual differences in BIS/BAS are associated with the organization of semantic networks and patterns of activation of expectancies contributing to differences in substance use behavior.

The outcome expectancy model for areca-quid chewing behavior

Outcome expectancies as regards areca-quid chewing played an important role in areca-quid addiction. In this study, areca-quid user expectancies will be explored. A total of 179 adolescents selected from high school completed the areca-quid chewing expectancy questionnaire and related chewing-behavior scale. Three factors (physical/emotional reward, negative consequences and social benefit) relating to areca-quid chewing behavior were explored by factor analysis and the two-dimensional model of chewing expectancy (positive-negative effect of chewing and physical-social reaction to chewing) was found using non-metric multi-dimensional scaling. The structure of the areca-quid chewing expectancy was determined for an adolescent group and the social factors involved in areca-quid chewing clearly warrant further investigation.

The role of adolescent social disinhibition expectancies in moderating the relationship between psychological distress and alcohol use and misuse

We examined the effects of adolescent social disinhibition expectancies and adult psychological distress on alcohol use and misuse in adulthood, using the 1970 British Cohort Study data. Multivariate imputation by chained equations filled in incomplete cases for 7023 men and 6896 women. A propensity to heavy alcohol use and misuse was predicted by social expectations of the releasing effects of alcohol acquired in adolescence (adolescent social disinhibition expectancies). Psychological distress at age 30 increased the likelihood of very heavy alcohol use in men and misuse of alcohol in men and women. An absence of adolescent social disinhibition expectancies protects adults from drinking alcohol. Moreover, among men without these expectancies, psychological distress did not predict heavy alcohol use, whereas this association was present among men with expectations of alcohol. Policies that aim to manage adult alcohol use should be initiated in adolescence. Reduction of psychological distress will prevent both men and women from misusing alcohol.

The development of alcohol use and outcome expectancies among American Indian young adults: a growth mixture model

Adolescence is an important developmental period for understanding alcohol use. American Indian youth are a group for whom various preventive interventions focusing on alcohol use have been implemented but have not necessarily been widely successful, highlighting the need to further refine our approaches. In the work reported here, we followed 464 14- to 18-year-old American Indian youth annually for seven years. We examined the development of alcohol use and positive alcohol outcome expectancies in parallel, using growth mixture modeling to identify classes with different trajectories of alcohol use and expectancies. We found five classes; the largest (n = 198) was made up of youth who experienced increases in both alcohol use and positive outcome expectancies. Initial levels of outcome expectancies were related to subsequent changes in alcohol use, while the reverse was not true, suggesting that interventions focusing on outcome expectancies are appropriate for a substantial number of youth. However, class heterogeneity in the relationships between the two processes pointed out that changes in expectancies may not always precede changes in alcohol use. Thus, intervention design implications are discussed for the class structures.

Alcohol expectancy multiaxial assessment: a memory network-based approach

Despite several decades of activity, alcohol expectancy research has yet to merge measurement approaches with developing memory theory. This article offers an expectancy assessment approach built on a conceptualization of expectancy as an information processing network. The authors began with multidimensional scaling models of expectancy space, which served as heuristics to suggest confirmatory factor analytic dimensional models for entry into covariance structure predictive models. It is argued that this approach permits a relatively thorough assessment of the broad range of potential expectancy dimensions in a format that is very flexible in terms of instrument length and specificity versus breadth of focus.