The relationship of positive and negative alcohol expectancies to patterns of consumption of alcohol in social drinkers

Development and validation of a Chinese Drinking Expectancies Questionnaire for young adults: A Hong Kong study

INTRODUCTION

Drinking expectancies, the perceived consequences of alcohol consumption, are noted to predict drinking behaviours. However, there is comparatively little research of drinking expectancies in non-Western populations. This study aimed to develop and validate a Chinese Drinking Expectancy Questionnaire (CDEQ-Adult) for Chinese young adults.

METHODS

Face and content validity were first assessed of items generated from literature review and previously conducted focus groups. Exploratory (EFA) and confirmatory factor analyses (CFA) were conducted with split-half samples from a random telephone survey that was conducted on Hong Kong Chinese adults between the ages of 18-34 (n = 675). The instrument's convergent validity and internal reliability were also examined.

RESULTS

The preliminary instrument items showed good content validity (Item Content Validity Index range: 0.8-1.0). The EFA yielded a 31-item, five-factor model consisting of five domains: Negative Consequences, Interpersonal Benefits, Increased Confidence, Health Benefits and Tension/Stress Reduction (variance explained 63.7%). The CFA revealed that the fit indices for the five-factor model using diagonal weighted least squares estimator were χ2 (256, N = 338) = 394.04, p < 0.001, comparative fit index 0.97, SRMR 0.07, RMSEA 0.06 (95% confidence interval 0.06, 0.08), suggesting a good fit of the model. The Cronbach's α coefficients were 0.94, 0.90, 0.86, 0.77 and 0.57, respectively for each of the five domains (n = 675). Significant associations with past month drinking behaviours and future drinking intentions give strong support for convergent validity.

DISCUSSION AND CONCLUSIONS

The CDEQ-Adult is a culturally relevant instrument for assessing drinking expectancies in Chinese young adults for use in future studies.

A systematic review and meta-analysis of the relationship between youth drinking, self-posting of alcohol use and other social media engagement (2012-21)

BACKGROUND AND AIM

Social networking sites (SNS) are interactive internet-based social platforms that facilitate information sharing. A growing body of literature on exposure to, and self-posting of, alcohol-related content on SNS has examined the relationship between SNS use and alcohol consumption in young people. This study aims to synthesise the literature exploring the relationship between exposure (i.e. viewing or listening of alcohol-related media) and self-posting (i.e. uploading images or text of alcohol content) of alcohol-related media on SNS on alcohol consumption.

METHODS

A pre-registered systematic review was conducted in June 2022 within PubMed, Scopus, PsycINFO and Web of Science. Original prospective and cross-sectional studies assessing youth and young adults (≤ 24 years of age) that measured exposure to alcohol-related media or posting of alcohol-related content on SNS and self-reported alcohol consumption outcomes were included. Meta-analyses were conducted on comparable methodologies.

RESULTS

Thirty studies were included (n = 19,386). Meta-analyses of cross-sectional studies showed both greater exposure (five studies; pooled β = 0.34, 95% confidence interval [CI] = 0.23, 0.44, i2 = 27.7%) and self-posting of alcohol-related content (six studies; pooled β = 0.57, 95%CI = 0.25,0.88, i2 = 97.8%) was associated with greater alcohol consumption. Meta-analyses of three prospective studies also identified that greater exposure predicted greater future alcohol consumption (three studies; pooled β = 0.13, 95%CI = 0.11,0.15, i2 = 0.0%). Narrative analyses of studies that could not be meta-analysed due to incompatible methodologies were also conducted. Most studies (all four prospective, one of two cross-sectional) identified positive associations between exposure to alcohol-related content and greater average consumption. Most studies (three of four prospective, four of six cross-sectional) reported a positive association between of alcohol-related self-posting and greater average alcohol consumption.

CONCLUSIONS

Both exposure to, and self-posting of, alcohol-related content on social networking sites are positively associated with current average consumption, problem drinking, and drinking frequency.

Positive but not negative affect is associated with increased daily drinking likelihood in non-clinical populations: systematic review and meta-analyses

Background: Recent meta-analytical findings indicate that affect regulation plays an important role in alcohol craving, consumption volume, and substance use. However, in view of mixed findings, the affect and drinking likelihood literature remains in need of clarification and consolidation.Objectives: This systematic review with meta-analyses interrogated the results from peer-reviewed studies among non-clinical populations that examined the relationship between daily affective states and intraday likelihood of alcohol consumption.Method: A PRISMA guided search of PsychINFO, PsycARTICLES, Science Direct, Wiley Online Library, PubMed, SCOPUS, and JSTOR databases was conducted. Multilevel meta-analyses yielded 11 eligible negative affect studies (2751 participants, 23 effect sizes) and nine studies on positive affect (2244 participants, 14 effect sizes).Results: The pooled associations between intra-day affect and alcohol consumption likelihood revealed no significant association between negative affective state and drinking likelihood (OR = .90, 95% CI [.73, 1.12]) and that positive affect was associated with increased drinking likelihood (OR = 1.17, 95% CI [1.09, 1.27]). Egger's test, P-curve, fail-safe N, and selection models analyses suggested that the obtained results were unlikely to be the product of publication bias and p-hacking alone.Conclusions: Results converge to suggest that, independent of age, affect measure used, and study design, a significant albeit modest relationship between positive affect and alcohol consumption likelihood exists, which does not appear to be the case for negative affect. In conjunction with other recent meta-analyses, current findings help map out a more nuanced understanding of the affect-alcohol/substance use relationship, with potential implications for interventions.

Correlates and Effects of Alcohol Use Expectancies Among Persons Living with HIV in Uganda

Unhealthy alcohol use fuels difficulties with HIV disease management and potentiates secondary transmission of HIV but less is known about how these alcohol use expectancies may shape alcohol use behaviors, particularly in the presence of depressive symptomatology. In this paper, we utilize data from a prospective study of 208 people living with HIV in Southwest Uganda, to examine the correlates of alcohol use expectancies and their association with unhealthy alcohol use. Affective depressive symptoms were positively associated with alcohol use expectancies. Gender moderation was observed such that depression was more strongly associated with alcohol use expectancies among women. In unadjusted analyses, alcohol use expectancies were marginally associated with unhealthy alcohol use and this association was not significant in adjusted analyses. Findings underscore the need to strengthen screening for depression and alcohol use within HIV care services, particularly among women.

Escaping the past and living in the present: a qualitative exploration of substance use among Syrian male refugees in Germany

Background

Syrians have been the largest group of refugees in Germany since 2014. Little is known about Syrian refugees` perspectives on substance use. The aim of this study is to investigate the perspective of male refugees from Syria and to foster specific knowledge and understanding of substance use.

Methods

We applied a qualitative study design. Five semi-structured focus group discussions with a total of 19 refugees were conducted in 2019 among the difficult to reach population of Syrian refugees. Audio recordings were translated and transcribed. We used a hybrid approach by integrating inductive and deductive thematic frameworks.

Results

We identified common themes. Firstly, refugees perceived that substances are widely available and accepted in Germany. Secondly, refugees perceived that rules and norms in Germany differ from rules and norms in the home country and favor availability of substances. Thirdly, substance use is related to the intention to escape the past. Fourthly, substance use is related to living in the present through connecting with others and being part of the community. Finally, mental health professional treatment for substance use is associated with shame.

Conclusions

Findings support Syrian refugees` perspectives of substance use as a way of both escaping the past and coping with psychosocial difficulties in the present in a socio-ecological understanding. Understanding the explanatory model of Syrian refugees can inform future interventions to prevent substance abuse and design tailored interventions. Further studies with Syrian refugees in more countries are needed to better understand resettled refugees` perspectives on substance use.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13031-021-00352-x.

Cross-fading motives for simultaneous alcohol and marijuana use: Associations with young adults' use and consequences across days

BACKGROUND

Many young adults engage in simultaneous alcohol and marijuana (SAM) use so that their effects overlap. Little is known about motivations for dual substance use and associations with use and consequences. This study examined daily-level associations between cross-fading motives and levels of alcohol and marijuana use and consequences.

METHODS

Young adults who reported SAM use in the month prior were surveyed in two 14-day bursts. Data included 1049 SAM use days from 281 young adults (age 18-25; M age = 21.80, SD = 2.16; 50 % women). Multilevel models assessed between- and within-person effects of cross-fading motives (i.e., to enhance the effects of marijuana and/or alcohol use by using them simultaneously) on alcohol and marijuana use and consequences, after adjusting for general enhancement, social, coping, and conformity motives and the amount of alcohol and marijuana used that day.

RESULTS

On 76 % of SAM use days, participants endorsed cross-fading motives (i.e., to enhance the effect of alcohol or marijuana or to get drunk and high at the same time). Having stronger cross-fading motives was associated with greater alcohol use, perceived intoxication, and positive alcohol consequences at the between- and within-person levels. In addition, between-person, individuals who reported stronger cross-fading motives on average reported more negative alcohol consequences and positive marijuana consequences on average. Cross-fading motives on a given day were not associated with marijuana use or marijuana consequences that day.

CONCLUSIONS

Cross-fading motives were common and varied from day to day. Understanding the motivational context for dual substance use may support future interventions for cross-fading.

Alcohol expectancies mediate the association between the neural response to emotional words and alcohol consumption

BACKGROUND

Both positive expectancies regarding the effects of alcohol and internalizing problems, including negative emotionality and deficits in emotion regulation, are known risk factors for alcohol use disorder (AUD). The current study is the first to investigate how neural response to emotional stimuli may impact alcohol expectancies and risk for AUD.

METHODS

Functional neuroimaging data was collected during an emotional word task from 168 emerging adults (M age = 19.65; 66% male). Activation to negative versus neutral words and positive versus neutral words was extracted for analyses. Participants also reported on their alcohol expectancies and information regarding alcohol use and problems was collected prospectively throughout adolescence and into adulthood (up to age 30).

RESULTS

Decreased activation in the inferior frontal gyrus (IFG) to negative versus neutral words was associated with increased post-scan alcohol consumption, measured as average drinks per year. There was a significant indirect effect of positive alcohol expectancies on the association between IFG activation and post-scan alcohol consumption, even when controlling for quantity of alcohol consumption prior to the scan.

CONCLUSIONS

These results are the first to provide evidence that positive alcohol expectancies account for variance shared between brain regions associated with emotion processing and increased drinking behaviors. Alcohol expectancies may provide a modifiable target for treatments to decrease the link between deficits in emotion regulation and increased alcohol use.

Effects of Observable Parent Alcohol Consequences and Parent Alcohol Disorder on Adolescent Alcohol Expectancies

BACKGROUND

Parental drinking and parent alcohol use disorder (AUD) are known predictors of adolescent positive alcohol expectancies, but their link to negative expectancies is unclear. Research suggests that parent drinking may indirectly predict adolescent expectancies through exposure to parental drinking events. However, exposure to parent negative alcohol consequences may be more relevant to adolescents' expectancies. The present study tested the mediating effect of parent observable negative alcohol consequences in the association between parent AUD and adolescent expectancies.

METHODS

This study used parent and adolescent data from the Adult and Family Development Project. A total of 581 adolescents reported on their alcohol expectancies across 2 waves of data, and their parents reported on potentially observable alcohol-related negative consequences during the first wave. Past-year and lifetime parent AUD were assessed with diagnostic interviews across 6 waves of data.

RESULTS

Mothers' observable consequences mediated the effect of her past-year AUD on adolescent negative expectancies in adolescence, but this effect did not hold at a 1.5-year follow-up. Mothers' lifetime AUD was the only prospective predictor of later adolescent negative expectancies. No father drinking variables predicted expectancies, and all models were invariant across child biological sex. Finally, older adolescent age prospectively predicted higher positive expectancies, whereas the adolescents' own drinking predicted lower negative expectancies.

CONCLUSIONS

These findings, in line with other recent studies, suggest that exposure to mothers' negative experiences with alcohol may counterintuitively normalize negative alcohol effects. This may paradoxically increase risk for adolescents rather than buffering the effects of a family history of parental AUD.

Self-fulfilling prophecies: Documentation of real-world daily alcohol expectancy effects on the experience of specific positive and negative alcohol-related consequences

Alcohol expectancies are consistently associated with alcohol use in cross-sectional and longitudinal studies. However, little research has examined whether alcohol expectancies on specific drinking occasions are associated with reported consequences on those days, particularly when controlling for the amount of alcohol consumed, thus differentiating the extent to which reported consequences may have resulted from alcohol or an "expectancy effect." This study examined consequence-specific daily expectancy effects. College students (N = 342; mean age 19.7 [standard deviation (SD) = 1.25], 52.9% female) participated in a longitudinal measurement burst study. During four 2-week intervals, participants used mobile phones to respond to 3 surveys per day via automated telephone interviews. The results showed that on days when college students had higher-than-average expectancies for specific subjective positive consequences (e.g., feeling more relaxed, being in a better mood), they were more likely to report experiencing those same consequences as a result of their alcohol use that day, even after controlling for how much they actually drank on that day. The same held true for subjective interpersonal negative consequences (e.g., becoming aggressive, rude, or obnoxious; embarrassing oneself), but not for less subjective physical/cognitive negative consequences (e.g., having a hangover, vomiting, getting hurt/injured, forgetting). The results suggest that one's expectations about the particular effects of alcohol tend to be self-fulfilling for subjective effects of alcohol even when they are not directly tied to the physiological effects of alcohol. The findings underscore the important role of alcohol expectancies, particularly the expectation of subjective positive social and tension-reduction/relaxation effects, in understanding problematic alcohol use. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

A meta-analysis of the effect of substance use interventions on emotion outcomes

OBJECTIVE

Emotional distress has been posited as a key underlying mechanism in the development and maintenance of substance use disorder (SUD), and patients seeking SUD treatment are often experiencing high levels of negative emotion and/or low levels of positive emotion. But the extent to which SUD interventions impact emotional outcomes among general SUD populations is yet unquantified. The current meta-analysis aims to fill this gap.

METHOD

A total of 11,754 records were screened for randomized, controlled trials examining the effect of behavioral SUD interventions on emotion outcomes. Our search yielded a total of 138 effect sizes calculated based on data from 5,146 individuals enrolled in 30 independent clinical trials. Random-effects meta-analysis was used to calculate pooled effect sizes, and metaregression analyses examined study-level moderators (e.g., intervention type).

RESULTS

Findings indicated a small but significant effect of SUD interventions on emotion outcomes, d = 0.157, 95% CI [0.052, 0.262] (k = 30). The effect size for negative emotion was nominally bigger, d = 0.162, 95% CI [0.056, 0.269] (k = 30), whereas the effect for positive emotion did not reach statistical significance, d = 0.062, 95% CI [-0.089, 0.213] (k = 7). Studies featuring SUD interventions designed to specifically target emotions (i.e., affect-regulation, mindfulness-based treatments) produced larger reductions in negative emotion compared with studies featuring interventions that did not contain specific emotion modules (e.g., contingency management).

CONCLUSIONS

Findings suggest that SUD interventions-especially mindfulness-based and affect-regulation treatments-indeed significantly reduce negative emotion, although relatively small effect sizes indicate potential room for improvement. Conclusions regarding positive emotion should be considered preliminary because of the limited numbers of samples assessing these outcomes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The paradoxical relationship between emotion regulation and gambling-related cognitive biases

Background

Gambling behavior presents substantial individual variability regarding its severity, manifestations, and psychological correlates. Specifically, differences in emotion regulation, impulsivity, and cognitive distortions have been identified as crucial to describe individual profiles with implications for the prevention, prognosis, and treatment of gambling disorder (GD).

Aims and method

The aim of the present study was to investigate the associations of gambling-related cognitions (measured according to the GRCS model) with impulsivity (UPPS-P model) and emotion regulation (CERQ model), in a sample of 246 gamblers with different levels of gambling involvement, using mixed-effects modelling to isolate theoretically relevant associations while controlling for the potentially confounding effects of sociodemographic and clinical covariates.

Results

Affective/motivational dimensions of UPPS-P impulsivity positive urgency and sensation seeking, on the one hand, and CERQ emotion regulation strategies reappraisal, rumination and blaming others, on the other, independently and significantly predicted distorted gambling-related cognitions.

Conclusions

These results (a) reinforce the ones of previous studies stressing the relevance of emotional and motivational processes in the emergence of gambling-related cognitive distortions; and (b) replicate the seemingly paradoxical finding that gamblers use emotion regulation strategies customarily considered as adaptive (i.e. reappraisal) to strengthen and justify their biased beliefs about gambling outcomes and controllability.

Problem Drinking, Alcohol Expectancy, and Thalamic Resting-State Functional Connectivity in Nondependent Adult Drinkers

Alcohol misuse is associated with thalamic dysfunction. The thalamus comprises subnuclei that relay and integrate information between cortical and subcortical structures. However, it is unclear how the subnuclei contribute to thalamic dysfunctions in problem drinking. We investigated resting-state functional connectivity (rsFC) of thalamic subregions in 107 nondependent drinkers (57 women), using masks delineated by white matter tractography. Thalamus was parceled into motor, somatosensory, visual, premotor, frontal association, parietal association, and temporal association subregions. Whole-brain linear regression, each against Alcohol Use Disorders Identification Test (AUDIT) and positive alcohol expectancy (AE) score with age as a covariate, was performed for each seed, for men and women combined, and separately. Overall, problem drinking was associated with increased thalamic connectivities, whereas AE was associated with a mixed pattern of increased and decreased connectivities. Motor, premotor, somatosensory, and frontal association thalamic connectivity with bilateral caudate head was positively correlated with AUDIT score in men and women combined. Connectivity of the right caudate head with frontal association and premotor thalamus was also positively correlated with AE score in men and women combined. In contrast, motor and premotor thalamic connectivity with a number of cortical and subcortical structures showed sex differences in the correlation each with AUDIT and AE score. In mediation analyses, AE score completely mediated the correlation between thalamic caudate connectivity and AUDIT score, whereas the model where AE contributed to problem drinking and, in turn, altered thalamic caudate connectivity was not supported. To conclude, thalamic subregional rsFCs showed both shared and distinct changes and sex differences in association with problem drinking and AE. Increased thalamic caudate connectivity may contribute to problem drinking via enhanced AE. The findings suggest the importance of examining thalamic subdivisions and sex in investigating the functional roles of thalamus in problem drinking.

Alcohol Use and Unprotected Sex Among HIV-Infected Ugandan Adults: Findings from an Event-Level Study

While alcohol is a known risk factor for HIV infection in sub-Saharan Africa (SSA), studies designed to investigate the temporal relationship between alcohol use and unprotected sex are lacking. The purpose of this study was to determine whether alcohol used at the time of a sexual event is associated with unprotected sex at that same event. Data for this study were collected as part of two longitudinal studies of HIV-infected Ugandan adults. A structured questionnaire was administered at regularly scheduled cohort study visits in order to assess the circumstances (e.g., alcohol use, partner type) of the most recent sexual event (MRSE). Generalized estimating equation logistic regression models were used to examine the association between alcohol use (by the participant, the sexual partner, or both the participant and the partner) and the odds of unprotected sex at the sexual event while controlling for participant gender, age, months since HIV diagnosis, unhealthy alcohol use in the prior 3 months, partner type, and HIV status of partner. A total of 627 sexually active participants (57% women) reported 1817 sexual events. Of these events, 19% involved alcohol use and 53% were unprotected. Alcohol use by one's sexual partner (aOR 1.70; 95% CI 1.14, 2.54) or by both partners (aOR 1.78; 95% CI 1.07, 2.98) during the MRSE significantly increased the odds of unprotected sex at that same event. These results add to the growing event-level literature in SSA and support a temporal association between alcohol used prior to a sexual event and subsequent unprotected sex.

Alcohol expectancies pre-and post-alcohol use disorder treatment: Clinical implications

BACKGROUND AND AIMS

Modification of elevated positive expectations of alcohol consumption (alcohol outcome expectancies; AOEs) is a key feature of Cognitive Behaviour Therapy (CBT) approaches to Alcohol Use Disorders (AUDs). Despite extensive research supporting the efficacy of CBT for AUD, few studies have examined AOE change. This study aimed to assess AOE change following completion of CBT for AUD and its association with drinking behaviour.

METHOD

One-hundred and seventy-five patients who completed a 12-week CBT program for AUD were administered the Drinking Expectancy Questionnaire (DEQ) at pre-treatment assessment and upon completion of treatment. Abstinence was achieved by 108 (61.7%) of completing patients. For patients who lapsed, the mean proportion of abstinent days was 93%.

RESULTS

DEQ scales assessing expectations of positive alcohol effects on tension reduction, assertiveness, and cognitive enhancement were significantly lower post-treatment (p<0.001). Expectations of negative effects on mood were higher post-treatment (p<0.001). The largest AOE change occurred on the tension reduction scale. Greater percentage of abstinent days over treatment was associated with lower pre-and post-treatment tension reduction expectancy scores (p<0.05). Drinking during treatment was associated with smaller changes in expectations of negative effects of alcohol on mood (p<0.05).

CONCLUSIONS

Individuals who completed CBT treatment for AUD showed significant AOE change. Tension reduction and affective change expectancies may be particularly important for abstinence and useful markers of lapse risk.

Testing the effects of explicit and implicit bidimensional attitudes on objectively measured speeding behaviour

Bidimensional attitudes have been shown to independently predict behaviour, with the positive dimension of attitude being a stronger predictor of behaviour than the negative dimension (e.g., Elliott, Brewster, et al., 2015, Br. J. Psychol, 106, 656). However, this positivity bias has been demonstrated with explicit attitude measures only and explicit attitude measures tap deliberative processes rather than automatic processes, which are known to be important in the execution of many behaviours. The aim of this study was to test whether implicit bidimensional attitudes can account for variance in speeding behaviour over and above explicit bidimensional attitudes and whether the positivity bias that is typically found with explicit attitudes generalizes to implicit attitudes. A total of 131 drivers completed a questionnaire measuring their explicit bidimensional attitudes towards speeding. They also completed Implicit Association Tests measuring their implicit bidimensional attitudes. Two weeks later, speeding behaviour was measured using a driving simulator. Explicit attitudes accounted for a significant proportion of the variance in subsequent speeding behaviour. Implicit attitudes accounted for a statistically significant increment to explained variance. The positive dimension of both explicit and implicit attitudes predicted speeding behaviour but the negative dimensions did not. Theoretical implications for understanding the potential attitudinal causes of behaviour and practical implications for behaviour‐change interventions are discussed.

Developmental relations between alcohol expectancies and social norms in predicting alcohol onset

Expectations about alcohol's effects and perceptions of peers' behaviors and beliefs related to alcohol use are each shown to strongly influence the timing of drinking onset during adolescence. The present study builds on prior work by examining the conjoint effects of within-person changes in these social-cognitive factors on age of adolescent drinking onset. We related youths' alcohol status (i.e., alcohol-naive, initiation during study, prior initiation) to increases in positive and negative alcohol outcome expectancies (AOEs), as well as increases in perceived peer/close friend alcohol use and acceptance, during adolescence. We also investigated whether changes in AOEs and perceived social norms prospectively predicted alcohol onset in alcohol-naïve adolescents. Participants were 1,023 adolescents aged 12.2 years on average at enrollment (SD = 0.98), 52% female, participating in an ongoing longitudinal survey on substance use and health behaviors. Positive AOEs, close friends' norms, and same-age peer norms increased linearly, whereas negative AOEs decreased linearly. Changes were attenuated for participants who remained alcohol-naïve and increased for participants who experienced initiation during the study. Furthermore, we found associations between individual changes in AOEs and perceived social norms. Finally, survival models revealed that onset of alcohol use was prospectively predicted by stronger initial positive AOEs, as well as increases in close friends' norms and decreases in negative AOEs over time. These findings emphasize codevelopment of AOEs and perceived social norms, coinciding with, and predictive of, onset of alcohol use, and point toward a unique role for within-individual changes in identifying youth at risk for early onset of alcohol use. (PsycINFO Database Record

Sex differences in the interacting roles of impulsivity and positive alcohol expectancy in problem drinking: A structural brain imaging study

Alcohol expectancy and impulsivity are implicated in alcohol misuse. However, how these two risk factors interact to determine problem drinking and whether men and women differ in these risk processes remain unclear. In 158 social drinkers (86 women) assessed for Alcohol Use Disorder Identification Test (AUDIT), positive alcohol expectancy, and Barratt impulsivity, we examined sex differences in these risk processes. Further, with structural brain imaging, we examined the neural bases underlying the relationship between these risk factors and problem drinking. The results of general linear modeling showed that alcohol expectancy best predicted problem drinking in women, whereas in men as well as in the combined group alcohol expectancy and impulsivity interacted to best predict problem drinking. Alcohol expectancy was associated with decreased gray matter volume (GMV) of the right posterior insula in women and the interaction of alcohol expectancy and impulsivity was associated with decreased GMV of the left thalamus in women and men combined and in men alone, albeit less significantly. These risk factors mediated the correlation between GMV and problem drinking. Conversely, models where GMV resulted from problem drinking were not supported. These new findings reveal distinct psychological factors that dispose men and women to problem drinking. Although mediation analyses did not determine a causal link, GMV reduction in the insula and thalamus may represent neural phenotype of these risk processes rather than the consequence of alcohol consumption in non-dependent social drinkers. The results add to the alcohol imaging literature which has largely focused on dependent individuals and help elucidate alterations in brain structures that may contribute to the transition from social to habitual drinking.

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Alcohol expectancy (AE) and impulsivity are risk factors for problem drinking.

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AE mediates the correlation between right insula GMV and problem drinking in women.

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AE and impulsivity interacts to mediate left thalamus GMV and problem drinking in all.

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Models where changes in GMV as a result of problem drinking are not supported.

Development and validation of the East Africa Alcohol Expectancy Scale (AFEXS)

OBJECTIVE

The purpose of this study was to develop and validate the East Africa Alcohol Expectancy Scale (AFEXS), a measure of alcohol expectancies for use with HIV-positive adults in East Africa.

METHOD

The study was conducted in several phases. The first involved development of the scale and an exploratory factor analysis (EFA) with a total of 209 HIV-positive, Ugandan men (n = 120) and women (n = 89). The second phase involved a confirmatory factor analysis (CFA) as well as validity analyses with a second, demographically similar, sample of 181 HIV-positive Ugandan men (n = 109) and women (n = 72). All participants were recruited from two ongoing cohort studies taking place at an HIV clinic in rural southwestern Uganda.

RESULTS

The EFA resulted in a 13-item, three-factor scale that explained 67% of the variance and showed excellent internal consistency (α = .89). The CFA showed good model fit with a final 11-item scale, χ(2)(41) = 68.60, p = .004; comparative fit index = .97; root mean square error of approximation = .06, 90% CI [.03, .09], that again showed excellent internal consistency and yielded the following three factors: sex-related (α = .94), release of inhibition (α = .61), and negative expectancies (α = .73).

CONCLUSIONS

The AFEXS is the first psychometrically validated alcohol expectancy scale available for use in Africa. The extent to which the AFEXS can be used with other populations and with adults from countries outside of East Africa requires ongoing validation.

Alcohol Expectancies Mediate the Relationship Between Age of First Intoxication and Drinking Outcomes in College Binge Drinkers

BACKGROUND

While prior research has shown that age of first intoxication (AI) is associated with negative alcohol outcomes, limited research has examined factors accounting for this relationship. Alcohol expectancies, or beliefs about the effects of alcohol, may explain such associations as both positive and negative expectancies have been shown to be key predictors of drinking outcomes.

OBJECTIVE

The present study examined expectancies as mediators between early AI and alcohol-related outcomes.

METHOD

Data collection occurred in 2012 and 2013. Participants were college students (N = 562, 65.8% women) who completed an online survey including measures of alcohol use history, alcohol expectancies, typical alcohol consumption, and alcohol-related problems. Structural equation modeling was used to test the hypothesized model.

RESULTS

Our findings support a model whereby AI is associated with drinking through its influence on both positive and negative expectancies. Specifically, an earlier AI was associated with stronger alcohol expectancies, which in turn, was associated with heavier alcohol use and alcohol-related problems.

CONCLUSIONS/IMPORTANCE

These findings are consistent with expectancy theory and previous research suggesting that more experienced drinkers hold stronger drinking-related beliefs, be it positive or negative, and these expectancies ultimately explain variability in alcohol use and problems. Our findings further support that expectancies play an important role in the initiation of drinking behavior.

Do positive alcohol expectancies have a critical developmental period in pre-adolescents?

OBJECTIVE

Positive outcome expectancies have been shown to predict initiation of alcohol use in children and to mediate and moderate the relationship between dispositional variables and drinking behavior. Negative outcome expectancies for alcohol appear to weaken as children progress to middle adolescence, but positive expectancies tend to increase during this time. Positive alcohol expectancies have been found to increase in children in third and fourth grades, indicating what some investigators have termed a possible critical period for the development of positive expectancies.

METHOD

In the present study, we assessed alcohol expectancies at baseline, 6, 12, and 18 months in 277 second-through sixth-grade students. Children completed the Alcohol Expectancy Questionnaire-Adolescent. Univariate analyses of covariance were conducted.

RESULTS

There were significant main effects for grade on positive alcohol-expectancy change for Global Positive Transformations at 12 and 18 months, Social Behavior Enhancement or Impediment at 6 and 12 months, and Relaxation/Tension Reduction at 6 and 18 months, whereby a consistent pattern emerged in that lower grades did not differ from each other, but they differed significantly from the higher grades.

CONCLUSIONS

Data support a critical developmental period for positive alcohol expectancies, with the greatest change observed between third and fourth grade and between fourth and fifth grade, and only in those expectancies clearly describing positive outcomes (e.g., Relaxation/Tension Reduction) via positive or negative reinforcement versus those with either combined or ambiguous outcomes (e.g., Social Behavior Enhancement or Impediment).

Gender Differences in the Effect of Depressive Symptoms on Prospective Alcohol Expectancies, Coping Motives, and Alcohol Outcomes in the First Year of College

Problematic alcohol use and risk for dependence peak during late adolescence, particularly among first-year college students. Although students matriculating into college with depressive symptoms experience elevated risk for alcohol problems, few studies have examined the intervening mechanisms of risk. In this study, we examined depressed mood at college entry on prospective alcohol expectancies, drinking motives, and alcohol outcomes during the first year of college, adjusting for pre-college factors. Participants (N = 614; 59% female, 33% non-White) were incoming college students from three universities who completed online self-report surveys prior to matriculating into college and at the end of their first year in college. We utilized path analysis to test our hypotheses. In women, the path that linked depressive symptoms to consequences was primarily attributable to the effect of pre-college drinking to cope on drinking to cope in college, which in turn was associated with alcohol consequences. In men, the effect of depressive symptoms on alcohol consequences in college was independent of pre-college and college factors, thus indicating the need for research that identifies mechanisms of risk in males. Interventions that address coping deficits and motivations for drinking may be particularly beneficial for depressed adolescent females during this high-risk developmental period.

PTSD-related alcohol expectancies and impulsivity interact to predict alcohol use severity in a substance dependent sample with PTSD

INTRODUCTION

Problematic alcohol use is highly comorbid with posttraumatic stress disorder (PTSD), and prior work has demonstrated that individuals with PTSD may self-medicate with alcohol in an effort to reduce their symptoms. The combination of impulsivity and alcohol-related expectancies influences the development of problematic drinking patterns. When examining individuals diagnosed with PTSD, PTSD-related alcohol expectancies may be particularly relevant to the etiology of problematic drinking. To date, no studies have specifically examined PTSD-specific alcohol expectancies as they relate to alcohol use severity in a clinical sample.

METHODS

The current study examined the relationship between impulsivity, PTSD-related alcohol expectancies, and severity of alcohol use in a sample of 63 individuals diagnosed with comorbid PTSD and substance use disorders who were receiving treatment in a residential substance use treatment program.

RESULTS

Results indicated that PTSD-related alcohol expectancies moderated the relationship between impulsivity and alcohol use severity. Specifically, at low to moderate levels of positive PTSD-related alcohol expectancies, impulsivity significantly predicted alcohol use severity, while impulsivity had no impact on the prediction of alcohol use severity when such expectancies were high. Additionally, the relationship between impulsivity, expectancies, and alcohol use severity was significant for positive, but not negative, PTSD-related alcohol expectancies.

CONCLUSIONS

Overall, these results suggest that impulsivity and PTSD-related alcohol expectancies interact to predict alcohol use severity in a comorbid PTSD and substance dependent sample.

Development and validation of a smoking expectancies measure for adolescents seeking to quit smoking

BACKGROUND

A more comprehensive understanding of factors that affect smoking cessation outcomes among adolescents may help enhance treatment interventions. One promising but underexplored factor that may influence cessation success is teens' specific expectancies or beliefs about smoking outcomes. The present study evaluated the validity and reliability of a new measure of expectancies and its association with cessation outcomes among 762 adolescent smokers participating in studies of the American Lung Association's Not On Tobacco cessation program.

METHODS

Self-report questionnaires were collected prior to and following participation in a smoking cessation program. Self-reported cigarette use was verified with expired-air carbon monoxide. A multistep exploratory and confirmatory factor analysis and reliability and validity analyses were performed.

RESULTS

Four theoretically related yet empirically independent factors were identified by the Smoking Expectancies Questionnaire (SEQ): (1) Positive Reinforcement, (2) Negative Reinforcement-Emotional Regulation, (3) Negative Reinforcement-Addiction and Withdrawal, and (4) Negative Outcomes/Risk. These factors could be subsumed by a single SEQ factor that reflected an overall concept of smoking expectancies relevant for adolescent smoking cessation. An overall SEQ Function score reflecting the balance between positive and negative expectancies predicted both preintervention cigarettes per day and cessation outcomes.

CONCLUSIONS

A single, overall SEQ Function score may prove useful for understanding the associations among individual, social, and contextual factors in predicting treatment outcomes. Additionally, study findings may assist with modifying smoking expectancies among cessation program participants, thereby enhancing treatment outcomes with diverse youth smoking populations.

Testing the bi-dimensional effects of attitudes on behavioural intentions and subsequent behaviour

Attitudes are typically treated as unidimensional predictors of both behavioural intentions and subsequent behaviour. On the basis of previous research showing that attitudes comprise two independent, positive and negative dimensions, we hypothesized that attitudes would be bi-dimensional predictors of both behavioural intentions and subsequent behaviour. We focused on health-risk behaviours. We therefore also hypothesized that the positive dimension of attitude (evaluations of positive behavioural outcomes) would better predict both behavioural intentions and subsequent behaviour than would the negative dimension, consistent with the positivity bias/offset principle. In Study 1 (cross sectional design), N = 109 university students completed questionnaire measures of their intentions to binge-drink and the positive and negative dimensions of attitude. Consistent with the hypotheses, both attitude dimensions independently predicted behavioural intentions and the positive dimension was a significantly better predictor than was the negative dimension. The same pattern of findings emerged in Study 2 (cross sectional design; N = 186 university students) when we predicted intentions to binge-drink, smoke and consume a high-fat diet. Similarly, in Study 3 (prospective design; N = 1,232 speed limit offenders), both the positive and negative dimensions of attitude predicted subsequent (6-month post-baseline) speeding behaviour on two different road types and the positive dimension was the better predictor. The implications for understanding the motivation of behaviour and the development of behaviour-change interventions are discussed.

The moderating effect of stimulus attractiveness on the effect of alcohol consumption on attractiveness ratings

AIMS

To explore the enhancing effect of alcohol consumption on attractiveness ratings, in that few studies on the Beer Goggles effect control the stimuli attractiveness level and researchers have seldom considered extending the effect to stimuli other than faces.

METHODS

Male and female participants (n = 103) were randomly assigned to alcohol consumption or placebo groups. Both groups were asked to assess the attractiveness of two types of pictures (faces and landscapes) with three levels of attractiveness for each stimulus category (high, moderate and low).

RESULTS

We found significant interactions between beverage type and attractiveness level. Attractiveness ratings for moderate- and low-attractiveness faces were significantly higher in the alcohol compared with placebo condition, while there was no significant difference for high-attractiveness stimuli between these two conditions. As for landscapes, only low-attractiveness stimuli were rated significantly higher in the alcohol condition.

CONCLUSION

Whether or not alcohol consumption leads to an increase in attractiveness ratings depends on the initial attractiveness of the stimulus materials. Alcohol consumption tends to affect ratings for stimuli with relatively low attractiveness. Furthermore, this effect is not limited to faces; it extends to other types of stimuli like landscapes.

Alcohol dependent patients have weak negative rather than strong positive implicit alcohol associations

RATIONALE

Alcohol dependence is characterised by motivational conflict (or ambivalence) in controlled cognitive processes, but it is unclear if ambivalence also exists within automatic cognitive processes, and if ambivalence operates between controlled and automatic processes.

OBJECTIVE

To investigate ambivalence operating within and between controlled and automatic processes in alcohol dependence.

METHOD

Alcohol-dependent patients who had recently completed inpatient alcohol detoxification (N = 47) and social drinking controls (N = 40) completed unipolar implicit association tests and self-report measures of alcohol approach and avoidance motivation and alcohol outcome expectancies.

RESULTS

As predicted, both positive and negative alcohol outcome expectancies were stronger in alcohol-dependent patients compared to controls, indicative of ambivalence. Groups did not differ on implicit alcohol-positive associations, but alcohol-dependent participants had significantly weaker alcohol-negative associations than controls. Regression analyses revealed that implicit negative associations accounted for unique variance in group membership after controlling for alcohol outcome expectancies.

CONCLUSIONS

Our findings demonstrate that alcohol dependent patients possess weak automatic alcohol-negative associations but not strong automatic alcohol-positive associations, and they suggest the presence of conflict between controlled and automatic processes with regard to negative alcohol cognitions.

Patterns of alcohol expectancies and alcohol use across age and gender

AIMS

To investigate the relationship between alcohol expectancies and alcohol use in a community sample as a function of age and gender.

METHODS

The study is based on a national probability sample of 6467 German adults. Respondents were grouped into five age groups ranging from 18 to 59 years. A brief version of the Comprehensive Alcohol Expectancy Questionnaire was used to assess alcohol expectancies. Alcohol use was assessed by the number of drinking days during the past month and the number of drinks on an average drinking day.

RESULTS

Prior to conducting group comparisons, measurement invariance across age and gender was established. Latent mean level comparisons showed that the endorsement of both positive and negative expectancies almost linearly decreased with increasing age. However, this decrease was not reflected in alcohol consumption patterns. Structural analysis of the expectancy factors and drinking variables showed that the predictive power of expectancies varied by age and gender. Particularly, expectancies related to social assertiveness and sexual enhancement were strong predictors only in younger, but not in older respondents. Conversely, expectancies related to tension reduction and impairment were the most important predictors of drinking in respondents older than 30 years, but not in younger age groups. Additionally, the onset and course of age-related changes in expectancies was moderated by gender.

CONCLUSIONS

The present study demonstrates substantial age-related changes in the relationship between alcohol expectancies and alcohol use. Moreover, the profile of alcohol expectancies appears to be more important than their absolute strength.

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.

Different phenotypic and genotypic presentations in alcohol dependence: age at onset matters

OBJECTIVE

Several theoretical typology models have been proposed to classify alcoholism into more homogeneous subtypes using various criteria, for which age at onset of alcohol dependence is shared across many models. We investigated the evidence for the distinction between early- versus late-onset alcoholism by examining relevant phenotypic and genotypic variables.

METHOD

Data are from 1,248 individuals with alcohol dependence, who were interviewed to collect detailed clinical information. Early versus late onset of alcohol dependence was defined by the age at onset of 22 years. Odds ratio (OR) and Cohen's d were calculated as effect size for comparisons of clinical features between the two groups. We adjusted interviewed age and gender in logistic regression models. Case-control genetic analyses were conducted for the association between HTR1B, SLC6A4, DRD2, and OPRμ1 genes and subgroups of alcohol dependence using a sample of 530 controls screened for alcohol problems.

RESULTS

Early-onset alcoholism exhibited significantly (p < .01) different clinical characteristics from late-onset alcoholism, including higher severity in alcohol dependence symptoms (d = 0.22) and maximum drinking quantity within 24 hours (d = 0.40), more rapid progression from regular drinking to meet alcohol dependence diagnosis (d = 1.73), higher expectancies for alcohol (d = 0.22-0.47), more comorbidity with externalizing disorders (ORs = 2.8-2.9), and greater prevalence of family alcohol use problems (d = 0.26-0.43). In addition, markers in the HTR1B and OPRμ1 genes showed genetic associations with subgroups of alcohol dependence (ORs = 1.5-2.4).

CONCLUSIONS

Our findings support that subgroups of alcohol dependence defined by onset age have phenotypic and genetic differences. The early-onset subgroup had more severe features for almost every aspect we examined. Coupled with genetic association findings, age at onset of alcohol dependence may serve as a simple but important clinical marker with implications for future etiological research and intervention.

To drink or not to drink: motives and expectancies for use and nonuse in adolescence

Drinking motives have a prominent role in cognitive models of adolescent and adult alcohol decision-making (Cooper, Russell, Skinner, & Windle, 1992; Cooper, 1994). The complementary construct of motivation not to drink has received less attention (Epler, Sher & Piasecki, 2009). We examined how abstinence motives interacted with drinking motives and alcohol expectancies to predict alcohol consumption in samples of US high school students (N>2500). Nondrinking motives predicted lower rates of lifetime and current alcohol use. Motives not to drink interacted with specific drinking motives, like social and coping motives, and alcohol expectancies to predict certain aspects of drinking behavior. For example, motives not to drink had the greatest impact on youth with weaker social motivations. Findings highlight the distinction between motives not to drink and other alcohol-related cognitions in predicting adolescent alcohol consumption. This work not only supports the utility of this construct in developing models of youth alcohol-related decision-making but also has implications for prevention programming.

Rose-colored beer goggles: the relation between experiencing alcohol consequences and perceived likelihood and valence

Although experiencing alcohol-related consequences has some influence on future drinking, this effect may be stronger based on the degree to which the consequence is viewed as positive versus negative, either by the individual or predefined by researchers. This study explored the relationship between experiencing positive and negative alcohol-related consequences and college students' perceptions of how likely those consequences were to occur in the future (i.e., likelihood), and their view of how positive or negative experiencing those consequences would be if they did experience them as a result of drinking (i.e., valence). Data were collected from 491 college students (mean age = 19.26; 56.4% female; 55.0% Caucasian; 33.2% Asian/Pacific Islander) through a computerized survey. Results indicated that experiencing more positive consequences in the past year was associated with viewing those consequences as both more likely to occur and more positive, while experiencing more negative consequences was associated with viewing them as less negative and no more likely to occur, except for those who had experienced the highest levels of negative consequences. These findings suggest that finding ways to reduce both perceptions as well as consequences themselves may be effective intervention tools.

Measuring pain medication expectancies in adults treated for substance use disorders

BACKGROUND

The U.S. prevalence of misuse of prescription opioid analgesics has increased substantially over the past decade but research on the factors influencing misuse of these medications remains preliminary. In the literature on alcohol, marijuana and stimulants, substance-related expectancies have been found to predict level of substance use. A similar line of research is needed to better understand reasons for misusing pain medications.

METHODS

This study utilized a sample of adults presenting to a large residential addictions treatment program (N=351). Participants were administered a new instrument, the Pain Medication Expectancy Questionnaire (PMEQ) as well as questions about current alcohol, illegal drug and pain medication misuse. Exploratory factor analysis was used to determine underlying factors of the PMEQ.

RESULTS

Results of the factor analysis supported a three-factor solution focusing on pleasure/social enhancement, pain reduction and negative experience reduction. In general, greater perceived expectancy of the positive effects of Prescription Opiate Analgesics (POAs) in all three domains were correlated with greater frequency of substance use and poorer mental health functioning. Expectancies directly related to the pain-reducing properties of POAs were also related to greater pain and poorer physical functioning.

CONCLUSIONS

This new measure of pain medication expectancies had sound psychometric properties and the resulting factors were associated with other clinically important aspects of patient functioning. The results highlight the need to assess for and address perceptions related to pain medication use in patients presenting to addictions treatment.

The reciprocal influences of perceived risk for alcoholism and alcohol use over time: evidence for aversive transmission of parental alcoholism

OBJECTIVE

This study examined how perceived risk for alcoholism and alcohol use influenced each other over time. We hypothesized an aversive transmission mechanism, by which some children of alcoholics may reduce their drinking because they perceive themselves to be at risk for future alcohol problems because of their parents' alcoholism.

METHOD

Using participants (N = 804, 47% female) from an ongoing longitudinal study of children of alcoholics (e.g., Chassin et al., 1991), we examined the reciprocal prospective relations between perceived risk for alcoholism and drinking across three measurement occasions, and also tested whether perceived risk for alcoholism mediated the effect of perceived parental alcoholism on subsequent drinking.

RESULTS

Mediation analyses provided evidence for aversive transmission, in which the effect of perceived parental alcoholism on alcohol use during young adulthood was decreased to the extent that perceived parental alcoholism predicted higher levels of perceived risk for alcoholism during emerging adulthood. Results indicated reciprocal effects between perceived risk for alcoholism and drinking over time, such that higher levels of perceived risk were associated with lower levels of drinking. Results were replicated using both self-report and collateral-report of alcohol use, and using both actual and perceived parental alcoholism.

CONCLUSIONS

Young adults may avoid drinking when they perceive their parent(s) to be alcoholic, and consequently perceive themselves to be at elevated risk for alcoholism. Given that beliefs about risk for alcoholism are potentially modifiable, increasing self-perceived risk for alcoholism may be one feasible way to reduce the intergenerational transmission of alcohol disorders within families.

Alcohol expectancies, drinking refusal self-efficacy and drinking behaviour in Asian and Australian students

The effects of alcohol expectancies (AE) and drinking refusal self-efficacy (DRSE) in predicting alcohol consumption in Caucasians has been well studied. However, the role of AE and DRSE in Asian students is still not well understood. This study reported on this using Caucasian (n=98) and Asian (n=92) student samples. Participants completed the Alcohol Use Disorder Identification Test (AUDIT) to measure their hazardous alcohol consumption, and the drinking expectancy profile (DEP) to assess their alcohol related expectancies and ability to resist drinking in certain situations. Results showed that Caucasians reported significantly higher confidence, higher sexual interest, and higher tension reduction expectancies than Asians. Conversely, Asians significantly expected cognitive enhancement and negative consequences more than Caucasians. Relative to Caucasians, the Asian sample also reported that they would be more able to refuse alcohol when under social pressure. Results from regression analyses showed that for the Caucasian sample, AE, DRSE and their interactions were significant predictors of alcohol consumption. For the Asian group, the only significant effect to emerge was that DRSE was negatively related to alcohol consumption. The clinical implications of the differential pattern of results between the samples are discussed in terms of self-efficacy and negative consequences of alcohol consumption, especially when dealing with university aged individuals.

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.

Alcohol expectancies, self-efficacy and coping in an alcohol-dependent sample

This study expanded earlier work conducted by this laboratory by examining the independent and interactive effects of avoidant coping strategies, positive and negative alcohol expectancies and self-efficacy, in predicting volume and frequency of alcohol consumption in a sample dependent on alcohol (n=296). Coping strategies were found to be salient predictors of frequency of drinking, while venting emotion interacted with negative expectancies to predict both volume and frequency of drinking. Venting emotion was also found to interact with drinking refusal self-efficacy in predicting volume of alcohol consumed. These interactions are discussed in terms of the cognitive and behavioural mechanisms thought to underlie drinking behaviour.

Young men's ambivalence toward alcohol

There is widespread concern about the health and social consequences of excessive alcohol consumption among young men. Interventions to reduce alcohol-related harm will be affected by ambivalence toward alcohol, because ambivalent attitudes are worse predictors of behaviour than are homogeneous attitudes. It is therefore important to identify aspects of alcohol consumption about which young men are not ambivalent. In-depth interviews were conducted with a socioeconomically diverse sample of 31 men, aged 18-21 living in London, UK. Ambivalence toward alcohol was widespread. None of the drinkers who were interviewed had uncomplicated positive evaluations of drinking: all mentioned compelling reasons not to drink. Most motives for drinking were also identified as reasons for not drinking if consumption became excessive. However, three motives for not drinking were not also motives for drinking: violence, alcoholism, and cost. These findings should be considered during the design of interventions to reduce the health and social consequences of excessive alcohol consumption amongst young men.

Alcohol-related associative strength and drinking behaviours: concurrent and prospective relationships

The first part of this research assessed the longitudinal relationships between alcohol-related associative strength and alcohol use measured at two time-points, 6 months apart. Cross-lagged results support the utility of alcohol-related associative strength to predict drinking behaviours prospectively and vice versa. These results remained after competing explanations of previous use, autocorrelations between memory measures, sensation seeking and background variables of age and gender were accounted for. Findings offer further evidence for an implicit cognitions approach to drinking processes. In the second part of our study, cross-sectional analysis investigated potential mediating mechanisms in the relation of associative strength to quantity and frequency dimensions of drinking. Mediational models provide preliminary evidence that implicit memory processes may have differential effects on quantity and frequency dimensions of drinking behaviours. The results point to the possibility that increasing awareness of implicit alcohol-related associations may have utility in interventions for young adults.

The Addiction-Stroop test: Theoretical considerations and procedural recommendations

Decisions about using addictive substances are influenced by distractions by addiction-related stimuli, of which the user might be unaware. The addiction-Stroop task is a paradigm used to assess this distraction. The empirical evidence for the addiction-Stroop effect is critically reviewed, and meta-analyses of alcohol-related and smoking-related studies are presented. Studies finding the strongest effects were those in which participants had strong current concerns about an addictive substance or such concerns were highlighted through experimental manipulations, especially those depriving participants of the substance. Theories to account for addiction-related attentional bias are discussed, of which the motivational theory of current concerns appears to provide the most complete account of the phenomenon. Recommendations are made for maximizing the precision of the addiction-Stroop test in future research.

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

AIMS

University student alcohol misuse is a considerable problem. Alcohol expectancy research has contributed significantly to our understanding of problem drinking in young adults. Most of this research has investigated positive expectancy alone. The current study utilized two measures of alcohol expectancy, the alcohol expectancy questionnaire (AEQ) and the drinking expectancy profile [consisting of the drinking expectancy questionnaire (DEQ) and the drinking refusal self-efficacy questionnaire] to predict severity of alcohol dependence, frequency of drinking, and the quantity of alcohol consumed per occasion.

METHODS

Measures of drinking behaviour and alcohol expectancy were completed by 174 undergraduate university students.

RESULTS

Positive alcohol expectancy factors accounted for significant variance in all three drinking indices, with the DEQ adding additional variance to AEQ scores on frequency and severity of alcohol dependence indices. Negative expectancy did not add incremental variance to the prediction of drinking behaviour in this sample. Drinking refusal self-efficacy and dependence beliefs added additional variance over positive and negative expectancies in the prediction of all three drinking parameters.

CONCLUSIONS

Positive expectancy and drinking refusal self-efficacy were strongly related to university student drinking. The incorporation of expectancy as a means of informing prevention approaches in tertiary education shows promise.

The effects of alcohol expectancies on drinking behaviour in peer groups: observations in a naturalistic setting

AIMS

To study the functionality of alcohol expectancies in predicting drinking behaviour in existing peer groups of young adults in a 'naturalistic' setting.

DESIGN AND SETTING

Young adults were invited to join an experiment with their peer group in a bar annex laboratory. During a 'break' of 50 minutes in this experiment, their activities, social behaviour and drinking behaviour were observed with digital video and audio equipment.

PARTICIPANTS

Twenty-eight peer groups were involved in this study. A peer group consisted of seven to nine people, with relationships ranging from intimate relations and close friendships to being acquaintances. A total of 238 participants were involved. Measurements Information of the drinking behaviour from observations and questionnaire data on alcohol expectancies provide the opportunity to look at how and which expectancies are related to actual drinking patterns. Multiple regression and multi-level analyses were applied.

FINDINGS

Expectancies on the positive and arousing effects of alcohol consumption were related to alcohol consumption in a naturalistic, social drinking situation, in addition to group effects of drinking. Expectancies on the negative and sedative effects of drinking, however, were not related to drinking.

CONCLUSIONS

The findings indicate that among young adults observed in a peer group and naturalistic drinking setting, positive expectancies about the effects of alcohol and expectancies about the effects of alcohol on arousal are related positively to drinking level.