The temporal "pulse" of drinking: Tracking 5 years of binge drinking in emerging adults

Improvement in coping skills from culturally-adapted digital CBT for Spanish-speaking Hispanics with substance use disorder: Secondary analysis of a randomized clinical trial

INTRODUCTION

Developing adaptive coping skills for avoiding substance use is a proposed treatment mechanism of cognitive behavioral therapy (CBT) for substance use disorder (SUD). However, the generalizability of research on treatment mechanisms of CBT for SUD is limited by the underrepresentation of racial/ethnic minorities in clinical trials. In a secondary analysis of clinical trial data, we tested whether a culturally-adapted digital CBT program for Hispanics ("Spanish CBT4CBT") improved the quality of coping skills for avoiding substance use. We also tested whether coping skills' quality was associated with reductions in primary substance use.

METHODS

Participants were Spanish-speaking Hispanic adults seeking outpatient treatment for SUD (n = 85; 68 % male; primary substance type: 36 % cannabis, 33 % alcohol, 26 % cocaine, 5 % other). They were randomized to 8 weeks of outpatient treatment as usual (TAU) or TAU + Spanish CBT4CBT and assessed for 6 months after treatment. The study conducted separate analyses for the full sample (n = 85) and for those who engaged in at least 5 treatment sessions ("treatment exposed"; n = 64). Daily substance use and coping skills' quality were assessed repeatedly during the treatment and follow-up periods. Bayesian mixed models for repeated measures tested hypotheses.

RESULTS

Among treatment-exposed participants, those receiving TAU + Spanish CBT4CBT improved the quality of coping skills more than TAU alone during the treatment period (b = 0.77; 95 % CI[0.08, 1.47]), but this difference was not detected during the follow-up period. In the full sample and treatment exposed subsample, participants with higher quality coping skills during the study reported less primary substance use (b = -0.67; 95 % CI[-1.08, -0.26]). Among treatment-exposed participants only, within-person increases in the quality of coping skills were associated with reductions in future primary substance use (b = -0.18; 95 % CI[-0.36, -0.01]).

CONCLUSIONS

Spanish-speaking Hispanics with SUD may improve the quality of their coping skills more when they are sufficiently exposed to a culturally-adapted digital CBT program during outpatient treatment. Coping skills' quality may be a mechanism of CBT for SUD among Hispanic populations. Spanish-speaking Hispanics' access to treatments that target mechanisms of behavior change may be expanded by digital therapeutics.

High peak drinking levels mediate the relation between impulsive personality and injury risk in emerging adults

BACKGROUND

Alcohol-induced injury is one of the leading causes of preventable morbidity and mortality. We investigated the relationship between impulsive personality and physical injury (e.g. falls, sports), and whether peak drinking quantity specifically, and/or risky behaviour more generally, mediates the relationship between impulsivity and injury in undergraduates.

METHOD

We used data from the winter 2021 UniVenture survey with 1316 first- and second-year undergraduate students aged 18-25 years (79.5% female) from five Canadian Universities. Students completed an online survey regarding their demographics, personality, alcohol use, risky behaviours, and injury experiences. Impulsivity was measured with the substance use risk profile scale, past 30-day peak alcohol use with the quantity-frequency-peak Alcohol Use Index, general risky behaviour with the risky behaviour questionnaire, and past 6-month injury experience with the World Health Organization's (2017) injury measurement questionnaire.

RESULTS

Of 1316 total participants, 12.9% (n = 170) reported having sustained a physical injury in the past 6 months. Mean impulsivity, peak drinking quantity, and risky behaviour scores were significantly higher among those who reported vs. did not report injury. Impulsivity and peak drinking quantity, but not general risky behaviour, predicted injury in a multi-level generalized mixed model. Mediation analyses supported impulsivity as both a direct predictor of physical injury and an indirect predictor through increased peak drinking (both p < .05), but not through general risky behaviour.

CONCLUSION

Results imply emerging adults with impulsive tendencies should be identified for selective injury prevention programs and suggest targeting their heavy drinking to decrease their risk for physical injury.

"On a night like this": A mixed-methods approach to understanding high-risk drinking events in college students

BACKGROUND

Previous research indicates college students report heavier drinking on certain events (e.g., 21st birthday). While past research has identified heavier drinking events, students' own reports of which events are associated with elevated drinking remains understudied. The current study utilized mixed methods to explore potential high-risk drinking events (HRDE) for college student drinkers and how these events differed from typical drinking and each other.

METHODS

College student drinkers (N = 204) reported the number of drinks they consume on nine predetermined events (e.g., Halloween). Students also responded to open-ended questions listing five events during which they had elevated drinking and indicating the amount consumed on each event. Open-ended responses were coded into similar event categories. Descriptive statistics for drinks consumed were calculated for predetermined and coded open-ended events. Chi-square analyses assessed differences in endorsement of open-ended events by birth sex, age group, and Greek membership. Two multilevel count regressions assessed within-person differences in number of drinks consumed between participants' typical drinking occasions and (1) highly endorsed open-ended events and (2) predetermined events.

RESULTS

For all open-ended event categories, average number of drinks consumed exceeded heavy episodic drinking thresholds; however, there was substantial variability. Comparing predetermined events to participants' typical drinking indicated elevated drinking on participants' birthdays, New Year's Eve, Halloween, Finals, and Spring Break; significant differences between events also emerged. Comparison of open-ended categories to participants' typical drinking indicated elevated drinking on birthdays, celebrations, parties, and holidays; however, there were no significant differences between open-ended events.

CONCLUSIONS

Students who drink alcohol report heavier drinking on specific calendar-based events (e.g., Spring Break). However, students also report non-calendar-related events (e.g., non-specific parties) as some of their highest drinking events. More research is needed to understand how intervention and prevention programs can be adapted to target both known calendar-based HRDE, and unknown, idiosyncratic HRDE.

Tobacco and cannabis use as moderators of the association between physical activity and alcohol use across the adult lifespan in the United States: NHANES, 2005-2016

Physically-active adults are more likely to consume alcohol, but this association may vary if adults also use other substances (i.e., tobacco and/or cannabis), which could increase substance-use related harms. This study examined whether tobacco and/or cannabis use moderated the associations between physical activity, odds of drinking and alcohol drinks/week. We used cross-sectional 2005-2016 National Health and Nutrition Examination Survey data (United States of America). Physical activity was assessed using device-based and self-reported moderate-to-vigorous physical activity (MVPA) and total physical activity hours/week. Individuals were categorized into one of four (poly)substance use categories, no tobacco/no cannabis, tobacco, cannabis, or tobacco/cannabis use. Regression models examined substance use as a moderator of the association between physical activity and the odds of drinking versus not drinking and alcohol drinks/week among light/moderate/heavy drinkers (≥12 drinks/year). Using cannabis or tobacco weakened the significant positive associations between total physical activity and self-reported recreational MVPA hours/week on odds of drinking (ORs = 0.978 and 0.967, respectively), such that the effect was negative or null when using cannabis or tobacco, respectively. Greater total physical activity and device-based MVPA hours/week was associated with consuming greater drinks/week (IRRs = 1.003 and 1.035, respectively). Using tobacco weakened the association between device-based MVPA and alcohol drinks/week (IRR = 0.934, 95% CI: [0.888, 0.982]). Cannabis and tobacco use weakened the association between physical activity and alcohol use. The positive association between physical activity and alcohol use may be limited to single substance users of alcohol and could reflect shared reasons for engaging in these behaviors, such as stress management or social motives.

The CLOCK 3111T/C polymorphism is associated with hour-by-hour physical activity levels only on weekends among Japanese male and female university students

BACKGROUND

CLOCK 3111T/C has been shown to be closely associated with morningness-eveningness, such as sleep-wake rhythms in healthy humans. However, previous studies examined the physical activity (PA) in a single day, and no study has investigated the relationships between CLOCK 3111T/C polymorphism and PA for an entire week. It was hypothesized that the CLOCK 3111T/C polymorphism might be associated with diurnal PA patterns, especially on the weekends.

METHODS

Eighty-one university students (male, n=14; female, n=67; age, 20.4±2.9 years) wore a digital accelerometer for 7 successive days, including the weekend, to collect hour-by-hour objectively-measured PA. CLOCK 3111T/C polymorphism was assessed using the oral mucosa. During the study, participants recorded their wake time and bedtime each day. Furthermore, lifestyle-related variables (i.e. morningness-eveningness, habitual meal and sleep timings) were collected using questionnaires. Linear mixed-effects models assessed the association of polymorphism (TT carriers vs. TC+CC carriers) with wake time and bedtime as well as daily PA throughout the week (time).

RESULTS

TT carriers had an earlier wake time (weekly mean: 44 min [95% CI, -82 to -5 min], time interaction: p=0.026) and bedtime (weekly mean: 30 min [95% CI, -61 min to - 15 sec], time interaction: p=0.048) than TC+CC carriers. Furthermore, TT carriers' wake time and bedtime on Saturday were significantly later than on other days (gene interaction: all p<0.05). On Saturday, the hour-by-hour PA in TT carriers was significantly greater than that in TC+CC carriers (hourly mean 1.7 min [95% CI, 0.2 to 3.4 min], time: p<0.001, group: p=0.028, interaction: p=0.155).

CONCLUSIONS

CLOCK 3111T/C polymorphism may be associated with objectively measured hour-by-hour PA only on Saturday. Academic/social obligations may mask the genetically determined biological rhythm of PA on weekdays.

Binge drinking in early adulthood: A machine learning approach

Binge drinking among young adults (18-25) has been recognized as a public health concern. Considerable variation among drinking behaviors have been found among this group. Several statistical methods are available to identify theoretically and empirically meaningful correlates of binge drinking. The present study evaluated three methods for identifying correlates of binge drinking, comparing logistic regression to two machine learning methods-classification tress and random forests. While each model identified similar correlates of binge drinking-such as propensity for engaging in risky behaviors, marijuana dependence, cocaine dependence, identifying as non-Hispanic white, and higher education-the AUC analysis showed that the random forest analysis more accurately classified positive cases of binge drinking. Random forests modelling of psychosocial data is a feasible approach for identifying correlates of binge drinking behaviors among young adults. Clinical implications are discussed related to screening for binge drinking in behavioral health organizations.

Daily Physical Activity, Sedentary Behavior and Alcohol Use in At-Risk College Students

BACKGROUND

The college years present an opportunity to establish health behavior patterns that can track across adulthood. Health behaviors tend to cluster synergistically however, physical activity and alcohol have shown a positive association.

PURPOSE

This study applied a multi-method approach to estimate between- and within-person associations between daily physical activity, sedentary behavior and alcohol use among polysubstance-using college students.

METHODS

Participants were screened for recent binge drinking and either tobacco or cannabis use. They wore an activPAL4 activity monitor and a Secure Continuous Remote Alcohol Monitor continuously in the field for 11 days, and completed daily online questionnaires at the beginning of each day to report previous day physical activity, sedentary behavior, and alcohol consumption.

RESULTS

Participants (N = 58, Mage = 20.5 years, 59% women, 69% White) reported meeting national aerobic physical activity guidelines (75%) and drinking 2-4 times in the past month (72%). On days when participants reported an hour more than usual of daily sedentary behavior, they reported drinking for less time than usual (γ = -.06). On days when participants took 1,000 more steps than usual, the longest episode of continuous transdermal alcohol detection was shorter (γ = -.03).

CONCLUSIONS

Daily physical activity and sedentary behavior were negatively associated with time-based measures of alcohol use with the lowest risk on days characterized by both activity and sedentary behavior. Intensive longitudinal monitoring of time-based processes can provide new insights into risk in multiple behavior change and should be prioritized for future work.

What really matters in binge drinking: A dominance analysis of binge drinking psychological determinants among University students

Introduction

Binge drinking (BD) is a public health concern, especially in young people. Multiple individual factors referring to different level of analyses - positional, inter-individual and intra-individual - are associated to BD. As they have mainly been explored separately, little is known about the psychological variables most associated with BD. This study, based on an integrative model considering a large number of variables, aims to estimate these associations and possible dominance of some variables in BD.

Methods

A sample of university students (N = 2851) participated in an internet survey-based study. They provided information on alcohol related variables (AUDIT, BD score), positional factors (sex, age), inter-individual factors (subjective norm, social identity, external motivations), and intra-individual factors (internal motivations, meta-cognitions, impulsivity and personality traits). The data were processed via a backward regression analysis including all variables and completed with a dominance analysis on variables that are significantly associated with BD intensity.

Results

The strongest variables associated with BD intensity were enhancement motives and drinking identity (average ΔR ² = 21.81%), followed by alcohol subjective norm and social motives (average ΔR ² = 13.99%). Other associated variables (average ΔR ² = 2,84%) were negative metacognition on uncontrollability, sex, coping motives, lack of premeditation, positive metacognition on cognitive self-regulation, positive urgency, lack of perseverance, age, conformity motives and loneliness.

Conclusion

Results offer new avenues at the empirical level, by spotting particularly inter-individual psychological variables that should be more thoroughly explored, but also at the clinical level, to elaborate new prevention strategies focusing on these specific factors.

COVID-19 stress and eating and drinking behaviors in the United States during the early stages of the pandemic

The coronavirus SARS-CoV-2 (COVID-19) pandemic has created widespread stress. Since many people cope with stress by eating, the current study investigated whether eating behaviors shifted among U.S. adults after the emergence of the pandemic. Data from national, crowdsourced surveys conducted on March 31st, 2020 and February 13th, 2019 were compared. Average levels of eating to cope and food addiction symptoms did not appear to shift during the early stages of the pandemic; however, U.S. adults ate about 14% more added sugars. Moreover, greater stress in response to the pandemic was associated with greater eating to cope, added sugars intake, food addiction symptoms, drinking to cope, and drinking frequency. These associations differed by the presence of state-level stay-at-home orders, perceived vulnerability to disease, age, U.S. political party affiliation, and gender. Although eating behaviors did not appear to majorly shift during the early stages of the pandemic, stress from the pandemic may intensify some maladaptive coping tendencies among U.S. adults.

Utility of different dimensional properties of drinking practices to predict stable low-risk drinking outcomes of natural recovery attempts

BACKGROUND

Functional measures indicating lower drinking problem severity predict stable low-risk drinking outcomes of recovery attempts, but findings for drinking practices are mixed. Because low-risk drinking outcomes are more common in natural than treatment-assisted recovery attempts, five studies of natural recovery attempts were integrated. Multiple dimensions of drinking practices during the year before recovery initiation were evaluated as predictors of post-recovery drinking (continuous abstinence, stable low-risk drinking, or unstable recovery involving relapse).

METHODS

Community-dwelling problem drinkers (N = 616, 68% male, mean age = 46.5 years) were enrolled soon after stopping alcohol misuse and followed prospectively for one year. A Timeline Followback interview assessed daily drinking during the year before recovery initiation and yielded four dimensions for analysis: frequency of heavy drinking days (4+/5+ drinks for females/males), mean ethanol consumption per drinking day, variability in days between heavy drinking days, and variability in ethanol consumed per drinking day.

RESULTS

Multinomial logistic regression models showed that variability in ethanol consumed per drinking day was the sole significant predictor of 1-year outcomes when all dimensions were evaluated together. The low-risk drinker group showed less fluctuation in quantities consumed on pre-recovery drinking days compared to the groups that abstained or relapsed (ps < 0.05).

CONCLUSIONS

Even when drinking heavily, problem drinkers who maintained low-risk drinking recoveries limited their quantities consumed within a relatively narrow range, a pattern they maintained post-recovery at much lower consumption levels. Assessing variability in quantities consumed may aid drinking goal selection.

Alcohol Use, Binge Drinking, and Drunkenness Experience in Adolescence: Complex Associations with Family, Peers, Social Context, and Risk Perceptions

Background: A number of correlates to adolescent substance use have been shown, yet their unique predictive influence is unclear. We investigated the incremental validity of demographics, family background, school variables, risk perception, parental alcohol attitudes, age of first alcohol use, peer group influence, and behavioral variables as they concurrently predicted last month alcohol use, binge drinking, and drunkenness experience frequency. Methods: Hierarchical multiple regression analyses in a sample of N = 743 adolescents (mean age = 15.01). Results: All predictors explained 26-40% of the total variance. Alcohol use was predicted by age, gender, having two working parents, academic family background, relationship to parents, relative risk perception, parental acceptance of alcohol use, age of first use, talking about positive aspects of alcohol, normality of alcohol use among peers, time spent with friends, and going out to clubs. Binge drinking was predicted by age, working parents, school problems, relative risk perception, parental alcohol acceptance, age of first use, talking about positive aspects of alcohol, time spent with friends, and going out to clubs. Drunkenness was predicted by age, relationship to parents, school problems, relative risk perception, age of first use, talking about positive aspects of alcohol, and going out to clubs. Conclusions: Researchers need to take the complexity of adolescent substance use into account when designing studies and interventions. Relative risk perception emerged as the strongest (positive) predictor, indicating that adolescents are able to rather accurately assess their own risk and risk awareness alone does not suffice to engage in protective behavior.

Parental Physical Force and Alcohol Use in Emerging Adults: Mediation by Psychological Problems

Research has indicated that negative parenting practices, such as physical punishment, are associated with negative outcomes in children. These negative outcomes can present during childhood and during emerging adulthood. One negative consequence can be excessive alcohol use, a problematic outcome with its own myriad consequences. The goal of the current study was to examine the effects of parental physical force on emerging adult functioning, specifically alcohol and psychological problems. A sample of 488 young adults completed questionnaires on current perceptions related to alcohol-related problems, physical and psychological aggression by their parents experienced during the previous year, and current emotional and behavioral functioning. Results showed full mediation between paternal physical force and emerging adult alcohol problems by emerging adult psychological problems. Emerging adult psychological problems partially mediated the effect of maternal physical force on emerging adult alcohol problem. Gender did not moderate these effects. The results support existing literature suggesting that the use of parental physical force may lead to a chain reaction of problems, even during emerging adulthood. These results also reveal that emerging adults report currently receiving physical force from their parents, which brings to light a concerning lack of literature on the use of parental physical force on emerging adult children. These results advocate for positive parenting practives and efforts to teach them, even for emerging adult children. The results may also clinically suggest that paying attention to parental force in emerging adult clients could yield a better understanding of their current functioning, especially including excessive alcohol use.

Transitions in drinking behaviors across the college years: A latent transition analysis

OBJECTIVE

College student alcohol use remains a considerable concern. While many colleges provide universal interventions surrounding matriculation, trends indicate alcohol use increases over the college years. This study utilized a person-centered approach to examine changes in drinking across college and predictors (expectancies, attitudes, norms, and gender) of increases in risky drinking. Understanding transitions in drinking patterns and predictors of risky transitions can help identify risky students, periods of increased risk, and inform prevention efforts.

METHOD

1429 first-year students were recruited from three universities across the USA. Students were assessed in the fall of each of the four years of college using a wide variety of drinking-related measures.

RESULTS

Latent transition analysis (LTA) identified five classes of students (Non-Drinkers, Weekend Light Drinkers, Weekend Heavy Drinkers, Occasional Heavy Episodic Drinkers, Heavy Drinkers). Heavy-Drinkers were not likely to move out of their status during all four years of college. All psychosocial factors were shown to predict class membership during the first year (e.g., higher positive expectancies were associated with greater likelihood of being in a higher risk class). Increased psychosocial risk factors also predicted transitioning to higher risk drinking classes, mostly for Non-Drinkers. Differences by gender were observed.

CONCLUSIONS

Results indicate many students maintain or increase risky drinking practices, rather than mature out, suggesting continued need for early prevention. Targeting positive attitudes during the first year may be particularly important for later transitions. Males may benefit more from targeted intervention during the transition between third and fourth years.

A Daily Diary Study of Drinking and Nondrinking Days in Nonstudent Alcohol Users

BACKGROUND

Emerging adults with lower educational attainment are at higher long-term risk for problematic drinking and alcohol use disorders. Efforts to gain a more in-depth understanding of the drinking habits of nonstudent emerging adults are critical to reduce disparities and to shed light on targets of intervention for this vulnerable group.

OBJECTIVES

The current investigation aimed to: (1) provide a description of the daily drinking habits of nonstudent emerging adult drinkers using a 14-day diary method, and (2) examine nondrinking days by assessing their reasons for not drinking as well as strategies used to avoid drinking.

METHODS

Participants were 27 (55.5% women) emerging adult drinkers recruited from the community.

RESULTS

On drinking days, multilevel results indicated that heavier alcohol use was positively associated with level of subjective intoxication and alcohol-related problems. Men reported higher alcohol use outcomes than women across all alcohol use indicators. Regarding nonconsumptive days, the most frequently endorsed reasons for not drinking largely reflected an internal motivation, while the least endorsed reasons were related to external constraints. Pertaining to strategies used to avoid drinking, the most frequently endorsed response related to choosing alternative enjoyable activities. Diary compliance with the 14-day protocol was 90.9% for at least one daily survey. Conclusion/Importance: The present investigation represents one of the first to examine drinking behaviors using a daily diary approach with nonstudent emerging adult drinkers. Study findings filled an important gap regarding our understanding of the context of drinking of an at-risk and understudied group of drinkers.

Time of Injury and Relation to Alcohol Intoxication in Moderate-to-Severe Traumatic Brain Injury: A Decade-Long Prospective Study

BACKGROUND

Knowledge about the causes and time of injury for traumatic brain injury (TBI) is important for the development of efficient prevention policies. We aimed to study time of injury and relation to alcohol intoxication for moderate-to-severe TBI in a level 1 trauma center in Norway.

METHODS

From October 2004 to September 2014, 493 consecutive patients (≥16 years) with moderate (Glasgow Coma Scale [GCS] score 9-13) and severe TBI (GCS score 3-8) were prospectively included in the Trondheim TBI Study (222 patients with moderate and 270 patients with severe TBI).

RESULTS

Mean age was 47 years (standard deviation 21 years). Positive blood alcohol concentration (BAC) was found in 29%, and median BAC was 41.5 mmol/L (interquartile range 28.7-54.3), equal to 1.91‰. Admissions were more frequent on Saturdays (relative risk [RR] 2.67, 95% confidence interval [CI] 1.87-3.80) and Sundays (RR 2.10, 95% CI 1.45-3.03) compared with Mondays, and positive BAC was more common on weekends than weekdays (43% vs. 16%). Furthermore, admissions were more frequent in June (RR 2.26, 95% CI 1.44-3.55), July (RR 2.07, 95% CI 1.31-3.28), and December (RR 2.07, 95% CI 1.31-3.28) compared with January. The number of patients with positive BAC was greatest in December (RR 5.75, 95% CI 1.99-16.63), and 70% of these were caused by falls.

CONCLUSIONS

Our findings demonstrate that moderate-to-severe TBI admissions display a clear weekly and seasonal variation and that alcohol is an important modifiable risk factor for moderate-to-severe TBI.

Moderation of alcohol craving reactivity to drinking-related contexts by individual differences in alcohol sensitivity: An ecological investigation

Laboratory cue exposure investigations have demonstrated that, relative to drinkers who report a high sensitivity to the pharmacologic effects of alcohol, low-sensitivity (LS) drinkers show exaggerated neurocognitive and behavioral reactivity to alcohol-related stimuli. The current study extends this line of work by testing whether LS drinkers report stronger cravings for alcohol in daily life. Data were from an ecological momentary assessment study in which participants (N = 403 frequent drinkers) carried a palmtop computer for 21 days and responded to questions regarding drinking behavior, alcohol craving, mood states, and situational context. Initial analyses identified subjective states (positive and negative mood, cigarette craving) and contextual factors (bar-restaurant location, weekend, time of day, presence of friend, recent smoking) associated with elevated craving states during nondrinking moments. Effects for nearly all these craving correlates were moderated by individual differences in alcohol sensitivity, such that the associations between situational factors and current alcohol craving were larger among LS individuals (as determined by a questionnaire completed at baseline). Complementary idiographic analyses indicated that self-reported craving increased when the constellation of situational factors more closely resembled individuals' observed drinking situations. Again, this effect was moderated by alcohol sensitivity, with greater craving response increases among LS drinkers. The findings align with predictions generated from theory and laboratory cue exposure investigations and should encourage further study of craving and incentive processes in LS drinkers. (PsycINFO Database Record

Toward the prevention of alcohol use disorders: Overdrinking (unintentional binge drinking) in a community sample

Approximately 64,000,000 people in the United States report binge drinking at least once in the past month. Unlike overeating and oversleeping, "overdrinking"-defined as drinking more than a person intends to drink-does not exist in the literature. Terms such as binge and problem drinking do not consider the intent of the drinker. The results of this pilot study suggest that most people drink more than they intend to drink. Moreover, they also report often being surprised that they overdrank. Smartphones may help overdrinkers be less often surprised by overdrinking and may prevent drinkers from developing an alcohol use disorder.

Alcohol consumption, drinker identity, and quality of life among students: why there cannot be one prevention strategy for all

INTRODUCTION

The objective for this study was to combine drinking characteristics and two subjective measures, drinker identity and alcohol-related quality of life, i.e., negative impact of alcohol on quality of life, to determine relevant profiles for indicated prevention programs. In particular, we hypothesized that different profiles of students with high level of alcohol consumption exist when exploring subjectivity.

METHODS

We performed an online survey among 16,930 students. We collected sociodemographics and environmental data, including alcohol-related quality of life, drinker identity, and drinking characteristics. We performed a hierarchical clustering on principal components. We described all variables in each cluster and explored between clusters differences by Kruskal-Wallis tests.

RESULTS

We identified five clusters as regarding drinker identity, drinking characteristics, and alcohol-related quality of life. Among these five clusters, three clusters presented high drinking characteristics. A very vulnerable cluster showed high level of alcohol consumption, impact on quality of life and on academic results, and strong drinker identity. An egodystonic cluster showed high level of consumption, mild impact on quality of life and on academic results, but low drinker identity. A cluster seemed short-term super-adapted in heavy drinking environment, showing high level of alcohol consumption and drinker identity, but low impact on quality of life and on academic results (all between clusters p values < 0.001 with Kruskal-Wallis tests).

CONCLUSION

The subjective experience of students from these clusters was significantly different (p value < 0.001), and could explain some inadequacy of certain prevention strategies, considering binge drinker student as a homogeneous group. Prospective studies are needed to explore changes over time of these clusters.

Annual Total Binge Drinks Consumed by U.S. Adults, 2015

INTRODUCTION

Binge drinking (four or more drinks for women, five or more drinks for men on an occasion) accounts for more than half of the 88,000 U.S. deaths resulting from excessive drinking annually. Adult binge drinkers do so frequently and at high intensity; however, there are known disparities in binge drinking that are not well characterized by any single binge-drinking measure. A new measure of total annual binge drinks was used to assess these disparities at the state and national levels.

METHODS

Behavioral Risk Factor Surveillance System 2015 data (analyzed in 2016) were used to estimate the prevalence, frequency, intensity, and total binge drinks among U.S. adults. Total annual binge drinks was calculated by multiplying annual binge-drinking episodes by binge-drinking intensity.

RESULTS

In 2015, a total of 17.1% of U.S. adults (37.4 million) reported an annual average of 53.1 binge-drinking episodes per binge drinker, at an average intensity of 7.0 drinks per binge episode, resulting in 17.5 billion total binge drinks, or 467.0 binge drinks per binge drinker. Although binge drinking was more common among young adults (aged 18-34 years), half of the total binge drinks were consumed by adults aged ≥35 years. Total binge drinks per binge drinker were substantially higher among those with lower educational levels and household incomes than among those with higher educational levels and household incomes.

CONCLUSIONS

U.S. adult binge drinkers consume about 17.5 billion total binge drinks annually, or about 470 binge drinks/binge drinker. Monitoring total binge drinks can help characterize disparities in binge drinking and help plan and evaluate effective prevention strategies.

Self-guided Change: The most common form of long-term, maintained health behavior change

Millions of people change risky, health-related behaviors and maintain those changes. However, they often take years to change, and their unhealthy behaviors may harm themselves and others and constitute a significant cost to society. A review-similar in nature to a scoping review-was done of the literature related to long-term health behavior change in six areas: alcohol, cocaine and heroin misuse, gambling, smoking, and overeating. Based on the limited research available, reasons for change and strategies for changing and for maintaining change were also reviewed. Fifty years of research clearly indicate that as people age, in the case of alcohol, heroin and cocaine misuse, smoking, and gambling, 80-90 percent moderate or stop their unhealthy behaviors. The one exception is overeating; only 20 percent maintain their weight loss. Most of these changes, when they occur, appear to be the result of self-guided change. More ways to accelerate self-guided, health-related behavior change need to be developed and disseminated.

Identifying the Intersection of Alcohol, Adherence and Sex in HIV Positive Men on ART Treatment in India Using an Adapted Timeline Followback Procedure

People living with HIV (PLHIV) on anti-retroviral treatment (ART) who drink are less adherent and more likely to engage in unprotected sex but the connections among these events are correlational. Using an adapted Timeline Follow-Back (A-TLFB) procedure, this paper examines the day by day interface of alcohol, medication adherence and sex to provide a fine grained understanding of how multiple behavioral risks coincide in time and space, explores concordance/discordance of measures with survey data and identifies potential recall bias. Data are drawn from a survey of behavior, knowledge and attitudes, and a 30 day TLFB assessment of multiple risk behaviors adapted for the Indian PLHIV context, administered to 940 alcohol-consuming, HIV positive men on ART at the baseline evaluation stage of a multilevel, multi-centric intervention study. On days participants drank they were significantly more likely to be medication non-adherent and to have unprotected sex. In the first day after their alcohol consuming day, the pattern of nonadherence persisted. Binge and regular drinking days were associated with nonadherence but only binge drinking co-occurred with unprotected sex. Asking about specific "drinking days" improved recall for drinking days and number of drinks consumed. Recall declined for both drinking days and nonadherence from the first week to subsequent weeks but varied randomly for sex risk. There was high concordance and low discordance between A-TLFB drinking and nonadherence but these results were reversed for unprotected sex. Moving beyond simple drinking-adherence correlational analysis, the A-TLFB offers improved recall probes and provides researchers and interventionists with the opportunity to identify types of risky days and tailor behavioral modification to reduce alcohol consumption, nonadherence and risky sex on those days.

Effects of depression and past-year binge drinking on cognitive control processes during a flanker task in college-aged adults

BACKGROUND

Recent but largely separate literatures have examined neurocognitive alterations related to both depression and binge drinking, suggesting similar patterns of impairments in attention control and decisional processes. However, depression and problematic alcohol use tend to co-occur, and few studies have examined whether cognitive processing effects of depression and binge drinking are independent or interacting.

OBJECTIVE

The current study examined joint effects of depressive symptoms and past-year binge drinking on cognitive processing (measured via EEG assessment).

METHODS

University students aged 18 and over (N = 46; 63.4% female) were recruited based on self-reported depressive symptoms and also provided reports of alcohol use (51% reported significant depression; 46% reported at-least one past-year binge-drinking episode). Participants completed a computerized flanker task, assessing cognitive control processes. Forty-one participants providing useable data were included in analyses.

RESULTS

Past-year binge drinking was associated with slower and more accurate behavioral responding. The interaction of binge-drinking and depressive symptoms was related to the magnitude of early attentional components (N1 and N2), with individuals reporting high depressive symptoms and a history of binge-drinking exhibiting attenuated early attentional engagement (e.g., less negative N1) coupled with enhanced attention control processing (e.g., more negative N2). Depressive symptoms also predicted a lack of discriminated P3 amplitudes on congruent versus incongruent trials.

CONCLUSION

The data suggest that depression and binge drinking in the past-year jointly interact to predict early attentional processing, with the pattern of responding consistent with a compensatory response process. Results highlight the importance of future work on binge-drinking accounting for co-occurring depression.

Sex and Adolescent Ethanol Exposure Influence Pavlovian Conditioned Approach

BACKGROUND

Alcohol use among adolescents is widespread and a growing concern due to long-term behavioral deficits, including altered Pavlovian behavior, that potentially contribute to addiction vulnerability. We tested the hypothesis that adolescent intermittent ethanol (AIE) exposure alters Pavlovian behavior in males and females as measured by a shift from goal-tracking to sign-tracking. Additionally, we investigated GLT-1, an astrocytic glutamate transporter, as a potential contributor to a sign-tracking phenotype.

METHODS

Male and female Sprague-Dawley rats were exposed to AIE (5 g/kg, intragastric) or water intermittently 2 days on and 2 days off from postnatal day (P) 25 to 54. Around P70, animals began 20 daily sessions of Pavlovian conditioned approach (PCA), where they learned that a cue predicted noncontingent reward delivery. Lever pressing indicated interaction with the cue, or sign-tracking, and receptacle entries indicated approach to the reward delivery location, or goal-tracking. To test for effects of AIE on nucleus accumbens (NAcc) excitatory signaling, we isolated membrane subfractions and measured protein levels of the glutamate transporter GLT-1 after animals completed behavior as a measure of glutamate homeostasis.

RESULTS

Females exhibited elevated sign-tracking compared to males with significantly more lever presses, faster latency to first lever press, and greater probability to lever press in a trial. AIE significantly increased lever pressing while blunting goal-tracking, as indicated by fewer cue-evoked receptacle entries, slower latency to receptacle entry, and lower probability to enter the receptacle in a trial. No significant sex-by-exposure interactions were observed in sign- or goal-tracking metrics. Moreover, we found no significant effects of sex or exposure on membrane GLT-1 expression in the NAcc.

CONCLUSIONS

Females exhibited enhanced sign-tracking compared to males, while AIE decreased goal-tracking compared to control exposure. Our findings support the hypothesis that adolescent binge ethanol can shift conditioned behavior from goal- to cue-directed in PCA, especially in females.

Heavy episodic drinking and alcohol-related injuries: An open cohort study among college students

AIM

The objective of this study is to assess the effects of Heavy Episodic Drinking (HED) on the incidence of alcohol-related injuries among university students in Spain, taking sex into consideration.

METHODS

We carried out an open cohort study among college students in Spain (992 women and 371 men). HED and alcohol-related injuries were measured by question 3rd and 9th of Alcohol Use Disorders Identification Test to every participant at the ages of 18, 20, 22, 24 and 27. For data analysis we used a Multilevel Logistic Regression for repeated measures adjusting for alcohol and cannabis use.

RESULTS

The incidence rate of alcohol-related injuries was 0.028year^-1 for females and 0.036year^-1 for males. The multivariate analysis showed that among females a high frequency of HED and use of cannabis are risk factors for alcohol-related injuries (Odds Ratio [OR]=2.64 and OR=3.68), while being more than 23 is a protective factor (OR=0.34). For males, bivariate analysis also showed HED like risk factor (OR=4.69 and OR=2.51). Finally, the population attributable fraction for HED among females was 37.12%.

CONCLUSIONS

HED leads to an increase of alcohol-related injuries in both sexes and being over 23 years old acts as a protective factor among women. Our results suggest that about one third of alcohol-related injuries among women could be avoided by removing HED.

Voluntary Binge Consumption of Ethanol in a Sweetened, Chocolate-Flavored Solution by Male and Female Adolescent Sprague Dawley Rats

BACKGROUND

The still maturing adolescent brain may be particularly vulnerable to lasting consequences of ethanol (EtOH) exposure. Yet, human adolescents are the age group most likely to engage in binge drinking (a pattern of drinking leading to blood EtOH concentrations (BECs) of 80 mg/dl or greater). Most studies to date assessing the long-term effects of adolescent EtOH exposure in outbred rodent populations have either used experimenter-administered EtOH to produce BECs in the binge range or assessed voluntary intake of EtOH at well below binge levels. Beginning with a modified schedule-induced polydipsia (SIP) procedure, this study examined the suitability of several approaches to induce voluntary binge-like consumption during adolescence in an outbred rat strain.

METHODS

Adolescent male and female Sprague Dawley rats were food deprived to 85% projected free-feeding weights beginning on postnatal day (P) 24 and were given 30 minutes of access to 10% EtOH in chocolate Boost^® or Boost^® alone daily from P28 to P41 (followed later by their daily allocation of food). Animals were tested within operant chambers (Exp. 1a, 1b and Exp. 2) or home and novel cages (Exp. 3). Animals received either scheduled delivery of banana pellets to examine SIP (Exp. 1a,b) or massed pellet presentation (Exp. 2 and Exp. 3). Blood samples were collected via the lateral tail vein on P33 and P41.

RESULTS

Intakes produced BECs frequently in the binge range (>80 mg/dl) and modeled binge-like consumption patterns, with high consumption days typically followed by 1 to 2 days of lower consumption; this variability was less evident with Boost^® alone. Consumption was not schedule induced and was generally high across all studies, although consumption in males appeared to be particularly pronounced when animals were tested in the presence of their cage mate.

CONCLUSIONS

Binge-like patterns of EtOH consumption were produced using these procedures in adolescent Sprague Dawley rats of both sexes and may prove to be a useful model for work examining the short- and long-term consequences of high levels of voluntary EtOH intake in adolescence.

Alcohol use variability in a community-based sample of nonstudent emerging adult heavy drinkers

BACKGROUND

While nonstudent emerging adults are at elevated risk for experiencing alcohol-related problems, there remains a paucity of research devoted specifically to addressing drinking in this group.

OBJECTIVES

The present study sought to offer unique insights into nonstudent drinking by examining drinking variability across 30 days using a retrospective diary method. Specific aims were to: (1) compare within- and between-person variability in alcohol use across 30 days, and (2) determine the extent to which central social-cognitive between-person factors (i.e., social expectancies, perceived drinking norms, social drinking motivations) predict between-person alcohol use as well as within-person variability in drinking.

METHODS

Participants were 195 (65.1% men) nonstudent emerging adults recruited from the community with a mean age of 21.9 (SD = 2.1) years.

RESULTS

Findings showed that a substantial portion of variation in daily alcohol consumption was attributable to the within-person (83%) rather than between-person (17.2%) level. Social expectancies, perceived drinking norms, and social motives were found to influence variability in daily alcohol consumption.

CONCLUSION

Our findings contribute to knowledge that could guide efforts to design and tailor intervention strategies to minimize the harms experienced by an understudied and at-risk population of drinkers.

Students worry about the impact of alcohol on quality of life: Roles of frequency of binge drinking and drinker self-concept

INTRODUCTION

The aim of this study was to clarify the impact of binge drinking, its intensity and frequency, and drinker self-concept on health-related quality-of-life (HRQOL) in students.

METHODS

This cross-sectional online survey included 16,930 students. We collected sociodemographics, environmental data, and drinking behaviors. We assessed HRQOL using the Alcohol Quality-of-Life scale, which explicitly explores the subjective negative impact on quality of life one attributes to his relationship with alcohol and the degree to which drinking is a part of an individual's self-concept. Data analyses were performed in 2015 and 2016. We described and compared binge drinkers and non-binge drinkers. Using a regression model we identified the independent factors associated with HRQOL.

RESULTS

The impact on HRQOL attributed to alcohol was significantly greater among binge drinkers. Factors of impact on HRQOL subjectively attributed to alcohol by students were: AUDIT-C score, interaction between gender and AUDIT-C score, strong individual identity as a drinker, binge-drinking frequency, financial difficulties, being a foreigner, fewer years since diploma, chronic condition, recent use of cannabis, psychostimulant, poppers or gambling. Sleep quality, ability to work, expenditure on alcohol, shame, and health-related concerns were the most strongly impacted quality of life areas.

CONCLUSIONS

Binge-drinking frequency should be considered as an important target in prevention programs. In addition, integrating findings on students' subjective perceptions of impairment of HRQOL by alcohol could enable the development of more acceptable and more relevant prevention messages.

Investigation of agreement between wastewater-based epidemiology and survey data on alcohol and nicotine use in a community

BACKGROUND/AIMS

Alcohol and nicotine are the two most used substances world-wide and associated with increased burden of disease. Since surveys on substance use may be difficult due to response biases, wastewater-based epidemiology (WBE) was developed as a more objective measure of nicotine and alcohol use. This study compares estimates of nicotine and alcohol use from a wastewater sampling campaign in a medium-sized Belgian city with a concurrently executed population survey.

METHODS

29,083 letters about participation in an online survey study on weekly alcohol and tobacco use were sent to the inhabitants of Lier, Belgium. Wastewater samples were collected from the associated treatment plant in four bi-weekly periods. Samples were analyzed using liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS). Ethylsulfate was used as alcohol biomarker and cotinine and trans-3'-hydroxycotinine as nicotine biomarker.

RESULTS

263 (1%) surveys were filled out on average per week. According to survey data, alcohol and nicotine were used less than in the rest of Belgium and this was matched by the wastewater data. Nicotine use, but not alcohol use, showed a significant variation over the sampling periods. Both nicotine and alcohol showed increase use during the weekend while only alcohol showed a different use pattern throughout the week.

CONCLUSION

No correlation between WBE and survey data could be demonstrated, possibly due to small sample sizes. However, this study shows that weekly trends in alcohol and nicotine use can be quickly detected from wastewater analysis and the occurrence of major events such as festivals can be identified.

Differences in weekday versus weekend drinking among nonstudent emerging adults

In the current investigation, we sought to examine "day-of-the-week" drinking of an at-risk sample of nonstudent emerging adults and whether specific factors are associated with differential drinking patterns. Our study aims were to (a) identify differences in weekday versus weekend drinking, and (b) examine specific expectancies (i.e., sociability, tension reduction) and demographic factors (e.g., age, sex) relating to weekend versus weekday drinking after controlling for harmful drinking and holiday drinking. Participants were heavy-drinking noncollege attenders recruited from the community (N = 238; 63.4% men, 35.7% women; M age = 21.92 years). They reported daily drinking for the previous 30 days and completed measures of harmful drinking, alcohol expectancies, and demographic information. Results showed that more drinks were consumed on the weekends (i.e., Thursday to Saturday) than weekdays, with 63% of drinks consumed on weekends. Multilevel modeling analyses indicated that weekday drinking was associated with tension-reduction expectancies, social expectancies, sex, and age. Weekend-drinking increases were related to social expectancies, but not tension-reduction expectancies. Our final model indicated that, after controlling for the effect of holiday drinking, the within-person weekday-weekend distinction explained 18% of the total variance. In general, our findings highlight the importance of alcohol expectancies and drinking contexts in understanding the drinking behaviors of nonstudents. The differential role of tension-reduction and social-facilitation expectancies on drinking throughout the week imply that different cognitive pathways are involved in weekday versus weekend drinking, and both types of expected alcohol effects should be targets of risk-reduction efforts with nonstudent drinkers.

Alcohol Effects on Stress Pathways: Impact on Craving and Relapse Risk

A significant amount of neurobiological research regarding the development of alcohol use disorders (AUDs) has focused on alcohol-related activation and long-term alterations in the mesocortical dopaminergic reward pathways. However, alcohol does not only interact with brain reward systems. Many of its acute and chronic effects may be related to allostatic adaptations in hypothalamic and extrahypothalamic stress regulation pathways. For example, acute binge intoxication is associated with hypothalamically driven increases in blood cortisol, norepinephrine, and sex steroid metabolite levels. This may contribute to the development of mesocortical sensitization to alcohol. Furthermore, chronic alcohol exposure is associated with systemic dysregulation of the hypothalamic pituitary adrenal axis, sympathetic adrenal medullary system, and sex steroid systems. This dysregulation appears to manifest as neuroendocrine tolerance. In this review, we first summarize the literature suggesting that alcohol-induced alterations in these hypothalamic systems influence craving and contribute to the development of AUDs. We note that for women, the effects of alcohol on these neuroendocrine stress regulation systems may be influenced by the rhythmic variations of hormones and steroids across the menstrual cycle. Second, we discuss how changes in these systems may indicate progression of AUDs and increased risk of relapse in both sexes. Specifically, neuroendocrine tolerance may contribute to mesocortical sensitization, which in turn may lead to decreased prefrontal inhibitory control of the dopaminergic reward and hypothalamic stress systems. Thus, pharmacological strategies that counteract alcohol-associated changes in hypothalamic and extrahypothalamic stress regulation pathways may slow the development and progression of AUDs.