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Oddo LE, Joyner KJ, Murphy JG, Acuff SF, Marsh NP, Steinberg A, Chronis-Tuscano A. Attention-deficit/hyperactivity disorder is associated with more alcohol problems and less substance-free reinforcement: A behavioral economics daily diary study of college student drinkers. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2024; 38:437-450. [PMID: 38271078 PMCID: PMC11116072 DOI: 10.1037/adb0000982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
OBJECTIVE Behavioral economic theory suggests that alcohol risk is related to elevated alcohol reinforcing efficacy (demand) combined with diminished availability of reinforcing substance-free activities, but little research has examined these reward-related processes at the daily level in association with comorbid conditions that might influence behavioral patterns and reward. Young people with attention-deficit/hyperactivity disorder (ADHD) report high levels of risky drinking, and this risk may be due in part to elevated demand for alcohol and diminished engagement in enjoyable and valued substance-free activities. METHOD College student drinkers (N = 101; 48.5% female; 68.3% White; 18-22 years old) with (n = 51) and without (n = 50) ADHD completed 14 consecutive daily diaries (diary entry n = 1,414). We conducted a series of multilevel path models to examine (a) the associations among ADHD and average daily alcohol demand, substance-free enjoyment, and response contingent positive reinforcement (RCPR) for goal-directed behaviors; (b) the associations among concurrent daily alcohol demand, substance-free reinforcement, and RCPR for goal-directed behaviors and daily alcohol use and alcohol-related negative consequences; and (c) the moderating effect of ADHD on these within-day associations. RESULTS ADHD was significantly associated with more daily alcohol-related negative consequences and less daily substance-free enjoyment and RCPR. Regardless of ADHD status, there were significant associations among behavioral economic risk factors and alcohol use and negative consequences, though effects differed within and between persons. There were no moderating effects of ADHD on within-person associations. CONCLUSIONS Results expose areas of impairment specific to drinkers with ADHD and advance theory on ADHD and hazardous drinking. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Murphy JG, Dennhardt AA, Utzelmann B, Borsari B, Ladd BO, Martens MP, White HR, Yurasek AM, Campbell KW, Witkiewitz K. A pilot trial of a brief intervention for cannabis use supplemented with a substance-free activity session or relaxation training. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2024; 38:255-268. [PMID: 38271079 PMCID: PMC11065625 DOI: 10.1037/adb0000988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
OBJECTIVE Cannabis use is increasing among college students and commonly co-occurs with anxiety symptoms in this age group. Interventions that reduce anxiety may also reduce cannabis use. Behavioral economic theory suggests that substance use reductions are most likely when there is an increase in substance-free reinforcement. This randomized pilot trial evaluated the efficacy of a brief motivational intervention (BMI) for cannabis supplemented by either a substance-free activity session (SFAS) or a relaxation training (RT) session for reducing cannabis use, problems, craving, and anxiety symptoms. METHOD One hundred thirty-two college students (Mage = 19.9; 54% female; 67% White, 31% Black) who reported five or more past-month cannabis use days were randomized to: (a) assessment-only (AO); (b) BMI plus SFAS; or (c) BMI plus RT. Participants in the BMI conditions received two individual counselor-administered sessions plus a brief phone booster session. Outcomes were evaluated 1- and 6-months postintervention. RESULTS Relative to assessment, both BMI + SFAS and BMI + RT were associated with significant reductions in cannabis problems and craving at 1-month follow-up, and significant reductions in anxiety at 6-month follow-up. Relative to AO, BMI + RT was associated with significant reductions in cannabis use at 1-month follow-up. There were no differences between BMI conditions. CONCLUSIONS This pilot trial was not adequately powered to conclusively evaluate relative efficacy but provides preliminary support for the short-term efficacy of both two-session interventions for reducing anxiety and cannabis-related risk among nontreatment seeking emerging adults. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- James G. Murphy
- Department of Psychology, University of Memphis, 400 Innovation Dr., Memphis, TN, 38152 United States
| | - Ashley A. Dennhardt
- Department of Psychology, University of Memphis, 400 Innovation Dr., Memphis, TN, 38152 United States
| | - Bettina Utzelmann
- Department of Psychology, University of Memphis, 400 Innovation Dr., Memphis, TN, 38152 United States
| | - Brian Borsari
- Mental Health Service (116B) San Francisco VA Health Care System, 4150 Clement Street, San Francisco, CA 94121, United States
- Department of Psychiatry and Behavioral Sciences, University of California – San Francisco, 401 Parnassus Ave, San Francisco, CA 94143, United States
| | - Benjamin O. Ladd
- Department of Psychology, Washington State University Vancouver, 14204 NE Salmon Creek Ave, Vancouver, WA 98686-9600, United States
| | - Matthew P. Martens
- College of Education, University of Missouri, 118D Hill Hall, Columbia, MO 65211, United States
| | - Helene R. White
- Center of Alcohol and Substance Studies, Rutgers, the State University of New Jersey, 607 Allison Road, Piscataway, NJ 08854, United States
| | - Ali M. Yurasek
- Department of Health Education and Behavior, University of Florida, FLG16, Gainesville, FL 32611, United States
| | - Kevin W. Campbell
- Department of Psychology, University of Memphis, 400 Innovation Dr., Memphis, TN, 38152 United States
| | - Katie Witkiewitz
- Department of Psychology, Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, 2650 Yale SE, Albuquerque, NM 87131, United States
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Murphy JG, Dennhardt AA, Tempchin J, Colgonis HE, McDevitt-Murphy ME, Borsari B, Berlin KS. Behavioral economic and wellness-based approaches for reducing alcohol use and consequences among diverse non-student emerging adults: study protocol for Project BLUE, a randomized controlled trial. Trials 2024; 25:173. [PMID: 38459579 PMCID: PMC10924404 DOI: 10.1186/s13063-024-08009-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 02/22/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Emerging adults (EAs) who are not 4-year college students nor graduates are at elevated risk for lifetime alcohol use disorder, comorbid drug use, and mental health symptoms, compared to college graduates. There is a need for tailored brief alcohol intervention (BAI) approaches to reduce alcohol risk and to facilitate healthy development in this high-risk population. Most BAIs include a single session focused on discussing risks associated with drinking and correcting normative beliefs about drinking rates. EAs may benefit from additional elements that enhance general wellness. The substance-free activity session (SFAS) aims to clarify life goals and values and increase goal-directed activities that provide alternatives to alcohol use, and the relaxation training (RT) session teaches relaxation and stress reduction skills. METHODS The present study is a randomized 3-group (BAI + SFAS vs. RT + SFAS vs. education control) trial with 525 EAs (175 per group; estimated 50% women and 50% African American) who report recent risky drinking and who are not students or graduates of 4-year colleges. Participants will have the option of completing the intervention sessions in person or via a secure video teleconference. Levels of drinking and alcohol-related problems will be evaluated at baseline and 1, 3, 6, and 12 months post-intervention. The primary hypothesis is that both BAI + SFAS and RT + SFAS participants will report significantly greater reductions in alcohol use and problems relative to education control participants, with no differences in outcomes between the two active treatment conditions. DISCUSSION The results of this study will inform alcohol prevention efforts for high-risk community dwelling emerging adults. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04776278.
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Affiliation(s)
- James G Murphy
- Department of Psychology, The University of Memphis, 400 Innovation Dr, Memphis, TN, 38152, USA.
| | - Ashley A Dennhardt
- Department of Psychology, The University of Memphis, 400 Innovation Dr, Memphis, TN, 38152, USA
| | - Jacob Tempchin
- Department of Psychology, The University of Memphis, 400 Innovation Dr, Memphis, TN, 38152, USA
| | - Hannah E Colgonis
- Department of Psychology, The University of Memphis, 400 Innovation Dr, Memphis, TN, 38152, USA
| | | | - Brian Borsari
- Mental Health Service (116B), San Francisco VAHCS, San Francisco, CA, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Kristoffer S Berlin
- Department of Psychology, The University of Memphis, 400 Innovation Dr, Memphis, TN, 38152, USA
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Murphy JG, Dennhardt AA, Tempchin J, Colgonis HE, McDevitt-Murphy M, Borsari B, Berlin KS. Behavioral Economic and Wellness-based Approaches for Reducing Alcohol Use and Consequences Among Diverse Non-Student Emerging Adults: Study Protocol for Project BLUE, a Randomized Controlled Trial. RESEARCH SQUARE 2024:rs.3.rs-3732598. [PMID: 38405755 PMCID: PMC10889067 DOI: 10.21203/rs.3.rs-3732598/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Background Emerging adults (EAs) who are not 4-year college students nor graduates are at elevated risk for lifetime alcohol use disorder, comorbid drug use, and mental health symptoms, compared to college graduates. There is a need for tailored brief alcohol intervention (BAI) approaches to reduce alcohol risk and to facilitate healthy development in this high-risk population. Most BAIs include a single session focused on discussing risks associated with drinking and correcting normative beliefs about drinking rates. EAs may benefit from additional elements that enhance general wellness. The Substance-Free Activity Session (SFAS) aims to clarify life goals and values and increase goal-directed activities that provide alternatives to alcohol use, and the Relaxation Training (RT) session teaches relaxation and stress reduction skills. Methods The present study is a randomized 3-group (BAI+SFAS vs. RT+SFAS vs. education control) trial with 525 EAs (175 per group; estimated 50% women & 50% African American) who report recent risky drinking and who are not students or graduates of 4-year colleges. Participants will have the option of completing the intervention sessions in person or via a secure video teleconference. Levels of drinking and alcohol-related problems will be evaluated at baseline and 1, 3, 6, and 12-months post-intervention. The primary hypothesis is that both BAI+SFAS and RT+SFAS participants will report significantly greater reductions in alcohol use and problems relative to education control participants, with no differences in outcomes between the two active treatment conditions. Discussion The results of this study will inform alcohol prevention efforts for high-risk community dwelling emerging adults. ClinicalTrialsgov Identifier NCT04776278.
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Affiliation(s)
| | | | | | | | | | - Brian Borsari
- University of California San Francisco Department of Psychiatry
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Tucker JA, Buscemi J, Murphy JG, Reed DD, Vuchinich RE. Addictive behavior as molar behavioral allocation: Distinguishing efficient and final causes in translational research and practice. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2023; 37:1-12. [PMID: 35787099 PMCID: PMC9811182 DOI: 10.1037/adb0000845] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Translational research on addictive behaviors viewed as molar behavioral allocation is critically reviewed. This work relates rates of behavior to rates of reinforcement over time and has been fruitfully applied to addictive behaviors, which involve excessive allocation to short-term rewards with longer term costs. METHOD Narrative critical review. RESULTS This approach distinguishes between final and efficient causes of discrete behaviors. The former refers to temporally extended behavior patterns into which the act fits. The latter refers to environmental stimuli or internal psychological mechanisms immediately preceding the act. Final causes are most clear when addictive behaviors are studied over time as a function of changing environmental circumstances. Discrete acts of addictive behavior are part of an extended/molar behavior pattern when immediate constraints on engagement are low and few rewarding alternatives are available. Research framed by efficient causes often use behavioral economic simulation tasks as individual difference variables that precede discrete acts. Such measures show higher demand for addictive commodities and steeper discounting in various risk groups, but whether they predict molar addictive behavior patterning is understudied. CONCLUSIONS Although efficient cause analysis has dominated translational research, research supports viewing addictive behavior as molar behavioral allocation. Increasing concern with rate variables underpinning final cause analysis and considering how study methods and temporal units of analysis inform an efficient or final cause analysis may advance understanding of addictive behaviors that occur over time in dynamic environmental contexts. This approach provides linkages between behavioral science and disciplines that study social determinants of health. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Jalie A. Tucker
- University of Florida and Center for Behavioral Economic Health
Research, Gainesville, FL
| | | | | | - Derek D. Reed
- University of Kansas and Cofrin Logan Center for Addiction Research
& Treatment, Lawrence, KS
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Vuchinich RE, Tucker JA, Acuff SF, Reed DD, Buscemi J, Murphy JG. Matching, behavioral economics, and teleological behaviorism: Final cause analysis of substance use and health behavior. J Exp Anal Behav 2023; 119:240-258. [PMID: 36541360 DOI: 10.1002/jeab.815] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/22/2022] [Accepted: 11/25/2022] [Indexed: 12/24/2022]
Abstract
Howard Rachlin and his contemporaries pioneered basic behavioral science innovations that have been usefully applied to advance understanding of human substance use disorder and related health behaviors. We briefly summarize the innovations of molar behaviorism (the matching law), behavioral economics, and teleological behaviorism. Behavioral economics and teleological behaviorism's focus on final causes are especially illuminating for these applied fields. Translational and applied research are summarized for laboratory studies of temporal discounting and economic demand, cohort studies of alcohol and other drug use in the natural environment, and experimental behavioral economic modeling of health behavior-related public health policies. We argue that the teleological behavioral perspective on health behavior is conducive to and merges seamlessly with the contemporary socioecological model of health behavior, which broadens the contextual influences (e.g., community, economic, infrastructure, health care access and policy) of individuals' substance use and other health risk behaviors. Basic-to-applied translations to date have been successful and bode well for continued applications of basic science areas pioneered by Howard Rachlin and his contemporaries.
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Affiliation(s)
| | - Jalie A Tucker
- University of Florida and Center for Behavioral Economic Health Research, Gainesville, FL
| | | | - Derek D Reed
- University of Kansas and Cofrin Logan Center for Addiction Research and Treatment, Lawrence, KS
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Thrailkill EA, DeSarno M, Higgins ST. Intersections between environmental reward availability, loss aversion, and delay discounting as potential risk factors for cigarette smoking and other substance use. Prev Med 2022; 165:107270. [PMID: 36152818 PMCID: PMC10876085 DOI: 10.1016/j.ypmed.2022.107270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 09/08/2022] [Accepted: 09/17/2022] [Indexed: 02/03/2023]
Abstract
Behavioral theory suggests that density of environmental rewarding activities and biases in decision making influence risk for substance use disorder (SUD). To better understand intersections of these potential risk factors, this study examined whether environmental reward predicted smoking status or other drug use and whether such associations were independent of two decision-making biases known to predict SUD risk, namely loss aversion and delay discounting. Individuals that reported current daily cigarette smoking (n = 186; >10 cigarettes/day) and never-smoking (n = 241; <100 cigarettes lifetime) were recruited with standard crowdsourcing methods. Participants answered questions on alcohol and other drug use. Environmental reward was assessed using the Reward Probability Index (RPI), and loss aversion (LA) and delay discounting (DD) using a gamble-acceptance task and monetary choice questionnaire, respectively. Associations of RPI, LA, and DD with cigarette smoking, alcohol use, other drug use, and combinations of co-use were examined with logistic regression controlling for sociodemographic variables (educational attainment, gender, age). Low RPI (odds ratio[OR] = 0.97, p = .006), low LA (OR = 1.22, p < .001), and high DD (OR = 1.12, p = .03), were each independently associated with increased risk for cigarette smoking, as well as other substance use, and use combinations. We saw no evidence that RPI was significantly influencing associations between LA and DD with smoking status or other substance use. Finally, RPI, but not LA or DD, was significantly associated with depressed mood and sleep disturbance. These results provide new evidence on associations of RPI with smoking status and other substance use while further documenting independent associations between LA and DD and those outcomes.
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Affiliation(s)
- Eric A Thrailkill
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Department of Psychological Science, University of Vermont, Burlington, VT, USA; Department of Psychiatry, University of Vermont, Burlington, VT, USA.
| | - Michael DeSarno
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Department of Biomedical Statistics, University of Vermont, Burlington, VT, USA
| | - Stephen T Higgins
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Department of Psychological Science, University of Vermont, Burlington, VT, USA; Department of Psychiatry, University of Vermont, Burlington, VT, USA
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Gex KS, Acuff SF, Campbell KW, Mun EY, Dennhardt AA, Borsari B, Martens MP, Murphy JG. Change in alcohol demand following a brief intervention predicts change in alcohol use: A latent growth curve analysis. Alcohol Clin Exp Res 2022; 46:1525-1538. [PMID: 35707989 PMCID: PMC9427684 DOI: 10.1111/acer.14887] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 05/12/2022] [Accepted: 06/09/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND The association between behavioral economic demand and various alcohol use outcomes is well established. However, few studies have examined whether changes in demand occur following a brief alcohol intervention (BAI), and whether this change predicts alcohol outcomes over the long term. METHODS Parallel process piecewise latent growth curve models were examined in a sample of 393 heavy drinking emerging adults (60.8% women; 85.2% white; Mage = 18.77). In these models, two linear slopes represented rates of change in alcohol use, heavy drinking episodes, alcohol-related problems, and demand (intensity and highest expenditure across all price points or Omax ) from baseline to 1 month (slope 1) and 1 month to 16 months (slope 2). Mediation analyses were conducted to estimate the effect of a BAI on 16-month alcohol outcomes through slope 1 demand. RESULTS A two-session BAI predicted significant reductions in all five outcomes from baseline to 1-month follow-up. Although no further reduction was observed from the 1-month to the 16-month follow-up, there was no regression to baseline levels. Slope 1 demand intensity, but not Omax , significantly mediated the association between BAI and both outcomes-heavy drinking episodes (Est. = -0.23, SE = 0.08, p < 0.01) and alcohol-related problems (Est. = -0.15, SE = 0.07, p < 0.05)-at the 16-month follow-up. CONCLUSIONS Reducing high valuation of alcohol among heavy drinking emerging adults within the first month following BAI is critical for the long-term efficacy of the intervention. A two-session BAI was associated with enduring reductions in alcohol demand, and the change in demand intensity, but not Omax , was associated with sustained reductions in heavy drinking and alcohol-related problems.
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Affiliation(s)
- Kathryn S. Gex
- Department of Psychiatry and Behavioral Sciences, Addiction Sciences Division, Medical University of South Carolina, 67 President St. MSC 864, Charleston, SC 29425,Corresponding Author and Phone: (843) 876-2084
| | - Samuel F. Acuff
- Department of Psychology, The University of Memphis, 400 Innovation Drive, Memphis, TN 38152
| | - Kevin W. Campbell
- Department of Psychology, The University of Memphis, 400 Innovation Drive, Memphis, TN 38152
| | - Eun-Young Mun
- Department of Health Behavior and Health Systems, School of Public Health, University of North Texas Health Science Center, 3500 Camp Bowie Blvd., Fort Worth, TX 76107
| | - Ashley A. Dennhardt
- Department of Psychology, The University of Memphis, 400 Innovation Drive, Memphis, TN 38152
| | - Brian Borsari
- San Francisco Veterans Affairs Health Care System, 4150 Clement St., San Francisco, CA 94121,University of California – San Francisco, Department of Psychiatry and Behavioral Sciences, 982 Mission St., San Francisco, CA 94103
| | - Matthew P. Martens
- The University of Missouri, Department of Educational, School, and Counseling Psychology, 118D Hill Hall, Columbia, MO 65211
| | - James G. Murphy
- Department of Psychology, The University of Memphis, 400 Innovation Drive, Memphis, TN 38152
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Higgins ST. Leveraging behavioral economics and reinforcement theory in treating heavy episodic drinking among college students. Alcohol Clin Exp Res 2022; 46:25-28. [PMID: 34866198 PMCID: PMC8799517 DOI: 10.1111/acer.14758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 11/24/2021] [Indexed: 01/03/2023]
Affiliation(s)
- Stephen T Higgins
- Department of Psychiatry, Vermont Center on Behavior and Health, University of Vermont, Burlington, Vermont, USA
- Department of Psychological Science, Vermont Center on Behavior and Health, University of Vermont, Burlington, Vermont, USA
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