Longitudinal examination of alcohol use motives, item-level protective behavioral strategies, and alcohol-related consequences

BACKGROUND

Alcohol misuse among college students is a public health concern. Protective behavioral strategies (PBS) can be used before, during, after, or instead of drinking to reduce alcohol use and negative consequences, but findings on their utility at the aggregate level are mixed. Although recent work has provided important information on the performance of individual PBS items, it is limited by research designs that are cross-sectional, do not examine consequences, or do not examine other important correlates, such as drinking motives. This study examines both the association between item-level PBS and alcohol-related negative consequences and the moderating effect of drinking motives longitudinally.

METHODS

College students from two universities (n = 200, 62.5% female, Mage = 20.16) completed the Drinking Motives Questionnaire-Revised, Protective Behavioral Strategies Survey, the Rutgers Alcohol Problem Index, and a measure of the quantity of alcohol use at baseline and 3-month follow-up. Generalized linear models were conducted to assess direct effects of item-level PBS on alcohol-related consequences and the moderating effects of drinking motives.

RESULTS

Two PBS items were associated with fewer alcohol-related consequences at follow-up, and two items were associated with greater alcohol-related consequences at follow-up. Drinking motives differentially moderated associations between item-level PBS and alcohol-related consequences for a proportion in the sample. Enhancement motives moderated the greatest number of associations, followed by coping, conformity, and social motives. Certain PBS (e.g., drink slowly, rather than gulp or chug) were moderated by several drinking motives, whereas other PBS items were not moderated by any motives.

CONCLUSION

Consistent with previous research, some item-level PBS were associated longitudinally with increased negative consequences, and some were associated with decreased negative consequences. Drinking motives, particularly enhancement, moderated several item-level PBS and consequence associations, suggesting that reasons for drinking may be important for understanding the associations between PBS strategies and alcohol-related consequences.

Whose Approval Matters Most? Examining Discrepancies in Self- and Other- Perceptions of Drinking

BACKGROUND

Research demonstrates that perceptions of others' attitudes toward drinking behaviors (injunctive norms) are strong predictors of alcohol consumption and problems. Personalized normative feedback (PNF) aims to reduce the discrepancy between one's perception of others' attitudes toward drinking and others' actual attitudes toward drinking. An implicit assumption of PNF is that self and (perceived) other attitudes toward drinking are aligned (thus, shifting one's perceptions of others' attitudes shifts one's own attitudes). However, there is minimal research on the extent to which alignment (or discrepancy) in self-other attitudes toward drinking is associated with alcohol-related outcomes.

METHODS

College students (N = 1,494; Mage = 20.11, 61.0% female, 66.4% White) who endorsed past-month heavy episodic drinking reported injunctive norms toward drinking on weekends, drinking daily, drinking to black out, and drinking and driving. Participants reported their perceptions of attitudes toward these drinking behaviors for three reference groups: close friends, typical university-affiliated peers, and parents. Outcomes included weekly drinking, alcohol problems, and alcohol-related risk.

RESULTS

Response surface analyses indicated that alignment in approval (versus alignment in disapproval) of drinking demonstrated a linear association with alcohol-related outcomes. Discrepancies in self-peer and self-parent attitudes were associated with alcohol-related outcomes and one's own attitudes (versus one's ratings of others' attitudes) of drinking were more strongly associated with outcomes.

CONCLUSIONS

Results provide evidence of how self-other discrepancies in attitudes toward drinking are associated with alcohol-related outcomes. Future work is needed to test whether self-other discrepancies in attitudes toward drinking impacts response to norms-based interventions.

Why get high? Coping and enjoyment motives mediate elevated cannabis demand and cannabis-related outcomes

OBJECTIVE

Cannabis is the most used psychoactive substance among adolescents and is a public health concern. Cannabis demand is a quantifiable measure of the reinforcing value of cannabis and comprises two latent-factors-amplitude (maximum consumption) and persistence (sensitivity to increasing costs). Cannabis demand and cannabis motives are important predictors of adolescent cannabis use and associated problems; however, little is known about how these two facets of motivation are causally related. Cannabis motives are thought to represent the final common pathway to cannabis use and may explain why elevated demand is associated with use and consequences. The present study tested whether internal cannabis motives (coping and enjoyment) mediated longitudinal associations between cannabis demand, use (hours high), and negative consequences.

METHOD

Participants aged 15-18 years old (n = 89, Mage = 17.0, SD = 0.9) who reported lifetime cannabis use completed online assessments of cannabis demand, motives, use and negative consequences at baseline, 3-month, and 6-month follow-up.

RESULTS

PROCESS mediation models revealed that enjoyment motives mediated the association between amplitude and persistence and use. In addition, coping motives mediated the association between amplitude and negative consequences.

CONCLUSIONS

These findings suggest that internal motives, while differentially related to aspects of demand and cannabis outcomes, are important in understanding adolescent cannabis use. Prevention efforts aimed at limiting access to cannabis and increasing access to substance-free activities may be important targets for adolescents. Further, cannabis interventions targeting specific motives for using (e.g., to cope with negative affect) may be important for reducing cannabis demand. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Alcohol and marijuana use predicting next-day absenteeism and engagement at school and work: A daily study of young adults

This study examined effects of alcohol and marijuana use on next-day absenteeism and engagement at work and school among young adults (18-25 years old) who reported past-month alcohol use and simultaneous alcohol and marijuana use. Participants completed twice daily surveys for five, 14-day bursts. The analytic sample was 409 [64 % were enrolled in university (N = 263) and 95 % were employed (N = 387) in at least one burst]. Daily measures included: any alcohol or marijuana use, quantity of alcohol or marijuana use (i.e., number of drinks, number of hours high), attendance at work or school, and engagement (i.e., attentiveness, productivity) at school or work. Multilevel models examined between- and within-person associations between alcohol and marijuana use and next-day absenteeism and engagement at school or work. Between-persons, the proportion of days of alcohol use days was positively associated with next-day absence from school, consuming more drinks was positively associated with next-day absence from work, and the proportion of days of marijuana use was positively associated with next-day engagement at work. At the daily-level, when individuals consumed any alcohol and when they consumed more drinks than average, they reported lower next-day engagement during school and work. When individuals used marijuana and when they were high for more hours than average, they reported lower next-day engagement during school. Findings suggest alcohol and marijuana use consequences include next-day absence and decrements in next-day engagement at school and work, which could be included in interventions aimed at ameliorating harmful impacts of substance use among young adults.

Can I see some ID? Examining validity of the marijuana purchase task among late adolescent cannabis users

Cannabis demand (i.e., reinforcing value) can be assessed using a marijuana purchase task (MPT; assesses hypothetical purchasing of cannabis at escalating prices) and has been related to use frequency, problems, and cannabis use disorder symptoms in adults. Cannabis demand has yet to be studied in adolescents, which can inform prevention and intervention efforts to reduce cannabis-related risks. The present study sought to validate the MPT with a sample of late adolescent lifetime cannabis users. Participants aged 15-18 years old (n = 115, Mage = 16.9, SD = 0.9) residing in a state with legalized cannabis use completed online assessments at baseline and 6-month follow-up. Convergent and divergent validity was examined, while principal component analysis was conducted to determine the factor structure and assess predictive validity. Three indices, Omax (i.e., maximum expenditure on cannabis), breakpoint (i.e., price suppressing consumption to zero), and alpha (i.e., degree to which consumption decreases with increasing price) were all significantly associated with cannabis use, consequences, craving, and expenditures and significantly differentiated low-risk users and high-risk users as measured by the Cannabis Use Disorders Identification Test-Revised (CUDIT-R). A two-factor solution reflecting amplitude (intensity, alpha, Omax) and persistence (breakpoint, Pmax) was observed. Both factors were associated with cannabis use and consequences in baseline regression models. At follow-up, persistence was associated with consequences; amplitude was not associated with either outcome. These findings provide initial evidence that the MPT is a valid measure for assessing cannabis demand among adolescents and can be used to understand mechanisms of adolescent cannabis use. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Repeated Assessment of Alcohol Use and Perceived Norms Among College Students Who Drink: Comparisons to a Minimal Assessment at 12-Month Follow-Up

OBJECTIVE

Clinical trials assessing efficacy of alcohol use interventions often aim to test differences between treatment and control conditions at several follow-up time points, requiring repeated assessment of outcomes (e.g., weekly number of drinks). There has been concern that repeated assessment may elicit assessment reactivity in which participants, even those who did not receive treatment, reduce their alcohol use, but findings in the literature have been mixed. The current study of assessment reactivity compared two control conditions that were part of a larger randomized controlled trial: (a) repeated assessment that completed surveys at baseline, 3-, 6-, and 12-month follow-ups, and (b) minimal assessment that only completed surveys at baseline and 12-month follow-up. Outcomes assessed at 12-month follow-up included (a) changes in alcohol use behavior and negative consequences, (b) changes in perceived descriptive and injunctive norms, and (c) participant attrition/retention.

METHOD

Participants were undergraduate students who reported at least one heavy drinking occasion (4+/5+ drinks for women/men) in the past month (N = 456; 63.3% female; mean age = 20.11 years).

RESULTS

Multiple regression models indicated no significant differences between the repeated and minimal assessment control conditions on any indices of alcohol use (p values ranged from .42 to .97), negative consequences (p = .39), or on perceived descriptive/injunctive norms (p = .60 and .23, respectively). Attrition at 12-month follow-up was low in both groups, but significantly higher (p = .006) in the repeated assessment condition (16.49%) than the minimal assessment condition (8.55%).

CONCLUSIONS

Repeated assessment did not elicit changes in alcohol use, negative consequences, or perceived norms. A minimal assessment control condition may not be necessary when assessing intervention efficacy across longitudinal follow-ups. However, when attrition at 12-month follow-up is a salient concern, a minimal assessment control may retain more participants than repeated assessment.

Simultaneous Alcohol and Marijuana Use Among Young Adults: A Scoping Review of Prevalence, Patterns, Psychosocial Correlates, and Consequences

BACKGROUND

Alcohol and marijuana are commonly used by young adults, and use of both substances, particularly at the same time, is prevalent among this population. Understanding the prevalence, patterns, correlates, and consequences of simultaneous alcohol and marijuana (SAM) use is important to inform interventions. However, this literature is complicated by myriad terms used to describe SAM use, including use with overlapping effects and same-day co-use.

OBJECTIVES

This scoping review identifies and describes the peer-reviewed literature focused on SAM use by young adults and distinguishes simultaneous use from same-day co-use of alcohol and marijuana. This review also provides a narrative summary of the prevalence of SAM use, patterns of SAM and other substance use, psychosocial correlates, and consequences of SAM use.

ELIGIBILITY CRITERIA

This review is limited to papers written in English and published in peer-reviewed journals between January 2000 and August 2021. It includes papers assessing simultaneous use or same-day co-use of alcohol and marijuana among young adults ages 18 to 30. Review papers, qualitative interviews, experimental lab studies, policy work, toxicology or medical reports, and papers focused on neurological outcomes are excluded.

SOURCES OF EVIDENCE

PubMed, PsycINFO, and Web of Science databases were searched. Databases were selected and the search strategy developed in consultation with an information specialist.

CHARTING METHODS

A data charting form was utilized to specify which information would be extracted from included papers. Eight categories of data were extracted: (1) research questions and hypotheses; (2) sample characteristics; (3) study procedures; (4) definition of SAM use; (5) prevalence of SAM use; (6) patterns of SAM and other substance use; (7) psychosocial correlates of SAM use; and (8) consequences of SAM use.

RESULTS

A total of 1,282 papers were identified through initial search terms. Through double-blind title/abstract screening and full-text review, the review was narrowed to 74 papers that met review inclusion criteria. Review of these papers demonstrated that SAM use was prevalent among young adults, particularly among those who reported heavier quantities and more frequent use of alcohol and marijuana. Enhancement-related motives for use were consistently positively associated with SAM use. SAM use was associated with greater perceived positive and negative consequences of alcohol and/or marijuana use. Inconsistencies in prevalence, patterns, correlates, and consequences were found between studies, which may be due to large variations in measurement of SAM use, populations studied, methodological design (e.g., cross-sectional vs. intensive longitudinal), and the covariates included in models.

CONCLUSIONS

The literature on simultaneous use and same-day co-use of alcohol and marijuana has expanded rapidly. Of the 74 included papers (61 on SAM use; 13 on same-day co-use), 60 papers (47 on SAM use; 13 on same-day co-use) were published within the last 5 years. Future research focusing on the ways in which SAM use confers acute risk, above and beyond the risks associated with separate consumption of alcohol and marijuana, is needed for understanding potential targets for intervention.

Effects of within- and between-person assessments of alcohol expectancies and valuations on use and consequences moderated by sex

BACKGROUND

Alcohol expectancies (AE; beliefs about the likelihood of outcomes) and valuations (beliefs about the desirability of outcomes) may help explain alcohol use by young adults. However, it remains unclear how variability in AE and valuations over time are related to alcohol-related outcomes, and whether these associations are moderated by sex. The current study addressed these gaps in knowledge by examining within-person variability among positive and negative AEs, valuations, and alcohol-related outcomes over a 12-month period.

METHODS

Data were collected from 433 college students (M_age  = 20.06; 59.81% women) who completed surveys at 4 timepoints: at baseline and 3-month, 6-month, and 12-month follow-up.

RESULTS

We found substantial within-person variability in both AE and valuations (intraclass correlation coefficients ranged from 50% to 66%), and differences in variability by sex, with women showing more variability than men. Multilevel models revealed that weekly drinking was significantly higher at timepoints in which participants held relatively greater AE for sociability, sexuality, and risk/aggression, but lower when participants expected greater effects on self-perception. Weekly drinking was also higher when participants reported more favorable valuation of risk/aggression. Participants experienced significantly more negative consequences at timepoints in which they held relatively greater AE for sexuality and self-perception. No AEs were associated with a reduced likelihood of negative consequences. Participants experienced more negative consequences at timepoints in which they reported more favorable valuation of self-perception No valuations were associated with fewer consequences. Several between- and within-person associations were moderated by sex.

CONCLUSIONS

These findings suggest that AE and valuations are dynamic, that young adults' beliefs about the effects of alcohol varied over time, and that both negative and positive AE and valuations may be important correlates of alcohol use and consequences. These findings have implications for interventions designed to challenge expectancies and valuations with the goal of reducing alcohol use and associated consequences.

Evaluation of the psychometric properties of the cannabis use disorders identification test - revised among college students

OBJECTIVE

Cannabis use is common among college students and is associated with a variety of negative consequences. The Cannabis Use Disorders Identification Test Revised (CUDIT-R) is an 8-item screening instrument designed to identify potentially problematic or harmful recent cannabis use. The purpose of the current study was to evaluate the internal consistency and validity of the CUDIT-R in a sample of college students who reported recent cannabis use (past 30 day).

METHODS

Participants (n = 229) completed the CUDIT-R and measures of smoking behavior (Daily Smoking Questionnaire; DSQ), cannabis related consequences (Marijuana Problem Index; MPI), and problematic cannabis use (self-reported DSM-5 Cannabis Use Disorder Criteria).

RESULTS

The CUDIT-R showed good internal consistency and concurrent validity with cannabis related outcome measures including; frequency of use, cannabis related consequences, and total DSM-5 criteria endorsed. The CUDIT-R also showed evidence of discriminant validity across DSM-5 severity classifications, achieved high levels of sensitivity (0.929) and specificity (0.704), and excellent area under the receiver operating characteristics curve when using a cutoff score of six. All items displayed high levels of discrimination and varied in terms of difficulty and information provided.

CONCLUSIONS

Overall, the CUDIT-R appears to be a reliable and valid screening measure when used to identify college students at risk for cannabis related problems. Future research should further evaluate the sensitivity and specificity of the CUDIT-R threshold scores with more rigorously established DSM-5 diagnoses, and across a range of populations. Research on the utility of using the CUDIT-R for measuring treatment outcomes is also warranted.

Differential Role of Cannabis Use Motives in Predicting Impairment Across Three Measures

OBJECTIVE

Previous research has demonstrated the utility of motivational models of cannabis use to predict the frequency of use and associated negative consequences. However, few existing studies have simultaneously investigated a range of motives across different measures of use-related problems, which limit the ability to assess the differential role various motives play. The purpose of the current study was to examine cannabis use motives as predictors of three measures of cannabis use risk.

METHOD

Participants (N = 229) who reported cannabis use within the past 30 days completed the Marijuana Motives Measures, as well as measures of typical smoking behavior and risk: Cannabis Use Disorders Identification Test-R (CUDIT-R; screening measure of hazardous cannabis use), Marijuana Problem Index (MPI; measure of broad psychosocial problems), and cannabis use disorder according to criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).

RESULTS

Cannabis use motives-particularly coping, enhancement, and conformity-contributed to the prediction of cannabis-related impairment beyond gender and the frequency of recent use. Among the motives scales, coping emerged as the most robust predictor across the three impairment measures and was the only motive to add unique variance to predictions of DSM-5 symptoms. Enhancement and conformity motives were predictive of the screening measure (CUDIT-R scores), and enhancement motives was also predictive of a measure of broad psychosocial problems related to cannabis use (MPI scores).

CONCLUSIONS

The results highlight the differential role various marijuana use motives play across related but distinct measures of impairment.

Criminogenic Needs, Substance Use, and Offending among Rural Stimulant Users

There is a need to understand the determinants of both substance use and criminal activity in rural areas in order to design appropriate treatment interventions for these linked problems. The present study drew on a predominant model used to assess and treat offenders -- the Risk-Need-Responsivity (RNR) model -- to examine risk factors for substance use and criminal activity in a rural drug using sample. This study extends the RNR model's focus on offenders to assessing rural-dwelling individuals using stimulants (N=462). We examined substance use and criminal justice outcomes at 6-month (91%) and 3-year (79%) follow-ups, and used Generalized Estimating Equations to examine the extent to which RNR criminogenic need factors at baseline predicted outcomes at follow-ups. Substance use and criminal justice outcomes improved at six months, and even more at three years, post-baseline. As expected, higher risk was associated with poorer outcomes. Antisocial personality patterns and procriminal attitudes at baseline predicted poorer legal and drug outcomes measured at subsequent follow-ups. In contrast, less connection to antisocial others and fewer work difficulties predicted lower alcohol problem severity, but more frequent alcohol use. Engagement in social-recreational activities was associated with fewer subsequent arrests and less severe alcohol and drug problems. The RNR model's criminogenic need factors predicted drug use and crime-related outcomes among rural residents. Services adapted to rural settings that target these factors, such as telehealth and other technology-based resources, may hasten improvement on both types of outcomes among drug users.

A systematic review of the free-pour assessment: Implications for research, assessment and intervention

Excessive alcohol consumption is a major concern. Alcohol consumption data are typically collected via self-report questionnaires. However, research has suggested that individuals are unable to identify a standard drink size and that their self-report may be influenced by certain environmental conditions, calling into question the reliability and validity of self-report. The free-pour is an objective measure that may provide a clearer picture of current alcohol consumption trends, individuals' knowledge of standard drink sizes, and accuracy of self-report. This systematic review of existing free-pour assessment methods suggests that individuals are unable to identify and pour standard drink sizes, with the largest discrepancies occurring for liquor and wine pours and pours into larger and wider glasses. Additional variables that appear to influence pouring behavior are gender, pouring location (e.g., home or laboratory), pouring task (e.g., selecting a line or physically pouring), and drinking history; however, additional research is necessary to better understand the effects of these variables on pouring behavior. These findings have important implications for the accuracy of self-report measures, as well as clinical implications for alcohol use screenings, alcohol education courses, and brief interventions for alcohol use. The systematic review concludes with recommendations for practical applications and future research of the free-pour assessment. (PsycINFO Database Record

Pour Convergence: College Students' Definitions and Free-Poured Volumes of Standard Alcohol Servings

We examined the correspondence between college students' ( N = 192, 71% women) definitions of free-pours and their free-poured volumes of beer, wine, and liquor. Participants' mean beer definitions and free-pours were positively correlated; participants' mean wine and liquor definitions were larger than their free-pours, which were fairly accurate. Contrary to what the aggregate mean values indicated, fewer than half of the participants accurately free-poured a standard volume of beer, wine, or liquor (37.4%, 35.1%, and 22.2%, respectively) or provided an accurate definition of beer (45.8%); similar to the aggregate data, few participants provided accurate definitions of standard serving of wine (12.2%) or liquor (12.8%) Instead, a majority of participants' definitions and free-pours were well over or under a standard serving. For all three types of alcohol, there was little correspondence between each individual participant's definitions and his or her free-poured volumes. These data suggest analyses of individual data points may provide information important for data collection, prevention, and intervention strategies.

Patient, Program, and System Barriers and Facilitators to Detoxification Services in the U.S. Veterans Health Administration: A Qualitative Study of Provider Perspectives

BACKGROUND

Because substance use disorder (SUD) treatment is expanding, and detoxification (detox) is often the entry point to SUD treatment, it is critical to provide ready access to detox services.

OBJECTIVES

The purpose of the current study was to examine patient, program, and system barriers or facilitators to detox access within an integrated health care system with variable rates of detox utilization across facilities.

METHODS

Inpatient and outpatient providers from 31 different U.S. Veterans Health Administration detox programs were interviewed.

RESULTS

Qualitative analyses identified six facilitators and 11 barriers to detox access. Facilitators included program staff and program characteristics such as encouragement and immediate access, as well as systemic cooperation and patient circumstances. Barriers to detox included programmatic and systemic problems, including lack of available detox services, program rules or admission requirements, funding shortages, stigma related to a SUD diagnosis or receiving detox services, and a deficiency of education and training. Other major barriers pertained to patients' lack of motivation and competing responsibilities.

CONCLUSIONS/IMPORTANCE

To improve detox access, health care settings should consider enhancing supportive relationships by emphasizing outreach, engagement, and rapport-building with patients, improving systemic communication and teamwork, educating patients on available detox services and the detox process, and addressing patient centered barriers such as resistance to detox or competing responsibilities. In addition, programs should consider open-door and immediate-admission policies. These approaches may improve detox access, which is important for increasing the likelihood of transitioning patients to SUD treatment, thus improving outcomes and reducing utilization of high-cost services.

Transitioning From Detoxification to Substance Use Disorder Treatment: Facilitators and Barriers

Although successful transitions from detoxification to substance use disorder treatment are associated with improved outcomes, many detoxification patients do not initiate treatment. This qualitative study informs detoxification and addiction treatment providers, and health systems, about how to improve detoxification to treatment transitions, by reporting detoxification providers' views of transition facilitators and barriers. The sample consisted of 30 providers from 30 Veterans Health Administration detoxification programs. Themes regarding transition facilitators and barriers emerged at the patient, program (detoxification programs, and addiction programs), and system levels. Detoxification program-level practices of discharge planning, patient education, and rapport building were reported as facilitating the transition to treatment. Six themes captured transition facilitators within addiction treatment programs: the provision of evidence-based practices, patient-centered care, care coordination, aftercare, convenience, and a well-trained and professional staff. This study expands previous literature on detoxification and addiction treatment by systematically and qualitatively examining factors that promote and hinder treatment initiation after inpatient and outpatient detoxification, from a provider perspective, in an era of health care reform and expanded substance use disorder treatment.

Retention in medication-assisted treatment for opiate dependence: A systematic review

Retention in medication-assisted treatment among opiate-dependent patients is associated with better outcomes. This systematic review (55 articles, 2010-2014) found wide variability in retention rates (i.e., 19%-94% at 3-month, 46%-92% at 4-month, 3%-88% at 6-month, and 37%-91% at 12-month follow-ups in randomized controlled trials), and identified medication and behavioral therapy factors associated with retention. As expected, patients who received naltrexone or buprenorphine had better retention rates than patients who received a placebo or no medication. Consistent with prior research, methadone was associated with better retention than buprenorphine/naloxone. And, heroin-assisted treatment was associated with better retention than methadone among treatment-refractory patients. Only a single study examined retention in medication-assisted treatment for longer than 1 year, and studies of behavioral therapies may have lacked statistical power; thus, studies with longer-term follow-ups and larger samples are needed. Contingency management showed promise to increase retention, but other behavioral therapies to increase retention, such as supervision of medication consumption, or additional counseling, education, or support, failed to find differences between intervention and control conditions. Promising behavioral therapies to increase retention have yet to be identified.

Criminal typology of veterans entering substance abuse treatment

Criminal justice involvement among veterans is a critical and timely concern, yet little is known about criminal histories and clinical characteristics among veterans seeking treatment for substance use disorders (SUDs). The present study examined criminal typology, clinical characteristics, treatment utilization, and 12-step mutual-help group (MHG) participation among veterans (N = 332) at intake to SUD treatment at the Department of Veterans Affairs (VA), and 6 months and 1 year post-intake. Cluster analysis yielded three types of criminal histories mild-(78.9%), moderate (13.6%), and severe (7.5%)-distinguished by type of offense, number of convictions, and number of months incarcerated. At intake, participants with mild criminal histories reported more alcohol problems and fewer legal and employment problems than participants with moderate and severe criminal histories. Participants with severe criminal histories were most likely to attend a 12-step MHG meeting in the year post-intake, but all groups had high attendance. When only participants who had attended at least one meeting in the year post-intake were compared, participants with mild criminal histories worked more steps and were more involved in 12-step practices. All groups improved between baseline and follow-up and did not differ at follow-ups on substance use or other clinical outcomes. Multiple regressions identified treatment utilization and MHG attendance, but not baseline criminal history, as significant predictors of improved substance use problem severity at follow-up. Outpatient treatment and 12-step MHG attendance appear to be important components of recovery for veterans with varying criminal histories. Clinicians in SUD treatment programs should screen for criminal histories at treatment intake to ensure appropriate treatment planning.

The influence of gender and age on Halstead-Reitan neuropsychological test performance

Age-cohort differences for seven tests from the Halstead-Reitan Neuropsychological Battery, for overall performance on the Impairment Index, and for a multivariate composite of the seven scores, were examined for 427 subjects falling into six age groups (15-24, 25-34, 35-44, 45-54, 55-64, and 65 years and over). Univariate and multivariate-discriminant analyses were performed. Poorer performance was observed across age-cohorts (linear trend) for all tests and the Impairment Index. A very modest Age-Cohort (linear trend) x Gender interaction was observed only for the Category Test. Decline in Category Test performance across age-cohorts was more pronounced for women than for men. For women, the best discrimination among age groups was observed for the Category Test. For men, Tactile Performance Localization Test discriminated best. The poorest discrimination among age groups was seen for Finger-Tapping for men and Tactile Performance Test--Total (time score) for women. Results were consistent with a model of specific nested within general decline. Although linear-trend across age groups was observed for all tests, the strongest discriminations were associated with neuropsychological tests of abstraction and complex problem-solving performance.

Young and old adults' ability to use different standards to evaluate understanding

In Experiment 1 we examined young (mean age = 22.88 years) and old (mean age = 70.79 years) adults' ability to evaluate their understanding of texts. We examined ability to detect nonsense words (a lexical standard), violations of prior knowledge (an external consistency standard), and inconsistent sentences (an internal consistency standard) that were nonadjacent in texts. Adults with more education detected more problems than less educated adults, and older adults were less able than young to use an internal consistency standard. No age differences were found for lexical and external consistency standards. In Experiment 2, older adults' (mean age = 71.02 years) ability to use an internal consistency standard of evaluation was affected by the amount of material intervening between inconsistent sentences, with hindered performance for nonadjacent inconsistencies. This was not true for younger adults (mean age = 22.59 years). Results are discussed in terms of older adults' possible retrieval difficulty and failure to regulate comprehension.

Is blood pressure an important variable in research on aging and neuropsychological test performance?

Regression analyses using Blood Pressure, Age, and the multiplicative effect of Blood Pressure and Age as predictors of performance (on selected tests from the Halstead-Reitan neuropsychological test battery) were done. Three hypotheses were tested with subjects ranging in age from 20 to 72 years of age: (1) blood pressure values predict neuropsychological test performance over a wide range of hypertensive and normotensive blood pressure values; (2) blood pressure predicts performance within the narrower range of normal and borderline values; (3) blood pressure X age interactions, when observed over this age and education range, are such that negative blood pressure effects on performance are larger for younger than older subjects. Regression analyses confirmed each of these hypotheses and indicated that strength of prediction was not reduced when participants free from hypertension-related complications and medication were tested. Blood pressure X age interactions were seen for Trailmaking-B Test and the Tactile Performance Test-Localization for the primary sample. However, only Blood Pressure main effects were observed for the Average Impairment Rating, the Categories Test, TPT-Memory and TPT-Localization when age, sex, and education were controlled. Implications of these findings for the role of blood pressure in aging research and for longitudinal studies with subjects free from the need for treatment with antihypertensive medications are discussed.

A longitudinal study of the performance of hypertensive and normotensive subjects on the Wechsler Adult Intelligence Scale

Performance on the Wechsler Adult Intelligence Scale was followed over two 5- to 6-year intervals for essential hypertensive Ss (EH; n = 22) free from medical complications and for normotensive Ss (N; n = 20). EH were treated with adrenergic beta-blocking drugs, diuretics, or both. Mean age was 46 years (SD = 12.6 years), initially (Time 1). Results were unaltered by adjustment for initial age. N improved modestly on the Verbal scale, from Time 1 to Time 2 only. EH neither improved nor declined on the Verbal scale. Scores remained unchanged for both EH and N Ss for the Performance scale. Overall, and at Times 2 and 3, Verbal scores were lower for the EH group. It was concluded that neither decline nor improvement in cognitive function over time are necessary outcomes of modest, carefully treated, uncomplicated hypertension in the middle years.

Validity of a short form of the category test in relation to age, education, and gender

Data for 289 subjects participating in an ongoing study of neuropsychological test performance were used to evaluate the relationship between age and prediction of performance on the long form of the Halstead-Reitan Category Test (CAT) from a short form developed by Calsyn, O'Leary, and Chaney (1980). The major questions were whether: (a) age, education, or gender would add to prediction of long (Y) from short form scores (X); (b) regression equations would be different for older and younger groups; (c) percent variance accounted for in long form scores by short form scores would be larger for younger as opposed to older subjects. For these relatively healthy subjects, prediction based on the short form was not enhanced in a clinically significantly manner by adding age, education, and gender as predictors. Regression equations for older and younger groups differed in intercept values but not in slopes. Percent variance accounted for in long form scores from short form scores did not differ when separate equations were used for younger and older subjects.

A longitudinal study of the performance of hypertensive and normotensive subjects on the Wechsler Adult Intelligence Scale

Performance on the Wechsler Adult Intelligence Scale was followed over two 5- to 6-year intervals for essential hypertensive Ss (EH; n = 22) free from medical complications and for normotensive Ss (N; n = 20). EH were treated with adrenergic beta-blocking drugs, diuretics, or both. Mean age was 46 years (SD = 12.6 years), initially (Time 1). Results were unaltered by adjustment for initial age. N improved modestly on the Verbal scale, from Time 1 to Time 2 only. EH neither improved nor declined on the Verbal scale. Scores remained unchanged for both EH and N Ss for the Performance scale. Overall, and at Times 2 and 3, Verbal scores were lower for the EH group. It was concluded that neither decline nor improvement in cognitive function over time are necessary outcomes of modest, carefully treated, uncomplicated hypertension in the middle years.

A longitudinal study of neuropsychological performance by hypertensives and normotensives: a third measurement point

The neuropsychological test performance of hypertensive and normotensive subjects was compared at three times of measurement over a 10-year period. The tests used were among those that are most sensitive to brain impairment in the Halstead-Reitan battery. In addition to individual test measures, a widely used clinical index of battery-wide performance--the Average Impairment Rating (AIR)--was used. Hypertensives exhibited lower mean levels of performance on the AIR at all times of measurement. However, the Blood Pressure Group x Time of Measurement interactions were not statistically significant, indicating that hypertensives and normotensives did not exhibit a differential rate of change (decline or improvement) over time. Hypertensives also performed more poorly for a measure of learning set formation (categories test) and two tests of memory for forms experienced by touch only (tactile perception memory and localization tests). However, Blood Pressure x Time of Measurement interactions were not observed for these measures.

Clinical significance of cognitive performance by hypertensive patients

Fifty-four subjects with uncomplicated essential hypertension and 54 normotensive subjects were compared with regard to a widely employed clinical index of cognitive dysfunction (the Average Impairment Rating) calculated from neuropsychological tests that discriminate between brain-damaged and neurologically normal persons. Hypertensive subjects exhibited lower mean scores on this index when education was ignored, but results were not the same for highly educated and less well educated groups. There were no differences between exceptionally well educated hypertensive and normotensive subjects, but in the less well educated group, hypertensive subjects performed more poorly than normotensive subjects. The percentages of hypertensive and normotensive subjects scoring in a cognitively impaired range on the Average Impairment Rating were low and did not differ for either education group. These data indicate the important role of subtle differences in education level with respect to positive or negative findings for studies comparing hypertensive and normotensive subjects and illustrate the important role of clinical neuropsychological indices of cognitive dysfunction when one wishes to make meaningful inferences regarding cerebral cortical function in hypertensive subjects.

A longitudinal study of neuropsychological test performance for hypertensive and normotensive adults: initial findings

This study was designed to compare changes in performance on selected measures from the Halstead-Reitan neuropsychological test battery over a 5 to 6 year interval for normotensive and medically treated, uncomplicated essential hypertensive adults. Mean performance level was poorer for hypertensive than for normotensive groups on an average impairment index and a number of the individual impairment rating scores, but no Time of measurement X Blood pressure interactions were observed. There was no evidence of improvement or decline for normotensive or hypertensive adults and no evidence suggesting that the hypertensive group could be characterized as "cognitively impaired" in an absolute or clinical sense.

A longitudinal comparison of hypertensives and normotensives on the Wechsler Adult Intelligence Scale: initial findings

This study was designed to compare changes in performance on the Wechsler Adult Intelligence Scale over a 5- to 6-year test interval for normotensives and medically treated, uncomplicated essential hypertensives. The results indicated that normotensives improved from Time 1 to Time 2 on the Verbal scale but not on the Performance scale. Hypertensives exhibited no significant improvement or decline on either scale, although they performed less well on the Verbal scale at Time 2 than did normotensives. They also performed more poorly on the Performance scale when Time 1 and Time 2 scores were averaged. Participants who returned for Time 2 testing and those who participated only at Time 1 were compared. Verbal scaled scores at Time 1 were higher for returning than for nonreturning hypertensives, but, for normotensives, no differences were observed for those who returned for Time 2 testing and those who did not.

WAIS performance for different age groups of hypertensive and control subjects during the administration of a diuretic

This study examined the effects of age and hypertension on WAIS performance. Previous studies have reported that hypertension adversely affects cognitive functioning, but few have considered the influence of hypertension on discrete age groups. Hypertension was found to be negatively associated with WAIS Verbal scores for younger (21 to 39 years) but not older (45 to 65 years) subjects. Further, younger subjects attained higher WAIS Performance scores than did older subjects. Medication history was not associated with performance levels for hypertensives, nor was performance of controls influenced by whether or not they were tested while on a diuretic. When WAIS Performance scores were analyzed for subjects matched on WAIS Verbal scores across age (21 to 39 vs 45 to 65 years) and blood pressure (normotensive vs hypertensive), a significant age by blood pressure interaction was found. The effect of blood pressure on Performance scores was found to be greater for younger than for older subjects. The association between plasma renin activity (PRA) level and WAIS Performance scores was also examined. Contrary to previous findings PRA was not related to Performance scores. The results are discussed in the context of previous hypertension research and their implications for comparisons across age levels.

Anxiety and depression in young and middle aged hypertensive and normotensive subjects

This study examined the effects of essential hypertension on measures of anxiety and depression for two age groups of hypertensive (free from hypertension-related pathology and/or cardiovascular disease) and normotensive subjects. Hypertensive subjects had significantly higher State Anxiety scores and Zung Depression scores than did normotensive subjects. These differences between the blood pressure groups were due largely to the scores of the younger hypertensive subjects. The results of the present study are consistent with previous results from our laboratory that have found that younger hypertensives differed (relative to controls) from middle aged hypertensives on measures, such as, symptoms reported on the Cornell Medical Index and WAIS Performance scores. The results of the present study were discussed within the context of age associated differences in response to hypertension and factors that might account for these differences.

Symptoms reported on the Cornell Medical Index in relationship to hypertension and age

This study compared young and old hypertensive and normotensive subjects with respect to the number of symptoms reported on the Cornell Medical Index (CMI). The hypertensive subjects had more physical and psychological complaints than did the normotensive subjects. Differences in symptoms reported between the blood pressure groups were not concentrated in one specific category (e.g., cardiovascular) but were distributed over several categories. Age did not influence the number of symptoms reported for either blood pressure group. The results were discussed in the context of the lack of specificity of symptoms reported by hypertensive subjects, and to what extent reported symptoms on the CMI are influenced by knowledge of one's blood pressure status.

Feedback effects on spatial egocentrism in old age

In literature on egocentrism, a decline in the ability to decenter with advanced age is indicated. In the present study, the extent to which perspective-taking feedback and practice reduce the egocentric performance of elderly individuals was examined. Eighteen men (X = 68.9 years, sd. = 7.14) and 18 women (X x 72.4 years, sd. = 3.65) were each assigned to one of three treatment conditions: feedback, practice, or control. Either immediately or 2 weeks after training, subjects were post-tested on measures of spatial egocentrism, fluid intelligence, perceptual speed, and volume conservation. The effect of perspective-taking feedback was to improve scores on the spatial egocentrism task, but this influence did not directly generalize to the other ability measures. Emphasis was placed on the importance of enviromental/experiential variables in the acquistion and maintenance of cognitive abilities in old age.