Variants of the P3 event-related potential operate as indicators of distinct mechanisms contributing to problematic alcohol use.

Considerable research has linked relative reduction in the amplitude of the P3 event-related potential (ERP) during cognitive task performance (i.e., Target-P3) with increased risk of alcohol-related problems. A separate literature indicates that a relative increase in the amplitude of the P3 elicited by cues signaling alcohol availability (i.e., ACR-P3) also is associated with alcohol use and problems. To date, no research has integrated these seemingly discrepant findings. Here, we aimed to demonstrate that P3 amplitudes elicited in different task contexts reflect distinct domains of functioning relevant to problematic alcohol involvement (PAI), and therefore can inform heterogeneity in the etiology of PAI. 156 emerging adults (61% women; 88% White/Non-Hispanic) completed a mental rotation task and a picture-viewing task while ERPs were recorded. Participants also completed questionnaire measures of trait disinhibition, alcohol use, and alcohol-related problems. Findings from regression analyses indicated that (a) Target-P3 was negatively associated and ACR-P3 was positively associated with a PAI latent variable; (b) the two P3s accounted for unique variance in PAI, beyond that accounted for by recent drinking; and (c) the association between Target-P3 and PAI-but not ACR-P3 and PAI-was statistically mediated by trait disinhibition. The present findings highlight the unique contributions of distinct functional domains associated with disinhibition and incentive salience in the etiology of PAI. Moreover, findings are consistent with a nuanced understanding of the P3 ERP, whereby its specific meaning varies according to the task context in which it is elicited.

Daily Associations Between Injunctive Drinking Norms and Alcohol Consumption.

OBJECTIVE: Perception of others' approval of alcohol use (i.e., injunctive drinking norms) is strongly predictive of alcohol use, particularly among young adults (Krieger et al., 2016). While between-person injunctive norms predict alcohol use (Neighbors et al., 2008), there is evidence of within-person fluctuations in the relationship between norms and drinking (Graupensperger et al., 2021). The current study used ecological momentary assessment (EMA) to test within-person, day-level associations between injunctive norms and alcohol use, and to test whether social context moderated this association. METHOD: Participants (n=83, M age=24.0, 50.9% female) completed a two-week EMA protocol using a smartphone application. Injunctive norms, social context (type and gender of companions), and number of drinks consumed were assessed each morning following a drinking event. Multilevel models with repeated measures nested within participants tested main effects and interactions of between- and within-person injunctive norms, type of drinking companions, and gender of drinking companions on number of drinks consumed. RESULTS: Day-level injunctive norms were positively associated with drinking quantity over and above baseline norms. The effect of norms differed by social context such that norms were only positively related to drinking quantity when drinking with a friend or romantic partner (vs. drinking alone). Gender of friends with whom participants drank did not moderate the effect of norms on quantity. CONCLUSIONS: This study provides one of the first examinations of daily fluctuations in injunctive drinking norms. As norms represent a malleable target for intervention (White et al., 2019), results offer new information regarding possible intervention targets.

Development and Initial Validation of a Momentary Cannabis Craving Scale Within a Homogeneous Sample of U.S. Emerging Adults.

Given the popularity and ease of single-item craving assessments, we developed a multi-item measure and compared it to common single-item assessments in an ecological momentary assessment (EMA) context. Two weeks of EMA data were collected from 48 emerging adults (56.25% female, 85.42% White) who frequently used cannabis. Eight craving items were administered, and multilevel factor analyses were used to identify the best fitting model. The resulting scale's factors represented purposefulness/general desire and emotionality/negative affect craving. Convergent validity was examined using measures of craving, cannabis use disorder symptoms, frequency of use, cannabis cue reactivity, cannabis use, negative affect, and impulsivity. The scale factors were associated with cue-reactivity craving, negative affect, impulsivity, and subfactors of existing craving measures. For researchers interested in using a single item to capture craving, one item performed particularly well. However, the new scale may provide a more nuanced assessment of mechanisms underlying craving.

The association of histopathologic features after neoadjuvant chemo-immunotherapy with clinical outcome: Sub-analyses from the randomized double-blinded, placebo-controlled, Phase III IMagyn050/GOG3015/ENGOT-ov39 study.

OBJECTIVE: Histopathologic characteristics after neoadjuvant chemotherapy (NACT) may correlate with outcome. This study evaluates histopathologic features after immunotherapy and NACT/bevacizumab, and associated clinical outcomes. METHODS: Evaluable tissue from IMagyn050/GOG3015/ENGOT-ov39 patients from prespecified anatomic sites from interval cytoreductive surgery (ICS) after NACT/bevacizumab plus atezolizumab/placebo underwent central histopathologic scoring and analyzed with clinical outcomes. RESULTS: The predefined population had 243 evaluable NACT patients, with 48.1% tumors being PD-L1-positive. No statistically significant differences in PFS (16.9 months vs. 19.2 months, p = 0.21) or OS (41.5 months vs. 45.1 months, p = 0.67) between treatment arms were seen. Substantial residual tumor (RT) (3+) was identified in 26% atezolizumab vs. 24% placebo arms (p = 0.94). Most showed no (1+) necrosis (82% vs. 96%, respectively, p = 0.69), moderate (2+) to severe (3+) fibrosis (71% vs. 75%, respectively, p = 0.82), and extensive (2+) inflammation (53% vs. 47% respectively, p = 0.48). No significant histopathologic differences were identified by tissue site or by arm. Multivariate analyses showed increased risk for progression with moderate and substantial RT (13.6 mon vs. 21.1 mon, hazard ratio 2.0, p < 0.01; 13.6 mon vs. 21.1 mon, HR 1.9, p < 0.01, respectively); but decreased risk for death with extensive inflammation (46.9 mon vs. 36.3 mon, HR 0.65, p = 0.02). Inflammation also correlated with greater likelihood of response to NACT/bevacizumab plus immunotherapy (odds ratio 2.9, p < 0.01). Modeling showed inflammation as a consistent but modest predictor for OS. CONCLUSIONS: Detailed histologic assessment of ICS specimens appear to identify characteristics, such as inflammation and residual tumor, that may provide insight to certain clinical outcomes. Future work potentially leveraging emerging tools may provide further insight into outcomes.

Non-alcoholic beverage consumption among US adults who consume alcohol.

BACKGROUND AND AIMS: Non-alcoholic beverages (NABs) that mimic alcohol without inducing intoxication, such as non-alcoholic beers, non-alcoholic wines and spirit-free drinks, are increasing in popularity. It is unknown whether NABs help to mitigate or stimulate alcohol use. The present study aimed to describe NAB consumption practices among US adults consuming alcohol, characterize who is likely to consume NABs and examine whether NAB use influences desire for and perceived consumption of alcohol. DESIGN AND PARTICIPANTS: The survey study used data collected June-July 2023 from an on-line convenience sample. The first survey (n = 1906) assessed frequency of NAB consumption among US adults who consume alcohol. A second more detailed survey on use patterns was conducted with 466 respondents who reported past-year NAB consumption, of whom 153 (32.83%) screened positive on the CAGE questionnaire for alcohol use disorder (AUD). SETTING: This study took place in the United States. MEASUREMENTS: NAB consumption measures included type of NAB consumed, frequency, quantity, first consumption age, consumption reasons, consumption contexts and perceived effect on desire for and consumption of alcohol. Alcohol use measures included frequency, quantity and first consumption age. FINDINGS: Past-year NAB use was endorsed by 28.44% of respondents (61.70% ever used). Non-alcoholic liquor/'mocktails' were the most common NAB type consumed (83.69%). Compared with respondents without AUD, those who screened positive for AUD were significantly more likely to consume NABs in an effort to decrease or abstain from drinking alcohol [adjusted odds ratio (AOR) = 3.54, 95% confidence interval (CI) = 2.24-5.58] and 67.97% endorsed less alcohol consumption (3.23% endorsed more) due to their NAB use. NAB consumption frequency and quantity were significantly positively predicted by alcohol consumption frequency (AOR = 1.46, 95% CI = 1.17-1.83) and quantity (ß = 0.25, 95% CI = 0.15-0.35), respectively. CONCLUSION: Adults who consume alcohol and screen positive for alcohol use disorder report drinking non-alcoholic beverages as a harm reduction strategy.

Using mobile technology to influence alcohol-impaired driving risk perceptions and decisions.

OBJECTIVE: Despite significant individual and societal risk, alcohol-impaired driving (AID) remains prevalent in the United States. Our aim was to determine whether breathalyzer-cued warning messages administered via mobile devices in the natural drinking environment could influence real-world AID cognitions and behaviors. METHOD: One hundred twenty young adults (53% women; mean age = 24.7) completed 6 weeks of ecological momentary assessment (EMA) and provided breathalyzer samples using a BACtrack Mobile Pro linked to their mobile device. On mornings after drinking episodes, participants reported their driving activities from the previous evening (787 episodes). Participants were randomly assigned to receive warning messages if they reached a breath alcohol concentration (BrAC) ≥ .05, or no messages. Participants in the warnings condition reported their willingness to drive and perceived danger of driving at EMA prompts (1,541 reports). RESULTS: We observed a significant effect of condition, such that the association between cumulative AID engagement and driving after reaching a BrAC of .05 was dampened among individuals in the warnings condition, compared to those in the no warnings condition. Receiving a warning message was associated with increased momentary perceived danger of driving and decreased willingness to drive. CONCLUSIONS: We found that BrAC-cued warning messages reduced the probability of AID and willingness to drive while impaired, and increased the perceived danger of driving after drinking. These results serve as proof-of-concept for the use of mobile technology to deliver an adaptive just-in-time intervention to reduce the probability of AID. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Sleep and circadian influences on blood alcohol concentration.

STUDY OBJECTIVES: Anecdotally, adults reach higher levels of subjective intoxication on days they are fatigued or sleep-deprived, but sleep is not typically discussed as a predictor of blood alcohol concentration (BAC) in clinical settings. To inform clinical work and future research, this perspective reviews data examining the impact of sleep (process S) and circadian (process C) factors on indicators of BAC in humans and animal models. METHODS: Literature searches of medical and psychological databases were conducted to identify articles that manipulated sleep/circadian factors and reported effects on indicators of alcohol pharmacology (e.g. BAC, alcohol metabolism). RESULTS: Of the 86 full-text articles reviewed, 21 met inclusion criteria. Studies included manipulations of time of day, circadian phase (evidence for process C), and time in bed (evidence for process S). Evidence for time-of-day effects on alcohol pharmacology was most compelling. Studies also provided evidence for circadian phase effects, but failed to find support for time-in-bed effects. Although results were not uniform across studies, most evidence from human and animal models indicates that peak BACs occur toward the beginning of the biological day, with some studies indicating slower alcohol elimination rates at this time. CONCLUSIONS: Circadian factors likely influence alcohol pharmacokinetics, perhaps due to altered elimination of alcohol from the body. This means that individuals may reach higher BACs if they drink during the morning (when, for most people, circadian alerting is low) versus other times of the day. Alcohol prevention and intervention efforts should highlight sleep/circadian health as a potential contributor to alcohol-related harm.

Patient perceptions regarding alcohol use after bariatric surgery.

INTRODUCTION: Patients who have undergone bariatric surgery are at increased risk of an alcohol use disorder. Though patients understand this risk, the majority engage in post-surgical alcohol use. This suggests that education alone is not sufficient to reduce post-surgical drinking. To prevent development of post-surgical alcohol use disorders, we need better understanding of the reasons patients use alcohol following surgery. The purpose of this study was to identify factors associated with post-surgical alcohol use. METHOD: Patients (N = 20) who were 1-3 years post-bariatric surgery and were consuming alcohol at least twice monthly participated in a 60-min interview. Participants responded about their knowledge regarding risk of post-surgical alcohol use and reasons why patients may start drinking. Deductive and inductive coding were completed by two independent raters. RESULTS: Although nearly all participants were aware of the risks associated with post-surgical alcohol use, most believed that lifelong abstinence from alcohol was unrealistic. Common reasons identified for using alcohol after bariatric surgery included social gatherings, resuming pre-surgical use, and addiction transfer. Inductive coding identified three themes: participants consumed alcohol in different ways compared to prior to surgery; the effect of alcohol was substantially stronger than pre-surgery; and beliefs about why patients develop problematic alcohol use following surgery. CONCLUSION: Patients consume alcohol after bariatric surgery for a variety of reasons and they do not believe recommending abstinence is useful. Understanding patient perceptions can inform interventions to minimize alcohol use after bariatric surgery. Modifications to traditional alcohol relapse prevention strategies may provide a more robust solution to decreasing negative outcomes experienced by individuals undergoing bariatric surgery.

Using the Child Sheehan Disability Scale to Differentiate Severity Level in Youth With Anxiety Disorders and Obsessive Compulsive Disorder.

The current study extends the psychometric support for the Child Sheehan Disability Scale (CSDS) as a measure of impairment associated with childhood anxiety disorders, including obsessive compulsive disorder. The CSDS was completed by 1,481 predominately Caucasian youth (55.4% female) ages 8 to 17 (M = 12.68, SD = 2.78) from primarily two-parent households and a parent across community, outpatient, intensive outpatient treatment, and residential settings. The results replicated and extended the previously found strong convergent validity, discriminant validity, and treatment sensitivity with a revised parent-report item in the larger sample. Moreover, the CSDS successfully differentiated between patients receiving treatment of different levels of intensity. These data were used to develop preliminary qualitative descriptors associating individual scores with a likely level of indicated treatment to enhance the clinical applicability of the CSDS. This study establishes the CSDS as one of the briefest and most rigorously evaluated measures of impairment associated with child anxiety. However, the performance of the CSDS must be examined in more representative samples before being applied to diverse populations.

Alcohol demand as a predictor of drinking behavior in the natural environment.

BACKGROUND AND AIMS: Alcohol demand, a measure of alcohol's reinforcing value, is associated with greater alcohol consumption and alcohol-related problems. Although alcohol demand has primarily been evaluated as a 'trait-like', individual difference measure, recent evidence indicates that demand exhibits meaningful short-term fluctuations. We aimed to determine whether moment-to-moment fluctuations in alcohol demand in individuals' natural drinking environments predicted drinking occurrence, drinking continuation, and drinking quantity. DESIGN: Observational study. SETTING: Individuals' natural drinking environments in Columbia, Missouri, USA. PARTICIPANTS: Eighty-nine young adults (56% female; mean age = 24.8) participated from November 2018 to October 2020. Participants reported 14.5 drinking days [standard deviation (SD = 8.1)] and 4.1 drinks per occasion (SD = 2.5) during ecological momentary assessment (EMA). MEASUREMENTS: Participants completed the alcohol purchase task at baseline. Following this, participants reported on their alcohol demand (breakpoint, Omax , intensity) and drinking behavior during EMA at daily, timed prompts from 6 p.m. to 2 a.m. They provided breathalyzer samples using a BACtrack Mobile® Pro. Models tested concurrent and prospective (lagged) associations between alcohol demand and drinking occurrence and drinking continuation after drinking initiation. Additional models tested concurrent associations between demand and breath alcohol concentrations (BrACs). FINDINGS: Higher alcohol demand was associated with higher odds of drinking and continued drinking for all demand indices at the momentary [odds ratio (OR) = 1.27-1.56, ps ≤ 0.03] and day-level (OR = 2.14-3.39, ps < 0.001). Additionally, lagged demand predicted higher odds of drinking occurrence and continuation at the following prompt (OR = 1.32-1.53, ps ≤ 0.004). Higher alcohol demand was associated with higher BrACs at the momentary (bs = 0.0011-0.0026, ps ≤ 0.03) and day-level (bs = 0.0053-0.0062, ps < 0.001). At the person-level, findings varied depending on the demand measure. CONCLUSIONS: Alcohol demand appears to be associated with both when and how much individuals drink in their natural drinking environments. Elevations in alcohol demand appear to be associated with increased likelihood of drinking and continuing to drink, and greater total alcohol consumption, both within and across drinking days.

Comparing associations between mood and breath alcohol concentration in the laboratory and natural environment.

OBJECTIVE: Associations between mood and drinking are part of many theoretical models of problematic alcohol use. Laboratory and ecological momentary assessment (EMA) research on associations between mood and drinking behavior has produced mixed findings, and these constructs are often measured using different methods depending on research context. The present study compares associations between mood and alcohol consumption across research contexts (laboratory vs. daily life) and measurement methods (breathalyzer vs. self-report). METHOD: Forty-five young adults (53% women, Mage = 24.5) who drank moderate-to-heavy amounts completed an alcohol administration session and then 6 weeks of EMA with ambulatory breathalyzer samples. Participants reported their current mood (happy, nervous, upset, and excited) in both the laboratory and during EMA. Momentary, day, and person-level mood variables were examined in multilevel models predicting objective alcohol consumption [breath alcohol concentration (BrAC); lab and EMA] and subjective consumption (self-reported drinking occurrence and number of drinks; EMA). RESULTS: We identified discrepant mood-BrAC associations across laboratory and EMA contexts. Momentary excitement was negatively associated with BrAC in the lab, but positively associated with BrAC during EMA (ps < .01). We also identified discrepancies within EMA depending on the alcohol consumption measure used (BrAC or self-reported number of drinks) and the level of analysis (momentary or day). CONCLUSIONS: Studies testing theoretical models involving directional mood-alcohol associations (e.g., affective reinforcement models) need to carefully consider how research context and methods may influence findings of associations between mood and drinking. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Craving, stimulation, and sedation as predictors of alcohol demand under intoxication.

Objective: Alcohol demand has been evaluated predominately as a trait-like construct, reflecting individual differences in alcohol's reinforcement value. Increases in state-dependent alcohol demand under intoxication have been demonstrated, indicating a potential mechanism that may influence drinking behavior. This study evaluated the roles of craving and subjective alcohol response (stimulation, sedation) in this process, testing whether increases in craving and stimulation, and reductions in sedation, predicted increased alcohol demand during a laboratory-based drinking episode. Method: Young adults (N = 90; 53% male; M age = 22.2) attended two sessions in a within-subjects alcohol/placebo design. Craving, stimulation, sedation, and alcohol demand (breakpoint, Omax, intensity) were assessed once before beverage consumption and at multiple points afterward at varying blood alcohol concentrations (M peak BrAC = 0.102 g%). Multilevel models tested associations between momentary and between-person predictors (craving, stimulation, sedation) and alcohol demand after accounting for sex, time trends, and baseline covariates. Results: When intoxicated, participants reported higher alcohol demand across the majority of the ascending limb and decreasing demand across the descending limb. Participants reported increased demand at moments when experiencing higher craving, ps ≤ .001, and stimulation, with momentary stimulation incrementally predicting demand above craving, ps ≤ .04. Between-persons, higher alcohol-induced craving was associated with increased demand, ps ≤ .001, whereas between-person stimulation and sedation were less robustly associated with demand indicators. Conclusions: Results indicate that within-person craving and stimulation during intoxication are independently associated with changes in alcohol's reinforcing value. Findings suggest the potential for state-dependent alcohol demand to serve as an additional motivational index of processes underlying ongoing drinking behavior. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Decision strategies while intoxicated relate to alcohol-impaired driving attitudes and intentions.

OBJECTIVE: Approximately 28 million individuals engage in alcohol-impaired driving (AID) every year. This study investigated individuals' AID decision making strategies under intoxication, their variability across the breath alcohol concentration (BrAC) curve, and the association between strategy and AID attitudes, intentions, and behavior. METHOD: Seventy-nine adults (mean 23.9 years, 57% female) who drank alcohol ≥2 days per week and lived >2 miles away from their typical drinking locations completed an alcohol administration protocol and AID decision making task. AID attitudes, intentions, and behaviors were assessed repeatedly across the BrAC curve. Bayesian cognitive modeling identified decision strategies used by individuals on the AID decision making task, revealing whether alcohol consumption level and/or ride service cost factored into individuals' decisions to drive while impaired or obtain a ride. Additional analyses tested whether AID attitudes and intentions were related to individuals' decision strategies. RESULTS: Two decision strategies were examined on the ascending and descending limbs of the BrAC curve: compensatory (both consumption level and ride service cost factored into AID decisions) and non-compensatory (only consumption level factored into AID decisions). Switching to a compensatory strategy on the descending limb was associated with lower perceived intoxication, perceiving AID as less dangerous, and being willing to drive above the legal BrAC limit. CONCLUSIONS: Results suggest that risk for engaging in AID is higher for those using a cost-sensitive, compensatory strategy when making AID decisions under intoxication. Future research is needed to test whether AID countermeasures (e.g., subsidized ride services) are differentially effective according to decision strategy type. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Differential brain responses to alcohol-related and natural rewards are associated with alcohol use and problems: Evidence for reward dysregulation.

Multiple theoretical perspectives posit that drug use leads to biased valuation of drug-related reward, at the expense of naturally occurring rewarding activities (i.e., reward dysregulation). Recent research suggests that the comparative balance of drug-related and nondrug-related reward valuation is a powerful determinant of substance misuse and addiction. We examined differential neurophysiological responses-indexed with the P3 component of the event-related potential (ERP)-elicited by visual alcohol cues and cues depicting natural reward as a neurobiological indicator of problematic drinking. Nondependent, young adult drinkers (N = 143, aged 18-30 years) completed questionnaire measures assessing alcohol use and problems, and viewed alcohol cues (pictures of alcoholic beverages), high-arousing natural reward cues (erotica, adventure scenes), nonalcoholic beverage cues, and neutral scenes (e.g., household items) while ERPs were recorded. When examined separately, associations of P3-ERP reactivity to alcohol cues and natural reward cues with alcohol use and problems were weak. However, differential P3 response to the two types of cues (i.e., reward dysregulation P3) showed consistent and robust associations with all indices of alcohol use and problems and differentiated high-risk from lower-risk drinkers. The current results support the idea that the differential incentive-motivational value of alcohol, relative to naturally rewarding activities, is associated with increased risk for substance misuse and dependence, and highlight a novel neurophysiological indicator-the reward dysregulation P3-of this differential reward valuation.