Alcohol-associated liver disease and behavioral and medical cofactors: unmet needs and opportunities.

Chronic liver disease is a leading cause of death in the US and is often preventable. Rising burden, cost, and fatality due to liver disease are driven by intensified alcohol use in the US population and the contributions of comorbid conditions. This mini-review focuses on the topic of liver health in the context of chronic, behavioral cofactors of disease, using research-based examples from the Brown University Center for Addiction and Disease Risk Exacerbation (CADRE). Our aim is to illustrate the current challenges and opportunities in clinical research addressing liver health in the context of behavioral and medical comorbidity and to highlight next steps in this crucial area of public health research and clinical care.

A test of competing mediators linking trouble sleeping to cannabis use in adolescents and emerging adults.

This study examined day-level associations between trouble sleeping and three cannabis-use indices (likelihood/quantity of use and impaired control). We evaluated behavioral and cognitive mediators of the association between trouble sleeping and cannabis outcomes. Youth (N = 86, ages 15-24, 48.8% female, 58.8% White, 18.6% Latine) who regularly used cannabis were recruited for an intervention study. This preregistered secondary data analysis leveraged data from a 1-week ecological momentary assessment (EMA) study completed prior to intervention. Trouble sleeping, cannabis use, and impaired control over use were assessed each morning; negative affect, risk-taking propensity, and cannabis craving were assessed multiple times and aggregated to create a daily average. Multilevel structural equation modeling evaluated hypothesized temporally sequenced associations and putative mechanisms at the day (i.e., within) and person (i.e., between) level. In bivariate analyses at the person level, there were large-effect associations between trouble sleeping and craving and negative affect, and between craving and cannabis-use likelihood and quantity (rs from .34 to .48). In multilevel analyses at the day level, participants were less likely to use cannabis the next day after reporting more trouble sleeping (ß = -.65, p < .001). Trouble sleeping was not directly associated with subsequent cannabis-use quantity or impaired control, or indirectly via negative affect, risk-taking propensity, or craving. Trouble sleeping had differential relations with cannabis-use indices at the day and person levels. To promote youth health and reduce cannabis use, future research may consider the unique, person- and situation-driven mechanistic processes at play. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Cannabis craving in response to alcohol cues in the laboratory and in daily life among adolescents ages 15-17 years.

BACKGROUND: Most adolescents who drink alcohol also use cannabis, and adolescents who use both substances experience worse long-term outcomes than adolescents who use only one or the other. Recent clinical trials with adolescents and emerging adults show that alcohol cues are associated with elevated cannabis craving in the natural environment but not in the laboratory, highlighting cross-cue reactivity as a potential intervention target. This study extends this work to a younger sample of adolescents at an earlier stage of substance use to examine the generalizability of prior findings and inform etiological mechanisms. METHODS: Participants were 81 adolescents aged 15-17 years who endorsed past-month alcohol and lifetime cannabis use. They completed a laboratory cue reactivity protocol where they rated their cannabis craving during alcohol cue and control conditions. They also completed 24 days of ecological momentary assessment where they reported multiple times per day on their cannabis craving and whether alcohol cues were visible. RESULTS: Mixed models demonstrated lower cannabis craving following alcohol cue presentation in the laboratory compared to control cues, but higher cannabis craving during moments when alcohol was visible in daily life compared to moments when alcohol was not visible. Frequency of cannabis use at baseline was associated with greater cannabis craving in the laboratory and in daily life regardless of cue type or alcohol visibility, and cannabis craving following alcohol cue presentation in the laboratory was positively related to daily life cannabis craving across contexts. CONCLUSIONS: This study adds to prior work suggesting that daily life cannabis craving is elevated when alcohol cues are visible. This cross-cue reactivity may be one factor that drives and maintains alcohol and cannabis use in adolescence.

Access to medication for opioid use disorder supported by telemedicine and healthcare coverage: A web-based survey during the COVID-19 pandemic.

Background and Aims: Medications for opioid use disorder (MOUD) are highly effective in improving treatment outcomes and reducing overdose. Concerns about interrupted access to critical MOUD services led to expansion of telemedicine services during the COVID-19 pandemic in the US. The current study tested the hypothesis that telemedicine usage and healthcare coverage would be significantly associated with access to MOUD in the early phase of the COVID-19 pandemic. Design: A cross-sectional online survey was administered to a non-probability sample from June 18-July 19, 2020 using the Amazon Mechanical Turk platform. Setting: Northeastern United States during the early phase of the COVID-19 pandemic. At the time of the survey, federal regulators had waived the longstanding requirement for in-office visits for MOUD prescription receipt and provided guidance on increasing third-party payer reimbursement rates for telehealth visits in order to mitigate barriers to care associated with COVID-19 safety guidelines. Participants: Individuals 18 years or older residing in Connecticut, Massachusetts, New Jersey, New York, or Rhode Island were eligible to complete the survey. The analytic sample was participants who reported using opioids not as prescribed by a physician in the past seven days. Measurements: Demographics, telemedicine usage, and healthcare coverage were assessed as explanatory variables. The primary outcome was whether participants reported ability to access MOUD in the past four weeks. Findings: In this sample of individuals who used illicit opioids in the past week (N = 191), one in two individuals who utilized telehealth or had healthcare coverage were able to access MOUD, whereas only one in five of their respective counterparts who did not have telehealth access or healthcare coverage were able to access these medications. Conclusions: Telemedicine and healthcare coverage were associated with greater MOUD access early in the COVID-19 pandemic, when barriers to care were high. Such findings speak to the importance of not only extending but also formalizing temporary policy changes instituted during the pandemic to allow MOUD prescribing via telemedicine.

Peer-elicited alcohol craving in adolescents and emerging adults: Bridging the laboratory and natural environment.

BACKGROUND: Although peers figure prominently in developmental models of alcohol use, our understanding of the influence of peer social context in cue reactivity paradigms with adolescents and emerging adults in the human laboratory and the natural environment is limited. This study tested associations between alcohol craving among youth in the human laboratory using alcohol-related images, with and without peers, and in the natural environment using ecological momentary assessment (EMA). METHODS: Data for this preregistered secondary analysis were collected prior to randomization in two medication trials (N = 115). Participants completed an image cue exposure paradigm at the baseline laboratory session followed by approximately 7 days of EMA. RESULTS: In the laboratory, model-based mean comparisons from multilevel models (MLMs) showed that all drinking images elicited greater craving than neutral images. No differences were observed across the three image categories containing alcohol. Image category by age interactions demonstrated that, compared to older youth, younger youth displayed lower craving in response to neutral versus social drinking context with peers images and older, compared to younger, youth displayed higher craving in response to nonsocial drinking images versus social drinking contexts with peers images. In the natural environment, craving was greatest when youth were in the presence of alcohol-using peers and alcohol-related cues, regardless of age. Laboratory craving to alcohol images was positively associated with craving in the natural environment. CONCLUSIONS: For youth, peers are a salient social context associated with increased craving, particularly in the natural environment. Laboratory cue reactivity to alcohol images predicted real-world craving, further supporting the ecological validity of this paradigm in youth.

Leveraging Ecological Momentary Assessment to Examine Bi-directional Associations Between Sleep Quality, Adolescent/Young Adult Alcohol Craving and Use.

BACKGROUND: Alcohol use is common among adolescents and young adults (AYA) and linked to poor sleep quality. Poor sleep quality may also increase alcohol use and alcohol craving, yet bi-directional relations between sleep quality and AYA alcohol use are poorly understood. PURPOSE: This study examined bi-directional associations between sleep quality, alcohol craving, and alcohol use in AYA using ecological momentary assessment (EMA) and explored if biological sex, age, or race moderated these associations. METHODS: This pre-registered secondary analysis pooled EMA data from the baseline, pre-randomization period (M = 8.18 days, range = 1-17) in two double-blind randomized placebo-controlled clinical trials examining medication effects on alcohol use in AYA (N = 115). Each morning, participants reported sleep quality and alcohol consumption (i.e., number of standard drinks) from the previous day, and craving was rated at several random points each day. RESULTS: Multilevel modeling showed that poorer average sleep quality was associated with higher levels of alcohol craving for females but not for males, and better overall levels of sleep quality were associated with decreased likelihood of engaging in alcohol use. No other person- or day-level associations between sleep and alcohol use emerged. CONCLUSIONS: Better sleep quality may be protective against alcohol use in AYA, and female AYA who report poorer sleep quality may experience higher levels of alcohol craving. Research and clinical assessment of AYA sleep quality can contribute to understanding of factors promoting alcohol craving and use.

This study explored how alcohol use among adolescents and young adults influences sleep quality as well as how sleep quality influences alcohol use and alcohol craving. Each morning, for approximately 1 week, participants reported their alcohol use from the prior day and their sleep quality from the prior night. They also rated their alcohol craving several times each day. Results showed that better overall sleep quality was associated with a lower likelihood of alcohol use. Poorer average sleep quality was associated with higher alcohol craving for females but not males. These findings suggest that better sleep quality may protect against alcohol use among youth and serve as a protective factor against alcohol craving for females.

COVID-19-Related Stressors and Clinical Mental Health Symptoms in a Northeast US Sample.

Research has linked specific COVID-19-related stressors to the mental health burden, yet most previous studies have examined only a limited number of stressors and have paid little attention to their clinical significance. This study tested the hypothesis that individuals who reported greater COVID-19-related stressors would be more likely to have elevated levels of anxiety, posttraumatic stress symptoms, and serious psychological distress. METHODS: An online survey was administered to a convenience sample from 18 June to 19 July 2020, in US states that were most affected by COVID-19 infections and deaths at the time. Individuals who were 18 or older and residents of five Northeast US states were eligible to participate (N = 1079). In preregistered analyses, we used logistic regression models to test the associations of COVID-19 stressors with symptoms on the Generalized Anxiety Disorder-7 (GAD-7), Impact of Event Scale-Revised, and K6, adjusting for sociodemographic covariates. RESULTS: COVID-19-related stressors (i.e., essential worker status, worry about COVID-19 infection, knowing someone hospitalized by COVID-19, having children under 14 at home, loneliness, barriers to environmental rewards, food insecurity, loss of employment) were associated with meeting thresholds (i.e., positive screening) for anxiety, posttraumatic stress, and/or serious psychological distress. Loneliness and barriers to environmental rewards were associated with all mental health outcomes. LIMITATIONS: We used a non-probability sample and cannot assume temporal precedence of stressors with regard to development of mental health symptoms. CONCLUSIONS: These findings link specific stressors to the mental health burden of the COVID-19 pandemic.

In the Presence of Parents: Parental Heterosexism and Momentary Negative Affect and Substance Craving Among Sexual Minority Youth.

PURPOSE: We examined the influence of parental heterosexism on in vivo negative affect and substance craving among sexual minority youth (SMY) who use nicotine and other substances, and if that relation was strengthened when in the presence of their parent(s). METHODS: SMY (n = 42, ages 15-19) completed baseline assessments, including experiences of parental heterosexism (PH), and a 30-day ecological momentary assessment. Ecological momentary assessment reports included affective states (i.e., anger, anxiety, depression), substance craving (i.e., nicotine, cannabis, alcohol), and other contextual factors (e.g., presence of parents). Multilevel logistic regression models evaluated the study hypotheses. RESULTS: PH was associated with greater odds of reporting in-the-moment anger, depression, cannabis craving, and alcohol craving. Parental presence was associated with lower odds of reporting anxiety or depression, and greater odds of reporting nicotine craving. There was a significant interaction when predicting the odds of reporting anxiety. For SMY low in PH, parental presence was related to lower odds of reporting anxiety. As PH increased, parental presence had diminishing associations with the odds of reporting anxiety. DISCUSSION: Parenting behaviors can serve as protective and risk factors for negative affect and substance craving among SMY. Improving family-based interventions for SMY may be integral for enhancing healthy development and reducing health disparities.

Cannabis craving in response to alcohol cues among adolescents and young adults in the laboratory and in daily life.

Cannabis use among adolescents and young adults who drink alcohol is prevalent and relates to poorer clinical outcomes. Interrelated factors, such as cross-reactivity to alcohol cues, may contribute to the high prevalence of cannabis use among young persons who drink alcohol. We tested whether systematic presentation of alcohol cues in the laboratory and naturalistic presence of alcohol cues in daily life elicit cannabis craving. Data were compiled from two clinical trials. Participants (N = 54) were adolescents and young adults ages 15-24 who reported consuming alcohol at least twice per week, expressed interest in reducing alcohol use, and reported lifetime cannabis use. Participants provided laboratory and daily-life smartphone report data prior to randomization to treatment conditions in the parent trials. Mixed-effect models tested a priori hypotheses, which received mixed support. Cannabis craving was not heightened following alcohol-cue presentation in the laboratory but was elevated in daily life when alcohol cues were visible. The effect of laboratory alcohol cues was moderated by cannabis use frequency, with higher frequencies associated with greater cannabis craving, while the effect of daily-life alcohol cues on cannabis craving was not moderated by cannabis use frequency. Finally, alcohol cue-induced cannabis craving in the laboratory was associated with greater daily-life cannabis craving, irrespective of the presence of naturalistic alcohol cues. Overall, exposure to alcohol cues in daily life may flag situations with increased risk of cannabis craving, supporting the idea of cross cue reactivity and implicating naturalistic alcohol cues as an intervention target for individuals who co-use alcohol and cannabis. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Momentary Associations Among Minority Stress, Craving, Affect, and Nicotine Use Among Sexual Minority Youth.

OBJECTIVES: Sexual minority youth are more likely to use nicotine relative to heterosexual youth. The minority stress model posits these disparities are partly due to unique stress (i.e., minority stress) specific to their stigmatized identities. However, there is a dearth of research exploring the fine-grained dynamic interplay between minority stressors, mediating processes, and nicotine use in sexual minority youth's daily lives and natural environment. We leveraged ecological momentary assessment over a 30-day monitoring period to test the mediating effects of craving and negative and positive affect on the momentary associations between minority stressors and subsequent nicotine use among sexual minority youth who were active nicotine users and recruited from the community. METHODS: Participants were 85 nicotine users, ages 15-19 years old (M age = 17.96, SD = 1.10; 56.6% cisgender female; 56.6% bisexual; 73.5% non-Hispanic White) and half (51.8%) were daily nicotine users. RESULTS: Results indicated that exposure to a minority stressor was associated with momentary elevations in nicotine craving and negative affect and decreases in positive affect. Nicotine craving and positive affect were also associated with greater probability of subsequent nicotine use. The associations between minority stressors and subsequent nicotine use were mediated through craving and positive, but not negative affect. CONCLUSIONS: Our findings provide the first ecological momentary assessment evidence of these associations among sexual minority youth and help support and advance both addictions and sexual minority-specific models (e.g., minority stress) of nicotine use among youth.

Comprehensive measurement invariance of alcohol outcome expectancies among adolescents using regularized moderated nonlinear factor analysis.

Alcohol outcomes expectancies (AOEs) are robust predictors of alcohol initiation and escalation of drinking behavior among adolescents. Although measurement invariance is a prerequisite for inferring valid comparisons of AOEs across groups (e.g., age), empirical evidence is lacking. In a secondary data analysis study, we employed regularized moderated nonlinear factor analysis (MNLFA) to simultaneously test differential item functioning (DIF) across age, sex, race, ethnicity, socioeconomic status (SES), and alcohol initiation for a 22-item, two-factor measure of positive and negative AOEs among adolescents (analytic n = 936 drawn from a parent study of 1023 adolescents). Evidence of DIF was minimal, with no DIF for the negative AOE factor and DIF for only two items of the positive AOE factor. The item "feel grown up" exhibited DIF by age, and the item "feel romantic" exhibited DIF by SES. After accounting for DIF, the positive AOE latent factor mean differed by SES, age, and alcohol initiation, and exhibited lower variability by alcohol initiation. The negative AOE latent factor mean differed by sex and SES, with greater variability by SES and age and lower variability by alcohol initiation. Group-differences findings for age and alcohol initiation are consistent with prior work, and differences by sex and SES are a new contribution to the literature that should prompt additional research to ensure replicability. The present study demonstrates the utility of the MNLFA technique for examining comprehensive measurement invariance, particularly for applied researchers who seek to examine substantive research questions while accounting for any DIF present in the scales used.

Association of Substance Use With Behavioral Adherence to Centers for Disease Control and Prevention Guidelines for COVID-19 Mitigation: Cross-sectional Web-Based Survey.

BACKGROUND: Substance use is a risk factor for COVID-19 infection and adverse outcomes. However, reasons for elevated risk for COVID-19 in substance users are not well understood. OBJECTIVE: The aim of this study was to evaluate whether alcohol or other drug use is associated with adherence to Centers for Disease Control and Prevention (CDC) guidelines for COVID-19 mitigation. Preregistered analyses tested the hypothesis that greater use of alcohol and other drugs would be associated with lower CDC guideline adherence. A secondary objective was to determine whether substance use was associated with the likelihood of COVID-19 testing or outcome. METHODS: A cross-sectional web-based survey was administered to a convenience sample recruited through Amazon's Mechanical Turk platform from June 18 to July 19, 2020. Individuals aged 18 years or older and residing in Connecticut, Massachusetts, New Jersey, New York, or Rhode Island were eligible to participate. The exposure of interest was past 7-day use of alcohol, cigarettes, electronic cigarettes, cannabis, stimulants, and nonmedical opioids. The primary outcome was CDC guideline adherence measured using a scale developed from behaviors advised to reduce the spread of COVID-19. Secondary outcomes were likelihood of COVID-19 testing and a positive COVID-19 test result. All analyses accounted for the sociodemographic characteristics. RESULTS: The sample consisted of 1084 individuals (mean age 40.9 [SD 13.4] years): 529 (48.8%) men, 543 (50.1%) women, 12 (1.1%) other gender identity, 742 (68.5%) White individuals, 267 (24.6%) Black individuals, and 276 (25.5%) Hispanic individuals. Daily opioid users reported lower CDC guideline adherence than nondaily users (B=-0.24, 95% CI -0.44 to -0.05) and nonusers (B=-0.57, 95% CI -0.76 to -0.38). Daily alcohol drinkers reported lower adherence than nondaily drinkers (B=-0.16, 95% CI -0.30 to -0.02). Nondaily alcohol drinkers reported higher adherence than nondrinkers (B=0.10, 95% CI 0.02-0.17). Daily opioid use was related to greater odds of COVID-19 testing, and daily stimulant use was related to greater odds of a positive COVID-19 test. CONCLUSIONS: In a regionally-specific, racially, and ethnically diverse convenience sample, adults who engaged in daily alcohol or opioid use reported lower CDC guideline adherence for COVID-19 mitigation. Any opioid use was associated with greater odds of COVID-19 testing, and daily stimulant use was associated with greater odds of COVID-19 infection. Cigarettes, electronic cigarettes, cannabis, or stimulant use were not statistically associated with CDC guideline adherence, after accounting for sociodemographic covariates and other substance use variables. Findings support further investigation into whether COVID-19 testing and vaccination should be expanded among individuals with substance-related risk factors.

Day-level shifts in social contexts during youth cannabis use treatment.

OBJECTIVE: Social context plays a critical role in youth cannabis use. Yet few studies have examined if and when social contexts shift during cannabis use treatment. This study examined daily shifts in youths' social contexts with the goal of characterizing how specific social contexts (e.g., time with cannabis-using friends or siblings) relate to cannabis craving and use during cannabis treatment. METHOD: Participants were 65 cannabis users (51% male), ages 15-24 years, who participated in a double-blind randomized clinical trial that tested the effects of motivational enhancement and cognitive behavioral therapies plus either adjunctive pharmacotherapy or placebo on cannabis craving and use. Ecological momentary assessment (EMA) data, collected from a pre-randomization period through the completion of the six-week intervention, assessed youths' social contexts, cannabis use, and craving. RESULTS: Time-varying effects models identified shifts in social contexts during treatment. Overall, time spent with cannabis-using friends and siblings decreased, where time spent with non-using friends or alone increased across the trial. Time with parents or non-using siblings was unchanged. Comparing the relative associations of social contexts with same-day craving and use, more time with cannabis-using friends and with siblings was uniquely associated with greater craving and use. CONCLUSIONS: Social context is an important factor in youth substance-use treatment. While time spent with cannabis-using friends and siblings decreased over treatment for all participants, those who continued to spend time with using individuals reported greater craving and use. This research supports increased attention to shifting youths' social contexts to enhance treatment success. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Combined pharmacotherapy and evidence-based psychosocial Cannabis treatment for youth and selection of cannabis-using friends.

BACKGROUND: Theoretical models of behavior change argue that youth should decrease their time with cannabis-using friends and increase their time with non-using friends during treatment. Informed by behavior-change models of recovery and socialization and selection peer-influence models, the current study examined whether combining evidence-based psychosocial treatment with adjunctive pharmacotherapy helps youth decrease their affiliations with cannabis-using friends and increase their affiliations with non-using friends during cannabis misuse treatment. METHODS: Youth ages 15-24 years (51 % male), participated in a double-blind randomized clinical trial that tested the effects of motivational enhancement and cognitive behavioral therapy (MET-CBT) plus topiramate (N = 39) or placebo (N = 26) on cannabis craving and use. Ecological momentary assessment data, collected via smartphones throughout the six-week intervention, assessed youths' time with cannabis-using and non-using friends, cannabis use, and craving in daily life. Multiple group multilevel structural equation modeling tested study hypotheses. RESULTS: Across the topiramate (48 % completion rate) and placebo (77 % completion rate) conditions, greater time spent with cannabis-using friends promoted greater next day cannabis use and craving (socialization effect). In turn, cannabis craving, but not use, promoted continued selection of cannabis-using friends. This indirect effect was only supported in the placebo condition due to the selection piece of this cycle not being significant for youth who received topiramate. Neither cannabis craving nor use were associated with time with non-using friends the next day. CONCLUSIONS: MET-CBT and adjunctive topiramate pharmacotherapy interrupted youth selection processes. This finding suggests that changing peer affiliations could be one mechanism by which treatments can work.

How adolescents' working memory abilities relate to their alcohol craving in real-life contexts depends on biological sex.

AIM: We sought to elucidate whether stress, peers, and in vivo (i.e., direct) alcohol cues elicit alcohol craving in daily life among adolescents and to test whether individual variation in working memory function and biological sex alters these associations. METHODS: We leveraged ecological momentary assessment (EMA) to examine momentary associations between stress, peers, and direct alcohol cues with craving, assessed as "urge to drink alcohol," among 86 male (51.2 %) and female (48.8 %) frequent drinkers (i.e., two or more drinking days per week). Participants were ages 14-24 years (M = 20.7 years, SD = 2.1). Participants completed EMA throughout the day for about one week prior to randomization to a treatment condition for an AUD clinical trial. Pre-registered, secondary analyses focused on craving for assessments when adolescents were not drinking, and assessments occurring after drinking on drinking days were removed. Working memory performance was assessed in the laboratory via the Memory for Words subtest of the Woodcock-Johnson III Tests of Cognitive Abilities. RESULTS: Craving was heightened at more stressful moments and when adolescents were with their peers and in the presence of direct alcohol cues. Working memory function was not related to craving but altered the relation of momentary stress, peers, and cues with craving once biological sex-related differences were considered. Females generally had lower craving than males, but working memory function served to buffer against stress-induced craving for males. CONCLUSIONS: Higher working memory function buffered the in-the-moment relation of stress with alcohol craving for males but not females.

Associations between social network characteristics and alcohol use alone or in combination with cannabis use in first-year college students.

OBJECTIVE: Simultaneous use of alcohol and cannabis is common among young adults, but little research has examined social ties and their relation to simultaneous use. This study investigated the social network characteristics of college students at two time points in the first year of college. Participants were categorized into those who used alcohol and cannabis, such that their effects overlap (simultaneous users), those who used both substances without overlapping effects (concurrent users), and those who used alcohol only. METHOD: First-year college students (N = 1,294) completed online questionnaires during the fall and spring semester. At both assessments, participants nominated up to 10 important peers in their class, reported on peers' alcohol and cannabis use, and reported their own use of alcohol or cannabis with each peer. RESULTS: Concurrent and simultaneous users reported a greater proportion of drinking buddies than those who used alcohol only. A greater proportion of friends who used alcohol or cannabis, but not the proportion who were "drinking buddies" or "cannabis buddies," was associated with increased odds of simultaneous use relative to concurrent use. Participants nominated network ties that paralleled their own substance use (e.g., the majority of simultaneous users' networks ties were also simultaneous users). CONCLUSION: Having a larger percentage of friends who use cannabis and alcohol is associated with increased odds of using both substances at the same time, perhaps because it gives access to both substances at the same time. Interventions should account for amount of exposure to alcohol and cannabis use from network members. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Incubation of alcohol craving as it naturally occurs in a developmentally diverse sample of dependent and nondependent drinkers.

Longer periods of abstinence are shown to enhance response to alcohol cues among alcohol-dependent animals and humans, a phenomenon described as "incubation of craving." The present work examined the effects of days since last drink on general craving and alcohol-cued craving as it occurs in daily life and explored whether effects were influenced by age and dependence. Three samples were combined to include 266 drinkers ranging in age from 14 to 67 years recruited from the community; about half (59.4%) met criteria for alcohol dependence. Drinkers used handheld electronic devices to rate their subjective alcohol craving (assessed as "urge to drink") and situational context (e.g., presence of visible alcohol cues) at nondrinking times in daily life, with days since last alcohol use culled from timeline follow-back interviews and real-world reports. Drinkers at the lower end of the age range in this sample reported greater intensification of craving with more days of continuous abstinence than drinkers at the upper end of the age range. Age was not related to incubation of cue-elicited craving, in specific, however. For drinkers with dependence, craving when in the presence of visible alcohol cues intensified with more days of continuous abstinence, suggesting craving incubation. This study builds from important foundational work to demonstrate that incubation of cue-elicited craving occurs in dependent drinkers and applies regardless of age. Inasmuch as craving is a motivational drive that maintains alcohol use, understanding factors that influence craving in daily life holds promise for improving clinical care.

Does the Combination Matter? Examining the Influence of Alcohol and Cannabis Product Combinations on Simultaneous Use and Consequences in Daily Life.

BACKGROUND: Alcohol and marijuana/cannabis are frequently used simultaneously (i.e., SAM use). SAM use is complex, and the ways in which alcohol and cannabis are simultaneously used may reveal differential effects. The purpose of this study was to examine day-level effects of distinct alcohol and cannabis product combinations on simultaneous use and consequences on that day. METHODS: College student SAM users (N = 274; 50% women; Mage  = 19.82 years) were recruited to complete 54 days of data collection, including 5 repeated daily surveys each day. We identified 12 distinct product combinations reported during SAM-use days. We tested 4 reference groups, with one reflecting the most common use pattern and 3 potentially risky use patterns. We considered 3 outcomes (negative consequences, number of drinks, and number of cannabis uses) and used generalized linear mixed-effects models disentangling within- from between-person effects in all analyses. RESULTS: Using multiple products (≥2) of alcohol was consistently linked to higher odds of experiencing a negative consequence. Combining beer with only one cannabis product (leaf or concentrate) was consistently associated with lower odds of a consequence. Combining cannabis with multiple alcohol products was associated with heavier alcohol consumption. Using dual cannabis products also was associated with heavier cannabis consumption, but this pattern was not significantly different than using concentrate only on a given day. CONCLUSION: This is the first study to examine day-level influences of distinct alcohol and cannabis product combinations on consumption and consequences among young adult SAM users. Findings suggest that mixing alcohol products confers greater risk for negative consequences and heavier consumption, whereas there is little difference in cannabis consumption when using concentrate only vs. 2 cannabis products on a given day, except for concentrate + beer. Our findings support existing protective strategies of not mixing alcohol products and avoiding use of cannabis concentrate for SAM use as well.

The Altered Course of Learning: How Alcohol Outcome Expectancies Are Shaped by First Drinking Experiences.

According to expectancy theory, outcome expectancies are first formed vicariously (through observing other people) and then through direct experience. This cohort-sequential longitudinal study explored these expectancy origins in 1,023 youths (52% female, ages 10.5-15.5 years at recruitment, M = 12.47 years, SD = 0.95). Discontinuous multilevel growth models described patterns of change in expectancies before and after the first experience of distinct drinking milestones (i.e., first sip, first full drink, first heavy-drinking situation). Youths' expectations for positive and negative drinking outcomes generally increased and decreased over adolescence, respectively, reflecting general developmental trends. Drinking experiences altered learning trajectories, however, reifying positive expectancies and invalidating negative expectancies at each milestone and altering the course of expectancy change thereafter. For positive outcome expectancies, the influence of direct experience on learning was stronger when drinking milestones were met at an earlier age. Conversely, invalidation of negative expectancies was stronger when the first-drink milestone was met at a later age.

Heaviness of Alcohol Use, Alcohol Problems, and Subjective Intoxication Predict Discrepant Drinking Reports in Daily Life.

BACKGROUND: Self-reported consumption is pervasive in alcohol research, though retrospective recall bias is a concern. Fine-grained methods are designed to limit retrospection; yet, discrepancies can arise when comparing responses on fine-grained surveys with responses to retrospective surveys across weeks or months. Many fine-grained studies use both repeated daily surveys (RDS) and end-of-day (EOD) summaries, but little research has examined whether these survey types are consistent. The purpose of this study was to quantify the magnitude and directionality of discrepancy between EOD summaries and RDS and identify alcohol-related predictors of discrepancy. METHODS: As a part of a larger study, college student alcohol and cannabis users (N = 341; 53% women; Mage  = 19.79 years) were recruited to complete 56 days of data collection, including 5 daily assessments of their substance use and related constructs, one of which included an EOD summary of the previous day. Generalized linear mixed-effects models were used to examine between- and within-person predictors of a 5-category, discrepancy outcome: no discrepancy, low discrepancy where RDS < EOD, low discrepancy where EOD < RDS, high discrepancy where RDS < EOD, and high discrepancy where EOD < RDS. RESULTS: Discrepancies between EOD and RDS were observed in both directions. Alcohol problems predicted more alcohol consumption reported on the EOD survey than across RDS. Within-person alcohol quantity and hourly rate of consumption were most strongly related to less alcohol consumption reported on the EOD survey. Between- and within-person peak subjective intoxication and within-person liquor consumption were associated with discrepancies in both directions. CONCLUSIONS: Surveys requiring more retrospection may overestimate alcohol consumption in problematic drinkers and underestimate consumption on days where more alcohol is consumed than typical. Evidence also suggests that greater day-to-day instability in alcohol behavior is linked to less consistent reporting overall. More research is needed to discern factors contributing to inconsistent reporting on fine-grained surveys to maximize the validity of reports.