Mobile assessment of decisions to drink in young adults: Examining the role of incentives and disincentives.

BACKGROUND: Research on decision-making (DM) biases in persons with alcohol use disorder have largely relied on behavioral economic DM tasks, which do not assess the dynamic multitude of factors associated with real-world decisions about drinking. The current study extends the literature on DM and alcohol use by using a mobile daily diary approach to investigate whether, and how, real-world incentives and disincentives are associated with actual drinking decisions in college students. METHODS: We assessed current drinking and lifetime alcohol problems in 104 young adults (61.5% female, 84.5% White) who, for 14 days, used a mobile daily diary to respond to questions about drinking decisions from the day prior. Mobile prompts assessed daily data on the timing of drinking decisions, alcohol quantity initially decided to drink, quantity actually decided to drink, and the incentives that influenced drinking decisions. RESULTS: Users of the app reported high usability, high compliance rates were observed, and incentive responses were reduced to three subtypes: alcohol, social/party, and mood. Daily mobile measures of drinking quantity were strongly correlated with self-reported drinking 2 weeks prior to the daily assessment. Lifetime alcohol problems were positively related to the average quantity decided to drink per event, drinking more than initially decided, and higher levels of self-reported drinking-decision incentives. "Alcohol" and "social/party" incentives were positively related to the quantity the participant decided to drink at drinking events. Mood incentives and disincentives showed little to no significant relationships with drinking decisions. CONCLUSIONS: The results suggest that mobile data collection can be useful for assessing aspects of real-world drinking decisions and the influence of multiple drinking decision incentives.

The Influence of Harm Avoidance and Impulsivity on Delay Discounting Rates.

High rates of delay discounting are associated with a range of disorders characterized by behavioral disinhibition, such as substance abuse and childhood behavioral problems. The current study extends the research of the personality correlates of delay discounting by examining its association with two domains of disinhibited personality, impulsivity and low harm avoidance. Trait measures of impulsivity and harm avoidance as well as a delay discounting task were administered to 669 young adult subjects (350 male, 319 female). The primary hypothesis was that a combination of high impulsivity and low harm avoidance would be associated with the highest delay discounting rates. Delay discounting rates were significantly associated with high levels of impulsivity. Counterintuitively, the highest rates of delay discounting were associated with high rates of impulsivity and high rates of harm avoidance. Results suggest that those high in impulsivity and harm avoidance are more sensitive to immediate rewards. These results are novel and suggest more complex processes involved when considering a choice between an immediate and a delayed reward that may require longer waiting periods, which itself may be anxiety providing and perceived as potentially harmful.

A daily diary exploration of contexts and experiences associated with planned drinking decisions in young adults.

OBJECTIVE: Despite the potential for negative consequences, young adults continually engage in heavy alcohol use. Unplanned (vs. planned) drinking has been of particular interest in several studies, as it is theoretically suggested to be related to poor behavioral regulation and negative consequences. Ecological momentary assessment and daily diary (DD) studies have been used to examine the contexts and consequences of planned and unplanned drinking specifically, resulting in somewhat mixed findings surrounding the factors contributing to and consequences of planned drinking. The present DD study adds to this literature by studying rewarding incentives and physical contexts of planned versus unplanned alcohol use, as well as the experiences, or consequences, of planned drinking events. METHOD: Ninety-nine young adults took part in a mobile study investigating drinking decisions for the current day and day prior, reporting the rewarding incentives contributing to their decision, the context of drinking events, and the experience of each event. RESULTS: Planned drinking was associated with being influenced by social/party and alcohol incentives, as well as being at a bar and pregaming. There was a positive relationship between planned drinking and subjective level of intoxication, but not negative or positive experience. CONCLUSIONS: Planned drinking is likely associated with rewarding incentives and social contexts and may contribute to higher levels of subjective intoxication. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The event-based influence of incentivizing and physical contexts on daily alcohol initiation and consumption.

BACKGROUND: Young adults often decide to engage in heavy drinking. Learning more about the real-time factors that predict decisions to initiate a drinking episode and how much is consumed in any single drinking episode is necessary in developing our understanding of momentary alcohol use and discrete decisions surrounding alcohol use. METHODS: The current study examined the association between contextual factors and decisions to initiate and consume alcohol in 104 young adult individuals over 2 weeks via mobile daily diary. Participants responded to daily notifications about decisions to drink or not and the contextual factors surrounding each event. The contextual factors included the situation (e.g., bar setting and pregaming) and incentives (e.g., alcohol, social, and mood enhancement). RESULTS: Multilevel analyses revealed that incentives predicted both the initiation of drinking and the amount consumed. Event-based alcohol and mood incentives predicted the initiation of drinking, while alcohol, mood, and social/party incentives predicted how much was consumed at a specific event. However, context had a more complex association with drinking outcomes. Being in a bar, alone, or at a residence predicted decisions to initiate drinking, while being in a bar, pregaming situation, or other party situation with others who are drinking predicted how much a person drank. CONCLUSIONS: The results highlight the importance of studying event-specific predictors of drinking decisions and the complex association between context/location and the type of drinking decision or outcome.

Relations Among Adolescent Alcohol and Cannabis Co-Use, Adolescent Impulsive Traits, and Prospective Change in Impulsive Traits into Emerging Adulthood.

Models of personality suggest that adolescent substance use may be associated with adolescent impulsive traits as well as changes in impulsive traits from adolescence into emerging adulthood. However, little research has focused on how adolescent alcohol and cannabis co-use, an increasingly popular and risky substance use pattern, may relate to adolescent impulsive traits as well as changes in impulsive traits from adolescence to emerging adulthood. Therefore, the current study tested patterns of adolescent co-use and their links with adolescent impulsive traits and changes in impulsive traits into emerging adulthood. Data come from the Add Health study and encompassed two timepoints spanning adolescence (age 13-18) and emerging adulthood (age 19-25). A combination of latent profile analysis, mean comparisons, and latent difference scores were estimated. Results suggested that four profiles of co-users and alcohol-only users emerged, and profiles differed in levels of adolescent personality and prospective personality change. Importantly, frequent adolescent co-users had higher levels of adolescent sensation seeking and impulsivity, but also reported the steepest decline in both traits into emerging adulthood. Findings are discussed in terms of personality theory and public health implications.

An exploration of multivariate symptom clusters of cannabis use disorder in young adults.

AIMS: Since the release of the DSM-V, CUD has been understood as a unidimensional construct. However, continued research has identified separate symptom clusters relating to consumption, loss of control, and withdrawal within substance use disorder criteria that may pose separate risk factors and functional difficulties. The current study aims to examine how symptom clusters commonly manifest in young adults that use cannabis using a latent class analysis (LCA) and explore how these clusters are related to co-occurring psychological constructs. METHODS: 1174 (aged 18-34) participants completed a battery of assessments on substance use and other psychological constructs. LCA was conducted on 17 symptoms corresponding with DSM-V CUD criteria. Multinomial regressions were used to examine class membership and commonly co-occurring psychopathology and psychological constructs. RESULTS: LCA results identified a 'No problems' class, a 'Moderate consumption' class characterized by moderate probability of endorsing consumption items, a 'Consumption with Moderate Loss of Control' class, characterized by endorsing consumption and loss of control items but minimal endorsement of withdrawal items, a 'Consumption with Moderate Withdrawal' class characterized by moderate probability of endorsing all item types, and 'High Consumption, Loss of Control, Withdrawal' class characterized by high probability of endorsing all items. Multinomial regressions indicated some class differences in psychological constructs. CONCLUSIONS: Symptom clusters differed in terms of CUD criteria, especially for those in our sample with moderate/severe problems. Findings suggest intervention efforts may benefit from treatment targeted at various presentations of CUD.

Is lower severity alcohol use disorder qualitatively different than more severe manifestations? An evaluation of multivariate symptom clusters.

BACKGROUND AND AIMS: Alcohol use disorder (AUD), since the release of DSM-V, is conceptualized and studied as a unidimensional construct. However, previous research has identified clusters of AUD symptoms related to excessive consumption/tolerance, loss of control/social dysfunction and withdrawal/craving that have shown differential genetic risks, personality associations and predictive ability. Although past 'variable-centered' (e.g. factor-analytic) studies have demonstrated the importance of these clusters, the current study aimed to examine how these clusters commonly manifest using a 'person-centered' approach (e.g. latent class). DESIGN: Cross-sectional in-person assessment. SETTING: Indiana, USA. PARTICIPANTS: A convenience sample of 1390 young adults (mean age = 21.43, SD = 2.47) recruited for an over-representation of alcohol problems (65% with AUD). MEASUREMENTS: Latent class analysis (LCA) was conducted on 23 criteria from the Semi-Structured Interview on the Genetics of Alcoholism (SSAGA) that align with DSM-V AUD symptoms. Identified latent classes were characterized using multinomial regressions to examine the association of class and measures of alcohol use, other externalizing psychopathology, internalizing problems and personality. FINDINGS: LCA results identified a 'Low Problems' class (34% of sample), a 'Heavy Consumption' class (26%) characterized by high endorsement probabilities of essentially only consumption/tolerance symptoms, a 'Consumption and Loss of Control' class (31%) characterized by endorsing consumption/tolerance and loss of control/social dysfunction symptoms, and finally a 'Consumption, Loss of Control and Withdrawal' class (9%) characterized by high endorsement probabilities of all symptom clusters. Multinomial regression results indicated an increasing spectrum of severity in terms of psychological impairment. CONCLUSIONS: AUD appears to manifest as different clusters of symptoms at different severity levels.

Symptoms of anxiety, depression, and borderline personality in alcohol use disorder with and without comorbid substance use disorder.

OBJECTIVE: Alcohol use disorder (AUD) is highly comorbid with other substance use disorders (SUDs) as well as other psychiatric disorders, such as anxiety, depression, and Borderline Personality Disorder (BPD). However, studies of persons with AUD rarely account for its comorbidity with other SUDs. Some research suggests that BPD symptoms reflect an important connection between internalizing disorders and SUDs. The current study investigated: 1) the levels of trait anxiety and symptoms of depression and BPD in persons with an AUD as a function of comorbid SUDs (cannabis use disorder - CUD) and other substance use disorder (oSUD), and 2) the influence of BPD on the association between severity of overall lifetime SUD symptoms (AUD + CUD + oSUD) and both trait anxiety and symptoms of depression. METHOD: Trait anxiety and symptoms of depression and BPD were assessed in 671 young adults (351 men; 320 women; mean age 21 years) separated into four groups: Controls (n = 185), AUD-only (134), AUD + CUD (n = 210), and AUD + oSUD (n = 142). RESULTS: Trait anxiety and symptoms of depression and BPD were elevated in all AUD groups compared with controls, and in the AUD + oSUD group compared with all other groups as well. Structural models also indicated that BPD symptoms accounted for all of the variance in lifetime SUD symptoms associated with Trait Anxiety, and a significant portion of the variance in lifetime SUD symptoms associated with depression symptoms. CONCLUSION: Results indicate that when AUD is comorbid with oSUD, it is associated with more severe AUD symptoms and higher levels of trait anxiety and symptoms of both depression and BPD. The results also indicate that BPD symptoms account for the majority of the variance in SUD symptoms associated with both trait anxiety and depression, suggesting that a considerable amount of the internalizing symptomatology in AUD/SUDs is associated with BPD psychopathology.