Examining differential responses to the Take Care of Me trial: A latent class and moderation analysis.

Given prevalent alcohol misuse-emotional comorbidities among young adults, we developed an internet-based integrated treatment called Take Care of Me. Although the treatment had an impact on several secondary outcomes, effects were not observed for the primary outcome. Therefore, the goal of the current study was to examine heterogeneity in treatment responses. The initial RCT randomized participants to either a treatment or psychoeducational control condition. We conducted an exploratory latent class analysis to distinguish individuals based on pre-treatment risk and then used moderated regressions to examine differential treatment responses based on class membership. We found evidence for three distinct groups. Most participants fell in the "low severity" group (n = 123), followed by the "moderate severity" group (n = 57) who had a higher likelihood of endorsing a previous mental health diagnosis and treatment and higher symptom severity than the low group. The "high severity" group (n = 42) endorsed a family history of alcoholism, and the highest symptom severity and executive dysfunction. Moderated regressions revealed significant class differences in treatment responses. In the treatment condition, high severity (relative to low) participants reported higher alcohol consumption and hazardous drinking and lower quality of life at follow-up, whereas moderate severity (relative to low) individuals had lower alcohol consumption at follow-up, and lower hazardous drinking at end-of-treatment. No class differences were found for participants in the control group. Higher risk individuals in the treatment condition had poorer responses to the program. Tailoring interventions to severity may be important to examine in future research.

Efficacy of a minimally guided internet treatment for alcohol misuse and emotional problems in young adults: Results of a randomized controlled trial.

Many young adults struggle with comorbid alcohol misuse and emotional problems (i.e., depression and anxiety). However, there is currently a paucity of evidence-based, integrated, accessible treatment options for individuals with these comorbidities. The main goal of this study was to examine efficacy of a novel online, minimally guided, integrated program for comorbid alcohol misuse and emotional problems in young adults. Method: The study was an open-label two-arm RCT. Participants (N = 222, M age = 24.6, 67.6% female) were randomized to one of two conditions: the Take Care of Me program (an 8-week, online integrated treatment condition consisting of 12 modules), or an online psychoeducational control condition. Intervention modules incorporated content based on principles of cognitive behavioral therapy and motivational interviewing. Participants completed assessment data at baseline, at the end of treatment (i.e., 8 weeks), and at follow-up (i.e., 24 weeks). Data were analyzed using generalized linear mixed models. Results: We observed that participants in the treatment condition showed larger reductions in depression, hazardous drinking, as well as increases in psychological quality of life and confidence at the end of treatment. We did not find group differences on total alcohol use at follow-up, but participants in the treatment group reduced their hazardous drinking and improved their quality of life at 24-week follow-up. Conclusions: Our study provides promising initial evidence for the first iteration of the comorbid alcohol misuse and emotional problems online program.

Drinking to Cope During COVID-19 Pandemic: The Role of External and Internal Factors in Coping Motive Pathways to Alcohol Use, Solitary Drinking, and Alcohol Problems.

BACKGROUND: The COVID-19 pandemic has resulted in massive disruptions to society, to the economy, and to daily life. Some people may turn to alcohol to cope with stress during the pandemic, which may put them at risk for heavy drinking and alcohol-related harms. Research is needed to identify factors that are relevant for coping-motivated drinking during these extraordinary circumstances to inform interventions. This study provides an empirical examination of coping motive pathways to alcohol problems during the early stages of the COVID-19 pandemic. METHODS: Participants (N = 320; 54.7% male; mean age of 32 years) were Canadian adult drinkers who completed an online survey assessing work- and home-related factors, psychological factors, and alcohol-related outcomes over the past 30 days, covering a time period beginning within 1 month of the initiation of the COVID-19 emergency response. RESULTS: The results of a theory-informed path model showed that having at least 1 child under the age of 18, greater depression, and lower social connectedness each predicted unique variance in past 30-day coping motives, which in turn predicted increased past 30-day alcohol use (controlling for pre-COVID-19 alcohol use reported retrospectively). Income loss was associated with increased alcohol use, and living alone was associated with increased solitary drinking (controlling for pre-COVID-19 levels), but these associations were not mediated by coping motives. Increased alcohol use, increased solitary drinking, and greater coping motives for drinking were all independently associated with past 30-day alcohol problems, and indirect paths to alcohol problems from having children at home, depression, social connectedness, income loss, and living alone were all supported. CONCLUSIONS: Findings provide insight into coping-motivated drinking early in the COVID-19 pandemic and highlight the need for longitudinal research to establish longer term outcomes of drinking to cope during the pandemic.

Impulsivity moderates the effect of social anxiety on in-lab alcohol craving.

Social anxiety (SA) is thought to relate to alcohol misuse. However, current evidence is inconsistent - especially in young adulthood. Recent non-experimental data show that trait impulsivity moderates the effect of SA on alcohol misuse. Specifically, this work suggests that concurrently elevated impulsivity may draw attention to the immediate, anxiolytic effects of drinking - thus promoting alcohol misuse among those high in SA. Otherwise, without elevated impulsivity, a socially anxious person may not drink due to focusing on alcohol's possible negative outcomes (e.g., embarrassing behaviours). The next step in this research is to examine if impulsivity impacts in-the-moment subjective craving among socially anxious individuals. This was the goal of the present experiment. After baseline measures, undergraduate participants (N = 110) completed the Trier Social Stress Test followed by an alcohol (versus neutral) cue exposure. Subjective craving ratings were collected at both baseline and post-cue exposure. Moderation analyses revealed that socially anxious individuals endorsed strong cravings following an alcohol (but not a neutral) cue exposure, but only if they also had elevated impulsivity. In-lab craving was positively correlated with retrospective reports of alcohol misuse. Our findings demonstrate that impulsivity contributes to SA-related risk for alcohol misuse.

Efficacy of an Online Self-Help Treatment for Comorbid Alcohol Misuse and Emotional Problems in Young Adults: Protocol for a Randomized Controlled Trial.

BACKGROUND: Alcohol misuse and emotional problems (ie, depression and anxiety) are highly comorbid among Canadian young adults. However, there is a lack of integrated, accessible, and evidence-based treatment options for these young adults. OBJECTIVE: The main goal of this study is to develop and test the efficacy of an integrated, online self-help program designed to target both alcohol misuse and emotional problems. METHODS: A two-arm randomized controlled trial design will be used to compare the efficacy of the online integrated treatment to a psychoeducational control group. A target sample of 214 participants will be recruited and randomly assigned to either condition. The integrated treatment will last 8 weeks, and participants will work through 12 modules. Modules will incorporate content based on principles of cognitive behavioral therapy and motivational interviewing. Participants in the control group will receive links to psychoeducational resources and will have access to the full treatment after follow-up. The primary outcome will be the number of Canadian standard drinks consumed in the week leading up the assessment. Secondary outcomes of interest include symptoms of depression, anxiety, alcohol-related problems, quality of life, and use of other drugs. Assessments will be completed at 3 time-points: at baseline, at the end of treatment (ie, 8 weeks), and at follow-up (ie, 24 weeks). Upon completion, data will be analyzed using generalized linear mixed models. RESULTS: Data collection began in June 2018 and will continue until January 2020. Final study results will be submitted for publication by July 2020. CONCLUSIONS: Currently, there are no integrated treatments designed to target alcohol misuse and the range of emotional problems experienced by young adults. This research stands to provide an effective, accessible (ie, Web-based), and feasible option to treat the many struggling young adults in this country. TRIAL REGISTRATION: ClinicalTrials.gov ID NCT03406039; https://clinicaltrials.gov/ct2/show/NCT03406039 (Archived by WebCite at http://www.webcitation.org/72fDefnrh). REGISTERED REPORT IDENTIFIER: PRR1-10.2196/11298.

Examining co-patterns of depression and alcohol misuse in emerging adults following university graduation.

Depression and alcohol use disorders are highly comorbid. Typically, alcohol use peaks in emerging adulthood (e.g., during university), and many people also develop depression at this time. Self-medication theory predicts that depressed emerging adults drink to reduce negative emotions. While research shows that depression predicts alcohol use and related problems in undergraduates, far less is known about the continuity of this association after university. Most emerging adults "mature out" of heavy drinking; however, some do not and go on to develop an alcohol use disorder. Depressed emerging adults may continue to drink heavily to cope with the stressful (e.g., remaining unemployed) transition out of university. Accordingly, using parallel process latent class growth modelling, we aimed to distinguish high- from low-risk groups of individuals based on joint patterns of depression and alcohol misuse following university graduation. Participants (N = 123) completed self-reports at three-month intervals for the year post-graduation. Results supported four classes: class 1: low stable depression and low decreasing alcohol misuse (n = 52), class 2: moderate stable depression and moderate stable alcohol misuse (n = 35), class 3: high stable depression and low stable alcohol misuse (n = 29), and class 4: high stable depression and high stable alcohol misuse (n = 8). Our findings show that the co-development of depression and alcohol misuse after university is not uniform. Most emerging adults in our sample continued to struggle with significant depressive symptoms after university, though only two classes continued to drink at moderate (class 2) and high (class 4) risk levels.