Examining the validity of the addictions neuroclinical assessment domains in a crowdsourced sample of adults with current alcohol use.

Several dimensional frameworks for characterizing heterogeneity in alcohol use disorder (AUD) have been proposed, including the Addictions Neuroclinical Assessment (ANA). The ANA is a framework for assessing individual variability within AUD across three domains corresponding to the proposed stages of the addiction cycle: reward (binge-intoxication stage), negative emotionality (withdrawal-negative affect stage), and cognitive control (preoccupation-anticipation stage). Recent work has evaluated the ANA's three-factor structure and construct validity, primarily in treatment-seekers with AUD. We extended this research by examining the factor structure, bias across alcohol use severity, longitudinal invariance, and concurrent and predictive validity of a novel assessment of the ANA domains in adults with past 12-month regular (10 + alcohol units/week) alcohol use. Participants recruited from Prolific (N = 732), a crowdsourced data collection platform, completed various self-report measures. A test-retest subsample (n = 234) completed these measures 30 days later. Split-half exploratory factor analysis and confirmatory factor analysis supported the three-factor structure of the ANA. The overall factor structure was invariant across 30 days. Concurrently and prospectively, ANA domains demonstrated convergent validity concerning theoretically aligned alcohol-related, psychological, and personality measures. However, there was evidence of poor discriminant validity, and several cognitive control and reward items demonstrated bias across alcohol use severity. Future research is needed to improve the measurement of ANA domains using multimodal indicators, examine longitudinal changes in domains and their relationship with alcohol use severity, characterize phenotypic subgroups based on relative levels of domains, and compare the utility of the ANA with other proposed frameworks for measuring AUD heterogeneity. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Contextual decision-making and alcohol use disorder criteria: Delayed reward, delayed loss, and probabilistic reward discounting.

OBJECTIVE: Alcohol use disorder (AUD) is an etiologically heterogeneous psychiatric disorder defined by a collection of commonly observed co-occurring symptoms. It is useful to contextualize AUD within theoretical frameworks to identify potential prevention, intervention, and treatment approaches that target personalized mechanisms of behavior change. One theoretical framework, behavioral economics, suggests that AUD is a temporally extended pattern of cost/benefit analyses favoring drinking decisions. The distribution of costs and benefits across choice outcomes is often unequally distributed over time and has different probabilities of receipt, such that delay and probability become critical variables. The present study examines the relations between different forms of economic discounting (delayed reward, delayed cost, and probabilistic reward) and individual symptoms of AUD to inform etiological models. METHOD: Participants (N = 732; 41% female, 4.2% Black, 88.1% White, 8% Hispanic) completed an online survey with measures of AUD symptoms and economic discounting. We examined relations between economic discounting and AUD symptoms with zero-order correlations, in separate models (factor models), and in models controlling for an AUD factor (factor-controlled models). RESULTS: Delayed reward discounting was positively associated with the give up AUD criteria across all three levels of analysis. Probability discounting was associated with social/interpersonal problems across two out of three sets of analyses. Consistent with the broad discounting literature, effect sizes were small (range = -.15 to .13). CONCLUSIONS: These results support the idea that AUD criteria are etiologically distinct, resulting in varying AUD profiles between persons that are differentially associated with behavioral economic discounting. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Self-report assessment of alcohol sensitivity: An examination of the effects of different probes.

OBJECTIVE: Level of response (LOR) to alcohol is associated with several alcohol-related risk factors and outcomes. However, existing self-report measures of LOR have important limitations. For example, the Self-Rating of the Effects of Alcohol Scale assesses a limited range of alcohol-related effects. Although the Alcohol Sensitivity Questionnaire (ASQ) samples a broader range of effects, it uses different probes across effects, confounding type of effect with method variation associated with the use of different probes. Focusing on the ASQ, we systematically evaluate variation in estimated LOR as a function of how number of drinks to achieve an effect is probed. Our approach addresses a major limitation of existing LOR measures which fail to account for sensitivity variability across drinking occasions. METHOD: This study randomized 732 adult drinkers into one of four versions of the ASQ that assessed sensitivity to 15 alcohol-related effects, systematically varying the follow-up probes. RESULTS: Accounting for (a) the minimum number of drinks consumed before feeling an effect and (b) the maximum number of drinks consumed without feeling an effect for all effects is superior to the original ASQ approach in predicting relevant outcomes. CONCLUSIONS: Assessments of sensitivity should probe for minimum and maximum number of drinks across each of the effects. If impractical to probe for both, consistently probing for maximum number of drinks is desirable. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Meaningful associations in the adolescent brain cognitive development study.

The Adolescent Brain Cognitive Development (ABCD) Study is the largest single-cohort prospective longitudinal study of neurodevelopment and children's health in the United States. A cohort of n = 11,880 children aged 9-10 years (and their parents/guardians) were recruited across 22 sites and are being followed with in-person visits on an annual basis for at least 10 years. The study approximates the US population on several key sociodemographic variables, including sex, race, ethnicity, household income, and parental education. Data collected include assessments of health, mental health, substance use, culture and environment and neurocognition, as well as geocoded exposures, structural and functional magnetic resonance imaging (MRI), and whole-genome genotyping. Here, we describe the ABCD Study aims and design, as well as issues surrounding estimation of meaningful associations using its data, including population inferences, hypothesis testing, power and precision, control of covariates, interpretation of associations, and recommended best practices for reproducible research, analytical procedures and reporting of results.

The Case for Cognitive Interviewing in Survey Item Validation: A Useful Approach for Improving the Measurement and Assessment of Substance Use Disorders.

OBJECTIVE: To accurately identify substance use disorders, we must be confident of our ability to define and measure the construct itself. To date, research has demonstrated that the ways in which substance use disorder criteria are operationalized or assessed can significantly affect the information we obtain from these diagnoses. For example, differing operationalizations of the same construct, such as impaired control over substance use, can result in markedly different estimates of prevalence. This points to the need for approaches that aim to improve the validity of diagnostic assessments during the measure development phase. METHOD: We performed a scoping review of the cognitive interviewing literature, a technique that aims to provide a systematic way of identifying and reducing measurement error associated with the structure and content of assessment items. Along with this, we apply cognitive interviewing to items assessing alcohol tolerance. RESULTS: We argue that cognitive interviewing is well suited for reducing measurement error in substance use disorder assessment items. CONCLUSIONS: Incorporating cognitive interviewing into the item generation stage of measure development for substance use disorder assessments is a worthwhile endeavor for improving validity.

Affect relative to day-level drinking initiation: Analyzing ecological momentary assessment data with multilevel spline modeling.

Affect regulation models state that affect both motivates and reinforces alcohol use. We aimed to examine whether affect levels and rates of change differed across drinking versus nondrinking days in a manner consistent with affect regulation models. Four hundred four regularly drinking adults, aged 18-70 years, completed ecological momentary assessments over 3 weeks. Participants provided positive affect (PA; enthusiastic, excited, happy) and negative affect (NA; distressed, sad) reports during all prompts; alcohol consumption reports were also provided. Multilevel spline models revealed that on drinking days, PA was higher and NA was lower both before and after drinking compared to matched times on nondrinking days. PA and NA were also higher and lower, respectively, both before and after drinking, when heavy drinking days were compared to moderate drinking days. Examination of affect rates of change revealed that (a) accelerating increases in PA and accelerating decreases in NA preceded drinking initiation, (b) PA increases and NA decreases were seen up to 2 hr after drinking initiation, and (c) pre- and postdrinking PA increases were larger on heavy versus moderate drinking days, whereas only postdrinking NA decreases were larger on heavy drinking days. Results supported affect regulation models while adding nuance, showing accelerating changes in predrinking affect on drinking days and pre- and postdrinking differences in affect levels and rates of change across days of varying drinking intensity. Beyond theory, our results suggest that accelerating changes in affect may provide a clue to future commencement of heavy drinking, which may aid momentary intervention development. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Assessment of the Prodromal Questionnaire-Brief Child Version for Measurement of Self-reported Psychoticlike Experiences in Childhood.

Importance: Childhood psychoticlike experiences (PLEs) are associated with greater odds of a diagnosis of a psychotic disorder during adulthood. However, no known, well-validated self-report tools have been designed to measure childhood PLEs. Objective: To examine the construct validity and psychometric properties of a measure of PLEs, the Prodromal Questionnaire-Brief Child Version (PQ-BC). Design, Setting, and Participants: This validation study used data from the first wave of the Adolescent Brain and Cognitive Development (ABCD) Study, a prospective longitudinal study aimed at assessing risk factors associated with adverse physical and mental health outcomes from ages 9 to 10 years into late adolescence and early adulthood. The population-based sample of 3984 children within the ABCD data set was recruited from 20 research sites across the United States. Data for this study were collected from June 1, 2016, through August 31, 2017. Main Outcomes and Measures: The PQ-BC Total and Distress scores were analyzed for measurement invariance across race/ethnicity and sex, their associations with measures of PLEs, and their associations with known correlates of PLEs, including internalizing and externalizing symptoms, neuropsychological test performance, and developmental milestones. Results: The study analyses included 3984 participants (1885 girls [47.3%] and 2099 boys [52.7%]; mean [SE] age, 10.0 [0.01] years). The results demonstrated measurement invariance across race/ethnicity and sex. A family history of psychotic disorder was associated with higher mean (SE) PQ-BC Total (3.883 [0.352]; ß = 0.061; 95% CI, 0.027-0.094) and Distress (10.210 [1.043]; ß = 0.051; 95% CI, 0.018-0.084) scores, whereas a family history of depression or mania was not. Higher PQ-BC scores were associated with higher rates of child-rated internalizing symptoms (Total score: ß range, 0.218 [95% CI, 0.189-0.246] to 0.273 [95% CI, 0.245-0.301]; Distress score: ß range, 0.248 [95% CI, 0.220-0.277] to 0.310 [95% CI, 0.281-0.338]), neuropsychological test performance deficits such as working memory (Total score: ß = -0.042 [95% CI, -0.077 to -0.008]; Distress score: ß = -0.051 [95% CI, -0.086 to -0.017]), and motor and speech developmental milestone delays (Total score: ß = 0.057 [95% CI, 0.026-0.086] for motor; ß = 0.042 [95% CI, 0.010-0.073] for speech; Distress score: ß = 0.048 [95% CI, 0.017-0.079] for motor; ß = 0.049 [95% CI, 0.018-0.081] for speech). Conclusions and Relevance: These results provide support for the construct validity and demonstrate adequate psychometric properties of a self-report instrument designed to measure childhood PLEs, providing evidence that the PQ-BC may be a useful measure of early risk for psychotic disorders. Furthermore, these data suggest that PLEs at school age are associated with many of the same familial, cognitive, and emotional factors associated with psychotic symptoms in older populations, consistent with the dimensionality of psychosis across the lifespan.

Adolescent brain cognitive development (ABCD) study: Overview of substance use assessment methods.

One of the objectives of the Adolescent Brain Cognitive Development (ABCD) Study (https://abcdstudy.org/) is to establish a national longitudinal cohort of 9 and 10 year olds that will be followed for 10 years in order to prospectively study the risk and protective factors influencing substance use and its consequences, examine the impact of substance use on neurocognitive, health and psychosocial outcomes, and to understand the relationship between substance use and psychopathology. This article provides an overview of the ABCD Study Substance Use Workgroup, provides the goals for the workgroup, rationale for the substance use battery, and includes details on the substance use module methods and measurement tools used during baseline, 6-month and 1-year follow-up assessment time-points. Prospective, longitudinal assessment of these substance use domains over a period of ten years in a nationwide sample of youth presents an unprecedented opportunity to further understand the timing and interactive relationships between substance use and neurocognitive, health, and psychopathology outcomes in youth living in the United States.

Assessment of Withdrawal and Hangover is Confounded in the Alcohol Use Disorder and Associated Disabilities Interview Schedule: Withdrawal Prevalence is Likely Inflated.

BACKGROUND: The Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV (AUDADIS-IV) and AUDADIS-5 are diagnostic interviews used in major epidemiological and other studies of alcohol use disorder (AUD). Much of what we know regarding the prevalence of AUD in the United States is based upon this interview. However, past research and meta-analytic evidence suggest that differential operationalization of the AUD criteria across instruments can lead to differential endorsement of symptoms and resulting AUD diagnosis rates. In particular, studies employing the AUDADIS are observed to have markedly higher endorsement rates of withdrawal than other large epidemiological studies. One explanation for this is that when assessing withdrawal, the AUDADIS combines effects from the morning after drinking with those from the days following, thereby conflating hangover and withdrawal. METHODS: This study addresses whether this operationalization confounds rates of endorsement when compared to simpler, less ambiguous hangover or withdrawal stems. To this aim, 497 college student drinkers were randomized into 1 of 3 stem conditions: (i) hangover (n = 164), (ii) withdrawal (n = 167), or (iii) combined AUDADIS-IV (n = 166). RESULTS: Across conditions, participants were more likely to report the occurrence of each withdrawal symptom in the combined stem condition than in the explicit withdrawal stem condition, but not in the explicit hangover stem condition. Within the combined stem condition, probed symptoms were more likely to be reported as a result of a hangover. CONCLUSIONS: The AUDADIS potentially results in false positives for withdrawal, arguably a pathognomonic symptom of alcoholism and, in turn, likely affects rates of the diagnosis of AUD.

False negatives in the assessment of lifetime alcohol use disorders: a serious but unappreciated problem.

OBJECTIVE: Some individuals will not meet criteria for a lifetime alcohol use disorder (AUD) at a baseline assessment but will at a follow-up measurement, but not because the disorder began after the initial evaluation. Despite several research implications, this type of unreliability of lifetime AUD estimates has not been studied extensively. The present study investigated the extent of false negatives in the assessment of lifetime AUDs using longitudinal data. METHOD: A prospective cohort of college freshmen (baseline N = 489) were assessed seven times between ages 18 and 34 years using the Diagnostic Interview Schedule. Individuals were categorized as false negatives at the index assessment using a retrospective (using Diagnostic and Statistical Manual of Mental Disorders, Third Edition [DSM-III], and DSM-IV data), a prospective (using DSM-III data only), and a combined approach (using DSM-III data only). RESULTS: For DSM-IV, of the 29 ostensible new onsets at a follow-up 5 years later (age approximately 34 years), 28 (96%) reported meeting AUD criteria before the index assessment (age approximately 29 years). For DSM-III, of the 25 ostensible new onsets, the retrospective, prospective, and combined approaches categorized 18 (72%) individuals as false negatives at the index assessment. CONCLUSIONS: These findings further demonstrate sensitivity issues with lifetime AUD assessments and call into question the validity of "onset" cases that rely on only two waves of data, especially when the follow-up assessment fails to reassess lifetime fully (i.e., across the entire drinking history).

Does hangover influence the time to next drink? An investigation using ecological momentary assessment.

BACKGROUND: Measures of hangover are associated with current and future problematic alcohol use. At present, it is not known whether these associations reflect any direct influence of hangover events on near-term drinking behaviors. The current study aimed to determine whether hangover following a drinking episode influences time to next drink (TTND) and, if so, to determine the direction of this effect and identify any moderating personal or contextual factors. METHODS: Community-recruited, frequent drinkers oversampled for current smoking (N = 386) carried electronic diaries for 21 days, reporting on drinking behaviors and other experiences. Survival analysis was used to model data from 2,276 drinking episodes, including 463 episodes that were followed by self-reported hangover in morning diary entries. RESULTS: When tested as the sole predictor in a survival model, hangover was associated with increased TTND. The median survival time was approximately 6 hours longer after episodes with hangovers compared to those without. In a multivariate model, hangover was only significant in the presence of interaction effects involving craving at the end of the index drinking episode and the occurrence of financial stressors. Additional predictors of TTND in the final multivariate model included age, lifetime alcohol use disorder diagnosis, typical drinking frequency, day of the week, and morning reports of craving, negative affect, and stressors after the index episode. There was no association between morning reports of hangover and contemporaneous diary ratings of likelihood of drinking later the same day. CONCLUSIONS: The findings suggest that hangover has, at best, a modest or inconsistent influence on the timing of subsequent alcohol use among frequent drinkers.

Dispositional drinking motives: associations with appraised alcohol effects and alcohol consumption in an ecological momentary assessment investigation.

Alcohol use can be understood as a strategic behavior, such that people choose to drink based on the anticipated affective changes produced by drinking relative to those produced by alternative behaviors. This study investigated whether people who report drinking for specific reasons via the Drinking Motives Questionnaire-Revised (DMQ-R; Cooper, 1994) actually experience the alcohol effects they purportedly seek. As a secondary goal, we examined relations between drinking motives and indices of the amount of alcohol consumed. Data were drawn from 3,272 drinking episodes logged by 393 community-recruited drinkers during a 21-day Ecological Momentary Assessment investigation. After accounting for selected covariates, DMQ-R enhancement motives uniquely predicted real-time reports of enhanced drinking pleasure. DMQ-R coping motives were associated with reports of increased drinking-contingent relief and punishment. Enhancement motives uniquely predicted consuming more drinks per episode and higher peak intra-episode estimated blood alcohol concentration. The findings extend the evidence for the validity of the DMQ-R motive scores by demonstrating that internal drinking motives (enhancement and coping) are related to the experienced outcomes of drinking in the manner anticipated by theory.

Low sensitivity to alcohol: relations with hangover occurrence and susceptibility in an ecological momentary assessment investigation.

OBJECTIVE: The current investigation tested whether low sensitivity to alcohol, as measured by the Self-Rating of the Effects of Alcohol (SRE) form, is associated with hangover occurrence or resistance, two potentially important predictors of later problematic drinking outcomes. METHOD: Drinkers who reported using alcohol at least four times in the past month (N = 402) completed the SRE at baseline and used ecological momentary assessment methods with an electronic diary to record drinking behaviors and related experiences over 21 days. Each morning, the diary assessed prior-night drinking behaviors and the presence of current hangover. RESULTS: After adjustments for sex, body weight, age, and smoking status, higher SRE scores (indicating lower alcohol sensitivity) predicted hangover occurrence on postdrinking mornings (odds ratio [OR] = 1.24 per interquartile range [IQR], p = .003). However, when the number of drinks consumed in the drinking episode was covaried, SRE scores were negatively associated with hangover (OR = 0.67 per IQR, p <.001). An interaction between SRE scores and the number of drinks consumed indicated that low-sensitivity drinkers tend to be differentially resistant to hangover at a given number of drinks. Higher SRE scores were associated with consuming more drinks on average (generalized estimating equations coefficient = 2.20 per IQR, p <.001). CONCLUSIONS: Individuals lower in alcohol sensitivity appear to be more resistant to hangovers per unit of alcohol. However, they are also more likely to engage in excessive drinking, and this may account for their increased odds of experiencing hangover during an arbitrary monitoring period. Heavy consumption, hangover resistance, and hangover frequency may each be manifestations of low sensitivity to alcohol, an established risk factor for alcohol use disorder.

The subjective effects of alcohol-tobacco co-use: an ecological momentary assessment investigation.

Alcohol and tobacco use covary at multiple levels of analysis, and co-use of the 2 substances may have profound health consequences. To characterize the motivationally relevant processes contributing to co-use, the current study used ecological momentary assessment (EMA) to examine the subjective consequences of naturally occurring simultaneous use of alcohol and tobacco. Current smokers who reported frequently drinking alcohol (N=259) used electronic diaries to monitor their daily experiences for 21 days. Participants responded to prompted assessments and also initiated recordings when they smoked a cigarette or completed the first drink in a drinking episode. Momentary reports of smoking and alcohol consumption were associated with one another, and these effects remained after adjustment for occasion- and person-level covariates. When participants consumed alcohol, they reported increased pleasure and decreased punishment from the last cigarette. Smoking was associated with small increases in pleasure from the last drink. Ratings of buzzed and dizzy were synergistically affected by co-use of alcohol and tobacco. Co-use was also followed by higher levels of craving for both alcohol and tobacco. Results point to the importance of reward and incentive processes in ongoing drug use and suggest that alcohol intensifies real-time reports of the motivational consequences of smoking more strongly than smoking affects corresponding appraisals of alcohol effects.

Should the reorganization of addiction-related research across all the National Institutes of Health be structural?--The devil is truly in the details.

The recent proposal to dissolve the National Institute on Alcohol Abuse and Alcoholism and National Institute on Drug Abuse and create a new institute for substance use, abuse, and addiction will require significant effort by the staff of both institutes, the Advisory Councils, and outside experts to overcome complex challenges that could threaten its success. Although integration of the grants portfolios can be achieved, harmonization of goals and policies related to legal use of alcohol versus illegal consumption of drugs will present serious challenges. Consolidating the infrastructure of the 2 existing institutes would entail avoiding encroachment on grant funding. A new institute for substance use, abuse, and addiction would require an enormous amount of cooperation from other institutes as the portfolios of research on alcohol, tobacco, and other drug abuse should logically be transferred to the new institute. In the near term, a structural reorganization would be less efficient and more costly than the individual institutes are currently. Increasing efficiency and reducing costs over time will necessitate careful strategic planning. Success in this difficult task would be made easier and less costly by first implementing carefully placed building blocks of increasing functional reorganization. The newly created institute should increase opportunities for specialization within disorders of addiction, attract new leadership, and build a novel strategic plan that will energize scientists and staff and incorporate ideas of stakeholders to advance the public good in preventing and treating alcohol, tobacco, and all addictions. Attention must be paid to the devil in the details.

A new minimum legal drinking age (MLDA)? Some findings to inform the debate.

Despite support that the minimum legal drinking age (MLDA) of 21 is an important public health provision in the United States, a group of college presidents are petitioning for the MLDA to be lowered. To inform this debate, we examined whether heavy and risky drinking was associated with a stance to lower the MLDA in 865 college students under the age of 21. Results showed that, in comparison to other students, heavy/risky drinkers more often had a stance to lower the MLDA. Thus, for students, the MLDA debate seems to be less a philosophical issue about prohibition and harm reduction, and appears to be more a political stance that reflects students' concurrent behaviors. We discuss how drinking and MLDA laws in Europe might compare with the United States, and how future policy work might benefit from empirical and cross-cultural study.