Topiramate and motivational enhancement therapy for cannabis use among youth: a randomized placebo-controlled pilot study.

Cannabis misuse accounts for nearly all of the substance abuse treatment admissions among youth in the United States. Most youth do not experience sustained benefit from existing psychosocial treatments; however, medication development research for treating adolescent cannabis misuse is almost nonexistent. We conducted a double-blind, placebo-controlled, pilot study to test the potential efficacy of topiramate plus motivational enhancement therapy (MET) for treating cannabis use among adolescents. Sixty-six heavy cannabis users, ages 15 to 24 years, were randomized to one of two 6-week treatment conditions: topiramate plus MET or placebo plus MET. Topiramate was titrated over 4 weeks then stabilized at 200 mg/day for 2 weeks. MET was delivered biweekly for a total of three sessions. Only 48 percent of youths randomized to topiramate completed the 6-week trial (n = 19), compared with 77 percent of youths in the placebo condition (n = 20). Adverse medication side effects were the most common reason for withdrawal among participants in the topiramate group. Latent growth models showed that topiramate was superior to placebo for reducing the number of grams smoked per use day, but it did not improve abstinence rates. The same pattern of results was found when values for missing outcomes were imputed. We show that topiramate combined with MET demonstrated efficacy for reducing how much cannabis adolescents smoked when they used but did not affect abstinence rates. The magnitude of this effect was modest, however, and topiramate was poorly tolerated by youths, which calls into question the clinical importance of these findings.

Biobehavioral mechanisms of topiramate's effects on alcohol use: an investigation pairing laboratory and ecological momentary assessments.

Topiramate reduces drinking, but little is known about the mechanisms that precipitate this effect. This double-blind randomized placebo-controlled study assessed the putative mechanisms by which topiramate reduces alcohol use among 96 adult non-treatment-seeking heavy drinkers in a laboratory-based alcohol cue reactivity assessment and in the natural environment using ecological momentary assessment methods. Topiramate reduced the quantity of alcohol heavy drinkers consumed on drinking days and reduced craving while participants were drinking but did not affect craving outside of drinking episodes in either the laboratory or in the natural environment. Topiramate did not alter the stimulant or sedative effects of alcohol ingestion during the ascending limb of the blood alcohol curve. A direct test of putative mechanisms of action using multilevel structural equation mediation models showed that topiramate reduced drinking indirectly by blunting alcohol-induced craving. These findings provide the first real-time prospective evidence that topiramate reduces drinking by reducing alcohol's priming effects on craving and highlight the importance of craving as an important treatment target of pharmacotherapy for alcoholism.

Resilience in Organ Transplantation: An Application of the Connor-Davidson Resilience Scale (CD-RISC) With Liver Transplant Candidates.

End-stage liver disease (ESLD) is a chronic and debilitating condition associated with substantial psychological stress, morbidity, and mortality. The Connor-Davidson Resilience Scale (CD-RISC; Connor & Davidson, 2003 ) is a commonly used resilience measure. This research examined the validity of the CD-RISC among ESLD patients (N = 120) using exploratory factor analysis. Results supported a single-factor solution after removing poorly loading items. The CD-RISC also was correlated with measures of depression, anxiety, quality of life, social support, age, and cognitive ability, thus providing evidence to support its construct validity. Future research should confirm this factor structure and examine its predictive validity prior to widespread use among ESLD patients. This research represents the first step in this process and proposes an alternative version of the CD-RISC for this population.

Perceived danger while intoxicated uniquely contributes to driving after drinking.

BACKGROUND: Previous findings suggest that alcohol alters perceptions of risky behaviors such as drinking and driving. However, studies testing these perceptions as a predictor of drinking and driving typically measure these perceptions while participants are sober. This study tested whether the perceived danger of driving after drinking assessed while intoxicated was associated with increased willingness to drive and self-reported drinking-and-driving behavior over and above perceptions assessed while sober. Additionally, we tested the effect of acute tolerance on the perceived danger of driving after drinking assessed on the ascending and descending limbs of the breath alcohol concentration (BrAC) curve. METHODS: Eighty-two young adults attended 2 counterbalanced laboratory sessions. In one session, participants consumed a moderate dose of alcohol (men: 0.72 g/kg, women: 0.65 g/kg) and reported their perceived danger of driving and willingness to drive at multiple points across the BrAC curve. On a separate occasion, participants remained sober and appraised the dangerousness of driving at a hypothetical, illegal BrAC. RESULTS: Perceptions of the dangerousness of driving following alcohol administration were associated with increased willingness to drive and higher rates of self-reported drinking-and-driving behavior over and above perceptions reported when sober. Furthermore, perceived danger was reduced on the descending limb of the BrAC curve, compared with the ascending limb, suggesting the occurrence of acute tolerance. CONCLUSIONS: Results from this study suggest that intoxicated perceptions are uniquely associated with drinking-and-driving decisions and that the perceived danger of drinking and driving is lower on the descending limb of the BrAC curve. Efforts to prevent alcohol-impaired driving have focused on increasing awareness of the danger of driving after drinking. Prevention efforts may be enhanced by educating drivers about how intoxication can alter perceived danger, and interventions may benefit from targeting perceptions of dangerousness while individuals are intoxicated in addition to when they are sober.

Craving and acute effects of alcohol in youths' daily lives: Associations with alcohol use disorder severity.

Identifying factors associated with the progression from recreational to pathological drinking in youth holds high clinical and theoretical importance. The present study tested cross-sectional associations of alcohol use disorder (AUD) severity with putative mechanisms of AUD progression among youth ages 15-24 years, namely acute subjective effects of alcohol and craving. Male (n = 44) and female (n = 42) youth completed ecological momentary assessments when not drinking, just before drinking, and while drinking in the natural environment via handheld wireless devices. Youth were recruited from the community and were frequent and heavy drinkers, the majority (93%) with at least 1 AUD symptom (M = 3.4, SD = 2.4). Findings from youths' daily lives suggested that how youth feel while they drink depends, in part, on their severity of AUD pathology. In support of hypotheses, youths with more progressed drinking pathology (i.e., those with more symptoms of AUD) reported greater reductions in craving and tension while drinking, relative to nondrinking times. In partial support of hypotheses, males with greater AUD symptomatology reported marginally attenuated increases in stimulatory states while drinking; however, contrary to hypotheses, females with greater AUD symptomatology reported enhanced increases in stimulation while drinking. This research leveraged ecological momentary assessment methods to study subjective responses to alcohol and craving in youths' daily lives and to cross-sectionally test putative associations with AUD etiology. This work adds to literature supporting subjective responses to alcohol in the pathogenesis of alcoholism, specifically by highlighting their importance during the period in life when alcohol problems typically first emerge. (PsycINFO Database Record

Social contextual risk factors for stimulant use among adolescent American Indians.

OBJECTIVE: Stimulants are the most common and efficacious treatment for Attention-Deficit Hyperactivity Disorder (ADHD). We examined the relationship between stimulant misuse and social factors that could be malleable to prevention among American Indian (AI) adolescents. METHOD: Participants were AI students (N=3498) sampled from 33 schools in 11 states. Participants completed the American Drug and Alcohol Survey. A multilevel analytic approach was used to evaluate the effects of participant-level (level 1) variables (i.e., gender, grade, peer, school, family, stimulant prescribed by doctor) on lifetime and current simulant use to 'get high.' RESULTS: Nearly 7% of our sample had been prescribed stimulants and nearly 6% of the sample reported using stimulants to get high. Age [OR=1.22; 95% CI=1.09, 1.36, p<0.001], perception of peer substance use [OR=1.19; 95% CI=1.14, 1.23, p<0.001], parental monitoring [OR=0.96; 95% CI=0.92, 1.99, p=0.04], and stimulants prescribed by a doctor [OR=8.79, 95% CI=5.86, 13.18, p<0.001] were associated with ever using stimulants to get high. Perception of peer substance use, [b=0.09, SE=0.02, p<0.001, 95%CI [0.05, 0.13], and having stimulants prescribed by a doctor, [b=0.58, SE=0.21, p=0.006, 95%CI [0.17, 0.99], were associated with frequency of past month use to get high. There was also a significant quadratic effect for parental monitoring, suggesting that low and high levels were associated with increased stimulant use. CONCLUSIONS: Our results suggest a need for prevention efforts to be directed to AI youth who are prescribed stimulants.

Empirical Profiles of Alcohol and Marijuana Use, Drugged Driving, and Risk Perceptions.

OBJECTIVE: The present study sought to inform models of risk for drugged driving through empirically identifying patterns of marijuana use, alcohol use, and related driving behaviors. Perceived dangerousness and consequences of drugged driving were evaluated as putative influences on risk patterns. METHOD: We used latent profile analysis of survey responses from 897 college students to identify patterns of substance use and drugged driving. We tested the hypotheses that low perceived danger and low perceived likelihood of negative consequences of drugged driving would identify individuals with higher-risk patterns. RESULTS: Findings from the latent profile analysis indicated that a four-profile model provided the best model fit. Low-level engagers had low rates of substance use and drugged driving. Alcohol-centric engagers had higher rates of alcohol use but low rates of marijuana/simultaneous use and low rates of driving after substance use. Concurrent engagers had higher rates of marijuana and alcohol use, simultaneous use, and related driving behaviors, but marijuana-centric/simultaneous engagers had the highest rates of marijuana use, co-use, and related driving behaviors. Those with higher perceived danger of driving while high were more likely to be in the low-level, alcohol-centric, or concurrent engagers' profiles; individuals with higher perceived likelihood of consequences of driving while high were more likely to be in the low-level engagers group. CONCLUSIONS: Findings suggested that college students' perceived dangerousness of driving after using marijuana had greater influence on drugged driving behaviors than alcohol-related driving risk perceptions. These results support targeting marijuana-impaired driving risk perceptions in young adult intervention programs.

Subjective alcohol responses in a cross-sectional, field-based study of adolescents and young adults: Effects of age, drinking level, and dependence/consequences.

BACKGROUND: Adolescents are physically, cognitively, socially, and emotionally different than adults in ways that may partially explain why alcohol misuse typically develops during this period. Ample animal-science evidence and nascent ecological evidence points toward developmentally limited differences in sensitivity to alcohol's stimulatory and sedative effects. Field-based research methods were used to test for such age-related differences in a sample of adolescents through young adults. Potential moderating influences of estimated blood alcohol content (eBAC), as well as typical consumption and level of dependence/consequences were explored. METHODS: Subjective alcohol responses were collected from 1,364 participants, aged 17 to 32 years, recruited outside of venues where drinking takes place in a small metropolitan bar district. RESULTS: Self-reports of stimulatory response to alcohol were age-related, such that younger participants reported increased subjective stimulation at the time of data collection relative to older participants. Age-related differences in stimulatory responses were more pronounced at lower eBACs and among younger participants who typically drank more heavily. Stimulatory responses generally diminished among older than younger participants, although individuals with greater dependence/consequences consistently reported greater stimulation from drinking. Contrastingly, age, typical consumption, and dependence/consequences were not related to sedation in this sample. CONCLUSIONS: This research provides cross-sectional evidence to support age-, consumption-, and dependence/consequences-related differences in stimulatory alcohol responses among adolescents and young adults assessed within a bar-area context. While cross-sectional, the results of this field-based study provide support for the theory that addiction liability is developmentally linked and associated, in part, with age-related differences in subjective alcohol responses.

Emerging Pharmacologic Treatments for Adolescent Substance Use: Challenges and New Directions.

Adolescence is a key period in the development of substance use and misuse. Substance use typically begins during adolescence and prevalence rates for many substance use disorders peak before age 21 years. Yet, despite clinical demand, treatments for youth rely almost entirely on psychosocial interventions that yield only modest benefit. One potential way to improve treatment effects is to augment the best available psychosocial interventions with pharmacotherapy. Although pharmacotherapy research has advanced care for adults with substance use disorders, no medication is indicated for adolescents and controlled trials with teenagers are scant. Optimizing treatments for youth will require closing this important gap in medication development research. In this paper we review the paucity of pharmacotherapy research for adolescent substance misuse, and we discuss how we can leverage human laboratory paradigms and technology to advance our understanding regarding if and how medications may improve treatment options for youths.

Within-person associations between daily motivation and self-efficacy and drinking among problem drinkers in treatment.

Gaining a better understanding of the change process holds promise to improve alcohol treatment. Ecological momentary assessment (EMA) coupled with intensive longitudinal data (ILD) approaches have been proposed as promising methods that can advance change process research but have been used infrequently in alcohol use disorder (AUD) treatment research. The current study used these approaches to examine the within-person associations of motivation and self-efficacy and drinking among treatment-seeking problem drinkers. Participants (N = 96) received daily EMA surveys before, during, and after treatment for 7 weeks spread over a 9-month period. Multilevel modeling was used to test the within-person relationships between the change processes and drinking, controlling for between-person associations and prior drinking. Results indicated that daily fluctuations in motivation and self-efficacy significantly predicted drinking over the next 24 hours; however, several theory-driven hypotheses regarding factors that might moderate that relationship were not supported. Overall, results support the advantages of EMA and ILD as methods that can advance AUD treatment research. (PsycINFO Database Record

Latent growth classes of alcohol-related blackouts over the first 2 years of college.

Alcohol-related blackouts are common among college student drinkers. The present study extends prior work by examining latent growth classes of blackouts and several predictors of class membership. Participants (N = 709 college drinkers) completed a baseline survey at college entry and biweekly online assessments throughout freshman and sophomore years. Results revealed 5 latent growth class trajectories, reflecting varying experiences of blackouts at the beginning of college and differential change in blackouts over time. The largest class represented a relatively low-risk group (low decrease; 47.3%) characterized by endorsement of no or very low likelihood of blackouts, and decreasing likelihood of blackouts over time. Another decreasing risk group (high decrease; 11.1%) initially reported a high proportion of blackouts and had the steepest decrease in blackout risk over time. A small percentage showed consistently high likelihood of blackouts over time (high stable; 4.1%). The remaining 2 groups were distinguished by relatively moderate (moderate stable; 14.9%) and lower (low stable; 22.6%) likelihood of blackouts, which remained stable over time. Comparisons between classes revealed that students with greater perceived peer drinking, perceived peer approval of drinking, and enhancement motives upon entry to college tended to be in higher risk groups with consistent experiences of blackouts over time, whereas blackout likelihood decreased over time for students with greater conformity motives. Findings suggest that precollege preventive interventions may be strengthened by considering not only factors related to current risk for blackouts and other alcohol-related consequences, but also those factors related to persistence of these behaviors over time. (PsycINFO Database Record

Acute subjective response to alcohol as a function of reward and punishment sensitivity.

Individual differences in subjective response to alcohol play a crucial role in the development of heavy drinking and related problems. In light of this, a growing focus of research has been identifying factors that contribute to differences in response. The aim of the present study was to determine whether individual differences in the subjective experience of rewarding and aversive effects of alcohol are a specific manifestation of general differences in reward and punishment sensitivity. Eighty-nine participants (M age=22.4, SD=1.9; 47.2% women) consumed a moderate dose of alcohol, i.e., peak breath alcohol concentration (BrAC)≈0.080g%, and rated their level of stimulation and sedation at seven timepoints over the BrAC curve. Sensitivity to reward and punishment were assessed by a self-report questionnaire prior to consumption. Multilevel growth models showed that post-consumption changes in stimulation ratings varied as a function of participants' level of reward and punishment sensitivity. Drinkers more sensitive to reward reported feeling more stimulated shortly after drinking and exhibited an attenuated rate of decline in stimulation over the blood alcohol curve, relative to drinkers with less strong reward sensitivity. Reward sensitivity was not related to subjective ratings of sedation, and punishment sensitivity was not related to either stimulation or sedation ratings. Findings suggest that reward sensitivity may increase risk for alcohol misuse among young adult social drinkers by increasing their subjective feelings of stimulation while drinking.

The Protective Behavioral Strategies Scale-20: improved content validity of the Serious Harm Reduction subscale.

Excessive drinking in college leads to serious harms, but students who use protective behavioral strategies (PBS) avoid negative consequences by drinking in a safer manner. This study aimed to increase the content validity of the Serious Harm Reduction (SHR) subscale of the most widely used measure of PBS, the Protective Behavioral Strategies Scale (PBSS: Martens et al., 2005). An initial item pool was developed from literature on college student drinking, existing lists of drinking control strategies, and an online pilot survey of college students (N = 1,832). Items were also evaluated by focus groups of experts and members of the target population. Next, 1,376 students (57.9% women; Mage = 18.5 years; 86.3% White) completed questionnaires online. A subset (n = 170; 12.4%) completed a second survey 4-6 weeks later to examine test-retest reliability and criterion-related validity. The remaining students (n = 1,206) were divided into equal development and validation samples. Analyses included exploratory and confirmatory factor analysis of the development sample, factor structure replication, and gender invariance testing in the validity sample. Results of this process produced the PBSS-20, with an expanded SHR scale of eight items. The revised SHR scale demonstrated improved internal consistency and was associated with a broader range of alcohol-related negative consequences at follow-up. Given its focus on reducing serious harms, the SHR scale is arguably the most clinically relevant PBSS factor, and those who use this measure will benefit from the expanded breadth of SHR content and improved psychometric properties of the PBSS-20.

Ecological evidence that affect and perceptions of drink effects depend on alcohol expectancies.

AIMS: (1) To compare affective changes over drinking and non-drinking days among frequent drinkers and (2) to evaluate whether drinkers' expectations influence affective changes and perceived pleasure and relief from drinking. DESIGN: Observational study involving ecological momentary assessments collected via electronic diaries during the course of 3 weeks. SETTING: Drinkers' usual settings in Columbia, MO, USA. PARTICIPANTS: A total of 400 adult, frequent drinkers, aged 18-70 years. MEASUREMENTS: Ecological assessments included morning reports, pre-drinking random prompts, user-initiated first-drink reports and device-prompted follow-ups over drinking episodes. Participants rated positive (enthusiastic, excited, happy) and negative (distressed, sad) affect and perceived pleasure and relief from drinking in real time. A self-report questionnaire completed at baseline evaluated expectancies for enhanced sociability and tension reduction from drinking. FINDINGS: Relative to affective changes over non-drinking days, positive affect increased prior to drinking [95% confidence interval (CI) = 0.004, 0.023], and at first drink (95% CI = 0.238, 0.317), whereas negative affect decreased prior to drinking (95% CI = - 0.007, 0.000) and at first drink (95% CI = - 0.154, - 0.098). Sociability expectancies augmented increases in positive affect prior to drinking (95% CI = 0.009, 0.027) and at first drink (95% CI = 0.017, 0.169). Sociability expectancies also enhanced perceived pleasure from first drinks (95% CI = 0.046, 0.318). Tension-reduction expectancies attenuated decreases in negative affect at first drink (95% CI = - 0.133, - 0.029), but augmented perceived relief from first drinks (95% CI = 0.001, 0.304). CONCLUSIONS: Although theoretical models tend to focus on negative affective outcomes of drinking, changes in positive affect prior to drinking and early in drinking episodes are important for maintaining drinking behavior. Frequent drinkers' expectations for enhanced sociability or tension reduction from drinking influence their affective experiences over drinking days and perceptions of pleasure and relief from drinking.

An event-level investigation of hangovers' relationship to age and drinking.

Animal and human data suggest that adolescents experience hangover effects that are distinct from adults. The present study used ecological momentary assessment (EMA) methods to examine the temporal relationships between drinking and hangovers, and how this varied by age and sex. We hypothesized that alcohol's dose-dependent effects on hangover severity are more pronounced among adolescents and young adults than older drinkers. We also explored whether greater hangover severity would lead to a lower likelihood and volume of alcohol use later the same day. Data were pooled from 4 studies of drinkers (N = 274; ages 15 to 66 years) who completed a 4- to 14-day (M = 7.46, SD = 1.13) EMA monitoring period. Each morning, participants recorded how much alcohol they consumed the day before and rated their hangover severity. Participants who consumed a greater quantity of alcohol the prior day reported more severe hangover symptoms; however, there was an interaction between drinking volume and age, such that hangover was more severe among younger drinkers, especially at higher drinking levels. More severe hangover symptoms did not predict the likelihood of drinking later that day; however, on drinking days, more severe hangover symptoms predicted lower quantities of alcohol use later that day. This event-level effect did not vary as a function of age. Study outcomes did not vary by sex. Our findings suggest that younger drinkers experience more severe hangovers, and that greater hangover results in lighter drinking later that same day regardless of age.

Undifferentiated negative affect and impulsivity in borderline personality and depressive disorders: A momentary perspective.

Individuals with borderline personality disorder (BPD) often report experiencing several negative emotions simultaneously, an indicator of "undifferentiated" negative affect. The current study examined the relationship between undifferentiated negative affect and impulsivity. Participants with a current BPD (n = 67) or depressive disorder (DD; n = 38) diagnosis carried an electronic diary for 28 days, reporting on emotions and impulsivity when randomly prompted (up to 6 times per day). Undifferentiated negative affect was quantified using momentary intraclass correlation coefficients, which indicated how consistently negative emotion items were rated across fear, hostility, and sadness subscales. Undifferentiated negative affect at the occasion-level, day-level, and across 28 days was used to predict occasion-level impulsivity. Multilevel modeling was used to test the hypothesis that undifferentiated negative emotion would be a significant predictor of momentary impulsivity above and beyond levels of overall negative affect. Undifferentiated negative affect at the occasion and day levels were significant predictors of occasion-level impulsivity, but undifferentiated negative affect across the 28-day study period was only marginally significant. Results did not differ depending on BPD or DD status, though individuals with BPD did report significantly greater momentary impulsivity and undifferentiated negative affect. Undifferentiated negative affect may increase risk for impulsivity among individuals with BPD and depressive disorders, and the current data suggest that this process can be relatively immediate as well as cumulative over the course of a day. This research supports the consideration of undifferentiated negative affect as a transdiagnostic construct, but one that may be particularly relevant for those with BPD.

Spirituality and treatment of addictive disorders.

Spirituality is generally protective against the initiation of alcohol and drug use and progression to disordered use. In addition, mutual-help organizations, such as Alcoholics Anonymous, were founded on spiritual principles, and reliance on a "higher power" is a central component of the 12 steps. Despite this, spirituality is not commonly addressed in formal treatment of addictions. The purpose of this paper is to provide a summary of the role of spirituality in the development and recovery from addictive disorders for health care professionals.

Testing measurement invariance of the protective behavioral strategies scale in college men and women.

This study tested whether the measurement parameters of the Protective Behavioral Strategies Scale (PBSS; Martens et al., 2005) were equivalent for men and women in a college student sample. Multi-group confirmatory factor analyses tested whether a similar 3-factor latent structure was shared across gender groups and whether item origins (i.e., thresholds) and the strength of associations between individual items and latent factors (i.e., factor loadings) were equivalent across gender groups. Multiple indicators multiple causes (MIMIC) models tested whether gender differences in measurement parameters were explained by drinking patterns among college men and women. Results evidenced significant measurement bias (i.e., non-invariant measurement parameters) across gender groups at both the factor structure and individual item level. In addition, MIMIC models suggested that gender differences in item loadings and thresholds were not better explained by discrepancies in drinking patterns among male and female college students. Findings indicate that gender differences in latent factor scores may reflect measurement bias rather than true mean differences between gender groups, restricting meaningful comparisons of PBSS scores between college men and women. Implications for the assessment of specific strategies as well as clinical interventions among college students that include components on protective behavioral strategies are discussed.

Relations Among Caffeine Consumption, Smoking, Smoking Urge, and Subjective Smoking Reinforcement in Daily Life.

Caffeine consumption and cigarette smoking tend to occur within the same individuals and at the same time. One potential explanation for this co-use is that caffeine consumption increases subjective smoking reinforcement. Electronic diaries were used to collect momentary reports of smoking, caffeine consumption, temptation/urge to smoke, and subjective smoking reinforcement in 74 prequit smokers. Momentary reports of caffeine consumption and smoking were associated, replicating previous findings. These results remained significant when contextual factors (time of day, weekday/weekend, presence of others, presence of others smoking, location, and past hour alcohol consumption) were covaried. Caffeine consumption was also associated with positive cigarette appraisals and reports of strong temptation/urge to smoke and urge reduction from the prior cigarette. Under the conditions of caffeine consumption versus at other times, smokers were significantly more likely to report their last cigarette as producing a rush/buzz, being pleasant, relaxing, and tasting good. The effects for temptation/urge to smoke and rush/buzz varied as a function of latency since smoking. Caffeine consumption increased reports of urge to smoke and rush/buzz only when smoking occurred more than 15 minutes prior to the diary entry. Findings suggest that caffeine consumption influences some aspects of smoking motivation or affects memorial processing of smoking reinforcement.

Characterizing subjective responses to alcohol among adolescent problem drinkers.

Theoretical models of alcoholism emphasize the acute reinforcing properties of alcohol as chief determinants of drinking, and animal research suggests adolescents are uniquely sensitive to these effects. Human studies of these phenomena, however, are virtually nonexistent. We used ecological momentary assessment methods to capture adolescents' subjective responses to alcohol in real time in their natural environments. Adolescent participants were 22 problem drinkers, ages 15 to 19 years (M = 18.3, SD = 0.09; 55% female; 55% alcohol dependent). Participants consumed alcohol on 38% of days during a 1-week monitoring period, with an average of 5 drinks per occasion. Momentary data revealed that adolescents experience decreased stimulation and increased sedation and "high" across the ascending limb of the blood alcohol curve. Notably, greater craving predicted higher volumes of subsequent alcohol consumption during the episode, whereas greater "high" attenuated use. To test for developmental differences in these effects, we pooled these data with data from a similarly ascertained sample of 36 adult heavy drinkers, ages 24 to 64 years (M = 38.1, SD = 11.8; 50% female; 61% alcohol dependent). Adolescents were more sensitive to the stimulant effects of alcohol than adults. This study provides novel data on how adolescent problem drinkers experience alcohol in their natural contexts and illustrates how these effects, which appear to differ from adult problem drinkers, confer liability for future drinking.