Food approach and avoidance craving: A partial test of the Ambivalence Model of Craving.

Accumulating evidence from both cross-sectional and cue-reactivity studies supports the application of the Ambivalence Model of Craving (AMC) from the substance use literature to food craving. The focus of this extant work has been on the association between the two dimensions of food craving (approach and avoidance) and disordered eating behaviors. The present study extended existing validity data by investigating approach and avoidance food craving profiles and their associations with 1) disordered eating behaviors and 2) thinness/restriction and eating expectancies - a risk factor for disordered eating that is explicitly described by the AMC. It was anticipated that food craving profiles would parallel those defined by the AMC (i.e., approach oriented, avoidance oriented, ambivalent, indifferent) and that profiles defined by high avoidance food craving would be higher in compensatory behaviors, restricting behaviors, and thinness/restriction expectancies, while those defined by high approach food craving would be higher in binge eating and eating expectancies. A sample of 407 undergraduate students (54% female, 47% non-Hispanic White; Mage = 21 years) reported demographics, food craving disordered eating behaviors, and thinness/restriction and eating expectancies via an anonymous online survey. Latent profile analysis was used to test hypotheses. Hypotheses were partially supported. Four profiles were identified, but similar levels of approach and avoidance food craving were observed in each profile, with the intensity of the cravings increasing across the four profiles. Endorsement of disordered eating behaviors and expectancies also increased in intensity across the profiles. Findings suggest an additive, rather than interactive, effect of food craving.

Establishing Motivational Profiles to Drink among College Students: Converging Patterns Using Multiple Theories of Alcohol use.

Objective: While college student drinking has been studied utilizing many different theories and approaches, it is unclear how these theories may overlap in their explanation of problematic drinking. Rather than relying on one theory, examining overlap between multiple theories of alcohol use may lead to a better understanding of the motivational process underlying drinking behavior. The current study proposes that the Ambivalence Model of Craving, Behavioral Economics, and Alcohol Outcome Expectancy Theory account for the same underlying anticipatory process and sought to demonstrate this by establishing motivational profiles utilizing constructs within each theory. Methods: A total of 318 college student drinkers completed a series of surveys assessing their drinking behavior and the measures pertaining to each theory (i.e., Approach and Avoidance of Alcohol Questionnaire, Alcohol Purchase Task, Alcohol Expectancy Questionnaire). A latent profile analysis was used to establish profiles of motivational tendencies. Results: Results from the latent profile analysis indicated four profiles emerged, three of which were consistent with our hypotheses: approach, avoidance, and indifferent. The fourth motivational profile appeared to represent drinkers with an emerging approach tendency but relatively newer to drinking. The lack of ambivalent profile suggests that avoidant tendencies may develop later in response to an accumulation of experience with drinking. Lastly, these profiles demonstrated expected relationships with drinking behavior. Conclusion: This study is unique in its attempt to highlight similarities between theories. Results provide a useful integration of theories to allow for a more generalized understanding of motivational tendencies that develop in response to drinking experiences.

Effects of Therapist Feedback on the Therapeutic Alliance and Alcohol Use Outcomes in the Outpatient Treatment of Alcohol Use Disorder.

BACKGROUND: It is widely accepted that the therapeutic alliance (TA) is a mediator of psychotherapy effects, but evidence is sparse that the TA is an actual mechanism of behavior change. The purpose of this study was to provide the first systematic evidence regarding the TA as a mechanism of change in the treatment of alcohol use disorder (AUD). METHODS: Participants were 155 adult men and women presenting for individual outpatient treatment of AUD. Each was randomly assigned to 1 of 6 experienced therapists, who did or did not receive over 3 study phases postsession participant feedback on his/her ratings of the TA. All participants received a 12-session version of cognitive behavioral therapy for AUD. Participants rated the TA by use of the California Psychotherapy Alliance Scale (CALPAS) and reported their daily alcohol consumption between sessions and for 1 year posttreatment by use of the timeline followback interview. Multilevel statistical models that partitioned within- and between-participant effects and between-therapist effects were run to test the effects of feedback condition on the alliance and alcohol use, and the effects of the alliance on alcohol use. RESULTS: The study's main hypotheses that feedback causes an enhanced therapeutic alliance and that the alliance is associated with better alcohol use outcomes were not supported. CONCLUSIONS: Several methodological and substantive reasons for the pattern of findings are suggested, as well as directions for future research that would advance study of the TA as a mechanism of change in psychotherapy and in studying therapist effects on outcomes in general.

Reductions in Drinking Predict Increased Distress: Between- and Within-Person Associations between Alcohol Use and Psychological Distress During and Following Treatment.

BACKGROUND: As the nature of the association between alcohol use disorder (AUD) and other disorders is not well understood, the ways in which psychological distress changes during the course of treatment for AUD are relatively unknown. Existing literatures posit 2 competing hypotheses such that treatment for AUD concurrently decreases alcohol use and psychological distress or treatment for AUD decreases alcohol use and increases psychological distress. The current study examined the ways in which psychological distress changed as a function of treatment for AUD, including the relationship between psychological distress and drinking behaviors. METHODS: Secondary data analysis was conducted on an existing clinical trial dataset that investigated the effect of cognitive-behavioral therapy and therapeutic alliance feedback on AUDs. Specifically, data collected at baseline, posttreatment, 3-month, 6-month, 9-month, and 12-month follow-up assessments were examined. RESULTS: Results indicated decreases in heavy drinking days, increases in percentage of days abstinent, and decreases in overall psychological distress. Findings also revealed that changes in psychological distress did not predict changes in drinking at the next time interval; however, decreases in drinking predicted higher psychological distress at the next assessment. Further, average levels of psychological distress were positively associated with rates of drinking. CONCLUSIONS: The current study provides some insight into how psychological distress changes during the course of treatment for AUD, including the relationship between changes in drinking and such symptoms. Future research should continue to explore these relationships, including the ways in which treatment efforts can address what may be seen as paradoxical effects.

Support for a two-dimensional model of food craving using self-report questionnaire and cue-reactivity methodologies.

OBJECTIVE: Evidence supports the transdiagnostic importance of food cravings across the spectrum of disordered eating behaviors. The ambivalence model of craving (AMC), originally applied to substance use craving, highlights the need to consider not just the motivational state of "approach," but also that of "avoidance." The aims of this project were to (a) extend the existing literature by providing additional psychometric support for the food approach and avoidance questionnaire (FAAQ), (b) extend research supporting the validity of applying the AMC to disordered eating by incorporating a cue-reactivity paradigm, and (c) examine the unique contributions of the FAAQ and in-the-moment cue-elicited craving to the prediction of disordered eating. METHOD: Participants (N = 223; 52.0% female, age M = 20.51 years) were recruited from a large southeastern university. Participants completed a food cue-reactivity paradigm and measures of food craving and disordered eating in a lab setting. RESULTS: The factor structure and construct validity of the FAAQ was supported and both general states of food craving (i.e., FAAQ) and cue-elicited food craving were incrementally associated with the spectrum of disordered eating behaviors. As anticipated, both FAAQ and in-the-moment cue-elicited approach were primarily associated with overeating behaviors, whereas FAAQ and cue-elicited avoidance were primarily associated with restrictive eating behaviors. DISCUSSION: Findings highlight the importance of including an avoidance dimension of food craving and have important implications for disordered eating prevention and intervention work.

Development and Psychometric Evaluation of a Brief Approach and Avoidance of Alcohol Questionnaire.

BACKGROUND: The Approach and Avoidance of Alcohol Questionnaire (AAAQ) was developed as a measure of craving to assess both desires to consume and desires to avoid consuming alcohol. Although the measure has been used in a variety of populations to predict future alcohol use behavior, the factor structures observed vary based on sample type (e.g., clinical vs. college samples) and may be overly long for use in repeated measures designs. The current article describes the development of a brief version of the AAAQ for use in clinical populations. METHODS: Using existing data sets of individuals in treatment for alcohol use disorder, exploratory analyses (e.g., exploratory factor analysis and item response theory) were conducted using an inpatient sample (N = 298) at a substance abuse treatment facility. Confirmatory analyses (e.g., confirmatory factor analysis and multiple regression) were conducted using an inpatient detoxification sample (N = 175) and a longitudinal outpatient treatment sample (N = 53). RESULTS: The brief AAAQ had comparable internal consistency, explained a similar amount of variance in alcohol consumption and related problems, and exhibited superior model fit as compared to the original measure. CONCLUSIONS: These findings indicate that the brief AAAQ is an effective tool to assess alcohol craving in clinical populations in treatment settings.

The association between caffeinated alcoholic beverages and the perpetration of intimate partner violence.

Background: Problematic alcohol use is a recognized risk factor for intimate partner violence (IPV) perpetration.Objective: The use of caffeinated alcoholic beverages (CAB) appears to be associated with high-risk drinking behavior but the relationship between CAB use and IPV has yet to be explored.Methods: Sixty male and 40 female married or dating participants responded to an online survey including measures of past-year alcohol use and partner violence.Results: Logistic regression analyses revealed that CAB users were significantly more likely to perpetrate physical assault and partner injury after controlling for age, sex, ethnicity, income, and heavy alcohol use. The relationship between CAB use and perpetration of sexual coercion was better accounted for by heavy alcohol use.Conclusion: Results from the current study suggest that there exists an independent link between CAB use and partner violence perpetration.

Provocation and target gender as moderators of the relationship between acute alcohol use and female perpetrated aggression.

Acute alcohol use appears to exert a small but significant effect on female perpetrated aggression in the laboratory but there has been no effort to evaluate comprehensively the situational moderators of this relationship. This preliminary review was intended to explore the moderating effects of provocation and target gender on alcohol-related aggression among females in this understudied area of research. Moderator analyses were conducted on 14 studies. Despite limitations imposed by the sparsity of laboratory based research on alcohol-related aggression among females, initial results suggest that alcohol may exert stronger effects over female aggression following high (d = 0.25, k = 8, p < .01, 95% CI = 0.10-0.40) rather than low (d = -0.07, k = 6, p = .52, 95% CI = -0.29-0.15) provocation and when targets of aggression are female (d = 0.19, k = 9, p = .01, 95% CI = 0.04-0.34) rather than male (d = -0.06, k = 4, p = .61, 95% CI = -0.30-0.18). Results offer initial insight into situational risk factors pertinent to research and treatment of alcohol-related aggression among females while serving as an impetus for future research in this critical, neglected area of study.

The role of craving in emotional and uncontrolled eating.

This study presents a novel application of the cognitive processing model of alcohol craving (CPMA) from the addictions field to the role of food craving in the well-established restrained eating-overeating relationship associated with binge eating disorder (BED). A community sample (N = 1058, ages 18-66) completed an online survey assessing four core domains: restrained eating, trait food craving, uncontrolled eating, and emotional eating. In accordance with the CPMA, food craving emerged as a significant indirect effect of the association between restrained eating and both uncontrolled and emotional eating. Gender did not significantly moderate any direct or indirect associations, suggesting that gender may not change the pattern of association between restrained eating and different facets of overeating. Results suggest that treatments targeting binge eating behaviors may benefit from 1) explicitly addressing the activation of food craving rather than concentrating on reducing restrained eating and 2) recognizing that food craving may be an important gender-neutral target with the potential to reduce binge and overeating behaviors. Future research should extend these preliminary findings by examining the application of the CPMA to eating behaviors while jointly investigating antecedents and contextual factors.

Development and psychometric evaluation of a rapid intimate partner violence perpetration screening tool.

Current methods of identifying intimate partner violence (IPV) perpetration rely upon lengthy screening instruments, partner injury, and legal involvement. There exist no viable, brief screening tools to facilitate the rapid and early identification of IPV perpetration. The development of a brief IPV screening tool would reduce participant burden and compensation in research as well as aid in self-identification and appropriate consultation for treatment. Three samples were recruited and administered an IPV assessment measure. Receiver Operating Characteristic (ROC) curve analyses were used to determine a critical subset of items that could be rapidly administered and used to accurately detect physical IPV perpetrators. A set of four items emerged that were capable of differentiating between partner violent and nonviolent participants in Samples 1 (the Area Under the ROC Curve (AUC) = .95, SE = .02), 2 (AUC = .98, SE =.01), and 3 (AUC = .94, SE = .04). Internal consistency of the screening items was acceptable across samples and the scores on the screening tool were significantly associated in the expected direction with all assessed risk factors for IPV. Initial evaluation of the rapid IPV perpetration screening tool suggests that it may help satisfy the growing need to quickly determine research eligibility and to help college students self-identify risk, offering objective data upon which to base the decision for follow-up consultation.

Individual Differences in Approach and Avoidance Inclinations Moderate the Effect of Self-Control Depletion on Ad-Lib Drinking.

BACKGROUND: This study sought to examine how exerting self-control to inhibit stereotype use affects alcohol consumption. In addition, we sought to expand previous findings via examination of how individual differences in motivations to approach or avoid alcohol consumption interact with self-control depletion to determine the regulation of ad-lib drinking behavior. METHODS: Sixty-one social drinkers (31 female) were recruited to participate in a socially relevant self-control depletion task in which they were randomly assigned to 1 of 2 creative writing conditions: (i) the self-control depletion condition with explicit instructions to refrain from using stereotypes, or (ii) the nondepletion condition in which no instructions were given regarding the use of stereotypes. Participants then completed an ad-lib drinking task and self-report questionnaires pertaining to their motivation to consume alcohol. RESULTS: As predicted, results indicated a significant 3-way interaction between depletion condition, approach inclinations, and avoidance inclinations. Specifically, self-control depletion predicted greater drinking disinhibition (i.e., mean sip size, total alcohol consumption) only among participants high in both approach and avoidance. CONCLUSIONS: Taken together, results from this study highlight the importance of both approach and avoidance inclinations in the failure to regulate alcohol consumption following a routine, socially relevant form of self-control depletion. Our results also suggest that the high approach/high avoidance motivational profile may predict the greatest risk among those actively trying to regulate their drinking.

Dyadic violence and readiness to change among male intimate partner violence offenders.

BACKGROUND: Although readiness to change is associated with mandated partner violence treatment compliance and subsequent violent behaviour among male offenders (e.g. Scott and Wolfe, 2003; Eckhardt et al., 2004), our understanding of the factors associated with pretreatment change remains limited. Offender research indicates that individual and dyadic violent behaviour are highly variable and that such variability may provide insight into levels of pretreatment change (Holtzworth-Munroe and Stuart, 1994; Archer, 2002). AIMS/HYPOTHESES: We sought to examine the associations between indicators of change and individual as well as dyadic violence frequency in a sample of male partner violence offenders. METHOD: To determine whether severity and perceived concordance in the use of violence among male offenders and their female partners influenced readiness to change at pretreatment, 82 recently adjudicated male perpetrators of intimate partner violence were recruited into the current study and administered measures of readiness to change violent behaviour (Revised Safe at Home Scale; Begun et al., 2008) as well as partner violence experiences (Revised Conflict Tactics Scale; Straus et al., 1996). RESULTS: Analyses revealed an interaction between offender-reported male and female violence in the prediction of pretreatment readiness to change such that greater male violence was associated with greater readiness to change among males who reported that their female partners perpetrated low, but not high, levels of violence. Consistently, greater female violence was associated with lower readiness to change only among the most violent male offenders. CONCLUSIONS AND IMPLICATIONS FOR CLINICAL PRACTICE: Results provide support for the assertion that the most violent offenders may be the most resistant to partner violence intervention efforts, particularly when they perceive themselves to be victims as well. Enhanced motivational and couples programming may facilitate treatment engagement among the high-risk group of male offenders who report concordant relationship violence.

Examining the daily reciprocal relations between alcohol abstinence self-efficacy and drinking among non-treatment seeking individuals with alcohol use disorder (AUD).

Theoretical and empirical models of alcohol use and misuse indicate that abstinence self-efficacy (ASE) predicts improvements in treatment outcomes among individuals with alcohol use disorder (AUD). More recently, studies have begun examining daily fluctuations in ASE to better understand in-the-moment determinants of drinking behaviors. With the goal of assessing how ASE is implicated in maintenance (rather than changing) of hazardous drinking patterns, the current study examined daily reciprocal relations between ASE and drinking among individuals with AUD. Non-treatment seeking adults (n = 63) with AUD were recruited and completed daily surveys assessing ASE and drinking behaviors for 14 days. Data were analyzed using time-lagged multilevel modeling. Results indicated that both within- and between-person elevations in ASE predicted decreased likelihood of drinking, but only within-person ASE predicted fewer drinks consumed on drinking days. Previous-day drinking behavior was unrelated to next-day ASE; however, higher percentage of drinking days during the monitoring period (between-person) was associated with lower daily ASE. These results demonstrate that confidence in one's ability to abstain from drinking varies considerably across days, and that fluctuations may be implicated in daily drinking decisions. The lack of effect of previous-day drinking on ASE (combined with the significant effect of average drinking frequency) may suggest that sustained periods of reduced drinking or abstinence are necessary to impact ASE. This study points to ASE's role in the maintenance of daily drinking behavior among non-treatment-seeking individuals with AUD and reiterates the importance of self-efficacy in behavioral control and decision-making at the daily level.

Gender differences in natural language factors of subjective intoxication in college students: an experimental vignette study.

BACKGROUND: Examining the natural language college students use to describe various levels of intoxication can provide important insight into subjective perceptions of college alcohol use. Previous research (Levitt et al., Alcohol Clin Exp Res 2009; 33: 448) has shown that intoxication terms reflect moderate and heavy levels of intoxication and that self-use of these terms differs by gender among college students. However, it is still unknown whether these terms similarly apply to other individuals and, if so, whether similar gender differences exist. METHODS: To address these issues, the current study examined the application of intoxication terms to characters in experimentally manipulated vignettes of naturalistic drinking situations within a sample of university undergraduates (n = 145). RESULTS: Findings supported and extended previous research by showing that other-directed applications of intoxication terms are similar to self-directed applications and depend on the gender of both the target and the user. Specifically, moderate intoxication terms were applied to and from women more than men, even when the character was heavily intoxicated, whereas heavy intoxication terms were applied to and from men more than women. CONCLUSIONS: The findings suggest that gender differences in the application of intoxication terms are other-directed as well as self-directed and that intoxication language can inform gender-specific prevention and intervention efforts targeting problematic alcohol use among college students.

Therapists' first impression of treatment motivation moderates the relationship between the client-rated therapeutic alliance and drinking outcomes during treatment.

INTRODUCTION: First impressions can influence interpersonal relationships for extended periods, with negative first impressions leading to more negative judgments and behaviors between individuals months after their initial meeting. Although common factors such as therapeutic alliance (TA) are well studied, less is known of the potential influence of a therapist's first impression of their client's motivation on TA and drinking outcomes. Based on data from a prospective study of the perceptions of the TA among clients receiving cognitive-behavioral treatment (CBT), this study examined how therapists' first impressions may moderate the relationship between client-rated TA and drinking outcomes during treatment. METHODS: One hundred fifty-four adults participated in a 12-week course of CBT and completed measures of TA and drinking behaviors following each treatment session. Additionally, therapists completed a measure of their first impression of their client's motivation for treatment following the first session. RESULTS: Time-lagged multilevel modeling revealed a significant within-person TA by therapists' first impression interaction that predicted percent days abstinent (PDA). Specifically, among participants rated as lower on first impressions of treatment motivation, higher within-person TA predicted greater PDA in the interval prior to the next treatment session. Within-person working alliance was not associated with PDA among individuals rated higher on first impressions of treatment motivation who demonstrated higher PDA throughout treatment. Furthermore, significant between-person TA by first impressions interactions were found for both PDA and drinks per drinking day (DDD), such that among individuals with lower treatment motivation, TA positively predicted PDA and negatively predicted DDD. CONCLUSION: Although therapists' first impressions of a client's treatment motivation are positively associated with treatment outcomes, clients' perception of the TA may mitigate the impact of poor first impressions. These findings highlight the need for additional nuanced examinations of the relationship between TA and treatment outcomes, emphasizing the contextual factors that influence this relationship.

Pretreatment changes in drinking: Theoretical and methodological implications for alcohol use disorder treatment outcome research.

BACKGROUND: There is a growing recognition of the importance of changes in drinking prior to the first treatment session (i.e., pretreatment change). A major limitation of past studies of pretreatment change is the reliance on retrospective reporting on drinking rates between the baseline assessment and the first treatment session collected at the end of treatment. The present study sought to extend previous findings by examining 12-month treatment outcomes and correlates of pretreatment changes in drinking measured weekly during treatment. METHODS: Data from a randomized behavioral clinical trial examining the effect of therapeutic alliance feedback on drinking outcomes were analyzed (n = 165). All participants received cognitive behavioral therapy for alcohol dependence, completed pre and posttreatment assessments, and provided weekly measures of drinking during treatment. RESULTS: Results indicated that approximately half of the sample reduced their heavy drinking days by 70% or more and number of drinking days by 50% or more prior to beginning treatment. Further, individuals who reported greater consideration of how their problematic drinking affected their social environment displayed greater changes in drinking days prior to treatment. Changes in heavy drinking days were also related to relationship status, such that individuals who were single/never married were less likely to change prior to treatment than those who were married/cohabitating or separated/divorced. CONCLUSION: These confirm the importance of pretreatment change in the study of treatment outcomes, and suggest that interpersonal processes, including the appraisal of drinking behavior in a social context, may play an important role in pretreatment changes in drinking.

Disaggregating within- and between-person effects of affect on drinking behavior in a clinical sample with alcohol use disorder.

OBJECTIVE: The goal of the current study was to better understand affect-drinking relations among those diagnosed with an alcohol use disorder (AUD), as recent meta-analytic work suggests that daily negative affect may not universally predict subsequent alcohol consumption in those nondependent on alcohol. Specifically, we investigated the between- and within-person effects of positive and negative affects on drinking. METHOD: Participants (n = 92) who met AUD diagnostic criteria completed a 90-day daily assessment of drinking behavior and positive and negative affects. RESULTS: Time-lagged multilevel modeling revealed that within-person elevations in negative affect predicted increased odds and quantity of drinking later in the day. Relations between positive affect and drinking were nonsignificant. CONCLUSIONS: These findings are in contrast to recent meta-analytic findings and highlight the complexity of affect-drinking relations among those diagnosed with AUD. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Online Crowdsourcing as a Quasi-Experimental Method for Collecting Data on the Perpetration of Alcohol-Related Partner Aggression.

Cross-sectional survey, prospective, and experimental data have been evaluated to better understand the role of alcohol as a contributing cause of intimate partner aggression. Laboratory-based alcohol administration studies provide controlled data regarding causality, but the use of this methodology lacks ecological validity and has been hampered by rigorous procedural and financial demands. Online crowdsourcing is an emerging pseudoexperimental methodology with low costs, rapid data collection, access to diverse populations, greater ecological validity, and the potential to facilitate prolific research to supplement the chronic scarcity of experimental data. The current rapid review first summarizes prior methodological approaches to investigating the proximal influence of alcohol on partner aggression, then reviews prior crowdsourcing research in the disparate areas of alcohol and partner aggression, then describes aggression paradigms that may be readily adapted to online administration. We conclude by introducing recommendations for future quasi-experimental research investigating alcohol-related partner aggression research using the online crowdsourcing methodology. Initial evidence suggests that online crowdsourcing may yield appropriate samples and that existing paradigms may be adapted to rapidly, efficiently, and ethically supplement experimental alcohol-related partner aggression research.

Approach and avoidance alcohol inclinations in heavy drinking college students: An ecological momentary assessment study.

BACKGROUND: Understanding the motivational determinants of drinking among college students is necessary to improve the identification of those at greatest risk and to inform prevention and treatment interventions. Alcohol craving, or the desire to use alcohol, is considered one important factor in the development and maintenance of drinking behaviors. Recent evidence suggests that the link between alcohol craving (approach inclinations) and alcohol use is moderated by desires not to use alcohol (avoidance inclinations). Using ecological momentary assessment, the present study investigated the influence of motivational conflict (high desires to use and high desires to not use alcohol) on alcohol consumption among college students. METHODS: Undergraduate students (n = 80; 88.8% female) completed assessments of alcohol-related behaviors and alcohol motivation five times daily for fourteen days. RESULTS: Although between-person effects were nonsignificant, significant within-person effects indicated that avoidance inclinations attenuated the effect of approach inclinations in the prediction of drinking (controlling for age, gender, drinking history, affect, day of week, and time of day). CONCLUSIONS: Findings highlight the need for consideration of the unique effects of both approach and avoidance inclinations in the prediction of alcohol consumption and draw attention to the need for further investigation into the complex interplay of these processes in daily life.

A meta-analytic review of the relationship between cyber aggression and substance use.

BACKGROUND: Prior research has demonstrated that various substances of abuse play a contributing role to acts of physical and verbal aggression. It is less clear if and to what extent substance use is associated with an increased risk in perpetrating cyber aggression, an emerging form of aggressive behavior that occurs through digital communication. METHODS: A comprehensive review of the literature resulted in 15 studies and 18 unique samples from which effect size estimates were calculated. RESULTS: Analyses resulted in a moderate, significant mean observed correlation indicating that individuals who engaged in substance use were more likely than those who did not to perpetrate cyber aggression (r = 0.24, k = 18, 95% CI = 0.20, 0.28). Comparing data across types of substances revealed that alcohol use represents a stronger risk factor for cyber aggression than nicotine, cannabis, or other illicit drugs. Results also suggest a stronger relationship between substance use and cyber aggression among older than younger samples and in the context of intimate partner rather than peer aggression. Comparable estimates of substance-related cyber aggression emerged across types of cyber aggression and perpetrator gender. CONCLUSIONS: Further research is required to increase confidence in estimates used in moderation analyses. As with traditional aggression, alcohol use appears to represent a risk factor for cyber aggression, though it is unclear if the disinhibitory properties of alcohol are the mechanism of action for substance-related cyber aggression.