Does Social Support Moderate the Association between Adverse Childhood Experiences and Substance-Related Problems?

Background: More than half of individuals in the United States have had adverse childhood experiences (ACEs), which can result in physical and mental distress. ACEs has been linked with greater likelihood of harmful alcohol and drug use. Research has found that protective factors, such as social support, may potentially buffer against harmful substance use engagement among those who have experienced ACEs. The purpose of this study was to examine associations between perceived social support, ACEs, and alcohol and cannabis-related problems. Moreover, this study aimed to examine if specific domains of perceived social support (family, friends, and significant other) moderated the relationship between ACEs and alcohol and cannabis-related problems. Method: Validated measures of ACEs, perceived social support, and alcohol and cannabis problems were collected in a sample of 401 emerging adults via Prolific Academic (an online data collection platform). Results: Overall perceived social support and domains such as perceived family and friend social support moderated the relationship between ACEs and alcohol-related problems but not ACEs and cannabis-related problems. The association between ACEs and alcohol-related problems was strongest at low levels of perceived family and friend social support. Perceived social support was not associated with cannabis-related problems. Conclusions: Lack of social support is a potential risk factor for alcohol-related problems among emerging adults. Bolstering perceived social support from family and friends among those who have experienced ACEs may be beneficial in intervention and treatment efforts aiming to reduce harmful substance use in this population.

Gender Moderates the Association Between Cognitive Reappraisal and Alcohol-Related Problems Among Adolescents.

BACKGROUND/OBJECTIVE: Alcohol use typically begins in adolescence, and the risk of later alcohol use disorders increases with earlier age of onset. Emotion dysregulation in adolescence has been linked to alcohol use. The present study seeks to extend previous findings by examining whether gender moderates the association between emotion regulation strategies (suppression and cognitive reappraisal) and alcohol-related problems in a longitudinal sample of adolescents. METHOD: Data were collected as part of an ongoing study of high school students from the south-central region of the USA. The sample included 693 adolescents who participated in a study on suicidal ideation and risk behaviors. The majority of participants were girls (54.8%), white (85%) and heterosexual (87.7%). Baseline (T1) and 6-month follow-up (T2) data were analyzed for the present study. RESULTS: Negative binomial moderation analyses revealed that gender moderated the association between cognitive reappraisal and alcohol-related problems, such that the association between reappraisal and alcohol-related problems was significantly stronger for boys than for girls. Gender did not moderate the association between suppression and alcohol-related problems. CONCLUSIONS: The results suggest that emotion regulation strategies may be a particularly useful target for prevention and intervention efforts. Future research should consider tailoring adolescent alcohol prevention and intervention efforts focused on emotion regulation strategies by gender to bolster cognitive reappraisal skills and decrease suppression.

Cannabis use in civilian college students and college student service members/veterans: the moderating effect of anxiety.

Background: Cannabis is the most commonly used illicit drug on college campuses. Research suggests that Student Service Members/Veterans (SSM/V) may be more likely to use alcohol than civilian students, but little research has focused on cannabis use in these two samples. Objectives: The purpose of the current study was to compare cannabis use frequency, cannabis use disorder (CUD) symptoms, and cannabis-related problems between civilian students and SSM/V. A second aim was to determine if group differences in these outcomes were moderated by symptoms of depression, stress, or anxiety. Methods: The sample included 164 college SSM/V (80.4% female, 19.6% male) and 456 civilian (78% female, 22% male) college students. Participants completed an online survey assessing demographics, number of days of past month cannabis use, cannabis-related problems, CUD symptoms, and a measure of anxiety, depression, and stress. Results: Negative binomial regressions indicated no significant differences in number of days of past-month cannabis use or past-year cannabis-related problems between civilian students and SSM/V, although SSM/V reported more past-year CUD symptoms. Moderation analyses revealed that at elevated levels of anxiety, SSM/V students used cannabis more frequently than civilian students. Conclusion: These findings indicate that when experiencing elevated levels of anxiety, SSM/V use cannabis more frequently than civilian students, suggesting that anxiety may be a more prominent risk factor for frequency of cannabis use for SSM/V compared to civilian students. Education, prevention, and intervention efforts specifically addressing anxiety in this demographic are needed.

The behavioral economics of driving after drinking among college drinkers.

BACKGROUND: Driving after drinking (DAD) among college students is a significant public health concern, yet little is known about specific theoretical risk factors for DAD, beyond drinking level, among college student drinkers. This study had the following aims: (i) to examine the associations between elevated alcohol demand and DAD, (ii) to determine whether demand decreases in response to a hypothetical driving scenario, (iii) to determine whether drivers who report DAD in the past 3 months would show less of a reduction in demand in response to the hypothetical driving scenario, and (iv) to determine whether delayed reward discounting (DRD) is associated with DAD. METHOD: Participants were 419 college students who reported at least 1 day of past-month alcohol use. Participants completed 2 alcohol purchase tasks (APTs) that assessed hypothetical alcohol consumption across 17 drink prices with and without a driving scenario, a delay-discounting task, and a series of questions regarding DAD. RESULTS: In logistic regression models that controlled for drinking level, demographics, and sensation seeking, participants reporting higher demand intensity (95% confidence interval [95% CI] [1.04, 2.34]), breakpoint (95% CI [1.23, 2.28]), Omax (95% CI [1.03, 1.53]), and lower elasticity (95% CI [0.15, 1.02]) were more likely to report DAD. Additionally, in analyses of covariance, DAD(+) participants exhibited significantly less of a reduction in demand between the standard and the driving APT (intensity, p < 0.01, breakpoint, p = 0.05, and Omax , p < 0.01). A binary logistic regression model with identical covariates revealed that DRD is not associated with DAD. CONCLUSIONS: DAD is associated with elevated/inelastic demand and less sensitivity to a hypothetical driving scenario. Drinkers with elevated demand should be prioritized for DAD intervention efforts.

The moderating effect of gender on the relation between expectancies and gambling frequency among college students.

Compared to college females, college males are more likely to report frequent gambling. Research on gambling outcome expectancies has shown that expectations about gambling influence gambling behavior and that endorsement of particular expectancies differs by gender. Knowledge regarding the differential predictive utility of specific gambling expectancies based on gender would help to determine how beliefs about gambling may be fundamentally different for men and women. The present study explored whether gender moderates the relation between gambling expectancy and gambling frequency in a college sample. 421 college students completed an online survey that included questions about their demographics, gambling frequency, and gambling expectancies. Hierarchical regression analyses indicated that gender moderated the relations between the expectancies of social consequences, material gain, and gambling frequency. For females, greater endorsement of social consequences predicted less frequent gambling. For both males and females, greater endorsement of material gain predicted more frequent gambling. The current findings can help inform prevention and intervention efforts by identifying gambling expectations that are differentially related to college student gambling behavior choices.

Elevated alcohol demand is associated with driving after drinking among college student binge drinkers.

BACKGROUND: Alcohol-impaired driving among college students represents a significant public health concern, yet little is known about specific theoretical and individual difference risk factors for driving after drinking among heavy drinking college students. This study evaluated the hypothesis that heavy drinkers with elevated alcohol demand would be more likely to report drinking and driving. METHOD: Participants were 207 college students who reported at least 1 heavy drinking episode (4/5 or more drinks in 1 occasion for a woman/man) in the past month. Participants completed an alcohol purchase task that assessed hypothetical alcohol consumption across 17 drink prices and an item from the Young Adult Alcohol Consequences Questionnaire that assessed driving after drinking. RESULTS: In binary logistic regression models that controlled for drinking level, gender, ethnicity, age, and sensation seeking, participants who reported higher demand were more likely to report driving after drinking. CONCLUSIONS: These results provide support for behavioral economics models of substance abuse that view elevated/inelastic demand as a key etiological feature of substance misuse.

Examining Differences in Emotion Dysregulation Between Emerging Adult Alcohol-Only Users, Abstainers, and Simultaneous Users.

Objective: Simultaneous use of alcohol and cannabis is associated with more negative consequences than use of either substance alone. Research suggests that emotion dysregulation is linked to alcohol, cannabis, and polysubstance use. However, no previous research has examined whether emotion dysregulation scores differ among individuals without past month substance use (abstainers), individuals who report past-month alcohol use only (no past month cannabis or simultaneous use; alcohol-only users), and individuals who engage in past-month simultaneous alcohol and cannabis use (simultaneous users). Our aim was to examine differences in overall levels of emotion dysregulation and emotion dysregulation subscales between these groups. Methods: The sample included 468 college students. Participants completed an online survey assessing demographics, emotion dysregulation, average number of drinks per week, days of monthly cannabis use, and simultaneous use of alcohol and cannabis. Results: A one-way ANOVA showed significant differences in emotion dysregulation between alcohol-only users, abstainers, and simultaneous users. A Bonferroni post hoc analysis revealed significant differences in emotion dysregulation for simultaneous users (p = .004) compared to alcohol-only users and abstainers. A series of ANOVAs were run to examine emotion dysregulation subscale scores and significant differences were found for impulse control difficulties (p = .003) and limited access to emotion regulation strategies (p = .005) for simultaneous users compared to alcohol-only users and abstainers, and for non-acceptance of emotional responses (p = .018) for simultaneous users compared to and alcohol-only users. Conclusion: These findings indicate that simultaneous users have higher levels of emotion dysregulation, higher levels of impulse control difficulties, greater non-acceptance of emotions, and greater lack of access to emotion regulation strategies compared to abstainers and alcohol-only users.

A longitudinal examination of alcohol use and emotion dysregulation in adolescence.

Underage drinking is a serious public health concern with magnified physical and psychological risks. Previous research suggests that emotion dysregulation is one factor linked to alcohol use. Limited research has examined emotion dysregulation and alcohol use in adolescent populations, thus the present study aimed to examine the links by assessing the role of emotion dysregulation and its subscales in adolescent alcohol use over time. Participants were 695 high school students, with 309 students having completed Time 2 data collection at a 6-month follow-up. Participants completed measures that assessed Alcohol Use, Emotion Dysregulation, and Emotion Dysregulation subscales. In a negative binomial hurdle model, adolescents with greater emotion regulation difficulties at baseline had significantly greater odds of endorsing any alcohol use at baseline. Greater emotion dysregulation did not significantly predict drinking status or drinking level 6 months later when controlling for baseline alcohol use. Adolescents who reported greater emotional clarity difficulties at baseline were more likely to report any alcohol use at baseline. Among adolescents who drink, reporting greater difficulties accessing emotion regulation strategies was associated with greater alcohol use at baseline and 6 months later. These findings indicate that emotion dysregulation is a cross-sectional marker of alcohol use in adolescents; however, results did not show emotion dysregulation to be a prospective predictor of greater alcohol use. Future research is needed to replicate findings in a more diverse sample of adolescents. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A randomized pilot trial of a mobile phone-based brief intervention with personalized feedback and interactive text messaging to reduce driving after cannabis use and riding with a cannabis impaired driver.

INTRODUCTION: Driving after cannabis use (DACU) and riding with a cannabis-impaired driver (RWCD) are national public health concerns. Though driving impairments and increased crash risk make DACU and RWCD two of the riskiest cannabis-related behaviors, many continue to drive after use and ride with others who are under the influence and do not view DACU or RWCD as dangerous. The current study examined the efficacy of an accessible, low-cost, mobile phone-based brief intervention aimed at reducing DACU and RWCD among college cannabis users in the context of a randomized three-group pilot trial. METHOD: Participants were 97 college cannabis users (67.4 % women; average age = 21.34; 80.4 % Caucasian) who endorsed DACU at least three times in the past three months. After completing baseline measures, the study randomly assigned participants to one of three conditions: a) a substance impaired-driving personalized feedback plus MI-style interactive text messaging intervention (PF + MIT); b) a substance impaired-driving personalized feedback only intervention (PF); and c) a substance information control condition (IC). All conditions completed outcome measures three months postintervention. RESULTS: Generalized linear mixed models (GLMM) analyses indicated that after controlling for sex, cannabis users in the PF + MIT condition significantly reduced DACU and RWCD over time compared to those in the IC condition. CONCLUSIONS: These findings provide preliminary support for the short-term efficacy of a mobile phone-based intervention in decreasing DACU and RWCD among college cannabis users. Future research should determine whether these reductions in driving behaviors persist past three months.

A mobile phone-based brief intervention with personalized feedback and interactive text messaging is associated with changes in driving after cannabis use cognitions in a proof-of-concept pilot trial.

Driving after cannabis use (DACU) is a significant public health concern and represents one of the riskiest cannabis-related behaviors. Though years of research has demonstrated that cannabis use impairs driving ability, many college students report believing that cannabis use does not impair their driving abilities. This perception of low danger may contribute to a permissive attitude toward DACU. The present proof-of-concept pilot study examined the preliminary efficacy of a mobile phone-based intervention with personalized feedback and text messaging to increase perceptions of dangerousness of DACU. Participants were 77 college cannabis users (65.8% women; average age = 21.2; 88.3% Caucasian) who endorsed DACU at least three times in the past 3 months. After completing baseline measures, participants were randomly assigned to one of three conditions: (a) personalized feedback plus interactive text messaging (PFT), (b) personalized feedback only (PF), or (c) informational control (IC). Participants completed outcome measures 3 months post intervention. Repeated measures mixed models revealed that compared to those in the IC condition, cannabis users in the PFT condition reported significantly greater increases over time in the perception of dangerousness of DACU. These findings provide initial support for the short-term efficacy of a mobile phone-based intervention for changing perceptions related to dangerousness of DACU among college cannabis users. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Sleep moderates the relationship between stress and craving in individuals with opioid use disorder.

Opioid use disorder (OUD) is a national public health concern. Craving, stress, and exposure to conditioned drug cues are implicated in risk of relapse to opioids. Although impaired sleep has been implicated in risk of relapse to other substances of misuse, little research to date has examined the relationship between sleep and craving in individuals with OUD. The present study examined sleep as a moderator of the relationship between craving and stress in a randomized controlled human laboratory study. Individuals with current OUD (N = 39) completed a 1-night hospital stay to control for factors that may affect craving, stress, and sleep. Sleep was monitored via an actigraphy watch and the Pittsburgh Sleep Quality Index. The next morning, participants were randomized to a 15-min laboratory stress task or a no-stress condition. All participants were then exposed to a 15-min opioid cue paradigm, and craving was measured via self-report. Moderation models were conducted to evaluate whether the sleep indices moderated the relationship between stress condition (independent variable) and craving (dependent variable). Average self-reported nightly sleep duration moderated the relationship between stress condition and craving for participants in the no-stress condition (b = 0.95, p < .05). Specifically, participants in the no-stress condition with lower average nightly sleep duration exhibited significantly greater craving following the opioid cue paradigm. Although preliminary, the findings add to the literature on craving, stress, and sleep among individuals with OUD. Sleep impairment may be an important target of a comprehensive, long-term treatment plan for some patients with OUD. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Evaluating alcohol demand, craving, and depressive symptoms among women in alcohol treatment.

BACKGROUND: Depression and alcohol craving predict drinking and relapse rates among alcohol treatment seekers. Alcohol demand, or one's valuation of alcohol may be another determinant of drinking. There is little known about alcohol demand and its association with depression, craving, and drinking among treatment-seeking adults. METHOD: Participants were 71 women with elevated depressive symptoms seeking outpatient treatment for alcohol use disorder (AUD). At baseline, participants self-reported daily drinking amount, alcohol craving, depressive symptoms, and alcohol demand assessed with the alcohol purchase task (APT; a task requesting participants to make hypothetical purchases of drinks at escalating prices). Baseline associations among alcohol demand, depressive symptoms, alcohol craving, and drinking severity were assessed. RESULTS: Participants averaged 40.68 (SD = 11.78) years of age, consumed 8.84 (SD = 5.14) drinks per drinking day and reported 15.45 (SD = 7.51) heavy drinking days in the past 30 days, and had an average PHQ-9 depression score of 13.00 (SD = 4.28). Results suggest that the alcohol demand metrics of intensity (consumption level when drinks are free) and Omax (maximum expenditure on alcohol) were associated with drinks per drinking day, whereas craving and depressive symptoms were not significantly associated with drinking. The number of heavy drinking days were not significantly associated with demand, craving, or depressive symptoms. CONCLUSIONS: These results suggest that demand may reflect unique risk for drinking relative to craving or depressive symptoms. These findings provide support for the utility of the APT within a clinical setting to assess individualized valuation of alcohol.

A Mobile Phone-Based Brief Intervention With Personalized Feedback and Text Messaging Is Associated With Reductions in Driving After Drinking Among College Drinkers.

OBJECTIVE: Driving after drinking (DAD) among college students remains a significant public health concern and is perhaps the single riskiest drinking-related behavior. Counselor-delivered and web-based Brief Alcohol Interventions (BAIs) have been shown to reduce DAD among college students, but to date no study has evaluated the efficacy of a single-session mobile phone-based BAI specific to DAD. The present study examined whether a driving-specific BAI delivered via mobile phone would significantly decrease DAD among college students compared to an informational control. METHOD: Participants were 84 college students (67.1% women; average age = 23; 52.4% White) who endorsed driving after drinking two or more drinks at least twice in the past 3 months. After completing baseline measures, participants were randomly assigned to receive either (a) DAD information or (b) DAD mobile BAI that included personalized feedback and interactive text messaging. Participants completed outcome measures at 3-month follow-up. RESULTS: Repeated-measures mixed modeling analyses revealed that students receiving the mobile phone-based BAI reported significantly greater reductions in likelihood of DAD (three or more drinks) and the number of drinks consumed before driving than students in the information condition at 3-month follow-up. CONCLUSIONS: These findings provide preliminary support for the short-term efficacy of a mobile phone-based BAI for reducing DAD among college students.

Substance use disorders in military veterans: prevalence and treatment challenges.

Substance use disorders (SUDs) are a significant problem among our nation's military veterans. In the following overview, we provide information on the prevalence of SUDs among military veterans, clinical characteristics of SUDs, options for screening and evidence-based treatment, as well as relevant treatment challenges. Among psychotherapeutic approaches, behavioral interventions for the management of SUDs typically involve short-term, cognitive-behavioral therapy interventions. These interventions focus on the identification and modification of maladaptive thoughts and behaviors associated with increased craving, use, or relapse to substances. Additionally, client-centered motivational interviewing approaches focus on increasing motivation to engage in treatment and reduce substance use. A variety of pharmacotherapies have received some support in the management of SUDs, primarily to help with the reduction of craving or withdrawal symptoms. Currently approved medications as well as treatment challenges are discussed.

Posttraumatic Stress Disorder: Overview of Evidence-Based Assessment and Treatment.

Posttraumatic stress disorder (PTSD) is a chronic psychological disorder that can develop after exposure to a traumatic event. This review summarizes the literature on the epidemiology, assessment, and treatment of PTSD. We provide a review of the characteristics of PTSD along with associated risk factors, and describe brief, evidence-based measures that can be used to screen for PTSD and monitor symptom changes over time. In regard to treatment, we highlight commonly used, evidence-based psychotherapies and pharmacotherapies for PTSD. Among psychotherapeutic approaches, evidence-based approaches include cognitive-behavioral therapies (e.g., Prolonged Exposure and Cognitive Processing Therapy) and Eye Movement Desensitization and Reprocessing. A wide variety of pharmacotherapies have received some level of research support for PTSD symptom alleviation, although selective serotonin reuptake inhibitors have the largest evidence base to date. However, relapse may occur after the discontinuation of pharmacotherapy, whereas PTSD symptoms typically remain stable or continue to improve after completion of evidence-based psychotherapy. After reviewing treatment recommendations, we conclude by describing critical areas for future research.

Drinking-and-Driving-Related Cognitions Mediate the Relationship Between Alcohol Demand and Alcohol-Impaired Driving.

OBJECTIVE: Elevated behavioral economic demand for alcohol has been shown to be associated with drinking and driving in college students. The present study sought to clarify the underlying mechanisms of this relationship by examining whether drinking-and-driving-related cognitions (e.g., attitudes, perceptions, and normative beliefs) mediate the association between alcohol demand and drinking and driving. METHOD: A total of 134 young adult social drinkers completed an alcohol purchase task and measures of perceived dangerousness of drinking and driving, normative beliefs about drinking and driving, and perceived driving limit (i.e., perceived number of drinks one could consume and still drive safely). The frequency of drinking and driving in the past year was assessed via self-report. RESULTS: Individuals who reported drinking and driving exhibited greater alcohol demand (intensity, Omax, and elasticity) compared with those who did not engage in drinking and driving. Increased demand was also correlated with more favorable drinking-and-driving cognitions. Indirect effects tests revealed that perceived driving limit partially mediated the relationship between alcohol demand and drinking-and-driving behavior, even after accounting for drinking level, sex, and delay discounting. CONCLUSIONS: These findings provide further support for the utility of behavioral economic theory in understanding drinking-and-driving behavior. In particular, they provide evidence for one mechanism-drinking-and-driving-related cognitions-by which alcohol demand influences drinking and driving. Additional research using longitudinal and experimental designs is required to confirm this model and to identify other potential mediators.

Brief Motivational Interventions Are Associated With Reductions in Alcohol-Impaired Driving Among College Drinkers.

OBJECTIVE: Alcohol-impaired (AI) driving among college students remains a significant public health concern and may be the single most risky drinking outcome among young adults. Brief motivational interventions (BMIs) have been shown to reduce alcohol use and problems, but their specific efficacy for decreasing AI driving among college students is unknown. The present study analyzed data from three randomized controlled trials of BMI (Murphy et al., 2010: n = 74; Borsari et al., 2012: n = 530; and Martens et al., 2013: n = 365) to evaluate whether BMIs are associated with reductions in AI driving among college student drinkers. METHOD: Participants in all three studies were randomized to BMI or control conditions. Participants reported whether they had driven under the influence (yes/no) following the BMI over the follow-up period. RESULTS: Separate binary logistic regression analyses were conducted for each study. For Studies 1 and 2, these analyses revealed that a BMI was significantly associated with reductions in AI driving at the final (6-month and 9-month, respectively) follow-up compared with the control condition. For Study 3, analyses revealed that a single-component BMI focused on the correction of misperceptions of descriptive norms was significantly associated with reductions in AI driving compared with the control group at the final (6-month) followup, whereas a single-component BMI focused on the use of protective behavioral strategies was not. Change in drinking level did not mediate the relationship between the condition and the change in AI driving. CONCLUSIONS: Counselor-administered BMIs that include descriptive normative feedback are associated with significant reductions in AI driving compared with control.

Alcohol craving and demand mediate the relation between posttraumatic stress symptoms and alcohol-related consequences.

Posttraumatic stress (PTS) symptoms are associated with alcohol-related consequences, but there is a need to understand mediators that may help explain the reasons for this relationship. Individuals with PTS may experience elevated craving and alcohol reward value (demand), which may contribute to risk for alcohol-related consequences. We examined relationships between PTS status, craving, alcohol demand, and alcohol-related consequences in PTS-positive (n = 64) and PTS-negative (n = 200) college students (M age = 21.7; 77% women; 54% Caucasian; 34% African American) who endorsed past-month alcohol use. We tested craving and alcohol demand as mediators of the relation between PTS status and alcohol-related consequences. Craving (B = .04, SE = .02, 95% CI [.01, .10]), demand intensity (B = .02, SE = .02, 95% CI [.001, .07]), and demand elasticity (B = .05, SE = .03, 95% CI [.006, .12]) significantly mediated the association between PTS symptoms and alcohol-related consequences. Craving remained a significant mediator in a multiple mediators model (B = .08, SE = .04, 95% CI [.03, .19]). Craving and alcohol demand may partially explain the relation between PTS status and alcohol-related consequences. Craving may be especially salient for individuals with PTS symptoms, as it may lead to more severe alcohol-related consequences even in the absence of elevated alcohol consumption.