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OBJECTIVE: Research among young adults (YA), in samples of majority White college students, indicates links between posting about alcohol on social media and self-reported drinking behavior. We sought to extend this work by examining unique associations between public versus private posting about alcohol and the high-risk outcome of alcohol-related blackouts among a sample of racially/ethnically diverse YA not in 4-year college. METHOD: A sample of 499 participants (ages 18-29; 52.5% female; 37.5% Black/African American, 26.9% White, 25.3% Hispanic/Latinx) completed an online survey about social media use and drinking behavior. RESULTS: Across three platforms (Instagram, TikTok, Twitter [now known as "X"]), public posting on Instagram was most common. Adjusting for covariates, a higher frequency of private posting about alcohol was associated with a higher frequency of past-month blackouts. Tests of simple effects of posting on blackouts within racial/ethnic subgroups indicated that private posting about alcohol was significantly associated with past-month blackouts only among those who most strongly identified as Black/African American or White but not among those who most strongly identified as Hispanic/Latinx. Further, public posting was significantly associated with past-month blackouts, though the association was specific to White participants. CONCLUSIONS: Whether posting about alcohol may be useful in identifying risky drinking behavior may depend on racial/ethnic identification as well as whether private or public posting is being considered. Results have implications for eventual online interventions, which can identify individuals potentially at risk for hazardous drinking based on their social media posting behavior. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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BACKGROUND: Cannabis demand (i.e., relative value) is usually assessed as a trait-level risk-factor for cannabis use and consequences. This study examined within-person variability in day-level intensity (i.e., amount consumed at zero cost) and Omax (i.e., maximum cannabis expenditure) and tested hypotheses that demand would be positively associated with day-level cannabis use. METHODS: Young adults (n=85) reporting past-month simultaneous alcohol and cannabis use completed two daily surveys for 30 days. Morning surveys assessed prior-day cannabis use and evening surveys assessed day-level demand (i.e., intensity, Omax). Multilevel models tested day-level effects of intensity and Omax on any cannabis use and flower use frequency and quantity (i.e., grams). RESULTS: Approximately 52 % and 46 % of variability in intensity and Omax, respectively, was due to within-person change. At the day-level, higher intensity and Omax were associated with higher likelihood of any cannabis use, regardless of formulation; Omax was associated with use of flower in particular; and intensity was associated with the highest quantity of use. At the person-level, only Omax was associated with flower use likelihood, and only intensity was associated with flower quantity across days. CONCLUSIONS: Cannabis demand demonstrated day-to-day variability, conceivably in response to various internal states and external factors. Intensity and Omax were related to elevated likelihood of using any cannabis, particularly flower, at the day-level. Overall, these data illustrate the validity and utility of brief cannabis demand measures, which might be used to further understand cannabis' reinforcing value at a fine-grained level.
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Uso de la Marihuana , Humanos , Masculino , Femenino , Adulto Joven , Uso de la Marihuana/epidemiología , Adolescente , Adulto , Cannabis , Consumo de Bebidas Alcohólicas/epidemiología , Fumar Marihuana/epidemiología , Encuestas y CuestionariosRESUMEN
OBJECTIVE: Despite experiencing alcohol-related consequences, college students continue to drink at high rates. Hypothetical evaluations of alcohol-related consequences (i.e., evaluations of where potential/hypothetical consequences lie on a spectrum from extremely positive to extremely negative) may contribute to the maintenance of drinking patterns among students. The purpose of the present study was to describe hypothetical evaluations in a sample of students mandated to an alcohol intervention, examine changes over time, and investigate the influence of both baseline and time-varying experienced consequences. METHOD: This study was a secondary data analysis from a longitudinal randomized controlled trial. Participants were 474 mandated students (Mage = 18.65; 55.5 % male, 77.6 % White). Students completed an initial baseline assessment of demographics, alcohol use, consequences, and hypothetical evaluations, and 3-month and 9-month follow-up assessments that included hypothetical evaluations and experienced consequences. RESULTS: Hierarchical linear modeling (HLM) analyses revealed significant change in hypothetical evaluations over time such that they became less negative. A piecewise model demonstrated that this change happened between baseline and 3-month, with no additional change between 3-month and 9-month. The experience of consequences at baseline did not significantly moderate changes in either time interval. Time-varying consequences also had no significant effect on same-timepoint hypothetical evaluations. CONCLUSIONS: This study is the first to examine changes in hypothetical evaluations over time among mandated college students. Counter to expectations, hypothetical evaluations became less negative at 3-month follow-up. Though preliminary, findings add to the understanding of hypothetical evaluations of alcohol-related consequences.
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Consumo de Alcohol en la Universidad , Percepción del Tiempo , Humanos , Masculino , Adolescente , Femenino , Consumo de Bebidas Alcohólicas/epidemiología , Estudiantes , UniversidadesRESUMEN
AIM: Participating in a drinking game (DG) is common practice among university students and can increase students' risk for heavy drinking. Given the theoretical link between motivations to drink and alcohol use, careful consideration should be given to students' motivations to play DGs. In this study, we examined the factor structure, internal consistency, and concurrent validity of a revised version of the motives for playing drinking games (MPDG) scale, the MPDG-33. METHODS: University students (n = 3345, Mage = 19.77 years, SDage = 1.53; 68.8% = women; 59.6% = White) from 12 U.S. universities completed a confidential online self-report survey that included the MPDG-33 and questions regarding their frequency of DG participation and typical drink consumption while playing DGs. RESULTS: Confirmatory factor analysis indicated the 7-factor model fit the data adequately, and all items had statistically significant factor loadings on their predicted factor. All subscales had adequate to excellent internal consistency and were positively correlated with the frequency of DG participation and the typical number of drinks consumed while playing DGs (though the correlations were small). CONCLUSION: Findings suggest that the MPDG-33 can be reliably used in research and clinical settings to assess U.S. university students' motives for playing DGs.
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Consumo de Alcohol en la Universidad , Motivación , Estudiantes , Humanos , Femenino , Masculino , Adulto Joven , Análisis Factorial , Estudiantes/psicología , Estados Unidos , Universidades , Consumo de Alcohol en la Universidad/psicología , Adolescente , Consumo de Bebidas Alcohólicas/psicología , Consumo de Bebidas Alcohólicas/epidemiología , Encuestas y Cuestionarios , Autoinforme , Adulto , Reproducibilidad de los ResultadosRESUMEN
Background: Links between alcohol-induced blackouts and sexual assault (SA) are understudied. We tested whether: (1) history of blackouts, past 30-day blackouts, and past 30-day blackout intentions would be higher among women with histories of SA relative to women without; (2) baseline history of blackouts, past 30-day blackouts, and blackout intentions would predict an increase in SA severity (i.e., a continuous variable that considers SA tactic type and assault frequency) at a one-year follow-up. Methods: 1721 undergraduate women completed a baseline survey and 313 completed the follow-up. Results: Women with SA history had 2.10 higher odds of history of blackouts, 1.47 higher odds of past 30-day blackout during "one" drinking episode, 1.78 higher odds of blackout during a "few" drinking episodes, 3.21 higher odds of blackout during "most/all" drinking episodes, and 1.54 higher odds of blackout intentions in the last 30-days. Longitudinally, history of blackouts and past 30-day blackouts at baseline were associated with an increase in SA severity at follow-up, when peak drinks were not controlled. Conclusion: Longitudinal findings provide some evidence that lifetime history of blackouts and past 30-day blackouts are significant predictors of an increase in SA severity at follow-up and therefore an essential target for interventions.
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OBJECTIVE: Among college students, student-athletes are at increased risk for heavy alcohol consumption, participation in risky drinking practices (e.g., playing drinking games [DG]), and adverse alcohol-related consequences relative to non-student-athletes. Within the student-athlete population, level of sports participation (e.g., recreational or varsity sports) can affect alcohol use behaviors and consequences, but our understanding of the extent to which level of sports participation influences engagement in DG is limited. Thus, in the present study, we examined differences in frequency of participation in DG, typical drink consumption while playing DG, negative DG consequences, and motives for playing DG among varsity, recreational, and non-student-athletes. METHOD: College students (n = 7,901 across 12 U.S. colleges/universities) completed questionnaires on alcohol use attitudes, behaviors, and consequences. RESULTS: Student-athletes (recreational or varsity sports) were more likely to have participated in DG within the past month than non-student-athletes. Among students who reported past-month DG play, recreational athletes played more often and endorsed more enhancement/thrills motives for playing DG than non-student-athletes, and student-athletes (recreational or varsity) endorsed higher levels of competition motives for playing DG than non-student-athletes. CONCLUSIONS: These findings shed light on some risky drinking patterns and motives of recreational athletes who are often overlooked and under-resourced in health research and clinical practice. Recreational and varsity student-athletes could benefit from alcohol screening and prevention efforts, which can include provision of competitive and alcohol-free social activities and promotion of alcohol protective behavioral strategies to help reduce recreational athletes' risk for harm while playing DG.
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Consumo de Alcohol en la Universidad , Atletas , Motivación , Estudiantes , Humanos , Masculino , Femenino , Atletas/psicología , Atletas/estadística & datos numéricos , Adulto Joven , Universidades , Estudiantes/psicología , Estudiantes/estadística & datos numéricos , Consumo de Alcohol en la Universidad/psicología , Consumo de Bebidas Alcohólicas/epidemiología , Consumo de Bebidas Alcohólicas/psicología , Adolescente , Encuestas y Cuestionarios , Asunción de Riesgos , Deportes/psicología , Juegos Recreacionales/psicología , AdultoRESUMEN
OBJECTIVE: Bystander intervention (BI) is a promising approach for promoting collective behavior change that has been applied to several domains, including sexual assault, bullying, and more recently, problematic alcohol use. Accurately measuring the strategies that bystanders use to reduce others' alcohol-related risk is an essential step toward improving bystanders' ability to reduce alcohol-related harm in their communities, but current measures of BI are not easily modifiable and applicable for alcohol-related BI. The current study aimed to develop a valid and reliable measure of the bystander construct most proximal to the reduction of risk: bystander strategies. METHOD: Young adults (N = 1,011) who reported being around someone who showed signs of alcohol intoxication in the past 3 months were recruited via Qualtrics Panels to participate in an online survey; a subsample (n = 345) completed a 2-week follow-up. Psychometric evaluation included exploratory and confirmatory factor analyses, item response theory analyses, convergent validity, and test-retest reliability. RESULTS: An initial set of 52 items was reduced to 17 items, representing two different factors. The first factor, Level 1, reflected strategies used during circumstances of acute risk. The second factor, Level 2, reflected strategies used to reduce risk for more longstanding problems with alcohol. Both factors demonstrated good model fit, strong internal consistency, evidence of convergent validity, and moderate test-retest reliability. CONCLUSIONS: This novel measure can contribute to the production of knowledge about the use and efficacy of peer-focused strategies and the value of BI training for alcohol use.
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Consumo de Bebidas Alcohólicas , Humanos , Femenino , Masculino , Adulto Joven , Consumo de Bebidas Alcohólicas/psicología , Consumo de Bebidas Alcohólicas/epidemiología , Consumo de Bebidas Alcohólicas/prevención & control , Adolescente , Adulto , Reproducibilidad de los Resultados , Psicometría/métodos , Psicometría/normas , Intoxicación Alcohólica/psicología , Intoxicación Alcohólica/prevención & control , Estudios de Seguimiento , Conducta de AyudaRESUMEN
OBJECTIVE: Young adults who engage in simultaneous alcohol and cannabis use report heavy use of both substances. Event-level studies examining differences between consequences experienced on simultaneous use compared with single substance use days have been mixed. Although studies often control for alcohol use levels, few have examined how quantity of alcohol may influence consequences experienced on simultaneous use days. Furthermore, little research has examined the relationship between simultaneous use and positive consequences or explored individual consequences. This study examined differences in consequences experienced on simultaneous use versus single substance use days (alcohol-only, cannabis-only) including endorsement of specific consequences and examined the relationship among simultaneous use, consequences, and alcohol consumption. METHOD: Young adults who engage in simultaneous use (N = 86) completed 30 days of daily surveys reporting substance use and positive and negative consequences. RESULTS: Simultaneous use days were associated with more negative and positive consequences than single substance use (alcohol-only and cannabis-only) days. We also examined endorsement of specific positive and negative consequences on alcohol-only, cannabis-only, and simultaneous use days. The effect of day type (simultaneous use vs. alcohol-only) on consequences was moderated by alcohol quantity. On lighter drinking days, more positive and negative consequences were endorsed if it was a simultaneous use versus alcohol-only day. On heavier drinking days, number of consequences did not differ between simultaneous use and alcohol-only days. CONCLUSIONS: Findings from this study point to simultaneous use as both reinforcing and high risk and highlight the importance of intervening even on lighter drinking simultaneous use occasions to reduce harms.
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Cannabis , Trastornos Relacionados con Sustancias , Adulto Joven , Humanos , Consumo de Bebidas Alcohólicas/epidemiología , Etanol , Encuestas y CuestionariosRESUMEN
INTRODUCTION: Adolescent exposure to alcohol-related content on social media is common and associated with alcohol use and perceived norms; however, little is known about how exposure differs by the source of the content (e.g., peer or 'influencer'). The purpose of this study was to utilise qualitative methods to compare adolescent perspectives on peer- versus influencer-generated alcohol content on social media. METHODS: Nine virtual semi-structured focus groups were conducted with adolescents (aged 15-19 years), following a general script aimed at ascertaining adolescent comparative perspectives on peer and influencer alcohol-related media content and the contexts in which it occurs. RESULTS: Five main themes emerged: (i) although both influencers and peers post predominantly positively-valenced alcohol content online, adolescents perceived some differences between these posts; (ii) adolescents perceived their peers to be more cautious and strategic when posting about alcohol than influencers are; (iii) the decision to engage with peer or influencer alcohol-related posts is influenced by a number of factors; (iv) both peer and influencer posts were perceived to send the message that drinking is acceptable, normal or cool; and (v) adolescents believed they are more likely to be influenced by peers' alcohol posts than influencers' alcohol posts, with some exceptions. DISCUSSION AND CONCLUSIONS: Future studies should aim to further understand the unique attributes and circumstances in which exposure to peer and influencer alcohol-related posts impact adolescent alcohol-related cognitions and behaviours. This knowledge will inform prevention and intervention efforts, such as media literacy training and media-specific parenting practices.
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Conducta del Adolescente , Medios de Comunicación Sociales , Humanos , Adolescente , Grupo Paritario , Consumo de Bebidas Alcohólicas/epidemiología , CogniciónRESUMEN
The current study described how positive sexual experiences impact hypothetical subjective evaluations at follow up relative to baseline. Eighty-eight college students who engaged in weekly heavy episodic drinking participated. At baseline, participants reported alcohol use and hypothetical evaluations of alcohol-involved sexual experiences. During a 28-day ecological momentary assessment (EMA), participants completed next morning surveys and reported whether they engaged in a sexual/romantic experience and subjective evaluation of any sexual/romantic experience. At follow-up, participants re-reported all hypothetical evaluations. Associations between baseline and follow-up evaluations for "living out a sexual fantasy" and having an "alcohol-facilitated sexual experience" were not moderated by gender or positive sexual experiences. However, associations between baseline and follow-up "alcohol-intensified sex" were moderated by gender and having a positive sexual experience during the EMA study. Among women who had a positive sexual experience, evaluations of alcohol-intensified sex remained stable over time. For men who had a positive sexual experience, evaluations at follow up became less positive relative to their evaluations at baseline. Whereas positive sexual experiences served to confirm positive evaluations over time for women, evaluations decreased for men. Women and men who did not engage in sexual experiences did not need/rely on actual lived experiences in order to maintain their positive evaluations over time. Placing such a high emphasis on alcohol on intensifying sex without actual lived experience of negotiating consent when drinking could place college students at increased risk of sexual perpetration/victimization.
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Consumo de Alcohol en la Universidad , Víctimas de Crimen , Masculino , Humanos , Femenino , Consumo de Bebidas Alcohólicas/epidemiología , Etanol , Conducta Sexual , Estudiantes , UniversidadesRESUMEN
OBJECTIVE: Excessive alcohol use is very prevalent among young adults, and consequences of drinking are often observed by witnesses. Understanding the circumstances under which witnesses of risky alcohol use help others and whether they perceive these circumstances as an opportunity to engage in bystander intervention are important, but valid measures of these constructs are needed. The current study is a psychometric evaluation of the Exposure to Hazardous Drinking in Others (EHDO) scale and a single-item indicator of Perceived Alcohol-Related Bystander Opportunity (PARBO). METHOD: Young adults (N = 1,011; 46.0% women) who reported being around someone who showed signs of alcohol intoxication in the past 3 months were recruited via Qualtrics Panels. The initial item set for the EHDO was developed through qualitative methods and reflected observed or reported risks or consequences. Factor analyses and Item Response Theory analyses were used to reduce and categorize EHDO items, and construct validity was assessed for the EHDO and the PARBO item. RESULTS: An initial set of 33 EHDO items was reduced to 21, representing two factors: Situational Risk Signs and Problematic Pattern. Both factors demonstrated good model fit, internal consistency, and evidence of convergent validity. The PARBO item showed good construct validity but was distinct from the EHDO. CONCLUSIONS: These instruments are useful for measuring secondhand alcohol risks in a community and are particularly applicable for evaluating bystander intervention for alcohol risk.
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Consumo de Bebidas Alcohólicas , Psicometría , Humanos , Femenino , Masculino , Adulto Joven , Consumo de Bebidas Alcohólicas/psicología , Consumo de Bebidas Alcohólicas/epidemiología , Psicometría/métodos , Psicometría/instrumentación , Psicometría/normas , Adulto , Adolescente , Intoxicación Alcohólica/psicología , Intoxicación Alcohólica/epidemiologíaRESUMEN
BACKGROUND: Sexual assault is prevalent on college campuses and most commonly is perpetrated by men. Problematically, there is a dearth of evidence-based prevention programs targeting men as perpetrators of sexual aggression. The Sexual Assault and Alcohol Feedback and Education (SAFE) program is an integrated alcohol and sexual assault prevention intervention for college men who engage in heavy drinking that aims to address sexual aggression proclivity and alcohol use outcomes by incorporating social norms theory, bystander intervention, and motivational interviewing. OBJECTIVE: This study aims to examine the initial feasibility-, acceptability-, and efficacy-related outcomes of a randomized pilot trial of an integrated alcohol and sexual assault prevention program for college men who engage in heavy drinking. METHODS: This study included 115 college men who engaged in heavy drinking, who were randomly assigned to the SAFE program or a mindfulness-based control condition (MBCC). The feasibility of implementation, adequacy of participant retention, fidelity and competency of program administration, and satisfaction and utility of the intervention were evaluated. The primary outcomes of alcohol use and sexual aggression were evaluated at 2 and 6 months after baseline. The secondary outcomes of perceived peer norms, risks for sexual aggression, and bystander intervention were also assessed. The extent to which the motivational interviewing session with personalized normative feedback facilitated changes in the proximal outcomes of drinking intentions, motivation to change, and self-efficacy was also examined. RESULTS: The study procedures resulted in high program completion and retention (>80%), high fidelity to the program manual (>80% of the content included), high competency in program administration, and high ratings of satisfaction and program utility in addressing sexual relationships and alcohol use. Both groups reported declines in the number of drinks per week and number of heavy drinking days. Compared with the MBCC participants, the SAFE participants reported higher motivation to change alcohol use after the program, as well as greater use of alcohol protective behavioral strategies at 6 months. Compared with the MBCC participants, the SAFE participants also reported lower perceived peer engagement in sexual coercion, perceived peer comfort with sexism, and peer drinking norms at 2 and 6 months. However, no group differences were observed in sexual aggression severity, rape myth acceptance, or the labeling of sexual consent. Results regarding bystander intervention intentions were mixed, with the MBCC group showing decreased intentions at 2 months and the SAFE group reporting increased intentions at both 2 and 6 months. CONCLUSIONS: The findings provide promising evidence for the feasibility, acceptability, utility, and preliminary efficacy of the SAFE program in reducing alcohol use and positively influencing perceived peer norms and intentions for bystander intervention among college men who drink. TRIAL REGISTRATION: ClinicalTrials.gov NCT05773027; https://clinicaltrials.gov/study/NCT05773027.
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Influential psychological theories hypothesize that people consume alcohol in response to the experience of both negative and positive emotions. Despite two decades of daily diary and ecological momentary assessment research, it remains unclear whether people consume more alcohol on days they experience higher negative and positive affect in everyday life. In this preregistered meta-analysis, we synthesized the evidence for these daily associations between affect and alcohol use. We included individual participant data from 69 studies (N = 12,394), which used daily and momentary surveys to assess affect and the number of alcoholic drinks consumed. Results indicate that people are not more likely to drink on days they experience high negative affect, but are more likely to drink and drink heavily on days high in positive affect. People self-reporting a motivational tendency to drink-to-cope and drink-to-enhance consumed more alcohol, but not on days they experienced higher negative and positive affect. Results were robust across different operationalizations of affect, study designs, study populations, and individual characteristics. These findings challenge the long-held belief that people drink more alcohol following increases in negative affect. Integrating these findings under different theoretical models and limitations of this field of research, we collectively propose an agenda for future research to explore open questions surrounding affect and alcohol use.
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Afecto , Consumo de Bebidas Alcohólicas , Humanos , Afecto/fisiología , Consumo de Bebidas Alcohólicas/epidemiología , Consumo de Bebidas Alcohólicas/psicología , Motivación , Evaluación Ecológica Momentánea , Encuestas y CuestionariosRESUMEN
The first year of college is often marked by increased levels of alcohol consumption; first-year students also vary in their sense of fitting in on campus. Research has amply documented the links between social and enhancement drinking motives with various alcohol outcomes among college students. However, it is unclear how perceived levels of fitting in on campus potentially buffers or amplifies the relationship between drinking motives and drinking behavior. We explored whether perceptions of fitting in on campus moderated effects of social and/or enhancement drinking motives on drinks per week. A sample of 121 heavy drinking first year college students (50 % female, 58 % non-Latinx White, M = 18 years of age) were assessed twice in their first semester (baseline, 3 months) in the context of an alcohol-specific intervention. Hierarchical linear regressions were conducted to test whether drinking motives (social and enhancement) at baseline prospectively predicted drinks per week at 3 months. We hypothesized a positive association between both drinking motives and drinks per week; whether fitting in moderates these relationships was exploratory. Regression analyses yielded non-significant main effects of social motives, enhancement motives, and feelings of fitting in on drinks per week. There was no significant interaction for social motives, but the interaction between enhancement motives and fitting in was significant. Participants with a low sense of fitting in had a strong positive relationship between enhancement motives and drinks per week. Improving perceptions of fitting in for first-year college students may potentially reduce the association between enhancement drinking motives and drinks per week.
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Consumo de Alcohol en la Universidad , Consumo de Bebidas Alcohólicas , Humanos , Femenino , Lactante , Masculino , Motivación , Estudiantes , Emociones , Universidades , Etanol , Adaptación PsicológicaRESUMEN
BACKGROUND: Pregaming, or drinking before going out, is a commonly practiced risky behavior. Drinking motives are well-established predictors of alcohol use and negative alcohol consequences. Given the influence of context on drinking practices, motives specific to pregaming may affect pregaming behaviors and outcomes above and beyond general drinking motives. Thus, we examined how pregaming motives are related to pregaming behaviors and negative alcohol consequences. METHODS: Using data from two national cross-sectional online studies, the current study included undergraduates who pregamed at least once in the past month (n=10,200, Mage=19.9, women=61%, white=73.6%; 119 U.S. universities). Participants completed assessments of demographics, general drinking motives, pregaming motives, pregaming frequency/consumption, and negative alcohol consequences. Data were analyzed using hierarchical linear models accounting for nesting of participants within sites. RESULTS: When controlling for demographic factors and general drinking motives, interpersonal enhancement motives and intimate pursuit motives were positively associated with pregaming frequency, pregaming consumption, and negative alcohol consequences. Situational control motives were negatively associated with pregaming consumption and negative alcohol consequences. Barriers to consumption motives were negatively associated with pregaming frequency but positively associated with negative alcohol consequences. CONCLUSIONS: Students who pregame to make the night more fun or to meet potential dating partners appear to be at particular risk for negative alcohol consequences. Motives may be modifiable, particularly via cognitive/behavioral strategies. Findings suggest that specific motives may be appropriate intervention targets when trying to reduce pregaming behaviors and negative alcohol consequences.
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Consumo de Alcohol en la Universidad , Etanol , Humanos , Femenino , Estados Unidos/epidemiología , Universidades , Estudios Transversales , Motivación , Estudiantes , Consumo de Bebidas AlcohólicasRESUMEN
Importance: Three of 4 adults in treatment for alcohol use disorder (AUD) report symptoms of insomnia. Yet the first-line treatment for insomnia (cognitive behavioral therapy for insomnia, CBT-I) is often delayed until abstinence is established. Objective: To test the feasibility, acceptability, and preliminary efficacy of CBT-I among veterans early in their AUD treatment and to examine improvement in insomnia as a mechanism for improvement in alcohol use outcomes. Design, Setting, and Participants: For this randomized clinical trial, participants were recruited through the Addictions Treatment Program at a Veterans Health Administration hospital between 2019 and 2022. Patients in treatment for AUD were eligible if they met criteria for insomnia disorder and reported alcohol use in the past 2 months at baseline. Follow-up visits occurred posttreatment and at 6 weeks. Interventions: Participants were randomly assigned to receive 5 weekly sessions of CBT-I or a single session about sleep hygiene (control). Participants were asked to complete sleep diaries for 7 days at each assessment. Main Outcomes and Measures: Primary outcomes included posttreatment insomnia severity (assessed using the Insomnia Severity Index) and follow-up frequency of any drinking and heavy drinking (4 drinks for women, ≥5 drinks for men; number of days via Timeline Followback) and alcohol-related problems (Short Inventory of Problems). Posttreatment insomnia severity was tested as a mediator of CBT-I effects on alcohol use outcomes at the 6-week follow-up. Results: The study cohort included 67 veterans with a mean (SD) age of 46.3 years (11.8); 61 (91%) were male and 6 (9%) female. The CBT-I group included 32 participants, and the sleep hygiene control group 35 participants. Of those randomized, 59 (88%) provided posttreatment or follow-up data (31 CBT-I, 28 sleep hygiene). Relative to sleep hygiene, CBT-I participants reported greater decreases in insomnia severity at posttreatment (group × time interaction: -3.70; 95% CI, -6.79 to -0.61) and follow-up (-3.34; 95% CI, -6.46 to -0.23) and greater improvements in sleep efficiency (posttreatment, 8.31; 95% CI, 1.35 to 15.26; follow-up, 18.03; 95% CI, 10.46 to 25.60). They also reported greater decreases in alcohol problems at follow-up (group × time interaction: -0.84; 95% CI, -1.66 to -0.02), and this effect was mediated by posttreatment change in insomnia severity. No group differences emerged for abstinence or heavy-drinking frequency. Conclusions and Relevance: In this randomized clinical trial, CBT-I outperformed sleep hygiene in reducing insomnia symptoms and alcohol-related problems over time but had no effect on frequency of heavy drinking. CBT-I should be considered a first-line treatment for insomnia, regardless of abstinence. Trial Registration: ClinicalTrials.gov Identifier: NCT03806491.
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Alcoholismo , Terapia Cognitivo-Conductual , Trastornos del Inicio y del Mantenimiento del Sueño , Veteranos , Adulto , Humanos , Masculino , Femenino , Persona de Mediana Edad , Veteranos/psicología , Resultado del TratamientoRESUMEN
AIMS: Alcohol biosensors, including the BACtrack Skyn, provide an objective and passive method of continuously assessing alcohol consumption in the natural environment. Despite the many strengths of the Skyn, six key challenges in the collection and processing of data include (1) identifying consumed alcohol; (2) identifying environmental alcohol; (3) identifying and determining the source of missing or invalid data; (4) achieving high participant adherence; (5) integrating Skyn and self-report data; and (6) implications for statistical inference. In this report we outline these challenges, provide recommendations to address them and identify future needs. DESIGN AND SETTINGS: Procedures from several laboratory and field-based pilot studies are presented to demonstrate practical recommendations for Skyn use. Data from a pilot study including a 7-day ecological momentary assessment period are also presented to evaluate effects of environmental alcohol on BACtrack Skyn readings. CONCLUSIONS: To address challenges in the collection and processing of data from the BACtrack Skyn alcohol biosensor, researchers should identify goals in advance of data collection to anticipate the processing necessary to interpret Skyn data. The Transdermal Alcohol Sensor Data Macro (TASMAC) version 2.0 software can help to process data rapidly; identify drinking events, missing data and environmental alcohol; and integrate the sensor with self-report data. Thorough participant orientation and regular contact in field studies can reduce missing data and enhance adherence. Many recommended methods for Skyn use are applicable to other alcohol sensors and wearable devices.
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Técnicas Biosensibles , Dispositivos Electrónicos Vestibles , Humanos , Proyectos Piloto , Etanol , Técnicas Biosensibles/métodos , Recolección de Datos , Consumo de Bebidas AlcohólicasRESUMEN
OBJECTIVE: The prototype willingness model (PWM) provides a framework for understanding simultaneous alcohol and cannabis use by highlighting important psychosocial (e.g., attitudes, norms) predictors of and pathways (via willingness and/or intentions) to simultaneous use. We examined both the PWM reasoned and social reaction pathways in relation to simultaneous use. METHOD: Eighty-nine young adults self-monitored alcohol, cannabis, and simultaneous use and related constructs for 30 days via daily assessments. RESULTS: Day-level simultaneous use specific attitudes, norms, perceived vulnerability, intentions, and willingness each predicted simultaneous use, while only day-level intentions and willingness predicted number of negative consequences. We observed significant indirect effects for the two social reaction pathways examined (from descriptive norms to willingness to simultaneous use; from perceived vulnerability to willingness to simultaneous use). Only direct effects were seen for the cognitions in the reasoned pathway; injunctive norms predicted simultaneous use, and attitudes predicted simultaneous use with no mediation by intentions. CONCLUSIONS: Findings support applying the PWM to event-level simultaneous use among young adults. Future work should establish if PWM day-level constructs are modifiable targets that may be utilized in intervention work focused on reducing simultaneous use and related harms. (PsycInfo Database Record (c) 2023 APA, all rights reserved).