Understanding alcohol use and alcohol use disorders from a developmental psychopathology perspective: Research advances, challenges, and future directions.

As part of the special issue of Development and Psychopathology honoring the remarkable contributions of Dr Dante Cicchetti, the current paper attempts to describe the recent contributions that a developmental psychopathology perspective has made in understanding the development of alcohol use and alcohol-related problems over the lifespan. The paper also identifies some of the future challenges and research directions. Because the scope of this task far exceeds the confines of a journal length article this paper does not attempt a comprehensive review. Rather, it builds on an earlier review and commentary that was published in Development and Psychopathology in 2013, with a similar goal.)Building on that work and updating its conclusions and suggestions for future directions, the current paper emphasizes findings from the research areas that were identified for further study in 2013 and the findings that have been published since that time.

Alcohol and cannabis co-use: Receptiveness to treatments and application to intervention planning.

Given the prevalence of alcohol and cannabis co-use among college students, prevention for co-use is crucial. We examined hypothetical receptiveness to substance-specific interventions among students who reported co-use. Students who use alcohol and cannabis were more receptive to alcohol interventions than cannabis interventions. Campus prevention experts should consider offering evidence-based alcohol-focused interventions as a potential pathway for decreasing substance use among college students who engage in co-use.

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

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

Predictors of symptom course in alcohol use disorder.

BACKGROUND: Symptoms often play an important role in the scientific inquiry of psychological disorders and have been theorized to play a functional role in the disorders themselves. However, little is known about the course of specific symptoms and individual differences in course. Understanding the course of specific symptoms and factors influencing symptom course can inform psychological theory and future research on course and treatment. METHODS: The current study examined alcohol use disorder (AUD) criteria to explore how etiologically relevant covariates differentially affected the course of individual criteria. The study examined 34,653 participants from Wave 1 (2001-2002) and Wave 2 (2003-2004) of the National Epidemiological Survey on Alcohol and Related Conditions (NESARC), to analyze the extent to which AUD symptom course is predicted by alcohol consumption patterns, family history of alcoholism, the presence of internalizing and externalizing disorders, and race. RESULTS: The course of all AUD criteria was significantly influenced by these predictors, with the magnitude of the influence varying across different criteria and different aspects of the course (i.e., onset, persistence, recurrence). The strength of the relationship is partially related to the theoretical proximity of a given covariate to AUD symptomatology, with heavy drinking being the strongest and family history of AUD being the weakest. The course of all criteria was strongly associated with the prevalence of the criterion in the overall sample. CONCLUSIONS: The course of AUD criteria is heterogeneous, appearing to be influenced by conceptually proximal predictors, the prevalence of the criterion, and perhaps an underlying common factor. Diagnostic accuracy may be improved by including a criterion related to alcohol consumption. Future work should include exploring the interchangeability of criteria and alternative operationalization of them.

Alcohol use disorder conceptualizations and diagnoses reflect their sociopolitical context.

The present paper highlights how alcohol use disorder (AUD) conceptualizations and resulting diagnostic criteria have evolved over time in correspondence with interconnected sociopolitical influences in the United States. We highlight four illustrative examples of how DSM-defined alcoholism, abuse/dependence, and AUD have been influenced by sociopolitical factors. In doing so, we emphasize the importance of recognizing and understanding such sociopolitical factors in the application of AUD diagnoses. Last, we offer a roadmap to direct the process of future efforts toward the improved diagnosis of AUD, with an emphasis on pursuing falsifiability, acknowledging researchers' assumptions about human behavior, and collaborating across subfields. Such efforts that center the numerous mechanisms and functions of behavior, rather than signs or symptoms, have the potential to minimize sociopolitical influences in the development of diagnostic criteria and maximize the treatment utility of diagnoses.

Age Specificity of Effects of Health Problems on Drinking Reduction: A Lifespan Developmental Analysis.

Older adult drinking poses a growing public health concern, especially given the ongoing aging of the United States population. As part of a larger lifespan developmental project contrasting predictors of drinking reductions across different periods of adulthood, we tested age differences in effects of health problems on drinking declines across young adulthood, midlife, and older adulthood. We predicted these effects to be developmentally specific to midlife and older adulthood. We also tested moderation by alcohol use disorder (AUD) symptomatology and by indices of sociodemographic disadvantage (sex and race/ethnicity). Analyses used data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), leveraging NESARC's vast age range (18-90 + ; N = 43,093) and two waves of longitudinal data. Multiple-group cross-lag models tested differences across age groups in cross-lag paths between health problems and alcohol consumption. As hypothesized, health problem effects on drinking reductions were developmentally specific to midlife and older adulthood. However, models testing moderation by AUD symptomatology showed that these adaptive effects of health problems on drinking reductions did not extend to those with one or more AUD symptoms. Little evidence was found for moderation by sex or race/ethnicity. Findings support the notion of health concerns as a pathway to drinking reduction that increases in importance across the adult lifespan. However, given the moderation by AUD symptoms, findings also highlight a need to understand barriers to health-related pathways to drinking reduction among relatively severe midlife and older adult drinkers. These findings hold implications for lifespan developmental tailoring of clinical, public health, and policy interventions.

A Clinical Psychologist Who Studies Alcohol.

In this article, I describe why I believe the study of alcohol use and its consequences is a rich and rewarding area of scholarly activity that touches on multiple disciplines in the life sciences, the behavioral sciences, and the humanities. I then detail the circuitous path I took to become an alcohol researcher and the various challenges I encountered when starting up my research program at the University of Missouri. A major theme of my journey has been my good fortune encountering generous, brilliant scholars who took an interest in me and my career and who helped guide and assist me over the course of my career. I also highlight selected, other professional activities I've been involved in, focusing on editorial work, quality assurance, and governance of professional societies. While the focus is on my training and work as a psychologist, the overarching theme is the interpersonal context that nurtures careers.

Psychopathology as dynamic markers of alcohol initiation across development: A three-year longitudinal examination.

Sipping, an early form of alcohol initiation, is associated with aspects of psychopathology and personality that reflect long-term risk for harmful alcohol use. In the Adolescent Brain and Cognitive Development cohort (N = 11,872), sipping by age 9-10 was concurrently associated with impulsivity, other aspects of externalizing, and prodromal schizophrenia symptoms. Still, these associations were cross-sectional in nature, leaving open the possibility that these features of psychopathology and personality might not reflect long-term risk for alcohol consumption and related harm across development. Here, we attempted to replicate baseline concurrent associations across three waves of data to extend concurrent associations to prospective ones. Most cross-sectional associations replicated across waves, such that impulsivity, other aspects of externalizing, reward sensitivity (e.g., surgency, sensation seeking), and prodromal schizophrenia symptoms were associated with increased odds of having sipped alcohol by the age of 12. Nevertheless, not all concurrent associations replicated prospectively; impulsigenic features did not reflect long-term risk for sipping. Thus, some psychopathology features appeared to reflect stable risk factors, whereas others appeared to reflect state-dependent risk factors. All told, sipping might not reflect long-term risk for harmful alcohol use, and the nature of sipping may change across development.

Alcohol use disorder criteria exhibit different comorbidity patterns.

BACKGROUND AND AIMS: Alcohol use disorder is comorbid with numerous other forms of psychopathology, including externalizing disorders (e.g. conduct disorder) and, to a lesser extent, internalizing conditions (e.g. depression, anxiety). Much of the time, overlap among alcohol use disorder and other conditions is explored at the disorder level, assuming that criteria are co-equal indicators of other psychopathology, even though alcohol use disorder criteria span numerous varied domains. Emerging evidence suggests that there are symptom clusters within the construct of alcohol use disorder that relate differentially with important external criteria, including psychopathology and allied personality traits (e.g. impulsivity, novelty-seeking). The present study mapped individual alcohol use disorder criteria onto internalizing and externalizing dimensions. DESIGN AND PARTICIPANTS: We used multivariate and factor analytical modeling and data from two large nationally representative samples of past year drinkers (n = 25 604; 19 454). SETTING: United States. MEASUREMENTS: Psychopathology was assessed using the Alcohol Use Disorder and Associated Disabilities Interview Schedule, yielding alcohol use disorder criteria, internalizing diagnoses (i.e. major depressive disorder, dysthymia, social anxiety disorder, generalized anxiety disorder, specific phobia, agoraphobia and panic disorder) and externalizing diagnoses and symptoms (i.e. antisocial personality disorder, conduct disorder and three impulsivity items drawn from borderline personality disorder criteria). Alcohol consumption was assessed in terms of past-year drinking frequency, usual amount of alcohol consumed on drinking days, binge drinking frequency, intoxication frequency, and maximum number of drinks in a 24-hour period. FINDINGS: Four different patterns emerged. First, several alcohol use disorder criteria were relatively weakly associated with externalizing and internalizing. Secondly, withdrawal was associated with internalizing, but this association was not specific to distress. Thirdly, there was a general lack of specificity between alcohol use disorder criteria and narrower forms of internalizing, despite what might be predicted by modern models of addiction. Fourthly, recurrent use in hazardous situations reflected higher degrees of externalizing and lower internalizing liability. CONCLUSIONS: Different symptom combinations appear to yield differential expressions of alcohol use disorder that are disorder-specific, or reflect broader tendencies toward externalizing, internalizing or both.

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

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

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

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

A life span developmental investigation of marriage and problem-drinking reduction.

While prior literature has largely focused on marriage effects during young adulthood, it is less clear whether these effects are as strong in middle adulthood. Thus, we investigated age differences in marriage effects on problem-drinking reduction. We employed parallel analyses with two independent samples (analytic-sample Ns of 577 and 441, respectively). Both are high-risk samples by design, with about 50% of participants having a parent with lifetime alcohol use disorder. Both samples have been assessed longitudinally from early young adulthood to the mid-to-late 30s. Separate parallel analyses with these two samples allowed evaluation of the reproducibility of results. Growth models of problem drinking tested marriage as a time-varying predictor and thereby assessed age differences in marriage effects. For both samples, results consistently showed marriage effects to be strongest in early young adulthood and to decrease somewhat monotonically thereafter with age, reaching very small (and nonsignificant) magnitudes by the 30s. Results may reflect that role transitions like marriage have more impact on problem drinking in earlier versus later adulthood, thereby highlighting the importance of life span developmental research for understanding problem-drinking desistance. Our findings can inform intervention strategies aimed at reducing problem drinking by jumpstarting or amplifying natural processes of adult role adaptation.

Who Opts In to Alcohol Feedback and How Does That Impact Behavior? A Pilot Trial.

OBJECTIVE: Personalized feedback interventions are effective in reducing alcohol consumption and related problems. However, little is known about the role of choice in outcomes. The current study sought to (a) characterize individuals who opt in for brief alcohol-related feedback, (b) assess participants' consistency in that choice over two time points, and (c) evaluate changes in peak alcohol consumption among those who did and did not receive feedback. METHOD: Participants reporting past-12-month alcohol consumption were recruited through Prolific. At the outset of the survey, participants were asked if they would like to receive feedback on their drinking at the end of the survey ("opt in"). Participants at Time 1 (T1; N = 732) were 41% female, 91% White, and 8% Hispanic (mean age = 36, SD = 12.25, range: 18-80). A subset was invited back for a 30-day retest (Time 2 [T2]; n = 234). RESULTS: Those reporting higher maximum drinks and more drug use were more likely to opt in to feedback than those with lower use. Further, 85% of participants were consistent in their choice of whether to receive feedback across T1 and T2 (κ = .65). Among heavy drinking participants with T1 and T2 data (n = 163), there was an effect of feedback on intensity of consumption at T2. CONCLUSIONS: Individuals who engage in heavy alcohol use are more likely to opt in to personalized alcohol feedback, and most do so consistently. Among heavy drinkers, feedback at T1 reduced intensity of consumption at T2, but the effect was small and requires future replication in more diverse samples.

How Robust Is the p Factor? Using Multitrait-Multimethod Modeling to Inform the Meaning of General Factors of Youth Psychopathology.

We used multitrait-multimethod (MTMM) modeling to examine general factors of psychopathology in three samples of youth (Ns = 2119, 303, 592) for whom three informants reported on the youth's psychopathology (e.g., child, parent, teacher). Empirical support for the p-factor diminished in multi-informant models compared with mono-informant models: the correlation between externalizing and internalizing factors decreased and the general factor in bifactor models essentially reflected externalizing. Widely used MTMM-informed approaches for modeling multi-informant data cannot distinguish between competing interpretations of the patterns of effects we observed, including that the p-factor reflects, in part, evaluative consistency bias or that psychopathology manifests differently across contexts (e.g., home vs. school). Ultimately, support for the p-factor may be stronger in mono-informant designs, although it is does not entirely vanish in multi-informant models. Instead, the general factor of psychopathology in any given mono-informant model likely reflects a complex mix of variances, some substantive and some methodological.

A brief young adult alcohol problems screening test: Short form development using combinatorics.

Objective: To develop a shortened form of the Young Adult Alcohol Problems Screening Test1 (YAAPST; original length = 27 items) using a novel combinatorial approach. Participants: 489 college freshmen, half of whom were above average risk for alcohol use disorder based upon family history, attending a large, Midwestern University followed prospectively for 16-17 years across 7 measurement occasions (waves). Methods: Using an exhaustive combinatorial approach, we evaluated all possible combinations of questions and questionnaire length. Each candidate short-form was evaluated using part-whole correlations, alpha coefficients, and polyserial correlations with DSM-III criteria. Results: The 12-item scale, the Brief-YAAPST, was chosen as the best candidate short-form as this scale had the fewest items while maintaining strong reliability and validity. Conclusions: Complete enumeration optimization effectively produced a 12-item short form with minimal loss of reliability and validity making the Brief-YAAPST a desirable assessment alternative when there are concerns about participant or client burden.

Individual-, peer-, and parent-level substance use-related factors among 9- and 10-year-olds from the ABCD Study: Prevalence rates and sociodemographic differences.

Background: Although a relatively large body of research has identified multiple factors associated with adolescent substance use, less is known about earlier substance-related factors during preadolescence, including curiosity to use substances. The present study examined individual-, peer-, and parent-level domains pertaining to substance use and how these domains vary by sociodemographic subgroups and substance type. Methods: Participants were 11,864 9- and 10-year-olds from the baseline sample of the Adolescent Brain Cognitive Development (ABCD) Study. Youth-reported measures were curiosity to use substances and perceived peer substance use. Parent-reported measures were availability of and rules about substances. Generalized logistic mixed models (GLMM) were used to compare these measures across alcohol, nicotine, and marijuana and across sociodemographic subgroupings (sex, race/ethnicity, household income, and family history of alcohol problems). GLMM was then used to examine predictors of curiosity to use by substance type. Results: The most striking descriptive differences were found between race/ethnicity and income categories (e.g., positive associations between greater income and greater availability of alcohol). In multivariable analyses, greater curiosity to use alcohol was associated with being male, higher household income, perceived peer alcohol use, and easy alcohol availability; greater curiosity to use nicotine was associated with being male, perceived peer cigarette use, easy availability of cigarettes, and no parental rules about cigarette use. Conclusions: This study identified substance use-related individual-, peer-, and parent-level factors among a diverse, national sample. Findings highlight the importance of considering sociodemographic and substance-specific variability and may help identify risk and protective factors preceding adolescent substance use.

Cross-sectional and longitudinal AUD symptom networks: They tell different stories.

Modern theoretical models of Alcohol Use Disorder (AUD) highlight the different functional roles played by various mechanisms associated with different symptoms. Symptom network models (SNMs) offer one approach to modeling AUD symptomatology in a way that could reflect these processes and provide important information on the progression and persistence of disorder. However, much of the research conducted using SNMs relies on cross-sectional data, which has raised questions regarding the extent they reflect dynamic processes. The current study aimed to (a) examine symptom networks of AUD and (b) compare the extent to which cross-sectional network models had similar structures and interpretations as longitudinal network models. 17,360 participants from Wave 1 (2001-2002) and Wave 2 (2003-2004) of the National Epidemiological Survey on Alcohol and Related Conditions (NESARC) were used to model cross-sectional and longitudinal AUD symptom networks. The cross-sectional analyses demonstrate high replicability across waves and central symptoms consistent with other cross-sectional studies on addiction networks. The longitudinal network shared much less similarity than the cross-sectional networks and had a substantially different structure. Given the increasing attention given to the network perspective in psychopathology research, the results of this study raise concerns about interpreting cross-sectional symptom networks as representative of temporal changes occurring within a psychological disorder. We conclude that the psychological symptom network literature should be bolstered with additional research on longitudinal network models.

Sociodemographic differences in youth alcohol sipping's nomological network.

BACKGROUND: Previous research has established that certain features of personality (e.g., impulsivity), psychopathology (e.g., impulsivity, mood disorder, thought disorder), and contextual factors (e.g., parenting, parental alcohol use) are associated with an increased likelihood of having sipped alcohol in youth, and substance involvement and problems in adolescence and adulthood. What is less clear from the existing literature is whether well-established risk factors of substance use are consistent across sociodemographic characteristics (i.e., gender, race/ethnicity, religious affiliation, income, parental education). METHODS: We used a large, community sample of 9- and 10-year-olds (N = 11,872; 53% female) to examine whether various sociodemographic characteristics moderate the associations between sipping behavior and its various well-established correlates (e.g., impulsivity, behavioral inhibition and activation, psychopathology, parenting, and family conflict). RESULTS: There were small mean level differences in sipping across sociodemographic characteristics. Across sociodemographic characteristics, however, sipping was fairly uniformly associated with youth-reported impulsivity, behavioral activation, prodromal psychosis symptoms, mood and externalizing disorder diagnoses, family environment, and parental alcohol consumption indices. Effects were sometimes slightly more pronounced among groups for which alcohol consumption is relatively nonnormative: Sipping among female youth was slightly more associated with thought disorder psychopathology than among male youth (D = 0.07), and was slightly more associated with some aspects of psychopathology and impulsivity for Black youth than White and Hispanic youth (Ds were 0.07 and 0.09). CONCLUSIONS: Broadly, our findings suggest that the psychosocial correlates of precocious alcohol use are relatively consistent across sociodemographic factors.