The daily association between affect and alcohol use: A meta-analysis of individual participant data.

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.

Coping Flexibility and Alcohol-Related Outcomes: Examining Coping Motives as Mediators.

Background: Coping has been implicated in the etiology and treatment of problem drinking. Traditional, static measurement of coping styles (e.g., approach, avoidance, social support) may fail to capture how adaptive a given coping style may be. Coping flexibility is an emerging construct, associated with psychological health, and one that may shed light on coping's role in drinking risk. Coping flexibility includes (1) discontinuation of an ineffective coping strategy ("Discontinuation") and (2) production of an alternative strategy ("Implementation"). This study is the first to our knowledge to examine its association to drinking outcomes. Further, because coping deficits are theorized to lead to drinking through coping motives, we also examined mediated pathways from coping flexibility to alcohol outcomes via coping motives. Methods: College students (N = 528) completed an online assessment. Data were analyzed using path analysis. Control variables included sex and coping styles. Results: In path analytic models, Implementation was negatively associated with alcohol use and, indirectly via coping motives, negatively associated with alcohol consequences. The direct effect on alcohol use remained when controlling for coping styles and sex, but the mediational pathway was no longer significant. Conclusions: This study provides some evidence for the protective role of coping flexibility in alcohol use behavior, which may have implications for how best to address coping skills in alcohol interventions. The direct effect of Implementation on drinking suggests that there may be utility in teaching clients a flexible approach to coping in treatment. Replication, particularly with longitudinal designs, is needed.

Friends-Based Protective Strategies and Unwanted Sexual Experiences: A Daily Diary Examination of First Year College Women.

Risk for unwanted sexual experiences can emerge in social contexts-the same contexts that early college women navigate with their friends. Though friends naturally engage in prevention strategies, less is known about how capable guardianship influences risk. Using multilevel structural equation modeling, the present study examined guardianship at the person- and situation-level. First year college women (N = 132) completed eight weekends of daily surveys. We examined whether guardianship (e.g., more friends present, greater proportion of female friends, no intoxicated friends) would reduce unwanted sexual experience risk and if this relation was mediated by friends-based strategy use. An alternative model was also tested with the same predictors, but unwanted sexual experiences as the mediator and friends-based strategy use as the outcome. Over half (58%) of extended weekend nights with friends involved drinking or using drugs. Friends-based strategies were used on 29% of nights. Across models, being with one or more intoxicated friends was associated with friends-based strategy use and an unwanted sexual experience, but only at the situation-level. Parents, educators, and policy makers can encourage college women to draw on their social networks to enhance safety. Interventions could incorporate more universal strategies for responding to risk in social contexts.

Minority Stress and Nicotine Use and Dependence among Sexual Minority Youth.

Sexual minority youth (SMY), especially those who are plurisexual (e.g. bisexual, pansexual, queer), are more likely to use nicotine or develop nicotine dependence than their heterosexual peers, and this disparity is often attributed to minority stress (e.g. discrimination). This study tested the association between minority stress and nicotine use and dependence among SMY and examined the moderating role of impulsivity. A sample of SMY (N = 85; aged 14-19; 80.6% White; 80% plurisexual) who were active nicotine users were recruited from the community. Results indicated that greater discrimination experiences were associated with more nicotine use days and higher nicotine dependence symptoms. However, impulsivity did not moderate the relationship between discrimination and nicotine use or dependence. These results highlight the potential importance of minority stress in understanding SMY's risk for nicotine use and dependence. This research suggests the need for identifying factors that could place some SMY at greater risk for nicotine use and dependence and points to potential clinical implications for nicotine cessation interventions for SMY.

Cannabis Outcome Expectancies, Cannabis Use Motives, and Cannabis Use among a Small Sample of Frequent Using Adults.

Background: Little is known about the factors influencing use among frequent cannabis users, defined here as using at least three times per week. Outcome expectancies and motives for cannabis use have been independently examined in relation to cannabis use, but not among frequent users. Further, the associations among distinct expectancies and motives for cannabis use have yet to be explored. The current study examined whether expectancies influence cannabis use through cannabis use motives among frequent users. Additionally, we examined more nuanced relationships among three cannabis outcome expectancies (relaxation/tension reduction, social, perceptual/cognitive) and four motives (enhancement, social, coping, expansion). Method: Bayesian path analysis with informative priors was used to examine associations among expectancies, motives, and outcomes in a sample of 54 (63% male) young adult frequent users (i.e., at least three times per week; 65% used daily). Participants were recruited from the community and completed self-report questionnaires assessing cannabis use, expectancies, and motives. Results: Findings support hypotheses that cannabis use expectancies were associated with unique motives for frequent cannabis users. Perceptual/cognitive enhancement expectancies were the only expectancy to consistently relate to all four cannabis use motives. Social expectancies were related to enhancement, social, and expansion motives for use, and relaxation/tension reduction expectancies were associated with coping motives. Conclusions: Results extend previous work examining direct and indirect effects of expectancies and motives among frequent using young adults. Findings support the potential clinical utility of exploring the perceived functional benefits of cannabis use for individual frequent users as well as potential alternatives that might serve similar functions with fewer risks and consequences.

A Qualitative Study on Friends and the Social Context of Sexual Victimization: Implications for Campus-Based Interventions.

Sexual victimization (SV) risk can begin in social contexts, ones where friends are present, though it is unclear how friends might be integrated into SV prevention. Using focus groups, female college drinkers described (a) the role of friends in preventing SV, (b) the strategies friends use to reduce vulnerability, and (c) the barriers to implementation. Friends-based strategies (keeping tabs on one another, using signals to convey potential danger, interrupting escalating situations, taking responsibility for friends, relying on male friends) and barriers (intoxication, preoccupation, situation ambiguity, social consequences) were discussed. Interventions can draw on these strategies, but must address the critical barriers.

Learning from drinking experiences in college: A test of reciprocal determinism with drinking refusal self-efficacy.

Problematic drinking is common in college, with many students experiencing a range of detrimental alcohol-related consequences. An understanding of the etiological factors involved in the development and maintenance of this behavior is important, as it would inform intervention efforts. Drinking refusal self-efficacy (DRSE) plays a central role in drinking behavior. Social learning theory's principle of reciprocal determinism suggests that cognitions such as DRSE are not only learned over time from drinking experiences but also impact an individual's subsequent drinking behavior. To date, no study has tested reciprocal determinism in relation to DRSE. Accordingly, in the current study, we examined within-person reciprocal associations between DRSE and drinking experiences (alcohol use and related consequences) in college drinkers during the first year of college (n = 728). Data were drawn from a larger study of trauma, posttraumatic stress, and substance use in young adulthood. Data were analyzed using a random intercept cross-lagged panel model to disaggregate between-person and within-person effects. At the between-person level, DRSE was negatively associated with both alcohol use and alcohol-related consequences. Furthermore, DRSE exhibited significant negative prospective within-person associations with alcohol-related consequences but not with alcohol consumption. Both alcohol consumption and alcohol-related consequences exhibited significant negative prospective within-person associations with DRSE. As such, findings support reciprocal determinism between alcohol-related consequences and DRSE. These findings have several clinical implications, as they point to a risky learning process that could be targeted in treatment or in prevention programs. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Reciprocal processes in trauma and coping: Bidirectional effects over a four-year period.

OBJECTIVE: Both trauma exposure and coping are strong predictors of mental health outcomes. There is evidence that trauma and coping are linked, with cross-sectional work suggesting that individuals with more trauma exposure show poorer coping ability (i.e., more avoidance coping, less approach coping). To date, no study has examined the temporal directionality of this association, a question with important clinical implications. METHOD: Using a longitudinal data set over 4 years of college (N = 787), we examined bidirectional associations between trauma exposure and 3 coping styles (approach, avoidance, social support seeking). Our data analytic approach allowed us to examine both within-person and between-person effects, to better determine how change occurs at the individual level. Coping was assessed using the Brief Cope (Carver, 1997), and trauma exposure was assessed using the Traumatic Life Experiences Questionnaire (Kubany et al., 2000). Gender, baseline posttraumatic stress disorder symptoms, and precollege trauma were included as statistical control variables. RESULTS: The between-person effects were consistent with the cross-sectional literature. Interestingly, rather than an increase in avoidance coping and trauma exposure over time, the within-person findings suggested an adaptive cycle over time, in which increased trauma exposure marginally predicted an increase in approach coping (B = .05, p = .07), and approach coping predicted decreased trauma exposure (B = -.07, p = .04). CONCLUSIONS: Our study sheds new light on how coping and stressful events may impact one another across time. Findings suggest that a focus on approach-based coping skills may be an important direction for prevention efforts. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Distress-Related Internalizing Symptoms Interact With Externalizing Symptoms to Predict Alcohol Problems in an Inpatient Adolescent Sample.

BACKGROUND AND OBJECTIVES: Previous research has yielded equivocal findings regarding whether internalizing symptoms are risk factors for adolescent hazardous alcohol use (AU), specifically in the presence of externalizing symptoms. This may be due to the type of internalizing symptoms examined (ie, distress vs fear), and the use of primarily normative rather than clinical samples. Thus, we tested internalizing and externalizing symptom interactions as they relate to adolescent hazardous AU in a high-risk, clinical sample of adolescents. METHODS: Adolescents (N = 101; 66% female; Mage = 15) were recruited from an inpatient psychiatric unit and assessed for current symptoms. Hypotheses were tested by running a series of moderation models regressing hazardous AU on a set of internalizing symptoms (ie, depression, generalized anxiety disorder [GAD], social anxiety, separation anxiety, school avoidance, and panic), each interacting with externalizing symptoms. RESULTS: We observed significant interactions between several internalizing symptoms (depression, GAD, and panic symptoms) and externalizing symptoms predicting hazardous AU. These internalizing symptoms were unrelated to AU at low and average levels of externalizing symptoms, but were positively related to AU at high levels of externalizing symptoms. DISCUSSION AND CONCLUSIONS: In this clinical sample, distress-related internalizing symptomatology was associated with risk for, and not protection against, hazardous AU, but only when accompanied by high externalizing symptoms. SCIENTIFIC SIGNIFICANCE: Findings suggest that whether or not internalizing symptoms operate synergistically with externalizing symptoms to predict hazardous AU depends on the subdomain of internalizing symptoms (distress vs fear) and perhaps the type of sample (ie, clinical vs community). (Am J Addict 2019:00:00-00).

Examining cannabis protective behavioral strategy use using multiple methods.

PURPOSE ­: Cannabis use among young adults is increasing, despite being associated with several negative consequences. Protective behavioral strategies (PBSs) are a potential mechanism of behavior change for reducing substance use, yet PBS use for cannabis is not well understood. The purpose of this paper is to further define and measure the PBS construct for cannabis. DESIGN/METHODOLOGY/APPROACH ­: A community sample of cannabis users (n = 54) participated in eight focus groups discussing the use of PBSs. Participants completed surveys regarding demographics, cannabis use habits and cannabis problems. The authors also administered an existing measure of cannabis PBS and asked them to generate new or unique protective strategies that they had used or had heard of others using. FINDINGS ­: Thematic analysis of qualitative focus group data provided information about cannabis users' reasons for regulating cannabis use (e.g. health or legal problems, interpersonal) as well as strategies to moderate cannabis use or attenuate their risk for experiencing adverse consequences (e.g. distraction, existential/spiritual strategies). Analyses of quantitative survey data revealed that use of PBSs was negatively correlated with cannabis outcomes. Perceived helpfulness of strategies was an important predictor of decreased cannabis use and adverse consequences. RESEARCH LIMITATIONS/IMPLICATIONS ­: Findings expand the understanding of the definition and measurement of strategies for regulating cannabis use and reducing related risk of experiencing adverse consequences. ORIGINALITY/VALUE ­: This is the first study to examine cannabis-related PBS using both qualitative and quantitative methods, which provide insights into the definition of PBS and for future refinements of PBS measurement.

Coping trajectories in emerging adulthood: The influence of temperament and gender.

OBJECTIVE: The study of coping has far-reaching implications for understanding psychopathology and resilience, as well as for the treatment of psychological disorders. Developmental work has examined how the ability to cope changes across time in children and adolescents; however, work in emerging adulthood is still lacking. Coping is thought to emerge from basic biological and psychological processes, such as temperament and gender, which may influence the trajectory of coping use over time. METHOD: Using a sample of college students (N = 1,000), our 4-year longitudinal study with yearly assessments sought to (a) examine the trajectory of coping styles in emerging adulthood and to (b) examine the influence of temperament and gender on these coping trajectories. RESULTS: Our findings suggest that young adults' use of avoidance strategies decreased slightly over college, whereas the use of approach strategies and social support seeking remained stable. Temperament (BIS/BAS) and gender were related to certain coping styles at baseline and appeared to have an influence on some of these trajectories over time, though these associations were complex. CONCLUSIONS: This work may inform intervention research attempting to promote adaptive coping because it may help identify young adults most in need of such interventions.

Enlisting friends to reduce sexual victimization risk: There's an app for that but nobody uses it.

OBJECTIVE: The Circle of Six (Co6) phone application (app), winner of the White House's Apps Against Abuse Challenge, seeks to incorporate friends into sexual victimization risk reduction. Despite its growing presence on college campuses, the feasibility/acceptability of the app to college women is unknown. This mixed methods study sought to fill this gap. PARTICIPANTS: College women (n = 44) participated in summer/fall 2015. METHODS: Participants completed questionnaires, used the Co6 app for 2 months, and returned to report their experiences. RESULTS: Consistent with the app's aim, women reported greater intentions to help friends versus strangers in sexually aggressive situations. However, app use was low over follow-up. Reasons women gave for not using the app included redundancy with existing smart phone features and discomfort with group messaging. Some saw the app as an emergency only resource. CONCLUSIONS: The Co6 app may not meet the real world needs of college women.

The Role of Posttraumatic Growth in a Randomized Controlled Trial of Cognitive-Behavioral Conjoint Therapy for PTSD.

Posttraumatic growth (PTG) is defined as a positive psychological change that can emerge following a traumatic life event. Although documented in noninterventional studies of traumatized individuals, there are scant data on the potential for therapy to induce or improve PTG. Thus, the primary goal of this study was to examine changes in PTG in a controlled trial of cognitive-behavioral conjoint therapy for posttraumatic stress disorder versus waitlist (CBCT for PTSD; Monson & Fredman, 2012). We also examined whether pretreatment relationship satisfaction and PTSD symptomatology moderated change in PTG. There were 40 couples (75% with a female partner with PTSD) who were randomized to either immediate CBCT for PTSD or a 3-month waitlist (WL). Compared to WL, individuals who received treatment immediately demonstrated a significant increase in PTG. There was a moderate effect size between-group difference (Hedge's g = 0.45). There was a nonsignificant relationship with a moderate effect size (Hedge's g = 0.65) for the positive effect of pretreatment relationship satisfaction on the trajectory of PTG, but no effect of pretreatment PTSD symptoms. Results suggested that CBCT for PTSD facilitated PTG, even with a limited focus on PTG in this conjoint intervention. Future research should target PTG as a treatment goal and further examine the role of close others in facilitating development of PTG.

A Preliminary Examination of the Effects of Pretreatment Relationship Satisfaction on Treatment Outcomes in Cognitive-Behavioral Conjoint Therapy for PTSD.

OBJECTIVE: The primary goal of the present study was to investigate whether pre-treatment relationship satisfaction predicted treatment drop-out and posttraumatic stress disorder (PTSD) symptom outcomes within a trial of cognitive-behavioral conjoint therapy (CBCT) for PTSD (Monson & Fredman, 2012). Additionally, we examined the influence of pre-treatment relationship distress on relationship outcomes. METHOD: Thirty-seven patients and their intimate partners who participated in a course of CBCT for PTSD were assessed for PTSD symptoms with the Clinician-Administered PTSD Scale and PTSD Checklist, and for intimate relationship functioning with the Dyadic Adjustment Scale. CBCT for PTSD is a conjoint therapy designed to improve PTSD symptoms and enhance relationship functioning. Patients had to meet diagnostic criteria for PTSD to be included in the study; however, couples were not required to be in distressed relationships to receive treatment. RESULTS: Neither patients' nor partners' pre-treatment relationship satisfaction, nor their interaction, predicted treatment drop-out (ORs = .97-1.01) or completing patients' post-treatment PTSD symptom severity (sr2 ≤ .03). However, participants who were in distressed relationships prior to treatment made greater gains in relationship satisfaction compared with those who began treatment in more satisfied relationships (g = 1.02). CONCLUSIONS: Among patients receiving CBCT for PTSD, treatment drop-out and improvements in PTSD symptoms may be independent of pre-treatment relationship functioning, whereas improvements in relational functioning may be greater among those distressed prior to treatment.