Who's at greatest risk? Latent profiles of alcohol and cannabis use and related consequences among college students.

BACKGROUND: There is significant heterogeneity in alcohol and cannabis use patterns among college students, with some engaging in use patterns that heighten their risk for adverse consequences. Person-centered approaches can help identify those subgroups of students with riskier use patterns. Latent Profile Analyses (LPA) were conducted to identify subgroups based on alcohol and cannabis use frequency and quantity, to explore demographic covariates and to examine mean differences across subgroups on alcohol- and cannabis-related consequences, simultaneous use, and other substance use. METHODS: Participants were 2,423 college students (Mage = 20.1; 72  % female) recruited from seven US universities who endorsed past-month alcohol and cannabis use and completed an online survey of substance use behaviors. RESULTS: A four-profile solution was the best fitting model. Profile 1 represented "light, infrequent alcohol and cannabis use" (73.8 %), Profile 2 represented "heavy, infrequent alcohol and moderate, frequent cannabis use" (15.9 %), Profile 3 represented "moderate, frequent alcohol and cannabis use" (5.6 %) and Profile 4 represented "very heavy, frequent alcohol and heavy, frequent cannabis use" (4.7 %). Students who identify as male, White non-Hispanic, and/or Greek-affiliated were more likely to be in the heavy alcohol use profiles. Profiles 3 and 4 represent high-risk profiles, with both having a higher likelihood of simultaneous use, Profile 3 endorsing more cannabis consequences, and Profile 4 endorsing more alcohol consequences. CONCLUSION: Results suggest that heavy alcohol or heavy co-use heightens risk for serious adverse consequences.

Quality of Life and Opioid Use Motives: Direct and Indirect Associations with Risky Opioid Use in a Community Sample of Adults.

Purpose: The opioid epidemic in the United States has resulted in mass mortality and economic costs exceeding $1 trillion. Poor health-related quality of life is evident among individuals entering treatment for opioid use disorder (OUD). Yet, little research has examined the influence of quality of life on risky opioid use among non-treatment-seeking adults. To help inform OUD prevention efforts, this study examined the association among quality of life domains, opioid use motives, and risky opioid behaviors in a community sample of opioid users. Methods: Participants (N = 278) were adults who endorsed past month opioid use and were not currently in treatment for OUD. Participants responded to questions regarding their opioid use and misuse, opioid use motives, opioid use consequences, and quality of life. Results: The physical health domain of quality of life was associated with risky opioid use. Specifically, poorer physical health predicted risky opioid use and this relationship was partially explained by more social and pain motives to use opioids. Surprisingly, no other quality of life domains predicted risky opioid use. Conclusion: This study represents a meaningful first step in identifying optimal targets for OUD prevention efforts with community samples. Our findings suggest that physical health is an important quality of life indicator to prevent opioid-related harm and development of OUD.

Values of College Students Mandated to an Alcohol Intervention: A Qualitative Examination.

Background: Personal values motivate action and have been shown to influence behavioral choices. Objectives: The purpose of this qualitative study was to identify which values are important to college student drinkers and what underlying principles and motivations support those values. A sample of 198 students who received a university mandate to complete an alcohol education intervention following a campus alcohol policy violation wrote essays regarding their values. These essays were categorized and thematically analyzed by the research team. Results: The majority of values fell under the category of Relationships, followed by Morality, Future Orientation, Wellness, and Benevolence. Conclusions: Most students placed a high value on their commitment to others, which may provide insight into effective and novel ways in which health messages could be communicated to college students. Additionally, findings show a relative lack of future-oriented values, particularly among the heavy-drinking students. Because future orientation is associated with engaging in less risky health behaviors, results suggest it may be beneficial to cultivate goal setting tasks early in college student education to enhance the efficacy of health promotion messages.

Attitude toward heavy drinking as a key longitudinal predictor of alcohol consumption and problems.

BACKGROUND: Little research has considered the importance of a person's attitude toward heavy drinking when evaluated against other well-known predictors of alcohol use and related harm including drinking motives and drinker identity. The current study aimed to evaluate whether one's favorable attitude toward heavy drinking is a unique predictor of prospectively assessed drinking-related outcomes when considered against descriptive and injunctive norms, drinking intentions, drinking motives, and drinker identity. METHODS: Participants in the current study comprised mandated students (n = 374; 54% male) who violated a campus alcohol policy and received a brief intervention (eCHECKUP TO GO). Analyses included the use of negative binomial regression to examine baseline predictors- attitude toward heavy drinking, perceived descriptive and injunctive norms, drinking intentions, drinking motives, and drinker identity-of prospective alcohol use outcomes and alcohol-related problems 1 month later. RESULTS: We found that one's attitude toward heavy drinking remains a significant predictor of binge frequency, peak drinking, and alcohol-related problems when accounting for norms, intentions, motives, and identity. CONCLUSIONS: This study has important theoretical and intervention implications. Indeed, the finding that one's attitude toward heavy drinking remains a significant predictor of alcohol-related outcomes when intentions are included in the model has implications within the theory of planned behavior. Furthermore, attitude toward heavy drinking has predictive utility when considered against descriptive and injunctive norms, drinking motives, and drinker identity. These findings contribute to a growing literature suggesting that attitudes could be an important intervention target when the goal is to change drinking behavior.

Opportunities for reducing college drinking: The roles of drinking attitudes and blackout experience.

BACKGROUND: As many as 35% of college students report having been drunk in the past month, and greater alcohol use and alcohol-related problems are associated with a positive attitude toward heavy drinking. One serious consequence of heavy drinking is alcohol-induced blackout. When they occur, alcohol-induced blackouts present a unique opportunity to increase motivation to change drinking. However, it is unclear under what conditions an alcohol-related heavy drinking attitude and experiencing a blackout represent an opportunity to change and how experiencing a blackout(s) influences an individual's motivation to reduce drinking and actual behavior. METHODS: This study tested the interplay between one's positive attitude toward heavy drinking and experiencing a blackout in the past year in predicting motivation to reduce drinking (Study 1) and its impact on drinking over time (Study 2). Data were derived from complementary datasets collected at two universities (Study 1 n = 703, mean age = 20.63 years, 44% male, 52% White; Study 2 n = 568, mean age = 19.18 years, 72% male, 84% White). Drinking behavior was measured using a modified Daily Drinking Questionnaire, the Drinking Norms Rating Form, the Alcohol Use Disorders Identification Test (AUDIT), and estimated peak blood alcohol concentration (BAC). Regression analyses were conducted to determine whether a blackout would moderate the association between attitude and motivation to reduce drinking (Study 1) and drinking over time (Study 2). RESULTS: Results revealed a significant interaction between attitude and blackout, such that individuals who experience a blackout (vs. those who do not) and positively evaluate heavy drinking evidenced lower motivation to reduce drinking (Study 1) and higher levels of estimated peak BAC (Study 2). CONCLUSIONS: Drinkers with a negative attitude toward heavy drinking who have experienced a blackout have the strongest motivation to reduce drinking and the greatest reductions in peak drinking behavior over time. These effects are over and above that related to the level of alcohol consumed. For young adults who do not positively endorse heavy drinking, blackouts may present a "moment of opportunity" for intervention.

Predictors of receptivity to an alcohol intervention among mandated students.

OBJECTIVE: Students in violation of campus alcohol policy often must participate in an alcohol risk reduction intervention, and some mandated students express overt resistance to change. This study tested a priori hypotheses about psychological variables that might predict receptivity to an online brief alcohol intervention. METHOD: Participants were 193 students (56% male, 88% underclassmen, 70% white) who were referred to the campus Office of Alcohol and Other Drugs after being cited for alcohol policy violations. Before their mandated online alcohol intervention, they completed a baseline assessment consisting of demographics and questionnaires about their alcohol use, attitudes toward moderate and heavy drinking, beliefs about the centrality of alcohol in college life, perceived descriptive and injunctive drinking norms, trait defensiveness, social desirability and response to the event leading to their sanction. They also responded to a set of questions about how interested in, open-minded, and likely to benefit they were from the computer-delivered alcohol intervention they were about to take. RESULTS: Controlling for covariates and all other predictors, greater receptivity to intervention was predicted by heavier alcohol consumption, positive attitude towards moderate drinking, perceptions that peers were less approving of heavy drinking, and taking personal responsibility for the incident. CONCLUSIONS: Among students mandated to participate in an alcohol intervention, openness to benefitting from the intervention varies in predictable ways. Because intervention receptiveness is associated with post-intervention change, we offer suggestions to tailor mandated interventions in ways that might improve outcomes.

Cognitive-Affective Change Mechanisms in Personalized Normative Feedback via the Articulated Thoughts in Simulated Situations Paradigm.

The research explored explanatory mechanisms of change for a personalized normative feedback (PNF) intervention, through an adapted application of the Articulated Thoughts in Simulated Situation (ATSS) cognitive think-aloud paradigm. A sample of 70 (51% female) U.S. adjudicated students were randomly assigned to one of three conditions: a PNF-ATSS condition, a PNF-Only condition (without ATSS), and an active Control+ATSS condition which received psychoeducation about alcohol use. Students in both the PNF-Only and PNF-ATSS conditions reported significant reductions in their misperceived peer drinking norms and alcohol-related consequences at the 30-day follow-up, relative to students in the control condition. Participants in the PNF-ATSS condition drank significantly fewer drinks per week at follow-up than participants in the PNF-Only condition, but not less than participants in the control condition. Significant indirect effects were found for the ATSS codes of participants' neutrality and believability toward PNF content. This study presents a proof of concept for an adapted ATSS think-aloud methodology as a clinical science intervention tool to specify the cognitive-affective processes of change linked to complex intervention for particular problems, persons, and contexts.

A climate for evidence-based practice implementation in the patient-centred medical home.

INTRODUCTION: The patient-centred medical home (PCMH) is an important part of health care reform. While there is hope, the PCMH model can facilitate the provision of higher quality care, the extent to which organizational climate within the PCMH supports the implementation of evidence-based practices (EBPs) is unknown. Identifying and addressing factors that facilitate implementation and use of EBPs within the PCMH are crucial for improving the health and health care of the United States. METHODS: This study used mixed methods to assess EBP implementation climate (ie, the extent to which organizational members perceive that the adoption and use of EBPs is expected, supported, and rewarded) and attitudes about EBPs in two PCMH clinics. RESULTS: Staff and physicians from two Rhode Island PCMHs, the Family Care Centre (FCC; n = 39) and Internal Medicine Clinic (IMC; n = 21), participated in this study. Results identified differences between FCC and IMC with regard to attitudes toward EBPs and implementation climate. Compared with the IMC, FCC staff and physicians reported significantly more positive attitudes toward EBPs and greater willingness to adopt EBPs. FCC staff and physicians reported significantly greater educational support for EBPs than IMC staff and physicians. Analysis of in-depth interviews revealed themes regarding attitudes toward EBPs. Most physicians reported valuing EBPs, although a number of barriers to EBP use were identified including time pressure, disjointed coordination of services, complexity of patients' presenting health concerns, and patient choice. CONCLUSIONS: Understanding factors that facilitate EBP implementation in the PCMH is important given widespread adoption of the PCMH model. Barriers to EBP implementation in the PCMH must be addressed for the sustainable implementation of EBP in the PCMH. Improving implementation climate may be an effective strategy to aid in creating an organizational context conducive to consideration and use of EBPs.