Comparative feasibility and preliminary efficacy of CBT for insomnia among adults seeking and not seeking addiction treatment.

Two out of three adults seeking treatment for alcohol or other substance use disorders report co-occurring symptoms of insomnia. This study compared the feasibility, acceptability, and preliminary efficacy of cognitive behavioural therapy for insomnia (CBT-I) among adults seeking and not seeking treatment for substance use. Adults with alcohol or other substance use disorders (n = 22, 32% female, 82% White; Mage = 39.5) completed assessments at baseline, post-treatment, and at 6 week follow-up. Of those, 11 were and 11 were not enrolled in substance use treatment. All received CBT-I. Multiple imputation was used for missing data. Data were analysed using repeated measures analyses of variance. In the substance use treatment group, 6/11 completed post and 5/11 completed follow-up. In the non-treatment group, 9/11 completed post and 7/11 completed follow-up. Participants in both groups reported improvements in insomnia severity, sleep onset latency, and dysfunctional beliefs about sleep, with most effects evident at post and follow-up. There was a marginal group-by-time interaction in the change in frequency of substance use, with only participants not in substance use treatment reporting decreases at follow-up. Participants in substance use treatment reported significant reductions in substance-related problems and symptoms of post-traumatic stress disorder over time; however, they also reported more symptoms at baseline. CBT-I produces similar reductions in insomnia but is relatively less feasible among individuals in (versus not in) treatment for substance use disorder. This may be due to the more complex logistics of accessing CBT-I among those in treatment. We speculate that integrating CBT-I into treatment for addictions may improve feasibility in this population. clinicaltrials.gov NCT04198311.

Testing a brief, self-guided values affirmation for behavioral activation intervention during COVID-19.

This pilot study tested a single-session digital values affirmation for behavioral activation (VABA) intervention. Hypotheses predicted the VABA intervention would be more effective than an active control condition in improving mood, decreasing COVID-19 fear/worry and depressive symptoms, and promoting positively reinforcing behaviors during early weeks of the COVID-19 pandemic. Participants were a diverse sample of undergraduate students (N = 296) under a state-wide lockdown. Students were randomized to either VABA, a 10-min values clarification and affirmation task, or Control, a time- and attention-matched task. Positive and negative affects were assessed pre- and post-intervention. At next-day follow-up, positive and negative affects were reassessed, as well as past 24-h behavioral activation and depressive symptoms. Within-group increases in positive affect were observed in both conditions (VABA d = 0.39; Control d = 0.19). However, VABA produced a significantly larger increase than Control (F[2] = 3.856, p = .022, d = 0.22). At 24-h follow-up, behavioral activation, which was significantly higher in VABA versus Control (t[294] = -5.584, p < .001, d = 0.65), predicted fewer depressive symptoms (R2 change = .019, ß = -.134, p = .003). VABA is an ultra-brief intervention that appears to have acute effects on mood-enhancement and behavioral activation.

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.

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.

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.

A Test of the Theory of Planned Behavior in the Prediction of Alcohol-Induced Blackout Intention and Frequency.

BACKGROUND: This study examined the theory of planned behavior (TPB) as an explanatory model for alcohol-induced blackouts among college students. Blackouts are periods of time wherein individuals continue to function and engage in their social environment but do not remember it as a result of consuming large quantities of alcohol. Social cognitive factors posited within TPB, such as perceived norms and personal attitudes toward alcohol consumption, are reliable predictors of alcohol use and related problems. However, research to date has not examined these theoretical antecedents as predictors of alcohol-induced blackout. METHODS: College students with a history of blackout (N = 384) completed a baseline survey, and a subsample (N = 120) completed a 1-month follow-up survey. Negative binomial mediation models were used to evaluate intentions to blackout as a mediator of the norms, attitudes, and self-efficacy to avoid blackout-blackout frequency association at baseline and 1-month follow-up. RESULTS: Norms, attitudes, and self-efficacy to avoid blackout all significantly predicted blackout intentions at baseline, which in turn predicted more frequent blackouts both at baseline and at 1-month follow-up. Notably, blackout attitudes demonstrated both direct and indirect associations with blackout frequency. CONCLUSIONS: Prospective analyses provided partial support for the TPB, with only attitudes and intentions demonstrating prospective associations with actual blackout frequency. Given the particularly strong association between blackout attitudes and frequency of blackouts, attitudes may represent an important and novel target for prevention and intervention efforts.

Sex-Specific Link Between Emotional Vulnerability and Poor Weight Control in Cigarette Smokers.

BACKGROUND: Cigarette smoking and poor weight control independently and synergistically increase risk for morbidity and mortality. However, few studies have examined the etiological role of emotion-regulatory dysfunction in the link between smoking and poor weight control, as well as the possible moderating role of sex. METHOD: Participants (n = 577; Mage = 44.42; SD = 13.80; 52.7% female) were daily smokers who completed a single survey online through Qualtrics. Emotional vulnerability was indexed by a latent construct comprised of the subscales from the Distress Tolerance Scale (DTS) and the Anxiety Sensitivity Index-3 (ASI-3). A regression model was constructed to examine the relation between emotional vulnerability and poor weight control, measured via body mass index (BMI). RESULTS: Emotional vulnerability was significantly and positively associated with BMI (b = .08, p = .020). The effect was moderated by sex, such that emotional vulnerability was significantly related to BMI in female smokers (b = .15, p = .002), but not in male smokers (b = .01, p = .806). CONCLUSIONS: Emotional vulnerability appears to be a novel female-specific psychological mechanism related to poor weight control in smokers. Possible limitations are discussed.

Self-Efficacy to Limit Drinking Mediates the Association between Attitudes and Alcohol-Related Outcomes.

Personal attitudes toward alcohol consumption are reliable predictors of alcohol use and related problems, with emerging work suggesting that one's favorable attitude toward limited drinking (i.e., at levels below the threshold for heavy episodic drinking) is a buffer against alcohol use and binge drinking. However, little work has examined the specific mechanism(s) through which one's personal attitude toward limited drinking is associated with alcohol use and related problems. One such mechanism may be an individual's self-efficacy to limit their alcohol use. The current study aimed to evaluate whether self-efficacy to limit one's alcohol use mediates the association between one's personal attitude toward limited drinking and actual alcohol use and related problems over time. Participants were mandated students (n = 568; 28% female) who violated campus alcohol policy and received a brief motivational intervention. Mediation models were used to test (a) self-efficacy to limit one's alcohol use as a traditional mediator of the attitudes-drinking quantity association and (b) self-efficacy and drinking quantity as serial mediators of the attitudes-alcohol-problems link. Favorable attitudes toward limiting drinking at baseline were positively associated with self-efficacy to limit drinking at 1 month, which was associated with a reduction in drinking quantity at 3 months; this, in turn, was associated with a reduction in alcohol-related problems at 5 months. These findings provide a rationale for incorporating attitudes and self-efficacy in the development and refinement of intervention strategies.

Smoking-related weight and appetite concerns and use of electronic cigarettes among daily cigarette smokers.

Weight control is a common motive for cigarette smoking.  Some individuals also report using electronic cigarettes (e-cigarettes) for weight control.  This study tested the hypothesis that the tendency to use combustible cigarettes for weight/appetite control would be associated with higher odds of current e-cigarette use among adult daily combustible cigarette smokers. Participants (n = 577; Mage = 44.42; 52.7% female) were recruited to participate in an online survey. Smoking for weight/appetite control was assessed via the Smoking-Related Weight and Eating Episodes Test (SWEET). Results indicated that higher scores on two SWEET subscales were significantly associated with increased odds of current e-cigarette use: smoking to suppress appetite (OR = 1.356,CI95% = 1.116-1.646, p = .002) and smoking to prevent overeating (OR = 1.314, CI95% = 1.101-1.567, p = .002). Scores on the other SWEET subscales were not significantly associated with current e-cigarette use.  These findings indicate that daily smokers who smoke to manage their appetite and eating may be more likely to use e-cigarettes, potentially because e-cigarettes will also serve this function. Future research should evaluate beliefs about e-cigarettes in management of appetite and eating behavior, and the acute effects of e-cigarettes on weight and eating behavior relative to combustible cigarettes.

Distinctions in Alcohol-Induced Memory Impairment: A Mixed Methods Study of En Bloc Versus Fragmentary Blackouts.

BACKGROUND: Blackouts-or memory loss for all or part of a drinking event-are reliable predictors of alcohol-related consequences. Studies suggest a distinction between en bloc (complete memory loss) and fragmentary (off-and-on memory loss) blackouts; however, research has not consistently differentiated between these 2 forms of blackout. This study aimed to validate the distinction between en bloc and fragmentary blackouts among young adults. METHODS: Data were collected using qualitative (Study 1) and quantitative (Study 2) research methods. Participants in both studies were college students with a history of alcohol-induced memory impairment. They were recruited using community advertisement (Study 1, N = 50, 56% female) and Qualtrics survey panels (Study 2, N = 350, 56% female). Study 1 participants engaged in 8 focus groups. Discussions were audio-recorded, transcribed verbatim, and coded using applied thematic analysis. Findings guided assessment of en bloc and fragmentary blackout in Study 2. In Study 2, a separate sample of participants completed an online survey assessing drinking behavior, alcohol-induced memory impairment, and theoretical correlates of en bloc and fragmentary blackouts. RESULTS: Study 1 participants differentiated between en bloc and fragmentary blackouts (which they referred to as "blackouts" and "brownouts," respectively) based on duration and extent of memory loss. They indicated that blackouts occur along a continuum, with en bloc "blackouts" at the extreme. They also stated that the term "blackout drinking" does not always imply memory loss. Study 2 participants reported higher rates of "brownouts" (81%) than "blackouts" (54%). They reported less negative outcome expectancies and attitudes, greater personal approval, higher prevalence estimates, lower self-efficacy, and stronger intentions for "brownouts" than "blackouts" (p < 0.001). Women perceived "blackouts/brownouts" as more prevalent than men and reported lower intentions to experience "blackouts" (p < 0.005). CONCLUSIONS: Young adults are more permissive of fragmentary than en bloc blackout. En bloc blackouts may be a target for future interventions.

Blackouts as a Moderator of Young Adult Veteran Response to Personalized Normative Feedback for Heavy Drinking.

BACKGROUND: Blackouts-or periods of alcohol-induced amnesia for all or part of a drinking event-have been identified as independent predictors of alcohol-related harm that may be used to identify individuals who would benefit from intervention. However, little is known about the prevalence and impact of blackouts among Veterans. This study examined blackouts as a moderator of young adult veteran response to a brief, online personalized normative feedback (PNF) intervention for heavy drinking. METHODS: Veterans scoring ≥3/4 (women/men) on the Alcohol Use Disorders Identification Test completed a baseline and 1-month assessment as part of a larger intervention trial (N = 571; 83% male; age M = 28.9, SD = 3.3). Participants were randomized to alcohol PNF (n = 285) or a video game attention control (n = 286). Hierarchical regression was used to examine the interaction between intervention condition and blackouts on alcohol-related outcomes at 1-month follow-up. RESULTS: At baseline, 26% of participants reported loss of memory for drinking events in the past 30 days. The interaction between condition and blackouts was significant, such that PNF participants who had experienced blackouts at baseline reported greater decreases in drinking quantity at 1 month than those who had not, and only PNF participants who had experienced baseline blackouts reported a decrease in alcohol problems at follow-up. CONCLUSIONS: PNF appears to be particularly effective for individuals who have experienced alcohol-induced blackout, perhaps because blackouts prime them for feedback on their alcohol use. While other negative consequences may also prime individuals for behavior change, blackouts are posited as a particularly useful screening tool because they are prevalent among young adults, have a strong association with alcohol-related harm, and are assessed in widely used clinical measures.

A Declaration of Independence: Implicit Alcohol Associations Have Independent, not Interactive, Relationships with Alcohol Consumption and AUD Risk.

AIMS: The current study aimed to test for potential interactive effects of three implicit alcohol-related associations (drinking identity, alcohol approach and alcohol excitement) in predicting concurrent and prospective alcohol consumption and risk of alcohol use disorders (AUDs) in two samples of the US undergraduate drinkers and non-drinkers. SHORT SUMMARY: We investigated the independent and interactive effects of three implicit associations on alcohol consumption and risk of AUD in two US undergraduate student samples. We found that implicit associations had independent but not interactive effects on concurrent and subsequent alcohol consumption and risk of AUD in two independent samples. METHODS: Implicit drinking identity, alcohol approach and alcohol excitement associations were assessed in two US undergraduate student samples (Sample 1: N = 300, 55% female; Sample 2: N = 506, 57% female). Alcohol consumption and risk of AUD were assessed at baseline (Samples 1 and 2) and 3 months later (Sample 2). We fit zero-inflated negative binomial models to test for independent and interactive effects of the three implicit associations on alcohol consumption and risk of AUD. RESULTS: Although we found multiple, unique main effects for alcohol associations, we found minimal evidence of interactions between implicit alcohol-related associations. There was no reliable evidence of interactions in models in predicting alcohol consumption or risk of AUD, concurrently or prospectively, in either sample. CONCLUSIONS: Contrary to expectations, results from both studies indicated that implicit alcohol-related associations in the US undergraduate samples generally have independent, not interactive, relationships with alcohol consumption and risk of AUD.

A Confirmatory Factor Analysis of the Smoking and Weight Eating Episodes Test (SWEET).

INTRODUCTION: The Smoking and Weight Eating Episodes Test (SWEET; Adams et al. 2011) is a self-report measure designed to assess multiple reasons why and when smokers use cigarettes for appetite, weight, and shape management, that was initially developed and validated in young female smokers. PURPOSE: The aim of the current study was to evaluate the factor structure and psychometric properties of the SWEET measure among both male and female daily cigarette smokers. METHOD: Participants (n = 577; Mage = 44.42; SD = 13.80; 52.7% female) were daily smokers recruited through Qualtrics Online Sample for an anonymous study on smoking and health. On average, participants reported smoking for 25.7 years (SD = 14.35), smoked 17.0 cigarettes per day (SD = 8.38), and had moderate levels of tobacco dependence. RESULTS: Confirmatory factor analyses supported the initial factor structure found in the original SWEET measure suggesting a four-factor structure fit the data well, but not a one-factor structure. Factors included using cigarettes for appetite suppression, using cigarettes to prevent overeating, smoking to cope with body dissatisfaction, and using cigarettes to cope with appetite-related withdrawal symptoms. Tests of measurement invariance revealed no significant differences when evaluating SWEET scores by participant sex. The SWEET factor scores evidenced internal consistency, known groups validity, convergent validity with related constructs (compensatory eating behaviors, tobacco dependence) and cessation-relevant variables (smoking abstinence expectancies, prior withdrawal symptoms), and discriminant validity with physical activity and sedentary behavior. CONCLUSIONS: The present study provides evidence in support of the validity and reliability of scores on the SWEET as a multidimensional measure of smoking for appetite, weight, and body-related concerns in male and female daily cigarette smokers.

Off-Campus Residence as a Risk Factor for Heavy Drinking Among College Students.

BACKGROUND: College student alcohol use is a public health problem. OBJECTIVES: The aim of this study was to examine associations between residence and drinking behaviors among college students. We hypothesized that living off-campus independently or with peers would be associated with riskier drinking than living on-campus, and living with parents would be associated with less risky drinking than living on-campus. METHODS: We analyzed data from two separate studies conducted at two four-year universities in the Northeast. Study 1 examined data from 1286 students (57% female) attending a private university. In Study 2, analyses were replicated and extended with 2408 students (67% female) from a public university. We conducted regression analyses that controlled for age, race, gender, and class year to determine the unique association of residence on typical and peak drinking, frequency of heavy drinking, and alcohol-related consequences. RESULTS: In both samples, students living off-campus without parents reported more frequent alcohol consumption, larger drinking quantities, more frequent heavy drinking, and a greater number of alcohol-related consequences than students living on-campus (ps <.001). In Study 2, students living off-campus with their parents exhibited significantly fewer risky drinking behaviors than those living on-campus (ps <.001). CONCLUSIONS: Living off-campus - either independently or with peers - is a risk factor for heavy drinking and consequences. This group exhibits more risky drinking behaviors and alcohol-related consequences than students living on-campus, independent of age and class year. Therefore, students moving off-campus may be appropriate targets for alcohol misuse prevention programs.

Shame and Guilt-Proneness as Mediators of Associations Between General Causality Orientations and Depressive Symptoms.

The present study examined the roles of shame- and guilt-proneness as mediators of associations between general causality orientations and depressive symptoms. We expected autonomy would be associated with less depressive symptoms based on higher guilt-proneness and lower shame-proneness, whereas control would be associated with more depressive symptoms based on lower guilt-proneness and higher shame-proneness. Undergraduates (N = 354) completed assessments of general causality orientations, shame- and guilt-proneness, and depressive symptoms in exchange for extra credit. Results of mediation analyses were generally supportive of the framework indicating that shame- and guilt-proneness mediate associations between self-determination and depressive symptoms. Autonomy was indirectly associated with less depressive symptoms through positive associations with guilt-proneness, in spite of unexpected positive associations with shame-proneness. Control and impersonal orientation were indirectly associated with more depressive symptoms through positive associations with shame-proneness. Results extend previous research relating self-determination to mental health in providing preliminary support suggesting that individual differences in self-determination facilitate differential tendencies in experiencing guilt and shame.

Blood is thicker than booze: Examining the role of familism and gender in alcohol use and related consequences among Hispanic college students.

The present study evaluated cultural, ethnic, and gender differences in drinking and alcohol-related problems among Hispanic students. Familism protects against negative outcomes in Hispanic populations, thus we expected familism to buffer against alcohol problems. Participants (N = 623; 53% female) completed a battery of measures. Results suggested that familism was protective against drinking. Furthermore, alcohol use mediated the association between familism and alcohol-related problems. In sum, understanding that culture plays an important role in people's behaviors and identifying protective factors is critical to inform culturally sensitive prevention and intervention efforts.

A Longitudinal Examination of the Associations Between Shyness, Drinking Motives, Alcohol Use, and Alcohol-Related Problems.

BACKGROUND: The current study evaluated the roles of drinking motives and shyness in predicting problem alcohol use over 2 years. METHODS: First-year college student drinkers (n = 818) completed assessments of alcohol use and related problems, shyness, and drinking motives every 6 months over a 2-year period. RESULTS: Generalized linear mixed models indicated that shyness was associated with less drinking, but more alcohol-related problems. Further, shyness was associated with coping, conformity, and enhancement drinking motives, but was not associated with social drinking motives. However, when examining coping motives, moderation analyses revealed that social drinking motives were more strongly associated with coping motives among individuals higher in shyness. In addition, coping, conformity, and enhancement motives, but not social motives, mediated associations between shyness and alcohol-related problems over time. Finally, coping motives mediated the association between the interaction of shyness and social motives and alcohol-related problems. CONCLUSIONS: Together, the results suggest that shy individuals may drink to reduce negative affect, increase positive affect, and fit in with others in social situations, which may then contribute to greater risk for subsequent alcohol-related problems.

Drinking games and contextual factors of 21st birthday drinking.

BACKGROUND: 21st birthday celebrations are among the highest risks for alcohol use throughout emerging adulthood and celebrants often experience a range of alcohol-related consequences. OBJECTIVES: The present research considered what happens when drinking games are paired with an already high-risk event (i.e., 21st birthday celebrations) and how drinking games compare with other contextual factors on 21st birthdays. METHODS: Approximately four days after turning 21, 1124 college students (55% women) completed an online survey assessing alcohol use and related consequences experienced during their birthday celebrations. Participants were also asked whether drinking games and other contextual factors were associated with their celebrations. RESULTS: Overall, 18% of participants reported playing drinking games during their 21st birthday celebrations. These individuals reported consuming more alcohol, had higher estimated BACs, and experienced more negative consequences than those who did not play drinking games. The association between playing drinking games and alcohol use and negative consequences was stronger for men. The effect of drinking games on negative consequences was mediated through elevated BAC levels. Receiving bar specials, having drinks purchased, playing drinking games, and loud music were uniquely and significantly associated with all alcohol outcomes. CONCLUSION: Together, these results suggest that drinking games are part of a larger context of risk contributing to extreme drinking on 21st birthdays. Furthermore, these results will help to facilitate interventions that are more individually tailored to target specific contextual risks, behaviors, and events.

Does self-affirmation augment the effects of a mandated personalized feedback intervention? A randomized controlled trial with heavy drinking college students.

OBJECTIVE: Theory and evidence indicate that affirming the value of the self before exposure to a threatening message fosters more open-minded appraisal of message content. We predicted that college students mandated to a computer-delivered personalized feedback intervention (PFI) and who engaged in a self-affirmation (SA) exercise would demonstrate reduce drinking and consequences relative to those who received an attention control. METHOD: Participants were 484 undergraduates (age 18-24, 56% male, 78% White) mandated to participate in an alcohol intervention following a first-time alcohol policy violation. After a baseline assessment, each was randomized to SA (n = 256) or attention control (n = 227) prior to a computer-delivered PFI intervention. Posttest measures included an affirmation manipulation check; primary outcomes (past month weekly quantity, peak drinks, binge frequency, consequences) were assessed at 1-, 3-, 6-, 9-, and 12-month follow-ups. We used latent growth curve modeling to test study hypotheses. RESULTS: The SA exercise increased positive self-evaluation at posttest (p < .001). Overall reductions in drinking and consequences were observed at early follow-up (all p < .05), but the SA manipulation was not associated with intercept or slope factor differences in the models. Engaging in assessments during COVID restrictions was generally associated with reduced drinking and consequences. CONCLUSIONS: The SA exercise did not differentially affect trajectories of alcohol use and consequences, despite evidence that the exercise had the predicted effect on participant's self-evaluations. The lack of SA effects could be attributed to a nonthreatening PFI intervention that is generally accepted among mandated students. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Do hypothetical evaluations of alcohol related consequences change over time? Examining the influence of past and ongoing consequences.

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.