Protective behavioral strategies underutilization mediates effect of a brief motivational intervention among socially anxious undergraduate drinkers.

Social anxiety (SA) is implicated in problematic undergraduate drinking. Brief motivational interventions (BMIs) reduce problematic undergraduate drinking. However, not all students benefit. Identification of vulnerable subgroups is an important next step. The current study examined the role of SA and protective behavioral strategies (PBS) on BMI outcomes. We reanalyzed a subset of data (53.3%; N = 120; 62.5% male) from a randomized trial in which heavy drinking undergraduates were randomized to a BMI or control. SA, past-month typical drinks, peak drinks, weekly quantity, alcohol problems, and PBS were assessed at baseline and 6 weeks. Main effects and interaction among the intervention condition (BMI vs. control) and SA group (low vs. high) were tested on alcohol outcomes and PBS. High SA undergraduates reported greater baseline drinking, more alcohol problems, and lower PBS. Post-BMI, high SA drinkers continued to report greater peak drinks, typical drinks, alcohol problems, and lower PBS use, controlling for baseline use. Among the BMI condition, parallel multiple mediation analyses revealed the PBS subscale Manner of Drinking uniquely mediated the relationship between SA and heavier post-BMI drinking. The PBS Manner of Drinking and Serious Harm Reduction subscales jointly mediated the relationship between SA and greater post-BMI alcohol problems. BMIs may need to be refined to improve outcomes for socially anxious drinkers. Increasing PBS utilization post-BMI may help improve BMI efficacy in this vulnerable group. Clinical implications are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The role of underutilization of protective behavioral strategies in the relation of social anxiety with risky drinking.

Social anxiety is prominent among undergraduates and increases the risk of experiencing alcohol problems. In fact, social anxiety more than quadruples the risk of developing an alcohol use disorder, yet it is inconsistently related to heavier drinking. Inconsistent findings may be due to lack of attention on protective behavioral strategies (PBS) among socially anxious drinkers. PBS are cognitive-behavioral strategies to reduce drinking and alcohol-related harm. Due to the nature of social anxiety, affected individuals may be especially vulnerable to PBS underutilization, leading to heavier and more problematic drinking. The current study examined the mediating role of PBS in the relationships of social anxiety with past-month drinking and alcohol problems using cross-sectional data among current (past-month) heavy undergraduate drinkers (N = 431). Social anxiety was significantly positively related to past-month alcohol problems and peak drinking. Social anxiety was significantly negatively related to typical drinking, drinking frequency, and PBSS Manner of Drinking. Social anxiety was indirectly (via PBSS Manner of Drinking) related to greater past-month peak drinks and more drinking problems. Findings suggest that socially anxious persons may be vulnerable to heavier and more problematic drinking due to PBS underutilization. Treatment implications are discussed.

Context-specific drinking and social anxiety: The roles of anticipatory anxiety and post-event processing.

Individuals with clinically elevated social anxiety are especially vulnerable to alcohol-related problems, despite not drinking more than those with less anxiety. It is therefore important to identify contexts in which socially anxious persons drink more to inform intervention efforts. This study tested whether social anxiety was related to greater drinking before, during, or after a social event and whether such drinking was related to the psychosocial factors anticipatory anxiety or post-event processing (PEP; review of the social event). Among past-month drinkers, those with clinically elevated or higher social anxiety (HSA; n = 212) reported more anticipatory anxiety, more pre-event drinking to manage anxiety, and PEP than those with normative or lower social anxiety (LSA; n = 365). There was a significant indirect effect of social anxiety on pre-drinking via anticipatory anxiety. Social anxiety was related to more drinking during the event indirectly via the serial effects of anticipatory anxiety and pre-drinking. Unexpectedly, PEP did not mediate or moderate the relation between social anxiety and post-event drinking. In sum, anticipatory anxiety was related to more drinking before, during, and after a social event and HSA drinkers were especially vulnerable to drinking more to manage this anxiety, which increased drinking before and during the event. This effect was specific to anticipatory anxiety and not evident for another social anxiety-specific risk factor, PEP. Thus, anticipatory anxiety may be an important therapeutic target for drinkers generally and may be especially important among HSA drinkers.

The relative impact of nicotine dependence, other substance dependence, and gender on Bechara Gambling Task performance.

Individuals with substance use disorders (SUDs) tend to focus more on immediate, rather than cumulative, consequences of their actions on measures of decision-making. This type of decision-making may contribute to continued substance use. The present study compared the performance of four groups of individuals on one measure of decision-making, the Bechara Gambling Task (BGT). The groups were (a) heavy smokers with comorbid substance dependence (n = 40), (b) heavy smokers with no history of substance dependence (n = 19), (c) substance dependent never smokers (n = 26), and (d) never smokers with no history of substance dependence (n = 34). Analysis revealed that there were no significant main effects of gender or SUD status. However, a significant gender by SUD status interaction was found, such that men with an SUD performed more poorly on the BGT than men without an SUD history. Women with and without an SUD both performed poorly on this task. Unexpectedly, no differences in BGT performance were found between smokers and nonsmokers. Overall, findings indicate that having an SUD, other than nicotine dependence, is correlated with poor BGT performance in men only. The BGT did not differentiate between women with and without SUDs, and therefore, may not be an appropriate measure of decision-making in women.

Social anxiety and alcohol-related impairment: The mediational impact of solitary drinking.

Social anxiety disorder more than quadruples the risk of developing an alcohol use disorder, yet it is inconsistently linked to drinking frequency. Inconsistent findings may be at least partially due to lack of attention to drinking context - it may be that socially anxious individuals are especially vulnerable to drinking more often in specific contexts that increase their risk for alcohol-related problems. For instance, socially anxious persons may drink more often while alone, before social situations for "liquid courage" and/or after social situations to manage negative thoughts about their performance. Among current (past-month) drinkers (N=776), social anxiety was significantly, positively related to solitary drinking frequency and was negatively related to social drinking frequency. Social anxiety was indirectly (via solitary drinking frequency) related to greater past-month drinking frequency and more drinking-related problems. Social anxiety was also indirectly (via social drinking frequency) negatively related to past-month drinking frequency and drinking-related problems. Findings suggest that socially anxious persons may be vulnerable to more frequent drinking in particular contexts (in this case alone) and that this context-specific drinking may play an important role in drinking problems among these high-risk individuals.

Distress Tolerance Among Students Referred for Treatment Following Violation of Campus Cannabis Use Policy: Relations to Use, Problems, and Motivation.

Students referred to treatment after violating campus drug policies represent a high-risk group. Identification of factors related to these students' cannabis use could inform prevention and treatment efforts. Distress tolerance (DT) is negatively related to substance-related behaviors and may be related to high-risk cannabis use vulnerability factors that can impact treatment outcome. Thus, the current study tested whether DT was related to cannabis use frequency, cannabis-related problems, and motivation to change cannabis use among 88 students referred for treatment after violating campus cannabis policies. DT was robustly, negatively related to cannabis use and related problems. DT was also significantly, negatively correlated with coping, conformity, and expansion motives. DT was directly and indirectly related to cannabis problems via coping (not conformity or expansion) motives. Motives did not mediate the relation of DT to cannabis use frequency. DT may be an important target in treatment with students who violate campus cannabis policies.

Social anxiety and heavy situational drinking: coping and conformity motives as multiple mediators.

INTRODUCTION: Individuals with clinically elevated social anxiety are at greater risk for alcohol use disorder, and the relation between social anxiety and drinking problems is at least partially accounted for by drinking more in negative emotional (e.g., feeling sad or angry) and personal/intimate (e.g., before sexual intercourse) situations. Identification of cognitive/motivational factors related to drinking in these high-risk situations could inform the development of treatment and prevention interventions for these high-risk drinkers. METHOD: The current cross-sectional study examined the mediating effect of drinking motives on the relationship between social anxiety and drinking these high-risk situations among undergraduates (N=232). RESULTS: Clinically elevated social anxiety was associated with greater coping and conformity motives. Both coping and conformity motives mediated the relation between social anxiety and heavier alcohol consumption in negative emotional and personal/intimate contexts. CONCLUSIONS: Multiple mediation analyses indicated that these motives work additively to mediate the social anxiety-drinking situations relationship, such that heavy situational drinking among undergraduates with clinically elevated social anxiety can be jointly attributed to desire to cope with negative affect and to avoid social scrutiny.

Randomized controlled trial of brief alcohol screening and intervention for college students for heavy-drinking mandated and volunteer undergraduates: 12-month outcomes.

This is the first randomized trial testing whether heavy-drinking undergraduates mandated to the Brief Alcohol Screening and Intervention for College Students (BASICS) program following a campus alcohol violation would benefit as much as heavy-drinking volunteers up to 1 year postintervention using control groups with high-risk drinkers to model disciplinary-related and naturalistic changes in drinking. Participants (61% male; 51% mandated; 84% Caucasian; M age = 20.14 years) were screened for heavy drinking and randomized to BASICS (n = 115) or assessment-only control (n = 110). Outcome measures (drinking, alcohol problems) were collected at baseline, 4 weeks, 3, 6, and 12 months postintervention. At 4 weeks postintervention, intent-to-treat multilevel longitudinal models showed that regardless of referral group (mandated or volunteer), BASICS significantly decreased weekly drinking, typical drinks, and peak drinks relative to controls (ds = .41-.92). BASICS had a large effect on decreases in alcohol problems (d = .87). At 12 months postintervention, BASICS participants (regardless of referral group) reported significantly fewer alcohol problems (d = .56) compared with controls. Significant long-term intervention gains for peak and typical drinks were sustained in both referral groups relative to controls (ds = .42; .11). Referral group had no significant main effect and did not interact with intervention condition to predict outcomes. Given that BASICS was associated with less drinking and fewer alcohol problems (even among heavier drinking mandated students up to 1 year postintervention), provision of BASICS-style programs within disciplinary settings may help reduce heavy and problematic drinking among at-risk students. (PsycINFO Database Record

College drinking problems and social anxiety: The importance of drinking context.

Social anxiety more than quadruples the risk of developing an alcohol use disorder, yet it is inconsistently linked to heavy alcohol use. Elucidation of the relation between social anxiety and alcohol use is an important next step in treating and preventing risky drinking. College students routinely face potentially anxiety-provoking social situations (e.g., meeting new people) and socially anxious undergraduates are especially vulnerable to alcohol-related impairment. Drinking to cope with social anxiety is thought to reinforce alcohol use, yet research on coping-motivated drinking among socially anxious students has yielded inconsistent findings. Further, undergraduate drinking varies by drinking context, yet the role of context in drinking behaviors among socially anxious individuals remains unclear. The current study sought to examine the relationship of social anxiety and drinking quantity in specific drinking contexts among undergraduates (N = 611). We also evaluated whether relevant drinking contexts mediated the relationship between social anxiety and alcohol-related problems. Clinically elevated social anxiety was related to heavier consumption in negative emotion (e.g., feeling sad or angry) and personal/intimate (e.g., before sexual intercourse) contexts, but not social/convivial contexts (e.g., parties, bars). Quantity of alcohol consumed in negative emotion and personal/intimate contexts mediated the relationship between social anxiety and drinking problem severity. Drinking in personal/intimate contexts demonstrated a unique mediational role. Findings suggest that heavy drinking in particular contexts (especially personal/intimate and negative emotion) may play an important role in drinking problems among socially anxious individuals.

Do positive alcohol expectancies have a critical developmental period in pre-adolescents?

OBJECTIVE: Positive outcome expectancies have been shown to predict initiation of alcohol use in children and to mediate and moderate the relationship between dispositional variables and drinking behavior. Negative outcome expectancies for alcohol appear to weaken as children progress to middle adolescence, but positive expectancies tend to increase during this time. Positive alcohol expectancies have been found to increase in children in third and fourth grades, indicating what some investigators have termed a possible critical period for the development of positive expectancies. METHOD: In the present study, we assessed alcohol expectancies at baseline, 6, 12, and 18 months in 277 second-through sixth-grade students. Children completed the Alcohol Expectancy Questionnaire-Adolescent. Univariate analyses of covariance were conducted. RESULTS: There were significant main effects for grade on positive alcohol-expectancy change for Global Positive Transformations at 12 and 18 months, Social Behavior Enhancement or Impediment at 6 and 12 months, and Relaxation/Tension Reduction at 6 and 18 months, whereby a consistent pattern emerged in that lower grades did not differ from each other, but they differed significantly from the higher grades. CONCLUSIONS: Data support a critical developmental period for positive alcohol expectancies, with the greatest change observed between third and fourth grade and between fourth and fifth grade, and only in those expectancies clearly describing positive outcomes (e.g., Relaxation/Tension Reduction) via positive or negative reinforcement versus those with either combined or ambiguous outcomes (e.g., Social Behavior Enhancement or Impediment).

Brief motivational intervention for college drinking: the synergistic impact of social anxiety and perceived drinking norms.

Despite the efficacy of Brief Alcohol Screening and Intervention for College Students (BASICS), students with higher social anxiety appear vulnerable to poorer outcomes. A possible explanation for these outcomes is that corrective normative feedback (an active component of BASICS) may be less effective for socially anxious students if their beliefs about others' drinking are less malleable because of intense fear of negative evaluation for deviating from perceived drinking norms. This study evaluated whether socially anxious students demonstrated less change in perceived norms during BASICS. We also examined whether change in norm endorsement moderated the relation between social anxiety and BASICS outcomes. Undergraduates (n = 52) who underwent BASICS completed measures of drinking, social anxiety, and perceived norms at baseline and 4 weeks post-BASICS. Higher social anxiety was related to less change in norm endorsement after receiving BASICS. Change in perceived norms during treatment moderated the relation between social anxiety and follow-up drinking. Among students with smaller change in norm endorsement after BASICS, higher social anxiety was related to heavier follow-up drinking. Among students with greater changes to norm endorsement during BASICS, the effect of social anxiety was nonsignificant. Results suggest that corrective perceived norms interventions may be less effective among socially anxious students, contributing to continued heavy drinking. Development of social anxiety-specific BASICS components warrants attention.

Development and validation of the Family Health Behavior Scale.

OBJECTIVE: The purpose of the current study was to develop a psychometrically sound, parent-report measure of family and child behaviors related to obesity in children between 5- and 12-years-old. METHODS: Item generation, item selection, and initial exploratory factor analysis yielded a 27-item measure called the Family Health Behavior Scale (FHBS). RESULTS: The FHBS contains four subscales measuring health-promoting family behaviors, obesogenic behaviors, meal-time routines, and family physical activity habits. Parent ratings on the FHBS were shown to predict their child's weight classification. The FHBS also demonstrated adequate internal consistency and temporal stability. CONCLUSIONS: The results of the study suggest that the FHBS is a promising measure of family eating and physical activity habits related to obesity in children.

Clinical outcomes of a brief motivational intervention for heavy drinking mandated college students: a pilot study.

OBJECTIVE: The aim of this study was to evaluate a brief motivational intervention (BMI) for reducing risky alcohol use and alcohol-related problems among mandated (M) and voluntary (V) student drinkers to determine (a) whether BMI-mandated students report greater decreases in alcohol use and related problems, relative to no treatment; (b) whether a BMI is comparably effective for mandated and voluntary students; and (c) whether a mandated control group shows greater changes in alcohol use and related problems relative to a voluntary control group. METHOD: Participants were undergraduate student research volunteers (62% male) who met heavy drinking criteria and completed measures of alcohol use and alcohol problems at baseline and 4 weeks after intervention. Participants (N = 84) were randomly assigned to treatment (T) or assessment-only control (C) conditions (mandated students were assigned to a brief wait list). RESULTS: Participants assigned to treatment reported consuming fewer drinks after the intervention (MT: M = 14.11 drinks; VT: M = 14.05) relative to control groups (MC: M = 20.71; VC: M = 16.53). Evaluation of alcohol-related problems indicated a significant effect of referral status, such that mandated students reported significantly fewer problems at the follow-up assessment relative to volunteers. CONCLUSIONS: BMIs are comparably effective for mandated and voluntary students and may result in larger reductions in alcohol use than disciplinary attention alone. More longitudinal research is needed to evaluate the long-term impact of a BMI among mandated students.

College student smokers' cognitive appraisal of high-risk activities.

OBJECTIVE: Students who smoke are more likely to engage in risky behaviors such as binge drinking and unprotected sex (Schnieder and Morris, Environ Behav. 1999; 23:575-591). The goals of the present study were to determine whether smokers assess these behaviors as lower risk than nonsmokers, and if smoking rate influences risk perceptions. METHODS: Participants were 303 college students. Cognitive Appraisal of Risky Activities (Fromme et al., Cognit Ther Res. 1997; 21:421-442) and smoking were assessed August-November, 2006. RESULTS: Smokers reported significantly less risk, more benefit, and more involvement in risky behaviors than nonsmokers (p < .01). In hierarchical linear regression, risk perceptions moderated the association between smoking and (a) expected benefit from risky sexual behaviors (beta = -1.121, p < .05); and (b) expected involvement with illicit drugs (beta = -.313, p < .01). CONCLUSIONS: College smokers' assessment of high-risk behaviors influenced their intended involvement. Risk perception change may therefore alter their involvement in high-risk behaviors.