Impact of a Multicomponent Educational Intervention on Community Pharmacy-Based Naloxone Services Implementation: A Pragmatic Randomized Controlled Trial.

BACKGROUND: Despite US naloxone access laws, community pharmacists lack training and confidence in providing naloxone. OBJECTIVE: To assess the impact of the Empowering Community Pharmacists program on pharmacists' knowledge, perceived barriers, attitudes, confidence, and intentions regarding naloxone services implementation, as well as naloxone prescriptions dispensed. METHODS: A 3-month pragmatic randomized controlled trial was conducted from December 2018 to March 2019. Alabama community pharmacists were recruited by mail, email, phone, and fax and randomized to intervention (monthly resources/reminders + educational webinar) or control (monthly reminders only). Outcome measures were assessed via online surveys at baseline (T1), immediately post-intervention (T2), and 3 months post-intervention (T3), including naloxone knowledge (%correct); perceived barriers, attitudes, confidence, and intention regarding naloxone services implementation (7-point Likert-type scale; 1 = strongly disagree, 7 = strongly agree); and number of naloxone prescriptions dispensed. Mean differences between control and intervention from T1 to T3 were assessed using 2-way mixed analysis of variance and adjusted analyses were conducted using generalized estimating equations with negative binomial distribution to assess associations between variables. RESULTS: Of 55 participants (n = 27 intervention, n = 28 control), most were female (80.3%), white (80.6%), in independently owned pharmacies (39.1%). Increases in mean [SD] confidence (5.52 [1.03]-6.16 [0.74], P < 0.0005) and intention (5.35 [1.51]-6.10 [0.96], P = 0.023) occurred from pre- to post-program within the intervention group and were statistically significant compared with control (confidence P = 0.016, intention P = 0.014). Confidence (exp(ß) = 1.46, P = 0.031) and perceived barriers (exp(ß) = 0.75, P = 0.022) were associated with number of naloxone prescriptions dispensed. CONCLUSION AND RELEVANCE: The Empowering Community Pharmacists program improved community pharmacists' confidence and intention regarding naloxone services implementation. Other states can adapt program elements according to their laws. CLINICALTRIALS.GOV IDENTIFIER: NCT05093309.

Using the Multiple-Choice Procedure to Measure the Relative Reinforcing Efficacy of Gambling: Initial Validity Evidence Among College Students.

The multiple choice procedure (MCP) is used to assess the relative reinforcing value of concurrently available stimuli. The MCP was originally developed to assess the reinforcing value of drugs; the current within-subjects study employed the MCP to assess the reinforcing value of gambling behavior. Participants (N = 323) completed six versions of the MCP that presented hypothetical choices between money to be used while gambling ($10 or $25) versus escalating amounts of guaranteed money available immediately or after delays of either 1 week or 1 month. Results suggest that choices on the MCP are correlated with other measures of gambling behavior, thus providing concurrent validity data for using the MCP to quantify the relative reinforcing value of gambling. The MCP for gambling also displayed sensitivity to reinforcer magnitude and delay effects, which provides evidence of criterion validity. The results are consistent with a behavioral economic model of addiction and suggest that the MCP could be a valid tool for future research on gambling behavior.

Associations among depressive symptoms, drinking motives, and risk for alcohol-related problems in veterinary students.

Hazardous alcohol consumption among medical students appears to occur at a level comparable to the general population; however, among medical students, it has been found that the motivation to use alcohol partially stems from unique stressors related to their professional training. Although veterinary students may also experience psychological distress in association with their training, little work has focused on the way that these students use alcohol to cope with their distress. The current study sought to examine the severity of depressive symptoms and alcohol consumption among veterinary students as well as students' specific motives for drinking alcohol. The majority of our sample reported experiencing at least one depressive symptom, and a significant proportion engaged in high-risk drinking, with men reporting more harmful alcohol use patterns. Drinking motives related to managing internal bodily and emotional states accounted for variance in drinking patterns. Further, drinking to ameliorate negative emotions partially accounted for the relationship between psychological distress and high-risk drinking. The results of this study suggest that depressive symptoms among veterinary students may be related to harmful drinking patterns, due to alcohol being used as a coping mechanism to regulate emotions. The findings from this study can be used to develop targeted interventions to promote psychological well-being among veterinary students.

Towards the development of laboratory methods for studying drinking games: initial findings, methodological considerations, and future directions.

BACKGROUND: Drinking games are prevalent among college students and are associated with increased alcohol use and negative alcohol-related consequences. There has been substantial growth in research on drinking games. However, the majority of published studies rely on retrospective self-reports of behavior and very few studies have made use of laboratory procedures to systematically observe drinking game behavior. OBJECTIVES: The current paper draws on the authors' experiences designing and implementing methods for the study of drinking games in the laboratory. RESULTS: The paper addressed the following key design features: (a) drinking game selection; (b) beverage selection; (c) standardizing game play; (d) selection of dependent and independent variables; and (e) creating a realistic drinking game environment. CONCLUSIONS: The goal of this methodological review paper is to encourage other researchers to pursue laboratory research on drinking game behavior. Use of laboratory-based methodologies will facilitate a better understanding of the dynamics of risky drinking and inform prevention and intervention efforts.

The Hazardous Drinking Games Measure (HDGM): a multi-site implementation.

BACKGROUND: Drinking game participation has been associated with increased frequency and quantity of alcohol use, as well as alcohol-related problems, in college students. To date, the assessment of drinking games typically entails the use of self-developed measures of frequency of participation and amount of alcohol consumed while playing. OBJECTIVES: The Hazardous Drinking Games Measure (HDGM) is the first effort to create a comprehensive yet concise method of assessing drinking game participation. The HDGM assesses drinking during games, the specific types of drinking games played, and negative consequences experienced as a result of playing drinking games. METHOD: Data from three samples of college students (n = 1002) who completed the HDGM and other self-report questionnaires of drinking behaviors were used for exploratory analyses. RESULTS: Exploratory analyses suggest that the HDGM adequately captures the nuances of drinking game participation in this population and demonstrates initial evidence of good content and criterion-related validity and test-retest reliability. However, the HDGM did not predict risky drinking above and beyond standard measures of drinks per week and alcohol-related problems in any samples. CONCLUSION: The HDGM may be useful for campus-wide assessment of drinking games and as a source of game-specific feedback when integrated into campus prevention and intervention efforts.

An exploratory factor analysis of an e-CHUG drinking motives scale with mandated students.

OBJECTIVE: Colleges maintain alcohol policies in response to student alcohol misuse, and sanctions for violating these policies often mandate students to attend alcohol education and/or counseling (Anderson & Gadaleto, 2021). Electronic Checkup to Go (e-CHUG) is a widely used online motivational intervention program that provides feedback to college students to encourage them to alter their drinking behaviors (eCheckup to Go, 2021). While measures included in e-CHUG have clear clinical utility, their psychometric properties have not been evaluated. The present study was designed to evaluate the factor structure and validity of the 18-item drinking motives scale included in the intervention. METHOD: Participants were 3,546 students from a large public university who were mandated to complete e-CHUG (58% male, MAge = 19.06, SDAge = 1.35) between 2013 and 2021. Students completed a battery of measures, including questions regarding alcohol consumption, drinking motives and consequences, and the Alcohol Use Disorders Identification Test (AUDIT). RESULTS: An exploratory factor analysis was conducted to investigate the structure of the drinking motives scale. Two factors were retained: The first factor represented coping motives, and the second factor represented a mixture of enhancement and social motives. Hierarchical regression analyses explored the associations between the retained drinking motives factors and alcohol-related variables. Both coping motives and enhancement/social motives positively and uniquely predicted drinking consequences and AUDIT scores. CONCLUSIONS: This study provides support for the construct and incremental validity of e-CHUG's drinking motives measure and could have important implications for the consideration of drinking motives during e-CHUG interventions. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Why get high? Coping and enjoyment motives mediate elevated cannabis demand and cannabis-related outcomes.

OBJECTIVE: Cannabis is the most used psychoactive substance among adolescents and is a public health concern. Cannabis demand is a quantifiable measure of the reinforcing value of cannabis and comprises two latent-factors-amplitude (maximum consumption) and persistence (sensitivity to increasing costs). Cannabis demand and cannabis motives are important predictors of adolescent cannabis use and associated problems; however, little is known about how these two facets of motivation are causally related. Cannabis motives are thought to represent the final common pathway to cannabis use and may explain why elevated demand is associated with use and consequences. The present study tested whether internal cannabis motives (coping and enjoyment) mediated longitudinal associations between cannabis demand, use (hours high), and negative consequences. METHOD: Participants aged 15-18 years old (n = 89, Mage = 17.0, SD = 0.9) who reported lifetime cannabis use completed online assessments of cannabis demand, motives, use and negative consequences at baseline, 3-month, and 6-month follow-up. RESULTS: PROCESS mediation models revealed that enjoyment motives mediated the association between amplitude and persistence and use. In addition, coping motives mediated the association between amplitude and negative consequences. CONCLUSIONS: These findings suggest that internal motives, while differentially related to aspects of demand and cannabis outcomes, are important in understanding adolescent cannabis use. Prevention efforts aimed at limiting access to cannabis and increasing access to substance-free activities may be important targets for adolescents. Further, cannabis interventions targeting specific motives for using (e.g., to cope with negative affect) may be important for reducing cannabis demand. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The bystander intervention for problematic alcohol use model (BIPAUM).

Objective: The study aimed to identify phases of bystander intervention (BI) for problematic alcohol use (PAU) among college students. Participants: Twenty focus groups and nine interviews were conducted. Methods: Transcripts were thematically analyzed. Results: The phases of the Bystander Intervention for Problematic Alcohol Use Model (BIPAUM) include: (1) plan in advance, (2) notice and interpret a sign, (3) decide (i.e., assume responsibility, assess support/feasibility to intervene, and identify intervention strategy), (4) intervene, and (5) assess outcomes. Assessing outcomes loops to influence future behavior and each phase is influenced by barriers and facilitators. Conclusions: These unique phases should be considered when designing and evaluating intervention programs for PAU to meet students' needs and better reduce PAU. Future research should empirically test the BIPAUM. The results of the current study demonstrate a promising opportunity for applying BI to PAU, with the goal of reducing risky drinking among college students.

A Systematic Review of Validated Measures of U.S.-Based Bystander Intervention-Related Constructs.

This review aimed to identify U.S.-based, construct-validated measures of bystander intervention. Following PRISMA-P guidelines, electronic databases were searched, and emails were solicited identifying 8,559 articles for title screening. Abstracts and full texts were double screened, resulting in 24 scales meeting inclusion criteria: (a) measured a bystander-related construct in a situation where there was a potential for actual or perceived imminent physical or emotional harm, (b) written in English, and (c) statistically validated on U.S. samples. Most scales addressed the domain of interpersonal violence (67%), with fewer relating to bias/bullying (8.2%), mental health crises (12.5%), and substance use (12.5%). Most scales (71%) assessed the "take action" step of the situational model. The modal construct represented was intent/willingness/likelihood to intervene (50%). The average number of items on a scale was 14, and most (79%) provided Likert-style response options. None of the validated scales assessing behavior first accounted for an opportunity. Sample sizes ranged from 163 to 3,397, with the modal setting from colleges. Overall, samples were young (21.8 years old), White (75%), women (64%), and heterosexual (89%). Results indicate the need to validate additional measures that capture the "interpreting the situation as problematic" step of the situational model. Scales also need to be validated using diverse samples, particularly within the mental health crisis domain. Across all domains, validated measures need to be developed that first account for an opportunity when measuring actual bystander behavior. The information gleaned can be used to assist researchers in selecting measures and guide future measure development.

Latent class analysis of drinking game consequences among college drinkers.

Participation in drinking games has been identified as one specific alcohol-related context linked to increased risk for heavier alcohol consumption and negative consequences among college students. Despite advances in drinking game research, questions remain about the different types of individuals at risk from participating. The current study utilized latent class analysis to classify individuals based on their endorsement of eight negative drinking game consequences from the Hazardous Drinking Games Measure. Analyses included identification of classes among 656 college students, followed by covariate analyses regressing class membership on motives for playing drinking games, general drinking motives, impulsivity facets, general problematic alcohol use, and specific drinking game behaviors. A total of three classes were identified, including a class with the fewest number of problems, a class with higher rates of hangovers and becoming sick, and a class with relatively higher rates of a majority of the other consequences. Classes differed in endorsement of motives, impulsivity facets, general problematic consumption, and drinking game behaviors. Generally, coping, conformity, and social general drinking motives; conformity and enhancement and thrills motives for playing drinking games; the impulsivity facet of negative urgency; the number of drinks consumed while playing drinking games; playing consumption type drinking games; and general problematic alcohol use were associated with more problematic class membership. Results highlight distinct classes of individuals at risk from drinking game participation. Recommendations for future studies and potential prevention and intervention efforts are also discussed.

Substance use behaviors among college students in the food service industry.

Objective: Food service employment is associated with substance use, risk of substance use disorders and various negative consequences. Previous research has not examined the substance use patterns of students employed in food service positions. Method: During Fall of 2018, 276 undergraduates completed an anonymous online survey regarding current employment status and substance use. Results: Compared to students employed in other positions, students in food service positions reported higher levels of drinking to cope with negative affect, negative urgency, workplace substance use, marijuana use, marijuana-related problems, and motives. Food service employment was also a significant predictor of marijuana use and related consequences. Conclusions: Students in food service positions, relative to other employment positions, report elevated substance use behavior, risk factors, and negative consequences. Food service employment also contributed variance to models accounting for marijuana use and related consequences. Prevention and intervention strategies should be investigated to mitigate risk for this population.

An investigation of the reinforcing value of video game playing relative to concurrently available monetary alternatives.

OBJECTIVE: Video game playing (VGP) has received recent attention as a result of sharing many similarities with other addictive behaviors. Behavioral economic models are commonly used to understand drug use and other addictive behaviors and may similarly inform conceptual models of VGP. METHOD: The present study employed behavioral economic principles to conceptualize relative reinforcing value for playing video games compared to concurrently available alternative potential monetary reinforcers. Participants (N = 81) played three video games picked to represent games of low, medium, and high quality (i.e., OutDrive, Forza Motorsport 1, and Forza Motorsport 7), with quality designations based on the research teams' assessment of various features of the game (e.g., graphics, sound, immersion) as well as the game's market value at the time the study was conducted. Participants played each game for 10 min and completed Visual Analog Scales and a multiple-choice procedure (MCP) designed to assess relative reinforcing value at various time points during and after each session. RESULTS: As hypothesized, both subjective ratings and relative reinforcing value increased as the designated quality of the game increased. More specifically, the high-quality game was rated as more fun and likable and had a higher MCP crossover point than the medium and low-quality games. CONCLUSIONS: Like other behavioral addiction studies, results suggest that methodologies and behavioral measures commonly used in drug administration literature can be effectively applied to VGP. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Relations among motives, negative urgency, and mindfulness skills in college drinkers.

Heavy alcohol use continues to be a common problem among the college student population, and numerous negative consequences can be attributed to student drinking. Several factors, including drinking motives and impulsivity, have been studied to better understand college drinking behaviors. Research has identified that coping motives (i.e., drinking to reduce negative affect) and negative urgency (i.e., the tendency for rash reaction in response to negative affect) are both closely linked to alcohol-related problems and to one another. The primary purpose of this study was to test if mindfulness skills moderate the relation between negative urgency and drinking to cope. To test for moderation, 683 college student drinkers responded to self-report measures of drinking behaviors, drinking motives, impulsivity, and daily utilization of mindfulness skills. Four separate regression models tested for the mindfulness skills of observing, describing, acting with awareness, and accepting without judgment as potential moderators to the relation between negative urgency and coping motives. The mindfulness skill of accepting without judgment significantly moderated (i.e., dampened) the positive relation between negative urgency and drinking to cope. Results may be useful in developing targeted intervention and prevention efforts to test among students, as skills training may benefit individuals with long-standing impulsive personality traits who engage in the traditionally problematic behavior of drinking to cope.

Brief alcohol intervention with college student drinkers: face-to-face versus computerized feedback.

Research has demonstrated that brief interventions featuring personalized feedback can be used to decrease alcohol use among heavy-drinking college students. The current study investigated the efficacy of face-to-face and computer delivered interventions relative to an assessment-only control condition. The content of the personalized feedback was identical across the face-to-face and computerized conditions. There were 84 at-risk students assessed before, and 4 weeks after, the delivery of the interventions. The results suggest that both face-to-face and computerized interventions were equally successful in reducing the quantity and frequency of alcohol consumption, and that both interventions were more effective than the control condition. Participants also rated both interventions as acceptable, although the face-to-face intervention was given a more favorable rating. These initial results suggest that computerized interventions can be used to efficiently reduce alcohol use among college students. (PsycINFO Database Record (c) 2009 APA, all rights reserved).

Measurement of substance-free reinforcement in addiction: A systematic review.

A robust body of theoretical and experimental work highlights the influence of alternative, substance-free rewards on decisions to use alcohol and other drugs. However, translational applications have been limited in part by the lack of consensus on how to measure substance-free reinforcement in applied and clinical settings. The current study summarizes extant research utilizing self-report reinforcement or reward methodologies, and critically reviews the psychometric properties of the available measures. These studies (N = 50) fell into three categories: measures of recent substance-related and substance-free activity participation and enjoyment (n = 32), measures of time or monetary resource allocation (n = 15), and rating scale measures of reward availability and experience (n = 8). The available research suggests that, consistent with experimental laboratory research and with behavioral economic predictions, there is an inverse relation between substance-free reinforcement and substance use. These studies also support the clinical utility of these measures in predicting substance use severity and course. Reinforcement measures could be improved by enhancing content validity, multimethod convergent validity, and generalizability.

Differential Role of Cannabis Use Motives in Predicting Impairment Across Three Measures.

OBJECTIVE: Previous research has demonstrated the utility of motivational models of cannabis use to predict the frequency of use and associated negative consequences. However, few existing studies have simultaneously investigated a range of motives across different measures of use-related problems, which limit the ability to assess the differential role various motives play. The purpose of the current study was to examine cannabis use motives as predictors of three measures of cannabis use risk. METHOD: Participants (N = 229) who reported cannabis use within the past 30 days completed the Marijuana Motives Measures, as well as measures of typical smoking behavior and risk: Cannabis Use Disorders Identification Test-R (CUDIT-R; screening measure of hazardous cannabis use), Marijuana Problem Index (MPI; measure of broad psychosocial problems), and cannabis use disorder according to criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). RESULTS: Cannabis use motives-particularly coping, enhancement, and conformity-contributed to the prediction of cannabis-related impairment beyond gender and the frequency of recent use. Among the motives scales, coping emerged as the most robust predictor across the three impairment measures and was the only motive to add unique variance to predictions of DSM-5 symptoms. Enhancement and conformity motives were predictive of the screening measure (CUDIT-R scores), and enhancement motives was also predictive of a measure of broad psychosocial problems related to cannabis use (MPI scores). CONCLUSIONS: The results highlight the differential role various marijuana use motives play across related but distinct measures of impairment.

Evaluation of the psychometric properties of the cannabis use disorders identification test - revised among college students.

OBJECTIVE: Cannabis use is common among college students and is associated with a variety of negative consequences. The Cannabis Use Disorders Identification Test Revised (CUDIT-R) is an 8-item screening instrument designed to identify potentially problematic or harmful recent cannabis use. The purpose of the current study was to evaluate the internal consistency and validity of the CUDIT-R in a sample of college students who reported recent cannabis use (past 30 day). METHODS: Participants (n = 229) completed the CUDIT-R and measures of smoking behavior (Daily Smoking Questionnaire; DSQ), cannabis related consequences (Marijuana Problem Index; MPI), and problematic cannabis use (self-reported DSM-5 Cannabis Use Disorder Criteria). RESULTS: The CUDIT-R showed good internal consistency and concurrent validity with cannabis related outcome measures including; frequency of use, cannabis related consequences, and total DSM-5 criteria endorsed. The CUDIT-R also showed evidence of discriminant validity across DSM-5 severity classifications, achieved high levels of sensitivity (0.929) and specificity (0.704), and excellent area under the receiver operating characteristics curve when using a cutoff score of six. All items displayed high levels of discrimination and varied in terms of difficulty and information provided. CONCLUSIONS: Overall, the CUDIT-R appears to be a reliable and valid screening measure when used to identify college students at risk for cannabis related problems. Future research should further evaluate the sensitivity and specificity of the CUDIT-R threshold scores with more rigorously established DSM-5 diagnoses, and across a range of populations. Research on the utility of using the CUDIT-R for measuring treatment outcomes is also warranted.

A brief abstinence test for college student smokers: a feasibility study.

Cigarette smoking among college students is prevalent and correlated with other unhealthy behaviors. Reinforced abstinence (e.g., contingency management) has been demonstrated to be an effective method for reducing substance use in a variety of populations and across a variety of drugs, including cigarettes. Reinforced abstinence has seldom been used specifically targeting a college student population. A Brief Abstinence Test (BAT) has been used to effectively reduce cocaine use among methadone maintenance patients (Robles, Silverman, Preston, Cone, Katz, Bigelow, & Stitzer, 2000). However, no published studies have investigated the use of a BAT to reduce the use of cigarettes. The current study implemented a 3-week intervention (Baseline 1, BAT, and Baseline 2 weeks) for smoking abstinence among college students. Forty-two percent of the sample met abstention criteria during the BAT. Carbon monoxide and urinalysis scores decreased significantly from Baseline 1 to the BAT phase but did not differ significantly from BAT to Baseline 2. These results suggest that the BAT may have utility initiating abstinence in both clinical and research contexts.

Behavioral economic approaches to reduce college student drinking.

There is a need for novel, theory-based approaches to reduce heavy drinking on college campuses. Behavioral economics has guided basic laboratory research on drug administration for over 30 years and has recently been applied to human substance use in naturalistic and clinical settings. This paper provides an introduction to behavioral economics, reviews applications of behavioral economics to college student drinking, and describes prevention and intervention strategies that are consistent with behavioral economic theory. Behavioral economic theory predicts that college students' decisions about drinking are related to the relative availability and price of alcohol, the relative availability and price of substance-free alternative activities, and the extent to which reinforcement from delayed substance-free outcomes is devalued relative to the immediate reinforcement associated with drinking. Measures of problem severity are based on resource allocation towards alcohol and the relative value of alcohol compared to other reinforcers. Policy and individual level prevention approaches that are consistent with behavioral economic theory are discussed, including strategies for increasing the behavioral and monetary price of alcohol, increasing engagement in rewarding alternatives to substance use, and counteracting student drinkers' tendency to overvalue immediate relative to delayed rewards.

Predictors of motivation to change alcohol use among referred college students.

The current study investigated motivation and its relationship with alcohol use and life satisfaction. Participants were 49 undergraduates referred to a university-based clinic to participate in a brief alcohol intervention. All participants completed measures assessing readiness to change drinking, frequency of alcohol use and related problems, and life satisfaction. As hypothesized, higher levels of motivation to change drinking were related to higher frequency and quantity of alcohol use, alcohol-related problems, and lower levels of life satisfaction. Results indicate the importance of assessing motivation in students referred to receive alcohol interventions.