Behavioral economic and value-based decision-making constructs that discriminate current heavy drinkers versus people who reduced their drinking without treatment.

OBJECTIVE: A substantial number of people reduce their consumption of alcohol in the absence of formal treatment; however, less is known about the mechanisms of change. The aim of this study is to explore whether constructs derived from behavioral economics and computational decision-modeling characterize the moderation of alcohol consumption that many heavy drinkers experience without treatment. METHOD: Between-subject, preregistered design. People who reside in the United Kingdom and who drink heavily (n = 60) or used to drink heavily but now consume alcohol in moderation (n = 60) were recruited. Participants completed self-report behavioral economic measures (alcohol demand and alcohol-related and alcohol-free reinforcement) and a two-alternative forced choice task in which they chose between two alcoholic (in one block) or two soft drink images (in a different block). A drift-diffusion model was fitted to responses from this task to yield the underlying parameters of value-based choice. RESULTS: Compared to heavy drinkers, moderated drinkers had significantly lower alcohol demand, Omax, p = .03, Cohen's d = .36; elasticity, p = .03, rank-biserial correlation (rrb) = .21, and higher proportionate alcohol-free reinforcement (p < .001, Cohen's d = .75). However, contrary to hypotheses, there were no robust between-group differences in value-based decision-making (VBDM) parameters. CONCLUSIONS: Self-report behavioral economic measures demonstrate that alcohol moderation without treatment is characterized by lowered alcohol demand and greater behavioral allocation to alcohol-free reinforcement, in line with behavioral economic theory. However, a computerized VBDM measure yielded inconclusive findings. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Changes in alcohol use during COVID-19 and associations with contextual and individual difference variables: A systematic review and meta-analysis.

OBJECTIVE: The present study meta-analyzed studies examining changes in alcohol consumption during the coronavirus disease (COVID-19) pandemic and systematically reviewed contextual and individual difference factors related to these changes. METHOD: Following the preferred reporting items for systematic reviews and meta-analysis (PRISMA) protocol, studies were gathered via PsycINFO, PubMed/MEDLINE, and preprint databases (published April 29, 2021) that examined individual-level changes in consumption during the initial COVID-19 mitigation measures (before October 2020). Next, sample proportion increases and decreases in consumption, in addition to mean change in consumption variables from pre- to during-COVID, were meta-analyzed, and contextual and individual difference variables related to consumption changes during the pandemic were summarized. RESULTS: One hundred and twenty-eight studies provided data from 58 countries (M n = 3,876; Mdn n = 1,092; aggregate sample n = 492,235). The average mean change in alcohol consumption was nonsignificant (Cohen's d = -0.01, p = .68); however, meta-analysis revealed that 23% of participants reported increases in consumption and 23% reported decreases. These changes were moderated by per capita gross domestic product and country. Narrative synthesis revealed multiple predictors of increased drinking, including contextual changes (e.g., children at home, income loss, working remotely), individual difference variables (being female, a young-to-middle aged adult, or Black), and mental health/alcohol-related risk factors (e.g., depression). CONCLUSIONS: The identified factors associated with increased alcohol consumption should be considered in planning behavioral health services during future crisis events that abruptly alter everyday environments in ways that increase stress and decrease access to naturally occurring rewards. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

COVID-19 impacts on drinking and mental health in emerging adults: Longitudinal changes and moderation by economic disruption and sex.

BACKGROUND: There are significant concerns that the COVID-19 pandemic may have negative effects on substance use and mental health, but most studies to date are cross-sectional. In a sample of emerging adults, over a two-week period during the pandemic, the current study examined: (1) changes in drinking-related outcomes, depression, anxiety, and posttraumatic stress disorder and (2) differences in changes by sex and income loss. The intra-pandemic measures were compared to pre-pandemic measures. METHODS: Participants were 473 emerging adults (Mage  = 23.84; 41.7% male) in an existing longitudinal study on alcohol misuse who were assessed from June 17 to July 1, 2020, during acute public health restrictions in Ontario, Canada. These intra-pandemic data were matched to participant pre-pandemic reports, collected an average of 5 months earlier. Assessments included validated measures of drinking, alcohol-related consequences, and mental health indicators. RESULTS: Longitudinal analyses revealed significant decreases in heavy drinking and adverse alcohol consequences, with no moderation by sex or income loss, but with substantial heterogeneity in changes. Significant increases in continuous measures of depression and anxiety were present, both of which were moderated by sex. Females reported significantly larger increases in depression and anxiety. Income loss >50% was significantly associated with increases in depression. CONCLUSIONS: During the initial phase of the pandemic, reductions in heavy drinking and alcohol consequences were present in this sample of emerging adults, perhaps due to restrictions on socializing. In contrast, there was an increase in internalizing symptoms , especially in females, highlighting disparities in the mental health impacts of the pandemic.

Behavioral economics of substance use: Understanding and reducing harmful use during the COVID-19 pandemic.

Behavioral economic research demonstrates that alcohol and drug consumption is (a) an inverse function of constraints on access to the substance and (b) a direct function of constraints on access to alternative rewards. Physical distancing interventions and economic consequences of the COVID-19 pandemic have resulted in unprecedented reductions in many of the constraints on substance use and in critical evolutionarily salient sources of alternative reward, such as social interaction, physical activity, leisure activities and hobbies, and academic and occupational pursuits. Thus, behavioral economics suggests that the pandemic and necessary public health response have created a "perfect storm" for exacerbation of individual-level and population-level substance use problems and also points to multilevel intervention strategies. We summarize this perspective and research by highlighting 3 critical behavioral processes that will influence drug and alcohol consumption. First, the sudden absence of many effective constraints on substance use (work, school, community, or service obligations) will reduce the actual and perceived cost of use. Second, physical distancing measures will reduce the availability, and increase the cost, of many rewarding substance-free activities and commodities. Third, increased uncertainty around current and future events increases discounting of delayed rewards. These effects will be especially pernicious among populations with existing health disparities. Next, we outline interventions suggested by behavioral economics to mitigate the impact of COVID-19 on substance use that are aimed at increasing perceived costs of use; increasing access to substance-free activities, including treatment; and lengthening the timeframe for behavioral allocation and altering environmental contexts to promote healthy choices. (PsycInfo Database Record (c) 2021 APA, all rights reserved).