Prospective Associations Between Anxiety Sensitivity, Distress Intolerance, Depressive Symptoms, and Indices of Alcohol and Cannabis Use Among Veterans.

OBJECTIVE: There is substantial evidence linking anxiety sensitivity and distress intolerance to depressive symptoms, and further evidence linking depressive symptoms to alcohol and cannabis use. However, the prospective indirect associations of anxiety sensitivity and distress intolerance with alcohol and cannabis use through depressive symptoms remain uncertain. Thus, the current study examined whether depressive symptoms mediated the associations between anxiety sensitivity and distress intolerance with alcohol and cannabis use frequency, quantity, and problems in a longitudinal sample of veterans. METHOD: Participants (N = 361; 93% male; 80% White) were military veterans with lifetime cannabis use recruited from a Veterans Health Administration in the Northeastern United States. Eligible veterans completed three semi-annual assessments. Prospective mediation models were used to test for the effects of baseline anxiety sensitivity and distress intolerance on alcohol and cannabis use quantity, frequency and problems at 12 months via depressive symptoms at 6 months. RESULTS: Baseline anxiety sensitivity was positively associated with 12-month alcohol problems. Baseline distress intolerance was positively associated with 12-month cannabis use frequency and quantity. Baseline anxiety sensitivity and distress intolerance significantly predicted increased alcohol problems and cannabis use frequency at 12 months through depressive symptoms at 6 months. There were no significant indirect effects of anxiety sensitivity and distress intolerance on alcohol use frequency or quantity, cannabis use quantity, or cannabis problems. CONCLUSIONS: Anxiety sensitivity and distress intolerance share a common pathway to alcohol problems and cannabis use frequency through depressive symptoms. Interventions focused on modulating negative affectivity may reduce cannabis use frequency and alcohol problems.

Applying Bayesian cognitive models to decisions to drive after drinking.

BACKGROUND AND AIMS: Despite widespread negative perceptions, the prevalence of alcohol-impaired driving (AID) in the United States remains unacceptably high. This study used a novel decision task to evaluate whether individuals considered both ride service cost and alcohol consumption level when deciding whether or not to drive, and whether the resulting strategy was associated with engagement in AID. DESIGN: A two-sample study, where sample 1 developed a novel AID decision task to classify participants by decision strategy. Sample 2 was used to cross-validate the task and examine whether decision strategy classifications were predictive of prior reported AID behavior. SETTING: A laboratory setting at the University of Missouri, USA. PARTICIPANTS: Sample 1 included 38 student participants from introductory psychology classes at the University of Missouri. Sample 2 included 67 young adult participants recruited from the local community. MEASUREMENTS: We developed a decision task that presented hypothetical drinking scenarios that varied in quantity of alcohol consumption (one to six drinks) and the cost of a ride service ($5-25). We applied a Bayesian computational model to classify choices as consistent with either: integrating both ride cost and consumption level (compensatory) or considering only consumption level (non-compensatory) when making hypothetical AID decisions. In sample 2, we assessed established AID risk factors (sex, recent alcohol consumption, perceived safe limit) and recent (past 3 months) engagement in AID. FINDINGS: In sample 1, the majority of participants were classified as using decision strategies consistent with either a compensatory or non-compensatory process. Results from sample 2 replicated the overall classification rate and demonstrated that participants who used a compensatory strategy were more likely to report recent AID, even after accounting for study covariates. CONCLUSIONS: In a hypothetical alcohol-impaired driving (AID) decision task, individuals who considered both consumption level and ride service cost were more likely to report recent AID than those who made decisions based entirely on consumption level.

Event-Level Predictors of Alcohol-Impaired Driving Intentions.

OBJECTIVE: Alcohol-impaired driving is a significant public safety concern and is highly prevalent among young adults. Considerable research has examined between-person predictors of alcohol-impaired driving, but there has been little research on factors that predict alcohol-impaired driving at the event level. This pilot/feasibility study was designed to identify within-person, event-level predictors of alcohol-impaired driving intentions in the natural environment using an ecological momentary assessment (EMA) design. METHOD: Thirty-six young adult, moderate drinkers (M age = 22.9 years; 72.2% female; M drinks per occasion = 3.2) were recruited from a university area to complete 2 weeks of EMA. They reported on their subjective levels of intoxication, perceived dangerousness of driving, and driving intentions during real-world drinking episodes. Breath alcohol concentrations were collected with a portable breath alcohol analyzer. RESULTS: Event-level perceived danger and subjective intoxication most strongly predicted intentions to drive after drinking, such that higher perceived danger and intoxication predicted lower willingness to drive, after adjusting for baseline alcohol-impaired driving attitudes (ps < .001). When we accounted for perceived danger during drinking episodes at the event and person level, baseline attitudes were no longer predictive of willingness to drive. Higher event-level breath alcohol concentration also predicted lower willingness to drive (p = .003). CONCLUSIONS: This study is the first to demonstrate that event-level risks of alcohol-impaired driving can be collected during drinking episodes in the natural environment. Findings indicate that subjective perceptions of intoxication and risk more strongly predict alcohol-impaired driving intentions than objective intoxication. Findings also suggest that event-level perceptions of intoxication and driving risk may be fruitful targets for interventions to reduce alcohol-impaired driving.

Training Health Services Psychologists for Research Careers in Addiction Science.

Addiction is a growing public health crisis, yet comparatively very few health services psychology programs include formal training in addiction science (Dimoff, Sayette, Norcross, 2017). Health services psychologists (i.e., psychologists who integrate psychological science and practice to understand development and functioning; APA, 2015) are well-suited to study and treat addiction, and doctoral level training is an ideal time to prepare future health services psychologists to do so. One possible barrier to incorporating addiction science training is the necessity of a multidisciplinary approach to study and treat addiction and related health behaviors. We focus primarily on clinical science training and argue for a multi-faceted approach to doctoral training in addiction science that would prepare trainees for research careers. The proposed training model emphasizes the importance of mentorship, coursework, grant preparation, responsible conduct of research, prevention, intervention, and treatment, and invited speakers and conference attendance. Each of these components is discussed with an emphasis on addiction science. We offer suggestions for incorporating portions of this training model for programs with few addiction science related resources. We also discuss the importance of enhancing diversity and inclusion in addiction training and offer brief recommendations on this topic.

Young Adults Make Rational Sexual Decisions.

We examined risky sexual choice under the lens of rational decision-making. Participants (N = 257) completed a novel sexual-choice task in which they selected from among hypothetical sexual partners varying in physical attractiveness and in the probability that one would contract a sexually transmitted infection (STI) from a one-time sexual encounter with them. We found that nearly all participants evaluated the sexual-choice alternatives in a coherent fashion consistent with utility-based theories of rational choice. In subsequent analyses, we classified participants' responses according to whether their sexual preferences were based on maximizing attractiveness or minimizing the risk of STIs. Finally, we established an association between sexual choice in our task and reported real-world sexual risk-taking.

Decision Making and Alcohol: Health Policy Implications.

Many negative outcomes associated with alcohol consumption stem from individual decision making, such as the decision whether or not to drive after drinking. Understanding biases in decision making as they relate to alcohol, and measuring variability in decision strategies across individuals, can be a tool for improving policy. For alcohol-related policy, both addiction and the acute effects of intoxication are potential sources of bias or heterogeneity in decision strategy, and we provide a brief primer on how they can affect decision making. We then discuss two alcohol policy domains, alcohol impaired driving and excessive consumption. We review potential implications of major findings in decision making research for each of these domains, and point out how policy could take account of biases and variability in decision making.

Explicit Attitudes, Working Memory Capacity, and Driving After Drinking.

BACKGROUND: Attitudes toward driving after drinking are strongly predictive of drinking and driving behavior. This study tested working memory capacity (WMC) as a moderator of the association between attitudes and drinking and driving behavior. Consistent with dual process models of cognition, we hypothesized that the association between perceived danger and drinking and driving would be stronger for individuals with higher WMC. METHODS: Participants (N = 161) enrolled in larger alcohol administration study were randomly assigned to an alcohol (n = 57), placebol (n = 52), or control (n = 52, not included) beverage condition. Past-year frequency of driving after drinking and WMC were assessed at baseline. Attitudes were assessed by asking participants to rate the perceived danger of driving at their current level of intoxication twice on the ascending limb (AL1, AL2), at peak breath alcohol concentration (BrAC), and twice on the descending limb (DL1, DL2). RESULTS: Analyses across the BrAC curve indicated that the hypothesized interaction was observed for the alcohol but not placebo condition. Analyses for each assessment point indicated that the interaction was significant for the ascending limb and peak BrAC. In the alcohol condition, for those higher in WMC, lower perceived dangerousness was strongly associated with increased driving after drinking (AL1: incident rate ratios [IRR] = 5.87, Wald's χ2  = 12.39, p = 0.006, 95% CI [2.19, 15.75]; AL2: IRR = 8.17, Wald's χ2  = 11.39, p = 0.001, 95% CI [2.41, 27.66]; Peak: IRR = 5.11, Wald's χ2  = 9.84, p = 0.002, 95% CI [1.84, 14.16]). Associations were not significant at low WMC. CONCLUSIONS: Results suggest that individuals higher in WMC are more likely to act consistently with their explicit attitudes toward drinking and driving. Findings may have implications for existing drinking and driving interventions and suggest the potential for novel interventions targeting implicit associations or WMC.

Developmental changes in the feedback related negativity from 8 to 14 years.

The study examined age related changes in the magnitude of the Feedback Related Negativity (FRN) in 8-14 year old children performing a variation of a Go/No-Go task. Participants were presented with four stimuli and tasked with mapping each of them either to a response or to a "no response" by trial and error guided by feedback. Feedback was valid for two stimuli (Go and No-Go) and invalid (.5 positive; .5 negative feedback) for the other two stimuli. The amplitude of the FRN was evaluated as a function of age separately for Go and No-Go trials. The results indicated that while performance on valid Go trials improved with age, accuracy on valid No-Go trials remained stable with age. FRN amplitude was found to be inversely related to age such that smaller FRN amplitudes were observed in older children even after controlling for variance in learning. Additionally, the FRN was found as a predictor of post-learning performance on Go trials but not on No-Go trials, regardless of age. These results do not provide support to the link between the FRN and inhibition control as measured by No-Go performance, but do suggest a link with other executive control abilities called for by the Go condition.

Differential Associations of UPPS-P Impulsivity Traits With Alcohol Problems.

OBJECTIVE: The UPPS-P model posits that impulsivity comprises five factors: positive urgency, negative urgency, lack of planning, lack of perseverance, and sensation seeking. Negative and positive urgency are the traits most consistently associated with alcohol problems. However, previous work has examined alcohol problems either individually or in the aggregate, rather than examining multiple problem domains simultaneously. Recent work has also questioned the utility of distinguishing between positive and negative urgency, as this distinction did not meaningfully differ in predicting domains of psychopathology. The aims of this study were to address these issues by (a) testing unique associations of UPPS-P with specific domains of alcohol problems and (b) determining the utility of distinguishing between positive and negative urgency as risk factors for specific alcohol problems. METHOD: Associations between UPPS-P traits and alcohol problem domains were examined in two cross-sectional data sets using negative binomial regression models. RESULTS: In both samples, negative urgency was associated with social/interpersonal, self-perception, risky behaviors, and blackout drinking problems. Positive urgency was associated with academic/occupational and physiological dependence problems. Both urgency traits were associated with impaired control and self-care problems. Associations for other UPPS-P traits did not replicate across samples. CONCLUSIONS: Results indicate that negative and positive urgency have differential associations with alcohol problem domains. Results also suggest a distinction between the type of alcohol problems associated with these traits-negative urgency was associated with problems experienced during a drinking episode, whereas positive urgency was associated with alcohol problems that result from longer-term drinking trends.

Acute subjective response to alcohol as a function of reward and punishment sensitivity.

Individual differences in subjective response to alcohol play a crucial role in the development of heavy drinking and related problems. In light of this, a growing focus of research has been identifying factors that contribute to differences in response. The aim of the present study was to determine whether individual differences in the subjective experience of rewarding and aversive effects of alcohol are a specific manifestation of general differences in reward and punishment sensitivity. Eighty-nine participants (M age=22.4, SD=1.9; 47.2% women) consumed a moderate dose of alcohol, i.e., peak breath alcohol concentration (BrAC)≈0.080g%, and rated their level of stimulation and sedation at seven timepoints over the BrAC curve. Sensitivity to reward and punishment were assessed by a self-report questionnaire prior to consumption. Multilevel growth models showed that post-consumption changes in stimulation ratings varied as a function of participants' level of reward and punishment sensitivity. Drinkers more sensitive to reward reported feeling more stimulated shortly after drinking and exhibited an attenuated rate of decline in stimulation over the blood alcohol curve, relative to drinkers with less strong reward sensitivity. Reward sensitivity was not related to subjective ratings of sedation, and punishment sensitivity was not related to either stimulation or sedation ratings. Findings suggest that reward sensitivity may increase risk for alcohol misuse among young adult social drinkers by increasing their subjective feelings of stimulation while drinking.

Area under the curve as a novel metric of behavioral economic demand for alcohol.

Behavioral economic purchase tasks can be readily used to assess demand for a number of addictive substances, including alcohol, tobacco, and illicit drugs. However, several methodological limitations associated with the techniques used to quantify demand may reduce the utility of demand measures. In the present study, we sought to introduce area under the curve (AUC), commonly used to quantify degree of delay discounting, as a novel index of demand. A sample of 207 heavy-drinking college students completed a standard alcohol purchase task and provided information about typical weekly drinking patterns and alcohol-related problems. Level of alcohol demand was quantified using AUC--which reflects the entire amount of consumption across all drink prices--as well as the standard demand indices (e.g., intensity, breakpoint, Omax, Pmax, and elasticity). Results indicated that AUC was significantly correlated with each of the other demand indices (rs = .42-.92), with particularly strong associations with Omax (r = .92). In regression models, AUC and intensity were significant predictors of weekly drinking quantity, and AUC uniquely predicted alcohol-related problems, even after controlling for drinking level. In a parallel set of analyses, Omax also predicted drinking quantity and alcohol problems, although Omax was not a unique predictor of the latter. These results offer initial support for using AUC as an index of alcohol demand. Additional research is necessary to further validate this approach and to examine its utility in quantifying demand for other addictive substances such as tobacco and illicit drugs.

Increased behavioral economic demand and craving for alcohol following a laboratory alcohol challenge.

BACKGROUND AND AIMS: Although increases in subjective alcohol craving have been observed following moderate doses of alcohol (e.g. priming effects), the effects of alcohol consumption on behavioral economic demand for alcohol are largely unstudied. This study examined the effects of alcohol intoxication on alcohol demand and craving. DESIGN: A between-subjects design in which participants were randomly assigned to either an alcohol (n = 31), placebo (n = 29) or control (n = 25) condition. SETTING: A laboratory setting at the University of Missouri, USA. PARTICIPANTS: Eighty-five young adult moderate drinkers were recruited from the University of Missouri and surrounding community. MEASUREMENTS: Change in demand for alcohol across time was measured using three single items: alcohol consumption at no cost (i.e. intensity), maximum price paid for a single drink (i.e. breakpoint) and total amount spent on alcohol (i.e. Omax). Alcohol demand at baseline was also assessed using an alcohol purchase task (APT). Craving was assessed using a single visual analog scale item. FINDINGS: In the alcohol group compared with the combined non-alcohol groups, intensity, breakpoint and craving increased from baseline to the ascending limb and decreased thereafter (Ps < 0.05; Omax , P = 0.06). Change in craving following alcohol consumption was significantly associated with change in each of the demand indices (Ps < 0.0001). Finally, the demand single items were associated with corresponding indices from the APT (Ps < 0.05). CONCLUSIONS: Alcohol demand increases following intoxication, in terms of both the maximum amount people are willing to pay for one drink and the number of drinks people would consume if drinks were free. Behavioral economic measures of alcohol value can complement subjective craving as measures of moment-to-moment fluctuations in drinking motivation following intoxication.