Descriptive drinking norms: For whom does reference group matter?

OBJECTIVE: Perceived descriptive drinking norms often differ from actual norms and are positively related to personal consumption. However, it is not clear how normative perceptions vary with specificity of the reference group. Are drinking norms more accurate and more closely related to drinking behavior as reference group specificity increases? Do these relationships vary as a function of participant demographics? The present study examined the relationship between perceived descriptive norms and drinking behavior by ethnicity (Asian or White), sex, and fraternity/sorority status. METHOD: Participants were 2,699 (58% female) White (75%) or Asian (25%) undergraduates from two universities who reported their own alcohol use and perceived descriptive norms for eight reference groups: "typical student"; same sex, ethnicity, or fraternity/sorority status; and all combinations of these three factors. RESULTS: Participants generally reported the highest perceived norms for the most distal reference group (typical student), with perceptions becoming more accurate as individuals' similarity to the reference group increased. Despite increased accuracy, participants perceived that all reference groups drank more than was actually the case. Across specific subgroups (fraternity/sorority members and men) different patterns emerged. Fraternity/sorority members reliably reported higher estimates of drinking for reference groups that included fraternity/ sorority status, and, to a lesser extent, men reported higher estimates for reference groups that included men. CONCLUSIONS: The results suggest that interventions targeting normative misperceptions may need to provide feedback based on participant demography or group membership. Although reference group-specific feedback may be important for some subgroups, typical student feedback provides the largest normative discrepancy for the majority of students.

A randomized clinical trial evaluating a combined alcohol intervention for high-risk college students.

OBJECTIVE: The current study is a multisite randomized alcohol prevention trial to evaluate the efficacy of both a parenting handbook intervention and the Brief Alcohol Screening and Intervention for College Students (BASICS) intervention, alone and in combination, in reducing alcohol use and consequences among a high-risk population of matriculating college students (i.e., former high school athletes). METHOD: Students (n = 1,275) completed a series of Web-administered measures at baseline (in the summer before starting college) and follow-up (after 10 months). Students were randomized to one of four conditions: parent intervention only, BASICS only, combined (parent and BASICS), and assessment-only control. Intervention efficacy was tested on a number of outcome measures, including peak blood alcohol concentration, weekly and weekend drinking, and negative consequences. Hypothesized mediators and moderators of intervention effect were tested. RESULTS: The overall results revealed that the combined-intervention group had significantly lower alcohol consumption, high-risk drinking, and consequences at 10-month follow-up, compared with the control group, with changes in descriptive and injunctive peer norms mediating intervention effects. CONCLUSIONS: The findings of the present study suggest that the parent intervention delivered to students before they begin college serves to enhance the efficacy of the BASICS intervention, potentially priming students to respond to the subsequent BASICS session.

Evaluating level of specificity of normative referents in relation to personal drinking behavior.

OBJECTIVE: Research has found perceived descriptive norms to be one of the strongest predictors of college student drinking, and several intervention approaches have incorporated normative feedback to correct misperceptions of peer drinking behavior. Little research has focused on the role of the reference group in normative perceptions. The current study sought to examine whether normative perceptions vary based on specificity of the reference group and whether perceived norms for more specific reference-group norms are related to individual drinking behavior. METHOD: Participants were first-year undergraduates (n = 1,276, 58% female) randomly selected from a university list of incoming students. Participants reported personal drinking behavior and perceived descriptive norms for eight reference groups, including typical student; same gender, ethnicity, or residence; and combinations of those reference groups (e.g., same gender and residence). RESULTS: Findings indicated that participants distinguished among different reference groups in estimating descriptive drinking norms. Moreover, results indicated misperceptions in drinking norms were evident at all levels of specificity of the reference group. Additionally, findings showed perceived norms for more specific groups were uniquely related to participants' own drinking. CONCLUSIONS: These results suggest that providing normative feedback targeting at least one level of specificity to the participant (i.e., beyond what the "typical" student does) may be an important tool in normative feedback interventions.

Identification with mainstream culture and preference for alternative alcohol treatment approaches in a community sample.

Although various treatment approaches are available for alcohol problems, less than 25% of individuals with alcohol use disorders obtain treatment. The purpose of this study is to evaluate interest in attending alternative alcohol treatments, such as meditation and acupuncture, compared to Alcoholics Anonymous (AA). A community sample of 156 adult participants concerned about their drinking were recruited through flyers and newspaper advertisements to complete a Web-based survey assessing identification with mainstream culture, sexual identity, and likelihood to attend alternative alcohol treatments. Participants reported higher likelihood of attending alternative treatments as compared to AA, and lesbian, gay, and bisexual participants (28.2% of the sample) were more likely to attend alternative treatments than heterosexual participants. A series of regression analyses were conducted to test whether the relationship between sexual identity and likelihood to attend alternative treatments was mediated by identification with mainstream culture. Participants who were less strongly identified with mainstream culture, regardless of sexual identity, reported higher likelihood of attending alternative treatments. These findings highlight that, for certain subgroups of the population, alternative treatments for alcohol misuse are appealing and suggest the need for future research testing the efficacy of alternative treatments for alcohol problems.

Social support and depressive symptomatology among HIV-positive women: the mediating role of self-esteem and mastery.

Women constitute an increasing proportion of individuals contracting HIV in the United States and, once diagnosed, are living longer lives since the advent of combination antiretroviral therapies. HIV-positive women, who are disproportionately ethnic minority, face unique challenges to their psychosocial adaptation. Findings from a survey of 373 mainly indigent African-American and Puerto Rican women living with HIV/AIDS in the New York City area indicated high levels of depressive symptomatology, which were inversely related to HIV-related social support from friends, relatives, partner, and groups/ organizations. In line with the Cognitive Adaptation Model, structural equation modeling indicated that psychological resourcefulness (i.e., self-esteem and mastery) mediated the effects of social support on depressive symptomatology. Findings suggest the need to assess HIV-positive women for social isolation and depression and to provide them with interventions such as support groups that capitalize on their existing strengths, including their psychological resourcefulness.

Lithium augmentation of nortriptyline for subjects resistant to multiple antidepressants.

Lithium augmentation, the most studied augmentation strategy for depression, has not been evaluated in patients with a history of non-response to multiple antidepressants. The objective of this study was to assess the efficacy of lithium augmentation for patients with a history of treatment resistant depression who also failed a prospective trial of nortriptyline. We enrolled 92 subjects with treatment resistant depression. Treatment resistance was defined by at least one, but no more than five, adequate trials of antidepressants during the current episode. Subjects were treated with nortriptyline (NT) for 6 weeks. Those subjects who tolerated NT for 6 weeks and whose depression did not respond (n=35) were randomized to receive either lithium (n=18) or placebo (N=17) augmentation of nortriptyline for an additional 6 weeks. Response was defined as an equal to or greater than 50% decrease in HAM-D-17 scores. After 6 weeks of double-blind augmentation, 12.5 % of subjects responded to lithium and 20.0% to placebo. Our results revealed no significant difference between lithium and placebo augmentation. While lithium augmentation seems to be useful in depression refractory to a single medication in some studies, our data suggest limited usefulness of this option for patients refractory to multiple treatments. More definitive data await the outcome of the NIMH Sequential Treatment Alternatives to Relieve Depression (STAR*D) study.

Treatment-related adverse events and outcome in a clinical trial of fluoxetine for major depressive disorder.

Treatment-related adverse events (TRAEs), particularly those that occur early on, may increase the likelihood for premature discontinuation of antidepressants. The purpose of this study was to examine the relationship between TRAEs and outcome in depressed outpatients enrolled in an 8-week, 20 mg, open trial of fluoxetine. A total of 384 patients (54.7% women, mean age 39.9 +/- 10.5 years) were enrolled in the trial. Study visits occurred at baseline and every other week. Somatic complaints were assessed during each study visit. Somatic complaints that, in the opinion of the evaluating physician, were probably related or related to treatment with fluoxetine were entered in the analysis as TRAEs. We then tested whether 1) developing at least one TRAE, 2) developing at least one moderate or severe TRAE, 3) the number of TRAEs reported during the entire trial, or 4) the number of TRAEs reported during each 2-week interval predicted whether patients would respond to fluoxetine, or prematurely discontinue treatment. None of the above scores predicted whether patients responded to or prematurely discontinued the trial. These findings failed to reveal any relationship between side effects and treatment outcome for patients with MDD enrolled in an 8-week, 20 mg, fixed dose, open trial of fluoxetine.