A randomized pilot trial of a mobile delivered brief motivational interviewing and behavioral economic alcohol intervention for emerging adults.

OBJECTIVE: Mobile health (mHealth) interventions show potential to broaden the reach of efficacious alcohol brief motivational interventions (BMIs). However, efficacy is mixed and may be limited by low participant attention and engagement. The present study examined the feasibility, acceptability, and preliminary efficacy of a live text-message delivered BMI in a pilot randomized clinical trial. METHOD: Participants were 66 college students (63.6% women; 61.9% White; Mage = 19.95, SD = 1.66) reporting an average of 11.88 (SD = 8.74) drinks per week, 4.42 (SD = 3.59) heavy drinking episodes (HDEs), and 8.44 (SD = 5.62) alcohol-related problems in the past month. Participants were randomized to receive either (a) education or (b) an alcohol BMI plus behavioral economic substance-free activity session (SFAS), each followed by 4 weeks of mini sessions. All sessions were administered via live text-message. Participants completed assessments postintervention (after the 4th mini session) and at 3-month follow-up. RESULTS: 90.9% completed both initial full-length sessions and at least two of the four mini sessions with 87.9% retention at 3-month follow-up. Participants found the interventions useful, interesting, relevant, and effective, with no between-group differences. There were no statistically significant group differences in drinks per week or alcohol-related problems at follow-up, but BMI + SFAS participants reported fewer past-month HDEs than those who received education. CONCLUSIONS: Live text-messaging to deliver the BMI + SFAS is feasible and well-received. The preliminary efficacy results should be interpreted cautiously due to the small sample size but support further investigation. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The Utility of Assessing Alexithymia, in Addition to Coping, in the Context of Posttraumatic Stress.

ABSTRACT: The distinction between alexithymia and coping in relation to posttraumatic stress has not been fully explored. The present study examined the extent to which alexithymia explained unique variance in posttraumatic stress, beyond the variance explained by coping, in a sample of trauma-exposed adults ( N = 706; M age = 19.41 years, SD = 1.5; 77.1% female). Then, we explored the effect of race on these associations, comparing participants who identified as Black ( n = 275) to those who identified as White ( n = 337). Avoidant-emotional coping showed stronger correlations (compared with problem-focused and active-emotional coping) with total alexithymia, difficulty identifying feelings, and difficulty describing feelings. In regression analyses, we found alexithymia explained unique variance in posttraumatic stress severity beyond the effect of coping. Results did not differ by racial identity. These findings suggest that despite some overlap between alexithymia and coping, each shows unique relations with posttraumatic stress.

Open trial of a personalized feedback intervention and substance-free activity supplement for veterans with PTSD and hazardous drinking.

This study reports findings from an open trial of a two-session intervention for veterans with symptoms of PTSD and hazardous drinking. Rooted in behavioral economic theory, this intervention aimed to decrease alcohol use and increase alcohol-free activities through personalized and normative feedback. This trial assessed the feasibility and acceptability of the intervention in a sample of 15 veterans. Participants completed assessments at baseline and post-intervention (1-month and 3-months). Thirteen participants (86.6%) were retained between the baseline assessment and second intervention session. Acceptability data indicated that veterans overwhelmingly viewed the intervention positively with little dropout between the two sessions. Further, participants in our study reduced alcohol consumption from 37.30 (SD = 17.30) drinks per week at baseline to 22.50 (SD = 27.75) drinks per week at the 1-month assessment and then to 14.60 (SD = 18.64) at the 3-months assessment, representing medium to large effects. PTSD severity also decreased from 57.20 (SD = 16.72) at baseline to 48.90 (SD = 18.99) at the 1-month assessment, representing a small effect. Though effect sizes from pilot trials should be interpreted with caution, findings suggest that this intervention was well-received, feasible to deliver, and may have resulted in improvements in intervention targets.

Wanting, Liking, and Missing Out: Exploring the Role of Reward Functioning in the Overlap Between PTSD and Depression.

ABSTRACT: Diminished reward functioning (anhedonia) is an aspect of multiple psychiatric diagnoses and is a critical component of depression, yet it has rarely been examined in the context of posttraumatic stress disorder (PTSD). Deficits in reward function may be a transdiagnostic factor contributing to the high rate of comorbidity between PTSD and depression. The present study examined the commonality and distinction between PTSD and depression and their relationship to reward functioning using a bifactor model in a sample of 106 trauma-exposed undergraduates. Results indicated a strong commonality factor between PTSD and depression. Of three indices of reward functioning (i.e., hedonic pleasure, reward motivation, and environmental reward availability), environmental reward availability alone was related to unique latent factors for PTSD and depression, and their commonality. Findings suggest that environmental context may be the key to understanding the role of reward in PTSD, depression, and psychopathology broadly.

Posttraumatic stress disorder, drinking to cope, and harmful alcohol use: A multivariate meta-analysis of the self-medication hypothesis.

The association between posttraumatic stress disorder (PTSD) and harmful alcohol use has often been explained through the self-medication hypothesis via coping-related drinking motives. However, the magnitude of the indirect effect of PTSD on harmful alcohol use through coping motives is unclear. This study aggregated this indirect effect using a meta-analytic structural equation modeling approach and explored moderators that influenced the indirect effect. We identified articles from PsycINFO, PubMed/MEDLINE, and PROQUEST (through June 22, 2021) containing measures of (a) PTSD symptoms, (b) coping-related drinking, and (c) harmful alcohol use. Thirty-four studies yielding 69 effect sizes were included (mean N = 387.26 participants; median N = 303.5; range = 42-1,896; aggregate sample n = 15,128). Coping motives mediated the relation between PTSD and harmful alcohol use, accounting for 80% of the variance in the total effect. Moderating variables and evidence of publication bias were also found. Findings suggest that coping-related drinking is a strong mediator in the relation between PTSD and harmful alcohol use and that the strength of the indirect effect is meaningfully influenced by measurement approach, sample characteristics, and study design. Additional longitudinal and multivariate studies are needed to establish directionality and account for additional variance. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The associations between posttraumatic stress disorder and delay discounting, future orientation, and reward availability: A behavioral economic model.

The theoretical framework of behavioral economics, a metatheory that integrates operant learning and economic theory, has only recently been applied to posttraumatic stress disorder (PTSD). A behavioral economic theory of PTSD reflects an expansion of prior behavioral conceptualization of PTSD, which described PTSD in terms of respondent and operant conditioning. In the behavioral economic framework of PTSD, negatively reinforced avoidance behavior is overvalued, in part due to deficits in environmental reward, and may be conceptualized as a form of reinforcer pathology (i.e., excessive preference for and valuation of an immediate reinforcer). We investigated cross-sectional relationships between PTSD severity and several constructs rooted in this behavioral economic framework, including future orientation, reward availability, and delay discounting in a sample of 110 military personnel/veterans (87.2% male) who had served combat deployments following September 11, 2001. Total PTSD severity was inversely related to environmental reward availability, ß = -.49, ΔR2 = 0.24, p < .001; hedonic reward availability, ß = -.32, ΔR2 = 0.10, p = .001; and future orientation, ß = -.20, ΔR2 = 0.04, p = .032, but not delay discounting, r = -.05, p = .633. An examination of individual symptom clusters did not suggest that avoidance symptoms were uniquely associated with these behavioral economic constructs. The findings offer support for a behavioral economic model of PTSD in which there is a lack of positive reinforcement as well as a myopic focus on the present.

Alcohol use and coping in a cross-sectional study of African American homicide survivors.

The loss of a loved one to homicide is associated with considerable distress, often in the form of posttraumatic stress disorder (PTSD) and complicated grief (CG), and alcohol misuse. Yet alcohol-related problems and loss from a homicide are issues that disproportionally affect African Americans. The present study investigated alcohol use in a sample of 54 African American homicide survivors. Although there was a low prevalence of hazardous drinking, alcohol use was associated with higher levels of PTSD, complicated grief, and depression severity. In addition, scores on the Alcohol Use Disorders Identification Test (AUDIT) were correlated with active emotional coping and avoidant emotional coping. In analyses of PTSD symptom clusters, emotional numbing and hyperarousal symptoms were significantly correlated with AUDIT total score.

What's the Harm in Getting High? Evaluating Associations Between Marijuana and Harm as Predictors of Concurrent and Prospective Marijuana Use and Misuse.

OBJECTIVE: Substantial research has demonstrated the importance of implicit cognitive processes underlying substance use. However, there is a scarcity of research on implicit processes related to marijuana use. We adapted and tested the predictive validity (concurrent and prospective) of an implicit measure evaluating the strength of associations between marijuana and harm based on research demonstrating less marijuana use among individuals who report stronger explicit attitudes of marijuana's harms. METHOD: A community sample of 187 U.S. young adults living in a state with legal recreational marijuana use completed an Implicit Association Test (IAT) evaluating marijuana-harm associations and measures of marijuana use and risk of cannabis use disorder (CUD) over time. RESULTS: The marijuana-harm IAT had good internal consistency, and scores did not vary as a function of biological sex, legal age status for recreational marijuana use, or college student status. Scores did vary as a function of lifetime and recent use such that lifetime and current abstainers had stronger marijuana-harm associations. Zero-inflated negative binomial regression models demonstrated that marijuana-harm IAT scores significantly predicted concurrent risk of CUD and use such that stronger marijuana-harm associations were associated with less use and risk of CUD. Results evaluating outcomes longitudinally found limited support for IAT scores predicting increases in use over time and no support for predicting changes in risk of CUD over time. CONCLUSIONS: Findings provide preliminary evidence that stronger marijuana-harm associations may act as a protective factor against marijuana use and risk of CUD.

Self-control, implicit alcohol associations, and the (lack of) prediction of consumption in an alcohol taste test with college student heavy episodic drinkers.

The high levels of problematic drinking in college students make clear the need for improvement in the prediction of problematic drinking. We conducted a laboratory-based experiment that investigated whether implicit measures of alcohol-related associations, self-control, and their interaction predicted drinking. Although a few studies have evaluated self-control as a moderator of the relationship between implicit measures of alcohol-related associations and drinking, this study extended that work by using a previously-validated manipulation that included a more (vs. less) cognitively demanding task and incentive to restrain drinking and by evaluating multiple validated measures of alcohol-related associations. Experimental condition was expected to moderate the relationship between implicit measures of alcohol-related associations and drinking, with a more positive relationship between alcohol-related associations and drinking among participants who completed the more (vs. less) cognitive demanding task. Secondary aims were to evaluate how individual differences in control factors (implicit theories about willpower and working memory capacity) might further moderate those relationships. One hundred and five U.S. undergraduate heavy episodic drinkers completed baseline measures of: drinking patterns, three Implicit Association Tests (evaluating drinking identity, alcohol excite, alcohol approach associations) and their explicit measure counterparts, implicit theories about willpower, and working memory capacity. Participants were randomized to complete a task that was more (vs. less) cognitively demanding and were given an incentive to restrain their drinking. They then completed an alcohol taste test. Results were not consistent with expectations. Despite using a previously validated manipulation, there was no evidence that one condition was more demanding than the other, and none of the predicted interactions reached statistical significance. The findings raise questions about the relation between self-control, implicit measures of alcohol-related associations, and drinking, as well as the conditions under which implicit measures of alcohol-related associations predict alcohol consumption in the laboratory.

Hazardous drinking has unique relationships with implicit and explicit drinking identity.

Measures of drinking identity are predictive of hazardous drinking. The extent to which hazardous drinking is differentially related to implicit compared to explicit drinking identity is not well understood. Neurocognitive models of addiction indicate that chronic alcohol use is associated with deficits in self-awareness which could limit the growth or recognition of drinking identity for individuals engaging in hazardous drinking. This might be particularly true for more reflective explicit measures of identity because their assessment and underlying cognitive processes rely more on self-awareness and conscious introspection. We predicted there would be different patterns of relationships between hazardous drinking and implicit/explicit drinking identity measures. A linear model was predicted to better fit the hazardous drinking and implicit identity relationship whereas a non-linear model was predicted to better fit the hazardous drinking and explicit identity relationship due to decreased ability to reflect on changes in identity at high levels of hazardous drinking. The present study is a re-analysis of a large secondary dataset (Project Implicit Mental Health; N = 11,320) which included measures of hazardous drinking (e.g., Alcohol Use Disorder Identification Test) and implicit/explicit identity. Results were consistent with predictions. The relationship between hazardous drinking and implicit drinking identity was best modeled by a linear function whereas the relationship between hazardous drinking and explicit drinking identity was best modeled by a non-linear cubit spline function. These findings are consistent not only with neurocognitive models but also with dual process formulations that implicit and explicit drinking identity are somewhat related but also quite distinct.

Mood selectively moderates the implicit alcohol association-drinking relation in college student heavy episodic drinkers.

Multiple studies indicate that implicit alcohol-related associations (i.e., indices of relatively fast, spontaneous processes) predict drinking. An important next step is to investigate moderators of the implicit association-drinking relationship. Mood state has been proposed as a moderator of this relationship: implicit associations have been theorized to be stronger predictors of drinking under positive mood states. From the same theoretical perspective, explicit measures (indices of relatively slow, reflective processes) have been proposed to be stronger predictors of drinking under negative mood states. The current study evaluated these hypotheses by investigating whether mood state (manipulated via exposure to a brief video clip) moderated the relations between three types of implicit alcohol-related associations (alcohol excite, alcohol approach, and drinking identity), their explicit counterparts, and drinking in a taste test that included beer and soft drinks. A sample of 152 undergraduate social drinkers (81 men; 71 women) completed baseline measures of implicit alcohol-related associations, their explicit counterparts, and typical drinking behaviors. Participants then viewed a mood-state-inducing video clip (positive, neutral, or negative), and completed the taste test. Results were mixed but generally indicated that prediction of drinking by baseline implicit alcohol excite (but not alcohol approach or drinking identity) associations was moderated by mood. Specifically, implicit alcohol excite associations were more negatively associated with drinking after viewing the sad video and more positively associated with drinking after watching the happy/neutral video. Moderation was also observed for the explicit counterpart of alcohol excite. Findings are discussed in terms of models of negative reinforcement drinking. (PsycINFO Database Record

Evaluating Within-Person Change in Implicit Measures of Alcohol Associations: Increases in Alcohol Associations Predict Increases in Drinking Risk and Vice Versa.

AIMS: Implicit measures of alcohol associations (i.e. measures designed to assess associations that are fast/reflexive/impulsive) have received substantial research attention. Alcohol associations related to the self (drinking identity), the effects of alcohol (alcohol excite) and appetitive inclinations (alcohol approach) have been found to predict drinking cross-sectionally and over time. A critical next step in this line of research and the goal of this study is to evaluate whether increases in the strength of these associations predict increases in drinking and vice versa. These hypotheses were tested in a sample of first- and second-year US university students: a sample selected because this time period is associated with initiation and escalation of drinking, peak levels of alcohol consumption and severe alcohol-related negative consequences. SHORT SUMMARY: This study's purpose was to evaluate whether increases in the strength of alcohol associations with the self (drinking identity), excitement (alcohol excite) and approach (alcohol approach) as assessed by implicit measures predicted subsequent increases in drinking risk and vice versa using a longitudinal, university student sample. Results were consistent with hypotheses. METHODS: A sample of 506 students' (57% women) alcohol associations and alcohol consumption were assessed every 3 months over a 2-year period. Participants' consumption was converted to risk categories based on NIAAA's criteria: non-drinkers, low-risk drinkers and high-risk drinkers. A series of cross-lagged panel models tested whether changes in alcohol associations predicted subsequent change in drinking risk (and vice versa). RESULTS: Across all three measures of alcohol associations, increases in the strength of alcohol associations were associated with subsequent increases in drinking risk and vice versa. CONCLUSION: Results from this study indicate bi-directional relationships between increases in alcohol associations (drinking identity, alcohol excite and alcohol approach) and subsequent increases in drinking risk. Intervention and prevention efforts may benefit from targeting these associations.

Implicit and explicit drinking identity predict latent classes that differ on the basis of college students' drinking behaviors.

BACKGROUND: The purpose of this study was to identify distinct classes of college students on the basis of recent and past drinking behaviors and evaluate how implicit and explicit measures of drinking identity predict membership in these classes. METHODS: US undergraduate students (N=456) completed online implicit (Implicit Association Test) and explicit (self-report) measures of drinking identity and assessments of drinking behaviors, including past month drinking, at-risk drinking in the past year, and lifetime history of intoxication. Latent class analysis (LCA) was used to identify classes of college students based on their drinking behaviors. RESULTS: LCA identified five classes: (1) Lifetime Nondrinker, (2) Recent Nondrinker/Past Risk, (3) Light Drinker, (4) Moderate Drinker, and (5) Heavy Drinker. Overall, stronger implicit and explicit drinking identities were uniquely associated with greater odds of belonging to classes with greater alcohol consumption and related consequences relative to those classes characterized by lower alcohol consumption and consequences. Notably, explicit drinking identity was positively associated with odds of membership to the Recent Nondrinker/Past Risk class relative to the Lifetime Nondrinker and Light Drinker classes, and implicit and explicit drinking identities were positively associated with odds of membership to the Heavy Drinker class relative to all other classes. CONCLUSIONS: Findings suggest that drinking identity is sensitive to risky drinking experiences in the past, is especially strong among the highest-risk group of college student drinkers, and may be an important cognitive factor to consider as a target for intervention.

The Role of Context in the Implementation of Trauma-Focused Treatments: Effectiveness Research and Implementation in Higher and Lower Income Settings.

In recent years, the implementation of trauma-focused treatments has expanded across settings that vary widely in the availability of resources, infrastructure, and personnel. The present review aims to inform researchers, policy makers, trainers, and administrators about this diverse range of research. Taking a global health perspective, this review of effectiveness trials and implementation studies compares strategies used in high-income countries to those in low- and medium-income countries. A primary difference between studies in high-income and low- and medium-income countries is the relative emphasis placed on fidelity or adaptation. Adaptations used in low- and medium-income countries might offer useful ideas for increasing the portability, impact, and accessibility of evidence-based interventions in high-income countries.

Resolving an identity crisis: Implicit drinking identity and implicit alcohol identity are related but not the same.

Two variations of the Implicit Association Test (IAT), the Drinking Identity IAT and the Alcohol Identity IAT, assess implicit associations held in memory between one's identity and alcohol-related constructs. Both have been shown to predict numerous drinking outcomes, but these IATs have never been directly compared to one another. The purpose of this study was to compare these IATs and evaluate their incremental predictive validity. US undergraduate students (N=64, 50% female, mean age=21.98years) completed the Drinking Identity IAT, the Alcohol Identity IAT, an explicit measure of drinking identity, as well as measures of typical alcohol consumption and hazardous drinking. When evaluated in separate regression models that controlled for explicit drinking identity, results indicated that the Drinking Identity IAT and the Alcohol Identity IAT were significant, positive predictors of typical alcohol consumption, and that the Drinking Identity IAT, but not the Alcohol Identity IAT, was a significant predictor of hazardous drinking. When evaluated in the same regression models, the Drinking Identity IAT, but not the Alcohol Identity IAT, was significantly associated with typical and hazardous drinking. These results suggest that the Drinking Identity IAT and Alcohol Identity IAT are related but not redundant. Moreover, given that the Drinking Identity IAT, but not the Alcohol Identity IAT, incrementally predicted variance in drinking outcomes, identification with drinking behavior and social groups, as opposed to identification with alcohol itself, may be an especially strong predictor of drinking outcomes.

Not the same old thing: Establishing the unique contribution of drinking identity as a predictor of alcohol consumption and problems over time.

Drinking identity-how much individuals view themselves as drinkers-is a promising cognitive factor that predicts problem drinking. Implicit and explicit measures of drinking identity have been developed (the former assesses more reflexive/automatic cognitive processes; the latter more reflective/controlled cognitive processes): each predicts unique variance in alcohol consumption and problems. However, implicit and explicit identity's utility and uniqueness as predictors relative to cognitive factors important for problem drinking screening and intervention has not been evaluated. Thus, the current study evaluated implicit and explicit drinking identity as predictors of consumption and problems over time. Baseline measures of drinking identity, social norms, alcohol expectancies, and drinking motives were evaluated as predictors of consumption and problems (evaluated every 3 months over 2 academic years) in a sample of 506 students (57% female) in their first or second year of college. Results found that baseline identity measures predicted unique variance in consumption and problems over time. Further, when compared to each set of cognitive factors, the identity measures predicted unique variance in consumption and problems over time. Findings were more robust for explicit versus implicit identity and in models that did not control for baseline drinking. Drinking identity appears to be a unique predictor of problem drinking relative to social norms, alcohol expectancies, and drinking motives. Intervention and theory could benefit from including and considering drinking identity. (PsycINFO Database Record

Evaluating the Relationship between Explicit and Implicit Drinking Identity Centrality and Hazardous Drinking.

INTRODUCTION: Drinking identity strength (how strongly one views oneself as a drinker) is a promising risk factor for hazardous drinking. A critical next step is to investigate whether the centrality of drinking identity (i.e., the relative importance of drinking vs. other identity domains, like well-being, relationships, education) also plays a role. Thus, we developed explicit and implicit measures of drinking identity centrality and evaluated them as predictors of hazardous drinking after controlling for explicit drinking identity strength. METHODS: Two studies were conducted (Ns = 360 and 450, respectively). Participants, who self-identified as full-time students, completed measures of explicit identity strength, explicit and implicit centrality, and the Alcohol Use Disorders Identification Test (AUDIT). Study 1a evaluated two variants of the implicit measure (short- vs. long-format of the Multi-category Implicit Association Test); Study 1b only included the long form and also assessed alcohol consumption. RESULTS: In Study 1a, implicit and explicit centrality measures were positively and significantly associated with AUDIT scores after controlling for explicit drinking identity strength. There were no significant differences in the implicit measure variants, but the long format had slightly higher internal consistency. In Study 1b, results replicated for explicit, but not implicit, centrality. CONCLUSIONS: These studies provide preliminary evidence that drinking identity centrality may be an important factor for predicting hazardous drinking. Future research should improve its measurement and evaluate implicit and explicit centrality in experimental and longitudinal studies.