Feasibility and Acceptability of Using Ecological Momentary Assessment to Evaluate Alcohol Use with American Indian Women.

BACKGROUND: Ecological momentary assessments (EMA) are one way to collect timely and accurate alcohol use data, as they involve signaling participants via cell phones to report on daily behaviors in real-time and in a participant's natural environment. EMA has never been used with American Indian populations to evaluate alcohol consumption. The purpose of this project was to determine the feasibility and acceptability of EMA for American Indian women. METHODS: Eligible participants were American Indian women between the ages of 18 and 44 who were not pregnant and had consumed more than one drink within the past month. All participants received a TracFone and weekly automated messages. Self-reported measures of daily quantity and frequency of alcohol consumption, alcohol type, and context were assessed once per week for four weeks. Baseline measurements also included the Drinking Motives Questionnaire-Revised (DMQ-R) and the Interpersonal Support Evaluation List (ISEL). RESULTS: Fifteen participants were enrolled in the study. All but one participant completed all data collection time points, and drinking patterns were consistent across the study period. A total of 420 records were completed across 86 drinking days and 334 non-drinking days. Participants reported drinking an average of 5.7 days over the 30-day period and typically consumed 3.99 drinks per drinking occasion. Sixty-six percent of participants met gender-specific cut-points for heavy episodic drinking, with an average of 2.46 binge drinking occasions across the four week study period. CONCLUSIONS: This proof-of-concept project showed that EMA was both feasible and acceptable for collecting alcohol data from American Indian women. Additional studies are necessary to fully implement EMA with American Indian women to better understand the drinking motives, contexts, patterns, and risk factors in this population.

Stress System Response and Decision Making in Heavy Episodic Users of Alcohol and Online Video Games.

Objective: Few empirical studies have addressed stress system response and subsequent decision making in problematic online video game players who also consume alcohol. Method: Participants were randomly assigned to either receive a psychosocial stressor, including evaluated public speaking and mental arithmetic, or control condition. Salivary cortisol, cardiovascular and subjective responses were collected. Following, decision making was assessed using the Iowa Gambling Task. Results: In this sample of moderate internet gamers (N = 71; 45 male, 16.9% meeting suggested DSM-5 criteria for internet gaming disorder), 53.52% met gender-specific cut-points for heavy episodic drinking. Overall, participants in the TSST condition demonstrated elevated systolic and diastolic blood pressure, self-reported anxiety, and negative affect (ps < .05). However, response to the TSST was varied, particularly in individuals reporting binge internet gaming (6 h or more consecutive use in the last 30 d) who did not display the expected decline in positive affect in response to the TSST (p = .02). Differences in greater advantageous decision making between heavy episodic internet gaming participants in the stress condition, versus those reading a travel magazine, were also noted. These differences were not significant in participants reporting an absence of heavy episodic gaming behavior. Conclusions: These findings support the continued study of individuals who engage in problematic internet gaming behavior, particularly those who engage in heavy episodic use of alcohol.

Web-Based Alcohol Intervention in First-Year College Students: Efficacy of Full-Program Administration Prior to Second Semester.

BACKGROUND: Commercially available, web-based interventions for the prevention of alcohol use are being adopted for universal use with first-year college students, yet few have received empirical evaluation. OBJECTIVES: This randomized controlled trial investigated the effectiveness of a novel, commercially available, personalized web-based alcohol intervention, Alcohol-Wise (version 4.0, 3rd Millennium Classrooms), on multiple measures of alcohol consumption, alcohol consequences, alcohol expectancies, academic achievement, and adaptation to college in first-year students. METHOD: Participants received Alcohol-Wise either prior to first semester or were waitlisted and received the intervention second semester. As longitudinal effectiveness was of interest, follow-up surveys were conducted 10 weeks (n = 76) and 24 weeks (n = 64) following the web-based alcohol intervention. RESULTS: Completion of Alcohol-Wise had effects on academic achievement. Specifically, at the 24 week follow-up, academic achievement was higher in participants who received the intervention first semester of their freshman year as compared to the waitlist control. The incremental rise in heavy episodic drinking during the first semester of college was also reduced in waitlisted participants by Alcohol-Wise administration prior to second semester. Conclusion/Importance: Implications for the timing of web-based alcohol interventions to include administration prior to both first and second semesters of the freshman year are discussed.

Neurophysiological correlates of moderate alcohol consumption in older and younger social drinkers.

BACKGROUND: Nearly 40% of adults aged 65 and older in the United States consume alcohol. Research in older adults has largely examined potential health effects of a moderate drinking lifestyle. Examination of acute effects in this population is generally lacking. To investigate alcohol-induced alteration of electrophysiological correlates of attention in this population, we employed a covert attentional task. We hypothesized that moderate alcohol administration as well as older age would reduce P3 amplitude and increase latency. We anticipated an interaction such that, relative to their age-matched controls, older adults receiving alcohol would be more affected than their younger counterparts. METHODS: Participants included healthy older (aged 50 to 67; n = 20; 9 men) and younger (aged 25 to 35; n = 12; 5 men) moderate drinkers. Participants received either a moderate dose of alcohol (breath alcohol concentration ~50 mg/dl) or a placebo beverage. Following absorption, the task was administered and neurophysiological measures were obtained. P3 amplitude and latency were separately subjected to ANOVA across cue conditions using age and dose as independent variables. RESULTS: As predicted, P3 amplitude in older adults was significantly lower than in younger adults across cue conditions. An age by alcohol interaction was detected, revealing that older adults receiving alcohol showed lower P3 amplitudes than any other group. An age effect for P3 latency was found, with older adults having longer latencies than their younger counterparts. A significant age by alcohol interaction for P3 latency was detected, revealing that older adults receiving alcohol displayed delayed P3 latencies relative to older adults receiving placebo. In contrast, younger adults receiving alcohol had reduced latency compared to those receiving placebo, although this effect did not reach significance. CONCLUSIONS: Results suggest that older adults demonstrated alcohol-related shifts in P3 characteristics during an intentional attention task, whereas younger adults failed to demonstrate this pattern.

Differential effects of moderate alcohol consumption on performance among older and younger adults.

BACKGROUND: Studies exploring differential effects of acute alcohol consumption on younger and older adults are lacking within the field of alcohol research, especially those using moderate doses. Previous studies addressing this question have tended to use complex behavioral tasks too broad to isolate specific neurocognitive processes affected by both alcohol and aging. Compromises in cognitive efficiency (i.e., the ability to respond both quickly and accurately) have previously been identified in both elderly and acutely intoxicated individuals. METHODS: The present study employed a visual-spatial, 2-choice reaction time (RT) task to evaluate the interactive effects of aging and alcohol on cognitive efficiency. Our primary outcome measure was an efficiency ratio derived from each participant's response accuracy (ACC) and mean RT (%correct/RT). Younger (25 to 35; n = 22) and older (55 to 74; n = 37) participants were randomly assigned to receive either a placebo or moderate alcohol dose intended to produce a peak breath alcohol concentration of 0.04%. Participants performed the task at peak alcohol levels. RESULTS: A significant interaction between age group and dose assignment was observed, F(3, 55) = 4.86, p = 0.03, for the efficiency ratio. Younger participants who received alcohol performed significantly better than did their older counterparts regardless of alcohol condition and despite no differences in performance between the 2 age groups in the placebo condition. Additional correlation analyses between ACC and RT suggested that moderately intoxicated older adults become more accurate as response times increase. This relationship was not observed in older adults in the placebo condition. CONCLUSIONS: These data suggest that healthy individuals exhibit a differential susceptibility to the effects of alcohol depending on their age. Unfortunately, because of the presumed safety of moderate alcohol doses and a lack of studies investigating the interactive effects of acute alcohol consumption and aging, most individuals are unlikely to be aware of this relationship between alcohol consumption and age.

Contrasting behavioral effects of acute nicotine and chronic smoking in detoxified alcoholics.

BACKGROUND: Current literature suggests that acute nicotine administration provides a compensatory mechanism by which alcoholics might alleviate attentional deficits. In contrast, chronic smoking is increasingly recognized as negatively affecting neurobehavioral integrity. These opposing effects have not been simultaneously examined. Thus, we sought to a) extend previous work by exploring the effects of acute nicotine effects on vigilance components of attention and replicate previous findings suggesting that treatment-seeking alcoholics experience benefit to a greater extent than do other groups; and b) to examine the impact of chronic smoking on these tasks and across subgroups. METHODS: Substance abusing participants (N=86) were recruited and subgrouped on the basis of dependency criteria as either alcoholics, alcoholics with co-morbid stimulant dependence, or stimulant dependent individuals. Groups of cigarette-smoking (N=17) and non-smoking (N=22) community controls were recruited as comparison groups. Smoking subjects were assigned a placebo, low, or high dose nicotine patch in a double-blind placebo controlled fashion. Non-smoking controls were administered either a placebo or low dose. Testing occurred after dose stabilization. RESULTS: General linear models indicated greater sensitivity to acute nicotine administration among alcoholics than other groups when controlling for the effect of intensity of smoking history, as reflected by pack-years. Pack-years correlated negatively with performance measures in alcoholics but not stimulant abusing subgroups or smoking controls. Finally, regression analyses demonstrated that pack-years predicted poorer performance only for the alcoholic subgroup. CONCLUSIONS: These results support previous work finding a compensatory effect of acute nicotine administration on attentional performance in alcoholics and reinforce the consideration of recent nicotine use as a confound in neurocognitive studies of alcoholics. Of particular interest is the finding that smoking history as reflected in pack-years predicted poorer performance, but only among alcoholics. Further systematic study of these opposing effects among alcoholics and other groups using a broader array of tasks is needed.

Nicotine effects on immediate and delayed verbal memory after substance use detoxification.

Decrements in verbal memory are commonly reported by detoxified treatment-seeking individuals. Although acute nicotine has been shown to improve attentional performance, its effects on verbal memory in substance abusers have not been addressed. Treatment-seeking alcohol-dependent (ALCs, n = 29; 14 male), illicit-stimulant-dependent (predominantly cocaine; STIMs, n = 25; 15 male), and alcohol- and illicit-stimulant-dependent (ALC/STIMs, n = 50; 35 male) participants with comorbid nicotine dependence were studied. Subjects had been abstinent from their drugs of choice for 41 (±18) days and were in short-term abstinence from tobacco (∼8-10 hours). Subjects received double-blind administration of either transdermal nicotine (high dose: 21/14 mg for men and women, respectively, or low dose: 7 mg) or placebo. The Logical Memory (LM) subtest from the Wechsler Memory Scale-Revised (WMS-R) was used to assess immediate and delayed verbal memory recall. Results indicated that STIMs receiving the high dose of nicotine recalled more words at immediate recall than STIMs who received placebo. Trend level differences were also noted at delayed recall between STIM nicotine and placebo doses. Nicotine failed to impact either recall in alcoholic subgroups. Although not the primary focus, results also revealed differences in the forgetting rates between the groups with the ALC/STIMs demonstrating the steepest forgetting slope. In summary, this study suggests that nicotine effects may be differentially experienced by substance-using subgroups; that nicotine may have a direct effect on memory; and that in considering neurocognitive processes (e.g., encoding vs. retrieval), underlying endpoint indicators (e.g., correct recall) may be critical in predicting outcomes.

Nicotine as a factor in stress responsiveness among detoxified alcoholics.

AIMS: The effect of transdermal nicotine on stress reactivity was investigated in currently smoking, detoxified, substance-dependent individuals (65% alcohol dependent, n = 51; 31 male) following a psychosocial stressor. METHODS: Using a randomized, double-blind, placebo-controlled design, subjects were assigned to receive either active transdermal nicotine (low or high dose) or placebo. Six hours following nicotine administration, subjects performed a laboratory psychosocial stressor consisting of two 4-min public-speaking sessions. RESULTS: Consistent with prior reports, substance-dependent individuals displayed a blunted stress response. However, a review of the cortisol distribution data encouraged additional analyses. Notably, a significant minority of the substance-dependent individuals (33%) demonstrated elevated poststress cortisol levels. This group of responders was more likely to be alcohol dependent and to have received the high dose of nicotine [χ2(2) = 32, P < 0.0001], [χ2(2) = 18.66, P < 0.0001]. Differences in salivary cortisol responses between responders and nonresponders could not be accounted for by the length of sobriety, nicotine withdrawal levels, anxiety or depressive symptomatology at the time of the psychosocial stressor. CONCLUSION: These results suggest that nicotine administration may support a normalization of the salivary cortisol response following psychosocial stress in subgroups of substance-dependent individuals, particularly those who are alcohol dependent. Given the association between blunted cortisol levels and relapse, and the complex actions of nicotine at central and peripheral sites, these findings support the systematic study of factors including nicotine, which may influence stress reactivity and the recovery process in alcohol-dependent individuals.

Acute alcohol administration and placebo effectiveness in older moderate drinkers: influences on cognitive performance.

OBJECTIVE: Placebo effectiveness and subsequent influence on cognitive performance were investigated in older moderate drinkers (ages 50-69; N = 30; 15 men) following acute alcohol administration. METHOD: Double-blind, placebo-controlled alcohol administration techniques were designed to produce peak breath alcohol concentration levels consistent with an episode of social drinking (approximately 40 mg/100 ml). Cognitive performance, measured via a covert attentional processing task, was assessed. Participants were also asked to rate their perceived levels of intoxication and impairment. RESULTS: The placebo beverage was effective in older moderate drinkers, with 63% of participants who received placebo reporting that they received alcohol. Placebo beverage effectiveness influenced cognitive performance. Participants who received placebo, but reported they received alcohol, demonstrated slower reaction times on the covert attentional processing task, similar to those receiving alcohol. Placebo effects did not influence accuracy on the covert attentional processing task or self-reported measures of intoxication and impairment. As expected, participants who received alcohol had less accuracy on the covert attentional processing task and more self-reported impairment and intoxication than those who received placebo, regardless of placebo effectiveness. CONCLUSIONS: These results suggest that belief of having received a moderate dose of alcohol has an effect on reaction time similar to that of its pharmacological effect in older moderate drinkers. Although placebo effects are not novel, these findings suggest that cognitive processes are differentially affected. The study of moderate doses and more complex real-world tasks is an important next step.

Effects of acute alcohol consumption in older and younger adults: perceived impairment versus psychomotor performance.

OBJECTIVE: Perceived impairment and psychomotor performance following acute alcohol administration in older (ages 50-74, n=42; 22 male) and younger (ages 25-35, n=26; 12 male) adults were investigated in this study. METHOD: Double-blind, placebo-controlled alcohol administration techniques were designed to produce peak levels of breath alcohol concentration consistent with an episode of social drinking (40 mg/100 ml). Behavioral measures (Trail Making Test, Forms A and B), as well as measures of self-reported perceived intoxication and impairment, were administered on the ascending and descending limbs at common time points after beverage ingestion. RESULTS: Results indicated that psychomotor performance differences did not parallel self-reported levels of perceived impairment. Relative to younger adults, older adults exhibited performance deficits on the ascending limb while simultaneously reporting less perceived impairment. Conversely, on the descending limb, older adults who received alcohol reported more perceived impairment than did those who received placebo, although psychomotor performance between these two groups of older drinkers did not differ. For younger participants, a moderate dose of alcohol facilitated performance on the ascending limb; however, these differences were not reflected on the descending limb. CONCLUSIONS: These results reinforce the common knowledge that self-reported measures may not provide an accurate reflection of performance outcomes and, importantly, that older adults may be impaired even under a moderate dose of alcohol, although they may not be aware (i.e., report) of this impairment.

The role of selected factors in the development and consequences of alcohol dependence.

Gender, family history, comorbid psychiatric and substance use disorders, and age all influence a person's risk for alcoholism. In addition, these factors interact with alcoholism to influence neurocognitive functioning following detoxification. This article examines these factors and considers how they interact with each other. This complexity reinforces the need for both animal and human studies and suggests multiple factors that may be sensitive to differential prevention, intervention, and treatment efforts. Thus, it is imperative that hypothesis-driven research designs be directed to identifying the relative potency of these factors and their interactions.

Neonatal ethanol and nicotine exposure causes locomotor activity changes in preweanling animals.

Sprague-Dawley rats were used to investigate the effects of neonatal ethanol (ETOH) and nicotine (NIC) exposure on activity levels in preweanling offspring. Male and female pups received daily oral intubations of ethanol ((ETOH) 5 g/kg/day), nicotine ((NIC) 12 mg/kg/day), ethanol and nicotine ((ETOH+NIC) 5 g/kg/day+12 mg/kg/day) or isocaloric maltose (control) on either postnatal days (PND) 1-7 or PND 8-14. A non-treated control group was also included. Peak blood ethanol concentrations (BECs) measured in a separate subset of animals ranged from 167 and 344 mg/dl depending upon neonatal treatment and period of exposure. Subjects were tested in an open field apparatus on PND 19-21. Animals exposed to ETOH or ETOH+NIC on PND 1-7 were hyperactive relative to the other treatment groups. In contrast, animals exposed to NIC or ETOH+NIC during PND 8-14 were hypoactive relative to other treatment groups. Males appeared more sensitive than females on measures of anxiety (distance traveled in the center of the open field) but this also varied dependent on neonatal treatment and period of exposure. These findings suggest that the third trimester is a critical period for ETOH and NIC effects on offspring activity although the pattern of effects on activity are different depending on when drug exposure occurred during the neonatal period.

Neonatal ethanol exposure but not neonatal cocaine selectively reduces specific isolation-induced vocalization waveforms in rats.

This study was designed to examine the interaction of neonatal ethanol and cocaine exposure on isolation induced ultrasonic vocalizations using an oral gavage method of drug administration. There were 5 neonatal treatment groups including 3.0 g/kg ethanol, 20 mg/kg cocaine, both 3.0 g/kg ethanol and 20 mg/kg cocaine, an intubated control and a nonintubated control. Drug was administered twice daily from postnatal days (PND) 4 - 10. On PND 14, subjects were tested for a 6 min test to assess the rate and type of ultrasonic vocalizations displayed. As previously reported using an intragastric "artificial rearing" administration procedure, pups exposed to ethanol displayed reductions in the number of ultrasonic vocalizations across the test session. Pups exposed to both drugs showed similar deficits to those pups receiving ethanol alone. In contrast, cocaine had no effect on this outcome measure. Sonographic analysis of the vocalizations revealed that ethanol's effects appeared to be selective to certain waveforms rather than a general reduction across all wave types and again, cocaine had no impact on the proportion of the various wave types. These findings provide further support that neonatal ethanol exposure can have significant effects on maternal/infant communication and may play a role in many of the long-term effects associated with ethanol exposure during development.