Abstinence Challenge Research Articles

ABC-Training for Alcohol Use During a Voluntary Abstinence Challenge: A Randomized Controlled Trial

AbstractThe current study aimed to test the effectiveness of ABC-training in influencing drinking behaviors during voluntary abstinence challenges, compared with Approach Bias Modification (ApBM) and sham-ApBM. We conducted two randomized controlled trial studies with three between-subject conditions: ABC-training, conventional ApBM, and sham-ApBM. Assessments were conducted at baseline, midtest, and posttest and at 2-week, 3-month, and 6-month follow-ups. Participants were Dutch drinkers enrolled in the online abstinence challenge “IkPas” (Study 1: N = 261, mage = 57.47, SD = 10.01; Study 2: N = 319, mage = 55.65, SD = 10.81). Pre-registered outcomes included number of days abstinent and number of binge drinking days during the challenge and alcohol consumption at follow-ups. We found no significant difference in pre-registered outcomes between conditions. However, exploratory analysis revealed a higher success rate in abstinence during the challenge for participants who received ABC-training in both studies. Although ABC-training did not demonstrate significant effectiveness in changing pre-registered drinking behaviors compared with controls, exploratory findings suggest it enhanced success rates of abstinence during the challenge. Further research is needed to explore the generalizability of these results to broader populations, including clinical samples as well as people wanting to quit other addictions (e.g., smoking).

Evaluating a 30-day alcohol abstinence challenge in heavy-drinking individuals with and without chronic pain: feasibility, safety, and perceived benefits

IntroductionTo combat high-risk alcohol consumption, we introduced a 30-day alcohol abstinence challenge targeted at heavy drinkers with and without chronic pain. Our study aimed to assess the challenge's feasibility and safety and to explore its perceived benefits. Our exploratory aim was to identify participants' coping strategies during the challenge. MethodsOur single-arm study recruited heavy drinkers from a pain clinic and a university setting (n = 34, 64.7% chronic pain). Participants underwent a modified community-based 30-day challenge, which included motivational interviewing, an individualized start date, and weekly phone check-ins. ResultsWe found the 30-day challenge was feasible and safe; 72.3% of eligible heavy drinkers participated in the challenge with no serious adverse events. Most challengers (94.1%) reported some benefit from the challenge, which included improvements in alcohol withdrawal symptoms, sleep, and alcohol abstinence self-efficacy, but not in pain. We identified 25 perceived benefits and 21 coping strategies. ConclusionOur study confirms that a 30-day alcohol abstinence challenge is a feasible and safe intervention for heavy drinkers with and without chronic pain, yielding notable health benefits. The challenge also facilitated the development of effective coping strategies. Future studies should explore the long-term benefits of such interventions in broader outpatient settings.

An empirically based typology of temporary alcohol abstinence challenge participants using latent class analysis.

Identifying subgroups of Temporary (alcohol) Abstinence Challenge (TAC) participants may offer opportunities to enhance intervention effectiveness. However, knowledge about such subgroups is missing. This study aimed to (i) describe a TAC population; (ii) identify subgroups of participants based on determinants of changes in drinking behaviour; and (iii) characterise subgroups in terms of sociodemographic and other characteristics. Data from 3803 Dutch TAC participants were analysed to identify subgroups using three-step Latent Class Analysis. Classes were based on determinants of changes in drinking behaviour (i.e., drinking refusal self-efficacy, craving and behavioural automaticity) and were characterised by sociodemographic characteristics, drinking behaviour, previous participation in TACs, self-reported health and life satisfaction. The majority of TAC participants were female, highly educated, employed, 53 years old on average, participated in previous TACs and reported relatively high alcohol use. Four classes of participants were identified: (i) 'ordinary drinkers' (49.0%); (ii) 'drinkers in control' (21.4%); (iii) 'habitual drinkers with perceived control to refuse' (18.4%); and (iv) 'drinkers not in control' (11.2%). Class 2 drank least often and non-excessive volumes, while other classes typically drank 4 or more days per week and 3 to 4 glasses per drinking day, with the highest alcohol use found in class 4. Different configurations of determinants in this study's four subgroups may require different intervention approaches and might inform personalised support. Future research is needed to examine the predictive value of these subgroups on post-challenge drinking behaviour to assess support needs and participation value.

Effectiveness of a self-help guide during a temporary alcohol abstinence challenge: a randomized controlled trial.

The popularity of temporary abstinence challenges (TACs) concerning alcohol consumption is increasing. Support is found to be essential for participants to help them get through a challenge. This study aimed to evaluate the additional effect of a self-help guide, based on health behaviour theories and behaviour change techniques, on (i) successful completion of a TAC and (ii) changes in drinking refusal self-efficacy (DRSE), behavioural automaticity, craving, and alcohol consumption. A randomized controlled trial was performed (OSF registries: OSF.IO/B95VU). NoThanks participants received a questionnaire before the TAC (T0) and 8months after the TAC (T1). Out of a subgroup of 1308 respondents who were interested in additional support, 652 were randomly assigned to receive the guide (experimental group), and 656 did not receive any additional support (control group). Logistic regressions and (generalized) linear mixed model analyses were used. After 8months, all participants showed a significant decrease in behavioural automaticity, craving, and alcohol consumption, irrespective of group assignment. No significant changes were observed in the DRSE. This degree of change over time in behavioural automaticity, craving, and alcohol consumption did not differ between the experimental and control group. Sensitivity analyses with participants in the experimental group, who differed in exposure to the guide, did not show differences either. The self-help guide, and how it was designed, added no value to the TAC. Future research should focus on more bottom-up, customized support and explore what (different subgroups of) participants think they need as extra support during a TAC.

Sober Curiosity and Participation in Temporary Alcohol Abstinence Challenges in a Cohort of U.S. Emerging Adults.

Thus far, behavioral health research in the United States has not explored the prevalence or correlates of sober curiosity (SC; exploratory or experimental abstinence or moderation) or temporary alcohol abstinence challenges (TAACs; e.g., "Dry January"), despite significant attention in media and popular discourse. We explored these activities in a sample of U.S. emerging adults (e.g., ages 18-29), a population with higher-risk drinking behavior yet some of the lowest rates of treatment engagement for alcohol use problems. Survey data were collected in 2021-2022 among participants (n = 1,659; M age = 24.7 years). We assessed SC awareness/engagement and past-year TAAC participation, and differences across demographics and behavioral characteristics. Overall, 9% of emerging adults were familiar with SC and 7% had participated in a TAAC in the past year. Half of TAAC participants reported drinking less after the TAAC, and 15% remained abstinent after the TAAC ended. SC familiarity and TAAC were both associated with past-month heavy drinking, cannabis use, higher Alcohol Use Disorders Identification Test (AUDIT) scores, more past-year alcohol and cannabis consequences, past-year substance use treatment, and greater readiness to quit alcohol. Both SC and TAACs may have potential to engage young people with a desire to moderate or eliminate their alcohol consumption. This may occur directly through use of these strategies or by helping them connect to additional services. Future research can help the field understand the uptake of SC and TAACs, gauge efficacy, and identify avenues to link young people to resources and interventions.

Temporary abstinence challenges: What do we need to know?

Participation in temporary abstinence challenges (TAC) continues to increase with campaigns established in several countries. Temporarily abstaining from alcohol as part of such challenges is associated with ongoing benefits including reductions to alcohol consumption after the TAC. We identified three research priorities regarding TACs which are outlined in this paper. First, the role of temporary abstinence itself is unclear with post-TAC reductions in alcohol consumption still apparent among participants who do not remain fully abstinent throughout the challenge. It is necessary to establish to what degree temporary abstinence itself, rather than the combination of abstinence and the additional supports provided by TAC organisers (e.g., mobile applications, online support groups), contributes to changes in consumption after the TAC. Second, little is known about the psychological changes underlying these changes in alcohol consumption, with conflicting evidence as to whether increases in someone's belief in their ability to avoid drinking mediates the association between participation in a TAC and reductions in consumption afterwards. Other potential psychological and social mechanisms of change have been subjected to little, if any, scrutiny. Third, evidence of increased consumption post-TAC among a minority of participants indicates a need to establish for whom or in what circumstances participation in a TAC may result in unintended negative consequences. Focussing research in these areas would increase the confidence with which participation could be encouraged. It would also enable campaign messaging and additional supports to be prioritised and tailored to be as effective as possible in facilitating long-term change.

Implementation and Process Evaluation of Alcohol Free for 40: Community-Based Programming to Reduce Alcohol Consumption.

Alcohol consumption is known to increase risk for chronic diseases and other negative health outcomes. Abstinence, even temporary, from alcohol consumption can have positive health impacts. In this article, we describe implementation and process evaluation of Ochsner Eat Fit's Alcohol Free for 40 (AFF40), an annual, 40-day voluntary alcohol abstinence challenge that takes place in six regions of Louisiana. Participants are challenged to abstain from alcohol consumption for 40 days to promote behavior change. To support participants' success, staff conduct pre and post metrics (physical and laboratory) and host community-based events to encourage replacement behaviors. Process evaluation included measures of reach, recruitment, dose, and fidelity through tracking of participant registrations, an exit survey, media analytics, and program activity logs. In 2021, 493 participants enrolled in AFF40, with 347 completing laboratory metrics and 298 completing physical metrics. Majority of exit survey respondents (74.5%) reported no alcohol consumption during the 40-day challenge and that they planned to participate in AFF40 2022 (90.9%). The Eat Fit team documented moderate engagement (48.7% of enrolled participants) in program events. Social and digital impressions and page views recorded 23,591 hits while print media resulted in over 750,000 impressions. AFF40 has shown to be highly engaging for participants and effective in supporting temporary abstinence from alcohol. Incorporating stronger methods and evaluation will enhance future program implementation and community impact. Lessons learned and implications for practice are transferable to other community-based efforts to reduce alcohol consumption.

P119 Mass Media as a Means of Engagement and Reach During Alcohol Free for 40 (AFF40)

<h3>Objective</h3> To report the process evaluation findings as it relates to mass media methods used to recruit and engage participants in Alcohol Free for 40 (AFF40). <h3>Use of Theory or Research</h3> The social marketing theory was used to promote voluntary behavior change and promote health strategies for participant adoption. Effective social marketing campaigns used a variety of medias such as social, mass, and digital. <h3>Target Audience</h3> Adults 21 and older looking to abstain from alcohol to improve their overall health. <h3>Program Description</h3> AFF40 is an annual 40-day voluntary alcohol abstinence challenge that is hosted by the Ochsner Eat Fit^TM team of registered dietitians. Participants are challenged to abstain from alcohol consumption for 40 days to promote better health. Strategic planning is used to develop, implement, and evaluate media content (recruitment and program related) across multiple communication channels. <h3>Evaluation Methods</h3> Process evaluation included the tracking of reach, engagement rates, impressions, reactions, downloads, and pageviews from multiple media sources. <h3>Results</h3> During the four months of recruitment and program implementation, the AFF40 Facebook and Instagram pages published 62 posts, reached 104,080 people, recorded 530 new page follows, and had an engagement rate of 6.97% (engagement/reach*100). The AFF40 Facebook group had 934 active members and 4,189 reactions. The AFF40 website registered 719 unique pageviews and the Ochsner blog resulted in 4,796 unique pageviews across six alcohol related articles. Print media garnered 750,000 impressions across 3 newspaper articles. A 2-month span of radio segments (5 times per day each week) added 276,500 impressions. Six television news segments aired with indeterminable reach. <h3>Conclusions</h3> Using technology in the form of mass media allowed for wide participant reach and program engagement in AFF40. Future community-based program efforts may consider the use of multiple communication channels in recruiting, engaging, and disseminating program information. We believe the use of multiple channels, rather than singular, was key to program success in promoting behavior change. <h3>Funding</h3> Ochsner Health

Practice Quit Attempts: Scoping Review of a Novel Intervention Strategy

Fostering practice quit attempts (PQAs)--that is, attempts to not smoke for a few hours or days, without pressure to permanently quit--represents a potential means to engage more individuals who smoke in efforts to change their smoking. However, little is known about interventions designed to foster PQAs. We aimed to identify the available evidence on PQA-focused intervention strategies and their impact on quit attempt and cessation outcomes. We conducted a scoping review of behavioral and pharmacological treatment studies targeting PQAs among adult cigarette smokers. The systematic literature search yielded 3,879 articles, and the full-text review was narrowed to 86. Twenty-three studies were deemed relevant, and 5 were added through other sources, yielding 28 studies total. Fifteen studies included behavioral intervention techniques focused on the development and rehearsal of individualized coping skills, whereas eight studies provided brief advice/instruction. More than half of the PQA-focused interventions incorporated sampling of nicotine replacement products, through either guided or ad lib use. Five studies reported on PQA-focused digital health interventions that prompted brief abstinence challenges. Of eight large-scale controlled trials, six demonstrated an increase in quit attempt and cessation outcomes among the PQA-focused intervention group. Fostering PQAs through behavioral and pharmacological interventions offers a promising technique for cessation induction that warrants future research.

Reward-related attentional capture predicts non-abstinence during a one-month abstinence challenge

BackgroundWhile it is generally recognised that cognitive attributes can predict behaviour change outcomes in the field of addiction this question is typically studied in treatment seeking samples (to predict treatment outcomes and relapse). However the concept of behaviour change applies to the entire spectrum of addiction-like behaviours and initiatives such as temporary abstinence challenges offer insight into an understudied but equally relevant point of the spectrum. Thus the current study examined whether reward-related attentional capture predicted non-abstinence during IkPas (the Dutch national dry January campaign translated: NoThanks!). MethodParticipants included 1130 adults who had complete baseline data and performed above chance level on the cognitive task. Of these 683 participants completed the post-IkPas assessment and were included in the primary analysis. A binary logistic regression examined whether reward-related attentional capture predicted drinking during IkPas controlling for alcohol use at baseline (among other potential confounders). ResultsParticipants who showed greater reward-related attentional capture before IkPas were more likely to not remain abstinent from drinking during IkPas (p = .014). Findings were replicated using multiple imputation to replace missing data (p = .013). ConclusionThese findings provide important insights into the cognitive mechanisms that support successful behaviour change such as the ability to ignore task-irrelevant reward cues and may inform the development of tools that individuals could use to maximise their likelihood of achieving successful behaviour change.

Short- and Longer-Term Benefits of Temporary Alcohol Abstinence During 'Dry January' Are Not Also Observed Among Adult Drinkers in the General Population: Prospective Cohort Study.

The alcohol abstinence challenge 'Dry January' continues to grow, but there is a lack of knowledge of how Dry January participants compare to the general population. There is also a need to determine whether benefits experienced by Dry January participants are unique to that group or are also observed among other people. We conducted a prospective cohort study using online questionnaires in early January, February and August 2019. We compared 1192 Dry January participants and 1549 adult drinkers who did not attempt to abstain from alcohol. Key outcomes were self-rated physical health, psychological well-being (Warwick-Edinburgh Mental Well-Being Scale), control over drinking (Drink Refusal Self-Efficacy Scale (DRSE)) and alcohol intake (Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) subscale). Baseline differences in demographic and alcohol consumption variables were included as covariates in between-group analyses. Dry January participants had higher SES, poorer well-being, higher AUDIT-C scores and less control over their drinking than the general population. Beneficial changes in health, WEMWBS, DRSE and AUDIT-C observed among people completing Dry January were not observed among other adult drinkers. Dry January appears to attract people who are heavier drinkers than the general population and who are more concerned about their alcohol intake. Completion of Dry January is associated with short- and longer-term benefits to well-being that are not observed in the general population.

Temporary abstinence during Dry January: predictors of success; impact on well-being and self-efficacy

Background: Temporary alcohol abstinence conveys physiological benefits. Less well-known are its effects on well-being and general self-efficacy (GSE), and how use of support during alcohol abstinence challenges affects success rates.Methods: In this study, 4232 adults participating in ‘Dry January’ completed a baseline questionnaire and a 1-month follow-up questionnaire. Key follow-up variables related to whether respondents completed the abstinence challenge, their use of support provided by Dry January, and changes in well-being and GSE. Analyses also examined whether well-being and GSE explained variance in the likelihood of completing Dry January not accounted for by other variables known to be associated with successful attempts at Dry January.Results: Participation in Dry January was associated with increases in well-being and GSE among all respondents: these changes were larger among people who successfully completed the challenge. In multivariate analysis, greater use of email support was a significant independent correlate of completing Dry January.Conclusions: This paper adds to growing evidence that support provided through organised abstinence challenges is associated with changes in beliefs linked to harmful drinking. However, there is a need for further research to help us to understand what forms of support are most effective for different drinkers.

Preliminary results on the impact of one-month alcohol abstinence challenge on mental health

Preliminary results on the impact of one-month alcohol abstinence challenge on mental health

Effects of reduced nicotine content cigarettes on individual withdrawal symptoms over time and during abstinence.

In the United States, the Food and Drug Administration (FDA) has initiated a public dialogue about reducing the nicotine content of cigarettes. A reduced-nicotine standard could increase withdrawal symptoms among current smokers. We examined the impact of switching smokers to cigarettes that varied in nicotine content on withdrawal symptoms over 6 weeks. A secondary analysis (N = 839) of a 10-site, double-blind clinical trial of nontreatment-seeking smokers was completed. Participants were instructed to smoke study cigarettes, containing 0.4 to 15.8 mg of nicotine/g of tobacco, for 6 weeks and were then abstinent overnight. Using latent growth curves, trajectories of individual withdrawal symptoms were compared between the reduced nicotine content (RNC) conditions and a normal nicotine content (NNC) condition. Path analyses compared symptoms after overnight abstinence. Relative to NNC cigarettes, participants smoking RNC cigarettes had increased anger/irritability/frustration and increased appetite/weight gain during the initial weeks, but the symptoms resolved by Week 6. Individuals who were biochemically verified as adherent with using only the 0.4 mg/g cigarettes had higher sadness levels (Cohen's d = .40) at Week 6 compared with the NNC condition, although symptoms were mild. After a post-Week 6 overnight abstinence challenge, some RNC conditions relative to NNC condition exhibited reduced withdrawal. Individuals who were biochemically confirmed as adherent to the lowest nicotine condition experienced only mild and transient symptom elevations. Thus, a reduced-nicotine standard for cigarettes produced a relatively mild and temporary increase in withdrawal among nontreatment-seeking smokers (ClinicalTrials.gov No. NCT01681875). (PsycINFO Database Record

Preconception and Prenatal Smoking among Maine Women: Defining Risk and Determining the Impact of Efforts by Care Providers to Promote Cessation

Introduction: Smoking before and during pregnancy is a risk for women and their babies, but encouraging tobacco abstinence challenges practitioners.Aims: We define correlates of tobacco use around pregnancy and determine the impact of providers’ efforts to encourage abstinence.Methods: We analysed responses (2000 – 2010) from the Pregnancy Risk Assessment Monitoring System questionnaire for Maine, United States, a state with higher than average smoking rates. We performed multivariable logistic regression analysis with demographic and behavioural independent variables, and smoking in the last 3 months before and in the last 3 months of pregnancy as dependent variables.Results: Of 12,409 questionnaire responders, 32% smoked before pregnancy; 60.5% of these women continued during pregnancy. Women were more likely to smoke before pregnancy and to continue during pregnancy if they had a previous birth, were unmarried, had ≤ a high school education, or had a household income ≤ $20,000/year. Pre-pregnancy smokers were more likely to continue smoking during pregnancy if their gestational weight gain was less than recommended and, surprisingly, if they recalled a provider discussion about smoking cessation.Conclusions: We identify women at risk for smoking before and during pregnancy and demonstrate that current tobacco abstinence interventions by providers may not always be effective.

Voluntary temporary abstinence from alcohol during "Dry January" and subsequent alcohol use.

Research suggests that temporary abstinence from alcohol may convey physiological benefits and enhance well-being. The aim of this study was to address a lack of information about: (a) correlates of successful completion of a planned period of abstinence, and (b) how success or failure in planned abstinence affects subsequent alcohol consumption. 857 British adults (249 men, 608 women) participating in the "Dry January" alcohol abstinence challenge completed a baseline questionnaire, a 1-month follow-up questionnaire, and a 6-month follow-up questionnaire. Key variables assessed at baseline included measures of alcohol consumption and drink refusal self-efficacy (DRSE). In bivariate analysis, success during Dry January was predicted by measures of more moderate alcohol consumption and greater social DRSE at baseline. Multivariate analyses revealed that success during Dry January was best predicted by a lower frequency of drunkenness in the month prior to Dry January. Structural equation modeling revealed that participation in Dry January was related to reductions in alcohol consumption and increases in DRSE among all respondents at 6-month follow-up, regardless of success, but indicated that these changes were more likely among people who successfully completed the challenge. The findings suggest that participation in abstinence challenges such as Dry January may be associated with changes toward healthier drinking and greater DRSE, and is unlikely to result in undesirable "rebound effects": very few people reported increased alcohol consumption following a period of voluntary abstinence.

Working memory-related neural activity predicts future smoking relapse.

Brief abstinence from smoking impairs cognition, particularly executive function, and this has a role in relapse to smoking. This study examined whether working memory-related brain activity predicts subsequent smoking relapse above and beyond standard clinical and behavioral measures. Eighty treatment-seeking smokers completed two functional magnetic resonance imaging sessions (smoking satiety vs 24 h abstinence challenge) during performance of a visual N-back task. Brief counseling and a short-term quit attempt followed. Relapse during the first 7 days was biochemically confirmed by the presence of the nicotine metabolite cotinine. Mean percent blood oxygen level-dependent (BOLD) signal change was extracted from a priori regions of interest: bilateral dorsolateral prefrontal cortex (DLPFC), medial frontal/cingulate gyrus, posterior cingulate cortex (PCC), and ventromedial prefrontal cortex. Signal from these brain regions and additional clinical measures were used to model outcome status, which was then validated with resampling techniques. Relapse to smoking was predicted by increased withdrawal symptoms, decreased left DLPFC and increased PCC BOLD percent signal change (abstinence vs smoking satiety). Receiver operating characteristic analysis demonstrated 81% area under the curve using these predictors, a significant improvement over the model with clinical variables only. The combination of abstinence-induced decreases in left DLPFC activation and reduced suppression of PCC may be a prognostic marker for poor outcome, specifically early smoking relapse.

Effect of abstinence challenge on brain function and cognition in smokers differs by COMT genotype

The val allele of the catechol-O-methyltransferase (COMT) val(158)met polymorphism has been linked with nicotine dependence and with cognitive performance in healthy volunteers. We tested the hypothesis that the val allele is a risk factor for altered brain function and cognition during nicotine abstinence as compared with the normal smoking state. Chronic smokers (n=33) were genotyped prospectively for the COMT polymorphism for balanced selection of met/met, val/met and val/val groups. A visual N-back working memory task was performed during two separate blood oxygen level-dependent (BOLD) functional magnetic resonance imaging sessions in counterbalanced order: (1) smoking as usual, and (2)>or=14 h confirmed abstinence. Significant genotype by session interactions were observed for BOLD signal in right dorsolateral prefrontal cortex (DLPFC; (P=0.0005), left DLPFC (P=0.02) and dorsal cingulate/medial prefrontal cortex (P=0.01) as well as for task reaction time (P=0.03). Smokers with val/val genotypes were more sensitive to the abstinence challenge than carriers of the met allele, with the greatest effects on BOLD signal and performance speed at the highest working memory load. These data suggest a novel brain-behavior mechanism that may underlie the increased susceptibility to nicotine dependence and smoking relapse associated with the COMT val allele. Exploration of the effects of COMT inhibitors as a possible smoking cessation aid in this group may be warranted.