Drinking Outcomes Research Articles

Helicopter Parenting and Drinking Outcomes Among College Students: The Moderating Role of Family Income

Helicopter parenting, a form of overcontrol defined by intense levels of monitoring and supervision, has been linked to an increase in risky behaviors in emerging adults. However, the context may modify how helicopter parenting operates on adjustment in this population. The current study sought to better understand the contextualizing role of family income on the relations between helicopter parenting and drinking behaviors during college. Undergraduates (N = 171; 49% female; M age = 18.82; 68% White; M family income = $60,001–$75,000) completed measures of helicopter parenting, income, and multiple indices of alcohol consumption and problematic drinking. To accommodate the zero-inflated data for the outcome variable, two-part regression modeling was used to examine whether the interaction among (maternal or paternal) helicopter parenting and income was significant. Although the interaction was not significant for the binary models, the interaction generally predicted the magnitude of drinking. For low-income college students, increased helicopter parenting from mothers and fathers deterred most drinking behaviors. For high-income college students, increased maternal and paternal helicopter parenting was associated with a greater degree of average number of drinks consumed per day and drinking to intoxication. Overall, the results suggest that considering the economic conditions of families is important when examining the influence of parenting behaviors on young adult drinking patterns. While helicopter parenting might not be adaptive for high-income families, this form of parenting might serve a different function in low-income families by reducing risky behaviors of undergraduates.

The Altered Course of Learning: How Alcohol Outcome Expectancies Are Shaped by First Drinking Experiences

According to expectancy theory, outcome expectancies are first formed vicariously (through observing other people) and then through direct experience. This cohort-sequential longitudinal study explored these expectancy origins in 1,023 youths (52% female, ages 10.5–15.5 years at recruitment, M = 12.47 years, SD = 0.95). Discontinuous multilevel growth models described patterns of change in expectancies before and after the first experience of distinct drinking milestones (i.e., first sip, first full drink, first heavy-drinking situation). Youths’ expectations for positive and negative drinking outcomes generally increased and decreased over adolescence, respectively, reflecting general developmental trends. Drinking experiences altered learning trajectories, however, reifying positive expectancies and invalidating negative expectancies at each milestone and altering the course of expectancy change thereafter. For positive outcome expectancies, the influence of direct experience on learning was stronger when drinking milestones were met at an earlier age. Conversely, invalidation of negative expectancies was stronger when the first-drink milestone was met at a later age.

The effect of impulsivity and drinking motives on alcohol outcomes in college students: a 3-year longitudinal analysis

Objective: Substance use is a public health concern and cross-sectional studies have found that impulsivity and drinking motives influence substance use in emerging adults. Despite these findings, longitudinal studies with nuanced measures of impulsivity and drinking motives are needed. Participants: The current study investigated the three-year relationship between impulsivity-related traits, drinking motives, sex, and drinking outcomes in a sample of 509 college students (47.47% male; 81% White). Methods: The effects of impulsivity traits and drinking motives on problematic drinking outcomes were evaluated using linear mixed effects models. Results: The results confirmed the hypothesized relationship between traits of impulsivity, drinking motives, and alcohol outcomes over time. Further, sex significantly interacted with drinking motives longitudinally in its relationship with alcohol use outcomes. Conclusions: These results indicate that intervention efforts may need to be tailored to specific individual attributes to target direct correlates of alcohol use behavior to increase effectiveness.

Cannabis and alcohol use in young adults: Connections

Does cannabis use result in increased dangerous alcohol use? Prior research shows the opposite: Negative drinking outcomes may be exacerbated by cannabis use in young adults. However, there have been few longitudinal studies of this. A recent study of 997 students who were assessed four times a year for frequency of cannabis and alcohol use, as well as negative alcohol consequences, found that in some cases, increases in cannabis frequency were associated with some of the more severe alcohol consequences, including risky behavior, poor self‐care and symptoms of alcohol dependence. There was no evidence of the moderating role of gender. The study, “Does Cannabis Use Predict More Severe Types of Alcohol Consequences? Longitudinal Associations in a 3‐Year Study of College Students,” was published in April by Alcoholism: Clinical and Experimental Research; the lead author was Jeffrey D. Wardell.

Tomar alcohol antes de salir: la previa en adolescentes argentinos y su relación con normas sociales y motivos de previa

La previa (i.e., el consumo de alcohol antes de asistir al evento de la salida en el que puede, o no, consumirse más alcohol) incrementa marcadamente el riesgo de experimentar consecuencias negativas asociadas al consumo de alcohol. Aunque el consumo de alcohol es muy prevalente entre los adolescentes argentinos, son escasos los trabajos centrados en la previa. Este trabajo describe el consumo de alcohol y la conducta de previa en adolescentes argentinos (13 a 18 años), identifica el efecto de las normas descriptivas y los motivos de previa sobre la frecuencia de previa y la cantidad de alcohol consumido durante esta práctica, y examina variaciones en el consumo general de alcohol y en la cantidad de consecuencias negativas derivadas, en función de realizar, o no, la previa. Participaron 402 adolescentes (52.7 % mujeres) que completaron una encuesta sobre consumo de alcohol, consecuencias negativas asociadas, conducta y motivos de previa, y normas descriptivas sobre estos encuentros. El 60 % de los adolescentes reportó conducta de previa en el último año en la que consumieron, en promedio, 70 gramos de alcohol. El 85 % continuó tomando alcohol después de la previa. Quienes exhiben conducta de previa, comparados con quienes beben pero no hacen previa, consumen significativamente más alcohol y experimentan más consecuencias negativas derivadas de este consumo. A nivel multivariado, las normas descriptivas fueron el mejor predictor de los indicadores de previa. Los hallazgos sugieren que la previa sería un factor de riesgo para tener trayectorias de consumo problemático y sería beneficioso prevenir este tipo de prácticas.

Ibudilast for alcohol use disorder: study protocol for a phase II randomized clinical trial

BackgroundAlcohol use disorder (AUD) is a chronic and relapsing condition for which current pharmacological treatments are only modestly effective. The development of efficacious medications for AUD remains a high research priority with recent emphasis on identifying novel molecular targets for AUD treatment and to efficiently screen new compounds aimed at those targets. Ibudilast, a phosphodiesterase inhibitor, has been advanced as a novel addiction pharmacotherapy that targets neurotrophin signaling and neuroimmune function.MethodsThis study will conduct a 12-week, double-blind, placebo controlled randomized clinical trial of ibudilast (50 mg BID) for AUD treatment. We will randomize 132 treatment-seeking men and women with current AUD. We will collect a number of alcohol consumption outcomes. Primary among these is percent heavy drinking days (PHDD); secondary drinking outcomes include drinks per day, drinks per drinking day, percent days abstinent, percent subjects with no heavy drinking days, and percent subjects abstinent, as well as measures of alcohol craving and negative mood. Additionally, participants will have the option to opt-in to a neuroimaging session in which we examine the effects of ibudilast on neural activation to psychosocial stress and alcohol cues. Finally, we will also collect plasma levels of proinflammatory markers, as well as subjective and biological (salivary cortisol) markers of stress response.DiscussionThis study will further develop ibudilast, a safe and promising novel compound with strong preclinical and clinical safety data for AUD, and will probe biological mechanisms underlying the effects of Ibudilast on stress, neuroinflammation, and alcohol cue-reactivity and craving. If ibudilast proves superior to placebo in this study, it will set the stage for a confirmatory multi-site trial leading to FDA approval of a novel AUD treatment.Trial registrationClinicalTrials.gov NCT03594435 “Ibudilast for the Treatment of Alcohol Use Disorder”. Registered on 20 July 2018.

Inside Alcohol Behavioral Couple Therapy (ABCT): In-session speech trajectories and drinking outcomes

The alcohol treatment literature has established in-session client speech as a mechanism of change that therapist behavior can influence and that can predict drinking outcomes. This study aimed to explore temporal patterns of in-session speech in Alcohol Behavioral Couple Therapy (ABCT), including the unique interplay between client and partner speech and the role of speech trajectories in predicting client drinking outcomes. Participants were 165 heterosexual couples receiving ABCT in one of four clinical trials. We coded client speech on an utterance-by-utterance basis using the System for Coding Couples' Interactions in Therapy–Alcohol. We focused on individual-level speech codes of change talk and sustain talk and couple-level variables of positive and negative interactions. We segmented the initial and midtreatment sessions into quartiles to conduct path analyses and latent growth curve models. Path analyses suggested that clients and partners may not have been aligned in terms of treatment goals at the start of the therapy. This misalignment within couples was pronounced during the initial session and decreased by the midtreatment session, reflecting progression toward treatment goals. Of the latent growth curve models, only client sustain talk during the midtreatment session predicted greater client drinking at the end of treatment. Results provide insight into the inner workings of ABCT and suggest recommendations for ABCT therapists. This study also supports a growing consensus that sustain talk may be a stronger mechanism of change than change talk in various alcohol treatment interventions.

Sleep Problems and Drinking Frequency among Urban Multiracial and Monoracial Adolescents: Role of Discrimination Experiences and Negative Mood.

Mounting evidence suggests that multiracial adolescents may be at greater risk than their monoracial peers for both sleep problems and alcohol use. However, mechanisms underlying these uniquely-heightened risky health behaviors among multiracial adolescents remain a gap in the literature. This cross-sectional study examined a risk pathway involving discrimination experiences and negative mood underlying racial disparities in concurrent sleep problems and drinking frequency. Students at an urban, socioeconomically-disadvantaged high school (N=414; grades 9–11, Mage=16.00 [SD=1.08]; 57% female; 17% multiracial, 41% Black, 22% White, 18% Asian, 2% Other; 12% Hispanic/Latinx) completed a survey. Path analysis demonstrated that associations of multiracial status with sleep problems (insomnia symptom severity and insufficient weekday sleep duration), but not drinking frequencies (past-year drinking or past-2-week binge-drinking frequencies), were explained by discrimination experiences and, in turn, negative mood. In ancillary analysis excluding White students, the serial indirect risk pathway was significant for both insomnia symptom severity and past-year drinking frequency outcomes. Discrimination experiences and negative mood may function as intermediate factors contributing to racial disparities in adolescent sleep problems, although longitudinal replication is needed.

Less adolescent alcohol and cannabis use: More deviant user groups?

Adolescent drinking and cannabis use in Norway declined in the 2000s, and we tested the assumption that psychosocial problems were more strongly related to substance use when the prevalence was quite low (2012/2013) than when it was considerably higher (2002). Data stemmed from school surveys of almost 20 000 students aged 14-17 years in 2002 and 2012/2013 in the four largest cities in Norway. We assessed how various deviant behaviours and depressive mood were related to past-year measures on any alcohol intoxication, frequent intoxication (6+ times) and any cannabis use, and tested whether the associations varied significantly by survey year. The prevalence of any intoxication episodes dropped markedly from 2002 (50%) to 2012/2013 (28%), as did the prevalence of frequent intoxication (29% vs. 10%) and any cannabis use (15% vs. 7%). Deviant behaviours and depressive mood were either more closely related to the drinking outcomes in 2012/2013 than in 2002, or the associations showed no temporal change. None of the associations with cannabis use varied significantly by survey year. The assumption that psychosocial problems correlated more strongly with alcohol and cannabis use in a low-prevalence period (2012/2013) as compared to a high-prevalence period (2002) was partly supported, but only with respect to drinking. The strength of the associations with cannabis use was stable, which may reflect that the proportion reporting any use of the drug was low even in the relatively 'high-prevalence' period.

Parental supply of sips and whole drinks of alcohol to adolescents and associations with binge drinking and alcohol-related harms: A prospective cohort study

BackgroundParents frequently supply alcohol to their children, often only sips. We investigated whether supply of sips and whole drinks, from parents and other sources, are differentially associated with subsequent drinking outcomes. MethodsA cohort of 1910 adolescents (mean age 12.9yrs) were surveyed annually over seven years from 2010−11. We examined prospective, adjusted associations between the quantity of supply from parental and non-parental sources in the preceding 12 months and five outcomes in the subsequent year, over several consecutive years: binge drinking; alcohol-related harms; symptoms of alcohol abuse, dependence and alcohol use disorder (AUD). ResultsIn early waves, most parental supply comprised sips, while supply of whole drinks increased in later waves. Among those not receiving alcohol from other sources, parental supply of sips was associated with increased odds of binge drinking (OR: 1.85; 99.5 % CI: 1.17–2.91) and alcohol-related harms (OR: 1.70; 99.5 % CI: 1.20–2.42), but not with reporting symptoms of alcohol abuse, dependence or AUD, compared with no supply. Relative to no supply, supply of sips from other sources was associated with increased odds of binge drinking (OR: 2.04; 99.5 % CI: 1.14–3.67) only. Compared with supply of sips, supply of whole drinks by parents or others had higher odds of binge drinking, alcohol-related harms, symptoms of dependence and of AUD. Secondary analysis demonstrated that supply of larger quantities was associated with an increased risk of all outcomes. ConclusionParental provision of sips is associated with increased risks and the supply of greater quantities was associated with an increasing risk of adverse outcomes. Clinical Trial RegistrationClinicalTrials.gov (NCT02280551).

Association of alcohol control policies with adolescent alcohol consumption and with social inequality in adolescent alcohol consumption: A multilevel study in 33 countries and regions

Background Previous research found inconsistent associations between alcohol control policies and socioeconomic inequality with adolescent drinking outcomes. This study expands the focus beyond individual associations to examine whether a combination of policies is related to socioeconomic inequality in adolescent drinking outcomes and whether this relationship varies across survey years.Methods Multilevel modelling of 4 waves of repeat cross-sectional survey data (2001/02, 2005/06, 2009/10, and 2013/14) from the Health Behaviour in School-aged Children (HBSC) study was carried out. The sample was composed of 671,084 adolescents (51% girls) aged 11, 13, and 15 (mean age=13.58; SD=1.65) from 33 European and North American countries/regions. The dependent variables were lifetime alcohol consumption, weekly alcohol consumption, and lifetime drunkenness. Independent variables were of three types: individual-level variables (age, sex, Family Affluence Scale, and the Perceived Family Wealth), time-level variable (survey year), and context-level variables (minimum legal drinking age, physical availability, advertising restrictions, a total alcohol policy index, and affordability of alcohol).Results The total alcohol policy index showed a negative relationship with both lifetime and weekly consumption. Higher affordability of alcohol was related to higher lifetime and weekly consumption and higher lifetime drunkenness. Family Affluence Scale was positively related to all three alcohol measures and Perceived Family Wealth was negatively related to lifetime drunkenness, with these associations increasing across survey years. The total alcohol policy index buffered the associations of Family Affluence Scale and Perceived Family Wealth with adolescent drinking outcomes.Conclusion A combination of alcohol control policies is more effective in reducing adolescent drinking outcomes than single policy measures. Reducing the affordability of alcohol stood out as the most successful single measure. Socioeconomic inequalities (i.e. higher alcohol consumption and drunkenness in adolescents with higher family affluence and higher drunkenness in adolescents perceiving their families to be poor) have persisted and even increased across survey years. A combined alcohol control policy can help in tackling them.

A randomized controlled trial of a virtual reality based, approach-avoidance training program for alcohol use disorder: a study protocol

BackgroundThe approach-avoidance training program (AATP) has shown preliminary promise as an add-on to standard treatment for alcohol dependence. However, knowledge is lacking as to whether the effectiveness of AATP can be enhanced further when performed in a typical drinking situation. The main aim of this study is to investigate whether approach-avoidance training implemented in a virtual reality bar environment is superior to the classical joystick PC-version of the AATP.MethodsThe study will be implemented as a randomized controlled trial. A total of 204consecutively enrolled alcohol use disorder (AUD) patients, recruited from alcohol inpatient clinics in Germany, Poland and Denmark, will be randomized into one of three groups at the start of standard alcohol treatment: group A) stimuli-relevant AATP + treatment as usual (TAU); group B) stimuli-relevant AATP in virtual reality + TAU, and group C) TAU only (control group). Treatment outcomes will be assessed at pre-treatment, post-treatment and 3-month follow-up. Repeated-measures ANOVA will be applied to compare the trajectories of the groups over time on drinking, craving and impulsiveness outcomes. It is hypothesized that the two experimental groups will achieve better treatment outcomes compared to group C and that group B will achieve better outcomes than group A.DiscussionThis study is the first trial examining the effectiveness of stimuli-relevant AATP delivered in a VR environment. The use of VR has shown promise in enhancing the effectiveness of other psychological treatments and since AATP has already been shown effective as add-on treatment, it is of interest to investigate whether these effects can be further enhanced by implementing the program in more ecologically valid environments. If proven effective, the AATP-VR can, like the AATP, be implemented easily and cheaply as add-on treatment or continued care to enhance the effectiveness of current evidence-based treatment.Trial registrationClinicalTrials.gov ID: NCT04283305Registration date: 24.02.20

Effect of holistic relapse prevention intervention among individuals with alcohol dependence: a prospective study at a mental health care setting in India

Present study examined effectiveness of Integrative Body Mind Spirit (I-BMS) intervention among individuals with alcohol dependence. A 2-group single blind RCT design was used, comparing I-BMS to treatment as usual (TAU) on drinking and psychological outcomes. One hundred participants diagnosed with alcohol dependent syndrome were randomly assigned to receive 7 sessions of I-BMS or TAU. Measurements done by a registered nurse who was blinded to the experimental design used standardized questionnaire on wellbeing, readiness to change, craving, quantity and frequency of drinking before and up to 6 months after the intervention. With respect to the within group effects, the I-BMS group demonstrated significant improvement in all outcome measures with large effect size. Compared to TAU, I-BMS participants showed lesser relapse rates and quantity of drinking at 3-month follow-up, reduction in craving and drinking days at 2-month follow-up. At 6 months follow-up, participants in I-BMS group reported significant improvement in wellbeing and motivation compared to TAU. Results of binary logistic regression showed that number of previous attempts and living in urban area positively predicted participant’s relapse possibility at 6-month follow-up. Results suggest that I-BMS is worthy of further efficacy testing. In conclusion, it is feasible to implement I-BMS intervention for individuals with alcohol dependence.

The relationship between unplanned drinking and event-level alcohol-related outcomes.

Alcohol misuse among college students is a persistent public health problem. Identifying the circumstances which influence alcohol misuse can inform the development of interventions to reduce risk for adverse outcomes in this population. Prior research suggests that people who engage in unplanned drinking report more alcohol-related consequences, and that unplanned heavy drinking is associated with consequences at the within-person level. The present study involved exploration of the within-person relationship between drinking events that were unplanned (vs. planned) in the morning and later quantity consumed, negative and positive consequences, and overall event evaluations. College student drinkers (N = 96) provided data on their drinking experiences each morning during a 28-day ecological momentary assessment study. Hierarchical linear models revealed that unplanned drinking events were associated with lower alcohol quantity, fewer alcohol-related consequences, and lower ratings on how "worth it" the drinking event was, compared to planned events. In contrast to prior work highlighting the risk associated with unplanned heavy drinking, our findings indicate that drinking events that are planned (vs. unplanned) are related to increased consumption and the experience of negative consequences. Additional research is needed to more definitively assess the differences between planned and unplanned drinking events and their relationship to adverse alcohol-related outcomes among college students. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

A multiple mediation model of trait worry and hazardous drinking among treatment-seeking smokers: the roles of coping and conformity drinking motives

ABSTRACT Alcohol use is associated with poorer smoking cessation-related outcomes, and smokers with elevated levels of worry experience greater smoking cessation problems. Yet, little is known about the explanatory mechanisms that may underlie the relationship between trait worry and hazardous drinking among smokers. Therefore, this study explored the explanatory roles of coping and conformity drinking motives in the relationship between trait worry and hazardous drinking outcomes including alcohol consumption, alcohol problems, maximum number of drinks, and the number of prior alcohol quit attempts among treatment-seeking smokers. Participants included 377 treatment-seeking smokers who consumed at least one alcoholic drink in the last year (48% female; 86.2% Caucasian; M age = 34.83 years, SD = 13.38). Results showed a significant indirect effect of trait worry through coping-related drinking motives in relation to alcohol consumption, alcohol problems, maximum number of drinks, and number of prior drinking quit attempts. These findings were evident after controlling for gender, cigarette dependence, and current psychopathology. These findings suggest that coping drinking motives are one mechanism that may explain the relation between trait worry and hazardous drinking outcomes among treatment-seeking smokers.

Does Cannabis Use Predict More Severe Types of Alcohol Consequences? Longitudinal Associations in a 3-Year Study of College Students.

Prior research shows that negative drinking outcomes among young adults may be exacerbated by cannabis use. However, to date, there have been few longitudinal studies of associations between cannabis use and negative alcohol-related consequences. This study examined longitudinal within-person associations between cannabis use and several domains of negative alcohol consequences among young adults and explored the moderating role of sex. We analyzed data from N=997 students assessed 4 times per year over the first 3years of university. At each time point, participants completed measures of past-month cannabis use frequency, typical weekly number of drinks, and 8 domains of negative alcohol consequences. Longitudinal associations were examined in multilevel models. Within-person changes in frequency of cannabis use were not uniquely associated with changes in total alcohol consequences aggregated across several alcohol consequence domains. However, when examining alcohol consequence domains separately, within-person increases in cannabis use frequency were specifically associated with increases in some (but not all) of the more severe types of alcohol consequences, including risky behaviors, poor self-care, and alcohol dependence symptoms. No support was observed for the moderating role of sex in the longitudinal within-person associations between cannabis use and alcohol consequence domains. Findings suggest that within-person changes in cannabis use frequency among young adults are associated with corresponding changes in some domains of alcohol consequences (but not others) when examined over the course of several years. Results may inform targeted harm reduction interventions for young adult drinkers who use cannabis, although future research is needed to clarify the mechanisms of the observed associations.

Optimizing internet-delivered cognitive behaviour therapy for alcohol misuse: a study protocol for a randomized factorial trial examining the effects of a pre-treatment assessment interview and health educator guidance

BackgroundAlcohol misuse is a common, disabling, and costly issue worldwide, but the vast majority of people with alcohol misuse never access treatment for varying reasons. Internet-delivered cognitive behaviour therapy (ICBT) may be an attractive treatment alternative for individuals with alcohol misuse who are reluctant to seek help due to stigma, or who live in rural communities with little access to face-to-face treatment. With the growing development of ICBT treatment clinics, investigating ways to optimize its delivery within routine clinic settings becomes a crucial avenue of research. Some studies in the alcohol treatment literature suggest that assessment interviews conducted pre-treatment may improve short- and long-term drinking outcomes but no experimental evaluation of this has been conducted. Further, research on internet interventions for alcohol misuse suggests that guidance from a therapist or coach improves outcomes, but more research on the benefits of guidance in ICBT is still needed.MethodsThis study is a 2X2 factorial randomized controlled trial where all of the expected 300 participants receive access to the Alcohol Change Course, an eight-week ICBT program. A comprehensive pre-treatment assessment interview represents factor 1, and guidance from a health educator represents factor 2. All participants will be asked to respond to measures at screening, pre-treatment, mid-treatment, post-treatment and 3, 6 and 12 months after treatment completion.DiscussionThis study will provide valuable information on optimization of ICBT for alcohol misuse within routine clinic settings.Trial registrationClinicalTrials.gov, registered June 13th 2019, NCT03984786

Utility of different dimensional properties of drinking practices to predict stable low-risk drinking outcomes of natural recovery attempts

BackgroundFunctional measures indicating lower drinking problem severity predict stable low-risk drinking outcomes of recovery attempts, but findings for drinking practices are mixed. Because low-risk drinking outcomes are more common in natural than treatment-assisted recovery attempts, five studies of natural recovery attempts were integrated. Multiple dimensions of drinking practices during the year before recovery initiation were evaluated as predictors of post-recovery drinking (continuous abstinence, stable low-risk drinking, or unstable recovery involving relapse). MethodsCommunity-dwelling problem drinkers (N = 616, 68% male, mean age = 46.5 years) were enrolled soon after stopping alcohol misuse and followed prospectively for one year. A Timeline Followback interview assessed daily drinking during the year before recovery initiation and yielded four dimensions for analysis: frequency of heavy drinking days (4+/5+ drinks for females/males), mean ethanol consumption per drinking day, variability in days between heavy drinking days, and variability in ethanol consumed per drinking day. ResultsMultinomial logistic regression models showed that variability in ethanol consumed per drinking day was the sole significant predictor of 1-year outcomes when all dimensions were evaluated together. The low-risk drinker group showed less fluctuation in quantities consumed on pre-recovery drinking days compared to the groups that abstained or relapsed (ps < 0.05). ConclusionsEven when drinking heavily, problem drinkers who maintained low-risk drinking recoveries limited their quantities consumed within a relatively narrow range, a pattern they maintained post-recovery at much lower consumption levels. Assessing variability in quantities consumed may aid drinking goal selection.

Stressors and Drinking in Sexual Minority Women: The Mediating Role of Emotion Dysregulation.

Sexual minority women are at elevated risk for exposure to stressors (both traumatic and discriminatory) and have higher rates of alcohol consumption and problems. The psychological mediation framework (Hatzenbuehler, 2009) suggests that both general (e.g., traumatic events to which minorities and nonminorities may be exposed) and minority-group-specific (e.g., discrimination) stressors contribute to psychopathology through mediators such as emotion dysregulation. Guided by this framework, the present study longitudinally examined the relationship between stressors and problematic drinking outcomes (i.e., binge drinking and alcohol-related problems), as mediated by emotion dysregulation, in sexual minority women (SMW). It addressed two research questions: (1) whether stressors longitudinally predict problematic drinking outcomes in SMW, as mediated by emotion dysregulation, and (2) for which specific forms of stressor (i.e., traumatic events and/or discrimination) this mediational relationship is present. Young adult women (N = 1057) who identified as lesbian or bisexual completed annual measures of daily heterosexism, traumas, and drinking outcomes for four years, and completed a measure of emotion dysregulation during the third year of data collection. We found an indirect relationship between discrimination and problematic drinking outcomes via emotion dysregulation. These findings are consistent with the psychological mediation framework (Hatzenbuehler, 2009) and suggest that SMW group-specific processes such as discrimination may be especially important in conferring risk for problem drinking via emotion dysregulation. Clinicians are advised to assess unique stressors faced by SMW and their potential contribution to problematic drinking outcomes, and to target emotion dysregulation in alcohol treatments.

Patient-Centered Placement Matching of Alcohol-Dependent Patients Based on a Standardized Intake Assessment: Primary Outcomes of an Exploratory Randomized Controlled Trial

Background: Placement matching guidelines are promising means to optimize patient-centered care and to match patients’ treatment needs. Despite considerable research regarding placement matching approaches to optimize alcohol abuse treatment, findings are inconclusive. Objectives: To investigate whether the use of patient-centered placement matching (PCPM) guidelines is more effective in reducing heavy drinking and costs 6 months after discharge from an inpatient alcohol withdrawal treatment compared to usual referral to aftercare. Secondary aims were to investigate whether age, gender, trial site or level of care (LOC) are moderators of efficacy and whether patients who were actually referred to the recommended LOC had better treatment outcomes compared to patients who were treated under- or overmatched. Methods: Design. Exploratory randomized controlled trial with measurements during withdrawal treatment and 6 months after initial assessment. Setting. Four German psychiatric clinics offering a 7–21 day inpatient qualified withdrawal program for patients suffering from alcohol dependence. Participants. From 1,927 patients who had a primary diagnosis of alcohol dependence and did not have organized aftercare when entering withdrawal treatment, 299 were invited to participate. Of those, 250 were randomized to the intervention group (IG, n = 123) or the control group (CG, n = 127). Intervention. The PCPM were applied to patients of the IG by feeding back a recommendation to a LOC for aftercare that was calculated from the Measurements in the Addictions for Triage and Evaluation (MATE) and discussed with the staff of the treatment unit. Patients of the CG received a general feedback regarding their MATE interview on request. Measurements. The MATE, the Client Socio-Demographic and Service Receipt Inventory-­European Version and the MATE-Outcomes were administered. Data were analyzed using generalized linear models. Results: In the intention-to-treat analysis, there were no significant differences between IG and CG regarding days of heavy drinking (incident risk ratio [IRR] 1.09; p = 0.640), direct (IRR 1.06; p = 0.779), indirect (IRR 0.77; p = 0.392) and total costs (IRR 0.89; p = 0.496). Furthermore, none of the investigated moderator variables affected statistically significant drinking or cost-related primary outcomes. Regardless of group allocation, patients who received matched aftercare reported significantly fewer days of heavy drinking than undermatched patients (IRR 2.09; p = 0.004). For patients who were overmatched, direct costs were significantly higher (IRR 1.79; p = 0.024), but with no additional effects on alcohol consumption compared to matched patients. Conclusions: While the use of PCPM failed to affect the actual referral to aftercare, our findings suggest that treating patients on the recommended LOC may have the potential to reduce days of heavy drinking compared to undertreatment and costs compared to overtreatment.