Chronic pain (CP) and hazardous/harmful drinking (HD) commonly co-occur. HD contributes to the onset and severity of CP, while CP severity predicts alcohol use disorder relapse. Integrated treatments for CP and HD are needed in rural areas, where CP and alcohol-related consequences occur at higher rates and treatment accessibility is lower. This study assessed the acceptability and feasibility of an app-based cognitive-behavioral intervention for CP and HD. Participants (n = 32) were rural residents reporting CP and HD (mean age = 49.81, SD = 8.79). Participants were randomized to intervention or assessment-only control. Self-report questionnaires at baseline and 12-week follow-up assessed program acceptability, pain, alcohol involvement, and functioning. Timely recruitment and low attrition (3.2%) supported procedure feasibility, while app engagement suggested intervention feasibility and acceptability. Descriptive statistics suggest reductions in pain (37% reduction in median pain in intervention group vs. 10% in control group). Changes in alcohol-related behavior were not consistent across outcomes and warrant further study (e.g., no change in median heavy drinking episodes in intervention, with 77% reduction in control; 60% reduction in alcohol consequences in intervention vs. 27% in control). This mobile intervention is feasible and acceptable for rural residents and may help address CP and functioning among those who engage in HD.

ABSTRACTPreliminary animal and human studies have shown that blood dihydrotestosterone concentrations are increased in males with alcohol use disorder, and 5α‐reductase inhibitors, which decrease dihydrotestosterone concentrations, reduce alcohol consumption. To gain mechanistic insight, we studied the effects of reduced dihydrotestosterone concentrations following pharmacological 5α‐reductase inhibition on alcohol cue‐elicited brain activity and alcohol craving in males with problematic alcohol use. To this end, this randomized, placebo‐controlled, crossover challenge experiment investigated associations between dihydrotestosterone concentrations and brain functional magnetic resonance imaging (fMRI) activity during exposure to visual alcohol cues and alcohol craving following a single dose of 5 mg finasteride versus placebo in 50 males with heavy episodic drinking. We used finasteride because it specifically inhibits 5α‐reductase II activity, which is the main enzyme converting testosterone to dihydrotestosterone. Dihydrotestosterone concentrations were lower in the finasteride condition in comparison to the placebo condition, but not significantly associated with brain activation patterns or craving. In the exploratory analyses, we found higher brain activity during exposure to visual stimuli in the right and left caudate nuclei, the right superior frontal gyrus and the left insula in the finasteride condition versus the placebo condition. Moreover, finasteride versus placebo was associated with a higher wish to not drink alcohol. The results of this experimental study do not support the à priori hypothesis that dihydrotestosterone concentrations play a role in brain activation during exposure to visual alcohol cues, but indicate that finasteride effects may be mediated by other pathways. Future studies are requested to investigate the effects of reduced dihydrotestosterone concentrations over a longer time and to shed light on the molecular mechanisms underlying the here observed effects of finasteride.Trial Registration: DRKS00020569

BackgroundAlcohol-induced blackouts (AIBs) are a serious consequence of alcohol use that are strongly associated with experiencing excess alcohol−related harms. AIBs are common and recurrent among young adults who drink. The risk factors for AIBs include dynamics of alcohol use (quantity, speed, duration), alcohol-related behaviors (eg, playing drinking games, not using protective behavioral strategies), and factors related to the subjective experience of alcohol intoxication (eg, expectancies, motivations).ObjectiveThis study seeks to examine 2 modifiable behaviors that have been shown to impact both alcohol consumption and subjective experiences of intoxication and may therefore be associated with AIB risk: (1) other substance use and (2) sleep.MethodsApproximately 50 participants will be recruited to participate in this study. Interested individuals will complete an online screening assessment, and those who are eligible (young adults who report recent heavy episodic drinking and AIBs) will be invited to an in-person baseline visit. At the baseline visit, participants will complete a baseline assessment, be fitted with a wrist-worn alcohol sensor (BACtrack Skyn) and a sleep or activity ring sensor (Oura ring), and receive training on the study protocol. Participants will complete a 14-day intensive data collection period consisting of twice daily scheduled mobile surveys and participant-initiated drinking surveys with hourly follow-ups. Participants will also wear the alcohol and sleep or activity sensors continuously during this 14-day period. After the intensive data collection period ends, participants will complete an in-person return visit to return their sensors, complete a follow-up survey, and receive compensation. The data will be processed and cleaned, and analyses will include multi-level structural equation models.ResultsThis study was funded in July 2025. Data collection is projected to span January 2026 through June 2026.ConclusionsThis study seeks to understand 2 key modifiable behaviors that may be associated with increased AIB risk by leveraging multiple forms of innovative measurement. The integration of ecological momentary assessments with 2 sensors to capture alcohol use and sleep also supports potential applications in future digital interventions. This study will further enhance our preliminary data on the feasibility and acceptability of these methods, providing opportunities for conducting future research on a larger scale.

AimThe present study examined the joint development and co-occurrence of psychological distress (mainly depressive and anxiety symptoms), heavy episodic drinking (HED) and daily cigarette smoking from adolescence to adulthood.MethodsData were drawn from two prospective longitudinal cohorts: the TAM study (N = 2194; ages 16–52 years) and the FinnTwin16 study (N = 5563; ages 16–35 years). Latent class analysis identified distinct trajectory groups, and multinomial regression was used to examine associations with sociodemographic factors.ResultsAcross both cohorts, several trajectory groups emerged: low levels of all three health concerns, high levels of all and high distress with low-to-moderate substance use. In the TAM cohort with longer follow-up time, additional groups included increasing HED and a group indicating moderate levels of all with a peak in daily cigarette smoking. Sociodemographic factors were associated with trajectory group membership. Men were more likely to belong to groups characterized by higher HED and lower distress, while women were more often in groups with higher distress and lower substance use. Participants from non-nuclear families were more likely to belong to groups with elevated substance use or distress. Low parental socioeconomic position was associated with increased likelihood of belonging to high-risk groups in both cohorts.ConclusionsThese findings highlight the importance of considering the interplay between substance use and mental health across the life course, as well as the role of early sociodemographic context in shaping these trajectories. Tailored interventions and treatment should account for these differing developmental patterns and background factors.

Mental health matters? An examination of how anxiety and depression influence the alcohol-e-cigarette use relationship.

Background: Adolescents face unique challenges as they transition from childhood to adulthood, which can be marked by risky behaviours such as substance use and sexual activities. The present study analyses the relationship between risky sexual behaviour and the use of psychoactive substances, namely alcohol, cannabis, and other illegal substances, among students aged 15–16 years in 23 European countries, to investigate potential between-country differences. Method: Data were extracted from the 2019 European School Survey Project on Alcohol and Other Drugs (ESPAD) cross-sectional survey. Risky sexual behaviour was defined as self-reported unprotected sex. Substance use, other individual risk behaviours, and parenting indicators were investigated as key predictors. Results: A 9.8% of 16-year-old students in Europe reported sexual intercourse without a condom in the past year, and 7.8% had unprotected sex while not using alcohol/drugs, with a higher prevalence observed among males (8.5%) than among females (7.1%). Prevalence ranged from 3.2% in Georgia to 16.0% in Sweden. The multivariate analysis revealed significantly higher odds of engaging in sexual intercourse without a condom in illicit drug users (cannabis, inhalants, cocaine, ecstasy) and heavy episodic drinkers, students who went out in the evening, and those belonging to non-traditional families. Conclusions: Unprotected sex in the past year and substance use are strongly associated amid 16-year-old students in Europe. The prevalence of risky sexual behaviours across European countries does not follow a clear geographical pattern, suggesting that simple macro-level factors, such as broad regional or cultural groupings, may only partially explain prevalence differences.

Alcohol use behaviors (AUBs) manifest in a variety of normative and problematic ways across the life course, all of which are heritable. Twin studies show that genetic influences on AUBs change across development, but this is usually not considered in research identifying and investigating the genes linked to AUBs. Understanding the dynamics of how genes shape AUBs could point to critical periods in which interventions may be most effective and provide insight into the mechanisms behind AUB-related genes. In this project, we estimated how genetic influences on AUBs unfold across development using longitudinal modelling of polygenic scores (PGSs). Using results from genome-wide association studies (GWASs), we created PGSs to index individual-level genetic risk for multiple AUB-related dimensions: Consumption, Problems, a temporally variable pattern of drinking associated with a preference for beer (BeerPref) and externalizing behavior (EXT). We created latent growth curve models and tested PGSs as predictors of latent growth factors (intercept, slope, quadratic) underlying trajectories of AUBs. PGSs were derived in six longitudinal epidemiological cohorts from the United States, United Kingdom and Finland. Participant data were obtained from the longitudinal studies AddHealth, ALSPAC, COGA, FinnTwin12, the older Finnish Twin Cohort and Spit for Science (total n = 19 194). These cohorts included individuals aged 14 to 67, with repeated measures collected over a span of 4 to 36 years. Primary measures included monthly frequency of typical alcohol consumption (CON) and heavy episodic drinking (HED). When drinking behaviors were averaged across time, higher Consumption, Problems and EXT PGSs were robustly associated with higher levels of CON and HED (βs ranged from 0.105 to 0.333, P < 3.09E-04) and higher BeerPref PGSs with higher HED (β = 0.064, P = 3.65E-05). However, these PGSs were largely not associated with drinking trajectories in the latent growth curve models. In the meta-analysis, only PGSs for chronic alcohol Problems consistently predicted a steeper slope (increasing trajectory) of CON across time (B = 0.470, P = 4.20E-06). Other PGSs were associated with latent growth factors in some individual cohorts, but there was a large degree of heterogeneity. Genetic associations appear to differ not only between alcohol use behaviors, but also across developmental time points and across cohorts, highlighting the need for genetic studies to take such heterogeneity into account. Individual-level genetic profiles may be useful to point to personalized intervention timelines, particularly for individuals with high genetic risk scores for alcohol problems.

Day-level alcohol-related problems (ARPs)-such as craving, difficulty limiting/stopping, tolerance, impairment, and withdrawal-may signal risk for alcohol use disorder in young adults' natural settings. ARPs may relate to how people drink (e.g., intensity, speed, duration), but these consumption dynamics are difficult to assess accurately through self-reports. We tested the association between ARPs and alcohol consumption dynamics in young adults using wearable transdermal alcohol concentration (TAC) sensors and daily diaries. College students (N = 79; 55.7% female, 86.1% White, Mage = 20.1) who frequently engaged in heavy episodic drinking wore TAC sensors and completed daily diaries over four consecutive weekends (89.9% completion rate). ARPs were measured the morning after drinking events. Three consumption dynamics were extracted from TAC data: speed (rise rate), intensity (peak), and duration (rise duration) of drinking. Analyses using unadjusted models showed that young adults reported more ARPs on days with faster rise rates, higher peaks, or longer rise durations compared with their own slower, lower, and shorter days. Adjusted models including all three TAC features showed that faster rise rates and longer rise durations were independently associated with ARPs, but higher peaks were not. These findings provide novel evidence that the speed and duration of drinking-not just the amount-may be key targets for ARP prevention among young adults. These insights would not have emerged without the rich, objective measurement of drinking dynamics offered by TAC sensors. TAC features may help indicate existing alcohol-related impairment, warranting investigation of their prospective links to alcohol use disorder risk. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Drinking patterns underlying the effects of COVID-19 economic impacts on alcohol use disorder (AUD) severity are poorly understood, yet critical for alcohol messaging during global crises. We examined whether the effects of COVID-19 economic impacts (CEIs) on AUD severity were mediated by drinking volume and/or maximum drinks. Data are from the National Alcohol Survey's COVID Cohort, collected prepandemic in 2019-early 2020 (Wave 1), 2021 (Wave 2), and 2022 (Wave 3) using probability sampling via an online survey (n = 1062 across all waves). Past-year drinking volume categories were abstention and 7 drinking categories ranging from ≤1 drink/month to >4 drinks/day. Past-year drinking maximum categories were lifetime abstainers, former drinkers, <4/5 drinks (women/men), 4-7/5-7, 8-11, and 12+. AUD severity was classified as none (0-1 symptoms), mild (2-3), moderate (4-5), or severe (6+). CEIs were measured as the count of five economic hardship items (e.g., job loss and pay reduction). Path modeling examined direct and indirect effects of CEIs on AUD severity via drinking volume and maximum, separately, controlling for demographics and associations across key variables over time. CEIs predicted both drinking volume (p < 0.05) and maximum at Wave 2 (p < 0.01) and Wave 3 (each p < 0.05). In turn, both drinking variables at Wave 2 predicted AUD severity at Wave 2 (each p < 0.001), and at Wave 3 (each p < 0.001). Indirect effects via multiple pathways were statistically significant but precluded specifying lagged effects due to reduced model goodness of fit. Findings suggest people drank more and with higher intensity when facing pandemic-related economic hardships. Both maximum drinking and average volume increased concurrent AUD severity and mediated CEI effects. Health messages and policies targeting reductions in overall alcohol consumption and heavy episodic or high-intensity drinking during economic crises may mitigate the development of AUD symptoms among people experiencing negative economic impacts.

This study aimed to investigate risk factors associated with risky sexual behaviors (RSBs) and HIV seropositivity among students from four universities in KwaZulu-Natal, South Africa. A case-control methodology was used. The sample consisted of 500 students (375 HIV negative students and 125 students living with HIV). Adjusted logistic regression modeling was performed to assess the association of predictors with RSBs and HIV seropositivity. Data showed that heavy episodic drinking [aOR: 2.73, (95% CI: 1.38; 5.44), p = 0.004], drugs before sex [aOR: 7.46, (95% CI: 2.11; 27.88), p = 0.003], and a higher number of lifetime sex partners increased students' likelihood of having multiple concurrent sex partners (2-5 lifetime partners) [aOR: 4.22, (95% CI: 1.69; 10.54), p = 0.002] and ≥ 6 lifetime partners [aOR: 16.36, (95% CI: 6.18; 43.28), p < 0.001]. These findings indicate a need for South African universities to offer HIV prevention programs that inform students of how participation in particular risky activities can result in engagement in specific RSBs, contributing to a heightened HIV infection risk. Re-evaluation and strengthening of these prevention programs can ensure optimal efficiency in the battle against HIV infection.

ObjectiveTo prevent harmful effects of alcohol use, various countries implement policies preventing excessive and heavy episodic drinking. To enable the evaluation of the impact of such policies on (future) drinking behaviour, we aimed to develop a model that predicts alcohol consumption patterns.MethodsThe model predicts alcohol use in three stages. First, a logistic submodel predicts probabilities of drinking any alcohol. Second, for drinkers, a submodel predicts the weekly consumption through a negative binomial distribution for the number of beverages. Finally, based on the predicted weekly consumption, a logistic submodel predicts probabilities of heavy episodic drinking. The distribution for the weekly consumption was calibrated, targeted to predict the prevalence of excessive and heavy episodic drinking accurately. Model parameters were estimated using Dutch individual-level cross-sectional survey data covering the years 2008–2022. The characteristics age, sex, education, calendar time and their interactions were used as predictors and the model accounts for trend breaks in the data. Model performance was assessed by comparing population-level predictions with observed data on which the model was calibrated (2014–2022).ResultsA comparison between predictions of the calibrated model and observed data shows that the prevalences of excessive (error <0.2 percent point (pp)) and heavy episodic drinking (error <0.1 pp) align, averaged over the years 2014–2022. Visual inspection using qq-plots and within-sample validation over time further indicates that the model fits well for predicting excessive and heavy episodic drinking, based on the predicted distribution for the weekly consumption.ConclusionsWe developed a model for alcohol consumption patterns based on Dutch data. This model enables evaluation of the impact of interventions on the (future) prevalence of excessive and heavy episodic drinking.

This study examined the long-term mental health outcomes associated with childhood gun violence exposure by race/ethnicity and gender. Data were drawn from the National Longitudinal Survey of Youth 1997 (1997–2021). Gun violence exposure was measured as any exposure before age 18. Mental health outcomes assessed included depressive symptoms, heavy episodic drinking, and daily cigarette smoking. Hierarchical generalized linear models were used. Findings indicate that about 16.15% of the respondents reported childhood exposure to gun violence before the age of 18. Gun violence exposure was significantly associated with depressive symptoms among white men, white women, and Hispanic women. Additionally, it was associated with higher odds of heavy episodic drinking among Black men, white women, and Hispanic women. Gun violence exposure was associated with higher odds of daily smoking for all groups. The study findings suggest that there is a high prevalence of childhood exposure to gun violence in the U.S. The relationship between childhood gun violence exposure and adult mental health outcomes varies by race/ethnicity and gender. These results highlight the need for gun violence preventions and interventions tailored to specific demographic groups to address the long-term mental health consequences of childhood gun violence exposure.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11524-025-01034-2.

This article introduces the common and unique latent transition analysis (CULTA), a novel approach to studying alcohol intoxication dynamics in young adults engaged in heavy episodic drinking. CULTA merges the common and unique trait-state model with latent transition analysis to separate stable, traitlike intoxication components from transient fluctuations while modeling transitions between distinct drinking profiles. A sample of 222 young adults wore transdermal alcohol concentration sensors for 6 days, capturing real-time alcohol levels. The CULTA model decomposed intoxication variability into common and unique influences across four transdermal alcohol concentration features-peak, rise rate, fall rate, and duration. Latent intoxication profiles were identified, and transition probabilities between profiles were estimated with a focus on the influence of alcohol use disorder risk measured by the Alcohol Use Disorders Identification Test. Two latent intoxication profiles emerged. The first, chronic heavy episodic drinking, was characterized by persistently high intoxication without significant inertia, while the second, inertia-driven drinking, featured moderate episodic intoxication with a strong autoregressive effect, reflecting lingering intoxication that dissipates over time. Individuals with higher Alcohol Use Disorders Identification Test scores were more likely to remain in or transition to the chronic heavy episodic drinking profile. Although peak intoxication and rise rate showed limited individual variability, fall rate and duration varied substantially, marking them as potential targets for intervention. CULTA advances our understanding of alcohol intoxication by distinguishing stable from transient influences and modeling transitions between drinking states. These findings suggest that interventions should address both persistent and situational aspects of intoxication-especially by reducing duration and fall rate-and encourage research across longer periods and populations. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Protective behavioral strategies and planned drinking relate to high intensity drinking and consequences at the day level.

BackgroundThis study examined trends in cannabis and alcohol use among Canadian adults and across socio-economic subgroups over four waves of the COVID-19 pandemic from 2020 to 2022. Interactions between socio-economic status (SES) and gender, ethnoracial background, and age as they are associated with alcohol and cannabis use were examined.MethodsData were collected from nine consecutive web-based cross-sectional surveys of adults living in Canada (8,943 participants) conducted from May 2020 to January 2022. Substance use measurements included self-reported changes in alcohol and cannabis use compared to before the pandemic, heavy episodic drinking (HED) (i.e., consumption of 4 or more and 5 or more standard drinks on one drinking occasion for men and women, respectively), and cannabis use in the past 7 days. The Wilcoxon rank-sum test was used to test for equality of the prevalence of substance use. Stepwise logistic regression models were used to assess the associations of SES and its interactions with gender, ethnoracial background, and age with alcohol and cannabis use.ResultsThe prevalence of increased alcohol and cannabis use differed through the pandemic waves depending on SES. The prevalence of HED and increased cannabis use were similar across SES groups. Having a moderate or high household income and being unemployed were associated with HED and a perceived increase in alcohol use. People in racial and ethnic minority groups with a household income of $40,000 to $79,999 had greater odds of engaging in HED than White persons in households with less than $40,000. Women and individuals aged 40 to 59 years with a high household income (≥$120,000) were more likely to report increased alcohol consumption than men and individuals aged 18 to 39 years in households with an income of less than $40,000. Protective factors associated with HED were being a woman with a university degree and an older adult with a college degree. Protective factors associated with cannabis use or perceived increases in cannabis use included women with a university degree, aged 39 years or more with a university or college degree and being in racial and ethnic minority groups with a university degree.ConclusionsAssociations between SES and substance use differ by gender, race and age. To reduce health disparities, public health interventions should account for these interactions.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12889-025-25423-z.

Theories posit that acute alcohol responses predict development of future heavy alcohol use and alcohol related problems. The most prominent of these theories is the low-level response theory that purports less intense alcohol responses are associated with later development of alcohol use disorder. The counter modified differentiator model posits greater stimulant effects with lower sedative effects predict future heavy drinking. The present study provided a concurrent testing of these theories in a large-scale cohort of young adult Swiss men. Data were derived from two waves of the Cohort Study on Substance Use Risk Factors in 2749 French-speaking, current alcohol consuming young adult men aged 25.7 years at baseline and 28.5 years at follow-up. Participants completed the 6-item Anticipated Brief Biphasic Alcohol Effects Scale with the instructions of the anticipated effects they feel after consuming five standard drinks and the stimulation and sedation subscales were used in analyses. Associations of these scores with volume of drinking and frequency of heavy episodic drinking were determined both at baseline and at 3-year follow-up. Models were adjusted for covariates including disinhibited personality and family history of alcohol problems. Results show that anticipated stimulation effects of alcohol predicted increasing alcohol consumption over time and anticipated sedative alcohol effects predicted reductions in consumption (p-values ≤ .001). The present study supported the modified differentiator model in that higher anticipated stimulation and lower sedation predicted future alcohol consumption patterns. This may be useful to prevent heavy drinking and inform pharmacological interventions intended to reduce pleasurable effects.

Transgender and nonbinary (TNB) youth are at increased risk of bullying and substance use, and gender identity outness may play a role. These associations may also differ for subgroups of TNB youth given evidence of gender differences in bullying and substance use. The current study tested the indirect effects of gender identity outness on substance use through gender-based bullying and the differences among TNB subgroups. We used data from a cross-sectional national sample of 3,726 TNB youth collected in 2017 to examine the indirect effects of gender identity outness on substance use (alcohol use, heavy episodic drinking [HED], marijuana use, cigarette use) through gender-based bullying. Moderated mediation analyses tested potential differences in associations by TNB subgroup (transgender boys, transgender girls, nonbinary youth assigned female at birth [AFAB], nonbinary youth assigned male at birth [AMAB]). Gender identity outness was indirectly associated with all substance use outcomes through gender-based bullying. TNB subgroups moderated specific pathways in the models. Greater outness was associated with more gender-based bullying for nonbinary youth AFAB and transgender boys (stronger association for nonbinary youth AFAB). Greater gender-based bullying was associated with more HED and marijuana use for nonbinary youth AFAB and transgender boys (stronger associations for transgender boys). Last, greater outness was associated with more HED only for nonbinary youth AMAB. Gender-based bullying may be an underlying mechanism between gender identity outness and substance use among TNB youth, and outness may be a stronger risk factor for bullying and alcohol use for nonbinary youth than for other transgender youth.

Intimate partner violence (IPV) is a major public health concern. Heavy episodic drinking (HED; i.e., drinking 5+ drinks for men or 4+ drinks for women in a 2-hr period) is a contributing cause of IPV, yet HED does not elicit IPV for all individuals, under all circumstances. Theory and research have identified important intrapersonal moderators of alcohol-related IPV. However, these approaches fall short in conceptualizing alcohol-related IPV from an interpersonal perspective. Guided by the I³ model, the present study used a dyadic approach to examine associations between partners' HED, interpersonal stress perceptions (defined as partners' perceptions of each other's appraisal of stressful life situations), and psychological and physical/sexual IPV perpetration. Sixty-seven mixed-gender couples (N = 134 individuals) in committed relationships provided data via an online self-report questionnaire. Actor-partner interdependence models showed that when HED was low, couples' likelihood of perpetrating IPV was independent of the accuracy of partners' perceptions of each other's stress. However, increases in HED were associated with increased risk for IPV perpetration among couples who had accurate perceptions of each other's stress, whereas among couples in which one partner under- or overestimated how stressed the other felt, the risk for IPV perpetration did not increase as HED increased. If replicated, these findings provide support that under- and overestimating partners' stress may dampen the disinhibiting effects of HED on IPV perpetration that exist among couples who perceive their partners' stress accurately. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Pain and alcohol consumption among people living with HIV: examining the moderating roles of depression and social support.

Parental permissiveness toward alcohol use is associated with increased drinking among college students. In the U.S., Greek-affiliated students drink more and experience more negative consequences than other students. This study explored associations among student Greek affiliation, parental permissiveness toward heavy episodic drinking (HED), and alcohol use outcomes among first-year college students. Parent-student dyads (n = 294) completed surveys during high school and the first semester of college at a large public university in the U.S. Paired- and independent-samples t-tests and regression analyses were conducted. Parental permissiveness toward HED was higher among Greek-affiliated students than non-Greek-affiliated students, from parent and student perspectives, before and during college. In regression analyses, student Greek affiliation and perceived parental permissiveness were associated with greater alcohol use and HED. Greek status moderated associations between perceived parental permissiveness of HED and alcohol use (but not HED) such that the relationship was less pronounced for Greek-affiliated students compared to non-Greek-affiliated students. Our results suggest that interventions that aim to reduce perceived parental permissiveness toward HED, such as parent-based normative feedback interventions, may be an effective strategy to reduce drinking among first-year Greek-affiliated students.