Individual Alcohol Use Research Articles

Everybody Is…Drinking! Interpretation Bias in Problematic Drinkers With and Without Mild to Borderline Intellectual Disability

ABSTRACTBackground: Problematic alcohol use is characterized by disrupted associative processing of environmental clues, where problematic drinkers interpret ambiguous, alcohol-relevant clues in an alcohol-related way. The present study examined the strength of this interpretation bias in a large sample (N = 230) of light and problematic drinkers with and without mild to borderline intellectual disability (MBID, IQ 50–85). Method: All participants were asked to finish 24 open-ended, ambiguous scenarios with their first, spontaneous response. Results: Consistent with the hypothesis, problematic drinkers with and without MBID were found to have an interpretation bias toward alcohol. The difference in the strength of the bias between light and problematic drinkers was strongest for negative scenarios. Participants with MBID showed a stronger interpretation bias compared to participants without MBID, especially on the negative scenarios. Conclusion: Problematic drinkers tend to interpret ambiguous, alcohol-relevant clues in an alcohol-related way and this tendency increases with higher levels of alcohol use–related problems. These results extend our knowledge on substance use disorder and provide new lines of inquiry for the assessment and treatment of problematic alcohol use in individuals with MBID.

Contribution of the Mission in Afghanistan to the Burden of Past-Year Mental Disorders in Canadian Armed Forces Personnel, 2013.

The purpose of this study was to estimate the contribution of the mission in Afghanistan to the burden of mental health problems in the Canadian Armed Forces (CAF). Data were obtained from the 2013 Canadian Forces Mental Health Survey, which assessed mental disorders using the World Health Organization's Composite International Diagnostic Interview. The sample consisted of 6696 Regular Force (RegF) personnel, 3384 of whom had deployed in support of the mission. We estimated the association of past-year mental health problems with Afghanistan deployment status, adjusting for covariates using logistic regression; population attributable fractions (PAFs) were also calculated. Indication of a past-year mental disorder was identified in 18.4% (95% confidence interval [CI], 17.0% to 19.7%) of Afghanistan deployers compared with 14.6% (95% CI, 13.3% to 15.8%) in others. Afghanistan-related deployments contributed to the burden of a past-year disorder (PAF = 8.7%; 95% CI, 3.0% to 14.2%), with the highest PAFs being seen for panic disorder (34.7%) and posttraumatic stress disorder (32.1%). The PAFs for individual alcohol use disorders and suicide ideation were not different from zero. Child abuse, however, had a much greater PAF for any past-year disorder (28.7%; 95% CI, 23.4% to 33.7%) than did the Afghanistan mission. The mission in Afghanistan contributed significantly to the burden of mental disorders in the CAF RegF in 2013. However, the much stronger contribution of child abuse highlights the need for strong military mental health systems, even in peacetime, and the need to target the full range of determinants of mental health in prevention and control efforts.

Adolescent Substance Use, Aggressive Behaviors, and Peer Context Behavioral Norms

The goal of this study was to examine behavioral norm effects in 2 peer contexts (classroom, school) on adolescent substance use (tobacco, alcohol, cannabis) and aggressive behaviors (bullying, physical fighting). Participants were 5,642 adolescents (Mage = 14.29 years, SD = 1.26; 49% boys). There were 3 hypotheses. First, behavioral norms in both contexts affect individual behavior. Second, classroom norms have stronger effects on individual behavior than school norms. Third, classroom and school norms interact and exacerbate each other’s influence. Results indicated that classroom norms had stronger effects than school norms on individual tobacco and alcohol use. Furthermore, school norms had equal or stronger effects than classroom norms on the 2 indicators of aggressive behaviors. There was no evidence for an interaction between classroom and school norms for any dependent variable. This study demonstrates that the complexity of multiple (nested) peer contexts should be considered to fully understand peer influence processes.

Alcohol Consumption, Craving, and Craving Control Efforts Assessed Daily in the Context of Readiness to Change Among Individuals with Alcohol Dependence and PTSD

Research has demonstrated the positive association between alcohol craving and alcohol use and has identified craving as a central component of alcohol use disorders (AUD). Despite potential clinical implications, few studies have examined the relationship between craving and alcohol use in individuals with AUD and common psychiatric comorbidities or explored possible moderators of the craving–alcohol use relationship. The current study used daily monitoring data to: 1) replicate previous findings detecting a positive relationship between craving and alcohol use in individuals with AUD and co-occurring posttraumatic stress disorder (PTSD) and 2) extend these findings by examining the influence of initial change motivation on the craving–use relationship and within-day associations among craving, efforts to control craving, and alcohol consumption. Participants were 84 individuals with alcohol dependence and PTSD enrolled in an intervention study. Generalized estimating equations using pre-treatment baseline daily data revealed significant main effects for craving, craving control, and motivation to change alcohol use. Daily craving was positively related to alcohol use. Greater change motivation and craving control (i.e., efforts to resist craving, avoidance of thoughts and feelings related to craving) were negatively related to alcohol use. A significant interaction was detected between baseline change motivation and daily craving indicating that the association between craving and alcohol use was significantly stronger for those with low baseline change motivation. A significant interaction was also detected between craving control and daily craving, suggesting that participants were more likely to consume alcohol when experiencing high levels of craving if they reported low levels of craving control. Findings bolster the idea that efforts to prevent or ameliorate craving are critical to treatment success for individuals with AUD and PTSD who are seeking to reduce or quit drinking.

Peer Leaders and Substance Use Among High-Risk Adolescents

Objective: To examine the association between individual drug use and peer leaders use. Method: Analysis of drug use behaviors of 525 students randomized into three arms—control, standard, and networked where peers serve as group leaders. Results: Among the combined male and female group, there was no association between peer leader and individual use. Among males, peer leader use at baseline was positively associated with individual alcohol use at post-test. Among females, peer leader use at post-test was negatively associated with marijuana and cigarette use. Conclusion: Having peer leaders in the network condition decreased the odds of marijuana and cigarette use among females. The opposite effect was found in males.

Individual-, family-, and school-level interventions for preventing multiple risk behaviours relating to alcohol, tobacco and drug use in individuals aged 8 to 25 years

To assess the effects of interventions at the individual, family and school level that aim to target multiple substance use behaviours (two or more from alcohol, tobacco, cannabis, other substance use) for the primary or secondary prevention of substance use and related harms in individuals aged 8 to 25.

Substance Use Disorders and Intimate Partner Violence Perpetration among Male and Female Offenders.

The current investigation sought to examine the direct associations and interactions among individual and concurrent alcohol, cocaine, cannabis, and opioid use diagnoses with the perpetration of intimate partner violence as well as to assess gender differences across these associations within a large forensic sample of male and female offenders. Participants (1,290 male and 294 female) completed a court-mandated substance abuse evaluation during which they completed a clinical interview, either endorsing or denying recent physical partner violence perpetration. Specific substance use disorders were diagnosed based primarily upon responses to the clinical interview and were used to predict partner violence perpetration using logistic regression. Alcohol and cocaine use disorders were significantly associated with IPV perpetration over the past year. Cannabis and opioid use disorders were not directly associated with IPV. A comorbid alcohol use diagnosis increased the likelihood of IPV perpetration among participants with either a cannabis or a cocaine use disorder while participants with an alcohol use disorder were less likely to be violent if they had also met criteria for a cannabis use disorder. These relationships held across males and females. The current findings emphasize the importance of assessing associations between specific substances of abuse in researching and predicting partner violence and suggest that future efforts focus on the development of integrated treatments for co-occurring partner violence and substance use disorders.

Take One for the Team? Influence of Team and Individual Sport Participation on High School Athlete Substance Use Patterns

The current Web-based survey investigated the association between team or individual sport participation (or both) and self-reported alcohol and tobacco use among high school athletes (N = 1,275) transitioning to college. Peak blood alcohol concentration, weekly drinking, and alcohol-related problems were significantly lower among athletes in individual sports compared to other groups. Athletes competing in both team and individual sports reported greater lifetime tobacco use and combined alcohol/tobacco use compared to individual or team sports alone. Preventive strategies targeting high school athletes in general and those participating in team sports in particular may be useful in minimizing future alcohol use and related problems.

Ondansetron reduces naturalistic drinking in nontreatment-seeking alcohol-dependent individuals with the LL 5'-HTTLPR genotype: a laboratory study.

One hypothesis suggests that the differential response to ondansetron- and serotonin-specific re-uptake inhibitors (SSRIs) may be due to a functional polymorphism of the 5'-HTTLPR promoter region in SLC6A4, the gene that codes for the serotonin transporter (5-HTT). The LL 5'-HTTLPR genotype is postulated to be specifically sensitive to the effects of ondansetron with SS/SL 5'-HTTLPR genotypes sensitive to SSRIs. This study tests this hypothesis by matching nontreatment-seeking alcohol-dependent (AD) individuals with LL genotype to ondansetron and SS/SL genotypes to the SSRI sertraline, and mismatching them assessing naturalistic and bar-laboratory alcohol drinking. Seventy-seven AD individuals were randomized to 1 of 2 counterbalanced arms to receive sertraline 200 mg/d or ondansetron 0.5 mg/d for 3 weeks followed by an alcohol self-administration experiment (ASAE) and then received placebo for 3 weeks followed by a second ASAE. Individuals then received the alternate drug for 3 weeks followed by a third ASAE. Drinks per drinking day (DDD with drinks in standard drinking units) for 7 days prior to each ASAE and milliliters consumed during each ASAE were the primary outcomes. Fifty-five participants completed the study. The genotype × order interaction was significant, F(1, 47) = 8.42, p = 0.006, for DDD. Three analyses of covariance were conducted for DDD during the week before each ASAE. Ondansetron compared to sertraline resulted in a significant reduction in DDD during the week before the first, F(1, 47) = 7.64, p = 0.008, but not the third ASAE. There was no difference in milliliters consumed during each ASAE. This study modestly supports the hypothesis that ondansetron may reduce DDD in AD individuals with the LL genotype as measured naturalistically. By contrast, there was no support that ondansetron reduces drinking during the ASAEs or that sertraline reduces alcohol use in individuals who have SS/SL genotypes. We provide limited support that ondansetron may reduce drinking in nontreatment-seeking individuals with the LL genotype.

Alcohol and substance use in multiple sclerosis

BackgroundFew studies have examined the prevalence of alcohol and drug use in individuals with multiple sclerosis (MS). The current study sought to examine the prevalence and associated demographic, disease-related, and psychological correlates of substance use in an East Coast United States outpatient MS sample. Methods157 individuals with MS completed questionnaires prior to, during or after their visit with an MS neurologist. These questionnaires included: the Alcohol Use Disorders Identification Test—Consumption (AUDIT-C), CAGE, CAGE—Adapted to Include Drugs (CAGE-AID), Patient Health Questionnaire—9 item (PHQ-9), Beck Depression Inventory—Second Edition (BDI-II) and Hospital Anxiety and Depression Scale—Anxiety (HADS-A). ResultsOn the AUDIT-C, 40% of individuals with MS met or exceeded the cutoff for excessive alcohol use. They were more highly educated and younger than non-drinkers. Utilizing the CAGE, 6% of the sample met criteria for a lifetime history of excessive alcohol use and men endorsed higher rates of alcohol use than women. Only a small portion of the sample endorsed a history of drug use (CAGE-AID, 4%). Drug use was associated with greater disability and depression symptoms, but lower self-reported anxiety. ConclusionsCurrent alcohol use was prevalent in this sample, and excessive use was associated with men, younger age, and more education. Reported drug use was minimal and associated with greater disability, more self-reported depression, but fewer anxiety symptoms.

Alcohol use and HIV disease management: The impact of individual and partner-level alcohol use among HIV-positive men who have sex with men

Alcohol use among HIV-positive (HIV+) individuals is associated with decreased adherence to antiretroviral therapy (ART) and consequently poorer HIV treatment outcomes. This study examined the independent association of individual and partner-level alcohol use with HIV disease management among men who have sex with men (MSM) in primary partnerships. In total, 356 HIV+ MSM and their male primary partners completed a baseline visit for a longitudinal study examining the role of couple-level factors in HIV treatment. The Alcohol Use Disorders Identification Test (AUDIT) was administered to assess the individual and the partner-level alcohol use. Primary outcome variables included self-reported ART adherence, ART adherence self-efficacy, and HIV viral load. Results demonstrated that abstainers, compared to hazardous drinkers, had higher self-efficacy to integrate and persevere in HIV treatment and a lower odds of having a detectable viral load. Participants with a partner-abstainer, versus a partner-hazardous drinker, had less self-efficacy to persevere in HIV treatment, a lower odds of 100% three-day adherence and a higher viral load. Together, these findings suggest that assessment and treatment of both the patient's and the patient's primary partner's pattern of alcohol consumption is warranted when attempting to optimize HIV care among MSM.

Exploring substance use normalization among adolescents: A multilevel study in 35 countries

The substance use normalization thesis predicts that adolescent substance users are less likely to report substance use risk factors in high than in low prevalence countries. This study tests whether national population-level alcohol, cigarette and cannabis prevalence rates moderate the strength of the relationship between individual level social and behavioral risk factors and individual level alcohol, cigarette and cannabis use. Data from 2009/2010 Health Behaviour in School-Aged Children Study (N = 68,045, age = 15) from 35 countries was analyzed using logistic Hierarchical Linear Modeling. As expected based on low cannabis prevalence rates in all countries studied, no evidence of normalization was found for recent cannabis use. Also in line with the normalization thesis, results show that for substance use that reaches above 40% in at least some of the countries studied (drunkenness, alcohol and cigarette use), adolescents who reported use are less likely to report social and behavioral risk factors in high prevalence countries than in low prevalence countries. However, support for the normalization thesis was only partial in that results show that in models where evidence for normalization was found, there are risk factors that predict substance use to an equal degree regardless of country level prevalence rates. The current research shows that the normalization thesis is a useful framework for understanding the contextual aspects of adolescent alcohol, tobacco, and cannabis use. The study has implications for drug prevention as it suggests that selective prevention efforts may be particularly useful in low prevalence countries where screening based on risk factors may usefully identify adolescents at most risk for developing drug use problems. This approach may be less useful in high prevalence countries where screening based on risk factors is less likely to satisfactorily identify those at risk for developing drug use problems.

Depression, Readiness for Change, and Treatment Among Court-Mandated DUI Offenders

Objective: The current study is part of a larger study that was designed to evaluate the impact of brief interventions on subsequent alcohol and drug use in individuals convicted of driving under the influence (DUI). This element considers the interaction of depression levels with treatment on subsequent substance use and problems related to substance use. Methods: Subjects were referred to the Research Institute on Addictions from various courts in the Western New York area for clinical evaluation and treatment referral, if further treatment was indicated. A total of 765 individuals were referred to the program, with 549 agreeing to participate. Participants were assessed at baseline using a number of different measures, with depression and readiness to change among them. A follow-up assessment took place 18 to 24 months following the baseline, with subsequent treatment experiences being one of the primary measures of interest for this study. A total of 443 participants were successfully interviewed at follow-up. Results: The high depression group had greater readiness to change and a greater likelihood of entering treatment than the low depression group (p's < .001). ANCOVAs showed depression by treatment interactions for drug problem severity, drug use, DUI risk, alcohol expectancies, abstinence self-efficacy, and psychiatric distress (all p's < .05). Furthermore, the treated high depression group made the largest positive gains across all outcomes (all p's < .01). Conclusions: The readiness to change, treatment entry, and ANCOVA results all support the approach of Wells-Parker et al. (2006) that depression may be a strong indicator of DUI offenders’ readiness to change their substance use behavior.

Group Influences on Individuals’ Drinking and Other Drug Use at Clubs

This article examines effects of the social group on individual alcohol and drug use upon entry and exit from the club. Based on collected biological measurements of alcohol and other drug use, this study explores whether social group indicators (e.g., group characteristics) are predictive of alcohol and other drug use for individual club patrons. A total of 368 social groups, representing 986 individuals (50.7% female), were anonymously surveyed, and biological measures of alcohol and other drug use were collected at entrance and exit to clubs on a single evening. Both individual and group-level indicators were assessed. Because data were clustered by club, event, and group, mixed-model regressions were conducted to account for non-independence. Group indicators of high blood alcohol concentration were being in a group that intends to get drunk, that has at least one member who regularly gets drunk, and that has discrepancies in its expectations regarding drug use. Group indicators related to cocaine use were high levels of drug use expected among group members, little discrepancy among the group members regarding the drug use expected, and high levels of intentions to get drunk. In addition, older groups were more likely to have higher levels of cocaine use. There were less consistent findings regarding group effects on marijuana use. The most consistent finding was that high drug use expectations were related to higher levels of marijuana use. Together, these data suggest that strategies should focus on recognizing group indicators as risks for group members. Promoting social responsibility for group members may create safer club experiences among young adults. These efforts could model designated-driver programs as a way to increase safety and social responsibility.

The role of drinking in new and existing friendships across high school settings.

We use 9 Add Health high schools with longitudinal network data to assess whether adolescent drinkers choose friends who drink, prefer friends whose friends drink, if selection differs between new and existing friendships, and between schools. Utilizing dynamic social network models that control for friend influences on individual alcohol use, the results show that drinkers do not strongly prefer friends who drink. Instead, they favor close friends whose friends’ drink, suggesting that alcohol matters for selection on the social groups and environments that friends connect each other to. The role of alcohol use differs by whether friendships are new or existing, however, with bridging connections being less stable. Moreover, selection processes, and the implications of alcohol use for friendship, vary in important ways between schools.

Drinking buddies and their prospective influence on alcohol outcomes: Alcohol expectancies as a mediator.

The process by which peers or the social network influence individual alcohol use, particularly among adults, remains a necessary area of research. The purpose of the present study was to examine the longitudinal influence of "drinking buddies" on alcohol outcomes (i.e., alcohol use, heavy drinking, and alcohol-related problems) as mediated by alcohol expectancies of social facilitation. Participants were 1347 (men = 660, women = 687) newly married individuals recruited from the community. They were assessed at the time of marriage and through the fourth wedding anniversary. Longitudinal mediation across time was evaluated using latent growth modeling. Overall, the prospective association between the number of drinking buddies in the social network and all three alcohol outcomes was mediated by alcohol expectancies. In testing group invariance across gender, findings suggest that social-facilitation expectancies may be more relevant to men than women in predicting typical alcohol use and alcohol-related problems. Given that the social network may impact alcohol use at least in part through social expectancies, tailoring alcohol interventions to modify these specific beliefs may be particularly beneficial. In addition, strategies that target drinkers' social networks or their drinking buddies specifically may be useful.

Developmental emergence of alcohol use disorder symptoms and their potential as early indicators for progression to alcohol dependence in a high risk sample: A longitudinal study from childhood to early adulthood.

This study characterized developmental emergence of individual alcohol use disorder (AUD) symptoms, and evaluated their ability as early indicators of progression into alcohol dependence (AD), conditional upon gender, parental alcohol dependence, early onset of drinking, and level of delinquent behavior at onset. The two parameters of interest were (a) likelihood of specific AUD symptom appearance once drinking has begun, and (b) primacy of symptom appearance as an indicator of likelihood for eventual move into diagnosis. We analyzed prospective data from a community sample of high risk youth from childhood to early adulthood. Symptoms that were at higher probability of being experienced at drinking onset and that could serve as good indicators for the early stage of disease progression were: persistent desire or unsuccessful efforts to control alcohol use (AD4), and continued use despite having persistent or recurrent interpersonal problems (AA4). Tolerance (AD1) may serve as an indicator for the intermediate stage of progression. Young people tended to be at an elevated risk for developing AD6 (activities given up), AD7 (physical/psychological problems), and AA3 (legal problems) in later years so these symptoms may be good indicators for later stages of progression. In addition to being male, an early onset drinker, or high in delinquent behavior, drinkers who experienced AA4 or AD1 as first symptoms were at higher risk for progression to AD. We also identified two high risk clusters: late onset drinkers with AA4 as first symptom, and children of alcoholics with AD1 as first symptom.

Commentary on the Study: Impact of Depressive Symptoms on Future Alcohol Use in Patients with Co-Occurring Bipolar Disorder and Alcohol Dependence: A Prospective Analysis in an 8-Week Randomized Controlled Trial of Acamprosate (Prisciandaro et al.)

Comorbidity of alcohol abuse and dependence with bipolar disorders is high. The aim of this short commentary is to review a current study investigating the impact of depressive symptoms and craving on alcohol use in individuals with co-occurring bipolar disorder and alcohol dependence. The strengths of Prisciandaro and colleagues' (2012) study are reviewed. The research group collected data as part of an 8-week, randomized, double-blind, placebo-controlled trial of acamprosate treatment in comorbid individuals. The importance of the study lies in highlighting the complex relationship between bipolar affective disorder symptoms, in particular depression, and alcohol use in a prospective design. It also overcomes several shortcomings of previous studies, since trajectories of both disorders within a short time frame of 1 week were hitherto rarely investigated. While the current study is successfully shedding light on the relationship between depressive symptoms, craving, and alcohol use in comorbid individuals, future studies may also investigate the influence of rapid cycling, mixed states, and psychotic symptoms on alcohol consumption and vice versa. Further, other comorbid samples could be included like first episode versus subjects with multiple affective episodes or comorbidity in males versus females. This research may provide a better basis for future psychotherapy and pharmacotherapy or integrated treatment approaches in these comorbid and severely affected individuals.

Under-reporting of alcohol and substance use versus other psychiatric symptoms in individuals living with HIV

Substance use is known to negatively impact outcomes in patients living with HIV by decreasing adherence to and effectiveness of antiretroviral therapies. Alcohol and other drug abuse and dependence are widespread among HIV-positive individuals, though reported rates vary greatly by study, suggesting the possibility of under-reporting. The extent to which patients minimize symptoms and the factors that influence reporting remain to be determined. The present study sought to gauge the degree to which substance use is under-reported in a primary care HIV clinic by evaluating the influence of anonymity versus confidentiality of self-report on endorsement rates. Patients (n = 55) currently receiving medical treatment completed a confidential questionnaire assessing the presence of alcohol abuse, other drug misuse, and Generalized Anxiety Disorder (GAD). Another group of 55 patients completed a comparable survey, but did so anonymously. The two groups were similar in terms of demographic characteristics, but self-report of substance use differed depending on how symptoms were assessed, with anonymous questionnaires yielding significantly (p<0.05) higher rates, compared to confidential surveys. Under-reporting appeared specific to alcohol and substance use, with no statistically significant differences between anonymous and confidential surveys in the proportion of patients endorsing symptoms of GAD. The fact that the screener specifically designed to identify patients in need of further evaluation produced lower rates of reported alcohol and drug use suggests that more work is needed to identify appropriate tools for accurately assessing substance use in HIV-positive patients so that adequate referrals and services can be offered to those in need.

Impact of Depressive Symptoms on Future Alcohol Use in Patients with Co‐Occurring Bipolar Disorder and Alcohol Dependence: A Prospective Analysis in an 8‐Week Randomized Controlled Trial of Acamprosate

Bipolar disorders and alcohol use disorders commonly co-occur, yet little is known about the proximal impact of bipolar symptoms on alcohol use in patients with this comorbidity. The present study examined the impact of depressive symptoms and alcohol craving on proximal alcohol use in patients with co-occurring bipolar disorder and alcohol dependence. Data were collected during an 8-week randomized controlled trial of acamprosate for individuals with co-occurring bipolar disorder and alcohol dependence (n = 30). Depressive symptoms and alcohol craving were assessed biweekly using the Montgomery Asberg Depression Rating Scale (MADRS) and the Obsessive Compulsive Drinking Scale (OCDS), respectively. Daily alcohol use data were available via administration of the Time-line Follow-back interview at baseline and at subsequent weekly study visits. Correlational analyses and hidden Markov modeling were used to examine the prospective relationships between depressive symptoms, alcohol craving, and alcohol use. Depressive symptoms and alcohol craving were significantly correlated with proximal (i.e., 1 week later) alcohol use across a variety of alcohol consumption summary measures. In hidden Markov models, depressive symptoms (OR = 1.3, 95% credible interval = [1.1, 1.5]) and alcohol craving (OR = 1.6, 95% credible interval = [1.4, 1.9]) significantly predicted transitioning from a light to a heavy drinking state, or remaining in a heavy drinking state. The results from the present study suggest that depressive symptoms and alcohol craving increase proximal risk for alcohol use in individuals with co-occurring bipolar and alcohol use disorders.