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APA Journal: Psychology of Addictive Behaviors

Computer-assisted behavioral therapy and contingency management for cannabis use disorder.Open in a New Window

Computer-assisted behavioral treatments hold promise for enhancing access to and reducing costs of treatments for substance use disorders. This study assessed the efficacy of a computer-assisted version of an efficacious, multicomponent treatment for cannabis use disorders (CUD), that is, motivational enhancement therapy, cognitive–behavioral therapy, and abstinence-based contingency-management (MET/CBT/CM). An initial cost comparison was also performed. Seventy-five adult participants, 59% Black, seeking treatment for CUD received either, MET only (BRIEF), therapist-delivered MET/CBT/CM (THERAPIST), or computer-delivered MET/CBT/CM (COMPUTER). During treatment, the THERAPIST and COMPUTER conditions engendered longer durations of continuous cannabis abstinence than BRIEF (p < .05), but did not differ from each other. Abstinence rates and reduction in days of use over time were maintained in COMPUTER at least as well as in THERAPIST. COMPUTER averaged approximately $130 (p < .05) less per case than THERAPIST in therapist costs, which offset most of the costs of CM. Results add to promising findings that illustrate potential for computer-assisted delivery methods to enhance access to evidence-based care, reduce costs, and possibly improve outcomes. The observed maintenance effects and the cost findings require replication in larger clinical trials. (PsycINFO Database Record (c) 2015 APA, all rights reserved)


Parental involvement in brief interventions for adolescent marijuana use.Open in a New Window

Adolescents (aged 12–18 years) identified in a school setting as abusing marijuana and other drugs were randomly assigned to complete 1 of 2 brief interventions (BIs). Adolescents and their parent (N = 259) were randomly assigned to receive either a 2-session adolescent only (BI-A) or a 2-session adolescent and additional parent session (BI-AP). Interventions were manualized and delivered in a school setting by trained counselors. Adolescents were assessed at intake and at 6 months following the completion of the intervention. Using a latent construct representing 6-month marijuana use outcomes, current findings supported previous research that BI-AP resulted in superior outcomes when compared to BI-A. The presence of a marijuana dependence diagnosis at baseline predicted poorer outcomes when compared to youth without a diagnosis. Both baseline diagnostic status and co-occurring conduct problems interacted with intervention condition in predicting marijuana use outcomes. A marijuana dependence diagnosis resulted in poorer marijuana use outcomes within the BI-A condition when compared to BI-AP. Co-occurring conduct problems were associated with poorer marijuana use outcomes within the BI-AP intervention when compared to BI-A. Implications for implementing BIs given diagnostic status, parent involvement, and co-occurring conduct problems are discussed. (PsycINFO Database Record (c) 2015 APA, all rights reserved)


Recovery from cannabis use disorders: Abstinence versus moderation and treatment-assisted recovery versus natural recovery.Open in a New Window

The present study of recovery from cannabis use disorders was undertaken with 2 primary objectives that address gaps in the literature. The first objective was to provide an exploratory portrait of the recovery process from cannabis use disorders, comparing individuals who recovered naturally with those who were involved in treatment. The second objective was to explore systematically the similarities and differences between abstinence and moderation recoveries. Adults who have recovered from a cannabis use disorder were recruited in the community (N = 119). The abstinence and treatment-assisted participants exhibited higher levels of lifetime cannabis problem severity than the moderation and natural recovery participants, respectively. As well, cognitive factors were identified as the most useful strategies for recovery (e.g., thinking about benefits and negative consequences of cannabis), followed by behavioral factors (e.g., avoidance of triggers for use and high-risk situations). Findings lend further support to the effectiveness of cognitive, motivational, and behavioral strategies as helpful actions and maintenance factors involved in the recovery process. The findings also generally support the idea that cannabis use disorders lie on a continuum of problem severity, with moderation and natural recoveries more likely to occur at the lower end of the continuum and abstinence and treatment-assisted recoveries more likely to occur at the upper end. (PsycINFO Database Record (c) 2015 APA, all rights reserved)


Willpower versus “skillpower”: Examining how self-efficacy works in treatment for marijuana dependence.Open in a New Window

Self-efficacy has repeatedly been demonstrated to be a robust predictor of outcomes in the treatment of marijuana use disorders. It is not clear, however, how increases in confidence in ability to refrain from use get translated into actual improvements in drug-related outcomes. Marlatt, among others, viewed the acquisition and use of coping skills as the key to behavior change, and self-efficacy as a cognitive state that enabled coping. But that model of behavior change has not been supported, and few studies have shown that the effects of self-efficacy are mediated by coping or by other processes. The current study combined 3 marijuana treatment trials comprising 901 patients to examine the relationships between self-efficacy, coping, and potential mediators, to determine if the effects of self-efficacy on outcomes could be explained. Results of multilevel models indicated that self-efficacy was a strong predictor of adaptive outcomes in all trials, even when no active treatment was provided. Tests of mediation showed that effects of self-efficacy on marijuana use and on marijuana-related problems were partially mediated by use of coping skills and by reductions in emotional distress, but that direct effects of self-efficacy remained largely unexplained. The results are seen as supportive of efforts to improve coping skills and reduce distress in marijuana treatment, but also suggest that additional research is required to discover what is actually occurring when substance use changes, and how self-efficacy enables those changes. (PsycINFO Database Record (c) 2015 APA, all rights reserved)


Internalizing and externalizing psychopathology as predictors of cannabis use disorder onset during adolescence and early adulthood.Open in a New Window

Risk-related liabilities associated with the development of cannabis use disorders (CUDs) during adolescence and early adulthood are thought to be established well before the emergence of the index episode. In this study, internalizing and externalizing psychopathology from earlier developmental periods were evaluated as risk factors for CUDs during adolescence and early adulthood. Participants (N = 816) completed 4 diagnostic assessments between the ages 16 and 30, during which current and past CUDs were assessed as well as a full range of psychiatric disorders associated with internalizing and externalizing psychopathology domains. In unadjusted and adjusted time-to-event analyses, externalizing but not internalizing psychopathology from proximal developmental periods predicted subsequent CUD onset. A large proportion of adolescent and early adult cases, however, did not manifest any externalizing or internalizing psychopathology during developmental periods before CUD onset. Findings are consistent with the emerging view that externalizing disorders from proximal developmental periods are robust risk factors for CUDs. Although the identification of externalizing liabilities may aid in the identification of individuals at risk for embarking on developmental pathways that culminate in CUDs, such liabilities are an incomplete indication of overall risk. (PsycINFO Database Record (c) 2015 APA, all rights reserved)


Chronic adolescent marijuana use as a risk factor for physical and mental health problems in young adult men.Open in a New Window

Some evidence suggests that youth who use marijuana heavily during adolescence may be particularly prone to health problems in later adulthood (e.g., respiratory illnesses, psychotic symptoms). However, relatively few longitudinal studies have prospectively examined the long-term physical and mental health consequences associated with chronic adolescent marijuana use. The present study used data from a longitudinal sample of Black and White young men to determine whether different developmental patterns of marijuana use, assessed annually from early adolescence to the mid-20s, were associated with adverse physical (e.g., asthma, high blood pressure) and mental (e.g., psychosis, anxiety disorders) health outcomes in the mid-30s. Analyses also examined whether chronic marijuana use was more strongly associated with later health problems in Black men relative to White men. Findings from latent class growth curve analysis identified 4 distinct subgroups of marijuana users: early onset chronic users, late increasing users, adolescence-limited users, and low/nonusers. Results indicated that the 4 marijuana use trajectory groups were not significantly different in terms of their physical and mental health problems assessed in the mid-30s. The associations between marijuana group membership and later health problems did not vary significantly by race. Findings are discussed in the context of a larger body of work investigating the potential long-term health consequences of early onset chronic marijuana use, as well as the complications inherent in studying the possible link between marijuana use and health effects. (PsycINFO Database Record (c) 2015 APA, all rights reserved)


The academic consequences of marijuana use during college.Open in a New Window

Although several studies have shown that marijuana use can adversely affect academic achievement among adolescents, less research has focused on its impact on postsecondary educational outcomes. This study utilized data from a large longitudinal cohort study of college students to test the direct and indirect effects of marijuana use on college grade point average (GPA) and time to graduation, with skipping class as a mediator of these outcomes. A structural equation model was evaluated taking into account a variety of baseline risk and protective factors (i.e., demographics, college engagement, psychological functioning, alcohol and other drug use) thought to contribute to college academic outcomes. The results showed a significant path from baseline marijuana use frequency to skipping more classes at baseline to lower first-semester GPA to longer time to graduation. Baseline measures of other drug use and alcohol quantity exhibited similar indirect effects on GPA and graduation time. Over time, the rate of change in marijuana use was negatively associated with rate of change in GPA, but did not account for any additional variance in graduation time. Percentage of classes skipped was negatively associated with GPA at baseline and over time. Thus, even accounting for demographics and other factors, marijuana use adversely affected college academic outcomes, both directly and indirectly through poorer class attendance. Results extend prior research by showing that marijuana use during college can be a barrier to academic achievement. Prevention and early intervention might be important components of a comprehensive strategy for promoting postsecondary academic achievement. (PsycINFO Database Record (c) 2015 APA, all rights reserved)


Testing an expanded theory of planned behavior model to explain marijuana use among emerging adults in a promarijuana community.Open in a New Window

Opinions about marijuana use in the United States are becoming increasingly favorable, making it important to understand how psychosocial influences impact individuals’ use in this context. Here, we used the theory of planned behavior to examine the influence of initial attitudes, norms, and efficacy to resist use on initial intentions and then to examine the effect of initial intentions on actual marijuana use measured 1 year later using data drawn from a community with relatively high use. We expanded the traditional theory of planned behavior model by investigating 2 types of normative influence (descriptive and injunctive) and 2 types of intentions (use intentions and proximity intentions), reasoning that exposure to high use in the population may produce high descriptive norms and proximity intentions overall, but not necessarily increase actual use. By contrast, we expected greater variability in injunctive norms and use intentions and that only use intentions would predict actual use. Consistent with hypotheses, intentions to use marijuana were predicted by injunctive norms (and attitudes) and in turn predicted marijuana use 1 year later. By contrast, descriptive norms were relatively high among all participants and did not predict intentions. Moreover, proximity intentions were not predictive of actual use. We also found that increasing intentions to use over a 1-year period predicted greater use. Given the greater efficacy of theory-based as compared with non–theory-based interventions, these findings provide critical information for the design of successful interventions to decrease marijuana-associated harms. (PsycINFO Database Record (c) 2015 APA, all rights reserved)


Can marijuana make it better? Prospective effects of marijuana and temperament on risk for anxiety and depression.Open in a New Window

Increases in marijuana use in recent years highlight the importance of understanding how marijuana affects mental health. Of particular relevance is the effect of marijuana use on anxiety and depression given that marijuana use is highest among late adolescents/early adults, the same age range in which risk for anxiety and depression is the highest. Here we examine how marijuana use moderates the effects of temperament on level of anxiety and depression in a prospective design in which baseline marijuana use and temperament predict anxiety and depression 1 year later. We found that harm avoidance (HA) is associated with higher anxiety and depression a year later, but only among those low in marijuana use. Those higher in marijuana use show no relation between HA and symptoms of anxiety and depression. Marijuana use also moderated the effect of novelty seeking (NS), with symptoms of anxiety and depression increasing with NS only among those with high marijuana use. NS was unrelated to symptoms of anxiety and depression among those low in marijuana use. The temperament dimension of reward dependence was unrelated to anxiety and depression symptoms. Our results suggest that marijuana use does not have an invariant relationship with anxiety and depression, and that the effects of relatively stable temperament dimensions can be moderated by other contextual factors. (PsycINFO Database Record (c) 2015 APA, all rights reserved)


Which matters most? Demographic, neuropsychological, personality, and situational factors in long-term marijuana and alcohol trajectories for justice-involved male youth.Open in a New Window

Justice-involved youth have high rates of alcohol and marijuana use. However, little is known about what may drive these rates over time. Using a large-scale (N = 1,056; 41.4% African American, 33.5% Hispanic) longitudinal study with strong retention (M retention = 90% over Years 1–7), we utilized random-effects regression to determine the comparative contribution of four sets of factors in justice-involved males’ patterns of marijuana and heavy alcohol use (number of times drunk) over 7 years of follow-up: demographic, personality, situational, and neuropsychological factors. Across both marijuana and heavy alcohol use models, three factors were particularly strong contributors to lower rates of substance use: (a) Hispanic ethnicity, (b) less exposure (street) time, and (c) better impulse control. Similarly, two factors were strong contributors to increased rates of marijuana and heavy alcohol use: (a) delinquent peers and (b) family member arrest. Together, these findings indicate the relative superiority of these independent variables over other categories (i.e., neuropsychological factors) in predicting high-risk youths’ long-term (7-year) rates of substance use. These findings also suggest the importance of evaluating the connection of these areas for high-risk, adjudicated youth. (PsycINFO Database Record (c) 2015 APA, all rights reserved)


Gateway to curiosity: Medical marijuana ads and intention and use during middle school.Open in a New Window

Over the past several years, medical marijuana has received increased attention in the media, and marijuana use has increased across the United States. Studies suggest that as marijuana has become more accessible and adults have become more tolerant regarding marijuana use, adolescents perceive marijuana as more beneficial and are more likely to use if they are living in an environment that is more tolerant of marijuana use. One factor that may influence adolescents’ perceptions about marijuana and marijuana use is their exposure to advertising of this product. We surveyed sixth- to eighth-grade youth in 2010 and 2011 in 16 middle schools in Southern California (n = 8,214; 50% male; 52% Hispanic; mean age = 13 years) and assessed exposure to advertising for medical marijuana, marijuana intentions, and marijuana use. Cross-lagged regressions showed a reciprocal association of advertising exposure with marijuana use and intentions during middle school. Greater initial medical marijuana advertising exposure was significantly associated with a higher probability of marijuana use and stronger intentions to use 1 year later, and initial marijuana use and stronger intentions to use were associated with greater medical marijuana advertising exposure 1 year later. Prevention programs need to better explain medical marijuana to youth, providing information on the context for proper medical use of this drug and the potential harms from use during this developmental period. Furthermore, as this is a new frontier, it is important to consider regulating medical marijuana advertisements, as is currently done for alcohol and tobacco products. (PsycINFO Database Record (c) 2015 APA, all rights reserved)


Identifying classes of conjoint alcohol and marijuana use in entering freshmen.Open in a New Window

The current study identified classes of conjoint marijuana and alcohol use in entering college freshmen using latent profile analysis (N = 772; 53% male, 60% White; Mage = 18). Results yielded 4 distinct groups: Class 1 (moderate drinking with recent marijuana use: 22% of sample), Class 2 (moderate drinking with no recent marijuana use: 25%), Class 3 (light drinking with no recent marijuana use: 40%) and Class 4 (heavy drinking with recent marijuana use: 14%). Separate pairwise contrasts examined cross-class differences in demographics and drinking behaviors, comparing differences in drinking when current marijuana use was controlled (Class 1 vs. 4) and differences in marijuana use when drinking was held relatively constant (Class 1 vs. 2). Among moderate drinkers, recent marijuana users were more likely to drink more than intended, drink to get drunk, and had more problems (including higher rates of blackouts, physical injury, and DUI) relative to peers who refrained from marijuana. No cross-class differences were found for alcohol expectancies or behavioral motives. Findings from these analyses show the presence of distinct groups of conjoint users with different drinking behaviors and consequence profiles, and suggest that conjoint alcohol-marijuana use may be more problematic overall than single substance involvement and highlight the need for developing campus prevention and intervention programs that address the increased risk from polysubstance involvement. (PsycINFO Database Record (c) 2015 APA, all rights reserved)


Coping-motivated marijuana use correlates with DSM-5 cannabis use disorder and psychological distress among emerging adults.Open in a New Window

Compared to other age cohorts, emerging adults, ages 18–25 years, have the highest rates of marijuana (MJ) use. We examined the relationship of using MJ to cope with negative emotions, relative to using MJ for enhancement or social purposes, to MJ-associated problems and psychological distress among emerging adults. Participants were 288 community-dwelling emerging adults who reported current MJ use as part of a “Health Behaviors” study. Linear and logistic regressions were used to evaluate the adjusted association of coping-motivated MJ use with the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) cannabis use disorder, MJ-related problem severity, depressive symptoms, and perceived stress. After adjusting for other variables in the regression model, using MJ to cope was positively associated with having DSM-5 cannabis use disorder (OR = 1.85, 95% CI [1.31, 2.62], p < .01), MJ problem severity (b = .41, 95% CI [.24, .57], p < .01), depression (b = .36, 95% CI [.23, .49], p < .01), and perceived stress (b = .37, 95% CI [.22, .51], p < .01). Using MJ for enhancement purposes or for social reasons was not associated significantly with any of the dependent variables. Using MJ to cope with negative emotions in emerging adults is associated with MJ-related problems and psychological distress. Assessment of MJ use motivation may be clinically important among emerging adults. (PsycINFO Database Record (c) 2015 APA, all rights reserved)


Associations among trauma, posttraumatic stress disorder, cannabis use, and cannabis use disorder in a nationally representative epidemiologic sample.Open in a New Window

Research in community and clinical samples has documented elevated rates of cannabis use and cannabis use disorders (CUDs) among individuals with trauma exposure and posttraumatic stress disorder (PTSD). However, there is a lack of research investigating relations between, and correlates of, trauma and cannabis phenotypes in epidemiologic samples. The current study examined associations between trauma (i.e., lifetime trauma exposure and PTSD) and cannabis phenotypes (i.e., lifetime cannabis use and CUD) in a nationally representative sample. Participants were individuals who participated in Waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (n = 34,396; 52.4% women; age, M = 48.0 years, SD = 16.9). Lifetime DSM–IV Criterion A trauma exposure was significantly associated with lifetime cannabis use (OR = 1.215) but was only marginally associated with CUD (OR = 0.997). Within the trauma-exposed sample, lifetime PTSD showed a significant association with CUD (OR = 1.217) but was only marginally associated with lifetime cannabis use (OR = 0.992). Partially consistent with hypotheses, lifetime trauma was associated with greater odds of lifetime cannabis use, whereas PTSD was associated with greater odds of CUD. Longitudinal research investigating patterns of onset of these events/disorders is needed. (PsycINFO Database Record (c) 2015 APA, all rights reserved)


Variability in medical marijuana laws in the United States.Open in a New Window

Marijuana use and its distribution raise several complex health, social, and legal issues in the United States. Marijuana is prohibited in only 23 states and promarijuana laws are likely to be introduced in these states in the future. Increased access to and legalization of medical marijuana may have an impact on recreational marijuana use and perception through increased availability and decreased restrictiveness around the drug. The authors undertook an analysis to characterize the policy features of medical marijuana legislation, including an emphasis on the types of medical conditions that are included in medical marijuana laws. A high degree of variability in terms of allowable medical conditions, limits on cultivation and possession, and restrictiveness of policies was discovered. Further research is needed to determine if this variability impacts recreational use in those states. (PsycINFO Database Record (c) 2015 APA, all rights reserved)


Behavioral couples therapy for smoking cessation: A pilot randomized clinical trial.Open in a New Window

Behavioral couples therapy (BCT) has been found to improve long-term abstinence rates in alcohol- and substance-dependent populations but has not been tested for smoking cessation. This pilot study examined the feasibility and acceptability of BCT for smoking-discordant couples. Forty-nine smokers (smoking >10 cigarettes/day) with nonsmoking partners were randomized to receive a couples social support (BCT-S) intervention or an individually delivered, standard smoking cessation treatment (ST). The couples were married or had been cohabiting for at least 1 year, with partners who had never smoked or had not used tobacco in 1 year. Both treatments included 7 weekly sessions and 8 weeks of nicotine replacement therapy. Participants were followed for 6 months posttreatment. The Partner Interaction Questionnaire was used to measure perceived smoking-specific partner support. Participants were 67% male and 88% White. Biochemically verified cessation rates were 40.9%, 50%, and 45% in BCT-S and 59.1%, 50%, and 55% in ST at end of treatment, after 3 month, and after 6 months, respectively, and did not differ significantly between treatment conditions at any time point. Perceived smoking-specific partner support at posttreatment did not significantly differ between treatment groups. Results of this pilot study do not provide support for the efficacy of BCT in smoking-discordant couples. (PsycINFO Database Record (c) 2015 APA, all rights reserved)


The interactive effects of emotion regulation and alcohol intoxication on lab-based intimate partner aggression.Open in a New Window

This study draws on Finkel and Eckhardt’s (2013) I³ framework to examine the interactive effects of 2 emotion regulation strategies—anger rumination (an impellance factor) and reappraisal (an inhibition factor), and alcohol intoxication (a disinhibition factor)—on intimate partner aggression (IPA) perpetration as measured with an analogue aggression task. Participants were 69 couples recruited from a large Midwestern university (total N = 138). Participants’ trait rumination and reappraisal were measured by self-report. Participants were randomized individually to an alcohol or placebo condition, then recalled an anger event while using 1 of 3 randomly assigned emotion regulation conditions (rumination, reappraisal, or uninstructed). Following this, participants completed an analogue aggression task involving ostensibly assigning white noise blasts to their partner. Participants in the alcohol condition displayed greater IPA than participants in the placebo condition for provoked IPA, but not unprovoked IPA. Results also revealed interactions such that for those in the alcohol and rumination group, higher trait reappraisal was related to lower unprovoked IPA. For provoked IPA, higher trait rumination was related to greater IPA among those in the alcohol and rumination condition and those in the placebo and uninstructed condition. In general, results were consistent with I³ theory, suggesting that alcohol disinhibits, rumination impels, and trait reappraisal inhibits IPA. The theoretical and clinical implications of these findings are discussed in the context of current knowledge about the influence of alcohol intoxication and emotion regulation strategies on IPA perpetration. (PsycINFO Database Record (c) 2015 APA, all rights reserved)


Effects of ostracism and sex on alcohol consumption in a clinical laboratory setting.Open in a New Window

Drinking to cope with negative affect is a drinking pattern that leads to problematic alcohol use both in college and after graduation. Despite theory and correlational evidence to this effect, establishing a link between stress and alcohol consumption among college students in the laboratory has yielded both a limited number of studies and, at times, inconsistent results. The present study attempts to resolve these issues through investigating the effects of an ecologically relevant stressor—ostracism—on alcohol consumption in a clinical laboratory setting. Social drinking college students (N = 40; 55% female) completed a 5-min game of Cyberball and were randomly assigned either to be included or excluded in the virtual ball-toss game. The amount (in ml) of beer consumed in a subsequent mock taste test served as our primary dependent variable, with breath alcohol concentration (BrAC) as a secondary dependent variable. Results indicated that excluded participants reported a trend toward an increase in negative affect from pre- to post-Cyberball, and endorsed significantly lower self-esteem, belonging, control, and belief in a meaningful existence compared to included participants. A significant Sex × Condition effect indicated that excluded women consumed less beer than both included women and excluded men, supported by a nonsignificant trend in BrAC. Men did not differ in their consumption of beer as a result of Cyberball condition. Implications of sex and social context on alcohol use are discussed, as well as ostracism as a method for investigating relationships between social stress and alcohol use. (PsycINFO Database Record (c) 2015 APA, all rights reserved)


Binge drinking, depression, and electrocortical responses to emotional images.Open in a New Window

Binge drinking and depression are highly prevalent, associated with cognitive and affective impairments, and frequently co-occur. Yet little research has examined their joint relations with such processing impairment. The current study examines the relation between symptoms of depression, binge drinking, and the magnitude of early (early posterior negativity, EPN) and later (P3 and late positive potential, LPP) visual processing components of affectively negative, positive, and neutral visual stimuli. Participants included 42 undergraduate students recruited on the basis of depressive symptoms. Results of repeated measures analyses of variance (ANOVAs; Depression × Binge × Emotion × Laterality) showed that binge drinkers exhibited lower LPP amplitudes for negative images, compared with nonbinge drinkers, regardless of depression, consistent with motivational models of alcohol abuse. Otherwise, differences across depressed and nondepressed groups were largest among binge drinkers, including a pattern of stronger early attentional engagement (EPN) to negative and neutral images, but decreased later processing (P3 and LPP) across all emotional categories, consistent with a vigilance-avoidance response pattern. (PsycINFO Database Record (c) 2015 APA, all rights reserved)


Predrinking, alcohol use, and breath alcohol concentration: A study of young adult bargoers.Open in a New Window

Predrinking (preloading, pregaming) has been found to be related to alcohol use and intoxication. However, most research relies on estimates of blood alcohol concentration and does not control for usual drinking pattern. We assessed whether predrinking was associated with subsequent alcohol consumption and breath alcohol concentration (BrAC) among 287 young adult bargoers (173 men [60.3%], Mage = 21.86 years, SD = 2.55 years) who were recruited in groups in an entertainment district of a midsized city in Ontario, Canada. We also examined whether predrinking by other group members interacted with individual predrinking in relation to amount consumed/BrAC. Adjusting for nesting of individuals within groups in hierarchical linear models, predrinkers were found to consume more drinks in the bar district and over the entire night compared to nonpredrinkers and had higher BrACs at the end of the night controlling for drinking pattern. A group- by individual-level interaction revealed that individual predrinking predicted higher BrACs for members of groups in which at least half of the group had been predrinking but not for members of groups in which less than half had been predrinking. This study confirms a direct link of predrinking with greater alcohol consumption and higher intoxication levels. Group- by individual-level effects suggest that group dynamics may have an important impact on individual drinking. Given that predrinking is associated with heavier consumption rather than reduced consumption at the bar, initiatives to address predrinking should include more effective policies to prevent intoxicated people from entering bars and being served once admitted. (PsycINFO Database Record (c) 2015 APA, all rights reserved)


The magnitude of drug attentional bias is specific to substance use disorder.Open in a New Window

The visual probe task with eye tracking is a sensitive measure of cocaine and alcohol cue attentional bias. Despite the high comorbidity between cocaine and alcohol dependence, attentional bias studies have examined the influence of cocaine- and alcohol-related cues separately. The aim of this experiment was to directly compare the magnitude of cocaine and alcohol cue attentional bias in individuals dependent on cocaine or cocaine and alcohol. Individuals who met criteria for cocaine dependence (n = 20) or both cocaine and alcohol dependence (n = 20) completed a visual probe task with eye tracking. Cocaine-dependent participants displayed an attentional bias toward cocaine, but not alcohol. In contrast, cocaine-alcohol dependent participants displayed an attentional bias to both cocaine and alcohol, and the magnitude of these biases did not differ. The magnitude of cocaine cue attentional bias, however, was significantly smaller in the cocaine-alcohol dependent group compared to the cocaine-dependent group. These results suggest that fixation time during the visual probe task is sensitive to clinically relevant differences in substance use disorders. The incentive value of cocaine-related cues, however, may differ for individuals who are also dependent on alcohol. (PsycINFO Database Record (c) 2015 APA, all rights reserved)


Insecure attachment styles, relationship-drinking contexts, and marital alcohol problems: Testing the mediating role of relationship-specific drinking-to-cope motives.Open in a New Window

Research and theory suggest that romantic couple members are motivated to drink to cope with interpersonal distress. Additionally, this behavior and its consequences appear to be differentially associated with insecure attachment styles. However, no research has directly examined drinking to cope that is specific to relationship problems, or with relationship-specific drinking outcomes. Based on alcohol motivation and attachment theories, the current study examines relationship-specific drinking-to-cope processes over the early years of marriage. Specifically, it was hypothesized that drinking to cope with a relationship problem would mediate the associations between insecure attachment styles (i.e., anxious and avoidant) and frequencies of drinking with and apart from one’s partner and marital alcohol problems in married couples. Multilevel models were tested via the actor-partner interdependence model using reports of both members of 470 couples over the first nine years of marriage. As expected, relationship-specific drinking-to-cope motives mediated the effects of actor anxious attachment on drinking apart from one’s partner and on marital alcohol problems, but, unexpectedly, not on drinking with the partner. No mediated effects were found for attachment avoidance. Results suggest that anxious (but not avoidant) individuals are motivated to use alcohol to cope specifically with relationship problems in certain contexts, which may exacerbate relationship difficulties associated with attachment anxiety. Implications for theory and future research on relationship-motivated drinking are discussed. (PsycINFO Database Record (c) 2015 APA, all rights reserved)


End-of-treatment abstinence self-efficacy, behavioral processes of change, and posttreatment drinking outcomes in Project MATCH.Open in a New Window

This study evaluated whether alcohol abstinence self-efficacy at the end of alcohol treatment was moderated by utilization of behavioral processes of change (coping activities used during a behavior change attempt). It was hypothesized that self-efficacy would be differentially important in predicting posttreatment drinking outcomes depending on the level of behavioral processes, such that the relation between self-efficacy and outcomes would be stronger for individuals who reported low process use. Analyses were also estimated with end-of-treatment abstinence included as a covariate. Data were analyzed from alcohol-dependent individuals in both treatment arms of Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity; N = 1,328), a large alcohol treatment study. Self-efficacy was moderated by behavioral process use in predicting drinking frequency 6 and 12 months posttreatment and drinking quantity 6 months posttreatment such that self-efficacy was more strongly related to posttreatment drinking when low levels of processes were reported than high levels, but interactions were attenuated when end-of-treatment abstinence was controlled for. Significant quadratic relations between end-of-treatment self-efficacy and 6- and 12-month posttreatment drinking quantity and frequency were found (p < .001, ƒ² = 0.02–0.03), such that self-efficacy most robustly predicted outcomes when high. These effects remained significant when end-of-treatment abstinence was included as a covariate. Findings highlight the complex nature of self-efficacy’s relation with drinking outcomes. Although the interaction between self-efficacy and behavioral processes was attenuated when end-of-treatment abstinence was controlled for, the quadratic effect of self-efficacy on outcomes remained significant. The pattern of these effects did not support the idea of “overconfidence” as a negative indicator. (PsycINFO Database Record (c) 2015 APA, all rights reserved)


Examining temptation to drink from an existential perspective: Associations among temptation, purpose in life, and drinking outcomes.Open in a New Window

Temptation to drink (TTD), defined as the degree to which one feels compelled to drink in the presence of internal or external alcohol-related cues, has been shown to predict alcohol-treatment outcomes among individuals with alcohol-use disorders (AUDs). Research examining TTD from an existential perspective is lacking and little is known about how existential issues such as purpose in life (PIL) relate to TTD, which is surprising given the role of existential issues in many treatments and mutual help approaches for AUDs. In the current study, we examined the longitudinal associations in a sample of 1726 among TTD, PIL, and drinking outcomes using data from Project MATCH (1997, 1998). Parallel process latent growth curve analyses indicated that PIL and TTD were significantly associated across time, such that higher initial levels of PIL and increases in PIL over time were associated with lower initial levels of TTD and decreases in TTD over time. Higher initial levels of TTD, lower initial levels of PIL, increases in TTD, and decreases in PIL were significantly associated with greater intensity and frequency of drinking and greater drinking-related consequences at the 15-month follow-up. Accordingly, TTD and PIL may be important constructs for clinicians to consider throughout the course of treatment. Future studies should examine if and how various kinds of treatments for AUDs are associated with increases in PIL, and whether these increases are related to decreased TTD and reduced drinking. (PsycINFO Database Record (c) 2015 APA, all rights reserved)


Older adults who are at risk of driving under the influence: A latent class analysis.Open in a New Window

Despite increasing rates of substance use among older adults, their risk of driving under the influence of alcohol and/or drugs (DUI) has received scant research attention. This study identified DUI risk profiles among individuals aged 50+ years based on their substance use patterns, previous DUI incidents, and previous arrests. This study’s analytic sample of 11,188 individuals came from the public use data sets of the 2008 to 2012 National Survey on Drug Use and Health. Latent class analysis identified a 4-class model as the most parsimonious. Class 1 (63% of the analytic sample; lowest risk group) exhibited the lowest probabilities of substance use and trouble with law while Class 4 (9% of the sample; highest risk group) included binge/heavy drinkers who are also likely to use illicit drugs and had the highest probabilities of self-reported DUI and previous arrests. Class 2 (18.5%) and Class 3 (9.5%) exhibited low-to-medium DUI risks. Class 4 had the highest proportions of Blacks and divorced or never married persons and had lowest education and income, poorest self-rated health, and highest rates of mental health problems of all classes. Screening for substance abuse and comorbid mental health conditions should be included in protocols for assessing older adults’ driving safety. More effort is also needed to improve access to substance abuse treatment and address mental health problems among older adults at high risk for DUI. (PsycINFO Database Record (c) 2015 APA, all rights reserved)


Do students use contextual protective behaviors to reduce alcohol-related sexual risk? Examination of a dual-process decision-making model.Open in a New Window

Recent studies suggest drinking protective behaviors (DPBs) and contextual protective behaviors (CPBs) can uniquely reduce alcohol-related sexual risk in college students. Few studies have examined CPBs independently, and even fewer have utilized theory to examine modifiable psychosocial predictors of students’ decisions to use CPBs. The current study used a prospective design to examine (a) rational and reactive pathways and psychosocial constructs predictive of CPB use and (b) how gender might moderate these influences in a sample of college students. Students (n = 508) completed Web-based baseline (mid-Spring semester) and 1- and 6-month follow-up assessments of CPB use; psychosocial constructs (expectancies, normative beliefs, attitudes, and self-concept); and rational and reactive pathways (intentions and willingness). Regression was used to examine rational and reactive influences as proximal predictors of CPB use at the 6-month follow-up. Subsequent path analyses examined the effects of psychosocial constructs, as distal predictors of CPB use, mediated through the rational and reactive pathways. Both rational (intentions to use CPB) and reactive (willingness to use CPB) influences were significantly associated with increased CPB use. The examined distal predictors were found to effect CPB use differentially through the rational and reactive pathways. Gender did not significantly moderate any relationships within in the model. Findings suggest potential entry points for increasing CPB use that include both rational and reactive pathways. Overall, this study demonstrates the mechanisms underlying how to increase the use of CPBs in programs designed to reduce alcohol-related sexual consequences and victimization. (PsycINFO Database Record (c) 2015 APA, all rights reserved)


Identifying risky drinking patterns over the course of Saturday evenings: An event-level study.Open in a New Window

Gaining a better understanding of young adults’ excessive drinking on nights out is crucial to ensure prevention efforts are effectively targeted. This study aims to identify Saturdays with similar evening drinking patterns and corresponding situation-specific and person-specific determinants. Growth mixture modeling and multilevel logistic regressions were based on 3,084 questionnaires completed by 164 young adults on 514 evenings via the Internet-based cell phone optimized assessment technique (ICAT). The results showed that the 2-group solution best fitted the data with a “stable low” drinking pattern (64.0% of all evenings, 0.2 drinks per hour on average, 1.5 drinks in total) and an “accelerated” drinking pattern (36.0%, increased drinking pace from about 1 drink per hour before 8 p.m. to about 2 drinks per hour after 10 p.m.; 11.5 drinks in total). The presence of more same-sex friends (ORwomen = 1.29, 95% CI [1.09–1.53]; ORmen = 1.35, 95% CI [1.15–1.58], engaging in predrinking (ORwomen = 2.80, 95% CI [1.35–5.81]; ORmen = 3.78, 95% CI [1.67–8.55] and more time spent in drinking establishments among men (ORmen = 1.46, 95% CI [1.12–1.90] predicted accelerated drinking evenings. Accelerated drinking was also likely among women scoring high on coping motives at baseline (ORwomen = 2.40, 95% CI [1.43–4.03] and among men scoring high on enhancement motives (ORmen = 2.36, 95% CI [1.46–3.80]. To conclude, with a total evening consumption that is almost twice the threshold for binge drinking, the identified accelerated drinking pattern signifies a burden for individual and public health. Promoting personal goal setting and commitment, and reinforcing self-efficacy and resistance skills training appear to be promising strategies to impede the acceleration of drinking pace on Saturday evenings. (PsycINFO Database Record (c) 2015 APA, all rights reserved)


Premeditation moderates the relation between sensation seeking and risky substance use among young adults.Open in a New Window

Young adulthood is a peak period for externalizing behaviors such as substance abuse and antisocial conduct. Evidence from developmental neuroscience suggests that externalizing conduct within this time period may be associated with a “developmental asymmetry” characterized by an early peak in sensation seeking combined with a relatively immature impulse control system. Trait measures of impulsivity—sensation seeking and premeditation—are psychological manifestations of these respective systems, and multiple prior studies suggest that high sensation seeking and low premeditation independently confer risk for distinct forms of externalizing behaviors. The goal of the present study was to test this developmental asymmetry hypothesis, examining whether trait premeditation moderates the effect of sensation seeking on substance use and problems, aggression, and rule-breaking behavior. Using a cross-sectional sample of college-enrolled adults (n = 491), we applied zero-inflated modeling strategies to examine the likelihood and level of risky externalizing behaviors. Results indicated that lower premeditation enhanced the effect of higher sensation seeking on higher levels of positive and negative alcohol consequences, more frequent drug use, and more problematic drug use, but was unrelated to individual differences in antisocial behaviors. Our findings indicate that the developmental asymmetry between sensation seeking and a lack of premeditation is a risk factor for individual differences in problematic substance use among young adults, and may be less applicable for antisocial behaviors among high functioning individuals. (PsycINFO Database Record (c) 2015 APA, all rights reserved)


Prevalence and correlates of sipping alcohol in a prospective middle school sample.Open in a New Window

Research documents an association between early use of alcohol and adverse outcomes. Most studies on drinking initiation exclude sipping or confound sips with consumption of a full drink. However, even a few sips of alcohol can constitute a meaningful experience for naïve drinkers. Prior research with this project indicated that sipping before middle school predicted subsequent adverse outcomes (at high-school entry), even controlling for child externalizing and sensation seeking and parent alcohol use. The present study extends our prior work by examining the correlates of early sipping and sipping onset. The sample was comprised of 1,023 6th, 7th, and 8th graders (52% female; 24% non-White, and 12% Hispanic). Participants completed Web-based surveys on 5 occasions over the course of 2 years. The prevalence of sipping at Wave 1 was 37%, with 29% of never-sippers initiating sipping within 2 years. Sipping was associated with stronger alcohol-related cognitions and low school engagement as well as contextual influences in the peer, sibling, and parent domains. Sipping onset among never-sippers was prospectively predicted by sensation seeking and problem behavior as well as parental and sibling influences. More important, mere availability of alcohol was a strong correlate both concurrently and prospectively. Further analyses demonstrated that youth who sipped alcohol with parental permission had a lower profile of risk and healthier relationships with parents as compared with youth who reported unsanctioned sipping. Findings point to the importance of considering fine-grained early drinking behavior and call for further attention to sipping in research on initiation of alcohol use. (PsycINFO Database Record (c) 2015 APA, all rights reserved)


Do therapist behaviors differ with Hispanic youth? A brief look at within-session therapist behaviors and youth treatment response.Open in a New Window

Brief addiction treatments, including motivational interviewing (MI), have shown promise with youth. One underexamined factor in this equation is the role of therapist behaviors. We therefore sought to assess whether and how therapist behaviors differ for Hispanic versus non-Hispanic youth and how that may be related to treatment outcome. With 80 substance-using adolescents (M age = 16 years; 65% male; 59% Hispanic; 41% non-Hispanic), we examined the relationship between youth ethnicity and therapist behaviors across two brief treatments (MI and alcohol/marijuana education [AME]). We then explored relationships to youth 3-month treatment response across four target outcomes: binge drinking days, alcohol-related problems, marijuana use days, and marijuana-related problems. In this study, therapists showed significantly more MI skills within the MI condition and more didactic skills in the AME condition. With respect to youth ethnicity, across both conditions (MI and AME), therapists used less MI skills with Hispanic youth. Contrary to expectations, therapists’ use of MI skills was not connected to poorer outcomes for Hispanic youth across the board (e.g., for binge drinking days, marijuana use days, or marijuana-related problems). Rather, for Hispanic youth, therapists’ use of lower MI skills was related only to poorer treatment outcomes in the context of alcohol-related problems. The observed relationships highlight the importance of investigating salient treatment interactions between therapist factors and youth ethnicity to guide improvements in youth treatment response. (PsycINFO Database Record (c) 2015 APA, all rights reserved)


The relationship between psychological distress and adolescent polydrug use.Open in a New Window

Polydrug use is relatively common among adolescents. Psychological distress is associated with the use of specific drugs, and may be uniquely associated with polydrug use. The purpose of this study was to test the association of psychological distress with polydrug use using a large adolescent sample. The sample consisted of 10,273 students aged 12–17 years from the State of Victoria, Australia. Participants completed frequency measures of tobacco, alcohol, cannabis, inhalant, and other drug use in the past 30 days, and psychological distress. Control variables included age, gender, family socioeconomic status, school suspensions, academic failure, cultural background, and peer drug use. Drug-use classes were derived using latent-class analysis, then the association of psychological distress and controls with drug-use classes was modeled using multinomial ordinal regression. There were 3 distinct classes of drug use: no drug use (47.7%), mainly alcohol use (44.1%), and polydrug use (8.2%). Independent of all controls, psychological distress was higher in polydrug users and alcohol users, relative to nondrug users, and polydrug users reported more psychological distress than alcohol users. Psychological distress was most characteristic of polydrug users, and targeted prevention outcomes may be enhanced by a collateral focus on polydrug use and depression and/or anxiety. (PsycINFO Database Record (c) 2015 APA, all rights reserved)


Thresholds of probable problematic gambling involvement for the German population: Results of the Pathological Gambling and Epidemiology (PAGE) Study.Open in a New Window

Consumption measures in gambling research may help to establish thresholds of low-risk gambling as 1 part of evidence-based responsible gambling strategies. The aim of this study is to replicate existing Canadian thresholds of probable low-risk gambling (Currie et al., 2006) in a representative dataset of German gambling behavior (Pathological Gambling and Epidemiology [PAGE]; N = 15,023). Receiver-operating characteristic curves applied in a training dataset (60%) extracted robust thresholds of low-risk gambling across 4 nonexclusive definitions of gambling problems (1 + to 4 + Diagnostic and Statistical Manual for Mental Disorders-Fifth Edition [DSM-5] Composite International Diagnostic Interview [CIDI] symptoms), different indicators of gambling involvement (across all game types; form-specific) and different timeframes (lifetime; last year). Logistic regressions applied in a test dataset (40%) to cross-validate the heuristics of probable low-risk gambling incorporated confounding covariates (age, gender, education, migration, and unemployment) and confirmed the strong concurrent validity of the thresholds. Moreover, it was possible to establish robust form-specific thresholds of low-risk gambling (only for gaming machines and poker). Possible implications for early detection of problem gamblers in offline or online environments are discussed. Results substantiate international knowledge about problem gambling prevention and contribute to a German discussion about empirically based guidelines of low-risk gambling. (PsycINFO Database Record (c) 2015 APA, all rights reserved)


The influence of impulsiveness on binge eating and problem gambling: A prospective study of gender differences in Canadian adults.Open in a New Window

This study investigated the degree to which facets of impulsiveness predicted future binge eating and problem gambling, 2 theorized forms of behavioral addiction. Participants were 596 women and 406 men from 4 age cohorts randomly recruited from a Canadian province. Participants completed self-report measures of 3 facets of impulsiveness (negative urgency, sensation seeking, lack of persistence), binge-eating frequency, and problem-gambling symptoms. Impulsiveness was assessed at baseline, and assessments of binge eating and problem gambling were followed up after 3 years. Weighted data were analyzed using zero-inflated negative binomial and Poisson regression models. We found evidence of transdiagnostic and disorder-specific predictors of binge eating and problem gambling. Negative urgency emerged as a common predictor of binge eating and problem gambling among women and men. There were disorder-specific personality traits identified among men only: High lack-of-persistence scores predicted binge eating and high sensation-seeking scores predicted problem gambling. Among women, younger age predicted binge eating and older age predicted problem gambling. Thus, there are gender differences in facets of impulsiveness that longitudinally predict binge eating and problem gambling, suggesting that treatments for these behaviors should consider gender-specific personality and demographic traits in addition to the common personality trait of negative urgency. (PsycINFO Database Record (c) 2015 APA, all rights reserved)


How do impulsivity traits influence problem gambling through gambling motives? The role of perceived gambling risk/benefits.Open in a New Window

Although substantial research suggests that motivations have been found to mediate the relationships between impulsivity traits and various forms of substance use, no studies have examined how gambling motives may mediate the relationships between impulsivity traits and problem gambling. The primary purpose of this study was to test an integrative model linking impulsivity traits and gambling problems, evaluating the mediating effects of gambling motives. Participants were 594 students (73% male; age, M = 19.92 years; SD = 2.91) enrolled in public high schools or universities. Young people who tend to act rashly in response to extremely positive moods showed higher enhancement and coping motives, which in turn were positively related to gambling problems. Individuals with higher levels of sensation seeking were more likely to have higher levels of enhancement motives, which in turn were also positively related to gambling problems. The model was examined in several groups, separately for the level of perceived gambling risk/benefits (lower perceived gambling risk, higher perceived gambling risk, lower perceived gambling benefits, and higher perceived gambling benefits). There were significant differences between these groups for this division. These findings suggest that prevention and/or treatment strategies might need to consider the model’s variables, including impulsivity traits and gambling motives, in accordance with individual levels of perceived gambling risk/benefits. (PsycINFO Database Record (c) 2015 APA, all rights reserved)
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