[Show abstract][Hide abstract] ABSTRACT: Background:
Binge drinking is associated with numerous negative consequences. The prevalence and intensity of binge drinking is highest among young adults. This randomized trial tested the efficacy of a 12-week interactive text message intervention to reduce binge drinking up to 6 months after intervention completion among young adults.
Methods and findings:
Young adult participants (18-25 y; n = 765) drinking above the low-risk limits (AUDIT-C score >3/4 women/men), but not seeking alcohol treatment, were enrolled from 4 Emergency Departments (EDs) in Pittsburgh, PA. Participants were randomized to one of three conditions in a 2:1:1 allocation ratio: SMS Assessments + Feedback (SA+F), SMS Assessments (SA), or control. For 12 weeks, SA+F participants received texts each Thursday querying weekend drinking plans and prompting drinking limit goal commitment and each Sunday querying weekend drinking quantity. SA+F participants received tailored feedback based on their text responses. To contrast the effects of SA+F with self-monitoring, SA participants received texts on Sundays querying drinking quantity, but did not receive alcohol-specific feedback. The control arm received standard care. Follow-up outcome data collected through web-based surveys were provided by 78% of participants at 3- months, 63% at 6-months and 55% at 9-months. Multiple imputation-derived, intent-to-treat models were used for primary analysis. At 9-months, participants in the SA+F group reported greater reductions in the number of binge drinking days than participants in the control group (incident rate ratio [IRR] 0.69; 95% CI .59 to.79), lower binge drinking prevalence (odds ratio [OR] 0.52; 95% CI 0.26 to 0.98]), less drinks per drinking day (beta -.62; 95% CI -1.10 to -0.15) and lower alcohol-related injury prevalence (OR 0.42; 95% CI 0.21 to 0.88). Participants in the SA group did not reduce drinking or alcohol-related injury relative to controls. Findings were similar using complete case analyses.
An interactive text-message intervention was more effective than self-monitoring or controls in reducing alcohol consumption and alcohol-related injury prevalence up to 6 months after intervention completion. These findings, if replicated, suggest a scalable approach to help achieve sustained reductions in binge drinking and accompanying injuries among young adults.
PLoS ONE 11/2015; 10(11):e0142877. DOI:10.1371/journal.pone.0142877 · 3.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Title:
Cost-effectiveness of motivational intervention with significant others for patients with alcohol misuse AIMS: To estimate the incremental cost, cost-effectiveness, and benefit-cost ratio of incorporating a significant other (SO) into motivational intervention for alcohol misuse.
We obtained economic data from the one year with the intervention in full operation for patients in a recent randomized trial.
The underlying trial took place at a major urban hospital in the USA.
The trial randomized 406 (68.7% male) eligible hazardous drinkers (196 during the economic study) admitted to the emergency department or trauma unit.
The motivational interview condition consisted of one in-person session featuring personalized normative feedback. The significant other motivational interview condition comprised one joint session with the participant and SO in which the SO's perspective and support were elicited.
We ascertained activities across 445 representative time segments through work sampling (including staff idle time), calculated the incremental cost in per patient of incorporating an SO, expressed the results in 2014 U.S. dollars, incorporated quality and mortality effects from a closely related trial, and derived the cost per quality-adjusted life year (QALY) gained.
From a health system perspective, the incremental cost per patient of adding an SO was $341 [95% confidence interval (CI): $244 to $438]. The incremental cost per year per hazardous drinker averted was $3,623 (CI: $1,777 to $22,709), the cost per QALY gained $32,200 (CI: $15,800 to $201,700), and the benefit-cost ratio was 4.73 (95% CI: 0.75 to 9.66). If adding an SO into the intervention strategy were concentrated during the hours with highest risk or in the trauma unit, it would become even more cost-beneficial.
Using criteria established by the World Health Organization (cost-effectiveness below the country's GDP per capita), incorporating a significant other into a patient's motivational intervention for alcohol misuse is highly cost effective.
[Show abstract][Hide abstract] ABSTRACT: Objective:
Students referred to school administration for alcohol policies violations currently receive a wide variety of interventions. This study examined predictors of response to 2 interventions delivered to mandated college students (N = 598) using a stepped care approach incorporating a peer-delivered 15-min brief advice (BA) session (Step 1) and a 60- to 90-min brief motivational intervention (BMI) delivered by trained interventionists (Step 2).
Analyses were completed in 2 stages. First, 3 types of variables (screening variables, alcohol-related cognitions, mandated student profile) were examined in a logistic regression model as putative predictors of lower risk drinking (defined as 3 or fewer heavy episodic drinking [HED] episodes and/or 4 or fewer alcohol-related consequences in the past month) 6 weeks following the BA session. Second, we used generalized estimating equations to examine putative moderators of BMI effects on HED and peak blood alcohol content compared with assessment only (AO) control over the 3-, 6-, and 9-month follow-ups.
Participants reporting lower scores on the Alcohol Use Disorders Identification Test, more benefits to changing alcohol use, and those who fit the "Bad Incident" profile at baseline were more likely to report lower risk drinking 6 weeks after the BA session. Moderation analyses revealed that Bad Incident students who received the BMI reported more HED at 9-month follow-up than those who received AO.
Current alcohol use as well as personal reaction to the referral event may have clinical utility in identifying which mandated students benefit from treatments of varying content and intensity. (PsycINFO Database Record
Journal of Consulting and Clinical Psychology 10/2015; DOI:10.1037/a0039800 · 4.85 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: High rates of cognitive impairment persist in human immunodeficiency virus (HIV) infection, despite improved health outcomes and reduced mortality through widespread use of antiretroviral therapy (ART). Heavy alcohol use and cigarette smoking are potential contributors to neurocognitive impairment in people living with HIV (PLWH), yet few studies have examined their influence concurrently. Here we investigated the effects of self-reported alcohol use and smoking on learning, memory, processing speed, verbal fluency, and executive function in 124 HIV-positive men who have sex with men [age (mean ± SD) = 42.8 ± 10.4 years], engaged with medical care. All participants were heavy drinkers. Duration of HIV infection averaged 9.9 ± 7.6 years, and 92.7% were on a stable ART regimen. Participants completed a neuropsychological battery and assessment of past 30-day substance use. Average number of drinks per drinking day (DPDD) was 5.6 ± 3.5, and 33.1% of participants were daily smokers. Rates of neurocognitive impairment were the highest in learning (50.8%), executive function (41.9%), and memory (38.0%). Multiple regression models tested DPDD and smoking status as predictors of neurocognitive performance, controlling for age and premorbid intelligence. Smoking was significantly, negatively related to verbal learning (p = .046) and processing speed (p = .001). DPDD was a significant predictor of learning (p = .047) in a model that accounted for the interaction of DPDD and smoking status. As expected, premorbid intelligence significantly predicted all neurocognitive scores (ps < .01), and older age was associated with slower processing speed (ps < .01). In conclusion, smoking appears to be associated with neurocognitive functioning deficits in PLWH beyond the effects of heavy drinking, aging, and premorbid intelligence. Smoking cessation interventions have the potential to be an important target for improving functional outcomes in heavy drinking PLWH.
AIDS Care 10/2015; DOI:10.1080/09540121.2015.1093595 · 1.60 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Substance use among adolescents with one or more psychiatric disorders is a significant public health concern. In this study, 151 psychiatrically hospitalized adolescents, ages 13-17 with comorbid psychiatric and substance use disorders, were randomized to a two-session Motivational Interviewing intervention to reduce substance use plus treatment as usual (MI) vs. treatment as usual only (TAU). Results indicated that the MI group had a longer latency to first use of any substance following hospital discharge relative to TAU (36days versus 11days). Adolescents who received MI also reported less total use of substances and less use of marijuana during the first 6months post-discharge, although this effect was not significant across 12months. Finally, MI was associated with a significant reduction in rule-breaking behaviors at 6-month follow-up. Future directions are discussed, including means of extending effects beyond 6months and dissemination of the intervention to community-based settings.
[Show abstract][Hide abstract] ABSTRACT: Background
The study aim was to assess the prevalence and co-occurrence of alcohol and sexual risk behaviors among emergency department (ED) patients in community hospitals.Methods
Systematic screening of ED patients (N = 6,486; 56.5% female) was conducted in 2 community hospitals in the northeast during times with high patient volume, generally between the hours of 10 AM to 8 PM, Monday through Saturday. Screening occurred from May 2011 through November 2013. Assessment included validated measures of alcohol use and sexual risk behavior.ResultsOverall results identified high rates of alcohol use, sexual risk behaviors, and their co-occurrence in this sample of ED patients. Specifically, ED patients in between the ages of 18 and 35 were consistently highest in hazardous alcohol use (positive on the Alcohol Use Disorders Identification Test or endorsing heavy episodic drinking [HED]), sexual risk behaviors, and the co-occurrence of alcohol and sex-risk behaviors.Conclusions
Findings show a high co-occurrence of hazardous drinking and unprotected sex among ED patients and highlight the role of HED as a factor associated with sexual risk behavior. Efforts to integrate universal screening for the co-occurrence of alcohol and sexual risk behavior in ED settings are warranted; brief interventions delivered to ED patients addressing the co-occurrence of alcohol and sexual risk behaviors have the potential to decrease the risk of sexually transmitted infections and HIV among a large number of patients.
Alcoholism Clinical and Experimental Research 09/2015; 39(10). DOI:10.1111/acer.12842 · 3.21 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Animal and human data suggest that adolescents experience hangover effects that are distinct from adults. The present study used ecological momentary assessment (EMA) methods to examine the temporal relationships between drinking and hangovers, and how this varied by age and sex. We hypothesized that alcohol's dose-dependent effects on hangover severity are more pronounced among adolescents and young adults than older drinkers. We also explored whether greater hangover severity would lead to a lower likelihood and volume of alcohol use later the same day. Data were pooled from 4 studies of drinkers (N = 274; ages 15 to 66 years) who completed a 4- to 14-day (M = 7.46, SD = 1.13) EMA monitoring period. Each morning, participants recorded how much alcohol they consumed the day before and rated their hangover severity. Participants who consumed a greater quantity of alcohol the prior day reported more severe hangover symptoms; however, there was an interaction between drinking volume and age, such that hangover was more severe among younger drinkers, especially at higher drinking levels. More severe hangover symptoms did not predict the likelihood of drinking later that day; however, on drinking days, more severe hangover symptoms predicted lower quantities of alcohol use later that day. This event-level effect did not vary as a function of age. Study outcomes did not vary by sex. Our findings suggest that younger drinkers experience more severe hangovers, and that greater hangover results in lighter drinking later that same day regardless of age. (PsycINFO Database Record
(c) 2015 APA, all rights reserved).
[Show abstract][Hide abstract] ABSTRACT: Ecological momentary assessment (EMA) has afforded several important advances in the field of alcohol research, including testing prominent models of alcohol abuse etiology in “high resolution.” Using high-tech methods for signaling and/or assessment, such as mobile electronic diaries, personal data assistants, and smartphones, EMA approaches potentially can improve understanding of precipitants of drinking, drinking patterns, and consequences. For example, EMA has been used to study complex drinking patterns and dynamic predictors of drinking in near–real time. Compared with other methods, EMA can better sample and capture changes in these phenomena that occur in relatively short time frames. EMA also has several potential applications in studying the consequences of alcohol use, including physical, interpersonal,
behavioral, and legal problems. However, even with all these potential capabilities, EMA research in the alcohol field still is associated with some limitations, including the potential for measurement reactivity and problems with acceptability and compliance. Despite these limitations, electronically based EMA methods are versatile and are capable of capturing data relevant to a variety of momentary influences on both alcohol
use and consequences. Therefore, it will be exciting to fully realize the potential of future applications of EMA technologies, particularly if the associated costs can be reduced.
Alcohol research : current reviews 08/2015; 36(1):19-27.
[Show abstract][Hide abstract] ABSTRACT: Introduction:
Misreporting smoking behavior is common among younger smokers participating in clinical trials for smoking cessation. This study focused on the prevalence of and factors associated with adolescent misreporting of smoking behaviors within the context of a randomized clinical trial for smoking cessation.
Adolescent smokers (N=129) participated in a randomized clinical trial that compared two brief interventions for smoking cessation. Following the final (6-month) follow-up, a confidential, self-administered exit questionnaire examined the extent to which participants admitted to having misreported smoking quantity, frequency and/or consequences during the study. Factors associated with under- and over-reporting were compared to accurate-reporting.
One in 4 adolescent smokers (25.6%) admitted to under-reporting during the study and 14.7% admitted to over-reporting; 10.9% of the adolescents admitted to both under- and over-reporting. Rates of admitted misreporting did not differ between treatment conditions or recruitment site. Compared to accurate-reporting, under- and over-reporting were significantly associated with home smoking environment and the belief among adolescents that the baseline interviewer wanted them to report smoking more or less than they actually smoked. Compared to accurate reporters, over-reporters were more likely to be non-White and to report being concerned with the confidentiality of their responses.
A post-study confidential debriefing questionnaire can be a useful tool for estimating rates of misreporting and examining whether potential differences in misreporting might bias the interpretation of treatment effects. Future studies are needed to thoroughly examine potentially addressable reasons that adolescents misreport their smoking behavior and to develop methods for reducing misreporting.
[Show abstract][Hide abstract] ABSTRACT: Stepped care approaches for mandated college students provide individual brief motivational interventions (BMI) only for individuals who do not respond to an initial, low-intensity level of treatment such as Brief Advice (BA). However, how BMIs facilitate change in this higher-risk group of mandated students remains unclear. Perceived descriptive norms and alcohol-related expectancies are the most commonly examined mediators of BMI efficacy but have yet to be examined in the context of stepped care. Participants were mandated college students (N = 598) participating in a stepped care trial in which mandated students first received BA. Those who reported continued risky drinking 6 weeks following a BA session were randomized to either a single-session BMI (N = 163) or an assessment-only comparison condition (AO; N = 165). BMI participants reduced alcohol-related problems at the 9 month follow up significantly more than AO participants. Multiple mediation analyses using bootstrapping techniques examined whether perceived descriptive norms and alcohol-related expectancies mediated the observed outcomes. Reductions in perceptions of average student drinking (B = -.24; 95% CI [-.61, -.04]) and negative expectancies (B = -.13; 95% CI [-.38, -.01]) mediated the BMI effects. Furthermore, perceived average student norms were reduced after the BMI to levels approximating those of students who had exhibited lower risk drinking following the BA session. Findings highlight the utility of addressing perceived norms and expectancies in BMIs, especially for students who have not responded to less intensive prevention efforts. (PsycINFO Database Record
(c) 2015 APA, all rights reserved).
Psychology of Addictive Behaviors 06/2015; DOI:10.1037/adb0000092 · 2.09 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Past research has shown that underage college-student drinkers (UCSDs) report increased subjective craving and exhibit stronger attentional biases to alcohol following alcohol-cue exposure. To date, less research has examined whether momentary decreases in alcohol craving are associated with reductions in attentional bias. One experimental manipulation that has been used to produce within-session decreases in alcohol craving is to extend the duration of laboratory-based alcohol-cue exposure protocols. The aim of this study was to examine the effects of both brief and extended alcohol-cue exposure on subjective craving and attentional bias among UCSDs. Eighty participants were randomized either to a group that received a short, in vivo, alcohol-cue-exposure period (short-exposure group [SE], 2 3-min blocks) or to a group that received a long-exposure period (long-exposure group [LE], 6 3-min blocks). Both groups completed a visual probe task before and after cue exposure to assess changes in attentional bias. Analyses revealed no group differences in mean craving or mean attentional bias before or after cue exposure. Further, exploratory analyses revealed no sex differences in our measures of craving or attentional bias. For Group LE, but not Group SE, within-session changes in craving positively predicted within-session changes in attentional bias. However, further analyses revealed that this relationship was significant only for women in the LE group. Implications for treatments that aim to reduce craving and/or attentional bias are discussed. (PsycINFO Database Record
(c) 2015 APA, all rights reserved).
[Show abstract][Hide abstract] ABSTRACT: Cue-elicited craving for alcohol is well established but extinction-based treatment to extinguish this response has generated only modest positive outcomes in clinical trials. Basic and clinical research suggests that D-cycloserine (DCS) enhances extinction to fear cues under certain conditions. However, it remains unclear whether DCS would also accelerate extinction of cue-elicited craving for alcohol. The goal of the current study was to examine whether, compared with placebo (PBO), DCS enhanced extinction of cue-elicited craving among treatment-seeking individuals with alcohol use disorders (AUDs). Participants were administered DCS (50 mg) or PBO 1 h before an alcohol extinction paradigm in a simulated bar environment on two occasions. The extinction procedures occurred 1 week apart and were fully integrated into outpatient treatment. Subjective craving for alcohol was the primary variable of interest. Follow-up cue reactivity sessions were conducted 1 week and 3 weeks later to ascertain persisting DCS effects. Drinking outcomes and tolerability were also examined. DCS was associated with augmented reductions in alcohol craving to alcohol cues during the first extinction session and these effects persisted through all subsequent sessions, suggesting facilitation of extinction. Participants in the DCS condition reported significant short-term reductions in drinking, although these did not persist to follow-up, and found the medication highly tolerable. These findings provide evidence that DCS enhances extinction of cue-elicited craving for alcohol in individuals with AUDs in the context of outpatient treatment. The potential clinical utility of DCS is discussed, including methodological considerations and context-dependent learning.
[Show abstract][Hide abstract] ABSTRACT: Unhealthy alcohol use is common among HIV-infected patients and contributes to co-morbidities, cognitive decline, unprotected sex, and poor medication adherence. Studies consistently show missed opportunities to address unhealthy alcohol use as part of care. Although treatment of other drug use has been integrated into HIV care in some settings, more information is needed regarding provider attitudes regarding the need for integration of alcohol treatment and HIV care.
We surveyed 119 HIV and 159 addiction providers regarding the following domains: existing knowledge, desire for new knowledge (with subdomains relative advantage, compatibility, and complexity of integrating knowledge), and individual and program development needs. Scale scores for each domain were correlated with demographics to identify factors associated with training need.
Both HIV and addiction providers reported agreement with statements of existing knowledge and the need for additional skills. The priority attributed to training, however, was low for both groups. Knowledge and perceived prevalence of HIV and unhealthy alcohol use increased with years of experience. Perceived prevalence correlated with compatibility but not the relative advantage of training.
Though addressing alcohol use and HIV was acknowledged to be important, the priority of this was low, particularly early career providers. These providers may be important targets for training focusing on motivating coordination of care and skills related to assessment and counseling.
Addictive Disorders & Their Treatment 03/2015; 14(1):16-28. DOI:10.1097/ADT.0000000000000040
[Show abstract][Hide abstract] ABSTRACT: Topiramate reduces drinking, but little is known about the mechanisms that precipitate this effect. This double-blind randomized placebo-controlled study assessed the putative mechanisms by which topiramate reduces alcohol use among 96 adult non-treatment-seeking heavy drinkers in a laboratory-based alcohol cue reactivity assessment and in the natural environment using ecological momentary assessment methods. Topiramate reduced the quantity of alcohol heavy drinkers consumed on drinking days and reduced craving while participants were drinking but did not affect craving outside of drinking episodes in either the laboratory or in the natural environment. Topiramate did not alter the stimulant or sedative effects of alcohol ingestion during the ascending limb of the blood alcohol curve. A direct test of putative mechanisms of action using multilevel structural equation mediation models showed that topiramate reduced drinking indirectly by blunting alcohol-induced craving. These findings provide the first real-time prospective evidence that topiramate reduces drinking by reducing alcohol's priming effects on craving and highlight the importance of craving as an important treatment target of pharmacotherapy for alcoholism.
[Show abstract][Hide abstract] ABSTRACT: The discipline of behavioral economics integrates principles from psychology and economics to systematically characterize decision-making preferences. Two forms of behavioral economic decision making are of relevance to HIV risk behavior: delay discounting, reflecting preferences for immediate small rewards relative to larger delayed rewards (i.e., immediate gratification), and probability discounting, reflecting preferences for larger probabilistic rewards relative to smaller guaranteed rewards (i.e., risk sensitivity). This study examined questionnaire-based indices of both types of discounting in relation to sexual risk taking in an emergency department sample of hazardous drinkers who engage in risky sexual behavior. More impulsive delay discounting was significantly associated with increased sexual risk-taking during a drinking episode, but not general sexual risk-taking. Probability discounting was not associated with either form of sexual risk-taking. These findings implicate impulsive delay discounting with sexual risk taking during alcohol intoxication and provide further support for applying this approach to HIV risk behavior.
AIDS and Behavior 09/2014; 19(3). DOI:10.1007/s10461-014-0909-6 · 3.49 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The effect of alcohol-cue exposure on eliciting craving has been well documented, and numerous theoretical models assert that craving is a clinically significant construct central to the motivation and maintenance of alcohol-seeking behavior. Furthermore, some theories propose a relationship between craving and attention, such that cue-induced increases in craving bias attention toward alcohol cues, which, in turn, perpetuates craving. This study examined the extent to which alcohol cues induce craving and bias attention toward alcohol cues among underage college-student drinkers. We designed within-subject cue-reactivity and visual-probe tasks to assess in vivo alcohol-cue exposure effects on craving and attentional bias on 39 undergraduate college drinkers (ages 18-20). Participants expressed greater subjective craving to drink alcohol following in vivo cue exposure to a commonly consumed beer compared with water exposure. Furthermore, following alcohol-cue exposure, participants exhibited greater attentional biases toward alcohol cues as measured by a visual-probe task. In addition to the cue-exposure effects on craving and attentional bias, within-subject differences in craving across sessions marginally predicted within-subject differences in attentional bias. Implications for both theory and practice are discussed. (PsycINFO Database Record (c) 2014 APA, all rights reserved).