Drinking Motives Mediate the Relationship Between Facets of Mindfulness and Problematic Alcohol Use

Abstract

Mindfulness is a multi-faceted construct, and research suggests that certain components (e.g., Acting with Awareness, Nonjudging) are associated with less problematic alcohol use. Recent research has examined whether specific drinking motives mediate the relationship between facets of mindfulness and alcohol use. The current study sought to extend this research by examining whether certain drinking motives would mediate the relationship between facets of mindfulness and problematic alcohol use in a sample of 207 college students classified as engaging in problematic drinking. Participants completed the Five Facet Mindfulness Questionnaire (FFMQ), Drinking Motives Questionnaire-Revised (DMQ-R), and Alcohol Use Disorders Identification Test (AUDIT). Results indicated that lower levels of Coping motives significantly mediated the relationship between greater Acting with Awareness and lower AUDIT score and between greater Nonjudging and lower AUDIT score. Lower levels of Conformity motives significantly mediated the relationship between greater Acting with Awareness and lower AUDIT score. These findings offer insight into specific mechanisms through which mindfulness is linked to less problematic drinking, and also highlight associations among mindfulness, drinking motives, and alcohol use among a sample of problematic college student drinkers. Future research should determine whether interventions that emphasize Acting with Awareness and Nonjudging facets of mindfulness and/or target coping and conformity motives could be effective for reducing problematic drinking in college students.

Full text

Drinking Motives Mediate the Relationship between Facets of
Mindfulness and Problematic Alcohol Use
Christine Vinci, Ph.D1, Claire A. Spears, Ph.D2, MacKenzie R. Peltier, M.A3, and Amy L.
Copeland, Ph.D3
1Rice University
2The Catholic University of America
3Louisiana State University
Abstract
Mindfulness is a multi-faceted construct, and research suggests that certain components (e.g.,
Acting with Awareness, Nonjudging) are associated with less problematic alcohol use. Recent
research has examined whether specific drinking motives mediate the relationship between facets
of mindfulness and alcohol use. The current study sought to extend this research by examining
whether certain drinking motives would mediate the relationship between facets of mindfulness
and problematic alcohol use in a sample of 207 college students classified as engaging in
problematic drinking. Participants completed the Five Facet Mindfulness Questionnaire (FFMQ),
Drinking Motives Questionnaire-Revised (DMQ-R), and Alcohol Use Disorders Identification
Test (AUDIT). Results indicated that lower levels of Coping motives significantly mediated the
relationship between greater Acting with Awareness and lower AUDIT score and between greater
Nonjudging and lower AUDIT score. Lower levels of Conformity motives significantly mediated
the relationship between greater Acting with Awareness and lower AUDIT score. These findings
offer insight into specific mechanisms through which mindfulness is linked to less problematic
drinking, and also highlight associations among mindfulness, drinking motives, and alcohol use
among a sample of problematic college student drinkers. Future research should determine
whether interventions that emphasize Acting with Awareness and Nonjudging facets of
mindfulness and/or target coping and conformity motives could be effective for reducing
problematic drinking in college students.
Keywords
mindfulness; drinking motives; alcohol use; college students
Corresponding Author: Christine Vinci, Ph.D., Postdoctoral Research Fellow, Rice University, Department of Psychology - MS 25,
6100 Main Street, Houston, TX 77005, Phone: 713-348-3890, christine.vinci@rice.edu, Alternative Email: cvinci28@gmail.com.
Ethical Standards All data collection procedures presented here were approved by the University’s Institutional Review Board (IRB)
and thus have been performed in accordance with the ethical standards in the 1964 Declaration of Helsinki and its later amendments.
The authors declare no conflict of interest.
HHS Public Access
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Introduction
Problematic drinking among college students is typically defined as an individual’s rate of
drinking (explained below) and/or the negative consequences experienced in relation to
alcohol use (Ham & Hope, 2003). When compared to their non-college-aged peers, college
students report greater levels of problematic drinking, specifically indicating higher rates of
drinking alcohol, binge drinking (five or more drinks on one occasion), and heavy drinking
(five or more drinks on one occasion on five or more days in past month) – statistics that
have been consistent since the early 1990’s (SAMSHA, 2014; Wechsler et al., 2002).
Specifically, 59.4% of college students report drinking alcohol (39% of whom report binge
drinking and 12.7% report heavy drinking; SAMHSA, 2014). In a review of the literature of
college student drinking, Perkins (2002) reported a multitude of negative consequences
associated with heavy drinking, including academic impairment, unintended and unprotected
sexual activity, suicidal ideation and attempts, impaired driving, interpersonal violence, and
property damage.
Excess alcohol use is commonly motivated by attempts to alleviate negative affect and/or
enhance positive affect, and multiple theoretical models (e.g., Baker, Piper, McCarthy,
Majeskie, & Fiore, 2004; Conger, 1956; Cooper, Frone, Russell, & Mudar, 1995) have
proposed these relationships. Specifically, Cooper et al. (1995) examined a motivational
model of alcohol use, theorizing that drinking alcohol is motivated by efforts to regulate
both positive and negative mood states. Coping motives (i.e., drinking to regulate negative
emotions), enhancement motives (i.e., drinking to increase positive emotions), and
conformity motives (i.e., drinking due to pressure from others) are posited to differentially
predict alcohol use and subsequent alcohol-related problems and can each be conceptualized
as aiming to regulate mood in some way (whereas drinking for social motives, for instance,
is considered drinking for positive, social reasons; Cooper, 1994). Specifically, adolescents
and adults reporting higher levels of coping motives (when compared to those endorsing
primarily enhancement motives) indicate higher levels of depression (Cooper et al., 1995).
On the other hand, increased endorsement of enhancement motives (versus coping motives)
has been linked to increased levels of positive affect in adults (Cooper et al., 1995).
Importantly, alcohol-related problems have been associated with endorsement of coping
motives (among adolescents and college students) and conformity motives (among
adolescents; Cooper, 1994; Kuntsche, Knibbe, Gmel, & Engels, 2005). Enhancement
motives have been associated with alcohol problems as well, via a mediational path that
indicated heavy alcohol use mediated the relationship between enhancement motives and
alcohol problems among adolescents (Cooper, 1994).
Understanding ways to reduce maladaptive drinking motives may contribute to decreasing
alcohol problems and heavy alcohol use. Mindfulness is one such promising factor, and can
be defined as “paying attention in a particular way: on purpose, in the present moment, and
nonjudgmentally” (Kabat-Zinn, 1994, p.4). Trait mindfulness (or the tendency for mindful
attention and responding in daily life; Brown & Ryan, 2003) is negatively associated with
alcohol use and drinking-related problems (Adams et al., 2015; Black, Semple, Pokhrel, &
Grenard, 2011; Fernandez, Wood, Stein, & Rossi, 2010; Murphy & MacKillop, 2011).
Mindfulness is considered a multi-faceted construct, and a commonly used measure of trait
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mindfulness, the Five Facet Mindfulness Questionnaire (FFMQ; Baer, Smith, Hopkins,
Krietemeyer, & Toney, 2006), includes five subscales: 1)
Observing
(paying attention to
thoughts, feelings and physical sensations), 2)
Describing
(putting thoughts, emotions, and
other experiences into words), 3)
Acting with Awareness
(staying focused on present-
moment activities; opposite of “auto-pilot”), 4)
Nonjudging
(noticing thoughts and feelings
without judging them or criticizing oneself), and 5)
Nonreactivity
(perceiving thoughts and
feelings without reacting or getting caught up in them).
Though not much research has examined which specific facets of mindfulness are associated
with problematic alcohol use, both Fernandez et al. (2010) and Murphy and MacKillop
(2011) found that higher scores on the Acting with Awareness and Nonjudging subscales
were associated with decreased problematic use. Similarly, Reynolds et al. (2015) reported
that Acting with Awareness was related to lower alcohol use (Reynolds, Keough, &
O’Connor, 2015). Negative associations with problematic alcohol use have also been found
for the subscales of Describing (Fernandez et al., 2010) and Nonreactivity (Murphy &
MacKillop, 2011), and the interaction of Observing and Nonreactivity has predicted
substance use (Eisenlohr-Moul, Walsh, Charnigo, Lynam, & Baer, 2012). Specifically,
Observing was associated with less substance use when Nonreactivity was high, whereas
Observing was associated with more substance use when Nonreactivity was low. These
findings suggest that certain facets (e.g., Observe) may differentially predict substance use,
depending on how the facets relate to one another. Implications of these unique interactions
are important, as some facets, such as Observe, may be only useful in reducing substance
use specifically when combined with other facets.
Mindfulness might be particularly relevant for reducing problematic drinking motives.
Mindfulness involves paying attention to thoughts and emotions and accepting them as they
are, without automatically reacting or trying to change them (Bishop et al., 2004; Kabat-
Zinn, 1994). Thus, people with high levels of trait mindfulness might be less likely to turn to
alcohol as a way to change uncomfortable affective states. In fact, Bowen and Enkema
(2014) found that within a clinical sample of treatment-seeking substance users, among
individuals who endorsed using substances as a way to avoid coping, greater dispositional
mindfulness was associated with lower dependence severity, suggesting that mindfulness
may act as a protective factor. Other research suggests that the association between
perceived stress and alcohol use is weaker among more mindful individuals (Adams et al.,
2015), and mindfulness-based treatment appears to weaken relationships among negative
emotions, craving, and drinking (Witkiewitz & Bowen, 2010; Witkiewitz et al., 2011).
Overall, mindfulness may reduce motivation to drink in attempt to manage mood, which
could then lead to reductions in problematic alcohol use.
Research has begun to investigate the relationships among mindfulness, motives for
drinking, and problematic alcohol use. Two prior studies (both using college student
samples) have examined these associations. Reynolds et al. (2015) found that among
undergraduate students at a western university (
n
= 76), the Accepting without Judgment
facet of mindfulness was associated with lower likelihood of drinking for coping and
conformity motives; the Acting with Awareness facet was negatively associated with alcohol
use. In a sample of college students at a southwestern university (
n
= 297), Roos, Pearson,
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and Brown (2015) found that coping motives mediated the relationship between Acting with
Awareness, Describing, and Nonjudging and alcohol use/alcohol-related problems.
Enhancement motives mediated the relationship between Acting with Awareness and
Nonjudging and alcohol problems. Finally, conformity motives mediated the relationship
between Acting with Awareness and Describing and alcohol problems. The results from
these two studies highlight the importance of better understanding how specific aspects of
mindfulness may be linked to drinking motives and behavior among college students.
However, additional research on mindfulness and drinking motives among college student
drinkers who are at-risk for developing more severe drinking behaviors is needed, which is
the focus of the current study.
Despite high levels of binge drinking and heavy drinking among college students
(SAMSHA, 2014), the vast majority of college student drinkers do not have a current
alcohol use disorder. A nationally representative sample of college students found that 18%
had a current diagnosis of an alcohol use disorder (either abuse or dependence; Slutske,
2005). However, the risk of developing a prolonged alcohol use problem is much higher for
college students who engage in problematic drinking. Specifically, problematic drinking in
college has been found to predict the future occurrence of alcohol-related problems (e.g.,
employment difficulties, lower educational attainment) and the development of alcohol-
related disorders in a 10-year follow-up study (Jennison, 2004). Thus, it is critical to develop
interventions for college students who exhibit high-risk drinking patterns. Brief intervention
research has shown success through targeting problematic college student drinkers (Baer,
Kivlahan, Blume, McKnight, & Marlatt, 2001; Borsari & Carey, 2000; Kulesza, Apperson,
Larimer, Copeland, 2010; Kulesza, McVay, Larimer, & Copeland, 2013). Mindfulness-based
interventions also have potential in this population (Ostafin & Marlatt, 2008; Ostafin, Bauer,
& Myxter, 2012), and in order to tailor mindfulness-based interventions for those engaging
in problematic drinking, it is important to understand mechanisms that might link
mindfulness to healthier drinking patterns.
Thus, the present study examined drinking motives as potential mediators of the relationship
between mindfulness and drinking behavior in a sample of problematic college student
drinkers. Specifically, the current study investigated whether specific drinking motives
(coping, enhancement, social, and conformity) would mediate the relationship between
certain facets of mindfulness and problematic alcohol use. Based on previous research
(Murphy & MacKillop, 2011; Reynolds et al., 2015; Roos et al., 2015), we hypothesized that
Acting with Awareness and Nonjudging would be associated with lower problematic alcohol
use. In addition, we expected that mindfulness would be more strongly related to coping
motives than enhancement motives, given that mindfulness appears particularly helpful in
preventing problematic drinking in reaction to negative emotions (Adams et al., 2015;
Witkiewitz & Bowen, 2010; Witkiewitz et al., 2011). As such, we hypothesized that coping
motives would mediate the relationship of Acting with Awareness and problematic alcohol
use, as well as Nonjudging and problematic alcohol use. We also expected that conformity
motives would mediate the relationship between Acting with Awareness and problematic
alcohol use (based on findings from Roos et al., 2015).
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Method
Participants
Participants were current undergraduate students at a large southeastern university. In order
to target problematic college student drinkers, eligible participants had to score six or higher
on the Alcohol Use Disorders Identification Test (AUDIT; Aertgeerts et al., 2000; Devos-
Comby & Lange, 2008; Kokotailo et al., 2004; Meneses-Gaya et al., 2009) and endorse
coping and/or enhancement as primary drinking motives on the Drinking Motives
Questionnaire-Revised (DMQ-R). For complete details regarding number of participants
deemed ineligible and reasons for ineligibility, please see original paper (masked for
review).
Procedures
Data were drawn from a larger study examining the impact of a brief mindfulness
intervention on affect and urge to drink in college student drinkers deemed to be at-risk for
alcohol-related problems (masked for review). The current study utilized baseline measures
from the parent study. The study was approved by the university’s Institutional Review
Board, and all participants completed the informed consent process.
Measures
Demographic Questionnaire—This measure collected information on participant
demographics including age, gender, and race/ethnicity.
Alcohol Use Disorders Identification Test (AUDIT; Babor, Higgins-Bindle,
Saunders, & Monteiro, 2001)—The AUDIT is a 10-item self-report questionnaire that
assesses level of problematic drinking. Questions are rated on a Likert scale from 0 – 4 and
are summed to form the total score. For college students, a score of six or higher has been
identified as the best cut-off score for indicating levels of problematic drinking when
examining ideal sensitivity and specificity outcomes (Aertgeerts et al., 2000; Devos-Comby
& Lange, 2008; Kokotailo et al., 2004; Meneses-Gaya et al., 2009). For instance, among 302
college students, Kokotailo and et al. (2004) found that a score of six or greater had a
sensitivity of 91% and specificity of 60% for detecting problematic levels of drinking.
Aertgeerts et al. (2000) found that among 3,564 college students, a cut-off score of 6 showed
a sensitivity of 80% and specificity of 78%. Thus, all participants scored six or higher on the
AUDIT in the current analyses. Internal consistency for the current study was acceptable (
r
= .64).
Drinking Motives Questionnaire-Revised (DMQ-R; Cooper, 1994)—The DMQ-R
is a 20- item self-report measure assessing four types of drinking motives: Coping,
Enhancement, Social, and Conformity. Each question is rated from 1 (
never
) to 5 (
almost
always
). Drinking primarily for coping and/or enhancement reasons has been previously
identified as being associated with wanting to alter an emotional state (Cooper, 1994).
Sample items From The Coping Subscale are “How often do you drink to cheer up when
you’re in a bad mood?” and “How often do you drink to forget your worries?” Sample items
from the Enhancement subscale include “How often do you drink because it’s exciting?”
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and “How often do you drink because it gives you a pleasant feeling?” Sample items from
the Social subscale include “How often do you drink to celebrate a special occasion with
friends?” and “How often do you drink because it makes social gatherings more fun?”
Sample items from the Conformity subscale include “How often do you drink to be liked?”
“How often would you say you drink to fit in with the group you like?” and “How often do
you drink so you don’t feel left out?” In college student samples, the DMQ-R has
demonstrated high internal consistency (MacLean & Lecci, 2000) and good predictive
validity of drinking problems and heavy drinking (Cooper, 1994). Internal consistency
scores were as follows for the current study: Coping (
r
= .83), Enhancement (
r
= .84), Social
(
r
= .62), and Conformity (
r
= .84).
Five Facet Mindfulness Questionnaire (FFMQ; Baer et al., 2006)—The FFMQ is a
39-item self-report measure that assesses trait mindfulness according to five subscales:
Observing, Describing, Acting with Awareness, Nonjudging, and Nonreactivity. Each
question is rated on a 5- point Likert scale from 1 (
never or rarely true
) to 5 (
very often or
always true
). The FFMQ has demonstrated good internal consistency in college students
(Baer et al., 2006). Internal consistency scores for each subscale were as follows for the
current study: Observing (
r
= .70), Describing (
r
= .91), Acting with Awareness (
r
= .87),
Nonjudging (
r
= .87), and Nonreactivity (
r
= .71).
Analytic Plan
First, linear regression analyses examined associations between FFMQ facets and AUDIT
scores for the entire sample. Second, simple mediation models were tested with Hayes’
(2013) PROCESS macro (model number = 4) in order to test whether drinking motives
(each subscale of the DMQ-R) mediated the relationship between facets of mindfulness
(each subscale of the FFMQ) and problematic drinking (total AUDIT score). Five thousand
bootstrapped samples were used to estimate the indirect effect, and bias-corrected
confidence intervals were developed around the estimated indirect effect. This approach to
mediation has several strengths such as not requiring normality of the sample distribution
and providing greater statistical power (by using the bias-corrected bootstrapping; Hayes,
2013). Furthermore, this approach allows the estimate of the indirect effect to be
independent of the total effect, and the total effect does not have to be significant in order for
mediation to occur (Hayes, 2013). Thus, regardless of results from associations between
FFMQ subscales and alcohol use, mediation models were tested for all FFMQ facets.
Results
Data were analyzed with SPSS version 22. Following screening, the final sample consisted
of 207 problematic college student drinkers (76.3% women). Participants were primarily
Caucasian (85.5%), followed by African American (6.3%), Hispanic (3.5%), and Other
(4.8%). Means and standard deviations for all variables are presented for the entire sample in
Table 1.
Drinking characteristics of the sample, including frequency, quantity, and binge drinking
(defined in this study as consuming six or more drinks on one occasion, which is the
wording utilized in the AUDIT) can be found in Table 2. Bivariate correlations among
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FFMQ subscales, drinking motives, and problematic alcohol are displayed in Table 3. The
FFMQ facet of Observe was associated with increased Social motives; Acting with
Awareness was associated with lower Coping and lower Conformity motives; Nonjudging
was also associated with lower Coping motives. Total AUDIT score was associated with
increased Enhancement, Coping, and Conformity drinking motives, and with lower Acting
with Awareness and Nonjudging scores.
When all subscales of the FFMQ were entered simultaneously to predict AUDIT score, the
overall model was significant
F
(5,206) = 2.78,
p
= .019,
R
2 = .07, and the Acting with
Awareness facet was the only FFMQ subscale that was uniquely related to lower AUDIT
score (β = −.150;
t
= −2.08,
p
= .038). We also entered each FFMQ facet individually to
predict AUDIT score, and both Acting with Awareness
F
(1,206) = 8.51,
p
= .004,
R
2 = .04]
and Nonjudging [
F
(1,206) =
4.26, p
= .040,
R
2 = .02] separately predicted lower AUDIT
score.
Lower levels of Coping motives significantly mediated the relationship between higher
Acting with Awareness and lower AUDIT score (95% CI: −.921,−.164). Figure 1 presents
the complete results for this model. Lower Coping motives also significantly mediated the
relationship between greater Nonjudging and lower AUDIT score (95% CI: −.711,−.139) for
the entire sample. Figure 2 presents the complete results for this model. Lower levels of
Conformity motives significantly mediated the relationship between higher Acting with
Awareness and lower AUDIT score (95% CI: −.483,−.005). Figure 3 presents the complete
results for this model.
Discussion
The current cross-sectional investigation sought to determine whether drinking motives
mediated relationships between facets of mindfulness and problematic alcohol use in college
students who engage in at-risk drinking. This study is novel in that previous work has not
examined problematic college student drinkers, and the present study focuses exclusively on
this population. Both the Acting with Awareness and Nonjudging facets of mindfulness were
associated with lower levels of problematic drinking. However, once all facets were entered
in analyses simultaneously, only Acting with Awareness was uniquely related to lower
problematic drinking. Primary findings indicated that Coping motives significantly mediated
relationships between: 1) Acting with Awareness and AUDIT score, and 2) Nonjudging and
AUDIT score. Conformity motives significantly mediated the relationship between Acting
with Awareness and AUDIT score. If replicated in longitudinal studies, these findings could
contribute to the development of interventions to reduce problematic drinking in college
students. And although more research is needed to clarify the causal nature of these
relationships, the findings offer insight into potential mechanisms underlying associations
between mindfulness and alcohol use.
Regarding the first primary outcome, greater levels of Acting with Awareness were
associated with lower likelihood of drinking as a way to cope with negative emotions, which
was then related to lower levels of problematic drinking. This finding makes sense in light of
current theories highlighting the importance of drinking to manage unpleasant mood (Baker
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et al., 2004; Cooper et al., 1995; Conger 1956). Individuals who are less likely to function
on automatic pilot and who are more likely to focus/pay attention to their present-moment
behavior have lower levels of problematic drinking. This finding confirms prior research
indicating that Acting with Awareness is negatively associated with problematic alcohol use
(Fernandez et al., 2010; Murphy and MacKillop, 2011) and extends the findings of Roos et
al. (2015) that Coping motives may be one important pathway explaining this relationship in
both college student drinkers (Roos et al., 2015) and problematic college student drinkers
(the current study). Mindfulness-based interventions that teach present-focused attention and
purposeful action may help to reduce motives to cope with negative mood by drinking,
which might result in decreased problematic drinking in college students.
Second, Coping motives significantly mediated the relationship between Nonjudging and
total AUDIT score. Examples of Nonjudging items from the FFMQ include, “I criticize
myself for having irrational or inappropriate emotions” and “I disapprove of myself when I
have irrational ideas.” Thus, those who are less judgmental of their inner experiences may be
less likely to drink in an attempt to cope with negative emotions, and accordingly are thus
less likely to engage in problematic drinking. This finding is also supported by prior
research indicating that the Nonjudging facet is negatively associated with problematic
alcohol use (Fernandez et al., 2010; Murphy and MacKillop, 2011). However, our results
indicate that at least part of the association between Nonjudging and alcohol use is due to
lower motives to manage mood by drinking. Again, these results are also in alignment with
Roos et al.’s (2015) findings who also found that coping motives mediated the relationship
between Nonjudging and alcohol use/alcohol problems. Individuals who are able to notice
their thoughts and emotions without judging them may feel less distressed, which would
reduce motives to drink to manage mood and ultimately reduce problematic drinking.
Third, Acting with Awareness was associated with lower likelihood of drinking to conform
to social situations, which was then related to lower levels of problematic drinking. Our
findings indicate that individuals who thoughtfully consider how to act in a given situation
(instead of being on autopilot) are less likely to endorse drinking to conform in these types
of social situations, resulting in lower levels of problematic drinking. Combined with the
findings from Roos et al. (2015), which also found that conformity motives mediated the
relationship between Acting with Awareness and alcohol problems, evidence suggests that
problematic college student drinkers show a similar pattern. It may be useful for future
research to examine the role of conformity motives in relationships between mindfulness
and alcohol use among individuals with elevated social anxiety, as almost 50% of
individuals with lifetime social anxiety disorder also meet criteria for a lifetime alcohol use
disorder (Buckner, Heimberg, Ecker, & Vinci, 2013; Grant et al., 2005; Kessler, Berglund,
Demler, Jin, Merikangas, & Walters, 2005). Previous research has found that individuals
high in social anxiety are more likely to endorse drinking for conformity and coping motives
(Lewis et al., 2008); however, other work has found no association between social anxiety
and conformity motives (Ham, Bonin, & Hope, 2007). Constructs related to social anxiety,
such as anxiety sensitivity and neuroticism, have been linked to increased endorsement of
conformity and coping motives (Comeau, Stewart, & Loba, 2001; Stewart & Devine, 2000;
Stewart, Loughlin, & Rhyno, 2001; Stewart & Zeitlin, 1995; Stewart, Zvolensky, & Eifert,
2002). Given that conformity and coping motives are often considered negative
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reinforcement motives (e.g., drinking to avoid unpleasant emotional states or to avoid social
rejection; Cooper, 1994), it follows that individuals endorsing anxiety-related symptoms
might endorse these motives for drinking. Future research might examine whether greater
Acting with Awareness could reduce social conformity motives and associated alcohol use in
individuals with high levels of social anxiety.
Consistent with hypotheses, coping motives appeared more relevant than enhancement
motives in explaining relationships between mindfulness and alcohol use, as enhancement
motives did not mediate any of the relationships tested in the current study. One possible
reason for the lack of findings regarding enhancement motives is that our sample was
predominantly female (76.3%). Recently, Leigh and Neighbors (2009) found that for male
college students, enhancement motives mediated the relationship between mind/body
awareness and alcohol use, as well as nonattachment to thoughts and alcohol use. However,
they did not find any significant results among women. Thus, the role of enhancement
motives in mediating associations between mindfulness and drinking may be different for
men vs. women. Additional research is needed to examine potential gender differences
across various college student samples and specifically among problematic college student
drinkers. A second reason for our null findings regarding enhancement motives may be that
our study only included participants identified as engaging in problematic drinking. As such,
mindfulness might be particularly beneficial in terms of preventing problematic drinking
during moments of emotional distress for problematic drinkers. Extant research suggests that
mindfulness minimizes emotional reactivity to distressing stimuli or situations (Arch &
Craske, 2006, 2010; Britton, Shahar, Szepsenwol, & Jacobs, 2012; Feldman, Greeson, &
Senville, 2010). Mindfulness may also weaken associations between emotional distress and
problematic drinking (Adams et al., 2015; Witkiewitz et al., 2011). Furthermore, both
Conger’s (1956) tension reduction hypothesis and Baker et al.’s (2004) affective processing
model highlight motivations to reduce emotional distress (rather than motivations to increase
positive emotions) as primary factors promoting and maintaining problematic alcohol use.
Limitations of the current study should be noted. These data are cross-sectional and causal
inferences cannot be made. For instance, our findings do not necessarily imply that being
less judgmental causes a decrease in coping motives, resulting in decreased problematic
drinking. It is plausible, for example, that individuals who do not drink as a way of
managing their mood become less judgmental over time, which then results in less
problematic drinking. Our findings can only assert that associations exist among these
constructs. Thus, future research in this area should examine these variables in a longitudinal
manner. The current sample consisted of college student drinkers who were primarily
Caucasian women who engage in problematic drinking; therefore generalizability may be
limited. Future research should examine whether the current findings extend to males and
more racially/ethnically diverse populations. Of the prior studies examining relationships
among mindfulness, drinking motives, and alcohol use (Reynolds et al., 2015; Roos et al.,
2015), each utilized a college student sample. Additional research is needed in more diverse
populations, including non-college students and individuals with clinical alcohol use
disorders. Furthermore, examining potential gender differences regarding these variables
would be useful in order to determine whether certain drinking motives and/or mindfulness
facets are more/less important for men versus women. Gender differences were not
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examined in the current study because of the relatively small number of male participants (
n
= 49). Readers should also note that the effect sizes for relationships between mindfulness
facets and alcohol use were relatively small, and there are clearly a number of important
factors (in addition to mindfulness) that may predict less problematic drinking.
Data for this study were taken from a larger study, in which participants were screened for
problematic levels of drinking (i.e., AUDIT score of 6 or greater and endorsement of
primarily enhancement and/or coping motives), and thus results may only generalize to
students who engage in problematic drinking. Furthermore, the internal consistency of the
AUDIT was at most adequate, and this should be considered when interpreting the current
study’s findings. The AUDIT and the DMQ-R were the only measures of alcohol use
administered to participants in this study; future research should include additional measures
to provide more detailed information on quantity, frequency, and binge drinking (e.g., by
using the Timeline Followback; Sobell & Sobell, 2003). However, the current study is
strengthened by a relatively large sample of at-risk drinkers, examination of multiple facets
of mindfulness, and investigation of novel mediating pathways to elucidate mechanisms
underlying relationships between mindfulness and alcohol use.
Overall, our findings highlight associations among mindfulness, drinking motives, and
alcohol use for college students who engage in problematic drinking. Research should
examine whether interventions emphasizing Acting with Awareness and Nonjudging facets
of mindfulness and/or targeting coping and conformity motives could be effective for
reducing problematic drinking in college students. Mindfulness-based treatments for
substance use are very promising (Bowen et al., 2009; Bowen, Chawla, & Marlatt, 2011;
Bowen et al., 2014; Brewer et al., 2009; Brewer et al., 2011; Chiesa & Serretti, 2014; Davis,
Goldberg, Anderson, Manley, Smith, & Baker, 2014; Garland, Manusov, Froeliger, Kelly,
Williams, & Howard, 2014; Grant et al., 2015; Himelstein, Saul, & Garcia-Romeu, in press;
Vidrine et al., under review; Witkiewitz et al., 2014). Refining and enhancing mindfulness-
based treatments is a continuous process in order to provide the most efficacious treatments
to college students with problematic substance use. Results of the current study offer insight
into potential mechanisms linking specific aspects of mindfulness to lower alcohol use. If
results are replicated in longitudinal studies, these findings could contribute to the
development of effective interventions for problematic drinking in college students.
Acknowledgments
Funding: This work was supported by the National Cancer Institute through the University of Texas MD Anderson
Cancer Center’s Support Grant CA016672, by the National Institute on Minority Health and Health Disparities
under Award Number K99MD010468, and by National Center for Complementary and Integrative Health under
Award Number K23AT008442. The content is solely the responsibility of the authors and does not necessarily
represent the official views of the National Institutes of Health.
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Figure 1.
Model indicating the Mediating Effect of Coping Motives on Acting with Awareness and
Alcohol Use (** =
p
< .01; * =
p
< .05)
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Figure 2.
Model indicating the Mediating Effect of Coping Motives on Nonjudging and Alcohol Use
(** =
p
< .01; * =
p
< .05)
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Figure 3.
Model indicating the Mediating Effect of Conformity Motives on Acting with Awareness
and Alcohol Use (** =
p
< .01; * =
p
< .05)
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Author Manuscript Author Manuscript Author Manuscript Author Manuscript
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Table 1
Means and Standard Deviations (in parentheses) on Study Variables
Mean (SD)
% Caucasian 85.5%
Age 20.13 (1.89)
AUDIT Total 10.03 (4.28)
DMQ-R Coping 1.84 (.85)
DMQ-R Enhancement 3.35 (.97)
DMQ-R Social 1.17 (.33)
DMQ-R Conformity 2.77 (.91)
FFMQ Observe 3.25 (.59)
FFMQ Describe 3.47 (.76)
FFMQ Acting with Awareness 3.07 (.69)
FFMQ Nonjudgment 3.30 (.75)
FFMQ Nonreactivity 2.96 (.55)
Note
. DMQ-R = Drinking Motives Questionnaire; FFMQ = Five Facet Mindfulness Questionnaire
Mindfulness (N Y)
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Table 2
Percent of Sample Endorsing Certain Drinking Behaviors
Frequency of Drinking
Monthly or less 5.3%
2 – 4 times per month 36.2%
2 – 3 times per week 52.7%
4 or more times per week 5.8%
Quantity of Drinking
1 – 2 drinks per day 9.2%
3 – 4 drinks per day 53.1%
5 or 6 drinks per day 29.5%
7 or more drinks per day 8.2%
Six or more drinks on one occasion
Never 10.1%
Monthly or less 46.9%
2 – 4 times per month 35.3%
2 – 3 times per week 7.2%
Daily or almost daily .5%
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Table 3
Bivariate Correlations among AUDIT total, Drinking Motives, and FFMQ Subscales
1. 2. 3. 4. 5. 6. 7. 8. 9. 10.
1. AUDIT Total - - - - - - - - - -
2. DMQ-R
Enhancement .274
**
-- -------
3. DMQ-R Coping .311
**
.271
**
- - - - - - - -
4. DMQ-R Social .028 .258
**
.176
*
-------
5. DMQ-R
Conformity .201
**
.789
**
.392
**
.338
**
-----
6. FFMQ Observe .042 .070 .044 .183
**
.077 - - - - -
7. FFMQ Describe −.132 −.084 −.109 −.051 −.016 .163
*
- - - -
8. FFMQ Acting
with Awareness −.200
**
−.125 −.248
**
.017 −.148
*
−.006 .249
**
- - -
9. FFMQ
Nonjudgment −.143
*
−.111 −.220
**
−.044 −.044 −.122 .129 .205
**
- -
10. FFMQ
Nonreactivity −.117 .065 −.105 −.009 .058 .189
**
.234
**
.152
*
.065 -
Note
. DMQ-R = Drinking Motives Questionnaire; FFMQ = Five Facet Mindfulness Questionnaire.
*p
< .05;
** p
< .01
Mindfulness (N Y)
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