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A Dual-Process Decision-Making Model Examining the Longitudinal Associations Between Alcohol-Induced Blackouts and Alcohol Use Disorder Risk Among College Student Drinkers
Abstract
Objective:
Utilize a dual-process decision-making model to examine the longitudinal associations between alcohol-induced blackouts (blackouts) and alcohol use disorder (AUD) risk symptoms among college student drinkers.
Method:
Undergraduate drinkers (N = 2,024; 56% female; 87% White; 5% Hispanic) at a large northeastern university completed online surveys each semester during their first (T1, T2), second (T3, T4), third (T5, T6), and fourth (T7, T8) years of college (87% retention across the study). Path analyses were examined testing the longitudinal associations between T1 willingness to experience a blackout, T1 intentions to avoid a blackout, T2-T8 drinking, T2-T8 blackouts, and T8 AUD risk symptoms. Hypotheses 1-2 tested the associations between T1 willingness, T1 intentions, T2-T8 drinking, and T2-T8 blackouts. Hypothesis 3 tested the associations between T2-T8 drinking, T2-T8 blackouts, and T8 AUD risk symptoms.
Results:
Students experienced an average of 8 (SD = 8) blackouts during college. Approximately 1,457 (88.8%) of participants reported experiencing 1 of 8 AUD risk symptoms. T1 willingness was positively associated with T2-T8 blackouts. T2-T8 drinking and T2-T8 blackouts were positively associated with T8 AUD risk symptoms. T1 willingness significantly indirectly impacted T8 AUD risk symptoms through its association with T2-T8 blackouts.
Conclusions:
Results estimated that, on average, college student drinkers experienced 8 blackouts across 4 years of college and 88% of participants reported experiencing at least one symptom of AUD in the last semester of college. Willingness to experience a blackout influenced students' AUD risk symptoms through the number of blackouts they experienced throughout college.
... By modeling effects of mutually exclusive combinations of drinking intentions and willingness, we showed that planning to drink predicted the highest rates of drinking any alcohol and drinking above heavy and high-intensity thresholds, and greater willingness further increased students' drinking probabilities, over and above the effects of their intentions to drink or not drink. These findings confirm other reports that greater willingness to drink is associated with a higher odds of drinking (Lewis et al., 2016), but also disputes conclusions from some studies that willingness is a better or stronger predictor than intentions (e.g., Glenn et al., 2024;Litt et al., 2014): On planned drinking days, students had a 28.8% chance of engaging in HED if they were willing to get drunk, a rate far exceeding the 10.2% chance of heavy drinking on unplanned drinking days when students also said they were willing to get drunk. This joint consideration of drinking intentions and willingness also narrowed the "intention-behavior gap" observed in prior studies of student drinking (see Caudwell et al., 2018). ...
Objective: We examined alcohol use and consequences across five categories of same-day drinking intentions and willingness and tested whether same-day motives and protective strategies predicted differences in outcomes across categories of intentions and willingness. Method: In a 14-week ecological momentary assessment design, undergraduate student participants (N = 196) reported drinking intentions and behaviors over 13 surveys weekly (four morning surveys [Thursday through Sunday]; three midday, early, and late evening surveys [Thursday through Saturday]). On average, participants were 20.61 years old (SD = 1.50; range 17–25), 63% identified as female (n = 124), 29% as male (n = 57), and 8% identified as neither male nor female (n = 15; i.e., nonbinary; transgender; genderqueer; agender). Participants reported numbers of drinks consumed on the evening (past 2 hr) and morning (previous day) surveys. Multilevel generalized linear models tested effects of drinking intentions/willingness categories, motives, protective strategies, and interactions between key variables on alcohol use and consequences in several models. Results: Rates and quantities of drinking were highest on planned drinking days, and especially high when students planned to get drunk. When enhancement and social motives were elevated, students were more likely to drink and consumed more drinks even on unplanned drinking days, and especially when socializing with others. Effects of coping motives were weaker and sparse. Harm reduction protective strategies were associated with more positive and negative consequences with little variation across planned and unplanned drinking days. Conclusion: Jointly considering drinking intentions and willingness narrows the intention-behavior gap in student drinking and suggests potential areas of focus for messaging around responsible drinking.
... On nights when an AIB is experienced, college students experience an average of 3.5 additional consequences compared to non-AIB nights . AIBs have also been associated with longer term consequences such as experiencing symptoms of alcohol use disorder (AUD; Glenn et al., 2023;Studer et al., 2019;Yuen et al., 2021). What makes these statistics even more concerning is the frequency in which student drinkers report experiencing an AIB. ...
Background
Alcohol‐induced blackouts (AIBs) are common in college students. Individuals with AIBs also experience acute and chronic alcohol‐related consequences. Research suggests that how students drink is an important predictor of AIBs. We used transdermal alcohol concentration (TAC) sensors to measure biomarkers of increasing alcohol intoxication (rise rate, peak, and rise duration) in a sample of college students. We hypothesized that the TAC biomarkers would be positively associated with AIBs.
Methods
Students were eligible to participate if they were aged 18–22 years, in their second or third year of college, reported drinking 4+ drinks on a typical Friday or Saturday, experienced ≥1 AIB in the past semester, owned an iPhone, and were willing to wear a sensor for 3 days each weekend. Students (N = 79, 55.7% female, 86.1% White, Mage = 20.1) wore TAC sensors and completed daily diaries over four consecutive weekends (89.9% completion rate). AIBs were assessed using the Alcohol‐Induced Blackout Measure‐2. Logistic multilevel models were conducted to test for main effects.
Results
Days with faster TAC rise rates (OR = 2.69, 95% CI: 1.56, 5.90), higher peak TACs (OR = 2.93, 95% CI: 1.64, 7.11), and longer rise TAC durations (OR = 4.16, 95% CI: 2.08, 10.62) were associated with greater odds of experiencing an AIB.
Conclusions
In a sample of "risky" drinking college students, three TAC drinking features identified as being related to rising intoxication independently predicted the risk for daily AIBs. Our findings suggest that considering how an individual drinks (assessed using TAC biomarkers), rather than quantity alone, is important for assessing risk and has implications for efforts to reduce risk. Not only is speed of intoxication important for predicting AIBs, but the height of the peak intoxication and the time spent reaching the peak are important predictors, each with different implications for prevention.
Background:
Adolescence and young adulthood are developmental periods where both initiation and escalation of alcohol consumption is common. While existing literature highlights the potential role alcohol-induced blackouts (AIBs) may have on the development of alcohol use disorders as well as how impulsivity is associated with alcohol use, research to date has not been conducted within the United States. Therefore, this study aimed to examine longitudinal associations between AIBs and hazardous alcohol use risk (AUDIT) in adolescents and young adults, while exploring the moderating effects of impulsivity facets (i.e., premeditation and urgency).
Methods:
Participants were recruited for a longitudinal ecological momentary assessment (EMA) study in Texas, examining cognitions and alcohol use. The analytical sample comprised 556 participants (58.6% female, 70.8% White, Mage = 21.5, SD = 2.5). Data were collected at baseline and a 12-month follow-up.
Results:
Utilizing generalized linear regression models, results revealed a significant prospective association between AIBs and AUDIT scores. Findings indicated premeditation significantly moderated this association, whereas urgency did not.
Conclusion:
Targeting prevention programs, particularly toward adolescents and young adults with a history of AIBs, especially those with elevated levels of premeditation, may be effective in mitigating the risk of alcohol use disorder development.
Background
Alcohol‐induced blackouts describe memory loss resulting from alcohol consumption. Approximately half of college students report experiencing a blackout in their lifetime. Blackouts are associated with an increased risk for negative consequences, including serious injury. Research has documented two types of blackouts, en bloc (EB) and fragmentary (FB). However, research is limited by the lack of a validated measure that differentiates between these two forms of blackout. This study used a mixed‐methods approach to improve the assessment of FB and EB among young adults. Specifically, we sought to improve the existing Alcohol‐Induced Blackout Measure (ABOM), which was derived from a relatively small pool of items that did not distinguish FB from EB.
Methods
Study 1 used three rounds of cognitive interviewing with U.S. college students (N = 31) to refine existing assessment items. Nineteen refined blackout items were retained for Study 2. Study 2 used face validity, factor analysis, item response theory, and external validation analyses to test the two‐factor blackout model among U.S. heavy‐drinking college students (N = 474) and to develop and validate a new blackout measure (ABOM‐2).
Results
Iterative factor analyses demonstrated that the items were well represented by correlated EB and FB factors, consistent with our hypothesis. External validation analyses demonstrated convergent and discriminant validity. These analyses also provided preliminary evidence for the two factors having differential predictive validity (e.g., FB correlated with enhancement drinking motives, while EB correlated with coping and conformity motives).
Conclusions
The Alcohol‐Induced Blackout Measure‐2 (ABOM‐2) improves the measurement of blackout experiences among college students. Its use could facilitate the examination of EB and FB as differential predictors of alcohol‐related outcomes in future studies.
One-third to half of emerging adult drinkers report experiencing alcohol-induced blackouts in the past year, and blackouts increase the risk for negative consequences. Qualitative methods provide valuable tools for scientific inquiry, allowing for in-depth understanding of lived experiences. The goal of the present study was to gain insight into emerging adults' recent blackout experiences. One hundred heavy drinking college students (age 18-20) completed a baseline survey, 28 days of ecological momentary assessment (EMA) of their alcohol use and consequences, and a follow-up interview. A subset of 37 (46% female, 13.5% Hispanic/Latinx, 54% non-Hispanic ethnicity/White race) endorsed a blackout (forgot what they did during or after drinking) and were interviewed regarding their recent blackout experience. A semi-structured interview guide focused on several key questions regarding intentions and/or willingness to black out, how friends reacted to their blackout, and social norms for blacking out. A priori as well as emergent themes were generated from review of coded data. Qualitative themes included: blackouts are often unintentional, heavy drinking young adults express willingness to black out, friends react in a variety of ways to blackouts, and blackouts are perceived as common and acceptable. Data provide insight into the phenomenology of blackouts among college students, revealing that although college students may not intend to, they are often willing to black out. Future qualitative studies on blackouts among non-college-attending emerging adults are warranted. Such work can inform theory and future survey studies to better understand this high-risk behavior. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
The first year of college may carry especially high risk for onset of alcohol use disorders. We assessed the one-year incidence of alcohol use disorders (AUD) among incoming first-year students, predictors of AUD-incidence, prediction accuracy and population impact. A prospective cohort study of first-year college students (baseline: N = 5843; response rate = 51.8%; 1-year follow-up: n = 1959; conditional response rate = 41.6%) at a large university in Belgium was conducted. AUD were evaluated with the AUDIT and baseline predictors with the Composite International Diagnostic Interview Screening Scales (CIDI-SC). The one-year incidence of AUD was 3.9% (SE = 0.4). The most important individual-level baseline predictors of AUD incidence were being male (OR = 1.53; 95% CI = 1.12–2.10), a break-up with a romantic partner (OR = 1.67; 95% CI = 1.08–2.59), hazardous drinking (OR = 3.36; 95% CI = 1.31–8.63), and alcohol use characteristics at baseline (ORs between 1.29 and 1.38). Multivariate cross-validated prediction (cross-validated AUC = 0.887) shows that 55.5% of incident AUD cases occurred among the 10% of students at highest predicted risk (20.1% predicted incidence in this highest-risk subgroup). Four out of five students with incident AUD would hypothetically be preventable if baseline hazardous drinking was to be eliminated along with a reduction of one standard deviation in alcohol use characteristics scores, and another 15.0% would potentially be preventable if all 12-month stressful events were eliminated. Screening at college entrance is a promising strategy to identify students at risk of transitioning to more problematic drinking and AUD, thus improving the development and deployment of targeted preventive interventions.
Blackouts are typically considered a negative consequence of alcohol use. Yet some college students report consuming alcohol with the intention of blacking out. This study examined intentions and motives for blackout drinking among young adults in college. College students with a past-year history of blackout (N = 350, 56% female, 73% White) completed an anonymous online survey. Descriptive statistics were used to examine the incidence of blackout intentions, and individuals who did and did not report future blackout intentions were then compared on drinking patterns, depressive symptoms, social norms, and outcome expectancies. Overall, 135 participants (39%) reported consuming alcohol in the past 30 days with the intention of losing memory of the night's events, and 107 (31%) reported blackout intentions in the next 30 days. When asked (via open text box) to indicate their motives for past blackout intentions, the majority of participants provided responses that fit with coping, social, or enhancement drinking motives. A larger proportion of men than women reported blackout intentions. As a group, those reporting future blackout intentions reported heavier, more frequent, and more problematic drinking, as well as more symptoms of depression and more positive (but not negative) outcome expectancies. A substantial subset of college students reporting a blackout in the past year also endorsed intentions to experience a blackout in the next 30 days. Given strong associations between intentions and subsequent behavior, interventions targeting blackout styles of drinking are warranted. The extent to which "blackout" drinking motives differ from traditional drinking motives is unclear. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
Objective
A retrospective case–control study was conducted to evaluate whether frequent binge drinking between the age of 18 and 25 years was a risk factor for alcohol dependence in adulthood.
Setting
The Department of Addictive Medicine and the Clinical Investigation Center of a university hospital in France.
Participants
Cases were alcohol-dependent patients between 25 and 45 years and diagnosed by a psychiatrist. Consecutive patients referred to the Department of Addictive Medicine of a university hospital between 1 January 2017 and 31 December 2017 for alcohol dependence were included in the study. Controls were non-alcohol-dependent adults, defined according to an Alcohol Use Disorders Identification Test score of less than 8, and were matched on age and sex with cases. Data on sociodemographics, behaviour and alcohol consumption were retrospectively collected for three life periods: before the age of 18 years; between the age of 18 and 25 years; and between the age of 25 and 45 years. Frequency of binge drinking between 18 and 25 years was categorised as frequent if more than twice a month, occasional if once a month and never if no binge drinking.
Results
166 adults between 25 and 45 years were included: 83 were alcohol-dependent and 83 were non-alcohol-dependent. The mean age was 34.6 years (SD: 5.1). Frequent binge drinking between 18 and 25 years occurred in 75.9% of cases and 41.0% of controls (p<0.0001). After multivariate analysis, frequent binge drinking between 18 and 25 years was a risk factor for alcohol dependence between 25 and 45 years: adjusted OR=2.83, 95% CI 1.10 to 7.25.
Conclusions
Frequent binge drinking between 18 and 25 years appears to be a risk factor for alcohol dependence in adulthood. Prevention measures for binge drinking during preadulthood, especially frequent binge drinking, should be implemented to prevent acute consequences as injury and death and long-term consequences as alcohol dependence.
Trial registration number
NCT03204214 ; Results.
Blackouts (periods of alcohol-induced anterograde amnesia) are common among young adults and place individuals at significant risk for alcohol-related harm; thus, researchers have advocated for increased efforts to educate young adults on blackouts. This qualitative study examined college student knowledge of blackouts as well as their ideas for intervening on blackout drinking behavior in order to inform prevention and intervention efforts. College students who had experienced a blackout in the past 6 months participated in eight focus groups, stratified by gender (N = 50, five to eight/group, 56% female). Discussions followed a semistructured agenda. Audio recordings were transcribed verbatim and coded using applied thematic analysis. Themes related to knowledge were reviewed in comparison to the empirical literature. Empirically derived risk factors for blackouts included biology (e.g., genetics, biological sex), drinking behavior (i.e., rate of consumption), other drug use, and “indirect” influences (e.g., pregaming, drinking location). Participants’ knowledge of the risk factors for blackout was inconsistent and, in some cases, inaccurate. While participants generally understood the behavioral risk factors for blackouts, they demonstrated less understanding of the role of genetics, biological sex, drinking speed (vs. quantity), and other drug use. They also identified dehydration and sleep as perceived risk factors for blackout. They suggested avenues for intervention at the policy (e.g., amnesty policies), peer (e.g., expressing concern), and individual (e.g., education) levels. College students with a history of blackout have limited understanding of the biological risk factors for blackout. These knowledge gaps represent targets for intervention. Findings indicate promise for blackout-specific interventions.
Sexual assault is a troubling epidemic that plagues college campuses across the United States, and is often proceeded by drinking by the perpetrator and/or victim. The goal of this study was to examine the effect of level of intoxication, history of alcohol-related blackouts, and childhood sexual abuse (CSA) on the likelihood of being a victim or perpetrator of coercive sexual activities. Participants (N = 2,244) were part of a 6-year longitudinal study which explored alcohol use and associated behavioral risks during college. A subsample (N = 1,423) completed 30 days of daily diary surveys across four years of college. Participants provided daily reports of their alcohol consumption, sexual coercion perpetration, and sexual coercion victimization. Using hierarchical linear models, results indicated that increases in daily estimated blood alcohol concentration (eBAC) were associated with a greater likelihood of being a victim and a perpetrator of sexual coercion. In addition, main effects of CSA and history of blackouts predicted a greater likelihood of being coerced into sexual activity, but blackouts were not associated with being a perpetrator. A significant interaction between blackouts and event-level eBAC indicated that individuals with a history of blackouts had a greater likelihood of sexual coercion victimization relative to those without prior blackouts. Finally, having a history of blackouts and CSA was predictive of a lower likelihood of being a perpetrator of sexual coercion at higher eBACs relative to those without a history of blackouts. Thus, prevention efforts should integrate the impact of blackouts and CSA on sexual coercion victimization and perpetration.
Alcohol-related blackouts are common among college student drinkers. The present study extends prior work by examining latent growth classes of blackouts and several predictors of class membership. Participants (N = 709 college drinkers) completed a baseline survey at college entry and biweekly online assessments throughout freshman and sophomore years. Results revealed 5 latent growth class trajectories, reflecting varying experiences of blackouts at the beginning of college and differential change in blackouts over time. The largest class represented a relatively low-risk group (low decrease; 47.3%) characterized by endorsement of no or very low likelihood of blackouts, and decreasing likelihood of blackouts over time. Another decreasing risk group (high decrease; 11.1%) initially reported a high proportion of blackouts and had the steepest decrease in blackout risk over time. A small percentage showed consistently high likelihood of blackouts over time (high stable; 4.1%). The remaining 2 groups were distinguished by relatively moderate (moderate stable; 14.9%) and lower (low stable; 22.6%) likelihood of blackouts, which remained stable over time. Comparisons between classes revealed that students with greater perceived peer drinking, perceived peer approval of drinking, and enhancement motives upon entry to college tended to be in higher risk groups with consistent experiences of blackouts over time, whereas blackout likelihood decreased over time for students with greater conformity motives. Findings suggest that precollege preventive interventions may be strengthened by considering not only factors related to current risk for blackouts and other alcohol-related consequences, but also those factors related to persistence of these behaviors over time.
Background:
Alcohol-induced blackouts, or memory loss for all or portions of events that occurred during a drinking episode, are reported by approximately 50% of drinkers and are associated with a wide range of negative consequences, including injury and death. As such, identifying the factors that contribute to and result from alcohol-induced blackouts is critical in developing effective prevention programs. Here, we provide an updated review (2010 to 2015) of clinical research focused on alcohol-induced blackouts, outline practical and clinical implications, and provide recommendations for future research.
Methods:
A comprehensive, systematic literature review was conducted to examine all articles published between January 2010 through August 2015 that focused on vulnerabilities, consequences, and possible mechanisms for alcohol-induced blackouts.
Results:
Twenty-six studies reported on alcohol-induced blackouts. Fifteen studies examined prevalence and/or predictors of alcohol-induced blackouts. Six publications described the consequences of alcohol-induced blackouts, and 5 studies explored potential cognitive and neurobiological mechanisms underlying alcohol-induced blackouts.
Conclusions:
Recent research on alcohol-induced blackouts suggests that individual differences, not just alcohol consumption, increase the likelihood of experiencing an alcohol-induced blackout, and the consequences of alcohol-induced blackouts extend beyond the consequences related to the drinking episode to include psychiatric symptoms and neurobiological abnormalities. Prospective studies and a standardized assessment of alcohol-induced blackouts are needed to fully characterize factors associated with alcohol-induced blackouts and to improve prevention strategies.
Objective:
Despite showing reductions in college student drinking, interventions have shown some inconsistency in their ability to successfully decrease consequences. With the goal of improving prevention efforts, the purpose of this study was to examine the role of consequence-specific constructs, in addition to drinking, that influence students' experiences with alcohol-related problems. The study examined how drinking and protective behaviors mediated the relationships between students' willingness to experience consequences, intentions to avoid them, and four categories of alcohol-related problems (physiological, social, sexual, and academic).
Method:
First-year college student drinkers (n = 2,024) at a large northeastern university completed surveys during the fall and spring of their freshman year.
Results:
As expected, different patterns of associations emerged for physiological and nonphysiological consequences. When physiological consequences (e.g., hangover, vomiting) were examined, drinking significantly mediated the effect of willingness on the consequences. Drinking-specific protective behaviors indirectly influenced consequences through drinking behaviors whereas general protective behaviors did not. When nonphysiological (e.g., social, sexual, academic) consequences were examined, drinking and general protective behaviors emerged as significant mediators of the effects of willingness and intentions on the consequences, whereas drinking-specific protective behaviors did not.
Conclusions:
The results suggest that prevention efforts (e.g., personalized feedback) could be tailored to address specific types of protective behaviors as well as specific types of consequences frequently experienced by college students.
Objective: 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 1) rational and reactive pathways and psychosocial constructs predictive of CPB use, and 2) how gender might moderate these influences in a sample of college students. Method: 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. Results: 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. Discussion: 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.
Orientation Week is a series of events at the beginning of the university year that introduces incoming students to university life. It is also the period of the academic year when students consume more alcohol than at any other time. Recently, we demonstrated that alcohol consumption during Orientation Week was related to alcohol consumption during the academic year. The aim of the present study was to determine whether a brief Ecological Momentary Intervention (EMI) implemented during Orientation Week could reduce alcohol consumption during Orientation Week and throughout the academic year.
Participants were 130 freshman-year university students (72 women, 58 men) randomly assigned to either an Ecological Momentary Assessment (EMA) condition or an EMA-EMI condition. In both conditions, participants reported pre-university, Orientation Week, and academic year weekend alcohol consumption. Those in the EMA-EMI condition also received EMI text messages promoting moderation every night during Orientation Week.
Although the EMI did not reduce men's drinking, women in the EMA-EMI condition, compared with women in the EMA condition, consumed significantly fewer drinks during Orientation Week, M = 17.1, SD = 13.3, vs. M = 26.4, SD = 22.5, respectively, t(70) = -1.927, p < .05, Cohen's d = 0.473, and reported consuming fewer weekend drinks during the academic semester, M = 5.0, SD = 3.3, vs. M = 7.5, SD = 6.3, respectively, t(70) = -2.263, p < .05, d = 0.451.
This study represents the first important step in reducing drinking among university students by developing and using EMIs during Orientation Week.
Within the domain of risk-related behavior, many times the decision to engage is not a product of premeditation or intention. The prototype willingness model was created to capture and explain the unintended element of risk behavior. The present study aimed to evaluate the importance of willingness versus intention, two important constructs within the prototype willingness model, in relation to spring break drinking behavior when assessed at both high and low extremities. College undergraduates (N = 275) completed questionnaires prior to spring break regarding their anticipated spring break activities. Willingness and intention were assessed for different levels of risk. Specifically, participants indicated the extent to which they intended to (a) get drunk and (b) drink enough to black out or pass out; and the extent to which they were willing to (a) get drunk and (b) drink enough to black out or pass out. When classes resumed following spring break, the students indicated the extent to which they actually (a) got drunk and (b) drank enough to black out or pass out. Results demonstrated that when the health-related risk was lower (i.e., getting drunk), intention was a stronger predictor of behavior than was willingness. However, as the level of risk increased (i.e., getting drunk enough to black out or pass out), willingness more strongly predicted behavior. The present study suggests that willingness and intentions differentially predict spring break alcohol-related behavior depending on the extremity of behavior in question. Implications regarding alcohol interventions are discussed.
The focus of the study was to examine (1) the unique variance between willingness to experience specific consequences (e.g., vomit) and reported experience of the consequence after controlling for drinking, and (2) the relationships between consequence specific constructs (attitudes and norms) and willingness to experience specific consequences in the context of a structural equation model. Freshmen students (n = 167) from a large northeastern university were randomly selected to participate. Results indicated willingness to experience consequences accounted for significant variance across consequence outcomes controlling for drinking. Significant relationships were observed between consequence specific constructs (attitudes and norms) and students' willingness to experience consequences. Findings provide empirical support that alcohol-related consequences have multiple determinants and are not only a function of alcohol consumption. Prevention efforts may benefit from a more comprehensive approach that includes both drinking and consequence-specific constructs as targets of change.
Race and gender may be important considerations for recognizing alcohol related problems in Black and White young adults. This study examined the prevalence and age of onset of individual alcohol problems and alcohol problem severity across race and gender subgroups from a longitudinal study of a community sample of adolescents followed into young adulthood (N=166; 23-29 yrs. old who were drinkers). All alcohol problems examined first occurred when subjects were in their late teens and early 20s. Drinking in hazardous situations, blackouts, and tolerance were the most common reported alcohol problems. In race and gender comparisons, more males than females experienced alcohol problems. Blacks generally had a later age of onset of alcohol problems. Multivariate regressions showed greater alcohol problem severity in males compared to females, but no significant differences between Blacks and Whites. Education, family environment and earlier alcohol use behaviors and expectancies were reliable predictors of alcohol problem severity in young adulthood. White males were at particular risk for experiencing more severe alcohol problems. Findings may inform the design of more targeted interventions for alcohol problems in different populations.
Three studies are described that assess elements of a new model of adolescent health-risk behavior, the prototype/willingness (P/W) model (F. X. Gibbons & M. Gerrard, 1995, 1997). The 1st analysis examined whether a central element of the prototype model, behavioral willingness, adds significantly to behavioral expectation in predicting adolescents' smoking behavior. The 2nd set of analyses used structural-equation-modeling procedures to provide the 1st test of the complete model in predicting college students' pregnancy-risk behavior. Finally, the 3rd study used confirmatory factor analysis to assess the independence of elements of the model from similar elements in other health behavior models. Results of the 3 studies provided support for the prototype model and, in particular, for 2 of its primary contentions: (a) that much adolescent health-risk behavior is not planned and (b) that willingness and intention are related but independent constructs, each of which can be an antecedent to risk behavior.
Alcohol primarily interferes with the ability to form new long-term memories, leaving intact previously established long-term memories and the ability to keep new information active in memory for brief periods. As the amount of alcohol consumed increases, so does the magnitude of the memory impairments. Large amounts of alcohol, particularly if consumed rapidly, can produce partial (i.e., fragmentary) or complete (i.e., en bloc) blackouts, which are periods of memory loss for events that transpired while a person was drinking. Blackouts are much more common among social drinkers--including college drinkers--than was previously assumed, and have been found to encompass events ranging from conversations to intercourse. Mechanisms underlying alcohol-induced memory impairments include disruption of activity in the hippocampus, a brain region that plays a central role in the formation of new autobiographical memories.
To examine whether starting to drink at an early age is associated with developing alcohol dependence at a younger age and chronic relapsing dependence, controlling for respondent demographics, smoking and illicit drug use, childhood antisocial behavior and depression, and family alcoholism history.
Cross-sectional survey.
Nationwide face-to-face survey with a multistage probability sample.
A total of 43,093 adults were surveyed in 2001-2002.
Based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria, lifetime alcohol dependence, dependence within 10 years of starting drinking, multiple episodes, an alcohol dependence episode in the past year, episodes exceeding 1 year, and meeting 6 or 7 dependence criteria.
Relative to respondents who began drinking at 21 years or older, those who began drinking before age 14 years were more likely to experience alcohol dependence ever and within 10 years of first drinking (adjusted hazard ratios and 95% confidence intervals [CIs], 1.78 [1.51-2.11] and 1.69 [1.38-2.07], respectively). They also more often experienced past-year dependence and multiple dependence episodes (adjusted odds ratios, 1.93 [95% CI, 1.40-2.64] and 3.09 [95% CI, 2.19-4.35], respectively). Among alcohol-dependent persons, the odds were 2.62 (95% CI, 1.79-3.84) for having at least 1 episode exceeding 1 year and 2.89 (95% CI, 1.97-4.23) for meeting 6 or 7 dependence diagnostic criteria.
There is a need to screen and counsel adolescents about alcohol use and to implement policies and programs that delay alcohol consumption.
Objective
To estimate the total number of alcohol-related consequences students experience during 4 years of college and examine early college indicators that result in higher rates of consequences.
Method
Undergraduate drinkers (N = 1,744; 58% female; 87% White; 5% Hispanic) at a large northeastern university completed an online survey at the end of the fall and spring semesters during their first (T1, T2), second (T3, T4), third (T5, T6), and fourth (T7, T8) years of college (87% retention across the study). First, descriptive statistics were calculated to estimate the total number of alcohol-related consequences students experienced across all 4 years of college. Second, a structural equation model was examined to identify early college indicators that influence individuals experienced more cumulative consequences.
Results
Students experienced an average of 102 (SD = 89.91) alcohol-related consequences during 4 years of college. Next, early parental approval of consequences, but not peer drinking norms, were positively associated with students’ willingness to experience consequences, which in turn, were positively associated with higher alcohol consumption and greater total consequences.
Conclusions
Results estimated that, on average, students experienced 102 alcohol-related consequences across all 4 years of college. Parental approval of consequences influenced students’ total consequences through their willingness to experience consequences and drinking behaviors. Findings from the current study have several important implications for interventions.
Background and aims
Experience of alcohol‐induced memory blackouts in adolescence may be an important risk factor for later harms. This longitudinal study i) modelled trajectories of alcohol‐related blackouts throughout adolescence, ii) explored early‐adolescent predictors of blackout trajectories, and iii) examined the association between blackout trajectories and alcohol use disorder (AUD) symptoms.
Design
Longitudinal study in which data from six annual surveys of a longitudinal cohort of Australian adolescents were used to model latent class growth trajectories of blackouts, adjusting for alcohol consumption frequency and typical quantity. Regression models were used to determine whether parent, child, and peer factors at baseline (Mage=12.9) predicted profiles of blackout trajectory membership and whether blackout trajectories predicted meeting criteria for AUD in early adulthood (Mage=19.8).
Setting and participants
Australian adolescents (n=1821; Mage=13.9 years until Mage=18.8 years).
Measurements
Alcohol‐related blackouts, alcohol consumption frequency, typical consumption quantity, and DSM‐5 AUD in early adulthood were all self‐reported.
Findings
We identified a three‐class solution: delayed alcohol initiation, rare blackouts (n=701; 38.5%); early initiation, rare blackouts (n=869; 47.7%); and early initiation, increasing blackouts (n=251; 13.8%). Female sex was associated with increased risk of early initiation, increasing blackouts relative to delayed initiation, rare blackouts (RRR: 3.90; 99.5% CI: 1.96, 7.76) and relative to early initiation, rare blackouts (RRR: 2.89; 99.5% CI: 1.42, 5.87). Early initiation, rare blackouts (OR: 1.96; 99.5% CI: 1.17, 3.29) and early initiation, increasing blackouts (OR: 4.93; 99.5% CI: 2.32, 10.48) were each associated with increased odds of meeting criteria for AUD in early adulthood relative to delayed initiation, rare blackouts. Early initiation, increasing blackouts was associated with increased odds of meeting criteria for AUD in early adulthood relative to early initiation, rare blackouts (OR: 2.51; 99.5% CI: 1.18, 5.38).
Conclusions
Females in Australia appear to be at higher risk of adolescent alcohol‐related blackouts independent of alcohol consumption levels and age of initiation. Alcohol‐related blackouts may be associated with later alcohol use disorder.
Objective:
Women are less likely than men to be arrested for driving under the influence (DUI) of alcohol or another drug, yet their proportion of DUI offenders is growing. Understanding how DUI recidivism risk varies for men and women is of practical utility for DUI assessment and intervention programs. The goals of the current study are to determine if there are different sets of predictors for men and women and whether gender-specific DUI recidivism risk scales perform better than a single recidivism scale for both men and women.
Method:
We rely on statistically driven techniques to develop gender-specific and total sample recidivism risk scales. We then test the ability of the scales to predict recidivism within 12 months among a large sample (N = 10,827, 22.3% female) of DUI offenders court mandated to a DUI intervention in Mississippi.
Results:
Predictors of recidivism were drawn from measures of criminal history, substance use disorders, driving behaviors, and accidents. Gender-specific models yielded different sets of recidivism risk factors for men and women, with minimal overlap between the two. Male risk factors were criminal history and heavy alcohol consumption. For women, evidence of a substance use disorder was a unique predictor. Having a prior DUI arrest, driving behaviors, and a physical health consequence of alcohol or drug use (i.e., weight loss) were shared predictors for both sexes.
Conclusions:
Findings suggest that within broad categories of risk factors, the predictive validity of specific assessment items may vary by sex. Our methods represent progression toward more efficient prediction of DUI recidivists.
Background and Aims
Alcohol‐induced blackout (AIB) is a common alcohol‐related adverse event occurring during teenage years. Although research provides evidence that AIB predicts acute negative consequences, less is known about the associations of AIB with chronic consequences, such as alcohol dependence (AD). This study estimated the associations between an experience of AIB at age 20 and the incidence, maintenance, and severity of AD at age 25 among Swiss men.
Design
Prospective cohort study with 5.5 years separating baseline and follow‐up.
Setting
Switzerland.
Participants
Swiss male drinkers (n = 5,469, age 20 at baseline) drawn from the Cohort Study on Substance Use Risk Factors (C‐SURF).
Measurements
Self‐report questionnaires assessing AIB, AD, alcohol (drinking volume, binge drinking), cigarette and cannabis use, several risk factors (sensation seeking, family history of problematic alcohol use, age of first alcohol intoxication) and sociodemographic variables.
Findings
Generalized estimating equation models with and without adjustment for risk factors, including alcohol use and socio‐demographics, showed that AIB at age 20 significantly predicted the incidence of AD at age 25 in men without AD at age 20 (OR[95%CI], unadjusted: 2.52[2.04, 3.11], p<.001; fully adjusted: 1.47[1.13, 1.91], p=.004), maintenance of AD in men with AD at age 20 (OR[95%CI], unadjusted: 1.82[1.12, 2.95], p=.015; fully adjusted: 1.66[1.00, 2.76], p=.048), and AD severity (IRR[95%CI], unadjusted: 1.89[1.69, 2.11], p<.001; fully adjusted: 1.20[1.10, 1.31], p<.001).
Conclusions
Among Swiss men, alcohol‐induced blackout at age 20 predicts the development, maintenance and severity of alcohol dependence at age 25.
Objective:
College student alcohol use remains a considerable concern. While many colleges provide universal interventions surrounding matriculation, trends indicate alcohol use increases over the college years. This study utilized a person-centered approach to examine changes in drinking across college and predictors (expectancies, attitudes, norms, and gender) of increases in risky drinking. Understanding transitions in drinking patterns and predictors of risky transitions can help identify risky students, periods of increased risk, and inform prevention efforts.
Method:
1429 first-year students were recruited from three universities across the USA. Students were assessed in the fall of each of the four years of college using a wide variety of drinking-related measures.
Results:
Latent transition analysis (LTA) identified five classes of students (Non-Drinkers, Weekend Light Drinkers, Weekend Heavy Drinkers, Occasional Heavy Episodic Drinkers, Heavy Drinkers). Heavy-Drinkers were not likely to move out of their status during all four years of college. All psychosocial factors were shown to predict class membership during the first year (e.g., higher positive expectancies were associated with greater likelihood of being in a higher risk class). Increased psychosocial risk factors also predicted transitioning to higher risk drinking classes, mostly for Non-Drinkers. Differences by gender were observed.
Conclusions:
Results indicate many students maintain or increase risky drinking practices, rather than mature out, suggesting continued need for early prevention. Targeting positive attitudes during the first year may be particularly important for later transitions. Males may benefit more from targeted intervention during the transition between third and fourth years.
The present study used a prospective longitudinal design to examine whether willingness to experience negative alcohol-related consequences mediated the effects of personality on consequences (e.g., blacking out, getting into a fight, and regretted sex). Students (N = 2024) were assessed at three time points: fall semester of the students' first year in college (baseline), 6-months post-baseline, and one-year post-baseline. Personality constructs were assessed at baseline (i.e., impulsivity, sensation seeking, self-regulation), willingness to experience negative alcohol-related consequences was assessed at baseline and 6-months, and negative alcohol-related consequences were examined at baseline and one-year post-baseline. A structural path model was used to examine if willingness mediated the effects of personality on consequences. Baseline drinking was included as a covariate in the model. Results demonstrated willingness to experience consequences significantly mediated the effects of impulsivity, sensation seeking, and self-regulation on consequences. Findings from this study support the idea that consequence-specific cognitions, such as willingness, can explain changes in consequences associated with personality. This suggests that intervention efforts aimed at reducing negative alcohol-related consequences could benefit from the inclusion of consequence-specific cognitions, personality (e.g., impulsivity, sensation seeking, and self-regulation), and drinking.
Background:
Blackouts-or memory loss for all or part of a drinking event-are reliable predictors of alcohol-related consequences. Studies suggest a distinction between en bloc (complete memory loss) and fragmentary (off-and-on memory loss) blackouts; however, research has not consistently differentiated between these 2 forms of blackout. This study aimed to validate the distinction between en bloc and fragmentary blackouts among young adults.
Methods:
Data were collected using qualitative (Study 1) and quantitative (Study 2) research methods. Participants in both studies were college students with a history of alcohol-induced memory impairment. They were recruited using community advertisement (Study 1, N = 50, 56% female) and Qualtrics survey panels (Study 2, N = 350, 56% female). Study 1 participants engaged in 8 focus groups. Discussions were audio-recorded, transcribed verbatim, and coded using applied thematic analysis. Findings guided assessment of en bloc and fragmentary blackout in Study 2. In Study 2, a separate sample of participants completed an online survey assessing drinking behavior, alcohol-induced memory impairment, and theoretical correlates of en bloc and fragmentary blackouts.
Results:
Study 1 participants differentiated between en bloc and fragmentary blackouts (which they referred to as "blackouts" and "brownouts," respectively) based on duration and extent of memory loss. They indicated that blackouts occur along a continuum, with en bloc "blackouts" at the extreme. They also stated that the term "blackout drinking" does not always imply memory loss. Study 2 participants reported higher rates of "brownouts" (81%) than "blackouts" (54%). They reported less negative outcome expectancies and attitudes, greater personal approval, higher prevalence estimates, lower self-efficacy, and stronger intentions for "brownouts" than "blackouts" (p < 0.001). Women perceived "blackouts/brownouts" as more prevalent than men and reported lower intentions to experience "blackouts" (p < 0.005).
Conclusions:
Young adults are more permissive of fragmentary than en bloc blackout. En bloc blackouts may be a target for future interventions.
Background
Riding with a drinking driver (RWDD) is a serious concern that leads to numerous preventable deaths every year. There is a significant gap in research on empirically tested predictors of RWDD that could be implemented in prevention efforts. College students are in need of such prevention efforts, as they have some of the highest rates of alcohol‐related crash fatalities and may RWDD more than their non‐college peers. The current study utilized behavioral decision‐making approach to examine predictors of RWDD and declining a ride from a drinking driver (Decline) in older college students.
Methods
Students (n=791) in their 3rd year of college were enrolled from 3 large and diverse universities. Psychosocial (e.g., expectancies, norms) and decision‐making variables (willingness to RWDD and intentions to use alternatives) were assessed in the fall of their 3rd year. One year later, RWDD and Decline behaviors were assessed. Zero‐inflated Poisson (ZIP) analyses were used to assess how decision‐making variables predicted RWDD and Decline behavior. Associations between psychosocial and decision‐making variables were also assessed.
Results
Thirteen percent of students reported RWDD and ~28% reported Decline behavior. Willingness to RWDD and typical weekly drinking were both associated with increases in RWDD (OR = 1.58 and 1.40, respectively), whereas intentions to use alternatives, sex, and ethnicity were not associated with RWDD. Only weekly drinking was associated with Decline, with an increase of drinking associated with increased Decline (OR= 1.48). All psychosocial variables were significantly associated with the decision‐making variables except positive expectancies.
Conclusions
Results provide evidence that willingness to RWDD is a predictor of future RWDD, even if students intend to use safe alternatives. Future research is needed to better understand decision‐making factors that influence Decline. Results also suggest prevention and interventions efforts, such as brief motivational interviewing, Parent‐Based Interventions, and normative feedback interventions could be adapted to reduce RWDD.
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The current study examined two research aims: (1) Identify latent statuses of college students who share common patterns of single or repeated experiences with distinct types of negative alcohol-related consequences during the first two years of college; and (2) Examine how changes in students' living arrangements were associated with transitions in the consequence statuses. Using a sample of college student drinkers (N = 1706), four latent statuses were identified that distinguished among distinct combinations of single and repeated experiences across the multiple consequence subtypes: No Consequences, Physical Non-Repeaters, Multiple Consequences, and Multiple Consequences Repeaters. Students who remained in on-campus living spaces were most likely to belong to lower-risk statuses at T1, and remain in those statuses at T2. We found that moving into Greek housing had strongest effects among students who started in the No Consequences status, while students who moved to off-campus housing were most likely to remain in the Multiple Consequences status. Given that students who moved out of on-campus residences were more likely to transition into high-risk statuses, interventions that target students who intend to move to off-campus or fraternity housing should be implemented during the first year of college.
Background:
Alcohol-related blackouts are a common consequence of heavy drinking, and these blackouts pose risk for injury and other adverse health outcomes.
Objective:
To examine the prevalence and correlates of blackouts among underage drinkers.
Methods:
Youth (ages 14-20) presenting to a suburban Emergency Department (ED) completed screening surveys. Among those reporting past-year alcohol consumption, we examined past 3-month blackouts in relation to: background characteristics (e.g., demographics, fraternity/sorority involvement), substance use, sexual risk behaviors and incapacitated sexual assault (unaware/unable to consent due to alcohol/drugs), forced sexual assault, positive depression screening, and reason for ED visit (injury vs. medical).
Results:
In total, 2,300 past-year drinkers participated: 58% female, 75% Caucasian, and mean age = 18.4. Regarding past 3-month blackouts, 72.7% reported none, 19.3% reported monthly or less, and 8% reported monthly or more. Multivariate cumulative logit regression indicated that blackout frequency was positively associated with: college involvement in Greek life, alcohol use severity, prescription drug misuse, marijuana, screening positive for depression, incapacitated sexual assault, and a gender by alcohol use severity interaction.
Conclusion:
With one-quarter of this clinical sample reporting recent blackouts, as well as the association between blackout frequency and health risk behaviors and other outcomes, findings underscore the need for programs focusing on substance use, depression, and preventing sexual assault. Interventions should also address poly-substance use and drinking motives. Although findings highlight how college students in Greek life may be at high risk for blackouts, many participants not in college also reported blackouts, suggesting that interventions in other settings are also needed.
Background:
Research has previously identified a high-risk subgroup of college students who experience high levels of multiple and repeated alcohol-related consequences (MRC group). The purpose of this study was to examine the association between consequence-specific normative influences and experiencing multiple and repeated drinking-related consequences using a person-centered approach. Normative subgroups were identified using latent profile analysis (LPA), which were then used to predict MRC group status at 6-month follow-up.
Methods:
First-year college student drinkers (N = 2,024) at a large northeastern university completed online surveys during the fall and spring semesters of their freshman year. Retention was high with 92% of invited participants completing T2, of which the MRC group accounted for 27%.
Results:
Three student profiles were identified from LPA on T1 data: Nonpermissive Parents (77%), Positive Peer and Parent Norms (21%), and Permissive Parents (3%). Logistic regression revealed that both the Positive Peer and Parent Norms and Permissive Parents profiles had significantly higher odds of MRC group membership at follow-up (1.81 and 2.78 times greater, respectively).
Conclusions:
The results suggest value in prevention efforts that include normative beliefs about alcohol-related consequences. Further, parental norms in particular have the potential to enhance interventions, especially through direct communication of disapproval for experiencing consequences.
Background
Alcohol-related blackouts are periods of amnesia that reflect the failure of the brain to record memories of what transpires while drinking. This paper examined the incidence, predictors, and behavioral correlates of blackouts among emerging adults and examined whether questions about blackouts could serve as better markers of risk for other alcohol related harms than questions about levels of consumption. Methods
In 2012 to 2013, 1,463 (68%) of 2,140 respondents 1-year past high school reported having consumed alcohol. They were asked whether, in the past 6months because of drinking, they forgot where they were or what they did. The survey also explored demographics, substance use behaviors, and other alcohol-related problems in the past 6months. Chi-square and logistic regression analyses explored bivariate and multivariate predictors of blackouts and other alcohol-related problems. ResultsTwenty percent of respondents who ever drank alcohol reported a blackout in the past 6months. Blackouts were more prevalent among females and those who, in the past 30days, used multiple drugs, more frequently binged, were drunk, smoked, had lower body weight, and lived in college dorms. After controlling for drinking levels, having a blackout was the strongest independent predictor of most other alcohol problems examined, including in the past 6months because of drinking, missing class or work, getting behind in work or school, doing something respondents later regretted, arguing with friends, experiencing an overdose, and total number of alcohol problems reported. It was also an independent predictor of hangovers, damaging property, getting hurt, and trouble with police. Conclusions
Because blackouts indicate drinking at levels that result in significant cognitive and behavioral impairment, questions about blackouts could serve as important, simple screeners for the risk of experiencing other alcohol related harms. Additional work on this subject is warranted.
Background:
Early onset drinking is associated with later heavy drinking and related consequences. Early drinking onset and binge drinking are also independently associated with blackouts, which are periods of amnesia for events during a drinking episode. The objective of this study was to examine how early onset drinking relates to changes in the frequency of experiencing blackouts across 3 years controlling for year-specific binge drinking.
Methods:
Participants (N = 1,145; 67.9% female) from a 6-year, longitudinal study are included in these analyses. Measures of self-reported age at drinking onset included ages at first drink, first high, and first drunk, which were used to create a latent early onset drinking factor. Frequency of binge drinking and blackouts were assessed annually during Years 4 to 6.
Results:
Overall, 69.2% of participants reported experiencing blackouts. After controlling for year-specific binge drinking, a growth curve model indicated that early onset drinkers reported more frequent blackouts at Year 4. There were, however, no significant effects of acceleration or deceleration in the frequency of blackouts across the 3 years. Early onset drinkers continued to experience more frequent blackouts compared with those who initiated alcohol use later, despite decreases in binge drinking over time.
Conclusions:
Early onset drinkers reported more frequent blackouts across all 3 years, indicating that early alcohol initiation predisposes those individuals to continue to experience more frequent blackouts, despite a decrease in their binge drinking. This may be due to various factors, such as altered hippocampal development and functioning resulting from early alcohol exposure.
There is considerable debate about the prospective association between alcohol-dependence symptoms and alcohol-related blackouts. The goal of this study was to examine the associations among alcohol-dependence symptoms, blackouts, and social and emotional consequences during the transition out of college.
Participants (N = 829; 66% female) were part of a 6-year longitudinal study designed to explore alcohol use and risky behaviors during and after college. Data for these analyses were from Years 4 and 5 of data collection, which most closely corresponded to the transition out of college. Using cross-lagged models, we tested the prospective associations of alcohol-dependence symptoms, blackout frequency, and social and emotional consequences.
Alcohol-dependence symptoms in Year 4 predicted increased frequency of blackouts and social and emotional consequences during the subsequent year. Blackouts during Year 4 also significantly predicted increased alcohol-related social and emotional consequences, but not dependence symptoms, in Year 5.
Although blackouts do not predict the development of alcohol-dependence symptoms, they increase the risk for less severe alcohol-related consequences during the transition out of college. This may result from the cognitive reconciliation of negative behaviors that occur during these episodes of amnesia.
Consequences of heavy drinking include alcohol-induced blackouts, which are periods of amnesia for all or part of a drinking event. One risk factor for blackouts is family history of problematic alcohol use (FH+); however, research rarely distinguishes maternal from paternal FH+. The objective of this study was to examine whether maternal or paternal FH+ better predicts likelihood of experiencing blackouts than a general measure of overall FH+, and whether gender moderates this association.
Participants (N=1164; 65.4% are female) were first-time college freshmen (age range=17-19) who participated in a 6-year, 10-assessment, longitudinal study in the United States. Alcohol-induced blackouts, the dependent measure, were dichotomized (yes/no) based on endorsement of memory problems after drinking using a single item during Years 4-6. FH+, captured at baseline, was coded if participants self-reported that their mother, father, or any of their four grandparents were a possible or definite problem drinker.
Overall, 773 (66.4%) participants reported experiencing blackouts during Years 4-6. Women were more likely to report blackouts than men; however, compared with women with a maternal FH+, men with a maternal FH+ were more than twice as likely to report blackouts.
Men appear to be more susceptible than women to the effects of a maternal FH+. Genetic and environmental explanations for this finding are discussed. In sum, these findings are an important step toward understanding a significant yet understudied negative consequence of heavy alcohol use.
Copyright © 2015 Elsevier Ltd. All rights reserved.
Brief feedback sessions have been shown to reduce alcohol consumption in college student samples. However, these feedback sessions show mixed results in reducing negative consequences of alcohol consumption. Because the discussion of alcohol consequences is a component of feedback sessions, it was seen as important to evaluate the degree to which college students perceive these consequences as negative. The present study assessed college students' perceptions of positivity-negativity of alcohol related consequences they experienced during the past year. The findings revealed college students' perceptions of positivity-negativity varied depending on the consequence that was assessed. Most consequences were considered negative by greater than 50% of the sample. There were six consequences that were not considered negative by the majority of the sample and of these, all were considered positive or neutral by greater than at least 50% of the sample. Finally, perceived positivity of the consequences were associated with higher weekly drinking patterns for vomiting, blackouts, regretted sex, late to work/class, skipping an evening meal, and being hungover. Results are discussed in reference to improving brief alcohol interventions for college students.
The present study examined risk factors related to "blacking out" (e.g., temporary periods of memory loss during drinking) during preparty drinking events (i.e., pregaming, predrinking). Participants were students from two universities on the West Coast who reported past month prepartying (N = 2,546) in online surveys administered in the fall of 2008. Among these students, 25% (n = 636) reported blacking out during at least one occasion in which they prepartied in the past month. A logistic regression model underscored that Greek student affiliation, family history of alcohol abuse, frequency of prepartying, and both playing drinking games and consuming shots of liquor while prepartying increased the likelihood of blacking out. Limitations and implications for future research and collegiate prevention strategies are discussed.
The current study tested age of onset as a moderator of intervention efficacy on drinking and consequence outcomes among a high-risk population of college students (i.e., former high school athletes).
Students were randomized to one of four conditions: assessment only control, combined parent-based intervention (PBI) and brief motivational intervention (BMI), PBI alone, and BMI alone. Participants (n = 1,275) completed web-administered measures at baseline (summer before starting college) and 10-month follow-up.
Overall, the combined intervention demonstrated the strongest and most consistent reductions across all outcomes, particularly with the youngest initiators. Participants who initiated drinking at the youngest ages had significantly lower peak drinking, typical weekly drinking, and reported consequences at follow-up when they received the combined intervention when compared to the control group. The BMI and PBI groups, when examined independently, demonstrated significant effects across outcomes but were inconsistent across the different age groups.
Results suggest the combination of a PBI and a peer-delivered BMI is an appropriate and efficacious way to reduce drinking and related consequences among individuals who initiated drinking earlier in adolescence and are at an increased risk of experiencing alcohol problems.
Three studies compared the predictive validity of three proximal antecedents to risk behavior: behavioral intention (BI), behavioral expectation (BE), and behavioral willingness (BW). In Study 1, BW was the only significant predictor of change in substance use in early adolescence (age 13), whereas only BI was significant in middle adolescence (age 16). In Study 2, BW was a better predictor of change in smoking among young adolescents than was BE, but BE became predominant by middle adolescence. By late adolescence, previous behavior surpassed both BE and BW. When only smoking initiation was examined, BW was a better predictor than was BE. In Study 3, BI, BW, and BE independently predicted class skipping. However, BI was a better predictor for students more experienced with the behavior, whereas BW was superior for less experienced students. The findings provide evidence of a developmental shift from more reactive to more reasoned processing, as experience with the behavior increases.
A brief overview of theories of health behaviour that are based on the expectancy-value perspective is presented. This approach maintains that health behaviours are the result of a deliberative decision-making process that involves consideration of behavioural options along with anticipated outcomes associated with those options. It is argued that this perspective is effective at explaining and predicting many types of health behaviour, including health-promoting actions (e.g. UV protection, condom use, smoking cessation), but less effective at predicting risky health behaviours, such as unprotected, casual sex, drunk driving or binge drinking. These are behaviours that are less reasoned or premeditated - especially among adolescents. An argument is made for incorporating elements of dual-processing theories in an effort to improve the 'utility' of these models. Specifically, it is suggested that adolescent health behaviour involves both analytic and heuristic processing. Both types of processing are incorporated in the prototype-willingness (prototype) model, which is described in some detail.
Studies of health behaviour based on the expectancy-value perspective (e.g. theory of reasoned action) are reviewed, along with studies based on the prototype model.
These two sets of studies together suggest that the dual-processing perspective, in general, and the prototype model, in particular, add to the predictive validity of expectancy-value models for predicting adolescent health behaviour.
Research and interventions that incorporate elements of dual-processing and elements of expectancy-value are more effective at explaining and changing adolescent health behaviour than are those based on expectancy-value theories alone.
Alcohol abuse among college students is prevalent, yet few instruments with sound reliability and validity are available to assess these problems in this population. As part of a large, baseline assessment battery for a prospective study of offspring of alcoholics, the 27-item Young Adult Alcohol Problems Screening Test (YAAPST) was given to 490 freshmen at a large midwestern university; approximately 9 months later, 482 subjects completed the scale again. In addition to asking about such traditional problems as experiencing blackouts and driving while intoxicated, the YAAPST included specific items relating to college experiences (eg, getting into sexual situations that were later regretted, missing classes, and receiving lower grades than usual). The YAAPST was designed to assess these drinking consequences over two different time frames, lifetime and past year, and also to indicate the frequency of occurrence during the past year. Results indicated that the YAAPST is a unidimensional scale with good psychometric properties (good internal consistency and test-retest reliability). Three different approaches were used to demonstrate the validity of the YAAPST. Findings supported criterion validity (with interview-based alcohol abuse/dependence diagnoses as the criterion), concurrent validity (comparing the YAAPST with other drinking measures), and construct validity (correlating the YAAPST with etiologically relevant personality, motivational, and peer influence variables). The YAAPST is a promising screening instrument for alcohol problems in college students. It has excellent psychometric properties and the potential to provide a range of useful information to the clinician or researcher.
In the past 25 years, numerous publications have cited "blackouts" as a major prodromal symptom of alcoholism. In contrast, this study, based on a structured interview with 100 hospitalized alcoholics, revealed that more than one-third of the subjects had never experienced a blackout and that, among those who did report the experience, blackouts generally began well along in the course of alcoholism rather than at an early stage. Blackouts were positively associated with severity and duration of alcoholism, extent and duration of alcohol consumption per drinking episode, capacity for drinking large amounts, "loss of control," neglect of meals, gulping drinks, and a history of head trauma. Only one patient had experienced blackouts after moderate drinking.
Amnesia drinking episodes among a national probability sample of 12,686 young adults are examined at two points in their lives: when they were ages 19 to 26 in 1984 and 23 through 30 in 1988. Prospective blackout patterns of early onset, late onset, chronicity, and remission were analyzed using logistic regression statistical models. Results indicate that the relative risk of short-term memory loss while drinking is significantly associated with increased alcohol consumption, age of drinking onset, the number of alcoholic relatives, and, principally, with the individual's capacity to control drinking behavior. It is concluded that the blackout remission rate observed among a substantial proportion (68%) of young adults may not fit the progressive, irreversible model of alcoholism.
To examine the relationship between age of drinking onset and patterns of use, abuse of other substances, and the prevalence of other alcohol-related problems in a population of midwestern high school seniors.
We analyzed self-report survey data on public school students' history of alcohol and other drug use and related problems from the Minnesota Student Survey conducted in 1989. The sample consisted of 2,650 male and female seniors, representing a 10% random sample of all white seniors in the study.
The findings suggest that early onset of alcohol use (by age 12) is associated with subsequent abuse of alcohol and related problem behaviors in later adolescence, including alcohol-related violence, injuries, drinking and driving, and absenteeism from school or work, as well as increased risks for using other drugs.
This paper identifies the preadolescent years from age 10 to 12 as a particularly vulnerable period for the development of early alcohol dependence and abuse. Delaying alcohol use onset to age 13 may significantly reduce the risk of severe alcohol abuse in later adolescence.
The authors conducted an e-mail survey of 772 college students to learn more about their experiences with blackouts. Approximately half (51%) of those who had ever consumed alcohol reported they had experienced a blackout at some point in their lives, and 40% had experienced 1 in the year before the survey. Among those who drank in the 2 weeks before the survey, nearly 1 in 10 (9.4%) had experienced a blackout during that period. Many later learned that, during the blackout, they had vandalized property, driven an automobile, had sexual intercourse, or engaged in other risky behaviors. Experiencing 3 or more blackouts was associated with a variety of other experiences, including heavier drinking, lower grades, an earlier age of drinking onset, and having others express concerns about their drinking. The female students who reported blackouts during the 2 weeks before the survey drank far less than male students did during this time period, supporting the use of gender-specific definitions of risky drinking.
A substantial proportion of U.S. college students drink alcoholic beverages and report significant deleterious effects. The present study describes the development and initial validation of a measure designed to capture a broad range of alcohol-related consequences experienced by male and female college students.
College students (N=340, 176 women) completed a self-report questionnaire battery consisting of information about demographic characteristics, drinking behaviors, and drinking consequences. Drinking consequences were assessed with a composite measure based on the Drinker Inventory of Consequences, the Young Adult Alcohol Problem Screening Test (YAAPST) and items developed by the researchers. To assess concurrent validity, a subset of the total sample (n=126) also completed the Rutgers Alcohol Problem Index (RAPI).
Confirmatory factor analyses supported an eight-factor solution (Social-Interpersonal Consequences, Impaired Control, Self-Perception, Self-Care, Risk Behaviors, Academic/Occupational Consequences, Physical Dependence, and Blackout Drinking), with all factors loading on a single, higher-order factor. YAACQ total scores correlated with alcohol quantity and frequency, and the RAPI. Gender comparisons suggest that the YAACQ assesses constructs of interest equally well for women and men.
These results offer preliminary support for this measure. Research and clinical applications include the potential to predict future problems by specific type of consequence and to offer detailed feedback about drinking consequences to students as part of a preventive intervention. As such, the YAACQ may serve as an aid in both the description of and intervention for heavy drinking in college.