Content uploaded by Laura Mezquita
Author content
All content in this area was uploaded by Laura Mezquita
Content may be subject to copyright.
Fax +41 61 306 12 34
E-Mail karger@karger.ch
www.karger.com
Research Report
Eur Addict Res 2011;17:250–261
DOI: 10.1159/00 0328510
Drinking Motives in Clinical and General
Populations
LauraMezquita a SherryH.Stewart b ManuelI.Ibáñez a MaríaA.Ruipérez a
HelenaVilla a JorgeMoya a GenerósOrtet a
a Department of Basic and Clinical Psychology and Psychobiology, Jaume I University, Castellón , Spain;
b Departments of Psychiatry, Psychology, and Community Health and Epidemiology, Dalhousie University,
Halifax , Canada
forcement drinking motives. Conclu sion: The Spanish M
DMQ-R is a reliable and valid measure of drinking motives
and has potential for assisting with treatment planning for
problem drinkers. Copyr ight © 2011 S. K arger AG, Basel
Introduction
Alcohol abuse is a high-risk behavior for health and
has been shown to be associated with more than 60 ill-
nesses, both physical and mental, as well as numerous
social problems
[1, 2] . In Spain, 93.7% of the population
between 15 and 64 years of age have consumed alcohol at
least once, while most people drink regularly (76.7% dur-
ing the last year, 64.6% in the last month, and 14.9% dai-
ly in the last month). Moreover, 5.5% of the population
engaged in high-risk levels of alcohol use in the last month
[3] .
From an integrative perspective, alcohol use and mis-
use is inf luenced by a variety of proximal and distal, bio-
logical (e.g. the level of response to alcohol
[4] ), psycho-
logical (e.g. expectancies and personality disorders
[5, 6] ),
and social variables (e.g. economic factors
[7, 8] ).
‘Drinking motives’ or the reasons why people drink
alcohol are among the proximal psychological variables
Key Words
Drinking motives ⴢ Psychometrics ⴢ General population ⴢ
Clinical population ⴢ Alcohol
Abstract
Aims: This paper had three aims: (1) to validate a Spanish ad-
aptation of the Modified Drinking Motives Questionnaire-
Revised (M DMQ-R), (2) to explore the relationship of each
drinking motive with different patterns of alcohol use, and
(3) to compare the drinking motives of moderate drinkers,
heavy drinkers, and alcohol abusing/dependent individuals.
Methods: Two studies were carried out. In Study 1, a sample
of 488 participants completed the M DMQ-R and a self-re-
port scale of alcohol consumption in order to study the fac-
tor structure and different indices of reliability and validity
of the Spanish M DMQ-R. In Study 2, we compared the drink-
ing motives of moderate and heavy drinkers from Study 1
and an additional sample of 59 clinical drinkers. Results: The
M DMQ-R demonstrated sound reliability and validity indi-
ces. Coping-with-anxiety, social, and enhancement motives
predicted higher alcohol use on weekends, but only coping-
with-anxiety and social motives were related to consump-
tion on weekdays. Furthermore, moderate drinkers had the
lowest scores for all motives, whereas alcohol-dependent
participants obtained the highest scores for negative rein-
Recei ved: January 11, 2011
Accepted: A pril 12, 2011
Publish ed online: June 21, 2011
E
u
r
o
p
e
a
n
Add
i
ct
i
o
n
c
R
e
e
s
a
r
h
Laura Mezqu ita
Depa rtment of Basic and Clinic al Psychology and Ps ychobiology
Jaume I University, Av. de Vicent Sos Bay nat, s/n
ES–12071 Castel lón (Spain)
Tel. +34 964 729 712, E-Mail l mezquit
@ psb.uji.es
© 2011 S. Karger AG, Basel
1022–6877/11/0175–0250$38.0 0/0
Accessible online at:
www.karger.com/ear
Drinking Motives Eur Addict Res 2011;17:250–261
251
that have been studied in an effort to prevent excessive
alcohol consumption. Many such studies have investigat-
ed drinking motives from the perspective of learning the-
ory, based on the premise that individuals drink to obtain
a desired reinforcement. For example, Farber et al.
[9] hy-
pothesized and validated the existence of two drinking
motive factors that could be labeled as positive reinforce-
ment factors (social motives) and negative reinforcement
factors (coping motives), respectively. Cooper et al.
[10]
validated the existence of these two factors (social and
coping) and included a third factor, which they called en-
hancement motives. This latter factor is characteristic of
individuals who report consuming alcohol ‘because it is
exciting’ or ‘to get a high’. These three motives were as-
sessed by the Drinking Motives Questionnaire (DMQ)
[10] .
C o o p e r [11] was inspired by Cox and Klinger’s [12] the-
oretical structure for drinking motives to propose a fur-
ther revised 4-factor model. The four drinking motives
in their revised model involve categorizing the desired
consequences of drinking based on (a) the type of rein-
forcement desired (positive or negative reinforcement)
and (b) the source of reinforcement (internal or external).
Crossing these two dimensions results in four distinct
drinking motives: social (external, positive reinforce-
ment), enhancement (internal, positive reinforcement),
conformity (external, negative reinforcement), and cop-
ing (internal, negative reinforcement) motives. All four of
these motives were evaluated by the Drinking Motives
Questionnaire Revised (DMQ-R) when the conformity
motives scale was added to the original DMQ.
Social motives (i.e. drinking to facilitate or improve
social relationships or to enhance enjoyment of a party)
are the most frequently endorsed drinking motives
among all age groups
[10, 11, 13] . Results show that social
motives are related to nonproblematic alcohol use [11, 14 –
16] , and are negatively associated with alcohol-related
problems in young adults
[17] . A possible explanation
could be that moderate alcohol consumption is socially
accepted and provides an opportunity to intensify friend-
ships, facilitating the achievement of new relationships
[18] .
Unlike social motives, enhancement motives have
been consistently related to heavy drinking
[19] and to
alcohol-related problems among both adolescents and
adults
[10, 11, 17, 20, 21] . However, when heavy drinking
is statistically controlled, enhancement motives do not
predict alcohol-related problems
[10 , 11, 2 2 –24] , suggest-
ing that heavy drinking mediates the relationship be-
tween enhancement motives and alcohol problems.
The relationship between conformity motives and al-
cohol use variables has been studied mainly among ado-
lescents
[25, 26] . Although conformity motives may hy-
pothetically be positively related to alcohol use
[11] , some
studies have found a negative association with drinking
levels, but a positive association with alcohol-related
problems
[11, 27, 28] . It is therefore possible that the role
of conformity motives may vary across different alcohol-
related behaviors, environments, or stages of drinking
history. For instance, they may be important in adoles-
cents, probably in an interaction with specific contexts,
such as drinking at parties
[11] , or drinking to fit into a
peer group that acts violently
[28] . They may also be quite
important in causing relapses among recovering alcohol-
ics since clinical patients have reported relapses due to
social pressure to resume alcohol consumption
[29, 30] .
The evidence derived from clinical practice therefore
shows that training in drink refusal skills can be useful
in helping prevent relapses among treated alcoholics
[31,
32] . This suggests that conformity motives should receive
increased attention in the adult alcohol use literature.
Coping motives have been associated with both heavy
drinking
[17, 20, 33] and alcohol-related problems in
young drinkers
[14 , 34 –36] , adult drinkers [10] , and alco-
hol-dependent adults
[37–39] . Recent studies [23] suggest
that it is important to differentiate between two subtypes
of coping motives based on findings that there appear to
be two distinct internal negative reinforcement pathways
to alcohol dependence
[40] .
Thus, the DMQ-R [11] was further modified, resulting
in the creation of a questionnaire with 28 items and a the-
oretical 5-factor structure: the Modified Drinking Motives
Questionnaire Revised (M DMQ-R)
[41] . This measure di-
vides the original coping motive factor into two distinct
motives: coping-wit h-anxiety and coping-with-depression
[ 23 ]. Grant et al. [23] showed empirically that the 5-factor
model fit the M DMQ-R data better than a 4-factor model
that is conceptually equivalent to that of Cooper
[11] .
Moreover, each coping motive appears to be differentially
related to drinking outcomes. In a concurrent prediction
of alcohol use among Canadian undergraduates, enhance-
ment and social drinking motives predicted drinking fre-
quency, while enhancement, social, and coping-with-
depression motives predicted drinking quantity. In pro-
spective analyses, only coping-with-depression motives
predicted alcohol-related problems. However, when drink-
ing levels were controlled, only coping-with-anxiety pre-
dicted alcohol-related problems prospectively
[23] .
To date, the psychometric properties of the M DMQ-R
have only been evaluated in samples of English-speaking
Mezquita /Stewart /Ibáñez /Ruipérez /
Villa
/Moya /Ortet
Eur Addict Res 2011;17:250–261
252
undergraduates [23] . The purpose of this study was to ex-
plore the psychometric properties of the M DMQ-R in a
middle-aged Spanish sample drawn from the general
population, and to compare the scores obtained with
those of patients diagnosed with alcohol abuse/depen-
dence.
Study 1: Psychometric Evaluation of the M DMQ-R in
a General Population Spanish Sample
S a m p l e
The sample was obtained using the ‘snowball’ method
where participants in turn contacted new participants.
Initial participants were assessed in several public insti-
tutions (city halls, universities), health services (waiting
rooms of primary care services) and private companies
(tile factories) in Castellón Province. All participants
completed the questionnaires anonymously.
The initial sample was made up of 575 participants.
Those indicating that they did not drink alcohol (n = 77),
or who did drink, but gave no information about the
quantity of alcohol consumption (n = 9), or did not com-
plete the M DMQ-R correctly (n = 1) were excluded from
the analysis, leaving a final sample of 488 participants
(51.5% women) with a mean age of 39.8 years (SD = 13.2).
In terms of their educational background, 2.2% of the
participants had not completed elementary school, 13.0%
had only completed elementary school, 32.2% had only
completed high school, and 52.6% had completed a uni-
versity education.
After 3 months, 51 participants completed the ques-
tionnaires again. Those indicating t hat they did not drink
alcohol (n = 9) or did not complete the M DMQ-R cor-
rectly (n = 2) were excluded from the analysis, leaving 40
pa rt icip ants (60 .0% wom en) wit h a me an age of 37.8 yea rs
(SD = 14.6) in the retest sample. In terms of education,
10.5% had only completed elementary school, 26.3% had
only completed high school, and 63.2% had completed a
university education.
Materials and Procedure
First, subject matter experts translated the M DMQ-R
[23] from English to Spanish. A back-translation was then
carried out to compare this second version to the original
questionnaire. This process resulted in a Spanish version
that could be considered comparable to the original En-
glish version.
The respondents provided sociodemographic data
(gender, age, educational level), drinking motives on the
M DMQ-R, and alcohol use measures on the Alcohol In-
take Scale (AIS)
[42] . Three months later, 51 volunteer
participants completed the questionnaires again in order
to examine the test-retest reliability of the M DMQ-R.
The M DMQ-R consists of 28 items, each contributing
to 1 of 5 subscales: social, coping-with-anxiety, coping-
with-depression, enhancement, or conformity. Taking
into consideration all the occasions on which they drink,
participants indicate how often they drink for the reason
specified in each item on a 5-point Likert scale ranging
from 1 (almost never/never) to 5 (almost always/always).
The AIS taps alcohol use during the week and on
weekends (frequency and quantity). With respect to fre-
quency of alcohol use during the week, participants are
asked four separate questions about drinking beer, wine,
cocktails, and hard liquor, respectively, on a scale of ‘nev-
er or hardly ever’ (0) to ‘daily’ (4). With regard to using
these beverages on the weekend, consumption frequency
is again measured by four separate questions using a scale
ranging from ‘never or hardly ever’ (0) to ‘four or more
weekends in a month’ (4). Composite frequency per week
and per weekend variables were created by adding alco-
hol-use frequency scores from each of the beverages to
obtain a total score from 0 to 16. Units consumed during
the week and on the weekend are evaluated through two
semistructured questions, which enable researchers to
determine the number of standard drinks consumed per
participant. In Spain, a standard drink is considered
equivalent to 10 g of alcohol
[43] .
A n a l y s i s
First, we conducted descriptive analyses to character-
ize the sample in terms of typical drinking quantity and
frequency. Second, we conducted a confirmatory factor
analysis of the M DMQ-R to examine the internal struc-
ture of the questionnaire and to compare the adequacy of
the 5-factor model with a model conceptually similar to
Cooper’s 4-factor model (with coping-anxiety and cop-
ing-depression items constrained to load on a single ge-
neric coping factor) [23].
Confirmatory multigroup analyses were performed to
determine the factorial invariance of the questionnaire
across men and women and across different age groups.
We calculated Cronbach’s ␣ to test the internal consis-
tency of the M DMQ-R scales. In addition, we used intra-
class correlations to examine the test-retest reliability of
the scales. Finally, hierarchical regression analyses were
performed to test the concurrent validity of the measure.
In this case we controlled for gender and age, the predic-
tor variables were the different drinking motives from the
Drinking Motives Eur Addict Res 2011;17:250–261
253
M DMQ-R, and the criterion variables were drinking fre-
quency and drinking quantity during the week and on
the weekend from the AIS.
R e s u l t s
Descriptive Analysis
Mean alcohol use in the total sample was 3.69 (SD =
5.25) standard drinks
[44] during the week and 7.35
(SD = 7.26) standard drinks on the weekend. The mean
drinking frequency score was 2.26 (SD = 2.30) during the
week and 5.05 (SD = 3.33) on the weekend (total drinking
frequency score from 0 to 16).
Mean alcohol use in the retest sample was 3.72 (SD =
4.72) standard drinks during the week and 7.18 (SD =
6.28) standard drinks on the weekend. The mean drink-
ing frequency was 2.48 (SD = 2.30) during the week and
4.98 (SD = 3.38) on the weekend.
Confirmatory Factor Analysis
EQS (Version 6.1) software was used to perform all
confirmatory factor analyses
[45] . First, the data were
screened to determine the appropriate model estimation
method. For the M DMQ-R scores, the normalized esti-
mate of Mardia’s coefficient of multivariate kurtosis
[46]
indicated significant non-normality in the data
[47] . Ac-
cordingly, the Satorra-Bentler robust method was used
[45] . The variance-covariance matrix was the basis of the
analysis, and the metric of the latent factors was defined
by setting factor variances to 1.0.
Overall, the hypothesized correlated 5-factor model of
drinking motives provided an adequate to excellent fit
for the data [23] [ 2 (340, n = 488) = 722.44, p ! 0.001;
RMSEA = 0.05 (90% CI: 0.043, 0.053); CFI = 0.94; IFI =
0.94].
Moreover, the standardized loadings of the indicator
variables on their hypothesized factors were all salient
(i.e. 6 0.30) [48] ( table1 ), with the exception of item 18 on
the conformity factor. We decided to maintain this item
to allow for comparability with other studies that also use
the M DMQ-R. Nevertheless, the multivariate Lagrange
multiplier tests for adding parameters suggested cross-
loadings of item 13 on the enhancement motives factor,
item 7 on the coping-with-anxiety motives factor, and
item 8 on the social motives factor. Given the generally
good fit of the model, the statistical significance of all un-
standardized factor loadings, the salience of the vast ma-
jority of the standardized factor loadings, and the absence
of a substantive basis for making changes implied by the
Lagrange multiplier tests, we did not make any post-hoc
modifications to the hypothesized model
[48, 49] .
Finally, when we compared the goodness-of-fit indices
of the 5-factor model with a model of four factors concep-
tually similar to Cooper’s model
[11] [ 2 (344, n = 488) =
751.83, p ! 0.001; RMSEA = 0.05 (90% CI: 0.044, 0.054);
CFI = 0.93; IFI = 0.93], the 2 difference test revealed a
significant decrement in model fit from the 5- to the
4-factor model [ 2 diff (4) = 21.39, p ! 0.001] as was seen
in the analysis of the original version of the M DMQ-R
[23] . In the same way, the Akaike Information Criterion
(AIC
[50] ) showed that the 5-factor model (AIC = 42.44)
provided a better fit to the data than the 4-factor model
(AIC = 63.83)
[48] .
Testing Factorial Invariance across Gender
Factorial invariance of the M DMQ-R was tested across
gender using hierarchical cumulative steps
[49] . In this
case, the sample was 482 because we excluded 6 respon-
dents who did not report their gender. First, we tested the
model separately in each gender group. The fit indices
were adequate for men [ 2 (340, n = 234) = 533.52, p !
0.001; RMSEA = 0.05 (90% CI: 0.041, 0.057); CFI = 0.93;
IFI = 0.93] and excellent for women [ 2 (340, n = 248) =
486.33, p ! 0.001; RMSEA = 0.04 (90% CI: 0.033, 0.050);
CFI = 0.96; IFI = 0.96]. We then tested for configural in-
variance across gender. Marker indicator variables were
used to set the metric of the latent factors for tests of facto-
rial invariance across gender. For each factor, the indicator
variable with the smallest difference between the unstan-
dardized factor loading for men and for women was se-
lected as the marker indicator (i.e. item 10 for social, item
8 for coping-with-anxiety, item 16 for coping-with-de-
pression, item 26 for enhancement, and item 24 for con-
formity). Fit indices showed an adequate fit for the data
[ 2 (680, n = 482) = 1,024.30, p ! 0.001; RMSEA = 0.05
(90% CI: 0.040, 0.051); CFI = 0.94; IFI = 0.94]. The addition
of cross-gender equivalence constraints for factor loading
did not result in a significant degradation in fit [compared
to the conf igu ral model, 2 dif f (23) = 17.79, p 1 0.50], sug-
gesting invariance. Additionally, constraining factor vari-
ance to be equivalent across gender did not result in a sig-
nificant decrease in fit [ 2 diff (5) = 2.7, p 1 0.50], again
suggesting invariance. Finally, adding the factor covari-
ance constraints across gender also failed to result in a
significant decrease in fit [ 2 diff (10) = 15.77, p 1 0.10].
Testing Factorial Invariance across Age Groups
The same process used to test factorial invariance
across gender groups was us ed to test fac toria l inva riance
across age groups [i.e. between younger adults (n = 249,
age range: 17–37) and older adults (n = 239, age range:
Mezquita /Stewart /Ibáñez /Ruipérez /
Villa
/Moya /Ortet
Eur Addict Res 2011;17:250–261
254
38–81)], which were created using a median split method.
First, we tested the model separately in each age group.
The fit indices were adequate for younger adults [ 2 (340,
n = 249) = 582.32, p ! 0.001; RMSEA = 0.05 (90% CI:
0.046, 0.061); CFI = 0.94; IFI = 0.94] and excellent for old-
er adults [ 2 (340, n = 239) = 431.61, p ! 0.001; RMSEA =
0.03 (90% CI: 0.023, 0.043); CFI = 0.96; IFI = 0.96]. In this
case, the marker indicator variables used to set the metric
of the latent factors for tests of factorial invariance across
age groups were items 1 (social), 2 (coping-with-anxiety),
3 (enhancement), 22 (coping-with-depression), and 28
(conformity). Fit indices showed an adequate fit for the
data when we tested the configural invariance across age
groups [ 2 (680, n = 488) = 1,004.63, p ! 0.001; RMSEA
= 0.04 (90% CI: 0.038, 0.050); CFI = 0.94; IFI = 0.94]. The
addition of cross-group equivalence constraints for factor
loading did not result in a significant degradation in fit
[compared to the configural model; 2 diff (22) = 20.65,
p 1 0.50], suggesting invariance. Additionally, constrain-
ing factor variance to be equivalent across groups result-
ed in a significant decrease in fit [ 2 diff (5) = 24.39, p !
0.001]. According to the Lagrange multiplier test, only t he
Tab le 1. Standardized factor loadings (SL), and standard errors (SE) for the 5-factor model of drinking motives
Items Social Coping-
with-anxiety
Coping-with-
depression
Enhancement C onformity
SL SE SL SE SL SE SL SE SL SE
1 As a way to celebrate 0.61 0.05
4 Because it is what most of my friends do
when we get together
0.64 0.05
7 To be sociable 0.45 0.04
10 Because it is customary on special occasions 0.73 0.05
13 Because it makes a social gathering more
enjoyable
0.77 0.05
2 To relax 0.40 0.05
8 Because I feel more self-confident or sure of myself 0.63 0.06
11 Because it helps me when I am feeling nervous 0.44 0.06
19 To reduce my anxiety 0.35 0.05
5 To forget my worries 0.72 0.05
14 To cheer me up when I’m in a bad mood 0.71 0.06
16 To numb my pain 0.49 0.04
17 Because it helps me when I am feeling depressed 0.64 0.05
20 To stop me from dwelling on things 0.69 0.04
21 To turn off negative thoughts about things in my life 0.63 0.04
22 To help me feel more positive about things in my life 0.68 0.04
23 To stop me from feeling so hopeless about the future 0.62 0.03
27 To forget painful memories 0.65 0.05
3 Because I like the feeling 0.61 0.05
6 Because it is exciting 0.71 0.05
9 To get a high 0.59 0.06
12 Because it’s fun 0.81 0.05
26 Because it makes me feel good 0.64 0.05
15 To be liked 0.72 0.06
18 So that others won’t kid me about not using 0.27 0.06
24 Because my friends pressure me to use 0.51 0.06
25 To fit in with a group I like 0.68 0.05
28 So I won’t feel left out 0.66 0.06
Ada pted from Grant et al. [23].
Drinking Motives Eur Addict Res 2011;17:250–261
255
enhancement factor variance varied across age groups
(younger adults 1 older adults). Moreover, adding the fac-
tor covar ia nce constr ai nts acr oss age groups also f aile d to
result in a significant decrease in fit [ 2 diff (10) = 15.50,
p 1 0.10].
Mean Differences in Drinking Motives across
Gender
The M DMQ-R demonstrated invariance across gen-
der. Meaningful cross-gender comparisons of levels of
drinking motives were therefore possible. To explore the
differences between genders, we used a between-groups
(gender) multivariate analysis of variance with each of
the five drinking motive scores serving as dependent
measures. We did not find an overall multivariate effect
of gender. Furthermore, we did not find significant dif-
ferences across gender in any of the drinking motive
scales at the univariate level. In addition, both gender
groups reported social 1 enhancement 1 coping-with-
anxiety 1 coping-with-depression 1 conformity motives.
In both groups, a set of dependent sample t tests showed
that all of these differences between drinking motives
were significant at p ! 0.001, apart from coping-with-de-
pression and conformity drinking motives (men: t = 0.79,
p = 0.43; women: t = 1.61, p = 0.11).
Mean Differences in Drinking Motives across Age
Groups
As we found factorial invariance between age groups,
we proceed to compare drinking motives endorsement
between younger and older adults performing a multi-
variate analysis of variance. The results showed differ-
ences between age groups across motives [ F (5, 482) =
8.42, p ! 0.001]. Univariate statistics showed that youn-
ger adults scored higher than older adults in enhance-
ment [ F (1) = 35.50, p ! 0.001], social [ F (1) = 13.59, p !
0.001], and coping-with-anxiety [ F (1) = 4.567, p ! 0.05]
drinking motives. Moreover, both age groups scored
higher in social drinking motives following by enhance-
ment, coping-with-anxiety, coping-with-depression, and
conformity drinking motives, respectively. A set of de-
pendent sample t tests in each group showed that the dif-
ferences between each pair of drinking motives were sig-
nificant at p ! 0.001 apart from coping-with-depression
and conformity drinking motives (younger adults: t =
2.23, p ! 0.05; older adults: t = 0.27, p = 0.789).
Factor Intercorrelations and Internal Consistency
As expected, there were significant intercorrelations
between scales ( table 2 ). The highest correlation was
found between coping-with-anxiety and coping-with-
depression motives (0.74). If compared w ith Cooper’s
[11]
4-factor model of drinking motives, similar results are
apparent. The highest correlation was found between so-
cial and enhancement drinking motives (0.60; external
positive reinforcement vs. internal positive reinforce-
ment), and the lowest correlation was found between en-
hancement and conformity drinking motives (0.35; in-
ternal positive reinforcement vs. external negative rein-
forcement).
Internal consistency on the scales ranged from ␣ =
0.63 (coping-with-anxiety) to ␣ = 0.88 (coping-with-de-
pression). Though the coping-with-anxiety subscale’s in-
ternal consistency is below the widely accepted 0.70 cut-
off, it is acceptable by Loewenthal’s
[51] standard, which
indicates that a Cronbach’s ␣ 6 0.60 is adequate for short
scales (i.e. scales with ! 10 items).
Test-Retest Reliability
The M DMQ-R subscale means and standard devia-
tions for the retest are presented in table2 at each time
point for the subset of participants who completed the
two assessments.
The intraclass correlation coefficients between the cor-
responding subscales at time 1 and time 2 were all sig-
nificant (p ! 0.05; table2 ). Intraclass correlation coeffi-
cients for the coping-with-depression, enhancement, and
social motives scales were in the excellent range, in the
good range for conformity, and in the fair range for cop-
ing-with-anxiety
[52] . A series of paired samples t tests
revealed no signif icant dif ferences in scores across the two
testing times, again suggesting stability of motives scores.
Concurrent Validity
In order to determine the concurrent validity of the M
DMQ-R, hierarchical regression analyses were performed
controlling both age and gender. In this case, the criterion
variables were the four alcohol-use variables from the AIS
(i.e. drinking frequency during the week, drinking fre-
quency on the weekend, standard drinks consumed dur-
ing the week, and standard drinks consumed on the
weekend), and the predictor variables were the five dif-
ferent drinking motives from the M DMQ-R ( table3 ).
Social motives and coping-with-anxiety motives were
related to alcohol-use variables, both on weekdays and on
weekends. Generally speaking (except for drinking fre-
quency on the weekend), coping-with-anxiety motives
showed stronger associations with the drinking criterion
variables than did social motives. By contrast, enhance-
ment motives were only related to alcohol-use variables
Mezquita /Stewart /Ibáñez /Ruipérez /
Villa
/Moya /Ortet
Eur Addict Res 2011;17:250–261
256
Tab le 2 . Descriptive statistics for the M DMQ-R and intercorrelations for the subscales
DMQ-R M subscales Full sample (n = 488) Test-retest (n = 40)
mean SD ␣factor correlations time 1 t ime 2 ICCT1T2 t
1 2 3 4 5 mean SD me an SD
1 Social 2.35 0.84 0.78 – 0.44 0.37 0.60 0.39 2.45 0.84 2.34 0.81 0.75 –1.24
2 Coping-with-anxiety 1.21 0.40 0.63 – 0.74 0.54 0.49 1.15 0.33 1.18 0.30 0.51 0.50
3 Coping-with-depression 1.14 0.33 0.88 – 0.47 0.43 1.14 0.29 1.12 0.24 0.87 –0.72
4 Enhancement 1.62 0.75 0.82 – 0.35 1.73 0.87 1.59 0.81 0.76 –1.57
5 Conformity 1.11 0.30 0.75 – 1.16 0.30 1.13 0.29 0.73 –0.88
Int raclass correlations (ICCs) measuring subscale test-retest reliabilities over 3 months, and paired t tests to determine significance
and direction of change in drinking motives. All factor intercorrelations are significant at p < 0.01. In the test-retest, all ICC values are
significant at p < 0.001. All t are nonsignificant at p > 0.05.
Tab le 3. Sequential linear regression analysis predicting concurrent alcohol-use criterion variables
Step Indicator variable(s) Frequency of drinking during the week S tandard drinks during the week
BSE
B
adjusted
R2
⌬
R2
BSE
B
adjusted
R2
⌬
R2
1 (Constant) 2.50‡0.45 4.29‡1.02
Gender –1.02 0.20 –0.22‡–2.40 0.45 –0.23‡
Age 0.03 0.01 0.19‡0.08 0.09‡0.08 0.02 0.19‡0.09 0.09‡
2 (Constant) –0.83 0.62 –4.81†1.39
Gender –0.90 0.19 –0.20‡–2.14 0.41 –0.21‡
Age 0.05 0.01 0.28‡0.11 0.02 0.28‡
Social 0.46 0.14 0.17†0.95 0.32 0.15†
Coping-with-anxiety 1.91 0.38 0.33‡3.43 0.84 0.26‡
Coping-with-depression –0.14 0.43 –0.02 1.66 0.96 0.10
Enhancement 0.20 0.17 0.06 0.32 0.39 0.05
Conformity –0.94 0.36 –0.12*0.23 0.16‡–1.31 0.81 –0.08 0.26 0.18‡
Step Indicator variable(s) Frequency of drinking on the weekend Standard drinks on the weekend
BSE
B
adjusted
R2
⌬
R2
BSE
B
adjusted
R2
⌬
R2
1 (Constant) 8.79‡0.66 20.40‡1.36
Gender –1.37 0.30 –0.21‡–3.60 0.61 –0.25‡
Age –0.04 0.01 –0.17‡0.06 0.07‡–0.19 0.02 –0.34‡0.17 0.17‡
2 (Constant) 2.30†0.84 7.03‡1.75
Gender –1.06 0.25 –0.16‡–3.04 0.52 –0.21‡
Age 0.00 0.01 –0.00 –0.11 0.02 –0.20‡
Social 1.15 0.19 0.29‡1.34 0.40 0.16†
Coping-with-anxiety 1.61 0.50 0.19†3.53 1.05 0.19†
Coping-with-depression 0.46 0.58 0.05 2.04 1.21 0.09
Enhancement 1.10 0.23 0.25‡2.5 0.48 0.26‡
Conformity –2.33 0.49 –0.21‡0.35 0.29‡–3.92 1.02 –0.16‡0.40 0.24‡
* p < 0.05; † p < 0.01; ‡ p < 0.001.
Drinking Motives Eur Addict Res 2011;17:250–261
257
on the weekend. Of all the drinking motive variables, en-
hancement motives showed the strongest relation with
the qu ant ity consu med on t he weeke nd. Conformi ty m o-
tives were negatively related to drinking frequency both
on weekdays and on weekends, and to standard drinks
consumed on the weekend. Nevertheless, low positive
correlations found across conformity motives and drink-
ing frequency on the weekdays (0.12, p ! 0.05), drinking
frequency on weekend (0.11, p ! 0.05), standard drinks
on the weekdays (0.18, p ! 0.05), and standard drinks on
the weekend (0.14, p ! 0.05) in the bivariate correlations
suggest that this negative association in the multiple re-
gressions was due to a suppressor effect [53].
Study 2: Comparison of Drinking Motives in a
Spanish General Population Sample with a
Sample of Patients Diagnosed with Alcohol
Abuse/Dependence
Sample
The patient sample consisted of 59 individuals (84.7%
men), with a mean age of 47.8 (SD = 8.3) years. Of the to-
tal patient sample, 3.4% had not completed elementary
school, 57.6% had only completed elementary school,
28.8% had only completed high school, and 10.2% had
completed university education. They were all diagnosed
with alcohol abuse/dependence by clinicians (psychia-
trists and psychologists) according to DSM-IV-TR crite-
ria
[54] . The clinicians also ruled out any other diagnosis
of substance abuse/dependence according to DSM-IV-TR
diagnostic criteria. All of the patients were receiving
treatment at the San Agustín Addictive Behavior Unit in
Castelló.
The control sample used was the same as in the Study
1 sample, apart from 6 participants who did not provide
information on their gender. In order to determine
whether drinking motives vary across various stages of
drinking history, we differentiated moderate drinkers
(men ! 28 standard drinks/week, women ! 17 standard
drinks/week; n = 433) from heavy drinkers (men 6 28
standard drinks/week, women 6 17 sta ndard drinks/
week; n = 49) in the general population sample
[2] .
We first tested whether the three groups of drinkers
were equivalent in demographic characteristics (age and
gender). We did not find significant differences in age
(t = 1.25, p = 0.21) or gender [ 2 (1) = 0.29, p = 0.59] be-
tween moderate and heavy drinkers. However, we found
significant differences in age between outpatients and
moderate drinkers (t = 4.49, p ! 0.001), and between out-
patients and heavy drinkers (t = 5.07, p ! 0.001), with the
outpatients proving significantly older in each case.
Moreover, we found a higher proportion of men in the
outpatient sample when compared with both the moder-
ate drinkers sample [ 2 (1) = 26.66, p ! 0.001] and the
heavy drinkers sample [ 2 (1) = 18.95, p ! 0.001].
Materials and Procedure
The screening was performed in the San Agustín Ad-
dictive Behav ior Unit in Castelló by exper t cl inicia ns. Pa-
tients were informed that participation was voluntary,
they were evaluated in individual sessions, and they pro-
vided written informed consent. The Structured Clinical
Interview for DSM Axis I Disorders
[55] was used to de-
termine alcohol abuse/dependence diagnoses. In addi-
tion, participants completed the M DMQ-R and the sub-
stance use scales. The participants received EUR 30 as
compensation for participating in the research.
A n a l y s i s
A multivariate analysis of covariance was performed
in which the dependent variables were the five different
drinking motives, and the independent variable was al-
cohol use group (moderate drinkers, heavy drinkers, and
clinical drinkers). We included age and gender as covari-
ates to control for demographic differences between the
groups of drinkers. Moreover, in the case of each signifi-
ca nt m ain effe ct o f alcohol use group, we p erformed Bon-
ferroni post-hoc tests to determine where the significant
group differences lay.
R e s u l t s
Table4 shows the mean and standard deviation for
each of the alcohol-use groups on the M DMQ-R scales.
The multivariate analysis of covariance showed a sig-
nificant multivariate main effect of alcohol use group
[ F (10, 1,066) = 45.66, p ! 0.001]. Univariate main effects
of alcohol use group were seen for each of the five drink-
ing motives scales (see table4 for F-statistics and effect
size information).
Bonferroni post-hoc tests showed that moderate
drinkers scored significantly lower for all five drinking
motives compared to both heavy drinkers and alcohol
abusing/dependent outpatients ( table 4 ). We found no
significant differences between heavy drinkers and alco-
hol abusing/dependent outpatients on either the social or
enhancement motives subscales (i.e. positive reinforce-
ment motives; table4 ). Alcohol abusing/dependent out-
patients scored significantly higher than heavy drinkers
on coping-with-anxiety, coping-with-depression, and
Mezquita /Stewart /Ibáñez /Ruipérez /
Villa
/Moya /Ortet
Eur Addict Res 2011;17:250–261
258
conformity motives subscales (i.e. negative reinforcement
motives; table4 ).
In terms of within-group effects, heavy drinkers
scored highest on social motives, followed by enhance-
ment, coping-with-anxiety, coping-with-depression, and
conformity motives. The same rank ordering of the five
alcohol use motives was found in moderate drinkers as
in heavy drinkers. The only exception was that coping-
with-depression and conformity motives scores failed to
differ among the moderate drinkers. In contrast to the
other two groups of drinkers, outpatients indicated the
highest scores on coping-with-anxiety motives, followed
by social, enhancement, coping-with-depression, and
conformity motives, respectively.
Discussion
This study examined the psychometric properties of
the M DMQ-R in a Spanish sample drawn from the gen-
eral population. In Study 1, the confirmatory factor anal-
yses indicated that the 5-factor model provided a good fit
to the M DMQ-R scores of Spanish drinkers.
When we compared the 5-factor model to a model
conceptually equivalent to Cooper’s 4-factor model
[11] ,
we found a superior fit to the data of the 5-factor solution,
similar to previous findings with Canadian undergradu-
ates
[23] . Moreover, we found factorial invariance of the
M DMQ-R across gender. We consequently compared
the drinking motives across gender groups and found no
significant drinking motive differences across gender
groups. These results are unlike those of Grant et al.
[23]
who found higher social motives in Canadian undergrad-
uate males than in undergraduate females using the M
DMQ-R, and Cooper et al.
[10] who found higher social
as well as enhancement and (generic) coping motives in
men than in women in an American general population
sample using the 3-factor DMQ. These discrepancies
could reflect developmental differences between under-
graduate students and adults, differences in power be-
tween the current study and Cooper et al.
[10] , or cross-
cultural differences in drinking motives [27, 56].
In addition, the M DMQ-R showed factorial invari-
ance across two age groups of younger versus older adults.
However, when we compared drinking motive endorse-
ment between younger and older adults, we found that
the younger adults showed significantly higher enhance-
ment, social, and coping-with-anxiety drinking motives,
which is in line with previous studies which assessed so-
cial, enhancement, and (generic) coping drinking mo-
tives in young adults versus middle age samples (i.e.
[10]
vs.
[13] ).
All scales were acceptable in terms of internal consis-
tency for scales of this length
[51] . Test-retest reliability
over 3 months was good to excellent for all scales, except
for the coping-with-anxiety scale where the stability was
only fair. The relatively lower stability of this scale may
have been due to the influence of participants’ actua l state
of anxiety levels when answering the coping-with-anxi-
ety motives scale.
W h en we te st ed t he co nc u rr en t v al id it y of t he M D MQ -
R in a general population Spanish sample, after control-
ling gender and age, we found that different drinking mo-
tives predicted several alcohol-use variables. We found
that enhancement motives predict higher alcohol-use (fre-
quency and quantity) on the weekend – the times when
heavier consumption is more likely
[3] – which is in line
with Kuntsche and Cooper’s
[57] findings in adolescents.
Nonetheless, social and coping-with-anxiety motives
predicted higher alcohol-use both on weekdays and on
Tab le 4. Means (SD) and differences in drinking motives between moderate drinkers, heavy drinkers, and outpatients
a. Moderate drinkers
(n = 433)
b. Heavy drinkers
(n = 49)
c. Outpatients
(n = 59)
d
(b-a)
d
(c-a)
d
(c-b)
F univariate Partial
eta2
1 Social 2.27 (0.81) 2.92 (0.88) 2.88 (0.88) 0.77‡0.72‡0.05 25.60 0.09
2 Enhancement 1.54 (0.69) 2.28 (0.89) 2.53 (1.02) 0.92‡1.14‡0.26 63.04 0.19
3 Coping-with-anxiety 1.16 (0.31) 1.59 (0.71) 2.90 (1.11) 0.78‡2.14‡1.41‡289.99 0.52
4 Coping-with-depression 1.09 (0.26) 1.44 (0.55) 2.49 (1.00) 0.81‡1.92‡1.30‡249.78 0.48
5 Conformity 1.09 (0.27) 1.25 (0.47) 1.55 (0.59) 0.42†1.00‡0.56‡46.21 0.15
O utpatients were diagnosed with alcohol abuse/dependence according to DSM-IV-TR criteria. Means are covariate-adjusted to
control for group differences in age and gender. Differences between groups calculated with the Bonferroni test. † p < 0.01; ‡ p < 0.001.
Cohen’s d values of 0.20, 0.50, and 0.80 correspond to small, medium, and large effect sizes, respectively [56]. All univariate F (d.f. =
2,536) values and eta2 were significant at p < 0.001.
Drinking Motives Eur Addict Res 2011;17:250–261
259
weekends, with coping-with-anxiety motives proving the
stronger predictor in all cases except for frequency of con-
sumption on weekends. These findings highlight the im-
portance of considering the drinking context (in this case
time of the week: weekday vs. weekend) when examining
the drinking behavior correlates of the various drinking
motives. Moreover, these findings suggest that it is impor-
tant to separate coping-with-anxiety and coping-with-de-
pression motives, in that only the former but not the latter
were concurrently assoc iated with i ncreased consumption
in our sample. However, coping-with-anxiety and coping-
with-depression were not strongly related to drinking fre-
quency and drinking quantity in a previous study with
Canadian undergraduates
[23] . This difference between
the two studies in the correlates of coping-with-anxiety
motives may be due to age and/or cultural differences.
When we compare our results with samples of a similar
age, undifferentiated coping drinking motives predicted
higher alcohol-use in an American sample from the gen-
eral population
[10] . However, the study by Cooper et al.
[10] used the DMQ, which does not differentiate between
coping-with-anxiety and coping-with-depression mo-
tives. Taken together, these results suggest that although
coping drinking motives may not be strongly related to
alcohol use in young people, they may be more relevant to
drinking among middle-aged adults, particularly coping-
with-anxiety motives. This raises the possibility that
drinking to deal with stress and to manage unpleasant
feelings of tension and worry may become more relevant
i n pr e d ic t i n g q u a nt i t y an d f re q u en c y of d r i nk i n g t h ro u g h-
out the week during the transition from young adulthood
to middle age, as drinkers gain more experience with the
anxiety-reducing effects of alcohol use.
When we compared alcohol-use motives between
moderate drinkers, heavy drinkers, and alcohol abusing/
dependent outpatients, we found that scores for all drink-
ing motives were significantly lower in moderate con-
sumers than in either heavy drinkers or alcohol abusing/
dependent outpatients. Outpatients scored significantly
higher than heavy drinkers in negative reinforcement
drinking motives (coping-anxiety, coping-depression,
and conformity), but we found no significant differences
between the latter two drinker groups in positive rein-
forcement drinking motives (social and enhancement).
Moreover, even though positive reinforcement motives
(social and enhancement) were the most strongly en-
dorsed by moderate drinkers and heavy drinkers, fol-
lowed by negative reinforcement motives (coping-with-
anxiety, coping-with-depression, and conformity drink-
ing motives), the pattern of relative endorsement was
different in the outpatients sample (i.e. coping-anxiety 1
social 1 enhancement 1 coping-depression 1 conformi-
ty). Coping-with-anxiety motives were endorsed as
strongly as social motives, and coping-with-depression
motives were endorsed as strongly as enhancement mo-
tives in the outpatient sample.
These findings could indicate that the relative weight
of each drinking motive varies at different stages of an
individual’s history of alcohol use. Negative reinforce-
ment motives would therefore be more salient when an
alcohol abuse or dependence pattern is developed, while
positive reinforcement motives have a salient role in ini-
tial and heavy drinking stages. Another possible explana-
tion is that some drinking motives could facilitate the
development of heavy drinking and/or alcohol disorders.
Higher scores in coping-with-anxiety, coping-with-de-
pression, and conformity drinking motives could be
risky drinking motives for the development of alcohol
abuse/dependence. These findings are consistent with t he
results of previous studies, in which coping and confor-
mity motives predicted drinking problems regardless of
heavy consumption
[11, 23] . In addition, we found no dif-
ferences for enhancement motives between heavy drink-
ers and alcohol abusers/dependents. However, as expect-
ed, heavy drinkers did score higher than moderate drink-
ers on a variety of motives, with the strongest between-
group difference on enhancement motives. This pattern
of results is consistent with previous findings that en-
hancement motives are most strongly connected with
heavy drinking, and negative reinforcement motives
with alcohol problems
[11, 23] .
The present study has several limitations. First, alco-
hol use was based on self-report measures, and not as-
sessed using more objective methods, such as blood alco-
hol level
[58] . Second, some of the factor loadings were
not as salient as the original version of the questionnaire
[23], mainly in the case of items from the coping-with-
anxiety scale. This fact may be attributed to the adapta-
tion process (i.e. translation and back-translation) or to
sociocultural differences between Spain and Canada. To
address this issue in the future, it would be advisable to
perform cross-cultural studies about drinking motives
using the M DMQ-R. Third, the relatively lower test-re-
test reliability of the coping-with-anxiety motives scale
suggests that it must be used with caution. Fourth, the
low sample size in the retest sample made it difficult to
test the factorial stability in the general population by
performing a confirmatory factor analysis at time 2. Per-
forming this kind of analysis in the future could help
tease apart whether the low intraclass correlation coeffi-
Mezquita /Stewart /Ibáñez /Ruipérez /
Villa
/Moya /Ortet
Eur Addict Res 2011;17:250–261
260
cient of the coping-with-anxiety scale is due to the lower
alpha coefficients of the coping-with-anxiety scale, to is-
sues with the factorial stability of this scale, or to changes
in motivation linked to state anxiety changes across time.
Fifth, taking into account that coping motives had
bee n r el ate d t o a lc ohol -rel at ed pro blem s i n p re vi ous st ud -
ies, it would be advisable to assess alcohol-related prob-
lems in future studies (e.g. using the Alcohol Use Disor-
ders Identification Test)
[59] . It would help to clarify the
different roles of coping-with-anxiety and coping-with-
depression drinking motives in predicting not only alco-
hol use, but also alcohol-related problems in a middle-
aged adult population. Sixth, in Study 2, the number of
participants differed quite dramatically between groups
(moderate drinkers = 433, heavy drinkers = 49, and alco-
hol-dependent = 59). Larger sample sizes of heavy drink-
ers and alcohol abusing/dependent individuals should be
included in future studies. That would also allow for test-
ing of the factorial structure of the measure in alcohol-
dependent patients, to ensure that alcohol-dependent pa-
tients drink alcohol for the same set of reasons as those
in the general population. Seventh, it is important to
point out that outpatients were diagnosed when they be-
gan with the treatment. For this reason, it is possible that
some patients were free of alcohol use disorder (AUD)
diagnoses when they participated in the present study,
which may have served to minimize between alcohol use
group differences in drinking motives. Moreover, since
diagnostic assessments were not conducted with the gen-
eral population sample, it is possible that some individu-
als with diagnosable AUDs were included in either/both
of the two non-AUD groups in Study 2 (i.e. moderate
and heavy alcohol users groups). Finally, since this was
a cross-sectional study, it would be useful to conduct
further prospective studies to clarify whether the ‘risky’
negative reinforcement drinking motives (conformity,
coping-with-anxiety, and coping-with-depression) are a
cause and/or consequence of alcohol abuse/dependence,
and whether elevated enhancement motives are a cause
and/or consequence of heavy drinking.
In general, the M DMQ-R appears to be a reliable and
valid measure of drinking motives in a Spanish general
population sample. The M DMQ-R has potential for as-
sisting with treatment planning for heavy drinkers or
those with alcohol abuse/dependence issues. For exam-
ple, if a clinical patient obtains high scores in conformity
motives, planning an assertiveness training treatment
[31, 60] or offering social skills training might be most
useful. If the patient obtains high scores in coping-with-
anxiety motives, for example, relaxation training
[61]
might be an appropriate treatment component. If a pa-
tient obtains a high score on coping-with-depression mo-
tives, a behavioral activation treatment might be most ap-
propriate
[62] .
Acknowledgements
Funding for this study was provided by the Spanish Ministry
of Science Grant PSI2008-05988, the Spanish Ministry of Health
(PNSD 2009) and the Fundació Caixa-Castelló Bancaixa Grant
E-2009-05 and E-2010-12. The authors wish to thank the profes-
sionals at the San Agustín Addictive Behavior Unit in Castelló for
their help with the diagnostic process and assessments.
References
1 Anderson P, Baumberg B: Alcohol in Eu-
rope – public health perspective: report sum-
mary. Drugs Educ Prev Pol 2006;
13: 483–
488.
2 World Health Organization (WHO): Global
status report on alcohol. Geneva, Depart-
ment of Mental Hea lth and Substance Abuse
of the WHO, 2004.
3 Spanish Drug Observatory: SDO Report
2007. Madrid, Ministry of Health and Con-
sumer Affairs, 2007.
4 Schuckit MA, Smith TL, Tipp JE: The self-
rating of t he effects of alcohol (SRE) form as
a retrospective measure of the risk for alco-
holism. Addiction 1997;
92: 979–988.
5 Zimmermann J, Junge C, Niemann J, Wong
JWM, Preuss UW: Alcohol consumption
and expectations of its effects in the border
region of Pomerania: Comparison of Ger-
man and Polish adolescents. Eur Addict Res
2010;
16: 170–178.
6 Preuss UW, Johann M, Fehr C, Koller G,
Wodarz N, Hess elbrock V, Wong WM, Soyka
M: Personality disorders in alcohol-depen-
dent individuals: relationship with alcohol
dependence severity. Eur Addict Res 2009;
15: 188 –195.
7 Gustafsson NKJ: Alcohol consumption in
Southern Sweden after major decreases in
Danis h spirits taxe s and increase s in Swedish
travellers’ quotas. Eur Addict Res 2010;
16:
152–161.
8 Ruipérez MA, Ibáñez MI, Villa H, Ortet G:
Factores biopsicosociales en el consumo de
alcohol (Biopsychosocial factors in alcohol
consumption); in Oblitas LA (ed): Atlas de
psicología de la salud. Bogotá, PSICOM edi-
tores, 2006.
9 Farber PD, Khav ari KA, Doug lass FM: A fac-
tor analytic study of reasons for drinking:
empirical validation of positive and negative
reinforcement dimensions. J Consult Clin
Psychol 1980;
48: 780–781.
10 Cooper ML, Russell M, Sk inner JB, Windle
M: Development and validation of a three-
dimensional measure of drinking motives.
Psychol Assess 1992;
4: 123–132.
11 Cooper ML: Motivations for alcohol use
among adolesc ents: development and va lida-
tion of a four-factor model. Psychol Assess
1994;
6: 117–128.
12 Cox WM, Klinger E: A motivationa l model
of alcohol use. J Abnorm Psycho 1988;
97:
168–180.
Drinking Motives Eur Addict Res 2011;17:250–261
261
13 Stewar t SH, Zeitlin SB, Samoluk SB: Exami-
nation of a three-dimensional drinking mo-
tives questionnaire in a young adult univer-
sity stu dent sample. Behav Res The r 1996;
34:
61–71.
14 Simons J, Correia CJ, Carey KB: A compari-
son of motives for ma rijuana and alc ohol use
among experienced users. Addict Behav
2000;
25: 153–160.
15 Stewart SH, L oughlin HL , Rhyno E: Interna l
drinking motives mediate personalit y do-
main-drink ing relations in young adults.
Pers Individ Diff 20 01;
30: 271–286.
16 Windle M: A n alcohol involvement ty pology
for adolescents: convergent validity and lon-
gitudinal stability. J Stud A lcohol 1996;
57:
627–637.
17 Labouvie E, Bates ME: Reasons for alcohol
use in young adulthood: validation of a
three-dimensional measure. J Stud Alcohol
2002;
63: 145 –155.
18 Engels RCME, ter Bogt T: Influences of risk
behaviors on the quality of peer relations in
adolescence. J Youth Adolesc 2001;
30: 675–
695.
19 Kuntsche E, Knibbe R, Gmel G, Engels R:
Who drinks and why? A review of socio-de-
mographic, personality, and contextual is-
sues behind the drinking motives in young
people. Addict Behav 2006;
31: 18 44 –1857.
20 Cooper ML , Agocha VB, Sheldon MS: A mo-
tivation al perspect ive on risky behav iors: the
role of persona lity and affect regulatory pro-
cesses. J Pers 2000;
68: 1059–1088.
21 Cronin CJ: Reasons for drinking versus out-
come expectancies in the prediction of col-
lege student drinking. Subst Use Misuse
1997;
32: 1287–1311.
22 Carriga n G, Samoluk SB, Stewa rt SH: Exam-
ination of the short form of the Inventory of
Drinking Situations (IDS-42) in a young
adult university student sample. Behav Res
Ther 1998;
36: 789–807.
23 Grant VV, Stewart SH, O’Connor RM,
Blackwel l E, Conrod PJ: Psychomet ric evalu-
ation of the five-factor Modified Drink ing
Motives Questionnaire – Revised in under-
graduates. Addict Behav 2007;
32: 2611–2632.
24 Stewart SH, Chambers L: Relationships be-
tween drinking motives and drinking re-
straint. Addict Behav 2000;
25: 269–274.
25 Brown J, Finn P: Drinking to get drunk:
f ind in gs of a sur ve y o f ju ni or a nd s en ior hi gh
school students. J Alcohol Drug Educ 1982;
27: 13–25.
2 6 Gl ik sma n L: Deve lopm ent al a spe cts of mo ti-
vation to drink: a cross-sectional investiga-
tion. Med Law 1983;
2: 377–383.
27 Ku ntsche E, Stewa rt SH, Cooper M L: How sta-
ble is the motive-alcohol use l ink? A cross-na-
tional validation of the Drinking Motives
Questionnaire Revised among adolescents
from Switzerland, Canada, and the United
States. J St ud Alcohol Drugs 20 08;
69: 388–396.
28 Kuntsche E, Knibbe R, Engels R, Gmel G:
Bullying and fighting among adolescents –
do drin king motives and alcohol use mat ter?
Addict Behav 2007;
32: 3131–3135.
29 Marlatt GA, Gordon J R: Determina nts of re-
lapse: implications for the maintenance of
behavior change; in Davidson PO, Davidson
SM (eds): Behavioral Medicine: Changing
Healthy Lifestyles . New York, Brunner/Ma-
zel, 1980, pp 410–452.
30 Zywiak W H, Stout RL, Trefry W B, Glasser I,
Connors GJ, Maisto SA, Westerberg VS: Al-
cohol relapse repetition, gender, and predic-
tive validity. J Subst Abuse Treat 2006;
30:
349–353.
31 Brown LS, Ostrow F: The development of an
assertiveness program on an alcoholism
unit. Int J Addict 1980;
15: 323–327.
32 Epstein EE, McCrady BS: A Cognitive-Be-
havioral Treatment Progra m for Overcom-
ing Alco hol Problems: Therapist Gu ide. New
York, Oxford University Press, 2009.
33 Montgomery RL , Benedicto JA, Haem merlie
FM: Personal vs. social motivations of un-
dergraduates for using a lcohol. Psychol Rep
1993;
73: 960–962.
34 Cooper ML, Frone MR, Rusell M, Mudar P:
Drinking to regulate positive and negative
emotions: a motivational model of alcohol
use. J Pers Soc Psychol 1995;
69: 990–1005.
35 McNally AM, Palfai TP, Levine RV, Moore
BM: Attachment dimensions and drinking-
related problems among young adults: the
mediational role of coping motives. Addict
Behav 2003;
28: 1115–1127.
36 Windle M, Windle RC: Coping strategies,
drinking motives, and stressful life events
among middle adolescents: associations
with emot ional and behav ioral problems and
with academic functioning. J Abnorm Psy-
chol 1996;
105: 551–560.
37 Carpenter K M, Hasin DS: A prospective
evaluation of the relationship between rea-
sons for drinking and DSM-IV alcohol-use
disorders. Addict Behav 1998;
23: 41–46.
38 Car penter KM, Hasi n DS: Reasons for dr ink-
ing alc ohol: relationships w ith DSM-IV alc o-
hol diagnoses and alcohol consumption in a
communit y sample. Psychol Addict Behav
1998;
12: 168 –184 .
39 Carpenter K M, Hasin DS: Drinking to cope
with neg ative affect a nd DSM-IV alcohol use
disorders: a test of three alternat ive explana-
tions. J Stud Alcohol 1999;
60: 694–704.
40 Conrod PJ, Pihl RO, Stewart SH, Dongier M:
Validation of a system of classifying female
substance abusers based on persona lity and
motivation al risk factor s for substance abuse .
Psychol Addict Behav 2000;
14: 243–256.
41 Blackwell E, Conrod PJ: A five-dimensional
measure of drinking motives. Unpublished
manuscript, Department of Psycholog y,
University of British Columbia, 2003.
42 Grau E, Ortet G: Personalit y traits and alco-
hol consumpt ion in a sample of non-alcohol-
ic women. Pers Individ Diff 1999;
27: 1057–
1066.
43 Rodríguez-Martos A, Gual A, Llopis JJ: The
‘standard drink unit’ as a simplified record-
ing system of alcohol consumption and its
measurement in Spain. Med Clin 1999;
112:
446–50.
44 Gual A, Martos AR, Lligoña A, Llopis JJ:
Does the concept of a standard drink apply
to viticultural societies? Alcohol Alcohol
1999;
34: 153–160.
45 Bentler PM: EQS 6 Structural Equations
Progra m Manual. Enci no, Multivariat e Soft-
ware Inc., 2006.
46 Mardia KV: Measures of multivariate skew-
ness and kurtosis with applications. Bio-
metrika 1970;
57: 519–530.
47 Bentler PM, Wu EJC: EQS for Windows Us-
er’s Guide. Encino, Multivariate Software
Inc., 1995.
48 Brown TA: Conf irmatory factor analysis for
applied research. New York, Guilford Press,
2006.
49 Byrne BM: Structural equation modeling
with EQS: basic concepts, applications, and
programming , ed 2. Mahwah, Erlbaum,
2006.
50 Akaike H: Factor analysis and AIC. Psy-
chometrika 1987; 52: 317–332.
5 1 L o ew en t ha l K M: A n I nt r od uc t io n to Ps yc h o-
logical Tests and Scales. London, UCL Press
Limited, 1996.
52 Cicchetti DV: Guidelines, criteria, and rules
of thumb for evaluating normed and stan-
dardized assessment instruments in psy-
chology. Psychol Assess 1994;
6: 284–290.
53 Paulhus DL, Robins RW, Trzesniewski KH,
Tracy JL: Two replicable suppressor situa-
tions in personalit y research. Multivariate
Behav Res 2004;
39: 303–328.
54 American Psychiatric Association (APA):
Diagnostic and statistical manual of mental
disorders, ed 4. Washington, APA, 2000.
55 First MB, Spitzer RL, Gibbon M, Wil liams
JBW: The structured clinical interview for
DSM-IV Axis I disorders (SCID-I) (clinical
version). Barcelona, Mason, 1999.
56 Cohen J: A power primer. Psychol Bul l 1992;
112: 155–159.
57 Kuntsche E, Cooper ML: Drinking to have
fun and to get drunk: motives as predictors
of weekend drinking over and above usual
drin king habits. D rug Alcohol Depend 2010;
110: 259–262.
58 De Beaurepa ire R, Luka siewicz M, Beauverie
P, et al: Comparison of self-reports and bio-
logical measures for a lcohol, tobacco, and il-
licit drugs consumption in psychiatric inpa-
tients. Eur Psychiatr 2007;
22: 540–548.
59 World Health O rganizat ion (WHO): AUDIT
– The Alcohol Use Disorders Identification
Test: Guidelines for Use in Primary Care.
Geneva, Department of Mental Health and
Substance Dependence of the WHO, 2001.
60 Secades R., Fernández JR: Efficacious psy-
chological treatments for drug-addiction:
nicotine, alcohol, cocaine and heroin. Psico-
thema 2001;
13: 365–380.
61 Nejad L, Volny K: Treating Stress and Anxi-
ety: A practitioner’s Guide to Evidence-
Based Approaches. Norwa lk, Crown House
Publishing Limited, 2008.
62 Pérez M, García JM: Efficacious psychologi-
cal treatments for depression. Psicothema
2001;
13: 493–510.