Antony C. Moss

The effects of responsible drinking messages on attentional allocation and drinking behaviour

AIMS Four experiments were conducted to assess the acute impact of context and exposure to responsible drinking messages (RDMs) on attentional allocation and drinking behaviour of younger drinkers and to explore the utility of lab-based methods for the evaluation of such materials. METHODS A simulated bar environment was used to examine the impact of context, RDM posters, and brief online responsible drinking advice on actual drinking behaviour. Experiments one (n = 50) and two (n = 35) comprised female non-problem drinkers, whilst Experiments three (n = 80) and 4 (n = 60) included a mixed-gender sample of non-problem drinkers, recruited from an undergraduate student cohort. The Alcohol Use Disorders Identification Test (AUDIT) was used to assess drinking patterns. Alcohol intake was assessed through the use of a taste preference task. RESULTS Drinking in a simulated bar was significantly greater than in a laboratory setting in the first two studies, but not in the third. There was a significant increase in alcohol consumption as a result of being exposed to RDM posters. Provision of brief online RDM reduced the negative impact of these posters somewhat; however the lowest drinking rates were associated with being exposed to neither posters nor brief advice. Data from the final experiment demonstrated a low level of visual engagement with RDMs, and that exposure to posters was associated with increased drinking. CONCLUSIONS Poster materials promoting responsible drinking were associated with increased consumption amongst undergraduate students, suggesting that poster campaigns to reduce alcohol harms may be having the opposite effect to that intended. Findings suggest that further research is required to refine appropriate methodologies for assessing drinking behaviour in simulated drinking environments, to ensure that future public health campaigns of this kind are having their intended effect.

'Neknomination': Predictors in a sample of UK university students

Objectives To identify prevalence and predictors of participation in the online drinking game ‘neknomination’ amongst university students. Method A convenience sample of 145 university students participated in a study about drinking behaviours, completing a questionnaire about their participation in neknomination, the Alcohol Use Disorders Identification Test, and the Resistance to Peer Influence Scale. Results Out of 145 students sampled, 54% took part in neknomination in the previous month. Mann–Whitney U tests revealed significantly higher scores on the Alcohol Use Disorders Identification Test, and significantly lower scores on the Resistance to Peer Influence Scale, for those who had participated in neknomination. A significant correlation was also shown between specific peer pressure to neknominate, and engagement in neknomination. A logistic regression analysis indicated that scores on the Alcohol Use Disorders Identification Test, but not the Resistance to Peer Influence Scale, predicted classification as an individual who participated in neknomination. Conclusions We found that over half of respondents had participated in a neknomination game in the past month, with almost all male respondents having done so. Participation in neknomination was strongly associated with general hazardous drinking behaviour but not with resistance to peer influence. Further research is needed to understand the role of engagement with social media in drinking games and risky drinking.

Testing a frequency of exposure hypothesis in attentional bias for alcohol-related stimuli amongst social drinkers

Aims To examine whether a group of social drinkers showed longer response latencies to alcohol-related stimuli than neutral stimuli and to test whether exposure to 1) an alcohol-related environment and 2) consumption related cues influenced the interference from alcohol-related stimuli. Methods A 2 × 2 × 2 × 5 factorial design with Exposure Group (high, low) and Consumption Group (high, low) as between-participant factors and Word Type (alcohol, neutral) and Block (1–5) as within-participant factors was used. Forty-three undergraduate university students, 21 assigned to a high exposure group and 22 to a low exposure group, took part in the experiment. Exposure Group was defined according to whether or not participants currently worked in a bar or pub. Consumption Group was defined according to a median split on a quantity–frequency measure derived from two questions of the Alcohol Use Disorders Identification Test (AUDIT) questionnaire. A modified computerised Stroop colour naming test was used to measure response latencies. Results Exposure and consumption factors interacted to produce greater interference from alcohol-related stimuli. In particular, the low consumption group showed interference from alcohol-related stimuli only in the high exposure condition. Exposure did not affect the magnitude of interference in the high consumption group. Conclusions Attentional bias is dependent upon exposure to distinct types of alcohol-related cues.

Knowledge of drinking guidelines does not equal sensible drinking

1242 www.thelancet.com Vol 374 October 10, 2009 that reported an associa tion between unemployment and increased suicide and homicide also found increased deaths directly from alcohol abuse. The missing link is that concurrent alcohol intoxication could be a factor in as many as 65% of suicides. That is no more improbable than alcohol being a factor in some irresponsible car crashes or unpremeditated murders. The alcohol and violence special interest group of the UK Public Health Association has been focusing on the need to make policy makers aware that people with alcohol problems usually have multiple needs and they typically present for health care on the basis of those other needs. Risky drinking often overlaps with experiences such as clinical depression or homelessness or domestic abuse but, for example, a depressed woman fl eeing from a violent spouse whose hungry children now lack shelter seems unlikely to begin her engagement with a clinician by saying “Doctor, my priority today is to discuss my concealed drink problem”. We already know that alcohol and unemployment interact and heavy drinking precedes much fatal self harm. Andreas Lundin and Tomas Hemmingsson’s prescient Comment stresses the “moderating eff ect of unemployment benefi ts” on suicide. Does this make the present punitive approach of the UK benefi ts system towards people with alcohol problems seem a little imprudent?

To suppress, or not to suppress? That is repression: Controlling intrusive thoughts in addictive behaviour

Research to understand how individuals cope with intrusive negative or threatening thoughts suggests a variety of different cognitive strategies aimed at thought control. In this review, two of these strategies--thought suppression and repressive coping--are discussed in the context of addictive behaviour. Thought suppression involves conscious, volitional attempts to expel a thought from awareness, whereas repressive coping, which involves the avoidance of thoughts without the corresponding conscious intention, appears to be a far more automated process. Whilst there has been an emerging body of research exploring the role of thought suppression in addictive behaviour, there remains a dearth of research which has considered the role of repressive coping in the development of, and recovery from, addiction. Based on a review of the literature, and a discussion of the supposed mechanisms which underpin these strategies for exercising mental control, a conceptual model is proposed which posits a potential common mechanism. This model makes a number of predictions which require exploration in future research to fully understand the cognitive strategies utilised by individuals to control intrusive thoughts related to their addictive behaviour.

Habit predicts in-the-moment alcohol consumption.

AIM The objective of this study was to examine whether habit predicts in-the-moment behavioural intention (amount of alcohol poured) and behavioural enactment (amount and proportion of alcohol consumed) controlling for craving and positive alcohol expectancies. METHOD Forty-six college students, who defined themselves as social drinkers, were tested individually in a laboratory setting. After completing a measure of craving they were given a bottle of non-alcoholic beer and a cup, asked to pour a drink, and then drink as much as they liked. They were not informed that the beer was non-alcoholic. They were subsequently asked to complete measures of alcohol use and misuse, positive alcohol expectancies and habit. RESULTS Positive alcohol expectancies were positively and significantly associated with the amount of alcohol poured and the amount and proportion of alcohol consumed. Habit was positively and significantly associated with the amount and proportion of alcohol consumed but not with the amount of alcohol poured. Hierarchical regression analyses revealed that only habit was a significant predictor of both the amount and proportion of alcohol consumed. Even though measures of intention (amount of alcohol poured) and behaviour (amount and proportion of alcohol consumed) were positively correlated, habit was shown to effectively discriminate between these measures. CONCLUSIONS These findings suggest that habit predicts in-the-moment behavioural enactment in terms of the amount and proportion of alcohol consumed.

Impact of alcohol-promoting and alcohol-warning advertisements on alcohol consumption, affect, and implicit cognition in heavy-drinking young adults: A laboratory-based randomized controlled trial

Objectives There is sparse evidence regarding the effect of alcohol‐advertising exposure on alcohol consumption among heavy drinkers. This study aimed to assess the immediate effects of alcohol‐promoting and alcohol‐warning video advertising on objective alcohol consumption in heavy‐drinking young adults, and to examine underlying processes. Design Between‐participants randomized controlled trial with three conditions. Methods Two hundred and four young adults (aged 18–25) who self‐reported as heavy drinkers were randomized to view one of three sets of 10 video advertisements that included either (1) alcohol‐promoting, (2) alcohol‐warning, or (3) non‐alcohol advertisements. The primary outcome was the proportion of alcoholic beverages consumed in a sham taste test. Affective responses to advertisements, implicit alcohol approach bias, and alcohol attentional bias were assessed as secondary outcomes and possible mediators. Typical alcohol consumption, Internet use, and television use were measured as covariates. Results There was no main effect of condition on alcohol consumption. Participants exposed to alcohol‐promoting advertisements showed increased positive affect and an increased approach/reduced avoidance bias towards alcohol relative to those exposed to non‐alcohol advertisements. There was an indirect effect of exposure to alcohol‐warning advertisements on reduced alcohol consumption via negative affect experienced in response to these advertisements. Conclusions Restricting alcohol‐promoting advertising could remove a potential influence on positive alcohol‐related emotions and cognitions among heavy‐drinking young adults. Producing alcohol‐warning advertising that generates negative emotion may be an effective strategy to reduce alcohol consumption. Statement of contribution What is already known on this subject? Exposure to alcohol advertising has immediate and distal effects on alcohol consumption. There is some evidence that effects may be larger in heavy drinkers. Alcohol‐warning advertising has been found to have mixed effects on alcohol‐related cognitions. What does this study add? Among heavy‐drinking young adults: Alcohol advertising does not appear to have an immediate impact on alcohol consumption. Alcohol advertising generates positive affect and increases alcohol approach bias. Alcohol‐warning advertising that generates displeasure reduces alcohol consumption.

The Science of Absent Evidence: Is There Such Thing as an Effective Responsible Drinking Message?

Aims To review the effectiveness of responsible drinking messages (RDMs). Methods We searched PsycINFO, MEDLINE and Google Scholar to June 2016 for studies evaluating the effectiveness of RDMs. Only eight studies met the inclusion/exclusion criteria. Due to a small number of search results and broad inconsistency in methods and outcome measures, quantitative synthesis was not possible so a narrative summary of findings was conducted. Results A review of findings from these articles suggested a disjointed approach in terms of the format and content of RDMs evaluated, as well as the dependent variables used to judge their effectiveness. An overall pattern emerged suggesting that RDMs may have beneficial effects across various outcome measures, including reducing prospective alcohol use. However, due to the inconsistent approach to both the development and evaluation of RDMs, it was not possible to draw any clear conclusions in terms of effectiveness, or indeed the potential size of any effects. Conclusions A systematic approach to the development and evaluation of RDMs is recommended to ensure that a clearer evidence base is established in this area, particularly in light of the substantial public funds which are often spent on RDM campaigns. Short summary A systematic review of studies evaluating the effectiveness of responsible drinking message campaigns reveals an inconsistent approach to message design and evaluation. Findings of the review suggest the need for a more consistent approach to aid in the development of a clearer evidence base in this area.

Attentional Bias for Alcohol-Related Stimuli among Belief Based and Non-Belief Based Non-Drinkers

Background/Aims: Research has provided evidence for an association between attentional biases for substance-related stimuli and the development and maintenance of a variety of addictive behaviours. Attempts at reducing attentional bias amongst harmful and dependent drinkers have provided evidence to suggest that reduced attentional bias in heavy drinkers would lead to necessary reductions in alcohol intake. We tested one aspect of this assumption by measuring attentional bias amongst non-drinkers who, if the link between attentional bias and actual drug use is causal, should demonstrate no attentional bias for alcohol-related stimuli. Methods: An alcohol Stroop task was administered to belief-based abstainers, non-belief based abstainers and light social drinkers to measure attentional biases for alcohol-related words compared to neutral words. Results: Belief-based abstainers demonstrated significant attentional bias for alcohol-related stimuli, whilst non-belief based abstainers and light social drinkers did not. Conclusion: Attentional biases towards alcohol-related stimuli are not specific to harmful and problem drinkers, which has implications for interventions based on attentional bias change.

Contemporary perspectives on cognition in addictive behaviors

• A presentation of some of the latest developments in research on cognition in addictive behaviors.