Jessica R. Skidmore

Computerized versus motivational interviewing alcohol interventions: impact on discrepancy, motivation, and drinking.

The authors conducted two randomized clinical trials with ethnically diverse samples of college student drinkers in order to determine (a) the relative efficacy of two popular computerized interventions versus a more comprehensive motivational interview approach (BASICS) and (b) the mechanisms of change associated with these interventions. In Study 1, heavy drinking participants recruited from a student health center (N = 74, 59% women, 23% African American) were randomly assigned to receive BASICS or the Alcohol 101 CD-ROM program. BASICS was associated with greater post-session motivation to change and self-ideal and normative discrepancy relative to Alcohol 101, but there were no group differences in the primary drinking outcomes at 1-month follow-up. Pre to post session increases in motivation predicted lower follow-up drinking across both conditions. In Study 2, heavy drinking freshman recruited from a core university course (N = 133, 50% women, 30% African American) were randomly assigned to BASICS, a web-based feedback program (e-CHUG), or assessment-only. BASICS was associated with greater post-session self-ideal discrepancy than e-CHUG, but there were no differences in motivation or normative discrepancy. There was a significant treatment effect on typical weekly and heavy drinking, with participants in BASICS reporting significantly lower follow-up drinking relative to assessment only participants. In Study 2, change in the motivation or discrepancy did not predict drinking outcomes. Across both studies, African American students assigned to BASICS reported medium effect size reductions in drinking whereas African American students assigned to Alcohol 101, e-CHUG, or assessment did not reduce their drinking.

The Effect of Drink Price and Next-Day Responsibilities on College Student Drinking: A Behavioral Economic Analysis

More than [3/4] of U.S. college students report a heavy drinking episode (HDE; 5 (for men) and 4 (for women) drinks during an occasion) in the previous 90 days. This pattern of drinking is associated with various risks and social problems for both the heavy drinkers and the larger college community. According to behavioral economics, college student drinking is a contextually bound phenomenon that is impacted by contingencies such as price and competing alternative reinforcers, including next-day responsibilities such as college classes. This study systematically examines the role of these variables by using hypothetical alcohol purchase tasks to analyze alcohol consumption and expenditures among college students who reported recent heavy drinking (N = 207, 53.1% women). The impact of gender and the personality risk factor sensation seeking (SS) were also assessed. Students were asked how many drinks they would purchase and consume across 17 drink prices and 3 next-day responsibility scenarios. Mean levels of hypothetical consumption were highly sensitive to both drink price and next-day responsibility, with the lowest drinking levels associated with high drink prices and a next-day test. Men and participants with greater levels of SS reported more demand overall (greater consumption and expenditures) than women and students with low SS personality. Contrary to our hypotheses women appeared to be less sensitive to increases in price than men. The results suggest that increasing drink prices and morning academic requirements may be useful in preventing heavy drinking among college students.

Symptoms of depression and PTSD are associated with elevated alcohol demand.

BACKGROUND Behavioral economic demand curves measure individual differences in motivation for alcohol and have been associated with problematic patterns of alcohol use, but little is known about the variables that may contribute to elevated demand. Negative visceral states have been theorized to increase demand for alcohol and to contribute to excessive drinking patterns, but little empirical research has evaluated this possibility. The present study tested the hypothesis that symptoms of depression and PTSD would be uniquely associated with elevated alcohol demand even after taking into account differences in typical drinking levels. METHOD An Alcohol Purchase Task (APT) was used to generate a demand curve measure of alcohol reinforcement in a sample of 133 college students (50.4% male, 64.4% Caucasian, 29.5% African-American) who reported at least one heavy drinking episode (5/4 or more drinks in one occasion for a man/woman) in the past month. Participants also completed standard measures of alcohol consumption and symptoms of depression and PTSD. RESULTS Regression analyses indicated that symptoms of depression were associated with higher demand intensity (alcohol consumption when price=0; ΔR(2)=.05, p=.002) and lower elasticity (ΔR(2)=.04, p=.03), and that PTSD symptoms were associated with all five demand curve metrics (ΔR(2)=.04-.07, ps<.05). CONCLUSIONS These findings provide support for behavioral economic models of addiction that highlight the role of aversive visceral states in increasing the reward value of alcohol and provide an additional theoretical model to explain the association between negative affect and problematic drinking patterns.

Reinforcing efficacy moderates the relationship between impulsivity-related traits and alcohol use.

Studies have shown that impulsivity-related traits are associated with alcohol use among college students. It is possible that individual differences in susceptibility to reinforcement from alcohol, which reflects the extent to which an individual values alcohol, moderates this relationship. Data were collected from 255 college students at a large, urban university who reported consuming alcohol at least once in the past 30 days. Two impulsivity-related-traits, Urgency and Sensation Seeking, were examined, as well as the reinforcing efficacy indices of Omax (maximum alcohol expenditure) and Demand Intensity (consumption when price = zero). Findings indicated that Omax moderated the relationship between both impulsivity-related traits and alcohol consumption, and between Urgency and alcohol-related problems. Demand Intensity also moderated the relationship between both impulsivity-related traits and alcohol use, but did not moderate the relationship between either trait and alcohol-related problems. Results from this study suggest that college students high in certain impulsivity-related traits and for whom alcohol is a highly valued reinforcer have a high risk for excessive alcohol consumption and an increased probability of experiencing negative alcohol-related problems.

Behavioral economic predictors of brief alcohol intervention outcomes

OBJECTIVE The present study attempted to determine whether behavioral economic indices of elevated alcohol reward value, measured before and immediately after a brief alcohol intervention, predict treatment response. METHOD Participants were 133 heavy drinking college students (49.6% female, 51.4% male; 64.3% Caucasian, 29.5% African American) who were randomized to 1 of 3 conditions: motivational interviewing plus personalized feedback (brief motivational interventions; BMI), computerized personalized feedback intervention (electronic check-up to go; e-CHUG), and assessment only. RESULTS Baseline level of alcohol demand intensity (maximum consumption) significantly predicted drinks per week and alcohol problems at 1-month follow-up and baseline relative discretionary expenditures on alcohol significantly predicted drinks per week and alcohol problems at 6-month follow-up. BMI and e-CHUG were associated with an immediate postsession reduction in alcohol demand (p < .001, ηp2 = .29) that persisted at the 1-month follow-up, with greater postsession reductions in the BMI condition (p = .02, ηp2 = .06). Reductions in demand intensity and Omax (maximum expenditure) immediately postintervention significantly predicted drinking reductions at 1-month follow up (p = .04, ΔR2 = .02, and p = .01, ΔR2 = .03, respectively). Reductions in relative discretionary expenditures on alcohol at 1-month significantly predicted drinking (p = .002, ΔR2 = .06,) and alcohol problem (p < .001, ΔR2 = .13) reductions at the 6-month follow-up. CONCLUSIONS These results suggest that behavioral economic reward value indices may function as risk factors for poor intervention response and as clinically relevant markers of change in heavy drinkers.

A behavioral economic supplement to brief motivational interventions for college drinking.

Basic behavioral and neurobiological research has demonstrated that deficiencies in naturally occurring substance-free rewards are both a cause and a consequence of substance abuse that are due in part to the systematic discounting of delayed substance-free rewards. Existing brief motivational interventions (BMIs) for alcohol abuse do not target this mechanism of change. The goal of this uncontrolled pilot study was to evaluate a behavioral economic Substance-Free Activity Session (SFAS) to traditional alcohol BMIs. Participants were 13 college freshmen who reported two or more heavy drinking episodes (>5/4 drinks in an occasion for men/women) in the past month. All participants completed a baseline assessment and a BMI that addressed alcohol use. In addition, participants received the SFAS, a 50-min individual session that attempts to increase engagement in constructive alternatives to drinking by enhancing the salience of delayed rewards (academic and career success) and the patterns of behavior (academic and extracurricular engagement) leading to these outcomes. At the 1-month follow-up assessment, participants reported significant reductions in heavy drinking, and moderate to large effect size reductions in weekly drinking and peak blood alcohol levels. The results of this pilot study provide preliminary support for the efficacy of this behavioral economic intervention session as a supplement to traditional alcohol BMIs.

The impact of elevated posttraumatic stress on the efficacy of brief alcohol interventions for heavy drinking college students

Brief alcohol interventions (BAIs) have been widely adopted for use with college students and are associated with significant reductions in drinking and problems. However, many students do not respond to these approaches and little is known about risk factors for poor response. The current study investigated one possible risk factor by examining the impact of posttraumatic stress (PTS) symptoms on BAI efficacy. This study presents pooled data from two randomized clinical trials that examined the efficacy of counselor-administered BAIs compared with computerized interventions. Participants were 207 college students (53.1% women, 68.1% White/Caucasian, 16.9% with elevated post-traumatic stress) who reported past-month heavy episodic drinking. Follow-up assessments were completed six months post-intervention. Analyses testing differences in frequency of past-month heavy episodic drinking revealed a significant post-traumatic stress by time interaction (F(1,165)=8.27, p=.005) such that individuals screening positive for PTS showed larger reductions in heavy episodic drinking at follow-up. A significant three-way interaction between time, PTS, and intervention condition (F(2,167)=5.76, p=.004) was found for alcohol related consequences. Specifically, among individuals screening positive for PTS, only those that received the counselor-administered BAI showed a significant reduction in consequences at follow-up. These results suggest that overall college students with PTS may respond well to BAIs and that counselor-delivered BAIs may be more efficacious than computer-delivered interventions for reducing alcohol problems for these high-risk students.

Alcohol-related consequences in African American and European American college students

Approximately 50% of college students report a heavy drinking episode in the past 2 weeks. This pattern of heavy episodic drinking places them at risk for experiencing alcohol-related problems. In addition, important ethnic differences exist between European American and African American college students in terms of drinking. European American college students report consuming more alcohol than African American college students, but little research exists on the differences in types and rates of problems. The current study sought to examine the differences in problems among 451 African American and European American college students using a comprehensive measure of alcohol-related problems. The effect of gender was also examined as research has found consistent gender differences in drinking. European American students experienced more problems overall and greater levels of social/interpersonal problems and risky behaviors even after controlling for drinking level. In addition, women reported significantly greater levels of problems in all domains except physical dependence, risky behaviors, and self-perception when drinking was controlled for.

The role of positive consequences of alcohol in the relation between sensation seeking and drinking

College students exhibit high levels of heavy drinking that are often associated with negative consequences, including unsafe sexual activity, injury, and legal trouble. The fact that students continue to drink despite these outcomes suggests they experience salient positive consequences. A known risk factor of drinking is the personality trait sensation seeking (SS), which may influence how a person interprets alcohol-related consequences and ultimately result in increased alcohol consumption. In this study, we examined the relations between SS, positive and negative consequences, and drinking among college students. Participants were 206 undergraduates who reported recent heavy drinking (53% female, 65% white, and 26% African-American). Students with higher levels of SS reported drinking more and also indicated experiencing more positive consequences as a result of their drinking than participants with lower levels of SS. This relation between SS and drinking was mediated by positive consequences, suggesting that one reason why students with higher levels of SS drink more than other students is that they experience more positive consequences from drinking. This could be due to increased social interactions typical of high SS students, resulting in a more positive appraisal of the drinking context. These conclusions may inform college drinking prevention and intervention programs.

Relations Between Heavy Drinking, Gender, and Substance-Free Reinforcement

Behavioral economic theory and laboratory research have suggested that substance abuse may be associated with diminished engagement in enjoyable substance-free activities (substance-free reinforcement). However, college students, in particular men, have reported numerous social benefits from drinking that might mitigate the expected inverse relation between drinking and substance-free reinforcement. In this study, we examined the relations between college student heavy drinking, gender, and several categories of substance-free reinforcement (peer, dating, sexual, school, and family activities). Participants were 246 undergraduate students who were classified as a function of their reported frequency of heavy drinking during a typical week in the past month (120 heavy drinkers, 126 light drinkers). Heavy drinking was associated with significantly higher substance-free peer and sexual reinforcement. This association was gender invariant and remained significant in multiple regression models that controlled for gender, ethnicity, and fraternity or sorority membership. Substance-free reinforcement did not predict frequency of heavy drinking in models that included levels of substance-related reinforcement. The results indicate that college student heavy drinking is not associated with global deficits in substance-free reinforcement and is instead associated with increased peer and sexual activity that occurs outside the context of drinking or drug use. Prevention programs should help students to compensate for the potential loss of social reinforcement associated with reductions in drinking.