Kelly S. DeMartini

Optimizing the Use of the AUDIT for Alcohol Screening in College Students.

The screening and brief intervention modality of treatment for at-risk college drinking is becoming increasingly popular. A key to effective implementation is use of validated screening tools. Although the Alcohol Use Disorders Identification Test (AUDIT) has been validated in adult samples and is often used with college students, research has not yet established optimal cutoff scores to screen for at-risk drinking. Four hundred and one current drinkers completed computerized assessments of demographics, family history of alcohol use disorders, alcohol use history, alcohol-related problems, and general health. Of the 401 drinkers, 207 met criteria for at-risk drinking. Receiver operating characteristic (ROC) curve analysis revealed that the area under the ROC (AUROC) of the AUDIT was .86 (95% CI [.83, .90]). The first 3 consumption items of the AUDIT (AUDIT-C; AUROC = .89, 95% CI [.86, .92]) performed significantly better than the AUDIT in the detection of at-risk drinking in the whole sample, and specifically for females. Gender differences emerged in the optimal cutoff scores for the AUDIT-C. A total score of 7 should be used for males, and a score of 5 should be used for females. These empirical guidelines may enhance identification of at-risk drinkers in college settings.

Reduction of alcohol drinking in young adults by naltrexone: a double-blind, placebo-controlled, randomized clinical trial of efficacy and safety.

OBJECTIVE Naltrexone, an opioid antagonist, may facilitate reduction in drinking among young adults. We compared the efficacy and safety of naltrexone administered daily plus targeted dosing with placebo to reduce drinking in young adults who engage in heavy drinking. METHOD A randomized, double-blind, placebo-controlled study was conducted in an outpatient research center in March 2008-January 2012. Participants were aged 18-25 years and reported ≥ 4 heavy drinking days in the prior 4 weeks. Interventions included naltrexone 25 mg daily plus 25 mg targeted (at most daily) in anticipation of drinking (n = 61) or daily/targeted placebo (n = 67). All participants received a personalized feedback session and brief counseling every other week. Primary outcomes were percent heavy drinking days and percent days abstinent over the 8-week treatment period. Secondary outcomes included number of drinks per drinking day and percentage of days with estimated blood alcohol concentration (BAC) levels ≥ 0.08 g/dL. RESULTS Of 140 randomized patients, 128 began treatment, comprising the evaluable sample. During treatment, percent heavy drinking days (naltrexone: mean = 21.60, SD = 16.05; placebo: mean = 22.90, SD = 13.20) (P = .58) and percent days abstinent (naltrexone: mean = 56.60, SD = 22.52; placebo: mean = 62.50, SD = 15.75) (P = .39) did not differ by group. Naltrexone significantly reduced the number of drinks per drinking day (naltrexone: mean = 4.90, SD = 2.28; placebo: mean = 5.90, SD = 2.51) (P = .009) and percentage of drinking days with estimated BAC ≥ 0.08 g/dL (naltrexone: mean = 35.4, SD = 28.40; placebo: mean = 45.7, SD = 26.80) (P = .042). There were no serious adverse events. Sleepiness was more common with naltrexone. CONCLUSIONS Naltrexone did not reduce frequency of drinking or heavy drinking days, but reduced secondary measures of drinking intensity. While effects were modest, the risk-benefit ratio favors offering naltrexone to help young adult heavy drinkers reduce the amount of alcohol they drink. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00568958.

Psychometrically Improved, Abbreviated Versions of Three Classic Measures of Impulsivity and Self-Control

Self-reported impulsivity confers risk factor for substance abuse. However, the psychometric properties of many self-report impulsivity measures have been questioned, thereby undermining the interpretability of study findings using these measures. To better understand these measurement limitations and to suggest a path to assessing self-reported impulsivity with greater psychometric stability, we conducted a comprehensive psychometric evaluation of the Barratt Impulsiveness Scale-11 (BIS-11), the Behavioral Inhibition and Activation Scales (BIS/BAS), and the Brief Self-Control Scale (BSCS) using data from 1,449 individuals who participated in substance use research. For each measure, we evaluated (a) latent factor structure, (b) measurement invariance, (c) test-criterion relationships between the measures, and (d) test-criterion relations with drinking and smoking outcomes. Notably, we could not replicate the originally published latent structure for the BIS, BIS/BAS, or BSCS or any previously published alternative factor structure (English language). Using exploratory and confirmatory factor analysis, we identified psychometrically improved, abbreviated versions of each measure: 8-item, 2-factor BIS-11 (root-mean-square error of approximation [RMSEA] = .06, comparative fit index [CFI] = .95); 13-item, 4-factor BIS/BAS (RMSEA = .04, CFI = .96); and 7-item, 2-factor BSCS (RMSEA = .05, CFI = .96). These versions evidenced (a) stable, replicable factor structures, (b) scalar measurement invariance, ensuring our ability to make statistically interpretable comparisons across subgroups of interest (e.g., sex, race, drinking/smoking status), and (c) test-criterion relationships with each other and with drinking/smoking. This study provides strong support for using these psychometrically improved impulsivity measures, which improve data quality directly through better scale properties and indirectly through reducing response burden.

Integrating behavioral health services into a university health center: patient and provider satisfaction.

The goals of this study were to (a) describe an Integrated Behavioral Health Care (IBHC) program within a university health center and (b) assess provider and patient acceptability and satisfaction with the IBHC program, including behavioral health screening and clinical services of integrated behavioral health providers (BHPs). Fifteen providers (nine primary care providers and six nurses) and 79 patients (75% female, 65% Caucasian) completed program ratings in 2010. Providers completed an anonymous web-based questionnaire that assessed satisfaction with and acceptability of behavioral health screening and the IBHC program featuring integrated BHPs. Patients completed an anonymous web-based questionnaire that assessed program satisfaction and comfort with BHPs. Providers reported that behavioral health screening stimulated new conversations about behavioral health concerns, the BHPs provided clinically useful services, and patients benefited from the IBHC program. Patients reported satisfaction with behavioral health services and reported a willingness to meet again with BHPs. Providers and patients found the IBHC program beneficial to clinical care. Use of integrated BHPs can help university health centers support regular screening for mental and behavioral health issues. Care integration increases access to needed mental health treatment.

Interventions to Reduce Alcohol Use among HIV-Infected Individuals: A Review and Critique of the Literature

Alcohol use disorders are common among HIV-infected individuals and are associated with adverse physiological complications and increased engagement in other health risk behaviors. This paper provides a review and critique of interventions to reduce alcohol use among HIV-infected individuals, including a: (a) synthesis of core intervention components and trial designs; (b) summary of intervention efficacy to reduce alcohol use outcomes; and (c) methodological critique and guidance for future research. We reviewed 14 behavioral interventions that reported on alcohol use outcomes among HIV-infected individuals. Findings were mixed for intervention efficacy to reduce alcohol frequency and quantity. There was limited evidence that interventions reduced binge drinking frequency or alcohol abuse or dependence symptoms. Despite the prevalence of disordered alcohol use among HIV-infected individuals, there is lack of efficacious intervention approaches. Efficacious intervention approaches to reduce alcohol use among HIV-infected individuals are urgently needed.

Effects of choice on intervention outcomes for college students sanctioned for campus alcohol policy violations

This study tested the hypothesis that client choice influences intervention outcomes. We recruited 288 student drinkers (60% men, 67% freshmen) required to participate in an intervention due to a violation of campus alcohol policy. Participants were randomized either to self-chosen or researcher-assigned interventions. In the choice condition they selected either a brief motivational intervention (BMI) or a computer-delivered educational program. In the assigned condition they received 1 of the 2 interventions, assigned randomly. Follow-up assessments at 1 and 2 months revealed that choice was associated with higher intervention satisfaction. However, the assigned and choice conditions did not differentially change on consumption or consequences across intervention type. Overall, change scores favored the BMI over the computer-delivered intervention on consumption and consequences. Exploratory analyses revealed that given the choice of intervention, heavier-drinking students self-selected into the face-to-face BMI. Furthermore, among the students who received a BMI, the students who chose it (despite their heavier drinking) reduced drinks per drinking day more than did the assigned students. In summary, offering a choice of intervention to students mandated for campus alcohol violations increased the chance that at-risk students will select a more intensive and effective intervention.

A New Look at Risk-Taking: Using a Translational Approach to Examine Risk-Taking Behavior on the Balloon Analogue Risk Task

Models of risk-taking typically assume that the variability of outcomes is important in the likelihood of making a risky choice. In an animal model of the Balloon Analogue Risk Task (BART), within-session variability, or the coefficient of variability (CV), was found to be a novel predictor of behavior (Jentsch et al., 2010). Human studies have not investigated how BART performance differs when using the CV versus a traditional BART measure (e.g., number of pumps). This study sought to determine whether the CV provides a unique and valuable alternative index of risk-taking on the BART, and to determine the relationship of the CV to self-reported alcohol consumption. Young adult heavy drinkers (n = 58, 72% male, mean age 21.53) completed an assessment of drinking patterns and a modified version of the BART. Multiple regression results indicated that CV is a unique predictor of total explosions and total money earned on the BART. Higher levels of variability were associated with fewer explosions but less money earned, whereas more pumps was associated with more explosions but more money. Higher CV was also associated with lower lifetime and past 3 months peak drinking quantity, higher levels of self-efficacy to control drinking, and lower levels of drinking acceptability (i.e., injunctive norms). Total pumps was associated with higher lifetime peak drinking, lower self-efficacy to control drinking, and higher levels drinking acceptability. Overall, the CV can provide an alternative method of assessing BART performance and the association of risk-taking with drinking patterns.

Novel Approaches to Individual Alcohol Interventions for Heavy Drinking College Students and Young Adults

Efficacious alcohol interventions for college students and young adults have been developed but produce small effects of limited duration. This paper provides a review and critique of novel (e.g., a significant deviation from a traditional, brief, and motivational intervention) interventions published between 2009 and 2014 to reduce alcohol use in this population and covers intervention format/components and efficacy on alcohol outcomes. We reviewed 12 randomized controlled trials of novel, individual-level alcohol interventions that reported alcohol outcomes. Four domains of novel interventions are discussed: content (e.g., pharmacotherapy and automatic action tendency retraining), setting (e.g., health centers and ED), modality (e.g., mobile technology), and treatment integration. Findings were mixed for intervention efficacy to reduce amount and frequency of alcohol consumption. Few studies assessed impact on alcohol-related problems. Despite the prevalence of efficacious interventions, there is still an urgent need for novel treatment approaches and delivery mechanisms for this difficult-to-treat population.

Urgency traits moderate daily relations between affect and drinking to intoxication among young adults

BACKGROUND Young adults with higher trait urgency (i.e., a tendency to act rashly in response to heightened affect) may be especially vulnerable to heavy drinking. The current study examined 1) the influence of urgency on daily relations between affect and drinking to intoxication, and 2) whether urgency influenced the effectiveness of naltrexone (vs. placebo) for reducing alcohol use. METHODS This study is a secondary analysis of data from 126 (n=40 female) heavy drinking young adults, ages 18-25, enrolled in a double-blind, 8-week clinical trial comparing brief motivational intervention and either naltrexone or placebo. Multilevel models examined whether trait urgency moderated daily relations between positive and negative affect and drinking to intoxication, measured by an estimated blood-alcohol concentration (eBAC) at or above the legal limit (≥0.08g%). Person-level interactions examined whether naltrexone was more effective than placebo at reducing the odds of eBAC≥0.08g% for individuals with higher vs. lower trait urgency. RESULTS On days of greater within-person positive or negative affect, young adults with higher urgency were more likely to drink to intoxication than those with lower urgency. Naltrexone reduced the odds of drinking to intoxication significantly more than placebo, independent of positive or negative urgency. CONCLUSIONS Although naltrexone treatment reduced drinking overall, young adults with higher trait urgency were still at increased risk for hazardous drinking following times of strong positive or negative mood. Targeted interventions are needed to reduce the risk of heavy drinking among young adults with high trait urgency.

Longitudinal findings from a randomized clinical trial of naltrexone for young adult heavy drinkers.

OBJECTIVE Behavioral interventions for young adults show limited effects 1-year posttreatment. Few studies have examined the longitudinal outcomes of pharmacotherapy trials to reduce heavy drinking. This study examined the posttreatment, longitudinal effects of the first placebo-controlled trial of naltrexone in young adult heavy drinkers. METHOD Randomized, double-blind, placebo-controlled, 8-week trial. Follow-up assessments at posttreatment (8 weeks [8W]), 3 months [3M], 6 months [6M], and 12 months [12M]). Participants were young adults ages 18-25 (N = 118) who reported ≥4 heavy drinking days in the prior 4 weeks. Outcomes were percent days heavy drinking (PHDD), percent days abstinent (PDA), and drinks per drinking day (DPDD). RESULTS There were no time effects on PHDD. Treatment improvements were maintained posttreatment. A main effect of time was found for PDA. Both conditions continued to increase PDA posttreatment. For DPDD, a Treatment ×Time interaction emerged. In the naltrexone condition, DPDD increased from 8W to 6M and decreased from 6M to 12M, resulting in no net change posttreatment. The placebo group had a nonsignificant decrease in DPDD. The result was a significant benefit of naltrexone at 8W but not 12M. CONCLUSIONS Participants showed improvements or no change on most outcomes over 1 year posttreatment. Naltrexone had significant benefits over placebo at 8W. Although differences among groups diminished during follow-up, overall effects were maintained. Behavioral monitoring during treatment may impact long-term outcomes more than a single intervention following discontinuation of active medication. (PsycINFO Database Record