Lex Lemmers

DRINKING MOTIVES, ALCOHOL EXPECTANCIES, SELF-EFFICACY, AND DRINKING PATTERNS*

The current study focused on the associations between drinking motives, alcohol expectancies, self-efficacy, and drinking behavior in a representative sample of 553 Dutch adolescents and adults. Data were gathered by means of self-report questionnaires and a 14-days drinking diary. A model was postulated in which negative expectancies and self-efficacy were directly associated with drinking, and in which drinking motives mediated the associations between positive expectancies, and drinking. The findings of multivariate analyses showed that drinking motives were related to general indicators of drinking and to drinking levels in specific situations. Furthermore, self-efficacy was moderately related to all drinking variables. Negative expectancies were related to general drinking variables but hardly to drinking in specific situations. Positive expectancies were hardly related to drinking in multivariate analyses and therefore mediation models could not be tested. No systematic moderator effects were apparent for age and gender on the associations between drinking motives, alcohol expectancies, self-efficacy, and drinking.

Effectiveness of a web-based brief alcohol intervention and added value of normative feedback in reducing underage drinking: a randomized controlled trial.

Background Current insights indicate that Web-based delivery may enhance the implementation of brief alcohol interventions. Previous research showed that electronically delivered brief alcohol interventions decreased alcohol use in college students and adult problem drinkers. To date, no study has investigated the effectiveness of Web-based brief alcohol interventions in reducing alcohol use in younger populations. Objective The present study tested 2 main hypotheses, that is, whether an online multicomponent brief alcohol intervention was effective in reducing alcohol use among 15- to 20-year-old binge drinkers and whether inclusion of normative feedback would increase the effectiveness of this intervention. In additional analyses, we examined possible moderation effects of participant’s sex, which we had not a priori hypothesized. Method A total of 575 online panel members (aged 15 to 20 years) who were screened as binge drinkers were randomly assigned to (1) a Web-based brief alcohol intervention without normative feedback, (2) a Web-based brief alcohol intervention with normative feedback, or (3) a control group (no intervention). Alcohol use and moderate drinking were assessed at baseline, 1 month, and 3 months after the intervention. Separate analyses were conducted for participants in the original sample (n = 575) and those who completed both posttests (n = 278). Missing values in the original sample were imputed by using the multiple imputation procedure of PASW Statistics 18. Results Main effects of the intervention were found only in the multiple imputed dataset for the original sample suggesting that the intervention without normative feedback reduced weekly drinking in the total group both 1 and 3 months after the intervention (n =575, at the 1-month follow-up, beta = -.24, P = .05; at the 3-month follow-up, beta = -.25, P = .04). Furthermore, the intervention with normative feedback reduced weekly drinking only at 1 month after the intervention (n=575, beta = -.24, P = .008). There was also a marginally significant trend of the intervention without normative feedback on responsible drinking at the 3-month follow-up (n =575, beta = .40, P =.07) implying a small increase in moderate drinking at the 3-month follow-up. Additional analyses on both datasets testing our post hoc hypothesis about a possible differential intervention effect for males and females revealed that this was the case for the impact of the intervention without normative feedback on weekly drinking and moderate drinking at the 1-month follow-up (weekly drinking for n = 278, beta = -.80, P = .01, and for n = 575, beta = -.69, P = .009; moderate drinking for n = 278, odds ratio [OR] = 3.76, confidence interval [CI] 1.05 - 13.49, P = .04, and for n = 575, OR = 3.00, CI = 0.89 - 10.12, P = .08) and at the 3-month follow-up (weekly drinking for n = 278, beta = -.58, P = .05, and for n = 575, beta = -.75, P = .004; moderate drinking for n = 278, OR = 4.34, CI = 1.18 - 15.95, P = .04, and for n = 575, OR = 3.65, CI = 1.44 - 9.25, P = .006). Furthermore, both datasets showed an interaction effect between the intervention with normative feedback and participant’s sex on weekly alcohol use at the 1-month follow-up (for n = 278, beta = -.74, P =.02, and for n = 575, beta = -.64, P =.01) and for moderate drinking at the 3-month follow-up (for n = 278, OR = 3.10, CI = 0.81 - 11.85, P = .07, and for n = 575, OR = 3.00, CI = 1.23 - 7.27, P = .01). Post hoc probing indicated that males who received the intervention showed less weekly drinking and were more likely to drink moderately at 1 month and at 3 months following the intervention. For females, the interventions yielded no effects: the intervention without normative feedback even showed a small unfavorable effect at the 1-month follow-up. Conclusion The present study demonstrated that exposure to a Web-based brief alcohol intervention generated a decrease in weekly drinking among 15- to 20-year-old binge drinkers but did not encourage moderate drinking in the total sample. Additional analyses revealed that intervention effects were most prominent in males resulting in less weekly alcohol use and higher levels of moderate drinking among 15- to 20-year-old males over a period of 1 to 3 months. Trial Registration ISRCTN50512934; http://www.controlled-trials.com/ISRCTN50512934/ (Archived by WebCite at http://www.webcitation.org/5usICa3Tx)

Targeting young drinkers online: the effectiveness of a web-based brief alcohol intervention in reducing heavy drinking among college students: study protocol of a two-arm parallel group randomized controlled trial

BackgroundThe prevalence of heavy drinking among college students and its associated health related consequences highlights an urgent need for alcohol prevention programs targeting 18 to 24 year olds. Nevertheless, current alcohol prevention programs in the Netherlands pay surprisingly little attention to the drinking patterns of this specific age group. The study described in this protocol will test the effectiveness of a web-based brief alcohol intervention that is aimed at reducing alcohol use among heavy drinking college students aged 18 to 24 years old.Methods/DesignThe effectiveness of the What Do You Drink web-based brief alcohol intervention will be tested among 908 heavy drinking college students in a two-arm parallel group randomized controlled trial. Participants will be allocated at random to either the experimental (N = 454: web-based brief alcohol intervention) or control condition (N = 454: no intervention). The primary outcome measure will be the percentage of participants who drink within the normative limits of the Dutch National Health Council for low-risk drinking. These limits specify that, for heavy alcohol use, the mean consumption cannot exceed 14 or 21 glasses of standard alcohol units per week for females and males, respectively, while for binge drinking, the consumption cannot exceed five or more glasses of standard alcohol units on one drinking occasion at least once per week within one month and six months after the intervention. Reductions in mean weekly alcohol consumption and frequency of binge drinking are also primary outcome measures. Weekly Ecological Momentary Assessment will measure alcohol-related cognitions, that is, attitudes, self-efficacy, subjective norms and alcohol expectancies, which will be included as the secondary outcome measures.DiscussionThis study protocol describes the two-arm parallel group randomized controlled trial developed to evaluate the effectiveness of a web-based brief alcohol intervention. We expect a reduction of mean weekly alcohol consumption and frequency of binge drinking in the experimental condition compared to the control condition as a direct result of the intervention. If the website is effective, it will be implemented in alcohol prevention initiatives, which will facilitate the implementation of the protocol.Trial registrationNetherlands Trial Register NTR2665.

Using Ecological Momentary Assessment in Testing the Effectiveness of an Alcohol Intervention: A Two-Arm Parallel Group Randomized Controlled Trial

Background Alcohol consumption of college students has a fluctuating nature, which might impact the measurement of intervention effects. By using 25 follow-up time-points, this study tested whether intervention effects are robust or might vary over time. Methods Data were used from a two-arm parallel group randomized controlled trial applying ecological momentary assessment (EMA) with 30 data time-points in total. Students between 18 and 24 years old who reported heavy drinking in the past six months and who were ready to change their alcohol consumption were randomly assigned to the experimental (n = 456: web-based brief alcohol intervention) and control condition (n = 451: no intervention). Outcome measures were weekly alcohol consumption, frequency of binge drinking, and heavy drinking status. Results According to the intention-to-treat principle, regression analyses revealed that intervention effects on alcohol consumption varied when exploring multiple follow-up time-points. Intervention effects were found for a) weekly alcohol consumption at 1, 2, 3, 4, and 7 weeks follow-up, b) frequency of binge drinking at 1, 2, 7, and 12 weeks follow-up, and c) heavy drinking status at 1, 2, 7, and 16 weeks follow-up. Conclusions This research showed that the commonly used one and six month follow-up time-points are relatively arbitrary and not using EMA might bring forth erroneous conclusions on the effectiveness of interventions. Therefore, future trials in alcohol prevention research and beyond are encouraged to apply EMA when assessing outcome measures and intervention effectiveness. Trial registration Netherlands Trial Register NTR2665

The Effectiveness of a Cue-Reminder Intervention to Reduce Adolescents' Alcohol Use in Social Contexts

AIMS To examine the use of a cue-reminder to target alcohol use among youth in social contexts. METHODS Two experiments were conducted. First, among 92 late adolescents, we tested if a cue-reminder could be effectively associated with information about empowerment, awareness and monitoring of ones own limits with regard to alcohol use. Second, among 107 young adults, the effect of the cue in a real-life drinking setting was examined. RESULTS The first study showed that adolescents in the experimental condition recalled more empowerment information compared with adolescents in the control condition (mean 2.00 ± 0.92 vs mean 1.52 ± 0.96, P = 0.017), indicating the possibility of creating an association between a symbol (cue-reminder) and empowerment information with regard to alcohol use. In the second study, significant interaction effects between general drinking frequency and condition were found in relation to having an alcoholic consumption (β = -0.24; P = 0.027) and to the amount of alcoholic consumptions (β = -0.24; P = 0.035), suggesting that the presence of the cue-reminder in a drinking situation may have an inhibitory effect on alcohol consumption among frequent drinkers. CONCLUSION The cue-reminder seems to have the potential to function as an intervention to reduce excessive alcohol use in social settings.

Longitudinal associations between attitudes towards binge drinking and alcohol-free drinks, and binge drinking behavior in adolescence

Alcohol attitudes are often considered an important predecessor of drinking behavior, although the literature is equivocal. Lately, attention has turned to enhancing positive cognitions on alcoholic-free drinks to discourage heavy drinking. The current study was the first to longitudinally examine associations between attitudes towards binge drinking and alcohol-free drinks and binge drinking behavior in a cross-lagged path model in Mplus. Participants were 293 adolescents (131 boys, M(age)=16.1 years) who filled in two online questionnaires with a six-month interval. Binge drinking behavior and attitudes towards binge drinking and alcohol-free drinks were all significantly correlated at both waves. The multivariate model, however, showed that only higher levels of binge drinking at T1 were prospectively related to more positive binge drinking attitudes at T2, and not vice versa. Analyses were controlled for sex, educational level, and age. Findings discard the Theory of Planned Behavior, but rather seem consistent with the Theory of Cognitive Dissonance, i.e., adolescents may adapt their cognitions to their behavior. More longitudinal research with several time points and over a longer period of time is needed to further examine the development of attitudes and drinking behavior.

The effectiveness of a web-based brief alcohol intervention in reducing heavy drinking among adolescents aged 15 to 20 years with a low educational background: study protocol for a randomized controlled trial

BackgroundThe serious negative health consequences of heavy drinking among adolescents is cause for concern, especially among adolescents aged 15 to 20 years with a low educational background. In the Netherlands, there is a lack of alcohol prevention programs directed to the drinking patterns of this specific target group. The study described in this protocol will test the effectiveness of a web-based brief alcohol intervention that aims to reduce alcohol use among heavy drinking adolescents aged 15 to 20 years with a low educational background.Methods/designThe effectiveness of the What Do You Drink (WDYD) web-based brief alcohol intervention will be tested among 750 low-educated, heavy drinking adolescents. It will use a two-arm parallel group cluster randomized controlled trial. Classes of adolescents from educational institutions will be randomly assigned to either the experimental (n = 375: web-based brief alcohol intervention) or control condition (n = 375: no intervention). Primary outcomes measures will be: 1) the percentage of participants who drink within the normative limits of the Dutch National Health Council for low-risk drinking, 2) reductions in mean weekly alcohol consumption, and 3) frequency of binge drinking. The secondary outcome measures include the alcohol-related cognitions, attitudes, self-efficacy, and subjective norms, which will be measured at baseline and at one and six months after the intervention.DiscussionThis study protocol presents the study design of a two-arm parallel-group randomized controlled trial to evaluate the effectiveness of the WDYD web-based brief alcohol intervention. We hypothesized a reduction in mean weekly alcohol consumption and in the frequency of binge drinking in the experimental condition, resulting from the web-based brief alcohol intervention, compared to the control condition.Trial registrationNetherlands Trial Register NTR2971

The effectiveness of the What Do You Drink (WDYD) web-based brief alcohol intervention over time: a two-arm parallel group randomized controlled trial applying an ecological momentary assessment approach

The aim of the current study was to test whether the web-based brief alcohol intervention entitled “What Do You Drink” (WDYD) can sustain a reduction in alcohol use among heavy drinking students after one, three, and six months follow-up. A two-arm parallel group randomized controlled trial applying an ecological momentary assessment (EMA) approach with 30 data time-points was conducted in the Netherlands, 2010-2011. Students aged 18 to 24 years old who reported heavy drinking in the past six months and who were ready to change behaviour were included in the study. Participants were randomized into the experimental (n = 456: WDYD intervention) or control condition (n = 451: no intervention). Outcome measures were weekly alcohol consumption and frequency of binge drinking. Latent growth curve analyses to model individual change in alcohol use over time by condition revealed that participants in the experimental condition had significantly lower weekly alcohol consumption and frequency of binge drinking compared to participants in the control condition that sustained after three (B0 = -2.60, p < .001; B1 = 0.16, p = 0.08) and six (B0 = -0.14, p = 0.01; B1 = 0.00, p = 0.19) months follow-up, respectively. Additional linear regression analyses indicated that the intercept differences resulted from an increase in alcohol use for participants in the control condition compared to those in the experimental condition. The WDYD intervention was shown to be effective in preventing an increase in weekly alcohol consumption and frequency of binge drinking shortly after the intervention that sustained after three and six months post-intervention, respectively. Trial registration: Netherlands Trial Register NTR2665.

Behandeling van problematisch drinkende jongeren

SamenvattingWat weten we over de effecten van behandelinterventies voor jongeren die problematisch alcohol gebruiken? In dit artikel worden de resultaten beschreven van een literatuurreview, uitgevoerd door het Trimbos-instituut in het kader van Resultaten Scoren. Het betrof een ‘review van reviews’ met een brede scope: de duur van de beschreven behandelinterventies loopt uiteen. Uit de resultaten bleek dat vooral motiverende gespreksvoering, eventueel aangevuld met feedback en normatieve vergelijkingen, cognitieve gedragstherapie en meeromvattende gezinstherapie, effectief zijn in het verminderen van alcoholgebruik en alcoholgerelateerde problemen. Van veel andere behandelingen, zoals farmacotherapie en het Minnesota-model, zijn enige aanwijzingen voor effectiviteit gevonden, maar daar kunnen nog geen harde conclusies aan verbonden worden. De gevonden resultaten geven aanleiding voor het ontwikkelen van nieuwe protocollen voor de Nederlandse behandelpraktijk voor jongeren, effectonderzoek en implementatie volgens afgesproken standaarden.

Actieplan beginnende alcoholproblemen

SamenvattingProbleemdrinkers vormen een steeds groter probleem voor de volksgezondheid en de economie. Nederland kent meer dan een miljoen probleemdrinkers, die de samenleving naar schatting 2,5 miljard euro per jaar kosten.