Rachel L. Bachrach

Development and initial validation of a measure of motives for pregaming in college students

OBJECTIVE Pregaming (i.e., drinking alcohol prior to going out) is a common and risky drinking practice on college campuses. Yet, little is known about what motivates students to pregame as no motives measure exists specifically targeting pregaming. The current study describes the development and initial validation of a measure to assess motives for pregaming and to evaluate associations between these motives and pregaming behavior. METHOD In a multi-stage process using three different college samples, both qualitative (i.e., focus groups) and quantitative methods were used to derive the Pregaming Motives Measure (PGMM). After initial item generation (Stage I: N=43, 74% male) and refinement with exploratory factor analysis (Stage II: N=206, 61% male), a confirmatory factor analysis was performed to establish the structure of the PGMM (Stage III: N=321, 34% male). The pattern of associations of the derived factors, pregaming behavior, and general drinking motives was explored to provide evidence for initial construct validity. Last, the indirect effect of pregaming motives on alcohol problems via pregaming behavior was assessed. RESULTS Findings indicated that the PGMM differed both in content from general drinking motives and that the PGMM items generated load on factors labeled Inebriation/Fun, Instrumental, and Social Ease. Moreover, the Inebriation/Fun and Instrumental motives were significantly associated with pregaming behavior. PGMM motives also both directly and indirectly predicted alcohol-related consequences. CONCLUSIONS Findings corroborate other data on pregaming, suggesting that this behavior may be driven by desires for quick inebriation and conviviality and related to problems only via increased drinking. The PGMM offers targeted assessment of pregaming and other social drinking behavior that can lead to deleterious outcomes.

Age of drinking onset as a moderator of the efficacy of parent-based, brief motivational, and combined intervention approaches to reduce drinking and consequences among college students.

BACKGROUND The current study tested age of onset as a moderator of intervention efficacy on drinking and consequence outcomes among a high-risk population of college students (i.e., former high school athletes). METHODS Students were randomized to one of four conditions: assessment only control, combined parent-based intervention (PBI) and brief motivational intervention (BMI), PBI alone, and BMI alone. Participants (n = 1,275) completed web-administered measures at baseline (summer before starting college) and 10-month follow-up. RESULTS Overall, the combined intervention demonstrated the strongest and most consistent reductions across all outcomes, particularly with the youngest initiators. Participants who initiated drinking at the youngest ages had significantly lower peak drinking, typical weekly drinking, and reported consequences at follow-up when they received the combined intervention when compared to the control group. The BMI and PBI groups, when examined independently, demonstrated significant effects across outcomes but were inconsistent across the different age groups. CONCLUSION Results suggest the combination of a PBI and a peer-delivered BMI is an appropriate and efficacious way to reduce drinking and related consequences among individuals who initiated drinking earlier in adolescence and are at an increased risk of experiencing alcohol problems.

Drinking consequence types in the first college semester differentially predict drinking the following year

The objectives of the present study were to examine the utility of distinguishing among negative consequence types when seeking to predict drinking later in college, to understand which consequences in particular were associated with future drinking, and to determine the direction of those associations. We also examined whether there were differences in the types of drinking outcomes (quantity, frequency, binge) predicted by unique consequences. Finally, we tested whether the link between consequences and future drinking was different for men versus for women. Incoming first year college students (n=997; 65% female) completed an online assessment in September of the first college year, and again at the same time the following year. Results of structural equation model tests offered support for the utility of distinguishing among different consequence types, as specific consequences experienced during the first semester of college were associated differently with drinking at the beginning of the second school year. Gender differences also were observed. For both men and women, social consequences were associated with increases in drinking over time. Blackout drinking also evidenced prospective prediction, but differentially for men and women. For men, these consequences were associated with later increases in drinking, whereas for women, they were associated with a diminution in drinking the next year. For men, only consequences associated with self-care (impairment in physical activity, physical appearance, less time to pursue recreation) predicted decreases in drinking at Year 2. Prediction was generally similar across drinking outcomes. Results suggest that whether negative consequences result in downward titration, escalation, or no change at all in later drinking depends on the type of consequence experienced, and who experiences it.

The Role of Posttraumatic Stress and Problem Alcohol Involvement in University Academic Performance

OBJECTIVE The present study examines how Posttraumatic Stress Disorder (PTSD) during the first year of university affects academic performance and whether alcohol behavior mediates the relationship between PTSD and poor academic outcomes. METHOD University students (N = 1,002; 65% female; Mage = 18.11) completed a baseline web survey, and 5 subsequent surveys throughout freshman year assessing variables of interest. RESULTS Mediation analyses were not significant; however, students who developed PTSD had a lower grade point average and experienced more alcohol consequences by the end of freshman year. Unremitted PTSD and alcohol consequences were associated with leaving university by years end. CONCLUSIONS Findings suggest that assessment of trauma-related symptoms and alcohol behavior might benefit interventions aimed at students with academic difficulties.

Predicting problematic alcohol use with the DSM-5 alternative model of personality pathology.

High comorbidity between personality disorders and alcohol use disorders appears related to individual differences in underlying personality dimensions of behavioral undercontrol and affective dysregulation. However, very little is known about how the Diagnostic and Statistical Manual of Mental Disorders (5th edition; DSM-5) Section III trait model of personality pathology relates to alcohol problems or how the strength of the relationship between personality pathology and alcohol problems changes with age and across gender. The current study examined these questions in a sample of 877 participants using the General Assessment of Personality Disorder to assess general personality dysfunction, the Personality Inventory for DSM-5 to measure specific traits, and the Alcohol Use Disorder Identification Test (AUDIT) to assess problematic alcohol use. Results demonstrated that general personality pathology (Criterion A) was significantly related to problematic alcohol use after controlling for age and gender effects. Furthermore, 2 of the 5 higher-order personality trait domains (Criterion B), Antagonism and Disinhibition, remained significant predictors of problematic alcohol use after accounting for the influence of general personality pathology; however, general personality pathology no longer predicted hazardous alcohol use once Antagonism and Disinhibition were added into the model. Finally, these 2 specific traits interacted with age, such that Antagonism was a stronger predictor of AUDIT scores among older individuals and Disinhibition was a stronger predictor of alcohol problems among younger individuals. Findings support the general validity of this new personality disorder diagnostic system and suggest important age effects in the relationship between traits and problematic alcohol use. (PsycINFO Database Record

Posttraumatic Stress Symptoms and Alcohol Problems: Self‐Medication or Trait Vulnerability?

BACKGROUND AND OBJECTIVES Posttraumatic stress symptoms (PTSD) and problem alcohol use (ALC) commonly co-occur, but the nature of this co-occurrence is unclear. Self-medication explanations have been forwarded, yet traits such as tendency toward negative emotionality and behavioral disconstraint also have been implicated. In this study we test three competing models (Self-Medication, Trait Vulnerability, Combined Dual Pathway) of PTSD-ALC prospectively in a college sample. METHOD Participants (N=659; 73% female, M age=18) provided data at college matriculation (Time 1) and 1 year later (Time 2). RESULTS Structural equation models showed disconstraint to meditate the path from PTSD symptoms to alcohol problems, supporting a trait vulnerability conceptualization. Findings regarding negative emotionality and self-medication were more mixed. Negative emotionality played a stronger role in cross-sectional than in prospective analyses, suggesting the importance of temporal proximity. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE Self-regulation skills may be an important focus for clinicians treating PTSD symptoms and alcohol misuse disorders concurrently.

PTSD symptom course during the first year of college

OBJECTIVES In this study we examined patterns of transition in posttraumatic stress disorder (PTSD) symptoms over the 1st year of college. We also examined 2 factors that might predict these transitions: trauma exposure and alcohol involvement. METHOD Matriculating students (N = 944; 65% female) completed assessments of PTSD, trauma exposure, and alcohol use and consequences multiple times in their freshman year. Three symptom classes (no symptoms, moderate symptoms, and severe symptoms) were identified. Examination of transitions from 1 status to another was conducted with latent transition analysis. RESULTS These models revealed considerable variability in the course of PTSD symptoms. The most common pattern was resolution, yet a significant portion of students showed other patterns. Symptom worsening was more commonly observed in the 2nd semester. Trauma exposure had a deleterious effect on PTSD symptom change trajectories, as did alcohol involvement, though less consistently so. CONCLUSIONS Interventions that focus on the timing and correlates of symptom progression may benefit college students with posttraumatic distress. (PsycINFO Database Record

Social Surrogate Use in Those Exposed to Trauma: I Get By with a Little Help from My (Fictional) Friends

Traumatic events bring an increased need for social connection but paradoxically can make relationships more difficult. The current research examines the unique role social surrogates such as favorite TV shows, books, and celebrities may play in fulfilling the social needs of people who have experienced trauma. Across two studies we predicted and found that experiencing traumatic events is associated with higher interest in using social surrogates. Furthermore, individuals who have experienced trauma without developing PTSD are able to effectively use social surrogates to combat social isolation. However, perhaps because PTSD symptoms often are associated with impaired social functioning, those with PTSD actually feel worse after social surrogate use. Implications for trauma, PTSD, social surrogates, and social self research are discussed.

Peer alcohol behavior moderates within-level associations between posttraumatic stress disorder symptoms and alcohol use in college students.

Self-medication theory (SMT) posits that individuals exposed to trauma and resulting posttraumatic stress symptoms (PTSD) are at risk for heavy drinking and associated negative consequences. Close peer alcohol use is also a powerful predictor of alcohol involvement in college, particularly influencing those with greater negative affect. As individuals with PTSD may rely on peers for support, peer drinking behaviors are possibly putting them at further risk for greater alcohol use and resulting consequences. To test self-medication processes, the present study examined the relationship between weekday PTSD symptoms, weekend alcohol behavior, and the influence of both emotionally supportive peer and other friend drinking behavior by investigating: (a) whether weekday PTSD symptoms predicted subsequent weekend alcohol use and consequences; and (b) whether the relationship between weekday PTSD symptoms and weekend alcohol behavior was moderated by various drinking behaviors of one’s peers. Trauma-exposed heavy-drinking college students (N = 128) completed a baseline assessment and 30 daily, Web-based assessments of alcohol use and related consequences, PTSD symptoms, and peer alcohol behavior. Results directly testing SMT were not supported. However, friend alcohol behavior moderated the relationship between weekday PTSD and weekend alcohol behavior. Findings highlight the importance of peer drinking as both a buffer and risk factor for problematic drinking and provide useful information for interventions aimed at high-risk drinkers.

Associations among trauma, depression, and alcohol use profiles and treatment motivation and engagement in college students

ABSTRACT Objective: This study examined how profiles of alcohol use and symptoms of common mental health disorders (depression and posttraumatic stress disorder [PTSD]) influenced the perceived need for and actual seeking of different types of treatment (for alcohol versus psychological distress) in college student drinkers. Participants: Undergraduate students (n = 164) were assessed between September 2009 and August 2015. Methods: We classified students into different symptom profiles using model-based clustering and compared these profiles on a variety of variables. Results: The cluster model yielded three profiles: Low Risk (n = 66), Concomitant (n = 35), and Heavy Drinking (n = 63). Students in these profiles significantly differed in alcohol consumption, alcohol-related cognitions and problems, and perceptions of need and prior engagement in treatment. Conclusion: A variety of strategies can be used to engage students experiencing heavy drinking and/or mental health problems into treatment on campus.