Tyler B. Wray

Event-level associations between affect, alcohol intoxication, and acute dependence symptoms: Effects of urgency, self-control, and drinking experience

This study used experience sampling to examine within-person associations between positive affect, anxiety, sadness, and hostility and two outcomes: alcohol intoxication and acute dependence symptoms. We examined the role of urgency, premeditation, and perseverance in predicting the alcohol outcomes and tested whether the affective associations varied as a function of urgency. Participants completed baseline assessments and 21 days of experience sampling on PDAs. Hypotheses were partially confirmed. Positive affect was positively, and sadness inversely, associated with intoxication. Hostility was associated with intoxication for men but not women. Negative urgency moderated the association between anxiety and intoxication, making it stronger. However, positive urgency did not moderate the effect of positive affect. Heavier drinkers exhibited the greatest number of symptoms, yet the association between intoxication and acute signs of alcohol disorder was attenuated among these individuals. Results support the use of experience sampling to study acute signs and symptoms of high risk drinking and dependence.

Sexual risk taking among young adult dual alcohol and marijuana users.

Use of alcohol and marijuana among college students is common and use of these substances may increase the likelihood of risky sexual behavior. The present study found significant associations between risky sexual behavior and both mean BAC per drinking day and marijuana use intensity. However, hypothesized interactions between marijuana use and BAC were not supported. In addition, positive and negative urgency and premeditation were each significantly associated with the likelihood of risky sex. Substance use and facets of impulsivity and self-control exhibited direct associations with risky sexual behavior but hypothesized moderation effects were not supported. Associations between urgency and risky sexual behavior varied as a function of gender and trait positive affect.

Daily Associations Between Alcohol Use and Unprotected Anal Sex Among Heavy Drinking HIV-Positive Men Who Have Sex with Men

Men who have sex with men (MSM) account for the largest proportion of new HIV infections in the United States. Alcohol may facilitate HIV transmission by increasing unprotected anal sex, but few studies have focused on transmission behaviors in HIV-positive MSM. This study explored daily associations between alcohol use and sexual behavior among heavy drinking HIV-positive MSM using a 30-day Timeline Followback interview. Results of generalized estimating equations indicated that greater alcohol consumption on a given day was associated with a linear increase in the odds of having unprotected anal sex with partners of any HIV status. However, the odds of reporting unprotected anal sex with HIV-negative or HIV-status unknown partners increased in a curvilinear fashion, occurring primarily at very heavy levels of use (12+ drinks). Results suggest that very heavy drinking increases the risk of engaging in sexual behavior that has the potential for transmitting HIV to other men.ResumenLos hombres que tienen relaciones sexuales con hombres (HSH) representan la mayor proporción de nuevos casos de VIH en los Estados Unidos. El uso de alcohol puede facilitar la transmisión del VIH mediante el aumento de relaciones sexuales anales sin protección, pero pocos estudios se han enfocado en estos comportamientos entre HSH VIH-positivo. Este estudio exploró asociaciones diarias entre el consumo de alcohol y la conducta sexual entre HSH VIH-positivo utilizando la entrevista Timeline Followback de 30 días. Los resultados de las Ecuaciones de Estimación Generalizadas (GEE) indicaron que el mayor consumo de alcohol en un día determinado es asociado con un aumento lineal en las probabilidades de tener sexo anal sin protección sin importar si la pareja es portadora de VIH o no. Sin embargo, las probabilidades de informar sobre el sexo anal sin protección con parejas VIH-negativas o VIH estatus desconocido aumentó de forma curvilínea, ocurriendo principalmente durante situaciones de muy alto uso de alcohol (12 tragos o más). Los resultados sugieren que altos consumos de alcohol aumentan el riesgo de involucrarse en conductas sexuales que tiene el potencial de transmitir el VIH a otros hombres.

Assessing Sexual Motives for Drinking Alcohol among HIV-Positive Men who have Sex with Men

Individuals who drink alcohol for the explicit motive of facilitating or enhancing sex may be more likely to engage in risky sexual behavior, including having sex under the influence of alcohol. However, efforts to assess sexual motives for drinking (SMDs) have been very limited to date. We examined the psychometric properties of a 5-item measure of SMDs in a sample of HIV-positive heavy drinking men who have sex with men. Findings provided excellent support for the scales internal consistency and concurrent validity with a well-established measure of sexual alcohol expectancies (SAEs). Good discriminant validity was also established, as SMDs were correlated with other drinking motives but uniquely predicted the proportion of sex acts occurring under the influence of alcohol and other drugs, over and above other drinking motives and SAEs. SMDs were not significantly associated with unprotected anal intercourse. Adjusting for alcohol problem severity, higher SMDs were associated with lower willingness to consider changing drinking. Results suggest this measure of SMDs exhibits sound psychometric properties and may be useful in studies examining the association between alcohol use and sexual behavior. (PsycINFO Database Record

Effects of alcohol intoxication and autonomic arousal on delay discounting and risky sex in young adult heterosexual men

OBJECTIVES The relationship between alcohol use and risky sexual behavior is complex and depends on psychological and environmental factors. The alcohol myopia model predicts that, due to alcohols impact on attention, the behavior of intoxicated individuals will become increasingly directed by salient cues. Autonomic arousal (AA) may have a similar effect on attention. Experiential delay discounting (DD) may be increased by both alcohol consumption and AA due to their common effects and may mediate the relationship between these conditions and risky sex. METHODS This study employed a 3 (alcohol, placebo, control)×2 (high, low arousal) experimental design to examine the effects of acute alcohol intoxication and AA on experiential delay discounting, subjective sexual arousal, and risky sex. RESULTS Path models revealed complex results that only partially supported study hypotheses. Ratings of subjective sexual arousal did not differ across either beverage or arousal conditions. DD was also unrelated to any study variable. However, subjective sexual arousal was positively related to risky sexual intentions. Alcohol intoxication was also positively associated with increased unprotected sex intentions, consistent with past studies. CONCLUSIONS These results affirm the role of subjective sexual arousal and alcohol intoxication in risky sexual decision-making, yielding effect sizes similar to comparable past studies. The lack of differences across autonomic arousal groups also suggests that effects of attentional myopia may be behavior-specific. Failure to replicate effects of alcohol intoxication on DD also suggests reservation regarding its involvement in alcohol-involved risky sex.

Systematic Review of Interventions to Reduce Problematic Alcohol Use in Men who have Sex with Men

ISSUES Rates of heavy drinking, alcohol problems and alcohol-related disorders are high among men who have sex with men (MSM) and are an important public health issue. Associations between heavy drinking and human immunodeficiency virus (HIV) acquisition among MSM also suggest that drinking may have more severe and chronic consequences for this population relative to others. Consequently, effective interventions to reduce heavy drinking and alcohol-related risk factors among MSM are needed. APPROACH We conducted a systematic review of randomised controlled trials of interventions to reduce heavy drinking and/or alcohol-related problems among MSM. We searched five electronic databases, screened 3722 records and identified 5 studies involving 1022 participants that satisfied inclusion criteria, which included having: (i) incorporated a comparison condition; (ii) randomised participants to groups; and (iii) reported quantitative outcomes. KEY FINDINGS The methodological quality of studies varied, and meta-analysis was not conducted because of heterogeneity in intervention approaches and outcomes. Studies provided preliminary support for the use of motivational interviewing/motivational enhancement-based interventions (MI) and hybrid MI and cognitive behavioural therapy treatments for heavy drinking among MSM over no treatment. Perhaps the most important conclusion of this review, however, is that well-designed, theoretically informed research focused on establishing the efficacy of interventions for hazardous drinking and alcohol use disorders among MSM is alarmingly scarce. CONCLUSIONS Effective interventions to reduce hazardous drinking among MSM and prevent key alcohol-related outcomes, including risk for HIV transmission and health problems among HIV-positive MSM, are needed to mitigate health disparities in this population.

Computer-based HIV adherence promotion interventions: a systematic review: Translation Behavioral Medicine.

Researchers have instituted a range of methodologies to increase access to HIV adherence interventions. This article reviews studies published through January 2014 utilizing computer-based delivery of such interventions to persons living with HIV. A systematic review of five databases identified ten studies (three RCTs, three pilot studies, three feasibility studies, and one single-group trial) that met the inclusion criteria. Descriptions of the interventions’ content and characteristics are included. Interventions varied widely in terms of program structure, theoretical framework, and content. Only six studies reported medication adherence outcomes. Of these, four (five RCTS and one single group pre-post test) reported significant improvement in adherence using various measures, and two approached significance. Results suggest that computer-delivered adherence interventions are feasible and acceptable among both HIV-positive adolescents and adults. Definitive conclusions regarding clinical impact cannot be drawn due to the small number of adequately powered randomized trials in this review. Additional randomized controlled research is needed to draw inferences regarding intervention efficacy.

Alcohol-Related Infractions among College Students: Associations with Subsequent Drinking as a Function of Sensitivity to Punishment

Problematic alcohol use on college campuses is a significant concern. Violations of campus alcohol policies can lead to disciplinary action from the university. These and other alcohol-related legal infractions may be a sign of significant alcohol-related problems. However, few studies have focused on determining predictors of alcohol-related infractions among college students. Likewise, the role of infractions in reducing future use is unclear. In the present study, we tested whether alcohol-related infractions were associated with decreased alcohol use, and whether the effect of the infraction varied as a function of initial drinking levels, sensitivity to punishment (SP), and sensitivity to reward (SR) in a 6-month prospective design. Alcohol use, grade point average, and SR were significantly associated with receiving an alcohol-related infraction. For heavier drinkers, receiving an infraction was associated with decreased drinking at follow-up, and this decrease was most pronounced among those with higher sensitivity to punishment. SP appeared to increase responsiveness to the infraction, resulting in greater attenuation of drinking at follow-up.

Daily co-occurrence of alcohol use and high-risk sexual behavior among heterosexual, heavy drinking emergency department patients

BACKGROUND Global association and experimental studies suggest that alcohol use may increase sexual behavior that poses risk for exposure to sexually transmitted infections (STI) among heterosexual men and women. However, results from longitudinal and daily recall studies exploring the co-occurrence of alcohol use with various sexual risk outcomes in more naturalistic contexts have been mixed, and the bulk of this research has focused on college students. METHODS The current study enrolled heavy-drinking emergency department (ED) patients and used a cross-sectional, 30-day Timeline Followback (TLFB) method to examine the daily co-occurrence between alcohol use and three sexual behavior outcomes: Any sex, unprotected intercourse (UI), and UI with casual partners (versus protected intercourse [PI] with casual partners, or UI/PI with steady partners). RESULTS Results indicated that increasing levels of alcohol use on a given day increased the odds of engaging in any sexual activity and that heavy drinking (but not very heavy drinking) on a given day was associated with an increased odds of engaging in UI with either steady or casual partners. However, day-level alcohol use was not associated with an increased odds of UI with casual partners. CONCLUSIONS These findings suggest that alcohol may play an important role in increasing risk for HIV/STIs among heterosexuals, and support the continued need to target heavy drinking in sex risk reduction interventions. However, our results also suggest that alcohol may not universally result in unprotected sex with casual partners, a behavior posing perhaps the highest risk for HIV/STI transmission.

Mania and sexual risk: Associations with behavioral self-regulation

INTRODUCTION Risky sexual behavior among young adults is a central public health concern. Hallmark cognitive effects of mania involve grandiose extrinsic goal-setting, which may be part of a tendency to approach rewarding cues while underestimating potential negative consequences. Poor impulse control also reflects a tendency to seek reward and rely on emotional decision-making. In contrast, effortful control is associated with adaptive decision making. METHODS Participants (n=595) completed measures of impulsivity, risk for mania, and risky sexual behavior. Relationships between risk for mania, behavioral self-regulation, and risky sexual behavior were examined in a negative binomial hurdle model. RESULTS For the hurdle portion, sensation-seeking was positively associated with the likelihood of engaging in risky sexual behavior. Effortful control was inversely associated with the likelihood of engaging in risky sexual behavior, but only among those high in risk for mania. Among those endorsing engagement in risky sex, urgency was positively, and effortful control negatively, associated with frequency of risky sex. Risk for mania was positively associated with frequency of risky sex, but only for those low in effortful control. LIMITATIONS Findings were among a homogeneous, young adult, nonclinical population, limiting generalizability. Examining these associations among a clinical population in an active manic episode is warranted. CONCLUSION Results suggest high levels of effortful control may diminish the hallmark effects of mania on cognition thereby reducing engagement in risky sexual behavior. Treatments targeting emotion-based rash action and effortful decision making may be particularly important for those experiencing manic symptoms.