Vivian M. Gonzalez

Role of Impulsivity in the Relationship Between Depression and Alcohol Problems Among Emerging Adult College Drinkers

Depression is common among college students and higher levels of depression are associated with greater alcohol-related problems. However, depression is frequently not found to be directly associated with more alcohol use. This study examined whether various aspects of impulsivity (negative urgency, lack of premeditation, lack of perseverance, sensation seeking, and delay discounting) and drinking to cope with negative affect help to account for the relationship between depression and alcohol problems among emerging adult college drinkers who reported at least a minimal level of depressive symptoms. In this cross-sectional study, 143 emerging adult (between 18 and 25 years old) female (69.9%, n = 100) and male (30.1%, n = 43) college drinkers with at least minimal depressive symptoms completed measures of depression, alcohol use and problems, drinking to cope, and impulsivity. A multiple mediation analysis revealed that only negative urgency and drinking to cope partially mediated the depression-alcohol problems relationship. Moderated mediation analyses revealed that impulsivity-related constructs did not significantly interact with drinking to cope to increase alcohol problems. It appears that alcohol use is particularly problematic for students with elevated depression, and this is partly attributable to depressions association with negative urgency, in addition to its association with drinking to cope. Our findings suggest that students who suffer from depression may engage in problematic drinking behavior in part because negative affect is detrimental to their short-term impulse control and decision making, independent of maladaptive attempts to regulate affect through drinking to cope.

Solitary and social heavy drinking, suicidal ideation, and drinking motives in underage college drinkers

In college students, solitary heavy drinking (i.e., while alone) is associated with depression and with higher rates of drinking problems than heavy drinking in social contexts. This study explored the relationship among heavy episodic drinking context, suicidal ideation, and drinking motives among underage college drinkers (n=91) with a history of passive suicidal ideation. Participants completed measures of depression, suicidal ideation, alcohol consumption and problems, and drinking motives. Multiple regression analyses revealed that suicidal ideation, but not depression, was significantly related to solitary heavy drinking. Neither was related to social heavy drinking. Enhancement motives for drinking, but not other drinking motives (i.e., social, conformity, drinking to cope), were significantly associated with social heavy drinking. In contrast, only drinking to cope was associated with solitary heavy drinking. These findings suggest that greater suicidal ideation is associated with greater frequency of becoming intoxicated while alone, and that this drinking is motivated by attempts to cope. Solitary heavy drinking is a potentially dangerous coping strategy for an individual experiencing suicidal ideation.

Results of a Pilot Test of a Self-Administered Smartphone-Based Treatment System for Alcohol Use Disorders: Usability and Early Outcomes

BACKGROUND This paper provides results from a pilot study focused on assessing early-stage effectiveness and usability of a smartphone-based intervention system that provides a stand-alone, self-administered intervention option, the Location-Based Monitoring and Intervention for Alcohol Use Disorders (LBMI-A). The LBMI-A provided numerous features for intervening with ongoing drinking, craving, connection with supportive others, managing life problems, high-risk location alerting, and activity scheduling. METHODS Twenty-eight participants, ranging in age from 22 to 45, who met criteria for an alcohol use disorder used an LBMI-A-enabled smartphone for 6 weeks. RESULTS Participants indicated the LBMI-A intervention modules were helpful in highlighting alcohol use patterns. Tools related to managing alcohol craving, monitoring consumption, and identifying triggers to drink were rated by participants as particularly helpful. Participants also demonstrated significant reductions in hazardous alcohol use while using the system (56% of days spent hazardously drinking at baseline vs. 25% while using the LBMI-A) and drinks per day diminished by 52%. CONCLUSIONS Implications for system improvement as well as suggestions for designing ecological momentary assessment and intervention systems for substance use disorders are discussed.

Drinking to cope as a statistical mediator in the relationship between suicidal ideation and alcohol outcomes among underage college drinkers

Etiological models of alcohol use that highlight the role of negative affect and depression have not been applied to the association of suicidality and alcohol use. The authors examined whether a motivational model of alcohol use could be applied to understand the relationship between suicidal ideation and alcohol outcomes in a sample of underage college drinkers who had a history of passive suicidal ideation (n = 91). In this cross-sectional study, regression analyses were conducted to examine whether drinking to cope with negative affect statistically mediated or was an intervening variable in the association between suicidal ideation and alcohol outcomes. Results revealed that drinking to cope was a significant intervening variable in the relationships between suicidal ideation and alcohol consumption, heavy episodic drinking, and alcohol problems, even while controlling for depression. These results suggest that the relationship between suicidal ideation and alcohol outcomes may be due to individuals using alcohol to regulate or escape the distress associated with suicidal ideation. Consideration of alcohol-related models can improve the conceptualization of research on suicidality and alcohol use.

Comparison of a smartphone app for alcohol use disorders with an Internet-based intervention plus bibliotherapy: A pilot study.

OBJECTIVE To date, no research has evaluated the efficacy of a stand-alone, smartphone-based intervention for individuals with an alcohol use disorder. The current pilot study evaluated the short-term outcomes of a smartphone-based intervention for alcohol use disorders compared with an Internet-based brief motivational intervention plus bibliotherapy. METHOD Adults (18 to 45 years old) with an alcohol use disorder received either the Location-Based Monitoring and Intervention for Alcohol Use Disorders (LBMI-A; n = 28), a smartphone-based intervention, or the online Drinkers Check-up plus bibliotherapy (DCU + bib; n = 26). These groups were compared using the Timeline Followback interview for percent days abstinent (PDA), percent heavy drinking days (PHDD), and drinks per week (DPW) from baseline to 6 weeks after the introduction of the interventions. RESULTS Multilevel models revealed that the LBMI-A resulted in a significant increase in PDA over the course of the study, whereas the DCU + bib did not. Effect sizes for change from baseline for PDA suggest that the DCU + bib resulted in moderate a decrease, whereas the LBMI-A resulted in a large increase in PDA. Both interventions resulted in significant decreases in PHDD and DPW. The LBMI-A produced larger reductions in the first 3 to 4 weeks after the intervention was introduced than the DCU + bib. On weeks with greater LBMI-A usage, participants reported less DPW and PHDD. CONCLUSIONS Both interventions resulted in significant decreases in alcohol use over the 6-week trial, which is promising for stand-alone technology-based intervention systems aimed at individuals with an alcohol use disorder. (PsycINFO Database Record

Solitary heavy drinking, social relationships, and negative mood regulation in college drinkers

In college students, solitary (i.e., while alone) heavy episodic drinking is associated with depression, suicidal ideation, drinking to cope, and having greater alcohol-related problems than heavy drinking only in social contexts. This study explored the possible explanatory factors for solitary heavy drinking. Social (n = 58) and solitary heavy episodic drinking (n = 32) emerging adult college students were compared in regards to: alcohol-related problems and dependence severity, negative affect, social relationship issues, socially related coping skills, and negative mood regulation. Multiple analyses of covariance revealed that solitary heavy drinkers were significantly higher in alcohol-related problems, severity of dependence, suicidal ideation, hopelessness, depression, loneliness, and drinking to cope and were lower in negative mood regulation expectancies and social competence. Heavy drinking groups did not differ in social network size, perceived social support, or in their drinking social network size or satisfaction. Our findings suggest that solitary heavy drinkers are not socially isolated or lacking in social support; however, they do experience greater social discomfort and difficulties with negative mood regulation than social heavy drinkers. Interventions focused on depression, affect regulation, adaptive coping, and alcohol abuse would be helpful with this population to address their related problems.

Association of solitary binge drinking and suicidal behavior among emerging adult college students.

Emerging adult college students who binge drink in solitary contexts (i.e., while alone) experience greater depression and suicidal ideation than do students who only binge drink in social contexts, suggesting that they may be at greater risk for suicidal behavior. This study examined the association of a previous suicide attempt, one of the best predictors of future suicide attempts and suicide, and severity of recent suicidal ideation with drinking in solitary and social contexts. Participants were binge drinking, emerging adult (18- to 25-year-old) college students (N=182) drawn from two studies of college drinkers. A logistic regression analysis revealed that both suicide attempt history and severity of suicidal ideation were significantly associated with a greater likelihood of being a solitary binge drinker as opposed to only a social binge drinker. Students with a previous suicide attempt were nearly four times more likely to be solitary binge drinkers. Multiple regression analyses revealed that suicide attempt history was significantly associated with greater frequency and quantity of drinking in solitary, but not social contexts. Suicidal ideation was significantly associated with drinks per solitary drinking day, but not frequency of solitary drinking once suicide attempt history was accounted for. Given the associations found between solitary binge drinking and a history of suicide attempts, as well as greater severity of recent suicidal ideation, it appears that these students are in need of suicide prevention efforts, including treatment efforts aimed at reducing binge drinking.

Suicidal ideation and drinking to cope among college binge drinkers

Suicidality among college students is associated with binge drinking and alcohol-related problems. Consistent with motivational models of alcohol use, drinking to cope (DTC) is a significant intervening variable in the association between suicidal ideation and alcohol use and problems among students. This study examined whether several factors shown to be associated with both suicidal ideation and DTC (i.e., impulsivity, mood regulation expectancies, and coping skills) account for the relationship between these variables, as well as the associations of depression and hopelessness with DTC. Participants were 109 emerging adult (18- to 25-year-old) college students who reported at least one episode of binge drinking during a typical month in the past year. Hierarchical regression analyses revealed that while greater negative urgency and low negative mood regulation expectancies were significantly associated with DTC, suicidal ideation remained significantly associated with DTC, even when controlling for depression. Suicidal ideation showed a stronger association with DTC than either depression or hopelessness both before and after accounting for other variables. These findings suggest that suicidal ideation has a direct association with DTC, and that negative urgency and mood regulation expectancies may be useful treatments targets for reducing alcohol misuse among emerging adult students who experience suicidal ideation.

Energy drink use, problem drinking and drinking motives in a diverse sample of Alaskan college students

Background Recent research has identified the use of caffeinated energy drinks as a common, potentially risky behaviour among college students that is linked to alcohol misuse and consequences. Research also suggests that energy drink consumption is related to other risky behaviours such as tobacco use, marijuana use and risky sexual activity. Objective This research sought to examine the associations between frequency of energy drink consumption and problematic alcohol use, alcohol-related consequences, symptoms of alcohol dependence and drinking motives in an ethnically diverse sample of college students in Alaska. We also sought to examine whether ethnic group moderated these associations in the present sample of White, Alaska Native/American Indian and other ethnic minority college students. Design A paper-and-pencil self-report questionnaire was completed by a sample of 298 college students. Analysis of covariance (ANCOVA) was used to examine the effects of energy drink use, ethnic group and energy drink by ethnic group interactions on alcohol outcomes after controlling for variance attributed to gender, age and frequency of binge drinking. Results Greater energy drink consumption was significantly associated with greater hazardous drinking, alcohol consequences, alcohol dependence symptoms, drinking for enhancement motives and drinking to cope. There were no main effects of ethnic group, and there were no significant energy drink by ethnic group interactions. Conclusion These findings replicate those of other studies examining the associations between energy drink use and alcohol problems, but contrary to previous research we did not find ethnic minority status to be protective. It is possible that energy drink consumption may serve as a marker for other health risk behaviours among students of various ethnic groups.

Recognition of mental illness and suicidality among individuals with serious mental illness

This preliminary study investigated the association of insight (defined as a patients recognition of having a mental illness) with depression and suicidality among individuals with schizophrenia (N = 1009), bipolar I disorder (N = 297), and recurrent major depression (N = 162). Participants completed interviews at 2 time periods, 6-months apart. Individuals who were recognized having a mental illness reported significantly greater depression than those who denied having a mental illness. Recognition of mental illness was significantly related, both retrospective and prospectively, with suicidal ideation and attempts. No significant differences were found between the diagnostic groups in these relationships. Although there are many clinical benefits associated with insight, these findings suggest there may possibly be cause for concern in attempting to increase insight among individuals with a serious mental illness. However, current evidence suggests that certain forms of treatment may be beneficial in improving insight, while resulting in a decrease in negative affect, rather than an increase.