Adolescent bullying victimisation and alcohol-related problem behaviour mediated by coping drinking motives over a 12 month period

BackgroundDespite the adverse externalising risks associated with bullying victimisation, no study has investigated the underlying mechanisms of adolescent victims' engagement with alcohol. This current study investigated the development of risky coping drinking motives as a mediator in the relationship between adolescent school victimisation and alcohol-related problem behaviour using a longitudinal design over 12 months.MethodWe recruited 324 participants, aged 13 to 15 from schools across London, England. Participants were surveyed during class time at 2 time points: baseline and 12 months. At both time points participants answered questions related to bullying victimisation, alcohol-related problem behaviour, drinking motives and the quantity by frequency of alcohol consumption.ResultsThe relationships between victimisation, drinking and drinking motives were investigated using Pearson correlations. Path analysis showed that victimisation leads both directly and indirectly, through coping motives to alcohol-related problems, rather than to the quantity and frequency of alcohol use. Significance of mediation was tested using 5000 bias corrected and accelerated bootstrapped intervals. Baseline victimisation was significantly correlated with baseline alcohol-related problem behaviour and predictive of future problems at 12 months. Drinking to cope at 12 months partially mediated the relationship between baseline victimisation and alcohol-related problems at 12 months.ConclusionsResults show that victims of bullying are drinking alcohol in a risky style, partly due to the development of self medicating drinking behaviour. Victims of bullying could therefore benefit from coping skills interventions targeting negative affect regulation in order to reduce the risk for future alcohol misuse.     

Exploring patterns of alcohol misuse in treatment-seeking UK veterans: A cross-sectional study

AimsTo explore patterns of alcohol misuse in a sample of treatment-seeking veterans compared to the UK Armed Forces personnel population and the general public. Furthermore, the present study investigated which variables were associated with alcohol misuse in this sample, and in particular what factors were associated with increased or decreased severity of alcohol misuse.MethodThe present study investigated alcohol misuse in treatment-seeking veterans and compared it with the UK Armed Forces and the general public. In addition, it explored associations between sociodemographic, physical health and mental health variables and alcohol misuse.ResultsResults suggested that treatment-seeking veterans report different patterns of alcohol misuse compared to the UK Armed Forces and the general public. This group was more likely to report alcohol dependence and alcohol-related harm. They also reported higher levels of overall alcohol misuse than the general public. Mental health problems including PTSD, anxiety and depression, as well as anger, functional impairment and being single were all related to greater alcohol misuse. Being older and not in work were related to reduced alcohol misuse.ConclusionsThese findings add further weight to the importance of ensuring appropriate support is provided to personnel leaving the Armed Forces. Treatment-seeking veterans have specific patterns of alcohol-related needs that should be addressed. Knowing more about the common alcohol-related problems in this group can help inform and improve mental health interventions. Findings on related variables will help in identifying those individuals who may be at most risk of alcohol-related problems.     

Patient factors predicting early alcohol-related readmissions for alcoholics: role of alcoholism severity and psychiatric co-morbidity

The current study was undertaken primarily to identify whether psychiatric co-morbidity was associated with the rate and time of alcohol-related inpatient readmissions for a group of 255 patients discharged from alcoholism treatment at a midwestern rural medical center. A structured interview obtained information regarding psychiatric disorders, including depression, antisocial personality disorders and polysubstance abuse, as well as alcohol history and sociodemographics. Ninety-eight subjects (38.4% of sample) were readmitted for alcoholism-related diagnoses within 15 months of discharge. Patients with a long history of heavy drinking, high daily alcohol consumption and history of previous alcoholism treatment were most likely to be readmitted with an alcoholism-related primary diagnosis. Once these variables were controlled for, other major psychiatric disorders, polysubstances abuse and sociodemographic variables did not appear to predict time to readmission. However, other potentially more sensitive outcome measures such as return to drinking were not evaluated in the present study.     

Comparison of a Population-Based Sample of “Risky Drinking” Smokers and Groups Consuming Just One Substance

This population-based study compares a group of “risky drinking” smokers (n = 137) with groups of either smokers (n = 760) or “risky drinkers” (n = 173) regarding sociodemographic, behavioral and motivational variables. The study took place in a rural and urban region of Germany in 1997. No differences were found in sociodemographics, nicotine-related variables, frequency of alcohol consumption, and most alcohol-related diagnoses. People who drink and smoke show a higher proportion of alcohol dependence (ES: h =. 20), drink more alcohol per occasion (ES: d =. 39), and are more motivated to decrease alcohol consumption (ES: h =. 45). The data suggest focusing research in more alcohol-related clinical settings and examining the relationship between smoking cessation and alcohol reduction.     

Comparison of a population-based sample of "risky drinking" smokers and groups consuming just one substance

This population-based study compares a group of "risky drinking" smokers (n = 137) with groups of either smokers (n = 760) or "risky drinkers" (n = 173) regarding sociodemographic, behavioral and motivational variables. The study took place in a rural and urban region of Germany in 1997. No differences were found in sociodemographics, nicotine-related variables, frequency of alcohol consumption, and most alcohol-related diagnoses. People who drink and smoke show a higher proportion of alcohol dependence (ES: h = .20), drink more alcohol per occasion (ES: d = .39), and are more motivated to decrease alcohol consumption (ES: h = .45). The data suggest focusing research in more alcohol-related clinical settings and examining the relationship between smoking cessation and alcohol reduction.     

LETTERS TO THE EDITORS

ABSTRACT

Alcohol and marijuana are the most commonly used substances for college-attending young adults. This study evaluated differences in substance-specific consequence attribution by alcohol-marijuana use patterns (concurrent alcohol and marijuana [CAM; use of both substances, not at same time] and simultaneous [SAM; use of both, at same time]) as well as alcohol-only (AO). First-year college students with prior alcohol use (N = 610, 50.9% women, 71% White, M_age = 18) completed an online assessment of past-three-month substance use, including SAM, and related consequences. Results indicated that polydrug (SAM and CAM) users reported greater alcohol involvement and earlier alcohol initiation than AO, and polydrug use was associated with more alcohol-related problems, including sexual risk taking and alcohol-related blackouts. When restricted to SAM/CAM users, logistic regressions indicated that SAM users reported an increased incidence in two marijuana-related problems relative to CAM (driving after using and academic difficulties), but lower rates of social problems. SAM users were also less likely to attribute substance-related social problems to alcohol. Overall, findings highlight variations that exist within alcohol-marijuana polydrug users and show areas to consider for intervention development and future research.     

Brief alcohol intervention in the emergency department: moderators of effectiveness

OBJECTIVE: Prior research supports the effectiveness of brief interventions for reducing alcohol misuse among patients in the emergency department (ED). However, limited information is available regarding the mechanisms of change, which could assist clinicians in streamlining or amplifying these interventions. This article examines moderators of outcomes among ED patients, ages 19 and older, who participated in a randomized controlled trial of a brief intervention for alcohol misuse. METHOD: Injured patients (N= 4,476) completed a computerized survey; 575 at-risk drinkers were randomly assigned to one of four brief intervention conditions, and 85% were interviewed again at 3-month and 12-month follow-ups. RESULTS: Regression models using the generalized estimating equations approach examined interaction effects between intervention condition (advice/no advice) and hypothesized moderator variables (stage of change, self-efficacy, acute alcohol use, attribution of injury to alcohol) on alcohol outcomes over time. Overall, participants who reported higher levels of self-efficacy had lower weekly consumption and consequences, whereas those with higher readiness to change had greater weekly consumption and consequences. Furthermore, individuals who attributed their injury to alcohol and received advice had significantly lower levels of average weekly alcohol consumption and less frequent heavy drinking from baseline to 12-month follow-up compared with those who attributed their injury to alcohol but did not receive advice. CONCLUSIONS: This study provides novel data regarding attribution for alcohol-related injury as an important moderator of change and suggests that highlighting the alcohol/injury connection in brief, ED-based alcohol interventions can augment their effectiveness.     

Do outcomes after behavioral couples therapy differ based on the gender of the alcohol use disorder patient?

ObjectiveThis naturalistic study (conducted from 1992 to 1998) of behavioral couples therapy (BCT) compared female and male alcohol use disorder (AUD) patients on improvement and on drinking and relationship outcomes after BCT. We also evaluated gender differences on presenting clinical problems and extent of BCT participation.MethodParticipants were 103 female and 303 male AUD patients (98.5% alcohol dependence, 1.5% alcohol abuse) and their heterosexual partners, mostly White in their forties. Couples received 20–22 BCT sessions over 5–6 months. Drinking outcomes were percentage days abstinent (PDA) and alcohol-related problems. Relationship outcome was Dyadic Adjustment Scale. Outcome data were examined at baseline, post-treatment, and 6- and 12-month follow-up. Presenting problems were demographics, alcohol problem severity, illicit drug use, emotional distress, and relationship adjustment. BCT participation was BCT attendance and BCT-targeted behaviors.ResultsWe found few differences between female and male patients, who did not differ on improvement and outcomes after BCT. Both females and males showed significant large effect size improvements through 12-month follow-up on PDA and alcohol-related problems, and significant small to medium effect size improvements on relationship adjustment. Both females and males had high levels of BCT participation. Gender differences in presenting clinical problems (females being lower on age, years problem drinking, and baseline PDA, and higher on emotional distress) did not translate into gender differences in response to BCT.ConclusionResults showed no support for the suggestion that BCT might lead to greater improvement and better outcomes for female than male AUD patients on drinking or on relationship outcomes.     

Forgiveness and gratitude trajectories among persons undergoing alcohol addiction therapy

Background: The first studies concerning changes in moral virtues during alcohol addiction therapy were published during the last decade. However, as all of these studies applied a variable-oriented approach, it is impossible to capture differences between starting points and changes in variables of interest. 

Method: In this study, we employed a person-oriented approach to identify trajectories of change in two moral virtues—forgiveness and gratitude—during alcohol addiction treatment. The sample consisted of 358 alcohol-dependent individuals who were receiving outpatient therapy. Measurements were taken (1) at the beginning of the basic treatment, (2) after its completion (5–7?weeks from baseline), and (3) about six months later. Three forgiveness scales and the Gratitude Questionnaire (GQ-6) were used to assess the patients’ moral virtues. 

Results: Latent class growth analysis (LCGA) revealed four trajectories for self-forgiveness and gratitude, and three trajectories for forgiveness of others and feeling forgiven by God. For patients with a low baseline level of moral virtues, the changes varied depending on the kind of moral virtue. Patients with a relatively high initial level of moral virtues maintained that level in subsequent measurements. Significant correlates of trajectory class membership were gender, education, age, religiosity, diagnosis of coexisting psychiatric disorders, and frequency of attending Alcoholics Anonymous (AA) meetings. 

Conclusions: This study highlights the clinical importance of considering differences at the baseline level and in changes of forgiveness and gratitude, as well as personal and alcohol-related correlates of trajectory group membership among people who participate in alcohol addiction therapy.     

A Meta-Analytic Investigation of Emotional Intelligence and Alcohol Involvement

The relationship between emotional intelligence (EI) and alcohol involvement has been investigated by numerous studies. The present meta-analysis analyzed the findings of these studies. The meta-analysis, based on 16 effect sizes from 11 studies with a total of 2,271 participants, showed that lower EI was significantly related to higher alcohol involvement, r = ?.18. Lower EI was significantly associated with both alcohol-related problems, r = ?.32 and level of alcohol use, r = ?.10, but the association was significantly higher with alcohol-use-related problems. The results suggest that future research would most profitably examine the role of EI in alcohol consumption-related problems.     

Sport-related achievement motivation and alcohol outcomes: An athlete-specific risk factor among intercollegiate athletes

Intercollegiate athletes report greater alcohol consumption and more alcohol-related problems than their non-athlete peers. Although college athletes share many of the same problems faced by non-athletes, there are some consequences that are unique to athletes. Studies have demonstrated that alcohol negatively affects athletic performance including increased dehydration, impeded muscle recovery, and increased risk for injury. Beyond risk factors for alcohol misuse that may affect college students in general, research has begun to examine risk factors that are unique to collegiate athletes. For example, research has found that off-season status, the leadership role, and athlete-specific drinking motives are associated with increased alcohol use. Given these findings, it is possible that other athlete-specific variables influence alcohol misuse. One such variable may be sport achievement orientation. The purpose of the current study was to examine the relationship between sport achievement orientation and alcohol outcomes. Given previous research regarding seasonal status and gender, these variables were examined as moderators. Varsity athletes (n = 263) completed the Sport Orientation Questionnaire, which assesses sport-related achievement orientation on three scales (Competitiveness, Win Orientation, and Goal Orientation). In addition, participants completed measures of alcohol use and alcohol-related problems. Results indicated that Competitiveness, Win Orientation, and Goal Orientation were all significantly associated with alcohol use, but not alcohol-related problems. Moreover, these relationships were moderated by seasonal status and gender. These interactions, clinical implications, and limitations are discussed.     

A Comparison of Problems-of-Life for Blacks and Whites Entering Substance Abuse Treatment Programs

Abstract

Blacks in the general population experience alcohol-related health problems to a greater extent than Whites, even though surveys of drinking behavior find that Blacks generally drink no more than Whites and, in fact, at younger ages Blacks actually drink less than Whites. In this study, Blacks and Whites entering randomly selected state-supported substance abuse treatment programs within a given period of time were interviewed and administered a battery of assessment instruments; results are derived from the Addiction Severity Index. A major research question was whether the higher rates of alcohol-related problems for Blacks in the general population were matched by greater severity of life-problems for Blacks in a clinical treatment population. Blacks had more severe problems than Whites in two problem areas: employment support and other drug use. Results point to socioeconomic factors as well as combined alcohol and other drug use as potential contributors to the greater alcohol-related health problems for Blacks in the general population. Comprehensive study of alcohol and other drug use norms and customs within the Black community is recommended to aid in the development of prevention and treatment strategies for alcohol-related problems among Blacks.     

Profile of Addicted Patients Who Reenter Treatment Programs

ABSTRACT.?Background: Clinical experience shows that some patients who suffer from drug addiction are readmitted to treatment programs multiple times because of relapses that occur after they leave these programs. Patients who reenter treatment programs repeatedly may do so because they have problems or difficulties that were not addressed or that were not satisfactorily solved during previous treatment periods. This study explored the differential profile of addicted patients who reenter treatment programs. Methods: A sample of 252 addicted patients (203 male and 49 female) who sought outpatient treatment was assessed. Data regarding sociodemographic factors, drug consumption factors (assessed using the EuropASI), psychopathological factors (assessed using the Symptom Checklist-90—Revised [SCL-90-R]), and personality variables (assessed using the Millon Clinical Multiaxial Inventory II [MCMI-II]) were collected. Results: A 65.9% (n = 166) of drug-addicted patients were readmitted into treatment programs. All of the variables for which data were collected were compared between these treatment repeaters and patients who were admitted for the first time. Significant differences between the 2 groups of patients were found for some of the variables that we examined. Treatment repeaters were generally older and had a poorer employment situation than first-time admits. Treatment repeaters were also more likely to report polyconsumption and to have sought treatment for alcohol abuse. Moreover, some of the scores for several EuropASI, SCL-90-R, and MCMI-II variables were statistically significantly different from those of the first-time admits. Conclusions: According to these results, patients who reenter treatment programs often present with more severe addiction problems. All of these data suggest that treatment programs should incorporate a detailed analysis regarding the existence and nature of prior treatments into the baseline protocols and they should offer follow-up services to patients who have completed their treatments. The implications of these results for further research and clinical practice are discussed.     

Personality and motivational correlates of alcohol consumption and alcohol-related problems among excessive drinking university students

ObjectivesThe study had three objectives: (1) to assess relationships between personality characteristics and alcohol consumption and alcohol-related problems among university students who drink alcohol excessively; (2) to assess relationships between motivational structure and alcohol consumption and problems among students who consume excessive amounts of alcohol; and (3) to assess how personality characteristics and motivational structure are related to each other and how the two are jointly related to alcohol consumption and problems.DesignPersonality, motivational structure, alcohol use, and alcohol-related problems were assessed among 111 undergraduate students.FindingsMediation analyses showed that both maladaptive motivational structure and novelty seeking predicted participants' alcohol-related problems beyond that predicted by alcohol consumption.ConclusionFuture research should aim to reduce alcohol-related negative consequences by targeting students with a maladaptive motivational structure, while taking into account the role of personality characteristics. Screening and intervention programmes would benefit from addressing novelty seeking and maladaptive motivation.     

Brief alcohol intervention for general hospital inpatients: a randomized controlled trial

AIM: To test the effectiveness of a brief alcohol intervention among non-dependent general hospital inpatients with alcohol problems, delivered by either a specialized liaison service or hospital physicians. METHOD: All inpatients of 29 wards from four general hospitals of one region in Germany were screened for alcohol problems (n=14,332). Of those screening positive, 595 patients were included in a randomized controlled group design using a time-frame. Patients with alcohol dependence were not considered in this study. Patients received Motivational Interviewing based counselling either by a specialized liaison service, by hospital physicians trained under routine conditions or received hospital treatment as usual without additional counselling. One year later, alcohol consumption, motivation and well-being were assessed. Sample survey analyses and generalized estimating equations were conducted. RESULTS: At baseline, the three groups differed regarding motivation, with higher motivation among the controls. At follow-up, the groups did not differ regarding alcohol consumption, alcohol-related problems and well-being. All groups decreased their alcohol consumption significantly. Regarding motivation, longitudinal analyses revealed significant interaction effects of time and intervention (p<0.05), indicating a stronger increase of readiness to change drinking and a less profound drop of readiness to seek help among those who received intervention compared to the controls. CONCLUSION: The intervention was not effective in reducing alcohol consumption or in increasing well-being 12 months after hospitalization. It had a positive effect on readiness to change drinking and on readiness to seek formal help for alcohol problems. The intervention groups compensated their lag of motivation.     

An evaluation of the performance of the self-rating of the effects of alcohol questionnaire in 12- and 35-year-old subjects

OBJECTIVE: A low level of response (LR) to alcohol was originally established through evidence of less alcohol-related change in several parameters at a given blood alcohol level. This is a genetically influenced phenotype associated with an increased risk for alcoholism. When measured by a retrospective questionnaire (the Self-Rating of the Effects of Alcohol [SRE] scale), a lower LR (here indicated by a report that more drinks were historically needed for various effects) correlates with a family history of alcoholism and numerous alcohol use-related variables. The current analyses address the questions of how higher SRE scores (as indicators of a low LR) relate to alcohol use and problems across different age groups and when considered in the context of demography (e.g., age, gender, and weight), as well as the number of items endorsed on the questionnaire. METHOD: SRE data (scores and numbers of items endorsed), demography, and alcohol-related variables (quantity, frequency, and problems) were evaluated in two populations. The first population included 334 12-year-old children from the Avon Longitudinal Study of Parents and Children, and the second included more than 400 35-year-old men from the San Diego Prospective Study. In each group, Pearson correlations were established among all variables, and items that were significantly linked to alcohol-related outcomes were entered into regression analyses as predictors of these outcomes. RESULTS: In both samples, SRE scores correlated with all alcohol-related outcomes, with the highest values for the maximum quantity of alcohol consumed. Relationships between the SRE score and alcohol-related variables remained robust in both populations when entered into regression analyses incorporating demography and the number of SRE items answered by subjects. CONCLUSIONS: The SRE score appears to perform relatively similarly across the two populations regarding relationships with alcohol quantity, frequency, and problems. The most consistent results were observed for the maximum quantity of alcohol consumed.     

Reduction in heavy drinking as a treatment outcome in alcohol dependence

In the field of clinical alcohol disorders treatment in North America, abstinence continues to be largely viewed as the optimal treatment goal; however, there is a growing awareness of limitations when abstinence is considered the only successful outcome. Although this issue has been discussed in research settings, new studies on the public health significance of heavy drinking (defined as five or more standard drinks per drinking day in men, and four or more standard drinks per drinking day in women) in the past 10 years suggest that clinical providers should consider the value of alternative outcomes besides abstinence. A focus on abstinence as the primary outcome fails to capture the impact of treatment on reduction in the pattern and in the frequency of alcohol consumption. In addition, evaluating reduction in drinking as “positive” has value for patients as an indicator of clinical progress. Measurement of continuous variables, such as the quantity and the frequency of alcohol consumption, has provided a clearer understanding of the scope of alcohol-related morbidity and mortality at the societal level, and of the relationship between individual patient characteristics and the naturalistic course of alcohol use, abuse, and dependence. A review of these characteristics suggests that there are clinical benefits associated with reducing heavy drinking in alcohol-dependent patients. Given the significant public health consequences associated with heavy drinking and the benefits associated with its reduction, it is proposed that researchers, public health professionals, and clinicians consider using reduction in heavy drinking as a meaningful clinical indicator of treatment response, and that outcomes be individualized to patients' goals and readiness to change.     

Understanding the relationship between social anxiety and alcohol use in college students: A meta-analysis

Many college students use alcohol, and most of these students experience problems related to their use. Emerging research indicates that socially anxious students face heightened risk of experiencing alcohol-related problems, although the extant research on alcohol use and social anxiety in this population has yielded inconsistent findings. This meta-analysis was conducted to examine the relationship between social anxiety and alcohol variables in college students. A literature search was used to identify studies on college students that included measures of social anxiety and at least one of the alcohol variables of interest. All analyses were conducted using random effects models. We found that social anxiety was negatively correlated with alcohol use variables (e.g., typical quantity and typical frequency), but significantly positively correlated with alcohol-related problems, coping, conformity, and social motives for alcohol use, and positive and negative alcohol outcome expectancies. Several moderators of effect sizes were found to be significant, including methodological factors such as sample ascertainment approach. Given that social anxiety was negatively related to alcohol use but positively related to alcohol-related problems, research is needed to address why individuals high in social anxiety experience more problems as a result of their alcohol use. Avoidance of social situations among socially anxious students should also be taken into account when measuring alcohol use. The primary limitation of this study is the small number of studies available for inclusion in some of the analyses.     

Alcohol-related cognitions: do they predict treatment outcome?

Relationships have been reported between alcohol-related cognitions and a range of demographic, drinking behavior, and drinking problem variables. There has been speculation that such cognitions might help predict treatment outcome. We investigated the ability of one class of alcohol-related cognitions--motivations (specifically, reasons for limiting drinking)--to predict the outcomes of a secondary prevention program. Heavily drinking university men were randomly assigned to three groups with different intensities of self-regulation training. Data from the combined sample (n = 40) were analyzed, since outcomes did not differ significantly by treatment level. Four motivation factors, alcohol consumption variables, and alcohol-related problems were assessed pre and posttreatment. Multiple regression analyses were used to assess the ability of pretreatment motivations to predict change on selected outcome measures. Two motivational factors were found significantly and differently related to program outcomes. Implications of these findings for future research and treatment effectiveness are discussed.