Alcohol expectancies and drinking in different age groups

Aims Because expectancies about the effects of alcohol change as drinking experience is accumulated, it is likely that the relationship of expectancy to drinking will differ with age. In this study, we examine the prediction of drinking behavior from positive and negative outcome expectancy at different ages. Design Data were collected as part of the National Alcohol Survey, using a multi‐stage area probability sample of the household population of the 48 contiguous United States. Participants US residents aged 12 and older (n = 2875). Measurements Survey questions included drinking habits (frequency, quantity, frequency of drunkenness, maximum quantity) and beliefs about the effects of alcohol (alcohol expectancies). Findings Structural equation models tested the relationship of positive and negative expectancy to drinking behavior in six age groups. Outcome expectancy accounted for a larger portion of the variance in drinking among younger respondents than among older respondents. However, suppression effects were common. When suppression effects were considered, positive expectancy predicted drinking better than negative expectancy only among respondents under 35, while negative expectancy was a better predictor of drinking status in most respondents over 35 years. Among drinkers, positive expectancy predominated over negative expectancy when suppression effects were considered. Conclusions These results suggest that negative expectancy predicts abstention, while positive expectancy predicts level of drinking among drinkers. In expectancy research, differences between drinkers and abstainers, age of participants and the presence of suppression effects should be taken into account.     

T wo-year longitudinal study expectancies and drinking adolescents of alcohol am ong Norwegian

A bstract A im s. The potential importance of alcohol outcome expectancies in the initiation and maintenance of drinking has been supported by studies showing that these expectancies are present before drinking begins, and that they predict drinking both cross-sectionally and longitudinally. Although initiation of drinking behavior may be influenced by expectancy, subsequent drinking experience may modify expectations. We used structural modeling techniques to investigate the relative influence of expectancy and drinking in a three-wave longitudinal study of Norwegian adolescents . D esign. Survey incorporating self-administered questionnaires . Setting. Twenty-two schools in Hordaland County on the west coast of Norway . Participants. Nine hundred and twenty-four seventh-grade students; 45.7% female . M easurem ents. Alcohol use (frequency, quantity, drunkenness); the Norwegian version of the Alcohol Expectancy Questionnaire for adolescents . Findings. Among students who were already drinkers upon entry into the study, expectations of positive social effects of alcohol predicted drinking longitudinally. Among those who began drinking during the study, these social expectancies predicted drinking initiation, but drinking also influenced subsequent expectancy in the early stages of drinking . C onclusions. These results support a reciprocal relationship of drinking to positive expectancy, highlighting the importance both of expectancies on influencing drinking, and of early drinking experiences on the development of positive expectancies.     

A view through the gateway: expectancies as a possible pathway from alcohol to cannabis

Aim. The aim of this study was to test the hypothesis that cannabis outcome expectancies would be more positive in adolescents who drink alcohol than in non-drinkers. Participants and setting. The participants in the study were 4544 11-16-year-olds attending eight secondary schools located in the north-west midlands of England. Procedure. Participants completed an anonymous self-report questionnaire that incorporated sections designed to tap adolescents' expectancies of positive and negative outcomes of alcohol and cannabis use, together with other questions relating to substance use and associated issues. Results. Four reliable six-item scales were derived, and used to measure positive and negative alcohol and cannabis outcome expectancies. Negative expectancies were relatively stable across age and frequency of substance use, particularly for alcohol. However, positive expectancies for both substances increased markedly with age and, independently, with frequency of use. Positive alcohol and cannabis outcome expectancies were meaningfully related to expectancies of future substance use, and to measures of problem drug use and resistance to peer influence, supporting the validity of these expectancy measures, and their possible value as diagnostic screening instruments. The main hypothesis of the study was supported: among respondents who reported never using cannabis, positive cannabis outcome expectancies increased and negative cannabis outcome expectancies decreased with increasing frequency of alcohol use. Conclusions. The results are consistent with a version of the 'gateway hypothesis' for the relationship between alcohol and cannabis use (alcohol use leads to changes in cannabis expectancies and thereby to cannabis use), but a proper test of the hypothesis requires a longitudinal study.     

Implicit and explicit alcohol cognitions and observed alcohol consumption: three studies in (semi)naturalistic drinking settings

Aims Dual‐process models imply that alcohol use is related to implicit as well as explicit cognitive processes. Few studies have tested whether both types of processes are related to ad libitum drinking. In a series of three studies, we tested whether both implicit and explicit alcohol‐related cognitions predicted the amount of alcohol consumed in an ad libitum (semi)naturalistic drinking situation. Design Two experimental studies used trained confederates (same‐sex peers) who consumed either alcoholic or non‐alcoholic beverages, while observing participants' drinking behaviour in a 30‐minute session. The third study involved observations of participants' alcohol use during a 45‐minute session in which participants spent time with five to seven friends. Setting A (semi)naturalistic drinking setting, a laboratory bar. Participants Participants were undergraduates recruited at Radboud University (study 1: n = 115; study 2: n = 121; study 3: n = 200). Measurements We used coding of drinking behaviour from observations, questionnaire data on positive alcohol expectancies and alcohol use patterns and implicit association tests to assess alcohol associations. Findings Implicit associations were not related to observed alcohol use, whereas explicit positive expectancies were related positively to observed alcohol use in study 1 and study 2. Conclusions Among undergraduate students in (semi)naturalistic drinking settings with peers, implicit alcohol‐related cognitions do not predict the amount of alcohol consumed.     

Cognitive motivations for drinking among alcoholics: factor structure and correlates.

The aims of this study were to: a) Identify factors reflecting reasons for drinking and expectancies regarding the effects of drinking among inpatient alcoholics; b) Examine the relationship between these cognitive "motivations" for drinking and both patterns of alcohol consumption and various personal and social consequences of consumption. The factors which emerged relate to negative mood reduction, positive mood enhancement, and social functioning. Although the factors identified in this investigation were not associated with quantity of alcohol consumed, small to moderate associations were found between scores on three of four factors and a variety of adverse physical and occupational consequences of alcohol abuse.     

A comparison of correlates of DSM-IV alcohol abuse or dependence among more than 400 sons of alcoholics and controls

BACKGROUND: Alcohol dependence and abuse are defined as separate disorders. However, relatively few data are available about whether the same characteristics predict both syndromes. METHODS: Complete data were available from the 15 year follow-up of 411 men who originally had been evaluated from a university population at about age 20. Both baseline data gathered prospectively and the retrospective ratings in six domains of life functioning were analyzed for their relationship to the development of alcohol abuse or dependence during the follow-up. RESULTS: Baseline characteristics of a family history of substance use disorders, the quantity and frequency of drinking, the history of alcohol-related problems, and the level of response to alcohol all predicted future alcohol abuse or dependence, but only an alcoholic second-degree relative or a first-degree drug-dependent family member differentially predicted dependence. Logistic regression analyses revealed that similar baseline characteristics combined to predict dependence and, separately, abuse. When the domains of functioning during the 15 years were included, positive alcohol expectancies, poor coping mechanisms, low level of social support, and drinking in the environment contributed to both dependence and abuse, although the relationship was stronger for dependence. CONCLUSIONS: The predictors and correlates of alcohol abuse and dependence in this group of men were similar. Further research in additional populations and on other drugs is needed to determine if the two syndromes overlap sufficiently to be combined.     

Brief Motivational Interviewing for DWI Recidivists Who Abuse Alcohol and Are Not Participating in DWI Intervention: A Randomized Controlled Trial

Background: Driving while impaired (DWI) recidivists with unresolved alcohol use problems pose an ongoing risk for traffic safety. Following conviction, many do not participate in mandated alcohol evaluation and intervention programs, or continue to drink problematically after being relicensed. This study investigated if, in DWI recidivists with alcohol problems and not currently involved in DWI intervention, Brief Motivational Interviewing (BMI) produced greater reductions in risky drinking at 6‐ and 12‐month follow‐up compared to an information‐advice control condition. Additional analyses explored whether BMI was associated with greater readiness to change, subsequent substance abuse treatment service utilization, and satisfaction compared to the control condition. Methods: Male and female recidivists with drinking problems and not currently engaged in DWI intervention were recruited, evaluated, and then randomly assigned to receive 1 of 2 manualized interventions: 30‐minute BMI session or information‐advice. Participants, interviewers, researchers, and statisticians were blind to assignment. Outcomes were changed in: percent of risky drinking days (i.e., ≥3 standard drinks/d for males; ≥2 for females) in the previous 6 months derived from the Timeline Followback, biomarkers of alcohol abuse (GGT, AST, ALT, MCV) by blood assay, and alcohol abuse‐related behaviors using the MMPI‐Mac scale. Data from the Readiness to Change Questionnaire, a substance abuse service utilization questionnaire, and the Client Satisfaction Scale were also collected. Results: Analyses revealed significant declines in risky drinking with both interventions. BMI (n = 92) resulted in a 25% reduction in risky drinking days at 12‐month follow‐up, which compared to the control intervention (n = 92) represented a significant decline from 6‐month levels. Exposure to BMI also produced significantly greater improvement at 6‐month follow‐up in a biomarker of alcohol abuse and a behavioral measure related to recidivism risk. Exploration of readiness to change, substance abuse service utilization, and satisfaction with intervention indicated a perception of BMI being more useful in coping with problems. Conclusions: Brief MI approaches warrant further implementation and effectiveness research as an opportunistic DWI intervention strategy to reduce risks associated with alcohol use outside of clinical and DWI relicensing settings.     

Ethnic differences in positive alcohol expectancies during childhood: the Pittsburgh Girls Study

Background: Positive expectancies about alcohol’s effects are more likely to be endorsed with increasing age through adolescence, and the strength of positive alcohol expectancies in children appears to differ by ethnicity. Little is known about the extent to which differences in a measure’s psychometric properties as a function of development and ethnicity may account for changes that are observed over time and ethnic differences. This study used measurement invariance methods to examine ethnic differences in the development of alcohol expectancies, and examined risk factors associated with girls’ positive expectancies. Methods: African‐American (56%) and Caucasian (44%) girls (n = 570) in the age 7 cohort of the Pittsburgh Girls Study, and the girl’s primary caretaker, were followed annually for 4 years (ages 7–10). Girls reported on alcohol expectancies at each wave, and physical aggression at Year 1. In Year 1, caretakers reported on neighborhood drug use, their own substance‐related problems, and depression in the girl. Structural equation modeling was used to examine measurement invariance of positive alcohol expectancies, and to test associations of risk factors to initial level and change in expectancies. Results: Five of 8 positive alcohol expectancy items showed measurement equivalence for African‐American and Caucasian girls in cross‐sectional, but not longitudinal, analyses. Measurement equivalence over ages 7–10 was demonstrated for Caucasian girls, and over ages 7–8 and 9–10 (i.e., a two‐part model) for African‐American girls. Risk factor analyses indicated that, for Caucasian girls, greater physical aggression was associated with higher initial positive expectancies. Conclusions: Some developmental change and ethnic differences in the performance of positive expectancy items were identified, highlighting the utility of measurement invariance methods. Risk factor analyses suggest the potential benefit of targeted alcohol prevention interventions for certain girls.     

Alcohol Expectancies and Drinking Refusal Self‐Efficacy Mediate the Association of Impulsivity With Alcohol Misuse

Background: Recent work suggests that 2 biologically based traits convey risk for alcohol misuse: reward sensitivity/drive and (rash) impulsiveness. However, the cognitive mechanisms through which these traits convey risk are unclear. This study tested a model predicting that the risk conveyed by reward sensitivity is mediated by a learning bias for the reinforcing outcomes of alcohol consumption (i.e., positive alcohol expectancy). The model also proposed that the risk conveyed by rash impulsiveness (RI) is mediated by drinkers’ perceived ability to resist alcohol (i.e., drinking refusal self‐efficacy). Methods: Study 1 tested the model in a sample of young adults (n = 342). Study 2 tested the model in a sample of treatment‐seeking substance abusers (n = 121). All participants completed a battery of personality, cognitive, and alcohol use questionnaires and models were tested using structural equation modeling. Results: In both studies, the hypothesized model was found to provide a good fit to the data, and a better fit than alternative models. In both young adults and treatment‐seeking individuals, positive alcohol expectancy fully mediated the association between reward sensitivity and hazardous alcohol use. For treatment seekers, drinking refusal self‐efficacy fully mediated the association between RI and hazardous drinking. However, there was partial mediation in the young adult sample. Furthermore, neither trait was directly associated with the other cognitive mediator. Conclusions: The hypothesized model was confirmed on a large sample of young adults and replicated on a sample of treatment‐seeking substance abusers. Taken together, these findings shed further light on the mechanisms through which an impulsive temperament may convey risk for alcohol misuse.     

Brief prevention for adolescent risk-taking behavior

Aims Despite widespread prevention efforts to decrease adolescent risk‐taking, substance use and driving after drinking (DD) are prevalent in the United States. The current study compared the efficacy of an abbreviated version of Drug Abuse and Resistance Education (DARE‐A) to a new Risk Skills Training Program (RSTP). Design Adolescent participation in drinking, drug use, DD and riding with a drunk driver was examined longitudinally. After baseline assessments, adolescents were randomly assigned to the RSTP, DARE‐A or a no intervention control group and then completed 2‐month post‐test and 6‐month follow‐up assessments. Setting Adolescents attended a mid‐sized suburban high school. Participants The sample (N = 300) was comprised of 58% females and the age range was 14–19 years. Intervention The RSTP was developed to target several risk behaviors and to examine the feasibility of conducting a brief personalized prevention program in a group setting. DARE‐A focused on increasing knowledge and understanding the deleterious effects of substance use. Measurements Risk‐taking behavior, perception of peer risk‐taking and positive and negative alcohol expectancies were assessed. Findings RSTP participants decreased participation in several risk behaviors at post‐test, but reductions were not maintained at 6‐month follow‐up. The control and DARE‐A groups increased their positive and decreased their negative alcohol expectancies. The control group increased their alcohol consumption. Conclusions Results suggest that a brief, personalized, group prevention program is a feasible approach to reducing adolescent risk‐taking. Strategies must be developed to solidify these positive changes so that they are longer‐lasting.     

Assessing the Severity of Hazardous Drinking and Related Consequences Among Incarcerated Women

Background: Recent epidemiological efforts have demonstrated the utility of measuring individual differences in the severity of alcohol use along a single severity continuum marked by alcohol‐related problems, symptoms of alcohol dependence, and the social consequences of drinking. Translation of this utility to specialized clinical populations is not assured. The expected inter‐relationships among problems, symptoms and consequences, and enhanced sensitivity of combined assessments require confirmation in applied clinical settings. Method: Subjects were 245 incarcerated women who met Alcohol Use Disorders Identification Test criteria for hazardous use of alcohol. Participants were recruited from a statewide adult correctional facility for an ongoing clinical trial testing the effectiveness of brief motivational interviewing on alcohol use and HIV risk behaviors. Participants ranged in age from 18 to 56 (M = 34.1, SD = 8.9), 71.4% were Caucasian, and 65.7% reported <12 years of education. Results: Analyses suggested that the 6 problems of alcohol abuse, 7 symptoms for alcohol dependence, and 14 alcohol‐related social consequences loaded to a single factor (0.38 to 0.85) that formed a continuum of alcohol severity. Contrary to epidemiological studies, physical fights and being arrested were the most prevalent consequences and were associated with lower alcohol severity in this population. Three of the five items that discriminated best between higher and lower alcohol severity were related to familial and relationship consequences. Conclusions: Consistent with epidemiological studies, alcohol severity can be measured among incarcerated hazardously drinking women on a single continuum that includes alcohol problems, symptoms, and social consequences. Replication of the expected alignment of problems and symptoms supports the construct validity of the continuum and further challenges the proposed hierarchical structure of abuse/dependence distinction. Large differences in rates of specific consequences and observed effectiveness of tailored social consequence items suggest the benefits of cross‐sample validation to improve evaluation of clinical outcomes.     

Trajectory classes of heavy episodic drinking among Asian American college students

Aims Heavy episodic drinking (HED) among Asian Americans is a growing concern. However, little is known about the etiology and developmental patterns of HED among Asian Americans, even though this group is one of the fastest‐growing populations in the United States. Design Three year longitudinal design. Participants Sample included 404 Asian American college students transitioning from high school, through the college years. Measurement Measures included heavy episodic drinking, parental and peer relationships, alcohol expectancies, drinking values, and alcohol‐related problems. Findings Results from growth‐mixture models (GMM) identified two discrete latent classes of HED comprising 59% of our sample: these trajectory classes (high increasers and low increasers) corresponded to expected changes and stability in well‐established correlates of drinking behaviour, including alcohol‐related problems, personal drinking values and alcohol expectancies. Parental awareness and caring and quality of peer relationships during senior year of high school were associated directly and indirectly with HED class membership. Conclusion These findings advance the literature by providing information about the developmental course of HED among Asian American young adults. The significant within‐group variability in problematic drinking in this sample highlights the fact that subgroups of high‐risk drinkers can be identified even in relatively low‐risk groups such as Asian Americans.     

Reductions in alcohol and cocaine use following a group coping intervention for HIV‐positive adults with childhood sexual abuse histories

Aims Few interventions exist to reduce alcohol and non‐injection drug use among people living with HIV/AIDS. This study tested the effects of a coping group intervention for HIV‐positive adults with childhood sexual abuse histories on alcohol, cocaine and marijuana use. Design Participants were assigned randomly to the experimental coping group or a time‐matched comparison support group. Both interventions were delivered in a group format over 15 weekly 90‐minute sessions. Setting and Participants A diverse sample of 247 HIV‐positive men and women with childhood sexual abuse were recruited from AIDS service organizations and community health centers in New York City. Measurements Substance use was assessed pre‐ and post‐intervention and every 4 months during a 12‐month follow‐up period. Using an intent‐to‐treat analysis, longitudinal changes in substance use by condition were assessed using generalized estimating equations. Findings At baseline, 42% of participants drank alcohol, 26% used cocaine and 26% used marijuana. Relative to participants in the support group, those in the coping group had greater reductions in quantity of alcohol use (Wald χ²₍₄₎ = 10.77, P = 0.029) and any cocaine use (Wald χ²₍₄₎ = 9.81, P = 0.044) overtime. Conclusions Many HIV patients, particularly those with childhood sexual abuse histories, continue to abuse substances. This group intervention that addressed coping with HIV and sexual trauma was effective in reducing alcohol and cocaine use, with effects sustained at 12‐month follow‐up. Integrating mental health treatment into HIV prevention may improve outcomes.     

Conjoint developmental trajectories of young adult substance use

Background. Despite the prominence of comorbidity among substances and the recent attention focused on trajectory‐based approaches to characterizing developmental change, little research in the substance use field has simultaneously considered both course and comorbidity. Methods. Using nationally representative panel data from the Monitoring the Future Project (MTF; n = 32,087; 56% female; 82% Caucasian), we identified developmental courses of heavy drinking, smoking, and marijuana use using 4 waves of data spanning ages 18 to 26 in a multi‐cohort young adult sample. Comorbidity was examined by cross‐classifying group membership in substance use trajectories. Finally, the extent to which risk factors (sex, race, alcohol expectancies, delinquency, sensation seeking, depressive affect, religiosity, academic achievement, and parent education) accounted for combinations of comorbidity that occurred at a rate greater than chance was examined. Results. For each substance, we identified 4 courses of substance use that were largely consistent with those found in the literature (chronic high use, late‐onset use, developmentally limited use, and low‐use), with a fifth moderate smoking group. Heavy drinking, smoking, and marijuana use were each highly associated, and distinct patterns of comorbidity were evident, with greatest agreement along the diagonal. All risk factors explained comorbidity to some degree, with delinquency, sensation seeking, alcohol expectancies, and religion in particular predicting combinations of comorbidity that were characterized by early onset and chronic high use. Conclusions. Cross‐substance trajectory concordance was high, with parallel changes in substance use over emerging adulthood. This suggests similar developmental timing of use, perhaps due to the experience of developmental transitions that have a common influence on use of different substances. Prediction of combinations of comorbidity characterized by early onset and persistently high use suggests that to some extent, individuals use multiple substances because of a common vulnerability to each, rather than directional relations among substances (e.g., cross‐tolerance, cueing).     

Substance dependence, family history of alcohol dependence and neuropsychological functioning in adolescence

Aims. It was hypothesized that adolescent substance dependence moderates the relationship between family history of alcohol dependence and neuropsychological functioning. Design. This study compared the neuropsychological functioning of nonabusing and alcohol and drug-dependent adolescents with and without a family history of alcohol dependence using hierarchical multiple regressions and general factorial analyses. Setting. Substance-dependent adolescents were recruited and tested in inpatient alcohol and drug abuse treatment programs after 3 weeks of abstinence. A matched sample of non-abusing adolescents was recruited from the same San Diego-area communities. Participants. Substance-dependent adolescents (n = 101) met DSM-III-R criteria for dependence on alcohol and at least one other substance. Non-abusing adolescents (n = 50) had no substance use disorders. Groups were comparable on socio-economic status. Participants were 44% female, ages 13-18, and had no serious head injuries or neurological disorders. Measurements. Information was gathered on demographics, family history, substance involvement, and conduct disorder behaviors and adolescents were administered neuropsychological tests covering language, visuospatial, verbal memory, attention and executive functioning domains. Findings. The hypothesis was supported for language and attention tests. Substance involvement interacted with family history of alcohol dependence to predict language and attention functioning. Family history negative non-abusers performed better than the other adolescents. Conclusions. The pattern of results suggests that family history of alcohol dependence and adolescent substance use are separate risk factors for poorer neuropsychological performance in youth.     

Socioeconomic status and drinking patterns in young adults

Aims To investigate the relationship between several indicators ofsocioeconomic status and drinking patterns in young adulthood. Design Data collected in a longitudinal study of young adults was analysed usingrepeated‐measures models to examine the relationship between income, occupationalactivity and educational achievement and patterns of drinking. Setting These data were collected as part of a longitudinal study ofa birth cohort of New Zealanders. They were interviewed for themost part in a central location using a face‐to‐face methodand a computer‐assisted alcohol interview. Participants The participants were members of the Dunedin Multidisciplinary Healthand Development study aged 18, 21 and 26 years. Nine hundred andsixty‐nine study members contributed to the analysis. Study membershave been found to be broadly representative of the New Zealandpopulation and cross national studies suggest findings are generalizableto other similar market economies. Measurements Three indicators of socioeconomic status were used; educationalachievement, occupational activity and income. The educational achievementindicator at age 18 had three levels that ranged from no school qualificationsto higher school qualifications. For age 21 two additional categoriesof tertiary educational achievement were included to make five categories andfor age 26 higher tertiary degrees were included in the measureto make six categories. Five categories of occupational activitywere used. Income data was also used. Two measures of alcohol consumptionwere used. These were the frequency of drinking and the typicalquantity of alcohol consumed per drinking occasion in the past year. Findings Frequency of drinking increased over these early adult yearsand the quantities consumed peaked at age 21 and decreased thereafterfor both males and females. Frequency of drinking was influencedby income with the higher income respondents drinking more oftenand this was persistent overtime. Quantity of drinking was mostinfluenced by educational achievement. The less well‐educated youngadult drank significantly more during a drinking occasion and atall ages. There was also a relationship between educational achievement andfrequency of drinking for males at age 18 and a relationship between women’soccupational activity and the quantities they consumed. Conclusions The finding that the dimensions of drinking operate differently explainsthe lack of consistency in previous research, which has investigated socioeconomicstatus and the volumes of alcohol consumed. The findings of higherquantities consumed among those of lower social status may explain someof the reduced life expectancy found among those with lower socioeconomicstatus.     

Alcohol Use and Sexual Risk Behavior among College Students: Understanding Gender and Ethnic Differences

Objectives: The purpose of the current study was to assess the role of gender and ethnicity in the relationship between alcohol use and risky sexual behavior. Method: Sexually active college students (n = 425) reported on alcohol expectancies, perceived risk of HIV, and drinking and sexual behavior in the context of a larger health behavior survey. Results: Approximately one-third of participants reported binge drinking 3 or more times in the past two weeks. African-American women reported less drinking and less positive alcohol expectancies than other women. Older men engaged more often than younger men in binge drinking and reported more sexual partners in the past year. Younger age and greater perceived risk for HIV were positively associated with condom use for both women and men. Conclusion: Collectively, these findings suggest that alcohol abuse and HIV prevention efforts among young adults need to consider gender, ethnicity, and age.     

Predictors of condom use in women receiving court-mandated drug and alcohol treatment: implications for intervention

Women who abuse substances are at a high-risk for contracting HIV. Condom use interventions are important in reducing HIV in high-risk populations, but current interventions have small effects. The aim of this study is to examine the relative impact of substance use, personal variables (sexual impulsivity and condom expectancies), and relationship variables (perceptions of relationship commitment and partner risk, perceptions of power within the relationship) on condom use in women in court-mandated substance abuse treatment. Information was collected from 312 sexually active women in an inpatient drug and alcohol treatment facility in the Southeastern US Participants completed questionnaires and were interviewed using the Timeline Follow-back method and provided information about sexual activity in the 30-days prior to intake, including type of sexual event, co-occurrence with substance use, condom use, and characteristics of sexual partners and the nature of the relationship. Multilevel logistic modeling revealed that perception of relationship commitment, condom outcome expectancies, and age significantly affected condom use for women in the sample. Specifically, condom use was least likely when women reported that the relationship was committed (odds ratio [OR] = 0.31, 95% confidence interval [CI]: 0.23, 0.43) or when the participant was older (OR = 0.96, 95% CI: 0.94, 0.99), and more likely when women reported more positive condom outcome expectancies (OR = 1.02, 95% CI: 1.00, 1.03). The findings suggest that perceptions of relationship commitment, regardless of perceptions of partner risk, strongly affect condom use among women court-mandated into drug and alcohol treatment. In addition, positive outcome expectancies (e.g., positive self-evaluations and perceived positive partner reactions) are associated with a greater likelihood of condom use. These findings have important implications for condom use interventions, which have failed to produce large or lasting effects within this population.     

Consequences of an Adolescent Onset and Persistent Course of Alcohol Dependence in Men: Adolescent Risk Factors and Adult Outcomes

Background: While there is an extensive literature on the correlates of alcohol use disorders (AUD; alcohol abuse and dependence), there are relatively few prospective studies of representative birth cohorts that have examined the unique effects of an adolescent onset and persistent course of AUD on a wide range of psychosocial variables. Methods: A longitudinal, community‐based sample of 530 men was used to examine the impact of an adolescent onset (AUD+ at age 17) and persistent course (AUD+ at age 29) of AUD on adolescent and adult functioning including substance use, antisocial behavior, mental health problems, overall psychosocial functioning, environmental risk and protective factors, and social outcomes such as peer and romantic relationships, marriage, educational and occupational attainment, and parenthood. Results: An adolescent onset of AUD (n = 57) was associated with severe deficits across multiple domains of psychosocial functioning in adolescence. Measures of behavioral disinhibition in adolescence were strong predictors of a persistent course of AUD (n = 93). Nearly 40% of men with an adolescent onset were able to desist by age 29, and were similar, but not identical to men who never experienced an AUD in terms of adult functioning. Men with an adolescent onset and persistent course of AUD exhibited the most severe deficits in functioning. Conclusion: Results emphasize the importance of examining developmental course to understand the etiology of AUD. Our findings are optimistic in that individuals who desist from AUD are able to achieve high levels of psychosocial functioning. Our findings suggest that future research on the persistence of AUD into adulthood should focus on the contributions of behavioral disinhibition and social environment variables including peer and romantic relationships.     

Alcoholics Anonymous attendance, decreases in impulsivity and drinking and psychosocial outcomes over 16 years: moderated-mediation from a developmental perspective

Aims To examine whether decreases in impulsivity account for links between Alcoholics Anonymous (AA) attendance and better drinking and psychosocial outcomes, and whether these mediational ‘effects’ are conditional on age. Design A naturalistic study in which individuals were assessed at baseline, and 1, 8 and 16 years later. Setting Participants initiated help‐seeking through the alcohol intervention system (detoxification programs, information and referral centers). Participants Individuals with alcohol use disorders and no prior history of substance abuse treatment at baseline [n = 628; 47% women; mean age = 34.7 years (standard deviation = 9.4)]. Measurements Self‐reports of impulsivity and drinking pattern at baseline and year 1, duration of AA (number of weeks) in year 1 and drinking (alcohol use problems, self‐efficacy to resist drinking) and psychosocial outcomes (emotional discharge coping, social support) at baseline and follow‐ups. Findings Controlling for changes in drinking pattern, decreases in impulsivity were associated with fewer alcohol use problems, better coping and greater social support and self‐efficacy at year 1, and better coping and greater social support at year 8. Decreases in impulsivity statistically mediated associations between longer AA duration and improvements on all year 1 outcomes and indirect effects were moderated by participant age (significant only for individuals 25 years of age or younger). Conclusions Decreased impulsivity appears to mediate reductions in alcohol‐related problems over 8 years in people attending Alcoholics Anonymous.