Naltrexone for heroin dependence treatment in St. Petersburg, Russia

Naltrexone may be more effective for treating opioid (heroin) dependence in Russia than in the U.S. because patients are mostly young and living with their parents, who can control medication compliance. In this pilot study we randomized 52 consenting patients who completed detoxification in St. Petersburg to a double blind, 6-month course of biweekly drug counseling and naltrexone, or counseling and placebo naltrexone. Significant differences in retention and relapse favoring naltrexone were seen beginning at 1 month and continuing throughout the study. At the end of 6 months, 12 of the 27 naltrexone patients (44.4%) remained in treatment and had not relapsed as compared to 4 of 25 placebo patients (16%; p<0.05). Since heroin dependence is the main way HIV is being spread in Russia, naltrexone is likely to improve treatment outcome and help reduce the spread of HIV if it can be made more widely available.     

A Longitudinal Study of European Students' Alcohol Use and Related Behaviors as They Travel Abroad to Study

Background: Travelling away from home can be associated with fewer limits on behavior, particularly for students who participate in exchange programs. Aims: To examine the effects of eight moderators on change in alcohol use and related negative outcomes, drug use and unprotected sexual behavior in European study abroad students before, during, and after their time abroad. Methods: A three wave (before departure, while abroad, and after their return) longitudinal design collecting data on the frequency and volume of alcohol consumed, heavy episodic drinking, alcohol-related outcomes, drug use, and unprotected casual sex. Results: The baseline survey was completed by 1145 students participating in one or two semester exchange programs (67.5% spent up to a semester abroad), of which 906 participated in two or more waves, representing 42 and 33 countries of origin and destination, respectively. Mean age was 22.2?years (SD?=?2.28) and 72.7% were female. Students increased the amount of alcohol consumed by 35% (B?=?0.32; 95% CI 0.287–0.349) and experienced more alcohol-related consequences (B?=?0.15; 95% CI 0.089–0.219) during the study abroad experience, though levels fell below pre-departure levels when they returned home. Factors related to greater alcohol use while abroad include pre-departure expectations about alcohol use during the study abroad experience, psychological adjustment to the host country, academic involvement, and host country living costs. No statistically meaningful change in drug use and unprotected sexual behavior was observed. Conclusions: Studying abroad exposes European students to additional time-limited alcohol-related health risks.     

Alcohol Use and Correlates of Binge Drinking among University Students on the Island of Sardinia,Italy

An anonymous questionnaire was administered to a sample of 1,911 students at Sardinia's main university during the fall of 1997. The questionnaire assessed various behaviors relating to alcohol including its use during or outside meals and binge drinking, defined as five or more drinks in a row. A significantly higher number of males reported drinking alcohol outside of meals and binge drinking than females, and males were also more likely to report impaired driving and consequences after drinking alcohol than females. A logistic regression model was used to determine correlates of binge drinking using demographics, health-risk behaviors, and leisure activities. The model confirmed being a male as one of the strongest correlates, but also included first drinking alcohol before age 17, marijuana use, living away from parents, cigarette use, having multiple sex partners, and exercising. The results indicate that alcohol use is prevalent among university students and is related to the use of other substances. Further investigation is warranted with particular attention paid to gender as a determinant of use.     

Socioecological Factors Related to Hazardous Alcohol use among Female Sex Workers in Lilongwe,Malawi: A Mixed Methods Study

Background: Alcohol use is pervasive among female sex workers (FSW) placing them at increased risk of violence and sexual risk behaviors. FSW often live and work where alcohol is highly normative. Objective: To understand the socioecological influences on hazardous alcohol use among FSW in Malawi. Methods: In 2014, 200 FSW identified through venue-based sampling in Lilongwe, Malawi, completed a quantitative behavioral survey, with a sub-sample participating in qualitative interviews. Multivariable log-binomial regression was used to identify associations between hazardous alcohol use (AUDIT score ≥ 7) and time in sex work, clients per week, unprotected sex, alcohol use with clients, and living environment. Qualitative interviews enhanced findings from quantitative data and identify emergent themes around socioecological influences on alcohol use. Results: Over 50% reported hazardous alcohol use and lived in an alcohol-serving venue. Hazardous alcohol use was associated with sex work duration of ≥2 years (aPR: 1.30; 95%CI: 1.02,1.65) and alcohol use at last sex with a client (aPR: 1.29; 95%CI: 1.06,1.57). FSW perceived alcohol as a facilitator for sex work by reducing inhibitions and attracting clients, but acknowledged alcohol leads to violence and/or unprotected sex. Despite these risks and a motivation to reduce use, FSW feared that refusing to drink would be tantamount to turning away clients. Conclusions: Although FSW recognized alcohol-related risks, the norms and power dynamics of sex work perpetuated hazardous alcohol use. Multilevel interventions are needed to collectively change norms around drinking and sex work that will enable FSW to reduce alcohol consumption when engaging in their work.     

The Role of Pregnancy Concerns in the Relationship between Substance Use and Unprotected Sex among Adolescents

Background: Substance use and unprotected sex are prevalent among adolescents. The link between substance use and unprotected sex is well-established. Research has also highlighted how adolescents’ attitudes and risk perceptions regarding unprotected sex, including concerns about pregnancy (“Getting pregnant would force me to grow up too fast”), are associated with unprotected sex and unplanned pregnancy. However, less research has examined the potential relationship between pregnancy concerns and substance use among adolescents. Objectives: The study prospectively examined (1) differences in pregnancy concerns across patterns of substance use and (2) whether pregnancy concerns mediate the relationship between substance use and later unprotected sex among a sample of middle and high school students. Method: 98 adolescents [M(SD) age = 14.28(1.68), 59.4% female, 59.4% black/African American] completed self-report measures of marijuana and alcohol use, pregnancy concerns, and unprotected sex across three time points over 6?months (T1–T3). Results: Substance users (alcohol/marijuana) reported fewer pregnancy concerns compared to non-substance users (t?=?2.99, p = .04). Pregnancy concerns at T2 mediated the relationship between T1 lifetime substance use and later unprotected sex (T3) (indirect effect: b?=?0.10, CI[.01–.41]; direct effect: b?=?0.15, p = .32), controlling for gender, age, and race. More frequent substance use (T1) was related to fewer pregnancy concerns at T2 (b = ?0.10, p = .04); fewer pregnancy concerns were related to increased likelihood of later unprotected sex (b = ?1.02, p = .02). Conclusions: Findings offer new insight into associations between substance use and unprotected sex and suggest that substance use and sexual health interventions should target pregnancy concerns.     

Heavy Alcohol Use Among Migrant and Non-Migrant Male Sex Workers in Thailand: A Neglected HIV/STI Vulnerability

Background: There is scarce research on male sex workers in the context of alcohol use. While heavy alcohol use has been established as a risk factor for HIV and STI infections among men who have sex with men (MSM), men who engage in sex work with other men, particularly from the Global South, have not been included in these studies. Moreover, studies among male sex workers in Asia often do not explore migration contexts of these men. Objectives: The objective of this exploratory study is to examine the prevalence and correlates of heavy alcohol use among migrant and non-migrant male sex workers in Bangkok and Pattaya, Central Thailand. Methods: Between August and October 2015, 18–24 year-old migrant and non-migrant male sex workers (n = 212) were recruited from various male sex work-identified venues (bars, clubs, massage parlors, and go-go bars) to take an interviewer-administered cross-sectional survey in Bangkok and Pattaya, Thailand. Measures were adapted from previous studies in similar populations and included structured questions across four domains, including demographic characteristics, alcohol use, stimulant use, and sexual behaviors. Multivariable logistic regression assessed the independent associations between heavy alcohol use (heavy versus not heavy) and demographic characteristics, stimulant use and sexual behavior. Results: Heavy alcohol use was prevalent among one-third of participants. Heavy alcohol use was positively associated with male sex workers who were non-migrant and Thai, currently using stimulants, having 15 or more male clients in the past month and having first consumed alcohol at age 15 years or younger. Conclusions: Current HIV prevention efforts should consider subpopulations of MSM, including male sex workers and migrants, as well as other risk behaviors like alcohol, as important contexts for HIV and STI risks.     

Binge drinking among adolescents in Russia: Prevalence,risk and protective factors

Despite evidence that alcohol misuse has been having an increasingly detrimental effect on adolescent wellbeing in Russia in recent years this phenomenon has been little researched. Using data from 2112 children from the Arkhangelsk Social and Health Assessment (SAHA) 2003, this study examined which factors acted as ‘risk’ or ‘protective’ factors for adolescent binge drinking within three domains we termed the ‘family environment’, the ‘alcohol environment’ and ‘deviant behaviour’. The results showed that in the presence of comparatively moderate levels of binge drinking among both boys and girls, being able to access alcohol easily, being unaware of the risks of binge drinking and having peers who consumed alcohol increased the risk of adolescent binge drinking — as did playing truant, smoking and marijuana use, while parental warmth was protective against binge drinking for girls. Our finding that risk and protective factors occur across domains suggests that any interventions targeted against adolescent binge drinking may need to simultaneously focus on risk behaviours in different domains, while at the same time, broader social policy should act to limit the availability of alcohol to adolescents in Russia more generally.     

Social and structural aspects of the overdose risk environment in St. Petersburg, Russia

BackgroundWhile overdose is a common cause of mortality among opioid injectors worldwide, little information exists on opioid overdoses or how context may influence overdose risk in Russia. This study sought to uncover social and structural aspects contributing to fatal overdose risk in St. Petersburg and assess prevention intervention feasibility.MethodsTwenty-one key informant interviews were conducted with drug users, treatment providers, toxicologists, police, and ambulance staff. Thematic coding of interview content was conducted to elucidate elements of the overdose risk environment.ResultsSeveral factors within St. Petersburg's environment were identified as shaping illicit drug users’ risk behaviours and contributing to conditions of suboptimal response to overdose in the community. Most drug users live and experience overdoses at home, where family and home environment may mediate or moderate risk behaviours. The overdose risk environment is also worsened by inefficient emergency response infrastructure, insufficient cardiopulmonary or naloxone training resources, and the preponderance of abstinence-based treatment approaches to the exclusion of other treatment modalities. However, attitudes of drug users and law enforcement officials generally support overdose prevention intervention feasibility. Modifiable aspects of the risk environment suggest community-based and structural interventions, including overdose response training for drug users and professionals that encompasses naloxone distribution to the users and equipping more ambulances with naloxone.ConclusionLocal social and structural elements influence risk environments for overdose. Interventions at the community and structural levels to prevent and respond to opioid overdoses are needed for and integral to reducing overdose mortality in St. Petersburg.     

A Qualitative Assessment of Alcohol Consumption and Sexual Risk Behaviors Among Men Who Have Sex With Men and Transgender Women in Peru

Background: Peruvian men who have sex with men (MSM) and transgender women (TGW) experience the double burden of a highly concentrated HIV epidemic with a high prevalence of alcohol use disorders (AUDs). Recent research has associated both with risky sexual behaviors, including unprotected sex, having multiple sexual partners, engaging in sex work, having recent sexually transmitted infections, and having HIV-infected partners. AUDs have also been associated in MSM/TGW with being unaware of HIV+ status. Objectives: This study aims to further examine issues associated with alcohol consumption, HIV infection, and risk behaviors in a qualitative analysis of focus groups conducted with MSM/TGW in Peru. Methods: A total of 26 MSM/TGW participants with AUDs participated in three semi-structured focus groups in Lima, Peru. Content analysis was facilitated by software, and specific themes were elucidated. Results: Participants described their drinking patterns, including the types of alcoholic drinks they consumed. They depicted drinking frequently and over multiple-day sessions. Problematic drinking behaviors were described, as well as the perceived characteristics of alcohol dependence. Interestingly, HIV-infected participants who were prescribed antiretroviral therapy did not believe that their drinking affected their medication adherence. These insights can aid in the design of future interventions aiming to reduce problematic drinking as well as HIV-related risk behaviors and, subsequently, HIV incidence. Conclusions: Peruvian MSM/TGW exhibit problematic drinking, which may be associated with risky sexual behaviors and HIV transmission. Interest in reducing alcohol consumption was high, suggesting the need for targeted behavioral and pharmacological interventions.     

Drinking motives, protective behavioral strategies, and experienced consequences: Identifying students at risk

The association between drinking motives and protective behavioral strategies was explored, including whether individuals with different drinking motives were more or less likely to utilize protective behavioral strategies and whether the combination of drinking motives and use of protective strategies may help identify individuals at elevated risk for alcohol-related problems. The final sample included 358 college students (59.2% female; M=18.47 years old, SD=.58). Individuals who had greater enhancement and social motives for drinking used protective strategies less frequently, controlling for number of drinks per week; those who had greater conformity motives used protective strategies more frequently. Coping motives were not significantly correlated with the mean of protective factors, but were associated with less frequently using individual strategies. Using protective strategies more frequently was associated with consuming fewer drinks and having lower RAPI scores. Interactions of drinking motives with the number of protective strategies tended to be non-significant; however, significant interactions indicated that greater coping and conformity motives were especially associated with negative outcomes among individuals who used fewer protective strategies.     

Alcohol use and HIV risk behaviors among HIV-infected hospitalized patients in St. Petersburg, Russia

PURPOSE: Russia has high per capita alcohol consumption and an injection-drug-use-driven HIV epidemic. However, the role of alcohol in the spread of HIV infection in Russia is largely unexplored. Thus, we assessed recent alcohol use and associated HIV risk behaviors among HIV-infected persons in St. Petersburg, Russia. METHODS: We recruited HIV-infected hospitalized patients from the Botkin Infectious Disease Hospital between June 2001 and March 2002. Interviewers assessed alcohol and drug use with the addiction severity index (ASI) and sex- and drug-risk behaviors with the risk assessment battery (RAB). Lifetime abuse or dependence diagnoses for alcohol and drugs were established by a physician with addiction medicine training. RESULTS: Among 201 subjects, diagnoses of abuse or dependence (AB/DEP) were common: 9% (19/201) had only alcohol AB/DEP; 39% (78/201) had alcohol and drug AB/DEP; 47% (95/201) had only drug AB/DEP; and 4% (9/201) had no diagnosis of alcohol or drug AB/DEP. Sex- and drug-risk behaviors varied significantly by substance use diagnosis. Subjects with any alcohol AB/DEP had higher sex-risk RAB scores than those with drug only AB/DEP (6.1 versus 3.9, p<.0001). Among subjects with any diagnosis of drug AB/DEP, having in addition an alcohol diagnosis was associated with unclean needle use in the last six months (33% (26/78) versus 21% (20/95), p=0.08). CONCLUSIONS: Lifetime alcohol diagnoses of abuse or dependence were present in nearly one-half of hospitalized HIV-infected patients in St. Petersburg, Russia and were associated with significantly higher sex-risk behaviors and borderline significantly higher drug-risk behaviors. As HIV infection spreads rapidly in Russia and Eastern Europe, these data support the need for HIV risk-reduction interventions in alcohol abusing populations and raise the potential of benefit by addressing alcohol use in HIV-infected populations.     

Comparison of Sexual and Drug Use Behaviors Between Female Sex Workers in Tijuana and Ciudad Juarez,Mexico

Female sex workers (FSWs) have been documented to have high rates of sexually transmitted diseases and HIV in many parts of the world. However, little work has been done to characterize the prevalence of these infections along the U.S.–Mexican border, where sexual tourism and culturally sanctioned sex work among nationals is widespread. The objective of this study was to compare differences in background characteristics, HIV risk behaviors, drug use, and sexually transmitted infection/HIV prevalence between FSWs who participated in a behavioral risk intervention in two U.S.–Mexican border cities. Baseline data were collected from March 2004 through September 2005. Data from 295 FSWs were compared between Tijuana and Ciudad (Cd.) Juarez. Among 155 FSWs in Tijuana and 140 in Cd. Juarez, HIV seroprevalence was 4.8% and 4.9%, respectively. FSWs in Cd. Juarez were more likely to test positive for active syphilis (31.3%) compared with Tijuana (11.8%) but did not differ in terms of the prevalence of gonorrhea and chlamydia. FSWs in both sites reported high levels of unprotected sex and use of drugs; however, FSWs in Cd. Juarez were more likely than those in Tijuana to ever have injected drugs (75% vs. 25%, p <.001). Heroin and cocaine use and injection drug use were significantly more common in Cd. Juarez, whereas methamphetamine use was more common in Tijuana. Injection of vitamins was common in both cities. Logistic regression analyses suggested that being younger, working in Cd. Juarez, and using heroin or cocaine were independently associated with active syphilis infection. In Tijuana, methamphetamine use was strongly associated with active syphilis infection. These preliminary results suggest that risk profiles for HIV/sexually transmitted infection among FSWs in these two Mexico–U.S. border cities differ, suggesting a need to tailor interventions to the specific needs in each city.     

Police sexual coercion and its association with risky sex work and substance use behaviors among female sex workers in St. Petersburg and Orenburg,Russia

BackgroundExtensive research documents that female sex workers (FSWs) in Russia are very vulnerable to abuses from police, including police sexual coercion. However, despite qualitative data suggesting abusive policing practices are more likely for FSWs contending with substance abuse issues and risky sex work contexts, there is a paucity of quantitative study evaluating these associations specifically in terms of police sexual coercion. Such research is needed to guide structural interventions to improve health and safety for FSWs in Russia and globally.ObjectiveThe purpose of this study is to assess the prevalence of police sexual coercion among FSWs from two Russian cities, St. Petersburg and Orenburg, and to determine whether riskier sex work behaviors and contexts and substance use behaviors, including both IDU and risky alcohol use, are associated with increased risk for sexual coercion from police.MethodFSWs in St. Petersburg and Orenburg were recruited via time-location and convenience sampling and completed structured surveys on demographics (age, education), sex work risks (e.g., violence during sex work) and substance use. Logistic regression analyses assessed associations of substance use and risky sex work with police sexual coercion, adjusting for demographics.ResultsParticipants (N = 896) were aged 15 and older (94% were 20+ years). Most (69%) reported past year binge alcohol use, and 48% reported IDU the day before. Half (56%) reported 4+ clients per day. Rape during sex work ever was reported by 64%. Police sexual coercion in the past 12 months was reported by 38%. In the multivariate model, both current IDU (AOR = 2.09, CI = 1.45–3.02) and past year binge alcohol use (AOR = 1.46, CI = 1.03–2.07) were associated with police sexual coercion, as was selling sex on the street (not in venues) (AOR = 7.81, CI = 4.53–13.48) and rape during sex work (AOR = 2.04, CI = 1.43–2.92).ConclusionCurrent findings document the substantial role police sexual violence plays in the lives of FSWs in Russia. These findings also highlight heightened vulnerability to such violence among self-managed and substance abusing FSWs in this context. Structural interventions addressing police violence against FSWs may be useful to improve the health and safety of this population.     

Impulsivity and Problem Drinking in College: Examining the Mediating Role of Sex-Related Alcohol Expectancies and Alcohol Use at Sex

Background: Dispositional impulsivity has been consistently implicated as a risk factor for problem drinking among college students and research suggests that this relationship may be explained in part by alcohol expectancies. A subset of alcohol expectancies, sex-related alcohol expectancies, is particularly linked to problem drinking among college students. The acquired preparedness model of risk postulates that people with dispositional impulsivity develop stronger sex-related alcohol expectancies, are subsequently more likely to drink at problematic levels in sexual situations, and thus, engage in more problem drinking. Objectives: Using this model, the current study examined whether sex-related alcohol expectancies and alcohol use at sex mediated the relationship between impulsivity and problem drinking among college students. Methods: College students (N = 101) completed self-report measures of alcohol use, sex-related alcohol expectancies, and five dimensions of impulsivity: negative urgency, positive urgency, sensation seeking, lack of premeditation, and lack of perseverance. Results: Two facets of impulsivity—sensation seeking and lack of premeditation—provided unique contributions to problem drinking. Sex-related alcohol expectancies significantly mediated the effects of lack of premeditation and sensation seeking on problem drinking. In support of the acquired preparedness model, the relationship between the impulsivity traits and problem drinking was serially mediated by sex-related alcohol expectancies and alcohol use at sex. Conclusions: Results suggest that sensation seeking and lack of premeditation continue to be areas of intervention for problem drinking among college students, and implicate sex-related alcohol expectancies as an area of intervention for alcohol use at sex and problem drinking.     

Bullying Victimization,Binge Drinking,and Marijuana Use among Adolescents: Results from the 2013 National Youth Risk Behavior Survey

The current research examines the association between bullying victimization, binge drinking, and marijuana use among adolescents. We seek to determine if this association varies based on the type of bullying experienced, traditional or cyberbullying. We used data from the 2013 Youth Risk Behavior Survey, a nationally representative sample of high school students in the United States. The dependent variables were binge drinking and marijuana use. Our key independent variable, bullying victimization, included both traditional and cyberbullying. We estimated logistic regression models, by gender, to examine the association between bullying victimization and substance use. About 25% of the sample reported bullying victimization, including 10.39% for only traditional, 5.47% for only cyber, and 9.26% for both. Traditional bullying was not significantly associated with binge drinking, but was negatively related to marijuana use. Being the victim of cyberbullying and both types of bullying was significantly associated with binge drinking and marijuana use. We also found important gender differences. The current research adds to a growing list of studies that suggests that cyberbullying is associated with more adverse outcomes than traditional bullying. Bullying prevention and intervention efforts should focus on reducing cyberbullying and providing adolescents with the skills needed to effectively deal with cyberbullying.     

Drinking Reasons and Alcohol Problems by Work Venue Among Female Sex Workers in Guangxi,China

Objective: Alcohol use is a key determinant of sexual risk behaviors, but pathways to alcohol use in the context of commercial sex still remain unclear. The present study explores reasons for drinking and their roles on alcohol use problems among female sex workers (FSWs) in different types of commercial sex venues. Method: In 2009, a sample of 1,022 FSWs from Guangxi, China completed a survey containing a 10-item Alcohol Use Disorders Identification Test (AUDIT) and a 28-item measure of reasons for drinking. Factor analysis revealed five reasons for drinking: suppression, disinhibition, work requirement, sexual enhancement, and confidence booster. Results: All identified reasons except confidence booster appeared to be related to a higher tendency of developing alcohol use problems among FSWs. Types of commercial sex venues moderated the relationship between work requirement and alcohol use problems. Conclusions: Alcohol-risk reduction interventions among this population need to provide them with alternative approaches to regulate emotions and modify their misconceptions about alcohol's sexual enhancing function. More attention is needed to FSWs’ vulnerability to the negative influence of occupational drinking.     

Alcohol-Attributable Calories Consumed as a Result of Binge Drinking: A National Survey of Drinkers in the United States

Aims: Estimate the alcohol-attributed calories associated with respondents' (a) most recent binge drinking episode, and (b) binge drinking across a thirty-day period. Methods: Examined responses to a module of the 2008 Behavioral Risk Factor Surveillance System (BRFSS), completed by a 10-state sample in the United States (n = 7,375), in order to estimate the alcohol-attributed calories consumed among binge drinkers. Alcohol-attributed calories were estimated by multiplying number of drinks consumed for each category (beer, wine, liquor drinks, and pre-mixed flavored drinks) collected in the BRFSS by caloric averages based on two data sources. Results: In the past 30 days, respondents averaged 4.13 (SD = 5.84) binge drinking episodes, and consumed an average of 4.15 (SD = 3.55) beers, .67 (SD = 1.56) glasses of wine, 1.49 (SD = 2.53) shots of liquor, and .15 (SD = .79) pre-mixed flavored beverages during their most recent binge drinking episode. The average amount of alcohol-attributed calories consumed during this binge drinking episode was 991.76 (SD = 578.71), with men consuming significantly more calories than females. Conclusions: Dietary guidelines suggest the calories associated with alcoholic beverages should be considered as part of one's limited allotment of calories associated with solid fats and sugars, yet our results highlight alcohol as a major contributor (approximately 1,000 calories) to the proposed daily caloric needs on binge drinking days.     

Binge Drinking,Marijuana Use,and Friendships: The Relationship Between Similar and Dissimilar Usage and Friendship Quality

Abstract

While it is commonly understood that the substance use of peers influences an individual's substance use, much less is understood about the interplay between substance use and friendship quality. Using a sample of 2,148 emerging adults nested within 1,074 dyadic friendships, this study separately investigates how concordance and discordance in binge drinking and marijuana use between friends is related to each friend's perceptions of friendship quality. Because “friendship quality” is a complex construct, we employ a measure containing five sub-elements – companionship, a lack of conflict, willingness to help a friend, relationship security, and closeness. Results for both binge drinking and marijuana use reveal that individuals in friendship pairs who are concordant in their substance use perceive significantly higher perceptions of friendship quality than individuals in dyads who are dissimilar in substance use. Specifically, concordant binge drinkers estimate significantly higher levels of companionship, relationship security, and willingness to help their friend than concordant non-users, discordant users, and discordant non-users. However, the highest amount of conflict in friendships is found when both friends engage in binge drinking and marijuana use. Several interpretations of these findings are discussed. Overall, concordance between friends’ binge drinking and marijuana use appears to help some elements of friendship quality and harm others.     

Childhood Adversity and Hazardous Drinking: The Mediating Role of Attachment Insecurity

Background: Harmful alcohol use is associated with disease and mortality. Identifying new determinants of harmful drinking may aid the 16.3 million adults who have alcohol use disorders. Childhood adversity is associated with alcohol use, but is not amenable to change. Attachment insecurity (anxiety and avoidance) may be associated with alcohol use and may be a target for modification or used to personalize interventions. Objectives: This study aims to (a) identify the association between attachment insecurity and harmful drinking, (b) determine if attachment insecurity may mediate between childhood adversity and harmful drinking, and (c) test sex as a moderator between attachment insecurity and harmful drinking in the mediation relationship. Methods: Adult primary care patients (N = 348, 60% women) completed a cross-sectional survey study using validated measures in 2012. Statistical analyses were performed using Hayes's PROCESS macro in SPSS. Results: Childhood adversity was reported by 61% of the cohort and 18% endorsed harmful drinking. Attachment anxiety was associated with harmful drinking (p >.001), but attachment avoidance was not (p =.11). Attachment anxiety may mediate between childhood adversity and harmful drinking (95% CI:.03–.14). Sex did not moderate the relationships between attachment anxiety and harmful drinking in the mediation relationship (women: 95% CI:.031–.179; men: 95% CI:.003.–.182). Conclusions/Importance: Attachment anxiety may mediate between childhood adversity and harmful drinking in both men and women. Attachment anxiety may be a potential therapeutic target for people with a history of childhood adversity.     

Association Between Drinking Goal and Alcohol Use One Year After Residential Treatment: A Multicenter Study

This study examined whether patients’ drinking goals at admission to and discharge from 12 residential alcohol use disorder treatment programs were associated with alcohol-related outcomes at 1-year follow-up. Detoxified patients (N = 289) completed assessments at admission, after treatment, and at 1-year follow-up. Drinking goals of abstinence, conditional abstinence (in principle abstinence but potential occurrence of lapses or drinking, when urges are strong), and controlled drinking changed during treatment and predicted the 1-year follow-up outcomes (abstinence, number of standard drinks, and number of days to the first alcohol use). Goals at discharge had a better predictive value. The goal of abstinence at discharge had better outcomes than conditional abstinence; the poorest had controlled drinking.