Challenging implicit and explicit alcohol-related cognitions in young heavy drinkers

AIMS: To test whether an expectancy challenge (EC) changes implicit and explicit alcohol-related cognitions and binge drinking in young heavy drinkers. This is important for theoretical and practical reasons: the EC presents a critical test for the hypothesized mediational role of alcohol cognitions and the EC has been presented as a promising intervention to counter alcohol problems in heavy drinking youth. SETTING, PARTICIPANTS AND INTERVENTION: Ninety-two heavy drinking college and university students (half women) were assigned randomly to the EC or control condition (a sham alcohol experiment in the same bar-laboratory). MEASUREMENTS: Explicit alcohol cognitions and alcohol use were assessed with paper-and-pencil measures. Alcohol use was assessed prior to the experiment and during a 1-month follow-up. Implicit alcohol-related cognitions were assessed with two versions of the Implicit Association Test (IAT), adapted to assess implicit valence and arousal associations with alcohol. FINDINGS AND CONCLUSIONS: The EC resulted in decreased explicit positive arousal expectancies in men and women alike. There was some evidence for a differential reduction in implicit arousal associations, but findings depended on the version of the IAT and on the scoring-algorithm used. In men (but not in women) there was a short-lived differential reduction in prospective alcohol use (significant in week 3 of the follow-up), and this reduction was partially mediated by the decrease in explicit positive arousal expectancies. These findings suggest that an EC successfully changes explicit alcohol cognitions and that this may have short-lived beneficial effects in heavy drinking young men.     

Reducing the standard serving size of alcoholic beverages prompts reductions in alcohol consumption

Aims

To test whether reducing the standard serving size of alcoholic beverages would reduce voluntary alcohol consumption in a laboratory (study 1) and a real‐world drinking environment (study 2). Additionally, we modelled the potential public health benefit of reducing the standard serving size of on‐trade alcoholic beverages in the United Kingdom.

Design

Studies 1 and 2 were cluster‐randomized experiments. In the additional study, we used the Sheffield Alcohol Policy Model to estimate the number of deaths and hospital admissions that would be averted per year in the United Kingdom if a policy that reduces alcohol serving sizes in the on‐trade was introduced.

Setting

A semi‐naturalistic laboratory (study 1), a bar in Liverpool, UK (study 2).

Participants

Students and university staff members (study 1: n = 114, mean age = 24.8 years, 74.6% female), residents from local community (study 2: n = 164, mean age = 34.9 years, 57.3% female).

Interventions and comparators

In study 1, participants were assigned randomly to receive standard or reduced serving sizes (by 25%) of alcohol during a laboratory drinking session. In study 2, customers at a bar were served alcohol in either standard or reduced serving sizes (by 28.6–33.3%).

Measurements

Outcome measures were units of alcohol consumed within 1 hour (study 1) and up to 3 hours (study 2). Serving size condition was the primary predictor.

Findings

In study 1, a 25% reduction in alcohol serving size led to a 20.7–22.3% reduction in alcohol consumption. In study 2, a 28.6–33.3% reduction in alcohol serving size led to a 32.4–39.6% reduction in alcohol consumption. Modelling results indicated that decreasing the serving size of on‐trade alcoholic beverages by 25% could reduce the number of alcohol‐related hospital admissions and deaths per year in the United Kingdom by 4.4–10.5% and 5.6–13.2%, respectively.

Conclusions

Reducing the serving size of alcoholic beverages in the United Kingdom appears to lead to a reduction in alcohol consumption within a single drinking occasion.     

Context effects on alcohol cognitions

This article summarizes a symposium on context and alcohol-related cognitions presented at the 2004 Annual Meeting of the Research Society on Alcoholism in Vancouver, British Columbia, Canada. The studies reported here examine how the manipulation of contextual variables influences the availability of alcohol outcome expectancies and implicit memories for alcohol associations. The symposium illustrates the range of context variables and shows some of the potential impact of retrieval on cognitions that predict alcohol use. Two of the studies explore naturalistic drinking contexts: one examines the impact of stress induction, and one assesses within survey question placement effects. A variety of measures of alcohol cognitions were used. The results demonstrate that alcohol cognitions are more accessible in alcohol-related contexts. Moreover, availability of alcohol associations and expectancies depended on individual differences. These results underscore the potential value of memory processes in the retrieval and measurement of alcohol cognitions. The findings have direct implications for improving methods of predicting alcohol use and in understanding the role of alcohol cognitions in various contexts associated with alcohol use.     

Evaluating a cognitive model of ALDH2 and drinking behavior

Background: Despite evidence for genetic influences on alcohol use and alcohol‐related cognitions, genetic factors and endophenotypes are rarely incorporated in cognitive models of drinking behavior. This study evaluated a model of ALDH2 and drinking behavior stipulating cognitive factors and alcohol sensitivity as accounting for genetic influences on drinking outcomes. Methods: Participants were Asian‐American young adults (n = 171) who completed measures of alcohol cognitions (drinking motives, drinking refusal self‐efficacy, and alcohol expectancies), alcohol sensitivity, drinking behavior, and alcohol‐related problems as part of a prospective study. Structural equation modeling (SEM) evaluated a model of drinking behavior that stipulated indirect effects of ALDH2 on drinking outcomes through cognitive variables and alcohol sensitivity. Results: The full model provided an adequate fit to the observed data, with the measurement model explaining 63% of the variance in baseline heavy drinking and 50% of the variance in alcohol‐related problems at follow‐up. Associations of ALDH2 with cognitive factors and alcohol sensitivity were significant, whereas the association of ALDH2 with drinking was not significant with these factors included in the model. Mediation tests indicated significant indirect effects of ALDH2 through drinking motives, drinking refusal self‐efficacy, and alcohol sensitivity. Conclusions: Results are consistent with the perspective that genetic influences on drinking behavior can be partly explained by learning mechanisms and implicate cognitive factors as important for characterizing associations of ALDH2 with drinking.     

Brief alcohol intervention and alcohol assessment do not influence alcohol use in injured patients treated in the emergency department: a randomized controlled clinical trial

Aims To evaluate the effectiveness of brief alcohol intervention (BAI) in reducing alcohol use among hazardous drinkers treated in the emergency department (ED) after an injury; in addition it tests whether assessment of alcohol use without BAI is sufficient to reduce hazardous drinking. Design Randomized controlled clinical trial with 12‐month follow‐up conducted between January 2003 and June 2005. Setting Urban academic emergency department (ED) of the Lausanne University Hospital, Lausanne, Switzerland. Participants A total of 5136 consecutive patients attending ED after an injury completed a seven‐item general and a three‐item alcohol screen and 1472 (28.7%) were positive for hazardous drinking according to the National Institute on Alcohol Abuse and Addiction definition; of these 987 (67.1%) were randomized into a BAI group (n = 310) or a control group with screening and assessment (n = 342) or a control group with screening only (n = 335) and then a total of 770 patients (78.0%) completed the 12‐month follow‐up procedures. Intervention A single 10–15‐minute session of standardized BAI conducted by a trained research assistant. Measurements Percentage of participants who have changed to low‐risk drinking at follow‐up. Findings Data obtained at 12 months indicated that similar proportions were low‐risk drinkers in BAI versus control groups with and without assessment (35.6%, 34.0%, 37.0%, respectively, P = 0.71). Data also indicated similar reductions in drinking frequency, quantity, binge drinking frequency and Alcohol Use Disorders Identification Test (AUDIT) scores across groups. All groups reported similar numbers of days hospitalized and numbers of medical consults in the last 12 months. A model including age groups, gender, AUDIT and injury severity scores indicated that BAI had no influence on the main alcohol use outcome. Conclusions This study provides the evidence that a 10–15‐minute BAI does not decrease alcohol use and health resource utilization in hazardous drinkers treated in the ED, and demonstrates that commonly found decreases in hazardous alcohol use in control groups cannot be attributed to the baseline alcohol assessment.     

The roles of alcohol-related self-statements in social drinking

Recent literature showed that expectancies or cognitions have been proposed as a major factor in influencing the amount of alcohol an individual consumes and the behavioral consequences following consumption. However, how alcohol expectancies influence alcohol consumption is unclear; this paper reports two studies of the relationship. Study I examined the relationship between alcohol consumption and alcohol-related positive and negative self-statements in 110 social drinkers. The results showed that, in a nondrinking situation, the alcohol expectancies and variables measuring consumption and alcohol-related problems were correlated. Also, subjects who perceived their "alcoholic sets" as negative consumed more than those who perceived theirs as positive. Study II investigated changes in self-statement responding in 8 light and 8 heavy drinkers in a "normal" pub drinking situation. The results showed that alcohol-dependent self-statements in the light drinkers were relatively stable across time and between drinking and nondrinking environments. However, the alcohol-dependent self-statements of heavy drinkers became more negative during the drinking session. Furthermore, the degree and nature of such changes appeared to be related to alcohol-associated problems and consumption.     

Age- and sex-dependent effects of footshock stress on subsequent alcohol drinking and acoustic startle behavior in mice selectively bred for high-alcohol preference

Background: Exposure to stress during adolescence is known to be a risk factor for alcohol‐use and anxiety disorders. This study examined the effects of footshock stress during adolescence on subsequent alcohol drinking in male and female mice selectively bred for high‐alcohol preference (HAP1 lines). Acoustic startle responses and prepulse inhibition (PPI) were also assessed in the absence of, and immediately following, subsequent footshock stress exposures to determine whether a prior history of footshock stress during adolescence would produce enduring effects on anxiety‐related behavior and sensorimotor gating. Methods: Alcohol‐naïve, adolescent (male, n = 27; female, n = 23) and adult (male, n = 30; female, n = 30) HAP1 mice were randomly assigned to a stress or no stress group. The study consisted of 5 phases: (1) 10 consecutive days of exposure to a 30‐minute footshock session, (2) 1 startle test, (3) one 30‐minute footshock session immediately followed by 1 startle test, (4) 30 days of free‐choice alcohol consumption, and (5) one 30‐minute footshock session immediately followed by 1 startle test. Results: Footshock stress exposure during adolescence, but not adulthood, robustly increased alcohol drinking behavior in both male and female HAP1 mice. Before alcohol drinking, females in both the adolescent and adult stress groups showed greater startle in phases 2 and 3; whereas males in the adolescent stress group showed greater startle only in phase 3. After alcohol drinking, in phase 5, enhanced startle was no longer apparent in any stress group. Males in the adult stress group showed reduced startle in phases 2 and 5. PPI was generally unchanged, except that males in the adolescent stress group showed increased PPI in phase 3 and females in the adolescent stress group showed decreased PPI in phase 5. Conclusions: Adolescent HAP1 mice appear to be more vulnerable to the effects of footshock stress than adult mice, as manifested by increased alcohol drinking and anxiety‐related behavior in adulthood. These results in mice suggest that stress exposure during adolescence may increase the risk for developing an alcohol‐use and/or anxiety disorder in individuals with a genetic predisposition toward high alcohol consumption.     

Solitary versus social drinking: an experimental study on effects of social exposures on in situ alcohol consumption

Background: Whereas the effects of modeling and of drinking contexts on alcohol use are documented, studies are lacking regarding the effect of given social exposures on actual alcohol consumption during drinking episodes (i.e., in situ alcohol consumption, the quantity of alcohol actually ingested in given occasion, e.g., in grams). Methods: Applying the experimental paradigms, our study investigates the impact of social condition (alone vs. with others) on in situ alcohol consumption (analog measurements) of 123 young adults who participated in 2 wine‐tasting sessions (one together with others, i.e., group condition; 1 solitary, i.e., individual condition: the sequence of participation was assigned at random). Bivariate and multivariate analyses, that is, paired‐ and independent‐samples t‐tests and repeated measure analysis of variance, were applied to investigate the effects through both transversal and longitudinal perspectives. Results: In the first session, higher average amounts of alcohol were consumed in the group condition compared with the individual one. Conversely, higher average consumption was recorded in the individual compared with the group condition in the second session. Considering simultaneously data from the 2 experimental sessions demonstrated that subjects consumed higher amounts of alcohol in individual condition when this condition was organized subsequent and not prior to the group condition. Yet, alcohol consumption in group condition appeared to not vary between the 2 sessions. Conclusions: Results first highlight the effects of social condition on in situ alcohol consumption. However, they also suggest that in situ exposition to others drinking is possibly involved in shaping the perception of context‐related drinking norms, which might further influence subsequent drinking behaviors in an analogous context. Beyond the issues of imitation effects, these findings raise the issues of the development of preventive initiatives aiming to induce changes in individuals’ perception of context‐specific drinking norms.     

Subdiagnostic alcohol use by depressed men and women seeking outpatient psychiatric services: consumption patterns and motivation to reduce drinking

Background: This study examined alcohol use patterns among men and women with depression seeking outpatient psychiatric treatment, including factors associated with recent heavy episodic drinking and motivation to reduce alcohol consumption. Methods: The sample consisted of 1,183 patients aged 18 and over who completed a self‐administered, computerized intake questionnaire and who scored ≥10 on the Beck Depression Inventory‐II (BDI‐II). Additional measures included current and past alcohol questions based on the Addiction Severity Index, heavy episodic drinking (≥5 drinks on 1 or more occasions in the past year), alcohol‐related problems on the Short Michigan Alcoholism Screening Test (SMAST), and motivation to reduce drinking using the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES). Results: Among those who consumed any alcohol in the past year (73.9% of the sample), heavy episodic drinking in the past year was reported by 47.5% of men and 32.5% of women. In logistic regression, prior‐year heavy episodic drinking was associated with younger age (p = 0.011), male gender (p = 0.001), and cigarette smoking (p = 0.002). Among patients reporting heavy episodic drinking, motivation to reduce alcohol consumption was associated with older age (p = 0.008), greater usual quantity of alcohol consumed (p < 0.001), and higher SMAST score (p < 0.001). Conclusions: In contrast to prior clinical studies, we examined subdiagnostic alcohol use and related problems among psychiatric outpatients with depression. Patients reporting greater drinking quantities and alcohol‐related problems also express more motivation to reduce drinking, providing intervention opportunities for mental health providers that should not be overlooked.     

Mood and implicit alcohol expectancy processes: predicting alcohol consumption in the laboratory

Background: Implicit positive alcohol expectancy (PAE) processes are thought to respond phasically to external and internal stimuli—including mood states—and so they may exert powerful proximal influences over drinking behavior. Although social learning theory contends that mood states activate mood‐congruent implicit PAEs, which in turn lead to alcohol use, there is a dearth of experimental research examining this mediation model relative to observable drinking. Moreover, an expectancy theory perspective might suggest that, rather than influencing PAEs directly, mood may moderate the association between PAEs and drinking. To test these models, this study examined the role of mood in the association between implicitly measured PAE processes (i.e., latency to endorse PAEs) and immediate alcohol consumption in the laboratory. Gender differences in these processes also were examined. Method: College students (N = 146) were exposed to either a positive, negative, or neutral mood induction procedure, completed a computerized PAE reaction time (RT) task, and subsequently consumed alcohol ad libitum. Results: The mood manipulation had no direct effects on drinking in the laboratory, making the mediation hypothesis irrelevant. Instead, gender and mood condition moderated the association between RT to endorse PAEs and drinking in the laboratory. For males, RT to tension reduction PAEs was a stronger predictor of volume of beer consumed and peak blood alcohol concentration in the context of general arousal (i.e., positive and negative mood) relative to neutral mood. RT to PAEs did not predict drinking in the laboratory for females. Conclusions: The results show that PAE processes are important determinants of immediate drinking behavior in men, suggesting that biased attention to mood‐relevant PAEs—as indicated by longer RTs—predicts greater alcohol consumption in the appropriate mood context. The findings also highlight the need to consider gender differences in PAE processes. This study underscores the need for interventions that target automatic cognitive processes related to alcohol use.     

Different measures of alcohol consumption and risk of coronary heart disease and all-cause mortality: 11-year follow-up of the Whitehall II Cohort Study

Aims To investigate the relationship between three measures of alcohol consumption obtained simultaneously in a large cohort and the validated risk of coronary heart disease and all‐cause mortality during follow‐up. Design Prospective cohort study with median follow‐up of 11 years. Setting The Whitehall II Cohort Study: London‐based civil service. Participants A total of 10 308 (33% female) civil servants aged 35–55 years at baseline (1985–88). Measurements Self‐reported volume of alcohol consumed during past week, frequency of drinking over past year, usual amount consumed per drinking session. Main outcome measures Coronary heart disease and all‐cause mortality until 1999. Findings A U‐shaped relationship was found between volume of alcohol consumed per week and outcome. Compared to those who drank moderately (10–80 g alcohol per week), non‐drinkers and those drinking more than 248 g per week had approximately a twofold increased risk of mortality. The optimal frequency of drinking was between once or twice a week and daily, after adjustment for average volume consumed per week. Those drinking twice a day or more had an increased risk of mortality (male hazard ratio 2.44 95% CI 1.31–4.52) compared to those drinking once or twice a week. Drinking only once a month or only on special occasions had a 50% increased risk of mortality. The usual amount consumed per drinking session was not indicative of increased health risk in this cohort. Conclusions Epidemiological studies should collect information on frequency of drinking in addition to average volume consumed in order to inform sensible drinking advice.     

Beliefs about fetal alcohol spectrum disorder among men and women at alcohol serving establishments in South Africa

Background: South Africa has one of the highest rates of fetal alcohol spectrum disorder (FASD) in the world. However, little is known about what men and women who attend alcohol serving establishments believe about alcohol use during pregnancy and how these beliefs may be related to alcohol use. Objectives: To understand FASD beliefs and related behaviors among men and women attending alcohol-serving establishments. Methods: We surveyed 1047 men (n?=?565) and women (n?=?482) -including pregnant women and men with pregnant partners- attending alcohol serving establishments in a township located in Cape Town, South Africa. Results: Among both pregnant (n?=?53) and non-pregnant (n?=?429) women, 54% reported drinking alcohol at least 2–4 times per month, and 57% reported having at least 3–4 alcohol drinks during a typical drinking session. Pregnant women were less likely to believe that they should not drink alcohol and that alcohol can harm a fetus when compared to non-pregnant women. Similar findings were observed between men with pregnant partners compared to men without pregnant partners. Among women, beliefs about how much alcohol pregnant women can safely drink were associated with self-reported alcohol use. Conclusions: Efforts to address FASD need to focus on understanding how men and women perceive alcohol use during pregnancy and situational factors that contribute to alcohol consumption among pregnant women attending alcohol serving establishments. Structural and individual-level interventions targeting women at alcohol serving establishments should be prioritized to mitigate alcohol use during pregnancy.     

The effects of alcohol expectancies on drinking behaviour in peer groups: observations in a naturalistic setting

AIMS: To study the functionality of alcohol expectancies in predicting drinking behaviour in existing peer groups of young adults in a 'naturalistic' setting. DESIGN AND SETTING: Young adults were invited to join an experiment with their peer group in a bar annex laboratory. During a 'break' of 50 minutes in this experiment, their activities, social behaviour and drinking behaviour were observed with digital video and audio equipment. PARTICIPANTS: Twenty-eight peer groups were involved in this study. A peer group consisted of seven to nine people, with relationships ranging from intimate relations and close friendships to being acquaintances. A total of 238 participants were involved. Measurements Information of the drinking behaviour from observations and questionnaire data on alcohol expectancies provide the opportunity to look at how and which expectancies are related to actual drinking patterns. Multiple regression and multi-level analyses were applied. FINDINGS: Expectancies on the positive and arousing effects of alcohol consumption were related to alcohol consumption in a naturalistic, social drinking situation, in addition to group effects of drinking. Expectancies on the negative and sedative effects of drinking, however, were not related to drinking. CONCLUSIONS: The findings indicate that among young adults observed in a peer group and naturalistic drinking setting, positive expectancies about the effects of alcohol and expectancies about the effects of alcohol on arousal are related positively to drinking level.     

Risky alcohol use in adolescence: the role of genetics (DRD2, SLC6A4) and coping motives

Background: Drinking to cope (i.e., drinking to forget or alleviate negative feelings) has been found to be associated with adolescents’ heavy drinking and alcohol‐related problems. Additionally, it is widely accepted that genetic factors are involved in alcohol use and dependence. Studies are only beginning to reveal, however, which specific genotypes are related to drinking behaviors, and it is unknown whether they may interact with coping motives in predicting adolescents’ risky drinking. The aim of this study was to examine relationships between the dopamine D2 receptor gene (DRD2) Taq1A polymorphism (rs1800497), a serotonin transporter gene (SLC6A4) polymorphism (5‐HTTLPR), coping motives, and adolescents’ binge drinking and alcohol‐related problems. Methods: Participants in this cross‐sectional study were 282 Dutch adolescents (mean age 17.4, 47% men) who had consumed alcohol at least once in their life. Results: Coping motives were positively related to both binge drinking and alcohol‐related problems, while DRD2 and SLC6A4 genotypes were not. DRD2, but not the SLC6A4 genotype, interacted with coping motives. The link between coping motives and alcohol outcomes was stronger among those carrying the DRD2 risk (A1) allele. Conclusions: This study extends the present literature by providing additional insight into the etiological factors of adolescent drinking behavior. An interaction between a vulnerability gene (DRD2) and a cognitive factor (coping drinking) was found to be related to adolescents’ binge drinking and alcohol‐related problems.     

Overestimation of peer drinking: error of judgement or methodological artefact?

Aims To examine whether inclusion of both self‐ and peer‐referent items in the context of a single social norms drinking questionnaire plays an active role in producing the much‐reported tendency for young people to overestimate the extent of peers' alcohol‐related behaviour and the permissiveness of their attitudes towards alcohol. Design, setting, participants and measurements In a between‐subjects design pupils attending two Scottish secondary schools (n = 1074; 12–18 years; 52.5% male) completed one of three questionnaires designed to measure a range of alcohol‐related behaviours, attitudes and perceptions: a paradigmatic multiple‐target questionnaire included self‐ and peer‐referent items while two single‐target questionnaires included self‐referent or peer‐referent items only. Findings Pupils' self‐reported drinking behaviours and attitudes were similar, regardless of whether multiple or single‐target versions of the questionnaire were used, as were perceptions of peers' frequencies of alcohol use and drunkenness. In contrast, by comparison with pupils who responded to a single‐target version that omitted self‐referent items, use of a multiple‐target questionnaire was significantly more likely to result in reports that peers would consume alcoholic drinks when with friends and hold more permissive or liberal attitudes towards alcohol. Conclusions Social norms research and related health promotion programmes that seek to reduce the extent of overestimation of peer drinking norms are heavily reliant upon multiple‐target drinking questionnaires. The use of such a questionnaire may lead to more distorted or extreme perceptions being reported by pupils compared to single‐target versions, which omit self‐referent drinking items. By implication, use of multiple‐target questionnaires may encourage young people to ‘over‐overestimate’ peer drinking norms.     

The subjective, rather than the disinhibiting, effects of alcohol are related to binge drinking

Background: Evidence suggests that alcohol‐related problems are associated with impulsivity and disinhibited behavior. Less certain is whether disinhibited behavior is due to an impulsive disposition or alcohol’s ability to disinhibit some people more than others. There are a range of disinhibited behaviors associated with alcohol, including excessive alcohol consumption, bingeing. The study tested whether nondependent alcohol bingers showed more disinhibition after placebo and/or alcohol relative to nonbingers and whether this was related to enhanced motivation to drink following a priming dose of alcohol. Methods: Twenty participants (10 bingers) attended the laboratory twice. Baseline measures included impulsivity, alcohol‐related cognitions, alcohol urge, and mood. Participants were preloaded with alcohol (male: 0.6 g/kg, female: 0.5 g/kg) and placebo (counterbalanced). After a 20‐minute rest, participants completed 2 impulsivity tasks (Two Choice & Time Estimation) separated by second urge and mood ratings. Results: Bingers did not show greater impulsivity characteristics but were more concerned about their drinking (p = 0.02) and ability to control drinking (p = 0.04). A priming effect was found: alcohol urge increased after alcohol but not placebo (p = 0.006). Bingers reported greater tolerance to the sedative (p = 0.05) and lightheaded (p = 0.04) effects of alcohol, relative to nonbingers. Binge status was not associated with impulsivity task performance, while preload type (alcohol/placebo) supported only marginal associations. Conclusions: Risk of binge drinking in nondependent individuals is not strongly affected by impulsive personality characteristics or alcohol’s ability to induce behavioral disinhibition. However, alcohol did lead to a priming effect and bingers were more tolerant to the sedative and lightheaded effects of alcohol relative to placebo. Risk of binge drinking is associated with the subjective effects of a priming dose of alcohol.     

Randomized controlled trial of a brief intervention for unhealthy alcohol use in hospitalized Taiwanese men

Aims To evaluate the effectiveness of a brief intervention in hospitalized Taiwanese men to reduce unhealthy alcohol consumption. Design Randomized controlled trial. Setting Medical/surgical wards of a medical centre in Taipei, Taiwan. Participants Of 3669 consecutive adult male in‐patients, 616 were identified as unhealthy alcohol users (>14 drinks/week) and assigned randomly to either usual care (n = 308) or a brief intervention (n = 308). Measurements Primary outcomes were changes in alcohol consumption at 4, 9 and 12 months, including self‐reported weekly alcohol consumption, drinking days and heavy drinking episodes assessed by 7‐day time‐line follow‐back. Secondary outcomes were (i) self‐reported alcohol problems, (ii) health‐care utilization (hospital days and emergency department visits), (iii) self‐reported seeking of speciality treatment for alcohol problems and (iv) 3‐month Quick Drinking Screen. Findings Based on intention‐to‐treat analyses, the intervention group consumed significantly less alcohol than the control group among both unhealthy drinkers and the subgroup of alcohol‐dependent participants over 12 months, on both 7‐day and 3‐month assessments. Adjunctive analyses of only those who completed all assessments found that total drinks consumed did not remain significant. Significantly more participants with alcohol use disorders in the intervention than in the control group (8.3%, 19 of 230 versus 2.1%, four of 189) consulted specialists by 12 months (P = 0.01). However, alcohol‐related problems and health‐care utilization did not differ significantly in the two groups during follow‐up. Conclusions Data from Taiwan confirm that brief in‐hospital intervention can result in a reduction in alcohol intake by men who drink heavily or are diagnosed with an alcohol use disorder.     

The relation between hypothalamic-pituitary-adrenal (HPA) axis activity and age of onset of alcohol use

Aims Hypothalamic–pituitary–adrenal (HPA) axis activity may prove a viable biomarker for identifying those susceptible to alcohol use disorders. The purpose of this study was to examine the relation of the age at which adolescents begin drinking with diurnal and stress cortisol. Design Adolescents' diurnal cortisol levels on a normal day and cortisol levels during a stress procedure were examined in relation to the age of onset of alcohol use. Setting and participants All adolescents (aged 14–20 years) were part of a general population study in the Netherlands (n = 2286). Measurements Ten assessments of salivary cortisol taken on a normal day (diurnal cortisol), as well as during a social stress procedure (stress cortisol) were used as indicators of HPA axis activity. Findings The age at which the first alcoholic drink was consumed varied as a function of cortisol levels at the onset of as well as during the stress procedure. Those who began drinking at an earlier age showed lower cortisol levels at the onset of the stressful tasks (r² = 0.14, P < 0.001) and during the stressful tasks (r² = 0.10, P < 0.05), although not after the tasks (cortisol recovery). Effects were strongest for anticipatory pre‐task cortisol levels. Differences in diurnal cortisol levels did not explain variance in the age at which adolescents had begun drinking. Conclusions Lessened activity of the hypothalamic–pituitary–adrenal axis at the onset of and during a stress procedure is present in adolescents who begin drinking at an early age.     

Motivational pathways from antecedents of alcohol use to consequences: a structural model of using alcohol to cope with negative affect

ABSTRACT

Background: Drinking among college-aged individuals can be problematic. The motivational model of use, which examines various cognitive factors, personal characteristics, and environmental factors, can provide a greater understanding of what contributes toward the decision to drink in these young adults. Objectives: The current study evaluates proposed paths from risk factors for alcohol use, motives for drinking, and subsequent outcomes of alcohol use, drawing from seminal research on the motivational model and drinking motives. Methods: This model was tested in a sample of 303 undergraduate drinkers (77.9% female, mean age = 19.8 years), and evaluated the potential impact of gender and pattern of use. Results: Results indicate that expectancies, maladaptive coping, and negative affect personality styles are associated with coping motives for drinking, and that coping motives are significantly related to problems associated with use. These results are similar for males and females, and among heavy and lighter drinkers. Conclusion: Findings support the role of the coping motive in problematic outcomes associated with drinking and suggest that expectancies, negative affect personality styles, maladaptive coping, and drinking motives are potential targets of prevention and intervention.     

Internet‐based prevention for alcohol and cannabis use: final results of the Climate Schools course

Aims To establish the long‐term efficacy of a universal internet‐based alcohol and cannabis prevention programme in schools. Methods A cluster‐randomized controlled trial was conducted to assess the effectiveness of the Climate Schools: Alcohol and Cannabis Course. The evidence‐based course, aimed at reducing alcohol and cannabis use, is facilitated by the internet and consists of 12 novel and curriculum consistent lessons delivered over 6 months. Participants A total of 764 year 8 students (13 years) from 10 Australian secondary schools were allocated randomly to the internet‐based prevention programme (n = 397, five schools), or to their usual health classes (n = 367, five schools). Measures Participants were assessed at baseline, immediately post, and 6 and 12 months following completion of the intervention, on measures of alcohol and cannabis knowledge, attitudes, use and related harms. Results This paper reports the final results of the intervention trial, 12 months following the completion of the Climate Schools: Alcohol and Cannabis Course. The effectiveness of the course 6 months following the intervention has been reported previously. At the 12‐month follow‐up, compared to the control group, students in the intervention group showed significant improvements in alcohol and cannabis knowledge, a reduction in average weekly alcohol consumption and a reduction in frequency of drinking to excess. No differences between groups were found on alcohol expectancies, cannabis attitudes or alcohol‐ and cannabis‐related harms. The course was found to be acceptable by teachers and students as a means of delivering drug education in schools. Conclusions Internet‐based prevention programs for school‐age children can improve student's knowledge about alcohol and cannabis, and may also reduce alcohol use twelve months after completion.