The daily association between affect and alcohol use: a meta-analysis of individual participant data

Influential psychological theories hypothesize that people consume alcohol in response to the experience of both negative and positive emotions. Despite two decades of daily diary and ecological momentary assessment research, it remains unclear whether people consume more alcohol on days they experience higher negative and positive affect in everyday life. In this preregistered meta-analysis, we synthesized the evidence for these daily associations between affect and alcohol use. We included individual participant data from 69 studies (N = 12,394), which used daily and momentary surveys to assess affect and the number of alcoholic drinks consumed. Results indicate that people are not more likely to drink on days they experience high negative affect, but are more likely to drink and drink heavily on days high in positive affect. People self-reporting a motivational tendency to drink-to-cope and drink-to-enhance consumed more alcohol, but not on days they experienced higher negative and positive affect. Results were robust across different operationalizations of affect, study designs, study populations, and individual characteristics. These findings challenge the long-held belief that people drink more alcohol following increases in negative affect. Integrating these findings under different theoretical models and limitations of this field of research, we collectively propose an agenda for future research to explore open questions surrounding affect and alcohol use.The present study was funded by the Canadian Institutes of Health Research Grant MOP-115104 (Roisin M. O’Connor), Canadian Institutes of Health Research Grant MSH-122803 (Roisin M. O’Connor), John A. Hartford Foundation Grant (Paul Sacco), Loyola University Chicago Research Support Grant (Tracy De Hart), National Institute for Occupational Safety and Health Grant T03OH008435 (Cynthia Mohr), National Institutes of Health (NIH) Grant F31AA023447 (Ryan W. Carpenter), NIH Grant R01AA025936 (Kasey G. Creswell), NIH Grant R01AA025969 (Catharine E. Fairbairn), NIH Grant R21AA024156 (Anne M. Fairlie), NIH Grant F31AA024372 (Fallon Goodman), NIH Grant R01DA047247 (Kevin M. King), NIH Grant K01AA026854 (Ashley N. Linden-Carmichael), NIH Grant K01AA022938 (Jennifer E. Merrill), NIH Grant K23AA024808 (Hayley Treloar Padovano), NIH Grant P60AA11998 (Timothy Trull), NIH Grant MH69472 (Timothy Trull), NIH Grant K01DA035153 (Nisha Gottfredson), NIH Grant P50DA039838 (Ashley N. Linden-Carmichael), NIH Grant K01DA047417 (David M. Lydon-Staley), NIH Grant T32DA037183 (M. Kushner), NIH Grant R21DA038163 (A. Moore), NIH Grant K12DA000167 (M. Potenza, Stephanie S. O’Malley), NIH Grant R01AA025451 (Bruce Bartholow, Thomas M. Piasecki), NIH Grant P50AA03510 (V. Hesselbrock), NIH Grant K01AA13938 (Kristina M. Jackson), NIH Grant K02AA028832 (Kevin M. King), NIH Grant T32AA007455 (M. Larimer), NIH Grant R01AA025037 (Christine M. Lee, M. Patrick), NIH Grant R01AA025611 (Melissa Lewis), NIH Grant R01AA007850 (Robert Miranda), NIH Grant R21AA017273 (Robert Miranda), NIH Grant R03AA014598 (Cynthia Mohr), NIH Grant R29AA09917 (Cynthia Mohr), NIH Grant T32AA07290 (Cynthia Mohr), NIH Grant P01AA019072 (P. Monti), NIH Grant R01AA015553 (J. Morgenstern), NIH Grant R01AA020077 (J. Morgenstern), NIH Grant R21AA017135 (J. Morgenstern), NIH Grant R01AA016621 (Stephanie S. O’Malley), NIH Grant K99AA029459 (Marilyn Piccirillo), NIH Grant F31AA022227 (Nichole Scaglione), NIH Grant R21AA018336 (Katie Witkiewitz), Portuguese State Budget Foundation for Science and Technology Grant UIDB/PSI/01662/2020 (Teresa Freire), University of Washington Population Health COVID-19 Rapid Response Grant (J. Kanter, Adam M. Kuczynski), U.S. Department of Defense Grant W81XWH-13-2-0020 (Cynthia Mohr), SANPSY Laboratory Core Support Grant CNRS USR 3413 (Marc Auriacombe), Social Sciences and Humanities Research Council of Canada Grant (N. Galambos), and Social Sciences and Humanities Research Council of Canada Grant (Andrea L. Howard)

Mindfulness practice moderates the relationship between craving and substance use in a clinical sample

Thesis (Master's)--University of Washington, 2016-05Objective: Relapse following treatment for substance use disorders is highly prevalent, and craving has been shown to be a primary predictor of relapse. Mindfulness-based relapse prevention (MBRP) is a psychosocial aftercare program integrating mindfulness and cognitive-behavioral approaches, aimed at reducing the risk and severity of relapse. Results from a recent randomized clinical trial demonstrate enhanced remission resilience for MBRP participants versus both cognitive-behavioral and treatment-as-usual controls. The current study investigated between-session formal and informal mindfulness practice, a hypothesized primary mechanism of action in this treatment, as an attenuating factor in the relationship between craving and substance use. Method: Participants in this secondary analysis were 57 eligible adults who completed either inpatient treatment or intensive outpatient treatment for substance use disorders, were randomized in the parent study to receive MBRP, and completed relevant follow-up assessments. Results: For formal mindfulness practice at post-course, both number of days per week (p=.006) and number of minutes per day (p=.010) significantly moderated the relationship between craving at post-course and number of substance use days at 6-month follow up. Informal practice did not significantly influence the craving-use relationship in this analysis. Conclusions: These results indicate that increasing formal mindfulness practice may reduce the link between craving and substance use for MBRP participants and enhance remission resiliency

Intensive Longitudinal Assessment of Cannabis use and Related Experiences

Thesis (Ph.D.)--University of Washington, 2020Cannabis misuse is a behavior associated with substantial negative life outcomes and is a growing public health concern. Epidemiology indicates cannabis misuse peaks during young adulthood, which has been identified as an important developmental period for intervention. Many young adults use cannabis to cope with unpleasant momentary experiences, and those who do frequently experience more substantial negative cannabis-related and mental health consequences. Based on behavioral theory, and the allostatic model (or self-medication hypothesis), recently developed effective treatments for substance misuse have focused on improving craving management by adjusting peoples' avoidant relationship with unpleasant momentary experiences such as craving and negative affect. Despite demonstrated effectiveness, there is limited empirical evidence to support craving management as a hypothesized mechanism of action for mindfulness-based treatments. The present dissertation project addresses this gap in the literature with a systematic review and two empirical research studies. The review compiles existing scientific research on the association between mindfulness, a primary hypothesized moderator of craving, and psychiatric outcomes. The first study investigates the longitudinal association between craving and use with single-time point assessment, and intensive longitudinal assessment. The second study explores dispositional and momentary factors as hypothesized moderators of the association between craving and use. Results from the present dissertation project carry significant import for future trials of treatments targeting craving and craving management. Findings indicate that intensive longitudinal assessment of craving may produce more valid results than single time-point assessment alone, and dispositional non- judgment of experience may moderate the association between momentary craving and subsequent use for problematic cannabis users

Self-medication and experiential avoidance: Using network analysis to understand young adult cannabis use

In the United States, cannabis is one of the two most commonly used substances, with the highest rates of use reported during young adulthood. The self-medication theory suggests that cannabis use may be a behavioral response to cope with unwanted mood and emotion. Additional theories under study were the dynamic model of addiction and the paradoxical effects of thought suppression and experiential avoidance. The current study used ecological momentary assessment to evaluate these three theories among young adult college student cannabis users by investigating contemporaneous and temporal links between positive and negative affect, craving, intoxication level, and coping style. Participants (N=86) were students at a large public university in the Pacific Northwest using cannabis two or more days per week, with problems related to cannabis use, and interest in changing their use. During a two-week ecological momentary assessment period, participants completed four daily self-reports. We constructed associative and temporal networks to test each of the three theories during cycles of cannabis use and cycles of cannabis non-use. Results provided evidence to support the dynamic model of addiction, as well as the paradoxical effects of thought suppression and experiential avoidance. However, there was mixed evidence related to the self-medication theory. The expected link between negative affect and level of intoxication was only observed in the contemporaneous model and not in the temporal model. Future research may investigate these theories among those using other substances, with more severe presentations, or greater readiness to change their use

Attempted training of alcohol approach and drinking identity associations in US undergraduate drinkers: null results from two studies

There is preliminary evidence that approach avoid training can shift implicit alcohol associations and improve treatment outcomes. We sought to replicate and extend those findings in US undergraduate social drinkers (Study 1) and at-risk drinkers (Study 2). Three adaptations of the approach avoid task (AAT) were tested. The first adaptation – the approach avoid training – was a replication and targeted implicit alcohol approach associations. The remaining two adaptations – the general identity and personalized identity trainings – targeted implicit drinking identity associations, which are robust predictors of hazardous drinking in US undergraduates. Study 1 included 300 undergraduate social drinkers. They were randomly assigned to real or sham training conditions for one of the three training adaptations, and completed two training sessions, spaced one week apart. Study 2 included 288 undergraduates at risk for alcohol use disorders. The same training procedures were used, but the two training sessions occurred within a single week. Results were not as expected. Across both studies, the approach avoid training yielded no evidence of training effects on implicit alcohol associations or alcohol outcomes. The general identity training also yielded no evidence of training effects on implicit alcohol associations or alcohol outcomes with one exception; individuals who completed real training demonstrated no changes in drinking refusal self-efficacy whereas individuals who completed sham training had reductions in self-efficacy. Finally, across both studies, the personalized identity training yielded no evidence of training effects on implicit alcohol associations or alcohol outcomes. Despite having relatively large samples and using a well-validated training task, study results indicated all three training adaptations were ineffective at this dose in US undergraduates. These findings are important because training studies are costly and labor-intensive. Future research may benefit from focusing on more severe populations, pairing training with other interventions, increasing training dose, and increasing gamification of training tasks

Means, Standard Deviations, and Tests for Training Effects for Experimental and Control Groups in Study 2.

<p><i>Note</i>. Training effect refers to the results of the ANOVAs used to test for possible training effects (i.e., the results of the condition x time interactions for all variables other than cravings, alcohol and non-alcohol image preferences; for those variables, the results refer to condition main effect). Analyses for approach avoid training include AUDIT scores as a covariate; analyses for personalized identity include drinks per week as a covariate. Partial η² = SS _effect / (SS _effect + SS _error). Scores for the AAT and IAT are D scores with higher scores indicating greater bias. The AAT bias scores presented here are the baseline bias scores and the bias scores immediately following the second training session. Intentions = future drinking intentions or number of drinks participants expect to drink over the next week. Social Pressure, Opportunistic, Emotional Relief = drinking-related self-efficacy factors with higher scores indicating greater self-efficacy. Alcohol and Non-alc IP = alcohol and non-alcohol image preferences or the ratings of the images used in the AAT, higher scores = image being more appealing.</p><p>Means, Standard Deviations, and Tests for Training Effects for Experimental and Control Groups in Study 2.</p

Pain, cannabis use, and physical and mental health indicators among veterans and nonveterans: results from the National Epidemiologic Survey on Alcohol and Related Conditions-III

AbstractChronic pain is associated with mental and physical health difficulties and is prevalent among veterans. Cannabis has been put forth as a treatment for chronic pain, and changes in laws, attitudes, and use patterns have occurred over the past 2 decades. Differences in prevalence of nonmedical cannabis use and cannabis use disorder (CUD) were examined across 2 groups: veterans or nonveterans and those reporting or not reporting recent pain. Data from the National Epidemiologic Survey on Alcohol and Related Conditions-III (2012-2013; n = 36,309) were analyzed using logistic regression. Prevalence differences (PDs) for 3 cannabis outcomes (1) past-year nonmedical cannabis use, (2) frequent (≥3 times a week) nonmedical use, and (3) DSM-5 CUD were estimated for those reporting recent moderate to severe pain (veterans or nonveterans) and veterans reporting or not reporting recent pain. Difference in differences was calculated to investigate PDs on outcomes associated with residence in a state with medical cannabis laws (MCLs). Associations between physical and mental health and cannabis variables were tested. The results indicated that the prevalence of recent pain was greater among veterans (PD = 7.25%, 95% confidence interval (CI) [4.90-9.60]). Among veterans, the prevalence of frequent cannabis use was greater among those with pain (PD = 1.92%, 98% CI [0.21-3.63]), and among veterans residing in a state with MCLs, the prevalence of CUD was greater among those reporting recent pain (PD = 3.88%, 98% CI [0.36-7.39]). Findings failed to support the hypothesis that cannabis use improves mental or physical health for veterans with pain. Providers treating veterans with pain in MCL states should monitor such patients closely for CUD

Pain, cannabis use, and physical and mental health indicators among veterans and non-veterans

AbstractChronic pain is associated with mental and physical health difficulties and is prevalent among veterans. Cannabis has been put forth as a treatment for chronic pain, and changes in laws, attitudes, and use patterns have occurred over the past 2 decades. Differences in prevalence of nonmedical cannabis use and cannabis use disorder (CUD) were examined across 2 groups: veterans or nonveterans and those reporting or not reporting recent pain. Data from the National Epidemiologic Survey on Alcohol and Related Conditions-III (2012-2013; n = 36,309) were analyzed using logistic regression. Prevalence differences (PDs) for 3 cannabis outcomes (1) past-year nonmedical cannabis use, (2) frequent (≥3 times a week) nonmedical use, and (3) DSM-5 CUD were estimated for those reporting recent moderate to severe pain (veterans or nonveterans) and veterans reporting or not reporting recent pain. Difference in differences was calculated to investigate PDs on outcomes associated with residence in a state with medical cannabis laws (MCLs). Associations between physical and mental health and cannabis variables were tested. The results indicated that the prevalence of recent pain was greater among veterans (PD = 7.25%, 95% confidence interval (CI) [4.90-9.60]). Among veterans, the prevalence of frequent cannabis use was greater among those with pain (PD = 1.92%, 98% CI [0.21-3.63]), and among veterans residing in a state with MCLs, the prevalence of CUD was greater among those reporting recent pain (PD = 3.88%, 98% CI [0.36-7.39]). Findings failed to support the hypothesis that cannabis use improves mental or physical health for veterans with pain. Providers treating veterans with pain in MCL states should monitor such patients closely for CUD