A Test of Multisession Automatic Action Tendency Retraining to Reduce Alcohol Consumption Among Young Adults in the Context of a Human Laboratory Paradigm.

BACKGROUND: Young adult heavy drinking is an important public health concern. Current interventions have efficacy but with only modest effects, and thus, novel interventions are needed. In prior studies, heavy drinkers, including young adults, have demonstrated stronger automatically triggered approach tendencies to alcohol-related stimuli than lighter drinkers. Automatic action tendency retraining has been developed to correct this tendency and consequently reduce alcohol consumption. This study is the first to test multiple iterations of automatic action tendency retraining, followed by laboratory alcohol self-administration. METHODS: A total of 72 nontreatment-seeking, heavy drinking young adults ages 21 to 25 were randomized to automatic action tendency retraining or a control condition (i.e., sham training ). Of these, 69 (54% male) completed 4 iterations of retraining or the control condition over 5 days with an alcohol drinking session on Day 5. Self-administration was conducted according to a human laboratory paradigm designed to model individual differences in impaired control (i.e., difficulty adhering to limits on alcohol consumption). RESULTS: Automatic action tendency retraining was not associated with greater reduction in alcohol approach tendency or less alcohol self-administration than the control condition. The laboratory paradigm was probably sufficiently sensitive to detect an effect of an experimental manipulation given the range of self-administration behavior observed, both in terms of number of alcoholic and nonalcoholic drinks and measures of drinking topography. CONCLUSIONS: Automatic action tendency retraining was ineffective among heavy drinking young adults without motivation to change their drinking. Details of the retraining procedure may have contributed to the lack of a significant effect. Despite null primary findings, the impaired control laboratory paradigm is a valid laboratory-based measure of young adult alcohol consumption that provides the opportunity to observe drinking topography and self-administration of nonalcoholic beverages (i.e., protective behavioral strategies directly related to alcohol use)

Very brief, web-based interventions for reducing alcohol use and related problems among college students: A review

Very brief, web-based alcohol interventions have great potential due to their convenience, ease of dissemination, and college students’ stated preference for this intervention modality. To address the efficacy of these interventions, we conducted a review of the literature to identify randomized, controlled trials (RCTs). Fifteen published reports were included. All RCTs meeting criteria for inclusion tested an intervention that featured personalized feedback on students’ patterns of alcohol consumption. This review found some evidence to support the efficacy of very brief, web-based interventions among college students for alcohol use reduction. Several trials, however, reported no evidence of efficacy and it is possible that methodological limitations of some of the studies could have had an impact on their results. This review did not yield evidence to support the efficacy of very-brief, web-based interventions for reduction of alcohol-related problems among college students. We found evidence to support the efficacy of two main types of intervention content: (a) focused solely on personalized normative feedback designed to correct misconceptions about peer alcohol consumption and (b) multi-component interventions. Future research is needed to test enhancements to very brief, web-based interventions that feature personalized feedback on patterns of alcohol use and to determine for which types of college drinkers (e.g., heavier or lighter drinkers) these interventions are most efficacious. In addition, future studies are needed to test novel, very brief, web-based interventions featuring approaches other than personalized feedback. In summary, this review yielded some evidence supporting very brief, web-based interventions in reducing alcohol use but not related problems in college students. Very brief, web-based interventions are worth pursuing given their convenience, privacy and potential public health benefit

Predictors of Pretreatment Commitment to Abstinence: Results from the COMBINE Study

OBJECTIVE: Patients entering treatment for alcohol problems do not have uniform treatment goals, and a pretreatment drinking goal has a significant impact on treatment outcome. The objective of this study was to understand better how an array of individual characteristics, including factors that affect treatment, are related to treatment goals before beginning alcohol treatment in the COMBINE (Combining Medications and Behavioral Interventions) Study. METHOD: Participants were alcohol-dependent individuals (N = 1,156; 357 women) recruited at 11 outpatient academic alcoholism-treatment clinics across the United States to participate in a randomized, double-blind, placebo-controlled trial that combined behavioral intervention with acamprosate and/or naltrexone. Treatment goal was coded as controlled drinking, conditional abstinence, or total abstinence. Multinomial logistic regressions assessed whether there were significant relationships between predictor variables and pretreatment goal selection. RESULTS: Lower levels of alcohol-related consequences, lower readiness to change, higher family income, more daily drinkers in social network, and lack of prior treatment or Alcoholics Anonymous engagement predicted choice of a controlled drinking goal over a total abstinence goal. Fewer alcohol-related consequences, lower readiness to change, and more daily drinkers in-network predicted choice of a conditional abstinence goal over a total abstinence goal. CONCLUSIONS: Higher levels of functioning, lower levels of consequences, no prior involvement in treatment and Alcoholics Anonymous, and a more drinking-saturated social environment are associated with the choice of a non-abstinence goal

Randomized controlled trial of a very brief, multicomponent web-based alcohol intervention for undergraduates with a focus on protective behavioral strategies

Objective: THRIVE (Kypri et al., 2009; 2013; 2014), a very brief, freely-available, multi-component web-based alcohol intervention originally developed and tested among students in Australia and New Zealand, was tested in the United States. We also evaluated effects of systematically varying the protective behavioral strategies (PBS) component of the intervention to include shorter, focused lists of Direct (e.g., alternating alcoholic with non-alcoholic drinks) or Indirect (e.g., looking out for friends) strategies. Method: Undergraduates with past-month heavy drinking (N=208) were randomized to education/assessment Control or 1 of 3 US-THRIVE variants including Direct PBS only, Indirect PBS only, or Full (Direct and Indirect PBS). Results: After 1 month, compared to the Control condition, Full condition participants reported fewer drinks per week (rate ratio [RR]=.62) and lower peak drinking (RR=.74). The Indirect-only condition reported reduced peak drinking (RR=.74) and a trend toward fewer drinks per week (RR=.78). Changes in drinking relative to Control were significant through 6 months for the Full and Indirect-only conditions. There were no significant differences between the Direct-only and Control conditions. US-THRIVE was not associated with decreased heavy drinking or alcohol-related problems relative to Control. Conclusions: To our knowledge this was the first study to systematically vary the types of PBS provided in an intervention. Initial results suggest US-THRIVE is efficacious. Compared to Control, presenting Indirect PBS only as part of US-THRIVE was associated with lower drinks per week and peak past 30-day drinking. Targeting Indirect PBS may be more appropriate for non-treatment-seeking young adults receiving a brief intervention

Predictors of pretreatment commitment to abstinence: results from the COMBINE study.

ObjectivePatients entering treatment for alcohol problems do not have uniform treatment goals, and a pretreatment drinking goal has a significant impact on treatment outcome. The objective of this study was to understand better how an array of individual characteristics, including factors that affect treatment, are related to treatment goals before beginning alcohol treatment in the COMBINE (Combining Medications and Behavioral Interventions) Study.MethodParticipants were alcohol-dependent individuals (N = 1,156; 357 women) recruited at 11 outpatient academic alcoholism-treatment clinics across the United States to participate in a randomized, double-blind, placebo-controlled trial that combined behavioral intervention with acamprosate and/or naltrexone. Treatment goal was coded as controlled drinking, conditional abstinence, or total abstinence. Multinomial logistic regressions assessed whether there were significant relationships between predictor variables and pretreatment goal selection.ResultsLower levels of alcohol-related consequences, lower readiness to change, higher family income, more daily drinkers in social network, and lack of prior treatment or Alcoholics Anonymous engagement predicted choice of a controlled drinking goal over a total abstinence goal. Fewer alcohol-related consequences, lower readiness to change, and more daily drinkers in-network predicted choice of a conditional abstinence goal over a total abstinence goal.ConclusionsHigher levels of functioning, lower levels of consequences, no prior involvement in treatment and Alcoholics Anonymous, and a more drinking-saturated social environment are associated with the choice of a non-abstinence goal