Improving the Measurement of the Reinforcement Sensitivity Theory in Alcohol Misuse: Evidence from a New Laboratory Task

Gray’s revised Reinforcement Sensitivity Theory (RST) posits that the behavioural inhibition system (BIS) resolves motivational conflict by allocating resources for approach (behavioural activation system [BAS]) or avoidance (Fight/Flight/Freeze System [FFFS]). Persons with a strong BIS over-attend to threat, leading to elevated anxiety and behavioural ambivalence. The role of elevated BIS in alcohol use is complex, as anxiety may promote self-medication drinking, while attention to threat may be a protective factor. Theory and recent data suggests that a concurrent strong BAS makes the anxiolytic effects of alcohol more salient, biasing BIS conflict towards drinking. Existing laboratory tasks do not measure BIS as a conflict system and therefore, examinations of the complex interplay between the BIS and BAS for understanding alcohol use are limited. This study tested a new laboratory task [Motivational Flanker Task (MFT)] that better reflects the revised BIS and FFFS and used this new measure to test BAS as a moderator of the BIS-alcohol misuse relation. Undergraduates (N=150) completed self-reports of BAS/BIS/FFFS, and alcohol misuse, and completed the MFT and the Point Scoring Reaction Time Task (PSRTT). Results indicated that MFT measurement of BIS motivational conflict was consistent with self-report and PSRTT measures. MFT measurement of BAS (reward responsivity), but not FFFS (punishment sensitivity) was consistent with self-report measures. An elevated BIS was linked to alcohol misuse, but only at high BAS. These results demonstrate that the MFT is a promising measure of the revised BIS. Further, considering the joint effects of BIS and BAS clarified risk for alcohol misuse

Clarifying the revised Behavioural Inhibition System as a Risk Factor for Anxiety-Related Alcohol Misuse in Young Adulthood: New Insights from Experimental and Prospective Studies

ABSTRACT Clarifying the revised Behavioural Inhibition System as a Risk Factor for Anxiety-Related Alcohol Misuse in Young Adulthood: New Insights from Experimental and Prospective Studies Matthew Keough, Ph.D. Concordia University, 2016 Theoretical models posit that anxious persons drink alcohol to self-medicate negative emotions. However, existing data suggest that the anxiety pathway is complex. While there is high comorbidity of anxiety and alcohol use disorders in adults, evidence earlier in the risk trajectory (in young adulthood) is highly mixed. Gray’s Reinforcement Sensitivity Theory (RST) provides a useful framework for clarifying the anxiety-drinking pathway in young adults. The RST implicates the behavioural inhibition system (BIS) as a risk factor for alcohol misuse. Important theoretical revisions were made to the BIS 15 years ago, but these changes have been slow to enter the empirical literature. The revised BIS is a motivational conflict system. In response to competing goals (e.g., reward vs. punishment), the revised BIS inhibits behaviour, giving rise to high anxiety, attention to threat, and behavioural ambivalence. Accordingly, BIS-anxiety may promote self-medication drinking, while sensitivity to motivational conflict may lead to indecisiveness about drinking and attention to threat. Theory suggests that a strong Behavioural Approach System (BAS) should enhance the anxiolytic effects of alcohol use, which should be salient to those high in the BIS. However, few studies have been able to examine these interactive effects since most work has not tested the predictions of the revised RST. Using experimental (Study 1) and prospective (Study 2) studies, the primary aim of this dissertation was to clarify the BIS-related pathway to alcohol misuse among young adults. Study 1 (N = 110) was an experimental design that aimed to examine the cognitive mechanisms of this pathway. Results demonstrated that individuals with a strong BIS and a strong BAS expected elevated positive mood (rather than reduced anxiety) in response to an alcohol cue when feeling anxious. Study 2 (N = 119) sought to examine the BAS as a moderator of BIS-risk for alcohol misuse during the transition out of university. Findings indicated that those high in the BIS showed impeded maturing out of alcohol misuse during this transition if they were also strong in BAS impulsivity. Conversely, young adults with a strong BIS rapidly reduced alcohol misuse if they were concurrently low in BAS impulsivity. Overall, the moderating role of the BAS clarified BIS-risk for alcohol misuse. Findings shed light on the cognitive mechanisms underlying BIS-related drinking and provide a first look on how the BIS and the BAS interact to set the stage for long-term alcohol problems in young adulthood

Motivations for Participation in Physical Activity Across the Lifespan

This investigation explored motivations for engaging in physical activity and how they varied across the lifespan. A total of 1,885 individuals completed a comprehensive questionnaire concerning personal style, activity interests, motives for exercising, and biosocial information as part of an initiative to improve physical activity advisement and programming. The first part of the research called for an exploratory factor analysis (EFA) of a 20-item measure of both intrinsic and extrinsic motivations related to participation in exercise, while the second was based in an analysis of differences on the EFA factor scores across five age groups: teens, 20s, 30s, 40s, and 50s+. EFA results suggested a four-factor (oblique rotation) solution that appeared to provide an adequate and generalizable map of intrinsic and extrinsic motivations for exercise. The factors were labeled as follows: mental toughness, toned and fit, fun and friends, and stress reduction. Not surprisingly, mean scores on toned and fit were the highest of the four factor means across all age groups. Univariate ANOVAs of age group differences were statistically significant for each of the four factors; moreover, all four factors showed statistically significant linear trends. Two factors, toned and fit and stress reduction, revealed higher motivation scores with increasing age, while the remaining two, mental toughness and fun and friends, exhibited declining scores with increasing age. These findings taken in the context of previous research on age-related motivational differences offered insights into current challenges for enhancing exercise participation, particularly for older individuals

Solitary drinking is associated with specific alcohol problems in emerging adults

Hazardous drinking in emerging adulthood is associated with multiple domains of alcohol problems, which range in type and severity. Alcohol problems at the severe end of the spectrum (e.g., impaired control) may be early warning signs of alcohol use disorders (AUDs) among emerging adults. However, given the emphasis in the literature on predictors of overall problem risk, we still know very little about predictors of these specific (and severe) domains of alcohol problems in emerging adults. Many emerging adults drink at social events (e.g., parties), but an estimated 15% engage in solitary drinking. Solitary drinking – a developmentally atypical behavior in emerging adulthood – may be especially risky. Data suggests that frequent solitary drinking may reflect a loss of control over drinking, leading to hazardous use and subsequent problems. Accordingly, we expected that frequent solitary drinking among emerging adults would predict severe alcohol problems that map onto diagnostic criteria for AUDs and these effects would be mediated by hazardous alcohol use. Undergraduates (N = 118) completed self-report measures as a part of a larger study on motivation and alcohol use. As predicted, path analysis showed that solitary drinking positively predicted hazardous alcohol use, and this in turn predicted severe alcohol problems associated with diagnostic criteria for AUDs, particularly risky behaviors and blackout drinking. Solitary drinking also positively predicted less severe problems of diminished self-perception and poor self-care through hazardous use. Though comparatively smaller, some indirect effects were observed from social drinking (at parties, but not at bars) to alcohol problems, via hazardous alcohol use. Overall, our results suggest that solitary drinking is particularly harmful in emerging adulthood

Young adult concurrent use and simultaneous use of alcohol and marijuana: A cross-national examination among college students in seven countries

Introduction: Many young adults report frequent co-use of alcohol and marijuana, with some individuals engaging in simultaneous use (SAM; use of both substances within the same occasion resulting in an overlap of their effects) and others in concurrent use (CAM; use of both substances during a similar time period [e.g., past 30 days] but not within the same occasion). Emerging work demonstrates that SAM relative to CAM use places individuals at a greater risk for substance-related harms; however, these results primarily rely on U.S. samples. The goal of the present multi-country study was to examine prevalence rates of CAM and SAM use and examine differences in past 30-day SAM/CAM use on alcohol/marijuana substance-related outcomes among college students from seven countries. Methods: A total of 9171 (70.5% women; Mean age = 20.28, SD = 3.96) college students participated in the cross-sectional online survey study. Results: Among students who endorsed use of both alcohol and marijuana in the past 30-days (n = 2124), SAM use (75.8%) was far more prevalent than CAM use (24.2%). Moreover, ∼75% of students endorsed SAM use within each country subsample. Regression models showed that SAM vs. CAM use was associated with greater alcohol and marijuana use and negative consequences. Conclusions: College students from around the world endorse high rates of SAM use, and this pattern of co-use is associated with greater frequency of use and substance-related harms. On college campuses, SAM use should be a target of clinical prevention/intervention efforts and the mechanisms underpinning the unique harms of SAM need to be clarified.Fil: Bravo, Adrian J.. College of William and Mary; Estados UnidosFil: Prince, Mark A.. State University of Colorado at Boulder; Estados UnidosFil: Pilatti, Angelina. Universidad Nacional de Córdoba. Instituto de Investigaciones Psicológicas. - Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Investigaciones Psicológicas; ArgentinaFil: Mezquita, Laura. Universitat Jaume I; EspañaFil: Keough, Matthew T.. University of York; Reino UnidoFil: Hogarth, Lee. University of Exeter; Reino Unid

Examining co-patterns of depression and alcohol misuse in emerging adults following university graduation

Depression and alcohol use disorders are highly comorbid. Typically, alcohol use peaks in emerging adulthood (e.g., during university), and many people also develop depression at this time. Self-medication theory predicts that depressed emerging adults drink to reduce negative emotions. While research shows that depression predicts alcohol use and related problems in undergraduates, far less is known about the continuity of this association after university. Most emerging adults “mature out” of heavy drinking; however, some do not and go on to develop an alcohol use disorder. Depressed emerging adults may continue to drink heavily to cope with the stressful (e.g., remaining unemployed) transition out of university. Accordingly, using parallel process latent class growth modelling, we aimed to distinguish high- from low-risk groups of individuals based on joint patterns of depression and alcohol misuse following university graduation. Participants (N = 123) completed self-reports at three-month intervals for the year post-graduation. Results supported four classes: class 1: low stable depression and low decreasing alcohol misuse (n = 52), class 2: moderate stable depression and moderate stable alcohol misuse (n = 35), class 3: high stable depression and low stable alcohol misuse (n = 29), and class 4: high stable depression and high stable alcohol misuse (n = 8). Our findings show that the co-development of depression and alcohol misuse after university is not uniform. Most emerging adults in our sample continued to struggle with significant depressive symptoms after university, though only two classes continued to drink at moderate (class 2) and high (class 4) risk levels

Optimizing internet-delivered cognitive behaviour therapy for alcohol misuse—a randomized factorial trial examining effects of a pre-treatment assessment interview and guidance

Background: Internet-delivered cognitive behavioral therapy (ICBT) for alcohol misuse has potential to radically improve access to evidence-based care, and there is a need to investigate ways to optimize its delivery in clinical settings. Guidance from a clinician has previously been shown to improve drinking outcomes in ICBT, and some studies suggest that pre-treatment assessments may contribute in initiating early change. The objective of this study was to investigate the added and combined effects of a pre-treatment assessment interview and guidance on the outcomes of ICBT for alcohol misuse delivered in an online therapy clinic. Methods: A 2X2 factorial randomized controlled trial was conducted where participants received access to an 8-week ICBT program, and either a pre-treatment assessment interview (Factor 1), guidance (Factor 2), a combination of these, or neither of these. Participants were 270 individuals (66.8% female, mean age = 46.5) scoring 8 or more on the Alcohol Use Disorders Identification Test and consuming 14 standard drinks or more in the preceding week. Primary outcomes were number of drinks consumed and number of heavy drinking days during the preceding week, 3 months post-treatment. Results: Large within-group effects were found in terms of alcohol reductions (dw ≥ 0.82, p < 0.001), but neither of the factors significantly improved drinking outcomes. Guidance was associated with greater adherence (i.e. completed modules). Conclusions: Neither a pre-treatment assessment interview nor guidance from a clinician appears to improve drinking outcomes resulting from internet-delivered cognitive behaviour therapy for alcohol misuse when delivered in a routine online therapy clinic. Trial registration: NCT03984786. Registered 13 June 2019, https://clinicaltrials.gov/ct2/show/NCT03984786. Keywords: Alcohol; Assessment reactivity; Cognitive behavior therapy; Guidance; Internet; Treatmen

CANreduce 2.0 Adherence-Focused Guidance for Internet Self-Help Among Cannabis Users: Three-Arm Randomized Controlled Trial

Background: Despite increasing demand for treatment among cannabis users in many countries, most users are not in treatment. Internet-based self-help offers an alternative for those hesitant to seek face-to-face therapy, though low effectiveness and adherence issues often arise. Objective: Through adherence-focused guidance enhancement, we aimed to increase adherence to and the effectiveness of internet-based self-help among cannabis users. Methods: From July 2016 to May 2019, cannabis users (n=775; male: 406/575, 70.6%, female: 169/575, 29.4%; age: mean 28.3 years) not in treatment were recruited from the general population and were randomly assigned to (1) an adherence-focused guidance enhancement internet-based self-help intervention with social presence, (2) a similar intervention with an impersonal service team, and (3) access to internet as usual. Controls who were placed on a waiting list for the full intervention after 3 months underwent an assessment and had access to internet as usual. The primary outcome measurement was cannabis-use days over the preceding 30 days. Secondary outcomes included cannabis-dependence severity, changes in common mental disorder symptoms, and intervention adherence. Differences between the study arms in primary and secondary continuous outcome variables at baseline, posttreatment, and follow-up were tested using pooled linear models. Results: All groups exhibited reduced cannabis-use days after 3 months (social presence: -8.2 days; service team: -9.8 days; internet as usual: -4.2 days). The participants in the service team group (P=.01, d=.60) reported significantly fewer cannabis-use days than those in the internet as usual group; the reduction of cannabis use in the social presence group was not significant (P=.07, d=.40). There was no significant difference between the 2 intervention groups regarding cannabis-use reduction. The service team group also exhibited superior improvements in cannabis-use disorder, cannabis-dependence severity, and general anxiety symptoms after 3 months to those in the internet as usual group. Conclusions: The adherence-focused guidance enhancement internet-based self-help intervention with an impersonal service team significantly reduced cannabis use, cannabis-use disorder, dependence severity, and general anxiety symptoms. Trial registration: ISRCTN Registry ISRCTN11086185; http://www.isrctn.com/ISRCTN11086185. Keywords: adherence; cannabis; cognitive behavioral therapy; common mental disorders; drug abuse; guidance; internet; mental disorder; mental health; motivational interviewing; randomized controlled trial; self-help; social presence; therapy

Impulsivity moderates the effect of social anxiety on in-lab alcohol craving

Social anxiety (SA) is thought to relate to alcohol misuse. However, current evidence is inconsistent – especially in young adulthood. Recent non-experimental data show that trait impulsivity moderates the effect of SA on alcohol misuse. Specifically, this work suggests that concurrently elevated impulsivity may draw attention to the immediate, anxiolytic effects of drinking – thus promoting alcohol misuse among those high in SA. Otherwise, without elevated impulsivity, a socially anxious person may not drink due to focusing on alcohol's possible negative outcomes (e.g., embarrassing behaviours). The next step in this research is to examine if impulsivity impacts in-the-moment subjective craving among socially anxious individuals. This was the goal of the present experiment. After baseline measures, undergraduate participants (N = 110) completed the Trier Social Stress Test followed by an alcohol (versus neutral) cue exposure. Subjective craving ratings were collected at both baseline and post-cue exposure. Moderation analyses revealed that socially anxious individuals endorsed strong cravings following an alcohol (but not a neutral) cue exposure, but only if they also had elevated impulsivity. In-lab craving was positively correlated with retrospective reports of alcohol misuse. Our findings demonstrate that impulsivity contributes to SA-related risk for alcohol misuse