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

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

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

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

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

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

Examining differential responses to the Take Care of Me trial: A latent class and moderation analysis

Given prevalent alcohol misuse-emotional comorbidities among young adults, we developed an internet-based integrated treatment called Take Care of Me. Although the treatment had an impact on several secondary outcomes, effects were not observed for the primary outcome. Therefore, the goal of the current study was to examine heterogeneity in treatment responses. The initial RCT randomized participants to either a treatment or psychoeducational control condition. We conducted an exploratory latent class analysis to distinguish individuals based on pre-treatment risk and then used moderated regressions to examine differential treatment responses based on class membership. We found evidence for three distinct groups. Most participants fell in the “low severity” group (n = 123), followed by the “moderate severity” group (n = 57) who had a higher likelihood of endorsing a previous mental health diagnosis and treatment and higher symptom severity than the low group. The “high severity” group (n = 42) endorsed a family history of alcoholism, and the highest symptom severity and executive dysfunction. Moderated regressions revealed significant class differences in treatment responses. In the treatment condition, high severity (relative to low) participants reported higher alcohol consumption and hazardous drinking and lower quality of life at follow-up, whereas moderate severity (relative to low) individuals had lower alcohol consumption at follow-up, and lower hazardous drinking at end-of-treatment. No class differences were found for participants in the control group. Higher risk individuals in the treatment condition had poorer responses to the program. Tailoring interventions to severity may be important to examine in future research

Interactive Effects of the BIS and the BAS on Trajectories of Alcohol Misuse after University Graduation

Reinforcement Sensitivity Theory predicts that those with a strong behavioral inhibition system (BIS) likely experience considerable anxiety and uncertainty during the transition out of university. Accordingly, they may continue to drink heavily to cope during this time (a period associated with normative reductions in heavy drinking), but only if they also have a strong behavioral approach system (BAS) to enhance the anxiolytic effects of drinking. The purpose of this study was to test this hypothesis. Participants completed online measures prior to and at 3-month intervals over the course of the year following graduation. As hypothesized, results showed that an elevated BIS predicted impeded maturing out, but only when the impulsivity facet of BAS was also elevated. In contrast, a strong BIS predicted rapid maturing out if BAS impulsivity was weak. Study findings advance our understanding of BIS-related alcohol misuse trajectories in young adulthood and provide direction for clinical interventions

Depression, Environmental Reward, Coping Motives and Alcohol Consumption During the COVID-19 Pandemic

Increases in the incidence of psychological distress and alcohol use during the COVID-19 pandemic have been predicted. Environmental reward and self-medication theories suggest that increased distress and greater social/environmental constraints during COVID-19 could result in increases in depression and drinking to cope with negative affect. The current study had two goals: (1) to clarify the presence and direction of changes in alcohol use and related outcomes after the introduction of COVID-19 social distancing requirements, and; (2) to test hypothesized mediation models to explain individual differences in alcohol use during the early weeks of the COVID-19 pandemic. Participants (n = 1127) were U.S. residents recruited for participation in an online survey. The survey included questions assessing environmental reward, depression, COVID-19-related distress, drinking motives, and alcohol use outcomes (alcohol use; drinking motives; alcohol demand, and solitary drinking). Outcomes were assessed for two timeframes: the 30 days prior to state-mandated social distancing (‘pre-social-distancing’), and the 30 days after the start of state-mandated social distancing (‘post-social-distancing’). Depression severity, coping motives, and frequency of solitary drinking were significantly greater post-social-distancing relative to pre-social-distancing. Conversely, environmental reward and other drinking motives (social, enhancement, and conformity) were significantly lower post-social distancing compared to pre-social-distancing. Time spent drinking and frequency of binge drinking were greater post-social-distancing compared to pre-social-distancing, whereas typical alcohol quantity/frequency were not significantly different between timeframes. Indices of alcohol demand were variable with regard to change. Mediation analyses suggested a significant indirect effects of reduced environmental reward with drinking quantity/frequency via increased depressive symptoms and coping motives, and a significant indirect effect of COVID-related distress with alcohol quantity/frequency via coping motives for drinking. Results provide early evidence regarding the relation of psychological distress with alcohol consumption and coping motives during the early weeks of the COVID-19 pandemic. Moreover, results largely converged with predictions from self-medication and environmental reinforcement theories. Future research will be needed to study prospective associations among these outcomes