The Relationship Between Social Anxiety and Alcohol and Marijuana Use Outcomes Among Concurrent Users: A Motivational Model of Substance Use

Background: College students with more social anxiety symptoms are particularly vulnerable to problematic alcohol and marijuana use given their susceptibility for elevated anxiety symptoms in social settings combined with the normative nature of substance use. Existing research has established substance use as coping motivated for these students when examining alcohol and marijuana use problems separately. The next step is to determine whether students with more social anxiety who use both substances do so for similar or different reasons. The current study tested a comprehensive (i.e., all variables in the same model) motivational model of alcohol/marijuana use in a sample of college students from 10 universities across the United States who endorsed both past-month alcohol and marijuana use. Methods: College students were recruited through psychology department participant pools and completed an online survey assessing mental health symptoms, substance use motives, and substances use behaviors. Current sample comprised concurrent alcohol/marijuana users (n = 2,034), 29.6% of whom endorsed clinically indicated levels of social anxiety and nearly one-fourth exceeded the cutoff for hazardous drinking (23.2%) and hazardous marijuana use (21.9%). Results: Across both substances, coping motives significantly mediated the positive relationship between social anxiety symptoms and substance use problems. Unique to alcohol, conformity motives mediated the association between social anxiety symptoms and alcohol-related problems. Conclusions: Taken together, students with more social anxiety who are focused on anxiety management may use either alcohol or marijuana; however, these students may experience more alcohol-related problems when drinking to fit in with peers

College Student Mental Health: An Evaluation of the DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure

© 2018 American Psychological Association. The DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure was developed to aid in clinical decision-making for clients seeking psychiatric services and to facilitate empirical investigation of the dimensional nature of mental health issues. Preliminary evidence supports its utility with clinical samples. However, the brief, yet comprehensive structure of the DSM-5 Level 1 measure may benefit a high-risk population that is less likely to seek treatment. College students have high rates of hazardous substance use and co-occurring mental health symptoms, yet rarely seek treatment. Therefore, the current study evaluated the psychometric properties (i.e., construct and criterion-related validity) of the DSM-5 Level 1 measure with a large, diverse sample of non-treatment-seeking college/university students. Data from 7,217 college students recruited from 10 universities in 10 different states across the United States evidenced psychometric validation of the DSM-5 Level 1 measure. Specifically, we found acceptable internal consistency across multi-item DSM-5 domains and moderate to strong correlations among domains (internal validity). Further, several DSM-5 domains were positively associated with longer, validated measures of the same mental health construct and had similar strengths of associations with substance use outcomes compared to longer measures of the same construct (convergent validity). Finally, all DSM-5 domains were negatively associated with self-esteem and positively associated with other theoretically relevant constructs, such as posttraumatic stress (criterion-related validity). Taken together, the DSM-5 Level 1 measure appears to be a viable tool for evaluating psychopathology in college students. Several opportunities for clinical application and empirical investigation of the DSM-5 Level 1 measure are discussed

A Latent Profile Analysis of Social Anxiety and Alcohol Use Among College Students

Background The social, normative nature of alcohol use may make college students with social anxiety vulnerable to problematic alcohol use. Yet, social anxiety is typically unrelated to drinking quantity or frequency. One potential explanation is that researchers primarily use a variable-centered approach to examine alcohol use among students with social anxiety, which assumes population homogeneity. Methods The current study utilized a person-centered approach to identify distinct classes among 674 college students (69.6% female) based on social anxiety characteristics and alcohol use behaviors, and tested how these classes differed in their experience of adverse outcomes. Results Latent profile analysis resulted in six distinct classes of students – two classes with low levels of social anxiety and non-problematic drinking behaviors that differed based on frequency of alcohol use, three classes with moderate levels of social anxiety that differed based on quantity, frequency, and extent of problematic drinking behaviors, and one class with high levels of social anxiety and low, frequent problematic drinking behaviors. Two classes – moderate levels of social anxiety and heavy, problematic drinking behaviors or high levels of social anxiety and light, problematic drinking behaviors – appeared to have riskier profiles due to endorsing more social anxiety-specific beliefs about social impressions while drinking and more emotional distress. Conclusions Current findings offer clarity surrounding the role of alcohol use in the association between social anxiety and problematic alcohol use. Although preliminary, findings demonstrate that comorbid social anxiety and alcohol use disorder symptoms appear to place students at greater risk for adverse outcomes

Are There Social Benefits? Exploring the Role of Positive Consequences in the Relationship Between Social Anxiety Symptoms and Negative Drinking Consequences

Research has shown that college students with social anxiety experience more alcohol-related negative consequences, regardless of the amount of alcohol they consume. To better understand this relationship, it is important to examine social anxiety as a multidimensional construct, as well as explore the positive outcomes these students experience from drinking. The current study sought to examine the impact of positive drinking consequences on the relationship between behavioral (i.e. interaction and performance-type) and cognitive (i.e. fear of negative evaluation) social anxiety symptoms and alcohol-related negative consequences. Participants were 544 traditional age college students who reported consuming alcohol in the past month and completed measures of social anxiety symptoms, positive drinking consequences, and alcohol-related negative consequences. Positive drinking consequences moderated the relationship between social anxiety and alcohol-related negative consequences, such that students with more fear of negative evaluation and that experienced more positive drinking consequences reported more negative drinking consequences. Future directions and implications are discussed

Thinking While Drinking: Fear of Negative Evaluation Predicts Drinking Behaviors of Students With Social Anxiety

College students with social anxiety disorder experience more alcohol-related negative consequences, regardless of the amount of alcohol they consume. Social anxiety refers to psychological distress and physiological arousal in social situations due to an excessive fear of negative evaluation by others. The current study examined within-group differences in alcohol-related negative consequences of students who met or exceeded clinically-indicated social anxiety symptoms. In particular, we tested a sequential mediation model of the cognitive (i.e., fear of negative evaluation) and behavioral (protective behavioral strategies) mechanisms for the link between social anxiety disorder subtypes (i.e., interaction and performance-type) and alcohol-related negative consequences. Participants were 412 traditional-age college student drinkers who met or exceeded the clinically-indicated threshold for social anxiety disorder and completed measures of fear of negative evaluation, protective behavioral strategies (controlled consumption and serious harm reduction), and alcohol-related negative consequences. Fear of negative evaluation and serious harm reduction strategies sequentially accounted for the relationship between interaction social anxiety disorder and alcohol-related negative consequences, such that students with more severe interaction social anxiety symptoms reported more fear of negative evaluation, which was related to more serious harm reduction strategies, which predicted fewer alcohol-related negative consequences. Future directions and implications are discussed

Protective Behavioral Strategies and Hazardous Drinking Among College Students: The Moderating Role of Psychological Distress

There is increasing evidence that mental health problems may attenuate the relationship between protective behavioral strategies (PBS) and alcohol outcomes. However, psychological distress may also affect these relationships. Further, it appears that different types of PBS have differential relationships with alcohol outcomes. The current study examined the degree to which psychological distress moderated the associations PBS subtypes had with hazardous drinking and alcohol-related negative consequences. Participants were 632 traditional-age undergraduate students (M = 20.04, standard deviation = 1.48) who had consumed alcohol within the past 30 days and completed online self-report measures designed to assess PBS use, level of psychological distress, hazardous drinking patterns, and alcohol-related negative consequences. Serious harm reduction PBS were associated with less hazardous drinking and less alcohol-related negative consequences, and these associations were strengthened for those experiencing greater psychological distress. Controlled consumption PBS were associated with less hazardous drinking, but this association was not moderated by psychological distress. These findings highlight the potential benefit of teaching serious harm reduction PBS to college students experiencing elevated levels of psychological distress

Social Anxiety and Alcohol-Related Outcomes: The Mediating Role of Drinking Context and Protective Strategies

Purpose: Students with social anxiety are vulnerable to hazardous drinking patterns due to their social evaluative fears and tendency to perceive alcohol use as a socially-approved, normative behavior. These students do not drink as often as their peers, yet they experience more alcohol-related consequences. Thus, it is important to identify specific anxiety-provoking drinking contexts that trigger these students to engage in hazardous episodic drinking. These students are also less likely to seek treatment for mental health or substance use issues, pointing to the importance of examining their use of protective strategies, particularly in those anxiety-provoking contexts. Evidence supports the unique roles of drinking context and protective strategies as influencing the link between social anxiety and alcohol-related outcomes. Therefore, the current study tested the unique and synergistic effects of drinking context and protective strategies on the social anxiety-alcohol outcomes relationship. Materials and methods: Data from 678 traditional-aged college students were collected via measures assessing social anxiety symptoms, drinking contexts, and safe and risky drinking behaviors. Results: Mediation analyses indicated that negative coping drinking contexts and serious harm reduction protective strategies independently mediated the link between interaction social anxiety and hazardous drinking, and between social anxiety and alcohol-related consequences, respectively. Further, negative coping drinking contexts and serious harm reduction strategies sequentially mediated the positive association between interaction social anxiety and alcohol-related consequences. Conclusions: There appears to be a complex interplay of cognitive, social, and environmental factors making students with social interaction fears more susceptible to alcohol-related harm and less focused on using safe drinking strategies. Implications and directions for future research are outlined

The Status of SBIRT Training in Health Professions Education: A Cross-Discipline Review and Evaluation of SBIRT Curricula and Educational Research.

Purpose: To assess the quality of curricular research on the Screening Brief Intervention and Referral to Treatment (SBIRT) approach and determine the presence of useful training modalities, particularly motivational interviewing (MI) training, across health care training curricula. Method: The authors conducted a systematic review of published, peer-reviewed studies in PubMed, ERIC, CINAHL, Ovid HealthSTAR, and PsycINFO databases through March 2021 for English-language studies describing SBIRT, a curriculum for health care trainees, and curricular intervention outcomes. After the records were independently assessed, data were extracted and 20% of the studies were double-coded for interrater reliability. Results: Of 1,856 studies, 95 were included in the review; 22 had overlapping samples and were consolidated into 10 nested studies, leaving 83 total. Interrater reliability ranged from moderate (κ = .74, P \u3c .001) to strong (κ = .91, P \u3c .001) agreement. SBIRT training was delivered to trainees across many professions, including nursing (n = 34, 41%), medical residency (n = 28, 34%), and social work (n = 24, 29%). Nearly every study described SBIRT training methods (n = 80, 96%), and most reported training in MI (n = 54, 65%). On average, studies reported 4.06 (SD = 1.64) different SBIRT training methods and 3.31 (SD = 1.59) MI training methods. Their mean design score was 1.92 (SD = 0.84) and mean measurement score was 1.89 (SD = 1.05). A minority of studies measured SBIRT/MI skill (n = 23, 28%), and 4 studies (5%) set a priori benchmarks for their curricula. Conclusions: SBIRT training has been delivered to a wide range of health care trainees and often includes MI. Rigor scores for the studies were generally low due to limited research designs and infrequent use of objective skill measurement. Future work should include predefined training benchmarks and validated skills measurement

Motivational Interviewing Training of Substance Use Treatment Professionals: A Systematic Review

Background: Through evaluations of training programs, systematic reviews, and meta-analyses, advances in identifying best practices for disseminating motivational interviewing (MI) have emerged. To advance this work further, inclusion of thorough descriptions of the following is needed in research publications: study (design, trainee characteristics, setting characteristics), training and coaching methods (if applicable), trainer qualifications, and evaluation of MI skills. Methods: The purpose of this study was to systematically evaluate the research on MI training of substance use treatment professionals for the inclusion of such descriptions. Twenty-five studies were reviewed using a scoring rubric developed by the authors. Results: Just over two-thirds of the studies (68%) were randomized controlled trials of MI training. The majority of studies provided information about: a) trainee characteristics (professional background = 76%, education = 60%, experience = 56%); b) setting characteristics (80%); c) training methods (format = 96%, length = 92%); d) coaching (76%); and e) evaluation of MI skills (92%). Conclusion: Findings suggest advancements in MI training studies since previous reviews, especially in regards to the inclusion of feedback and coaching. However, this review also found that inconsistencies in methods and reporting of training characteristics, as well as limited follow-up assessment of trainee skill continue to limit knowledge of effective training methods

Screening for Alcohol Use Disorders In College Student Drinkers With the AUDIT and the USAUDIT: A Receiver Operating Characteristic Curve Analysis

Background: The Alcohol Use Disorders Identification Test (AUDIT) and its consumption subscale (AUDIT-C) are international gold standard screeners for identifying at-risk drinkers. Items have been modified to reflect United States low-risk drinking guidelines in the USAUDIT and USAUDIT-C, which also perform well in identifying at-risk drinkers. The USAUDIT may also be used to screen for potential AUD, an important first step to identify individuals needing diagnostic testing and treatment referrals. Objectives: The present study sought to evaluate the sensitivity and specificity of each measure in predicting potential AUDs via diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition in a college sample. Methods: Participants were 382 college student drinkers (Mage = 20.2, SD = 1.5; 68.7% female) who completed online surveys assessing alcohol use, at-risk drinking, and AUD symptom endorsement. Receiver operating curves provide optimal cutoff scores for each measure in overall, male, and female samples. Results: Results indicated the AUDIT and USAUDIT are equally superior in detecting potential AUD in the current sample. Recommended cutoff scores for detecting likely AUD with the USAUDIT are 12 for males (sensitivity = 62.0%, specificity = 86.6%) and 8 for females (sensitivity = 65.3%, specificity = 87.7%). Conclusions: Whereas prior work supports the USAUDIT-C in detecting at-risk drinking, the current study supports the AUDIT and USAUDIT in detecting potential AUD. Based on prior work, and in an effort to be consistent with standard US drinking guidelines, we recommend using the USAUDIT in screening and brief interventions across college campuses