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Exposure to trauma (particularly interpersonal trauma), post-traumatic stress disorder (PTSD) symptoms, and low distress tolerance (DT; the ability to tolerate negative internal states), are all related to risk for alcohol use disorders (AUD). The aim of this study was to examine the main and interactive effects of PTSD symptom severity and DT in relation to current (past 30-day) alcohol consumption and binge drinking among emerging adult men and women with a history of sexual/physical assault. Participants were 572 undergraduate students (66% women) with a history of physical/sexual assault endorsing past month alcohol use. Participants completed the Distress Tolerance Scale (DTS), the PTSD Checklist for DSM-V (PCL-5), and an abbreviated Timeline Followback Questionnaire (TLFB), which assessed past 30-day total alcohol consumption (i.e., total number of drinks) and binge drinking frequency (i.e., 5+ drinks [4+ for women]). Negative binomial regression analyses revealed that male sex, higher trauma load (i.e., total number of trauma categories endorsed), and higher PTSD symptom severity were associated with both higher number of total drinks and higher frequency of binge drinking episodes. However, DT was not associated with either alcohol outcome when PTSD symptom severity was entered in the models. The interaction of PTSD symptom severity and DT was not significantly associated with total alcohol consumption or binge drinking. These results highlight the importance of investigating the unique contributions of PTSD symptoms and DT (as well as other transdiagnostic cognitive-affective constructs) in the onset and maintenance of AUD.

PURPOSE: We assessed feasibility of the ethyl glucuronide biomarker (EtG) through nail sampling to measure alcohol use among youth living with HIV in the United States (YLWH, N=183); we also evaluated concordance between this EtG biomarker and self-reported measures of alcohol use, specifically, the Alcohol Timeline Followback (TFLB) and Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). METHODS: EtG, TFLB, and ASSIST were collected at 4-points over 1-year. At baseline and 52-weeks, 78.1% and 70.1% respectively, provided a valid (full or partial) sample. RESULTS: At 16-weeks, EtG was associated with ASSIST (r=0.25, p

BACKGROUND We sought to compare self-reported alcohol consumption using Timeline Followback (TLFB) to biomarker-based evidence of significant alcohol use (phosphatidylethanol [PEth] > 20 ng/ml). Using data from patients with HIV (PWH) entering a clinical trial, we asked whether TLFB could predict PEth > 20 ng/ml and assessed the magnitude of association between TLFB and PEth level. METHODS We defined unhealthy alcohol use as any alcohol use in the presence of liver disease, at-risk drinking, or alcohol use disorder. Self-reported alcohol use obtained from TLFB interview was assessed as mean number of drinks/day and number of heavy drinking days over the past 21 days. Dried blood spot samples for PEth were collected at the interview. We used logistic regression to predict PEth > 20 ng/ml and Spearman correlation to quantify the association with PEth, both as a function of TLFB. RESULTS Among 282 individuals (99% men) in the analytic sample, approximately two-thirds (69%) of individuals had PEth > 20 ng/ml. The proportion with PEth > 20 ng/ml increased with increasing levels of self-reported alcohol use; of the 190 patients with either at-risk drinking or alcohol use disorder based on self-report, 82% had PEth > 20 ng/ml. Discrimination was better with number of drinks per day than heavy drinking days (AUC: 0.80 [95% CI: 0.74 to 0.85] vs. 0.74 [95% CI: 0.68 to 0.80]). The number of drinks per day and PEth were significantly and positively correlated across all levels of alcohol use (Spearman's R ranged from 0.29 to 0.56, all p values

BACKGROUND: It is widely accepted that the therapeutic alliance (TA) is a mediator of psychotherapy effects, but evidence is sparse that the TA is an actual mechanism of behavior change. The purpose of this study was to provide the first systematic evidence regarding the TA as a mechanism of change in the treatment of alcohol use disorder (AUD). METHODS: Participants were 155 adult men and women presenting for individual outpatient treatment of AUD. Each was randomly assigned to one of 6 experienced therapists, who did or did not receive over 3 study phases post-session participant feedback on his/her ratings of the TA. All participants received a 12-session version of cognitive behavioral therapy for AUD. Participants rated the TA by use of the California Psychotherapy Alliance Scale (CALPAS) and reported their daily alcohol consumption between-sessions and for one year post-treatment by use of the Timeline Followback Interview. Multilevel statistical models that partitioned within- and between-participant effects and between-therapist effects were run to test the effects of feedback condition on the alliance and alcohol use, and the effects of the alliance on alcohol use. RESULTS: The study’s main hypotheses that feedback causes an enhanced therapeutic alliance, and that the alliance is associated with better alcohol use outcomes, were not supported. CONCLUSIONS: Several methodological and substantive reasons for the pattern of findings are suggested, as well as directions for future research that would advance study of the TA as a mechanism of change in psychotherapy and in studying therapist effects on outcomes in general.

Marijuana is the most widely used illicit substance in the United States, and its use is especially prevalent among young adults. Over the past two decades, there has been an overall decline in perceived harmfulness of marijuana use in young adults ages 18-30, despite growing evidence that chronic marijuana use may be associated with cognitive impairment. There have been mixed results regarding the effects of chronic marijuana use on inhibitory control. Furthermore, previous literature has shown inconsistent results regarding processing speed in marijuana users. The current study examined inhibitory control and processing speed in chronic marijuana-using young adult college students and healthy controls ages 18-22. 33 healthy controls (mean age: 19.18 ± 1.13; 18 male) and 28 chronic marijuana users (mean age: 20.25 ± 1.17; 19 male) were included in the study. Chronic marijuana users had to have used marijuana ≥5 times/week over the past year to be eligible. Participants were instructed to remain abstinent from marijuana use for 12 hours prior to the study visit. The 30-day Timeline Followback (TLFB) was used to assess recent marijuana use and participants were asked to estimate age at first marijuana use and lifetime days of marijuana use. Participants completed the Stroop Color Word Task (SCWT), and the interference t-score was used as a measure of inhibitory control. Furthermore, we examined marijuana use characteristics (i.e. age at first use, lifetime marijuana use, and past 30-day marijuana use) in relation to performance on the SCWT. Additionally, exploratory analyses investigated differences in the color and word conditions of the SCWT between the two groups and as a function of marijuana use characteristics. Results indicated no significant group differences on the interference, word, and color conditions of the SCWT. Furthermore, there were no significant correlations between age at first use, lifetime marijuana use, and past 30-day marijuana use with any conditions of the SCWT, but, there was a trend for greater past 30-day marijuana use to be associated with poorer performance on the color condition (r(26) = -0.26, p = 0.09). These findings indicate that chronic, heavy marijuana use may not be associated with impairments in inhibitory control or processing speed, which is consistent with other studies examining current use, heavy use, and chronic use in adolescents, young adults, and adults. Further research is needed to determine whether chronic, heavy marijuana use during young adulthood affects higher-order cognitive functioning skills needed for success in college, starting a career, and transitioning into adulthood.

BackgroundMethamphetamine has been consistently associated with positive psychotic symptoms, but little is known about whether the reverse also occurs.AimsThis study determined whether the relationship between methamphetamine use and positive psychotic symptoms is bidirectional over 12 months. The impact of lifetime psychotic disorders and methamphetamine dependence on these relationships was also examined.MethodA total of 201 regular (at least monthly) primary methamphetamine users were recruited from free needle and syringe programmes in three Australian cities. Data on the frequency of methamphetamine and other drug use (from Timeline Followback inteviews) and the severity of positive psychotic symptoms (using the Brief Psychiatric Rating Scale) in the past 2 weeks were collected in 12 contiguous monthly face-to-face interviews (mean of 9.14/11 (s.d. = 3.16) follow-ups completed). Diagnoses were derived using the Psychiatric Research Interview for DSM-IV Substance and Mental Disorders.ResultsThe mean age of participants was 31.71 years (s.d. = 8.19) and 39% (n = 77) were women. At baseline 55% (n = 110) were dependent on methamphetamine and 51% (n = 102) had a lifetime psychotic disorder. Cross-lagged dynamic panel models found a significant bidirectional relationship between psychotic symptoms and methamphetamine use (Comparative Fit Index (CFI) = 0.94, standardised root mean square residual (SRMR) = 0.05, root mean square error of approximation (RMSEA) = 0.05, 95% CI 0.04–0.06). The magnitude of the relationship in each direction was similar, and the presence of methamphetamine dependence or a lifetime psychotic disorder did not have an impact on results.ConclusionsA dynamic, bidirectional relationship between methamphetamine and psychotic symptoms of similar magnitude in each direction was found over 1 year. This suggests integrated treatments that target methamphetamine, psychotic symptoms and their interrelationship may be of most benefit.

Objective: Several studies suggest that alcohol and cannabis co-users are heavier drinkers and experience more alcohol-related consequences. However, day-level associations between co-use and drinking levels are mixed. One reason may be that individual characteristics moderate the daily impact of using alcohol alone or in conjunction with cannabis. The theory would suggest that highly impulsive individuals may drink more on co-use days, yet this assertion remains untested. Therefore, the current study tested whether impulsivity moderated the effect of co-use on same-day drinking quantity within veterans, a high-risk sample for substance use and impulsivity. Method: In a longitudinal observational study, co-using veterans (N = 139) completed three semi-annual assessments reporting on their daily drinking quantity and cannabis use via Timeline Followback (Observations = 19,245) and impulsivity via the UPPS-P. Mixed effect modeling was used to test hypotheses that co-use (compared to alcohol-only) days would be associated with heavier drinking for those high (but not low) in positive and negative urgency. Results: Significant interactions were found for positive urgency (PU) and lack of perseverance (LP), such that individuals at mean and low levels of PU and LP drank less on co-use (compared to alcohol-only) days. There were no significant interactions for other UPPS-P impulsivity facets. Conclusion: Findings are consistent with a substitution/compensatory effect for individuals at mean and low levels of both UPPS-P facets, and may be a byproduct of frequent cannabis use in veterans. In contrast, findings suggest that co-use and alcohol-only days may be characterized by similarly high levels of drinking for highly impulsive individuals. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The timeline followback (TLFB) takes more resources to collect than the Alcohol Use Disorder Identification Test (AUDIT-C). We assessed agreement of TLFB and AUDIT-C with the biomarker phosphatidylethanol (PEth) and compared changes in TLFB and PEth among persons with HIV (PWH) using secondary data from randomized trials. We calculated operating characteristics and agreement between TLFB (> 1 and > 2 average drinks/day), AUDIT-C ≥ 4 and PEth ≥ 20 among 275 men with HIV. Median age was 57 years, 80% were African-American; and 17% white. Sixty-eight percent had PEth ≥ 20, 46% reported > 2 average drinks/day on TLFB, 61% reported > 1 average drinks/day on TLFB, and 72% had an AUDIT-C ≥ 4. Relative to PEth, sensitivity for AUDIT-C ≥ 4 was 84% (kappa = 0.36), and for TLFB > 1 average drink/day was 76% (kappa = 0.44). Change in alcohol use appeared greater using TLFB measures than PEth. Strategies to robustly assess alcohol use in PWH may require both self-report and biomarkers.

Background: Khat (Catha edulis) is a traditionally used substance in African and Arab countries that contains the amphetamine-like alkaloid cathinone. Khat use among Ethiopian students is a growing concern. This study aims to describe khat use, psychological problems, and motivation to change and to determine associated factors of khat use among students from Jimma University seeking psychological assistance.Methods: In a cross-sectional study, a sample of 717 students from Jimma University, southwestern Ethiopia, who seek assistance to reduce khat use were recruited. The study used Amharic and Afaan Oromoo language versions of common psychological instruments and employed them as part of a comprehensive tablet computer-delivered self-report assessment battery, comprising the SRQ-20, the PCL-5, the LEC-5, the AUDIT, and the SOCRATES-khat. In addition, socio-demographic, economic variables, and functioning problems due to severe mental disorders were assessed. The analysis relied on the data of the 575 included participants and used clinical cut-off values to describe this treatment-seeking sample and hierarchical regression models to determine variables associated with khat use.Results: The sample showed high khat use in the past month (M = 31.55 bundles, SD = 28.53, on M = 15.11 days, SD = 8.54); 17.0% showed highly problematic use. The sample was extremely burdened with comorbid psychiatric problems: 21.6% reported functioning problems due to past mental disorders, 60.2% scored above the cut-off for current common mental disorders, 37.9% screened positive for PTSD, and 47.1% reported hazardous alcohol use. Small to medium intercorrelations between variables were detected, and in hierarchical regression models, higher motivation to change khat use was associated with higher use of the substance.Conclusions: This study clearly shows the need to develop research instruments, screening methods, and assistance services for khat-using students at Jimma University. Study participants' high mental health burden shows the need for targeted intervention programs that go beyond brief interventions for khat use. Furthermore, the study highlights challenges for implementing such services: the barriers to utilization for females and khat users without comorbid mental health problems.

Background: Daily diary studies have shown that caffeinated alcoholic beverages (CABs) are associated with more risk than consuming alcohol alone; however, daily diary studies are time intensive. T...

Background A hyper-engaged habit system may be common in alcohol use disorders (AUDs). Regarding drinking patterns, habit may be expressed as higher levels of drinking autoregression, where previous day drinking is correlated with next day drinking. This study utilized dynamic structural equation models (DSEM) with intensive longitudinal data to understand whether alcohol habit relates to drinking autoregression and variable levels of alcohol consumption. Methods Participants were adult drinkers (N=313) who completed baseline self-report assessments of past 30-day alcohol consumption and alcohol habit. Alcohol habit was measured by the Self Report Habit Index (SRHI). Thirty-day coding of the Timeline FollowBack assessed total daily drinking and any daily heavy drinking. Results The DSEM model for daily drinking found a weak but significant autoregressive data structure. Alcohol habit was related to increased mean drinking but did not strengthen the autoregressive effect of drinks per day. Higher alcohol habit was associated with higher levels of drinks per day person-specific variability. This pattern was replicated with the DSEM model for heavy drinking. Alcohol habit did not impact the autoregressive effect of heavy drinking but was associated with higher levels of heavy drinking. Conclusions While both drinks per day and heavy drinking showed a significant autoregressive structure, evidence of alcohol habit did not strengthen this effect. Alcohol habit did impact drinking variability; higher alcohol habit is associated with greater levels of drinking variability and higher mean drinking. Strategies to regulate drinking variability, including heavier drinking occasions, could target AUD habit.

BackgroundHeavy drinking among people living with HIV (PLWH) worsens their health outcomes and disrupts their continuum of care. Brief interventions to reduce heavy drinking in primary care are effective, but in heavy-drinking PLWH, more extensive intervention may be needed. Lengthy interventions are not feasible in most HIV primary care settings, and patients seldom follow referrals to outside treatment. Utilizing visual and video features of smartphone technology, we developed the “HealthCall” app to provide continued engagement after brief intervention, in order to reduce drinking and improve other aspects of HIV care while making minimal demands on providers.MethodsAlcohol-dependent patients at a large urban HIV clinic were randomized to one of three groups: (1) Motivational Interviewing (MI) plus HealthCall (n=39), (2) NIAAA Clinician’s Guide (CG) plus HealthCall (n=38), or (3) CG-only (n=37). Baseline drinking-reduction interventions were ∼25 minutes, with brief (10-15 min) check-in sessions at 30 and 60 days. HealthCall involved daily use of the smartphone for 3-5 min/day, covering drinking and other aspects of the prior 24 hours. Outcomes assessed at 30 and 60 days, and 3, 6 and 12 months, included drinks per drinking day, drinks per day, and days drank, using the Timeline Followback. Analysis were conducted using generalized linear mixed models with pre-planned contrasts.ResultsStudy retention was excellent (85%-94% across timepoints) and unrelated to treatment arm or patient characteristics. During treatment, patients in MI+HealthCall drank less than others (p=0.07-0.003). However, at 6 and 12 months, drinking was lowest among patients who had been in CG+HealthCall (p=0.04-0.06).ConclusionDuring treatment, patients in MI+HealthCall drank less than patients in the CG conditions. However, at 6 and 12 months, drinking was lower among patients in CG+HealthCall. Given the importance of drinking reduction and the low costs and time required for HealthCall, pairing HealthCall with brief interventions within HIV clinics merits widespread consideration.

BACKGROUND Alcohol contributes to numerous annual deaths and various societal problems not just in adult, but also in adolescent, populations. Therefore, it is vital to find methods for reliably detecting alcohol use for early preventative measures. Research has shown phosphatidylethanol (PEth) to be superior to self-report instruments and indirect biomarkers for alcohol consumption in adult populations. However, the transferability onto an adolescent population has not yet been investigated. METHODS N = 106 adolescents and young adults aged between 13 and 21 years were included. PEth analysis using high-pressure liquid chromatography-tandem mass spectrometry was performed on dried blood spot samples. Self-report questionnaires for alcohol consumption (Alcohol Use Disorders Identification Test-Consumption, AUDIT-C, and Timeline Followback, TLFB) and drug and alcohol consumption (Detection of Alcohol and Drug Problems in Adolescents, DEP-ADO) were completed by each participant. RESULTS AUDIT-C scores showed large correlations with PEth 16:0/18:1 (rs = 0.732) and PEth 16:0/18:2 (rs = 0.661) concentrations. AUDIT-C with a cutoff value ≥3 was largely correlated with PEth 16:0/18:1 (η = 0.411) and showed a medium-sized correlation with PEth 16:0/18:2 (η = 0.397) concentrations. Using an AUDIT-C cutoff value ≥5 showed large correlations with both PEth 16:0/18:1 (η = 0.510) and PEth 16:0/18:2 (η = 0.497) concentrations, respectively. ROC curves indicated higher PEth concentrations are a good model for detecting positive AUDIT-C cutoff values (AUROC range: 0.800 to 0.849). PEth concentrations showed medium to large correlations with DEP-ADO and TLFB subscales (range rs = 0.469 to 0.746). CONCLUSION The results suggest that PEth is a reliable and objective marker for quantifying alcohol consumption in adolescents and young adults. This could be of importance for early preventative measures against hazardous alcohol consumption, which is increasingly common at younger ages.

OBJECTIVE: The aim of this study was to compare data on both alcohol use and alcohol-related consequences between intensive longitudinal data collection and the retrospective Timeline Followback (TLFB) interview. METHOD: Heavy drinking college students (n = 96; 52% women) completed daily reports across a 28-day period to assess alcohol use and positive and negative consequences of drinking. They returned to the lab at the end of this period to complete a TLFB assessing behavior over those same 28 days. First, t tests were used to compare variables aggregated across the full 28 days at the between-person level. Next, hierarchical linear modeling was used to examine within-person differences between methods for each variable in weekly and daily increments. RESULTS: Many alcohol use and consequence variables were significantly different when derived from self-reports during TLFB versus daily reports. In contrast to prior work, we found that higher estimates of drinking were reported retrospectively on the TLFB than on the daily reports. In addition, discrepancies were greater on some variables for heavier drinkers and when more time had elapsed between the end of the daily reporting period and TLFB collection. CONCLUSIONS: Recall of drinking behavior during TLFB and daily reports may differ in systematic ways, with discrepancies varying based on participant and methodological characteristics.

Objectives The Timeline Followback (TLFB) was originally developed to assess alcohol consumption patterns (American Journal of Public Health, 86, 1996, 966) and has been increasingly modified for Web‐based use. Additionally, new modes of substance use administration have emerged, creating a need for an adaptable TLFB tool than can capture data such as cannabis product potency or prescription drug use. Our goal was to validate an online TLFB that reliably assesses a wide range of substances in greater detail. Methods Using a within‐subjects counterbalanced design, daily substance use data were collected from 50 college students over a 14‐day retrospective period using both the traditional in‐person TLFB and online TLFB (O‐TLFB). Results All substance use variables, including detailed measures of cannabis metrics, correlated significantly (r's ranged from .653 to .944, p, Using a within‐subjects counterbalanced design, a new online Timeline Followback (TLFB) tool was validated against the in‐person TLFB and other measures of substance use. Substance use variables, including detailed measures of cannabis metrics, correlated significantly between TLFB versions, suggesting the new online TLFB is an accessible, versatile, and secure tool for substance use assessment that is relevant to a variety of biomedical and psychological research contexts.

Background There are two main categories of retrospective self-report alcohol consumption measures: summary and daily drinking. Time-efficient summary measures have been criticized for being less able to capture sporadic and unpatterned drinking. A novel retrospective summary measure, the Typical and Atypical Drinking Diary (TADD), may produce more precise estimates of alcohol consumption than the gold-standard daily measure, the Timeline Followback (TLFB). Objective To establish how accurately the TADD and TLFB retrospectively capture alcohol consumption compared to the Daily Drinking Diary (DDD) method. Method Forty-three university undergraduates (77% female) concurrently recorded their daily alcohol consumption for 28 consecutive days using daily drinking diaries. Participants then retrospectively estimated their alcohol consumption using both the TADD and TLFB 28 days following completion of the 28-day daily consumption period. Results When compared against the drinking data obtained from the DDD method, the TADD consistently produced accurate retrospective estimates of total alcohol consumption, number of drinking days, and number of heavy drinking episodes. Contrariwise, the TLFB significantly underestimated all aspects of drinking. Underreporting on the TLFB was hypothesized to be associated with social desirability bias. Conclusion The TADD is a valid and reliable instrument for retrospectively measuring alcohol consumption and drinking variability in the university student population.

Background Functional measures indicating lower drinking problem severity predict stable low-risk drinking outcomes of recovery attempts, but findings for drinking practices are mixed. Because low-risk drinking outcomes are more common in natural than treatment-assisted recovery attempts, five studies of natural recovery attempts were integrated. Multiple dimensions of drinking practices during the year before recovery initiation were evaluated as predictors of post-recovery drinking (continuous abstinence, stable low-risk drinking, or unstable recovery involving relapse). Methods Community-dwelling problem drinkers (N = 616, 68% male, mean age = 46.5 years) were enrolled soon after stopping alcohol misuse and followed prospectively for one year. A Timeline Followback interview assessed daily drinking during the year before recovery initiation and yielded four dimensions for analysis: frequency of heavy drinking days (4+/5+ drinks for females/males), mean ethanol consumption per drinking day, variability in days between heavy drinking days, and variability in ethanol consumed per drinking day. Results Multinomial logistic regression models showed that variability in ethanol consumed per drinking day was the sole significant predictor of 1-year outcomes when all dimensions were evaluated together. The low-risk drinker group showed less fluctuation in quantities consumed on pre-recovery drinking days compared to the groups that abstained or relapsed (ps Conclusions Even when drinking heavily, problem drinkers who maintained low-risk drinking recoveries limited their quantities consumed within a relatively narrow range, a pattern they maintained post-recovery at much lower consumption levels. Assessing variability in quantities consumed may aid drinking goal selection.

Background Prompted by the ongoing debate regarding whether cannabis serves as a complement to or substitute for alcohol, this study uses prospective data to examine daily associations between medicinal versus recreational cannabis and alcohol use in veterans. Methods Three semi-annual waves of Timeline Followback Interview data were collected from a sample of veterans who reported co-using alcohol and cannabis on at least one day (N = 115; 56% medicinal users; 93% male; 62,100 observations). Linear mixed effects models were used to examine the association between daily cannabis use and number of drinks consumed across time for both medicinal and recreational users and to examine the frequency medicinal cannabis used to substitute for alcohol. Results Compared to medicinal users, recreational users were more likely to drink more on cannabis use days relative to non-use days. Among medicinal users, those endorsing more frequent use of cannabis as a substitute for alcohol reported fewer number of drinks consumed on days when cannabis was used relative to non-use days. Conclusions Among veterans, recreational users are at greater risk for increased drinking when co-using cannabis at the daily level, an association that is stable over time. Medicinal users may be at lower risk for increased drinking on days when cannabis is also used, especially those who endorse using cannabis to substitute for alcohol. Findings help clarify the debate on cannabis-alcohol substitution or complementary associations in a sample of veterans and suggests that alcohol interventions should address cannabis use as a risk factor, especially for recreational users.

BACKGROUND Timeline Followback (TLFB) interview methods are used to assess a variety of health behaviors, including alcohol use, drug use, and sexual behavior. While several online TLFBs have been developed, most focus on single behaviors, and few studies have explored their validity in assessing multiple risk behaviors using a single online TLFB. OBJECTIVE To examine the validity of a customizable web application (Timeline) for assessing alcohol use, drug use, and sexual behavior among high-risk men who have sex with men. METHODS Participants (N = 15 men) completed standardized survey instruments before undergoing a 30-day daily diary procedure where they submitted daily reports of health risk behaviors via smartphone. They then completed a Timeline at the end of the 30-day period covering the same time interval. RESULTS Comparing a baseline administration of Timeline with popular surveys of health risk behaviors supported Timeline's validity (r = 0.41-0.59 for alcohol use, r = 0.83 for drug use, and r = 0.34-0.52) for sexual behaviors. While participants reported similar amounts of each behavior via daily diary as they did on a follow-up Timeline (r = 0.55-0.88 for alcohol use, r = 0.69 for drug use, and r = 0.87-0.92 for sexual behaviors), results provided evidence of underreporting on the Timeline. Timing of behaviors also frequently disagreed across these methods. CONCLUSIONS Timeline is valid for assessing overall engagement in alcohol use, drug use, and sexual behavior over a 30-day window. However, researchers interested in the specific timing of behaviors within assessment intervals should use smaller follow-up intervals (e.g., 7 days, 14 days) or more intensive reporting methods (e.g., daily diary).

Background Quantifying cannabis use is complex due to a lack of a standardized packaging system that contains specified amounts of constituents. A laboratory procedure has been developed for estimating physical quantity of cannabis use by utilizing a surrogate substance to represent cannabis, and weighing the amount of the surrogate to determine typical use in grams. Method This secondary analysis utilized data from a multi-site, randomized, controlled pharmacological trial for adult cannabis use disorder (N = 300), sponsored by the National Drug Abuse Treatment Clinical Trials Network, to test the incremental validity of this procedure. In conjunction with the Timeline Followback, this physical scale-based procedure was used to determine whether average grams per cannabis administration predicted urine cannabinoid levels (11-nor-9-carboxy-Δ9-tetrahydrocannabinol) and problems due to use, after accounting for self-reported number of days used (in the past 30 days) and number of administrations per day in a 12-week clinical trial for cannabis use disorder. Results Likelihood ratio tests suggest that model fit was significantly improved when grams per administration and relevant interactions were included in the model predicting urine cannabinoid level (X2 = 98.3; p Conclusions This study provides support for the use of a scale-based method for quantifying cannabis use in grams. This methodology may be useful when precise quantification is necessary (e.g., measuring reduction in use in a clinical trial).

Background The current study examined correlates of cognitive insight in people enrolled in a methamphetamine pharmacotherapy trial; whether cognitive insight at the start of the trial predicted medication adherence and reductions in methamphetamine use during the trial; and, whether insight would remain stable over the trial or improve with reductions in methamphetamine use. Methods A subset of people enrolled in a 12-week randomised placebo-controlled pharmacotherapy trial for methamphetamine dependence completed the Beck Cognitive Insight Scale, comprising subscales for Self-Reflection and Self-Certainty, at baseline (n = 152) and at week 12 (n = 79). Medication adherence was expressed as the percentage of non-missed doses measured using eCAP™ technology. Methamphetamine use days were assessed using the Timeline Followback. Results At baseline, greater Self-Reflection was correlated with more severe methamphetamine withdrawal, and hostility, whereas Self-Certainty was correlated with less education and longer duration of methamphetamine use. No relationship was found between BCIS subscales at baseline and medication adherence (Self-Reflection b[SE] = −0.73 [0.43] p = .09; Self-Certainty b[SE] = −0.31 [0.48] p = .52,). Neither BCIS subscale was predictive of reduced methamphetamine use at 12 weeks (Self-Reflection b[SE] = 0.001 [0.01] p = .95 Self-Certainty b[SE] = −0.003 [0.01], p = .74). Self-Reflection decreased over the trial (t = 3.42, p = .001) but this was unrelated to change in methamphetamine use (Self-Reflection, b[SE] = −1.68 [1.16] p = .15) Change in methamphetamine use was found to be a significant predictor of Self-Certainty at 12 weeks (b [SE] = −2.71 [1.16] p = .02). Conclusions We found no evidence that cognitive insight predicted medication adherence or methamphetamine reduction in people engaged in this trial. Ongoing or increased methamphetamine use predicted increased Self-Certainty at 12 weeks.

Prenatal alcohol exposure (PAE) has been linked to poor pregnancy outcomes, yet there is no recognized standard for PAE assessment, and the specific effects of quantity, frequency, and timing remain largely unknown. The Safe Passage Study was designed to investigate the role of PAE in a continuum of poor peri- and postnatal outcomes. The objective of this manuscript is to describe the rationale for, and feasibility of, modifications to the traditional Timeline Followback (TLFB) for collecting PAE information in a large cohort of pregnant women. Participants from the Northern Plains region (in the United States) and Cape Town, South Africa, were followed prospectively using a modified 30-day TLFB interview, administered up to five times, to obtain detailed PAE information. Required modifications for our population included capturing information regarding sharing, type/brand, container size, and duration, in order to accurately record the amount of alcohol consumed. PAE status was defined for 99.9% of the 11,892 enrolled pregnancies at least once during pregnancy and for 92% across all trimesters. Of 53,823 drinks reported, 98% had all items necessary for standard drink computation. Sharing was reported for 74% of drinks in Cape Town, South Africa and for 10% in the Northern Plains. Compared to referent values from the traditional TLFB, 74% and 67% of drinks had different alcohol-by-volume and container size, respectively. Furthermore, a statistically significant difference was found between the number of containers reported and the number of standard drinks computed, using information from the modified TLFB. This is the first study of this size to wholly encompass all of these changes into a single measure in order to more accurately calculate daily consumption and assess patterns over time. The methods used to collect PAE information and create alcohol exposure measures likely increased the accuracy of standard drinks reported and could be generalized to other populations.

Dating abuse is a prevalent and consequential public health problem. However, relatively few studies have compared methods of collecting self-report data on dating abuse perpetration. This study compares two data collection methods—(a) the Timeline Followback (TLFB) retrospective reporting method, which makes use of a written calendar to prompt respondents’ recall, and (b) an interactive voice response (IVR) system, which is a prospective telephone-based database system that necessitates respondents calling in and entering data using their telephone keypads. We collected 84 days of data on young adult dating abuse perpetration using IVR from a total of 60 respondents. Of these respondents, 41 (68%) completed a TLFB retrospective report pertaining to the same 84-day period after that time period had ended. A greater number of more severe dating abuse perpetration events were reported via the IVR system. Participants who reported any dating abuse perpetration were more likely to report more frequent abuse perpetration via the IVR than the TLFB (i.e., may have minimized the number of times they perpetrated dating abuse on the TLFB). The TLFB method did not result in a tapering off of reported events past the first week as it has in prior studies, but the IVR method did result in a tapering off of reported events after approximately the sixth week. We conclude that using an IVR system for self-reports of dating abuse perpetration may not have substantial advantages over using a TLFB method, but researchers’ choice of mode may vary by research question, resources, sample, and setting.

Although tobacco (TOB) and marijuana (MJ) are often co-used in pregnancy, little is known regarding the joint impact of MJ + TOB on offspring development, including the developing neuroendocrine stress system. Further, despite evidence for sex-specific impacts of prenatal exposures in preclinical models, the sex-specific impact of prenatal MJ + TOB exposure on offspring neuroendocrine regulation in humans is also unknown. In the current study, overall and sex-specific influences of MJ + TOB co-use on offspring cortisol regulation were investigated over the first postnatal month. 111 mother-infant pairs from a low-income, racially and ethnically diverse sample participated. Based on Timeline Followback data with biochemical verification, three groups were identified: (1) prenatal MJ + TOB, (2) TOB only, and (3) controls. Baseline cortisol and cortisol stress response were assessed at seven points over the first postnatal month using a handling paradigm in which saliva cortisol was assessed before, during, and following a standard neurobehavioral assessment (NICU Network Neurobehavioral Scale). A significant exposure group by offspring sex interaction emerged for baseline cortisol over the first postnatal month (p = .043); MJ + TOB-exposed males showed 35-36% attenuation of baseline cortisol levels vs. unexposed and TOB-exposed males (ps ≤ .003), while no effects of exposure emerged for females. Both MJ + TOB and TOB-exposed infants showed a 22% attenuation of cortisol stress response over the first postnatal month vs. unexposed infants (ps .03), with evidence for sex-specific effects in exploratory analyses. Although results are preliminary, this is the first human study to investigate the impact of prenatal MJ exposure on infant cortisol and the first to reveal a sex-specific impact of prenatal MJ + TOB on cortisol regulation in humans. Future, larger-scale studies are needed to elucidate mechanisms and consequences of sex-specific effects of MJ and MJ + TOB on the developing neuroendocrine stress system.

This study investigates the level of agreement between problem gamblers and their concerned significant others (CSOs) regarding the amount of money lost when gambling. Reported losses were analyzed from 266 participants (133 dyads) seeking treatment, which included different types of CSO-gambler dyads. The intraclass correlation coefficients (ICCs) concerning the money lost when gambling during the last 30 days were calculated based on the timeline followback. In order to model reports that were highly skewed and included zeros, a two-part generalized linear mixed-effects model was used. The results were compared from models assuming either a Gaussian, two-part gamma, or two-part lognormal response distribution. Overall, the results indicated a fair level of agreement, ICC = .57, 95% CI (.48, .64), between the gamblers and their CSOs. The partner CSOs tended to exhibit better agreement than the parent CSOs with regard to the amount of money lost, ICCdiff = .20, 95% CI (.03, .39). The difference became smaller and inconclusive when reports of no losses (zeros) were included, ICCdiff = .16, 95% CI (- .05, .36). A small simulation investigation indicated that the two-part model worked well under assumptions related to this study, and further, that calculating the ICCs under normal assumptions led to incorrect conclusions regarding the level of agreement for skewed reports (such as gambling losses). For gambling losses, the normal assumption is unlikely to hold and ICCs based on this assumption are likely to be highly unreliable. Funding Agencies|Svenska Spels Independent Research Council [2013-0015]

Electronic cigarettes (e-cigs) are a nicotine delivery device that have recently been linked to alcohol use. Many individuals that smoke cigarettes transition to e-cigs as an alternative to cigarette use, despite potential negative health effects of e-cigs. No research to date has examined how former smokers that have transitioned to e-cigs differ from former smokers that do not use e-cigs, particularly in relation to alcohol use. Further, no research has examined how former smokers that use e-cigs regularly or socially may differ in alcohol consumption.Using an online community dwelling sample (Former smokers N = 198, mean age = 34.70, SD = 11.45, 56.1% female, 78.3% Caucasian, 37.9% e-cig users), the present study assessed smoking status and alcohol use, with the latter assessed using a timeline followback calendar and the alcohol use disorder identification test (AUDIT).In all former smokers, total drinks (b = 4.01, p = 0.02) and average drinks per drinking day (b = 0.61, p =.01) were both related to e-cig use status, with e-cig users reporting higher alcohol consumption. Among e-cig using former smokers, social users, but not regular users, showed positive relationships with AUDIT scores, b = 1.90, p =.02, total drinks, b = 9.12, p.001, average drinks, b = 0.98, p =.006, and hazardous drinking status, OR = 3.21, p =.01.Findings suggest that: (1) former smokers who use e-cigs may have a potential for higher alcohol use; and (2) those who use e-cigs socially may be at heightened risk for hazardous patterns of alcohol consumption. This should be taken into consideration by healthcare providers.

The Quick Drinking Screen (QDS) and Timeline Followback (TLFB), measures of alcohol use, have yielded similar reports of drinking with English speakers. The present study, a secondary data analyses, compared three measures of alcohol use (i.e., QDS, TLFB, and AUDIT) with Russian-speaking women. This is the first study to compare all three measures. This study replicated the findings of studies with English speakers, and demonstrated that brief screening measures (QDS, AUDIT) provide reliable summary measures of alcohol use when compared to a detailed drinking measure (TLFB). The use of brief screening measures is recommended for use with Russian women.

Objective Multiple studies show that behavioral couples therapy (BCT) is more efficacious than individually based therapy (IBT) for substance use and relationship outcomes among patients with alcohol use disorder. To facilitate dissemination, a multicouple, rolling admission Group BCT (G-BCT) format has been suggested as an alternative to the 1 couple at a time, conjoint Standard BCT (S-BCT) format. This randomized study compared outcomes of G-BCT versus S-BCT over a 1-year follow-up. The authors predicted that G-BCT, as compared to S-BCT, would have equivalent (i.e., noninferior) improvements on substance and relationship outcomes. Method Participants were patients (N = 101) with alcohol dependence and their heterosexual relationship partners without substance use disorder. Participants were mostly White, in their 40s, and 30% of patients were women. Patients were randomized to either G-BCT plus 12-step-oriented IBT or S-BCT plus IBT. Primary outcomes included Timeline Followback Interview percentage days abstinent and Inventory of Drug Use Consequences measure of substance-related problems. Secondary outcome was Dyadic Adjustment Scale. Outcome data were collected at baseline, posttreatment, and quarterly for 1-year follow-up. Results Results overall found no support for the predicted statistical equivalency of G-BCT and S-BCT. Rather than the predicted equivalent outcomes, substance and relationship outcomes were significantly worse for G-BCT than S-BCT in the last 6-9 months of the 12-month follow-up period, because G-BCT deteriorated and S-BCT maintained gains during follow-up. Conclusion This was the first study of the newer rolling admission group format for BCT. It proved to have worse not equivalent outcomes compared to standard conjoint BCT. (PsycINFO Database Record

Tobacco and marijuana are some of the most common prenatal substance exposures worldwide. The social acceptability and political landscape of marijuana and its potency have changed dramatically in the last two decades leading to increased use by pregnant women. Despite evidence for increasing marijuana use and high rates of co-use of tobacco (TOB) and marijuana (MJ) during pregnancy, the impact of prenatal exposure to each substance is typically studied in isolation. We investigated the influence of co-exposure to TOB and MJ on infant neurobehavioral development over the first postnatal month. Participants were 111 mother-infant pairs from a low-income, diverse sample (Mean age = 25 ± 5; 54% minorities). TOB and MJ use were assessed by Timeline Followback interview with biochemical confirmation. Three groups were identified: (a) prenatal MJ + TOB, (b) prenatal TOB only, (c) controls. Newborn neurobehavior was assessed at seven time points over the first postnatal month using the NICU Network Neurobehavioral Scale. MJ + TOB-exposed infants showed decreased ability to self-soothe (Self-regulation) and attend to stimuli (Attention), and increased need for examiner soothing (Handling) and low motor activity (Lethargy) versus unexposed infants. Despite low levels of MJ use in MJ + TOB co-users, co-exposure was associated with nearly double the impact on infant self-soothing and need for examiner soothing versus TOB-exposure alone. Effects of MJ + TOB co-exposure appeared more pronounced for daughters than for sons. Although results are preliminary, they highlight additional risk from dual exposure to MJ + TOB vs. TOB exposure alone, particularly for daughters. Results also highlight the critical importance of investigating prenatal exposures in concert and the need for intervention efforts to address MJ co-use in pregnant TOB users.

Hair ethyl glucuronide (hEtG) is a marker used for previous alcohol consumption. Correlations have been reported between the amount of alcohol consumed and hEtG concentration, but little has been published regarding relatively low levels of alcohol consumption and associated hEtG concentrations close to the limit of quantification (LOQ). Here, we investigate hEtG concentrations in non-excessive (

In addition to dichotomous measures of abstinence, smoking studies may use daily cigarette consumption as an outcome variable. These counts hold the promise of more efficient and detailed analyses than dichotomous measures, but present serious quality issues - measurement error and heaping - if obtained by retrospective recall. A doubly-coded dataset with a retrospective recall measurement (timeline followback, TLFB) and a more precise instantaneous measurement (ecological momentary assessment, EMA) serves as a calibration dataset, allowing us to predict EMA given TLFB and baseline factors. We apply this model to multiply impute precise cigarette counts for a randomized, placebo-controlled trial of bupropion with only TLFB measurements available. To account for repeated measurements on a subject, we induce correlation in the imputed counts. Finally, we analyze the imputed data in a longitudinal model that accommodates random subject effects and zero inflation. Both raw and imputed data show a significant drug effect for reducing the odds of non-abstinence and the number of cigarettes smoked among non-abstainers, but the imputed data provide efficiency gains. This method permits the analysis of daily cigarette consumption data previously deemed suspect due to reporting error and is applicable to other self-reported count data sets for which calibration samples are available. Copyright © 2015 John Wiley & Sons, Ltd.

OBJECTIVE This descriptive paper assesses the applicability of knowledge about alcoholic relationships to treatment-seeking alcoholic women. METHODS One hundred and nine heterosexual couples were recruited between 1997 and 2000 for a randomized clinical trial of treatments for female alcoholics. Measures included the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders IV, Timeline Followback Interview, Areas of Change Questionnaire, Dyadic Adjustment Scale-Revised, Spouse Behavior Questionnaire, and Drinking Patterns Questionnaire. RESULTS Couples reported moderate levels of relationship distress the women claimed that relationship issues were important antecedents to their alcohol consumption. Male partners reported frequent use of active and passive strategies for coping with their wives drinking. CONLCUSIONS Results suggest that findings on marital distress are applicable to both populations, but that findings on reasons for drinking from male-primary alcoholic couples may not be fully applicable to female-primary alcoholic couples.

Alcohol hangover is a combination of mental, sympathetic, and physical symptoms experienced the day after a single period of heavy drinking, starting when blood alcohol concentration approaches zero. How individual measures/domains of hangover symptomology might differ with moderate to heavy alcohol consumption and how these symptoms correlate with the drinking markers is unclear. We investigated the amount/patterns of drinking and hangover symptomology by the categories of alcohol drinking. We studied males and females in three groups: 12 heavy drinkers (HD, &gt, 15 drinks/week, 34&ndash, 63 years old (y.o.)), 17 moderate drinkers (MD, 5&ndash, 14 drinks/week, 21&ndash, 30 y.o.), and 12 healthy controls (social/light drinkers, SD, &lt, 5 drinks/week, 25&ndash, 54 y.o.). Demographics, drinking measures (Timeline followback past 90 days (TLFB90), Alcohol Use Disorders Identification Test (AUDIT)), and alcohol hangover scale (AHS) were analyzed. Average drinks/day was 5.1-times greater in HD compared to MD. Average AHS score showed moderate incapacity, and individual measures and domains of the AHS were significantly elevated in HD compared to MD. Symptoms of three domains of the AHS (mental, gastrointestinal, and sympathetic) showed domain-specific significant increase in HD. A domain-specific relation was present between AUDIT and specific measures of AHS scores in HD, specifically with the dependence symptoms. Exacerbation in hangover symptomology could be a marker of more severe alcohol use disorder.

Understanding variability in smoking patterns may inform smoking cessation interventions. Retrospective reports of cigarettes smoked per day may be biased and typically do not provide temporal precision regarding when cigarettes are smoked. However, real-time, user-initiated tracking, such as logging each time a cigarette is smoked, can be burdensome over long time frames. In this study, adult, non-treatment seeking daily smokers (N = 22) used an electronic, smart lighter to light and timestamp cigarettes for 14 days. Participants reported number of cigarettes smoked per day (CPD) via a mobile device (daily diary) and retrospectively reported CPD at the end of the study using the Timeline Followback (TLFB). Self-reported lighter satisfaction and adherence varied with 68% of participants reporting that they liked using the lighter and participants reporting using the lighter for 92% of cigarettes smoked, on average. Lighter-estimated CPD did not differ from daily diary-estimated CPD, but was significantly lower than TLFB estimates. The lighter resulted in greater day-to-day variability relative to other methods and fewer rounded cigarette counts (digit bias) relative to the TLFB. The lighter appears to be feasible for capturing data on smoking patterns in daily smokers. Though false positive cigarettes are likely low, additional technologies that augment data captured from the lighter may be necessary to reduce false negatives (missed cigarettes) and alternative lighter designs may appeal more to certain smokers.

PURPOSE This study examined concurrent and longitudinal associations between two dimensions of affiliation in Alcoholics Anonymous (AA)-attendance and spiritual awakening-and drinking outcomes among adult patients who were in treatment for alcohol dependence in Warsaw, Poland. In a study conducted at four addiction treatment centers, male and female patients (n = 118) with a DSM-IV diagnosis of alcohol dependence were assessed at baseline (Time 1 or T1), 1 month (T2), and 6-12 months postbaseline (T3) for AA meeting attendance, various aspects of AA affiliation, and alcohol use. Alcoholics Anonymous meeting attendance and alcohol consumption were measured using the Timeline Followback interview. Self-report of having had a spiritual awakening was measured using a modified version of the Alcoholics Anonymous Involvement Scale. RESULTS There were no cross-sectional or longitudinal associations between AA meeting attendance and improved drinking outcomes. In contrast, self-report of a spiritual awakening between T2 and T3 was significantly associated with abstinence (OR = 2.4, p < .05) and the absence of any heavy drinking (OR = 3.0, p < .05) at T3, even when demographic and clinical characteristics were statistically controlled. CONCLUSIONS Self-reports of spiritual awakening predicted improved drinking outcomes in a Polish treatment sample.

This study tested an integrated relapse model drawing hypotheses from both interpersonal and intra-individual relapse models. It was hypothesized that the relationships between alcohol-specific social support (support for drinking and support for not drinking) and drinking outcomes would be partially mediated by motivation.Participants were 158 women with alcohol use disorders participating in two linked randomized controlled trials. One trial compared standard individual cognitive behavioral therapy (CBT) for alcohol use disorders with female-specific CBT for alcohol use disorders; the other compared alcohol behavioral couple therapy with blended individual CBT and alcohol behavioral couple therapy. Measures included the Important People Interview to measure social-support variables, the Timeline Followback to measure drinking variables, and the Stages of Change Readiness and Treatment Eagerness Scale to measure motivation.Results of structural equation modeling suggested a mediational role of motivation in the relationship between support for drinking and drinking frequency. Individuals with more network support for drinking at baseline had less motivation for abstinence at the end of treatment, which predicted drinking frequency over the 6 months after treatment. The indirect effect of baseline support for drinking on 6-month follow-up drinking frequency was statistically significant. A similar, although only marginally significant, pattern was found for the relationship between support for not drinking and drinking frequency. Individuals with more social network for not drinking at baseline had more motivation at the end of treatment at the trend level, which in turn predicted 6-month follow-up drinking frequency. The indirect effect of baseline support for not drinking on 6-month follow-up drinking frequency trended toward significance.This study offers preliminary evidence that motivation is one mechanism by which abstinence-specific social support affects treatment outcome.

Heat maps are presented here as an innovative technique for evaluating longitudinal drinking outcomes. The Life Transitions Study followed alcohol dependent individuals for 2.5 years during 2004-2009 in a Midwestern city (N = 364). The TimeLine Follow-Back obtained drinking information. Heat map results were compared with those obtained using growth mixture modeling. Heat map classes differed significantly on baseline clinical and demographic indicators. Data were gathered with support from NIAAA R01AA014442.

A recent study comparing the Quick Drinking Screen (QDS) with the Timeline Followback (TLFB) found that in a nonclinical population of problem drinkers both measures produced reliable summary measures of drinking. The current study was designed to replicate these findings with a clinical population of alcohol abusers. The data were collected over three years (2004-2006).Participants were 124 alcohol abusers who voluntarily enrolled for outpatient treatment. Over half (52.4%) were female with an average age of almost 40 years. About a third were married, had completed university, and a quarter were unemployed and nonwhite. Participants reported having a drinking problem for an average of 8.3 years, and reported drinking on about 5 days per week, averaging six drinks per drinking day. On two different occasions, they responded to two different sets of questions about their alcohol use. The instruments were: (a) the Quick Drinking Screen (QDS), a summary drinking measure, administered by telephone prior to the assessment; and (2) the TLFB self-administered by computer at the assessment.As in a previous study, this study found that the QDS and the TLFB, two very different drinking measures, collected similar aggregate drinking data for four drinking variables in a clinical sample of alcohol abusers.When it is not necessary or not possible to gather detailed drinking data, the QDS produces reliable brief summary measures of drinking for problem drinkers. Generalization to nonclinical samples awaits further research.

Accruing evidence of an association between drinking and smoking relapse suggests that it is important to measure alcohol use in smoking cessation studies. However, most studies do not do so, often because of the extra time burden required for these assessments. Data from participants (N=634) in two smoking cessation clinical trials were used to examine the relationship between short and longer periods of monitoring for a number of Timeline Followback (TLFB) drinking metrics at baseline and during treatment. High intercorrelations were found between short (7 and 14 days) and longer (30 and 60 days) time windows for baseline drinking data. Intercorrelations between short (last 7 days of treatment) and longer (entire treatment period) time windows of drinking data during the smoking cessation treatment period were also mostly in the high range. Although total abstinence was significantly overestimated with shorter time windows, for those who were misclassified, percentage of days abstinent was high and percentage of heavy drinking days and number of drinks per drinking day were low during the longer period. Thus, a brief estimate of alcohol use over 7 days at baseline is likely to provide a representative assessment of percentage of days abstinent, percentage of heavy drinking days, and number of drinks per drinking day. To estimate abstinence at baseline and during treatment, however, a more comprehensive period of monitoring may be required.

When assessing individuals with alcohol use disorders, measurement of drinking can be a resource intensive activity, particularly because many research studies report data for intervals ranging from 6 to 12 months prior to the interview. This study examined whether data from shorter assessment intervals is sufficiently representative of longer intervals to warrant the use of shorter intervals for clinical and research purposes. Participants were 825 problem drinkers (33.1% female) who were recruited through media advertisements to participate in a community-based mail intervention in Toronto, Canada. Participants' Timeline Followback (TLFB) reports of drinking were used to investigate the representativeness of different time windows for estimating annual drinking behavior. The findings suggest that for aggregated reports of drinking and with large sample (e.g., surveys), a 1-month window can be used to estimate annual consumption. For individual cases (e.g., clinical use) and smaller samples, a 3-month window is recommended. These results suggest that shorter time windows, which are more time and resource efficient, can be used with little to no loss in the accuracy of the data.

The impacts of two types of social desirability bias, self-deceptive enhancement (SDE) and impression management (IM), were examined on self-reports of gambling problems, measured by the South Oaks Gambling Screen (SOGS), and recent gambling behavior, as measured by the Timeline Followback (TLFB) method, in a sample of college students (N = 191), and a sample of treatment-seeking problem gamblers (N = 49). Consistent with our expectations, IM was negatively associated with SOGS scores in both samples. IM was most highly correlated with SOGS scores among treatment-seeking participants (r = -.44, p < .01). Substantial numbers of participants in both samples had high enough IM scores as to call into question the validity of their self-report gambling data, according to published interpretive guidelines. With respect to SDE, we had predicted that it would be positively related to gambling behaviors and gambling-related problems, but found that SDE was inversely related to SOGS scores in both samples. Very little evidence was found for social desirability effects on TLFB scores. Thus, preliminary evidence was obtained that self-report data on gambling problems, but not on gambling behavior (frequency of gambling and amount of time and money spent), may be susceptible to the effects of impression management in both college students and treatment-seeking gamblers.

The present study examined the effectiveness of the 2-week period currently used in the categorization of heavy episodic drinking among college students. Two-week drinker-type labels included the following: nonbinge drinker, binge drinker, and frequent binge drinker.Three samples of college student drinkers (104 volunteers, 283 adjudicated students, and 238 freshmen male students) completed the 3-month Timeline Followback assessment of drinking. Drinking behavior during the last 2 weeks of the month before the study was compared with drinking behavior during the first 2 weeks of the same month to compare behavior and resulting labels during both 2- week periods.Inconsistencies existed in drinker-type labels during the first 2 weeks of the month and the last 2 weeks of the month for all three samples. Between 40% and 50% of participants in the three samples were classified as a different drinker type across the month. Nonbinge drinkers experienced a wide range of alcohol-related problems, and much variation existed among the frequent-binge-drinker label.The results suggest that the current definition needs to be modified to accurately identify risky-drinking college students. Expanding the assessment window past 2 weeks of behavior, as well as developing different classification schemes, might categorize risky drinkers more accurately.

BACKGROUND There is a need for an effective and feasible alcohol screening instrument. The aim of the study was to evaluate how the abbreviated versions of the Alcohol Use Disorders Identification Test (AUDIT) questionnaire perform in comparison with the original AUDIT and what the optimal cutoffs are when screening for heavy drinking among women. METHODS All the 40-year-old women in the city of Tampere, Finland, are invited yearly for a health screening. From 1 year, data from 894 women (response rate 68.2%) invited for a health screening were utilized in the study. The original 10-item AUDIT, AUDIT-C, Five Shot, AUDIT-PC, AUDIT-3, AUDIT-QF, and CAGE were evaluated against the Timeline Followback. Consumption of at least 140 g of absolute ethanol per week on average during the past month was considered heavy drinking. RESULTS In the Timeline Followback, the mean+/-SD weekly reported alcohol consumption was 45+/-67 g (range 0-936 g) of absolute ethanol. Of the women, 6.2% (55/894) were heavy drinkers. The optimal combination of sensitivity and specificity was reached for the AUDIT with cutoff > or =6, for the AUDIT-C with cutoff > or =5, for the Five Shot with cutoff > or =2.0, for the AUDIT-PC with cutoff > or =4, and for the AUDIT-QF with cutoff > or =4. When choosing the optimal cutoffs, the AUDIT-C, the Five Shot, the AUDIT-PC, and the AUDIT-QF performed as well as the 10-item AUDIT. With these cutoffs, sensitivities were 0.84 to 0.93 and specificities were 0.83 to 0.90. The AUDIT-3 and the CAGE did not perform as well as the other questionnaires. CONCLUSIONS The 10-item AUDIT, AUDIT-C, Five Shot, AUDIT-PC, and AUDIT-QF seem to be equally effective tools in screening for heavy drinking among middle-aged women. However, their applicability is achieved only if the cutoffs are tailored according to gender.

We tested the feasibility and performance of the Interactive Voice Response Technology (IVR) in the assessment of sexual behavior self-reports, relative to self-administered questionnaire (SAQ) and Timeline Followback (TLFB) methods. The sample consisted of 44 sexually active Hispanic students recruited at the University of Texas at El Paso who reported daily about sexual behaviors and substance use. Thirty-three participants (75%, 18 women, 15 men) were retained for at least 80 days of the 91-day IVR. At follow-up, sexual behaviors and substance use were assessed by questionnaire (summary) reports and by TLFB, referring to the same 3-month interval. ANOVAs with normalized variables indicated less reporting in the TLFB and over-reporting of substance use in the questionnaire relative to the daily IVR self-reports. Gender moderated the effects of assessment mode, which were observed among women only. HLM analyses indicated a significant decrease in self-reports over time, suggesting reactivity of self-monitoring via IVR on behavior.

Although mean corpuscular volume (MCV), aspartate aminotransferase (AST), alanine aminotransferases (ALT), and the AST/ALT ratio are sometimes used as markers of alcohol disorders, their utility has not been established in older persons. We determined the tests’ performance characteristics for (1) at-risk drinking, (2) CAGE positivity, (3) at-risk drinking and CAGE positivity, and (4) a clinician-recorded diagnosis of alcohol abuse/dependence in a study of older male veterans receiving primary care. Participants (n = 587) included patients who had MCV, AST, and/or ALT data collected as part of routine care no more than 12 weeks before or after enrollment. MCV, AST, and ALT test results were obtained from the VA's database. At enrollment, the Timeline Followback and Alcohol Use Disorders Identification Test (AUDIT) were used to identify at-risk drinkers (≥15 drinks per week or AUDIT score ≥ 8), and the CAGE questionnaire was administered to identify participants with a history abuse/dependent drinking (CAGE score ≥ 2). Participants’ medical records were reviewed to identify subjects with a clinician-recorded diagnosis of alcohol abuse/dependence. The prevalence of abnormal test results for MCV (threshold value = > 98), AST (> 41), ALT (> 41), and the AST/ALT ratio (> 2) was 11%, 4%, 4%, and 5%, respectively. The occurrence of at-risk drinking, CAGE positivity, at-risk drinking and CAGE positivity, and a clinician-recorded diagnosis of alcohol abuse/dependence was 11%, 25%, 5%, and 9%, respectively. Test sensitivity ranged from 3.9% to 25.4% and specificity from 88.5% to 97.1%, whereas positive likelihood ratios varied from 0.72 to 4.01 and negative likelihood ratios from 0.82 to 1.04. Areas under the receiver operating characteristic curve were similar (range = 0.50–0.58) across tests. In conclusion, MCV, AST, ALT, and the AST/ALT ratio are not useful markers of alcohol disorders in older male veterans.

This study compared reports of alcohol consumption using an Interactive Voice Response (IVR) system and the Timeline Followback (TLFB). One hundred eighty-two daily smokers who were not alcohol dependent provided once daily reports of alcohol consumption using an IVR system and participated in a weekly TLFB interview. The reporting time period was 7 days after participants attempted to quit smoking as part of participation in a smoking cessation clinical trial. The results revealed moderate to high correlations between reports of drinking behavior as assessed by IVR and TLFB. Reporting biases for both IVR and TLFB were approximately equal, with a slight trend toward underreporting drinking on the TLFB. Compliance with the IVR system was poor. This study provides preliminary evidence that it is possible to use an IVR system for the assessment of alcohol use in smokers participating in a clinical trial, and IVR seems to adequately assess drinking behavior in those that use the system. However, future studies should focus on improving compliance with IVR in this population.

The current study uses a within-subjects randomized design with the Timeline Followback (TLFB) method administered in groups or to individuals to determine the equivalence of these methods.One hundred and four male and female college students who reported drinking at least once in the past 3 months completed the TLFB during a one-on-one interview, as well as in a group setting days apart. The two administrations were counterbalanced among the participants. Drinking variables assessed were drinking days, average drinks, total drinks, and maximum drinks consumed both during a 3-month (90 days) and a 1-month (30 days) period.Repeated measures analyses revealed no differences within subjects between the individual TLFB and the group TLFB on any of the four assessed drinking variables in the past 3 months and the past 1 month. Pearson's correlation coefficients revealed strong and significant correlations between the two administration styles. Heavy episodic drinking behavior was similar across administration styles as well. No differences between administration styles were consistent regardless of which administration was received first.The study suggests that the group TLFB yields similarly accurate results to the previously validated individual TLFB. The group-administered TLFB could be used in clinical and research settings as an efficient means of collecting information from large numbers of individuals.

The current study compares retrospective self-reports of quantity and frequency of drinking with the Timeline Followback (TLFB) method administered in groups or to individuals to determine the equivalence of these methods.Two hundred and eleven male college students who reported drinking at least two times per week participated; 118 completed the TLFB in a group setting, and 93 completed it individually. Drinking variables assessed were drinking days, average drinks and total drinks during a 30-day period.Pearson's correlation coefficients revealed significant correlations between single-item quantity and frequency measures and the TLFB on all three variables for the two administration styles. Furthermore, the group TLFB yielded similar correlations to self-reports as the individual TLFB on drinking days and average drinks. However, the correlation between total drinks on the TLFB and the individual item report of drinking days was higher for individual administration than in the group administration.This study suggests that the group TLFB yields an accurate portrayal of students' quantity, but not frequency, of use. In addition, the group-administered TLFB has the potential to parallel individual interviews and serve as an efficient means of collecting information, but further studies with modified research designs are necessary to validate this alternate method of TLFB administration.

Aims This study examined the validity of two methods of classifying binge drinkers. Methods Adult drinkers ( n = 166) completed the Alcohol Use Questionnaire (AUQ) and a Timeline Followback (TLFB) interview to characterize drinking during the past 28 days. Using Townshend and Duka's (2005) recommendations, answers on three AUQ items (average drinks per hour, number of times drunk within the prior 6 months and percentage of times drunk when drinking) were used to derive a binge score that was then used to classify drinkers as Binge, Non-Binge and Unclassifiable. Two methods for calculating binge scores were compared: (a) Participant-derived, using participants' answers on the 3 AUQ items; and (b) Staff-derived, staff used TLFB interview information to answer the 3 AUQ items. Additionally, Participant- and Staff-derived classifications were used to predict future drinking behaviors assessed by a second TLFB interview. Results Participant- and Staff-derived binge scores had a low concordance rate. Staff-derived classifications were better than Participant-derived classifications at predicting future binge drinking behavior and identifying group differences in drinking behavior reported during the second TLFB interview (average drinks per hour, number of times drunk within the prior 6 months, and percentage of times drunk when drinking). Conclusions Classifying drinkers using staff-guided TLFB interview methods instead of self-reported participant generalizations of typical drinking habits better relates to real-world drinking. Classification schemes that rely on dichotomous categorization of drinkers (Binge vs. Non-Binge) may be missing individuals who engage in harmful patterns of drinking. A continuous scale or index characterizing problematic drinking may be more useful.

Although use of both alcohol and tobacco is common among college-attending young adults, little is known about the stability of co-use over time. Difficulties in studying change in these behaviors may reflect inconsistencies in how smoking in particular is categorized. This study used longitudinal data, gathered at three time points three months apart, to examine cigarette and alcohol use profiles and the stability of profile structure and membership. Undergraduate student smokers' (N=320) past 30-day alcohol and cigarette use was assessed using the timeline followback procedure. Smoking (number of cigarettes and number of smoking days) and drinking (number of drinks and number of binges) were entered into a latent transition analysis (LTA) to identify the latent taxonomic structure within the sample, and determine the probability of movement between groups over time. A three-profile solution emerged at each time point. The LTA probabilities highlighted both progression and reduction in the lower-use groups. Overall, findings revealed notable changes in tobacco and alcohol use behaviors over the span of six months, affecting both profile structures and individual membership status. This suggests that among young adults both tobacco and alcohol use are temporally unstable behaviors, particularly among those using at lower levels. © 2014 Informa UK Ltd.