Search

Cannabis use continues to escalate among emerging adults and college attendance may be a risk factor for use. Severe cases of cannabis use can escalate to a cannabis use disorder, which is associated with worse psychosocial functioning. Predictors of cannabis use consequences and cannabis use disorder symptom severity have been identified; however, they typically employ a narrow set of predictors and rely on linear models. Machine learning is well suited for exploratory data analyses of high-dimensional data. This study applied decision tree learning to identify predictors of cannabis user status, negative cannabis-related consequences, and cannabis use disorder symptoms. Undergraduate college students (N = 7000) were recruited from nine universities in nine states across the U.S. Among the 7 trees, 24 splits created by 15 distinct predictors were identified. Consistent with prior research, one's beliefs about cannabis were strong predictors of user status. Negative reinforcement cannabis use motives were the most consistent predictors of cannabis use disorder symptoms, and past month cannabis use was the most consistent predictor of probable cannabis use disorder. Typical frequency of cannabis use was the only predictor of negative cannabis-related consequences. Our results demonstrate that decision trees are a useful methodological tool for identifying targets for future clinical research.

BACKGROUND: Progression through the stages of change is proposed to be a mechanism underlying the effects of treatment for alcohol use disorder (AUD). However, examining stages of change as a mechanism of treatment effects requires that the measure is invariant across patient subgroups, treatment conditions, and time. In the present study, we examined measurement invariance of the University of Rhode Island Change Assessment Scale (URICA) in Project MATCH using an exploratory structural equation modeling (ESEM) approach. METHODS: We conducted a secondary data analysis of Project MATCH (N=1726; M(age)=40.2, SD=10.9; 75.7% male; 80.0% non-Hispanic white), a multisite randomized clinical trial that tested three AUD treatments: Motivational Enhancement Therapy, Cognitive-Behavioral Therapy, or Twelve-Step Facilitation. Participants completed the 24-item URICA for assessing the stages of change in relation to drinking at baseline and posttreatment (3 months after baseline). RESULTS: A 4-factor ESEM provided a good fit to the data and a better fit to the data than a conventional 4-factor confirmatory factor analysis model. Further, the URICA demonstrated scalar invariance across each patient subgroup at baseline (sex, ethnicity, marital status, education, and parental history of AUD) and treatment condition at follow-up. However, the URICA was not longitudinally invariant as the metric model resulted in a significant decrement in model fit. CONCLUSIONS: The measurement invariance of the URICA over time was not supported. Longitudinally invariant measures of the stages of change are needed to appropriately test the proposal that progression through the stages explains treatment effects.

Objective The high rate of statistically significant findings in the sciences that do not replicate in a new sample has been described as a "replication crisis." Few replication attempts have been conducted in studies of alcohol use disorder (AUD), and the best method for determining whether a finding replicates has not been explored. The goal of the current study was to conduct direct replications within a multisite AUD-randomized controlled trial and to test a range of replication metrics. Method We used data from a large AUD clinical trial (Project Matching Alcoholism Treatments and Client Heterogeneity [Project MATCH], n = 1,726) to simulate direct replication attempts. We examined associations between drinking intensity and negative alcohol-related consequences (Model 1), sex differences in drinking intensity (Model 2), and reductions in drinking following treatment (Model 3). We treated each of the 11 data collection sites as unique studies such that each subsample was treated as an "original" study, and the remaining 10 subsamples were viewed as "replication" studies. Replicability metrics included the consistency of statistical significance, overlapping confidence intervals, and consistency of the direction of the effect. We also tested effect replication and heterogeneity using meta-analysis. Results We observed between 0% and 100% replicability across the replicability metrics depending on which subsample was treated as the "original" study. Meta-analyses indicated results were more similar across subsamples with no significant heterogeneity for Models 1 and 2. Conclusions We recommend researchers focus on effect sizes and use meta-analysis to evaluate the level of replicability. We also encourage direct replication attempts and sharing of data and code to facilitate direct replication. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

OBJECTIVE: Use of protective behavioral strategies (PBS) has been associated with reduced alcohol-related harms among college students. However, most of this research has been conducted among U.S. samples. The present study examines the use of PBS in an international context. METHOD: Participants (n = 1512) were recruited from universities in Spain (n = 298), Argentina (n = 439), and the U.S. (n = 775) to determine if there are differences in PBS use across countries and/or across sex. Further, we examined whether the association between PBS use and negative consequences differ across country and sex. RESULTS: We found that U.S. students reported the most frequent use of Stopping/Limiting Drinking PBS (M = 3.32, SD = 1.23) compared to Argentine (M = 2.89, SD = 0.97) and Spanish (M = 2.83, SD = 0.94) students. Argentine students reported the least frequent use of Serious Harm Reduction PBS (M = 4.57, SD = 0.99) compared to U.S. (M = 5.09, SD = 0.98) and Spanish (M = 5.03, SD = 0.78) students. Elastic net regression analyses stratified by country indicated most individual PBS predicted decreased negative alcohol-related consequences, although two items consistently predicted increased consequences and we observed some variability in the most predictive specific strategies in each country. Across each subscale and for 32 of 40 individual items, females reported more frequent use of PBS than males (ps

Young adult drinkers engage in a range of drinking patterns from abstaining to heavy drinking in both the United States and Sweden. Heavy drinking during young adulthood in both countries is associated with a variety of negative consequences. Personalized feedback interventions have been identified as effective prevention strategies to prevent or reduce heavy drinking in the United States. This study examined transitions in drinking profiles and compared the efficacy of a personalized feedback intervention for 3965 young adults in the United States (1,735) and Sweden (2230) during their transition out of high school. Using goodness-of-fit criteria, results indicated that three drinking profiles exist among young adults transitioning out of high school: very low drinkers/abstainers, moderate to heavy drinkers, and very heavy drinkers. Latent Markov models revealed a moderating effect of country on personalized feedback intervention such that intervention condition participants in the United States were more likely to belong to the light drinker/abstainer or moderate to heavy profile relative to the very heavy drinking profile at 6-month follow-up. There was no significant effect of personalized feedback intervention in Sweden. Future research could investigate the impact of when personalized feedback interventions are administered and could examine if personalized feedback interventions should be more intentionally culturally adapted in order to be more effective.

Cannabis use disorder (CUD) is commonly assessed using self-report items based on its symptoms as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM) that are scored on a dichotomous scale (yes/no) to indicate symptom presence; however, scoring items on a dichotomy may result in relatively limited sensitivity for research. Thus, we developed a 13-item measure of CUD, the Self-Reported Symptoms of CUD (SRSCUD), based on the 11 symptoms described in the DSM-5 that is scored on a 4-point response scale indicating degree of severity. In the present study, we conduct an initial evaluation of the psychometric properties of the SRSCUD. Past-month cannabis users (N = 2,077) were recruited from nine universities in nine states throughout the U.S. Each item of the SRSCUD loaded saliently onto a single factor of CUD symptoms in both exploratory and confirmatory factor analyses. The SRSCUD was strongly correlated with measures of cannabis use, dependence severity, and cannabis-related problems. In addition, the SRSCUD was moderately positively correlated with a well-known risk factor for CUD (coping motives) and moderately negatively correlated with a well-known protective factor for CUD (protective behavioral strategies). These correlations mostly remained statistically significant while controlling for CUD symptom count and diagnosis using dichotomized SRSCUD items. Receiver operator characteristic curve analyses revealed that the SRSCUD had excellent sensitivity/specificity for predicting probable CUD. Although more research evaluating performance of the SRSCUD compared to a clinical diagnosis is needed, we found preliminary evidence for construct validity of this measure. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The goals of individuals seeking treatment for alcohol use disorder (AUD) are typically quantified as abstinent or nonabstinent (e.g., moderate drinking) goals. However, treatment goals can vary over time and be influenced by life circumstances. This study aims to identify predictors of treatment goal change and direction of change from baseline to six-month follow-up among individuals seeking treatment for AUD.This study is a secondary analysis of data from the Relapse Replication and Extension Project. The study included participants who completed assessments at baseline and six-month follow-up in the analysis (n = 441). We used decision trees to examine 111 potential predictors of treatment goal change. The study cross-validated results using random forests. The team examined changes in goal between baseline and follow-up (Decision Tree 1) and quantified them as being toward or away from a complete abstinence goal (Decision Tree 2).Nearly 50 % of the sample changed their treatment goal from baseline to 6 months, and 68.7 % changed from a nonabstinence goal toward a complete abstinence goal. The study identified seven unique predictors of goal change. The most common predictors of changing a treatment goal were number of recent treatment sessions prior to enrolling in the study, other substance use, negative affect, anxiety, social support, and baseline drinks per drinking day. Participants with a greater number of recent treatment sessions and who sought social support were most likely to change their goal. Additionally, individuals with more substance use tended to change away from complete abstinence goals. Cross-validation supported baseline drinks per drinking day, social support, baseline maximum blood alcohol concentration (BAC), lifetime tobacco use, baseline average BAC, lifetime cocaine use, Inventory of Drinking Situations total score, and Situational Confidence Questionnaire average score as important predictors.This study identified seven unique predictors of treatment goal change while in AUD treatment. Prior treatment, drinking to cope, and social support were most associated with goal changes. This information can inform providers who seek to understand factors associated with treatment goal selection and changes in goals during treatment.

The purpose of the present study was to examine tests of interaction effects between cannabis protective behavioral strategies use and a range of risk/protective factors for negative cannabis-related consequences. We recruited 2,226 college students (M(age) = 20.28, SD = 3.37; 68.8% female; 75.4% white) from 10 universities throughout the U.S. who reported using cannabis in the past month to complete an online survey. Measures assessed cannabis use, negative cannabis-related consequences, cannabis protective behavioral strategies use, and 35 risk/protective factors (including socio-demographic characteristics). Cannabis protective behavioral strategies use was negatively correlated with negative cannabis-related consequences while including the risk/protective factors as covariates. Most importantly, 33% and 54% of the interaction effects tested were statistically significant, depending on the covariates entered into the model. The interaction effects had a consistent pattern such that the positive association between greater risk and negative cannabis-related consequences was weaker as cannabis protective behavioral strategies use increased. Findings suggest that the nature of these interaction effects are not specific for any given risk/protective factor. We draw parallels to research on alcohol protective behavioral strategies and offer suggestions for moving the cannabis protective behavioral strategies field forward.

Background: Cannabis protective behavioral strategies (PBS) are behaviors used before, during, after, and/or instead of cannabis use to reduce consumption, intoxication, and related harms. To leverage PBS to address the global health burden of cannabis use, especially in light of the changes in cannabis-related policies around the world, a better understanding of PBS across cultures is needed. In the present study, we conduct a cross-cultural examination of cannabis PBS use among college students. Method: Participants were 1175 college students (U.S. [n = 697], Argentina [n = 153], Uruguay [n = 46], Spain [n = 169], and the Netherlands [n = 66]) who reported past-month cannabis use (63.3% female; Mage = 20.96, SD = 3.95). Results: We found differences in the frequency of cannabis PBS use across countries such that the U.S. and Spain samples reported the most frequent cannabis PBS use and the Netherlands sample reported the least frequent cannabis PBS use. Although not statistically significant, we found that cannabis PBS use was positively correlated with cannabis-related outcomes (i.e., frequency, quantity, and negative consequences of cannabis use) among the Argentina and the Netherlands samples. Finally, across all countries but the Netherlands, females reported more frequent cannabis PBS use than males, but the associations of PBS with cannabis-related outcomes were larger for males than females. Conclusions: Given preliminary evidence for cultural differences in cannabis PBS use, future research is needed to better understand the cultural factors underlying these differences to inform the delivery of interventions aimed at reducing the harms of cannabis among college students.

Alcohol use disorder (AUD) is among the most prevalent psychiatric disorders and is associated with enormous public health costs. Although AUD and other addictive behaviors have been described as chronic relapsing conditions, most individuals who develop AUD will eventually recover. This narrative review provides an overview of definitions of recovery, with a focus on recovery from AUD. The definitions reviewed include those developed by key stakeholder groups, as well as definitions derived from recent quantitative and qualitative studies of individuals who meet criteria for AUD and attempt to resolve their problems with or without treatment or who self-identify as pursuing or achieving recovery. The literature reviewed supports a definition of recovery as an ongoing dynamic process of behavior change characterized by relatively stable improvements in biopsychosocial functioning and purpose in life. The review concludes that definitions of recovery that rely solely on abstinence from alcohol and the absence of AUD symptoms fail to capture the multidimensional and heterogeneous pathways to recovery that are evident among individuals in general population and clinical samples.

The purpose of the present study was to examine interaction effects between alcohol protective behavioral strategies (PBS) and a variety of risk and protective factors for experiencing negative alcohol-related consequences using data from a large, multi-site sample of college students. We recruited 5090 college students (71.2% female; 77.4% White; Mean Age = 20.89, SD = 4.44) who reported any alcohol use in the past month from psychology department participant pools at 10 universities across the U.S. to complete an online survey. Alcohol PBS use was a statistically significant negative predictor of alcohol-related problems while controlling for each antecedent variable individually. In terms of moderation effects, 26 out of 35 interactions (74.3%) were statistically significant in the models controlling only for sex. When controlling for frequency and quantity of alcohol use, 24 of 33 interactions (72.7%) were statistically significant. The nature of these interaction effects was largely the same: more frequent alcohol PBS use reduced the positive associations between risk factors and alcohol-related problems. The lack of specificity of these interaction effects calls into question the limited contributions of tests of interaction effects between alcohol PBS and individual antecedent variables. Comprehensive tests of interaction effects between alcohol PBS and antecedent variables with large samples are needed to move the field forward, especially replication attempts of interactions effects reported in single studies.

Background Substance use disorders are prevalent and returning to substance use (i.e., relapse) following treatment is common, underscoring the need for effective treatments that will help individuals maintain long-term reductions in substance use. Mindfulness-based interventions (MBIs) have been increasingly developed and evaluated for the treatment of substance use disorders. The aim of this article was to update a systematic review conducted by Li et al. in 2017 on the outcomes of randomized control trials of MBIs for substance use disorders. In addition, we provided a session-by-session examination of the most widely used MBI protocols. Methods We conducted a comprehensive literature search of the PubMed, PsycINFO, and Web of Science databases from January of 2016 through April of 2020. Studies were included based on the following criteria: 1) examined the effects of an MBI, 2) employed a randomized controlled trial design with repeated measures, including secondary data analyses of randomized controlled trials, and 3) enrolled participants seeking treatment for substance use disorders. Results The search identified 902 publications and 30 studies were eligible for inclusion and data extraction. MBIs appear to be as effective as existing evidence-based treatments for substance use disorders at reducing the frequency and quantity of alcohol and drug use, substance-related problems, craving for substance use, and at increasing the rate of abstinence. Conclusions Future directions include additional large scale randomized controlled trials, investigation of the most suitable settings and protocols, examination of patient populations that may benefit most from MBIs, and dissemination and implementation research.

Today’s college students have grown up with legalized gambling and access to a variety of gambling venues. Compared to the general adult population, rates of disordered gambling among college students are nearly double. Previous research suggests that the desire to win money is a strong motivator to gamble (Neighbors et al. in J Gambl Stud 18:361–370, 2002a); however, there is a dearth of literature on attitudes towards money in relation to gambling behavior. The current study evaluated the association between the four subscales of the Money Attitude Scale (Yamauchi and Templer in J Pers Assess 46:522–528, 1982) and four gambling outcomes (frequency, quantity, consequences and problem severity) in a sample of college students (ages 18–25; N = 2534) using hurdle negative binomial regression model analyses. Results suggest that college students who hold high Power–Prestige or Anxiety attitudes toward money were more likely to gamble and experience greater consequences related to their gambling. Distrust attitudes were negatively associated with gambling behaviors. Retention-Time attitudes were not significantly associated with gambling behaviors and may not be directly relevant to college students, given their often limited fiscal circumstances. These findings suggest that money attitudes may be potential targets for prevention programs in this population.