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1.  The Mediating Roles of Coping, Sleep, and Anxiety Motives in Cannabis Use and Problems among Returning Veterans with PTSD and MDD 
Veterans with posttraumatic stress disorder (PTSD) and major depressive disorder (MDD), the two most prevalent mental health disorders in the Iraq and Afghanistan veterans, are at increased risk for cannabis use and problems including cannabis use disorder (CUD). The present study examined the relationship of PTSD and MDD with cannabis use frequency, cannabis problems, and CUD as well as the role of three coping-oriented cannabis use motives (coping with negative affect, situational anxiety, and sleep) that might underlie this relationship. Participants were veterans (N = 301) deployed post 9/11/2001 recruited from Veterans Health Administration facility in the Northeast US based on self-reported lifetime cannabis use. There were strong unique associations between PTSD and MDD and cannabis use frequency, cannabis problems, and CUD. Mediation analyses revealed the three motives accounted, in part, for the relationship between PTSD and MDD with three outcomes in all cases but for PTSD with cannabis problems. When modeled concurrently, sleep motives, but not situational anxiety or coping with negative affect motives, significantly mediated the association between PTSD and MDD with use. Together with coping motives, sleep motives also fully mediated the effects of PTSD and MDD on CUD and in part the effect of MDD on cannabis problems. Findings indicate the important role of certain motives for better understanding the relation between PTSD and MDD with cannabis use and misuse. Future work is needed to explore the clinical utility in targeting specific cannabis use motives in the context of clinical care for mental health and CUD.
doi:10.1037/adb0000210
PMCID: PMC5218528  PMID: 27786514
cannabis; motives; PTSD; depression; sleep
2.  Proceedings of the 14th annual conference of INEBRIA 
Holloway, Aisha S. | Ferguson, Jennifer | Landale, Sarah | Cariola, Laura | Newbury-Birch, Dorothy | Flynn, Amy | Knight, John R. | Sherritt, Lon | Harris, Sion K. | O’Donnell, Amy J. | Kaner, Eileen | Hanratty, Barbara | Loree, Amy M. | Yonkers, Kimberly A. | Ondersma, Steven J. | Gilstead-Hayden, Kate | Martino, Steve | Adam, Angeline | Schwartz, Robert P. | Wu, Li-Tzy | Subramaniam, Geetha | Sharma, Gaurav | McNeely, Jennifer | Berman, Anne H. | Kolaas, Karoline | Petersén, Elisabeth | Bendtsen, Preben | Hedman, Erik | Linderoth, Catharina | Müssener, Ulrika | Sinadinovic, Kristina | Spak, Fredrik | Gremyr, Ida | Thurang, Anna | Mitchell, Ann M. | Finnell, Deborah | Savage, Christine L. | Mahmoud, Khadejah F. | Riordan, Benjamin C. | Conner, Tamlin S. | Flett, Jayde A. M. | Scarf, Damian | McRee, Bonnie | Vendetti, Janice | Gallucci, Karen Steinberg | Robaina, Kate | Clark, Brendan J. | Jones, Jacqueline | Reed, Kathryne D. | Hodapp, Rachel M. | Douglas, Ivor | Burnham, Ellen L. | Aagaard, Laura | Cook, Paul F. | Harris, Brett R. | Yu, Jiang | Wolff, Margaret | Rogers, Meighan | Barbosa, Carolina | Wedehase, Brendan J. | Dunlap, Laura J. | Mitchell, Shannon G. | Dusek, Kristi A. | Gryczynski, Jan | Kirk, Arethusa S. | Oros, Marla T. | Hosler, Colleen | O’Grady, Kevin E. | Brown, Barry S. | Angus, Colin | Sherborne, Sidney | Gillespie, Duncan | Meier, Petra | Brennan, Alan | de Vargas, Divane | Soares, Janaina | Castelblanco, Donna | Doran, Kelly M. | Wittman, Ian | Shelley, Donna | Rotrosen, John | Gelberg, Lillian | Edelman, E. Jennifer | Maisto, Stephen A. | Hansen, Nathan B. | Cutter, Christopher J. | Deng, Yanhong | Dziura, James | Fiellin, Lynn E. | O’Connor, Patrick G. | Bedimo, Roger | Gibert, Cynthia | Marconi, Vincent C. | Rimland, David | Rodriguez-Barradas, Maria C. | Simberkoff, Michael S. | Justice, Amy C. | Bryant, Kendall J. | Fiellin, David A. | Giles, Emma L. | Coulton, Simon | Deluca, Paolo | Drummond, Colin | Howel, Denise | McColl, Elaine | McGovern, Ruth | Scott, Stephanie | Stamp, Elaine | Sumnall, Harry | Vale, Luke | Alabani, Viviana | Atkinson, Amanda | Boniface, Sadie | Frankham, Jo | Gilvarry, Eilish | Hendrie, Nadine | Howe, Nicola | McGeechan, Grant J. | Ramsey, Amy | Stanley, Grant | Clephane, Justine | Gardiner, David | Holmes, John | Martin, Neil | Shevills, Colin | Soutar, Melanie | Chi, Felicia W. | Weisner, Constance | Ross, Thekla B. | Mertens, Jennifer | Sterling, Stacy A. | Shorter, Gillian W. | Heather, Nick | Bray, Jeremy | Cohen, Hildie A. | McPherson, Tracy L. | Adam, Cyrille | López-Pelayo, Hugo | Gual, Antoni | Segura-Garcia, Lidia | Colom, Joan | Ornelas, India J. | Doyle, Suzanne | Donovan, Dennis | Duran, Bonnie | Torres, Vanessa | Gaume, Jacques | Grazioli, Véronique | Fortini, Cristiana | Paroz, Sophie | Bertholet, Nicolas | Daeppen, Jean-Bernard | Satterfield, Jason M. | Gregorich, Steven | Alvarado, Nicholas J. | Muñoz, Ricardo | Kulieva, Gozel | Vijayaraghavan, Maya | Adam, Angéline | Cunningham, John A. | Díaz, Estela | Palacio-Vieira, Jorge | Godinho, Alexandra | Kushir, Vladyslav | O’Brien, Kimberly H. M. | Aguinaldo, Laika D. | Sellers, Christina M. | Spirito, Anthony | Chang, Grace | Blake-Lamb, Tiffany | LaFave, Lea R. Ayers | Thies, Kathleen M. | Pepin, Amy L. | Sprangers, Kara E. | Bradley, Martha | Jorgensen, Shasta | Catano, Nico A. | Murray, Adelaide R. | Schachter, Deborah | Andersen, Ronald M. | Rey, Guillermina Natera | Vahidi, Mani | Rico, Melvin W. | Baumeister, Sebastian E. | Johansson, Magnus | Sinadinovic, Christina | Hermansson, Ulric | Andreasson, Sven | O’Grady, Megan A. | Kapoor, Sandeep | Akkari, Cherine | Bernal, Camila | Pappacena, Kristen | Morley, Jeanne | Auerbach, Mark | Neighbors, Charles J. | Kwon, Nancy | Conigliaro, Joseph | Morgenstern, Jon | Magill, Molly | Apodaca, Timothy R. | Borsari, Brian | Hoadley, Ariel | Scott Tonigan, J. | Moyers, Theresa | Fitzgerald, Niamh M. | Schölin, Lisa | Barticevic, Nicolas | Zuzulich, Soledad | Poblete, Fernando | Norambuena, Pablo | Sacco, Paul | Ting, Laura | Beaulieu, Michele | Wallace, Paul George | Andrews, Matthew | Daley, Kate | Shenker, Don | Gallagher, Louise | Watson, Rod | Weaver, Tim | Bruguera, Pol | Oliveras, Clara | Gavotti, Carolina | Barrio, Pablo | Braddick, Fleur | Miquel, Laia | Suárez, Montse | Bruguera, Carla | Brown, Richard L. | Capell, Julie Whelan | Paul Moberg, D. | Maslowsky, Julie | Saunders, Laura A. | McCormack, Ryan P. | Scheidell, Joy | Gonzalez, Mirelis | Bauroth, Sabrina | Liu, Weiwei | Lindsay, Dawn L. | Lincoln, Piper | Hagle, Holly | Wallhed Finn, Sara | Hammarberg, Anders | Andréasson, Sven | King, Sarah E. | Vargo, Rachael | Kameg, Brayden N. | Acquavita, Shauna P. | Van Loon, Ruth Anne | Smith, Rachel | Brehm, Bonnie J. | Diers, Tiffiny | Kim, Karissa | Barker, Andrea | Jones, Ashley L. | Skinner, Asheley C. | Hinman, Agatha | Svikis, Dace S. | Thacker, Casey L. | Resnicow, Ken | Beatty, Jessica R. | Janisse, James | Puder, Karoline | Bakshi, Ann-Sofie | Milward, Joanna M. | Kimergard, Andreas | Garnett, Claire V. | Crane, David | Brown, Jamie | West, Robert | Michie, Susan | Rosendahl, Ingvar | Andersson, Claes | Gajecki, Mikael | Blankers, Matthijs | Donoghue, Kim | Lynch, Ellen | Maconochie, Ian | Phillips, Ceri | Pockett, Rhys | Phillips, Tom | Patton, R. | Russell, Ian | Strang, John | Stewart, Maureen T. | Quinn, Amity E. | Brolin, Mary | Evans, Brooke | Horgan, Constance M. | Liu, Junqing | McCree, Fern | Kanovsky, Doug | Oberlander, Tyler | Zhang, Huan | Hamlin, Ben | Saunders, Robert | Barton, Mary B. | Scholle, Sarah H. | Santora, Patricia | Bhatt, Chirag | Ahmed, Kazi | Hodgkin, Dominic | Gao, Wenwu | Merrick, Elizabeth L. | Drebing, Charles E. | Larson, Mary Jo | Sharma, Monica | Petry, Nancy M. | Saitz, Richard | Weisner, Constance M. | Young-Wolff, Kelly C. | Lu, Wendy Y. | Blosnich, John R. | Lehavot, Keren | Glass, Joseph E. | Williams, Emily C. | Bensley, Kara M. | Chan, Gary | Dombrowski, Julie | Fortney, John | Rubinsky, Anna D. | Lapham, Gwen T. | Forray, Ariadna | Olmstead, Todd A. | Gilstad-Hayden, Kathryn | Kershaw, Trace | Dillon, Pamela | Weaver, Michael F. | Grekin, Emily R. | Ellis, Jennifer D. | McGoron, Lucy | McGoron, Lucy
doi:10.1186/s13722-017-0087-8
PMCID: PMC5606215
3.  Drinking Location and Pregaming as Predictors of Alcohol Intoxication Among Mandated College Students 
Substance use & misuse  2016;51(8):983-992.
Background
Both drinking location and pregaming have been associated with heavy alcohol use among college students, yet the manner by which they uniquely contribute to alcohol intoxication remains unclear.
Objective
The current study examined the unique utility of drinking location and pregaming in predicting alcohol intoxication among college students who violated campus alcohol policy.
Method
Between 2011 and 2012, mandated college students who reported drinking prior to their referral events (N=212, 41% female, 80% White, Mage =19.4 y) completed a computerized assessment of drinking location and related behaviors as part of larger research trial. Chi-squared statistics, t-tests, one-way analyses of covariance, and regression were used to examine study aims.
Results
Participants were most likely (44%) to report drinking in off-campus housing prior to the referral event, and approximately half (47%) reported pregaming. Alcohol intoxication on the night of the referral event differed significantly as a function of both drinking location and pregaming, but pregaming did not moderate the association between drinking location and alcohol intoxication among mandated students. Female birth sex, pregaming, and drinking at either fraternities or off-campus housing predicted greater levels of alcohol intoxication on the night of the referral incident, while drinking in a residence hall/dorm predicted lower intoxication.
Conclusions/Importance
Drinking location and pregaming are distinct predictors of alcohol intoxication among mandated college students. Future interventions may benefit from targeting both where and how college students consume alcohol.
doi:10.3109/10826084.2016.1152496
PMCID: PMC4884131  PMID: 27070480
Alcohol; college students; drinking; location; pregaming
4.  Does a Brief Motivational Intervention Reduce Frequency of Pregaming in Mandated Students? 
Substance use & misuse  2016;51(8):1056-1066.
Background
Pregaming, also known as frontloading or predrinking, is a common but risky drinking behavior among college students. However, little is known about the way in which a brief motivational intervention (BMI) addressing general alcohol use and consequences may impact pregaming frequency.
Objectives
This study examined whether mandated students reduced frequency of pregaming following a BMI when pregaming was spontaneously discussed and whether gender moderated these effects.
Methods
Participants (n = 269, 32% female) were mandated college students who had received a campus-based alcohol citation and continued to exhibit risky alcohol use six weeks after receiving a brief advice session. Participants were randomized to a brief motivational intervention (BMI, n = 145) or assessment only (AO, n = 124) and completed follow-up assessments at 3, 6, and 9 months postintervention. Hierarchical Linear Modeling (HLM) was used to examine both between-person (Level 2) effects (i.e., condition) and within-person (Level 1) effects (i.e., time) on pregaming frequency. Analyses examining discussions of pregaming within the BMI were conducted using a sub-sample of the BMI sessions which had been transcribed (n = 121).
Results
Participants in the BMI group did not significantly reduce the frequency of pregaming compared to those in the AO group, even when pregaming was explicitly discussed during the BMI. Moreover, the BMI was equally ineffective at reducing pregaming frequency for both males and females.
Conclusion/Importance
Pregaming frequency appears to be resistant to conventional intervention efforts, but recent research suggests several innovative strategies for addressing pregaming in the college student population.
doi:10.3109/10826084.2016.1152494
PMCID: PMC4884148  PMID: 27070727
Pregaming; brief intervention; alcohol; college students; mandated
5.  Pregaming, Drinking Duration, and Movement as Unique Predictors of Alcohol Use and Cognitions Among Mandated College Students 
Substance use & misuse  2016;51(8):993-1001.
Background
Pregaming is a common phenomenon among college students and is associated with increased risks such as heavy drinking, alcohol-related consequences, and violating campus alcohol policies. However, the mechanism by which pregaming increases student risk is unclear.
Objectives
The current study aimed to delineate the role of personal endorsement of pregaming, duration of an entire drinking episode on the night of an alcohol violation, and movement from one location to another in predicting alcohol use and violation-related cognitions.
Methods
Participants (N = 113) were college students who had received an alcohol violation. Hierarchical multiple regressions were conducted to investigate the predictive value of pregaming endorsement, duration of drinking, and movement on drinking behaviors [number of drinks consumed and estimated blood alcohol content (eBAC)] on the night of the alcohol violation as well as violation-related cognitions (responsibility, aversiveness).
Results
Pregaming and duration of drinking were significant predictors of alcohol consumption and eBAC on the night of the violation, whereas movement was not. Duration of the drinking episode was significantly related to increased perceived responsibility for the alcohol violation.
Conclusions/importance
Self-reported pregaming and the duration of the drinking episode appear to be better targets than movement for prevention and intervention efforts addressing pregaming on college campuses. Interventions should continue focusing on reducing pregaming and its associated consequences, especially for those who report a longer duration of drinking following a pregaming episode.
doi:10.3109/10826084.2016.1152491
PMCID: PMC4884156  PMID: 27070369
Pregaming; duration of drinking; movement; event-related cognitions; mandated college students; alcohol
6.  Informing Alcohol Interventions for Student Service Members/Veterans: Normative Perceptions and Coping Strategies 
Addictive behaviors  2016;57:76-82.
Objective
The current study aimed to inform future interventions for heavy alcohol use and problems among college students by examining the utility of normative perceptions and coping strategies in predicting alcohol use among student service members/Veterans (SSM/Vs).
Methods
SSM/Vs and civilian students (N = 319) at a large university in the Southern Plains completed self-report measures of demographics, alcohol use and related behaviors, and coping strategies.
Results
Both SSM/Vs and civilian students significantly overestimated the typical weekly drinking quantities and frequencies of same-sex students on campus. Among SSM/Vs, normative perceptions of typical student (not military-specific) drinking and substance-related coping strategies significantly predicted drinks consumed per week, while substance-related coping predicted alcohol-related consequences.
Conclusions
Despite the theoretical importance of similarity to normative referents, military-specific norms did not significantly improve the prediction of SSM/Vs’ personal drinking behavior. Moreover, neither typical student nor military-specific norms predicted alcohol-related consequences among SSM/Vs after accounting for substance-related coping strategies. Future research may examine the efficacy of descriptive normative feedback and the importance of military-specific norms in alcohol interventions for SSM/Vs.
doi:10.1016/j.addbeh.2016.02.009
PMCID: PMC4775361  PMID: 26894552
alcohol; college students; military; descriptive norms
7.  Extreme Consumption Drinking Gaming and Prepartying Among High School Students 
Drinking games and prepartying (i.e., drinking before going to a social gathering/event) have emerged as high-risk drinking behaviors in high school students. The present study examines the current prepartying behaviors of high school students who report current participation in extreme consumption games (e.g., Chugging) with those who do not. High school students (N=182) reporting current drinking games participation completed anonymous surveys. Gamers who prepartied frequently (vs. those who did not) were approximately 1.5 times more likely to play extreme consumption games, even after controlling for demographics, typical consumption, and participation in other types of drinking games. Practitioners should target adolescents who participate in extreme consumption games, particularly those who participate in this high-risk activity as a form of prepartying.
doi:10.1080/1067828X.2014.898168
PMCID: PMC4916969  PMID: 27346931
Drinking games; prepartying; hazardous alcohol use; problem behaviors; adolescents
8.  Which individual therapist behaviors elicit client change talk and sustain talk in motivational interviewing? 
Objective
To identify individual therapist behaviors which elicit client change talk or sustain talk in motivational interviewing sessions.
Method
Motivational interviewing sessions from a single-session alcohol intervention delivered to college students were audio-taped, transcribed, and coded using The Motivational Interviewing Skill Code (MISC), a therapy process coding system. Participants included 92 college students and eight therapists who provided their treatment. The MISC was used to code 17 therapist behaviors related to the use of motivational interviewing, and client language reflecting movement toward behavior change (change talk), away from behavior change (sustain talk), or unrelated to the target behavior (follow/neutral).
Results
Client change talk was significantly more likely to immediately follow individual therapist behaviors [affirm (p = .013), open question (p < .001), simple reflection (p < .001), and complex reflection (p < .001)], but significantly less likely to immediately follow others (giving information (p < .001) and closed question (p < .001)]. Sustain talk was significantly more likely to follow therapist use of open questions (p < .001), simple reflections (p < .001), and complex reflections (p < .001), and significantly less likely to occur following therapist use of therapist affirm (p = .012), giving information (p < .001), and closed questions (p < .001).
Conclusions
Certain individual therapist behaviors within motivational interviewing can either elicit both client change talk and sustain talk or suppress both types of client language. Affirm was the only therapist behavior that both increased change talk and also reduced sustain talk.
doi:10.1016/j.jsat.2015.09.001
PMCID: PMC4936274  PMID: 26547412
Motivational interviewing; therapy process; alcohol use; brief intervention; change language
9.  Drinking Games Participation Among High School and Incoming College Students: A Narrative Review 
The transition from high school to college has been characterized as a potentially vulnerable period due to decreased parental supervision and increased autonomy. This transition can increase participation in high-risk behaviors such as drinking games (DGs), which are a social drinking activity that encourages intoxication and are associated with negative alcohol-related consequences. To date, there has not been a narrative review of DG research that examines this activity among high schoolers and incoming college students specifically, and thus, the current review bridges this gap. Findings indicate that DG participation is consistently linked to negative consequences (e.g., passing out, becoming sick) and other high-risk behaviors, such as prepartying (drinking before going to a social event). In addition, DG participation was linked to demographic (e.g., age, gender), psychological (e.g., personality, alcohol cognitions), and contextual/cultural factors (e.g., the college drinking culture). These findings have implications for current prevention and intervention efforts and suggest promising directions for future research.
doi:10.1097/01.JAN.0000481966.33116.a5
PMCID: PMC4784108  PMID: 26950835
Drinking games; alcohol use; adolescents; high school students; incoming college students; college transition
10.  A systematic review of behavioural interventions to reduce preoperative alcohol use 
Drug and alcohol review  2015;10.1111/dar.12285.
Issues
Preoperative alcohol use is associated with an increase in postoperative morbidity and mortality. Short-term abstinence prior to elective surgery has been shown to reduce postoperative risks. Therefore, behavioural intervention (BI) targeting risky drinking may have significant utility in preventing surgical complications.
Approach
The literature was systematically reviewed to identify the scope and outcomes of BIs aiming to reduce alcohol use in risky drinkers before they underwent surgery. Five databases were searched using PRISMA criteria. Of 1243 studies identified, four met pre-established inclusion criteria: (i) implementation of a BI prior to an elective surgery; (ii) the BI-targeted alcohol use among risky drinkers; and (iii) printed in English.
Key Findings
Two studies indicated significant reductions in alcohol use at follow ups, and one study demonstrated reductions in postoperative risks. These findings are encouraging, but in light of methodological limitations, the efficacy of preoperative BIs for risky drinking could not be determined.
Implications
Future efforts to screen and implement BIs addressing alcohol use in preoperative patients should carefully define risky drinking, allow ample time for recruitment prior to surgery, implement empirically supported interventions, examine the impact of relevant covariates, and consider the statistical power needed to detect change in postoperative complications.
Conclusion
Given the strong link between preoperative alcohol use and postoperative risks, additional research on preoperative BIs is critically needed. Existing research suggests several promising directions for research that may enhance future intervention efforts with this high-risk population.
doi:10.1111/dar.12285
PMCID: PMC4695381  PMID: 26120973
alcohol drinking; preoperative period; elective surgical procedure; brief psychotherapy; behavioural medicine
11.  Predicting Utilization of Healthcare Services in the Veterans Health Administration by Returning Women Veterans: The Role of Trauma Exposure and Symptoms of Posttraumatic Stress 
Psychological services  2015;12(4):412-419.
Combat exposure and military sexual trauma (MST) are prevalent among returning women Veterans and associated with increased alcohol use and psychological distress. However, it remains unclear the extent to which combat exposure and MST are associated with utilization of healthcare in the Veterans Health Administration (VHA). The current study explored the relationships among alcohol use and distress in women who deployed in support of Operations Enduring Freedom, Iraqi Freedom, and New Dawn (OEF/OIF/OND). It was hypothesized that increased PTSD and depression symptomatology and trauma exposure would be related greater VHA utilization, whereas alcohol misuse would predict lower VHA use. Participants (N = 133) completed an internet-based survey of deployment experiences, substance use, mental health, and utilization of VHA services. In this sample, 33% endorsed MST exposure, 64% endorsed combat exposure, and 78% indicated exposure to the aftermath of battle. Multiple regression models found combat exposure – but not MST or aftermath – to be significantly associated with alcohol use and symptoms of PTSD and depression. Only 37% of participants reported use of VHA services, and logistic regression models indicated that PTSD symptomatology was the only unique predictor of VHA use. Findings suggest potential barriers for women who endured sexually based trauma in a military setting in seeking treatment at the VHA.
doi:10.1037/ser0000057
PMCID: PMC4632644  PMID: 26524283
women Veterans; alcohol; military sexual trauma; PTSD; deployment
12.  Mandated College Students’ Response to Sequentially-Administered Alcohol Interventions in a Randomized Clinical Trial Using Stepped Care 
Objective
Students referred to school administration for alcohol policies violations currently receive a wide variety of interventions. This study examined predictors of response to two interventions delivered to mandated college students (N = 598) using a stepped care approach incorporating a peer-delivered 15-minute BA session (BA; Step 1) and a 60–90 minute brief motivational intervention delivered by trained interventionists (BMI; Step 2).
Method
Analyses were completed in two stages. First, three types of variables (screening variables, alcohol-related cognitions, mandated student profile) were examined in a logistic regression model as putative predictors of lower-risk drinking (defined as 3 or fewer heavy episodic drinking [HED] episodes and/or 4 or fewer alcohol-related consequences in the past month) six weeks following the BA session. Second, we used generalized estimating equations to examine putative moderators of BMI effects on HED and peak blood alcohol content (pBAC) compared to assessment-only control (AO) over the 3, 6, and 9 month follow-ups.
Results
Participants reporting lower scores on the Alcohol Use Disorders Identification Test (AUDIT), more benefits to changing alcohol use, and those who fit the ‘Bad Incident’ profile at baseline were more likely to report lower risk drinking 6 weeks after the BA session. Moderation analyses revealed that ‘Bad Incident’ students who received the BMI reported more HED at 9-month follow up than those who received AO.
Conclusion
Current alcohol use as well as personal reaction to the referral event may have clinical utility in identifying which mandated students benefit from treatments of varying content and intensity.
doi:10.1037/a0039800
PMCID: PMC4738020  PMID: 26460571
alcohol; brief advice; brief motivational intervention; peers
13.  In-session Processes of Brief Motivational Interventions in Two Trials with Mandated College Students 
Objective
Each year, thousands of college students receive mandated intervention as a sanction for alcohol use or alcohol-related behavior. For these mandated students, Brief Motivational Interventions (BMIs) are currently the most efficacious individual intervention. However, little is known about how the technical (therapist behaviors) and relational (e.g., global ratings of therapist empathy) components of BMIs influence client language as well as subsequent change in alcohol use and consequences in mandated students.
Method
This study used the Motivational Interviewing Skills Code (MISC 2.0; Miller, Moyers, Ernst, & Amrhein, 2003) to code BMI sessions from two randomized clinical trials that facilitated significant reductions in alcohol use (Study 1, n = 91) and alcohol-related consequences (Study 2, n = 158) in mandated students.
Results
There were significant relationships among therapist behaviors, global scores, and client language both for and against change, yet there were no links between in-session client language and subsequent changes in alcohol use or problems. In contrast, relational aspects of MI (global ratings of therapist MI Spirit and client self-exploration) were most predictive of post-session alcohol use. Mediation models incorporating both technical and relational components revealed that higher levels of client self-exploration mediated the relationship between higher therapist ratings of MI Spirit and improved drinking at follow-up.
Conclusions
Findings highlight the importance of considering how both technical and relational components of MI may influence alcohol use in mandated college students, and also suggest more exact analyses to better understand this complex relationship.
doi:10.1037/a0037635
PMCID: PMC4323774  PMID: 25111429
Motivational Interviewing; therapy process; alcohol use; brief intervention; change language
14.  Descriptive Norms and Expectancies as Mediators of a Brief Motivational Intervention for Mandated College Students Receiving Stepped Care for Alcohol Use 
Background and Aims
Stepped care approaches for mandated college students provide individual Brief Motivational Interventions (BMI) only for individuals who do not respond to an initial, low-intensity level of treatment such as Brief Advice (BA). However, how BMIs facilitate change in this higher-risk group of mandated students remains unclear. Perceived descriptive norms and alcohol-related expectancies are the most commonly examined mediators of BMI efficacy, but have yet to be examined in the context of stepped care.
Methods
Participants were mandated college students (N = 598) participating in a stepped care trial in which mandated students first received BA. Those who reported continued risky drinking 6 weeks following a BA session were randomized to either a single-session BMI (N=163) or an Assessment-only comparison condition (AO; N = 165). BMI participants reduced alcohol-related problems at the 9 month follow up significantly more than AO participants. Multiple mediation analyses using bootstrapping techniques examined whether perceived descriptive norms and alcohol-related expectancies mediated the observed outcomes.
Results
Reductions in perceptions of average student drinking (B = -.24; CI = -.61 to -.04) and negative expectancies (B = -.13; CI = -.38 to -.01) mediated the BMI effects. Furthermore, perceived average student norms were reduced after the BMI to levels approximating those of students who had exhibited lower risk drinking following the BA session.
Conclusions
Findings highlight the utility of addressing perceived norms and expectancies in BMIs, especially for students who have not responded to less intensive prevention efforts.
doi:10.1037/adb0000092
PMCID: PMC4688248  PMID: 26098125
Mediation; perceived descriptive norms; alcohol expectancies; alcohol; motivational interventions
15.  The Technical Hypothesis of Motivational Interviewing: A Meta-Analysis of MI’s Key Causal Model 
Objective
The technical hypothesis of motivational interviewing (MI) posits that therapist implemented MI skills will be related to client speech regarding behavior change and that client speech will predict client outcome. The current meta-analysis is the first aggregate test of this proposed causal model.
Method
A systematic literature review, using stringent inclusion criteria, identified k = 16 reports describing 12 primary studies. Review methods calculated the inverse-variance-weighted pooled correlation coefficient for the therapist to client and the client to outcome paths across multiple targeted behaviors (i.e., alcohol or illicit drug use, other addictive behaviors).
Results
Therapist MI-consistent skills were correlated with more client language in favor of behavior change (i.e., change talk; r = .26, p < .0001), but not less client language against behavior change (i.e., sustain talk; r = .10, p = .09). MI-inconsistent skills were associated with less change talk (r = −.17, p = .001) as well as more sustain talk (r = .07, p = .009). Among these studies, client change talk was not associated with follow-up outcome (r = .06, p = .41), but sustain talk was associated with worse outcome (r = −.24, p = .001). In addition, studies that examined composite client language (e.g., an average of negative and positive statements) showed an overall positive relationship with client behavior change (r = .12, p = .006; k = 6).
Conclusions
This meta-analysis provides an initial test and partial support for a key causal model of MI efficacy. Recommendations for MI practitioners, clinical supervisors, and process researchers are provided.
doi:10.1037/a0036833
PMCID: PMC4237697  PMID: 24841862
motivational interviewing; change talk; sustain talk; change language; therapy process
16.  Response of Heavy-drinking Voluntary and Mandated College Students to a Peer-led Brief Motivational Intervention Addressing Alcohol Use 
Little is known about the way in which mandated and heavy-drinking voluntary students comparatively respond to peer-led brief motivational interventions (BMIs) and the mediators and moderators of intervention effects. Research suggests mandated students may be more defensive due to their involvement in treatment against their will and this defensiveness, in turn, may relate to treatment outcome. Furthermore, it is not clear how mandated and heavy-drinking voluntary students perceived satisfaction with peer-led BMIs relates to treatment outcomes. Using data from two separate randomized controlled trials, heavy drinking college students (heavy-drinking voluntary, N= 156; mandated, N = 82) completed a peer-led Brief Motivational Intervention (BMI). Both mandated and heavy-drinking volunteer students significantly reduced drinking behaviors at 3-month follow-up, reported high levels of post-intervention session satisfaction, yet no effects for mediation or moderation were found. Findings offer continued support for using peer counselors to deliver BMIs; however, results regarding the mechanisms of change were in contrast to previous findings. Implications for treatment and future areas of research are discussed.
doi:10.1016/j.jsat.2014.06.005
PMCID: PMC4175063  PMID: 25073447
College students; alcohol; peer counselors; brief intervention
17.  Sustain Talk Predicts Poorer Outcomes among Mandated College Student Drinkers Receiving a Brief Motivational Intervention 
Within-session client language that represents a movement toward behavior change (change talk) has been linked to better treatment outcomes in the literature on motivational interviewing (MI). There has been somewhat less study of the impact of client language against change (sustain talk) on outcomes following an MI session. This study examined the role of both client change talk and sustain talk, as well as therapist language, occurring during a brief motivational intervention (BMI) session with college students who had violated college alcohol policy (N = 92). Audiotapes of these sessions were coded using a therapy process coding system. A series of hierarchical regressions were used to examine the relationships among therapist MI-consistent and MI-inconsistent language, client change talk and sustain talk, as well as global measures of relational variables, and drinking outcomes. Contrary to prior research, sustain talk, but not change talk, predicted poorer alcohol use outcomes following the BMI at 3- and 12-month follow-up assessments. Higher levels of client self-exploration during the session also predicted improved drinking outcomes. Therapist measures of MI-consistent and MI-inconsistent language, and global measures of therapist acceptance and MI spirit were unrelated to client drinking outcomes. Results suggest that client sustain talk and self-exploration during the session play an important role in determining drinking outcomes among mandated college students receiving a BMI addressing alcohol use.
doi:10.1037/a0037296
PMCID: PMC4212208  PMID: 25222170
Motivational Interviewing; therapy process; alcohol use; brief intervention; change language; mandated students
18.  Associations among Trauma, Posttraumatic Stress, and Hazardous Drinking in College Students: Considerations for Intervention 
Current addiction reports  2015;2(1):58-67.
Students with trauma and posttraumatic stress are disproportionately at risk for heavy drinking and for alcohol-related consequences. Brief motivational interventions (BMIs) have been shown to reduce hazardous drinking in college students, and could serve as a first-line approach to reduce heavy drinking in students with trauma and posttraumatic stress (PTS). Yet the standard BMI format may not adequately address the factors that lead to hazardous drinking in these students. Here, we review the literature on PTS and hazardous drinking in college students, and highlight cognitive (self-efficacy, alcohol expectancies) and behavioral (coping strategies, emotion regulation skills, protective behaviors) factors that may link trauma and PTS to drinking risk. Incorporating these factors into standard BMIs in a collaborative way that enhances their personal relevance may enhance intervention efficacy and acceptability for these at-risk students.
doi:10.1007/s40429-015-0044-0
PMCID: PMC4497782  PMID: 26167448
Posttraumatic stress disorder; College students; Alcohol; Treatment; Brief motivational intervention
19.  Hospitalizations for Students With an Alcohol-Related Sanction: Gender and Pregaming as Risk Factors 
Objective
The purpose of this study is to investigate whether pregaming (i.e., drinking prior to a social event) is a risk factor for hospitalization.
Participants
Participants (N=516) were undergraduate students with an alcohol-related sanction.
Method
Participants completed a survey about alcohol use, as well as behaviors and experiences prior to and during the referral event. The dependent variable was whether participants received medical attention at an emergency department during the sanction event.
Results
Results indicated that older students, females who pregame, students with higher alcohol use screening scores, lighter drinkers, and higher numbers of drinks before the referral event all increased the odds of receiving medical attention. Pregaming alone was not significantly related to receiving medical attention in the multivariate analysis.
Conclusions
Female students who pregame appear to be at risk for requiring hospitalization after drinking when controlling for the number of drinks consumed.
doi:10.1080/07448481.2014.897952
PMCID: PMC4040963  PMID: 24635415
alcohol; emergency department; gender; pregaming; prevention
20.  Phone-Delivered Brief Motivational Interventions for Mandated College Students Delivered During the Summer Months 
Objective
Across the United States, tens of thousands of college students are mandated to receive an alcohol intervention following an alcohol policy violation. Telephone interventions may be an efficient method to provide mandated students with an intervention, especially when they are away from campus during summer vacation. However, little is known about the utility of telephone-delivered brief motivational interventions.
Method
Participants in the study (N = 57) were college students mandated to attend an alcohol program following a campus-based alcohol citation. Participants were randomized to a brief motivational phone intervention (pBMI) (n = 36) or assessment only (n = 21). Ten participants (27.8%) randomized to the pBMI did not complete the intervention. Follow-up assessments were conducted 3, 6, and 9 months post-intervention.
Results
Results indicated the pBMI significantly reduced the number of alcohol-related problems compared to the assessment-only group. Participants who did not complete the pBMI appeared to be lighter drinkers at baseline and randomization, suggesting the presence of alternate influences on alcohol-related problems.
Conclusion
Phone BMIs may be an efficient and cost-effective method to reduce harms associated with alcohol use by heavy-drinking mandated students during the summer months.
doi:10.1016/j.jsat.2014.01.001
PMCID: PMC3972287  PMID: 24512944
21.  The Impact of Military Deployment and Reintegration on Children and Parenting: A Systematic Review 
Hundreds of thousands of children have had at least 1 parent deploy as part of military operations in Iraq (Operation Iraqi Freedom; OIF; Operation New Dawn; OND) and Afghanistan (Operation Enduring Freedom; OEF). However, there is little knowledge of the impact of deployment on the relationship of parents and their children. This systematic review examines findings from 3 areas of relevant research: the impact of deployment separation on parenting, and children's emotional, behavioral, and health outcomes; the impact of parental mental health symptoms during and after reintegration; and current treatment approaches in veteran and military families. Several trends emerged. First, across all age groups, deployment of a parent may be related to increased emotional and behavioral difficulties for children, including higher rates of health-care visits for psychological problems during deployment. Second, symptoms of PTSD and depression may be related to increased symptomatology in children and problems with parenting during and well after reintegration. Third, although several treatments have been developed to address the needs of military families, most are untested or in the early stages of implementation and evaluation. This body of research suggests several promising avenues for future research.
doi:10.1037/a0035055
PMCID: PMC4383395  PMID: 25844014
military; veterans; deployment; parenting
22.  Not Just Fun and Games: A Review of College Drinking Games Research From 2004 to 2013 
Drinking games are a high-risk social drinking activity consisting of rules and guidelines that determine when and how much to drink (Polizzotto et al., 2007). Borsari's (2004) seminal review paper on drinking games in the college environment succinctly captured the published literature as of February 2004. However, research on college drinking games has grown exponentially during the last decade, necessitating an updated review of the literature. This review provides an in-depth summary and synthesis of current drinking games research (e.g., characteristics of drinking games, and behavioral, demographic, social, and psychological influences on participation) and suggests several promising areas for future drinking games research. This review is intended to foster a better understanding of drinking game behaviors among college students and improve efforts to reduce the negative impact of this practice on college campuses.
doi:10.1037/a0036639
PMCID: PMC4356507  PMID: 25222171
drinking games; alcohol-related problems; prevention; intervention; college students
23.  Tailgating and Pregaming by College Students with Alcohol Offenses: Patterns of Alcohol Use and Beliefs 
Substance use & misuse  2014;49(14):1928-1933.
Research indicates that pregaming (drinking before a social event) and tailgating (drinking before a sporting event) are two culturally ingrained alcohol use behaviors by college students. We examined the prevalence of these two activities in a sample of college students (N = 354) who violated campus alcohol policy and were mandated to receive an alcohol intervention in fall 2010. Results indicated that alcohol consumption and other risk factors were related to pregaming and tailgating. These findings are discussed in the context of clinical implications and future directions for research. This study was funded in part by the National Institutes of Health.
doi:10.3109/10826084.2014.949008
PMCID: PMC4216232  PMID: 25183437
pregaming; tailgating; alcohol use; college student drinking; social norms; descriptive norms; alcohol beliefs
24.  Towards the development of laboratory methods for studying drinking games: Initial findings, methodological considerations, and future directions 
Background
Drinking games are prevalent among college students and are associated with increased alcohol use and negative alcohol-related consequences. There has been substantial growth in research on drinking games. However, the majority of published studies rely on retrospective self-reports of behavior and very few studies have made use of laboratory procedures to systematically observe drinking game behavior.
Objectives
The current paper draws on the authors’ experiences designing and implementing methods for the study of drinking games in the laboratory.
Results
The paper addressed the following key design features: (a) drinking game selection; (b) beverage selection; (c) standardizing game play; (d) selection of dependent and independent variables; and (e) creating a realistic drinking game environment.
Conclusions
The goal of this methodological review paper is to encourage other researchers to pursue laboratory research on drinking game behavior. Use of laboratory-based methodologies will facilitate a better understanding of the dynamics of risky drinking and inform prevention and intervention efforts.
doi:10.3109/00952990.2014.931408
PMCID: PMC4182566  PMID: 25192209
Alcohol; college students; drinking games
25.  When and why does pregaming occur? Commentary on Kuntsche & Labhart 
Addiction (Abingdon, England)  2013;108(10):10.1111/add.12321.
doi:10.1111/add.12321
PMCID: PMC3883060  PMID: 24033780
predrinking; adolescents; alcohol

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