Addressing the Negatively Reinforcing Effects of Alcohol in Brief Alcohol Interventions for College Students

Clinical Translation

Addressing the Negatively Reinforcing Effects of Alcohol in Brief Alcohol Interventions for College Students

Alicia K. Klanecky, PhD & Erika Ruhnke, BS

Department of Psychological Science, Creighton University, Omaha NE

Alicia K. Klanecky, PhD

Erika Ruhnke, BS

A considerable amount of research has demonstrated that college students engage in drinking for the negatively reinforcing effects of alcohol. Some students such as those with more severe trauma histories are at greater risk of drinking for these reasons. However, much less emphasis has been placed on drinking motives in brief alcohol interventions. The current article intends to summarize a recently published manuscript, highlighting the negatively reinforcing effects of alcohol via an experimental paradigm (Klanecky, Ruhnke, & Meyer, 2019), as well as more thoroughly discuss how such information can be incorporated into brief alcohol interventions.     

Klanecky et al. (2019) examined the relations among child/adolescent trauma, emotion regulation difficulties, and alcohol-related tension reduction expectancies in college students using an experimental mood induction. Undergraduate students were randomly assigned to an experimentally-induced negative or neutral mood condition with questionnaire batteries completed pre- and post-induction. Statistical procedures were limited to students who reported exposure to at least one prior traumatic event (n=134) and analyses accounted for PTSD symptoms. Findings indicated a main effect for mood condition such that participants in the negative condition reported heightened tension reduction expectancies post-induction compared to the neutral mood condition. Consistent with study hypotheses, a two-way interaction identified that the increase in tension reduction expectancies for those in the negative mood condition was especially salient for participants with more severe early sexual abuse. The two-way interaction finding with cumulative trauma exposure identified a trend in the same direction. A second trend suggested tension reduction expectancies were higher for participants in the negative mood condition, as reports of sexual abuse and emotion regulation difficulties increased.

Overall, results showed that students generally endorse the negatively reinforcing effects of alcohol when experiencing acute negative affect. Such endorsements prompt drinking patterns where alcohol is used to reduce negative emotional experiences (Cooper, Frone, Russell, & Mudar, 1995). Drinking to reduce negative affect (or drinking to cope) is a significant and unique predictor of problem drinking and alcohol-related consequences including alcohol use disorder characteristics (Kuntsche, Knibbe, Gmel, & Engels, 2005; Merrill, Wardell, & Read, 2014). However, very few studies to date have specifically addressed drinking to cope in brief alcohol interventions. The few recent studies that have worked to address drinking to cope report promising findings in reducing coping motives and corresponding alcohol-related risk (Anker, Kushner, Thuras, Menk, & Unruh, 2016; Blevins & Stephens, 2016).

For example, Blevins and Stephens (2016) conducted a brief alcohol intervention delivered in-person with college students randomly assigned to receive either standard personalized feedback (i.e., with norm comparisons and a discussion of alcohol-related consequences) or the standard feedback plus motives-based feedback. A manipulation check indicated that information on coping motives was new to students, and those who received the personalized feedback with motives-related information reported reduced coping motives at two-month follow-up. Change in drinking to cope with depression, specifically, predicted alcohol quantity and problems at follow-up.

Clinicians may engage clients in discussions centered around their reasons or motives for drinking. Such discussion can be facilitated by completion of the Drinking Motives Questionnaire-Revised (DMQ-R) (Cooper, 1994) or the Modified DMQ-R (Grant, Stewart, O’Connor, Blackwell, & Conrod, 2007), should clinicians want to parse apart drinking to cope with anxiety and/or depression. After the client is presented with their baseline motives assessment information, discussion can identify the “good” followed by the “not so good” aspects or consequences associated with coping motives. Delivered within a motivational interviewing style, the clinician can extend the “not so good” conversation to research information identifying coping motives has associated with more drinking and more alcohol-related consequences. As evidenced by Blevins and Stephens (2016), this information will likely be new to most students. “Good” aspects of drinking to cope identified by clients can be framed within the more comprehensive perspective of “not so good” aspects and known risks. Depending on the client’s goals, the clinician can move forward with an emphasis on lowering risk.

Alternative methods of coping with negative affect (e.g., talking to a friend or being around a pet) can be brainstormed and implemented. Clinicians could encourage clients take an “experiment-like” approach, rating negative affect before and after engaging in alternative coping methods to gather more objective information on method effectiveness. Additionally, protective behavioral strategies (Martens et al., 2005) may be introduced and discussed as methods to reduce the likelihood of experiencing alcohol-related consequences when drinking, if harm reduction is the goal. Strategies before, during and/or after a drinking event can be generated with the clinician’s assistance (e.g., limiting number of drinks, alternating alcohol and non-alcohol beverages) and clients can identify which strategies they could implement.

Approaches to addressing coping motives, as outlined above, can be incorporated into already existing personalized feedback interventions, which are common and effective (Cronce & Larimer, 2011; Scott-Sheldon, Carey, Elliott, Garey, & Carey, 2014). Further, while trauma exposure in college students is prevalent (Klanecky et al., 2019; Monahan et al., 2013) and linked to drinking motives (e.g., Gilmore & Bountress, 2016), mixed research exists on the need to address trauma-specific risk information within brief alcohol interventions (Gilmore & Bountress, 2016; Gilmore, Lewis, & George, 2015; Monahan et al., 2013). Should clinicians want to incorporate trauma-specific information into personalized feedback interventions, the Adverse Childhood Experiences (ACE) Questionnaire – Short Form (Felitti et al., 1998) may be considered. Endorsement of ACE items are summed, with higher scores representing more severe early trauma exposure and related to increased adverse outcomes including problem drinking. The ACE may be incorporated into baseline assessment and scores incorporated into personalized feedback interventions. Clients’ ACE scores could be framed such that higher scores (particularly 4 or more) are associated with greater alcohol-related risks and consequences. The incorporation of trauma-specific information into brief alcohol interventions utilizing personalized feedback should be tested empirically.

References

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