Background

Alcohol and drug use disorders (AUDs and SUDs) and their combination are relatively common and often occur together. However, the relationships of potential early life correlates of alcohol and drug disorders to the combined diagnoses have rarely been evaluated in long-term prospective studies or in populations at high risk of one of these diagnoses but not the other.

Methods

Data were analyzed from 397 males (half with an alcohol-dependent father) who had no AUDs or SUDs at age 20 and who were followed approximately every 5 years for 3 decades. Early life correlates and the course of AUDs, SUDs, and combined disorders were evaluated for 4 groups of subjects based on subsequent alcohol and/or drug diagnoses.

Results

While the overall rates of the development of AUDs and SUDs were 41 and 21%, respectively, the rates of the second substance-related diagnosis were almost 2-fold higher for individuals who had the first condition. Among potential risk factors, scores for externalizing traits were elevated for men with AUDs, SUDs, and their combination, but a low level of response (low LR) to alcohol was associated only with the risk of AUDs, even when observed in the context of SUDs. The same earlier life characteristics that related to AUDs and to SUDs also related to the combination of these diagnoses in the same person. Finally, in this prospective study, subjects with both AUDs and SUDs had a more severe course than subjects with either condition alone.

Conclusions

This prospective evaluation of a group at high risk of AUDs confirmed the selective impact of the low LR on the risk of AUDs, the relationship of externalizing characteristics to both AUDs and SUDs and confirmed the more severe clinical course for both conditions when seen together.

Background

Student heavy drinking and associated problems are common at most universities and fluctuate throughout the calendar year, with marked increases during celebrations. Most studies of student drinking are limited to the academic year itself, and relatively few focus specifically on special heavy drinking events. Even fewer studies include drinking during summer break and subsequent school return.

Methods

In the context of an experimental protocol, beginning in January 2014, alcohol-related characteristics were evaluated 8 times over 55 weeks for 462 college freshmen, including periods that incorporated a campus festival, summer, and school return. Baseline predictors of drinking quantities over time included demography, substance use patterns, as well as environmental and attitudinal characteristics. Product-moment correlations evaluated relationships between baseline characteristics and subsequent quantities, and simultaneous entry regression analyses evaluated which characteristics most robustly predicted usual and maximum drinks over time.

Results

Maximum drinks per occasion increased 18% from the early spring (4/8/14 to 5/6/14) to the campus festival period (5/7/14 to 6/3/14), decreased 29% in the summer (7/8/14 to 8/5/14), and increased 31% on school return (10/7/14 to 11/4/14). The most robust predictors of higher quantities in regression analyses included items from each of the 3 major domains with the most consistent results seen for most baseline alcohol-related items and descriptive drinking norms (R(2) = 0.20 to 0.31).

Conclusions

These data demonstrate important changes in students' drinking during the calendar year, including expected large increases during the month of a 1-day festival, large decreases over the summer, and resumption of relatively high quantities upon return to school.

Objective

Heavy drinking is common on college campuses, with a marked increase from high school to freshman year. Programs addressing heavy campus drinking often personalize prevention protocols to fit a student's demography and prior drinking characteristics. Few efforts have individualized approaches to address a person's vulnerability through his or her low level of response (low LR) to alcohol.

Method

This article describes the recently completed 55-week outcome in drinking quantities and problems for the >90% of 500 participants in a prevention program at a U.S. university (62% female, mean age = 18 years) who completed a 4-week series of 50-minute videos delivered via the Internet. We evaluated whether, for low LRs, participation in an educational approach that focused on a low LR (the LR-based [LRB] condition) was associated with better outcomes than a state-of-the-art (SOTA) general education or with a no-intervention control condition.

Results

Using a mixed-design analysis of variance and focusing on the most closely ethnically matched high and low LR pairs, students with low LRs in the LRB condition demonstrated the greatest decreases in usual and maximum drinks over the 55 weeks, especially when compared with closely ethnically matched students with high LRs. Low LR controls showed the highest drinking values over time.

Conclusions

This study underscores the potential importance of targeting a person's specific preexisting vulnerability toward heavy drinking when he or she enters college. The approach can be used in a relatively inexpensive protocol of video education sessions delivered via the Internet.

Background

Heavy drinking is common during transitions from high school to college. Optimal programs for diminishing risks for high alcohol consumption often tailor the approach to the specific needs of students. This study describes the results of an Internet-based prevention protocol that tailors the information to the risk associated with a pre-existing phenotype, the Low level of Response (Low LR) to alcohol.

Methods

Using stratified random assignment, 454 freshmen with Low and High LR values were assigned to 2 education groups (LR-based where all examples were given the context of the Low LR model of heavy drinking or a State Of The Art (SOTA) Group where the same lessons were taught but without an emphasis on LR) or a no-intervention Control Group. Individuals in the 2 education groups viewed 50-minute online videos once per week for 4 weeks. Changes in drinking patterns were assessed at Baseline, 4 weeks, and 8 weeks using a 2 (LR status) by 3 (education group) by 3 (time points) analysis of variance, with additional tests for ethnicity and sex.

Results

Low LR participants tended to decrease their usual (p < 0.06) and maximum (p < 0.05) drinks per occasion most prominently when assigned to the LR-based protocol, while those with High LRs improved more in the SOTA Group. The most robust differences were seen when controlling for ethnicity. The effect sizes were small to medium.

Conclusions

These results support the advantages of carrying out prevention via the Internet and in tailoring the approach to a pre-existing phenotype.

Background

Heavy alcohol consumption and alcohol problems among college students are widespread and associated with negative outcomes for individuals and communities. Although current methods for prevention and intervention programming have some demonstrated efficacy, heavy drinking remains a problem. A previous pilot study and a recent large-scale evaluation (Schuckit et al., , ) found that a tailored prevention program based on a risk factor for heavy drinking, low level of response (low LR) to alcohol, was more effective at reducing heavy drinking than a state-of-the-art (SOTA) standard prevention program for individuals with the low LR risk factor.

Methods

This study enrolled 231 first-semester college freshmen with either high or low LR into the same level of response-based (LRB) or SOTA online prevention programs as in the previous reports (consisting of 4 weeks of video modules), as well as a group of matched controls not receiving alcohol prevention, and compared changes in alcohol use between these groups across a 6-month period.

Results

Individuals in alcohol prevention programs had a greater reduction in maximum drinks per occasion and alcohol use disorder symptoms than controls. There was limited evidence for interactions between LR and prevention group in predicting change in alcohol use behaviors; only among participants with strict adherence to the program was there an interaction between LR and program in predicting maximum drinks per occasion. However, overall, low LR individuals showed greater decreases in drinking behaviors, especially risky behaviors (e.g., maximum drinks, frequency of heavy drinking) than high LR individuals.

Conclusions

These results indicate that prevention programs, including brief and relatively inexpensive web-based programs, may be effective for persons at highest risk for heavier drinking, such as those with a low LR. Tailored programs may provide incremental benefits under some conditions. Long-term follow-ups and further investigations of tailored prevention programs based on other risk factors are needed.