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Protective behavioral strategies mediate the relationship between behavioral economic risk factors and alcohol-related problems.

ABSTRACT: Behavioral economic measures of alcohol reward value and future orientation have received support as predictors of alcohol consumption, alcohol-related problems, and response to intervention. Protective behavioral strategies (PBS) have been shown to be a significant mediator between a variety of risk factors and alcohol-related problems. The current article examines direct and mediating associations between measures of alcohol reward value (proportionate substance-related activity participation and enjoyment) and future orientation, use of PBS, and alcohol-related problems. Participants were 393 undergraduates (39.2% male, 78.9% Caucasian) who reported at least 2 past-month binge drinking episodes (5 and 4 drinks for men and women, respectively). This study is a secondary analysis of data collected previously as part of a brief intervention study. Alcohol reward value and future orientation were significantly associated with both protective behavioral strategies and alcohol problems. PBS was a significant partial mediator between these variables and alcohol-related problems after controlling for gender, level of alcohol consumption, and sensation seeking. This study provides support for the hypothesis that high levels of reinforcement from alcohol relative to alternatives and low consideration of the future may lead to patterns of dysregulated drinking with few harm-reduction strategies that increase risk for alcohol problems. In addition to directly targeting PBS, brief alcohol interventions for college students should attempt to increase future orientation and substance-free activities. (PsycINFO Database Record

SUBMITTER: Voss AT

PROVIDER: S-EPMC5794516 | biostudies-literature | 2018 Feb

REPOSITORIES: biostudies-literature

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Protective behavioral strategies mediate the relationship between behavioral economic risk factors and alcohol-related problems.

Voss Andrew T AT Soltis Kathryn E KE Dennhardt Ashley A AA Martens Matthew P MP Murphy James G JG

Experimental and clinical psychopharmacology 20180111 1

Behavioral economic measures of alcohol reward value and future orientation have received support as predictors of alcohol consumption, alcohol-related problems, and response to intervention. Protective behavioral strategies (PBS) have been shown to be a significant mediator between a variety of risk factors and alcohol-related problems. The current article examines direct and mediating associations between measures of alcohol reward value (proportionate substance-related activity participation ...[more]

PMID: 29323504

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Project description:Rationale: Lung-protective ventilation (LPV) improves outcomes in patients with acute respiratory distress syndrome (ARDS) and has also shown benefits in patients without ARDS. Despite this evidence, LPV use remains low.Objectives: To understand clinicians' perceptions of using behavioral economic strategies to improve rates of LPV use.Methods: We conducted semistructured interviews of clinicians across seven intensive care units within a university health system. We purposefully sampled clinicians of different professional backgrounds and experience levels. Each interview included descriptions of three of five strategies grounded in behavioral economic theory designed to facilitate clinicians' use of LPV: 1) an order set autopopulated with LPV settings ("default"), 2) an order set providing a choice between autopopulated LPV settings and open-ended order entry for alternative settings ("active choice"), 3) requirement of written justification if settings other than LPV were ordered or documented ("accountable justification"), 4) automated ARDS identification and clinician prompting ("alert"), and 5) provision of clinicians' and their peers' individual rates of LPV use ("peer comparison"). Descriptions were followed by open-ended questions to elicit perceptions about advantages, disadvantages, and acceptability. Initial interview transcripts were reviewed by two investigators to develop a thematic codebook, which was refined iteratively with the use of constant comparative methods.Results: We completed 17 interviews of physicians, nurse practitioners, and respiratory therapists. Strategies that prepopulated settings (default, active choice, and accountable justification) were perceived as providing benefit by reducing workloads and serving as cognitive prompts. The default and active choice strategies were more acceptable than accountable justification, which was perceived as potentially frustrating due to workflow impedance. The alert strategy was met with concerns about alert accuracy and alarm fatigue. The peer comparison strategy led to concerns about timing and fear of punitive measures. Participants believed that the default and active choice strategies would be highly acceptable, whereas few interviewees thought the alert would be acceptable. The active choice strategy was most consistently identified as potentially highly effective.Conclusions: Behavioral economic strategies have great potential as acceptable and potentially effective strategies to increase the use of LPV.

Project description:Introduction:Behavioral economic theory views addiction as a reinforcer pathology characterized by excessive demand for drugs relative to alternatives. Complementary to this theory, Lamb and Ginsburg (Pharmacology Biochemistry and Behavior, 164, 2018, 62) describe addiction as a behavioral allocation disorder and predict that decisions to drink under increasingly stringent constraints are a central indicator of addiction. This study used a modified demand-curve paradigm to examine alcohol demand in the context of a next-day contingency (high opportunity cost demand) as a specific indicator of a severe pattern of alcohol problems.Methods:Participants were 370 undergraduates (61.1% female, 86.5% white, Mage = 18.8) reporting multiple past-month heavy drinking episodes (5/4 drinks per occasion for men/women) who completed 2 versions of an alcohol purchase task (APT), along with measures of past-month alcohol use and problems. In 1 APT (low opportunity cost), students imagined they had no next-day responsibilities, and in the other APT (high opportunity cost), they imagined having a 10:00 am test the next day. Item-response theory analyses were used to determine mild and severe alcohol problems from the Young Adult Alcohol Consequences Questionnaire (Journal of Studies on Alcohol, 67, 2006, 169), and the most and least severe binge drinking days throughout the week.Results:Low opportunity cost demand (? = 0.15, p = 0.02) significantly predicted beyond high opportunity cost demand for the least severe problems, and high opportunity cost demand (? = 0.17, p = 0.009) significantly predicted beyond low opportunity cost demand for the most severe problems. Similarly, low opportunity cost demand (? = 0.26, p < 0.001) was more highly associated with weekend drinking, whereas high opportunity cost demand (? = 0.21, p = 0.001) was more highly associated with weekday drinking.Conclusions:The current results suggest high opportunity cost alcohol demand is a distinct marker of severe alcohol problems among college student heavy drinkers.

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Protective behavioral strategies mediate the relationship between behavioral economic risk factors and alcohol-related problems.

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Protective behavioral strategies mediate the relationship between behavioral economic risk factors and alcohol-related problems.

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