When wanting to change is not enough: automatic appetitive processes moderate the effects of a brief alcohol intervention in hazardous-drinking college students

Addiction Science & Clinical Practice

Brian D Ostafin¹  Tibor P Palfai² 

[1] Department of Psychology, University of Groningen, Grote Kruisstraat 2/1, 9712, TS, Groningen, The Netherlands

[2] Department of Psychology, Boston University, Boston, MA, USA

关键词: Addiction;    Self-regulation;    Self-control;    Motivational intervention;    Implicit association test;    Alcohol;    Automatic processes;   

Others  :  789335
DOI  :  10.1186/1940-0640-7-25

 received in 2012-02-06, accepted in 2012-10-22,  发布年份 2012

【 摘 要 】

Background

Research indicates that brief motivational interventions are efficacious treatments for hazardous drinking. Little is known, however, about the psychological processes that may moderate intervention success. Based on growing evidence that drinking behavior may be influenced by automatic (nonvolitional) mental processes, the current study examined whether automatic alcohol-approach associations moderated the effect of a brief motivational intervention. Specifically, we examined whether the efficacy of a single-session intervention designed to increase motivation to reduce alcohol consumption would be moderated by the strength of participants’ automatic alcohol-approach associations.

Methods

Eighty-seven undergraduate hazardous drinkers participated for course credit. Participants completed an Implicit Association Test to measure automatic alcohol-approach associations, a baseline measure of readiness to change drinking behavior, and measures of alcohol involvement. Participants were then randomly assigned to either a brief (15-minute) motivational intervention or a control condition. Participants completed a measure of readiness to change drinking at the end of the first session and returned for a follow-up session six weeks later in which they reported on their drinking over the previous month.

Results

Compared with the control group, those in the intervention condition showed higher readiness to change drinking at the end of the baseline session but did not show decreased drinking quantity at follow-up. Automatic alcohol-approach associations moderated the effects of the intervention on change in drinking quantity. Among participants in the intervention group, those with weak automatic alcohol-approach associations showed greater reductions in the amount of alcohol consumed per occasion at follow-up compared with those with strong automatic alcohol-approach associations. Automatic appetitive associations with alcohol were not related with change in amount of alcohol consumed per occasion in control participants. Furthermore, among participants who showed higher readiness to change, those who exhibited weaker alcohol-approach associations showed greater reductions in drinking quantity compared with those who exhibited stronger alcohol-approach associations.

Conclusions

The results support the idea that automatic mental processes may moderate the influence of brief motivational interventions on quantity of alcohol consumed per drinking occasion. The findings suggest that intervention efficacy may be improved by utilizing implicit measures to identify those who may be responsive to brief interventions and by developing intervention elements to address the influence of automatic processes on drinking behavior.

【 授权许可】

   
2012 Ostafin and Palfai; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Wechsler H, Dowdall GG, Davenport A, Castillo S: Correlates of college student binge drinking. Am J Public Health 1995, 85:921-926.
• [2]Andersson B, Hibell B, Jävinen M, Room R (Eds): Youth Drinking Cultures: European Experiences. Aldershot, UK: Ashgate Publishing Ltd; 2007.
• [3]Engs RC, Diebold BA, Hanson DJ: The drinking patterns and problems of a national sample of college students. J Alcohol Drug Educ 1994, 41:13-33.
• [4]O’Neil SE, Parra GR, Sher KJ: Clinical relevance of heavy drinking during the college years: Cross-sectional and prospective perspectives. Psychol Addict Behav 2001, 15:350-359.
• [5]Jensen CD, Cushing CC, Aylward BS, Craig JT, Sorell DM, Steele RG: Effectiveness of motivational interviewing interventions for adolescent substance use behavior change: a meta-analytic review. J Consult Clin Psych 2011, 79:433-440.
• [6]Carey KB, Scott-Sheldon LAJ, Carey MP, DeMartini KS: Individual-level interventions to reduce college student drinking: a meta-analytic review. Addict Behav 2007, 32:2469-2494.
• [7]Dunn C, Deroo L, Rivara FP: College students’ readiness to reduce binge drinking: criterion validity of a brief measure. Addiction 2001, 109:236-238.
• [8]Miller WR: Motivational interviewing: research, practice, and puzzles. Addict Behav 1996, 21:835-842.
• [9]Borsari B, Carey KB: Effects of a brief motivational intervention with college student drinkers. J Consult Clin Psych 2000, 68:728-733.
• [10]Marlatt GA, Baer JS, Kivlahan DR, Dimeff LA, Larimer ME, Quigley LA, Somers JM, Williams E: Screening and brief intervention for high-risk college student drinkers: results from a 2-year follow-up assessment. J Consult Clin Psych 1998, 66:604-615.
• [11]McMahon J, Jones BT, Smith I: Negative expectancy based intervention within a motivational interviewing context. 1996. [Paper presented at the annual conference of the British Psychological Society]
• [12]McNally AM, Palfai TP, Kahler CW: Motivational interventions for heavy drinking college students: examining the role of discrepancy-related psychological processes. Psychol Addict Behav 2005, 19:79-87.
• [13]Branscum P, Sharma M: A review of motivational interviewing-based interventions targeting problematic drinking among college students. Alcsm Treat Quart 2010, 28:63-77.
• [14]Murphy JG, Benson TA, Vuchinich RE, Deskins MM, Eakin D, Flood AM, McDevitt-Murphy OT: A comparison of personalized feedback for college student drinkers delivered with and without a motivational interview. J Stud Alcohol 2004, 65:200-203.
• [15]Carey KB, Henson JM, Carey MP, Maisto SA: Which heavy drinking college students benefit from a brief motivational intervention? J Consult Clin Psych 2007, 75:663-669.
• [16]Deutsch R, Strack F: Reflective and impulsive determinants of addictive behavior. In Handbook of implicit cognition and addiction. Edited by Wiers RW, Stacy AW. Thousand Oaks CA: Sage; 2006:45-57.
• [17]Wiers RW, Bartholow BD, van den Wildenberg E, Thush C, Engels RCME, Sher K, Grenard J, Ames SL, Stacy AW: Automatic and controlled processes and the development of addictive behaviors in adolescents: a review and a model. Pharmacol Biochem Be 2007, 86:263-283.
• [18]Bechera A, Noel X, Crone EA: Loss of willpower: abnormal neural mechanisms of impulse control and decision making in addiction. In Handbook of implicit cognition and addiction. Edited by Wiers RW, Stacy AW. Thousand Oaks CA: Sage; 2006:215-232.
• [19]Fazio RH, Towles-Schwen T: The MODE model of attitude-behavior processes. In Dual process theories in social psychology. Edited by Chaiken S, Trope Y. New York: Guilford; 1999:97-116.
• [20]De Houwer J: A structural analysis of indirect measures of attitudes. In The psychology of evaluation: Affective processes in cognition and emotion. Edited by Musch J, Klauer KC. Mahwah, NJ: Lawrence Erlbaum; 2003:219-244.
• [21]Field M, Mogg K, Zetteler J, Bradley BP: Attentional biases for alcohol cues in heavy and light social drinkers: the roles of initial orienting and maintained attention. Psychopharmacology 2004, 176:88-93.
• [22]Noël X, Colmant M, Van Der Linden M, Bechara A, Bullens Q, Hanak C, Verbanck P: Time course of attention for alcohol cues in abstinent alcoholic patients: the role of initial orienting. Alcohol Clin Exp Res 2006, 30:1871-1877.
• [23]Stormark KL, Laberg JC, Nordby H, Hugdahl K: Alcoholics’ selective attention to alcohol stimuli: automated processing? J Stud Alcohol 2000, 61:18-23.
• [24]Cox W, Hogan LM, Kristian MR, Race JH: Alcohol attentional bias as a predictor of alcohol abusers’ treatment outcome. Drug Alcohol Depen 2002, 68:237-243.
• [25]Carpenter KM, Schreiber E, Church S, McDowell D: Drug Stroop performance: relationships with primary substance use and treatment outcome in a drug-dependent outpatient sample. Addict Behav 2006, 31:174-181.
• [26]Waters AJ, Shiffman S, Sayette MA, Paty JA, Gwaltney CH, Balabanis MH: Attentional bias predicts outcome in smoking cessation. Health Psychol 2003, 22:678-387.
• [27]Greenwald AG, McGhee DE, Schwartz JLK: Measuring individual differences in implicit cognition: the Implicit Association Test. J Pers Soc Psychol 1998, 74:1464-1480.
• [28]Wiers RW, van Woerden N, Smulders FTY, de Jong PJ: Implicit and explicit alcohol-related cognitions in heavy and light drinkers. J Abnormal Psychol 2002, 111:648-658.
• [29]Ostafin BD, Palfai TP: Compelled to consume: the Implicit Association Test and automatic alcohol motivation. Psychol Addict Behav 2006, 20:322-327.
• [30]Ostafin BD, Brooks JJ: Drinking for relief: negative affect increases automatic alcohol motivation in coping-motivated drinkers. Motiv Emotion 2011, 35:285-295.
• [31]Palfai TP, Ostafin BD: Alcohol-related motivational schema among hazardous drinkers: assessing implicit response tendencies using the modified-IAT. Behav Res Ther 2003, 41:1149-1162.
• [32]Ostafin BD, Marlatt GA, Greenwald AG: Drinking without thinking: an implicit measure of alcohol motivation predicts failure to control alcohol use. Behav Res Ther 2008, 46:1210-1219.
• [33]Saunders JB, Aasland OG, Babor TF, de la Fuente JR, Grant M: Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption-II. Addiction 1993, 88:791-804.
• [34]National Institute on Alcohol Abuse and Alcoholism Task Force: Recommended alcohol questions. 2003. http://www.niaaa.nih.gov/research/guidelines-andresources/recommended-alcohol-questions webcite.
• [35]Biener L, Abrams DB: The Contemplation Ladder: Validation of a measure of readiness to consider smoking cessation. Health Psychol 1991, 10:360-365.
• [36]Clair M, Stein LA, Martin R, Barnett NP, Colby SM, Monti PM, Golembeske C, Lebeau R: Motivation to change alcohol use and treatment engagement in incarcerated youth. Addict Behav 2011, 36:674-680.
• [37]McGee R, Williams S, Kypri K: College students’ readiness to reduce binge drinking: criterion validity of a brief measure. Drug Alcohol Depen 2010, 109:236-238.
• [38]Schneider W, Eschman A, Zuccolotto A: E-Prime user’s guide. Pittsburgh, PA: Psychology Software Tools; 2002.
• [39]Greenwald AG, Nosek BA, Banaji MR: Understanding and using the Implicit Association Test: I. An improved scoring algorithm. J Pers Soc Psychol 2003, 85:197-216.
• [40]Wood MD, Read JP, Palfai TP, Stevenson JF: Social influence processes and college student drinking: the mediational role of alcohol outcome expectancies. J Stud Alcohol 2001, 62:32-43.
• [41]Hurlbut BT, Sher KJ: Assessing alcohol problems in college students. J Am Coll Health 1992, 41:49-58.
• [42]Miller WR, Tonigan JS, Longabaugh R: The drinker inventory of consequences (DrInc): An instrument for assessing adverse consequences of alcohol abuse. Test manual. Bethesda, MD: National Institute on Alcohol Abuse and Alcoholism; 1995. [Project MATCH Monograph Series, vol 4]
• [43]Miller WR, Rollnick S: Motivational interviewing: Preparing people to change addictive behavior. New York: Guilford Press; 1991.
• [44]Aiken LS, West SG: Multiple regression: Testing and interpreting interactions. Thousand Oaks, CA: Sage; 1991.
• [45]Widiger TA, Smith GT: Substance use disorder: Abuse, dependence and dyscontrol. Addiction 1994, 89:267-282.
• [46]Friese M, Hofmann W, Wänke M: When impulses take over: moderated predictive validity of explicit and implicit attitude measures in predicting food choice and consumption behavior. Brit J Soc Psychol 2008, 47:397-419.
• [47]McClelland DC, Koestner R, Weinberger J: How do self-attributed and implicit motives differ? Psychol Rev 1989, 96:690-702.
• [48]Perugini M: Predictive models of implicit and explicit attitudes. Brit J Soc Psychol 2005, 44:29-45.
• [49]Daeppen JB, Gaueme J, Bady P, Yersin B, Calmes JM, Gmel G: Brief alcohol intervention and alcohol assessment do not influence alcohol use in injured patients treated in the emergency department: a randomized controlled clinical trial. Addiction 2007, 102:1224-1233.
• [50]Karpinski A, Steinman RB: The single category implicit association test as a measure of implicit social cognition. J Pers Soc Psychol 2006, 91:16-32.
• [51]Wiers RW, van de Luitgaarden J, van den Wildenberg E, Smulders FTY: Challenging implicit and explicit alcohol-related cognitions in young heavy drinkers. Addiction 2005, 100:806-819.
• [52]Gawronski B, Strack F: On the propositional nature of cognitive consistency: dissonance changes explicit, but not implicit, attitudes. J Exp Soc Psychol 2004, 40:535-542.
• [53]Houben K, Havermans RC, Wiers RW: Learning to dislike alcohol: conditioning negative implicit attitudes toward alcohol and its effect on drinking behavior. Psychopharmacology 2010, 211:79-86.
• [54]Schoenmakers TM, de Bruin M, Lux IRM, Goertz AG, Van Kerkhof DHAT, Wiers RW: Clinical effectiveness of attentional bias modification training in abstinent alcoholic patients. Drug Alcohol Depend 2010, 109:30-36.
• [55]Palfai TP: Automatic Processes in the Self-Regulation of Addictive Behaviors. In Handbook of implicit cognition and addiction. Edited by Wiers RW, Stacy AW. Thousand Oaks CA: Sage; 2006:411-424.
• [56]Ostafin BD, Bauer C, Myxter P: Mindfulness decouples the relation between automatic alcohol motivation and drinking behavior. J Soc Clin Psychol 2012, 31:729-745.
• [57]Ostafin BD, Marlatt GA: Surfing the urge: Experiential acceptance moderates the relation between automatic alcohol motivation and hazardous drinking. J Soc Clin Psychol 2008, 27:426-440.
• [58]Mastroleo NR, Murphy JG, Colby SM, Monti PM, Barnett NP: Incident-specific and individual-level moderators of brief intervention effects with mandated college students. Psychol Addict Behav 2011, 25:616-624.
• [59]Hunt WA, Barnett LW, Branch LG: Relapse rates in addiction programs. J Clin Psych 1971, 27:455-456.