Research suggests late adolescence and emerging adulthood (EA; roughly encompassing ages 18-25) are associated with increased risk for development of substance misuse, abuse, and dependence.  Despite increased risk overall during this period, there is considerable variability in drinking trajectories during young adulthood (Schulenberg et al., 1996; Tucker et al., 2005). Much of the research on alcohol use and prevention during EA has focused on students who matriculate into college during this period (Larimer & Cronce, 2002), with relatively little research focused on etiology and prevention of alcohol use among individuals who do not immediately matriculate to college (White et al., 2005).  Further, little research has compared trajectories of alcohol use and consequences in international samples, including the individual, social, and environmental/cultural factors influencing trajectories and transitions in alcohol use patterns. Finally, almost no research has systematically evaluated efficacy of preventive interventions offered prior to the transition from high school as a means of altering trajectories during EA. The current research is designed to address these gaps, through a longitudinal study of a cohort of high school students in both the US and Sweden, and the evaluation of web-based interventions offered to a random subset (n=400 per country) at the end of high school as a means of reducing or preventing excessive alcohol consumption and related consequences.  Specific aims of the current application are: 1) Evaluate intrapersonal, peer, parental, environmental, and cultural predictors of alcohol use trajectories upon the transition from high school in US and Swedish populations, guided by the Theory of Triadic Influence; 2) Evaluate the efficacy of a web-based interactive feedback and skills intervention in reducing alcohol use and negative consequences over a four-year follow-up period; 3) Evaluate moderators of intervention efficacy, including individual-level and cultural factors; and 4) Evaluate mediators of intervention efficacy.  Aims will be achieved through a longitudinal follow-up survey of 2400 teens across 2 sites: the King Country region of Washington State and the Skane region of Sweden. Teens will be recruited during their senior year in high school and assessed twice per year for 4 years. 

Alcohol use, misuse and resulting negative consequences among college students have been extensively documented. Despite substantial efforts and recent advances in understanding and preventing excessive consumption and related harm, considerable gaps in the literature regarding etiology and maintenance of high-risk college drinking remain. Prior research has documented that negative alcohol-related events can promote changes to drinking behavior, motivations for change, and cognitions related to drinking. The proposed study will help to understand how self-change might occur among young adult college students as a result of experienced negative consequences. In this proposal, we use an event-level perspective to examine the interrelationships of expectancies, drinking, and consequences. Using Interactive Voice Response (IVR), 400 college students will report on their expectancies, drinking, and alcohol-related consequences three times daily for four two-week intervals over one year. By using daily reports over time, we can ensure temporal relationships between expectancies, drinking, and consequences; minimize recall bias; investigate reciprocal relationships of expectancies, drinking and consequences; and examine both within- and between-person influences on drinking and consequences. Using multilevel modeling, we will (1) examine the daily relationships between alcohol expectancies and alcohol use; (2) study bidirectional influences of expectancies, consequences, and drinking over time; (3) examine whether the immediate consequences of drinking change subsequent expectancies and drinking over time; and (4) examine the time-varying and time-invarying moderators of the within-person relationships between expectancies, drinking, and consequences. The factors related to self-change are important for understanding the maintenance and fluctuations of high-risk drinking and may ultimately help inform interventions targeted to drinkers who are at risk for consequences but are not seeking intervention or treatment.

Heavy episodic drinking (HED) among college students is a persistent public health problem with severe consequences, including development of substance-use disorders, psychosocial problems, health risks, accidental injuries, and death. National US survey data indicate more than 80% of college students report consuming alcohol in the past year, with 44% reporting heavy episodic drinking (HED; 5/4 drinks per occasion for men/women) at least once in the previous 2 weeks. In addition, it has been reported that nearly all college smokers drink alcohol and usually smoking and HED co-occur. One National US survey found 98% of current smokers drank alcohol and 44-59% of drinkers smoked cigarettes. Furthermore, the co-occurrence risk was greatest among students who reported greater alcohol consumption (OR=4.21, p< .0001), having a drinking problem (OR = 3.31, p< .0001), and those who reported using drinking to cope with their problems (OR=2.19, p< .05). In order to achieve a better understanding of these risk behaviors and identify potential points for intervention, the overall aim of the proposed study is to develop an individually-tailored, computerized intervention targeting HED among college student smokers. The first aim of this research is to gain a better understanding of these processes using ecological momentary assessment (EMA). The information obtained from EMA daily reports of drinking and smoking will be used to model the dynamics of proximal influences on HED. The results from these models will thereby identify points of intervention for college student smokers who engage in HED. Following from this basic research, we plan to translate the models into an intervention that would be administered in real-time via an interactive program installed on an electronic device. The final aim of the proposed study will be to evaluate the efficacy of the empirically-based intervention in a randomized controlled trial comparing the computerized intervention to an electronic assessment-only control groups in a sample (n=126) of college student smokers who engage in HED. More specifically, the computerized intervention will incorporate components of the successful intervention, Brief Alcohol Screening and Intervention for College Students (BASICS), as well as a recently developed brief smoking intervention for nontreatment seeking college student smokers. The intervention, BASICS-ED, will be administered in real-time on an electronic device. The program will be developed using branching algorithms, such that ongoing assessment of momentary changes in an individual’s environment will determine the selection and ordering of modules, providing individually-tailored BASICS messages and the smoking intervention in real-time. Project Description

To give you some context, past research has shown that college students tend to drink the most and experience the most extreme consequences (e.g., alcohol poisoning, sexual assault) during specific events that are deemed celebratory occasions where the typical drinking patterns or personal limits regarding alcohol don't seem to apply. ESP is in the second stage of a 5 year federally funded project and is designed to examine the effectiveness of a web-based vs. in-person motivational intervention designed to help college students stay safe while celebrating their 21st birthdays and going on spring break trips (2 specific events that have been associated with extreme drinking). In addition, we are also recruiting friends that students plan to celebrate with during these events to be involved in the study to help make sure that the participant stays safe while celebrating/vacationing.

The study evaluates an indicated prevention intervention among college students at risk for experiencing marijuana-related negative consequences (i.e., frequent users).  It follows an R21 study which suggests the continued need for examination of personalized feedback as an active component in interventions aimed at reducing marijuana use. The research is a natural extension of our previous and ongoing work and has the potential to offer a needed option for emerging adult marijuana users who may be on a trajectory toward potentially life-altering negative consequences related to their marijuana use.   

The purpose of this research is to reduce alcohol-related negative consequences and drinking behavior among college students. This study will contrast the efficacy of personalized normative feedback regarding specific reference groups (i.e., gender-, ethnicity-, and residence-type-specific feedback) versus a generic (typical college student) reference group, evaluate the role of salience or relevance of the normative reference group in moderating the efficacy of personalized feedback regarding descriptive drinking norms, and evaluate the unique and combined influences of feedback regarding descriptive and injunctive norms on drinking behavior 

Posttraumatic stress disorder (PTSD) and alcohol use disorders (AUD) co-occur frequently, which is concerning given that individuals with PTSD/AUD are more treatment resistant and prone to relapse following treatment compared to individuals with only AUD. This relationship may be explained by theories positing that individuals with PTSD/AUD use alcohol to cope with distressing PTSD symptoms. Theories of PTSD suggest that emotional engagement, or evoking key emotional experiences related to the trauma memory, is crucial in resolving symptoms. However, trauma-related symptoms and emotions are often not addressed in treatment for AUD. Thus, lack of emotional engagement may contribute to alcohol relapse through a cycle where unresolved PTSD symptoms maintain alcohol cravings and use. Given the treatment refractory nature of PTSD/AUD, understanding underlying mechanisms explaining how symptoms of PTSD may contribute to alcohol relapse and how we may best intervene with this population is of great clinical importance. The overall goal of this study is to examine emotional engagement with the trauma memory during treatment for AUD as a predictor of decreased relapse to alcohol use following treatment. Specifically, this research will investigate the direct relationship between emotional engagement and self-reported alcohol cravings and relapse at 3-months post-treatment for AUD, the relationship between beliefs about ability to tolerate trauma-related emotions, coping motives for alcohol use and self-reported alcohol cravings and relapse at 3-months post-treatment for AUD, and whether coping beliefs mediate the relationship between emotional engagement, alcohol cravings, and relapse. This study will enroll 100 women currently in treatment for alcohol dependence with co-occurring trauma histories and symptoms of PTSD. Assessments will be conducted at pre-treatment, post-treatment, and at 3-month follow-up. In order to explore study aims, emotional engagement will be manipulated through a 3 session narrative writing assignment designed to elicit engagement with the trauma memory and level of emotional engagement will be assessed with both self-report and coding. In addition, beliefs about ability to tolerate trauma-related distress and coping motives for alcohol use as well as cravings and relapse will be examined. Overall, this study seeks to better understand mechanisms of relapse to alcohol use in women with PTSD/AUD, and has the potential to identify important intervention targets for this difficult to treat population. 

Heavy drinking among college students continues to be a public health concern for colleges and universities throughout the United States. Prevalence rates of heavy episodic drinking in college populations range from 40 to 50%, with nearly one out of four students reporting extreme drinking tendencies including frequent heavy episodic drinking (3 times or more within a two-week period), as well as drinking on 10 or more occasions within the past 30 days.

Despite the utility of parent communication documented in recent empirical studies, a notable gap exists in the prevention literature after the first year in college. There are no published reports examining implementation of parent approaches beyond that point. This is concerning as there is growing evidence suggesting that alcohol-related consequences are increasing for older students aged 21-24. The under-examination of parents beyond the first year may derive from the continuation of the widespread assumption that parents’ influence on their students recedes at this stage of development. Moreover, an important component of the success of parent-based interventions hinges on parents’ willingness to communicate with their students. We know of no studies examining parental willingness to communicate with their students about alcohol throughout college. Thus, the present research represents the next logical step in our research program by proposing to conduct a comprehensive examination of variables influencing parents’ willingness to communicate with their students about alcohol throughout their entire college experience. The purpose of the study is to gain a better understanding of parental communication and its relationship to student drinking behavior by examining patterns that emerge while individuals are under legal drinking age on through 21.

To this extent, the aims of the proposed research are to:

1. Examine the processes by which predictors and mediating constructs of parental communication about alcohol are associated with parent-student communications.

2. Examine the processes by which parent-student communications about alcohol predict student drinking mediating constructs and subsequent student drinking outcomes.

3. Examine developmental changes using a prospective longitudinal design between parent communication constructs and student drinking outcomes through the entire college experience.

The broad, long-term objective of the current research is to reduce the prevalence of disordered gambling and co-morbid substance use disorders and related harm in the population, through development of efficacious and cost-effective indicated prevention/early intervention techniques. While many individuals gamble as an occasional form of entertainment, a significant subset of the population experiences substantive harm related to their gambling. Gambling has been described as a behavioral addiction, with considerable neurobiological and symptom similarity to substance use disorders (SUD). Further, disordered gambling is associated with very high rates of alcohol and drug (AOD) use and SUD co-morbidity. Gambling has been conceptualized as a continuum, from no gambling and non-problem gambling, to at-risk gambling, to diagnosable pathological gambling. Disordered gambling (at-risk and pathological) is estimated to affect 3-5% of the U. S. adult population, with higher rates often reported in young adult (college aged) populations. Disordered gambling has been associated with a host of serious consequences for the gambler and society, including financial, legal, social, familial, and work/educational difficulties as well as elevated rates of anxiety, depression, and suicidal ideation and behavior. These findings have lead to an increasing recognition of disordered gambling as a significant public health problem. The current research builds on our prior work on development of indicated prevention approaches for disordered gambling (R21 MH067026). Our findings indicate a brief, personalized feedback intervention (PFI) utilizing graphic feedback and motivational enhancement strategies is efficacious in reducing gambling and related consequences in a vulnerable population (college students) at risk for or already evidencing pathological gambling. Based on these encouraging findings, we propose to evaluate the longer-term efficacy of this approach, and determine relative efficacy of web- and in-person implementation of PFI interventions, for at-risk gamblers with co-morbid SUDs. Specific aims are: 1) Evaluate relative efficacy of in-person vs. web-based PFIs in comparison to assessment only, in reducing gambling behavior, AOD use, and related consequences of at-risk college student gamblers with SUDs. Participants (N=375) screened as at-risk gamblers with SUD will be randomly assigned to one of 3 conditions: a) in-person motivational PFI; b) web-based PFI; or c) repeated assessment comparison group, assessed at post-intervention, 3-, 6-, 12-, and 24-month follow-up. 2) Evaluate choice of intervention, gambling motives, and substance use as moderators of efficacy. 3) Evaluate mediators of intervention efficacy, including perceived descriptive gambling norms, readiness to change, illusions of control, and depth of processing of information.

Research suggests that perceptions and misperceptions of the normative nature of high-risk and that providing personalized information on actual norms can lead to reductions in drinking and risky sexual behavior. The long-term goal of this research is to reduce alcohol consumption, alcohol-related risky behavior, and their negative consequences among college students. This research will have both theoretical and practical implications regarding interventions designed to combat the serious health problems posed by college student drinking and risky sexual behavior. The primary aims of this research will be carried out by conducting 3 separate studies over 5 years at the University of Washington

The program goals are to (1) improve specific programs funded by the Victims of Torture Program; (2) transfer capacity to VTF partners to use the design, implementation, monitoring and evaluation (DIME) process; (3) enhance the field of torture and trauma treatment by expanding knowledge on the needs of torture and trauma-affected populations. As part of this project we will be adapting Cognitive Processing Therapy for PTSD for torture survivors in the Democratic Republic of Congo and in South, Central, and Northern Iraq.

Numerous clinical trials have shown that Motivational Interviewing (MI; Miller & Rollnick, 2002) is an efficacious treatment for alcohol use disorders (AUD) and related health behavior problems (Burke, Dunn, Atkins, & Phelps, 2005; Elliott, Carey, & Bolles, 2008; Rubak, Sandbaek, Lauritzen, & Christensen, 2005). However, there is comparatively little information on the therapy mechanisms of MI (Huebner & Tonigan, 2007). Process research has typically relied on behavioral coding schemes such as the Motivational Interviewing Skills Code (MISC; Miller, Moyers, Ernst, & Amrhein, 2008). Although MI mechanism research with the MISC has produced some of the best data to date (e.g., Moyers et al., 2007), behavioral coding has a number of limitations: 1) it is phenomenally labor intensive, 2) objectivity, reliability, and transportability of coding can be challenging, and 3) it is inflexible (i.e., any new codes require completely new coding).

The current proposal brings together a highly interdisciplinary team to develop linguistic processing tools to automate the coding of the MISC and the related Motivational Interviewing Treatment Integrity (MITI; Moyers, Martin, Manuel, Miller, & Ernst, 2007). The coding of both systems is based on two types of linguistic data: what is said, and how it is said. Our team members in computer science, cognitive science, and electrical engineering are leading researchers in text-mining and speech signal processing, and their methods will be applied to MI transcripts and recordings to automate coding of the MISC/MITI.

The core, methodological tool will be the topic model (Steyvers & Griffiths, 2007), a Bayesian model of linguistic knowledge representation. The topic model identifies groupings of words that constitute meaning units (or topics), and recent extensions have used it with tagged data (e.g., MISC codes) in which the model learns what specific text is associated with specific tags.

Two specific aims encompass the current proposal: 1) Assess the accuracy of the topic model to automatically code the MISC/MITI using transcripts and voice recordings of MI sessions, and 2) Test MI theory (within session and long-term outcome) using approximately 1,167 sessions of MI coded in Aim 1. These aims will be accomplished using three MI intervention studies: two studies focused on college student drinking and one hospital-based study of drug abuse. The long-term objectives are to use innovative linguistic tools to study the therapy mechanisms of MI and in the process, develop more efficient systems for collecting psychotherapy process data. Alcohol use disorders continue to represent an incredible societal burden in terms of death, health complications, fractured relationships, and economic costs. The current research will provide innovative tools for studying why therapy works, which in turn can help to ameliorate some of the deleterious effects of AUD.

The broad, long-term objective of the current research is to reduce the prevalence of problem drinking and related harm in at-risk subgroups of emerging adult women. Prior research has established that specific subgroups of youth are at elevated risk for hazardous drinking; this disparity is particularly striking for young lesbian and bisexual women. The proposed research aims to evaluate risk and protective factors for hazardous drinking in young women, focusing on both self-medication and social influences. Although more is known regarding the relative prevalence of drinking behaviors in at-risk women, there is little research examining risk factors or protective factors for drinking that are specific to this population. Furthermore, few studies have examined possible mediators and moderators of drinking in young at-risk women, especially studies utilizing longitudinal or event-level methodologies. These methodologies are critical in order to reduce recall distortion, adequately examine temporal relationships between variables, and understand the development of hazardous drinking over time. The purpose of the present application is test the role of self-medication and coping motives and the role of social influences and identity salience in predicting drinking behavior among young (age 18-25) at-risk women. We will examine both how these behaviors change over time and will also conduct a smaller exploratory study to examine drinking at the event-level women who drink. To accomplish this objective the study will include 900 women recruited through online networking communities and advertisements. Hazardous drinking and proposed mediators and moderators of drinking will be assessed annually for three years. A subgroup of 100 women who drink at least twice per week will complete two weeks of daily measures annually to examine risk factors and drinking behavior at the daily level. Specific aims are: 1) testing a self-medication model of high risk drinking, where stressors, psychological distress, and drinking to cope are examined in relation to hazardous drinking over time; 2) testing a social influences model of high risk drinking, where social influences, social norms, social motives, and identity salience are examined in relation to drinking hazardous drinking over time; 3) To examine event-level within-person relationships between stress, psychological distress, covariation in social contexts, and situation-specific drinking norms in predicting daily drinking behavior.