Alcohol Expectancy Challenges: A Comprehensive Review

Transcription

1 Alcohol Expectancy Challenges: A Comprehensive Review Khatidja S. Ali, M.A. Leslie A. Robinson, Ph.D. Ashley M. Hum, M.S. Ashley A. Jackson, M.S. The Department of Psychology The University of Memphis, USA

2 Alcohol Outcome Expectancies Definition: the cognitive, affective, and behavioral outcomes an individual expects to occur due to drinking. 1 Expectancies vary from individual to individual. 2 Expectancies are contextual (i.e. the same individual s will vary based on the situation) Leigh, Connors, Maisto, & Derman, 1992

3 Positive Alcohol Outcome Expectancies Enhanced Socialization Sexual Enhancement Relaxation Assertion

4 The Role of Expectancies in Drinking Adult participants who expect positive outcomes drink more frequently. 1 consume more alcohol. 2 show more signs of problem drinking. 3 Teens who expect positive outcomes (even before they drink) are more likely to start drinking earlier. 4 to consume more alcohol Fromme et al., Werner, Walker, & Green, Christiansen et al., Carey, 1995

5 Alcohol Expectancy Challenge (AEC) Alcohol Expectancy Challenges (AECs) are treatments aimed at reducing positive expectancies. These treatments typically use bar-labs in which participants: 1. drink an alcoholic beverage or placebo 2. interact with each other 3. guess who consumed alcohol Outcome Participants will learn that they can t correctly guess who really drank based on behavior.

6 AEC Trials Theoretically, participants who have undergone an AEC should Have fewer positive outcome expectancies Drink less However, the outcomes of RCTs has been mixed.

7 Purpose of this Review Examine the effects of AECs on outcome expectancies alcohol consumption Examine the relative strengths and weaknesses of the literature Develop a research agenda for the area of AEC

8 Selection of Studies to Review Studies had to include a RCT using an AEC. Studies had to measure changes in outcome expectancies. Studies had to measure changes in alcohol consumption.

9 Methods Used to Review the Studies Twelve studies that met inclusion criteria were identified. We coded characteristics of the participants (gender, age, ethnicity, typical drinking patterns). sample size of the studies. types of control groups. assessment instruments. self-identification and misclassification errors made by participants.

10 Participant Characteristics of the Studies Reviewed Studies were limited to mostly Caucasian samples. young college students. Four studies had only male participants, 2 studies had only female participants, and 6 studies used both genders. Studies reported minimal information about the drinking patterns of the participants.

11 Methodological Characteristics of the Studies Reviewed Overall, the studies sample sizes had a mean of 123 participants (range ). Control groups included assessment only, alternative treatment groups, attention/monitoring conditions, etc. A variety of measures were used within the same study to assess change in expectancies (Mean = 5.07, SD = 2.20). Most studies (93%) assessed alcohol consumption by measuring the consumption of Standard Drinks (SD).

12 AECs Procedures Used by the Studies Studies have used varying procedures for expectancy challenges. Researchers have provided little information regarding the identification errors made by participants. Only 40% reported info on self-identification errors. Only 50% provided info on misclassification errors.

13 Calculation of Expectancy Outcomes We counted the number of measures finding significant differences between the Txmt Group & Controls. We then divided by the total number of measures used to evaluate each group comparison. % significant = # sig measures/total # measures.

14 Results of Treatment vs. Control Comparisons % of Significantly Different Expectancy Measures

15 Average Differences in Expectancies Overall, only 30% of the time were expectancies significantly different across groups.

16 Mediation Only two studies explored the mediating role of expectancies on consumption of alcohol. Only one study found that expectancies mediated the effects of alcohol consumption.

17 Alcohol Outcomes Most studies (79%) used only one measure for alcohol (i.e. number of SDs). Only 21% of studies measured heavy episodic drinking. We reported significant group vs. control differences on any measure of alcohol consumption. Only 36% of the time were there significant differences in alcohol consumption on any measure.

18 Conclusions Although the NIAAA (2002) has identified the AEC as a proven method to reduce alcohol use among college students (i.e. Tier 1 intervention), this review sounds a cautionary note regarding the helpfulness of AECs. Only 30% of the time were expectancies significantly different across groups. Only 36% of the time were there significant differences in alcohol consumption.

19 Limitations Lack of power randomized controlled studies (n = 12) tests of mediation

20 Where Do We Go From Here? Sufficient power to identify small to moderate effect sizes Measures of self-identification and misclassification errors Relevant measures of expectancies targeted by the intervention Thorough measures of drinking patterns Test for mediation effects

21 References Carey, K. B. (1995). Alcohol-related expectancies predict quantity and frequency of heavy drinking among college students. Psychology of Addictive Behaviors, 9, Christiansen, B. A., Smith, G. T., Roehling, P. V., & Goldman, M. S. (1989). Using alcohol expectancies to predict adolescent drinking behavior after one year. Journal of Consulting and Clinical Psychology, 57,, Connors, G. J., Maisto, S. A., & Derman, K. H. (1992). Alcohol-related expectancies and their applications to treatment. In R. R. Watson n (Ed.), Drug and alcohol abuse reviews: Vol. 3. Alcohol abuse treatment (pp ). Totowa, NJ: Humana Press. Fromme, K., Stroot, E. A., & Kaplan, D. (1993). Comprehensive effects fects of alcohol: Development and psychometric assessment of a new expectancy questionnaire. Psychological Assessment, 5, Leigh, B. C. (1989). In search of the seven dwarves: Issues of measurement m and meaning in alcohol expectancy research. Psychological Bulletin, 105, Werner, M. J., Walker, L. S., & Greene, J. W. (1993). Alcohol expectancies, problem drinking, and adverse health consequences. Journal of Adolescent Health. 14,

22 Alcohol Expectancy Challenge Studies Corbin, W. R., McNair, L. D., & Carter, J. A. (2001). Evaluation of a treatment-appropriate cognitive intervention for challenging alcohol outcome expectancies. Addictive Behaviors, 26, Darkes, J., & Goldman. M. S. (1993). Expectancy Challenge and drinking reduction: Experimental evidence for a mediation process. Journal of Counseling and Clinical Psychology, 2, Darkes, J., & Goldman, M. S. (1998). Expectancy Challenges and drinking reduction: Process and Structure in the Alcohol Expectancy Network. Experimental and Clinical Psychopharmacology, 6, Dunn, M.E., Lau, H. C., & Cruz, I. Y. (2000). Changes in activation of alcohol expectancies in memory in relation to changes in alcohol use after participation in an expectancy challenge program. Experimental and Clinical Psychopharmacology, 8, Keillor, R. M., Perkins, W. B., & Horan, J. J. (1999). Effects of videotaped expectancy challenges on alcohol consumption of adjudicated students. Journal of Cognitive Psychotherapy, 13, Kulick, A. D. (2002). A new expectancy-challenge prevention program: The effects of drinking and alcohol expectancy in at-risk collegiate women. Dissertation Abstracts International, 67, Lau-Barraco, C., Dunn, M. E. (2008). Evaluation of a single-session Expectancy challenge intervention to reduce alcohol use among college students. Psychology of Addictive Behaviors, 22,

23 Alcohol Expectancy Challenge Studies Musher-Eizenman, D. R. & Kulick, A. D. (2003). An Alcohol Expectancy-Challenge prevention program for at-risk college women. Psychology of Addictive Behaviors, 17, Van de Luitgaarden, J., Wiers, R. W., Knibbe, R. A., & Boon, B. J. (2006). From the laboratory to real life: A pilot study of an expectancy challenge with heavy drinking young people on holiday. Substance Use and Misuse, 41, Van de Luitgaarden, J., Wiers, R. W., Knibbe, R. A., & Candel, M. J. (2007). Single-session expectancy challenge with young heavy drinkers on holiday. Addictive Behaviors, 32, Wiers, R. W., & Kummeling, R. H. C. (2004). An experimental test of an alcohol expectancy challenge in mixed gender groups of young heavy drinkers. Addictive Behaviors, 29, Wiers, R. W., Van de Luitgaarden, J., Van den Wildenberg, E., & Smulders, F. T. Y. (2005). Challenging implicit and explicit alcohol-related cognitions in young heavy drinkers. Addiction, 100, Wood, M. D., Capone, C., Laforge, R., Erickson, D. J., & Brand, N. H. (2007). Brief Motivational intervention and alcohol expectancy challenge with heavy drinking college students: A randomized factorial study. Addictive Behaviors, 32,