Alcohol Expectancy Challenges: A Comprehensive Review

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

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). 2 1. Leigh, 1989 2. Connors, Maisto, & Derman, 1992

Positive Alcohol Outcome Expectancies Enhanced Socialization Sexual Enhancement Relaxation Assertion

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. 4 1. Fromme et al., 1993 3. Werner, Walker, & Green, 1993 2. Christiansen et al., 1989 4. Carey, 1995

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.

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.

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

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.

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.

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.

Methodological Characteristics of the Studies Reviewed Overall, the studies sample sizes had a mean of 123 participants (range 25-335). 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).

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.

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.

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

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

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.

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.

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.

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

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

References Carey, K. B. (1995). Alcohol-related expectancies predict quantity and frequency of heavy drinking among college students. Psychology of Addictive Behaviors, 9, 236-241. 241. 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,, 93-99. 99. 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. 203-231). 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, 19-26. Leigh, B. C. (1989). In search of the seven dwarves: Issues of measurement m and meaning in alcohol expectancy research. Psychological Bulletin, 105, 361-373. 373. Werner, M. J., Walker, L. S., & Greene, J. W. (1993). Alcohol expectancies, problem drinking, and adverse health consequences. Journal of Adolescent Health. 14, 446-452. 452.

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, 475-488. Darkes, J., & Goldman. M. S. (1993). Expectancy Challenge and drinking reduction: Experimental evidence for a mediation process. Journal of Counseling and Clinical Psychology, 2, 344-353. Darkes, J., & Goldman, M. S. (1998). Expectancy Challenges and drinking reduction: Process and Structure in the Alcohol Expectancy Network. Experimental and Clinical Psychopharmacology, 6, 64 76. 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, 566-575. 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, 179-187. 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, 5394. 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, 168-175.

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