Kate B. Carey - US grants

DESCRIPTION: (Applicant's Abstract) The long-term goal of this Stage I therapy development project is to reduce drug abuse and its negative consequences in persons with co-occurring schizophrenia. Persons diagnosed with both schizophrenia and a drug use disorder experience substantial dysfunction and poor treatment outcomes. Most receive treatment in the mental health system and do not acknowledge drug abuse as a problem. The Transtheoretical Model of Change, along with recent advances in motivational interventions, provides a useful framework to understand and change drug abuse in this context. The proposed research will occur in three phases. First, we will conduct formative research to guide the adaptation of assessment and intervention materials for use with persons with schizophrenia. Second, we will evaluate the reliability and validity of two theoretically important measures (readiness-to-change, decisional balance) in a sample of 100 outpatients with schizophrenia; these instruments will serve as the primary change measures in the pilot test of the motivational intervention. Third, we will develop and evaluate the feasibility of a brief motivational intervention intended to enhance readiness for drug abuse treatment. Twenty outpatients with DSM-IV diagnoses of schizophrenia and drug abuse or dependence will receive an individualized motivational intervention, designed to supplement their ongoing psychiatric treatment. Assessments at pre- and post-treatment and at a 12-week follow-up will evaluate therapy acceptability, readiness-to-change, psychiatric status, drug use, treatment involvement, and HIV risk behaviors. We predict that participants receiving the motivational intervention will increase their readiness to engage in drug abuse treatment and their perception of the advantages of reducing drug use, and decrease their perception of the disadvantages of such change. Exploratory analyses will evaluate the effects of the motivational intervention on treatment involvement, HIV risk behavior, and drug use.

DESCRIPTION: (Applicant's Abstract) This application requests support for an Independent Scientist Award (K02) for Kate Carey, Ph.D., and describes the applicant's research and career development plans. The applicant's previous and current NIDA-funded research focuses on substance use and abuse among severely and persistently mentally ill outpatients. Her career goals include (a) acquiring expertise in developing therapies that enhance motivation for change, (b) conducting treatment outcome research, and (c) mentoring junior scientists. This proposal describes two of three currently funded projects. Project 1 is an ongoing NIMH-funded study that is evaluating the efficacy of two prevention interventions for adults with severe mental illness. Participants are randomly assigned to a substance use reduction group, a HIV risk reduction group, or a standard treatment only group, all designed as supplements to outpatient psychiatric treatment. Both groups run for 10 sessions over 5 weeks, and incorporate education, motivational enhancement and behavioral skills components. Participants complete baseline, post-treatment, 3-month and 6-month follow-up assessments. Project 2 is a NIDA-funded Phase I therapy development project. This sequential research plan includes (a) psychometric research to identify measures that are sufficiently reliable and valid to serve as measures of outcome, and (b) the development and initial pilot testing of an add-on module designed to enhance readiness of outpatients with schizophrenia and drug use disorders to engage in drug treatment. Future plans involve continuing the therapy development process started in Project 2 with more sophisticated designs, optimizing the long-term effectiveness of motivational interventions by supplementing them with skills-based therapies, and identifying characteristics of responders and non-responders. The applicant's career development plans focus on activities designed to facilitate continued progress toward senior status and leadership in the field. These include continued skill development through courses and consultation with leading therapy development centers; collaboration with a productive group of local colleagues; conducting programmatic research; and providing research mentoring to junior scientists. This award would allow the applicant protected time (teaching relief and summer support) to continue to develop her research on the treatment of substance abuse among the severely mentally ill.

The long-term goal of this research is to reduce the risks associated with binge drinking among college students. Approximately 40% of college students are binge drinkers, defined as consuming 5 or more drinks at a single occasion for men (4 or more drinks for women) at least once in the last 2 weeks. Binge drinking is associated with a variety of academic, social, and health-related problems. Preliminary findings support the use of brief, motivational interventions (BMIs) to reduce binge drinking and its' negative consequences. BMIs used with college students often consist of an initial assessment session followed by an individualized feedback session. The latter includes personalized feedback (PF) with normative comparisons, and alcohol education (AE) with tips for reducing risk, delivered in a client-centered, motivational style. This proposal describes two related studies designed to evaluate the efficacy of BMIs with binge drinking college students. All BMIs will be enhanced with feedback related to the co-occurrence of drinking and risky sexual behavior, and each study will determine whether adding a decisional balance (DB) exercise to the "basic" BMI enhances outcomes. In Study l, 411 binge drinkers will be recruited from the general population of college students. Participants will be randomly assigned to an assessment only condition, a basic BMI (PF and AE), or an enhanced BMI (PF, AB and DB). All participants will provide data regarding drinking and related problems at 1, 6, and 12 months post-intervention. In Study 2, 411 binge drinkers will be recruited from among the students referred to a campus substance abuse agency. In this study, all participants will receive an intervention; they will be randomly assigned to AE, basic BMI (PF and AB), or enhanced BMI (PF, AB and DB). Analyses will determine (a) the effects of BMIs on drinking behavior and alcohol-related consequences, (b)the incremental utility of the DB exercise, and (c) the mediational role of hypothesized mechanisms of change (e.g., changes in norm perception and decisional balance). Findings will help to establish the efficacy of BMIs for reducing binge drinking and related problems in college students, and the generalizability of BMIs to students who have come to the attention of campus authorities because of alcohol-related infractions.

DESCRIPTION (provided by applicant): The long-term objective of this study is to reduce high-risk drinking and negative alcohol-related consequences in college students. The proposed research will evaluate outcomes, predictors and moderators of outcomes, and cost-effectiveness of three types of brief motivational interventions (BMIs): an empirically supported counselor-administered intervention and two computerized interventions (Alcohol 101 Plus and AlcoholEdu). Although these computer-administered BMIs are widely used and marketed, we lack controlled studies on behavioral outcomes for either of these prevention programs. Participants will be 700 at-risk student drinkers who have been sanctioned to receive an alcohol intervention because they violated residence hall alcohol policy. These referred students will be randomized to one of the three BMIs or to a delayed intervention control, and assessed at baseline and at 1, 6, and 12 months post-intervention. First, we will test hypotheses that (a) in the short-term, student drinkers who receive any of the interventions will reduce high-risk drinking and experience fewer negative consequences of drinking relative to students in the delayed intervention control condition; and (b) in the long-term, students who receive counselor-administered BMIs will reduce high-risk drinking and negative consequences to a greater extent than will students who receive either computer-administered BMI. Second, we will assess whether personal (e.g., gender, baseline drinking), motivational (e.g., readiness to change), and social influence (e.g., perceived norms, social network composition) variables will predict and/or moderate student response to the BMIs. Third, we will combine information on both the efficacy and the costs of all three interventions in a cost-effectiveness analysis. The results of the this study will provide guidance to university and college administrators who currently must make policy decisions without efficacy data regarding computer-administered BMIs, or information on the relative cost-effectiveness of BMIs administered by computer vs. by trained counselors.

DESCRIPTION (provided by applicant): This application requests support for an Independent Scientist Award (K02) for Kate Carey, PhD, and describes the applicant's research and career development plans. Dr. Carey's career goals are: (a) to develop, implement, and evaluate motivational interventions for risky drinking college students that are sensitive to the developmental context of college drinking; (b) to refine data analytic skills necessary to conduct state-of-the science longitudinal studies and to evaluate mechanisms and correlates of intervention related change; and (c) to mentor junior colleagues in the development and evaluation of alcohol abuse based prevention interventions. The research plan includes two currently funded and one planned study that evaluate the efficacy of brief motivational interventions (BMIs) in college drinkers. Study 1 recruits at-risk drinkers and compares a basic BMI to a BMI enhanced with a decisional balance exercise to an assessment-only control; participants provide assessment data at baseline, post-intervention, 1-, 6-, and 12- month follow-ups. Study 2 recruits students who are mandated to an intervention because of alcohol violations of school policy; in this study, the basic BMI is compared to a CD-ROM alcohol education program, with the same assessment schedule being used in Study 1. Study 3 will recruit students who have violated residence hall alcohol policies, and will compare the basic BMI with the CD-ROM educational tool. For all three studies, hypotheses regarding mediators and moderators of intervention effects will be evaluated. These and future research projects form a program of research that will test the efficacy of BMIs for selective and indicated prevention, and clarify the mechanisms through which they work. The proposed award would allow the applicant protected time to expand her alcohol interventions research, to acquire new and strengthen existing scientific skills, to collaborate with other senior scientists, and to provide research training to junior scientists.

The long-term objective of this study is to reduce high-risk drinking and negative alcohol-related consequences in college students. The proposed research will evaluate outcomes, predictors and moderators of outcomes, and cost-effectiveness of three types of brief motivational interventions (BMIs): an empirically supported counselor-administered intervention and two computerized interventions (Alcohol 101 Plus and AlcoholEdu). Although these computer-administered BMIs are widely used and marketed, we lack controlled studies on behavioral outcomes for either of these prevention programs. Participants will be 700 at-risk student drinkers who have been sanctioned to receive an alcohol intervention because they violated residence hall alcohol policy. These referred students will be randomized to one of the three BMIs or to a delayed intervention control, and assessed at baseline and at 1, 6, and 12 months post-intervention. First, we will test hypotheses that (a) in the short-term, student drinkers who receive any of the interventions will reduce high-risk drinking and experience fewer negative consequences of drinking relative to students in the delayed intervention control condition;and (b) in the long-term, students who receive counselor-administered BMIs will reduce high-risk drinking and negative consequences to a greater extent than will students who receive either computer-administered BMI. Second, we will assess whether personal (e.g., gender, baseline drinking), motivational (e.g., readiness to change), and social influence (e.g., perceived norms, social network composition) variables will predict and/or moderate student response to the BMIs. Third, we will combine information on both the efficacy and the costs of all three interventions in a cost-effectiveness analysis. The results of the this study will provide guidance to university and college administrators who currently must make policy decisions without efficacy data regarding computer-administered BMIs, or information on the relative cost-effectiveness of BMIs administered by computer vs. by trained counselors.

PROJECT SUMMARY/ABSTRACT High volume drinking and related adverse consequences pose significant health concerns at US colleges and universities; drinking behavior often leads to students being sanctioned for violations of campus alcohol policy. Given the widespread use of mandated alcohol interventions for these students, optimizing their initial effects and their duration could substantially mitigate adverse alcohol outcomes. Self-affirmation represents a promising adjunct to brief alcohol interventions, particularly those delivered via computer that are popular but tend to have smaller effects. Basic research shows that when self-affirmation exercises precede the receipt of health information, they decrease defensiveness and resistance to threatening health information and increase acceptance and processing of health messages. Furthermore, the facilitative effects of self-affirmation are strongest among those at higher risk. Because many mandated students display both defensiveness and high drinking severity, use of self-affirmation to enhance information processing and reduce defensive responding could optimize the efficacy of an active alcohol intervention in this at-risk subpopulation. We propose to use a two-group randomized design to investigate the effect of a self-affirmation exercise prior to an empirically supported brief alcohol intervention consisting of computer-delivered personalized normative feedback (PNF). Building on an extensive history of academic-student affairs collaborations, we will recruit 450 mandated students from a large public university over the course of 5 semesters. Our primary aim is to examine the additive effects of an initial self-affirmation (SA) manipulation prior to receiving PNF (SA + PNF) relative to Control + PNF on alcohol use and consequences. This study extends prior work by evaluating the ability of self-affirmation exercises to supplement active alcohol interventions (rather than just health messages), and tracking the impact on alcohol use over a longer (12-month) follow-up period. Secondary aims include (a) testing theoretically-derived mediation sequences that explain the SA + PNF effects on alcohol use and alcohol consequences, incorporating mechanisms of action associated with both self-affirmation and brief alcohol interventions, and (b) the examination of theoretical moderators of the effects of SA + PNF on alcohol use and alcohol consequences. We will use latent growth curve modeling analyses to examine direct and indirect intervention effects on alcohol use and consequence trajectories from (pre-intervention) baseline assessment across 1-, 3-, 6-, 9- and 12-month follow-ups. The public health goal of this research is to reduce the acute and chronic effects of alcohol misuse by improving the efficacy of a low intensity brief alcohol intervention. The findings of this study have both practical and theoretical implications. Demonstration of the additive utility of a very brief self-affirmation exercise could improve the efficacy and impact of currently available computer- delivered interventions for mandated students; it may also expand the reach of self-affirmation theory, leading to adaptation of self-affirmation for use with other at-risk populations receiving brief alcohol interventions.

Project Summary Using mobile technology that most students already have in their pockets, we propose a novel use of SMS text messages to change campus drinking norms. We aim to correct exaggerated perceptions of drinking norms, and thereby reduce excessive drinking, by delivering push notifications representing accurate, campus-specific, pro-moderation descriptive norms (what others do) and injunctive norms (what others approve of). We predict that with repeated exposure over time, this information will compete with other sources of normative information to which students are exposed during their first year of college. In this exploratory R21, we will develop and refine message content and pilot test the delivery methods. First, with input from student advisors, we will survey a representative sample of 300 students about personal behaviors and attitudes, and perceived descriptive and injunctive norms, for a wide range of alcohol-related behaviors and protective strategies. Extending the range of behaviors previously studied in the norms literature, these data will yield campus-specific norms and identify items with the largest self-other discrepancies as potential sources of corrective feedback. Second, we will translate the content into a pool of text messages and solicit feedback, iteratively, from approximately 40 first-year students. Third, we will conduct a pilot test of the SMS-delivered pro-moderation norms intervention to evaluate the effect of receiving these text messages on perceived peer norms, and high volume drinking and consequences. First year students (N=120) who are underage but report risky drinking (>4/day or >14/week for men; >3/day or >7/week for women) will be randomly assigned to two conditions differing by text content: alcohol norms or control. All will receive 5-6 text messages per week over 12 weeks. Process measures, 3-month post-test, and 3-month follow-up assessments will yield feasibility, acceptability, and preliminary outcome data to inform future larger scale randomized trials. We predict that the experimental condition will be acceptable and interesting, will protect against increases in pro-drinking perceived norms, and will result in less risky drinking and fewer alcohol consequences, relative to control. This project has public health significance because high volume drinking has harmful consequences to self and others, and has proven to be hard to change on college campuses; individual-level interventions typically have limited reach, and environmental policy changes can be hard to implement. This mHealth intervention offers a novel approach to prevention during a period of transition, and this study will provide proof-of-concept that SMS text messages can be used over time to correct exaggerated alcohol norms, a mechanism known to reduce excessive drinking and its negative consequences.

PROJECT SUMMARY/ABSTRACT The persistence of risky drinking among young adults in college calls for continued efforts to prevent harms related to alcohol. Current prevention interventions have achieved some success, but the majority of those interventions rely on a single mechanism of change: correcting exaggerated drinking norms. We propose to test a novel prevention strategy targeting another mechanism of change: creating attitude-behavior dissonance. To date, changing alcohol-related attitudes and the resulting attitude-behavior discrepancy have not been harnessed as a behavior change strategy for alcohol abuse prevention. Informed by an extensive literature showing strong and consistent associations between alcohol attitudes and drinking behavior, we adapted a brief counter-attitudinal advocacy (CAA) manipulation to the alcohol prevention context. The goals of the proposed research are to demonstrate (a) the utility of CAA to change high volume drinking and related consequences, (b) that attitude change and attitude-behavior dissonance mediates the CAA manipulation effect, and (c) that CAA-induced risk reduction is not inferior to an established intervention based on Personalized Normative Feedback (PNF). To achieve these goals, we propose a pair of studies implemented across two sites. First we conduct an initial survey to document peer behaviors and normative perceptions (N = 500 at each site), required to deliver accurate, campus-specific PNF. Next we conduct an RCT with 2 experimental conditions (CAA and PNF) and a 3rd assessment only control condition to determine the impact of CAA on alcohol outcomes. For the RCT, we will recruit a total of 600 heavy drinking students who endorse >2 alcohol-related negative consequence. Based on pilot work, we designed a prompt to elicit counter-attitudinal statements in favor of moderate drinking. Drawing from the college intervention literature, we will also use a standard PNF condition as a comparison. We will collect alcohol outcomes at 1-, 3-, and 6-month follow-ups. We will test hypotheses that, relative to assessment only control, the CAA manipulation will (a) increase positive moderate drinking attitudes, (b) decrease positive heavy drinking attitudes, (c) increase attitude- behavior dissonance, and (d) decrease drinks per drinking day, binge frequency, peak BAC, and alcohol consequences, and increase PBS. We will also test the hypothesis that CAA condition will be no less efficacious than (i.e., not inferior to) the PNF condition in reducing drinks per drinking day, binge frequency, peak BAC, and alcohol consequences. In addition, we will test hypotheses about participant characteristics (drinker identity, preference for consistency) that might moderate the influence of the CAA manipulations on drinking behaviors. This study will demonstrate the generalizability of attitude change theory and CAA methods to the alcohol prevention context, as well as their generalizability across demographically different settings. Implications for the public health include establishing the efficacy of a new approach for reducing high volume drinking and related consequences among young adults engaging in at-risk drinking.