James G Murphy, PhD - US grants

PROJECT SUMMARY/ABSTRACT Alcohol misuse remains a major public health problem in emerging adults (age 18-25). Excessive drinking is the largest source of morbidity and mortality in this age group and also predicts subsequent alcohol problems across the lifespan. A large number of cross-sectional studies have found significant associations between alcohol misuse and indices from behavioral economics. Specifically, two novel behavioral economic domains - alcohol demand and proportionate alcohol-related reinforcement - have been consistently associated with alcohol misuse in emerging adults in cross-sectional and laboratory studies. These motivational measures may clarify the development of alcohol misuse, but no longitudinal studies have been conducted to date. The proposed study will use a longitudinal risk design to systematically investigate the relationship between these measures and changes in alcohol misuse in emerging adults. Specifically, the study will leverage these novel risk indicators to predict changes in drinking from age 22 to 25, a time period when many individuals `mature out' of alcohol misuse but others exhibit persistently high levels of problem drinking. To address this question, the study will assess 530 at-risk drinkers (50% male/50% female) every three months from 22 to 25 using in- person and Internet-based assessments. The study has two primary aims. The first primary aim is to predict changes in alcohol misuse in emerging adults using the novel behavioral economic measures - individually, in combination with one another, and in the context of established risk factors. The second primary aim is to examine mediating and moderating relationships. Mediational analyses will test whether the behavioral economic variables causally mediate the development of alcohol misuse over time or, alternatively, whether their influence is mediated by the established mechanisms. Moderator analyses will systematically examine differences based on college status (i.e., college vs. non-college) and other substance use. The study also has a secondary aim to inform future intervention studies. This exploratory aim is to identify the most salient periods of change and the concurrent psychosocial factors that increase or decrease the value of alcohol. Collectively, the study will leverage recent advances in behavioral economics to make major contributions to understanding of alcohol misuse over the transition to adulthood.

Brief alcohol interventions (BAI) are among the most cost-effective preventive care measures available and the evaluation of these interventions with high-risk and difficult-to-reach populations is an NIAAA priority. Although emerging adults (EAs) who attend college often have access to brief alcohol interventions (BAIs), there is a critical need to enhance both the efficacy and potential for dissemination of these approaches with high-risk non-student EAs. EAs who are not 4-year college students or graduates report higher levels of alcohol-related problems, greater levels of comorbid drug use and mental health symptoms, and higher risk for chronic alcohol use disorder compared to college graduates. Most BAIs include a single session focused explicitly on discussing risks associated with drinking and correcting normative beliefs about drinking rates without addressing the reasons why EAs may drink, including stress and limited behavioral alternatives to drinking. Because many EAs who do not graduate from college are socially and economically marginalized, an approach that encourages them to drink less without providing the tools to reduce stress and develop mood- enhancing behavioral substitutes to drinking or drug use is unlikely to be successful. The Substance-Free Activity Session (SFAS) attempts to increase engagement goal-directed activities that might provide alternatives to alcohol use and also includes strategies for coping with stress/depression. The two-session (plus booster) BAI+SFAS approach has demonstrated efficacy for reducing both alcohol use/problems and depressive symptoms in two randomized clinical trials with college EAs and may be a more promising approach than single-session BAIs for higher-risk non-student EAs. Two critical next steps are to: 1) evaluate the BAI+SFAS with non-student EAs, and 2) determine if a two-session Relaxation Training (RT) +SFAS approach, which would enhance wellness and address two synergistic risk factors for alcohol misuse, demonstrates similar efficacy as the BAI+SFAS intervention. If so, this wellness-based approach may have greater potential for dissemination than approaches that include a BAI because the session content may be more appealing to EAs (managing stress and increasing positive activities). Thus, the primary goal of the proposed study is to establish the efficacy of these novel BAI approaches with high-risk community dwelling EAs, and a secondary goal is to identify factors that may increase potential for dissemination. We will conduct a randomized 3-group (BAI+SFAS vs. RT+SFAS vs. education control) trial with 525 EAs (175 per group; estimated 50% women & 50% African American) who report recent heavy drinking and who are not students or graduates of 4-year colleges. Outcomes will be assessed at 1, 3, 6, and 12 months post-intervention. We hypothesize that at follow-up both BAI+SFAS and RT+SFAS participants will report significantly greater reductions in alcohol use and problems relative to education control participants, with no differences in outcomes between the two active treatment conditions.

PROJECT SUMMARY/ABSTRACT Alcohol misuse remains a major public health problem in emerging adults (age 18-25). Excessive drinking is the largest source of morbidity and mortality in this age group and predicts subsequent alcohol problems across the lifespan. Although most emerging adults ?mature out? of hazardous drinking and transition into moderate use, many continue a developmentally persistent pattern of alcohol misuse, and the predictors of differential trajectories remain largely unknown. A large number of cross-sectional studies have found significant associations between alcohol misuse and indices from behavioral economics, thus we are currently conducting a longitudinal investigation of behavioral economic indicators as processes in regular binge drinkers from their early twenties (21-24) to their mid-twenties (24-27). However, this ?parent? R01 study does not include any measures of biological risk factors, so the proposed R21 study aims to collect neurophysiological measures of reward processing in a subsample at two timepoints spaced 8 months apart during the parent longitudinal study. The neurophysiological measures include two event-related potential (ERP) components that are robustly associated with reward processing: (1) P3, which reflects the incentive salience of alcohol-related vs. alcohol-free stimuli and (2) Reward Positivity (RewP), which will reflect sensitivity to immediate versus delayed reward. These ERP data would permit systematic investigation of the ERPs as biomarkers of persistent alcohol risk, a substantially understudied relationship in the existing literature. To address this question, the study will recruit 355 participants from the existing study to complete additional EEG sessions during already-scheduled study visits. This study has two primary aims. The first aim is to integrate cross-sectional neurophysiological measures into the ongoing longitudinal study to examine the utility of these measures to predict problematic alcohol use individually and in conjunction with behavioral economic indicators. The second aim is to determine correspondence between longitudinal changes in neurophysiological and behavioral economic indices of risk and their relations to alcohol misuse. Longitudinal models will be used to examine if changes in the neurophysiological indicators are responsible for changes in alcohol misuse over time and to disentangle overlapping versus independent influences.