Articles of Public Interest

College students’ attitudes about their own drinking predict how much they will drink, how many alcohol-related consequences they will experience, and their odds of experiencing blackouts. A study published in Alcohol: Clinical and Experimental Research found that when students considered drinking heavily to be positive, they tended to drink considerably more. However, when they felt limiting their drinking to a moderate number of drinks would be enjoyable and beneficial, they experienced fewer blackouts and other harmful consequences. The study authors suggest that new strategies that address students’ attitudes about moderate versus heavy drinking could be effective in preventing students from harm related to alcohol use.

To understand how different individual and social factors influenced students’ drinking, researchers engaged 500 students at a university in the northeastern United States. The students, aged 18 to 24, had been mandated to participate in a single-session alcohol intervention program for a first-time violation of campus alcohol policies and were then followed for one year after the intervention. Students were evaluated at baseline and one, three, six, nine, and 12 months regarding their drinking behaviors and experiences, their attitudes about moderate and heavy drinking at those time points, and how much they intended to drink in the subsequent month. They were asked, for example, how enjoyable, wise, and beneficial they felt it would be to limit their drinking to what is considered moderate drinking and how they feel about drinking more heavily. Moderate drinking for adults is three drinks for women and four drinks for men; heavy drinking is four or more drinks for women and five or more drinks for men.

Students’ attitudes about drinking changed over time and influenced how much they drank. For every one-unit increase in their own average measure of favorable attitudes toward drinking moderately instead of heavily, the odds of experiencing a blackout dropped by 20 percent, and the number of other alcohol-related consequences decreased by 10 percent. On the other hand, for every one-unit increase in favorable attitudes toward heavy drinking, the number of drinks they consumed and their likelihood of experiencing a blackout increased by 25 percent and 30 percent, respectively.

Students’ perceptions about their peers’ drinking influenced their drinking. Those who believed their peers drank more heavily reported drinking more themselves than those who believed their peers drank less. Specifically, students drank 20 percent more drinks per week for each additional drink they perceived their peers to drink. Students whose attitudes about heavy drinking were more positive drank more than those whose attitudes were less favorable. For every one-unit increase in favorable attitude toward heavy drinking, they drank 50 percent more drinks and experienced 30 percent more alcohol-related consequences.

Most interventions for problem alcohol use focus on correcting perceptions of how much peers drink. While this study found perceptions of peer behavior influenced individuals’ own behavior, it also identified another important target for interventions to prevent alcohol-related harm: students’ attitudes and beliefs about their drinking. More studies are needed to determine whether these findings will be applicable to a more diverse population of students and those not mandated to participate in the intervention.

Longitudinal analysis for between- and within-person influences of descriptive alcohol drinking norms and attitudes on drinking outcomes. A. DiBello, M.B. Miller, M.R. Hatch, N. Mastroleo, K. Carey. (https://doi.org/10.1111/acer.70008)

Black sexual minority men and transgender women (sexual and gender minorities; SGM) consume more alcohol on average than people in the general population. The findings of an innovative study exploring links between certain social and personal influences and the drinking patterns of (predominantly) gay, bisexual, and queer Black men and transgender women found that reasons for higher alcohol use included exposure to current and past social networks characterized by frequent or problematic drinking. Higher alcohol use in this population is also linked to raised anxiety symptoms and Latine identity, the study found. Previous research has suggested that people with intersecting minoritized identities, such as being Black and gay, may be especially vulnerable to risky drinking. Black gay men report higher levels of heavy episodic drinking compared to Black heterosexual men, and Black people experience greater harms resulting from alcohol use than White people do. In sexually minoritized populations, these harms could potentially include a raised risk of HIV infection. Research on social influences contributing to alcohol use has focused on White and heterosexual populations, however. Furthermore, little is known about alcohol use among Black non-cisgender people. For the study in Alcohol: Clinical & Experimental Research, investigators evaluated whether certain factors were associated with more frequent or heavier drinking among Black SGM.

Researchers worked with 138 Black study participants aged 16–35 living in Chicago between 2018–19. The participants, all HIV-negative, filled out questionnaires on demographics, including their sexual identity, housing, and employment; their drinking in the past month; their depression and anxiety symptoms; and their exposure to problematic alcohol use in childhood. They also reported on the frequency of alcohol use of up to 5 close people in their social networks (confidants). The investigators used statistical analysis to explore associations between these and other factors and the outcome of participants’ reported drinking.

Participants were, on average, 25 years old. Ninety-three percent identified as gay, bisexual, or queer, and 16% as transgender. Almost 7 in 10 participants reported alcohol use in the past month—exceeding national norms for Black Americans and LGBTQ Americans—averaging 2½ drinks on each occasion. Most of the social network confidants they nominated were close family or friends, of whom 28% reportedly drank alcohol at least several times a week. Higher drinking among study participants was linked to their proportion of confidants who drank several times a week or more, having lived before age 18 with someone who consumed alcohol excessively, being both Black and Latine and experiencing higher anxiety symptoms.

The study highlights the interplay of personal and social factors affecting alcohol consumption among Black, sexually minoritized men and transgender people. Previous research has implicated structural racism and anti-LGBTQ policies in both anxiety and heavy drinking. Possibly, racism, homophobia, and transphobia intersect to generate a new form of discrimination, as perhaps experienced by Black Latine men; alternatively, the alcohol use in that population could reflect a cultural drinking norm. Social network influences may result from people's attraction to those who are like them in some regard (e.g., in drinking behaviors); alternatively (or additionally), individuals’ alcohol use may come to resemble friends’ drinking over time. Interventions aimed at preventing or treating hazardous drinking in this population should address a range of personal and social influences, including social drinking norms, intersectional discrimination, and mental health. More research is needed to identify causal mechanisms of harmful alcohol use among Black sexual-minority men.

Social network alcohol use is associated with individual-level alcohol use among Black sexually minoritized men and gender expansive people: Findings from the Neighborhoods and Networks (N2) cohort study. C.-H. Shrader, D.T. Duncan, A. Santoro, E. Geng, H. Kranzler, D. Hasin, D. Shelley, B. Kutner, S.E. Sherman, Y.-T. Chen, M. Durrell, R. Eavou, H. Hillary, W. Goedel, J.A. Schneider, J.R. Knox. (https://doi.org/10.1111/acer.70009)

The developmental risk linked to mild-to-moderate prenatal alcohol exposure (PAE) can be identified in infants, according to a study that tested a screening tool with 130 newborns. In alcohol-exposed babies, the tool picked up subtle differences in attention and regulation that are associated with lower cognitive and motor functioning in early childhood. This finding points to a critical opportunity for early intervention and the potential for improving long-term outcomes. People exposed to alcohol in utero can face lifelong impacts on their physical growth, learning, and behavior, a constellation of symptoms known as Fetal Alcohol Spectrum Disorder (FASD). In the US, up to 1 in 20 school-age children may be affected by FASD. FASD is typically not identified until children are in school, and misdiagnoses are common. The effects of mild-to-moderate PAE, the most common range of exposure, have been especially challenging to characterize. For the study in Alcohol: Clinical & Experimental Research, investigators tested a tool assessing newborns’ neurological and behavioral responses that had not previously been studied with infants exposed to alcohol in utero.

Researchers aimed to determine whether the Neonatal Intensive Care Unit Network Neurobehavioral Scale, First Edition (NNNS-I) could distinguish between infants with low-to-moderate PAE and those without PAE. They worked with parents who were pregnant between 2018 and 2022 and evaluated 130 babies from birth to age 6–9 months. Babies of parents with self-reported alcohol use during pregnancy or positive biomarkers for alcohol were assigned to a PAE group (55%); the others (45%) made up the control group. The babies’ neurodevelopment was assessed soon after birth and again at 6–9 months. The tracked behaviors in the newborn period included alertness, self-soothing, excitability, lethargy, muscle tone, reflexes, and others. The researchers used statistical analysis to look for associations between the babies’ neurodevelopmental measures and PAE. Based on NNNS-I scores, the babies were assigned a profile indicating behavioral risk (high, mixed, or low).

The average reported alcohol consumption of parents in the PAE group was 1.1 drinks a week; 2 in 3 reported at least one episode of binge drinking, with the majority of those occurring in the periconceptional period, and 3 in 5 had at least one positive biomarker for alcohol. On the NNNS-I, infants with PAE scored higher than the no-exposure babies for lethargy, hypertonicity (higher muscle tone), lower attention scores, and stress signs during the testing (such as tremors ), an unusual combination. After adjusting for certain other factors, the attention and lethargy scores remained significant. Based on their scores, 28 babies were considered at high behavioral risk, 22 at mixed behavioral risk, and 53 at low behavioral risk. All 3 profiles included infants with PAE, reflecting the variability of outcomes. Nevertheless, the study revealed significant differences in NNNS-I scores among babies with mild-to-moderate PAE and no PAE, and infants with positive biomarkers for alcohol were more likely to be in the high-risk group.

While the NNNS-I is not a diagnostic tool, it identified shortly after birth a distinct neurobehavioral profile associated with mild-to-moderate PAE and brain vulnerabilities implicated in FASD. The findings point to the possibility of providing more intensive follow-up and monitoring and neurodevelopmental intervention much earlier in life. Studies that track children's development over time are needed to show whether the NNNS-I can predict FASD.

Abnormal neurobehavior profiles observed in the newborn period following low-to-moderate prenatal alcohol exposure. J. Maxwell, M. Roberts, J. Lowe, X. Ma, J.F. Kotulski, A.L. Salisbury, L. Bakhireva. (https://doi.org/10.1111/acer.70013).

Men with alcohol dependence who also have a history of mental health issues or hazardous drug use were significantly more likely to have attempted suicide, according to a study just published in Alcohol: Clinical and Experimental Research. The large Japanese study found that one in five men being treated for alcohol dependence had a history of mental health issues, and fifteen percent had attempted suicide. The study highlights opportunities for earlier and multifaceted interventions, including suicide prevention, to address the needs of people with alcohol dependence and mental health issues.

Researchers analyzed data from four thousand men in inpatient treatment for alcohol dependence in Japan to understand how common it was for men in inpatient treatment for alcohol dependence to have co-occurring concerns, such as depression, anxiety, and insomnia, and any relationships that might exist between these concerns and patterns of drug and alcohol use onset, and other health and genetic factors.

The analysis revealed a high prevalence of history of mental comorbidities, mainly mood disorders and suicide attempts. More than 600 of the four thousand men had attempted suicide. Twenty percent of men in the study had a history of a mental health issue, with 14 percent reporting the most common diagnosis of depression. Five percent of participants reported drug use, with more than half trying drugs for the first time in their teens, and a third starting in their twenties, and almost all using drugs before the onset of advanced alcohol use disorder.

Drinking appeared to affect the men's mental health both before and after the onset of advanced alcohol use disorder, pointing to a cycle where mental health issues may contribute to problem drinking, which in turn worsens mental health issues. Most were diagnosed with a mental health issue at some point after they began drinking regularly. Mood disorders were most commonly diagnosed around the time that men's alcohol use disorder became advanced. In contrast, disorders such as anxiety and schizophrenia more commonly occurred before the onset of advanced alcohol use disorder. Insomnia more often began after the onset of advanced alcohol use disorder. Thirty-five percent of those who attempted suicide did so before their alcohol use disorder became advanced, and half attempted suicide after the onset of advanced alcohol use disorder.

Participants received their first mental health diagnosis at an average age of 40 years old and had experienced an average lag of nine years after the onset of advanced alcohol use disorder before receiving treatment for alcohol dependence. Men with mental health issues had an earlier onset of advanced alcohol use disorder and were first treated for alcohol dependence at younger ages than their counterparts without mental health issues.

The study's findings point to an opportunity for earlier identification and treatment of problem drinking and mental health issues when a healthcare provider recognizes either issue in a patient. Both behavioral and medication interventions have been shown to help treat both mental health and alcohol use disorders.

History of mental comorbidities and their relationships with drinking milestones, hazardous drug use, suicide attempts, and the ADH1B and ALDH2 genotypes in 4116 Japanese men with alcohol dependence: An exploratory study. A. Yokoyama, T. Yokoyama, Y. Yumoto, T. Takimura, T. Toyama, J. Yoneda, K. Nishimura, R. Minobe, T. Matsuzaki, M. Kimura, S. Matsushita. (https://doi.org/10.1111/acer.70014)