Understanding Harmful Alcohol Use in Context: Utility of Dynamic Assessment of Behavioral Economic Risk Factors

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PROJECT SUMMARY Excessive alcohol use and alcohol use disorder (AUD) remain prevalent in the United States, with the mortality rate associated with alcohol use increasing. Despite ongoing developments, many existing treatments for harmful alcohol use and AUD have only modest effects. There is a clear need for more effective intervention strategies, which could be informed by theoretically-driven etiological research on alcohol use and recovery in individuals’ natural environments. Behavioral economics suggests two candidate processes that harmful alcohol use may occur through: rapid devaluation of future outcomes (delay discounting, DD); and over- valuation of alcohol (reinforcing value, defined as demand or preference for alcohol). While researchers are currently equipped with methods to manipulate these processes, the changes they produce are ephemeral; and the majority of evidence suggesting DD, and to a lesser extent alcohol value, play an etiological role in substance use are from trait levels of these measures. The scientific goals of this K99/R00 are to determine the predictive utility of state-level measures of delay discounting (Aim 1) and alcohol value (Aim 2) for real-time alcohol use in the field during maintenance of harmful alcohol use (Study 1; K99); and to subsequently determine whether these findings generalize to natural recovery from AUD (Study 2, Aim 3; R00). Participants will be community-dwelling adults engaging in excessive alcohol use (Study 1; N = 64), and those who have recently recovered from AUD without intervention (Study 2; N = 64). Participants in both studies will be in the age range at which excessive drinking and onset of AUD peak (21-35 years old). In both Studies 1 and 2, participants will complete baseline sessions, a 21-day ecological momentary assessment (EMA) period, and an end-of-study visit. EMAs will be randomly delivered throughout the day to assess DD and measures of alcohol value. During the EMA period, alcohol use will be both objectively measured using transdermal alcohol sensors and by self-report. The knowledge gained through these aims will guide the development of more effective interventions for excessive alcohol use and AUD by testing the predictive utility of theoretically- grounded processes; and complement the candidate’s basic laboratory expertise in behavioral economics. Research and training activities will be completed at the University of Florida, which is home to the Center for Behavioral Economic Health Research, multiple NIH-funded addiction-related research centers, and extensive career development opportunities. A strong mentoring team of AUD experts will guide the candidate’s development of skills to conduct field-based research using technologically-advanced assessment methods in populations with excessive alcohol use and AUD; an enhanced understanding of behavioral economics as applied to AUD; and additional time to establish herself in the field as an alcohol researcher. Ultimately, this training will ensure the candidate’s success in obtaining a faculty position in a research-focused institution and confer the skills and knowledge needed to substantively contribute to reducing harmful alcohol use and AUD.