Development and preliminary examination of two brief personalized feedback interventions focused on lab-based and EMA alcohol cues to reduce hazardous young adult alcohol use

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PROJECT SUMMARY/ABSTRACT Alcohol misuse and negative consequences remain prevalent among young adults (YAs) (Hingson et al., 2017; Schulenberg et al., 2018). Meta-analytic findings on the efficacy of brief alcohol interventions suggest that these effects may not be as strong as previously believed (Huh et al., 2015), highlighting the continuing need to develop effective interventions to reduce YA alcohol misuse. This application will develop and test two online personalized feedback interventions (PFIs) that focus on recognizing urges to drink in response to alcohol cues (e.g., beer bottle) as well as strategies for coping with urges. Alcohol cues evoke subjective craving and physiological and neural responses among drinkers (Reynolds & Monti, 2014; Schacht et al., 2013). Cue reactivity has been demonstrated in the natural environment among older adolescent and YA drinkers. On occasions when alcohol cues are present, YAs report stronger urges to drink, and on days with stronger urges to drink they report more alcohol consumption (Ramirez & Miranda, 2014). PFIs have not explicitly targeted cue reactivity, and many YAs may have limited awareness of this phenomenon. A cue-based PFI may reduce YA alcohol misuse by enhancing YAs’ awareness of their own personal cues that elicit alcohol-seeking behavior and by equipping YAs with skills for coping with urges. This current application will develop two online Cue Reactivity PFIs: (a) a lab-based Cue Reactivity PFI that summarizes cue reactivity from an in vivo cue reactivity session with exposure to preferred alcoholic beverages, and (b) a Cue Reactivity PFI that capitalizes on the utility of ecological momentary assessment (EMA) to capture alcohol cues as experienced in the natural environment. The EMA period includes 17 days of surveys (4x/day) to report cue exposure, craving, and alcohol outcomes. Both PFIs will focus on recognizing alcohol cues, understanding responses to cues, and acquiring coping skills. In Study 1 (Aim 1), a series of focus groups will be conducted with YA heavy drinkers (ages 18-24) to refine the procedures and interventions for a pilot study. Study 2 is a pilot study with a community sample of 200 YA heavy drinkers (ages 18-24) who report thinking about stopping or reducing their drinking. Participants are randomized to one of four conditions (n = 50 per group): (1) Lab- based Cue Reactivity PFI, (2) Lab-based assessment only control (AOC), (3) EMA-based Cue Reactivity PFI, or (4) EMA-based AOC. We will examine the feasibility and acceptability of the PFIs (Aim 2A), evaluate PFI effects on craving, drinking, and consequences at 2-week and 3-month follow-ups, relative to AOC conditions (Aims 2B-C), evaluate Lab-based versus EMA-based PFI effects on drinking outcomes (Aim 2D), and examine condition as a moderator of the association between craving and drinking at follow-up as well as explore moderators (e.g., biological sex) of intervention effects (Aim 2E). This research has great potential to inform advancements to personalized feedback interventions targeting YA alcohol use.