Behavioral economic and wellness-based approaches for reducing alcohol use and consequences among diverse non-student emerging adults

短暂的酒精干预（BAI）是最具成本效益的预防保健措施， 对高危和难以接触的人群进行这些干预措施的评价是NIAAA的优先事项。虽然 上大学的新兴成年人（EAs）通常可以获得简短的酒精干预（BAI）， 迫切需要提高这些高风险方法的有效性和推广潜力， 非学生的EAs。非4年制大学生或毕业生的EA报告与酒精相关的 问题，更高水平的共病药物使用和精神健康症状，以及更高的慢性酒精风险 与大学毕业生相比，大多数BAI都包括一个单独的会议， 讨论与饮酒有关的风险，纠正关于饮酒率的规范性信念， 解决为什么EA可能会喝酒的原因，包括压力和有限的行为替代饮酒。 由于许多没有大学毕业的职业教育机构在社会和经济上被边缘化， 鼓励他们少喝酒，但不提供减轻压力和培养情绪的工具- 加强饮酒或吸毒的行为替代品不太可能成功。无物质 活动会议（SFAS）试图增加参与目标导向的活动， 酒精使用的替代品，还包括应对压力/抑郁症的战略。两会 (plus助推器）BAI+SFAS方法已证明有效减少酒精使用/问题， 抑郁症状在两个随机临床试验与大学EA，可能是一个更有前途的 方法比单届BAI为高风险的非学生EA。接下来的两个关键步骤是：1）评估 BAI+SFAS与非学生EA，以及2）确定是否两个会话放松训练（RT）+SFAS 这种方法将提高健康水平，并解决酗酒的两个协同风险因素， 证实了与BAI+SFAS干预相似的疗效。如果是这样，这种基于健康的方法可能会 比包括BAI的方法具有更大的传播潜力，因为会议内容可能 更吸引EA（管理压力和增加积极活动）。因此， 拟议的研究是建立这些新的BAI方法与高风险社区居住的有效性 环境影响评估，第二个目标是确定可能增加传播潜力的因素。我们会进行 一项随机3组（BAI+SFAS vs. RT+SFAS vs.教育对照）试验，525例EA（每组175例; 估计50%的妇女和50%的非洲裔美国人）报告最近酗酒，不是学生， 四年制大学毕业生。将在干预后1、3、6和12个月评估结局。我们 假设在随访时，BAI+SFAS和RT+SFAS参与者报告的 与教育控制参与者相比，酒精使用和问题的减少， 两种积极治疗条件之间的结果。

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.