Elsevier

Addictive Behaviors

Volume 38, Issue 1, January 2013, Pages 1464-1471
Addictive Behaviors

Drinking consequence types in the first college semester differentially predict drinking the following year

https://doi.org/10.1016/j.addbeh.2012.07.005Get rights and content

Abstract

The objectives of the present study were to examine the utility of distinguishing among negative consequence types when seeking to predict drinking later in college, to understand which consequences in particular were associated with future drinking, and to determine the direction of those associations. We also examined whether there were differences in the types of drinking outcomes (quantity, frequency, binge) predicted by unique consequences. Finally, we tested whether the link between consequences and future drinking was different for men versus for women. Incoming first year college students (n = 997; 65% female) completed an online assessment in September of the first college year, and again at the same time the following year. Results of structural equation model tests offered support for the utility of distinguishing among different consequence types, as specific consequences experienced during the first semester of college were associated differently with drinking at the beginning of the second school year. Gender differences also were observed. For both men and women, social consequences were associated with increases in drinking over time. Blackout drinking also evidenced prospective prediction, but differentially for men and women. For men, these consequences were associated with later increases in drinking, whereas for women, they were associated with a diminution in drinking the next year. For men, only consequences associated with self-care (impairment in physical activity, physical appearance, less time to pursue recreation) predicted decreases in drinking at Year 2. Prediction was generally similar across drinking outcomes. Results suggest that whether negative consequences result in downward titration, escalation, or no change at all in later drinking depends on the type of consequence experienced, and who experiences it.

Highlights

► We tested different negative drinking consequence types to predict drinking later in college. ► We also sought to examine gender differences. ► Whether drinking decreases, increases, or remains the same depends on the type of consequence. ► At least some of these pathways are different for men and women.

Introduction

The early months of the first year of college are the time when students are at greatest risk for heavy drinking and associated consequences (Sher and Rutledge, 2007, Schulenberg and Maggs, 2002, White et al., 2005). Though for many students heavy alcohol involvement will diminish over time (Chassin, Flora, & King, 2004), consequences during the early college months are important nonetheless, because they are acutely hazardous (i.e., drunk driving, STD risk, interpersonal aggression). Early consequences may also be important in shaping drinking later in college (Read, Merrill, Kahler, & Strong, 2007). Social learning models posit that personal experience is one avenue through which individuals learn and therefore acquire drinking behavior (Maisto, Carey, & Bradizza, 1999). As such, personally experienced drinking outcomes (consequences) may facilitate learning (Stasiewicz & Maisto, 1993). Through consequences, drinking is either reinforced or punished, and future drinking is modified accordingly.

A nascent literature has begun to examine the connection between alcohol-related consequences and future drinking in college students (Barnett et al., 2006, Mallett et al., 2006, Merrill et al., in press). Typically this literature has focused on consequences that would seem at face value to be negative, unpleasant, or aversive for students (e.g., blackouts, social embarrassment, hangovers), and therefore should predict decreases in drinking. Yet somewhat surprisingly, while some studies do show downward titration of drinking following negative consequences (e.g., Barnett et al., 2006, Barnett et al., 2004), others show persistence and even escalation in drinking patterns in the wake of these events (e.g., Mallett et al., 2006, Read et al., 2007). This suggests that seemingly aversive consequences do not necessarily punish drinking behavior, and in fact may reinforce it. Research to date has sought to understand this apparent paradox through examination of individual-level factors such as drinking history and personal meaning of the consequences (Barnett et al., 2006, Mallett et al., 2008).

Aspects of alcohol consequences themselves also may play a role in the learning process. The types of consequences that college students encounter are myriad (e.g., Chung and Martin, 2002, Jennison, 2004, O'Neill and Sher, 2000, Vik et al., 2000). Recent research points to the utility of distinguishing among consequence types, as each may be driven by different etiological processes (Merrill & Read, 2010) and may be associated with different outcomes (Nelson et al., 1996, O'Neill and Sher, 2000, Read et al., 2007). In particular, rather than discouraging future heavy drinking, some types of consequences (e.g., blackouts, hangovers, social embarrassment) are not only tolerable, but may even be desirable to students (Mallett et al., 2008). Thus, upward or downward changes in drinking following a consequence may depend, among other things, on the type of consequence experienced.

Much of the extant research examining the influence of specific types of alcohol consequences on later drinking has examined how consequences may predict problem drinking in later adulthood (e.g., Nelson et al., 1996, O'Neill and Sher, 2000). Though an important endeavor, examination of more temporally proximal drinking outcomes can help to shed light on naturalistic, experiential-based changes in drinking that occur during college, and can also provide early identification of at-risk drinkers. To our knowledge, only one study has examined the prospective influence of specific consequence types on later within-college drinking. Using the Young Adult Alcohol Consequences Questionnaire, a measure that assesses eight distinct domains of alcohol-related problems, Read et al. (2007) found two indices of problem drinking – impaired control and physiological dependence symptoms – to predict risky drinking later that same semester.

Gender may influence whether and what students learn from their drinking experiences, and thus may be an important moderator of the association between alcohol consequences and subsequent alcohol use. Gender differences in alcohol consequences have been noted (e.g., Park and Grant, 2005, Perkins, 2002, Substance Abuse and Mental Health Services Administration, 2002–2006), as have gender-based differences in etiological processes that contribute to drinking (see Nolen-Hoeksema, 2004). Interestingly, at least some data suggest that men and women differ in the way that they perceive and experience alcohol consequences (LaBrie et al., 2008, Park and Grant, 2005). It is not known if some consequences affect drinking differentially for men and women. This would be important information, as interventions may benefit from tailoring to males or females, depending on the consequences.

Knowledge of which consequences are most likely to be associated with later drinking, and for whom these consequences are most relevant, could be important for college-based intervention efforts. Interventions that incorporate personalized feedback on drinking behaviors are widely used and have strong empirical support (Larimer and Cronce, 2007, National Institute on Alcohol Abuse and Alcoholism, 2002). Such interventions could easily be modified to emphasize certain types of consequences in feedback sessions to maximize intervention impact.

With our study, we sought to examine the utility of distinguishing among consequence types when predicting drinking later in college in order to understand which types of consequences were associated with future drinking, and to elucidate the direction of those associations. We also sought to examine whether there were differences in the types of drinking that unique consequences could predict. Based on prior work (Read et al., 2007), we expected that consequences associated with heavier alcohol involvement (e.g., impaired control, dependence symptoms) would predict continued drinking, as the presence of these types of consequences suggests that alcohol behavior has progressed to a level that is more entrenched, and perhaps less mutable. Finally, we sought to test whether the link between consequences and future drinking was different for men versus for women. As no studies have examined gender differences in how consequences affect future drinking, we forwarded no a priori predictions regarding the effects of gender. Several studies have found support for the examination of unique dimensions of drinking behavior (e.g., Conrod et al., 2011, Presley and Pimentel, 2006, Read et al., 2008, Stahre et al., 2006), and so we examined three distinct indices of alcohol consumption– quantity, frequency, and heavy episodic (“binge”) drinking– to determine whether prediction by specific consequences varied according to drinking outcome.

Section snippets

Participants

A total of 997 participants were involved in the present study (65% female, Mage = 18.12, SD = 0.45). Self-reported ethnicity of the sample was as follows: 723 identified as Caucasian (72%); 113 as Asian (11%); 90 as African-American (9%); 33 as Hispanic (3%); 34 as Other (3%); and four participants did not report ethnicity (< 1%). At baseline, approximately 650 (65%) participants reported having consumed alcohol at least once during the previous year (i.e., senior year of high school).

Procedure

Participants

Data analytic plan

Some of the alcohol use and consequences variables had a slight positive skew and a few were highly kurtotic (skewness ranged from 1.04 to 3.88; kurtosis ranged from 1.12 to 18.87). Our analysis of missing data showed that seventy-eight percent (n = 779) of participants had data on all alcohol consequence indices at all 4 time points during the first semester, and 94% (n = 935) had alcohol consequence data on at least 3 of the 4 time points. Eighty-eight percent (n = 874) of participants had data on

Descriptives and bivariate associations

Table 1 shows the means, standard deviations, and bivariate correlations among all model variables. The mean number of monthly alcohol consequences over the first semester (T1–T4) was 4.13 (SD = 6.02) for women and 3.86 (SD = 6.00) for men. Thus, there was substantial variability in the frequency of negative alcohol consequences in this sample. As shown in Table 1, blackout consequences were the most highly endorsed consequence type, while dependence consequences were rare for both genders.

Discussion

Findings from this study suggest that whether negative consequences result in downward titration, escalation, or no change in drinking depends on the type of consequence experienced, and that at least some of these pathways are different for men and women. This study also highlights the importance of distinguishing among consequence types. When measured as an aggregate score, total negative alcohol consequences predicted increases only in binge drinking the next year. However, a far more

Role of funding source

Funding for this study was provided by NIDA grant R01 DA018993 to Dr. Jennifer P. Read; the NIMH had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.

Contributors

Author Read (with co-Is acknowledged below) designed the study and wrote the protocol. Authors Wardell and Read undertook the statistical analysis, and together did much of the writing of the manuscript. Author Bachrach assisted with literature searches and summaries of previous related work, and all authors reviewed and edited multiple drafts of this manuscript. All authors made meaningful intellectual contributions to and have approved the final manuscript.

Conflict of interest

All authors declare that they have no conflicts of interest relevant to this study or the publication of these findings.

Acknowledgments

We gratefully acknowledge our collaborators Drs. Paige Ouimette, Craig Colder, and Jacquelyn White for their many contributions to the design and implementation of this study.

We would like to thank Sherry Farrow, Jennifer Merrill, Jackie White, Ashlyn Swartout, and the members of the UB Alcohol Research Lab for their many efforts to support data collection for this study, and the participants for the information that they provided.

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    This work was supported by a grant from the National Institute on Drug Abuse (R01DA018993) to Dr. Jennifer P. Read.

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