Emerging adult risky drinkers living in disadvantaged communities often have limited
access to rewarding activities and adult roles that offer alternatives to heavy drinking.
Guided by behavioral economics, this cluster randomized controlled trial will evaluate a
brief behavioral intervention aimed at increasing future orientation and engaging
pro-social alternatives to drinking delivered using a peer-driven sampling method and
digital platform well suited for accessing their social networks.

Digital Motivational Behavioral Economic Intervention to Reduce Risky Drinking Among Community-Dwelling Emerging Adults

Alcohol Drinking

Brief motivational interventions (BMIs) to reduce risky drinking in college students are
well established as beneficial, but the needs of emerging adult (EA) risky drinkers who
live in disadvantaged communities and are not fulltime college students have been
neglected. They tend to have more constrained access to rewarding opportunities, adult
roles, and activities that present pro-social alternatives to heavy drinking. When
coupled with the foreshortened time horizons typical of many EAs, this suggests the need
for interventions that not only enhance motivation to reduce drinking, but guide EAs to
engage in alternatives to heavy drinking and orient their behavior toward longer-term
positive goals. Guided by behavioral economics (BE), this study will disseminate and
evaluate a brief motivational BE intervention that combines BMI elements with the
Substance Free Activity Session shown to reduce drinking by increasing future orientation
and engagement in pro-social alternatives. The intervention will be delivered using a
digital platform appropriate for EAs whose social networks operate through such
communications. Because peers influence substance use, a peer-driven sampling method
(Respondent Driven Sampling [RDS]) will be used to recruit 500 community-dwelling EAs
ages 18-28 for a cluster randomized controlled trial that compares the intervention with
a health education control condition. Additional EA target population members ("seed"
participants, n = 250) will start RDS recruitment but are not part of the intervention
evaluation sample. The evaluation study will assess participants' drinking practices and
problems, BE outcome predictors, and social networks at enrollment and at 1, 6, and
12-month follow-ups. Intervention efficacy and behavior change mechanisms will be
examined. Reduced alcohol demand and delay discounting and favorable post-intervention
shifts in future orientation, substance-free vs. substance-involved activities, and use
of protective behavioral strategies to reduce drinking-related harms are predicted to
mediate intervention effects. Social network analysis will assess whether the
intervention attenuates network promotion of individual drinking. The study will be the
first to test a web-based alcohol reduction intervention focused on BE principles and to
use digital RDS to reach community-dwelling EAs for intervention. The study will
translate and test BE mediators and moderators of change, and the digital intervention
has high potential for reach and scalability with under-served community risk groups.

Motivational Behavioral Economic Alcohol Intervention

Health Education

At each assessment point, participants will complete an online TLFB concerning their
daily drinking during the past month, an interval found sufficiently long to characterize
drinking patterns. Using a calendar that covers the 30-day recall interval, participants
record how many standard drinks of beer, wine, or liquor they consumed each day. Drinks
per week will be calculated for tests of study hypotheses along with other metrics for
descriptive purposes (frequency of gender adjusted heavy and high intensity drinking
days).The TLFB is considered the "gold standard" for obtaining reliable and accurate
reports of alcohol consumption using a variety of assessment modalities (e.g., interview,
online, phone) and is accepted by the FDA for use as an efficacy endpoint of percentage
of heavy drinking days in clinical trials.

The Brief Young Adult Alcohol Consequences Questionnaire asks about 24 negative events
during the past month (e.g., neglected obligations, driving after drinking) and includes
common and less severe consequences suitable for use with younger populations. The
B-YAACQ is reliable yet sensitive to changes in alcohol use, has high internal
consistency, and includes common but less severe consequences. Scores, ranging from 0-24,
are predicted by typical drinking as well as by BE-relevant indices of impulsivity and
poor self-regulation. Higher scores indicate participants are experiencing more negative
events associated with their drinking.

Participants report past month frequency and rate the enjoyment of 36 activities that are
substance free vs. substance involved. Frequency and enjoyment ratings are multiplied to
obtain a cross-product that reflects reinforcement derived from the activity, and the
relative reinforcement value of alcohol (R-ratio) is computed for analysis
[(alcohol-related total/(alcohol-free total + alcohol- related total)]. Participants also
report the number of hours spent engaging in several activity categories during a typical
week in the past month (work, exercise, drinking, recreation).

This adjusting delay discounting task yields accurate discount rates in less than one
minute. Values are well correlated with the established longer adjusting amount delay
discounting procedure. Delays are adjusted based on participants' responses in a series
of 5 trials in which a hypothetical monetary reward amount is held constant. The task
directly measures ED50, which is the delay at which the current reward value is half its
nominal dollar amount. Outcomes will not be incentivized because hypothetical and real
money generate equivalent measures.

This questionnaire asks participants to report how many standard drinks they would
consume across 20 prices ($0 to $40) in an imaginary drinking setting, which yields
multiple observed and derived indices reflecting sensitivity to price changes that
correspond with actual alcohol use. Elasticity of demand and intensity (consumption at
$0) will be used for analysis. Relative insensitivity to price changes ("inelastic"
demand) is related to risky drinking and alcohol problems, and intensity has incremental
utility to predict alcohol use disorder symptoms beyond drinking practices.

The RDEA index reflects strength of preference for alcohol in relation to other
discretionary commodities common in the personal economies of younger adults and predicts
alcohol problems and outcomes. It is based on participant reports of money spent during
the past month on nonessential items (e.g., clothing, music, recreation) and on alcoholic
beverages, regardless of whether the alcohol was consumed. Participants also report
dollars saved voluntarily, which reflects resource allocation for future goals. Lower
RDEA values and proportionately greater allocation to savings than alcohol predict
positive drinking outcomes.

Web-based alcohol risk reduction brief intervention

Digital Motivational Behavioral Economic Intervention to Reduce Risky Drinking Among Community-Dwelling Emerging Adults

About this trial

Study ID

Status

Type

Phase

Placebo

Accepting

Trial Timing

What is this trial about?

What are the participation requirements?

Locations

Location

Status