یک رویکرد فرد محور برای شناخت تقویت منفی نوشیدن در میان دانشجویان سال اول

The current study used a person-centered approach (i.e. latent profile analysis) to identify distinct types of college student drinkers based on the predictions of motivational, social learning, and stress and coping theories of maladaptive drinking. A large sample (N = 844; 53% female) of first-year undergraduates from two institutions, public and private, who reported consuming one or more drinks in the last three months completed measures of depressive and anxiety symptoms, positive alcohol-outcome expectancies, negative life events, social support, drinking motives, drinking level and drinking-related problems. Latent profile analysis revealed a small subgroup of individuals (n = 81, 9%) who conformed to the anticipated high-risk profile; specifically, this group demonstrated high levels of negative affect, coping motives, drinks per week, and drinking-related problems. However, additional groups emerged that showed patterns inconsistent with the proposed vulnerability profile (e.g., high negative affect, positive expectancies, and negative life events, but relatively low drinking levels). Findings from our person-centered approach showing the presence of groups both consistent and inconsistent with the predictions of motivational, social learning, and stress and coping theories highlight the need to identify and target certain college students for prevention and intervention of negative affect-related drinking.

It is generally accepted that drinking to cope with negative affect is a maladaptive pattern associated with a multitude of negative outcomes in the population in general (Carpenter and Hasin, 1999 and Cooper et al., 1995) and in college students more specifically (Carey and Correia, 1997, Kassel et al., 2000 and Park and Levenson, 2002). It is also agreed upon that high levels of negative affect are not sufficient in terms of identifying individuals who display maladaptive levels of alcohol use and drinking-related problems (Cooper et al., 1988 and Greeley and Oei, 1999). The consensus explanation for the inconsistent associations between negative affect and these drinking outcomes is that they vary in strength, and possibly direction, across a wide array of cognitive, interpersonal, and environmental factors (Cooper et al., 1988 and Greeley and Oei, 1999). In the current study we sought to build on recent research using person-centered approaches for identifying discrete categories of drinkers (e.g., Coffman et al., 2007, Mackie et al., 2011 and O'Connor and Colder, 2005). Our goal was to identify college students who displayed profiles consistent with negative affect-related drinking (based on reports of theoretically-relevant vulnerability factors) and compare them to students with different drinking profiles with respect to their drinking-related problems. A person-centered approach might prove especially informative if (a) there are relatively small groups of individuals for whom negative affect corresponds to maladaptive drinking and related problems, and (b) there are additional groups who possess some or all of the risk factors of interest, but do not display maladaptive drinking levels and/or the associated problems. We focused on college students, since they are a population at elevated risk for binge drinking and alcohol abuse compared to a same-aged, non-college population (Slutske, 2005). 1.1. Theoretical models of negative affect-related drinking Vulnerability models positing a central role of negative affect as a cause of maladaptive drinking have drawn heavily from social learning, motivational, and stress and coping models. Social learning (Maisto, Carey, & Bradizza, 1999) and motivational (Cox & Klinger, 1988) models of alcohol use purport that drinking is heavily influenced by one's cognitions, or outcome expectancies, that form as a result of both direct and indirect experiences with alcohol. Similar to the tenets of tension-reduction theory (Conger, 1956), social learning theory contends that individuals who lack the skills to cope with stress or negative affect may turn to alcohol to manage their affect; in doing so, they are likely to form expectations that drinking is an effective way to reduce tension and stress, thereby making it more likely that they will drink when faced with stress or negative affect in the future (Maisto et al., 1999). Stress and coping models, on the other hand, acknowledge the critical role of social support in buffering the negative effects of life stressors (Cronkite and Moos, 1995 and Holahan et al., 1999). Specifically, following negative life events, individuals who lack social support may be at greater risk for engaging in maladaptive or avoidant coping behavior, such as drinking. Stressful life events often require people to modify aspects of their thinking, behavior, or lifestyle, and these adjustments may consequently tax coping resources. However, close, supportive relationships with others may help people to view stressors as less overwhelming and threatening. These relationships also may help to offset, or buffer the effects of stress through the provision of instrumental or emotional support (Cronkite & Moos, 1995), thereby making drinking and/or drinking to cope (an avoidant coping response), less likely. Although not exhaustive, social learning and stress and coping models together identify several key vulnerability factors for maladaptive drinking that served as the focus for the current study. Specifically, we focused on positive expectancies and drinking motives from motivational and social learning models and negative life events and social support from stress and coping models. Below we describe how these variables (and, in some cases, their interactions) have been implicated in negative affect-related drinking. 1.1.1. Positive expectancies Research has shown that positive alcohol-outcome expectancies, or beliefs about alcohol's favorable effects, moderate the association between life stress and negative affective states and outcomes such as drinking to cope motivation and drinking level (e.g., Cooper et al., 1992 and Cooper et al., 1995). More specifically, participants in these studies were at greatest risk for maladaptive drinking if they endorsed higher levels of life stress and/or negative affect along with higher levels of positive expectancies. Thus, accounting for positive expectancies and drinking motives when extracting drinking classes might help to differentiate individuals for whom high levels of negative affect or life stress co-occur with viewing alcohol as a viable coping strategy. 1.1.2. Drinking motives Drinking motives are another critical individual difference factor that might help to distinguish between more or less problematic drinking profiles. Although similar to alcohol expectancies, motives are thought to be more proximally related to an individual's alcohol use, in that one might hold a specific expectation for alcohol's effects but might not be motivated to drink for that reason (Cooper, 1994). Cooper (1994) examined four principal motives for drinking, namely drinking to conform, drinking to be social, drinking to cope with negative affect, and drinking to enhance positive mood; only the internally-generated motives (i.e., coping and enhancement) predicted both drinking and drinking problems (although enhancement was linked to problems via quantity). Furthermore, a large-scale review of studies on drinking motives found that of the four motives, coping motives were the strongest predictor of drinking-related problems (Kuntsche, Knibbe, Gmel, & Engels, 2005). There is also evidence that the association between drinking level and drinking-related problems depends on the relative levels of negative affect and coping motives. For example, Martens et al. (2008) found that among individuals with high coping motives, those with high levels of negative affect, compared to those with low levels of negative affect, showed a stronger positive association between drinking level and drinking-related problems. Notably, this interactive effect of negative affect and drinking was not present among individuals with low levels of coping motives. These interactive effects have important implications in terms of identifying groups with varying degrees of alcohol-related problems. Specifically, these findings suggest that there might be subgroups that are elevated on one or two of these dimensions (i.e., negative affect, drinking to cope motives and drinking level), but such groups might not demonstrate the level of drinking-related problems found among individuals elevated on all three dimensions. Finally, results from Gmel, Labhart, Fallu, and Kuntsche (2012) indicated that the relative levels of drinking motives (to each other) might be important in terms of identifying individuals at risk for drinking-related problems. Consistent with the broad literature, individuals with relatively higher coping motives reported higher levels of drinking-related problems. However, individuals who reported relatively higher levels of social and conformity motives reported fewer drinking-related problems. These findings raise the possibility that subgroups characterized by high coping motives, relative to other motives, might exhibit the highest levels of drinking-related problems. 1.1.3. Life events and social support Negative life events and lack of social support also have been identified as important risk factors in research examining depression vulnerability and alcohol risk (Cronkite and Moos, 1995 and Holahan et al., 1999). Low levels of social support and exposure to negative life events may be more closely associated with maladaptive drinking patterns among individuals with depressive symptoms, as evidenced in a study of clinically depressed individuals who also reported alcohol use (Holahan, Moos, Holahan, Cronkite, & Randall, 2004). Compared to community controls, depressed individuals reported drinking to cope more often. Moreover, Holahan et al. (2004) found evidence for moderation, such that among depressed participants, coping motives were endorsed most frequently among those who also reported both a high number of negative life events and low levels of social support. Similarly, in a non-clinical sample of college students, Hussong, Hicks, Levy, and Curran (2001) also found support for moderation such that students who perceived lower levels of social support from friends increased their drinking if they also reported high levels of sadness during the preceding weekend. Two additional studies, however, suggest the relation between social support and maladaptive drinking may be more complex. Cooper et al. (1992) reported that individuals endorsing high levels of social support, coupled with negative life events and positive expectancies, reported a greater number of drinking-related problems. Similarly, Peirce, Frone, Russell, and Cooper (1996) found that appraisal/belonging support (i.e. the belief that others can offer advice, and are available to socialize and to relax with) exacerbated the association between financial stress and coping motives. On the other hand, tangible social support (i.e., expectations that others would help with specific tasks, such as providing a ride or offering a place to stay) buffered the association. These counterintuitive findings raise the possibility of discrete classes of negative affect-related drinkers that might differ with respect to the role of social support, especially within the context of other vulnerability factors. 1.2. Drinking motive profiles Recent research has attempted to identify distinct drinking profiles, but these studies have focused largely on typologies of individuals' drinking motives. For example, among adolescents Mackie et al. (2011) found four drinking motive classes, with most individuals being categorized as social drinkers (i.e., drink with friends/at parties) or social and enhancement drinkers (i.e., to get high/drunk); only 10% of the sample was classified into a class characterized by high endorsement of coping (i.e., drinking when feel bad/lonely) and social motives. Comparisons of classes indicated that the coping/social class demonstrated the highest levels of depression, anxiety and drinking level. Coffman et al. (2007) found similar drinking classes among high school 12th graders, with about 18% of the students classified as “multi-reason” drinkers, whose motives included anger/frustration, to get away from problems as well as getting high and having a good time. Multi-reason drinkers also reported the highest levels of drunkenness in the past year. Taken together, results from studies using person-centered analytic approaches, along with Gmel et al. (2012), suggest that identification of relevant negative affect-related drinking classes should take into account a variety of drinking motives (e.g. social motives). Moreover, inclusion of other relevant correlates in the model, such as negative affect and drinking level, might allow for a more nuanced discrimination of the different drinking subtypes. 1.3. The current study The central aim of the current study was to identify individuals who demonstrate maladaptive tension-reduction/self-medication patterns of drinking in the hope of identifying clinically relevant groups of negative affect-related drinkers. We built on previous research using person-centered analytic approaches to identify drinking motive typologies by including additional correlates identified in these studies, such as drinks peer week, anxiety and depressive symptoms (Coffman et al., 2007 and Mackie et al., 2011), and individual difference factors identified in social learning and stress and coping models, including positive alcohol expectancies, negative life events, and social support. We posited that inclusion of the relevant vulnerability dimensions could help to produce a more detailed and nuanced understanding of negative affect-related drinker types. Moreover, we elected to focus on the aforementioned variables since they are more amenable to intervention/modification than more distal antecedents such as family history and personality characteristics (e.g., impulsivity). Finally, we validated the identified classes by examining how they differed on drinking-related problems. Based on motivational, social learning, and stress and coping theories, we hypothesized that at least one group with high negative affect, low social support, high drinking to cope motivation (relative to other motives), and high positive expectancies would emerge and that this group would report the highest level of drinking-related problems.