استفاده از استراتژی رفتاری حفاظتی و انگیزش برای نوشیدن: بررسی جایگزین ها برای استراتژی های نوشیدنی

Protective behavioral strategy (PBS) use is associated with less alcohol consumption and fewer alcohol-related problems. Further, greater endorsement of social or enhancement drinking motives (i.e., positive motives) is associated with less frequent PBS use. Limited research has, however, explored coping or conformity motives (i.e., negative motives) in relation to PBS. Consequently, the present study aimed to (1) identify the types of PBS most strongly associated with negative and positive motives and (2) examine different types of PBS as mediators of the relationship between each drinking motive and alcohol outcomes. Participants were college students (n = 303; 70% women) who completed measures of drinking motives, PBS, alcohol use, and alcohol-related problems. Results indicated that greater endorsement of positive drinking motives were more strongly associated with less frequent use of PBS while drinking whereas negative motives were more strongly related to less frequent Alternatives to Drinking strategy use. Further, strategies used while drinking were more relevant in a model of positive drinking motives and Alternatives to Drinking strategies were more relevant in a model of negative motives. These findings may suggest that whereas individuals with stronger positive motives have difficulty using strategies while drinking, individuals who drink to cope or conform have greater difficulty utilizing Alternatives to Drinking strategies. Based on our results demonstrating that different types of PBS are more relevant for various types of drinkers, it may be important for future interventions to discuss not only the participant's PBS use but also their motivations for consuming alcohol.

Drinking motives are reasons for consuming alcohol and are associated with alcohol use (Cooper, 1994). Predominant motivations for drinking include social (i.e., drinking to be more outgoing), enhancement (i.e., drinking to increase positive affect), coping (i.e., drinking to decrease negative affect), and conformity (i.e., drinking to avoid negative peer evaluation). Social and enhancement motives are positive reinforcement motives; coping and conformity motives are negative reinforcement motives. Having stronger negative motives can be considered a risk factor because they are associated with alcohol-related problems, such as alcohol use disorders (Carpenter & Hasin, 1999). Research has suggested that drinking motives are associated with protective behavioral strategy (PBS) use, or behaviors that individuals can use to limit alcohol consumption and/or alcohol-related problems. Individuals who typically endorse more positive motives compared to negative motives use fewer PBS (LaBrie et al., 2011 and Martens et al., 2007). Further, PBS use mediated the associations between positive motives and alcohol outcomes, but not between coping motives and outcomes (Martens et al., 2007); stronger positive motives were related to less PBS use, which in turn predicted greater alcohol consumption; there was no relationship for negative motives. Importantly, the above studies examining drinking motives and PBS used items from the PBSS (Martens et al., 2005), which measures strategies used while drinking (SWD) that can only be used in social environments (Martens et al., 2007). Therefore, these strategies may be relevant for those motivated to drink in social situations, and not be applicable to those who drink for negative reinforcement purposes, where they often drink alone (Mohr et al., 2001). Because individuals who drink to avoid negative affect and peer evaluation are at greater risk for experiencing alcohol-related problems, it is important to identify types of PBS that are problematic for these individuals. Furthermore, examining the relationship between drinking motives and other PBS addresses a methodological limitation raised by Prince, Carey, and Maisto (2013). That is, by focusing on types of PBS beyond SWD, researchers can examine broader PBS (e.g., finding Alternatives to Drinking) implemented outside social situations. Alternatives to Drinking (ATD) strategies from the Strategy Questionnaire (SQ; Sugarman & Carey, 2007) are behaviors to avoid alcohol consumption, which may be relevant for those who drink to reduce negative affect. Therefore, it may be useful to examine ATD strategies as related to negative drinking motives. To date, one study has examined these strategies and drinking motives together, finding significant negative associations with social and coping motives (Patrick, Lee, & Larimer, 2011). However, this construct was only measured by one item (i.e., “Choose not to drink alcohol”). To build upon these preliminary results, the present study used multiple ATD strategies to use a more reliable assessment and test the influence of indirect effects between drinking motives, PBS, and alcohol outcomes. Findings could provide researchers with information for skills-based alcohol interventions, such that interventionists could tailor intervention information by discussing specific PBS that are more efficacious given an individual's motivations. In the present research, we aimed to examine associations between various drinking motives and PBS. We hypothesized that negative motives would be associated with less frequent ATD strategies compared to positive motives. We also examined different types of PBS as mediators of the relationship between each drinking motive and alcohol outcomes.

Analyses were conducted using Mplus 6.1 (Muthén & Muthén, 1998–2010). Maximum likelihood estimation was used to accommodate missing data (< 5%). Bivariate correlations revealed that the PBSS composite was negatively correlated with social, r(303) = − .35, p < .001, enhancement, r(303) = − .36, p < .001, coping-anxiety, r(303) = − .23, p < .001, and coping-depression drinking motives, r(303) = − .12, p < .044. The PBSS composite was unrelated to conformity motives, r(303) = − .04, p = .463. ATD were negatively correlated with social, r(303) = − .12, p < .031, conformity, r(303) = − .20, p = .001, coping-anxiety, r(303) = − .23, p < .001, and coping-depression motives, r(303) = − .22, p < .001. ATD were unrelated to enhancement motives, r(303) = − .11, p = .066. Overall, positive motives were more strongly related to SWD, and negative motives were more strongly associated with ATD. 3.1. Mediation models To assess the strength of relationships between individual drinking motives and SWD strategies, we tested PBS as a mediator of the association between drinking motives and alcohol outcomes. The fit for this model was poor: χ2(26) = 261.94, RMSEA = .173, CFI = .826, TLI = .631, SRMR = .142. We then removed the negative drinking motives. This modified model ( Fig. 1) had substantially better fit: χ2(11) = 33.14, RMSEA = .081, CFI = .969, TLI = .921, SRMR = .041. Moreover, a likelihood ratio test indicated that the inclusion of all motives yielded significantly worse model fit than the positive motives alone, Δχ2(15) = 228.80, p < .001. This indicates that SWD are more relevant in a model of positive motives than negative motives. Regarding indirect effects, PBS significantly mediated the association between enhancement motives and use, B = 0.78, SE = 0.32, p = .016, bootstrap 95% CI [0.30, 1.62] and problems, B = 0.42, SE = 0.17, p = .016, bootstrap 95% CI [0.16, 0.86]. PBS did not significantly mediate the relationship between social motives and use, B = 0.32, SE = 0.22, p = .150, bootstrap 95% CI [− 0.01, 0.90] nor problems, B = 0.17, SE = 0.12, p = .149, bootstrap 95% CI [− 0.01, 0.48] after controlling for enhancement motives. Full-size image (15 K) Fig. 1. Protective behavioral strategies (PBS) as a mediator between positive drinking motives and alcohol outcomes of consumption and problems. Only PBS types that are used while drinking are included. MoD = manner of drinking; S/LD = stopping/limiting drinking; SHR = serious harm reduction. Standard errors are in parentheses. Direct effects between drinking motives and alcohol outcomes were included in the analysis but omitted from the figure for clarity. Gender was controlled for as well. The model was bootstrapped with n = 10,000 iterations, and bias-corrected confidence intervals were used for significance tests. R2 = .276 for PBS Alternatives to Drinking, R2 = .219 for alcohol consumption, and R2 = .219 for alcohol-related problems. **p < .01. ***p < .001. Figure options We then examined the relationships between drinking motives, alcohol outcomes, and the mediation of only the ATD subscale for PBS. This full model had poor fit: χ2(10) = 198.25, RMSEA = .249, CFI = .827, TLI = .379, SRMR = .150. We then removed positive motives from the model, leaving only negative motives. Though none of the specific indirect effects were significant, 1 this modified model ( Fig. 2) had substantially better fit: χ2(2) = 5.59, RMSEA = .077, CFI = .994, TLI = .934, SRMR = .012. Moreover, a likelihood ratio test indicated that the inclusion of all motives yielded significantly worse model fit than negative motives alone, Δχ2(8) = 192.66, p < .001. This indicates that ATD strategies are more relevant as a mediator in a model of negative motives as compared to a model of all motives. Full-size image (15 K) Fig. 2. Protective behavioral strategies (PBS) Alternatives to Drinking as a mediator between negative drinking motives and alcohol outcomes of consumption and problems. Coping-A = drinking to cope with anxiety; Coping-D = drinking with cope with depression; MoD = manner of drinking; S/LD = stopping/limiting drinking; SHR = serious harm reduction. Standard errors are in parentheses. Direct effects between drinking motives and alcohol outcomes were included in the analysis but omitted from the figure for clarity. Gender was controlled for as well. The model was bootstrapped with n = 10,000 iterations and bias-corrected confidence intervals were used for significance tests. R2 = .064 for PBS Alternatives to Drinking, R2 = .106 for alcohol consumption, and R2 = .107 for alcohol-related problems. *p < .05.