The present study examined the degree to which morally injurious experiences (MIEs; i.e., atrocities of war, psychological consequences of war, and leadership failure/betrayal) and moral injury (i.e., guilt, shame, difficulties with forgiveness, and withdrawal associated with exposure to MIEs) were associated with symptoms of depression, anxiety, posttraumatic stress disorder (PTSD), suicidality, hazardous alcohol use, and drug abuse symptoms. In addition, we examined moral injury and PTSD symptoms as mediators of the association between MIEs and these outcomes (exploratory model). Participants (n = 244) were a predominantly veterans community-based military sample. Our primary model (i.e., single mediation model) revealed that moral injury mediated associations between two MIEs (i.e., atrocities of war and leadership failure/betrayal) and depressive symptoms, anxiety symptoms, hazardous alcohol use, and PTSD symptoms. However, our exploratory model (i.e., a dual simultaneous mediation model) revealed that moral injury was not significantly associated with any health outcomes after controlling for the effects of MIE dimensions and PTSD symptoms. Within this model, PTSD symptoms significantly mediated the effects of both atrocities of war MIEs and leadership failure/betrayal MIEs on depressive symptoms, anxiety symptoms, suicidality, and hazardous alcohol use. Findings provide preliminary support for moral injury as a mechanism linking exposure to MIEs to both mental health and hazardous alcohol use. Taken together, moral injury appears to be an important target for intervention among combat military personnel.

Influential psychological theories hypothesize that people consume alcohol in response to the experience of both negative and positive emotions. Despite two decades of daily diary and ecological momentary assessment research, it remains unclear whether people consume more alcohol on days they experience higher negative and positive affect in everyday life. In this preregistered meta-analysis, we synthesized the evidence for these daily associations between affect and alcohol use. We included individual participant data from 69 studies (N = 12,394), which used daily and momentary surveys to assess affect and the number of alcoholic drinks consumed. Results indicate that people do not drink more often on days they experience high negative affect, but are more likely to drink and drink heavily on days high in positive affect. People self-reporting a motivational tendency to drink-to-cope and drink-to-enhance were estimated to consume more alcohol, but not to consume more alcohol on days they experience higher negative and positive affect. Results were robust across different operationalizations of affect, study designs, study populations, and individual characteristics. Based on our findings, we collectively propose an agenda for future research to explore open questions surrounding affect and alcohol use.

Objective Computerized interventions are cost-effective and can quickly deliver individual feedback to many students. However, in-person interventions are more efficacious. The current study sought to improve the efficacy of a popular online intervention via emailed boosters with personalized feedback. Participants Participants were 213 student drinkers at a southeastern public university, ages 18–24. Methods Students were randomized into: 1) intervention only, or 2) intervention plus booster. Alcohol consumption and related problems were assessed at baseline, 2 weeks post, and 4 weeks post. Results Boosters yielded reductions in drinking, but not alcohol-related problems. Boosters were associated with significant reductions for drinking frequency, heavy drinking days, peak drinks, and associated BAC. Protective behavioral strategies (PBS) moderated this effect, with significant reductions for students low in PBS, but not students already highly engaged in PBS use. Conclusions Easy dissemination and low cost make emailed boosters a very efficient way to promote student health.

The current investigation sought to examine “day of the week” drinking of an at-risk sample of nonstudent emerging adults and whether specific factors are associated with differential drinking patterns. Our study aims were to: (1) identify differences in weekday versus weekend drinking, (2) examine specific expectancies (i.e., sociability, tension reduction) and demographic factors (e.g., age, sex) as relating to weekend versus weekday drinking after controlling for harmful drinking and holiday drinking. Participants were 238 (63.4% men, 35.7% women; M age = 21.92 years) heavy drinking noncollege-attenders recruited from the community. They reported daily drinking for the previous 30 days and completed measures of harmful drinking, alcohol expectancies, and demographic information. Results showed that more drinks were consumed on the weekends (i.e., Thursday to Saturday) than weekdays, with 63% of drinks consumed on weekends. Multilevel modeling analyses indicated that weekday drinking was associated with tension reduction expectancies, social expectancies, sex, and age. Weekend drinking increases were related to social expectancies but not tension reduction expectancies. Our final model indicated that, after controlling for the effect of holiday drinking, the within-person weekday/weekend distinction explained 18% of the total variance. In general, our findings highlight the importance of alcohol expectancies and drinking contexts in understanding the drinking behaviors of nonstudents. The differential role of tension reduction and social facilitation expectancies on drinking throughout the week imply different cognitive pathways are involved in weekday versus weekend drinking and both types of expected alcohol effects should be targets of risk-reduction efforts with nonstudent drinkers.

Relationships among adult children of alcoholics (ACOAs) and parent and peer relations and depressive mood were examined among 136 ACOAs and 436 non-ACOAs. As compared to non-ACOAs, ACOAs reported less positive relationships to mothers, fathers, and peers, and more depressive mood; however, more positive relationships to parents and peers significantly reduced the strength of the association between ACOA categorization and depressive mood. Examination of data from ACOAs alone revealed that maternal alcoholism was related to less positive relationships to their mothers and to their peers; however, paternal alcoholism did not predict the quality of the relationship to fathers, mothers, or peers. Attachment to parents and peers and the gender of the alcohol-abusing parent were associated with depressive symptoms among ACOAs.

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Moral injury (MI) results from perpetration of or exposure to distressing events, known as morally injurious events (MIEs), that challenge moral beliefs and values. Due to the type of involvement in recent military conflicts, many veterans report MIEs that may cause dissonance and, in turn, MI. Although two existing measures assess MIEs, neither currently assesses the defining characteristics of MI (i.e., guilt, shame, difficulty forgiving self and others, and withdrawal). The present study reports the initial psychometric test of a modified version (Robbins, Kelley, Hamrick, Bravo, & White, 2017) of the Moral Injury Questionnaire – Military version (MIQ-M; Currier, Holland, Drescher, & Foy, 2015) in a sample of 328 military personnel (e.g., veterans, National Guard/reservists, active duty members). The MIQ-M was modified to assess both MIEs and the defining characteristics of MI. Exploratory factor analyses suggested a three-factor model of MIEs consisting of Atrocities of war, Psychological consequences of war, and Leadership failure or betrayal. The modified MIQ-M factors were correlated with defining characteristics of MI. In addition, each MIE factor and associated defining characteristics of MI were positively correlated with symptoms of posttraumatic stress disorder, depression, and anxiety, as well as substance use. The modified MIQ-M is a reliable measure of MI that is comprised of three subscales that are associated with, but distinct from, mental health outcomes. Although findings are promising, further research evaluating the applicability of the modified MIQ-M in clinical settings is required to establish construct validity of the defining characteristics and secondary manifestations of MI.

Influential psychological theories hypothesize that people consume alcohol in response to the experience of both negative and positive emotions. Despite two decades of daily diary and ecological momentary assessment research, it remains unclear whether people consume more alcohol on days they experience higher negative and positive affects in everyday life. In this preregistered meta-analysis, we synthesized the evidence for these daily associations between affect and alcohol use. We included individual participant data from 69 studies (N = 12,394), which used daily and momentary surveys to assess the affect and the number of alcoholic drinks consumed. Results indicate that people are not more likely to drink on days they experience high negative affect but are more likely to drink and drink heavily on days high in positive affect. People self-reporting a motivational tendency to drink-to-cope and drink-to-enhance consumed more alcohol but not on days they experienced higher negative and positive affects. Results were robust across different operationalizations of affect, study designs, study populations, and individual characteristics. These findings challenge the long-held belief that people drink more alcohol following increase in negative affect. Integrating these findings under different theoretical models and limitations of this field of research, we collectively propose an agenda for future research to explore open questions surrounding affect and alcohol use.