Applying behavioral economics to understand changes in alcohol outcomes during the transition to adulthood: Longitudinal relations and differences by sex and race.

Abstract

Objective: Population drinking trends show clear developmental periodicity, with steep increases in harmful alcohol use from ages 18 to 22 followed by a gradual decline across the 20s, albeit with persistent problematic use in a subgroup of individuals. Cross-sectional studies implicate behavioral economic indicators of alcohol overvaluation (high alcohol demand) and lack of alternative substance-free reinforcers (high proportionate alcohol-related reinforcement) as potential predictors of change during this developmental window, but longitudinal evidence is sparse. Method: Using a sample of emerging adults (N = 497, M age = 22.61 years, 62% female, 48.69% White, 40.44% Black), this study examined prospective, bidirectional relations between both past-week heavy drinking days (HDD) and alcohol problems and proportionate alcohol-related reinforcement (reinforcement ratio), alcohol demand intensity (consumption at zero price), alcohol demand O max (maximum expenditure), and change in demand elasticity (rate of change in consumption across escalating price) over five assessments (every 4 months) using random intercept cross-lagged panel models. Results: Alcohol problems and HDD decreased across assessments. Significant between-person effects indicated that each behavioral economic variable was associated with increased drinking risk. Change in reinforcement ratio was positively associated with decreases in alcohol problems. Multigroup invariance modeling revealed distinct risk pathways in that change in demand intensity and O max predicted change in alcohol problems for male participants and change in intensity predicted change in alcohol problems for non-White participants. Conclusion: The study provides consistent support for proportionate alcohol-related reinforcement and mixed support for demand as withinperson predictors of reductions in drinking. Public Health Significance StatementThis study demonstrates that reductions in the value of alcohol relative to alternative alcohol-free activities precede reductions in alcohol-related problems, which provide support for intervention and treatment approaches that increase reinforcement from alternative activities.

Longitudinal examination of alcohol demand and alcohol‐related reinforcement as predictors of heavy drinking and adverse alcohol consequences in emerging adults

“…The present study critically extends a sizeable body of cross-sectional literature [18,32] and initial longitudinal work [48,49] by providing a robust longitudinal examination of prospective and bidirectional associations between key behavioral economic indicators and alcoholrelated outcomes among a relatively large sample of emerging adults.…”

“…The present study critically extends a sizeable body of cross‐sectional literature [18,32] and initial longitudinal work [48,49] by providing a robust longitudinal examination of prospective and bidirectional associations between key behavioral economic indicators and alcohol‐related outcomes among a relatively large sample of emerging adults. The results revealed several relationships that were consistent with behavioral economic predictions [14,15], in addition to others that were less consistent or not supported.…”

“…[48] found evidence of bidirectional associations between demand intensity and heavy drinking across a 1‐year follow‐up period, but inconsistent results for other demand indicators. More recently, an observational study found that decreases in proportionate reinforcement were associated with decreases in alcohol problems in general, and demand indicators were selectively predictive in males and racial minority participants [49], providing further initial evidence.…”

Behavioral Economic and Wellness-based Approaches for Reducing Alcohol Use and Consequences Among Diverse Non-Student Emerging Adults: Study Protocol for Project BLUE, a Randomized Controlled Trial

“…Behavioral economic measures. The modi ed Activity Level Questionnaire measures past-month activity frequency and enjoyment with Likert scales and separate items for substance-related and substance-free activities (Acuff et al, 2023). The frequency and enjoyment ratings are multiplied to obtain a crossproduct score that re ects reinforcement derived from the activity.…”

“…A recent daily diary study with non-student EA drinkers indicated that engagement in alternative enjoyable activities was the most frequently endorsed strategy to avoid drinking (Lau-Barraco & Linden-Carmichael, 2019). The Substance-Free Activity Session (SFAS) was developed to supplement alcohol-focused BAIs and uses MI, personalized normative feedback, goal setting, and an episodic future thinking exercise to target the behavioral economic mechanisms of substance-free reinforcement and delayed reward discounting (Acuff et al, 2023). The SFAS encourages EAs to identify and discuss the long-term bene ts associated with their life goals and to consider how their current patterns of time allocation and drinking (which are aggregated as personalized feedback) might impact those valued goals (Murphy et al, 2019) (Gex et al, 2023;Meshesha et al, 2020).…”