Consistent with self-medication theory, young adults who endorse using alcohol to cope with stressful events via negative reinforcement (i.e., to provide relief or reduction of stress or depressed mood) experience continued heavy drinking and are particularly at-risk for negative outcomes including greater alcohol-related consequences and depressive symptoms. Young adults who drink to cope may lack more adaptive means of managing distress or have a lack of alternative, adaptive coping mechanisms. Although some interventions have been developed to address alcohol use and drinking to cope, many show minimal, if any, main effects. To date, the majority of these interventions provide a general list of coping skills and do not further assess if individuals have learned and utilized the skills. Other brief web-based intervention approaches that provide more thorough information and content on coping strategies and emotion regulation skills either do not specifically target individuals who drink to cope or do not assess coping skill knowledge and utilization directly. A more comprehensive, interactive approach to learning coping skills may be needed by teaching concrete skills, showing video demonstration of the concepts, and then assessing coping skill utilization. This R34 application seeks to address previous limitations and enhance the efficacy of web-based interventions by developing measurement tools to assess weekly coping skill acquisition, knowledge, use, and barriers to use, and incorporating these tools in the development of an interactive web-based intervention with text-message reminders for young adults who drink to cope. Phase 1 includes formative research on the development of an interactive web-based intervention with text-message reminders for young adults with alcohol-related consequences who report drinking to cope with stressful events and developing tools to assess acquisition, knowledge, and utilization of web-based coping skills. We will conduct a series of focus groups, discussion with experts, rapid prototyping sessions, and a usability study with interviews to further refine the intervention and obtain user feedback (Aims 1 and 2). The intervention will be developed by including interactive modules on coping skills, assignments to practice the skills, text-message reminders, and weekly assessments on coping skill knowledge, acquisition, skill utilization, and barriers to use. Phase 2 will be a pilot study with weekly assessments to determine feasibility, acceptability, utilization of coping skills, and preliminary alcohol outcomes (Aim 3). A total of 120 young adults will be randomized to the 4-week, web-based drinking to cope intervention (n=60) or an assessment only control (n=60) where they will complete 4 weekly assessments on knowledge, acquisition, and use of coping skills and a 1- and 3-month follow-up. Findings have important public health implications as we will develop and refine intervention and coping skill assessment strategies among a population of individuals for whom current intervention options have been shown to be less effective.
Young adults (ages 18-25) who drink to cope with distress are at-risk for negative outcomes including greater alcohol-related consequences and depressive symptoms. Interventions that provide coping skills often show a brief list of strategies and do not assess skill knowledge and utilization, suggesting a more comprehensive approach is needed. Consistent with NIAAA's Strategic Plan, the proposed study aims to enhance the efficacy of web-based interventions by developing measurement tools to assess weekly coping skill acquisition, knowledge, and use, and incorporating these tools in the development of an interactive web- based intervention with text-message reminders for young adults who drink to cope.
