Presentation is loading. Please wait.

Presentation is loading. Please wait.

Motivations for Alcohol Use Evan Goulding, MD, PhD Department of Psychiatry and Behavioral Sciences Feinberg School of Medicine Northwestern University.

Similar presentations


Presentation on theme: "Motivations for Alcohol Use Evan Goulding, MD, PhD Department of Psychiatry and Behavioral Sciences Feinberg School of Medicine Northwestern University."— Presentation transcript:

1 Motivations for Alcohol Use Evan Goulding, MD, PhD Department of Psychiatry and Behavioral Sciences Feinberg School of Medicine Northwestern University

2 © Alcohol Medical Scholars Program 2 Alcohol Related Problems  Costly: $185 billion  Lethal: 3 rd leading modifiable cause death

3 © Alcohol Medical Scholars Program 3  Alcohol use common –Drink during lifetime= 90%  BUT only some develop problems –Disorder during lifetime = 15%  Problems take time to develop  Gives clinicians time to intervene  NEED TO KNOW WHO IS AT RISK Identify Risk Factors

4 © Alcohol Medical Scholars Program 4 Reasons As Risks  Certain reasons → ↑ risk  Knowing reasons (motivations) –Identifies risk –Can guide intervention –Assist ↓ use and harm

5 © Alcohol Medical Scholars Program 5 Three Cases  Common characteristics – 18 yr old males, starting college – Say drinking makes going out more fun  Tom: –likes the high, it’s exciting, pleasant  Rich: –helps enjoy party, celebrate, fit in, be liked, sociable  Harry: –likes feeling, ↑ confidence, helps upset, cheers up

6 © Alcohol Medical Scholars Program 6 Lecture Covers  Alcohol use and problems  Risk factors for problems  Types of motivations for use  Personality, motivations, problems  How motivations guide treatment

7 © Alcohol Medical Scholars Program 7 Key Points  Different motivations for use: – Exist – Predict different levels of risk  Asking about motivations: – Can guide clinical care

8 © Alcohol Medical Scholars Program 8 Lecture Topic  Alcohol use and problems  Risk factors for problems  Types of motivations for use  Personality, motivations, problems  How motivations guide treatment

9 © Alcohol Medical Scholars Program 9 Alcohol Use Disorder (AUD) –Tolerance –Withdrawal –↑ Amount/time use –Desire/inability to ↓ use –↑ Time obtain/use/recover –↓ Other due to use –Use despite problems –↓ Role obligations –Hazardous use –Interpersonal problems –Craving  Use → impairment   ≥ 2, 12-mo period

10 © Alcohol Medical Scholars Program 10 Safe Drinking Limits  For women: –Drinks per occasion≤ 3 –Drinks per week≤ 7  For men: –Drinks per occasion≤ 4 –Drinks per week≤ 14

11 © Alcohol Medical Scholars Program 11 At-Risk Drinking  Above limits = at-risk drinking  ↑ Probability –Liver disease –Financial and marital problems –Serious injuries –Problematic use

12 © Alcohol Medical Scholars Program 12 Alcohol Use Patterns  Abstain (0 drinks last mo, < 12/yr): 49%  Low-risk drinking:22%  At-risk drinking w/out AUD:21%  AUD: 8%

13 © Alcohol Medical Scholars Program 13 Use Problems  By age 18: –75% tried alcohol –60% intoxicated ≥ 1x  Quantities peak early 20s –Then quantities ↓  Ongoing ↑ quantities → problems  Onset use to dependence ~ 15yrs

14 © Alcohol Medical Scholars Program 14 Identifying Risk Important  Only some develop problems  Problems develop over time  Opportunity to intervene  NEED TO KNOW WHO IS AT RISK

15 © Alcohol Medical Scholars Program 15 Lecture Topic  Alcohol use and problems  Risk factors for problems  Types of motivations for use  Personality, motivations, problems  How motivations guide treatment

16 © Alcohol Medical Scholars Program 16 Genes Contribute  Explain ~ 50% risk for problems  Operate via 4 characteristics 1. Impaired breakdown of alcohol: ↓ risk 2. Low level sensitivity to alcohol: ↑ risk 3. Some psychiatric disorders: ↑ risk 4. Some personality traits: ↑ risk

17 © Alcohol Medical Scholars Program 17 Role of Personality Traits  Personality = stable pattern of – Thinking – Feeling – Behaving In relation to oneself and others  Traits genetically influenced

18 © Alcohol Medical Scholars Program 18 Traits That Risk  ↑ Sensation seeking  ↓ Conscientiousness  ↑ Impulsivity  ↑ Negative mood  ↑ Mood lability

19 © Alcohol Medical Scholars Program 19 Environment Contributes  Family –Lower levels support → ↑ risk  Peers –Heavy drinking → ↑ risk  Social/cultural –Belief most people drink heavily → ↑ risk  Current status –Lack rewards/stress → ↑ risk  Current situation –Easy get alcohol (cheap, close) → ↑ risk

20 © Alcohol Medical Scholars Program 20 Motives As Link  Genetic/environmental → motives  Motives → use/problems Different outcomes Different motivations Different traits  Motives identify risk pathways

21 © Alcohol Medical Scholars Program 21 Lecture Topic  Alcohol use and problems  Risk factors for problems  Types of motivations for use  Personality, motivations, problems  How motivations guide treatment

22 © Alcohol Medical Scholars Program 22 Motivational Model of Use  Alcohol use –Goal directed behavior –Goal: desire to achieve some outcome –Make decisions to drink/how much based goal  Different goals have different –Preceding risk factors (personality traits) –Subsequent outcomes (low-risk, at-risk use)

23 © Alcohol Medical Scholars Program 23 Motivations: 2 Dimensions  Valence: direction of mood change –↑ Positive mood –↓ Negative mood  Source: change mood by altering an –Internal state –External situation

24 4 Types of Motivations External Internal Positive Negative SOURCE VALENCE Social -Good time w/ friends -Be sociable (↑ + mood, external source ) Conformity -Be liked, fit in -Friends pressure (↓ - mood, external source ) Enhancement -Get high -Fun, exciting (↑ + mood, internal source ) Coping -Forget problems -Help when depressed -Feel more confident (↓ - mood, internal source )

25 © Alcohol Medical Scholars Program 25 Common Motives  Good time with friends~72% (social)  Get high ~48% (enhancement)  Relax~41% (coping)  Boredom~23% (coping)  Get away problems~21% (coping)  Due frustration/anger~17% (coping)  Fit in~10% (conformity) Terry-McElrath, YM et al, J Drug Issues 39, (2009)

26 © Alcohol Medical Scholars Program 26 Types of Young Drinkers  Social ~50% –Endorse social motives  Enhancement/social ~30% –Endorse enhancement and social motives  Coping/enhancement/social ~10% –Strongly endorse coping motives –Also enhancement and social motives

27 © Alcohol Medical Scholars Program 27 Lecture Topic  Alcohol use and problems  Risk factors for problems  Types of motivations for use  Personality, motivations, problems  How motivations guide treatment

28 © Alcohol Medical Scholars Program 28 Motives - Drinking Outcomes  Social motives (be sociable, enjoy party) -Low-risk drinking -Drink at mixed sex parties/bars, w/ families  Enhancement motives (get high, fun) –At-risk drinking, ↑ risk AUD ~1.3 fold –Drink at bars w/ same sex friends  Coping motives (forget problems, cheer up) –At-risk drinking, ↑ risk AUD ~1.5 fold –Drink at home alone

29 © Alcohol Medical Scholars Program 29 Motives - Personality Traits  Enhancement motives –↑ sensation seeking –↓ conscientiousness –↑ impulsivity  Coping motives –↑ negative mood –↑ mood lability –↑ impulsivity

30 © Alcohol Medical Scholars Program 30 Motives As Link ↑ Impulsivity ↑ Sensation seek ↓ Conscientious ↑ Alcohol use ↑ Alcohol problems ↑ Negative mood ↑ Mood lability Coping Enhancement Personality Motives Outcomes

31 © Alcohol Medical Scholars Program 31 Changes With Age (18 to 35)  Personality –Impulsivity ↓ –Negative mood/mood lability ↓  Motivations –Enhancement ↓ (get high47 → 32%) –Coping ↓ (boredom 23 → 6%)  Drinking patterns –Use ↓ after ~22yo –Alcohol related problems ↓

32 © Alcohol Medical Scholars Program 32 Coping Links Change  Coping links change personality/problems  Continued coping → ↑ risk use/problems ↓ Use ↓ Problems ↓ Coping ↑ Mood stability ↑ Self- control

33 © Alcohol Medical Scholars Program 33 Clinical Implications  Match Rx to personality traits  Rx target improved coping skills  Recognize coping motives to: –Identify risk –Provide feedback

34 © Alcohol Medical Scholars Program 34 Lecture Topic  Alcohol use and problems  Risk factors for problems  Types of motivations for use  Personality, motivations, problems  How motivations guide treatment

35 © Alcohol Medical Scholars Program 35 Prevention in High School  Limited ↓ drinking generic programs  Improve by target personality traits  Educate target students about –Coping/enhancement → ↑ drinking/problems –Alternative coping skills  These steps ↓ –Drinking/problems –Coping motives

36 © Alcohol Medical Scholars Program 36 Prevention in College  Similar approach might help  Important – peak alcohol use early 20s – onset AUD in some  Brief intervention student health – ↓ alcohol use if at-risk use

37 © Alcohol Medical Scholars Program 37 Brief Intervention  Ask – if drink, frequency, quantity  Advise – state concern, recommend change  Assess – willingness change  Assist – if ready help change  Arrange – reinforce change w/ follow up

38 © Alcohol Medical Scholars Program 38 Asking Why Drink Helps  Identify individuals at risk –Coping → ↑ heavy use, ↑ problems (directly) –Enhancement → ↑ heavy use → ↑ problems  Guide intervention –Feedback about risk of different motives –Coping → alternatives to ↓ negative mood –Enhancement → alternatives to ↑ positive mood

39 © Alcohol Medical Scholars Program 39 Case #1  Type: social/ enhancement  Risk: intermediate  Traits: ↑ sensation, ↓ conscientious, ↑ impulsivity  Discuss: risks enhancement motives  Suggest: alternatives to ↑ positive mood Tom- likes feeling, getting high, exciting, pleasant

40 © Alcohol Medical Scholars Program 40 Case #2  Type: social/ conformity  Risk: lower  Traits: none  Discuss: use within safe drinking limits Rich- helps enjoy party, celebrate, fit in, be liked, sociable

41 © Alcohol Medical Scholars Program 41 Case #3  Type: social/ enhancement/coping  Risk: higher  Traits: ↑ negative/labile mood, ↑ impulsivity  Discuss: risks coping motives  Suggest: alternatives to ↓ negative mood  Consider: referral for alcohol, mood problems Harry- likes feeling, ↑ confident, helps upset, cheer up

42 © Alcohol Medical Scholars Program 42Summary  Traits → motivations → outcomes  Coping –Risk: ↑ heavy alcohol use, ↑ problems –Traits: ↑ negative mood, ↑ mood lability, ↑ impulsivity –Provide: alternatives to ↓ negative mood  Enhancement -Risk: ↑ heavy alcohol use → ↑ problems -Traits: ↑ sensation seeking, ↓ conscientious, ↑ impulsivity -Provide: alternatives to ↑ positive mood  Ask motives → ↑ clinical care, ↓ progress AUD


Download ppt "Motivations for Alcohol Use Evan Goulding, MD, PhD Department of Psychiatry and Behavioral Sciences Feinberg School of Medicine Northwestern University."

Similar presentations


Ads by Google