A qualitative examination of intentions and willingness for heavy drinking among young adult high-intensity drinkers.

Abstract

Objective: Heavy episodic drinking (HED) and high-intensity drinking (HID) are common in young adulthood but pose unique risks. Quantitative studies have used the Theory of Planned Behavior (TPB) and the Prototype-Willingness Model (PWM) to understand decision-making processes underlying alcohol misuse. However, our understanding of intentions (plans) and willingness (openness) for HED/HID is in its nascent stages. This study represents the first qualitative examination of relationships between intentions and willingness to engage in HED/HID. Method: We conducted individual interviews among 28 young adult high-intensity drinkers (12 male, 15 female, 1 trans male; M age = 23 years). Interviews focused on HED/HID events with open-ended questions examining: (a) variability in intentions/willingness by occasion and within a drinking event; (b) formation of intentions for consumption and/or intoxication; and (c) interplay of willingness and intentions on heavy drinking nights. Verbatim transcripts were coded within NVivo software and content was analyzed using applied thematic analysis. Results: Participants described intentions and willingness as varying by occasion and perceived their shifting across a drinking event. Intentions for heavy drinking reflected a desired level of intoxication, rather than a specific number of drinks. Willingness, rather than intentions, to engage in heavy drinking/HID was more evident. Conclusions: Findings have significant implications for future measurement work in this area. There may be value in assessing intentions and willingness multiple times per day and during the drinking event itself. We also recommend that intentions for both consumption and intoxication levels be assessed, particularly in studies aiming to examine impaired control. Public Health SignificanceThis study demonstrated the importance of both intentions and willingness as decision-making factors that influence heavy drinking in young adults. Our findings showed that young adults more so plan for a level of intoxication, rather than a specific number of drinks to consume. We also highlight that young adults perceive that their intentions and willingness to drink and become intoxicated change during the drinking event itself, which has implications for targeting these factors in the moment.

Understanding the motives, contexts, and consequences of unplanned versus planned drinking in daily life.

“…We provided similar competing hypotheses for drinking at a friend’s place and ultimately supported our qualitative themes (Stevens, Boyle, et al, 2021) by showing that drinking in this location on a given day, but not on a given occasion, was related to planned drinking. To our knowledge, we are the first to examine this location for these two types of drinking events; thus, more research is needed to determine the replicability of this effect, including whether these findings hold when examining unplanned heavy drinking or drinking more than intended.…”

“…Indeed, we originally expected that drinking with friends, strangers/acquaintances, or with larger group of intoxicated people might influence an individual's decision to drink via the social norms of the drinking event. That said, when young adults described intending to drink-at all and regardless of level of consumption-they were most often with friends or around other people, including those who were intoxicated (Stevens, Boyle, et al, 2021). Thus, future research that examines the influence of drinking with friends or intoxicated people on other types of unplanned drinking (e.g., drinking more than intended) may find disparate relations.…”

“…1Since our preregistration on October 29, 2019 (https://osf.io/tcuk4) but prior to data analysis, emerging research in this area (e.g., Lauher et al, 2020), including some of our own qualitative work (Stevens, Boyle, et al, 2021), supports competing hypotheses that we provide transparently in text.…”

Gender and Childhood Victimization: A Longitudinal Study of Heavy Drinking in Young Adulthood

“…Fourth, prevention efforts working at multiple levels must include modifying norms and beliefs about drinking behavior [93], including willingness and intention to engage in heavy drinking [3] and drinking contexts [14]. As well, research into emerging areas of neurobiology has led to better understandings of medical intervention models to reduce alcohol and other addictions in adulthood [94].…”

“…Most often defined as four or more drinks (for women) and five or more drinks (for men) in a relatively short window of time [1], heavy drinking remains a relatively common behavior among older adolescents and young adults, often tapering off after the transition to adulthood [2,3]. Close links are found in the literature between substance use and mental health symptomatology, such as depression, with some cases identifying substance use as a cause and others classifying substance use as an effect [4,5].…”