Alcohol-Induced Amnesia and Personalized Drinking Feedback: Blackouts Predict Intervention Response

Abstract

Alcohol-induced amnesia (‘blackout’) is a reliable predictor of alcohol-related harm. Given its association with other negative consequences, experience of alcohol-induced amnesia may serve as a teachable moment, after which individuals are more likely to respond to intervention. To test this hypothesis, alcohol-induced amnesia was evaluated as a moderator of brief intervention effect on (a) alcohol-related consequences and (b) the proposed intervention mediators, protective behavioral strategies and peak blood alcohol concentration (BAC). Baseline alcohol risk measured using the Alcohol Use Disorders Identification Test (AUDIT) was also evaluated as a moderator to rule out the possibility that amnesia is simply an indicator of more general alcohol risk. College students (N = 198) reporting alcohol use in a typical week completed assessments at baseline and one-month follow-up as part of a larger intervention trial. Participants were randomized to assessment only (AO; n = 58) or personalized feedback intervention (PFI; n = 140). Hierarchical regression was used to examine direct and indirect intervention effects. A significant group by amnesia interaction revealed that only PFI participants who had experienced alcohol-induced amnesia in the past month reported decreases in alcohol consequences at one-month follow-up. The PFI reduced alcohol-related consequences indirectly through changes in peak BAC, but only among those who had experienced amnesia at baseline. In contrast, baseline alcohol risk (AUDIT) did not moderate intervention effects, and use of protective behavioral strategies did not statistically mediate intervention effects. Findings suggest that loss of memory for drinking events is a unique determinant of young adult response to brief alcohol intervention. Normative feedback interventions may be particularly effective for individuals who have experienced alcohol-induced amnesia in the past 30 days.

Opportunities for reducing college drinking: The roles of drinking attitudes and blackout experience

“…It is also worth noting that the results of this study seem to indicate that interventions should target both blackouts and attitudes toward drinking, as it was the combination of these variables that influenced actual behavior change. Consistent with this idea, both of these variables have been found to impact the effectiveness of drinking-related intervention programs in previous studies (DiBello et al, 2018b;Miller et al, 2018a;Miller et al, 2019a).…”

“…In event-level studies, young adults also report less favorable evaluations of drinking events and stronger perceptions that the event was not worthwhile the morning after experiencing a blackout (Fairlie et al, 2016;Merrill et al, 2019). In the context of alcohol interventions, recent experience of a blackout has also been associated with increased responsiveness to personalized alcohol feedback (Miller et al, 2018a;Miller et al, 2019a et al, 2013). Thus, the potential impact of blackouts on subsequent drinking behavior may largely depend on one's underlying attitude toward heavy drinking.…”

Intentions and motives to experience alcohol-induced blackout among young adults in college.

“…Given variability in the language and time frames used to assess alcohol-induced blackout across studies, the exact prevalence of each of these forms of blackout is unclear. Among young adults who drink, lifetime prevalence of any type of blackout is estimated at 50% (Barnett et al, 2014; Marino & Fromme, 2015; Wilhite & Fromme, 2015); however, past-month incidence ranges from 25% to 68% across studies (Acuff et al, 2019; LaBrie, Hummer, Kenney, Lac, & Pedersen, 2011; Miller, DiBello, Carey, & Pedersen, 2018; Miller, DiBello, Meier, et al, 2019). Although few studies differentiate between en bloc and fragmentary blackout (or “blackouts” and “brownouts”), en bloc blackouts tend to be less common and evaluated more negatively than fragmentary blackouts (Hartzler & Fromme, 2003a; Miller, Merrill, et al, 2018; White, Signer, Kraus, & Swartzwelder, 2004).…”

Heterogeneity of Pregamers by Consumption and Reinforcement Reasons: A Latent Profile Analysis

“…Therefore, a systematic discussion of the benefits and risks of pregaming, ideally using personalized feedback and motivational interviewing, may be required to facilitate interest in reducing pregaming. The experience of blackouts in relation to pregaming may be particularly effective, as blackouts have been found to moderate the efficacy of personalized normative feedback (PNF) interventions addressing overall alcohol use in college (Miller et al., ) and veteran (Miller et al., ) populations. In contrast, Risk‐averse pregamers experienced negative consequences from their drinking despite protective motives.…”