Baseline protective behavioral strategy use predicts more moderate transdermal alcohol concentration dynamics and fewer negative consequences of drinking in young adults’ natural settings.

Abstract

Objective: Test whether frequent protective behavioral strategies (PBS) users report (a) fewer alcohol-related consequences and (b) less risky alcohol intoxication dynamics (measured via transdermal alcohol concentration [TAC] sensor "features") in daily life. Method: Two hundred twenty-two frequently heavy-drinking young adults (M age = 22.3 years) wore TAC sensors for 6 consecutive days. TAC features peak (maximum TAC), rise rate (speed of TAC increase), and area under the curve (AUC) were derived for each day. Negative alcohol-related consequences were measured in the morning after each self-reported drinking day. Past-year PBS use was measured at baseline. Results: Young adults reporting more frequent baseline PBS use showed (a) fewer alcohol-related consequences and (b) lower intoxication dynamics on average (less AUC, lower peaks, and slower rise rates). Limiting/stopping and manner of drinking PBS showed the same pattern of findings as the total score. Serious harm reduction PBS predicted fewer negative alcohol-related consequences, but not TAC features. Multilevel path models showed that TAC features peak and rise rate partially explained associations between PBS (total, limiting/stopping, and manner of drinking) and consequences. Independent contributions of PBS subscales were small and nonsignificant, suggesting that total PBS use was a more important predictor of risk/protection than the specific types of PBS used. Conclusions: Young adults using more total PBS may experience fewer alcohol-related consequences during real-world drinking episodes in part through less risky intoxication dynamics (TAC features). Future research measuring PBS at the daily level is needed to formally test TAC features as day-level mechanisms of protection from acute alcohol-related consequences. Public Health Significance StatementThis study shows that among young adults who report frequent heavy drinking, those who report more versus less frequently using protective behavioral strategies (PBS) show lower intoxication peaks and slower intoxication increases during drinking events, as well as fewer negative alcohol-related consequences following drinking events. Differences in alcohol intoxication dynamics as PBS frequency increased explained 10%-21% of the PBS association with alcohol-related consequences. These results support further investigation of PBS at the daily level that tests whether intoxication dynamics provide a mechanism through which PBS reduce consequences in natural settings.

Profiles of alcohol intoxication and their associated risks in young adults’ natural settings: A multilevel latent profile analysis applied to daily transdermal alcohol concentration data.

“…TAC features correspond with self-reported drink counts ( r = .6–.7; Russell et al, 2022; van Egmond et al, 2020), and the unique variability of TAC features is meaningful for alcohol-related risk. TAC features predict alcohol-related consequences adjusted for drink counts (Russell et al, 2022) and provide an indirect path through which protective behavior use is associated with reduced alcohol-related consequences (Russell et al, 2024).…”

“…Features of these curves characterize the alcohol intoxication dynamics of the day, providing aspects of alcohol consumption events beyond the number of drinks consumed. These features include the speed of alcohol absorption (rise rate) and elimination (fall rate), the time spent biologically exposed to alcohol (duration), the maximum intoxication level (peak), and the cumulative burden of alcohol exposure (area under the curve [AUC]; Didier et al, 2024;Fridberg et al, 2022;Leffingwell et al, 2013;Russell et al, 2022Russell et al, , 2024. TAC features correspond with self-reported drink counts (r = .6-.7; Russell et al, 2022;van Egmond et al, 2020), and the unique variability of TAC features is meaningful for alcoholrelated risk.…”

“…High-peak, fast-rate, short-duration events suggest rapid and heavy alcohol consumption, whereas moderate-peak, slow-rate, long-duration events suggest slower and more evenly paced drinking. Research has used AUC as predictor of behavioral risk (e.g., Gunn et al, 2021;Russell et al, 2022Russell et al, , 2024Simons et al, 2015). Although AUC is useful for prediction of outcomes (Russell et al, 2022(Russell et al, , 2024Simons et al, 2015), it is not easily interpretable.…”

“…Research has used AUC as predictor of behavioral risk (e.g., Gunn et al, 2021;Russell et al, 2022Russell et al, , 2024Simons et al, 2015). Although AUC is useful for prediction of outcomes (Russell et al, 2022(Russell et al, , 2024Simons et al, 2015), it is not easily interpretable. This is because AUC is a composite summary of TAC episode length by intoxication "height", and therefore, the same AUC could result from a day with long, slow-changing, lowpeaked TAC and from a day with short, fast-changing, high-peaked TAC.…”

“…Most research using TAC sensors has examined associations between features and outcomes by testing each feature individually (Clapp et al, 2017;Russell et al, 2022Russell et al, , 2024Simons et al, 2015). Only one study has tested an interaction between TAC features (Simons et al, 2015), showing that a longer average time to peak (analogous to a slower rise rate) was more strongly associated with baseline alcohol use disorder (AUD) symptoms if a person tended to show low versus high TAC peaks on average.…”