Characterizing subjective responses to alcohol among adolescent problem drinkers.

Abstract

Theoretical models of alcoholism emphasize the acute reinforcing properties of alcohol as chief determinants of drinking, and animal research suggests adolescents are uniquely sensitive to these effects. Human studies of these phenomena, however, are virtually nonexistent. We used ecological momentary assessment methods to capture adolescents' subjective responses to alcohol in real time in their natural environments. Adolescent participants were 22 problem drinkers, ages 15 to 19 years (M = 18.3, SD = 0.09; 55% female; 55% alcohol dependent). Participants consumed alcohol on 38% of days during a one-week monitoring period, with an average of 5 drinks per occasion. Momentary data revealed that adolescents experience decreased stimulation and increased sedation and ‘high’ across the ascending limb of the blood alcohol curve. Notably, greater craving predicted higher volumes of subsequent alcohol consumption during the episode, whereas greater ‘high’ attenuated use. To test for developmental differences in these effects, we pooled these data with data from a similarly ascertained sample of 36 adult heavy drinkers, ages 24 to 64 years (M = 38.1, SD = 11.8; 50% female; 61% alcohol dependent). Adolescents were more sensitive to the stimulant effects of alcohol than adults. This study provides novel data on how adolescent problem drinkers experience alcohol in their natural contexts and illustrates how these effects, which appear to differ from adult problem drinkers, confer liability for future drinking.

Application of an alcohol clamp paradigm to examine inhibitory control, subjective responses, and acute tolerance in late adolescence.

“…Potential explanations for these differences include the disparate assessment contexts and the examination of a higher BAC range in the present study. Notably, the use of in vivo assessments in the former study revealed high levels of stimulation before BAC levels were appreciable, possibly reflecting stimulation from the social context, and perhaps explaining the decline in stimulation as BAC increased (Miranda, et al, 2014). In contrast, the use of intravenous alcohol in this study served to remove non-pharmacological cues.…”

“…Examining links between subjective responses and craving can clarify in-the-moment processes by which subjective responses correspond with consumption (Miranda, et al, 2014; Rose, et al, 2010). Although other alcohol challenge studies have reported associations of alcohol-induced stimulation with craving (e.g., Bujarski & Ray, 2014; Ray, et al, 2010; Rose, et al, 2010), the present study addressed this question by modeling two discrete intervals of the BAC trajectory.…”

Subjective alcohol responses in a cross-sectional, field-based study of adolescents and young adults: Effects of age, drinking level, and dependence/consequences

“…We expected that younger age would be associated with greater self-reported stimulation and lesser sedation among adolescents and young adults recruited in an ecologically valid setting and in the context of a natural drinking episode. Previous ecological momentary assessment (EMA) research found that adolescents experience greater stimulation while drinking in the natural environment, relative to adults, but this effect diminished at higher estimated eBACs (Miranda et al, 2014). Therefore, we also tested for interactive effects of age and eBAC, and expected that the relation of age to stimulatory responses to alcohol would be attenuated at higher eBACs.…”

“…These youth reached peak breath alcohol levels at a faster rate than is typical of adults administered a similar alcohol dose, while also showing smaller behavioral changes than anticipated given their BAC (Behar et al, 1983). A recent ecological study assessed dose-related changes in subjective ratings of stimulation and sedation on the ascending limb of intoxication using handheld wireless devices among a small sample of 29 adolescents aged 15 to 19 (Miranda et al, 2014). Youth were instructed to record subjective stimulatory and sedative states just before beginning to drink as well as their subjective responses following each of the first three standard drinks of a drinking episode, which produced an average estimated BAC (eBAC) equivalent to the Behar study (.04 mg/ml).…”

Emerging Pharmacologic Treatments for Adolescent Substance Use: Challenges and New Directions

“…These findings implicate craving as an important treatment target for pharmacotherapy. We also recently applied these methods to characterize adolescents’ subjective responses to alcohol use (87). Prior to this advance, because of legal and ethical restrictions on administering alcohol to underage youths in the laboratory, our understanding of how alcohol affects teenagers relied entirely on retrospective reports, animal models, and one small alcohol administration study with boys, ages 8 to 15, nearly 35 years ago (80).…”