Inlay

Objective: Theories posit that acute alcohol responses predict the development of future heavy alcohol use and alcohol-related problems. The most prominent of these theories is the low-level response theory, which purports that less intense alcohol responses are associated with later development of alcohol use disorder. The counter-modified differentiator model posits that greater stimulant effects with lower sedative effects predict future heavy drinking. The present study provided a concurrent testing of these theories in a large-scale cohort of young adult Swiss men. Method: Data were derived from two waves of the Cohort Study on Substance Use Risk Factors in 2,749 French-speaking, current alcohol-consuming young adult men age 25.7 years at baseline and 28.5 years at follow-up. Participants completed the 6-item Anticipated Brief Biphasic Alcohol Effects Scale with the instructions of the anticipated effects they feel after consuming five standard drinks, and the stimulation and sedation subscales were used in analyses. Associations of these scores with volume of drinking and frequency of heavy episodic drinking were determined both at baseline and at 3-year follow-up. Models were adjusted for covariates, including disinhibited personality and family history of alcohol problems. Results: Results show that anticipated stimulation effects of alcohol predicted increasing alcohol consumption over time, and anticipated sedative alcohol effects predicted reductions in consumption (p values ≤ .001). Conclusions: The present study supported the modified differentiator model in that higher anticipated stimulation and lower sedation predicted future alcohol consumption patterns. This may be useful for preventing heavy drinking and informing pharmacological interventions intended to reduce the pleasurable effects. Public health significance statement: This is the first large general population study of young men showing that not only low-level responses to sedative effects of alcohol may increase future alcohol use, but also high-level responses to stimulating effects. This may be useful to identify high-risk individuals in large-scale surveys or integrated into primary health care screening programs for young adults to prevent the development of alcohol use disorder. It may be helpful to study the effects of pharmacological interventions like naltrexone or acamprosate, intended to reduce the motivation to drink and the pleasurable, positively reinforcing effects. Newer studies indicate that glucagon-like peptide-1 (GLP-1) receptor agonists may hold promise in the reduction of hazardous drinking, potentially by reducing alcohol’s stimulatory and rewarding effects.