Health Risk Factors in Alcohol Use and Abuse among Young Adults - Literature review Example

Health Risk Factors in Alcohol Use and Abuse among Young Adults (18-30) Student Name University Health Risk Factors in Alcohol Use and Abuse among Young Adults (18-30) Excessive alcohol consumption and alcohol-related problems are widespread among young adults. One of the most prevalent mental disorders in the general population (APA, 1994), alcohol abuse, along with alcohol dependence, constitutes a particularly significant public health concern among young adults between the ages of 18 and 30 (Ham & Hope, 2003). In large-scale epidemiological studies, researchers have found that as many as 18% of young adults meet the criteria for alcohol dependence at some point in life and up to 23% of college students can be classified as frequent binge drinkers (Wechsler, Lee, Kuo, & Lee, 2000). Some of the most alarming consequences of alcohol abuse include drunk driving, serious accidents (Adlaf, Mann, Paglia, 2003), as well as high-risk sexual behaviors (Dunn, Bartee, & Perko, 2003). Drinking can lead to interpersonal, academic, and legal problems as well as physical illness (O'Hare, 2000; Werch, et. al.2003). While alcohol abuse has been studied for years, it has been recently suggested that, among young adults this problem has not received the necessary attention. Mason and Luckey (2003) argue that young adult drinkers are a unique yet understudied group with particular characteristics and needs as compared to adult alcohol users. Knowing these distinguishing features is imperative for maximizing the effectiveness of alcohol abuse treatment and prevention programs for young adults. A great deal of research has been done to identify various risk factors for heavy or problematic alcohol consumption. Scientists have looked at a wide range of biological and psychosocial factors seeking to find what predisposes an individual to alcohol related problems. Individual differences in personality traits, affective state, behavioural disinhibition, and motivation or reasons for drinking have been implicated in the development of alcohol abuse and alcohol-related problems. Personality and Alcohol Use Personality is hardly a uniformly defined concept. Nathan (2003) reviews various definitions of personality, concluding that it is most often defined as “internal, unique, enduring, active, causal, and integrating” (p. 183). Likewise, Mulder (2002) defines personality as involving “behaviors and emotions which are characteristic of an individual, stable over time and situations, and have some motivational and adaptive significance” (p. 45). Not surprisingly, various measures of personality have been employed to evaluate personality of alcohol abusers. The conceptualization of alcohol addiction as a symptom of personality maladjustment quickly became the focus of extensive criticism as simplistic and myopic, failing to take into consideration a wide range of social, cultural, and biological factors that play an important role in the complex etiology of alcohol abuse (Sutker & Allain, 2002). Nevertheless, when viewed within the integrative, multifactorial framework of alcohol abuse etiology, certain aspects of personality have shown to be important predictive factors (Conway, Kane, Ball, James,Piling & Rounsaville, 2003). Researchers using personality models with the normal distribution of traits found in the general population have tried to determine if particular patterns of personality traits appear to be unique and specific to alcohol abusers. The strongest evidence has been found for the link between alcohol abuse and traits related to affectivity, or emotionality, and impulsivity, or behavioral disinhibition (Martin, Lynch, Pollock, & Clark, 2000; Mulder, 2002; Sher, Bartholow, & Wood, 2000). Thus, individuals who are predisposed to experiencing negative emotions more easily and more frequently are also more likely to drink heavily and to develop alcohol-related problems. Greater neuroticism or negative emotionality has been found among alcohol abusers compared to non-abusers (Sher, Bartholow, & Wood, 2000), alcohol abusers compared to users of other drugs as well as among undergraduate heavy drinkers compared to their light drinking peers (Stewart, Loughlin, & Rhyno, 2001). The five-factor model of personality and alcohol abuse. A widely accepted and validated multidimensional model of personality is the Big Five factor model. The five factors that comprise the model include Neuroticism (N) that refers to the level of emotional adjustment and instability; Extraversion (E) that describes the activity level, interpersonal interactions, need for stimulation; Openness to experience (O) involves the active seeking of experiences; Agreeableness (A) refers to interpersonal interactions on the continuum "from compassion to antagonism"; and Conscientiousness (C) assesses one's goal-directed behavior (Costa and Widiger, 1994). The Five-Factor model has proven useful in identifying the links between personality and alcohol abuse. The most consistent findings support the role of the Neuroticism (N) and Conscientiousness (C) factors in the prediction of drinking problems. Drinking Motives Although various risk factors for alcohol abuse have been examined separately, it appears that various motivational factors interact leading to the development of drinking-related problems. Thus, drinking is most likely associated with a combination of motivational factors for drinking. Therefore, it is important to examine the interplay of different drinking motives in relation to alcohol-related problems. Specifically, this research examines the interactions among these motives for drinking to determine how these factors work together to create a pathway to alcohol use and abuse. Drinking motives refer to reasons for using alcohol and, according to the motivational theory (Cox & Klinger, 1990), constitute the final, direct pathway to alcohol use and alcohol-related problems through which more distant factors, such as personality variables, negative affect, and behavioral under-control exert their influence. The four drinking motives are categorized along two dimensions, the source of the reward and the nature of the reinforcement (Cooper, 1994). Each drinking motive is characterized by somewhat unique antecedents and consequences but also shares similarities across each of the two dimensions. The two internal drinking motives, coping and enhancement, are more strongly related to personality variables than the externally generated motives and may show more cross-situational consistency (Cooper, 1994). In contrast, externally generated motives, social and conformity, may be more tied to situational cues and would, therefore, be less stable across situations and less strongly linked to personality factors. Both positive reinforcement motives, enhancement and social, appear to be more normative and more frequently reported. They have been found to predict increased alcohol consumption but their role in the development of drinking problems has not been consistently demonstrated. Coping motives, on the other hand, have been linked to both increased use of alcohol as well as the development of alcohol-related problems whereas conformity appears to be less tied to alcohol involvement. Cox and Klinger (1990) argued that the final path leading to alcohol consumption is motivational, that is, the decision to drink or not to drink is based on weighing the expected consequences of drinking versus the effects of not drinking. According to Cox and Klinger, if the expected effect of drinking is viewed as more positive, then the person makes a conscious or unconscious decision to consume alcohol. Earlier research focused primarily on two general types of drinking motives, drinking to cope with stress or emotional problems and drinking to achieve social affiliation (see Baer, 2002 for review). Likewise, one's motives to drink can be externally generated. If one drinks to be externally positively reinforced, he or she is motivated by obtaining social rewards, enhancing one's social interactions- social motives. If the individual is motivated by external, negative reinforcement, he or she drinks to avoid social rejection-conformity motive. This motivational model has been validated and its factor structure has been confirmed among adults as well as high school and college age adolescents and young adults and found to fit the data better than alternative, one-, two-, and three- factor models (MacLean & Lecci, 2000). Research on each of these four factors is reviewed below. Coping motives. Coping motives refer to drinking to avoid or reduce the experience of negative affect, such as depression and anxiety. Thus, it is a negatively reinforced, internally generated reason for alcohol consumption. Drinking to cope is also often described as drinking for tension and stress reduction and self-medication. Coping motives, therefore, are often related to the tendency to experience negative emotions. For instance, anxiety symptoms and anxiety sensitivity predict the tendency to use alcohol for coping (Comeau, Stewart, & Loba, 2001; Kushner, Thuras, Abrams, Brekke, & Stritar, 2001). Likewise, depressed mood predicted alcohol coping among high school and college (Flynn, 2000) students. Drinking to cope is often found to be a strong predictor of alcohol consumption (Woldt & Bradley, 2000), of high-risk or heavy drinking (Rutledge & Sher, 2001), and alcohol-related problems, such as social and occupational dysfunction, symptoms of alcohol dependence, and withdrawal (Holahan, Holahan, Moos, Cronkite, & Randall, 2003). In a recent study, Holahan and colleagues (2003) found that drinking to cope among depressed patients increased the likelihood of drinking problems up to four years later and greater alcohol consumption across the ten-year interval. Coping motives were found to mediate the association between depression and alcohol use/alcohol problems among adults (Pierce et al., 2004) and adolescents (Windle & Windle, 2006). Hussong (2003) found that coping motives mediated the association between neuroticism and alcohol use and alcohol problems. Coping motives were also predicted by neuroticism in studies by Stewart and colleagues (Stewart et al., 2000; Stewart and Devine, 2000) and by Loukas and others (2000). Thus, a body of literature suggests that neurotic individuals who have a tendency to experience psychological distress may use alcohol as a means of coping with such negative emotions as depression and anxiety. Drinking to cope, in turn, leads to increased alcohol consumption and may be related in particular to alcohol-related problems. Enhancement motives. Enhancement drinking motives refer to drinking as the means to increase positive affect. Thus, like coping, enhancement motives are internally generated. Unlike coping, enhancement drinking is positively reinforced. Enhancement, along with social motives, the other positive reinforcement motive, has been found to be endorsed more frequently than negative reinforcement motives and thus appears to be somewhat more normative (Cooper, et. al., 2003). It is found to be particularly high among younger individuals and seems to decline with age, unlike the other motives. Overall, individuals whose behavior tends to be under-controlled are more likely to use alcohol-seeking to enhance positive affect. Enhancement drinking motives predict increased alcohol involvement but appear to be less likely to be directly related to alcohol-use problems. Social motives. Social motives for alcohol consumption refer to drinking to obtain positive social rewards, or to fulfill social affiliation needs. Thus, it is a positive reinforcement, externally generated drinking motive. Like other motives, social ones are associated with increased drinking but do not usually predict high-risk drinking or alcohol-related problems (Ham & Hope, 2003). Social motives predict drinking in social situations, such as parties and celebrations, and appear to be most normative among the four motives, particularly among adolescents and young adults (Bradizza, et. al., 1997). Unlike the two internally generated drinking motives, coping and enhancement, social motives are generally not as strongly associated with personality variables. For instance, two studies by Stewart and colleagues (Stewart & Devine, 2000; Stewart, Laughlin, & Rhyno, 2001) found that social motives were not predicted by any personality domains. Thus, socially motivated drinkers are likely to drink primarily in social situations. Social motives appear to be the most common, normative reason for drinking, particularly among young adults. They may increase the likelihood of heavy alcohol consumption but are not consistently found to be associated with alcohol-related problems. Conformity motives. More recently identified as a unique motive for alcohol consumption, conformity motives involve drinking to conform to external social pressures, to avoid social ostracism (Ham & Hope, 2003). It is a negatively reinforced, external motive for consuming alcohol. Less frequently studied than the other three drinking motives, conformity is associated with drinking in social settings where there is a strong pressure to drink and has been found to negatively relate to quantity and frequency of alcohol use (Cooper, et. al., 2003). The association between conformity motives and alcohol-related problems has been somewhat inconsistent and may be affected by gender and age. For instance, Wild and others (2001) found that college men who drank primarily for conformity reasons were less likely to become problem drinkers. On the other hand, Cooper et al. (2003) found that conformity was positively related to alcohol-related problems among adolescents. Stewart, Zvolensky, and Eifert (2001) found that conformity mediated the link between high anxiety sensitivity and increased drinking behavior, particularly among men. Just as social, the other external drinking motive, conformity is not strongly predicted by personality domains. Their alcohol consumption is likely to be less than that of other drinkers;however, a link between conformity and alcohol-related problems has also been found. Summary Various drinking motivational factors related to young adults alcohol consumption were examined in this research. The body of literature reviewed in this paper implicates personality traits of neuroticism (N) and conscientiousness (C), internalizing symptoms of depression and anxiety, as well as subjective well-being (SWB), behavioral disinhibition (BD), and drinking motives in the development of alcohol related problems. However, the exact role of each of these factors and the interactions among them are unclear. Drinking motives appear to be directly related to alcohol consumption and alcohol abuse. Personality traits of N and C, IS, SWB, and BD are also related to alcohol use and abuse but possibly not directly so. The relationship between the more distal factors and alcohol involvement may be mediated by drinking motives. References Adlaf, E. M., Mann, R. E., Paglia, A. (2003). Drinking, cannabis use and driving among Ontario students. Canadian Medical Association Journal, 168(5): 565-566. American Psychiatric Association (1994). 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