In the United States, one in every 100 adults is confined to a correctional facility. Approximately 60% of inmates have an alcohol use disorder (AUD). When compared to the general population, inmates are twice as likely to have AUD. As they are unable to readily access alcohol, inmates entering a correctional facility with AUD are at high risk for the lethal alcohol withdrawal syndrome (AWS). AWS is preventable and yet correctional nurses process new inmates without an evidence-based clinical practice guideline (CPG) to assess for AUD, the prerequisite for AWS. The purpose of this project was to develop an evidence-based CPG with implementation algorithm to guide the inmate assessment for AUD. The ACE star model of knowledge transformation guided the project, the AGREE II was used to develop the CPG, and the Delphi technique was used to evaluate the final CPG with algorithm. Nationally, 20 correctional health experts were identified and asked to participate in the Delphi expert panel, although 11 experts agreed to participate only 9 completed the evaluation. The experts were correctional health experts, nurses and physicians, from different regions of the United States. The resulting CPG satisfied all 23-items of the AGREE II. Through 2 Delphi panel rounds, all participants recommended the CPG with minor modifications (6 experts recommended as presented while the 3 recommended with modifications). At the project conclusion, all 9 experts agreed the CPG will help improve the identification, referral, and management of inmates with AUD. This project contributes to positive social change as the CPG addresses a serious problem, AUD with possible AWS, in a vulnerable population. The CPG may be generalizable for use in other correctional facilities.

Social norms interventions have been shown to be effective in reducing problematic alcohol use on college campuses. However, not all interventions have been successful, and the campus environment may be responsible for the variable reactions that students have to these interventions. The following three articles investigate the nature and utility of social norms interventions in an environment where alcohol use is relatively low. The first article details an online social norms intervention implemented on a low-use campus. Results suggest that if adapted to the campus culture, a social norms approach to reducing alcohol use could be successful in this unique environment. The second article investigates the impact of social norms in the form of censuring alcohol use. Using the theory of reasoned action, the study shows how alcohol use differs for those exposed to different types of norms, and how attitude toward being censured may change whether exposure to a particular social norm is indicative of decreased alcohol use. The third article is a process evaluation of the social norms intervention in a unique environment. It reviews difficulties encountered in implementing an intervention as well as recommendations for future online approaches to intervention implementation.

Alcohol use and abuse among college/university students continues as a major public health concern.  One potential source of alcohol-related harm is the inability of students to estimate their current level of intoxication (gBAC).  The current four field studies use breathalyzers to investigate student gBAC and the efficacy of a variety of BAC-feedback tools at promoting greater awareness of driving risks while under the influence of alcohol.     The research was conducted across 89 nights spanning seven academic semesters from Fall 2009 to Fall 2012.  Research tables were setup between the hours of 6:00pm and 2:00am at three locations near downtown bar establishments and one on-campus location near a late-night dining facility.  Unique subject codes were created to track participants across multiple nights of participation.  In total, 12,432 blood alcohol concentration (BAC) readings were collected from 10,225 unique individuals. Study 1 examined general epidemiology across all nights.  The average BAC of drinking participants was .100 mL/L.  Results revealed significant differences in BAC as a function of demographic and environmental factors.  Additionally, it was found the average student was incorrect in estimating his or her BAC by .034 mL/L. Studies 2 and 3 examined the accuracy of BAC-estimation tools (i.e., nomograms, sobriety tests, and phone applications) and the efficacy of these tools to increase awareness of driving-related risks.  On average, both nomograms and BAC-estimation phone applications were incorrect in estimating BAC by over .05 mL/L.  Sobriety tests performed slightly better than chance at discriminating BACs of .08 mL/L.   Participants receiving BAC-feedback had increased awareness of driving risk across levels of intoxication. Nomogram and breathalyzer feedback tended to promote healthier perceptions of external risk.  Sobriety testing shifted the internal perception of feeling less safe to drive.  No effect was observed for BAC-estimation phone applications. Study 4 found individuals who received breathalyzer feedback across multiple nights of the research were significantly more accurate at estimating their BAC.  Specifically, individuals on the fifth night of participation were .017 mL/L more accurate at estimating their BAC as compared to the first night.  Future research areas and policy implications are discussed. / Ph. D.

Indiana University-Purdue University Indianapolis (IUPUI) / Alcoholics often experience difficulties ceasing drinking, potentially related to excessive behavioral inflexibility that either precedes or results from high alcohol consumption. Components of the Wisconsin Card-Sorting Task (WCST) a type of Attentional Set-Shifting (AttSS) task measuring impairments in behavioral flexibility have been modified to measure similar constructs within animals. Previous work has shown impaired AttSS in abstinent alcoholics and nonalcoholic individuals with a family history of alcoholism, as well as in mice exposed to chronic-intermittent alcohol vapor (Gierski et al., 2013; Hu et al., 2015; Oscar-Berman et al., 2009). The aim of the current study was to assess whether selectively-bred High- vs. Low- Alcohol Preferring (HAP vs LAP) mice display behavioral inflexibility as measured by an operant AttSS task, and furthermore, whether a history of voluntary drinking in cross-bred HAP (cHAP) mice further increases inflexibility. Impairments in the AttSS task are assessed by evaluating the number of trials to reach criterion, as well as the number and types of errors committed during the second experimental phase. In Experiment 1, male and female HAP and LAP mice first learned to press one of two levers signaled by a visual cue, but random with respect to spatial orientation, for a 0.1% saccharin solution reward. The following experimental phase consisted of an egocentric discrimination, such that side (left or right) now signaled correct reinforcement and the location of the visual cue was irrelevant. In Experiment 2, prior to identical operant procedures as Experiment 1, male and female cHAP mice were given free-choice access to 10% alcohol or water for seven weeks. Ethanol-exposed animals drank an average of 29.6 g/kg/day.

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Of growing interest in the study of sexual minority experiences is the concept of community connectedness. Community connectedness reflects the cognitive and affective components of being affiliated with a particular community of similar others. Within the limited work that has been done, lesbian, gay, bisexual, and transgender (LGBT) community connectedness has typically been looked at as a predictor of positive outcomes, such as increased psychological well-being. However, there is limited evidence that LGBT community connectedness may be related to higher levels of substance use. This study aimed to explore the relationship that LGBT community connectedness has with alcohol use, taking into account a variety of potential confounding variables, including race, socioeconomic status, religiosity, and positive feelings towards one's sexual orientation. A total of 243 sexual minority participants (19.8% asexual, 29.2% bisexual, 22.2% gay/lesbian, 16.0% pansexual, and 12.8% other) were gathered through the use of targeted online social media advertising. A directed acyclic graph (DAG) was created to identify implications regarding variable covariance. Following the creation of the DAG, the implications were tested using bivariate correlations and the DAG was adjusted based on significant statistical relationships between variables. After the testing of the implications, we tested the hypothesis that LGBT community connectedness would predict alcohol use by regressing alcohol use on community connectedness controlling for the confounding variables identified using the DAG (age, LGB positive identity, race, religiosity, SES, and sexual orientation). The variables accounted for 11.37% variance in alcohol use, and higher community connectedness predicted more alcohol use (b=0.81, SEB=0.33, p=0.01). While connection to the LGBT community is typically explored as a positive form of social support, the current work found positive relationship between community connectedness and alcohol use for sexual minorities. The relationship between LGBT community connectedness and alcohol use should be explored in more depth to understand the pathways between a sense of connection and alcohol use. The work may indicate the need for non-alcohol based LGBT spaces to be more prevalent, so that community connection is not reliant on the use of alcohol-based spaces such as gay bars.

While overall rates of college student drinking have declined slightly since 1980, extreme forms of drinking are escalating. A comprehensive review of all aspects of alcohol use among college students completed by a panel of scientists and college presidents concluded that very few approaches for dealing with student drinking can be considered empirically validated, and they strongly encouraged additional efforts to develop and validate effective strategies. Expectancy challenge approaches designed to reduce risky drinking through changing key expectancies have been identified as one of the few validated strategies, but this approach has not been developed into a format that is reliably effective with females or readily delivered in a single meeting. Widespread implementation of expectancy-based strategies is dependent on further evolution of a pragmatic format of this approach while maintaining effectiveness with groups that has already been established and increasing effectiveness with other groups. The purpose of the present study was to develop and evaluate a new version of expectancy challenge to accomplish two specific goals that are critical for widespread dissemination and implementation. First, new content focused on key expectancies typically held by heavy drinking females was developed in an effort to achieve significant reductions in alcohol use among women. Second, the content of the intervention for men and women was condensed to a single session. To demonstrate the effectiveness of the redesigned expectancy challenge in reducing drinking among high-risk individuals, the intervention was implemented with heavy drinking males and females at a large state university. Exposure to the single session expectancy challenge led to significant changes in alcohol expectancies and significant reductions in subsequent drinking in both males and females in comparison to participants randomly assigned to an active control condition or an assessment-only control condition. These findings represent a critical step in the process of translating a theory-based intervention strategy validated in intensive academic laboratory designs, into a more practical format while maintaining, and even enhancing effectiveness. The single session expectancy challenge developed and validated in this project is more accessible to those seeking effective drinking reduction strategies for college campuses and will encourage further development of pragmatic strategies based on expectancy theory.