Research is reviewed on the association between alcohol outcome expectancies and consumption which has led many to argue that manipulating expectancies might be a route to manipulating consumption for problem prevention and treatment. Studies indirectly and directly evaluating this latter position are reviewed. Expectancies predicting treatment outcome: two studies have shown that the more positive expectancies held at treatment, the poorer is treatment outcome, but five other studies have failed to find this. Three related studies have shown that the more negative expectancies held at treatment, the better the treatment outcome. This evaluation provides evidence inconsistent with the main position for positive expectancy and limited support for negative. Expectancy manipulations and ad libitum consumption: three studies in the laboratory have shown that increasing positive expectancies through word priming increases subsequent consumption and two studies have shown that increasing negative expectancies decreases it. A single study in the field showed a similar relationship. This evaluation provides evidence consistent with the main position but is limited by measuring consumption changes over only 1-2 hours. Prevention programmes with expectancy components: seven projects are reviewed in which positive expectancies were targeted, but only two report an expectancy change analysis and in both cases the expectancy change did not relate to subsequent consumption. This evaluation provides evidence inconsistent with the main position. Expectancy challenge: two related studies are reviewed in which positive expectancy challenges reduce subsequent consumption but changes in expectancy were not evaluated as predictors of consumption change. Two studies are reviewed which found a reduction in positive expectancy following expectancy challenge but no reduction in consumption. One study is reviewed in which when negative expectancy was increased in treatment there was a better treatment outcome at 3 months follow-up than when it was not. This evaluation provides evidence inconsistent with the main position for positive expectancy and limited consistent evidence for negative. It is concluded that the research has still to be done that securely links expectancy manipulations with subsequent changes in consumption, and fulfils the early promise from association studies.

A review of expectancy theory and alcohol consumption.

Patient predictors of alcohol treatment outcome: A systematic review

Re-framing 'binge drinking' as calculated hedonism: Empirical evidence from the UK

Drinking is influenced by youth (mis)perceptions of how their peers drink. If misperceptions can be corrected, young people may drink. The objective of this review is to determine whether social norms feedback reduces alcohol misuse in university or college students.

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Social norms interventions to reduce alcohol misuse in University or College students

Patient characteristics as predictors of alcohol use disorder treatment outcome were examined on three levels, identifying whether or not variables were significant predictors of drinking-related outcome in univariate analysis, in multivariate analysis, and in multivariate analyses limited to studies including several “key predictors.” Also, a model was developed to predict total percentage of variance in treatment outcome accounted for in each study using each of the key predictors and a range of methodological factors. The most consistent univariate predictors were baseline alcohol consumption, dependence severity, employment, gender, psychopathology rating, treatment history, neuropsychological functioning, alcohol-related self-efficacy, motivation, socioeconomic status/income, treatment goal, and religion. When these key predictors were combined into multivariate analyses, baseline alcohol consumption and gender showed substantial reductions in predictive consistency whereas the remaining variables were not greatly affected. The most consistent predictors overall were dependence severity, psychopathology ratings, alcohol-related self-efficacy, motivation, and treatment goal. The two predictor variables most associated with greater variance accounted for in predictive models, when controlling for broader methodological variables, were baseline alcohol consumption and dependence severity. Few predictor variables were examined in more than a third of studies reviewed, and few variables were found to be significant predictors in a clear majority of studies. However, a subset of variables was identified, which collectively could be considered to represent a consistent set of predictors. Too few studies controlled for other important predictor variables. Attempts to synthesize findings were often hampered by lack of agreement of the best measure for predictor variables.

Regular article Patient predictors of alcohol treatment outcome: A systematic review

OBJECTIVE: Numerous studies have demonstrated the existence and effect of normative misperceptions on heavy episodic drinking behavior. However, there has been little work on these processes or application of normative-belief interventions outside the U.S. college system. The aim of the current study, therefore, was to investigate heavy episodic drinking and normative misperceptions in a U.K. university setting. METHOD: An email containing a link to a survey Web site was distributed to all current undergraduate students at the University of Paisley, Scotland. In addition to age and gender questions, the survey contained items on students' personal behavior and perception of the level of that behavior in three groups of increasing social distance: close friends, other students of the same age, and other people of the same age in U.K. society in general. RESULTS: Completed surveys from 500 respondents were returned. In keeping with previous research, significant correlations were found between the respondents' behavior and the perception of that behavior in others, with beliefs about the most proximal individuals being the most strongly correlated. The majority of respondents were also found to overestimate alcohol consumption in other students. An age effect was noted, in which misperceptions appeared to decrease with age but did not vary between genders. CONCLUSIONS: The findings of the study indicate that the normative-belief alcohol consumption processes that have been found on U.S. college campuses also operate in U.K. university settings. This raises the possibility of applying social-norms interventions from the United States to the United Kingdom and potentially elsewhere in the world. Furthermore, the study noted apparent age effects in the degree of misperception, the implications of which are discussed.

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Normative beliefs, misperceptions, and heavy episodic drinking in a British student sample.

Male alcohol dependent clients (N = 53), who were given the Alcohol Expectancy Questionnaire and the Negative Alcohol Expectancy Questionnaire upon admission to a residential alcohol treatment program, were successfully followed-up 1 month and 3 months after discharge to assess their compliance with the treatment goal of total abstinence. At 1 month, neither demographic variables nor alcohol expectancies were associated with outcome consumption. At 3 months, however, the demographic variable, age, total negative expectancy (but not total positive) and the two subscales, global positive expectancy and continued-drinking negative expectancy (representing longer term expected negative consequences), were. The potential importance of negative alcohol expectancy in drinking decisions and the limitations of the study were identified.

Negative and positive alcohol expectancies as predictors of abstinence after discharge from a residential treatment program: a one-month and three-month follow-up study in men.

Aims: Several studies funded by the UK government have been influential in understanding rates of 'binge drinking' in the UK. This analysis aims to establish consistency between results and clarify UK rates of binge drinking. Method: The relevant sections of these surveys were compared: the Scottish Health Survey (SHS) 1998, the General Household Survey (GHS) 2002, and the Health Survey for England (HSE) 2003. In addition the methodology used by the Health Protection Agency in the Adult Drinking Patterns in Northern Ireland (2003) was compared with the approach used by the SHS, GHS, and HSE. Results: Marked differences were observed between the results of the GHS 2002 and both the SHS 1998 and the HSE 2002 despite each using a similar methodology, with the HSE 2003 reporting a rate of 'binge drinking' in young males of 57%, and the GHS reporting a rate of 35%. This difference may be largely attributed to variations in the criteria in binge drinking in each study. These differences in interpretation do not appear to have been acknowledged. Indeed several key documents on alcohol harm reduction made inaccurate citations of previous surveys. Conclusion: The media rhetoric on escalating rates of binge drinking in the UK should be regarded with caution until trends are based on standardized recording and reporting.

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Establishing rates of binge drinking in the UK: anomalies in the data.

Binge drinking has sparked considerable interest and concern. However, despite this interest little is known about the lay understanding of binge drinking and whether there are differences in understanding by gender, age and level of deprivation.Aims: This study investigated the beliefs and attitudes to binge drinking of a sample in the Inverclyde area.Methods: Using both cluster and quota sampling, 586 subjects completed a structured interview, using open questions about their beliefs on binge drinking and whether it was a problem generally and locally.Findings: Definitions of binge drinking tended to concentrate on intoxication and some described a dependent drinking pattern. Causes and solutions offered were varied but pointed-up levels of deprivation in respect of jobs and entertainment. More subjects regarded binge drinking as a problem in society than locally, which is consistent with research suggesting that misperceptions of others’ drinking increases with social distance. Differences in beliefs w...

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Binge drinking behaviour, attitudes and beliefs in a UK community sample: An analysis by gender, age and deprivation.

Negative alcohol expectancy (NAE) reliably discriminates between social drinkers who are satisfied with their current consumption and those who are not (even when the variable, consumption, is controlled). Positive alcohol expectancy does not. A role for NAE as representing motivation for change in social drinkers is suggested.

John McMahon

Papers

Normative beliefs, misperceptions, and heavy episodic drinking in a British student sample.

Negative and positive alcohol expectancies as predictors of abstinence after discharge from a residential treatment program: a one-month and three-month follow-up study in men.

Establishing rates of binge drinking in the UK: anomalies in the data.

Binge drinking behaviour, attitudes and beliefs in a UK community sample: An analysis by gender, age and deprivation.

Social drinkers' negative alcohol expectancy relates to their satisfaction with current consumption: measuring motivation for change with the NAEQ.