Development and Initial Testing of a Multi-Component Breath Alcohol-Focused Intervention for Young Adults - PROJECT SUMMARY/ABSTRACT Nearly 1 in 4 young adults meet Alcohol Use Disorder criteria. Current interventions tend to yield small effects and there is a lack of efficacious, in-the-moment behavioral interventions. Technology and smartphone apps have great promise but there are no moderate drinking apps with evidence of efficacy for young adults. Blood alcohol concentration (BAC) is an important in-the-moment intervention target but estimating BAC without technology and implementing moderate drinking strategies are both challenging. A recent R21 (AA023368, PI: Leeman) tested 3 moderate drinking technologies as solo interventions. Young adults were randomized to use 1 of these technologies—1) smartphone breath alcohol device and app; 2) BAC-estimator app, or 3) self-texting, drink counting procedure—in a lab alcohol self-administration session. While there were no significant differences in alcohol self-administration based on technology, participants then had open access to the 3 technologies for a 2-week period. Compared to baseline, participants reported nearly a drink per drinking day less, on average, in the 2-week period. They used at least 1 form of technology on 72% of drinking days, and 9 times total, on average, despite only being compensated for using each technology once. Participants often used more than 1 form of technology in a drinking episode and described barriers like forgetting and using certain technologies in some contexts but not others. Based on these findings, the optimal approach is for the 3 moderate drinking technologies to be developed and tested as a combined intervention. In developing ways to facilitate moderate drinking technology use, we will explore “higher” and “lower tech” options. Additional technology may optimize use of the 3 technologies. A new app could help users switch easily among technologies and facilitate selection based on current context using tools like geospatial location. However, these 3 technologies do not require much skill or cellular data and some people have limitations with internet access or cellular data, thus “lower tech” options (e.g., phone alarms as reminders) are also appealing. Given the R21 tested the 3 moderate drinking technologies as solo interventions, as a combined intervention, we lack feasibility data; preliminary efficacy data compared to a control condition; negative consequence data versus baseline; and data on possible mechanisms. Thus, we need R34 support to formally develop a combined, multi-modal intervention to prepare for an R01. We propose a 3-stage project, beginning with formative research (N=25) testing brief, MI-based counseling revised from our R21 study, plus open use of the 3 moderate drinking technologies for 2 weeks with “lower tech” facilitation and a formative interview. In Stage 2, we will create an app as “higher-tech” facilitation and design a multi-modal attention control condition. In Stage 3, we will conduct a pilot RCT to evaluate feasibility, acceptability, usability and preliminary efficacy of a combined, multi-modal intervention. “Higher” and “lower tech” facilitation will be implemented. This research will address gaps from lack of precision medicine and efficacious in-the moment intervention for young adults.
