Alcohol demand and alcohol use disorder among adolescents and young adults who drink heavily: An exploratory analysis including sex differences

Behavioral economic alcohol demand, or the reward value of alcohol consumption, consistently shows associations between alcohol use and alcohol use disorder (AUD) in adults, yet research within clinical youth populations (considered to be ages 15-24) remains limited. It is critical to better understand how demand functions in clinical youth populations to predict alcohol related outcomes. Moreover, given the narrowing gap between male and female youth in alcohol use prevalence in recent years, exploring sex differences in alcohol demand and its role in the relationship between demand, alcohol use, alcohol-related problems, and AUD is important. The current study used data from two samples of adolescents and young adults from the community (N = 127; ages 16-25, M_age = 20.57, SD = 2.27; 56.35 % female; 91.27 % white), one treatment seeking (n = 94) and one non-treatment seeking (n = 33), to examine the relationship between demand indices and alcohol use outcomes and to explore the role of sex in these relationships. Demand intensity (the number of standard drinks a person would consume if drinks were $0), O_max (maximum money spent across prices, i.e., number of drinks purchased × price), and price sensitivity (α; the rate alcohol consumption decreases as prices increase) were significantly associated with alcohol use quantity and frequency outcomes, but not alcohol-related problems or AUD severity. Although male youth had significantly greater intensity relative to female youth, intensity was more strongly associated with drinking days in female youth. Broadly, our findings support the importance of evaluating alcohol demand in clinical youth as well as sex differences in alcohol demand. Our results also speak to the need for interventions targeting sex-specific mechanisms and moderators of alcohol use.