Understanding positive heavy drinking attitudes: daily variability and their role in intervention-related changes in...

Alcohol use and its related harms remain highly prevalent among young adults, with heavy drinking and alcohol-induced blackouts posing significant public health risks. This study had two goals: first, we examined attitudes toward heavy drinking as both stable (between-person) and dynamic (within-person) predictors of alcohol use and consequences among heavy-drinking young adults. Furthermore, we explored changes in attitudes toward heavy drinking as a mediator of intervention efficacy.

The data for the current work come from a larger randomized controlled trial where participants in the intervention condition completed 30 days of daily surveys assessing attitudes toward heavy drinking and drinking outcomes. Generalized linear mixed models were used to test within- and between-person associations between daily attitudes and odds of drinking on a given day, same-day drinking quantity, high-intensity drinking (HID), alcohol-related consequences, and blackout. Exploratory mediation analyses leveraged data from all participants in the full trial collected at baseline, post-intervention, and 3-month follow-up and tested whether changes in attitudes mediated intervention effects on HID.

Results indicated that individuals with more favorable attitudes toward heavy drinking consumed more drinks per day on average. Within-person fluctuations were especially influential: on days when participants held more favorable attitudes than usual, they reported greater odds of drinking (vs. not), significantly higher drinking quantity, and greater odds of HID (vs. not), alcohol-related consequences (vs. not), and blackout (vs. not). In exploratory analyses, the digital health intervention (the "Drinking Dashboard") reduced favorable attitudes toward heavy drinking, which in turn mediated reductions in HID.

Findings demonstrate that attitudes toward heavy drinking are both dynamic and modifiable. Day-to-day variability in attitudes predicted same-day risky drinking behaviors, and changes in attitudes served as a mechanism of intervention efficacy. These results highlight attitudes as both a proximal risk factor and a key target for digital interventions aimed at reducing alcohol-related harm among young adults.