The Role of Fall Rate From Transdermal Alcohol Concentration on Alcohol-Related Consequences in College Students

Alcohol elimination rate is associated with acute alcohol consequences, yet it remains difficult to measure reliably in real-world settings. Wearable transdermal alcohol concentration (TAC) sensors provide a feasible option through passive, continuous monitoring of biological alcohol exposure. This facilitates precise testing of whether alcohol elimination rate predicts alcohol-related consequences in naturalistic environments. Additionally, a faster alcohol elimination rate may buffer or reduce the risk of alcohol-related consequences following high and/or rapid consumption.

Two observational studies (Alcohol Habits Study [n = 222] and Project ACE [n = 79]), each using a different alcohol sensor, were used in this study. Participants of both studies were young adults from universities who frequently engaged in heavy episodic drinking. Alcohol-related consequences were collected through daily self-reports the morning after drinking days and included metrics across multiple domains such as physical symptoms, interpersonal conflict, safety risk, sexual risk, and miscellaneous. Alcohol elimination rate and other dynamics were extracted from TAC-positive trajectories for each day. Associations were tested using multilevel modeling.

Both studies showed that days with faster elimination rates were associated with more alcohol-related consequences, although statistical significance was observed only in Project ACE. In the Alcohol Habits Study, a significant day-level interaction indicated that the association between peak TAC and alcohol-related consequences was reduced on days with faster alcohol elimination rates. Similar findings emerged in Project ACE but did not reach significance. Both studies demonstrated the same pattern of conditional association: as the daily fall rate increased, the simple association between peak TAC and alcohol-related consequences diminished to the point of non-significance.

Our results provide novel evidence that alcohol elimination may have (a) an independent association with alcohol-related consequences in natural settings and (b) a buffering impact on the association between peak TAC and alcohol-related consequences. The results span two studies using two separate wearable sensors, supporting the validity of findings. Future research testing these associations in larger and more diverse samples is warranted.