(PS1-B34) Pre-treatment Utilization of Coping Skills Among Adolescents with Alcohol Use Disorder: Associations with Clinical Phenotypes

Background: Alcohol remains the most used substance among adolescents and emerging adults and confers risk for a host of acute and longer-term harmful consequences. Etiologically, poor coping skills heightens risk for developing alcohol use disorder (AUD). In treatment contexts, most evidence-based interventions target the acquisition of adaptive substance-specific coping skills (e.g., coping with craving, drink refusal skills). Most of this work focused on adults and found that learning and applying larger repertoires of substance-specific coping is associated with less drinking and fewer alcohol-related consequences. Our understanding of alcohol-specific coping skill use just before initiating alcohol treatment and whether findings with adults generalize to adolescents remains largely unknown. This study characterized the pre-treatment alcohol-specific coping skills of adolescents with AUD and tested the hypotheses that coping skill use would be associated with less drinking and fewer alcohol consequences in daily life and lower self-reported alcohol craving during an experimental human laboratory analogue of high-risk drinking contexts.

Methods: Adolescents and emerging adults (N=40) aged 18 to 20 years with AUD were recruited for a clinical trial testing the effects of medication on alcohol use. Approximately half were female (52%; sex assigned at birth) and 33% identified as racial and/or ethnic minorities. Pre-randomization, youth completed the Coping Strategies Scale (CSS) to assess pre-treatment alcohol-specific coping skills, a 28-day Timeline Follow Back interview to assess drinking, and the Rutgers Alcohol Problem Index. Youth also underwent an alcohol cue reactivity paradigm that assessed self-reported alcohol craving following in vivo water and alcoholic cues. We considered examining CSS subscales separately, as well as a mean of all items; however, approach and avoidance coping were significantly correlated (𝑟=.886) and thus not tested as unique predictors.
 

Findings: Sex (assigned at birth) and age were included as covariates due to known associations with drinking. Linear regressions found coping skills (i.e., mean CSS scores) were negatively associated with total drinking (β=-.308, p< .05), positively associated with alcohol-related problems (β=.468, p< .01), but not associated with craving (β=-.023, p >.05).

Conclusions: In line with our hypothesis, youth with greater pre-treatment utilization of alcohol-specific coping skill use reported less drinking at treatment onset. These results align with previous research that found individuals with AUD had reduced frequency of drinking when using substance-specific coping skills. In contrast with our hypothesis and some prior research, alcohol-specific coping pre-treatment was associated with more alcohol-related problems, suggesting that youth with more severe AUD who are seeking treatment begin to utilize alcohol-specific coping strategies even before treatment starts. Coping skills did not impact cue-elicited craving among youth. Limitations and future directions will be discussed.