Alcohol Expectancy Challenges:
A Comprehensive Review
Khatidja S. Ali, M.A.
Leslie A. Robinson, Ph.D.
Ashley M. Hum, M.S.
Ashley A. Jackson, M.S.
The Department of Psychology
The University of Memphis, USA
Alcohol Outcome Expectancies
Definition: the cognitive, affective, and
behavioral outcomes an individual expects to
occur due to drinking.1
Expectancies vary from individual to
individual.2
Expectancies are contextual (i.e. the same
individual’s will vary based on the situation).2
___________________________________________________________________________
1. Leigh, 1989
2. Connors, Maisto, & Derman, 1992
Positive Alcohol Outcome Expectancies
Enhanced Socialization
Sexual Enhancement
Relaxation
Assertion
The Role of Expectancies in Drinking
Adult participants who expect positive outcomes…
drink more frequently.1
consume more alcohol.2
show more signs of problem drinking.3
Teens who expect positive outcomes (even before
they drink) are more likely…
to start drinking earlier.4
to consume more alcohol.4
_____________________________________________________________________________
1. Fromme et al., 1993
3. Werner, Walker, & Green, 1993
2. Christiansen et al., 1989
4. Carey, 1995
Alcohol Expectancy Challenge (AEC)
Alcohol Expectancy Challenges (AECs) are
treatments aimed at reducing positive expectancies.
These treatments typically use “bar-labs” in which
participants:
1. drink an alcoholic beverage or placebo
2. interact with each other
3. guess who consumed alcohol
Outcome Participants will learn that they can’t
correctly guess who really drank based on behavior.
AEC Trials
Theoretically, participants who have
undergone an AEC should…
Have
fewer positive outcome expectancies
Drink less
However, the outcomes of RCTs has been
mixed.
Purpose of this Review
Examine the effects of AECs on
outcome expectancies
alcohol consumption
Examine the relative strengths and weaknesses
of the literature
Develop a research agenda for the area of AEC
Selection of Studies to Review
Studies had to include a RCT using an AEC.
Studies had to measure changes in outcome
expectancies.
Studies had to measure changes in alcohol
consumption.
Methods Used to Review the Studies
Twelve studies that met inclusion criteria were
identified.
We coded…
characteristics of the participants (gender, age,
ethnicity, typical drinking patterns).
sample size of the studies.
types of control groups.
assessment instruments.
self-identification and misclassification errors
made by participants.
Participant Characteristics
of the Studies Reviewed
Studies were limited to…
mostly Caucasian samples.
young college students.
Four studies had only male participants, 2 studies had
only female participants, and 6 studies used both
genders.
Studies reported minimal information about the
drinking patterns of the participants.
Methodological Characteristics
of the Studies Reviewed
Overall, the studies’ sample sizes had a mean of 123
participants (range 25 - 335).
Control groups included assessment only, alternative
treatment groups, attention/monitoring conditions , etc.
A variety of measures were used within the same study to
assess change in expectancies (Mean = 5.07, SD = 2.20).
Most studies (93%) assessed alcohol consumption by
measuring the consumption of Standard Drinks (SD).
AECs Procedures Used by the Studies
Studies have used varying procedures for expectancy
challenges.
Researchers have provided little information
regarding the identification errors made by
participants.
Only 40% reported info on self-identification errors.
Only 50% provided info on misclassification errors.
Calculation of Expectancy Outcomes
We counted the number of measures finding
significant differences between the Txmt Group
& Controls.
We then divided by the total number of measures
used to evaluate each group comparison.
% significant = # sig measures/total # measures.
Results of Treatment vs. Control Comparisons
% of Significantly Different Expectancy Measures
Average Differences in Expectancies
Overall, only 30% of the time were
expectancies significantly different across
groups.
Mediation
Only two studies explored the mediating role
of expectancies on consumption of alcohol.
Only one study found that expectancies
mediated the effects of alcohol consumption.
Alcohol Outcomes
Most studies (79%) used only one measure for
alcohol (i.e. number of SDs).
Only 21% of studies measured heavy episodic
drinking.
We reported significant group vs. control differences
on any measure of alcohol consumption.
Only 36% of the time were there significant
differences in alcohol consumption on any measure.
Conclusions
Although the NIAAA (2002) has identified the
AEC as a proven method to reduce alcohol use
among college students (i.e. Tier 1 intervention),
this review sounds a cautionary note regarding
the helpfulness of AECs.
Only 30% of the time were expectancies
significantly different across groups.
Only 36% of the time were there significant
differences in alcohol consumption.
Limitations
Lack of…
power
randomized controlled studies (n = 12)
tests of mediation
Where Do We Go From Here?
Sufficient power to identify small to moderate effect
sizes
Measures of self-identification and misclassification
errors
Relevant measures of expectancies targeted by the
intervention
Thorough measures of drinking patterns
Test for mediation effects
References
Carey, K. B. (1995). Alcohol-related expectancies predict quantity and frequency
of heavy drinking among college students. Psychology of Addictive
Behaviors, 9, 236-241.
Christiansen, B. A., Smith, G. T., Roehling, P. V., & Goldman, M. S. (1989).
Using alcohol expectancies to predict adolescent drinking behavior after one
year. Journal of Consulting and Clinical Psychology, 57, 93-99.
Connors, G. J., Maisto, S. A., & Derman, K. H. (1992). Alcohol-related
expectancies and their applications to treatment. In R. R. Watson (Ed.),
Drug and alcohol abuse reviews: Vol. 3. Alcohol abuse treatment (pp. 203231). Totowa, NJ: Humana Press.
Fromme, K., Stroot, E. A., & Kaplan, D. (1993). Comprehensive effects of
alcohol: Development and psychometric assessment of a new expectancy
questionnaire. Psychological Assessment, 5, 19-26.
Leigh, B. C. (1989). In search of the seven dwarves: Issues of measurement and
meaning in alcohol expectancy research. Psychological Bulletin, 105, 361-373.
Werner, M. J., Walker, L. S., & Greene, J. W. (1993). Alcohol expectancies,
problem drinking, and adverse health consequences. Journal of Adolescent
Health. 14, 446-452.
Alcohol Expectancy Challenge Studies
Corbin, W. R., McNair, L. D., & Carter, J. A. (2001). Evaluation of a treatment-appropriate
cognitive intervention for challenging alcohol outcome expectancies. Addictive
Behaviors, 26, 475-488.
Darkes, J., & Goldman. M. S. (1993). Expectancy Challenge and drinking reduction:
Experimental evidence for a mediation process. Journal of Counseling and Clinical
Psychology, 2, 344-353.
Darkes, J., & Goldman, M. S. (1998). Expectancy Challenges and drinking reduction:
Process and Structure in the Alcohol Expectancy Network. Experimental and Clinical
Psychopharmacology, 6, 64−76.
Dunn, M.E., Lau, H. C., & Cruz, I. Y. (2000). Changes in activation of alcohol expectancies
in memory in relation to changes in alcohol use after participation in an expectancy
challenge program. Experimental and Clinical Psychopharmacology, 8, 566-575.
Keillor, R. M., Perkins, W. B., & Horan, J. J. (1999). Effects of videotaped expectancy
challenges on alcohol consumption of adjudicated students. Journal of Cognitive
Psychotherapy, 13, 179-187.
Kulick, A. D. (2002). A new expectancy-challenge prevention program: The effects of
drinking and alcohol expectancy in at-risk collegiate women. Dissertation Abstracts
International, 67, 5394.
Lau-Barraco, C., Dunn, M. E. (2008). Evaluation of a single-session Expectancy challenge
intervention to reduce alcohol use among college students. Psychology of Addictive
Behaviors, 22, 168-175.
Alcohol Expectancy Challenge Studies
Musher-Eizenman, D. R. & Kulick, A. D. (2003). An Alcohol Expectancy-Challenge
prevention program for at-risk college women. Psychology of Addictive Behaviors, 17,
163-166.
Van de Luitgaarden, J., Wiers, R. W., Knibbe, R. A., & Boon, B. J. (2006). From the
laboratory to real life: A pilot study of an expectancy challenge with “heavy drinking”
young people on holiday. Substance Use and Misuse, 41, 353−368.
Van de Luitgaarden, J., Wiers, R. W., Knibbe, R. A., & Candel, M. J. (2007). Single-session
expectancy challenge with young heavy drinkers on holiday. Addictive Behaviors, 32,
2865-2878.
Wiers, R. W., & Kummeling, R. H. C. (2004). An experimental test of an alcohol expectancy
challenge in mixed gender groups of young heavy drinkers. Addictive Behaviors, 29,
215−220.
Wiers, R. W., Van de Luitgaarden, J., Van den Wildenberg, E., & Smulders, F. T. Y. (2005).
Challenging implicit and explicit alcohol-related cognitions in young heavy drinkers.
Addiction, 100, 806−819.
Wood, M. D., Capone, C., Laforge, R., Erickson, D. J., & Brand, N. H. (2007). Brief
Motivational intervention and alcohol expectancy challenge with heavy drinking college
students: A randomized factorial study. Addictive Behaviors, 32, 2509-2528.