Master Thesis Child & Adolescent Psychology Date: 15-07-2017
Student number: 1033271 Supervisor: Dr. S. Peters
Second reader: R. van der Cruijsen
The relationship between
impulsivity and alcohol use
among adolescents
Abstract
Alcohol use among adolescents is a frequently discussed issue. Recent research shows a link between impulsivity and alcohol use, but results are often inconsistent. The current study examined the link between impulsivity and alcohol use among adolescents, aged between 12 to 26 (N = 246). Impulsivity was measured using two different measurements, both a self-report (BIS-11) and a behavioral measurement (BART). It was expected that impulsive
individuals tend to drink more alcohol. Results showed that the BIS-11 Motor Impulsivity, the BIS-11 Total Impulsivity and the BART number of explosions are a significant predictor for the amount of lifetime alcohol use. The BIS-11 Non-planning Impulsiveness, the BIS-11 Motor Impulsiveness, the BIS-11 Total Impulsiveness and the BART number of explosions are a significant predictor for the amount of alcohol consumed in the last month.
Consequently, it can be concluded that there is a relationship between impulsivity and alcohol use, but this relationship is far more complex and may be influenced by other factors. Further research is needed to examine the relationship between impulsivity in more detail, focusing on different measurements of impulsivity.
The relationship between impulsivity and alcohol use among adolescents Binge drinking is a common pattern of excessive alcohol use in the Netherlands amongst adolescents and young adults. The Website of ‘Centraal Bureau voor de Statistiek’
(http://www.statline.cbc.nl) provides information about binge drinking in the Netherlands. Stolle, Sack & Thomasius (2009) define binge drinking as “the consumption of at least 4 (for girls) or 5 (for boys) standard units of alcohol (e.g. 0.3L beer, 0.2L wine of 0.04L spirits) with the aim of becoming drunk” (p. 324). In 2013 the National Survey on Drug Use and Health reported that over a fifth of the participants reported binge drinking in the month prior to the survey. 60.1 Million Americans age 12 and above participated in this survey (Siqueira, Smith & Committee on Substance Abuse, 2015). 5.4 Million participants aged 12 to 20 years
reported binge drinking. Research over the past years shows a link between alcohol use and impulsivity (Coskunipinar, Dir & Cyders, 2013; Hutchinson, Patock-Peckham, Cheong & Nagoshi, 1998; Nagoshi, Wilson & Rodriguez, 1991; Waldeck & Miller, 1997). These studies report that men and women who were more impulsive consumed alcohol more often.
However, the link between alcohol use and impulsivity is measured in various ways and therefore results of those studies can be inconsistent. It is important to investigate the link between alcohol use and impulsivity among adolescents. The link between impulsiveness and alcohol use has implications for several psychiatric illnesses and cognitive development (DSM-5; American Psychiatric Association, 2013; Chamorro et al., 2012; Sharma, Kohl, Morgan & Clark, 2013). Shin, Hong and Jeon (2012) emphasized that alcohol use amongst adolescents is a concern to public health because it affects the forming of ones identity in this developmental phase. During adolescence identity forming is an important part of the
development of an individual and is usually accompanied by substance use (Arnett, 2005). The use of substances during adolescence can be explained in two ways. First, substances such as alcohol are used by individuals to gain new experiences before settling down into
adulthood. Second, forming an identity can be difficult and confusing and thus the use of substances can offer an escape from the stressful transition an individual might undergo during adolescence.
Impulsivity has been described in widely varying ways, such as behaviours that are “spontaneous, unplanned, reckless, potentially dangerous, rash or performed without
consideration of their consequences” (Sharma, Kohl, Morgan & Clark, 2013, p. 559), but also as manifestations of low self-control or low effortful control (Hoyle, 2006; Strayhorn, 2002). Individuals who are considered impulsive experience difficulties in inhibiting responses and prefer a smaller short-term reward over a bigger long-term reward (Franken & Muris, 2005; Vigil-Colet & Codorniu-Raga, 2004). Eysenck & Eysenck (1985) deem impulsivity to be a component of psychoticism. Patton, Stanford and Barratt (1995) propose a factor model where the different components of impulsivity are categorized as ‘attentional impulsiveness’, ‘motor impulsiveness’ and ‘non-planning’. Although researchers differ in their exact
definition, it is clear that impulsivity can be seen as a broad personality trait and has influence on thoughts and acts of human beings. In this study impulsivity will be considered a
personality trait which can be described as the desire to obtain pleasure, arousal and satisfaction (Hollander & Rosen, 2000) and the inability to inhibit or delay the behaviours (Hollander & Wong, 1995b).
As discussed before, impulsivity has been linked to alcohol use, where more impulsive people tend to drink more. Several studies have linked impulsivity and impulsive decision making to more and faster consumption of alcohol and proved that impulsivity is an important concept in alcohol misuse and (long-term) alcohol use disorders among individuals (Bjork, Hommer, Grant & Danube, 2004; Courtney et al., 2012; Dom, Hulstijn & Sabbe, 2006; Grau & Ortet, 1999; Labouvie & McGee, 1986; MacKillop, Mattson, MacKillop, Castelda and Donovick, 2007; Rubio et al., 2008).
An interesting research group in the context of alcohol use are adolescents. Adolescence is a developmental period, where both impulsivity and alcohol use vary more than in other age groups (Arnett, 1992; Curcio & George, 2011; Steinberg, 2008). Adolescence is a mental stage which ranges, according to the American Psychological Association (2002), from age 10 till the age of 21-25 years. In general research the consensus is that individuals aged 10 to 19 are considered adolescents.(Sacks, 2003; WHO).
Before adolescence and in early adolescence, one of the reasons for low alcohol
consumption is because of legal reasons. The Dutch government for example, tries to prevent excessive alcohol use, alcohol misuse and alcohol addiction by prohibiting selling alcohol to youths under 18 years old (Art. 20 lid 1 DHW). During late adolescence, legal restrictions no longer apply. Moreover, impulsivity varies more in adolescence and this has a link with alcohol use (Steinberg, 2008; Curcio & George, 2011). Alcohol use during adolescence is considered as normal behaviour and a persistent social issue (Stautz & Cooper, 2013). In general, risk-taking behaviour increases during adolescence and alcohol use is one of the most dominant forms of risk-taking behaviour during this developmental period (Hibell et al., 2012; Spear, 2000). Assumptions are made that alcohol use rises in adolescence as a result of changes around the time of puberty in the brain. Those changes in the brain result in increased psychological and neural manifestations of reward-seeking behaviour. The cognitive control system slows down in developing (Steinberg, 2008; Harden & Tucket-Drob, 2011).
According to Shulman and colleagues (2016) “psychological and neural manifestations of reward sensitivity increase between childhood and adolescence, peak sometime during the late teen years, and decline thereafter, whereas psychological and neural reflections of better cognitive control increase gradually and linearly throughout adolescence and into the early 20s” (p. 103). The capacity for impulse control and inhibition grows and impulsivity declines linearly from ages 12 to 24 years (Harden & Tucker-Drob, 2011). Altogether, impulsivity and
alcohol use are significantly higher during adolescence than adulthood, and assumptions can be made that the reason for that is the underdevelopment of the adolescent brain (Grano et al., 2004; Stanford, Greve, Boudreaux & Mathias, 1996).
In the studies that research the link between impulsivity and alcohol use, these factors are measured using different tools and can therefore give inconsistent results. For impulsivity the UPPS (Urgency, Premeditation, Perseverance and Sensation Seeking) Impulsive Behavior Scale (Whiteside and Lynam, 2001) is often used. The UPPS is used in the studies of Treloar, Morris, Pedersen and McCarthy (2012), Shin, Hong and Jeon (2012) and Magid and Colder (2007) and measures impulsivity traits. The UPPS represents the four sub-dimensions of impulsivity, including Premeditation, Urgency, Sensation Seeking, and Perseverance, by measuring the outcome of a 45-item questionnaire. Another tool to measure impulsivity is the Barratt Impulsiveness Scale (BIS-11; Patton, Stanford & Barratt, 1995). Henges and
Marczinski (2012) used the BIS-11 to measure impulsivity, next to the cued go/no-go task. The BIS-11 is a 30-item self-report instrument and assesses the personality dimension of impulsivity. The BIS-11 is one of the two impulsivity measures used in the current study.
In a study about potential problem drinking by Lejuez et al. (Lejuez et al. 2002) the Balloon Analogue Risk-Taking Task (BART; a behavioral measure that measures impulse decision making) and the BIS-11 were used to measure impulsivity. The study demonstrated that the BART and the BIS-11 are significantly positively correlated. Higher scores on the impulsivity measurements BART and BIS-11 were linked to higher scores of problem drinking. The BIS-11 and the BART are two highly validated measures and will therefore be used as reliable measurements in this study. The BART will be used as an impulsivity measure in this study.
To measure alcohol use, a number of different tools were used. Treloar et al. (Treloar, Morris, Pedersen & McCarthy, 2012) used The Drinking Styles Questionnaire (Smith et al.,
1995) to measure the frequency and quantity of alcohol consumption of 816 college students. The Alcohol Expectancy Questionnaire (AEQ; Goldman et al., 1997), which consists of 68 items, was used to examine the expectations of the positive effects of alcohol use. Drinking and driving expectancies were assessed by using the PEDD-Y (McCarthy et al., 2006). Several questions were asked to assess how participants perceived the negative consequences of drinking and driving as well as the danger this leads to and the ethics of drinking and driving. Finally, participants were asked to give an indication of the frequency of driving after consuming alcohol and the quantity of alcohol they would drink when driving. All UPPS traits were associated with drinking-and-driving frequency and quantity. But only the Urgency scale of the UPPS uniquely contributed to drinking (and driving).
Henges and Marczinski (2012) used The TimeLine Follow-Back (TLFB) as a self-report of alcohol use over the past 30 days (Sobell & Sobell, 1992) on 109 young adults, aged 18 to 21 years. The Personal Drinking Habits Questionnaire (PDHQ) was used to describe
participants typical drinking experiences (Vogel-Sprott, 1992). Inhibitory control was investigated using the cued go/no-go reaction time task (Marczinsky & Fillmore, 2003). Positive links were found between the total number of drinks consumed and BIS-11 total scores, between the number of heavy drinking days and BIS-11 scores and the number of drunk days and BIS-11 scores (Henges & Marczinski; 2012). The Cued Go/No-Go task scores predicted the highest number of drinks consumed on one occasion during the last month. The different relations with the BIS-11, the Cued Go/No-Go task and the alcohol variables can be explained by the statement of Marczinsky and Fillmore that impulsivity may have different components, measured with different tools, that contribute to the drinking patterns.
Another study also investigated the role of impulsivity on alcohol use (Shin, Hong and Jeon; 2012) on 190 healthy individuals, with a broader age range (18 to 25 years) than Henges’ and Marczinskis’ study (2012). They included the frequency of alcohol use,
alcohol-related problems, binge drinking and alcohol use disorders. Frequency of alcohol use was measured by how many days the participant drank alcohol per month, for the past 12 months. Frequency of binge drinking was measured with this question on how many days they drank five (for males) or four (for females) or more drinks in a row. Alcohol-related problems in the past 12 months were indexed using the Rutgers Alcohol Problem Index (RAPI; White & Labouvie, 1989). Alcohol-use disorders, as described in the Diagnostic and Statistical Manual (DSM-IV) were measured by the Composite International Diagnostic Interview (CIDI)
alcohol sub-scale (Cottler et al., 1991). A positive relationship was found between the Urgency- and Sensation-seeking-scale and the frequency of alcohol use. The Premeditation scale was related to the decrease in alcohol use over the last year. Alcohol related problems were significantly predicted by higher scores on the Urgency and Sensation Seeking scale. Urgency and Sensation Seeking were positively associated with binge drinking and alcohol-use disorders. The overall conclusion of this study was that the different characteristics of impulsivity relate with different characteristics of alcohol use (Shin, Hong and Jeon; 2012).
Magid and Colder (2007) tested the relationship between impulsivity and alcohol use and substance-related disorders in a different way and studied the factor structure of the UPPS and associations with college drinking on 367 undergraduates. An alcohol use index was created. by multiplying frequency by quantity. The Rutgers Alcohol Problem Index (RAPI) measured alcohol problems. Participants who scored high on the sub-scale premeditation showed lower levels of alcohol use, while participants who scored high on the sub-scale sensation seeking showed higher levels of alcohol use. Urgency and perseverance were positively, respectively negatively, associated with alcohol-related problems.
Relatively few studies investigated the link between impulsivity and alcohol use in adolescents. Thompson, Roemer and Leadbeater (2015) examined impulsive personality (sensation seeking and lack of perseverance), parental monitoring and alcohol use
descriptives in participants age 16 through 28 years old. Alcohol use was measured. Alcohol related harms were determined with the Harmful Effects of Alcohol Scale, adapted from the Personalized Alcohol Use Feedback scale. Sensation seeking was assessed with the
Zuckerman Kuhlman Personality Questionnaire (Zuckerman, 2002). Lack of perseverance was measured using the regulation of attention, impulsivity and activity subscale of the Brief Child and Family Phone Interview (Cunningham et al., 2009). The Colorado Self-Report of Family Functioning Inventory (Barber, Olsen & Shagle, 1994) was used to assess parental monitoring. Thompson, Roemer and Leadbeater (2015) tried to map the effects of sensation-seeking, lack of perseverance and parental monitoring on levels of alcohol use and alcohol-related harm. The sub-scale sensation seeking was more strongly alcohol-related to alcohol use than to alcohol-related harm. The sub-scale lack of perseverance was more strongly related to
alcohol-related harm than to alcohol use (Thompson, Roemer and Leadbeater; 2015).
The studies discussed earlier give evidence for a relation between impulsivity and alcohol use. The results however, are not always consistent and the assumption is made that the use of different impulsivity and alcohol use measures leads to these discrepancies. Moreover, few studies have focused on adolescence. The current study aims to investigate this possible relationship between impulsivity and alcohol use with an extended version of the alcohol questionnaire of Ames and colleagues (Ames, Grenard, Thush, Sussman, Wiers et al., 2007). Peters et al. (2016) developed and validated this extended version of the alcohol
questionnaire. The questionnaire can be filled out on-line and at home, on recent and lifetime alcohol use. This questionnaire is a fast manner to describe alcohol use. It distinguishes it-self from other alcohol questionnaires such as the Alcohol Use Disorders Identification Test (AUDIT; Babor, Higgins-Biddle & Saunders, 2001) and Rutgers Alcohol Problem Index (RAPI; White & Labouvie, 1989) by focussing less on problematic drinking. The extended version of Ames and colleagues is used only to describe alcohol use.
Moreover, impulsivity will be examined by two different measurements, one self-report (BIS-11) and one behavioural (BART). The BART and the BIS-11 scores reflect the trait impulsivity and will serve as the independent variables in this study.
The BART is a behavioral task, which is laboratory based, that measures impulsive decision making (Reynolds, Ortengren, Richards & Wit, de, 2006). The BART was created to provide a context in which risk-taking behaviour could be examined. In this task risk-taking behavior is rewarded up to a limit where further risk-taking leads to negative results (Lejuez et al., 2002). The BART is extended as a methodology to measure impulsivity in adolescents (Lejuez, Aklin, Zvolensky & Pedulla, 2003). These data indicated that high risk-taking behaviour on the BART was related to self-reported risk-taking behaviour in real life. The BART is an useful behavioural measurement for the assessment of impulsivity in adolescents. The BIS-11, The Barratt Impulsiveness Scale, is a self-report questionnaire, focusing on impulsive action, thought process and personal attitude. Individuals who score higher on the BIS-11 showed greater participation in a number of sensation-seeking or risk-taking
behaviors, for example alcohol use (Klein & Papouchis, 2010).
Impulsivity was measured using both a self-report and a behavioural measurement for three reasons: First, the veracity of a self-report can be affected by the presumed negative consequences of reporting private information (Aklin et al., 2005); Second, some participants could lack the comprehension to correctly report their own behaviour (Ladouceur et al., 2000); Third, the used measurement is mostly composed of questions that directly examine the behaviour under question (Andrew & Cronin, 1997). In order to circumvent the
complications of using one of these tools, both self-report and a behavioural measurement are needed to form a reliable construct of impulsivity (Chamorro et al., 2012). Two different measurements are used in this study to be sure that the measures of impulsivity are reliable.
In this study the main research question was whether impulsivity predicted alcohol use in adolescents. This relationship will be controlled for gender and age. It is hypothesized that adolescents with high impulsivity tend to drink more alcohol (Bjork, Hommer, Grant & Danube, 2004; Courtney et al., 2012; Dom, Hulstijn & Sabbe, 2006; Grau & Ortet, 1999; Labouvie & McGee, 1986; MacKillop, Mattson, MacKillop, Castelda and Donovick, 2007; Rubio et al., 2008).
Methods.
Participants.
This study was part of a larger project on cognitive and affective development (i.e. Braams, van Duijvenvoorde, Peper & Crone, 2015; Peper, Koolschijn Crone, 2013; Peters, Braams, Raijmakers, Koolschijn & Crone, 2014). Participants aged 14 to 26 years old (M = 16.66, SD = 3.26) were found through the use of advertising on high schools in the West of the Netherlands (N = 246). Demographics for participants were as follows: N = 246 (125 females, 120 males). To measure the intelligence of the participants two sub-scales
(Similarities and Block Design) of the Wechsler Intelligence Scale for Children (WISC-III) and the Wechsler Adult Intelligence Scale (WAIS-IV) were used. IQ ranged between 80 and 135 (M = 107.74, SD = 9.99). Participants aged 12 through 17 years old received a gift and their parents were compensated with €30,- for travel expenses, while participants aged 18 and above received a compensation of €60,-. The instructions of the alcohol questionnaire
included information regarding the confidentiality of the answers given by the participants, and that none of the answers will be shared with third parties. This study was approved by the Institutional Review Board at the University Medical Centre. Participants (or parents of underage participants) were obliged to sign an informed consent.
Materials.
The Barratt Impulsiveness Scale [BIS-11] (Patton et al., 1995)
The BIS-11 is a 30-item questionnaire intended to measure impulsivity. The BIS-11 is the most frequently used measure to investigate impulsivity and is used to broaden our
knowledge concerning the relationship between impulsivity and other personal characteristics (Stanford et al., 2009). The BIS-11 contains behavioral and personality descriptions of
impulsive propensities. This measure utilises a Likert-scale subdivided in 4 possible answers: rarely/never, occasionally, often and almost always/always (Pechorro, Ayala-Nunes, Ray, Nunes, Gonçalves, 2016). Personality and behavioral constructs of impulsivity can be measured with this self-report measurement. The original version of this questionnaire was designed to asses impulsivity as a single construct. However, research on this topic led to the knowledge that impulsivity is a multi-dimensional construct consisting of 6 factor: attention, motor, self-control, cognitive complexity, perseverance, and cognitive instability. These factors can be subdivided into three categories: Motor Impulsiveness (acting without thinking; factors motor and perseverance), Non-planning Impulsiveness (guidance for the present and not the future; self-control and cognitive complexity) and Attentional Impulsiveness (lack of focus; factors attention and cognitive instability) (Patton et al. 1995; Pechorro, Ayala-Nunes, Ray, Nunes, Gonçalves, 2016). The BIS-11 has mostly shown tolerable psychometric
characteristics, namely “internal consistency, Cronbach’s alpha values ranging from .62 to .83), test–retest stability (.66 to–.83) and criterion-related validity (see Vasconcelos et al. 2012)” (p. 2754, Pecheorro, Ayala-Nunes, Ray, Nunes, Gonçalves, 2016). The categories motor impulsiveness, non-planning impulsiveness and attentional impulsiveness are used to provide a window for impulsivity in this study.
The Balloon Analogue Risk-taking Task [BART] (Lejuez et al., 2002)
The BART is a behavioral measure that measures impulse decision making (Reynolds, Ortengren, Richards & Wit, de, 2006). The BART is a measure that is used to study risk-taking behaviour through a computerized task (Lejuez et al., 2002). By weighing the
conceptualized potential reward versus the potential loss, the BART mimics actual risk-taking behaviour. During this task, the participants are confronted with a computer program
displaying a balloon, and are given the chance to earn a monetary reward by pumping up the balloon by pressing a button. Every time the participant presses the button a little air is added to the balloon and a little money is added to the counter. Air can be added up to a certain threshold on which the balloon is full and will explode. By pumping air into the balloon the risk of exploding as well as the potential reward increases. When the participants choses to stop, the amount of money on the counter will be deposited onto the bank. However, when the participant doesn’t stop and the balloon explodes, the amount of money on the counter will be lost. The capacity of the balloon is not known to the participant. The absence of this
information makes it possible to assess both the initial reaction and the change in response due to the gained experience with the task. After money is collected or a balloon has burst a new balloon will appear to repeat the trial up to a 30 times (Lejuez et al. 2002). The adjusted average number of pumps on unexploded balloons is the score that measures risk-propensity and impulsivity. The greater the average number, the greater the risk-propensity and
impulsivity.
Self-report: Alcohol Questionnaire (Ames et al., 2007)
Participants filled out a questionnaire on recent and lifetime alcohol use. This questionnaire was developed by Ames et al. (Ames, Grenard, Thush, Sussman, Wiers et al., 2007). Two additional questions were asked in our extended version. This questionnaire also
not only focusses on recent alcohol use, but also on lifetime alcohol use. The instructions of the questionnaire stated that the answers of the participants were confidential and would not be revealed to others. Lifetime alcohol use was measured by the number of total alcoholic beverages used in the respondents total lifetime, where bottles and cans count as 1.5 glasses. The scale consisted of 11 categories: 0, 1-10, 11-20, 21-30, 31-40, 41-50, 51-60, 61-70, 71-80, 81-90 and >90(Peters et al., 2015). Recent alcohol use was measured by the number of total alcohol beverages used in the last month on a scale from 0-50+, consisting of 10 categories: 0, 1-2, 3-4, 5-6, 7-10, 11-15, 16-20, 21-30, 31-50 and >50. Two extra questions were asked. 1) At which age did you have your first drink? And 2) At which age were you drunk for the first time? A scale variable was constructed by transferring the ordinal results into a mean-score. 75.45 glasses of alcohol consumed in their lives was the average (SD = 24.85). The average for the last month was 20.71 glasses (SD = 16.35). Alcohol use was correlated with age (lifetime: r = .557, p < .001; recent: r = .425, p < .001).
Statistical analysis
The relationship between impulsivity on the one hand and alcohol use on the other hand is investigated by 24 stepwise regression analyses. For the prediction of alcohol we used lifetime use, recent use (last month), the age of the first alcoholic drink and the age of first being drunk. The influence of impulsivity on the four alcohol variables is also controlled for the possible confounding variables of gender and age. Intelligence had no significant
correlation with alcohol use nor impulsivity and was dropped in the regression analyses. The aim was to predict alcohol life use, recent alcohol use, the age of the first alcoholic drink and the age of first being drunk independently out of impulsivity and the confounding variables to see what was the influence of impulsivity on the dependent variables. 24 Linear regression
models were created. In block 1 these dependent variables were predicted out of gender and age, and in block 2 out of impulsivity.
Results
Table 1 provides an overview of the variables gender, age, total IQ, alcohol use, the BIS-11 and the BART.
Table 1 - Descriptives of gender, age, total IQ, alcohol use, BIS-11 and BART.
Variables Number Mean Standard Range Deviation
Gender Age Total IQ
Alcohol life time use Alcohol use per month Age first drink
Age first drunk BIS-11 Motor BIS-11 Attention BIS-11 Non-planning BIS-11 Total
BART number of explosions BART mean pumps with success
245 246 220 246 246 166 108 246 246 246 246 215 215 .49 16.67 107.74 36.45 9.35 14.04 15.59 21.64 16.35 24.66 62.65 11.81 10.91 .50 3.26 9.99 39.36 14.47 2.04 1.70 3.70 3.27 4.45 9.30 3.67 6.50 - 12.08-26.62 80-135 .00-91.00 .00-50.00 4-19 12-22 13-36 8-27 13-38 41-100 2-23 1.11-44.44
To control if the BART and the BIS-11 measure the same concept of impulsivity, Pearson correlations were calculated. The only significant correlation was found between the BIS-11 Attention Impulsiveness scale and the BART number of explosions (r = .177, p = .009). The rest of the subscales from the BIS-11 were not significantly correlated with one of the two BART variables (all p’s >.05).
Before looking into the relationship between impulsivity and alcohol use, the
relationships with total IQ are demonstrated. Table 2 shows the correlations with Total IQ, the BIS-11, the BART and the alcohol questionnaire. None of the correlations were significant (all p’s >.05).
Table 2 - Correlations with TIQ and impulsivity and alcohol use.
Variables R(100) Significance
BIS-11
BIS-11 Motor x TIQ .009 .899
BIS-11 Attentional x TIQ -.003 .966
BIS-11 Non-planning x TIQ -.096 .154
BIS-11 Total x TIQ -.044 .519
BART
BART number of explosions x TIQ -.023 .733
BART mean pumps with success x TIQ .031 .648
Alcohol Questionnaire
Alcohol use life scale x TIQ .099 .141
Alcohol use month x TIQ .076 .259
Age first drink x TIQ .028 .727
Age first drunk x TIQ .138 .161
Independent Samples Tests were used to analyze the differences between men and women on impulsivity (BIS-11 and BART) and alcohol use (alcohol questionnaire). None of the variables showed a significant difference between men and women (p >.05).
Correlations were also calculated between age, impulsivity and alcohol use (see table 3). None of the BART variables correlated significantly with age (p <.05). One sub-scale of the BIS11, specifically Nonplanning Impulsivity, correlated significantly with age (r = -.219, p = .001). Alcohol use and age were significantly correlated. All results are showed in table 3.
Table 3 - Correlations with age and impulsivity and alcohol use.
Variables R(100) Significance
BIS-11
BIS-11 Motor x Age -.023 .724
BIS-11 Attentional x Age -.020 .757
BIS-11 Non-planning x Age -.219 .001*
BIS-11 Total x Age -.121 .059
BART
BART number of explosions x Age .052 .452
BART mean pumps with success x Age .114 .097
Alcohol Questionnaire
Alcohol use life scale x Age .778 < .001*
Prediction of lifetime alcohol use with the BIS-11 and BART subscales
The regression analysis showed that the confounding variable of age (β = .777, p < .001) was significant in the prediction of alcohol life use, and the variable gender (β = -.040, p = .310) was not significant in the prediction of alcohol life use. In the model with BIS-11 Motor Impulsivity (β = .116, p < .010), 61.8 % of the variance is explained (F (3,241) = 129.929, p < .001), in the model without BIS-11 Motor 60.4% of the variance is explained (F(2,242) = 184.669, p < .001). Consequently, BIS-11 Motor Impulsivity is a significant predictor (F Change (3,241) = 8.699, p < .010) of the alcohol use in lifetime. BIS-11 Motor Impulsivity led to 1.4% extra explained variance of lifetime alcohol us. The results were summarized in table 4.
Table 4 - Results of the stepwise regression analysis of lifetime alcohol use and BIS-11 Motor.
B SE B Β Step 1 Constant -119.713 9.328 Age 9.532 .537 .774*** Sex -2.793 3.465 -.035 Step 2 Constant -147.058 12.508 Age 9.505 .485 .781*** Sex -3.625 3.127 -.046 BIS-11 Motor 1.249 .423 .118**
Note: R2 = .602, ΔR2 = .013 for step 2 (p = .004). *** p < .001, ** p < .010, * p < .05.
In the model with BIS-11 Total Impulsivity (β = .088, p < .05), 61.2% of the variance is explained (F(3,241) = 126.603, p < .001), in the model without BIS-11 Total Impulsivity 60.4% is explained (F(2,242) = 184.669, p < .001). consequently, BIS-11 Total Impulsivity is a significant predictor (F Change (3,241) = 4.749, p < .05) of the alcohol use in lifetime. BIS-11 Total Impulsivity led to 0.8% extra explained variance of lifetime alcohol use. The results were summarized in table 5.
Table 5 - Results of the stepwise regression analysis of lifetime alcohol use and BIS-11 Total. B SE B β Step 1 Constant -119.713 9.328 Age 9.532 .537 .774*** Sex -2.793 3.465 -.035 Step 2 Constant -145.119 14.443 Age 9.592 .492 .789*** Sex -2.997 3.151 -.038 BIS-11 Total .372 .171 .088*
Note: R2 = .602, ΔR2 = .007 for step 2 (p = .035). *** p < .001, ** p < .010, * p < .05.
In the model with BART number of explosions (β = .100, p < .05), 60.8 % of the variance is explained (F(3,241) = 108.956, p < .001), in the model without BART number of explosions 59.8% is explained (F(2,242) = 157.522, p < .001). Consequently, BART number of explosions is a significant predictor (F Change (3,241) = 5.353, p < .05) of the alcohol use in lifetime. BART number of explosions led to 1.0% extra explained variance of lifetime alcohol use. The results were summarized in table 6.
Table 6 - Results of the stepwise regression analysis of lifetime alcohol use and BART number of explosions. B SE B Β Step 1 Constant -119.713 9.328 Age 9.532 .537 .774*** Sex -2.793 3.465 -.035 Step 2 Constant -131.160 10.467 Age 9.472 .532 .769*** Sex -3.650 3.450 -.046 Bart Number of explosions 1.090 .471 .100*
The BIS-11 Attentional Impulsivity (β = .067, p = .103), the BIS-11 Non-planning Impulsivity (β = .038, p = .365) and the BART mean number of pumps (β = .055, p = .214) were no significant predictors of lifetime alcohol use.
Prediction of alcohol monthly use with the BIS-11 and BART subscales
In the model with BIS-11 Motor Impulsiveness (β = .157, p < .01), 44.2% of the variance is explained (F(3,241) = 63.545, p < .001), in the model without BART number of explosions 41.7% is explained (F(2,242) = 86.577, p < .001). Consequently, BIS-11 Motor Impulsiveness is a significant predictor (F Change (3,241) = 10.608, p < .01) of the recent alcohol use. BIS-11 Motor Impulsiveness led to 2.5% extra explained variance of recent alcohol use. The results were summarized in table 7.
Table 7 - Results of the stepwise regression analysis of recent alcohol use and BIS-11 Motor Impulsiveness. B SE B Β Step 1 Constant -39.039 3.773 Age 2.863 .220 .645*** Sex .501 1.420 .017 Step 2 Constant -52.625 5.576 Age 2.917 .216 .650*** Sex .304 1.394 .011 BIS-11 Motor .615 .189 .157**
Note: R2 = .410, ΔR2 = .023 for step 2 (p = .002). *** p < .001, ** p < .010, * p < .05.
In the model with BIS-11 Non-planning Impulsiveness (β = .114, p < .05), 42.9% of the variance is explained (F(3,241) = 60.464, p < .001), in the model without BART number of explosions 41.7% is explained (F(2,242) = 86.577, p < .001). Consequently, BIS-11 Non-planning Impulsiveness is a significant predictor (F Change (3,241) = 5.219, p < .05) of the recent alcohol use. BIS-11 Non-planning Impulsiveness led to 1.2% extra explained variance of recent alcohol use. The results were summarized in table 8.
Table 8 - Results of the stepwise regression analysis of recent alcohol use and BIS-11 Non-planning Impulsiveness. B SE B β Step 1 Constant -39.039 3.773 Age 2.863 .220 .645*** Sex .501 1.420 .017 Step 2 Constant -50.089 6.114 Age 3.008 .224 .671*** Sex .524 1.408 .018 BIS-11 Non-planning .370 .162 .114*
Note: R2 = .410, ΔR2 = .012 for step 2 (p = .029). *** p < .001, ** p < .010, * p < .05.
In the model with BIS-11 Total Impulsiveness (β = .143, p < .01), 43.7% of the variance is explained (F(3,241) = 62.384, p < .001), in the model without BART number of explosions 41.7% is explained (F(2,242) = 86.577, p < .001). Consequently, BIS-11 Total Impulsiveness is a significant predictor (F Change (3,241) = 8.577, p < .01) of the recent alcohol use. BIS-11 Total Impulsiveness led to 2.0% extra explained variance of recent alcohol use. The results were summarized in table 9.
Table 9 - Results of the stepwise regression analysis of recent alcohol use and BIS-11 Total Impulsiveness.
B SE B β Step 1 Constant -39.039 3.773 Age 2.863 .220 .645*** Sex .501 1.420 .017 Step 2 Constant -54.350 6.413 Age 2.973 .219 .663*** Sex .637 1.399 .022 BIS-11 Total .222 .076 .143**
Note: R2 = .410, ΔR2 = .019 for step 2 (p = .005). *** p < .001, ** p < .010, * p < .05.
In the model with BART number of explosions (β = .127, p < .05), 42.3% of the variance is explained (F(3,241) = 51.644, p < .001), in the model without BART number of explosions 40.8% is explained (F(2,242) = 72.922, p < .001). Consequently, BART number of
explosions is a significant predictor (F Change (3,241) = 5.792, p < .05) of the recent alcohol use. BART number of explosions led to 1.5% extra explained variance of recent alcohol use. The results were summarized in table 10.
Table 10 - Results of the stepwise regression analysis of recent alcohol use and BART number of explosions. B SE B β Step 1 Constant -39.039 3.773 Age 2.863 .220 .645*** Sex .501 1.420 .017 Step 2 Constant -45.530 4.806 Age 2.944 .244 .632*** Sex .114 1.583 .004 Bart Number of explosions .520 .216 .127*
Note: R2 = .410, ΔR2 = .016 for step 2 (p = .017). *** p < .001, ** p < .010, * p < .05.
The BIS-11 Attentional Impulsiveness (β = .076, p = .125) and the BART mean pumps for success (β = .100, p = .061) were no significant predictors of recent alcohol use.
Prediction of first alcoholic drink with the BIS-11 and BART subscales
In the models to predict the age of drinking alcohol for the first time, with the BIS-11 subscales and the BART subscales as predictors, none of the predictors were significant (BIS-11 Motor Impulsiveness, β = -.022, p = .761; BIS-(BIS-11 Attentional Impulsiveness, β = -.037, p = .605; BIS-11 Non-planning Impulsiveness, β = -.042, p = .567; BIS-11 Total Impulsiveness, β = -.042, p = .567; BART number of explosions, β = .007, p = .928; BART mean of success, β = -.023, p = .759).
Prediction of first being drunk with the BIS-11 and BART subscales
In the models to predict the age of being drunk for the first time, with the BIS-11 subscales and the BART subscales as predictors, none of the predictors were significant.
( BIS-11 Motor Impulsiveness, β = -.161, p = .078; BIS-11 Attentional Impulsiveness,
β = -.044, p = .633; BIS-11 Non-planning Impulsiveness, β = -.140, p = .125; BIS-11 Total
Impulsiveness, β = -.150, p = .104; BART number of explosions, β = .-.058, p = .533; BART mean of success, β = -.038, p = .676).
Discussion
General discussion
The current study investigated the relationship between impulsivity and alcohol use and whether impulsivity could predict alcohol use among adolescents. This relationship was examined using the Balloon Analogue Risk Taking Task [BART], the Barratt Impulsiveness Scale [BIS-11] and a customizedAlcohol Questionnaire. Several variables of the impulsivity construct predicted the total use of alcohol in a lifetime and the use of alcohol in the last month. Results showed that the BIS-11 Motor Impulsivity, the BIS-11 Total Impulsivity and the BART number of explosions are significant predictors for the total amount of alcohol used in a lifetime. The BIS-11 Non-planning Impulsiveness, the BIS-11 Motor Impulsiveness, the BIS-11 Total Impulsiveness and the BART number of explosions are significant predictors for the amount of alcohol consumed in the last month.
The results suggest there is a relationship between impulsivity and alcohol use, measured by the BIS-11, the BART and the alcohol questionnaire. In the following paragraphs these results will be discussed in light of general research on the relationship between impulsivity and alcohol use.
Differences with other studies
The hypothesis of this study was that impulsivity, measured with both the BIS-11 and the BART, would have a positive relationship with alcohol use among adolescents. The
results however showed that not all of the subscales of the BIS-11 and the BART were significant predictors for the amount of alcohol used in a lifetime, recent alcohol use (the last month), the age of being drunk for the first time and the age of drinking alcohol for the first time. The results found in this study contradict the results of earlier studies which have found significant relationships between all of the subscales of the BIS-11 and the BART and alcohol questionnaires.
According to the studies of Bjork, Hommer, Grant and Danube (2004), Courtney and colleagues (2012), Henges and Marczinski (2012) and Rubio and colleagues (2008) there is a positive relationship between impulsivity, measured with the BIS-11 and/or the BART, and alcohol use. The difference in outcome between the current study and other studies can be explained by the different approach of measuring the variables impulsivity and alcohol use, the chosen statistical analysis and the characteristics of the sample.
The study of Bjork, Hommer, Grant and Danube (2004) differed from the current study on multiple aspects. First, the sample of the study of Bjork, Hommer, Grant and Danube (2004) differed from the sample of the current study because the participants in this study were mental health care patients with real alcohol use problems, whereas the sample of the current study consisted of a random group of participants. These patients were undergoing a treatment at the National Institutes of Health Clinical Centre in Bethesda, Maryland (USA). The different characteristics of the participants implicates that the discrepancy in outcome could be explained by the different level of alcohol use between the samples. The alcohol variable was based on being a detoxified alcohol-dependent patient or non-alcohol dependent participant, whereas the current study used an alcohol questionnaire. Second, the age range in this study was broader than in the current study, 19 to 63 vs. 14 to 26 in the current study. The impulsivity variable varies more because of the different ages in the sample. Third, the
regression analyses (step-wise ANOVA) compared to the independent two-tailed t-tests this study used. Therefore, results of this study are difficult to compare with the current study.
The study of Courtney and colleagues (2012) also differed from the current study on several aspects. First, the sample of this study contained problem drinkers from a community sample of treatment seeking problem drinkers in Los Angeles (USA) instead of non-problem drinkers. This implicates that the discrepancy in outcomes could be explained by the different level of alcohol use between the samples, which is a result of the alcohol use
problems of the participants. The alcohol variable was based on being a problem-drinker or a non-problem-drinker, whereas an alcohol questionnaire was used in the current study. Second, the age range was broader than the current study, 21 to 65 vs. 14 to 26. The impulsivity
variable varies more because of the different ages in the same sample. Third, the statistical analyses used in this study differ from the current study. The current study used regression analyses (step-wise ANOVA) compared to the SEM framework this study used. Therefore, results of this study are difficult to compare with the current study.
The study of Henges and Marczinsky (2012) also differed from the current study on various aspects. First, the age-range of this study was smaller than the current study, 18 to 21 vs. 14 to 26. The impulsivity variable varies more because of the different ages in the same sample. Second, this study divided the sample in two groups (binge drinking or non-binge drinking) compared to the one group with all levels of alcohol use. The current study used an alcohol questionnaire while this study did not. This implicates that the discrepancy in
outcome could be explained by the different level of alcohol use between the samples, which is a result of binge drinking. Third, the statistical analyses weren’t the same as the current study. The current study used regression analyses (step-wise ANOVA) compared to the Pearson correlations. Therefore, results of this study are difficult to compare with the current study.
The study of Rubio and colleagues (2008) also differed from the current study on several aspects. First, the used sample contains only heavy drinkers compared to a sample consisting of all levels of alcohol use. This implicates that the discrepancy in outcome could be explained by the different level of alcohol use between the samples of the current study and this study, which is a result of the alcohol use disorders of the participants. The current study used an alcohol questionnaire while this study did not. Second, more individuals participated in this study, 471 vs. 246. The results of this study are more reliable because the larger sample gives the statistical analyses a larger power. And third, the statistical analyses weren’t the same as the current study. The current study used regression analyses (step-wise
ANOVA) compared to ANOVA or independent 2-tailed t-tests in a 4 year follow-up this study used. Therefore, results of this study are difficult to compare with the current study.
Alternative explanations
In the current study, the relationship between impulsivity and alcohol use is proved for some of the used impulsivity variables. Because impulsivity is such a wide and complex construct, other factors may also influence this relationship and could explain why not every impulsivity variable significantly correlated with alcohol use.
First, the used measurements for impulsivity may not measure the aspect of
impulsivity that is considered as a predictor of alcohol use. The assumption can be made that the BIS-11 and the BART do not measure the construct of impulsivity that predicts the variance in alcohol use, as was found in this study. Moreover, no correlation was found between the BIS-11 and the BART. As Smillie and Jackson (2006) pointed out in their article, impulsivity is a common name for a multitude of dimensions. According to Fernie and
colleagues (Fernie et al., 2013) “there are several distinct facets of behavioural impulsivity, many of which overlap with subcomponents of executive (dys)function (Bickel et al., 2012)”
(p. 1916). Fernie and colleagues (Fernie et al., 2013) describe the different aspects of impulsivity and the way to measure them and conclude that that impulsivity is not a unitary construct.
Second, the study of Klein (2010) suggests that the behavioral assessment of risk-taking (measured with the BART) may measure a construct that is different to those specific behaviours assessed through self-report. Self-reported levels of impulsivity and risk-taking, measured with the BIS-11, were also not positively correlated with the behavioral
measurement (BART) in the study of Klein (2010). When using the BART as a measure of risk-taking and impulsivity an important consideration to be made is whether participants felt that they were actually taking a risk during the completion of the task. It is unclear if the risk measured by the BART is experienced as an actual risk. Moreover, it is not possible to make the assumption that risk-taking behaviour is the same construct as impulsivity. Risk-taking behaviour could however be a consequence of impulsivity. The BART may not be the right impulsivity measure to use when examining the relationship between impulsivity and alcohol use. Earlier results indicated that “self-report measures and behavioral measures assess
different forms of impulsivity, and that behavioral measures of impulsivity reflect at least apparently unrelated subtypes of impulsive behavior” (Reynolds, Ortengren, Richards & de Wit, 2006, p. 312).
Third, the sample used in the current study differs from the samples used in other research. Most studies which showed a link between impulsivity and alcohol use, used a sample which consisted of a different age range or was not limited to adolescents. The results of these studies are difficult to compare with the current study because the results can’t be
Limitations
Several limitations in this study should be considered. First, self-report bias was not controlled for in this study. The BIS-11, which was used as one of the impulsivity measures, is a self-report questionnaire and is therefore susceptible to bias. The alcohol measure was based on a self-report survey as well and thus may also be subject to self-report bias. Self-report bias may include over or under Self-reporting and can occur when individuals minimize or exaggerate behaviours such as impulsivity or alcohol use.
A second limitation to this study that should be taken into account is that alcohol use in our sample resulted in a non-normal distribution due to the fact that younger participants often reported no alcohol use, whereas older participants sometimes reached the maximum amount specified in the questionnaire. For a better representation only adolescents who drink alcohol should be taken into account in the study.
Implications for future research
Further research on impulsivity and alcohol use among adolescence is needed because alcohol use and misuse can cause disrupted cognitive development of adolescents and may continue to affect individuals into adulthood (Zeigler, Wang, Yoast, Dickinson, McCaffree et al., 2005). The excessive use of alcohol represents a significant public health problem (Aklin, Lejuez, Zvolensky, Kahler & Gwads, 2005; Resnick et al., 1997).
Individual constructs of impulsivity can be studied separately as they appear to impact alcohol use and outcomes differently based on the methodology of each study. Because general research shows evidence of a link between impulsivity and alcohol use, and the risks that come with it, future research on this topic has to consider the complex phenomena of impulsivity and the specific link of its factors with alcohol use, as well as the different available measurements of alcohol use and impulsivity. Different measurements of
impulsivity, for example the BART, the BIS-11, the UPPS, the Go/No-Go Task, should be used in a sample consisting of only adolescents who drink alcohol, so that the right aspects of impulsivity, which relate with alcohol use, are used. Self-report bias should be controlled for to prevent over- or underestimation of behavior by participants.
Conclusion
This study has shown that impulsivity has an effect on alcohol use among adolescents. Adolescents who score high on the BIS-11 and the BART are more likely to drink more alcohol. Specifically the subscale Motor Impulsiveness of the BIS-11 and the BIS-11 total have a clear link with alcohol use. Future research should investigate this link using a complete set of impulsivity measurements and control for self-report bias.
References
Aklin, W.M., Lejuez, C.W., Zvolensky, M.J., Kahler, C.W. & Gwadz, M. (2005). Evaluation of Behavioral measures of risk-taking propensity with inner city adolescents. Behavior
Research and Therapy, 43, 215-228.
American Psychiatric Association (2013). Diagnostic and statistical manual of mental
disorders (5th ed.). Washington, DC: APA.
Andrew, M. & Cronin, C. (1997). Two measures of sensation-seeking as predictors of alcohol use among high school males. Personality and Individual Differences, 22, 293-401. Ames, S.L., Grenard, J.L., Thush, C., Sussman, S. Wiers, R.W., Stacy, A.W. (2007).
Comparison of indirect assessments of association as predictors of marijuana use among at-risk adolescents. Experimental Clinical Psychopharmacology, 15, 204-218. Arnett, J. (1992). Reckless behavior in adolescence: A developmental perspective.
Developmental Review, 12(4), 339-373.
Arnett, J.J. (2005). The developmental context of substance use in emerging adulthood.
Journal of Drug Issues, 235-253.
Babor, T.F., Higgins-Biddle, J.C., Saunders, J.B. & Monteiro, M.G. (2001). AUDIT: The
Alcohol Use Disorders Identification Test (2nd). Geneva: World Health Organization.
Barber, B., Olsen, J. & Shagle, S. (1994). Association between parental psychological control and youth internalized and externalized behaviors. Child Development, 65, 1120 1136.
Bickel, W.K., Jarmolowicz, D.P., Mueller, E.T., Gatchalian, K.M., McClure, S.M. (2012). Are executive function and impulsivity antipodes? A conceptual reconstruction with special reference to addiction. Psychopharmacology, 221, 361-387.
Bjork, J.M., Hommer, D.W., Grant, S.J. & Danube, C. (2004). Impulsivity in abstinent alcohol-dependent patients: Relation to control subjects and type 1- or type 2-like
traits. Alcohol, 34, 133-150.
Chamorro, J., Bernardi, S., Potenza, M.N., Grant, J.E., Marsh, R., Wang, S. & Blanco, C. (2012). Impulsivity in the general population: A national study. Journal of Psychiatric
Research, 46, 994-1001.
Coskunpinar, A., Dir, A.L. & Cyders, M.A. (2013). Multidimensionality in impulsivity and alcohol use: A meta-analysis using the UPSS model of impulsivity. Alcoholism:
Clinical and Experimental Research, 37(9), 1441-1450.
Cottler, I.B., Robins, L.N., Grant, B.F., Blaine, J., Towle, L.H., Wittchen, H.U. & Sortorius, N. (1991). The CIDI-score substance abuse and dependence questions: cross-cultural and nosological issues. The WHO/ADAMHA field trial. The British Journal of
Psychiatry, 159, 653-658.
Courtney, K.E., Arellano, R., Barkley-Levenson, E., Gálvan, A., Poldrack, R.A., MacKillop, J., Jentsch, D. & Ray, L.A. (2012). The relationship between measures of impulsivity and alcohol misuse: An integrative structural equation modeling approach.
Alcoholism: Clinical and Experimental Research, 36(6), 923-931.
Cunningham, C. E., Boyle, M. H., Hong, S., Pettingill, P., & Bohaychuk, D. (2009). The Brief Child and Family Phone Interview (BCFPI): 1. Rationale, development, and
description of a computerized children’s mental health intake and outcome assessment
tool. Journal of Child Psychology and Psychiatry, 50(4), 416-423.
Curcio, A.L. & George, A.M. (2011). Selected impulsivity facets with alcohol use/problems: The mediating role of drinking motives. Addictive Behaviors, 36, 959-964.
Dom, G., Hulstijn, W. & Sabbe, B. (2006). Differences in impulsivity and sensation seeking between early- and late-onset alcoholics. Addictive Behaviors, 31, 298-308.
Drank- en Horecawet (1964, 7 October). Consulted on May 3rd 2017, via
Eysenck, S.B.G., Pearson, P.R., Easting, G. & Allsopp, J.F. (1985). Age norms for
impulsiveness, venturesomeness and empathy in adults. Personality and Individual
Differences, 6, 613-619.
Fernie, G., Peeters, M., Gullo, M.J., Christiansen, P., Cole, J.C., Sumnall, H. & Field, M. (2013). Multiple behavioural impulsivity tasks predict prospective alcohol
involvement in adolescents. Addiction, 108, 1916-1923.
Franken, I.H.A. & Muris, P. (2005). Individual differences in decision-making. Personality
and Individual Differences, 39, 991-998.
Goldman, Mark S., & Others. (1997). A Confirmatory Test of Hierarchical Expectancy Structure and Predictive Power: Discriminant Validation of the Alcohol Expectancy Questionnaire. Psychological Assessment, 9(2), 145-57.
Grano, N., Virtanen, M., Vahtera, J., Elovainio, M. & Kivimaki, M. (2004). Impulsivity as a predictor of smoking and alcohol consumption. Personality and Individual
Differences, 37 1693-1700.
Grau, E. & Ortet, G. (1999). Personality traits and alcohol consumption in a sample of non alcoholic women. Personality and Individual Differences, 27, 1057-1066.
Harden, K.P. & Tucker-Drob, E.M. (2011). Individual differences in the development of sensation seeking and impulsivity during adolescence: Further evidence for a dual systems model. Developmental Psychology, 47(3), 739-746.
Henges, A. L., & Marczinski, C. A. (2012). Impulsivity and alcohol consumption in young social drinkers. Addictive behaviors, 37(2), 217-220.
Hibell, B., Guttormsson, U., Ahlström, S., Balakireva, O., Bjarnason, T., Kokkevi, A., & Kraus, L. (2012). The 2011 ESPAD report: Substance use among students in 36
European countries. ESPAD.
Hollander, E., Wong, C.M. (1995b). Obsessive-compulsive spectrum disorders. Journal of
Clinical Psychiatry, 56(4), 3-6.
Hoyle, R.H. (2006). Personality and self-regulation: Trait and information-processing perspectives. Journal of Personality, 74, 1507-1526.
Hutchinson, G.T., Patock-Peckham, J.A., Cheong, J. & Nagoshi, C.T. (1998). Irrational beliefs and behavioral misregulation in the role of alcohol use among college students.
Journal of Rational Emotive and Cognitive Behavioral Therapy, 16(1), 61-74.
Klein, B. & Papouchis, N. (2010). An examination of affect regulation, impulsivity and risk
taking. ProQuest Dissertations and Theses.
Labouvie, E.W., & McGee, C.R. (1986). Relation of personality to alcohol and drug use in adolescence. Journal of Consulting and Clinical Psychology, 54, 289-293.
Ladouceur, R., Bouchard, C., Rheaume, N., Jacques, C., Ferland, F., Leblond, J. & Walker, M. (2000). In the SOGS an accurate measure of pathological gambling among children, adolescents and adults? Journal of Gambling, 16, 1-24.
Lejuez, C.W., Read, J.P., Kahler, C.W., Richards, J.B., Ramsey, S.E., Stuart, G.L., Strong, D.R. & Brown, R.A. (2002). Evaluation of a behavioral measure of risk-taking: The Balloon Analogue Risk Task (BART). Journal of Experimental Psychology: Applied,
8, 75-84.
Lejuez, C.W., Aklin, W.M., Zvolensky, M.J. & Pedulla, C.M. (2003). Evaluation of the Balloon Analogue Risk Task (BART) as a predictor of adolescent real-world risk taking behaviors. Journal of Adolescence, 26, 475-479.
MacKillop, J., Mattson, R.E., Anderson MacKillop, E.J., Castelda, B.A. & Donovick, P.J. (2007). Multidimensional assessment of impulsivity in undergraduate hazardous drinkers and controls. Journal of studies on alcohol and drugs, 68, 785-788
associations with college drinking. Personality and Individual Differences, 43, 1927 1937.
Marczinski, C.A. & Fillmore, M.T. (2003). Preresponse cues reduce the impairing effects of alcohol on the execution and suppression of responses. Experimental and Clinical
Psychopharmacology, 11, 110–117.
McCarthy, D. M., Pedersen, S. L., Thompsen, D. M., & Leuty, M. E. (2006). Development of a measure of drinking and driving expectancies for youth. Psychological Assessment,
18, 155– 164.
Nagoshi, C.T., Wilson, J.R. & Rodriguez, L.A. (1991). Impulsivity, sensation seeking and behavioral and emotional responses to alcohol. Alcoholism, Clinical & Experimental
Resarch, 15(4), 661-667.
Patton, J.H., Stanford, M.S. & Barratt, E.S. (1995). Factor structure of the Barratt impulsiveness scale. Journal of Clinical Psychology, 51, 768-774.
Pechorro, P., Ayala-Nunes, L., Ray, J.V., Nunes, C. & Gonçalves, R.B. (2016).The Barratt Impulsiveness Scale-11 Among a school sample of Portuguese Male and Female Adolescents. Journal of Child and Family Studies, 25, 2753-2764.
Peters, S., Jolles, D.J., Duivenvoorde, van, A.C.K., Crone, E.A. & Peper, J.S. (2015). The link between testosterone and amygdala – orbitofrontal cortex connectivity in adolescent alcohol use. Psychoneuroendocrinology, 53, 117-126.
Peters, S., Peper, J.S., van Duijvenoorde, A.C.K., Braams, B.R. & Crone, E.A. (2016). Amygdala-orbitofrontal connectivity predicts alcohol use two years later: A longitudinal neuroimaging study on alcohol use in adolescence. Developmenta Science, 1-16.
Reynolds, B., Ortengren, A., Richards, J.B. & de Wit, H. (2006). Dimensions of impulsive behavior: Personality and behavioral measures. Personality and Individual
Differences, 40, 305-315.
Resnick, M., Bearman, P. S., Blum, R. W., Bauman, K. E., Harris, K. M., Jones, J., Tabor, J., Beuhring, T., Sieving, R. E., Shew, M., Ireland, M., Bearinger, L. H., & Udry, J. R. (1997). Protecting adolescents from harm findings from the National Longitudinal Study on Adolescent Health. Journal of the American Medical Association, 278, 823 832.
Rubio, G., Jiménez, M., Rodríguez-Jiménez, R., Martínez, I., Ávila, C., Ferre, F., Jiménez Arriero, M.A., Ponce, G. & Palomo, T. (2008). The role of behavioral impulsivity in the development of alcohol dependence: A 4-year follow-up study. Alcoholism:
Clinical and Experimental Research, 32(9), 1681-1687.
Sacks, D. (2003). Age limits and adolescents. Pediatric Child Health, 8(9), 577. Siqueira, L., Smith, V.C. & Committee on Substance Abuse (2015). Binge drinking.
Pediatrics, 136(3), 718-726.
Sharma, L., Kohl, K., Morgan, T.A. & Clark, L.A. (2013). Impulsivity: Relations between self-report and behavior. Journal of Personality and Social Psychology, 104(3), 59 575.
Shin, S.H., Hong, H.G. & Jeon, S. (2012). Personality and alcohol use: The role of impulsivity. Addictive Behaviors, 37, 102-107.
Shulman, E.P., Smith, A.R., Silva, K., Icenogle, G., Duell, N., Chein, J. & Steinberg, L. (2016). The dual systems model: Review, reappraisal, and reaffirmation.
Developmental Cognitive Neuroscience, 17, 103-117.
Smillie, L.D. & Jackson, C.J. (2006). Functional impulsivity and reinforcement sensitivity theory. Journal of Personality, 74, 47-83.
Smith, G.T., McCarthy, D.M. & Goldman, M.S. (1995b). Self-reported drinking and alcohol related problems among adolescents: Dimensionality and validity over 24 months.
Journal of Studies on Alcohol, 56, 383–394.
Spear, L.P. (2000). The adolescent brain and age-related behavioral manifestations.
Neuroscience and Biobehavioral Reviews, 24, 417-463.
Sobell, L. C., & Sobell, M. B. (1992). Timeline follow-back. In Measuring alcohol
consumption (pp. 41-72). Humana Press.
Stanford, M.S., Greve, K.W., Boudreaux, J.K. & Mathias, C.W. (1996). Impulsiveness and risk taking behavior: Comparison of high-school and college students using the Barratt Impulsiveness Scale. Personality and Individual Differences, 21(6), 1073-1075. Stautz, K. & Cooper, A. (2013). Impulsivity-related personality traits and adolescent alcohol
use: A meta-analytic review. Clinical Psychology Review, 33, 574-592. Steinberg, L. (2008). A social neuroscience perspective on adolescent risk-taking.
Developmental review, 28, 78-106.
Stolle, M.S., Sack, P.M. & Thomasius, R. (2009). Binge drinking in Childhood and Adolescence. Deutsches Ärtzeblatt International, 106(19), 323-328.
Strayhorn, J.M. (2002). Self-control: Theory and research [Special issue]. Journal of the
American Academy of Child & Adolescent Psychiatry, 41, 7-16.
Substance Abuse and Mental Health Services Administration, Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H 48, HHS Publication No. (SMA) 14-4863. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014.
Thompson, K., Roemer, A., & Leadbeater, B. (2015). Impulsive personality, parental monitoring, and alcohol outcomes from adolescence through young
adulthood. Journal of Adolescent Health, 57(3), 320-326.
Treloar, H. R., Morris, D. H., Pedersen, S. L., & McCarthy, D. M. (2012). Direct and indirect effects of impulsivity traits on drinking and driving in young adults. Journal of studies
on alcohol and drugs, 73(5), 794-803.
Vigil-Colet, A. & Codurniu-Raga, M.J. (2004). Agression and inhibition deficits, the role of functional and dysfunctional impulsivity. Personality and Individual Differences,
37(7), 1431-1440.
Vogel-Sprott, M. (1992). Alcohol Tolerance and Social Drinking: Learning the
Consequences. New York: Guilford Press.
Waldeck, T.L. & Miller, L.S. (1997). Gender and impulsivity differences in licit substance use. Journal of Substance Abuse, 9, 296-275.
White, H.R. & Labouvie, E.W. (1989). Towards the assessment of adolescent problem drinking. Journal of Studies on Alcohol, 50, 30-37.
Whiteside, S.P. & Lynam, D.R. (2001). The five factor model and impulsivity: using a structural model of personality to understand impulsivity. Personality and Individual
Differences, 30, 669-689.
World Health Organization [WHO] (2000). Young people’s health – a challenge for society report of a study group on young people and health for all by the year 2000. Geneva. Zeigler, D.W., Wang, C.C., Yoast, R.A., Dickinson, B.D., McCaffree, M.A. Robinowitz, B.
& Sterling, M.L. (2005). The neurocognitive effecs of alcohol on adolescents and college students. Preventive Medicine, 40, 23-32.
Zuckerman, M. (2002). Zuckerman-Kuhlman Personality Questionnaire (ZKPQ): an alternative five-factorial model. Big five assessment, 377-396.
