Hayley Treloar Padovano

Aims: Limiting alcohol intake or not drinking at all reduces risk for multiple chronic diseases, including alcohol-associated liver disease (ALD). This research evaluated the feasibility, acceptability, and preliminary behavioral outcomes of a brief motivational interviewing (MI) intervention enhanced with personalized feedback and objective liver-health biomarkers. The intervention targeted active alcohol use disorder (AUD), including a patient subgroup diagnosed with ALD. Setting/Design and Participants: This preliminary clinical trial enrolled 33 participants with AUD and recent heavy alcohol consumption (seven or more drinks per week for women; fourteen or more drinks per week for men). The sample was 48.5% women and 30.3% Hispanic. The primary AUD cohort (n = 28) was recruited via digital and community outreach, while the subgroup with ALD (n = 5) was recruited primarily from a hepatology clinic. Follow-up was conducted three months after the baseline intervention. Measures and Findings: The motivational interviewing (MI) intervention integrated personalized reports combining liver-function blood tests, drinking summaries, and data from a custom smartphone application. From screening to three-month follow-up, average drinks per week decreased by 57%, and heavy drinking days decreased by 55%. Enrollment for the ALD subgroup was limited by stringent drinking inclusion criteria, primary reliance on a single hepatology clinic recruitment site, and a funding transition. Follow-up retention, however, was high across both groups (93% AUD-only; 100% ALD subgroup), demonstrating strong intervention acceptability among enrolled participants. Conclusions: Enhancing brief MI with personalized biobehavioral data proved an acceptable and promising approach to reduce alcohol consumption over three months. While enrollment highlighted the need for expanded recruitment settings and eligibility criteria in ALD populations, these preliminary findings warrant larger trials to test long-term intervention scalability and sustainability across clinical and community settings.

To evaluate the feasibility of a community- based, point-of-care (POC) screening and intervention model for Metabolic and Alcohol-associated Liver Disease (MetALD) in an underserved Rhode Island population. A partnership between the Brown University CADRE and Clínica Esperanza/Hope Clinic (CEHC) utilized electronic health record (EHR) screening followed by on-site FibroScan® imaging and a Motivational Interviewing (MI) lifestyle intervention. Preliminary pilot data identified liver stiffness (fibrosis) in 21% of participants and steatosis in 57%. All identified patients were previously unaware of their condition. Integrating POC diagnostics with culturally attuned behavioral interventions in a community- centric clinic can bypass traditional barriers to care and detect "silent" liver disease at treatable stages.

Alcohol outcome expectancies (AOEs), formed in early childhood, are correlates of future alcohol consumption and related problems. Social-cognitive theories suggest that AOEs become activated in specific social and physical location contexts. Prior research, primarily among university students, has aimed to identify situational influences on specific AOEs, as indexed by reports of AOEs in hypothetical drinking scenarios. This study aims to deepen understanding of AOE activation in real-world settings by examining social and physical situational correlates of AOE activation among adolescents ages 15-17 in daily life. Adolescents (evaluable n = 102) reporting any drinking in the past month completed smartphone reports for 24 days. Adolescents indicated their social setting (e.g., solitary, peers, family), physical location (e.g., home, friend's place, elsewhere), and strength of AOEs (tension reduction, enhancement, sociability) just prior to drinking in daily life. Adolescents' AOE activation prior to drinking was associated with their immediate social context and physical location. Specifically, drinking with peers present was associated with higher ratings of enhancement and sociability AOEs. In contrast, drinking with family members present and drinking at home were associated with lower ratings of enhancement and sociability AOEs. Our findings provide new information about social-contextual correlates of specific AOE domains in naturalistic settings among adolescents. Identifying situational relations with AOE activation in daily life is important to build social-cognitive models of alcohol-consumption behavior, particularly during adolescence as drinking experiences broaden. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Background: Many individuals with excessive alcohol consumption desire moderation but do not seek formalized treatment. Commercially available, technology‐assisted options are flexible and highly accessible, yet often not empirically validated.Methods: Individuals desiring alcohol moderation (age 21+) self‐selected to use Sunnyside®, a web application with tailored and adaptive text messaging. The evaluable dataset included 46,411 members who completed a baseline assessment, enrolled in the program, and tracked their drinking at least once. An adaptive and customizable weekly plan was generated from typical drinking patterns, goals, and weekly reported progress. Personalized daily messages included reminders for real‐time drink tracking, plans, and available interactive messaging with peer coaches. Generalized mixed‐effect growth models characterized change in drinks per week and daily drinking for 12 weeks after enrollment. Models allowed for nonlinear change and individual variability across members and weeks.Results: A majority (64.3%) of members reported typically drinking 7 of 7 days per week at baseline. During tracking, drinks per week decreased most in the initial weeks and slowed thereafter, with an overall 33% reduction in weekly drink counts. More severe alcohol‐use patterns and concern over drinking at baseline were associated with greater relative benefit.Conclusions: Drinking patterns appeared amenable to change during 12 weeks of daily drink tracking with Sunnyside®, a tailored web program to reduce drinking and improve overall wellness. Overall, the findings of this naturalistic study, one of the first of its kind, supplement data from randomized clinical trials and support the use of adaptive, technology‐assisted tools for alcohol moderation.

BackgroundDrinking commonly occurs in social settings and may bolster social reinforcement. Laboratory studies suggest that subjective effects and mood are mechanisms through which the social context influences alcohol consumption. Ecological momentary assessment (EMA) may be useful for extending these findings to the natural environment. This pre-registered secondary analysis of EMA data investigated the influence of the social environment on: (1) stimulating and sedating subjective effects of alcohol, (2) contentedness and negative affect, and (3) next-day evaluations of the drinking occasion.MethodsNontreatment seeking adults reporting past-month heavy drinking (N = 131; Mage = 28.09; 42% female) completed 7 days of EMA (in the morning, at random, and following drinking prompts), which included questions on their social context (drinking in the presence of known others or alone), contemporaneous stimulating and sedating effects, contentedness and negative affect, alcohol consumption, and next-day evaluations of a prior day's drinking event (how satisfying/pleasant was drinking). We used multi-level models in SAS 9.4 M7 software to examine relations among the variables.ResultsContemporaneous subjective effects (stimulating or sedating), negative affect, and contentedness did not significantly depend on the social context. For next-day evaluations of pleasure/satisfaction from drinking, context effects were dependent on consumption totals. As the total number of standard drinks consumed increased, recollections of pleasure/satisfaction were higher when drinking had occurred with others, relative to alone. At lower consumption totals, next-day evaluations did not appear to depend on social context.ConclusionsWhen reported contemporaneously, subjective effects and affect do not appear dependent upon the presence of known others. However, heavier drinking events, relative to lighter drinking events, are appraised more favorably the following day when occurring within social contexts.

Background and aims: The prominence of death during the COVID-19 pandemic was heightened by the potential of personally knowing someone who lost their life to the virus. The terror management theory (TMT) suggests that the salient presence of death has a pronounced effect on behavior and may result in the ossification of beliefs and actions aligned with one’s worldview (i.e., the mortality salience hypothesis). In this study, we evaluated how death exposure early in the COVID-19 pandemic could enact the process of firming up held beliefs and attitudes related to health and safety. Specifically, we tested the hypothesis that exposure to a personal loss during the pandemic would strengthen participants’ baseline attitudes and behaviors regarding COVID-19 safety guidelines. Method: Data were analyzed from a prospective, regional survey administered at two time points during the pandemic, June–July 2020 and May 2021, in five United States northeastern states. Baseline and follow-up surveys were administered approximately 12 months apart, with adherence to public guidance and death exposure measured at both timepoints and other safety measures at follow-up only. Findings: Our results indicated that there were significant main effects of death exposure on guideline adherence and support for COVID-related public policy. Contrary to the mortality salience hypothesis, death exposures after baseline were related to higher medical mistrust at follow-up for those high in adherence at baseline, rather than those with low adherence. Conclusion: Our results offer some conflicting evidence to the mortality salience hypothesis. Rather than entrench people in their worldviews, death in the context of the COVID-19 pandemic appeared to sway people away from their initial stances. This finding has important implications for TMT literature and for the COVID-19 pandemic response.

BackgroundMost adolescents who drink alcohol also use cannabis, and adolescents who use both substances experience worse long-term outcomes than adolescents who use only one or the other. Recent clinical trials with adolescents and emerging adults show that alcohol cues are associated with elevated cannabis craving in the natural environment but not in the laboratory, highlighting cross-cue reactivity as a potential intervention target. This study extends this work to a younger sample of adolescents at an earlier stage of substance use to examine the generalizability of prior findings and inform etiological mechanisms.MethodsParticipants were 81 adolescents aged 15-17 years who endorsed past-month alcohol and lifetime cannabis use. They completed a laboratory cue reactivity protocol where they rated their cannabis craving during alcohol cue and control conditions. They also completed 24 days of ecological momentary assessment where they reported multiple times per day on their cannabis craving and whether alcohol cues were visible.ResultsMixed models demonstrated lower cannabis craving following alcohol cue presentation in the laboratory compared to control cues, but higher cannabis craving during moments when alcohol was visible in daily life compared to moments when alcohol was not visible. Frequency of cannabis use at baseline was associated with greater cannabis craving in the laboratory and in daily life regardless of cue type or alcohol visibility, and cannabis craving following alcohol cue presentation in the laboratory was positively related to daily life cannabis craving across contexts.ConclusionsThis study adds to prior work suggesting that daily life cannabis craving is elevated when alcohol cues are visible. This cross-cue reactivity may be one factor that drives and maintains alcohol and cannabis use in adolescence.

Cannabis use among adolescents and young adults who drink alcohol is prevalent and relates to poorer clinical outcomes. Interrelated factors, such as cross-reactivity to alcohol cues, may contribute to the high prevalence of cannabis use among young persons who drink alcohol. We tested whether systematic presentation of alcohol cues in the laboratory and naturalistic presence of alcohol cues in daily life elicit cannabis craving. Data were compiled from two clinical trials. Participants (N = 54) were adolescents and young adults ages 15-24 who reported consuming alcohol at least twice per week, expressed interest in reducing alcohol use, and reported lifetime cannabis use. Participants provided laboratory and daily-life smartphone report data prior to randomization to treatment conditions in the parent trials. Mixed-effect models tested a priori hypotheses, which received mixed support. Cannabis craving was not heightened following alcohol-cue presentation in the laboratory but was elevated in daily life when alcohol cues were visible. The effect of laboratory alcohol cues was moderated by cannabis use frequency, with higher frequencies associated with greater cannabis craving, while the effect of daily-life alcohol cues on cannabis craving was not moderated by cannabis use frequency. Finally, alcohol cue-induced cannabis craving in the laboratory was associated with greater daily-life cannabis craving, irrespective of the presence of naturalistic alcohol cues. Overall, exposure to alcohol cues in daily life may flag situations with increased risk of cannabis craving, supporting the idea of cross cue reactivity and implicating naturalistic alcohol cues as an intervention target for individuals who co-use alcohol and cannabis. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Background: Although peers figure prominently in developmental models of alcohol use, our understanding of the influence of peer social context in cue reactivity paradigms with adolescents and emerging adults in the human laboratory and the natural environment is limited. This study tested associations between alcohol craving among youth in the human laboratory using alcohol‐related images, with and without peers, and in the natural environment using ecological momentary assessment (EMA).Methods: Data for this preregistered secondary analysis were collected prior to randomization in two medication trials (N = 115). Participants completed an image cue exposure paradigm at the baseline laboratory session followed by approximately 7 days of EMA.Results: In the laboratory, model‐based mean comparisons from multilevel models (MLMs) showed that all drinking images elicited greater craving than neutral images. No differences were observed across the three image categories containing alcohol. Image category by age interactions demonstrated that, compared to older youth, younger youth displayed lower craving in response to neutral versus social drinking context with peers images and older, compared to younger, youth displayed higher craving in response to nonsocial drinking images versus social drinking contexts with peers images. In the natural environment, craving was greatest when youth were in the presence of alcohol‐using peers and alcohol‐related cues, regardless of age. Laboratory craving to alcohol images was positively associated with craving in the natural environment.Conclusions: For youth, peers are a salient social context associated with increased craving, particularly in the natural environment. Laboratory cue reactivity to alcohol images predicted real‐world craving, further supporting the ecological validity of this paradigm in youth.