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Drug and Alcohol Dependence xxx (2014) xxx–xxx

Contents lists available at ScienceDirect

Drug and Alcohol Dependence

j ourna l h o me pa ge: www.elsev ier .com/ locate /drugalcdep

nteractions among drinking identity, gender and decisional balancen predicting alcohol use and problems among college students

awn W. Fostera,∗, Chelsie M. Youngb, Jennifer Bryanb, Mai-Ly N. Steersb,elson C.Y. Yeungb, Alexander V. Prokhorovc

Yale School of Medicine, Department of Psychiatry, New Haven, CT, United StatesUniversity of Houston, Department of Psychology, Houston, TX, United StatesUniversity of Texas MD Anderson Cancer Center, Cancer Prevention and Health Promotion Department, New Haven, CT, United States

r t i c l e i n f o

rticle history:eceived 26 April 2014eceived in revised form 20 July 2014ccepted 21 July 2014vailable online xxx

eywords:rinking identityenderecisional balancelcoholrinking

a b s t r a c t

Background: The aim of the present study was to test promising constructs (decisional balance and drink-ing identity) and their interaction with gender as predictors of risky college drinking. We expectedthat, consistent with previous work, drinking identity would be positively associated with alcohol con-sumption and problems. We further expected that drinking identity would be more strongly related tooutcomes among individuals scoring low in decisional balance. Additionally, we expect the relationshipbetween drinking identity and alcohol behavior to vary as a function of decisional balance.Methods: Participants included 329 undergraduates (M = 23.11; SD = 5.63; 74.47% female) who met heavydrinking criteria (defined as women who consumed 4 or more drinks per occasion and men who con-sumed 5 or more drinks per occasion) and completed an online survey comprised of self-report measures.Results: Decisional balance was negatively correlated with both drinking and problems, which par-tially supported expectations. As expected, drinking identity was positively correlated with drinkingand problems. A two-way interaction emerged between drinking identity and decisional balance regard-ing problems, indicating that drinking identity was associated with more problems, especially among
those lower in decisional balance. A three-way interaction between drinking identity, decisional balance,and gender emerged regarding problems such that drinking identity was associated with more problemsfor those lower in decisional balance and this effect was stronger among men.Discussion: Findings lend support to the perspective that decisional balance, drinking identity, and genderare all influential factors that are associated with the experience of alcohol problems.
© 2014 Elsevier Ireland Ltd. All rights reserved.

. Introduction

College students are more likely to drink heavily than theiron-college peers (Johnston et al., 2012). On average, about 40%f college students report having engaged in heavy drinking duringhe last two weeks (Johnston et al., 2006). Heavy episodic drink-ng (binge drinking) occurs when a woman consumes four drinksn a row or when a man consumes five drinks on one occasion ateast once in a 2-week period (Courtney and Polich, 2009). Heavy

Please cite this article in press as: Foster, D.W., et al., Interactions amoalcohol use and problems among college students. Drug Alcohol Depe

pisodic drinking among college students is associated with a rangef serious primary (e.g., psychological impairment, memory loss,isky sexual behavior, unplanned pregnancies, suicidal ideation,

∗ Corresponding author. Tel.: +1 203 974 7892.E-mail addresses: [email protected], [email protected]

D.W. Foster).

ttp://dx.doi.org/10.1016/j.drugalcdep.2014.07.024376-8716/© 2014 Elsevier Ireland Ltd. All rights reserved.

and addiction) and secondary consequences (e.g., academic impair-ment, sexual victimization, car accidents, violence, and death;Hingson and Zha, 2009; Gonzalez and Hewell, 2012; Ragsdale et al.,2012). Thus, the U.S. Surgeon General has declared reducing heavydrinking among college students a major health goal for the country(U.S. Department of Health and Human Services, 2012).

Although many college drinking interventions have been devel-oped and evaluated, findings have indicated modest effects of theseinterventions, especially over the longer term (see Scott-Sheldonet al., 2014 for a meta-analytic review). Thus, it is important tocontinue to explore predictors of risky college drinking, focusingon their complex interactions with one another, to provide ideasfor further tailoring of college drinking interventions. In this study,

ng drinking identity, gender and decisional balance in predictingnd. (2014), http://dx.doi.org/10.1016/j.drugalcdep.2014.07.024

we evaluated the relative contributions of some innovative andpromising predictors, decisional balance and drinking identity, andtheir interactions with gender to aid in the prediction of riskycollege drinking.

dx.doi.org/10.1016/j.drugalcdep.2014.07.024


http://www.sciencedirect.com/science/journal/03768716

http://www.elsevier.com/locate/drugalcdep

mailto:[email protected]

mailto:[email protected]


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.1. Decisional balance and college drinking

Researchers seeking to develop effective strategies to reducelcohol misuse and associated problems among college studentsave considered the importance of increasing motivation forffectual decision-making. In this context, the decisional balancerocedure is a motivational tool used to facilitate decision-makingnd asks individuals to list both their personal pros and cons ofaintaining and changing their drinking behaviors. This allows the

ndividual to reflect on their drinking behavior. Previous work sug-ests that decisional balance can be used to overcome denial andnhance alcohol problem recognition (McCrady and Epstein, 1999;ye et al., 1999), and that it has shown mixed outcomes as an inter-ention to decrease college drinking and related problems (Careyt al., 2006; Collins et al., 2005; LaBrie et al., 2006).

In addition to exploring the utility of decisional balance as anntervention, researchers have validated decisional balance as anssessment of the extent to which a person’s motivation is balancedoward behavior change (Collins et al., 2009; Cunningham et al.,997; King and Diclemente, 1993; Migneault et al., 1999). Deci-ional balance theoretically overlaps with motivation to change, aonstruct that stems from the Transtheoretical Model (Prochaskat al., 1992a,b). Studies have indicated that decisional balance haseen associated with drinking outcomes (e.g., LaBrie et al., 2006;hare et al., 2004). Research has also shown that decisional balanceas better predictive validity for drinking outcomes compared tolcohol expectancies (Noar et al., 2003) and readiness to changeCollins et al., 2009). Therefore, we expected that decisional bal-nce would be negatively associated with drinking and positivelyssociated with problems.

.2. Drinking identity

Although Transtheoretical Model-based drinking studies haveot specifically explored drinking identity (e.g., Sun et al., 2007),esearch generally suggests that drinking identity is positively asso-iated with alcohol consumption (e.g., Neighbors et al., 2010; Reedt al., 2007), which in turn is linked with alcohol-related prob-ems (e.g., Lindgren et al., 2013). Drinking identity is conceptualizeds how central or defining alcohol consumption is to one’s self-dentity (Conner et al., 1999). How integrated drinking is in one’self-identity may influence both drinking behavior and motivationor drinking. For instance, social media-related drinking identityi.e., posting photos of one consuming alcohol) was related to higherlcohol consumption and problematic alcohol-related behaviorsRidout et al., 2012).

.3. Gender

Previous research has demonstrated time and again that gen-er is a central factor to consider in alcohol research (Choo et al.,013; Korcha et al., 2014). With regard to increased drinking andssociated problems, males have consistently been shown to bet greater risk than females (e.g., Caetano, 1994; Greenfield et al.,000; Korcuska and Thombs, 2003; Randolph et al., 2009). Col-

ege students also report that they believe men drink more heavily,re more likely to drink and drive, are less concerned with cam-us alcohol use, and use fewer protective behavioral strategieshan their female counterparts (Lewis and Neighbors, 2004; Lewist al., 2009). In order to inform more effective interventions forargeted harm reduction, researchers have recognized the need foroth increased concentration on college populations and more in-


epth investigation of subgroup differences (e.g., gender; Cranfordt al., 2009; O’Brien et al., 2004). As such, research examiningender differences with respect to known antecedents to drink-ng (drinking identity) and buffers against drinking (decisional

PRESSependence xxx (2014) xxx–xxx

balance) may have both practical utility and clinical significancein terms of informing drink-reduction programs.

1.4. Interactions among decisional balance, drinking identity, andgender with respect to alcohol outcomes

Although these variables have been studied separately, theinteractions among these variables in their association with alco-hol use and related problems have not yet been fully explored.Regarding the influence of gender on decisional balance, previousresearch among students sanctioned for violating the university’salcohol policy revealed that males reported more pros to continuedrinking and that they were less ready to change their drinkinghabits relative to females (Carey and DeMartini, 2010). Further,males thought their friends were more approving of the alcoholsanction than females. Thus, males may have experienced socialpressure to maintain their drinking because their friends were moreunderstanding of them being sanctioned for alcohol use. How-ever, it is unclear if this effect would remain if students’ friendswere unaware that they were participating in an alcohol reductionprogram as student’s friends may be more aware of the amountof drinks the student is consuming and may be more likely toencourage increased drinking. O’Hea et al. (2003) examined genderdifferences in decisional balance without social pressure to engagein a given behavior and revealed that males reported greater pos-itivity than females in both smoking cessation and engagement inexercise, while no gender differences were revealed with dietaryfat reduction.

Further, drinking identity and gender differences therein havebeen revealed such that college males have reported strongerdrinking identities than college females (Foster et al., 2013). More-over, undergraduate males may view heavy drinking as part ofbeing a man (Peralta, 2007). The majority of college age malesperceive the ability to consume large amounts of alcohol withoutnegative consequences (e.g., vomiting, fainting) as masculine, andview the experience of these consequences as feminine and weak(Peralta, 2007). Past research has demonstrated that the process forchanging drinking behavior is different by gender such that men aremore likely to change after an adverse event whereas women aremore likely to change their drinking behavior when they are ableto modify how they identify with the behavior (Bischof et al., 2000;Klingemann, 1991).

1.5. Current study aims and hypotheses

The aim of the present study was to test promising constructs(decisional balance and drinking identity) and their interactionwith gender as predictors of risky college drinking. Consistentwith past research, we expected that drinking identity wouldbe positively associated with alcohol consumption and problems.Moreover, we examined the relationship between drinking iden-tity and alcohol outcomes by considering decisional balance as apotential moderator. Specifically, we expected that drinking iden-tity would be more strongly related to outcomes among individualsscoring low in decisional balance (that is, participants who receivea decisional balance score closer to 0, as calculated per detailsoutlined by Collins et al., 2009). As drinking identity is positivelyrelated to alcohol behavior, we expect this relationship to vary as afunction of decisional balance. To illustrate, it is possible that indi-viduals whose self-identity is strongly intertwined with alcoholconsumption (those high in drinking identity) may be at greaterrisk for problems if they also have low motivation to reduce their


drinking (those low in decisional balance). It is possible that thosewho are high in drinking identity may also experience or identifywith drinking-related problems such as going to school drunk orneglecting to study for a test. Thus, these problems may be viewed


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s humorous or banal and not be acknowledged as reason to changelcohol consumption. Therefore, we expected that decisional bal-nce would moderate the relationship between drinking identitynd alcohol-related problems such that those higher in drinkingdentity would report more problems compared to those lower inrinking identity, and this relationship would be stronger amonghose lower in decisional balance.

Taken together, we expect that: (1) decisional balance will beegatively associated with drinking and positively associated withroblems; (2) drinking identity will be positively associated withlcohol consumption and problems; (3) decisional balance willoderate the relationship between drinking identity and prob-

ems; and (4) the moderating influence of decisional balance onhe relationship between drinking identity and problems will dif-erentially emerge for males and females. More specifically, weypothesize that drinking identity will be most strongly relatedo problems among males low in decisional balance (not ready tohange), and less strongly related to problems among males high inecisional balance. In other words, we expect that decisional bal-nce will buffer against alcohol problems among males, regardlessf their drinking identity level, however this buffering effect wille less evident among females.

. Method

.1. Participants and procedure

The current research included 329 heavy drinking (defined as women whoeported consuming 4 or more drinks per occasion and men who reported con-uming 5 or more drinks per occasion) undergraduate students (74.47% female)rom a large public university in the south (total student body N = 39,820 in 2011)ho completed study materials as part of a larger intervention. Data were evalu-

ted at the baseline assessment of the larger trial. Participants were recruited viannouncements in classrooms (psychology, education, health, and human develop-ent and family studies) and flyers posted around campus. Participants completed

urveys online via DatStat and received course extra credit as compensation forheir involvement. Participants’ mean age was 23.11 years (SD = 5.63). Participantself-reported the following races: 55.73% Caucasian, 11.46% Black/African Ameri-an, 12.69% Asian, 0.93% Native Hawaiian/Pacific Islander, 7.12% Multi-Ethnic, 0.31%ative American/American Indian, and 11.76% Other. Additionally, 31.17% of par-

icipants reported as Hispanic/Latino.Measures

.2. Demographics

Participants reported demographic information including gender, age, racialackground, and ethnicity.

.3. Alcohol use

Alcohol consumption was measured using the Quantity/Frequency Scale (Baer,993; Marlatt et al., 1995), which is a five-item measure that assesses the number oflcoholic beverages and the number of hours spent drinking on a peak drinking eventithin the past month. The Quantity/Frequency Scale further assesses the number

f days out of the month that the individual consumed alcohol (0 = I do not drinkt all, 1 = about once per month, 2 = two to three times a month, 3 = once or twiceer week, 4 = three to four times per week, 5 = almost every day, or 6 = I drink onceaily or more). Alcohol consumption was also evaluated using the Daily Drinkinguestionnaire (Collins et al., 1985; Kivlahan et al., 1990), which measures the numberf standard drinks consumed on each day of the week (Monday–Sunday) within theast three months. Scores represent the average number of drinks consumed over theourse of each week during the previous month. Relative to other drinking indices,eekly drinking is a reliable index of problems among undergraduates (Borsari et al.,

001).

.4. Alcohol-related problems

The Rutgers Alcohol Problem Index (White and Labouvie, 1989) is a 25-item mea-


ure that assesses alcohol-related negative consequences in the last month ( = .93).esponses range from never (0) to 10 times or more (4). Items were rated based onow many times each problem occurred while drinking (e.g., “Went to work orchool high or drunk,” “Felt physically or psychologically dependent on alcohol”).otal summed scores ranged from 0 to 97 (White and Labouvie, 1989).

PRESSependence xxx (2014) xxx–xxx 3

2.5. Decisional balance

The Decisional Balance Sheet is a free recall task that evaluates the accessibilityof alcohol expectancies. Participants were asked to record as many benefits (pros)and disadvantages (cons) of “continuing to drink as you are now” and “drinking lessthan you do now” on numbered lines. Each participant received a decisional balancescore calculated from the ratio of pros and cons in compliance with Collins et al.(2009). Decisional balance proportion scores between 0.0 and 0.5 indicate that theindividual is leaning toward maintaining current levels of drinking. Scores rangingbetween 0.5 and 1.0 indicate that the individual is leaning toward reducing alco-hol consumption. Decisional balance scores at 0.5 signify an even balance betweenbenefits and disadvantages of changing or maintaining current drinking behaviors.

2.6. Drinking identity

Drinking identity was assessed using a five-item scale adapted from the smokerself-concept scale (Shadel and Mermelstein, 1996). The drinking identity scaleassesses the degree to which participants believe drinking is integrated into theirown self-concepts. Sample items include “Others view drinking as part of my per-sonality”, and “Drinking is part of who I am”. Respondents report the extent to whichthey agree with items ranging from 1 = Strongly disagree to 7 = Strongly agree. Scoresare then averaged for a mean drinking identify score ( = .94).

2.7. Readiness to change

The Readiness to Change Questionnaire (Rollnick et al., 1992) is a 12-item indexof level of agreement with statements about how individuals feel about their currentdrinking. Respondents used a 5-point Likert scale ranging from 1 (Strongly disagree)to 7 (Strongly agree) to rate items including “I should cut down on my drinking” and“My drinking is a problem.” Items measure ambivalence, recognition of an alcoholproblem, and active attempts to change drinking. This measure consists of threevalidated sub-scales: pre-contemplation, contemplation, and action. For the presentstudy, an overall readiness to change score was utilized.

2.8. Data analysis plan

The aim of the present study was to better understand relationships amongdecisional balance, drinking identity, gender, and alcohol-related problems. Thus,we conducted moderation analyses to determine whether there were gender differ-ences in decisional balance and drinking identity with respect to alcohol outcomes.To test our hypothesis that the relationship between drinking identity and alcoholoutcomes would be moderated by decisional balance, and that this effect would dif-fer based on gender, multiple hierarchical regressions were conducted. At Step 1,we included drinking identity, decisional balance, and gender as independent vari-ables. At Step 2, we added two-way product terms between drinking identity anddecisional balance, gender and drinking identity, and gender and decisional bal-ance to evaluate two-way interaction effects. At Step 3, we included the three-wayinteraction term between drinking identity, decisional balance, and gender.

All continuous independent variables were centered prior to analyses (Aiken andWest, 1991). Drinks per week were used as a covariate for all analyses where alcohol-related problems was the outcome, which allows us to determine whether effects onproblems are above and beyond alcohol consumption. In the present study, for sta-tistically significant interactions, simple slopes analyses were conducted to examinewhether the slopes of the regression lines differed from zero at high and low lev-els of the moderator or across different groups if the moderator is categorical (e.g.,males and females). In each simple slopes analysis, two regression equations wereconstructed. One equation represented the relationship between the independentvariable and dependent variable at a lower level of moderator (−1 SD); and anotherone represented the relationship between the independent variable and dependentvariable at a higher level of moderator (+1 SD). Similarly, when gender was themoderator, two separate regression equations were constructed to represent therelationship between the independent variable and the dependent variable amongmales and females.

3. Results

3.1. Descriptives

Means, standard deviations, and correlations for the key vari-ables are presented in Table 1. Drinking identity was significantlyand positively correlated with drinking and problems, indicatingthat higher levels of drinking identity were related to more drink-ing and alcohol-related problems. Thus, our findings with respect


to drinking identity are consistent with previous literature andsupport our expectations. Decisional balance was significantly andnegatively correlated with alcohol-related problems as well as alco-hol consumption variables (peak drinks and drinks per week).


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Table 1Means, standard deviations, ranges, and correlations among variables.

1. 2. 3. 4. 5. 6. 7.

1. Drinking identity –2. Decisional balance −0.05 –3. Readiness to Change 0.27*** 0.10† –4. Alcohol-related problems 0.40*** −0.17** 0.29*** –5. Peak drinks 0.13* −0.11* 0.17** 0.28*** –6. Drinking frequency 0.27*** −0.03 0.16** 0.21*** 0.13* –7. Drinks per week 0.34*** −0.16** 0.17** 0.46*** 0.38*** 0.51*** –Mean 0.81 0.68 0.42 32.17 7.18 5.25 8.94SD 1.19 0.17 1.21 9.99 3.63 2.00 7.71Minimum 0.00 0.00 −2.33 25.00 4.00 0.00 0.00Maximum 5.00 1.00 3.33 97.00 25.00 11.00 63.00

Note. SD = standard deviation.*** p < 0.001.** p < 0.01.* p < 0.05.

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urthermore, all drinking and alcohol-related problems indicesere positively related. Readiness to change was marginally pos-

tively associated with decisional balance, and was significantlyositively associated with alcohol problems and all consumptionariables. Finally, drinking identity and decisional balance werenrelated.

.2. Primary analyses

Regression analyses were conducted to evaluate relationshipsmong drinking identity, decisional balance, gender, and alcohol-elated problems. For the model wherein alcohol problems werexamined as dependent variables, we found a positive association


etween drinking identity and problems ( = 0.29, p < 0.0001). Thiss in line with expectations. However, contrary to expectations, weound a negative association between decisional balance and prob-ems ( = −0.11, p = 0.03). The covariate in the model was related to

able 2ierarchical regression analysis predicting alcohol outcomes from drinking identity, deci

Criterion Predictor

Alcohol-relatedproblems

Step 1 Drinks per week

Peak drinks

Decisional balance

Drinking identity

Gender

Step 2 Decisional balance × drinking identityDecisional balance × gender

Drinking identity × gender

Step 3 Decisional balance × drinking identityDrinks per week Step 1 Decisional balance

Drinking identity

Gender



Step 3 Decisional balance × drinking identityPeakdrinks

Step 1 Decisional balance

Drinking identity

Gender



Step 3 Decisional balance × drinking identity

ote. N = 329.*** p < .001.** p < .01.* p < .05.† p < .10.

alcohol-related problems as expected, with drinking as measuredby drinks per week being significantly associated with alcohol-related problems ( = 0.28, p < 0.0001). Thus, stronger identificationwith alcohol and heavier drinking were associated with experi-encing more alcohol-related problems; whereas decisional balancewas linked with fewer problems. At Step 2, significant two-wayinteractions emerged between drinking identity and decisional bal-ance ( = −0.19, p < 0.0001), and between gender and decisionalbalance ( = −0.13, p = 0.02), with respect to alcohol-related prob-lems. Problems were higher at higher levels of drinking identity,particularly among individuals lower in decisional balance. Sim-ilarly, men tended to report greater alcohol-related problems,especially if they were lower in decisional balance. The two-way


interaction between gender and drinking identity regarding alcoholproblems was not significant. At Step 3, the three-way interac-tion between drinking identity, decisional balance, and genderwith respect to alcohol problems was also significant ( = −0.17,

sional balance, and gender.

b t p �R2

0.39 5.10 0.28*** <.0001 0.28010.22 1.51 0.08 0.13

−6.30 −2.22 −0.11* 0.032.49 5.68 0.29*** <.00011.48 1.25 0.06 0.21

−9.83 −4.00 −0.19*** <.0001 0.3370−14.24 −2.25 −0.13* 0.02

1.26 1.49 0.09 0.14 × gender −12.92 −2.64 −0.17** 0.009 0.3492

−5.90 −2.67 −0.14* 0.01 0.13911.97 6.04 0.32*** <.00011.78 2.02 0.11* 0.04

−1.17 −0.59 −0.03 0.56 0.1516−0.36 −0.07 −0.004 0.94

1.87 2.75 0.18* 0.01 × gender −4.00 −1.00 −0.07 0.32 0.1516

−2.12 −1.89 −0.10† 0.06 0.13050.22 1.34 0.07 0.182.87 6.43 0.34*** <0.0001

−1.90 −1.88 −0.10† 0.06 0.13343.31 1.27 0.08 0.210.10 0.28 0.02 0.78

× gender −3.90 −1.93 −0.14† 0.05 0.1407


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Fig. 3. High drinking identity was associated with more alcohol-related problems,and this relationship was stronger among males with low decisional balance com-pared to males with higher decisional balance.

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ig. 1. High drinking identity was associated with more alcohol-related problems,nd this relationship was stronger among individuals lower in decisional balance.

= 0.009). The positive association between drinking identity andlcohol-related problems was stronger among men lower in deci-ional balance. A similar pattern was found for women (Table 2).

Analyses were replicated for alcohol consumption variablesweekly drinking and peak drinks). For the model whereineekly drinking was examined as the dependent variable, sig-ificant associations emerged as expected for decisional balance

= −0.14, p = 0.01), drinking identity ( = 0.32, p < 0.0001), andender ( = 0.11, p = 0.04). A significant two-way interactionmerged between drinking identity and gender with respect torinks per week ( = 0.18, p = 0.01). For the model wherein peakrinks was examined as the dependent variable, findings were con-istent with expectations in that gender exhibited significant mainffects on peak drinking ( = 0.34, p < 0.0001). Decisional balanceas marginally associated with peak drinks ( = −0.10, p = 0.06).

marginal two-way interaction emerged between decisional bal-nce drinking identity with respect to peak drinks ( = −0.10,

< 0.06). However, as expected, no three-way interactions emergeds significant with respect to alcohol consumption variables.

Interactions related to problems were graphed using parame-er estimates from the regression equation as described in Cohent al. (2003). Values in the figures represent the number of alcohol-elated problems that would be expected for an individual whocored one standard deviation above (high) and below (low) theean of drinking identity and one standard deviation above (high)

nd below (low) the mean of decisional balance. Fig. 1 reveals


hat drinking identity was associated with higher alcohol prob-ems, and this relationship was stronger among individuals lowern decisional balance compared to individuals higher in decisional

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Low dec ision al balance High dec ision al b alance

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ig. 2. High decisional balance was associated with less alcohol-related problems,nd this relationship was stronger among males.

Fig. 4. High drinking identity was associated with higher alcohol-related problems,and this relationship was stronger among females with low decisional balance com-pared to females with higher decisional balance.

balance. Taking gender and drinks per week into account, resultsfrom simple slopes analysis also indicated that the positive asso-ciation between drinking identity and alcohol-related problemswas significant at a lower level (−1 SD) of decisional balance(ˇ = 0.51, p < 0.001), but not at a higher level (+1 SD) of decisionalbalance ( = 0.05, p = 0.455). Thus, higher levels of decisional bal-ance may buffer against the positive association between drinkingidentity and alcohol-related problems. Fig. 2 shows the interactionbetween gender and decisional balance such that the negative asso-ciation between decisional balance and alcohol-related problemswas stronger among males than females. Controlling for drinkingidentity and drinks per week, simple slopes analysis revealed thatthe negative association between decisional balance and alcohol-related problems was significant for males ( = −0.37, p < 0.001),but not for females ( = −0.01, p = 0.854). Thus, findings suggest thatthe protective role of decisional balance in alcohol-related prob-lems may only be apparent among males. Figs. 3 and 4 summarizethe three-way interaction between drinking identity, decisionalbalance, and gender. Fig. 3 shows the pattern for males and Fig. 4for females. For males, controlling for drinks per week, resultsfrom simple slopes analysis indicated that the positive associationbetween drinking identity and alcohol-related problems was sig-nificant at a lower level of decisional balance ( = 0.68, p < 0.001),but not at a higher level of decisional balance ( = −0.03, p = 0.842).However, for females, results from simple slopes analysis indicatedthat the positive association between drinking identity and alcohol-


related problems was significant both at a lower level of decisionalbalance ( = 0.45, p < 0.001) and a higher level of decisional bal-ance ( = 0.23, p = 0.045) after controlling for drinks per week. Theseresults suggest that a higher level of decisional balance may be


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losely linked to the positive association between drinking iden-ity and alcohol-related problems among males but not females.hus, our expectations regarding an interaction between drinkingdentity and decisional balance with respect to drinking variables

ere partially supported; interactions emerged with respect toroblems, but not consumption.

. Discussion

The present research evaluated the influence of decisional bal-nce as a moderator of the relationship between drinking identitynd alcohol-related problems, and also examined how this associa-ion might differ as a function of gender. Based on previous researchhat indicates that motivation to reduce alcohol use is linked toecreased alcohol consumption and also increased alcohol-relatedroblems (McCrady and Epstein, 1999; Nye et al., 1999; Rollnickt al., 1992), we expected that decisional balance, conceptualizeds motivation to change behavior, would be negatively corre-ated with drinking and positively associated with problems. Thisypothesis was partially supported. As expected, decisional balanceas significantly and negatively correlated with drinking (peakrinks and drinks per week). This result makes intuitive sense as

ndividuals who are reflecting on the pros and cons of drinkingould most likely drink less.

However, contrary to expectations, we found a negative asso-iation between decisional balance and alcohol-related problems.ne possibility for this finding is that individuals who are higher

n decisional balance may have already reduced their drinking as arecautionary measure, and, therefore, experience fewer alcohol-elated problems. Alternatively, it is also plausible that heavierrinkers may not be ready or lack the motivation (as representedy lower decisional balance) to change their heavy drinking habitsespite experiencing greater alcohol-related problems. Along these

ines, it is also plausible that heavier drinkers may be experiencingore psychological reactance in response to the decisional balance,

nd therefore may be listing more pros and fewer cons to drinkinglower decisional balance) so as to avoid directly confronting theirlcohol-related problems.

We further found that, consistent with expectations, drinkingdentity was positively associated with drinking and problems. Thisesult is in line with previous research which evidenced that drink-ng identity is associated with increased drinking (e.g., Neighborst al., 2010; Reed et al., 2007) and perhaps, as a consequence,igher alcohol-related problems (e.g., Lindgren et al., 2013). Alsoonsistent with predictions, results revealed a significant two-ay interaction between drinking identity and decisional balance

egarding alcohol-problems, such that drinking identity was asso-iated with increased alcohol-related problems, particularly amonghose lower in decisional balance. In addition, tests of the sim-le slopes revealed that the positive association between drinking

dentity and alcohol-related problems was significantly differentrom zero at lower levels of decisional balance but not at higherevels of decisional balance.

According to Social Identity (Hogg et al., 2003; Terry and Hogg,996) and Self-Categorization Theory (Turner et al., 1987), an indi-idual’s identity is often shaped by group norms of importantroups to which they belong. That is, individuals who are highern drinking identity may associate with groups who tend to drink

ore heavily. Further, those who are lower in decisional balanceay be less motivated to change their drinking behavior. This lack

f motivation may stem from the fact that drinking is often vieweds an integral way for students to bond with in-group members in


ollege. Therefore, individuals who are lower in decisional balanceut higher in drinking identity may be less motivated to changeheir drinking behaviors in order to fit in with group norms, andonsequently, experience more alcohol-related problems.


Furthermore, results revealed a significant two-way interactionbetween decisional balance and gender with respect to prob-lems, such that higher decisional balance was associated withless alcohol-related problems, and this relationship was strongeramong males. Moreover, tests of the simple slopes revealed thatthe negative association between decisional balance and alcohol-related problems was significantly different from zero for men butnot for women. Thus, it appears that higher levels of decisionalbalance were more strongly associated with lower alcohol-relatedproblems for men relative to women. As aforementioned, the liter-ature has shown that men in college are more at-risk for drinkingand related problems than women (e.g., Caetano, 1994; Greenfieldet al., 2000; Korcuska and Thombs, 2003; Randolph et al., 2009).However, decisional balance appears to be linked with reductionsin alcohol-related problems, particularly for men.

Consistent with expectations, a three-way interaction for drink-ing identity, decisional balance, and gender with respect toalcohol-related problems emerged. That is, the positive associa-tion between drinking identity and alcohol-related problems wasstronger for men lower in decisional balance. This is consistentwith other research that has demonstrated that men tend to iden-tify more strongly with drinking than women (Foster et al., 2013).Further, the mean of the current sample for males on drinkingidentity (M = 1.21) was nearly double of that for females (M = .67).These findings highlight the fact that men who are higher in drink-ing identity and also lower in decisional balance might be at-riskfor developing more severe alcohol-related problems relative tomen or women lower in drinking identity or decisional balance.Moreover, a similar yet less pronounced pattern was evidencedfor women who were higher in drinking identity and lower indecisional balance. Therefore, researchers should consider pro-moting strategies to increase motivation to change and decreaseself-identification with drinking for these at-risk groups of menand women.

4.1. Limitations and future directions

The strengths of the present research should be consideredin light of some limitations. One limitation was that there wasa relatively low representation of males in the present study.Additionally, the data were cross-sectional. Thus, any causal infer-ences are attenuated. Future studies might consider examiningthe trajectories of drinking identity, decisional balance, and prob-lem alcohol use over time to better understand these associations.Future research might also explore whether engaging in decisionalbalance immediately prior to attending social drinking situationsmight mitigate drinking and alcohol-related problems, particularlyfor individuals high in drinking identity. This might better eluci-date the efficacy of decisional balance in the context of alcoholinterventions.

5. Conclusion

In the present study, we conducted a cross-sectional evaluationof the main effects and interactions of decisional balance, drinkingidentity and gender in predicting alcohol outcomes among col-lege students. Specifically, students who were male, had strongerdrinking identities, and a decisional balance that tipped away frombehavior change, reported higher levels of drinking and alcohol-related problems compared to their college peers. The overallimplication of the present research is that all of these factors andtheir interactions are important predictors that should be consid-ered in future assessments with college drinkers. Perhaps certain


at-risk groups could be targeted for more comprehensive inter-vention. Further, decisional balance, drinking identity, and theirintersection with gender could be combined into interventions that


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re tailored to these different groups’ needs. Future studies areeeded to explore these potential new ways to decrease alcohol-elated harm among college drinkers.

ole of funding sources

Preparation of this manuscript was supported in part byational Institute on Drug Abuse grant K12-DA-000167 (Dr. Foster).

ontributors

Dawn Foster designed the study, collected data, conducted lit-rature searches, and drafted the manuscript. Chelsie Young andelson Yeung supported the analyses. Jennifer Bryan supported the

ntroduction section. Mai-Ly Steers supported the discussion sec-ion. Alexander Prokhorov provided feedback to manuscript drafts.ll authors supported overall manuscript development.

onflict of interest statement

The authors declare that they have no conflicts of interest.

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