Addictive Behaviors 42 (2015) 222–226
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Addictive Behaviors
Is being mindful associated with reduced risk for internally-motivated drinking and alcohol use among undergraduates?☆ Ashley Reynolds ⁎, Matthew T. Keough, Roisin M. O’Connor Department of Psychology, Concordia University, Montreal, Québec H4B 1R6, Canada
H I G H L I G H T S • • • • •
The purpose was to parse out which mindfulness skills are central to alcohol use. Accepting without judgment was negatively associated with coping-motivated drinking. Accepting without judgment was negatively associated with conformity motives. Accepting without judgment was unassociated with enhancement-motivated drinking. Acting with awareness was a negative predictor of alcohol use.
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Available online 25 November 2014 Keywords: Mindfulness Acceptance without judgment Alcohol use Drinking motives
a b s t r a c t Mindfulness encompasses four core skills: observing, describing, acting with awareness, and accepting without judgment; which aim to increase one's awareness, tolerance, and acceptance of internal experiences (Baer et al., 2004). Despite promising clinical results that mindfulness reduces alcohol craving and relapse, complementary etiological research is underdeveloped. Theory suggests that those who are motivated to drink to change internal states (reduce negative/increase positive affect) are at risk for elevated alcohol use. The ability to accept one's affective state should preclude internally-motivated drinking, and thus, elevated alcohol use. The purpose of this study was to parse out which mindfulness skills are central to alcohol use. We hypothesized that accepting without judgment would be a unique negative predictor of internally-motivated drinking (drinking for coping and enhancement motives) and alcohol use. Students (N = 76) completed self-report measures of past month alcohol use and four motives for drinking: to cope, for enhancement, to conform, and for social reasons. Partially supporting our hypotheses, accepting without judgment was negatively associated with drinking for coping motives, but was unassociated with drinking for enhancement motives. Interestingly, acceptance without judgment was negatively associated with drinking for conformity motives (to reduce social rejection). Unexpectedly, acting with awareness, but not accepting without judgment, was a negative predictor of alcohol use. Our findings suggest that interventions aimed at reducing coping- and conformity-motivated drinking and alcohol use by young adults may benefit from incorporating mindfulness skills training (i.e., accepting without judgment; acting with awareness). © 2014 Elsevier Ltd. All rights reserved.
1. Introduction Mindfulness is attending to and accepting internal experiences (i.e., sensations, thoughts, and emotions) as impermanent and fleeting (Kabat-Zinn, 2000). When one is mindful, there is a reduced need to change unwanted internal experiences (Teasdale, 1999). In contrast, ☆ This research was supported by a Canadian Institutes of Health Research (CIHR) grant awarded to Dr. O’Connor. M.T. Keough was funded by a Vanier Canada Graduate Scholarship (CGS) awarded by CIHR during completion of part of this work. ⁎ Corresponding author at: Department of Psychology, Concordia University, PY-239, 7141 Sherbrooke St. West, Montreal, Québec, H4B 1R6, Canada. Tel.: + 1 514 848 2424x2390; fax: +1 514 848 4523. E-mail address: [email protected] (A. Reynolds).
http://dx.doi.org/10.1016/j.addbeh.2014.11.027 0306-4603/© 2014 Elsevier Ltd. All rights reserved.
individuals often drink alcohol to regulate internal mood states (e.g., reduce anxiety), which increases risky alcohol use (Cooper, 1994; Kuntsche, Knibbe, Gmel, & Engels, 2005). Consistent with this, clinicians have begun to use mindfulness-based treatments for alcohol use disorders, and some results support reductions in alcohol craving and relapse (see Zgierska et al., 2009 for a review). Although clinical findings are promising, complementary etiological research is currently underdeveloped, and existing studies have produced mixed findings. For example, Ostafin and Marlatt (2008) found that those who mindfully accepted current experiences had weak automatic activation of behavioral approach associations with alcohol. Yet, other studies find that good mind–body awareness predicts increased alcohol use (Bartholow, Sher, & Strathman, 2000; Leigh, Bowen, & Marlatt, 2005).
A. Reynolds et al. / Addictive Behaviors 42 (2015) 222–226
One thing that distinguishes these studies is that different facets of mindfulness were examined. The goal of the current study was to isolate which facet(s) of mindfulness is (are) associated with reduced risk for elevated alcohol use. We aim to further etiological models by examining mindfulness and alcohol use as correlates, which naturally occur, in a non-clinical sample. Baer, Smith, and Allen (2004) offer one widely used conceptualization of mindfulness; it includes four distinct core skills: observing, describing, acting with awareness, and accepting without judgment. Observing is the ability to notice and attend to both internal (e.g., emotions) and external phenomena (e.g., environmental sounds) (Kabat-Zinn, 1990; Segal, Williams, & Teasdale, 2002). Describing is the ability to recognize and attach words to internal experiences, while at the same time refraining from assigning meaning to the experiences (Baer et al., 2004). For example, a person with depression may attach the term “sadness” to their negative thoughts, but (if mindful) not draw the conclusion that their situation is hopeless (Goldstein, 2002; Segal et al., 2002). Acting with awareness is the ability to give one's full attention, in-the-moment, to an activity while resisting distractions (e.g., fully engaged in a novel while riding the bus) (Hanh, 1976). Last, accepting without judgment is the ability to accept the present moment and avoid judging, evaluating, and trying to change it (Dimidjian & Linehan, 2003a; Marlatt & Kristeller, 1999). To illustrate, those who accept without judgment notice and accept feelings of sadness or anxiety without actively trying to change these emotions. In contrast to mindfulness, which is the general awareness and acceptance of internal states, theory suggests that individuals who misuse alcohol often do so in an effort to regulate and change their emotions. According to social learning theory (SLT), individuals learn through experience that alcohol causes rewarding shifts in mood (decreased negative and increased positive affect); these experiences promote the formation of drinking motives (Bandura, 1977; Cooper, Frone, Russell, & Mudar, 1995; Read, Wood, Kahler, Maddock, & Palfai, 2003). Drinking motives are theorized as proximal predictors of alcohol use, and they vary along two dimensions: source (internal and external) and reinforcement valence (negative and positive) (Cooper, 1994). Individuals may drink in an effort to change an internal or external state. They may also drink to decrease or increase the likelihood of a negative or positive outcome, respectively. Crossing these dimensions yields four categories of motives: coping (internal, negative reinforcement, e.g., to relieve anxiety), enhancement (internal, positive reinforcement, e.g., to increase excitement), conformity (external, negative reinforcement, e.g., to avoid social rejection), and social (external, positive reinforcement, e.g., for social affiliation). Drinking for coping and enhancement motives—to change one's internal state—has been consistently linked with risk for alcohol misuse (e.g., heavy alcohol use; experiencing alcohol-related problems) (see Kuntsche et al., 2005 for a review). In comparison, drinking motivated by the desire to change an external state seems to be less risky. While a few studies have linked drinking for conformity motives to alcohol misuse (Magid, MacLean, & Colder, 2007; Stewart, Zvolensky, & Eifert, 2001), research consistently finds that drinking for social motives is unrelated to alcohol misuse (e.g., Merrill & Read, 2010; Merrill, Wardell, & Read, 2014; Read et al., 2003). Research identifying the predictors of risky internally-motivated drinking is warranted. An extensive literature has examined personality traits as theoretically meaningful predictors of coping and enhancement motivated drinking (e.g., Conrod, Pihl, Stewart, & Doniger, 2000; Stewart et al., 2001). While this research is central to developing etiological models of alcohol misuse, we propose that attention should also be given to more malleable predictors. The antithesis of drinking to change one's internal emotional state is to accept that state. Those who accept without judgment—a core mindfulness skill that is teachable (Baer, Smith, Hopkins, Krietemeyer, & Toney, 2006)—are able to refrain from labeling internal experiences as either good or bad and accept that all thoughts, emotions, and sensations are impermanent
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(Dimidjian & Linehan, 2003a, 2003b; Marlatt & Kristeller, 1999). Accepting without judgment leads to tolerance of unwanted internal experiences, and thus should dissuade individuals from engaging in maladaptive drinking for coping or enhancement purposes—where the goal is to regulate internal mood by drinking alcohol (Cooper, 1994). Being able to accept without judgment may be particularly central to decreasing risk for internally-motivated drinking, and, more broadly, reducing alcohol use. Research examining the link between mindfulness and drinking motives is sparse. To illustrate, Leigh and Neighbors (2009) found that mind/body awareness (maps onto Baer et al.'s, 2004, observing skill), nonattachment (maps onto Baer et al's describing skill), and acceptance (maps onto Baer et al's accepting without judgment skill) did not correlate with drinking for coping motives. Yet, they found a positive correlation between mind/body awareness (observing) and drinking for enhancement motives. A limitation of this study is that external drinking motives were not controlled for in the models. Therefore, we cannot draw conclusions about the unique effects of mindfulness skills on internal motives for drinking. The purpose of the current study was to identify the specific facets of mindfulness that are linked to both internal motives for drinking and alcohol use. We hypothesized that accepting without judgment would be a unique negative predictor of internally-motivated drinking and typical weekly alcohol use. Specifically, we expected that engaging in acceptance without judgment would be associated with reduced risk for drinking for coping and enhancement motives and it would be associated with reduced amount of alcohol consumed.
2. Method 2.1. Participants and procedure Seventy-six undergraduates (32 women; M age = 21.10 years, SD = 1.29; 75% Caucasian, 13% Asian, 5% Hispanic/Latino, 7% other) were recruited from a western U.S. university. Many participants lived on (9%) or off campus without family (63%), while 13% lived at home with family, 8% lived in a fraternity or sorority, and 7% indicated ‘other’. Because this study investigated drinking motives, only data from non-abstainers (≥ 1 drink in past month) were included. The self-report data were collected as part of a larger lab-based study on personality and alcohol misuse. Participants received $10/hour as compensation for their participation in the larger study, which took approximately 2.5 hours to complete. The self-report measures included in the current study were completed prior to the experimental manipulation that was relevant to the broader study hypotheses.
2.2. Self-report measures 2.2.1. The Kentucky Inventory of Mindfulness Skills (KIMS) (Baer et al., 2004) The KIMS has 39-items and assesses four mindfulness skills: observing (12-items; e.g., I notice when my moods begin to change), describing (8-items; e.g., I’m good at finding the words to describe my feelings), acting with awareness (10-items; e.g., When I am reading I focus all my attention on what I’m reading), and accepting without judgment (9items; e.g., I make judgments about whether my thoughts are good or bad, Note. item reverse scored). Participants indicated how true each statement was for them using a 5-point response scale (1 = never/ rarely true to 5 = almost always/always true). Sum scores were derived for each subscale. Previous work demonstrates good to excellent internal consistencies (α = .83–.91), adequate to good test–retest reliability (r = .65–.83), and concurrent validity (Baer et al., 2004) of the KIMS subscales. Internal consistencies were adequate to good in the current study (see Table 1).
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Table 1 Zero-order correlations, means, and SDs.
1. Observing 2. Describing 3. Acting with awareness 4. Accepting without judgment 5. Coping 6. Enhancement 7. Conformity 8. Social 9. Weekly alcohol use M SD Cronbach's α
1
2
3
4
5
6
7
8
9
– .33⁎⁎ .03 −.23⁎ −.02 .20 .07 .07 −.02 39.25 8.29 .81
– .22 .32⁎⁎ −.34⁎⁎ −.08 −.23⁎ −.20 .07 28.29 6.31 .86
– .17 −.12 −.12 −.13 −.21 −.23⁎ 29.88 5.69 .90
– −.42⁎⁎ −.29⁎ −.37⁎⁎ −.25⁎ −.07 33.19 6.34 .80
– .41⁎⁎ .35⁎⁎ .56⁎⁎ .12 2.10 0.74 .77
– .28⁎ .82⁎⁎ .43⁎⁎ 3.32 0.91 .83
– .38⁎⁎ −.07 1.70 0.80 .86
– .35⁎⁎ 3.62 0.83 .86
– 7.82 6.72 –
Note. Coping = coping drinking motives; enhancement = enhancement drinking motives; conformity = conformity drinking motives; social = social drinking motives; weekly alcohol use: total number of alcoholic drinks in typical week (in past month). Conformity drinking motives and weekly alcohol use variables were log transformed for correlations, but untransformed data were used for descriptive statistics. ⁎ p b .05. ⁎⁎ p b .01.
2.2.2. Drinking Motives Questionnaire—Revised (DMQ-R) (Cooper, 1994) The DMQ-R has 20-items and captures four drinking motives: coping (5-items; e.g., to forget your worries), enhancement (5-items; e.g., because you like the feeling), conformity (5-items; e.g., because your friends pressure you to drink), and social (5-items; e.g., to be sociable) motives. Participants indicated how often they drank for each motive using a 5-point response scale (1 = almost never/never to 5 = almost always/always). Mean scores were derived for each subscale. Previous work supports good internal consistency and validity of the DMQ-R subscales (α = .84–.88) (Cooper, 1994). See Table 1 for the internal consistencies of the DMQ-R in the present study. 2.2.3. Alcohol use (Cahalan, Cisin, & Crossley, 1969; Read & O’Connor, 2006) Participants indicated their frequency (0 = not at all in the past 30 days to 7 = every day of the week) and typical, per occasion quantity (0 = did not drink at all in the past 30 days to 10 = ten drinks per occasion) of alcohol use over the past month. A quantity by frequency composite was calculated; this reflected total number of drinks consumed in a typical week over the past month. This quantity by frequency product is widely used in the alcohol literature (e.g., Wardell, O’Connor, Read, & Colder, 2011). 3. Results 3.1. Data overview, descriptive statistics, and correlations A series of multiple regression analyses were used to test hypotheses. The data were first screened based on recommended best practices (Kline, 2009; Wilkinson & the Task Force on Statistical Inference, 1999). There were no missing cases. Three outliers on the alcohol use variable (b5% of all data) were replaced with the highest acceptable value within the +3 SD range. The conformity drinking motives and weekly alcohol use variables were highly skewed (skew index N3.0), which is common with drinking variables in non-clinical populations (Miller, Miller, Verhegge, Linville, & Pumariega, 2002). We applied a Log10 transformation, and this brought skew within normal limits for conformity drinking motives (skew index = 1.56) and weekly alcohol use (skew index = −.48). These transformed variables were used in all analyses. The remaining statistical assumptions of multiple regression were verified. See Table 1 for descriptive statistics and correlations. The total weekly alcohol use in our sample falls within the range reported in previous work with U.S. undergraduates (e.g., Ham, Bonin, & Hope, 2007; Romosz & Quigley, 2013). Zero-order correlations revealed that the describing mindfulness skill was a statistically significant negative correlate of
coping and conformity drinking motives, while accepting without judgment was a statistically significant negative correlate of all drinking motives. Enhancement and social drinking motives were statistically significant positive correlates of weekly alcohol use.
3.2. Hypothesis testing First, we tested the hypothesis that accepting without judgment would be a unique negative predictor of the two internal motives for drinking (see Table 2). In model one, coping drinking motives was the criterion variable, the remaining three drinking motives were entered as covariates, and the four mindfulness skills were tested as the predictors. The mindfulness skills predicted 11% variance above and beyond that accounted for by the covariates (Fchange = 3.20, p = .02). The full model accounted for 44% (Adj. R2 = .38) of the criterion variable variance, and only accepting without judgment was a statistically significant predictor of coping drinking motives. As expected, elevated accepting without judgment was associated with reduced drinking for coping motives. In model two, enhancement drinking motives was the criterion variable, the remaining three drinking motives were entered as covariates, and the four mindfulness skills were tested as the predictors. The mindfulness skills predicted 3% variance above and beyond that accounted for by the covariates (Fchange = 1.92, p = .12). The full model accounted for 70% (Adj. R2 = .67) of the criterion variable variance. Contrary to hypotheses, none of the mindfulness skills proved to be a statistically significant predictor of drinking for enhancement motives. For discriminant validity, two additional regression analyses were conducted with the four mindfulness skills predicting the two external drinking motives: conformity and social motives. In each model, the relevant drinking motive was regressed on the four mindfulness skills while controlling for the effect of the other three drinking motives (see Table 2). The model predicting conformity drinking motives accounted for 22% of the criterion variable variance (Adj. R2 = .14), with mindfulness skills alone predicting 7% of the variance above and beyond that accounted for by the covariates (Fchange = 1.57, p = .19). Interestingly, only accepting without judgment was a statistically significant predictor of conformity drinking motives. Elevated accepting without judgment was associated with reduced drinking for conformity motives. The model predicting social drinking motives explained 76% of the criterion variable variance (Adj. R2 = .73), with mindfulness skills alone predicting 2% of the variance above and beyond that accounted for by the covariates (Fchange = 1.70, p = .16). None of the mindfulness skills proved to be a statistically significant predictor of social drinking motives.
A. Reynolds et al. / Addictive Behaviors 42 (2015) 222–226 Table 2 Motives regressed on mindfulness skills.
Table 3 Weekly alcohol use regressed on mindfulness skills.
Predictors
B
SE
β
Coping motives (criterion) Enhancement Conformity Social Observing Describing Acting with awareness Accepting without judgment
−.13 .25 .52 −.06 −.13 .10 −.31
.13 .68 .15 .11 .10 .12 .11
−.16 .04 .59 −.06 −.14 .08 −.29
R2
f2
t
p
−.93 .36 3.51 −.56 −1.25 .83 −2.68
.35 .72 .00 .58 b.01 .21 .02 .41 .01 .01 .10
−.95 −.59 10.28 1.23 .56 .92 −1.57
.35 .56 .00 .22 .02 .58 b.01 .36 .01 .12 .04
.36 −.59 1.68 .27 −.63 .02 −1.87
.72 .56 .10 .79 b.01 .53 b.01 .98 b.01 .05 .07
3.48 10.33 1.83 −.46 −.43 −1.64 1.70
.00 .00 .07 .66 b.01 .67 b.01 .11 .04 .10 .04
.44 (.24–.64)a Enhancement motives (criterion) Coping −.10 Conformity −.36 Social .94 Observing .12 Describing .05 Acting with awareness .10 Accepting without judgment −.16
.11 −.08 .61 −.04 .09 .87 .10 .09 .10 .05 .11 .06 .11 −.13 .70 (.59–.80)a
Conformity motives (criterion) Coping .01 Enhancement −.01 Social .05 Observing .01 Describing −.01 Acting with awareness .00 Accepting without judgment −.04
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.02 .05 .02 −.12 .03 .36 .02 .03 .02 −.08 .02 .00 .02 −.24 .22 (.07–.37)a
Social motives (criterion) Coping .29 .08 .26 Enhancement .65 .06 .71 Conformity .84 .50 .11 Observing −.04 .08 −.03 Describing −.03 .08 −.03 Acting with awareness −.15 .09 −.10 Accepting without judgment .14 .08 .12 .76 (.68–.84)a
Note: Coping = coping drinking motives; enhancement = enhancement drinking motives; conformity = conformity drinking motives; social = social drinking motives. The motives not specified as the outcomes were entered as covariates in each model. Conformity drinking motives variable was log transformed prior to analyses. a 95% Confidence interval.
Last, we tested the hypothesis that accepting without judgment would be a unique negative predictor of weekly alcohol use (see Table 3). Weekly alcohol use was regressed on the four mindfulness skills. This model accounted for 7% (Adj. R2 = .02) of the criterion variable variance. Contrary to hypotheses, accepting without judgment was not a statistically significant predictor of weekly alcohol use. However, acting with awareness was supported as a statistically significant predictor of weekly alcohol use. Specifically, elevated acting with awareness was associated with decreased weekly alcohol use. 4. Discussion The goal of this study was to clarify which mindfulness skills relate to alcohol use. We predicted that the mindfulness skill of accepting without judgment would be associated with reduced risk for internally-motivated drinking and heavy alcohol use. Our results partially supported our hypotheses. As expected, the ability to accept the present moment without evaluating, judging, or trying to change it was associated with the reduced motive to drinking for coping purposes. Unexpectedly, acceptance without judgment was unrelated to drinking for enhancement motives, but, interestingly, it was associated with decreased drinking for conformity motives. Contrary to hypotheses, accepting without judgment was unrelated to alcohol use, though acting with awareness was associated with reduced amount of alcohol consumed.
Predictors
B
SE
β
R2
Observing −.03 .06 −.06 Describing .07 .06 .17 Acting with awareness −.14 .07 −.25 Accepting without judgment −.05 .06 −.10
f2
t
p
−.46 1.27 −2.10 −.75
.64 b.01 .20 .02 .04 .06 .45 b.01
.07 (.00–.17)a Note. Weekly alcohol use: total number of alcoholic drinks in typical week (in past month). Weekly alcohol use variable was log transformed prior to analyses. a 95% Confidence interval.
Our results help clarify the association between accepting without judgment and internally motivated drinking. Those who are able to accept internal experiences as impermanent should be less inclined to drink to change mood states; but, to our knowledge, only one published study has examined the association between mindfulness and drinking motives (Leigh & Neighbors, 2009). While this study provided some evidence that mindfulness skills were related to drinking for enhancement motives, an association between mindfulness and coping drinking motives was not supported. However, drinking motives are highly correlated with one another (Cooper, 1994; Cooper et al., 1995), and this overlap should always be controlled for to parse out unique effects of the mindfulness skills on individual motives. In contrast with Leigh and Neighbors (2009), we found that accepting without judgment (or acceptance) was negatively related to drinking for coping motives after controlling for shared variance among all motives. Similar to Leigh and Neighbors (2009), we too found that accepting without judgment was uncorrelated with drinking for enhancement motives, even after examining unique effects. The ability to accept without judgment may allow individuals to distance themselves from negative internal experiences more readily; however, detaching from positive experiences may be more complex. Further, the accepting without judgment subscale from the KIMS questionnaire that we used taps more directly the acceptance of negative— rather than positive—emotions (e.g., I believe some of my thoughts are abnormal or bad and I shouldn’t feel them). The items do not tap acceptance of one's current positive affective state, which seems most germane to motivations to drink for enhancement purposes. Interestingly, our data suggest that those who are able to accept without judgment are less likely to drink for conformity reasons. Although not hypothesized, this result aligns with motives models of negative reinforcement-motivated drinking (e.g., Cooper, 1994). University life is rich with social events where alcohol use is normative. Students often find themselves around new people, and this may promote drinking to reduce the anxiety associated with potential social rejection, particularly in new social contexts (Stewart et al., 2001). We speculate that those who are capable of accepting without judgment may be able to accept the anxiety they have in new social contexts as impermanent. Therefore, these individuals may not feel propelled to drink to fit in, as they know the negative/aversive feelings will not last, especially as they get to know people in the social context. Further empirical testing is needed to test this hypothesis. Furthermore, our results indicated that acceptance without judgment was unrelated to the amount of alcohol consumed. However, acting with awareness (i.e., the ability to give ones' full attention, by being in the moment, to an activity while resisting distractions) was linked to decreased weekly alcohol use. This mindfulness skill is believed to lead to increased self-monitoring, and thus (we speculate) may be important for limiting drinking. Consistent with this interpretation, Baer (2003) suggests that an increase in present-moment awareness may encourage an increase in self-management and may facilitate more adaptive responses. Our study clarifies how mindfulness skills relate to negative reinforcement-motivated drinking and alcohol use, but there are some limitations. First, our sample size was relatively small, but our small-
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to-medium effect sizes for supported statistical effects are promising for future replication work in larger samples (Cohen, 1988). Although our small sample size precluded the full test of mediation, the next step would be to examine whether motives mediate the link between mindfulness and alcohol use. Second, we examined individuals' reported use of mindfulness as a trait variable, as it naturally occurs. We did not train people to use mindfulness skills, thus there may be large variability in the use of mindfulness skills between individuals. A randomized control trial testing the effects of mindfulness skills training on drinking motives seems warranted. In addition, there is research to suggest that there is within person variability in mindfulness as well as drinking motives, thus suggesting there is utility in measuring these as state variables (Armeli, Conner, Cullum, & Tennen, 2010; Weinstein, Brown, & Ryan, 2009). The use of daily diary methodologies may allow us to clarify how the link between mindfulness and drinking motives unfold, possibly even pointing towards a bidirectional association between mindfulness and drinking motives. Third, we used the KIMS to measure mindfulness skills; however, there is also a measure available that is based on a five-factor model of mindfulness: Five Factor Mindfulness Questionnaire (FFMQ) (Baer et al., 2006). Like the KIMS (which the FFMQ is in part derived from), the FFMQ taps the constructs of observing, describing, and acting with awareness. However, unlike the KIMS, the FFMQ measures two distinct facets of accepting without judgment: non-judging of internal experiences and non-reactivity towards internal experiences. It would be interesting for future research to use the FFMQ to examine if these two aspects of acceptance differentially reduce risk for internally-motivated drinking and alcohol use. Taken together, the findings of the current study suggest that it may be useful to emphasize mindfulness skills of accepting without judgment and acting with awareness in prevention programs and treatments aimed at reducing heavy drinking. Our results are in line with extant work showing that accepting without judgment improves emotional regulation (Kabat-Zinn, 1990) and distress tolerance (Linehan, 1994). Thus, it may be such that individuals can learn that they do not need to drink in order to control their negative emotions. Rather, being able to accept negative emotions and being tolerant of the present moment without judging it or trying to change it may be one pathway to reduced risk for alcohol misuse. Role of funding sources Funding for this study was provided by a Canadian Institutes of Health Research (CIHR) (200602MFE-159098-160922) grant awarded to Dr. O’Connor. M. T. Keough was funded by a Vanier Canada Graduate Scholarship (CGS) awarded by CIHR during completion of part of this work. The financial support had no role in the study design, collection, analysis or interpretation of the data, writing the manuscript, or the decision to submit the manuscript for publication. Contributors Ashley Reynolds conducted literature searches, wrote the introduction, methods, and discussion. Matthew T. Keough conducted the analyses and wrote the results and assisted with edits on the introduction and discussion. Dr. O’Connor designed the study, collected the data as part of her post doctorate, and provided edits on the entire manuscript. Conflict of interest All authors declare that they have no conflicts of interest. Acknowledgements N/A.
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Addictive Behaviors
Is being mindful associated with reduced risk for internally-motivated drinking and alcohol use among undergraduates?☆ Ashley Reynolds ⁎, Matthew T. Keough, Roisin M. O’Connor Department of Psychology, Concordia University, Montreal, Québec H4B 1R6, Canada
H I G H L I G H T S • • • • •
The purpose was to parse out which mindfulness skills are central to alcohol use. Accepting without judgment was negatively associated with coping-motivated drinking. Accepting without judgment was negatively associated with conformity motives. Accepting without judgment was unassociated with enhancement-motivated drinking. Acting with awareness was a negative predictor of alcohol use.
a r t i c l e
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Available online 25 November 2014 Keywords: Mindfulness Acceptance without judgment Alcohol use Drinking motives
a b s t r a c t Mindfulness encompasses four core skills: observing, describing, acting with awareness, and accepting without judgment; which aim to increase one's awareness, tolerance, and acceptance of internal experiences (Baer et al., 2004). Despite promising clinical results that mindfulness reduces alcohol craving and relapse, complementary etiological research is underdeveloped. Theory suggests that those who are motivated to drink to change internal states (reduce negative/increase positive affect) are at risk for elevated alcohol use. The ability to accept one's affective state should preclude internally-motivated drinking, and thus, elevated alcohol use. The purpose of this study was to parse out which mindfulness skills are central to alcohol use. We hypothesized that accepting without judgment would be a unique negative predictor of internally-motivated drinking (drinking for coping and enhancement motives) and alcohol use. Students (N = 76) completed self-report measures of past month alcohol use and four motives for drinking: to cope, for enhancement, to conform, and for social reasons. Partially supporting our hypotheses, accepting without judgment was negatively associated with drinking for coping motives, but was unassociated with drinking for enhancement motives. Interestingly, acceptance without judgment was negatively associated with drinking for conformity motives (to reduce social rejection). Unexpectedly, acting with awareness, but not accepting without judgment, was a negative predictor of alcohol use. Our findings suggest that interventions aimed at reducing coping- and conformity-motivated drinking and alcohol use by young adults may benefit from incorporating mindfulness skills training (i.e., accepting without judgment; acting with awareness). © 2014 Elsevier Ltd. All rights reserved.
1. Introduction Mindfulness is attending to and accepting internal experiences (i.e., sensations, thoughts, and emotions) as impermanent and fleeting (Kabat-Zinn, 2000). When one is mindful, there is a reduced need to change unwanted internal experiences (Teasdale, 1999). In contrast, ☆ This research was supported by a Canadian Institutes of Health Research (CIHR) grant awarded to Dr. O’Connor. M.T. Keough was funded by a Vanier Canada Graduate Scholarship (CGS) awarded by CIHR during completion of part of this work. ⁎ Corresponding author at: Department of Psychology, Concordia University, PY-239, 7141 Sherbrooke St. West, Montreal, Québec, H4B 1R6, Canada. Tel.: + 1 514 848 2424x2390; fax: +1 514 848 4523. E-mail address: [email protected] (A. Reynolds).
http://dx.doi.org/10.1016/j.addbeh.2014.11.027 0306-4603/© 2014 Elsevier Ltd. All rights reserved.
individuals often drink alcohol to regulate internal mood states (e.g., reduce anxiety), which increases risky alcohol use (Cooper, 1994; Kuntsche, Knibbe, Gmel, & Engels, 2005). Consistent with this, clinicians have begun to use mindfulness-based treatments for alcohol use disorders, and some results support reductions in alcohol craving and relapse (see Zgierska et al., 2009 for a review). Although clinical findings are promising, complementary etiological research is currently underdeveloped, and existing studies have produced mixed findings. For example, Ostafin and Marlatt (2008) found that those who mindfully accepted current experiences had weak automatic activation of behavioral approach associations with alcohol. Yet, other studies find that good mind–body awareness predicts increased alcohol use (Bartholow, Sher, & Strathman, 2000; Leigh, Bowen, & Marlatt, 2005).
A. Reynolds et al. / Addictive Behaviors 42 (2015) 222–226
One thing that distinguishes these studies is that different facets of mindfulness were examined. The goal of the current study was to isolate which facet(s) of mindfulness is (are) associated with reduced risk for elevated alcohol use. We aim to further etiological models by examining mindfulness and alcohol use as correlates, which naturally occur, in a non-clinical sample. Baer, Smith, and Allen (2004) offer one widely used conceptualization of mindfulness; it includes four distinct core skills: observing, describing, acting with awareness, and accepting without judgment. Observing is the ability to notice and attend to both internal (e.g., emotions) and external phenomena (e.g., environmental sounds) (Kabat-Zinn, 1990; Segal, Williams, & Teasdale, 2002). Describing is the ability to recognize and attach words to internal experiences, while at the same time refraining from assigning meaning to the experiences (Baer et al., 2004). For example, a person with depression may attach the term “sadness” to their negative thoughts, but (if mindful) not draw the conclusion that their situation is hopeless (Goldstein, 2002; Segal et al., 2002). Acting with awareness is the ability to give one's full attention, in-the-moment, to an activity while resisting distractions (e.g., fully engaged in a novel while riding the bus) (Hanh, 1976). Last, accepting without judgment is the ability to accept the present moment and avoid judging, evaluating, and trying to change it (Dimidjian & Linehan, 2003a; Marlatt & Kristeller, 1999). To illustrate, those who accept without judgment notice and accept feelings of sadness or anxiety without actively trying to change these emotions. In contrast to mindfulness, which is the general awareness and acceptance of internal states, theory suggests that individuals who misuse alcohol often do so in an effort to regulate and change their emotions. According to social learning theory (SLT), individuals learn through experience that alcohol causes rewarding shifts in mood (decreased negative and increased positive affect); these experiences promote the formation of drinking motives (Bandura, 1977; Cooper, Frone, Russell, & Mudar, 1995; Read, Wood, Kahler, Maddock, & Palfai, 2003). Drinking motives are theorized as proximal predictors of alcohol use, and they vary along two dimensions: source (internal and external) and reinforcement valence (negative and positive) (Cooper, 1994). Individuals may drink in an effort to change an internal or external state. They may also drink to decrease or increase the likelihood of a negative or positive outcome, respectively. Crossing these dimensions yields four categories of motives: coping (internal, negative reinforcement, e.g., to relieve anxiety), enhancement (internal, positive reinforcement, e.g., to increase excitement), conformity (external, negative reinforcement, e.g., to avoid social rejection), and social (external, positive reinforcement, e.g., for social affiliation). Drinking for coping and enhancement motives—to change one's internal state—has been consistently linked with risk for alcohol misuse (e.g., heavy alcohol use; experiencing alcohol-related problems) (see Kuntsche et al., 2005 for a review). In comparison, drinking motivated by the desire to change an external state seems to be less risky. While a few studies have linked drinking for conformity motives to alcohol misuse (Magid, MacLean, & Colder, 2007; Stewart, Zvolensky, & Eifert, 2001), research consistently finds that drinking for social motives is unrelated to alcohol misuse (e.g., Merrill & Read, 2010; Merrill, Wardell, & Read, 2014; Read et al., 2003). Research identifying the predictors of risky internally-motivated drinking is warranted. An extensive literature has examined personality traits as theoretically meaningful predictors of coping and enhancement motivated drinking (e.g., Conrod, Pihl, Stewart, & Doniger, 2000; Stewart et al., 2001). While this research is central to developing etiological models of alcohol misuse, we propose that attention should also be given to more malleable predictors. The antithesis of drinking to change one's internal emotional state is to accept that state. Those who accept without judgment—a core mindfulness skill that is teachable (Baer, Smith, Hopkins, Krietemeyer, & Toney, 2006)—are able to refrain from labeling internal experiences as either good or bad and accept that all thoughts, emotions, and sensations are impermanent
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(Dimidjian & Linehan, 2003a, 2003b; Marlatt & Kristeller, 1999). Accepting without judgment leads to tolerance of unwanted internal experiences, and thus should dissuade individuals from engaging in maladaptive drinking for coping or enhancement purposes—where the goal is to regulate internal mood by drinking alcohol (Cooper, 1994). Being able to accept without judgment may be particularly central to decreasing risk for internally-motivated drinking, and, more broadly, reducing alcohol use. Research examining the link between mindfulness and drinking motives is sparse. To illustrate, Leigh and Neighbors (2009) found that mind/body awareness (maps onto Baer et al.'s, 2004, observing skill), nonattachment (maps onto Baer et al's describing skill), and acceptance (maps onto Baer et al's accepting without judgment skill) did not correlate with drinking for coping motives. Yet, they found a positive correlation between mind/body awareness (observing) and drinking for enhancement motives. A limitation of this study is that external drinking motives were not controlled for in the models. Therefore, we cannot draw conclusions about the unique effects of mindfulness skills on internal motives for drinking. The purpose of the current study was to identify the specific facets of mindfulness that are linked to both internal motives for drinking and alcohol use. We hypothesized that accepting without judgment would be a unique negative predictor of internally-motivated drinking and typical weekly alcohol use. Specifically, we expected that engaging in acceptance without judgment would be associated with reduced risk for drinking for coping and enhancement motives and it would be associated with reduced amount of alcohol consumed.
2. Method 2.1. Participants and procedure Seventy-six undergraduates (32 women; M age = 21.10 years, SD = 1.29; 75% Caucasian, 13% Asian, 5% Hispanic/Latino, 7% other) were recruited from a western U.S. university. Many participants lived on (9%) or off campus without family (63%), while 13% lived at home with family, 8% lived in a fraternity or sorority, and 7% indicated ‘other’. Because this study investigated drinking motives, only data from non-abstainers (≥ 1 drink in past month) were included. The self-report data were collected as part of a larger lab-based study on personality and alcohol misuse. Participants received $10/hour as compensation for their participation in the larger study, which took approximately 2.5 hours to complete. The self-report measures included in the current study were completed prior to the experimental manipulation that was relevant to the broader study hypotheses.
2.2. Self-report measures 2.2.1. The Kentucky Inventory of Mindfulness Skills (KIMS) (Baer et al., 2004) The KIMS has 39-items and assesses four mindfulness skills: observing (12-items; e.g., I notice when my moods begin to change), describing (8-items; e.g., I’m good at finding the words to describe my feelings), acting with awareness (10-items; e.g., When I am reading I focus all my attention on what I’m reading), and accepting without judgment (9items; e.g., I make judgments about whether my thoughts are good or bad, Note. item reverse scored). Participants indicated how true each statement was for them using a 5-point response scale (1 = never/ rarely true to 5 = almost always/always true). Sum scores were derived for each subscale. Previous work demonstrates good to excellent internal consistencies (α = .83–.91), adequate to good test–retest reliability (r = .65–.83), and concurrent validity (Baer et al., 2004) of the KIMS subscales. Internal consistencies were adequate to good in the current study (see Table 1).
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Table 1 Zero-order correlations, means, and SDs.
1. Observing 2. Describing 3. Acting with awareness 4. Accepting without judgment 5. Coping 6. Enhancement 7. Conformity 8. Social 9. Weekly alcohol use M SD Cronbach's α
1
2
3
4
5
6
7
8
9
– .33⁎⁎ .03 −.23⁎ −.02 .20 .07 .07 −.02 39.25 8.29 .81
– .22 .32⁎⁎ −.34⁎⁎ −.08 −.23⁎ −.20 .07 28.29 6.31 .86
– .17 −.12 −.12 −.13 −.21 −.23⁎ 29.88 5.69 .90
– −.42⁎⁎ −.29⁎ −.37⁎⁎ −.25⁎ −.07 33.19 6.34 .80
– .41⁎⁎ .35⁎⁎ .56⁎⁎ .12 2.10 0.74 .77
– .28⁎ .82⁎⁎ .43⁎⁎ 3.32 0.91 .83
– .38⁎⁎ −.07 1.70 0.80 .86
– .35⁎⁎ 3.62 0.83 .86
– 7.82 6.72 –
Note. Coping = coping drinking motives; enhancement = enhancement drinking motives; conformity = conformity drinking motives; social = social drinking motives; weekly alcohol use: total number of alcoholic drinks in typical week (in past month). Conformity drinking motives and weekly alcohol use variables were log transformed for correlations, but untransformed data were used for descriptive statistics. ⁎ p b .05. ⁎⁎ p b .01.
2.2.2. Drinking Motives Questionnaire—Revised (DMQ-R) (Cooper, 1994) The DMQ-R has 20-items and captures four drinking motives: coping (5-items; e.g., to forget your worries), enhancement (5-items; e.g., because you like the feeling), conformity (5-items; e.g., because your friends pressure you to drink), and social (5-items; e.g., to be sociable) motives. Participants indicated how often they drank for each motive using a 5-point response scale (1 = almost never/never to 5 = almost always/always). Mean scores were derived for each subscale. Previous work supports good internal consistency and validity of the DMQ-R subscales (α = .84–.88) (Cooper, 1994). See Table 1 for the internal consistencies of the DMQ-R in the present study. 2.2.3. Alcohol use (Cahalan, Cisin, & Crossley, 1969; Read & O’Connor, 2006) Participants indicated their frequency (0 = not at all in the past 30 days to 7 = every day of the week) and typical, per occasion quantity (0 = did not drink at all in the past 30 days to 10 = ten drinks per occasion) of alcohol use over the past month. A quantity by frequency composite was calculated; this reflected total number of drinks consumed in a typical week over the past month. This quantity by frequency product is widely used in the alcohol literature (e.g., Wardell, O’Connor, Read, & Colder, 2011). 3. Results 3.1. Data overview, descriptive statistics, and correlations A series of multiple regression analyses were used to test hypotheses. The data were first screened based on recommended best practices (Kline, 2009; Wilkinson & the Task Force on Statistical Inference, 1999). There were no missing cases. Three outliers on the alcohol use variable (b5% of all data) were replaced with the highest acceptable value within the +3 SD range. The conformity drinking motives and weekly alcohol use variables were highly skewed (skew index N3.0), which is common with drinking variables in non-clinical populations (Miller, Miller, Verhegge, Linville, & Pumariega, 2002). We applied a Log10 transformation, and this brought skew within normal limits for conformity drinking motives (skew index = 1.56) and weekly alcohol use (skew index = −.48). These transformed variables were used in all analyses. The remaining statistical assumptions of multiple regression were verified. See Table 1 for descriptive statistics and correlations. The total weekly alcohol use in our sample falls within the range reported in previous work with U.S. undergraduates (e.g., Ham, Bonin, & Hope, 2007; Romosz & Quigley, 2013). Zero-order correlations revealed that the describing mindfulness skill was a statistically significant negative correlate of
coping and conformity drinking motives, while accepting without judgment was a statistically significant negative correlate of all drinking motives. Enhancement and social drinking motives were statistically significant positive correlates of weekly alcohol use.
3.2. Hypothesis testing First, we tested the hypothesis that accepting without judgment would be a unique negative predictor of the two internal motives for drinking (see Table 2). In model one, coping drinking motives was the criterion variable, the remaining three drinking motives were entered as covariates, and the four mindfulness skills were tested as the predictors. The mindfulness skills predicted 11% variance above and beyond that accounted for by the covariates (Fchange = 3.20, p = .02). The full model accounted for 44% (Adj. R2 = .38) of the criterion variable variance, and only accepting without judgment was a statistically significant predictor of coping drinking motives. As expected, elevated accepting without judgment was associated with reduced drinking for coping motives. In model two, enhancement drinking motives was the criterion variable, the remaining three drinking motives were entered as covariates, and the four mindfulness skills were tested as the predictors. The mindfulness skills predicted 3% variance above and beyond that accounted for by the covariates (Fchange = 1.92, p = .12). The full model accounted for 70% (Adj. R2 = .67) of the criterion variable variance. Contrary to hypotheses, none of the mindfulness skills proved to be a statistically significant predictor of drinking for enhancement motives. For discriminant validity, two additional regression analyses were conducted with the four mindfulness skills predicting the two external drinking motives: conformity and social motives. In each model, the relevant drinking motive was regressed on the four mindfulness skills while controlling for the effect of the other three drinking motives (see Table 2). The model predicting conformity drinking motives accounted for 22% of the criterion variable variance (Adj. R2 = .14), with mindfulness skills alone predicting 7% of the variance above and beyond that accounted for by the covariates (Fchange = 1.57, p = .19). Interestingly, only accepting without judgment was a statistically significant predictor of conformity drinking motives. Elevated accepting without judgment was associated with reduced drinking for conformity motives. The model predicting social drinking motives explained 76% of the criterion variable variance (Adj. R2 = .73), with mindfulness skills alone predicting 2% of the variance above and beyond that accounted for by the covariates (Fchange = 1.70, p = .16). None of the mindfulness skills proved to be a statistically significant predictor of social drinking motives.
A. Reynolds et al. / Addictive Behaviors 42 (2015) 222–226 Table 2 Motives regressed on mindfulness skills.
Table 3 Weekly alcohol use regressed on mindfulness skills.
Predictors
B
SE
β
Coping motives (criterion) Enhancement Conformity Social Observing Describing Acting with awareness Accepting without judgment
−.13 .25 .52 −.06 −.13 .10 −.31
.13 .68 .15 .11 .10 .12 .11
−.16 .04 .59 −.06 −.14 .08 −.29
R2
f2
t
p
−.93 .36 3.51 −.56 −1.25 .83 −2.68
.35 .72 .00 .58 b.01 .21 .02 .41 .01 .01 .10
−.95 −.59 10.28 1.23 .56 .92 −1.57
.35 .56 .00 .22 .02 .58 b.01 .36 .01 .12 .04
.36 −.59 1.68 .27 −.63 .02 −1.87
.72 .56 .10 .79 b.01 .53 b.01 .98 b.01 .05 .07
3.48 10.33 1.83 −.46 −.43 −1.64 1.70
.00 .00 .07 .66 b.01 .67 b.01 .11 .04 .10 .04
.44 (.24–.64)a Enhancement motives (criterion) Coping −.10 Conformity −.36 Social .94 Observing .12 Describing .05 Acting with awareness .10 Accepting without judgment −.16
.11 −.08 .61 −.04 .09 .87 .10 .09 .10 .05 .11 .06 .11 −.13 .70 (.59–.80)a
Conformity motives (criterion) Coping .01 Enhancement −.01 Social .05 Observing .01 Describing −.01 Acting with awareness .00 Accepting without judgment −.04
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.02 .05 .02 −.12 .03 .36 .02 .03 .02 −.08 .02 .00 .02 −.24 .22 (.07–.37)a
Social motives (criterion) Coping .29 .08 .26 Enhancement .65 .06 .71 Conformity .84 .50 .11 Observing −.04 .08 −.03 Describing −.03 .08 −.03 Acting with awareness −.15 .09 −.10 Accepting without judgment .14 .08 .12 .76 (.68–.84)a
Note: Coping = coping drinking motives; enhancement = enhancement drinking motives; conformity = conformity drinking motives; social = social drinking motives. The motives not specified as the outcomes were entered as covariates in each model. Conformity drinking motives variable was log transformed prior to analyses. a 95% Confidence interval.
Last, we tested the hypothesis that accepting without judgment would be a unique negative predictor of weekly alcohol use (see Table 3). Weekly alcohol use was regressed on the four mindfulness skills. This model accounted for 7% (Adj. R2 = .02) of the criterion variable variance. Contrary to hypotheses, accepting without judgment was not a statistically significant predictor of weekly alcohol use. However, acting with awareness was supported as a statistically significant predictor of weekly alcohol use. Specifically, elevated acting with awareness was associated with decreased weekly alcohol use. 4. Discussion The goal of this study was to clarify which mindfulness skills relate to alcohol use. We predicted that the mindfulness skill of accepting without judgment would be associated with reduced risk for internally-motivated drinking and heavy alcohol use. Our results partially supported our hypotheses. As expected, the ability to accept the present moment without evaluating, judging, or trying to change it was associated with the reduced motive to drinking for coping purposes. Unexpectedly, acceptance without judgment was unrelated to drinking for enhancement motives, but, interestingly, it was associated with decreased drinking for conformity motives. Contrary to hypotheses, accepting without judgment was unrelated to alcohol use, though acting with awareness was associated with reduced amount of alcohol consumed.
Predictors
B
SE
β
R2
Observing −.03 .06 −.06 Describing .07 .06 .17 Acting with awareness −.14 .07 −.25 Accepting without judgment −.05 .06 −.10
f2
t
p
−.46 1.27 −2.10 −.75
.64 b.01 .20 .02 .04 .06 .45 b.01
.07 (.00–.17)a Note. Weekly alcohol use: total number of alcoholic drinks in typical week (in past month). Weekly alcohol use variable was log transformed prior to analyses. a 95% Confidence interval.
Our results help clarify the association between accepting without judgment and internally motivated drinking. Those who are able to accept internal experiences as impermanent should be less inclined to drink to change mood states; but, to our knowledge, only one published study has examined the association between mindfulness and drinking motives (Leigh & Neighbors, 2009). While this study provided some evidence that mindfulness skills were related to drinking for enhancement motives, an association between mindfulness and coping drinking motives was not supported. However, drinking motives are highly correlated with one another (Cooper, 1994; Cooper et al., 1995), and this overlap should always be controlled for to parse out unique effects of the mindfulness skills on individual motives. In contrast with Leigh and Neighbors (2009), we found that accepting without judgment (or acceptance) was negatively related to drinking for coping motives after controlling for shared variance among all motives. Similar to Leigh and Neighbors (2009), we too found that accepting without judgment was uncorrelated with drinking for enhancement motives, even after examining unique effects. The ability to accept without judgment may allow individuals to distance themselves from negative internal experiences more readily; however, detaching from positive experiences may be more complex. Further, the accepting without judgment subscale from the KIMS questionnaire that we used taps more directly the acceptance of negative— rather than positive—emotions (e.g., I believe some of my thoughts are abnormal or bad and I shouldn’t feel them). The items do not tap acceptance of one's current positive affective state, which seems most germane to motivations to drink for enhancement purposes. Interestingly, our data suggest that those who are able to accept without judgment are less likely to drink for conformity reasons. Although not hypothesized, this result aligns with motives models of negative reinforcement-motivated drinking (e.g., Cooper, 1994). University life is rich with social events where alcohol use is normative. Students often find themselves around new people, and this may promote drinking to reduce the anxiety associated with potential social rejection, particularly in new social contexts (Stewart et al., 2001). We speculate that those who are capable of accepting without judgment may be able to accept the anxiety they have in new social contexts as impermanent. Therefore, these individuals may not feel propelled to drink to fit in, as they know the negative/aversive feelings will not last, especially as they get to know people in the social context. Further empirical testing is needed to test this hypothesis. Furthermore, our results indicated that acceptance without judgment was unrelated to the amount of alcohol consumed. However, acting with awareness (i.e., the ability to give ones' full attention, by being in the moment, to an activity while resisting distractions) was linked to decreased weekly alcohol use. This mindfulness skill is believed to lead to increased self-monitoring, and thus (we speculate) may be important for limiting drinking. Consistent with this interpretation, Baer (2003) suggests that an increase in present-moment awareness may encourage an increase in self-management and may facilitate more adaptive responses. Our study clarifies how mindfulness skills relate to negative reinforcement-motivated drinking and alcohol use, but there are some limitations. First, our sample size was relatively small, but our small-
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to-medium effect sizes for supported statistical effects are promising for future replication work in larger samples (Cohen, 1988). Although our small sample size precluded the full test of mediation, the next step would be to examine whether motives mediate the link between mindfulness and alcohol use. Second, we examined individuals' reported use of mindfulness as a trait variable, as it naturally occurs. We did not train people to use mindfulness skills, thus there may be large variability in the use of mindfulness skills between individuals. A randomized control trial testing the effects of mindfulness skills training on drinking motives seems warranted. In addition, there is research to suggest that there is within person variability in mindfulness as well as drinking motives, thus suggesting there is utility in measuring these as state variables (Armeli, Conner, Cullum, & Tennen, 2010; Weinstein, Brown, & Ryan, 2009). The use of daily diary methodologies may allow us to clarify how the link between mindfulness and drinking motives unfold, possibly even pointing towards a bidirectional association between mindfulness and drinking motives. Third, we used the KIMS to measure mindfulness skills; however, there is also a measure available that is based on a five-factor model of mindfulness: Five Factor Mindfulness Questionnaire (FFMQ) (Baer et al., 2006). Like the KIMS (which the FFMQ is in part derived from), the FFMQ taps the constructs of observing, describing, and acting with awareness. However, unlike the KIMS, the FFMQ measures two distinct facets of accepting without judgment: non-judging of internal experiences and non-reactivity towards internal experiences. It would be interesting for future research to use the FFMQ to examine if these two aspects of acceptance differentially reduce risk for internally-motivated drinking and alcohol use. Taken together, the findings of the current study suggest that it may be useful to emphasize mindfulness skills of accepting without judgment and acting with awareness in prevention programs and treatments aimed at reducing heavy drinking. Our results are in line with extant work showing that accepting without judgment improves emotional regulation (Kabat-Zinn, 1990) and distress tolerance (Linehan, 1994). Thus, it may be such that individuals can learn that they do not need to drink in order to control their negative emotions. Rather, being able to accept negative emotions and being tolerant of the present moment without judging it or trying to change it may be one pathway to reduced risk for alcohol misuse. Role of funding sources Funding for this study was provided by a Canadian Institutes of Health Research (CIHR) (200602MFE-159098-160922) grant awarded to Dr. O’Connor. M. T. Keough was funded by a Vanier Canada Graduate Scholarship (CGS) awarded by CIHR during completion of part of this work. The financial support had no role in the study design, collection, analysis or interpretation of the data, writing the manuscript, or the decision to submit the manuscript for publication. Contributors Ashley Reynolds conducted literature searches, wrote the introduction, methods, and discussion. Matthew T. Keough conducted the analyses and wrote the results and assisted with edits on the introduction and discussion. Dr. O’Connor designed the study, collected the data as part of her post doctorate, and provided edits on the entire manuscript. Conflict of interest All authors declare that they have no conflicts of interest. Acknowledgements N/A.
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