Trait mindfulness and protective strategies for alcohol use: Implications for college student drinking

Accepted Manuscript Trait mindfulness and protective strategies for alcohol use: Implications for college student drinking

Emma I. Brett, Thad R. Leffingwell, Eleanor L. Leavens PII: DOI: Reference:

S0306-4603(17)30150-8 doi: 10.1016/j.addbeh.2017.04.011 AB 5145

To appear in:

Addictive Behaviors

Received date: Revised date: Accepted date:

10 October 2016 1 April 2017 5 April 2017

Please cite this article as: Emma I. Brett, Thad R. Leffingwell, Eleanor L. Leavens , Trait mindfulness and protective strategies for alcohol use: Implications for college student drinking. The address for the corresponding author was captured as affiliation for all authors. Please check if appropriate. Ab(2017), doi: 10.1016/j.addbeh.2017.04.011

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ACCEPTED MANUSCRIPT Running head: MINDFULNESS AND PROTECTIVE STRATEGIES Trait Mindfulness and Protective Strategies for Alcohol Use: Implications for College Student Drinking Emma I Brett, M.S.,a Thad R. Leffingwell, Ph.D.,a & Eleanor L. Leavens, M.S.a Department of Psychology, Oklahoma State University, Stillwater, OK

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Correspondence concerning this article should be addressed to Emma Brett, Department of Psychology, Oklahoma State University, 116 N. Murray, Stillwater, OK, 74078. Phone: 773.981.3662. Fax: 405.744.8067. Email: [email protected].

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Word count: 3,675 Tables: 3 Figures: 3

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Trait Mindfulness and Protective Strategies for Alcohol Use: Implications for College Student

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Drinking

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Date Resubmitted:

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March 31st , 2017

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Abstract Introduction. The use of Protective Behavioral Strategies (PBS) has been strongly linked with decreased experience of alcohol-related consequences, making them a potential target for intervention. Additionally, mindfulness is associated with decreased experience of alcohol-

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related consequences. The purpose of the current study was to evaluate a model of PBS as a

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mediator of the effect of mindfulness on alcohol-related consequences. Additionally,

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mindfulness as a moderator of the relationship between PBS and alcohol use and consequences was examined.

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Methods. College students (N = 239) at a large South Central university completed self-report

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measures of demographics, alcohol use and consequences, use of PBS, and trait mindfulness. Results. Results indicated that both higher levels of mindfulness and using more PBS predicted

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decreased alcohol-related consequences and consumption, with PBS mediating both relationships

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(p < .01). Those with higher levels of mindfulness were more likely to use PBS, with individuals using more PBS experiencing fewer alcohol-related consequences and consuming fewer drinks

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per week. Mindfulness moderated the relationship between PBS and consequences, with a

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significantly stronger negative relationship for those with lower levels of mindfulness. Conclusions. Individuals who are higher in trait mindfulness are more likely to use PBS, which

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leads to a decrease in the experience of alcohol-related consequences. Furthermore, for individuals lower in mindfulness, low PBS use may lead to increased experience of alcohol consequences. Interventions that incorporate PBS may be most beneficial for students who are low in mindfulness and unlikely to engage in drinking control strategies. Keywords: alcohol, consequences, college drinking, brief intervention, mindfulness

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1. Introduction Hazardous drinking behavior in college students continues to be a significant problem within the U.S. Nearly two in five (39%) full-time college students reported engaging in binge drinking episodes in the last year (Substance Abuse and Mental Health Services Administration,

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2014). Compared to non-college respondents of the same age, college students are more likely to

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report binge drinking episodes (4 or more drinks in a sitting for women, five or more drinks for

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men) and driving while under the influence (Hingson, 2010). Students who misuse alcohol put themselves at risk for a wide range of negative consequences, including increased risk for

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injuries, assault, and causing harm to others (Hingson, Zha, & Weitzman, 2009). Additionally,

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alcohol misuse by adolescents and young adults puts individuals at a greater risk for neurodegeneration and is associated with numerous neurocognitive deficits (Zeigler, et al.,

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2004). Due to this wide range of negative outcomes associated with heavy alcohol use as well as

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the vast costs to society, effective prevention and intervention efforts are crucial for this highrisk population.

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The use of protective behavioral strategies (PBS) while using alcohol may mitigate the

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harms associated with heavy alcohol use. PBS are behaviors that increase self-control while drinking and help reduce negative alcohol-related consequences (Pearson, 2013). There are a

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variety of different protective strategies, ranging from adding extra ice to your drink to avoiding taking shots or trying to out-drink those with whom one is drinking (Martens et al., 2005). Recent research has established an association between the use of PBS and alcohol use and outcomes: those who report more PBS use tend to drink less and experience fewer alcoholrelated problems (Pearson, 2013). Brief interventions for alcohol use that include personalized feedback, motivational interviewing, and a behavioral skills component, similar to PBS, are more

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efficacious than interventions that focus solely on education (Larimer & Cronce, 2007; Miller et al., 2013). The negative relationship between PBS and decreased experience of alcohol-related consequences has been replicated in numerous studies (Pearson, 2013; Martens et al., 2008);

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therefore, interest in PBS as a construct and as a potential mechanism for change in interventions

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has continued to increase. Though numerous studies have examined the association between PBS

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and other relevant variables, including PBS mediation models and moderators of the relationship between PBS and alcohol outcomes (Martens et al., 2008; D’Lima, Pearson, & Kelley, 2012;

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Patrick, Lee, & Larimer, 2011), PBS use is yet to be integrated into a specific theoretical

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framework (Pearson, 2013). Examining factors that predict PBS use along with replicable moderators are important for determining a theory for which PBS use relates to our current

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understanding of drinking behaviors. Moving toward this, numerous studies have examined PBS

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as a mediator of the relationship between individual difference variables and alcohol-use and associated consequences. Variables that appear to have a relationship with PBS include

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depressive symptoms (Martens, et al., 2008), self-regulation (Pearson, Kite, & Henson, 2013;

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D’Lima et al., 2012), and self-control (Pearson et al., 2013). Additionally, research has investigated potential moderators of PBS and alcohol use, such as negative urgency (Weaver,

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Martens, & Smith, 2012) and coping motives (Patrick et al., 2011). Given that PBS is linked to self-regulation and related constructs, PBS likely represents a drinking specific behavioral selfregulation strategy. For those who are high in self-control and/or low in negative urgency, PBS use might be intuitive, whereas individuals who are more impulsive or are low in self-control may be unaware of such strategies or unable to utilize them successfully.

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Mindfulness, or being nonjudgmentally aware and attentive to the present moment, is related to both self-control and goal achievement (Brown and Ryan, 2003; Masicampo & Baumeister, 2007). It is also negatively associated with specific facets of impulsivity, including negative urgency, positive urgency, and lack of perseverance (Peters, Erisman, Upton, Baer, &

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Roemer, 2011), facets related to drinking quantity, frequency, and related problems

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(Coskunpinar, Dir, & Cyders, 2013). PBS use while drinking can be thought of as a behavioral

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manifestation of maintaining awareness and self-control while drinking, both of which are closely related to mindfulness; therefore, examining associations between mindfulness and PBS

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may have important implications.

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Associations between mindfulness and alcohol use and related outcomes have been investigated in numerous studies. Broadly, trait mindfulness tends to be associated with

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decreased alcohol consumption and experience of fewer alcohol-related negative consequences

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(Fernandez, Wood, Stein, & Rossi, 2010; Smith et al., 2011; Shorey, Brasfield, Anderson, & Stuart 2014). Adults seeking treatment for substance use disorders have been found to have

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lower levels of mindfulness compared to adults not seeking treatment for substance use disorders

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(Shorey et al., 2014). Furthermore, nonjudging thoughts and feelings (an acceptance-based factor of mindfulness) seem to be negatively related to alcohol-related consequences (Fernandez et al.,

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2010). One study measured alcohol problems and mindfulness in urban firefighters and found that mindfulness was associated with fewer alcohol problems as well as fewer PTSD, depressive, and physical symptoms, even after controlling for other study variables (Smith et al., 2011). Due to the associations between mindfulness and reduced alcohol-related consequences, there is encouraging evidence in support of mindfulness-based interventions for problematic substance use (Bowen et al., 2009; Bowen et al., 2014).

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Though research has examined mindfulness as it relates to substance use broadly as well as interventions for substance use disorders, trait or state mindfulness has not been examined within any PBS and alcohol use framework. Because mindfulness has been linked to more goaldirected behavior and possibly less intrusive negative thinking, thus improving self-control

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(Masicampo & Baumeister, 2007), it seems likely that mindfulness would be positively

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associated with PBS use. A study by Brown and Ryan (2003) evaluated the ability of both state

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and trait mindfulness to predict self-regulation, and found that both significantly predicted selfregulation facets of behavioral autonomy and negative affect. Furthermore, mindfulness appears

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to be related to problem-focused coping strategies (Charoensukmongkol, 2013), suggesting that

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individuals who are more mindful may be more likely to engage in behavioral coping strategies, similar to PBS. It is currently unknown how mindfulness may be related to PBS use, but it is

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possible that use of such strategies may be especially important for individuals with low levels of

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mindfulness who are more likely to consume more alcohol and experience more negative consequences as a result of their drinking.

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To date, no research has examined a direct link between mindfulness and specific

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behavioral strategies to mitigate negative alcohol-related consequences; it is currently unclear how mindfulness might relate to PBS use. Because PBS represent a type of drinking control

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strategy and mindfulness increases self-control, it seems likely that mindfulness may be positively associated with PBS use, which in turn is associated with decreased alcohol consumption and consequences. It is also possible that PBS use is particularly important for individuals who are at higher risk for experiencing negative alcohol-related consequences (D’Lima et al., 2012; Weaver et al., 2012), such as individuals with lower levels of mindfulness (Roos, Pearson, & Brown, 2015). The primary aim of this study is to evaluate two separate

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models of PBS and mindfulness as they relate to alcohol use and related consequences. First, it was hypothesized that PBS would mediate the relationship between mindfulness and alcohol use and consequences. Second, it was predicted that mindfulness would be a moderator of the relationship between PBS and alcohol use and consequences such that PBS use would be more

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strongly negatively related to alcohol outcomes in those who are less mindful.

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2.1 Participants and Procedure

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2. Method

A convenience sample of undergraduate students who reported recent alcohol use from a

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large, public, south central university were recruited. Participants were eligible to participate if

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they were 18 years or older and reported at least one drinking episode within the past month. Participants completed all measures via an online survey and received credit within their

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psychology or speech course for participation. Eligible participants self-selected into the current

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study via an online research recruitment system and were then redirected to a secure website to complete the study. Participants received course credit upon completion of the study. No

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monetary or other compensation was offered. Participants who exited the survey prior to

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completion were not granted credit because there was no way to identify them as identifying information was collected via a separate survey upon study completion to protect their

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anonymity. All procedures were approved by the university’s Institutional Review Board. 2.2 Measures

Demographics. Participants completed demographic questions that included age, gender, ethnicity, year in school, current living situation, Greek system involvement, and marital/dating status.

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Alcohol Use. All participants completed the Daily Drinking Questionnaire (DDQ; Collins, Parks, & Marlatt, 1985). This 4-item measure assessed the amount an individual drank each day during a typical week over the past month as well as the number of hours spent drinking each day of a typical week during the past month. Convergent validity of the DDQ with

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its original measure was significantly correlated, Pearson’s r = .50.

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Protective behavioral strategies for alcohol use. Participants completed the Protective

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Behavioral Strategies Survey (PBSS; Martens et al., 2005) to measure engagement in protective behaviors while drinking. This is a 15-item measure in which participants are asked to rate the

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extent to which they engage in each behavior while drinking on a 6-point scale ranging from

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“never” to “always”. Examples of protective strategies include “use a designated driver” and “alternate alcohol and nonalcoholic drinks”. This measure has demonstrated construct and

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criterion validity along with high reliability (Martens, Pederson, Labrie, Ferrier, & Cimini,

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2007).

Alcohol-related consequences. To measure alcohol-related consequences, participants

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completed the Brief Young Adult Alcohol Consequences Questionnaire (B-YAACQ; Kahler,

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Strong, & Read, 2005). The B-YAACQ is a 24-item measure that assesses a number of potential consequences related to drinking experienced by college students during the past month. Items

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are dichotomous (yes/no) and range in severity from “while drinking, I have said or done embarrassing things” to “I have passed out from drinking”. This measure has been validated among college student samples and has demonstrated strong internal consistency (Kahler, Hustad, Barnett, Strong, & Borsari, 2008). Mindfulness. Participants completed the Five Facet Mindfulness Questionnaire (FFMQ; Baer, Smith, Hopkins, Krietemeyer, & Toney, 2006), a 39-item measure that assesses five

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separate facets of mindfulness: observing, describing, acting with awareness, nonjudging of inner experience, and nonreactivity to inner experience. Each item is rated on a five-point scale ranging from “never or very rarely true” to “very often or always true”. Each of the five facets have demonstrated at least acceptable reliability and validity (Christopher, Neuser, Michael, &

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Baitmangalkar, 2012).

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Validity Items. In order to help detect participants that were responding randomly or

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inaccurately, two scales from the Elemental Psychopathy Assessment (Lynam et al., 2011) were embedded throughout the survey. The infrequency and virtue scales are each made up of eight

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items that are very rarely endorsed by those who are responding honestly and accurately. If a

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participant endorsed four or more items on the infrequency scale or three or more items on the virtue scale, results were considered invalid (Lynam et al., 2011). Furthermore, five face valid

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items, such as “I answered all items honestly and accurately”, were included at the end of the

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survey to help identify random or inaccurate responding. 2.3 Data analytic plan

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Data were screened for missing values and outliers prior to analysis. Of the 442

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participants who agreed to participate in the study, 24 (2%) admitted random or dishonest responding or received significantly elevated scores on validity scales, 66 (15%) did not

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complete the majority of the survey, and 113 (26%) denied alcohol use over the past month at time of survey completion and therefore no longer met eligibility criteria and were excluded from analyses. Outliers (n = 9) were replaced with the value that was three standard deviations and one integer above the mean, as recommended by Tabachnick and Fidell (2007). Analyses proceeded in two steps. First, a simple mediation using the bias corrected bootstrap using 2,000 samples was conducted using procedures described by Hayes (2013) to test

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whether the use of PBS was a mediator for the relationship between mindfulness and alcohol use and related consequences. Second, mindfulness was examined as a potential moderator of the relationship between PBS and alcohol use and related consequences. Given the positive skew in both of the dependent variables, using the bias-corrected bootstrap confidence interval for

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indirect effects was most appropriate (Hayes, 2013). Gender was included as a covariate in all

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analyses given that men reported consuming significantly more alcohol than women per week.

2013).

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3. Results

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All analyses were completed using the SPSS PROCESS macro (IBM Corp, Armonk, NY; Hayes,

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3.1 Sample characteristics

The final sample consisted of 239 participants (see Table 1). Participants were an average

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of 19.46 years of age, with the majority being Caucasian (83.7%) and female (64.9%).

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Participants reported drinking an average of 10.36 drinks in a typical week, with 72% engaging in at least one binge drinking episode over the past month. Students reported experiencing an

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average of 5.82 alcohol-related consequences in the past month. Additionally, participants had an

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average score of 57.23 (out of 90) on the PBSS and 130.49 (out of 195) on the FFMQ. 3.2 PBS Mediation Model

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A simple mediation analysis was conducted to examine the use of PBS as a mediator of the relationship between mindfulness and both alcohol use and related consequences (Table 2). For the consumption model (Figure 1), results indicated that higher levels of mindfulness predicted decreased drinks per week (M = -0.13, t = -3.54, p < .001, 95% CI = -0.20 to -0.06). Additionally, mindfulness predicted increased use of PBS (M = 0.29, t = 5.34, p < .001, 95% CI = 0.18 to 0.39). Furthermore, greater use of PBS (M = -0.31, t = -7.76, p < .001, 95% CI = -0.39

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to -0.23), but no longer higher levels of mindfulness (p = .23), predicted decreased drinks per week. Results for the consequences model (Figure 2) also indicated that higher levels of mindfulness (M = -0.08, t = -4.64, p < .001, 95% CI = -0.12 to -0.05) and greater use of PBS (M = -0.15, t = -7.93, p < .001, 95% CI = -0.19 to -0.12) predicted decreased alcohol-related

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consequences. After including the mediator, higher levels of mindfulness still predicted

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decreased alcohol-related consequences (M = -0.04, t = -2.32, p = .021, 95% CI = -0.07 to -0.01.

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For both the consumption (bootstrapped CI = -0.13 to -0.06) and consequences (bootstrapped CI = -0.07 to -0.03) models, indirect effects of mindfulness were significant, as the confidence

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intervals did not contain zero.

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3.3 Mindfulness moderation model

For predicting drinks per week, there was a significant main effect for PBS ( = -0.60, t =

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-2.04, p < .05, 95% CI = -1.18 to -0.02), but not for mindfulness ( = -0.17, t = -1.26, p = .21,

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95% CI = -0.45 to 0.09); no significant interaction was present (p = .32). However, there were

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significant main effects for both PBS ( = -0.47, t = -3.32, p < .01, 95% CI = -0.75 to -0.19) and mindfulness ( = -0.18, t = -2.77, p < .01, 95% CI = -0.31 to -0.05) for predicting alcohol-related

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consequences, qualified by a statistically significant interaction ( = 0.002, t = 2.25, p = .025,

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95% CI = 0.0003 to 0.0045; Figure 3), which explained a significant increase in variance in experience of consequences, ΔR2 = 0.02, F(1, 235) = 5.06, p = 0.03. For both individuals low (one standard deviation below mean;  = -0.19, t(235) = -7.25, p < .01) and high (one standard deviation above mean;  = -0.11, t(235) = -4.12, p < .01) in mindfulness there was a relationship between PBS use and alcohol-related consequences. This relationship was stronger for those low in mindfulness versus high in mindfulness, indicating that individuals who used more PBS

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reported fewer alcohol-related consequences than those who used fewer PBS, but that the strength of the effect was weaker for individuals high in mindfulness. 4. Discussion The current study evaluated the relationship between the use of PBS, mindfulness,

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alcohol use, and related consequences. Results indicated that higher levels of trait mindfulness

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predicted PBS use, which in turn predicted decreased alcohol use and consequences.

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Mindfulness appeared to moderate the relationship between PBS and consequences, demonstrating that for those with low levels of mindfulness, the negative relationship between

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PBS use and experience of consequences was stronger.

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Students with higher levels of trait mindfulness were more likely to use PBS, in turn leading to reduced experience of alcohol-related consequences and weekly drinking. As PBS use

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has become increasingly important for understanding student drinking behaviors, it is important

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to determine factors that predict PBS use. The current findings suggest that levels of mindfulness can predict who is already using PBS. Given that interventions have been shown to modify PBS

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use and PBS has been found to mediate intervention (Pearson, 2013), interventions that

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incorporate a mindfulness component along with specific strategies to target PBS use may be beneficial. Mindfulness is a skill that can be practiced and improved upon (Bishop et al., 2004).

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Given the recent use of and support for mindfulness-based interventions for substance use disorders (Bowen et al., 2009; Bowen et al., 2014), interventions that integrate mindfulness and PBS skills may be particularly useful. Acting mindfully may improve an individual’s ability to utilize such skills while drinking. As individuals practice mindfulness skills, they may be better able to observe and recognize when their drinking leads to harmful outcomes and be better able to implement skills, such as PBS, to mitigate negative consequences.

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In predicting drinks per week, increased PBS was related to decreased alcohol use, but this relationship was not moderated by mindfulness. However, mindfulness did moderate the relationship between PBS and alcohol-related consequences. Individuals who used more PBS experienced fewer alcohol-related consequences regardless of levels of mindfulness, whereas

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those who used fewer PBS and were more mindful experienced fewer consequences than

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individuals who used fewer PBS and were less mindful. This relationship suggests that for those

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who have low levels of mindfulness, low PBS use may lead to increased experience of alcoholrelated consequences; drinkers low in mindfulness and with low engagement in protective

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strategies while drinking may be at an especially high risk for experiencing negative

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consequences. Interventions including behavioral skills components should target individuals who are low in mindfulness as they may benefit most from receiving such information, whereas

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it may be redundant for students who are already using PBS or similar strategies to regulate their

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drinking.

Though both mindfulness and PBS have been examined in relation to alcohol use and

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related consequences, this is the first study to examine mindfulness in a PBS use framework. In

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recent years, PBS use has been continuously examined with a variety of variables, though it has yet to be integrated into a theoretical framework. Determining factors that predict PBS use along

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with establishing moderators of the established negative relationship between PBS and experience of consequences are crucial steps toward determining how PBS fits into what is already known about drinking behaviors and subsequent consequences. Furthermore, though the literature supports the efficacy of brief interventions for alcohol use among college students, particularly interventions that include skills-based components (Larimer & Cronce, 2007), there is differential effectiveness among interventions; it is still largely unknown which components of

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interventions are most effective or whom interventions should target. Given that those higher in mindfulness often have greater self-control and increased behavioral autonomy and goal-directed behavior (Masicampo & Baumeister, 2007; Brown & Ryan, 2003), the association between mindfulness and PBS fits well within the literature’s conceptualization of PBS as drinking self-

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control strategies. Targeting individuals who are low in mindfulness may be a useful way to

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identify those who may benefit most from a brief intervention targeting mindfulness and use of

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PBS. Specifically, many individuals low in mindfulness may be unlikely to utilize behavioral skills such as PBS on their own, and may benefit the most from such interventions. However, it

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appears that individuals who do use PBS experience fewer alcohol-related consequences even if

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they are lower in mindfulness, suggesting the use of such skills alone may be enough to mitigate the experience of negative consequences. Future research should examine whether mindfulness-

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based interventions for alcohol use can be combined with drinking control strategies, resulting in

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an efficacious skills-based intervention with positive long-term benefits. The current study is not without limitations. First, all data was reported via self-report

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measures, therefore random and/or inaccurate reporting may have occurred. However, the use of

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validity items was included to reduce the impact of this issue. Second, the study relied on crosssectional data, limiting the ability to make temporal inferences. Future studies should include

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longitudinal designs to strengthen existing conclusions on PBS, as most of these studies have also utilized a cross-sectional design. Additionally, the sample was predominantly female, Caucasian, and lower classmen, reducing the ability to generalize results to all college students. Finally, consistent with previous literature, the FFMQ was used as a measure of trait mindfulness in the current study (Peters et al.,, 2011; Thompson & Waltz, 2007). However, mindfulness is also a state that fluctuates (Brown & Ryan, 2003), and it is possible the measurement was

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capturing individuals’ feelings at a particular moment in time that may not be truly representative of how they typically act. Despite these limitations, the current study is the first to investigate mindfulness in relation to PBS and alcohol use among college students who use alcohol. PBS mediated the

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relationship between mindfulness and both drinks per week and alcohol-related consequences.

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Furthermore, PBS appeared to be protective for college student drinkers who are less mindful,

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mitigating their experience of negative consequences. Additional research is needed to determine if brief interventions incorporating behavioral skills should specifically target individuals who

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are low in mindfulness. Also unknown is whether incorporating elements of mindfulness into

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interventions for alcohol misuse would increase PBS use or if drinking control skills need to be directly addressed. Finally, research should continue to address the questions of whom

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interventions should target and which components are most effective for which populations.

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Table 1 Participant demographics (N = 239) Variable Males (n = 84) Females (n = 155) Race n (%) Caucasian 68 (81%) 132 (85.2%) American Indian 7 (8.3%) 7 (4.5%) African American 4 (4.8%) 7 (4.5%) Hispanic/Latino 2 (2.4%) 4 (2.6%) Biracial 3 (3.6%) 2.1 (1.3%) Asian 0 (0%) 2 (1.3%) Other 0 (0%) 1 (0.6%) M (SD) M (SD) t(237) p Age 19.60 (1.83) 19.39 (1.91) .79 .430 DPW 13.63 (12.07) 8.60 (8.30) 3.42 .001 BYAACQ 5.88 (5.04) 5.79 (4.70) .14 .886 PBSS 53.02 (14.47) 59.51 (14.68) -3.28 .001 FFMQ 133.18 (16.72) 129.03 (16.75) 1.83 .069 Note. DPW = drinks per week. BYAACQ = Brief Young Adult Alcohol Consequences Questionnaire (higher scores indicate more consequences). PBSS = Protective Behavioral Strategies Survey (higher scores indicate greater PBS use). FFMQ = Five Facet Mindfulness Questionnaire (higher scores indicate greater levels of mindfulness).

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Table 2 Mediation model examining the effects of mindfulness (FFMQ) on drinks per week (DPW) and alcohol-related consequences (BYAACQ) via protective behavioral strategies (PBS) FFMQDPW B Lower bound Upper bound p -0.1311

-0.2042

-0.0581

.0005

Indirect effect via PBS

-0.0893

-0.1348

-0.0569

.0000

Direct effect

-0.0418

-0.1109

0.0274

.2349

Total effect

-0.0832

-0.1186

Indirect effect via PBS

-0.0440

-0.0656

Direct effect

-0.0392

-0.0725

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Lower bound

Upper bound

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-0.0479

.0000

-0.0253

.0000

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FFMQBYAACQ

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-0.0059

p

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Table 3 Moderation model examining mindfulness (FFMQ) as a moderator of the relationship between use of protective behavioral strategies (PBS) and drinks per week (DPW) and alcohol-related consequences (BYAACQ). DPW Lower bound Upper bound p  -0.17

-0.45

0.09

0.21

PBS

-0.60

-1.18

-0.02

0.04

FFMQ x PBS

0.002

-0.002

0.007

-0.18

-0.31

PBS

-0.47

-0.75

FFMQ x PBS

0.002

0.0003

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-0.19

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0.0045

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Figure 1 Mediation model with mindfulness predicting drinks per week via protective behavioral strategies. Protective Behavioral Strategies .286***

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Drinks Per Week

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Note. All regression coefficients are unstandardized. ** p < .05. *** p < .001.

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Figure 2 Mediation model with mindfulness predicting alcohol-related consequences via protective behavioral strategies. Protective Behavioral Strategies 0.286***

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Alcohol-related Consequences

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Note. All regression coefficients are unstandardized. ** p < .05. *** p < .001.

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10 9 8 7

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Mindfulness High

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Mindfulness Low

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Alcohol Consequences (BYAACQ score)

Figure 3 Effect of protective behavioral strategies (PBS) on alcohol-related consequences (BYAACQ) at high and low levels of mindfulness (FFMQ).

0 Low

Average

High

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Protective Behavioral Strategies (PBSS score)

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Note. High mindfulness scores correspond to scores one standard deviation above the mean and low scores correspond to scores one standard deviation below the mean.

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Role of Funding Sources No financial support was provided for the current study. Contributors EB and TL conceptualized the study. EB and EL oversaw data collection. EB analyzed data and EB, TL, and EL wrote sections of the manuscript. All authors contributed to interpretation of results and revisions of the manuscript.

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Conflict of Interest All authors declare that they have no conflicts of interest.

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Primary findings - The current study examined PBS and mindfulness as they relate to alcohol outcomes. - PBS mediated the relationship between mindfulness and alcohol outcomes. - Mindfulness moderated the relationship between PBS use and alcohol consequences. - Interventions targeting those low in mindfulness may be effective in reducing consequences.