A qualitative exploration of young adults’ perceptions of a new intervention for alcohol use disorder

Abstract

Background

Due to the rising prevalence of alcohol use disorders among young adults, the need for effective and accessible interventions has become increasingly imperative. In acknowledgment of this issue, we developed a novel intervention known as contingency management plus problem solving therapy (CM-PST). The aim of the current study was to gain insight into the perspectives on the effectiveness of the newly developed CM-PST using focus group discussion among young adults who consume alcohol regularly.

Materials and Methods

The study employed a qualitative research design, utilizing focus group discussions as the primary data collection method. Participants described their perceptions regarding the newly developed CM-PST. Semi-structured focus group sessions were conducted via Zoom in November 2022. A total of 19 young adults, aged 18-24 years old, participated in five focus group sessions. Data were analyzed using deductive content analysis.

Results

Participants demonstrated overall positive attitudes toward the novel intervention, recognizing the potential benefits, it could offer in terms of alcohol use reduction and emotional well-being. They emphasized the importance of incentives in motivating behavioral changes, as well as the practicality of problem-solving techniques in addressing everyday challenges. Additionally, participants provided valuable insights into potential barriers and implementation challenges, highlighting the need for flexible and personalized approaches to accommodate individual preferences and needs.

Conclusions

The results of this study contribute to the growing body of literature on innovative intervention approaches for young adults facing alcohol use issues. The findings shed light on the acceptability and perceived effectiveness of the CM-PST intervention from the perspective of the target population.

Keywords:

• Alcohol use and misuse
• qualitative
• contingency management
• problem solving therapy

Introduction

Problematic alcohol use, which includes binge drinking episodes, heavy alcohol use, once-a-week alcohol consumption for a sustained period over 35 times increases the risk of alcohol use disorder (AUD) [1]. AUD is a chronic disease characterized by an impaired ability to stop or control alcohol use [1]. Not only is it a costly major public health problem, but also leads to interpersonal issues and an inability to fulfill everyday responsibilities at work, school, or home [2], most prevalent in young adults (aged 18-24 yr) [3]. Approximately 95,000 people, including young adults die annually in the United States from alcohol-related causes, making alcohol one of the most preventable causes of death in the United States [4]. In addition, AUD has significant adverse lifetime health implications, especially among young adults. Heavy alcohol consumption among young adults contributes significantly to secondary problems such as death from alcohol-related unintentional injuries, including motor vehicle crashes, and sexual assaults [4]. Although AUD is a significant public health concern, alarmingly, in 2019 only 7.3% of adults with AUD aged ≥ 18 years received any treatment in the past year [5].

Effective integrated treatments for young adults with AUD or who may be at risk for developing AUD are lacking, and new and effective integrated behavior-change interventions tailored to this specific population are needed. One recommended way to reduce alcohol consumption and provide treatment for AUD is contingency management (CM), a form of behavior therapy that rewards individuals for evidence of positive behavioral change, such as abstinence from alcohol [6–8]. The guidelines from the National Institute on Alcohol Abuse and Alcoholism and the UK National Institute for Health and Clinical Excellence recommend CM as one of the most effective treatment approaches for AUD or reducing alcohol consumption, especially when combined with other behavioral therapies [4,9]. Prior RCTs showed that CM significantly reduced alcohol use and increased alcohol abstinence in virtually all adults aged 18-65 yr, yielding moderate effect sizes (d=.46-.53) [10–14]. For example, Benishek and colleagues (2014) revealed in their meta-analysis that, when compared to treatment-as-usual, the CM approach as a behavioral intervention for young adults with AUD can enhance abstinence during the time that the intervention was being implemented.

Although CM is evidenced-based and included in the treatment guidelines recommended for AUD or reducing alcohol consumption, it has not been well-studied in young adults who consume alcohol and who may be at risk for developing AUD. Importantly, the modest effect sizes associated with CM alone warrant new research on augmented treatment approaches.

To overcome these challenges and improve treatment efficacy, we developed an innovative integrated intervention of contingency management (CM) plus problem solving therapy (PST) called CM-PST. The CM-PST is a tailored behavioral intervention that enables young adult drinkers, including those who may be at risk for AUD, to successfully manage and overcome everyday life challenges influencing their alcohol intake. PST involves brief psychotherapy that has demonstrated beneficial outcomes for multiple health problems across different age groups, including young adults [15–19]. PST is described as a form of “inhibitory control skills training,” particularly relevant for addressing risky behaviors such as heavy alcohol consumption leading to AUD development [20]. It reduced alcohol consumption vs. no-treatment (e.g. wait-list) controls in young adults (aged 18-25 yr) with AUD [21,22]. Another study found that individuals who receive PST noticed increased alcohol abstinence [23]. CM-PST teaches participants problem-solving skills using a structured 5-step method including 1) setting goals and action planning; 2) stress management coping skills, 3) positive behavioral change (alcohol abstinence), 4) week-to-week monitoring of specific targets, and 5) homework assignments and activities to be done between sessions over the 12-week intervention. To iteratively refine CM-PST, it is important to gain insight into the needs and preferences of young adult drinkers who are or may be at risk for developing AUD. Furthermore, it is necessary to acquire a comprehensive understanding of the acceptability of the intervention. Acceptability has emerged as a crucial factor in the development, evaluation, and implementation of healthcare interventions. The effective implementation relies on the intervention’s acceptability to both the researcher and study participants. Therefore, the aim of the current study was to gain insight into the perspectives on the effectiveness of the newly developed CM-PST using focus group discussion among young adults who consume alcohol regularly.

Method

We used a qualitative descriptive design [24–26], with content analysis to address the research aim. The Institutional Review Board for the University of Illinois at Chicago approved the study, 2022-1047. All participants provided written consent.

Sample

Participants were recruited in October 2022 from a university in the Chicago metropolitan area through flyers posted in high-traffic areas on college campuses such as dorms, libraries, and students’ listservs, in addition to placing flyers on Facebook. Recruitment materials included a study email address and phone number. The flyers also directed potential participants to a website to complete a screening survey via REDCap. Those who contacted study staff by email or phone were directed to the screening survey. Self-report responses were used to determine focus group eligibility. Participants were deemed eligible if they were between 18-24 years old, spoke English and who currently consume alcohol one or more days per week. We designed our screening criteria to be inclusive, aiming to capture feedback from a diverse range of drinkers who could potentially be at risk for developing Alcohol Use Disorder (AUD).

A total of 39 young adults were screened. Among these, 23 people met the inclusion criteria, 20 agreed to participate in a focus group session, and 19 people ultimately participated in a focus group session.

Materials and procedures

Participants were randomly assigned to one of five focus group sessions (3-5 participants/session), sufficient to capture 90% of themes [27]. Focus groups were conducted via Zoom in November 2022.

We developed a structured focus group interview guide (Supplementary Appendix A) and followed effective guidelines recommended by Ayala & Elder [28], to inform the discussion. As such, we started with an icebreaker activity and introductory questions then moved to specific questions on various aspects of the intervention structure. Prior to attending the focus group, each participant read a summary of the newly developed CM-PST intervention manual, which was emailed to participants a few days prior to the session. The CM-PST intervention manual defined the main components of contingency management and problem-solving therapy, the CM-PST goals and principles, CM-PST intervention structure, format, content, and activities lists. Focus group sessions were recorded via both Zoom and a digital audio-recorder.

CM-PST intervention structure, format and content

We developed the CM-PST intervention by integrating the essential components of CM, which has been used successfully in people at risk for developing or who have AUD [29,30], with PST, from an existing PST intervention developed by our team [31,32]. CM-PST intervention consists of 8 sessions total, delivered remotely via Zoom videoconferences in individual sessions over 12 weeks. The first 4 sessions are delivered weekly, and the remaining 4 sessions every other week. The first session lasts ∼45 min. It consists of a counselor providing knowledge of how alcohol use impacts physical and mental health, and introduces participants to CM-PST and expectations involved in intervention participation. The remaining sessions last 1 hr/session and focus on setting goals and action planning, developing and practicing stress management coping skills to address life problems, such as school-related, family, relationship or employment issues. During these sessions, the counselor and the participant work through a CM-PST booklet and collaboratively identify problems occurring in the participant’s life, and then focus on exploring one or more of these problems while the counselor teaches the participant a structured approach for resolving them. The counselor also equips participants with skills to monitor specific targets such as submission of daily breathalyzers. Participants receive incentives for alcohol abstinence. Participant incentives start at a $10 gift card, with a $5 increase each subsequent measurement point on which alcohol is not detected or reported, to a maximum of $25, but no gift card on days when alcohol use is detected or reported, and the gift card reinforcer value will be re-set to $10. Between-session homework assignments are clearly defined by the counselor, and the booklet provides a useful framework for tracking progress.

All focus groups were conducted by an experienced moderator and an assistant moderator who encouraged active participation from all participants. The moderator provided a 10–15-minute presentation on CM-PST prior to focus group discussion to refresh participants’ memory regarding CM-PST. The presentation included an overview of CM-PST, principles, goals, intervention format, content, and structure. The moderator then introduced the topic for the focus group discussion and the purpose of the session. The first few questions included open-ended questions on participants’ perceptions on heavy drinking, challenges young adults face with cutting down drinking and receiving treatment for addiction. The remaining questions included participants’ perceptions of CM-PST, length of each of the 8-week sessions of the intervention, number of sessions in total for the intervention, and the role of the counselor. Participants were then asked about how CM-PST could assist with their everyday living, abstaining from alcohol, and improving general wellbeing. The focus groups lasted 90-120 min. Participants received $50 cash or gift card as compensation for their time.

Rigor

We followed Morse’s criteria to ensure study rigor (reliability, validity) [34]. The moderator and assistant moderator followed a semi-structured interview guide for consistency and were both trained in moderating focus group sessions. They also debriefed and discussed the initial focus group findings after each session. A coding system was developed to analyze the data by establishing a codebook informed by the semi-structured interview guide. We ensured transparency in our findings by including rich participants’ quotations in our results and by representing multiple participants from the five focus groups. Validity was also ensured by prolonged engagement with the data that included multiple readings of the transcripts, and discussion of meanings and quotes selection between the authors. The final sample size supported the aims of the study. We kept an audit trail that consisted of our memos, observations, and analytic processes.

Data analysis

Focus group session recordings were transcribed verbatim and analyzed using Dedoose, a qualitative data analysis software. The first and second authors conducted content analysis following a directed deductive approach [33]. Preliminary codes were developed based on the main categories discussed in the structured interview guide (e.g. general impression, length of the sessions, role of the counselors) and were grouped under one main theme related to the overall feedback on the CM-PST intervention. After developing the preliminary code book, the first author performed the initial first level analysis of the five focus group transcripts. The second author conducted a second level analysis and identified any coding differences, if they existed, by using distinct colors. The first two authors met regularly and reviewed all codes and categories and their application to the five focus group transcripts. Discrepancies were discussed and resolved through consensus to reach 100% coding agreement.

Results

Participant characteristics are shown in Table 1. The average age of the participants was 23.1 years (standard deviation [SD] = 0.99; range: 21-24). The majority of the participants were male (53%, n = 10). Almost half of the participants identified as South Asian or Southeast Asian (47%, n = 9), 8 people were White (42%), one person identified as Central Asian, and another one was Middle Eastern/North African. Eleven participants had a part-time job (58%) and five were working full-time (21%).

Table 1. Demographic and acculturation characteristics of participants.

Variables	Results
	Mean ± SD	N (percent)	Range: Min-Max
Age, years	23.1 ± 0.9		21.0 − 24.0
Sex
Male		10 (52.6%)
Female		9 (47.4%)
Race/Ethnicity
South Asian/Southeast Asian		9 (47.4%)
Caucasian/White		8 (42.1%)
Central Asian		1 (5.3%)
Middle Eastern/North African		1 (5.3%)
Working status
Part-time		11 (57.99%)
Full-time		5 (26.3%)
Not working		3 (15.8%)

Notes. SD, standard deviation; Min, minimum; Max, maximum.

Participants engaged in in-depth conversations about heavy drinking, addiction, and different ways to develop appropriate interventions. Below we described the theme related to the overall feedback on the CM-PST intervention and its associated categories. We also provided exemplar quotes from the participants.

Overall feedback on CM-PST intervention

When participants were asked to provide feedback on the CM-PST intervention in general, and in relation to specific areas of the intervention, their feedback was grouped into two major categories: content-related feedback and logistics-related feedback.

Content-related feedback

General impressions of the intervention were generally positive

Overall, participants had a positive initial impression of the intervention and its benefits: “I actually like the idea very much” (Focus group #2); “the thing is that the whole idea and the whole goal of this intervention is actually pretty good, and society needs it” (Focus group #2); however, there were mixed concerns about the monetary benefits that the participants in the actual intervention would receive. Some thought the monetary incentives would deter from the main objectives of the program, as exemplified by these two participants’ quotes:

My first impressions were, I usually feel a little apprehensive if an intervention is primarily reward or money…. Say you’re someone who’s addicted to alcohol, and you do this for eight weeks, you get a bunch of money, and then it’s over and you go right back to it…. However, I don’t feel that way necessarily about this intervention because of the therapy visits. (Focus group #2)

Similarly, this participant shared the following:

Actually, I’m not sure that people would stop drinking or refrain from drinking because there’s not a huge difference in the values from those people who are not drinking and the people who are coming to test after drinking, maybe intentionally or unintentionally. (Focus group #4)

While other participants shared that the monetary incentives could be a positive aspect for engaging young adults in the program:

The biggest thing that stood out to me was the monetary compensation, in part. Most people our age are trying to get on their own feet around this time. That’s with cost of living going up, that’s, I think, a big thing. (Focus group # 1)

Some participants reported that the way the intervention is set up, could be isolating to many young adults who are also looking for social and community support to assist them with their heavy drinking:

One of my initial impressions when I read through it… was that it… there’s definitely some positives to it, but the big negative… was it seems really isolating…. They go to the lab twice a week. They go to their therapy sessions, but it’s all them going through this alone. They have a therapist, they have people who are engaging with them, but they don’t have a community in any sense. (Focus Group session 5)

Intervention addressing alcohol problems and abstinence

Participants also had some mixed attitudes towards how the intervention might address alcohol problems. One participant said: “I think it might a good start, but I really think it is so embedded in the culture that it’s gonna take a larger culture shift to really produce an environment where it’s easy to not drink alcohol” (Focus group #3). On the other hand, another participant in the same focus group discussed how it depends on the focus of the intervention:

If they [researchers] made aware of how cutting back or cutting out alcohol is going to improve our life, our health, our day-to-day… it’ll just increase efficiency in our day-to-day activities…. if the emphasis is put on reducing or cutting out alcohol, then it might help with the peer pressure, but if it is put on reducing the stress and hence, reducing the alcohol because of the stress, then yeah, as somebody mentioned, it might not be as helpful in those peer pressure situations. (Focus group #3)

However, the majority of the participants agreed that the intervention will help young adults in addressing their alcohol problems and abstinence in some way: “I would say, helping the students abstaining from alcohol because that is the main objective of this intervention. I think the students will be really eager, too, getting to abstain from the alcohol” (Focus group #4).

CM-PST may improve everyday living

All participants agreed that the intervention will also assist in everyday living situations, and not just with alcohol. One participant shared: “I think that the first, assisting with everyday living, because you will teach the student very important lessons, yeah, how to solve problems in general. They are everyday problems” (Focus group #5). Similarly, a participant from another focus group also shared: “For everyday living, if the intervention’s successful and people reduce alcohol, I would say that they would, number one, have less anxiety and have better mental health. Which would result in better relationships. Which would then trigger them drinking less” (Focus group #1).

CM-PST may improve general health and well-being

Almost all participants agreed that the intervention would also improve the general health and well-being of young adults: “The first is, like he said, that people will like that the program will help them abstain from alcohol, and also, improving their health and wellbeing through a health counselor” (Focus Group #4). One participant in focus group #5 also shared his perspective:

As far as improving general health and wellbeing, I think it would be helpful in so far as it prevents negative cycles. I’m not convinced necessarily that it’ll improve general health and wellbeing long term unless someone like fully stops drinking or gets further help afterwards. (Focus group #5)

Challenges to the CM-PST intervention for young adults

When asked about challenges that may be faced when using CM-PST with young adults, participants discussed several potential challenges such as social judgement, isolation from the young adults’ social spaces, not taking the activities of the intervention seriously, different beliefs regarding alcohol abstinence versus alcohol moderation, motivation, use of other substances, and the monetary incentives. Below are examples from participants’ quotes reflecting the discussed challenges:

The biggest problem will be the motivation to keep going, the motivation to continue in this entire thing. I know it seems like a short amount of time, but 12 weeks out of a student’s life, or 12 weeks out of someone between 18 to 24, is a lot of time. (Focus group #1)

People might not take the homework activity seriously. They might not actually be as serious about doing the whole intervention as they are about the money maybe. (Focus group #3)

PST is an essential part of the intervention

All participants agreed that the problem-solving aspect of the intervention was essential to its effectiveness. Participants discussed how many young adults drink because of the problems and traumas they faced in their lives, and therefore, an intervention that addresses these issues by teaching them new skills would be beneficial:

I think any intervention is useless actually if you don’t have something like that to go forward. Otherwise it’s just a thing you did for a few weeks, and it doesn’t really change anything ‘cause you didn’t learn anything, and you can just go right back to it…. It’s really important to have something that you can actually learn and use going forward. I think that’s basically the most important part of an intervention. (Focus group #2)

CM part of the intervention is important due to the monetary incentive to continue participating

Participants discussed that the use of contingency management is “My, first impression was actually one thing is the monetary benefit” They want to make quick bucks they can just get into the study and then later get back to their own schedule” (Focus group #2).

Logistics-related feedback

Length of the sessions

Participants had different opinions of the adequacy of the length of the sessions (8 sessions). Some participants considered it to be a long-time commitment especially for young adults who are also students: “I think eight weeks does seem like a long time for me, especially with research studies just that I’ve read personally” (Focus group #1); others discussed that 12 weeks are very reasonable to address a problem such as heavy drinking and alcohol addiction:

It seems like eight sessions might be helpful because that will require them to abstain from alcohol for an extended period of time to hopefully figure out long form solutions to, and problem-solving techniques. I think if it was a lot shorter it might be less impactful possibly. (Focus group #2)

The importance of the health counselor creating a safe, non-judgmental space

Overall, participants had a positive opinion about the use of a health counselor throughout the intervention. They recommend ensuring that the counselor is friendly, maintains confidentiality, provides a safe space, be understanding and non-judgmental. One participant shared: “I think, many times, people need someone who they can share. They want someone who they can talk to about some problem, and many times, they are not able to find some trustworthy person who, like < Name > said, who won’t share those things to anybody. A health counselor should be the one they should go… he should be friendly, and he should try to get him a way to get out of the problem. Those things should be really helpful” (Focus group #4). Another participant also shared a similar perspective:

If you’re dealing with anyone with an addiction it’s really important to be understanding and for there not to be any judgment. To actually feel comfortable, but that’s just really difficult, …It’s difficult to feel comfortable as an innate characteristic, but that’s essentially what you would want to do.… Especially if you’re underage drinking, you have to be really, you have to want to talk about it and feel like it’s an open space. (Focus group #2)

Urine drug screen is an appropriate component, but may be challenging

Participants considered that completing a urine drug screen twice a week is appropriate for the purpose of the intervention.

I think twice a week is a good option… even if a person drinks alcohol, then it should remain in the body for two to three days… If you change from twice a week to thrice a week, then a person might not even get a chance to drink, so if a person wants to stop drinking genuinely, then three times is the best option to ultimately stop him from drinking. If he wants to slow down and just trying to get along, then twice a week is fine. (Focus group #4)

However, some participants considered that it might be challenging for young adults to commit to this task and be motivated on a regular basis:

Well, the monetary benefit is helpful, but I do know, especially ‘cause I’ve done previous research in psychiatry where people had to do some sort of drug screening. It is really hard to get people to submit drug screens on a regular basis. Especially when they are addicted to the substance. (Focus group #2)

Counseling is the most important part of the intervention

Participants agreed that the most important parts of the intervention are 1) having access to mental health counseling: “I think the most important part, as its been laid out, is the access to mental health counseling” (Focus group # 5); “I believe counseling is the best thing because people in today’s life are not very open to sharing their ideas, sharing their feelings, sharing the things they are struggling with” (Focus group #4); 2) discussing a topic that is rarely talked about for young adults: “A lotta these concerns are not addressed enough in this age group. They’re just seen as a exploration phase;” “I think part of the reason why heavy drinking is so prevalent is because it’s taboo before you turn 21” (Focus group #3); and the monetary incentive: “I think people get paid for the test and for not drinking alcohol is the best part, yeah, as far as my thinking” (Focus group #4).

Changes made to CM-PST intervention based on feedback from participants

Due to the fact that some participants considered in person urine drug submission a possible challenging task for young adults to commit to be motivated on a regular basis, we made changes to eliminate twice a week in person urine submission to instead use remote breathalyzer tests which are more discrete and required no transportation costs for participants. In addition, despite the mixed attitudes expressed by participants regarding how the CM-PST intervention might address alcohol problems, and the length of intervention, the holistic approach of CM-PST addressed both the behavioral and cognitive aspects of addiction, which is a compelling reason for no additional changes made to the intervention.

Discussion

The purpose of this focus group study was to gain insight into the perspectives regarding the newly developed CM-PST. As for the overall feedback on the CM-PST intervention, participants’ responses were grouped into two major categories: content-related feedback and logistics-related feedback. Regarding the feedback on the content, participants expressed positive overall impressions of the intervention. They mentioned that CM-PST has the potential to enhance daily life, overall health, and well-being. However, they also highlighted some challenges specific to the CM-PST intervention for young adults. It was emphasized that PST is a crucial component of the intervention. Additionally, the inclusion of CM in the intervention was deemed important because it provides a monetary incentive for continued participation. The logistic-related feedback highlighted several key points, including the length of the sessions, the significance of the health counselor establishing a secure and non-judgmental environment, the difficulties associated with utilizing urine drug screens, and the relevance of counseling. Our findings suggest that the intervention is appropriate for young adults who regularly consume alcohol and who may be at risk for developing AUD, and that they may benefit from CM-PST intervention. Young adults focus group participants expressed overall positive attitudes towards CM-PST. This is an encouraging finding, as it suggests that young adults are open to exploring and engaging with innovative approaches to improve alcohol abstinence and may increase the likelihood of participants embracing and benefiting from the newly developed CM-PST intervention. In addition, participants recognized the potential benefits of the CM-PST intervention, particularly in terms of alcohol use reduction and emotional well-being.

Consistent with previous study, CM and Problem-Solving Therapy have shown effectiveness in promoting behavior change [35,36], and enhancing coping skills [15,37]. Even though there were perceived barriers among some participants, namely traveling for a twice weekly urine drug submission might be challenging for young adults to commit to, mixed attitudes about how the CM-PST intervention might address alcohol problems, and the length of the intervention, we understand that mixed attitudes within a focus group are not uncommon, especially when discussing complex issues like alcohol use. Participants likely come from various backgrounds and have different experiences, which can lead to a range of opinions. We believe that the perceived benefits of CM could serve as motivators for young adults to actively participate in the intervention and commit to the recommended strategies. Furthermore, the participants emphasized the significance of incentives in motivating behavioral changes. Participants’ responses regarding CM as part of the intervention demonstrate the importance of employing reinforcement strategies that resonate with young adults, thereby enhancing the intervention’s effectiveness. Further, another key finding is the recognition of the practicality of problem-solving techniques incorporated in the CM-PST intervention. Young adults face various challenges in their daily lives, and having effective problem-solving skills can empower them to address these challenges constructively. By acknowledging the relevance of these techniques, participants signal their readiness to adopt and implement problem-solving strategies to enhance their coping abilities.

Limitations

Our study should be interpreted with consideration for certain limitations. First, we attempted to recruit individuals from a variety of racial/ethnic and age groups. However, the majority of participants consisted of Asian and White young adults. Furthermore, all the participants were between 21 and 24 years old, and consequently the alcohol consumption risks faced by other age groups could not be accounted for. Our focus group was conducted via Zoom, therefore, the virtual format restricted participation to those with internet access and may have limited communicative cues (eye contact, turn taking). However, the virtual format allowed for participants with difficulty in transportation to participate and may have reduced normative pressures common in face-to-face focus groups [38]. Further, findings may not be fully generalizable to the broader population. The study population focused on young adults and partial race/ethnicity, and their perceptions of the CM-PST intervention might differ from other age groups or populations with different backgrounds and experiences. Nevertheless, the results from our focus group study provides valuable qualitative insights into participants’ perceptions of the newly developed CM-PST intervention, serving as an essential preliminary exploration that can inform further research and intervention development.

Implications for future interventions

The insights gained from this focus group study carry important implications for future intervention design. Understanding the preferences and perspectives of the target population can inform researchers and practitioners in refining and adapting CM-PST to make it more accessible and appealing to young adults.

Conclusion

Overall, the results of this focus group study contribute valuable knowledge to the field of alcohol use disorder intervention and prevention for young adults. The positive attitudes and perceived benefits expressed by participants provide a strong foundation for further research and implementation of the CM-PST intervention.

Authors contributions

HH contributed to the conception and design of the study, the analysis, the drafting of the manuscript and its final approval, and she is in agreement with all aspects of the work. SA, SL, KR, MS, AF, and MJ contributed to the data collection, analysis, the drafting of the manuscript and its final approval, and they are in agreement with all aspects of the work. All authors read and approved the completed manuscript.

Ethics statements

This study was approved by the Institutional Review Boards of an affiliated university (2022-1047).

Acknowledgments

We express our sincere thanks to the participants in our study, who shared their time, experiences, and insights with us.

Disclosure statement

JM is a paid scientific consultant for Health Mentor, Inc. (San Jose, CA). The other authors report no conflicts of interest.

Data availability statement

The data that support the findings of the study are available on request from the corresponding author, upon reasonable request. The data are not public due to ethics restrictions.

Additional information

Funding

This research was supported by a National Institute on Alcohol Abuse and Alcoholism (NIAAA) grant awarded to Hagar Hallihan (K99AA030665). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Alcohol Abuse and Alcoholism or the National Institutes of Health. No sponsor or funding source has a role in the design or conduct of the study; collection, management, analysis or interpretation of the data; or preparation, review or approval of the manuscript.