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. Author manuscript; available in PMC: 2019 Jul 2.
Published in final edited form as: Exp Clin Psychopharmacol. 2018 Feb 1;26(2):132–137. doi: 10.1037/pha0000184

Adolescents Who Experienced Negative Alcohol Related Consequences Are Willing to Experience These Consequences Again in the Future

Matthias Wicki 1, Kimberly A Mallett 2, Marina Delgrande Jordan 3, Racheal Reavy 4, Rob Turrisi 4, Aurélie Archimi 5, Emmanuel Kuntsche 6
PMCID: PMC6604618  NIHMSID: NIHMS1030282  PMID: 29389210

Abstract

Alcohol use and risky single occasion drinking are common among adolescents and are associated with a higher risk of various negative social, physical, academic, or sexual consequences. Studies have shown that among college students, willingness to experience negative consequences is associated with a higher likelihood of experiencing these consequences in the future. However, it remains unclear how experiencing negative consequences influences adolescents’ willingness to experience them again. Based on a representative sample of 1,333 alcohol-using 14- to 15-year-olds (47.9% female) a path model was used to examine the associations between risky drinking, negative social and physical consequences, and willingness to experience the specific consequence in the future. As hypothesized, more frequent risky drinking was positively associated with experiencing negative consequences (i.e., saying or doing embarrassing things, regretted sexual experiences, impairment of schoolwork, problems with parents/friends, accident or injury, hangover, vomiting, memory lapses). Contrary to our second hypothesis, adolescents who experienced a negative consequence were also consistently willing to experience it in the future. Findings suggest that adolescents may see the experience of negative consequences as a necessary evil to attain the positive consequences. Prevention efforts may benefit from focusing on ways of attaining positive consequences by promoting alternatives to engaging in risky drinking practices, as well as reducing negative consequences (e.g., by promoting protective behavioral strategies).

Keywords: Adolescents, Willingness, Negative Consequences, Alcohol, Risky Single Occasion Drinking

Alcohol use and drunkenness increase substantially during early- and middle-adolescence (Inchley et al., 2016). Research has shown that drunkenness or risky single-occasion drinking (RSOD) is associated with a higher risk of negative physical, academic, interpersonal, sexual, and legal consequences (Boden & Fergusson, 2011; Bonnie & O’Connell, 2004; Gmel, Rehm, & Kuntsche, 2003; Miller, Naimi, Brewer, & Jones, 2007). To prevent these consequences, it is necessary to consider that a large proportion of variance in consequences is not accounted for by alcohol use per se (Larimer, Turner, Mallett, & Geisner, 2004; Mallett, Varvil-Weld, Turrisi, & Read, 2011; Turner, Larimer, & Sarason, 2000).

Willingness to Drink Alcohol and Experience Consequences

Based on the dual-pathway Prototype-Willingness Model (PWM; Gibbons, Gerrard, Lane, Suls, & Wallston, 2003), adolescents’ behavior is influenced by both reasoned action (i.e., intentions) and social reaction (i.e., willingness). Some adolescents go into situations where alcohol use may happen, but do not plan to engage in alcohol use and instead are simply open to the opportunity. Research has shown that, independent of each other, both intentions and willingness to drink significantly predict risky drinking (Gibbons, Gerrard, Blanton, & Russell, 1998; Gibbons et al., 2003).

While studies utilizing the PWM have examined willingness to drink among younger adolescents (e.g., Andrews, Hampson, & Peterson, 2011; Kalebić Maglica & Dorčić Martinac, 2016), less is known about their willingness to experience consequences. Research has shown that among older adolescents (i.e., 18–19-year-olds) who were willing to experience specific physical (i.e., memory lapses, vomit, hangover) and social (i.e., become rude or obnoxious) consequences reported higher rates of these problems compared to individuals with lower willingness (Mallett et al., 2011). This association was partially mediated by alcohol use (i.e., significant, positive α*β-path in Figure 1: Mallett et al., 2015), but also significant when controlling for alcohol use (Mallett et al., 2011; for an illustration see γ-path in Figure 1). Gender differences were not observed for the direct or the indirect effects (Mallett et al., 2015; Mallett et al., 2011). Based on these findings, prevention efforts for students who are motivated to avoid negative consequences may be advantageous when emphasizing the use of general protective behaviors (Mallett et al., 2015).

Figure 1.

Figure 1

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Heuristic Path Model Testing Consequence-Specific Pathways Between Willingness, Risky Single Occasion Drinking and Consequences.

The Current Study

The aim of the present study was to extend the research by Mallett et al. (2015; 2011) and to explore the relationship between experiencing alcohol-related consequences and individuals’ willingness to experience negative consequences in the future among adolescent drinkers. The present study explored how RSOD and experiences of negative consequences during the past 30 days were associated with willingness to experience the same negative consequences in the future (see Figure 1). The analyses were based on a representative population sample of 14- to 15-year-old adolescents in Switzerland (i.e., at the time in which the initiation of alcohol use usually occurs; Inchley et al., 2016).

Based upon previous work with an older population of emerging adults, we hypothesized that RSOD would be positively associated with consequences (β-path; Boden & Fergusson, 2011; Bonnie & O’Connell, 2004; Gmel et al., 2003; Mallett et al., 2015; Mallett et al., 2011; Miller et al., 2007). Additionally, we posited two competing hypotheses regarding the relationship between experiencing a negative consequence and adolescents’ reported willingness to experience the consequence in the future (ε-path). First, research has shown experiencing alcohol related problems does not always reduce subsequent drinking (Patrick & Maggs, 2008). This finding is consistent with research showing that young adults’ drinking behaviors are more influenced by positive rather than negative drinking experiences (Park, 2004), and with data showing that young adults perceive many drinking consequences positively rather than negatively (Mallett, Bachrach, & Turrisi, 2008; Patrick & Maggs, 2011). Based on these reports, we hypothesized that after having experienced a consequence, participants would be more willing to experience that same consequence in the future.

Alternatively, previous research has shown that young adults who reported experiencing consequences they deemed negative showed short-term reductions in subsequent alcohol use (Merrill, Read, & Barnett, 2013). Therefore, we hypothesized that experiencing a negative consequence would be associated with lower willingness to experience the same consequence in the future.

Method

Study Design

Data for this study came from the 2014 Swiss participation in the international Health Behaviour in School-aged Children (HBSC) survey (Inchley et al., 2016). The HBSC collects data every four years on 11- to 15-year-old boys’ and girls’ health and well-being, social environments, and health behaviors (however, questions on substance use are only assessed among an older subsample). In order to obtain a nationally representative sample, classes were randomly selected from a list of all 5th through 9th grade state school classes in Switzerland using a cluster sampling design (86% response rate) with a stratification by Swiss canton and grade. The study was approved by the Cantonal Ethics Committee of Vaud (Protocol 346/13). The data were collected with anonymous self-report questionnaires distributed in the classroom.

Sample

The gross sample for this study consisted of 4,060 girls and boys aged 14 and 15. Students were excluded if they had never used alcohol before (n=1,556, 38.3%) or if they did not drink in the last 30 days (n=1,058, 26.1%). Additionally, students who skipped all questions on willingness and consequences were excluded (n=122, 2.8%). The final sample consisted of 1,333 adolescents (47.9% female) between the ages of 14 and 15 (M = 14.6, SD = .49).

Measures

All questions were translated under the supervision of Addiction Switzerland into three Swiss official languages (German, French, and Italian) and then back translated into English in order to ensure the comparability with the original version. While questions on RSOD and sociodemographic variables are part of the international HBSC-questionnaire, the authors added questions on consequences and willingness.

RSOD.

To assess the frequency of RSOD, students were asked “Over the past 30 days, how many times have you had 5 or more alcoholic drinks at one occasion (i.e., one after the other over a short period of time)”. Answer categories were “never” (1), “once” (2), “twice” (3), “three to five times” (4), “six to nine times” (5), and “10 or more times” (6). RSOD was treated as an ordinal-scaled variable.

Consequences.

Alcohol-related consequences were assessed using a battery of questions adapted from the Young Adult Alcohol Problems Screening Test (YAAPST, Hurlbut & Sher, 1992). For each consequence students were asked “Over the past 30 days, how often did you experience the following after drinking alcohol?” and answers were dichotomized (once or more often coded=1, never=0). From the original variable list of 11 alcohol-related consequences for the present study, only the eight consequences endorsed by at least 5% of the final sample were used for analysis (See Table 1 for specific consequence items and prevalence rates).

Table 1.

Sample Description and Standardized Pathways Between Risky Single Occasion Drinking, Consequences, and Willingness

CONS   WILL β-path ε-path β*ε-path δ-path β*ε- + δ-path
RSOD → CONS CONS → WILL RSOD → WILL ind RSOD → WILL dir RSOD → WILL total
%yes %no %maybe %yes β (SE) sig β (SE) sig β (SE) sig β (SE) sig β (SE) sig
Social consequences  
 schoolwork 6.4 65.8 22.0 12.2 .278 (.045) *** .339 (.049) *** .094 (.021) *** −.052 (.035) ns .042 (.030) ns
 sexual contacts 6.6 66.9 21.7 11.5 .344 (.048) *** .232 (.053) *** .080 (.021) ** .080 (.033) ns .160 (.027) ***
 parents/friends 11.7 69.7 19.2 11.1 .323 (.037) *** .251 (.049) *** .081 (.019) *** .040 (.032) ns .121 (.028) ***
 embarrassing things 29.3 27.5 47.3 25.2 .384 (.030) *** .402 (.040) *** .155 (.020) *** −.050 (.030) ns .104 (.025) ***
 
Physical consequences
 accident 7.2 66.9 19.9 13.2 .344 (.043) *** .299 (.056) *** .103 (.023) *** .046 (.035) ns .149 (.029) ***
 vomiting 16.0 41.4 34.7 23.9 .368 (.036) *** .291 (.045) *** .107 (.020) *** .055 (.030) ns .162 (.027) ***
 memory lapses 22.0 43.7 35.9 20.4 .446 (.032) *** .425 (.043) *** .190 (.025) *** .003 (.035) ns .193 (.027) ***
 hangover 32.2 19.7 37.7 42.6 .435 (.027) *** .328 (.046) *** .143 (.023) *** .000 (.037) ns .143 (.029) ***
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Note: CONS = experienced negative consequences (past 30 days); WILL = willingness to experience the specific consequences in the future; RSOD = risky single occasion drinking (past 30 days). All pathways were additionally adjusted for age and gender. Sample sizes for path models varied between 1’287 and 1’301 due to missing values. Bonferroni-adjusted significance level for eight tests:

***

p<.000125

**

p<.00125

*

p<.00625

ns

p≥.00625.

Willingness.

Adapted from Gibbons et al. (2003) and Mallett et al. (2011), for each consequence item, participants were asked, “If you were to drink alcohol in the future, would you be willing to experience … as a potential consequence?”. Response options were on a 3-point scale: “certainly not” (coded as 0), “maybe” (1) and “yes, certainly” (2). The willingness measure has demonstrated good reliability (Mallett et al., 2015).

Sociodemographic variables.

Gender was coded (0) for girls and (1) for boys. Year and month of birth together with date of questionnaire completion were used to calculate participants’ age.

Analytic Strategy

Using the Mplus 7 statistical software (Muthén & Muthén, 2017) to test hypothesis I and II, a separate path model for each of the eight consequences was estimated, in which RSOD is related to willingness directly (δ-path), and indirectly through its association with a given consequence (β-path) which is in turn associated with willingness (ε-path). A logarithmic function was used to estimate associations with the dichotomous coded variable, consequences, and associations with the ordinally scaled variable, willingness, were estimated with an ordinal logit function. Consequences and willingness were additionally adjusted for age and gender (to avoid a bias due to potential gender differences in the relationships; in a preliminary analysis, the paths were also estimated separately for girls and boys and differences were explored in a multi-group analysis with Wald-tests). Missing responses on any given variable were minimal (<10%) and addressed using full information maximum likelihood estimation with standard errors robust to non-normality. In the result section, Bonferroni-adjusted significance levels are reported to avoid inflated type I error due to testing eight separate path models (Bonferroni, 1936).

As an exploratory analysis, the indirect effects of RSOD on willingness via consequences (β*ε-path) and their significance levels were estimated with the delta-method in the Mplus 7 statistical software (Muthén & Muthén, 2017). The cluster sampling design of students being nested within school classes was accounted for. Unfortunately, Mplus cannot account for cluster sampling design and perform bootstrapped standard errors, which is recommended when estimating indirect effects (MacKinnon, Fairchild, & Fritz, 2007). Therefore, in separate models, the effects were additionally estimated without adjusting for cluster sampling but using 10,000 bootstrap samples (results available on request) and the results obtained by the two estimation methods were compared (cf. Wicki et al., 2017).

Results

Young adolescents who endorsed consuming alcohol during the past month reported engaging in two episodes of RSOD on average (M = 1.96, SD = 1.20). The most commonly reported negative consequences were hangover and saying or doing embarrassing things, which received endorsement by one out of three adolescents (see Table 1). Participants reported they were least willing to experience negative consequences such as impaired schoolwork, regretted sexual contacts, problems with parent/friends, or sustain an accident. Participants were most willing to experience a future hangover (42.6% endorsed “yes, certainly”).

For all analyzed social and physical consequences, the higher the RSOD frequency the more likely consequences were reported (β-path, hypothesis I), which in turn was positively associated with willingness to experience the specific consequence in the future (ε-path, hypothesis II). The mediated pathway of RSOD on willingness (β*ε-path) was positive and significant. Findings from the re-estimated SEM, based on bootstrap sampling but not taking into consideration the cluster sampling design, were largely comparable to the results described above (results available upon request). The effect of RSOD on willingness (β*ε- + δ-path) was fully mediated by all consequences. The total effect of RSOD on willingness was significant and positive for all consequences except for impaired schoolwork.

Wald-tests in the multigroup-model indicated the presence of only two significant gender differences. The indirect path for memory lapses was stronger among girls than boys and the total path for sexual contacts was smaller among girls compared to boys (however, all four paths were positive and significant).

Discussion

The current study examined associations between episodes of RSOD and negative consequences reported during the past month and willingness to experience these consequences in the future in a nationally representative sample of Swiss 14- to 15-year-olds. The findings extend previous research that found willingness to experience negative consequences predicted actual reports of consequences controlling for alcohol use alone among college students residing in the United States (Mallett et al., 2015; Mallett et al., 2011).

Supporting hypothesis I, findings demonstrated that adolescents who engaged in RSOD were also more likely to experience negative consequences, which is consistent with the literature showing negative effects are an outcome of alcohol use (Boden & Fergusson, 2011; Bonnie & O’Connell, 2004; Gmel et al., 2003; Mallett et al., 2015; Mallett et al., 2011; Miller et al., 2007). Furthermore, the findings showed that the links between RSOD, negative consequences, and willingness to experience future consequences are largely comparable between boys and girls. This is in line with previous work indicating that cognitive mechanisms behind alcohol use are consistent for both genders (e.g., Wicki et al., 2017).

Additionally, we posited two competing hypotheses regarding the relationship between experiencing a negative consequence and adolescents’ reported willingness to experience the consequence in the future. Our findings supported the first hypothesis that willingness to experience the consequence, in light of the positive experiences that occur, might be higher following the experience of the consequence. This pattern of findings was consistent across all eight consequences, including more aversive outcomes such as regretted sexual experiences. This finding is worrisome and consistent with previous work that found college students who reported consequences were more likely to continue engaging in risky alcohol use (Mallett et al., 2008; Patrick & Maggs, 2008), thus reinforcing a cycle of problematic behavior and outcomes.

A possible explanation for these findings is that adolescents’ willingness to experience negative consequences may be seen as functional in order to attain positive consequences. Unfortunately, the present study did not assess whether young people perceive negative consequences as necessary evil, nor whether their perception of the consequences changed after experiencing them. However, the findings from studies exploring both negative and positive consequences simultaneously show that with each additional drink adolescents consumed the likelihood of experiencing both positive and negative consequences increased (Barnett et al., 2014). Results from other studies demonstrated that fun and positive social consequences (i.e., the two areas that motivate most adolescents to drink alcohol (Kuntsche et al., 2014)) were reported more frequently than any other domain of positive or negative consequences (Lee, Maggs, Neighbors, & Patrick, 2011). Therefore, the present findings may indicate that adolescents actually do learn from past negative experiences (i.e., although, for example, a hangover is seen as a negative consequence, it is an acceptable price to pay to attain the desired positive consequences). This interpretation is in line with theories of health behavior (e.g., Ajzen, 1991; Bandura, 1986; Rosenstock, 1990), and is supported by Park, Kim, and Sori (2013) showing that the actual experiences of positive outcomes from drinking were associated with subsequent RSOD, and by Merrill, Subbaraman, and Barnett (2016) showing that higher aversion to negative consequences was associated with less drinking.

The exploratory finding that the effect of RSOD on willingness is fully mediated via consequences further supports this interpretation, in showing that the willingness is, to a large extent, directly related to the actual experience of (negative) consequences. The overall association between RSOD and willingness (i.e., total effect) was significant and positive for all consequences except for impaired schoolwork. From students’ point of view, academic consequences are among the most aversive (Mallett et al., 2008). Compared to the other consequences, impaired schoolwork is rather a long-term consequence and less directly linked to the alcohol use (e.g., as a hangover is) so that it is likely less seen as a necessary evil.

The present findings should be interpreted within the limitation of the design. Future studies are needed that utilize longitudinal data and ecological momentary assessment (Wray, Merrill, & Monti, 2014) to explore the specific relationships between alcohol use, willingness, and consequences. Future research would also benefit from widening the focus on consequences to include positive consequences; and not only rely on researchers’ interpretation of outcomes but also respondents’ subjective evaluation of the valence of the outcomes (i.e., the extent of aversion vs. enjoyment related to the outcome; Merrill et al., 2016) in order to understand what variables influence adolescents’ willingness to experience consequences.

Conclusion

The present study shows that young adolescents who reported alcohol use in the past month were likely to experience various negative consequences, particularly if they engaged in RSOD. Experiencing negative consequences did not dampen adolescents’ willingness to experience them in the future, but rather fostered it. One explanation for this paradoxical finding may be that adolescents are willing to experience negative consequences in order to attain positive ones, which may be particularly important to them. These findings are consistent with previous work conducted on young adults attending college in the United States suggesting these risky patterns of behavior are fairly robust across adolescence and cultural context.

While the promotion of general protective behaviors may be an advantageous prevention approach for young adults who are not willing to experience negative social or physical consequences (Mallett et al., 2015), this approach seems less promising for those willing to experience negative consequences. More work is needed to better understand and target variables that can reduce individuals’ willingness to experience consequences and enhance intentions to avoid them (Mallett et al., 2015). An alternative way to target willingness would be to explore the aspired, positive consequence or motives for alcohol use (e.g., to socialize, to have an exciting experience, to cope with anxiety or with depression; cf. Grant, Stewart, & Mohr, 2009) among those who are willing to experience negative consequences or necessary evil. Targeted preventive or treatment interventions could directly promote alternative ways of attaining these goals without using alcohol (Cox & Klinger, 2011; Grant et al., 2009): for example, socializing and having fun in sports teams or scouting (Wurdak, Wolstein, & Kuntsche, 2016), listening to music (Jonker & Kuntsche, 2014) or engaging in behavioral activation to handle depressive symptomatology (Dimidjian et al., 2006).

Public Health Significance.

This study found that young adolescents who experienced a negative alcohol-related consequence were still willing to experience the consequence. This suggests that adolescents may perceive the experience of negative consequences as a necessary evil to attain the positive consequences. Prevention efforts may therefore benefit from promoting alternative ways of attaining positive consequences without engaging in risky drinking practices.

Acknowledgments

This research was supported by the Swiss Federal Office of Public Health (grant no. 13.001234/204.0001/−1095), the Swiss cantons and by NIAAA R01AA021117 awarded to Dr. Kimberly Mallett. The funding source had no other role other than financial support.

The authors would like to thank Béat Windlin, Edith Bacher, Andrea Kretschmann, Simon Marmet and Yvonne Eichenberger for their participation in the Swiss HBSC project.

Footnotes

The ideas expressed in this manuscript and prevalence of consequences or willingness to experience negative consequences have not been disseminated previously. Prevalence of risky single occasion drinking has been published as part of national and international research reports.

Disclosures

There are no conflicts of interest, such as financial, personal, or other relationships with other organizations or pharmaceutical/biomedical companies that may inappropriately impact or influence the research and interpretation of the findings.

Contributor Information

Matthias Wicki, Addiction Switzerland.

Kimberly A. Mallett, The Pennsylvania State University

Marina Delgrande Jordan, Addiction Switzerland.

Aurélie Archimi, Addiction Switzerland.

Emmanuel Kuntsche, Center for Alcohol Policy Research.

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