A Qualitative Examination of Intentions and Willingness for Heavy Drinking Among Young Adult High-Intensity Drinkers

Objective: Heavy episodic drinking (HED) and high-intensity drinking (HID) are common in young adulthood but pose unique risks. Quantitative studies have used the Theory of Planned Behavior (TPB) and the Prototype-Willingness Model (PWM) to understand decision-making processes underlying alcohol misuse. However, our understanding of intentions (plans) and willingness (openness) for HED/HID is in its nascent stages. This study represents the first qualitative examination of relationships between intentions and willingness to engage in HED/HID. Method: We conducted individual interviews among 28 young adult high-intensity drinkers (12 male, 15 female, 1 trans male; M (age) = 23 years). Interviews focused on HED/HID events with open-ended questions examining: (a) variability in intentions/willingness by occasion and within a drinking event; (b) formation of intentions for consumption and/or intoxication; and (c) interplay of willingness and intentions on heavy drinking nights. Verbatim transcripts were coded within NVivo software and content was analyzed using applied thematic analysis. Results: Participants described intentions and willingness as varying by occasion and perceived their shifting across a drinking event. Intentions for heavy drinking reflected a desired level of intoxication, rather than a specific number of drinks. Willingness, rather than intentions, to engage in heavy drinking/HID was more evident. Conclusions: Findings have significant implications for future measurement work in this area. There may be value in assessing intentions and willingness multiple times per day and during the drinking event itself. We also recommend that intentions for both consumption and intoxication levels be assessed, particularly in studies aiming to examine impaired control. Public Health Significance This study demonstrated the importance of both intentions and willingness as decision-making factors that influence heavy drinking in young adults. Our findings showed that young adults more so plan for a level of intoxication, rather than a specific number of drinks to consume. We also highlight that young adults perceive that their intentions and willingness to drink and become intoxicated change during the drinking event itself, which has implications for targeting these factors in the moment.

Automated summary

This study provided a qualitative analysis of intentions and willingness regarding heavy episodic drinking (HED) and high-intensity drinking (HID) in young adults, finding variability in intentions and willingness across occasions and drinking events. Young adults tend to plan for a desired level of intoxication rather than a specific number of drinks to consume.