Psychometric Validation of the Temptation and Restraint Inventory in Two Samples of College Drinkers 1

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1 Journal of Psychopathology and Behavioral Assessment ( C 2006) DOI: /s y Psychometric Validation of the Temptation and Restraint Inventory in Two Samples of College Drinkers 1 James MacKillop, 2,3 Stephen A. Lisman, 2 and Allison Weinstein 2 Received, 2004; accepted 0, 2005 Published online: xx xx Drinking restraint, commonly measured by the Temptation and Restraint Inventory (TRI; Collins & Lapp, 1992), refers to a cycle of temptation to drink alcohol and attempts to control alcohol use that results in excessive consumption. Recent research has examined college drinkers using the TRI, however, it has been validated only in adult samples. This study validated the TRI in two samples of college drinkers, designated as hazardous (n = 480) and harmful (n = 231) drinkers. Using confirmatory factor analysis, the previously reported higher order two-factor structure was identified in both samples. In addition, multiple regression analyses using derived component scores demonstrated that TRI performance was associated with degree of alcohol dependence in both samples. These data support the use of the TRI in college samples. KEYWORDS alcohol abuse; alcohol dependence; drinking restraint; temptation; psychometric properties; confirmatory factor analysis; principal components analysis. Drinking restraint (DR; Collins, 1993; Curry, Southwick, & Steele, 1987; Ruderman & McKirnan, 1984) is defined as alcohol use characterized by high desire to drink and concurrent attempts to control drinking, a pattern that frequently results in excessive use. This pattern of drinking has most often been measured by the Temptation and Restraint Inventory (TRI; Collins & Lapp, 1992), which has enabled the accumulation of convincing evidence that DR is a risk factor for alcohol misuse. For example, Collins and Lapp (1992) found that TRI performance predicted weekly alcohol consumption and dependence in adult moderate drinkers, a finding that has been subsequently replicated (Collins, Koutsky, & Izzo, 2000). In clinical samples, the TRI has been shown to predict days of heavy drinking, drinks per drinking day, and negative consequences of drinking (Connors, Collins, Dermen, & Koutsky, 1998); and has been demonstrated to predict alcohol problems more effectively than alcohol 1 These data were previously presented in November 2002 at the 36th annual meeting of the Association for the Advancement of Behavior Therapy, Reno, NV. 2 Department of Psychology, State University of New York at Binghamton. 3 To whom Correspondence should be addressed at Center for Alcohol and Addiction Studies, Brown University, Box G-BH, Providence, Rhode Island 02906; james mackillop@brown.edu. expectancies (Connor, Young, Williams, & Ricciardelli, 2000), a well-validated cognitive variable in drinking behavior (Goldman, Del Boca, & Darkes, 1999). The relevance of self-reported DR to alcohol use has been further demonstrated by the TRI s prediction of drinking-related variables in laboratory preparations. Collins, Gollinisch, and Izzo (1996) found that performance on the TRI predicted alcohol consumption in a taste-rating task. Similarly, using a cue reactivity paradigm, Palfai (2001) demonstrated that the TRI predicted urge to drink both prior to and following an alcohol cue exposure and predicted alcohol consumption in a taste-rating task. More recently the TRI has been used to examine DR in college students. Approximately 40% of college students are heavy drinkers (O Malley & Johnston, 2002) and excessive alcohol use contributes to numerous deleterious outcomes, including academic failure, drinking and driving, interpersonal violence, sexual assault, and death (Abbey, 2002; Perkins, 2002). This relationship between excessive alcohol use and negative outcomes in college students has prompted interest in the causal antecedents of college alcohol misuse, of which DR is one candidate. This hypothesis has been borne out empirically by several studies that have demonstrated robust associations between DR and college drinking. Williams and C 2006 Springer Science + Business Media, Inc.

2 MacKillop, Lisman, and Weinstein Ricciardelli (1999) reported that the TRI predicted alcohol consumption and severity of dependence in a sample of Australian adolescents. This was also the case in the United States, where Collins, Koutsky, Morsheimer, and MacLean (2001) found that the TRI predicted binge drinking and severity of dependence in American college students. In an initial cross-cultural study, Cox, Gutzler, Denzler, Siebke, and Florin (2001) found parallels between the TRI and alcohol use in American and German college students. Finally, in a laboratory study, Fillmore (2001) found that alcohol-induced urge priming predicted scores on the TRI s Temptation subscale in college drinkers. However, despite the TRI s use as a measure of DR in college students over the past decade, it has not been psychometrically validated for use in college samples. The TRI was originally developed using a sample of moderate drinkers recruited from the community and was found to have a higher order two-factor structure (Collins & Lapp, 1992). Subsequently, two groups have validated the TRI in clinical samples of alcohol-dependent individuals (Connor, Gudgeon, Young, & Saunders, 2004; Connors et al. 1998), but there have been no published studies in college samples. Thus, it is possible that the expression of DR is unformed or qualitatively different in younger samples. This would substantially undermine the findings to date using the TRI in college samples and would also have implications for the developmental course of DR. To address these issues, the goal of the current study was to validate the TRI in two samples of college drinkers, a hazardous drinking sample and a harmful drinking sample. Using an approach similar to that of Connors et al. (1998), confirmatory factor analysis was used to test a higher order two-factor model and a control single-factor model. In both samples, the hypothesis was that the original two-factor structure would be identified. In addition, the TRI s internal reliability and relationship to alcohol use variables were examined. METHOD Participants The hazardous drinking (HZD) sample consisted of participants recruited over three semesters, comprising undergraduate volunteers from several lower-level psychology courses at the State University of New York at Binghamton. The sample consisted of 480 participants (mean age = years, SD =.88; 51% male) who completed both the TRI and Alcohol Use Disorders Identification Test (AUDIT; see below) in a mass administration format. Participants were selected based on a score of eight or higher on the AUDIT, a validated criterion for hazardous drinking (Babor, Higgins-Biddle, Saunders, & Monteiro, 2001), or drinking that is associated with elevated risk for negative consequences. The harmful drinking (HMD) sample consisted of 231 (mean age = 20.96, SD = 1.13; 64% male) ambulatory drinkers recruited by posted flyer or classroom/ solicitation from the Binghamton University campus to participate in ongoing alcohol cue reactivity research. The criterion for inclusion was heavy alcohol use, operationalized as 20+/14+ standard drinks per week for men and women, respectively. These inclusion criteria were based on their association with risk for long-term alcohol-related medical problems (Dawson, 2000) and previous use as clinical criteria for brief interventions (Fleming et al., 2002). Two samples were assessed in order to validate the TRI for use in college samples characterized by multiple levels of consumption. The HZD sample was intended to represent moderate-to-high alcohol use, including individuals statistically at-risk for negative effects but not necessarily experiencing the negative consequences of drinking. In contrast, the HMD sample was recruited to represent unequivocally heavy drinkers who were drinking at levels that would result in negative consequences (Dawson, 2000). Given the intended differences between the samples, different measures were used to assess alcohol use and consequences. The HZD sample was evaluated using a well-validated screening measure with high sensitivity and specificity for predicting negative consequences from drinking, the Alcohol Use Disorders Identification Test (AUDIT). For a more fine-grained assessment of alcohol use and symptoms of alcohol dependence, the HMD sample was assessed using the Drinking Days Questionnaire (DDQ) and the Alcohol Dependence Scale (ADS). It should be noted, however, that participants in the HMD sample were not formally assessed for alcohol use disorders. Measures Temptation and Restraint Inventory (TRI) All participants completed the TRI (Collins & Lapp, 1992), which is a 15-item self-report measure of DR that asks participants to rate alcohol-related statements using a Likert scale ranging from one to nine, with semantic anchors of Always and Never. The development of the TRI involved adding two novel factors to the three factors that constituted the preexisting Restrained

3 Psychometric Validation of the Temptation and Restraint Inventory Drinking Scale (Ruderman & McKirnan, 1984). This resulted in two higher order factors, Cognitive and Emotional Preoccupation (CEP or Temptation ), and Cognitive and Behavioral Control (CBC or Restriction ). The higher order factor CEP is composed of three subordinate subscales: Govern, Emotion, and Cognitive Preoccupation. The Govern subscale contains items reflecting perceived inability to control one s drinking, the Emotion subscale contains items related to drinking to mitigate negative affective states, and the Cognitive Preoccupation subscale contains items related to cognitive intrusions about drinking. Similarly, the higher order factor CBC is composed of two subscales: Concern About Drinking and Restrict. Concern About Drinking contains items reflecting desire to stop drinking when exposed to alcohol cues, and Restrict contains items reflecting actual attempts to inhibit drinking. Taken together, the two higher order factors are purported to reflect the dual aspects of experiential desire to drink and behavioral attempts to inhibit drinking. Previous psychometric examinations of the TRI have revealed adequate internal reliability (Connors et al., 1998), as well as discriminant and convergent validity (Collins, Koutsky, & Izzo, 2000). Alcohol Use Disorders Identification Test (AUDIT) The AUDIT (Babor et al., 2001) is a 10-item selfreport screening measure of alcohol use. The AUDIT has been extensively validated in terms of psychometric properties and scores above 8 (range: 0 40) have been demonstrated to indicate statistical risk for negative consequences of drinking (Babor et al., 2001). Only the HZD sample was assessed using the AUDIT. Drinking Days Questionnaire (DDQ) The DDQ (Collins, Parks, & Marlatt, 1985) is a brief, face-valid quantitative measure of number of drinks per day of the week. In this study, the DDQ was adapted from its description in Collins et al. (1985) and was used to assess the average number of standard drinks consumed per week. Only the HMD sample was assessed using the DDQ. Alcohol Dependence Scale (ADS) The ADS (Skinner & Horn, 1984) is a 25-item selfreport measure of symptoms associated with alcohol dependence. The ADS yields a score from 0 to 40, and increases in score are linearly related to severity of dependence. The ADS has been examined in several studies and determined to have good psychometric properties (Skinner & Horn, 1984). Only the HMD sample was assessed using the ADS. Overview of Analytic Strategy Data screening procedures were undertaken as recommended by Tabachnik and Fidell (2001). This included examining the sample for univariate and multivariate outliers and evaluating TRI distribution normality. No participants from either sample were required to be excluded. Confirmatory factor analysis (CFA) was undertaken using AMOS 4.0 (Arbuckle, 1999). Model fit was assessed using three measures: the comparative fit index (CFI; Bentler, 1990), the goodness-of-fit index (GFI; Jöreskog &Sörbom, 1984) and a χ 2 test (Tabachnik & Fidell, 2001). For the CFI and GFI, values of.90 or greater reflect a good fit. In the case of the χ 2 test, since the test evaluates whether the observed matrix significantly differs from the proposed matrix, a nonsignificant p-value reflects a good fit (Tabachnik & Fidell, 2001). For both samples, the two-factor model was tested first, followed by a single factor model. For the two-factor model, both factors were permitted to correlate, as previous studies of the TRI have reported moderate positive correlations between factors (Collins & Lapp, 1992; Connors et al., 1998). In addition to confirmatory factor analysis, two other validation strategies were employed. Internal reliability of the overall TRI and both subscales was examined in both samples, and the relationship between CEP and CBC and alcohol use variables was examined. The latter was undertaken by generating component scores using a principal components analysis (PCA) and examining associations between TRI subscales and alcohol use variables using hierarchical linear regression. Given the potential for gender to have a significant association with alcohol use variables (Palfai, 2001), it was covaried by entering it into an initial step of the regression models. RESULTS Alcohol Use in the Hazardous and Harmful Drinking Samples In the HZD sample, the mean AUDIT score was (SD = 4.79). Since this sample was collected over three semesters, univariate analyses of

4 MacKillop, Lisman, and Weinstein Table I. Temptation and Restraint Inventory (TRI) Higher Order Two-Factor Model Standardized (SFL) and Unstandardized Factor Loadings (UFL) With Standard Errors (SE) for the Hazardous Drinking and Harmful Drinking Samples Hazardous drinking (n = 480) Harmful drinking (n = 231) 2nd order factors 1st order factors SFL UFL SE SFL UFL SE CEP Emotion Govern Cognitive preoccupation CBC Concern about drinking Restrict variance (ANOVAs) were conducted on each item of TRI by semester, but revealed no significant differences (p s >.20). In the HMD sample, male participants reported drinking an average of (SD = 13.24) standard drinks per week, ranging from 20 to 94; female participants reported drinking a mean of 23.5 (SD = 10.51), ranging from 14 to 63. These levels reflect alcohol use at approximately the 97th percentile for American 4-year college students (Meilman & Presley, 1997). The sample yielded a mean score of 12.2 on the ADS, reflecting approximately the 25th percentile of alcohol dependence as derived from inpatient samples (Skinner & Horn, 1984). Hazardous Drinking Sample For the HZD sample, the two-factor model was confirmed (CFI =.96; GFI =.98), although the χ 2 test revealed a significant difference between the proposed structure and the observed structure (χ 2 [4, N = 480] = 30.22, p <.01). It is important to note that large sample sizes contribute to the likelihood of significant χ 2 values, even in the presence of adequate fit according to other goodness-of-fit indices (Tabachnik & Fidell, 2001). Pearson s r between CEP and CBC was.40 (p <.001). The single-factor model was not confirmed in the HZD sample (CFI =.62; GFI =.68; χ 2 [90, N = 480] = ; p <.001). Standardized and unstandardized factor loadings for the higher order two-factor structure are presented in Table I. Harmful Drinking Sample For the HMD sample, the two-factor model was confirmed (CFI =.96; GFI =.97), although the χ 2 test revealed a significant difference between the proposed structure and the observed structure (χ 2 [4, N = 231] = 16.37, p <.01). Pearson s r between CEP and CBC was.47 (p <.001). The single-factor model was not confirmed for the HMD sample (CFI =.68; GFI =.72; χ 2 (90, N = 231) = ; p <.001). Standardized and unstandardized factor loadings for the higher order two-factor structure are presented in Table I. Internal Consistency The TRI in the HZD sample exhibited robust overall internal consistency (Cronbach s α =.87), with similar values for both subscales, CEP (α =.85) and CBC (α =.83). Similarly, the TRI in the HMD sample exhibited robust overall internal consistency (α =.87) and high internal consistency evident for both CEP (α =.85) and CBC (α =.80). Relationship to Alcohol Use and Dependence In the HZD sample, a PCA of the first order factors using an oblique rotation (direct oblimin with Kaiser normalization) and extracting components based on scree plot observation (Goldberg & Velicer, in press; Preacher & Macullum, 2003) replicated the higher order factor structure. As anticipated, two higher order components were generated, which accounted for a large proportion of the variance (73.96%) and were significantly correlated (r =.36, p <.01). Factor loadings are presented in Table II. Factor scores were generated for each of the two higher order factors and were used in the hierarchical multiple regressions analyses. In the HZD sample, entering gender in a first step and CEP into a second step, the overall model was significant (R 2 =.28; F (2, 155) = 30.07, p <.001). The CEP factor was significantly associated with AUDIT score (β =.53,

5 Psychometric Validation of the Temptation and Restraint Inventory Table II. Factor Loadings From Principal Components Analyses of the First Order Factors of the Temptation and Restraint Inventory (TRI) in Both the Hazardous Drinking and Harmful Drinking Samples Hazardous drinking (n = 480) Harmful drinking (n = 231) 1st order factors Factor 1 (CEP) Factor 2 (CBC) Factor 1 (CEP) Factor 2 (CBC) Emotion Govern Cognitive preoccupation Concern about drinking Restrict Note. Significant component loadings are in italic. p <.001), although gender was not (β =.03, p >.50). For CBC, the same approach was used and generated similar results. The overall model was significant (R 2 =.05; F (2, 155) = 4.78, p <.01) and CBC was significantly associated with AUDIT score (β =.23, p <.01), although gender was not (β =.07, p >.30). Like the HZD sample, a PCA was conducted on the first order factors in the HMD sample. Using observation of the scree plot as the basis for extraction, a twocomponent solution was identified, consistent with the CEP-CBC structure previously reported (Collins & Lapp, 1992) and in the CFA analyses above. Similarly to the HZD sample, these components accounted for 72.3% of the variance and were significantly correlated, r =.37, p <.001. The derived component loadings are depicted in Table II. Derived component scores from each TRI subscale were then examined in reference to self-reported weekly alcohol consumption (DDQ scores) and dependence (ADS scores). Independent hierarchical multiple regressions were performed, entering gender in a first block and CEP or CBC component scores in a second block predicting alcohol use variables. The CEP model was significantly associated with consumption (R 2 =.14; F (2, 228) = 19.92, p <.001), with both male gender (β =.38, p <.001) associated with greater consumption and higher CEP score exhibiting a marginal association (β =.11, p <.10). The CBC model was also significantly associated with consumption (R 2 =.15; F (2, 228) = 19.51, p <.001), however, in this case, male gender (β =.37, p <.001) was a significant associate, but CBC was not (β =.10, p >.10). In terms of dependence, the CEP model was significantly associated with dependence (R 2 =.15; F (2, 228) = 20.52, p <.001), with higher CEP (β =.39, p <.001) corresponding with higher dependence and no gender effect (β =.05, p >.40). The CBC model was also significantly associated with dependence (R 2 =.04; F (2, 228) = 4.88, p <.01) with higher CBC (β =.19, p <.01) corresponding with higher dependence and no gender effect (β =.08, p >.20). DISCUSSION These results demonstrate that the TRI retained its robust psychometric properties in two samples of college drinkers. On two of the three measures of goodness-offit, confirmatory factor analysis replicated the previously reported higher order factor structure of CEP (Temptation) and CBC (Restriction) in both samples. While the χ 2 test did not support the proposed factor structure, this is mitigated by the fact that the χ 2 test is oversensitive to discrepancies between the proposed and observed matrices with large ratios of cases to parameters (Tabachnik & Fidell, 2001). In contrast, the alternative single factor model provided a poor fit to the data on all three indices. The TRI also exhibited robust internal reliability overall and within each respective subscale for both samples. Finally, Temptation and Restriction performance were both associated with AUDIT and ADS score, the measures of dependence for the HD and HMD samples, respectively. Taken together, these data validate the use of the TRI for alcohol research in college samples with varying levels of alcohol involvement. One aspect of the results that warrants further discussion is the differential relationship between the TRI subscales and alcohol use variables in the HMD sample. In the case of weekly alcohol consumption, Temptation exhibited only a weak association and Restriction was not significantly associated. In both cases, however, gender was substantially associated with alcohol use, with male gender predicting greater alcohol use. These gender effects are likely to be a function of different entry criteria for men and women, and gender-based differences that relate to absolute alcohol consumption (e.g., body mass,

6 MacKillop, Lisman, and Weinstein proportionate adipose tissue). In contrast, performance on both Temptation and Restriction was significantly associated with alcohol dependence (as measured by the ADS) and gender had a negligible association. Thus, the TRI appears to not simply correspond with quantitative alcohol use, but rather with degree of alcohol dependence. This is consistent with the theoretical perspective that DR is a risk factor not just for alcohol use, but for pathological alcohol use (Collins, 1993). Two limitations require discussion. First, while the two samples were intended to represent different types of college drinkers, the study is limited by the fact that both did not complete the same measures to make them directly comparable. This was intentional insofar as each sample was evaluated using measures considered most appropriate for its intended characteristics, however, some overlap would be expected between groups and unfortunately the exact degree of that overlap cannot be evaluated. This issue would be more important, however, had different findings emerged by sample. Instead, the TRI appears to be valid in college drinking samples using multiple criteria for participation. A second limitation of the study is that the AUDIT and ADS were the only measures of alcohol dependence. The AUDIT is a screening measure and, while numerous reports document a linear relationship between AU- DIT score and alcohol dependence (Babor et al., 2001), it is neither an exhaustive nor a fine-grained measure. Similarly, while the ADS is a well-validated continuous measure of alcohol dependence, it assesses severity of dependence in primarily physical symptoms. As such, a broader battery, including measures such as the Drinking Related Inventory of Consequences (Miller, Tonigan, & Longabaugh, 1995), may provide a more highly resolved perspective on the actual negative consequences and degree of dependence in these samples. In addition, an expanded battery may permit including additional covariates beyond gender in future studies. For example, negative psychosocial consequences of drinking could be covaried in examining the relation between DR and physical dependence symptoms, and vice versa. While this study validates the use of the TRI in college samples, future research may be warranted in even younger samples. Very little is known about the developmental expression and progression of DR, whereas other cognitive variables, such as alcohol expectancies, have been identified in children as young as the 2nd grade and plotted across a developmental backdrop (Dunn & Goldman, 2000). It is possible that similar research might clarify the various possible expressions of DR across the lifespan. For example, DR may be a pattern of drinking that immediately commences when a subset of individuals initiate drinking, suggesting a target for secondary prevention. Alternatively, it is possible that DR is acquired via a series of negative consequences and marks incipient problems with alcohol, reliably preceding alcohol abuse or dependence. As such, DR may reflect a critical period during which a person is on the fence and could be used to identify individuals at-risk and incorporated into clinical approaches (Collins & Bradizza, 2001). Such questions minimally require cross-sectional studies in younger samples and ideally would use prospective designs. In summary, based on the increasing use of the TRI to examine DR in college drinkers, this study sought to validate the psychometric properties of the TRI in two samples of college drinkers. 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