Decisions in context: Impacts of drinking opportunities, constraints, and decisions processes on adolescent and young adult alcohol problems

Future efforts to reduce the substantial individual and public health costs related to alcohol use among adolescents and young adults will require the development of comprehensive theoretical approaches that represent the complexity of individual- and social-level processes that affect young people’s choices to use and abuse alcohol in different social contexts. In this chapter, we integrate psychosocial approaches to understanding adolescent and young adult drinking problems with sociological models of small group dynamics that accelerate drinking risks. In supporting this approach and assisting the development of more effective prevention interventions, we (1) summarize available psychosocial and social theories that explain alcohol use and problems in young people and their prevention implications, (2) describe current research into drinking contexts and the mechanisms by which young people select and use different drinking contexts, (3) emphasize the need to consider the dynamics of young people’s drinking decisions in contexts, (4) describe existing preventive interventions focused on reducing alcohol-related problems in young people, and (5) explain how an integrated theoretical approach can be used to develop effective context-based interventions to reduce risky drinking and related problems. We argue that Just-In-Time-Adaptive Interventions (JITAIs), which are sensitive to the specific choices that young people must make in social contexts, are most suitable and most likely to effectively intervene in the individual and small-group decision-making processes that underlie drinking and problems among adolescents and young adults.