Promoting Harm Reduction Among Young Adults: A Cross-Sectional Study of Consideration of Future Consequences, Alcohol-Related Consequences, and Motivation to Use Protective Behavioral Strategies

Background and purpose

Protective behavioral strategies (PBS) are evidence-based cognitive-behavioral approaches to reduce alcohol use and/or related consequences (Martens et al., 2005). Greater PBS use is consistently associated with lower alcohol consumption and fewer negative consequences (Pearson, 2013). However, despite their effectiveness, uptake of PBS remains limited (Lewis et al., 2022). Existing research has primarily focused on drinking motives and retrospective consequences, with less attention to forward-looking cognitive processes that may shape engagement in PBS use. This study examines whether consideration of future consequences (CFC) is associated with motivation to use PBS among young adults who use alcohol and cannabis.

Methods

Data were drawn from baseline assessments of Project EQUIP, a behavioral intervention targeting substance use among young adults (ages 18–24) in Texas. Participants were on average 22.08 years old (SD = 1.67). The sample was 34.4% male (coded 1 = male), and 57.9% were current students (coded 1 = current student). Participants reported drinking approximately three days per week and at least one recent alcohol-related consequence. Recruitment occurred via social media, listservs, flyers, and online advertisements. Measures included alcohol-related consequences (Young Adult Alcohol Consequences Questionnaire; YAACQ), consideration of future consequences (CFC), and motivation to use PBS (MPBS). Descriptive statistics and bivariate correlations were examined, followed by linear regression analyses predicting MPBS from CFC and YAACQ while controlling for demographic factors.

Results

Mean YAACQ scores indicated elevated alcohol-related consequences (M = 9.26, SD = 6.16), and CFC scores reflected moderate future orientation (M = 27.53, SD = 7.51). MPBS was low (M = 1.53, SD = 1.25), with most participants reporting lower levels of motivation. The linear regression model predicting MPBS was statistically significant, F(5, 139) = 3.96, p = .002, explaining 12.5% of the variance (R² = .125; adjusted R² = .093). Greater CFC was significantly associated with higher MPBS (β = .243, p = .003). Sex was significant predictor (β = −.183, p = .023), such that males reported lower MPBS compared to females. Student status was also significant (β = −.182, p = .035), indicating that current students reported lower MPBS compared to non-students. Age was not significantly associated with motivation to use PBS (β = −.008, p = .928). YAACQ were also not significantly associated with MPBS (β = .105, p = .197), suggesting that prior negative consequences were not primary drivers of motivation in this sample.

Conclusion and implications

Findings suggest that future-oriented cognition, rather than past negative consequences, may be a key driver of motivation to use PBS. This has important implications for social work practice and prevention science. Interventions could consider focusing on anticipation of future outcomes, decision-making, and goal alignment to reduce alcohol use and related risk behaviors among young adults. Social work practitioners are uniquely positioned to integrate future-oriented and harm reduction approaches into prevention programming across community settings.

The project was funded by NIAAA grant (R34AA028730), awarded to Dr. Melissa A. Lewis. However, the content is the sole responsibility of the authors, and not necessarily the official views of NIH.