The present study will assess the acceptability and feasibility of a brief intervention designed to help young heavy drinkers reduce their alcohol consumption. All participants will complete a brief (1-week) mindfulness intervention, and participants will be randomized to receive either active or inactive Respiratory-gated Auricular Vagal Afferent Nerve Stimulation (RAVANS) during two in-person laboratory visits. Heart rate variability data and self-report survey data will be collected to assess the impact of the intervention on autonomic regulation, alcohol consumption, and additional clinical measures.
Currently living in Massachusetts.
Aged 21-29 years old.
Consume either more than 14 standard drinks of alcohol per week OR at least 5 standard drinks in one day per week (in past 30 days).
Have sufficient English fluency to understand procedures and questionnaires.
Current or past diagnosis of a substance use disorder based on the Quick Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) Module C (Substance Use Disorders).
Active prescription for sedative/hypnotics, opioids, or anesthetic medications.
Active prescription for medications used to treat alcohol use disorder (AUD), e.g., naltrexone, disulfiram, acamprosate, etc.
Active psychosis or schizophrenia-spectrum disorder diagnosis.
Parallel
Active RAVANS
DeviceRAVANS employs non-invasive, transcutaneous auricular vagal nerve stimulation (taVNS) to stimulate vagal afferent nerve fibers exclusively during exhalation. Linking stimulation to exhalation creates a synergistic effect that appears to increase parasympathetic tone and impacts key brain areas implicated in problematic drinking, including the anterior cingulate cortex and prefrontal cortex. Because mindfulness training appears to impact complimentary neural mechanisms, applying stimulation during the outbreath of mindfulness practice may potentiate its effects, accelerate training, and improve capacity for attention and emotion regulation.
Brief Mindfulness-Based Intervention
BehavioralMindfulness-based interventions may improve interoceptive awareness and heart rate variability outcomes. Participants will be asked to practice 10 minutes of mindfulness meditation daily for 6 out of 7 days during the intervention week. They will also listen to a 30-minute mindfulness of breathing audio recording during Laboratory Visit 2.
RAVANS Effect on HRV Recovery
The primary outcome measure will be the mean normalized high-frequency heart rate variability (HF-HRV) power collected from the MoveSense device. This data will be collected continuously throughout Lab Visit 1 and Lab Visit 2. Outcome 1A will be the RAVANS effect on HRV recovery after craving cues, comparing across arms.
Mindfulness Effect on HRV Recovery
The primary outcome measure will be the mean normalized high-frequency heart rate variability (HF-HRV) power collected from the MoveSense device. This data will be collected continuously throughout Lab Visit 1 and Lab Visit 2. Outcome 1B will be Mindfulness intervention related Change in HRV recovery after craving cues, comparing Lab Visit 1 (no mindfulness training) to Lab Visit 1 (1-week of mindfulness training).
RAVANS Effect on HRV Response to Cues
The primary outcome measure will be the mean normalized high-frequency heart rate variability (HF-HRV) power collected from the MoveSense device. This data will be collected continuously throughout Lab Visit 1 and Lab Visit 2. Outcome 1C will be the RAVANS effect on HRV response during craving cues, comparing across arms.
Acceptability Measure
This outcome will assess the acceptability of mindfulness combined with Active RAVANS versus mindfulness combined with Inactive RAVANS among heavy alcohol drinkers. Participants in both study arms will rate the likelihood of recommending the intervention to family or friends interested in reducing their drinking, using a 7-point Likert scale (1 = "would definitely not recommend" to 7 = "would definitely recommend"). This is a 1 item measure and acceptability will be defined as a post-intervention mean rating greater than 4. Range of total score for this scale is 1-7 and higher scores indicate more acceptability.
The International Positive and Negative Affect Schedule Short Form (I-PANAS-SF)
This outcome will assess whether the combination of mindfulness practice and Active RAVANS is associated with changes in affective state. Affect will be measured using the International Positive and Negative Affect Schedule Short Form (I-PANAS-SF). The primary metric will be the ratio of mean positive affect ratings to mean negative affect ratings (M\_positive / M\_negative). This ratio obtained at the end of Lab Visit 2 (mindfulness session) will be compared to the ratio obtained at the end of Lab Visit 1 (control session) between the Active RAVANS and Inactive RAVANS arms. This 10-item self-report measure consisting of two 5-item subscales (Positive Affect and Negative Affect), each scored from 10 to 50, with higher scores on each subscale indicating greater levels of that affect.
7-day and 14-day Timeline Follow Back
This outcome will assess changes in alcohol consumption following mindfulness combined with Active RAVANS compared to mindfulness combined with Inactive RAVANS. Alcohol use will be measured using the TimeLine Follow-Back (TLFB) method, a standardized clinical and research assessment tool developed by Linda Sobell (Nova Southeastern University, 1996). The TLFB provides quantitative estimates of alcohol use over a specified recall period. Alcohol consumption reported after Lab Visit 2 will be compared between the Active RAVANS and Inactive RAVANS arms. This measure yields continuous outcomes such as total drinks, drinks per drinking day, percent drinking days, and percent heavy drinking days, with lower values indicating less alcohol use. There is no minimum or maximum on reported consumption.
Alcohol Urge Questionnaire (AUQ)
The Alcohol Urge Questionnaire (AUQ) consists of eight statements about the respondent's feelings and thoughts about drinking as they are completing the questionnaire (i.e., right now). Drinking refers to various types of alcohol, including beer, wine and liquor. The respondent is asked to respond to each statement about alcohol craving via a 8-item self-report measure of current (state) alcohol craving rated on a 7-point Likert scale ranging from "strongly disagree" to "strongly agree." Total scores range from 8 to 56 and higher scores indicate greater urge to drink.
Multidimensional Assessment of Interoceptive Awareness - Version 2 (MAIA-2)
The Multidimensional Assessment of Interoceptive Awareness (MAIA-2) is a 37-item self-report measure of interoceptive body awareness scored across 8 subscales, with each subscale calculated as the mean of its items and ranging from 0 to 5, where higher scores indicate more interoceptive awareness. The subscales: noticing ("I notice when I am uncomfortable in my body"), not-distracting ("I do not notice (I ignore) physical tension or discomfort until they become more severe"), not-worrying ("I start to worry that something is wrong if I feel any discomfort"), attention regulation ("When I am in conversation with someone, I can pay attention to my posture"), emotional awareness ("I notice that my breathing becomes free and easy when I feel comfortable"), self-regulation ("When I am caught up in thoughts, I can calm my mind by focusing on my body/breathing"), body listening ("I listen to my body to inform me about what to do"), and trusting ("I feel my body is a safe place").
Five Facet Mindfulness Questionnaire (FFMQ)
The Five Facet Mindfulness Questionnaire (FFMQ) is a 39-item scale that examines five factors that represent aspects of the current empirical conception of mindfulness. These five facets include: "observing, describing, acting with awareness, non-judging of inner experience, and non-reactivity to inner experience." An example item is "I pay attention to how my emotions affect my thoughts and behavior." Participants rate their degree of agreement with each of the items on a Likert-type scale ranging from 1 (Never or very rarely true) to 5 (Very often or always true), with higher scores indicating higher experience of mindfulness. Total scores range from 39 to 195 and facet scores from 8 to 40 (Non-reactivity 7-35), with higher scores indicating greater mindfulness.
Difficulties in Emotion Regulation 16 Item Version (DERS-16)
The DERS-16 is a 16-item self-report scale designed to assess emotional dysregulation on a 5-point Likert scale. The scale assesses 6 aspects of emotional dysregulation: non-acceptance of emotional responses ("When I'm upset, I become embarrassed for feeling that way"), difficulties engaging in goal directed behavior ("When I'm upset, I have difficulty thinking about anything else"), impulse control difficulties ("When I'm upset, I lose control over my behaviors"), lack of emotional awareness ("When I'm upset, I take time to figure out what I'm really feeling (reverse-scored)", limited access to emotion regulation strategies ("When I'm upset, it takes me a long time to feel better"), and lack of emotional clarity ("I have no idea how I am feeling"). Total scores range from 16 to 80 and higher scores indicating greater difficulties in emotion regulation.
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