Abstract
Background
Alcohol use among young adults has been associated with a range of negative consequences, including poor academic performance, higher risk of accidents, and increased likelihood of developing addictive behaviors. This age group (18–25 years) represents a key public health concern, as a significant proportion report alcohol consumption, and many engage in binge drinking.
Purpose
This article seeks to examine the relationship between attachment, alcohol expectancies, and metacognitive beliefs with the use of alcohol in young adults.
Methods
This study has a correlational research design. The study had 200 participants whose ages ranged between 18 and 25 years, divided into two groups. Group 1 comprising of 100 males and Group 2 comprising of 100 females. The sampling method was Nonprobability type criterion-based sampling. The dependent variable was alcohol use, and the independent variables were attachment style, alcohol expectancies and metacognitive beliefs about alcohol.
Results
The results have indicated significant relationships of positive alcohol expectancies and metacognitive beliefs about emotional self-regulation with the severity of alcohol use. Anxious and avoidant style of attached individuals consumed significantly more than securely attached ones. Moderate risk consumers reported positive expectancies and metacognition as significantly higher than low-risk consumers.
Conclusions
Findings suggest that attachment orientations, alcohol expectancies, and metacognition interact and affect young adults’ drinking behaviours. These results suggest that these psychological factors should be considered when designing interventions aimed at eradicating risky drinking behaviours.
Introduction
The National Institute on Alcohol Abuse and Alcoholism released data showing that alcohol consumption remains a critical public health issue that affects 60% of people aged 18–25 years old, and 37% of them participate in binge drinking. 1 Drinking beyond recommended limits yields multiple negative consequences, including physical harm, along with medical problems and problems with learning abilities and social dynamics. 2 Research by Hingson et al. 3 shows that early substance exposure enhances the risk of addiction alongside serious adverse outcomes. Research shows that psychological factors shape substance use behaviours because cognitive and emotional patterns strongly determine drinking habits and dependence risks. Early attachments with caregivers and alcohol-related beliefs and cognitive processes work together to shape this developmental pattern. 4
Attachment Style and Alcohol Use
According to attachment theories developed by John Bowlby and Mary Ainsworth, research shows that a child’s emotional development is influenced greatly by early caregiver bonding patterns. 5 The attachment experiences from early childhood determine adult stress management, including alcohol use as a self-soothing behaviour.
According to Liese et al., 6 insecure attachment among young adults results in elevated emotional challenges that cause them to use alcohol as a means for emotional control. Levitt and Leonard 7 discovered that people with insecure attachment modes often drink alcohol to handle relationship tensions, thus raising their chances of developing alcohol-use problems. Medical experts do not consider insecure attachment to be a mental disorder, though researchers have shown links between this dynamic and psychological issues. Studies reveal that clinical patients demonstrate insecure attachment symptoms in 86% of cases, whereas this condition affects 42% of people within the general population. 8 The research establishes insecure attachment patterns as a primary element that increases vulnerability to substance use disorders along with other psychological health disorders. 9 A weakened sense of security creates challenges for emotional regulation and stress management.
Alcohol Outcome Expectancies
People who use alcohol develop beliefs which describe how drinking impacts their experiences, like enhancing social ability and lowering tension. Young people face a greater risk of social influence regarding their drinking habits because of these expectations, which control their alcohol choices. 10
Positive expectancies about alcohol, which include perceptions that alcohol helps in socialising or reducing stress, contribute to heavy drinking behaviours in young adults. According to Blume and Guttu, 10 the development of particular expectancies leads to both frequent and excessive alcohol consumption. According to Dunne and Katz, 11 young adults succumb to binge drinking since positive alcohol expectancies create anticipations of negative alcohol-related actions.
Interventions designed to change and dispute positive alcohol-related expectancies according to cognitive theories help lower alcohol experimentation risks. According to Caselli et al., 12 such belief transformations cause substantial changes in alcohol consumption patterns in people dealing with alcohol disorders. The research framework confirms earlier theoretical methods, which demonstrate that prevention programs that focus on alcohol expectancies produce beneficial effects for preventing dangerous alcohol use among young adults.
Metacognition and Alcohol Use
The ability to think about and control thinking processes, known as metacognition, serves vital functions for understanding behaviours that lead to addiction. People who believe alcohol serves as their only tool for emotional control develop and maintain addictive behaviours according to studies by Hamonniere and Varescon. 13
Research shows that individuals’ metacognitive beliefs successfully predict their drinking behaviour patterns in the long term. Spada et al. 14 conducted research which investigated metacognitive beliefs related to alcohol consumption. Research by Spada et al. 14 revealed that positive metacognitive beliefs, which claim alcohol helps with emotional regulation, will promote greater alcohol intake. 14 Studies have shown negative metacognitive beliefs about alcohol control as an uncontrollable factor in relation to problematic drinking, even after receiving cognitive behavioural therapy (CBT). Traditional treatment methods demonstrate their inability to address problematic behaviours because they focus only on altering surface-level thinking patterns while ignoring the fundamental cognitive frameworks that drive these behaviours. Studies in metacognitive training have demonstrated that altering these beliefs leads people to achieve improved self-regulation while reducing their substance use tendencies. 15
The studies have individually highlighted the influence of attachment styles, alcohol outcome expectancies, and metacognitive beliefs on alcohol use. By examining these variables together in young adults, this research aims to provide insights that could contribute to the development of therapeutic approaches for addressing alcohol-related harm in this population.
Methodology
Aim
To study attachment styles, alcohol expectancies and Metacognition beliefs in young adults using alcohol.
Objectives
To study the relationship between attachment styles, alcohol expectancies and Metacognition beliefs in young adults using alcohol.
To examine and compare Metacognition beliefs, alcohol expectancies and attachment styles among low and moderate-risk alcohol intake in young adults based on the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST).
To assess and compare Metacognition beliefs, alcohol expectancies and attachment styles among male and female young adult alcohol users.
To study and compare Metacognition beliefs, alcohol expectancies and attachment styles in young adults with and without parental alcohol use.
To study the effect of alcohol expectancies, attachment styles and Metacognition beliefs on alcohol use among young adults.
Hypotheses
H1. There would be significant relationship between attachment styles, alcohol expectancies and metacognition beliefs in young adults using alcohol.
H2. There would be significant difference on metacognition beliefs, alcohol expectancies and attachment styles among low and moderate risk alcohol intake in young adults based on ASSIST.
H3. There would be significant difference on metacognition beliefs, alcohol expectancies and attachment styles among male and female young adult alcohol users
H4. There would be significant difference on Metacognition beliefs, alcohol expectancies and attachment styles in young adults with and without parental alcohol use.
H5. There would be significant effect of alcohol expectancies, attachment styles and metacognition beliefs on alcohol use among young adults.
Material and Methods
Research Design
A correlational research design was used in the study.
Sample Description
The sample consisted of 200 participants aged between 18 and 25 years, including both male and female which were divided into two groups. Group 1 comprised of 100 males and Group 2 comprised of 100 females. The groups were further divided based on low risk and moderate risk of alcohol use based on ASSIST.
Sampling Method
Nonprobability type criterion-based sampling method was used in the present study.
Inclusion Criteria
Males and females in the age range of 18–25 years.
Individuals who have consumed alcohol in the past year.
Those who scored between 1 and 10 on the ASSIST.
Subjects with an education level till 12th grade.
Exclusion Criteria
Those with any psychiatric illness as per ICD-10 DCR.
Those who are using or dependent upon any psychoactive substance except alcohol and nicotine.
Scales Description
Socio-demographic and Clinical Data Sheet
Semi-structured socio-demographic and clinical data sheet was used to collect information related to name, age, gender, education, past psychiatric history, including diagnosis, parents’ alcoholism, and alcohol consumption in the last one year.
Alcohol, Smoking and Substance Involvement Screening Test
Developed by an international expert team for the World Health Organisation in 2002, the ASSIST assesses lifetime and recent use of various substances. It has demonstrated high inter-observer reliability, with coefficients 0.90 for lifetime substance use assessments.
Alcohol Outcome Expectancies Scale (AOES)
The AOES is a self-report scale that measures alcohol expectancies and consists of 34 items measured by Leigh in 1993. The scale has shown acceptable levels of test-retest reliability, with coefficients typically above 0.70 and construct validity.
The Positive Alcohol Metacognitions (PAMS)
PAMS, Spada and Wells (2006b), is a 6-item positive metacognitive beliefs about alcohol use questionnaire. The internal consistency was found to be 0.88.16
The Negative Alcohol Metacognitions Scale (NAMS)
NAMS, also developed by Spada and Wells (2006b), is a 6-item measure referring to negative metacognitive beliefs about alcohol, such as uncontrollability and cognitive damage and showing good internal reliability 0.74.
The Adult Belonging Scale (AAS)
The AAS was developed in 1990 and assesses adult attachment styles: secure, anxious, and avoidant, where the subjects rate 18 statements using a 5-option Likert scale. Cronbach’s measures of internal consistency are 0.75.
Procedure
After getting approval from the Departmental Research Committee, those who fulfilled the inclusion and exclusion criteria were included in the study sample. Informed consent was taken from participants, and they were informed that all data offered in the questionnaires would be kept confidential and participation in the research project was solely voluntary (i.e., they could withdraw at any time). Directions for finishing the questionnaires were provided verbally and in writing. Participants were screened with the help of ASSIST. Those who scored 1 or more on the scale were included in the study and were asked to complete further assessment, including AAS, AOES, NAMS and PAMS. After the completion of data collection, scoring was done as per the scoring guidelines. After scoring the data, the data was tabulated, and the required statistical operations were performed.
Statistical Analysis
The data was analysed using IBM Statistical Package for Social Sciences (SPSS) version 26. Sample characteristics were analysed with the help of descriptive statistics. To study the relationship between attachment styles, alcohol expectancies, metacognition beliefs and alcohol use Pearson correlation coefficient was used. The effect of attachment styles, alcohol expectancies, metacognition beliefs on alcohol use was assessed through multiple linear Regression Analysis. To compare attachment styles, alcohol expectancies and metacognition beliefs in male and female young adults using alcohol at low and moderate risk, an Independent sample t-test was used.
Results
Socio-demographic Details
Sociodemographic Variables of Young Adults Using Alcohol (n = 200).
Table 1 summarises the sociodemographic data of young adults using alcohol (n = 200). The mean age was 21.14 years (SD = 2.13), with 13.96 years of education (SD = 0.932). The sample had equal gender distribution, 78.5% were from urban backgrounds, and 52% had parental alcohol use. Alcohol risk levels were low in 60% and moderate in 40% of participants.
Descriptive Analysis of Variables, Attachment Styles, Alcohol Expectancies and Metacognition Beliefs About Alcohol Among Young Adults Using Alcohol (n = 200).
Table 2 summarises the mean scores and standard deviations for attachment styles, alcohol expectancies, and metacognitive beliefs. The mean alcohol dependence score was 10.30 ± 5.486. On Attachment style, the mean and standard deviation scores were: avoidant (17.46 ± 4.439), secure (18.97 ± 5.360) and anxious (15.18 ± 4.656). Positive and negative alcohol expectancies averaged 58.97 ± 20.951 and 38.61, respectively. Specific expectancies ranged from 7.09 to 13.16. Positive metacognition was 22.22 ± 8.442, while negative metacognition averaged 7.73 ± 2.915.
Group Differences
Attachment Styles, Alcohol Expectancies and Metacognition Belief About Alcohol Between Male and Female Young Adults Using Alcohol (Male n = 100, Female n = 100, df = 198).
Table 3, the findings suggested that males scored higher in avoidant (t = 2.319, p = .021) and secure attachment (t = 2.320, p = .021), while females scored higher in sex-related alcohol expectancies (t = 3.746, p = .000) and social expectancies (t = 3.321, p = .001). Males reported stronger beliefs in alcohol’s cognitive harm (t = 3.124, p = .002) and overall negative metacognitions (t = 2.813, p = .005). Other differences were non-significant.
Shows Group Differences in Attachment Styles, Alcohol Expectancies and Metacognition Belief About Alcohol Between Low Risk and Moderate Risk Alcohol Users Among Young Adults Using Alcohol (Low Risk n = 120, Moderate Risk n = 80, df = 198).
Table 4 compares low-risk and moderate-risk alcohol users on various psychological factors. Moderate-risk users had significantly higher ASSIST scores (t = 16.893, p < .001) and greater avoidant (t = 3.948) and anxious attachment (t = 3.902), while secure attachment was lower (t = 11.739). They also reported higher positive alcohol expectancies, including social facilitation (t = 11.804), fun (t = 13.858), sex (t = 6.902), and tension reduction (t = 7.130), but lower negative expectancies (t = 8.696). Positive metacognition, emotional and cognitive self-regulation were higher (t = 10.802, t = 11.329, t = 5.035). Negative metacognition was also significantly higher, with uncontrollability (t = 3.539) and cognitive harm (t = 2.059, p = .041).
Shows Group Differences in Attachment Styles, Alcohol Expectancies and Metacognition Belief About Alcohol Among Young Adults Using Alcohol Between Parental Alcohol Present and Absent (Parental Alcohol Use Present n = 104, Absent n = 96, df = 198).
Table 5 results suggest Parental alcohol use was linked to higher ASSIST scores (t = 7.263, p = .000), greater avoidant (t = 4.114, p = .000) and anxious attachment style (t = 3.082, p = .002), but lower secure attachment (t = 5.063, p = .000). Those with parental alcohol use had higher positive expectancies (t = 7.411, p = .000) and lower negative expectancies (t = 4.008, p = .000). They also showed higher positive metacognition (t = 6.506, p = .000) and self-regulation (t = 7.194, p = .000), with significantly greater negative metacognition (t = 2.260, p = .025).
Correlation Between the Variables
Pearson Correlation Matrix for Attachment Styles, Alcohol Expectancies and Metacognition Belief About Alcohol Among Young Adults Using Alcohol (n = 200).
*Correlation is significant at the 0.05 level (2-tailed).
Table 6 shows a correlation matrix of the variables, where we can observe patterns of romantic attachment, alcohol expectancies, metacognition, and the severity of alcohol use among young adults. The aversive attachment types, avoidant and anxious, are positively associated with the severity of the alcohol problem (r = 0.232, r = 0.252, respectively, p < .01), while the secure type is inversely related to the level of alcohol use, r = –0.436, p < .01. Positive alcohol expectancies were highly positively associated with the amount consumed (r = 0.608, p < .01), and negatively associated with negative expectancies (r = –0.359, p < .01). Positive and negative metacognitive beliefs significantly, positively predicted alcohol use with positive metacognition beliefs showing the stronger relationship (r = 0.614, r = 0.269, respectively), t < 0.01. Participants’ PAE were significantly positively correlated with both anxious (r = 0.163; p < .01) and avoidant (r = 0.198, p < .00) attachment styles; concurrently, PAE had a significant negative relationship with secure attachment orientation (r = −0.430; p < .01). Therefore, secure attachment had a significant and positive relationship with negative alcohol expectancies, r = 0.447, p < .01. Positive and negative metacognitive beliefs were also significantly related to attachment styles: positive metacognitive beliefs were positively related to avoidant (r = 0.260) and anxious (r = 0.167) but negatively related to secure attachment (r = −0.311).
Regression Analysis
Stepwise Multiple Regression Analysis of Total Score of Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) as Dependent on Variable and Attachment Styles, Alcohol Expectancies and Metacognition Beliefs About Alcohol as Independent Variables (n = 200, df = 199).
*Significant at the 0.05 level (2-tailed).
Table 7 provides the stepwise multiple regression analysis of alcohol use severity: CI = confidence interval; LL = lower limit; UL = upper limit; β = standardised coefficient; R = correlation coefficient; R² = proportion of variance explained. The ASSIST score, with the predictors of attachment styles, alcohol expectancies, and metacognitive beliefs. Out of the metacognitive beliefs, positive belief in the ability to regulate emotions defined 42.9% of the variance (β = 0.340). For fun-related positive expectancies, R 2 = 0.501 (β = 0.156), whereas for negative expectancies R 2 = 0.528 (β = −0.103). Negative expectancies involving emotions accounted for 55.8%, secure attachment accounted for 57.2% (−0.136), and uncontrollability as a negative metacognitive belief accounted for 58.1% of the variance (0.398).
Discussion
The study explored how attachment styles relate to alcohol-related expectancies and metacognitive processes among young adults who consume alcohol. The study assessed alcohol use severity through ASSIST scores, which functioned as the dependent variable, while it measured attachment styles along with positive and negative alcohol expectancies and both positive and negative metacognitive beliefs as independent variables.
This research tested five different hypotheses, which evaluated the variable relationships as well as the distinctions between low and moderate-risk users alongside gender differences and parental effects. Stepwise regression, in addition to correlation and t-tests, constituted the data analysis methods. The results validate the impact of attachment on substance use because insecure attachment patterns lead to increased alcohol consumption through maladaptive coping mechanisms. 17 Research shows that parental alcohol consumption leads to insecure attachment and elevated positive drinking expectancies and metacognitive beliefs, which align with findings demonstrating how parental drinking patterns impact offspring alcohol use behaviours. 18 Secure attachment proved to be protective by decreasing the severity of alcohol consumption according to Schindler. 19
Research findings by Christiansen et al. 20 were validated through the observation that individuals with positive expectancies related to fun and social interaction consumed more alcohol, but negative expectancies based on cognition and physical effects were reported most frequently. The drinking habits of moderate-risk participants were supported by stronger positive expectancies regarding social facilitation and fun and tension reduction while showing less negative expectancies. 21 Research data revealed that males preferred alcohol for sexual activities and stress management, while females used it to regulate emotions and reduce tension in conformity with previous research. 22 The research confirmed that alcohol use severity depends most strongly on emotional self-regulation, together with positive expectancies along with negative expectancies and secure attachment and uncontrollability factors. The research findings demonstrate the requirement for treatment approaches that focus on changing attachment patterns and cognitive beliefs to decrease alcohol misuse. The research findings suggest that treatment approaches should combine interventions for attachment-based risks with cognitive therapy to decrease alcohol misuse. Future research should adopt longitudinal and neurophysiological approaches to establish causal relationships and enhance intervention strategies.
Footnotes
Acknowledgements
We extend our sincere gratitude to SGT University, Gurugram, for providing the necessary resources and support to conduct this research. We also appreciate the contributions of research participants, colleagues, and mentors who provided valuable insights throughout this study.
Authors’ Contributions
Shivangi Agrawal: Conceptualisation, Methodology, Data Collection, Statistical Analysis, Manuscript Writing, and Final Review.
Vikas Sharma: Supervision, Theoretical Framework, Critical Review, and Editing.
Both authors have read and approved the final manuscript.
Authors’ Information
Shivangi Agrawal is a Clinical Psychologist and Assistant Professor in Clinical Psychology with expertise in depression, anxiety, OCD, CBT, DBT, and schema therapy. Dr Vikas Sharma is a senior researcher and faculty member specialising in psychological research, mental health interventions, and statistical methodologies in behavioral sciences.
Availability of Data and Materials
The data supporting the findings of this study are available from the corresponding author upon reasonable request. Due to confidentiality and ethical considerations, data will not be shared publicly.
Consent for Publication
All authors have given their consent for the publication of this manuscript. Participants were informed that their anonymised data might be used for research purposes, and they provided written consent for the same.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.
Funding
The authors received no financial support for the research, authorship and/or publication of this article.
Statement of Ethics
This study was conducted following the ethical guidelines of the Indian Council of Medical Research (ICMR) and the Declaration of Helsinki. The study received ethical approval from the Institutional Ethics Committee of SGT University, Gurugram (Approval No: SGTU/FBSC/ECC/2021/33). All participants provided informed consent before participation.
