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We tested the moderating effect of internalizing distress on the efficacy of alcohol single\u2010 and multicomponent personalized feedback interventions (PFIs).<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Secondary data were analyzed from a randomized controlled trial (RCT) testing the efficacy of single and multicomponent PFIs, compared with an attention\u2010only control condition.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Participants were sampled from two West Coast universities in the United States. All study protocols were completed online.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>Participants (<jats:italic>n<\/jats:italic>\u2009=\u20091137) were college students (63% female; <jats:italic>M<\/jats:italic><jats:sub>age<\/jats:sub>\u2009=\u200920.1 years; 62.6% non\u2010Hispanic white) who reported on internalizing distress at baseline. Some individuals reported clinically significant symptoms (depression: mild\/moderate =\u200924.0%, severe\/extremely severe\u2009=\u200910.5%; anxiety: mild\/moderate\u2009=\u200919.6%, severe\/extremely severe\u2009=\u200911.4%; and stress: mild\/moderate\u2009=\u200937.5%, severe\/extremely severe\u2009=\u20096.0%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Interventions<\/jats:title><jats:p>There were four different alcohol single\u2010component PFIs administered and an attention\u2010only PFI control. Alcohol PFIs varied in their complexity and single\u2010component PFIs (i.e. personalized normative feedback) were compared with multicomponent PFI (i.e. containing additional alcohol\u2010focused psychoeducation).<\/jats:p><\/jats:sec><jats:sec><jats:title>Measurements<\/jats:title><jats:p>Baseline levels of internalizing distress were measured using the summed total of the Depression, Anxiety and Stress Scales (DASS). Drinking outcomes (alcohol consumption, peak eBAC, alcohol\u2010related consequences) were measured at baseline, 3, 6 and 12\u2009months post\u2010intervention.<\/jats:p><\/jats:sec><jats:sec><jats:title>Findings<\/jats:title><jats:p>Alcohol PFI (compared with attention\u2010only control) reduced alcohol consumption and related consequences at 6\u2010month [rate ratio (RR)<jats:sub>Consumption<\/jats:sub>\u2009=\u20090.85, <jats:italic>P<\/jats:italic>\u2009=\u20090.004] or 12\u2010month follow\u2010ups (RR<jats:sub>Consumption<\/jats:sub>\u2009=\u20090.76, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001; RR<jats:sub>Consequences<\/jats:sub>\u2009=\u20090.85, <jats:italic>P<\/jats:italic>\u2009=\u20090.020), regardless of baseline DASS score. Participants with higher DASS scores (compared with those with lower DASS scores) reported lower 6\u2010month alcohol consumption after receiving a single\u2010component intervention (RR\u2009=\u20090.80, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). However, individuals with higher DASS scores (compared to those with lower DASS scores) reported more 6\u2010month alcohol\u2010related consequences after receiving a multicomponent intervention (RR\u2009=\u20090.78, <jats:italic>P<\/jats:italic>\u2009=\u20090.004).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Personalized feedback interventions may demonstrate efficacy towards reducing drinking in young adults and appear similarly beneficial across levels of internalizing distress, although lower\u2010complexity interventions may be more efficacious.<\/jats:p><\/jats:sec>","DOI":"10.1111\/add.70044","type":"journal-article","created":{"date-parts":[[2025,4,9]],"date-time":"2025-04-09T09:27:10Z","timestamp":1744190830000},"page":"1666-1678","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Examining the longer\u2010term efficacy of brief, alcohol\u2010focused personalized feedback 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