Associations among Trauma, Posttraumatic Stress, and Hazardous Drinking in College Students: Considerations for Intervention

Problem drinking among university students in Berlin

OBJECTIVE

Problem-drinking among university students is common and poses serious health-related risks. Therefore, identifying and addressing associated factors is important.

PARTICIPANTS AND METHODS

A large cross-sectional online-survey with 12,914 university students from Berlin was conducted from November 2016 to August 2017. Relative-risk- and correlation-analysis was used to identify factors associated with problem-drinking and regular heavy-drinking. Independent t-tests compared impulsivity and personality traits, chi-square-tests compared drinking motives between risk- and non-risk-drinkers.

RESULTS

Male gender, tobacco-smoking, illegal substance use, impulsivity and various sociodemographic and psychosocial variables were significantly related to problem/heavy-drinking. Extraversion was a risk, conscientiousness and agreeableness were protective factors. Drinking-motives did not differ significantly between risk- and non-risk-drinkers. Generally, the main drinking-motives were to feel elated, relax and social purposes.

CONCLUSION

The identified markers and related problem behaviors may serve as a tool to enhance the identification of student subgroups at risk for problem/heavy-drinking, and hence improve targeted health-intervention-programs.

Negative urgency, PTSD symptoms, and alcohol risk in college students

Theoretical models of trauma and alcohol use suggest that trauma-exposed individuals with higher levels of PTSD symptoms are at increased risk of problematic and coping-oriented alcohol use to alleviate unwanted internal states. The goal of the current study was to evaluate whether these associations are enhanced among young adults who report engaging in impulsive behavior in the context of negative affect (i.e., high negative urgency). It was hypothesized that (a) higher negative urgency would be associated with problematic alcohol use; and that (b) negative urgency would moderate the association between PTSD symptoms and problematic alcohol use. Methods: This study used a cross-sectional, secondary data analysis design run on 213 participants: college students, ages 18-25, who endorsed both having an interpersonal traumatic event and current weekly alcohol use. Participants completed a series of assessments and self-report questionnaires. Results: Results of hierarchical linear regression models indicated that greater negative urgency was significantly associated with greater negative alcohol-related consequences and greater coping motives for alcohol, but not past 30-day binge frequency or past 30-day alcohol quantity. Negative urgency did not moderate associations between PTSD symptoms and alcohol outcomes. Conclusions: PTSD symptoms and negative urgency are uniquely associated with indices of alcohol risk in college students with a history of trauma exposure. However, individuals high in negative urgency are not necessarily consuming more alcohol, nor does negative urgency increase the association between PTSD symptoms and drinking outcomes in this population.

The co-occurrence of mental disorders among Dutch adolescents admitted for acute alcohol intoxication

Adolescents with substance use disorders are often diagnosed with co-occurring mental disorders. However, it is unknown if adolescent hospital admission for acute alcohol intoxication is also associated with co-occurring mental disorders. Therefore, the primary aim of this study is to estimate the prevalence of co-occurring mental disorders among Dutch adolescents admitted for acute alcohol intoxication. Secondly, this study aims to explore the cross-sectional relationship between the co-occurrence of mental disorders and patient characteristics, such as sex, age and blood alcohol concentration at admittance. Data were retrospectively collected from 726 adolescents admitted for acute alcohol intoxication. Overall, 245 (34%) of the 726 adolescents treated for acute alcohol intoxication were diagnosed with a co-occurring mental health disorder, such as attention-deficit hyperactivity disorder (13%) or autism spectrum disorder (2.1%). Attention-deficit hyperactivity disorder in particular seems to be more prevalent in the study population than in the general Dutch adolescent population.Conclusion: This study demonstrates that among adolescents admitted for acute alcohol intoxication, the prevalence of co-occurring mental disorders is a common and a relevant issue for treatment and prevention strategies. What is Known: • Alcohol consumption among adolescents has been associated with negative psychosocial effect. • Among adolescents admitted for acute alcohol intoxication, risk factors for psychological dysfunction appear to be inadequately assessed, documented and followed up. What is New: • The current study reports on the prevalence of co-occurring mental disorders among a substantial sample of adolescents admitted for acute alcohol intoxication. • Understanding the prevalence of co-occurring mental disorders is clinically relevant for the outpatient follow-up of adolescents admitted for acute alcohol intoxication.

Effects of processing positive memories on posttrauma mental health: A preliminary study in a non-clinical student sample

BACKGROUND AND OBJECTIVES

Although trauma research and therapy primarily focus on traumatic memories, recent evidence indicates positive memory processes play a role in the etiology/maintenance of posttraumatic stress disorder (PTSD) symptom severity. We examined the effects of a novel positive memory processing technique on PTSD symptom severity, depression symptom severity, affect, posttrauma cognitions, and self-esteem.

METHODS

Sixty-five trauma-exposed participants were randomly assigned to one of three conditions (narrating/processing vs. writing/processing two specific positive memories, or a time-matched control) and completed self-report measures pre- and post-task (T0). About one week later, participants repeated their assigned task condition and completed self-report measures pre- and post-task (T1). We conducted mixed ANOVAs to examine the impact of the technique on study variables over time.

RESULTS

The narrating condition had significant decreases in PTSD symptom severity, posttrauma cognitions, and negative affect from T0 pre-task to T1 post-task; and significant increases in positive affect from T0 pre-to-post-task and from T1 pre-to-post-task. The writing condition had significant increases in positive affect from T0 pre-to-post-task, but a significant decrease from T0 post-task to T1 post-task; and significant decreases in negative affect from T0 pre-to-post-task with an increase from T0 post-task to T1 post-task.

LIMITATIONS

Use of self-report measures, non-clinical convenience sample with less gender/ethnic/racial diversity, small sample size, methodological differences in time frames for measures, and no examination of follow-up effects.

CONCLUSIONS

Narrating and processing specific positive memories had a beneficial impact on PTSD symptom severity, posttrauma maladaptive cognitions, and affect; such results provide an impetus to examine positive memory interventions in trauma clinical work.

Associations among trauma, depression, and alcohol use profiles and treatment motivation and engagement in college students

OBJECTIVE

This study examined how profiles of alcohol use and symptoms of common mental health disorders (depression and posttraumatic stress disorder [PTSD]) influenced the perceived need for and actual seeking of different types of treatment (for alcohol versus psychological distress) in college student drinkers.

PARTICIPANTS

Undergraduate students (n = 164) were assessed between September 2009 and August 2015.

METHODS

We classified students into different symptom profiles using model-based clustering and compared these profiles on a variety of variables.

RESULTS

The cluster model yielded three profiles: Low Risk (n = 66), Concomitant (n = 35), and Heavy Drinking (n = 63). Students in these profiles significantly differed in alcohol consumption, alcohol-related cognitions and problems, and perceptions of need and prior engagement in treatment.

CONCLUSION

A variety of strategies can be used to engage students experiencing heavy drinking and/or mental health problems into treatment on campus.

Posttraumatic Stress, Coping Flexibility, and Risky Drinking Among Trauma-Exposed Male and Female College Students: The Mediating Effect of Delay of Gratification

BACKGROUND

The co-occurence of posttraumatic stress (PTS) and risky drinking has been demonstrated in diverse populations, including college students. However, the mechanisms underlying this co-occurrence, as well as the protective factors that may reduce risky drinking among trauma-exposed college students have yet to be fully understood in the literature.

OBJECTIVES

The present study builds upon self-regulation theories and previous empirical work to determine whether the effects of PTS and coping flexibility on risky drinking were mediated by delay of gratification among trauma-exposed college students. In addition, the potential moderating effect of gender on these relationships was examined.

METHODS

Participants included 624 trauma-exposed college students (68.4% female) attending a public university in the southeast region of the United States. Data were collected through an online survey. The hypothesized model was examined using a multigroup structural equation modeling approach.

RESULTS

As hypothesized, PTS had a significant, positive indirect effect on risky drinking through delay of gratification; however, the effect of PTS on delay of gratification was stronger for males than for females. Results also indicated that the indirect effect of coping flexibility on risky drinking through delay of gratification was significant and negative for males and females. Conclusions/Importance: The findings of this study suggest that delay of gratification might be an important mechanism underlying the co-occurrence of PTS and risky drinking. In addition, our results highlight the potential benefits of coping flexibility for college students coping with PTS.

PTSD and Pregaming in College Students: A Risky Practice for an At-Risk Group

BACKGROUND

College students with trauma exposure and PTSD are at risk for problem drinking. This may include more specific hazardous drinking practices such as pregaming (drinking prior to a social event), which is linked to increased alcohol-related consequences.

OBJECTIVES

The present study examined the association between pregaming and alcohol consequences and the role of trauma exposure and PTSD in predicting pregaming and alcohol-related consequences in a sample of college students using Multilevel Structural Equation Modeling (MSEM). We also assessed specific risk associated with PTSD relative to trauma exposure alone in relation to our outcomes.

METHODS

Participants were categorized into groups based on trauma exposure and PTSD symptoms via diagnostic interview: (1) No Trauma, those who had not experienced a Criterion A trauma; (2) Trauma Only, those who experienced a Criterion A trauma but did not currently have PTSD; and (3) PTSD, those with current full or partial PTSD related to a Criterion A trauma. Alcohol consumption and related consequences also were measured via interview (TLFB, B-YAACQ).

RESULTS

For all participants, nearly 50% more consequences were reported on pregaming days compared to nonpregaming drinking days. Those with PTSD were significantly more likely to pregame than those in the Trauma Only and No Trauma groups. Moreover, students with PTSD reported more consequences on pregaming days relative to the other two groups. In all analyses, the No Trauma and Trauma Only groups did not differ.

CONCLUSIONS

PTSD may confer risk both for pregaming and experiencing harmful consequences on pregaming days.

What Is Pregaming and How Prevalent Is It Among U.S. College Students? An Introduction to the Special Issue on Pregaming

Pregaming (or prepartying) can be defined as drinking before going to an event or gathering. The heavy consumption of alcohol and resulting negative consequences that are associated with pregaming have prompted scholars to investigate this risky drinking practice. Indeed, research on college pregaming has grown considerably within the past decade, with over 80 articles published since the seminal empirical studies on pregaming were published in 2007. This special issue in Substance Use & Misuse seeks to address a number of topics on pregaming among U.S. college students that are not well understood. The articles in this special issue explore pregaming behaviors among particular subgroups of students (i.e., college freshmen; postgraduates) as well as the following topics as they pertain to pregaming: exposure to trauma, emotion regulation, social norms, pregaming motives, protective behavioral strategies, and intervention efforts. This prologue to the special issue will discuss key points regarding the definition of pregaming, present an overview of the prevalence rates of pregaming among U.S. college students within the past decade, and introduce articles that advance the understanding of factors that contribute to the high-risk drinking context of pregaming.