Shyness, alcohol use disorders and ‘hangxiety’: A naturalistic study of social drinkers

Long-term effects of alcohol consumption on anxiety in adults: A systematic review

OBJECTIVE

Despite the high prevalence and comorbidity of alcohol consumption and anxiety, it is unclear whether alcohol consumption influences long-term anxiety. This study aimed to systematically review the literature on the long-term longitudinal effects of alcohol consumption on anxiety in adults.

METHODS

EMBASE, PsychInfo, Medline, and Web of Science databases were systematically searched from inception to April 12th, 2024. Articles analysing the relationship between alcohol consumption and anxiety symptoms or anxiety disorder diagnosis at least three-months later in adults were eligible. Articles were screened and extracted by two independent reviewers with study quality assessed using the Mixed Methods Appraisal Tool.

RESULTS

From 884 records, eight studies of mixed quality met inclusion criteria. One study using a sample representative of the USA population found low volume consumption was associated with lower long-term anxiety. All other studies used a convenience sample or a specific medical population sample. The significance and direction of the relationship between alcohol consumption and long-term anxiety in these studies varied, likely due to differences in alcohol consumption thresholds used and populations studied.

CONCLUSIONS

A paucity of research on the longitudinal effects of alcohol consumption on anxiety was found, highlighting a significant gap in the research literature. Furthermore, existing research, primarily focussed on clinical subpopulations, has yielded mixed results. Further research is needed to explore the longitudinal dose dependent impact of alcohol consumption on anxiety using samples representative of national populations.

Regrets, I've Had a Few: Exploring Factors Associated with Getting Drunk and Regret in an International Study of People Who Drink Alcohol

BACKGROUND

Excessive alcohol consumption is often followed by feelings of regret. This study aimed to explore country differences in experiences of drunkenness and regrets and predictors of experiencing a greater number of regrettable drinking occasions.

METHODS

This study draws on a sample of 82,821 respondents from 31 countries who completed the 2020 Global Drug Survey. Respondents were asked to report how many times in the last year they had been drunk, how many of those times they felt regret afterwards and to complete a range of sociodemographic measures.

RESULTS

In the last 12 months, the median times drunk was 6 and the median number of regretted occasions was 2. There was an inverse relationship between times drunk and regret. Respondents who got drunk more often regretted it a smaller percentage of the time than those who got drunk less often. Respondents from Argentina and Colombia regretted being drunk the most and Denmark the least. Being younger, in higher AUDIT categories were associated with more times drunk. Being a woman, having mental health conditions were associated with more regretted occasions.Discussion and conclusions: Country variations may reflect relative acceptability of being drunk. Those who drink more, per occasion, may become accustomed to the consequences and feel fewer regrets. Interventions promoting reduced alcohol consumption may benefit from encouraging people to consider their future regret following a drinking occasion but should account for lower levels of regret in those who get drunk more often.

Altered cortical thickness of the superior frontal gyrus and fusiform gyrus in individuals with subthreshold social anxiety

Subthreshold social anxiety (SSA) is a condition in which individuals experience social anxiety that does not reach the threshold required for a clinical diagnosis of a social anxiety disorder (SAD). Although SSA may not impair lives as severely as SAD, it can affect social functioning. However, only a few studies focused on structural neural correlates of SSA. We recruited 65 individuals with SSA and used the Leibowitz Social Anxiety Scale to assess their social and performance anxiety levels and other relevant measures of social anxiety. Voxel-wise whole-brain correlational analyses showed a positive association between the cortical thickness (CT) of the superior frontal gyrus (SFG) and social anxiety levels and a negative correlation between the CT of the fusiform gyrus (FG) and performance anxiety levels in individuals with SSA. Exploratory Pearson's correlation analyses showed significant positive correlations between the CT of the SFG and Generalized Anxiety Disorder-7 total scores and negative associations between the CT of the FG and Beck Anxiety Inventory total scores. Our study provides insight into the neural basis of SSA, particularly performance anxiety, by highlighting the association between CT in specific brain regions and SSA characteristics.

Investigating the effects of emotion dysregulation and repetitive negative thinking on alcohol hangover anxiety and depression

INTRODUCTION

Underlying factors associated with alcohol hangover psychological symptoms, such as anxiety and depression, have not been identified. Emotion dysregulation and repetitive negative thinking (RNT) are transdiagnostic factors associated with psychopathology, including non-hangover anxiety and depression. The current study prospectively examined the role of emotion dysregulation on subsequent alcohol hangover anxiety and depression symptoms, as well as the moderating role of RNT on this relation among university students.

METHODS

One hundred thirty-six participants completed baseline assessments of emotion dysregulation (DERS-16) and non-hangover anxiety and depression (DASS-21). Thirty-nine participants reported experiencing alcohol hangover at 2-week follow up and completed assessments of RNT (PTQ) and hangover anxiety and depression (modified DASS-21). Two independent regression-based moderation analyses were conducted to examine the relation of baseline emotion dysregulation, 2-week follow-up RNT, and hangover anxiety and depression symptoms after accounting for baseline non-hangover anxiety and depression symptoms.

RESULTS

Among those experiencing alcohol hangover (n = 39), emotion dysregulation and RNT were not associated with hangover related anxiety beyond non-hangover anxiety. Emotion dysregulation significantly predicted hangover depression but was rendered non-significant by the addition of RNT, which was significantly associated with hangover depression. RNT moderated the emotion dysregulation-hangover depression relation such that emotion dysregulation was not associated with future hangover depression at low levels of RNT but was positively associated with hangover depression at moderate to high levels of RNT.

CONCLUSION

Results provide preliminary support for the role of emotion dysregulation and RNT in hangover depression severity.

Does Personality, Trait Emotion Regulation, and Trait Attentional Control Contribute toward the Experience and Impact of an Alcohol Hangover?

Mixed results have been reported for the relationship between personality and hangover, but recent findings have indicated that regulatory and attentional control processes may relate to hangover severity and the impact of a hangover on completing daily activities. This study aimed to explore how these factors relate to hangover severity, hangover impact, and to unhealthy alcohol use. In total, 108 participants completed a survey, rating the severity and impact of their last-experienced hangover and completing measures of the above factors. Separate multiple linear regressions were conducted to analyse each outcome (severity, impact, unhealthy drinking). For severity, the overall regression was significant (Adj. R2 = 0.46, p < 0.001), with the attentional control factor ‘Focusing’ (B = −0.096, p = 0.011), and personality factor ‘Agreeableness’ (B = 0.072, p = 0.005) predicting severity. For impact, the overall regression was significant (Adj. R2 = 0.41, p < 0.001) with the attentional control factor ‘Shifting’ (B = −0.252, p = 0.021), personality factors ‘Extraversion’ (B = 0.225, p = 0.009) and ‘Agreeableness’ (B = −0.156, p = 0.042), and hangover severity (B = 1.603, p < 0.001) predicting impact. For unhealthy drinking, the overall regression model was significant (Adj. R2 = 0.45, p < 0.001) with emotion dysregulation factors ‘Awareness’ (B = 0.301, p = 0.044) and ‘Impulse Control’ (B = 0.381, p = 0.011) predicting unhealthy drinking. These findings add to our understanding of the heterogeneity of hangover experience and highlight that attentional control, emotion regulation, and personality play important roles in the experience and impact of a hangover.

'Some days I am a lunatic that thinks I can moderate': Amalgamating recovery and neo-liberal discourses within accounts of non-drinking among women active in the 'positive sobriety' community on Instagram in the UK

BACKGROUND

In recent years, reductions in drinking in the UK and the rise of online 'positive' sobriety communities have been observed, yet peer led support groups such as Alcoholics Anonymous (AA) and neo-liberal discourses of control and responsibility dominate public understandings of (problematic) alcohol use. This paper presents research exploring how women active in the 'positive sobriety' community on Instagram position and construct their non-drinking identities and relationships with alcohol within these overlapping discourses.

METHODS

Semi-structured interviews (n=15) and online content produced by women active in the positive sobriety community on Instagram were analysed using thematic analysis.

FINDINGS

Women challenged, reproduced and amalgamated AA discourses of addiction, and the broader discourses of neo-liberalism, in ways that positioned (alcohol) consumption, agency, control and individual responsibility as defining features of feminine identity making. Drawing on these discourses, binary understandings of problematic drinking, the identity of the 'alcoholic', and the need to reach 'rock bottom' in the recovery process were rejected and challenged, but at times reproduced. Whilst a broader framing of problematic drinking that situated drinking problems on a spectrum was constructed, abstinence was engaged with and promoted as the most effective way of gaining control and responsibility over drinking in gendered ways, and in establishing an authentic sense of self.

CONCLUSION

This paper contributes to emerging research on online 'positive' sobriety communities, their gendered nature, and the intertwined presence of traditional recovery and neo-liberal discourses in women's accounts. Online sober communities offered alternative spaces of support and allowed for sobriety and sober femininities to be framed more positively than within traditional AA conceptualisations. However, those involved may experience tensions around (a) the need to 'tell' their personal stories of complete abstinence whilst still appealing to those who seek to 'moderate' and (b) the pressure to create and craft an 'authentic' sober self on an online platform that demands a carefully curated self-image and personal 'brand'. Further research should aim to gain more understanding of the role social media plays in "doing" sobriety and non-drinking, how this is done by people of different genders, the intersectional experiences of those participating, and how these communities can be made more equally available and accessible to those who do not consider full abstinence as necessary, whilst still appealing to those that do.

Do symptoms of depression and anxiety contribute to heavy episodic drinking? A 3-wave longitudinal study of adult community members

Heavy episodic drinking (or binge drinking) is a significant public health concern. Self-medication using alcohol is often thought to explain the co-occurrence of heavy episodic drinking with depression and anxiety. Yet, there is little longitudinal work examining both depressive and anxiety symptoms and how they are independently related to heavy episodic drinking in adult community samples. To this end, we invited adult community members (N = 102) to come to the lab to complete validated measures of depressive symptoms (composite of CES-D-SF, SCL-90-D, and DASS-21-D), anxiety symptoms (DASS-21-A), and heavy episodic drinking (composite of frequency, severity, and perceptions) at baseline, and again three and six months later. Using a three-wave cross-lagged panel model, we tested reciprocal relations between heavy episodic drinking and each internalizing symptom. We found strong temporal stability in our study variables. Depressive symptoms were associated with increases in heavy episodic drinking, and anxiety symptoms were associated with decreases in heavy episodic drinking. In contrast, heavy episodic drinking did not predict either internalizing symptom over time. Results are consistent with the notion that individuals with greater depressive symptoms use alcohol to self-medicate, and that anxiety symptoms (particularly autonomic arousal) may be potentially protective against future heavy episodic drinking.

Associations between Mental Resilience, Mood, Coping, Personality, and Hangover Severity

Extensive research exists on relationships between psychological constructs and alcohol consumption. However, research on relationships with hangover severity remains limited. This study aimed to assess the associations between mental resilience, mood (i.e., depression, anxiety, and stress), coping, personality, and hangover severity. A total of N = 690 participants completed an online survey by answering questions regarding their demographics, alcohol use, hangover prevalence and severity, and several psychological assessments (Brief Resilience Scale, DASS-21, Brief Cope, and Brief Version of the Big Five Personality Inventory). Significant associations were found between hangover severity and mental resilience, mood, and avoidant coping. Higher levels of mental resilience were associated with less severe hangovers, whereas poorer mood was associated with more severe hangovers. No significant associations were found with personality traits. These findings demonstrate that several associations between psychological constructs and hangover severity exist and suggest a role of psychological factors in the pathology of the alcohol hangover. As our findings contrast with the results of previous studies that did not report an association between mental resilience and the presence and severity of hangovers, further research is warranted.

Shyness and susceptibility to social influence: Stronger concordance between norms and drinking among shy individuals

Despite a large body of work exploring associations between perceived norms and drinking and norms-based interventions for drinking, less work has examined moderators of associations between norms and drinking outcomes to determine potential sub-groups that might benefit most from brief norms-based interventions. The present study investigates shyness as a moderator of associations between drinking norms and alcohol use. We hypothesized that shyness would moderate associations between drinking norms and alcohol use such that individuals who are higher in shyness might be more sensitive to social influence and thus show stronger associations between drinking norms and alcohol use. Participants included 250 college students (70% female; 44.5% White/Caucasian) aged 18-26 (M = 21.02, SD = 2.16) who met heavy drinking criteria (4/5 drinks on one or more occasions in the past month for women/men). Participants completed measures of demographics, shyness, alcohol use, alcohol-related problems, and drinking norms remotely at baseline and one-month follow-up (N = 169). Drinking norms were negatively associated with shyness and positively associated with baseline and follow-up drinking. Shyness was negatively associated with baseline drinking but not associated with follow-up drinking. Interaction models tested longitudinal associations between shyness, descriptive drinking norms, and follow-up drinking, controlling for baseline drinking and gender. Results showed that associations between drinking norms and drinks per week were strongest among people who were higher in shyness. Individuals who are shy may be more susceptible to social influence and thus may benefit more from a norms-based drinking intervention. Future work may explore shyness as a moderator of norms-based intervention efficacy.

Faith-based intervention, change of religiosity, and abstinence of substance addicts

Objective:

To investigate the effects of developing religiosity on abstinence of substance abuse among recovering addicts in a faith-based and a secular-based treatment program.

Methods:

Religiosity of recovering addicts was measured using the 38-item Brief Multidimensional Measure of Religiousness/Spirituality at three points in time: at initiation of substance addiction treatment (wave 1), discharge from treatment (wave 2), and 6 months after treatment (wave 3). Latent growth curve modeling was used to assess the dynamic and developing effects of religiosity on after-treatment abstinence. Secular-based treatment emphasized the role of biological, psychological, and environmental determinants of substance abuse and provided detoxification interventions, such as counseling and group therapies, skill training, health care, and social support, however also relying on religious and spiritual growth to help recovery. Faith-based treatment fundamentally emphasized the Christian theory of addiction to consider substance abuse a sin caused by one’s spiritual void and separation from God, although it also acknowledged the importance of biological, psychological, and social needs of rehabilitants.

Results:

Recovering addicts in faith-based treatment had significantly higher levels of religiosity at each wave (intercept factor) and better religious development across the three waves (slope factor). This contributed to after-treatment abstinence and mediated the effect of treatment mode on after-treatment abstinence.

Conclusion:

Service practitioners and researchers should note the importance of dynamic and developing nature of religiosity in relation to the maintenance of abstinence after treatment is completed.

Does Alcohol Hangover Affect Emotion Regulation Capacity? Evidence From a Naturalistic Cross-Over Study Design

AIMS

The aim of this study was to investigate the effects of alcohol hangover on emotion regulation.

METHODS

Forty-five non-smoking, healthy participants aged between 18 and 30 years completed a lab-based emotion regulation task assessing cognitive reappraisal and an emotion regulation questionnaire (State-Difficulties in Emotion Regulation Scale [S-DERS]) when hungover (morning following a night of heavy drinking) and under a no-hangover condition in a naturalistic, within-subjects design study.

RESULTS

Participants reported poorer emotion regulation overall (P < 0.001, d = 0.75), and for the subscales 'Non-Acceptance', 'Modulation' and 'Clarity' (Ps ≤ 0.001, ds ≥ 0.62), but not 'Awareness' on the S-DERS, in the hangover versus the no-hangover condition. Hangover did not impair emotion regulation ability as assessed using the lab-based task (Ps ≥ 0.21, ds ≤ 0.40), but there was a general negative shift in valence ratings (i.e. all images were rated more negatively) in the hangover relative to the no-hangover condition (P < 0.001, d = 1.16).

CONCLUSION

These results suggest that emotion regulation in everyday life and emotional reactivity may be adversely affected by alcohol hangover, but some emotion regulation strategies (e.g. deliberate cognitive reappraisal) may be unaffected.