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Balters S, Schlichting M, Walton TO, Kochenderfer MJ, Kaysen D. A month in review: longitudinal dynamics between daily PTSD symptom networks, affect, and drinking behaviors in female college students. Front Psychol 2024; 15:1388539. [PMID: 39139596 PMCID: PMC11319128 DOI: 10.3389/fpsyg.2024.1388539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 07/03/2024] [Indexed: 08/15/2024] Open
Abstract
Introduction Sexual victimization (SV) is common among college women, with approximately half of those who have experienced SV meeting criteria for posttraumatic stress disorder (PTSD) within a year. Both SV and PTSD are associated with alcohol misuse among college women, often explained by the self-medication hypothesis. Existing literature focuses on overall PTSD severity rather than potential day-to-day fluctuations in specific symptoms, which might play a crucial role in understanding alcohol misuse risk. Studies also examine only same-day or next-day associations between PTSD and drinking, neglecting the potential for longer-term changes. Methods This study explores the short-term longitudinal stability and time-lagged predictive dynamics of PTSD symptoms, affect, and drinking behavior among 174 female college heavy episodic drinkers over four weeks. Participants were categorized into three groups: those with a history of SV and PTSD (n = 77), women with SV but without PTSD (n = 59), and women without prior trauma history (n = 38) to be able to examine differences by trauma exposure, and PTSD. We compared the longitudinal stability of PTSD symptom networks, affect (arousal, positive affect, and negative affect), and drinking behavior across groups. Support vector regression determined which PTSD symptom networks and affect best predict drinking behavior at specific time lags within a 0-7 day range. Results The PTSD group showed higher longitudinal stability for PTSD symptom networks (adjusted ps <.049) and arousal (adjusted ps <.048), but lower stability for negative affect (adjusted p =.013) and drinking behavior, including alcohol cravings (adjusted p =.019) and consumption (adjusted ps =.012), compared to the comparison groups. This suggests individuals with PTSD have more stable symptoms and arousal levels but greater fluctuations in negative affect and alcohol-related behaviors. Secondary analysis revealed PTSD symptom networks optimally predicted alcohol cravings with a three-day time lag (r=.88, p <.001) and consumption with a four-day time lag (r=.82, p <.001). Discussion These findings challenge assumptions regarding immediate effects of PTSD and affect on drinking behavior and underscore the need for therapeutic approaches that consider longer-range effects. Future research should expand on these findings by incorporating longer-range assessments and exploring a broader range of symptom interactions.
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Affiliation(s)
- Stephanie Balters
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, CA, United States
| | - Marc Schlichting
- Department of Aeronautics and Astronautics, School of Engineering, Stanford University, Stanford, CA, United States
| | - Thomas O. Walton
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States
| | - Mykel J. Kochenderfer
- Department of Aeronautics and Astronautics, School of Engineering, Stanford University, Stanford, CA, United States
| | - Debra Kaysen
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, CA, United States
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Amstadter AB, Lönn SL, Sundquist J, Kendler KS, Sundquist K. Testing Phenotypic Models of Posttraumatic Stress Disorder and Alcohol Use Disorder Comorbidity Using Longitudinal Registry Data. J Stud Alcohol Drugs 2023; 84:378-388. [PMID: 36971747 PMCID: PMC10364782 DOI: 10.15288/jsad.22-00209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 12/13/2022] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVE Two predominant phenotypic models of causality exist to explain the high co-occurrence of posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD): the self-medication and susceptibility models. Population-based longitudinal studies that simultaneously examine both models are needed. Thus, the goal of the present study is to test these models using the Swedish National Registries. METHOD Registries were used to conduct longitudinal Cox proportional hazard models (n ≈ 1.5 million) and cross-lagged panel models (N ≈ 3.8 million) with follow-up periods of ~23 years. RESULTS Covarying for cohort and socioeconomic status, Cox proportional hazards model results found strong support for the self-medication model. Results showed that PTSD predicted increased risk for AUD among both men (HR = 4.58 [4.42, 4.74]) and women (HR = 4.14 [3.99, 4.30]), significantly more so for men (interaction HR = 1.11 [1.05, 1.16]). Support was also found for the susceptibility model, although the effects were lower in magnitude than those for the self-medication model. AUD increased risk for PTSD among men (HR = 2.53 [2.47, 2.60]) and women (HR = 2.06 [2.01, 2.12]), and significantly more so for men (interaction term HR = 1.23 [1.18, 1.28]). Cross-lagged model results of simultaneously testing both models found support for bidirectionality. The PTSD-to-AUD paths and the AUD-to-PTSD paths were of modest effect for men and women. CONCLUSIONS The results from both complementary statistical approaches demonstrate that the models of comorbidity are not mutually exclusive. Although the Cox model results evidenced more support for the self-medication pathway, the cross-lagged model results suggest that the prospective relationships between these disorders are nuanced across development.
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Affiliation(s)
- Ananda B. Amstadter
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, Virginia
- Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia
| | - Sara L. Lönn
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
- Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kenneth S. Kendler
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, Virginia
- Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia
| | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
- Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
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3
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Hahn CK, Kilimnik CD, Brady KT, Marx BP, Rothbaum BO, Saladin ME, Gilmore AK, Metts CL, Back SE. Early intervention using written exposure therapy for PTSD and AUD symptoms following sexual assault: Description of design and methodology. Contemp Clin Trials 2023; 125:107002. [PMID: 36436732 PMCID: PMC9989773 DOI: 10.1016/j.cct.2022.107002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 10/31/2022] [Accepted: 11/09/2022] [Indexed: 11/25/2022]
Abstract
The co-occurrence of posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) is common following sexual assault and associated with more severe symptomology and increased likelihood of sexual revictimization. Integrated interventions aimed at reducing PTSD and AUD symptoms following recent sexual assault are needed and should address barriers to care and early treatment termination. The proposed study will test a novel, brief (5 to 7 sessions) intervention that integrates Written Exposure Therapy for PTSD and Cognitive Behavioral Therapy for AUD, and is initiated within the first six weeks post-assault. In Phase 1, qualitative analysis of content gathered during focus groups with treatment providers will be conducted to inform intervention development. In Phase 2, a proof-of-concept pilot study (n = 10) of the intervention, Substance Use Skills Training and Exposure Post-Sexual Assault (STEPS), will be conducted. In Phase 3, a pilot randomized controlled trial (RCT) among 54 recent sexual assault survivors will be implemented using the updated manualized STEPS intervention to evaluate feasibility and preliminary efficacy in reducing PTSD and AUD symptoms. Ecological momentary assessments will be used to assess daily alcohol use, craving, affect, intrusions and avoidance. The effects of STEPS on commonly associated symptoms (e.g., depression, substance use) will be examined. The proposed study has the potential to make a significant public health impact by advancing knowledge on the link between sexual assault and co-occurring PTSD and AUD and informing early intervention efforts for this high-risk population.
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Affiliation(s)
- Christine K Hahn
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, 67 President St., 2nd Fl. S., MSC 861, Charleston, SC, USA.
| | - Chelsea D Kilimnik
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, 67 President St., 2nd Fl. S., MSC 861, Charleston, SC, USA.
| | - Kathleen T Brady
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, 67 President St., 2nd Fl. S., MSC 861, Charleston, SC, USA.
| | - Brian P Marx
- Department of Psychiatry, Boston University School of Medicine, 720 Harrison Avenue, Boston, MA 02118, USA.
| | - Barbara O Rothbaum
- Emory School of Medicine, Emory University, 01 Dowman Dr., Atlanta, GA 30322, USA.
| | - Michael E Saladin
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, 67 President St., 2nd Fl. S., MSC 861, Charleston, SC, USA
| | - Amanda K Gilmore
- Department of Health Policy and Behavioral Sciences, Mark Chaffin Center for Healthy Development, School of Public Health, Georgia State University, Atlanta, GA 30303, USA.
| | - Christopher L Metts
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, 67 President St., 2nd Fl. S., MSC 861, Charleston, SC, USA.
| | - Sudie E Back
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, 67 President St., 2nd Fl. S., MSC 861, Charleston, SC, USA; Ralph H. Johnson Veterans Affairs Medical Center, 109 Bee St. Charleston, SC 29401, USA.
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Rodriguez L, Read JP. Trauma cue-elicited emotional response profiles influence acute experiences of alcohol urge. J Behav Ther Exp Psychiatry 2022; 77:101772. [PMID: 36113909 DOI: 10.1016/j.jbtep.2022.101772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 05/24/2022] [Accepted: 07/29/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND AND OBJECTIVES Affective responses to trauma cues in individuals with posttraumatic stress (PTS) can evoke a desire to drink and may shed light on novel mechanisms of PTS-drinking. The present study aimed to (1) identify and characterize patterns of acute emotional responses (ER) to trauma cues and (2) examine how these patterns influence drinking urge. METHODS University students (N = 304; Mage = 19; 52.3% female) completed a structured clinical interview to confirm trauma history and PTS. At an experimental session one week later, participants completed a series of three trauma cue exposures. Affect and drinking urge were measured at baseline, after each cue exposure, and at experiment's end. RESULTS Latent profile analysis of ER yielded a five-profile solution: (1) Nonresponders (2) Low Responders (3) Moderate Responders (4) Resilient Responders and (5) High Responders. Profiles differed by trait neuroticism, PTS, and emotion dysregulation, with High Responders as the most severe group. In latent growth curve models, profiles significantly predicted alcohol urge trajectories in a graded pattern. High Responders, with the greatest affective intensity, showed the strongest urge. Duration of affect was also implicated with Resilient Responders, who had similar intensity but faster overall affective recovery time compared to High Responders, demonstrating lower mean levels of urge. LIMITATIONS External validity is limited. CONCLUSIONS Individual differences in ER to trauma cues are important for understanding alcohol urge. Findings can inform integrative treatments for PTS-drinking by targeting ER to shorten affective recovery to trauma reminders and reduce the need for alcohol use as a regulation strategy.
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Affiliation(s)
- Lauren Rodriguez
- Department of Psychology, State University of New York, University at Buffalo, USA; 386 Park Hall, Buffalo, NY, 14260-4110, USA.
| | - Jennifer P Read
- Department of Psychology, State University of New York, University at Buffalo, USA; 231 Park Hall, Buffalo, NY, 14260-4110, USA.
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Bird ER, Stappenbeck CA, Blayney J, Kaysen D, George WH. Examination of Sex-Related Distress and Self-Medication Drinking Model in U.S. College Women. JOURNAL OF SEX RESEARCH 2022; 59:1192-1200. [PMID: 35275036 DOI: 10.1080/00224499.2022.2044444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Adult sexual assault (ASA) in college remains a concern. Consequently, many college-aged women experience negative emotions surrounding sexual activity (sex-related distress). Consistent with self-medication theory, some drink to cope with sex-related distress, which may reduce distress, but lead to greater drinking quantity before sex and negative sexual consequences. How women with ASA histories navigate sexual situations and cope with sex-related distress is under researched. We examined ASA, sex-related distress, and drinking to cope motives to understand correlates of drinking before sex. First and second year college women (n = 300) reported on a recent sexual experience in the past six weeks. In the full sample, ASA severity was associated with a greater likelihood of drinking before sex, while general sex-related distress was associated with a lower likelihood. General sex-related distress was associated with event-specific sex-related distress and sexual consequences. There were no differences in number of pre-sex drinks or subjective intoxication during sexual activity based on ASA. In a subsample of women who drank before sexual activity (n = 179), drinking to cope with sex-related distress motives mediated the association between sex-related distress and sexual consequences. Interventions can draw on these findings to target self-medication drinking in consensual sexual situations.
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Affiliation(s)
| | | | - Jessica Blayney
- Department of Psychiatry and Behavioral Sciences, University of Washington
| | - Debra Kaysen
- Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center
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Greenberg NR, Zhai ZW, Hoff RA, Krishnan-Sarin S, Potenza MN. An exploratory study of problematic shopping and problematic video gaming in adolescents. PLoS One 2022; 17:e0272228. [PMID: 35947621 PMCID: PMC9365157 DOI: 10.1371/journal.pone.0272228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 07/14/2022] [Indexed: 12/24/2022] Open
Abstract
Problematic video gaming (PVG) and problematic shopping (PS) are addictive behaviors prevalent in adolescents, characterized by positive and negative reinforcement, and associated with psychosocial impairment. This study examined how PS and PVG relate in adolescents. It also examined how PS interacts with PVG in relation to health/functioning measures. Survey data from 3,657 Connecticut high-school students were evaluated. Chi-square analyses and logistic regression models were used to assess relationships between PS and measures of PVG. Interaction analyses measured effects of PS on relationships between PVG and health/functioning measures. Relative to adolescents without PS, those with PS had 8.79-fold higher odds of exhibiting PVG and were more likely to endorse gaming to relieve anxiety and impairment due to gaming. Interaction analyses revealed that in adolescents with PS, the relationships between PVG and aggressive behaviors, including fighting, serious fighting leading to physical injury, and weapon-carrying, were stronger than in adolescents without PS. PS strongly relates to PVG, and among youth reporting PS, there are stronger associations between PVG and aggressive behaviors. Prevention efforts for adolescents should consider the co-occurrence of PS and PVG. PS and PVG may be linked by negative reinforcement and propensities for aggressive and addictive behaviors, suggesting that further research should explore possible interventions targeting stress management and maladaptive coping.
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Affiliation(s)
| | - Zu Wei Zhai
- Program in Neuroscience, Middlebury College, Middlebury, Vermont, United States of America
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Rani A. Hoff
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Suchitra Krishnan-Sarin
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Marc N. Potenza
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, United States of America
- Connecticut Mental Health Center, New Haven, Connecticut, United States of America
- Connecticut Council on Problem Gambling, Wethersfield, Connecticut, United States of America
- Child Study Center, Yale School of Medicine, New Haven, Connecticut, United States of America
- Department of Neuroscience, Yale University, New Haven, Connecticut, United States of America
- * E-mail:
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7
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Berhe O, Gerhardt S, Schmahl C. Clinical Outcomes of Severe Forms of Early Social Stress. Curr Top Behav Neurosci 2021; 54:417-438. [PMID: 34628586 DOI: 10.1007/7854_2021_261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Early social stress, particularly severe but nevertheless frequent forms such as abuse and neglect, are among the major risk factors for the development of mental disorders. However, we only have very limited knowledge of the psychobiological disease mechanisms underlying the influence of early life stress and stress-related disorders during this vulnerable phase of life. Early stress can have long-lasting adverse effects on the brain and other somatic systems, e.g. through influences on brain development. In adulthood, the prior experience of abuse or neglect can result in complex clinical profiles. Besides conditions such as mood and anxiety disorders as well as posttraumatic stress disorder, substance use disorders (SUD) are among the most prevalent sequelae of early social stress. Current social stress further influences the development and maintenance of these disorders, e.g., by increasing the risk of relapses. In this chapter, we will first give an overview of currently used methods to assess the phenomenology and pathophysiology of stress-related disorders and then focus on the phenomenological and neurobiological background of the interaction between early social stress and SUD. We will give an overview of important insights from neuroimaging studies and will also highlight recent findings from studies using digital tools such as ecological momentary assessment or virtual reality to capture the influence of early social stress as well as current social stress in everyday life of persons with SUD.
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Affiliation(s)
- Oksana Berhe
- Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Heidelberg, Germany
| | - Sarah Gerhardt
- Department of Addictive Behaviour and Addiction Medicine, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Heidelberg, Germany
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Heidelberg, Germany.
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Braun TD, Uebelacker LA, Ward M, Holzhauer CG, McCallister K, Abrantes A. "We really need this": Trauma-informed yoga for Veteran women with a history of military sexual trauma. Complement Ther Med 2021; 59:102729. [PMID: 33965560 DOI: 10.1016/j.ctim.2021.102729] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 03/27/2021] [Accepted: 04/30/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Up to 70% of women service members in the United States report military sexual trauma (MST); many develop post-traumatic stress disorder (PTSD) and co-occurring disorders. Trauma-informed yoga (TIY) is suggested to improve psychiatric symptoms and shown feasible and acceptable in emerging research, yet no work has evaluated TIY in MST survivors. The current quality improvement project aimed to examine TIY's feasibility, acceptability, and perceived effects in the context of MST. DESIGN Collective case series (N = 7). SETTING New England Vet Center. INTERVENTIONS Extant TIY program (Mindful Yoga Therapy) adapted for Veteran women with MST in concurrent psychotherapy. MAIN OUTCOME MEASURES Attrition and attendance; qualitative exit interview; validated self-report measure of negative affect pre/post each yoga class, and symptom severity assessments and surveys before (T1; Time 1) and after the yoga program (T2; Time 2). RESULTS Feasibility was demonstrated and women reported TIY was acceptable. In qualitative interviews, women reported improved symptom severity, diet, exercise, alcohol use, sleep, and pain; reduced medication use; and themes related to stress reduction, mindfulness, and self-compassion. Regarding quantitative change, results suggest acute reductions in negative affect following yoga sessions across participants, as well as improved affect dysregulation, shame, and mindfulness T1 to T2. CONCLUSIONS TIY is both feasible and acceptable to Veteran women MST survivors in one specific Vet Center, with perceived behavioral health benefits. Results suggest TIY may target psychosocial mechanisms implicated in health behavior change (stress reduction, mindfulness, affect regulation, shame). Formal research should be conducted to confirm these QI project results.
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Affiliation(s)
- Tosca D Braun
- VA Central Western Massachusetts, 421 N. Main St., Leeds, MA, 01053, United States; West Springfield, MA Vet Center, 95 Ashley Ave., West Springfield, MA, 01089-1352, United States; Centers for Behavioral and Preventive Medicine, The Miriam Hospital, 196 Richmond St., Providence, RI, 02903, United States(1); Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Box G-BH, 700 Butler Drive, Providence, RI, 02906, United States.
| | - Lisa A Uebelacker
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Box G-BH, 700 Butler Drive, Providence, RI, 02906, United States; Psychosocial Research, Butler Hospital, 345 Blackstone Blvd., Providence, RI, 02906, United States.
| | - Mariana Ward
- Memorial Sloan Kettering, Sloan Kettering Institute, 1275 York Ave., New York, NY, 10065, United States.
| | - Cathryn Glanton Holzhauer
- VA Central Western Massachusetts, 421 N. Main St., Leeds, MA, 01053, United States; Department of Psychiatry, University of Massachusetts Medical School, 55 Lake Ave., North Worcester, MA, 01655, United States.
| | - Kelly McCallister
- West Springfield, MA Vet Center, 95 Ashley Ave., West Springfield, MA, 01089-1352, United States.
| | - Ana Abrantes
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Box G-BH, 700 Butler Drive, Providence, RI, 02906, United States; Behavioral Medicine and Addictions Research, Butler Hospital, 345 Blackstone Blvd., Providence, RI, 02906, United States.
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9
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Rappaport LM, Cusack SE, Sheerin CM, Amstadter AB. Intraindividual association of PTSD symptoms with binge drinking among trauma-exposed students. J Couns Psychol 2021; 68:571-581. [PMID: 33764116 DOI: 10.1037/cou0000543] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
People, particularly undergraduate students, who report elevated symptoms of posttraumatic stress disorder (PTSD) are at elevated risk of binge drinking. The present study used ecological momentary assessment to (a) evaluate whether PTSD severity, specifically, or psychological distress, generally, are associated with binge drinking and (b) examine the self-medication and susceptibility models of the comorbidity of PTSD with binge drinking while accounting for shared liability (i.e., the between-person association of PTSD symptom severity with binge drinking). Within a larger study of undergraduate student mental health, for 14 days, students who reported a potentially traumatic experience (N = 276) reported nightly on use of alcohol and psychoactive substances and thrice daily on current affect, internalizing symptoms, and PTSD symptoms. Daily binge drinking, per the NIAAA definition, was analyzed using multivariate mixed effects, multilevel logistic regression. Results support the self-medication model; participants were more likely to binge drink on days marked by elevated PTSD symptoms, OR = 2.82, p < .01. Binge drinking was also more likely on weekends, OR = 4.21, p < .0001, and days marked by elevated daily positive affect, OR = 1.60, p < .001. Binge drinking was not associated with concurrent depressive or general anxiety symptoms (p > .30). PTSD symptoms were not associated with use of cannabis or other substances (p > .06). Regarding the susceptibility model, following a binge drinking episode, participants reported elevated depressive symptoms, B = 0.34, p = .04, but no change in affect, PTSD symptoms, or general anxiety symptoms (p > .16). Results suggest that, beyond understanding who is at risk for binge drinking, fluctuations in PTSD severity clarify when students engage in binge drinking. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Lance M Rappaport
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University
| | - Shannon E Cusack
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University
| | - Christina M Sheerin
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University
| | - Ananda B Amstadter
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University
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Renaud F, Jakubiec L, Swendsen J, Fatseas M. The Impact of Co-occurring Post-traumatic Stress Disorder and Substance Use Disorders on Craving: A Systematic Review of the Literature. Front Psychiatry 2021; 12:786664. [PMID: 34970169 PMCID: PMC8712572 DOI: 10.3389/fpsyt.2021.786664] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/16/2021] [Indexed: 12/29/2022] Open
Abstract
The frequent co-occurrence of post-traumatic stress disorder (PTSD) and substance use disorders (SUDs) leads to manifestations of both conditions that are more severe and more resistance to treatment than single disorders. One hypothesis to explain this synergy is the impact of intrusive memories on craving which, in turn, increases the risk of relapse among patients with substance use disorders. The aim of this systematic review is to examine this possibility by assessing the impact of PTSD and its symptoms on craving among dual disorder patients. Using PRISMA criteria, four databases were comprehensively searched up to June, 2021, in order to identify all candidate studies based on broad key words. Resulting studies were then selected if they examined the impact of PTSD or PTSD symptoms on craving, and if they used standardized assessments of PTSD, SUD, and craving. Twenty-seven articles matched the selection criteria and were included in this review. PTSD was found to be significantly associated with increased craving levels among patients with alcohol, cannabis, cocaine, tobacco, and other substance use disorders. Exposition to traumatic cues among dual disorder patients was also shown to trigger craving, with an additive effect on craving intensity when exposure to substance-related cues occurred. In addition, certain studies observed a correlation between PTSD symptom severity and craving intensity. Concerning mechanisms underlying these associations, some findings suggest that negative emotional states or emotion dysregulation may play a role in eliciting craving after traumatic exposure. Moreover, these studies suggest that PTSD symptoms may, independently of emotions, act as powerful cues that trigger craving. These findings argue for the need of dual disorder treatment programs that integrate PTSD-focused approaches and emotion regulation strategies, in addition to more traditional interventions for craving management.
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Affiliation(s)
- Fabien Renaud
- Pôle Inter-établissement d'addictologie, CHU de Bordeaux et Centre Hospitalier Charles Perrens, Bordeaux, France
| | - Louise Jakubiec
- Pôle Inter-établissement d'addictologie, CHU de Bordeaux et Centre Hospitalier Charles Perrens, Bordeaux, France.,University of Bordeaux/CNRS-UMR 5287, Bordeaux, France
| | - Joel Swendsen
- University of Bordeaux/CNRS-UMR 5287, Bordeaux, France.,EPHE, PSL Research University, Paris, France
| | - Melina Fatseas
- Pôle Inter-établissement d'addictologie, CHU de Bordeaux et Centre Hospitalier Charles Perrens, Bordeaux, France.,University of Bordeaux/CNRS-UMR 5287, Bordeaux, France
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11
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Sanjuan PM, Pearson MR, Fokas K, Leeman LM. A mother's bond: An ecological momentary assessment study of posttraumatic stress disorder symptoms and substance craving during pregnancy. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2020; 34:269-280. [PMID: 31829665 PMCID: PMC7064398 DOI: 10.1037/adb0000543] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Pregnant women with substance use disorder (SUD) comprise an underserved population with complex treatment needs, including complications from trauma histories and comorbid psychological disorders. Using ecological momentary assessment, we examined momentary fluctuations in posttraumatic stress disorder (PTSD) symptoms, prenatal bonding, and substance craving, among pregnant women in SUD treatment who had a history of trauma. We hypothesized that (a) PTSD symptoms and prenatal bonding would each be associated with substance craving and (b) PTSD symptoms would be negatively associated with prenatal bonding, and this would at least partially account for the association between PTSD symptoms and substance craving (i.e., indirect effect). Participants (n = 32) were on average 27.1 weeks pregnant (SD = 5.27), 27.8 years old (SD = 4.54), and predominantly Hispanic/Latina (66%). At the within subjects level, higher momentary ratings of PTSD symptoms were associated with lower quality (but not intensity of preoccupation) of prenatal bonding, which in turn was associated with greater craving. Lower quality of prenatal bonding partially mediated the positive association between PTSD symptoms and craving, which remained strong after accounting for prenatal bonding. Our results provide some preliminary support for considering interventions aimed at stabilizing or decreasing PTSD symptoms and stabilizing or increasing prenatal bonding to reduce substance craving and, thus, the risk of perinatal substance use among women with SUD and trauma histories. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | | | - Kathryn Fokas
- Center on Alcoholism, Substance Abuse, and Addictions
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Greene T, Gelkopf M, Fried EI, Robinaugh DJ, Lapid Pickman L. Dynamic Network Analysis of Negative Emotions and DSM-5 Posttraumatic Stress Disorder Symptom Clusters During Conflict. J Trauma Stress 2020; 33:72-83. [PMID: 31433530 DOI: 10.1002/jts.22433] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 12/10/2018] [Accepted: 12/15/2018] [Indexed: 01/01/2023]
Abstract
Investigating dynamic associations between specific negative emotions and PTSD symptom clusters may provide novel insights into the ways in which PTSD symptoms interact with, emerge from, or are reinforced by negative emotions. The present study estimated the associations among negative emotions and the four DSM-5 PTSD symptom clusters (intrusions, avoidance, negative alterations in cognitions and mood [NACM], and arousal) in a sample of Israeli civilians (n = 96) during the Israel-Gaza War of July-August 2014. Data were collected using experience sampling methodology, with participants queried via smartphone about PTSD symptoms and negative emotions twice a day for 30 days. We used a multilevel vector auto-regression model to estimate temporal and contemporaneous temporal networks. Contrary to our hypothesis, in the temporal network, PTSD symptom clusters were more predictive of negative emotions than vice versa, with arousal emerging as the strongest predictor that negative emotions would be reported at the next measurement point; fear and sadness were also strong predictors of PTSD symptom clusters. In the contemporaneous network, negative emotions exhibited the strongest associations with the NACM and arousal PTSD symptom clusters. The negative emotions of sadness, stress, fear, and loneliness had the strongest associations to the PTSD symptom clusters. Our findings suggest that arousal has strong associations to both PTSD symptoms and negative emotions during ongoing trauma and highlights the potentially relevant role of arousal for future investigations in primary or early interventions.
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Affiliation(s)
- Talya Greene
- Department of Community Mental Health, University of Haifa, Haifa, Israel
| | - Marc Gelkopf
- Department of Community Mental Health, University of Haifa, Haifa, Israel.,NATAL, Israel Trauma and Resiliency Center, Tel Aviv, Israel
| | - Eiko I Fried
- Department of Psychology, Leiden University, Leiden, the Netherlands.,Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - Donald J Robinaugh
- Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands.,Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Liron Lapid Pickman
- Department of Community Mental Health, University of Haifa, Haifa, Israel.,NATAL, Israel Trauma and Resiliency Center, Tel Aviv, Israel
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13
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Lane A, Waters A, Black A. Ecological momentary assessment studies of comorbid PTSD and alcohol use: A narrative review. Addict Behav Rep 2019; 10:100205. [PMID: 31528685 PMCID: PMC6742902 DOI: 10.1016/j.abrep.2019.100205] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 07/03/2019] [Accepted: 07/14/2019] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION PTSD and harmful alcohol use, including alcohol use disorder (AUD), frequently co-occur. Recent research has used ecological momentary assessment (EMA) to examine the associations between PTSD symptoms and alcohol-related variables, such as craving for alcohol, alcohol use, and the presence of alcohol-related problems. The overall purpose of this narrative review is to summarize this emerging literature. METHODS Inclusion criteria for studies were: 1) Use of ecological momentary assessment as the method for gathering data on alcohol use and/or craving in populations with both problematic alcohol use and PTSD, and the inclusion of an assessment of both PTSD symptoms and at least one alcohol use variable during EMA; and 2) At screening, participants were required to meet study criteria for a) elevated PTSD symptoms or trauma exposure, and b) alcohol use. RESULTS The pertinent extant literature is reviewed in terms of four underlying themes: Methodological considerations of EMA research in a population with PTSD symptoms and harmful alcohol use; Associations between PTSD symptoms and alcohol use variable/s; Moderators of PTSD-alcohol use associations; Mediators of PTSD-alcohol use associations. CONCLUSIONS Collectively, studies provide support for the self-medication hypothesis. Several variables were found to moderate association between PTSD symptoms and alcohol-related variables. EMA data may ultimately be useful in identifying when individuals are at risk for harm due to increased symptoms or alcohol misuse and may inform treatment approaches administered remotely.
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Affiliation(s)
- A.R. Lane
- Department of Medical and Clinical Psychology at Uniformed Services University
| | - A.J. Waters
- Department of Medical and Clinical Psychology at Uniformed Services University
| | - A.C. Black
- Office of Institutional Research at Yale University, 2 Whitney Avenue, New Haven, CT 06510, United States of America
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14
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Erwin MC, Dennis PA, Coughlin LN, Calhoun PS, Beckham JC. Examining the relationship between negative affect and posttraumatic stress disorder symptoms among smokers using ecological momentary assessment. J Affect Disord 2019; 253:285-291. [PMID: 31077971 PMCID: PMC6620145 DOI: 10.1016/j.jad.2019.04.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 02/12/2019] [Accepted: 04/07/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) and negative affect (e.g., anger, depression, anxiety), are highly co-occurring. It remains unclear whether changes in PTSD symptoms subsequently impact negative affect, or vice versa. This study assessed associations between moment-to-moment PTSD symptoms and negative affect in a sample of smokers with PTSD to determine directionality of this relationship. METHODS Participants (N = 125) enrolled in two smoking cessation studies with co-occurring PTSD and cigarette use completed measures of PTSD and negative affect. Ecological momentary assessment (EMA) methodology was used to record symptoms during a one-week baseline period, during which participants smoked ad lib. Cross-lagged path analyses assessed PTSD symptoms and negative affect for directionality of their relationship, controlling for whether an EMA reading was smoking or non-smoking. Path analyses examined the lagged associations between PTSD symptoms and negative affect. RESULTS Results found PTSD symptom severity at T-1 was significantly related to negative affect levels at time T, but negative affect at time T-1 was not associated with PTSD symptom severity at time T. Results indicated the model retaining the cross-lagged effect of PTSD symptom severity on negative affect provided better fit to the data than other models. LIMITATIONS Limitations included use of self-report data, brief measures of symptoms, participants already had PTSD and/or MDD, participants were recruited from a specific clinical population, and use of DSM-IV data. CONCLUSIONS Results suggest PTSD symptoms drive day-to-day fluctuations in negative affect, and highlight the importance of evaluating negative affect in the treatment of PTSD.
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Affiliation(s)
- Meredith C. Erwin
- Durham VA Health Care System, Durham, NC,University of Toledo, Department of Psychology, Toledo, OH
| | - Paul A. Dennis
- Durham VA Health Care System, Durham, NC,Research and Development Service, Durham Veterans Affairs Medical Center, Durham, NC,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Lara N. Coughlin
- Durham VA Health Care System, Durham, NC,Addiction Recovery Research Center, Virginia Tech Carilion Research Institute, Roanoke, VA
| | - Patrick S. Calhoun
- Durham VA Health Care System, Durham, NC,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC,VA Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, NC,Health Science Research and Development Service, Durham Veterans Affairs Medical Center, Durham, NC
| | - Jean C. Beckham
- Durham VA Health Care System, Durham, NC,Research and Development Service, Durham Veterans Affairs Medical Center, Durham, NC,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC,VA Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, NC
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15
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Simons JS, Simons RM, Keith JA, Grimm KJ, Stoltenberg SF, O'Brien C, Andal K. PTSD symptoms and alcohol-related problems among veterans: Temporal associations and vulnerability. JOURNAL OF ABNORMAL PSYCHOLOGY 2018; 127:733-750. [PMID: 30284858 PMCID: PMC6237643 DOI: 10.1037/abn0000376] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Posttraumatic stress disorder (PTSD) is associated with elevated risk of both alcohol use disorder (AUD) and related conduct problems, which are associated with behavioral and emotional dysregulation. We conducted an intensive longitudinal burst design study with 10 weeks of experience sampling over the course of 1.5 years with 250 veterans of recent conflicts. We tested time-series models of daily associations between posttraumatic stress symptoms (PTSS), alcohol dependence syndrome, and conduct problems. Exacerbations of PTSS predicted higher dependence syndrome and conduct problems the next day. This effect was significant after controlling for both concurrent (i.e., same-day) associations between drinking and the outcomes as well as the strength of associations between the outcomes from one day to the next (i.e., autoregression). Affect lability and disinhibition were hypothesized vulnerability factors increasing the strength of within-person predictors of dependence syndrome and conduct problems. Lability and disinhibition were associated with greater dependence syndrome symptoms and conduct problems over the follow-up period. Consistent with expectation, lability rather than disinhibition increased the association between drinking and dependence syndrome as well as the strength of association between dependence syndrome symptoms from one day to the next. Moderating effects of disinhibition in the conduct problems model were not significant. Importantly, results indicated reciprocal associations over time. Lability potentiated the association between dependence syndrome symptoms and next day PTSS, whereas disinhibition potentiated the association between conduct problems and next day PTSS. Results demonstrate complex dynamic associations between PTSS, AUD symptoms, and conduct problems over time indicative of broad regulatory impairments. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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16
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Cohn AM, Elmasry H, Ehlke SJ. Utilization, receptivity and reactivity to Interactive Voice Response daily monitoring in risky drinking smokers who are motivated to quit. Tob Induc Dis 2018; 16:25. [PMID: 31516425 PMCID: PMC6659485 DOI: 10.18332/tid/84972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 02/01/2018] [Accepted: 02/02/2018] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Interactive Voice Response (IVR) technology has become an increasingly popular and valid method for collecting Ecological Momentary Assessment (EMA) data on a variety of health-risk behaviors, including daily alcohol use and cigarette smoking, and for stimulating behavior change. However, very little research has evaluated the parameters of IVR compliance and reactivity in respondents who may have greater problem severity than samples previously examined in published IVR studies. This study examined the prevalence and correlates of use, receptivity and reactivity to IVR monitoring in 77 untreated risky drinking smokers who were motivated to quit within the next 6 months. METHODS Respondents completed twice daily IVR assessments for 28 days and were re-assessed immediately after IVR to measure receptivity and reactivity to daily monitoring and six months post-baseline. RESULTS Mean compliance rate was 70.6%, with a morning rate of 72.4% and an evening compliance rate of 68.9% out of all possible surveys. IVR assessments of drinking and smoking were significantly associated with baseline paper-pencil reports of the same. African-American participants and those who reported more daily stressful events were more compliant. Between the baseline session and the 6-month follow-up, 68% of the sample reported engaging in some form of smoking behavior change (50% reduction in CPD, a quit attempt, past-month continuous abstinence). Nearly 80% reported increased awareness of their behavior due to the IVR and 40% reported intentional behavior change from IVR monitoring. The odds of making a quit attempt at the 6-month follow-up were significantly higher among respondents who reported making purposeful changes to their smoking as a result of IVR monitoring (AOR=3.25, p<0.05). CONCLUSIONS Reactivity was associated with behavior change outcomes. IVR may be a useful tool for motivating behavior change in smokers with alcohol-use problems.
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Affiliation(s)
- Amy M Cohn
- Battelle Memorial Institute, Arlington, United States
| | - Hoda Elmasry
- Hoda Elmasry was at the Schroeder Institute for Tobacco Research and Policies Studies, Washington, United States at the time of data analysis and when the manuscript was submitted
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17
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Hallgren KA, Delker BC, Simpson TL. Effects of Initiating Abstinence from Alcohol on Daily Craving and Negative Affect: Results from a Pharmacotherapy Clinical Trial. Alcohol Clin Exp Res 2018; 42:634-645. [PMID: 29286542 PMCID: PMC5832597 DOI: 10.1111/acer.13591] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 12/21/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Craving and negative affect are distressing and commonly experienced during alcohol use disorder (AUD) treatment. Patients may assume that initiating abstinence will intensify their cravings and negative affect despite limited empirical data to support this assumption. This study extends and replicates, under improved methodological conditions, previous work that found reductions in daily craving associated with initiating abstinence. METHODS Seventy-eight adults (80.8% male, 57.1% Caucasian) in a clinical trial testing prazosin for AUD provided daily reports of drinking, craving, and negative affect for up to 12 weeks (mean = 64.77 daily reports). Participants were classified into 3 subgroups based on whether and when they initiated 14 days of continuous abstinence, including (i) "abstinence initiators" who quit drinking during treatment (n = 17), (ii) "already abstainers" who were abstinent at the start of treatment (n = 20), and (iii) "continued drinkers" who never initiated abstinence (n = 41). The timing and degree of change in craving and negative affect were compared across these groups using multivariate growth curve modeling. RESULTS All participant subgroups reported gradual reductions in craving over the course of treatment, with "abstinence initiators" reporting additional sudden reductions in craving upon initiating abstinence from alcohol. "Continued drinkers" reported higher levels of craving than "already abstainers" throughout the full course of treatment. Negative affect followed a different pattern of change, with "abstinence initiators" experiencing gradual reductions in negative affect after initiating abstinence but no changes prior to or immediately upon initiating abstinence, and with "already abstainers" and "continued drinkers" experiencing no changes in negative affect over time. CONCLUSIONS Initiating abstinence is associated with immediate reductions in craving, followed by gradual reductions in both craving and negative affect. Results provide insight into the timing and magnitude of changes in theoretically and clinically important variables and may help patients anticipate when to expect improvement in craving and negative effect.
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Affiliation(s)
- Kevin A. Hallgren
- Department of Psychiatry and Behavioral Sciences, University of Washington
| | - Brianna C. Delker
- Department of Psychiatry and Behavioral Sciences, University of Washington
- Department of Psychology, Western Washington University
| | - Tracy L. Simpson
- Department of Psychiatry and Behavioral Sciences, University of Washington
- Center of Excellence in Substance Abuse Treatment and Education (CESATE) and Mental Illness Research Education and Clinical Center (MIRECC), VA Puget Sound Health Care System, Seattle WA
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18
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Bachrach RL, Read JP. Peer alcohol behavior moderates within-level associations between posttraumatic stress disorder symptoms and alcohol use in college students. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2017; 31:576-588. [PMID: 28703614 DOI: 10.1037/adb0000285] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Self-medication theory (SMT) posits that individuals exposed to trauma and resulting posttraumatic stress symptoms (PTSD) are at risk for heavy drinking and associated negative consequences. Close peer alcohol use is also a powerful predictor of alcohol involvement in college, particularly influencing those with greater negative affect. As individuals with PTSD may rely on peers for support, peer drinking behaviors are possibly putting them at further risk for greater alcohol use and resulting consequences. To test self-medication processes, the present study examined the relationship between weekday PTSD symptoms, weekend alcohol behavior, and the influence of both emotionally supportive peer and other friend drinking behavior by investigating: (a) whether weekday PTSD symptoms predicted subsequent weekend alcohol use and consequences; and (b) whether the relationship between weekday PTSD symptoms and weekend alcohol behavior was moderated by various drinking behaviors of one's peers. Trauma-exposed heavy-drinking college students (N = 128) completed a baseline assessment and 30 daily, Web-based assessments of alcohol use and related consequences, PTSD symptoms, and peer alcohol behavior. Results directly testing SMT were not supported. However, friend alcohol behavior moderated the relationship between weekday PTSD and weekend alcohol behavior. Findings highlight the importance of peer drinking as both a buffer and risk factor for problematic drinking and provide useful information for interventions aimed at high-risk drinkers. (PsycINFO Database Record
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Affiliation(s)
- Rachel L Bachrach
- Department of Psychology, University at Buffalo, State University of New York
| | - Jennifer P Read
- Department of Psychology, University at Buffalo, State University of New York
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19
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Neupert SD, Desmarais SL, Gray JS, Cohn AM, Doherty S, Knight K. Daily stressors as antecedents, correlates, and consequences of alcohol and drug use and cravings in community-based offenders. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2017; 31:315-325. [PMID: 28383933 DOI: 10.1037/adb0000276] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Justice-involved individuals with alcohol and drug use problems reoffend at higher rates than their nonusing counterparts, with alcohol and drug use serving as an important vector to recidivism. At the daily level, exposure to stressors may exacerbate problematic alcohol and drug use; at the individual level, prior treatment experiences may mitigate substance use as individuals adapt to and learn new coping mechanisms. We conducted a daily diary study using Interactive Voice Response technology over 14 consecutive days with 117 men on probation or parole participating in a community-based treatment program (n = 860 calls) and referred to medication-assisted treatment. Participants reported daily stressors, craving for alcohol and illegal drugs, and use of alcohol and illegal drugs 1 time each day. Results of multilevel models showed significant day-to-day fluctuation in alcohol and drug craving and use. In concurrent models, increases in daily stressors were associated with increases in cravings and use of illegal drugs. Prior treatment experience modified many of these relationships, and additional lagged models revealed that those with less treatment experience reported an increase in next-day alcohol craving when they experienced increases in stressors on the previous day compared to those with more treatment experience. Collectively, these findings highlight the importance of tailoring treatment as a function of individual differences, including prior treatment experiences, and targeting daily stressors and subsequent cravings among justice-involved adults with alcohol and drug use problems. (PsycINFO Database Record
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Affiliation(s)
| | | | - Julie S Gray
- Institutional Effectiveness and Reporting, The University of Texas at Arlington
| | - Amy M Cohn
- Schroeder Institute for Tobacco and Policy Studies, Truth Initiative
| | | | - Kevin Knight
- Institute of Behavioral Research, Texas Christian University
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20
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Langdon KJ, Rubin A, Brief DJ, Enggasser JL, Roy M, Solhan M, Helmuth E, Rosenbloom D, Keane TM. Sexual Traumatic Event Exposure, Posttraumatic Stress Symptomatology, and Alcohol Misuse Among Women: A Critical Review of the Empirical Literature. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2016. [DOI: 10.1111/cpsp.12167] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Kirsten J. Langdon
- National Center for PTSD; Women's Health Sciences Division; VA Boston Healthcare System; Boston University School of Medicine
| | - Amy Rubin
- National Center for PTSD; VA Boston Healthcare System; Boston University School of Medicine
| | - Deborah J. Brief
- National Center for PTSD; VA Boston Healthcare System; Boston University School of Medicine
| | | | - Monica Roy
- VA Boston Healthcare System; Boston University School of Medicine
| | - Marika Solhan
- VA Boston Healthcare System; Boston University School of Medicine
| | - Eric Helmuth
- National Center for PTSD; Boston University School of Public Health
| | - David Rosenbloom
- National Center for PTSD; Boston University School of Public Health
| | - Terence M. Keane
- National Center for PTSD; VA Boston Healthcare System; Boston University School of Medicine
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21
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DiMauro J, Renshaw KD, Kashdan TB. Beliefs in negative mood regulation and daily negative affect in PTSD. PERSONALITY AND INDIVIDUAL DIFFERENCES 2016. [DOI: 10.1016/j.paid.2016.02.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Grice JW, Cohn A, Ramsey RR, Chaney JM. On Muddled Reasoning and Mediation Modeling. BASIC AND APPLIED SOCIAL PSYCHOLOGY 2015. [DOI: 10.1080/01973533.2015.1049350] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
| | - Amy Cohn
- The Schroeder Institute for Tobacco Research and Policy Studies
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23
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Jaffe AE, DiLillo D, Hoffman L, Haikalis M, Dykstra RE. Does it hurt to ask? A meta-analysis of participant reactions to trauma research. Clin Psychol Rev 2015; 40:40-56. [DOI: 10.1016/j.cpr.2015.05.004] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 04/07/2015] [Accepted: 05/17/2015] [Indexed: 11/26/2022]
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Grice JW. From means and variances to persons and patterns. Front Psychol 2015; 6:1007. [PMID: 26257672 PMCID: PMC4513286 DOI: 10.3389/fpsyg.2015.01007] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 07/03/2015] [Indexed: 11/22/2022] Open
Abstract
A novel approach for conceptualizing and analyzing data from psychological studies is presented and discussed. This approach is centered on model building in an effort to explicate the structures and processes believed to generate a set of observations. These models therefore go beyond the variable-based, path models in use today which are limiting with regard to the types of inferences psychologists can draw from their research. In terms of analysis, the newer approach replaces traditional aggregate statistics such as means, variances, and covariances with methods of pattern detection and analysis. While these methods are person-centered and do not require parametric assumptions, they are both demanding and rigorous. They also provide psychologists with the information needed to draw the primary inference they often wish to make from their research; namely, the inference to best explanation.
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Affiliation(s)
- James W Grice
- Department of Psychology, Oklahoma State University , Stillwater, OK, USA
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25
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Read JP, Radomski S, Borsari B. Associations among Trauma, Posttraumatic Stress, and Hazardous Drinking in College Students: Considerations for Intervention. CURRENT ADDICTION REPORTS 2015; 2:58-67. [PMID: 26167448 PMCID: PMC4497782 DOI: 10.1007/s40429-015-0044-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Students with trauma and posttraumatic stress are disproportionately at risk for heavy drinking and for alcohol-related consequences. Brief motivational interventions (BMIs) have been shown to reduce hazardous drinking in college students, and could serve as a first-line approach to reduce heavy drinking in students with trauma and posttraumatic stress (PTS). Yet the standard BMI format may not adequately address the factors that lead to hazardous drinking in these students. Here, we review the literature on PTS and hazardous drinking in college students, and highlight cognitive (self-efficacy, alcohol expectancies) and behavioral (coping strategies, emotion regulation skills, protective behaviors) factors that may link trauma and PTS to drinking risk. Incorporating these factors into standard BMIs in a collaborative way that enhances their personal relevance may enhance intervention efficacy and acceptability for these at-risk students.
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Affiliation(s)
- Jennifer P. Read
- Department of Psychology, University at Buffalo, State University of New York, Buffalo, NY 15260, USA
| | - Sharon Radomski
- Department of Psychology, University at Buffalo, State University of New York, Buffalo, NY 15260, USA
| | - Brian Borsari
- Mental Health and Behavioral Sciences Service, Providence VAMC and Warren Alpert Medical School of Brown University, Providence, RI, USA
- Center for Alcohol and Addiction Studies, Brown University, Box G-S121-5, Providence, RI 02903, USA
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26
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Tripp JC, McDevitt-Murphy ME, Avery ML, Bracken KL. PTSD Symptoms, Emotion Dysregulation, and Alcohol-Related Consequences Among College Students With a Trauma History. J Dual Diagn 2015; 11:107-17. [PMID: 25793550 PMCID: PMC4437848 DOI: 10.1080/15504263.2015.1025013] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Posttraumatic stress disorder (PTSD), alcohol use, and alcohol-related consequences have been linked to emotion dysregulation. Sex differences exist in both emotion regulation dimensions and alcohol use patterns. This investigation examined facets of emotion dysregulation as potential mediators of the relationship between PTSD symptoms and alcohol-related consequences and whether differences may exist across sexes. METHODS Participants were 240 college students with a trauma history who reported using alcohol within the past three months and completed measures of PTSD symptoms, emotion dysregulation, alcohol consumption, alcohol-related consequences, and negative affect. The six facets of emotion dysregulation were examined as mediators of the relationship between PTSD symptoms and alcohol-related consequences in the full sample and by sex. RESULTS There were differences in sexes on several variables, with women reporting higher PTSD scores and lack of emotional awareness. Men reported significantly more drinks per week in a typical week and a heavy week. There were significant associations between the variables for the full sample, with PTSD showing associations with five facets of emotion dysregulation subscales: impulse control difficulties when upset, difficulties engaging in goal-directed behavior, nonacceptance of emotional responses, lack of emotional clarity, and limited access to emotion regulation strategies. Alcohol-related consequences were associated with four aspects of emotion dysregulation: impulse control difficulties when upset, difficulties engaging in goal-directed behavior, nonacceptance of emotional responses, and limited access to emotion regulation strategies. Two aspects of emotion regulation, impulse control difficulties and difficulties engaging in goal directed behavior, mediated the relationship between PTSD symptoms and alcohol-related consequences in the full sample, even after adjusting for the effects of negative affect. When examined separately by gender, impulse control difficulties remained a mediator for men and difficulties engaging in goal directed behavior for women. CONCLUSIONS These analyses shed light on processes that may underlie "self-medication" of PTSD symptoms. Gender-specific interventions targeting emotion dysregulation may be effective in reducing alcohol-related consequences in individuals with PTSD. Women may possibly benefit from interventions that focus on difficulties engaging in goal-directed behavior, while men may benefit from interventions that target impulse control difficulties when upset.
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