Momentary associations between stress and alcohol craving in the naturalistic environment: differential associations for Black and White young adults

Affective dynamics surrounding craving, non-heavy alcohol use and binge drinking in female patients with alcohol use disorder and controls: An experience sampling method study

BACKGROUND AND AIMS

Studies show that higher levels of positive affect (PA) and lower levels of negative affect (NA) are related to craving and alcohol consumption at a daily level in men, but little is known on these associations at a momentary level, and whether they are present in women. This study measured the dynamics of within-person NA and PA surrounding craving, non-heavy alcohol use and binge drinking in women with alcohol use disorder (AUD) and female controls without AUD.

METHODS

53 female patients with AUD and 75 female controls, all recruited in Belgium, were included in an experience sampling study where they reported on momentary NA, PA, craving and alcohol use in daily life over a period of 12 months. Assessments occurred eight times a day on Thursdays, Fridays and Saturdays in seven bursts of three weeks.

RESULTS

Within-person NA at a previous assessment (t-1) predicted craving at the current assessment (t0) in patients with AUD in a positive linear [β = 0.043; 95% confidence interval (CI) = 0.002, 0.057; P = 0.041] and quadratic fashion (β = 0.034; CI = 0.011, 0.057; P = 0.004). Within-person PA at t-1 predicted craving at t0 in patients with AUD with a positive quadratic relation (β = 0.042; CI = 0.08, 0.065; P < 0.001). Within-person NA at t-1 negatively predicted non-heavy alcohol use at t0 in a linear fashion in controls (β = -0.495; CI = -0.677, -0.312; P < 0.001) and patients with AUD (β = -0.276; CI = -0.421, -0.132; P < 0.001). Within-person PA at t-1 significantly predicted non-heavy alcohol use at t0 with a positive linear term (β = 0.470; CI = 0.329, 0.610; P < 0.001) in controls, but with a positive linear term (β = 0.399; CI = 0.260, 0.454; P < 0.001) and a positive quadratic term (β = 0.203; CI = 0.060, 0.347; P = 0.003) in patients with AUD. Within-person NA at t-1 predicted binge drinking at t0 in patients with AUD with a significant quadratic term (β = 0.236; CI = 0.060, 0.412; P = 0.008), but not for controls. Within-person PA at t-1 predicted binge drinking at t0 in patients with AUD with a significant quadratic term (β = 0.378; CI = 0.215, 0.542; P < 0.001), and this was also the case for controls (β = 0.487; CI = 0.158, 0.770; P < 0.001). Non-heavy alcohol use at t0 predicted lower levels of NA at t+1 in both patients with AUD (β = -0.161; SE = 0.044; CI = -0.248, 0.074; P = 0.001) and controls (β = -0.114; CI = -0.198, -0.029; P = 0.010). Non-heavy alcohol use at t0 also predicted higher levels of PA at t+1 in both patients with AUD (β = 0.181; CI = 0.088, 0.274; P < 0.001) and controls (β = 0.189; CI = 0.101, 0.278; P < 0.001).

CONCLUSIONS

The momentary relation between affect and craving or alcohol use seems to be non-linear in female patients with alcohol use disorder, whereby a worse mood predicts subsequent alcohol use, though more for binge drinking than for non-heavy alcohol use.

Evidence that personalized racial stress procedures elicit a stress response and increases alcohol craving among Black adults with alcohol use disorder: A laboratory pilot study

BACKGROUND

The objective of this study was to pilot test newly developed personalized imagery procedures to investigate the impact of racial stress on alcohol craving and emotional and physiological response in Black adults with alcohol use disorder (AUD).

METHODS

Twenty Black adults (45% women, meanage=37.05, SDage=13.19) with AUD participated in two sessions. In the first, participants described a stressful personal event involving their race and a neutral relaxing situation and these descriptions were used to develop scripts for the subsequent laboratory exposure session. The second session was an experimental provocation session in which participants reported on alcohol craving and emotional response before and after imagined exposure to stress and neutral conditions using personalized racial stress and neutral/relaxing scripts. Conditions were randomized and counterbalanced across subjects, and heart rate and blood pressure were assessed before and after each image.

RESULTS

Alcohol craving and negative emotions significantly increased, and positive emotions decreased following the racial stress script relative to the neutral/relaxing script. We found no differences in physiological response. Exploratory analyses found that increase in alcohol craving was correlated with racial identity exploration but not racial identity commitment, men reported greater reductions in anger than women in the neutral condition only, and income was correlated with fear in the racial stress condition only.

CONCLUSIONS

This study provides evidence that personalized racial stress procedures elicit a stress response and increases alcohol craving and emotional response but not physiological response among Black adults with AUD. These findings warrant replication in a larger study.

Daily and Momentary Associations Between Gender Minority Stress and Resilience With Alcohol Outcomes

BACKGROUND AND PURPOSE

Minority stressors have been linked with alcohol use among transgender and gender diverse (TGD); however, no ecological momentary assessment studies have examined daily links between minority stress and alcohol use specifically among TGD. This study examined gender minority stressors and resilience as predictors of same-day or momentary alcohol-related outcomes. Feasibility and acceptability of procedures were evaluated.

METHODS

Twenty-five TGD adults (mean age = 32.60, SD = 10.82; 88% White) were recruited Canada-wide and participated remotely. They completed 21 days of ecological momentary assessment with daily morning and random surveys (assessing alcohol outcomes, risk processes, gender minority stressors, resilience), and an exit interview eliciting feedback.

RESULTS

Gender minority stress had significant and positive within-person relationships with same-day alcohol use (incidence risk ratio (IRR) = 1.12, 95% confidence interval [CI] [1.02, 1.23]), alcohol-related harms (IRR = 1.14, 95% CI [1.02, 1.28]), and coping motives (IRR = 1.06, 95% CI [1.03, 1.08]), as well as momentary (past 30-min) alcohol craving (IRR = 1.32, 95% CI [1.18, 1.47]), coping motives (IRR = 1.35, 95% CI [1.21, 1.51]), and negative affect (IRR = 1.28, 95% CI [1.20, 1.36]). Gender minority stress indirectly predicted same-day drinking via coping motives (ab = 0.04, 95% CI [0.02, 0.08]). Resilience was positively associated with same-day alcohol use (IRR = 1.25, 95% CI [1.03, 1.51]) but not harms.

CONCLUSIONS

TGD adults may use alcohol to cope with gender minority stress, which can increase the risk for alcohol-related harms. Interventions are needed to eliminate gender minority stressors and support adaptive coping strategies.

Associations between day-level affect profiles and same-day substance use among young adults

OBJECTIVE

Emotions play a critical role in health risk behaviors, including substance use. However, current research often focuses exclusively on average levels of positive and negative affect, neglecting the complexity of daily emotional patterns. By capturing multiple dimensions of affect, including arousal and discrete states, we can improve our understanding of proximal predictors of substance use. The present study demonstrates the utility of a novel methodological approach for assessing affect patterns in daily life in relation to alcohol and cannabis use.

METHOD

Daily diary data from N = 154 young adults who reported recent heavy episodic drinking and simultaneous use of alcohol and cannabis were analyzed using a mixed-indicator latent profile analysis to identify and describe day-level affective patterns and outcomes.

RESULTS

Results revealed five distinct day-level profiles of affect: undifferentiated negative affect days, undifferentiated positive affect days, high-arousal positive affect days, mixed affect days, and low reactivity days. Undifferentiated positive affect days, high-arousal positive affect days, and low reactivity days were associated with significantly greater odds of same-day alcohol use compared to days characterized by undifferentiated negative affect (χ² = 10.55, p = .032).

CONCLUSIONS

Findings suggest that daily affect patterns differentially impact alcohol use and can inform the development of interventions for problematic substance use. Additionally, the innovative methodological approach employed herein could be applicable for investigating the role of emotion in other health behaviors. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Therapeutics for Substance-Using Women: The Need to Elucidate Sex-Specific Targets for Better-Tailored Treatments

In the last decade, alcohol consumption in the US has risen by 84% in women compared with 35% in men. Furthermore, research has shown that sex- and gender-related differences may disadvantage women in terms of developing a range of psychological, cognitive, and medical problems considerably earlier in their drinking history than men, and despite consuming a similar quantity of substances. While this "telescoping" process has been acknowledged in the literature, a concomitant understanding of the underlying biobehavioral mechanisms, and an increase in the development of specific treatments tailored to women, has not occurred. In the current chapter we focus on understanding why the need for personalized, sex-specific medications is imperative, and highlight some of the potential sex-specific gonadal and stress-related adaptations underpinning the accelerated progress from controlled to compulsive drug and alcohol seeking in women. We additionally discuss the efficacy of these mechanisms as novel targets for medications development, using exogenous progesterone and guanfacine as examples. Finally, we assess some of the challenges faced and progress made in terms of developing innovative medications in women. We suggest that agents such as exogenous progesterone and adrenergic medications, such as guanfacine, may provide some efficacy in terms of attenuating stress-induced craving for several substances, as well as improving the ability to emotionally regulate in the face of stress, preferentially in women. However, to fully leverage the potential of these therapeutics in substance-using women, greater focus needs to the placed on reducing barriers to treatment and research by encouraging women into clinical trials.

Daily stress predicts later drinking initiation via craving in heavier social drinkers: A prospective in-field daily diary study

Stress has been linked to increased alcohol use but how stress may increase drinking in social drinkers is not well understood. Negative reinforcement processes may explain this link but the role of specific motivational processes, such as craving, and how these motivational processes are altered by drinking have not been studied. The current study assessed social drinkers (n = 81) for recent quantity and frequency of alcohol intake (quantity and frequency index, QFI) upon study enrollment, who then completed 30 days of electronic daily records of stress, craving, and alcohol intake. Multilevel structural equation models tested if person-averaged (between-person) and daily (within-person) craving mediated the link between stress and later drinking each evening and if recent quantity-frequency of drinking (QFI) moderated these associations. At the between-person level, both greater subjective stress, Est = .38, 95% confidence interval (CI) [.19, .57], and higher QFI predicted higher levels of craving, Est = .34, 95% CI [.20, .49]. Higher craving predicted more frequent drinking throughout the study, Est = .34, 95% CI [.01, .29]. At the within-person level, higher subjective stress predicted higher within-person craving; and the link between craving and later drinking was significant among those who had a higher QFI, Est = .84, 95% CI [.58, 1.12]. The subjective stress-drinking relationship was mediated by a greater alcohol craving response in social drinkers, and higher the QFI, greater the alcohol craving response. These results indicate that both higher levels of stress and greater recent alcohol intake patterns sensitize the craving response that in turn facilitates later alcohol intake. The findings suggest that higher recent alcohol use predict greater stress-potentiated initiation of drinking via higher craving responses. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The 24-hour rhythm in alcohol craving and individual differences in sleep characteristics and alcohol use frequency

BACKGROUND

Evidence implicates sleep/circadian factors in alcohol use, suggesting the existence of a 24-h rhythm in alcohol craving, which may vary by individual differences in sleep factors and alcohol use frequency. This study sought to (1) replicate prior findings of a 24-h rhythm in alcohol craving, and (2) examine whether individual differences in sleep timing, sleep duration, or alcohol use frequency are related to differences in the timing of the peak of the craving rhythm (i.e., the acrophase) or magnitude of fluctuation of the rhythm (i.e., amplitude). Finally, whether such associations varied by sex or racial identity was explored.

METHODS

Two-hundred fifteen adult drinkers (21 to 35 years of age, 72% male, 66% self-identified as White) completed a baseline assessment of alcohol use frequency and then smartphone reports of alcohol craving intensity six times a day across 10 days. Sleep timing was also recorded each morning of the 10-day period. Multilevel cosinor analysis was used to test the presence of a 24-h rhythm and to estimate acrophase and amplitude.

RESULTS

Multilevel cosinor analysis revealed a 24-h rhythm in alcohol craving. Individual differences in sleep timing or sleep duration did not predict rhythm acrophase or amplitude. However, alcohol use frequency moderated this rhythm wherein individuals who used alcohol more frequently in the 30 days prior to beginning the study had higher mean levels of craving and greater rhythm amplitudes (i.e., greater rhythmic fluctuations). Associations did not vary by sex or racial identity.

CONCLUSIONS

Results show that alcohol craving exhibits a systematic rhythm over the course of the 24 h and that the frequency of alcohol use may be relevant to the shape of this rhythm. Consideration of daily rhythms in alcohol craving may further our understanding of the mechanisms that drive alcohol use.