Motivational pathways from antecedents of alcohol use to consequences: a structural model of using alcohol to cope with negative affect

The development of compulsive coping behavior depends on dorsolateral striatum dopamine-dependent mechanisms

Humans greatly differ in how they cope with stress, a natural behavior learnt through negative reinforcement. Some individuals engage in displacement activities, others in exercise or comfort eating, and others still in alcohol use. Across species, adjunctive behaviors, such as polydipsic drinking, are used as a form of displacement activity that reduces stress. Some individuals, in particular those that use alcohol to self-medicate, tend to lose control over such coping behaviors, which become excessive and compulsive. However, the psychological and neural mechanisms underlying this individual vulnerability have not been elucidated. Here we tested the hypothesis that the development of compulsive adjunctive behaviors stems from the functional engagement of the dorsolateral striatum (DLS) dopamine-dependent habit system after a prolonged history of adjunctive responding. We measured in longitudinal studies in male Sprague Dawley rats the sensitivity of early established vs compulsive polydipsic water or alcohol drinking to a bilateral infusion into the anterior DLS (aDLS) of the dopamine receptor antagonist α-flupentixol. While most rats acquired a polydipsic drinking response with water, others only did so with alcohol. Whether drinking water or alcohol, the acquisition of this coping response was insensitive to aDLS dopamine receptor blockade. In contrast, after prolonged experience, adjunctive drinking became dependent on aDLS dopamine at a time when it was compulsive in vulnerable individuals. These data suggest that habits may develop out of negative reinforcement and that the engagement of their underlying striatal system is necessary for the manifestation of compulsive adjunctive behaviors.

Intolerance of Uncertainty, Negative Reinforcement Alcohol Use Motives, and Hazardous Drinking in College Students with Clinically Elevated Worry

Background: Hazardous drinking has remained high for college students in recent years, and individuals who endorse drinking to cope with emotional distress or to conform socially report higher levels of alcohol use. Intolerance of uncertainty, a core process underlying generalized anxiety disorder, has been linked to negative reinforcement drinking motives; however, no research, to date, has examined the role of intolerance of uncertainty in terms of alcohol use motives and hazardous drinking among individuals with generalized anxiety disorder. Objective: The current study was designed to examine the relationships between intolerance of uncertainty, coping and conformity alcohol use motives, and hazardous drinking in an analogue generalized anxiety disorder sample. Methods: Participants were 323 college students (M_age = 19.25, SD = 2.23, Range = 18-40) who endorsed past-year alcohol use and clinically elevated levels of worry. Self-report measures were completed online for course credit. Results: Partially consistent with our hypotheses, uncertainty paralysis predicted greater levels of coping motives, but not conformity motives. Desire for predictability did not predict either drinking motive. Mediation analyses revealed that there was a significant indirect effect of uncertainty paralysis on more hazardous drinking through greater coping motives. Conclusion: Overall, these findings highlight the potential utility of targeting behavioral inhibition due to uncertainty to reduce unhealthy coping via alcohol use and subsequent hazardous alcohol use.

A longitudinal study among young adults into the predictive effect of perceived efficacy of behavioural strategies and the moderating role of drinking motives on use of protective behavioural strategies

INTRODUCTION

Although protective behavioural strategies (PBS) have shown to be effective in minimising alcohol-related negative consequences, research on the explanatory factors of their use is very scarce. Perceived efficacy has been demonstrated to be one of the most relevant explanatory factors in the use of health-related protective behaviours. The present study prospectively examines the relationship between the perceived efficacy of PBS in reducing alcohol-related negative consequences and the use of PBS in a community-based sample of young adults. In addition, the moderating role of drinking motives in this relationship is also examined.

METHODS

Prospective design with a baseline assessment and a 2-month follow up. Using a targeted sampling procedure, 339 young adults were recruited from the community [mean age: 21.1 (SD = 2.21); female = 50.7%] and completed questionnaires to measure perceived efficacy of PBS and drinking motives at baseline and PBS use at follow up.

RESULTS

Perceived efficacy of PBS at baseline was positively associated with PBS use at follow up, and these relationships were weaker as social, enhancement and coping motives scores increased.

DISCUSSION AND CONCLUSIONS

Our findings support the need to include the perceived efficacy of PBS to reduce alcohol-related negative consequences in future interventions aimed at promoting PBS use. Moreover, these interventions should be personalised according to the initial levels of participants' drinking motives, incorporating elements that allow for neutralising their negative effects on PBS use (e.g. training in coping skills for those with strong coping motives).

The role of substance use coping in linking depression and alcohol use from late adolescence through early adulthood

Although theoretical models highlight the role of coping motivations in promoting co-development of depression and alcohol use, few longitudinal studies have examined such processes across early adulthood. The current study examined the role of coping in the association between depression and alcohol use across late adolescence and early adulthood. A control sample of adolescents (N = 498) from a longitudinal prevention trial completed the Brief Symptom Inventory, Life Events Coping Inventory, and a self-report survey on alcohol use at ages 17, 22, and 23, as well as the Composite International Diagnostic Interview at age 28-30. Path analyses integrated self-report and diagnostic measures. Although gender differences were observed in mean levels of depression, alcohol use, and the use of substances to cope, we did not find gender differences in structural relations across these domains over time. Substance use coping served as an intervening pathway in the association between alcohol use and depression both at the symptom level from age 17 to 23, and in predicting longer term diagnostic outcomes at ages 28-30. Depressive symptoms in early adulthood were indirectly related to major depressive disorder (MDD) through two independent paths, including the stability of depressive symptoms over time, and through the influence of depression on increasing the tendency to use substances to cope with stress. Our results underscore that coping effects provide unique predictive power across developmental transitions, over and above the stability of depressive symptoms and alcohol use, underscoring coping motives as a promising intervention target that may prevent co-occurring depression and substance use. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The relationship between the psychological capital of male individuals with drug abuse and relapse tendency: A moderated mediation model

This study aims to explore the mechanism of psychological capital's influence on relapse tendency of drug addicts under the COVID-19, and construct a moderated mediation model. 977 individuals with drug addiction who come from a mandatory drug rehabilitation center in China completed the Chinese versions of Psychological capital Questionnaire, the Relapse Tendency Questionnaire,the Coping Style Questionnarie and the Life History Strategy Scale.The results showed that(1) there was a significant negative correlation between psychological capital and relapse tendency;(2)positive coping style mediated the relationship between psychological capital and relapse tendency;(3) life history strategy is an important moderator between psychological capital and positive coping style.These findings help us to better understand the impact of psychological capital and positive coping style on relapse tendency.

Shifts in alcohol consumption during the COVID-19 pandemic: early indications from Australia

BACKGROUND AND AIM

The effect of the COVID-19 pandemic on alcohol consumption is currently unclear. This study aimed to provide early estimates of how stress and demographics will interact with shifts in harmful alcohol consumption from before the COVID-19 outbreak to 2 months into social distancing.

DESIGN

Cross-sectional convenience sample.

SETTING

Australia.

PARTICIPANTS

A total of 1684 Australians aged 18-65 years who drink at least monthly.

MEASUREMENTS

Items from the Alcohol Use Disorders Identification Test (AUDIT) and the stress subscale of the Depression Anxiety and Stress Scale (DASS).

FINDINGS

Overall, harmful drinking decreased during social distancing measures in our sample [2019 score = 8.2, 95% confidence interval (CI) = 7.9-8.4; during the pandemic = 7.3, 95% CI = 7.1-7.6]. Younger drinkers, particularly young women, decreased their consumption the most, but there was a small increase in consumption in middle-aged women. Drinkers experiencing high levels of stress also reported a relatively higher shift in harmful consumption compared with those with low levels of stress (β = 0.65, P = 0.003), despite reporting a small decrease overall.

CONCLUSIONS

The closure of licensed premises and social distancing measures in Australia in response to the COVID-19 outbreak appear to have reduced harmful alcohol consumption in younger drinkers, particularly young women.

Linking Big Five Personality Domains and Facets to Alcohol (Mis)Use: A Systematic Review and Meta-Analysis

AIMS

The goal of this investigation was to synthesize (un)published studies linking Big Five personality domains and facets to a range of alcohol use outcomes. Meta-analyses were conducted to quantify the unique associations between alcohol use outcomes and each Big Five personality domains over and above other domains. Within each domain, meta-analyses also were conducted to examine the unique contribution of each personality facet in predicting alcohol use outcomes.

METHODS

Systematic literature reviews were performed in PsycINFO and PubMed using keywords related to alcohol use and personality. Peer-reviewed and unpublished studies were screened and coded for the meta-analyses. A total of 80 independent samples were subjected to correlated effects meta-regressions.

RESULTS

Over and above other Big Five personality domains, both conscientiousness and agreeableness were negatively correlated with alcohol consumption, risky/hazardous drinking and negative drinking-related consequences. Facet-level analyses indicated that deliberation and dutifulness were uniquely associated with alcohol (mis)use over and above other conscientiousness facets, and compliance and straightforwardness were uniquely associated with alcohol (mis)use over and above other agreeableness facets. Extraversion-namely excitement seeking-was correlated with alcohol consumption, whereas neuroticism-namely impulsiveness and angry hostility-was correlated with negative drinking-related consequences.

CONCLUSIONS

Personality characteristics are robust correlates of alcohol (mis)use. Examining relevant narrowband traits can inform mechanisms by which personality affects drinking behaviors and related problems, and ways to enhance clinical interventions for alcohol use disorder. Gaps in this literature and future research directions are discussed.

Modified Drinking Motives Questionnaire-Revised: Psychometric Validation in a Psychiatric Sample of Young Adults with Predominantly Polysubstance Use

INTRODUCTION

Measures of motives for alcohol use provide an important avenue for understanding underlying psychological reasons that drive substance use and predict distinct patterns of use. The Modified Drinking Motives Questionnaire-Revised (MDMQ-R; Grant, Stewart, O'Connor, Blackwell, Conrod, 2007) measures five drinking motives: social, enhancement, conformity, coping-with-anxiety, and coping-with-depression. The MDMQ-R and its predecessors have previously been validated only in non-clinical normative samples.

PURPOSE

Therefore, the present study aimed to validate the factor structure and internal consistency of the MDMQ-R in a diverse psychiatric sample of substance-using young adults that presented with either exclusive alcohol use or polysubstance use.

METHOD

Participants were 255 substance-using young adults (18-26 years; M = 21.17) admitted to the young adult partial hospitalization treatment program at a private psychiatric hospital (62% female; 78% White; 43% students).

RESULTS

A confirmatory factor analysis revealed that items loaded on their respective latent factors (ps < 0.01; loadings between 0.50 and 0.90; reliabilities between 0.80 and 0.94). However, goodness of fit statistics were not reflective of model fit found in Grant et al. (2007) in the overall sample, as well as in alcohol-only and polysubstance-using samples.

DISCUSSION

Results suggest that the factor structure of the MDMQ-R did not replicate in the present sample. Potential explanations and future directions are discussed in light of the results, including generalizability and clinical utility.

Associations Between Transdiagnostic Cognitive-Affective Vulnerability Factors, Negative Reinforcement Drinking Motives, and Problematic Alcohol Use among Undergraduates

Anxiety sensitivity, distress tolerance, and emotion regulation difficulties have each demonstrated significant individual associations with problematic alcohol use and negative reinforcement motives for alcohol use among college students. However, extant research has yet to examine these three factors simultaneously with regard to the possibility of differential associations with alcohol consumption, alcohol-related problems and coping and conformity motives for alcohol use. As such, the present study sought to examine whether such differential associations exist within a sample of undergraduates reporting past year alcohol use. Methods: Participants were 379 undergraduate students reporting alcohol use in the past year who completed self-report measures for course credit. Results: After controlling for the effects of sex, lifetime marijuana use status, and negative affectivity, greater anxiety sensitivity social concerns and difficulties with emotional awareness were associated with more alcohol-related problems. Greater anxiety sensitivity social concerns and impulse control difficulties were associated with greater conformity alcohol use motives, and greater impulse control and emotional clarity difficulties were associated with greater coping motives. Conclusions: These findings suggest that greater fears of anxiety symptoms because of their potential negative social consequences and certain emotion regulation difficulties (i.e., impulse control, emotional clarity, emotional awareness) may be particularly problematic because they are associated with alcohol-related problems and negative reinforcement motives for use among undergraduates.

An examination of the extent to which drinking motives and problem alcohol consumption vary as a function of deprivation, gender and age

INTRODUCTION

Existing research points to a link between socioeconomic factors, alcohol consumption and harms, while another body of work documents the importance of varying motivations to drink in shaping alcohol behaviours. Yet, little is currently known about the extent to which alcohol consumption may be differentially associated with drinking motives as a function of deprivation, gender and age.

METHODS

Cross-sectional analysis of data from a UK sample aged between 18 and 75 years (n = 1639; 51% male, Mage 47.74, SD 14.66). Structural equation modelling, using clustering to account for the multi-level nature of the data set, was carried out to assesses the relationships between deprivation (Index of Multiple Deprivation), occupation, age, gender and problem alcohol consumption (Alcohol Use Disorder Identification Test) and social, conformity, enhancement and coping drinking motives.

RESULTS

Coping, enhancement and conformity, but not social, motives were associated with problem alcohol consumption. Drinking motives were stronger predictors of problem consumption than gender and age, with motives tending to be endorsed more strongly by younger and male respondents. Responses from participants with working-class occupations tended to be characterised by elevated endorsements of coping motives.

DISCUSSION AND CONCLUSION

Drinking motives are stronger predictors of problem alcohol consumption than socio-demographic variables although these factors exert influences on people's motives to drink.

Development of emotion regulation across the first two years of college

INTRODUCTION

Emotion regulation is thought to develop substantially from late adolescence into early adulthood; further, the rate of development purportedly varies based on personal and contextual characteristics. However, little research has explicitly documented this maturation in young adulthood or identified its determinants. We aimed to (1) characterize how adaptive (positive reappraisal, emotional social support-seeking) and maladaptive (suppression, substance use coping) emotion regulation strategies changed over time and (2) predict change in each strategy based on baseline personal, social, and motivational characteristics.

METHODS

We followed a sample of 1578 students entering university in the northeastern United States across their first two years, assessing them four times.

RESULTS

As expected, social support-seeking increased and suppression decreased. However, contrary to expectations, cognitive reappraisal declined over time while substance use coping increased. Women generally used more adaptive emotion regulation strategies than did men; social engagement and connection and eudaimonic well-being were generally predictive of using more adaptive coping over time.

CONCLUSIONS

Overall, students did not consistently demonstrate maturation to more adaptive emotion regulation and in fact exhibited decrements over the first two years of college. Students' baseline characteristics accounted for substantial degrees of change in emotion regulation. These findings suggest potentially fruitful directions for interventions to assist college students in developing more adaptive emotion regulation skills.

Assessment of coexisting psychosis and substance misuse: complexities, challenges and causality

Substance misuse worsens the prognosis for people suffering psychosis and places them at risk of being denied appropriate mental health service interventions. To increase the chances of its success, the plan of management for patients with coexisting psychosis and substance misuse should be based on a valid formulation of their problems, which in turn is dependent on the clinician having (a) a thorough understanding of the bidirectional and changing ways that substance use and mental illness symptoms can interact, (b) an awareness of their own biased implicit assumptions about causality in explaining these interactions and (c) a framework for assessment and formulation. This article addresses these three areas with reference to the evidence base and to clinical experience in a way that guides mental health clinicians in the assessment of patients with coexisting psychosis and substance misuse.

Examination of using alcohol to cope, depressive symptoms, and perceived social support in persons with HIV and Hepatitis C

Depression is common among people living with HIV (PLWH) and some likely turn to alcohol to cope with this emotional distress. Using alcohol to cope is associated with increased alcohol use, persistent longitudinal alcohol use, and alcohol-related problems. This association is particularly concerning among PLWH who are co-infected with Hepatitis C (HCV) because alcohol adds to the damage already caused by HCV. Despite data showing the associated risks of using alcohol to cope, scant research has examined factors that might contribute to coping-based alcohol use in HIV-HCV patients, such as limited social support. Baseline data from a randomized trial of strategies to reduce alcohol use in co-infected HIV and HCV adult patients (n=110) were analyzed. Multiple linear regression models were used to estimate the association between using alcohol to cope, depression, and four aspects of social support, controlling for demographic variables. Results showed that using alcohol to cope was not significantly correlated with social support but was significantly correlated with depressive symptoms. In fact, depressive symptoms and severity of alcohol consumption accounted for nearly 45% of the variance related to coping-based alcohol use. These data highlight the central role of depression in the coping motives-alcohol use relationship among co-infected patients.

The Relationship between Negative Affect and Alcohol and Marijuana Use Outcomes among Dual Users

Background: Past research with college students has found that substance use motives, particularly coping motives, mediate the relationship between negative affect and alcohol- and marijuana-related outcomes. Objectives: This study aimed to investigate substance use motives of dual users of both substances (past 30-day use; not necessarily simultaneous use) and identify any mediation effects that are either common to both substances or substance-specific. Methods: The majority of dual users (n = 2,034) identified as being White, non-Hispanic (63.8%), female (69.08%), and reported a mean age of 20.24 (SD = 3.16) years. To test study aims, path models were conducted such that negative affect (stress, depressive and anxiety symptoms) were independently modeled as predictors of substance use outcomes (i.e. quantity and consequences) via substance use motives. Results: All three negative affect symptoms were indirectly related to both alcohol and marijuana consequences via coping motives, such that higher negative affect was associated with higher coping motives; which in turn were positively associated with consequences. Substance-specific effects were also found: (a) stress was indirectly related to both alcohol and marijuana use quantity via enhancement motives, (b) depressive/anxiety symptoms were indirectly related to alcohol use quantity via enhancement motives, and (c) all three negative affect symptoms were indirectly related to both marijuana use quantity and negative consequences via expansion motives. Conclusions: Findings suggests that dual users of alcohol and marijuana with negative affect symptoms engage in substance use for similar reasons as single substance users with negative affect symptoms. Intervention efforts should examine ways to replace substance-related coping and expansion methods with non-substance-related methods.

Motives for and impairment associated with alcohol and marijuana use among college students

INTRODUCTION

Alcohol and marijuana use are prevalent on college campuses. As recreational marijuana use is legalized, more undergraduate students may use marijuana in combination with alcohol. The motives for, frequency of, and impairment associated with dual use (alcohol and marijuana) compared to alcohol-only use may differ. We examined motives for, frequency of, and impairment associated with alcohol use and dual use at a university in a state where recreational marijuana has been legalized.

METHOD

Undergraduate college students completed an anonymous online survey (N = 430) concerning alcohol and marijuana frequency, motives, and impairment. Students were classified as either alcohol-only users (n = 279) or dual users (n = 151).

RESULTS

Analyses indicated that among alcohol-only users, social motives predicted more alcohol use, while among dual users, enhancement motives predicted more alcohol and marijuana use and impairment. Coping motives predicted more marijuana use among dual users, but not more alcohol use. Frequency of alcohol and marijuana use predicted more impairment across both the alcohol-only and dual users.

CONCLUSIONS

Future research should examine the influence of marijuana use over time to understand how motives may change for previous alcohol-only users.

Cross-cultural examination of different personality pathways to alcohol use and misuse in emerging adulthood

BACKGROUND

Previous research has identified different, but not mutually exclusive, etiological pathways (i.e., the positive affect regulation pathway, the negative affect regulation pathway and the deviance proneness pathway) to alcohol use and misuse in which personality characteristics play a key role.

OBJECTIVES

The present study aimed to simultaneously and cross-culturally examine all these personality pathways to alcohol use in a large sample of young adult drinkers (N = 1280) from the US, Argentina, and Spain.

METHOD

Structural equation modeling was conducted to test the models. Multi-group models were conducted to test model invariance across countries and gender groups.

RESULTS

In the whole sample, low conscientiousness and extraversion were related to alcohol outcomes through enhancement drinking motives (i.e., positive affect regulation pathway), low emotional stability was related through coping drinking motives (i.e., negative affect regulation pathway), and low conscientiousness and low agreeableness were related through antisocial behavior (i.e., deviance proneness pathway). The model was invariant between gender groups. Some minor, yet significant, differences across countries arose. Specifically, antisocial behavior was a significant mediator of the association between agreeableness and alcohol use, but only in the US subsample.

CONCLUSIONS

The present findings suggest that risky-personality pathways for alcohol use and alcohol-related problems may be generalized across gender groups and cultures in young adults.

Attentional and Neural Processing of Affective and Alcohol-Related Images in University-Attending Emerging Adults

High-risk drinking is prevalent in university-attending emerging adults. This coincides with a critical time for the development of higher level cognitive and emotional processing and underlying neurobiological mechanisms. Cognitive and emotional processing seems to have a particularly sensitive relationship with alcohol. The current study sought to examine the relationship between alcohol use and neurophysiology in an emerging adult, university-attending population. Neurophysiological response, defined as event-related potentials, to alcohol-related and emotionally affective images were evaluated in 23 drinkers and 21 nondrinkers. Drinkers had a greater attentional response to alcohol, positive, and negative images compared to nondrinkers. No differences were found between groups for attentional response (P2) to neutral images or for later emotional processing (late positive potential) for any stimuli type. These data suggest that this drinking population processes alcohol stimuli and affective images similarly and more robustly than nondrinking peers. These data support a relationship between alcohol and emotional processing in emerging adults.

The relationship between executive functions and emotion regulation in females attending therapeutic community treatment for substance use disorder

BACKGROUND

Difficulties in emotion regulation influence the development of substance use disorder (SUD), its severity, course, treatment outcomes, and relapse. Impaired executive functions (EFs) are common in SUD populations and may relate to emotion dysregulation. The current study tested whether performance on three basic EF tasks ('working memory', 'inhibition', and 'task-switching') and/or inventory-based assessment of EF were related to difficulties in emotion regulation in females attending residential SUD therapeutic community treatment.

METHODS

Cross-sectional design in which participants (N=50, all female) completed a questionnaire battery including the Difficulties in Emotion Regulation Scale (DERS) and Behavior Rating Inventory of Executive Function - Adult Version (BRIEF-A) was used. Participants also completed neuropsychological assessment of EF including the Working Memory Index (WMI; Wechsler Adult Intelligence Scale), and measures of inhibition and task-switching (Color-Word Interference Test; Delis-Kaplan Executive Function System).

RESULTS

Executive dysfunction, as assessed by the Global Executive Composite (GEC; BRIEF-A), and personality disorder indicators (Standardised Assessment of Personality - Abbreviated Scale; SAPAS) were positively correlated with DERS scores. Sequential hierarchical regression indicated that task-switching, GEC, and SAPAS scores statistically predicted DERS scores, while working memory and inhibition did not. Mediation analysis indicated that there was a significant indirect effect of GEC scores and task-switching performance on DERS scores, through SAPAS scores.

CONCLUSIONS

Impairment of EF, particularly task-switching, is related to difficulties in emotion regulation in a female sample attending residential SUD treatment. Cognitive training interventions that improve task-switching performance may be beneficial in promoting effective emotion regulation and improved SUD treatment outcomes.