Christine Vinci

A BIOPSYCHOSOCIAL MODEL OF SOCIAL ANXIETY AND SUBSTANCE USE

Emerging prospective work suggests that individuals with social anxiety disorder (SAD) may be at particular risk for developing substance use disorders (SUD). Yet, little is known about why this may be so. Most research has utilized existing theories of substance use (e.g. tension reduction‐based theories) to understand SAD–SUD relations. However, these theories do not address why individuals with social anxiety, in particular, experience such high rates of substance‐related problems. A possible explanation may lie in the nature of social anxiety itself, which is characterized not only by chronically elevated negative affective states, but by low positive affect, fear of scrutiny, and social avoidance. These aspects of social anxiety may work in concert to place these especially vulnerable individuals at risk for SUD. The current paper presents a biopsychosocial model of SAD‐SUD comorbidity that focuses on several specific facets of social anxiety that may be especially related to SUD risk. The utility of this model is evaluated via a review of the literature on the relations between SAD and substance‐related behaviors.

Smoking and Social Anxiety: The Roles of Gender and Smoking Motives

Although social anxiety appears to be a risk factor for smoking and nicotine dependence, little work has identified factors that may play a role in these relationships. The current study examined the role of gender and smoking motives in these relationships among 945 (73.0% female) undergraduates, 91 of whom were current daily smokers. Among women, social anxiety was related to daily smoking status, whereas it was related to dependence severity among men. After controlling for past-week smoking frequency, social anxiety was related to affiliative attachment and behavioral choice-melioration smoking motives. Both motives mediated the relationship between social anxiety and nicotine dependence severity, although affiliative attachment motives uniquely mediated this relationship. Results suggest that socially anxious individuals who view cigarettes as having some of the same characteristics as social interactions may be particularly vulnerable to more severe nicotine dependence. Results also highlight the importance of considering gender in the relationships between social anxiety and smoking behaviors.

Unique relationships between facets of mindfulness and eating pathology among female smokers

Female smokers often have higher levels of eating disorder symptoms than non-smokers, and concerns about eating and weight might interfere with smoking cessation. Thus, it is critical to identify factors to promote healthier eating and body image in this population. Initial research suggests that specific aspects of trait mindfulness predict lower body dissatisfaction and eating disorder symptoms among non-smokers. However, these relationships are unknown among smokers. The current study examined associations between facets of trait mindfulness and eating disorder symptoms in 112 college female smokers (83% Caucasian; mean age 20 years, SD=1.69). After controlling for relevant sociodemographic variables, Describing and Nonjudging facets of mindfulness predicted lower bulimic symptoms and body dissatisfaction (ps<.05), while Acting with Awareness predicted lower bulimic and anorexic symptoms, ps<.05. Observing predicted higher anorexic symptoms, p<.05. These results suggest that specific mindfulness facets are related to lower eating disorder symptoms among smokers, whereas other facets are not associated or have a positive relationship with these symptoms. Mindfulness-based interventions focusing on Describing, Nonjudging, and Acting with Awareness may help to reduce eating pathology among female smokers, which could potentially improve smoking cessation rates in this population.

PTSD-related alcohol expectancies and impulsivity interact to predict alcohol use severity in a substance dependent sample with PTSD

INTRODUCTION Problematic alcohol use is highly comorbid with posttraumatic stress disorder (PTSD), and prior work has demonstrated that individuals with PTSD may self-medicate with alcohol in an effort to reduce their symptoms. The combination of impulsivity and alcohol-related expectancies influences the development of problematic drinking patterns. When examining individuals diagnosed with PTSD, PTSD-related alcohol expectancies may be particularly relevant to the etiology of problematic drinking. To date, no studies have specifically examined PTSD-specific alcohol expectancies as they relate to alcohol use severity in a clinical sample. METHODS The current study examined the relationship between impulsivity, PTSD-related alcohol expectancies, and severity of alcohol use in a sample of 63 individuals diagnosed with comorbid PTSD and substance use disorders who were receiving treatment in a residential substance use treatment program. RESULTS Results indicated that PTSD-related alcohol expectancies moderated the relationship between impulsivity and alcohol use severity. Specifically, at low to moderate levels of positive PTSD-related alcohol expectancies, impulsivity significantly predicted alcohol use severity, while impulsivity had no impact on the prediction of alcohol use severity when such expectancies were high. Additionally, the relationship between impulsivity, expectancies, and alcohol use severity was significant for positive, but not negative, PTSD-related alcohol expectancies. CONCLUSIONS Overall, these results suggest that impulsivity and PTSD-related alcohol expectancies interact to predict alcohol use severity in a comorbid PTSD and substance dependent sample.

Exposure to negative affect cues and urge to smoke.

While much of the cue exposure literature for cigarette smoking has focused on external cues, little has been done in the area of exposing participants to internal cues, such as negative affect (NA), despite the important role of such cues in maintaining smoking behavior. Smokers were exposed to an NA mood induction to induce an urge to smoke and then exposed to NA cues over several trials in an attempt to decrease this urge. Participants (N = 32) were undergraduate smokers assigned to either the exposure or control group for the mood induction procedure, which occurred over 8 trials. All participants viewed NA images and listened to NA music at Trial 1. The exposure group continued to view NA images and listened to NA music, and the control group viewed neutral images and listened to neutral music for 6 subsequent trials lasting about 5 min each. Both groups were exposed to NA images and NA music at Trial 8. NA and urge to smoke ratings were assessed at the end of each trial; heart rate was measured continuously. Results indicated that the mood induction procedure induced NA and urge to smoke, but the extinction procedure did not decrease urge over trials. Heart rate data were not associated with self-report data. In conclusion, the mood induction procedure in the present study appears to be an efficient way to induce urge to smoke. However, further research is necessary to determine why urge to smoke seems to be resistant to extinction.

Examination of the relationship between PTSD and distress tolerance in a sample of male veterans with comorbid substance use disorders

Distress tolerance (DT), the perceived or actual ability to tolerate negative emotional or physical states, is inversely related to posttraumatic stress disorder (PTSD) symptoms in civilian, community samples. No studies to date have examined the relationship between DT and PTSD in clinical samples of veterans with a comorbid diagnosis of PTSD and a substance use disorder (SUD). Thus, the present study examined the relationship between DT and PTSD in a sample of predominately African American, male veterans (n = 75) diagnosed with comorbid PTSD and SUD (according to a structured clinical interview). Results of hierarchical linear regression models indicated that DT was inversely related to total PTSD symptom severity score, above and beyond depressive symptoms and SUD severity. Of the 4 symptom clusters, DT was inversely associated with intrusions and hyperarousal. These findings are discussed in light of previous work with civilian samples. Determining whether treatment incorporating DT skills would be useful for veterans undergoing PTSD treatment should be evaluated.

Cannabis use vulnerability among socially anxious users: cannabis craving during a social interaction.

Socially anxious individuals appear especially vulnerable to cannabis-related problems. However, the nature of the social anxiety-cannabis relation remains unclear. The present study examined the timing and specificity of cannabis craving in response to a social anxiety induction task among 82 (71% female) cannabis users randomly assigned to either a social interaction or reading task. Participants completed ratings of substance (cannabis, alcohol, cigarette) craving at baseline (prior to being informed of task assignment), before, during, and after task. The Time × Condition interaction was significant such that cannabis craving increased from before to during the task among participants in the social interaction condition, but not among those in the reading condition. This effect was specific to cannabis craving and was not observed for craving for alcohol or cigarettes. Data suggest that increases in state social anxiety may play a role in cannabis use behaviors.

The relationship between depression level and smoking motives in college smokers

While the link between cigarette smoking and depression symptomatology has been well established, more research is needed to determine how smoking motives are related to depression levels in smokers. Specifically, smoking motives related to the friendship-like attachment to smoking (i.e., affiliative attachment) may play an important role in individuals reporting depressive symptomatology. The present study examined the relationship between three smoking motives and depression levels in a sample of 79 mildly nicotine-dependent, college student cigarette smokers. A hierarchical multiple regression analysis was conducted with depression as the dependent variable and gender and cigarettes per day as the independent variables (Step 1), positive and negative reinforcement motives (Step 2), and affiliative attachment motives (Step 3). Results of regression analyses indicated that affiliative attachment motives explained significant variance in participant depression level above and beyond that explained by positive and negative reinforcement motives. These findings suggest that smokers with elevated depression should be assessed for social functioning and affiliative attachment smoking motives, and future research should be conducted to determine if individuals with high levels of affiliative attachment may benefit from smoking cessation treatment programs with an enhanced social support component.

The Unique Associations of Sexual Assault and Intimate Partner Violence With PTSD Symptom Clusters in a Traumatized Substance-Abusing Sample.

Objective: There is a high occurrence of sexual assault (SA) and intimate partner violence (IPV) among people with substance use disorders and an established association between substance use and posttraumatic stress disorder (PTSD), but no research has examined associations between combinations of these traumas and PTSD symptom profiles among people who abuse substances. Thus, this study aimed to examine how combinations of SA and IPV histories contribute to the severity of symptoms within PTSD symptom clusters above and beyond the impact of exposure to other traumas in a substance abusing population. Method: Participants were men and women (N = 219) with trauma histories seeking treatment in a substance abuse facility. Multivariate analyses of covariance examined differences on Clinician Administrated PTSD Scale cluster scores in people with experiences of SA and/or IPV in comparison to people with other types of trauma, controlling for number of PTSD criterion A events. Results: SA was associated with increased symptom severity across all 3 PTSD symptom clusters, whereas IPV was not associated with differences in cluster scores. In addition, survivors of IPV had consistent levels of avoidance symptoms regardless of whether they had also experienced SA, but people who had not experienced IPV only evidenced increased avoidance symptoms when they had experienced SA. Follow-up analyses testing gender differences indicated that these findings were largely similar for men and women. Conclusions: SA should be assessed in people in substance use treatment settings to conceptualize their unique presentations of PTSD symptoms and inform treatment planning.

Smoking topography and outcome expectancies among individuals with schizotypy

Compared to smokers in the general population, smokers with schizophrenia smoke more cigarettes per day and have higher nicotine dependence and biochemical indicators of nicotine intake. They also have more intense smoking topography and greater positive smoking expectancies. Little is known about the relationship between smoking and schizotypy, defined as the personality organization reflecting a vulnerability to schizophrenia-spectrum pathology. This study assessed schizotypy symptoms, smoking characteristics and behaviors, and smoking expectancies in young adults with psychometrically defined schizotypy and demographically matched controls without schizotypy. Smokers with schizotypy had higher nicotine dependence and smoked more cigarettes per week compared to control smokers. They were also more likely to endorse greater positive consequences (i.e., improved state enhancement, stimulation, social facilitation, taste/sensorimotor manipulation, reduced negative affect and boredom) and fewer negative consequences of smoking. Smokers with schizotypy and control smokers did not differ on smoking topography or carbon monoxide levels. This is the first known study to investigate relationships between these smoking-related variables in smokers with schizotypy. Individuals with schizotypy possessed certain smoking-related characteristics and smoking expectancies similar to those with schizophrenia. This offers preliminary insight into unique smoking-related factors among individuals with schizotypy and highlights the importance of continued research in this area.