Cynthia A. Stappenbeck

Collegiate heavy drinking prospectively predicts change in sensation seeking and impulsivity

Recent models of alcohol use in youth and young adulthood have incorporated personality change and maturation as causal factors underlying variability in developmental changes in heavy drinking. Whereas these models assume that personality affects alcohol use, the current prospective study tested the converse relation. That is, we tested whether, after accounting for the effect of traits on drinking, collegiate heavy drinking in turn predicted individual differences in change in alcohol-related aspects of personality. We also examined whether affiliation with heavy-drinking peers better accounted for this relation. Following a cohort of recent high school graduates (N=1,434) through the college years, we found evidence for transactional relations between heavy drinking and changes in impulsivity and sensation seeking. Both traits predicted increases in heavy drinking, but more important, heavy drinking predicted increases in sensation seeking and impulsivity. In final models, social influences did not underlie the effect of heavy drinking on increases in sensation seeking and impulsivity. The results of this investigation suggest that collegiate heavy drinking may negatively and pervasively impact a wide range of behaviors because of its effect on personality change.

Drinking motives moderate daily relationships between PTSD symptoms and alcohol use

Posttraumatic stress disorder (PTSD) and alcohol dependence (AD) frequently co-occur, although results of both cross-sectional and longitudinal studies evaluating the nature of their relationship have been mixed. There has been varied support for competing models explaining how these conditions influence one another. To assess both the self-medication and mutual maintenance models, as well as examine the potential moderating role of drinking motives, the current study used Generalized Estimating Equations to evaluate daily associations for an average of 7.3 days between PTSD symptoms and alcohol use in a mixed-gender sample of individuals who met criteria for both PTSD and AD. Results generally supported a self-medication model with elevated PTSD symptoms predictive of greater alcohol use on that same day and on the following day. Contrary to a mutual maintenance model prediction, drinking did not predict next-day PTSD symptoms. Results also indicated that both coping and enhancement drinking motives were significant moderators of the PTSD and drinking relationships, suggesting that these relationships may be more or less salient depending on an individuals particular drinking motivations. For example, among those higher on coping drinking motives, a 1-unit increase in PTSD symptom severity was associated with a 35% increase in amount of alcohol consumed the same day, while among those low on coping drinking motives, a 1-unit PTSD increase was associated with only a 10% increase in alcohol consumption. We discuss implications of these findings for the larger literature on the associations between PTSD and alcohol use as well as for clinical interventions. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

Gender differences in relationships among PTSD severity, drinking motives, and alcohol use in a comorbid alcohol dependence and PTSD sample.

Alcohol dependence (AD) and posttraumatic stress disorder (PTSD) are highly prevalent and comorbid conditions associated with a significant level of impairment. Little systematic study has focused on gender differences specific to individuals with both AD and PTSD. The current study examined gender-specific associations between PTSD symptom severity, drinking to cope (i.e., reduce negative affect), drinking for enhancement (i.e., increase positive affect), and average alcohol use in a clinical sample of men (n = 46) and women (n = 46) with comorbid AD and PTSD. Results indicated that PTSD symptoms were highly associated with drinking-to-cope motives for both men and women, but with greater drinking for enhancement motives for men only. Enhancement motives were positively associated with average alcohol quantity for both men and women, but coping motives were significantly associated with average alcohol quantity for women only. These findings suggest that for individuals with comorbid AD and PTSD, interventions that focus on reducing PTSD symptoms are likely to lower coping motives for both genders, and targeting coping motives is likely to result in decreased drinking for women but not for men, whereas targeting enhancement motives is likely to lead to reduced drinking for both genders.

Proximal Relationships Between PTSD Symptoms and Drinking among Female College Students: Results from a Daily Monitoring Study

Self-medication has been theorized to explain comorbidity between posttraumatic stress disorder (PTSD) and drinking, whereupon problem drinking develops in order to modulate negative affect and ameliorate PTSD symptoms. Daily monitoring methodologies may help refine our understanding of proximal relations between PTSD, affect, and alcohol use. One hundred thirty-six female college drinkers with a past history of sexual victimization and 38 female college drinkers with no past trauma history completed electronic monitoring of PTSD symptoms, affect, alcohol use, and alcohol cravings, daily for 4 weeks. A two-part mixed hurdle model was used to examine likelihood of drinking and amount of alcohol consumed on drinking days. We found significant relationships between daily PTSD symptoms, affect, and drinking. On days women experienced more intrusive and behavioral avoidance symptoms of PTSD, they experienced stronger urges to drink and were more likely to drink on that day. On days in which women experienced more negative affect than their average, they experienced stronger urges to drink, whereas on days in which women experienced more of the dysphoric symptoms associated with PTSD than their average, they drank less. On days with higher positive affect, women reported stronger urges to drink and were more likely to drink. Results suggest the need to examine both aspects of affect and specific PTSD symptoms as they may differentially predict drinking behavior. Differences in the ways in which PTSD symptoms and affect influence drinking suggest that interventions more specifically address the function of drinking behaviors in reducing alcohol use among college women.

A longitudinal investigation of heavy drinking and physical dating violence in men and women

Examinations of heavy drinking and dating violence have typically focused on either female victimization or male perpetration; yet recent findings indicate that mutual aggression is the most common pattern of dating violence. The current study investigated the relation between heavy drinking and dating violence for both men and women. Participants (N=2247) completed surveys that assessed their heavy drinking and dating violence frequency across the first three years of college. Findings indicated that heavy drinking and dating violence were both relatively stable across time for men and women, but the relation between heavy drinking and dating violence differed by gender. For men, heavy drinking and dating violence were concurrently associated during their freshman year (Year 1), whereas for women heavy drinking during their sophomore year (Year 2) predicted dating violence in their junior year (Year 3). In addition to providing educational material on healthy relationships and conflict resolution techniques, intervention efforts should target both heavy drinking and dating violence for men during or prior to their freshman year of college, whereas women may primarily benefit from efforts to reduce their heavy drinking.

Symptoms of posttraumatic stress predict craving among alcohol treatment seekers: results of a daily monitoring study.

Alcohol use disorders (AUDs) and Posttraumatic Stress Disorder (PTSD) commonly co-occur. Craving for alcohol is a common aspect of AUD, with and without PTSD, and is one of the key predictors of continued problematic alcohol use among treatment seekers. The present study sought to investigate the self-medication hypothesis using daily Interactive Voice Response (IVR) reports to examine the relationships between PTSD symptomatology and both same-day and next-day alcohol craving. Twenty-nine individuals with an AUD (26 of whom screened positive for PTSD) entering AUD treatment provided daily IVR data for up to 28 days regarding their alcohol use, craving, and 7 symptoms of PTSD. Given the nested nature of daily data, generalized estimating equations using a negative binomial distribution and a log link function were used to test hypotheses. Results suggest that days with greater overall PTSD severity are associated with greater alcohol craving, and greater reports of startle and anger/irritability were particularly associated with same-day craving. The next-day results suggest that the combination of the 7 PTSD symptoms did not predict next-day craving. However, greater distress from nightmares the previous night, emotional numbing, and hypervigilance predicted greater next-day craving, while greater anger/irritability predicted lower next-day craving. These findings highlight the importance of assessing the relationship between specific symptoms of PTSD and alcohol cravings in order to increase our understanding of the functional interplay among them for theory building. Additionally, clinicians may be better able to refine treatment decisions to more efficiently break the cycle between PTSD-related distress and AUD symptoms.

The effects of alcohol, emotion regulation, and emotional arousal on the dating aggression intentions of men and women.

Verbal and physical dating aggression is prevalent among college-aged men and women, especially a pattern of mutual aggression in which both partners engage in aggression. Alcohol intoxication and anger arousal have been implicated in the occurrence of aggression, and the ability to regulate ones emotions may interact with both alcohol intoxication and emotional arousal to predict dating aggression. The current study is the first known experimental investigation to examine the effects of alcohol intoxication, alcohol expectancies, emotion regulation, and emotional arousal on dating aggression. Participants were randomized to receive alcohol (n = 48), placebo (n = 48), or no alcohol (n = 48). Intoxicated men and women expressed more verbal and physical aggression intentions than those in the no-alcohol condition, and individuals in the placebo condition did not significantly differ from those in the alcohol and no-alcohol conditions. These results suggest that the pharmacological effects of alcohol were important to the occurrence of dating aggression, whereas the effects of expectancy are less clear. Among those less able to engage in cognitive reappraisal, individuals who consumed or believed they consumed alcohol expressed more verbal and physical aggression intentions than those who received no alcohol. Those with higher arousal who were better able to suppress their emotions expressed fewer verbal and physical aggression intentions than those with lower arousal. In addition to reducing alcohol consumption, interventions for dating aggression might incorporate emotion regulation skills, with a focus on understanding the circumstances in which cognitive reappraisal and emotion suppression are relatively more effective. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

An event-level examination of sex differences and subjective intoxication in alcohol-related aggression

Laboratory-based experimental research has demonstrated that the pharmacological effects of alcohol can increase aggressive responding. Given mixed findings and concerns regarding task validity, however, it remains uncertain whether this effect holds constant across men and women and whether variability in subjective alcohol intoxication contributes to alcohol-related aggression. In this investigation, the authors used 4 years of event-level data in a sample of 1,775 college students (140,618 total observations) to provide a test of laboratory-derived findings on the link between alcohol and aggression in an alternative methodology. They found support for several such findings: (a) Within-person increases in alcohol intoxication, as assessed by estimated blood alcohol concentrations (eBACs), were associated with increases in the probability of aggression at the drinking-episode level; (b) this association was significantly stronger among men than among women; and (c) within-person variability and between-persons individual differences in levels of subjective alcohol intoxication were associated with aggression over and beyond eBACs. Cross-methodological replication can reduce the impact of constraints specific to experimental studies on conclusions regarding alcohols relation with aggression.

Balanced placebo design: Revolutionary impact on addictions research and theory

Prior to the publication of Marlatt, Demming, and Reids (1973, Journal of Abnormal Psychology, 81, 233–241) manuscript entitled “Loss of control drinking in alcoholics: An experimental analogue,” the disease model of alcoholism prevailed. Central to the model was the belief that alcoholics suffer from a loss-of-control such that any drinking resulted in unregulated consumption and intoxication. In a masterfully crafted experimental investigation that represented an early use of the balanced placebo design (BPD), G. Alan Marlatt and his colleagues demonstrated that a priming drink of alcohol had no effect on how much alcoholics consumed during an ad libitum assessment of alcohol consumption. Marlatts publication reflected a departure from conventional wisdom by challenging the strict adherence to the disease model of alcoholism and contributed to advancements in both addictions research and theory. This article is dedicated to describing these advancements including: (1) a revised understanding of the symptomatology and etiology of alcoholism; (2) the development of cognitive-behaviorally oriented alcohol interventions; (3) the effects of alcohol on behavior and the role of alcohol expectancies; (4) the use of the BPD; and (5) the development of behavioral assessment strategies for addictions by innovating in vitro procedures for measuring ad libitum alcohol consumption unobtrusively. In the 40 years since its publication, Marlatt et al. (1973, Journal of Abnormal Psychology, 81, 233–241) continues to have a profound impact on research and theory and is a testament to G. Alan Marlatts status as a visionary and pioneer in the field of addictions research.

Young Men's Condom Use Resistance Tactics: A Latent Profile Analysis

Research suggests that many men have used a variety of tactics to avoid using condoms when having sex with women. Guided by previous work demonstrating that mens use of coercive condom resistance tactics was predicted by negative attitudes toward women, inconsistent condom use, multiple partners, and sexual sensation seeking, the current study used latent profile analysis (LPA) to determine whether similar constructs were associated with a variety of resistance tactics. A community sample of 313 moderate-drinking men participated, of whom 80% reported employing at least one condom use resistance tactic since adolescence. The LPA revealed three classes of men. In general, men with the least negative beliefs about women, low levels of sexual sensation seeking and impulsivity, and positive beliefs about condoms (Condom Positive/Low Hostility) reported less use of resistance tactics than men with moderate sexual sensation seeking and impulsivity, negative beliefs about condoms, and moderate (Condom Negative/Moderate Hostility) or high (Condom Negative/High Hostility) negative attitudes about women. The classes also differed in terms of their sexual behaviors. This study demonstrated that sexual risk behavior interventions should not only address the tactics through which men resist using condoms but also tailor these efforts to mens individual characteristics.