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 included 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 higher 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-Direct Behavior, Nonacceptance of Emotional Reponses, 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.

Objective Posttraumatic stress (PTS) symptoms are associated with alcohol-related consequences, but there is a need to understand mediators that may help explain the reasons for this relationship. Individuals with PTS may experience elevated craving and alcohol reward value (demand), which may contribute to risk for alcohol-related consequences. Method We examined relationships between PTS status, craving, alcohol demand, and alcohol-related consequences in PTS-positive (n = 64) and PTS-negative (n = 200) college students (M age = 21.7; 77% women; 54% Caucasian; 34% African American) who endorsed past-month alcohol use. We tested craving and alcohol demand as mediators of the relation between PTS status and alcohol problems. Results Craving (B = .04, SE = .02, 95% CI = .01 – .10), demand intensity (B = .05, SE = .03, 95% CI = .0009 – .17), and demand elasticity (B = .05, SE = .03, 95% CI = .006 – .03) significantly mediated the association between PTS symptoms and alcohol problems. Craving remained a significant mediator in a multiple mediators model (B = .08, SE = .04, 95% CI = .03 – .19). Conclusions Craving and alcohol demand may partially explain the relation between PTS status and alcohol-related consequences. Craving may be especially salient for individuals with PTS symptoms, as it may lead to more severe alcohol-related consequences even in the absence of elevated alcohol consumption.

Abstract Study Objectives Post-9/11 veterans are particularly vulnerable to insomnia disorder. Having accurate prevalence rates of insomnia disorder in this relatively young, diverse population, is vital to determine the resources needed to identify and treat insomnia disorder. However, there are no accurate prevalence rates for insomnia disorder in post-9/11 veterans enrolling in the VA Healthcare System (VHA). We present accurate prevalence of insomnia disorder, and correlates, in a large sample of post-9/11 veterans enrolling in a VHA. Methods This was an observational study of 5,552 post-9/11 veterans newly enrolling for health care in a VHA. Data were collected using VA eScreening. Insomnia diagnosis was determined using a clinical cutoff score of ≥ 11 on the Insomnia Severity Index. Measures also included sociodemographic, service history, posttraumatic stress disorder (PTSD), depression, suicidal ideation, alcohol misuse, military sexual trauma, traumatic brain injury (TBI), and pain intensity. Results About 57.2% of the sample population had insomnia disorder. Our sample was nationally representative for age, sex, ethnicity, branch of the military, and race. The sample also was at high-risk for a host of clinical disorders, including PTSD, TBI, and pain; all of which showed higher rates of insomnia disorder (93.3%, 77.7%, and 69.6%, respectively). Conclusions The findings suggest alarmingly high rates of insomnia disorder in this population. Examining and treating insomnia disorder, especially in the context of co-occurring disorders (e.g. PTSD), will be a necessity in the future.

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