A Systematic Review of the Self‐Medication Hypothesis in the Context of Posttraumatic Stress Disorder and Comorbid Problematic Alcohol Use

Hawn, Sage E.; Cusack, Shannon E.; Amstadter, Ananda B.

doi:10.1002/jts.22521

Cited by 165 publications

(114 citation statements)

References 68 publications

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“…The self-medication hypothesis has also been used to explain the relationship between depression and alcohol use/problems [reviewed in (34)]. Evidence further suggests a mediating role of coping motives in the association of peritraumatic distress and alcohol-related problems [e.g., (35)]. While coping motives are central to the self-medication hypothesis, other domains of drinking motives include enhancement motives (i.e., drinking to enhance positive mood), social motives (e.g., affiliation with peers) and conformity motives [e.g., peer pressure; (36,37)].…”

Section: Introductionmentioning

confidence: 99%

Depression, Environmental Reward, Coping Motives and Alcohol Consumption During the COVID-19 Pandemic

et al. 2020

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Background: Increases in the incidence of psychological distress and alcohol use during the COVID-19 pandemic have been predicted. Behavioral theories of depression and alcohol self-medication theories suggest that greater social/environmental constraints and increased psychological distress during COVID-19 could result in increases in depression and drinking to cope with negative affect. The current study had two goals:(1) to examine self-reported changes in alcohol use and related outcomes after the introduction of COVID-19 social distancing requirements, and; (2) to test hypothesized mediation models to explain individual differences in self-reported changes in depression and alcohol use during the early weeks of the COVID-19 pandemic.Methods: Participants (n = 833) were U.S. residents recruited for participation in a single online survey. The cross-sectional survey included questions assessing environmental reward, depression, COVID-19-related distress, drinking motives, and alcohol use outcomes. Outcomes were assessed via retrospective self-report for two timeframes in the single survey: the 30 days prior to state-mandated social distancing ("pre-socialdistancing"), and the 30 days after the start of state-mandated social distancing ("postsocial-distancing").Results: Depression severity, coping motives, and some indices of alcohol consumption (e.g., frequency of binge drinking, and frequency of solitary drinking) were significantly greater post-social-distancing relative to pre-social-distancing. Conversely, environmental reward and other drinking motives (social, enhancement, and conformity) were significantly lower post-social distancing compared to presocial-distancing. Behavioral economic indices (alcohol demand) were variable with regard to change. Mediation analyses suggested a significant indirect effect of reduced environmental reward with drinking quantity/frequency via increased depressive symptoms and coping motives, and a significant indirect effect of COVID-related distress with alcohol quantity/frequency via coping motives for drinking.McPhee et al. Alcohol Use During COVID-19Discussion: Results provide early cross-sectional evidence regarding the relation of environmental reward, depression, and COVID-19-related psychological distress with alcohol consumption and coping motives during the early weeks of the COVID-19 pandemic. Results are largely consistent with predictions from behavioral theories of depression and alcohol self-medication frameworks. Future research is needed to study prospective associations among these outcomes.

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Section: Introductionmentioning

confidence: 99%

Depression, Environmental Reward, Coping Motives and Alcohol Consumption During the COVID-19 Pandemic

et al. 2020

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“…The self-medication hypothesis has also been used to explain the relationship between depression and alcohol use/problems (reviewed in Turner et al, 2018). Evidence further suggests a mediating role of coping motives in the association of peritraumatic distress and alcohol-related problems (e.g., Hawn et al, 2020b).…”

Section: Introductionmentioning

confidence: 99%

Depression, Environmental Reward, Coping Motives and Alcohol Consumption During the COVID-19 Pandemic

McPhee¹,

Keough²,

Rundle³

et al. 2020

Preprint

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Increases in the incidence of psychological distress and alcohol use during the COVID-19 pandemic have been predicted. Environmental reward and self-medication theories suggest that increased distress and greater social/environmental constraints during COVID-19 could result in increases in depression and drinking to cope with negative affect. The current study had two goals: (1) to clarify the presence and direction of changes in alcohol use and related outcomes after the introduction of COVID-19 social distancing requirements, and; (2) to test hypothesized mediation models to explain individual differences in alcohol use during the early weeks of the COVID-19 pandemic. Participants (n = 1127) were U.S. residents recruited for participation in an online survey. The survey included questions assessing environmental reward, depression, COVID-19-related distress, drinking motives, and alcohol use outcomes (alcohol use; drinking motives; alcohol demand, and solitary drinking). Outcomes were assessed for two timeframes: the 30 days prior to state-mandated social distancing (‘pre-social-distancing’), and the 30 days after the start of state-mandated social distancing (‘post-social-distancing’). Depression severity, coping motives, and frequency of solitary drinking were significantly greater post-social-distancing relative to pre-social-distancing. Conversely, environmental reward and other drinking motives (social, enhancement, and conformity) were significantly lower post-social distancing compared to pre-social-distancing. Time spent drinking and frequency of binge drinking were greater post-social-distancing compared to pre-social-distancing, whereas typical alcohol quantity/frequency were not significantly different between timeframes. Indices of alcohol demand were variable with regard to change. Mediation analyses suggested a significant indirect effects of reduced environmental reward with drinking quantity/frequency via increased depressive symptoms and coping motives, and a significant indirect effect of COVID-related distress with alcohol quantity/frequency via coping motives for drinking. Results provide early evidence regarding the relation of psychological distress with alcohol consumption and coping motives during the early weeks of the COVID-19 pandemic. Moreover, results largely converged with predictions from self-medication and environmental reinforcement theories. Future research will be needed to study prospective associations among these outcomes.

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“…Individuals with alcohol use or physical health concerns may thus benefit from combined treatment approaches. The alcohol use findings are noteworthy as previous studies have documented co-morbidities among PTSD and alcohol abuse, yet rarely examine whether PTSD symptoms drive alcohol abuse longitudinally (74). These findings are important to replicate in future research integrating PTSD symptoms and psychosocial outcomes.…”

Section: Discussionmentioning

confidence: 94%

Causal discovery identifies posttraumatic stress as a driver of internalizing symptoms across independent veteran and civilian populations

Pierce

Kirsh

Ferguson

et al. 2020

Preprint

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Background: Approximately half of patients with posttraumatic stress disorder (PTSD) also meet criteria for internalizing disorders, yet few studies assess reciprocal longitudinal relations among these symptoms. Methods: We used longitudinal causal discovery in a veteran cohort for hypothesis-generation about PTSD and internalizing symptom drivers (n=240), followed by hypothesis-testing in two independent civilian cohorts with similar symptom assessments over time (n=79 and n=116). Results: In the veteran cohort, causal discovery revealed PTSD symptoms drove internalizing symptoms, which subsequently impacted social functioning; all independent of problematic alcohol use. This replicated in treatment-seeking anxiety disorders (AD, n = 79) and substance abuse (SA, n = 116) samples with significantly better model fit for PTSD symptoms driving internalizing symptoms, versus internalizing symptoms driving PTSD symptoms (BIC change for AD sample = 175.1, p<.001; BIC change for SA sample = 571.6, p<.001). We also found better model fit with PTSD symptoms driving anxiety symptoms, versus anxiety symptoms driving PTSD symptoms (BIC change for AD sample = 71.8, p < .001; BIC change for SA sample = 568.9, p < .001). Posthoc analysis in the veteran sample revealed that hyperarousal and cognitive and affective disturbance bridged between other PTSD symptoms and internalizing symptoms. Conclusions: Our findings suggest that internalizing symptoms that emerge in the context of PTSD are more likely to be driven by PTSD symptoms. These results highlight the need for a PTSD- and trauma-informed approach to treating internalizing symptoms, and provide preliminary evidence for cognition and mood disruption as a factor driving comorbidity.

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A Systematic Review of the Self‐Medication Hypothesis in the Context of Posttraumatic Stress Disorder and Comorbid Problematic Alcohol Use

Cited by 165 publications

References 68 publications

Depression, Environmental Reward, Coping Motives and Alcohol Consumption During the COVID-19 Pandemic

Depression, Environmental Reward, Coping Motives and Alcohol Consumption During the COVID-19 Pandemic

Depression, Environmental Reward, Coping Motives and Alcohol Consumption During the COVID-19 Pandemic

Causal discovery identifies posttraumatic stress as a driver of internalizing symptoms across independent veteran and civilian populations

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