Daily associations between PTSD, drinking, and self-appraised alcohol-related problems.

Abstract

Alcohol dependence (AD) and posttraumatic stress disorder (PTSD) are highly comorbid, yet limited research has focused on PTSD and daily drinking as they relate to self-appraised alcohol-related problems. In treatment contexts, patients’ appraisals of alcohol-related problems have implications for assessment, intervention strategies, and prognosis. This study investigated the moderating effect of within-person (daily symptoms) and between-person (overall severity) differences in PTSD on the association between daily drinking and same-day alcohol-related problems. Participants with comorbid AD and PTSD (N = 86) completed one week of Interactive Voice Recognition data collection, and logistic and gamma-adjusted multilevel models were used to estimate odds and magnitude of self-appraised alcohol-related problems. Results revealed that both within-person and between-person PTSD moderated the association between number of drinks and severity of self-appraised problems. As within-person and between-person PTSD symptoms increased, there was a weaker association between number of drinks consumed and perceived alcohol-related problems. Contrasts further revealed that on non-drinking and light-drinking days, PTSD (both daily symptoms and overall severity) was positively associated with ratings of alcohol-related problems. However, PTSD was not associated with alcohol-related problems on heavier drinking days. In conclusion, more severe PTSD is associated with a less directly contingent relationship between drinking quantity and perceived alcohol-related problems. These findings suggest the importance of further investigations of this moderating effect as well as clinical treatment of comorbid AD and severe PTSD with functional analysis of drinking.

Ecological momentary assessment studies of comorbid PTSD and alcohol use: A narrative review

“…Response rate of 91.3%PTSD symptoms associated with same-day craving (cross-sectional);PTSD symptoms not associated with next-day craving (prospective); Greater distress from nightmares, emotional numbing, & hypervigilance predicted ↑ next-day craving; greater anger/irritability predicted ↓ next-day craving;Craving not associated with next-day PTSD symptoms (prospective)Simpson et al (2014)USACorrelational86 civilians & veterans (44 M/42 F) with comorbid PTSD & alcohol dependence (AD) who indicated a desire to decrease alcohol useMean age = 44.7 EMA: PTSD symptoms (12-items, how bothered they were during the previous day)(also DV in select analyses) (Deviation score) EMA: Alcohol use (total number of standard drinks past day) (also IV in select analyses) (Deviation score)Coping & Enhancement Drinking Motives (Moderators); Hardware/software: IVR Frequency: 1/day for 6–20 days (BL period of larger study) Trigger: Participants told to make a daily call regarding the previous day Compliance: Sample provided data for at least 50% of days of 28-day monitoring period. Response rate of 95.3%PTSD symptoms predicted same-day (cross-sectional) & next-day (prospective) alcohol use (within-);Alcohol use predicted same-day (cross-sectional) & next-day (prospective) PTSD symptoms (within-);Those with higher (vs. lower) coping drinking motives & lower (vs. higher) enhancement motives had greater ↑ in alcohol consumption the same day they experienced a 1-unit increase in PTSD symptomsWilson et al (2017)USACorrelational86 civilians & veterans (44 M/42 F) with comorbid PTSD & alcohol dependence (AD) who indicated a desire to decrease alcohol use.Mean age = 44.7 EMA: Alcohol use (number of standard drinks prior day) EMA: Alcohol-related problems (1-item, 0–9 scale; “Yesterday, to what extent did you experience any negative consequences or problems related to your drinking?”)Mean PTSD symptoms (between-) & Deviation PTSD symptoms (within-) (Moderators) Hardware/software: IVR Frequency: 1/day for 4–16 days (BL period of larger study) Trigger: Participants told to make a daily call regarding the previous day Compliance: Sample provided data for at least 50% of days of 28-day monitoring periodAs within- and between- PTSD symptoms ↑, association between number of drinks consumed & alcohol-related problems ↓ Note: IVR = interactive voice response. PDA = personal digital assistant; OEF = Operation Enduring Freedom; OIF = Operation Iraqi Freedom.…”

“…While all the above studies examined baseline variables as moderator variables, Wilson et al (2017) examined time-varying PTSD symptoms as a moderator variable. Specifically, they were interested in examining the moderating effect of within-person (daily symptoms) and between-person (overall severity) PTSD symptoms on the association between alcohol use and same-day alcohol-related problems.…”

“…Specifically, they were interested in examining the moderating effect of within-person (daily symptoms) and between-person (overall severity) PTSD symptoms on the association between alcohol use and same-day alcohol-related problems. Alcohol-related problems were assessed using a single item in which participants reported on a 9-point Likert scale (0 = none at all to 8 = worse ever ) the extent to which they experienced any negative consequences or problems relating to their drinking (Wilson et al, 2017). First, they found that both overall PTSD severity (between-) and daily PTSD symptom severity (within-) predicted self-reported alcohol-related problems that same day (Wilson et al, 2017), thereby demonstrating the expected positive association between PTSD symptoms and an alcohol-related variable.…”

“…More relevant here, as PTSD symptoms (both between- and within- person) increased, the association between number of drinks consumed and alcohol-related problems changed. Specifically, on days on which PTSD symptom severity was greater than a subject-specific average, more alcohol-related problems were reported on non-drinking and on moderate drinking days (3 drinks consumed) (but not on heavier drinking days) (Wilson et al, 2017). Thus, PTSD severity moderated the relationship between alcohol use and alcohol-related problems.…”

“…Thus, PTSD severity moderated the relationship between alcohol use and alcohol-related problems. Wilson et al (2017) noted that individuals with high levels of PTSD severity may experience alcohol-related problems from even a small amount of alcohol, or that they engage in negative coping strategies that lead to negative outcomes regardless of the amount of alcohol consumed.…”