Ecological momentary assessment of PTSD symptoms and alcohol use in combat veterans.

Abstract

Despite high rates of comorbid hazardous alcohol use and posttraumatic stress disorder (PTSD), the nature of the functional relationship between these problems is not fully understood. Insufficient evidence exists to fully support models commonly used to explain the relationship between hazardous alcohol use and PTSD including the self-medication hypothesis and the mutual maintenance model. Ecological momentary assessment (EMA) can monitor within-day fluctuations of symptoms and drinking to provide novel information regarding potential functional relationships and symptom interactions. This study aimed to model the daily course of alcohol use and PTSD symptoms and to test theory-based moderators, including avoidance coping and self-efficacy to resist drinking. A total of 143 recent combat veterans with PTSD symptoms and hazardous drinking completed brief assessments of alcohol use, PTSD symptoms, mood, coping, and self-efficacy 4 times daily for 28 days. Our results support the finding that increases in PTSD are associated with more drinking within the same 3-hr time block, but not more drinking within the following time block. Support for moderators was found: Avoidance coping strengthened the relationship between PTSD and later drinking, while self-efficacy to resist drinking weakened the relationship between PTSD and later drinking. An exploratory analysis revealed support for self-medication occurring in certain times of the day: Increased PTSD severity in the evening predicted more drinking overnight. Overall, our results provide mixed support for the self-medication hypothesis. Also, interventions that seek to reduce avoidance coping and increase patient self-efficacy may help veterans with PTSD decrease drinking.

e-PTSD: an overview on how new technologies can improve prediction and assessment of Posttraumatic Stress Disorder (PTSD)

“…Possemato et al (2015) assessed the relationship between alcohol use and the intensity of PTSD by EMA. The authors reported an accentuation of alcohol use as a function of PTSD severity, particularly overnight.…”

Self-medication with alcohol or drugs for mood and anxiety disorders: A narrative review of the epidemiological literature

“…One clinical method that is particularly powerful for assessing the SMH is the ecological momentary analysis method, which uses real‐time data to uncover the complex interplay between MD/AD symptoms and substance use. Previous work using this method has shown support for the SMH (Gorka, Hedeker, Piasecki, & Mermelstein, 2017; Possemato et al., 2015). Epidemiological studies using general population samples can overcome some of the limitations of treatment‐seeking samples, such as treatment‐seeking bias, by being representative of the general population (Alegria et al., 2010; Crum, La Flair et al., 2013; Crum, Mojtabai et.al., 2013; Farmer et al., 2017; Feingold, Weiser, Rehm, & Lev‐ran, 2015, 2016; Fergusson, Boden, & Horwood, 2009; Kessler et al., 1997; Kuo, Gardner, Kendler, & Prescott, 2006; Lazareck et al., 2012; Liang, Chikritzhs, & Lenton, 2011; Martins et al., 2012; Martins, Keyes, Storr, Zhu, & Chilcoat, 2009; Menary, Kushner, Maurer, & Thuras, 2011; Robinson, Sareen, Cox, & Bolton, 2011; Sareen et al., 2001; Swendsen et al., 1998; Wolitzky‐Taylor, Bobova, Zinbarg, Mineka, & Craske, 2012).…”

Web-Delivered CBT Reduces Heavy Drinking in OEF-OIF Veterans in Primary Care With Symptomatic Substance Use and PTSD

“…A detailed description of our iterative development process involving both veteran and behavioral health clinician input has been reported (Possemato et al, 2015). Due to name overlap with another web-based program for veterans, we have changed the name of the program from “Coming Home and Moving Forward” to “Thinking Forward”.…”