Posttraumatic stress disorder, drinking to cope, and harmful alcohol use: A multivariate meta-analysis of the self-medication hypothesis.

Luciano, Matthew T.; Acuff, Samuel F.; Olin, Cecilia C.; Lewin, Rivian K; Strickland, Justin C.; McDevitt-Murphy, Meghan E.; Murphy, James G.

doi:10.1037/abn0000764

Cited by 20 publications

(12 citation statements)

References 54 publications

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“…Taken together, these studies provide support for the self-medication model, highlighting potential mechanisms such as coping-related drinking, emotion regulation, and negative affect (Luciano et al, 2022;Weiss et al, 2022).…”

Section: Theoretical Models Of Ptsd+audmentioning

confidence: 54%

“…In microlongitudinal studies, such as studies using experience sampling or daily diary designs, which collect a large amount of data typically over moments, days, or weeks, increases in PTSD symptoms precede alcohol use (Sullivan et al, 2020;Dworkin et al, 2021). Taken together, these studies provide support for the self-medication model, highlighting potential mechanisms such as coping-related drinking, emotion regulation, and negative affect (Luciano et al, 2022;Weiss et al, 2022).…”

Section: Theoretical Models Of Ptsd þ Audmentioning

confidence: 85%

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Comorbid posttraumatic stress disorder and alcohol use disorder in low- and middle-income countries: A narrative review

Kaysen

Stolk-Cooke

Kaminer

et al. 2022

Camb. prisms Glob. ment. health

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Much of the research on posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) has been conducted in high income countries. However, PTSD and AUD commonly co-occur (PTSD+AUD), are both associated with high global burden of disease, and disproportionately impact those in low-and middle-income countries (LMICs). This narrative review attempts to synthesize the research on prevalence, impact, etiological models, and treatment of PTSD+AUD drawing from research conducted in high income countries and discussing the research that has been conducted to date in LMICs. The review also discusses overall limitations in the field, including a lack of research on PTSD+AUD outside of high-income countries (HICs), issues with measurement of key constructs, and limitations in sampling strategies across comorbidity studies. Future directions are discussed, including a need for rigorous research studies conducted in LMICs that focus on both etiological mechanisms and on treatment approaches.

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Section: Theoretical Models Of Ptsd+audmentioning

confidence: 54%

Section: Theoretical Models Of Ptsd þ Audmentioning

confidence: 85%

Comorbid posttraumatic stress disorder and alcohol use disorder in low- and middle-income countries: A narrative review

Kaysen

Stolk-Cooke

Kaminer

et al. 2022

Camb. prisms Glob. ment. health

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“…Here, we sought to replicate those findings in a larger sample and to compare two mediation models that differed in the hypothesized direction of effect by using information on ages of onset of the disorders to establish temporality. The forward model, consistent with the self-medication hypothesis 15,16,17 , posits that M/ADs mediate the relationship between ACEs and SD diagnoses. In the reverse model, consistent with M/ADs being substance induced 18 , SD mediates the relationship between ACEs and M/ADs.…”

Section: Introductionmentioning

confidence: 76%

“…The self-medication hypothesis 15,16,17 , first posited in 1997, states that psychopathology is accompanied by aversive internal states that motivate individuals to use psychoactive substances to relieve them 57 . Research has shown that ACEs negatively impact emotion regulation skills 58,59 , which help individuals modulate distressing emotions in adaptive ways.…”

Section: Discussionmentioning

confidence: 99%

Adverse Childhood Events, Mood and Anxiety Disorders, and Substance Dependence: Gene X Environment Effects and Moderated Mediation

Kranzler,

Davis,

Feinn

et al. 2023

Preprint

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Background: Adverse childhood events (ACEs) contribute to the development of mood and anxiety disorders and substance dependence. However, the extent to which these effects are direct or indirect and whether genetic risk moderates them is unclear. Methods: We examined associations among ACEs, mood/anxiety disorders, and substance dependence in 12,668 individuals (44.9% female, 42.5% African American/Black, 42.1% European American/White). We generated latent variables for each phenotype and modeled direct and indirect effects of ACEs on substance dependence, mediated by mood/anxiety disorders (forward or self-medication model) and of ACEs on mood/anxiety disorders, mediated by substance dependence (reverse or substance-induced model). In a sub-sample, we also generated polygenic scores for substance dependence and mood/anxiety disorder factors, which we tested as moderators in the mediation models. Results: Although there were significant indirect effects in both directions, mediation by mood/anxiety disorders (forward model) was greater than by substance dependence (reverse model). Greater genetic risk for substance dependence was associated with a weaker direct effect of ACEs on substance dependence in both the African- and European-ancestry groups (i.e., gene-environment interaction) and a weaker indirect effect in European-ancestry individuals (i.e., moderated mediation). Conclusion: We found greater evidence that substance dependence results from self-medication of mood/anxiety disorders than that mood/anxiety disorders are substance induced. Among individuals at higher genetic risk for substance dependence who are more likely to develop a dependence diagnosis, ACEs exert less of an effect in promoting that outcome. Following exposure to ACEs, multiple pathways lead to mood/anxiety disorders and substance dependence. Specification of these pathways could inform individually targeted prevention and treatment approaches.

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“…Research exploring the PTSD–alcohol use co-occurrence highlights the bidirectional and transactional associations between PTSD symptomatology and the maintenance and/or exacerbation of alcohol use over time through the use of alcohol use to cope with negative emotional states (Brady et al, 2004; Hawn, Cusack, et al, 2020). For instance, adults with PTSD symptoms may use alcohol to cope (i.e., self-medicate; Khantzian, 1985) with the symptoms of PTSD (Haller & Chassin, 2014; Luciano et al, 2022). Alcohol craving has also been found to increase during periods of time when PTSD symptoms are elevated (Possemato et al, 2015; Simons et al, 2018; Simpson et al, 2014).…”

mentioning

confidence: 99%

The development and initial validation of the Trauma-Related Alcohol Use Coping Measure (TRAC).

Lebeaut,

Zegel,

Steinberg

et al. 2024

Psychology of Addictive Behaviors

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Objective: Posttraumatic stress disorder (PTSD) symptoms and alcohol use commonly co-occur and present a prevalent clinical comorbidity. The self-medication/coping model has been applied most consistently to understand the PTSD-alcohol use association. However, there is a relative paucity of self-report measures designed to assess motivations for alcohol use, specifically for coping with PTSD symptoms. The goals of the present study were to develop and validate a measure that assesses the use of alcohol to cope with specific facets of PTSD symptomatology across two independent samples. Method: Two samples were evaluated: a universitybased sample (N = 617; 77.0% women; M age = 22.3; SD = 5.20) composed of racially diverse trauma-exposed students and a nationally representative sample (N = 510; 52.5% women; M age = 39.5; SD = 10.9) of traumaexposed adults who endorsed PTSD symptoms and past-year hazardous drinking. Both samples completed identical online questionnaire batteries. A Trauma-Related Alcohol Use Coping (TRAC) measure was developed and validated across both samples. Results: Confirmatory factor analysis was used to support the latent, hierarchical structure of the TRAC measure (total score; coping with intrusion, avoidance, negative alterations in cognitions and mood, and arousal/reactivity symptoms) and supported an 18-item version of the TRAC measure (university-based sample [N = 617]: RMSEA = 0.047, 90% CI [.04, .05]; SRMR = 0.043; CFI = 0.95; TLI = 0.95; nationally representative sample [N = 510]: RMSEA = 0.045, 90% CI [.04, .05]; SRMR = 0.021; CFI = 0.98; TLI = 0.97). The TRAC measure demonstrated excellent internal consistency, convergent, and discriminant validity with well-established measures of mental health, known-groups validity, and incremental validity relative to non-PTSD coping-motivated drinking. Conclusions: Overall, the TRAC measure can be used to assess the extent to which alcohol use is related to coping with PTSD symptoms. Public Health Significance StatementThis study highlights the development of a measure that assesses the use of alcohol to cope with specific facets of posttraumatic stress disorder symptomatology. The measure evinced strong psychometric properties, including internal consistency, convergent and discriminant validity, known-groups validity, and incremental validity, and provided both research and clinical utility.

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Posttraumatic stress disorder, drinking to cope, and harmful alcohol use: A multivariate meta-analysis of the self-medication hypothesis.

Cited by 20 publications

References 54 publications

Comorbid posttraumatic stress disorder and alcohol use disorder in low- and middle-income countries: A narrative review

Comorbid posttraumatic stress disorder and alcohol use disorder in low- and middle-income countries: A narrative review

Adverse Childhood Events, Mood and Anxiety Disorders, and Substance Dependence: Gene X Environment Effects and Moderated Mediation

The development and initial validation of the Trauma-Related Alcohol Use Coping Measure (TRAC).

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