PTSD, alcohol dependence, and conduct problems: Distinct pathways via lability and disinhibition

Abstract

This study tested the role of affect lability and disinhibition in mediating associations between PTSD symptoms and two forms of alcohol-related problems, dependence syndrome symptoms (e.g., impaired control over consumption) and conduct problems (e.g., assault, risk behaviors). Genotype at the serotonin transporter linked polymorphic region (5-HTTLPR) was hypothesized to moderate associations between traumatic stress and PTSD symptoms. In addition, the study tested whether childhood traumatic stress moderated associations between combat trauma and PTSD symptoms. Participants were 270 OIF/OEF/OND veterans. The hypothesized model was largely supported. Participants with the low expression alleles of 5-HTTLPR (S or LG) exhibited stronger associations between childhood (but not combat) traumatic stress and PTSD symptoms. Affect lability mediated the associations between PTSD symptoms and alcohol dependence symptoms. Behavioral disinhibition mediated associations between PTSD symptoms and conduct related problems. Conditional indirect effects indicated stronger associations between childhood traumatic stress and lability, behavioral disinhibition, alcohol consumption, AUD symptoms, and associated conduct problems via PTSD symptoms among those with the low expression 5-HTTLPR alleles. However, interactions between combat trauma and either childhood trauma or genotype were not significant. The results support the hypothesis that affect lability and behavioral disinhibition are potential intermediate traits with distinct associations with AUD and associated externalizing problems.

PTSD symptoms and alcohol-related problems among veterans: Temporal associations and vulnerability.

“…In this regard, exacerbations in PTSS may result in dyscontrolled drinking characteristic of dependence syndrome and contribute to a wide variety of conduct related problems (e.g., interpersonal conflict) that can occur independent of drinking level. This perspective is consistent with between-subjects research indicating that associations between PTSD and alcohol-related problems are mediated by both affect and behavioral dysregulation (Miller, Vogt, Mozley, Kaloupek, & Keane, 2006; Read, Merrill, Griffin, Bachrach, & Khan, 2014; Simons et al, 2017). This suggests that the functional association extends beyond coping with negative affect and symptoms and that there are two distinct pathways linking PTSD and alcohol related problems.…”

“…In this regard, the autoregressive parameter may be conceptualized as the manifestation of the latent alcohol use disorder itself. Consistent with previous research and theory, we anticipated that affect lability effects would be more pronounced in the dependence syndrome relative to conduct problems model (McCarthy et al, 2010; Simons et al, 2017).…”

“…To date, the majority of daily process studies are framed around a self-medication model and do not examine associations between PTSD symptoms and alcohol-related problems. Alcohol use (e.g., number of drinks consumed) and alcohol-related problems (e.g., drinking more than intended, social or interpersonal problems that may be exacerbated by alcohol) may have distinct predictors (Glantz, Weinberg, Miner, & Colliver, 1999; Simons et al, 2017) and level of alcohol consumption does not sufficiently account for variation in associated alcohol-related problems (Sadava, 1985). However, studies that have assessed negative consequences at the daily level indicate that PTSD symptoms are associated with alcohol problems over and above daily drinking (Gaher et al, 2014; Hruska, Pacella, George, & Delahanty, 2017; Wilson et al, 2017).…”

Associations of serotonin transporter gene promoter polymorphisms and monoamine oxidase A gene polymorphisms with oppositional defiant disorder in a Chinese Han population

“…Thus, the S allele of 5-HTTLPR may increase the risk for ODD, whilst the L allele may be protective. These results are consistent with previous reports showing that the S allele was associated with violent suicide [ 30 ] and violence, ADHD [ 31 ], PTSD, alcohol dependence, and conduct problems [ 32 ], but not with personality traits [ 33 ]. However, a study showed that the L allele of 5-HTTLPR might increase the risk of attacking behaviors in the Alzheimer’s patients [ 34 ], which is contrary to our findings.…”

Insomnia severity as a mediator of the association between mental health symptoms and alcohol use in young adult veterans

“…Thus, it is possible that depression, PTSD, and insomnia operate through one another in such a way that independent effects are attenuated when all symptoms are included in the model. Alternatively, it is possible that rates of clinically significant PTSD were too low in this sample to establish direct associations between PTSD symptoms and alcohol-related outcomes, as a number of studies linking PTSD symptoms to alcohol outcomes included clinician-administered assessments of PTSD and/or larger proportions of participants who met criteria for PTSD (Fuehrlein et al, 2014; McDevitt-Murphy et al, 2015; Simons et al, 2017). …”