The Indirect Effect of Posttraumatic Stress Disorder Symptoms on Current Alcohol Use Through Negative Cognitions in Sexual Minority Men

Abstract

Self-medication theory posits that some trauma survivors use alcohol to cope with posttraumatic stress disorder (PTSD) symptoms, but the role of negative posttraumatic cognitions in this relationship is not well defined. We examined associations among PTSD symptoms, posttraumatic cognitions, and alcohol intoxication frequency in 290 men who have sex with men (MSM), who reported a history of childhood sexual abuse (CSA). Using a bootstrap approach, we examined the indirect effects of PTSD symptoms on alcohol intoxication frequency through posttraumatic cognitions regarding the self, world, and self-blame. In separate regression models, higher levels of PTSD symptoms and posttraumatic cognitions were each associated with more frequent intoxication, accounting for 2.6% and 5.2% of the variance above demographics, respectively. When examined simultaneously, posttraumatic cognitions remained significantly correlated with intoxication frequency whereas PTSD symptoms did not. Men reporting elevated posttraumatic cognitions faced increased odds for current alcohol dependence, odds ratio (OR) = 2.19, 95% CI [1.13, 4.22], compared with men reporting low posttraumatic cognitions, independent of current PTSD diagnosis. A higher level of PTSD symptom severity was indirectly associated with more frequent alcohol intoxication through cognitions about the self and world; the indirect to total effect ratios were 0.74 and 0.35, respectively. Negative posttraumatic cognitions pertaining to individuals' self-perceptions and appraisals of the world as dangerous may play a role in self-medication with alcohol among MSM with a history of CSA. Interventions targeting these cognitions may offer potential for reducing alcohol misuse in this population, with possible broader implications for HIV-infection risk.

The Indirect Relationship between Interpersonal Trauma History and Alcohol Use via Negative Cognitions in a Multisite Alcohol Treatment Sample

“…The current findings thus broadly support the cognitive model of PTSD (Ehlers & Clark, 2000) and the self-medication hypothesis (see McCauley et al, 2012;Vujanovic et al, 2016), in which alcohol or drugs may function as a tool to avoid trauma-related negative cognitions and associated arousal and distress. Moreover, the findings build on previous evidence suggesting that negative cognitions about the self and others/the world may play an important role in the development, maintenance, and remission of posttraumatic sequelae (Dekel et al, 2013;Scher et al, 2017;Zhou et al, 2015) including substance use (Allwood et al, 2014;Banerjee et al, 2018;Blevins et al, 2016;Jayawickreme et al, 2012;Thompson & Kingree, 2010).…”

The Posttraumatic Cognitions Inventory (PTCI): Psychometric evaluation in veteran men and women with trauma exposure.

“…There were small and significant correlations between scores on the PTCI-9 and two forms of behavioral dysregulation: disordered eating and alcohol use. Other studies have found a relationship between PTSD and disordered eating in veterans (Huston et al, 2019;Mitchell & Wolf, 2016) and a link between negative posttraumatic cognitions and alcohol use (Banerjee et al, 2018;Lyons et al, 2020). Disordered eating and alcohol use may serve as coping strategies for managing internal experiences associated with negative cognitions about the self, world, and self-blame (Engelberg et al, 2007;Khantzian, 1997).…”

Recension de la littérature sur la relation entre les cognitions post-traumatiques, le blâme de soi et les symptômes de trouble de stress post-traumatique après une agression sexuelle

“…Snipes et al (2017) ont montré que les croyances post-traumatiques sur la sexualité et le pouvoir médiaient partiellement la relation entre le viol et les symptômes du TSPT chez les hommes. De plus, deux études ont exploré le rôle médiateur des cognitions post-traumatiques sur la relation entre le niveau de consommation d'alcool et les symptômes du TSPT (Blayney et al, 2016 ;Banerjee et al, 2018). Seule l'étude de Banerjee et al (2018) a révélé que les cognitions post-traumatiques médiaient la relation entre les symptômes du TSPT et la fréquence d'intoxication alcoolique (ß = 0,11).…”