Resilience in alcohol use disorder: associations with negative and positive emotionality, quality of life, and disorder severity

ABSTRACT

In previous work looking at individuals exposed to childhood trauma, we have found that decreased neuroticism, impulsivity, and trait anxiety, and increased conscientiousness are associated with a decreased risk of alcohol use disorder (AUD), suggesting these characteristics contribute to a relative resilience to alcohol misuse. In the current study we confirm and expand on these findings using the Connor-Davidson Resilience Scale (CD-RISC), which assesses resilience based on individual characteristics and coping mechanisms as well as social relationships. We analyzed CD-RISC data from two NIAAA protocols 1) the Natural History Protocol (NHP) (n = 245;156 with AUD, 89 without AUD);2) the COVID-19 Pandemic Impact on Alcohol Protocol (C19PIA) (n = 280;77 with AUD, 203 without AUD). Participants ranged from non-drinking healthy volunteers to heavy drinkers. In addition to the CD-RISC, assessments included the Structured Clinical Interview for DSM-5 disorders, and questionnaires related to problematic alcohol use, positive and negative affect, personality, perceived stress, and quality of life (i.e., physical health, psychological health, social relationships, and environment). Data analysis was conducted using general linear models, and analyses were run separately for the two independent samples due to differences in data collection methodology. For the C19PIA protocol sample, analyses were conducted on measures collected both pre-pandemic and during the pandemic. In both the NHP and C19PIA samples, CD-RISC score was negatively associated with neuroticism, negative affect, and perceived stress, and positively associated with extraversion, conscientiousness, positive affect, and all four quality of life measures. In the C19PIA sample, these results were consistent for analyses of both pre-pandemic and pandemic-associated measures. CD-RISC score was lower in individuals with AUD compared to those without AUD. In the NHP sample, which was enriched for individuals with AUD, greater resilience was associated with decreased AUD severity, and decreased anxiety and depression symptoms, among those diagnosed with AUD. A similar association between resilience and decreased AUD severity was observed in the C19PIA sample before the pandemic. Resilience was also associated with a reduction in impaired control over drinking in the C19PIA sample, both before and during the pandemic. The current findings highlight resilience as a key construct associated with multiple factors at the individual, social, and environmental levels. Of note, the same resilience-associated factors were observed both before and during the COVID 19 pandemic, with the latter representing a major stressor for many individuals. The finding that greater resilience is associated with decreased disorder severity and reduced depression and anxiety symptoms among those with AUD highlights the potential of resilience-oriented approaches to treatment. These approaches, often promoted for trauma-exposed individuals, could also prove beneficial for alcohol use disorder.Copyright © 2023