Conformity motives for alcohol use are associated with risky sexual behavior among alcohol-dependent patients in residential substance abuse treatment.

Alcohol misuse is associated with a variety of negative outcomes, including risky sexual behavior (RSB). In an attempt to better identify the subset of individuals at greatest risk for these negative outcomes, a growing body of research has begun to examine the role of alcohol use motives in risk for alcohol use-related negative outcomes. Although the majority of research in this area has focused on coping motives, conformity motives may be particularly relevant to outcomes such as RSB. Specifically, conformity motives may operate as a proxy risk factor for RSB, reflecting the tendency to engage in interpersonally-oriented risk behaviors in order to avoid rejection, interpersonal conflict, or social ostracism. Therefore, the current study examined the relation between conformity motives for alcohol use and RSB in a sample of 94 patients in a residential substance abuse treatment center. Results indicated that conformity motives were associated with RSB above and beyond other motives for alcohol use, as well as relevant covariates. Findings support the notion that conformity motives may operate as a proxy risk factor that could assist in identifying individuals at elevated risk for engaging in RSB.

Examining the effects of alexithymia on the relation between posttraumatic stress disorder and over-reporting.

OBJECTIVE: Empirical examinations of the relation between posttraumatic stress disorder (PTSD) and objective measures of symptom over-reporting may be useful for identification of mechanisms of this previously observed relation. The present study examined the moderating effect of alexithymia, defined as a deficit in the ability to identify and describe emotions, on the relation between PTSD and over-reporting. METHOD: Seventy-five veterans diagnosed with PTSD were recruited from an outpatient Veterans Affairs facility and the community. Participants were administered the Miller Forensic Assessment of Symptoms Test, along with the Toronto Alexithymia Scale and PTSD Checklist within a larger study of behavioral and physiological correlates of PTSD. RESULTS: Hierarchical linear regression analyses showed a significant moderating effect of alexithymia, such that the relation between PTSD symptom severity and over-reporting was only significant in the presence of elevated alexithymia. Evaluation of the subscales of the Toronto Alexithymia Scale showed that the effect was greatest for the Difficulty Describing Emotions subscale. CONCLUSIONS: Alexithymia should be considered as a potential mechanism contributing to the over-reporting phenomena observed in the assessment and treatment of PTSD, and warrants further study. Brief interventions to improve understanding and description of emotional experiences may help to improve accuracy of symptom report. (PsycINFO Database Record

The impact of intolerance of emotional distress and uncertainty on veterans with co-occurring PTSD and substance use disorders.

The risk of developing a substance use disorder (SUD) is significantly higher among veterans with posttraumatic stress disorder (PTSD). Veterans with this co-occurrence have poorer outcomes than singly diagnosed veterans, which may be related to two risk factors: intolerance uncertainty (IU) and low tolerance of emotional distress (TED). We hypothesized low TED and high IU would independently and interactively relate to heightened PTSD symptomatology and trauma-cue elicited SUD cravings. A sample of 70 veterans (M age=50; 95% men; 65% Black) with co-occurring PTSD-SUD was recruited. The Posttraumatic Stress Disorder Checklist (PCL), Craving Questionnaire, Distress Tolerance Scale, and Intolerance of Uncertainty Scale were administered. In general, low TED and high IU were significantly correlated with the PCL total and subscale scores. When examined within regression models, low TED was associated with elevated PCL scores and trauma-cue elicited SUD cravings; IU was not. However, there was a significant interaction between IU and TED; veterans with elevated IU and low TED had higher PCL Total, Hyperarousal, and Intrusions scores. This highlights the importance of assessing TED and IU among veterans with co-occurring PTSD-SUD, as these risk factors may not only be prognostic indicators of outcomes, but also treatment targets.

Suicide risk among male substance users in residential treatment: Evaluation of the depression-distress amplification model.

Suicide is a leading cause of death and is significantly elevated among those with substance use disorders (SUDs). However, specific mechanisms of suicide in this population have been relatively understudied. The depression-distress amplification model posits that one pathway to increased suicide risk is through the intensification of depressive symptoms by anxiety sensitivity cognitive concerns. However, this model has not been tested in populations with SUDs. The current study tested the depression-distress amplification model of suicide risk and examined the relation of anxiety sensitivity to suicide risk in a sample of men in residential SUD treatment. Consistent with prior work, anxiety sensitivity cognitive concerns were significantly associated with suicide risk. Moreover, and consistent with the depression-distress amplification model, anxiety sensitivity cognitive concerns related to elevated suicide risk among those with a current major depressive episode specifically, above and beyond insomnia (another risk factor for suicide) and relevant covariates. The results of this study corroborate the relevance of anxiety sensitivity cognitive concerns and the depression-distress amplification model to suicide risk in an at-risk clinical sample of SUD patients. Findings suggest the importance of assessing anxiety sensitivity cognitive concerns and targeting this vulnerability through brief interventions to reduce suicide risk.

Cannabis use disorder treatment barriers and facilitators among veterans with PTSD.

In light of recent data demonstrating large variability in the diagnosis of cannabis use disorders (CUDs) within the Veterans Affairs Health Care System (VA), it is important to elucidate VA-specific barriers and facilitators to CUD diagnosis and treatment engagement. This issue is particularly salient among veterans with posttraumatic stress disorder (PTSD), given that PTSD is the most common co-occurring psychiatric disorder among veterans with CUD and is associated with poorer treatment outcomes. The goal of the current study was to evaluate the potential role of system-, clinician-, and patient-level factors associated with both CUD diagnosis and treatment engagement. Key personnel were interviewed from PTSD programs with both low and high rates of CUD and substance use disorder (SUD) programs with both low and high rates of SUD treatment engagement. Common themes emerged across clinics that may represent barriers to CUD diagnosis and treatment engagement and included, for example, clinician's concerns about negative consequences associated with CUD diagnosis (e.g., service connection). Potential facilitators to CUD diagnosis and treatment also emerged and included the use of formal assessment approaches when evaluating veterans for SUDs. Together, findings suggest opportunities, such as CUD-specific education and training for clinicians, to improve VA care.

A multimodal examination of emotional responding to a trauma-relevant film among traumatic motor vehicle accident survivors.

The Facial Action Coding System (Ekman & Friesen) has shown promise as a behavioral measure of emotional experience. The current study examined the degree of (de)synchrony between self-reported and facial expressions of fear, disgust, and sadness in response to a traumatic event-relevant film among individuals who had experienced a traumatic motor vehicle accident. Given high rates of comorbidity between posttraumatic stress symptoms (PTSS) and depressive symptoms, the potential impacts of both PTSS and depressive symptoms on emotional responding were examined. Results demonstrated synchrony between self-reported and facial expressions of disgust and sadness; however, no association between measures of fear was observed. Furthermore, depressive symptoms were associated with greater fear responding and PTSS were associated only with self-reported fear. Together, results support the importance of examining discrete negative emotions, rather than broad valence categories, when examining fear-based responding in traumatic event-exposed populations. Additional research examining the psychometric properties of the Facial Action Coding System as a measure of discrete emotional experiences among traumatic event-exposed individuals is needed to advance multimodal assessment approaches that yield incremental information for understanding emotional responding in this population.

Examination of Increased Mental Contamination as a Potential Mechanism in the Association Between Disgust Sensitivity and Sexual Assault-Related Posttraumatic Stress.

Disgust sensitivity and feelings of mental contamination have both been independently linked to posttraumatic stress symptoms following sexual assault. Theory suggests that feelings of mental contamination may arise, at least in part, as a result of interpreting feelings of disgust experienced in relation to sexual assault to mean that one has been contaminated or tainted by the experience. This study involved an initial test of this model by examining relations among disgust sensitivity, feelings of mental contamination, and posttraumatic stress symptom severity among a sample of female sexual assault victims. Results suggested that one mechanism through which disgust sensitivity might relate to posttraumatic stress symptom severity is through its association with increased feelings of mental contamination. These findings highlight the importance of assessing feelings of disgust and mental contamination among victims of sexual assault, and the need for future research to elucidate the nature of these relations with posttraumatic stress.

The association between distress tolerance and cannabis use-related problems: the mediating and moderating roles of coping motives and gender.

Recent research has linked distress intolerance to a greater incidence of cannabis use-related problems. Additionally, individuals reporting coping motives for cannabis use might be particularly vulnerable to use-related problems, and tendencies to use coping motives may be influenced by gender. The current study sought to extend the literature by examining the role of distress tolerance on cannabis use-related problems and the potential influences of coping motives for use and gender. Participants were 118 cannabis-using adults (Mage = 29.84). As hypothesized, highly distress intolerant individuals reported more cannabis-use related problems. Further, coping motives mediated the relationship between distress tolerance and cannabis use-related problems, and this effect was more powerful for women than for men. The current study adds to our understanding of the impact of distress tolerance and problematic patterns of cannabis use.

Marijuana use among traumatic event-exposed adolescents: posttraumatic stress symptom frequency predicts coping motivations for use.

Contemporary comorbidity theory postulates that people suffering from posttraumatic stress symptoms may use substances to cope with negative affect generally and posttraumatic stress symptoms specifically. The present study involves the examination of the unique relation between past two-week posttraumatic stress symptom frequency and motives for marijuana use after accounting for general levels of negative affectivity as well as variability associated with gender. Participants were 61 marijuana-using adolescents (M(age)=15.81) who reported experiencing lifetime exposure to at least one traumatic event. Consistent with predictions, past two-week posttraumatic stress symptoms significantly predicted coping motives for marijuana use and were not associated with social, enhancement, or conformity motives for use. These findings are consistent with theoretical work suggesting people suffering from posttraumatic stress use substances to regulate symptoms.

The relationship between alexithymia and alcohol-related risk perceptions: The moderating effect of general trauma in a college population.

The current study explored the moderating influence of general trauma exposure (GTE) on the relationship between alexithymia and alcohol-related risk perceptions. Undergraduate college students (N=237) completed a battery of self-report measures. After controlling for relevant variables, results indicated that the interaction between alexithymia and GTE significantly predicted alcohol-related risk perception. Simple effects revealed that for students who reported higher rates of GTE, alexithymia positively predicted risk perception; this relationship did not exist among students with lower GTE. Exploratory analyses indicated that despite increased risk perception, individuals with GTE also reported greater alcohol-related problems compared to students with low trauma exposure. The current study highlights the importance of examining risk perception abilities in individuals with alexithymia and GTE as well as the impact of risk perception on alcohol-related risk behaviors.