Coping Drinking Research Articles

Episode-specific drinking-to-cope motivation and next-day stress-reactivity

Background: Research consistently shows drinking-to-cope (DTC) motivation is uniquely associated with drinking-related problems. We furthered this line of research by examining whether DTC motivation is predictive of processes indicative of poor emotion regulation. Specifically, we tested whether nighttime levels of episode-specific DTC motivation, controlling for drinking level, were associated with intensified affective reactions to stress the following day (i.e. stress-reactivity). Design and Methods: We used a micro-longitudinal design to test this hypothesis in two college student samples from demographically distinct institutions: a large, rural state university (N = 1421; 54% female) and an urban historically Black college/university (N = 452; 59% female). Results: In both samples the within-person association between daily stress and negative affect on days following drinking episodes was stronger in the positive direction when previous night's drinking was characterized by relatively higher levels of DTC motivation. We also found evidence among students at the state university that average levels of DTC motivation moderated the daily stress-negative affect association. Conclusions: Findings are consistent with the notion that DTC motivation confers a unique vulnerability that affects processes associated with emotion regulation.

Coping Motives Moderate Efficacy of Personalized Normative Feedback Among Heavy Drinking U.S. College Students.

Personalized normative feedback (PNF) interventions have received empirical support, are presumed to work by reducing normative misperceptions, and have been found to be particularly efficacious for those who drink for social reasons. However, PNF interventions also offer direct comparisons between one's own drinking and normative drinking, which may be especially important for coping drinkers. The present research evaluated whether reduced perceived norms and drinking at follow-ups varied as a function of coping motives. Aims were examined as a secondary analysis of a PNF intervention study among 252 U.S. college students. Following baseline assessment, participants were randomly assigned to receive PNF or assessment only. Follow-up assessments occurred 3 and 6 months after baseline. Findings indicated that the PNF intervention was more effective at both follow-ups in reducing drinking, but not alcohol use problems, for participants scoring higher in coping motives. Furthermore, coping motives were the only drinking motive that uniquely moderated PNF efficacy. Analyses indicated that intervention effects on drinking varied as a function of coping drinking motives; however, intervention effects on norms did not vary by coping motives. Finally, coping motives were found to moderate associations between perceived norms and drinking. These results suggest that coping motives may be useful for identifying young adults-and presumably others-who can most benefit from PNF approaches. Furthermore, PNF may influence future drinking behavior through mechanisms other than changes in perceived norms. Future investigations could examine other pathways through which PNF may reduce drinking.

Drinking to cope with negative emotions moderates alcohol use disorder treatment response in patients with co-occurring anxiety disorder

BackgroundEpidemiological studies and theory implicate drinking to cope (DTC) with anxiety as a potent moderator of the association between anxiety disorder (AnxD) and problematic alcohol use. However, the relevance of DTC to the treatment of alcohol use disorder (AUD) in those with a co-occurring AnxD has not been well studied. To address this, we examined whether DTC moderates the impact of two therapies: (1) a cognitive behavioral therapy (CBT) designed to reduce DTC and anxiety symptoms; (2) a progressive muscle relaxation training (PMRT) program designed to reduce anxiety symptoms only. MethodsPatients undergoing a standard AUD residential treatment with a co-occurring AnxD (N=218) were randomly assigned to also receive either the CBT or PMRT. DTC in the 30 days prior to treatment was measured using the Unpleasant Emotions subscale of the Inventory of Drinking Situations. ResultsConfirming the predicted moderator model, the results indicated a significant interaction between treatment group and level of pre-treatment DTC behavior. Probing this interaction revealed that for those reporting more pre-treatment DTC behavior, 4-month alcohol outcomes were superior in the CBT group relative to the PMRT group. For those reporting less pre-treatment DTC behavior, however, 4-month alcohol outcomes were similar and relatively good in both treatment groups. ConclusionsThese findings establish a meaningful clinical distinction among those with co-occurring AUD-AnxD based on the degree to which the symptoms of the two disorders are functionally linked through DTC. Those whose co-occurring AUD-AnxD is more versus less strongly linked via DTC are especially likely to benefit from standard AUD treatment that is augmented by a brief CBT designed to disrupt this functional link.

Drinking to Cope Motivation as a Prospective Predictor of Negative Affect.

Consistent with research indicating that drinking to cope (DTC) motivation might exacerbate negative affective states within or immediately proximal to discrete drinking episodes, we examined whether yearly deviations in more global levels of DTC motivation prospectively predicted depressive and anxious affect over several weeks. College students (N = 521, 52% women) completed baseline measures of drinking motives, recent depression and anxiety symptoms, recent alcohol use, and alcohol use disorder symptoms on a secure website. Approximately 2 weeks after completing this survey, participants completed the 30-day daily diary portion of the study in which they reported on their current-day affective states. This yearly assessment burst in which participants completed a baseline survey and a daily diary assessment was repeated for 3 additional years. We found that changes in DTC motivation were positively associated with changes in depressive and anxious affect in the subsequent month, after we controlled for changes in concurrent anxiety and depressive symptoms, drinking level, enhancement drinking motivation, and alcohol use disorder symptoms. Our findings are consistent with the notion that DTC motivation confers a unique vulnerability for emotion dysregulation, and that drinking for such reasons possibly prolongs or exacerbates negative affective states.

Alcohol Use Disorders: Translational Utility of DSM-IV Liabilities to the DSM-5 System.

Young adults have some of the highest rates of problem drinking and alcohol use disorders (AUDs) relative to any other age. However, recent evidence suggests that the DSM-IV hierarchical classification system of AUDs does not validly represent symptoms in the population; instead, it evinces a unitary, dimensional classification scheme. The DSM-5 has been altered to fit this changing, evidence-based conceptualization. Nevertheless, little is understood about the degree to which known risk factors for DSM-IV AUD diagnoses will transfer to the new DSM-5 guidelines in this group of high-risk drinkers. The current study built a coherent model of liabilities for DSM-IV AUDs in young adults and tested for transferability to DSM-5. N = 496 college students (51.10% male) were assessed on a variety of factors related to AUD risk, including demographics, substance use (past 90-days), and drinking motives. Liability models were created using all variables in Structural Equation Modeling to test direct and indirect effects on DSM diagnostic status. The best model under the DSM-IV was chosen based on fit and parsimony. This model was then applied to the DSM-5 system to test for transferability. The best the fitting model for DSM-IV included direct influences of drug use, quantity-frequency of alcohol consumption, and social and coping drinking motives. Improved model fit was found when the DSM-5 system was the outcome. Knowledge of risk factors for AUDs appear to transfer well to the new diagnostic system.

Episode-specific drinking-to-cope motivation, daily mood, and fatigue-related symptoms among college students.

The goal of the present study was to examine whether within-person, episode-specific changes in drinking-to-cope (DTC) motivation from the previous evening were associated with concurrent daily mood and fatigue-related symptoms among college student drinkers (N = 1,421; 54% female). We conducted an Internet-based daily diary study in which students reported over 30 days on their previous night's drinking level and motivation and their current mood (i.e., sadness, anxiety, anger/hostility, and positive mood) and fatigue-related symptoms. Hypotheses were tested using hierarchical linear models in which the current day's outcome was predicted by last night's levels of DTC motivation and drinking, controlling for drinking to enhance motivation, sex, current day's physical symptoms and drinking, and yesterday's level of the outcome. Subsequent models also predicted outcomes 2 days following the drinking event. Relative increases in previous night's DTC motivation were associated with higher levels of current day negative mood and fatigue-related symptoms and lower levels of positive mood. Also, the association between episode-specific DTC motivation and negative mood was stronger in the positive direction when individuals reported higher levels of nonsocial drinking from the previous night. Last, episode-specific DTC showed similar associations with sadness and anger/hostility 2 days after the drinking event. The results are generally consistent with the posited attention allocation and ego-depletion mechanisms. Findings suggest that the deleterious effects of repeated episodes of DTC, over time, could help to explain the increased likelihood of alcohol-related problems seen in prior studies.

Drinking-to-cope motivation and negative mood-drinking contingencies in a daily diary study of college students.

This study examined whether global drinking-to-cope (DTC) motivation moderates negative mood-drinking contingencies and negative mood-motivation contingencies at the daily level of analysis. Data came from a daily diary study of college student drinking (N = 1,636; 53% female; Mage = 19.2 years). Fixed-interval models tested whether global DTC motivation moderated relations between daily negative mood and that evening's drinking and episodic DTC. Time-to-drink models examined whether global DTC motivation moderated the effects of weekly negative mood on the immediacy of drinking and DTC in the weekly cycle. More evening drinking occurred on days characterized by relatively higher anxiety or anger, and students were more likely to report DTC on days when they experienced greater sadness. However, only the daily Anxiety × Global DTC Motivation interaction for number of drinks consumed was consistent with hypotheses. Moreover, students reported drinking, heavy drinking, and DTC earlier in weeks characterized by relatively higher anxiety or anger, but no hypothesized interactions with global DTC motivation were found. RESULTS indicate that negative mood is associated with increased levels of drinking and drinking for coping reasons among college students but that the strength of these relations does not differ by global levels of DTC motivation. These findings raise the possibility that global DTC measures are insufficient for examining within-person DTC processes. Further implications of these results are discussed, including future directions that may determine the circumstances under which, and for whom, DTC occurs.

Mechanisms underlying alcohol-approach action tendencies: the role of emotional primes and drinking motives.

The tendency to approach alcohol-related stimuli is known as the alcohol-approach bias and has been related to heavy alcohol use. It is currently unknown whether the alcohol-approach bias is more pronounced after emotional priming. The main aim of this study was to investigate whether positive and negative emotional primes would modulate the alcohol-approach bias. For this purpose, a new contextual emotional prime-approach avoidance task was developed, containing both negative and positive emotional primes. Explicit coping drinking motives were expected to be related to an increased alcohol-approach bias after negative primes. Results of 65 heavy and 50 occasional drinkers showed that the alcohol-approach bias was increased in both groups during negative emotional priming. This appeared to be due to slower alcohol avoidance rather than faster alcohol approach. This change in alcohol-approach bias was positively related to explicit enhancement drinking motives and negatively related to alcohol use-related problems. A stronger alcohol-approach bias in heavy compared to occasional drinkers could not be replicated here, and coping drinking motives were not related to the alcohol-approach bias in any of the emotional contexts. The current findings suggest that both occasional and heavy drinkers have a selective difficulty to avoid alcohol-related cues in a negative emotional context. Negative reinforcement may therefore be involved in different types of drinking patterns. The influence of emotional primes on alcohol-related action tendencies may become smaller when alcohol use becomes more problematic, which is in line with habit accounts of addiction.

A longitudinal study of the effects of coping motives, negative affect and drinking level on drinking problems among college students

We examined among college students the interactive effects of drinking to cope (DTC) motivation, anxiety and depression symptoms, and drinking level in predicting drinking-related problems (DRPs). Using an Internet-based survey, participants (N = 844, 53% women) first reported on their drinking motives and monthly for up to three months, they reported on their drinking level, anxiety, depression, and DRPs. We found a three-way interaction between DTC motivation and average levels of drinking and anxiety (but not depression) in predicting DRPs. Specifically, among individuals with stronger DTC motives, higher mean levels of anxiety were associated with a stronger positive association between mean drinking levels and DRPs. We did not find three-way interactions in the models examining monthly changes in anxiety, depression, and drinking in predicting monthly DRPs. However, individuals high in DTC motivation showed a stronger positive association between changes in drinking level and DRPs. The results are discussed in terms of mechanisms related to attention-allocation and self-control resource depletion.

All it takes is one: drinking games, prepartying, and negative drinking consequences among high school students

Prepartying (i.e. drinking before a social event/gathering) and participation in drinking games are two high-risk drinking behaviors practiced by adolescents. Engaging in both these drinking behaviors may contribute to a multiple risk paradigm, wherein the risk associated with one’s general drinking is combined with the additional risk of rapidly ingesting alcohol as a result of one or both these activities. The present study examines this paradigm among high school students who reported alcohol use (N = 240). Controlling for age and typical alcohol consumption, results indicated that participation in prepartying or drinking games was associated with more negative alcohol-related outcomes than non-participation. However, participation in both risky behaviors, as opposed to one, did not give rise to negative additive effects. Thus, students who participate in just one of these activities warrant the same attention from health professionals and school personnel as those who participate in both. Importantly, results also showed that students who reported drinking games participation and prepartying endorsed social and coping drinking motives just as frequently as students who only reported drinking games participation. However, students who engaged in multiple high-risk drinking behaviors were more inclined to drink to enhance the intensity of the “high” associated with alcohol use.

The Relationship Between Parent and Student Religious Coping and College Alcohol Use

The present study examined social support and alcohol norms as mediators of the relationship between religious coping and college drinking (e.g., frequency and heavy drinking). The sample consisted of college students (n = 129) and their parents (n = 113). Religious coping (parent and student) was associated with less frequent alcohol use and less heavy drinking. Using a path model to test direct and indirect effects, the mediators were entered simultaneously and allowed to correlate with each other. Alcohol norms mediated the relationship between religious coping and drinking outcomes. Social support was not a significant mediator. Broader protective implications of religious coping are discussed.

Commentary on Littlefield et al. (2013): Enhancement and coping drinkers—non‐existent or difficult to find?

Commentary on Littlefield <i>et al</i>. (2013): Enhancement and coping drinkers—non‐existent or difficult to find?

Drinking context and problematic alcohol consumption in young Swedish women

Previous research has indicated that a variety of contextual factors are involved in the development of drinking behavior. An integrated perspective can extend our understanding of the context and circumstances in which individuals drink. In this study, a person-oriented approach, cluster analysis, was used to identify drinking context clusters in a population of 20- and 25-year-old Swedish women. A further aim was to analyze how these clusters were associated with problematic alcohol consumption (high episodic drinking (HED) and alcohol use disorder (AUD)). A total of 760 respondents were interviewed, some in 1996 and some in 2001. Self-reported effects of drinking and situational factors associated with drinking alcohol were used in the cluster analysis procedure. Logistic regression models were used to analyze the associations with problematic alcohol consumption. The results revealed four distinct clusters of drinking patterns: coping drinkers, social drinkers, controlled drinkers, and moderate drinkers. Differences between clusters concerning problematic alcohol consumption were found. HED was significantly more common among the social drinkers and alcohol use disorder was more prevalent among the coping drinkers. Age differences and to a lesser extent secular trends in drinking pattern could be observed. The findings suggest that information on drinking context can help to explain differences in patterns of risky drinking and AUD. This highlights the importance of identifying groups of individuals with potentially harmful drinking patterns, which could be the target of specific preventive actions.

Motivational typologies of drinkers: do enhancement and coping drinkers form two distinct groups?

This study used a person-centered approach to test whether drinking motive typologies could be identified. Longitudinal study of college students within the intensive multivariate prospective alcohol college-transitions (IMPACTS) data set. University campus in the United States. University students (baseline n reporting alcohol motives = 2158; baseline age = 18.60 years old). The drinking motives questionnaire-revised (DMQ-R). Using Steinley & Brusco's cluster analysis approach [based on the theoretical ratio expected between the within sum of squares and the total sum of squares when the data are divided into two clusters when no cluster structure is present; the cut-off for the ratio is 0.25 for uniform (multivariate uniform) distributions and 0.36 for normal (multivariate normal) distributions], we examined whether there was evidence for distinct clusters of individuals that differed on their overall level of motives to drink. We tested the fit of a one-group (cluster) solution compared to multi-cluster solutions. Both cross-sectionally and prospectively, the data could not be partitioned into two or more clusters [regardless of whether the cut-off assuming a multivariate uniform distribution (i.e. 0.25) or the more liberal multivariate normal distribution (i.e., 0.36) was used]. These findings showed that enhancement and coping drinkers do not form two distinct groups but, rather, these motives exist on a continuum such that individuals who are high in one internal motive tend to be high in the other motive. Coping and enhancement drinkers do not form two distinct groups. Variable-centered approaches to drinking motives may be a better alternative to classifying all drinkers as either enhancement or coping drinkers for both clinical and research endeavors.

Beyond self-reports: Drinking motives predict grams of consumed alcohol in wine-tasting sessions.

The link between drinking motives and alcohol-related outcomes has been investigated extensively, yet almost exclusively using retrospective self-reports that are subject to recall bias. This study overcomes this limitation using an experimental design to test whether the 4 drinking-motive dimensions (social, enhancement, coping and conformity, as measured in the baseline questionnaire) predict the quantity of alcohol actually ingested during 2 wine-tasting sessions conducted approximately 3 and 7 weeks after the baseline motive assessment. Regression modeling was based on an analog measurement of grams of pure alcohol among 123 young adults. Self-reported data at baseline concurred with the data collected during the experimental sessions, that is, alcohol consumption was high for males and enhancement drinkers and low for conformity drinkers. Coping drinkers significantly increased their consumption between the first and second sessions, while social drinkers tended to decrease theirs. Yet when separately considering data recorded during the first session, none of the drinking motives predicted the amounts of alcohol actually consumed. To conclude, this study demonstrates that motives predict actual alcohol consumption, which is consistent with evidence-based self-reports. Particularly, enhancement and coping drinkers seem to take advantage of the drinking situation probably because they usually appreciate the psychoactive properties of alcohol, either to maximize pleasurable sensations or to alleviate negative ones. However, if the setting is unusual (first tasting session), situational characteristics may "overrule" the effect of personal motives.

Shared genetic contributions to early-onset drinking and drinking to cope motives

IntroductionRecent evidence from empirical studies indicates that individuals who begin drinking at an early age may be more likely to use alcohol to cope with negative mood states and stress; however, the mechanisms underlying this association are unclear. One possibility is that early drinking directly increases risk for drinking to cope (DTC). Alternatively, the association between early drinking and DTC may be indirect, attributable to overlapping genetic or environmental factors. No prior genetically informative study has investigated the sources of covariation underlying the early-onset drinking-DTC association. MethodEarly-onset drinking (before age 15) was assessed using structured clinical interviews in a sample of 7130 male and female participants aged 19–56years from the Virginia Adult Twin Study of Psychiatric and Substance Use Disorders (VATSPSUD, Kendler & Prescott, 2006). DTC was assessed using the mood management scale of the alcohol use inventory (Horn & Wanberg, 1983). The sources of the covariation between early first drink and DTC were estimated using bivariate twin modeling. ResultsEarly drinking onset was reported by 28% of males and 16% of females and was associated with significantly higher DTC scores (phenotypic correlation: males=.19, females=.22). Results from bivariate twin models indicated that the association between early-onset drinking and DTC was completely attributable to shared genetic factors that contribute to both behaviors. ConclusionsGreater DTC among early-onset drinkers may not reflect a direct causal process, as shared biological pathways may explain vulnerability to stress-related drinking seen among early-onset drinkers.

Testing the specificity between social anxiety disorder and drinking motives

This study tested the specificity of the relationship between social anxiety disorder (SAD) and coping drinking motives (versus enhancement drinking motives and social drinking motives) within the context of a range of potentially confounding variables measured during adolescence (e.g., quantity and frequency of alcohol use, coping drinking motives) and substantively important variables assessed during young adulthood (e.g., other anxiety disorders and major depressive disorder). A sample of high school sophomores and juniors (n=717) completed measures of substance use and risk factors during adolescence and were then prospectively followed-up in early- and middle-young adulthood, and psychiatric diagnoses and drinking motives (i.e., coping, enhancement, and social) were assessed each time. Findings indicated that SAD was specifically related to coping motives (measured during early-to-middle young adulthood) after controlling for the effects of a range of alcohol and mental health variables. In addition, adolescent variables predicted young adult drinking motives as did major depressive disorder and other anxiety disorders. These findings are discussed within a conceptual framework of the functional role (e.g., self-medication) that drinking motives, and especially coping drinking motives, may play in the etiology of alcohol problems and disorders. Implications for prevention and treatment interventions are discussed.

Suicidal ideation and drinking to cope among college binge drinkers

Suicidality among college students is associated with binge drinking and alcohol-related problems. Consistent with motivational models of alcohol use, drinking to cope (DTC) is a significant intervening variable in the association between suicidal ideation and alcohol use and problems among students. This study examined whether several factors shown to be associated with both suicidal ideation and DTC (i.e., impulsivity, mood regulation expectancies, and coping skills) account for the relationship between these variables, as well as the associations of depression and hopelessness with DTC. Participants were 109 emerging adult (18- to 25-year-old) college students who reported at least one episode of binge drinking during a typical month in the past year. Hierarchical regression analyses revealed that while greater negative urgency and low negative mood regulation expectancies were significantly associated with DTC, suicidal ideation remained significantly associated with DTC, even when controlling for depression. Suicidal ideation showed a stronger association with DTC than either depression or hopelessness both before and after accounting for other variables. These findings suggest that suicidal ideation has a direct association with DTC, and that negative urgency and mood regulation expectancies may be useful treatments targets for reducing alcohol misuse among emerging adult students who experience suicidal ideation.

On Issues of Validity and Especially on the Misery of Convergent Validity

On Issues of Validity and Especially on the Misery of Convergent Validity

Alexithymia and alcohol consumption: The mediating effects of drinking motives

The association between alexithymia and alcohol consumption has been well documented. However, little research has investigated the mechanisms behind the association. In the present study, the relationship between alexithymia, drinking motives and alcohol consumption was examined in a group of social (non-problem) drinkers. In a cross-sectional study, 862 participants completed the Toronto Alexithymia Scale, Drinking Motives Questionnaire, and provided alcohol consumption information. Regression analyses revealed that alexithymia predicts alcohol consumption. Formal mediation analyses demonstrated that this relationship was fully mediated by social, enhancement and coping drinking motives, and partially mediated by conformity. Drinking motives may represent one mechanism to explain the association between alexithymia and alcohol consumption.