Associations between early internalizing symptoms and speed of transition through stages of alcohol involvement.

Alcohol use disorders and internalizing disorders are highly comorbid, but how this comorbidity unfolds over development is not well understood. The present study investigated effects of internalizing symptoms in late childhood on speed of transition between three alcohol involvement milestones: first drink, first binge, and onset of first alcohol dependence symptom. Greater early internalizing symptoms were expected to predict a later age of first drink, a slower transition from first drink to first binge, and a faster transition from first binge to first dependence symptom. The effects of age and moderating effects of gender were also examined. Data were from a longitudinal study of children of alcoholics and matched controls (N = 454) followed from late childhood to midlife. Generally, stage-specific hypotheses were not supported; rather, greater internalizing symptoms predicted an earlier age of first drink and a faster transition through the full interval from first drink to first dependence symptom. Regarding gender moderation, internalizing significantly predicted a faster transition between each milestone as well as through the full interval among women but not men. These results suggest that early internalizing problems confer risk for a rapid transition through all stages of alcohol involvement, and this risk may be limited to women.

Interactive and Indirect Effects of Anxiety and Negative Urgency on Alcohol-Related Problems.

BACKGROUND: Although drinking for tension reduction has long been posited as a risk factor for alcohol-related problems, studies investigating anxiety in relation to risk for alcohol problems have returned inconsistent results, leading researchers to search for potential moderators. Negative urgency (the tendency to become behaviorally dysregulated when experiencing negative affect) is a potential moderator of theoretical interest because it may increase risk for alcohol problems among those high in negative affect. This study tested a cross-sectional mediated moderation hypothesis whereby an interactive effect of anxiety and negative urgency on alcohol problems is mediated through coping-related drinking motives. METHODS: The study utilized baseline data from a hazardously drinking sample of young adults (N = 193) evaluated for participation in a randomized controlled trial of naltrexone and motivational interviewing for drinking reduction. RESULTS: The direct effect of anxiety on physiological dependence symptoms was moderated by negative urgency such that the positive association between anxiety and physiological dependence symptoms became stronger as negative urgency increased. Indirect effects of anxiety and negative urgency on alcohol problems (operating through coping motives) were also observed. CONCLUSIONS: Although results of the current cross-sectional study require replication using longitudinal data, the findings suggest that the simultaneous presence of anxiety and negative urgency may be an important indicator of risk for alcohol use disorders via both direct interactive effects and indirect additive effects operating through coping motives. These findings have potentially important implications for prevention/intervention efforts for individuals who become disinhibited in the context of negative emotional states.

Comparison of subjective response to alcohol in Caucasian and Hispanic/Latino samples.

Individual differences in subjective response (SR) to alcohol (e.g., stimulation, sedation) are a significant predictor of negative alcohol outcomes. Previous studies have reported ethnic differences in SR (e.g., between some Asian populations and Caucasians), but very few studies have examined SR among Hispanic/Latino individuals. To address this gap in the literature, the present study utilized data from a large-scale, placebo-controlled alcohol administration study to examine differences in SR between Hispanic/Latino and Caucasian individuals. Social drinkers (N = 447) aged 21 to 25 years were randomized to receive either a dose of alcohol targeting a blood alcohol concentration (BAC) of .08 g% or placebo. Only non-Hispanic Caucasian participants (n = 234) and Hispanic/Latino participants (n = 87) were utilized in analyses. SR was assessed at baseline, on the ascending limb of the blood alcohol curve, at peak BAC, and on the descending limb. Repeated measures ANCOVA was utilized to examine interactions between beverage condition, ethnicity, and time predicting SR. The interaction between beverage condition, ethnicity, and time was significant only for low-arousal negative SR (negative sedative effects), such that Hispanic/Latino individuals experienced stronger sedative effects under alcohol (vs. placebo) compared with Caucasian individuals. Caucasians and Hispanic/Latinos showed a similar profile of response with respect to positive aspects of SR (e.g., stimulation). In summary, Hispanic/Latino individuals reported stronger negative SR to alcohol compared with Caucasian individuals, which may be protective against alcohol-related problems. However, future studies are needed to investigate why Hispanic/Latino males remain at relatively high risk for alcohol problems despite stronger negative SR relative to Caucasians. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Contextual influences on subjective and behavioral responses to alcohol.

Differential sensitivity to alcohol effects (e.g., increased stimulation and decreased sedation) is associated with heavier use and problems. Although genetic factors contribute to alcohol response (AR), environmental factors may also play a role. This study examined effects of physical context on AR using a between subjects placebo-controlled design. There were 157 (57% male) participants (ages 21-30) who were randomized to 1 of 4 conditions based on beverage (placebo or alcohol [target BrAC = .08 g%]) and physical context (simulated bar or traditional lab). AR was assessed using the Subjective Effects of Alcohol Scale and the Biphasic Alcohol Effects Scale, as well as behavioral tasks including the Balloon Analogue Risk Task (BART) and its negative reinforcement counterpart (MRBURNS). A beverage condition by context interaction emerged for low arousal positive subjective response (SR), and among women, for performance on the BART task. In the lab context only, alcohol (relative to placebo) was associated with stronger low arousal positive SR and, for women, with impaired performance on the BART task. This suggests that a less stimulating lab context may be better suited to differentiating positive alcohol effects from expectancies, whereas a bar context may be better suited to detecting expectancy effects. The findings also suggest that the ability to better appreciate positive alcohol effects (relative to expectations) in less stimulating contexts may lead to a strengthening of these effects among individuals who drink in these environments.

Hybrid cognitive behavioral therapy versus relaxation training for co-occurring anxiety and alcohol disorder: a randomized clinical trial.

OBJECTIVE: Treatment for alcohol use disorder (AUD) is far less effective for those with a co-occurring anxiety disorder. Surprisingly, adding an independent anxiety treatment to AUD treatment does not substantially improve the poor alcohol outcomes of these patients. This may reflect the lack of attention from independent treatments to the dynamic interaction of anxiety symptoms with alcohol use and drinking motivation. On the basis of this view, we assembled a cognitive behavioral therapy (CBT) program designed to both reduce anxiety symptoms and weaken the links between the experience of anxiety and the motivation to drink. METHOD: 344 patients undergoing residential AUD treatment with current social phobia, generalized anxiety disorder, or panic disorder were randomly assigned to receive either the CBT or an active comparison treatment, progressive muscle relaxation training (PMRT). Assessments took place immediately following treatment and 4 months later (n = 247). RESULTS: As predicted, the CBT group demonstrated significantly better alcohol outcomes 4 months following treatment than did the PMRT group. Although both groups experienced a substantial degree of anxiety reduction following treatment, there were no significant group differences immediately after treatment and only a slight advantage for the CBT group 4 months after treatment. CONCLUSIONS: These findings suggest that specific interventions aimed at weakening the association between the experience of anxiety and drinking motivation play an important role in improving the alcohol outcomes of these difficult-to-treat patients beyond that of anxiety reduction alone.

Greater elevation in risk for nicotine dependence per pack of cigarettes smoked among those with an anxiety disorder.

OBJECTIVE: Recent work shows that the time from the initial use of nicotine, cannabis, and alcohol to the onset of dependence on these substances is shorter ("telescoped") in anxiety-disordered individuals. Previously, we hypothesized that telescoping may result from a shared neurobiology underlying both anxiety disorders and dependence. This hypothesis implies that telescoping occurs because individuals with an anxiety disorder transition to dependence with less overall drug exposure ("dependence susceptibility"). To investigate this further, we examined an estimate of the amount smoked (rather than the time transpired) from smoking initiation milestones to the onset of nicotine dependence in those with and without an anxiety disorder. METHOD: We used the subset of respondents in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) Wave 1 who reported having smoked at least 100 cigarettes (N = 18,013). All data were based on face-to-face interviews. RESULTS: Individuals with any anxiety disorder transitioned to nicotine dependence after smoking fewer total cigarettes than did individuals with no anxiety disorder. Furthermore, those with more than one anxiety disorder transitioned to nicotine dependence after smoking fewer cigarettes than did those with one anxiety disorder only. Several potentially confounding covariates were controlled for in these analyses. CONCLUSIONS: Dependence susceptibility is a novel concept with the potential to inform theoretical accounts of and prevention strategies for substance dependence among those with an anxiety disorder. In addition to nicotine, our theory and past data suggest that dependence susceptibility for other addictive substances (e.g., alcohol) also would be found among those with an anxiety disorder.

The prevalence and clinical implications of self-medication among individuals with anxiety disorders.

Alcohol dependence (AD) is more likely to occur among individuals with rather than without an anxiety disorder. Self-medication theory (SMT) holds that drinking behavior is negatively reinforced when alcohol temporarily reduces anxiety and that the resulting escalation of drinking increases the risk for AD. We set out to empirically scrutinize SMT using the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) dataset. We found that only a minority (about 20%) of anxiety disordered individuals endorsed drinking to control anxiety symptoms. This minority drank more alcohol, had a higher cross-sectional rate of AD, and was at higher risk for developing new AD over four years compared to anxiety disordered non-self-medicators and individuals with no anxiety disorder. Consistent with SMT, increased prospective risk for AD among self-medicators is partially mediated by an increased level of alcohol use. Understanding the processes that promote and inhibit self-medication should be a priority for anxiety disorder researchers.