Childhood Maltreatment and Use of Aggression among Veterans with Co-occurring PTSD and Alcohol Use Disorder: The Mediating Role of Hostile Cognitions.

History of childhood maltreatment is common among military veterans, particularly those with posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD). Childhood maltreatment is associated with negative psychosocial outcomes, including use of aggression during adulthood. Prior research has identified maladaptive cognitions as a key mediating variable in the association between early life trauma and aggression. Given the high rates of comorbid PTSD and AUD among veterans and the increased risk of aggression when these conditions co-occur, it is critical to examine malleable intervention targets, such as maladaptive cognitions, for this population. The current secondary analyses examined the mediating role of hostile cognitions on the associations between childhood maltreatment and adulthood aggression in a sample of dually diagnosed veterans. Participants were veterans with co-occurring PTSD and AUD (N = 73) who were enrolled in a larger randomized controlled laboratory trial. Participants completed self-report measures of childhood maltreatment, hostile cognitions, and aggressive behavior. Three models were tested to examine the mediating effect of hostility on the associations between childhood maltreatment, abuse, and neglect on aggression. Results indicated that hostility fully mediated the effect of maltreatment on aggression and partially mediated the effect of childhood abuse on aggression. The effect of childhood neglect on aggression was nonsignificant. Hostile cognitions may be a critical intervention target for veterans with co-occurring PTSD and AUD and history of childhood maltreatment, particularly for those who have experienced higher levels of childhood abuse.

Effects of alcohol problem discrepancy on relationship adjustment: The moderating role of conflict negotiation among couples with alcohol use disorder and intimate partner violence.

Alcohol use disorder (AUD) has well-known negative effects on romantic relationship functioning, including the occurrence of intimate partner violence (IPV). A separate literature focused on community couples indicates that relationship functioning is more likely to suffer when partners report greater discrepancies in alcohol consumption. It is important to expand this literature to couples with AUD and to examine the role of impactful AUD domains in dyadic functioning. Furthermore, few studies have examined adaptive, treatment-malleable factors that could potentially offset the negative impact of alcohol discrepancies on relationship functioning. This study examined the association between couples' alcohol problem discrepancies and relationship adjustment, as well as the moderating effect of self-reported adaptive conflict negotiation behaviors. Participants were 100 couples (N = 200 individual participants) with intimate partner violence wherein at least one partner met diagnostic criteria for AUD. Actor-Partner Interdependence Models indicated that greater alcohol problem discrepancy was associated with lower dyadic adjustment. Moderation analyses revealed that the highest level of relationship adjustment was observed among couples with lower alcohol problem discrepancy and greater negotiation behaviors, while relationship adjustment was similar for couples with larger alcohol problem discrepancy, regardless of negotiation behaviors. Although further study is needed to clarify under what specific conditions adaptive negotiation behaviors are most helpful, they appear to be beneficial for some couples in this sample. We found no evidence that negotiation behaviors may be harmful among these high-risk couples.

Gender moderates the association between acute alcohol intoxication and facial emotion recognition in a naturalistic field study setting.

BACKGROUND: Alcohol intoxication is associated with significant negative social consequences. Social information processing theory provides a framework for understanding how the accurate decoding and interpretation of social cues are critical for effective social responding. Acute intoxication has the potential to disrupt facial emotion recognition. If alcohol impairs the processing and interpretation of emotional cues, then the resultant behavioral responses may be less effective. The current study tested the association between alcohol intoxication and facial emotion recognition in a naturalistic field study of intoxicated participants. METHODS: 114 participants (59.4% men; Mage  = 24.2 years) who had been consuming alcohol were recruited in the downtown area of a mid-size town surrounded by several drinking establishments in the mid-southern United States. Participants were shown images depicting 5 facial displays of emotions (happy, sad, anger, disgust, and no emotion) portrayed by 1 male and 1 female actor per emotion and breath alcohol concentration (BrAC) was measured by the field breathalyzer test (M = 0.078%, SD = 0.052). RESULTS: BrAC was significantly negatively associated with emotion recognition accuracy when controlling for average alcohol use, B = -.35, t = -2.08, p < 0.05, F(3, 110) = 5.28, p < 0.01, R2  = 0.13. A significant BrAC × gender interaction was revealed, B = -0.39, t = -2.07, p = 0.04, ΔR2  = 0.033, p = 0.04, such that men (but not women) displayed a significant negative association between BrAC and emotion recognition accuracy. CONCLUSIONS: Acute intoxication was associated with impaired facial emotion recognition, particularly for men, in a field study context. Findings support and extend some previous experimental laboratory-based research and suggest that intoxication can impair the decoding stage of social information processing.

Craving Moderates the Effects of Intranasal Oxytocin on Anger in Response to Social Stress Among Veterans With Co-Occurring Posttraumatic Stress Disorder and Alcohol Use Disorder.

PURPOSE/BACKGROUND: Posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) commonly co-occur among US military veterans. Oxytocin may have therapeutic value in treating both conditions. The potential for oxytocin to augment affective features common to PTSD and AUD, such as anger, is relevant to inform emerging treatments. METHODS/PROCEDURES: We examined the influence of intranasally administered oxytocin on connections between alcohol craving and stress-induced anger in a sample of 73 veterans (91.3% men) with co-occurring PTSD and AUD. Participants self-administered oxytocin (40 IU) or placebo (saline) 45 minutes before completing the Trier Social Stress Task (TSST). Self-reports of alcohol craving and anger were assessed pre- and post-TSST using a modified visual analog scale. Multiple regression analysis, including main effects for group, baseline craving, and their interaction, was used to predict post-TSST anger. FINDINGS/RESULTS: A marginally significant interaction was observed, suggesting a positive association between baseline craving and anger for those in the oxytocin group (B = 0.65, P = 0.01). Among those reporting low craving, participants in the oxytocin group reported significantly lower post-TSST anger than those in the placebo group. IMPLICATIONS/CONCLUSIONS: The current study is among the first to examine relevant psychosocial moderators that may influence the effects of oxytocin among veterans with comorbid PTSD and AUD. Although oxytocin attenuated ratings of anger after a stress task among those with low baseline craving, findings suggest that oxytocin may not be as effective at reducing anger, a highly salient factor in PTSD, for individuals experiencing high levels of craving. Findings are consistent with the social salience hypothesis and suggest that individual differences in alcohol craving should be considered when evaluating oxytocin as a potential treatment for individuals with comorbid PTSD and AUD.

Alcohol Intoxication Impairs the Bystander Intervention Process in a Hypothetical Sexual Assault: A Field Investigation.

Objective: High rates of alcohol-related sexual assault among young adults represent a significant public health problem. Bystander intervention programs are a promising strategy to reduce sexual assault incidence. However, little is known about how bystander intoxication may modify bystander intervention effectiveness. We examined the role of bystander intoxication and intoxication levels of the hypothetical victim and perpetrator on outcomes associated with Latané and Darley's (1970) steps of bystander intervention, which include noticing a situation, assessment of risk and need for intervention, taking personal responsibility for intervening, and selecting an intervention. Method: In a field setting, participants were recruited from a downtown area surrounded by several drinking establishments. After providing informed consent, 327 participants (45% women) ages 21 - 29 years listened to one of four sexual assault vignettes (varied by victim and perpetrator intoxication), responded to questionnaires assessing outcomes related to steps of bystander intervention, and completed a field breathalyzer test to measure intoxication level. Results: We found that increased participant intoxication was related to decreased accuracy of situation recall and assessment of risk and need for intervention, but not ratings of personal responsibility to intervene, chosen intervention strategy, or confidence to intervene. Conclusions: Intoxication could influence how a bystander interprets a hypothetical nonconsensual sexual interaction at the level of accurate situation recall and risk assessment. If the early steps of information processing are impaired by intoxication, later steps of intervention enactment may not occur successfully. Bystander intervention programming may consider incorporating training to overcome the impairing effects of intoxication for identifying harmful situations and choosing to intervene.

Effect of Alcohol Intoxication on Bystander Intervention in a Vignette Depiction of Sexual Assault.

OBJECTIVE: Alcohol-related sexual violence remains a public health problem. Despite the popularity of sexual assault bystander intervention programs, these may be limited in addressing bystander intoxication because the effects of intoxication on intervening in a sexual assault are unknown. Therefore, we tested the effects of alcohol intoxication on the five steps of bystander intervention in a sexual assault vignette. METHOD: Young adults (N = 128; 50% women) were randomly assigned to consume alcohol (target blood alcohol concentration = 0.08%; n = 64) or a nonalcoholic control beverage (n = 64) in a bar-laboratory. Next, participants were presented with a vignette describing events occurring in a convivial drinking context that ends with nonconsensual sexual behavior. Latané and Darley's bystander intervention model steps were assessed in a semistructured interview. RESULTS: Participants in the control condition recalled the story more accurately (Step 1: notice the event) and reported greater risk/need for intervention (Step 2), but they did not differ on the latter three steps of bystander intervention compared with alcohol-condition participants. Intoxication effects were similar for men and women. Furthermore, risk/need for intervention (Step 2) partially mediated the effect of alcohol condition on personal responsibility (Step 3) and relative benefits versus costs from intervening (Step 4). CONCLUSIONS: Prevention programs should consider the effects of alcohol on detecting a sexual assault and the need to intervene. If intoxicated bystanders do not detect a sexual assault, then bystanders will not reach the crucial steps (i.e., taking responsibility for intervening; willingness and ability to intervene) required to intervene successfully.

The effects of alcohol intoxication on young adult women's identification of risk for sexual assault: A systematic review.

Alcohol-related sexual assault among young adult women continues to present a public health concern. Social information-processing theory provides an organizing framework for understanding how alcohol intoxication can impair the processing of sexual assault risk cues and behavioral responding in sexual assault scenarios. The aim of the present article was to systematically review the extant research on the effects of alcohol intoxication on sexual assault risk information processing among young adult women. We selected relevant research through a systematic search of scientific databases, using key words related to young adult women, alcohol intoxication, and risk recognition, resulting in 14 independent research samples meeting all criteria. Studies used a variety of methods and dependent measures, precluding quantitative analysis of results. Thirteen of the 14 studies identified report at least partial support for intoxication impairing the attention to cues, interpretation of social information, or intended behavioral response in a hypothetical sexual assault scenario. Given some mixed findings, further research is warranted to identify contextual and individual differences related to risk detection and intended responding and to fully test other aspects of social information processing. Results have implications for improving alcohol-related sexual assault prevention programs by addressing the impact of alcohol intoxication on processing sexual assault risk information. (PsycINFO Database Record

Facial emotion identification and sexual assault risk detection among college student sexual assault victims and nonvictims.

OBJECTIVE: High rates of sexual victimization among college students necessitate further study of factors associated with sexual assault risk detection. The present study examined how social information processing relates to sexual assault risk detection as a function of sexual assault victimization history. PARTICIPANTS: 225 undergraduates (Mage = 19.12, SD = 1.44; 66% women). METHODS: Participants completed an online questionnaire assessing victimization history, an emotion identification task, and a sexual assault risk detection task between June 2013 and May 2014. RESULTS: Emotion identification moderated the association between victimization history and risk detection such that sexual assault survivors with lower emotion identification accuracy also reported the least risk in a sexual assault vignette. CONCLUSIONS: Findings suggest that differences in social information processing, specifically recognition of others' emotions, are associated with sexual assault risk detection. College prevention programs could incorporate emotional awareness strategies, particularly for men and women who are sexual assault survivors.

Pregaming and Emotion Regulation's Relationship to Alcohol Problems in College Students: A Cross-Sectional Study.

BACKGROUND: Pregaming is a high-risk drinking behavior associated with increased alcohol consumption and alcohol-related problems. Quantity of alcohol consumed does not fully explain the level of problems associated with pregaming; yet, limited research has examined factors that may interact with pregaming behavior to contribute to the experience of alcohol-related problems. OBJECTIVES: The current study examined whether use of two emotion regulation strategies influence pregaming's contribution to alcohol-related problems. METHODS: Undergraduates (N = 1857) aged 18-25 years attending 19 different colleges completed an online survey in 2008-2009. Linear mixed models were used to test whether emotion regulation strategies moderate the association between pregaming status (pregamers vs. non/infrequent pregamers) and alcohol-related problems, when controlling for alcohol consumption, demographic covariates, and site as a random effect. RESULTS: Greater use of cognitive reappraisal was associated with decreased alcohol problems. Expressive suppression interacted with pregaming status. There was no relationship between pregaming status and alcohol problems for students who rarely used expression suppression; however, the relationship between pregaming status and alcohol problems was statistically significant for students who occasionally to frequently used expression suppression. CONCLUSIONS/IMPORTANCE: Findings suggest that the relationship between pregaming and alcohol-related problems is complex. Accordingly, future studies should utilize event-level methodology to understand how emotion regulation strategies influence alcohol-related problems. Further, clinicians should tailor alcohol treatments to help students increase their use of cognitive reappraisal and decrease their use of suppression.

Posttraumatic Stress Symptoms and Nonmedical Prescription Drug Use Among College Students With Trauma Exposure.

OBJECTIVE: Nonmedical prescription drug use, defined as using the drug without a prescription or in ways for which it is not prescribed, and traumatic event exposure are highly prevalent among college students. Despite evidence that posttraumatic stress symptoms could place college students at risk for nonmedical prescription drug problems, no studies have examined this relationship. This study was a preliminary examination of posttraumatic stress symptoms, lifetime nonmedical prescription drug use, hazardous use, and dependence symptoms among college students with trauma exposure. METHODS: Participants were students attending a rural college in Virginia, recruited through psychology classes, flyers, LISTSERVs, and announcements at student events. All students who reported experiencing at least one traumatic event were included (N = 119); participants' mean age was 19.7 years (SD = 1.90), about half were women (n = 63, 53%), and most were Caucasian (n = 103, 87%). RESULTS: Nearly 60% of participants (n = 71) reported using nonmedical prescription drugs at least once during their lifetime and were more likely than those with no use to report hazardous alcohol use (p < .01) and depressive symptoms (p < .05). There were no other significant differences between those who did and did not report use of nonmedical prescription drugs. Regression analyses showed that posttraumatic stress symptom frequency was positively associated with hazardous nonmedical prescription drug use, after controlling for gender, depressive symptoms, and hazardous alcohol use (p < .001). Posttraumatic stress symptom frequency was higher for those with any nonmedical prescription drug dependence symptoms (p < .001), but was unrelated to whether the student had ever engaged in nonmedical prescription drug use. CONCLUSIONS: Findings suggest that consideration of the types of behaviors and problems a college student is experiencing related to nonmedical prescription drug use may be more relevant to posttraumatic stress symptom frequency than dichotomous measures of nonmedical prescription drug use alone. Further, the association between the frequency of posttraumatic stress symptoms and both hazardous nonmedical prescription drug use and dependence symptoms among college students with a trauma history deserves further investigation due to the resulting vulnerability to increasingly negative outcomes.