Posttraumatic Stress and Alcohol Use Among Hispanic/Latinx University Students: A Moderated Indirect Effect Model of Coping-Related Drinking and Anxiety Sensitivity.

Objective: Posttraumatic stress symptoms (PTSS) and anxiety sensitivity (AS) are associated with increased alcohol use and coping-motivated drinking among university students. This study among trauma-exposed Hispanic/Latinx university students sought to examine the indirect effect of PTSS on alcohol use severity through coping-motivated drinking and test the moderating role of AS and AS subfacets. Methods: University students who identified as Hispanic/Latinx (N = 830) were recruited from a large, urban, southern university and completed online, self-report questionnaires. Results: A significant interactive effect of PTSS and AS on coping-motivated drinking emerged. PTSS exerted a significant indirect effect on alcohol use severity, through coping-motivated drinking. Simple slope analyses revealed that PTSS was associated with coping-motivated drinking across all levels of AS. Post hoc results revealed unique biological sex differences in probable diagnosis odds ratios. Conclusions: These findings indicate that PTSS and AS are associated with coping-motivated drinking and alcohol use severity in trauma-exposed, Hispanic/Latinx university students.

The development and initial validation of the Trauma-Related Alcohol Use Coping Measure (TRAC).

OBJECTIVE: Posttraumatic stress disorder (PTSD) symptoms and alcohol use commonly co-occur and present a prevalent clinical comorbidity. The self-medication/coping model has been applied most consistently to understand the PTSD-alcohol use association. However, there is a relative paucity of self-report measures designed to assess motivations for alcohol use, specifically for coping with PTSD symptoms. The goals of the present study were to develop and validate a measure that assesses the use of alcohol to cope with specific facets of PTSD symptomatology across two independent samples. METHOD: Two samples were evaluated: a university-based sample (N = 617; 77.0% women; Mage = 22.3; SD = 5.20) composed of racially diverse trauma-exposed students and a nationally representative sample (N = 510; 52.5% women; Mage = 39.5; SD = 10.9) of trauma-exposed adults who endorsed PTSD symptoms and past-year hazardous drinking. Both samples completed identical online questionnaire batteries. A Trauma-Related Alcohol Use Coping (TRAC) measure was developed and validated across both samples. RESULTS: Confirmatory factor analysis was used to support the latent, hierarchical structure of the TRAC measure (total score; coping with intrusion, avoidance, negative alterations in cognitions and mood, and arousal/reactivity symptoms) and supported an 18-item version of the TRAC measure (university-based sample [N = 617]: RMSEA = 0.047, 90% CI [.04, .05]; SRMR = 0.043; CFI = 0.95; TLI = 0.95; nationally representative sample [N = 510]: RMSEA = 0.045, 90% CI [.04, .05]; SRMR = 0.021; CFI = 0.98; TLI = 0.97). The TRAC measure demonstrated excellent internal consistency, convergent, and discriminant validity with well-established measures of mental health, known-groups validity, and incremental validity relative to non-PTSD coping-motivated drinking. CONCLUSIONS: Overall, the TRAC measure can be used to assess the extent to which alcohol use is related to coping with PTSD symptoms. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

PTSD Symptom Severity and Alcohol Use among Firefighters: The Role of Emotion Regulation Difficulties.

OBJECTIVE: Heightened rates of posttraumatic stress disorder (PTSD) symptoms and alcohol use have been documented among firefighters. Emotion regulation difficulties (ERD) are clinically relevant to both PTSD and alcohol use. Few studies have examined the role of ERD in the association of PTSD symptoms with alcohol use severity and alcohol use motives among firefighters. Thus, the present investigation examined the indirect effect of PTSD symptom severity on alcohol use severity and alcohol use motives through ERD. METHODS: The sample was comprised of 685 firefighters (Mage = 38.65, SD = 8.57, 93.6% male) recruited from an urban fire department in the southern U.S. to complete an online survey. Indirect effects were calculated using 10,000 bootstrapped samples. Effects were examined after accounting for years of fire service, occupational stress, trauma load (i.e., number of traumatic event types experienced); in models evaluating alcohol use motives as outcomes, other alcohol use motives (i.e., alternate motives subscales) were included as additional covariates. RESULTS: First, ERD explained the association of PTSD symptom severity with alcohol use coping motives (ß = .01, SE = .003, 95% CI [.004-.01]). Furthermore, ERD did not significantly account for the association of PTSD symptom severity with alcohol use severity (ß = .02, SE = .01, 95% CI [-.004-.04]), alcohol use enhancement motives (ß = -.003, SE = .002, 95%CI [-.007-.000]), alcohol use social motives (ß = .004, SE = .002, 95% CI [-.000-.01]), or alcohol use conformity motives (ß = -.002, SE = .002, 95% CI [-.006-.02]). CONCLUSIONS: Results demonstrated that, among firefighters, PTSD symptom severity is positively related to alcohol use coping motives through heightened ERD. Clinical implications and future directions are discussed.

Firearm ownership and storage practices among United States firefighters and emergency medical services personnel.

Compared with the general U.S. population, firefighters (FF) and emergency medical services (EMS) workers (FF + EMS personnel) are at increased risk for firearm suicide. Although secure firearm storage is associated with reduced risk of firearm suicide, no study has examined the prevalence and sociodemographic correlates of firearm ownership and storage practices among U.S. FF + EMS personnel. A total of 141 U.S. FF + EMS personnel completed a structured, web-based self-report questionnaire. Overall, 76.6% (n = 108) of FF + EMS personnel in our sample reported owning a personal firearm, among whom 85.2% (n = 92) reported owning more than one firearm. Among firearm owners, 42.6% (n = 46) reported secure firearm storage (i.e., unloaded and locked) and 57.4% (n = 62) reported nonsecure firearm storage (i.e., loaded and/or unlocked). FF + EMS personnel who cited personal safety as the only reason for firearm ownership, as opposed to reporting other or multiple reasons for ownership (e.g., hunting), were at increased odds of reporting nonsecure storage practices (69.4% vs. 47.5%; OR = 2.51, 95% CI [1.14, 5.55], p = .023). Most FF + EMS personnel in our sample reported firearm ownership, and approximately half of the firearm owners reported nonsecure firearm storage practices. Promoting secure firearm storage practices among FF + EMS personnel might decrease risk of firearm suicide and other forms of firearm-related injuries. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

COVID-19-Related Medical Vulnerability and Mental Health Outcomes Among US First Responders.

OBJECTIVE: The present investigation examined the main and interactive effects of coronavirus disease 2019 (COVID-19)-related medical vulnerability (CMV; the number of medical conditions with potential to elevate COVID-19 risk) and first responder status (emergency medical services roles vs non-emergency medical services roles) on mental health symptoms. METHODS: A national sample of 189 first responders completed an online survey between June and August 2020. Hierarchal linear regression analyses were conducted and included the following covariates: years served as a first responder, COVID-19 exposure, and trauma load. RESULTS: Unique main and interactive effects emerged for both CMV and first responder status. COVID-19-related medical vulnerability was uniquely associated with anxiety and depression, but not alcohol use. Simple slope analyses revealed divergent results. CONCLUSIONS: Findings suggest that first responders with CMV are more likely to experience anxiety and depressive symptoms and that these associations may vary by first responder role.

Evaluation of an integrated personalized feedback intervention for hazardous drinkers with elevated anxiety sensitivity and PTSD symptoms: Protocol for a randomized controlled trial.

Background: Hazardous drinking and posttraumatic stress disorder (PTSD) are commonly co-occurring conditions among adults. Motivational enhancement interventions, such as personalized feedback interventions (PFI), have demonstrated efficacy for reducing hazardous drinking. Emerging though scant literature has evaluated PFI for co-occurring PTSD and hazardous alcohol use. A transdiagnostic risk factor that may underlie this co-occurrence and inform novel PFI development is anxiety sensitivity (AS). Objective: To use a randomized controlled trial to evaluate the efficacy of a novel, computer-based PFI for hazardous drinkers with at least subclinical PTSD and elevated AS (AP-PFI), against a time-matched comparison condition (C-PFI). Methods: Participants (N = 100) will be recruited and enrolled from the Houston, TX community. The study includes: an in-person visit (baseline diagnostic assessment, a brief intervention, and a post-intervention assessment) and two follow-up assessments (1-week and 1-month). Participants who meet study inclusion criteria will be randomized to one of two conditions at baseline: AP-PFI or C-PFI. AP-PFI will consist of a brief, single-session, computer-delivered, PFI-based intervention that provides integrative and normative feedback about alcohol use, AS, and PTSD symptoms. C-PFI will be time-matched but will only include alcohol-related feedback. Conclusions: AP-PFI is designed to provide feedback about alcohol use, PTSD symptoms, and AS and their interplay and deliver psychoeducation on harm-reduction techniques, interoceptive exposure exercises, and stress management strategies. The intervention may address extant gaps in treatment for these co-occurring conditions by providing a brief, evidence-based, motivational enhancement intervention that is cost-effective with potential to be disseminated across a variety of healthcare settings.

The Role of Anxiety Sensitivity in the Association Between Childhood Maltreatment and Sleep Disturbance Among Adults in Psychiatric Inpatient Treatment.

ABSTRACT: The present investigation examined associations of childhood maltreatment, anxiety sensitivity (AS), and sleep disturbance among a diverse sample of adults in psychiatric inpatient treatment. We hypothesized that childhood maltreatment would be indirectly associated with greater sleep disturbance through elevated AS. Exploratory analyses examined the indirect effect models with three AS subscales ( i.e. , physical, cognitive, and social concerns) as parallel mediators. A sample of adults in acute-care psychiatric inpatient treatment ( N = 88; 62.5% male; Mage = 33.32 years, SD = 11.07; 45.5% White) completed a series of self-report measures. After accounting for theoretically relevant covariates, childhood maltreatment was indirectly associated with sleep disturbance through AS. Parallel mediation analyses revealed that no individual subscale of AS significantly accounted for this association. These findings suggest that heightened levels of AS may explain the association between childhood maltreatment and sleep disturbance among adults in psychiatric inpatient treatment. Interventions targeting AS can be brief and efficacious and have the potential to improve clinical outcomes among psychiatric populations.

Distress overtolerance among firefighters: Associations with posttraumatic stress.

OBJECTIVE: Firefighters experience heightened rates of posttraumatic stress disorder (PTSD) symptoms compared to the general population. Nascent literature has identified distress overtolerance (DO; i.e., the tendency to persist through extremely high levels of distress despite harmful consequences) as a construct of potential relevance to PTSD symptomatology, though empirical research is lacking. The present study examined incremental associations between DO subscales (Capacity for Harm: persevering through distress despite its effect on 1's wellbeing; Fear of Negative Evaluation: persisting through distress due to a fear of being negatively evaluated by others should they quit) and PTSD symptom severity and symptom cluster severity (i.e., intrusion, avoidance, negative alterations in cognitions and mood [NACM], arousal and reactivity) among firefighters. METHOD: Participants included 282 trauma-exposed firefighters (91.8% male, Mage = 40.4, SD = 9.6). Covariates included years in the fire service, trauma load (i.e., number of trauma exposure types), and negative affect. RESULTS: Results indicated that Capacity for Harm was a significant incremental correlate of total PTSD symptom severity (ΔR² = .045, p = .004), NACM symptoms (ΔR² = .061, p < .001), and arousal/reactivity symptoms (ΔR² = .047, p = .005). Fear of Negative Evaluation was not significantly related to any criterion variables. CONCLUSION: Further work examining DO-PTSD relations is necessary to inform intervention and policy for the fire service. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

PTSD Symptom Severity, Pain Intensity, and Pain-Related Disability Among Trauma-Exposed Firefighters: the Moderating Role of Mindfulness.

Objectives: Firefighters are regularly exposed to potentially traumatic and injurious events and are at increased risk for developing posttraumatic stress disorder (PTSD) symptoms, pain, and pain-related disability. Mindfulness (i.e., present-oriented awareness and nonjudgmental acceptance of cognitions and bodily sensations) may influence PTSD-pain relations in firefighter populations and inform mutual maintenance models. The current cross-sectional study sought to examine the moderating role of mindfulness on the associations between PTSD symptom severity and pain-related disability and intensity among trauma-exposed firefighters. Methods: Firefighters (N = 266; M age = 40.48, SD = 9.70; 92.5% male) were recruited from a large, southwestern metropolitan area and voluntarily completed an online, self-report survey advertised throughout the fire department. Results: Accounting for covariates (i.e., age, years in the fire service, trauma load), a significant interactive effect of PTSD symptom severity and mindfulness on pain-related disability (ΔR 2 = 0.05, B = - 0.16, p < .001), but not pain intensity, emerged. Simple slope analyses revealed that PTSD symptom severity was associated with pain-related disability for those with low, but not high mindfulness. Post hoc analyses examining mindfulness facets revealed significant main effects of acting with awareness, non-judging of inner experience, and nonreactivity to inner experience on pain-related disability. Significant interactive effects of observing, describing, and nonreactivity to inner experience with PTSD symptom severity on pain-related disability emerged. Conclusions: Mindfulness moderates PTSD symptom severity and pain-related disability associations in trauma-exposed firefighters. Future work should further examine these associations among first responders, using experimental and/or longitudinal methodologies.

Mindful attention training workshop for firefighters: Design and methodology of a pilot randomized clinical trial.

Mindfulness-based interventions have demonstrated efficacy with regard to diverse psychological symptoms across populations. Few studies have evaluated the efficacy of mindfulness-based interventions for firefighters. This pilot randomized clinical trial (RCT) is designed to determine the preliminary efficacy, feasibility, and acceptability of a novel mindfulness-based workshop (entitled "Healthy Action Zone Mindful Attention Training" [HAZMAT]) developed for firefighters (Clinical Trials Identifier: NCT04909216). An anticipated sample size of 100 firefighters from a large fire department in the southern U.S. will be recruited. Firefighters will be randomized to: (1) HAZMAT workshop or (2) waitlist comparison condition. Outcomes will be assessed at baseline and five follow-up time-points: post-workshop, 1-week follow-up, 1-month follow-up, 3-month follow-up, and 6-month follow-up. First, we will evaluate the acceptability of the HAZMAT workshop as defined by firefighters' self-reported satisfaction with the workshop. Feasibility will be defined by the proportion of firefighters who start and complete the full workshop. Second, we will examine the efficacy of the HAZMAT workshop, as compared to waitlist, on psychological symptom reduction, as defined by: self-reported symptom severity of PTSD, depression, anxiety, suicidal ideation, and alcohol use at each follow-up time-point. Third, we will evaluate the impact of the HAZMAT workshop, as compared to waitlist, on putative treatment targets, indexed via self-reported levels of (1) mindful attention and (2) nonjudgmental acceptance each follow-up time-point.

Mental Health Correlates of Probable Posttraumatic Stress Disorder, Probable Alcohol Use Disorder, and Their Co-Occurrence among Firefighters.

Firefighters demonstrate high rates of posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD). Research has yet to compare how these diagnoses and their co-occurrence relate to firefighter mental health. This study evaluated trauma load, PTSD, alcohol use, depression, sleep, suicide risk, anger, and occupational stress across four discrete groups of firefighters (N = 660): (1) trauma-exposed only (n = 471), (2) probable PTSD-only (n = 36), (3) probable AUD-only (n = 125), and (4) probable PTSD-AUD (n = 28). Firefighters completed an online survey. Firefighters with probable PTSD-AUD demonstrated higher scores on all criterion variables, except trauma load, compared to firefighters with probable AUD-only or trauma-only. Firefighters with probable PTSD-AUD and probable PTSD-only reported similar levels of all indices, except alcohol use severity and suicide risk, which were higher among the probable PTSD-AUD group. Results provide preliminary empirical evidence of the deleterious impact of PTSD-AUD comorbidity among firefighters.

Associations between Lower-Order Anxiety Sensitivity Facets and PTSD Symptomatology among Trauma-Exposed Firefighters.

Firefighters are chronically exposed to potentially traumatic events, augmenting their risk of developing posttraumatic stress disorder (PTSD). The current study aimed to examine the incremental associations of lower-order dimensions of anxiety sensitivity (AS), examined concurrently, and PTSD symptom severity among a sample of trauma-exposed firefighters. We hypothesized that AS physical and cognitive concerns would be strongly associated with all PTSD symptom clusters and overall symptom severity, after controlling for theoretically relevant covariates (trauma load; years in fire service; alcohol use severity; depressive symptom severity). Participants were comprised of firefighters (N = 657) who completed an online questionnaire battery and endorsed PTSD Criterion A trauma exposure. Results revealed that the AS cognitive concerns, but not AS physical concerns, was significantly and robustly associated with overall PTSD symptom severity, intrusion symptoms, and negative alterations in cognitions and mood (∆R2's = .028-.042; p's < .01); AS social concerns was incrementally associated with PTSD avoidance (∆R2 = .03, p < .01). Implications for firefighter-informed, evidence-based interventions are discussed.

Anxiety sensitivity and suicide risk: Mindfulness as a psychological buffer for Black adults.

BACKGROUND: Anxiety sensitivity (AS), defined as the fear of anxiety-related sensations, is associated with increased risk for suicide and related behavior. However, investigations of AS have centered on primarily non-Hispanic White men and women and with limited attention to clinically relevant underlying factors. METHODS: The purpose of this preliminary study was to examine the indirect effect of AS on suicide ideation and elevated suicide risk through mindfulness in a sample of 307 Black adults (79.2% female; Mage = 22.4, SD = 5.6). Participants completed an online questionnaire battery that included measures of AS, mindfulness, suicide ideation, and elevated suicide risk. RESULTS: After controlling for age and gender, results indicated that AS was directly and indirectly associated with suicide ideation and elevated suicide risk via lower levels of mindfulness. LIMITATIONS: Limitations include using a cross-sectional methodological design and exclusive reliance on self-report measures. CONCLUSIONS: These findings provide preliminary insight into novel risk and protective factors that influence suicide ideation and elevated suicide risk among Black Americans.

Exploring the impact of the COVID-19 pandemic on the mental health of first responders.

The present investigation evaluated the preliminary impact of COVID-19 exposure on first responder mental health. Data were collected between June and August 2020. The sample was comprised of 189 first responders (Mage = 47.58, SD = 10.93; 21% female), recruited nationally, who completed an online survey. Results indicated that COVID-19-exposed first responders were more likely to be emergency medical services [EMS] personnel (vs. non-EMS) in career (vs. volunteer) roles. COVID-19-exposed first responders reported higher alcohol use severity; no other between-group differences were noted. COVID-19-related worry and medical vulnerability were incrementally associated with more severe symptoms of anxiety and depression; only COVID-19-related worry was associated with alcohol use severity. Among the subset of first responders (n = 122) who reported COVID-19 exposure, COVID-19-related worry was significantly associated with PTSD symptom severity. Covariates included gender, trauma load, years as a first responder, and COVID-19 exposure. Clinical and policy implications as well as future directions will be discussed.

Childhood maltreatment severity and suicidal ideation among adults receiving acute-care psychiatric inpatient services: The role of distress tolerance.

Objective: Persons in psychiatric inpatient hospitals represent a unique population with high rates of suicidal ideation and behavior as well as childhood maltreatment. Lower levels of perceived distress tolerance (DT) are associated with a history of childhood maltreatment and suicidal ideation and behavior in adulthood. Our study examined the association of childhood maltreatment severity with self-report and behavioral indices of suicide through perceived DT in a sample of adults in an acute-care psychiatric inpatient unit. We hypothesized that lower levels of perceived DT would account for the association between (a) childhood maltreatment severity and suicidal ideation severity and (b) childhood maltreatment severity and prehospitalization suicidality. Method: The sample was composed of 94 trauma-exposed adults (60% men; Mage = 33.43; SD = 12.06) admitted to a psychiatric acute-care inpatient hospital in a large metropolitan area in the southern United States. Approximately 55% of the sample were hospitalized due to suicidality, with an average number of 1.28 (SD = 2.42) prior suicide attempts; 3% of patients exhibited suicidality during their hospitalization. All patients reported experiencing at least one type of childhood maltreatment, with varying degrees of exposure. We conducted indirect effects analyses using PROCESS Macro for SPSS. Results: Childhood maltreatment severity was indirectly associated with both suicidal ideation severity and prehospitalization suicidality through DT. Conclusions: Findings advance our understanding of the association between childhood maltreatment and increased risk for suicidal ideation and behavior in adulthood, specifically among the psychiatric inpatient population. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Examining Transdiagnostic Factors among Firefighters in Relation to Trauma Exposure, Probable PTSD, and Probable Alcohol Use Disorder.

OBJECTIVE: Firefighters represent a distinct group of first responders that are at heightened risk of developing posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD). Assessing the role of transdiagnostic factors that underlie PTSD-AUD associations can inform specialized interventions among this population. This study included urban firefighters (N = 657) with probable PTSD-AUD (n = 27), probable PTSD-alone (n = 35), probable AUD-alone (n = 125), and trauma-exposure-only (n = 470). Methods: All firefighters completed a self-report, online questionnaire battery. Between group differences in anxiety sensitivity (AS), distress tolerance (DT), mindfulness, and emotional regulation difficulties (ERD) were assessed. It was hypothesized that firefighters with probable PTSD-AUD would endorse elevated AS and ERD, and reduced DT and mindfulness in comparison to all other diagnostic groups. Relationship status was included as a covariate in all comparisons. Results: Firefighters with probable PTSD-AUD endorsed elevated AS and ERD, and reduced DT and mindfulness in comparison to firefighters with trauma-exposure-only and probable AUD-alone. Firefighters with probable PTSD-AUD and probable PTSD-alone did not significantly differ. Conclusions: Given these findings, this line of inquiry has great potential to inform specialized, evidence-based mental health programming among firefighter populations, who represent a unique population susceptible to trauma-exposure, PTSD symptomology, and problematic alcohol use.

Posttraumatic stress, alcohol use severity, and alcohol use motives among firefighters: The role of anxiety sensitivity.

INTRODUCTION: Firefighters are vulnerable to developing posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD). Anxiety sensitivity (AS) is a cognitive-affective mechanism with clinical relevance to both PTSD and AUD. The current study examined the potential role of AS in the association of PTSD symptomatology with alcohol use severity and alcohol use motives among a large sample of firefighters. Heightened PTSD and high AS were expected to be associated with alcohol use severity and coping-oriented alcohol use motives. Heightened PTSD symptomatology was expected to be indirectly associated with alcohol use severity and coping motives through high AS. Covariates included number of years in the fire service and the number of traumatic event types endorsed. METHODS: Participants included 652 urban firefighters (93.3% male; Mage = 38.7, SD = 8.57). Firefighters completed an online questionnaire battery. RESULTS: PTSD symptomatology was positively associated with alcohol use and coping motives. AS was positively associated with alcohol use coping motives but not alcohol use severity. AS partially explained the association between PTSD symptomatology and coping, conformity, and social motives, but did not significantly account for the relationship between PTSD symptom severity and enhancement motives or alcohol use severity. CONCLUSIONS: Among firefighters, the association between PTSD and alcohol use coping, conformity, and social motives is partially accounted for by AS. Clinical and research implications are discussed.

PTSD symptom severity and impulsivity among firefighters: Associations with alcohol use.

Firefighters represent a unique population at high risk for trauma exposure, posttraumatic stress disorder (PTSD), and alcohol use. This study explored the main and interactive effects of PTSD symptom severity and impulsivity with regard to alcohol use severity. We hypothesized that higher levels of PTSD symptom severity and impulsivity would be related to greater alcohol use severity. Covariates included trauma load, depressive symptom severity, and romantic relationship status. The sample was comprised of 654 firefighters (Mage = 38.65, SD = 8.60) who endorsed exposure to potentially traumatic events and lifetime alcohol use. Firefighters completed an online questionnaire battery. A series of hierarchical regressions was conducted. PTSD symptom severity and impulsivity were significantly, incrementally associated with alcohol use severity, and a significant interactive effect was documented; firefighters with heightened PTSD symptom severity and impulsivity had the highest levels of alcohol use severity. This line of inquiry has great potential to inform prevention and intervention efforts for this vulnerable population. Clinical and research implications are discussed.

Post-traumatic stress and alcohol use disorders: recent advances and future directions in cue reactivity.

The comorbidity of post-traumatic stress disorder (PTSD) and alcohol use disorders (AUD) is prevalent, complex, and difficult to treat. Cue reactivity paradigms offer a clinically relevant scientific avenue to advance our understanding of PTSD/AUD comorbidity and ultimately inform evidence-based interventions. Cue reactivity paradigms evoke emotional, behavioral, and/or physiological responses by manipulating external (e.g. images, smells, scripts) cues. Through evaluation of how individuals with PTSD/AUD respond to trauma or alcohol cues (e.g. craving, distress, avoidance) in 'real' time, the theoretical framework for understanding functional associations between PTSD and AUD is refined. This brief narrative review of the recent literature (2015-present) will focus upon (1) summarizing the recently published cue reactivity studies relevant to PTSD/AUD, (2) explicating the limitations of the literature, and (3) discussing future empirical directions.