Posttraumatic Stress and Problem Drinking at the Transition Out of College.

The objective of the present study was to examine how symptoms of posttraumatic stress disorder (PTSD) may confer drinking risk as students with trauma histories complete college and move toward independent adulthood. Students (N = 283) completed assessments of trauma, posttraumatic stress, and alcohol use and consequences at four time points during the year following their fourth year of college. Some students had transitioned out of the college environment, whereas others had not. We examined how transition status moderated within-person associations between changes in PTSD and corresponding changes in alcohol outcomes over time. Using multilevel modeling, we examined differences in within-person PTSD-alcohol associations comparing students who were (1) continuing as fifth-year seniors, (2) graduated and pursuing graduate education, and (3) graduated and left the university setting. Alcohol use and consequences tended to decline on average from the fourth to fifth year post-matriculation. Yet, within-person increases in posttraumatic stress symptomatology across the fifth year were associated with greater alcohol consequences, but only for those students who had left the university setting. These data suggest that the transition out of college may be an important developmental context that is associated with increased vulnerability for negative consequences from stress-related drinking. Findings may have important implications for campus-based prevention efforts geared toward the facilitation of a successful transition into independent adulthood.

PTSD and Pregaming in College Students: A Risky Practice for an At-Risk Group.

BACKGROUND: College students with trauma exposure and PTSD are at risk for problem drinking. This may include more specific hazardous drinking practices such as pregaming (drinking prior to a social event), which is linked to increased alcohol-related consequences. OBJECTIVES: The present study examined the association between pregaming and alcohol consequences and the role of trauma exposure and PTSD in predicting pregaming and alcohol-related consequences in a sample of college students using Multilevel Structural Equation Modeling (MSEM). We also assessed specific risk associated with PTSD relative to trauma exposure alone in relation to our outcomes. METHODS: Participants were categorized into groups based on trauma exposure and PTSD symptoms via diagnostic interview: (1) No Trauma, those who had not experienced a Criterion A trauma; (2) Trauma Only, those who experienced a Criterion A trauma but did not currently have PTSD; and (3) PTSD, those with current full or partial PTSD related to a Criterion A trauma. Alcohol consumption and related consequences also were measured via interview (TLFB, B-YAACQ). RESULTS: For all participants, nearly 50% more consequences were reported on pregaming days compared to nonpregaming drinking days. Those with PTSD were significantly more likely to pregame than those in the Trauma Only and No Trauma groups. Moreover, students with PTSD reported more consequences on pregaming days relative to the other two groups. In all analyses, the No Trauma and Trauma Only groups did not differ. CONCLUSIONS: PTSD may confer risk both for pregaming and experiencing harmful consequences on pregaming days.

Personality-Based PTSD Subtypes in Young Adults.

The symptom presentation of Posttraumatic Stress Disorder (PTSD) varies widely between individuals, which can complicate both diagnosis and treatment. Personality may help to explain this variability, and personality-based subtypes of PTSD (Externalizing, Internalizing, Simple; Miller et al., 2003) have been identified for this purpose. Yet, empirical tests of these subtypes have been limited, focusing largely on older samples with combat trauma or other homogenous trauma types. Our study examined PTSD subtypes in two samples of young adults with heterogeneous trauma exposure using cluster analyses. We tested for subtype-based heterogeneity in traumatic response (i.e., PTSD symptomatology). Results revealed that, across the two samples, Externalizing (low conscientiousness, moderate neuroticism), Internalizing (low extraversion, moderate neuroticism), and Simple (low neuroticism) personality-based subtypes emerged, consistent with the existing literature. Subtype-based differences in PTSD symptom severity also were observed, with the Simple subtype generally exhibiting less severe PTSD symptomatology than Internalizing and Externalizing subtypes. However, the subtypes did not differ in terms in number or type (interpersonal versus non-interpersonal) of traumatic experiences. Findings support PTSD subtypes and their relevance for post-traumatic response, particularly PTSD severity, in young adults with a variety of trauma types.

Sexual victimization histories and substance use trajectories during the transition out of college.

The college years are a period of peak vulnerability for sexual victimization (SV) and substance misuse. During college, students with SV histories report riskier substance use patterns, yet little is known about the influence of SV on substance use behaviors as students begin to transition away from the college environment. This was the purpose of the present study. College seniors (N = 480; 61% female) reported on their alcohol and drug use behaviors across 5 time points spanning 1 calendar year. For many, this year included the transition out of college. Latent growth curve analysis was used to determine whether trajectories for alcohol and drug use as well as alcohol and drug consequences differed based on SV histories (no SV, precollege SV, college SV, precollege + college SV). Results revealed that at the start of senior year, young adults with SV histories reported greater substance use and consequences relative to nonvictimized peers. Over the year, SV histories were associated with steeper declines in substance use and consequences. Despite the declines, those who were revictimized across developmental time periods (precollege + college SV) consistently reported higher alcohol use and consequences across the transitional year, although this did not replicate for other drugs. In sum, although alcohol and other drug involvement among those with SV histories decreased over time, precollege + college SV histories continued to be a persistent risk factor for heavier alcohol use behaviors. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Associations among trauma, depression, and alcohol use profiles and treatment motivation and engagement in college students.

OBJECTIVE: This study examined how profiles of alcohol use and symptoms of common mental health disorders (depression and posttraumatic stress disorder [PTSD]) influenced the perceived need for and actual seeking of different types of treatment (for alcohol versus psychological distress) in college student drinkers. PARTICIPANTS: Undergraduate students (n = 164) were assessed between September 2009 and August 2015. METHODS: We classified students into different symptom profiles using model-based clustering and compared these profiles on a variety of variables. RESULTS: The cluster model yielded three profiles: Low Risk (n = 66), Concomitant (n = 35), and Heavy Drinking (n = 63). Students in these profiles significantly differed in alcohol consumption, alcohol-related cognitions and problems, and perceptions of need and prior engagement in treatment. CONCLUSION: A variety of strategies can be used to engage students experiencing heavy drinking and/or mental health problems into treatment on campus.

Mechanistic Role of Emotion Regulation in the PTSD and Alcohol Association.

OBJECTIVE: Posttraumatic Stress Disorder (PTSD) has been linked to problematic alcohol use. Those with PTSD have greater difficulty regulating emotions, which may help to explain the PTSD-drinking co-occurrence. However, emotion regulation as a mediator of PTSD-alcohol associations has been limited. In the present study, we examined this association. METHOD: College students (N = 466, Mage = 19.5, 53% female) were assessed for PTSD by structured clinical interview, and were categorized into three groups: those who had not experienced a significant trauma (No Trauma, n = 182), those who had experienced a significant trauma but did not have current PTSD symptoms (Trauma Only, n = 171), and those with significant trauma and with current PTSD (partial or full; PTSD, n = 113). Alcohol use over the past six months and emotion regulation were assessed via self-report (DDQ; Collins, Parks, & Marlatt, 1985; DERS; Gratz & Roemer, 2004). RESULTS: Findings revealed that those with trauma and clinically significant PTSD reported greater difficulty with emotion regulation than those who had not been exposed to trauma, which in turn significantly predicted alcohol use. This mediating effect was not found in those with trauma exposure alone, suggesting an important role for PTSD in this pathway. Findings also indicated that the ability to control emotion-based impulses is a particularly relevant mediating facet of emotion regulation. CONCLUSION: These results implicate emotion regulation as a potential explanatory link between PTSD and alcohol use, lending further support to the inclusion of emotion regulation training in PTSD treatment.

Identification of hazardous drinking with the Young Adult Alcohol Consequences Questionnaire: Relative operating characteristics as a function of gender.

Heavy and problematic drinking is common on college campuses and is associated with myriad hazardous outcomes. The Young Adult Alcohol Consequences Questionnaire (YAACQ; Read et al., 2006) was developed to provide comprehensive and expedient assessment of negative consequences of young adult drinking and has been used in a number of research and clinical settings. To date, no empirically derived cutoffs for the YAACQ have been available for use in the identification of those drinkers at greatest risk. This was the objective of the present study. In a large (N = 1,311) and demographically heterogeneous multisite sample, we identified cutoff scores for the YAACQ, and the contrasted detection of hazardous drinking using these cutoffs with those recommended for the Alcohol Use Disorders Identification Test (AUDIT). We also examined whether cutoffs differed by gender. Results of receiver operating characteristic (ROC) analysis yielded cutoffs that delineate 3 levels (or zones) of hazardous drinking risk: low, moderate, and high. A cutoff of 8 differentiated those at low risk from those at moderate risk or greater, and a cutoff of 16 differentiated between moderate and high risk. These zones corresponded to other indices of risky drinking, including heavy episodic "binge" drinking, more frequent alcohol consumption, and engagement in alcohol risk behaviors. Scores differentiating low to moderate risk differed for men (8) and women (10), whereas the cutoff for high risk was the same (16) across the sexes. Findings suggest that the YAACQ can be used to reliably assess level of drinking risk among college students. Furthermore, these cut scores may be used to refer to interventions varying in intensity level, based on level of indicated alcohol risk. (PsycINFO Database Record

Associations among Trauma, Posttraumatic Stress, and Hazardous Drinking in College Students: Considerations for Intervention.

Students with trauma and posttraumatic stress are disproportionately at risk for heavy drinking and for alcohol-related consequences. Brief motivational interventions (BMIs) have been shown to reduce hazardous drinking in college students, and could serve as a first-line approach to reduce heavy drinking in students with trauma and posttraumatic stress (PTS). Yet the standard BMI format may not adequately address the factors that lead to hazardous drinking in these students. Here, we review the literature on PTS and hazardous drinking in college students, and highlight cognitive (self-efficacy, alcohol expectancies) and behavioral (coping strategies, emotion regulation skills, protective behaviors) factors that may link trauma and PTS to drinking risk. Incorporating these factors into standard BMIs in a collaborative way that enhances their personal relevance may enhance intervention efficacy and acceptability for these at-risk students.

The role of goals and alcohol behavior during the transition out of college.

Personal goals are desired outcomes that guide behavior (Palfai, Ralston, & Wright, 2011), and are typically oriented around age-appropriate developmental tasks (e.g., college graduation, employment). Goals and their pursuit take on much salience during senior year of college as individuals prepare for the transition into adult roles. This also is a time during which naturalistic changes in alcohol consumption are occurring. These changes may impact the relationship between age-related goals and their attainment, thus compromising the likelihood of a successful transition out of college. The present study examined whether and how changes in drinking over senior year moderate the association between achievement goals and related developmental task attainment as students move toward transitioning out of college. Alcohol-involved college seniors (N = 437; 62.5% female) were assessed via web survey in September of their senior year and again 1 year later (T4). Results of multinomial logistic regression revealed that greater achievement goals were predictive of college graduation (vs. remaining a continuing undergraduate), but only for those whose drinking decreased during senior year. Among those graduated by T4 (n = 307), achievement goals predicted pursuing graduate education (vs. being unemployed), but only for students whose drinking increased during senior year. Thus, achievement goals are important predictors of goal attainment as students prepare to transition out of college, and these goals can interact with drinking in complex ways during this time. Findings suggest that interventions aimed at bolstering personal goals and reducing drinking during senior year may increase the likelihood of successful transitions out of the college environment.