Social anxiety and alcohol-related outcomes: the mediating role of drinking context and protective strategies

Purpose: Students with social anxiety are vulnerable to hazardous drinking patterns due to their social evaluative fears and tendency to perceive alcohol use as a socially-approved, normative behavior. These students do not drink as often as their peers, yet they experience more alcohol-related consequences. Thus, it is important to identify specific anxiety-provoking drinking contexts that trigger these students to engage in hazardous episodic drinking. These students are also less likely to seek treatment for mental health or substance use issues, pointing to the importance of examining their use of protective strategies, particularly in those anxiety-provoking contexts. Evidence supports the unique roles of drinking context and protective strategies as influencing the link between social anxiety and alcohol-related outcomes. Therefore, the current study tested the unique and synergistic effects of drinking context and protective strategies on the social anxiety-alcohol outcomes relationship. 

Materials and methods: Data from 678 traditional-aged college students were collected via measures assessing social anxiety symptoms, drinking contexts, and safe and risky drinking behaviors.

Results: Mediation analyses indicated that negative coping drinking contexts and serious harm reduction protective strategies independently mediated the link between interaction social anxiety and hazardous drinking, and between social anxiety and alcohol-related consequences, respectively. Further, negative coping drinking contexts and serious harm reduction strategies sequentially mediated the positive association between interaction social anxiety and alcohol-related consequences. 

Conclusions: There appears to be a complex interplay of cognitive, social, and environmental factors making students with social interaction fears more susceptible to alcohol-related harm and less focused on using safe drinking strategies. Implications and directions for future research are outlined.     

Protective behavioral strategies for reducing alcohol involvement: A review of the methodological issues

Alcohol use among college students remains a major public health concern with many students experiencing negative alcohol-related consequences as a result of their drinking. Protective behavioral strategies (PBS) have been conceptualized as skills used by drinkers to moderate their drinking and/or resulting consequences. The correlational evidence for the relationships among PBS, alcohol use, and related problems has been mixed. Experimental research reveals inconsistent relationships among intervention condition, PBS use, and alcohol outcomes. There is currently insufficient evidence to support the claim that PBS function as a mechanism of behavior change for college drinkers. We propose that the inconsistencies found in the correlational and experimental research are explained in part by psychometric and methodological issues. This review summarizes measurement and methodological issues in studies that have directly assessed the relationship between PBS and alcohol use and/or alcohol-related consequences in college drinking samples. Additionally, we provide some suggestions and future directions to overcome methodological and conceptual limitations and to advance understanding of the role of protective behavioral strategy use in reducing alcohol involvement among college drinkers.     

The nature and correlates of young women's peer-directed protective behavioral strategies

Objective

Recently, a number of studies have identified self-employed Protective Behavioral Strategies (PBS) as effective in decreasing the level of alcohol-related harm among young people. However, much of the published research has ignored important gender differences, such as women's increased tendency to rely on PBS that are social in nature. To further the understanding of women's PBS, the current study sought to investigate the nature and correlates of the strategies young women employ to keep their friends safe when drinking (i.e., peer-directed PBS).

Method

A scale measuring peer-directed PBS was developed and administered in conjunction with existing measures of alcohol consumption, personal PBS, and peer attachment. Participants consisted of 422 women aged 18–30 years, recruited among psychology students and the general public.

Results

Exploratory factor analysis revealed two clusters of peer-directed PBS; those that were aimed at reducing intoxication among one's friends and those that were designed to minimize alcohol-related harms. Further analysis found a positive relationship between women's tendency to implement personal and peer-directed PBS and that risky drinkers were less likely to engage in personal or peer-directed PBS (either type).

Conclusion

Findings indicate that personal and peer-directed PBS are related behaviors that are less frequently adopted by risky drinkers.     

Sleep quality,problematic cannabis use and posttraumatic stress symptoms among medical cannabis users

This study aimed to investigate the interactive influence of problematic cannabis use on the relation between sleep quality and posttraumatic stress symptoms (PTSS). Hypotheses were tested cross-sectionally among 151 medical cannabis users with PTSS. Consistent with hypotheses, we found sleep quality to be associated with PTSS severity. In addition, results indicated a significant interaction such that individuals with poor sleep quality and problematic cannabis use had the highest PTSS severity (particularly hyperarousal symptoms). Results suggest that medical cannabis users with the greatest risk of severe PTSS may be those with a combination of poor sleep quality and problematic cannabis use.     

Protective behavioral strategies mediate the effect of drinking motives on alcohol use among heavy drinking college students: gender and race differences

Objective

This study examined the extent to which protective behavioral strategies (PBS) mediated the influence of drinking motives on alcohol consumption, and if these hypothesized relationships were corroborated across subsamples of gender and race.

Method

Online surveys were completed by 1592 heavy drinking college undergraduates from two universities (49.9% male and 50.1% female; 76.9% Caucasian and 23.1% Asian). Independent samples t-tests compared males and females as well as Caucasians and Asians on measures of drinking motives, PBS use, and alcohol consumption, and structural equation models examined the mediating role of PBS.

Results

Consistent with predictions, t-tests revealed that males reported greater levels of consumption than females, but females reported greater use of PBS than males. Caucasians reported greater consumption levels, endorsed higher enhancement motives, and higher PBS related to serious harm reduction, but Asians endorsed higher coping and conformity motives, and PBS focused on stopping/limiting drinking. In multiple-sample SEM analyses, PBS were shown to largely mediate the relationship between motives and consumption in all demographic subsamples.

Conclusions

Findings indicate that PBS use leads to reductions in drinking despite pre-established drinking motives, hence pointing to the potential value of standalone PBS skills training interventions in lowering alcohol use among diverse groups of heavy drinking college students.     

Drinking motives, protective behavioral strategies, and experienced consequences: Identifying students at risk

The association between drinking motives and protective behavioral strategies was explored, including whether individuals with different drinking motives were more or less likely to utilize protective behavioral strategies and whether the combination of drinking motives and use of protective strategies may help identify individuals at elevated risk for alcohol-related problems. The final sample included 358 college students (59.2% female; M=18.47 years old, SD=.58). Individuals who had greater enhancement and social motives for drinking used protective strategies less frequently, controlling for number of drinks per week; those who had greater conformity motives used protective strategies more frequently. Coping motives were not significantly correlated with the mean of protective factors, but were associated with less frequently using individual strategies. Using protective strategies more frequently was associated with consuming fewer drinks and having lower RAPI scores. Interactions of drinking motives with the number of protective strategies tended to be non-significant; however, significant interactions indicated that greater coping and conformity motives were especially associated with negative outcomes among individuals who used fewer protective strategies.     

Protective strategies: A mediator of risk associated with age of drinking onset

The goal of the current study was to determine if failure to develop/utilize alcohol-specific strategies to manage drinking behavior might serve as a mechanism through which early alcohol exposure leads to higher levels of later alcohol use and alcohol-related negative consequences, while taking into account impulsivity as an underlying risk factor for both of these outcomes. Data were collected between September and December of 2005 from a random sample of college students via an online survey. A total of 309 students provided complete data on all measure of interest. Separate regression analyses predicting typical weekly alcohol consumption and alcohol-related problems indicated that use of alcohol-specific protective strategies partially mediated the effect of age of first use on these outcomes. An earlier age of onset was associated with less frequent use of alcohol-specific protective strategies, which in turn was associated with drinking- and alcohol-related problems. Implications for tailoring alcohol prevention and intervention programs targeting adolescents are discussed.     

Novel pharmacological treatment strategies for posttraumatic stress disorder

Introduction: A wide range of medications have been studied for posttraumatic stress disorder (PTSD) and a number are registered for this indication. Nevertheless, current pharmacotherapies are only partially effective in some patients, and are minimally effective in others. Thus novel treatment avenues need to be explored.

Areas covered: In considering novel pharmacological agents for the treatment of PTSD, this paper takes a translational approach. We outline how advances in our understanding of the underlying neurobiology of PTSD may inform the identification of potential new treatment targets, including glutamatergic, noradrenergic and opioid pathways.

Expert commentary: Continued investigation of the neural substrates and signalling pathways involved in responses to trauma may inform the development of novel treatment targets for future drug development for PTSD. However, the translation of preclinical findings to clinical practice is likely to be complex and gradual.     

The relationship of stress and coping methods to adolescent marijuana use

As the use of marijuana among adolescents remains high, more effective interventions are needed. We conducted this cross‐sectional survey at an outpatient, university‐based, adolescent clinic to determine the prevalence of marijuana use in an inner‐city adolescent population and to examine the relationship of stress and coping methods to marijuana user status (never user, experimenter, and frequent user). The subjects were 918 adolescents aged 12–21 years. Lifetime use in this population was 59% (n = 611) with 18.4% (n = 191) reporting frequent weekly use. Almost all (97%) marijuana users acknowledged marijuana use by friends. Stepwise logistic regression analysis showed that negative life events, greater use of the negative coping method of anger and less frequent use of the positive coping method of parental support were significantly and independently related to marijuana user status. In the presence of high peer use, exploring parent‐child relationships and use of anger coping and intervening accordingly may decrease marijuana use.     

Depressive Symptoms and Drinking Outcomes: The Mediating Role of Drinking Motives and Protective Behavioral Strategies Among College Students

Background: College students with depressive symptoms tend to engage in more hazardous drinking and experience more alcohol-related consequences to cope with their symptoms. Given the perceived tension reducing effects of alcohol among these students, it is important to explore how protective factors, such as protective behavioral strategies, account for the relationships among depressive symptoms, drinking motives, and alcohol-related outcomes. Objective: To examine the mediating role of drinking motives and protective behavioral strategies on the associations that depressive symptoms have with typical weekly alcohol consumption, hazardous drinking, and alcohol-related negative consequences in a sample of college student drinkers. Methods: Traditional age college students (n = 566, 73% women; 58% White, non-Hispanic) completed measures of depression, drinking motives, protective behavioral strategies, weekly alcohol use, hazardous drinking, and alcohol-related negative consequences. Results: Coping with depression motives and controlled consumption PBS explained the association between depression and weekly alcohol consumption and hazardous drinking whereas coping with depression motives and serious harm reduction PBS explained the depression-negative consequences relationship. Conformity motives and serious harm reduction PBS explained the association between depression and hazardous drinking and alcohol-related negative consequences. Conclusions: Findings suggest that students with more depressive symptoms would benefit from clinical interventions tailored to address negative reinforcement drinking motives and, by extension, increase student utilization of PBS related to minimizing harm. Clinical and research implications are provided.     

Protective Behavioral Strategies Mediate the Relation Between Sensation Seeking and Marijuana-Related Consequences

Background: Greater levels of sensation seeking are associated with experiencing more marijuana-related consequences (MRC). Protective behavioral strategies (PBS) use is associated with both the lower frequency of marijuana use and fewer marijuana-related consequences. However, research has not examined whether PBS use mediates the relation between sensation seeking and MRC. Methods: The current study is a secondary data analysis of the initial Marijuana Outcomes Study Team data collection. A path analysis was conducted to assess for indirect effects from both risk and experience seeking (facets of sensation seeking) to MRC via frequency of PBS use, controlling for marijuana use frequency. Results: We found negative relations between both experience seeking and PBS and MRC, and a positive relation between risk seeking and MRC. Furthermore, PBS mediated the relation between both risk and experience seeking and MRC. Conclusions: Results suggest that PBS is a mediator of the sensation seeking-MRC relationship. Discussions about selecting and implementing PBS use may be particularly useful for treatment of clients high in risk seeking.     

Semester and event-specific motives for alcohol use during Spring Break: Associated protective strategies and negative consequences

Motives surrounding alcohol use behavior are important for understanding college student drinking. However, no previous research has addressed how motives for and against drinking during specific events associated with high-risk drinking, such as Spring Break, may differ from motives for and against drinking during the regular semester. Further, we examine the extent to which semester and Spring Break motives are associated with alcohol use, protective behavioral strategies (PBS), and consequences. Participants were college students (N = 261; 55% women) who provided data both immediately prior to (Wave 1) and after (Wave 2) Spring Break. Fun/Social motives for drinking were greater for Spring Break, and Driving motives against drinking were lower for Spring Break, compared to semester drinking. Relax and Image motives for drinking and Physical/Behavioral motives for not drinking during Spring Break did not differ from semester motives. Spring Break motives for and against drinking were associated with total drinks, maximum drinks, PBS, and experienced negative consequences during Spring Break. Students' specific motives regarding drinking during Spring Break predict high-risk drinking and may be utilized in creating salient event-specific interventions.     

Protective behavioral strategy use and motivations for drinking: Exploring Alternatives to Drinking strategies

Protective behavioral strategy (PBS) use is associated with less alcohol consumption and fewer alcohol-related problems. Further, greater endorsement of social or enhancement drinking motives (i.e., positive motives) is associated with less frequent PBS use. Limited research has, however, explored coping or conformity motives (i.e., negative motives) in relation to PBS. Consequently, the present study aimed to (1) identify the types of PBS most strongly associated with negative and positive motives and (2) examine different types of PBS as mediators of the relationship between each drinking motive and alcohol outcomes. Participants were college students (n = 303; 70% women) who completed measures of drinking motives, PBS, alcohol use, and alcohol-related problems. Results indicated that greater endorsement of positive drinking motives were more strongly associated with less frequent use of PBS while drinking whereas negative motives were more strongly related to less frequent Alternatives to Drinking strategy use. Further, strategies used while drinking were more relevant in a model of positive drinking motives and Alternatives to Drinking strategies were more relevant in a model of negative motives. These findings may suggest that whereas individuals with stronger positive motives have difficulty using strategies while drinking, individuals who drink to cope or conform have greater difficulty utilizing Alternatives to Drinking strategies. Based on our results demonstrating that different types of PBS are more relevant for various types of drinkers, it may be important for future interventions to discuss not only the participant's PBS use but also their motivations for consuming alcohol.     

Single and dual diagnoses of major depressive disorder and posttraumatic stress disorder predicted by triple comorbid trajectories of tobacco,alcohol, and marijuana use among urban adults

Background: The adverse consequences of major depressive disorder (MDD) and posttraumatic stress disorder (PTSD) affect a significant portion of the US population every year (i.e., 15 million for MDD; 8 million for PTSD) and are of public health concern. The current study examines tobacco, alcohol, and marijuana use as possible longitudinal predictors of MDD and/or PTSD. Methods: A community sample of 674 participants (53% African Americans and 47% Puerto Ricans; 405 females and 269 males) were recruited from the Harlem Longitudinal Development Study. We used Mplus software to obtain the triple trajectories of tobacco, alcohol, and marijuana use from mean age 14 to 36. Logistic regression analyses were then conducted to examine the associations between those triple trajectory groups and a single diagnosis of MDD or PTSD as well as a dual diagnosis of MDD with PTSD at age 36. Results: The observed percentages of MDD, PTSD, and the comorbidity of MDD and PTSD were 17%, 8%, and 5%, respectively. The heavy use of all 3 substances group was associated with an increased likelihood of having MDD (adjusted odds ratio [AOR]?=?3.14, P?<?.01), PTSD (AOR?=?3.91, P?<?.05), and MDD with PTSD (AOR?=?6.64, P?<?.01), as compared with the tobacco and alcohol use group. Conclusions: Treatment programs to quit or reduce the use of tobacco, alcohol, and marijuana may help decrease the prevalence of MDD and PTSD. This could lead to improvements in individualized treatments for patients who use tobacco, alcohol, and marijuana and who have both MDD and PTSD.     

Post-traumatic stress disorder: an evaluation of existing pharmacotherapies and new strategies

Post-traumatic stress disorder (PTSD) is often a chronic and disabling anxiety disorder that develops after exposure to a traumatic event. Researchers have demonstrated efficacy for both pharmacologic and psychosocial interventions in the treatment of PTSD. First-line pharmacotherapeutic options are the selective serotonin re-uptake inhibitors and serotonin noradrenaline re-uptake inhibitors. Older antidepressant agents, such as the tricyclic antidepressants and the monoamine oxidase inhibitor, phenelzine, have also proven efficacy in PTSD among more established agents. However, concerns for side effects have limited frequent use of these. Existing pharmacologic agents produce meaningful results and bear the advantage of treating depression and other co-morbid disorders, yet still fall short of being ideal due to limited response and remission rates and tolerability issues. The need for improving pharmacotherapy of PTSD remains compelling and directions for further research are discussed.     

The Role of Protective Behavioral Strategies,Social Environment,and Housing Type on Heavy Drinking among College Students

Background: Though research has examined heavy drinking by housing type, the link between type of college student housing and protective behavioral strategies (PBS) has rarely been examined comparing different college campuses. Objectives: The purpose of this study is to examine the role of housing type, perceptions of peer drinking, and PBS with respondent heavy drinking among undergraduate college students from one Southeastern and one Midwestern university in the United States. Methods: 1,448 college students enrolled in undergraduate courses at two public universities completed a paper and pencil survey of attitudes and experiences about dating, sexuality, and substance use. Data were analyzed using multiple group path analysis. Results: Students living in Greek housing perceived their close friends as engaging in more risky drinking, and had higher rates of heavy drinking compared to those living in other housing types. The effect of perceptions of peer drinking on PBS was significantly different between campuses as were several other indirect pathways to heavy drinking. Conclusion/Importance: Understanding more about the differing roles of college residential environments can help inform effective drinking interventions, and reduce heavy drinking among college students.     

Risky sexual behavior among cannabis users: The role of protective behavioral strategies

Cannabis users tend to use condoms less often than cannabis abstainers, placing them at risk for sexually transmitted disease and unplanned pregnancies. This is especially problematic among college students, who experience such problems at especially high rates. Despite accumulating data indicating that cannabis users are less likely to use condoms, little research has identified potentially malleable cognitive vulnerability factors that may be related to condom use in this vulnerable population. Thus, the current study tested whether cannabis users believed others use condoms less often and/or whether they engaged in less condom-related protective behavior strategies (PBS) than cannabis abstainers and whether cannabis use status was indirectly related to condom use via these vulnerability factors. Among 214 college students (64 past-month cannabis users), cannabis users engaged in less PBS (although cannabis use was unrelated to normative beliefs). Cannabis use status was indirectly related to condom use via PBS and cannabis use status was unrelated to condom use after controlling for PBS. Results highlight the importance of PBS use among cannabis users, a group at particular risk for risky sexual behaviors.     

Post-traumatic stress disorder and opioid use disorder: A narrative review of conceptual models

Post-traumatic stress disorder is highly prevalent among individuals who suffer from opioid use disorder. Compared to individuals with opioid use disorder alone, those with post-traumatic stress disorder have a worse course of illness, occupational functioning, and physical health. The neurobiological pathways underlying each disorder overlap substantially, and there are multiple pathways through which these disorders may interact. This narrative review explores evidence underpinning 3 explanatory perspectives on comorbid post-traumatic stress disorder and opioid use disorder: The opioid susceptibility model (a.k.a.: the Self-Medication Hypothesis), the post-traumatic stress disorder susceptibility model, and the common factors model. Diagnostic implications, treatment implications, and directions for future research are discussed.     

Post-traumatic stress disorder: emerging concepts of pharmacotherapy

Post-traumatic stress disorder (PTSD) can result from a traumatic experience that elicits emotions of fear, helpless or horror. Most individuals remain asymptomatic or symptoms quickly resolve, but in a minority intrusive imagery and nightmares, emotional numbing and avoidance, and hyperarousal persist for decades. PTSD is associated with psychiatric and medical co-morbidities, increased risk for suicide, and with poor social and occupational functioning. Psychotherapy and pharmacotherapy are common treatments. Whereas, research supports the efficacy of the cognitive behavioral psychotherapies, there is insufficient evidence to unequivocally support the efficacy of any specific pharmacotherapy. Proven effective pharmacologic agents are sorely needed to treat core and targeted PTSD symptoms, and for prevention. This review describes current and emerging pharmacotherapies that advance these goals.