Gender and Direction of Effect of Alcohol Problems and Internalizing Symptoms in a Longitudinal Sample of College Students

Background: Alcohol problems and internalizing symptoms are consistently found to be associated but how they relate to each other is unclear. Objective: The present study aimed to address limitations in the literature of comorbidity of alcohol problems and internalizing symptoms by investigating the direction of effect between the phenotypes and possible gender differences in college students. Method: We utilized data from a large longitudinal study of college students from the United States (N = 2607). Three waves of questionnaire-based data were collected over the first two years of college (in 2011–2013). Cross-lagged models were applied to examine the possible direction of effect of internalizing symptoms and alcohol problems. Possible effects of gender were investigated using multigroup modeling. Results: There were significant correlations between alcohol problems and internalizing symptoms. A direction of effect was found between alcohol problems and internalizing symptoms but differed between genders. A unidirectional relationship varying with age was identified for males where alcohol problems initially predicted internalizing symptoms followed by internalizing symptoms predicting alcohol problems. For females, a unidirectional relationship existed wherein alcohol problems predicted internalizing symptoms. Conclusions/Importance: We conclude that the relationship between alcohol problems and internalizing symptoms is complex and differ between genders. In males, both phenotypes are predictive of each other, while in females the relationship is driven by alcohol problems. Importantly, our study examines a population-based sample, revealing that the observed relationships between alcohol problems and internalizing symptoms are not limited to individuals with clinically diagnosed mental health or substance use problems.     

Anxiety and depression in alcohol use disorder individuals: the role of personality and coping strategies

Background: Anxiety and depression favor the maintenance and relapse of alcohol use disorders (AUDs). Some five factor model personality dimensions (e.g. high neuroticism, low extraversion, and conscientiousness) and coping strategies (e.g. high avoidant and low problem-focused) are associated with AUD and with anxiety and/or depression in AUD individuals. Objectives: This study aimed to investigate personality and coping in an AUD population as potential predictors of anxiety and depression. Methods: Through a cross-sectional and multicenter study, 122 AUD people (74 men and 48 women) responded to a sociodemographic interview and three self-questionnaires assessing personality (BFI), coping strategies (brief COPE), and anxiety-depression symptomatology (HADS). Comparative and correlational analyses, as well as hierarchical regressions, were performed. Results: AUD women show higher neuroticism, use more emotion-focused coping and less problem-focused coping than AUD men. They also present higher anxiety. Neuroticism is associated with an ineffective use of coping strategies. Other dimensions, such as openness to experience, extraversion, and conscientiousness, show negative relationships with avoidant coping and positive links with problem-focused strategies. Neuroticism, avoidant coping and gender are predictive for anxiety. Both avoidant and problem-focused coping, but no personality dimension, are predictive for depression. Conclusion: These findings underscore the importance of interventions involving specific coping strategies in AUD patients (whether or not anxiety and/or depression is present), both to reduce alcohol use and prevent relapse. Specific therapeutic support for women would be beneficial in the case of anxiety comorbidity.     

Neurotic Personality Traits and Risk for Adverse Alcohol Outcomes: Chained Mediation through Emotional Disorder Symptoms and Drinking to Cope

Background: Rates of alcohol abuse are high on Canadian postsecondary campuses. Individual trait differences have been linked to indices of alcohol use/misuse, including neurotic traits like anxiety sensitivity (AS) and hopelessness (HOP). We know little, though, about how these traits confer vulnerability. AS and HOP are related to anxiety and depression, respectively, and to drinking to cope with symptoms of those disorders. Neurotic personality may therefore increase risk of alcohol use/abuse via (1) emotional disorder symptoms and/or (2) coping drinking motives. Objectives: Allan and colleagues (2014) found chained mediation through AS-generalized anxiety-coping motives-alcohol problems and AS-depression-coping motives-alcohol problems. We sought to expand their research by investigating how emotional disorder symptoms (anxiety, depression) and specific coping motives (drinking to cope with anxiety, depression) may sequentially mediate the AS/HOP-to-hazardous alcohol use/drinking harms relationships among university students. Methods: This study used cross-sectional data collected in Fall 2014 as part of the Movember-funded Caring Campus Project (N = 1,883). The survey included the SURPS, adapted DMQ-R SF, and AUDIT-3. Results: AS and HOP were both related to hazardous alcohol and drinking harms via emotional disorder symptoms and, in turn, coping drinking motives. All indirect pathways incorporating both mediators were statistically significant, and additional evidence of partial specificity was found. Conclusions/Importance: The study's results have important implications for personality-matched interventions for addictive disorders.     

Risk Factors for Alcohol-Related Problems Among Victims of Partner Violence

Despite the high prevalence of alcohol-related problems and disorders among women who experience intimate partner violence (IPV), factors related to current alcohol use are understudied. We examined current risk factors for alcohol-related problems among 143 substance-using, IPV-exposed women recruited from an urban community from 2007 to 2010. Posttraumatic stress disorder (PTSD) symptom severity was associated with alcohol-related problems and a positive alcohol screen; physical IPV severity was related to alcohol dependence. Post hoc analyses revealed that PTSD symptom severity mediated relationships between physical IPV severity and hazardous, harmful, and dependent drinking. Focusing on managing PTSD symptoms and physical IPV in community-based interventions may halt the progression from alcohol use to dependence.     

Multisubstance Use Among Treatment-Seeking Smokers: Synergistic Effects of Coping Motives for Cannabis and Alcohol Use and Social Anxiety/Depressive Symptoms

Objective: This study examined the impact of coping motives for cannabis and alcohol use on the relation between social anxiety/depressive symptoms and severity of substance use for alcohol, tobacco, and cannabis among treatment-seeking smokers who also use cannabis and alcohol. Methods: The sample included 197 daily cigarette smokers (M_Age 34.81 years, SD = 13.43) who reported using cannabis and alcohol. Results: Hierarchical multiple regression analyses were conducted wherein separate models were constructed for each dependent variable. Among individuals with higher social anxiety, alcohol coping motives were associated with heavier drinking, and this was more pronounced among those low in depressive symptoms. Similarly, those at greater risk for nicotine dependence were anxious individuals with lower depressive symptoms who endorse coping-oriented motives for using cannabis. Further, among those with higher social anxiety, cannabis coping motives were associated with marginally greater drinking, particularly for those high in depressive symptoms. Conclusions: The present findings support the perspective that among multisubstance users, the interplay between social anxiety, depressive symptoms, and coping-oriented motives for using one substance (e.g., cannabis or alcohol) may pose difficulties in refraining from other substances (e.g., tobacco). This observation highlights the importance of tailoring multisubstance treatments to specific needs of multiusers for whom single-substance interventions may be less effective. Findings also support previous work exploring the benefits of concurrently treating co-occurring substance use and lend credence to the perspective that motivation to use substances for coping reasons is of central theoretical and clinical relevance.     

Bullying Perpetration and Victimization as Externalizing and Internalizing Pathways: A Retrospective Study Linking Parenting Styles and Self-Esteem to Depression,Alcohol Use,and Alcohol-Related Problems

Background: Emerging research suggests significant positive associations between bullying and substance use behaviors. However, these studies typically focused either on the link between substance use and bullying perpetration or victimization, and few have conceptualized bullying perpetration and/or victimization as mediators. Objective: In this study, we simultaneously tested past bullying perpetration and victimization as mediational pathways from retrospective report of parenting styles and global self-esteem to current depressive symptoms, alcohol use, and alcohol-related problems. Methods: Data were collected from a college sample of 419 drinkers. Mediation effects were conducted using a bias-corrected bootstrap technique within a structural equation modeling framework. Results: Two-path mediation analyses indicated that mother and father authoritativeness were protective against bully victimization and depression through higher self-esteem. Conversely, having a permissive or authoritarian mother was positively linked to bullying perpetration, which in turn, was associated with increased alcohol use, and to a lesser degree, more alcohol-related problems. Mother authoritarianism was associated with alcohol-related problems through depressive symptoms. Three-path mediation analyses suggested a trend in which individuals with higher self-esteem were less likely to report alcohol-related problems through lower levels of bullying victimization and depression. Conclusions/Importance: Results suggested that bullying perpetration and victimization may, respectively, serve as externalizing and internalizing pathways through which parenting styles and self-esteem are linked to depression and alcohol-related outcomes. The present study identified multiple modifiable precursors of, and mediational pathways to, alcohol-related problems which could guide the development and implementation of prevention programs targeting problematic alcohol use.     

Indicators of Adolescent Alcohol Use: A Composite Risk Factor Approach

A self-reported alcohol inventory measured prevalence and frequency of lifetime, recent, and current alcohol use by an opportunity sample of 3226 young people aged 11–18 in Welsh secondary schools in 2005 comparing findings to extant U.K. and European levels. A risk factor-based questionnaire enabled comprehensive, sensitive sample profiling by gender and age, combining factor analysis with logistic regression to identify composite risk factors influential upon alcohol use by young people in Wales and salient to policy makers and practitioners, notably the endogenous factors: anti-social behaviour/attitudes, inadequate relationships/activities in school, negative experiences in school, lack of commitment to school, and impulsivity. Overlap with composite risk factors for youth offending was identified, but not with drug use, suggesting that the commonly cited “gateway” relationship between elements of “substance use” requires further examination. The study's limitations and implications are discussed.     

Motivators and Influences on American Indian Adolescent Alcohol Use and Binge Behavior: A Qualitative Exploration

We explore the four-class drinking motives model within the context of peer and family influence on American Indian (AI) adolescent alcohol use, specifically binge behavior. A qualitative cross-sectional case-control study design was utilized; in-depth interviews were collected with 38 AI adolescents from one tribal community. Results suggest a three-class model more accurately captures drinking motives among cases and that family influence is as important as peer. Cases weren't connected to school whereas controls were strongly attached, and engaged in extracurricular programs. Adolescents illuminated culturally relevant prevention strategies that are family based, teach coping skills, and promote school bonding and structured community-based activity.     

Social Problem Solving and Adolescent Alcohol Use Within the Context of Well-Established Risk Factors for Adolescent Alcohol Use

Social problem solving has been associated with alcohol use in adolescents, but has not been examined within the context of well-established risk factors, such as childhood conduct problems, parental history of alcohol use, association with deviant peers, and behavior undercontrol. This study surveyed 120, 18-year-old first-year college students to examine whether poor social problem solving is a risk factor for adolescent alcohol use above and beyond the other well-established risk factors and to examine whether social problem solving is a moderator between behavior undercontrol and alcohol use in adolescents. Hierarchical multiple regressions found that social problem solving was not a significant risk factor above and beyond well-established risk factors for adolescent alcohol use. Furthermore, social problem solving was not a significant moderator between behavior undercontrol and adolescent alcohol use. The results also indicated that association with deviant peers and family income accounted for significant variance in adolescent alcohol use, suggesting association with deviant peers and family income are the risk factors that are most strongly related to adolescent alcohol use.     

Alcohol Use Disorders and Depression: Protective Factors in the Development of Unique versus Comorbid Outcomes

This study examines protective factors for young adult alcohol use disorders, depression, and comorbid alcohol use disorders and depression. Participants were recruited from all fifth-grade students attending 18 Seattle elementary schools. Of the 1,053 students eligible, 808 (77%) agreed to participate. Youths were surveyed when they were 10 years old in 1985 and followed to age 21 years in 1996 (95% retention). Protective factors were measured at age 14 years. Young adult disorders were assessed with the Diagnostic Interview Schedule. Alcohol refusal skills, academic skills, school and family bonding, parental rewards, school rewards, and family cohesion at age 14 years were associated with decreased risk for comorbidity at age 21 years.     

Psychological Risk Factors for Alcohol,Cannabis, and Various Tobacco Use among Young Adults: A Longitudinal Analysis

Background: Alcohol, cannabis, and tobacco use are prevalent in young adults and may be differentially related to psychological symptoms characterized as externalizing or internalizing. Objectives: This study examined the use of alcohol, cannabis, and various tobacco products in relation to externalizing (ADHD) versus internalizing factors (depression, anxiety), hypothesizing alcohol and cannabis use are associated with externalizing factors whereas tobacco use is related to internalizing factors. Methods: Data from a 2-year longitudinal study of 2,397?US college students (aged 18–25) launched in 2014 were analyzed. Adult ADHD Self-Report Scale, Patient Health Questionnaire-9 item (assessing depressive symptoms), and the Zung Self-Rating Anxiety Scale scores were examined in relation to subsequent past 30-day use of alcohol, cannabis, and tobacco products (cigarettes, little cigars/cigarillos, smokeless tobacco, e-cigarettes, hookah), as well as nicotine dependence per the Hooked on Nicotine Checklist. Results: Participants were 20.49 (SD = 1.93) years old, 64.7% female, and 65.5% White. In multivariable analyses, greater ADHD symptoms predicted alcohol and cannabis use (p = .042 and p = .019, respectively). Cigarette and little cigar/cigarillo use were predicted by greater depressive (p = .001 and p = .002, respectively), and anxiety symptoms (p = .020 and p = .027, respectively). Nicotine dependence was correlated with greater anxiety symptoms (p = .026). Counter to hypotheses, smokeless tobacco use was predicted by greater ADHD symptoms (p = .050); neither e-cigarette nor hookah use were predicted by these psychological symptoms. Conclusions/Importance: Research examining risk factors for tobacco use must distinguish among the various tobacco products. Moreover, interventions may need to differentially target use of distinct substances, including among the range of tobacco products.     

Disordered Eating among Adolescents Whose Parents Misuse Alcohol: Protective and Risk Factors

Studies show that children of alcoholics constitute an at-risk population. This study attempted to understand the impact of parental alcohol misuse on the disordered eating behaviors of children, based on a sample of 838 teenagers from alcohol-misusing parents in Minnesota. These teenagers had significantly higher prevalence rates of all the seven eating disordered symptoms that were studied. The study also identified a few protective factors: those who did not develop any of the disordered eating symptoms were more satisfied with their present weight and proud of their body. Further, they had less worry of being sexually abused and perceived that their schools were relatively alcohol-free.     

Personality Risk Factors and Readiness to Change in Mandated and Voluntary College Students Enrolled in an Alcohol Intervention Program

This study compared personality risk factors and readiness to change drinking behavior among mandated and volunteer college students. The sample (N = 583) completed three measures of motivation to change and personality risk factors at baseline, 3 months, and 6 months between 2011 and 2012. Linear mixed models were used to determine an association of continuous outcome variable(s) with covariates over time. Participants in the action stage had lower impulsivity scores. Gender was significant, with females showing the highest anxiety and lowest sensation seeking. The findings indicate a number of future directions to advance innovative alcohol intervention and treatment programs on college campuses.     

Gender Differences in Risk and Protective Factors for Alcohol Use and Substance Use Problems among Hispanic Adolescents

This study investigates gender differences within the context of risk and protective factors for alcohol use and substance use problems in a sample of 8,992 Hispanic students in grades 6 through 12, who responded to a statewide survey of alcohol and other drug use. The effects of gender, grade, and risk and protective factors on past-month alcohol use, binge drinking, and risk for substance use problems are examined. Results show that outcomes were moderated by gender, such that females had greater predicted probabilities than males for alcohol use, binge drinking, and risk for substance use problems across levels of risk and protective factors. An ecological framework is applied to speculate why Hispanic female adolescents were more vulnerable than their males to problem alcohol use.     

Trajectories of Adolescent Alcohol Use: The Effect of Individual and Social Risk Factors by Race

This study examined racial differences across African-American, Hispanic, and White participants in the impact that individual and social risk factors have on drinking behavior trajectories. Data from the National Longitudinal Study of Adolescent Health from seventh through ninth graders (N = 4,372) were used. Participants reported on frequency of drinking across the four waves and risk factors at Wave 1. Growth mixture modeling revealed four trajectories for alcohol use that included Abstainers, Early Starters, Late Starters, and De-Escalators. Social and individual indicators of risk were differently predictive of group membership to the problematic drinking trajectories. Differences across racial groups suggested that a lack of future orientation may be a salient risk factor for African-American and Hispanic youths' alcohol use, and peer alcohol use may be a salient risk factor for White youths' alcohol use. The findings of this study suggest that there may be individual differences in risk factors that provide insight for prevention efforts.     

Sexual Victimization in Female and Male College Students: Examining the Roles of Alcohol use,Alcohol Expectancies,and Sexual Sensation Seeking

Alcohol and alcohol expectancies relate to sexual victimization. The present study examined these links in a sample of 407 predominantly Hispanic male and female college students, along the Mexico–US border. The study also examined the independent contribution of sexual sensation seeking to the prediction of victimization. Results showed that victimization was associated with alcohol risk, alcohol consumption-related problems, and positive alcohol expectancies. Importantly, sexual sensation seeking independently predicted victimization and did so after controlling for alcohol risk and expectancies. Our results suggest that associations among victimization, alcohol risk, and expectancies generalize to Hispanic women and men. The study's limitations are noted.     

Alcohol and Cigarette Use and Misuse Among Hurricane Katrina Survivors: Psychosocial Risk and Protective Factors

The present study examined survivors' use and misuse of cigarettes and alcohol following Hurricane Katrina. We also examined several psychosocial factors that we expected would be associated with higher or lower rates of substance use following the hurricane. Participants were 209 adult survivors of Hurricane Katrina interviewed in Columbia, SC or New Orleans, LA between October 31, 2005 and May 13, 2006. Results revealed that survivors were smoking cigarettes, consuming alcohol, and experiencing alcohol consumption-related problems at a substantially higher rate than expected based on pre-hurricane prevalence data. Results also suggested that certain psychosocial factors were associated with participants' substance use and misuse following the hurricane.     

ADHD Presentation and Alcohol Use Among Juvenile Offenders: A Group-Based Trajectory Modeling Approach

While research has consistently identified attention deficit hyperactivity disorder (ADHD) as a risk factor for alcohol use in adolescence, there has yet to be an examination of how the multiple presentations of the disorder may differentially predict alcohol use. Some have posited that the individual symptom clusters of attention deficit hyperactivity disorder may actually represent distinct and unrelated disorders, providing impetus for examining whether or not they differentially predict alcohol use. Low self-control has consistently been found to be a predictor of alcohol use; therefore it is expected to be the driving force behind ADHD's predictive power for understanding alcohol use. Using the Pathways to Desistance data, this research sought to examine the relevance of this symptom cluster for understanding alcohol use among juvenile offenders. Utilizing group-based trajectory modeling, six alcohol use trajectories across adolescence were identified among the sample of juvenile offenders. Multinomial logistic regression indicated that Predominantly Inattentive Presentation predicted membership to the high chronic drinking pattern, while Predominantly Hyperactive-Impulsive Presentation did not predict membership to any trajectory. The Combined Presentation was found to be the best predictor of membership to the high chronic drinking group. These findings provide impetus for further exploration of the inattentive symptom cluster so that mechanisms by which it affects alcohol use may be better understood.     

Depression and Risk for Problem Drinking in Latino Migrant Day Laborers

Background: Given the structural vulnerability of Latino migrant day laborers (LMDLs) to unstable and poorly paying work, harsh living conditions and frequent inability to support or even visit families in country of origin, psychological distress is a common response and one frequently implicated in risky outcomes such as problem drinking. Objectives: The purpose of this study was to examine the relation of three different forms of psychological distress to problem drinking in LMDLs: depression, anxiety, and desesperación, the latter a popular Latino culture-based idiom of psychological distress. Methods: A cross sectional survey of 344 LMDLs was conducted in the San Francisco Bay Area from January to June of 2014. Independent contributions of depression, anxiety, and desesperación in explaining problem drinking as measured by a modified version of the AUDIT, were assessed using multiple linear regression analysis. Results: Depression was significantly associated with risk for problem drinking while other forms of psychological distress were not. Conclusion/Importance: Findings provide stronger empirical support for the association between depression and problem drinking, a long suspected but under-demonstrated relationship in the literature on LMDLs. Implications for preventing problem drinking as well as mitigating psychological distress more generally for LMDLs are discussed.