The Role of Emotion Dysregulation in Heightened Alcohol Craving Related to Posttraumatic Stress Disorder and Depression Symptoms

Abstract

Objective: Compared to their male counterparts, women with alcohol use disorders (AUD) alone and those with symptoms of co-occurring emotional disorders (posttraumatic stress disorder, PTSD, and depression) are particularly likely to have increased alcohol craving in response to negative affect and daily stressors. Emotion dysregulation is one transdiagnostic construct that may underlie heightened craving in response to stress within this population. In a secondary data analysis, the current study examined emotion dysregulation as a mediator of the associations of posttraumatic stress symptoms (PTSS) and depression symptoms with heightened stress-induced alcohol craving, as measured in the lab. Given the overlap in symptoms, the relative associations of PTSD and depression symptom clusters with stress-induced craving were explored. Method: 50 women Veterans (84% White, 88% Non-Hispanic, M_age=45.68) attended two in-lab sessions. Self-report measures of emotion dysregulation, PTSD, and depression symptoms were administered at baseline. During session two, participants reported on alcohol craving and negative affect at baseline and again after a personalized stress induction procedure. Results: Emotion dysregulation mediated the association of greater PTSS with heightened stress-induced craving, although emotion dysregulation was not a mediator of the association between depression and stress-induced craving. Greater alcohol craving after the stress induction was positively associated with cognitive-affective symptoms in PTSD and depression (and not with other symptom clusters of these diagnoses, e.g., avoidance, somatic-vegetative symptoms). Conclusions: Emotion dysregulation may be a transdiagnostic factor that helps to explain greater alcohol cravings and drinking in stressful contexts among women Veterans with heightened symptoms of co-occurring emotional disorders.

Keywords:

• Women
• veterans
• alcohol
• emotion regulation
• depression stress
• posttraumatic stress disorder

Acknowledgements

The opinions expressed here are those of the authors and do not represent the official policy or position of the U.S. Department of Veterans Affairs or the U.S. government.

Author note

Data and analytic code and methods are available upon request submitted to the corresponding author, [email protected]. This study was not preregistered.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1 Participants who did not report a Criteria A event (n = 11) demonstrated significantly lower PTSD symptom severity compared to those with a Criteria A event, t(13.85) = −2.31, p = 0.04; no difference were found on emotion dysregulation or baseline level of cravings.

2 Post-hoc alternative models including controlling for total AUDIT (AUD severity), condition (cognitive reappraisal v. psychoeducation control, from parent study), and reverse mediation (Cole & Maxwell, 2003; Preacher, 2015) were conducted for both PTSS and depression models. Including the AUDIT or condition as covariates in the models did not improve model fit and revealed the same pattern of results. The reverse mediation models supported the directionality of primary path models, with no significant indirect effects through emotion dysregulation from PTSS or depression.

Additional information

Funding

Work supported by Dept. of Veterans Affairs, Veterans Health Administration CSR&D grant CX001951 (PI: Holzhauer) and VA VISN 1 Career Development Award (PI: Holzhauer).