Negative Affect Mediates the Association between Posttraumatic Cognitions and Craving in Veterans with Posttraumatic Stress Disorder and Alcohol Use Disorder

Abstract

Objective: The co-occurrence of posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) is common. Individuals with PTSD/AUD commonly drink to cope with PTSD symptoms, which maintains PTSD/AUD, and may result in increased craving for alcohol. Negative affect is implicated in negative reinforcement models of craving. Further, Emotional Processing Theory posits that posttraumatic cognitions lead to the experience of negative affect, which may result in increased craving in PTSD/AUD. The current study aims to advance the understanding of craving in PTSD/AUD by evaluating if specific posttraumatic cognitions (e.g., cognitions about the self, world, and self-blame) are associated with increased negative affect, and whether higher negative affect is associated with heightened craving. Methods: Three separate simple mediation models were utilized to test if negative affect mediated the relationship between each specific posttraumatic cognition type and craving among 136 treatment-seeking veterans with PTSD/AUD. Results: We found that negative affect mediated the association between all posttraumatic cognition types and craving. Specifically, viewing oneself as being unable to handle PTSD-related distress, viewing the world as very dangerous, and blaming oneself for one’s role in a traumatic event were all associated with increased negative affect, which was related to higher craving. Conclusions: Given that posttraumatic cognitions improve via trauma-focused treatment for PTSD, future work should evaluate whether improvements in posttraumatic cognitions via trauma-focused treatment lead to decreased negative affect and craving in PTSD/AUD.

Keywords:

• Posttraumatic stress disorder (PTSD)
• alcohol use disorder (AUD)
• craving
• negative affect

Acknowledgments

The authors would like to thank Kaitlyn Panza, PhD, for her invaluable contributions to discussions about alcohol craving in the context of PTSD comorbidity. This project was presented as a poster presentation at the 2019 35th Annual International Society for Traumatic Stress Studies Annual Meeting in Boston, Massachusetts.

Disclosure statement

Drs. Norman and Haller, and Ms. Rivera reported receiving funding from the US Department of Veterans Affairs during the conduct of this study. Mr. Lyons reported receiving funding from the National Institute on Alcohol Abuse and Alcoholism during the conduct of this study. Authors have no conflicts of interest or additional funding sources to disclose.

Additional information

Funding

This material is the result of work supported with resources and the use of facilities at the National Center for PTSD, the VA San Diego Healthcare System, and the Center of Excellence for Stress and Mental Health. Funding for this work was made possible by a Veterans Affairs Clinical Science Research and Development Merit Grant [1I01CX000756] (PI: Sonya Norman, PhD). Mr. Lyons was supported by an institutional T32 fellowship [T32AA013525] through the National Institute on Alcohol Abuse and Alcoholism.