The Effect of Anxiety Sensitivity on Alcohol Consumption Among Individuals With Comorbid Alcohol Dependence and Posttraumatic Stress Disorder

Center for the Treatment and Study of Anxiety, University of Pennsylvania, Philadelphia, PA 19104, USA.
Psychology of Addictive Behaviors (Impact Factor: 2.09). 05/2011; 25(4):721-6. DOI: 10.1037/a0023799
Source: PubMed


Existing research has shown that anxiety sensitivity (AS) is positively associated with alcohol use, and that individuals with high AS use alcohol to avoid or escape negative affect associated with aversive stimuli. The current study investigated the associations between AS and drinking behavior among individuals with comorbid alcohol dependence and posttraumatic stress disorder (PTSD). We assessed baseline PTSD symptoms, AS, and drinking behavior among 151 participants enrolled in a randomized clinical trial for alcohol dependence. We hypothesized that AS would moderate the association between PTSD symptoms and drinking behavior, with PTSD symptoms being more strongly associated with drinking behavior among individuals with high AS. Results showed that AS was strongly associated with PTSD (r = .48) and moderately associated with drinking behavior (r = .18). As predicted, the interaction of AS with severity of PTSD symptoms was associated with frequency of drinking; however, contrary to our hypothesis, PTSD symptoms were more strongly associated with drinking behavior among individuals with relatively low AS. The implication of the present results for treatment of both PTSD and alcohol dependence are discussed.

Download full-text


Available from: Samantha G Farris, Apr 15, 2014
17 Reads
  • Source
    • "Furthermore, PTSD treatment has been shown to reduce AS severity (Gutner et al. 2013). Notably, more severe AS is related to increased substance use among individuals with PTSD (Gillihan et al. 2011). While AS, a largely cognitive construct, appears to be integral to PTSD symptomatology, emotional processes are also theorized to be central to PTSD (Foa and Kozak 1986; Foa and Rothbaum 1998). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Individuals with posttraumatic stress disorder (PTSD) exhibit deficits in cognitive and emotional processes. PTSD severity is positively associated with anxiety sensitivity (AS) and difficulties in emotion regulation, and difficulties in emotion regulation mediate the relation between AS and PTSD. However, previous research has not examined the interactive nature of these variables. Associations between PTSD, AS, and difficulties in emotion regulation were examined in patients with PTSD in a residential substance use treatment program (N = 120). Conditional process analyses indicated an interactive effect of difficulties in emotion regulation and AS for predicting PTSD symptom severity. For individuals high in emotion regulation difficulties, PTSD symptom severity was high regardless of level of AS; conversely, for individuals high in AS, increased PTSD severity was observed regardless of level of emotion regulation difficulties. Results suggest directions for future research, including examination of whether targeting patient-specific cognitive-affective processes enhances PTSD treatment response among substance-dependent individuals.
    Cognitive Therapy and Research 04/2015; 39:245-252. DOI:10.1007/s10608-014-9648-2 · 1.70 Impact Factor
  • Source
    • "co - morbid anxiety and AUDs ( Brady et al . , 2007 ) ; however , serotonin reuptake inhibitors have shown to be efficacious as well ( e . g . Brady et al . , 2005 ; Book et al . , 2008 ) . Researchers should consider examining additional treatment modules to address anxiety symptoms , including interoceptive exposures ( Zvolensky et al . , 2008 ; Gillihan et al . , 2011 ) and practice tolerating uncertainty , which may aid in habituation to un - pleasant or uncomfortable worries and bodily sensations . The current study used different types of CBT treatments for AUDs , including individual CBT ( gender neutral and female - specific ) and couple CBT ( standard and ' blended ' in - dividual / couple ) . "
    [Show abstract] [Hide abstract]
    ABSTRACT: It is unclear whether co-morbid anxiety disorders predict worse drinking outcomes during attempts to change drinking behavior. Studies have yielded mixed results, and have rarely examined drinking outcomes based on a specific type of anxiety disorder. Women with alcohol use disorders (AUDs) are of particular interest as they are at risk for co-morbid anxiety [Kessler et al. (1997) Lifetime co-occurrence of DSM-III-R alcohol abuse and dependence with other psychiatric disorders in the national co-morbidity survey. Arch Gen Psychiat 54:313-21]. Participants were 260 women with AUDs participating in an alcohol-treatment outcome studies. The Timeline Follow-Back was used to assess drinking frequency (percent days drinking) prior, within and 6 months post-treatment. The current study tested the hypothesis that having at least one lifetime anxiety disorder diagnosed at baseline using the Structured Clinical Interview for DSM Disorders would be associated with more drinking at all study time points. Exploratory analyses examined patterns of drinking outcomes by specific anxiety diagnoses. Lifetime anxiety diagnosis was linked to poorer drinking outcomes post-treatment (β = 0.15, P = 0.020), despite less frequent drinking prior to treatment. Analyses by specific anxiety diagnosis indicated that generalized anxiety disorder predicted poorer drinking outcomes within treatment (β = 0.14, P = 0.018) and during follow-up (β = 0.16, P = 0.014). Co-morbid anxiety problems complicate treatment for AUDs among women. Further, specific anxiety disorders should be evaluated as distinct constructs as evidenced by the differential outcomes related to generalized anxiety disorder. Implications for treatment development for women with AUDs are discussed.
    Alcohol and Alcoholism 01/2012; 47(2):143-8. DOI:10.1093/alcalc/agr155 · 2.89 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Many studies have reported that Anxiety Sensitivity (AS) is positively associated with alcohol use or other alcohol-related variables. More recent mediator and moderator models have shown promise in elucidating mechanisms within this relationship; the literature to date suggests that the relationship between AS and alcohol is likely mediated by problematic coping motives. However, few studies have considered the effects of depression within the AS-alcohol use relationship, despite a strong body of evidence linking AS to subsequent depression and depression to subsequent alcohol use problems, independently. Therefore, the current study assessed depression as a potential mediator of this relationship. Participants were 418 sequential admissions to a substance abuse treatment facility. A mediation analysis using bootstrapping was utilized in order to estimate indirect effects of AS on alcohol dependence through depression. Results reveal an indirect effect suggesting that the effects of anxiety sensitivity on alcohol dependence are mediated by symptoms of depression. More specifically, the effects of AS total score and AS somatic sensations on alcohol dependence were mediated by symptoms of depression. Lastly, a dual mediator model demonstrated that both depression and problematic coping uniquely mediate the relationship between AS and alcohol dependence. While preliminary in nature, the current study provides evidence supporting the hypothesis that depression is an important factor to consider when examining the relationship between AS and alcohol dependence.
    Addictive behaviors 04/2014; 39(8):1243-1248. DOI:10.1016/j.addbeh.2014.04.002 · 2.76 Impact Factor
Show more