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Anxiety sensitivity and self-reported alcohol consumption rates in university women

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Abstract

A growing literature suggests a significant relationship between “anxiety sensitivity” (AS; fear of anxiety symptoms) and alcohol use/abuse. The present study examined the relationship between levels of AS and self-reported rates of weekly alcohol consumption and frequency of “excessive drinking” (i.e., number of times legally intoxicated per year). Subjects were 30 nonalcoholic university women, divided into three AS groups (high, moderate, and low) based upon scores on the Anxiety Sensitivity Index (ASI). High AS women reported consuming significantly more alcoholic beverages on a weekly basis and drinking to excess more times per year than low AS controls. ASI scores were found to be significantly positively correlated with both measures of self-reported alcohol consumption. The results support the hypothesis of a positive relationship between AS levels in young adult women and extent of excessive alcohol use.

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... While cross-sectional research consistently links AS to alcohol use (e.g., Stewart, Peterson, & Pihl, 1995;Stewart, Zvolensky, & Eifert, 2001), prospective research examining whether AS is a risk factor for alcohol misuse has not consistently supported this relationship. In young adolescents, baseline levels of AS are unrelated to the number of drinks consumed per occasion and to binge drinking at follow up (Jurk et al., 2015;Malmberg et al., 2013), suggesting AS is not a risk factor for alcohol misuse. ...
... We tested whether AS is a risk factor for, or complication of, alcohol misuse by conducting a comprehensive meta-analysis. While crosssectional research has found conflicting evidence of AS's association with quantity of alcohol use (Stewart et al., 1995, research does suggest AS is related to increased frequency of alcohol consumption , frequency of binge drinking (Stewart et al., 1995, and alcohol-related problems (Chavarria et al., 2015). Given these findings, we expected to find similar results in prospective research on AS. ...
... We tested whether AS is a risk factor for, or complication of, alcohol misuse by conducting a comprehensive meta-analysis. While crosssectional research has found conflicting evidence of AS's association with quantity of alcohol use (Stewart et al., 1995, research does suggest AS is related to increased frequency of alcohol consumption , frequency of binge drinking (Stewart et al., 1995, and alcohol-related problems (Chavarria et al., 2015). Given these findings, we expected to find similar results in prospective research on AS. ...
Article
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Anxiety sensitivity (AS) refers to a dispositional tendency to respond to one's anxiety sensations with fear. Longstanding theoretical accounts implicate AS in alcohol misuse; however, the relationship between AS and alcohol misuse remains unclear. We addressed this by testing whether AS is a risk factor for, and/or complication of, alcohol misuse by conducting a rigorous meta-analysis using random effect models. Our literature search yielded 15 studies (N = 9459). Studies were included if they used a longitudinal design, assessed AS and alcohol misuse at baseline, and assessed alcohol misuse and/or AS at follow-up. Results failed to support AS as a risk factor for, or complication of, alcohol misuse. Researchers are encouraged to test if the link between AS and alcohol misuse emerges under specific conditions (e.g., elevated state anxiety).
... While cross-sectional research consistently links AS to alcohol use (e.g., Stewart, Peterson, & Pihl, 1995;Stewart, Zvolensky, & Eifert, 2001), prospective research examining whether AS is a risk factor for alcohol misuse has not consistently supported this relationship. In young adolescents, baseline levels of AS are unrelated to the number of drinks consumed per occasion and to binge drinking at follow up (Jurk et al., 2015;Malmberg et al., 2013), suggesting AS is not a risk factor for alcohol misuse. ...
... We tested whether AS is a risk factor for, or complication of, alcohol misuse by conducting a comprehensive meta-analysis. While crosssectional research has found conflicting evidence of AS's association with quantity of alcohol use (Stewart et al., 1995, research does suggest AS is related to increased frequency of alcohol consumption , frequency of binge drinking (Stewart et al., 1995, and alcohol-related problems (Chavarria et al., 2015). Given these findings, we expected to find similar results in prospective research on AS. ...
... We tested whether AS is a risk factor for, or complication of, alcohol misuse by conducting a comprehensive meta-analysis. While crosssectional research has found conflicting evidence of AS's association with quantity of alcohol use (Stewart et al., 1995, research does suggest AS is related to increased frequency of alcohol consumption , frequency of binge drinking (Stewart et al., 1995, and alcohol-related problems (Chavarria et al., 2015). Given these findings, we expected to find similar results in prospective research on AS. ...
Article
Anxiety sensitivity (AS) refers to a dispositional tendency to respond to one’s anxiety sensations with fear. Longstanding theoretical accounts implicate AS in alcohol misuse; however, the relationship between AS and alcohol misuse remains unclear. We addressed this by testing whether AS is a risk factor for, and/or complication of, alcohol misuse by conducting a rigorous meta-analysis using random effect models. Our literature search yielded 15 studies (N = 9,459). Studies were included if they used a longitudinal design, assessed AS and alcohol misuse at baseline, and assessed alcohol misuse and/or AS at follow-up. Results failed to support AS as a risk factor for, or complication of, alcohol misuse. Researchers are encouraged to test if the link between AS and alcohol misuse emerges under specific conditions (e.g., elevated state anxiety).
... Research investigating the relationship between AS and alcohol use has focused on the higher-order construct of AS. In general, AS predicts excessive alcohol consumption (Stewart et al., 1995(Stewart et al., , 2001 and alcohol use problems (Howell et al., 2010), and prospectively predicts the development of alcohol use disorders (Schmidt et al., 2007). However, a recent study highlighted the need to account for depression in the relationship between AS and alcohol use problems. ...
... The current study was designed to investigate the effects of the general and specific AS factors on alcohol consumption and problematic alcohol use. Based on prior studies (Allan et al., 2015;Schmidt et al., 2007;Stewart et al., 1995Stewart et al., , 1997Stewart et al., , 2001, it was expected that general AS would be positively associated with alcohol consumption and problematic alcohol use. In addition, based on studies conducted by Harwell and colleagues (2011) and Koven and colleagues (2005), it was hypothesized that AS cognitive concerns would be associated with increased alcohol consumption and problematic alcohol use. ...
... This study investigated the unique effects of the general AS factor and the AS subfactors on alcohol use and misuse. As hypothesized, and consistent with previous work (Allan et al., 2015;Schmidt et al., 2007;Stewart et al., 1995Stewart et al., , 1997Stewart et al., , 2001, general AS was significantly related to increased problematic alcohol use, when we controlled for age, gender, and depression. No significant association was found between general AS and alcohol consumption. ...
Article
Objective: The misuse of alcohol is related to numerous detrimental health effects. Research has determined anxiety sensitivity (AS) to be a risk factor for problematic alcohol use. To date, no studies have investigated this relationship using a bifactor model of AS. This study used a bifactor model to determine the effects of the general AS factor and the cognitive, physical, and social concerns subfactors on alcohol-related outcomes. Method: The sample consisted of 329 participants selected from a larger sample of individuals in a brief smoking-cessation intervention. Latent factor models were used to determine the effects of the bifactor model of AS on alcohol use behavior. Results: The general AS factor was significantly associated with alcohol use problems but not alcohol consumption. The AS subfactors of cognitive, physical, and social concerns were not significantly related to either alcohol variable. Conclusions: The findings are inconsistent with previous research that has found associations between the AS subfactors and alcohol-related outcomes. The use of a bifactor model of AS allowed the variance associated with AS to be parceled out of the subfactors, indicating that general AS accounts for the relationship between AS and alcohol misuse.
... For example, hazardous drinking college students have significantly greater anxiety sensitivity than both non-hazardous drinkers and non-drinkers . Additionally, alcohol consumption and alcohol-related consequences among students are positively correlated with anxiety sensitivity levels Stewart et al., 1995). ...
... Yet, it will be important for longitudinal work to examine whether hazardous drinkers' evidence greater suicide risk over time. Third, In addition to the direct and total effects, examination of the "a path" (the association of hazardous drinking with anxiety sensitivity) in the current study replicated past work (MacDonald et al., 2000;Stewart et al., 1995). More severe hazardous drinking indeed correlated with anxiety sensitivity both in the full sample and among hazardous drinkers. ...
Article
Suicide is a leading cause of death among college students. Although previous work indicates that the (hazardous) use of alcohol contributes to suicidal ideation/risk, little work has examined potential underlying explanatory factors. One example is anxiety sensitivity (AS). The current study evaluated whether AS explains associations between hazardous drinking and suicidal ideation and risk among college students. Data from racially/ethnically diverse students (N = 1,206; 76.7% non-White; Mage = 22.13) were analyzed. Hazardous drinking was a significant predictor of suicidal ideation (p < 0.001) and risk (p < 0.001). There were significant indirect associations of hazardous drinking via AS with both ideation (b = 0.07, 95% CI [0.05, 0.10]) and risk (b = 0.04, 95% CI [0.03, 0.06]); AS explained a significant portion of variance in both associations (42.6–51.4%). AS cognitive concerns (but not physical or social concerns) contributed significantly to the explanatory pathways. Students who engaged in hazardous drinking were also greater than twice as likely to screen positive for suicide risk (p < 0.001). The findings suggest that AS, particularly cognitive concerns, partially accounts for the associations between hazardous drinking and suicidal ideation/risk. Hazardous drinking may exacerbate AS which, in turn, may influence suicidal ideation and risk; however, results need to be replicated with longitudinal data.
... Anxiety sensitivity is a cognitive factor that reflects the extent to which an individual experiences physiological arousal as potentially harmful or dangerous (Kushner, Thuras, Abrams, Brekke, & Stritar, 2001;Reiss & McNally, 1985). Anxiety sensitivity is a risk factor for anxiety and depression (Naragon-Gainey, 2010) and it has consistently been related to hazardous drinking among those without HIV (seronegatives; Schmidt, Buckner, & Keough, 2007;Stewart, Peterson, & Pihl, 1995;Stewart, Samoluk, & MacDonald, 1999). Research suggests greater arousal-dampening effects of alcohol for individuals with higher anxiety sensitivity when compared with lower anxiety sensitivity (e.g., Stewart, Zvolensky, & Eifert, 2001;Zack, Poulos, Aramakis, Khamba, & MacLeod, 2007). ...
... Research suggests greater arousal-dampening effects of alcohol for individuals with higher anxiety sensitivity when compared with lower anxiety sensitivity (e.g., Stewart, Zvolensky, & Eifert, 2001;Zack, Poulos, Aramakis, Khamba, & MacLeod, 2007). Individuals with higher anxiety sensitivity also report greater alcohol-related problems, including increased rates of excessive alcohol consumption (Conrod, Stewart, & Pihl, 1997;Stewart et al., 1999), drinking to legal intoxication more frequently (Stewart et al., 1995(Stewart et al., , 2001, and higher rates of alcohol dependence (Lewis & Vogeltanz-Holm, 2002). Further, longitudinal studies have implicated anxiety sensitivity in the development of alcohol problems. ...
... What was new was learning that this subjective-emotional effect of alcohol could be at least partially cognitively mediated since the high dose of alcohol significantly dampened high AS participants' sober tendency to catastrophize the meaning of arousal-related bodily sensations. Dose-dependent alcohol-induced reductions in somatic reactivity to hyperventilation were observed in both the high and low AS groups alike making it an unlikely candidate to explain high AS individuals' greater drinking (e.g., Stewart et al., 1995). Results of this study suggested that high AS individuals are particularly sensitive to alcohol-induced dampening of their fear and catastrophizing in response to arousalrelated physical sensations. ...
Article
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Le présent article résume notre programme de recherche sur la sensibilité à l’anxiété (SA) – un facteur dispositionnel cognitif et affectif impliquant des craintes de sensations liées à l’anxiété en raison de croyances selon lesquelles ces sensations entraînent des conséquences catastrophiques. La SA et ses dimensions d’ordre inférieur sont considérées comme des facteurs transdiagnostiques de risque ou de maintien des troubles émotionnels et des troubles addictifs. La compréhension des mécanismes par lesquels la SA exerce ses effets peut révéler des cibles d’intervention clés pour les programmes de prévention et de traitement axés sur la SA. Dans le présent article, je passe en revue les recherches fondamentales que nous avons menées pour comprendre les mécanismes qui relient la SA à ces troubles et à leurs symptômes. Je décris également les interventions transdiagnostiques ciblées sur la SA et j’illustre la manière dont la recherche fondamentale a permis d’orienter le contenu de ces interventions. Enfin, je passe en revue les projets en cours dans mon laboratoire et je souligne les orientations futures importantes dans ce domaine. Bien que des progrès considérables aient été réalisés au cours des trois dernières décennies et que la recherche ait considérablement fait avancer notre compréhension de la SA en tant que facteur transdiagnostique, de nombreuses questions restent en suspens. Les réponses devraient nous aider à affiner les interventions afin d’en faire bénéficier au maximum les personnes qui ont une grande peur d’avoir peur.
... Anxiety sensitivity refers to a cognitive or personality style that involves an expectation or fear that anxiety and physical arousal will lead to physical illness, social embarrassment, loss of mental control, or some combination of these (Reiss, Peterson, Gursky, & McNally, 1986). As such, it is associated with a five-fold increased risk for the longer term development of panic-related anxiety disorders (Mailer & Reiss, 1992) and corresponds with self-reported rates of alcohol (Stewart, Peterson, & Pihl, 1995) and anxiolytic prescription drug use (Bruce, Speigel, Gregg, & Nuzzarello, 1992). Furthermore, this personality style is associated with sensitivity to the anxiety-reducing effects of alcohol and the tendency to self-report motives for alcohol use that reflect the desire to self-medicate negative emotions (Conrod, Pihl, & Vassileva, 1998;Stewart & Pihl, 1994). ...
Article
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This study explored the validity of classifying a community-recruited sample of substance-abusing women (N = 293) according to 4 personality risk factors for substance abuse (anxiety sensitivity, introversion–hopelessness, sensation seeking, and impulsivity). Cluster analyses reliably identified 5 subtypes of women who demonstrated differential lifetime risk for various addictive and nonaddictive disorders. An anxiety-sensitive subtype demonstrated greater lifetime risk for anxiolytic dependence, somatization disorder, and simple phobia, whereas an introverted–hopeless subtype evidenced a greater lifetime risk for opioid dependence, social phobia, and panic and depressive disorders. Sensation seeking was associated with exclusive alcohol dependence, and impulsivity was associated with higher rates of antisocial personality disorder and cocaine and alcohol dependence. Finally, a low personality risk subtype demonstrated lower lifetime rates of substance dependence and psychopathology.
... Several studies have investigated the link between AS and alcohol use. Stewart et al. (1995) found university women with high AS self-reported consuming significantly more alcoholic beverages than those with low AS. Similarly, Moser et al. (2014) found that AS predicted heavy drinking among college students. ...
Article
Full-text available
Objective: Research on the association between anxiety sensitivity (AS) and substance use is mixed, with some studies showing a positive association and others showing no association. Other relevant variables, such as social anxiety and outcome expectancies, may help us understand how and for whom AS is linked to substance use. This study tested (a) the associations between AS and alcohol use, cannabis use, and drinking games and pregaming behaviors among young adults, and (b) the mediating role of social anxiety and moderating role of outcome expectancies in these associations. Method: Participants (N = 199, 69% women) were young adults (19 to 25 years) who completed a 30-minute online self-report questionnaire on their substance use. Results: Results revealed significant negative associations between AS and drinking game and pregaming participation. AS was not directly associated with other substance use outcomes. The association between AS and hazardous cannabis use was moderated by relaxation and tension reduction expectancies, but outcome expectancies did not moderate any of the other associations between AS and substance use outcomes. Social anxiety mediated the associations between AS and hazardous cannabis use and both drinking game and pregaming participation. Conclusions: Findings highlight the complex association between AS and different substance use outcomes. Outcome expectancies and social anxiety may help explain how AS is associated with hazardous cannabis use and drinking game/pregaming participation, respectively. More effective interventions can be developed by understanding the relation between AS and substance use.
... AS, defined as the fear of anxiety-related sensations and cognitions (e.g., concerns related to increased heart rate and/or racing thoughts) [23,24], is a malleable [25], cognitive-affective vulnerability risk factor that is conceptually distinct from both trait anxiety [26] and PTSD [27]. AS has been positively related to hazardous drinking [28][29][30] and coping-oriented drinking motives across various populations [31][32][33][34] and is related to increased rates of consumption and alcohol use disorder (AUD) [35,36]. Further, AS is implicated in the development and maintenance of PTSD [37][38][39] and may underlie hazardous drinking-PTSD comorbidity by amplifying PTSD symptomatology (e.g., hyperarousal) and motivating drinking to down-regulate such affect [22,40,41]. ...
Article
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Background: Hazardous drinking and posttraumatic stress disorder (PTSD) are commonly co-occurring conditions among adults. Motivational enhancement interventions, such as personalized feedback interventions (PFI), have demonstrated efficacy for reducing hazardous drinking. Emerging though scant literature has evaluated PFI for co-occurring PTSD and hazardous alcohol use. A transdiagnostic risk factor that may underlie this co-occurrence and inform novel PFI development is anxiety sensitivity (AS). Objective: To use a randomized controlled trial to evaluate the efficacy of a novel, computer-based PFI for hazardous drinkers with at least subclinical PTSD and elevated AS (AP-PFI), against a time-matched comparison condition (C-PFI). Methods: Participants (N=100) will be recruited and enrolled from the Houston, TX community. The study includes: an in-person visit (baseline diagnostic assessment, a brief intervention, and a post-intervention assessment) and two follow-up assessments (1-week and 1-month). Participants who meet study inclusion criteria will be randomized to one of two conditions at baseline: AP-PFI or C-PFI. AP-PFI will consist of a brief, single-session, computer-delivered, PFI-based intervention that provides integrative and normative feedback about alcohol use, AS, and PTSD symptoms. C-PFI will be time-matched but will only include alcohol-related feedback. Conclusions: AP-PFI is designed to provide feedback about alcohol use, PTSD symptoms, and AS and their interplay and deliver psychoeducation on harm-reduction techniques, interoceptive exposure exercises, and stress management strategies. The intervention may address extant gaps in treatment for these co-occurring conditions by providing a brief, evidence-based, motivational enhancement intervention that is cost-effective with potential to be disseminated across a variety of healthcare settings.
... Da eine erhöhte AS auch mit Psychopathologie außerhalb des Angststörungsspektrums wie z.B. Alkohol-und andere Substanz-gebundenen Störungen (Stewart, Peterson & Pihl, 1995;Zvolensky & Schmidt, 2003), Schmerz-assoziierten Erkrankungen (Ocañez, McHugh & Otto, 2010), der Posttraumatischen Belastungsstörung (Boffa & Schmidt, 2019), Suizidalität (Norr, Allan, Reger & Schmidt, 2018) und Affektiven Erkrankungen (Cox, Enns, Freeman & Walker, 2001;Lambert et al., 2004;Taylor, Koch, Woody & McLean, 1996) Symptomschwere assoziiert ist (Merikangas et al., 1996;zur Übersicht: Roy-Byrne et al., 2000), oder ...
Thesis
Angsterkrankungen stellen mit einer 12-Monats-Prävalenz von 14% die häufigsten psychischen Erkrankungen in der westlichen Gesellschaft dar. Angesichts der hohen querschnittlichen wie sequentiellen Komorbidität von Angsterkrankungen, der ausgeprägten individuellen Einschränkungen sowie der hohen ökonomischen Belastung für das Gesundheitssystem ist neben therapeutischen Behandlungsansätzen die Entwicklung von kurzzeitigen, kostengünstigen und leicht zugänglichen Präventionsmaßnahmen von großer Bedeutung und steht zunehmend im Fokus des gesundheitspolitischen Interesses, um die Inzidenz von Angsterkrankungen zu reduzieren. Voraussetzung für die Entwicklung von gezielten und damit den effektivsten Präventionsmaßnahmen sind valide Risikofaktoren, die die Entstehung von Angsterkrankungen begünstigen. Ein Konstrukt, das in der Literatur als subklinisches Symptom in Form einer kognitiven Vulnerabilität für Angsterkrankungen und damit als Risikofaktor angesehen wird, ist die sogenannte Angstsensitivität (AS). AS umfasst die individuelle Tendenz, angstbezogene körperliche Symptome generell als bedrohlich einzustufen und mit aversiven Konsequenzen zu assoziieren. Das Ziel der vorliegenden Arbeit war daher die Etablierung und Validierung eines Präventionsprogramms zur Reduktion der AS an einer nicht-klinischen Stichprobe von 100 Probanden (18-30 Jahre) mit einer erhöhten AS (Anxiety Sensitivity Index [ASI-3] ≥17) sowie die Rekrutierung von 100 alters- und geschlechtsangeglichenen Probanden mit niedriger Angstsensitivität (ASI-3 <17). In einem randomisiert-kontrollierten Studiendesign durchliefen die Probanden mit hoher AS entweder das über fünf Wochen angelegte „Kognitive Angstsensitivitätstraining“ (KAST) als erste deutschsprachige Übersetzung des Computer-basierten „Cognitive Anxiety Sensitivity Treatment“ (CAST) von Schmidt et al. (2014) oder wurden der Wartelisten-Kontrollgruppe zugeteilt. Das KAST Training bestand aus einer einmaligen Vermittlung kognitiv-behavioraler Psychoedukation zum Thema Stress und Anspannung sowie deren Auswirkungen auf den Körper und der Anleitung von zwei interozeptiven Expositionsübungen (‚Strohhalm-Atmung‘ und ‚Hyperventilation‘), die über den anschließenden Zeitraum von fünf Wochen in Form von Hausaufgaben wiederholt wurden. Es konnte gezeigt werden, dass die Teilnehmer des KAST-Programms nach Beendigung des Trainings (T1) eine signifikant niedrigere AS-Ausprägung im Vergleich zur Wartelisten-Kontrollgruppe aufwiesen und diese Reduktion auch über den Katamnese-Zeitraum von sechs Monaten (T2) stabil blieb. Ergänzend wurde auch die Targetierbarkeit weiterer intermediärer Risikomarker wie der Trennungsangst (TA), des Index der kardialen Sensitivität sowie der Herzratenvariabilität (HRV) untersucht, die jedoch nicht durch das KAST-Training direkt verändert werden konnten. Im Vergleich der Subgruppen von Probanden mit hoher AS und gleichzeitig hoher TA (Adult Separation Anxiety Questionnaire [ASA-27] ≥22) und Probanden mit hoher AS, aber niedriger TA (ASA-27 <22) zeigte sich, dass die AS-TA-Hochrisikogruppe ebenfalls gut von der KAST-Intervention profitieren und eine signifikante Reduktion der AS erzielen konnte, indem sie sich bei T1 dem Niveau der Gruppe mit niedriger TA anglich. Zudem korrelierte die prozentuale Veränderung der Einstiegswerte der inneren Anspannung während der Strohhalm-Atmungsübung positiv mit der prozentualen Veränderung der dimensionalen TA bei T1. Zusammenfassend weisen die Ergebnisse der vorliegenden Arbeit erstmalig auf die Wirksamkeit der deutschsprachigen Übersetzung des CAST-Programms (Schmidt et al., 2014), eines Computer-basierten, und damit leicht zu implementierenden sowie kostengünstigen Programms, in Bezug auf die Reduktion der AS sowie indirekt der TA hin und können damit zur indizierten und demnach besonders effektiven Prävention von Angsterkrankungen in Hochrisikogruppen beitragen.
... There are data in the literature showing that people with high AS use more alcohol and are more risky in terms of addiction. It was reported that there is a positive correlation between excessive alcohol consumption and AS (19), and AS is a prospective predictor for alcohol use disorder (20). It is stated that people with high AS are more sensitive to the negative reinforcing effects of alcohol and substances (21,22). ...
Article
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Objective: The aim of this study was to examine the levels of game addiction and anxiety sensitivity in young adults who play online games. Method: The study was conducted cross-sectionally on the sociodemographic data form, the Anxiety Sensitivity Index and the Game Addiction Scale Short Form, which were delivered to volunteers who reported that they played online games through an online research platform. Game addiction was evaluated according to the monothetic and polythetic formats of the scale. Results: 7.8% of the 438 participants are game addicts according to the Game Addiction Scale Short Form monothetic format, and 40.9% are game addicts according to the polythetic format. Anxiety sensitivity levels in game addicts are higher than in non-game addicts. Anxiety sensitivity is higher in women. According to the monothetic format, game addiction does not differ in terms of age, gender, marital status and educational status, and according to the polythetic format, game addiction is higher in undergraduate and widow/divorced individuals. Conclusion: As a trait-like factor, anxiety sensitivity may lay the groundwork for game addiction. The relationship between anxiety sensitivity and problematic game playing needs to be examined in more detail to screen depression and anxiety disorders.
... One possibility is that AS may be related more to alcohol problems and less to alcohol consumption, which further tends to weaken the relationship between AS and hazardous drinking since AUDIT total scores partially consist of AUDIT Alcohol Consumption (with the other AUDIT subfactor being Alcohol Problems). Indeed, though several studies have reported a relation between AS and greater alcohol consumption (Cox, Swinson, Shulman, Kuch, & Reichman, 1993;Lammers, Kuntsche, Engels, Wiers, & Kleinjan, 2013;Paulus, Manning, et al., 2017;Stewart, Peterson, & Pihl, 1995;Stewart, Zvolensky, & Eifert, 2001), the large majority of studies have not found evidence of an association between AS and greater alcohol consumption (Buckner, Bonn-Miller, Zvolensky, & Schmidt, 2007;Chavarria et al., 2015;Guillot et al., 2018;Johnson et al., 2008;Leyro, Zvolensky, Vujanovic, & Bernstein, 2008;Novak, Burgess, Clark, Zvolensky, & Brown, 2003;Paulus, Valadka, et al., 2017;Paulus, Vujanovic, & Wardle, 2016;Woicik, Stewart, Pihl, & Conrod, 2009;Zvolensky et al., 2007), including the current study. Also concordant with this possibility, the evidence for an association between AS and hazardous drinking (AUDIT total scores) has been mixed, with some studies reporting evidence of this association (Guillot et al., 2018;Paulus, Manning, et al., 2017;Zvolensky et al., 2019;Zvolensky et al., 2014) and other studies not finding evidence of this association (Bakhshaie, Zvolensky, Allan, Vujanovic, & Schmidt, 2015;Haas et al., 2019;Paulus, Valadka, et al., 2017;Zvolensky, Kotov, Antipova, & Schmidt, 2003), including the current study. ...
Article
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Anxiety sensitivity (AS)—fearfulness of anxiety symptoms—has been implicated in the etiology of emotional disorders (e.g., depressive and anxiety disorders) and linked to cigarette smoking and other substance use (SU). However, studies examining AS in relation to SU primarily have been conducted with racially/ethnically heterogeneous or mostly European American samples. Hence, this cross-sectional study involving secondary analysis of baseline data focused on investigating associations of AS with cigarette smoking and other SU in a sample of 630 non-treatment-seeking African American smokers (37.3% female; M age = 49.6 years; M cigarettes smoked per day = 15.4). After screening out individuals with non-nicotine substance dependence, participants reported their demographics, AS, dysphoria symptoms (i.e., depression and anxiety symptoms), and SU. In regression analyses controlling for dysphoria symptoms, age, education level, income level, and years of regular smoking, AS was positively associated with tobacco withdrawal severity (β = .12, p = .007), overall smoking motives (β = .17, p < .001), alcohol use problems (β = .12, p = .005), and other (non-nicotine, nonalcohol) SU problems (β = .16, p < .001). Though lacking the passage of time between assessments needed to provide strong evidence of mediation, unplanned analyses further revealed indirect associations of AS with several SU variables through dysphoria symptoms. Current findings are consistent with those found in prior samples and suggest that AS is similarly related to SU in African Americans, who may benefit from interventions that have been helpful in improving AS, dysphoria symptoms, and SU in other groups.
... One way to develop integrated interventions is to focus on common elements that may be maintaining the comorbid conditions, such as anxiety sensitivity (AS). Defined as the fear of anxiety-related sensations (Reiss, 1991;Reiss et al., 1986), AS is a transdiagnostic vulnerability factor involved in the etiology and maintenance of emotional disorders (Naragon-Gainey, 2010;Olatunji and Wolitzky-Taylor, 2009) and hazardous drinking Stewart et al., 1995Stewart et al., , 1999. AS is also a prospective predictor of AUD (Schmidt et al., 2007) and has been implicated as a common factor contributing to the comorbidity of emotional symptoms/disorders and AUD (Baillie et al., 2010;Boschloo et al., 2013;DeHaas et al., 2002;Stewart et al., 1999), making it an ideal target for comorbid alcohol-emotion intervention. ...
Article
Integrated treatments for hazardous drinking and anxiety/depression are virtually nonexistent. Anxiety sensitivity (AS) is a common mechanism for both anxiety/depression and hazardous drinking. This article presents a study protocol for the development and testing of an integrated remotely delivered AS/hazardous drinking personalized feedback intervention (PFI). Hazardous drinking college students with elevated AS (n=130) will be randomly assigned to a single session of a novel integrated PFI for AS/hazardous drinking or control condition. Follow-ups will occur at one week, one month, and three-months. This study will serve as an initial test and proof-of-concept for an integrated AS/hazardous drinking PFI.
... High sensitivity is associated with individuals attempts to control or escape negative inner experiences (e.g., Papachristou, Theodorou, Neophytou, & Panayiotou, 2018;Stewart, Zvolensky, & Eifert, 2002). Furthermore, empirical evidence supports the association of anxiety sensitivity with increased symptoms related to emotional disorders (see Olatunji & Wolitzky-Taylor, 2009, for a meta-analysis), alcohol misuse (e.g., Stewart, Peterson, & Pihl, 1995;Stewart, Zvolensky, & Eifert, 2002), and pain (see Ocañez, Kathryn McHugh, & Otto, 2010, for a meta-analysis). ...
Article
Objective: Numerous psychological constructs exist to describe different facets of emotional responding, but they have rarely been examined together. We empirically modeled the associations between four psychological constructs (mindfulness, emotional nonacceptance, experiential avoidance, and anxiety sensitivity) of individuals' responses to their affective experience, hypothesizing that a bifactor model would fit the data best. Method: We used exploratory structural equation modeling, a novel latent variable modeling framework, to compare five measurement models of emotional responding in an online community sample (N = 307). Results: A bifactor model including a general emotional responding factor had substantial factor loadings from nearly all items, with mixed results for specific factors. Exploratory analyses supported the significant association of avoidant emotional responding and psychopathology/well-being. Conclusion: The general avoidant emotional responding factor appears to overlap most directly with experiential avoidance and may be a transtheoretical construct relevant to mental health.
... Although well-validated as a risk factor for affective domains such as anxiety and depression (Naragon-Gainey, 2010;Olatunji & Wolitzky-Taylor, 2009), anxiety sensitivity has shown strong relations to substance use such as smoking (Leventhal & Zvolensky, 2015) and alcohol use (DeMartini & Carey, 2011). Specifically, individuals with elevated anxiety sensitivity report greater alcohol-related problems (Conrod, Stewart, & Pihl, 1997;Stewart, Samoluk, & MacDonald, 1999) and have higher rates of alcohol dependence (Lewis & Vogeltanz-Holm, 2002), greater likelihood of alcohol use disorder/ substance use disorder (Allan, Macatee, Norr, Raines, & Schmidt, 2015) and more frequently drink to intoxication (Stewart, Peterson, & Pihl, 1995;Stewart, Zvolensky, & Eifert, 2001). Research also suggests that those with elevated anxiety sensitivity experience greater arousaldampening effects of alcohol (e.g., Stewart et al., 2001;Zack, Poulos, Aramakis, Khamba, & MacLeod, 2007) and engage in drinking to cope with distress (Mackinnon, Kehayes, Clark, Sherry, & Stewart, 2014). ...
Article
Although past work has documented reduction in alcohol use severity among smokers following smoking cessation treatment, little is known regarding factors associated with this reduction. The current study sought to examine relations between trajectories of change in anxiety sensitivity and non-targeted alcohol use severity from baseline to one year following smoking cessation treatment. Individuals (n = 386) were adult daily smokers engaged in a smoking cessation treatment study. Measures of alcohol use severity and anxiety sensitivity were collected at baseline as well as 1-, 3-, 6-, and 12-months post-treatment. Latent growth curve modelling was used to estimate intercepts and slopes. Anxiety sensitivity (M = −0.87 95% CI [-1.19, −0.54], p < 0.001) and alcohol use severity (M = −0.22 95% CI [-0.38, −0.06], p = 0.006) each significantly reduced over time. Reductions in anxiety sensitivity were strongly associated with reductions in alcohol use over time (r = 0.63, 95% CI [0.18, 1.09], p = 0.006). Changes in anxiety sensitivity positively correlated with changes in alcohol use severity. Examinations of means suggest that anxiety sensitivity reduced earlier whereas alcohol use severity reduced later in the follow-up period. If replicated establishing temporal precedence of change, these results could implicate anxiety sensitivity reduction as one avenue towards reduced alcohol use severity, among smokers.
... AS differs from trait anxiety which is a tendency to respond fearfully to stressors (DeMartini and Carey, 2011;McNally, 1989). High (versus low) AS has been associated with higher levels of weekly alcohol consumption (M = 7.4 vs. 2.2 drinks/wk) among nonalcoholic university women (Stewart et al., 1995). High AS, but not trait anxiety, also predicted AUD development over a 24-month followup period among 440 young adults (Schmidt et al., 2007). ...
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Background: Stress and anxiety are widely considered to be causally related to alcohol craving and consumption, as well as development and maintenance of alcohol use disorder (AUD). However, numerous preclinical and human studies examining effects of stress or anxiety on alcohol use and alcohol-related problems have been equivocal. This study examined relationships between scores on self-report anxiety, anxiety sensitivity, and stress measures and frequency and intensity of recent drinking, alcohol craving during early withdrawal, as well as laboratory measures of alcohol craving and stress reactivity among heavy drinkers with AUD. Methods: Media-recruited, heavy drinkers with AUD (N = 87) were assessed for recent alcohol consumption. Anxiety and stress levels were characterized using paper-and-pencil measures, including the Beck Anxiety Inventory (BAI), the Anxiety Sensitivity Index-3 (ASI-3), and the Perceived Stress Scale (PSS). Eligible subjects (N = 30) underwent alcohol abstinence on the Clinical Research Unit; twice daily measures of alcohol craving were collected. On day 4, subjects participated in the Trier Social Stress Test; measures of cortisol and alcohol craving were collected. Results: In multivariate analyses, higher BAI scores were associated with lower drinking frequency and reduced drinks/drinking day; in contrast, higher ASI-3 scores were associated with higher drinking frequency. BAI anxiety symptom and ASI-3 scores also were positively related to Alcohol Use Disorders Identification Test total scores and AUD symptom and problem subscale measures. Higher BAI and ASI-3 scores but not PSS scores were related to greater self-reported alcohol craving during early alcohol abstinence. Finally, BAI scores were positively related to laboratory stress-induced cortisol and alcohol craving. In contrast, the PSS showed no relationship with most measures of alcohol craving or stress reactivity. Conclusions: Overall, clinically oriented measures of anxiety compared with perceived stress were more strongly associated with a variety of alcohol-related measures in current heavy drinkers with AUD.
... alcohol-related problems (Conrod, Stewart, & Pihl, 1997;Stewart et al., 1999), more frequent drinking to intoxication (Stewart et al., 1995;Stewart, Zvolensky, & Eifert, 2001), and higher rates of alcohol dependence (Lewis & Vogeltanz-Holm, 2002). Longitudinally, anxiety sensitivity has been shown to predict development of alcohol use disorder (Schmidt et al., 2007). ...
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Smoking and drinking frequently co-occur. For example, alcohol use is associated with lapses during quit attempts. However, little is known regarding psychological factors explaining drinking among smokers. Anxiety sensitivity is a risk factor associated with hazardous drinking and drinking to cope and/or conform, although little is known about mechanisms underlying such associations. One potential explanatory factor is emotion dysregulation. The current study examined emotion dysregulation as an explanatory factor underlying anxiety sensitivity and five alcohol-related outcomes: hazardous drinking, alcohol consumption, alcohol problems coping-oriented drinking and drinking to conform. Participants for this study were 467 treatment-seeking adult daily smokers (48.2% female; Mage=36.7 years, SD = 13.6) who reported smoking an average of 16.5 cigarettes per day. Results indicated significant indirect effects of anxiety sensitivity via emotion dysregulation in relation to hazardous drinking, alcohol consumption, alcohol problems, drinking to cope, and drinking to conform. Effects were medium sized. Alternative models testing indirect effects of emotion dysregulation via anxiety sensitivity in relation to outcomes and anxiety sensitivity via outcomes in relation to emotion dysregulation were non-significant with small effect sizes. Follow-up tests examined effects of anxiety sensitivity via specific emotion dysregulation sub-factors. Thus, among treatment-seeking smokers, emotion dysregulation may explain the associations of anxiety sensitivity with alcohol-related outcomes. This pattern of findings highlights the potential importance of interventions targeting emotion dysregulation among hazardous drinking smokers.
... One explanation may be that in situations where many friends are present (including potential romantic partners), young adult women who score high on coping motives use alcohol as a means to overcome nervousness, insecurity, and self-consciousness in social situations. This interpretation is consistent with several studies suggesting that social concerns, anxiety sensitivity, and coping motives are important factors in predicting alcohol use among women (Reyno et al. 2006;Stewart et al. 1995;Stewart et al. 2001). As has been argued previously, adolescent women may use alcohol as a means to ease anxiety (Kuntsche et al. 2006). ...
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While drinking motives are well-established proximal predictors of alcohol use, less is known about their role in event-level drinking behavior. The present study examines whether the interaction between individuals’ drinking motives and the number of friends present at a given moment can predict alcohol consumption over the course of the evening. Using the Internet-based cell phone-optimized assessment technique (ICAT), 183 young adults (53.0 % female, mean age = 23.1) in French-speaking Switzerland completed cell phone questionnaires every Thursday, Friday, and Saturday evening over five weekends. A total of 7205 questionnaires completed on 1441 evenings were analyzed. Drinking motives and gender were assessed at baseline, while the hourly alcohol consumption rate and number of friends present were assessed at 8 p.m., 9 p.m., 10 p.m., 11 p.m., and midnight. Multilevel growth curve models with time-invariant and time-varying covariates were estimated for men and women separately. Among women, enhancement motives were associated with an increase in the hourly alcohol consumption rate over the course of the evening (b = .025; p < .05). The impact of the number of friends present on the hourly consumption rate was stronger among those women who scored high on coping motives at baseline (b = .028; p < .05). Among men, drinking motives were found to have no moderating effects. Results highlight the role of drinking motives and their interactions with situational characteristics in determining event-level drinking, especially among women. Strategies to prevent risky weekend drinking should focus on both the social environment in which drinking takes place (e.g., the drinking group) and individual drinking motives.
... Overall, these findings suggest that internalizing disorders independent of comorbid externalizing disorders and demographic variables do not pose a significant risk for future AUDs in community samples, and challenge notions of an internalizing developmental pathway as a risk factor for AUDs (Hussong et al., 2011). The present research, however, was framed at the disorder-level of analysis, and it is possible that more subtle forms of internalizing tendencies that do not rise to the threshold of diagnosis may pose a risk for future AUDs (e.g., Stewart et al., 1995) as might other forms of internalizing disorders not assessed here, such as some subsets of personality disorders (Røysamb et al., 2011). We also pooled individual psychiatric disorders into domains and subdomains to form inclusive diagnostic categories to increase statistical power and, consequently, may have obscured unique associations that individual disorders within these domains have with AUD onset (Hussong et al., 2011;Nichter and Chassin, 2015). ...
Article
Background: The developmental pathways associated with an enhanced risk for future alcohol use disorders (AUDs) continue to be a topic of both interest and debate. In this research, internalizing and externalizing disorders were evaluated as prospective predictors of the index AUD episode onset, separately within three developmental periods: early-to-middle adolescence (age 13.0-17.9), late adolescence (18.0-20.9), and early adulthood (21.0-30.0). Methods: Participants (N=816) were initially randomly selected from nine high schools in western Oregon and subsequently interviewed on four separate occasions between ages 16 and 30, during which current and past AUDs were assessed as well as a full range of psychiatric disorders associated with internalizing and externalizing psychopathology domains. Results: In adjusted analyses for each of the three developmental periods investigated, externalizing domain psychopathology from the most proximal adjoining developmental period predicted AUD onset. Distal externalizing psychopathology also predicted AUD onset among early adult onset cases. Proximal or distal internalizing psychopathology, in comparison, was not found to be a significant predictor of AUD onset in adjusted analyses for any of the developmental periods examined. Conclusions: Findings overall suggest that externalizing developmental histories are robust predictors of AUD onset within the age range during which index episodes are most likely to occur, and that gender does not moderate this association.
... However, beyond the research on clinical disorders, there are con icting ndings on the relation between a generally anxious disposition and alcohol use. Some show a weak to moderate positive relation (e.g., Stewart, Peterson, & Pihl, 1995), whereas others demonstrate a negative association (e.g., Ham, Bonin, & Hope, 2007) or no association (Grau & Ortet, 1999). Overall, though, this eld emphasizes trait-like individual differences that are stable across time and situations at the expense of investigation into more state-like dispositions that are speci c to certain situations. ...
Article
Abstract The drinking culture in Western societies infiltrates many aspects of life, including early romantic relationships. This study investigated factors that predict drinking on dates and the impact of date drinking on feelings of intimacy. Regression analyses of questionnaire data revealed that expectancies, general drinking tendencies, and partner’s drinking as well as their interactions with gender and ethnicity contributed to explaining alcohol consumption on dates. Intimacy was significantly predicted by alcohol usage on dates, but the effects of drinking by self and partner varied by gender. Women’s own drinking positively predicted their sense of intimacy, but their partner’s drinking was linked to decreased intimacy. Men’s reports showed significant effects but in the opposite direction. The Discussion section considers implications for dating and future research.
... Anxiety sensitivity is a dispositional variable or personality style that involves a fear of arousal-related sensations (e.g., increased respiration and palpitations) based on the belief that these sensations portend dire consequences (e.g., physical illness, loss of mental control, or social embarrassment) (Reiss, Peterson, Gursky, & McNally, 1986). Elevated levels of anxiety sensitivity are associated with increased risk for anxiety-related disorders (Maller & Reiss, 1992) and substance abuse (Stewart, Peterson, & Pihl, 1995). As a personality style, anxiety sensitivity has been found to be associated with sensitivity to the anxiety-reducing effects of alcohol (MacDonald, Baker, Stewart, & Skinner, 2000;Stewart & Pihl, 1994), as well as to higher levels of coping and conformity motives for drinking (Stewart, Zvolensky, & Eifert, 2001). ...
Chapter
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Co-morbidity is defined as the presence of any co-occurring condition in a patient with an index disease (Kranzler & Rosenthal, 2003). Epidemiologic surveys of psychopathology in the United States have found that while approximately half of the general population will experience a major psychiatric illness at some point over their lifetime, the majority of affected individuals will simultaneously meet diagnostic criteria for two or more disorders (Kessler et al., 1994). Co-morbidity has important clinical implications including: more severe symptoms, more functional disability, longer illness duration, and higher treatment service utilization (see de Graaf, Bijl, ten Have, Beekman, & Vollebergh, 2004). One of the most common co-morbid conditions is anxiety disorder cooccurring with substance use disorder. Studies that have examined rates of alcohol dependence in anxiety disorder outpatient samples suggest ranges from 15% to 30% depending on the particular anxiety disorders (see Barlow, 1997). Other epidemiologic studies cite lifetime prevalence rates of clinically significant anxiety disorders in patients with alcohol dependence as ranging from 25% to 45% (Kushner et al., 2005). These rates of alcohol dependence in anxiety disorder patients, and of anxiety disorders in alcoholism patients, are markedly elevated relative to base-rates in the general population. Nonetheless, co-morbidity studies with patient populations can lead to overestimates of co-morbidity due to the issue of ‘‘Berkson’s bias’’ – the fact that individuals with more than one disorder may be more likely to seek treatment than those with only one disorder (Galbaud du Fort, Newman, & Bland, 1993). Thus, population-based studies are important to examine ‘‘true’’ rates of co-morbidity of anxiety and substance use disorders. In the Epidemiological Catchment Area Survey (ECA), which included more than 20,000 respondents from five communities in the United States, alcoholics were significantly more apt to have a co-morbid anxiety disorder than non-alcoholics (19.4% vs. 13.1%) (Regier et al., 1990). Moreover, the ECA survey found that individuals with any anxiety disorder had a 50% increase in the odds of being diagnosed with a lifetime alcohol use disorder (alcohol abuse or dependence). Co-morbid psychiatric symptoms, such as anxiety, can make accurate assessment of substance use more difficult and is associated with a poorer substance use outcome following treatment (Kranzler & Rosenthal, 2003). Indeed, anxiety disorders may especially complicate the treatment of substance use disorders in that they have been found to take significantly longer to remit as compared to mood disorders (Wagner, Krampe, & Stawicki, 2004). Another issue relates to whether the anxiety disorder is seen as being ‘‘independent’’ of the substance use disorder or ‘‘substance-induced’’. The former views onset of an anxiety disorder occurring before that of an alcohol disorder and/or persisting after the substance abuse is resolved and in need of specific treatment. The latter views onset of an anxiety disorder occurring after that of an alcohol disorder due to substance intoxication and/or withdrawal and not in need of specific treatment; rather, substance-induced anxiety disorders will resolve as the substance abuse is brought under control. Using the criteria of the Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association [APA], 1994) in a large epidemiologic survey, Grant et al. (2004) concluded that the vast majority of the anxiety disorders found in the general population and in alcoholism treatment settings are independent of substance abuse (see chapter 1).
... These were multiplied to yield a "drinks per week" composite variable (c.f. Stewart, Peterson, & Pihl, 1995). Participants also reported their age, gender, year of university study, and family income. ...
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This study investigated whether Coping Motivated and Enhancement Motivated drinkers differ in their degree of semantic activation of alcohol concepts on a primed Stroop colour-naming task following exposure to negative and positive affect primes, respectively. Participants were 48 undergraduates (not necessarily problem drinkers) who had elevated scores on the Coping Motivated or Enhancement Motivated subscale of the Drinking Motives Questionnaire - Revised. The Stroop task involved negative, positive and neutral primes that preceded alcohol and no-alcohol target words. As hypothesized, Coping Motivated drinkers showed semantic activation of alcohol concepts following exposure to negative but not neutral primes. Also as hypothesized, Enhancement Motivated drinkers showed semantic activation of alcohol concepts following exposure to positive but not negative primes. Unexpectedly, semantic activation of alcohol concepts was also observed among Coping Motivated drinkers following positive primes and among Enhancement Motivated drinkers following neutral primes. Theoretical implications are discussed, as are implications for improving cognitive behavioral interventions for problem drinkers.
... Furthermore, it appears that within this reinforcement-specific pathway to substance misuse, specific facets of neurotic personality determine the nature of the negative reinforcement gained by using substances. For example, anxiety sensitivity (AS) is related to self-reported rates of alcohol (Stewart, Peterson, & Pihl, 1995) and anxiolytic prescription drug use (Bruce, Spiegal, Gregg, & Nuzzarello, 1995), as well as a tendency to report motives for alcohol and drug use that reflect a desire to self-medicate anxious symptoms (Comeau et al., 2001;Conrod et al., 1998). By contrast, research has shown that individuals prone to depression in response to a significant life stressor are more likely to drink to cope with their negative affect, which in turn predicts greater substance use and related problems (Carpenter & Hasin, 1998;Peirce, Frone, Russell, & Cooper, 1994). ...
Article
The Substance Use Risk Profile Scale (SURPS) is based on a model of personality risk for substance abuse in which four personality dimensions (hopelessness, anxiety sensitivity, impulsivity, and sensation seeking) are hypothesized to differentially relate to specific patterns of substance use. The current series of studies is a preliminary exploration of the psychometric properties of the SURPS in two populations (undergraduate and high school students). In study 1, an analysis of the internal structure of two versions of the SURPS shows that the abbreviated version best reflects the 4-factor structure. Concurrent, discriminant, and incremental validity of the SURPS is supported by convergent/divergent relationships between the SURPS subscales and other theoretically relevant personality and drug use criterion measures. In Study 2, the factorial structure of the SURPS is confirmed and evidence is provided for its test–retest reliability and validity with respect to measuring personality vulnerability to reinforcement-specific substance use patterns. In Study 3, the SURPS was administered in a more youthful population to test its sensitivity in identifying younger problematic drinkers. The results from the current series of studies demonstrate support for the reliability and construct validity of the SURPS, and suggest that four personality dimensions may be linked to substance-related behavior through different reinforcement processes. This brief assessment tool may have important implications for clinicians and future research.
... These groups are high levels of negative thinking (NT), anxiety sensitivity (AS), sensation seeking (SS), and low levels of impulse control (IMP) [4]. These personality profiles have been identified as risk factors not only for substance abuse [11][12][13][14][15][16][17][18], but also for mental health problems like depression [19], anxiety [20], hyperactivity [21], and reckless behavior [22]. ...
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Problematic substance use and mental health problems often co-occur in adolescents. Effective school-based interventions that are brief and target multiple problems are promising in the field of health promotion. Preventure is a brief, school-based, selective preventive intervention, tailored to four personality profiles. Preventure has already proved effective on alcohol outcomes. Previous trials also reveal effects on several mental health outcomes, yet the evidence for these outcomes is limited. This study presents the results of the Dutch Preventure Trial, on a range of mental health outcomes. In a cluster RCT, including 699 high risk students (mean age 14 years), the intervention effects on mental health problems at 2, 6, and 12 months post intervention were tested in the total high risk population and in four specific personality groups. No significant intervention effects were found on 22 from the 24 tests. A positive intervention effect on anxiety was found in the anxiety sensitivity personality group at 12-month follow-up, and a negative intervention effect on depression was found at 12-month follow-up in the negative thinking group. In post hoc growth curve analyses these effects were not found. This study found no convincing evidence for the effectiveness of Preventure in The Netherlands on mental health problems. This finding is not in line with the results of an earlier effectiveness study in the UK. This highlights the need for more research into the knowledge transfer model of interventions, to ensure that interventions are effective in a variety of circumstances.
... According to Pihl and Peterson, these personality traits reflect individual variability in psychobiological systems responsible for affect, cognition, and susceptibility to substance abuse. Indeed, HOP and AS have been associated with greater alcohol-related problems in adolescence and adulthood (Krank et al., 2010;Stewart & Kushner, 2001;Stewart, Peterson, & Pihl, 1995). Youth high in SS and IMP report a variety of risky alcohol use patterns, including heavy drinking (Conrod, Stewart, Comeau, & Maclean, 2006;Krank et al., 2010) and adults high in SS and IMP are more prone to alcohol dependence (Conrod et al., 2000). ...
Article
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Specific personality dimensions may increase susceptibility to alcohol misuse by encouraging motives for drinking that are associated with risky alcohol use. In the current study, we examined associations between personality risk factors (hopelessness (HOP), anxiety sensitivity (AS), sensation seeking (SS), and impulsivity (IMP)) and drinking motives (coping, conformity, enhancement, and social motives) in a sample of high-risk youth receiving child protection services. These personality factors were assessed using the Substance Use Risk Profile Scale (SURPS) and drinking motives were assessed using the Drinking Motives Questionnaire-Revised (DMQ-R). The structural validity of the DMQ-R was first explored in this novel sample of high-risk adolescents using principal components analysis. Correlational analyses showed that HOP and IMP were associated with drinking to cope with negative emotions, and AS was associated with drinking to conform. Unexpectedly, enhancement motives were not related to any of the personality dimensions. This suggests that youth receiving child welfare services who are high in the described personality risk factors drink primarily for negative reinforcement.
... While theory predicts that those high in AS may drink alcohol to reduce anxiety, the documented associations between AS and problematic drinking (i.e., alcohol use and experiencing related problems) are mixed [15][16][17]. These inconsistent findings suggest that the association between AS and problematic drinking is complex. ...
Article
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Tension reduction theory states that persons high in anxiety sensitivity (AS) are particularly sensitive to alcohol's anxiolytic effects and thus may engage in problematic drinking to reduce distress. However, the literature is mixed, suggesting a complex AS pathway to problematic drinking. Elevated AS may promote drinking to alleviate anxiety, while alcohol's initial aversive physiological effects (e.g., increased heart rate) and potentially negative outcomes may deter use among those high in AS. For anxiety sensitive persons to drink, they must temporarily disregard alcohol's negative effects and instead focus on the immediate tension-reducing effects of drinking. Accordingly, anxiety sensitive individuals, who act impulsively when anxious (i.e., negative urgency), may be at risk for heavy drinking and experiencing alcohol-related problems. The goal of our study was to test this prediction. Given that gender differences have been consistently documented in the alcohol use literature, we also examined gender as a secondary moderator. Method: Undergraduates (N=346) completed self-reports of AS, negative urgency, and drinking habits. Results: Moderation analyses revealed that AS positively predicted alcohol-related problems, but only when negative urgency was elevated and this was true for men but not for women. Counter to predictions, the effect of AS on alcohol use was not moderated by negative urgency. However, gender did moderate the AS-alcohol use association, such that AS was negatively associated with alcohol use in men, but was unrelated in women. Conclusions: We found partial support for our hypotheses. Our findings place anxiety sensitive men, who are also high in negative urgency, at unique risk for alcohol-related problems. Clinical interventions may benefit from concurrently targeting negative urgency to reduce problematic drinking risk among anxiety sensitive men.
... Schmidt, Lerew and Joiner [89] did not arrive at the same conclusions but they found that high scores on the ASI were more likely to exacerbate depressive symptoms in the context of anxiety. Finally, Samoluk and colleagues [86] confirmed previous research (e.g., [87,90]) by demonstrating the important role anxiety sensitivity has on alcohol consumption. Participants with high anxiety sensitivity were more likely to consume greater amounts of alcohol in solitary situations than those with low anxiety sensitivity or individuals drinking in a social context. ...
Chapter
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For more than 60 years, researchers have been interested in determining the impact of expectations on treatment outcome. Earlier studies mostly focused on two types of expectations: prognostic and process expectations. Aims: To review how four different types of expectations (prognostic, process, anxiety expectancy and anxiety sensitivity) contribute to psychotherapy outcome, and to the development of clinical disorders, especially anxiety. Conclusions: First, the role of process and prognostic expectancies in clinical disorders and psychotherapy outcome should be clarified by addressing the methodological flaws of the earlier expectancy studies. Second, studies, especially those on anxiety disorders, may benefit from evaluating the four different types of expectations to determine their relative impact on outcome, and on the development and maintenance of these disorders. Third, possible links with other clinical disorders should be further explored. Finally, expectancies should be assessed prior to treatment and after several sessions to determine the extent to which the treatment's failure in modifying initial low expectancies contribute to a poor outcome.
... V rámci zneužívání návykových látek na základ negativního posílení urují speciÞ cké aspekty neurotické osobnosti formu negativního posílení, která vychází z užívání tchto látek. Napíklad jedinci trpící nadmrnou úzkostí užívají zvýšené dávky alkoholu (Stewart, et al., 1995). 0,001). ...
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Abstrakt: Cílem příspěvku je prezentace výsledků školní dotazníkové studie se zaměřením na rizikové chování adolescentů ve vztahu k jejich sebepojetí. Testování proběhlo na vybraném školském zařízení. Výzkumný vzorek (N = 200) tvořili žáci ve věku 11 – 15 let, tzn. žáci 2. stupně ZŠ. V poslední době byly v rámci různých studií detailněji popsány vztahy mezi jednotlivými typy rizikového chování a mezi nízkým nebo vysokým sebehodnocením. Byly popsány např. vztahy mezi nízkým sebehodnocením s delikvencí a agresivními tendencemi nebo zneužívání návykových látek. V rámci školní dotazníkové studie jsme se zaměřili na oblast sebepojetí dospívajících v širším kontextu. Testová baterie obsahovala Rosenbergovu škálu sebehodnocení (RŠS/RSES), aktualizovanou revizi Dotazníku sebepojetí školní úspěšnosti (SPAS) a další dotazníkové nástroje zaměřené na oblast rizikového chování a osobnostních charakteristik. Příspěvek bude tedy zaměřen na hlavní souvislosti mezi vybranými faktory těchto použitých nástrojů. Abstract: The aim of this paper is to present the results of a school questionnaire survey focusing on risky behavior of adolescents in relation to their self-image. The testing took place on one secondary school. The research sample (N = 205) consisted of children aged 11 to 15 years, ie. 2nd grade elementary school pupils. Recently, in the various studies described in detail the relationships between different types of risky behavior and between low or high self-esteem. They were described as the relationship between low self-esteem delinquency and aggressive tendencies or substance abuse. Within the school questionnaire study we focused on the area of adolescent self-concept in a broader context. Test battery included Rosenberg self-esteem scale (RSES), an updated revision of school achievement, self-concept Questionnaire (SPAS) and other instruments questionnaire focused on risk behavior and personality characteristics. The paper will therefore focus on the main connection between selected factors of the instruments used.
... V rámci zneužívání návykových látek na základ negativního posílení urují speciÞ cké aspekty neurotické osobnosti formu negativního posílení, která vychází z užívání tchto látek. Napíklad jedinci trpící nadmrnou úzkostí užívají zvýšené dávky alkoholu (Stewart, et al., 1995). 0,001). ...
Conference Paper
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Cílem příspěvku je prezentace výsledků školní dotazníkové studie se zaměřením na rizikové chování adolescentů ve vztahu k jejich sebepojetí. Testování proběhlo na vybraném školském zařízení. Výzkumný vzorek (N = 200) tvořili žáci ve věku 11 – 15 let, tzn. žáci 2. stupně ZŠ. V poslední době byly v rámci různých studií detailněji popsány vztahy mezi jednotlivými typy rizikového chování a mezi nízkým nebo vysokým sebehodnocením. Byly popsány např. vztahy mezi nízkým sebehodnocením s delikvencí a agresivními tendencemi nebo zneužívání návykových látek. V rámci školní dotazníkové studie jsme se zaměřili na oblast sebepojetí dospívajících v širším kontextu. Testová baterie obsahovala Rosenbergovu škálu sebehodnocení (RŠS/RSES), aktualizovanou revizi Dotazníku sebepojetí školní úspěšnosti (SPAS) a další dotazníkové nástroje zaměřené na oblast rizikového chování a osobnostních charakteristik. Příspěvek bude tedy zaměřen na hlavní souvislosti mezi vybranými faktory těchto použitých nástrojů.
... The lack of ability to delay behavioural response in impulsive individuals [24] is a risk factor for abuse of drugs due to a self-regulation deficit [25]. Highly anxious sensitive persons showed increased levels of drinking [26,27] are more responsive to the anxiety-reducing effect of alcohol, are more likely to use alcohol to cope with negative feelings [28], and have a higher incidence of problem drinking symptoms [29]. They often cope with their negative feelings by using a combination of withdrawal (from social situations), dependence (on others to make them feel better), or use of alcohol and/or drugs. ...
Article
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Background Substance use and abuse is a growing problem among adolescents with mild to borderline intellectual disabilities (ID). Substance use patterns in general population are similar to patterns among non-disabled peers, but substance use has more negative consequences for adolescents with mild to borderline ID, and they are at an increased risk for developing a substance use disorder. Nevertheless, effective and evidence based prevention programs for this groups are lacking. The study described in this protocol tested the effectiveness of a selective intervention aimed at reducing substance use in adolescents with mild to borderline ID and behavioral problems. In the intervention, participants acquire competences to deal with their high-risk personality traits. Methods A randomized controlled trial will be conducted among 14–21-year old adolescents with mild to borderline ID and behavioral problems admitted to treatment facilities in the Netherlands. Inclusion criteria are previous substance use and personality risk for substance use. Participants will be individually randomized to the intervention (n = 70) or control (n = 70) groups. The intervention group will be exposed to six individual sessions and five group sessions carried out by two qualified trainers over six-week period. Primary outcomes will be the percentage reduction in substance use (for alcohol: percentage decrease of binge drinking, weekly use and problematic use, for cannabis: the percentage decrease of lifetime cannabis use and weekly use and for hard drug: the percentage decrease of lifetime use). Secondary outcomes will be motives for substance use, intention to use, and internalizing and externalizing behavioral problems. All outcome measures will be assessed after two, six, and twelve months after the intervention. Discussion This study protocol describes the design of an effectiveness study of a selective prevention program for substance use in adolescents with mild to borderline ID and behavioral problems. We expect a significant reduction in alcohol, cannabis and hard drug use among adolescents in the intervention group compared with the control group. Trial registration This trial is registered in the Dutch Trial Register (Cochrane Collaboration) as NTR5037 registered at 15 April 2015.
Article
Objective: The high comorbidity between posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) is well-established and complex. However, there is a need to explore transdiagnostic constructs that may underlie this association to better understand what accounts for this comorbidity and to inform treatment development. Method: Thus, the present study utilized a large, cross-sectional dataset (N = 513; Mage = 38.25 years, SD = 10.07; 49.9% female), based on national recruitment, to (1) examine whether the associations between PTSD symptom severity (PCL-5) and alcohol use severity (AUDIT) were statistically mediated by (a) anxiety sensitivity (SSASI); and (b) difficulties with emotion regulation (DERS-16); and (2) examine whether coping motives for drinking moderate this indirect effect. Sex assigned at birth was included as a covariate. Results: When examining the hypothesized mediators (SSASI and DERS-16) in separate models, there was a statistically significant indirect effect of PCL-5 on AUDIT through both SSASI and DERS. However, when both SSASI and DERS were entered into a model simultaneously, only SSASI served as a statistically significant mediator. Coping motives for drinking did not moderate the observed indirect effect. Conclusions: The current findings highlight anxiety sensitivity and emotion regulation as transdiagnostic processes that may explain, at least partially, the relationship between PTSD symptom severity and alcohol use; however, stronger evidence was evident for anxiety sensitivity. These findings may help inform the development of refined, streamlined interventions for PTSD and alcohol use that directly target these processes.
Article
Background: Previous research suggests that high anxiety sensitivity (AS) - a fear of arousal-related body sensations - may have implications not only for mental health symptoms but also for functional impairment. The aim of the present study was to examine whether elevated AS is associated with functional impairment by way of heightened anxiety symptoms and resultant depressive symptoms or unhealthy coping behaviours (i.e., alcohol use, exercise avoidance, sleep problems) in a chained mediation model. Method: Participants were 128 treatment-seeking individuals with high AS who qualified for an anxiety, depression, or posttraumatic stress disorder diagnosis. They completed self-report measures of AS, anxiety, depression, and unhealthy coping behaviours as part of a pre-treatment assessment battery for a larger study examining the efficacy of a cognitive behavioural intervention for AS. Data were analyzed using path analysis. Results: Results revealed a direct association between AS and functional impairment that was partially mediated through a chained indirect pathway from AS to anxiety symptoms to depression symptoms to functional impairment. Unhealthy coping behaviours did not serve as mediators. Limitations: Results are limited by the cross-sectional nature of the data. Conclusions: The present findings have clinical implications insofar as supporting the relevance of reducing AS and focusing on depressive symptoms when seeking to improve clients' functioning.
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Objective: Alcohol use and related problems increase during adolescence and peak in early adulthood. Tension reduction theories suggest that those high in anxiety sensitivity (AS) may be at risk for misusing alcohol for its anxiolytic effects. Cognitive theories point to drinking motives and alcohol expectancies as explanatory mechanisms of this risk pathway. This study examined AS risk for prospective alcohol misuse, as explained by an unfolding cognitive process, among those transitioning out of Collège d’enseignement général et professionnel (CEGEP, i.e., junior college equivalent in Quebec, Canada). We hypothesized that there would be trait-like (average levels over time), positive associations between AS, coping motives, tension-reduction alcohol expectancies, and alcohol use and problems, and that AS would lead to state-like (occasion-specific, reciprocal associations) bidirectional and positive associations between alcohol cognitions and outcomes. Method: Final-year CEGEP students (N = 193) completed three online questionnaires at 6-month intervals assessing AS, drinking motives (coping, enhancement), alcohol expectancies (tension reduction, sociability/liquid courage), and alcohol use/problems. State–trait modeling was used for hypothesis testing. Results: Consistent with hypotheses, at the “trait” level, drinking motives and alcohol expectancies were positively associated, and drinking motives and sociability/liquid courage expectancies were positively associated with alcohol problems. At the “state” level, AS positively predicted coping motives and alcohol use, tension-reduction expectancies positively predicted coping motives, and coping motives and sociability/liquid courage expectancies positively predicted alcohol use. Conclusions: Results suggest that AS is a risk factor for coping-motivated drinking, and that there is interplay between cognitions that may help understand emerging adult alcohol risk pathways.
Article
Given the high prevalence and considerable clinical and societal burden of anxiety disorders, preventive measures are urgently warranted to reduce their incidence and overall healthcare impact. Anxiety sensitivity (AS) – a key element in learning theories of anxiety disorders in the context of interoceptive conditioning – constitutes a malleable risk factor of particularly panic disorder and separation anxiety, which share developmental, nosological, epidemiological and pathomechanistic characteristics. The computer-assisted ‘Cognitive Anxiety Sensitivity Treatment’ (CAST) targeting interoceptive anxiety symptoms (cf. Schmidt et al., 2014) was translated, intensified and culturally adapted to German and evaluated in a sample of 105 healthy adult volunteers with elevated AS (mean ASI-3: 29.5) applying a randomized design. Success of the intervention was measured as a function of AS and separation anxiety (ASA-27) ∼6 weeks (T1) and ∼6 months (T2) after the intervention. As compared to waitlist, CAST resulted in a significant reduction of AS at both T1 and T2. Separation anxiety was not directly reduced by the intervention, but decreased mediated by a decline in AS. A composite interoceptive score capturing changes in sensitivity to respiratory symptoms during the baseline therapist-accompanied CAST session was shown to be predictive of overall response at T1. In sum, CAST-German Version was successfully established as an effective intervention reducing AS, while at the same time indirectly decreasing separation anxiety. A composite interoceptive score predicting treatment response might aid in further delineating risk markers informing targeted preventive interventions for anxiety disorders.
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Schizophrenia is a mental disorder that affects how a person reacts with the surrounding world. Patients with schizophrenia have a lower quality of life. The long-term cost for supporting patients with schizophrenia is far greater than that of many other mental disorders. The cost of supporting schizophrenia patients is about 1%–3% of the national health care cost in most of the developed nations. This cost is almost up to 20% of the direct expenses of all types of mental health cost. Case studies are detailed qualitative investigation where a single or few participants are investigated. Case studies can explain social phenomena, that is, events happening in the society that relate to everyday living problem. Data in case studies can be gathered by documentation, interview, archival records, direct observation, participant observation, and physical artifact. Interview is a well-established technique for data collection in case study. There are various case studies on managing different symptoms and quality of life associated with schizophrenia patients. In the current study, the eligibility criteria for the selection of case studies are their effectiveness in addressing issues related to the management of schizophrenia. This chapter reviews prior case studies of the management of schizophrenia and explains why case studies are important for understanding and treating schizophrenia.
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Depression and anxiety are the most common psychological disorders to have a comorbid diagnosis with alcohol use disorders (AUDs). There have been inconsistent findings regarding the direction of these relationships, and few studies have attempted to determine the causal direction of the relationship between AUDs and the development of depression and anxiety. To provide some clarity on this debate, we provide an overview of the different factors that are contributing to this common comorbid diagnosis. We explain the complex relationship between these disorders by discussing the association between alcohol dependence and depressive symptoms; and the association between alcohol dependence and anxiety symptoms—with some discussion of the causal role of genetic predisposition to developing a comorbid diagnosis. The role of anxiety sensitivity, the mediating role of rumination, and experiential avoidance are discussed; with a focus on how self-medication contributes to individuals utilizing alcohol to cope with the negative affect associated with depression and anxiety. We also show how specific psychosocial risk factors are contributing to comorbidity. Based on our review, we suggest that our understanding of the comorbidity between AUDs, anxiety, and depression can be enhanced by identifying multiple risk factors that might be predictive of a comorbid diagnosis.
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Purpose: This study investigated the relationship between the clinical and sociodemographic characteristics of patients with bipolar disorder and schizophrenia and the levels of anxiety sensitivity. Materials and Methods: Fifty-nine patients (33 females, 26 males) with bipolar disorder in the euthymic period without any comorbid mental disorders between the ages of 18-65 and 65 (28 females, 37 males) clinically stable patients with schizophrenia, and 88 (47 females, 41 males) healthy volunteer consist the sample group of the study. Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HDRS) were applied for patients with bipolar disorder, Positive and Negative Syndrome Scale (PANSS) for patients with schizophrenia and Anxiety Sensitivity Index-3 (ASI-3) to the whole sample group. Results: ASI-3 total, cognitive, and social subscale scores were significantly higher in patients with bipolar disorder and schizophrenia compared to the control group. Patients with bipolar disorder who had previous suicide attempts had significantly higher ASI-3 physical and total scores than those who did not attempt suicide. There was a significant linear correlation between physical, cognitive, and total scores of ASI-3 and PANSS positive scores of patients with schizophrenia. Conclusion: Anxiety sensitivity is higher in patients diagnosed with bipolar disorder and schizophrenia compared to healthy individuals. This study revealed that anxiety sensitivity is a predictor of previous suicide attempts in bipolar disorder, and in schizophrenia, it is associated with disorder severity, particularly with positive psychotic symptoms
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У статті представлені результати перекладу та адаптації методики SURPS «Шкала ризику розвитку залежності від психоактивних речовин» російською мовою. Чотири субшкали методики, що відповідають чотирьом добре теоретично обґрунтованим конструктам — «депресивність», «тривожність», «імпульсивність», «пошук стимуляції». Вираженість цих рис на особистісному рівні асоційована з ризиком розвитку залежності від психоактивних речовин та прогнозує можливий вибір психоактивної речовини та етіологію залежності, спираючись на наявну особистісну мотивацію. Представлені кофіцієнти надійності для шкал за методами Альфа Кронбаха та Лямбда 2. За допомогою методу xi-квадрат на результатах вибірки проілюстрована можливість окремих питань-індикаторів передбачити приналежність досліджуваних до когорти без діагностованої залежності або до когорти з діагностованою залежністю. Відповідність оригінальної факторної моделі шкали SURPS емпірично виявленим на російськомовних досліджуваних закономірностям встановлена та модифікована за допомогою методу конфірматорного факторного аналізу.
Article
Objective: Posttraumatic stress symptoms (PTSS) have been found to be associated with alcohol (mis)use among college students. Anxiety sensitivity has been theoretically and empirically linked to both PTSS and alcohol (mis)use. The goal of the present study was to extend research by examining the relations among PTSS, anxiety sensitivity, and alcohol misuse within a sample of trauma-exposed Black college students. Methods: Participants were 121 Black undergraduate college students who endorsed exposure to a traumatic event (M age = 22.98, 77.7% female). Results: Correlational findings provide support for significant positive relations between PTSS and both anxiety sensitivity and alcohol misuse. Further, analyses revealed a significant indirect effect of anxiety sensitivity on alcohol misuse through PTSS. Specifically, greater anxiety sensitivity was associated with higher levels of PTSS, which, in turn, were associated with higher levels of alcohol misuse. Conclusions: These findings suggest that the assessment of anxiety sensitivity may be useful in identifying trauma-exposed Black individuals who are likely to experience alcohol misuse and the clinical utility of addressing PTSS in this population reporting anxiety sensitivity to possibly prevent alcohol misuse and related negative consequences.
Article
Background: The aim of the current study was to examine the associations between the specific mindfulness skills of observing, describing, awareness, nonjudgment, and nonreactivity in terms of anxiety sensitivity (AS), distress tolerance (DT), and intolerance of uncertainty (IU) among college students with problematic alcohol use. Methods: Participants were 202 (69.3% male, Mage = 18.96, SD = 2.24, Range = 18-45 years) undergraduate college students with problematic alcohol use who completed self-report measures for course credit. Results: Results indicated that after controlling for the effects of gender, smoking status, marijuana use status, and negative affectivity, greater use of the mindfulness skill of observing was associated with higher AS, greater describing was associated with lower AS and higher DT, greater nonjudgment was associated with lower AS and IU and higher DT, and greater nonreactivity was associated with increased DT. Awareness did not significantly predict any of the examined risk factors. Conclusions: These results suggest that specific mindfulness skills are associated with a greater tolerance of physiological, emotional and uncertain states. An important next step will be to examine whether mindfulness skills are associated with decreased problematic alcohol use due to improvements in these anxiety-related risk factors.
Article
Aim To explore whether specific groups of adolescents (i.e., scoring high on personality risk traits, having a lower education level, or being male) benefit more from the Preventure intervention with regard to curbing their drinking behaviour. Design A clustered randomized controlled trial, with participants randomly assigned to a 2-session coping skills intervention or a control no-intervention condition. Setting Fifteen secondary schools throughout The Netherlands; 7 schools in the intervention and 8 schools in the control condition. Participants 699 adolescents aged 13–15; 343 allocated to the intervention and 356 to the control condition; with drinking experience and elevated scores in either negative thinking, anxiety sensitivity, impulsivity or sensation seeking. Measurements Differential effectiveness of the Preventure program was examined for the personality traits group, education level and gender on past-month binge drinking (main outcome), binge frequency, alcohol use, alcohol frequency and problem drinking, at 12 months post-intervention. Intervention and comparator Preventure is a selective school-based alcohol prevention programme targeting personality risk factors. The comparator was a no-intervention control. Findings Intervention effects were moderated by the personality traits group and by education level. More specifically, significant intervention effects were found on reducing alcohol use within the anxiety sensitivity group (OR = 2.14, CI = 1.40, 3.29) and reducing binge drinking (OR = 1.76, CI = 1.38, 2.24) and binge drinking frequency (β = 0.24, p = 0.04) within the sensation seeking group at 12 months post-intervention. Also, lower educated young adolescents reduced binge drinking (OR = 1.47, CI = 1.14, 1.88), binge drinking frequency (β = 0.25, p = 0.04), alcohol use (OR = 1.32, CI = 1.06, 1.65) and alcohol use frequency (β = 0.47, p = 0.01), but not those in the higher education group. Post hoc latent-growth analyses revealed significant effects on the development of binge drinking (β = − 0.19, p = 0.02) and binge drinking frequency (β = − 0.10, p = 0.03) within the SS personality trait. Conclusions The alcohol selective prevention program Preventure appears to have effect on the prevalence of binge drinking and alcohol use among specific groups in young adolescents in the Netherlands, particularly the SS personality trait and lower educated adolescents.
Article
Understanding the nature and influence of specific risk profiles is increasingly important for health behavior promotion. The purpose of this article is to document the value of two factors—anxiety sensitivity (AS) and working memory capacity (WMC)—for enhancing risk for the initiation and/or maintenance of a range of negative health behaviors. AS is a distress-related risk factor that potentiates avoidance/coping motivations for negative health behaviors. Stress provides the conditions for negative somatic and affective states, and AS amplifies the aversiveness of these experiences and correspondingly hinders adaptive functioning. In contrast, low WMC is hypothesized to exert its effect by decreasing the capacity to filter out current temptations, attenuating a focus on longer-term goals and impairing the application of relevant coping skills at times of stress. In this review, we provide conceptual models for the separate roles of high AS and low WMC in negative health behaviors, review the influence of these factors on specific health behavior exemplars (eating behaviors/obesity, physical activity, smoking, alcohol use, and sleep promotion), provide preliminary evidence for their value as independent treatment targets for health-behavior promotion, and encourage specific research directions in relation to these variables.
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Despite extensive evidence linking childhood exposure to adverse parenting and subsequent substance use, the extant research literature is more limited regarding individual difference factors that may moderate this association. This study examines the moderating role of anxiety sensitivity (AS) in the association between childhood exposure to parental threatening behaviors and substance use in a sample of late adolescents with clinical anxiety. One hundred fifty-one late adolescents with clinical levels of anxiety (18.61 years old; SD = 0.91) completed measures assessing childhood exposure to parental threatening behaviors, AS, alcohol/tobacco and illicit substance use frequency, negative affect, and history of negative life events. A significant moderating effect of AS in the association between childhood exposure to parental threatening behaviors and both average and illicit drug use was found—even after controlling for participants’ age and history of negative life events. Specifically, for individuals with high AS, as childhood exposure to parental threatening behaviors increased so too did average and illicit substance use frequency; however, for individuals with low AS, childhood exposure to parental threatening behaviors was not significantly associated with either substance use frequency. Findings underscore the profound impact that early negative experiences have on substance use outcomes, particularly for individuals with high AS who have difficulty coping with and regulating physiological arousal. Limitations and clinical implications of these findings are discussed.
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The effects of a weight-training program on trait and state anxiety on one group of chemically dependent adults were investigated. The subjects (N=18) were in-patients in a rehabilitation program for substance abuse (Therapeutic Community) for one year. Subjects were randomly assigned to two groups. Experimental group (N=12) received a weight training program (bodybuilding) 3 days per week for 8 weeks. Control group (N=6) was designated as the control group and received no exercise treatment over the 8-week period. Pre and post-test measures included the STAI questionnaire. The initial level of anxiety (trait and state) was low and after eight weeks the bodybuilding program did not produce a significant decrease in anxiety (trait and state).
Article
Motivational model of alcohol use suggests that the decision to drink is a goal-directed process in which individuals choose to drink based on their expectation that drinking will have desired outcomes. According to the model, drinking motives can be described with four categories referred as Social, Coping, Enhancement and Conformity Motives. Anxiety sensitivity (AS) is one of the personality traits that has been found to be significantly related with drinking motives. AS consists of beliefs that the experience of anxiety symptoms leads to illness or additional anxiety. The aim of the present study was to examine the relationship between drinking motives and AS in university students using alcohol. Participants were 411 university students (225 females and 186 males). Of the total sample, 313, of which 177 were female and 136 were male, reported using alcohol. All participants were administered Anxiety Sensitivity Index-Revised, Alcohol Use Disorders Identification Test, Drinking Motives Questionnaire-Revised and Demographic Information Form. Students with high AS reported more alcohol use for Coping, Social and Conformity Motives than those with moderate and low AS. Hierarchical regression analyses revealed that Social Motive was significantly predicted by "fear of publicly observable anxiety symptoms", Conformity Motive was significantly predicted by "fear of publicly observable anxiety symptoms" and "fear of cognitive dyscontrol". Results were discussed within the findings in the literature.
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Using survey data from the Promise Academy in the Harlem Children’s Zone, we estimate the effects of high-performing charter schools on human capital, risky behaviors, and health outcomes. Six years after the random admissions lottery, youths offered admission to the Promise Academy middle school score 0.279 (0.073) standard deviations higher on academic achievement outcomes, 0.067 (0.076) standard deviations higher on an index of academic attainment, and 0.313 (0.091) standard deviations higher on a measure of on-time benchmarks. Females are 10.1 percentage points less likely to be pregnant as teenagers, and males are 4.4 percentage points less likely to be incarcerated.
Chapter
Prior studies have indicated a high prevalence of comorbidity between problematic levels of eating and drinking. This high co-prevalence has been partly attributed to the disinhibiting effects of alcohol on eating behaviors. Specifically, alcohol consumption has been shown to increase food intake by disinhibiting eating behaviors. Alternately, it is also possible that food and alcohol consumption might become associated through repeated pairings. Through these repeated pairings, food cues and food consumption might elicit alcohol cravings and subsequent alcohol use. Similarly, alcohol cues and alcohol consumption might elicit food cravings and subsequent food intake. Finally, other common factors might explain both eating and drinking behaviors. In particular, the tendency to cope with distress through food and alcohol consumption has been shown to increase the risk for problematic levels of eating and drinking. The current chapter will review evidence supporting and theories underlying these pathways in order to better understand the high co-prevalence of problematic eating and drinking.
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Comments on research in "soft psychology" involving more ephemeral and unreplicable areas of study, focusing on the question of how large an effect must be to be considered important. The binomial effect size display (R. Rosenthal and D. B. Rubin; see record 1982-22591-001) is viewed as a useful way to display the practical magnitude of an effect size, regardless of whether the dependent variable is dichotomous or continuous. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Some of the shortcomings in interpretability and generalizability of the effect size statistics currently available to researchers can be overcome by a statistic that expresses how often a score sampled from one distribution will be greater than a score sampled from another distribution. The statistic, the common language effect size indicator, is easily calculated from sample means and variances (or from proportions in the case of nominal-level data). It can be used for expressing the effect observed in both independent and related sample designs and in both 2-group and n-group designs. Empirical tests show it to be robust to violations of the normality assumption, particularly when the variances in the 2 parent distributions are equal. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Examined the effects of anxiety-sensitivity (AS) levels, and 1.00 ml/kg alcohol, on autonomic and subjective-emotional responses to aversive stimulation (i.e., noise bursts). Ss were 30 university women divided into 3 AS groups (high, moderate, and low), on the basis of Anxiety Sensitivity Index (ASI) scores. When sober, high-AS women provided higher emotional arousal ratings while anticipating the noise bursts than did low-AS women. Alcohol dampened the noise burst-anticipation ratings, particularly in the high-AS group. ASI scores were positively correlated with degree of sober skin conductance level (SCL) reactivity and with degree of alcohol dampening of SCL reactivity. Thus, high-AS women may use alcohol to normalize their anticipatory emotional and electrodermal overreactivity to threat. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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This is an account of what I have learned (so far) about the application of statistics to psychology and the other sociobiomedical sciences. It includes the principles "less is more" (fewer variables, more highly targeted issues, sharp rounding off), "simple is better" (graphic representation, unit weighting for linear com- posites), and "some things you learn aren't so." I have learned to avoid the many misconceptions that surround Fisherian null hypothesis testing. I have also learned the importance of power analysis and the determination of just how big (rather than how statistically significant) are the effects that we study. Finally, I have learned that there is no royal road to statistical induction, that the informed judgment of the investigator is the crucial element in the interpretation of data, and that things take time.
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The results of two studies1,2 in the Archives have been interpreted as being suggestive of reduced benzodiazepine receptor sensitivity (or, more specifically, a shift in benzodiazepine receptor "setpoint"2) resulting in reduced ɣ-aminobutyric acid (GABA) function in panic disorder, with these abnormalities possibly being pathogenic. We suggest two possible alternative or additional explanations.These Results Could Be Secondary to Chronic Alcohol Use.—In both studies,1,2 drinking history was either not assessed or not reported. Yet there is a strong relationship between alcohol abuse and the panic-related disorders.3-5 Data6-9 attest to the fact that rates of panic disorder in alcoholics and rates of alcohol abuse in patients with panic disorder are unusually high compared with the rates in the general population.10There is increasing evidence that alcohol mediates many of its pharmacologic effects through the GABA-ergic receptor system, from behavioral, electrophysiological, and ...
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Lilienfeld, Jacob, and Turner (1989) questioned the conceptual and empirical distinction between anxiety sensitivity and trait anxiety, and suggested that results attributed to anxiety sensitivity are more parsimoniously explained by trait anxiety. In the present article, I clarify the theoretical distinction between these constructs, and provide further data that support this distinction.
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Recent studies have demonstrated that sons of male alcoholics with multigenerational family histories of male alcoholism are characterized by sober heart-rate hyperreactivity to aversive stimuli, susceptibility to alcohol-induced dampening of that hyperreactivity and by increased resting heart rate while intoxicated. Regression analyses indicate that the magnitude of alcohol-induced change in resting and reactive cardiac response is significantly and powerfully associated with the degree of self-reported voluntary alcohol consumption among 85 non-alcoholic males who are either lacking or who have moderate or extensive family histories of male alcoholism. It appears that heightened sensitivity to alcohol-induced increase in resting and decrease in reactive heart rate might mark or underlie familial risk for developing alcoholism.
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To the Editor. — The results of two studies1,2 in the Archives have been interpreted as being suggestive of reduced benzodiazepine receptor sensitivity (or, more specifically, a shift in benzodiazepine receptor "setpoint"2) resulting in reduced ɣ-aminobutyric acid (GABA) function in panic disorder, with these abnormalities possibly being pathogenic. We suggest two possible alternative or additional explanations.These Results Could Be Secondary to Chronic Alcohol Use.—In both studies,1,2 drinking history was either not assessed or not reported. Yet there is a strong relationship between alcohol abuse and the panic-related disorders.3-5 Data6-9 attest to the fact that rates of panic disorder in alcoholics and rates of alcohol abuse in patients with panic disorder are unusually high compared with the rates in the general population.10There is increasing evidence that alcohol mediates many of its pharmacologic effects through the GABA-ergic receptor system, from behavioral, electrophysiological, and
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—Stewart et al raise an im- portant point, namely, the reason patients with panic disorders have abnormal benzodiazepine receptor sensitivity. However, their suggestion that previous alcohol or benzodiazepine exposure could result in anxiogenic responses to flumazenil are but two in a range of possible causes. Before considering these, we can offer some more direct support for their contention that alcoholism may be of relevance. Their bibliography of clinical studies in this area could be usefully expanded to include a recent review that directly addresses the alcoholism/panic disorder comorbidity question and postulates several neurochemical mechanisms for this.1 Moreover, the marked similarity between the symptoms of withdrawal and panic attacks has been documented.2 A possible explanation for this is provided by recent neurochemical studies that demonstrated that acute and long-term ethanol exposure increases the sensitivity of the benzodiazepine receptor to the inverse agonist dimethoxy-methyl-β carboline-3-carboxylate (DMCM).3,4 Since ethanol exposure
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Evaluated a scale for measuring anxiety sensitivity (i.e., the belief that anxiety symptoms have negative consequences), the Child Anxiety Sensitivity Index (CASI), in 76 7th–9th graders and 33 emotionally disturbed children (aged 8–15 yrs). The CASI had sound psychometric properties for both samples. The view that anxiety sensitivity is a separate concept from that of anxiety frequency and that it is a concept applicable with children was supported. The CASI correlated with measures of fear and anxiety and accounted for variance on the Fear Survey Schedule for Children—Revised and the State-Trait Anxiety Inventory for Children (Trait form) that could not be explained by a measure of anxiety frequency. The possible role of anxiety sensitivity as a predisposing factor in the development of anxiety disorder in children is discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
The goals of the present study were to measure the relationship between alcohol consumption in 93 female social drinkers and their cognitive functioning and mood in the sober state, and to investigate the possible causal effects of alcohol consumption on these variables. In the first test session, a limited relationship was seen between previous alcohol consumption and sober cognitive performance. A strong relationship was found between alcohol Consumption and self-reported depression and anger in the sober state. Either a prolonged reduction in alcohol consumption or a prolonged maintenance of alcohol consumption was undertaken by random subsets of the original sample. In the second test session 6 weeks later, women who had been randomly selected to reduce their alcohol intake showed decreases in depression, anger, and mental confusion when they were sober, relative to women who maintained or increased their alcohol consumption over the same perlad of time. We found no changes in cognitive performance In these groups. We concluded that the simplest explanation of the findings is that relatively low levels of alcohol consumption produce wbstantial increases in depression and anger in the sober state in female social drinkers. The value of considering alcohol consumption as a continuous variable rather than a dichotomous variable with “safe” and “unsafe” zones was discussed.
Article
The personality traits of anxiety sensitivity and dependency and their relationship to the experience of panic anxiety and panic disorder with agoraphobia were investigated. The Anxiety Sensitivity Index (ASI) and the Interpersonal Dependency Inventory (IDI) were completed by 116 university students and 23 clinical panic disorder (with agoraphobia) patients. Nineteen percent of the college control sample reported prior experience with spontaneous panic attacks. Patients scored significantly higher than controls on the ASI, total IDI, and the “lack of social self-confidence” subscale of the IDI. Non-clinical student panickers and non-panickers failed to differ significantly on any of the personality measures, suggesting that dependency and anxiety sensitivity may be more likely results of repeated experiences of panic over time and agoraphobic avoidance than they are predisposing factors. The ASI scores were found to correlate significantly with the IDI and with two of its subscales, suggesting that anxiety sensitive individuals tend to be low in social self-confidence and highly reliant on significant others.
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The literature on drinking motives suggests that individuals drink for three distinct reasons: coping motives (CM: to reduce and/or avoid negative emotional states); social motives (SM: to affiliate with others); and enhancement motives (EM: to facilitate positive emotions). Cooper, Russell, Skinner and Windle (1992) [Psychological Assessment, 4, 123–132] developed a 3-dimensional self-report instrument, the Drinking Motives Questionnaire (DMQ), with subscales designed to assess relative frequency of drinking for each of these three motives. This study was designed to examine the psychometric properties of the DMQ in a large sample of young adult university students. Three hundred and fourteen students voluntarily served as subjects; 266 students (85% of the total sample; 196F and 70M) reported drinking on the DMQ. These students were divided into two age groups [20 yr and under (n = 117); 21 yr and older (n = 149)]. Analyses of variance indicated: (a) main effects of gender, with men scoring significantly higher on the DMQ-EM subscale and tending to score higher on the DMQ-SM subscale when compared to women; (b) a main effect of age group on the DMQ-EM subscale, with younger students scoring significantly higher than older students; and (c) a significant main effect of drinking motive, with the most relatively frequent drinking reported for SM and the least for CM overall. Although mild-to-moderate shared variance between subscales was noted, the three subscales of the DMQ were found to possess adequate-to-high levels of internal consistency. A confirmatory factor analysis (CFA) showed that the hypothesized 3-factor model provided a better fit than either a unidimensional or 2-factor model in explaining the underlying structure of the DMQ. Some suggestions for improvements in DMQ item content are made. The present results replicate and extend previous findings by Cooper and colleagues to a sample of university students, and support the utility of using the DMQ in future investigations of the drinking motives of young adults.
Article
The present study was designed to examine the relationship between anxiety sensitivity (AS; fear of anxiety symptoms) and alcohol use motives. The Anxiety Sensitivity Index (ASI), the State-Trait Anxiety Inventory-Trait Subscale (STAI-T), and the Drinking Motives Questionnaire (DMQ) were administered to 314 university students. Higher ASI scores were found to be significantly associated with greater scores on the Coping Motives (CM) subscale of the DMQ, particularly in the female subjects. In contrast, ASI scores were not found to be related in a linear fashion to scores on either the Enhancement Motives (EM) or Social Motives (SM) subscales of the DMQ. A regression equation involving a weighted linear combination of scores on the ASI and STAI-T significantly predicted scores on the CM subscale of the DMQ; the regression equation was significantly better at predicting the frequency of coping-related drinking in women than men. When “primary” motives were examined, a significantly greater percentage of high than low AS subjects (particularly high AS women) were found to drink primarily for coping-related motives, and a significantly greater percentage of low than high AS subjects were found to drink primarily for social-affiliative motives. This pattern of drinking motives points to potential difficulties with alcohol in individuals (particularly women) who are high in both AS and trait anxiety, since drinking primarily for CM as opposed to SM has previously been shown to be associated with more drinking alone, heavier alcohol consumption, and more severe alcohol-related problems.
Article
The purpose of this study was to (a) compare people who experienced recent panic attacks (panickers) with nonpanickers and (b) determine, the factors associated with panic attacks in nonclinical subjects. Two hundred and fifty-six students completed the Panic Attack Questionnaire (PAQ), the State-Trait Anxiety Inventory (STAI), the Beck Depression, Inventory (BDI), the Profile of Mood States (POMS), and two measures of fear/avoidance. Over 22% of the subjects reported one or more panic attacks in the 3 weeks, prior to testing. Comparisons of panickers and nonpanickers showed that panickers (a) scored higher on measures of anxiety, depression, etc., and (b) reported more first-order relatives who have panic attacks. The panic attacks were characterized by (a) having a sudden onset, (b) an average of eight DSM-III symptoms, and (c) occurring in a wide variety of situations (especially social situations). Subjects who experienced unpredictable panic attacks differed, on several measures from subjects with only predictable attacks. Finally, panickers reported experiencing several symptoms not included in DSM-III. Similarities, between panickers and patients with Panic Disorder and Agoraphobia and the assessment of panic-related, disorders are discussed.
Article
The purposes of this article are to summarize the author's expectancy model of fear, review the recent studies evaluating this model, and suggest directions for future research. Reiss' expectancy model holds that there are three fundamental fears (called sensitivities): the fear of injury, the fear of anxiety, and the fear of negative evaluation. Thus far, research on this model has focused on the fear of anxiety (anxiety sensitivity). The major research findings are as follows: simple phobias sometimes are motivated by expectations of panic attacks; the Anxiety Sensitivity Index (ASI) is a valid and unique measure of individual differences in the fear of anxiety sensations; the ASI is superior to measures of trait anxiety in the assessment of panic disorder; anxiety sensitivity is associated with agoraphobia, simple phobia, panic disorder, and substance abuse; and anxiety sensitivity is strongly associated with fearfulness. There is some preliminary support for the hypothesis that anxiety sensitivity is a risk factor for panic disorder. It is suggested that future researchers evaluate the hypotheses that anxiety and fear are distinct phenomena; that panic attacks are intense states of fear (not intense states of anxiety); and that anxiety sensitivity is a risk factor for both fearfulness and panic disorder.
Article
The construct of anxiety sensitivity (AS) has occupied an increasingly important place in theorizing and research on anxiety and anxiety disorders. Although a number of recent studies have provided support for the construct validity of the principal operationalization of AS, the Anxiety Sensitivity Index (ASI), the relation of the AS construct and the ASI to trait anxiety continues to be a source of controversy. Key issues in the AS-trait anxiety debate include the assimilative nature of traits and the concept of incremental validity. Recent research on AS lends some support to the claim that trait anxiety cannot fully account for AS findings. Important areas for future AS research include (1) demonstrating that AS is a risk factor for panic disorder and related conditions, lather than simply a consequence of these conditions, (2) developing and utilizing multiple operationalizations of constructs, (3) minimizing the impact of potentially inapplicable items, (4) testing for interactions between AS and other variables, and (5) testing hierarchical factor models that allow trait anxiety and AS to coexist as higher- and lower-order factors, respectively. Researchers in this area will need to develop alternative measures of the AS construct, recognize the distinction between different levels of trait specificity, clarify a number of theoretical issues relevant to the AS construct, and continue to subject predictions to stringent theoretical risks.
Article
The present study examined the prevalence of alcohol dependence among panic disorder patients. Twenty-four of 100 patients had a history of alcohol dependence according to DSM-III-R criteria; only one patient met criteria for current alcohol dependence. The lifetime prevalence obtained for this clinic sample exceeded that for the general population, and appeared to be due primarily to higher than expected rates among women. A childhood history of anxiety disorders and co-morbid diagnoses of social phobia and major depression were each associated with relatively higher rates of alcohol dependence. The clinical implications of these findings are discussed.
Article
The relationship between substance abuse and panic-related anxiety can be divided into two broad areas: the incidence of anxiety disorders in substance abuse patients and the incidence of substance abuse in patients with panic-related anxiety disorders. Studies indicate that approx. 10-40% of alcoholics have a panic-related anxiety disorder, and about 10-20% of anxiety disorder patients abuse alcohol or other drugs. The majority of patients with both an anxiety and alcohol disorder report that anxiety problems preceded alcohol problems. In some cases substance abuse (e.g. cocaine) triggers the onset of panic attacks. Most patients believe that self-medication is efficacious despite the fact that they appear to have a more serious clinical condition (e.g. higher rates of depression). Directions for future research are outlined, including the proposal for a study to examine the effects of an anxiety intervention procedure for anxious alcoholics to reduce relapse rates.
Article
The authors report an abbreviated version of the Michigan Alcoholism Screening Test (MAST). They hypothesized, on the basis of previously published data, that scores based on ten of the questions of the MAST would be as effective in discriminating between alcoholics and nonalcoholics as scores based on all 25 questions. The responses of 60 alcoholic and 62 nonalcoholic psychiatric patients supported their hypothesis.
Article
Previous studies have found some significant, but weak, gender differences in panic and agoraphobia with females generally being more symptomatic. The present study sought to expand this line of research by examining alcohol use and self-medication in relation to gender differences and measures of psychopathology. Seventy-four male and 162 female patients with panic disorder with agoraphobia were compared. There were some significant, but relatively small, gender differences with females reporting higher levels of phobic avoidance. Males reported significantly more weekly alcohol intake and also perceived alcohol to be a more effective strategy in coping with anxiety. Alcohol-related factors were significantly correlated with several measures of psychopathology for males but this was less evident in females. The correlations were not large but the results do suggest that a subset of males consume moderate to large amounts of alcohol, believe self-medication to be an effective anti-anxiety strategy, and yet report higher levels of psychopathology such as social fears.
Self-report issues in addictive behaviors [Special issue]
  • L C Sobell
  • M C Sobell
Sobell, L. C., & Sobell, M. C. (Eds.) (1990). Self-report issues in addictive behaviors [Special issue]. Behavioral Assessment, 12( 1).
Gender differences in alcohol and anxiolytic medication use in panic disor-der [summary] Anxiety sensitivity and the prediction of panic in a non-clinical sample [Summary] Anxiety sensitivity and self-reported rea0n
  • S H Stewart
Stewart, S. H. (1995). Gender differences in alcohol and anxiolytic medication use in panic disor-der [summary]. Can&un Psychology, 36 (Za), 81. Stewart, S. H., Dubois-Nguyen, I., & Pihl, R. 0. (1990). Anxiety sensitivity and the prediction of panic in a non-clinical sample [Summary]. Conudiun Psychology, 31,338. Stewart, S. H., Karp, J.. Piil, R. 0.. & Peterson, R. A. (1995). Anxiety sensitivity and self-reported rea0n.r for drug use. Manuscript submitted for publication.
AIcohol abuse in victims of trauma: A critical review Anxiety sensitivity and alcohol use motives
  • S H Stewart
  • S B Zeitlin
Stewart, S. H.. & Zeitlin, S. B. (in press). AIcohol abuse in victims of trauma: A critical review. Psycological Bulk& Stewart, S. H.. & Zeitlin, S. B. (1994). Anxiety sensitivity and alcohol use motives. Journal of Anxiety disorders, 9.229-240.
Alcohol-induced heart-rate change, family history, and prediction of weekly alcohol consumption by nonalalcoholic males
  • Peterson
Alcohol and tension reduction: An update on research and theory
  • Cappell
The interaction of alcohol expectancies, personality, and psychopathology among inpatient alcoholics [summary]
  • Karp
Anxiety sensitivity and the prediction of panic in a non-clinical sample [Summary]
  • Stewart
Alcohol abuse in victims of trauma: A critical review
  • S H Stewart
  • S B Zeitlin