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Anxiety Sensitivity and Situation-Specific
Drinking in Women With Alcohol Problems
Sandra M. Reyno, MSc
Sherry H. Stewart, PhD
Catrina G. Brown, PhD
Peter Horvath, PhD
Juliana Wiens, MSW
We examined the unique contributions of depression, anxiety, and anxiety sensitivity (AS)
in predicting frequency of drinking in different high-risk situations among 60 women
receiving treatment for alcohol problems. Participants completed the Beck Depression
Inventory-II, Beck Anxiety Inventory, Anxiety Sensitivity Index, and Short Form Inventory of
Drinking Situations (IDS-42). Together, the negative emotionality variables reliably
predicted scores on the IDS-42 negative and temptation drinking situations subscales but
did not reliably predict scores on the IDS-42 positive drinking situations subscales. With one
exception, only AS contributed unique variance in predicting negative and temptation
context drinking. Both AS and depression contributed unique variance in predicting
drinking in conflict with others situations. Implications for treating comorbid emotional
and alcohol-use disorders in women are discussed. [Brief Treatment and Crisis Intervention
6:268–282 (2006)]
KEY WORDS: comorbidity, anxiety sensitivity, depression, situation-specific drinking,
alcohol-use disorders, women.
Self-reported anxiety and depression frequently
co-occur with heavy or ‘‘at-risk’’ and problem
levels of alcohol consumption in females. Anx-
iety, depression, and somatoform disorders are
more commonly observed in female at-risk
drinkers (more than 20 g of alcohol per day) com-
pared with female moderate drinkers/abstainers
(Bott, Meyer, Rumpf, Hapke, & John, 2005).
King, Bernardy, and Hauner (2002) found female
‘‘problem drinkers’’ (those who consume 11 or
more drinks per week or 5 or more drinks on one
occasion at least once per week) recruited from
treatment centers and the community report
greater depressive symptoms and perceived
stressful life events compared with female light
drinkers.
There has been some controversy as to
whether anxiety and depressive disorders and
From the Department of Psychology, Dalhousie University
(Reyno, Stewart), Department of Psychiatry, Dalhousie
University (Stewart), Maritime School of Social Work,
Dalhousie University (Brown, Wiens), and Department of
Psychology, Acadia University (Horvath).
Contact author: Sherry H. Stewart, Department of
Psychiatry, Dalhousie University, 8th Floor, AJL Memorial
Building, 5909 Veterans Memorial Lane, Halifax, NS B3H
2E2, Canada. E-mail: sherry.stewart@dal.ca.
doi:10.1093/brief-treatment/mhl007
Advance Access publication July 6, 2006
ªThe Author 2006. Published by Oxford University Press. All rights reserved. For permissions, please e-mail:
journals.permissions@oxfordjournals.org.
268
symptoms are causes and/or consequences of
heavy and problem drinking in women. Wang
and Patten (2002) used longitudinal data from
the Canadian National Health Survey to exam-
ine the effects of alcohol consumption on major
depression. Consistent with the position that
heavy drinking causes elevated depression,
the researchers found an increased risk of major
depression at follow-up for females who re-
ported persistent heavy drinking (more than
five drinks on at least one occasion per month)
compared with women who reported light/mod-
erate levels of alcohol consumption. In contrast,
research with adolescents indicates that the on-
set of psychiatric disorders tends to precede al-
cohol abuse/dependence in this population
(Rohde, Lewinsohn, & Seeley, 1996). Similarly,
emotional disorders tend to precede problem
drinking in women, suggesting that for females,
anxiety and depression may contribute to the
development of alcohol-use problems (Gilman
& Abraham, 2001; Hartka et al., 1991; Helzer
& Pryzbeck, 1988; Kessler et al., 1997).
In individuals with depression and/or anx-
iety, comorbid drinking problems have been
attributed to the tension-reducing and numb-
ing properties of alcohol. In essence, individ-
uals with elevated arousal or negative affect
drink to reduce or cope with psychological
distress or to ‘‘self-medicate’’ (Conger, 1956).
C. J. Holahan, C. K. Holahan, Moos, Cronkite,
and Randall (2003) conducted a longitudinal
study examining associations between de-
pression, levels of alcohol consumption, and
drinking to cope with life stress in a commu-
nity sample of adults receiving treatment for
depression. Baseline drinking to cope with
negative life situations was associated with
increased alcohol consumption at each stage
of follow-up. In a related longitudinal study,
C.J.Holahan,Moos,C.K.Holahan,Cronkite,
and Randall (2001) found baseline drinking
to cope was associated with a stronger rela-
tionship between symptoms of anxiety and
depression and drinking problems at fol-
low-ups of 1, 4, and 10 years.
Drinking to cope with anxiety may be more
common in some anxiety disorders, such as so-
cial phobia (Thomas, Randall, & Carrigan, 2003),
or in subgroups with specific psychological
characteristics (Kushner, Abrams, Thuras, &
Hanson, 2000). For example, anxiety sensitivity
(AS; the fear of anxiety-related physical and
mental sensations) may be an underlying factor
contributing to the commonly observed comor-
bidity between some anxiety disorders and
substance abuse/dependence. Higher levels of
AS are observed in individuals with comorbid
anxiety and alcohol-use disorders compared
to those with either disorder alone. Also, the
risk of alcoholism is particularly increased in
individuals with anxiety disorders character-
ized by high levels of AS, such as panic disor-
der, social phobia, and posttraumatic stress
disorder (Cox, Norton, Swinson, & Endler,
1990; Morris, Stewart, & Ham, 2005; Stewart,
1996). AS may also be involved in the link be-
tween depression and alcohol-use problems as
high levels of AS are observed in individuals
with depression (Otto, Pollack, Fava, Uccello,
& Rosenbaum, 1995).
AS has been posited to mediate the relation-
ship between anxiety disorders and alcohol
use/abuse (Kushner, Thuras, Abrams, Brekke, &
Stritar, 2001). This mediator model proposes
that the association between certain anxiety
disorders and alcohol abuse is at least partially
explained or accounted for by the relationship
of the anxiety disorder to AS and AS to alcohol
abuse. In this model, high AS leads to increased
anxiety symptoms, which in turn promote
coping-motivated drinking. Anxiety disorder
individuals with high AS will consume greater
quantities of tension-reducing substances such
as alcohol due to the anxiety-dampening prop-
erties of these substances. Over time, these
individuals will learn to self-medicate or con-
trol their anxiety/tension through alcohol
Anxiety Sensitivity in Women With Alcohol Problems
Brief Treatment and Crisis Intervention / 6:3 August 2006 269
use. Sensitivity to alcohol’s tension reduction
effects may be enhanced in individuals with
higher levels of AS. Consistent with this pos-
sibility, individuals with higher AS report
increased drinking to cope with negative affec-
tive states (Stewart & Zeitlin, 1995; Stewart,
Zvolensky, & Eifert, 2002) and display greater
reduction of anticipatory anxiety following
alcohol consumption (MacDonald, Baker,
Stewart, & Skinner, 2000; Stewart & Pihl, 1994).
The relative contribution of depression, anx-
iety, and AS to problem drinking has been ex-
amined in university students (Koven, Heller, &
Miller, 2005). AS and anxiety measures pre-
dicted problem drinking, whereas depressive
symptoms did not contribute significant vari-
ance to drinking behaviors and attitudes when
assessed anxiety variables were statistically
controlled. One dimension of AS, fear of cogni-
tive dyscontrol (FCD), accounted for the rela-
tionship between AS and problem drinking.
This finding is consistent with that of Lawyer,
Karg, Murphy, and McGlynn (2002). These
researchers also found the FCD factor of the
Anxiety Sensitivity Index (ASI) more strongly
correlated with drinking in certain high-risk
situations among university students. Koven
et al. (2005) suggest that individuals with
high FCD may drink to seek relief from anxiety
and to increase their perceptions of control,
although the contributions of FCD may be
outweighed by mental and physical depen-
dence following habitual alcohol misuse.
The observed relationship between AS
and alcohol consumption has encouraged re-
searchers to examine associations between
AS and patterns of situation-specific drinking.
Examination of the contexts in which people
drink can tell us something about their under-
lying motives for alcohol use. For example, if
they frequently drink heavily in situations in-
volving conflict with others, presumably,
their drinking is motivated by a desire to deal
with the negative affect triggered by interper-
sonal conflict. Researchers have found a signif-
icant association between ASI scores and
negative situation substance use in males be-
ing treated for substance abuse in a Veteran
Affairs inpatient center (DeHass, Calamari,
Blair, & Martin, 2001). In nonclinical samples
of university students, ASI scores predicted
negative context drinking (in situations in-
volving conflict with others, unpleasant emo-
tions, and physical discomfort) and not
positive context drinking (Lawyer et al.,
2002; Samoluk & Stewart, 1998). ASI scores
have also predicted drinking in testing per-
sonal control situations, indicating that in
some temptation situations, high AS individ-
uals may drink to prove to themselves that
they have control over their alcohol use
(Samoluk & Stewart, 1998).
The present study builds on previous re-
search examining the association of negative
emotionality factors with situation-specific
drinking behaviors. The goal of the study
was to examine the unique contribution of
depression, anxiety, and AS in predicting
frequency of drinking in different situations
among women receiving treatment for alcohol
problems. Based on previous research (DeHass
et al., 2001; Koven et al., 2005; Lawyer et al.,
2002; Samoluk & Stewart, 1998), it was pre-
dicted that the measures of negative emotional-
ity would together predict negative and
temptation context drinking and not positive
context drinking. It was predicted that AS
would predict negative and temptation context
drinking even after the contributions of anxi-
ety and depression were controlled (cf. Koven
et al., 2005). It was also predicted that the
Mental Incapacitation Concerns (MIC) factor
of the ASI (similar to the FCD factor) would
be more strongly associated with negative con-
text drinking than the Physical Concerns (PC)
factor of the ASI (similar to the Fear of Somatic
Sensations factor). A third, commonly studied AS
factor, Social Concerns (SC), was also examined
REYNO ET AL.
270 Brief Treatment and Crisis Intervention / 6:3 August 2006
in relation to negative and temptation context
drinking for exploratory purposes.
i
Methods
Participants
As part of a larger project exploring women’s
use of alcohol as self-medication for depression
(Stewart et al., 2006), participants were
recruited from a public treatment service for
women with alcohol, gambling, or drug prob-
lems in the Nova Scotia Capital District Health
Authority. A sample of 60 women currently re-
ceiving treatment for alcohol problems agreed
to participate in this study. The average age
of the participants was 41.3 years (range 18–
61 years). Approximately two thirds of the sam-
ple (68.9%) was unemployed.
ii
Income levels
were reported by 54 participants, with the fol-
lowing breakdown: 48.1% reported income of
less than $10,000 Canadian per annum, 18.5%
reported income between $10,000 and $20,000
per annum, 13.0% reported income between
$20,000 and $30,000 per annum, 3.7% reported
income between $30,000 and $40,000 per
annum, 5.6% reported income between
$40,000 and $50,000 per annum, and 11.1%
reported income above $60,000 per annum.
Ethnicity of the participants was as follows:
77.2% Caucasian, 8.3% Native, 6.2% African
Canadian, and 8.3% mixed.
iii
Approximately
one third (36.2%) of the participants had com-
pleted some postsecondary education (univer-
sity, diploma, or college). Only 28.1% of the
sample reported living with a partner or
spouse. Just under half of the participants
reported that they were suffering from at least
one other substance use problem in addition to
their alcohol-use problem (48.3%).
Measures
Demographic Measure. A self-report ques-
tionnaire designed by the authors was used
to assess various demographic variables (i.e.,
age, education, living arrangement) and history
and treatment of alcohol and other drug-use
problems. In addition, the questionnaire in-
cluded questions on typical quantity of alcohol
consumption per drinking occasion (number of
standard alcoholic beverages) and typical fre-
quency of alcohol use (days per month) in
the year prior to the initiation of the partici-
pant’s current treatment program. Quantity
and frequency were assessed in a manner sim-
ilar to that used in previous research (e.g.,
Stewart, Peterson, & Pihl, 1995).
Anxiety Sensitivity Index. The ASI was used
to assess AS levels in the sample (Peterson &
Reiss, 1992). The ASI is a self-report measure
assessing fear of anxiety sensations and beliefs
that the sensations are potentially harmful. The
ASI has very good psychometric properties in
a variety of clinical and nonclinical populations
(Olatunji et al., 2005; Peterson & Heilbronner,
1987; Rodriguez, Bruce, Pagano, Spencer, &
Keller, 2004; Schmidt & Joiner, 2002). Along
with the overall total ASI score, three primary
factors of the ASI (PC, MIC, and SC) were
also scored based on the three-factor solution
recommended by Zinbarg, Barlow, and Brown
(1997).
Beck Depression Inventory-II. The Beck De-
pression Inventory-II (BDI-II) (Beck, Steer, &
Brown, 1996) is a 21-item self-report measure
i
Lawyer et al. (2002) examined a two-factor solution of
AS (FCD versus fear of somatic sensations), whereas
we used the commonly accepted three-factor solution
(Zinbarg, Barlow, & Brown, 1997).
ii
Approximately one quarter of the sample did not provide
information on employment status.
iii
Approximately one fifth of the sample did not report
ethnicity.
Anxiety Sensitivity in Women With Alcohol Problems
Brief Treatment and Crisis Intervention / 6:3 August 2006 271
that assesses cognitive, affective, and somatic
symptoms of depression. For each item, respon-
dents choose from a group of sentences the one
that best describes how they have been feeling
in the previous 2 weeks. Research supports the
reliability and validity of this depression mea-
sure (Dozios, Dobson, & Ahnberg, 1998; Hiroe
et al., 2005; Steer, Ball, Ranieri, & Beck, 1997).
Beck Anxiety Inventory. The Beck Anxiety
Inventory (BAI) (Beck & Steer, 1990) is a 21-item
self-report measure that assesses symptoms of
anxiety. This measure requires the respondent
to rate the degree they were bothered by each
symptom in the past week on a 4-point scale that
ranges from 0 (not bothered at all) to 3 (severely
bothered). Research supports the reliability and
validity of this measure (Contreas, Fernandez,
Malcarne, Ingram, & Vaccarino, 2004; Osman,
Kopper, Barrios, Osman, & Wade, 1997).
Inventory of Drinking Situations. The brief
(42 items) version of the Inventory of Drinking
Situations (IDS-42) was used to assess heavy
drinking frequency across different situations
(Annis, Graham, & Davis 1987). The IDS-42 con-
sists of subscales assessing positive context
drinking (pleasant times with others, social cues
to drink, pleasant emotions), negative context
drinking (conflict with others, unpleasant emo-
tions, physical discomfort), and temptation con-
text drinking (testing personal control, urges
and temptations). The IDS-42 shows excellent
psychometric properties among both clinical
samples of individuals who abuse alcohol and
nonclinical samples alike. These properties in-
clude good convergent and discriminant valid-
ity and good structural validity (Carrigan,
Samoluk, & Stewart, 1998; Stewart, Conrod,
Samoluk, Pihl, & Dongier, 2000; Stewart,
Samoluk, Conrod, Pihl, & Dongier, 1999). Par-
ticipants rated frequency of heavy drinking
in different situations in their past year of
drinking prior to their current treatment.
Procedure
Participants were recruited from a public treat-
ment service for women with alcohol, gam-
bling, or drug problems. Women reporting
alcohol-use problems and currently receiving
treatment for alcohol problems were invited
to participate in this study. After providing in-
formed consent, study participants completed
the questionnaires and sociodemographic meas-
ures described above. Each participant received
$20.00 Canadian as compensation for their time
and effort.
Results
The study data were analyzed using SPSS for
Windows (version 11). No serious violations
of assumptions for regression were identified,
and no univariate or multivariate outliers were
detected.
Sample Means
For this sample, the mean and standard devia-
tions for the emotionality measures were as fol-
lows: BDI, 31.02 (SD ¼11.15)
iv
; ASI, 34.48
(SD ¼14.04); and BAI, 27.18 (SD ¼13.50). Mean
scores on the IDS-42 lower order subscales
ranked from highest to lowest were as follows:
Unpleasant Emotions, 3.11 (SD ¼0.64); Social
Cues to Drink, 2.97 (SD ¼0.87); Conflict with
Others, 2.89 (SD ¼0.73); Pleasant Times with
Others, 2.88 (SD ¼0.76); Pleasant Emotions,
2.81 (SD ¼0.75); Testing Personal Control,
2.78 (SD ¼0.92); Urges and Temptations,
2.78 (SD ¼0.87); and Physical Discomfort ¼
2.38 (SD ¼0.77). The IDS-42 subscale means
and standard deviations are very similar to val-
ues previously reported for IDS-42 subscale
iv
For participants with some partial data missing from the
BDI-II, missing values replacement was performed based
on item means, prior to calculation of the BDI-II total
score.
REYNO ET AL.
272 Brief Treatment and Crisis Intervention / 6:3 August 2006
scores in women alcoholics (Birch, Stewart, &
Brown, in press). Scores on BDI, ASI, and BAI
are elevated relative to norms from women in
the general population as might be expected
in a sample of women with alcohol problems.
Adequate to excellent internal consistency
was observed for the IDS-42 subscales, with
Cronbach’s alphas ranging from .73 to .91.
Mean score for the three ASI subscales ranked
from highest to lowest were as follows: ‘‘SC,’’
2.68 (SD ¼0.88); ‘‘PC,’’ 2.09 (SD ¼0.92);
and ‘‘MIC,’’ 1.95 (SD ¼1.29). Cronbach’s alphas
for the ASI factors were good for the PC and
MIC subscales (.82 and .84, respectively), but
internal consistency was lower for the SC
subscale (.59).
v
Correlations Between Emotionality
Measures and IDS-42 Subscale Scores
The total score on each emotionality measure
was correlated with the lower order factors
or subscales on the IDS-42 (see Table 1). A
Bonferroni-adjusted alpha of .002 (.05/24 com-
parisons) was used for determining statistical
significance. One-tailed tests were used since
directional predictions had been made a priori.
With this correction, only the ASI significantly
correlated with drinking in contexts involving
conflict with others, unpleasant emotions,
physical discomfort, testing personal control,
and urges and temptations (i.e., negative con-
text and temptation drinking). The negative
emotionality measures were not associated with
drinking in contexts involving social cues to
drink, pleasant emotions, or pleasant times with
others (positive context drinking).
Regression Analyses for Negative
Emotionality Variables Predicting IDS-42
Subscales
Standard multiple regressions were used to
assess how well the negative emotionality
measures together predicted situation-specific
drinking on the various IDS-42 subscales and
to see which of these gave unique predictive
information (see Table 2).
For the IDS-42 dependent variable conflict
with others, the proportion of variance that
could be predicted from the independent var-
iables was 33.3%. The independent variables
reliably predicted the dependent variable
(p,.001). Both the ASI and BDI contributed
significantly to the regression (p,.001 and
p,.05, respectively). For the IDS-42 depen-
dent variable unpleasant emotions, the propor-
tion of variance in the dependent variable that
could be predicted by the independent varia-
bles was 19.1%. The independent variables re-
liably predicted the dependent variable (p,
.01). A trend was found for the ASI to contrib-
ute unique variance to the regression (p,.06).
Similar findings were evident for IDS physical
TABLE 1. Correlations Between ASI, BDI, and BAI Total
Scores and IDS-42 Subscale Scores
IDS-42 subscale scores ASI BDI BAI
Negative situations
Conflict with Others 0.51*** 0.37** 0.27*
Unpleasant Emotions 0.42*** 0.23 0.35**
Physical Discomfort 0.50*** 0.22 0.39***
Temptation situations
Testing Personal Control 0.54*** 0.28* 0.37**
Urges and Temptations 0.44*** 0.26* 0.32*
Positive situations
Pleasant Times
with Others
0.14 0.04 0.01
Social Cues to Drink 0.10 0.04 0.01
Pleasant Emotions 0.07 0.06 0.16
Note. Bonferroni-adjusted alpha p,.002 indicated in bold.
*p,.05. **p,.01. ***p,.001.
v
Although lower, the SC subscale alpha is marginally
acceptable (i.e., close to .60) given consideration of its
short scale length (Costa & McCrae, 1992; Meehl & Golden,
1982).
Anxiety Sensitivity in Women With Alcohol Problems
Brief Treatment and Crisis Intervention / 6:3 August 2006 273
discomfort. Proportion of variance that could
be predicted by the independent variables
was 25.2% (p,.001). Only the ASI contrib-
uted significantly to the regression (p,.01).
For the IDS-42 dependent variable Testing
Personal Control, the proportion of variance
that could be predicted from the dependent var-
iables was 29.1%. The independent variables
reliably predicted the dependent variable (p,
.001). Only the ASI contributed significantly
to the regression (p,.005). For the IDS-42 de-
pendent variable Urges and Temptations, the
TABLE 2. Summary of Simple Regression Analyses for Negative Emotionality Variables Predicting Heavy Drinking in
the Various IDS-42 Drinking Contexts
ASI BDI BAI R
2
F
Negative situations
Conflict with Others .333 8.48***
B0.032 0.020 0.019
SE B 0.008 0.009 0.010
b0.613*** 0.306* 0.348
Unpleasant Emotions .191 4.17**
B0.015 0.001 0.007
SE B 0.008 0.009 0.009
b0.325
t
0.013 0.138
Physical Discomfort .252 5.94***
B0.025 0.002 0.004
SE B 0.009 0.010 0.010
b0.464** 0.032 0.075
Temptation situations
Testing Personal Control .291 7.26***
B0.031 0.003 0.004
SE B 0.010 0.012 0.012
b0.476** 0.041 0.061
Urges and Temptations .205 4.55**
B0.023 0.007 0.002
SE B 0.010 0.011 0.011
b0.380* 0.096 0.028
Positive situations
Pleasant Times with Others .033 0.582
B0.013 0.002 0.009
SE B 0.010 0.011 0.011
b0.223 0.030 0.154
Social Cues to Drink .020 0.363
B0.011 0.005 0.010
SE B 0.011 0.013 0.013
b0.172 0.060 0.150
Pleasant Emotions .088 1.65
B0.017 0.001 0.021
SE B 0.009 0.010 0.011
b0.330 0.011 0.384
t
p,.06. *p,.05. **p,.01. ***p,.001.
REYNO ET AL.
274 Brief Treatment and Crisis Intervention / 6:3 August 2006
proportion of variance that could be predicted
from the dependent variables was 20.5%. The
independent variables reliably predicted the
dependent variable (p,.01). Once again only
the ASI contributed significantly to the regres-
sion (p,.05).
For the IDS-42 dependent variable Pleasant
Times with Others, the proportion of variance
that could be predicted from the dependent
variables was only 3.3%. The independent var-
iables did not reliably predict the dependent
variable (p¼.78). For the IDS-42 dependent
variable Social Cues to Drink, the proportion
of variance that could be predicted from the
dependent variables was only 2.0%. The
independent variables did not reliably predict
the dependent variable (p¼.63). For the
IDS-42 dependent variable Pleasant Emotions,
the proportion of variance that could be pre-
dicted from the dependent variables was
only 8.8%. The independent variables did
not reliably predict the dependent variable
(p¼.19).
Correlations Between ASI Subscale and
IDS-42 Subscale Scores
Next, the scores on the PC, MIC, and SC sub-
scales from the ASI were correlated with the
lower order factors or subscales on the IDS-
42 (see Table 3). A Bonferroni-adjusted alpha
of .002 (.05/24 comparisons) was used for deter-
mining statistical significance of the correla-
tions between the ASI subscale scores and
the IDS-42 subscale scores. Again, one-tailed
tests were used as directional predictions had
been made a priori. With this correction, the
PC subscale scores correlated significantly with
all the negative and temptation situations sub-
scales of the IDS-42, the MIC subscale scores
correlated significantly with the Testing Per-
sonal Control subscale, and the SC subscale
scores correlated significantly with the Conflict
with Others, Physical Discomfort, and Testing
Personal Control subscales.
Regression Analyses for ASI Subscale Scores
Predicting IDS-42 Subscale Scores
Standard multiple regression was used to assess
how well the ASI subscale scores as a group pre-
dicted negative, temptation, and positive con-
text drinking on the IDS-42 subscales (see
Table 4). These measures in combination reli-
ably predicted negative and temptation context
drinking and not positive context drinking.
The PC factor of the ASI contributed unique
variance to the regression predicting scores
on the Physical Discomfort subscale of the
IDS-42. Also trends were observed for the PC
subscale to contribute unique variance to the
prediction of two other IDS-42 subscales: Un-
pleasant Emotions and Urges and Temptations
(both p,.06). The SC factor of the ASI contrib-
uted unique variance to the Conflict with
Others and Testing Personal Control subscales
of the IDS-42 (see Table 4).
TABLE 3. Correlations Between the ASI Subscale Scores
and IDS-42 Subscale Scores
IDS-42 lower order
factors scores PC MIC SC
Negative situations
Conflict with Others 0.440*** 0.337** 0.490***
Unpleasant Emotions 0.452*** 0.339** 0.300*
Physical Discomfort 0.540*** 0.344** 0.405***
Temptation situations
Testing Personal
Control
0.478*** 0.440*** 0.478***
Urges and
Temptations
0.449*** 0.288* 0.353**
Positive situations
Pleasant Times
with Others
0.155 0.080 0.025
Social Cues to Drink 0.120 0.016 0.055
Pleasant Emotions 0.116 0.066 0.116
Note. Bonferroni-adjusted alpha p,.002 shown in bold.
*p,.05. **p,.01. ***p,.001.
Anxiety Sensitivity in Women With Alcohol Problems
Brief Treatment and Crisis Intervention / 6:3 August 2006 275
Discussion
Consistent with the study hypotheses, partici-
pants’ scores on the ASI were significantly cor-
related with scores on the IDS-42 subscales
assessing negative context drinking (i.e.,
Conflict with Others, Unpleasant Emotions,
Physical Discomfort) and temptation drinking
(i.e., Testing Personal Control, Urges and Temp-
tations). ASI scores were not significantly asso-
ciated with positive context drinking (i.e.,
Pleasant Emotions, Pleasant Times with Others,
and Social Cues to Drink). As with nonclinical
samples (Samoluk & Stewart, 1998), it appears
TABLE 4. Summary of Simple Regression Analyses for ASI Subscale Scores Predicting Heavy Drinking in the Various
IDS-42 Drinking Contexts
PC MIC SC R
2
F
Negative situations
Conflict with Others .267 6.21***
B0.113 0.044 0.302
SE B 0.167 0.101 0.134
b0.145 0.078 0.362*
Unpleasant Emotions .205 4.56**
B0.295 0.016 0.013
SE B 0.151 0.089 0.119
b0.418
t
0.031 0.017
Physical Discomfort .300 7.58***
B0.445 0.046 0.073
SE B 0.165 0.098 0.130
b0.542** 0.079 0.086
Temptation situations
Testing Personal Control .306 7.79***
B0.095 0.175 0.331
SE B 0.200 0.118 0.157
b0.096 0.245 0.319*
Urges and Temptations .210 4.69**
B0.394 0.037 0.097
SE B 0.198 0.117 0.156
b0.425
t
0.057 0.100
Positive situations
Pleasant Times with Others
B0.254 0.050 0.120 .037 0.676
SE B 0.197 0.116 0.154
b0.304 0.084 0.138
Social Cues to Drink
B0.252 0.103 0.056 .027 0.483
SE B 0.223 0.132 0.175
b0.268 0.154 0.058
Pleasant Emotions
B0.241 0.173 0.031 .061 1.104
SE B 0.184 0.111 0.145
b0.312 0.307 0.039
t
p,.06. *p,.05. **p,.01. ***p,.001.
REYNO ET AL.
276 Brief Treatment and Crisis Intervention / 6:3 August 2006
that women in treatment for alcohol-use prob-
lems reporting high levels of AS are more likely
than others to drink in negative and temptation
contexts but no more likely than others to drink
in positive context situations.
The PC and SC factors of the ASI showed
a stronger relationship with negative context
drinking than did the MIC factor. This is in con-
trast to previous findings with nonclinical sam-
ples (Koven et al., 2005; Lawyer et al., 2002).
Among women in treatment for substance
use problems, it appears that concerns with loss
of mental control (e.g., phrenophobia) do not
influence drinking in negative and temptation
contexts. Alternatively, fears of somatic sensa-
tions reflecting physiological tension (i.e., in-
creased heart rate, feeling shaky) influence
drinking in situations involving physical dis-
comfort, unpleasant emotions, and urges and
temptations, whereas concerns about the social
consequences of one’s anxiety influence drink-
ing in situations involving conflict with others
and testing personal control. The unique rela-
tionship between scores on the SC factor and
the IDS-42 Testing Personal Control subscale
suggest that testing personal control drinking
may be socially driven among women with al-
cohol-use problems. It may be that socially con-
cerned individuals are trying to prove to others
that they can control their drinking.
The study findings are consistent with the
self-medication theory that would predict in-
creased consumption of alcohol by individuals
with high AS due to the anxiety-dampening
properties of this substance. In negative con-
texts, the tension-reducing properties of alco-
hol may act to negatively reinforce alcohol
consumption. In temptation situations, cog-
nitive preoccupation with past drinking
behaviors (e.g., failed attempts to restrain
drinking) may lead to psychological distress
that promotes alcohol use (Collins, 1993). In
both negative and temptations contexts, drink-
ing to cope with unpleasant emotions and/or
physical discomfort may regulate alcohol con-
sumption.
Alternatively, rather than acting as a motivat-
ing factor for the consumption of alcohol in dis-
tressing situations, high AS may develop in
chronic heavy drinkers from increasing con-
cerns about withdrawal symptoms (sensations
of bodily arousal). In the latter case, high AS
would be a consequence of alcohol misuse
rather than a contributing factor in the devel-
opment of alcohol-use problems. Most likely,
a vicious cycle is at play where frequent
drinking to cope with negative situations
may increase withdrawal symptoms, further
contributing to the use of alcohol to reduce
physiological arousal/tension and control with-
drawal symptoms.
In studies with nonclinical samples, individ-
uals who report higher levels of drinking-to-
cope motives (as opposed to drinking for social
motives) consume more alcohol in general
and more on days with negative experiences
(Cooper, Frone, Russell, & Mudar, 1995; Mohr
et al., 2005). Drinking in negative contexts is
associated with longer durations of high alcohol
consumption levels and solitary (nonsocial)
drinking behaviors (Annis et al., 1987), and
drinking to cope is associated with increased
alcohol-related problems and alcohol-use disor-
ders (Carpenter & Hasin, 1999; Cooper, 1994;
Cooper et al., 1995). These findings suggest that
coping-motivated drinking may be a risk factor
for the development and maintenance of alco-
hol abuse/dependence.
AS may play a unique role in negative
affect-driven, coping-related drinking. In the
current study, higher levels of AS predicted
drinking in negative and temptation contexts,
even after controlling for anxiety and depres-
sion. This suggests that AS better relates to
negative context drinking than other negative
emotionality factors. Stewart et al. (2000) also
found a significant relationship between AS
and negative context drinking in a sample of
Anxiety Sensitivity in Women With Alcohol Problems
Brief Treatment and Crisis Intervention / 6:3 August 2006 277
substance-abusing women but not between AS
and temptation context drinking. This discrep-
ant finding may be attributed to the different
cohorts in the two studies. More specifically,
the women in the current study were clients
specifically in treatment for alcohol problems,
whereas the women in the Stewart study
were community-recruited substance abusers
in general, only some of whom had alcohol-
use problems.
The research findings indicate that the rela-
tionship between AS and alcohol use cannot
be accounted for by the relationship of AS with
anxiety as AS contributes unique variance to
negative context drinking after statistically
controlling for anxiety symptoms (cf. DeHass
et al., 2001). Preliminary evidence also suggests
that AS mediates or partially accounts for the
association between posttraumatic stress dis-
order symptoms and negative situation drink-
ing (Stewart et al., 2000). However, further
research is needed to see if AS also acts as a me-
diator of alcohol misuse in other types of anx-
iety disorders that commonly co-occur with
alcohol abuse/dependence such as social phobia
and panic disorder/agoraphobia.
Consistent with the unique relationship be-
tween AS and alcohol use, Swendsen et al.
(2000) conducted a prospective study examin-
ing associations between daily reported mood
states (i.e., nervousness, sadness) and alcohol
consumption. Of negative mood states, only
anxiety predicted subsequent alcohol con-
sumption. Specifically, the authors found that
earlier reports of nervousness predicted later
increased consumption of alcohol beverages.
Alcohol ingestion was in turn associated with
a short-term reduction in nervous mood. Con-
sistent with these findings, Hussong, Galloway,
and Feagans (2005) also found a significant as-
sociation between fear-related daily mood
states and increased drinking in university
students reporting higher levels of coping-
motivated drinking. Participants actually
drank less on days when they experienced
sad mood.
In this sample, both AS and depression inde-
pendently predicted drinking in situations in-
volving conflict with others. This finding
highlights the unique relationship of depres-
sion and drinking in distressing interpersonal
situations and suggests that women with sub-
stantial depressive symptoms may be most
likely to relapse in negative drinking contexts
specifically involving conflict with others. This
is an important point in treatment planning for
women suffering from comorbid depression
and alcohol-use disorders.
There are several limitations in this study.
First, although the women in this study self-
reported alcohol-use problems and were cur-
rently receiving treatment for alcohol misuse,
diagnostic measures of alcohol abuse and de-
pendence were not administered. Similarly, al-
though we included measures of depression
and anxiety, no diagnostic measures of depres-
sive and anxiety disorders were included in
the present study. Secondly, the use of a
cross-sectional, correlational methodology
precludes the establishment of causality and
directionality. For example, although the
study findings show a relationship between
AS and negative and temptation context drink-
ing, further research is needed to determine
whether a causal relationship exists and, if
so, whether AS causes alcohol misuse in these
situations and/or vice versa. Finally, it is un-
clear if the results of this study would also
apply to men. Previous research suggests that
anxiety-related variables including AS are
more strongly associated with coping-motivated
drinking and alcohol abuse in women than men
(Cox, 1987; Sher, 1991; Stewart, Karp, Pihl, &
Peterson, 1997; Stewart & Zeitlin, 1995). How-
ever, a significant association between AS and
negative context drinking has also been found
in males with alcohol abuse problems (DeHass
et al., 2001).
REYNO ET AL.
278 Brief Treatment and Crisis Intervention / 6:3 August 2006
AS appears to strongly relate to alcohol con-
sumption in certain high-risk situations among
women in treatment for alcohol-use problems,
suggesting that AS should be a target for assess-
ment and treatment in this population. A recent
randomized controlled study with female uni-
versity students with high and low AS found
that a brief cognitive behavior therapy program
targeting elevated AS symptoms lead to re-
duced alcohol problems as well as reduced con-
formity-motivated drinking and emotional
relief alcohol expectancies (Watt, Stewart,
Birch, & Bernier, 2006). Another randomized
controlled trial among women with substance
use problems showed that brief interventions
targeting the underlying motivations for sub-
stance misuse (including one that focused on
AS) resulted in significant reductions in sub-
stance use problems (Conrod et al., 2000). These
studies’ results support the contention that
brief treatments targeting high AS may actually
reduce alcohol and other substance use prob-
lems; however, replication among treatment-
seeking populations with more severe alcohol
problems is warranted (Watt, Conrod,
Stewart, & Schmidt, in press).
Further study is needed to determine if AS
is actually a longitudinal risk factor for the
development of alcohol abuse/dependence as
research suggests that AS develops in child-
hood. Learning experiences in childhood and
genetics have been suggested to play equal roles
in the development of this personality factor
(Stein, Jang, & Livesley, 1999; Watt, Stewart, &
Cox, 1998). Targeting AS in youth, therefore,
could potentially prevent the development of
alcohol misuse in later life. In fact, a recent ran-
domized controlled trial of a set of targeted
interventions designed to treat the underlying
risk factors for alcohol abuse in high-school
students showed that an intervention targeting
elevated AS resulted in increased alcohol ab-
stinence and decreased problematic drinking
(Conrod, Stewart, Comeau, & MacLean, in press).
As this study was conducted with older adoles-
cents who had already begun drinking, future
research should investigate the preventative ef-
ficacy of such an approach by administering
such brief AS-focused interventions even ear-
lier, before youth begin experimenting with
drinking.
Acknowledgments
This research was supported by a grant from the
Nova Scotia Health Research Foundation awarded to
Sherry H. Stewart, Catrina G. Brown, Peter Horvath,
and Juliana Wiens. The first author completed this
project as a comprehensive requirement toward the
completion of her PhD in Clinical Psychology at
Dalhousie University. The research assistance of
Sarah Larsen is gratefully acknowledged. The
authors would also like to thank the women clients
who participated in this study and the Directors and
service providers at Addiction Prevention and
Treatment Services, Capital District Health
Authority, Nova Scotia, Canada, for their assistance
with participant recruitment. Conflict of interest:
None declared.
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