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

Center for the Treatment and Study of Anxiety, University of Pennsylvania, Philadelphia, PA 19104, USA.
Psychology of Addictive Behaviors (Impact Factor: 2.75). 05/2011; 25(4):721-6. DOI: 10.1037/a0023799
Source: PubMed


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

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Available from: Samantha G Farris, Apr 15, 2014
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    • "Furthermore, PTSD treatment has been shown to reduce AS severity (Gutner et al. 2013). Notably, more severe AS is related to increased substance use among individuals with PTSD (Gillihan et al. 2011). While AS, a largely cognitive construct, appears to be integral to PTSD symptomatology, emotional processes are also theorized to be central to PTSD (Foa and Kozak 1986; Foa and Rothbaum 1998). "
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    ABSTRACT: Individuals with posttraumatic stress disorder (PTSD) exhibit deficits in cognitive and emotional processes. PTSD severity is positively associated with anxiety sensitivity (AS) and difficulties in emotion regulation, and difficulties in emotion regulation mediate the relation between AS and PTSD. However, previous research has not examined the interactive nature of these variables. Associations between PTSD, AS, and difficulties in emotion regulation were examined in patients with PTSD in a residential substance use treatment program (N = 120). Conditional process analyses indicated an interactive effect of difficulties in emotion regulation and AS for predicting PTSD symptom severity. For individuals high in emotion regulation difficulties, PTSD symptom severity was high regardless of level of AS; conversely, for individuals high in AS, increased PTSD severity was observed regardless of level of emotion regulation difficulties. Results suggest directions for future research, including examination of whether targeting patient-specific cognitive-affective processes enhances PTSD treatment response among substance-dependent individuals.
    Full-text · Article · Apr 2015 · Cognitive Therapy and Research
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    • "co - morbid anxiety and AUDs ( Brady et al . , 2007 ) ; however , serotonin reuptake inhibitors have shown to be efficacious as well ( e . g . Brady et al . , 2005 ; Book et al . , 2008 ) . Researchers should consider examining additional treatment modules to address anxiety symptoms , including interoceptive exposures ( Zvolensky et al . , 2008 ; Gillihan et al . , 2011 ) and practice tolerating uncertainty , which may aid in habituation to un - pleasant or uncomfortable worries and bodily sensations . The current study used different types of CBT treatments for AUDs , including individual CBT ( gender neutral and female - specific ) and couple CBT ( standard and ' blended ' in - dividual / couple ) . "
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    ABSTRACT: It is unclear whether co-morbid anxiety disorders predict worse drinking outcomes during attempts to change drinking behavior. Studies have yielded mixed results, and have rarely examined drinking outcomes based on a specific type of anxiety disorder. Women with alcohol use disorders (AUDs) are of particular interest as they are at risk for co-morbid anxiety [Kessler et al. (1997) Lifetime co-occurrence of DSM-III-R alcohol abuse and dependence with other psychiatric disorders in the national co-morbidity survey. Arch Gen Psychiat 54:313-21]. Participants were 260 women with AUDs participating in an alcohol-treatment outcome studies. The Timeline Follow-Back was used to assess drinking frequency (percent days drinking) prior, within and 6 months post-treatment. The current study tested the hypothesis that having at least one lifetime anxiety disorder diagnosed at baseline using the Structured Clinical Interview for DSM Disorders would be associated with more drinking at all study time points. Exploratory analyses examined patterns of drinking outcomes by specific anxiety diagnoses. Lifetime anxiety diagnosis was linked to poorer drinking outcomes post-treatment (β = 0.15, P = 0.020), despite less frequent drinking prior to treatment. Analyses by specific anxiety diagnosis indicated that generalized anxiety disorder predicted poorer drinking outcomes within treatment (β = 0.14, P = 0.018) and during follow-up (β = 0.16, P = 0.014). Co-morbid anxiety problems complicate treatment for AUDs among women. Further, specific anxiety disorders should be evaluated as distinct constructs as evidenced by the differential outcomes related to generalized anxiety disorder. Implications for treatment development for women with AUDs are discussed.
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    ABSTRACT: The prevalence of post-traumatic stress disorder (PTSD) has reached epidemic proportions among U.S. veterans, many of whom also have concurrent alcohol use disorder. This case report describes improvements in PTSD symptom severity and memory dysfunction in a combat-exposed veteran with persistent PTSD and alcohol use disorder following two treatments of stellate ganglion block (SGB). PTSD severity was measured using the PTSD Checklist, Military Version. Memory function was evaluated using the Rey Auditory Verbal Learning Test. One month after the first SGB, a 43.6% reduction in PTSD severity was observed along with increases in immediate memory (50%), recent memory (28%), and recognition memory (25%). Following a second SGB, PTSD severity decreased by 57.7% and memory function substantially improved, with pronounced changes in immediate memory (50%), recent memory (58%), and recognition memory (36%). One year after SGB treatments, the patient has stopped drinking alcohol, continues to have sustained relief from PTSD, has improved memory function, and has become gainfully employed. Future studies that employ robust epidemiologic methodologies are needed to generate confirmatory evidence that would substantiate SGB's clinical utility as an adjunctive treatment option for PTSD.
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