Traumatized People with Alcohol Use Disorder Likely Need a Range of Interventions to Address Risky Drinking

People with post-traumatic stress disorder (PTSD) and alcohol use disorder (AUD) who are successfully treated for trauma likely need additional interventions addressing persistent drinking patterns, according to a new study. The study provides the first laboratory evidence of an indirect mechanism by which trauma can drive alcohol cravings even after successful PTSD treatment, and may generate a new framework for treating PTSD and AUD together. The two conditions frequently co-occur, in part because PTSD motivates drinking as a means of coping. People with PTSD and AUD experience higher alcohol cravings compared to those with AUD alone, and are more likely to drop out of treatment and resume risky drinking. Successful treatment for PTSD does not in itself lead to improved AUD outcomes. This may be because PTSD amplifies negative emotions (affect), and in people who use alcohol to cope, these feelings become conditioned triggers for drinking. This creates a cycle of negative reinforcement drinking that can operate independently of trauma symptoms. The study in Alcoholism: Clinical & Experimental Research is the first controlled investigation of negative affect in PTSD–AUD. Researchers aimed to determine how PTSD symptoms, coping motives for drinking, and negative feelings influenced alcohol cravings among young adults with trauma histories.

Investigators worked with 189 college students who had experienced a sexual or physical assault and drank alcohol every week; 49% had PTSD and 84% had AUD. The participants underwent detailed interviews about their assaults and their recent alcohol use, and took a questionnaire assessing their motivation for drinking. Their experiences of assault were captured in brief recorded audio narratives. The participants were exposed to the personalized trauma cues as well as to neutral narrative cues (a description of a person changing a light bulb). These were combined with beverage cues — the participants’ favorite alcoholic drinks, or a glass of water (neutral cue) — in four different combinations: trauma narrative and alcohol cue; trauma narrative and neutral beverage cue; neutral narrative and alcohol cue; and neutral narrative and neutral beverage cue. During this process they rated their desire to drink and their emotional state. Salivation measures generated additional data on craving. The researchers used statistical analysis to examine associations between trauma and alcohol cues and the participants’ emotional state and alcohol cravings.

The trauma cues increased self-reported alcohol craving among participants with higher PTSD symptom severity and not among those with lesser trauma symptoms. The severity of PTSD symptoms did not directly influence the intensity of the cravings. Instead, people with higher PTSD symptoms confronting trauma cues reported more intense negative emotions and higher alcohol cravings than other participants. The shift in negative affect fully explained the shift in cravings. In response to negative emotions, the participants most prone to using alcohol for coping experienced greater increases in craving than those who did not rely on alcohol to cope. The alcohol cues increased both craving and salivation, and again the participants’ intensity of trauma symptoms did not influence that link. Trauma and beverage cues did not interact to drive cravings and salivation, instead influencing those responses independently of each other.

The findings reinforce the concept of negative emotions as an integral link between trauma reminders and alcohol craving. Negative emotions unrelated to trauma reminders will trigger alcohol craving in this population. Learning to manage negative feelings more generally might improve drinking outcomes in PTSD-AUD. The researchers recommend that models of negative reinforcement drinking in PTSD-AUD  should not assume that PTSD symptoms alone cause individuals to drink to cope with negative emotion. People with PTSD-AUD may benefit from treatments that address coping motives for drinking and conditioned craving responses to alcohol. The researchers called for additional investigation of the interactions between alcohol consumption, PTSD or other stressors, identity (such as race and ethnicity), and emotions.

Negative affect and alcohol craving in trauma-exposed young adult drinkers. E. Berenz, S. Edalatian Zakeri, A. Demos, K. Paltell, H. Bing-Canar, S. Kevorkian, R. Ranney (pp xx).

ACER-20-4590.R2