Influences of Major Depression and Posttraumatic Stress Disorder on Trauma and Alcohol Cue Reactivity

Despite established support for the development of posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) comorbidity by way of self-medication alcohol use, models of PTSD-AUD etiology rarely account for the role of other common comorbidities in risk processes, namely major depressive disorder (MDD). Past studies indicate that approximately 50.0% of individuals with PTSD and 40.3% of individuals with AUD meet criteria for current MDD. Importantly, MDD may interact with PTSD to influence AUD risk by enhancing incentive for self-medication and/or by increasing motivation for alcohol-related reward. Laboratory models of trauma and alcohol cue reactivity are well suited to evaluate how depression and PTSD may work together on risk for AUD. The trauma and alcohol cue reactivity paradigm assesses craving in response to four combinations of narrative (trauma vs. neutral) and beverage (alcohol vs. water) cues. The current study examined the main and interactive effects of PTSD (Clinician Administered PTSD scale for DSM-5; CAPS) and depression symptoms (Center for Epidemiologic Studies Depression Scale-Revised; CESD-R) on trauma and alcohol cue reactivity. Forward-fitted linear mixed effects models with deviance testing were conducted to ascertain the impact of the within-subjects factors (narrative cue and beverage cue) and covariates (PTSD symptoms and depressive symptoms) on self-reported and physiological (salivation, in grams) alcohol craving after controlling for cumulative trauma exposure. For craving, there was a main effect of total depressive symptoms on self-reported craving, after accounting for the interaction between PTSD symptoms and narrative cue, B = 0.418, p = .028, and improved model fit above an initial base model, X2 = 4.74, p < .05. However, total depressive symptoms did not significantly interact with narrative or beverage cues to predict craving, p’s > .05. Further, depression did not exhibit main or interactive effects on salivation, p’s > .05. These results suggest that depressive symptoms may increase subjective craving for alcohol, regardless of trauma or alcohol contextual cues. Further research is needed to explain the role of MDD in PTSD-AUD etiology and maintenance.