The Influences of PTSD and Distress Tolerance on Trauma and Alcohol Cue Reactivity

Self-medication models posit that posttraumatic stress disorder (PTSD) increases risk for developing alcohol use disorder (AUD), due the tendency to use alcohol to cope with trauma-related negative affect and memories. However, successfully treating PTSD does not improve AUD outcomes compared to standard AUD treatment alone, suggesting that clinically impacting self-medication in PTSD-AUD may be nuanced. One promising clinical intervention target to decrease self-medication is distress tolerance (DT). The trauma and alcohol cue reactivity paradigm, which measures salivation and self-reported alcohol craving in response to four combinations of narrative (personalized trauma vs. neutral) and beverage (alcohol vs. water) cues, is well-suited to evaluate role of DT in comorbid PTSD-AUD. The current study evaluated DT in relation to trauma and alcohol cue reactivity (i.e., craving, salivation) in a high-risk sample of 185 university students (50.3% female) endorsing lifetime interpersonal trauma exposure and current weekly alcohol consumption. Forward-fitting linear mixed effects models were used to examine (a) the influence of the within-subjects factors (narrative cue, beverage cue) and covariates (DT, PTSD symptoms) on physiological and subjective craving, and (b) the role of DT in a moderated-mediation model of self-medication. Contrary to prediction, there were no main effects of DT in relation to craving (B = -0.281, p = .074) or salivation (B = -0.092, p = .217), and DT did not significantly interact with narrative cue to predict craving (B = 0.189, p = .184). However, DT significantly interacted with beverage cue in relation to craving (B = -0.293, p = .011), such that individuals low, as compared to high, in DT reported greater craving for alcohol in response to the alcohol, but not water, beverage cue. In the context of a moderated-mediation model of self-medication, DT did not moderate the association between negative affect and craving (t = 0.630, p = .529), or an association between trauma cue and negative affect (t = -0.674, p = .501). The findings suggest that among trauma-exposed young adult drinkers, low DT may not exacerbate self-medication use. Instead, DT may influence alternative processes of AUD risk, such as susceptibility to conditioned craving responses to alcohol.