Negative Affect Mediates the Association between Posttraumatic Cognitions and Craving in Veterans with Posttraumatic Stress Disorder and Alcohol Use Disorder

Abstract Objective: The co-occurrence of posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) is common. Individuals with PTSD/AUD commonly drink to cope with PTSD symptoms, which maintains PTSD/AUD, and may result in increased craving for alcohol. Negative affect is implicated in negative reinforcement models of craving. Further, Emotional Processing Theory posits that posttraumatic cognitions lead to the experience of negative affect, which may result in increased craving in PTSD/AUD. The current study aims to advance the understanding of craving in PTSD/AUD by evaluating if specific posttraumatic cognitions (e.g., cognitions about the self, world, and self-blame) are associated with increased negative affect, and whether higher negative affect is associated with heightened craving. Methods: Three separate simple mediation models were utilized to test if negative affect mediated the relationship between each specific posttraumatic cognition type and craving among 136 treatment-seeking veterans with PTSD/AUD. Results: We found that negative affect mediated the association between all posttraumatic cognition types and craving. Specifically, viewing oneself as being unable to handle PTSD-related distress, viewing the world as very dangerous, and blaming oneself for one’s role in a traumatic event were all associated with increased negative affect, which was related to higher craving. Conclusions: Given that posttraumatic cognitions improve via trauma-focused treatment for PTSD, future work should evaluate whether improvements in posttraumatic cognitions via trauma-focused treatment lead to decreased negative affect and craving in PTSD/AUD.

• Publication year

  2020

• Venue

  Journal of dual diagnosis

• Publication date

  2020-04-07

• Fields of study

  Medicine, Psychology

• Identifiers
  DOI 10.1080/15504263.2020.1741754PMID 32255410PMCID PMC7483830
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar, PubMed

• No claims are published for this paper.

• No concepts are published for this paper.

• Mediation, Moderation, and Conditional Process Analysis

  2020influential reference
• Mediation analysis.

  2019cited by this paper
• Efficacy of Integrated Exposure Therapy vs Integrated Coping Skills Therapy for Comorbid Posttraumatic Stress Disorder and Alcohol Use Disorder: A Randomized Clinical Trial.

  2019cited by this paper
• The Burden of Co-Occurring Alcohol Use Disorder and PTSD in U.S. Military Veterans: Comorbidities, Functioning, and Suicidality

  2018cited by this paper
• The Clinician-Administered PTSD Scale for DSM–5 (CAPS-5): Development and Initial Psychometric Evaluation in Military Veterans

  2017cited by this paper
• Trauma- and Stress-Induced Response in Veterans with Alcohol Dependence and Comorbid Post-Traumatic Stress Disorder.

  2016cited by this paper
• Drinking motives among heavy-drinking veterans with and without posttraumatic stress disorder

  2015cited by this paper
• Maximizing the utility of a single site randomized controlled psychotherapy trial.

  2015cited by this paper
• Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure (COPE): Therapist Guide

  2014cited by this paper
• Drinking motives moderate daily relationships between PTSD symptoms and alcohol use.

  2014cited by this paper
• Treatment of co-occurring PTSD-AUD: effects of exposure-based and non-trauma focused psychotherapy on alcohol and trauma cue-reactivity.

  2014cited by this paper
• Craving and Physiological Reactivity to Trauma and Alcohol Cues in PTSD and Alcohol Dependence

  2013cited by this paper
• Comorbidity of posttraumatic stress disorder with alcohol dependence among US adults: results from National Epidemiological Survey on Alcohol and Related Conditions.

  2013cited by this paper
• Symptoms of posttraumatic stress predict craving among alcohol treatment seekers: results of a daily monitoring study.

  2012cited by this paper
• Gender-specific associations between trauma cognitions, alcohol cravings, and alcohol-related consequences in individuals with comorbid PTSD and alcohol dependence.

  2012cited by this paper
• Cognitive Change Predicts Symptom Reduction With Cognitive Therapy for Posttraumatic Stress Disorder

  2012cited by this paper
• Prevalence and Axis I comorbidity of full and partial posttraumatic stress disorder in the United States: results from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions.

  2011cited by this paper
• Substance use disorders in Iraq and Afghanistan veterans in VA healthcare, 2001-2010: Implications for screening, diagnosis and treatment.

  2011cited by this paper
• Craving and physiological reactivity to trauma and alcohol cues in posttraumatic stress disorder and alcohol dependence.

  2010cited by this paper
• Trauma-focused imaginal exposure for individuals with comorbid posttraumatic stress disorder and alcohol dependence: revealing mechanisms of alcohol craving in a cue reactivity paradigm.

  2006cited by this paper
• Emotional Processing Theory (EPT) and Exposure Therapy for PTSD

  2006cited by this paper
• Cognitive changes during prolonged exposure versus prolonged exposure plus cognitive restructuring in female assault survivors with posttraumatic stress disorder.

  2004cited by this paper
• Impact of craving on alcohol relapse during, and 12 months following, outpatient treatment.

  2004cited by this paper
• Addiction motivation reformulated: an affective processing model of negative reinforcement.

  2004cited by this paper
• Seeking Safety: A Treatment Manual for PTSD and Substance Abuse

  2003cited by this paper
• Alcohol craving predicts drinking during treatment: an analysis of three assessment instruments.

  2003cited by this paper
• Trauma and substance cue reactivity in individuals with comorbid posttraumatic stress disorder and cocaine or alcohol dependence.

  2002cited by this paper
• A three-pathway psychobiological model of craving for alcohol.

  1999cited by this paper
• The Posttraumatic Cognitions Inventory (PTCI): Development and validation.

  1999cited by this paper
• Psychometric properties of the Penn Alcohol Craving Scale.

  1999cited by this paper
• Timeline Follow-Back A Technique for Assessing Self-Reported Alcohol Consumption

  1992cited by this paper
• Development and validation of brief measures of positive and negative affect: the PANAS scales.

  1988cited by this paper
• The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations.

  1986cited by this paper

• Evaluating the Cognitive Effects of Video-Induced Negative Affect in College Students: A Comparative Study between Acute Exercise and Music Listening

  2023cites this paper
• Craving, distress tolerance, emotion dysregulation, and experiential avoidance among patients in early recovery from opioid use disorder in residential programs

  2023cites this paper
• Posttraumatic cognitions and sexual assault: Understanding the role of cognition type in posttraumatic stress symptoms and problematic alcohol use.

  2022cites this paper
• Mindfulness in Survivors of Cumulative Childhood Interpersonal Trauma: a Buddhist Conceptualization of Suffering and Healing

  2022cites this paper
• The Posttraumatic Cognitions Inventory (PTCI): Psychometric evaluation in veteran men and women with trauma exposure.

  2022cites this paper
• Journal of Dual Diagnosis: Highlights from the 2020 Issues

  2021cites this paper
• The Impact of Co-occurring Post-traumatic Stress Disorder and Substance Use Disorders on Craving: A Systematic Review of the Literature

  2021influential citation
• Distress tolerance and special alcohol metacognitions behave differently in the association of negative affect with alcohol-related patterns in men with problematic alcohol use in the abstinence phase.

  2020cites this paper