An event-level evaluation of women's self-medicated drinking: The role of sexual assault severity, affect, and drinking motives

Do betrayal-based moral injury and drinking to cope explain the association between military sexual trauma and alcohol consumption?

The present study examined two sequential mediation models in which betrayal-based moral injury and drinking to cope were hypothesized to explain the associations between sexual assault/sexual harassment and alcohol consumption. Participants were a community sample of 93 current or former U.S. military women (30.4 years; SD = 8.01) who completed an online, anonymous survey. In both models, sexual assault and sexual harassment and alcohol consumption were explained by betrayal-based moral injury and drinking to cope. It may be important to assess for and therapeutically address betrayal-based moral injury as it may be a mechanism that drives alcohol consumption.

From sleep to sip? Examining a daily model of sleep and trauma-related drinking among sexual violence survivors

OBJECTIVE

Alcohol misuse is common among women who have experienced sexual violence and is often attributed to the self-medication model of alcohol use to alleviate posttraumatic stress disorder (PTSD) symptoms. Despite the proximal theorized role of PTSD symptoms, less attention has been given to daily associations between PTSD symptoms, trauma-related drinking to cope (TRD) motives, and ensuing alcohol use by survivors. Moreover, despite indications that poor sleep impacts affective functioning and may exacerbate daily PTSD symptoms, the role of sleep duration and quality in drinking to cope with PTSD symptoms is not well understood. This study examined an integrated model testing whether shorter sleep duration and poorer sleep quality predict greater daily PTSD symptoms and, in turn, greater alcohol use later that day through TRD motives.

METHOD

Participants were 82 cisgender women (Mage = 22.8, 73.2% White, 13.4% Hispanic/Latina, 56.1% heterosexual, 30.5% bisexual) who had experienced sexual violence. Participants completed ecological momentary assessment measures and wore actigraphs for 3 weeks.

RESULTS

Contrary to hypotheses, shorter-than-usual sleep duration did not predict greater alcohol use quantity via daily PTSD symptoms and TRD motives. However, poorer-than-usual sleep quality predicted greater PTSD symptoms that day, which in turn predicted greater same-day TRD motives.

CONCLUSIONS

Findings underscore the importance of sleep quality in heightened PTSD symptoms but suggest survivors did not drink more to alleviate trauma-related distress. Future research should examine other drinking motives among survivors to inform proximal interventions to prevent alcohol misuse. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Beyond Force, Incapacitation, or Verbal Coercion: Rates and Outcomes of Sexual Assault without Warning

To date, most sexual assault research has focused on specific perpetrator tactics, including verbal coercion, substance-related incapacitation, and force. Responding to recent calls to assess a broader range of nonconsensual sexual experiences, we examined the occurrence and outcomes of sexual assault without warning - when a perpetrator "just does" a behavior without giving a chance to say "no." Participants were 850 college students (Mage = 19.70; 70% cisgender women, 28% cisgender men, 2% transgender/gender expansive), including 38% (n = 325) who reported sexual assault since age 14. Among these survivors, 72% reported sexual assault without warning, including 18% for whom this was the only tactic experienced. Sexual assault without warning was most often used to obtain nonconsensual sexual contact (23% of the sample) but also attempted (11%) and completed penetration (13%). Relative to no such experience, sexual assault without warning was associated with more severe posttraumatic stress, depression, and anxiety, but fewer past-month drinks per week. Although more alcohol use and related consequences were better predicted by incapacitated sexual assault, sexual assault without warning was consistently associated with mental health problems. Findings support the integration of this tactic into sexual assault assessments for college students of diverse gender and sexual identities.

A month in review: longitudinal dynamics between daily PTSD symptom networks, affect, and drinking behaviors in female college students

Introduction

Sexual victimization (SV) is common among college women, with approximately half of those who have experienced SV meeting criteria for posttraumatic stress disorder (PTSD) within a year. Both SV and PTSD are associated with alcohol misuse among college women, often explained by the self-medication hypothesis. Existing literature focuses on overall PTSD severity rather than potential day-to-day fluctuations in specific symptoms, which might play a crucial role in understanding alcohol misuse risk. Studies also examine only same-day or next-day associations between PTSD and drinking, neglecting the potential for longer-term changes.

Methods

This study explores the short-term longitudinal stability and time-lagged predictive dynamics of PTSD symptoms, affect, and drinking behavior among 174 female college heavy episodic drinkers over four weeks. Participants were categorized into three groups: those with a history of SV and PTSD (n = 77), women with SV but without PTSD (n = 59), and women without prior trauma history (n = 38) to be able to examine differences by trauma exposure, and PTSD. We compared the longitudinal stability of PTSD symptom networks, affect (arousal, positive affect, and negative affect), and drinking behavior across groups. Support vector regression determined which PTSD symptom networks and affect best predict drinking behavior at specific time lags within a 0-7 day range.

Results

The PTSD group showed higher longitudinal stability for PTSD symptom networks (adjusted ps <.049) and arousal (adjusted ps <.048), but lower stability for negative affect (adjusted p =.013) and drinking behavior, including alcohol cravings (adjusted p =.019) and consumption (adjusted ps =.012), compared to the comparison groups. This suggests individuals with PTSD have more stable symptoms and arousal levels but greater fluctuations in negative affect and alcohol-related behaviors. Secondary analysis revealed PTSD symptom networks optimally predicted alcohol cravings with a three-day time lag (r=.88, p <.001) and consumption with a four-day time lag (r=.82, p <.001).

Discussion

These findings challenge assumptions regarding immediate effects of PTSD and affect on drinking behavior and underscore the need for therapeutic approaches that consider longer-range effects. Future research should expand on these findings by incorporating longer-range assessments and exploring a broader range of symptom interactions.

A serial Mediation Model of Depression and Drinking Motives Underlying Problem Drinking Among Hispanic College Women Following Rape

Problem drinking and depression are common following sexual assault. The current study applied a coping motives model of drinking and examined the association between rape experiences and problem drinking serially mediated by depression symptoms and coping-depression drinking motives among Hispanic college women. A total of 330 college women were classified into a single rape experience (SGL) group (n = 44), a multiple rape experiences (MLT) group (n = 70), and a no sexual assault experience group (n = 221). Participants completed self-report measures online. Serial mediation analyses with multi-categorical predictors found that significantly increased alcohol consumptions in rape survivors compared to individuals with no sexual assault experience were largely explained by the serially connected underlying mechanisms of depression symptoms and coping-depression drinking motives. The prevalence rates of rape experiences in this Hispanic female sample are alarming, suggesting Hispanic college women as a particularly vulnerable group for rape. The current results contribute to a greater understanding of the effects of rape experiences on behavioral and emotional outcomes among young Hispanic women who have been underrepresented in sexual victimization research. The findings emphasize the importance of assessing depression symptoms and coping-depression drinking motives in Hispanic rape survivors to reduce risks for hazardous drinking behavior.

Sexual Decision Making When Intoxicated: Women's Reasons for and Against Having Sex in a Laboratory-Based Scenario

Young adult women report high condom use intentions, but inconsistent condom use. Cognitive appraisals during sexual encounters are important determinants of condom use decisions, but a nuanced understanding of what cognitions emerge during women's "hot states" (e.g., sexual arousal, alcohol intoxication) remains lacking. To address this gap, we examined women's heat of the moment cognitions in their own words using mixed methods. Young adult women (N = 503; Mage = 25.01, SDage = 2.66) were randomized to a beverage condition (alcohol or control), then read and responded to questions about an eroticized sexual scenario. The nature and strength of reasons for and against having sex were reported before and after learning no condom was available. Multilevel models revealed intoxicated participants were more likely to let the partner decide how far to go sexually than sober participants at both timepoints, but the strength of cognitive appraisals (reasons for, reasons against, and feeling conflicted) only differed between beverage conditions after knowledge of no condom. These results suggest alcohol myopia was evident in the presence of inhibition conflict. Content analysis of these reasons revealed multifaceted cognitions that changed upon learning there was no condom. Findings highlight cognitions to target through interventions and underscore the importance of both alcohol and situational context in decision making.

Web-Based Screening, Brief Intervention, and Referral to Treatment for Traumatic Stress and Alcohol Misuse Among Survivors of Sexual Assault and Intimate Partner Violence: Usability and Acceptability Study

BACKGROUND

Recent survivors of intimate partner violence (IPV) and sexual assault (SA) are at a high risk for traumatic stress and alcohol misuse. IPV and SA survivors face barriers to services for traumatic stress and alcohol misuse and have low service utilization rates. One way to increase access to services for this population is the use of web-based screening, brief intervention, and referral to treatment (SBIRT), an evidence-informed approach for early identification of traumatic stress and alcohol and drug misuse and connecting individuals to treatment.

OBJECTIVE

This study aims to assess the usability and acceptability of a web-based SBIRT called CHAT (Choices For Your Health After Trauma) tailored to address traumatic stress and alcohol misuse following past-year IPV, SA, or both.

METHODS

Phase 1 involved gathering feedback about usability and acceptability from focus groups with victim service professionals (22/52, 42%) and interviews with past-year survivors of IPV, SA, or both (13/52, 25%). Phase 2 involved gathering feedback about the acceptability of an adapted version of CHAT in an additional sample of recent survivors (17/52, 33%). Survey data on history of IPV and SA, posttraumatic stress disorder symptoms, alcohol and drug use, and service use were collected from survivors in both phases to characterize the samples. Qualitative content and thematic analyses of the interviews and focus group data were conducted using a coding template analysis comprising 6 a priori themes (usability, visual design, user engagement, content, therapeutic persuasiveness, and therapeutic alliance).

RESULTS

Six themes emerged during the focus groups and interviews related to CHAT: usability, visual design, user engagement, content, therapeutic persuasiveness, and therapeutic alliance. Phase 1 providers and survivors viewed CHAT as acceptable, easy to understand, and helpful. Participants reported that the intervention could facilitate higher engagement in this population as the web-based modality is anonymous, easily accessible, and brief. Participants offered helpful suggestions for improving CHAT by updating images, increasing content personalization, reducing text, and making users aware that the intervention is confidential. The recommendations of phase 1 participants were incorporated into CHAT. Phase 2 survivors viewed the revised intervention and found it highly acceptable (mean 4.1 out of 5, SD 1.29). A total of 4 themes encapsulated participant's favorite aspects of CHAT: (1) content and features, (2) accessible and easy to use, (3) education, and (4) personalization. Six survivors denied disliking any aspect. The themes on recommended changes included content and features, brevity, personalization, and language access. Participants provided dissemination recommendations.

CONCLUSIONS

Overall, CHAT was acceptable among victim service professionals and survivors. Positive reactions to CHAT show promise for future research investigating the efficacy and potential benefit of CHAT when integrated into services for people with traumatic stress and alcohol misuse after recent IPV and SA.

Associations among sexual assault, posttraumatic stress, drinking to cope with anxiety, and alcohol use based on gender identity and sexual orientation

BACKGROUND

Sexual assault (SA) is experienced by a substantial proportion of emerging adult college students and is associated with elevated rates of posttraumatic stress disorder (PTSD) and alcohol use. This study examines the mediating role of posttraumatic stress symptoms (PTSS) in the associations among SA severity, drinking to cope with anxiety, and average weekly drinks while considering the moderating roles of gender identity and sexual orientation.

METHODS

A total of 2160 college students who were diverse in gender (cisgender women, 64.4%; cisgender men, 30.6%, and transgender and gender diverse [TGD] individuals = 4.9%) and sexual orientation (heterosexual = 68.0%, LGBQ+ = 32.0%) completed measures of SA severity, PTSS, drinking to cope with anxiety motives, and average weekly drinks.

RESULTS

The mediation model for the full sample indicated significant indirect effects of SA severity on drinking to cope with anxiety through PTSS, but not on average weekly drinks. Moderation analyses revealed differential relationships between the variables based on both gender identity and sexual orientation. For instance, the association between SA severity and PTSS was stronger for cisgender women and TGD individuals than cisgender men, and for LGBQ+ individuals than heterosexual individuals. While the association between PTSS and average weekly drinks was only significant for cisgender men, the association between PTSS and drinking to cope with anxiety was significant for both cisgender men and women but not TGD individuals. Furthermore, the association between SA severity and drinking to cope with anxiety was stronger for cisgender women than cisgender men.

CONCLUSIONS

Findings from this study demonstrate sexual orientation and gender identity differences and similarities in the associations of SA severity, PTSS, drinking to cope with anxiety, and alcohol use. Results are discussed in relation to the self-medication hypothesis and tailoring interventions for diverse groups.

Event-level positive and negative reinforcement risk factors for alcohol use: Moderation by individual-level alcohol consequences and post-traumatic stress disorder symptom severity

BACKGROUND

The multistage model of drug addiction posits that risk processes contributing to alcohol use change as individuals develop alcohol use disorders. However, few studies have tested this theory outside of the lab or at the event level. We assessed whether event-level associations between positive reinforcement (e.g., positive affect, sociability expectancies) and negative reinforcement risk factors (e.g., negative affect, tension reduction expectancies) and same-/next-day alcohol consumption varied as a function of an individual's level of alcohol consequences. Given elevated alcohol use consequences among individuals with post-traumatic stress disorder (PTSD) and disruptions in reward processing that affect this population, we also tested whether these processes differed based on the presence and severity of PTSD.

METHODS

We used data from a 30-day ecological momentary assessment study with 174 undergraduate women who regularly engaged in heavy episodic drinking. A majority (78%) of the sample had experienced sexual assault and 44% had current PTSD. Analyses used Bayesian multilevel structural equation modeling with diffuse (non-informative) priors. We used markov chain monte carlo (MCMC) algorithms to generate a series of 10,000 random draws from the multivariate posterior distribution of our sample for each model.

RESULTS

Results partially supported the multistage model. Event-level negative reinforcement risk factors only predicted more alcohol consumption among individuals who experienced more alcohol consequences. Findings for positive reinforcement risk factors were partially consistent with hypotheses. Overall, findings appear to operate similarly across PTSD symptom severity.

CONCLUSIONS

Results suggest that interventions for heavy episodic drinking could benefit from attending to an individual's level of alcohol consequences. For example, preventive interventions for individuals who tend to experience few consequences may benefit more from addressing positive reinforcement risk factors, while treatment interventions for those who experience more consequences may benefit from attending to both positive and negative reinforcement.