Possemato Kyle, Maisto Stephen A, Wade Michael, Barrie Kimberly, McKenzie Shannon, Lantinga Larry J, Ouimette Paige
Center for Integrated Healthcare, Syracuse VA Medical Center.
Psychol Addict Behav. 2015 Dec;29(4):894-905. doi: 10.1037/adb0000129.
Despite high rates of comorbid hazardous alcohol use and posttraumatic stress disorder (PTSD), the nature of the functional relationship between these problems is not fully understood. Insufficient evidence exists to fully support models commonly used to explain the relationship between hazardous alcohol use and PTSD including the self-medication hypothesis and the mutual maintenance model. Ecological momentary assessment (EMA) can monitor within-day fluctuations of symptoms and drinking to provide novel information regarding potential functional relationships and symptom interactions. This study aimed to model the daily course of alcohol use and PTSD symptoms and to test theory-based moderators, including avoidance coping and self-efficacy to resist drinking. A total of 143 recent combat veterans with PTSD symptoms and hazardous drinking completed brief assessments of alcohol use, PTSD symptoms, mood, coping, and self-efficacy 4 times daily for 28 days. Our results support the finding that increases in PTSD are associated with more drinking within the same 3-hr time block, but not more drinking within the following time block. Support for moderators was found: Avoidance coping strengthened the relationship between PTSD and later drinking, while self-efficacy to resist drinking weakened the relationship between PTSD and later drinking. An exploratory analysis revealed support for self-medication occurring in certain times of the day: Increased PTSD severity in the evening predicted more drinking overnight. Overall, our results provide mixed support for the self-medication hypothesis. Also, interventions that seek to reduce avoidance coping and increase patient self-efficacy may help veterans with PTSD decrease drinking.
尽管共病危险饮酒和创伤后应激障碍（PTSD）的发生率很高，但这些问题之间功能关系的本质尚未完全明确。目前存在的证据不足以充分支持常用于解释危险饮酒与PTSD之间关系的模型，包括自我药疗假说和相互维持模型。生态瞬时评估（EMA）可以监测症状和饮酒行为在一天内的波动情况，以提供有关潜在功能关系和症状相互作用的新信息。本研究旨在对饮酒行为和PTSD症状的日常过程进行建模，并检验基于理论的调节因素，包括回避应对方式和抵制饮酒的自我效能感。共有143名近期有PTSD症状且存在危险饮酒行为的退伍军人，在28天内每天进行4次简短评估，内容包括饮酒情况、PTSD症状、情绪、应对方式和自我效能感。我们的研究结果支持以下发现：PTSD症状的加重与同一3小时时间段内饮酒量的增加有关，但与随后时间段内饮酒量的增加无关。研究发现了调节因素的作用：回避应对方式强化了PTSD与随后饮酒行为之间的关系，而抵制饮酒的自我效能感则削弱了PTSD与随后饮酒行为之间的关系。一项探索性分析显示，支持在一天中的某些时段存在自我药疗现象：晚上PTSD严重程度的增加预示着夜间饮酒量的增加。总体而言，我们的研究结果对自我药疗假说提供了混合支持。此外，旨在减少回避应对方式并提高患者自我效能感的干预措施，可能有助于患有PTSD的退伍军人减少饮酒。
