Newswise — The process contributing to an individual’s alcohol consumption may be linked to the consequences that person experiences from drinking, a new study suggests. Among people who have experienced fewer negative consequences from drinking, the extent to which they want alcohol to make them feel more sociable—a positive reinforcer—is relatively likely to predict heavier drinking. Among people who have experienced greater drinking consequences, however, feelings of anxiety and depression—negative reinforcers—are more likely to predict higher alcohol consumption. This new research provides some support for the multistage model of drug addiction, which theorizes that risk factors contributing to drinking change as people transition from recreational drinking to developing an alcohol use disorder (AUD). Recreational drinking is believed to be driven by positive reinforcements, such as the expectation of increased sociability, while drinking among individuals with alcohol use disorder is theorized to be driven by negative reinforcements, such as reducing feelings of stress, anxiety, and depression. The multistage model implies that prevention and treatment approaches for risky alcohol use should reflect this shift. Several elements of the multistage model have been supported by research, but little is known about how it may manifest in everyday life. For the study in Alcohol: Clinical & Experimental Research, investigators explored the influence of alcohol consequences, which is strongly correlated with AUD symptoms, on the link between positive and negative risk factors and alcohol use, using methods that captured day-to-day drinking experiences.
The researchers worked with data from 174 undergraduate women who had consumed at least four drinks on one occasion (heavy episodic drinking) twice or more in the last month. Over 30 days, all participants filled out two surveys a day about the consequences of their drinking (e.g., neglected responsibilities), positive and negative affect (e.g., joy, sadness), how much they expected or desired alcohol to relieve their tension or increase their sociability, and their alcohol consumption in the past 24 hours. The researchers used statistical analysis to explore associations between factors influencing alcohol use.
The participants reported drinking on 30% of days, averaging four drinks per drinking day, and almost half of those days involved heavy episodic drinking. Half the participants met the criteria for likely AUD. Negative reinforcement risk factors (a low mood, or higher expectation or desire for alcohol to alleviate their tension) predicted more alcohol consumption, but only among those who had experienced greater alcohol consequences. This is in line with the multistage model of drug addiction. Some data suggested that sociability expectancies influenced drinking among people with fewer alcohol consequences. However, contrary to the multistage model, positive emotions were also linked to increased drinking among those who’d experienced relatively high alcohol consequences, suggesting that positive affect remains a relevant driver of alcohol use even as negative affect becomes more salient.
These findings are somewhat consistent with the multistage model of drug addiction and may help explain why people developing AUD continue to drink heavily despite negative consequences. Prevention and treatment intervention may benefit from being tailored to the most salient risk factors for an individual. For example, targeting tension reduction expectations may be a useful strategy for people experiencing more alcohol consequences. Further research is needed to clarify these associations.
Event-level positive and negative reinforcement risk factors for alcohol use: Differential associations based on individual-level alcohol consequences and post-traumatic stress disorder (PTSD) symptom severity. C. Dyar, D. Kaysen. (pp xx)
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