Probing paradoxical alcohol effects on approach (versus avoidance) of trauma processing in drinkers with PTSD - Project Summary / Abstract Trauma and posttraumatic stress disorder (PTSD) commonly present among individuals seeking treatment for alcohol use, and trauma sequelae can considerably challenge alcohol treatment approaches. Following trauma, humans often turn to social connections to process their experiences. Yet, trauma and posttraumatic symptoms also can engender mistrust of others, interpersonal vulnerability, fear of rejection, and social avoidance that disrupt adaptive, protective social support. Unmet drives for social processing might lead individuals to seek out alcohol to facilitate interpersonal connection. Social motivations are the most common reasons for drinking broadly, and alcohol has been shown to increase reported social bonding, interpersonal disclosure, and perceived closeness. Despite this, current theoretical models attempting to explain PTSD- related drinking overwhelmingly suggest that drinkers turn to alcohol to avoid processing trauma-related affect. Such theoretical emphasis on negative reinforcement has shaped current treatment efforts for PTSD-related problem drinking, which often focus on processing and/or confronting trauma experiences to presumably reduce avoidance-based drinking. However, the research teams’ preliminary findings from focus groups of frequent drinking adults with provisional PTSD suggest that many drinkers also report drinking to approach processing trauma memories, thoughts, and emotions, particularly in social drinking contexts. Such perceived effects of alcohol on social trauma processing may play a key role in maintaining PTSD-related drinking yet, to date, have not been tested. The proposed study aims to characterize the extent to which drinkers with PTSD anticipate beneficial trauma processing effects before social drinking events (i.e., expected trauma processing; Aim 1) and whether drinkers experience social drinking events as having facilitated trauma processing (i.e., experienced trauma processing; Aim 2). Efforts also will characterize drinkers’ reflections of trauma processing in these specific drinking events, including aspects of the social context and relevance of trauma processing to future posttraumatic symptoms (Aim 3). Frequent drinking adults with PTSD (n = 100) will complete momentary surveys before and after drinking events in a 21-day ecological momentary assessment (EMA) design. Drinkers who report expected or experienced trauma processing (a subset, n = 20) will provide in- depth, idiographic information through a follow-up qualitative interview on the perceptual, sociocontextual, and successive factors at play in such drinking events. Findings will begin to characterize the extent to which perceived trauma processing effects encourage individuals to seek out social drinking in the aftermath of trauma and/or reinforce PTSD-related drinking over time, thus suggesting the need for larger investigations. Future research can explore psychosocial/physiological mechanisms underlying any such effects, and clinical research could work to modify extant interventions to encourage trauma processing in the absence of alcohol.
