A Daily Process Examination of Alcohol Use and PTSD in Female College Students

描述（由申请人提供）：本NIAAA R21探索性/发展性应用的总体目标是研究使用经验抽样方法（ESM）识别高危人群、女性性虐待和性侵犯受害者饮酒问题的认知和情感风险因素的可行性。青年期是性侵犯和酗酒的高风险时期。此外，性侵犯是酗酒问题增加的一个危险因素，也会导致酒精使用障碍与创伤后应激障碍共病。自我药物治疗假说已被提出作为对这种共病的解释，因此问题饮酒发展为试图调节负面影响和改善创伤后应激障碍症状。然而，(a)研究没有包括非创伤暴露的对照组，(b)创伤后应激障碍和对问题饮酒的负面影响的综合和独特贡献尚未同时研究，(c)这些关系尚未使用ESM方法进行检查，(d)研究没有检查与日常监测相关的测量反应性。本研究建议使用经验抽样方法来更好地完善我们对创伤后应激障碍、负面情绪和酒精使用之间的时间关系的理解。对酒精使用和情绪的多重日常评估以及多层次模型的应用减少了回忆失真，并允许同时检查人与人之间的问题，这些问题涉及哪些特征使人们更容易饮酒（人与人之间的预测因素），以及饮酒是否会增加对创伤后应激障碍症状的反应，而不是负面情绪（人与人之间的因素）。150名有儿童性虐待（CSA）或成人性侵犯（SA）历史的女大学生，以及30名没有创伤历史的女大学生，将被要求完成一份关于创伤后应激障碍症状、负面影响、酒精使用和饮酒冲动的电子日记，每天2次，持续4周。将包括一个比较组，以检查重复每日测量的影响。多水平回归分析将用于解决以下具体目标：(1)测试创伤暴露，创伤后应激障碍和负面影响在增加饮酒和冲动中的作用，包括人与人之间和人与人之间，正如自我用药模型所预测的那样；(2)探索性分析应对动机在PTSD症状和负性情绪与饮酒行为和冲动的人际关系中的调节作用；(3)与无监测情况相比，检查与日常监测相关的测量反应性程度。这些问题的答案将用于指导未来的预防工作，旨在减少性侵犯、关系暴力或战斗暴露等创伤性事件后的问题饮酒模式。

DESCRIPTION (provided by applicant): The overall objective of this NIAAA R21 Exploratory/Developmental application is to examine the feasibility of using experience sampling methodologies (ESM) to identify cognitive and emotional risk factors for problem drinking in an at-risk population, female sexual abuse and assault victims. Young adulthood is a period of high risk for both sexual assault and high risk drinking. Moreover, sexual assault is a risk factor for increases in problem drinking as well as alcohol use disorders comorbid with PTSD. The self-medication hypothesis has been proposed as an explanation for this comorbidity, whereupon problem drinking develops as an attempt to modulate negative affect and ameliorate PTSD symptoms. However, (a) studies have not included non-trauma exposed comparison groups, (b) the combined and unique contributions of PTSD and negative affect on problem drinking have not been studied concurrently, (c) these relationships have not been examined using ESM methodologies, and (d) studies have not examined measurement reactivity associated with daily monitoring. This study proposes using the experience sampling method to better refine our understanding of the temporal relations between PTSD, negative affect, and alcohol use. Multiple daily assessments of alcohol use and mood and the application of multilevel modeling reduces recall distortion and allows for simultaneous examination of both within- and between-person questions regarding what characteristics place people at greater risk for drinking (between-person predictors) and whether drinking increases in response to PTSD symptoms over and above negative mood (within-person factors). 150 female college students with a past history of child sexual abuse (CSA) or adult sexual assault (SA), and 30 female college students with no past trauma history, will be signaled to complete an electronic diary of PTSD symptoms, negative affect, alcohol use, and urges to drink, 2 times daily for 4 weeks. A comparison group will be included to examine the impact of repeated daily measurement. Multilevel regression analyses will be used to address the following specific aims: (1) To test the role of trauma exposure, PTSD, and negative affect in increasing drinking and urges, both between- and within-persons, as predicted by the self-medication model; (2) conduct exploratory analyses of coping motives as a moderator of the within-person relationship between symptoms (PTSD and negative affect) and drinking behavior and urges; (3) Examine degree of measurement reactivity associated with daily monitoring compared to a no-monitoring condition. Answers to these questions will be used to guide future prevention efforts aimed at reducing problematic drinking patterns following traumatic events like sexual assault, relationship violence or combat exposure.