Interactions between adaptive coping and drinking to cope in predicting naturalistic drinking and drinking following a lab-based psychosocial stressor
Highlights
► Coping motives and adaptive coping interact to predict in-lab drinking under stress. ► Motives more strongly predict in-lab drinking when one lacks adaptive coping skills. ► Coping motives and adaptive coping do not interact to predict past month drinking.
Introduction
Alcohol misuse continues to be a public health concern. Point prevalence estimates suggest that about 9% of the U.S. population meet criteria for an alcohol use disorder (Grant et al., 2004), while lifetime prevalence rates are closer to 20% (Kessler et al., 2005). Accordingly, understanding the individual and contextual-level factors that contribute to alcohol use is an important endeavor. As reviewed below, several studies have been conducted to examine how drinking motives (why one drinks) and coping styles (how one copes with stress and negative affect) may confer risk for alcohol problems. Both constructs may be modifiable through intervention, making understanding their influence on alcohol use particularly important for prevention efforts. Each of these factors has separate extant literatures, yet by definition these constructs are not independent. It is unclear whether and how coping motivation for drinking and general adaptive coping skills may work together to influence alcohol use. In addition, the influence of these factors on drinking in the context of a negative mood induction has not been well studied. In the present study, we sought to test whether the association between coping motivation for alcohol use and adaptive coping skills interact to predict drinking both in the laboratory following a social stressor task and in a naturalistic environment (past month drinking, retrospectively reported).
Motivational models (Cooper, 1994, Cox and Klinger, 1988) highlight drinking for both external and internal (i.e., affective) reasons. Though there are a few different models of alcohol use motivation, all share inclusion of drinking to enhance positive emotions (enhancement motives) and drinking to cope with, or alleviate, negative emotions (coping motives). Other motives, less consistently related to problem drinking in adults include drinking to facilitate social situations (social motives) and to “fit in” (conformity motives).
Of the motive types, coping motives have most consistently been associated with problem drinking. Coping motives have been shown to be associated with alcohol use across multiple samples (Cooper et al., 1992, Kassel et al., 2000, Kuntsche et al., 2005, Laurent et al., 1997, Park et al., 2004, Park and Levenson, 2002), and in both cross-sectional (Cooper, 1994, Cooper et al., 1995, Cooper et al., 1988, Williams and Clark, 1998, Windle and Windle, 1996) and longitudinal studies (Holahan, Moos, Holahan, Cronkite, & Randall, 2001). However, much of this research examines the influence of coping motives on self-reported drinking behavior, regardless of whether negative affect is activated, and without regard to other individual-difference factors that may make coping motives more or less influential. Thus, there remains a need for research examining the influence of coping motives on drinking behavior (a) in the context of stress and (b) in combination with the influence of other psychosocial factors, such as adaptive coping skills.
Coping skills, the specific cognitive activities or behaviors people employ in response to stressors or problems, are grouped into broad categories of coping styles. Several models and types of coping styles have been posited and measured (Skinner, Edge, Altman, & Sherwood, 2003). One of the most widely used measures to assess coping styles is the COPE (Carver, Scheier, & Weintraub, 1989). Some of the skills assessed by this measure can be categorized as useful or adaptive coping skills, while others are less useful or maladaptive.
Adaptive coping is often action oriented (Lazarus, 1991) and involves altering the problem or environment that is causing the distress (Folkman, Lazarus, Dunkel-Schetter, DeLongis, & Gruen, 1986). Coping skills most commonly identified as adaptive include active coping, planning, suppression of competing activities, restraint coping, positive reinterpretation and growth, acceptance, religion, and seeking out of social support (Litman, 2006). On the other hand, among the types of maladaptive coping, avoidant coping is the most commonly researched. Avoidant coping generally involves removing oneself from experiencing or thinking about a stressful situation (Carver et al., 1989). Specific types of coping skills typically identified as avoidant include behavioral disengagement, denial, mental disengagement, and substance use (Litman, 2006). In general, whereas adaptive coping strategies predict better health outcomes and less drinking, greater reliance on maladaptive coping styles, and avoidant coping in particular, is associated with greater drinking (Bonin et al., 2000, Cooper et al., 1988, Cooper et al., 1992, Cooper et al., 1995, Willis et al., 2001).
Individuals may lie anywhere on a continuum from low to high levels of adaptive and/or avoidant coping skills. In the present study we were primarily interested in adaptive coping skills, in part because it is these that interventions seek to enhance (Litt et al., 2009, Longabaugh and Morgenstern, 1999). Further, theoretically, it is a lack of adaptive coping that most likely interacts with coping motives for alcohol use to predict drinking, as described below.
Theoretically and empirically, both low levels of adaptive coping in general and high coping motives for drinking may independently promote heavy drinking, but it is unclear whether and under what circumstances these two risk factors may interact to predict alcohol use.
It has been suggested that one reason coping motives may lead to problem drinking is that individuals who drink to cope may do so because they do not have other more adaptive ways to cope in their repertoire (Cooper et al., 1995). Similarly, social learning theory models (Abrams and Niaura, 1987, Bandura, 1969, Maisto et al., 1999) and social cognitive models of relapse (Marlatt & Donovan, 2005) suggest that drinking alcohol may occur specifically for individuals with deficits in adaptive modes of coping when they have the desire to reduce negative affect. Following from these theories, a moderational model of their influence would suggest that individual differences in the use of alcohol to cope may be more or less relevant for predicting drinking depending on one's level of general adaptive coping skills. The combination of a lack of adaptive coping and coping motives may place individuals at particular risk for heavier drinking — drinking to cope may be more strongly associated with alcohol use among those who have not learned or do not tend to rely on other adaptive coping mechanisms. Though avoidant coping may predict drinking behavior, tending to use a range of avoidant coping strategies is likely less relevant for whether one uses drinking specifically as a coping strategy on any given occasion.
Interactive influences of adaptive coping and coping motives should be most relevant to the context of stress. One key element of social learning theories (Bandura, 1986, Maisto et al., 1999) is differential reinforcement, a concept that suggests that a behavior may be reinforced in some situations and not others. Individuals who endorse high coping motives for drinking may experience alcohol as a more powerful reinforcer following stress than individuals without such motives for drinking. In turn, coping motivated drinking is a behavior likely reinforced by drinking during those times when the individual actually experienced negative emotions and a subsequent reduction of such emotions following alcohol use. A reliance on alcohol to cope would not be a learned behavior during those times where negative affect is not present. Thus, in a test of whether coping motives predict increased drinking among individuals who also lack adaptive coping skills, it is important that stress actually is activated. To our knowledge, there have been no empirical examinations of whether one's general adaptive coping skills may moderate the influence of coping motives on drinking behavior when examining this within the context of stress.
In the present study, we sought to examine the interaction between coping motives for alcohol use and general adaptive coping strategies in the prediction of alcohol use. Both in-lab alcohol consumption following a stressor task and retrospective reports of alcohol use were measured in a sample of 50 social drinkers. We hypothesized that higher coping motives would predict alcohol use in the lab following stress induction to a greater extent for individuals with low adaptive coping skills. We then examined whether an interaction between coping motives and adaptive coping would also be observed on past month self-reports of both alcohol use quantity and frequency, when stress was not necessarily activated.
Section snippets
Participants
Data from the present study are drawn from measures collected as part of a separate study (Thomas, Merrill, Von Hofe, & Magid, under review), with the primary purpose of examining interactions among drinking motives, stress induction, and gender. For that study, individuals (N = 210) were recruited from the community via advertisements and initially screened over the telephone for major inclusion/exclusion criteria. Inclusion criteria were ages 21–50, alcohol use between 5 and 15 days in a typical
Data analytic plan
Multiple regression models were used to examine predictors of mls beer consumed in the laboratory. Predictors included scores on the coping motives subscale of the Drinking Motives Questionnaire, adaptive coping scores, and their interaction. Gender and drinks per drinking day were covaried in the model predicting beer consumption, given that males tend to drink more and in order to account for differences in alcohol consumed in the lab that are a function of one's tendency to drinking heavier
Descriptives
Outcome variables were normally distributed. Table 1 presents descriptives. There were no significant differences on demographics or variables of interest between individuals who received the TSST versus those who did not (and were therefore not included in the present study; all ps > .05). Table 2 presents bivariate correlations among model variables. Adaptive coping was negatively associated with NDD, DDD and mls beer consumed, while coping motives were not significantly associated with any of
Discussion
In the present study, we found marginal support for the hypothesized interaction between coping motives for drinking and adaptive coping skills on drinking, such that coping motives and in-lab drinking following a stressor were most strongly associated in the context of low adaptive coping skills. This suggests that individuals who use adaptive coping skills less often, or who use a smaller range of adaptive coping skills, may have overlearned patterns of relying on alcohol as a coping
Role of funding source
Funding for this study was provided by NIAAA grant R21AA16289 to Dr. Suzanne E. Thomas and NIAAA training support (T32AA007474-24) to Dr. Jennifer E. Merrill. NIAAA had no role in the study design, collection, analysis or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication.
Contributors
Dr. Suzanne Thomas designed the study and wrote the protocol, and both Suzanne Thomas and Jennifer Merrill developed the research question for the present study. Jennifer Merrill conducted literature searches for the research question of interest in the present study, conducted the statistical analysis, and wrote the first draft of the manuscript. Both authors contributed to and have approved the final manuscript.
Conflict of interest
Both authors declare that they have no conflicts of interest.
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2020, Child Abuse and NeglectCitation Excerpt :Further, La Flair et al. (2013) found that women reporting any childhood physical abuse, sexual abuse, neglect or witnessed intimate partner violence were more likely to transition from a lower stage of drinking to a hazardous or severe stage between NESARC waves 1 and 2 (La Flair et al., 2013). The mechanisms by which ACEs confer increased risk for morbidity are likely multifactorial, inclusive of epigenetic changes in the stress response (Cooper, Frone, Russell, & Mudar, 1995; Mehta et al., 2013; Ramo-Fernández et al., 2019; Tyrka, Price, Marsit, Walters, & Carpenter, 2012; Yang et al., 2013) and maladaptive coping mechanisms (Filipas & Ullman, 2006; Merrill & Thomas, 2013; Metzger et al., 2017). One potential explanation for the association between ACE exposure and negative alcohol outcomes is the self-medication hypothesis.