Distress tolerance in social versus solitary college student drinkers
Introduction
Despite years of research, college student drinking continues to present a major health problem within the United States. Full-time college students are more likely to drink and drink heavily compared to same-age peers not in college (SAMHSA, 2014), and approximately 1 in 4 students experiences consequences as a result of drinking at some point during their time in college (Wechsler, Dowdall, Maenner, Gledhill-Hoyt, & Lee, 1998). Previous research suggests that certain subsets of students may be especially at risk of serious drinking consequences, and it is therefore important to better identify such students so that more effective steps can be taken to prevent such consequences.
Young adults who report that they drink to manage negative affect may be at greater risk for problematic drinking consequences than those who drink for other reasons. Research has demonstrated that motivation to drink as a means to cope with negative affect tends to predict more problematic drinking than do enhancement and social drinking motives (Cooper, 1994, Cooper et al., 1992, Holyfield et al., 1995, Kuntsche et al., 2005, Rafnsson et al., 2006). Distress tolerance is one factor that is likely to influence coping with negative affect. It reflects a person's likelihood of enduring, attending to, and alleviating perceived emotional discomfort (Simons & Gaher, 2005), and it has predicted a variety of adverse consequences that are purportedly regulated by self-control, such as substance abuse (Grant and Chamberlain, 2014, Zvolensky and Hogan, 2013).
The ability to tolerate distress likely acts on the mechanism of negative urgency (Kaiser, Milich, Lynam, & Charnigo, 2012). Negative urgency – commonly conceptualized as a component of impulsivity – refers to the tendency to act rashly when experiencing adverse emotions such as sadness (Wray, Simons, Dvorak, & Gaher, 2012). Therefore, in a model that predicts substance abuse, negative affect is likely to be experienced as more aversive in people with low distress tolerance who then behave impulsively and engage in risky drinking behaviors due to a sense of negative urgency (Kaiser et al., 2012). Wray et al. (2012) found more support for this model than a direct relationship between distress tolerance and risky drinking behaviors. This model also helps to explain the plethora of indirect relationships that have been suggested between distress tolerance and alcohol abuse, such as evidence from Marshall-Berenz, Vujanovic, and MacPherson (2011), who found that distress tolerance partially mediated the relationship between impulsivity and coping motives among people with PTSD, and evidence from Buckner, Keough, and Schmidt (2007), who found that distress tolerance mediated the relationship between depression and problems with alcohol and cannabis.
The relationship between distress tolerance and negative affectivity is made even more intriguing when it is examined in the context of the motivation to cope with negative affect. Because distress tolerance is related to drinking to cope (Howell et al., 2010, Marshall-Berenz et al., 2011) and coping motives strongly predict alcohol-related problems in college students (Cooper et al., 1992, Kuntsche et al., 2005), the relationship between distress tolerance and alcohol-related problems may be best captured in a mediational model rather than through direct effects (Martens et al., 2008). In addition to assessing differences in distress tolerance across groups of college student drinkers, this study proposes to assess the validity of distress tolerance measures in predicting alcohol-related consequences via coping motives.
Although the majority of college students who drink do not experience many severe negative consequences, the subset of students who drink to cope appear to be at a higher risk of engaging in risky behaviors (e.g., driving while intoxicated) and experiencing negative consequences (e.g., arrests for driving while intoxicated; Wray et al., 2012). Therefore, it is important to identify the characteristics of the students who engage in this pattern of drinking. One such group may be college students who drink heavily in isolation. Previous research has demonstrated that these students are at greater risk for experiencing more and more severe drinking consequences than their social-drinking peers (Christiansen, Vik, & Jarchow, 2002). Compared to social drinkers, solitary heavy drinkers endorse more coping motives, experience more serious consequences such as increased suicidal ideation (Gonzalez, Collins, & Bradizza, 2009), and have greater difficulty regulating negative mood (Gonzales & Skewes, 2013). For these individuals, distress tolerance might exert a greater influence on their alcohol consumption and alcohol-related consequences through negative urgency and coping mechanisms. Therefore, it is likely that college students who drink heavily alone also have lower levels of distress tolerance than students who engage in other patterns of drinking. This study proposes to examine those group differences in distress tolerance.
There are many means by which researchers have been studying distress tolerance over the past decade, using either self-report questionnaires that assess one's perceived ability to withstand distress or measures that capture the behaviorally demonstrated capacity to tolerate distress (Leyro, Zvolensky, & Bernstein, 2010). While both types of measures have been linked to alcohol-related problems (Daughters et al., 2005a, Daughters et al., 2005b, Simons and Gaher, 2005), the literature is mixed on their efficacy at predicting problems directly (Howell et al., 2010). As was suggested above, distress tolerance appears to impact alcohol use and alcohol-related problems indirectly, via mechanisms such as negative urgency and coping motives. The relationship between distress tolerance and alcohol-related problems is made especially problematic by the myriad of ways in which tolerance is assessed, as well as the types of distress captured by such measures. For example, although self-report measures of distress tolerance correlate well with one another and behavioral measures of distress tolerance correlate well with one another (Anestis et al., 2012), these different modalities do not always hang together and, indeed, may be addressing different aspects of distress (e.g., perceptions of how one will respond to distress versus behavioral responses during physiological discomfort; McHugh et al., 2011). The question then becomes which of these two types of measures are better at measuring the component of distress that best predicts alcohol-related problems.
Comprehensive reviews of the utility of distress tolerance measures to predict specific psychopathology, such as alcohol abuse, are lacking (Anestis et al., 2012). Simons and Gaher (2005), Wray et al. (2012), and Buckner et al. (2007) reported evidence between low self-reported distress tolerance and more alcohol problems, but Howell et al. (2010) did not find a significant, direct relationship between low distress tolerance and a greater number of problems. With respect to behavioral measures, one study found evidence that low distress tolerance can predict subsequent dropout from a substance abuse treatment program (Daughters et al., 2005a, Daughters et al., 2005b) and another linked low distress tolerance to failed attempts to stop smoking (Brown, Lejuez, Kahler, Strong, & Zvolensky, 2005). Other studies have found evidence of an indirect relationship between behavioral measures of distress tolerance and problematic alcohol use (Daughters et al., 2009, Gorka et al., 2012). However, to our knowledge, there has not yet been evidence to suggest a direct relationship between any behavioral measure of distress tolerance and alcohol-related problems per se.
Even so, there is a robust theoretical argument for a relationship between behavioral distress tolerance and alcohol-related problems. For example, Anestis et al. (2012) found support for the predictive validity of self-report and behavioral measures of distress tolerance (e.g., the Distress Tolerance Scale and Distress Tolerance Test, respectively) for impulsive behaviors, which are important to the realm of alcohol consumption because facets of impulsivity (e.g., negative urgency) have been shown to predict maladaptive alcohol consumption and alcohol-related problems (Kaiser et al., 2012, Shin et al., 2012). The conflicting results span different types of distress tolerance measures, and the evidence suggesting that both may be useful in predicting alcohol-related consequences highlights the importance of a multimodal assessment of distress tolerance.
In an attempt to address these concerns, this study compared solitary and social drinkers across a self-report measure and a behavioral measure of distress tolerance. The first measure, the distress intolerance self-report (DISR) scale, is brief measure of distress tolerance that includes ten items from four established measures of distress and anxiety tolerance (i.e., Anxiety Sensitivity Index, Discomfort Intolerance Scale, Distress Tolerance Scale, and Frustration Discomfort Scale). In a recent study, these ten questions were shown to have the highest factor loadings for a single “distress intolerance” factor in both clinical and nonclinical samples (McHugh & Otto, 2012). This finding was important because the succinct assessment of distress tolerance is very useful given the lack of a gold standard for self-reported distress tolerance among the variety of measures available (McHugh and Otto, 2012, McHugh et al., 2011). Although the DISR has not yet been used to predict alcohol-related problems, the Discomfort Intolerance Scale (DIS) and Distress Tolerance Scale (DTS) have been independently linked to alcohol-related problems (Howell et al., 2010, Simons and Gaher, 2005). The Anxiety Sensitivity Index (ASI) and the Frustration Discomfort Scale (FDS) have not yet been used to predict alcohol-related problems, but the ASI has predicted coping motives for alcohol use (Stewart & Zeitlin, 1995), and the FDS was shown to be related to similar constructs such as “internet addiction” and problems with self-control (Harrington, 2005, Ko et al., 2008).
Although we know of no published studies that have examined the relationship between behaviorally demonstrated distress tolerance and alcohol-related problems, there are a few studies that have used behavioral distress tolerance measures to examine the relationship between distress tolerance and alcohol use. The Paced Auditory Serial Addition Test, or PASAT, has typically been the measure used in such studies. For example, Gorka et al. (2012) reported using the PASAT to predict early termination from a drug and alcohol treatment facility. These authors found that subjects with lower distress tolerance (as indicated by premature termination of the PASAT) were more likely to leave treatment early than individuals with greater distress tolerance. Daughters et al. (2009) found a relationship between early PASAT termination and greater amounts of alcohol use among Caucasian (but not ethnic minority) youths aged 9–13 (Daughters et al., 2009).
As mentioned above, the PASAT has not yet been used to predict drinking consequences in a college student population; in fact, to our knowledge there are no published studies that have attempted to link any behavioral measure of distress tolerance to alcohol-related problems per se. The aforementioned evidence suggests that the PASAT, though previously untested, is perhaps the behavioral measure of distress tolerance that has the greatest likelihood of predicting alcohol-related problems, and therefore it may be the behavioral measure that best reflects differences in distress tolerance across solitary and social college student drinkers.
In summary, college students who drink heavily in isolation seem to be at greater risk of experiencing more and more severe alcohol-related consequences. There is also literature to suggest that they have higher rates of depressive symptoms and more motives to drink to cope with negative affect. Despite the fact that distress tolerance has been linked to negative affect, coping motives, and alcohol-related problems, differences in distress tolerance have not been compared across groups of solitary heavy drinkers and other drinkers. Therefore, this study hypothesizes that distress tolerance – assessed via a self-report and a behavioral measure – will vary across groups of college student drinkers, such that individuals who drink heavily alone will have greater levels of distress tolerance than college students who endorse other drinking patterns.
A second set of analyses will examine the ability of both distress tolerance measures to predict alcohol-related consequences in college students. Although there is some evidence that both self-report and behavioral measures of distress tolerance can predict amount of alcohol use, there is less evidence for a direct relationship between such measures and alcohol-related consequences. Furthermore, much of the research seems to suggest an indirect relationship between distress tolerance and alcohol-related consequences, as previous studies have shown that low distress tolerance is related to greater incidence of depression and coping motives, which subsequently predict more drinking consequences. Therefore, specific predictions about a direct relationship between distress tolerance and alcohol-related consequences are tenuous, whereas a mediation model linking distress tolerance, coping motives, and alcohol-related problems is likely to be more robust. This set of analyses will test the hypothesis that greater coping motives will significantly mediate the relationship between low distress tolerance and alcohol-related problems.
Section snippets
Participants
The sample included 134 undergraduates (67.9% women) with an average age of 23.31 (SD = 5.94, range 18–43) from a midsized Western university. Most were Caucasian (74.6%) or Latino/Latina (15.7%). The rest were African-American (N = 5), Asian-American (N = 2), Native American (N = 1), or “other” (N = 5). Two-thirds (68.7%) were single, 28.4% were either married or living in a committed relationship, and four individuals were divorced or separated.
Procedures
College students were recruited from lower-division
Differences across solitary and social drinkers
Students' average distress tolerance scores, number of drinking consequences, estimated amount of drinks consumed in the past three months, and coping motives scores are listed in Table 1. Of the 134 students sampled, 27 (20.1%) endorsed either binge drinking (i.e., 4 or more drinks for women, 5 or more drinks for men) of alcohol either by themselves in a social situation or alone in the past three months. One-way ANOVA revealed a significant difference between solitary and social drinkers with
Discussion
Previous research has demonstrated that young adults who drink to cope with negative affect and who drink heavily alone are more likely than their peers to experience negative drinking consequences (Christiansen et al., 2002, Kuntsche et al., 2005). In addition, distress tolerance has been used to predict negative drinking consequences in college students for nearly a decade, although primarily through indirect means such as coping motives (Howell et al., 2010, Simons and Gaher, 2005). In order
Role of funding sources
This research was supported by Idaho State University (ISU). ISU had no role in the collection, analysis, or interpretation of these data, writing the manuscript, or the decision to submit the paper for publication.
Contributors
Ms. Williams and Dr. Vik designed the study, conducted statistical analyses, and wrote the manuscript. Ms. Williams collected the data with the help of a research assistant. Dr. Wong supervised the final analyses of this data.
Conflict of interest
All authors declare that they have no conflicts of interest.
Acknowledgments
The authors wish to thank Troy Savary for his assistance in data collection. IRB approval was through Idaho State University's Human Subjects Committee.
References (48)
- et al.
Distress tolerance and early smoking lapse
Clinical Psychology Review
(2005) - et al.
Problematic alcohol and cannabis use among young adults: The roles of depression and discomfort and distress tolerance
Addictive Behaviors
(2007) - et al.
College student heavy drinking in social contexts versus alone
Addictive Behaviors
(2002) - et al.
Distress tolerance and early adolescent externalizing and internalizing symptoms: The moderating role of gender and ethnicity
Behavior Research and Therapy
(2009) - et al.
Solitary and social heavy drinking, suicidal ideation, and drinking motives in underage college drinkers
Psychology of Addictive Behaviors
(2009) - et al.
Impulsive action and impulsive choice across substance and behavioral addictions: Cause or consequence?
Addictive Behaviors
(2014) - et al.
Anxiety sensitivity, distress tolerance, and discomfort intolerance in relation to coping and comformity for alcohol use and alcohol use problems among young adult drinkers
Addictive Behaviors
(2010) - et al.
Negative urgency, distress tolerance, and substance abuse among college students
Addictive Behaviors
(2012) - et al.
Why do young people drink? A review of drinking motives
Clinical Psychology Review
(2005) - et al.
Impulsivity and alcohol-use coping motives in a trauma-exposed sample: The mediating role of distress tolerance
Personality and Individual Differences
(2011)
Refining the measurement of distress intolerance
Behavior Therapy
Discomfort intolerance: Development of a construct and measure relevant to panic disorder
Journal of Anxiety Disorders
Personality and alcohol use: The role of impulsivity
Addictive Behaviors
Anxiety sensitivity and alcohol use motives
Journal of Anxiety Disorders
A comprehensive review of the Paced Auditory Serial Addition Test (PASAT)
Archives of Clinical Neuropsychology
Detecting college student binge drinkers using an extended time frame
Addictive Behaviors
Natural reduction of binge drinking among college students
Addictive Behaviors
Trait-based affective processes in alcohol-involved risk behaviors
Addictive Behaviors
Evaluating distress tolerance measures: Interrelations and associations with impulsive behaviors
Cognitive Therapy and Research
Problem drinking among college students: A review of recent research
Journal of the American College of Health
Adolescent alcohol expectancies in relation to personal and parental drinking patterns
Journal of Abnormal Psychology
Psychometric evaluation of the customary drinking and drug use record (CDDR): A measure of adolescent alcohol and drug involvement
Journal of Studies on Alcohol
Motivations for alcohol use among adolescents: Development and validation of a four-factor model
Psychological Assessment
Development and validation of a three-dimensional measure of drinking motives
Psychological Assessment
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