Worry moderates the relation between negative affectivity and affect-related substance use in adolescent males: a prospective study of maladaptive emotional self-regulation☆
Introduction
It is becoming increasingly apparent that adolescents who are particularly vulnerable to unpleasant emotional states have a heightened likelihood of engaging in a number of unhealthy behaviors. High negative affectivity, defined as strong predisposition to experience states of anger, frustration, sadness, and anxiety (Watson & Clark, 1984), has been associated with dangerous driving, sexual risk-taking, violent offending, and substance use (Caspi et al., 1997; Chassin, Pillow, Curran, Molina, & Barrera, 1993; Krueger, Caspi, Moffitt, Silva, & McGee, 1996; Mezzich et al., 1997; Whalen, Jamner, Henker, & Delfino, 2001). These behaviors may represent habitual maladaptive efforts to dampen or avoid the frequent unpleasant emotional states associated with high negative affectivity. Interestingly, some studies indicate either no direct relation or a marginally significant relation between negative affect and substance use (Clark, Parker, & Lynch, 1999; Hussong, Curran, & Chassin, 1998; Stice & Gonzales, 1998; Swaim, Oetting, Edwards, & Beauvais, 1989). These equivocal findings have spawned a search for characteristics that might identify subgroups of adolescents who are most likely to regulate their emotions through substance use (e.g. Shoal & Giancola, 2003). However, notably absent from this line of investigation are measures of other maladaptive means of regulating negative emotions. If substance use renders a specific pharmacological or cognitive effect that lessens negative affect, then other behaviors that result in a similar effect should be expected to displace drug use in serving this function.
The appraisal-disruption model of alcohol use (Sayette, 1993) describes the effect that may be sought after. According to this model, prior alcohol consumption lessens the degree to which stressful stimuli trigger the activation of similar unpleasant information in the drinker’s long-term memory. In as much as individuals who are high in negative affectivity are most influenced by negative emotion dampening motives for using alcohol or other drugs (Cooper, Frone, Russell, & Mudar, 1995; Sher, 1991), they might be the most likely to identify and regularly strive for this type of preemptive emotional processing disruption. However, if another means of achieving this type of cognitive interference is utilized, adolescents who rely upon this alternative technique might show a weaker relation between negative affectivity and substance use.
According to cognitive theorists, worry may be such a technique. Worry has been defined as repeated mental rehearsal of possible dangers or problems, without arriving at a satisfactory solution or resolution (Mathews, 1990). The relation between worry behavior and anxiety symptoms is small enough to suggest that measures of anxiety and worry do not reflect the same experience (Segerstrom, Tsao, Alden, & Craske, 2000). Furthermore, individuals with similar levels of overall negative affectivity appear to vary substantially in worry behavior (Barlow, 1988). It has been proposed that chronic worriers may utilize this behavior as a means of controlling negative affect by substituting verbal activity for emotionally and physiologically arousing images (Borkovec & Inz, 1990; Roemer & Borkovec, 1993). Thus, in contrast to the common belief that worry is entirely unpleasant, worriers may actually achieve some degree of avoidance of aversive imagery by focusing on verbal reasoning and thinking in abstract terms (Borkovec, Ray, & Stoeber, 1998). As a result, worry is capable of inhibiting emotional processing and lessening constructive coping with negative affect (Mathews, 1990).
To the extent that worry prevents complete activation of fear structures in memory (Brown, 1997) it functions similarly to alcohol use according to Sayette’s (1993) model. These models suggest that both activities are proactive avoidance behaviors that function to inhibit immediate and unpleasant emotional processing. Furthermore, while they may serve this function, both substance use (Tiffany, 1990) and worry (Roemer & Borkovec, 1993) are often perceived by the individual as automatic and largely uncontrollable. Given these similarities, adolescents who habitually achieve inhibition of emotional processing through worry may be less prone than non-worriers to rely upon substance use for that purpose.
The present study utilized a longitudinal design to examine the relations between negative affectivity, worry, fearfulness, and affect-related substance use in adolescent boys. Fearfulness must be assessed to address the alternative hypothesis that high worriers are simply characterized by a fearful inhibition toward drug use or other risky behavior. Thus, within this model, negative affectivity conceptually differs from worry in that negative affectivity describes overall proneness to unpleasant emotional states, while worry describes a particular cognitive behavior aimed at avoiding these states. In turn, fearfulness represents a very specific aspect of negative affectivity that might actually lessen the likelihood of substance use. Given these conceptual distinctions, it was hypothesized that negative affectivity, worry, and fearfulness will be significantly correlated but largely independent of one another. Regarding the central aim of the present study, it was hypothesized that individuals who are low in worry will show a stronger relation between general negative affectivity and affect-related substance use than will individuals who are high in worry. This effect is expected even with a measure of fearfulness included in the model to account for the possibility that worry’s effect can be accounted for by fear of the consequences of drug use.
Section snippets
Participants
The participants in this study were boys who were tested during the first and third assessment waves of a prospective investigation at the Center for Education and Drug Abuse Research (CEDAR) in Pittsburgh, PA. The CEDAR project is an ongoing 20-year study aimed at determining the etiology of substance use disorders. Families were recruited from the greater Pittsburgh area from SUD treatment programs, psychiatric clinics and other research projects at the University of Pittsburgh, and through
Data reduction
The 8 worry items were summed to generate a worry scale on which higher scores indicated greater tendency to worry (α=0.73). The parent and teacher report worry items significantly correlated with the remaining worry scale score at r=0.28 and 0.22, respectively, suggesting that utilizing other reporters did not detract substantially from the internal consistency of the scale. The items from the three T1 measures of negative affectivity were submitted to an exploratory factor analysis using the
Discussion
In light of worry’s similarity to habitual reliance upon alcohol as a means of limiting unpleasant emotional experiences, it was hypothesized that it might displace substance use as a means of coping with high negative affectivity. Preliminary analyses indicated that negative affectivity, worry, and fearfulness were all relatively stable from time one to time two. They also indicated that while overall negative affectivity and worry were related, they represented significantly different
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This research was conducted at the Center for Education and Drug Abuse Research (CEDAR), which is located in the School of Pharmaceutical Sciences at the University of Pittsburgh and supported by grant P50-DA-05605-14 from the National Institute on Drug Abuse.