Problematic alcohol use, trauma history, and PTSD symptom level: A path analysis
Open accessAbstract
Objective: This study examined associations between multidimensional experiential avoidance, alcohol use motives, alcohol use, and alcohol-related consequences among individuals with a history of trauma and varying levels of posttraumatic stress disorder (PTSD) symptoms. Methods: A total of 459 college students completed measures online, and the analysis sample was limited to the 313 participants who reported a past Criterion A traumatic event. These participants were separated into two groups based on DSM-IV TR diagnostic criteria: those with a high level of PTSD symptomatology (n = 34) and those with a low level of PTSD symptomatology (n = 279). A multi-group path model examined associations between experiential avoidance, drinking motives, alcohol use, and alcohol problems across these two groups. Results: The majority of participants were female (n = 192, 61.3%) and Caucasian (n = 281, 89.8%) and had a mean age of 19.37 (SD = 2.04). Two unique pathways to alcohol-related problems were observed. Among those with a high level of PTSD symptomatology, distress endurance (ability to behave effectively when under distress) was inversely associated with alcohol-related consequences via alcohol motives and use. For those with a low level of PTSD symptomatology, distress aversion (negative attitudes about, or lack of acceptance of, distress) was positively associated with alcohol-related consequences via alcohol motives and use. Conclusions: Results suggest unique pathways to alcohol consequences as a function of trauma symptom severity and may explain some of the comorbidity between PTSD and alcohol use disorders. Multidimensional indices of experiential avoidance may shed light on risk and resilience factors in PTSD.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Multidimensional components of EA explained the relationship between comorbid PTSD and alcohol use disorders.
“Another research group found that multidimensional components of EA explained the relationship between comorbid PTSD and alcohol use disorders [9].”
From Measuring Experiential Avoidance: Evidence toward Multidimensional Predictors of Trauma Sequelae (2017) · cites this paper as [9]
Cites
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005) · Archives of General Psychiatry · doi:10.1001/archpsyc.62.6.593 · Cited by 20,391 · see citing works
SAUNDERS, J. B., AASLAND, O. G., BABOR, T. F., DE LA FUENTE, J. R., & GRANT, M. (1993) · Addiction · doi:10.1111/j.1360-0443.1993.tb02093.x · Cited by 13,482 · see citing works
Posttraumatic Stress Disorder in the National Comorbidity Survey
Kessler, R. C. (1995) · Archives of General Psychiatry · doi:10.1001/archpsyc.1995.03950240066012 · Cited by 10,379 · see citing works
Psychometric properties of the PTSD checklist (PCL)
Blanchard, E. B., Jones-Alexander, J., Buckley, T. C., & Forneris, C. A. (1996) · Behaviour Research and Therapy · doi:10.1016/0005-7967(96)00033-2 · Cited by 3,997 · see citing works
Hayes, S. C., Wilson, K. G., Gifford, E. V., Follette, V. M., & Strosahl, K. (1996) · Journal of Consulting and Clinical Psychology · doi:10.1037//0022-006x.64.6.1152 · Cited by 3,595 · see citing works
Motivations for alcohol use among adolescents: Development and validation of a four-factor model.
Cooper, M. L. (1994) · Psychological Assessment · doi:10.1037/1040-3590.6.2.117 · Cited by 2,399 · see citing works
Addiction motivation reformulated: an affective processing model of negative reinforcement
Baker, T. B., Piper, M. E., McCarthy, D. E., Majeskie, M. R., & Fiore, M. C. (2004) · Psychological Review · doi:10.1037/0033-295x.111.1.33 · Cited by 2,162 · see citing works
Measuring experiential avoidance: A preliminary test of a working model
Hayes, S. C., Strosahl, K., Wilson, K. G., Bissett, R. T., Pistorello, J., Toarmino, D., Polusny, M. A., Dykstra, T. A., Batten, S. V., Bergan, J., et al. (2004) · The Psychological Record · doi:10.1007/bf03395492 · Cited by 2,140 · see citing works
LISREL Approaches to Interaction Effects in Multiple Regression
Jaccard, J. J., & Wan, C. K. (1996) · Sage eBooks · doi:10.4135/9781412984782 · Cited by 890 · see citing works
Stress and alcohol use: Moderating effects of gender, coping, and alcohol expectancies.
Cooper, M. L., Russell, M., Skinner, J. B., Frone, M. R., & Mudar, P. (1992) · Journal of Abnormal Psychology · doi:10.1037/0021-843x.101.1.139 · Cited by 817 · see citing works
Stress and alcohol use: Moderating effects of gender, coping, and alcohol expectancies.
Cooper, M. L., Russell, M., Skinner, J. B., Frone, M. R., & al, E. (1992) · Journal of Abnormal Psychology · doi:10.1037//0021-843x.101.1.139 · Cited by 816 · see citing works
Experiential avoidance as a functional dimensional approach to psychopathology: An empirical review
Chawla, N., & Ostafin, B. (2007) · Journal of Clinical Psychology · doi:10.1002/jclp.20400 · Cited by 805 · cited 1× · see citing works
“Experiential avoidance refers to avoidance of the experience of negative affective states (Chawla & Ostafin, 2007; Hayes, Wilson, Gifford, Follette, & Strosahl, 1996).”
BackgroundThe stressor criterion in DSM-IV posttraumatic stress disorder: an empirical investigation
Breslau, N., & Kessler, R. C. (2001) · Biological Psychiatry · doi:10.1016/s0006-3223(01)01167-2 · Cited by 526 · see citing works
Gámez, W., Chmielewski, M., Kotov, R., Ruggero, C., & Watson, D. (2011) · Psychological Assessment · doi:10.1037/a0023242 · Cited by 524 · see citing works
Foa, E. B., Riggs, D. S., Massie, E. D., & Yarczower, M. (1995) · Behavior Therapy · doi:10.1016/s0005-7894(05)80096-6 · Cited by 496 · see citing works
Examining the role of drinking motives in college student alcohol use and problems
Read, J. P., Wood, M. D., Kahler, C. W., Maddock, J. E., & Palfai, T. P. (2003) · Psychology of Addictive Behaviors · doi:10.1037/0893-164x.17.1.13 · Cited by 384 · see citing works
Leeies, M., Pagura, J., Sareen, J., & Bolton, J. M. (2010) · Depression and Anxiety · doi:10.1002/da.20677 · Cited by 300 · see citing works
Tull, M. T., Gratz, K. L., Salters, K., & Roemer, L. (2004) · Journal of Nervous & Mental Disease · doi:10.1097/01.nmd.0000144694.30121.89 · Cited by 298 · see citing works
Substance use and posttraumatic stress disorders: Symptom interplay and effects on outcome
Read, J. P., Brown, P. J., & Kahler, C. W. (2004) · Addictive Behaviors · doi:10.1016/j.addbeh.2004.02.061 · Cited by 273 · see citing works
Domestic violence and alcohol use: Trauma-related symptoms and motives for drinking
Kaysen, D. L., Dillworth, T. M., Simpson, T. L., Waldrop, A. E., Larimer, M. E., & Resick, P. A. (2006) · Addictive Behaviors · doi:10.1016/j.addbeh.2006.09.007 · Cited by 273 · see citing works
Understanding comorbidity between ptsd and substance use disorders: Two preliminary investigations
Saladin, M. E., Brady, K. T., Dansky, B. S., & Kilpatrick, D. G. (1995) · Addictive Behaviors · doi:10.1016/0306-4603(95)00024-7 · Cited by 271 · see citing works
Optimizing the use of the AUDIT for alcohol screening in college students.
DeMartini, K. S., & Carey, K. B. (2012) · Psychological Assessment · doi:10.1037/a0028519 · Cited by 240 · see citing works
LISREL analyses of interaction effects in multiple regression
Jaccard, J. J., & Wan, W. (1996) · Cited by 235 · see citing works
Stewart, S. H., Zvolensky, M. J., & Eifert, G. H. (2002) · Behavior Modification · doi:10.1177/0145445502026002007 · Cited by 205 · see citing works
Approach and avoidance coping responses among older problem and nonproblem drinkers.
Moos, R. H., Brennan, P. L., Fondacaro, M. R., & Moos, B. S. (1990) · Psychology and Aging · doi:10.1037//0882-7974.5.1.31 · Cited by 195 · see citing works
Read, J. P., Colder, C. R., Merrill, J. E., Ouimette, P. C., White, J. W., & Swartout, A. G. (2012) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0028210 · Cited by 189 · see citing works
The role of emotion in the psychological functioning of adult survivors of childhood sexual abuse
Marx, B. P., & Sloan, D. M. (2002) · Behavior Therapy · doi:10.1016/s0005-7894(02)80017-x · Cited by 184 · see citing works
Motives to drink as mediators between childhood sexual assault and alcohol problems in adult women
Grayson, C. E., & Nolen–Hoeksema, S. (2005) · Journal of Traumatic Stress · doi:10.1002/jts.20021 · Cited by 182 · see citing works
Marshall‐Berenz, E. C., Vujanovic, A. A., Bonn‐Miller, M. O., Bernstein, A., & Zvolensky, M. J. (2010) · Journal of Traumatic Stress · doi:10.1002/jts.20568 · Cited by 158 · cited 1× · see citing works
“Lower distress tolerance has been related to PTSD symptom severity and to a subtype of symptom severity, avoidance (Marshall-Berenz et al., 2010; Vujanovic, Bonn-Miller et al., 2011).”
BackgroundApproach and avoidance coping responses among older problem and nonproblem drinkers.
Moos, R. H., Brennan, P. L., Fondacaro, M. R., et al. (1990) · Psychology and Aging · doi:10.1037/0882-7974.5.1.31 · Cited by 141 · see citing works
Stewart, S. H., Mitchell, T., Wright, K. D., & Loba, P. (2003) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2003.07.006 · Cited by 139 · see citing works
Personality factors and alcohol use: A mediator analysis of drinking motives
Kuntsche, E. N., von Fischer, M., & Gmel, G. E. (2008) · Personality and Individual Differences · doi:10.1016/j.paid.2008.08.009 · Cited by 138 · see citing works
Vujanovic, A. A., Bonn-Miller, M. O., Potter, C. M., Marshall, E. C., & Zvolensky, M. J. (2011) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-010-9209-2 · Cited by 134 · see citing works
Lehavot, K., Stappenbeck, C. A., Luterek, J. A., Kaysen, D. L., & Simpson, T. L. (2013) · Psychology of Addictive Behaviors · doi:10.1037/a0032266 · Cited by 130 · see citing works
Levin, M. E., Lillis, J., Seeley, J., Hayes, S. C., Pistorello, J., & Biglan, A. (2012) · Journal of American College Health · doi:10.1080/07448481.2012.673522 · Cited by 113 · cited 2× · see citing works
“…& Moos, 1990), heavy or abusive drinking in adult males (Cooper, Russell, Skinner, Frone, & Mudar, 1992), alcohol abuse and dependence within college students (Levin et al., 2012), and greater alcohol consumption and alcohol-related problems among adolescents (Laurent, Catanzaro, & Callan, 1997).”
BackgroundTreatment of Co-occurring Posttraumatic Stress Disorder and Substance Use Disorders
Berenz, E. C., & Coffey, S. F. (2012) · Current Psychiatry Reports · doi:10.1007/s11920-012-0300-0 · Cited by 107 · see citing works
Marshall-Berenz, E. C., Vujanovic, A. A., & MacPherson, L. (2011) · Personality and Individual Differences · doi:10.1016/j.paid.2010.11.033 · Cited by 104 · see citing works
Dixon, L. J., Leen‐Feldner, E. W., Ham, L. S., Feldner, M. T., & Lewis, S. F. (2009) · Addictive Behaviors · doi:10.1016/j.addbeh.2009.06.008 · Cited by 98 · see citing works
Laurent, J., Catanzaro, S. J., & Callan, M. K. (1997) · Journal of Studies on Alcohol · doi:10.15288/jsa.1997.58.644 · Cited by 84 · see citing works
Amygdala involvement in human avoidance, escape and approach behavior
Schlund, M. W., & Cataldo, M. F. (2010) · NeuroImage · doi:10.1016/j.neuroimage.2010.06.058 · Cited by 81 · see citing works
Fossos, N., Kaysen, D. L., Neighbors, C., Lindgren, K. P., & Hove, M. C. (2011) · Addictive Behaviors · doi:10.1016/j.addbeh.2011.06.001 · Cited by 69 · see citing works
Mellman, T. A., Alim, T. N., Brown, D. D., Gorodetsky, E. K., Búzás, B., Lawson, W. B., Goldman, D. A., & Charney, D. S. (2009) · Depression and Anxiety · doi:10.1002/da.20627 · Cited by 66 · see citing works
Baseline functioning among individuals with posttraumatic stress disorder and alcohol dependence
Drapkin, M. L., Yusko, D. A., Yasinski, C. W., Oslin, D. W., Hembree, E. A., & Foa, E. B. (2011) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2011.02.012 · Cited by 63 · see citing works
Waldrop, A. E., Santa Ana, E. J., Saladin, M. E., McRae, A. L., & Brady, K. T. (2007) · The American Journal on Addictions · doi:10.1080/10550490701643484 · Cited by 62 · see citing works
Biobehavioral Stress Response: Protective And Damaging Effects
Yehuda, R., & McEwen, B. S. (2004) · Medical Entomology and Zoology · Cited by 59 · see citing works
Posttraumatic Stress and Alcohol Use Motives
Vujanovic, A. A., Marshall‐Berenz, E. C., & Zvolensky, M. J. (2011) · Journal of Cognitive Psychotherapy · doi:10.1891/0889-8391.25.2.130 · Cited by 58 · see citing works
O’Hare, T., & Sherrer, M. V. (2011) · Addictive Behaviors · doi:10.1016/j.addbeh.2011.01.006 · Cited by 56 · see citing works
Harvey, B. H., Naciti, C., Brand, L., & Stein, D. J. (2004) · Annals of the New York Academy of Sciences · doi:10.1196/annals.1314.035 · Cited by 53 · see citing works
Yeater, E. A., Austin, J. L., Green, M. J., & Smith, J. E. (2010) · Psychological Trauma Theory Research Practice and Policy · doi:10.1037/a0021779 · Cited by 50 · see citing works
Merwin, R. M., Rosenthal, M. Z., & Coffey, K. A. (2008) · Cognitive Therapy and Research · doi:10.1007/s10608-008-9225-7 · Cited by 50 · see citing works
Corchs, F., Nutt, D., Hood, S. D., & Bernik, M. (2009) · Biological Psychiatry · doi:10.1016/j.biopsych.2009.01.031 · Cited by 46 · see citing works
O’Hare, T., Shen, C., & Sherrer, M. V. (2010) · Journal of Traumatic Stress · doi:10.1002/jts.20515 · Cited by 44 · see citing works
dos Santos, L., de Andrade, T. G. C. S., & Zangrossi, H. (2004) · Psychopharmacology · doi:10.1007/s00213-004-2120-3 · Cited by 43 · see citing works
The Enduring Influence of Drinking Motives on Alcohol Consumption After Fateful Trauma
Beseler, C. L., Aharonovich, E., & Hasin, D. S. (2011) · Alcoholism Clinical and Experimental Research · doi:10.1111/j.1530-0277.2010.01431.x · Cited by 38 · see citing works
Maack, D. J., Tull, M. T., & Gratz, K. L. (2011) · Cognitive Therapy and Research · doi:10.1007/s10608-011-9362-2 · Cited by 37 · see citing works
Correlates of Post-Traumatic Stress Disorder in Male and Female Community Clients
O’Hare, T., Sherrer, M. V., Yeamen, D., & Cutler, J. (2009) · Social Work in Mental Health · doi:10.1080/15332980802052373 · Cited by 32 · see citing works
Correlates of Comorbid PTSD and Polysubstance Use in Sexual Assault Victims
Ullman, S. E., Townsend, S. M., Starzynski, L. L., & Long, L. (2006) · Violence and Victims · doi:10.1891/0886-6708.21.6.725 · Cited by 31 · see citing works
Correlates of Comorbid PTSD and Polysubstance Use in Sexual Assault Victims
Ullman, S. E., Townsend, S. M., Starzynski, L. L., et al. (2006) · Violence and Victims · doi:10.1891/vv-v21i6a004 · Cited by 7 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
The structure of common emotion regulation strategies: A meta-analytic examination
Naragon-Gainey, K., McMahon, T. P., & Chacko, T. P. (2017) · Psychological Bulletin · doi:10.1037/bul0000093 · Cited by 588 · see citing works
Vicarious Trauma and Vicarious Posttraumatic Growth among Substance Abuse Treatment Providers
Cosden, M., Sanford, A., Koch, L. M., & Lepore, C. E. (2016) · Substance Abuse · doi:10.1080/08897077.2016.1181695 · Cited by 50 · see citing works
Nickerson, A., Barnes, J. B., Creamer, M. C., Forbes, D., McFARLANE, A. C., O'Donnell, M. L., Silove, D. M., Steel, Z., & Bryant, R. A. (2014) · Journal of Abnormal Psychology · doi:10.1037/a0037920 · Cited by 33 · see citing works
Ouden, L. D., Tiego, J., Lee, R. S. C., Albertella, L., Greenwood, L., Fontenelle, L. F., Yücel, M., & Segrave, R. A. (2020) · Addictive Behaviors · doi:10.1016/j.addbeh.2020.106464 · Cited by 32 · see citing works
The Health Belief Model in the Context of Alcohol Protective Behavioral Strategies
Leon, A. N. D., Peterson, R. S., Dvorak, R. D., Leary, A. V., Kramer, M. P., Burr, E. K., Toth, E., & Pinto, D. A. (2022) · Psychiatry · doi:10.1080/00332747.2022.2114270 · Cited by 26 · see citing works
Self-citationFeingold, D., & Zerach, G. (2020) · Addictive Behaviors · doi:10.1016/j.addbeh.2020.106776 · Cited by 20 · see citing works
Measuring Experiential Avoidance: Evidence toward Multidimensional Predictors of Trauma Sequelae
Lewis, M., & Naugle, A. (2017) · Behavioral Sciences · doi:10.3390/bs7010009 · Cited by 20 · see citing works
“However, these findings are consistent with another study that identified individual subscales of the MEAQ as predictors of PTSD symptomatology in a college sample [9].”
BackgroundResultInfluentialTuliao, A. P., Jaffe, A. E., & McChargue, D. E. (2016) · Journal of Dual Diagnosis · doi:10.1080/15504263.2016.1146382 · Cited by 20 · see citing works
Read, J. P., Radomski, S. A., & Borsari, B. E. (2015) · Current Addiction Reports · doi:10.1007/s40429-015-0044-0 · Cited by 15 · see citing works
The Effects of Childhood Sexual Abuse and Other Trauma on Drug Court Participants
Wolf, M. R., Nochajski, T. H., & Farrell, H. M. G. (2015) · Journal of Social Work Practice in the Addictions · doi:10.1080/1533256x.2014.996228 · Cited by 14 · see citing works
Bitsoih, J., Patock‐Peckham, J. A., Canning, J. R., Ong, A., Becerra, A., & Broussard, M. L. (2023) · Behavioral Sciences · doi:10.3390/bs13030197 · Cited by 9 · see citing works
PTSD-SUD Comorbidities in the Context of Psychological Injury and Law
Young, G. C., & Wang, J. X. (2015) · Psychological Injury and Law · doi:10.1007/s12207-015-9229-z · Cited by 3 · see citing works
Mapping affective pathways to compulsion: Insights from an aversive devaluation approach
Sallie, S. N., Casero, V., Sonkusare, S., & Voon, V. (2025) · Journal of Behavioral Addictions · doi:10.1556/2006.2025.00089 · Cited by 1 · see citing works
Trim, E. E. (2015) · Cited by 1 · see citing works
Lewis, M. M., Naugle, A. E., DiBacco, T. A., Katte, K., Smith, C. A., & Blematl, A. R. (2022) · Current Psychology · doi:10.1007/s12144-022-03447-7
Basting, E. J., Frost-Helms, C. V., Medenblik, A. M., Garner, A. R., Jensen, M. C., Sullivan, J. A., Shorey, R. C., & Stuart, G. L. (2024) · Sexual and Gender Diversity in Social Services · doi:10.1080/29933021.2024.2433476
Childhood trauma, complex PTSD, and severity of online sports betting in French bettors
d’Agostino, M., Tessier, S., Zerhouni, O., & Romo, L. (2025) · European Journal of Trauma & Dissociation · doi:10.1016/j.ejtd.2025.100602
Karthik, R. K., Haney‐Caron, E., & Allwood, M. A. (2025) · Substance Use & Misuse · doi:10.1080/10826084.2025.2575437
Morrow, A., Rubin, M., Niles, A. N., Tripp, P., Satre, D. D., Woolley, J. D., O’Donovan, A., & Nishimi, K. M. (2026) · Cognitive Therapy and Research · doi:10.1007/s10608-026-10751-0
Anoje, C., James, B. O., & Ebiti, N. W. (2026) · Advances in Dual Diagnosis · doi:10.1108/add-08-2025-0043
- Authors
- Dvorak, R. D., Arens, A. M., Kuvaas, N. J., Williams, T. J., & Kilwein, T. M.
- Affiliations
- North Dakota State University (US)
- University of Central Florida (US)
- Venue
- Journal of Dual Diagnosis
- Publisher
- Informa UK Limited
- Published
- 2013-11
- Volume
- 9
- Issue
- 4
- Pages
- 281-291
- ISSN
- 1550-4263 (ISSN-L)
- 1550-4271
- OpenAlex
- W2006797060
- Cited by
- 22
- References
- 55
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 1 · 2023: 1 · 2022: 2 · 2020: 2 · 2019: 1 · 2018: 1 · 2017: 2 · 2016: 2 · 2015: 4 · 2014: 1
- FWCI
- 2.60
- Type
- journal article
- Language
- en
- Open access
- Locations
- Journal of Dual Diagnosis (publishedVersion)
- Journal of International Crisis and Risk Communication Research (submittedVersion)
- Funders
- McGill University
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- alcohol abuse, post-traumatic stress disorder, trauma history, experiential avoidance, drinking motives, alcohol-related consequences, PTSD symptom severity, university students, resilience
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review