Posttraumatic stress disorder (PTSD) is one of the most frequently co-occurring disorders among people seeking treatment for alcohol use disorders (AUD; Dansky et al., 1997; Reynolds et al., 2005). Unfortunately, substance users with PTSD improve less in standard addictions treatment programs and relapse more quickly upon discharge (e.g., Brown et al., 1996; Ouimette et al., 1999). Understanding the mechanisms through which PTSD contributes to poorer AUD outcomes is an important step towards improving treatment for these individuals (Stewart et al., 1998). In the present work, we aim to investigate the applicability of a robust social psychological model of self-control to PTSD-AUD. Specifically; over 100 studies have demonstrated that engaging in effortful self-control impairs ability to perform subsequent acts of self-regulation, even in seemingly unrelated domains (Hagger et al., 2010). Depletion models of self-control (Baumeister et al., 1998) theorize that this occurs because self-control behaviors tap a shared and limited regulatory resource. Consequently, self-control efforts in one domain (e.g., regulating emotion) deplete cognitive resources available towards other demands (e.g., behavioral inhibition). This model has not yet been extended to understanding PTSD-AUD, but it suggests a novel mechanism whereby efforts to avoid trauma-related thoughts and emotion (a key characteristic of PTSD) may deplete self-control resources and reduce capacity to resist subsequent alcohol cravings. Intriguingly, several techniques (e.g., positive mood induction, glucose administration) have been shown to 'reset' self-control resources in nonclinical samples (e.g., Tice et al., 2007; Gailliot et al., 207). Thus, in addition to improving understanding of PTSD-AUD, this work may also open the door to a number of innovative treatment advancements (e.g., applying regulatory restorative techniques to reduce likelihood of relapse in AUD patients with PTSD). The purpose of the present study is to examine the applicability of self- control models to PTSD-AUD comorbidity using a unique blend of methodologies from both the cue-reactivity and social psychology literatures. Our overall aims are to examine 1) the extent to which suppression of trauma-related emotion acts to 'deplete' subsequent self-control ability, 2) whether a common restorative factor (glucose) bolsters self-control in this population and 3) relevance to alcohol cue-elicited craving and physiological reactivity (e.g., salivation, heart rate, heart rate variability, electrodermal response). Towards these aims, recently abstinent individuals with PTSD-AUD will participate in a controlled laboratory experiment designed to test the effects of a) suppressing trauma-elicited distress and b) consuming glucose on behavioral inhibition tasks commonly used to index depletion in social psychology research and on alcohol-cue elicited craving and psychophysiological reactivity. Results are expected to support a new conceptualization of PTSD- AUD comorbidity and to lay the groundwork for a series of studies exploring the model's full scope and clinical implications.
Posttraumatic stress disorder (PTSD) is one of the most frequently co-occurring disorders among people seeking treatment for alcohol use disorders (AUD) and unfortunately, is associated with poorer physical and mental health outcomes, higher healthcare costs and greater relapse rates. In the current application, a laboratory-based study of individuals with PTSD-AUD is proposed to assess whether a well-supported social psychological model of self- control can shed new light on the mechanisms through which PTSD may contribute to poorer AUD outcomes. Results are expected to support a new conceptualization of PTSD-AUD and to lay the groundwork for investigating how self-control models can improve public health and treatment outcomes.
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