Researchers have identified alcohol use as a common concern among women who have experienced sexual violence (SV), with important public health implications. Posttraumatic stress disorder (PTSD) symptoms following sexual victimization may contribute to these increased rates of alcohol use. The predominant theoretical explanation for these associations is the self-medication hypothesis, which posits that sexual violence survivors use alcohol in order to cope with the psychological distress associated with acute experiences of PTSD. Despite the temporal, within-person nature of this theory, little attention has been given to daily associations between acute PTSD symptoms, trauma-related drinking to cope, and ensuing alcohol use by SV survivors. Moreover, little research has examined sleep duration as a factor that may play an important role in this process, despite emerging theory suggesting that sleep loss has crucial effects on affective functioning and may exacerbate daily PTSD symptoms. Drawing on these findings, the central hypotheses in the present study are that shorter than usual sleep duration is likely to have a proximal effect on increased PTSD symptoms the next day, and that greater than usual PTSD symptoms will in turn predict increased alcohol use later that day through increased trauma-related drinking to cope motives. In addition, we expect that acute PTSD symptoms and trauma-related drinking to cope may be a serial indirect pathway through which shorter than usual sleep duration leads to increased next-day alcohol consumption among female SV survivors. To test these hypotheses, a sample of 80 community women with a history of sexual violence who are problematic drinkers will complete repeated daily measures of sleep duration, PTSD symptoms, trauma- related drinking to cope, and alcohol use over three weeks using ecological momentary assessment (EMA). Sleep duration each night will be assessed using an integrated measure of actigraphy and self-report; self- reported PTSD symptoms, trauma-related drinking to cope motives and alcohol use will be assessed via cell prompts sent to participants three times a day in the morning, afternoon, and evening. These innovative methodological approaches will permit a prospective examination of dynamic symptom changes to capture daily predictors of increased alcohol use. Findings from this study are expected to clarify key proximal processes that promote acute drinking behaviors among women who have experienced sexual violence. Results may inform the development of effective intervention strategies to reduce drinking to cope among sexual assault survivors and, in turn, help prevent alcohol use and related health consequences in this population.
Increased alcohol use resulting from sexual victimization represents a significant public health problem, often leading to persistent physical and psychological difficulties experienced by female survivors that result in enormous healthcare costs and loss of productivity. Research examining daily predictors of alcohol use that are prevalent among sexual violence survivors can inform the development of effective intervention strategies aimed at identifying and reducing rates of drinking in this population. Consistent with this goal, the current study will examine the proximal role of acute sleep loss, PTSD symptoms, and trauma-related drinking to cope in exacerbating daily alcohol use by women who have experienced sexual violence.
