URI study aims to improve understanding of alcohol use disorder among individuals with PTSD

Drinking alcoholic beverages is often associated with celebration, and seen as a way to enhance positive emotions felt from an achievement, or a gathering or friends. However, for those experiencing post-traumatic stress disorder, alcohol may also be used to dampen not just negative feelings, but positive emotions as well, and to escape from experiencing strong feelings altogether.

Understanding why people drink alcohol is key to treating alcohol use disorder, which affects a staggering number of people with PTSD, according to University of Rhode Island psychology Professor Nicole Weiss, whose new study aims to broaden the understanding of reasons for drinking among those who have experienced trauma. Funded by a $500,000 grant from the National Institutes of Health, Weiss hopes that findings of her study will improve treatment outcomes for people with PTSD experiencing alcohol use disorder.

“We tend to see positive emotional experiences as desirable, something that can make us more resilient to everyday stressors,” Weiss said. “While research suggests this is true for most, our early evidence with people with PTSD suggests a more complex picture. We have found that individuals with PTSD are less accepting of positive emotions, judging them to be undesirable, unpredictable, and, at times, frightening.”

This can be a problem because nearly all psychological interventions assume that positive emotions lead to favorable outcomes, and thus aim to indiscriminately increase individuals’ positive emotional experiences, Weiss said. “If our earlier research findings are replicated in this study, the implication may be that interventions for alcohol use among individuals with PTSD may benefit from first assessing individuals’ reactions to positive emotions and, as indicated, addressing nonaccepting responses to positive emotions,” she said.

People experiencing PTSD have been shown to experience aversive reactions to positive emotions and to use alcohol to dampen these emotional experiences. The arousal some positive emotions elicit, including increased heart rate, faster breathing, and sweating associated with intense positive emotions such as excitement, may serve as a trigger for PTSD symptoms among individuals with a history of trauma, which is similarly characterized by marked physiological reactions that cause intense distress, Weiss said. She has also found that some individuals with PTSD experience competing negative emotions in the context of positive emotional experiences. For instance, they report feeling like they do not deserve to feel happy or are uncomfortable with positive emotions.

“We have found that individuals with PTSD sometimes turn to alcohol to manage the discomfort associated with positive emotions,” Weiss said, noting research converges to show that individuals may use alcohol to dampen emotional experiences. “However, while alcohol can temporarily reduce feelings of discomfort, its long-term effects are deleterious. Alcohol use can quickly become problematic and lead to alcohol use disorder. By better understanding the relationships between positive emotions and alcohol use among individuals with PTSD, we can intercept these processes before they occur.”

Weiss is recruiting 150 people in the Providence area who use alcohol and have experienced trauma in the past, about half of whom will have a PTSD diagnosis. After meeting with staff in Weiss’ lab, study participants will complete a survey in an app on their phones five times a day, answering questions about their PTSD symptoms, their emotions, and their alcohol use. They’ll also complete a survey whenever they begin drinking alcohol. After 30 days, participants will visit Weiss’ lab in Providence for a final in-person interview to share their reasons for using alcohol over that time.

“That data will help us identify people’s experiences immediately before and after they use alcohol, ultimately improving our understanding of why people with PTSD are using alcohol,” Weiss said. “We will use this information to improve alcohol treatment for people with PTSD.”

Research reported in this publication was supported by the National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health under Award Number R21AA030686. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.