Category: Addictive Behaviors
Poor distress tolerance, alcohol craving and mild Traumatic Brain Injury (mTBI) have been independently studied as predictors of alcohol use. We simultaneously examined the associations of these three predictors on alcohol use in Veterans entering randomized clinical trials (RCTs) of topiramate treatment for alcohol use disorder at the San Francisco Veterans Affairs Medical Center.
Participants were assessed for mTBI (Neurobehavioral Symptom Inventory; clinician-administered TBI evaluation), alcohol craving (Obsessive Compulsive Drinking Scale, OCDS), distress tolerance (Distress Tolerance Scale, DTS), and alcohol consumption (Timeline Followback). Multiple 3-step, hierarchical regression models were conducted to determine the extent to which measures of craving, mTBI, and distress tolerance explained the variance in number of standard alcoholic drinks consumed (DC) in the week prior to enrollment. OCDS total was entered at step 1. NSI scores, time since last mTBI, and count of mTBIs were entered at Step 2, and DTS total at Step 3. Variables were trimmed from the model when not significantly related to DC.
OCDS total accounted for 12% of the variance in DC at Step 1, F(1,54)=8.2, p < .01. Adding mTBI count at Step 2, explained an additional 6% of the variance in DC, F(2,53)=4.2, p=.05. DTS total explained an additional 10% of the variance at Step 3, F(3,52)=7.4, p < .01. DTS total score was positively associated with DC (rr=.27, p=.02). In follow-up analyses we re-ran our 3-step model including individual subscales of OCDS and DTS and trimmed subscales when not significantly related to DC. In Step 1 of our follow-up model, OCDS Compulsive subscale accounted for 20% of the variance in DC, F(1, 54)=13.65, p < .01. In Step 2, mTBI count explained an additional 6% of the variance in DC, F(2, 53)=4.22, p < .05. In Step 3, DTS tolerance, appraisal , and regulation explained an additional 16% of the variance in DC, F(5, 50)=7.32, p < .01.
Number of mTBIs and distress tolerance predicted alcohol use even after accounting for alcohol craving in Veterans entering RCTs for topiramate treatment. Alcohol-related craving was associated with increased drinking. Surprisingly, lower count of mTBIs and better distress tolerance were associated with increased alcohol use. This study did not consider a number of potential mediating variables which could have impacted the relationship between mTBI, distress tolerance and alcohol use. Variables include degree of cognitive dysfunction, financial means to buy alcohol, and degree of current stress. Replication and further research in this area is warranted as it could impact treatment outcome in RCTs of topiramate treatment.
Alexander Kinzler– Research Coordinator, San Francisco VA Medical Center / UCSF, San Francisco, California
David Pennington– San Francisco VA Medical Center / UCSF
Jennifer Bielenberg– San Francisco VA Medical Center / UCSF
Jennifer Dack– San Francisco VA Medical Center / UCSF
Lamisha Muquit– San Francisco VA Medical Center / UCSF
Melissa O'Donnell– San Francisco VA Medical Center / UCSF
Edith Harris– San Francisco VA Medical Center / UCSF
Fleurette Fong– San Francisco VA Medical Center / UCSF
Brooke Lasher– San Francisco VA Medical Center / UCSF
Ellen Herbst– San Francisco VA Medical Center / UCSF
Steven Batki– San Francisco VA Medical Center / UCSF
San Francisco VA Medical Center / UCSF
San Francisco, California