The unique role of drinking to cope in the aetiology of and intervention for alcohol use problems

Abstract

Negative affect has a profound motivational effect on alcohol use problems, but understanding of the underlying mechanisms is incomplete. In this thesis, evidence is reported which supports the claim that the tendency to use alcohol to cope with negative affect is a unique mediator of the risk that both external (socioeconomic deprivation, environmental adversity) and internal adversity (internalising problems, lack of adaptive coping strategies) confer for alcohol use problems. Furthermore, the direct effect of drinking to cope (DTC) on alcohol problems was invariant across genders and countries and could not be explained by level of alcohol consumption, suggesting that another mechanism underpins the universal risk conferred by DTC. A novel finding is that DTC was uniquely associated with bleak expectations regarding future goals, characterised by less positive, vivid, achievable, important and specific goals. The implication is that bleak prospects of hazardous drinkers who drink to cope could play a role in the risk of alcohol problems, and interventions which improve their prospects could potentially be effective in mitigating alcohol use problems. To test this proposal, three small randomised controlled intervention studies investigated whether providing alternative adaptive coping strategies for negative affect would mitigate proxies for alcohol problems. Study one found that a brief training of mindful breath counting attenuated noise stress-induced alcohol-seeking in a lab setting in a general undergraduate sample. The second and third study trained alternative adaptive coping strategies that emphasised visualising future adaptive responses to negative affect in hazardous drinking undergraduates who drink to cope, and these studies demonstrated preliminary effectiveness in improving alcohol-related outcomes at two-week and four-week follow-up in the UK and South African samples respectively. These findings suggest that building resilience to negative affect by training engagement with positive future strategies may mitigate some of the risk of alcohol problems in young adult hazardous drinkers who drink to cope with negative affect.