Women who have experienced rape are more likely to engage in heavy alcohol use and condom nonuse. In this secondary analysis, we examined whether rape history moderated the effects of Retraining Alcohol and Condom Tendencies, a brief integrated approach bias modification intervention for reducing alcohol use and increasing condom use. Sixty women between 18 and 24 (M = 19.88, SD = 1.50) reporting heavy alcohol use and unprotected sex with casual partners were randomly assigned to a training condition (n = 31; 42% experienced rape) or a sham-control condition (n = 29; 34% experienced rape). Participants in the training condition were trained to make avoidance movements away from alcohol stimuli and approach movements toward condom stimuli over four training sessions. Among women who experienced rape, there were large effects between treatment and control conditions on all outcomes (alcohol use dpp2 = -0.87, condom use dpp2 = 0.63, and negative condom attitudes dpp2 = -1.02). Significant Time × Condition interactions were found for alcohol approach bias, condom approach bias, and condom use, with women in the training condition showing reduced alcohol approach bias, increased condom approach bias, increased condom use, and improved condom attitudes relative to controls (ps < .05). A significant three-way interaction (Time × Condition × Rape History) indicated that women with a history of rape in the treatment condition exhibited the largest reductions in alcohol consumption. Effects on condom use and attitudes did not differ by rape history. Retraining Alcohol and Condom Tendencies effectively reduced alcohol use and improved condom use behaviors among high-risk college women, with particularly strong effects on alcohol use for women with a history of rape. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Objective: To examine associations between post-traumatic stress symptoms (PTSS), impulsivity, drinking motives, and alcohol outcomes among college women who experienced adult sexual violence. Participants: 122 college women from a large southeastern university, predominantly White (90.2%), ages 18-24, reporting adult sexual violence and weekly alcohol consumption. Methods: Participants completed validated measures assessing PTSS, positive and negative urgency, coping and enhancement drinking motives, alcohol use, and alcohol consequences. Path analysis tested direct and indirect associations among these variables. Results: PTSS had significant direct effects on negative urgency and coping motives, and indirect effects on alcohol consequences via these variables. Positive urgency had a significant effect on enhancement motives, which subsequently was significantly associated with alcohol outcomes. Standardized coefficients ranged from β = .22 to .47 across significant pathways, indicating moderate effect sizes. Coping motives, unexpectedly, correlated negatively with alcohol use but positively with consequences. Conclusions: Findings underscore the distinct roles of negative and positive urgency and drinking motives in influencing alcohol outcomes among college women survivors of sexual violence, highlighting implications for targeted interventions.

Background: Posttraumatic stress disorder (PTSD) and substance use disorders (SUD) frequently co-occur during adolescence and are associated with substantial functional impairment and elevated risk for chronic comorbidity. Despite strong evidence supporting integrated, trauma-focused treatments for adults with PTSD + SUD, the adolescent treatment literature remains limited.Objective: This review synthesizes current evidence on the integrated treatments for co-occurring PTSD + SUD problems among adolescents and youth, with emphasis on evaluating the strength of the evidence and identifying key directions for future research.Method: Targeted searches identified randomized controlled trials, open trials, pilot studies, and feasibility studies evaluating treatments for adolescents with PTSD + SUD problems. Studies were included if they reported PTSD and/or substance use outcomes. Findings from the adult PTSD + SUD literature were reviewed to inform developmentally appropriate adaptation for youth.Results: The adolescent evidence base is sparse. Risk Reduction Through Family Therapy (RRFT) is the only integrated treatment supported by multiple randomized controlled trials, demonstrating durable improvements in PTSD symptoms and substance use. Preliminary evidence also supports Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure for Adolescents (COPE-A). Across studies, trauma-focused treatment was not associated with increased substance use and was generally acceptable to adolescents. However, conclusions are constrained by small samples, heterogeneous interventions, and limited long-term and implementation data.Conclusions: Integrated, trauma-focused psychotherapies appear safe and promising for adolescents with co-occurring PTSD + SUD problems. Larger trials, mechanistic research, and implementation-focused studies are needed to inform best practices and expand access to effective care.

Alcohol and cannabis are the first and second most used substances among adolescents. Adolescence is a period of considerable development, making the adolescent brain particularly vulnerable to negative effects of alcohol and cannabis use. Developing and testing interventions that target both alcohol and cannabis use during adolescence are vital to decreasing costly consequences. Biases in cognitive processing of drug-related stimuli play an important role in the development and maintenance of problematic substance use. The Approach-Avoidance Task (AAT) is a computerized program, effective in assessing implicit approach biases for both alcohol and cannabis, in which participants make approach or avoidance movements in response to an irrelevant feature of an image presented on a screen (e.g., push when in portrait, pull when in landscape). A modified version of the AAT is also used as an approach bias modification (ApBM) intervention, to retrain participants’ implicit biases toward or away from stimuli by presenting the target stimuli predominantly in one format (e.g., push or pull). Despite research demonstrating the effectiveness of AAT interventions to reduce problematic alcohol and cannabis use, there is a dearth of research examining this intervention among adolescents. This protocol paper describes a NIDA-funded randomized control trial (RCT) to evaluate an integrated mobile ApBM intervention to target co-occurring alcohol and cannabis use among treatment-seeking adolescents. Outcomes will be measured from pre-treatment through a three-month follow-up. The sampling procedures, assessment protocol, description of the intervention, and planned statistical approaches to evaluating outcomes are detailed. Clinical and research implications of this work are also discussed.

Trauma exposure and alcohol use often co-occur. Unveiling predictors of drinking behavior, including among those with varying levels of trauma exposure, can inform behavioral health prevention and treatment efforts in at-risk populations. The current study examined associations between depressive symptoms, avoidant coping, gender, and alcohol use among emerging adults with and without trauma exposure and posttraumatic stress disorder (PTSD). Participants were 238 emerging adults between the ages of 21 and 30 years (M = 24.75; SD = 2.61) in one of three groups: trauma-exposed with PTSD (n = 70); trauma-exposed with no PTSD (n = 83); or a no trauma (control) group (n = 85). Demographics, parental alcohol problems, depressive symptoms, and avoidant coping were examined as predictors of drinks per drinking day. Chi-square, t-test, bivariate, and group path analysis were conducted. Among participants, men consumed greater amounts of alcohol than women across all three groups. Group assignment based on trauma history and PTSD significantly moderated the association between avoidant coping and alcohol use such that avoidant coping had a significant effect on alcohol use among participants in the trauma-exposed and PTSD groups. There was also a significant group × gender × avoidant coping interaction such that, among participants in the control group, men had attenuated alcohol use at low levels of avoidant coping and increased at high levels of avoidant coping. No effects of race were observed. Results highlight the importance of avoidant coping as a risk factor for problematic drinking, unveiling a specific intervention target for reducing co-occurring PTSD and problematic alcohol use.

BackgroundYouth who experience traumatic events are at a substantially higher risk of engaging in substance use and sexual risk behaviors and problems (eg, HIV acquisition) than their non–trauma-exposed counterparts. Evidence-based substance use and risky sexual behavior prevention may reduce the risk of these outcomes. Trauma-focused mental health treatment provides a window of opportunity for the implementation of such preventive work with these youth. However, overburdened clinicians face challenges in adding prevention content while implementing evidence-based treatments. Mobile health (mHealth) tools can help reduce this burden in delivering prevention curricula. Trauma-Informed Prevention for Substance Use and Risky Sexual Behavior (TIPS) is an mHealth app that was developed to aid trauma-focused cognitive behavioral therapy (TF-CBT) clinicians in the implementation of an evidence-based risk behavior prevention curriculum. ObjectiveThe goal of this paper is to describe the rationale for and development of the TIPS app and present the results of a mixed methods approach for the initial evaluation of its usability. MethodsParticipants included clinicians (n=11), adolescents (n=11), and caregivers (n=10) who completed qualitative interviews and an adapted version of the Website Analysis and Measurement Inventory. ResultsIn total, 4 overarching themes emerged from the participants’ answers to the qualitative interview questions, demonstrating a generally positive response to the app. The themes were (1) strength of app content, (2) suggestions about app content, (3) esthetics and usability, and (4) benefits to the patient and session implementation. Clinicians, adolescents, and caregivers all agreed that the content was very relevant to adolescents and used examples and language that adolescents could relate to. All 3 groups also discussed that the content was comprehensive and addressed issues often faced by adolescents. All 3 groups of users made suggestions about the esthetics, which mostly comprised suggestions to change the font, color, or pictures within the app. Of all the groups, adolescents were most positive about the esthetics and usability of the app. Results from the Website Analysis and Measurement Inventory further illustrated the users’ favorable reaction to the TIPS app, with 100% (11/11) of clinicians, 100% (10/10) of caregivers, and most adolescents (7/11, 64%) selecting strongly agree or somewhat agree to the following statement: “This app has much that is of interest to me.” Adolescents generally found the app easier to use than did caregivers and clinicians. ConclusionsThe TIPS app shows promise as an mHealth tool for TF-CBT clinicians to integrate evidence-based substance use, risky sexual behavior, and HIV prevention during treatment. Future research, including a randomized controlled trial comparing TF-CBT implementation with and without the inclusion of the app, is necessary to evaluate the feasibility and efficacy of the app in reducing the risk of substance use and risky sexual behavior among trauma-exposed adolescents. Trial RegistrationClinicalTrials.gov NCT03710720; https://clinicaltrials.gov/study/NCT03710720

Trauma exposure and drinking motives (e.g., social, enhancement, coping) are both associated with increased alcohol use and related problems. Studies have frequently investigated this relationship by examining drinking motives, such as drinking to cope with negative affect, in isolation, yet few studies have examined motives simultaneously in trauma-exposed populations. It is also unclear whether the relationship between drinking motives and alcohol use outcomes differs as a function of population characteristics (e.g., gender, trauma type). Using latent profile analysis, we aimed to (a) identify latent profiles characterized by drinking motives, assessed with the Drinking Motives Questionnaire (DMQ), in two samples: primarily male veterans with combat trauma (N = 174) and civilians with interpersonal trauma (N = 152), and (b) determine whether associations with alcohol use outcomes of consumption and binge drinking (BD) would differ by sample. A three-class solution was replicated across both samples: profiles characterized by moderate Social scores and low Enhancement and Coping scores (low ENH/COP), moderate scores across all domains (medium DMQ), and elevated scores across all domains (high DMQ). In both samples, profile membership was differentially associated with consumption and BD. Findings suggest patterns of drinking motives may be similar across different trauma-exposed populations, but associations with alcohol outcomes likely differ in meaningful ways. Results can help inform targeted interventions at different treatment settings, such as community health centers or VA hospitals.

Opioid use continues to represent a significant public health problem in the United States, as well as globally. The opioid epidemic has motivated advances in the effective treatment of opioid use disorder (OUD), with a particular focus on medications for OUD (MOUD), including methadone, buprenorphine, and naltrexone. Although these medications are remarkably effective, MOUD expansion initiatives alone have not been sufficient to combat the opioid epidemic. Further, critical questions remain regarding the effectiveness of these medications for individuals who initiate opioid use under age 16. Key strategies to combat the opioid epidemic, including MOUD and naloxone distribution, target intervention for individuals who have already developed an OUD. Like every other health problem, shifting attention earlier in the etiological process can lend itself to a more cost-effective approach by preventing the onset of behaviors that contribute to subsequent increases in morbidity and mortality. Therefore, we argue that targeted interventions for adolescents with substance use problems, including for non-opioid drugs (i.e., cannabis, alcohol), is critical to prevent the onset of OUD and turn the tide of the opioid overdose epidemic. In line with this call to action to move toward earlier intervention as a public health strategy, we propose several concrete recommendations. These include use of universal screening and prevention strategies for teens, an enhanced focus on addressing mental health (i.e., depression, trauma-related anxiety) and ecological (i.e., low caregiver monitoring, affiliating with substance using peers) precursors of substance use initiation in adolescents, a significant restructuring of resource allocation to more effectively and equitably address youth substance use and mental health problems, and continuous efforts dedicated to the de-stigmatization of the disease of substance use disorders.

Experiences of racial discrimination are pervasive among Black youth, resulting in psychosocial problems such as depression and anxiety. Rumination plays a key role in linking racial discrimination and internalizing concerns. Developmental age has also been shown to influence the extent to which racial discrimination and rumination impact mental health; however, studies have yet to explore the interplay between these factors. This study examined the association between racial discrimination and internalizing concerns among Black youth, whether racial discrimination was indirectly associated with internalizing concerns through rumination, and whether developmental age moderated these direct and indirect effects. Participants included 158 pre- and early-adolescent youth recruited from a community sample (Mage = 11.56 years; 53% female). Data were from baseline questionnaire responses from a larger longitudinal study conducted in the Southeastern United States examining the effects of interpersonal stressors on youth mental health outcomes. Racial discrimination was directly and indirectly associated with internalizing concerns through rumination. Developmental age moderated the indirect link between racial discrimination and depressive symptoms via rumination with the association being stronger as participant age increased. The impact of racial discrimination on mental health among Black youth is informed by maladaptive coping strategies such as rumination and developmental age. Such factors help to identify who is most at risk for the impact of racial discrimination and potential intervening targets. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Drunkorexia is characterized by a group of behaviors designed to minimize caloric intake while maximizing levels of alcohol intoxication. Individuals plan and modify their diet, via skipping meals, exercising, or purging, to save calories for a night of alcohol consumption. Minimal research has examined risk factors related to drunkorexia, and little is known regarding associated problems. We used structural equation modeling to test associations between coping and enhancement motives, drive for thinness, body dissatisfaction, and disordered eating (i.e., bulimia behaviors) and drinking among an at-risk college population (N = 364). Drive for thinness and alcohol coping motives were positively associated with drunkorexia. Notably, drunkorexia was associated with alcohol-related outcomes, but not bulimia. While common risk factors are shared with eating pathology, drunkorexia appears to be a unique construct apart from bulimia behaviors. Results indicate drunkorexia behaviors may extend past normative drinking and place individuals at increased risk of alcohol-related problems. The current study contributes to greater understanding of functional models and maladaptive outcomes related to drunkorexia behaviors.

Child maltreatment and traumatic events are well established risk factors for adolescent substance use problems, but little is known about the unique contributions of etiological factors on trauma-exposed youths' pre-treatment substance use in clinical settings. This study examined associations between substance use and risk and protective factors measured across multiple ecological levels among a unique sample of youth seeking treatment for trauma-related mental health problems in child advocacy centers. Participants were adolescents (N = 135; 85% female; 60% white, 31% black) aged 13-17 years (M = 15.4) with >= 1 experience of child maltreatment or other interpersonal violence, current substance use, and >= 5 PTSD symptoms. Youth and caregivers completed validated questionnaires and clinical interviews at a pre-treatment assessment in a randomized controlled trial of a treatment for co-occurring traumatic stress and substance use. Negative binomial regression models identified different patterns of risk and protective factors for alcohol and cannabis. Clinical implications of these results are discussed, including the potential targets for integrated psychotherapies that address co-occurring substance use and traumatic stress in youth.

Adolescents exposed to trauma experience disproportionate rates of HIV/STI. However, integrated treatment for trauma and sexual risk behavior is rare. To inform integrated prevention efforts, the current study describes prevalence and correlates of sexual risk behavior among adolescents seeking treatment for symptoms of posttraumatic stress and substance use disorders. Adolescents aged 13–18 years (N = 135; 88% female) with histories of interpersonal violence exposure completed pre-treatment questionnaires in a randomized controlled trial of an integrated psychotherapy for trauma and substance use symptomology. Adolescents reported high rates of sexual risk behaviors relative to national estimates and general mental health treatment samples. Symptoms of reexperiencing, substance use, and peer deviance were related to sexual risk behavior beyond the influence of other trauma symptoms. Individual and contextual psychosocial factors may be stronger predictors of sexual risk behavior than posttraumatic stress disorder symptoms among adolescents with trauma symptomology. Integrated interventions targeting traumatic stress, substance use, and sexual risk behavior concurrently may prevent revictimization and HIV/STI incidence among trauma-exposed youth.

Sexual abuse prior to age 18 may put some women at risk for engaging in sexual risk taking. This association could exist, in part, as a result of the impact of posttraumatic stress symptoms on behavioral regulation. The current study utilized a path analysis to investigate the association between severity of sexual abuse before age 18, posttraumatic stress symptoms, poor behavioral regulation, and expected engagement in sexual risk taking among college women. The sample consisted of 88 college women with experiences of sexual abuse prior to the age of 18. Severity of sexual abuse predicted posttraumatic stress symptoms. In addition, posttraumatic stress symptoms predicted poor behavioral regulation, which in turn predicted expected engagement in sexual risk taking. These findings indicate functional mechanisms involved in sexual decision making of women who have had past sexual abuse and experience posttraumatic stress symptoms.

OBJECTIVE:Affective and emotional dysregulation are consistently linked to greater alcohol use and related consequences, including risky sexual behavior. Moreover, these associations are even stronger among women with experiences of sexual assault. The current study tested affect, alexithymia, positive urgency, and negative urgency as predictors of alcohol use, alcohol-related consequences, and risky sexual behavior and the moderating impact of rape history on these associations among a sample of college women. METHOD:Participants were 1,005 college women between the ages of 18 and 25. Approximately 20% of the sample (n = 204) reported a history of rape since age 14. RESULTS:Positive and negative urgency statistically mediated the associations between negative affect and alexithymia and the alcohol and risky sex outcomes. Positive urgency was directly associated with alcohol use, while negative urgency was directly associated with alcohol-related consequences. Moreover, rape history moderated these associations, indicating that positive affect may be an important protective factor among women who have experienced rape. CONCLUSIONS:The current study identified important unique risk and protective pathways that may increase or reduce women's risk for alcohol-related consequences and risky sexual behavior. Importantly, these pathways are comprised of constructs that are malleable and modifiable and can be targeted and changed through intervention. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

OBJECTIVE:To understand how interpersonal trauma (IPT), stress response, and drinking to cope converge to predict stress-induced drinking, a risk factor for alcohol use disorder.METHOD:Young adults with no substance use disorder were classified into three trauma history groups: (a) IPT with PTSD (n = 27), (b) IPT without PTSD (n = 35), and (c) Control (no trauma-history/no PTSD; n = 36). Participants completed a baseline assessment, including a structured clinical interview, to confirm PTSD diagnosis, followed by the Trier Social Stressor Task (TSST) and an alcohol use task. Subjective units of distress and blood serum cortisol were collected at standardized timepoints throughout the tasks.RESULTS:In all three groups (PTSD, IPT, control), males consumed more alcohol in the lab than females. Participants in the PTSD group had significantly higher drinking to cope motives, which were associated with greater subjective reactivity; however, neither drinking to cope motives nor subjective reactivity to the TSST predicted post-stressor alcohol consumption for those with PTSD.CONCLUSIONS:The interplay among trauma history, stress, and drinking among young adults is nuanced; additional lab-based studies are needed to further clarify the nuanced connection between trauma history, acute stress reactions, and alcohol use. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Decades of research demonstrate that childhood exposure to traumatic events, particularly interpersonal violence experiences (IPV; sexual abuse, physical abuse, witnessing violence), increases risk for negative behavioral and emotional outcomes, including substance use problems (SUP) and posttraumatic stress disorder (PTSD). Despite this well-established link-including empirical support for shared etiological and functional connections between SUP and PTSD -the field has been void of a gold standard treatment for adolescent populations. To address this gap, our team recently completed a large randomized controlled trial to evaluate the efficacy of Risk Reduction through Family Therapy (RRFT), an integrative and exposure-based risk-reduction and treatment approach for adolescents who have experienced IPV and other traumatic events. The purpose of this paper is to provide a detailed description of the design and methods of this RCT designed to reduce SUP, PTSD symptoms, and related risk behaviors, with outcomes measured from pre-treatment through 18 months post-entry. Specifically, the recruitment and sampling procedures, assessment measures and methods, description of the intervention, and planned statistical approaches to evaluating the full range of outcomes are detailed. Clinical and research implications of this work are also discussed.

The current study examined emotion regulation variables (alexithymia, negative urgency, distress tolerance) and their relationship to traumatic event exposure, emotional intelligence (EI), and health outcomes: posttraumatic stress (PTS) symptoms, antisocial behaviors, alcohol use, and alcohol-related problems. Data from 561 undergraduate students and structural equation modeling was used to test the hypotheses. Results indicated both traumatic experiences and EI predicted PTS symptoms directly and indirectly, via alexithymia and distress tolerance. Conversely, traumatic experiences and EI predicted antisocial behaviors and both alcohol outcomes directly and indirectly. EI was indirectly related to alcohol-related problems via PTS and antisocial behaviors, regardless of alcohol consumption.

This study tested a structural equation model linking reinforcement sensitivity to subsequent emotion-based impulsivity (i.e., positive and negative urgency), alcohol use, and risky sexual behavior among a sample of 753 undergraduate drinkers. A hypothesized Sensitivity to Punishment (SP) × Sensitivity to Reward (SR) interaction significantly predicted both positive and negative urgency. At low levels of SR, SP had a significant negative effect on positive urgency and a significant positive effect on negative urgency. However, at high levels of SR, SP had significant positive effects on both types of urgency. Results indicated that positive and negative urgency mediate the associations between reinforcement sensitivity and both alcohol use and risky sexual behavior. Moreover, results demonstrated that at low levels of SR, SP is indirectly associated with decreased alcohol use. However, as SR increases, SP is indirectly associated with increased alcohol use and risky sexual behavior, due to the joint effect of high SP and SR on emotion-based impulsivity. (PsycInfo Database Record (c) 2020 APA, all rights reserved).