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      Ecological momentary assessment studies of comorbid PTSD and alcohol use: A narrative review

      review-article
      a , * , a , b
      Addictive Behaviors Reports
      Elsevier

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          Abstract

          Introduction

          PTSD and harmful alcohol use, including alcohol use disorder (AUD), frequently co-occur. Recent research has used ecological momentary assessment (EMA) to examine the associations between PTSD symptoms and alcohol-related variables, such as craving for alcohol, alcohol use, and the presence of alcohol-related problems. The overall purpose of this narrative review is to summarize this emerging literature.

          Methods

          Inclusion criteria for studies were: 1) Use of ecological momentary assessment as the method for gathering data on alcohol use and/or craving in populations with both problematic alcohol use and PTSD, and the inclusion of an assessment of both PTSD symptoms and at least one alcohol use variable during EMA; and 2) At screening, participants were required to meet study criteria for a) elevated PTSD symptoms or trauma exposure, and b) alcohol use.

          Results

          The pertinent extant literature is reviewed in terms of four underlying themes: Methodological considerations of EMA research in a population with PTSD symptoms and harmful alcohol use; Associations between PTSD symptoms and alcohol use variable/s; Moderators of PTSD-alcohol use associations; Mediators of PTSD-alcohol use associations.

          Conclusions

          Collectively, studies provide support for the self-medication hypothesis. Several variables were found to moderate association between PTSD symptoms and alcohol-related variables. EMA data may ultimately be useful in identifying when individuals are at risk for harm due to increased symptoms or alcohol misuse and may inform treatment approaches administered remotely.

          Highlights

          • Narrative review of EMA studies examining association between PTSD symptoms and alcohol-related variables.

          • Collectively, studies provide support for the self-medication hypothesis.

          • Several variables were found to moderate association between PTSD symptoms and alcohol-related variables.

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          Most cited references53

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          Ecological Correlations and the Behavior of Individuals

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            National estimates of exposure to traumatic events and PTSD prevalence using DSM-IV and DSM-5 criteria.

            Prevalence of posttraumatic stress disorder (PTSD) defined according to the American Psychiatric Association's Diagnostic and Statistical Manual fifth edition (DSM-5; 2013) and fourth edition (DSM-IV; 1994) was compared in a national sample of U.S. adults (N = 2,953) recruited from an online panel. Exposure to traumatic events, PTSD symptoms, and functional impairment were assessed online using a highly structured, self-administered survey. Traumatic event exposure using DSM-5 criteria was high (89.7%), and exposure to multiple traumatic event types was the norm. PTSD caseness was determined using Same Event (i.e., all symptom criteria met to the same event type) and Composite Event (i.e., symptom criteria met to a combination of event types) definitions. Lifetime, past-12-month, and past 6-month PTSD prevalence using the Same Event definition for DSM-5 was 8.3%, 4.7%, and 3.8% respectively. All 6 DSM-5 prevalence estimates were slightly lower than their DSM-IV counterparts, although only 2 of these differences were statistically significant. DSM-5 PTSD prevalence was higher among women than among men, and prevalence increased with greater traumatic event exposure. Major reasons individuals met DSM-IV criteria, but not DSM-5 criteria were the exclusion of nonaccidental, nonviolent deaths from Criterion A, and the new requirement of at least 1 active avoidance symptom.
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              Ecological Momentary Assessment (Ema) in Behavioral Medicine

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                Author and article information

                Contributors
                Journal
                Addict Behav Rep
                Addict Behav Rep
                Addictive Behaviors Reports
                Elsevier
                2352-8532
                17 July 2019
                December 2019
                17 July 2019
                : 10
                : 100205
                Affiliations
                [a ]Department of Medical and Clinical Psychology at Uniformed Services University
                [b ]Office of Institutional Research at Yale University, 2 Whitney Avenue, New Haven, CT 06510, United States of America
                Author notes
                [* ]Corresponding author at: Department of Medical and Clinical Psychology, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814, United States of America amanda.lane@ 123456usuhs.edu
                Article
                S2352-8532(19)30059-8 100205
                10.1016/j.abrep.2019.100205
                6742902
                31528685
                ca0c8e88-6c60-42da-bc24-4cc1e3ea33fc

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 7 April 2019
                : 3 July 2019
                : 14 July 2019
                Categories
                Review article

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