Day-to-day links between negative affect, distress intolerance, and alcohol use.

OBJECTIVE

Negative reinforcement models theorize that state negative affect should predict alcohol use; however, research examining the relationship between heightened negative affect and same-day drinking has produced equivocal results. Focusing on alcohol craving, a psychological mechanism that has clear implications on behavior, as an outcome may help elucidate this process. Further, it may be that an individual's ability to tolerate distress associated with negative affect drives cravings for alcohol to alleviate such emotions. Thus, the goal of this study was to investigate the extent to which state-level distress intolerance mediates associations between negative affect and alcohol craving and use using a longitudinal daily diary design among a diverse, national sample of drinkers.

METHODS

One week of daily diary data from 82 participants (n = 530 observations) endorsing problematic past-year alcohol use were analyzed using a multilevel mediation model.

RESULTS

Day-to-day fluctuations in negative affect were significantly associated with heightened distress intolerance and alcohol craving, but not consumption. Multilevel mediation analyses revealed that, controlling for participants' average levels of negative affect and distress intolerance, day-to-day distress intolerance mediated the relation between negative affect and alcohol craving.

CONCLUSIONS

Elevated state distress intolerance is a proximal risk factor for heightened alcohol craving among people with a range of alcohol use severity. This study underscores the importance of conceptualizing and assessing distress intolerance as a state-level construct. Findings also emphasize the need to focus on craving to better understand processes that drive alcohol use from a negative reinforcement model perspective.

PUBLIC HEALTH SIGNIFICANCE STATEMENT: Individuals who have difficulty managing daily stress or negative emotions may experience stronger urges to drink alcohol. This study demonstrates that momentary intolerance of distress helps explain the link between negative emotions and alcohol craving. Interventions aimed at improving in-the-moment distress tolerance may help reduce alcohol cravings and, in turn, lower the risk of problematic drinking.