انگیزه های نوشیدن تقویت منفی واسطه ارتباط حساسیت اضطراب و افزایش رفتار نوشیدن

We examined whether certain “risky” drinking motives mediate the previously established relation between elevated anxiety sensitivity (AS) and increased drinking behavior in college student drinkers (n=109 women, 73 men). Specifically, we administered the Anxiety Sensitivity Index (ASI), Revised Drinking Motives Questionnaire, and a quantity-frequency measure of typical drinking levels. Participants were parceled according to high (n=30), moderate (n=29), and low (n=34) AS levels. As expected, high AS participants reported a higher typical weekly drinking frequency than the low and moderate AS students regardless of gender. Similarly, high AS participants (particularly high AS men) reported a higher yearly excessive drinking frequency than low AS students. Only the negative reinforcement motives of Coping and Conformity were found to independently mediate the relations between AS and increased drinking behavior in the total sample. High AS women's greater drinking behavior was largely explained by their elevated Coping Motives, while heightened Conformity Motives explained the increased drinking behavior of high AS men. Finally, associations between AS and increased drinking behavior in university students were largely attributable to the “social concerns” component of the ASI. We discuss the observed relations with respect to the psychological functions of drinking behavior that may portend the development of alcohol problems in young adult high AS men and women.

Anxiety sensitivity (AS) is an individual difference variable involving beliefs that anxiety-related sensations are associated with negative consequences, such as physical illness, mental incapacitation, or social embarrassment (McNally, 1996 and Stewart eta l., 1997). Elevated levels of anxiety sensitivity have been observed among individuals with diagnosed anxiety disorders including patients with panic disorder (e.g. Stewart, Knize, & Pihl, 1992) and social phobia (e.g. Ball, Otto, Pollack, Uccello, & Rosenbaum, 1995). Longitudinal research has demonstrated that high AS serves as a pre-morbid vulnerability factor for the development of panic attacks and anxiety disorders (Schmidt et al., 1997 and Maller and Reiss, 1992). In addition to AS's association with anxiety disorders, theorists have argued that it may be a risk factor for greater alcohol use behavior and for alcohol use disorders (McNally, 1996 and Stewart et al., 1999). Given their extreme fear of anxiety, high AS individuals should be more motivated than others to learn to use any drug (e.g. alcohol) which is capable of reducing anxious emotions or arousal sensations (Stewart et al., 1999). The fact that high AS individuals are particularly sensitive to the fear dampening effects of alcohol (e.g. Conrod et al., 1998, MacDonald et al., 2000 and Stewart and Pihl, 1994) suggests that they should have increased opportunity to learn about such rewarding consequences of drinking. Empirical research suggests high AS levels may be related to alcohol use disorders by virtue of their association with greater drinking levels and/or “risky” reasons for drinking (see Stewart et al., 1999, for review). Indeed, AS levels are positively associated with self-reported weekly drinking rates in panic disorder patients (Cox, Swinson, Shulman, Kuch, & Reichman, 1993), and with self-reported weekly drinking rates and yearly excessive drinking episodes in university women (Stewart, Peterson, & Pihl, 1995). Despite this relatively-well established relation between AS and increased drinking behavior, it is not clear whether the higher self-reported weekly drinking levels of high AS individuals are due to a greater drinking quantity, frequency, or both (cf. Stewart et al., 2000 and Vogel-Sprott, 1983). Moreover, since the Stewart et al. (1995) study focused exclusively on female university students, it remains unknown whether the relation of AS to increased drinking behavior varies across gender. In addition to personality variables such as AS, drinking motives also appear to be related to levels of alcohol use, and to drinking problems (Cooper, 1994, Cooper et al., 1995 and Cooper et al., 1992). For example, Coping, Conformity, Enhancement, and Social Motives all predict unique aspects of drinking behavior (e.g. Carrigan, Samoluk & Stewart, 1998). Specifically, higher levels of alcohol use are associated with Coping and Enhancement Motives (internal motives) as compared to Social Motives (external motives; Cooper, 1994 and Cooper et al., 1992). Further, Coping and Conformity Motives (negative reinforcement motives) directly predict drinking problems, whereas Enhancement and Social Motives (positive reinforcement motives) do not (Cooper, 1994 and Cooper et al., 1992). Given these patterns of relations to drinking behaviors and drinking outcomes, Coping, Conformity, and Enhancement Motives have been described as relatively “risky” reasons for drinking (e.g. Cooper, 1994). High AS individuals do display “risky” drinking motives as measured by the three-factor Drinking Motives Questionnaire (DMQ; Cooper et al., 1992) or its revised four-factor version (DMQ-R; Cooper, 1994). In particular, AS is an independent predictor of Coping and Conformity Motives (Conrod et al., 1998, Stewart et al., 1997, Stewart and Zeitlin, 1995 and Stewart et al., 1999). Nonetheless, it is not clear whether drinking motives mediate previously established relations between AS and drinking behavior (cf. Cooper et al., 1995, Stewart and Devine, 2000 and Stewart et al., 2000). A “mediator variable” explains the relationship between a predictor and a given criterion, thereby permitting increased understanding of why the predictor–criterion relation exists ( Baron & Kenny, 1986). Researchers have proposed that drinking motives are the final common pathway to alcohol use and abuse, through which other risk factors (such as personality factors) exert their influences on drinking behavior (e.g. Cooper, 1994 and Cox and Klinger, 1988). A mediational perspective would suggest that high AS individuals drink more than others at least in part because they drink primarily to relieve aversive states (i.e., for Coping and/or Conformity Motives). Moreover, because AS presents somewhat differently in women and men (e.g., men's greatest anxiety-related concerns falling in the social concerns domain; Stewart et al., 1998 and Stewart eta l., 1997) the relative importance of Conformity versus Coping motives in explaining high AS individuals’ greater drinking behavior might vary across gender. A final area requiring further investigation pertains to the specific relations of the various lower-order AS components with increased drinking behaviors. It is now fairly well established that AS is organized hierarchically with several lower-order components each of which loads on a higher-order general AS factor (e.g. Zinbarg, Barlow, & Brown, 1997). The most replicable lower-order AS components appear to be physical concerns, psychological concerns, and social concerns about the consequences of anxiety-related sensations (e.g. McWilliams et al., 2000 and Zinbarg, 1999). Only one study to date has examined relations between these lower-order AS components and drinking behavior. McWilliams and Asmundson (1999) recently showed that social concerns, but not psychological concerns or physical concerns, were predictive of increased drinking behavior among a large sample of university students. The present study had several aims. First, we sought to determine whether AS levels are associated with particular aspects of drinking behavior in a large, mixed-gender, undergraduate sample. We hypothesized that high AS levels would be associated with overall greater drinking behavior compared to moderate and low AS levels. We explored whether this predicted relationship varied across drinking behavior measures (i.e. typical drinking quantity, typical weekly drinking frequency, and yearly excessive drinking episodes) and/or across gender. Second, we examined the role of certain “risky” drinking motives in mediating the hypothesized relations between high AS and increased drinking behavior. We hypothesized that Coping and Conformity drinking motives would independently mediate the tendency of high AS individuals to engage in increased drinking behavior. We also examined the mediating roles of Coping and Conformity motives separately in each gender group to determine whether the particular drinking motive mediators might differ between university men and women. Finally, we examined the associations between each lower-order AS component and the three drinking behavior measures. Of the three previously identified lower-order AS components of physical, psychological, and social concerns (e.g. Stewart, Taylor, & Baker 1997), we expected that AS social concerns would show the strongest relations with increased drinking behavior (cf. McWilliams & Asmundson, 1999).