Posttraumatic Stress, Alcohol Use, and Alcohol Use Motives among Non-Hispanic Black/African American College Students: The Role of Emotion Regulation

Abstract

Objective:

The associations between posttraumatic stress disorder (PTSD) symptom severity, alcohol use, and alcohol use motives are well-established. Emotion regulation difficulties have been implicated in the association between PTSD symptoms and alcohol use. A dearth of empirical work, however, has examined these associations among Black/African American college students, a population with high prevalence of exposure to potentially traumatic events, PTSD symptomatology, and alcohol-related consequences.

Methods:

This study examined PTSD symptoms, emotion regulation difficulties, and alcohol use severity and motives among a sample of Black/African American trauma-exposed college students (N = 282; 77.4% identified as female; Mage = 22.36, SD = 4.71).

Results:

PTSD symptom severity was related to alcohol use and coping and conformity motives for alcohol use through heightened emotion regulation difficulties. Findings were significant above and beyond the effects of trauma load (i.e., number of potentially traumatic event types experienced).

Conclusions:

This study extends past work to an understudied population and contributes to groundwork for culturally informed interventions.

Introduction

College students are at risk for alcohol use disorder (AUD; SAMHSA, 2020). AUD is characterized by a pattern of alcohol use resulting in impairment in overall physical, psychological, and/or social functioning (APA, 2013). Indeed, students who report greater alcohol use while in college are more likely to exhibit AUD symptomatology during and after college (Prince et al., 2019). Epidemiological studies have demonstrated that alcohol use rates vary across racial and ethnic groups (Delker et al., 2016; Falk et al., 2008; O’Malley & Johnston, 2002; Rodriguez-Seijas et al., 2019). However, little scientific attention has focused on alcohol use and alcohol use motives among college students who identify as Black/African American. Extant work suggests alcohol consumption may be lower in Black/African American college students, compared to white students (Cacciola & Nevid, 2014; Taylor & Su, 2022). However, Black/African American adults may experience higher rates of certain negative alcohol-related problems, including AUD persistence and alcohol-related mortality (Fan et al., 2019; Shield et al., 2013). Rates of alcohol-related legal problems and health consequences (e.g., chronic pancreatitis) may be higher, as well (Wilcox et al., 2016; Zemore et al., 2016). Furthermore, AUD treatment utilization is lower among Black/African American adults (Tucker et al., 2020). Taken together, this body of work underscores the importance of continued research in this area to elucidate psychological factors that may be related to alcohol use and motives among Black/African American students, an understudied population.

One factor with relevance to alcohol use and motives among college students, broadly, is posttraumatic stress disorder (PTSD) symptomatology. Estimated rates of exposure to potentially traumatic events among college students are variable depending on study methodology and criteria used to define trauma. Research suggests that approximately 32% of college students report experiencing a potentially traumatic event in the last year (Tubbs et al., 2019). Further, the rate of probable PTSD among college students is variable, with recent work suggesting rates are at approximately 25.3% (Cusack et al., 2019). Notably, Black/African American adults may experience heightened trauma exposure and PTSD symptomatology compared with their non-Hispanic white counterparts (Ai et al., 2011; Alegría et al., 2013; Sibrava et al., 2019). For example, Black/African American college students are more likely to experience interpersonal trauma than their non-Hispanic white peers (e.g., physical/sexual assault; Edman et al., 2016). Specifically, epidemiological research has indicated that Black/African American adults are more likely to experience child maltreatment and witness domestic violence (Roberts et al., 2011). Rates of exposure to participation in organized violence and sexual violence are also elevated (McLaughlin et al., 2019). Furthermore, exposure to race-based stressors, including systemic racism and racial discrimination, has been shown to exacerbate PTSD symptomatology and substance use among Black/African American adults (Bird et al., 2021; Gerrard et al., 2012; Sibrava et al., 2019), highlighting the importance of continued work focused on examining associations between PTSD symptoms and alcohol use among this population.

Among Black/African American college students, heightened PTSD symptoms are related to greater alcohol use and motivations for use (Haas et al., 2019; Messina et al., 2015). Specifically, Black/African American young adults report drinking alcohol to cope with negative emotions and experiencing subsequent negative drinking consequences, such as increased rates of physical injury and social problems (Desalu et al., 2019; Mulia & Zemore, 2012; Pittman & Kaur, 2018; Witbrodt et al., 2014). Furthermore, exposure to race-related stress, such as racism and discrimination, may play a relevant role in drinking behaviors among this group (Pittman et al., 2019). According to the biopsychosocial stress-coping model (Clark et al., 1999), the stress related to experiencing racial discrimination may result in heightened psychological stress responses and lower coping resources, and emotional responses to such experiences may increase vulnerability for drinking alcohol as a potential coping mechanism (Desalu et al., 2019). For example, using a longitudinal design, Cooper and colleagues (2008) found that Black/African American adolescents who drink alcohol report less salient coping motives compared to white adolescents, but rates of coping-oriented alcohol use among Black/African American adults surpass those of white counterparts by early adulthood. Furthermore, coping motives for alcohol use in adolescence more strongly predict alcohol use over time among Black/African American individuals (Cooper et al., 2008). Given the patterns of associations between PTSD symptoms and alcohol use among Black/African American college students, it is imperative to examine malleable transdiagnostic psychological factors with clinical relevance to the development of novel, specialized alcohol use interventions.

Emotion regulation is one such transdiagnostic psychological factor with relevance to both alcohol use and PTSD (Radomski & Read, 2016). Recent conceptualizations of emotion regulation focus on the functionality of emotions and emphasize various adaptive responses to emotional distress, including a) awareness, understanding, and acceptance of emotions; b) capacity to control behaviors during negative emotional states; c) flexible use of situationally-appropriate strategies to modify the severity and/or length of emotional responses; and d) openness to experience negative emotions in the service of pursuing meaningful life activities (Gratz & Tull, 2010). An extant body of research has demonstrated that, among college students broadly, emotion regulation difficulties are associated with alcohol-related problems (Dvoark et al., 2014) and PTSD symptomatology (O’Bryan et al., 2015) and relate to the co-occurrence of PTSD symptoms and alcohol use (Radomski & Read, 2016). Indeed, emotion regulation is a well-established factor related to PTSD symptomatology among Black/African American individuals (Carter et al., 2020). Black/African American students reporting probable PTSD also evince greater levels of emotion regulation difficulties (Weiss et al., 2013). Further, emotion regulation difficulties have been identified as an explanatory factor in the association between PTSD symptom severity and increased alcohol use and heighted coping motives among college students (Radomski & Read, 2016), as well as heightened alcohol use coping motives among trauma-exposed college students (Tripp et al., 2015). Experiences with cultural stressors (e.g., racial discrimination) may exacerbate emotion regulation difficulties by contributing to greater higher allostatic load (Miller et al., 2021), which may increase potential risk for alcohol use over time (English et al., 2018).

Theoretically, emotion regulation difficulties may explain the association between PTSD symptom severity and alcohol use severity and alcohol use motives among Black/African American college students. Among Black/African American college students, specifically, both PTSD symptoms and difficulties regulating emotions may be amplified by the chronic stress of racism and discrimination (Miller et al., 2021). Consistent with the self-medication model of PTSD-alcohol use relations (Hawn et al., 2020), heightened PTSD symptoms may lead to increased alcohol use due to difficulties in regulating negative emotional states. Indeed, emotion regulation is an important multidimensional factor (Gratz & Roemer, 2004) relevant to the effective management of PTSD symptoms (Koole, 2010). Black/African American students with heightened PTSD symptoms may evince greater emotion regulation difficulties, due at least in part to heightened allostatic load and higher rates of stress related to managing the chronic individual impact of structural racism, which can lead to using alcohol to manage negative emotional states (coping-oriented drinking; Hitch et al., 2021). Notably, extant literature relevant to this arena of inquiry is focused predominantly on non-Hispanic white college student samples. Available research suggests the additive stress experienced by Black/African American college students in terms of racial discrimination, racial trauma, and/or various forms of stress stemming from systemic and institutional racism may contribute to both PTSD symptomatology and increased alcohol use (e.g., Bird et al., 2021; Miller et al., 2021; Pittman & Kaur, 2018), as well as emotion regulation difficulties (English et al., 2018; Williams et al., 2022). It is important to understand the relations among these factors among Black/African American trauma-exposed college students to inform the groundwork for culturally appropriate intervention development.

Against this backdrop, the present investigation examined associations between PTSD symptom severity, emotion regulation difficulties, and alcohol use severity and motives (i.e., coping, enhancement, conformity, and social) among non-Hispanic Black/African American undergraduate students. First, we hypothesized that higher PTSD symptom severity would be positively and directly associated with alcohol use severity and alcohol use motives. Second, we hypothesized that higher PTSD symptom severity would be related indirectly to increased alcohol use severity and increased alcohol use coping motives, specifically, through emotion regulation difficulties. The model was not expected to be significant for other alcohol use motives (i.e., enhancement, conformity, social). All effects were anticipated after considering trauma load (i.e., number of traumatic event types experienced; Akbari et al., 2022).

Methods

Participants

This study is a secondary data analysis of a larger cross-sectional project examining stress and health-related behaviors among university students. To be eligible for the parent study, participants were required to be English-speaking students (i.e., undergraduate or post-baccalaureate) currently enrolled at the university and to provide informed consent. Participants were ineligible if they did not provide informed consent. Data were collected at one time point from 2016–2020. Participants in the present cross-sectional investigation included 282 non-Hispanic Black/African American college students enrolled in a large urban university in the southern United States. Study inclusion criteria required participants to be at least 18 years of age, to identify as non-Hispanic and Black/African American, and to endorse a history of lifetime alcohol use and exposure to a potentially traumatic event consistent with Diagnostic Statistical Manual, 5^th edition PTSD Criterion A (DSM-5; APA, 2013) and as assessed via the Life Events Checklist for DSM-5 (LEC-5; Weathers et al., 2013). Of the 4,977 students who consented to the study, 4,128 completed all relevant measures and 282 were included in this secondary analysis due to meeting the specified inclusion criteria. Please see Table 1 for a summary of participant characteristics.

Table 1.

Participant Characteristics

Variable	Mean (SD) / n (%)
Gender 1
Female	221 (77.5%)
Male	61 (21.5%)
Age 1	22.4 (4.7)
Sexual orientation 1
Heterosexual	186 (83.8%)
Bisexual	13 (5.9%)
Gay or Lesbian	5 (2.3%)
Asexual	10 (4.5%)
Pansexual	3 (1.4%)
Other	4 (1.8%)
Queer	1 (0.5%)
Marital status 1
Single/Never married	267 (93.7%)
Married	14 (4.9%)
Divorced	4 (1.4%)
Academic year 1
Freshman	30 (10.5%)
Sophomore	69 (24.2%)
Junior	78 (27.4%)
Senior	101(35.4%)
Post-Baccalaureate (graduated with degree but currently enrolled in classes)	7 (2.5%)
Trauma load 2	5.2 (3.3)
Trauma exposure 2
Natural disaster	231 (81.1%)
Fire or explosion	86 (30.2%)
Transportation accident	220 (77.2%)
Serious accident	111 (38.9%)
Exposure to toxic substance	37 (13.0%)
Physical assault	133 (46.7%)
Assault with a weapon	50 (17.5%)
Sexual assault	49 (17.2%)
Other unwanted or uncomfortable sexual experience	95 (33.3%)
Combat or exposure to a war-zone	21 (7.4%)
Captivity	18 (6.3%)
Life-threatening illness or injury	109 (38.2%)
Severe human suffering	53 (18.6%)
Sudden violent death	51 (17.9%)
Sudden accidental death	53 (18.6%)
Serious injury, harm, or death you caused to someone else	30 (10.5%)
Any other stressful event or experience	142 (49.8%)
Probable PTSD (PCL-5 ≥ 33)3	59 (20.9%)
Hazardous alcohol use (AUDIT ≥ 8)4	62 (22.0%)

Note. N = 282; SD= standard deviation; PTSD = posttraumatic stress disorder

¹Demographics Questionnaire;

²Life Events Checklist for DSM-5 (LEC-5; Weathers et al., 2013);

³PTSD Checklist for DSM-5 (PCL-5; Blevins et al., 2015);

⁴Alcohol Use Disorders Identification Test (AUDIT; Saunders et al., 1993).

Measures

Demographics questionnaire

Participants were asked to self-report demographic information (e.g., race, ethnicity, gender, age). Race and ethnicity were used as inclusion criteria in the present investigation.

Life Events Checklist for DSM-5 (LEC-5; Weathers et al., 2013)

The LEC-5 is a self-report questionnaire used to screen for potentially traumatic events experienced at any time throughout the lifespan. Participants were provided with a list of 16 potentially traumatic events (e.g., combat, sexual assault, transportation accident) as well as an additional item assessing for ‘other’ potentially traumatic events not listed. Participants indicated whether each listed event “happened to me”, “witnessed it”, “learned about it”, “part of my job”, or “not sure.” Exposure to potentially traumatic events was defined by endorsement of “happened to me”, “witnessed it”, “learned about it”, or “part of my job” to the potentially traumatic event items. A ‘trauma load’ variable indexing each participant’s total number of traumatic life event types was created and evaluated as a covariate in the present analyses, while exposure to potentially traumatic event(s) was used as an inclusion criterion.

PTSD Checklist for DSM-5 (PCL-5; Weathers et al., 2013)

Participants were asked to complete the PCL-5 about the “worst” traumatic event type they endorsed on the LEC-5. The PCL-5 is a 20-item self-report questionnaire that measures PTSD symptom severity over the past month. Each of the 20 items reflects a symptom of PTSD according to DSM-5 criteria (American Psychiatric Association, 2013). Participants were asked to rate each item on a 5-point Likert-type scale ranging from 0 (not at all) to 4 (extremely) to indicate how much they have been bothered by the symptom in the past month. Total symptom severity scores range from 0 to 80, with higher scores indicating greater symptom severity. A score of 33 or greater is the suggested cut-off for a probable diagnosis of PTSD (e.g., Bovin et al., 2016). The PCL-5 has displayed good psychometric properties (Blevins et al., 2015). Among trauma-exposed Black/African American adults, the PCL-5 has displayed excellent psychometric properties (Bird et al., 2021). Internal consistency was excellent for the PCL-5 total score in the current study (α = .94). The PCL-5 was examined as the predictor variable.

Brief Difficulties in Emotion Regulation Scale (DERS; Bjureberg et al., 2016)

The DERS-16 is a 16-item self-report questionnaire designed to assess emotion regulation difficulties. Developed from the original 36-item DERS (Gratz & Roemer, 2004), the DERS-16 is a multidimensional tool that includes five subscales: Lack of Emotional Clarity (e.g., “I have difficulty making sense out of my feelings”); Difficulties Engaging in Goal-Directed Behavior (e.g., “I have difficulty getting work done”); Impulse Control Difficulties (e.g., “I become out of control”); Limited Access to Effective Emotion Regulation Strategies (e.g., “I believe that I will remain that way for a long time”); and Nonacceptance of Emotional Responses (e.g., “I feel ashamed with myself for feeling that way”). Participants were asked to rate each item using a 5-point Likert-type scale ranging from 1 (almost never) to 5 (almost always). The total score ranges from 16 to 80, with higher scores reflecting increased emotion regulation difficulties. The DERS-16 has demonstrated good psychometric properties (Bjureberg et al., 2016). Similarly, internal consistency for the DERS-16 was excellent in the current sample (α = .96). The DERS-16 total score was evaluated as an explanatory variable.

Alcohol Use Disorders Identification Test (AUDIT; Saunders et al., 1993)

The AUDIT is a 10-item self-report questionnaire designed to assess hazardous and harmful alcohol use (Babor et al., 2001). Participants were asked to answer questions regarding quantity and frequency of alcohol behaviors and problems over the past year using a 5-point Likert-type scale ranging from 0 to 4. The total score ranges from 0 to 40, with higher scores indicating increased symptom severity. Previous research has demonstrated strong psychometric properties for the AUDIT (Babor et al., 2001). Further, the AUDIT has previously demonstrated good psychometric properties in a sample of Black/African American college students (Haas et al., 2019). Internal consistency for the AUDIT total score was good in the present investigation (α = .81). The AUDIT total score was evaluated as an outcome variable.

Drinking Motives Questionnaire – Revised Short Form (DMQ-R-SF; Kuntsche & Kuntsche, 2009)

The DMQ-R-SF is a 12-item self-report questionnaire designed to assess participants’ reasons for consuming alcohol. The DMQ-R-SF measures the frequency with which individuals consume alcohol, separated by motivation into four categories: Coping (i.e., drinking to cope with negative emotions), Enhancement (i.e., drinking to enhance positive mood or well-being), Conformity (i.e., drinking to conform or avoid social censure and rejection), and Social (i.e., drinking to obtain positive social rewards). Each subscale consists of three items that are summed to produce scores ranging from 3 to 9 with higher scores reflecting increased motivation. Internal consistency was excellent for the DMQ-R-SF social subscale (α = .90), good for the conformity subscale (α = .83), good for the coping subscale (α = .85), and acceptable for the enhancement subscale (α = .60). Each subscale was evaluated as an outcome variable.

Procedure

Participants were recruited for the study via Sona Systems, a secure cloud-based software tool for universities. College students were able to log-in to the Sona System to view a recruitment flyer about the study. Interested students could then view a link to the informed consent form and online survey. The online survey was comprised of a battery of self-report questionnaires, and the estimated completion time was 1.5–2 hours. Those who completed the survey received course credit for participation. The study was approved by the relevant institutional review board.

Data Analytic Plan

Analyses were conducted using SPSS version 26. First, means, standard deviations, and zero-order correlations for all constructs of interest were examined. Next, indirect effect analyses were conducted using PROCESS Macro for SPSS Version 4.0 (Hayes & Preacher, 2014). Regression coefficients for each hypothesized path were evaluated. For all models, PTSD symptom severity (PCL-5 total sore) was utilized as the predictor variable and emotion regulation difficulties (DERS total score) as an explanatory variable. Five separate analyses were conducted to examine alcohol-related outcomes: (1) alcohol use severity (AUDIT total score), (2) alcohol use coping motives (DMQ-R-SF: Coping subscale), (3) alcohol use enhancement motives (DMQ-R-SF; Enhancement subscale), (4) alcohol use conformity motives (DMQ-R-SF; Conformity subscale) and (5) alcohol use social motives (DMQ-R-SF; Social subscale). Trauma load (LEC-5 total score) was included as a covariate all models. In models evaluating alcohol use motives as outcome variables, additional covariates included the alternate alcohol use motives. To detect the indirect effects of the predictor variable (PCL-5 total score) on the outcome variables via emotion regulation difficulties (DERS total score), 5,000 bootstrap re-samples were conducted. Confidence intervals not including zero are considered statistically significant (Hayes, 2012).

Results

Descriptive Statistics

Please see Table 1 for a summary of participant characteristics. The sample was comprised of 282 university students (221 identified as female; 61 identified as male) who identified as Black/African American and non-Hispanic/Latinx. The mean age of the sample was 22.4 (SD = 4.7). The most commonly reported potentially traumatic event types experienced were being exposed to a natural disaster (81.1%), transportation accident (77.2%), physical assault (46.7%), and serious accident (38.9%).

Bivariate Correlations

Means, standard deviations, and zero-order correlations among study variables are presented in Table 2. PTSD symptom severity was positively associated with emotion regulation difficulties and alcohol use severity. Further, PTSD symptom severity was positively associated with alcohol use-related coping, enhancement, and conformity motives but was not correlated with social motives. Emotion regulation difficulties was positively correlated with alcohol use severity and all four drinking motives.

Table 2.

Means, Standard Deviations, Ranges, and Bivariate Correlations Between Study Variables

Variable	1	2	3	4	5	6	7	8	9	10
1. Age	-
2. Gender	−.10	−
3. LEC-5a	.14*	−.10	−
4. PCL-5b	−.02	.06	.40**	−
5. DERSc	−.26**	.05	.14*	.42**	−
6. AUDITd	−.06	−.05	.28**	.29**	.36**	-
8. DMQ-R-SF: Coping 7otives subscaled	−.07	.11	.15**	.32**	.40**	.36**	-
8. DMQ-R-SF: Enhancement motives subscaled	−.11	.01	.07	.16**	.27**	.38**	.48**	-
9. DMQ-R-SF: Conformity motives subscaled	−.09	−.08	.07	.23**	.35**	.37**	.46**	.33**	-
10. DMQ-R-SF: Social motives subscaled	−.16**	.03	.01	.06	.18**	.25**	.35**	.61**	.27**	-
Mean/n	22.36	223	5.23	17.60	34.19	5.58	4.56	5.57	3.86	6.09
Standard Deviation/%	4.71	77.4	3.28	16.41	13.77	4.81	1.80	1.60	1.46	2.04
Range	18–49	0–3	1–17	0–66	16–71	1–29	3–9	3–9	3–9	3–9

Note.

^**p < .01;

^*p < .05;

^aCovariate.

^bPredictor.

^cExplanatory variable.

^dOutcome

Gender: % listed as males (Coded: 0 = male, 1 = female, 3 = transgender); LEC-5 = Life Events Checklist for DSM-5 total score (Weathers et al., 2013); PCL-5 = PTSD Checklist for DSM-5 total score (Blevins et al., 2015); DERS = Brief Difficulties in Emotion Regulation Scale total score (Bjureberg et al., 2016); AUDIT = Alcohol Use Disorders Identification Test total score (Saunders et al., 1993); DMQ-R-SF = Drinking Motives Questionnaire Revised Short Form (Kuntsche & Kuntsche, 2009).

Tests of Indirect and Direct Effects

Please see Table 3 for a summary of analyses of indirect and direct effects. A significant total effect of PTSD symptom severity on alcohol use severity emerged. Further, there was a significant positive indirect effect of PTSD symptom severity on alcohol use severity via emotion regulation difficulties. Indeed, PTSD symptom severity was significantly and positively associated with emotion regulation difficulties, and emotion regulation difficulties was significantly and positively associated with alcohol use severity.

Table 3.

Standardized Regression Coefficients: Indirect Effect Models

Y	Model	Model R2	β	p	Bootstrapped	95% CI
AUDIT	PCL-5 → DERS (a)	.18**	.37	<.001	.27	.46
	DERS → AUDIT (b)	.19**	.11	<.001	.06	.15
	PCL-5 → AUDIT (c)	.11*	.06	.001	.02	.09
	PCL-5 → AUDIT (c’)		.02	.30	-.02	.06
	PCL-5 → DERS → AUDIT (a*b)		.04		.02	.06
DMQ-R-SF: Coping motives subscale	PCL-5 → DERS (a)	.27**	.32	<.001	.22	.41
	DERS →DMQ-R-SF Coping motives subscale (b)	.39*	.02	.004	.01	.04
	PCL-5 → DMQ-R-SF Coping motives subscale (c)	.37*	.02	.001	.01	.03
	PCL-5 → DMQ-R-SF Coping motives subscale (c’)		.01	.04	.001	.03
	PCL-5 → DERS → DMQ-R-SF Coping motives subscale (a*b)		.01		.002	.01
DMQ-R-SF: Enhancement motives subscale	PCL-5 → DERS (a)	.29**	.29	<.001	.19	.39
	DERS → DMQ-R-SF Enhancement motives subscale (b)	.46	.01	.23	−.005	.02
	PCL-5 → DMQ-R-SF Enhancement motives subscale (c)	.46	.002	.65	−.008	.01
	PCL-5 → DMQ-R-SF Enhancement motives subscale (c’)		.0001	.98	−.01	.01
	PCL-5 → DERS → DMQ-R-SF Enhancement motives subscale (a*b)		.002		−.002	.01
DMQ-R-SF: Conformity motives subscale	PCL-5 → DERS (a)	.28**	.30	<.001	.20	.40
	DERS → DMQ-R-SF Conformity motives subscale (b)	.26*	.02	.008	.01	.04
	PCL-5 → DMQ-R-SF Conformity motives subscale (c)	.24	.01	.084	−.001	.02
	PCL-5 →DMQ-R-SF Conformity motives subscale (c’)		.004	.48	−.01	.02
	PCL-5 → DERS → DMQ-R-SF Conformity motives subscale (a*b)		.01		.002	.01
DMQ-R-SF: Social motives subscale	PCL-5 → DERS (a)	.30**	.29	<.001	.19	.38
	DERS → DMQ-R-SF Social motives subscale (b)	.38	−.0001	.99	−.02	.02
	PCL-5 → DMQ-R-SF Social motives subscale (c)	.38	−.01	.30	−.02	.01
	PCL-5 → DMQ-R-SF Social motives subscale (c’)		−.01	.33	−.02	.01
	PCL-5 → DERS → DMQ-R-SF Social motives subscale (a*b)		.00		−.005	.01

Note.

^**p < .001

^*p <.05.

The standard error and 95% CI for a*b are obtained using the bootstrapping technique with 5000 resamples. PCL-5 (PTSD symptom severity) is the predictor in all models. DERS (emotion regulation difficulties) is the indirect predictor in all models. CI (lower) is the lower bound of a 95% CI; CI (upper) is the upper bound of a 95% CI. Path a indicates effect of X on M; b, effect of M on Y controlling for X; c, effect of X on Y; c’, direct effect of X on Y, controlling for M. All total, direct, and indirect paths are noted after controlling for the variance accounted for by theoretically relevant covariates. Model 1 includes trauma load; the remaining models include trauma load and alternate alcohol use motives. PCL-5 = PTSD Checklist for DSM-5; DERS = Brief Difficulties in Emotion Regulation Scale; AUDIT = Alcohol Use Disorders Identification Test; DMQ-R-SF = Drinking Motives Questionnaire Revised Short Form.

With regard to alcohol use coping motives, a significant total effect of PTSD symptom severity alcohol use coping motives was found. Further, there was a significant positive indirect effect of PTSD symptom severity on coping-related alcohol use motives via emotion regulation difficulties. Specifically, PTSD symptom severity was significantly and positively related to emotion regulation difficulties, and emotion regulation difficulties was significantly and positively associated with coping motives.

There was not a significant total effect of PTSD symptom severity on alcohol use enhancement motives. The indirect effect of PTSD symptom severity on enhancement-related alcohol use motives through emotion regulation difficulties was not significant. PTSD symptom severity was significantly and positively associated with emotion regulation difficulties, but emotion regulation difficulties was not significantly related to enhancement motives.

Similarly, a significant total effect of PTSD symptom severity on alcohol use conformity motives was not established. The indirect effect of PTSD symptom severity on conformity-related alcohol use motives through emotion regulation difficulties was significant. PTSD symptom severity was significantly and positively related to emotion regulation difficulties, and emotion regulation difficulties was significantly and positively associated with conformity motives.

Lastly, a significant total effect of PTSD symptom severity on social alcohol use motives was not established. Also, there was not significant indirect effect of PTSD symptom severity on social motives for alcohol use through emotional regulation difficulties.

Discussion

Consistent with hypotheses, PTSD symptom severity was positively associated with alcohol use severity, suggesting Black/African American students with elevated PTSD symptomatology reported greater alcohol use. Additionally, PTSD symptom severity was associated with alcohol use severity via emotion regulation difficulties. This is consistent with research indicating that emotion regulation difficulties may explain the link between PTSD symptom severity and alcohol use (Hawn et al., 2020; Hitch et al., 2021). Exposure to various race-related stressors may be associated with greater emotion regulation difficulties as well as alcohol use among Black/African American adults due to heightened allostatic load (English et al., 2018; Miller et al., 2021). This underscores the importance of incorporating indices of race-related stress, racial trauma, and racial discrimination in extensions of this work (Pieterse et al., 2022; Williams et al., 2021) and to design studies to explicitly understand the psychological impacts of cultural and systemic stressors on PTSD symptomatology, emotion regulation, and alcohol use (Robertson & Carter, 2022). Indeed, emerging research has highlighted the importance of considering the role of emotion regulation difficulties in PTSD among Black/African American individuals (Carter et al., 2020; Weiss et al., 2013).

Furthermore, as expected, PTSD symptom severity was positively associated with coping motives for alcohol use, indicating those reporting higher PTSD symptomatology also reported increased motivation to drink as a way of coping with negative affect. PTSD symptom severity was indirectly associated with coping motives via emotion regulation difficulties. Thus, Black/African American students with PTSD symptomatology may experience greater difficulties regulating emotions as a result of PTSD symptoms and the additive stress of racial trauma, and thus be more likely to use alcohol to cope with negative emotional states. Among Black/African American students with a history of trauma exposure, the cumulative burden of race-related stressors may have important implications for emotion regulation difficulties and PTSD (Brooks Holliday et al., 2020; Ebersole al., 2012; Wilson & Gentzler, 2021). Indeed, biopsychosocial perspectives suggest these difficulties may deplete adaptive coping strategies, thereby increasing the possibility that students may drink alcohol in an effort to avoid negative emotions (Buckner et al., 2021).

PTSD symptom severity was positively associated with conformity motives for alcohol use, suggesting that students reporting increased PTSD symptoms also reported elevated motivation to drink for conformity reasons (e.g., to “ft in”). Although not anticipated, there was an indirect effect of PTSD symptom severity on conformity motives via emotion regulation difficulties. Using alcohol for conformity purposes is related to higher alcohol-related problems among Black/African American students (Gardner et al., 2020). Theoretically, those with PTSD symptoms may experience heightened emotion regulation difficulties and subsequently drink to avoid aversive social consequences, such as being ostracized by peers, perhaps to reduce possible sources of additive stress. Social belongingness is indeed an important aspect of the college experience and may impact alcohol use (Gopalan & Brady, 2020; Torgerson et al., 2018), and Black/African American students rely on their peers and campus student groups as vital sources of social support (Goodwill et al., 2022). Although Black/African students may be less likely to use alcohol and/or to attend drinking-related events, as compared with white students (Greene & Maggs, 2020), they may experience increased motivation to drink as one way to avoid social exclusion and to “fit in” (Gardner et al., 2020). This may be especially relevant for Black/African American students who are already experiencing difficulties regulating emotions due to PTSD symptomatology (Gardner et al., 2020).

Findings also suggested that PTSD symptom severity was not associated with enhancement motives or social motives for alcohol use, which supports the notion that avoidance-oriented (vs. approach-oriented) alcohol use motives may be more relevant for Black/African American students with PTSD symptomatology. Thus, among Black/African American students, emotion regulation difficulties may not explain why some students with PTSD symptomatology drink to enhance positive mood or to obtain social rewards. Furthermore, approach-oriented motives are related to drinking to enhance a positive mood or to obtain social rewards (e.g., “have fun at a party”; Cooper et al., 2008). Indeed, Black/African American students may be less likely to drink in social situations and drinking culture on college campuses may often occur in environments that are primarily dominated by white students (Greene & Maggs, 2020). Theoretically, Black/African American students who use alcohol may be more motivated to do so to cope with negative affect or to avoid social censure than to enhance positive mood. Replication and extension of this work is necessary, and it would be helpful to leverage ecological momentary assessment methodologies to assess daily relations among PTSD symptoms, alcohol use and motivations for use, emotion regulation, and racial trauma and stress.

Although not the primary study aims, several additional findings are worthy of note. First, nearly 24% of the sample met criteria for probable PTSD (indexed by a score of 33 or greater on the PCL-5; Bovin et al., 2016), which approximates the rate (37.1%) found by Weiss and colleagues (2013) in a sample of trauma-exposed Black/African American college students enrolled at a historically black university. Twenty-five percent of the sample met criteria for hazardous alcohol use (indexed by a score of 8 or greater on the AUDIT; Saunders et al., 1993). Other work has found higher rates, with 39.8% of African American students and 43.4% of Afro-Caribbean students in the sample reporting hazardous alcohol use (Bowman Heads et al., 2018). Further, the mean trauma load score (M = 5.2, SD = 3.3) was higher than that found by Cusack and colleagues’ (2020) large sample of college students with a history of alcohol use and trauma exposure (M = 2.0, SD = .98). The mean PTSD symptom severity score (PCL-5 total score = M = 17.6; SD = 16.7) was less than that of a primarily white sample of trauma-exposed college students (M = 22.02, SD = 17.52; Paltell et al., 2020). Taken together, these findings underscore the importance of building our understanding of factors related to alcohol use among Black/African American college students and the role of PTSD symptomatology, emotion regulation, and racial trauma and stress in those associations (Miller et al., 2021).

Results should be considered in light of study limitations. First, the study relied exclusively on self-report measures and utilized a cross-sectional design. Thus, inferences about temporality or causality cannot be made, and method variance or social desirability bias cannot be ruled out. Future work should integrate experimental or longitudinal designs as well as interview-based measures of symptomatology to better understand relations of these variables. For example, future work may integrate the Clinician Administered PTSD Scale for DSM-5 (Weathers et al., 2013), which considered the gold standard in PTSD assessment, to determine presence of a Criterion A index trauma (APA, 2013). Second, and relatedly, the measures utilized are well-established but psychometric support for their validity among Black student samples is limited, underscoring the importance of culturally informed measure development and validation. Third, the current study was conducted among a non-clinical sample of university students, potentially limiting generalizability to clinical or community samples of Black/African American individuals. Fourth, we did not include Hispanic/Latinx Black individuals in the current project, limiting generalizability to adults who identify as Black and Hispanic/Latinx. Fifth, our sample was predominantly comprised of students who self-identified as female, and it is important to conduct extend this work to various genders. Sixth, the enhancement subscale of the DMQ-R-SF demonstrated only fair internal consistency in the current study, potentially highlighting the need for psychometric work focusing on validation of the DMQ-R-SF for use among Black/African American adults. Seventh, we did not include measures of racism, racial discrimination, racial trauma, acculturative stress, or social support, thus limiting our ability to more definitely extrapolate upon the impacts of these important factors on the models tested. It is important for future studies to integrate mixed-methods designs to assess culturally-relevant variables using both quantitative and qualitative methodologies (e.g., Pieterse et al., 2022). Future work may aim to evaluate the efficacy of emotion regulation skills in targeting alcohol use severity and alcohol use motives among Black/African American college students. Furthermore, future directions may include exploring explanatory factors (e.g., coping motives, emotion regulation, experiential avoidance) that may be involved in the association between PTSD symptoms and alcohol outcomes. Indeed, this line of inquiry has the potential to advance culturally informed treatments for PTSD and alcohol-related symptomatology.

Figure 1.

Model Reflecting Proposed Hypotheses Note. PTSD = posttraumatic stress disorder; PCL-5 = PTSD Checklist for DSM-5; DERS = Brief Difficulties in Emotion Regulation Scale; AUDIT = Alcohol Use Disorders Identification Test; DMQ-R-SF = Drinking Motives Questionnaire Revised Short Form.