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. Author manuscript; available in PMC: 2021 Mar 26.
Published in final edited form as: Exp Clin Psychopharmacol. 2019 Sep 26;28(3):328–336. doi: 10.1037/pha0000321

A Model of Reinforcement Sensitivity, Impulsivity, Alcohol Use, and Risky Sexual Behavior in a Sample of Young Adult Drinkers

Austin M Hahn 1,2, Raluca M Simons 3, Jeffrey S Simons 3, Logan E Welker 3
PMCID: PMC7096258  NIHMSID: NIHMS1045600  PMID: 31556678

Abstract

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 SP (sensitivity to punishment) × SR (sensitivity to reward) 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.

Keywords: reward sensitivity, punishment sensitivity, negative urgency, positive urgency, alcohol, risky sexual behavior

Risky sexual behavior among college students is a significant public health concern. According to the American College Health Association (2015), 51% of college students reported not using a condom and 48% reported not using any form of contraceptive the last time they had vaginal intercourse. Accordingly, young adults (e.g., persons under the age of 25) account for approximately half of all new sexually transmitted infections (STI; Satterwhite et al., 2013; Forhan et al., 2009). Alcohol use, and the disinhibition association with intoxication, has been identified as a strong predictor of risky sexual behavior (Elifson, Klein, & Sterk, 2006; Hipwell, Stepp, Chung, Durand, & Kennan, 2012; Patrick & Maggs, 2009; Simons, Simons, Maisto, Hahn, & Walters, 2018; Turchik, Garske, Probst, & Irvin, 2010). Engaging in problematic drinking and risky sexual behavior can come with significant cost, not only to the individual, but also to society as a whole. Understanding the etiological process and the role of underlying personality risk factors (e.g., reinforcement sensitivity and emotion-based impulsivity) is essential to improving safer alcohol consumption and expression of sexuality among young adults.

Reward and Punishment Sensitivity

Gray’s Reinforcement Sensitivity Theory (RST; Gray, 1991) may be especially relevant to understanding the relationship between alcohol use and risky sexual behavior. The RST posits three systems (behavioral activation system [BAS], behavioral inhibition system [BIS], and fight-flight-freezing system [FFFS]) that influence an individual’s behavioral decision making. Sensitivity to reward (SR) is derived from the BAS, suggesting that individuals high in SR will show a greater propensity to engage in behaviors associated with reward (Gray, 1970; Gray, 1982; Gray and McNuaghton, 2000). Conversely, sensitivity to punishment (SP) is conceptualized as synergistic elevation in both the BIS and FFFS, leading some researchers to theorize that higher SP may act as a protective factor against high-risk behaviors (Corr, 2001; Coor, 2004; Gray, 1991; Franken & Muris, 2006). As such, SP and SR may be important personality characteristics associated with both alcohol use and risky sexual behavior.

Although SP has been theorized as a potential protective factor against problematic behavior, findings have not been consistent. For example, multiple studies have found an inverse relationship between SP and substance use (Lyvers, Hasking, Albrecht, & Thorberg, 2012; Jonker et al., 2014; Simons & Arens, 2007; Wray, Simons, & Dvorak, 2011). However, several other studies have found no associations between SP and substance use (Lyvers et al., 2011), while some even found positive associations (Knyazev, 2004; Voigt et al., 2009). This inconsistency may be due to intermediate negative reinforcement mechanisms that are associated with both SP and substance use, in which SP could indirectly increase substance use. Specifically, SP is associated with greater levels of emotion dysregulation and trait negative affect (Erdle & Rushton, 2010; Smillie, Pickering, & Jackson, 2006), two factors often associated with problematic substance use (Simons, Gaher, Oliver, Bush, & Palmer, 2005; Simons, Wills, & Neal, 2014).

SR may also be an important contributor to the complexity of the relationship between SP and problematic outcomes. SR is consistently associated with increased alcohol use (Jonker, Ostafin, Glashouwer, van Hemel-Ruiter, & de Jong, 2014; Lyvers, Duff, & Hasking, 2011; van Hemel-Ruiter, de Jong, & Wiers, 2015). It has been theorized that higher levels of SR increase a person’s likelihood to associate alcohol-related cues to reward, subsequently increasing alcohol use (Kabbani & Kambouropoulos, 2013; Palfai & Ostafin, 2003; Smith & Anderson, 2001). Moreover, SR is associated with greater positive alcohol-related expectancies (Gullo, Dawe, Kambouropoulos, Staiger, & Jackson, 2010), appetitive motivation (Kambouropolous & Staiger, 2004), and receptiveness to the stimulatory effects of alcohol (Dawe, Gullo, & Loxton, 2004), all of which would increase subsequent alcohol use.

The RST suggests that the interaction between SP and SR can more accurately predict behavior, due to the conditional effect one has on the other (Corr, 2004). A growing amount of literature has examined this interaction in relation to substance use. Some studies have found positive associations between SP and problematic outcomes that is strengthened at higher levels of SR (O’Connor, Stewart, Marlatt, 2009; Wardell et al., 2011). However, other studies have found an inverse relationship between SP and substance use that it weakened at high levels of SR (Simons & Arens, 2007; Simons, Dvorak, & Batien, 2008). Thus, although there is a general trend in the aforementioned findings with regard to the effect of SR, the relationship between SP and substance use is still unclear. Research indicates that high SP is associated with increased trait negative affect (Erdle & Rushton, 2010; Smillie et al., 2006), while high SR is associated with elevated trait positive affect (Carlson, Pritchard, & Dominelli, 2013; O’Connor, Colder, & Hawk, 2004). The RST’s joint subsystems hypothesis suggests that high levels of both SP and SR may lead to dysregulated emotional functioning (Corr, 2001; 2004). As such, high levels of both SP and SR would likely be associated with greater emotion-based impulsivity (i.e., positive and negative urgency). An important step in better understanding the relationships between reinforcement sensitivity and risk behaviors (e.g., alcohol use and risky sexual behavior) may be to incorporate intermediate personality-related mechanisms (i.e., emotion-based impulsivity) that may mediate these associations.

Impulsivity

Individual differences in impulsivity play an important role in excessive alcohol use and subsequent problematic outcomes, such as risky sexual behavior. Positive and negative urgency, two facets of impulsivity, are recognized as strong predictors of both alcohol use and associated behavioral dysregulation (Deckman & DeWall, 2011; Derefinko et al., 2014; Hahn, Simons, & Hahn, 2016; Simons, Maisto, & Wray, 2010). Negative urgency refers to an individual’s inclination to engage in impulsive behavior expression in response to intense negative emotionality (Whiteside & Lynam, 2001). On the other hand, positive urgency refers to the propensity to engage in impulsive behavior in response to intense positive emotionality (Cyders & Smith, 2007). Both positive and negative urgency have been linked to alcohol misuse (Cyders & Smith, 2008; Grimaldi, Napper, & LaBrie, 2014). However, recent research indicates that individuals high in positive urgency may have a propensity to consume a greater amount of alcohol and subsequently experience problems, while those high in negative urgency experience more alcohol-related consequences regardless of quantity of alcohol consumption (Hahn, Simons, Hahn, 2016; Shishido, Gaher, & Simons, 2013).

Emotion-based dysregulation has also been investigated in relation to risky sexual behavior. For instance, Bancroft and colleagues (2003) found that negative mood was associated with greater likelihood of seeking sexual partners or engaging in casual sex among a sample of gay men. Moreover, positive emotional states are also associated with a greater likelihood to engage in risky behaviors such as drug and alcohol use and sexual activity (Cyders, Rainer, & Smith, 2009). Thus, individuals who tend to act rashly in response to either intense positive or negative emotions would likely be at an increased risk to engage in risky sexual behavior. Consistent with this notion, research shows a significant association between negative urgency and risky sexual behavior (Derefinko et al., 2014). In fact, studies by both Deckman and Dewall (2011) and Simons, Maisto, & Wray (2010) revealed a significant effect of negative urgency on risky sexual behavior over and above the effect of alcohol use. Positive urgency has also been identified as a predictor of risky sexual behavior (Zapolski et al., 2009), however there has been less attention given to the relationship between positive urgency and risky sex, and the findings have not been completely conclusive. For example, Simons et al. (2010) found positive urgency to be associated with unprotected sex in women, but not in men. Evidently, both positive and negative urgency may be important factors with regard to both alcohol-related outcomes and risky sexual behavior. Examining both facets of urgency as mediators between SP/SR and subsequent alcohol use and risky sexual behavior may aid in a better understanding these relationships.

Current Study

The current study tested a structural equation model linking reinforcement sensitivity, impulsivity (i.e., positive and negative urgency), alcohol use, and risky sexual behavior. A SP × SR interaction was hypothesized to predict positive and negative urgency. Specifically, we expected the effect of SP on both types of urgency to be conditional on levels of SR, such that SP would have the strongest positive effects on positive and negative urgency at high levels of SR. Moreover, positive and negative urgency were hypothesized to mediate the conditional effects of SP and SR on alcohol use and risky sexual behavior.

Method

Participants

Participants were 753 undergraduates from the University of South Dakota. The inclusion criteria for the current study were that participants must have been between the ages of 18 and 25 years and report consuming alcohol at least once per average week during the past three months. The University of South Dakota IRB approved all procedures for the current study (Protocol Number: 2014.207; Study Title: Reaction Time and Behavior). Approximately 69% of the sample were women. The mean age was 19.87 (SD=1.50). Ninety-three percent of the sample were white, 2% was black, 1% was Asian, 1% was Native American, and 3% was multiracial. Two percent of the sample was Latino. The demographic distribution of the sample was consistent with the student population at the University of South Dakota. Participants were recruited through an online scheduling system. All questionnaires were completed online. The reliability and validity for the online assessment of personality characteristics and alcohol use have been supported by prior research (Gosling, Vazire, Srivastava, & John, 2004). A total of 1,190 participants participated in the study, but only 753 participants who met the inclusion criteria were included in the analyses. A subset of this sample participated in an intervention study, which has been reported previously (Hahn, Simons, Simons, Wiers, & Welker, 2019).

Measures

Reward and Punishment Sensitivity.

Reward and punishment sensitivity were assessed using the Sensitivity to Punishment/Sensitivity to Reward Questionnaire (SPSRQ; Torrubia et al., 2001). The SPSRQ has 48 yes/no items, with each subscale containing 24 items. Cronbach’s alpha coefficients were .83 for reward sensitivity and .87 for punishment sensitivity. Latent variables were created for reward sensitivity and punishment sensitivity using parceling with each latent variable having three parcels. Parcels were created based on item-test correlations (Little, Cunningham, Shahar, & Widaman, 2002).

Positive and Negative Urgency.

Positive and negative urgency were assessed using the positive and negative urgency subscales of the UPPS-P Impulsive Behavior Scale (Lynam et al., 2007). The UPPS-P has 59 total items rated on a four-point Likert scale. The negative and positive urgency subscales have 12 and 14 items, respectively. The Cronbach’s alpha coefficients were .89 for negative urgency and .94 for positive urgency. Latent variables were created for the negative urgency and positive urgency latent variables using parceling, with each latent variable having three parcels. Parcels were created based on item-test correlations (Little et al., 2002).

Alcohol Use.

The latent variable for alcohol use was comprised of weekly alcohol consumption over the past three months, the AUDIT-C (i.e., alcohol consumption over the past year), and the number of days binge drinking during the past 30 days. Average weekly alcohol use was assessed using the Daily Drinking Questionnaire-Modified (DDQ-M; Dimeff et al., 1999). Participants reported the number of drinks they consumed on a seven-day grid. The grid represented each day of the week (i.e., Monday-Sunday) during an average week over the last three months. Average weekly alcohol use was calculated as the total number of drinks reported across the seven-day grid. The DDQ-M is a validated measure with good reliability (Baer, Kivlahan, Blume, McKnight, & Marlatt, 2001; Marlatt et al., 1998). The AUDIT-C is a validated three-item alcohol screen to assess quantity of alcohol consumption over the past year (Bush et al., 1998; Bradley et al., 2003; Saunders, Aasland, Babor, de la Fuente, & Grant, 1993). Binge drinking over the past 30 days was assessed by two questions. Women were asked how many days over the past 30 days did they consume four or more standard drinks during one drinking episode. Men were asked how many days over the past 30 days they consumed five or more standard drinks.

Risky Sexual Behavior.

Risky sexual behavior was assessed using the Sexual Risk Survey (SRS; Turchik & Garske, 2009). The SRS has 23-items used to measure the frequency of sexual risk behaviors. The scoring was completed through recoding based off a large-scale multi-university standardization (Turchik, Walsh, & Marcus, 2014). The latent variable for risky sexual behavior was comprised of three subscales from the SRS (Sexual Risk Taking with Uncommitted Partners [eight items], Impulsive Sexual Behaviors [five items], and Intent to Engage in Risky Sexual Behaviors [two items]).

Statistical Analyses

Preliminary data cleaning and descriptive analyses were conducted using Stata 15 (StataCorp, 2017). The range and distribution of variables was examined. Data cleaning and examination was conducted using procedures outlined by Tabachnick and Fidell (2007). Structural equation modeling (SEM) was conducted using Mplus 7.4 (Muthen & Muthen, 2015) using full information maximum likelihood with robust standard errors (MLR), which allows for the inclusion of missing data. Lastly, indirect effects were also calculated for this path analysis using bias-corrected bootstrap confidence intervals. A two-step approach was utilized, such that the measurement model was examined followed by the structural model (Kline, 2011). Goodness of fit, or how accurately the observed relationships match the model relationships, was measured using fit statistics.

Results

Descriptive Statistics

Descriptive statistics are shown in Table 1 and a correlation matrix is shown in Table 2. The average number of drinks per week was 13.00 (SD = 12.50). Male participants scored higher on all variables except sensitivity to punishment. Alcohol use and risky sexual behavior had positive significant associations with all predictor variables except for SP.

Table 1.

Descriptive Statistics

Predictor M(SD) Skew Kurtosis
SP
 Parcel 1 0.54(0.29) −0.08 2.07
 Parcel 2 0.49(0.29) 0.04 2.07
 Parcel 3 0.46(0.30) 0.15 2.06
SR
 Parcel 1 0.38(0.30) 0.32 2.09
 Parcel 2 0.40(0.27) 0.27 2.29
 Parcel 3 0.49(0.28) 0.08 2.12
Negative Urgency
 Parcel 1 0.99(0.67) 0.29 2.77
 Parcel 2 2.27(0.71) 0.18 2.40
 Parcel 3 2.28(0.69) 0.19 2.59
Positive Urgency
 Parcel 1 1.97(0.65) 0.61 2.98
 Parcel 2 1.79(0.72) 0.74 2.90
 Parcel 3 1.87(0.72) 0.67 2.94
Alcohol Use
 DDQ-M 13.00(12.50) 3.02 7.95
 Binge Drinking 3.57(3.86) 1.80 7.09
 AUD-C 5.36(2.49) 0.23 2.28
Risky Sexual Behavior
 Uncommitted Partners 5.75(6.83) 1.47 4.73
 Impulsive Sexual Acts 5.02(4.84) 1.05 3.43
 Intent to Engage in Risky Sex 1.16(1.87) 1.74 5.48
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Note. N = 753. Sex is coded 0 = female, 1 = male.

Table 2.

Correlation Matrix for Indicators

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18.
1. Gender
2. SP-1 −.21‡
3. SP-2 −.07† .66‡
4. SP-3 −.06 .65‡ .69‡
5. SR-1 .16‡ .21‡ .26‡ .27‡
6. SR-2 .23‡ .12§ .21‡ .23‡ .68‡
7. SR-3 .22‡ .10§ .16‡ .19‡ .57‡ .60‡
8. NU-1 .02 .14‡ .25‡ .22‡ .26‡ .20‡ .16‡
9. NU-2 −.01 .23‡ .32‡ .26‡ .26‡ .20‡ .12‡ .75‡
10. NU-3 .09† .16‡ .29‡ .23‡ .31‡ .24‡ .22‡ .70‡ .76‡
11. PU-1 .17‡ .04 .19‡ .10§ .27‡ .24‡ .17‡ .57‡ .66‡ .70‡
12. PU-2 .22‡ −.02 .13‡ .03 .25‡ .25‡ .16‡ .51‡ .60‡ .62‡ .83‡
13. PU-3 .17‡ −.01 .11§ .02 .28‡ .24‡ .18‡ .56‡ .60‡ .64‡ .85‡ .84‡
14. DDQ-M .28‡ −.06 −.00 .02 .17‡ .19‡ .18‡ .19‡ .17‡ .19‡ .24‡ .23‡ .22‡
15. Binge .21‡ −.03 .01 −.00 .18‡ .16‡ .12§ .19‡ .17‡ .21‡ .22‡ .22‡ .22‡ .59‡
16. AUD-C .36‡ −.06 .02 −.02 .21‡ .23‡ .19‡ .22‡ .21‡ .24‡ .24‡ .25‡ .25‡ .65‡ .63‡
17. SRS-1 .13‡ −.08 −.04 .00 .21‡ .15‡ .06 .20‡ .18‡ .22‡ .24‡ .24‡ .24‡ .27‡ .33‡ .31‡
18. SRS-2 .19‡ −.05 −.02 .02 .26‡ .23‡ .12§ .20‡ .22‡ .26‡ .27‡ .27‡ .25‡ .32‡ .38‡ .37‡ .72‡
19. SRS-3 .28‡ −.06 .01 .01 .24‡ .23‡ .11§ .13‡ .20‡ .20‡ .26‡ .27‡ .23‡ .27‡ .31‡ .33‡ .53‡ .66‡
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Note. N = 753. Men = 1 (n = 232), Women = 0 (n = 521). SR = Sensitivity to Reward. SP = Sensitivity to Punishment. NU = Negative Urgency. PU = Positive Urgency. SRS-1 = Sex with Uncommitted Partners. SRS-2 = Impulsive Sex Acts. SRS-3 = Intent to Engage in Risky Sex. SP-1–3, SR-1–3, NU-1–3, and PU-1–3 refer to parcels.

†

p <.05

§

p < .01

‡

p <.001.

Measurement Model

The hypothesized measurement model contained 18 observed variables and six latent variables: SP, SR, positive urgency, negative urgency, alcohol use, and risky sexual behavior. Each latent variable had three indicators constructed of existing subscales or parcels. The latent construct of risky sexual behavior was comprised of three of the SRS subscales: Sexual Risk Taking with Uncommitted Partners, Impulsive Sexual Behaviors, and Intent to Engage in Risky Sexual Behaviors. The latent variable for alcohol use was comprised of weekly alcohol use, number of binge drinking episodes in the last month, and the AUD-C. Latent variables were created for reward sensitivity, punishment sensitivity, negative urgency, and positive urgency using parceling with each latent variable having three parcels. Parcels were created based on item-test correlations (Little et al., 2002). The initial measurement model was a good fit to the data, χ2(120, N = 753) = 248.04, p < .001; RMSEA = .038, 90% CI[ .031, .044]; CFI = .981; SRMR = .031. The indicators loaded well onto each latent variable with standardized factor loadings ranging from .71 (SR parcel 3) to .93 (Impulsive Sexual Behaviors).

Structural Model

Figure 1 presents the structural model. SP, SR, and sex of participant were exogenous variables. Sex was included as a covariate with paths to all endogenous variables. Direct paths were specified from SP and SR to both positive and negative urgency. An additional direct path was specified from positive urgency to alcohol use, and direct paths from negative urgency and alcohol use to risky sexual behavior were included. Positive and negative urgency disturbance terms were allowed to covary. The structural model was a good fit to the data, χ2(138, N = 753) = 364.80, p < .001; RMSEA = .047, 90% CI[ .041, .053]; CFI = .968; SRMR = .046. Next, a SP × SR latent variable interaction was introduced to the model with paths to positive urgency and negative urgency.

Figure 1.

Figure 1.

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Structural model (N = 753). All values are standardized coefficients. Solid lines represent significant paths, dashed indicates non-significance. *p<.05, **p<.01, ***p<.001. The disturbance terms for negative and positive urgency were allowed to covary and sex was included as a covariate. These paths were omitted for clarity.

Direct Effects.

As hypothesized, there was a significant SP × SR interaction on both positive and negative urgency. Conditional effects of SP on both types of urgency were calculated at low (i.e., 1 SD below the mean), mean, and high (i.e., 1 SD above the mean) levels of SR. At the mean of SR, SP was significantly associated with negative urgency (b = 0.28, p < .001), but was not significantly associated with positive urgency (b = −0.03, p = .544). At high levels of SR, SP was significantly associated with both positive urgency (b = 0.13, p = .033) and negative urgency (b = 0.37, p < .001). Interestingly, at low SR, SP had a significant negative association with positive urgency (b = −0.19, p = .003), but had a significant positive association with negative urgency (b = 0.18, p < .014). The interactions are depicted in Figure 2.

Figure 2.

Figure 2.

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Direct effects of punishment sensitivity on positive and negative urgency as a function of reward sensitivity. Low SR = reward sensitivity −1 SD. High SR = reward sensitivity +1 SD.

Positive urgency had a significant direct effect on alcohol use, while negative urgency and alcohol had significant direct effects on risky sexual behavior. Men reported higher levels of positive urgency (β = 0.13, p = .001) and alcohol use (β = 0.32, p < .001). However, participant sex was not significantly associated with negative urgency (β = 0.01, p = .793) or risky sexual behavior (β = 0.06, p = .200).

Indirect Effects.

The indirect effects were calculated using bias-corrected bootstrapping (MacKinnon, Lockwood, & Williams, 2004) in Mplus 7.4 (Muthén & Muthén, 2015). Positive and negative urgency mediated all effects of SP and SR on alcohol use and risky sexual behavior. Specifically, at low SR, SP had a negative indirect effect on alcohol use. At mean SR, SP had a positive indirect effect on risky sexual behavior. At high SR, SP had positive indirect effects on both alcohol and risky sexual behavior. See Table 3 for conditional indirect effects of SP outcomes at varying levels of SR.

Table 3.

Conditional Indirect Effects of Punishment Sensitivity at Low, Mean, and High Levels of SR

Path b SE 95% CI
Low SR
SP → PU → ALC −.06 .02 [−.113, −.022]
SP → PU → ALC → Risky Sex −.02 .01 [−.056, −.010]
SP → NU → Risky Sex .03 .02 [.008, .071]
Mean SR
SP → PU → ALC −.01 .01 [−.039, .016]
SP → PU → ALC → Risky Sex −.00 .01 [−.019, .007]
SP → NU → Risky Sex .05 .01 [.027, .082]
High SR
SP → PU → ALC .04 .02 [.005, .074]
SP → PU → ALC → Risky Sex .02 .01 [.003, .037]
SP → NU → Risky Sex .07 .02 [.036, .109]
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Note. SP = Sensitivity to Punishment. SR = Sensitivity to Reward. ALC = Alcohol Use. PU = Positive Urgency. NU = Negative Urgency. Low SR = SR at −1 SD below the mean. High SR = SR at +1 SD above the mean. Effects were calculated using bias corrected bootstrapped confidence intervals. Significance is represented by a confidence interval that does not contain zero.

Discussion

In general, previous studies have found higher levels of SR to be associated with greater substance use (Jonker et al., 2014; Lyvers et al., 2011; van Hemel-Ruiter et al., 2015) and risky sexual behavior (Voigt et al., 2009), and the current findings were congruent. With regard to effects of SP, however, previous findings have been less consistent. This inconsistency may have been due, in part, to the examination of independent effects of SP without consideration of the interaction between SP and SR. Moreover, inconsistencies may be due to the lack of intermediate or mediating variables. The joint subsystems hypothesis suggests that emotional dysregulation and impulsivity occurs among people with high levels of both SP and SR (Corr, 2004). Indeed, the results are consistent with this theory, with the largest conditional effects of SP occurring at high levels of SR and emotion-based impulsivity fully mediating the effects of SP and SR on alcohol use and risky sexual behavior. The results indicate that SP may act as a protective factor, risk factor, or have no significant association with positive urgency depending on the level of SR. That is, at low levels of SR, SP is negatively associated with positive urgency and subsequently functions as a protective factor for alcohol use and risky sexual behavior. However, as SR increases, the relationship between SP and positive urgency strengthens and becomes positive, thus increasing risk for alcohol use risky sexual behavior. On the other hand, SP had a positive association with negative urgency, regardless of SR. However, as SR increased, the association between SP and negative urgency became stronger.

The differences between the interaction effect on positive and negative urgency is likely due to the unique relationships between reinforcement sensitivity and trait affectivity. Previous research suggests that heightened levels of SP are associated with greater negative affect (Erdle & Rushton, 2010; Smillie, et al., 2006), whereas high SR is associated with increased positive affect (O’Connor et al., 2004). As such, people high in both SP and SR likely experience competing emotional pressure. A person who is high in both SP and SR may engage in impulsive behavior as a way to eliminate or reduce the emotional valence during periods of intense negative affectivity, but may also engage in impulsive behavior during times of intense positive affect to enhance or sustain a rewarding emotional state.

Altogether, these findings suggest elevations in either SR or SP can increase one’s risk for alcohol use and risky sexual behavior, but the highest risk is among those with high levels of both SR and SP, due to the subsequent increase in emotion-based impulsivity. In general, being sensitive to reward is associated with increases in positive affectivity and life satisfaction (O’Connor et al., 2004). However, as SR increases, so too does risk for significant problematic outcomes. Similarly, having heightened sensitivity to punishment allows a person to inhibit behavior and to evaluate potential consequences. Nonetheless, high levels of SP are associated with emotional distress and negative affect (Corr, 2008; Gray, 1982).

Clinical Implications

The findings of the current study support previous reinforcement sensitivity research and also indicate that risk for problematic behavior may be highest at high levels of both SP and SR. However, the findings also demonstrated that the associations between reinforcement sensitivity and risk behavior were fully accounted for by positive and negative urgency, suggesting that emotional and behavioral dysregulation (i.e., positive and negative urgency) are core factors underlying alcohol use and risky sexual behavior. Considering the fact that positive and negative urgency mediated the associations between reinforcement sensitivity and both alcohol use and risky sexual behavior, preventative and clinical interventions that target these emotion-based impulsivity facets may be especially important. Specifically, negative urgency demonstrated a direct effect on risky sexual behavior. Thus, sexual health interventions that target negative urgency to increase one’s coping skills and subsequent ability to regulate and manage emotional responses could be effective means for reducing risk. For example, interventions that aim to increase distress tolerance skills (i.e., dialectical behavior therapy [DBT]; Linehan, 1993), could increase one’s ability to tolerate intense negative emotions without engaging in risky behavioral patterns. Positive urgency, on the other hand, was indirectly associated risky sexual behavior due to its effect on alcohol use. Thus, among people high in positive urgency, reductions in alcohol use would likely yield subsequent reductions in risky sexual behavior. Interventions that provide psychoeducation and develop skills to maintain long-term goal-directed behavior when experiencing heightened positive arousal could be particularly beneficial. As such, fully assessing and understanding the etiological factors underlying a person’s potentially hazardous behavior may increase the likelihood of treatment success in reducing problematic alcohol use and or risky sexual behavior. Importantly, the current study did not use a clinical population. As such, the clinical implications discussed above should be interpreted with caution.

Limitations and Directions for Future Research

Several limitations to this study should be noted. First, the current study used a college sample. Although alcohol use and risky sexual behavior are relatively common among college students, the results of this study may not generalize to young adults that are not college students. Additionally, the sample for this study consisted of predominantly white female college students. As such, it is unclear if the findings are consistent with more heterogeneous college populations. The current study also utilized a cross-sectional design. Finally, not excluding or controlling for past or present psychiatric diagnoses and other substance use is a limitation. Past or present psychiatric diagnoses and other substance use may confound the current findings due to unique associations between certain psychiatric diagnoses, variables included in the model, and other substance use. Future research employing different designs (e.g., experimental, longitudinal), varying covariates (e.g., psychiatric diagnosis), and a more diverse sample is needed to further clarify the strengths and limitation of the findings reported here.

Conclusion

The current study contributed to the literature in multiple ways. First, this study demonstrated the unique associations between reinforcement sensitivity and emotion-based impulsivity. Specifically, these findings supported the theory that elevated SP is associated with greater negative emotional dysregulation, while SR is associated with greater positive emotional dysregulation. Moreover, this study also demonstrated the SP × SR interaction as integral to understanding these associations. The current study also identified positive and negative urgency as mediators between reinforcement sensitivity and two behavioral outcomes, alcohol use and risky sexual behavior.

Public Significance Statement.

This study suggests that people who are high in both punishment sensitivity and reward sensitivity tend to act more impulsively when experiencing intense positive and negative emotions, and thus have the highest risk for problematic alcohol use and risky sexual behavior. Tolerance of emotional distress when experiencing negative emotions and maintaining long-term goal directed behavior when experiencing positive emotions may represent important treatment targets in risk reduction interventions.

Acknowledgements

This research was supported in part by grants from the National Institute on Alcohol Abuse and Alcoholism F31AA024025 (PI: Hahn) and R01AA017433 (PI: Simons), National Institute on Drug Abuse (T32NA007288), Center for Brain and Behavioral Research (PI: Hahn), and University of South Dakota Graduate School (PI: Hahn).

Footnotes

Conflict of Interest

No conflict declared

Findings from the current study were presented at the American Psychological Association 2017 Annual Meeting. A subset of the sample for the current study participated in a subsequent intervention study for which the findings were published in Clinical Psychological Science.

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