Brain Development and the Association between Stress and Alcohol Use. a Developmentally Informed Test of Negative Reinforcement Theory

Background:

Late adolescence/emerging-adulthood are developmental stages where risk-taking behavior is expected, but the consequences of such are often mis-understood. In particular, the act of self-medication using alcohol or other substances, typically begins with peer support, and can quickly become problematic when used for long term symptom relief. At the same time these developmental periods are full of external expectations and demands that include long-term career and life planning, without the benefit of a fully developed pre-frontal cortex, which is the part of the brain responsible for regulation of thoughts, actions and emotions (Arnsten, 2009). We also know perceived stress during these developmental periods can impact grey matter development in the pre-frontal cortex, and exposure to even mild stress that is not within the locus of control of the individual can degrade existing function, which is developmentally problematic.

The association between stress and alcohol use is well-established (Witkiewitz et al., 2018; Cooper et al., 1992). This association is consistent with negative reinforcement theory which suggests that alcohol relieves aversive states, of which stress may be one (Koob, 2013; Stasiewicz & Maisto, 1993).

Despite these known associations, questions remain. At what point in human development does the association between stress and alcohol appear? Does the association between stress and alcohol appear for problem levels of alcohol use or any alcohol use? Finally, what factors might mediate the association? Understanding the stress-alcohol association may help to inform multi-disciplinary intervention efforts aimed at preventing alcohol use initiation.

Methods: Data for the current analysis were drawn from a longitudinal study of young men (n=622) in high-poverty neighborhoods in a mid-sized northeastern U.S. city. The first wave used random-digit dialing and a variety of strategies were used to minimize attrition over the 12-year follow up. Three waves of data are used in the present analysis, with participants ages 16-28 included in analysis.

Participants were asked to rate the amount of stress in their lives and asked to report on the quantity and frequency of alcohol use. Psychosocial assessments were completed including: Brief Symptom Inventory (Derogatis, 1977), Buss-Durkee (1992) Hostility Inventory, and consequences of alcohol use. Structural equation modeling was conducted in MPlus (Muthén & Muthén, 2007).

Results: Participants reported high levels of stress and high levels of alcohol consumption and consequences. The association between stress and alcohol use appeared between ages of 17.89 and 19.28 and persisted through the third wave of the study. Structural equation modeling revealed a significant association between stress and any alcohol use and heavy drinking (5 or more drinks) increasing over time. The Buss-Durkee Hostility Inventory mediated the relationship between stress and alcohol use in waves 2 and 3. Stress predicted consequences of alcohol use in wave 3.

Implications: Findings suggest that emerging-adulthood may be an opportune time to intervene in the development of the stress-alcohol association. Effective intervention may be multidisciplinary, with primary care providers screening for stress and alcohol use and providing referral to behavioral health clinicians to promote adaptive strategies to cope with stress (Linn et al., 2023).