Daily state distress tolerance and alcohol use motivation among individuals with posttraumatic stress disorder symptoms who endorse hazardous alcohol use.

Objective: Hazardous drinking and posttraumatic stress disorder (PTSD) are both highly prevalent and frequently comorbid conditions that result in more severe outcomes than either individual condition. It is therefore a priority to identify malleable treatment mechanisms that may underlie the hazardous drinking–PTSD comorbidity to inform evidence-based intervention efforts. Distress tolerance (DT), or the perceived ability to withstand negative affect states, is theoretically relevant to both hazardous drinking and PTSD symptoms. DT is relatively stable, but recent work indicates that it also maintains statelike qualities. Past work has not examined state DT as it relates to PTSD symptoms and comorbid hazardous drinking. Method: The present study employed a national sample of adults with PTSD symptoms who endorsed hazardous alcohol use (N = 85; 71.8% female). Multilevel structural equation modeling (MSEM) was used to investigate the following aims using ecological momentary assessment over a 21-day period: examine whether lower state DT mediates the association between PTSD symptoms at baseline and latent variables of (a) alcohol use motivation (i.e., coping motives, craving, intention to drink) and (b) hazardous drinking behavior (i.e., consumption, drink recency, negative consequences). Results: A statistically significant indirect effect was observed such that higher baseline PTSD severity was associated with greater alcohol use motivation via lower state DT; however, this indirect effect was not significant for the model examining hazardous drinking behavior. Conclusions: Results underscore the importance of assessing state DT in clinical interventions that support individuals managing PTSD symptoms and the craving, intention, and motivation to drink due to these symptoms as they navigate momentary challenges to engage with or avoid distress.