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Introduction Depression and problem drinking are comorbid in emerging adulthood, yet the processes that link them are not well understood. Research has argued that shame has a unique influence on the experience of problematic drinking, but this has rarely been assessed at the state level. Using ecological momentary assessments (EMAs), we assessed whether shame, and not guilt, mediated the association between baseline depression and alcohol use and problems. Methods One hundred and eighty-four emerging adults (Mage= 19.27) completed a 12-day EMA study. Multilevel models were used to test hypotheses. Results In a model with alcohol use as the outcome, there were no significant associations between shame or guilt and alcohol use at the within- or between-subjects level. In a model with alcohol problems as the outcome, guilt was positively associated with alcohol problems but only at the daily level. At the between-subjects level and after controlling for guilt, there was a significant association between depression, shame, and alcohol problems; average levels of shame mediated the association between depression and alcohol problems. In post-hoc reverse directionality models, average alcohol problems mediated the relationship between depression and shame and guilt at the between-person level. No mediation was present for alcohol use. Conclusion After controlling for guilt, shame is an emotion that helps explain risk for alcohol problems among depressed emerging adults, which has implications for targeted interventions. Reciprocal associations between shame, guilt, and alcohol problems emerged highlighting the need for more fulsome assessments of shame and guilt in future EMA research.

Aims Alcohol use follows a developmental trajectory—steadily increasing and peaking in the early stages of emerging adulthood (e.g. first year of university) and declining thereafter. While most individuals ‘mature out’ of problem drinking as they move through emerging adulthood, some continue to drink heavily and experience serious problems. Tension reduction theory identifies social anxiety (SA) as a potential risk factor for problem drinking during emerging adulthood. However, mixed data suggest that the associations between SA and drinking behaviours are not straightforward. Cross-sectional studies demonstrate that socially anxious emerging adults are at risk for problem drinking, but only if they are also high in trait impulsivity. This study aimed to expand on previous work by examining trait impulsivity as moderator of the prospective associations between SA and maturing out of problem drinking in emerging adulthood. Methods Undergraduates (N = 302) completed online self-reports at regular intervals (6-months) over an 18-month period, resulting in four waves of data. Results Unconditional latent growth curve models indicated that alcohol problems (but not use) declined linearly over time. Next, conditional growth curve models revealed that SA was associated with impeded maturing out of alcohol problems, but this effect was only present in socially anxious participants with high levels of trait impulsivity. Conclusion Our study advances growing literature on the crucial moderating role that impulsivity plays in the SA pathway to problem drinking. Clinical interventions for problem drinking among socially anxious students should both assess for and target concurrent impulsivity.

Aims Comorbid alcohol use and depression have the highest prevalence among emerging adults and are associated with a number of consequences. Self-medication theory posits individuals with depression use alcohol to cope with their negative emotions. Preliminary work has investigated the social context of depression-related drinking and found that solitary drinking is a risky, atypical behaviour in emerging adulthood that is associated with alcohol misuse. However, it is unknown about what is unfolding in the moment that is driving depression-related drinking in solitary contexts. Accordingly, we used an experimental study to examine if shame mediated the association between depression and in-lab alcohol craving. Methods Emerging adults (N = 80) completed a shame induction followed by an alcohol cue exposure in either a solitary or social condition. We used moderated mediation to test hypotheses. Results Consistent with hypotheses, conditional indirect effects supported the mediation of depression and alcohol craving through shame among those in the solitary condition, but not in the social condition. There was no support for guilt as a mediator. Conclusion Our study demonstrates that shame is a specific emotional experience that contributes to solitary drinking among depressed emerging adults. It is important to use these results to inform interventions that directly target solitary contexts and shame.

We conducted a longitudinal study to examine person-centered heterogeneity in problem drinking risk during the 2019 Coronavirus disease (COVID-19) pandemic. We aimed to differentiate high- from low-risk subgroups of drinkers during the pandemic, to report on the longitudinal follow-up of the baseline sample reported in Wardell et al. (Alcohol Clin Exp Res, 44, 2020, 2073), and to examine how subgroups of drinkers differed on coping-related and pre-pandemic alcohol vulnerability factors.Canadian alcohol users (N = 364) were recruited for the study. Participants completed surveys at four waves (spaced 3 months apart), with the first being 7 to 8 weeks after the COVID-19 state of emergency began in Canada. The data were analyzed using a parallel process latent growth class analysis followed by general linear mixed models analysis.We found evidence for three latent classes: individuals who increased drinking (class 1; n = 23), low-risk drinkers (class 2; n = 311), and individuals who decreased drinking (class 3; n = 30). Participants who increased (vs. those who decreased) problem drinking during the pandemic struggled with increasing levels of social disconnection and were also increasingly more likely to report drinking to cope with these issues. Those in the increasing class (relative to low-risk drinkers) reported increasing levels of depression during the study. Relative to low-risk drinkers, participants in the increasing class had higher pre-pandemic AUDIT scores, greater frequency of solitary drinking, and higher alcohol demand. Interestingly, participants in the decreasing class had the highest pre-pandemic AUDIT scores.We examined longitudinal data to identify subgroups of drinkers during the pandemic and to identify factors that may have contributed to increased problem drinking. Findings suggest that while most of the sample did not change their alcohol use, a small portion of individuals escalated use, while a small portion decreased their drinking. Identifying the vulnerability factors associated with increased drinking could aid in the development of preventative strategies and intervention approaches.

Background: Emerging adulthood is associated with heavy drinking. Despite overall heavy use, studies show considerable heterogeneity in emerging adult drinking habits. Lau-Barraco and colleagues (2016 b) identified three subtypes (high, moderate, low) of emerging adult heavy drinkers based on patterns of use across common drinking situations. Heavy situational drinkers had more alcohol problems, mental health symptoms, and coping/conformity motives for alcohol use.Objective: Our goal was to replicate and extend the aforementioned study, expecting to find the same subgroups, then examining whether certain risk factors predicted subgroup membership.Methods/Results: Undergraduates (N = 497) completed online self-report measures and a latent profile analysis (LPA) found support for three similar subtypes; low, "moderate" (higher endorsement of pleasant emotion/social pressure situations, relative to the low group), and high. Univariate ANOVAs, followed by pairwise comparisons, found that heavy situational drinkers scored highest on measures of alcohol problems, problem gambling, drug use, depression, and anxiety compared to the other two groups, and consistent with previous findings.Conclusions: This study showed that emerging adults who drink heavily across various situations are likely to engage in other addictive behaviors and struggle with mental health symptoms. Identifying one's personal risk factors and their riskiest drinking situations is critical for developing targeted intervention programs and increasing the understanding of the heterogeneous nature of drinking behaviors in emerging adults in Canada.

Young adulthood (ages 18 to 30 years old), a developmental age of exploration, is marked by new experiences and transitions. Cannabis use frequency is highest in young adulthood compared to other age periods. Social anxiety (characterized by fear, shyness, and inhibition in social situations where scrutiny and judgment is possible) is also prevalent during young adulthood. Social anxiety may be a complex predictor of cannabis use frequency and problems (e.g., any negative physical, emotional, or social outcome from use). Social anxiety may act as a risk factor as individuals may use cannabis frequently to manage their fear of negative evaluation and associated unpleasant affective states. The purpose of this meta-analysis was to quantify the magnitude of the associations between social anxiety and two cannabis variables (frequency of use and problems) in young adulthood. A comprehensive literature review was conducted to identify studies that included measures of social anxiety and at least one cannabis-related variable of interest among young adults. Eighteen studies were included in the meta-analysis. Results revealed a small, statistically significant positive association between social anxiety and cannabis problems (r = 0.197, k = 16, p =0.001), and a nonsignificant association between social anxiety and cannabis use frequency (r = 0.002, k = 16, p = 0.929). The association between social anxiety and cannabis use frequency was moderated by the mean age such that samples with older mean ages exhibited a stronger correlation. Additionally, the association between social anxiety and cannabis problems was moderated by clinically significant levels of social anxiety, such that samples with fewer participants who met clinical levels of social anxiety exhibit a stronger correlation. This meta-analysis supports the idea that there is a complex relation between social anxiety and cannabis outcomes during young adulthood.

An established body of literature indicates that children with autism spectrum disorder (ASD) have difficulty understanding figurative language due to a deficit in theory of mind, or the ability to consider the beliefs of other people. Children with ASD tend to similarly fail traditional theory of mind tasks which assess their ability to represent false beliefs. Our claim is, however, is that these tasks involve cognitive processing demands that might mask false belief understanding because they require elicited or verbal responses. We examined whether children with ASD demonstrate false-belief understanding when tested with a spontaneous-response false belief task which measures children’s eye gaze durations. The two child participant groups were composed of 20 males with ASD (aged 3 to 9 years) and 20 typically developing males (aged 2 to 5 years) who were individually matched according to verbal mental age. Children with ASD and typically developing children listened to a change-of-location story accompanied by a book with matching and non-matching pictures. The final page showed the character searching for her object in a location that was either consistent or inconsistent with her belief. Both groups of children looked reliably longer at the belief-consistent picture, regardless of whether the character’s belief was true or false, though children with ASD were slower to do so. We suggest that a spontaneous response assessment technique can potentially reveal figurative language comprehension in children with ASD in future research.

Dissociative symptoms and suicidality are transdiagnostic features of posttraumatic stress disorder (PTSD) and borderline personality disorder (BPD). The primary objective of this study was to examine associations between dissociation (i.e., depersonalization and derealization) and suicidality (i.e., self-harm and suicide attempts) among individuals with PTSD and BPD. We analyzed data from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III; N = 36,309). The Alcohol Use Disorder and Associated Disabilities Interview Schedule for DSM-5 was used to assess lifetime PTSD and BPD. Estimated rates of self-harm among individuals who endorsed dissociation were 15.5%-26.2% for those with PTSD and 13.7%-23.5% for those with BPD, and estimates of suicide attempts among individuals who endorsed dissociation were 34.5%-38.1% for those with PTSD and 28.3%-33.1% for those with BPD. Multiple logistic regressions were conducted to examine the associations between dissociation (derealization, depersonalization, and both) and both self-harm and suicide attempts among respondents with PTSD and BPD. The results indicated that dissociation was associated with self-harm and suicide attempts, especially among individuals with BPD, aORs = 1.39-2.66; however, this association may be driven in part by a third variable, such as other symptoms of PTSD or BPD (e.g., mood disturbance, PTSD or BPD symptom severity). These results may inform risk assessments and targeted interventions for vulnerable individuals with PTSD, BPD, or both aimed at mitigating the risk of self-harm and suicide.

Background Cannabis can be prescribed for posttraumatic stress disorder (PTSD) and chronic pain, and comorbid cannabis use disorder (CUD) can occur in both conditions. Research demonstrates that PTSD and chronic pain commonly co-occur. Methods Data were acquired from the National Epidemiologic Survey on Alcohol and Related Conditions-III (N = 36,309). Past-year CUD and PTSD were assessed using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-5. Past-year physician-confirmed chronic pain was self-reported and classified as musculoskeletal (e.g., arthritis), digestive (e.g., pancreatitis), and nerve (e.g., reflex sympathetic dystrophy) pain. Weighted cross-tabulations assessed sociodemographic, psychiatric, and chronic pain condition variables among those with PTSD versus no PTSD, among the entire sample and among those with CUD and chronic pain. Multiple logistic regressions examined the relationship between PTSD and chronic pain with CUD. CUD characteristics were also evaluated across PTSD and chronic pain groups. Results Rates of CUD were elevated in PTSD (9.4%) compared to those without (2.2%). The odds of CUD were greater for PTSD+digestive pain, PTSD+nerve pain, and PTSD+any chronic pain compared to having neither PTSD nor chronic pain (odds ratio range: 1.88-2.32). PTSD with and without comorbid chronic pain was associated with overall elevated rates of adverse CUD characteristics, including earlier age of onset, greater usage, and greater CUD severity. Conclusions PTSD with and without chronic pain is associated with elevated rates and severity of CUD. These results may have implications for prescribing practices and understanding individuals at risk for developing CUD.

Problem drinking and gambling are addictive behaviours experienced by young adults and commonly occur with narcissism. Research has acknowledged two distinct forms of narcissism: grandiose and vulnerable. There has been work that has examined the relationship between grandiose and vulnerable narcissism and addictive behaviours, but it has been limited, particularly with vulnerable narcissism. Evidence suggests vulnerable narcissism, but not grandiose narcissism, is associated with greater negative affect. Accordingly, shame, a potent social emotion could be a mediator in the narcissism-addiction pathway. Shame has been implicated in both vulnerable narcissism and problem drinking and gambling. Thus, we hypothesized that shame would mediate the relationship between vulnerable narcissism and addictive behaviours. Young adults (N = 210) completed self-report baseline (Time 1) and 1-month follow-up (Time 2) assessments of shame, narcissism, problem drinking, and gambling. As predicted, those with elevated vulnerable narcissism at Time 1 had increased shame at Time 2, which predicted problem drinking and gambling at Time 2. This relationship was not observed for grandiose narcissism. Overall, our results suggest that feelings of shame are essential to understanding the vulnerable narcissism-addiction pathway, and an important consideration when designing clinical interventions for at-risk young adults.

The first year of university is associated with the heaviest alcohol and drug use for young adults. Trait mindfulness decreases risk for harmful substance use broadly, but less is known about its protective role against alcohol and drug use during the first year of university. We hypothesized that specific facets of trait mindfulness (acting with awareness, nonjudging of inner experience, and nonreactivity to inner experience) would predict reduced alcohol and drug use among first-year university students. Given that the same facets of trait mindfulness protect against anxiety and depression (i.e., emotional psychopathology), we expected low levels of emotional psychopathology to mediate these effects. First-year undergraduates (N = 308) completed online self-reports in a longitudinal study. Facets of trait mindfulness were assessed at the beginning of the semester (Time 1). Emotional psychopathology, alcohol use, and drug use were assessed 4 months later (Time 2). Results revealed that the acting with awareness, nonjudging of inner experience, and nonreactivity to inner experience facets predicted decreased alcohol and drug use at Time 2 (controlling for Time 1 outcomes). These effects were mediated by low levels of emotional psychopathology. Our study demonstrates that first-year students who are high in specific facets of trait mindfulness are less likely to experience elevated emotional psychopathology, and in turn, are less likely to engage in harmful alcohol and drug use.

Background Gambling and tobacco smoking are highly comorbid among North American adults. However, there is a paucity of treatment options that are integrated (i.e. targeting both gambling and tobacco smoking simultaneously), accessible, and evidence based. Methods The aim of this two-arm open-label randomized controlled trial is to examine the effectiveness of an online, self-guided integrated treatment for problem gambling and tobacco smoking. A target sample of 214 participants will be recruited and be randomized into either an 8-week integrated or gambling only control condition. Both conditions will consist of seven online modules following cognitive behavioural therapy and motivational interviewing principles. Our three primary outcomes are (1) the number of days gambled, (2) money spent on gambling activities, and (3) time spent in gambling activities. Secondary outcomes include gambling disorder symptoms, cigarette use, and nicotine dependence symptoms. Assessments will be completed at baseline, at completion (i.e. 8 weeks from baseline), and at follow-up (i.e. 24 weeks from baseline). Generalized linear mixed modelling will be used to evaluate our primary and secondary outcomes. We expect that participants receiving online integrated treatment will show larger reductions in gambling relative to those receiving a control gambling only intervention. We further hypothesize that reductions in smoking will mediate these group differences. Discussion The rates of problem gambling and tobacco smoking are high in North America; yet, the treatment options for both are limited, with no integrated treatments available. If supported, our pilot study will be a cost-effective and accessible way to improve treatments for co-occurring problem gambling and tobacco use. Trial registration ClinicalTrials.gov NCT03614884. Registered on August 3, 2019

Background: Gambling and tobacco smoking are highly comorbid among North American adults. However, there is a paucity of treatment options that are integrated (i.e., targeting both gambling and tobacco smoking simultaneously), accessible, and evidence based.Methods: The aim of this two-arm randomized controlled trial is to examine the effectiveness of an online, self-guided integrated treatment for problem gambling and tobacco smoking. A target sample of 214 participants will be recruited and be randomized into either an eight-week integrated or gambling-only control condition. Both conditions will consist of seven online modules following cognitive behavioral therapy and motivational interviewing principles. Our three primary outcomes are (1) number of days gambled, (2) money spent on gambling activities, and (3) time spent in gambling activities. Secondary outcomes include gambling disorder symptoms, cigarette use, and nicotine dependence symptoms. Assessments will be completed at baseline, at completion (i.e., eight-weeks from baseline), and follow-up (i.e., 24-weeks from baseline). Generalized linear mixed modelling will be used to evaluate our primary and secondary outcomes. We expect that participants receiving online integrated treatment will show larger reductions in gambling relative to those receiving a control gambling only intervention. We further hypothesize that reductions in smoking will mediate these group differences.Discussion: The rates of problem gambling and tobacco smoking are high in North America; yet, the treatment options for both are limited, with no integrated treatments available. If supported, our intervention will be a cost-effective and accessible way to improve treatments for co-occurring problem gambling and tobacco use.Trial registration: Clinicaltrials.gov; ID NCT03614884. Registered August 3, 2019

Background The COVID-19 pandemic has resulted in massive disruptions to society, to the economy, and to daily life. Some people may turn to alcohol to cope with stress during the pandemic, which may put them at risk for heavy drinking and alcohol-related harms. Research is needed to identify factors that are relevant for coping-motivated drinking during these extraordinary circumstances to inform interventions. This study provides an empirical examination of coping motive pathways to alcohol problems during the early stages of the COVID-19 pandemic. Methods Participants (N = 320; 54.7% male; mean age of 32 years) were Canadian adult drinkers who completed an online survey assessing work- and home-related factors, psychological factors, and alcohol-related outcomes over the past 30 days, covering a time period beginning within 1 month of the initiation of the COVID-19 emergency response. Results The results of a theory-informed path model showed that having at least 1 child under the age of 18, greater depression, and lower social connectedness each predicted unique variance in past 30-day coping motives, which in turn predicted increased past 30-day alcohol use (controlling for pre-COVID-19 alcohol use reported retrospectively). Income loss was associated with increased alcohol use, and living alone was associated with increased solitary drinking (controlling for pre-COVID-19 levels), but these associations were not mediated by coping motives. Increased alcohol use, increased solitary drinking, and greater coping motives for drinking were all independently associated with past 30-day alcohol problems, and indirect paths to alcohol problems from having children at home, depression, social connectedness, income loss, and living alone were all supported. Conclusions Findings provide insight into coping-motivated drinking early in the COVID-19 pandemic and highlight the need for longitudinal research to establish longer term outcomes of drinking to cope during the pandemic.

Objectives: Chronic pain and generalized anxiety disorder (GAD) are co-occurring, and both conditions are independently associated with substance misuse. However, limited research has examined the impact of comorbid GAD and chronic pain on substance misuse. The aim of this article was to examine the associations between comorbid GAD and chronic pain conditions compared to GAD only with nonmedical opioid use, drug abuse/dependence, and alcohol abuse/dependence in a Canadian, population-based sample. Methods: Data came from the 2012 Canadian Community Health Survey–Mental Health ( N = 25,113). Multiple logistic regressions assessed the associations between comorbid GAD and chronic pain conditions (migraine, back pain, and arthritis) on substance misuse. Results: Comorbid GAD + back pain and GAD + migraine were associated with increased odds of nonmedical opioid use compared to GAD only. However, the relationship was no longer significant after controlling for additional chronic pain conditions. No significant relationship was found between GAD + chronic pain conditions with drug or alcohol abuse/dependence. Conclusions: Comorbid GAD + back pain and GAD + migraine have a unique association with nonmedical opioid use in Canadians compared to GAD only, and chronic pain multimorbidity may be driving this relationship. Results emphasize the need for screening for substance misuse and prescription access in the context of GAD and comorbid chronic pain.

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Background Alcohol and gambling problems are common in young adults. Self-medication theory states that young adults with depression drink and/or gamble to escape negative emotions. Research shows that depression is a risk factor for drinking/gambling problems, but more work is needed to examine mediators underlying these associations. One potential mediator is shame. Shame is a self-directed emotion that follows a negative life event and is characterized by intense feelings of inferiority, worthlessness, and embarrassment. Depressed individuals are especially susceptible to shame (and associated emotions). Shame has also been implicated in risk for addiction. Accordingly, we predicted that elevated shame would explain why depression is associated with both alcohol and gambling problems. Methods A longitudinal design was used to examine this hypothesis. Undergraduates (N = 210) completed self-reports of depression at baseline (Time 1) and then completed self-reports of shame, alcohol misuse, gambling problems one month later (Time 2). Results Results showed that individuals with elevated depression at Time 1 endorsed high levels of shame at Time 2, which in turn predicted more gambling (β = .038, 95% CI [.010, .087]) and alcohol problems (β = .249, 95% CI [.123, .435]) at Time 2. We found that increased levels of shame explained the effects of depression on problem drinking and gambling. Conclusions Study findings improve our understanding of the depressive pathway to addiction by providing evidence for shame as a potential mechanism of this pathway. Impact Reducing shame can be a target of clinical interventions for young adults with depression and alcohol/gambling problems.