Mediated and moderated associations between cumulative lifetime stressor exposure, emotional dysregulation, impulsivity, and lifetime alcohol use: A cross-sectional scoping study of UK drinkers

Abstract

Stress, trait impulsivity, and emotional dysregulation are independent predictors of alcohol use and misuse, but little is known about the potential mechanisms that link these risk factors together. To address this issue, we carried out an exploratory cross-sectional study, on UK-based participants. Our preregistered, hypothesised theoretical framework was that emotional dysregulation mediates the association between cumulative lifetime stressor exposure and lifetime alcohol use. We also hypothesised that heightened impulsivity would strengthen these relations. As hypothesised, emotional dysregulation fully mediated the relation between cumulative lifetime stressor exposure and lifetime alcohol use. Several facets of impulsivity moderated these associations. For example, as levels of negative urgency increased, the associations between cumulative lifetime stressor exposure and emotional dysregulation, emotional dysregulation and lifetime alcohol use, and lifetime stress exposure and lifetime alcohol use, via emotional dysregulation, strengthened. These preliminary findings propose a theoretically framed model which integrates several prominent risk-factors for alcohol misuse, extending prior research and generating interesting and novel lines of enquiry for longitudinal and cross-cultural analyses. The findings also highlight the potential clinical utility of screening for lifetime stress exposure while tailoring personalised treatment interventions.

Keywords: Addiction; Alcohol; Impulsivity; Risk-taking; Stress.

Fig. 1.

A conceptual diagram illustrating the hypothesised associations between cumulative lifetime stressor exposure (X), emotional dysregulation (M), lifetime alcohol use (Y), and impulsivity (W).

Fig. 2.

Johnson-Neyman plots illustrating the moderating role of impulsivity measurements in the mediated relation between cumulative lifetime stressor exposure, emotional dysregulation, and lifetime alcohol use. Note. The shaded area represents the region of significance (p < .05). Emotional dysregulation was measured using the Difficulties in Emotional Regulation Scale Short Form. Cumulative lifetime stressor exposure was assessed using the Stress and Adversity Inventory for Adults. Lifetime alcohol use was measured using the Lifetime Drinking History Questionnaire. Negative and positive urgency, (lack of) perseverance, (lack of) premeditation, and sensation seeking were assessed using the Shortened UPPS–P Impulsive Behaviour Scale. Risk-taking was measured using average number of space bar presses for unburst balloons during the Balloon Analogue Risk Task. Delay discounting was calculated as 1 minus the area under the curve score (so that greater scores reflect greater delay discounting) on the Titrating Alternatives Delay Discounting Task.