The interacting effect of depressive symptoms, gender, and distress tolerance on substance use problems among residential treatment-seeking substance users

Abstract

Background Depression is associated with substance use problems; however, the specific individual characteristics influencing this association are not well identified. Empirical evidence and theory suggest that gender and distress tolerance—defined behaviorally as an individual’s ability to persist in goal-directed behavior while experiencing negative affective states—are important underlying factors in this relationship. Hence, the purpose of the current study was to examine whether gender and distress tolerance moderate the relationship between depressive symptoms and substance use problems. Methods Participants included 189 substance users recruited from a residential substance abuse treatment center. The Short Inventory of Problems-Alcohol and Drugs scale was used to measure self-reported substance use problems. The Beck Depression Inventory was used to assess self-reported depressive symptoms. Gender was self-reported, and distress tolerance was behaviorally indexed by the Computerized Paced Auditory Serial Addition Task. Results Hierarchical linear regression analysis indicated a significant three-way interaction of depressive symptoms, gender, and distress tolerance on substance use problems, adjusting for relevant demographic variables, anxiety symptoms, impulsivity, as well as DSM-IV psychiatric disorders. Probing of this three-way interaction demonstrated a significant positive association between depressive symptoms and substance use problems among females with low distress tolerance. Conclusion Findings indicate that female treatment-seeking substance users with high levels of depressive symptoms exhibit greater substance use problems if they also evidence low distress tolerance. Study implications are discussed, including the development of prevention and intervention programs that target distress tolerance skills.

Depression, posttraumatic stress, and alcohol misuse in young adult veterans: The transdiagnostic role of distress tolerance

“…This is particularly interesting in the context of the mixed results of previous studies that have examined the moderating effect of gender (Ali et al, 2015; Tull et al, 2012; Wolitzky-Taylor et al, 2015). Because so few studies have tested for moderated mediation, it will be important for future studies to also examine gender as a moderator within a veteran sample to determine if this effect is replicated.…”

“…These studies have examined a range of outcomes, such as alcohol and substance use frequency (e.g., Duranceau et al, 2014), alcohol and substance use motives (e.g., Marshall-Berenz et al, 2011; Vujanovic et al, 2011b), and treatment success (e.g., Daughters et al, 2005a). They have also differed with respect to statistical methods, examining both moderation (e.g., Ali et al, 2015; Tull et al, 2012) and mediation (e.g., Potter et al, 2011; Wolitzky-Taylor et al, 2015) models.…”

“…In addition, some previous research has examined gender as a moderator of the relationship between mental health, distress tolerance, and substance use (Ali et al, 2015; Bujarski et al, 2012; Tull et al, 2012; Wolitzky-Taylor et al, 2015). The results of these studies were mixed, with some results suggesting the mediating role of distress tolerance is stronger among males (Tull et al, 2012), others suggesting the effect is stronger among females (Ali et al, 2015), and still others suggesting no moderating effect (Wolitzky-Taylor et al, 2015). Given significant efforts to connect women veterans with needed mental health services (U.S.…”

Internalized stigma as an independent risk factor for substance use problems among primary care patients: Rationale and preliminary support

“…Future work should utilize a longitudinal design and consider how internalized stigma might intersect with other important constructs such as race/ethnicity, gender, and HIV/AIDS stigma. Second, we did not include covariates such as low distress tolerance and substance use severity shown to be significantly related to SUP in past research (Allensworth-Davies et al, 2012; Ali et al, 2015). Hence, more comprehensive evaluations of the relationship between internalized stigma and SUP are warranted.…”

“…Third, internalized stigma has been shown to be modifiable through intervention (Luoma et al, 2008, 2012). At the same time, it would be more challenging to address other SUP-related risk factors, such as participant characteristics (Ali et al, 2015; Kiluk et al, 2013), higher quantity/frequency of use (Bennett et al, 2009; Blanchard et al, 2003), and greater psychiatric comorbidity (Ali et al, 2015; Buckner et al, 2007; Gorka et al, 2012). …”