Daily Stress Predicts Later Drinking Initiation via Craving in Heavier Social Drinkers: A Prospective In-Field Daily Diary Study

Stress has been linked to increased alcohol use but how stress may increase drinking in social drinkers is not well understood. Negative reinforcement processes may explain this link but the role of specific motivational processes, such as craving, and how these motivational processes are altered by drinking have not been studied. The current study assessed social drinkers (n = 81) for recent quantity and frequency of alcohol intake (quantity and frequency index, QFI) upon study enrollment, who then completed 30 days of electronic daily records of stress, craving, and alcohol intake. Multilevel structural equation models tested if person-averaged (between-person) and daily (within-person) craving mediated the link between stress and later drinking each evening and if recent quantity-frequency of drinking (QFI) moderated these associations. At the between-person level, both greater subjective stress, Est = .38, 95% confidence interval (CI) [.19,.57], and higher QFI predicted higher levels of craving, Est = .34, 95% CI [.20,.49]. Higher craving predicted more frequent drinking throughout the study, Est = .34, 95% CI [.01,.29]. At the within-person level, higher subjective stress predicted higher within-person craving; and the link between craving and later drinking was significant among those who had a higher QFI, Est = .84, 95% CI [.58, 1.12]. The subjective stress-drinking relationship was mediated by a greater alcohol craving response in social drinkers, and higher the QFI, greater the alcohol craving response. These results indicate that both higher levels of stress and greater recent alcohol intake patterns sensitize the craving response that in turn facilitates later alcohol intake. The findings suggest that higher recent alcohol use predict greater stress-potentiated initiation of drinking via higher craving responses. General Scientific Summary The findings from this study provide ecological evidence that subjective stress is associated with a higher craving response, which in turn predicts a greater likelihood of later drinking. Both the craving response and its relationship to later drinking is greater in heavier social drinkers. This study supports the hypothesis that higher levels of alcohol intake is related to a sensitized shift toward greater alcohol motivation in response to stress in social drinkers.