Differentiating action from inaction: Longitudinal relations among impulsive personality traits, internalizing symptoms, and drinking behavior

Alcohol is one of the most commonly used substances in the U.S., particularly among young adults (Grant et al., 2015, Knight et al., 2002), and rates of young adult drinking have been steadily increasing over the past decade (Grant et al., 2017). Heavy alcohol consumption (≥5 drinks per day or >15 per week for men or ≥4 or more per drinks per day or >8 per week for women; Niaaa, 2017) in young adults is associated with a variety of negative consequences, including alcohol-impaired driving, risky sex, alcohol-induced blackouts, and mortality (King et al., 2023, Mokdad et al., 2004, NIAAA, 2017, Perkins, 2002, Waddell and Marszalek, 2022, Wechsler et al., 1995). Although most young adults reduce their drinking over time, prior research suggests that a significant percentage continue heavy drinking into adulthood (e.g., Lee & Sher, 2018), which increases their risk for negative outcomes well into adulthood (e.g., Littlefield et al., 2012, Lee et al., 2015, Waddell et al., 2021, Waddell et al., 2021). Therefore, it remains important to understand risk factors for heavy, problem drinking in young adults to better inform prevention efforts.

One well-established risk factor for heavy drinking and alcohol-related problems is impulsivity (Moeller, Barratt, Dougherty, Schmitz, & Swann, 2001). Despite decades of diverging theoretical views on how to best characterize impulsivity (e.g., Cloninger, 1996, Cyders et al., 2014, Dick et al., 2010, Zuckerman and Kuhlman, 2000, Whiteside and Lynam, 2001), impulsivity has remained a strong, consistent predictor of drinking behavior (Coskunpinar et al., 2013, Dick et al., 2010, Halvorson et al., 2023). Theories of impulsivity often emphasize a combination of biopsychosocial aspects as the foundation of impulsive traits. For instance, studies have found that there is a strong genetic component to impulsivity, particularly in its relation to the development of heavy drinking and alcohol use disorders (Lejuez et al., 2010). Similarly, research demonstrates that psychosocial influences such as drinking culture, age of first drink, and peer/parental relationships may affect relations between impulsivity and alcohol consumption (Ennett et al., 2008).

One theory of impulsivity that is particularly important to the longitudinal relations between impulsivity, internalizing symptoms, and alcohol use is the UPPS-P model of impulsivity (Lynam et al., 2007, Whiteside and Lynam, 2001). The UPPS-P model, perhaps the most-studied modern theoretical view of impulsivity, suggests that there are five distinct impulsive traits, indicative of positive urgency (i.e., rash action in a positive mood state), negative urgency (i.e., rash action in a negative mood state), a lack of premeditation (i.e., little forethought before acting), a lack of perseverance (i.e., inability to stay focused on one task at a time), and sensation seeking (i.e., thrill/rewarding seeking behaviors; Lynam et al., 2007, Whiteside and Lynam, 2001, Cyders et al., 2014). Furthermore, meta-analyses suggest that positive and negative urgency are the strongest predictors of alcohol-related problems, a lack of premeditation and perseverance are the strongest predictors of heavy drinking, and sensation seeking is the strongest predictor of any drinking (Coskunpinar et al., 2013).

In addition to strong, consistent associations between impulsivity and drinking behavior, studies have linked impulsivity with internalizing symptoms. Carver, Johnson, and Joormann (2008) proposed that individuals with higher levels of impulsivity struggle to potentiate reflexive, automatic tendencies, which leads to either approach (i.e., action) or avoidance (i.e., inaction) oriented behavior. Carver, Johnson, and Joormann (2008)’s model suggests that cognitive control is needed to both inhibit action-oriented impulsive responses (e.g., drinking alcohol, engaging in risky behavior) as well as inaction-oriented impulsive responses (e.g., repelling others/isolating from others). Studies demonstrating associations between impulsive traits and heavy, habitual drinking patterns (Coskunpinar et al., 2013) provide support for the “action” aspect of Carver et al. (2008)’s model. Evidence for relations between impulsive traits and internalizing symptoms would support the “inaction” aspect of Carver et al. (2008)’s model, but such relations are less often studied. Some studies find cross-sectional relations between negative urgency and internalizing symptoms, including a large mega-analysis of individual participant data showing that negative urgency has a moderate-to-large effect size on depressive and anxiety symptoms (Berg, Latzman, Bliwise, & Lilienfeld, 2015). Unfortunately, longitudinal work in this area is scant, though one study found that higher levels of urgency were prospectively associated with increased depressive symptoms in youth aged 10–12 (Smith, Guller, & Zapolski, 2013).

Furthermore, few longitudinal studies have sought to simultaneously examine impulsive traits, drinking behavior, and internalizing symptoms, despite the theoretical appeal of testing approach/action-oriented outcomes (i.e., drinking) and avoidance/inaction-oriented outcomes (i.e., internalizing symptoms) as distinct mechanisms. Considering that impulsive traits confer risk for heavy drinking and internalizing symptoms (e.g., Berg et al., 2015, Dick et al., 2010), and both heavy drinking and internalizing symptoms confer risk for problem drinking (e.g., Coskunpinar et al., 2013, King et al., 2022, Wechsler et al., 1994), it is possible that distinct facets of impulsivity confer risk for negative alcohol consequences through unique mechanisms of action (i.e., heavy drinking) versus inaction (i.e., internalizing symptoms). Although some research studies examining constructs of impulsivity and internalizing symptoms have ordered internalizing symptoms as a precursor to impulsivity (Royuela-Colomer et al., 2021, Felton et al., 2020), models differentiating whether impulsive traits predict action (i.e., heavy drinking) versus avoidance/inaction (i.e., internalizing symptoms) longitudinally place impulsive traits as the precursor to internalizing symptoms (and heavy drinking), which may confer risk for later alcohol problems.

Since individuals with higher levels of negative urgency are prone to negative affectivity (e.g., Berg et al., 2015) and have less effective coping skills (e.g., Hoyer & Correia, 2020), one possibility is that individuals with higher levels of negative urgency struggle to inhibit the automatic tendency to repel/isolate, which indirectly confers risk for negative alcohol consequences through increased levels of internalizing symptoms. In contrast, individuals with higher levels of lack of premeditation and perseverance (i.e., a lack of conscientiousness; Cyders et al., 2014) may struggle to inhibit their automatic tendency toward drinking, in line with previous studies (e.g., Coskunpinar et al., 2013, King et al., 2023, Waddell et al., 2023, Waddell et al., 2022), which may indirectly confer risk for negative alcohol consequences through increased consumption.

To address these potential pathways from impulsive personality traits to negative alcohol consequences, the current study tested whether impulsive traits were differentially associated with negative alcohol consequences through heavy drinking and internalizing symptoms using three waves of longitudinal data across a one-year period. First, it was hypothesized that a lack of premeditation and a lack of perseverance at T1 would indirectly predict T3 negative alcohol consequences through heavy T2 drinking patterns. Second, it was hypothesized that negative urgency at T1 would indirectly predict T3 negative alcohol consequences through higher T2 internalizing symptoms. Indirect relations for sensation seeking and positive urgency were considered exploratory.

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