Despite widely documented inequities in alcohol use among minoritized individuals in the U.S., studies to understand the social and structural drivers of these outcomes have been limited. The new study highlights the importance of examining inequities in social determinants of health to aid the development of successful, culturally informed interventions for alcohol use disorder.
“We now have evidence that the pathway between stress and alcohol craving is stronger for Black individuals—it’s a very real and quantifiable outcome,” said corresponding author Sarah Pedersen, Ph.D., associate professor of psychiatry
According to a national survey, nearly 15 million Americans over the age of 12 have diagnosed alcohol use disorder, or AUD. The repercussions of AUD extend beyond the individual’s personal life and health, and affect their families, friendships and careers.
Previous research has shown that Black Americans experience more chronic stress because of structural racism. To better understand how social and structural inequities compound, and whether their effects are different for Black and white adults in the U.S., Pedersen and colleagues provided study participants with a smartphone app that sent six daily prompts to record stress levels and alcohol cravings throughout a 10-day period that included two weekends—a time of the week when people traditionally drink more.
The goal of the study was to understand the momentary processes immediately preceding drinking behavior. Conducting the research outside the controlled lab environment was key, since the types of stressors that people experience in their daily lives are varied and impossible to simulate accurately.
The researchers found that higher stress throughout the study period was associated with higher alcohol craving for Black but not white participants, irrespective of income. But even more importantly, momentary increases in stress predicted subsequent increases in alcohol craving at the next assessment only in Black individuals, suggesting a process of drinking to cope with stress.
The findings highlight an opportunity to develop mobile health technologies that address alcohol craving in the moment and suggest that a combination of just-in-time interventions with policy changes aimed at decreasing downstream stressors, such as those caused by structural racism, might be particularly impactful in reducing alcohol risk for Black individuals.
“The lifetime impact of structural racism may be tightening associations between momentary stressors and alcohol consumption,” said Pedersen. “Rectifying discriminatory policies that persist for communities of color, along with developing culturally responsive interventions to help people cope with stress in the moment, may be key to addressing inequities in alcohol use disorder at the root.”
Additional authors on this manuscript are Traci Kennedy, Ph.D., Jordan Holmes, B.A., and Brooke Molina, Ph.D., all of Pitt.
CREDIT: Sarah Pedersen
CAPTION: Sarah Pedersen, Ph.D., associate professor of psychiatry and psychology, University of Pittsburgh.