Behavioral Impaired Control over Alcohol: Comparing Self-Medication and Behavioral Economic Models with the Interacting Effects of Acute Stress, Chronic Stress with Physical Neglect History, and Sex Assigned at Birth

The Self-Medication Model predicts that individuals exposed to chronic stressful life histories (life experiences and physical neglect) will exhibit exaggerated behavioral impaired control over alcohol (i.e., IC; drinking beyond intended and/or recommended limits during ad libitum drinking) after experiencing acute stress. The Behavioral Economics Model predicts those with physical neglect histories (denied necessities) will be more likely to exhibit behavioral IC regardless of the presence or absence of acute and/or other chronic stress. Neither of these competing theories of alcohol addiction makes precise or distinct predictions concerning sex differences. We randomized groups of 2–3 drinkers (N = 210, 105 women, 105 men) to stress or no stress and alcohol or expectancy placebo conditions followed by a 90 min ad libitum social drinking session. We used the GLIMMIX procedure in SAS 9.4 to conduct a multilevel model for the number of standardized drinks ordered and Peak Blood Alcohol Concentration (BAC). We found significant three-way interactions of physical neglect level by stress condition by sex assigned at birth. Consistent with the Self-Medication Model, women with mean + 1 unit greater physical neglect histories showed higher behavioral IC only when the acute stress was present. In accordance with the Behavioral Economics Model, men with mean + 1 unit greater physical neglect histories showed higher behavioral IC when the acute stress was absent. Our competing theory test highlights the importance of physical neglect in alcohol misuse as well as the need to update etiological theories of addiction by accounting for sex differences.