How chronic self-regulatory stress, poor anger regulation, and momentary affect undermine treatment for alcohol use disorder: Integrating social action theory with the dynamic model of relapse

We tested the hypothesis that indices of chronic self-regulatory stress specified by Social Action Theory (SAT; Ewart, 2011) and indices of affect specified by the Dynamic Model of Relapse (DMR; Witkiewitz & Marlatt, 2004) predict daily alcohol use by persons in outpatient treatment for alcohol use disorder (AUD). Participants (69 men, 50 women; aged 19–76) in AUD outpatient programs completed 2 baseline laboratory assessments, then provided daily ecological momentary assessment (EMA) reports of state affect and alcohol use for 28 days. SAT indices of chronic self-regulatory stress were obtained in the laboratory with the Social Competence Interview (SCI) and the Anger Transcendence Challenge (ATC). Chronic regulatory stress was indexed by blood pressure responses to both tasks. Emotion regulation capabilities were indexed by anger regulation behavior observed during ATC, and by self-ratings of recent positive social interactions and goal thoughts. DMR indices of trait and state affect were obtained with ...