Unraveling the Link Between Trauma and Problematic Alcohol Use Over Time: The Influence of Executive Function and Social Cognition Deficits.

The co-occurrence of posttraumatic stress symptoms (PTSS) and problematic alcohol use (PAU) is well established, yet the mechanisms linking them remain unclear. Trauma may impair executive function (EF) and social cognition, such as emotion recognition and theory of mind (ToM), which hinder emotional regulation and increase reliance on alcohol as a coping strategy. This study examined whether deficits in EF and social cognition mediate the relationship between PTSS and PAU. A two-wave longitudinal design was employed with 200 Taiwanese adults exposed to trauma recruited from the community and psychiatric clinics. At baseline (Time 1), participants completed self-report measures of trauma, PTSS and PAU, along with computerized tasks assessing EF, emotion recognition and ToM. One month later (Time 2), PTSS and PAU were reassessed in 143 participants. PTSS at Time 1 directly predicted PAU at both Time 1 and Time 2, supporting the self-medication hypothesis. In addition, PTSS indirectly influenced PAU through deficits in EF, emotion recognition and ToM. These findings suggest that cognitive and social-cognitive impairments are key risk factors for alcohol misuse among trauma-exposed individuals. Interventions targeting EF and social cognition may therefore help reduce PAU and support trauma recovery.