Ashamed and Alone—Risk Factors for Alcohol Craving Among Depressed Emerging Adults

Abstract Aims Comorbid alcohol use and depression have the highest prevalence among emerging adults and are associated with a number of consequences. Self-medication theory posits individuals with depression use alcohol to cope with their negative emotions. Preliminary work has investigated the social context of depression-related drinking and found that solitary drinking is a risky, atypical behaviour in emerging adulthood that is associated with alcohol misuse. However, it is unknown about what is unfolding in the moment that is driving depression-related drinking in solitary contexts. Accordingly, we used an experimental study to examine if shame mediated the association between depression and in-lab alcohol craving. Methods Emerging adults (N = 80) completed a shame induction followed by an alcohol cue exposure in either a solitary or social condition. We used moderated mediation to test hypotheses. Results Consistent with hypotheses, conditional indirect effects supported the mediation of depression and alcohol craving through shame among those in the solitary condition, but not in the social condition. There was no support for guilt as a mediator. Conclusion Our study demonstrates that shame is a specific emotional experience that contributes to solitary drinking among depressed emerging adults. It is important to use these results to inform interventions that directly target solitary contexts and shame. Depression and alcohol are comorbid and are associated with negative outcomes. Literature has suggested the relevance of contextual and emotional factors in understanding this comorbidity. We found that shame uniquely mediated the association between depression and in-lab alcohol craving, and solitary context moderated this association.