title: The interacting effect of depressive symptoms, gender, and distress tolerance on substance use problems among residential treatment-seeking substance users.
abstract: BACKGROUND
  Depression is associated with substance use problems; however, the specific individual characteristics influencing this association are not well identified. Empirical evidence and theory suggest that gender and distress tolerance-defined behaviorally as an individual's ability to persist in goal-directed behavior while experiencing negative affective states-are important underlying factors in this relationship. Hence, the purpose of the current study was to examine whether gender and distress tolerance moderate the relationship between depressive symptoms and substance use problems.
  
  
  METHODS
  Participants included 189 substance users recruited from a residential substance abuse treatment center. The Short Inventory of Problems-Alcohol and Drugs scale was used to measure self-reported substance use problems. The Beck Depression Inventory was used to assess self-reported depressive symptoms. Gender was self-reported, and distress tolerance was behaviorally indexed by the Computerized Paced Auditory Serial Addition Task.
  
  
  RESULTS
  Hierarchical linear regression analysis indicated a significant three-way interaction of depressive symptoms, gender, and distress tolerance on substance use problems, adjusting for relevant demographic variables, anxiety symptoms, impulsivity, as well as DSM-IV psychiatric disorders. Probing of this three-way interaction demonstrated a significant positive association between depressive symptoms and substance use problems among females with low distress tolerance.
  
  
  CONCLUSIONS
  Findings indicate that female treatment-seeking substance users with high levels of depressive symptoms exhibit greater substance use problems if they also evidence low distress tolerance. Study implications are discussed, including the development of prevention and intervention programs that target distress tolerance skills.
authors.affiliation: Department of Behavioral and Community Health, University of Maryland, College Park, MD 20742, USA. Electronic address: binaali@umd.edu.
authors.forename: Bina
authors.initials: B
authors.lastname: Ali
authors.affiliation: Department of Psychology, University of Maryland, College Park, MD 20742, USA.
authors.forename: C J
authors.initials: CJ
authors.lastname: Seitz-Brown
authors.affiliation: Department of Psychology, University of North Carolina, Chapel Hill, NC 27599, USA. Electronic address: daughter@unc.edu.
authors.forename: Stacey B
authors.initials: SB
authors.lastname: Daughters
mesh_terms: D000328:Adult; D001007:Anxiety / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D055030:Drug Users / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012114:Residential Treatment; D016320:Substance Abuse Treatment Centers / Q000379:methods; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy
keywords: Depression; Inpatient treatment; Negative affect; Substance abuse