Distress Tolerance Predicts Substance Use Motivations and Problems in Young Adults Across Four Continents

Grace Anderson, Fordham University


Substance use disorders (SUDs) are associated with tremendous morbidity and mortality worldwide. Distress tolerance (DT), the capacity to withstand uncomfortable emotional and physical experiences, appears to reduce risk for SUDs. Some evidence suggests DT is particularly salient in individuals who rely on substances to cope with strong negative emotions, however, studies of this effect are restricted almost entirely to US samples. It is not yet known whether DT can avert problematic substance use in other countries, creating a barrier to developing generalizable SUD interventions. The present study tested two models of problems (e.g., risky behavior, poor academic and job performance) related to (1) alcohol use and (2) cannabis use in a sample of university students from six regions across North and South America, Africa, and Europe (total N = 5,858). We examined DT in relation to various motives for using alcohol and cannabis (i.e., coping, conformity, social, enhancement, expansion) and investigated whether any of these motivational dimensions statistically mediated DT’s association with use problems. I used multiple-group structural equation modeling (SEM) to examine the consistency of these pathways across all six regions. I predicted that DT would be linked to lower alcohol and cannabis use problems, and that much of this association would be accounted for by distress tolerance’s inverse relationship with using these substances to cope with negative emotion. Study results confirmed that DT is negatively associated with alcohol and cannabis use problems while controlling for age at first substance use, past month quantity of substance use, and gender and that this effect was consistent across the 6 subsamples. Additionally, in the full sample and across all regions, coping motives for both alcohol and cannabis use had the largest association with DT compared to the other use motives. This suggests that in university students across global regions, lower DT is associated with higher endorsement of coping motives for use and with higher reports of problems related to use. SEM findings were consistent with mediation between distress tolerance and alcohol- and cannabis-related problems through substance use motives in the full sample. Coping motives for alcohol use explained much of DT’s association with alcohol-related problems and the effect was consistent across the 6 regions. On the other hand, coping and conformity motives were equally important as mediators of DT and cannabis-related problems. However, this effect differed significantly across regions of the world. Overall, I believe these findings signal that DT has potential as a prevention and intervention target for alcohol and cannabis use disorders, and perhaps other SUDs (e.g., tobacco, opioids), around the world.

Subject Area

Clinical psychology

Recommended Citation

Anderson, Grace, "Distress Tolerance Predicts Substance Use Motivations and Problems in Young Adults Across Four Continents" (2022). ETD Collection for Fordham University. AAI29321755.