The Role of Emotion Dysregulation In Problematic Alcohol Use and Coping with Problems
DOI:
https://doi.org/10.5708/EJMH.19.2024.0018Keywords:
emotion regulation, alcoholism, stress, problem-solving, addictionAbstract
Introduction: Emotional factors are often specified as playing an important role in the context of problematic alcohol use and alcohol addiction.
Aims: This study focused on examining the relationship between difficulties in emotion regulation, perceived personal problems, and problematic alcohol use.
Methods: 374 participants from the general population in Slovenia and Croatia (34.8% men, 65.2% women) with an average age of 44.28 years (range: 26 to 74 years) completed the Alcohol Use Disorders Identification Test (AUDIT), Individual Problems and Strengths Scale (IPS) and Difficulties in Emotion Regulation Scale – Short Form (DERS-SF).
Results: A higher level of problematic alcohol use positively correlated with difficulties in emotion regulation and the assessment of individual problems (p ≤ .010). Multiple linear regression analysis demonstrated that higher AUDIT scores were positively associated with two dimensions of difficulties in emotion regulation: impulse control difficulties (β = 0.22, p = .008) and lack of emotional awareness (β = 0.15, p = .010). Difficulties in emotion regulation completely mediated the effect of individual problems on problematic alcohol use (indirect effect: 0.18, CI [–.06, –.31]; p < .001): higher levels of individual problems contribute to higher levels of problematic alcohol use through the effect of difficulties in emotion regulation.
Conclusions: The findings indicate the vulnerability of individuals with difficulties in emotion regulation to problematic alcohol use. Difficulties in emotion regulation are an important factor to consider for understanding the development, maintenance, and treatment of alcoholism and problematic alcohol use.
References
Aldwin, C. M., & Yancura, L. A. (2004). Coping. In C. D. Spielberger (Ed.), Encyclopedia of Applied Psychology (pp. 507–510). Elsevier.
https://doi.org/10.1016/B0-12-657410-3/00126-4
Ashenberg Straussner, S. L. (2011). Children of substance-abusing parents: An overview. In S. L. Ashenberg Straussner & C. Huff Fewell (Eds.), Children of substance-abusing parents (pp. 1–27). Springer.
https://doi.org/10.1891/9780826165084
Ashton, K., Bellis, M. A., Davies, A. R., Hughes, K., & Winstock, A. (2017). Do emotions related to alcohol consumption differ by alcohol type? An international cross-sectional survey of emotions associated with alcohol consumption and influence on drink choice in different settings. BMJ Open, 7(10), Article e016089.
http://dx.doi.org/10.1136/bmjopen-2017-016089
Berking, M., Margraf, M., Ebert, D., Wupperman, P., Hofmann, S. G., & Junghanns, K. (2011). Deficits in emotion-regulation skills predict alcohol use during and after cognitive-behavioral therapy for alcohol dependence. Journal of Consulting and Clinical Psychology, 79(3), 307–318.
https://doi.org/10.1037/a0023421
Boden, J. M., & Fergusson, D. M. (2011). Alcohol and depression. Addiction, 106(5), 906–914.
https://doi.org/10.1111/j.1360-0443.2010.03351.x
Corbin, W. R., Farmer, N. M., & Nolen-Hoekesma, S. (2013). Relations among stress, coping strategies, coping motives, alcohol consumption and related problems: A mediated moderation model. Addictive Behaviors, 38(4), 1912–1919.
https://doi.org/10.1016/j.addbeh.2012.12.005
Dermody, S. S., Cheong, J., & Manuck, S. (2013). An evaluation of the stress-negative affect model in explaining alcohol use: The role of components of negative affect and coping style. Substance Use & Misuse, 48(4), 297–308.
https://doi.org/10.3109/10826084.2012.761713
Dora, J., Piccirillo, M., Foster, K. T., Arbeau, K., Armeli, S., Auriacombe, M., Bartholow, B., Beltz, A. M., Blumenstock, S. M., Bold, K., Bonar, E. E., Braitman, A., Carpenter, R. W., Creswell, K. G., De Hart, T., Dvorak, R. D., Emery, N., Enkema, M., Fairbairn, C. E., … King, K. M. (2023). The daily association between affect and alcohol use: A meta-analysis of individual participant data. Psychological Bulletin, 149(1-2), 1–24.
https://doi.org/10.1037/bul0000387
Dragan, M. (2015). Difficulties in emotion regulation and problem drinking in young women: The mediating effect of metacognitions about alcohol use. Addictive Behaviors, 48, 30–35.
https://doi.org/10.1016/j.addbeh.2015.04.008
Dvorak, R. D., Sargent, E. M., Kilwein, T. M., Stevenson, B. L., Kuvaas, N. J., & Williams, T. J. (2014). Alcohol use and alcohol-related consequences: Associations with emotion regulation difficulties. American Journal of Drug and Alcohol Abuse, 40(2), 125–130.
https://doi.org/10.3109/00952990.2013.877920
Fetzner, M. G., McMillan, K. A., Sareen, J., & Asmundson, G. J. G. (2011). What is the association between traumatic life events and alcohol abuse/dependence in people with and without PTSD? Findings from a nationally representative sample. Depression and Anxiety, 28(8), 632–638.
https://doi.org/10.1002/da.20852
Ghafaryan Shirazi, Y., Lindblom, J., Punamäki, R.-L., Yli-Peltola, M., & Peltonen, K. (2023). Emotional awareness and internalizing problems: A preliminary test of state and trait associations among adolescents. European Journal of Mental Health, 18, Article e0007.
https://doi.org/10.5708/EJMH.18.2023.0007
Gostečnik, C., Repič, T., Cvetek, M., & Cvetek, R. (2010). Hidden mission of the psyche in abuse and addiction. Journal of Religion and Health, 49, 361–376.
https://psycnet.apa.org/doi/10.1007/s10943-009-9264-8
Gratz, K. L., & Roemer, E. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment, 26, 41–54.
https://psycnet.apa.org/doi/10.1023/B:JOBA.0000007455.08539.94
Gross, J. J. (1998). The emerging field of emotion regulation: An integrative review. Review of General Psychology, 2(3), 271–299.
https://psycnet.apa.org/doi/10.1037/1089-2680.2.3.271
Hasking, P., Lyvers, M., & Carlopio, C. (2011). The relationship between coping strategies, alcohol expectancies, drinking motives and drinking behaviour. Addictive Behaviors, 36(5), 479–487.
https://doi.org/10.1016/j.addbeh.2011.01.014
Hayes, A. F. (2013). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. The Guilford Press
Horvath, S. A., Shorey, R. C., & Racine, S. E. (2020). Emotion dysregulation as a correlate of food and alcohol disturbance in undergraduate students. Eating Behaviors, 38, Article 101409.
https://doi.org/10.1016/j.eatbeh.2020.101409
Hussong, A. M., Jones, D. J., Stein, G. L., Baucom, D. H., & Boeding, S. (2011). An internalizing pathway to alcohol use and disorder. Psychology of Addictive Behaviors, 25(3), 390–404.
https://doi.org/10.1037/a0024519
Jakubczyk, A., Trucco, E. M., Kopera, M., Kobyliński, P., Suszek, H., Fudalej, S., Brower, K. J., & Wojnar, M. (2018). The association between impulsivity, emotion regulation, and symptoms of alcohol use disorder. Journal of Substance Abuse Treatment, 91, 49–56.
https://doi.org/10.1016/j.jsat.2018.05.004
Jerebic, D., & Jerebic, S. (2012). Različni modeli zdravljenja odvisnosti in relacijska družinska terapija [Various models of addiction treatment and relational family therapy]. Bogoslovni vestnik, 72(2), 297–309.
http://www.teof.uni-lj.si/uploads/File/BV/BV-72-2-Jerebic.pdf
Karyadi, K. A., & King, K. M. (2011). Urgency and negative emotions: Evidence for moderation on negative alcohol consequences. Personality and Individual Differences, 51(5), 635–640.
https://psycnet.apa.org/doi/10.1016/j.paid.2011.05.030
Kaufman, E. A., Xia, M., Fosco, G., Yaptangco, M., Skidmore, C. R., & Crowell, S. E. (2016). The difficulties in emotion regulation scale short form (DERS-SF): Validation and replication in adolescent and adult samples. Journal of Psychopathology and Behavioral Assessment, 38, 443–455.
https://psycnet.apa.org/doi/10.1007/s10862-015-9529-3
Kelly, T. H., & Bardo, M. T. (2016). Emotion regulation and drug abuse: Implications for prevention and treatment. Drug and Alcohol Dependence, 163(Suppl 1), S1–S2.
https://doi.org/10.1016/j.drugalcdep.2016.02.038
Kober, H. (2014). Emotion regulation in substance use disorders. In J. J. Gross (Ed.), Handbook of emotion regulation (pp. 428–446). The Guilford Press.
Kushner, M. G., Abrams, K., & Borchardt, C. (2000). The relationship between anxiety disorders and alcohol use disorders: A review of major perspectives and findings. Clinical Psychology Review, 20(2), 149–171.
https://doi.org/10.1016/S0272-7358(99)00027-6
Lane, R. D., & Smith, R. (2021). Levels of emotional awareness: Theory and measurement of a socio-emotional skill. Journal of Intelligence, 9(3), Article 42.
https://doi.org/10.3390%2Fjintelligence9030042
Martens, M. P., Neighbors, C., Lewis, M. A., Lee, C. M., Oster-Aaland, L., & Larimer, M. E. (2008). The roles of negative affect and coping motives in the relationship between alcohol use and alcohol-related problems among college students. Journal of Studies on Alcohol and Drugs, 69(3), 412–419.
https://doi.org/10.15288/jsad.2008.69.412
Mennin, D. S., Holaway, R. M., Fresco, D. M., Moore, M. T., & Heimberg, R. G. (2007). Delineating components of emotion and its dysregulation in anxiety and mood psychopathology. Behavior Therapy, 38(3), 284–302.
https://doi.org/10.1016/j.beth.2006.09.001
Moos, R. H., & Moos, B. S. (2006). Participation in treatment and Alcoholics Anonymous: A 16-year follow-up of initially untreated individuals. Journal of Clinical Psychology, 62(6), 735–750.
https://doi.org/10.1002%2Fjclp.20259
Murphy, A., Taylor, E., & Elliott, R. (2012). The detrimental effects of emotional process dysregulation on decision-making in substance dependence. Frontiers in Integrative Neuroscience, 6, Article 101.
https://doi.org/10.3389/fnint.2012.00101
Paulus, D. J., Bakhshaie, J., Lemaire, C., Garza, M., Ochoa-Perez, M., Valdivieso, J., Velasco, R. V., Bogiaizian, D., Kauffman, B. Y., Robles, Z., Neighbors, C., & Zvolensky, M. J. (2016). Negative affectivity and problematic alcohol use among Latinos in primary care: The role of emotion dysregulation. Journal of Dual Diagnosis, 12(2), 137–147.
https://doi.org/10.1080/15504263.2016.1172897
Petit, G., Luminet, O., Maurage, F., Tecco, J., Lechantre, S., Ferauge, M., Gross, J. J., & de Timary, P. (2015). Emotion regulation in alcohol dependence. Alcoholism – Clinical & Experimental Research, 39(12), 2471–2479.
https://doi.org/10.1111/acer.12914
Philippot, P., & Feldman, R. S. (Eds.). (2004). The regulation of emotion. Psychology Press.
Phillips, M. L., Drevets, W. C., Rauch, S. L., & Lane, R. (2003). Neurobiology of emotion perception II: Implications for major psychiatric disorders. Biological Psychiatry, 54(5), 515–528.
https://doi.org/10.1016/s0006-3223(03)00171-9
Pinsof, W. M., Zinbarg, R. E., Lebow, J. L., Knobloch-Fedders, L. M., Durbin, E., Chambers, A., Latta, T., Karam, E., Goldsmith, J., & Friedman, G. (2009). Laying the foundation for progress research in family, couple, and individual therapy: The development and psychometric features of the initial systemic therapy inventory of change. Psychotherapy Research, 19(2), 143–156.
https://doi.org/10.1080/10503300802669973
Rothschild, B. (2017). The body remembers Volume 2: Revolutionizing trauma treatment. W. W. Norton & Company.
Saunders, J. B., Aasland, O. G., Babor, T. F., de la Fuente, J. R., & Grant, M. (1993). Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption-II. Addiction, 88(6), 791–804.
https://doi.org/10.1111/j.1360-0443.1993.tb02093.x
Sayette, M. A. (2017). The effects of alcohol on emotion in social drinkers. Behaviour Research and Therapy, 88, 76–89.
https://doi.org/10.1016%2Fj.brat.2016.06.005
Schick, M. R., Nalven, T., & Spillane, N. S. (2020). The factor structure of self-esteem and its association with alcohol use in American Indian (AI) adolescents. American Journal of Orthopsychiatry, 90(6), 712–719.
https://doi.org/10.1037/ort0000504
Schore, A. N. (2001). The effects of early relational trauma on right brain development, affect regulation, and infant mental health. Infant Mental Health Journal, 22(1-2), 201–269.
https://doi.org/10.1002/1097-0355(200101/04)22:1<201::AID-IMHJ8>3.0.CO;2-9
Schore, A. N. (2003). Affect regulation and the repair of the self. W. W. Norton.
Sher, K. J., & Gerkin, E. R. (2007). Alcohol and affect regulation. In J. J. Gross (Ed.), Handbook of emotion regulation (pp. 560–580). The Guilford Press.
Sher, K. J., & Rutledge, P. C. (2007). Heavy drinking across the transition to college: Predicting first-semester heavy drinking from precollege variables. Addictive Behaviors, 32(4), 819–835.
https://doi.org/10.1016%2Fj.addbeh.2006.06.024
Shin, S. H., Hong, H. G., & Jeon, S.-M. (2012). Personality and alcohol use: The role of impulsivity. Addictive Behaviors, 37(1), 102–107.
https://doi.org/10.1016/j.addbeh.2011.09.006
Siegel, D. J. (2012). The developing mind: How relationships and the brain interact to shape who we are (2nd ed.). The Guilford Press.
Silani, G., Bird, G., Brindley, R., Singer, T., Frith, C., & Frith, U. (2008). Levels of emotional awareness and autism: An fMRI study. Social Neuroscience, 3(2), 97–112.
https://doi.org/10.1080/17470910701577020
Simon, B., Thury, A. Á., Török, L., Földesi, I., Csabafi, K., & Bagosi, Z. (2023). The effects of alcohol on anxiety-like, depression-like, and social behavior immediately and a day after binge drinking. Alcohol, 112, 17–24.
https://doi.org/10.1016/j.alcohol.2023.05.004
Simonič, B., & Osewska, E. (2023). Emotional experience and consequences of growing up in a family with alcoholism in adult children of alcoholics. The Person and the Challenges, 13(1), 63–81.
https://doi.org/10.15633/pch.13105
Sinha, R. (2001). How does stress increase risk of drug abuse and relapse? Psychopharmacology, 158, 343–359.
https://doi.org/10.1007/s002130100917
Sinha, R. (2022). Alcohol’s negative emotional side: The role of stress neurobiology in alcohol use disorder. Alcohol Research: Current Reviews, 42(1), Article 12.
https://doi.org/10.35946/arcr.v42.1.12
Solis, J. M., Shadur, J. M., Burns, A. R., & Hussong, A. M. (2012). Understanding the diverse needs of children whose parents abuse substances. Current Drug Abuse Reviews, 5(2), 135–147.
https://doi.org/10.2174%2F1874473711205020135
Stellern, J., Xiao, K. B., Grennell, E., Sanches, M., Gowin, J. L., & Sloan, M. E. (2023). Emotion regulation in substance use disorders: A systematic review and meta-analysis. Addiction, 118(1), 30–47.
https://doi.org/10.1111/add.16001
Straussner, S. L. A. (2004). Assessment and treatment of clients with substance use disorders: An overview. In S. L. A. Straussner (Ed.), Clinical work with substance-abusing clients (3rd ed., pp. 3–38). The Guilford Press.
Sudraba, V., Millere, A., Deklava, L., Millere, E., Zumente, Z., Circenis, K., & Millere, I. (2015). Stress coping strategies of drug and alcohol addicted patients in Latvia. Procedia - Social and Behavioral Sciences, 205, 632–636.
https://doi.org/10.1016/j.sbspro.2015.09.099
Thompson, R. A., Lewis, M. D., & Calkins, S. D. (2008). Reassessing emotion regulation. Child Development Perspectives, 2(3), 124–131.
https://doi.org/10.1111/j.1750-8606.2008.00054.x
Thorberg, F. A., & Lyvers, M. (2006). Negative Mood Regulation (NMR) expectancies, mood, and affect intensity among clients in substance disorder treatment facilities. Addictive Behaviors, 31(5), 811–820.
https://doi.org/10.1016/j.addbeh.2005.06.008
Tice, D. M., & Bratslavsky, E. (2000). Giving in to feel good: The place of emotion regulation in the context of general self-control. Psychological Inquiry, 11(3), 149–159.
https://doi.org/10.1207/S15327965PLI1103_03
Tice, D. M., Bratslavsky, E., & Baumeister, R. F. (2001). Emotional distress regulation takes precedence over impulse control: If you feel bad, do it! Journal of Personality and Social Psychology, 80(1), 53–67.
https://doi.org/10.1037/0022-3514.80.1.53
Tripp, J. C., & McDevitt-Murphy, M. E. (2015). Emotion dysregulation facets as mediators of the relationship between PTSD and alcohol misuse. Addictive Behaviors, 47, 55–60.
https://doi.org/10.1016/j.addbeh.2015.03.013
VanGeest, J. B., Johnson, T. P., & Alemagno, S. A. (2017). History of substance abuse research in the United States. In J. B. VanGeest, T. P. Johnson, & S. A. Alemagno (Eds.), Research methods in the study of substance abuse (pp. 3–25). Springer.
http://dx.doi.org/10.1007/978-3-319-55980-3_1
Verdejo-Garcia, A., Lawrence, A. J., & Clark, L. (2008). Impulsivity as a vulnerability marker for substance-use disorders: Review of findings from high-risk research, problem gamblers and genetic association studies. Neuroscience and Biobehavioral Reviews, 32(4), 777–810. https://doi.org/10.1016/j.neubiorev.2007.11.003
World Health Organization. (2007). International Classification of Diseases 11th Revision.
https://icd.who.int/en
World Health Organization. (2018). Global status report on alcohol and health 2018.
https://www.who.int/publications/i/item/9789241565639
World Health Organization. (2024, January 30). Alcohol.
https://www.who.int/health-topics/alcohol#tab=tab_1
Published 2024-04-30
How to Cite
