Alexithymia in alcohol dependent patients is partially mediated by alcohol expectancy

Association between alexithymia, emotional intelligence, smoking addiction, and alcohol use disorder among a sample of Lebanese adults

BACKGROUND

Alexithymia can be associated with worse addictive traits, while emotional intelligence is associated with better addictive outcomes. In Lebanon, the prevalence of cigarette and waterpipe smoking is on the rise, although people are aware of the associated harms. Also, around 11% of Lebanese adults have experienced alcohol use disorder (AUD). This study aimed to assess the association between alexithymia, emotional intelligence, smoking (cigarette and waterpipe), and AUD among a sample of Lebanese adults.

METHODS

A web-based cross-sectional study carried out between February and April 2020, during the lockdown period, enrolled 408 community-dwelling adults. The survey link was shared on social media to reach participants from all Lebanese districts/governorates.

RESULTS

Taking antidepressants (Beta = 4.37) was significantly associated with more cigarette dependence, while female gender (Beta = -1.52) and having a high vs. low monthly income (Beta = 1.02) were significantly associated with less cigarette dependence. None of the variables, including alexithymia, were significantly associated with waterpipe dependence. Female gender (Beta = -0.15) and higher emotional intelligence (Beta = -0.003) were significantly associated with less AUD, whereas higher alexithymia (Beta = 0.003) was significantly associated with more AUD.

CONCLUSION

This study could demonstrate a significant association between alexithymia and cigarette smoking and alexithymia and alcohol consumption. Future research is warranted to investigate the mediating effect of emotional intelligence and how these results may be used to meet the needs of alexithymic individuals with addictions.

Alexithymia mediates the association between childhood trauma and adolescent E-cigarette use

BACKGROUND

Adolescent electronic cigarette use (e-cigarette) is a public health concern and factors associated with vaping remain to be understood. Childhood emotional abuse/neglect is a risk factor for e-cigarettes. Yet, pathways by which trauma impacts use remain unclear. Alexithymia (i.e., difficulties identifying and describing feelings) is one possible link. Indeed, emotional abuse/neglect leads to difficulties identifying and verbalizing emotions. This impairment may lead to distress and promote e-cigarette use as a coping strategy.

METHODS

Using parallel mediation, this study examined the degree to which alexithymia, assessed using the Toronto Alexithymia Scale, mediates the link between emotional abuse/neglect, assessed using the Child and Adolescent Trauma Screen, and e-cigarette use. The sample (n = 166) consisted of adolescents from a larger multi-wave study.

RESULTS

Emotional abuse/neglect predicted difficulty describing feelings (effect = 0.23, p = 0.001), which in turn predicted e-cigarette use (effect = 0.30, p = 0.004). Moreover, difficulty describing feelings mediated the link between emotional abuse/neglect and e-cigarette use (sum of indirect 95% CI [1.68, 16.48]). Difficulty identifying feelings was not a significant mediator and the externally-oriented thinking subscale was excluded due to low reliability.

CONCLUSIONS

As e-cigarettes are often used in social contexts, teens who experience difficulty describing feelings may vape as a means of connecting emotionally with others. Moreover, nicotine, found in most e-cigarettes, releases dopamine and noradrenaline in the brain modulating action, learning, and memory processes; plausibly, improving verbalization of emotions. Programming which identifies nuances in alexithymia among adolescents with emotional abuse/neglect could mitigate e-cigarette use or delay initiation.

A comparison of the associations between alexithymia and both non-suicidal self-injury and risky drinking: The roles of explicit outcome expectancies and refusal self-efficacy

Both non-suicidal self-injury (NSSI) and risky drinking are positively associated with alexithymia, a personality trait characterized by difficulties appraising feelings and an externally orientated thinking style. Although researchers have studied the associations between alexithymia and both NSSI and risky drinking, the underlying factors of both associations are rarely compared. Using path analysis, we compared the mediating effects of behaviour-specific outcome expectancies and self-efficacy beliefs on the associations between alexithymia and both NSSI and risky drinking. A sample of 627 university students (76.10% female, Mage = 20.75, SD = 1.88) completed a battery of questionnaires. Alexithymia exhibited indirect effects on NSSI via affect regulation expectancies, pain expectancies, communication expectancies, and low self-efficacy to resist NSSI. Alexithymia exhibited indirect effects on risky drinking via expectations of increased confidence and negative consequences. However, the indirect effects differed depending on the valance of the emotion the individual had difficulties appraising. Our findings indicate that the underlying factors in the associations between alexithymia and both NSSI and risky drinking could differ. Where individuals who have difficulties appraising negative emotions may engage in NSSI to help regulate negative feelings, they may consume alcohol to gain more confidence in expressing their feelings. Clinical implications are discussed.

Childhood trauma, alexithymia, and mental states recognition among individuals with alcohol use disorder and healthy controls

BACKGROUND

Although prior work indicates a link between childhood trauma, alexithymia, and mental states recognition, empirical support is limited. Moreover, findings based on adult samples are mixed. Previous studies demonstrate that childhood trauma might either enhance, preserve, or reduce mental states recognition in selected at-risk populations. The current study investigates whether alcohol use disorder (AUD) status moderates the association between childhood trauma, alexithymia, and mental states recognition in a treatment-seeking AUD sample and non-AUD healthy adults.

METHODS

Data comes from 255 individuals participating in an ongoing project that compares emotional and behavioral functioning of patients treated in an inpatient setting for AUD and a comparison sample of 172 healthy controls (HCs). Mental states recognition was measured using a computerized version of the Reading the Mind in the Eyes Task (RMET). The presence of childhood trauma was assessed with the Childhood Trauma Questionnaire. Alexithymia was measured with the Toronto Alexithymia Scale (TAS-20). Demographic information, as well as alcohol drinking and psychopathological symptoms were assessed. A moderated mediation model was estimated whereby alexithymia was included as a mediator in the association between childhood trauma and RMET performance, with AUD diagnosis status moderating the link between alexithymia and RMET performance.

RESULTS

Findings provide support for moderated mediation. Childhood emotional trauma impacted negative mental states recognition performance via difficulty describing feelings, but only among HCs (p < 0.01).

CONCLUSIONS

Findings highlight the impact that AUD status has on the association between early life emotional trauma and difficulty describing feelings on individual differences in mental states recognition.

The Influence of Alexithymia on Alcohol Craving, Health-Related Quality of Life and Gender in Alcohol-Dependent Outpatients

Alexithymia is a vulnerability factor for physical and mental illness that can significantly influence the daily function of alcohol-dependent patients. The aim of this study was to examine the indirect effect of obsessive thoughts and compulsive behaviors involving alcohol craving on the relationship between alexithymia, quality of life (QoL) of psychological well-being and health status. Three hundred and eighty-one outpatients (263 males and 118 females) in treatment for alcohol dependence completed self-report measures of alexithymia, alcohol craving, GHQ-28 (QoL-psychological well-being) and SF-36 (QoL-health status). Males scored significantly higher than females on aspects of alexithymia, and females reported significantly higher levels of alcohol craving. Path analysis showed an indirect effect of alcohol craving on the relationship between alexithymia, QoL-psychological well-being and self-reported QoL-health status for males only. The current study provides important new information about impaired self-reported health status and well-being among male alcohol-dependent treatment seekers with alexithymia.

Impact of the interaction between alexithymia and the adult attachment styles in participants with alcohol use disorder

The current study aims to investigate the effect of the interaction between adult attachment styles and alexithymia among participants with alcohol use disorder (AUD). This study is cross-sectional, conducted between November 2017 and March 2018, which enrolled 789 community-dwelling participants. The interaction between alexithymia and secure relationship tended to significance (p = 0.057). Higher interaction between alexithymia and a fearful relationship style (β = 0.04) were significantly associated with higher AUD. The interaction model revealed the importance of stratifying the results according to presence/absence of alexithymia. Being a female and having a secure relationship style were significantly associated with lower AUD in both groups. Being divorced was significantly associated with higher AUD in both groups. Increasing age (β = -1.48), secondary (β = -4.65), and university level of education (β = -6.46) were significantly associated with lower AUD in the non-alexithymic group. Intermediate monthly income (β = 2.69) and being widowed (β = 8.24) were significantly associated with higher AUD in the non-alexithymic group. High monthly income (β = 3.46) was significantly associated with higher AUD in the alexithymic group. The results of this study showed that the consideration of the combination between attachment styles and alexithymia is of significance in the diagnosis and therapy of alcohol use disorders.

Factors associated with alcohol use disorder: the role of depression, anxiety, stress, alexithymia and work fatigue- a population study in Lebanon

Background

International research showed that common mental disorders such as depression, anxiety, social anxiety, stress, alexithymia and having insecure attachment styles are risk factors for alcohol use disorder (AUD). Our objective was to study the factors associated withAUD in a sample of the Lebanese population.

Methods

During the period lasting from November 2017 to March 2018, a sample of 789 Lebanese participants agreed to contribute to a cross-sectional study (53.23% males). Alcohol use disorder was assessed using the Alcohol Use Disorder Identification Test (AUDIT).

Results

A high risk of AUD was associated with higher alexithymia (ORa = 1.030; CI 1.009–1.051), depression (ORa = 1.076; CI 1.050–1.103) and suicidal ideation (ORa = 1.253; CI 1.026–1.531) in a significant manner. In opposition, a higher number of kids (ORa = 0.863; CI 0.752–0.991), being a female (ORa = 0.460; CI 0.305–0.694) and higher emotional management (ORa = 0.962; CI 0.937–0.988) were significantly associated with lower AUD risk.

A cluster analysis derived three mutually exclusive clusters. Cluster 1 formed 45.4% of the sample and assembled people with psychological difficulties (work fatigue and high stress, high emotional work fatigue and low emotional intelligence, low self-esteem, high social phobia, high alexithymia); Cluster 2 formed 34.4% of the sample and assembled people with high wellbeing (low suicidal ideation, low emotional work fatigue, depression and anxiety, high emotional intelligence, high self-esteem and low social phobia); whereas cluster 3 formed 20.2% of the sample and represented people with mental dysfunction (high anxiety and depression, high suicidal ideation, low self-esteem and high social phobia, low emotional intelligence, high emotional work fatigue). People with psychological difficulties (cluster 1) (Beta = 5.547; CI 4.430–6.663), and people in distress (cluster 3) (Beta = 7.455; CI 5.945–8.965) were associated with higher AUDIT scores than those with high wellbeing (cluster 2).

Conclusion

AUD seems to be influenced by several factors among the Lebanese population, including alexithymia, stress, anxiety and work fatigue. Healthcare professionals should spread awareness to reduce the prevalence of these factors.

The associations between alexithymia and both non-suicidal self-injury and risky drinking: A systematic review and meta-analysis

BACKGROUND

Nonsuicidal self-injury (NSSI; direct harm to the body without suicidal intent) and risky drinking are two behaviours that serve emotion regulatory functions. When underlying emotional problems are untreated, individuals may shift between NSSI and risky drinking. Both behaviours are associated with alexithymia, difficulties identifying and describing emotions and retaining an externally orientated thinking style. However, it is unknown to what extent the associations are similar and under what circumstances (e.g. sex, age) they may differ.

METHOD

To compare both associations we conducted an extensive review using several databases. Overall, 20 NSSI-related articles and 33 risky drinking-related articles met the inclusion criteria.

RESULTS

A meta-analysis revealed significant positive associations between total alexithymia scores, difficulties identifying feelings, difficulties describing feelings and both NSSI and risky drinking. However, these associations appear stronger for NSSI. Further, externally orientated thinking was associated with risky drinking but not NSSI. Age had opposing moderating effects on the relationships, with the association between alexithymia and NSSI being stronger in younger samples and the association between alexithymia and risky drinking being stronger in older samples. Further, the association between alexithymia and NSSI was stronger for female only samples compared to male only samples.

LIMITATIONS

The review was limited to English articles. High levels of heterogeneity were observed. The majority of the studies included were cross-sectional.

CONCLUSION

These results imply that NSSI and risky drinking may have both shared and distinguishable correlates. Alexithymia can be targeted in treatment to potentially reduce the likelihood of individuals shifting between behaviours to regulate their emotions.

Factors associated with alexithymia among the Lebanese population: results of a cross-sectional study

Background

To our knowledge, no research project on alexithymia has been conducted in Lebanon. The objective of this study was to assess risk factors associated with alexithymia in a representative sample of the Lebanese population.

Methods

This is a cross-sectional study, conducted between November 2017 and March 2018, which enrolled 789 participants from al districts of Lebanon. The Toronto Alexithymia Scale (TAS-20) was used to measure alexithymia, the Alcohol Use Disorders Identification Test to assess alcohol use, drinking patterns, and alcohol-related issues, the Rosenberg self-esteem scale to evaluate self-worth, the Hamilton depression rating scale and Hamilton Anxiety Scale to screen for depression and anxiety respectively, the Three-Dimensional Work Fatigue Inventory to measure physical, mental and emotional work fatigue respectively, the Columbia–Suicide Severity Rating Scale to evaluate suicidal ideation and behavior, the Perceived Stress Scale to measure stress, the Liebowitz Social Anxiety Scale to help identify a social anxiety disorder and the Quick Emotional Intelligence Self-Assessment to measure emotional intelligence.

Results

The results showed that 395 (50.4%) were not alexithymic, 226 (28.8%) were possible alexithymic, whereas 163 (20.8%) were alexithymic according to established clinical cutoffs. Stress (Beta = 0.456), emotional exhaustion (Beta = 0.249), the AUDIT score (Beta = 0.225) and anxiety (Beta = 0.096) were associated with higher alexithymia, whereas low emotional work fatigue (Beta = −0.114) and being married (Beta = −1.933) were associated with lower alexithymia.

People in distress (Beta = 7.33) was associated with higher alexithymia scores, whereas people with high wellbeing (Beta = −2.18), an intermediate (Beta = −2.90) and a high (Beta = −2.71) family monthly income were associated with lower alexithymia compared to a low one.

Conclusion

Alexithymia appears to be influenced by many factors, including stress, anxiety, and burnout. To reduce its prevalence, it is important that health professionals educate the public about these factors. Further studies on a larger scale are needed to confirm our findings.

Association Between Interoception and Emotion Regulation in Individuals With Alcohol Use Disorder

INTRODUCTION

Sensing body-related information includes interoceptive sensibility (the tendency to focus on internal body sensations) and accuracy (precision in perceiving real internal processes). Interoception and emotion regulation have both been linked to alcohol use disorder (AUD). However, the association between these factors have not been investigated within a clinical group of individuals with AUD.

OBJECTIVES

The current study examines associations between emotion regulation and interoceptive accuracy and sensibility among individuals with AUD and healthy controls (HCs).

METHODS

The sample comprised 165 individuals meeting criteria for AUD and 110 HCs. Interoceptive sensibility was assessed with a self-report measure (the Private Body Consciousness subscale) and interoceptive accuracy - with a behavioral measure (the Schandry test). Emotion regulation domains: non-acceptance of negative emotions, inability to engage in goal-directed behaviors when experiencing negative emotions, difficulties controlling impulsive behaviors when experiencing negative emotions, limited access to effective emotion regulation strategies, and lack of own emotional awareness and clarity were assessed with the Difficulties in Emotion Regulation Scale (DERS). Associations between interoception and emotion regulation were assessed while controlling for sleep problems, depressive symptoms, age, and sex.

RESULTS

Higher interoceptive accuracy was negatively associated with DERS subscale of non-acceptance of negative emotions in the AUD group (but not in the HC group). Higher interoceptive sensibility was significantly associated with problems in controlling impulsive behaviors when experiencing negative emotions. This association was moderated by symptoms of AUD. Higher interoceptive sensibility was associated with higher emotional awareness, but only in the HC group.

CONCLUSIONS

Individuals with AUD who are more interoceptively accurate may be more effective in regulating their emotions. On the other hand, individuals with AUD who are more interoceptively sensible, may have problems with controlling their behaviors while experiencing negative emotional states.

Alexithymia and Alcohol Dependence: The Roles of Negative Mood and Alcohol Craving

Background: Alexithymia is a personality trait associated with emotion regulation difficulties. Up to 67% of alcohol-dependent patients in treatment have alexithymia. Objectives: The objective of this study was to investigate the direct and indirect effects of alexithymia, negative mood (stress, anxiety, and depression) and alcohol craving on alcohol dependence severity. Methods: Three hundred and fifty-five outpatients (mean age = 38.70, SD = 11.00, 244 males, range 18-71 years) undergoing Cognitive-Behavioral Therapy for alcohol dependence completed the Toronto Alexithymia Scale (TAS-20), Depression Anxiety Stress Scales (DASS-21), Obsessive Compulsive Drinking Scale (OCDS), and Alcohol Use Disorders Identification Test (AUDIT) prior to the first treatment session. Results: Alexithymia had an indirect effect on alcohol dependence severity, via both negative mood and alcohol craving (b = 0.03, seb = 0.008, 95% CI: 0.02-0.05). An indirect effect of negative mood on alcohol dependence via alcohol craving was also observed (b = 0.12, seb = 0.03, 95% CI: 0.07-0.16). Conclusions/importance: Alexithymia worked through negative mood and alcohol craving leading to increased alcohol dependence severity, indicating that craving had an indirect effect on the relationship between alexithymia and alcohol dependence severity. Targeting alcohol craving and negative mood for alcohol-dependent patients with alexithymia seems warranted.

Social Interaction Anxiety, Alexithymia, and Drinking Motives in Australian University Students

In young adults at university, social interaction anxiety has been linked to elevated risk of alcohol-related problems, as has alexithymia. The present study sought to assess whether social interaction anxiety is, like alexithymia, associated with the primary motive of drinking to cope with negative affect. There were 126 undergraduates (76 females, 50 males), aged 18-25 years, who were recruited from two southeast Queensland universities to complete validated self-report measures of problematic drinking, alexithymia, drinking motives, and social interaction anxiety. As predicted, social interaction anxiety was positively related to problematic drinking and coping motives for drinking. Alexithymia mediated the relationship of social interaction anxiety with coping motives. Findings were consistent with a developmental hypothesis of the links between social anxiety, alexithymia, and drinking motives. Given the cross-sectional design of the current study, longitudinal research is ultimately needed to confirm such interpretations of alexithymia and alcohol use among socially anxious young adults at university.

Alexithymia in Young Adults With Substance Use Disorders: Critical Issues About Specificity and Treatment Predictivity

Several studies have reported high rates of alexithymia in drug-dependent individuals, but supporting evidence attests association between alexithymia and a variety of psychiatric disorders, raising doubts about its specificity. Moreover, controversies are emerging about alexithymia assessment: self-report measures present shortcomings with respect to discriminant validity and reliability. As regards treatment for substance use disorders (SUDs), alexithymia has been linked to poorer outcomes, but the results are inconsistent. The aim of the present study is to investigate alexithymia in substance-dependent young adults by examining: (a) the specificity of alexithymia in drug-dependent inpatients, compared to healthy individuals and patients with psychiatric disorders (behavioral and emotional disorders) and (b) the predictivity of alexithymia in determining treatment outcomes in terms of relapses, drop-outs from treatment and the rate of relapse per month of treatment. Two studies were conducted to fulfill these aims: Study 1 and Study 2. Study 1 involved 90 late adolescents, aged 17-21. To fulfill the first aim, 30 inpatients diagnosed with SUD were compared with 30 healthy controls and 30 individuals referred to an outpatient neuropsychiatric unit (a). The participants completed the Toronto Alexithymia Scale-20 (TAS-20) and the Symptom Checklist-90-Revised (SCL-90-R). The results indicated that both clinical groups reported higher TAS-20 scores than the non-clinical subjects, but they did not differ from each other (a); moreover, a large correlation was detected between alexithymia and depressive symptoms, as assessed by the SCL-90-R. Study 2 involved 55 inpatients with SUD recruited in a therapeutic community. The participants completed the TAS-20, and clinicians filled out the Observer Alexithymia Scale (OAS). No association was found between self-report and observational measures. Neither self-reported nor observed alexithymia predicted the number of relapses, drop-out from treatment, or the rate of relapses per month of treatment (b). When the interaction with gender was explored, the global score of alexithymia and the "Distant" OAS subscale predicted the number rate relapses only in males. The TAS-20 did not discriminate between the clinical groups. The limited ability of both observed and self-reported measures in predicting treatment outcome raises questions on the specificity of alexithymia among the substance-dependent inpatient population.

Interpersonal and intrapersonal emotional processes in individuals treated for alcohol use disorder and non-addicted healthy individuals

INTRODUCTION

Prior work largely confirms the presence of various emotional processing deficits among individuals with an alcohol use disorder (AUD); however, their specificity and relevance still warrant investigation. The aim of the current study was to compare selected aspects of emotional processing (i.e., mental state recognition, alexithymia, and emotional intelligence) between individuals treated for an AUD and healthy individuals.

METHODS

The AUD sample consisted of 92 abstinent men with AUD who were participating in an 8-week inpatient abstinence-based treatment program in Warsaw, Poland. The healthy control (HC) group consisted of 86 men recruited from the Medical University of Warsaw and the Nowowiejski Hospital administrative staff. Baseline information about demographics, psychopathological symptoms, and severity of alcohol problems was obtained. Mental states recognition was assessed using the Reading the Mind in the Eyes Test (RMET). Alexithymia was measured with the Toronto Alexithymia Scale (TAS-20). The Schutte Self-Report Emotional Intelligence Test (SSEIT) was used to measure emotional intelligence (EI).

RESULTS AND CONCLUSIONS

After accounting for potentially confounding variables (demographics, severity of depression, anxiety symptoms) in MANCOVA models, patients with AUD presented deficits in identification and description of their own emotional states, as well as lower emotion regulation skills when compared to HCs. No between-group differences were observed in self-reported recognition of other people's emotions, social skills, and a behavioral measure of mental states recognition. Specific rather than general emotion-processing deficits in participants with AUD were identified, suggesting problems with processing of intrapersonal emotional signals.

Alexithymia and problematic alcohol use: A critical update

There has been a substantial growth in empirical research aimed at examining the co-occurrence of alexithymia and problematic alcohol use and alcohol use disorder (AUD) since Thorberg, Young, Sullivan, and Lyvers (2009) original review article. The objective of the present paper is therefore to provide a critical update review of research on alexithymia and problematic alcohol use published since 2009. A systematic search was conducted through PsychINFO, Medline, and ProQuest databases to obtain relevant literature published between 2009 and 2016. Studies that involved measures of alexithymia and problematic alcohol use among clinical and non-clinical samples were included. Prevalence rates of alexithymia among Alcohol Dependent (AD) samples were identified between 30 and 49%, and were therefore much lower than originally reported. The findings of this update review highlight an indirect relationship between alexithymia and alcohol problem severity that is mediated by a number of psychological drinking constructs (e.g., alcohol expectancy, drinking motives, craving and alcohol related intrusive thoughts) and psychological risk factors for the development of alcohol related problems (e.g., mood and emotion dysregulation, attachment, trauma, and cognitive function). In addition, this review provides reasonable evidence to support alexithymia as an independent risk factor for alcohol related problems among clinical samples only. In conclusion, alexithymia is a multifaceted construct that has a complex relationship with various risk factors and psychological drinking constructs. The growing body of research highlights the demand for understanding the interrelationships between alexithymia, psychosocial risk factors, and problematic alcohol use in order to tailor and target therapeutic interventions.

Heterogeneity of emotional and interpersonal difficulties in alcohol-dependence: A cluster analytic approach

BACKGROUND

Emotional and interpersonal impairments have been largely reported in alcohol-dependence, and their role in its development and maintenance is widely established. However, earlier studies have exclusively focused on group comparisons between healthy controls and alcohol-dependent individuals, considering them as a homogeneous population. The variability of socio-emotional profiles in this disorder thus remains totally unexplored. The present study used a cluster analytic approach to explore the heterogeneity of affective and social disorders in alcohol-dependent individuals.

METHODS

296 recently-detoxified alcohol-dependent patients were first compared with 246 matched healthy controls regarding self-reported emotional (i.e. alexithymia) and social (i.e. interpersonal problems) difficulties. Then, a cluster analysis was performed, focusing on the alcohol-dependent sample, to explore the presence of differential patterns of socio-emotional deficits and their links with demographic, psychopathological and alcohol-related variables.

RESULTS

The group comparison between alcohol-dependent individuals and controls clearly confirmed that emotional and interpersonal difficulties constitute a key factor in alcohol-dependence. However, the cluster analysis identified five subgroups of alcohol-dependent individuals, presenting distinct combinations of alexithymia and interpersonal problems ranging from a total absence of reported impairment to generalized socio-emotional difficulties.

CONCLUSIONS

Alcohol-dependent individuals should no more be considered as constituting a unitary group regarding their affective and interpersonal difficulties, but rather as a population encompassing a wide variety of socio-emotional profiles. Future experimental studies on emotional and social variables should thus go beyond mere group comparisons to explore this heterogeneity, and prevention programs proposing an individualized evaluation and rehabilitation of these deficits should be promoted.

The association between depression and craving in alcohol dependency is moderated by gender and by alexithymia factors

Alexithymia is a multifaceted personality trait that involves difficulties in identifying and describing feelings to others, a poor fantasy life and an externally oriented cognitive style. Alexithymia has been described as a vulnerability factor for mental and physical diseases. We investigated in a group of 158 alcohol-dependent patients (103 men, 55 women) the association between depression and craving for alcohol when these patients were starting a detoxification program, and the moderating impact of gender and alexithymia on this relation. We first found an interaction between depression and gender in the prediction of craving in the sense that only for women an increase in depressive mood was related to an increase in total craving. When examining gender separately, we found that alexithymia factors acted as moderators. For women, the link between depression and craving was strengthened for the ones scoring higher on "difficulties describing feelings". But for men, the link between depression and craving was reduced for the ones scoring higher on "externally-oriented thinking". These findings suggest that in some cases that need to be identified more systematically in the future, the "externally-oriented thinking" alexithymia factor can exert - at least in the short term - some protective effects.

Relationship between emotional processing, drinking severity and relapse in adults treated for alcohol dependence in Poland

AIMS

Growing data reveals deficits in perception, understanding and regulation of emotions in alcohol dependence (AD). The study objective was to explore the relationships between emotional processing, drinking history and relapse in a clinical sample of alcohol-dependent patients.

METHODS

A group of 80 inpatients entering an alcohol treatment program in Warsaw, Poland was recruited and assessed at baseline and follow-up after 12 months. Baseline information about demographics, psychopathological symptoms, personality and severity of alcohol problems was obtained. The Schutte Self-Report Emotional Intelligence (EI) Test and Toronto Alexithymia Scale (TAS) were utilized for emotional processing assessment. Follow-up information contained data on drinking alcohol during the last month.

RESULTS

At baseline assessment, the duration of alcohol drinking was associated with lower ability to utilize emotions. Patients reporting more difficulties with describing feelings drank more during their last episode of heavy drinking, and had a longer duration of intensive alcohol use. A longer duration of the last episode of heavy drinking was associated with more problems identifying and regulating emotions. Poor utilization of emotions and high severity of depressive symptoms contributed to higher rates of drinking at follow-up.

CONCLUSIONS

These results underline the importance of systematic identification of discrete emotional problems and dynamics related to AD. This knowledge has implications for treatment. Psychotherapeutic interventions to improve emotional skills could be utilized in treatment of alcohol-dependent patients.

Risky cannabis use is associated with alexithymia, frontal lobe dysfunction, and impulsivity in young adult cannabis users

Risky or problematic alcohol use by young adults has been found to be associated with factors such as alexithymia, frontal lobe dysfunction, reward sensitivity, and impulsivity. One interpretation is that these factors reflect inherent traits that predispose to risky substance use in general, a notion examined in the present study. Alexithymia, everyday frontal lobe functioning, sensitivity to reward and punishment, and impulsivity were examined in 138 young adult cannabis users who were divided into Low Risk (n = 99) and Risky (n = 39) users according to their Cannabis Use Disorder Identification Test (CUDIT) scores. Risky cannabis use was significantly positively associated with alexithymia, multiple signs of frontal lobe dysfunction in everyday life, and impulsivity. A broader pattern of dysfunction was indicated for risky cannabis use than for risky alcohol use in this sample. Findings are interpreted as likely reflecting not only inherent traits that predispose to risky substance use in general, but also perhaps residual effects of recent heavy cannabis use in the Risky user group. Longitudinal research is needed to disentangle these competing possibilities.

Alexithymia in patients with substance use disorders: state or trait?

Previous research on substance use disorders (SUD) has yielded conflicting results concerning whether alexithymia is a state or trait, raising the question of how alexithymia should be addressed in the treatment of SUD-patients. The absolute and relative stabilities of alexithymia were assessed using the Toronto Alexithymia Scale (TAS-20) and its subscales. In total, 101 patients with SUD were assessed twice during a 3-week inpatient detoxification period while controlling for withdrawal symptoms and personality disorder traits. The relative stability of the total TAS-20 and subscales was moderate to high but showed remarkable differences between baseline low, moderate, and high alexithymic patients. A small reduction in the mean levels of the total TAS-20 scores and those of one subscale revealed the absence of absolute stability. The levels of alexithymia were unrelated to changes in withdrawal symptoms, including anxiety- and depression-like symptoms. The differences between low, moderate, and high alexithymic patients in terms of the change in alexithymia scores between baseline and follow-up indicated a strong regression to the mean. The findings suggest that alexithymia in SUD patients as measured using the TAS-20 is both a state and trait phenomenon and does not appear to be related to changes in anxiety- and depression-like symptoms.

Avoidance coping strategies, alexithymia and alcohol abuse: a mediation analysis

Alexithymia and avoidance coping strategies are both associated with alcohol abuse, but their effects have been seldom studied simultaneously. The present study investigated the interplay between alexithymia and avoidance coping strategies in predicting the severity of alcohol abuse in an alcohol-dependent sample. The TAS-20 and COPE-NVI questionnaires were administered to 110 alcoholic inpatients enrolled into a recovery program at the Center for Alcohol Abuse of the Department of Clinical Medicine, Sapienza University of Rome, Italy. The alcohol abuse index consisted of the mean alcohol units consumed by participants and days of abstinence before being enrolled into the recovery program. Results showed that alexithymic alcoholics consumed significantly more alcohol and were less abstinent than non-alexithymic alcoholics. Concerning the relationship among alexithymia, coping strategies and alcohol abuse, data showed that alexithymia completely mediated the effects of avoidance coping strategies on alcohol abuse, suggesting that avoidance strategies have therefore an indirect effect on alcohol abuse among alcoholics. Theoretical and clinical implications of the results are discussed.

The relationship of alexithymia to emotional dysregulation within an alcohol dependent treatment sample

Difficulties regulating emotions have implications for the development, maintenance, and recovery from alcohol problems. One construct thought to impede the regulation of emotion is alexithymia. Alexithymia is characterized by difficulties identifying, differentiating and expressing feelings, a limited imagination and fantasy life, and an externally-oriented thinking style (e.g., prefer talking about daily activities rather than feelings). Given that poor emotion regulation skills have been found to predict posttreatment levels of alcohol use, and that several defining characteristics of alexithymia bear similarity to deficits in emotion regulation skills, it is possible that alexithymia may predict poorer alcohol treatment outcomes. Thus, the present study first examined the relationship of alexithymia to several other emotion regulation measures and then investigated the impact of alexithymia on attrition and alcohol treatment outcomes in men and women (N=77) enrolled in a 12-week cognitive-behavioral intervention for alcohol dependence. At baseline, higher scores on alexithymia were associated poorer emotion regulation skills, fewer percent days abstinent, greater alcohol dependence severity, and several high-risk drinking situations. Alexithymia was unrelated to attrition and to level of alcohol consumption at posttreatment. Overall, the construct of alexithymia is shown to be related to several theoretically-related constructs (e.g., emotion regulation, mindfulness) but demonstrated a limited relationship to drinking outcomes in those seeking treatment for alcohol dependence.

Alexithymia and alcohol consumption: the mediating effects of drinking motives

The association between alexithymia and alcohol consumption has been well documented. However, little research has investigated the mechanisms behind the association. In the present study, the relationship between alexithymia, drinking motives and alcohol consumption was examined in a group of social (non-problem) drinkers. In a cross-sectional study, 862 participants completed the Toronto Alexithymia Scale, Drinking Motives Questionnaire, and provided alcohol consumption information. Regression analyses revealed that alexithymia predicts alcohol consumption. Formal mediation analyses demonstrated that this relationship was fully mediated by social, enhancement and coping drinking motives, and partially mediated by conformity. Drinking motives may represent one mechanism to explain the association between alexithymia and alcohol consumption.

Alexithymia in relation to parental alcoholism, everyday frontal lobe functioning and alcohol consumption in a non-clinical sample

BACKGROUND

Recent studies have indicated that 45-67% of those in treatment for alcohol use disorders suffer from alexithymia, a multifaceted personality trait characterized by difficulties identifying and describing emotions and an externally oriented cognitive style. The high reported prevalence rates of alexithymia among those with alcohol dependence led to speculation that alexithymia is a personality dimension that may predispose to risky or problematic alcohol use.

METHODS

This notion was examined in 314 adult volunteers (54% female) aged 18-45 years (M=27.6 years), all of whom reported at least occasional alcohol consumption, who completed online surveys assessing alexithymia (Toronto Alexithymia Scale, or TAS-20), parental alcoholism (Children of Alcoholics Screening Test, or CAST), everyday signs of frontal lobe dysfunction (Frontal Systems Behavior Scale, or FrSBe) and risky alcohol use (Alcohol Use Disorders Identification Test, or AUDIT).

RESULTS

TAS-20 scores were positively correlated with the index of parental alcoholism CAST, index of frontal lobe dysfunction FrSBe and measure of alcohol-related problems AUDIT. Chi-square test showed an association between TAS-20-defined alexithymia and being the offspring of an alcoholic parent as defined by CAST. Regression analysis showed that frontal lobe dysfunction (FrSBe) mediated the relationship between alexithymia (TAS-20 total score) and risky alcohol use (AUDIT).

CONCLUSIONS

The findings suggest that alexithymia is related to deficiencies in frontal lobe functioning that may reflect a heritable predisposition to alcohol problems.