Emotion regulation and drug abuse: Implications for prevention and treatment

Addiction and autonomy: Why emotional dysregulation in addiction impairs autonomy and why it matters

An important philosophical issue in the study of addiction is what difference the fact that a person is addicted makes to attributions of autonomy (and responsibility) to their drug-oriented behavior. In spite of accumulating evidence suggesting the role of emotional dysregulation in understanding addiction, it has received surprisingly little attention in the debate about this issue. I claim that, as a result, an important aspect of the autonomy impairment of many addicted individuals has been largely overlooked. A widely shared assumption in the philosophical literature is that for addiction to impair a person's autonomy it has to make them (in some sense) take drugs against their will. So-called "willing addicts" are therefore usually seen as exempted from the autonomy impairment believed to characterize "unwilling addicts," the latter being those who "truly want" to stop using drugs but find their attempts repeatedly derailed by failures of self-control. In this article, I argue that the association between addiction and emotional dysregulation shows why this assumption is false. Emotional dysregulation is not only consistent with the possibility that many addicts take drugs "willingly," it supports the hypothesis that they use drugs because they truly want to. The article proposes an explanation for why emotional dysregulation should nevertheless be seen as an aspect of their loss of control and an important reason why they have impaired autonomy. I end by exploring some implications of this account for addict's decision-making capacity when they are prescribed the drugs to which they are addicted.

A systematic review of virtual reality therapies for substance use disorders: Impact on secondary treatment outcomes

BACKGROUND AND OBJECTIVES

Virtual reality (VR) therapy may be an effective tool in treating urges and cravings in substance use disorder (SUD). Given the high co-occurrence of difficulties with mood, anxiety, and emotional dysregulation with SUD, this review sought to examine the extant literature on the efficacy of VR for SUD in improving these secondary treatment outcomes.

METHODS

A systematic literature review was conducted following PRISMA guidelines in PubMed, PsychInfo, and Embase. Studies were included if they utilized immersive VR, were conducted with individuals with substance use disorder/dependence/misuse, and included measures of mood, anxiety, depression, emotional dysregulation, or retention in treatment.

RESULTS

Seven articles met our inclusion criteria. Five studies were conducted on patients using nicotine and utilized a cue-exposure intervention. VR was effective at reducing substance use and cravings in the majority of studies. Results on the efficacy of VR for improving mood, anxiety, and emotional regulation were mixed. Work examining retention in treatment was limited.

DISCUSSION AND CONCLUSIONS

VR for SUD has the potential to improve mood and anxiety symptoms as well as retention in treatment for patients with SUD, particularly if the therapy targets these psychological symptoms. Future studies examining components of VR for SUD in individuals with drug use disorders, as well as examinations of targeted interventions for associated mood, emotional dysregulation, and retention in treatment, are necessary.

SCIENTIFIC SIGNIFICANCE

This is the first systematic review of the impact of VR on mood, anxiety, and emotional dysregulation for individuals with substance use.

Longitudinal effects of interoceptive awareness training through mindful awareness in body-oriented therapy (MABT) as an adjunct to women's substance use disorder treatment: A randomized controlled trial

BACKGROUND

Training in interoceptive awareness is a promising behavioral approach for improving substance use disorder (SUD) treatment. This study examined the longitudinal effects of Mindful Awareness in Body-oriented Therapy (MABT) as an adjunct to women's SUD treatment. MABT teaches interoceptive awareness skills to promote self-care and emotion regulation.

METHODS

Women in intensive outpatient treatment for SUD at three community clinics were recruited and randomly assigned to one of three study conditions Treatment as Usual (TAU) + MABT, TAU + Women's Health Education (WHE), and TAU only. Four assessments were delivered over one year (N = 187) baseline, 3, 6 and 12 months to examine primary outcome of percent days abstinent from substance use, and secondary outcomes of emotion dysregulation, craving, psychological distress, mindfulness and interoceptive awareness. Changes in outcomes across time were assessed using multilevel mixed effects linear regression.

RESULTS

Substance use improved significantly for MABT vs. TAU at 6 months and 12 months. Positive longitudinal effects on secondary outcomes for MABT were evident on respiratory sinus arrhythmia (RSA), a physiological index of emotion regulation; on craving; and on interoceptive awareness skills. Analyses based on participants who completed >75% of the intervention sessions revealed additional immediate significant improvements for MABT vs. TAU and WHE on depressive symptoms and emotion regulation difficulties and longitudinal improvement on mindfulness skills.

CONCLUSIONS

Results show MABT to be efficacious for longitudinal health outcomes to support women's recovery as an adjunct to community-based SUD treatment.

Psychological and Autonomic Correlates of Emotion Dysregulation among Women in Substance Use Disorder Treatment

BACKGROUND

Emotion regulation is increasingly recognized as important for the prevention and treatment of substance use disorder (SUD). However, there is an identified lack of physiological indexes of emotion dysregulation in SUD treatment studies, critically needed to better understand the link between emotion regulation capacity (measured physiologically) and self-report health outcomes among individuals in SUD treatment.

OBJECTIVE

To examine the association between respiratory sinus arrhythmia (RSA) and self-report health outcomes among women in SUD treatment.

METHODS

This is a cross-sectional study based on baseline data from 217 women enrolled in a randomized control trial to study a mind-body intervention as an adjunct to SUD treatment. All participants were enrolled in community-based outpatient treatment. Participants were administered questionnaires to examine sample characteristics, mental health symptoms, and interoceptive awareness and mindfulness skills. RSA data was gathered as an index of emotion dysregulation. Descriptive statistics, bivariate correlations, and regression were used in the analyses.

RESULTS

Findings highlight the extensive trauma histories, low SES, and the high symptoms of distress in this sample. RSA was only significantly correlated with interoceptive awareness after controlling for age and BMI. Measures of symptomatic distress and mindfulness were not correlated with RSA. Conclusions/Importance: Results provide the first evidence of RSA as an index of interoceptive awareness in this population. The inclusion of biomarkers such as RSA in SUD clinical studies may help identify individuals that are in need of targeted treatments that include interoceptive awareness training focused on improving emotion regulation.