Elsevier

Addictive Behaviors

Volume 33, Issue 2, February 2008, Pages 388-394
Addictive Behaviors

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Difficulties in emotion regulation and impulse control in recently abstinent alcoholics compared with social drinkers

https://doi.org/10.1016/j.addbeh.2007.10.002Get rights and content

Abstract

Background

Early abstinence from chronic alcohol dependence is associated with increased emotional sensitivity to stress-related craving as well as changes in brain systems associated with stress and emotional processing. The aim of the current study was to examine potential difficulties in emotion regulation during early alcohol abstinence using the recently validated Difficulties of Emotion Regulation Scale (DERS).

Method

Recently abstinent treatment-seeking alcohol abusers (n = 50) completed the DERS during their first week of inpatient treatment and at discharge (5 weeks later). These responses were compared to a group of social drinkers (n = 62).

Results

Compared with social drinkers, alcohol-dependent patients reported significant differences in emotional awareness and impulse control during week 1 of treatment. Significant improvements in awareness and clarity of emotion were observed following 5 weeks of protracted abstinence. However, significant difficulties with impulse control persisted until discharge.

Conclusion

Findings from the DERS indicate protracted stress-related impulse control problems in abstinent alcoholics, which may contribute to increased relapse vulnerability.

Introduction

Early abstinence from alcohol is associated with changes in neural stress and reward systems that can include atrophy in subcortical and frontomesal regions (Bartsch et al., 2007). Moreover, recent imaging studies have shown that these brain regions are also associated with the experience and regulation of emotion (Ochsner & Gross, 2005). While alcohol-related changes in emotion, stress and reward-related brain regions have been well documented difficulties in emotion regulation (ER) have not been fully assessed.

Common definitions of ER relate to the way in which humans control their experience and expression of emotion under distress by employing strategies such as suppression, repression and cognitive reappraisal (Gross, 2002). Notably, these strategies are psychologically effortful and a conflict in different regulatory goals may occur during stress, shifting attention towards more immediate and often pleasure-seeking goals (Tice, Bratslavsky, & Baumeister, 2001). This conflict may in turn jeopardize volitional behavior through loss of impulse control (Kuhl & Koole, 1994).

The neuropathology of ER and the manner in which it is compromised may therefore have important implications for treatment outcome in abstinent alcoholics. Impulsivity has often been associated with relapse in various drugs of abuse (Evenden, 1999), and increased sensitivity to stress and alcohol craving has been observed during early abstinence (Fox, Berquist, Hong, & Sinha, 2007a). To date, however, the construct has not been assessed in alcoholics, partly due to its complexity, and partly due to the lack of a validated scale. This study aims to examine ER in early abstinent alcohol-dependent individuals compared with social drinkers using the Difficulties in Emotion Regulation Scale (DERS).

The DERS is an inclusive scale and defines ER in terms of four major factors: the understanding of emotion, the acceptance of emotion, the ability to control impulsive behavior and the ability to access ER strategies benefiting the individual and the specific goals of the situation. The scale has recently been validated in cocaine dependent patients (Fox, Axelrod, Paliwal, Sleeper, & Sinha, 2007b), however, its validity and functionality as a diagnostic tool in alcohol abusing populations, has not been examined.

Section snippets

Participants

Fifty treatment-seeking alcohol dependent (AD) individuals (41M/9F) and 62 social drinkers (SDs; 30M/32F) were recruited through local advertisements. AD patients met DSM-IV criteria for current alcohol dependence and tested positive in a urine toxicology screen upon entry into a locked inpatient facility. Exclusion criteria included dependence on substances other than alcohol or nicotine. SDs with current or past diagnoses of any substance dependence were also excluded. All participants were

Participants

AD patients were significantly older (37.5 ± 8.2 versus 33.7 ± 9.4; p = 0.03), less educated (12.9 ± 1.7 versus 14.9 ± 2.0; p < 0.0001) and comprised significantly fewer females compared with the SDs (21.9% versus 78.1%; p = 0.0002). They also reported significantly greater years of alcohol use (18.2 ± 8.4 versus 8.2 ± 8.1; p = 0.0001) and number of days of alcohol use in the past month (23.5 ± 9.3 versus 4.6 ± 6.1%; p < .0001). Both groups were well matched for lifetime prevalence of mood disorder (AD: 8.9% versus SD:

Discussion

This is the first study to examine ER difficulties in treatment-engaged AD patients during a period of early abstinence that is marked by an overall distress state. AD patients reported an overall problem with emotion regulation compared with SDs in the first few days of abstinence; in particular with emotional awareness and impulse control. Awareness of emotional states has been widely associated with alcoholism through the facilitation of avoidant coping (Hasking and Oei, 2007) which, in

Acknowledgements

This study was supported by grants R0I-AA13892 (Sinha), K02-DA17232 (Sinha) and M01-RR00125 (Yale GCRC). We also wish to thank staff at the Substance Abuse Treatment Unit, Clinical Neuroscience Research Unit and General Clinical Research Center at Yale University.

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