Alexithymia, craving and attachment in a heavy drinking population

doi:10.1016/j.addbeh.2010.12.016

Addictive Behaviors

Volume 36, Issue 4, April 2011, Pages 427-430

https://doi.org/10.1016/j.addbeh.2010.12.016 Get rights and content

Abstract

Up to fifty per cent of individuals with Alcohol use disorders (AUD) also have alexithymia a personality construct hypothesized to be related to attachment difficulties. The relationship between alexithymia, craving, anxious attachment and alcohol-dependence severity was examined in 254 patients participating in a Cognitive-Behavioral Therapy (CBT) program for alcohol-dependence. Participants completed the Toronto Alexithymia Scale (TAS-20), the Obsessive Compulsive Drinking Scale (OCDS), the Revised Adult Attachment Anxiety Subscale (RAAS-Anxiety) and the Alcohol Use Disorder Identification Test (AUDIT). MANOVA indicated that individuals with alexithymia reported significantly higher levels of total OCDS, obsessive thoughts about alcohol, and compulsive drinking urges and behavior, compared to the non-alexithymic group. Regression analyses found that anxious attachment partially mediated the relationship between alexithymia and craving. Anxious attachment may be a potential treatment target to reduce alcohol consumption in those with alcohol-dependence and alexithymia.

Research Highlights

► There were significant relationships of alexithymia, craving and anxious attachment. ► Alexithymic alcoholics reported higher levels of craving and alcoholism severity. ► Anxious attachment partially mediated the relationship of alexithymia and craving.

Section snippets

Participants

Two hundred and fifty four patients (176 males and 78 females) were recruited from a hospital outpatient Cognitive Behavioral Treatment (CBT) program for alcohol-dependence. Male and female participant mean ages were 36.84 years (SD = 11.34) and 39.03 years (SD = 9.25), respectively. The study inclusion criteria included a diagnosis of alcohol-dependence in accordance to DSM-IV-TR (APA, 2000) criteria. All were evaluated before pharmacotherapy (including anti-craving medication) was introduced.

Intercorrelations

Relationships among the TAS-20 scales, OCDS scales, RAAS-Anxiety and AUDIT scale were examined by means of Pearson correlation coefficients across all participants (see Table 1).

Group comparisons

Based on established TAS-20 classification criteria, 32.4% of the sample was categorized as alexithymic and 42.3% as non-alexithymic. A two-way multivariate analysis of variance (MANOVA) was conducted with the independent variables of group (alexithymic, non-alexithymic), and gender and the dependent variables OCDS,

Discussion

Our results highlight the importance of alexithymia and difficulties identifying and describing feelings as related to preoccupation, obsessions and compulsive behaviors regarding drinking in those with alcohol-dependence. In this study 32.4% of this alcohol-dependent group was classified as alexithymic and 42.3% as non-alexithymic. This is less than previously reported prevalence rates of 45–67% (Thorberg et al., 2009). Furthermore, alcohol-dependence severity, alexithymia and insecure

Role of Funding Sources

None.

Contributors

None.

Conflict of Interest

None for any author.

Acknowledgments

Parts of this paper were presented at the Asian Conference of the Social Sciences in June 2010 at Osaka Japan.

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Bipolar disorder (BD) and alcohol use disorder (AUD) commonly co-occur and their interplay is influenced by several factors. Alexithymia is connected to BD and AUD; affective temperaments serve as risk factors for both; craving contributes to the development and maintenance of AUD. The present study tested whether alexithymia play a mediating role in the relationship between affective temperaments and craving in alcoholic bipolar patients.
151 alcoholic bipolar patients (38 % females, mean age: 45.69 ± 9.04 years) were enrolled. The Mini International Neuropsychiatric Interview (MINI), the Brief Psychiatric Rating Scale (BPRS), the Toronto Alexithymia Scale (TAS-20), the Temperament Evaluation of the Memphis, Pisa, Paris and San Diego scale (TEMPS-A), and the Typology Craving Questionnaire (CTQ) were administered. Correlations among TAS-20, TEMPS-A, CTQ were conducted. Regression analyses were applied to verify the mediating hypothesis.
Difficulty in identifying feelings mediated the association between anxious temperament and craving (Indirect effect: 0.42, BCaCI: 0.22–0.69), cyclothymic temperament and craving (Indirect effect: 0.55, BCaCI: 0.30–0.87), irritable temperament and craving (Indirect effect: 0.45, BCaCI: 0.19–0.80). TAS-20 difficulty in communicating feelings to others mediated the association between anxious temperament and craving (Indirect effect: 0.20, BCaCI: 0.06–0.41).
The sample size did not allow subgroup analyses. Data were collected cross-sectionally and in a single center. We did not investigate whether BD or AUD occurred first, although it might influence the mediation role of alexithymia.
Among alcoholic bipolar patients, assessing and targeting alexithymia may be useful to modulate craving and, in turn improve, the general mental status of patients.
Depression in Chinese men with methamphetamine dependence: Prevalence, correlates and relationship with alexithymia
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The comorbidity between substance use disorder and major depressive disorder is a typical dual diagnosis in the field of substance addiction. However, the prevalence and correlates of depression in methamphetamine addicts and whether it is associated with drug craving and alexithymia have been rarely reported in the Chinese population.
We recruited 585 methamphetamine-dependent males from a drug rehabilitation center in China and 203 healthy controls. Demographic and drug use data were collected. Depression was assessed using the Mini International Neuropsychiatric Interview (M.I.N·I.). Methamphetamine cravings and alexithymia were assessed using the Desire for Drugs Questionnaire (DDQ) and the Toronto Alexithymia Scale (TAS).
The prevalence rate of depression in methamphetamine-dependent men was 16.58 % (97/585). The scores of DDQ desire and intention, DDQ negative reinforcement, total DDQ, difficulty identifying feelings (DIF), difficulty describing feelings (DDF), and total TAS score of depressed patients were higher than those of non-depressed patients. However, only DDQ negative reinforcement score, DIF, DDF, and total TAS score remained significant after Bonferroni correction. Additionally, logistic regression analysis found that age, DIF score, and DDQ negative reinforcement score were significant factors contributing to depression in methamphetamine-dependent men.
Our findings suggest that the prevalence of depression is significantly higher in methamphetamine-dependent men than in the healthy Chinese population. Furthermore, age, components of alexithymia and drug craving are risk factors for depression in methamphetamine addicts.
Early parent-child interactions and substance use disorder: An attachment perspective on a biopsychosocial entanglement
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Citation Excerpt :
In fact, this would open the debate of whether this association is a pure comorbidity, a merely diagnostic comorbidity, related to item overlap, or an aethiopathogenic comorbidity, in which the relationship between internalising symptoms and SUD is causal (Feinstein, 1970). Independently from which is the true meaning of this association, literature seems to agree that internalising symptoms increase the risk of substance use beyond a maladaptive attachment in healthy subjects (Niyonsenga et al., 2012; Pellerone et al., 2016; Kim et al., 2017; Shin et al., 2011; Meredith et al., 2020; Greger et al., 2017; Chen et al., 2020) and clinical populations (De Palo et al., 2014; Miljkovitch et al., 2005; Musetti et al., 2016; Schindler et al., 2007; Vismara et al., 2019; Wedekind et al., 2013; Thorberg et al., 2011; De Rick et al., 2009; Fowler et al., 2013; Owens et al., 2014), also longitudinally (Gidhagen et al., 2018). Considering familial moderators, several cross-sectional studies in healthy subjects showed that a problematic family environment (Cleveland et al., 2014; De Wit et al., 1999; Hayre et al., 2019; Kanamori et al., 2016; Kostelecky, 2005; Luk et al., 2015; Scragg et al., 2008 Zdankiewicz-Ścigała and Ścigała, 2020; Winham et al., 2015; Vungkhanching et al., 2004; Massey et al., 2014;
This review aims to elucidate environmental and genetic factors, as well as their epigenetic and neuroendocrine moderators, that may underlie the association between early childhood experiences and Substance Use Disorders (SUD), through the lens of parental attachment.
Here we review those attachment-related studies that examined the monoaminergic systems, the hypothalamic pituitary adrenal stress response system, the oxytoninergic system, and the endogenous opioid system from a genetic, epigenetic, and neuroendocrine perspective.
Overall, the selected studies point to a moderating effect of insecure attachment between genetic vulnerability and SUD, reasonably through epigenetic modifications. Preliminary evidence suggests that vulnerability to SUDs is related with hypo-methylation (e.g. hyper-expression) of high-risk polymorphisms on the monoaminergic and hypothalamic pituitary adrenal system and hyper-methylation (e.g. hypo-expressions) of protective polymorphisms on the opioid and oxytocin system. These epigenetic modifications may induce a cascade of neuroendocrine changes contributing to the subclinical and behavioural manifestations that precede the clinical onset of SUD. Protective and supportive parenting could hence represent a key therapeutic target to prevent addiction and moderate insecure attachment.
Is alexithymia related to retention and relapses in patients with substance use disorders?: A one year follow-up study
2021, Addictive Behaviors
Alexithymia is related to a higher severity of substance use disorders (SUD); however, few longitudinal studies have been performed on how alexithymia impacts treatment outcomes. This study aims to evaluate alexithymia as a factor that could influence retention and the time of the first relapse in a one-year follow-up in an outpatient treatment center for SUD. In total, 126 SUD outpatients (74.60% males; M age = 43.71, SD = 14.61 years) were evaluated at baseline with an AdHoc questionnaire for sociodemographic variables, the European Addiction Severity Index (EuropASI), the Semi-structured Clinical Interview for Axis I and Axis II Disorders of the DSM-IV, and the Toronto Alexithymia Scale (TAS-20). The prevalence of alexithymia was 41.3% and the mean score of TAS-20, was 57.27 (SD = 12.84). At baseline, alexithymia was related to a lower education level, cannabis use disorder, the psychological item of EuropASI, and mood spectrum disorders. In the Kaplan-Meier analysis, SUD patients with alexithymia were in treatment for less time and presented earlier relapses than non-alexithymic patients. In the Cox regression, alexithymia was only associated with less time in treatment. Therefore, alexithymia may have an important role in the outcomes of SUD treatment, and hence, therapeutic approaches for SUD that cover emotional impairments associated with alexithymia should be investigated and developed.
Impact of the interaction between alexithymia and the adult attachment styles in participants with alcohol use disorder
2020, Alcohol
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.
The associations between alexithymia and both non-suicidal self-injury and risky drinking: A systematic review and meta-analysis
2020, Journal of Affective Disorders
Citation Excerpt :
Lyvers et al. (2014b) did not report this association. Kopera et al. (2018), Lyvers et al. (2014b), Thorberg et al. (2010, 2011a), utilised all three subscales of the TAS-20 and reported a significant positive relationship between DIF and risky drinking. However, results for DDF and EOT were mixed.
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.
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.
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.
The review was limited to English articles. High levels of heterogeneity were observed. The majority of the studies included were cross-sectional.
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.

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Short CommunicationAlexithymia, craving and attachment in a heavy drinking population

Abstract

Research Highlights

Section snippets

Participants

Intercorrelations

Group comparisons

Discussion

Role of Funding Sources

Contributors

Conflict of Interest

Acknowledgments

Addictive Behaviors

Journal of Psychosomatic Research

Journal of Psychosomatic Research

Addictive Behaviors

Journal of Substance Abuse Treatment

Comprehensive Psychiatry

Journal of Psychosomatic Research

Addictive Behaviors

Addictive Behaviors

Personality and Individual Differences

Alexithymia, a risk factor in alcohol addiction? A brief research report on Romanian population

Journal of Cognitive and Behavioral Psychotherapies

Diagnostic and statistical manual of mental disorders

The Obsessive-Compulsive Drinking Scale—A self-rated instrument for the quantification of thoughts about alcohol and drinking behavior

Alcoholism-Clinical and Experimental Research

Alcohol Use Disorders Identification Test: Guidelines for use in primary care

The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations

Journal of Personality and Social Psychology

Impact of craving on alcohol relapse during, and 12 months following, outpatient treatment

Alcohol and Alcoholism

Working models of attachment: Implications for explanation, emotion, and behavior

Journal of Personality and Social Psychology

Adult attachment, working models, and relationship quality in dating couples

Journal of Personality and Social Psychology

Validity of the obsessive compulsive drinking scale in a heavy drinking population

Alcoholism-Clinical and Experimental Research

Short Communication
Alexithymia, craving and attachment in a heavy drinking population