Alexithymia and alcohol use disorders: a critical review

Metacognition in persons with substance abuse: Findings and implications for occupational therapists

Background

Addiction is a massive public health problem in which a person’s occupational life is compromised and metacognition is impaired. Occupational therapists may play a critical role in addiction rehabilitation, but more information about patterns of metacognitive deficit co-occurring with addictive behaviour is needed to develop interventions that specifically target these impairments.

Purpose

This study examined whether persons with addiction(s) demonstrated specific patterns of metacognitive deficit on four subscales of metacognition measuring self-reflectivity, understanding others’ thoughts, decentration, and mastery.

Method

Using a mixed-methods design, qualitative data were obtained via the Indiana Psychiatric Illness Interview, which was then rated using a quantitative scale, the Metacognition Assessment Scale–Abbreviated.

Findings

Persons with addiction(s) demonstrated significant impairments in metacognitive mastery but not other areas of metacognition.

Implications

Occupational therapy interventions for addiction should focus on improving metacognitive mastery. Future efficacy studies of interventions to improve mastery and overall outcomes are warranted.

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.

Identity disturbance and problems with emotion regulation are related constructs across diagnoses

OBJECTIVE

This study examined the relation between identity disturbance and emotion dysregulation in a cross-diagnostic sample. We assessed whether these constructs are related and relevant beyond borderline personality disorder (BPD).

METHOD

We recruited 127 participants who completed measures assessing identity disturbance, emotion dysregulation, anxiety, and depression. The sample included primarily depressed adults meeting criteria for multiple diagnoses as well as psychiatrically healthy participants.

RESULTS

Identity disturbance was significantly higher among psychiatric participants with and without BPD compared to healthy controls. Emotion dysregulation was a significant predictor of identity disturbance, even when controlling for BPD diagnosis, depression, and anxiety. In particular, clarity in emotional situations and problems using emotion regulation strategies were most closely related to identity disturbance.

CONCLUSION

The results of this study suggest that future research should examine identity disturbance and its relation with emotion regulation transdiagnostically.

The Relationships between Early Trauma, Dissociation, and Alexithymia in Alcohol Addiction

OBJECTIVE

Addiction is often considered a dissociative behavior that is related to alexithymia and developmental trauma. The study aims were to explore the relationships between early trauma, alexithymia, and dissociation.

METHODS

A total of 117 (males=60; females=57) alcohol-addicted individuals and 117 healthy individuals (males=60; females=57) were administered a series of self-report questionnaires that assess traumatic experiences, alexithymia, and pathological dissociation.

RESULTS

Correlation analyses indicated significant correlations between alexithymia, dissociation, and trauma and a significant difference between the target and control groups, with higher alexithymia and dissociation scores in the target group.

CONCLUSION

These findings suggest that trauma, alexithymia, and dissociation are predictors of alcohol addiction.

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.

The TAS-20 more likely measures negative affects rather than alexithymia itself in patients with major depression, panic disorder, eating disorders and substance use disorders

BACKGROUND

This study evaluates whether the difference in Toronto Alexithymia Scale-20 item (TAS-20) between patients with major depression (MD), panic disorder (PD), eating disorders (ED), and substance use disorders (SUD) and healthy controls persisted after controlling for the severity of anxiety and depression.

METHODS

Thirty-eight patients with MD, 58 with PD, 52 with ED, and 30 with SUD and 78 healthy controls (C) completed the TAS-20, the Hamilton Rating Scale for Anxiety (Ham-A), the Hamilton Rating Scale for Depression (Ham-D).

RESULTS

The differences in TAS-20 scores observed between patient groups, regardless of the type of their disorders, and controls disappeared after controlling for the effect of anxiety and depression severity. In contrast, the differences in severity of anxiety and depression between patients and controls were still present, after excluding the effect of alexithymic levels.

CONCLUSIONS

Our data suggest that alexithymic levels, as measured by the TAS-20, are modulated by the severity of symptoms, supporting the view that alexithymia can represent a state phenomenon in patients with MD, PD, ED and SUD, because the TAS-20 seems overly sensitive to a general distress syndrome, and it is more likely to measure negative affects rather than alexithymia itself.

Neural activation during processing of aversive faces predicts treatment outcome in alcoholism

Neuropsychological studies reported decoding deficits of emotional facial expressions in alcohol-dependent patients, and imaging studies revealed reduced prefrontal and limbic activation during emotional face processing. However, it remains unclear whether this reduced neural activation is mediated by alcohol-associated volume reductions and whether it interacts with treatment outcome. We combined analyses of neural activation during an aversive face-cue-comparison task and local gray matter volumes (GM) using Biological Parametric Mapping in 33 detoxified alcohol-dependent patients and 33 matched healthy controls. Alcoholics displayed reduced activation toward aversive faces-neutral shapes in bilateral fusiform gyrus [FG; Brodmann areas (BA) 18/19], right middle frontal gyrus (BA46/47), right inferior parietal gyrus (BA7) and left cerebellum compared with controls, which were explained by GM differences (except for cerebellum). Enhanced functional activation in patients versus controls was found in left rostral anterior cingulate cortex (ACC) and medial frontal gyrus (BA10/11), even after GM reduction control. Increased ACC activation correlated significantly with less (previous) lifetime alcohol intake [Lifetime Drinking History (LDH)], longer abstinence and less subsequent binge drinking in patients. High LDH appear to impair treatment outcome via its neurotoxicity on ACC integrity. Thus, high activation of the rostral ACC elicited by affective faces appears to be a resilience factor predicting better treatment outcome. Although no group differences were found, increased FG activation correlated with patients' higher LDH. Because high LDH correlated with worse task performance for facial stimuli in patients, elevated activation in the fusiform 'face' area may reflect inefficient compensatory activation. Therapeutic interventions (e.g. emotion evaluation training) may enable patients to cope with social stress and to decrease relapses after detoxification.

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.

Metacognitive mastery moderates the relationship of alexithymia with cluster C personality disorder traits in adults with substance use disorders

Cluster C personality disorder traits have been observed in substance use disorders and linked with poorer outcome. One potential factor which may cause these disturbances in personality function is alexithymia, or the inability to name and express emotion. There may be other proximate factors which moderate the impact of alexithymia on the expression of cluster C traits, such as metacognitive mastery, which is the ability to use knowledge about mental states of self and others to cope with distress and solve social problems. To examine the possibility that mastery mediated the effects of alexithymia on cluster C traits, we assessed each of these constructs using the Metacognitive Assessment Scale Abbreviated, Toronto Alexithymia Scale and SCID II among 58 adults in an early phase of recovery from substance misuse disorders in a residential setting. Results of a multiple regression revealed that, after controlling for symptom severity and severity of substance misuse history, metacognitive mastery moderated the effect of alexithymia on number of cluster C traits. A median split and subsequent ANCOVA revealed that participants with higher levels of alexithymia and poorer metacognitive mastery had more cluster C traits than the other groups. These findings may have clinical implications, suggesting that patients with substance use disorders may benefit from treatment which addresses metacognitive mastery.

Attachment and alcohol use amongst athletes: the mediating role of conscientiousness and alexithymia

OBJECTIVE

The present study aims to explore the mediating effects of conscientiousness and alexithymia in the relationship between parental attachment style and alcohol use in a large sample of athletic young people.

METHOD

Participants included 434 French sport sciences students. Alcohol use, parental attachment style, conscientiousness and alexithymia were assessed. The hypotheses were tested by using regression and bootstrapping mediation analyses.

RESULTS

Maternal insecure attachment style is positively associated with alcohol use. The current study highlights a multiple pathway in this relationship. The results reveal the mediating effect of low conscientiousness and alexithymia between maternal insecure attachment and alcohol use.

CONCLUSION

Athletes' alcohol use seems to be the result of a complex association of underlying psychological factors.

Predictors of painkiller dependence among people with pain in the general population

OBJECTIVES

Self-medication with painkillers is widespread and increasing, and evidence about influences on painkiller dependence is needed to inform efforts to prevent and treat problem painkiller use.

DESIGN

Online questionnaire survey.

PARTICIPANTS

People in the general population who had pain and used painkillers in the last month (N = 112).

MEASUREMENTS

Pain frequency and intensity, use of over-the-counter and prescription painkillers, risk of substance abuse (Screener and Opioid Assessment for Patients with Pain [SOAPP] scale), depression, anxiety, stress, alexithymia, pain catastrophizing, pain anxiety, pain self-efficacy, pain acceptance, mindfulness, self-compassion, and painkiller dependence (Leeds Dependence Questionnaire).

RESULTS

In multiple regression, the independent predictors of painkiller dependence were prescription painkiller use (β 0.21), SOAPP score (β 0.31), and pain acceptance (β -0.29). Prescription painkiller use mediated the influence of pain intensity. Alexithymia, anxiety, and pain acceptance all moderated the influence of pain.

CONCLUSIONS

The people most at risk of developing painkiller dependence are those who use prescription painkillers more frequently, who have a prior history of substance-related problems more generally, and who are less accepting of pain. Based on these findings, a preliminary model is presented with three types of influence on the development of painkiller dependence: 1) pain leading to painkiller use, 2) risk factors for substance-related problems irrespective of pain, and 3) psychological factors related to pain. The model could guide further research among the general population and high-risk groups, and acceptance-based interventions could be adapted and evaluated as methods to prevent and treat painkiller dependence.

A family history of alcoholism relates to alexithymia in substance use disorder patients

OBJECTIVES

Previous research identified alexithymia as a potential risk factor for substance use disorders (SUD). More insight into the relation between alexithymia and SUD is needed in order to treat SUD effectively. Therefore, we investigated whether a familial vulnerability to alcoholism relates to the presence and severity of alexithymia in SUD patients.

METHOD

Hospitalized, abstinent SUD-patients (n=187), were assessed with the Toronto Alexithymia Scale (TAS-20) and Addiction Severity Index (EuropASI). A maternal, paternal, and total continuous measure of the Family History of Alcohol (FHA) was developed. Kruskal-Wallis tests and Spearman correlations were used to relate the composite scores of FHA to alexithymia as a categorical and continuous measure. Multivariate regression models were performed to control for the effects of confounders on the relation between FHA and alexithymia.

RESULTS

Compared to moderate (33%) and low (17%) alexithymic SUD-patients, high alexithymic (50%) patients were more likely to have fathers with alcohol problems (P=0.004). Such a difference was not found for mothers with alcohol problems. The composite FHA-score was significantly associated with alexithymia (Rs=.19, P=0.01). However, only a paternal FHA, independent from disturbed family functioning, related to the degree of alexithymia (β=.13, P=0.06), especially to the Difficulty Identifying Feelings as measured by the TAS-20 (β=.16, P=0.02).

CONCLUSIONS

The relation between a paternal FHA and a higher degree of alexithymia in SUD-patients suggests that alexithymia could mediate the familiality of alcoholism or SUD in the paternal line.

Insula's functional connectivity with ventromedial prefrontal cortex mediates the impact of trait alexithymia on state tobacco craving

RATIONALE

Alexithymia is a personality trait characterized by difficulty indentifying and describing subjective emotional experiences. Decreased aptitude in the perception, evaluation, and communication of affectively laden mental states has been associated with reduced emotion regulation, more severe drug craving in addicts, and structural/functional alterations in insula and anterior cingulate cortex (ACC). The insula and ACC represent sites of convergence between the putative neural substrates of alexithymia and those perpetuating cigarette smoking.

OBJECTIVES

We examined the interrelations between alexithymia, tobacco craving, and insula/ACC neurocircuitry using resting-state functional connectivity (rsFC).

METHODS

Overnight-deprived smokers (n = 24) and nonsmokers (n = 20) completed six neuroimaging assessments on different days both in the absence of, and following, varenicline and/or nicotine administration. In this secondary analysis of data from a larger study, we assessed trait alexithymia and state tobacco craving using self-reports and examined the rsFC of bilateral insular subregions (anterior, middle, posterior) and dorsal ACC.

RESULTS

Higher alexithymia in smokers predicted reduced rsFC strength between the right anterior insula (aI) and ventromedial prefrontal cortex (vmPFC). Higher alexithymia also predicted more severe tobacco craving during nicotine withdrawal. Critically, the identified aI-vmPFC circuit fully mediated this alexithymia-craving relation. That is, elevated alexithymia predicted decreased aI-vmPFC rsFC and, in turn, decreased aI-vmPFC rsFC predicted increased craving during withdrawal. A moderated mediation analysis indicated that this aI-vmPFC mediational effect was not observed following drug administration.

CONCLUSIONS

These results suggest that a weakened right aI-vmPFC functional circuit confers increased liability for tobacco craving during smoking abstinence. Individual differences in alexithymia and/or aI-vmPFC functional coupling may be relevant factors for smoking cessation success.

I don't know how I feel, therefore I act: alexithymia, urgency, and alcohol problems

This study examined the relationships between alexithymia, impulsivity, and alcohol use and related problems. The sample consisted of 429 undergraduate students who reported drinking alcohol at least once in the past 3 months. Negative urgency mediated the relationship between alexithymia and alcohol-related problems, whereas positive urgency mediated the relationship between alexithymia and alcohol consumption. In addition, positive urgency moderated the relationship between alexithymia and alcohol-related problems, increasing the strength of this association. These results indicate distinct relationships between alexithymia and negative urgency and positive urgency in predicting alcohol consumption and related problems. The findings of this research contribute to the body of the literature on alexithymia, self-regulation, and etiology of alcohol misuse and related consequences. Furthermore, the findings of the current study provide support for the importance of emotion identification and expression skills training in substance abuse treatment.

The interactive effects of emotional clarity and cognitive reappraisal on problematic cannabis use among medical cannabis users

This study examined whether emotional clarity (i.e., the extent to which one can identify and understand the type and source of emotions one experiences) and cognitive reappraisal (i.e., altering how potentially emotion-eliciting situations are construed to change their emotional impact) would individually or jointly be associated with problematic cannabis use among individuals receiving cannabis for medical reasons (n=153). Findings indicated that problematic cannabis use was predicted by the interaction between emotional clarity and cognitive reappraisal. In particular, low levels of emotional clarity combined with high levels of cognitive reappraisal predicted problematic cannabis use. The current study is the first to demonstrate the interactive effects of emotional clarity and the use of cognitive reappraisal in predicting substance use disorder outcomes. Such findings are important given the lack of empirical data demonstrating for whom and for which conditions cannabis is either beneficial or detrimental.

Mental state decoding and mental state reasoning in recently detoxified alcohol-dependent individuals

Impaired social cognition has been associated with interpersonal problems and with the development of and relapse into alcohol abuse. In the present study, self-reported trait empathy, decoding of complex mental states and cognitive and affective mental state reasoning were assessed in alcohol-dependent participants, and the association with executive function and psychopathological characteristics was investigated. Twenty recently detoxified alcohol-dependent patients and 20 matched healthy controls were assessed with an abbreviated German version of the interpersonal reactivity index, the revised reading the mind in the eyes test, the faux pas story test, the trail making test and the letter-number-sequencing test. Patients were impaired relative to controls with regard to mental state decoding on the eyes test and showed reduced faux pas detection and impaired mental state reasoning reflected by lower faux pas understanding and faux pas empathy scores. There were no group differences regarding self-reported trait empathy. Performance on the sociocognitive measures was related to executive functioning and the severity of depressive symptoms. Although self-report measures might not always reliably detect impairments of social cognition, behavioural measures suggest pronounced impairments of mental state decoding and mental state reasoning in association with alcohol dependence. Findings ought to be incorporated into current treatment strategies.

Emotional Dispositions and Substance Use: Mediating Effect of Alexithymia

Substance consumption behaviors can range from use to abuse, the latter including addictive behaviors. Relationships between emotionality, alexithymia and substance-consumption behaviors among young adults were investigated through an explanatory model wherein alexithymia fulfills a mediating function by acting as an emotion-adjustment process. 256 students (62.1% women) with a mean age of 20.7 yr. ( SD = 1.6), enrolled at two universities in southern France took part in the study. They filled out a substance-use questionnaire, the Émotionnalité positive et négative à 31 (EPN–31) emotionality scale, and the 20-item Toronto Alexithymia scale (TAS–20). Mediation analyses validated the hypothesis that emotional dimensions of alexithymia act as mediators between emotionality (negative emotionality and emotional arousal) and substance use. As a mediating factor, alexithymia may be regarded as a type of operational process that regulates emotions. These results could have important implications for clinical and therapeutic applications focusing on emotion-regulation strategies and substance use.

Impaired processing of emotion in music, faces and voices supports a generalized emotional decoding deficit in alcoholism

AIM

To test the generalized emotional decoding impairment hypothesis in alcoholism.

DESIGN

Cross-sectional behavioural study comparing emotion recognition conveyed by faces, voices and musical excerpts.

SETTING

Alcohol detoxification unit of Brugmann University Hospital.

PARTICIPANTS

Twenty-five recently detoxified alcohol-dependent patients were compared to 25 normal controls matched for sex, age and educational level.

MEASUREMENTS

From faces, voices and musical excerpts, participants were instructed to rate the intensity of several emotions on a scale from 0 for 'absent' to 9 for 'highly present'. Depression, anxiety and sustained/selective attention capacities were controlled for.

FINDINGS

Alcohol-dependent patients were less accurate than controls in identifying the target emotion in faces (P < 0.001), voices (P < 0.001) and musical excerpts (P < 0.001).

CONCLUSIONS

Alcohol-dependent patients who are completing detoxification are impaired in recognizing emotions conveyed by faces, voices and music; these results suggest a generalized emotional decoding impairment. Hypothetically, deficits in the fronto-parietal mirror neurone system could link all these disturbances together.

Alcohol mixed with energy drinks: methodology and design of the Utrecht Student Survey

This paper describes the methodology of the Utrecht Student Survey. This online survey was conducted in June 2011 by 6002 students living in Utrecht, The Netherlands. The aim of the survey was to determine the potential impact of mixing alcoholic beverages with energy drinks on overall alcohol consumption and alcohol-related consequences. In contrast to most previous surveys conducted on this topic, the current survey used a more appropriate within-subject design, comparing the alcohol consumption of individuals who consume alcohol mixed with energy drinks on occasions. Specifically, a comparison was conducted to examine the occasions during which these individuals consume this mixture versus occasions during which they consume alcohol alone. In addition to energy drinks, the consumption of other non-alcoholic mixers was also assessed when combined with alcoholic beverages. Furthermore, the reasons for consuming energy drinks alone or in combination with alcohol were investigated, and were compared to reasons for mixing alcohol with other non-alcoholic beverages. Finally, personality characteristics and the level of risk-taking behavior among the individuals were also assessed to explore their relationship with alcohol consumption. The Utrecht Student Survey will be replicated in the USA, Australia, and the UK. Results will be pooled, but also examined for possible cross-cultural differences.

Alexithymia is not a stable personality trait in patients with substance use disorders

The construct of alexithymia as a vulnerability factor for substance use disorders (SUD) is under debate, because of conflicting research results regarding alexithymia as a state or trait phenomenon. The absolute and relative stability of alexithymia were evaluated in a pre-post design as part of a randomised controlled trial, controlling for several co-variates. Assessments were done with the Toronto Alexithymia Scale (TAS-20) and the Addiction Severity Index (EuropASI) at baseline and follow-up of a 3-month trial of inpatient Cognitive Behavioural Therapy (CBT) with or without a Shared Decision Making intervention for 187 SUD patients. Paired sample t-tests and analyses of variance were performed to assess absolute stability, intraclass correlation coefficients were calculated for relative stability and multivariate linear regression models were used to evaluate the relation between co-variates and change in alexithymia. Mean level reduction of total TAS-20 and two subfactors demonstrated no absolute stability, but change in alexithymia differed for patients with low, moderate and high alexithymia scores. Relative stability of alexithymia was moderate to high for the total population, but differed according to low, moderate and high alexithymia scores. The EuropASI "psychiatry" domain, covering anxiety and depression, was related to alexithymia, but CBT-related variables were not. In conclusion, alexithymia is partly a state-dependent phenomenon, but not a stable personality trait in this SUD population.

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.

Child maltreatment, alexithymia, and problematic internet use in young adulthood

The goals of this study were to (a) examine the phenomenology and developmental correlates of problematic Internet use (PIU) in a large and diverse college student sample; (b) evaluate a developmental process model of PIU in which the expected association between child maltreatment and PIU would be explained by alexithymia; and (c) explore these relations as a function of gender and race. PIU was assessed in a sample of 1,470 college students (62.9 percent female, 37.1 percent male; M(age)=19.13 years [SD=1.49]; 46.1 percent Asian, 28.2 percent Hispanic, 16.3 percent White, 5.9 percent Black, and 3.5 percent Multiracial/Other) who participated in a larger study of young adult adaptation, which included measures of child maltreatment, alexithymia, self-concept, social support, and psychopathology. Males and Asian students endorsed higher levels of PIU than females and other ethnoracial groups, respectively. PIU was related to contemporaneous maladaptation in the form of decreased self-concept, lower social support, and increased psychopathology across groups. Experiences of child maltreatment were related to increased PIU, and mediation analyses showed that this relation was partially explained by alexithymia. These relations were comparable across males and females and between Asian and non-Asian respondents. The analyses provide evidence for the significant role of child maltreatment and the cognitive-affective deficits it precipitates in understanding pathways toward PIU in young adulthood. Our findings suggest that maltreated youth are at disproportionate risk for PIU, and their capacities to regulate and process emotion are important targets for prevention and therapeutic intervention.

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.

Alexithymia in alcohol dependent patients is partially mediated by alcohol expectancy

BACKGROUND

Up to fifty percent of alcohol dependent individuals have alexithymia, a personality trait characterised by difficulties identifying and describing feelings, a lack of imagination and an externalised cognitive style. Although studies have examined alexithymia in relation to alcohol dependence, no research exists on mechanisms underlying this relationship. The present study examined the mediational effect of alcohol expectancies on alexithymia and alcohol dependence.

METHODS

230 outpatients completed the Toronto Alexithymia Scale (TAS-20), the Drinking Expectancy Questionnaire (DEQ) and the Alcohol Use Disorder Identification Test (AUDIT).

RESULTS

Regression analysis showed that alexithymia and alcohol dependence was, in two of three cases, partially mediated through alcohol expectancy.

CONCLUSIONS

Alcohol expectancies of assertion and affective change show promise as mediators of alcohol dependence in individuals with alexithymia.

Alexithymia, craving and attachment in a heavy drinking population

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.

A confirmatory factor analysis of the Toronto Alexithymia Scale (TAS-20) in an alcohol-dependent sample

Confirmatory factor analyses were conducted to evaluate the factorial validity of the Toronto Alexithymia Scale in an alcohol-dependent sample. Several factor models were examined, but all models were rejected given their poor fit. A revision of the TAS-20 in alcohol-dependent populations may be needed.

Emotion Differentiation as Resilience Against Excessive Alcohol Use

Some people are adept at using discrete emotion categories ( anxious, angry, sad) to capture their felt experience; other people merely communicate how good or bad they feel. We theorized that people who are better at describing their emotions might be less likely to self-medicate with alcohol. During a 3-week period, 106 underage social drinkers used handheld computers to self-monitor alcohol intake. From participants’ reported experiences during random prompts, we created an individual difference measure of emotion differentiation. Results from a 30-day timeline follow-back revealed that people with intense negative emotions consumed less alcohol if they were better at describing emotions and less reliant on global descriptions. Results from ecological momentary assessment procedures revealed that people with intense negative emotions prior to drinking episodes consumed less alcohol if they were better at describing emotions. These findings provide support for a novel methodology and dimension for understanding the influence of emotions on substance-use patterns.

The relationship between alexithymia and alcohol-related risk perceptions: The moderating effect of general trauma in a college population

The current study explored the moderating influence of general trauma exposure (GTE) on the relationship between alexithymia and alcohol-related risk perceptions. Undergraduate college students (N=237) completed a battery of self-report measures. After controlling for relevant variables, results indicated that the interaction between alexithymia and GTE significantly predicted alcohol-related risk perception. Simple effects revealed that for students who reported higher rates of GTE, alexithymia positively predicted risk perception; this relationship did not exist among students with lower GTE. Exploratory analyses indicated that despite increased risk perception, individuals with GTE also reported greater alcohol-related problems compared to students with low trauma exposure. The current study highlights the importance of examining risk perception abilities in individuals with alexithymia and GTE as well as the impact of risk perception on alcohol-related risk behaviors.

Relationship of alexithymia and temperament and character dimensions with lifetime post-traumatic stress disorder in male alcohol-dependent inpatients

AIMS

The purpose of the present study was to evaluate the prevalence of lifetime post-traumatic stress disorder (PTSD) in male alcohol-dependent inpatients and to investigate the relationship of PTSD with alexithymia and temperament and character dimensions.

METHODS

Participants were 156 consecutively admitted male alcohol-dependent subjects. Patients were investigated using the Clinician-Administered PTSD Scale (CAPS), the Toronto Alexithymia Scale (TAS-20) and the Temperament and Character Inventory (TCI).

RESULTS

Among alcohol-dependent inpatients 32.1% were considered as having lifetime PTSD. Mean scores of alexithymia, novelty seeking (NS), harm avoidance (HA) and self-transcendence (ST) were higher in the PTSD group, whereas age and self-directedness (S) were lower. Among age and other factors of TAS-20, 'difficulty in identifying feelings (DIF)' predicted PTSD in a logistic regression model. When age and personality dimensions of TCI were taken as independent variables, S predicted PTSD in the logistic regression model. Finally, among subscales of TCI, 'impulsiveness versus reflection' (NS2) and 'congruent second nature versus bad habits' (S5) predicted PTSD.

CONCLUSIONS

Alexithymia and personality traits, particularly high DIF and S scores are related with lifetime PTSD diagnosis, even when controlling for age among alcohol-dependent inpatients. Causal relationships between alexithymia, personality dimensions and PTSD, and their implications on treatment are not clear and should be evaluated in longitudinal studies.