Alcohol addiction and the attachment system: an empirical study of attachment style, alexithymia, and psychiatric disorders in alcoholic inpatients

An exploration of ex-boarding school adults' attachment styles and substance use behaviours

Our study examines the relationship between boarding school attendance, adult attachment styles, parental bonding, and substance use, aiming was to quantitatively investigate if caregiver deprivation caused by boarding contributes to enduring outcomes in adults. In a sample of 149 adults, measures included AUDIT and DUDIT (substance use), Parental Bonding Instrument (parental care), and Experiences in Close Relationships (adult attachment). Pearson's correlation revealed a significant negative association between age at first boarding and anxiety, avoidant attachment styles, and poorer parental care, whilst a significant positive relationship was identified between age at first boarding and perceived parental care. This was supported by a hierarchical regression which demonstrated that the model predicted 29% of the variance in age at first boarding. These results contribute towards the formulation and treatment of ex-boarders and to research considering the effects of boarding school experiences on difficulties in adult life.

Mediating role of splitting in relation to attachment styles and shopping addiction

Introduction

Shopping can provide a sense of satisfaction and pleasure; however, if a person's excessive involvement in this behavior starts to negatively impact other aspects of their life, similar to other addictive behaviors like excessive internet use, gaming, and gambling, it may be classified as pathological. Given the lack of agreement regarding the classification of excessive shopping tendencies as a separate mental health condition or addictive behavior, taking a socio-emotional approach to explore the psychological factors that precede this behavior, may offer a better comprehension of it.

Methods

The purpose of this study was to examine the relationship between attachment styles and excessive shopping behavior, as well as to investigate the potential mediating effect of defense mechanisms like splitting on this relationship. Using convenience sampling, a group of 457 stock market employees (116 female, 341 male) between the ages of 24 and 60 were recruited. The researchers utilized a set of validated psychological questionnaires to assess the employees attachment styles, shopping addiction, and splitting tendencies.

Results

The results obtained from both the mediation model and path analysis suggest that attachment styles do not have a direct relationship with shopping addiction. Nonetheless, the study supports the impact of insecure anxious and avoidan attachment styles on splitting. Furthermore, the findings confirm that splitting has a mediating effect on the relationship between attachment styles and splitting.

Discussion

The present study enhanced our comprehension of the subconscious mechanisms underlying shopping tendencies. Specifically, the findings suggest that excessive tendencies towards shopping can be considered a maladaptive response resulting from insecure attachment styles and the unconscious utilization of the splitting defense mechanism.

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.

Polydatin as a therapeutic alternative for central nervous system disorders: A systematic review of animal studies

Polydatin, or piceid, is a natural stilbene found in grapes, peanuts, and wines. Polydatin presents pharmacological activities, including neuroprotective properties, exerting preventive and/or therapeutic effects in central nervous system (CNS) disorders. In the present study, we summarize and discuss the neuroprotective effects of polydatin in CNS disorders and related pathological conditions in preclinical animal studies. A systematic review was performed by searching online databases, returning a total of 110 records, where 27 articles were selected and discussed here. The included studies showed neuroprotective effects of polydatin in experimental models of neurological disorders, including cerebrovascular disorders, Parkinson's disease, traumatic brain injuries, diabetic neuropathy, glioblastoma, and neurotoxicity induced by chemical agents. Most studies were focused on stroke (22.2%) and conducted in male rodents. The intervention protocol with polydatin was mainly acute (66.7%), with postdamage induction treatment being the most commonly used regimen (55.2%). Overall, polydatin ameliorated behavioral dysfunctions and/or promoted neurological function by virtue of its antioxidant and antiinflammatory properties. In summary, this review offers important scientific evidence for the neuroprotective effects and distinct pharmacological mechanisms of polydatin that not only enhances the present understanding but is also useful for the development of future preclinical and clinical investigations.

Early parent-child interactions and substance use disorder: An attachment perspective on a biopsychosocial entanglement

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.

Attachment Styles, Personality Organization, and Substance Use as Predictors of Emotion Regulation Strategies "Suppression" and "Reappraisal" in Young Adults

BACKGROUND

As evidenced by current literature, there is a crucial link between emotion regulation, attachment, personality patterns, and substance abuse. However, knowledge regarding the exact interactions of these specific parameters in terms of substance abuse development is still sparse. Therefore, this study is aimed to shed light on how two specific emotion regulation strategies ("Reappraisal" and "Suppression") might be influenced by the relationship between attachment, structural deficits in personality organization, and addictive behaviors.

METHOD

A total sample of 299 non-clinical young adults (Age: M = 22; SD = 3.81; 74.2% females) filled in the Emotion Regulation Questionnaire (ERQ) together with the Adult Attachment Scale (AAS), the Personality Organization Inventory (IPO-16), and the Alcohol, Smoking and Substance Involvement Screening (ASSIST) by means of an online survey.

RESULTS

As suggested by hierarchical regression analysis, attachment specifically predicted differences in Emotion Regulation (ER), whereby the AAS subscales "Close" ness (β = -0.38, p < 0.01) and "Depend" ence (β = -0.18, p < 0.01) were negatively associated with increased use of maladaptive strategies of expressional suppression of emotion, and "Depend" (β = 0.26, p < 0.01) was positively associated with increased use of adaptive strategies of cognitive reappraisal.

DISCUSSION

In line with our assumptions, we observed a more secure attachment system to be predictive for an increased use of adequate emotion regulation strategies. The findings support the suggestion that a focus on underlying attachment-related processes in a psychotherapeutic setting might be a promising way to promote adaptive self-regulation of emotions.

Women in Christian Substance Abuse Treatment; Forgiveness, Attachment Styles, and Improvements in Co-occurring Mental Health Symptoms

The purpose of this study was to explore the efficacy of The Recovery Center at Shalom House Ministries and examine the relationship(s) between forgiveness, attachment styles, drug and alcohol abuse, self-reported mental health symptoms, and cognitive functioning. Participants (N = 118 women) attended Shalom Recovery (2016-2018). Statistically significant improvement was found between entrance and the 3-month mark on all measures, with 67.9% completing the program. Findings indicated that the revenge motivations correlated with depression, self-esteem, anxiety, and avoidance of intimacy with God, but only this latter scale contributed to a multiple regression model on revenge motivations at program entry.

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 the adults' attachment styles in Lebanon: The role of alexithymia, depression, anxiety, stress, burnout, and emotional intelligence

PURPOSE

To evaluate the association of adults' attachment styles with mental disorders in Lebanon.

DESIGN/METHODS

A cross-sectional observational study enrolled 789 participants between November 2017 and March 2018.

FINDINGS

People with distress (with dismissing- and fearful-dominant relationship styles) and people with instability (preoccupied-dominant relationship style with equal presence of the secured, fearful, and dismissing styles) had higher alcohol use disorder, alexithymia, depression, anxiety, stress, decreased emotional intelligence (emotional awareness, emotional management, and social-emotional awareness), burnout scores and suicidal ideation compared people with wellbeing, with a secure-dominant relationship style.

PRACTICE IMPLICATIONS

It is very important to assess bonding traits in disease prevention centers, caregiver institutions, employment assessments, and then coaching might help those individuals under risk to prevent mental health problems.

[Addiction as an attachment disorder]

BACKGROUND

There is no commonly accepted model for describing the development and treatment of substance use disorders (SUD); however, over several decades the attachment theory has represented an important basis for the clinical handling of SUD. This study gives a systematic review of empirical studies regarding the relationship between SUD and disorders of attachment behavior.

OBJECTIVE

Is there a positive relationship between disorders of attachment behavior and the presence of SUD?

METHOD

Various databases (PsychInfo, Web of Science, PubMed) were systematically searched in order to pinpoint relevant studies in books and articles published in English or German. Based on the results 22 publications were selected. After a stricter limitation to original research, 12 articles could finally be accepted as eligible.

RESULTS

A significant relationship was found between SUD and insecure attachment in 10 out of the 12 studies.

CONCLUSION

Based on the results of the research studies reviewed the hypothesis to characterize SUD as a possible expression of an attachment disorder was confirmed. This corroborates the importance of considering attachment parameters in dealing with prevention and treatment of SUD. Further research might focus on non-substance-related addictive disorders and therapy outcome studies.

Attachment and Substance Use Disorders-Theoretical Models, Empirical Evidence, and Implications for Treatment

Introduction: The article reviews attachment-oriented research in individuals with substance use disorders (SUDs). Based on attachment theory, substance abuse can be understood as "self-medication," as an attempt to compensate for lacking attachment strategies. Attachment theory suggests a developmental pathway from insecure attachment to SUD and, on the other hand, a negative impact of substance abuse on attachment security. Earlier reviews have indicated a general link but have been inconclusive with regard to other aspects. In the light of a growing body of research, this review is looking for evidence for the general link, for its direction, for differences due to different patterns of attachment, different substances and severities, comorbid psychiatric disorders, and age groups. Methods: Using medical and psychological databases, 34 cross-sectional studies, three longitudinal studies, and a systematic meta-analysis were identified. Methodological problems such as poor assessment of SUD and the use of different measures of attachment limit comparability. Results: All cross-sectional studies in the review confirm a link between insecure attachment and SUD. Results of longitudinal studies show insecure attachment to be a risk factor for SUD, while continued substance abuse impairs the ability to form close relationships. With regard to specific patterns of attachment, results mainly point toward very insecure patterns. They indicate different patterns of attachment in different groups of substance abusers, suggesting different developmental pathways. Fearful-avoidant attachment was frequent in heroin addicts, while alcohol abusers displayed more heterogeneous patterns. Comorbid mental disorders and severity of SUD seem to be important factors, but data are still inconclusive. The link between insecure attachment and SUD seems to be stronger in adolescence compared to adulthood. Discussion: The last decades have seen a substantial growth in studies on attachment and SUDs. Despite methodological problems, the general link between insecure attachment and SUD today is well established. Attachment theory might contribute to the understanding and treatment of SUDs in a significant way. But to do so, a lot of open questions have to be answered. We will need more carefully designed longitudinal studies, more studies connecting psychological data with brain processes, and more clinical trials.

Who stays in addiction treatment groups? Anxiety and avoidant attachment styles predict treatment retention and relapse

Attachment styles have been shown to be an important predictor of relationship quality and well-being. They have also been linked with ability to function well in groups. Insecure attachment styles are thought to be an underlying cause of addiction and represent a target for change in one-to-one therapy. How attachment styles themselves affect group therapy for addiction is understudied. The current study addresses this gap by examining the effects of attachment styles on relapse and treatment retention amongst a population of people attending addiction therapy groups. Fifty-eight individuals in such groups completed measures of attachment anxiety and avoidance. Participants were followed up 4 weeks later, and their continued treatment attendance and relapse status were recorded. In terms of treatment retention, high anxiety/high avoidant participants had the highest retention. In terms of relapse, low anxiety/high avoidant participants had the lowest rates. These results are discussed in terms of the potentially protective effects of avoidant attachment styles during group therapy and the role of anxiety attachment in the continued maintenance of both protective and risky personal relationships.

[Emotional experience of early traumatic experiences and relationship-specific attachment styles in alcohol-dependent patients]

Emotional experience of early traumatic experiences and relationship-specific attachment styles in alcohol-dependent patients Objectives: The present investigation studied the differences in emotional experiences among alcohol-dependent patients in inpatient psychotherapy, taking into account their traumatic experiences and relationship-specific attachment styles.

METHODS

Three standardized instruments were used on this clinical sample of 70 patients in inpatient psychotherapy: (1) Scales for Experiencing Emotions (SEE), (2) Childhood Trauma Questionnaire (CTQ), (3) Relationship-Specific Attachment Scales for Adults (RASA).

RESULTS

The results showed that traumatic experiences in childhood and adolescence as well as relationship-specific attachment styles were indeed associated with deficits in emotional experience and regulation. Especially emotional abuse was associated with deficits in emotional experience. An insecure attachment style was associated with a lower level of acceptance of emotions, a lower level of self-control, and dysfunctional emotion regulation. In particular, the attachment style to the mother seems to be important.

DISCUSSION

These results suggest that a distinction of alcohol-addicted patients, with respect to attachment styles and traumatic experiences in childhood and adolescent, seems to be important in order to define specific interventions to improve the ability to regulate emotions.

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.

Attachment and emotion regulation in substance addictions and behavioral addictions

Background Risky behaviors have been related to emotional regulation and attachment, which may constitute risk factors for developing an addictive behavior. However, there may also be differences between substance and non-substance-related addictions. Aims This study aimed to examine the relationship of emotional regulation and attachment, with substance (alcohol and drug abuse), and non-substance-related addictions (gambling disorder, video game addiction, and problematic Internet use) in adolescents and emerging adults. The study also aimed to examine gender differences for such predictors. Methods The sample comprised 472 students aged 13-21 years recruited from high schools and vocational education centers. Results Findings demonstrated that emotion regulation was predictive of all addictive behaviors assessed in this study (alcohol and drug abuse, gambling disorder, video game addiction, and problematic Internet use), whereas attachment predicted non-substance-related addictions (gambling disorder, video game addiction, and problematic Internet use). In addition, gender differences were found, with females scoring significantly higher in maternal and peer attachment, whereas males scored significantly higher in gambling disorder and video game addiction. Conclusion The findings may be useful for preventive and clinical interventions conducted with youth regarding addictive behaviors.

Data quality and factor analysis of the Danish version of the Relationship Scale Questionnaire

Background

The Relationship Scale Questionnaire (RSQ) is a widely-used measure of adult attachment, but whether the results obtained by the RSQ fit the attachment construct has only been examined to a limited extent.

Objective

The objectives of this study were to investigate the psychometric properties of the Danish translation of the RSQ and to test whether the results are consistent with the hypothesized model of attachment.

Methods

The study included two samples: 602 general practitioners and 611 cancer patients. The two samples were analyzed separately. Data quality was assessed by mean, median and missing values for each item, floor and ceiling effects, average inter-item correlations and Cronbach’s α for each subscale. Test-retest was assessed by intra-class correlations among 76 general practitioners. A confirmatory factor analysis was conducted to establish evidence of the four proposed subscales. Due to an inadequate fit of the model, data was randomly split into two equally sized subsamples and an exploratory factor analysis was conducted for all 30 items in the first subsample comprised of 286 cancer patients and 285 general practitioners. The EFA yielded a three-factor structure which was validated through a confirmatory factor analyses in a second subsample comprised of 278 cancer patients and 289 general practitioners.

Results

The data quality of the RSQ was generally good, except low internal consistency and low to moderate test-retest reliability. The four subscales of the RSQ were not confirmed by the confirmatory factor analysis. An exploratory factor analysis suggested a three-factor solution for both general practitioners and patients, which accounted for 61.1% of the variance among general practitioners and 62.5% among patients. The new three-factor solution was verified in a confirmatory factor analyses.

Conclusion

The proposed four-factor model of the RSQ could not be confirmed in this study. Similar challenges have been found by other studies validating the RSQ. An alternative three-factor structure was found for the RSQ.

Protective Action of Se-Supplement Against Acute Alcoholism Is Regulated by Selenoprotein P (SelP) in the Liver

Acute alcoholism is a major cause of cirrhosis and liver failure around the world. Selenium (Se) is an essential micronutrient promoting liver health in humans and animals. Selenoprotein P (SelP) is a glycoprotein secreted within the liver, which interacts with cytokines and the growth factor pathway to provide protection for hepatic cells. The present study was conducted to confirm the effect and mechanism of Se and SelP action in livers affected by acute alcoholism. In this study, a mouse model of acute alcoholism, as well as a hepatocyte model, was successfully established. The Se content of the liver was detected by atomic fluorescence spectrophotometry. The expression of messenger RNA (mRNA) was analyzed by quantitative polymerase chain reaction (qPCR). The protein expression of inflammatory factors was detected by ELISA. The other proteins were analyzed by western blotting. The results showed that pathological damage to the liver was gradually weakened by Se-supplementation, which was evaluated by hematoxylin and eosin (H&E) and TUNEL staining. Se-supplementation inhibited expression of pro-inflammatory factors TNF-α and IL-1β and promoted production of anti-inflammatory cytokine IL-10 in the liver with acute alcoholism. Se-supplementation also prevented the apoptosis of hepatocytes by suppressing the cleavage of caspases-9, 3, 6, 7, and poly(ADP-ribose) polymerase (PARP). Through correlational analysis, it was determined that the effects of Se-supplement were closely related to SelP expression, inflammatory cytokines, and apoptosis molecule production. The sienna of SelP further confirmed the protective action of Se-supplementation on the liver and that the mechanism of SelP involves the regulation of inflammatory cytokines and apoptosis molecules in acute alcoholism. These findings provide information regarding a new potential target for the treatment of acute alcoholism.

Attachment Theory and Maternal Drug Addiction: The Contribution to Parenting Interventions

Children's emotional and relational development can be negatively influenced by maternal substance abuse, particularly through a dysfunctional caregiving environment. Attachment Theory offers a privileged framework to analyze how drug addiction can affect the quality of adult attachment style, parenting attitudes and behaviors toward the child, and how it can have a detrimental effect on the co-construction of the attachment bond by the mother and the infant. Several studies, as a matter of fact, have identified a prevalence of insecure patterns among drug-abusing mothers and their children. Many interventions for mothers with Substance Use Disorders have focused on enhancing parental skills, but they have often overlooked the emotional and relational features of the mother-infant bond. Instead, in recent years, a number of protocols have been developed in order to strengthen the relationship between drug-abusing mothers and their children, drawing lessons from Attachment Theory. The present study reviews the literature on the adult and infant attachment style in the context of drug addiction, describing currently available treatment programs that address parenting and specifically focus on the mother-infant bond, relying on Attachment Theory.

A Longitudinal Examination of Depression Among Gambling Inpatients

Problem and pathological gamblers demonstrate high levels of depression, which may be related to coping styles, reactive emotional states, and/or genetics (Potenza et al., Arch Gen Psychiat 62(9):1015-1021, 2005; Getty et al., J Gambl Stud 16(4):377-391, 2000). Although depression impacts treatment outcomes (Morefield et al., Int J Men Healt Addict 12(3):367-379, 2013), research regarding depression among gamblers in residential treatment is particularly limited. This study attempts to address this deficit by examining the course of depressive symptoms among clients at a residential gambling program in the Western United States. Forty-four adults were administered a weekly measure of depression (Beck Depression Inventory-II, BDI-II) for eight consecutive weeks. Levels of depression were classified into three groups based on standard scoring criteria for the BDI-II: no/minimal, mild/moderate, and severe depression. Results from a mixed-model analysis indicated a main effect for group and time, as well as an interaction between group and time. Examination of the slopes for the rate of change for the three depression groups indicated no change in the non-depressed group and a decrease in depression scores over time for both the mild/moderate and severely depressed groups. The slopes for the two symptomatic depression groups were not significantly different, indicating a similar rate of change. We speculate that reductions in depression symptoms may be related to feelings of self-efficacy, environmental containment/stabilization, and therapeutic effects of treatment. These results help to illuminate the role of significant processes in residential treatment, including initial stabilization, insight, self-efficacy, and termination.

Exploring Attachment Patterns in Patients With Comorbid Borderline Personality and Substance Use Disorders

Studies exploring attachment patterns in samples of patients with borderline personality disorder (BPD) report a combination of preoccupied and fearful-avoidant patterns. This has been interpreted as reflecting the approach-avoidance dilemma of BPD. Comorbid substance use disorders (SUD) have not been considered in these studies, despite the high proportions of SUD among BPD patients and despite the more avoidant attachment in SUD samples. This cross-sectional, naturalistic study explores attachment patterns in a sample of comorbid (BPD and SUD) patients, comparing them to two samples of patients with either SUD or BPD only. Within-group comparisons replicated findings of both preoccupied and fearful-avoidant attachment in BPD and comorbid groups. But between-group comparisons showed that comorbid patients were significantly less preoccupied (p = 0.018) and more dismissing-avoidant (p = 0.030). Although both groups were similar in several psychiatric measures, attachment patterns of the comorbid group were more similar to substance abusers than to borderline patients.

Protective effect of Xingnaojia formulation on rats with brain and liver damage caused by chronic alcoholism

The aim of this study was to observe the effect of a formulation of traditional Chinese medicine extracts known as Xingnaojia (XNJ) on the liver function, learning ability and memory of rats with chronic alcoholism and to verify the mechanism by which it protects the brain and liver. A rat model of chronic alcoholism was used in the study. The spatial learning ability and memory of the rats were tested. The rats were then sacrificed and their brains and hepatic tissues were isolated. The activity of superoxide dismutase (SOD) and levels of glutamate (Glu), N-methyl D-aspartate receptor subtype 2B (NR2B), cyclin-dependent kinase 5 (CDK5) and cannabinoid receptor 1 (CB1) in the hippocampus were analyzed. The ultrastructure of the hepatic tissue was observed by electron microscopy. In addition, the activities of alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH) in serum were tested and the levels of low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides (TG) and total cholesterol (TCHOL) were analyzed. XNJ enhanced the learning and memory of rats with chronic alcoholism. Treatment with XNJ increased the activity of SOD, and decreased the expression levels of NR2B mRNA and NR2B, CB1 and CDK5 proteins in the brain tissues compared with those in the model rats. It also increased the activity of ALDH in the serum and liver, decreased the serum levels of LDL, TG and TCHOL and increased the serum level of HDL. These results indicate that XNJ exhibited a protective effect against brain and liver damage in rats with chronic alcoholism.

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.

Capacities for theory of mind, metacognition, and neurocognitive function are independently related to emotional recognition in schizophrenia

While many with schizophrenia spectrum disorders experience difficulties understanding the feelings of others, little is known about the psychological antecedents of these deficits. To explore these issues we examined whether deficits in mental state decoding, mental state reasoning and metacognitive capacity predict performance on an emotion recognition task. Participants were 115 adults with a schizophrenia spectrum disorder and 58 adults with substance use disorders but no history of a diagnosis of psychosis who completed the Eyes and Hinting Test. Metacognitive capacity was assessed using the Metacognitive Assessment Scale Abbreviated and emotion recognition was assessed using the Bell Lysaker Emotion Recognition Test. Results revealed that the schizophrenia patients performed more poorly than controls on tests of emotion recognition, mental state decoding, mental state reasoning and metacognition. Lesser capacities for mental state decoding, mental state reasoning and metacognition were all uniquely related emotion recognition within the schizophrenia group even after controlling for neurocognition and symptoms in a stepwise multiple regression. Results suggest that deficits in emotion recognition in schizophrenia may partly result from a combination of impairments in the ability to judge the cognitive and affective states of others and difficulties forming complex representations of self and others.

Attachment and family functioning in patients with internet addiction

OBJECTIVE

Although the Internet is used effectively in many areas of life, some users experience problems because of over-use due to a lack of control. The diagnostic criteria for Internet addiction include disruptions in family relationships, but adequate data on the attachment styles and family functioning associated with this condition are limited. This study aimed to investigate the attachment styles and family functioning of patients with Internet addiction.

METHOD

The sample included 30 male patients consecutively admitted to the Bakırköy Mental Health and Research Hospital Internet Addiction Outpatient Clinic, who were diagnosed in clinical interviews as having Internet addiction according to Young's (1998) criteria. Thirty healthy males who were matched with the experimental group in terms of sociodemographic characteristics were included as control subjects. Both groups provided sociodemographic data and completed the Beck Depression Inventory (BDI), the Experiences in Close Relationships Questionnaire-r (ECR-r) and the Family Assessment Device (FAD).

RESULTS

Patients with Internet addiction had higher BDI scores (P<.001) and higher attachment anxiety subscores on ECR-r (P<.001) compared with those in the control group. Patients with Internet addiction evaluated their family functioning as more negative and reported problems in every aspect addressed by the FAD. Scores on the FAD behaviour control, affective responsiveness, and problem-solving subscales (P<.05) and on the FAD communication, roles, and general functioning subscales (P<.001) were significantly higher in the patient compared with the control group.

CONCLUSION

Patients with Internet addiction have more anxious attachment styles as well as prominent disruptions in family functioning. Thus, it may be important to evaluate the attachment styles and family functioning of patients with Internet addiction. Indeed, comprehensive treatment approaches including other family members may make important contributions to treatment success.

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.

Attachment style, anxiety coping, and personality-styles in withdrawn alcohol addicted inpatients

BACKGROUND

Insecure early attachment experiences have been reported to play an important role in the manifestation in alcoholism. The purpose of this study was to investigate the relationship of attachment styles with anxiety, anxiety coping and dysfunctional personality styles, as well as with the prevalence of personality disorders, and adverse life-events in adolescence.

METHODS

59 inpatient alcohol addicted male (n=43) and female (n=16) patients were characterized by an attachment style scale (Relationships-style-questionnaire-RSQ) and completed a questionnaire battery comprising the State-Trait-Anxiety-Inventory (STAI), the Anxiety-Coping-Inventory (ABI), Temperament-and-character-inventory (TCI), Personality-system-interaction-inventory (PSI), and gave information on sociodemography, alcohol history, and adolescent adverse events. A structured interview (SKID-II) was performed to diagnose personality disorders.

RESULTS

Only 33% of subjects had a secure attachment style. Insecure attachment was associated with significantly higher trait-anxiety, higher cognitive avoidance to control anxiety, and higher values on most personality style dimensions directed to the pathological pole.

CONCLUSIONS

Despite the limitation due to a small sample size, the results of this study show that the consideration of attachment styles is of significance in the diagnosis and therapy of alcohol addiction. Attachment may characterize different styles to control emotional aspects, anxiety cues and interpersonal relationships in individuals suffering from alcohol addiction.

Alexithymia in personality disorders: correlations with symptoms and interpersonal functioning

Impairment in the ability to recognize and make sense of emotions has been hypothesized to be present in a sub-sample of people suffering from personality disorder (PD). In particular it is possible that difficulty recognizing and expressing feelings, or alexithymia, is related to many of the symptoms and problems in making sense of social interactions which are hallmarks of PD. In this study we measured levels of alexithymia with the Toronto Alexithymia Scale-20 and explored its correlations with the overall presence of PD and different PD diagnoses, symptoms, and interpersonal difficulties. Results were largely consistent with the hypothesis. Higher levels of alexithymia were related to high levels of global psychopathology and with dysfunctional representation of interpersonal relations. A sub-sample of patients, mostly suffering from avoidant, dependent, passive-aggressive and depressive PD, had alexithymic features and, in particular reported difficulties describing their feelings to others. A patient with cluster B PD featured no alexithymia. Implications of this study for future research and treatment are discussed.