The link between substance dependence and emotional illiteracy

The link between substance dependence and emotional illiteracy
Do you feel your heart beating faster, but you can't tell if you're excited or scared and can't put it into words? Do you have difficulty understanding other people's reactions? These are symptoms of alexithymia, a disorder of recognising and naming emotions. This is not a new phenomenon, many people have studied it in many ways, and many more have tried to prove its link with substance abuse. In the most comprehensive meta-analysis summarising research over the past 35 years, researchers at ELTE PPK have now shown that levels of alexithymia are much higher among addicts.

Researchers have long been interested in why people use mind-altering substances and have been trying to uncover possible antecedents and risk factors for substance use disorders. Evidence suggests that psychological factors play a significant role in the development of addictions and that substance users often suffer from emotional disturbances.

A specific form of emotional disorders is alexithymia, more commonly known as emotional illiteracy. Sufferers have difficulty verbalising their feelings of joy or sadness and have difficulty distinguishing their feelings from their physiological symptoms. Congenital problems, childhood trauma, or a lack of socialisation can cause abnormal personality traits.

The link between alexithymia and substance use began to be investigated in the 1980s concerning alcohol consumption. Since then, a number of studies have tried to unravel the mystery of the chicken-and-egg case. Associate professors Bernadette Kun and Gyöngyi Kökönyei, together with master's and doctoral students at ELTE PPK and University of Edinburgh researcher Zsófia Garai-Takács, analysed a total of 168 scientific publications published between 1988 and 2022 and identified a number of features that could contribute to a deeper understanding and treatment of both diseases.

In their complex review, the researchers considered all types of psychoactive substances (e.g., alcohol, nicotine, opiates, stimulants, hallucinogens), the modes of use (recreational and compulsive or problematic use), all age groups, and various measures of alexithymia and substance use.

And their results, published in Clinical Psychology Review, one of the most prestigious psychology journals, showed a clear and significant positive association between alexithymia and substance use disorder.

"This does not imply that alexithymia is responsible for the development of addictive disorders or vice versa, as the causal relationship may be influenced by many factors that have not been investigated so far."

- explains Bernadette Kun.

However, it has been shown that substance users have much higher levels of alexithymia than those who do not use mind-altering substances. This is particularly the case for problem users, i.e., alcohol or drug addicts, who show more pronounced difficulties with emotional processing than casual or recreational users. 

It was also found that the proportion of people with alexithymia is slightly higher among substance users than in the rest of society. However, this was not true in reverse, i.e., people with an affective disorder were not more likely to use drugs or alcohol.

The researchers also examined how different types of mind-altering drugs affected the results. The most significant associations were found for opiates, alcohol, and amphetamines. "There is a theory that individuals don't use this or that substance by chance but unconsciously choose which one best suits their psychological difficulties," says the PPK lecturer.

"Our results actually confirm that it is not possible to lump all types of substance users together in terms of emotional processes and levels of self-regulation. This should also be taken into account in their treatment."

A further important conclusion of the study is that of the main features of alexithymia (difficulties in identifying emotions, expressing emotions, and pragmatic and imaginative thinking), the problem of identifying emotions shows the strongest link with substance use. Translated into clinical practice, this means that addicts should primarily develop the skills responsible for recognising internal emotional experiences.

And how can it be useful to study a specific pathology still unknown to many? Researchers believe demonstrating a strong link between substance use and alexithymia could make prevention and intervention programmes more effective. For example, screening for the extent of alexithymia may be useful in identifying populations at risk of substance use. For substance users with high levels of alexithymia, they suggest using treatments that do not rely on intensive emotional communication with a therapist as an alternative. This could include computer-assisted cognitive therapy for cocaine addicts.

The results suggest that addiction treatment should include interventions to improve emotion regulation. Indeed, programmes that teach patients to identify, describe, and express emotions may be more effective in the long term, helping to maintain abstinence and avoid relapse.

The article, published in the journal Clinical Psychology Review, can be found here.