Trauma, alexithymia, emotional regulation and dissociation in alcohol use disorder, substance use disorder and polysubstance disorder
Background: Around 33-50% who attend treatment for substance use disorder (SUD) and alcohol use disorder (AUD) have a history of trauma. Experiencing trauma can lead to psychological disorders, difficulties with emotional regulation and dissociation. SUD and AUD can be chronic, relapsing disorders and understanding what individual factors affect addiction has important implications for treatment. Objective: The systematic review was interested in whether alexithymia affects abstinence after relapse prevention treatment (both psychological and pharmacological). The review was also interested in whether alexithymia is a stable trait after relapse prevention treatment (both psychological and pharmacological) as measured by the Toronto Alexithymia Scale. The research study investigates the relationships between trauma, dissociation, alexithymia, emotional regulation and SUD, AUD and polysubstance use. There has been little research looking at the relationships between these variables and how they compare in different types of substance use. It was hypothesised that patients with poly-substance addiction will have higher incidents of trauma, dissociation, alexithymia and poorer emotional regulation when compared to alcohol and drug dependence alone. Methods: A systematic search of articles published between January 1989 - January 2017 was carried out following the Cochrane (2008) guidelines. PSYCHInfo, Medline and Cinahl were the key databases searched. Papers were quality assessed to identify strengths and weaknesses. The research study is a qualitative, cross-sectional design that involved ninety-one AUD, SUD and poly-substance use participants who were attending outpatient NHS addiction services. They were asked to complete questionnaires assessing trauma, dissociation, alexithymia and emotional regulation. Results: The systematic review found twelve articles that related to the review questions. The systematic review found alexithymia did not impact on abstinence and there was no difference between abstinence after treatment between low and high alexithymic groups. There were mixed results for whether alexithymia score changes after relapse prevention treatment. Overall, the results suggest that alexithymia is relatively stable across SUD and AUD after relapse prevention treatment. The empirical study found that there is no difference between type of addiction and trauma, alexithymia and emotional regulation. People with polysubstance misuse reported significantly higher levels of dissociation than the other two groups. Multiple regression was conducted on the full data set and it was found that emotional regulation, alexithymia and dissociation were able to predict trauma in alcohol, drug and polysubstance users. Conclusions: The systematic review found that despite the assumption that people with alexithymia have higher rates of relapse and attrition this is not the case. Alexithymia has no impact on treatment outcome. The review also found that CBT was identified as an effective relapse prevention treatment for people with alexithymia. The research paper highlighted that the type of substance used by people who have experienced trauma may not be as important as previously thought. Also, understanding that poor emotional regulation, alexithymia and dissociation commonly co-occur with trauma so it may be important to screen for this when treating people with trauma who have co-morbid addictions.