Elsevier

Drug and Alcohol Dependence

Volume 180, 1 November 2017, Pages 439-444
Drug and Alcohol Dependence

Full length article
Emotion differentiation predicts likelihood of initial lapse following substance use treatment

https://doi.org/10.1016/j.drugalcdep.2017.09.007Get rights and content

Highlights

  • Protective factor against lapse to substance use after treatment entry is proposed.

  • Emotion differentiation is the ability to differentiate among negative affect terms.

  • Emotion differentiation is linked with lower risk for first lapse.

  • Emotion differentiation could be a specific treatment target for relapse prevention.

Abstract

Background

An estimated 40% to 70% of individuals treated for a substance use disorder relapse within one year following treatment (Walitzer and Dearing, 2006). Relapse is often driven by the need to cope with intense negative affect (Koob, 2013). Emotion differentiation, defined as the ability to distinguish among various emotion states, has been linked to better behavioral control in the face of negative affect (Kashdan et al., 2015). The aim of the current study was to determine if higher levels of emotion differentiation are associated with the risk of experiencing an initial lapse following entry into residential substance use treatment.

Methods

A total of 213 substance users (69.5% male, 94.4% African American, M age = 43.01 ± 11.35 years) entering residential treatment were assessed on study variables at pre- and post-treatment, and at 1-, 3-, 6- and 12-month post-treatment. Emotion differentiation was calculated using ratings on five negative affect items derived from the Positive and Negative Affect Schedule (PANAS; Watson et al., 1988) at five assessment points.

Results

A Cox proportional-hazards regression model adjusting for age and negative affect intensity demonstrates that for every unit increase in emotion differentiation, there is a 27% reduction in the likelihood of initial lapse on any given day (OR = 0.73; 95% CIs [0.56, 0.95]).

Conclusions

The ability to differentiate among negative emotion states protects against initial lapse following treatment.

Introduction

A predominant motivational force thought to drive substance use is its negative reinforcement via the relief of negative affect (Baker et al., 2004, Koob, 2013). This is especially true when individuals cease prolonged use of a substance, and therefore experience heightened negative affect due to psychological withdrawal (Baker et al., 2004). Consequently, when faced with increased negative affect following abstinence, individuals resort to the prepotent coping technique (i.e., substance use). It follows that among individuals who are recently abstinent, those who are better able to cope with negative affect would be less likely to experience an initial lapse. Indeed, evidence suggests that individuals who are able to tolerate negative affect stay abstinent for longer periods of time (Daughters et al., 2005, Strong et al., 2012). However, the specific mechanisms contributing to one’s ability to cope with negative affect remains undetermined.

Emotion differentiation may be one mechanism contributing to an individual’s ability to cope with negative affect states (Barrett et al., 2001, Kashdan et al., 2015). Individuals who are high in emotion differentiation are able to distinguish among negative affect states and represent their feelings using specific emotion adjectives (e.g., experience their negative affect as anger v. shame v. anxiety). Although previous research has linked constructs such as “emotional clarity” to drug use (Boden et al., 2013), emotion differentiation differs from emotional clarity in important ways. Whereas emotional clarity refers to an individual’s self-reported meta-knowledge about their emotional experiences (e.g., Boden et al., 2012), emotion differentiation is typically represented by an objective, behavioral measure using repeated measurements of affect (e.g., Kashdan et al., 2014, Pond Jr et al., 2012). In such studies, individuals with high emotion differentiation have smaller correlations over time among negative affect states. In contrast, individuals who are low in emotion differentiation tend to exhibit higher correlations over time, leading to an undifferentiated and general experience of negative affect (e.g., experience their negative affect as just feeling bad). For such individuals, negative affect states are more highly correlated over time.

It is thought that emotion differentiation helps individuals cope with negative affect because individuals high in emotion differentiation perceive more nuanced information about the context of their emotional experience, and therefore engage in purposeful behavior directed at regulating their negative affect (e.g., “I feel guilty, so I should apologize”) (Barrett et al., 2001, Kashdan et al., 2015). On the other hand, individuals with lower emotion differentiation may be less able to regulate negative affect using adaptive strategies and thus feel more overwhelmed by it, leading them to use maladaptive behaviors to alleviate their affect (e.g., “I’m upset, so I need a drink”).

Consistent with the idea that emotion differentiation helps individuals regulate negative affect and abstain from maladaptive substance use behaviors, evidence finds that underage social drinkers showing greater emotion differentiation among negative affect states are less likely to drink alcohol in response to negative affect (Kashdan et al., 2010). Differentiation of negative affect states is also protective against retaliating with aggression when feeling angry or engaging in non-suicidal self-injury when ruminating among individuals with borderline personality disorder (Zaki et al., 2013). Additionally, individuals with major depressive disorder (Demiralp et al., 2012) and social anxiety disorder (Kashdan and Farmer, 2014) have lower emotion differentiation ability compared to healthy controls.

Taken together, greater emotion differentiation appears to protect against maladaptive behaviors, including alcohol use. However, no study to date has examined whether this construct is associated with a greater likelihood of staying abstinent among treatment seeking substance users. Given that early abstinence from substance use is characterized by intensified negative affect and emotional vulnerability (e.g., Fox et al., 2007) emotion differentiation may prevent an individual from experiencing an initial lapse during this phase. Therefore, the current study aimed to examine whether greater emotion differentiation is associated with a lower probability of initial lapse following admission to substance use treatment.

Section snippets

Participants

Participants were current substance users, recruited upon admission from a 136-bed residential substance use treatment center in Northeast Washington, DC. Exclusion criteria for the study were <5th grade English reading level, current psychotic symptoms, and initiation of psychotropic medication within the past three months.

Two additional exclusion criteria were used for the current study: (1) participants with less than three time points of valid affect data due to attrition (n = 30), and (2)

Tests for systematic exclusion and participant characteristics

To test for systematic exclusion, three models, each consisting of a set of predictors were compared to a null intercept model, with the filter variable (identifying individuals excluded based on criteria described above) as the dependent variable. First, the filter variable was regressed on variables representing different past year diagnoses of substance dependence, current anxiety and depression diagnoses (listed in Table 1). No significant difference was observed between this model and the

Discussion

The present study examined whether emotion differentiation is associated with the likelihood of initial lapse following substance use treatment entry. Consistent with the hypothesis that emotion differentiation is a protective factor against relapse; participants with higher emotion differentiation ability had a lower likelihood of initial lapse after treatment entry over a period of one year. This novel finding suggests that the ability to differentiate among negative affect states may be

Conflict of interest

No conflict declared.

Financial disclosure

No financial disclosure to report.

Role of funding source

This research was supported by National Institute on Drug Abuse R01 DA026424 (PI: Daughters). This article is the sole responsibility of the authors and does not reflect the views of the National Institutes of Health.

Contributors

Deepika Anand originated the study concept, conducted the statistical analyses and drafted the manuscript. Yun Chen contributed to manuscript preparation and revisions. Kristen Lindquist advised on the study concept, statistical analysis and reviewed drafts of the manuscript. Stacey Daughters advised on all aspects of the study and provided critical revision of the manuscript for important intellectual content. All authors approved the final version for publication.

Acknowledgements

The authors would like to thank C.J. Seitz-Brown for study oversite and data management, as well as the study participants and staff whose time and effort made this research possible. The authors also thank the funding source that supported this research, i.e. National Institute on Drug AbuseR01 DA026424 (PI: Daughters).

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