The role of emotion processing deficits in alcohol dependence and relapse.


This study looks at an area close to our research hearts.

The role of emotion processing deficits in alcohol dependence and relapse.

It is a good overview of some of the literature. The underlying mechanism which prompts relapse is not unearthed in this study. You may have to wait until our current theoretical model is published to know what this neural mechanism is, so stay tuned?

“Emotional processing deficits are important factors in the development and course of alcohol dependence (AD) (e.g. OscarBerman and Bowirrat, 2005; Volkow et al., 2012). Perception, understanding and regulation of emotional experience interface with higher-level cognitive functions (cognitive set switching, response inhibition, decision making) in behaviors responding to incentives.

It is thought that alcohol-dependent individuals might use alcohol as a mechanism to regulate one’s affective experience (Lang et al., 1999), and this pathological coping mechanism may in turn lead to relapse (Moos and Moos, 2006). Some aspects of emotional processing have been selectively studied in relation to AD. One of them is alexithymia, a multifaceted construct characterized by difficulties in identifying and describing one’s own feelings  (Taylor et al., 1997). These characteristics have been shown to appear in 45–67% of alcohol-dependent patients (Thorberg et al., 2009) and may possibly predispose to AD development (Parker et al., 1989). AD patients whose scores on a self-report scale indicated alexithymia had a significantly younger age of onset and longer duration of problem drinking, greater alcohol consumption and significantly higher Michigan Alcohol Screening Test (MAST) scores compared to patients without alexithymia (e.g. Kauhanen et al., 1992; Uzun et al., 2003)…

Several theories attribute regulation of negative affect (NA) as a distinctive cause for alcohol consumption (Levenson et al., 1980; Colder and Chassin, 1993; Khantzian, 1997)…. Numerous studies have shown that self-reported negative mood predicts higher rates of relapse (e.g. Hodgins et al., 1995; Cooney et al., 1997) and most relapses occur during a state of NA (Hartka et al., 1991). In addition, individuals with substance use disorders and comorbid affective disorders have worse treatment outcomes (Hodgins et al., 1999; Curran et al., 2000; Conner et al., 2005; Kodl et al., 2008). Research findings indicate that deficits in verbal and nonverbal emotion recognition associated with alexithymic characteristics may be linked particularly to negative emotions (Lane et al., 2000; Parker et al., 2005). Other studies show that alcohol-dependent patients demonstrate deficits in accurately labeling emotions exhibited by unimodal auditory or visual stimuli (e.g. Philippot et al., 1999; Kornreich et al., 2001a,b; Maurage et al., 2009, 2011).

The same studies also show they overestimate the emotional intensity of affective stimuli compared with normal controls. Finally, difficulties in identification and description of one’s own emotional experience, together with impairments in perception and labeling of emotion displayed by others, may represent a broadly based emotion-processing deficit. These competencies are implied as one of the basic constituents of emotional intelligence (EI). Currently, EI is conceptualized as a set of emotional competencies such as recognition, understanding, regulation and utilization of emotions in thinking or acting (Matthews et al., 2007). …

Low EI could possibly lead to problem drinking, due to an inherent inability to manage NA, difficulties in interpersonal relations that lead to NA, and at least in youths, lack of socioemotional skills that help them resist peer pressure (Peterson et al., 2011). Lower EI was related to higher alcohol use in adolescents (Trinidad and Johnson, 2002) and lower trait EI was a significant predictor of alcohol-related problems in non-treated adults (Riley and Schutte, 2003)…

Difficulties in emotional decoding and alexithymia may be part of a more general deficit in EI observed in this population, giving the conceptual frame for research on emotional processing in alcoholism. Low EI could possibly manifest as an inability to manage NA or difficulties in interpersonal relations and socioemotional skills that lead to NA, thus increasing the risk for using alcohol as a coping mechanism (Moos and Moos, 2006). More severe deficits in perceiving emotions were found in patients who dropped out from treatment (Foisy et al., 2007). Importantly, Kornreich et al. (2002) showed that interpersonal difficulties serve as a mediator between emotional decoding accuracy and AD. These results support the view that inhibition of the automatic emotional response needs to be exercised in AD patients, and underline the importance of emotion management training for the prevention of relapse in AD patients.


In the present study, a distinctive set of the self-reported emotional characteristics was analyzed in a group of inpatients being treated for AD. According to the objectives of the study, associations between emotional processing and drinking history were explored. Models involving selected facets of emotion processing were also included as the predictors of relapse in the month preceding follow-up at 1 year.

Emotional processing and relapse

To our knowledge, this is the first prospective study where the association between different facets of self-reported EI and relapse were analyzed prospectively in a clinical sample of AD patients. We observed that better utilization of emotions was a protective factor for relapse

Hitherto, NA has been revealed as one of the significant relapse predictors. AD individuals with the concomitant affect-related disorders (anxiety or depression) have been shown to relapse more often (for rev., Bradizza et al., 2006), and retrospectively to report that relapse occurred in the context of NA (e.g. Zywiak et al., 1996). The results from the current study, showing that the severity of self-reported depressive symptoms contributed to relapse, are therefore consistent with the previous reports. It has been postulated that emotional dysregulation is a significant predictor of alcohol and drug use disorders, beyond the influence of NA itself (Bradley et al., 2011)…

…In the population of AD inpatients analyzed in our study, better utilization of emotions was a protective factor in relapse to drinking. The emotion utilization factor reflects the self-perception of oneself as someone who is able to use positive emotions to facilitate thinking or acting. The higher the score, the more the subject is convinced that his planning or decision making can be reinforced by positive affective state. To the extent that the results of the previous investigations can be applied to the current study, it is plausible that deficits in utilizing positive emotions to build cognitive or motivational resources, leads to ineffective coping strategies and urges to drink alcohol. Thus, patients who reported deficits in the integration of PA with cognitive or behavioral execution were more likely to relapse. It can be further speculated that a disability in experiencing positive emotions—lower PA— increases the likelihood of relapse. Those patients might drink to enhance PA. In a study of non-clinical sample of young adults from the families with high severity of AD, individuals who manifested lower ability to recognize complex emotions presented on faces were more likely to anticipate experiencing arousal/aggression decrease, sexual enhancement and global positive consequences due to alcohol use (Kopera et al., 2008)…

The association between alexithymia and alcohol consumption has been widely studied, however little research has investigated the underlining mechanisms (for rev., Thorberg et al., 2009). Recent reports revealed that anxious attachment (Thorberg et al., 2011a) may partially mediate the relationship between alexithymia and craving in AD.

Together, the current data suggest that people scoring high in alexithymia use alcohol to feel more confident in social situations, and overcome their emotional difficulties. The lack of emotional awareness, may lead to the experience of unidentified arousal, which is not linked to the emotional cause, especially when more arousal generating negative emotions are involved (Thorberg et al., 2011b). The results of the current study underline the importance of emotion management training for the prevention of relapse in AD patients.


  1. Kopera, M., Jakubczyk, A., Suszek, H., Glass, J. M., Klimkiewicz, A., Wnorowska, A., … & Wojnar, M. (2014). Relationship between emotional processing, drinking severity and relapse in adults treated for alcohol dependence in Poland. Alcohol and Alcoholism, agu099.

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