Fred Arne Thorberg

Alexithymia, craving and attachment in a heavy drinking population

Up to fifty per cent of individuals with Alcohol use disorders (AUD) also have alexithymia a personality construct hypothesized to be related to attachment difficulties. The relationship between alexithymia, craving, anxious attachment and alcohol-dependence severity was examined in 254 patients participating in a Cognitive-Behavioral Therapy (CBT) program for alcohol-dependence. Participants completed the Toronto Alexithymia Scale (TAS-20), the Obsessive Compulsive Drinking Scale (OCDS), the Revised Adult Attachment Anxiety Subscale (RAAS-Anxiety) and the Alcohol Use Disorder Identification Test (AUDIT). MANOVA indicated that individuals with alexithymia reported significantly higher levels of total OCDS, obsessive thoughts about alcohol, and compulsive drinking urges and behavior, compared to the non-alexithymic group. Regression analyses found that anxious attachment partially mediated the relationship between alexithymia and craving. Anxious attachment may be a potential treatment target to reduce alcohol consumption in those with alcohol-dependence and alexithymia.

Attachment in relation to affect regulation and interpersonal functioning among substance use disorder inpatients

Attachment theory has been conceptualised as an affect regulation theory, proposing that attachment is associated with the expression and recognition of emotions as well as interpersonal functioning. Previous research has reported affect regulation difficulties in substance use disorders and addiction has been considered an attachment disorder. However, scarce empirical research exists on the relationship of attachment in relation to affect regulation and interpersonal functioning in those with substance use problems. Thus, the objective of the present study was to investigate potential associations between attachment, negative mood regulation (NMR) expectancies, fear of intimacy and self-differentiation in substance abusers. The revised adult attachment scale (RAAS), the NMR expectancies scale, the fear of intimacy scale and the differentiation of self inventory were administered to a sample of 100 substance use disorder inpatients. Attachment accounted for significant variance in NMR expectancies and was also a strong predictor of fear of intimacy. The predictive utility of attachment also extended to self-differentiation, suggesting that attachment was strongly related to overall self-differentiation score, Emotional reactivity, Emotional cut-off and I position. These findings support attachment theory suggesting that attachment is associated with and predicts affect regulation abilities and difficulties in interpersonal functioning in a sample of substance use disorder inpatients. The inclusion and assessment of attachment appears to be important in the development of treatment programmes for substance abusing individuals.

Alexithymia in relation to parental alcoholism, everyday frontal lobe functioning and alcohol consumption in a non-clinical sample.

BACKGROUND Recent studies have indicated that 45-67% of those in treatment for alcohol use disorders suffer from alexithymia, a multifaceted personality trait characterized by difficulties identifying and describing emotions and an externally oriented cognitive style. The high reported prevalence rates of alexithymia among those with alcohol dependence led to speculation that alexithymia is a personality dimension that may predispose to risky or problematic alcohol use. METHODS This notion was examined in 314 adult volunteers (54% female) aged 18-45 years (M=27.6 years), all of whom reported at least occasional alcohol consumption, who completed online surveys assessing alexithymia (Toronto Alexithymia Scale, or TAS-20), parental alcoholism (Children of Alcoholics Screening Test, or CAST), everyday signs of frontal lobe dysfunction (Frontal Systems Behavior Scale, or FrSBe) and risky alcohol use (Alcohol Use Disorders Identification Test, or AUDIT). RESULTS TAS-20 scores were positively correlated with the index of parental alcoholism CAST, index of frontal lobe dysfunction FrSBe and measure of alcohol-related problems AUDIT. Chi-square test showed an association between TAS-20-defined alexithymia and being the offspring of an alcoholic parent as defined by CAST. Regression analysis showed that frontal lobe dysfunction (FrSBe) mediated the relationship between alexithymia (TAS-20 total score) and risky alcohol use (AUDIT). CONCLUSIONS The findings suggest that alexithymia is related to deficiencies in frontal lobe functioning that may reflect a heritable predisposition to alcohol problems.

Risky cannabis use is associated with alexithymia, frontal lobe dysfunction, and impulsivity in young adult cannabis users.

Abstract Risky or problematic alcohol use by young adults has been found to be associated with factors such as alexithymia, frontal lobe dysfunction, reward sensitivity, and impulsivity. One interpretation is that these factors reflect inherent traits that predispose to risky substance use in general, a notion examined in the present study. Alexithymia, everyday frontal lobe functioning, sensitivity to reward and punishment, and impulsivity were examined in 138 young adult cannabis users who were divided into Low Risk (n = 99) and Risky (n = 39) users according to their Cannabis Use Disorder Identification Test (CUDIT) scores. Risky cannabis use was significantly positively associated with alexithymia, multiple signs of frontal lobe dysfunction in everyday life, and impulsivity. A broader pattern of dysfunction was indicated for risky cannabis use than for risky alcohol use in this sample. Findings are interpreted as likely reflecting not only inherent traits that predispose to risky substance use in general, but also perhaps residual effects of recent heavy cannabis use in the Risky user group. Longitudinal research is needed to disentangle these competing possibilities.

Alexithymia in alcohol dependent patients is partially mediated by alcohol expectancy

BACKGROUND Up to fifty percent of alcohol dependent individuals have alexithymia, a personality trait characterised by difficulties identifying and describing feelings, a lack of imagination and an externalised cognitive style. Although studies have examined alexithymia in relation to alcohol dependence, no research exists on mechanisms underlying this relationship. The present study examined the mediational effect of alcohol expectancies on alexithymia and alcohol dependence. METHODS 230 outpatients completed the Toronto Alexithymia Scale (TAS-20), the Drinking Expectancy Questionnaire (DEQ) and the Alcohol Use Disorder Identification Test (AUDIT). RESULTS Regression analysis showed that alexithymia and alcohol dependence was, in two of three cases, partially mediated through alcohol expectancy. CONCLUSIONS Alcohol expectancies of assertion and affective change show promise as mediators of alcohol dependence in individuals with alexithymia.

Alexithymia and alcohol: The roles of punishment sensitivity and drinking motives

Alexithymia refers to difficulties identifying and describing feelings. It is suspected of being a risk factor for problematic drinking, an idea examined by this study. In 178 women and 84 men alexithymia was associated with male gender, coping motives for drinking and sensitivity to punishment. Individuals with alexithymia reported stronger coping motives and sensitivity to punishment compared to those with borderline or no alexithymia. Path analysis indicated that the relationship between the alexithymia dimension difficulties identifying feelings and coping motives was mediated by sensitivity to punishment, and the relationship between sensitivity to punishment and risky drinking was mediated by coping motives. These results suggest that alcohol may be used by individuals with alexithymia to help them cope with anxiety or other negative affect.

Mood and interpersonal functioning in heavy smokers

Male and female adult heavy smokers (n = 96) and non‐smokers (n = 123) were compared on the Depression Anxiety Stress Scales (DASS), Adult Attachment Scale (AAS), Fear of Intimacy Scale (FIS), Negative Mood Regulation (NMR) Scale and Affect Intensity Measure (AIM). Compared with non‐smokers, smokers scored significantly higher on DASS‐Stress, DASS‐Anxiety, and DASS‐Depression, and significantly lower on NMR, AAS‐Depend and AAS‐Close. Smokers also scored marginally higher on FIS. Results suggest mood and relationship dysfunction in smokers, similar to the findings of a previous investigation of detoxified inpatients undergoing treatment for substance (alcohol, heroin, or methamphetamine) dependence.

Caffeine Use and Alexithymia in University Students

Abstract Alexithymia refers to difficulties with identifying, describing, and regulating one’s own emotions. This trait dimension has been linked to risky or harmful use of alcohol and illicit drugs; however, the most widely used psychoactive drug in the world, caffeine, has not been examined previously in relation to alexithymia. The present study assessed 106 male and female university students aged 18-30 years on their caffeine use in relation to several traits, including alexithymia. The 18 participants defined as alexithymic based on their Toronto Alexithymia Scale (TAS-20) scores reported consuming nearly twice as much caffeine per day as did non-alexithymic or borderline alexithymic participants. They also scored significantly higher than controls on indices of frontal lobe dysfunction as well as anxiety symptoms and sensitivity to punishment. In a hierarchical linear regression model, sensitivity to punishment negatively predicted daily caffeine intake, suggesting caffeine avoidance by trait-anxious individuals. Surprisingly, however, TAS-20 alexithymia scores positively predicted caffeine consumption. Possible reasons for the positive relationship between caffeine use and alexithymia are discussed, concluding that this outcome is tentatively consistent with the hypo-arousal model of alexithymia.

Attachment security and alexithymia in a heavy drinking sample

Attachment difficulties have been proposed as a key risk factor for the development of alexithymia, a multifaceted personality trait characterised by difficulties identifying and describing feelings, a lack of imagination and an externally oriented thinking style. This study investigated the relationship between attachment and alexithymia in an alcohol-dependent population. Participants were 210 outpatients in a Cognitive Behavioural Treatment programme assessed on the Toronto Alexithymia Scale and the Revised Adult Attachment Scale. Significant relationships between anxious attachment and alexithymia factors were confirmed. Furthermore, alexithymic alcoholics reported significantly higher levels of anxious attachment and significantly lower levels of closeness (secure attachment) compared to non-alexithymic alcoholics. These findings highlight the importance of assessing and targeting anxious attachment among alexithymic alcoholics in order to improve alcohol treatment outcomes.

Drinking motives, alcohol expectancies and alexithymia in young adult social drinkers

The present study examined alexithymia, drinking motives and alcohol expectancies in a non-clinical sample of 100 young adults aged 18–30 years. Those with alexithymia scored higher on measures of coping motives for drinking and affective change expectancies than those without alexithymia. The findings suggest that people with alexithymia are more likely not only to drink to cope, but also to experience feelings of intensified negative mood after drinking, compared to people without alexithymia even when both groups show similar levels of drinking.