Does Inability To Express Emotions Affect Treatment In Substance Abuse?

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Academic Journal
Main Category: Alcohol / Addiction / Illegal Drugs
Also Included In: Psychology / Psychiatry
Article Date: 24 Jan 2012 - 10:00 PST

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Alexithymia describes a person's state of deficiency in understanding, processing, or describing emotions, and even though the rate for alexithymia in those with substance use disorders is reported to be almost 67%, there are few studies that have evaluated therapy in alexithymic SUD patients.

One therapy that proved fairly successful in high-scoring alexithymic SUD patients was group cognitive behavior therapy (CBT), and whilst alexithymia was linked to a lower dropout rate amongst participants, the Addiction Severity Index (ASI) alcohol composite score proved to be higher at follow-up.

The study authors wanted to establish the predictive value of alexithymia at baseline on recovery from a clinical viewpoint, hypothesizing that the outcome would be negatively linked to alexithymia, which would strongly argue for assessing alexithymia at admission and adjusting therapy for highly alexithymic patients.

They evaluated a total of 187 abstinent SUD inpatients at baseline using the Dutch version of the Toronto Alexithymia Scale (TAS-20) and the European ASI (EuropASI), which was also used at 3-month follow-up after a standard inpatient CBT (CBT-TAU group) or CBT with shared decision-making intervention (SDMI) (CBT-SDMI group).

All patients had one or more substance-related disorders according to the DSM-IV-TR, with the average score on the TAS-20 at baseline being 55.7 (SD = 11.3). The cutoff score showed that 36.9% were highly alexithymic, with 33.2% classified as low alexithymics. Those who were highly alexithymic were noted to have had fewer years of education [p =0.05] with more frequent unemployment [p = 0.05] compared with low-scoring alexithymics.

Those who scored higher for alexithymics showed greater problems in the 'work, income and education' [p= 0.04] field and in 'psychiatry' [p<0.001]. The researchers noted that whilst the average therapy time in days for highly alexithymic patients (116.0, SD = 58.9) was comparable with that for low scoring alexithymics [p = 0.26], the rates between those who completed the therapy were also similar with 50.7% for high- and low-scoring alexithymics [p=0.41]. They also noted that 54% of the high-scoring, and 45.7% of the low-scoring alexithymics were abstinent at follow-up [p=0.41].

In terms of the Europ-ASI, the researchers noted differences between baseline high- and low-scoring alexithymic patients in the 'work, income and education' field in the CBT-SDMI group, whilst those in the CBT-TAU group showed differences in the areas of 'family and social relations' and 'drugs'.

The findings showed that EuropASI change scores also generally improved equally between high- and low-scoring alexithymic patients, whilst alexithymia as a continuous score was principally positively linked to these change scores.

The researchers established that highly alexithymic SUD patients can benefit from CBT with or without SDMI, and that the degree of alexithymia is not negatively linked to resulting outcomes. They acknowledge the limitations of this study in terms of absence of systematic urine or blood samples to confirm abstinence, and not performing multi-method alexithymia assessments that include an observer scale.

By classifying alexithymia patients in two extremes categories the researchers established whether or not highly alexithymic SUD patient should be treated differently at the start of the treatment. They conclude that highly alexithymic SUD patients performed very well and alexithymia was linked to the treatment outcomes, and add that CBT can be used in this patient population even in those patients who show alexithymic features at intervention entry.

Written by Petra Rattue
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