Association between alexithymia and substance use: A systematic review and meta‐analysis

Abstract

Alexithymia has been associated with substance use, but the magnitude of the association has not been evaluated and sub‐group differences, if any, are unknown. The aim of this meta‐analysis is to systematically review the association between alexithymia and substance use (alcohol or illicit drugs). We identified studies through a systematic review of PubMed and Web of Science and obtained a total of 52 publications using the Toronto Alexithymia Scale‐20 scale. Random effects meta‐analysis was used to evaluate the overall and sub‐group associations. Of the studies, 50 were cross‐sectional and two longitudinal. Alexithymia was associated with any substance use (Cohen’s d = 0.62, 95% confidence interval [CI] 0.49–0.76), with little difference between estimates for use of alcohol or illicit drugs. A stronger association was observed for the alexithymia dimension “Difficulty in Identifying Feelings” (d = 0.64, 95% CI = 0.47–0.81) and “Difficulty in Describing Feelings” (d = 0.44, 95% CI = 0.32–0.55) than for “Externally Oriented Thinking” (d = 0.19, 95% CI = 0.09–0.28). The association was stronger in studies with clinical patient populations (d = 0.83, 95% CI = 0.62–1.05) than in those investigating general or student populations, and in studies with a majority of male rather than female participants. These findings suggest a strong overall association between alexithymia and substance use and a very strong association among clinical patient populations. The association may be stronger with the emotion‐related dimensions than with the cognition‐related dimension of alexithymia. As nearly all the studies were cross‐sectional, more longitudinal studies are needed.

Childhood Trauma, Emotional Awareness, and Neural Correlates of Long-Term Nicotine Smoking

“…Given the role of the DMN, SN, and FI-DMN states in emotion, it is tempting to speculate that the temporal dynamics of such states may be related to clinical measures of emotion dysregulation, such as alexithymia, which is characterized by difficulty identifying or describing feelings and by externally oriented thinking . Alexithymia is not only greater in those who do vs do not smoke but is also a risk factor for substance use and other psychiatric issues . Furthermore, alexithymia is associated with neurobiological variation in substance-using individuals but not in healthy controls, suggesting that considering alexithymia when measuring temporal dynamics may further clarify individual profiles, particularly in individuals who smoke nicotine long term.…”

Case report: Short-term psychotherapy for alexithymia in a patient with generalized anxiety disorder

“…This condition encompasses four main dimensions: (a) difficulty identifying and describing feelings; (b) difficulty distinguishing feelings from bodily sensations; (c) diminution of fantasy; and (d) concrete and minimally introspective ( 3 ). Individuals with alexithymia face difficulties in self-regulation and managing emotions due to diminished emotional awareness ( 4 ). Alexithymia have been implicated across a range of psychological disorders, with Leweke and colleagues finding a total prevalence rate of 21.36% in a mixed sample of psychiatric outpatients ( 5 ).…”

Bodily confusion: Lower differentiation of emotional and physiological states in student alcohol users

“…18 Alexithymia is associated with psychopathology, including anxiety, depression, eating disorders, 34 , 36 as well as substance use disorders. 17 The importance of alexithymia is increasingly recognised and studied in the context of alcohol use and misuse 13 , 32 , 38 as it affects between 30% and 49% of individuals with alcohol dependence, 9 compared to just about 10% in the general population. 30 Emerging evidence also suggests that alexithymic traits are higher in student social alcohol drinkers and binge drinkers (in whom repeated episodes of drinking till intoxications are intermitted with episodes of no‐drinking) compared to their low‐drinking counterparts.…”