Difficulties in emotion regulation among patients with substance use disorder and a history of exposure to traumatic events: the role of PTSD symptoms, emotional avoidance, shame, and guilt

Abstract

Introduction: Individuals with substance use disorder (SUD) often struggle significantly with regulating their emotions and there is a high prevalence of a history of exposure to traumatic events. Difficulties in emotion regulation and PTSD symptom severity contribute to elevated psychological burden, higher dropout rates, and increased risk of relapse. Currently, we still lack a precise understanding of the psychological mechanisms associated with difficulties in emotion regulation in SUD. Objectives: The objective of this study was to examine the magnitude and correlates of difficulties in emotion regulation among patients with SUD who have a history of exposure to traumatic events. We assessed the association between difficulties in emotion regulation and PTSD symptoms, emotional avoidance, shame, guilt, and substance use-related problems. Methods: This cross-sectional observational study was conducted in a naturalistic setting with 74 adult patients in long-term inpatient SUD treatment in Norway, including both sexes. A clinical interview measuring PTSD symptom severity was conducted and participants completed questionnaires about emotion regulation, emotional avoidance, shame, guilt, and substance use-related problems. Additional demographical and descriptive data were collected. Results: The patients reported substantial difficulties in emotion regulation, severe PTSD symptoms, severe emotional avoidance, and strong shame and guilt. Emotional avoidance and shame but not guilt or alcohol or substance use-related problems were associated with greater difficulties in emotion regulation beyond the difficulties contributed by PTSD symptom severity. Conclusions: Difficulties in emotion regulation were highly prevalent in this sample. The findings support targeting difficulties in emotion regulation, emotional avoidance, and shame especially in long-term SUD treatment for patients with a history of exposure to traumatic events. Reducing these factors may help potentially improve treatment outcomes and reduce suffering for this difficult-to-treat patient population.