The self-medication hypothesis of addictive disorders derives primarily from clinical observations of patients with substance use disorders. Individuals discover that the specific actions or effects of each class of drugs relieve or change a range of painful affect states. Self-medication factors occur in a context of self-regulation vulnerabilities--primarily difficulties in regulating affects, self-esteem, relationships, and self-care. Persons with substance use disorders suffer in the extreme with their feelings, either being overwhelmed with painful affects or seeming not to feel their emotions at all. Substances of abuse help such individuals to relieve painful affects or to experience or control emotions when they are absent or confusing. Diagnostic studies provide evidence that variously supports and fails to support a self-medication hypothesis of addictive disorders. The cause-consequence controversy involving psychopathology and substance use/abuse is reviewed and critiqued. In contrast, clinical observations and empirical studies that focus on painful affects and subjective states of distress more consistently suggest that such states of suffering are important psychological determinants in using, becoming dependent upon, and relapsing to addictive substances. Subjective states of distress and suffering involved in motives to self-medicate with substances of abuse are considered with respect to nicotine dependence and to schizophrenia and posttraumatic stress disorder comorbid with a substance use disorder.

The Self-medication Hypothesis of Substance Use Disorders: A Reconsideration and Recent Applications

Background: Emotional dysregulation (ED) is a transdiagnostic construct defined as the inability to regulate the intensity and quality of emotions (such as, fear, anger, sadness), in order to generate an appropriate emotional response, to handle excitability, mood instability, and emotional overreactivity, and to come down to an emotional baseline. Because ED has not been defined as a clinical entity, and because ED plays a major role in child and adolescent psychopathology, we decided to summarize current knowledge on this topic based on a narrative review of the current literature. Methods: This narrative review is based on a literature search of peer-reviewed journals. We searched the databases ERIC, PsycARTICLES, PsycINFO and PSYNDEX on June 2, 2020 for peer reviewed articles published between 2000 and 2020 in English language for the preschool, school, and adolescent age (2-17 years) using the following search terms: "emotional dysregulation" OR "affect dysregulation," retrieving 943 articles. Results: The results of the literature search are presented in the following sections: the relationship between ED and psychiatric disorders (ADHD, Mood Disorders, Psychological Trauma, Posttraumatic Stress Disorder, Non-suicidal Self-Injury, Eating Disorders, Oppositional Defiant Disorder, Conduct Disorder, Disruptive Disruptive Mood Dysregulation Disorder, Personality Disorders, Substance Use Disorder, Developmental Disorders, Autism Spectrum Disorder, Psychosis and Schizophrenia, and Gaming Disorder), prevention, and treatment of ED. Conclusion: Basic conditions of ED are genetic disposition, the experience of trauma, especially sexual or physical abuse, emotional neglect in childhood or adolescence, and personal stress. ED is a complex construct and a comprehensive concept, aggravating a number of various mental disorders. Differential treatment is mandatory for individual and social functioning.

/pdf/emotional-dysregulation-in-children-and-adolescents-with-lgdxpuyzz7.pdf

Emotional Dysregulation in Children and Adolescents With Psychiatric Disorders. A Narrative Review

This is a vast book, in its intellectual breadth and its extensive review of pertinent literature. The author has been director of a major medical school alcohol and drug abuse program but is also scholar, physician, philosopher, and psychoanalyst. In describing the intrapsychic experience of the compulsive drug user, Wurmser makes his most important contribution. The author emphasizes and supports with clinical evidence the finding that addicts, except for a few alcoholics and cigarette users, have serious psychopathological conditions that antedate their excessive drug use and that dominate treatment difficulties. The single diagnosis most frequently represented is the "borderline personality organization," extensively described recently by Kohut and Kernberg. In Wurmser's own Methadone Maintenance Program population, 10% of patients were frankly psychotic; 30%, severely paranoid or depressed; 30%, episodically deeply regressed; and only 30% had moderate psychopathological conditions controllable with methadone and the milieu of the treatment facility alone. Through examination

The Hidden Dimension: Psychodynamics in Compulsive Drug Use

RETRACTED: Alexithymia and alcohol use disorders: A critical review

Background: Previous studies have found that alexithymia plays an important role in the pathogenesis of Internet addiction. However, the effect of alexithymia on both metacognition and Internet addiction has yet to be examined. Methods: The Toronto Alexithymia Scale, Metacognition Questionnaire, and Internet Addiction Test were used to assess a sample of 356 college students. A parallel mediator effect analysis was applied to test the hypothesis that metacognition mediates the relationship between alexithymia and Internet addiction. Results: The parallel multiple mediator models showed that alexithymia predicted the five dimensions of metacognition and Internet addiction, and that three dimensions—cognitive confidence, positive beliefs about worry, and the need to control thoughts—partially mediated this relationship. Conclusion: Alexithymia could directly and indirectly predict Internet addiction via metacognition.

/pdf/effect-of-alexithymia-on-internet-addiction-among-college-3kedi74t.pdf

Effect of Alexithymia on Internet Addiction Among College Students: The Mediating Role of Metacognition Beliefs

Objectives:Adolescents with affect dysregulation, alexithymia, and underlying personality disorders (PD) are more vulnerable to substance abuse due to their emotional processing problems and interpersonal conflicts; thus, they abuse illicit drugs through negative reinforcement. Therefore, this study

Mood Regulation, Alexithymia, and Personality Disorders in Adolescent Male Addicts

Background: The co-occurrence of psychiatric and substance use disorder increases the duration of illness, hospitalization rates, and causes more functional impairment and legal problems, which may increase the burden of illness. Hence, identifying the risk factors of such comorbidity may help in mitigating such problems. Objective: This study examined the risk factors associated with comorbid Axis I and Axis II disorders in a sample of male Egyptian patients with substance abuse. Patients and Methods: A total of 158 male inpatients diagnosed with substance use disorder according to diagnostic and statistical manua-IV diagnostic criteria answered the Structured Clinical Interview for Axis I and Axis II disorders (SCID-I and SCID-II). They were also evaluated by the Addiction Severity Index scale and the Global Assessment of Functioning. Results: An overall 60% were diagnosed with another Axis I or Axis II disorder. An overall 26% of them had psychosis, and 21% had borderline personality disorder. Unemployment, history of child abuse, high cannabis, opioid and tramadol abuse, frequent overdosing, longer hospitalization, aggressive behavior, family dysfunction, and occupational and legal problems were significantly more in patients with comorbidity. Moreover, 62% of them had severe problems on the Addiction Severity Index scale. The predictive risk factors for comorbidity were familial problems, aggressive symptoms, cluster B personality traits, past history of psychiatric disorders, longer time of hospitalization, and lower Global Assessment of Functioning scores. Conclusions: Identifying the risk factors for psychiatric comorbidity in patients with substance dependence highlights the importance of developing a dual diagnosis service to meet the needs of this population.

Risk Factors Associated With Psychiatric Comorbidity in a Sample of Male Egyptian Patients With Substance Use Disorder

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Mood Regulation, Alexithymia, and Personality Disorders in Adolescent Male Addicts

Risk Factors Associated With Psychiatric Comorbidity in a Sample of Male Egyptian Patients With Substance Use Disorder