Emotional dysregulation as a predictor of cocaine severity and withdrawal symptoms

Background

Emotion dysregulation (ED) is conceptualized as difficulties in recognizing, modulating and expressing emotions. It is widely described that in stressful situations, cocaine users often engage in more impulsive and risky behaviors in an attempt to achieve immediate gratification. This impulsive behavior acts as a method of self-regulation, sustaining cocaine use over time and intensifying the addiction severity. The aim of the present study is to explore whether difficulties in emotion regulation predicts addiction severity and withdrawal symptoms severity in a sample of Spanish cocaine users hospitalized for detoxification. 

Methods

Sixty-eight inpatients (42.8 years, SD=8.3; 38.2% women) from the Addictive Behaviors Unit at Santa Creu and Sant Pau Hospital in Barcelona underwent a 14-day multidisciplinary intervention. They completed ED measures (DERS) upon hospitalization and measures of cocaine severity (SDS), severity of cocaine withdrawal symptoms (CSSA), and craving (WCS) at treatment completion. Bivariate analysis, through Pearson’s correlation calculations, and lineal multiple regression analyses were performed to address the purpose of the study. 

Results

Regarding cocaine withdrawal symptoms severity, significant and moderate correlations were found between CSSA and various DRES questionnaire subscales, including impulse (r=.346; p=.010), goals (r=.314; p=.019), non-acceptance (r=.368; p=.006), strategies (r=.385; p=.004) and total DERS score (r=.447; p=.001). In terms of addiction severity, we found only two noteworthy correlations were identified: a moderate correlation between SDS and DERS awareness (r=-.332; p=.010), and a mild correlation between SDS and DERS non-acceptance (r=.253; p=.047). Multiple linear regression analyses revealed that DERS subscales awareness, clarity, goals and non-acceptance at baseline predicted CSSA at hospitalization end (R2=.215; F=3,22(4,47); p=.020; f2=0.27; 1-β=.93). Additionally, DERS subscales strategies, awareness, goals, non-acceptance and impulse at treatment initiation predicted SDS at discharge (R2=.193; F=2,48(5,52); p=.043; f2=0.24; 1-β=.86). 

Conclusions

The study highlights the importance of emotion regulation difficulties as a robust predictor of both cocaine withdrawal symptoms and addiction severity. Higher scores in difficulties accessing emotion-regulation strategies suggest decreased emotional flexibility among cocaine users, potentially prioritizing affect regulation over self-regulation. Likewise, engagement in impulsive behaviors signal difficulties in handling stressful events, potentially clarifying why cocaine users exert more effort in alleviating short-term discomfort, even if it involves engaging in risky behaviors. Moreover, heightened addiction severity corresponds to reduced emotional awareness, indicating less emotional knowledge, a key component of emotional regulation. In conclusion, addressing ED is crucial in developing effective cocaine treatment protocols.