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Emotion regulation and motives for illicit drug use in opioid-dependent patients

Cognitive-behavioral approaches for people with opioid use disorder may be more widely circulated in clinical settings with the recent Food and Drug Administration approval of a mobile app that provides cognitive behavioral therapy (CBT) to patients with opioid use disorder.  As such, perhaps now more than ever, enhancing the precision of CBT for opioid use disorder could have important implications for helping more patients achieve remission.

Arriving at a more targeted CBT for opioid use disorder hinges upon a clearer understanding of what exactly drives drug use in this population. Prior research has found that people tend to abuse substances like alcohol and marijuana to “self-medicate” and escape from unpleasant emotions. The use of substances as a self-treatment for negative feelings reflect what was coined by Cooper and colleagues (1992) as coping motives for substance use. Subsequent studies have linked coping motives for substance use to difficulties with emotion regulation, a term that refers to the effective management of emotional states.  Specifically, if people struggle with managing negative emotions, they may be more likely to engage in unhealthy substance use patterns as a means of alleviating unpleasant sensations.

Although we have some understanding of the mechanisms that underlie motivations for substance use more generally, there have been very few studies that have actually evaluated these phenomena in opioid use disorder and none have used highly specific assessments of emotion regulation difficulties. We evaluated the relationship between difficulties with emotion regulation and motives for illicit drug use among people with opioid use disorder. Adults with opioid use disorder completed a questionnaire on motives for drug use and a questionnaire on challenges with regulating emotions across six categories. We found that coping motives for drug use were linked to emotion regulation difficulties. Perhaps most importantly, we found that only one of the six categories of challenges with emotion regulation uniquely predicted coping motives for drug use. This category, Nonacceptance of emotional responses, refers to negative reactions that someone might have to their own unpleasant emotions (in other words, a nonacceptance of negative feelings). Our research thus suggests that emotional nonacceptance may be an important pathway for drug use among people with opioid use disorder though additional studies should attempt to unpack the relationship between emotional nonacceptance and drug use patterns across a range of negative emotional experiences (such as frustration and sadness). Ultimately, targeted CBT interventions aimed at increasing emotion acceptance could be a useful adjunctive treatment in opioid use disorder. 

Read the full paper: Gold, A.K., Stathopoulou, G., Otto, M.W. (in press). Emotion regulation and motives for illicit drug use in opioid-dependent patients. Cognitive Behaviour Therapy. doi.org/10.1080/16506073.2019.1579256

Photo by: ep_jh

Pictured: Alexandra Gold, Michael W. Otto


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