Is alexithymia related to cannabis use disorder? Results from a case-control study in outpatient adolescent cannabis abusers

https://doi.org/10.1016/j.jpsychores.2017.02.012Get rights and content

Highlights

  • Studies on alexithymia among adolescent substance abusers are scarce.

  • 35.3% of the young outpatients with problematic cannabis use are alexithymic.

  • Difficulties in identifying and describing feelings are associated with cannabis problematic use.

  • Trait anxiety differentiates cannabis abusers from control participants.

Abstract

Objective

In recent decades, alexithymia has been considered a risk factor for multiple somatic and psychiatric conditions. Yet, whereas alexithymia has been extensively studied in adults with a substance misuse, only one study has reported data on cannabis abusers from the general population. Hence, our main objective was to explore alexithymia in a clinical sample of treatment-seeking young outpatients with a DSM-IV cannabis dependence or abuse diagnosis compared to controls.

Methods

120 young patients (95 males - mean age 17.9 years (SD = 2.8; 14 to 25)) with a cannabis dependence or abuse (DSM-IV-TR criteria evaluated with the MINI), seeking treatment in an addiction unit, and 110 healthy control subjects (77 males - mean age 18.2 years (SD = 3.4; 14 to 25)) participated in the study. They completed a battery of self-reports measuring alexithymia (TAS-20; BVAQ-B), depression (BDI-13) and state and trait anxiety (STAI).

Results

35.3% of cannabis users were alexithymic, and logistic regression analysis showed that the alexithymic components of difficulties identifying and describing feelings combined with trait anxiety predicted group membership.

Conclusion

This first study on young cannabis abusers and dependent subjects further emphasizes the importance of considering the affective style, and particularly the anxious temperament and alexithymia features, as factors associated with substance misuse during late adolescence.

Introduction

Alexithymia, which literally translates as “no words for mood”, introduced by Sifneos in 1973, refers to a specific emotional disturbance characterized by an inability to identify internal affective states and describe them verbally [1]. In clinical settings, alexithymic patients demonstrate an inability to distinguish emotions from physical sensations and “pensée opératoire”, a distinctive cognitive style characterized by a preoccupation with the details of external events as well as a lack of fantasy [2], [3].

Rates of alexithymia in the general population (adolescents and adults) have been reported as approximately 10% (9–17% for men and 5–10% for women [4], [5], [6], [7]), whereas estimates are as high as 70% in some clinical groups [8]. Alexithymia is alternatively considered a stable personality trait, a risk factor for physical illness and psychiatric disorders or a state reaction to various stressful situations [2], [3], [9]. Numerous studies have reported high levels of alexithymia in adult substance abusers, and some authors speculate that substances are used to compensate for deficits in emotional self-awareness [10]. Using self-report questionnaires (the Toronto Alexithymia Scales, TAS and TAS-20), rates of alexithymia ranged from 39% to 67% in adults diagnosed with substance abuse or dependence [9], [10], [11], [12]. Recent publications concluded in favor of a relative stability of alexithymia in substance abusers [13]. Some other recent studies in samples from the general population investigated differences in alexithymia rates and levels in relation to the age of the sample [14], [15], [16], [17], [18]. Thus, it seems important to determine these rates in younger samples of substance abusers since the involvement of alexithymia may vary with age. In a French study [19], the prevalence of alexithymia was 43.9% among 68 young substance abusers (substance not specified; age range from 15 to 24). Surprisingly, although alexithymia has been extensively studied in various substance use disorders, only Troisi et al. [20] measured it specifically in young cannabis abusing/dependent subjects in a community sample. They reported the prevalence of alexithymia (using the TAS-20) to be 30% among their 88 subjects with a cannabis abuse or dependence diagnosis. Nevertheless, the investigation of alexithymic features among adolescent cannabis abusers remains insufficient, and is inexistent in a clinical setting. This gap in the literature is even more surprising given that the proportion of cannabis users have considerably increased during the past few decades [21] and cannabis is the illegal substance most commonly abused by French young people; it has become a major public health concern [22].

Hence, this cross-sectional study was designed to investigate alexithymia in young outpatient cannabis misusers relative to matched control cases. Knowing the frequent association between alexithymia and negative affective state [23], we also examined whether the differences in alexithymia scores between the cannabis abusers (CA) and control participants remained after controlling for the effects of the severity of anxious and depressive symptoms. Our subsequent objective was to determine whether the levels of alexithymia and state and trait anxiety and depression predict cannabis misuse by adolescents.

Section snippets

Participants

One hundred and twenty adolescents and young adults (95 males), with a mean age of 17.9 years (SD = 2.8, 14–25), each diagnosed with a substance (cannabis) use disorder, were included in the group of cannabis abusers (CA). Participants were outpatients, recruited in addiction units located in Paris and its suburbs: 110 met the DSM-IV diagnostic criteria for cannabis dependence, and 10 met those for cannabis abuse only (using the appropriate section of the Mini-International Neuropsychiatric

Results

The descriptive statistics of the CA and control participants are presented in Table 1.

There were no significant between-group differences for age (t =  0.6, p = 0.538), gender (χ2 = 2.6, p = 0.110), educational level (χ2 = 12.1, p = 0.107) and economic status of the participants' families (χ2 = 10.9, p = 0.141).

Discussion

Our first aim was to further evaluate the emotional abilities, and particularly the implication of alexithymia, among adolescents/young adults with a cannabis abuse/dependence disorder in comparison with matched controls. Overall, our results confirmed that problematic cannabis use is associated with distinctive features of affective functioning.

For many years, alexithymia has been regarded as a risk factor for addictive disorders [10]. Links between alexithymia and dependence have previously

Declaration of interest

The authors report no conflict of interest.

Acknowledgements

GD's PhD was funded by the French Ministry of Research.

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      In recent years growing attention has been paid to the assessment and investigation of alexithymia in both clinical and non-clinical populations. Alexithymia has been shown to be associated with several clinical conditions such as depression, schizophrenia, autism spectrum disorder, substance and alcohol abuse, eating disorders, neurodegenerative disorders, and chronic pain conditions (Adenzato et al., 2012; Di Tella and Castelli, 2016; Dorard et al., 2017; Gaigg et al., 2018; Sturm and Levenson, 2011; Taylor and Bagby, 2004; Thorberg et al., 2009; Van't Wout et al., 2007). Within the general population, alexithymia is thought to exist on a continuum, with varying degrees of severity and rates that range from 9% to 17% for men and from 5% to 10% for women (Mattila et al., 2007; Salminen et al., 1999).

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