Alexithymia and alcohol use disorders: A critical review
Introduction
Alexithymia is a multifaceted construct that was first described by Sifneos (1973) as difficulty identifying and communicating feelings, differentiating feelings and somatic sensations of emotional arousal, a diminuation of fantasy and imagination and an externally oriented cognitive style (Nemiah, Freyberger, & Sifneos, 1976). Alexithymia is a cross-cultural phenomenon and has been identified in studies across 18 different ethnic and racial groups (Parker et al., 2005, Taylor et al., 2003). Between 45 and 67% of alcohol dependent individuals have been identified as alexithymic (Evren et al., 2008, Loas et al., 1997, Sauvage and Loas, 2006; Uzun, Ates, Cansever, & Ozsahin, 2003). Some evidence suggests that alexithymia may have an adverse impact on the treatment of alcohol use disorders (Loas et al., 1997, Ziolkowski et al., 1995), and given the substantial cost of such disorders worldwide (Lowinson, Ruiz, Millman, & Langrod, 2005), this relationship warrants closer attention. There is a limited amount of empirical evidence exploring the relationship between alexithymia and alcohol use, which is surprising as alexithymia has been hypothesised to be a risk factor in the genesis of alcohol use disorders (De Rick and Vanheule, 2006, de Timary et al., 2008, Taylor et al., 1997). Because people with alexithymia often feel uncomfortable in social situations (Uzun et al., 2003; Wise, Mann, & Shay, 1992), some researchers have proposed that alexithymic individuals use alcohol as a coping mechanism for stress or to improve interpersonal functioning (Kauhanen et al., 1992, Rybakowski et al., 1988). However few of these specific hypotheses have been empirically validated.
A number of key issues need to be addressed in examining the veracity of the link between alexithymia and alcohol dependence. First, the relationship between alexithymia and alcohol consumption as well as severity of alcohol problems requires examination. Second, various dimensions of alexithymia are potentially associated with differential risk in relation to alcohol use or response to alcohol and these relationships are worthy of inspection. Third, the predictive utility of alexithymia in terms of predicting relapse rates or response to treatment requires review. Because there has been no published critical review on alexithymia and alcohol use disorders to date, the aim of this paper is to conduct such a review.
Section snippets
Methods
For identification of the relevant studies a combination of key words was used: ‘alexithymia’, ‘alexithymic features’, ‘alexithymic’, ‘alcohol use disorder’, ‘alcohol misuse disorder‘, ‘alcohol dependence’, ‘alcohol misuse’, ‘alcohol abuse’, ‘alcohol use’, ‘alcohol’, ‘alcoholism’, ‘binge drinking’, ‘alcohol intoxication’, ‘alcohol abstinence’ and ‘alcohol problem’. Between October 2006 and August 2008 the following electronic databases were searched, varying the search strategies to accommodate
Early studies on alexithymia and alcohol dependence
Early evidence supporting the relationship between alexithymia and alcohol use disorders was gathered using the Schalling–Sifneos Personality Scale (SSPS) (Apfel & Sifneos, 1979). The SSPS is a self-report measure that consists of 20 items with lower scores indicating higher levels of alexithymia (Linden et al., 1995, Taylor and Bagby, 1988). The measure has face validity, but suffers from lack of concurrent validity and low internal consistency, probably due to a lack of psychometric
Studies on alexithymia and alcohol dependence after 1990
The broad purpose of this review is to examine the relationship between alexithymia and alcohol dependence. The first point highlighted by this review is that there is a lack of fundamental research assessing the relationship between alexithymia and alcohol use; the majority of research investigating alexithymia has done so in relation to factors such as attachment, personality traits, mood, affect intolerance and suicidal ideation in alcohol dependent samples. The studies that were reviewed
Effect sizes
The majority of studies reviewed in this paper did not report effect sizes for the relationships investigated and it is thus difficult to evaluate the strength of the relationships observed. The only exception is de Timary et al. (2008) who investigated the absolute and relative stability of alexithymia over time, after controlling for changes in anxiety and depression in a sample of alcohol dependent individuals undergoing alcohol withdrawal. The findings indicated small to moderate effect
Research agenda
There are a number of key issues that need to be addressed in examining the nature and extent of the link between alexithymia and alcohol problems. First there is a need to examine the multifaceted nature of alexithymia in relation to alcohol consumption. Only one cross-sectional study has investigated this relationship, indicating a strong association between alexithymia and alcohol consumption (Kauhanen et al., 1992). That investigation had a strong methodology, but the findings should be
Conclusions
This review has summarised the available literature on alexithymia and alcohol dependence, pointed out methodological limitations and identified areas for future research. Research studies have shown high prevalence rates of alexithymia in alcohol dependent populations, yet there is only preliminary evidence to indicate relationships between alexithymia, alcohol consumption and severity of alcohol problems, and limited evidence examining the different dimensions of alexithymia in relation to
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