Crimson Publishers Publish With Us Reprints e-Books Video articles

Full Text

Forensic Science & Addiction Research

Alexithymia and Addiction

Suprakash Chaudhury* and Swaleha Mujawar

Department of Psychiatry, India

*Corresponding author: Suprakash Chaudhury, Department of Psychiatry, Dr D Y Patil Medical College, Hospital & Research Centre, India

Submission: August 12, 2019;Published: October 21, 2019

DOI: 10.31031/FSAR.2019.05.000613

ISSN 2578-0042
Volume5 Issue2


Alexithymia was first described by Sifneos [1] as difficulty identifying and communicating feelings, differentiating feelings and somatic sensations of emotional arousal, a diminution of fantasy and imagination and an externally oriented cognitive style [2]. Studies have found that alexithymia is present across 18 different ethnic and racial groups [3]. Alexithymia is seen in around 6 and 10% in the general population [4-5]. However, when compared to non-addicted individuals, those with substance-use disorders more frequently exhibit alexithymia [6]. In patients with alcohol-use disorders percentages typically range from 45 to 67% [7]. Alexithymia can also be seen in people with a family history of alcoholism [8]. Some evidence suggests that alexithymia may have an adverse impact on the treatment of alcohol use disorders [9,10] and given the substantial cost of such disorders worldwide [11] this relationship warrants closer attention. Alexithymia is also commonly found in patients who are undergoing treatment for another drug abuse [12].

Substance-use disorders are linked with affective disorders, and alexithymia is seen in association with depressive [13,14] and anxiety disorders [15]. Thus, alexithymia may be seen in substance-use disorders simply because alexithymia is commonly observed in affective disorders that often accompany substance-use disorders. Thus, such individuals may seek to relieve depression or anxiety brought about by alexithymia by consuming alcohol or other drugs [16]. However, alexithymia may represent a separate entity, [17] consistent with observations that not all individuals with co-occurring alexithymia and substance dependence exhibit affective disorders [18]. Reports on alexithymia have shown a link between alexithymia and a chronically elevated stress response [19], perhaps because an inability to identify negative emotion makes such emotions harder to regulate. Alexi thymic individuals demonstrated more displacement behaviors, such as self-grooming and scratching, which may denote a failure to regulate distress [20]. Imaging studies using fMRI indicate that subjects with alexithymia have reduced activation of the temporoparietal junction and dorsomedial prefrontal cortex in the brain. These areas are related to mentalizing ability. These findings indicate that alexithymia is associated with an impairment in mentalizing ability resulting in an inability to understand the perspective of others [21]. Individuals with alexithymia also showed decreased executive function capabilities, with reductions in performance across multiple domains of executive function, including inhibition [22]. Since people with alexithymia usually feel uncomfortable in social situations [23], some studies have proposed that alexithymia individuals use alcohol as a coping mechanism for stress or to improve interpersonal functioning [24,25]. Studies suggest association between alexithymia and craving for drugs or alcohol, although the directionality has not been seen consistently. Negative correlations between alexithymia and subjective measures of craving for alcohol in response to alcohol cues have been found among patients with alcohol dependence [26], whereas positive correlations between alexithymia and cue-induced craving for methamphetamine have been seen in patients with methamphetamine dependence [27]. High alexithymia in heavy alcohol users is associated with increased craving for alcohol, compulsive urge to drink, and obsessive thoughts about alcohol [28].

De Haan et al. [29] in a study on inpatients with alcohol use disorder and found that the baseline alexithymia showed no relation to abstinence, time in treatment or changes in disorder severity at 1-year follow-up [29]. In another study de Haan et al. [29] showed that alexithymia was not related to abstinence, and high scoring alexithymics did not differ from low-scoring alexithymics in mean time in treatment or dropout rates (50 vs. 43%) [29]. It can also predict treatment engagement especially session attendance and working alliance, as it was found by Cleland et al. [30] That drug-dependent outpatients who were higher in alexithymia attended fewer sessions and formed weaker alliances [31]. A prospective study on subjects with alcohol dependence by Junghanns et al. [32] in 2005 found that alexithymia scores were not associated with the risk of relapse at 6-week follow-up [32]. A recent research confirmed that alexithymia was not associated with treatment adherence or retention in an 8-week randomized clinical trial by Morie et al. [18] in 2015 [18]. Thus, evidence on the relationship between alexithymia and treatment outcome is limited and non-univocal. Substance use treatment is hindered by high rates of relapse (60–70%) and premature termination, to the extent that it is more common for a patient to drop out of addiction treatment than to complete the treatment [32-35]. According to Hser et al. [34] completion of addiction treatment is one of the most consistent factors associated with a favorable treatment outcome [34,36]. This shows the importance of identifying predictors of treatment retention and adherence in such patients. Thus, there is evidence that alexithymia plays a role in development of alcohol use disorders and has the potential to interfere with its treatment. Unfortunately, it is neither assessed nor addressed in routine management of addictive disorders. Welldesigned studies are needed to establish the role of alexithymia in management and whether management of alexithymia can play a role in the treatment of substance use disorders.


  1. Sifneos PE (1973) The prevalence of alexithymic characteristics in psychosomatic patients. Psychother Psychosom 22(2): 255-262.
  2. Nemiah JC, Freyberger H, Sifneos PE (1976) Alexithymia: A view of the psychosomatic process. In: Hill O (Ed.), Modern trends in psychosomatic medicine, Butterworths, London, UK.
  3. Parker JDA, Shaughnessy PA, Wood LM, Majeski SA, Eastabrook JM (2005) Cross-cultural alexithymia: Validity of the 20-item Toronto alexithymia scale in North American aboriginal populations. J Psychosom Res 58(1): 83-88.
  4. Kokkonen P, Karvonen JT, Veijola J, Laksy K, Jokelainen J, et al. (2001) Prevalence and sociodemographic correlates of alexithymia in a population sample of young adults. Compr Psychiatry 42(6): 471-476.
  5. Hintikka J, Honkalampi K, Lehtonen J, Viinamaki H (2001) Are alexithymia and depression distinct or overlapping constructs? A study in a general population. Compr Psychiatry 42(3): 234-239.
  6. Chaudhury S, Das SK, Ukil B (2006) Psychological assessment of male alcoholism. Ind J Psychiatry 48(2): 114-117.
  7. Thorberg FA, Young RM, Sullivan KA, Lyvers M (2009) Alexithymia and alcohol use disorders: A critical review. Addict Behav 34(3): 237-245.
  8. Pombo S, Da Costa F, Fatima I, Cardoso N, Maria LF (2014) Alexithymia and alcohol dependence: Do different subtypes manifest different emotion regulations. Addict Res Theor 23(3): 1-9.
  9. Loas G, Fremaux D, Otmani O, Lecercle C, Delahousse J (1997) Is alexithymia a negative factor for maintaining abstinence? A follow-up study. Compr Psychiatry 38(5): 296-299.
  10. Ziolkowski M, Gruss T, Rybakowski JK (1995) Does alexithymia in male alcoholics constitute a negative factor for maintaining abstinence? Psychother Psychosom 63(3): 169-173.
  11. Lowinson JH, Ruiz P, Millman RB, Langrod JG (2005) Substance abuse: A comprehensive textbook. (4th edn), Lippincott, Williams & Wilkins, Philadelphia, USA.
  12. Lyvers M, Hinton R, Gotsis S, Roddy M, Edwards MS, et al. (2014) Traits linked to executive and reward systems functioning in clients undergoing residential treatment for substance dependence. Personal Individ Diff 70: 194-199.
  13. Taylor GJ, Bagbry RM, Parker JD (1997) Disorders of affect regulation: Alexithymia in medical and psychiatric illness. Cambridge University Press, UK.
  14. Taylor GJ, Bagby RM (2004) New trends in alexithymia research. Psychother Psychosom 73(2): 68-77.
  15. Onur E, Alkin T, Sheridan MJ, Wise TN (2013) Alexithymia and emotional intelligence in patients with panic disorder, generalized anxiety disorder and major depressive disorder. Psychiatry Q 84(3): 303-311.
  16. Stewart SH, Zvolensky MJ, Eifert GH (2002) The relations of anxiety sensitivity, experiential avoidance, and alexithymic coping to young adults motivations for drinking. Behav Modif 26(2): 274-296.
  17. Wise TN, Mann LS, Hill B (1990) Alexithymia and depressed mood in the psychiatric patient. Psychother Psychosom 54(1): 26-31.
  18. Morie K, Nich C, Hunkele K, Potenza M, Carroll K (2015) Alexithymia level and response to computer-based training in cognitive behavioral therapy among cocaine-dependent methadone-maintained individuals. Drug Alcohol Depend 152: 157-163.
  19. Martin JB, Pihl RO (1985) The stress-alexithymia hypothesis: Theoretical and empirical considerations. Psychother Psychosom 43(4): 169-176.
  20. Troisi A, Belsanti S, Bucci AR, Mosco C, Sinti F, et al. (2000) Affect regulation in alexithymia: An ethological study of displacement behavior during psychiatric interviews. J Nerv Ment Dis 188(1): 13-18.
  21. Moriguchi Y, Ohnishi T, Lane RD, Maeda M, Mori T, et al. (2006) Impaired self-awareness and theory of mind: An FMRI study of mentalizing in alexithymia. Neuroimage 32(3): 1472-1482.
  22. Koven NS, Thomas W (2010) Mapping facets of alexithymia to executive dysfunction in daily life. Personal Individ Diff 49(1): 24-28.
  23. Uzun AZ, Ates A, Cansever A, Ozsahin A (2003) Alexithymia in male alcoholics: Study in a Turkish sample. Comprehensive Psychiatry 44(4): 349-352.
  24. Kauhanen J, Julkunen J, Salonen JT (1992) Coping with inner feelings and stress: Heavy alcohol use in the context of alexithymia. Behavioral Medicine 18(3): 121-126.
  25. Rybakowski J, Ziolkowski M, Zasadzka T, Brzezinski R (1988) High prevalence of alexithymia in male patients with alcohol dependence. Drug and Alcohol Dependence 21(2): 133-136.
  26. Junghanns K, Tietz U, Dibbelt L, Kuether M, Jurth R, et al. (2005) Attenuated salivary cortisol secretion under cue exposure is associated with early relapse. Alcohol Alcoholism 40(1): 80-85.
  27. Saladin ME, Santa Ana EJ, La Rowe SD, Simpson AN, Tolliver BK, et al. (2012) Does alexithymia explain variation in cue-elicited craving reported by methamphetamine-dependent individuals. Am J Addict 21(2):130-135.
  28. Thorberg FA, Young RM, Sullivan KA, Lyvers M, Connor JP, et al. (2011) Alexithymia, craving and attachment in a heavy drinking population. Addict Behav 36(4): 427-430.
  29. De Haan HA, Schellekens AF, Van Der Palen J, Verkes RJ, Buitelaar JK, et al. (2012) The level of alexithymia in alcohol-dependent patients does not influence outcomes after inpatient treatment. Am J Drug Alcohol Abuse 38(4): 299-304.
  30. Cleland C, Magura S, Foote J, Rosenblum A, Kosanke N (2005) Psychometric properties of the Toronto Alexithymia Scale (TAS-20) for substance users. Psychosom Res 58(3): 299-306.
  31. De Haan HA, Joosten EA, Wijdeveld AG, Boswinkel PB, Van Der Palen J, et al. (2011) Cognitive behavioural treatment is as effective in high-as in low-scoring alexithymic patients with substance related disorders. Psychother Psychosom 80(4): 254-255.
  32. Junghanns K, Tietz U, Dibbelt L, Kuether M, Jurth R, et al. (2005) Attenuated salivary cortisol secretion under cue exposure is associated with early relapse. Alcohol 40(1): 80-85.
  33. Bradizza CM, Stasiewicz PR, Paas ND (2006) Relapse to alcohol and drug use among individuals diagnosed with co-occurring mental health and substance use disorders: A review. Clin Psychol Rev 26(2): 162-178.
  34. Hser YI, Evans E, Huang D, Anglin DM (2014) Relationship between drug treatment services, retention, and outcomes. Psychiatr Serv 55(7): 767-774.
  35. Stark MJ (1992) Dropping out of substance abuse treatment: A clinically oriented review. Clin Psychol Rev 12(1): 93-116.
  36. Brorson HH, Arnevik EA, Hendriksen KR, Duckert F (2013) Drop-out from addiction treatment: A systematic review of risk factors. Clin Psychol Rev 33(8): 1010-1024.

© 2019 Suprakash Chaudhury. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and build upon your work non-commercially.