Objectives: Self-report studies show that negative emotional states and ineffective use of emotion regulation strategies are key maintaining factors of substance use disorders (SUD). However, experimental research into emotional processing in adults with SUD is in its infancy. Theoretical conceptualizations of emotion regulation have shifted from a focus on individual (internal) processes to one that encompasses social and interpersonal functions - including the regulation of facial expression of emotion. The purpose of this study was to examine the individual and interpersonal emotion regulation capacity of 35 adults in residential treatment diagnosed with a SUD compared to 35 demographically matched controls (both samples M = 25 years; 37% females). Design and methods: Participants completed a facial emotion expression flexibility task while viewing emotive images, as well as the Difficulties of Emotion Regulation Scale (DERS) and the Social (Emotion) Expectancy Scale (SES). Results: Adults in SUD treatment experienced significantly more emotion regulation difficulties on all DERS subscales than controls. They also reported higher levels of negative self-evaluation and social expectancies not to feel negative emotions (anxiety and depression) compared to controls. Moreover, when viewing emotive images, the treatment sample showed significantly less flexibility of their emotional expression compared to the control sample. Conclusions: These findings demonstrate that the awareness, expression, and regulation of emotions are particularly difficult for people with SUD and this may maintain their substance use and provide an important target for treatment. Practitioner points: Compared to matched controls, adults with substance use disorders self-report significantly more difficulties with emotional awareness and regulation. Compared to matched controls, adults with substance use disorders report significantly greater expectancies not to show depression and anxiety. When viewing positive and negative images, adults with substance use disorders are significantly less flexible in their facial expression of emotion than matched controls in response to regulatory instructions. Emotion regulation should be measured and addressed as part of substance use disorder treatment.
