Negative life events are more common among those with substance use versus behavioral addiction histories

Negative life events can be a cause, consequence, and maintaining factor in addictions, and positive life events may play a protective role. We know little, however, about how the frequency of negative and positive life events differs across individuals with substance use problems and behavioral addictions like gambling and compulsive sexual behavior. This study sought to tease out these differences, while also trying to better understand the subjective experience of negative and positive life events amongst these sub-groups.

WHAT PROBLEM DOES THIS STUDY ADDRESS?

Negative life events, and to some degree positive life events, are thought to play a role in the development of both substance use problems and behavioral addictions like gambling and compulsive sexual behavior. For instance, earlier traumatic experiences may give rise to anxiety and depression symptoms, which people may in turn seek to manage with alcohol or other drugs, or activities like gambling (i.e., “self-medicate”). Also, different addictions produce different types and degrees of consequences. All forms of addiction cause psychological and social problems, and addictions involving alcohol/drugs use also produce intoxication-related accidents and injuries. At the same time, it is not understood to what degree different types of addiction are differentially associated with negative life events. Moreover, very few studies have examined the potential relationship between positive events and addictive problems, and even less is known about the subjective perception of life events that may underlie these relationships. This is important to examine because better knowledge of differences in the frequency, nature, and interpretation of life events among addicted sub-groups can inform our understanding of differential pathways leading to the development and maintenance of distinct addictive problems. This knowledge, in turn, could help clinical science better tailor addiction treatments to fit addiction sub-types.

HOW WAS THIS STUDY CONDUCTED?

This was a cross-sectional study in which the authors surveyed 319 individuals at a single point in time. Of their total sample, 58 had drug use problems suggestive of drug addiction, 50 had alcohol use problems suggestive of alcohol addiction, 48 had gambling problems suggestive of gambling addiction, 65 had compulsive sexual behaviors, and 98 were healthy controls. Participants with alcohol and other drug problems were recruited through mutual-help groups like AA, and private and public addiction treatment programs. Control group participants were recruited through advertisements posted on a university campus and on the internet.

Likelihood of addiction was assessed using standard questionnaires designed to measure the severity of each specific problem. These included the Drug Abuse Screening Test, Michigan Alcoholism Screening Test, South Oaks Gambling Screen, and Individual Compulsive Sexual Behavior Scale. As this research was conducted in Israel, these questionnaires were translated into Hebrew by study staff. Presence of addiction was confirmed using established cut-points on these measures, but was not verified using clinical interview.

The Life Experiences Survey was used to assess number and subjective experience (i.e., influence) of negative and positive life events (e.g., divorce, retirement, death of a loved one). The authors incorporated five additional items relevant to life in Israel, including military service, terror related events, and immigration experiences. Additionally, the questionnaire includes space for up to three other events which are not listed. Participants were asked to identify events that occurred throughout their lives, and to rate the perceived influence of each event on a 7-point scale ranging from -3 (extremely negative) to +3 (extremely positive), with 0 indicating a neutral event. Four scores were obtained from this questionnaire: 1) total number of negative events, 2) total number of positive events, 3) average influence of negative events, and 4) average influence of positive events.

Participants from the substance use problem groups completed study questionnaires at their recruitment site, and only filled out the addiction questionnaires pertinent to their primary addiction. Control participants completed the questionnaires in-person at the university or online.

The rates of co-occurring addiction related problems were highest in the drug use problem group (50%), followed by alcohol use problem (38%), gambling problem (23%), and compulsive sexual behavior (14%) groups. There were no differences between groups in the number of years each sub-group had experienced these problems. The addiction related problems groups consisted of mainly male participants, whereas the control group consisted primarily of females.

WHAT DID THIS STUDY FIND?

Regarding negative life events, both number and influence of events differed across groups. Participants with drug use problems, alcohol use problems, gambling problems, and compulsive sexual behavior all endorsed a significantly greater number of negative life events than controls, with those with drug use problems reporting the greatest number of negative events. Those with alcohol use problems perceived the negative events they experienced as the most influential on their lives. Conversely, controls reported experiencing fewer negative events and perceived them as less influential. Additionally, compulsive sexual behavior participants reported experiencing significantly fewer negative events than drug use problems participants and perceived them as less influential than alcohol use problems participants.

There were no significant group differences in the total number of positive events or the influence that such positive life events had on participants.

The authors also looked at the ratio of negative to positive life events. The drug use problems, alcohol use problems, and gambling problems groups reported experiencing significantly more negative versus positive life events, and all addiction groups perceived negative and positive events to have similar influence in their lives. However, although findings showed both the control and the compulsive sexual behavior groups reported roughly the same ratio of number of negative and positive life events, only the controls perceived their positive life events as more influential. In other words, controls appear to more strongly emphasize positive life events relative to negative ones.

WHAT ARE THE IMPLICATIONS OF THE STUDY FINDINGS?

Findings suggest individuals with both substance use and behavioral addictions have more negative life events than healthy controls and view these events as more influential. This is perhaps not surprising given negative events (including trauma) are well-known precursors, consequences, and maintaining factors in addiction related problems.

A major limitation of this study, however, is the authors were unable to factor in the objective intensity of negative and positive events in people’s lives. As such, it is not clear if participants’ interpretation of the influence of negative life events was a function of their sensitivity or vulnerability to negative events, or the intensity of the negative events themselves. Interestingly, in addition to endorsing fewer negative life events than controls, the compulsive sexual behavior group also endorsed fewer negative life events than the drug use problems group, suggesting negative life events may be less likely to give rise to, be a consequence of, or be a maintaining factor in, compulsive sexual behaviors.

It is also noteworthy that within-groups, those with drug use problems, alcohol use problems, and gambling problems had higher rates of negative versus positive life events, whereas for controls and those with compulsive sexual behavior, the ratio of negative to positive life events was not significantly different. Further, only the control group endorsed being more influenced by positive life events than negative life events. This suggests that although the control group didn’t endorse more positive versus negative life events, they viewed the positive events they did experience as more influential.

It is likely that higher rates of negative life events among those with addiction (versus controls) is in part a function of negative life events arising out of having an addiction (e.g., drug related arrests, accidents occurring while under the influence of alcohol and other drugs, financial crises). Because the authors could not control for the temporal relationship between negative and positive life events and addiction related problems, it is impossible to tease out how negative life events influence addiction in this sample.

Figure 1. A higher ‘influence’ score indicates that the negative or positive life event was more influential to the person experiencing it.

LIMITATIONS

Questionnaires were translated to Hebrew and were not validated in their new forms.
People’s ability to accurately recall all negative and positive life events on demand is questionable. It’s possible that differences between groups are more a function of recall capacity or other processes that influence memory consolidation like rumination, than actual number of positive and negative life events.
The authors note that experimental and controls groups were not matched on demographic factors. Controls were mostly female, while the experimental group was mostly male. Although the researchers factored gender into their statistical models, this between-groups difference could have affected results in unknown ways.
They also highlight the cross-sectional nature of this study, meaning the data that were collected represent a single point in time. Causality can’t be inferred from cross-sectional data because it’s impossible to know how different measurements may be temporally related. Said another way, one can’t know whether the life event caused the addiction, or the addiction caused the life event, from cross-sectional studies.

BOTTOM LINE

For individuals and families seeking recovery: Findings suggest individuals with addiction have more negative life experiences than healthy controls and that they are more influenced by these events. Conversely, those with addiction appear to experience a similar number of positive life events to healthy controls, but controls appear to be more influenced by these positive events. Additionally, those with substance use problems generally seem to have greater negative life events than those with gambling problems and compulsive sexual behavior. Though the present findings don’t allow us to separate out the complex relationships between negative life events and addiction, previous work has shown negative life events can play a major role in the development and maintenance of addiction, especially substance use disorders. Treatments that help individuals cope with and/or process negative life events are likely to support addiction recovery in meaningful ways. Also, given individuals with substance use problems may perceive positive events to be less meaningful and important than controls, treatments that help individuals with substance use problems focus on positive events to derive maximal benefit from them could be useful.
For treatment professionals and treatment systems: Findings suggest individuals with addiction have more negative life experiences than healthy controls and that they are more influenced by these events. Conversely, those with addiction appear to experience a similar number of positive life events to healthy controls, but controls appear to be more influenced by these positive events. Additionally, those with substance use problems generally seem to have greater negative life events than those with gambling problems and compulsive sexual behavior. Though the present findings don’t allow us to separate out the complex relationships between negative life events and addiction, previous work has shown negative life events can play a major role in the development and maintenance of addiction, especially substance use disorders. Providing patients with treatments that aid coping with negative life events are likely to support addiction recovery in meaningful ways. Also, because individuals with substance use problems perceive positive events to be less meaningful and important than controls, treatments that help individuals with substance use problems focus on positive events to derive maximal benefit from them could have meaningful clinical benefits.
For scientists: Findings suggest individuals with addiction have more negative life experiences than healthy controls and that they are more influenced by these events. Conversely, those with addiction appear to experience a similar number of positive life events to healthy controls, but controls appear to be more influenced by these positive events. Additionally, those with substance use problems generally seem to have greater negative life events than those with gambling problems and compulsive sexual behavior. Though the present findings don’t allow us to separate out the complex relationships between negative life events and addiction, previous work has shown negative life events can play a major role in the development and maintenance of addiction, especially substance use disorders. More longitudinal studies are needed that can parse out the complex relationships between the etiology and maintenance of addiction, and negative and positive life events.
For policy makers: Findings suggest individuals with addiction have more negative life experiences than healthy controls and that they are more influenced by these events. Conversely, those with problems suggestive of addiction appear to experience a similar number of positive life events to healthy controls, but controls appear to be more influenced by these positive events. Additionally, those with substance use problems generally seem to have greater negative life events than those with gambling problems and compulsive sexual behavior. Ensuring individuals in addiction recovery have access to treatments that can address and mitigate the effects of negative life events may be important for initiating and sustaining addiction remission.