Emotion regulation difficulties and experiencing trauma add complications in addiction treatment. To help inform treatment approaches for individuals with cocaine use disorder, this study examined how trauma experiences and emotion regulation were associated with cocaine use and depressive symptoms.
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Trauma experiences are known to be associated with substance use – with more severe experiences being associated with increased severity of cocaine use. Concurrently, difficulties with emotion regulation (e.g., the behavioral strategies used by individuals to modulate emotions) is also associated with substance use.
There is also evidence that these factors interact to influence behavior. Problems with emotion regulation have been found to impact depressive symptoms among trauma-exposed people. Additional evidence suggests that depressive symptoms may mediate – or explain – the relationship between emotion regulation and experiencing trauma among people who currently use cocaine. This together suggests that experiencing trauma, emotion regulation difficulties, and depression, may all work in combination to influence cocaine use.
The current research investigated how difficulties with emotion regulation and trauma experiences both individually and interactively impacted depressive symptoms and cocaine use.
This study was a cross-sectional observational study. Participants in the study (N=135) were treatment-seeking adults living in a large Southern US metropolitan area. Participants were recruited via community-based and online advertising strategies (e.g., newspaper ads, Craigslist) – that is, while recruited from the community, the study targeted those seeking treatment specifically for cocaine use disorder.
Participants were included in the study if they were 1) between 18 and 65 years old, 2) proficient in English, 3) and met criteria for current (i.e., past month) cocaine dependence based on DSM-IV. Participants were excluded from the participating if they a) endorsed current dependence on a substance other than cocaine (except nicotine) for which withdrawal symptoms were a concern (e.g., alcohol), b) had a current or past history of bipolar I disorder, schizophrenia, or any psychotic symptoms in the 6 months prior to screening, c) had a major unstable medical condition(s), d) active suicidal ideation in the 4 weeks prior to screening, d) used any medication which made participation in the study unsafe (e.g., psychotropics), and/or e) were pregnant or nursing at the time of screening.
The primary outcome of this research was cocaine use, which was measured in 2 ways. An objective urine drug screening (via Reditest 6 Cassette tests) measured cocaine use within 96 hours prior to participating in the study. Additionally, the Addiction Severity Index-Lite was used to gather self-report data on past month cocaine use. The study examined both number of days of cocaine use, a continuous outcome, and any cocaine use on the drug screen, a binary outcome. To examine how cocaine use was impacted by emotion regulation, trauma experiences, and depression these factors were operationalized using standardized measures. Problems with emotion regulation was measured using the Difficulties in Emotion Regulation Scale. This 36-item self-report scale is summed across measures resulting in a score from 36 (almost never experienced any problems regulating emotions) to 180 (experienced problems regulating emotions in almost every situation). Experiences of trauma was measured via the Life Events Checklist for the DSM-5. This self-report questionnaire asks participants to indicate if they experienced or witnessed each of 16 potentially traumatic experiences (e.g., sexual assault) during their lifetime. The number of endorsed events were summed together. Depression was operationalized as scores via the Beck Depression Inventory-II. This measure consists of 21 scale items (ranging from 0–3; with a max score of 63) to assess the severity of depressive symptoms in the past fortnight.
The researchers used statistical modeling to determine associations between emotion regulation, trauma experiences, depression, and cocaine use. Multiple regression analyses were run with depressive symptom scores and number of self-reported cocaine use days in the last month. Variables for emotion regulation and trauma experience were examined in separate blocks to determine how much of the unique variance they each account for in depression and cocaine use. These models adjusted for demographic variables (e.g., age and gender) known to be associated with depression and cocaine use. The researchers also controlled for recent concurrent alcohol and other drug use (e.g., cannabis) which are also associated with cocaine use, as well as total years of cocaine use.
Most participants for this study (N=135) identified as African American (n =100, 74.1%), followed by white/Caucasian (n = 16, 11.9%), then by Hispanic or Latino (n = 14, 10.4%), then Native American (n = 1, .7%), and the more than one race/ethnicity (n = 3, 2.2%). One person did not disclose their race/ethnicity (n = 1, .7%). Most participants had never been married (n =55, 40.7%), followed by divorced/separated (n = 51, 37.8%), married (n = 21, 15.6%), and widowed (n = 8, 5.9%). The vast majority of participants (86.7%) reported having completed ≥12 years of education. Around 43% of participants were not working at the time of participation. Nearly 60% of participants reported being treated for substance use ≥1 times during their life.
Gender was the strongest demographic correlate of cocaine use
Across multiple analyses, male gender was significantly associated with recent cocaine use. Age also significantly contributed to models, indicating that older participants were more likely to engage in recent cocaine use at time of participation.
Difficulties in emotion regulation and trauma experiences were associated with depressive symptoms
Measures of both difficulties in emotion regulation and trauma experiences were associated with worse depression for participants. However, emotion regulation and trauma experiences did not interact to influence reported depressive symptoms.
Difficulties in emotion regulation and trauma experiences were not associated with cocaine use
Neither emotion regulation nor trauma experiences had an impact on either self-reported cocaine use days or drug test verified binary cocaine use among participants. Furthermore, there was no evidence that the interaction of emotion regulation and trauma experiences were associated with either cocaine use outcome among this sample.
This study suggests that emotion regulation and trauma experiences are associated with depressive symptoms, but not recent cocaine use, among cocaine-using adults. However, the mechanisms by which this occurs is unclear.
The researchers found that difficulties with emotion regulation and experiencing trauma were independently and strongly associated with more depressive symptoms. However, when the researchers examined how these factors interacted with each other they did not find evidence that emotion regulation interacted with a history of trauma experiences in amplifying and worsening depressive symptoms. The researchers also failed to find associations between emotion regulation and trauma experiences and cocaine use, both when measured using self-report (past 30 days) and urine toxicology screens.
These results suggest that targeting interventions to address problems with emotion regulation and/or trauma experiences may be useful in treating depression, but less so for treating cocaine use among individuals with cocaine use disorder, where other factors may be more important. This work implies that the mechanisms through which emotion regulation and trauma experiences are associated with substance use behavior remain unclear. Prior research suggests there is a link between trauma and substance use, but the pathways through which this association occurs may be indirect. It is possible that mere exposure to a traumatic event is not enough to predict substance use – other factors may better explain drug use. For example, other research suggests that the severity of traumatic experiences may be more predictive of cocaine use than the number of traumatic experiences among people. In a similar vein, difficulties with emotion regulation may impact substance use through a desire to self-medicate. That is, challenges with emotional regulation may lead people to seek out drugs to modulate their negative emotional state. Also, given the cross-sectional nature of this study, it is plausible as well that depression symptoms leads to emotion regulation challenges and not just the other way around; it could also be reciprocal where they influence each other. Future research examining these different hypotheses may help inform substance use prevention and treatment strategies.
Difficulties with emotion regulation and experiencing trauma may contribute to depressive symptoms in treatment-seeking cocaine using adults. On the other hand, problems with emotion regulation or experiencing trauma may contribute to cocaine use among this sample. These results suggest that interventions targeting emotion regulation and/or trauma may be a viable way to treat depression among cocaine using adults. Providers working with cocaine using adults may want to consider incorporating such interventions as part of a holistic care plan. Such interventions may not necessarily reduce substance use but may be useful in treating other mental health issues that are part of constellation of symptoms many substance use disorder patients experience. Given the cross-sectional study design here – longitudinal research that examines these associations among emotion regulation, trauma, and substance use over time can help inform substance use prevention and intervention strategies.
Godfrey, C. J., Meyer, T. D., Boster, K. A., Vujanovic, A. A., & Schmitz, J. M. (2023). Trauma and emotion regulation: associations with depressive symptoms and cocaine use among treatment-seeking adults. International Journal of Mental Health and Addiction, 21(4), 2160-2174. doi.org/10.1007/s11469-021-00713-w
l
Trauma experiences are known to be associated with substance use – with more severe experiences being associated with increased severity of cocaine use. Concurrently, difficulties with emotion regulation (e.g., the behavioral strategies used by individuals to modulate emotions) is also associated with substance use.
There is also evidence that these factors interact to influence behavior. Problems with emotion regulation have been found to impact depressive symptoms among trauma-exposed people. Additional evidence suggests that depressive symptoms may mediate – or explain – the relationship between emotion regulation and experiencing trauma among people who currently use cocaine. This together suggests that experiencing trauma, emotion regulation difficulties, and depression, may all work in combination to influence cocaine use.
The current research investigated how difficulties with emotion regulation and trauma experiences both individually and interactively impacted depressive symptoms and cocaine use.
This study was a cross-sectional observational study. Participants in the study (N=135) were treatment-seeking adults living in a large Southern US metropolitan area. Participants were recruited via community-based and online advertising strategies (e.g., newspaper ads, Craigslist) – that is, while recruited from the community, the study targeted those seeking treatment specifically for cocaine use disorder.
Participants were included in the study if they were 1) between 18 and 65 years old, 2) proficient in English, 3) and met criteria for current (i.e., past month) cocaine dependence based on DSM-IV. Participants were excluded from the participating if they a) endorsed current dependence on a substance other than cocaine (except nicotine) for which withdrawal symptoms were a concern (e.g., alcohol), b) had a current or past history of bipolar I disorder, schizophrenia, or any psychotic symptoms in the 6 months prior to screening, c) had a major unstable medical condition(s), d) active suicidal ideation in the 4 weeks prior to screening, d) used any medication which made participation in the study unsafe (e.g., psychotropics), and/or e) were pregnant or nursing at the time of screening.
The primary outcome of this research was cocaine use, which was measured in 2 ways. An objective urine drug screening (via Reditest 6 Cassette tests) measured cocaine use within 96 hours prior to participating in the study. Additionally, the Addiction Severity Index-Lite was used to gather self-report data on past month cocaine use. The study examined both number of days of cocaine use, a continuous outcome, and any cocaine use on the drug screen, a binary outcome. To examine how cocaine use was impacted by emotion regulation, trauma experiences, and depression these factors were operationalized using standardized measures. Problems with emotion regulation was measured using the Difficulties in Emotion Regulation Scale. This 36-item self-report scale is summed across measures resulting in a score from 36 (almost never experienced any problems regulating emotions) to 180 (experienced problems regulating emotions in almost every situation). Experiences of trauma was measured via the Life Events Checklist for the DSM-5. This self-report questionnaire asks participants to indicate if they experienced or witnessed each of 16 potentially traumatic experiences (e.g., sexual assault) during their lifetime. The number of endorsed events were summed together. Depression was operationalized as scores via the Beck Depression Inventory-II. This measure consists of 21 scale items (ranging from 0–3; with a max score of 63) to assess the severity of depressive symptoms in the past fortnight.
The researchers used statistical modeling to determine associations between emotion regulation, trauma experiences, depression, and cocaine use. Multiple regression analyses were run with depressive symptom scores and number of self-reported cocaine use days in the last month. Variables for emotion regulation and trauma experience were examined in separate blocks to determine how much of the unique variance they each account for in depression and cocaine use. These models adjusted for demographic variables (e.g., age and gender) known to be associated with depression and cocaine use. The researchers also controlled for recent concurrent alcohol and other drug use (e.g., cannabis) which are also associated with cocaine use, as well as total years of cocaine use.
Most participants for this study (N=135) identified as African American (n =100, 74.1%), followed by white/Caucasian (n = 16, 11.9%), then by Hispanic or Latino (n = 14, 10.4%), then Native American (n = 1, .7%), and the more than one race/ethnicity (n = 3, 2.2%). One person did not disclose their race/ethnicity (n = 1, .7%). Most participants had never been married (n =55, 40.7%), followed by divorced/separated (n = 51, 37.8%), married (n = 21, 15.6%), and widowed (n = 8, 5.9%). The vast majority of participants (86.7%) reported having completed ≥12 years of education. Around 43% of participants were not working at the time of participation. Nearly 60% of participants reported being treated for substance use ≥1 times during their life.
Gender was the strongest demographic correlate of cocaine use
Across multiple analyses, male gender was significantly associated with recent cocaine use. Age also significantly contributed to models, indicating that older participants were more likely to engage in recent cocaine use at time of participation.
Difficulties in emotion regulation and trauma experiences were associated with depressive symptoms
Measures of both difficulties in emotion regulation and trauma experiences were associated with worse depression for participants. However, emotion regulation and trauma experiences did not interact to influence reported depressive symptoms.
Difficulties in emotion regulation and trauma experiences were not associated with cocaine use
Neither emotion regulation nor trauma experiences had an impact on either self-reported cocaine use days or drug test verified binary cocaine use among participants. Furthermore, there was no evidence that the interaction of emotion regulation and trauma experiences were associated with either cocaine use outcome among this sample.
This study suggests that emotion regulation and trauma experiences are associated with depressive symptoms, but not recent cocaine use, among cocaine-using adults. However, the mechanisms by which this occurs is unclear.
The researchers found that difficulties with emotion regulation and experiencing trauma were independently and strongly associated with more depressive symptoms. However, when the researchers examined how these factors interacted with each other they did not find evidence that emotion regulation interacted with a history of trauma experiences in amplifying and worsening depressive symptoms. The researchers also failed to find associations between emotion regulation and trauma experiences and cocaine use, both when measured using self-report (past 30 days) and urine toxicology screens.
These results suggest that targeting interventions to address problems with emotion regulation and/or trauma experiences may be useful in treating depression, but less so for treating cocaine use among individuals with cocaine use disorder, where other factors may be more important. This work implies that the mechanisms through which emotion regulation and trauma experiences are associated with substance use behavior remain unclear. Prior research suggests there is a link between trauma and substance use, but the pathways through which this association occurs may be indirect. It is possible that mere exposure to a traumatic event is not enough to predict substance use – other factors may better explain drug use. For example, other research suggests that the severity of traumatic experiences may be more predictive of cocaine use than the number of traumatic experiences among people. In a similar vein, difficulties with emotion regulation may impact substance use through a desire to self-medicate. That is, challenges with emotional regulation may lead people to seek out drugs to modulate their negative emotional state. Also, given the cross-sectional nature of this study, it is plausible as well that depression symptoms leads to emotion regulation challenges and not just the other way around; it could also be reciprocal where they influence each other. Future research examining these different hypotheses may help inform substance use prevention and treatment strategies.
Difficulties with emotion regulation and experiencing trauma may contribute to depressive symptoms in treatment-seeking cocaine using adults. On the other hand, problems with emotion regulation or experiencing trauma may contribute to cocaine use among this sample. These results suggest that interventions targeting emotion regulation and/or trauma may be a viable way to treat depression among cocaine using adults. Providers working with cocaine using adults may want to consider incorporating such interventions as part of a holistic care plan. Such interventions may not necessarily reduce substance use but may be useful in treating other mental health issues that are part of constellation of symptoms many substance use disorder patients experience. Given the cross-sectional study design here – longitudinal research that examines these associations among emotion regulation, trauma, and substance use over time can help inform substance use prevention and intervention strategies.
Godfrey, C. J., Meyer, T. D., Boster, K. A., Vujanovic, A. A., & Schmitz, J. M. (2023). Trauma and emotion regulation: associations with depressive symptoms and cocaine use among treatment-seeking adults. International Journal of Mental Health and Addiction, 21(4), 2160-2174. doi.org/10.1007/s11469-021-00713-w
l
Trauma experiences are known to be associated with substance use – with more severe experiences being associated with increased severity of cocaine use. Concurrently, difficulties with emotion regulation (e.g., the behavioral strategies used by individuals to modulate emotions) is also associated with substance use.
There is also evidence that these factors interact to influence behavior. Problems with emotion regulation have been found to impact depressive symptoms among trauma-exposed people. Additional evidence suggests that depressive symptoms may mediate – or explain – the relationship between emotion regulation and experiencing trauma among people who currently use cocaine. This together suggests that experiencing trauma, emotion regulation difficulties, and depression, may all work in combination to influence cocaine use.
The current research investigated how difficulties with emotion regulation and trauma experiences both individually and interactively impacted depressive symptoms and cocaine use.
This study was a cross-sectional observational study. Participants in the study (N=135) were treatment-seeking adults living in a large Southern US metropolitan area. Participants were recruited via community-based and online advertising strategies (e.g., newspaper ads, Craigslist) – that is, while recruited from the community, the study targeted those seeking treatment specifically for cocaine use disorder.
Participants were included in the study if they were 1) between 18 and 65 years old, 2) proficient in English, 3) and met criteria for current (i.e., past month) cocaine dependence based on DSM-IV. Participants were excluded from the participating if they a) endorsed current dependence on a substance other than cocaine (except nicotine) for which withdrawal symptoms were a concern (e.g., alcohol), b) had a current or past history of bipolar I disorder, schizophrenia, or any psychotic symptoms in the 6 months prior to screening, c) had a major unstable medical condition(s), d) active suicidal ideation in the 4 weeks prior to screening, d) used any medication which made participation in the study unsafe (e.g., psychotropics), and/or e) were pregnant or nursing at the time of screening.
The primary outcome of this research was cocaine use, which was measured in 2 ways. An objective urine drug screening (via Reditest 6 Cassette tests) measured cocaine use within 96 hours prior to participating in the study. Additionally, the Addiction Severity Index-Lite was used to gather self-report data on past month cocaine use. The study examined both number of days of cocaine use, a continuous outcome, and any cocaine use on the drug screen, a binary outcome. To examine how cocaine use was impacted by emotion regulation, trauma experiences, and depression these factors were operationalized using standardized measures. Problems with emotion regulation was measured using the Difficulties in Emotion Regulation Scale. This 36-item self-report scale is summed across measures resulting in a score from 36 (almost never experienced any problems regulating emotions) to 180 (experienced problems regulating emotions in almost every situation). Experiences of trauma was measured via the Life Events Checklist for the DSM-5. This self-report questionnaire asks participants to indicate if they experienced or witnessed each of 16 potentially traumatic experiences (e.g., sexual assault) during their lifetime. The number of endorsed events were summed together. Depression was operationalized as scores via the Beck Depression Inventory-II. This measure consists of 21 scale items (ranging from 0–3; with a max score of 63) to assess the severity of depressive symptoms in the past fortnight.
The researchers used statistical modeling to determine associations between emotion regulation, trauma experiences, depression, and cocaine use. Multiple regression analyses were run with depressive symptom scores and number of self-reported cocaine use days in the last month. Variables for emotion regulation and trauma experience were examined in separate blocks to determine how much of the unique variance they each account for in depression and cocaine use. These models adjusted for demographic variables (e.g., age and gender) known to be associated with depression and cocaine use. The researchers also controlled for recent concurrent alcohol and other drug use (e.g., cannabis) which are also associated with cocaine use, as well as total years of cocaine use.
Most participants for this study (N=135) identified as African American (n =100, 74.1%), followed by white/Caucasian (n = 16, 11.9%), then by Hispanic or Latino (n = 14, 10.4%), then Native American (n = 1, .7%), and the more than one race/ethnicity (n = 3, 2.2%). One person did not disclose their race/ethnicity (n = 1, .7%). Most participants had never been married (n =55, 40.7%), followed by divorced/separated (n = 51, 37.8%), married (n = 21, 15.6%), and widowed (n = 8, 5.9%). The vast majority of participants (86.7%) reported having completed ≥12 years of education. Around 43% of participants were not working at the time of participation. Nearly 60% of participants reported being treated for substance use ≥1 times during their life.
Gender was the strongest demographic correlate of cocaine use
Across multiple analyses, male gender was significantly associated with recent cocaine use. Age also significantly contributed to models, indicating that older participants were more likely to engage in recent cocaine use at time of participation.
Difficulties in emotion regulation and trauma experiences were associated with depressive symptoms
Measures of both difficulties in emotion regulation and trauma experiences were associated with worse depression for participants. However, emotion regulation and trauma experiences did not interact to influence reported depressive symptoms.
Difficulties in emotion regulation and trauma experiences were not associated with cocaine use
Neither emotion regulation nor trauma experiences had an impact on either self-reported cocaine use days or drug test verified binary cocaine use among participants. Furthermore, there was no evidence that the interaction of emotion regulation and trauma experiences were associated with either cocaine use outcome among this sample.
This study suggests that emotion regulation and trauma experiences are associated with depressive symptoms, but not recent cocaine use, among cocaine-using adults. However, the mechanisms by which this occurs is unclear.
The researchers found that difficulties with emotion regulation and experiencing trauma were independently and strongly associated with more depressive symptoms. However, when the researchers examined how these factors interacted with each other they did not find evidence that emotion regulation interacted with a history of trauma experiences in amplifying and worsening depressive symptoms. The researchers also failed to find associations between emotion regulation and trauma experiences and cocaine use, both when measured using self-report (past 30 days) and urine toxicology screens.
These results suggest that targeting interventions to address problems with emotion regulation and/or trauma experiences may be useful in treating depression, but less so for treating cocaine use among individuals with cocaine use disorder, where other factors may be more important. This work implies that the mechanisms through which emotion regulation and trauma experiences are associated with substance use behavior remain unclear. Prior research suggests there is a link between trauma and substance use, but the pathways through which this association occurs may be indirect. It is possible that mere exposure to a traumatic event is not enough to predict substance use – other factors may better explain drug use. For example, other research suggests that the severity of traumatic experiences may be more predictive of cocaine use than the number of traumatic experiences among people. In a similar vein, difficulties with emotion regulation may impact substance use through a desire to self-medicate. That is, challenges with emotional regulation may lead people to seek out drugs to modulate their negative emotional state. Also, given the cross-sectional nature of this study, it is plausible as well that depression symptoms leads to emotion regulation challenges and not just the other way around; it could also be reciprocal where they influence each other. Future research examining these different hypotheses may help inform substance use prevention and treatment strategies.
Difficulties with emotion regulation and experiencing trauma may contribute to depressive symptoms in treatment-seeking cocaine using adults. On the other hand, problems with emotion regulation or experiencing trauma may contribute to cocaine use among this sample. These results suggest that interventions targeting emotion regulation and/or trauma may be a viable way to treat depression among cocaine using adults. Providers working with cocaine using adults may want to consider incorporating such interventions as part of a holistic care plan. Such interventions may not necessarily reduce substance use but may be useful in treating other mental health issues that are part of constellation of symptoms many substance use disorder patients experience. Given the cross-sectional study design here – longitudinal research that examines these associations among emotion regulation, trauma, and substance use over time can help inform substance use prevention and intervention strategies.
Godfrey, C. J., Meyer, T. D., Boster, K. A., Vujanovic, A. A., & Schmitz, J. M. (2023). Trauma and emotion regulation: associations with depressive symptoms and cocaine use among treatment-seeking adults. International Journal of Mental Health and Addiction, 21(4), 2160-2174. doi.org/10.1007/s11469-021-00713-w
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