Adolescent Substance Use and Comorbid Psychopathology: Emotion Regulation Deficits as a Transdiagnostic Risk Factor

Abstract

Rates of substance use and comorbid psychopathology peak during adolescence, highlighting the need to identify transdiagnostic risk processes that cut across conditions and elucidate early embedded risk factors for comorbidity across development. The current review highlights emotion regulation deficits as a core transdiagnostic risk factor underlying the development of substance use, addiction, and comorbid psychopathology in adolescence. We present the dual systems model of neurological development to highlight adolescence as a critical period of increased risk for emotion regulation difficulties, corresponding risk behaviors, and psychopathology. We describe malfunction in the neurobiological regulation system underlying the relationship between emotion regulation and risk for addiction and comorbidity. We pull from two established developmental theories including both the externalizing pathway and the internalizing pathway to substance use disorders, which together highlight how early embedded risk in the form of emotion regulation deficits can explain mechanisms underlying the development of addiction and comorbid psychiatric disorders.

Neural underpinnings of the relationships between sensation seeking and emotion regulation in adolescents

“…Consistent with the optimal arousal hypothesis (Zuckerman, 1969), HSSs require more novel and intense sensation to reach and maintain a higher optimal level of emotional status. For example, adolescents who had deficits in emotion regulation might show lower neural sensitivity to rewards, leading them to engage in more sensation seeking to compensate for this lack of sensitivity (Shadur & Lejuez, 2015). Our finding also bolster support for the notion that the activation and arousal need characteristic of sensation seeking increase across adolescence.…”

“…As a special developmental stage, limbic-striatal system (responsible for sensation seeking) of adolescents are more rapidly developed and matured than the PFC (responsible for emotion regulation and cognitive control). Previous imaging studies suggest that the developmental imbalance between the sensation-seeking and emotion regulation system during this essential period could be a possible reason for the deficits in emotion regulation in HSSs (Shadur & Lejuez, 2015). Also, previous research found adolescents who have higher level of sensation seeking would have lower trait emotional intelligence (Bacon, Burak, & Rann, 2014).…”

Minority stress, emotion regulation, and substance misuse in sexual minorities

“…ER deficits have been shown to both increase vulnerability for using substances and alcohol to cope as well as developing a substance and/or alcohol use disorder (Shadur and Lejuez, 2015); more research in this area should elucidate the temporal order of discrimination and ER, as well as the function of alcohol and substance use in the context of minority stress.…”

“…Emotion regulation (ER), defined as the process by which individuals alter how they experience and express emotions (Gross, 1998), has been implicated in the onset and maintenance of many psychiatric disorders, including alcohol and substance misuse . Poor ER has been associated with increased symptoms of anxiety, depression, eating disorders, and alcohol and substance use disorders (Aldao, 2013(Aldao, , 2012Shadur and Lejuez, 2015). ER is a broad construct encompassing strategies , responses to positive affect (Feldman et al, 2008), rumination (Treynor et al, 2003), worry (Meyer et al, 1990), and distress tolerance (Simons and Gaher, 2005).…”

Adolescent Substance Use: Moving Screening Into the Practice Mainstream

“…Nurses also have the preparation in neuroscience to craft interventions that consider the interrelationship of substance use and the broader area of emotional regulation (Pokhrel et al., ). Adolescent substance use is a complex mix of developmental issues, at times comorbid psychiatric issues and often emotional regulation deficits (Shadur & Lejuez, ) As nurses move into the area of adolescent SU they should develop the appropriate whole person approach within a risk/resiliency framework that is inclusive of all the potential dynamics contributing to substance use in this population.…”