Difficulty in differentiating emotions predicts relapse in people recovering from alcohol use disorder

Heightened negative mood and stress during early recovery from alcohol use disorder (AUD) impair people’s ability to distinguish between emotions, which in turn predicts drinking relapse three months later. The findings, reported in Alcoholism: Clinical and Experimental Research, suggest a role for interventions to promote emotional regulation and differentiation among people in early AUD recovery.

Negative mood and emotional vulnerability are common during this period of recovery—a consequence of the physiological effects of chronic substance use, withdrawal symptoms, and stress. Previous studies have shown that people who can better navigate the emotional demands of the early recovery phase abstain from alcohol for longer. However, the mechanisms that might underpin emotional resilience in these individuals were unclear. Emotion differentiation—the ability to make subtle distinctions between similar emotion states (e.g. sadness versus jealousy)—is one mechanism that can contribute to emotion regulation, as a necessary first step for employing appropriate and effective strategies to regulate emotions. Recent research has shown that emotion differentiation is a dynamic time-varying process that can vary within individuals over short periods of time, as well as differing between individuals.

The new study used a technique called “ecological momentary assessment” to examine whether moments of heightened negative or positive mood are linked to differences in ability to differentiate emotions during the first year of an AUD recovery attempt. The researchers also assessed whether an individual’s average level of emotion differentiation would predict future alcohol use over a 3-month follow-up phase. The data were from 42 people in the greater Boston area, who—using a smartphone app—completed three randomly timed assessments, and up to three self-initiated assessments daily for six days (giving a total of 915 observations).

Statistical modeling showed that for a given individual, moments of elevated negative mood or stress were characterized by lower differentiation of negative emotion, while moments of elevated positive mood were characterized by greater differentiation of positive emotion. When comparing individuals, those with higher overall stress were less able to differentiate negative emotion. The research team further showed that better differentiation of negative—but not positive—emotion was associated with fewer days of drinking over the 3-month follow-up. However, there was no association of emotion differentiation with drinking quantity.

Overall, the findings indicate that for people in early AUD recovery, increased negative mood and stress—both hallmarks of the early recovery phase—are associated with diminished capacity for emotion differentiation. In turn, individuals with a higher overall ability to differentiate negative emotion appear better equipped to achieve recovery goals during this emotionally difficult transition phase. As such, emotion differentiation could be an important treatment target during early recovery, with a potential role for emotion literacy programs to help shore up emotional resilience through this vulnerable time.