Is Emotion Regulation the Key to Addiction Prevention?

There are many things that contribute to the development of addiction rather than one “smoking gun.” Research tells us that genetic predispositions, adverse childhood experiences, social learning, early exposure, and mental health concerns can all affect the emergence of addiction. Given this constellation of potential contributing factors, how are we to go about developing effective prevention strategies? One possibility is to address a common consequence of several of these factors—namely, difficulties in emotion regulation.

What is emotion regulation?

Since the 1990s, emotion regulation has been a key construct in social science research. In essence, emotion regulation is an individual’s ability to influence their emotional reactions using internal and external strategies (Gross, 1998; Thompson, 1994). Emotion regulation processes can modify the intensity, timing, quality, range, duration, and recovery from emotional experiences (Thompson, 1994). The ability to modify or regulate emotions is essential to existing in a social context; thus, deficits in emotion regulation skills can range from moderately challenging to severely incapacitating.

Emotion regulation is a set of skills that involve both internal and external processes. For example, emotion regulation strategies can include: (a) organizing one’s life in such a way as to increase the probability of positive emotional experiences and decrease the probability of difficult emotional experiences (e.g., regulating one’s environment; Thompson, 1994), (b) modifying one’s current situation to change its effects on emotional experiences (Gross, 2014), (c) modifying what one attends to in unavoidable situations (e.g., redirection, distraction; Gross, 2014; Thompson, 1994), (d) adjusting one’s cognitive appraisal of a situation (Gross, 2014) or modifying “one’s interpretation of emotionally meaningful information” (Thompson, 1994, p. 35), and (e) modifying emotional responses and selecting a different emotional expression (e.g., employing adaptive coping strategies to alter one’s mood; Gross, 2014; Thompson, 1994).

Thus, emotion regulation is a complex set of skills and processes that help individuals navigate their emotional experiences throughout their lives. Individuals who never developed these skills will struggle to manage their emotional experiences and may be more susceptible to opportunities for mood management through drugs of abuse or addictive behaviors.

How do we learn emotion regulation skills?

The ability to regulate emotions develops in the first few years of life with the maturation of neurobiological structures and systems. For example, during the first year of life, emotional arousal becomes more nuanced and complex and the prefrontal cortex (which assists with inhibitory processes) begins to develop (Thompson, 1994).

In addition to brain maturation, emotion regulation skills are learned via interactions with primary caregivers. Indeed, caregivers externally regulate the emotions of children by soothing them when they are upset, celebrating with them when they are joyful, validating their emotional experiences, supplying emotional support, providing distractions during uncomfortable situations, modeling emotional expression, offering insight into social and cultural emotional norms, and providing alternative interpretations to emotionally-arousing events (Thompson, 1994).

The secure attachment a child develops with a caregiver becomes the first, primary means of emotion regulation development. The attuned caregiver that serves as a buffer from emotional distress and a source of emotional support is, in effect, co-regulating the child’s emotional experiences (and thereby laying the groundwork for future independent emotion regulation; Katehakis, 2009; Thompson, 1994).

In the absence of a secure attachment with a caregiver, however, (due to disengaged, unavailable, neglectful, abusive, insensitive, or emotionally distant caregivers), children may never learn essential emotion regulation skills (Katehakis, 2009). Specifically, Katehakis (2009) writes, “For infants to attain a healthy self-regulating system they must first have the early experience of interactive regulation.” Thus, neurobiological maturation and the nature of attachments to primary caregivers are the impetus for emotion regulation development.

How is emotion regulation related to addiction?

At its core, addiction is a means of changing the way one feels. Drugs of abuse and addictive behaviors are both positively and negatively reinforcing (meaning they increase pleasurable feelings while also reducing dysphoric feelings) and often used as a method of mood management (Goodman, 2001; Griffiths, 2005). Drugs of abuse and addictive behaviors serve as powerful (albeit maladaptive) strategies for regulating emotions (e.g., “I feel bad, drinking alcohol helps me escape” or “I want to feel like I’m on top of the world, cocaine gives me the high I’m looking for”).

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Decades of research has confirmed the link between emotion regulation deficits and addiction. Specifically, individuals with difficulties regulating emotions are at higher risk of using drugs of abuse or engaging in addictive behaviors (Dingle et al., 2018; Prosek et al., 2018; Estevez et al., 2017; Cashwell et al., 2017). It appears that the lack of developed and effective emotion regulation strategies primes individuals to seek ways of changing how they feel through predictable means such as the use of drugs of abuse or engagement in addictive behaviors.

Although the substance use may initially serve as an effective means of mood modification, the subsequent neuroadaptations triggered by chronic use (e.g., downregulation of dopaminergic functioning), decreases the potential for positive reinforcement of the drug and increases the need for negative reinforcement via using substances to ward off withdrawal symptoms (Koob & Le Moal, 2008; Koob, 2009; Wise & Koob, 2014). Therefore, the strategy that began as a predictable form of emotion regulation soon becomes the source of emotional problems.

What can we do?

Emotion regulation skills are comprised of both internal and external strategies that need to be learned, often in social contexts (Thompson, 1994). Indeed, the enhancement of emotion regulation skills is a key factor in many therapeutic interventions for addiction (Cavicchioli et al., 2019; Giordano, 2022; Katehakis, 2009).

Perhaps one of the most effective prevention efforts for addiction, therefore, is to ensure that all children and youth have the opportunity to learn, develop, and strengthen emotion regulation skills. Knowing that emotion regulation occurs primarily in social contexts, the family unit, the school classroom setting, or therapeutic groups seem to be the best places for this preventative work to occur (Thompson, 1994). Training parents and teachers to assist in children’s development of effective emotion regulation skills and making counseling resources available to all students may be a successful means of preventing later addictive behaviors.