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Substance use to regulate intense posttraumatic shame in individuals with childhood abuse and neglect

Published online by Cambridge University Press:  13 June 2016

Julia Holl ,
Sebastian Wolff ,
Maren Schumacher ,
Anja Höcker ,
Elisabeth A. Arens ,
Gabriela Spindler ,
Malte Stopsack ,
Jonna Südhof ,
Philipp Hiller  and
Michael Klein
...Show all authors
Julia Holl*
Affiliation:
Ruprecht–Karls–University Heidelberg
Sebastian Wolff
Affiliation:
Ruprecht–Karls–University Heidelberg
Maren Schumacher
Affiliation:
Ruprecht–Karls–University Heidelberg
Anja Höcker
Affiliation:
University of Hamburg
Elisabeth A. Arens
Affiliation:
Goethe University, Frankfurt/Main
Gabriela Spindler
Affiliation:
Ruprecht–Karls–University Heidelberg
Malte Stopsack
Affiliation:
Ruprecht–Karls–University Heidelberg
Jonna Südhof
Affiliation:
Ruprecht–Karls–University Heidelberg
Philipp Hiller
Affiliation:
University of Hamburg
Michael Klein
Affiliation:
Catholic University of Applied Sciences, Cologne
Ingo Schäfer
Affiliation:
University of Hamburg
Sven Barnow
Affiliation:
Ruprecht–Karls–University Heidelberg
*
Address correspondence and reprint requests to: Julia Holl, Department of Clinical Psychology and Psychotherapy, Ruprechts-Karls-University Heidelberg, Hauptstrasse 47-51, 69117 Heidelberg, Germany; E-mail: julia.holl@psychologie.uni-heidelberg.de.
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Abstract

Childhood abuse and neglect (CAN) is considered as a risk factor for substance use disorder (SUD). Based on the drinking to cope model, this study investigated the association of two trauma-relevant emotions (shame and sadness) and substance use. Using ecological momentary assessment we compared real-time emotion regulation in situations with high and low intensity of shame and sadness in currently abstinent patients with CAN and lifetime SUD (traumaSUD group), healthy controls with CAN (traumaHC group), and without CAN (nontraumaHC group). Multilevel analysis showed a positive linear relationship between high intensity of both emotions and substance use for all groups. The traumaSUD group showed heightened substance use in low, as well as in high, intensity of shame and sadness. In addition, we found an interaction between type of emotion, intensity, and group: the traumaHC group exhibited a fourfold increased risk for substance use in high intense shame situations relative to the traumaSUD group. Our findings provide evidence for the drinking to cope model. The traumaSUD group showed a reduced distress tolerance for variable intensity of negative emotions. The differential effect of intense shame for the traumaHC group emphazises its potential role in the development of SUD following CAN. In addition, shame can be considered a relevant focus for therapeutic preinterventions and interventions for SUD after CAN.

Type
Regular Articles
Information
Development and Psychopathology , Volume 29 , Issue 3 , August 2017 , pp. 737 - 749
Copyright
Copyright © Cambridge University Press 2016 

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Footnotes

This research was supported by the German Federal Ministry of Education and Research (Bundesministerium für Bildung und Forschung 01KR1203B). The authors thank all participants who took part in this study, all cooperating clinical institutions, and Dr. Halina Sklenarova and Andreas B. Neubauer for data analysis support. The CANSAS Study Group members are Ingo Schäfer (Coordinator), Sven Barnow, Monika Bullinger, Martin Driessen, Martin Härter, Phillip Hiller, Thomas Hillemacher, Michael Klein, Christoph Muhtz, Ulrike Ravens-Sieberer, Norbert Scherbaum, Rainer Thomasius, Barbara Schneider, Karl Wegscheider, and Silke Pawils.

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