Associations between Emotion Regulation and NIAAA Recovery within an Alcohol Treatment Sample: Implications for Social Work Research and Practice

Background and Purpose: The National Institute on Alcohol Abuse and Alcoholism (NIAAA) finalized a definition of alcohol use disorder (AUD) recovery stipulating (1) remission from DSM-5 AUD (except for the craving item) and (2) cessation of heavy drinking (i.e., no more than three drinks per day or seven drinks per week for women and four drinks per day or 14 per week for men; Hagman et al., 2022). Emerging research on NIAAA recovery has shown that negative emotionality (i.e., depression, anxiety) is associated with NIAAA recovery outcomes post-AUD treatment (Linn et al., 2023). Furthermore, studies have evidenced relationships between emotion regulation mechanisms and alcohol use (e.g., Cooper et al., 1995). However, the relationship between emotion regulation and NIAAA recovery has not been examined. This study assesses the relationship between pre- and post-AUD treatment emotion regulation variables and achieving NIAAA recovery, with the goal of informing social work research and practice.

Methods: Study data were drawn from a randomized clinical trial assessing an emotion regulation treatment enhancement to standard Cognitive Behavioral Therapy for AUD (Stasiewicz et al., 2013). At baseline and post-treatment, participants (N = 194; 50% female; M_age = 50.3, SD_age = 10.75) completed questionnaires assessing demographic characteristics, DSM-5 AUD symptom criteria, alcohol use (via the Timeline Follow-Back), and emotion regulation (i.e., via the Emotion Regulation Questionnaire [ERQ] and the Difficulties in Emotion Regulation Scale [DERS]). NIAAA recovery was coded as a dichotomous outcome. Participants met NIAAA recovery if they were remitted from DSM-5 AUD symptoms (except the craving) post-treatment and reported no heavy drinking during the last two weeks of treatment. Those who met only one or neither criteria were considered to not meet NIAAA recovery. Logistic regression modeling examined the associations between emotion regulation pre- and post-treatment and post-treatment NIAAA recovery status.

Results: Twenty-four percent (n = 28) of individuals achieved NIAAA recovery status post-treatment. Higher scores on the reappraisal ERQ subscale at pre- (M = 26.24, OR = 1.12; p = .003) and post-treatment (M = 30.18, OR = 1.28; p = .001) predicted an increased likelihood of achieving NIAAA recovery status. Greater total posttreatment DERS scores (i.e., indicating greater difficulty in managing emotions) predicted a reduced likelihood of achieving NIAAA recovery status (M = 89.28, OR = .93; p = .006). Finally, greater DERS subscale scores, including difficulty engaging in goal-directed behavior (M = 12.02, OR = .81; p = .049), lack of emotional awareness (M = 13.05, OR = .79; p = .028), and limited access to emotion regulation strategies (M = 14.37, OR = .69; p = .003) predicted decreased odds of achieving NIAAA recovery status.

Conclusions and Implications: Skills related to emotional processing could be a mechanism through which individuals in AUD treatment decrease negative emotionality and increase the likelihood of achieving alcohol recovery. Given that social workers are so frequently involved in treating individuals with AUD, they are well-positioned to help continue to research the link between emotion regulation and alcohol recovery and help clients understand and improve their emotion regulation skills.