PREVALENCE OF EMOTIONAL DYSREGULATION AMONG YOUTH WITH SUBSTANCE USE DISORDER
Abstract
Purpose of the Study: This study examined the prevalence of emotional dysregulation among youth with substance use disorder (SUD) in selected rehabilitation centres in Kiambu County, Kenya.
Problem Statement: Despite ongoing treatment efforts, relapse rates among youth with SUD remain high in Kenya. Emotional dysregulation is a key factor sustaining addiction, yet rehabilitation programs often emphasize detoxification and general counseling while neglecting structured psychological interventions. Dialectical Behavior Therapy (DBT) has shown global effectiveness in enhancing emotional regulation, but its application in Kenyan settings is limited.
Methodology: A quasi-experimental design was employed, involving 108 inpatients aged 18–35 years across four rehabilitation centers. A sample of 68 participants was purposively selected and randomly assigned to experimental and control groups. Standardized self-report instruments including the Difficulties in Emotion Regulation Scale (DERS-16), Beck Anxiety Inventory (BAI), Beck Depression Inventory-II (BDI-II), and the Brief Substance Craving Scale (BSCS) were administered. Data was analyzed using chi-square tests, Pearson correlations, regression analysis, ANOVA, paired t-tests, and effect size measures.
Results: The findings indicated that 89.8% of participants exhibited emotional dysregulation, with 51.9% presenting moderate and 14.8% severe levels. Emotional dysregulation was strongly associated with substance cravings, anxiety, and depression. Key difficulties included impulse control, poor emotional awareness, and limited coping strategies, all of which heightened relapse vulnerability.
Conclusion: Emotional dysregulation is pervasive among youth with SUD in Kiambu County and undermines recovery outcomes.
Recommendations: Integrating DBT into rehabilitation programs is recommended to strengthen coping skills, reduce cravings, enhance treatment adherence, and minimize relapse. Policymakers should prioritize DBT adoption and expand professional training to enhance evidence-based care.
Keywords: Emotional dysregulation, substance use disorder, Dialectical Behavior Therapy, Kenya, youth, rehabilitation
References
Adams, C., & Sussman, S. (2018). Integrating biopsychosocial approaches in substance use treatment. Journal of Substance Abuse Treatment, 90(2), 45–53. https://doi.org/10.1016/j.jsat.2018.05.012
Aldao, A., Dixon-Gordon, K. L., & De Los Reyes, A. (2022). Emotion regulation and substance use disorders: A meta-analysis. Clinical Psychology Review, 91, 102112. https://doi.org/10.1016/j.cpr.2021.102112
Ambekar, A., Agrawal, A., Rao, R., Mishra, A., Khandelwal, S. K., & Chadda, R. K. (2019). Magnitude of substance use in India. Ministry of Social Justice and Empowerment, Government of India. https://socialjustice.gov.in
Azagba, S., Shan, L., & Latham, K. (2021). Emotion regulation and substance use among young adults. Addictive Behaviors, 112, 106640. https://doi.org/10.1016/j.addbeh.2020.106640
Beaulac, J., Vincent, A., & Robins, C. (2018). Emotional awareness in substance use treatment. Substance Abuse, 39(1), 67–74. https://doi.org/10.1080/08897077.2017.1373553
Bilican, I., Rizvi, S. L., & Kurtz, J. (2022). Digital dialectical behavior therapy: Expanding access through telehealth. Journal of Technology in Behavioral Science, 7(4), 410–421. https://doi.org/10.1007/s41347-022-00242-0
Bitta, M., Kariuki, S. M., & Newton, C. R. (2019). Mental health and substance use disorder treatment in Kenya. African Journal of Psychiatry, 22(1), 15–22. https://doi.org/10.4314/ajpsy.v22i1.15
Campbell, D. T., & Stanley, J. C. (2014). Experimental and quasi-experimental designs for research. Ravenio Books. https://doi.org/10.1037/13623-000
Cavicchioli, M., Movalli, M., & Maffei, C. (2023). Emotion dysregulation and relapse in addiction treatment. Addictive Behaviors, 141, 107634. https://doi.org/10.1016/j.addbeh.2022.107634
Chen, P. (2021). Emotional dysregulation and substance use among youth. Journal of Adolescent Health, 68(3), 455–462. https://doi.org/10.1016/j.jadohealth.2020.09.018
Daros, A. R., Williams, G. E., & Moser, J. S. (2023). Emotion regulation and relapse risk in substance use. Journal of Consulting and Clinical Psychology, 91(2), 112–125. https://doi.org/10.1037/ccp0000782
Dhumal, P., Shukla, R., & Tripathi, S. (2021). Challenges of rehabilitation in substance use disorder. Indian Journal of Psychiatry, 63(2), 155–162. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_100_21
Dimeff, L. A., Rizvi, S. L., & Koerner, K. (2021). Dialectical behavior therapy in substance use treatment. Journal of Substance Abuse Treatment, 130, 108450. https://doi.org/10.1016/j.jsat.2021.108450
Dror, I. (2017). The role of cognitive appraisal in emotional experience. Emotion Review, 9(3), 257–266. https://doi.org/10.1177/1754073916661637
Fox, H. C., Hong, K. I., & Sinha, R. (2022). Mindfulness-based interventions in substance use treatment. Drug and Alcohol Dependence, 231, 109273. https://doi.org/10.1016/j.drugalcdep.2022.109273
Giannelli, A., Brown, A., & Smith, T. (2019). DBT-based interventions for substance use among young adults. Journal of Substance Use, 24(6), 567–575. https://doi.org/10.1080/14659891.2019.1604298
Greener, I. (2008). Designing social research: A guide for the bewildered. Sage Publications. https://doi.org/10.4135/9781446218105
Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the DERS. Journal of Psychopathology and Behavioral Assessment, 26(1), 41–54. https://doi.org/10.1023/B:JOBA.0000007455.08539.94
Gross, J. J. (2015). Handbook of emotion regulation (2nd ed.). Guilford Press. https://doi.org/10.4324/9780203849875
Harvey, R., Watkins, E., & Mansell, W. (2019). Dialectical behavior therapy and substance use relapse. Addiction Research & Theory, 27(2), 125–133. https://doi.org/10.1080/16066359.2018.1503452
Kothari, C. R. (2003). Research methodology: Methods and techniques (2nd ed.). New Age International.
Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. Guilford Press.
Linehan, M. M. (2015). DBT skills training manual (2nd ed.). Guilford Press.
Linehan, M. M., & Wilks, C. R. (2015). The course and evolution of dialectical behavior therapy. American Journal of Psychotherapy, 69(2), 97–110. https://doi.org/10.1176/appi.psychotherapy.2015.69.2.97
MacCormack, J. K., & Lindquist, K. A. (2017). The role of appraisal in emotion construction. Emotion Review, 9(3), 207–214. https://doi.org/10.1177/1754073916650494
Maciejewski, P. K. (2018). Psychological models of emotion regulation in addiction. Clinical Psychology Review, 62, 11–25. https://doi.org/10.1016/j.cpr.2018.05.003
Mertens, J. R. (2022). Emotion regulation and comorbidity in addiction. Addiction Science & Clinical Practice, 17(1), 22. https://doi.org/10.1186/s13722-022-00291-9
Miller, A. L., Rathus, J. H., & Linehan, M. M. (2020). Dialectical behavior therapy with suicidal adolescents. Guilford Press.
NACADA. (2020). National survey on the status of alcohol and drug use in Kenya. National Authority for the Campaign Against Alcohol and Drug Abuse. https://nacada.go.ke
NACADA. (2022). Annual report on substance use and addiction in Kenya. National Authority for the Campaign Against Alcohol and Drug Abuse. https://nacada.go.ke
NACADA. (2023). Youth and substance use trends in Kiambu County. National Authority for the Campaign Against Alcohol and Drug Abuse. https://nacada.go.ke
Neacsiu, A. D., Rizvi, S. L., & Linehan, M. M. (2014). DBT skills use as a mediator and outcome of treatment for borderline personality disorder. Behaviour Research and Therapy, 57, 41–47. https://doi.org/10.1016/j.brat.2014.03.007
Reisenzein, R. (2017). Cognitive appraisal theories of emotion. Emotion Review, 9(3), 211–222. https://doi.org/10.1177/1754073916661951
Rizvi, S. L., Dimeff, L. A., & Skutch, J. M. (2016). Dialectical behavior therapy and digital interventions. Cognitive and Behavioral Practice, 23(2), 145–155. https://doi.org/10.1016/j.cbpra.2015.08.004
Robins, C. J., & Chapman, A. L. (2004). Dialectical behavior therapy: Current status, recent developments, and future directions. Journal of Personality Disorders, 18(1), 73–89. https://doi.org/10.1521/pedi.18.1.73.32771
Robinson, M. D. (2014). Cognitive theories of emotion. Emotion Review, 6(3), 169–173. https://doi.org/10.1177/1754073914522867
Schachter, S., & Singer, J. (1962). Cognitive, social, and physiological determinants of emotional state. Psychological Review, 69(5), 379–399. https://doi.org/10.1037/h0046234
Sefidkar, R., & Madadizadeh, F. (2022). Distress tolerance and emotion regulation in DBT. Addictive Behaviors Reports, 16, 100448. https://doi.org/10.1016/j.abrep.2022.100448
Sloan, E., Hall, K., Moulding, R., Bryce, S., Mildred, H., & Staiger, P. K. (2020). Emotion regulation as a transdiagnostic treatment target in SUD. Clinical Psychology Review, 78, 101852. https://doi.org/10.1016/j.cpr.2020.101852
Swales, M. A., & Heard, H. L. (2017). Dialectical behavior therapy: Distinctive features (2nd ed.). Routledge. https://doi.org/10.4324/9781315743394
Volkow, N. D., Koob, G. F., & McLellan, A. T. (2016). Neurobiologic advances from the brain disease model of addiction. New England Journal of Medicine, 374(4), 363–371. https://doi.org/10.1056/NEJMra1511480
Warner, R., & Murphy, S. (2021). Dialectical behavior therapy for relapse prevention. Addictive Disorders & Their Treatment, 20(1), 45–52. https://doi.org/10.1097/ADT.0000000000000216
Weaver, K. (2022). The role of theoretical frameworks in clinical research. Nursing Research, 71(1), 12–20. https://doi.org/10.1097/NNR.0000000000000561
Weiss, R. D., Griffin, M. L., & Gallop, R. J. (2021). Longitudinal study of emotional dysregulation in substance use treatment. Journal of Studies on Alcohol and Drugs, 82(3), 372–381. https://doi.org/10.15288/jsad.2021.82.372
White, R., Knight, T., & Barton, J. (2022). Implementing DBT in Ugandan rehabilitation programs. International Journal of Mental Health Systems, 16, 25. https://doi.org/10.1186/s13033-022-00555-4
