Relationship between somatization and psychiatric symptoms, especially anxiety, depression, alexithymia, and severity of addiction in male patients with alcohol and heroin addiction

ABSTRACT Objective: There are differences among studies examining comorbid somatization in alcohol and heroin addicts. The literature is unclear whether substance use disorders are related with somatization symptoms or with a high rate of alexithymia, depression, and anxiety associated with somatization. Therefore, the primary aim of this study was to compare heroin and alcohol addicts with regard to comorbidity of somatization and other psychiatric symptoms. In addition, we aimed to evaluate the relationship between somatization, addiction severity, depression, anxiety and alexithymia levels. Method: A total of 170 male outpatients, of whom 79 had been diagnosed as alcohol dependent and 91 as opiate dependent, were included in the study. A Sociodemographic Data Form, Addiction Profile Index, Symptom Checklist 90, and Toronto Alexithymia Scale-20 were administered to the patients. Results: Somatization, depression, anger and hostility, interpersonal sensitivity, and psychoticism were significantly higher in heroin addicts than in alcohol addicts. In a stepwise linear regression model with somatization symptoms as the dependent variable and addiction severity, anxiety, depression, obsessive compulsive, anger and hostility, phobic anxiety, interpersonal sensitivity, psychoticism, paranoia, and alexithymia symptoms as independent variables, anxiety symptoms and alexithymia were found to be positive predictors of somatization symptoms. Conclusion: It needs to be considered that in addictions to different substances, different psychiatric comorbid symptoms may occur. In addition, it is recommended that heroin- or alcohol-addicted patients with high somatic symptoms should be screened for anxiety disorders and alexithymic personality traits.

___

1. Maremmani I, Pani PP, Pacini M, Bizzarri JV, Trogu E, Maremmani AG, et al. Subtyping patients with heroin addiction at treatment entry: factor derived from the Self-Report Symptom Inventory (SCL-90). Ann Gen Psychiatry 2010 Apr 13;9:15.

2. Harris KM, Edlund MJ. Use of mental health care and substance abuse treatment among adults with co-occurring disorders. Psychiatr Serv 2005; 56:954-959.

3. Kelly TM, Daley DC. Integrated treatment of substance use and psychiatric disorders. Soc Work Public Health 2013; 28:388-406.

4. Hagen E, Erga AH, Hagen KP, Nesvåg SM, McKay JR, Lundervold AJ, et al. One-year sobriety improves satisfaction with life, executive functions and psychological distress among patients with polysubstance use disorder. J Subst Abuse Treat 2017; 76:81-87.

5. Yavuz M, Erdur B, Isik M, Bogday H, Ince H, Kok O, et al. The associations between somatization, alexithymia, and mental problems in adolescents. Anatol J Psychiatry 2018; 1.

6. Kandemir G, Ak I. Psychiatric aspects of medically unexplained symptoms. Current Approaches to Psychiatry 2013; 5:479-506. (Turkish)

7. Lipowski ZJ. Somatization: the concept and its clinical application. Am J Psychiatry 1988; 145:1358-1368.

8. Lipowski ZJ. Somatization and depression. Psychosomatics 1990; 31:13-21.

9. Ross HE, Cutler M, Sklar SM. Retention in substance abuse treatment. Role of psychiatric symptom severity. Am J Addict 1997; 6:293-303.

10. Tien AY, Schlaepfer TE, Fisch HU. Self-reported somatization symptoms associated with risk for extreme alcohol use. Arch Fam Med 1998; 7:33-37.

11. Pani PP, Maremmani AG, Trogu E, Vigna-Taglianti F, Mathis F, Diecidue R, et al. Psychopathology of addiction: May a SCL-90- based five dimensions structure be applied irrespectively of the involved drug? Ann Gen Psychiatry 2016; 15:13.

12. Taylor GJ. Recent developments in alexithymia theory and research. Can J Psychiatry 2000; 45:134-142.

13. Parker JD, Taylor GJ, Bagby RM. Alexithymia: relationship with ego defense and coping styles. Compr Psychiatry 1998; 39:91-98.

14. Taylor GJ, Bagby RM, Parker JDA, Grotstein J (Foreword). Disorders of Affect Regulation: Alexithymia in Medical and Psychiatric Illness. Cambridge: Cambridge University Press, 1997.

15. El Rasheed AH. Alexithymia in Egyptian Substance Abusers. Subst Abus 2001; 22:11-21.

16. Cleland C, Magura S, Foote J, Rosenblum A, Kosanke N. Psychometric properties of the Toronto Alexithymia Scale (TAS20) for substance users. J Psychosom Res 2005; 58:299-306.

17. De Rick A, Vanheule S. The relationship between perceived parenting, adult attachment style and alexithymia in alcoholic inpatients. Addict Behav 2006; 31:1265-1270.

18. Regier DA, Farmer ME, Rae DS, Locke BZ, Keith SJ, Judd LL, et al. Comorbidity of mental disorders with alcohol and other drug abuse. Results from the Epidemiologic Catchment Area (ECA) Study. JAMA 1990; 264:2511-2518.

19. Thorberg FA, Young RM, Sullivan KA, Lyvers M. Alexithymia and alcohol use disorders: a critical review. Addict Behav 2009; 34:237-245.

20. Freyberger H. Supportive psychotherapeutic techniques in primary and secondary alexithymia. Psychother Psychosom 1977; 28:337-42.

21. Honkalampi K, Hintikka J, Saarinen P, Lehtonen J, Viinamäki H. Is alexithymia a permanent feature in depressed patients? Results from a 6-month follow-up study. Psychother Psychosom 2000; 69:303-308.

22. Honkalampi K, Hintikka J, Tanskanen A, Lehtonen J, Viinamäki H. Depression is strongly associated with alexithymia in the general population. J Psychosom Res 2000; 48:99-104.

23. Shipko S. Alexithymia and somatization. Psychother Psychosom 1982; 37:193-201.

24. Hasin D, Katz H. Somatoform and substance use disorders. Psychosom Med 2007; 69:870-875.

25. Ogel K, Evren C, Karadag F, Gurol DT. The development, validity, and reliability of the Addiction Profile Index (API). Turk Psikyatri Derg 2012; 23:264-273. (Turkish)

26. Ogel K, Koc C, Basabak A, Ismen EM, Gorucu S. Development of Addiction Profile Index (BAPI) Clinical Form: reliability and validity study. Journal of Dependence 2015; 16:57-69. (Turkish)

27. Derogatis LR. Symptom Checklist-90-R (SCL-90-R): Administration, scoring, and procedures manual. Third ed., Minneapolis, MN NCS Pearson, 1994

28. Dag I. Symptom Checklist-90-R: validity and reliability. Turk Psikolojik Danisma ve Rehberlik Dergisi 1991; 1:45-52. (Turkish)

29. Bagby RM, Taylor GJ, Parker JD, Dickens SE. The development of the Toronto Structured Interview for Alexithymia: item selection, factor structure, reliability and concurrent validity. Psychother Psychosom 2006; 75:25-39.

30. Gulec H, Kose S, Gulec MY, Citak S, Evren C, Borckardt J, Sayar K. Reliability and factorial validity of the Turkish version of the 20-item Toronto Alexithymia Scale (TAS-20). Bulletin of Clinical Psychopharmacology 2009; 19:214-20.

31. Asan O, Tikir B, Okay I, Goka E. Sociodemographic and clinical features of patients with alcohol and substance use disorders in a specialized unit. Journal of Dependence 2015; 16:1-8. (Turkish)

32. Swendsen J, Conway KP, Degenhardt L, Dierker L, Glantz M, Jin R, et al. Socio-demographic risk factors for alcohol and drug dependence: the 10-year follow-up of the national comorbidity survey. Addiction 2009; 104:1346-1355.

33. Border R, Corley RP, Brown SA, Hewitt JK, Hopfer CJ, McWilliams SK, et al. Independent predictors of mortality in adolescents ascertained for conduct disorder and substance use problems, their siblings and community controls. Addiction 2018; 113:2107-2115.

34. Pektas O, Kalyoncu A, Mirsal H, Beyazyurek M. Sociodemographic variables, clinical features, and treatment outcomes between two sexes in alcohol dependent patients. Journal of Dependence 2001; 2:25-29.

35. Evren C, Evren B, Yancar C, Erkiran M. Temperament and character model of personality profile of alcohol- and drugdependent inpatients. Compr Psychiatry 2007; 48:283-288.

36. Emiral E. Assessment of Codependency and Alexithymia within the Frame. Bagimlilik Dergisi – Journal of Dependence 2019; 20:109-118. (Turkish)

37. Soyka M, Strehle J, Rehm J, Bühringer G, Wittchen HU. Six-Year Outcome of Opioid Maintenance Treatment in Heroin-Dependent Patients: Results from a Naturalistic Study in a Nationally Representative Sample. Eur Addict Res 2017; 23:97-105.

38. Leach D, Kranzler HR. An Interpersonal Model of Addiction Relapse. Addict Disord Their Treat 2013; 12:183-192.

39. Evren C, Ogel K. Dissociative symptoms among alcohol and substance dependents and its relationships with childhood trauma history, depression, anxiety, and alcohol/substance use. Anadolu Psikiyatr Derg 2003; 4:30-37. (Turkish)

40. Swendsen JD, Merikangas KR. The comorbidity of depression and substance use disorders. Clin Psychol Rev 2000; 20:173-189.

41. Bácskai E, Czobor P, Gerevich J. Gender differences in trait aggression in young adults with drug and alcohol dependence compared to the general population. Prog Neuropsychopharmacol Biol Psychiatry 2011; 35:1333-1340.

42. Smith MJ, Thirthalli J, Abdallah AB, Murray RM, Cottler LB. Prevalence of psychotic symptoms in substance users: a comparison across substances. Compr Psychiatry 2009; 50:245- 250.

43. Metrikin AS, Galanter M, Dermatis H, Bunt G. Somatization, anxiety and depression in a drug-free residential therapeutic community. Am J Addict 2003; 12:60-70.

44. Hassan I, Ali R. The association between somatic symptoms, anxiety disorders and substance use. A literature review. Psychiatr Q 2011; 82:315-328.

45. Escobar JI, Rubio-Stipec M, Canino G, Karno M. Somatic symptom index (SSI): a new and abridged somatization construct. Prevalence and epidemiological correlates in two large community samples. J Nerv Ment Dis 1989; 177:140-146.

46. Lieb R, Pfister H, Mastaler M, Wittchen HU. Somatoform syndromes and disorders in a representative population sample of adolescents and young adults: prevalence, comorbidity and impairments. Acta Psychiatr Scand 2000; 101:194-208.

47. Simon GE, VonKorff M. Somatization and psychiatric disorder in the NIMH Epidemiologic Catchment Area study. Am J Psychiatry 1991; 148:1494-1500.

48. Bonn-Miller MO, Vujanovic AA, Zvolensky MJ. Emotional dysregulation: association with coping-oriented marijuana use motives among current marijuana users. Subst Use Misuse. 2008; 43:1653-1665.

49. Betka S, Pfeifer G, Garfinkel S, Prins H, Bond R, Sequeira H, et al. How do self-assessment of alexithymia and sensitivity to bodily sensations relate to alcohol consumption? Alcohol Clin Exp Res. 2018; 42:81-88.