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. Author manuscript; available in PMC: 2021 Aug 1.
Published in final edited form as: Cognit Ther Res. 2020 Apr 17;44:811–819. doi: 10.1007/s10608-020-10101-8

Dampening of Positive Affect Predicts Substance Use During Partial Hospitalization

Andrew D Peckham a,b, R Kathryn McHugh a,b, Elizabeth T Kneeland a,b, Thröstur Björgvinsson a,b, Courtney Beard a,b
PMCID: PMC7863783  NIHMSID: NIHMS1585807  PMID: 33551519

Abstract

Background

Elevated positive affect is associated with craving for substances of abuse, yet little is known about regulation of positive emotion in substance use disorders. This study tested if the emotion regulation strategy of dampening (deliberately down-regulating positive affect) contributes to substance use outcomes in a transdiagnostic sample.

Methods

Participants (N = 120) were adults endorsing risky substance use, recruited from an acute psychiatric treatment program that requires abstinence during treatment. Craving and dampening were assessed at admission.

Results

A logistic regression to evaluate likelihood of substance use during treatment yielded a significant interaction between dampening and frequency of substance use in the previous month: odds of use during treatment were higher among those with heavier pre-treatment use, but only at high levels of dampening.

Conclusions

This study provides preliminary evidence that dampening increases risk for substance use among those with high levels of pre-treatment substance use. Findings are limited by the use of a general psychiatric sample, which did not include individuals seeking treatment for substance use disorders; future studies are needed to replicate this effect in individuals with substance use disorders. Results point to the need for interventions to enhance healthy regulation of positive affect in substance-using populations.

Keywords: dampening, positive affect, substance use, craving, emotion regulation

Elevated negative affect is widely understood as a risk factor, correlate, and consequence of substance use and substance use disorders (Cheetham, Allen, Yücel, & Lubman, 2010; McHugh & Kneeland, 2019). In addition to the experience of negative affect, research also identifies individual differences in the regulation of negative affect as an important predictor of substance use outcomes (Aldao, Nolen-Hoeksema, & Schweizer, 2010; Caselli et al., 2008; Nolen-Hoeksema & Harrell, 2002; Nolen-Hoeksema, Stice, Wade, & Bohon, 2007). For example, rumination on negative affect (i.e., repetitive, unproductive thought focused on negatively valenced thoughts or events) is an emotion regulation strategy that predicts alcohol use (Nolen-Hoeksema & Harrell, 2002), problems related to alcohol (Caselli et al., 2010), and problems with other substances of abuse (Nolen-Hoeksema et al., 2007).

A smaller body of research has considered how positive emotions and positive emotion regulation shape substance use outcomes (Cheetham et al., 2010). Although significantly less studied than negative affect, elevations in positive affect have long been recognized as a potential factor contributing to increased substance craving for some individuals (Dvorak, Waters, MacIntrye, & Gwaltney, 2018; Mason, Light, Escher, & Drobes, 2008; Tiffany, 1999). In addition to craving, the tendency to engage in impulsive behaviors while experiencing elevated positive affect (known as “positive urgency”) is linked to a range of substance use problems (for review, see Smith & Cyders, 2016), including substance use onset (Settles, Zapolski, & Smith, 2014), consequences related to substance use (Cyders, Flory, Rainer, & Smith, 2009), and increases in substance use over time (Cyders et al., 2009; Kaiser, Bonsu, Charnigo, Milich, & Lynam, 2016; Zapolski, Cyders, & Smith, 2009). Thus, for some individuals, elevated positive affect presents risks for substance use.

Despite these findings, much less is known about how the regulation of positive affect relates to substance use outcomes. Recent evidence suggests that several distinct problems with regulating positive emotion (including not accepting positive emotions, impulsivity in response to positive mood, and difficulties focusing on goal-directed behavior) may be linked to both alcohol and substance use disorders (Weiss, Darosh, Contractor, Schick, & Dixon-Gordon, 2019). In addition to these emotion regulation difficulties, individuals vary in tendencies to regulate positive affect through strategies that can include amplifying positive emotions (for example, savoring or elaborating on a positive mood), or conversely, strategies to intentionally reduce or down-regulate positive emotions, known as “dampening” (Feldman, Joormann, & Johnson, 2008; Quoidbach, Berry, Hansenne, & Mikolajczak, 2010). An increasing body of research suggests that difficulties with positive affect regulation are common in many psychological disorders (Carl, Soskin, Kerns, & Barlow, 2013). Crucially, tendencies to dampen positive affect are predictive of many poor outcomes across psychological disorders, including depression (Raes, Smets, Nelis, & Schoofs, 2012) and mania symptoms (Gilbert, Nolen-Hoeksema, & Gruber, 2013), and are cross-sectionally associated with symptoms of multiple anxiety disorders (Eisner, Johnson, & Carver, 2009). Existing studies have not evaluated whether dampening positive affect is related to substance use outcomes.

Why would use of dampening relate to substance use? We propose that specifically in the context of attempting to abstain or minimize substance use, some individuals may be motivated to dampen positive affect to avoid sensations, urges, or situations that precipitate use of substances. Although this premise has not yet been empirically tested, there are multiple potential pathways that could motivate use of dampening to avoid positive affect-related states preceding substance use. First, given established links between craving and heightened positive affect, individuals prone to experiencing craving in the context of elevated positive emotions might use dampening to manage affect-induced craving. Another possible pathway may be for individuals who have a tendency to respond impulsively to elevations in positive moods; these individuals might use dampening to avoid impulsive use of substances. Finally, evidence suggests that affective lability can be a motivator for substance use and problems related to use (Jahng et al., 2011; Simons, Carey, & Gaher, 2004); thus, some might use dampening as a strategy to “even out” labile mood states that might otherwise lead to substance use.

Although any of these pathways might make intuitive sense as a strategy to avoid affective states precipitating substance use, there is evidence from other populations that dampening is a maladaptive strategy that leads to unintended consequences. Multiple studies show that dampening predicts increases in depression (Hudson, Harding, & Mezulis, 2015; Raes et al., 2012; Raes et al., 2014), and brief experimental manipulations that induce dampening strategies increase negative affect (Burr, Javiad, Jell, Werner-Seidler, & Dunn, 2017, Dunn et al., 2018). Use of dampening in bipolar disorder is associated with motivations to avoid symptoms of mania (Edge et al., 2013), yet dampening also predicts increases in manic symptoms in those with bipolar disorder (Gilbert et al., 2013). Thus, we predict that dampening strategies may paradoxically contribute to increases in substance use, based on the premise that dampening could reflect an absence of other more adaptive strategies to avoid substance use. This prediction may be particularly relevant for individuals with more frequent or heavy patterns of substance use, as evidence shows that these individuals are more likely to engage in other maladaptive emotion regulation strategies such as rumination (Caselli et al., 2008).

Aims and Hypotheses

The overall aim of this study was to test the hypothesis that tendencies to dampen positive affect are related to substance use and substance craving. Using a naturalistic sample of adults with psychiatric disorders admitted to a partial hospitalization program that requires abstinence from alcohol and drugs during treatment, we selected participants who met criteria for risky alcohol or drug use at program admission and who reported using substances in the month leading up to partial hospitalization. Thus, although participants were not seeking treatment for substance use disorders and were not receiving such treatment, individuals in this study endorsed current risky patterns of drug or alcohol use. In this sample, we tested cross-sectional relationships between dampening positive affect, positive urgency, craving, and self-reported patterns of substance use. We hypothesized that (Hypothesis 1) trait dampening at admission would be cross-sectionally correlated with greater (1a) substance craving, (1b) frequency of substance use, and (1c) impulsivity in the context of elevated positive affect. Next, we conducted a naturalistic experiment to evaluate if tendencies to dampen positive affect prospectively predicted greater likelihood of substance use during partial hospitalization. We hypothesized that greater use of dampening and more frequent pre-treatment substance use would each predict increased likelihood of substance use during treatment (Hypothesis 2). In considering this hypothesis, we also tested the potential interaction of dampening and pre-treatment frequency of substance use in predicting substance use during treatment. We expected that dampening may only influence outcomes among those with higher pre-treatment levels of substance consumption, as these individuals might be more motivated to use strategies such as dampening to avoid substance use during partial hospitalization.

Methods

Participants and study setting

Participants in this study were patients attending a partial hospitalization program (PHP) for adults over the age of 18 at a private psychiatric hospital in the Northeastern United States. Treatment was provided on consecutive weekdays for a short period of time (typically 7 to 10 treatment days), with the goal of stabilization of symptoms and functioning and return to outpatient care. Treatment included CBT-informed group therapy, individual skills coaching, case management, and medication management (for details on program outcomes for mood, well-being, and related outcomes, see Björgvinsson et al., 2014). Patients presented with a variety of mood, anxiety, and related diagnoses; substance use disorders are not a focus of treatment (see Table 1 for demographic and clinical characteristics of the present sample). Treatment was not explicitly focused on substance use; however, all patients are required to remain abstinent from alcohol or drugs during the duration of their partial hospitalization.

Table 1.

Demographic and Clinical Characteristics.

Characteristic % or M (SD) N
Age 30.79 (12.62) 107
Gender 107
 Male 43.0
 Female 54.2
 Gender Fluid, Nonconforming, or Nonbinary 2.7
Race 107
 Asian 2.8
 Black 2.8
 White 86.9
 Do Not Know 0.9
 More than One Race 6.5
Ethnicity 107
 Non-Hispanic/Latinx 90.7
 Hispanic/Latinx 9.3
Inpatient Psychiatric Hospitalization in Last 6 Months 43.9 107
Length of Treatment (Days inc. weekends) 12.66 (3.30) 107
MINI Diagnoses:
 Major Depressive Episode (Current) 64.3 98
 Major Depressive Disorder (Lifetime) 70.41 98
 Bipolar Disorder (Lifetime) 35.11 94
 Panic Disorder (Current) 17.89 95
 Social Anxiety Disorder (Current) 29.79 94
 Obsessive-Compulsive Disorder (Current) 10.75 93
 Alcohol Use Disorder (Current) 42.86 91
 Drug Use Disorder (Current) 43.33 90
 Generalized Anxiety Disorder (Current) 56.67 90
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Note: MINI = MINI International Neuropsychiatric Interview. Participants could receive multiple diagnoses so percentages are greater than 100. MINI data were not available for all modules for all participants.

The present study includes patients from the PHP who provided written informed consent at admission for researchers to access their self-report and interview-based measures completed during partial hospitalization as part of standard clinical care. Because some participants are admitted to the partial hospital multiple times, we selected only those participants who were providing consent to research procedures for the first time. Data were collected from September 2017 to March 2018.

Study Design

Participants who provided informed consent were selected for analysis based on their responses to the Tobacco, Alcohol, and Drug Questionnaire (TAD), completed on the day of admission to the PHP. All self-report measures were administered using REDCap, a secure web-based computerized software system (Harris et al., 2009). The TAD includes several sub-measures assessing use of substances, including the Alcohol Use Disorders Identification Test-Consumption Questions (AUDIT-C; Bush, Kivlahan, McDonnell, Fihn, & Bradley, 1998; adapted from Saunders, Aasland, Babor, De La Fuente, & Grant, 1993) and the ten-item Drug Abuse Screening Test (DAST, Skinner, 1982)1. The TAD also includes questions assessing frequency of alcohol and drug use in the past 30 days (prior to treatment in the PHP). Participants were included in the present analysis if: they met criteria for risky alcohol use (score of 4 or higher on the AUDIT-C) and/or they met criteria for risky substance use (score of 3 or higher on the DAST-10). In addition, participants were included only if they endorsed at least one day of drug or alcohol use in the past 30 days prior to admission. As shown in Table 2, participants endorsed an average of 10.52 days (SD = 8.42) of use in the prior month, suggesting that the sample contained a range of use frequency, from infrequent to frequent use. In addition to the TAD completed on the first day of treatment, participants completed the following measures described below on either their first day of treatment (Responses to Positive Affect Dampening scale, Positive Urgency scale, PHQ-9, and Craving scale), second treatment day (Mini International Neuropsychiatric Interview), or last treatment day (Abstinence items).

Table 2.

Means, Standard Deviations, and Pearson Correlations Among Descriptive Statistics For Key Study Variables at Admission

M (SD) n Craving (T1) Positive Urgency Pre-Treatment Frequency of Use DAST-10 AUDIT-C PHQ-9
Dampening 20.02 (5.92) 106 .12 .21* .02 .04 −.001 .31**
Craving 3.23 (2.51) 106 .19 .49*** .40** .15 .09
Positive Urgency 1.85 (0.75) 106 .09 .31* .06 .10
Pre-Treatment Frequency of Use 10.52 (8.42) 107 .09 .16 .11
DAST-10 3.33 (2.03) 55 −.11 −.15
AUDIT-C 4.95 (2.00) 107 .003
PHQ-9 15.35 (5.52) 107
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Note. Dampening = Responses to Positive Affect Dampening subscale. PHQ-9 = Patient Health Questionnaire (Depression Measure). Pre-treatment Frequency of Use is shown in number of days using drugs or alcohol in month before treatment.

*

p < .05.

**

p < .01.

Additional Measures

MINI International Neuropsychiatric Interview

(MINI, Sheehan et al., 1998). The MINI is an interviewer-administered screening measure for psychiatric diagnoses. Trained psychology interns, practicum students, and post-doctoral fellows administered the MINI for this study on the second day of treatment. Table 1 presents the frequency of mood, anxiety, and substance use disorder diagnoses for this sample. MINI data were not available for 8.4% of participants for various reasons including clinical team decision, lack of time, or other reasons.

Craving Scale

(adapted from Weiss et al., 2003). The Craving Scale used in this study was a brief three-item measure assessing current craving, craving when reminded by something relevant to drugs and alcohol in the environment (e.g., cue-induced, referenced to the past week), and perceived likelihood of actual substance use if given the opportunity. Each item was rated on a zero (no craving) to 10 (high craving) scale, in 1-point increments; total mean scores were then calculated from summing the three items. Participants were instructed to consider their use of either drugs, alcohol, or both when answering these questions; previous versions of this measure have been validated among individuals with cocaine, opioid, and alcohol use disorders (Weiss et al., 2003; McHugh et al., 2014, McHugh, Fitzmaurice, Griffin, Anton, & Weiss, 2016). In the present study, internal consistency for this measure was acceptable at both admission (α = .74) and discharge (α = .75).

Abstinence Items

At discharge, a single item was added to the end of the craving measure asking participants to disclose whether they had used drugs or alcohol on any days during their partial hospitalization. To encourage truthful responding on this item, participants were informed that their individual responses to this item would not be disclosed to their clinicians at the PHP. Participants who endorsed substance use on this item were then asked to indicate the number of times they had used drugs or alcohol during partial hospitalization.

Responses to Positive Affect Scale-Dampening Subscale

(RPA, Feldman et al., 2008). The RPA is a measure of response styles to positive affect, modeled after Nolen-Hoeksema’s original Ruminative Responses Styles measure of rumination on negative affect (Nolen-Hoeksema & Morrow, 1991). The present study administered only the Dampening subscale (8 items), which prompts participants to consider how they typically respond when they feel “happy, excited or enthused.” Items all involve some strategy to reduce or counteract positive affect, such as “remind yourself these feelings won’t last.” Each item is rated on a 4-point scale from 1 (“almost never”) to 4 (“almost always),” with total scores being the sum of all items (range: 8–32). The reliability of the dampening subscale is well-established (Feldman et al., 2008); in the present study, the internal consistency for this measure was good at both admission (α = .83) and discharge (α = .86).

SUPPS-P Positive Urgency Subscale

(Cyders, Littlefield, Coffey, & Karyadi, 2014). This measure is a shortened version of the original Urgency, lack of Perseverance, lack of Planning, and Sensation seeking Impulsive Behavior Scale (Whiteside & Lynam, 2001; Lynam, Whiteside, Smith, & Cyders, 2006). We specifically included the four items assessing positive urgency, or tendencies towards impulsive behavior in the context of positive mood. Each item is rated on a 1 (“strongly agree”) to 4 (“strongly disagree”) scale; items are then re-coded as appropriate so that higher score indicate higher tendencies towards impulsive behavior. The total score reflects the mean of the four items. Previous studies have established the reliability and validity of this shortened measure (Cyders et al., 2014, Lozano, Diaz-Batanero, Rojas, Pilatti, & Fernandez-Calderon, 2018). In the present study, internal consistency for this measure was good (α = .85).

Patient Health Questionnaire – 9 Item Version

(Kroenke, Spitzer, & Williams, 2001). The PHQ-9 is a brief screening measure of current depression symptoms. It includes nine items rated on a 0 (“not at all”) to 3 (“nearly every day”) scale assessing symptoms of a major depressive episode. Previous studies have validated the use of this measure in a transdiagnostic psychiatric setting (Beard, Hsu, Rifkin, Busch, & Björgvinsson, 2016). Internal consistency in the present study was good (α = .84).

Analysis Plan

Analyses were completed in SPSS (version 23.0). Relationships among substance use, dampening, impulsivity, and craving were calculated using bivariate correlations (Hypothesis 1). Prediction of substance use based on pre-treatment dampening and pre-treatment frequency of use (Hypothesis 2) was tested using binary logistic regression, with post-hoc probing of significant interaction terms using the PROCESS macro for SPSS (Hayes, 2018). The exploratory aim of testing the relationship between change in dampening and change in craving was tested by first calculating change scores in each variable (subtracting admission scores from discharge scores) and then testing the magnitude of Pearson correlations between these change scores. Before testing primary hypotheses, all variables were graphed and checked for normality.

Results

Of 292 patients, 120 (41.1%) initially met criteria for risky alcohol use, drug use, or both. Of these, 13 did not complete measures at discharge, and therefore were not included in analyses because of missing data on key study outcome measures (substance use during treatment). These participants did not statistically differ from those participants who did complete discharge measures on craving, dampening, positive urgency, or demographic variables (ps > .43). Of the final sample of 107 participants, 22 (20.8%) met criteria for risky substance use on both the AUDIT and the DAST-10; 10 (9.3%) met criteria for the DAST-10 alone without meeting criteria for risky alcohol use on the AUDIT-C; and the remaining 75 (69.8%) met criteria for risky alcohol use only. Of the 32 participants meeting criteria for risky substance use on the DAST-10, the most commonly reported substances were cannabis (n = 24), cocaine and/or prescribed amphetamine-type stimulants (n = 14), and sedatives/benzodiazepines/sleeping pills (n = 9). Table 1 presents other relevant demographic and clinical characteristics of the sample, including diagnosis and length of treatment.

Cross-Sectional Analyses: Admission

Table 2 shows cross-sectional Pearson correlations among primary variables of interest. Contrary to Hypothesis 1, trait dampening as assessed on the day of admission was not significantly correlated with craving (1a) or frequency of pre-treatment substance use (1b). However, dampening was significantly correlated with positive urgency (1c), such that more frequent use of dampening positive affect was associated with more frequent impulsive actions during elevated positive emotions. Consistent with prior research, dampening was positively correlated with symptoms of depression. As would be expected, craving was robustly associated with frequency of pre-treatment substance use and with higher scores on the DAST-10.

Prediction of Substance Use During Treatment

Of 105 participants who completed the post-treatment craving questionnaire, 40 (38.1%) reported that they used alcohol or drugs during partial hospitalization (average length: 7–10 days), despite program guidelines requiring abstinence during treatment. There were no significant differences in age, gender, race, ethnicity, craving, dampening, positive urgency, depression symptoms, DAST-10 or AUDIT-C total scores between those who used vs. did not use substances during treatment (ps > .07). Of those 40 participants reporting substance use during treatment, 15 (37.5%) reported using substances on one occasion, while most (25, or 62.5% of people who reported use during treatment) reported having used drugs or alcohol more than once. This included 21 individuals who reported using substances “2 or 3 times,” 2 who reported using “4 or 5 times,” and 2 who reported daily use during treatment.

To evaluate Hypothesis 2 that frequency of pre-treatment substance use and higher levels of dampening would predict use during treatment, a binary logistic regression was computed with use during treatment (yes/no) as the outcome. Continuous predictor variables were mean-centered and standardized prior to analysis. Predictors included gender, depression symptom severity (at admission), craving (at admission), pre-treatment use, and dampening (at admission) entered in block 1, followed by the interaction term of dampening and pre-treatment use in block 2. The initial model was not significant; χ2(5) = 7.33, p = .20; Nagelkerke R2 = .09. However, the addition of the interaction term significantly improved model fit, χ2(1) = 10.43, p = .001, with a significant final model, χ2(6) = 17.76, p = .01; −2LL = 119.84, Nagelkerke R2 = .21. As Table 3 shows, the interaction term significantly predicted higher likelihood of substance use during treatment. Follow-up tests of conditional effects showed that pre-treatment frequency of substance use was predictive of use during treatment at high (84th percentile) levels of dampening only, B = 1.36, p = .003, CI: .46 – 2.25; pre-treatment frequency of use did not predict use during treatment at moderate (p = .20) or low (16th percentile; p = .20) levels of dampening. Figure 1 illustrates the relationship between dampening, pre-treatment substance use frequency, and use during treatment.

Table 3.

Logistic Regression Model Predicting Likelihood of Substance Use During Treatment (N = 104)

B SE Wald p-value OR 95% CI
Final Model χ2(6) = 17.76, p = .007; -2LL = 119.84, Nagelkerke R2 = .21
 Gender −.74 .44 2.83 .09 .48 .20–1.13
 Depression (PHQ-9) .07 .25 .08 .78 1.08 .65–1.78
 Craving (Admission) .01 .27 .002 .96 1.01 .60–1.72
 Frequency of substance use in month prior to treatment (days) .43 .28 2.39 .12 1.53 .89–2.63
 Dampening (Admission) .21 .23 .86 .35 1.24 .79–1.93
 Frequency of Use X Dampening Interaction .75 .26 8.11 .004 2.12 1.26–3.55
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Figure 1.

Figure 1

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Relationship Between Dampening, Pre-Treatment Frequency of Substance Use, and Substance Use During Partial Hospitalization

Discussion

Heightened positive emotions may increase risk for substance use via increased craving or impulsivity during positive moods. In the present study, we demonstrated that dampening, a strategy used to down-regulate positive emotions, is related to substance use among adults with psychiatric disorders. In a naturalistic psychiatric treatment setting, adults with risky substance use were more likely to continue using substances during treatment if they used more frequently in the month prior to treatment; however, this relationship was only significant for those who reported frequently dampening positive emotions. Dampening was not significantly correlated with craving; nor was it associated with pre-treatment frequency of use.

Findings of this study suggest that the relationship between dampening positive affect and use of substances is strongly linked to patterns of substance use in the 30-day period prior to treatment. Dampening alone did not predict use of substances, yet it moderated the effect of pre-treatment substance use on substance outcomes. Frequent or heavy substance use is a well-documented predictor of substance relapse (Moos & Moos, 2005), and substance use frequency is related to other maladaptive emotion regulation strategies such as rumination (Caselli et al., 2008). The present finding highlights the importance of understanding individual differences in positive affect regulation as another predictor of return to substance use. Although speculative, there are potential implications of this pattern. Recent evidence shows that alcohol and drug use disorders are related to general difficulties regulating positive emotions (Weiss et al., 2019). The current study suggests that among patients attending a psychiatric partial hospitalization program, one aspect of positive emotion regulation—dampening—may not impact substance outcomes at lower levels of use, yet for higher levels of use, it may be a harmful strategy for achieving abstinence. Nonetheless, we cannot establish directionality, and thus cannot rule out the possibility that people with higher levels of substance use who continue to use during treatment engage more in dampening as an emotion regulation strategy. Together with previous findings, this suggests the need for more research on how different aspects of positive emotion regulation contribute to substance use outcomes. Another future research question concerns the predictive utility of dampening as it relates to the development of substance use problems. For example, as use of substances increases, perhaps some individuals respond by shifting which strategies they use to regulate positive affect based on their level of consumption. More comprehensive longitudinal studies are needed to test this possibility.

The interaction between dampening and frequency of substance use also suggests the need to better understand motivations for dampening in individuals with substance use disorders in future studies. Individuals in the present study were selected based on the presence of a risky substance use based on validated screening tools; however, a substance use disorder was not required and thus the range of severity varied. Motivations for dampening vary considerably depending on the context in which this strategy is used, indicating the need for further investigation in those diagnosed with substance use disorders. For example, in bipolar disorder, motivations to avoid mania in people with a history of severe manic episodes are correlated with use of dampening (Edge et al., 2013), while the relationship between dampening and social anxiety has been described as a potential strategy to limit displays of emotion (Eisner et al., 2009). The present study suggest that dampening is a significant contributor to substance use outcomes at higher levels of substance use, but the motivation for engaging in dampening in this context is not clear.

Regardless of the specific motivation for dampening, these findings indicate that dampening is an important individual difference measure to consider in future research assessing substance use outcomes in clinical settings. Although this specific study was not conducted in a substance use treatment facility and did not recruit individuals seeking treatment for substance use disorders, it was nonetheless conducted in a setting in which continued use of substances carries several potential risks, such as dismissal from treatment, rupture with one’s treatment team, or interactions with new psychiatric medications. Future research is needed to identify how dampening may contribute to substance outcomes in settings that are more explicitly focused on substance use treatment and among people with more severe substance misuse.

Contrary to hypotheses, dampening assessed upon admission to the treatment program was not significantly correlated with initial levels of craving. This null finding may be attributable to several factors. Craving is highly dynamic (e.g., McMillan & Gilmore-Thomas, 1996), which limits our ability to compare a trait-like emotion regulation measure to a state that can rapidly change. Also, the craving measure used in the present study is intentionally brief and does not cover all potential triggers of craving. Notably, it does not specifically assess craving triggered by affective states or by stress. Individuals who may be motivated to dampen positive emotions in response to craving might only be expected to use this strategy age in response to emotion-relevant craving cues, rather than in response to craving that is triggered by other factors such as environmental cues.

Overall, results of this study are consistent with a growing literature on dampening as a predictor or correlate of poor outcome in multiple other domains, including in depression, bipolar disorder, and anxiety disorders (Edge et al., 2013; Eisner et al., 2009, Gilbert et al., 2013; Raes et al., 2012; Werner-Seidler, Banks, Dunn, & Moulds, 2013). Together with the current results, these studies provide consistent support for the idea that positive affect dysregulation is a transdiagnostic feature of psychopathology (Carl et al., 2013). Although more experimental studies manipulating dampening are needed, the current findings support the potential value for targeting reduction of dampening among people with problematic substance use. In addition to reducing maladaptive outcomes, replacing dampening with more adaptive strategies to manage elevated positive emotions could also lead to greater levels of positive affect in general in those with risky substance use. Determining if there is evidenced to support this possibility is an important goal for future research, given that positive emotions are linked with better outcomes in substance use disorders (e.g., Schlauch, Gwynn-Shapiro, Stasiewicz, Molnar, & Lang, 2013).

Several limitations are important to note. First, this study relied on a self-report measure of substance use both before and during treatment; this would be strengthened with objective confirmation of use, such as urine drug screens. Second, participants in this study were not seeking treatment for substance use disorders, and thus may have experienced low motivation to maintain sobriety during treatment. Related to this point, levels of craving and amount of substance use during treatment were relatively low. Thus, although all participants met criteria for risky alcohol or drug use, the generalizability of these findings to more severe substance use presentations (including substance use disorders) cannot be assumed. Future studies should seek to replicate these results in a sample with substance use disorders. Finally, the demographic composition of the partial hospitalization program was not racially or ethnically diverse, which limits the ability of these results to generalize more broadly.

In summary, this study provides evidence that attempts to regulate elevated positive emotions via dampening is related to substance use during treatment, in the context of heavier pre-treatment use. These results add to a growing body of literature suggesting that dampening has widespread consequences for mood and behavior and suggests that new treatment strategies may be needed to help manage responses to positive affect in those engaging in risky substance use.

Acknowledgments

We thank the participants of this study for their contribution. We thank Kirsten Christensen for her help with preparing and administering study measures.

Funding: Dr. Peckham received support from NIH grant F32 MH115530 during preparation of this manuscript. Dr. McHugh received support from NIH grant K23 DA035297.

Footnotes

Conflict of Interest: The authors declare that they have no conflict of interest.

Declarations:

Ethics Approval: This research was conducted in accordance with the 1964 Declaration of Helsinki ethical standards.

Consent to Participate: Informed consent was obtained from all individual participants.

1

Given the need for brief measures in an acute clinical setting, branching logic was used in the DAST measure, such that if participants denied any drug use during the past year (DAST Question #1), the remainder of the DAST measure (questions 2–10) was not administered.

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