All human beings experience emotion. However a number of individuals have difficulties recognising, processing and regulating their emotions. This set of emotional “deficits’ is classified as alexithymia. The prevalence rate of alexithymia in alcohol use disorders is between 45 and 67%. The objective of this paper is to review the published research on alexithymia and alcohol use, assess the methodological quality of this evidence, and draw the findings together to present a critical update on the relationship between alexithymia and alcohol use disorders. Yet, few research studies have comprehensively investigated alexithymia in alcohol use disorders, and a number of key issues still remain to be addressed in exploring the veracity of the link between alexithymia and alcohol use. For example, limited evidence exists regarding the association between alexithymia, alcohol consumption and severity of alcohol dependence. Furthermore, there is no current knowledge about the predictive utility of alexithymia in relation to more well researched and established psychological drinking constructs. Although alexithymia is often considered a risk factor for the development of alcohol use disorders, there is little evidence to support this notion. Given that alexithymia may have the potential to interfere with treatment outcomes, a better understanding of the role of alexithymia in alcohol use is needed.
Alexithymia is a multifaceted construct that was first described by Sifneos (1973) as difficulty identifying and communicating feelings, differentiating feelings and somatic sensations of emotional arousal, a diminuation of fantasy and imagination and an externally oriented cognitive style (Nemiah, Freyberger, & Sifneos, 1976). Alexithymia is a cross-cultural phenomenon and has been identified in studies across 18 different ethnic and racial groups (Parker et al., 2005 and Taylor et al., 2003). Between 45 and 67% of alcohol dependent individuals have been identified as alexithymic (Evren et al., 2008, Loas et al., 1997 and Sauvage and Loas, 2006; Uzun, Ates, Cansever, & Ozsahin, 2003). Some evidence suggests that alexithymia may have an adverse impact on the treatment of alcohol use disorders (Loas et al., 1997 and Ziolkowski et al., 1995), and given the substantial cost of such disorders worldwide (Lowinson, Ruiz, Millman, & Langrod, 2005), this relationship warrants closer attention. There is a limited amount of empirical evidence exploring the relationship between alexithymia and alcohol use, which is surprising as alexithymia has been hypothesised to be a risk factor in the genesis of alcohol use disorders (De Rick and Vanheule, 2006, de Timary et al., 2008 and Taylor et al., 1997). Because people with alexithymia often feel uncomfortable in social situations (Uzun et al., 2003;Wise, Mann, & Shay, 1992), some researchers have proposed that alexithymic individuals use alcohol as a coping mechanism for stress or to improve interpersonal functioning (Kauhanen et al., 1992 and Rybakowski et al., 1988). However few of these specific hypotheses have been empirically validated.
A number of key issues need to be addressed in examining the veracity of the link between alexithymia and alcohol dependence. First, the relationship between alexithymia and alcohol consumption as well as severity of alcohol problems requires examination. Second, various dimensions of alexithymia are potentially associated with differential risk in relation to alcohol use or response to alcohol and these relationships are worthy of inspection. Third, the predictive utility of alexithymia in terms of predicting relapse rates or response to treatment requires review. Because there has been no published critical review on alexithymia and alcohol use disorders to date, the aim of this paper is to conduct such a review.
This review has summarised the available literature on alexithymia and alcohol dependence, pointed out methodological limitations and identified areas for future research. Research studies have shown high prevalence rates of alexithymia in alcohol dependent populations, yet there is only preliminary evidence to indicate relationships between alexithymia, alcohol consumption and severity of alcohol problems, and limited evidence examining the different dimensions of alexithymia in relation to alcohol dependence. Hence the notion that alexithymia is a vulnerability factor in the development and maintenance of alcohol use disorders is premature. Despite limited support for a relationship between alexithymia and alcohol dependence, several studies have examined alexithymia in association with other risk factors for alcohol use including attachment, depression, personality disorder traits, emotional and perceptual dependency and suicidal ideation. In conclusion there is some, albeit weak evidence that alexithymia and alcohol dependence are related, and scarce evidence on the relationship between alexithymia and other psychological drinking related constructs. Given the high prevalence rates of alexithymia in this population, further research regarding the relationships between alexithymia and alcohol consumption, severity of dependence, abstinence and psychological drinking constructs including the potential role of alexithymia as a risk factor for alcohol use disorders and as a marker of treatment response, are clearly warranted.
