The Void That Never Fills: The Interplay Between Emotions And Substance Use Disorder
4/11/2025
Article written by: Anda-Gabriela Felea
„Addiction does not care who you are” (Burkholder, 2021, p. 4)
The bond between an addict and their substance of use can feel both all-consuming and oddly comforting. That which once offered perceived freedom and security to the consumer gradually transforms, trapping them in a damaging cycle as dependency occurs. The moment they come to recognize the difficulty of quitting, those struggling with addiction confront a range of complex and challenging emotional and behavioral consequences. Failing our attempts to let go of something we consciously recognize as harmful might lead to frustration, guilt, sadness, and isolation, especially when stigma is also at play. As Burkholder (2021) states, “Addiction affects mental health and mental health affects addiction.” When we move beyond the lens of common misconceptions, we come to understand that addiction does not stem from personal weakness, but from the interplay of various factors. In this regard, it is crucial to approach ourselves and others with compassion when confronting such sensitive issues. In the following article, I invite you to explore together, with curiosity and an open mind, the emotional mechanisms that play a key role in substance use from a scientific perspective, in order to gain a deeper understanding of the struggles people suffering from substance use disorder face.
„I wish I have had a break, but it didn’t work out when you feel as bad as I did […] If I had one day where I felt like ‘no, I’ll try not to use’. And then the anxiety was getting stronger and stronger and you’re kind of just thinking ‘I have it at home, so why shouldn’t I just take one, so I can feel a little better at least?’ So unfortunately, there were no breaks.”– Alicia (Arve, 2023, p. 361)
Firstly, we must ask ourselves: Which aspects of our emotional landscape make us more susceptible to substance use? Numerous studies have demonstrated that substances temporarily alleviate negative emotions in consumers (Gross & Ford, 2024). When human beings are confronted with emotional disorders such as depression, anxiety, or post-traumatic stress disorder, or when their overall affect leans toward negativity, they may become more vulnerable to substance consumption (Burgess-Hull & Epstein, 2021). Not only do difficult emotions play an important role, but so does the way humans handle them. If we didn’t learn proper strategies to manage our emotions while growing up, we would still find ways to cope with them. However, it will likely be in a more damaging way, such as suppressing our emotions or ruminating on past events. Consequently, individuals suffering from substance use disorder tend to rely on less adaptive strategies, often resorting to maladaptive ones (Roos et al., 2020). To gain an even clearer understanding of the issue, there are also stable emotion regulation abilities often deficient in these individuals. When people lack awareness, understanding, and acceptance of negative emotions, as well as goal-oriented behaviors, it might influence their substance use (Weiss et al., 2022). Lastly, people also have emotional vulnerabilities, which can make managing addiction even more challenging (Gross & Ford, 2024). These might take the form of distress intolerance, negative urgency, anxiety sensitivity, or stress reactivity (Gross & Ford, 2024).
“I am great at numbing myself if I don’t want to deal with something.“ – R2 (Bruins et al., 2024, p. 235)
But what about our positive emotions? No one experiences only negativity throughout their life, and it is equally important to understand the role of positive affect in addiction. After all, the desire to feel better often underlies the decision to resort to substance use. Research highlights that the stable predisposition to experience positive emotions and engage with the world in an optimistic and enthusiastic manner serves as a protective factor against substance use, while the dispositional difficulty in experiencing pleasure acts as a risk factor (Emery & Simons, 2020; Kiluk et al., 2019). On the one hand, if we experience positive emotions, we might also feel less of a need to consume. However, things become more complicated when individuals struggle to sustain these states on their own (Gross & Ford, 2024). Amplifying what feels good might seem like the right and intuitive choice, especially when you know it does not usually last (Gross & Ford, 2024). In this context, substances present themselves as a risky yet accessible and quick solution. Unfortunately, the need to boost low positive affect is evident in both the early stages of substance use and among individuals with severe substance use disorder (Gross & Ford, 2024).
“I noticed that I created calmness in my head with it (…) at a certain point the reasons you are using become different. Then it’s not because it is fun or social, but because you are like- Ah, I feel so nice and calm this way.”– R12 (Bruins et al., 2024, p.235)
Despite the progress made in understanding and addressing emotional regulation in addiction, challenges remain. The not-so-good news is that people suffering from substance use disorder still face significant barriers, such as limited access to rehabilitation centers and programs, legislative regulation, and social stigma. When asked why they didn’t seek treatment, the most common responses included: not being ready to stop, the inability to afford it, potential negative impacts on their job, concern about others’ opinions, not knowing where to find treatment, and the lack of programs offering the necessary type of care (Burkholder, 2021).
On a more positive note, there are now more therapeutic approaches and resources available, along with growing interest in research within this domain. We are not completely powerless in the face of addiction. An essential step is to learn to tolerate the cravings and not act on them. Therefore, developing adaptive strategies to manage the strong emotions associated with cravings is a key component that becomes the primary target of intervention (Gross & Ford, 2024; Kober & Bolling, 2014). Some directions of treatment and strategies used in a therapeutic context are: general emotion regulation and coping skills training, scheduling of pleasant activities, focusing on problem-solving and interpersonal skills, addressing relationship problems, mindful acceptance, and contingency management (Gross & Ford, 2024; Kober & Bolling, 2014; Marlatt & Donovan, 2005).
To conclude, discussions on these matters are rarely black and white, and our ability to regulate our emotions plays a central role in addressing it. When we look beyond the surface, we uncover complex interconnections and challenging emotions that contribute to addiction. It is essential to approach this issue with both compassion and critical thinking, and learn more about the mechanisms behind it to witness further progress.
References
Arve, K. (2023). “You get stuck in it”: Young people’s accounts of attempting to quit non-medical tramadol use. Nordic Studies on Alcohol and Drugs, 40(4), 355–370.
Bruins, J., Crutzen, S., Veling, W., & Castelein, S. (2024). How to quit cannabis when you have a mental illness: Study from the perspective of patients who have successfully quit. BJPsych Bulletin, 48(4), 234–240.
Burgess-Hull, A., & Epstein, D. H. (2021). Ambulatory assessment methods to examine momentary state-based predictors of opioid use behaviors. Current Addiction Reports, 8(1), 122–135.
Burkholder, T. (2021). Drug addiction & mental health.
Emery, N. N., & Simons, J. S. (2020). The role of affect, emotion management, and attentional bias in young adult drinking: An experience sampling study. Psychopharmacology, 237(5), 1557–1575.
Gross, J. J., & Ford, B. Q. (Eds.). (2024). Handbook of emotion regulation (3rd ed.).
Kiluk, B. D., Yip, S. W., DeVito, E. E., Carroll, K. M., & Sofuoglu, M. (2019). Anhedonia as a key clinical feature in the maintenance and treatment of opioid use disorder. Clinical Psychological Science, 7(6), 1190–1206.
Kober, H., & Bolling, D. (2014). Emotion regulation in substance use disorders. In J. J. Gross (Ed.), Handbook of emotion regulation (2nd ed., pp. 428–446).
Marlatt, G. A., & Donovan, D. M. (Eds.). (2005). Relapse prevention: Maintenance strategies in the treatment of addictive behaviors. Guilford Press.
Roos, C. R., Kober, H., Trull, T. J., MacLean, R. R., & Mun, C. J. (2020). Intensive longitudinal methods for studying the role of self-regulation strategies in substance use behavior change. Current Addiction Reports, 7(3), 301–316.
Weiss, N. H., Kiefer, R., Goncharenko, S., Raudales, A. M., Forkus, S. R., Schick, M. R., & Contractor, A. A. (2022). Emotion regulation and substance use: A meta-analysis. Drug and Alcohol Dependence, 230, 109131.