Substance Use Disorder and Emotional Dysregulation

Substance Use Disorder and Emotional Dysregulation

Emotional dysregulation is a term used to describe an unusually poor ability to control or regulate one’s emotions, or the behaviors that appear in connection with an emotional response. Lack of emotional self-control is known to play a supporting role in the development of substance abuse and substance addiction (now diagnosed together as substance use disorder), as well as in the development of the mental illness called bipolar disorder. In a study published in 2013 in the journal Drug and Alcohol Dependence, researchers from two U.S. institutions examined the interactions that take place between substance use disorder, bipolar disorder and a lowered ability to maintain emotional control.

Emotional Dysregulation Basics

Doctors also sometimes refer to emotional dysregulation as affect dysregulation. People with this form of mood instability have an unusual tendency to shift between various (potentially contradictory) emotional states. They also have an unusual tendency to experience significant spikes in the intensity of their emotional states. The shifting emotions found in affected individuals are commonly labeled together as mood swings. The presence of these swings and outsized emotional reactions can have an impact on a person’s life that range from mild to severe. Strongly impacted people may experience problems extreme enough to substantially decrease their ability to function normally in one or more aspects of their private or social lives. In addition to substance use disorder and bipolar disorder, diagnosable conditions that commonly include an element of emotional dysregulation include borderline personality disorder, disruptive mood dysregulation disorder and intermittent explosive disorder.

Substance Use Disorder

Substance use disorder (SUD) is a catchall term used to describe significant, personally or socially disruptive problems with either the non-addicted or addicted intake of drugs or alcohol. In addition to maintaining the larger SUD category, the American Psychiatric Association (APA) gives doctors the freedom to diagnose specific forms of the disorder that match the substance in question (e.g., alcohol use disorder, stimulant use disorder or opioid use disorder). Substance use disorder and its constituent subtypes became diagnosable in 2013, when the APA officially acknowledged the intertwined nature of abuse-related concerns and addiction-related concerns in the vast majority of affected individuals.

Bipolar Disorder

Bipolar disorder is the blanket term for several diagnosable conditions that feature periodic occurrences of an extremely excited or agitated state called mania (or a lesser form of excitement/agitation called hypomania) and periodic occurrences of a severe form of depression called major depression (or some less severe form of depressive illness). These conditions, each of which features its own characteristic mixture of manic or hypomanic and depressive episodes, go by names that include bipolar I disorder, bipolar II disorder, cyclothymic disorder and “other” specified bipolar and related disorder.

Effects of Interaction

In the study published in Drug and Alcohol Dependence, researchers from Harvard Medical School and Massachusetts General Hospital examined the consequences of the interaction between emotional dysregulation and substance use disorder in two groups of teenagers. One of these groups contained teens diagnosed with some form of bipolar disorder, while the other contained teens unaffected by bipolar disorder. The members of both groups were identified as high-risk for the onset of substance use disorder. In order to quantify the degree of emotional dysregulation in the participating adolescents, the researchers looked for unusually high scores on tests designed to uncover the presence of anxiety or depression, a decreased ability to maintain attention or focus, and an increased tendency toward aggressive behavior.

After reviewing their findings, the study’s authors concluded that, compared to teens with modest or non-existent indications of emotional dysregulation, teens with prominent indications of emotional dysregulation have clearly increased risks for involvement in alcohol use disorder, various forms of drug-related substance use disorder and the use of nicotine-containing tobacco. They also concluded that the substance use-promoting effects of emotional dysregulation are just as strong in teenagers unaffected by bipolar disorder as they are in teens with a bipolar disorder diagnosis.


Teenagers can have substantially increased levels of emotional dysregulation and still remain unaffected by increased risks for substance use disorder, the authors of the study published in Drug and Alcohol Dependence note. In fact, emotional dysregulation can appear in an individual up to twice more than normal before it begins to exert its substance use-promoting influence. The authors point toward a need for further research on the subject that takes place over considerably longer periods of time.

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