Avoidance as an explanatory mechanism for poor outcomes in treatment for substance use disorders

Substance use disorders (SUDs) are prevalent and lead to significant impairments in people\u27s lives in a variety of ways. One area which has gained attention is that of SUDs and their high comorbidity with mood and anxiety disorders. Many theories exist as to why these conditions often occur together, and the self-medication hypothesis is one that has perhaps the most research and general support behind it. The self-medication hypothesis states that individuals use substances to reduce negative affect which creates a feedback loop of negative reinforcement. Individuals then develop problematic substance use in addition to emotional dysregulation. One recent theory is that of an Avoidance-Coping Cognitive Model by Bacon and Ham (2010) which states that some individuals have an increased propensity to use alcohol to reduce social anxiety because of a heightened sensitivity to social threat. This reduction is achieved through automatic processes as a result of the chemical effects of alcohol and a controlled process of shifting attention away from a threatening stimulus. This paper proposes that such a relationship is not unique to alcohol or social anxiety and instead multiple components of avoidant coping (e.g. behavioral, cognitive, and emotional avoidance) form negative reinforcement feedback loops for a variety of substances and types of emotional dysregulation. The present study was conducted at a men\u27s transitional living SUD treatment center. Participants in the study filled out several measures of emotional functioning, avoidant coping styles, and completed a behavioral avoidance task. Treatment outcome measures were also collected with participant consent. A mediation model was hypothesized, such that avoidant coping would be related to both emotional dysfunction and treatment outcomes and would explain the relationship between emotional dysfunction and treatment outcomes as well. Results showed that higher avoidant coping did predict lower treatment completion and was related to greater emotional dysfunction, but the mediation model was not supported. A moderation analysis showed individuals who discontinued the behavioral avoidance task showed a different pattern of relationships with studied variables than individuals who completed the task. Implications of the present study and future directions for research are discussed