Psychobiological aspects of emotional regulation in alcohol use disordersAbstract:
This theoretical essay explores the relationships between different aspects of emotional regulation and alcohol use disorder. Emotional regulation is discussed as a critical process influenced by cognitive and neurobiological responses to alcohol, in which dysregulation is a key factor in the persistence and severity of this disorder. The essay highlights the impact of emotional strategies on alcohol consumption behaviors, further linking alcohol use disorder to broader cognitive and social impairments. The main findings indicate that alcohol exerts significant neurobiological and behavioral influences on emotional regulation in various individual contexts. Literature also indicates that emotional dysregulation, potentiated by alcohol consumption, is associated with cognitive and behavioral impairments, while adaptive regulatory strategies are related to benefits in the prevention and recovery of dependence.
Keywords:
alcohol abuse; emotions; behavioral problems
Resumo:
Este ensaio teórico explora as relações entre diferentes aspectos da regulação emocional e o transtorno por uso de álcool. A regulação emocional é discutida como um processo crítico influenciado por respostas cognitivas e neurobiológicas ao álcool, em que a desregulação é um fator-chave na persistência e gravidade desse transtorno. O ensaio destaca o impacto de estratégias emocionais nos comportamentos de consumo de álcool, vinculando ainda mais o transtorno por uso de álcool a deficiências cognitivas e sociais mais amplas. Os principais achados indicaram que essa substância exerce influências significativas, tanto neurobiológicas quanto comportamentais, sobre a regulação emocional em diversos contextos do indivíduo. A literatura também aponta que a desregulação emocional, potencializada pelo consumo de álcool, está associada a prejuízos cognitivos e comportamentais, enquanto estratégias regulatórias adaptativas estão relacionadas a benefícios na prevenção e recuperação da dependência.
Palavras-chave:
abuso de álcool; emoções; problemas do comportamento
Résumé :
Cet essai théorique explore les relations entre différents aspects de la régulation émotionnelle et le trouble lié à la consommation d’alcool. La régulation émotionnelle constitue un processus essentiel influencé par les réponses cognitives et neurobiologiques à l’alcool, la dérégulation jouant un rôle clé dans la persistance et la gravité de ce trouble. L’essai met en évidence l’impact des stratégies émotionnelles sur les comportements de consommation d’alcool, reliant davantage le trouble lié à la consommation d’alcool à des déficits cognitifs et sociaux plus larges. Les principales conclusions indiquent que l’alcool exerce des influences significatives, neurobiologiques et comportementales, sur la régulation émotionnelle dans divers contextes individuels. La littérature indique également que la dérégulation émotionnelle, exacerbée par la consommation d’alcool, est associée à des altérations cognitives et comportementales, tandis que les stratégies de régulation adaptatives sont liées à des bénéfices en matière de prévention et de rétablissement de la dépendance.
Mots-clés:
abus d’alcool; émotions; problèmes de comportement
Resumen:
Este ensayo teórico explora las relaciones entre diferentes aspectos de la regulación emocional y del trastorno por consumo de alcohol. La regulación emocional se discute como un proceso crítico influenciado por respuestas cognitivas y neurobiológicas al alcohol, en que la desregulación es un factor clave en la persistencia y gravedad de este trastorno. Este ensayo destaca el impacto de las estrategias emocionales en los comportamientos de consumo de alcohol, vinculando aún más el trastorno por consumo de alcohol con deficiencias cognitivas y sociales más amplias. Los principales hallazgos indican que el alcohol ejerce influencias significativas tanto neurobiológicas como conductuales sobre la regulación emocional en diversos contextos del individuo. La literatura también apunta a que la desregulación emocional, potenciada por el consumo de alcohol, se asocia con deterioros cognitivos y conductuales, mientras que las estrategias regulatorias adaptativas se relacionan con beneficios en la prevención y recuperación de esta dependencia.
Palabras clave:
abuso de alcohol; emociones; problemas de comportamiento
Introduction
Alcohol ranks as one of the most consumed psychoactive substances globally, behind only caffeine. Its usage is linked to a variety of health issues and social problems (Castillo-Carniglia, Keyes, Hasin, & Cerdá et al., 2019). Furthermore, it is associated with a range of physiological, psychological, and social harm caused by problematic use (Kranzler, 2023). In this context, Alcohol Use Disorder (AUD) is characterized by a pattern of problematic behavior marked by persistent alcohol consumption despite negative consequences. The transition from casual alcohol use to AUD can be understood within the framework of the alcohol consumption model. This model includes three phases: intoxication induced by excessive alcohol intake, adverse effects during withdrawal, and preoccupation with and anticipation of alcohol cravings (Koob & Volkow, 2016).
To understand the transition from alcohol use to AUD, as well as the factors that contribute to the persistence of dependence, emotional regulation has been studied within psychobiological contexts showing similarities to alcohol dependence. Emotional regulation is defined as the process of influencing one’s own emotions and their experienced impact (McRae & Gross, 2020). Research shows altered neural activation patterns in regions such as the prefrontal cortex, limbic system, and mesolimbic pathways, along with common disruptions in emotional processing, cognitive control, and impulse regulation (Kirk-Provencher, Hakimi, Andereas, Penner, & Gowin, 2024).
Recent research has highlighted strong links between problematic alcohol use and emotional dysregulation (Weiss et al., 2022), as well as between emotional regulation strategies and ongoing substance use (You, Rassu, & Meagher, 2023). Therefore, this study aims to provide a theoretical review, summarizing recent scientific findings and evidence on the relationship between alcohol consumption and emotional regulation.
Dynamics of emotional regulation: the etiology of adaptive strategies and the emotional regulatory cycle
The etiology of emotional regulation focuses on the interaction of biological, psychological, and social factors that actively influence how individuals create and express emotions. In this regard, the process model of emotional regulation breaks the regulation process into successive stages, each affected by both biological foundations and psychological, social, and cultural factors (Gross & Ford, 2023).
Biologically, emotional regulation is closely connected to the function of the prefrontal cortex, which manages emotional input from the limbic system and other brain structures involved in processing emotions. Research on neural plasticity indicates that over time, an individual’s emotional regulation techniques can influence and reshape the brain regions associated with this process. Genetic and neurochemical factors also play a significant role in emotional responses. For example, variations in serotonin (5-HT) function are linked to emotional sensitivity, as this neurotransmitter is essential for maintaining mood stability, controlling anxiety, and inhibiting behavioral reactions. Reduced serotonergic activity is related to increased emotional reactivity and impulsiveness. Similarly, dopamine (DA) is crucial for reward processing and motivation regulation. Changes in dopaminergic transmission can impair the ability to regulate affective states and predict consequences, thus affecting emotional regulation strategies.
Emotional development during childhood is greatly affected by interactions with caregivers and cognitive skills like attention and reappraisal. These factors influence how individuals handle emotional challenges, improving their ability to recognize, interpret, and control emotions. Positive caregiving experiences build secure attachment, which then encourages emotional resilience and the internalization of effective regulation techniques, such as self-soothing and cognitive restructuring. Conversely, inconsistent or neglectful caregiving can weaken these processes, making individuals more prone to emotional dysregulation. Social interactions can either intensify or calm emotions, teaching either healthy or dysfunctional coping strategies. Cultural norms and values determine which emotions are seen as appropriate and how they should be expressed, and this can vary widely across societies. These factors constantly interact to create unique patterns of emotional regulation for every individual.
Building on this, the process model of emotional regulation explains how individuals manage and influence their emotional responses to specific situations; it focuses attention on particular aspects of those situations, interprets the emotional significance of these aspects, and generates emotional responses (McRae & Gross, 2020). In this context, researchers have identified five points in the emotional process in which individuals can regulate their emotions: situation selection (avoidance), situation modification (coping), attention deployment (rumination, distraction), cognitive reappraisal (cognitive reappraisal, acceptance), and response modulation (suppression, physiological intervention). Within this model, individuals can use various strategies in response to a single emotionally charged situation, some of which are automatic and instinctive, while others require conscious effort and practice. As a result, scientific literature has focused on studying cognitive reappraisal and emotional suppression, becoming the most extensively researched strategies (Gross & Ford, 2023).
Cognitive reappraisal changes emotional responses by reinterpreting events. This method mainly activates the prefrontal cortex (PFC) and the anterior cingulate cortex, while decreasing activity in areas responsible for emotional evaluation, such as the insula and amygdala, and simultaneously activating cognitive control systems. This improves emotional regulation effectiveness, depending on the context in which it is used (McRae & Gross, 2020). People often make more suitable emotional choices with this technique, except in highly intense situations where cognitive reappraisal is less effective.
Emotional suppression, however, is part of the final modifiable stage of the emotional cycle, where it adjusts emotional responses by inhibiting expressions or behaviors linked to emotions and processes of emotional awareness. This approach involves the inhibitory systems of the ventromedial PFC and the central nervous system (CNS) (McRae & Gross, 2020). It is also associated with reduced emotional control due to increased activation in the limbic regions, which can be beneficial for the individual depending on the situation or context.
The role of emotional dysregulation in AUD: a psychobiological analysis
Emotional dysregulation is a key factor in understanding AUD. This link is mainly due to the neurological similarities and interactions between the two processes (Suzuki et al., 2020). Chronic activation of reward systems, as seen in ongoing alcohol use, disrupts the neurochemical pathways in the mesolimbic and mesocortical systems. Consequently, there is a reduction in D2 receptors in the PFC, which impacts emotional and cognitive areas involved in emotional regulation, including decreased activity in the PFC, orbitofrontal cortex, and anterior cingulate gyrus.
Studies involving individuals with AUD have also shown cognitive and regulatory changes related to both positive and negative emotions (Weiss et al., 2022). Participants with AUD in these studies showed a significant decrease in pleasure from non-substance-related stimuli (Kirk-Provencher, Hakimi, Andereas, Penner, & Gowin, 2024). Simultaneously, higher levels of impulsivity (Jakubczyk et al., 2018), anxiety (Lannoy et al., 2021), depression (Salguero, Pilatti, Michelini, Rivarola Montejano, & Pautassi, 2023), aggression (Weiss et al., 2021), and reduced distress tolerance (Zaorska et al., 2023) among individuals with AUD further explained the increase in negative emotions.
Similarly, emotional dysregulation is most strongly linked to the negative effect phase in AUD, which is closely connected to withdrawal symptoms (Koob & Volkow, 2016). During this phase, alcohol cravings activate neural circuits that are usually involved in emotional regulation processes. These include the PFC (specifically the dorsolateral and ventromedial regions), the anterior cingulate cortex, the amygdala, and the insula (Radoman, Fogelman, Lacadie, Seo, & Sinha, 2024). These regions are responsible for evaluating emotional significance, exercising cognitive control, and integrating interoceptive signals. However, these functions can become dysregulated during cravings and withdrawal. In this context, emotional dysregulation can be related to altered responses to negative emotions, which can increase the desire to consume alcohol (Suzuki et al., 2020).
Research has shown that individuals with AUD exhibit notable changes in behavioral patterns and emotional regulation strategies compared to the general population. Due to neural changes induced by alcohol consumption (Zeng et al., 2023), maladaptive response modulation strategies tend to dominate, often overshadowing adaptive ones. The research also highlights the reduced effectiveness of cognitive reappraisal in situations that impair PFC function, as occurs under the influence of alcohol. However, despite this diminished effectiveness caused by neural changes, using adaptive emotional regulation strategies-which improve emotional control-is linked to better outcomes in alcohol-dependent individuals. These moments of effective emotional regulation serve as a significant protective factor.
In severe cases of AUD, the persistence of substance dependence is mainly explained by abnormalities in cognitive control systems and emotional processing, which directly affect emotional regulation. These deficits can lead to alcohol relapses and cravings (Suzuki et al., 2020; Lannoy et al., 2021). Individuals with AUD and emotional dysregulation may also experience increased pain sensitivity and deficits in cognitive and social functions, making emotional regulation, emotional perception, and motivation for change especially difficult, thus hindering the maintenance of abstinence.
Specificities of emotional dysregulation in different patterns of alcohol consumption associated with AUD
AUD often coexists with other problematic drinking behaviors, such as binge drinking and heavy drinking. In this context, many studies have explored how emotional dysregulation affects various drinking patterns linked to AUD. Binge drinking, which involves consuming large amounts of alcohol (four to five drinks) in a short period, is most common among younger individuals. This behavior has been associated with symptoms of depression, anxiety, and loneliness (Lannoy et al., 2021), as well as using alcohol to cope with traumatic events. Studies have shown that binge drinkers have difficulty focusing on the emotional aspects of situations, which can impair emotional recognition. Additionally, excessive alcohol intake can cause neural changes like those seen in individuals with AUD.
Fluctuations between binge drinking and abstinence can significantly disrupt brain function by affecting key neural systems involved in cognitive and emotional regulation. Chronic cycles of intoxication and withdrawal have been shown to impair the PFC, which reduces executive functions such as impulse control, decision-making, emotional appraisal, and working memory. These deficits hinder an individual’s ability to respond appropriately to emotionally significant stimuli. Additionally, binge drinking alters the mesolimbic dopamine system, leading to increased reward sensitivity and diminished aversive learning. Together, these changes reinforce maladaptive emotional responses and compulsive alcohol-seeking behaviors, ultimately undermining emotional self-regulation (Gowin, Manza, Ramchandani, & Volkow, 2021; Pérez-García et al., 2022). When exposed to negative emotions, these individuals show clear deficits in generating appropriate emotional responses (Benzerouk et al., 2022). Similarly, they often struggle to identify emotions both internally and externally, which is a common trait among those who engage in heavy alcohol use (Lannoy et al., 2021).
Heavy drinking (defined as consuming 15 or more alcoholic drinks per week for men and eight or more for women) is linked to various negative outcomes in the physical, psychological, and social areas (Kranzler, 2023). Additionally, heavy drinking is often associated with high levels of aggression and violence. In this context, current research indicates that the combination of heavy drinking and emotional dysregulation increases the risk of violent behavior, especially when there is increased frustration, difficulty controlling impulses, and the lack or improper use of emotional regulation strategies to handle stressful situations or negative emotions (Neilson, Gulati, Stappenbeck, George, & Davis, 2023; Halmos, Leone, Parrott, & Eckhardt, 2021).
Emotional vulnerability in AUD: an analysis of impulsiveness, anxiety, and depression in emotional dysregulation
Emotional vulnerability, which is an individual’s tendency to experience disproportionate or prolonged negative emotional responses to adverse situations, is heavily influenced by environmental, cultural, and past experiences. This concept is key in understanding the emotional and cognitive processes involved in emotional disorders such as emotional dysregulation, impulsivity, anxiety, and depression. Factors like excessive selective attention to harmful stimuli, a tendency to focus on memories associated with negative emotions, negative interpretations of ambiguous situations, and rumination all contribute to emotional vulnerability. These elements are shaped by personal experiences, personality traits, and cognitive tendencies (Zuzama, Fiol-Veny, Roman-Juan, & Balle, 2020; Mansueto et al., 2022). They have significant psychological effects, including increased emotional sensitivity and biased processing of emotionally negative information, which can impair adaptive emotional responses. While unpleasant memories often intensify feelings of shame and failure, rumination and negative attentional biases are cognitive patterns linked to emotional dysregulation and psychiatric disorders, worsening symptoms of anxiety and depression (Aslan, Dorey, Grant, & Chamberlain, 2024; McGlinchey, Kirby, McElroy, & Murphy, 2021). Therefore, emotional vulnerability can hinder a person’s ability to regulate emotions effectively, leading to emotional imbalances and intensified mental health symptoms and dysfunctional behaviors, especially in individuals with AUD (Tariq, Gray, Gregory, & Chan, 2024).
In this context, a more in-depth analysis of impulsivity, a key factor in its interaction with emotional dysregulation and the development of AUD, is crucial. Impulsivity is defined as having difficulty with controlling impulses, delaying immediate gratification, and making thoughtful decisions (Jakubczyk et al., 2018). Several studies show a positive link between impulsivity-related traits and problematic alcohol use, often alongside emotional dysregulation (Stellern et al., 2023). Individuals with AUD and emotional dysregulation frequently face significant impulse control issues, which appear as challenges in managing alcohol consumption and the urge to drink after brief periods of abstinence. These behaviors often serve as coping mechanisms for negative emotions (Jakubczyk et al., 2020). Additional research suggests that, beyond impulsiveness, individuals with AUD struggle to evaluate the consequences of their alcohol-related actions, limiting their ability to delay immediate gratification for future rewards. This difficulty worsens emotional dysregulation and impulsivity (Luquiens et al., 2025).
Anxiety, often linked with impulsivity in individuals with AUD, is not only associated with a predisposition for emotional dysregulation (Wołyńczyk-Gmaj et al., 2022) but also with increased mood dysregulation and psychiatric symptoms. Furthermore, anxiety symptoms, when combined with emotional dysregulation, can worsen sleep problems such as insomnia (Wołyńczyk-Gmaj et al., 2022) and raise the risk of binge drinking episodes (Lannoy et al., 2021). The lack of effective emotional regulation strategies in individuals with AUD is strongly connected to the intensification of anxiety symptoms, especially those related to coping. In the case of Social Anxiety Disorder (SAD), it is more likely to be linked with problematic alcohol use compared to other anxiety disorders because of the absence of proper emotional regulation strategies to manage the disorder’s symptoms. Research shows that individuals with SAD often use alcohol to cope with negative emotions, frequently stemming from fear of stigma and external judgment (Kim & Kwon, 2020), highlighting the link between maladaptive emotional regulation strategies and anxiety within the context of AUD.
Considering that depression is commonly seen in individuals with alcohol-related issues, and that severe depressive symptoms are linked to increased alcohol consumption (Salguero et al., 2023), it is important to recognize that other substance use disorders, especially tobacco use disorder, have even higher rates of comorbidity among those with AUD (Castillo-Carniglia et al., 2019). Therefore, understanding the broader context of psychiatric comorbidities is key to accurately assessing emotional regulation challenges within this group. To cope with depressive symptoms, individuals often turn to alcohol to manage their emotions, relying on maladaptive emotional regulation strategies like suppression and rumination, which are misused during emotional processing cycles. This behavioral pattern is directly connected to mood disorders, excessive alcohol use, and the stigma associated with depression (Lannoy et al., 2021). Moreover, individuals with depressive symptoms and AUD are more likely to experience self-stigmatization, which can intensify suicidal behaviors, mainly because of an increased sense of personal weakness and negative self-beliefs (Saffari et al., 2022).
Influence and variations of sociodemographic and historical aspects on emotional regulation in individuals with AUD
As previously mentioned, emotional regulation results from the dynamic interaction between biological, psychological, and social factors. In this context, histories of trauma, social exclusion, and structural inequalities can intensify emotional challenges. Conversely, cultural and social differences play a crucial role in shaping coping strategies and emotional expression, both of which are essential components of emotional management. Considering these factors, it is important to examine how sociodemographic elements like age and gender, along with histories of abuse or trauma, influence emotional dysregulation in individuals with AUD.
Regarding age, literature suggests that adolescents and young adults between 12 and 20 years old are more likely to engage in excessive alcohol consumption compared to adults. However, variations in drinking patterns within this age group are heavily influenced by the specific cultural and environmental contexts of each social group. This stage of life is also linked to increased emotional vulnerability due to reduced sensitivity to the effects of excessive alcohol intake and neurological deficits resulting from the incomplete development of key brain structures, such as the PFC (Kuhns, Kroon, Lesscher, Mies, & Cousijn, 2022). Adolescence is recognized as a critical period for the maturation of emotional regulation (Silvers, 2022). Research shows that adolescents who are less capable of controlling their emotional impulses often rely on less adaptive coping strategies, such as avoidance, and are less likely to use distraction techniques to manage negative emotions. Furthermore, studies have found that cognitive reappraisal, an adaptive mechanism of emotional regulation, may be compromised during this period due to the PFC’s ongoing development and the overactivation of the amygdala, areas involved in emotional processing (Silvers, 2022). However, differences in emotional regulation strategies across age groups remain a topic of debate, with some studies failing to provide clear conclusions about how emotional responses differ between adolescents and adults (Smith et al., 2023).
Research on emotional regulation in alcohol-related problems has been limited, particularly regarding the differentiation between age groups. Studies focusing on specific age groups tend to center mainly on college students or adults. In this context, alcohol consumption among college students is often associated with symptoms of depression and anxiety and is frequently used as a coping mechanism for negative emotions (You et al., 2023). Additionally, studies with adults have observed a negative correlation between emotional suppression and excessive alcohol use, a finding that contrasts with studies on adolescents, in which this link was not identified (Teeters, Laves, King, & Brausch, 2023). In contrast, compared to college students, adults are more likely to engage in simultaneous alcohol and marijuana use (Lee et al., 2022) but show fewer deficits in emotional regulation (Weiss et al., 2022). These findings highlight a significant gap in our understanding of emotional regulation across different age groups of alcohol consumers.
When it comes to gender, several studies indicate that men tend to consume alcohol in larger amounts and are more likely to meet the criteria for AUD. They also show a higher likelihood of co-occurring alcohol and marijuana use, heavy drinking, and excessive consumption behaviors (Lee et al., 2022). Regarding emotional regulation strategies, cognitive reappraisal has been identified as a protective factor against AUD in women, with similar outcomes suggested for men (Teeters et al., 2023). This highlights the importance of cognitive reappraisal within the process model of emotional regulation as an effective strategy for both men and women in preventing AUD. As for maladaptive strategies, while some studies suggest women tend to favor suppression and avoidance more (Smith et al., 2023), others show no significant gender differences concerning the impact of these strategies on alcohol consumption (Teeters et al., 2023). These findings emphasize that behavioral differences between men and women regarding alcohol use and emotional regulation may vary depending on factors such as sample characteristics, geographic regions, and age groups of participants.
Additionally, within the context of historical factors, it is important to note that, among individuals with Post-Traumatic Stress Disorder (PTSD), issues related to impulse control, depressive symptoms, and cognitive aspects may be affected by past traumatic experiences, especially in individuals with AUD who lack effective emotional regulation strategies (Holzhauer, Sherrill, Musicaro, & Ellis, 2024). This finding highlights the protective role of emotional regulation strategies against excessive alcohol consumption, given the link between low cognitive reappraisal and increased alcohol use in this group.
Childhood abuse is a significant predictor of various comorbidities in individuals with substance dependence, including emotional regulation deficiencies and the development of adaptive emotional skills (Gerhardt et al., 2023). In the context of alcohol use, a history of childhood abuse is strongly associated with excessive alcohol consumption in adulthood. Individuals with AUD who experienced childhood abuse often show higher levels of emotional dysregulation and anxiety, which are positively linked to pain sensitivity and low pain tolerance (Zaorska et al., 2020). Additionally, alcohol consumption among those with a history of childhood abuse is frequently driven by emotional dysregulation, characterized by maladaptive coping strategies such as difficulty managing problems and limited emotional flexibility. These factors contribute to AUD as a way to cope with intense negative emotions, a pattern common among those who have experienced childhood abuse.
Conclusion
This theoretical review explored current research on emotional regulation and alcohol use. The findings show a strong link between alcohol consumption and emotional regulation, both in the brain and behavior, across different situations. Recent studies have also investigated these positive effects, showing that cognitive interventions designed to improve emotional regulation can effectively lower alcohol intake and related symptoms. For example, Knox, Hasin, Larson, and Kranzler (2019) showed that a short cognitive-emotional training program focused on boosting emotional awareness and regulation successfully reduced alcohol use among patients with AUD. Their results highlight the importance of improving cognitive-emotional processing in preventing and treating alcohol-related problems.
The study also found a notable gap in research on how emotional regulation differs across various age groups among people with alcohol-related issues. It further pointed out the ambiguity in gender-based studies, which are affected by regional, generational, and cultural factors. Future research should examine the connection between alcohol use and emotional regulation more deeply to create more effective treatments and prevention strategies for these conditions.
Data availability
The entire dataset supporting the results of this study is available within the article.
Acknowledgements
We thank Professor Andrew Kim of Toronto Metropolitan University, Canada, for his careful review and valuable feedback, which significantly enhanced the development of this manuscript.
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