Prevalence of alexithymia among substance abuse clients in therapeutic community treatment

Difficulty in identifying and communicating emotional states, or alexithymia, is a key component of emotional dysregulation, an etiologic factor for substance abuse disorders. Because insight oriented treatments require the ability to recognize and communicate emotions, individuals with alexithymia have poorer treatment outcomes. Previous studies have examined alexithymia in AOD clients in the early stages of recovery, but little is known about its prevalence among clients with persistent addiction problems such as those in long term residential settings. This study assessed the prevalence and correlates of alexithymia in a sample of 295 clients ages 13-64 from seven therapeutic community (TC) residences using the Toronto Alexithymia Scale (TAS-20). Possible scores on the TAS-20 range from 20 to 100, with higher scores indicating greater alexithymia. In this sample, 30% was highly alexithymic and 22% were mild to moderately alexithymic. We examined the relationship between TAS-20 score and client sex, age, ethnicity, educational level, primary drug of abuse, criminal justice involvement, prior treatment history, and time in treatment. In adjusted analysis, males scored an average of 5.4 points lower than females (p = 0.002). Each additional year of education was associated with a 1.2 point decrease (p = 0.011) and each additional month of treatment stay was associated with a 1.2 increase (p = 0.004) in TAS-20 score. Clients referred through the legal system scored an average of 3.9 points lower than those otherwise referred (p = 0.021). Discussion will highlight the implications for treatment delivery and suggest interventions for increasing emotional literacy.