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      Alexithymia in Young Adults With Substance Use Disorders: Critical Issues About Specificity and Treatment Predictivity

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          Abstract

          Several studies have reported high rates of alexithymia in drug-dependent individuals, but supporting evidence attests association between alexithymia and a variety of psychiatric disorders, raising doubts about its specificity. Moreover, controversies are emerging about alexithymia assessment: self-report measures present shortcomings with respect to discriminant validity and reliability. As regards treatment for substance use disorders (SUDs), alexithymia has been linked to poorer outcomes, but the results are inconsistent. The aim of the present study is to investigate alexithymia in substance-dependent young adults by examining: (a) the specificity of alexithymia in drug-dependent inpatients, compared to healthy individuals and patients with psychiatric disorders (behavioral and emotional disorders) and (b) the predictivity of alexithymia in determining treatment outcomes in terms of relapses, drop-outs from treatment and the rate of relapse per month of treatment. Two studies were conducted to fulfill these aims: Study 1 and Study 2. Study 1 involved 90 late adolescents, aged 17–21. To fulfill the first aim, 30 inpatients diagnosed with SUD were compared with 30 healthy controls and 30 individuals referred to an outpatient neuropsychiatric unit (a). The participants completed the Toronto Alexithymia Scale−20 (TAS-20) and the Symptom Checklist-90-Revised (SCL-90-R). The results indicated that both clinical groups reported higher TAS-20 scores than the non-clinical subjects, but they did not differ from each other (a); moreover, a large correlation was detected between alexithymia and depressive symptoms, as assessed by the SCL-90-R. Study 2 involved 55 inpatients with SUD recruited in a therapeutic community. The participants completed the TAS-20, and clinicians filled out the Observer Alexithymia Scale (OAS). No association was found between self-report and observational measures. Neither self-reported nor observed alexithymia predicted the number of relapses, drop-out from treatment, or the rate of relapses per month of treatment (b). When the interaction with gender was explored, the global score of alexithymia and the “Distant” OAS subscale predicted the number rate relapses only in males. The TAS-20 did not discriminate between the clinical groups. The limited ability of both observed and self-reported measures in predicting treatment outcome raises questions on the specificity of alexithymia among the substance-dependent inpatient population.

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          Drug dependence, a chronic medical illness: implications for treatment, insurance, and outcomes evaluation.

          The effects of drug dependence on social systems has helped shape the generally held view that drug dependence is primarily a social problem, not a health problem. In turn, medical approaches to prevention and treatment are lacking. We examined evidence that drug (including alcohol) dependence is a chronic medical illness. A literature review compared the diagnoses, heritability, etiology (genetic and environmental factors), pathophysiology, and response to treatments (adherence and relapse) of drug dependence vs type 2 diabetes mellitus, hypertension, and asthma. Genetic heritability, personal choice, and environmental factors are comparably involved in the etiology and course of all of these disorders. Drug dependence produces significant and lasting changes in brain chemistry and function. Effective medications are available for treating nicotine, alcohol, and opiate dependence but not stimulant or marijuana dependence. Medication adherence and relapse rates are similar across these illnesses. Drug dependence generally has been treated as if it were an acute illness. Review results suggest that long-term care strategies of medication management and continued monitoring produce lasting benefits. Drug dependence should be insured, treated, and evaluated like other chronic illnesses. JAMA. 2000;284:1689-1695.
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            The prevalence of 'alexithymic' characteristics in psychosomatic patients.

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              Cross validation of the factor structure of the 20-item Toronto Alexithymia Scale: an Italian multicenter study.

              The 20-item Toronto Alexithymia Scale (TAS-20) has been shown in previous research to measure a general dimension of alexithymia with three intercorrelated factors. This study evaluated the reliability and factorial validity of an Italian translation of the TAS-20 in a group of normal adults (N = 206) and in a mixed group of medical and psychiatric outpatients (N = 642). Using confirmatory factor analyses, the previously established three-factor model of the TAS-20 was found to be replicable in both groups. In addition, the Italian TAS-20 demonstrated adequate estimates of internal reliability and test-retest reliability. Although evaluation of the convergent, discriminant, and concurrent validity of the TAS-20 is required in Italian populations, the present results support the use of the Italian translation of the scale for clinical and research purposes.
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                Author and article information

                Contributors
                Journal
                Front Psychol
                Front Psychol
                Front. Psychol.
                Frontiers in Psychology
                Frontiers Media S.A.
                1664-1078
                22 May 2018
                2018
                : 9
                : 645
                Affiliations
                [1] 1Department of Developmental Psychology and Socialization, University of Padua , Padua, Italy
                [2] 2Department of Women's and Children's Health, University of Padua , Padua, Italy
                [3] 3Therapeutic Community “Villa Renata” , Venice, Italy
                [4] 4Childhood Adolescence Family Unit, Ulss6 Veneto , Padua, Italy
                Author notes

                Edited by: Lorys Castelli, Università degli Studi di Torino, Italy

                Reviewed by: Federica Galli, Università degli Studi di Milano, Italy; Sara Bottiroli, IRCCS Mondino, Italy

                *Correspondence: Alessandra Simonelli alessandra.simonelli@ 123456unipd.it

                This article was submitted to Clinical and Health Psychology, a section of the journal Frontiers in Psychology

                Article
                10.3389/fpsyg.2018.00645
                5972315
                1d752913-7117-4be8-8926-18aa280c3e14
                Copyright © 2018 Parolin, Miscioscia, De Carli, Cristofalo, Gatta and Simonelli.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 07 November 2017
                : 16 April 2018
                Page count
                Figures: 2, Tables: 4, Equations: 0, References: 109, Pages: 14, Words: 10820
                Categories
                Psychology
                Original Research

                Clinical Psychology & Psychiatry
                alexithymia,substance use disorder,young adulthood,treatment outcome,20 item -toronto alexithymia scale

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