Emotion regulation and mental health symptoms in adults who use substances: A mediation model

Depression and substance use frequently co-occur, posing significant challenges to affected individuals. While prior research has established associations between emotion regulation and depression, limited work has examined these associations among individuals who use substances and potential mechanisms that explain this association. Therefore, the aim of the present study is to examine the association between difficulties in emotion regulation and depression among adults who are in a treatment center for substance abuse (n = 124) and how this association may be mediated by anxiety and internalized stigma of substance abuse. A parallel mediation model was conducted to examine the association between difficulties in emotion regulation and depression with the mediators of anxiety and internalized stigma of substance use. Results suggest that difficulties in emotion regulation were indirectly associated with depression through both anxiety and internalized stigma of substance use. The results indicate full mediation, as the direct effect of emotion regulation on depression was not significant when anxiety and internalized stigma were included in the model. These findings highlight the distinct roles of anxiety and internalized stigma in linking emotion regulation difficulties to depressive symptoms, suggesting that emotion regulation deficits are associated with depressive symptoms through worry, fear, and internalized stigma. Implications of these findings include substance use treatment planning, specifically targeting mental health and stigma reduction.