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Emotion Regulation in the Association Between Posttraumatic Stress Disorder and Substance Use: A Systematic Review
Alice May Bowen1, Robert Calder2, Joanne Neale1
1National Addiction Centre, King's College London, London, UK.
Trauma, Violence & Abuse
|November 28, 2025
Summary
Difficulties in emotion regulation are key to understanding the link between posttraumatic stress disorder (PTSD) and substance use disorders (SUD). Addressing emotion regulation may improve integrated treatments for co-occurring PTSD and SUD.
Area of Science:
- Psychiatry
- Clinical Psychology
- Neuroscience
Background:
- Posttraumatic stress disorder (PTSD) and substance use disorders (SUD) frequently co-occur, posing significant clinical challenges.
- Existing interventions for co-occurring PTSD and SUD have limited efficacy and high dropout rates, necessitating a deeper understanding of underlying mechanisms.
- Emotion regulation difficulties are hypothesized to be a crucial factor in the PTSD-substance use association.
Purpose of the Study:
- To systematically review the role of emotion regulation in the association between PTSD and substance use.
- To explore potential differences in emotion regulation based on gender, trauma type, and social factors.
- To inform the development of more effective integrated interventions for individuals with co-occurring PTSD and SUD.
Main Methods:
- Systematic literature search across multiple databases (Medline, Embase, PsycInfo, ASSIA, CINAHL, Web of Science).
- Inclusion criteria applied to identify 33 relevant studies examining emotion regulation in PTSD and substance use.
- Analysis of findings regarding emotion regulation difficulties, gender, trauma type, and social factors.
Main Results:
- Mixed findings suggest difficulties in regulating both negative and positive emotions are significant in the PTSD-substance use association.
- Elevated emotion dysregulation observed in individuals with co-occurring PTSD-SUD compared to SUD alone.
- Preliminary evidence indicates potential differences in emotion regulation based on gender, trauma type, and social factors, requiring further investigation.
Conclusions:
- Findings support self-medication and negative reinforcement models of substance use in the context of PTSD.
- Difficulties in emotion regulation are a critical mechanism linking PTSD and substance use.
- Integrated interventions targeting emotion regulation may offer a promising therapeutic avenue for co-occurring PTSD and SUD.
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