"My baseline affect is displeasure": A qualitative study of affect regulation in people with substance use disorders

The affect regulation hypothesis, meaning that substances are used with intention to change affect, shows empirically the greatest relevance for people with substance use disorders (SUDs). However, less is known about the lived experience of affect regulation throughout the trajectory of an SUD. This study seeks to examine how affect regulation is experienced, understood, and described across different phases of an SUD by patients, next of kin, and clinicians.

We triangulated the perspectives of 39 informants (13 patients, 12 next of kin, and 14 clinicians) connected to a clinic for SUD treatment in Norway and used the window of tolerance and core affect models as a basis for the interviews. The interviews were analyzed using reflexive thematic analysis through a temporal frame (before using substances, developing an SUD, maintaining an SUD, and in recovery).

The analysis resulted in four main themes with accompanying subthemes: a dysregulated starting point, substances as preferred regulation, reaching a dead end, and hard in practice. Findings of difficulties with affect regulation were consistent across the different phases of an SUD.

Using the theoretical framework of the process model of affect regulation, the most evident difficulties can be described as impairments of metaregulation of affect. This study nuances the affect regulation hypothesis and encourages further research on the hypothesis of metaregulation of affect in the population with SUD. (PsycInfo Database Record (c) 2026 APA, all rights reserved).