A real-time exploration of the affect regulation hypothesis surrounding substance use

Substance use (SU) is often characterized as an affect regulation strategy. Yet, evidence is mixed for SU's acute affect regulation function, particularly in clinical populations and substances beyond cannabis and alcohol. We examined the affective antecedents and consequences surrounding use of alcohol, cannabis, and other substances among a high-risk clinical population.

Recently suicidal adults receiving psychiatric inpatient care (N = 95) completed baseline measures followed by 28 days of ecological momentary assessment after discharge. Seven daily surveys assessed current negative affect (NA) and positive affect and SU.

Within-person increases in affective intensity predicted any SU; any SU then predicted decreased affective intensity. When alcohol, cannabis, and other SU were analyzed separately, elevated NA predicted cannabis and other SU, while decreased NA predicted alcohol use. Further, alcohol use predicted subsequent increased NA, while cannabis use predicted decreased NA, and other SU predicted decreased positive affect. Sensitivity analyses were mixed, wherein the relationship between any SU and affect became somewhat more robust, while results considering each substance separately became nonsignificant.

Although affective antecedents are consistent with SU as an attempt at affect regulation, use itself did not reliably improve affect in this high-risk clinical sample, highlighting the value of other affect regulation strategies as intervention targets given the risks of SU. Future research should examine real-time changes in affect to understand the reinforcement properties of various substances and to explore the drivers and outcomes of the potential affect regulatory function of cannabis use in high-risk adults. (PsycInfo Database Record (c) 2026 APA, all rights reserved).