Mentalization and affect regulation reflected in interviews with men diagnosed with psychosis and substance abuse

Abstract

People with psychosis have a high prevalence of problematic substance use that is generally thought to complicate their treatment. One explanation of the co-occurrence of psychosis and substance-use disorders is that people with psychosis more often than others use substances to ameliorate distress by regulating their affect and self-experience. Affect regulation is related to mentalization, which can be problematic for many people with psychosis. The aim of this study was to investigate the relationship between substance use, mentalization, and affect regulation in psychosis from an experience-based perspective. We interviewed 12 men with diagnoses of psychosis and a concurrent substance-use disorder about their mental health problems, life history, relationships, and substance use. We analysed the semi-structured interviews thematically and deductively, and organized the data into two main themes, each containing related sub-themes. The first theme concerned general ways of handling distress, which we organized hierarchically according to the level of mentalization required. The other theme grouped together different regulating functions of substance use. We discuss, from a theoretical point of view, the systematic interactions among substance use, affect regulation, and mentalization indicated in the data and propose mentalization styles that may indicate especially high risk for substance abuse. These findings may have implications for theoretical understandings of how substance use and mental health problems interact and for verbal therapy for people with both psychosis and substance-use disorders.

Keywords:

• dual diagnosis
• substance use
• psychosis
• mental health

Funding

This work was supported by the Health & Medical Care Committee of the Regional Executive Board, Region Västra Götaland, Sweden.