The American Journal of Drug and Alcohol Abuse, 2012; 38(4): 299–304 Copyright © Informa Healthcare USA, Inc. ISSN: 0095-2990 print / 1097-9891 online DOI: 10.3109/00952990.2012.668597 The Level of Alexithymia in Alcohol-Dependent Patients Does Not Influence Outcomes after Inpatient Treatment Hein A. de Haan, M.D. 1,2 , Arnt F. A. Schellekens, M.D., Ph.D. 2,3 , Job van der Palen, Ph.D. 4,5 , Robbert-Jan Verkes, M.D., Ph.D. 6 , Jan K. Buitelaar, M.D., Ph.D. 7 , and Cor A. J. De Jong, M.D., Ph.D. 2 1 Tactus Addiction Treatment, Deventer, The Netherlands, 2 Nijmegen Institute for Scientist-Practitioners in Addiction, Nijmegen, The Netherlands, 3 Department of Psychiatry, University Medical Centre St Radboud, Nijmegen, The Netherlands, 4 Department of Research Methodology, Measurement and Data Analysis, University of Twente, Enschede, The Netherlands, 5 Medical School Twente, Medisch Spectrum Twente, Enschede, The Netherlands, 6 Pompe Center for Forensic Psychiatry, Nijmegen, The Netherlands, 7 Department of Cognitive Neurosciences, University Medical Centre St Radboud, Nijmegen, The Netherlands Background: The inability of individuals with Alcohol Use Disorders (AUD) to recognize and describe their feelings and cravings may be due to alexithymia. Previous researches have shown evidence for a negative influence of alexithymia on treatment outcomes in patients with AUD. Therefore, it was hypothesized that high alexithymic patients with AUD would benefit less from cognitive behavioral therapy (CBT) compared with low alexithymic patients. Methods: One hundred alcohol-dependent inpatients (DSM IV) were assessed with the Mini International Neuropsychiatric Interview for psychiatric disorders, the Toronto Alexithymia Scale (TAS-20), and the European Addiction Severity Index (EuropASI). Baseline alexithymia, as a categorical and continuous variable, was used to compare or relate baseline demographic and addiction characteristics, time in treatment, abstinence, and differences in addiction severity at 1-year follow-up. Analyses were performed using χ 2 test, analysis of variance or Kruskal–Wallis, paired t-tests or Wilcoxon’s signed rank tests, multivariate logistic, and linear regression models, as appropriate. Results: The prevalence of high alexithymia (TAS-20 > 61) was 45%. The total TAS-20 score correlated negatively with years of education (r ¼.21; p ¼ .04) and positively with the psychiatry domain of the EuropASI (r ¼ .23; p ¼ .04). Alexithymia showed no relation to abstinence, time in treatment, or change in severity of alcohol-related problems on the EuropASI. Conclusion: High alexithymic patients with AUD do benefit equally from inpatient CBT-like treatment as low alexithymic patients with AUD. Scientific significance: Multimethod alexithymia assessments with an observer scale have been advised to judge the relationship with resulting outcome in CBT. Keywords: substance use disorder, addiction severity, alcohol dependence, alexithymia INTRODUCTION Alexithymia is predominantly seen as a personality con- struct that is characterized by a difficulty in identifying and describing feelings, inability to discriminate between feel- ings and physical sensations, limited fantasy life, and an externally oriented way of thinking (1). The prevalence of alexithymia in population-based studies varies between 8 and 15% (2). Some researchers have reported the preva- lence of alexithymia up to 67% (3) in patients with alcohol use disorders (AUDs). In the general population, alexithy- mia has been associated with increasing age, low educa- tional level, poor perceived health, and depression (4,5). Additionally, in substance use disorders (SUDs), alexithy- mia was related to state of anxiety and depression (6). Alexithymia has also been related to several somatic and psychiatric disorders, especially somatoform, mood, anxiety, Posttraumatic Stress Disorder (PTSD), eating, and SUD (7). However, the support for alexithymia as a risk factor for AUD is present but limited (3,7–11). Alexithymia is a negative prognostic factor for psycho- logical treatments regarding insight, emotional awareness, or therapeutic alliance (12). However, in highly structured cog- nitive behavioral interventions, alexithymic patients seem to perform equally well as nonalexithymic patients (12). There is a lack of therapeutic evaluations for alexithy- mia in SUDs, including AUD. Evidence for a negative influence of alexithymia on attrition rates, abstinence, Address correspondence to Hein A. de Haan, Tactus Addiction Treatment, P.O. Box 154, 7400AD Deventer, The Netherlands. Tel: þ31-570500100. Fax: þ31-570500115. E-mail: h.dehaan@tactus.nl 299