1. RELATIONAL ANSWER COMPETENCE
AND ALEXITHYMIA IN ALCOHOL AND
DRUG ADDICTS
Walter Colesso
(University of Padova)
The Inaugural International Conference of Italian and
Italian American Psychologists
June 3-4, 2009
Astoria Hotel Palace, Palermo, Sicily

2. 1.1 INTRODUCTION: ALEXITHYMIA IN ALCOHOL AND DRUG ADDICTS
• Many researches show that the level of Alexithymia is significantly higher in a number
of clinical groups, including substance abusers (e.g. Uzun, 2003).
• Guilbaud, Loas, Corcos, Speranza, et al. (2002); Forges, Corcos, Spranza, Laoas et al.
(2004) demonstrated:
– There was a higher level of Alexithymia in patients with addictive behaviour (63 %
in alcoholics, 41 % in drug addicts), when compared with normal controls.
– Alexithymia was not correlated with age, gender or socio-educative level in their
sample of drug addicted patients.
– This difference was mostly due to the emotional component of Alexithymia but not
its cognitive one.
• Handelsman, Stein, Bernstein, Oppenheim, et al. (2000) found strong associations among
latent variables representing Alexithymia, neurotic and expressive forms of hostility,
and PTSD symptoms in alcohol-and drug-dependent individuals undergoing
rehabilitative treatment:
– The association did not depend on the type of abused substance.
– Results support the view that substance abusers have a paradoxical double problem
with emotion:
the inability to identify and express feelings
the over-experiencing of severe negative affect
– Findings were consistent with those of Cecero and Holmstrom (1997) and Haviland,
Hendryx, Shaw, and Henry (1994).

3. 1.1 INTRODUCTION: ALEXITHYMIA IN ALCOHOL AND DRUG ADDICTS
• For Lane and Schwartz (1987), Alexithymia is linked to a deficit of emotional
awareness.
• Jouanne, Edel and Carton (2005) found that there was no significant correlation
between Alexithymia, intensity of depressive mood and anxiety, and their
measures of emotional awareness.
• Loasa, Otmanib, Lecerclec, et al. (2000) tested the hypothesis that the emotional
and cognitive components of Alexithymia are associated with dependency in
alcoholics (operazionalized as depression, relational emotional dependency,
affirmation of autonomy):
– Contrary to normal, the emotional component of Alexithymia was totally related to
depression and to relational emotional dependency.
– The cognitive component of Alexithymia was related to depression and to the
affirmation of autonomy.
– They suggested that a particular cognitive style characterized by externally oriented
thinking, affirmation of autonomy as denial of interpersonal emotional dependency
could characterize alcoholics.

4. 1.1 INTRODUCTION: ALEXITHYMIA IN ALCOHOL AND DRUG ADDICTS
 Hesse and Floyd (2008) on the basis of affection exchange theory, found that:
 Alexithymia was inversely related to:
 affectionate experience
 happiness
 use of nonverbal immediacy cues
 affectionate communication in close relationships
 closeness in close relationships
 Alexithymia was positively related to:
 depression
 stress

5. 1.1 INTRODUCTION: ALEXITHYMIA IN ALCOHOL AND DRUG ADDICTS
• Summarizing:
• There is a higher level of Alexithymia (affective component : difficulties in
identifying feelings; difficulties verbalizing feelings; reduced ability to disentangle
emotional experience from physiology) in patient with addictive behaviour (alchool
and drug addicts) that in the control group.
• In literature we find interesting variables correlating positively or negatively with
Alexithymia measures, but it’s difficult to organize them into a consistent
framework.
• Thus I proposed a consistent and evidence-based relational framework to study
Alexithymia: the Relational Answer model – ERAAwC model – by L’Abate
(L’Abate, 2000; Corsi, 2002; Cusinato & Corsi, 2005).

6. 1.2 INTRODUCTION: ERAAWC MODEL
• It’s an integrative model of relationships among intimate and non-intimate others. In its
last version, this model includes seven component resources available and exchangeable
in relationships within self and others:
(E1) Emotionality, the trigger of Relational Answer as consequence of relational
stimuli
(E2) Emotionality as expressed in relationships. It is an output of Relational Answer
(R) Rationality, the adjuster of Relational Answer
(A) Activity, the output of Relational Answer
(Aw1) Awareness of own Relational Competence
(Aw2) Awareness as experiences of past relationship memory used in the present
(C) Perceived influence of the Relational Context
• These component resources represent the ERAAwC model.
• On the basis of literature, I have hypothesized negative relations between
Alexithymia, E2, Aw1, Aw2, and A and positive relations with E1 and C resources, in
alcohol and drug addicts. These hypothesis have been verified by an empirical
research.

7. 2.1 METHOD: PARTICIPANTS
• 60 rehabilitation multicenter inpatients (alcoholics, 25%; drug addicts, 75%) and
60 healthy subjects, matched, one to one, for age, gender, and socio-relational level.
• Participants come from: North-East of Italy.
• Period of administration: February - March 2009.
• Alcohol and drug addicts:
Age: M = 37.28 (SD = 9.14).
Gender: 83.33% males; 16.67% females.
Relational status: 60.00% single; 8.33% engaged; 3.33%cohabiting; 10.00% married;
18.33% separated or divorced.
Education: 58.33% primary or secondary school; 8.33% vocational school; 31.67 high
school; 1.67% college graduates.

8. 2.2 Method: Measures
Relational Answer Competences - ERAAwC model (Corsi, 2000;
Cusinato & Colesso, 2008)
Scale
• E1 Emotionality, the trigger of Relational Answer as consequence of relational stimuli (α = .72*)
• E2 Emotionality as expressed in relationships. It is an output of Relational Answer (α = .76*)
• R Rationality, the adjuster of Relational answer (α = .75*)
• A Activity, the output of Relational Answer (α = .73*)
• Aw1 Awareness of own Relational Competence (α = .73*)
• Aw2 Awareness as memories of past relational experiences (α = .70*)
• C perceived influence of the Relational Context (α = .69*)
Alexithymia
• TAS-20: Toronto Alexithymia Scale (Taylor, Bagby, & Parker; 1992) (α = .78*)
Subscales
T1 Difficulties in identifying feelings (α = .79*)
T2 Difficulties verbalizing feelings (α = .63*)
T3 Externally oriented style of thinking (α = .66*)
* (Cusinato, 2009)

9. 2.3 Method: Analysis
 T-test: comparison of alcohol and drug addicts with normal for Relational
Answer competences and Alexithymia measures.
 Pearson Correlation of observed data in clinical group.
 Structural Equation Models: The Causal Models for Observed Variables
of clinical group (Corbetta, 1992).

10. 3.1 Results

11. 3.2 Results
GOODNESS OF FIT:
CHI-SQUARE = 20.21; DF = 19; P = .38; RMSEA = 0.033; CFI = .99; GFI = .92; CHI-SQUARE/DF = 1.06
Comparison with
Causal Model of
352 non-clinical
individuals
(Cusinato, 2009)
Lack of
E1 A
New link
E1Aw2
Figure 1. Causal model for ERAAwC and TAS-20 variables of clinical group (n = 60)
Note: RAQ-2 subscales: E Emotionality1; E = Emotionality2; R = Rationality; A = Activity; Aw = Awareness1; Aw = Awareness2; C = Context;
1= 2 1 2
TAS-20 = total score of Toronto Alexithymia Scale (Taylor, Bagby, & Parker; 1992)

12. 3.3 Results

13. 4. Discussion
Findings are consistent with those in the literature (awareness acts indirectly on Alexithmia):
1. The level of Alexithymia (TAS-20) is significantly higher in alcohol and drug addicts than healthy subjects (t (118)
= 2.00; p < .05) but effect size is small (η2partial = 0.03);
2. The level of T2, difficulties verbalizing feelings (an emotional component of Alexithymia), is significantly higher
in alcohol and drug addicts than healthy subjects (t (118) = 2.65; p < .01) and its effect size is medium (η2partial = 0.06);
Moreover, this study research suggests:
1. There aren’t quantitative differences in Relational Answer Competences between alcohol and drug addicts in
rehabilitation centers, and healthy subjects.
2. A specific structure of Relational Answer Competences characterizes alcohol and drug addicts: Emotionality
(E1) – the trigger of Relational Answer as consequence of others relational stimuli – isn’t linked to Activity (A) - the
main output of Relational Answer.
3. Emotionality (E1) can’t be discharged completely in Relational Exchanges.
4. Emotionality (E1) mainly increases perceived influence and dependency from the Relational Context.
5. Perceived influence and dependency from the Relational Context (C) increases Alexithymia.
5. Alexithymia plays a protective action toward un discharged Emotionality, that increases in alcohol or drug addicts
and it is responsible for the suffering (anxiety, depression, …) that need to be mitigated by substance abuse (alcohol,
drugs, medicines)
Limits of the study: Clinical group (alcohol and drug addicts of rehabilitation multicenter inpatients)
Size of the clinical group (n = 60)

14. Thank You
walter.colesso@unipd.it
glad to be collaborating to Relational Competence studies
in Family Psychology