Aydın ERİNCİK, Graduate Student, Near East University, Graduate Education Institute, Nicosia TRNC, e-mail: aydiner35@hotmail.com ORCID: https://orcid.org/0000-0002-0331-4430
Assist. Assoc. Dr. Hande ÇELİKAY SÖYLER, Near East University, Faculty of Arts and Sciences, Nicosia TRNC, e-mail: hande.celikay@neu.edu.tr ORCID: https://orcid.org/0000-0001-6735-1321
Azime Nur GÜRBÜZ, Undergraduate Student, Ege University, Faculty of Letters, İzmir, e-mail: azimenurg@gmail.com ORCID: https://orcid.org/0000-0003-1982-4686
Abstract The aim of this study is to examine the relationship between substance use disorders and factors affecting substance use disorders, emotion regulation skills and attachment styles in 9th grade high school students. In addition, it was investigated which sociodemographic variables were affected by these variables. Research data were obtained by using Personal Information Form, Addiction Profile Index for Adolescents (API-E), Relationship Scales Questionnaire (PSA, Emotion Regulation Scale for Adolescents (CISS)). As a result of the analysis, it was determined that as the severity of addiction increased, external dysfunctional emotion regulation strategies increased. No significant relationship was observed between the severity of addiction and attachment styles. It was found that female students had a stronger desire for substance use and higher motivation to quit substance use than male students. The results obtained were discussed by comparing them with the findings in the literature, limitations and suggestions were shared in this direction.
Keywords: Adolescence, Substance Use, Emotion Regulation, Attachment Styles Article Submission Date: 28.10.2022 Article Accepted: 00.00.2022 Recommended Citation: Erincik, A., Çelikay Söyler, H. and Gürbüz, AN (2022). Investigation of the Relationship between Substance Use and Emotion Regulation and Attachment Styles in Ninth Grade High School Students, Journal of Social, Human and Administrative Sciences, 5(12): ?-?.
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Journal of Social, Humanities and Administrative Sciences 2022, 5(12): ?-? DOI: 10.26677/TR1010.2022. ISSN: 2667–422X Journal website: www.sobibder.org
RESEARCH PAPER
Examining the Relationship Between Substance use, Emotion Regulation and Attachment Styles in Ninth-Grade High School Students
Aydin ERINCIK, MSc. Student, Near East University, Institute of Graduate Programs, Nicosia TRNC, e-mail: aydiner35@hotmail.com ORCID: https://orcid.org/0000-0002-0331-4430
Assistant Prof. Dr. Hande ÇELİKAY SÖYLER, Near East University, Faculty of Arts and Sciences, Nicosia TRNC, e-mail: hande.celikay@neu.edu.tr ORCID: https://orcid.org/0000-0001-6735-1321
Azime Nur GÜRBÜZ, Undergraduate Student, Ege University, Faculty of Literature, İzmir, email: azimenurg@gmail.com ORCID: https://orcid.org/0000-0003-1982-4686
Abstract This research aims to examine the relationship between substance use disorders, the factors affecting substance use disorders, emotion regulation, and attachment styles in ninth-grade high school students. Additionally, it was examined which sociodemographic variables influenced these variables. Personal Information Form, Addiction Profile Index in Adolescents (BAPI-E), Relationship Scales Questionnaire (IÖA), and Emotion Regulation Scale (EIDDD) were used. A cross-sectional study model with a relational model was used to identify the relationship between the variables. It was found that as the severity of addiction increases in adolescents, external dysfunctional emotion regulation strategies increase. No significant relationship was observed between the severity of addiction and attachment styles. It has been found that female students have a more severe desire for substance use than male students, and their motivation to quit substance use is higher. The results were compared with findings from the literature, limitations and recommendations were presented.
Keywords: Adolescence, Substance Use, Emotion Regulation, Attachment Styles. Received: 28.10.2022 Accepted: 00.00.2022 Suggested Citation: Erincik, A., Çelikay Söyler, H. and Gürbüz, AN (2022). Examining the Relationship Between Substance use, Emotion Regulation, and Attachment Styles in Ninth-Grade High School Students, Journal of Social, Humanities and Administrative Sciences, 5(12): ?-?.
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INTRODUCTION Adolescence is a period between childhood and adulthood, and it is a stormy period in which many physical, emotional, cognitive and psychological changes develop rapidly (Santrock, 2014). Adapting to all these changes in a healthy way is important for the individual to lead a regular life in the following processes. However, adolescents who tend to explore their social environment may tend to use alcohol or illegal substances with the effect of the stormy process they experience and the contribution of the social environment (Baysan Arabacı et al., 2017:136). By the US Centers for Disease Control and Prevention (CDC), ‘adolescence’ represents individuals aged 15-17. (CDC, 2021). Therefore, studies on adolescents cover this age range. According to data published by the CDC, 15% of high school students use illegal drugs, and 14% abuse prescription opioids (CDC, 2022). According to the results of the studies conducted over the years, the lifetime prevalence of alcohol use in 8th, 10th, and 12th grade students was found to be 27%, 49%, and 66%, respectively. The prevalence of substance use or addiction in adolescents is 2.7-8% for alcohol; 2.7-7% for marijuana; It is in the range of 2-9% for illegal drugs. In addition, having a substance use disorder in adolescence is more common in boys than girls (espa et al., 2017). According to the data collected from 35 European countries in the last report of the European School Survey Project on Alcohol and Other Drug Use (ESPAD) published in 2019, the lifetime prevalence of substance use among students who have reached the age of 16 is 41% for cigarettes, 40% for electronic cigarettes and 40% for alcohol. 79, 17% for an illicit substance, 7.2% for volatiles, 3.4% for new generation psychoactives, and 9.2% for drug abuse (ESPAD, 2020:13-15). In our country, the most comprehensive studies on substance use in adolescence are stated in the 2012 Turkey Drug Report, which also examines the young population (Turkey Monitoring Center for Drugs and Drug Addiction, 2012:58-59). According to this report, lifetime prevalence of substance use was 4%, 3.6%, 3% and 4% in 1995, 1998, 2001 and 2003, respectively. While the rates of substance use other than cannabis were reported as 1% in 1995 and 3% in 2003, heroin use at least once was reported as 1.6% in 1998 and 2.1% in 2001. The results of the research, which is also included in the same report and conducted with a large sample group in 2011, show that the rate of adolescents who use substances at least once in their lifetime is 1.5%. This rate is higher for male students (2.3%) compared to female students (0.7%). Other recent studies examining the lifetime prevalence of substance use in high school students show that 24% of boys and 7.7% of girls are smokers, and the prevalence of lifetime substance use other than smoking is 8.2% in boys and 1.9% in girls. In a study examining cigarette and alcohol use, these rates are 35% for cigarettes and 18.7% for alcohol (Akkuş et al., 2017:42-67). There are many hereditary and environmental factors that affect substance use in adolescence (Gray and Squeglia, 2018:621). Curiosity, emulation and the desire to be acceptable among the peer group are the most common reasons, while the problems experienced and the pursuit of entertainment are also shown among the reasons that push adolescents to use drugs (Hall et al., 2016:267; Gürçay, 2008:39; TÜBİM, 2020:30). The emotion regulation skill of the individual plays an important role in the face of all these factors that lead to substance use. Emotion regulation means the power to monitor, control, evaluate and change the emotional reactions of the individual in various situations in order to achieve a goal (Kıral, 2011:22). When the situation we are in and our own desires do not match, emotion regulation strategies can come into play in order to influence and control the emotion experienced. Examples of these strategies are avoidance, cognitive reappraisal, rumination, and acceptance actions (Mcrae & Gross, 2020:2-3). In a meta-analysis study examining the studies on substance use and emotion regulation, there was no significant difference between the two variables.
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It was concluded that people who have difficulties in emotion regulation are more prone to substance use (Weiss et al., 2022:1). In addition, it has been observed in other studies that adolescents with alcohol and substance use have difficulties in emotion regulation (Weinberg & Klonsky, 2009:618; Wilens et al., 2013:6-7). In a study conducted on a group of inpatients receiving addiction treatment, it was observed that patients who self-injured had more difficulty in controlling their behavior and reaching emotion regulation strategies, especially in the face of negative emotions, in terms of emotion regulation skills. (Karagöz and Mountain, 2015:10). In a study examining the relationship between emotion regulation and substance use together with the hormone cortisol, it was found that low cortisol reactivity and difficulty in emotion regulation had an effect on substance use in adolescence (Poon et al., 2016:376). While the difficulties experienced by individuals in avoiding, enduring and regulating negative emotions have an important effect on their tendency to use alcohol-substance use (Baker et al., 2004), these difficulties increase the desire to use alcohol-substance (Willinger et al., 2002:611; Falk et al. , 2008). In addition, in order to get rid of the traumas experienced in childhood and the negative emotions that occur as a result, the adolescent may turn to alcohol-substance use. Developing emotion regulation skills is an effective method in the treatment of alcohol-substance use disorder in the individual (Berking et al., 2011). Family life is also an important environmental factor on substance use. At this point, the attachment style established with the caregiver in early childhood is of great importance. According to Attachment Theory (Bowlby, 1969), the infant seeks intimacy during the first years of life. If the caregiver shows him this closeness and can provide him with a safe base, the baby can explore the world without worry. He then turns to the caregiver and establishes a secure bond with him. This also contributes to the development of emotion regulation skills. However, in cases where a secure base cannot be provided, the baby becomes afraid and anxious and a secure attachment cannot be achieved. This attachment continues throughout the individual’s adolescence and adulthood and can be transferred to different relationships. Bowlby mentions that separation anxiety occurs when there is no secure attachment. Then, Mary Ainsworth identifies three different attachment styles as “secure”, “avoidant” or “anxious” as a result of her experimental studies with Ugandan babies (Bretherton, 1992; Ainsworth et al., 2015). Later, Bartholomew and Horowitz (Bartholomew and Horowitz, 1991) define four different attachment styles for adulthood: “secure attachment”, “preoccupied attachment”, “fearful attachment” and “indifferent attachment”. People with insecure attachment may have difficulty in regulating their emotions, coping with stress, and managing their relationships (Schindler, 2019). While individuals with secure attachment are successful in expressing and regulating their emotions, individuals with avoidant attachment may suppress their emotions, while those with anxious attachment may exaggerate their emotions. In such situations, it may be tempting to resort to psychotropic drugs to cope with emotions and stress, to meet the need for intimacy and relationship. In the review article published by Schindler (2019), the results of 34 cross-sectional and 3 longitudinal studies conducted on adolescents and adults, examining the relationship between substance use disorder and attachment, were collected. The results of cross-sectional studies show that there is a relationship between attachment and substance use disorder. In addition, longitudinal studies show that insecure attachment types pose a risk for substance use disorder. In the mate analysis study by Becoña et al. (2014), a total of 140 empirical articles and 8 reviews between 1980 and 2010 were examined. As a result of the study, it was reported that while insecure attachment was found as a risk factor for substance use, secure attachment could also be a protective factor. Many studies in addition to these meta-analysis studies show that there is a significant relationship between substance use and attachment style (Aydoğdu & Olcay Çam, 2013:142; Cömert & Ögel, 2014:32). Also, substance use disorder
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frequency was found to be lower in the group with high secure attachment scores (Cornellà-Font et al., 2020:24). In summary, the data in the literature are related to substance use, emotion regulation (Weiss, 2022 ; Weinberg & Klonsky, 2009; Wilens et al., 2013; Karagöz & Dağ, 2015; Poon et al., 2016; Baker et al., 2004; Willinger et al., 2002). ; Falk et al., 2008; Berking et al., 2011) and shows a relationship with attachment style (Schindler, 2019; Becoña, 2014; Aydoğdu & Olcay Çam, 2013; Cömert & Ögel, 2014; Cornellà-Font et al., 2020) ).
Purpose and Significance of the Study In the present study, the relationship between substance addiction and emotion regulation strategies and attachment styles in adolescents was investigated. It is aimed to provide detailed information in the field by examining emotion regulation in 4 subgroups. In addition, substance use was examined by considering sociodemographic variables. It is thought that the results of the research will be an important data source for future research.
METHOD Sample The population of this research is the 9th grade students of Çınarlı Vocational and Technical Anatolian High School in Konak District of İzmir. The research group consists of 294 high school students, 30 female and 264 male, with a mean age of 15.16 (Sd= .42).
Data Collection Tools Personal Information Form, Adolescent Addiction Profile Index (API-E), Relationship Scales Questionnaire (PSA), Adolescent Emotion Regulation Scale (ABRS) were used to obtain data on research variables.
Personal Information Form The personal information form, which was applied to obtain the demographic information of the participants, includes questions investigating sociodemographic information.
The Addiction Profile Index APİ-E Scale was developed by Prof.Dr. Dr. It was developed by Kültegin ÖGEL et al. The scale consists of 37 items and 5 subscales: ‘Substance use characteristics, Addiction diagnostic criteria, Effect of substance use on one’s life, Severe desire and motivation to quit substance use’ (Ögel et al., 2012a). BAPI total score is used to evaluate the severity of addiction (Ögel et al., 2012b:10). The Cronbach’s alpha coefficient was found to be between 0.89 for the whole scale and 0.63-0.86 for the subscales. The item-total score correlation coefficients are between 0.42-0.89. The Spearman Brown correlation coefficient for the whole scale was 0.83. As a result of the explanatory factor analysis, 4 factors were obtained, and it was concluded that these factors represented 52.39% of the total variance. BAPI craving subscale
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PAAS/PMAS and motivation subscale were found to be correlated with SOCRATES. The internal consistency coefficient for this study was found to be .88. It was observed that the BAPI total score and the MATT mean score and the combined scores of the sub-headings of medical status, substance use, legal status and family-social relations of the ASI Scale were correlated. The area under the ROC curve was 0.90, the sensitivity at the cutoff point for 4 points was 0.88, and the specificity was 0.78.
Relationship Scales Questionnaire The Relationship Scales Questionnaire, used to measure adult attachment styles, was developed by Griffin and Bartholomew (1994) and adapted into Turkish by Sümer and Güngör (1999). It includes a total of 30 items created using a 7-point Likert scale. Scale items are “1=Does not describe me at all”, “7=Describes me completely”. The scale consists of 4 sub-dimensions: secure, fearful, preoccupied and dismissive attachment. Continuous scores reflecting the four attachment styles were obtained by summing the items aiming to measure these sub-dimensions and dividing this total by the number of items in each scale subscale. Factor analysis was performed to determine the construct validity of the scale and 2 factors with eigenvalues higher than 1 were found. The reliability coefficient for the sub-dimensions is between .41 and .71. As a result of the comparison with the American sample, it was concluded that the data obtained from the Turkish sample were reliable and valid. The test-retest reliability was found to be between .54 and .78, and the internal consistency coefficient was between .27 and .61.
The Regulation of Emotions Questionnaire (REQ): This scale, which was developed by Phillips and Power (Philips and Power, 2007), is used to determine the emotion regulation strategies of adolescents and was adapted into Turkish in 2014 (Duy et al. Star, 2014). As a result of the explanatory and confirmatory factor analyzes applied to measure the construct validity of the scale, it was observed that the scale had a 4-dimensional structure as external non-functional, internal non-functional, internal functional and external functional, and other items except the 4th item were suitable for the model. As a result of the analysis of the data collected from 190 students in order to test the validity of the scale, it was found that there were significant relationships between emotion regulation strategies and related variables. The internal consistency coefficient of the scale was calculated as .76 for the external dysfunctional emotion regulation sub-dimension, .68 for the internal dysfunctional emotion regulation sub-dimension, .74 for the internal functional emotion regulation sub-dimension, and .57 for the external functional emotion regulation sub-dimension, respectively. Finally, the reliability of the scale was measured by applying the test to 175 students with a two-week interval using the test-retest method. .56 and .52 for external functional emotion regulation sub-dimension. As a result of the analyzes, it was determined that the validity and reliability of the scale were sufficient in measuring emotion regulation in adolescents. In the current study, internal consistency coefficients were found to be between .71 and .87 for 4 subscales.
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Procedure In the study, the cross-sectional research method was used in order to obtain instant information about the sample about the relationship between substance use, attachment styles and emotion regulation in adolescents. For sample selection, the typical case sampling method, which is one of the purposive sampling types and is defined as the selection of an average case representing the universe, was applied (Büyüköztürk et al., 2012:92). An application was made to the Near East University Scientific Research Ethics Committee in February 2019, and ethics committee approval was obtained with the project number of YDU/SB/2018/328. Following the approval of the ethics committee, the application permission was obtained from the Izmir Konak District Directorate of National Education with the permission letter dated 12 February 2019 and numbered 3066759. Voluntary consent forms were distributed to the 9th grade students of Çınarlı Vocational and Technical Anatolian High School and after their signatures were obtained, the application was started. The practices were carried out in the form of group practices during a 40-minute lesson in classrooms with 9th grade students, accompanied by a researcher and a counselor.
Statistical Analysis In order to analyze the main and sub-hypotheses of the research, normality assumptions were examined and the results are presented in Table 1. Table 1. Descriptive Statistics Regarding Mean Scores and Assumptions of Normality of Variables Considered in the Study Variables N 𝐗 ” Ss Skew Kurtosis 1. MKÖ 294 0.09 0.30 5.322 31.241 2. MT 294 0.37 1.74 6.662 54.036 3. MYE 294 0.34 1.90 8.256 80.559 4. MŞİ 294 0.09 0.46 5.992 37.648 5. MBM 294 0.19 0.81 4.142 15.769 6. BAPI-ET 294 0.46 1.74 5.521 31.569 7. İİDD 294 13.77 4.50 -.639 -.345 8. İİODD 294 11.67 4.91 .729 -.022 9. DİDD 294 10.21 4.13 .356 -.482 10. DİODD 294 9.34 4.07 1.336 1.610 BCI: Substance use characteristics, MT: Diagnosis, MYE: Effects on life, MSI: Violent desire, CBT: Motivation, API-ET: Addiction Severity Total Score, İİDD: Internal functional emotion regulation, IODD: Internal dysfunctional emotion regulation, DIDD: External functional emotion regulation, DIOD: External dysfunctional emotion regulation
When Table 1 is examined, the skewness-kurtosis coefficients, which are among the statistical techniques used to test the assumption of normality, take values between -2.0 and +2.0 for all sub-dimensions of emotion regulation strategies; It is seen that there is no value in this range in terms of substance addiction index sub-dimension and total scores. According to Kurtosis and Skewnes values, there are different value ranges regarding whether the mean scores obtained from the scales show a normal distribution; Some researchers (George & Mallery, 2010) state that values in the range of ± 2.0 are acceptable in providing the assumption of normality. It is thought that the assumption of normality in the mean scores obtained from the substance addiction profiles could not be ensured because the study did not work with a group using specific substances, but only selected students from a certain school type and from a certain level.
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Spearman Rank Correlation Coefficient was calculated in order to “examine the relationship between adolescents’ substance abuse and emotion regulation strategies”. While the Kruskal-Wallis H test was used to examine whether the substance addiction profile index sub-dimensions and total scores of adolescents differ significantly according to their attachment styles and family environment; Mann-Whitney U test was used to examine whether these scores differed significantly by gender. In addition, independent samples t-test was used to examine whether the sub-dimension scores obtained by the adolescents from the emotion regulation scale differ significantly according to the gender variable. RESULTS When Table 2, which gives information about the sociodemographic characteristics of the participants, is examined, 30 (10.2%) of the participants in the research group are female and 264 (89.8%) are male. When the data obtained from a total of 294 students are examined, 105 (35.7%) of the 9th grade students attending vocational high schools have a low perceived socioeconomic level in terms of income distribution, 103 (35.0%) are at medium level, and 86 (29.3%) are high. It is understood that he has a socio-economic level. 100 (34.0%) of the students in the research group are working and 194 (66.0%) are not working. While 239 (81.3%) students live with their parents, 55 (18.7%) students experience parental deprivation. When the students are analyzed according to their family structure, 226 (76.9%) students live with nuclear family, 26 (8.8%) students live with extended families, 32 (10.9%) students live with single parents and 10 (3.4%) students live with family elders. In terms of attachment styles, 80 (27.2%) students are seen as having secure attachment, 65 (22.1%) students with fearful attachment, 51 (17.3%) students with preoccupied attachment, and 98 (33.3%) students with dismissive attachment style. Forty-two (14.3%) of the students participating in the study had received psychological/psychiatric help before, while 252 (85.7%) did not receive any psychological/psychiatric help. Table 2. Descriptive Statistics on Demographic Characteristics of the Research Group
Demographic Characteristics Groups N Gender Female 30 10.2 Male 264 89.8
Socio-Economic Level
Low 105 35.7 Medium 103 35.0 High 86 29.3
Working Status
Employed 100 34.0 Unemployed 194 66.0 Parental Coexistence Status Parental Coexistence 239 81.3 Parental Deprivation 55 18.7
Living Family Environment
Nuclear Family 226 76.9 Extended Family 26 8.8 Single Parent 32 10.9 Family Elders 10 3.4
Attachment Styles
Secure Attachment 80 27.2 Fearful Attachment 65 22.1 Preoccupied Attachment 51 17.3 Indifferent Attachment 98 33.3
Status of Receiving Psychological/Psychiatric Help
Yes 42 14.3 No 252 85.7 Total 294 100.0
%
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In this study, nonparametric analysis techniques were used because the addiction profile index inventory used to determine the addiction severity scores of adolescents did not provide the normality assumptions for the study group of this research. In this direction, the Kruskal Wallis H-Test was calculated for the unrelated measurements included in the nonparametric tests to examine the sub-dimensions and total scores of the adolescents’ substance addiction profile indexes according to their attachment styles, and the results are reported in Table 3. Table 3. Kruskal Wallis H-Test Results for Examination of Addiction Profile Index Sub-dimension and Total Scores by Attachment Styles
attachment styles
N Xort Ss S.ort H p
BCO Safe 80 0.13 0.43 147.90 .554
.907 Fearful 65 0.05 0.15 142.39 Obsessive 51 0.10 0.32 147.41 Indifferent 98 0.09 0.22 150.61 MT Secure 80 0.36 1.50 150.23 .451
.930 Fearful 65 0.27 1.25 145.45 Obsessive 51 0.50 2.70 146.55 Indifferent 98 0.39 1.58 147.13 MYE Secure 80 0.37 1.78 151.71 3.268
.352 Fearful 65 0.27 1.01 151.61 Obsessive 51 0.49 3.22 139.58 Indifferent 98 0.28 1.51 145.46 MSI Secure 80 0.07 0.41 148.90 .744
.863 Fearful 65 0.04 0.27 146.89 Obsessive 51 0.07 0.44 143.88 Indifferent 98 0.13 0.60 148.64 MBM Secure 80 0.15 0.08 147.43 .277
.964 Fearful 65 0.17 0.09 147.72 Obsessive 51 0.15 0.09 145.14 Indifferent 98 0.26 0.09 148.64 BAPI-ET Safe 80 1.61 0.18 148.30 .197
.978 Fearful 65 1.08 0.13 147.45 Obsessive 51 2.24 0.31 143.58 Unregistered 98 1.92 0.19 148.92 BCI: Substance use characteristics, MT: Diagnosis, MYE: Effects on life, MSI: Cravings, CBT: Motivation, API-ET: Addiction Severity Total Score *p< ,05 , **p< ,01 As seen in Table 3, the addiction index sub-dimension and total scores aiming to reveal the substance addiction levels of adolescents do not differ significantly according to the attachment styles classified as secure, fearful, preoccupied and dismissive. (p> .05). When Table 4 is examined, the scores obtained by the adolescents in the research group in the sub-dimensions of craving for substance use (U= 3502.00, p< .05) and motivation to quit using substances (U= 3410.50, p< .05) differed significantly according to gender. while reaching the finding; it was found that substance use characteristics, diagnosis, effects of substance use on life, and API-E total score did not differ significantly according to the gender variable (p> .05). In order to examine the sources of the differentiation of the sub-dimensions of craving for substance use and motivation to quit use by gender, when the mean rank scores are examined, it is observed that female students have higher scores in both craving and motivation sub-dimensions than male students. Accordingly, it can be said that female students have a stronger desire for substance use than male students; Again, it can be said that female students have higher motivation to quit substance use than male students.
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Table 4. Mann Whitney U-Test Results for Examination of Addiction Profile Index Sub-dimension and Total Scores by Gender
Group n SO ST U zp BCO Female 30 155.25 4657.50 3727.50 -.647 .518 Male 264 146.62 38707.50 MT Female 30 162.28 4868.50 3516.50 -1.886 .059 Male 264 145.82 38496.50 MYE Female 30 157.93 4738.0093 3627.1600 -1.3 Male Female 30 162.77 4883.00 3502.00 -2.439 .015* Male 264 145.77 38482.00 MBM Female 30 165.82 4974.50 3410.50 -2.730 .006* Male 264 145.42 38390.50 BAPİ-ET Female 30 160.25 4807.50 3577.50 -1.018 .308 Male 38557 14650 Article properties , MT: Diagnosis, MYE: Effects on life, MSI: Severe desire, CBT: Motivation, API-ET: Addiction Severity Total Score *p< ,05 , **p< ,01 Table 5. Addiction Profile Index Sub-Dimension and Total Kruskal Wallis H-Test Results for Examining Scores by Family Environment
attachment styles
n Xort Ss S.ort H p
significant difference
BCO
Nuclear Family 226 0.06 0.23 140.72
18,370
.000**
1-4 2-4 3-4
Extended Family 26 0.28 0.66 157.15 Single Parent 32 0.09 0.20 161.56 Family Elders 10 0.23 0.34 230.55
MT
Nuclear Family 226 0.16 0.80 144.69
4.670
.198
—
Extended Family 26 2.00 4.70 162.56 Single Parent 32 0.60 1.84 155.23 Family Elders 10 0.30 0.94 147.00
MYE
Nuclear Family 226 0.15 1.03 144.36
5,890
.117
—
Extended Family 26 1.50 4.90 162.56 Single Parent 32 0.54 1.81 156.70 Family Elders 10 0.90 2.84 149.20
MSI
Nuclear Family 226 0.03 0.21 144.38
10,133
.017*
1-2
Extended Family 26 0.53 1.20 167.35 Single Parent 32 0.06 0.24 151.55 Family Elders 10 0.30 0.94 153.35
MBM
Nuclear Family 226 0.13 0.68 144.92
4,791
.188
—
Extended Family 26 0.57 1.39 159.77 Single Parent 32 0.31 0.99 154.73 Family Elders 10 0.20 0.63 150.80
BAPI-ET
Nuclear Family 226 0.26 1.00 141.25
12,869
.005*
1-4 2-4
Extended Family 26 1.90 4.38 151.81 Single Parent 32 0.64 1.43 167.00 With Elders 10 0.82 2.41 215.25 BCI: Substance use characteristics, MT: Diagnosis, MYE: Effects on life, MSI: Severe cravings, CDM: Motivation, API-ET: Severity of Addiction Total Score *p< .05 , **p< .001
When Table 5 is examined, the substance use diagnosis, the effect of substance use on life, and the motivation scores for quitting substance use, which are among the sub-dimensions of the addiction index aiming to reveal the severity of addiction of the adolescents constituting the research group, do not differ significantly according to the family environment variable (p> .05). ). Adolescents’ substance use characteristics scores differ statistically significantly according to the family environment variable (H=18.370, p< .001). This is meaningful
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11th
In order to determine the dimensions of the difference, the family environments classified in four different categories were reclassified as pairs among themselves and the sources of the significant difference were examined by using the Mann Whitney U test for each binary class. Mann Whitney U-test results show that adolescents living with family elders (SO=188.20) have higher substance use levels than adolescents living with nuclear families (SO=115.42). Similarly, adolescents living with family elders (SO=24.40) had higher mean scores from the sub-dimension of substance use characteristics than adolescents living with extended families (SO=16.23). Again, for the sub-dimension of substance use levels, it was concluded that the average scores of adolescents living with family elders (CI=28.95) were higher than those living with a single parent (CI=19.17). Again, when Table 4 is examined, the scores of adolescents’ cravings for substance use differ statistically significantly according to the family environment variable (H=10.133, p< .05). Similarly, in order to examine the source of the significant difference, family environment subgroups were reclassified among themselves in pairs and Mann Whitney U test was applied for each binary class. Analysis results show that adolescents living only with their extended family (SO=144.06) have higher mean scores from 71 craving subscales than adolescents living with nuclear family (SO=124.48). According to Table 4, the APPI-E total scores of the adolescents differ statistically according to the family environment variable (H=12.869, p< .05). When the Mann Whitney U-test was applied by reclassifying family environments as pairs among themselves, it was concluded that adolescents living with family elders (SO=176.15) had higher APPI-E total scores than adolescents living with their nuclear family (SO=115.96). Similarly, adolescents living with family elders (SO=24.00) have higher API-E total score averages than adolescents living with extended families (SO=16.38). Table 6. T-Test Results for Examination of Emotion Regulation Sub-Dimension Scores by Gender N 𝐱 $ SD sd t P Intrinsic Functional
Emotion Regulation Female 30 13.84 4.48 292 0.091 .928 Male 264 13.76 4.52 Intrinsic Dysfunctional Emotion Regulation Female 30 14.66 5.12 292 3.459 .001* Male 264 11.27 4.77 External Functional Emotion Regulation Female 30 11.26 4.21 292 1.446 .157 Male 264 10.09 4.11 External Functional Nonfunctional Emotion Regulation Female 30 10.08 4.57 292 0.945 .351 Male 264 9.25 4.01 p<.05*, p<.001** When Table 6 is examined, it is observed that only the internal dysfunctional emotion regulation scores of high school students, which are sub-dimensions of emotion regulation, differ significantly according to gender. (t(292)= 3.459, p< .05). When the source of this significant difference is examined, it is understood that the internal dysfunctional emotion regulation scores of female students ( =14.66) are higher than that of male students (=11.27). In order to examine the main hypothesis of the study, Spearman’s Rank Correlation Coefficient was calculated to examine the relationship between substance addiction and emotion regulation in adolescents. Correlation analysis results are given in Table 7.
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Table 7. Results of Spearman Correlation Analysis for Determining the Relationship Between the Variables Considered in the Study
N 1 2 3 4 5 6 7 8 9 10
1. BCO 294 —
2. MT 294 .499** —
3. MYE 294 .373** .580** —
4. MŞİ 294 .343** .589** .665** —
5. MBM 294 .379** .526** .609** .707** —
6. BAPI-ET 294 .877** .590** .547** .478** .524** —
7. İİDD 294 .089 .012 .045 .000 .041 .079 —
8. İİODD 294 .283** .247** .223** 180** .195** .274** .241** —
9. DIDD 294 .111 .032 .042 .022 .107 .106 .517** .396** —
10. DIODD 294 .351 .247** .147* .126* .133* .344** .214** .631** .336** — MCI: Substance use characteristics, MT: Diagnosis, MYE: Effects on life, MSI: Intense desire, CBM: Motivation, APPI-ET: Addiction Severity Total Score, IDD: Internal functional emotion regulation, IODD: Internal dysfunctional emotion regulation, DIDD: External functional emotion regulation, DIOD: External dysfunctional emotion regulationp<.05*, p<.001
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According to the correlation results, it was observed that there was a positive and significant relationship between the sub-dimensions of the addiction index and the total API-E scores of the adolescents in the study group (p .05). Intrinsic dysfunctional emotion regulation scores and substance use characteristics (r(294) = .28, p< .001), diagnosis (r(294) = .24, p< .001), effects of substance use on life (r(294) ) = .22, p< .001), craving for substance use (r(294) = .18, p< .001), motivation to quit substance use (r(294) = .19, p< .001) and addiction severity total scores (r(294) = .27, p< .001) were found to have positive, low and significant relationships. In addition, the participants’ external dysfunctional emotion regulation scores and diagnosis (r(294) = .24, p< .001), the effects of substance use on life (r(294) = .14, p< .001), severe substance use Desire (r(294) = .12, p< .001), motivation to quit substance use (r(294) = .13, p< .001) and addiction severity total scores (r(294) = .34, p It is understood that there are positive, low and significant relationships between < .001). However, no statistically significant difference was found between the external dysfunctional emotion regulation scores of adolescents and their substance use characteristics (r(294) = .35, p>.05). Accordingly, it can be said that external dysfunctional emotion regulation scores increase as the scores obtained from the sub-dimensions of the addiction index criteria that define substance use, excluding substance use characteristics, increase.
DISCUSSION, CONCLUSION AND RECOMMENDATIONS Two main problems were investigated in this study. First of all, ‘Is there a statistically significant relationship between adolescents’ substance abuse severity and emotion regulation strategies?’ As a result of the analyzes made to find the answer to the question, a significant relationship was found. This finding is consistent with the literature (Weinberg et al., 2009; Wilens et al., 2013; Berking et al., 2011). When this relationship was examined, it was concluded that as the severity of substance addiction increased in adolescents, external dysfunctional emotion regulation strategies were used more. It has been reported that as the scores obtained from this subscale increase, emotional, behavioral problems and somatic complaints increase, and social behavior and life satisfaction decrease (Duy & Yıldız, 2014:29). Accordingly, it can be concluded that such problems can be seen in adolescents with substance addiction. The second focus of the study, “Do adolescents’ substance addiction profile index sub-dimension and total scores differ significantly according to attachment styles?” As a result of the analyzes made to answer the question, no significant difference was found. In the study of Balcı (2011) on adolescents, it was stated that substance use was associated with insecure attachment. Meta-analysis studies by Schindler (2019) and Becoña et al. (2014:80-81) show that there is a significant relationship between attachment style and substance use. However, in the study of Becoña et al. (2014:82), they suggested that this relationship is affected by many factors related to the adolescent himself, his environment and his family, therefore, external factors should also be evaluated while examining the relationship between these variables. It can be thought that the finding, which differs from the literature, is due to these external factors. For example, if the type of school the students attend is considered as one of the external factors affecting this relationship, the sample of the study may have affected the result because it consisted of students from a single type of school. Other possible external factors are family environment and parental control. Considering that in the current study, adolescents living with family elders have significantly higher scores than those living with extended and nuclear families, it is seen that the effect of family environment on substance use is significant. However, it should not be forgotten that the factors that cause the individual to live with family elders can also cause significant differences. Divorce, family conflicts, death, illness, etc. grandparents in cases where the child/adolescent
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they can take care of it (Uğur, 2019:125). In similar situations, adolescents are at risk for substance use because family support and control cannot be provided (CDC, 2022). The results obtained in the research may have emerged depending on these factors. However, more detailed studies are needed for a comprehensive understanding of the effect of family environment on substance use. When we consider the gender variable, it was observed that female students had higher scores for internal dysfunctional emotion regulation strategies. The results are based on studies showing that the gender variable is related to emotion regulation (Zhao et al., 2014:12; Zimmerman & Iwanski; 2014:185) and a study showing that female students use emotion regulation strategies more than male students (Güçlü, 2009: 68) is consistent with. Elise Goubet et al. (2019:7) examined the frequency of using emotion regulation strategies together with the gender variable and reported that women use problem solving, social support, emotion expression and self-blame strategies more frequently than men. Considering that among these strategies, other than self-blame, are functional strategies, there is an inconsistency with the finding that female students use internal dysfunctional strategies in the current study. In the aforementioned study, the sample group consists of individuals between the ages of 18-31. Considering that the current study was conducted with a younger sample group with a mean age of 15.16, it can be thought that the age variable may have caused this difference. While women use dysfunctional emotion regulation strategies more than men in adolescence, they may use functional emotion regulation strategies more in adulthood. In order to test this claim, it is recommended to conduct further studies in which the sub-dimensions of emotion regulation strategies are handled together with the variables of age and gender. It was observed that the substance addiction profile index sub-dimension and total scores of adolescents also differed significantly according to gender. It was determined that female students had significantly higher scores on both the craving for substance use and the scores for quitting substance use. While there are studies in the literature showing a relationship between substance use and gender in high school students (Essau & LeBlanc, 2017; Kloos et al., 2009:124; Kulis et al., 2008:263), no relationship was found in a study conducted in our country (Tansel, 2017:1460). . Kuhn (2015:57) states that there is little gender-related difference in substance use among young adolescents, but the prevalence begins to be higher in males with age. It is also seen that alcohol use is higher in individuals who enter puberty at an earlier age. Considering that this study we have done covers early adolescence, the higher average of female students can be explained by this situation. In addition, when we look at the gender difference in the general population, it has been stated that although the rate of substance use is higher in men than in women, women are at the same risk of developing a substance use disorder as men, and moreover, craving and relapse can be seen more in women (National Institute on Drug Abuse, 2021). In line with the literature and the information obtained from the current study, it is thought that it will be important for the studies to focus on female students as well as male students, and further studies involving adolescents with dysfunctional emotion regulation strategies will provide useful information. In conclusion, the current research supports the data in the literature in terms of finding a relationship between substance addiction and emotion regulation skills in adolescents. It also reveals that substance addiction is associated with external dysfunctional emotion regulation. It also revealed that there is a relationship between the family environment and substance use. In addition, the effects of the gender variable on substance use, emotion regulation and attachment were examined and discussed in detail. A single sample of the research
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It is recommended to consider that it covers 9th grade students in the school and to work with larger sample groups in future studies.
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