Alcohol misuse as dysfunctional affect regulation: a network analysis of psychopathology across adulthood

BACKGROUND: Alcohol misuse is increasingly understood as a maladaptive form of affect regulation. This study examines the interplay between alcohol misuse, mental health symptoms, and age in a representative sample of Austrian adults, using network analysis to model these associations.

METHODS: Data from 2007 participants (49% women; average age of 48.2 ± 16 years), representative of the general Austrian population in terms of age, gender, federal state, and educational level, were analyzed using validated instruments: the CAGE questionnaire for alcohol misuse, PHQ-9 for depression, GAD-7 for anxiety, ISI-7 for insomnia, and PSS-4 for stress. Network analysis using a regularized Gaussian graphical model was conducted to explore interrelations among these variables alongside age. Centrality, stability, and gender-based network comparisons were assessed.

RESULTS: Overall, 21% of participants screened positive for alcohol misuse (CAGE ≥2). Bivariate analyses showed that individuals with suspected alcohol dependence reported higher levels of depression, anxiety, stress, and insomnia, and were younger. The regularized network analysis revealed a robust connection between alcohol misuse and depressive symptoms. Depression and anxiety emerged as central nodes in the network, while age was negatively associated with both alcohol misuse and psychopathological burden. No significant gender differences in network structure or global strength were found.

CONCLUSIONS: Findings support the conceptualization of alcohol misuse as a dysfunctional affect regulation strategy, particularly in relation to depressive symptoms. These results align with transdiagnostic models of emotional dysregulation and reinforce the need for preventive interventions focused on emotion regulation skills, particularly among younger adults and individuals with comorbid mental health conditions.