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What is the relationship between attachment difficulties, alexithymia, and substance misuse? A systematic literature review. And Investigating the relationship between alexithymia, depression, and problematic benzodiazepine use. Sophie Coles (21043979) Alexithymia Attachment Substance Misuse Benzodiazepine Benzodiazepine Use Benzodiazepine Dependence Depression Coping Impulsivity Attachment Difficulties What is the relationship between attachment difficulties, alexithymia, and substance misuse? A systematic literature review. Background: Substance misuse is common within the United Kingdom, having significant impact on health and public spending. It is important to understand the risk factors of substance misuse. Childhood trauma and insecure attachment styles are risk factors for substance use disorder (SUD). Furthermore, insecure attachment is a risk factor for alexithymia, which is prevalent within 45-67% SUD populations. Alexithymia is a trait in which individuals struggle to identify their emotional state. This review aims to summarise and synthesise the findings on the relationship between attachment difficulties, alexithymia, and substance misuse. Methods: Studies were identified through Ovid Medline, APA PsycInfo and Embase. Grey literature searches were conducted using APA PsycExtra and Google Scholar. Papers included were quantitative studies which used a validated measure of alexithymia, used measures relating to trauma or attachment difficulties, and focused on an adult substance misuse population. Data was analysed using narrative synthesis methodology. Results: The included 20 publications suggest an association between attachment difficulties and substance misuse, attachment difficulties and alexithymia and alexithymia and substance use. These findings suggest that attachment difficulties could indeed play a role in substance misuse and higher alexithymia could be a mechanism. These associations seemed stronger within clinical samples as opposed to non-clinical samples. Findings highlight a necessity to be aware of potential confounding factors, such as impulsivity and dissociation. The publications included were cross-sectional and therefore cannot infer any causal direction. Conclusions: Clinicians should be aware of the potential role of attachment difficulties and alexithymia whilst treating individuals with substance misuse. Highlights  Attachment difficulties and alexithymia are associated with problematic substance use.  The literature supports this possibility that problematic attachment affects substance misuse through alexithymia  Impulsivity and psychiatric disorders were associated with poor attachment, alexithymia, and substance misuse. Investigating the relationship between alexithymia, depression, and problematic benzodiazepine use. Background: Benzodiazepines are a class of sedative and anxiolytic drugs. Benzodiazepines are commonly prescribed in the United Kingdom for physical and mental health difficulties but are also widely used recreationally. When benzodiazepines are used for longer periods of time, they can have negative mental and physical effects. In addition, they have a high addiction and dependence potential. Alexithymia is a trait whereby individuals struggle to identify their emotional state. Alexithymia often co-occurs with depression. Both alexithymia and depression have previously been found to be risk factors for substance misuse. The aim of the current investigation is to evaluate whether alexithymia and depression are associated with increased risk of benzodiazepine dependence. In addition, the study aims to investigate if impulsivity and coping styles are potential mechanisms through which alexithymia and depression affect benzodiazepine dependence. Methods: 166 participants who have used benzodiazepine completed an online survey using a cross-sectional methodology. Mediational analyses were computed with alexithymia and depression as independent variables, and benzodiazepine dependence as a dependent variable. Mediational pathways were built using impulsivity and coping style as possible mediators. Results: The results found that both alexithymia and depression predicted benzodiazepine dependence. However, when entering alexithymia and depression together to predict benzodiazepine dependence, depression was the only significant predictor. Further mediational analyses indicated that non-planning impulsivity mediated the relationship of both alexithymia and depression on benzodiazepine dependence, whereas emotion-oriented coping mediated the relationship of depression and benzodiazepine dependence. Conclusion: Clinicians should be aware of the potential role of depression whilst treating individuals with benzodiazepine dependence. Due to the indirect effect of alexithymia on benzodiazepine via non-planning impulsivity, clinicians should be aware of potential implications of alexithymia and impulsivity on treatment in a subset of individuals. Highlights  Within the pathway model, depression predicts benzodiazepine dependence whereas alexithymia does not.  Non-planning impulsivity mediates the relationship between depression and benzodiazepine dependence. 80  Non-planning impulsivity mediates the relationship between alexithymia and benzodiazepine dependence.  Emotion-oriented coping mediates the relationship between depression and benzodiazepine dependence<p></p> 2026-04-24T00:00:00Z Text Thesis 10779/exe.32104522.v1 https://figshare.com/articles/thesis/What_is_the_relationship_between_attachment_difficulties_alexithymia_and_substance_misuse_A_systematic_literature_review_And_Investigating_the_relationship_between_alexithymia_depression_and_problematic_benzodiazepine_use_/32104522 All rights reserved