Racial/Ethnic Differences in Alcohol and Drug Misuse Among IPV-Victimized Women: Exploring the Role of Difficulties Regulating Positive Emotions

Abstract

Alcohol and drug misuse is prevalent and problematic among women who experience intimate partner violence (IPV). Emotional dysfunction has been identified as a key mechanism in the etiology, maintenance, and treatment of alcohol and drug misuse. However, existing research has not considered the role of race/ethnicity in the relations between emotional dysfunction and alcohol and drug misuse. Furthermore, past research in this area has focused almost exclusively on emotional dysfunction stemming from negative (vs. positive) emotions. The goals of the current study were as follows: (a) to explore whether levels of difficulties regulating positive emotions differ among Latina, African American, and White IPV-victimized women, and (b) to examine the moderating role of race/ethnicity in the relations between difficulties regulating positive emotions and alcohol and drug misuse. Participants were 197 IPV-victimized women recruited through the criminal justice system (M_age = 36.14; 51.8% African American, 31.5% White, and 16.8% Latina). Difficulties regulating positive emotions did not differ as a function of race/ethnicity. However, relations among difficulties regulating positive emotions and alcohol and drug misuse were significant for Latina and White but not African American IPV-victimized women. Moreover, race/ethnicity moderated an association between difficulties regulating positive emotions and drug misuse; this relation was significant and positive for White (compared with African American) IPV-victimized women. While preliminary, these results may inform culturally sensitive interventions for alcohol and drug misuse that are tailored to the unique needs of Latina, African American, and White IPV-victimized women.

Keywords

difficulties regulating positive emotions alcohol misuse drug misuse tobacco use racial/ethnic differences

Intimate partner violence (IPV) is an international public health concern associated with substantial personal and societal costs. Alcohol and drug misuse is one commonly reported consequence of IPV that is of particular public health and clinical significance. Results of one epidemiological study showed significantly higher prevalence rates of alcohol and drug use disorders among IPV victims (7.3% and 2.7%, respectively) versus nonvictims (2.3% and 0.4%, respectively) (Okuda et al., 2011). Moreover, extant research reveals a longitudinal association between IPV and alcohol and drug misuse, with IPV victimization increasing the odds of subsequent alcohol and drug misuse (Devries et al., 2014). Alcohol and drug misuse among IPV-victimized women is linked to a wide range of negative outcomes, including psychological distress (Sullivan & Holt, 2008), risky health behaviors (Campbell et al., 2008), legal problems (Oberleitner et al., 2013), and economic strain (Peterson et al., 2018). Furthermore, alcohol and drug misuse increases risk for IPV revictimization (Devries et al., 2014; El-Bassel et al., 2005). These findings underscore the importance of research on alcohol and drug misuse among IPV-victimized women.

One important consideration for future research in this area is the potential for racial/ethnic differences that may influence alcohol and drug misuse. Racial/ethnic minorities currently comprise approximately one third of the population of the United States (U.S. Census Bureau, 2016) and are expected to become a majority by 2050 (Colby & Ortman, 2017). However, there are limited studies investigating alcohol and drug misuse among racial/ethnic minorities, particularly in samples of IPV-victimized women, where significant racial/ethnic differences in IPV prevalence rates have been noted (Caetano et al., 2000; African Americans [23%–30%], Latinas [17%–21%], and Whites [11%–15%]), even when controlling for socioeconomic circumstances (Field & Caetano, 2004). In the general population, rates of alcohol and drug use among Latina and African American individuals are comparable with, if not less than, those of their White counterparts (Substance Abuse and Mental Health Services Administration, 2019). However, Latina and African American individuals experience greater problems related to alcohol and drug use than White individuals (Jones-Webb & Karriker-Jaffe, 2013; Pedersen et al., 2012; Wu et al., 2014), including more social consequences (Mulia et al., 2009), higher rates of alcohol and drug use disorders (McCabe et al., 2017), and more legal problems (Zapolski et al., 2014); this pattern of findings extends to IPV-victimized women (Sullivan et al., 2009). Furthermore, Latina and African American individuals demonstrate worse treatment outcomes for alcohol and drug use disorders, such as higher rates of dropout (Austin & Wagner, 2006) and earlier relapse (Walton et al., 2003), than White individuals. Thus, it is critical that research explores the role of race/ethnicity in factors linked to alcohol and drug misuse among IPV-victimized women. Such findings may inform interventions tailored to the unique needs of IPV-victimized women from diverse racial/ethnic groups.

Emotional dysfunction is one important factor to consider in relation to alcohol and drug misuse among different racial/ethnic groups of IPV-victimized women. Emotional dysfunction is a multifaceted construct involving maladaptive ways of responding to emotions, regardless of their intensity or reactivity, including (a) emotional awareness, clarity, and acceptance; (b) behavioral control in the context of intense emotions; (c) willingness to experience emotional distress to pursue meaningful activities; and (d) flexible use of adaptive strategies to modulate (vs. eliminate) the intensity and/or duration of emotional experiences (Gratz & Roemer, 2004; Gratz & Tull, 2010). Emotional dysfunction is considered a key mechanism in the etiology, maintenance, and treatment of alcohol and drug misuse (for literature reviews, see Weiss, Sullivan, & Tull, 2015; Weiss, Tull, et al., 2015). Higher levels of emotional dysfunction are linked to misuse of alcohol (Chandley et al., 2014; Dvorak et al., 2014; Messman-Moore & Ward, 2014; Veilleux et al., 2014) and drugs (Axelrod et al., 2011; Bonn-Miller et al., 2008, 2011; Fox et al., 2007). Furthermore, individuals with alcohol and drug use disorders report greater emotional dysfunction (Fox et al., 2007, 2008). In addition, emotional dysfunction is predictive of alcohol and drug outcomes following treatment (Axelrod et al., 2011; Berking et al., 2011).

However, the existing literature presents important limitations in linking emotional dysfunction to alcohol and drug misuse. First, despite evidence for greater emotional dysfunction among IPV-victimized individuals compared with their non-IPV-victimized counterparts (Lilly & Lim, 2013), a dearth of empirical investigations have explored the role of emotional dysfunction in alcohol and drug misuse among IPV-victimized women. IPV-victimized women may be at particular risk for emotional dysfunction as a result of elevated levels of negative affect—such as fear (Scheffer Lindgren & Renck, 2008)—stemming from their victimization. These women may use alcohol and/or drugs in an attempt to regulate these distressing emotional experiences (Weiss et al., 2012). However, we were only able to identify one such study: Weiss, Darosh, et al. (2018) used latent profile analysis to identify subgroups of IPV-victimized women characterized by varying levels of emotional dysfunction and then examined differences in clinically relevant outcomes (including alcohol and drug misuse) across subgroups. Results suggested three subgroups of IPV-victimized women differentiated by emotional dysfunction, and alcohol and drug misuse was most prevalent among the subgroup with the highest levels of emotional dysfunction.

Second, most research has focused on emotional dysfunction stemming from negative (vs. positive) emotions in alcohol and drug misuse. Recent literature indicates that individuals may experience emotional dysfunction in response to positive emotions (Cyders et al., 2007; Weiss, Gratz, & Lavender, 2015; Weiss, Tull, et al., 2018). For instance, individuals may be nonaccepting of positive emotional states (Weiss, Gratz, & Lavender, 2015), judging some positive emotions to be undesirable, unpredictable, or frightening (Beblo et al., 2013; Weiss, Gratz, & Lavender, 2015). Individuals who take a judgmental and evaluative stance toward their positive emotions may engage in attempts to suppress positive emotions (Beblo et al., 2012, 2013), possibly through alcohol and drug misuse. Individuals may also experience difficulties inhibiting impulsive behaviors in the context of positive emotions (Cyders et al., 2007; Weiss, Gratz, & Lavender, 2015; Weiss, Tull, et al., 2018). For instance, intense positive emotions may result in approach-related action urges (Gable & Harmon-Jones, 2008) or may reduce one’s capacity to control alcohol and drug misuse in the context of urges or cues for such behaviors (Inzlicht & Schmeichel, 2012); these, in turn, may result in alcohol and drug misuse. Finally, positive emotions may interfere with one’s ability to engage in goal-directed behaviors (Weiss, Gratz, & Lavender, 2015). As an example, positive emotion may increase distractibility (Straub et al., 2020), resulting in disadvantageous decision-making focused on short-term versus long-term goals (Slovic et al., 2004), shown to heighten the risk for alcohol and drug misuse (Bernhardt et al., 2017). Consistent with theory, recent studies have found difficulties regulating positive emotions to relate to alcohol and drug misuse (Weiss, Bold, et al., 2018; Weiss, Darosh, et al., 2018; Weiss et al., 2019; Weiss, Forkus, et al., 2018; Weiss, Tull, et al., 2018).

A final limitation is that existing research has not considered the role of race/ethnicity in the associations between emotional dysfunction and alcohol and drug misuse. Research shows racial/ethnic differences in emotional dysfunction (Butler et al., 2007; Gross et al., 2006; Gross & John, 2003; Weiss et al., 2017). For instance, Latina and African American individuals report higher use of expressive suppression—or attempts to hide, inhibit, or reduce emotions—than White individuals (Gross & John, 2003). Furthermore, Latina and African American individuals endorse greater utilization of avoidance strategies than White individuals (Chapman & Mullis, 2000; Montoro-Rodriguez & Gallagher-Thompson, 2009). Latina and African American individuals may be socialized in ways that generate greater emotional suppression and avoidance (Eid & Diener, 2001; Matsumoto et al., 2008). For instance, Latina and African American parents are more likely to use strategies to minimize their children’s displays of negative emotions compared with White parents (Halberstadt et al., 2011; Lugo-Candelas et al., 2015), perhaps because displays of emotions among Latina and African American individuals may be more likely to be viewed as threatening by White individuals (Kang & Chasteen, 2009). As such, parents may socialize their children to restrict emotional expression to protect them from acts of race-related discrimination (Nelson et al., 2012). These findings suggest that responses to emotions that may be maladaptive for individuals in some racial/ethnic groups may be adaptive to individuals in other groups.

Consistent with this assertion, past research has posited that emotional dysfunction may be adaptive in some contexts (Aldao, 2013). For instance, while generally linked to negative outcomes (Aldao et al., 2010), emotional avoidance use may result in short-term reductions in stress and anxiety stemming from threatening stimuli (Roth & Cohen, 1986) or reduce risk for conflict in the context of physical threat (Lewis et al., 2006). Moreover, some emotional avoidance has been shown to be associated with more adaptive outcomes for individuals in environments perceived as uncontrollable (Valentiner et al., 1994; Vitaliano et al., 1990), and racial/ethnic minorities—particularly those with a history of IPV victimization (Salcioglu et al., 2017)—may feel as though they have less control over their environments than their White counterparts (Shaw & Krause, 2001). Finally, some putatively maladaptive emotion regulation strategies are not as strongly linked to negative outcomes among Latina and African American individuals as White individuals (Butler et al., 2003; Gross & John, 2003). For example, Richman et al. (2011) found that denial and self-blame were associated with lower problem drinking among Latina and African American students relative to White students. These findings underscore the need for additional research that examines whether the relations of emotional dysfunction to alcohol and drug misuse differ as a function of race/ethnicity.

To address the aforementioned limitations, we explored the role of race/ethnicity in the associations among difficulties regulating positive emotions and alcohol and drug misuse among IPV-victimized women. In this study, we examined two hypotheses. First, given evidence for greater emotional dysfunction among racial/ethnic minorities (Gross & John, 2003), we expected Latina and African American participants to endorse higher levels of difficulties regulating positive emotions than White participants. Second, given evidence that emotional dysfunction does not always correlate with negative outcomes among racial/ethnic minorities (Richman et al., 2011), we expected that difficulties regulating positive emotions would be more strongly related to alcohol and drug misuse among White versus Latina and African American participants.

Method

Participants and Procedures

Data were collected as part of a larger study examining the influence of criminal orders of protection on the well-being of women victims in an IPV case. Criminal orders of protection are a tool used by justice system personnel, such as prosecutors/judges, in criminal proceedings or following an arrest to enhance the safety of victims of IPV by restricting the offenders’ contact with and/or treatment of the victim (Long et al., 2010). All procedures were reviewed and approved by the last author’s Institutional Review Board. Women were recruited from two courthouses in urban and suburban New England communities. Women were eligible to participate if they were a victim in a criminal IPV case with a male intimate partner, if their offender was arraigned approximately 12 to 15 months prior to recruitment, and if they spoke English or Spanish. Eligibility criteria were determined via records from the Family Violence Victim Advocate Office or the State of Connecticut Judicial Branch.

Potential participants were sent a letter by our study team inviting them to participate in a confidential 2-hr study. Interested participants were asked to call the study phone line in response to the mailed letter. Research assistants followed up on the recruitment letter with a phone call to those who did not respond either because the letter was returned or a call back was not received. If interested, eligible participants were scheduled to participate in an interview.

After providing written informed consent, face-to-face individual interviews were administered by trained masters- or doctoral-level female research associates or postdoctoral fellows in private offices. This precaution was taken to protect the participant’s safety and to ensure confidentiality. Participants were remunerated US$50 for their participation and provided with a list of community resources relevant to IPV, mental health, alcohol and drug misuse, social services, employment, and economic stability. In addition, we offered victims an opportunity to develop a detailed, individualized safety plan following the interview.

The final sample was comprised of 298 women. The current study used a subsample of 197 women who identified as Latina, African American, or White (eliminating 13 women who identified as another race or multiracial) and who completed the Difficulties in Emotion Regulation Scale–Positive (DERS-P; added to the study after data collection began; eliminating 88 women who did not complete the DERS-P). Participants ranged in age from 18 to 66 years (M = 36.47, SD = 11.55). In terms of racial/ethnic background, 51.8% of participants (n = 102) self-identified as African American, 31.5% (n = 62) as White, 16.8% (n = 33) as Latina, and 6.2% (n = 13) as either being of another race/ethnicity or multiracial. Slightly more than half of the women were unemployed for over a month prior to the interview (n = 101; 51.3%); 27.4% (n = 54) were employed full-time during the past month and 21.3% (n = 42) were employed part-time during the past month. Women’s monthly household income ranged from US$0 to US$6,400 (M = US$1,468.55; SD = US$1,094.21; median = US$1,200.00) and their mean level of education was 12.64 years (SD = 2.06). At the time of the study interview (i.e., 12–15 months after the arraignment), most women were not dating the offending partner (n = 142; 72.1%). Mean years in a relationship with the offending partner was 5.58, ranging from less than 1 month to 27 years (SD = 5.38).

Measures

Difficulties regulating positive emotions

The DERS-P (Weiss, Gratz, & Lavender, 2015) is a 13-item self-report measure that assesses overall difficulties regulating positive emotions (DERS-P Total) as well as the subscales of nonacceptance of positive emotions (DERS-P Accept), difficulties engaging in goal-directed behaviors when experiencing positive emotions (DERS-P Goals), and difficulties controlling impulsive behaviors when experiencing positive emotions (DERS-P Impulse). Higher scores indicate greater difficulties regulating positive emotions. Participants rate each item using a 5-point Likert-type scale (1 = almost never, 5 = almost always). The DERS-P demonstrates good reliability and validity (Cronbach’s αs in the current sample = .91, .88, .72, and .86 for DERS-P Total, DERS-P Accept, DERS-P Goals, and DERS-P Impulse, respectively).

Alcohol and drug misuse

The Alcohol Use Disorders Identification Test (AUDIT; Babor et al., 2001) is a 10-item self-report measure that assesses alcohol consumption, drinking behaviors, adverse reactions to drinking, and alcohol-related problems. Participants rate each item using a 5-point Likert-type scale (0 = never, 4 = daily or almost daily), with higher sum scores indicating greater alcohol misuse (Babor et al., 2001). A score of 8 or higher is associated with patterns of hazardous drinking. The AUDIT shows good reliability and validity (Cronbach’s α in the current sample = .85; Babor et al., 2001). The Drug Abuse Screening Test (DAST; Skinner, 1982) is a 10-item self-report measure that assesses the presence of problems related to drug use, such as occupational or relational problems, illegal activities, or regret. Participants endorse each item on a 2-point scale (0 = no, 1 = yes). Higher sum scores indicate greater drug misuse, with scores greater than or equal to 3 indicating drug use disorder. The DAST demonstrates good reliability and validity (Cronbach’s α in the current sample = .83).

Demographic and relationship characteristics

Women reported their age, race/ethnicity, income, education, and employment. Physical victimization was measured by the Revised Conflict Tactics Scale (CTS-2; Straus et al., 2003). Consistent with scoring procedures outlined in Straus et al. (2003), responses were recoded to the midpoint of the range: 0 = never during the past 30 days, 1 = once during the past 30 days, 2 = twice during the past 30 days, 3 = 3–5 times during the past 30 days, 4 = 6–10 times during the past 30 days, 5 = 11–20 times during the past 30 days, and 6 = more than 20 times during the past 30 days. Severity scores were calculated by summing the respective responses (Cronbach’s α = .73 for the 12 CTS physical victimization items). Sexual victimization was measured by the Sexual Experiences Survey (SES; Koss & Oros, 1982). The SES assesses sexual victimization more comprehensively than the CTS-2 (e.g., the CTS-2 does not measure sexual coercion using drugs or alcohol). The original SES response options are yes/no. To gain greater knowledge about the frequency of experiences in the past 30 days, the response options and scoring system from the CTS-2 were used. Cronbach’s α = .81 for the 10 SES sexual victimization items. Psychological victimization was measured by the Psychological Maltreatment of Women Inventory–Short Form (PMWI-SF; Tolman, 1999). The PMWI-SF is a more comprehensive measure of psychological victimization than the CTS-2 (e.g., the PMWI-SF assesses dominance and isolation, whereas the CTS-2 does not). Participants rate the extent to which each item applied to them during the past 30 days on a 5-point Likert-type scale (1 = never, 5 = very frequently) (Cronbach’s α = .97 for the 14 PMWI-SF items).

Analytic Plan

All study variables were assessed for assumptions of normality. Descriptive data on the primary study variables were calculated. Following this, analyses of variance (ANOVAs) were conducted to explore racial/ethnic (Latina vs. African American vs. White) differences in difficulties regulating positive emotions and alcohol and drug misuse. Pearson product–moment correlations were calculated to explore the bivariate associations between difficulties regulating positive emotions and alcohol and drug misuse. To address the question of whether race/ethnicity, difficulties regulating positive emotion, and their interaction are associated with alcohol and drug misuse, a moderation analysis was conducted with the PROCESS SPSS macro (Hayes, 2013). We used the DERS-P Total score (vs. the subscale scores) in the primary analyses to reduce the risk of Type II error. These analyses were restricted to the subsamples of African American and White individuals given the relatively small number of Latina individuals in this study. The PROCESS procedures use ordinary least squares regression and bootstrapping methodology, which confers more statistical power than standard approaches to statistical inference and does not rely on distributional assumptions. Bootstrapping was done with 1,000 random samples generated from the observed covariance matrix to estimate bias-corrected 95% confidence intervals (CIs) and significance values. Following the methods described by Aiken and West (1991), we plotted regression slopes of differences in alcohol and drug misuse in African American versus White participants, and conducted follow-up analyses to examine whether the slopes of the regression lines differed significantly from zero.

Results

Descriptive Data

During the 30 days prior to the study interview, 169 (85.8%) women reported being victimized by psychological IPV, 20 (10.2%) reported being victimized by physical IPV, and 15 (7.6%) reported being victimized by sexual IPV. Fourty-five (21.4%) women had alcohol use scores consistent with a possible alcohol use disorder. Thirty-six (18.3%) women had drug use scores consistent with a possible drug use disorder. See Table 1 for descriptive data on the primary study variables as well as their relations with demographic and relationship factors. Higher levels of overall difficulties regulating positive emotions were associated with less education; greater alcohol misuse was associated with lower income and less employment; and greater drug misuse was associated with younger age and less employment.

Table 1.

Descriptive Data and Correlations for the Primary Study Variables and Relationship and Demographic Characteristics.

Study Variables	1	2	3	4	5	6	7	8	9	10	11	12	13
1. DERS-P Total	—
2. DERS-P Accept	.88***	—
3. DERS-P Goals	.88***	.60***	—
4. DERS-P Impulse	.92***	.78***	.72***	—
5. AUDIT	.18*	.08	.21**	.20**	—
6. DAST	.14	.03	.21**	.12	.16*	—
7. Physical IPV	−.04	−.05	−.02	−.04	.01	.07	—
8. Sexual IPV	−.05	−.05	−.03	−.04	.02	.01	.15*	—
9. Psychological IPV	−.02	−.01	−.05	.02	−.13	−.05	.36***	.33***	—
10. Age	−.10	−.06	−.15*	−.06	.01	−.16*	−.03	.05	.03	—
11. Income	−.07	−.06	−.09	−.05	−.19**	−.14	−.03	.12	.18*	.06	—
12. Education	−.15*	−.12	−.14*	−.15	−.11	−.01	−.003	.13	.14	.03	.40***	—
13. Employment	−.05	−.01	−.09	−.03	−.22**	−.15*	.002	.08	.12	−.15	.46***	.20**	—
M (SD)	14.89 (4.52)	4.52 (1.75)	4.94 (1.87)	5.43 (1.46)	7.26 (5.03)	0.82 (1.68)	0.32 (1.21)	0.32 (1.87)	17.46 (16.27)	36.47 (11.55)	US$1,468.55 (US$1,094.21)	12.64 (2.06)	1.24 (0.86)
Cronbach’s α	.91	.88	.72	.86	.85	.83	.73	.81	.97

Note. DERS-P = Difficulties in Emotion Regulation Scale–Positive; AUDIT = Alcohol Use Disorder Identification Test; DAST = Drug Abuse Screening Test; IPV = intimate partner violence.

p < .05. **p < .01. ***p < .001.

Racial/Ethnic Differences in Emotional Dysfunction and Alcohol and Drug Misuse

See Table 2 for ANOVAs examining racial/ethnic differences in difficulties regulating positive emotions and alcohol and drug misuse. No significant differences emerged.

Table 2.

Between-Group Differences in Difficulties Regulating Positive Emotions and Alcohol and Drug Misuse as a Function of Race/Ethnicity.

Study Variables	White(n = 149)	African American(n = 86)	Latina(n = 45)	Test Statistic
Study Variables	M (SD)	M (SD)	M (SD)	Test Statistic
DERS-P	14.58 (3.29)	15.03 (4.96)	14.97 (5.11)	F(2, 197) = 0.20, p = .82, η² = .002
DAST	1.00 (2.04)	0.85 (1.60)	0.35 (1.01)	F(2, 196) = 1.70, p =.19, η² = .017
AUDIT	3.08 (5.25)	3.99 (6.36)	3.47 (3.47)	F(2, 197) = 1.15, p = .32, η² = .012

Note. DERS-P = Difficulties in Emotion Regulation Scale–Positive; DAST = Drug Abuse Screening Test; AUDIT = Alcohol Use Disorder Identification Test.

Correlations Between Emotional Dysfunction and Alcohol and Drug Misuse

Correlations in the overall sample show that difficulties regulating positive emotions were significantly and positively associated with alcohol (r = 18, p = .01), but not drug (r = .14, p = .06), misuse. However, among the subsamples, difficulties regulating positive emotions were (a) significantly associated with alcohol and drug misuse for White women (rs = .25 and .27, respectively; ps = .05 and .04, respectively); (b) significantly associated with drug (r =.37, p = .04), but not alcohol (r = .09, p = .61), misuse for Latina women; and (c) nonsignificantly associated with alcohol (r = .19, p = .06) and drug (r = .05, p = .65) misuse for African American women.

Moderation Analyses

The first moderation analysis examined race/ethnicity, difficulties regulating positive emotions, and their interaction on alcohol misuse. Difficulties regulating positive emotions, b = 0.45, SE = 0.23, t = 1.66, p = .05, 95% CI = [–0.002, 0.91]; race/ethnicity, b = 7.61, SE = 3.93, t = 1.94, p = .05, 95% CI = [–0.15, 15.37]; and their interaction, b = −0.46, SE = 0.26, t = −1.77, p = .08, 95% CI = [–0.97, 0.05] were not found to be significantly associated with alcohol misuse.

A second moderation analysis was conducted to examine race/ethnicity, difficulties regulating positive emotions, and their interaction on drug misuse. Difficulties regulating positive emotions, b = 0.17, SE = 0.07, t = 2.44, p = .02, 95% CI = [0.03, 0.30], but not race/ethnicity, b = 2.06, SE = 1.16, t = 1.77, p = .08, 95% CI = [–0.24, 4.36], were found to be significantly associated with drug misuse. The interaction between race and difficulties regulating positive emotions was also significantly associated with drug misuse, b = −0.15, SE = 0.08, t = −1.98, p = .049, 95% CI = [–0.30, –0.0001]. As illustrated in Figure 1, analysis of simple slopes revealed that difficulties regulating positive emotions were significantly and positively associated with drug abuse when participants were White, b = 0.17, SE = 0.07, t = 2.44, p = .02, 95% CI = [0.03, 0.30], but not when participants were African American, b = 0.01, SE = 0.04, t = 0.42, p = .67, 95% CI = [–0.05, 0.08].

Figure 1.

Difficulties Regulating Positive Emotions by Race Interaction for Drug Misuse.

Secondary Analyses

Correlations between the dimensions of difficulties regulating positive emotions and alcohol and drug misuse were calculated (see Table 1). Both alcohol misuse and drug misuse were significantly positively associated with difficulties engaging in goal-directed behaviors when experiencing positive emotions. Alcohol misuse was also significantly positively associated with difficulties controlling impulsive behaviors when experiencing positive emotions. Furthermore, ANOVAs examining racial/ethnic differences in the DERS-P subscales were conducted. No significant differences emerged—Accept: F(2, 194) = 1.47, p = .23, η² = .014; Goals: F(2, 194) = 0.20, p = .82, η² = .002; and Impulse: F(2, 194) = 0.07, p = .94, η² = .001.

Discussion

The goals of the current study were twofold: (a) to explore whether levels of difficulties regulating positive emotions differ among Latina, African American, and White IPV-victimized women, and (b) to examine the moderating role of race/ethnicity in the relation between difficulties regulating positive emotions and alcohol and drug misuse. Difficulties regulating positive emotions and alcohol and drug misuse did not differ as a function of racial/ethnic group. However, difficulties regulating positive emotions were differentially related to alcohol and drug misuse among the racial/ethnic groups. Moreover, race/ethnicity (African American vs. White) moderated the link between difficulties regulating positive emotions and drug misuse. These findings have important implications for theory, research, and practice.

The current study did not find racial/ethnic differences in difficulties regulating positive emotions. Existing research does indicate racial/ethnic differences in some aspects of emotional dysfunction (Butler et al., 2007; Gross et al., 2006; Gross & John, 2003; Weiss et al., 2017); however, this body of literature diverges from our investigation in two key ways. First, these studies focus on emotional dysfunction stemming from negative emotions. While a dearth of investigations that have examined racial/ethnic differences in positive emotional experiences, initial research in this area suggests that the expression and experience of positive emotions may be equally valued by individuals from diverse racial/ethnic groups (with the exception of pride, which may be more regulated among those racial/ethnic groups that adhere to collectivistic principles; Parker et al., 2012). These preliminary findings suggest that—because individuals of diverse racial/ethnic groups are socialized to experience and respond to positive emotions similarly—racial differences in emotional dysfunction stemming from positive emotions may not exist. Second, prior studies in this area have differed in their conceptualization and measurement of emotional dysfunction. Specifically, the vast majority of investigations have assessed the type and timing of emotion regulation strategies (e.g., reappraisal, suppression) on emotions, consistent with Gross’s (2015) model of emotion regulation. Conversely, and consistent with the conceptualization utilized in the current study, researchers may be interested in emotion regulation abilities, or ways in which individuals understand, regard, and respond to their emotions (Gratz & Roemer, 2004). These abilities are theorized to be a higher order process that determines the nature and success of emotion regulation strategies (Tull & Aldao, 2015). Finally, it is possible that the shared experience of IPV among the study participants may account for the lack of racial/ethnic differences in difficulties regulating positive emotions. Future research is needed to test these possible hypotheses.

Also inconsistent with prior research, we found equivalent levels of alcohol and drug misuse among Latina, African American, and White individuals in the current study. As was noted earlier, while Latina and African American individuals engage in comparable—or less—alcohol and drug use than White individuals (Substance Abuse and Mental Health Services Administration, 2019), they are more likely to experience consequences related to alcohol and drug use (McCabe et al., 2017; Mulia et al., 2009; Zapolski et al., 2014). These racial/ethnic differences have been attributed to larger systematic issues, such as poverty (Mulia et al., 2008), perceived prejudice (Mulia & Zemore, 2012), and discrimination (Martin et al., 2003). The composition of our sample may help to explain why racial/ethnic differences in alcohol and drug misuse were not detected. Specifically, women in our sample experienced adversities that have been found to contribute to risk for alcohol and drug misuse: They were victims of IPV, involved in the criminal justice system, and mostly unemployed, poor, and with lower levels of education. Future research would benefit from further exploring racial/ethnic differences in alcohol and drug misuse among populations that experience cumulative adversities.

At the bivariate level, difficulties regulating positive emotions were differentially related to alcohol and drug misuse among Latina, African American, and White individuals. Specifically, more difficulties regulating positive emotions were significantly related to greater alcohol and drug misuse for Latina and White individuals but were nonsignificantly associated among African American individuals. Our findings for White and African American individuals were in the hypothesized direction, and suggest that difficulties regulating positive emotions may be less likely to lead to negative outcomes among African American (vs. White) individuals. African American individuals may be socialized to respond differently to positive emotions, possibly as a means of protection from acts of race-related discrimination (Cole & Tan, 2007). Alternatively, social norms (e.g., celebratory drinking; Del Boca et al., 2004) or motives (e.g., positive reinforcement, or alcohol use to elicit, maintain, or enhance positive mood; Cooper et al., 2016) for alcohol and drug misuse may differ among African American and White individuals. These racial/ethnic differences, may in turn, explain the associations between difficulties regulating positive emotions and alcohol and drug misuse. These hypotheses should be tested in future studies.

Conversely, the finding that greater difficulties regulating positive emotions related to more alcohol and drug misuse among Latina individuals was unexpected. Indeed, existing research highlights fewer negative consequences for emotional dysfunction (e.g., alcohol use; Richman et al., 2011) among Latina individuals compared with White individuals. Future studies would benefit from further exploring the association of difficulties regulating positive emotions to alcohol and drug misuse among Latina individuals. For instance, although usually classified as a single ethnic group by researchers, there is significant within-group variability among Latina individuals, as they represent various national origins that each have their own culture. Thus, it is possible that the relation of difficulties regulating positive emotions to alcohol and drug misuse differs in Latina women as a function of national origin, as is true of other health outcomes (Cervantes et al., 2019; Stern et al., 2016). Nevertheless, initial evidence suggests the potential utility of assessing and treating difficulties regulating positive emotions among Latina individuals at risk for or with a history of alcohol and drug misuse.

Finally, moderation analyses provide support for a differential association between difficulties regulating positive emotions and drug misuse. Specifically, difficulties regulating positive emotions were significantly and positively associated with drug misuse among White (but not African American) IPV-victimized women. This finding has key implications for clinical practice. First, it suggests that difficulties regulating positive emotions may help to better identify White IPV-victimized women with drug misuse, and thus should be utilized in assessments with these women who are at risk for drug misuse, such as those who endorse other co-occurring risky behaviors (e.g., alcohol use) or physical (e.g., chronic pain) or emotional (e.g., posttraumatic stress disorder) distress. In addition, it underscores the potential utility of developing and refining treatments for drug misuse that address difficulties regulating positive emotions considering one’s racial/ethnic background. Finally, our results highlight the need for assessing and addressing racial/ethnic factors in drug use treatment.

Regarding the implications for research, our findings suggest that aggregating across race/ethnicity may obscure relations, further underscoring the need for (a) recruiting racially/ethnically diverse participants and (b) investigating the role of race/ethnicity. Moreover, future research must extend beyond examining racial/ethnic differences to identify the specific processes that underlie such differences (e.g., emotion socialization practices). Furthermore, given evidence that difficulties regulating positive emotions were not significantly associated with alcohol and drug misuse among African American IPV-victimized women, investigations are needed to identify alternative processes that may underlie drug misuse in this population (e.g., race-related discrimination; Martin et al., 2003). Finally, given the small number of Latina individuals in our sample, we were unable to test racial/ethnic differences between Latina individuals and both African American and White individuals. Replication in larger, more diverse samples is needed.

Although findings of the present study add to research on the role of race/ethnicity in the relation between emotional dysfunction and alcohol and drug misuse, limitations are noteworthy. First, the cross-sectional and correlational nature of the data precludes determination of the precise nature and direction of the relations of interest. For instance, although research suggests that difficulties regulating positive emotions may underlie the development, maintenance, and/or exacerbation of alcohol and drug misuse, it is likely that this association is bidirectional, with alcohol and drug misuse leading to more difficulties regulating positive emotions. Furthermore, the extent to which alcohol misuse and drug misuse are consequences of IPV victimization is unclear. Future studies should address this concern through prospective, longitudinal investigations. Second, although our focus on Latina, African American, and White IPV-victimized women may be considered a strength of this study, our findings cannot be assumed to generalize to other populations, including other IPV-victimized (e.g., men, women in bisexual or homosexual relationships) and alcohol- and drug-using (e.g., treatment-seeking) populations. For instance, the motives for alcohol and drug misuse may vary in important ways among IPV-victimized women. Indeed, there is some evidence that, in relationships characterized by IPV, male partners use coercion and control to force women to use alcohol and drugs (Warshaw et al., 2014), and women may be unable to negotiate alcohol and drug misuse without fear of negative consequences such as revictimization (Warshaw et al., 2014). Third, research is needed to examine the relations among difficulties regulating positive emotions and alcohol and drug misuse in racial/ethnic groups not represented here (e.g., American Indians/Alaska Natives, Native Hawaiians/Pacific Islanders, Asians). Fourth, racial/ethnic differences in the factor structure and psychometric properties of the DERS-P have not been evaluated. Research is needed to assess the utility of this scale for different racial/ethnic populations. Fifth, racial/ethnic status categorization alone does not explain cultural differences. Thus, it is necessary to investigate the role of culturally relevant factors (e.g., acculturation, enculturation, racial socialization, ethnic identity, race-related stress) in these relations. Furthermore, it will be important for future research to explore racial/ethnic differences in the demonstrated relations between difficulties regulating positive emotions and other clinically relevant outcomes such as posttraumatic stress disorder (Weiss, Darosh, et al., 2018; Weiss, Dixon-Gordon, et al., 2018) and risky sexual behavior (Weiss, Tull, et al., 2018; Zapolski et al., 2009). Finally, several demographic indicators (i.e., age, income, education, employment) were found to be associated with difficulties regulating positive emotions, alcohol misuse, and/or drug misuse. Given evidence for the utility of intersectional approaches to the study cumulative impact of risk among IPV-victimized women (Meyer et al., 2011; Peasant et al., 2017), future research would benefit from examination of the intersections among these factors in relation to difficulties regulating positive emotions, alcohol misuse, and drug misuse.

Despite these limitations, findings of the current study improve our understanding of relation of difficulties regulating positive emotions to alcohol and drug misuse among criminal justice–involved Latina, African American, and White IPV-victimized women. Specifically, our preliminary findings provide support for racial/ethnic differences in the associations among difficulties regulating positive emotions and alcohol and drug misuse, such that these relations were found to be significant for Latina and White (but not African American) participants. Our findings may inform culturally sensitive interventions for alcohol and drug misuse that are tailored to the unique needs of Latina, African American, and White individuals, underscoring the potential utility of targeting difficulties regulating positive emotions among Latina and White (but not African American) IPV-victimized women.

Footnotes

Authors’ Note

The opinions, findings, and conclusions or recommendations in this article are those of the authors and do not necessarily reflect those of the Department of Justice or the National Institutes of Health.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This project was supported by Award No. 2012-IJ-CX-0045 by the National Institute of Justice, Office of Justice Programs, U.S. Department of Justice. Work on this paper by the first author (N.H.W.) was supported by the National Institute on Drug Abuse (Grant Numbers K23DA039327 and L30DA038349) and the National Institute of General Medical Sciences (Grant Number P20GM125507).

ORCID iDs

Nicole H. Weiss

Ateka A. Contractor

Miranda E. Reyes

Tami P. Sullivan

Author Biographies

Nicole H. Weiss, PhD, is an assistant professor in the Department of Psychology at the University of Rhode Island and director of the Study of Trauma, Risk-taking, Emotions, and Stress Symptoms (STRESS) Lab. Her clinical and research interests focus on the role of emotion dysregulation in posttraumatic stress disorder (PTSD) and related risky, self-destructive, and health compromising behaviors, most notably substance use and HIV/sexual risk. She is also interested in the influence of cultural and contextual factors, including race/ethnicity and gender, on the interrelations among PTSD, emotion dysregulation, and risky behaviors.

Melissa R. Schick, MA, is a graduate student in the clinical psychology doctoral program at the University of Rhode Island. Her research focuses on positive psychotherapy interventions for substance use among college student populations.

Ateka A. Contractor, PhD, is an assistant professor in the Department of Psychology at the University of North Texas and director of the Study of Trauma Experiences, Signs, and Symptoms Lab. Her research attempts to address three major research questions: heterogeneity in traumatic experiences and corresponding PTSD symptomatology; mechanisms of PTSD’s comorbidity with depression, impulse-based symptoms, and substance use disorders; and the role of cultural and personality influences in PTSD’s symptomatology.

Miranda E. Reyes, MA, is a graduate student in the clinical psychology doctoral program at the University of Rhode Island. Her research focuses on the role of contextual/cultural factors in trauma/PTSD and risky behaviors.

Nazaret C. Suazo, BA, is a research assistant in the STRESS Lab at the University of Rhode Island. Her research focuses on the role of contextual/cultural factors in risky behaviors.

Tami P. Sullivan, PhD, is an associate professor in the Department of Psychiatry at the Yale University School of Medicine and the director of Family Violence Research and Programs. Her program of research focuses on individual- and system-level factors that affect the mental and physical health of women victims of intimate partner violence (IPV). At the individual level, she focuses on advancing knowledge of IPV, posttraumatic stress, substance use, and HIV/sexual risk, as well as other co-occurring problems. At the system level, she focuses on understanding the capacity of systems (e.g., criminal justice system) to meet the unique needs of IPV-exposed women.

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