The Relationship Between Drug Use, Impulsiveness and Emotional Dysregulation

A Pilot Study among Expatriates Living in the Netherlands

Bachelor Thesis, 2015

34 Pages, Grade: 1






List of Figures

List of Tables



1. Literature Review
1.1 Impulsiveness
1.2 Emotional Dysregulation
1.3 The Relationship between Impulsiveness and Emotional Dysregulation

2. The Expatriate
2.1 Research Question

3. Methodology
3.1 Experimental Design
3.2 Population
3.3 Materials
3.4 Procedure

4. Results
4.1 Emotional Dysregulation (Raw scores and graphs in Appendix 5)
4.2 Impulsiveness (Raw scores and graphs in Appendix 6)
4.3 Drug Use (Raw scores and graphs in Appendix 7)
4.4 Pearson’s (Appendix 6)

5. Discussion



Appendix 1

Appendix 2

Appendix 3

Appendix 4

Appendix 5

Appendix 6

Appendix 7

Appendix 8


I would like to thank Dr. Sheetal Shah and Dr. Erika O’Donnell for believing in my dreams and pushing me to be the best student and person I can be. Amr, Omneya, Khaled, Ola, Hania, Seifo, and Larousha—thank you for telling me every day that I could finish this successfully or for simply giving me belly aches from laughing every time I was getting too anxious. I love you all.


This project is dedicated to all the people I’ve harshly cut out of my life because of drug use. I’m sorry I wasn’t more compassionate or sympathetic to your struggles. This is also dedicated to all my booboos in Leiden—you make me a better human being every single day with your love and support. Finally this is also dedicated to my “Fat Cat”—I love you to the moon and back.

List of Figures

Figure 1: DERS Scoring Results Split According to Drug Use

Figure 2: BIS Results split by Drug use

Figure 3: Computation of results using Pearson’s

Figure 4: DERS

Figure 5: BIS-11

List of Tables

Table 1: DERS scoring

Table 2: BIS scoring

Table 3: DAST-20 scoring

Table 4: Results using Pearson's

Table 5: DERS tables (Unfiltered)

Table 6: DERS tables (filtered)

Table 7: BIS-11 tables (Unfiltered)

Table 8: BIS-11 tables (filtered)

Table 9: BIS-11 Scoring

Table 10: Drug use tables (Unfiltered)

Table 11: Drug use tables (filtered)


This pilot study asks the question, “What is the relationship between drug use and impulsiveness and emotional dysregulation?” by using a correlational research design based on the expat population in the Netherlands. Using quota and the snowball sampling technique, the researcher gathered expats between the ages of 18 and 30, who had either never tried any legal drugs since moving to the Netherlands but also those who had. They were to answer an online questionnaire containing 91 points selected from the Difficulties in Emotion Regulation (DERS), Barratt Impulsiveness Scale (BIS-11), and the Drug Abuse Questionnaire Test (DAST-20). Out of 41 participants in total, 10 participants were chosen for each group and a correlation coefficient was used to analyze the results. The hypothesis is that the experimental group would score higher with regard to impulsiveness and emotional dysregulation depending on their drug use score. The results confirmed the hypothesis and showed a moderately positive relationship between drug use and impulsiveness (r=0.43, n=20, p<0.05), but yielded statistically insignificant results regarding the relationship between drug use and emotional dysregulation (r=0.044, n=20, p<0.05). These results therefore indicate that expats who are taking drugs to have poorer impulse control. The insignificant results with regard to the relationship between emotional dysregulation and drug use could be due to confounding variables, and should be tested further in a follow-up study.


Information on the psychology of expatriation is limited even though reports of stress, drug use, and anxiety have been commonly reported among this group (Carraher, Shawn, Sullivan, Sherry, & Sarah, 2005). Since we do not yet have a clear expatriate prototype, it is therefore more helpful to understand the world around them by looking at their emotional, mental, and physical commitments and their impact on their lives. As globalization brings us closer together, so should our quest grow to investigate the significant impact these stressors have on one’s life, specifically regarding drug use.

The relationship between drug use, its causes and subsequent behaviors is highly complex as it is difficult to determine why people start taking them. There are several theories suggesting that it is due to either environmental, biological, or individual factors. (National Institute on Drug Abuse (NIDA), 2014). While there are many circumstances that mediate and moderate the relationship between an individual and drug use, impulsiveness and emotional dysregulation have been shown consistently to be the highest risk factors for someone to begin and keep using drugs (Whelan, 2012). The Netherlands has reported drug overdoses among this population group as recently as November 2014 (BBC Newsbeat, 2014). This leads to the question: “Is there a relationship between drug use and impulsiveness and emotional dysregulation among the expats in the Netherlands?”

1. Literature Review

1.1 Impulsiveness

The general concept of impulsivity can be defined as the tendency to act prematurely without thinking of the potential consequences (Berlin & Hollander, 2008). This differs from compulsivity which refers to the tendency to repeat the same, often purposeless actions and are sometimes associated with undesirable consequences (Berlin & Hollander, 2008). There seems to be a relationship between the two because even though impulsive behaviors do have an initial element of pleasure, they can lose this pleasurable quality over time, as many individuals re-engage in certain activities in a compulsive way in order to decrease dysphoria (Berlin & Hollander, 2008). This suggests that these urges are reinforced by the desire to alleviate anxiety and stress to obtain pleasure and gratification.

Impulsiveness and Drug Use

Drug use is common in individuals who have high levels of impulsivity, as it may be part of a pattern of impulsive behavior (National Institute on Drug Abuse [NIDA], 2014). Independent of how the substance abuse actually begins, it always makes the impulsive behavior worse (Futures Palm Beach, 2015). Even if the substances initially make the impulse seem more manageable, it actually causes one to lower one’s inhibitions and impairs one’s judgment, making it more difficult to practice effective coping skills in high-risk situations (National Institute on Drug Abuse [NIDA], 2014). The 2012 publication by The National Institute of Drug Abuse on “Drug, Brains, and Behavior: The Science of Addiction” discusses the ways that drug addiction is responsible for a decrease in impulse control while simultaneously increasing the individual’s desire to take more drugs. It indicates that the lessening of self-control occurs in the addict as well as the casual user, or the new user.

1.2 Emotional Dysregulation

The term “affect” is used to refer to the brief feelings that are experienced in response to a particular stimulus or situation (James 1884, 1894). These feelings have been regarded as having some evolutionary significance. Therefore, it plays an important role in facilitating decision-making and guiding behaviors (Gross, 1998). The roles of negative affect, positive affect, and effortful control have been shown to be significantly correlated with the use and maintenance of use of substances. (Cheetham, A., Allen, N. B., Yucel, M., & Lubman, D. I. 2010).

Theoretically, there are several ways that affect and drug use are linked, the most relevant being the role of affective processes on influencing motivational thoughts and behaviors. The experience of affect facilitates action: it directs attention, prepares the individual for rapid physical responses, and guides their behavior to meet a particular need (Gross, 1998; Thompson, 1994). Since affect plays an important role in reasoning and decision-making, human behavior is driven by emotion-motivated reasoning: our reasoning is biased toward select outcomes - such as drug use - that minimize negative and maximize positive affective states (Bechara & Damasio, 2002; Damasio, 2001).

Negative Affect

The relationship between negative affect and drug use is conceptualized in the oldest and most widely studied model of addiction: negative reinforcement. It argues that individuals who experience high levels of negative affect are at a higher risk of using drugs or alcohol as a coping mechanism in order to improve their mood or distract from negative feelings (McCollam, Burish, Maiso, & Sobell, 1980; Measelle, Stice, & Springer, 2006). Moreover, Baker et al.’s (2004) affective model of drug motivation suggests that substance use behaviors are engaged as an automatic coping response at low levels of negative affect. Exposure to negative affect has been found to be a motivating factor in the increase of self-reported craving (Childress et al., 1994; Fox, Berguist, Hong, & Sinha, 2007; Litt, Morse, Bauer, & Gaupp, 1997). There is also a strong link between negative affect and affective psychopathology meaning people are more likely to meet the diagnostic criteria for substance use disorder if they already met criteria for disorders that are characterized with negative affect, such as Avoidant Personality Disorder, Borderline Personality Disorder, and Obsessive-Compulsive Personality Disorder (Dawson, Grant, Stinson, & Chou, 2004).

Positive Affect

Positive affect may be associated with drug use at both, high and low levels, such as individuals who are prone to experiencing high levels of positive affect being more likely to engage in risky behaviors such as drug use. Individuals who experience higher levels of positive affect in response to drug use will be more likely to seek out these substances for hedonic purposes (Cheetham, A., Allen, N. B., Yucel, M., & Lubman, D. I. 2010). Also, low levels of positive affect in response to a non-drug related stimulus may prompt substance use as a way to compensate for this deficit. This does not mean, however, that positive and negative affect work opposite each other, but rather that they are independent systems that may occur at the same time to the same individual. (Cheetham, A., Allen, N. B., Yucel, M., & Lubman, D. I., 2010). Furthermore, Aguilar de Arcos et al. (2008) proposes that compulsive-like behavior that characterizes addiction is an underlying dysfunction in two interacting systems, impulsiveness and reflectiveness, as the influence of the dysfunctional impulsive system hijacks the reflective processes needed to control decision making.

Effortful Control

Temperamental effortful control is defined as the degree of control the individual has over impulses and emotions (Rothbart, Ellis, Rueda, & Posner, 2003). There are several ways in which effortful control could have an influence on substance use: having low levels of effortful control may leave individuals less able to effectively distract themselves from unpleasant feelings, low levels may interact with negative or positive affect, or impair someone’s ability to control ongoing use. This may not only be associated with drug use itself, but also with specific motivations for use such as to enhance one’s mood (Colder & O’Connor, 2002). Research has also shown that there may be dissociation between the level of control that substance users perceive themselves to have over their affective reactions and the level of control they actually have.

1.3 The Relationship between Impulsiveness and Emotional Dysregulation

Failure to control our impulses have been linked to a broad range of personal and social problems, including substance abuse, school failure, sexually transmitted diseases, violence, and crime (Baumeister, Heatheron, & Tice, 1994). The failure to self-regulate may occur because different regulatory goals are in conflict with each other, it is possible for impulse control and affect regulation to have a conflicting relationship (Tice, Bratslavsky, & Baumeister, 2001). Impulse control, in general, requires the person to stifle their quest for short-term, pleasurable rewards and rather pursue long-term goals. In order to achieve those, individuals must avoid responding to the immediate stimulus in their environment only. However, when under emotional distress, people may give priority to the short-term goals of feeling better and sacrifice long-range goals and this tendency to continue to give priority to short-term goals is detrimental to self-regulation (Tice, Bratslavsky, & Baumeister, 2001).

2. The Expatriate

An expatriate (or “expat”) is defined as a person who lives outside his/her native country, whether temporarily or permanently, whether for work, education, legal, or marriage purposes and there are expats of all age ranges (Dictionary [dot] com, 2015). Many types of work-related events including changes in work/family, taking a new job, discrimination, stereotyping, and social isolation, etc. have been examined, researched, and identified as stressful life events (Sullivan, 1992; Walls, Capella, and Green, 2001); (London 1997; Nelson and Stutton, 1990), (Price, 2000; Shaffer, Joplin, Bell, Lau, and Oguz, 2000). To avoid having to deal with the discomfort that many expats face, they look for mindless activities to pass the time, such as compulsive eating, skipping classes, and alcohol and drug use (Osumi, 2013).

The model of adaptation suggests that working internationally as an expat puts a person through a cycle of different phases until they reach final adaptation (Aswegen, 2009). The extent to which an expat is successful depends on how effectively they adjust to the “foreignness” of the new culture, meaning culture shock, the environmental context, such as adjusting to a new language, as well as the expat’s individual reactions to stressors (Aswegen, 2009). The “Diagnostic and Statistical Manual of Mental Disorders” (DSM) defines stressors as “predominantly acute events (with a duration of less than six months), or predominantly enduring circumstances (with a duration greater than six months)”. On a six-point scale, a score of six represents catastrophic stress and it is found that an expat on average receives a rating of four, indicating severe stress (Aswegen, 2009). This exposure to stress may lead to several problems, such as emotional and mental fatigue.

Aswegen (2009) found that travel and relocation does have a strong impact on an expat’s well-being and it can affect their performance at work, school, as well as their relationship with others. Truman, Shara, & Pompe (2011) have also found in their research that expats experience a higher risk for internalizing and externalizing problems, as well as a higher risk for substance use. Expats who internalize stress are shown to score twice as high with regard to feeling trapped, depressed, anxious and nervous. Expats who externalize their stress are shown to have higher levels of aggression in response to feeling that their global community’s emotional, professional, and relationship demands are exceedingly high. These behaviors suggest emotional dysregulation and poor impulse control. Finally, the study also showed that expats were at higher risk for substance abuse problems possibly due to the believe that it may reduce social pressure. However, it was also found that if high levels of emotional or mental fatigue are detected early on, it becomes much more feasible to manage their adjustment during the adaptation phases (Aswegen, 2009).

Expats in the Netherlands

The Netherlands has a total population of 16.5 million and in a report published by “Statistics Netherlands” in January 2015, it was found that the number of expats varies between 39,000 to 75,000 individuals, not including the “short-stay” internationals who stay between one to eight years and then leave, which make up approximately 500,000 of the population (Dutch News, 2015). Amsterdam alone is comprised of 177 nationalities and no other city in the world has that much diversity in a city of 756, 347 people, with the biggest immigrant groups being Moroccan, Turkish, British, German, and Surinamese (Amsterdam Advisor, 2009). Furthermore, most individuals smoking marijuana in the Netherlands are not Dutch, but expats and/or tourists (“I Am Expat”, 2014; Reuter, 2009). The Netherlands has also been rated the least friendly country for expats (Dutch Daily News, 2011), which could easily exacerbate the already stressful living conditions that an expat must face while living abroad.

2.1 Research Question

Based on this review, the following assumptions are made:

1) Impulsiveness and drug use are positively related.
2) Emotional dysregulation and drug use are positively related.

This leads to the research question, “Is there a relationship between drug use and impulsivity and emotional dysregulation among the expats in the Netherlands?”

3. Methodology

3.1 Experimental Design

A correlational research design was used to test if there was a relationship between drug use and impulsiveness and emotional dysregulation. Even though this design is vulnerable to confounding variables, it is the most ethical design to use for this subject. Since it is unethical for the researcher to administer or control the amount of drugs a participant takes, she looked for expats who either had already taken a legal drug and some who had not. Furthermore, due to the researcher’s limitations, she was only able to test impulsiveness and emotional dysregulation levels via self-reports, as opposed to more objective measures. This eliminates other designs she could have used that may have provided more internal control over the variables but with less ethicality, leaving the correlational design as the best choice to answer the research question.

This pilot study’s goal was to be explanatory research, as the design helps to explain how strong these relationships are and all data were collected at one time on the online survey software, Qualtrics. There were two groups, one experimental and one control group. Each group consisted of ten expats who currently live in the Netherlands. Expats who have tried at least one drug (not including alcohol) were placed in the experimental group while those who had not were placed in the control group. A correlation coefficient was used to test the strength of the relationship for the following groups: impulsiveness level and emotional dysregulation level with drug use (or without).

The independent variable for this study was the legal drug use and the dependent variables were the level of emotional dysregulation and impulsiveness. The hypothesis was that there would be a positive relationship between drug use and impulsiveness and drug use and emotional dysregulation.

3.2 Population

Quota sampling was the method used to recruit participants for this pilot study. In order to be included, the participant had to be an expatriate over the age of 18 who speaks English fluently. The researcher’s goal was to gather a study group of at least 100 participants, but she was only able to find a total number of 55 willing participants in the allotted time frame (nine days). Of them, only 41 participants managed to complete the questionnaire in time. Since there were more expats in the experimental group than in the control group, the researcher had to randomly choose a total number of participants in the experimental group to match the size of the control group (n=16). Four participants in the control group did not complete the questionnaire and therefore their responses were discarded leaving ten. The questionnaires represented the observation unit and the level of analysis represented their levels of impulsiveness, emotional dysregulation, and drug use.


Excerpt out of 34 pages


The Relationship Between Drug Use, Impulsiveness and Emotional Dysregulation
A Pilot Study among Expatriates Living in the Netherlands
Webster University
Senior Thesis
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ISBN (eBook)
ISBN (Book)
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drug use, living abroad, impulsiveness, emotional dysregulation, expatriates, netherlands, psychology, study
Quote paper
Reham Al Taher (Author), 2015, The Relationship Between Drug Use, Impulsiveness and Emotional Dysregulation, Munich, GRIN Verlag,


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