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From Binge Drinking to Future Alcohol Severity: The Role of

Emotion Regulation and Emerging Psychopathology

Authors

Carina Carbia a,b, María Soledad Rodríguezc,d, Samuel Suárez-Suáreze, Sonia Doallo f,d,
Fernando Cadaveiraf,d, Montserrat Corral f,d

Afiliations

a
Psychological Sciences Research Institute (IPSY) Louvain Experimental Psychopathology
research group (LEP), UCLouvain, Belgium

b
Institute of Neuroscience – Cellular and Molecular division (IoNS/CEMO) Laboratory of
Nutritional Psychiatry (NUPS), UCLouvain, Belgium

c
Department of Social, Basic Psychology and Methodology, Faculty of Psychology,
Universidade de Santiago de Compostela, Santiago de Compostela, Spain

d
Instituto de Psicoloxía (IPsiUS), Universidade de Santiago de Compostela, Spain

e
Health Sciences Department, University of Burgos, Burgos, Spain

f
Departamento de Psicoloxía Clínica e Psicobioloxía, Facultade de Psicoloxía, Universidade
de Santiago de Compostela, Santiago de Compostela, Spain

Corresponding Author: María Soledad Rodríguez, email: msoledad.rodriguez@usc.es

Declaration of Interest: Authors declare no conflicts of interest.

Acknowledgements: This work was supported by Grant PID2020-113487RB-I00 funded by

MCIU/AEI/ 10.13039/501100011033; Grant PNSD 2015/034 funded by PNSD; Grant
PSI2015-70525-P co-funded by MEIC and ERDF. Carina Carbia received funding from the
NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice.
Fonds de la Recherche Scientifique (FNRS) as a Chargé de Recherches (CR).
medRxiv preprint doi: https://doi.org/10.1101/2025.03.04.25323343; this version posted March 5, 2025. The copyright holder for this preprint
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ABSTRACT

Binge drinking (BD) during emerging adulthood increases the risk of developing alcohol use
disorders, yet not all individuals follow this trajectory. Deficits in emotion regulation has been
identified as a risk factor for psychopathology, but its specific role in shaping long-term alcohol
severity among young binge drinkers remains insufficiently understood. This study investigates
the role of emotion regulation difficulties as a mediator in the relationship between binge BD
and future alcohol severity in young people and the moderator role of emerging
psychopathological symptoms. We followed a cohort of 192 university students (53% female)
over two years, from ages 18 to 20 We measured alcohol consumption and emotion regulation
(Difficulties in Emotion Regulation Scale), as well as psychopathological symptoms (Brief
Symptom Inventory). Mediation and moderated mediation models were conducted with
PROCESS. Results show that BD predicts future alcohol severity, with emotion regulation
difficulties, specifically challenges in goal-directed behaviour, partially mediating this
relationship. Psychopathological symptoms moderated the effects, with difficulties in emotion
regulation being a significant predictor of future alcohol severity only in individuals with
emerging psychopathological symptoms. Additionally, the association between BD and future
alcohol severity was amplified in those with emerging psychopathological symptoms. These
findings offer new insights into the risk factors underlying the escalation of problematic alcohol
use and the interplay between BD, emotion regulation, and psychopathology. They also stress
the importance of early interventions focused on enhancing emotion regulation abilities in
young binge drinkers, especially those displaying early psychopathological symptoms.

Keywords: binge drinking, adolescence, trajectory, emotion regulation, risk factors, alcohol
medRxiv preprint doi: https://doi.org/10.1101/2025.03.04.25323343; this version posted March 5, 2025. The copyright holder for this preprint
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1.INTRODUCTION
Alcohol consumption is the leading risk factor for premature mortality among individuals aged
15 to 49 (World Health Organization [WHO], 2018). The most prevalent pattern of alcohol use
among young adults is binge drinking (BD), typically defined as consuming a considerable
quantity of alcohol in a short period that results in a blood alcohol concentration of at least 0.8
g/L (National Institute on Alcohol Abuse and Alcoholism, 2004). BD peaks in late adolescence,
particularly in the early 20s, coinciding with college years (Merrill & Carey, 2016). While al-
cohol use generally declines during emerging adulthood, a significant subset of individuals con-
tinues to binge drink into adulthood (Moure-Rodríguez et al., 2018). These persistent binge
drinkers (BDs) face a heightened risk of developing alcohol use disorders (AUDs) (Patrick et
al., 2021). Understanding the factors driving the progression from BD to problematic alcohol
use during the critical transition to early adulthood is essential for better identification of at-risk
subgroups. Since substance use and comorbid psychopathology peak during adolescence, it is
crucial to focus on transdiagnostic risk factors underlying the frequent co-occurrence of alcohol
misuse and mood disorders to develop effective prevention strategies that target multiple dis-
orders (Compas et al., 2017; González-Roz et al., 2024; Shadur & Lejuez, 2015).

In this sense, one risk factor that has gained attention over the last years due to its potential
transdiagnostic value is emotion regulation (Klein et al., 2022; Lincoln et al.; 2022; McLaughlin
et al, 2015; Schäfer et al., 2017). Emotion regulation refers to individuals' efforts to influence
which emotions they experience and express, effectively adapt to different situations, and
achieve desired emotional states (Gross, 1998). Deficits in emotion regulation have been pre-
viously demonstrated in patients with AUD, being more consistently associated with alcohol
use problems than frequency of alcohol use (Brown & Melas, 2024). A recent meta-analysis
(Stellern et al., 2023) concluded that individuals with AUD exhibit difficulties in different emo-
tion regulation dimensions, principally abilities related to impulsive behaviour, lack of adaptive
strategies and difficulties engaging in goal-directed behaviour. These difficulties are linked to
higher relapse rates (Fox et al., 2008; Shadur & Lejuez, 2015) and appear to contribute to higher
alcohol craving (Khosravani et al., 2017; Petit et al., 2015; You et al., 2023).

Thus, while poor emotion regulation increases alcohol misuse, chronic alcohol use further im-
pairs an individual’s ability to regulate emotions (Brown & Melas, 2024). According to the
negative reinforcement model of addiction, individuals may use substances as a maladaptive
coping mechanism to alleviate negative emotions, thereby reinforcing the cycle of substance
use and emotional dysregulation (Koob, 2013; Wise & Koob, 2014). Consequently, individuals
medRxiv preprint doi: https://doi.org/10.1101/2025.03.04.25323343; this version posted March 5, 2025. The copyright holder for this preprint
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with AUD and comorbid psychopathology exhibit even more severe deficits in emotion regu-
lations, with greater reliance on substance use as an ineffective emotion regulation strategy
(Berking et al., 2011; Shadur & Lejuez, 2015).

Given that adolescence is a critical period for the onset of psychiatric disorders (Compas et al.,
2017; McLaughlin et al., 2011; Rapee et al., 2019), difficulties in emotion regulation during
this stage may increase vulnerability to substance use. This developmental period is character-
ized by heightened social changes and increased stressors. Moreover, significant neuromatura-
tional changes are taking place, particularly in brain regions underlying self-control and emo-
tion regulation, such as the prefrontal cortex and limbic system (Ahmed et al., 2015) and con-
tinue to develop through adolescence into emerging adulthood (Andrews et al., 2021; Fombou-
chet et al., 2023). Thus, adolescents who engage in BD and lack adaptive emotion regulation,
might be at heightened risk for future alcohol severity and alcohol-related problems.

Despite this, limited research has explored the role of emotion regulation among young BDs
and its impact on future alcohol severity. Few longitudinal studies have examined how emotion
regulation and substance use interact over time. For example, Hessler and Katz (2010) found
that adolescents with poor emotion regulation were more likely to engage in substance use
seven years later. Even after controlling for baseline substance use, emotion dysregulation pre-
dicted future emergence of mood disorders and greater substance use, strengthening claims of
emotion regulation as a key transdiagnostic risk factor (Klein et al., 2022; Kliewer et al., 2016).

Building on existing evidence, this longitudinal study examines whether difficulties in emotion
regulation mediate the relationship between BD and trajectories of alcohol severity in university
students over a two-year period. Specifically, we hypothesize that BD will predict greater alco-
hol severity over time, with this relationship being partially explained by emotion regulation
difficulties (mediation hypothesis). Furthermore, we propose that psychopathological symp-
toms will serve as a moderator, influencing the strength of these associations (moderated me-
diation hypothesis). Specifically, we expect that young BDs with higher levels of psychopatho-
logical symptoms will exhibit a stronger relationship between emotion regulation difficulties
and future alcohol severity, suggesting that difficulties in managing emotions may be particu-
larly detrimental for those individuals who experience greater psychopathological symptoms.
Additionally, we hypothesize that psychopathological symptoms will moderate the direct effect
of BD on alcohol severity, such that the association will be stronger for those with greater psy-
chopathological symptoms. By examining these interconnections, this study aims to provide a
more nuanced understanding of the mechanisms underlying the risk of escalating alcohol use
medRxiv preprint doi: https://doi.org/10.1101/2025.03.04.25323343; this version posted March 5, 2025. The copyright holder for this preprint
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severity and highlight the potential role of emotion regulation and comorbid psychopathology
in shaping these trajectories.

2. MATERIALS AND METHODS

2.1. Sample and Procedures

The sample consisted of 192 participants (102 females) who were recruited as part of a longi-
tudinal study conducted within the scope of a larger research project investigating risk factors
and outcomes associated with BD in university students. At baseline, the sample was composed
by 267 participants and 192 at follow-up (two years later). For sample selection, a total of 2998
first-year students from the Universidade de Santiago de Compostela (USC, Spain) voluntarily
completed a questionnaire assessing sociodemographic information and alcohol and other sub-
stance consumption, including the adapted versions of the Alcohol Use Disorders Identification
Test (AUDIT; Babor et al., 2001; Bohn et al., 1995; Varela et al., 2005), Timeline Follow-Back
(TLFB; Sobell & Sobell, 1992), and the Cannabis Abuse Screening Test (CAST; Cuenca-Royo
et al., 2012; Legleye et al., 2007). Those interested in participating provided a telephone num-
ber/email and were scheduled for an initial visit. At this initial visit, the eligibility for study
participation was based on the following exclusion criteria: potential alcohol-related problems
(>20 AUDIT); psychopathological symptoms (≥ 90th percentile GSI score, Symptom Check-
list-90 SCL-90, Derogatis & Savitz,1999); neurological or systemic conditions that signifi-
cantly impacted neurocognitive function; regular use of psychoactive medications; consump-
tion of illicit substances in the las 6 months, except occasional cannabis (CAST <9); and family
history of alcoholism or a diagnosed major psychopathological disorder (defined as at least two
first-degree relatives or three or more first- or second-degree relatives with psychiatric history).
Participants reported their alcohol consumption at two different times: at baseline and follow-
up, when they were between 18/19 years old and between 20/21 years old. Emotion regulation
was assessed at follow-up, with the Spanish validation of the Difficulty in Emotion Regulation
Scale (DERS; Gratz & Roemer, 2004; Hervás & Jódar, 2008). Additionally, at follow-up, psy-
chopathological symptoms were measured using the Brief Symptom Inventory (BSI-18;
Derogatis, 2001; Derogatis, 2013). All participants gave written consent and received monetary
compensation for their participation. The study received approval from the USC´s Bioethics
Committee.
medRxiv preprint doi: https://doi.org/10.1101/2025.03.04.25323343; this version posted March 5, 2025. The copyright holder for this preprint
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2.2. Materials

Difficulty in Emotion Regulation Scale (DERS; Gratz & Roemer, 2004): This self-report
questionnaire assesses difficulties with emotion regulation. The DERS assesses six different
aspects of emotional regulation, including non-acceptance of emotional responses (Non-
Acceptance), lack of emotional awareness (Awareness), impulse control difficulties (Impulse),
difficulty engaging in goal-directed behaviour (Goals), lack of emotional clarity (Clarity) and
limited access to emotional regulation strategies (Strategies). Non-acceptance of emotional
responses examines the extent to which individuals experience additional negative emotion as
a result their evaluation of current emotional states (e.g. ‘‘When I’m upset, I become irritated
with myself for feeling that way’’). Lack of emotional awareness indexes the extent to which
individuals attend to and acknowledge their emotions (‘‘I am attentive to my feelings’’). Lack
of emotional clarity indexes difficulties in identifying which emotions a person is experiencing
or confusion about emotional experiences (e.g., ‘‘I have difficulty making sense out of my
feelings’’). Two domains focus on the extent to which emotions affect goal-directed behaviour.
Impulse control difficulties index the extent to which negative emotion increases the likelihood
of rash/impulsive action at the expense of future goals (e.g. ‘‘When I’m upset, I become out of
control’’). Difficulties engaging in goal-directed behaviour indexes the extent to which negative
emotions interrupt an individual’s ability to maintain focus on specific tasks (e.g., ‘‘When I’m
upset, I have difficulty getting work done’’). Finally, limited access to emotion regulation
strategies, focuses on an individual’s subjective belief in their ability to use emotion regulation
when needed. The total DERS score is calculated from the sum of all six subscales (range of 36
to 180), with higher scores indicating higher difficulties. The DERS has shown good internal
consistency (Cronbach’s α > 0.70); similar values were obtained in our study (0.93 Cronbach’s
α) with adequate predictive and construct validity (Hervás & Jódar, 2008).

Alcohol Use Disorders Identification Test (AUDIT; Babor et al., 2001): The AUDIT is a
screening tool developed by the WHO to identify problem drinkers, which includes questions
on alcohol use, dependence symptoms, and alcohol-related problems over the past 12 months.
In this study, the Galician-validated version was used. Scores range from 0 to 40 (high risk of
alcohol dependence). The Cronbach’s alpha in this sample was 0.812. The total AUDIT score
at follow-up was used as an index of alcohol severity in the models.

Alcohol Timeline Follow-Back calendar (TLFB; Sobell & Sobell, 1992): Participants
retrospectively completed a calendar for the past 180 days, recording the number of standard
medRxiv preprint doi: https://doi.org/10.1101/2025.03.04.25323343; this version posted March 5, 2025. The copyright holder for this preprint
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alcohol units consumed each day. This measure allowed us to compute the number of BD days
(over the past 180 days), defined as the consumption of ≥ 4 (female) or ≥ 6 (male) Spanish
standard drinks (10g of alcohol) on one single occasion. Number of BD episodes in the past
180 days was used in the statistical models as the main predictor.

Brief Symptom Inventory 18 (BSI-18; Derogatis, 2001; Derogatis, 2013): The BSI is a self-
report questionnaire with 18 items answered on a Likert scale. Considered a shortened version
of the SCL-90, it assesses psychopathological symptoms in both clinical and general
populations. It measures factors like Somatization, Depression, and Anxiety and a Global
Severity Index, which was used as an indicator of emerging psychopathological symptoms at
follow-up.

2.3. Statistical Analysis

Descriptive statistics, including demographic data, alcohol consumption, BSI-18 and DERS
scores were calculated. T tests were used to assess sex-related differences and to assess differ-
ences between groups with high and low psychopathological symptoms after a moderation ef-
fect was proven. Correlations between DERS subscales and drinking variables were computed.
Mediation and moderated mediation analyses were conducted with the PROCESS macro
(Hayes, 2012; Hayes, 2017), using the IBM Statistical Package SPSS Version 28.0.

The assumptions for the Mediation Model were as follows: binge drinking influences future
alcohol severity both directly and indirectly through emotion regulation difficulties. Specifi-
cally, we propose: (I) BD will directly predict alcohol severity and (II) the effect of BD on
future alcohol severity will be mediated by emotion regulation. The assumptions for the Mod-
erated Mediation in which psychopathological symptoms were proposed as moderator are as
follows: (I) The strength of the association between emotion regulation difficulties and future
alcohol severity will be moderated by psychopathological symptoms, such that this relationship
will be stronger for individuals with higher levels of psychopathological symptoms; (II) The
direct effect of BD on future alcohol severity will also be moderated by psychopathological
symptoms, such that the association between BD and alcohol severity will be stronger among
individuals with higher levels of psychopathological symptoms. Sample categorization in high
and low psychopathological symptoms was performed using the median split (BSI score at fol-
low-up, 50th percentile).
medRxiv preprint doi: https://doi.org/10.1101/2025.03.04.25323343; this version posted March 5, 2025. The copyright holder for this preprint
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3. RESULTS

3.1. Descriptive statistics and correlations

Descriptive statistics for the full sample are shown in Table 1. When comparing low and high
psychopathology groups, individuals with higher psychopathological symptoms exhibited more
alcohol use severity at follow-up and more pronounced difficulties in the total DERS score, and
all dimensions except Awareness. However, no significant differences between these two
groups were observed for the number of BD episodes at baseline. Correlations between study
variables can be found in Table 2. The number of BD episodes positively correlated with se-
verity of alcohol use as measured by the AUDIT total at follow-up (r = .638), as well as with
the total DERS score (r= .171). Among the DERS dimensions, the Goals dimension showed the
strongest correlation with the number of BD days (r = .191) and AUDIT total (r = .300).

3.2. Mediation analysis

The results indicate that while the number of BD episodes is the strongest predictor for later
alcohol use severity, there was a significant indirect effect mediated by emotion regulation. The
model explains 44% of the variance in predicting future alcohol severity two years later. This
association was mediated by the Goals dimension, that is, difficulties engaging in goal-directed
behaviour. Table 3 contains the coefficients of all regression-based models. A conceptual rep-
resentation can be found in Figure 1.

BD significantly predicted emotion regulation difficulties (B = .054, p = .008), indicating that

higher number of BD episodes was associated with greater difficulties in emotion regulation,
in particular difficulties in goal-directed behaviour. The overall model was significant (F2,189 =
74.283, p < .001, R² = .440) and explained 44.0% of the variance. Both BD (B = .196, p < .001)
and emotion regulation difficulties in Goals (B = .214, p = .001) were significant predictors of
alcohol severity, with a significant indirect effect of BD on alcohol severity through the Goals
dimension (B = .012, 95% CI = .002 - .024), supporting mediation. These findings suggest that
emotion regulation difficulties in goal-directed behaviour, partially explain the association be-
tween BD and alcohol severity, while BD still retains a significant direct influence on future
alcohol severity.

3.3 Moderated Mediation analysis

This model examined whether psychopathological symptoms at follow-up moderated both the
indirect effect and the direct effect of BD on future alcohol severity. The overall model was
medRxiv preprint doi: https://doi.org/10.1101/2025.03.04.25323343; this version posted March 5, 2025. The copyright holder for this preprint
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significant (F5,186 = 38.484, p < .001), explaining 51% of the variance. Table 3 contains the
coefficients of all regression-based models.

BD remained a significant predictor (B = .150, p < .001). The interaction between BD and
psychopathological symptoms was significant (B = .095, p = .006), indicating that psychopatho-
logical symptoms moderate the direct effect of BD on alcohol severity. The interaction between
emotion regulation difficulties and psychopathological symptoms was also significant (B =
.301, p = .022).

At low levels of psychopathological symptoms, the effect of emotion regulation on alcohol

severity was non-significant. However, at high levels of psychopathological symptoms the ef-
fect of emotion regulation on alcohol severity was significant (B = .307, p = .002), indicating
that difficulties in emotion regulation only significantly predicted alcohol severity for those
with high psychopathology. At low levels of psychopathological symptoms, the effect of BD
on alcohol severity was lower than at high levels (B = .150, p < .001). At high levels of psy-
chopathological symptoms, this effect was stronger (B = .245, p < .001), suggesting that BD
had a stronger association with future alcohol severity among individuals that develop psycho-
pathological symptoms. Figure 2 depicts a conceptual representation for the overall model and
psychopathology groups.

4. DISCUSSION

While emotion dysregulation is known to contribute to alcohol dependence, few studies have
explored its role in young non-clinical samples, such as university students who regularly binge
drink. This study examines how emotion regulation mediates the link between BD and future
alcohol severity over two years in young people without prior alcohol use disorders or
psychopathology. First, our findings show that a higher number of BD episodes was associated
with greater difficulties in emotion regulation. As hypothesized, while BD remained a
significant predictor of future alcohol severity, emotion regulation difficulties partially
mediated this relationship. Specifically, difficulties engaging in goal-directed behaviour under
distress—such as struggling to concentrate and complete tasks when experiencing negative
emotions—emerged as the key dimension associated with this mediation effect. Although our
sample excluded individuals with psychopathological disorders at baseline, emerging
psychopathological symptoms at follow-up significantly moderated these associations. Thus,
among individuals with high psychopathological symptoms, BD was a stronger predictor of
medRxiv preprint doi: https://doi.org/10.1101/2025.03.04.25323343; this version posted March 5, 2025. The copyright holder for this preprint
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alcohol severity than at low levels of symptomatology. Additionally, emotion regulation

difficulties predicted alcohol severity only in those with high psychopathological symptoms.

These results align with previous research demonstrating that emotion dysregulation is a critical
risk factor for substance use disorders (SUDs) (Cavicchioli et al., 2023; Fox et al., 2008; Weiss
et al., 2022). Individuals with SUDs exhibit poorer emotion regulation across all DERS
subscales, with Strategies and Impulse subscales showing the largest deficits (Stellern et al.,
2023). In view of this difficulties, substance use may serve as a maladaptive strategy to cope
with negative emotions (Stellern et al., 2023). In AUD patients, pre-treatment emotion
regulation skills predicted alcohol use during treatment, while post-treatment skills predicted
use at follow-up (Berking et al., 2011) and they are also linked to increased craving and relapse
vulnerability, even when controlling for other factors (Fox et al., 2008; Khosravani et al., 2017;
Petit et al., 2015; You et al., 2023). A recent meta-analysis showed that difficulties in reducing
the intensity and duration of negative emotions are associated with alcohol-related problems
and severity of the disorder (González-Roz et al., 2024).

In non-clinical samples of university students, high levels of emotion regulation difficulties

appear to be linked to a greater risk of alcohol-related problems (Benzerouk et al., 2022; Kim
& Kwon, 2020). In particular, the DERS Impulse and Goals dimensions were associated with
drinking speed and BD episodes, respectively (Benzerouk et al., 2022). These dimensions
reflect difficulties in disengaging from preoccupying affective states, which is linked to
cognitive control deficits (Gross, 2015; McRae & Gross, 2020), a brain network still undergoing
significant refinement until adulthood (Malagoli et al., 2022; Poon et al., 2016). Similarly,
Dvorak and colleagues (2014), using the DERS scale, demonstrated that impulse control
difficulties were positively related to the number of drinks consumed per week, while difficulty
engaging in goal-directed behaviour was associated with experiencing greater alcohol-related
consequences. Among young heavy drinkers, difficulties regulating both positive and negative
emotions appear to be more relevant as risk factors for alcohol problems than actual alcohol
consumption (Paulus et al., 2021). In this sense, limited access to emotion regulation strategies
significantly predicted alcohol-related problems via depression and anxiety coping motives but
did not predict alcohol consumption (Simons et al., 2017). Overall, research suggests that goal-
directed self-regulation deficits are associated with alcohol-related consequences rather than
alcohol use itself among college students (Teeters et al., 2023; Brown & Melas, 2024). Poor
emotion regulation likely not only predicts greater alcohol use severity but is also worsened by
continued drinking, creating a self-perpetuating cycle (Lannoy et al., 2021; Martini et al., 2025).
medRxiv preprint doi: https://doi.org/10.1101/2025.03.04.25323343; this version posted March 5, 2025. The copyright holder for this preprint
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In our study, emerging psychopathological symptoms moderated the relationship between BD,
emotion regulation difficulties, and future alcohol severity, explaining 51% of the variance at
follow-up. This suggests that emotion regulation difficulties and psychopathology jointly
heighten addiction risk, even in those without prior disorders. These findings align with
previous research showing that individuals with both substance use disorders and
psychopathology experience greater emotion regulation deficits and more severe substance use
(Berkin et al., 2011, Weiss et al., 2022). In a sample of 1,262 adolescents, greater emotion
regulation ability at baseline predicted lower psychopathology and substance dependence seven
years later (Klein et al., 2022), strengthening evidence of emotion regulation as a
transdiagnostic risk factor (Shadur & Lejuez, 2015).

While this study provides valuable insights, it has several limitations. Although the longitudinal
design strengthens temporal validity, causal interpretations should be made cautiously.
Additionally, self-reported emotion regulation difficulties may not fully capture the
complexities of real-world regulation processes. Future research should incorporate ecological
momentary assessments and examine emotion regulation flexibility (Chen et al., 2024, English
& Eldesouky, 2020) for a more nuanced understanding of these mechanisms and the trajectory
of alcohol use.

In conclusion, our study highlights that difficulties in goal-directed behaviour under negative
emotions partially mediate the link between BD and future alcohol severity, with emerging
psychopathological symptoms amplifying the effects. These findings highlight the crucial role
of BD—the most common pattern of alcohol misuse in adolescents—and emotion regulation in
the escalation of alcohol use during emerging adulthood. Furthermore, they underscore the need
for early interventions to strengthen emotion regulation skills in young BDs, especially those
with early signs of psychopathological symptoms.
medRxiv preprint doi: https://doi.org/10.1101/2025.03.04.25323343; this version posted March 5, 2025. The copyright holder for this preprint
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REFERENCES

1. Ahmed, S. P., Bittencourt-Hewitt, A., & Sebastian, C. L. (2015). Neurocognitive

bases of emotion regulation development in adolescence. Developmental Cognitive
Neuroscience, 15, 11–25. https://doi.org/10.1016/j.dcn.2015.07.006
2. Andrews, J. L., Ahmed, S. P., & Blakemore, S. J. (2021). Navigating the social en-
vironment in adolescence: The role of social brain development. Biological Psy-
chiatry, 89(2), 109–118. https://doi.org/10.1016/j.biopsych.2020.09.002
3. Babor, T. F., Higgins-Biddle, J. C., Saunders, J. B., Monteiro, M. G., & World
Health Organization. (2001). AUDIT: The Alcohol Use Disorders Identification
Test: Guidelines for use in primary health care (No. WHO/MSD/MSB/01.6a).
World Health Organization.
4. Berking, M., Margraf, M., Ebert, D., Wupperman, P., Hofmann, S. G., &
Junghanns, K. (2011). Deficits in emotion-regulation skills predict alcohol use dur-
ing and after cognitive–behavioral therapy for alcohol dependence. Journal of
Consulting and Clinical Psychology, 79(3), 307–318.
https://doi.org/10.1037/a0023421
5. Benzerouk, F., Djerada, Z., Naassila, M., Barrière, S., Kaladjian, A., & Gierski, F.
(2022). Role of impulsivity and emotion dysregulation dimensions on core charac-
teristics of binge drinking among university students. Psychologica Belgica, 62(1),
286–296. https://doi.org/10.5334/pb.1167
6. Bohn, M. J., Babor, T. F., & Kranzler, H. R. (1995). The Alcohol Use Disorders
Identification Test (AUDIT): Validation of a screening instrument for use in medi-
cal settings. Journal of Studies on Alcohol, 56(4), 423–432.
https://doi.org/10.15288/jsa.1995.56.423
7. Brown, W. C., & Melas, M. T. (2024). A narrative review of emotion regulation
abilities, strategy use, and their relationship to alcohol. Current Addiction Reports,
11(2), 199–209. https://doi.org/10.1007/s40429-024-00511-7
8. Cavicchioli, M., Tobia, V., & Ogliari, A. (2023). Emotion regulation strategies as
risk factors for developmental psychopathology: A meta-analytic review of longi-
tudinal studies based on cross-lagged correlations and panel models. Research on
Child and Adolescent Psychopathology, 51(3), 295–315.
https://doi.org/10.1007/s10802-022-00980-8
medRxiv preprint doi: https://doi.org/10.1101/2025.03.04.25323343; this version posted March 5, 2025. The copyright holder for this preprint
(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
All rights reserved. No reuse allowed without permission.

9. Chen, M. S., Bi, K., Han, X., et al. (2024). Emotion regulation flexibility and mo-
mentary affect in two cultures. Nature Mental Health, 2, 450–459.
https://doi.org/10.1038/s44220-024-00215-3
10. Compas, B. E., Jaser, S. S., Bettis, A. H., Watson, K. H., Gruhn, M. A., Dunbar, J.
P., & Thigpen, J. C. (2017). Coping, emotion regulation, and psychopathology in
childhood and adolescence: A meta-analysis and narrative review. Psychological
Bulletin, 143(9), 939–991. https://doi.org/10.1037/bul0000110
11. Cuenca-Royo, A. M., Sánchez-Niubó, A., Forero, C. G., Torrens, M., Suelves, J.
M., & Domingo-Salvany, A. (2012). Psychometric properties of the CAST and
SDS scales in young adult cannabis users. Addictive Behaviors, 37(7), 709–715.
https://doi.org/10.1016/j.addbeh.2012.02.012
12. Derogatis, L. R. (2001). Brief Symptom Inventory 18. Johns Hopkins University.
13. Derogatis, L. R. (2013). Inventario Breve de 18 Síntomas (BSI-18). Pearson.
https://www.cop.es/uploads/PDF/2015/BSI-Pearson.pdf
14. Derogatis, L. R., & Savitz, K. L. (1999). The SCL-90-R, Brief Symptom Inven-
tory, and Matching Clinical Rating Scales. In M. E. Maruish (Ed.), The use of psy-
chological testing for treatment planning and outcomes assessment (2nd ed., pp.
679–724). Lawrence Erlbaum Associates.
15. Dvorak, R. D., Sargent, E. M., Kilwein, T. M., Stevenson, B. L., Kuvaas, N. J., &
Williams, T. J. (2014). Alcohol use and alcohol-related consequences: Associa-
tions with emotion regulation difficulties. The American Journal of Drug and Al-
cohol Abuse, 40(2), 125–130. https://doi.org/10.3109/00952990.2013.877920
16. English, T., & Eldesouky, L. (2020). Emotion regulation flexibility. European
Journal of Psychological Assessment. https://doi.org/10.1027/1015-5759/a000556
17. Fombouchet, Y., Pineau, S., Perchec, C., Lucenet, J., & Lannegrand, L. (2023).
The development of emotion regulation in adolescence: What do we know and
where to go next? Social Development, 32(4), 1227–1242.
https://doi.org/10.1111/sode.12684
18. Fox, H. C., Hong, K. A., & Sinha, R. (2008). Difficulties in emotion regulation
and impulse control in recently abstinent alcoholics compared with social drinkers.
Addictive Behaviors, 33(2), 388–394.
https://doi.org/10.1016/j.addbeh.2007.10.002
medRxiv preprint doi: https://doi.org/10.1101/2025.03.04.25323343; this version posted March 5, 2025. The copyright holder for this preprint
(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
All rights reserved. No reuse allowed without permission.

19. González-Roz, A., Castaño, Y., Krotter, A., Salazar-Cedillo, A., & Gervilla, E.
(2024). Emotional dysregulation in relation to substance use and behavioral addic-
tions: Findings from five separate meta-analyses. International Journal of Clinical
and Health Psychology, 24(3), 100502.
https://doi.org/10.1016/j.ijchp.2024.100502
20. Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regu-
lation and dysregulation: Development, factor structure, and initial validation of
the Difficulties in Emotion Regulation Scale. Journal of Psychopathology and Be-
havioral Assessment, 26(1), 41–54.
https://doi.org/10.1023/B:JOBA.0000007455.08539.94
21. Gross, J. J. (1998). Antecedent- and response-focused emotion regulation: Diver-
gent consequences for experience, expression, and physiology. Journal of Person-
ality and Social Psychology, 74(1), 224–237. https://doi.org/10.1037/0022-
3514.74.1.224
22. Gross, J. J. (2015). Emotion regulation: Current status and future prospects. Psy-
chological Inquiry, 26(1), 1–26. https://doi.org/10.1080/1047840X.2014.940781
23. Hayes, A. F. (2012, February). PROCESS: A versatile computational tool for ob-
served variable mediation, moderation, and conditional process modeling. Re-
trieved from https://www.afhayes.com
24. Hayes, A. F. (2017). Introduction to mediation, moderation, and conditional pro-
cess analysis: A regression-based approach. Guilford Press.
25. Hervás, G., & Jódar, R. (2008). Adaptación al castellano de la Escala de Dificulta-
des en la Regulación Emocional. Clínica y Salud, 19(2), 139–156.
26. Hessler, D. M., & Katz, L. F. (2010). Brief report: Associations between emotional
competence and adolescent risky behavior. Journal of Adolescence, 33(1), 241–
246. https://doi.org/10.1016/j.adolescence.2009.04.007
27. Khosravani, V., Bastan, F. S., Ghorbani, F., & Kamali, Z. (2017). Difficulties in
emotion regulation mediate negative and positive affects and craving in alcoholic
patients. Addictive Behaviors, 71, 75–81.
https://doi.org/10.1016/j.addbeh.2017.03.002
28. Kim, S., & Kwon, J. H. (2020). Moderation effect of emotion regulation on the re-
lationship between social anxiety, drinking motives, and alcohol-related problems
among university students. BMC Public Health, 20(1), 709.
https://doi.org/10.1186/s12889-020-08776-5
medRxiv preprint doi: https://doi.org/10.1101/2025.03.04.25323343; this version posted March 5, 2025. The copyright holder for this preprint
(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
All rights reserved. No reuse allowed without permission.

29. Klein, R. J., Nguyen, N. D., Gyorda, J. A., & Jacobson, N. C. (2022). Adolescent
emotion regulation and future psychopathology: A prospective transdiagnostic
analysis. Journal of Research on Adolescence, 32(4), 1592–1611.
https://doi.org/10.1111/jora.12761
30. Kliewer, W., Riley, T., Zaharakis, N., Borre, A., Drazdowski, T. K., & Jäggi, L.
(2016). Emotion dysregulation, anticipatory cortisol, and substance use in urban
adolescents. Personality and Individual Differences, 99, 200–205.
https://doi.org/10.1016/j.paid.2016.04.072
31. Koob, G. F. (2013). Negative reinforcement in drug addiction: The darkness
within. Current Opinion in Neurobiology, 23(4), 559–563.
https://doi.org/10.1016/j.conb.2013.03.011
32. Lannoy, S., Duka, T., Carbia, C., Billieux, J., Fontesse, S., Dormal, V., Gierski, F., López-
Caneda, E., Sullivan, E. V., & Maurage, P. (2021). Emotional processes in binge drinking: A
systematic review and perspective. Clinical Psychology Review, 84, 101971.
https://doi.org/10.1016/j.cpr.2021.101971
33. Legleye, S., Karila, L., Beck, F., & Reynaud, M. (2007). Validation of the CAST,
a general population cannabis abuse screening test. Journal of Substance Use,
12(4), 233–242. https://doi.org/10.1080/14659890701476532
34. Lincoln, T. M., Schulze, L., & Renneberg, B. (2022). The role of emotion regula-
tion in the characterization, development and treatment of psychopathology. Na-
ture Reviews Psychology, 1(5), 272–286. https://doi.org/10.1038/s44159-022-
00040-y
35. Malagoli, C., Chiorri, C., Traverso, L., & Usai, M. C. (2022). Inhibition and indi-
vidual differences in behavior and emotional regulation in adolescence. Psycho-
logical Research, 86(4), 1132–1144. https://doi.org/10.1007/s00426-021-01577-5
36. Martini, E., Semeraro, S., Lannoy, S., & Maurage, P. (2025). Emotional pro-
cessing in binge drinking, tobacco use disorder, and their comorbidity in youth: A
preregistered PRISMA scoping review. Progress in Neuro-Psychopharmacology
& Biological Psychiatry, 136, 111138.
https://doi.org/10.1016/j.pnpbp.2024.111138
37. McLaughlin, K. A., Garrad, M. C., & Somerville, L. H. (2015). What develops
during emotional development? A component process approach to identifying
sources of psychopathology risk in adolescence. Dialogues in Clinical Neurosci-
ence, 17(4), 403–410. https://doi.org/10.31887/DCNS.2015.17.4/kamclaughlin
medRxiv preprint doi: https://doi.org/10.1101/2025.03.04.25323343; this version posted March 5, 2025. The copyright holder for this preprint
(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
All rights reserved. No reuse allowed without permission.

38. McLaughlin, K. A., Hatzenbuehler, M. L., Mennin, D. S., & Nolen-Hoeksema, S.

(2011). Emotion dysregulation and adolescent psychopathology: A prospective
study. Behaviour Research and Therapy, 49(9), 544–554.
https://doi.org/10.1016/j.brat.2011.06.003
39. McRae, K., & Gross, J. J. (2020). Emotion regulation. Emotion, 20(1), 1–9.
https://doi.org/10.1037/emo0000703
40. Merrill, J. E., & Carey, K. B. (2016). Drinking over the lifespan: Focus on college
ages. Alcohol Research: Current Reviews, 38(1), 103–114.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4872605/
41. Moure-Rodriguez, L., Carbia, C., Lopez-Caneda, E., Corral Varela, M., Cadaveira,
F., & Caamaño-Isorna, F. (2018). Trends in alcohol use among young people ac-
cording to the pattern of consumption on starting university: A 9-year follow-up
study. PLOS ONE, 13(4), e0193741. https://doi.org/10.1371/journal.pone.0193741
42. National Institute on Alcohol Abuse and Alcoholism (2004). NIAAA council ap-
proves definition of binge drinking. NIAAA Newsletter: Winter (NIH Publication
No. 04–5346, p. 3). https://pubs.niaaa.nih.gov/publications/Newsletter/win-
ter2004/Newsletter_Number3.pdf
43. Patrick, M. E., Evans-Polce, R. J., Parks, M. J., & Terry-McElrath, Y. M. (2021).
Drinking intensity at age 29/30 as a predictor of alcohol use disorder symptoms at
age 35 in a national sample. Journal of Studies on Alcohol and Drugs, 82(3), 362–
367. https://doi.org/10.15288/jsad.2021.82.362
44. Paulus, D. J., Heggeness, L. F., Raines, A. M., & Zvolensky, M. J. (2021). Diffi-
culties regulating positive and negative emotions in relation to coping motives for
alcohol use and alcohol problems among hazardous drinkers. Addictive Behaviors,
115, 106781. https://doi.org/10.1016/j.addbeh.2020.106781
45. Petit, G., Luminet, O., Maurage, F., Tecco, J., Lechantre, S., Ferauge, M., & de Ti-
mary, P. (2015). Emotion regulation in alcohol dependence. Alcoholism: Clinical
and Experimental Research, 39(12), 2471–2479.
https://doi.org/10.1111/acer.12914
46. Poon, J. A., Turpyn, C. C., Hansen, A., Jacangelo, J., & Chaplin, T. M. (2016).
Adolescent substance use and psychopathology: Interactive effects of cortisol reac-
tivity and emotion regulation. Cognitive Therapy and Research, 40, 368–380.
https://doi.org/10.1007/s10608-015-9735-8
medRxiv preprint doi: https://doi.org/10.1101/2025.03.04.25323343; this version posted March 5, 2025. The copyright holder for this preprint
(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
All rights reserved. No reuse allowed without permission.

47. Rapee, R. M., Oar, E. L., Johnco, C. J., Forbes, M. K., Fardouly, J., Magson, N.
R., & Richardson, C. E. (2019). Adolescent development and risk for the onset of
social-emotional disorders: A review and conceptual model. Behaviour Research
and Therapy, 123, 103501. https://doi.org/10.1016/j.brat.2019.103501
48. Schäfer, J. Ö., Naumann, E., Holmes, E. A., Tuschen-Caffier, B., & Samson, A. C.
(2017). Emotion regulation strategies in depressive and anxiety symptoms in
youth: A meta-analytic review. Journal of Youth and Adolescence, 46(2), 261–
276. https://doi.org/10.1007/s10964-016-0585-0
49. Shadur, J. M., & Lejuez, C. W. (2015). Adolescent substance use and comorbid
psychopathology: Emotion regulation deficits as a transdiagnostic risk factor. Cur-
rent Addiction Reports, 2, 354–363. https://doi.org/10.1007/s40429-015-0070-y
50. Simons, R. M., Hahn, A. M., Simons, J. S., & Murase, H. (2017). Emotion dysreg-
ulation and peer drinking norms uniquely predict alcohol-related problems via mo-
tives. Drug and Alcohol Dependence, 177, 54–58. https://doi.org/10.1016/j.dru-
galcdep.2017.03.014
51. Sobell, L. C., & Sobell, M. B. (1992). Timeline Follow-Back. In R. Z. Litten & J.
P. Allen (Eds.), Measuring alcohol consumption: Psychosocial and biochemical
methods (pp. 41–72). Humana Press. https://doi.org/10.1007/978-1-4612-0357-5_3
52. Stellern, J., Xiao, K. B., Grennell, E., Sanches, M., Gowin, J. L., & Sloan, M. E.
(2023). Emotion regulation in substance use disorders: A systematic review and
meta-analysis. Addiction, 118(1), 30–47. https://doi.org/10.1111/add.16052
53. Teeters, J. B., Laves, E. H., King, S. A., & Brausch, A. M. (2023). Gender moder-
ates the association between cognitive reappraisal and alcohol-related problems
among adolescents. Alcohol and Alcoholism, 58(2), 182–189.
https://doi.org/10.1093/alcalc/agac084
54. Varela, J., Braña, T., Real, E., & Rial, A. (2005). Validación empírica do AUDIT
(Cuestionario de identificación dos trastornos debido ó consumo de alcohol) na po-
boación xeral galega. Xunta de Galicia, Consellería de Sanidade, Sergas.
55. Weiss, N. H., Kiefer, R., Goncharenko, S., Raudales, A. M., Forkus, S. R., Schick,
M. R., & Contractor, A. A. (2022). Emotion regulation and substance use: A meta-
analysis. Drug and Alcohol Dependence, 230, 109131.
https://doi.org/10.1016/j.drugalcdep.2022.109131
medRxiv preprint doi: https://doi.org/10.1101/2025.03.04.25323343; this version posted March 5, 2025. The copyright holder for this preprint
(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
All rights reserved. No reuse allowed without permission.

56. Wise, R. A., & Koob, G. F. (2014). The development and maintenance of drug ad-
diction. Neuropsychopharmacology, 39(2), 254–262.
https://doi.org/10.1038/npp.2013.261
57. World Health Organization (2018). Global status report on alcohol and health
2018. World Health Organization. https://www.who.int/publica-
tions/i/item/9789241565639
58. You, D. S., Rassu, F. S., & Meagher, M. W. (2023). Emotion regulation strategies
moderate the impact of negative affect induction on alcohol craving in college
drinkers: An experimental paradigm. Journal of American College Health, 71(5),
1538–1546. https://doi.org/10.1080/07448481.2022.2049769
medRxiv preprint doi: https://doi.org/10.1101/2025.03.04.25323343; this version posted March 5, 2025. The copyright holder for this preprint
(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
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FIGURES
Figure 1.
Statistical parameters for the Mediation Model
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Figure 2.
Statistical parameters for the Moderated Mediation model
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TABLES
Table 1.
Descriptive characteristics of the total sample and psychopathology groups (Low vs. High) (Mean ± SD)
Total Low-P High-P
N (females) 192 (102) 100 (46) 92 (56)
a
BD days 15.39 (± 15.91) 14.26 (± 16.11) 16.63 (± 15.69)
AUDITb 6.38 (± 5.18) 5.08 (± 3.86) 7.79 (± 6.01)***
BSI-18 0.49 (± 0.37) 0.22 (± 0.14) 0.79 (± 0.31)***
DERS Total 77.15 (± 19.22) 68.02 (± 13.95) 87.08 (± 19.32)***
Non-Acceptance 13.46 (± 5.52) 11.41 (± 4.11) 15.68 (± 6)***
Awareness 15.42 (± 4.08) 14.9 (± 3.73) 15.98 (± 4.38)
Impulse 10.75 (± 4.54) 9.35 (± 3.66) 12.27 (± 4.93)***
Goals 14.29 (± 4.48) 12.78 (± 4.35) 15.93 (± 4.04)***
Clarity 10.05 (± 3.34) 8.56 (± 2.45) 11.67 (± 3.46)***
Strategies 13.23 (± 5.12) 11.02 (± 3.20) 15.63 (± 5.71)***
a
Measured at baseline, relative to the six prior months using the alcohol TLFB. b Measured at follow-
up. Low-P= Low Psychopathological symptoms. High-P = High Psychopathological Symptoms. *** p<
0.001, as per T-test between groups of Low and High psychopathology at follow-up, based on median
split (percentile 50).
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Table 2.
Correlation values between DERS scores and alcohol consumption variables at baseline and at follow-up.

BD DERS Non-
daysa total Acceptance Awareness Impulse Goals Clarity Strategies AUDIT

BD daysa --

DERS Total 0.171* --

Non-Acceptance 0.062 0.702** --

Awareness 0.083 0.483** 0.151* --

Impulse 0.174* 0.754** 0.352** 0.249** --

Goals 0.191** 0.705** 0.368** 0.183* 0.495** --

Clarity 0.096 0.767** 0.507** 0.393** 0.446** 0.432** --

Strategies 0.136 0.827** 0.476** 0.219** 0.642** 0.518** 0.604** --

AUDIT b 0.638** 0.285** 0.128 0.111 0.262** 0.300** 0.261** 0.196** --

a
Measured at baseline, relative to the six prior months using the alcohol TLFB. b Measured at follow-up. * p<
0.05,** p< 0.01
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Table 3.

Regression Coefficients for Mediation and Moderated Mediation Models

95% CI
Pathway Predictor B SE t p
(LL, UL)

Mediation Model

Emotion Regulation → Alcohol

M→Y 0.214 0.064 3.338 .001 [0.088, 0.340]
Severity

Binge Drinking → Emotion Reg-

X→M 0.054 0.020 2.683 .008 [0.014, 0.093]
ulation

Binge Drinking → Alcohol Se-

X → Y (Total Effect) 0.208 0.018 11.422 <.001 [0.172, 0.244]
verity

Binge Drinking → Alcohol Se-

X → Y (Direct Effect) 0.196 0.018 10.869 <.001 [0.161, 0.232]
verity

Binge Drinking → Emotion Reg-

Indirect Effect (X → M → Y) 0.012 0.005 — — [0.002, 0.024]
ulation → Alcohol Severity

Moderated Mediation Model

X → Y (Direct Effect, Moder- Binge Drinking → Alcohol Se-

0.150 0.023 6.476 <.001 [0.105, 0.196]
ated by BSI) verity

X × W Interaction (Moderation Binge Drinking × Psychopathol-

0.095 0.034 2.768 .006 [0.027, 0.162]
of Direct Effect) ogy

M × W Interaction (Moderation Emotion Regulation × Psycho-

0.301 0.130 2.309 .022 [0.044, 0.558]
of Indirect Effect) pathology

Conditional Effect of X on Y at Binge Drinking → Alcohol Se-

0.150 0.023 6.476 <.001 [0.105, 0.196]
Low BSI verity (Low BSI)

Conditional Effect of X on Y at Binge Drinking → Alcohol Se-

0.245 0.025 9.732 <.001 [0.195, 0.295]
High BSI verity (High BSI)

Conditional Effect of M on Y at Emotion Regulation → Alcohol

0.006 0.086 0.069 .945 [-0.164, 0.175]
Low BSI Severity (Low BSI)

Conditional Effect of M on Y at Emotion Regulation → Alcohol

0.307 0.098 3.134 .002 [0.114, 0.500]
High BSI Severity (High BSI)

Notes: B = unstandardized coefficient, SE = standard error, t = t-value, p = significance level, 95% CI = confi-
dence interval (lower and upper bounds). Low BSI= Low psychopathological symptoms based on median split
(percentile 50). High BSI= Low psychopathological symptoms based on median split (percentile 50).