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Heroin Addiction and Related Clinical Problems: 2026, 28: 215-222

Withdrawal-related and alexithymia-related somatic symptom profiles in Heroin Use Disorder and Gambling Disorder

Icro Maremmani, and Emanuela Atzori

Digital Object Identifier:
https://doi.org/10.62401/2531-4122-2026-24

Summary: Background: Previous studies of the SCL-90-derived Somatic Symptoms dimension have suggested that somatic distress in addiction cannot be understood solely in terms of acute opioid withdrawal. We explored a clinically proposed subdivision into withdrawal-related and alexithymia-related components, comparing their absolute severity and standardised dominance in Heroin Use Disorder (HUD) and Gambling Disorder (GD). Methods: This exploratory secondary analysis considered a baseline cohort of 972 patients with HUD and 110 with GD. Twelve items were assigned to the withdrawalrelated component and six to the alexithymia-related component. Mean scores required at least 70% of items to be valid. Dominance was determined by comparing the two z-scores standardised across the combined diagnostic sample; ties were excluded. Group means were compared using two-sided Welch tests, and dominance distributions using Pearson’s chisquare test. Results: HUD patients had higher withdrawal-related scores (1.34 versus 0.65), alexithymia-related scores (1.17 versus 0.61), and overall somatic scores (1.28 versus 0.64); all Welch p-values were <0.001. Among 1,079 patients classified for dominance, the alexithymia-related component was dominant in 456/969 HUD patients (47.1%) and 71/110 GD patients (64.5%; χ²(1)=12.089, p=0.001). Conclusions: Greater absolute somatic severity in HUD coexisted with more frequent alexithymia-related dominance in GD. The findings support further investigation of heterogeneity within the Somatic Symptoms dimension.

Keywords: Withdrawal-Related Somatic Symptoms; Alexithymia-Related Somatic Symptoms; Heroin Use Disorder; Gambling Disorder