Abstract
Background
This study explored the relationship between personality attributes and substance use disorder (SUD). Research has identified specific personality dimensions, such as neuroticism, psychoticism, antisocial personality traits, paranoia, and anxiety, as contributing factors to the initiation, maintenance, and relapse of SUD.
Purpose
To explore this connection, we examined the personality profiles of subjects with alcohol use disorder (AUD) and opioid use disorder (OUD).
Methods
A total of 928 subjects, 320 with AUD, 490 with OUD and 118 healthy controls (HC), in the age range of 16–65 years were recruited in the study. The Clinical Profile Sheet and the Multiphasic Personality Questionnaire (MPQ) were administered to HC and patients who fulfil the diagnostic criteria for substance dependence as defined by ICD-10 (WHO-1992).
Results
We found significant differences in personality profiles between individuals with OUD and AUD. Patients with AUD scored higher than OUD on the MPQ subscales for depression, mania, paranoia, and antisocial personality traits. All subscales of the MPQ showed elevated scores in subjects with SUD compared to HC.
Conclusion
Elevated scores on the MPQ subscales suggest that personality factors may contribute to the pattern of substance use and misuse in this cohort.
Introduction
Both individual differences and environmental factors have been recognised as playing a crucial role in addictive behaviour. 1 Personality traits and types are among the most common factors associated with substance use disorders (SUD).2–4 Cloninger (1987) suggests that personality traits and characteristics may play a central role in the development of alcohol use disorder (AUD). 5 Personality attributes remain a key factor in etiological theories of SUD.6–8 There is a well-established notion among researchers that individual differences in certain dimensions of personality might contribute to the aetiology of alcoholism and other SUD. 5 Evidence for this role of personality traits in alcoholism aetiology appears from studies that compare AUD and normal controls, consistently revealing differences in various personality self-report measures. 9
Studies of the genetic offspring of individuals with AUD indicate that personality aspects may partly work as a mediating risk factor in the inheritance of alcoholism.10, 11 Studies have found that individuals with alcohol dependence reported higher urges and scored higher on trait anger and anxiety.12–14 McCormick et al. (1998) used NEO-PI and found that individuals with SUD scored higher on neuroticism and lower on agreeableness and conscientiousness.4, 15 Interestingly, cocaine users scored higher on extraversion and openness compared to alcohol users.16–18 Furthermore, neuroticism, conscientiousness, agreeableness, and extroversion were all found to be related to different triggers of substance use including social rejection, negative emotional states, and tension.15, 19 Studies have identified impulsivity and sensation seeking as largely related to increased drinking among students.20–23 They scored higher on the Minnesota Multiphasic Personality Inventory subscales of hypomania and psychopathic deviate. 24 Additionally, personality attributes linked with substance usage include low self-confidence, low self-efficacy, low assertiveness, and self-esteem, along with external locus of control.25, 26 Studies have shown that individuals with SUD are likely to be more rebellious, impulsive and anxious; they are more excited to look mature and have a greater need for appreciation and approval.27–30 They also tend to be more pessimistic and alienated from social values.27, 31 Studies have found that individuals with SUD experience anger more often than the occasional users and are more likely to express anger outwardly towards other people or objects in the environment.32, 33 Additionally, they have less control over their anger. Using the MMPI, studies have shown that individuals with a neurotic personality type were more prone to treatment failure. 34 Furthermore, there are substance-specific differences in personality traits of individuals with SUD. Lebon et al., compared individuals with OUD, AUD and a random selected control group matched by age and demographics using Cloninger`s Temperament & Character Inventory. 18 They found patients with OUD scored greater in self-directedness and novelty-seeking than patients with AUD. Research suggests that alcohol, compared to other drugs, has a more directly proportionate association with high negative emotionality and low constraints. 35 Medina and Aizpiri (2005) 36 investigated the most frequent personality disorders related to alcohol dependence. Another study found dependent personality disorders to be the most prevailing (13.3%), followed by paranoid and obsessive-compulsive personality disorders (10% each). 37
The putative importance of personality is consistent with the high prevalence of personality disorders observed in AUD and OUD.
37
Studies have shown that:
Personality in childhood predicts alcohol use in adults.
38
Different personality conditions foretell the onset of AUD among adults.
39
Diagnosis of personality disorders portends time to relapse in treated patients with AUD.
40
Patients with SUD and borderline personality disorder experience craving more often as a result of tension, social rejection, negative emotional states, and negative physical states, than patients with SUD not diagnosed with borderline personality disorder.
41
Many studies report that excessive alcohol consumption is associated with social conditions that favour the development of psychological distress and isolation.
42
A wholesome understanding of the different personality traits or dimensions that might render men more susceptible to experiencing drug cravings could lead to additional treatment approaches, specifically relapse prevention skills. These personality dimensions include high novelty-seeking, impulsivity, high baseline anxiety, clinical depression, paranoid traits, and psychopathic deviation. All these factors may have a direct clinical implication in predicting relapse and managing substance dependence.
Methods
The present study aimed to examine the personality profiles of male subjects with alcohol and opioid use disorder (OUD) and compare them with healthy control (HC).
Sample
The total sample consisted of 928 subjects with 810 male subjects with SUD (320 with AUD and 490 with OUD) and 118 HC, aged 16–65 years. Participants were recruited from a tertiary care Drug De-addiction and Treatment Centre in North India. Ethical approval for the present research was taken from the Institute Ethics Committee. Informed permission was taken from all the participants.
Inclusion and Exclusion Criteria
Subjects who fulfilled the criteria for AUD and OUD as per the International Classification of Diseases (ICD-10), 43 including tobacco dependence were recruited in the study. Subjects with multiple substance dependence, co-morbid psychiatric diagnosis, Intellectual disability, epilepsy or illness causing cognitive dysfunction were excluded from the present study.
Tools
Socio-demographic and clinical profile sheet: The socio-demographic sheet accessed demographic information including age, education, religion, income, occupation, marital status, family type and residence. The clinical profile sheet collected information about the patients, index substance (primary substance of misuse), age at initiation, duration of use, age at dependence, onset, and duration of dependence.
Multiphasic personality questionnaire (MPQ): MPQ was used to assess the personality of clinical subjects and HC. Developed and validated in India by Murthy in 1970 the MPQ contains 100 items and is a forced-choice true-false questionnaire that measures personality subscales for anxiety, depression, mania, paranoia, schizophrenia, hysteria, psychopathic deviation, lie scale and repressor-sensitiser. 44 Score obtained for each subscale and pure item scores were used for analysis. An MPQ profile for HC was used for comparison with subjects with AUD and OUD.
Statistical Methods
Socio-demographic characteristics were compared across the three groups (AUD, OUD and HC) using explanatory statistics (Mean, SD) and inferential statistics (t-test, and chi-square tests). Additionally, t-tests were used to compare the alcohol-dependent and opioid-dependent groups with HC.
Results
The MPQ was administered to all 810 male subjects with AUD (N = 320), OUD (N = 490) and 118 HC. The subjects were in the age range of 16–65 years and had a mean of 32.47 years (SD of ±10.05). Their education (in years) varies between 0 and 20 years, with a mean of 11.71 years (SD ±3.17). Socio-demographic characteristics of the patients: Table 1 shows the comparison of socio-demographic variables between alcohol and OUD. The table indicates a significant difference in age and marital status between the groups AUD and OUD. Patients with AUD had a longer duration of illness and substance dependence. Clinical characteristics of the sample: Table 2 shows that the study participants’ age at the onset of substance use ranged from 9 to 55 years, with a mean of 22.27 years (SD ± 10.54). Similarly, the age at onset of substance dependence ranged from 12 to 47 years with a mean age of 25.44 years (SD ± 11.89). The duration of use also varied, lasting between 1 and 47 years, with a mean duration of 10.52 years (SD ± 9.19). Duration of substance dependence ranged from 1 to 37 years, with a mean of 7.32 years (SD ± 7.48). The age 118 male HC ranged between 18 and 65 years with a mean of 34.3 years (SD ± 8.22) Among these, 72 were married, 104 were from urban areas, and 70 had an undergraduate degree, while 48 had a postgraduate degree. MPQ scores of individuals with AUD and OUD were compared with scores of 118 healthy. Table 2 indicates that AUD patients started substance use, and became dependent, at a significantly older age compared to OUD patients. Duration of both substance use and dependence was also significantly longer in the AUD group. Differences between personality of AUD and OUD subjects: Personality differences between AUD and OUD subjects were explored using combined data of AUD and OUD as indicated in Table 3. It shows significant differences, with AUD patients scoring higher on depression, mania, paranoia and psychopathic deviation subscales compared to OUD patients. Further analysis of individual personality items, which are pure measure of clinical personality domains, pertaining to different MPQ subscales. Table 4 shows significant difference in the scales of mania and schizophrenia on the pure clinical items. Table 5 highlights the broader population with AUD and OUD showing a high prevalence of self-reported clinical symptoms. Specifically on pure item analysis, 44% reported anxiety, 70% depression, 45% mania, and 50% paranoia. Additionally, 32% reported psychotic symptoms, 53% hysteria-like symptoms, and 49% psychopathic tendencies. Interestingly, 27% scored high on the lie scale, suggesting a potential for underreporting socially desirable responses. Comparison of AUD and OUD combined with HC: Table 5 shows the comparison of substance-dependent and normal shows that substance-dependent subjects are significantly higher on all subscales of MPQ.
Comparison of Socio-demographic Characteristics of the Participants with AUD and OUD.
*P < .05 level.
Clinical Characteristics of the Patients with AUD and OUD (N = 810).
Personality Profile of AUD, OUD and Combined (AUD+OUD) on Sub-scales of MPQ.
Personality Profile of AUD, OUD and Combined (AUD+OUD) on Pure Clinical Items.
Comparison Between Personality Profile of Alcohol and Opioid-dependent Subjects with Healthy Controls.
Discussion
Understanding personality profiles related to substance abuse holds significant value from both theoretical and a practical perspective. An improved understanding of such a profile may offer insight into the general dynamics of addiction, ultimately leading to more effective drug prevention and treatment strategies. Researchers continue to debate the existence of a single ‘addictive personality type’.45, 46 Some propose a biological basis for such a personality. 47 However, this view suggests a single personality profile type underlying all addiction, rather than acknowledging the possibility of different personality profile associated with specific types of substance use and misuse.
Our study found that all personality subscales measured by the MPQ were significantly higher in patients with AUD and OUD compared to HC. This finding aligns with previous research by Bhojack et al. 48 who reported that patients with SUD scored higher on anxiety, suspicion and psychopathy traits compared to controls. Lather et al. 49 also employed the MPQ to explore personality traits associated with drug use vulnerability. Their analysis revealed that individuals with SUD scored higher on anxiety, depression, hysteria, mania, paranoia, schizophrenia and social desirability. They concluded that susceptibility to addiction varies based on individual personality profiles.
Studies exploring Eysenck`s personality theory to addiction, suggest that substance-dependent patients tend to be more extroverted and that extroverts have a higher need for stimulation and are relatively less conditioned by social norms and authority due to their lower cortical inhibition. 50 This translated to a more social nature, particularly within peer groups. These patients exhibit higher neuroticism, characterised by a highly responsive autonomic nervous system and a propensity for antisocial and psychotic tendencies. Moreover, Eysenck’s theory proposes that extroverts might be predisposed to stimulants, while introverts might gravitate towards depressants. 51
Conclusion
To conclude, the present findings uphold the notion that the personality profile of people with SUD differs significantly from HC. The elevated scores on all MPQ subscales in our study indicate a generally elevated personality profile on MPQ in individuals with AUD and SUD compared to controls, regardless of the specific substance used.
Footnotes
Abbreviations
OUD, Opioid Use Disorder; AUD, Alcohol Use Disorder; MPQ, Multiphasic Personality Questionnaire.
Authors’ Contributions
Dr. Devender Kumar Rana, Dr. Anil Malhotra, Dr. S K Mattoo, Dr. Debasish Basu all contributed to the study conceptualization and design. Dr. Devender Kumar Rana, Abhishek Verma, and Dr. Rama Malhotra worked on the writing of the original draft, formal analysis, review and editing. Dr. Krishan Kumar and Dr. Rajni Sharma worked on the review and editing. All authors evaluated the results and agreed to the final version of the manuscript.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.
Funding
The authors received no financial support for the research, authorship and/or publication of this article.
ICMJE Statement
Our study and results have not been submitted or published in any peer-reviewed journal. The present study is not a clinical trial.
Patient Consent
Written Informed agreement was taken from all participants, undergoing their voluntary involvement, data confidentiality and privacy protection.
Statement of Ethics
Approval was obtained from the appropriate authorities of the institute where the study was conducted. Confidentiality was maintained of each subject.
