Predicting relapse to substance abuse as a function of personality dimensions

Personality predicting relapse: A facet analysis of the NEO PI-R

BACKGROUND AND OBJECTIVES

Revised NEO Personality Inventory (NEO PI-R) domains are associated with substance use disorders (SUD), including potential for relapse. However, individual facets of the NEO PI-R domains have not been rigorously analyzed. This paper assesses NEO PI-R individual facets among participants with SUD and their value in predicting relapse.

METHODS

Between 2015 and 2018, all patients admitted to a single private rehabilitation center (n = 642) were offered participation in this study. Participants who completed NEO PI-R questionnaires at the start of treatment and with known relapse outcomes up to 1-year posttreatment were included (n = 441). Statistical analysis included a series of unadjusted univariate logistic regressions and additional adjusted multivariate regression controlling for employment status in healthcare.

RESULTS

Neuroticism, Agreeableness, and Conscientiousness domains had significant impacts on relapse. Three individual facets of Neuroticism were significant predictors of relapse, and seven individual facets within the Conscientiousness and Agreeableness domains were inversely related to relapse. When controlling for employment, Conscientiousness and three of its individual facets (Dutifulness, Competence, and Self-Discipline) continued to be significant in predicting relapse. The individual facets Impulsiveness and Straightforwardness also continued to be significant in predicting relapse.

CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE

Several personality domains and facets were significantly related to relapse, confirming and expanding on prior literature. This study focuses on the risk of relapse as it relates to NEO PI-R individual facets, which have not been previously explored with a sample size of this magnitude. These findings can guide clinical care of patients with SUD, allowing for more targeted treatment.

Predictors of Relapse to Alcohol and Substance Use: Are There Any Differences between 3 and 12 Months after Inpatient Treatment?

Understanding the factors that lead to relapse is important for developing effective treatment strategies. The aim of this study is to examine sociodemographic and clinical factors that predict relapse 3 and 12 months after inpatient treatment in patients with alcohol and substance use disorders. 247 patients were included in the study. A sociodemographic data form and the Addiction Profile Index-Clinical Form (API-C) were filled out during the first days of hospitalization and relapse information was obtained through outpatient interviews. Logistic regression analysis was used to assess predictive factors. Rates of relapse for the 3^rd and 12^th months were 40.5% and 74.6%, respectively. Motivation to quit substance use, risk of depression, being on probation, and being employed predicted relapse within the 3-month period. At the 12^th month, substance use intensity and motivation to quit were the factors associated with relapse. To conclude, motivation to quit is critical to maintaining both early and sustained remission. Moreover, divergent factors may be relevant at different stages of treatment. Defining relapse predictors early in the process and being vigilant to the change in the needs of patients as the treatment continues may help to develop a more effective and focused treatment plan.

Measurement of the dimensions of personality traits in patients addicted to psychoactive substances in context of relapses

Introduction: Recurrent use of psychoactive substances, including alcohol, affects most patients. It is an expression of the chronicity of the disease process. Understanding the causes of this phenomenon is the key to searching for effective therapeutic strategies for this disease.

The aim: Analysis of individual dimensions of personality traits in patients in the context of relapses.

Material and method: The research was carried out on a group of 301 people addicted to psychoactive substances staying in an addiction therapy center in Lubuskie and Zachodniopomorskie voivodships in Poland. The subjects were divided into two groups. The first group consisted of addicts with reported one-time therapy. The second group consisted of addicts who received at least two treatments at an addiction therapy center. The personality dimension was measured using the NEO-FFI questionnaire and the STAI questionnaire.

Results: The following percentages of neuroticism (NF NEUR) were marked in people addicted to psychoactive substances with a single stay in an inpatient treatment center: 8.55% with low intensity, 40.13% with moderate intensity and 51.32% with high intensity. On the other hand, in people addicted to psychoactive substances with multiple stays in an inpatient treatment center, the features of low-grade neuroticism were found to be 6.85%, 25.34% of moderate and 67.81% of high intensity (χ2 = 8.643, p = 0.013).

Conclusions: A higher score on the Nervousness Scale of the Neo FFI inventory has a significant impact on the course of addiction and the occurrence of relapses.

Hazardous alcohol consumption among older adults: A comprehensive and multi-national analysis of predictive factors in 13,351 individuals

Background

Older adults exhibit heightened vulnerability for alcohol-related health impairments. Increases in the proportion of older adults within the European Union’s total population and prevalence rates of alcohol use disorders in this age group are being observed. This large scale international study was conducted to identify those older adults with an increased risk to engage in hazardous drinking behaviour.

Methods

Socio-demographic, socio-economic, personality characteristics (Big Five Inventory, BFI-10), and alcohol consumption patterns of 13,351 individuals from 12 different European countries, collected by the Survey of Health, Aging, and Retirement in Europe, were analyzed using regression models.

Results

Age, nationality, years of education, as well as personality traits, were significantly associated with alcohol intake. For males, extraversion predicted increased alcohol intake (RR = 1.11, CI = 1.07–1.16), whereas conscientiousness (RR = 0.93, CI = 0.89–0.97), and agreeableness (RR = 0.94, CI = 0.90–0.99), were associated with a reduction. For females, openness to new experiences (RR = 1.11, CI = 1.04–1.18) predicted increased alcohol intake. Concerning excessive drinking, personality traits, nationality, and age-predicted consumption patterns for both sexes: Extraversion was identified as a risk factor for excessive drinking (OR = 1.15; CI = 1.09–1.21), whereas conscientiousness was identified as a protective factor (OR = 0.87; CI = 0.823–0.93).

Conclusion

Hazardous alcohol consumption in the elderly was associated with specific personality characteristics. Preventative measures, crucial in reducing deleterious health consequences, should focus on translating the knowledge of the association of certain personality traits and alcohol consumption into improved prevention and treatment.

Kann die Symptombelastung einen regulären oder irregulären Behandlungsabschluss bei Substanzkonsumstörungen vorhersagen?

Ziel der Studie Das Ziel der vorliegenden explorativen Studie war zu untersuchen, ob die subjektive Symptombelastung vor und während der Behandlung von PatientInnen mit einer Substanzkonsumstörung einen Einfluss darauf hat, ob die Behandlung regulär (d. h. in gegenseitigem Einverständnis zwischen Therapeut und Patient) oder irregulär (d. h. Therapeut oder Patient bricht ab) beendet wird.

Methodik In der vorliegenden, retrospektiven Untersuchung wurden 54 PatientInnen einer Drogenentzugs- und Entwöhnungsstation untersucht. Die Informationen zur Art des Behandlungsabschlusses wurden der Basisdokumentation und zur Symptombelastung der Brief-Symptom-Checkliste (BSCL) entnommen.

Ergebnisse Die Ergebnisse der binären logistischen Regressionsanalysen zeigten, dass eine allgemeine Reduktion der Symptombelastung während der Behandlung mit einem regulären statt einem irregulären Behandlungsabschluss einherging. Die Analysen der Subskalen der BSCL ergaben signifikante Effekte für eine Abnahme der Ängstlichkeit und des Paranoiden Denkens während der Therapie zugunsten eines regulären Behandlungsabschlusses. Des Weiteren sagten hohe Werte der Zwanghaftigkeit zu Behandlungsbeginn einen regulären Behandlungsabschluss vorher.

Schlussfolgerung Bei der Behandlung von PatientInnen mit Substanzkonsumstörungen erscheint es sinnvoll, die allgemeine subjektive Symptombelastung während der Behandlung zu erfragen, um Therapieabbrüche zu vermeiden. Insbesondere sollten die Ängstlichkeit und das Paranoide Denken in den Fokus der Behandlung rücken, da diese in der vorliegenden Studie einen regulären Behandlungsabschluss vorhersagten.

The role of personality functioning in drug misuse treatment engagement

BACKGROUND AND AIM

Personality functioning is predictive of drug misuse and relapse, yet little is known about the role of personality in engagement with the treatment process. This study aimed to estimate the extent to which broad- and facet-level characteristic adaptations contribute to or hinder treatment engagement, while controlling for psychosocial indicators.

DESIGN

Multi-site cross-sectional survey.

SETTING

In-patient treatment units covering 80% of residential treatment entries in Greece.

PARTICIPANTS

A total of 338 service users, 287 (84.9%) male, 51 (15.1%) female, average age 33.4 years.

MEASUREMENTS

Expressions of personality functioning (characteristic adaptations) were assessed using the Severity Indices of Personality Problems (SIPP-118). Treatment engagement was measured using the Client Evaluation of Self and Treatment, in-patient version (CEST).

FINDINGS

Dysfunctional levels of relational capacities predicted counselling rapport [β = 1.50, 95% confidence interval (CI) = 0.326-2.69, P = 0.013], treatment participation (β = 2.09, 95% CI = 1.15-3.11, P < 0.001) and treatment satisfaction (β = 1.65, 95% CI = 0.735-2.57, P < 0.001). Counselling rapport was also predicted by dysfunctional levels in self-control (β = 1.78, 95% CI = 0.899-2.67, P < 0.001), self-reflective functioning at the facet-level (β = 2.24, 95% CI = 1.01-3.46, P < 0.001) and aggression regulation (β = 1.43, 95% CI = 0.438-2.42, P = 0.005). Dysfunctional levels on social concordance (β = -1.90, 95% CI = -2.87 to -0.941, P = 0.001), emotional regulation (β = 1.90, 95% CI = 0.87-2.92, P < 0.001) and intimacy (β = 2.04, 95% CI = 1.31-3.05, P < 0.001) were significant predictors of treatment participation. Treatment readiness and desire for help predicted treatment engagement.

CONCLUSIONS

In people attending substance use treatment services, maladaptive interpersonal patterns and relational intimacy, emotional dysregulation and impulse control may be associated with low levels of counselling rapport and treatment participation. Low frustration tolerance and aggressive impulses also appeared to predict low participation.

What Components of Adolescents' Responsibility are Effective in Preventing Addiction?

Background

In most countries, the age of addiction is declining, and the prevalence of adolescent addiction is increasing. Many factors can affect the addiction tendency; one of them can be a sense of responsibility. This study was designed to evaluate the probable relation between addiction tendency and responsibility.

Materials and Methods

This cross-sectional study was conducted in Isfahan in 2018. A total of 496 high school students aged from 15 to 18 years were selected by a multistage cluster and systematic random sampling method. Students' responsibility and adolescents' addiction tendency questionnaire were used. The collected data were analyzed by the Statistical Package for the Social Sciences version 20 using Chi-square test, independent t-test, multivariate analysis of variance, and linear regression.

Results

The mean age of participants was 16.50 ± 1.12. The results showed that boys' out-of-home activities were more than girls (P < 0.001), but there was no significant difference between girls and boys regarding indoor activities. Furthermore, it was found that girls were more responsible than boys (P = 0.004) and addiction tendency was higher in boys (P = 0.001). Social responsibility and addiction tendency had a significant negative relationship in this research (P < 0.001). In addition, parents' education, the feeling of belonging, and the sense of security had an effect on the addiction tendency (P < 0.001 for all).

Conclusion

This study showed that social responsibility could affect the addiction tendency.

Validation of the Malay Version of Mini-IPIP among Substance Use Disorder Patients Attending Methadone Clinics in Malaysia

There has been an increasing interest in personality study over the years. This has led to the necessity for personality measures with good psychometric properties. However, good personality measures are usually too cumbersome to apply in real practical settings due to their length. This study aims to validate a commonly used short personality measure of the Big Five model, i.e., Mini-IPIP (Mini International Personality Item Pool), which has never been validated and used in the substance abuse population in the local setting. The participants were 239 individuals attending one of the six methadone clinics in Malaysia. Structural analysis was conducted using confirmatory factor analysis. Results showed a good model fit for Mini-IPIP when item-parcelling and adding-in correlated uniqueness items were applied (fit indices: Comparative Fit Index = 0.949, Standardised Root Mean Residual = 0.044). Our study supported the five-factor solution for the Mini-IPIP. It is valid and reliable to be used among individuals with drug abuse in Malaysia.

Effectiveness of methamphetamine abuse treatment: Predictors of treatment completion and comparison of two residential treatment programs

BACKGROUND

There is an increasing demand of evidence-based treatment options for methamphetamine users, but research in this field is limited. This study therefore evaluates the efficacy of two residential treatment programs for methamphetamine users.

METHOD

A total of 108 patients with a history of methamphetamine abuse from two inpatient rehabilitation centers were studied for psychiatric symptoms, craving, psychosocial resources, and cognitive functioning at the start and end of therapy. Patients from one center ("amphetamine type stimulant group") received conventional group therapy plus an additional 10 h of group therapy focusing on stimulant use. Patients from the other center ("treatment as usual") received conventional group therapy only. Predictors of drop-out were estimated.

RESULTS

A drop-out rate of 40.7% was observed without a significant difference between both centers. Patients remained significantly longer in treatment as usual compared to amphetamine type stimulant treatment. Irrespective of treatment program, craving and psychiatric symptoms significantly decreased while psychosocial resources, processing speed, and cognitive flexibility improved over time. Other cognitive measures yielded mixed results. History of injection drug use was a significant predictor for treatment drop-out.

CONCLUSIONS

Existing treatments are effective in reducing craving and psychiatric symptoms. Additional stimulant specific groups do not appear to influence treatment completion and secondary outcome measures. Institutions should therefore offer treatment for methamphetamine users, even if they do not provide a therapy content focusing on methamphetamine. History of injection drug use should receive attention in treatment to prevent drop-out. Changes in cognitive functioning need to be further explored.

Exploring the Demographic Factors and Facilitators to Addiction Abstinence

Background:

Accumulating evidence indicates a remarkable increase in substance addiction. Substance abuse and addiction impose severe social, political, economic, cultural and health-related damages on societies. Little is known, however, about demographic factors and facilitators to addiction abstinence. The purpose of the current study was to explore the factors associated with opioid avoidance.

Materials and Methods:

This cross-sectional study was performed to record socio-demographic data and facilitating factors to abstinence in 600 interviews, according to data collecting forms, with patients who had drug abuse disorders at Shiraz city during 2016. Correlation test, T-test, and ANOVA were employed for data analysis. P value <0.05 was considered as the significance level.

Result:

There was a significant difference between mean abstinence time and demographic factors such as age, sex, occupation and marital status. Also, 53% of people reported that they had the longest abstinence time using the narcotics anonymous (NA) method. TO 33% of patients, the most important facilitating factor in abstinence according to the patient’s opinion was family support.

Conclusion:

Individual, social, psychosocial and medical variables affect the abstinence duration of substance abuse. Identifying the factors associated with longer abstinence can be helpful in designing prevention and treatment programs for variables that affect the recurrence.

Latent-level relations between DSM-5 PTSD symptom clusters and problematic smartphone use

Common mental health consequences following the experience of potentially traumatic events include Posttraumatic Stress Disorder (PTSD) and addictive behaviors. Problematic smartphone use is a newer manifestation of addictive behaviors. People with anxiety severity (such as PTSD) may be at risk for problematic smartphone use as a means of coping with their symptoms. Unique to our knowledge, we assessed relations between PTSD symptom clusters and problematic smartphone use. Participants (N = 347), recruited through Amazon's Mechanical Turk (MTurk), completed measures of PTSD and smartphone addiction. Results of the Wald tests of parameter constraints indicated that problematic smartphone use was more related to PTSD's negative alterations in cognitions and mood (NACM) than to PTSD's avoidance factor, Wald χ²(1, N = 347) = 12.51, p = 0.0004; and more to PTSD's arousal compared to PTSD's avoidance factor, Wald χ²(1, N = 347) = 14.89, p = 0.0001. Results indicate that problematic smartphone use is most associated with negative affect and arousal among trauma-exposed individuals. Implications include the need to clinically assess problematic smartphone use among trauma-exposed individuals presenting with higher NACM and arousal severity; and targeting NACM and arousal symptoms to mitigate the effects of problematic smartphone use.

Characterization of comorbid PTSD in treatment-seeking alcohol dependent inpatients: Severity and personality trait differences

BACKGROUND

Post-traumatic stress disorder (PTSD) is often comorbid with alcohol dependence (AD), but little is known about the characteristics of AD treatment-seeking inpatients with PTSD. We examined differences between treatment-seeking alcohol dependent inpatients with and without comorbid PTSD. We hypothesized that those with AD and PTSD would have higher levels of: (1) alcohol use and AD severity; (2) anxiety and mood disorders; (3) neuroticism.

METHODS

Individuals (N=411, mean age=41.7±10.0years) with AD were monitored over 30days in a suburban inpatient alcohol treatment setting. Patients were evaluated to identify AD and comorbid PTSD, mood and anxiety disorders, alcohol use and dependence severity, personality, and aggression.

RESULTS

Those with PTSD (19% of the sample) did not differ in the amount of alcohol consumed, but had greater: (1) severity of AD (p=0.001, d=0.44); (2) diagnosis of anxiety (p=0.000, OR=3.64) and mood (p=0.000, OR=4.83) disorders; and (3) levels of neuroticism (p<0.001, d=0.67) and aggression (p<0.001, d=0.81).

CONCLUSIONS

AD patients with comorbid PTSD present a more severe phenotype across AD severity, frequency of anxiety and mood disorders, and levels of neuroticism and aggression. This group may benefit from concurrent treatment of both AD and PTSD. Future research can investigate neuroticism as a potential treatment target.

The role of childhood maltreatment in the altered trait and global expression of personality in cocaine addiction

BACKGROUND AND AIMS

Drug addictions are debilitating disorders that are highly associated with personality abnormalities. Early life stress (ELS) is a common risk factor for addiction and personality disturbances, but the relationships between ELS, addiction, and personality are poorly understood.

METHODS

Ninety-five research participants were assessed for and grouped by ELS history and cocaine dependence. NEO-FFI personality measures were compared between the groups to define ELS- and addiction-related differences in personality traits. ELS and cocaine dependence were then examined as predictors of personality trait scores. Finally, k-means clustering was used to uncover clusters of personality trait configurations within the sample. Odds of cluster membership across subject groups was then determined.

RESULTS

Trait expression differed significantly across subject groups. Cocaine-dependent subjects with a history of ELS (cocaine+/ELS+) displayed the greatest deviations in normative personality. Cocaine dependence significantly predicted four traits, while ELS predicted neuroticism and agreeableness; there was no interaction effect between ELS and cocaine dependence. The cluster analysis identified four distinct personality profiles: Open, Gregarious, Dysphoric, and Closed. Distribution of these profiles across subject groups differed significantly. Inclusion in cocaine+/ELS+, cocaine-/ELS+, and cocaine-/ELS- groups significantly increased the odds of expressing the Dysphoric, Open and Gregarious profiles, respectively.

CONCLUSIONS

Cocaine dependence and early life stress were significantly and differentially associated with altered expression of individual personality traits and their aggregation as personality profiles, suggesting that individuals who are at-risk for developing addictions due to ELS exposure may benefit from personality centered approaches as an early intervention and prevention.

Optimal neurocognitive, personality and behavioral measures for assessing impulsivity in cocaine dependence

BACKGROUND

Impulsivity may underlie the poor treatment retention and high relapse rates observed in cocaine-dependent persons. However, observed differences in measures of impulsivity between cocaine-dependent and healthy control participants often do not reach clinical significance, suggesting that the clinical relevance of these differences may be limited.

OBJECTIVES

To examine which measures of impulsivity (i.e. self-report impulsivity, self-report personality, neurocognitive testing) best distinguish cocaine-dependent and healthy control participants (i.e. showing differences at least 1.5 standard deviations [SD] from controls). Optimal measures were considered to demonstrate sufficient classification accuracy.

METHODS

Sixty-five recently abstinent cocaine-dependent and 25 healthy control participants were assessed using select neurocognitive tests and self-report questionnaires including the NEO Personality Inventory-Revised (NEO-PI-R), Temperament and Character Inventory (TCI), Barratt Impulsiveness Scale (BIS-11a), and the Frontal Systems Behavior Scale (FrSBe).

RESULTS

When corrected for years of education and gender, neurocognitive measures did not demonstrate clinically significant differences between cocaine-dependent and control participants. The personality measures TCI Purposefulness and Congruent Second Nature and NEO-PI-R Impulsiveness, and the self-rating measures FrSBe Disinhibition and BIS-11 Motor Impulsivity and Total successfully identified clinically meaningful elevations in impulsivity within cocaine-dependent participants (>1.5 SDs from controls). Furthermore, these measures achieved 84-93% accuracy in discriminating cocaine-dependent from control participants.

CONCLUSION

Clinically significant neurocognitive impairment in cocaine-dependent participants was not observed in this sample. As the BIS-11 or FrSBe are brief to administer, accurate, and have been shown to predict treatment retention and relapse, these measures appear to be optimal, relative to the personality measures, for examining trait impulsivity in cocaine dependence.

EMOTIONALLY AVOIDANT LANGUAGE IN THE PARENTING INTERVIEWS OF SUBSTANCE-DEPENDENT MOTHERS: ASSOCIATIONS WITH REFLECTIVE FUNCTIONING, RECENT SUBSTANCE USE, AND PARENTING BEHAVIOR

Parenting and emotion regulation are two known, and potentially interrelated, areas of impairment among substance-abusing mothers. In this study, we examine substance -abusing mothers' (positive and negative) emotion language word use during their discussion of negative parenting experiences on the Parent Development Interview for its association with reflective functioning (RF), recent substance-use history, and sensitivity to child cues. Within a sample of 47 methadone-maintained mothers, we evaluate the hypothesis that linguistic evidence of emotional avoidance (more frequent positive feeling words and less frequent negative emotion words) will be associated with lower RF, more recent substance use, and more insensitive parenting. Further, we evaluate whether language use mediates the association between self-focused RF and insensitive parenting. Results of hierarchical regressions suggest that more frequent positive feeling word use, but not negative emotion word use, is associated with lower RF, more recent substance use, and lower sensitivity to child cues. Positive feeling word use partially mediates the association between self-focused RF and insensitive parenting. Results are discussed in the context of their contribution to the literature on emotion and parenting in substance-abusing populations.

How neuroticism affects responses to anti-smoking messages

The effect of trait neuroticism on college students' (n=200) responses to anti-smoking public service announcements (PSAs) was examined using a 2 (neuroticism: high vs. low) × 3 (message type: personal testimony, secondhand smoke, and informative) × 3 (message: nested within message type) design. We hypothesized that those high in neuroticism would be avoidant toward anti-smoking messages, have quicker and stronger negative reactions and perceive the messages as more biased and less involving. As hypothesized, those high in neuroticism were more likely to want to avoid thinking about smoking as a function of viewing the messages and more likely to see messages as biased; however, neuroticism did not affect judgments of message involvement. Tobacco use and gender also affected message bias and avoidance. Those scoring high in neuroticism also responded quicker to negative emotion assessments to messages. Implications for the importance of neuroticism in message design and message processing research are discussed.

Neuroticism explained? From a non-informative vulnerability marker to informative person-context interactions in the realm of daily life

OBJECTIVES

Despite the well-replicated finding that neuroticism is associated with increased susceptibility for psychopathology, it remains unclear what 'vulnerability as indexed by neuroticism' represents in terms of everyday life emotional processes. This study examined the association between neuroticism and six phenotypes of daily life emotional responses: positive affect (PA), negative affect (NA), PA variability, NA variability, stress sensitivity, and reward experience, and investigated the contribution of genetic and environmental factors to these associations.

DESIGN

A prospective cohort study in a population-based sample of 416 adult female twins.

METHOD

A momentary assessment approach (experience sampling method) was used to collect multiple assessments of affect in daily life. Neuroticism was assessed with the Eysenck Personality Scale. Multi-level regression analyses were carried out to examine the association between neuroticism and the phenotypes of daily life emotional responses. Cross-twin, cross-trait analyses, and bivariate structural equation modelling (SEM) were performed in order to investigate the nature of these associations.

RESULTS

A high neuroticism score was associated with lower momentary PA levels and increased NA variability, independent of momentary NA, PA variability, stress sensitivity, and reward experience. Both the cross-twin, cross-trait analyses, and the bivariate SEM showed that unique, non-shared environmental factors drive the association between neuroticism and PA and that the association between neuroticism and increased NA variability is based on shared genetic factors as well as individual-specific environmental factors.

CONCLUSIONS

Neuroticism as measured by Eysenck questionnaire may index an environmental risk for decreased daily life PA levels and a genetic as well as an environmental risk for increased NA variability. Decomposing the broad measure of neuroticism into measurable persons-context interactions increases its 'informative' value in explaining psychopathology.

Individual vulnerability to addiction

The process of addiction is often studied in the neurosciences as a function of the quantity or type of substance consumed, with the ultimate goal of counteracting these effects by other pharmacological means. However, epidemiology and clinical research have extensively demonstrated that most individuals who use drugs do not develop dependence. Numerous factors may explain an individual's propensity to addiction. This review discusses these paradigms and summarizes research on individual differences that encompass cultural and sociodemographic factors, psychiatric or psychological vulnerability, and biological or genetic propensity to addiction. Although these different factors often interact in the expression of vulnerable phenotypes, it is possible to alter or control specific sources of vulnerability. For these reasons, integrating individual vulnerability to addiction across different research disciplines is likely to provide the greatest advances for intervention and prevention efforts.

Cannabis users differ from non-users on measures of personality and schizotypy

Accumulating evidence indicates that cannabis use may be a risk factor for schizophrenia (SZ), and chronic cannabis users score higher than non-users on measures of schizotypal personality traits. The purpose of the present study was to investigate the relations between normal personality, schizotypy, and cannabis use. Sixty-two chronic cannabis users and 45 cannabis-naïve controls completed a measure of normal personality, the NEO-Five Factor Inventory (NEO-FFI), and two measures of schizotypy, the schizotypal personality questionnaire (SPQ) and perceptual aberration scale (PAS). Substance use was assessed using the SCID I alcohol/drug module and a locally developed drug use questionnaire. On the NEO-FFI, users scored higher than controls on openness, but lower on agreeableness and conscientiousness, and endorsed greater schizotypy on the SPQ and PAS. Higher neuroticism predicted greater schizotypy in both groups, and, higher Extraversion predicted lower negative-syndrome schizotypy among users. Finally, duration of cannabis use was positively correlated with scores on the SPQ and PAS among users, suggesting a relation between overall cannabis use chronicity and schizotypy. These data show that cannabis users differ from non-users on dimensions of normal personality and schizotypy, and provide further evidence that cannabis use is associated with increased levels of psychosis-related personality traits.

Personality traits and mental health of severe drunk drivers in Sweden

The present study was intended to investigate personality characteristics and mental health of severe driving under influence (DUI) offenders in a Swedish cohort. More specifically the aim was to investigate the personality traits as assessed by The NEO personality inventory (NEO-PI-R) and aspects of mental health as assessed by the symptom checklist (SCL-90) as compared to the general population. The subjects were 162 severe DUI offenders (with the BAC >0.099%) with an age range of 18-88 years, 143 males and 19 females. It was found that the openness to experience and conscientiousness scales of NEO-PI-R differentiated Swedish DUI offenders from Swedish norm population. The differences between the DUI group and the general population on the on SCL-90 scales were all significant except on the Hostility scale. Two main subtypes of DUI offenders identified were roughly comparable to types I and II alcoholics, as in Cloninger's typology. Among all the scales used (personality traits, psychiatric comorbidity and alcohol use), the only factor that was predictive for future relapses to drunk driving was the factor of depression.

Personality traits and mental health states of methamphetamine-dependent and methamphetamine non-using MSM

This analysis considers the relation between personality traits, mental health states and methamphetamine (MA) use in 60 men who have sex with men (MSM). Thirty MA-dependent and 30 MA non-using MSM were assessed on the Neo Five Factor Inventory, the Brief Symptom Inventory, the Perceived Stress Scale, and the Posttraumatic Stress Disorder Checklist-Civilian Version tests. Our results indicate differences between groups on a variety of measures of personality traits and mental states. Specifically, MA-dependent participants were found to be more Neurotic, less Open, less Agreeable, and less Conscientious. Further, MA-dependent participants were found to have higher levels of Paranoid Ideation and higher levels of Interpersonal Sensitivity. Given the high prevalence of MA use in the MSM community and the association between MA use and sexual risk taking, our findings provided a clearer understanding of how individual personality traits may be a factor in the continued use of this drug among MSM. Further research should seek to incorporate individual personality traits into the development of efficacious MA-specific treatment interventions.

Predicting treatment outcome in stimulant dependence

The purpose of this review is to highlight some of the issues that need to be addressed to optimally use functional neuroimaging as a clinical tool to predict outcomes in substance use disorders. First, the importance of recognizing the clinical heterogeneity of the substance use disorders population is highlighted. We also emphasize that empirical and theoretical analyses support the idea that the courses of substance use disorders are relatively independent of the types of substance being used. Second, various approaches to the measurement and characterization of the longitudinal courses of substance use disorders are summarized. Third, predictors of outcomes are reviewed and their limitations are discussed. Within this context, we describe aspects of our work that focus on using functional magnetic resonance imaging to predict outcomes. Fourth, we discuss future directions, critical experiments, and the utility of functional neuroimaging as a clinical tool.

Five-factor model personality traits in opioid dependence

BACKGROUND

Personality traits may form a part of the aetiology of opioid dependence. For instance, opioid dependence may result from self-medication in emotionally unstable individuals, or from experimenting with drugs in sensation seekers. The five factor model (FFM) has obtained a central position in contemporary personality trait theory. The five factors are: Neuroticism, Extraversion, Openness to Experience, Agreeableness and Conscientiousness. Few studies have examined whether there is a distinct personality pattern associated with opioid dependence.

METHODS

We compared FFM personality traits in 65 opioid dependent persons (mean age 27 years, 34% females) in outpatient counselling after a minimum of 5 weeks in buprenorphine replacement therapy, with those in a non-clinical, age- and sex-matched sample selected from a national database. Personality traits were assessed by a Norwegian version of the Revised NEO Personality Inventory (NEO PI-R), a 240-item self-report questionnaire. Cohen's d effect sizes were calculated for the differences in personality trait scores.

RESULTS

The opioid-dependent sample scored higher on Neuroticism, lower on Extraversion and lower on Conscientiousness (d = -1.7, 1.2 and 1.7, respectively) than the controls. Effects sizes were small for the difference between the groups in Openness to experience scores and Agreeableness scores.

CONCLUSION

We found differences of medium and large effect sizes between the opioid dependent group and the matched comparison group, suggesting that the personality traits of people with opioid dependence are in fact different from those of non-clinical peers.

A genome-wide linkage analysis for the personality trait neuroticism in the Irish affected sib-pair study of alcohol dependence

Neuroticism is a personality trait which reflects individual differences in emotional stability and vulnerability to stress and anxiety. Consistent evidence shows substantial genetic influences on variation in this trait. The present study seeks to identify regions containing susceptibility loci for neuroticism using a selected sib-pair sample from Ireland. Using Merlin regress, we conducted a 4 cM whole-genome linkage analysis on 714 sib-pairs. Evidence for linkage to neuroticism was found on chromosomes 11p, 12q, and 15q. The highest linkage peak was on 12q at marker D12S1638 with a Lod score of 2.13 (-log p = 2.76, empirical P-value <0.001). Our data also support gender specific loci for neuroticism, with male specific linkage regions on chromosomes 1, 4, 11, 12, 15, 16, and 22, and female specific linkage regions on chromosomes 2, 4, 9, 12, 13, and 18. Some genome regions reported in the present study replicate findings from previous linkage studies of neuroticism. These results, together with prior studies, indicate several potential regions for quantitative trait loci for neuroticism that warrant further study.

Acupuncture treatment for women with concurrent substance use and anxiety/depression: an effective alternative therapy?

This exploratory study evaluated the benefits of adding auricular acupuncture to a 21-day outpatient structured psychoeducational treatment program for women with concurrent substance use problems, anxiety, and depression. Women receiving acupuncture (n = 185) reported having reduced physiological cravings for substances, felt significantly less depressed, less anxious, and were better able to reflect on and resolve difficulties than women in the control group (n = 101). It was found that auricular acupuncture, as an adjunct therapy to a comprehensive psychoeducational treatment program for women with addictions, shows promise in being an effective, more viable treatment alternative to anxiolytics.

Behavioural treatment of trichotillomania: Two-year follow-up results

Post-treatment evaluation studies of behaviour therapy (BT) for trichotillomania (TTM) have shown that BT is successful in reducing symptoms in this impulse-control disorder. The present study was aimed at investigating gain maintenance at long-term follow-up. TTM-related symptoms and other symptom characteristics were evaluated in 28 patients suffering from TTM before and after brief BT and at a 3-month and 2-year follow-up. The manual-based BT consisted of self-control procedures offered in six sessions. Pre-post effect sizes for TTM symptoms at post-treatment evaluation and at the two follow-ups were 2.91, 1.47, and .87. Compared to the post-treatment effects, the 3-month and 2-year follow-up effect sizes had decreased by 49% and 70%, respectively. Better 2-year follow-up results were associated with lower pre-treatment levels of depressive symptoms and with complete abstinence from hair pulling immediately after treatment.

Relapse to alcohol and drug use among individuals diagnosed with co-occurring mental health and substance use disorders: a review

This paper reviews the literature investigating relapse to alcohol and drug use among individuals dually diagnosed with a substance use and a co-occurring mood, anxiety, schizophrenia-spectrum, or personality disorder. Prevalence rates for each co-occurring set of disorders are discussed, followed by research studies that examine predictors of relapse to substance use within these groups. Relevant conceptual models well-suited to incorporating relapse as an outcome variable, and psychiatric factors both as predictor and outcome variables, are presented. Suggestions for future studies are provided. A priority area is developing and using consistent and well-articulated definitions of relapse across studies. Several diagnostic issues surfaced such as using structured clinical interviews to determine diagnosis (preferably following detoxification from alcohol and/or drugs), separating individuals with only alcohol use disorders from those with alcohol and drug use disorders in analyses, reporting the rates and types of overlap in mental health diagnoses, and conducting analyses that include and exclude multiply disordered individuals. Finally, future studies that focus on isolating predictors of relapse and abstinence could make substantive contributions to improving treatment for individuals with co-occurring substance use and mental health disorders.

Impact of different personality dimensions (NEO Five-Factor Inventory) on the outcome of alcohol-dependent patients 6 and 12 months after treatment

There is growing evidence that outpatient treatment might be equally effective as inpatient treatment for alcohol-dependent patients. Nevertheless, it is still unclear which patient group benefits most from outpatient treatment. Some personality traits such as emotional instability and high neuroticism are known risk factors for relapse after treatment. The purpose of the following study was to investigate the possible relationship between personality traits, measured by the NEO Five-Factor Inventory (NEO-FFI), and outcome after an intensive outpatient treatment program. Seventy-four alcohol-dependent patients who had completed the outpatient treatment program were included. Patients were examined at the beginning and end of the treatment, and 6 and 12 months after completion of the treatment. At the 6- and 12-month follow-up, 97% of the patients were successfully located and personally interviewed. Analyses revealed that 54 patients (73%) had been abstinent for the entire 12-month follow-up period. Twenty patients (27.4%) were found to be non-abstinent. Of these patients, 10 (13.5%) were found to be improved and 10 (13.5%) to have relapsed. Results indicate a remarkable stability of NEO-FFI scores over time, giving evidence for the usefulness of this instrument for the assessment of personality dimensions in alcohol-dependent patients. Patients who relapsed within 12 months after treatment had significantly higher scores on the personality domains of "neuroticism" and lower scores on the personality domains of "conscientiousness" than abstainers. These results are in line with prior research on this topic.

Personality characterizations of outpatients with schizophrenia, schizophrenia with substance abuse, and primary substance abuse

The study extended previous research on the relationship between personality traits and Axis I disorders. It examined personality differences between individuals diagnosed with schizophrenia and substance abuse and also included individuals dually diagnosed with both schizophrenia and substance abuse. Comparisons were made with respect to characteristics of both normal personality, as measured by the NEO Five-Factor Inventory (NEO-FFI), and disordered personality, as measured by the Millon Multiaxial Personality Inventory. On the NEO-FFI, all groups differed significantly from the NEO-FFI normative sample on at least three personality domains. As predicted, the dual diagnosis group showed the most personality deviance and pathology. The schizophrenia group was primarily distinguished by higher levels of agreeableness, whereas the substance abuse group was more extroverted and showed a prominence of Cluster B personality patterns. An unexpected finding was an interaction between diagnostic group and age, such that older relative to younger individuals in the single diagnosis groups showed greater personality adaptivity and moderation, whereas older individuals in the dual diagnosis group showed less.

NEO-PI-R Neuroticism Scores in Substance-Dependent Outpatients: Internal Consistency and Self-Partner Agreement

We evaluated internal consistency reliabilities and self-partner agreement on Revised NEO Personality Inventory (Costa & McCrae, 1992) Neuroticism (N) domain and facet scores (anxiety, angry hostility, depression, self-consciousness, impulsiveness, vulnerability) in a sample of 48 substance-dependent outpatients. Low internal consistency was seen for self-rated impulsiveness (alpha =.36). Agreement between self and partner reports was low for impulsiveness (.22) and vulnerability (.24) and was modest for the remaining facets of N (.31 to.34) and the N domain score (.31).

Personality, substance of choice, and polysubstance involvement among substance dependent patients

The authors compared the association of several personality traits, drug of choice, and polysubstance involvement in 325 individuals (44% male) receiving treatment for substance dependence on heroin, cocaine, and/or alcohol. Measures included the Structured Clinical Interview for DSM-III-R, the MacAndrew Alcoholism Scale (MAC), the socialization scale of the California Psychological Inventory (CPI-Soc), the novelty seeking dimension of the Temperament and Character Inventory (TCI-NS), and the conscientiousness domain of the NEO Five-Factor Inventory (NEO-C). Analyses adjusted for demographic covariates, affective and antisocial personality disorder, and substance dependence severity. Although scant evidence supported the hypothesis that these personality traits were associated with substance choice, CPI-Soc and MAC were associated linearly with the extent of polysubstance involvement. Also, patients who were dependent on two or more substances displayed higher levels of TCI-NS, CPI-Soc, and MAC. Findings implicate an association between behavioral disinhibition and a continuum of addiction defined primarily in terms of polysubstance involvement.

Dependency, impulsivity, and self-harm: traits hypothesized to underlie the association between cluster B personality and substance use disorders

Cluster B personality disorders (PDs) (i.e., antisocial, borderline, histrionic, and narcissistic) typically show a high degree of comorbidity with substance use disorders (SUDs). Previous research suggests that the broad-based personality domains of Disinhibition and Negative Temperament/Neuroticism may be common factors to both types of disorders. Using a two-phase process (i.e., screening and follow-up), this study examined three lower-order personality traits (i.e., dependency, impulsivity, and self-harm) that fall within the Disinhibition and Neuroticism domains. The study evaluated the hypotheses that these traits (a) are related both to cluster B PDs and to SUDs; and (b) underlie the association between the two types of disorders. Results indicate that impulsivity and self-harm play a significant role in cluster B PDs and SUDs, as well as in their association with each other. However, dependency was not associated with either type of disorder. These results indicate that sets of individual traits can be of significant utility in understanding the comorbidity between PDs and SUDs.

Personality, drug of choice, and comorbid psychopathology among substance abusers

The current study investigated the association between substance abuse/dependence, drug of choice, and the personality traits of negative emotionality, positive emotionality, and constraint (disinhibition) as measured by the Multidimensional Personality Questionnaire. The sample comprises 325 subjects from the Yale Family Study, a family study investigating the relation between substance-use disorders and anxiety disorders and their transmission in families. A total of 205 (63%) met criteria for lifetime substance abuse/dependence, with the remainder comprising the comparison group. The substance abusers were placed into one of four predominant drug of abuse/dependence categories (opioid, cocaine or stimulants, marijuana or sedatives, or alcohol) based upon best-estimate diagnoses and one of five self-reported drug of preference groups (polysubstance, opioid, cocaine or stimulants, marijuana or sedatives, and alcohol). First, findings demonstrate that individuals with substance abuse/dependence, compared to those without, scored lower on constraint even after adjusting for socio-demographic factors, comorbid psychiatric disorder, and current/remitted substance-use disorder. Individuals with substance abuse/dependence scored marginally higher on negative emotionality, but this difference was statistically significant only when comorbid psychopathology was not controlled. Second, findings show that individuals who differ with respect to drug of choice-whether defined in terms of the predominant drug of abuse/dependence or self-reported drug of preference-vary in terms of constraint. After controlling for socio-demographic indicators and comorbid psychopathology, scores on constraint generally decreased with the social deviance of the drug of choice, thereby underscoring a potentially important link between disinhibition and drug selection.

Co-morbidity of personality disorders in individuals with substance use disorders

This review summarizes the recent literature about personality disorders among substance abusers. First, it will be shown that personality disorders are highly prevalent co-morbid conditions among addicted individuals. Second, it is argued that this co-morbidity is likely to be accounted for by multiple complex etiological relationships. Finally, the clinical relevance of routine assessment of (maladaptive) personality traits in individuals admitting for substance abuse treatment will be discussed.

Relapse outcomes in a randomized trial of residential and day drug abuse treatment

Relapse outcomes at 6-, 12-, and 18-month intervals were compared between clients randomly assigned to day (n=114) versus residential (n=147) drug abuse treatment. Day clients were more likely than residential clients to relapse 6 months post-admission (OR=3.06, p<0.001); however, no setting differences at 12 or 18 months were found. Few baseline predictors were prospectively related to relapse at 12 and 18 months. These predictors were usual employment status (part-time OR=17.47, p<0.001; full-time OR=2.54, p<0.001), history of drug injecting (OR=5.39, p<0.01), multiple sex partners (OR=1.16, p<0.01), and not having a gay sexual partner (OR=0.05, p<0.03) during 6 months prior to admission. Still, these baseline predictors, together with the existing literature, could be used by drug treatment professionals to identify individuals who may be at high risk for relapse over time, and to offer specialized treatment and aftercare resources as intervention and prevention measures.