Personality As A Risk Factor For Drug Abuse (Encyclopedia of Drugs, Alcohol, and Addictive Behavior)
The term personality refers to those relatively enduring aspects of attitudes, feelings, responses, and behaviors that permit us to recognize a particular person whom we have known over time. It is, in a way, a fingerprint of an individual's psychological makeuphe framework of how the individual thinks and acts. Psychiatrists believe that this framework arises out of childhood, powerfully shaped by the actions of parenting and the other social and environmental factors on a complex set of genetic and other biological givens. It is then further molded throughout one's development to achieve more or less lasting form in adolescence and early adulthood.
In the nineteenth century, we said that some people had willpower or a strong character; now we might refer to their good coping skills or to their ego strengthifferent ways of describing global measures of effective functioning. Current terms for more specific descriptors of personality might include the poles of introversionxtroversion, or approachvoidance, as well as others.
There is a long tradition linking personality, or character, to alcohol and other substance use and abuse. In the popular imagination, the old usage of "alcoholic" or "drug fiend" conveyed images of weakness, untrustworthiness, and/or viciousness; more sophisticated imagery, "oral character," conveyed ideas of dependency and needinessnalogies to the greedy infant at the breast. Unfortunately, such simple postulates break down in the presence of the complexities of the real world: Not all substance abusers are frightening "drug fiends"; neither are they necessarily dependent, needy, demanding "oral characters."
The explanation for substance abuse is not found purely in the drug. Most adults are able to drink socially without becoming alcoholics; some of us are repeatedly exposed to opiates (e.g., after surgery) without becoming addicts. Clearly, the impact of personality on alcohol and other drug use depends on a variety of factorshe social context, the specific drug, and the stage of involvement with the drug. Is the individual brought up as a rich kid in the suburbs or poor in an inner-city ghetto? Is the person black or white? Do drugs and drug users surround the individual, and are they seen as normative, or are they considered dangerous, rare, and deviant? Is the drug a relatively weak reinforcer such as marijuana, or is it a powerful stimulant such as cocaine? Is the individual experimenting in the early stages of use, struggling with long-term dependency, or dominated by the pangs of withdrawal and craving? Although a number of predictor factors for substance abuse are known, such as age, sex, religiosity, and parental drug use, we do not know why only some of those at risk become drug dependent. Personality is another likely predictor of who will try a particular drug, who will continue to use it or abuse it, the success of the struggle with abstaining, and so forth.
As the preceding indicated, early thinking was that excessive drinking (alcohol) and smoking (tobacco) were linked to early childhood experiences of suckling and satiation, of hunger satisfied by taking something in through the mouth that resulted in blissful sleep. That this may, at least at times, be true was seen in one patient who had first been addicted to alcohol and then to a series of barbiturates and other sedatives; he said plaintively, "Doc, I could become addicted to orange juice if it gave me a dreamless sleep." Unfortunately, just as the thumb fails to provide milk, most drugs do not ultimately provide the desired endhe continuing sense of pleasure and/or relief. It was assumed that individuals who had had difficulty in the earliest stages of development might be particularly prone to some kinds of addictiono depressive drugs, such as alcohol, sedatives, or opiates, which provide dreamy reverie states or sleepnd that difficulty in later stages of development might predispose to use of activating drugs, such as the stimulant amphetamines or cocaine.
Ongoing clinical experience and changing theories led investigators to focus additionally on aggression and on regulation of feelings. For example, many addicts appear to have difficulty distinguishing anxiety and anger, and they experience strong feelings as overwhelming, leading to loss of control. The drug may substitute, both pharmacologically and symbolically, for the parento "magically" help the individual maintain control. It has also been noted that many addicts appear not to have learned from their parents how to recognize, evaluate, and appropriately respond to danger. Many, or all, of these additional factors may operate at once: Individuals may be trying to satisfy primitive impulses and needs; there may be a defect in the recognition and control of feeling states; and they may be struggling to adapt to a stressful environment. A particular drug may, for a particular individual, transiently resolve these issues. Heroin may satiate, dampen, and control aggressionnd provide relief from environmental pressuresor the moment. Amphetamines or cocaine may provide orgasmic pleasure, in the form of a "rush, as well as provide a sense of control and omnipotence. A patient who was dependent on amphetamines was panicked at the thought of dental anesthesia: "I can't stand the idea of not being in control, of being put to sleep. It's why I take the pills, to stay awake, to know what's happening."
Many individuals who misuse drugs will misuse many different kinds of drugshe polydrug abusers. There are also people who, even after extensive experimentation with a variety of drugs, will choose to use and/or abuse a single drug or class of drugsuch as opiates, sedatives, or stimulants. It has been suggested that such individuals are driven to seek a particular drug experience, since the various drugs indeed have differing physiological and psychological effects.
Some studies lend support to this notion of particular personality contributions to drug preference. For example, opiates tend to bolster withdrawal (from others) and repression (not acknowledging reality) by inducing a state of decreased motor activity, underresponsiveness to external situations, and reduction of perceptual intake. Such a state is conducive to reinforcing fantasies of omnipotence, magical wish-fulfillment, and self-sufficiency, but both sexual drive and aggression are diminished. In addition, there is evidence that opiate addicts are, in general, more severely impaired in terms of their ability to function in the ordinary world; they are less able to cope with the activities of daily living. In contrast, amphetamines elevate scores on autonomous functioning and sense of confidence; there is a feeling of heightened perceptual and motor abilities accompanied by a strengthened sense of potency and self-regard. These effects appear to serve the user's need to feel active and potent in the face of an environment perceived as hostile and threateningnd also to deny underlying fears of passivity.
It is important to remember that all of us have some quirks, that we do not always handle all kinds of stress equally well, that we all have some weaknesses in our personalities, some defects in our characters. These may predispose some of us to drug use and to particular drug choice. Others have significant defects in development, disordered adaptations to the real world in which we are expected to function; they may choose a particular drug or drugs to help them adapt to their difficultieso make up, in a sense, for what is lacking within them. They are in effect choosing and self-administering their own medicine. This has been referred to as the self-medication theory of drug abuse. Certainly, drugs are capable of dramatically reversing painful emotional states; they can mute or free us from unmanageable feelings and provide some with the feeling that "It's the only time I've ever felt normal." Unfortunately, these effects are short-lived; side effects and the complications of physical dependance, tolerance, and withdrawal become prominent and even dominate the chronic user, who has become a substance abuser.
Be cautioned: These studies were done on people who had already been using illicit drugs for many yearsho had been immersed in the "drug world" of copping (getting the drug), fearing detection and detention, and living with the altered state of consciousness induced by their drug of choice. These studies and others like them can tell us only of a correlation, not a causal relationship, where personality style or defect results in or leads to drug use/ abuse. There are, however, some longitudinal studies that have followed schoolchildren for enough years to have seen some of them enter the drug world. In general, they show remarkable agreement in the descriptions of those children who become seriously involved with drugs. They are the opposite of the stereotype of the Eagle Scout (who is "thrifty, loyal, brave, clean, and reverent"); instead, they may be characterized as impulsive, with difficulty tolerating feelings and delaying gratification, and as possessing an antisocial personality style given to breaking rules, oppositional behavior, risk taking, and sensation seeking. These personality characteristics are present before immersion in the drug culture and are altered as the individual moves from initial use to continuing use, to the transition from use to abuse, to cessation or control of abusend, all too often, to relapse.
Be further cautioned: These findings may have been true at the time of the studies but may prove to be specific to that moment of history and no longer true. Zinberg (1984) has pointed out that the setting in which one takes a drug, and therefore the meaning of the drug-induced experience, is continually changing:
Chronic users [of marijuana], those that began using prior to 1965 were observed to be more anxious, more antisocial, and more likely to be dysfunctional than were the naive subjects who were just beginning to use marijuana in 1968 By the late 1960s, drug use was being experienced as a more normative choice in the early 1970s, controlled marijuana users could not possibly have been described as individuals driven to drug use by deep-seated, self-destructive, unconscious motives [p. 174].
An alternative view that has been suggested is that a series of otherwise accidental environmental reinforcers may so interact as to result in drug use in the absence, or the limited availability, of otherwise more necessary and pleasurable commodities. Experiments have shown just such development of "excessive behavior" in both animals and humans during conditions of deprivationf not enough water or foodut they have not yet demonstrated such a role in the induction to drug use.
Despite these cautions, it appears that PERSONALITY is a contributor that predisposes some to substance use and abuse. Different personalities are likely to make differing contributions to drug use, depending on the particular drug, the historical moment, the social surround, and the other determinants of use. Although it is still difficult to demonstrate more than generalities about the personality of addictive behaviors, the construct of addictive personality (ies) may be "theoretically necessary, logically defensible, and empirically supportable" (Sadava, 1978). Without such a constructhich includes the characteristic response patterns of the individual, the symbolic meaning of the experience to the individual (while recognizing that this may be retrospective rationalization), as well as the specifics of the particular drug's pharmacologyt will be difficult to explain the variation in drug use among individuals with apparently comparable life experiences.
(SEE ALSO: Adjunctive Drug Taking; Causes of Substance Abuse; Conduct Disorder and Drug Use; Coping and Drug Use; Families and Drug Use; Vulnerability As Cause of Substance Abuse)
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WILLIAM A. FROSCH
REVISED BY REBECCA MARLOW-FERGUSON