Personality theories of addiction

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Personality theories of addiction are psychological models that associate personality traits or modes of thinking (i.e., affective states) with an individual's proclivity for developing an addiction. Models of addiction risk that have been proposed in psychology literature include an affect dysregulation model of positive and negative psychological affects, the reinforcement sensitivity theory model of impulsiveness and behavioral inhibition, and an impulsivity model of reward sensitization and impulsiveness. [1] [5] [6]

Contents

Role of affect dysregulation in addiction

Research has consistently shown strong associations between affective disorders and substance use disorders. Specifically, people with mood disorders are at increased risk of substance use disorders. [1] Affect and addiction can be related in a variety of ways as they play a crucial role in influencing motivated behaviours. For instance, affect facilitates action, directs attention, prepares the individual for a physical response, and guides behaviour to meet particular needs. [7] Moreover, affect is implicated in a range of concepts relevant to addiction: positive reinforcement, behaviour motivation, regulation of cognition and mood, and reasoning and decision making. [8] [9] Emotion-motivated reasoning has been shown to influence addictive behaviours via selecting outcomes that minimize negative affective states while maximizing positive affective states. [10]

Negative affect

The relationship between negative affect and substance use disorders has been the most widely studied model of addiction. It proposes that individuals who experience the greatest levels of negative affect are at the greatest risk of using substances or behaviours as a coping (psychology) mechanism. [11] [12] Here, substances and behaviours are used to improve mood and distract from unpleasant feelings. Once physical dependence has been established, substance abuse is primarily motivated by a desire to avoid negative affective states associated with withdrawal. Individuals high in affective mood disorders (anxiety) most commonly report high levels of negative affect associated with cravings. [13] [14] [15] The relationship between negative affect and addiction is not unidirectional. That is, while positive affect increases the likelihood of initiation of substance use, the negative affective states produced by withdrawal are the most commonly reported factors for continued use. [1]

Key to this concept is the Hedonic Hypothesis, which states that individuals initiate use of the substance or behaviour for their pleasurable effects, but then take it compulsively to avoid withdrawal symptoms, resulting in dependence. [16] Based on this hypothesis, some researchers believe that individuals engaging in risky use of substances or behaviours may be over-responding to negative stimuli, which leads to addiction.

Negative affect has also been a powerful predictor in terms of vulnerability to addiction in adolescents. High-risk adolescents have been found to be highly reactive to negative stimuli, which increases their motivation to engage in substance use following a negative emotion-arousing situation. [17] Moreover, it has been established that adolescents high in negative affect are at increased risk for moving from recreational use to problematic use despite a family history of addiction. [17]

Furthermore, the trait negative urgency, the propensity to engage in risky behaviour in response to distress, is highly predictive of certain aspects of substance abuse in adolescents. [18] Early individual differences in emotional differences in reactivity and regulation underlie the later emergence of the trait 'negative urgency'. [19]

Positive affect

Unlike negative affect, positive affect is related to addiction in both high and low forms. For example, individuals high in positive affect are more likely to engage in risky behaviour, such as drug use. Individuals with high positive affect in response to use are more likely to seek out substances for hedonic reasons. Conversely, low positive affect may prompt initial use due to lack of responsiveness to natural rewards. [1]

Extensive personality research has been done that links positive emotional states to individual differences in risky behaviour. [1] The trait 'positive urgency', defined as the tendency to engage in risky behaviour under conditions of extreme positive affect, is predictive of substance or behavioural problems that lead to addiction. [20] This trait represents an underlying dysregulation in response to extreme affective states and has a direct impact on behaviour. The trait 'positive urgency' has been shown to have a predictive relationship with increases in drinking quantity and alcohol-related problems in college, as well as drug use in college. [18] [21] Furthermore, this trait provides important information on how positive affect can increase the likelihood of engaging in substance abuse.

Another important factor to consider is the individual differences in the experience of pleasurable effects brought on by the substance or behaviour. It is reasoned that certain individuals may be more sensitive to the pleasurable effects and thus experience them with greater intensity, resulting in addiction. [1] For example, over-responsiveness to substance affects has been found in cocaine addicts – an increased response to methylphenidate in the brain regions associated with emotional reactivity and mood. [22] [23] [24] Thus, strong emotional responses that addicted individuals show in response to substances or behaviours might be results of enhanced sensitivity to their effects.

Individuals differ in the way by which they metabolize substances, such as alcohol; these positive reinforcing effects are partly predetermined. [1] Individual reactivity to the effects of substances may affect motivation to use. For example, if a person experiences strong positive (and weak negative) effects from a substance, due to their biochemical profile, their expectations of the positive effects from the substance will be heightened, therefore increasing their desire for continued use, resulting in dependence. [1] According to this model, the experience of the positive mood enhances implicit attention to substance cues and implicit associations between reward and substance use. [25]

Many addicts report symptoms of anhedonia (i.e., the inability to experience pleasure). [26] Results of chronic deviation of the brain's reward set point, which follow a prolonged intoxication, diminish responsiveness to natural positive stimuli. This may result in an over-responsiveness to substance-related cues, coupled with an impaired capacity to initiate behaviours in response to natural rewards. [27] Thus, low positive affect inhibits the individual's ability to replace drug-taking with other rewarding activities. It has also been proposed that during substance dependence the somatic states that guide decision-making are weakened in relation to natural rewards, while at the same time they enhance the emotional response to drug-related stimuli. [28]

Compulsive behaviours characterized by addiction are underpinned by two interacting systems:

  1. impulsivity; responsible for the rapid signalling of the affective importance of a stimuli
  2. reflection; cognitively evaluates the signal before altering the behavioural response.

Dysfunction in impulsivity exaggerates the emotional impact of the drug-related stimuli and attenuates the impact of natural reinforcement. [1] Dysregulation in reflection results in the inability to override impulsivity, thus resulting in addiction. [1] Under-responsiveness to naturally occurring positive stimuli is a crucial element that biases the individual towards the use of substances or behaviours and away from non-drug alternatives.

Effortful control

Temperamental effortful control is defined as the ability to suppress a dominant response in order to perform a subdominant response. [29] In other words, it is the degree of control the individual has over impulses and emotions, which includes the ability to focus or shift attention. Temperamental effortful control can influence addiction in a number of ways.

Low levels of effortful control can render the individual less able to distract themselves from unpleasant feelings or overcome strong affective impulses, resulting in maladaptive responses to distress – such as continued substance use. [1] Low effortful control may also interact with negative and positive affect, predisposing individuals to substance or behavioural use, and impair their ability to control use. [1]

A general inability to control affective states may impair the conditioning of behaviour associated with rewards and punishment, may increase susceptibility to biasing by substance-related cues, and could tax self-regulatory capacity. [1] Such conditions may render individuals unable to interrupt automatic drug-seeking behaviours. Abnormal levels of positive and negative affect can be increased by low effortful control. [30] [31] For example, high positive affect may interact with low effortful control in increasing risk of addiction amongst vulnerable populations.

Gray's reinforcement sensitivity theory

Gray's reinforcement sensitivity theory (RST) consists of two motivational systems: the behaviour inhibition system (BIS) and the behaviour activation system (BAS). [32] [33] The BIS is responsible for organizing behaviour in response to adverse stimuli. In other words, stimuli associated with punishment or the omission/termination of reward, are believed to underlie anxiety. The purpose of the BIS is to initiate behaviour inhibition, or interrupt ongoing behaviour, while the BAS is sensitive to stimuli that signal reward and/or relief from punishment (impulsivity). [32] [33] In accordance with the RST, an association was found between people with extreme scores in BIS/BAS and adjustment problems. BIS and BAS reactivity correspond with individual trait differences in positive affect and negative affect – The BAS is associated with trait impulsivity and positive affect, while the BIS is associated with trait negative affect. [34] [35] For instance, it has been postulated that high BIS is related to anxiety, while high BAS is related to conduct disorders or impulsivity. [33] [36]

According to this model, substance abuse problems may arise under two different personality traits: low BIS and high BAS. Since the BAS promotes the individual to pursue actions that may result in reward, BAS sensitivity is involved in the initiation of addiction. Significant associations have been found between high BAS such as alcohol misuse in school girls, hazardous drinking in men, illicit drug abuse, and tobacco use. BAS sensitivity is a significant predictor of reactivity to substance cues, or cravings. [5] [37] [38] [39] [40] [41] Conversely, BIS sensitivity is involved in avoiding negative situations or affect (such as withdrawal). Low BIS has been positively associated with continuing the addiction to relieve feelings of withdrawal, or for continued use to alleviate negative affect.

Model of impulsivity

The model of impulsivity states that individuals high in impulsivity are at greater risk of addictive behaviours. The model proposes a two dimensional trait characteristic for the initiation and continuation of substance/behavioural abuse:

Both high RD and RI individuals are found to have difficulty in making decisions that have future consequences. Individuals high in RD experience greater reinforcement when initially engaging in the addictive behaviour, and experience stronger conditioned associations with continued use. Individuals high in RI experience greater difficulty resisting cravings even in the face of negative consequences. [6] Some moderators of RD and RI on the severity of addiction are stress and negative affect (such as feeling depressed). [42] That is, individuals high in RD/RI who also experience high levels of negative affect or stress, present more severe addictive behaviours. For example, if an individual is experiencing emotional distress, the distress experienced may lessen impulse control if they believe that engaging in addictive behaviour will decrease negative affect. According to this model, adolescents who are high in RI are at greater risk for developing addictions. Low RI has been shown to moderate some of the risk of addiction due to family history. [43] [44] [45] [46] High RI for individual without a family history of addiction has been related to poor decision-making.

Five factor model

The five factors are:

Data analysis demonstrated that higher scores for N and O, and lower scores for C and A, lead to increased risk of drug use. [47] [48] Users of different drugs have different five factor personality profiles. [49] For example, Users of amphetamines, benzodiazepines, cannabis, cocaine, crack, heroin, legal highs, and nicotine belong to the type N, C (Insecures) and do not belong to the type E, C (Impulsives, Hedonists). On the contrary, users of ecstasy and LSD belong to the type E, C and do not belong to the type N, C. Detailed comparison of ecstasy and heroin users demonstrates that they are significantly different. [48] Heroin users have higher N, and lower E and A. Very low A score is typical for Volatile substance abuse.

Related Research Articles

<span class="mw-page-title-main">Substance abuse</span> Harmful use of drugs

Substance abuse, also known as drug abuse, is the use of a drug in amounts or by methods that are harmful to the individual or others. It is a form of substance-related disorder. Differing definitions of drug abuse are used in public health, medical, and criminal justice contexts. In some cases, criminal or anti-social behavior occurs when the person is under the influence of a drug, and long-term personality changes in individuals may also occur. In addition to possible physical, social, and psychological harm, the use of some drugs may also lead to criminal penalties, although these vary widely depending on the local jurisdiction.

Antisocial personality disorder is a personality disorder characterized by a limited capacity for empathy and a long-term pattern of disregard or violation of the rights of others. Other notable symptoms include impulsivity and reckless behavior, a lack of remorse after hurting others, deceitfulness, irresponsibility, and aggressive behavior.

<span class="mw-page-title-main">Substance-related disorder</span> Medical condition

Substance-related disorders, also known as substance use disorders, can lead to large societal problems. It is found to be greatest in individuals ages 18–25, with a higher likelihood occurring in men compared to women, and urban residents compared to rural residents. On average, general medical facilities hold 22% of patients with substance-related disorders, possibly leading to psychiatric disorders later on. Over 50% of individuals with substance-related disorders will often have a "dual diagnosis," where they are diagnosed with the substance use, as well as a psychiatric diagnosis, the most common being major depression, personality disorder, anxiety disorders, and dysthymia.

Substance dependence, also known as drug dependence, is a biopsychological situation whereby an individual's functionality is dependent on the necessitated re-consumption of a psychoactive substance because of an adaptive state that has developed within the individual from psychoactive substance consumption that results in the experience of withdrawal and that necessitates the re-consumption of the drug. A drug addiction, a distinct concept from substance dependence, is defined as compulsive, out-of-control drug use, despite negative consequences. An addictive drug is a drug which is both rewarding and reinforcing. ΔFosB, a gene transcription factor, is now known to be a critical component and common factor in the development of virtually all forms of behavioral and drug addictions, but not dependence.

Disinhibition, also referred to as behavioral disinhibition, is medically recognized as an orientation towards immediate gratification, leading to impulsive behaviour driven by current thoughts, feelings, and external stimuli, without regard for past learning or consideration for future consequences. It is one of five pathological personality trait domains in certain psychiatric disorders. In psychology, it is defined as a lack of restraint manifested in disregard of social conventions, impulsivity, and poor risk assessment. Hypersexuality, hyperphagia, and aggressive outbursts are indicative of disinhibited instinctual drives.

Irritability is the excitatory ability that living organisms have to respond to changes in their environment. The term is used for both the physiological reaction to stimuli and for the pathological, abnormal or excessive sensitivity to stimuli.

Emotion dysregulation is a range of emotional responses that do not lie within a desirable scope of emotive response, considering the stimuli.

Attentional bias refers to how a person's perception is affected by selective factors in their attention. Attentional biases may explain an individual's failure to consider alternative possibilities when occupied with an existing train of thought. For example, cigarette smokers have been shown to possess an attentional bias for smoking-related cues around them, due to their brain's altered reward sensitivity. Attentional bias has also been associated with clinically relevant symptoms such as anxiety and depression.

Cue reactivity is a type of learned response which is observed in individuals with an addiction and involves significant physiological and psychological reactions to presentations of drug-related stimuli. The central tenet of cue reactivity is that cues previously predicting receipt of drug reward under certain conditions can evoke stimulus associated responses such as urges to use drugs. In other words, learned cues can signal drug reward, in that cues previously associated with drug use can elicit cue-reactivity such as arousal, anticipation, and changes in behavioral motivation. Responses to a drug cue can be physiological, behavioral, or symbolic expressive. The clinical utility of cue reactivity is based on the conceptualization that drug cues elicit craving which is a critical factor in the maintenance and relapse to drug use. Additionally, cue reactivity allows for the development of testable hypotheses grounded in established theories of human behavior. Therefore, researchers have leveraged the cue reactivity paradigm to study addiction, antecedents of relapse, craving, translate pre-clinical findings to clinical samples, and contribute to the development of new treatment methods. Testing cue reactivity in human samples involves exposing individuals with a substance use disorder to drug-related cues and drug neutral cues, and then measuring their reactions by assessing changes in self-reported drug craving and physiological responses.

An addictive behavior is a behavior, or a stimulus related to a behavior, that is both rewarding and reinforcing, and is associated with the development of an addiction. There are two main forms of addiction: substance use disorders and behavioral addiction. The parallels and distinctions between behavioral addictions and other compulsive behavior disorders like bulimia nervosa and obsessive-compulsive disorder (OCD) are still being researched by behavioral scientists.

In the study of psychology, neuroticism has been considered a fundamental personality trait. In the Big Five approach to personality trait theory, individuals with high scores for neuroticism are more likely than average to be moody and to experience such feelings as anxiety, worry, fear, anger, frustration, envy, jealousy, pessimism, guilt, depressed mood, and loneliness. Such people are thought to respond worse to stressors and are more likely to interpret ordinary situations, such as minor frustrations, as appearing hopelessly difficult. The responses can include maladaptive behaviors, such as dissociation, procrastination, substance use, etc., which aids in relieving the negative emotions and generating positive ones.

<span class="mw-page-title-main">Impulsivity</span> Tendency to act on a whim without considering consequences

In psychology, impulsivity is a tendency to act on a whim, displaying behavior characterized by little or no forethought, reflection, or consideration of the consequences. Impulsive actions are typically "poorly conceived, prematurely expressed, unduly risky, or inappropriate to the situation that often result in undesirable consequences," which imperil long-term goals and strategies for success. Impulsivity can be classified as a multifactorial construct. A functional variety of impulsivity has also been suggested, which involves action without much forethought in appropriate situations that can and does result in desirable consequences. "When such actions have positive outcomes, they tend not to be seen as signs of impulsivity, but as indicators of boldness, quickness, spontaneity, courageousness, or unconventionality." Thus, the construct of impulsivity includes at least two independent components: first, acting without an appropriate amount of deliberation, which may or may not be functional; and second, choosing short-term gains over long-term ones.

<span class="mw-page-title-main">Extraversion and introversion</span> Personality trait

The traits of extraversion and introversion are a central dimension in some human personality theories. The terms introversion and extraversion were introduced into psychology by Carl Jung, although both the popular understanding and current psychological usage vary. Extraversion tends to be manifested in outgoing, talkative, energetic behavior, whereas introversion is manifested in more reflective and reserved behavior. Jung defined introversion as an "attitude-type characterised by orientation in life through subjective psychic contents", and extraversion as "an attitude-type characterised by concentration of interest on the external object".

<span class="mw-page-title-main">Substance use disorder</span> Continual use of drugs (including alcohol) despite detrimental consequences

Substance use disorder (SUD) is the persistent use of drugs despite substantial harm and adverse consequences as a result of their use. The National Institute of Mental Health (NIMH) states that “Substance use disorder (SUD) is a treatable mental disorder that affects a person's brain and behavior, leading to their inability to control their use of substances like legal or illegal drugs, alcohol, or medications. Symptoms can be moderate to severe, with addiction being the most severe form of SUD”. Substance use disorders (SUD) are considered to be a serious mental illness that fluctuates with the age that symptoms first start appearing in an individual, the time during which it exists and the type of substance that is used. It is not uncommon for those who have SUD to also have other mental health disorders. Substance use disorders are characterized by an array of mental/emotional, physical, and behavioral problems such as chronic guilt; an inability to reduce or stop consuming the substance(s) despite repeated attempts; operating vehicles while intoxicated; and physiological withdrawal symptoms. Drug classes that are commonly involved in SUD include: alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, sedatives, hypnotics or anxiolytics, stimulants, tobacco

An addictive personality refers to a hypothesized set of personality traits that make an individual predisposed to developing addictions. This hypothesis states that there may be common personality traits observable in people suffering from addiction; however, the lack of a universally agreed upon definition has marked the research surrounding addictive personality. Addiction is a fairly broad term; it is most often associated with substance use disorders, but it can also be extended to cover a number of other compulsive behaviors, including sex, internet, television, gambling, food, and shopping. Within these categories of addiction a common diagnostic scale involves tolerance, withdrawal, and cravings. This is a fairly contentious topic, with many experts suggesting the term be retired due to a lack of cumulative evidence supporting the existence of addictive personality. It has been claimed that characteristics of personality attributed to addictive personality do not predict addiction, but rather can be the result of addiction. However, different personality traits have been linked to various types of addictive behaviors, suggesting that individual addictions may be associated with different personality profiles. The strongest consensus is that genetic factors play the largest role in determining a predisposition for addictive behaviors. Even then, however, genes play different roles in different types of addictions. Forty to seventy percent of the population variance in the expression of addictions can be explained by genetic factors.

<span class="mw-page-title-main">Addiction</span> Disorder resulting in compulsive behaviours

Addiction is a neuropsychological disorder characterized by a persistent and intense urge to use a drug or engage in a behaviour that produces natural reward, despite substantial harm and other negative consequences. Repetitive drug use often alters brain function in ways that perpetuate craving, and weakens self-control. This phenomenon – drugs reshaping brain function – has led to an understanding of addiction as a brain disorder with a complex variety of psychosocial as well as neurobiological factors that are implicated in addiction's development. Classic signs of addiction include compulsive engagement in rewarding stimuli, preoccupation with substances or behavior, and continued use despite negative consequences. Habits and patterns associated with addiction are typically characterized by immediate gratification, coupled with delayed deleterious effects.

The biopsychological theory of personality is a model of the general biological processes relevant for human psychology, behavior, and personality. The model, proposed by research psychologist Jeffrey Alan Gray in 1970, is well-supported by subsequent research and has general acceptance among professionals.

Reinforcement sensitivity theory (RST) proposes three brain-behavioral systems that underlie individual differences in sensitivity to reward, punishment, and motivation. While not originally defined as a theory of personality, the RST has been used to study and predict anxiety, impulsivity, and extraversion. The theory evolved from Gray's biopsychological theory of personality to incorporate findings from a number of areas in psychology and neuroscience, culminating in a major revision in 2000. The revised theory distinguishes between fear and anxiety and proposes functionally related subsystems. Measures of RST have not been widely adapted to reflect the revised theory due to disagreement over related versus independent subsystems. Despite this controversy, RST informed the study of anxiety disorders in clinical settings and continues to be used today to study and predict work performance. RST, built upon Gray's behavioral inhibition system (BIS) and behavioral activation system (BAS) understanding, also may help to suggest predispositions to and predict alcohol and drug abuse. RST, a continuously evolving paradigm, is the subject of multiple areas of contemporary psychological enquiry.

Addiction vulnerability is an individual's risk of developing an addiction during their lifetime. There are a range of genetic and environmental risk factors for developing an addiction that vary across the population. Genetic and environmental risk factors each account for roughly half of an individual's risk for developing an addiction; the contribution from epigenetic risk factors to the total risk is unknown. Even in individuals with a relatively low genetic risk, exposure to sufficiently high doses of an addictive drug for a long period of time can result in an addiction. In other words, anyone can become an individual with a substance use disorder under particular circumstances. Research is working toward establishing a comprehensive picture of the neurobiology of addiction vulnerability, including all factors at work in propensity for addiction.

Functional impulsivity is a tendency to make quick decisions when it is optimal and beneficial. This impulsivity is in contrast with dysfunctional impulsivity, which is a tendency to make quick decisions when it is not optimal. Although both types can be associated with inaccurate results, functional impulsivity is often considered a point of pride because it can help individuals take full advantage of opportunities.

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