Index

8.8. The generality of personality characteristics across the addictions and research evidence for the existence of a relationship between personality and addiction

8.1. Introduction

In the previous chapter it was argued that gender differences in addictive orientations build upon “normal” orientations towards certain clusters of behaviours in males and females. The discussion of the nature of these differences drew on a “sociological” perspective. Now we are going to consider the possibility of the role of personality playing a part in the “addictive orientations”.

It is known that personality is a contributing factor to a variety of health problems, such as heart disease. For instance in a study of 3,500 initially healthy men it was shown that those characterised as being Type A (competitive, hard driving, and impatient, etc.) were about twice as likely as their Type B counterparts to develop angina myocardial infarction, and sudden cardiac death (Friedman & Rosenman 1974 in Pervin 1990). This relationship was stable even when statistical adjustments were made to control for traditional coronary risk factors (Rosenman et al, 1975 in Pervin 1990). Indeed, it has been assumed for some time that certain psychiatric syndromes may be influenced by pre-morbid personality characteristics, and that these personality characteristics may interact with treatment approaches (Deary, Peter, Austin & Gibson, 1998). More specifically in relation to addiction, its comprehension, prevention and treatment may improve significantly with any knowledge of the mechanisms and determinant factors related to its acquisition, development and maintenance. One of these factors includes the study of the possible relevance and contribution of personality.

Interestingly there seems to be quite a widespread acceptance of the idea of an “addictive personality” among the general public, though in recent years the contribution of personality in the research and theoretical field of addiction hasn’t been so popular. Nathan (1988) has argued that the search for a general tendency toward addiction has historically been an exploration for an “addictive personality” and has been generally unsuccessful. This may be because of a number of reasons.

First, within the different fields of addiction, i.e. alcohol, drug and eating disorders, the results have been quite divergent with different studies finding support for a wide range of personality characteristics. For instance in the field of alcoholism, impulsivity/disinhibition, (Sher & Trull, 1994), and links with antisocial personality disorder (Hesselbrock, Hesselbrock & Workman-Daniels, 1986) have been implicated. In the field of eating disorders, even though impulsivity has been found to be related to problems in this area, other dimensions such as obsessive compulsive characteristics (Fahy, 1991) personal ineffectiveness and low self esteem (Mayhew & Edelmann, 1989) have also been found. In just mentioning a small handful of studies it can be seen that the findings are broad-ranging and do not seem to fit into an overall picture of an addictive personality.

A related problem involves the ability of personality studies to reliably predict (rather than “postdict”) addictive involvement. Nathan (1988) investigated personality characteristics which predict substance abuse, addictive behaviours and treatment outcomes and concluded that only one common factor seemed to exist, this being a correlation between antisocial behaviour in childhood or adolescence, and an excessive use of alcohol in adult life. In relation to drug use, The Royal College of Psychiatrists summed up the research in the field stating that, “The best evidence is that no single underlying trait or unique constellation of personality features can be identified as predisposing to drug misuse” The Royal College of Psychiatrists, (1987, p.43).

It has been argued that most of the addictive personality arguments rely on an outdated and unsophisticated view of personality that ignores more recent concepts in the field of personality such as locus-of-control, risk-taking and sensation-seeking (Kerr, 1996). In sum, much research, which has been summarised in many reviews, has failed to identify a unique pattern of personality traits which characterise those who will become alcoholics or other substance abusers (e.g. Nathan, 1988; Sutker & Allain, 1988).

8.2. Why still pursue the possible involvement of personality?

Even though the role of personality in relation to an “addictive personality” has been criticised, the view that personality is involved in addiction remains, and the linking of personality and addictive behaviours is still pursued and continues to be present in the literature (Nurco & Lerner, 1999; Donovan, Soldz, Kelley & Penk, 1998). Maybe this continued presence and determination is to do with the inherent common-sense expectation that personality must have some form of involvement with addictive behaviour. The major aim of this chapter is to explore again some of the research investigating which personality characteristics have been associated with which addictive behaviours, with a view to examining whether or not the concept of addictive orientation may be elaborated and clarified through the use of personality data.

The investigation of some of the current and popular views on the existence of the addictive personality will be explored in relation to current conceptions in the personality literature. For instance some theorists claim that there may be a biological basis to addictive personality (Jacobs, 1989) and hence addictive behaviour, and this is one of the areas which will be looked at. The idea that addiction covers a range of behaviours, and not simply the taking or ingesting of substances, has led to several general theories of addiction which may have contributed to the continued interest in the idea of an addictive personality underlying all addictions (e.g. Blaszczynski, Buhrich & McConaghy, 1985; Gossop & Eysenck, 1980).

A degree of consistency has been found within addictive behaviours such as alcohol, yet the search for an overall addictive personality seems not to have been successful. It is possible that looking at personality in relation to the orientations described in the previous chapters would be a worthwhile route of investigation. This is because the function of the orientation maybe serves as a middle ground bridging the divide between the exploration of personality within individual behaviours and the search for a personality constellation which is applicable to a wide range of different addictive behaviours or addictive orientations. In among the criticisms, a number of prominent researchers have proposed theoretical models that include personality factors as pivotal elements in the development of addiction (e.g. Cloninger, 1987, Tarter, Alterman & Edwards, 1985). These may aid the development of hypotheses relating personality to the factor analytic results from the previous studies.

Certain groupings of addictive behaviours seem to cluster inherently around broad personality dimensions or characteristics, e.g. the excessive behaviours of “Self Orientated Hedonism” are characteristic of the stereotypical extrovert, dominant and with a lawless streak. This being the case it is likely that it is, in part, the person’s personality which contributes to the development of particular patterns or orientation to addiction. Personality factors may also help to reveal why there are important individual differences in frequency and amount of addictive behaviour engaged in, and why some people become addicted to some substances rather than others, and some do not become addicted at all.

8.3.i. Models of personality and addiction

Given an orderly relationship between personality factors and addictive orientation, the question of the direction of causality inevitably raises the question, is it the addictive personality which leads to addiction, or is the personality of the addict a consequence of the addiction? There are two main implicit models here which will explain the existing data. First, models exist that propose that personality is a pre-existing factor which increases the likelihood of an addiction developing (e.g. Eysenck, 1997 and Khantzian, 1985). Here it is thought that personality provides the primary source of motivation for addictive use. Taken to an extreme this view proposes that there are certain personality types that are predisposed to becoming addicted to certain substances or behaviours. Conversely personality characteristics can also be seen as a consequence of addictive involvement. This position may propose that factors such as psychosocial stressors cause addiction and result in personality changes. This second use of the term implies that certain personality traits only occur in addicts or that they are present in a stronger or modified way compared to non-addicted individuals (e.g. Barnes, 1983 in Kissin & Begleiter, 1983).

There is however some research which sheds light on this problem. It has been reported that considerable data across samples of varying age, gender, ethnicity and drug of choice, suggest that personality traits, such as neuroticism, predispose to later development of substance use problems, deviant and other risky behaviours (Tarter, 1988). Moreover, in the area of alcoholism there is evidence that personality correlates of clinical alcoholism differ from prospective personality predictors of subsequent risk for alcoholism, thus leading to distinctions between pre-alcoholic and clinical alcoholic personalities (Barnes, 1983 in Kissin & Begleiter, 1983). On the other hand, Sharma (1995) examined the relationship between drug dependence and personality traits among adolescents, and concluded that addictive personality preceded addictive behaviour, and that addiction itself does not create the profile of the addictive personality.

8.3.ii. Physiological model of personality in relation to addiction

Eysenck, (1997) takes an interesting position here in that he suggests that addictive behaviour fits into a “Psychological resource model”, in which addictive behaviours are adopted and utilised because they serve a useful function for the individual. He suggests that the nature of the functions they fulfil is related to the personality profile of the addict. For instance some addicts may have abnormally decreased arousal levels and orient themselves toward activities which compensate for the lacking stimulation, this resulting in an increase of arousal which is experienced as a more comfortable or rewarding state. For some people this once resourceful activity develops into a form of addiction, and he suggests that the reason this occurs is related to excessive dopamine functioning. This explanation is used in turn, to suggest the nature of the addictive personality. In other words the behaviour gives the user certain benefits and hence the behaviour is continued even though there may be unwanted consequences.

In relation to the physiological level others have proposed that alcoholics may have a sensitivity to alcohol, which makes them more vulnerable to its reinforcing effects (Levenson, Oyama & Meek, 1987). In one study it was demonstrated that individuals who are high on measures of impulsivity (a commonly quoted correlate of alcoholism) are likely to experience pronounced alcohol effects, in that its capacity to reduce physiological responses to stress (responses to electric shock and self disclosing speech) was more pronounced in this group of high scorers (op cit.). This evidence in part supports Eysenck’s theory of the addictive behaviour having “particular” benefits to certain individuals.

It has been proposed by Eysenck (1997) that two types of arousal distinguish the Extroversion and Neurosis dimensions of his personality theory. He put forward the idea that the biological basis of Neurosis originates from the sensitivity of the limbic autonomic system, which determines our reactivity to environmental and psychological stimuli. Highly reactive individuals are typically easily startled and agitated, and might be expected to use substances for their calming effects. In contrast, he proposed that the biological basis of Extroversion is closely related to the level of arousal in the neo cortex, with highly extroverted individuals having a low level of cortical arousal. Such individuals are not as reactive to stimuli and require larger amounts of stimulation to maintain an optimal level of cortical arousal, thus resulting in their extrovert behaviour. They might be expected to use with a view to providing excitement and distraction.

8.3.iii. Self-medication model: Relating personality and addiction

Eysenck’s general approach is supportive of one popular explanation of addiction, that psychologically, or mentally, disordered people may be using substances and behaviours to self-medicate, and that the motivation to “use” or “act” involves the need to control or alter feelings states that are inaccessible or cannot be put into words (Khantzian, 1985). Kjantzian & Mack (1994) also argue that, addictive behaviour is automatic and beyond awareness and that the use of substances is often a conscious attempt to avoid distressing feelings. For example an individual with depression may drink to excess in order to mask or reduce his depressive feelings, and due to this excessive drinking alcoholism may develop as a secondary problem. The underlying premise is that substances are chosen for their specific effects.

Khantzian (1985) has argued that addicts use their addiction as a form of self-medication to combat and cope with their psychological problems. He has also argued that the drug of choice is not random but rather specific to the individual’s psychopathology. He found for instance that heroin addicts preferred the calming and dampening effects of opiates and used it to defend against psychological pain and aggression. Amphetamines were reported to support an inflated self worth and a defensive style, which involved an active confrontation with the environment. Cocaine abuse was said to assuage depression, hyperactivity, bi-polar illness and Attention deficit hyperactivity disorder. Khantzian (op cit.) also found that most of his interviewed heroin addicts had histories of life-long exposure to violence in the family. It is thought that if anxiety and depression remains unverbalised they leave the person ill-equipped to deal with feelings and predisposed to drug abuse as a way of compensation.

A review of alcohol’s effects on emotional states suggests that alcohol can reduce anxiety and depression, although it must be said that these findings do not appear to be consistent across situations and individuals (Sher, 1987). There is evidence which suggests that alcohol and drugs alleviate a variety of different factors such as social problems, insomnia, depression, etc. but it is rarely reported that specific substances are sought to alleviate specific symptoms (Muesler, Drake & Wallach, 1998). Another possibility is that personality features may render an individual vulnerable to certain psychosocial stressors, which in turn predispose the individual to become involved with certain clusters of behaviours.

8.4. Biochemical, behavioural demands

It may be expected that genetic factors may play a role, as it is known that they are major contributors to practically all known personality traits, and because the major dimensions of personality implicated in addiction in particular are known to have high heritabilities (Eaves, Eysenck & Martin, 1989). The idea that personality has a genetic dimension has a long history, with Hebb (1955) advocating physiological underpinnings of behavioural psychology and developing a theory of optimum level of stimulation. In this theory arousal is the physiological basis of any behavioural drive. It was proposed that with low levels of arousal, an increase in arousal is rewarding and pleasurable, and at much higher initial levels of arousal, a decrease is rewarding. This type of idea is still embraced by researchers, and biological differences in the arousal of individuals is often cited in their theories of personality (e.g. Eysenck, 1967 and Kagan, 1996).

Research suggests that there are, indeed, genetic factors in alcoholism (McGue, 1995) and smoking (Rowe & Linver, 1995), and there is some evidence which suggests that even eating disorders and obesity have a genetic basis (Spelt & Meyer, 1995). Behavioural genetic studies have consistently indicated that genetic factors contribute to risk of substance abuse (McGue, 1995; Pickens et al, 1991) and have thereby implicated the existence of inherited, individual level risk factors for substance use disorders. As personality characteristics are thought to constitute an important instance of an individual level risk factor that is both associated with substance abuse risk (e.g. Sher & Trull, 1994) and are thought to be substantially heritable (e.g. Tellegen 1991) this line of reasoning gives further support to the investigation of the influence of personality on addictive orientation.

There is no direct evidence that the same genes are involved in different types of addiction, but if they were found to be then it would be expected that similar underlying personality factors may appear in connection with each. As it has been proposed that there are differences in arousal for either genetic or environmental reasons, and these differences affect an individual’s disposition, it is possible that this in turn may affect the choice of addictive behaviour or clusters of behaviours for addicts and non-addicts alike. This is because if there are differences in the individual’s preferred level of stimulation, and behaviour is strongly motivated by the desire to achieve an optimal arousal state, this would influence or determine the choice of addictive outlet or outlets. For instance the use of sensation-seeking behaviour e.g., drug taking, may be related to an attempt to correct low cortical activity, and use of nurturant activities e.g., over-consumption of food, may be related to the attempt to correct high cortical activity.

8.5. Anti-social personality disorder

Alcoholism and anti-social personality disorder have been considered linked in terms of “dis-inhibitory psychopathology”. This term refers to failures in self-control, and includes problems such as hyperactivity in childhood, anti-social behaviour, psychopathy and alcoholism (Sher & Trull, 1994). Anti-social personality disorder is a personality syndrome which involves an onset very early in life of a behaviour pattern that involves high levels of impulsivity and difficulty learning from punishment, characteristics that probably contribute to the high reported incidence of excessive use of substances in those with anti-social personality disorder (Regier et al, 1990). Research has estimated that both men and women with anti-social personality disorder have a 70% or greater probability of developing an alcohol use disorder (Hesselbrock, Hesselbrock & Workman-Daniels, 1986) This syndrome has been a popular avenue of investigation, and much research has shown that anti-social personality disorder is strongly related to both alcohol and drug addiction (Regier et al, 1990).

This relationship seems to have implications for different populations, as alcohol use disorders have been found to be highly correlated with both anti-social personality disorder and drug use disorder in both clinical (e.g. Hesselbrock, Meyer & Keener, 1986) and general populations (e.g. Helzer & Pryzbeck, 1988). The results from a general population survey of over 2,500 men and women indicated that serious anti-social behaviour (both conduct disorder and anti-social personality disorder), gender and a family history of problem drinking were all significantly associated with alcoholism. With regards to gender, being male increased the probability of alcoholism (Lewis & Bucholz, 1991). Interestingly it was also indicated that anti-social behaviour was a more powerful risk factor for women than for men. However despite this close association with alcoholism, having either anti-social personality or a positive family history of problem drinking identified only 53% of male alcoholics and 41% of female alcoholics. This implies the importance of further influential factors.

Broad personality dimensions which have been found to be linked with anti-social personality disorder include; neuroticism/emotionality, impulsivity/disinhibition and extroversion/sociability. However most importantly it is impulsivity/disinhibition which seems to be the most consistently related dimension, incorporating traits such as sensation seeking, aggressiveness, impulsivity and psychoticism (Sher & Trull, 1994). Individuals with anti-social personality disorder have shown deficits in delay of gratification, frequent sensation-seeking behaviour and vulnerability to boredom (Quay, 1965).

Interestingly, these dimensions have also attracted attention in the alcohol literature and in the same way as with anti-social personality, impulsivity/disinhibition appears to be relevant to alcoholism (see later section on alcohol). Anti-social personality disorder in individuals with a primary substance use disorder has also been consistently linked with a more severe course of illness and history including an earlier age of substance use disorder onset, more severe physical dependence and more adverse physical social consequences (Alterman & Cacciola, 1991). It has also been indicated that individuals with alcoholism and anti-social personality disorder have an increased likelihood of associated anxiety, affective and schizophrenic disorders (e.g. Regier et al, 1990).

Even though this seems to be fruitful area of enquiry it could be the case that substance abuse may contribute to anti-social personality characteristics so that instead of anti-social personality disorder being a risk factor for addiction it is a consequence of it. However it is thought that childhood conduct disorder is often a precursor of later anti-social personality disorder (Muesler et al 1998), and this gives additional weight to the argument that anti-social personality may be a contributing factor for addiction. A further important point is that both anti-social personality and alcoholism are highly heterogeneous and therefore generalisations may be limited due to this. However, there is an undeniable affinity between anti-social personality disorder and the more hedonistic orientations, and the notions of recklessness and vulnerability to boredom may be useful concepts in the elucidation of the hedonistic excessive behaviours.

8.6. Possible structures of personality variables which may link with addiction

Developments in the theory of personality have led to the advancement of hierarchical models of based on either three (e.g. Eysenck, 1967) or five factors (e.g. Costa & McCrae, 1992). These models have facilitated research on personality not only by providing a theoretically coherent structure for the array of hypothesised traits but also by suggesting systematic approaches to the assessment of the major dimensions of personality. A degree of consensus has emerged over the past few years for the validity of the five factor model of personality, although there are several competing models (Goldberg, 1993).

Ball (1995) found in cocaine using men and women that patients scoring higher on impulsivity/sensation seeking, neuroticism/anxiety and aggression/hostility exhibited greater addiction severity. These traits also grouped together in cluster analyses to define two subtypes of cocaine mis-users, a less pathological type and a more severe subtype (Ball, 1995). Ball also found that cocaine misusing women scored higher than men on impulsivity/sensation seeking, neuroticism/anxiety and aggression/ hostility, this suggesting greater sociopathic traits in women.

In the present study, the Interpersonal Adjective Scales, IASR-B5 (Trapnell & Wiggins, 1990) was chosen as the method of personality measurement. The five-factor measure examines what are now commonly regarded as the five principal dimensions of personality initially developed by factor analysis. The dimensions are the recognised “Big Five” of Dominance, Agreeableness, Neuroticism, Conscientiousness and Openness to experience.

8.7. Personality in relation to addictive behaviour in non-addicts

Before moving on to look at the evidence from the clinical population, what would lend further support to the investigation of personality in relation to addiction would be evidence that suggests a relationship between the normal use of addictive behaviour and personality in non-addicts. This information would very much support the case for the direction of causality, as it would suggest that orientation towards certain types of addictive behaviour is, in part, a normal consequence of personality, which has contributed to problematic effects in the clinical group.

In support of this idea, a study by Von Knorring and Oreland (1985) found that regular smokers were more extroverted, more sensation seeking and more easily bored than non-smokers. Interestingly they were also found to be more prone to the abuse of alcohol, glue, cannabis, amphetamines and morphine. This study supports the notion of a general tendency to addictive substances that may be personality based, in that in this study there seemed to be a “general” orientation to these addictive substances. If these results are extrapolated it may be deduced that the more extroverted, sensation seeking and easily bored an individual is, the more likely it is that the person will become addicted. It may also be noted that this array of behaviours closely resembles the “Self Orientated Hedonism” factor first revealed in chapter five. It is possible on the basis of this and other studies to begin to formulate how different personality characteristics may be associated with the different addictive orientations described in chapter five.

In the next section personality variables which have been found to be associated with various forms of addiction are looked at to provide further theoretical background upon which predictions may be made linking the factorial structure with personality variables. Though results have varied, it is also thought that there may be a common personality trait, which may contribute to an individual’s vulnerability to extreme appetitive behaviours. Alcohol abuse (Cloninger, Sigvardsson, Reich & Bohman, 1988) and bulimia (Bulik, Sullivan, Weltzin & Kaye, 1995), have both been characterised by an appetitive drive, and have been strongly associated with novelty seeking traits. Extroversion has also been a factor suggested as being associated with addiction though this is thought not to be the case with exercise addiction (Mathers & Walker, 1999).

A caveat should be entered at this point. To make a secure causal link between personality and addiction requires longitudinal predictive studies, as then personality is assessed before the onset of addictive behaviour and so the likelihood of personality having a direct effect on the development of addictive behaviour is greater. However the majority of the studies which have been conducted in this field have been correlational, and so it can be argued that the found personality variables are a consequence of the addiction rather than a contributing factor in the development of addiction. I shall return to this question later.

8.8. The generality of personality characteristics across the addictions and research evidence for the existence of a relationship between personality and addiction

Alcohol

Even though there is a high level of heterogeneity among alcoholics, awareness of the co-occurrence of alcoholism and psychiatric disorder has led to sub-typing of alcoholics. Over the years there have been a number of attempts to formulate sub-types (e.g. Jellinek, 1960). Cloninger (1987) proposed two major sub-types of alcoholics, called Type I and Type II, with the latter characterised by an earlier onset of problems, a more severe course and higher levels of criminality. It is of note, however, that this differentiation seems to overlap with the occurrence of anti-social personality disorder in Type II alcoholics, and with the concept of early versus late onset alcoholism (Penick, Powell, Nickel, & Bingham, (1994). Of particular interest are the findings using general cluster analytic techniques, which have tended to provide consistent evidence for at least two clusters which can broadly be termed as a personality disorder cluster and neurotic cluster (Morey & Blashfield, 1981 in Sher & Trull, 1994).

Babor, Dolinsky, Meyer & Hesselbrock (1992), in a similar vein, found a two-cluster solution. Type A alcoholism was characterised by a later onset of alcohol-related problems, less severe symptoms of substance use disorders, the absence of childhood risk factors, such as hyperactivity, minimal brain dysfunction, or conduct problems, and a lower probability of having received prior treatment for alcoholism. The Type B group is the opposite of the Type A which includes individuals with other higher rates of other substance use disorders and higher levels of life stress.

These distinctions are interesting as in the previous studies it was found that for female addicts in particular alcohol contributed to the Self Orientated Hedonism factor (Drugs factor); for males on the other hand alcohol came closest to contributing to the Other Orientated Nurturance factor. This possibly indicates that there are two main orientations towards alcoholism, with Type II or Type B falling into the more Hedonistic category and Type I or Type A perhaps falling into the more Nurturant category. This information also contributes to the prediction of which personality characteristics may be associated with which orientation.

Many studies have shown that personality variables are related to alcohol consumption and alcoholism (e.g. Cloninger, 1987; Cooper, Frone, Russell & Mudar, 1995). As has already been noted, one which has been shown to be associated with alcohol use is impulsivity/disinhibition, which incorporates traits such as sensation seeking (Sher & Trull, 1994). Interestingly some studies have suggested that sensation seeking is positively related to alcohol consumption even in samples of non-alcoholics (Andrew & Cronin, 1997). With alcoholics however it has most frequently been associated with Type II alcoholism (early onset, high genetic loading and severe social complications such as aggressiveness, complications at work and illegal drug abuse) (Cloninger, 1987).

It is thought that one implication of the high co-morbidity between alcoholism and anti-social personality disorder is that some alcoholics are likely to be impulsive and anti-social (Regier et al., 1990). With this apparent relationship between anti-social personality disorder and alcoholism, moving towards some form of a deviance proneness model emphasising traits related to impulsivity and dis-inhibition may have considerable explanatory power, especially for alcohol’s contribution to the Self Orientated Hedonism factor.

McGue, Slutske & Iacono, (1999) state that the vast majority of research linking personality to substance use disorders has focused on alcoholism. The bulk of the research (Sher & Trull, 1994) implicates two major dimensions of personality in the etiology of alcoholism. These are “negative emotionality” or the tendency to experience negative mood states and psychological distress and “behavioural dis-inhibition”. Compared to non-alcoholic individuals, alcoholics on average score higher on negative emotionality and behavioural dis-inhibition and there is some evidence which suggests that these differences predate alcoholism onset (e.g., Caspi, Moffitt, Newman & Silva, 1996; Cloninger, Sigvardsson, Reich & Bohman, 1988)

Interestingly, when the three broad dimensions of Eysenck’s personality theory are studied in relation to alcohol use in non-alcoholics, a positive relationship is generally found between psychoticism (this including traits such as aggressiveness, coldness, impulsivity, egocentricity and tough mindedness) (Eysenck & Eysenck, 1985) and extroversion with the consumption of alcohol (Martsh & Miller, 1997). In contrast to this, neuroticism seems only positively related to alcohol consumption among alcoholics, and the finding that alcoholics score high on various measures of neuroticism is well established (Sher & Trull, 1994).

Relating again to the “anti-social” and alcoholism link, Nathan (1988) investigated personality characteristics that predict substance abuse, addictive behaviours and treatment outcomes, and concluded that only one common factor seemed to exist, this being a correlation between anti-social behaviour in childhood or adolescence and excessive use of alcohol in adult life. However, in Nathan’s (1988) study many problematic drinkers showed no anti-social behaviour in childhood, and it is clear that many anti-social children do not develop drink problems as adults. Nathan (1988) concluded stating that if personality influences alcoholism risk, it does so as one of a myriad of risk factors rather than as the effect of the solitary impact of personality characteristics, the possession of which leads inevitably to an addiction.

Drugs

It can be said that, in general, in drug dependent samples, high Neuroticism is usually found and is often accompanied by high Psychoticism scores (Eysenck and Eysenck, 1985). These findings seem to be fairly robust. A study by Francis (1996), linking addiction with personality, listed all available studies for addiction to alcohol, opium, heroin, benzodiazepines, etc. In total, 19 studies were found specifically linking Psychoticism and drug addiction and 23 studies were found linking Neuroticism and drug addiction. Indeed the association is such that in one study with a sample of cocaine-using, pregnant and post-partum women, Neuroticism was the most powerful predictor of symptom severity for this sample (Ball & Schottenfeld, 1997). Sex differences appear not to change this pattern of high Neuroticism and Psychoticism, but women seem to have less elevated Neuroticism differences (Eysenck, 1997).

In a study using the Minnesota Multiphasic Personality Inventory (MMPI), investigating the personality of male and female adolescent drug users, it was found that for females Neuroticism was more important in the prediction of the use of licit drugs and cannabis, and Psychopathic deviance and Mania more important in the prediction of the use of other illicit drugs. For males, elevated Psychopathic deviance and Mania scores were strongly associated with extent of drug use (Lavelle, Hammersley & Forsyth, 1993).

Sensation seeking is another widely studied personality correlate of drug use disorders, with the finding that indicators of this personality characteristic are associated with drug use disorder status (McGue, Slutske & Iacono 1999). Zuckerman (1980) put forward a number of interesting links between biological processes and the personality construct of sensation seeking. He proposed that sensation seeking is a global trait, and can be described as, a desire for varied, novel and elaborate stimulation and experiences and the willingness to take risks for the sake of such pursuit. Sensation seeking appears to be correlated with Eysenck’s Extroversion dimension, especially the impulsivity factor of this dimension (Farley & Farley, 1970).

With reference to impulsivity, cocaine addicts have been characterised by excitability, lability of mood and impulsivity in comparison to alcoholics, poly-drug users and heroin users, poly-drug users being characterised by acute disturbance with paranoid thinking, massive anxiety and profound withdrawal (Donovan, Soldz, Kelley & Penk 1998). The idea that impulsivity may be one of the principal personality correlates of drug abuse seems to be meaningful, as individuals who are impulsive may be characterised by a lack of behavioural constraint, a lack of caution, and possibly even failure to conform to conventional moral expectations. Drug use and abuse are strongly discouraged by conventional cultural standards and are considered risky activities because of their illicit nature.

Individuals who are low on constraint may be at increased risk of drug abuse because they are less likely to accept and be less fearful of the consequences of failing to follow cultural norms governing drug use. Interestingly in a study comparing those with a substance use disorder with those without, rates of conduct disorder, anti-social personality disorder and nicotine dependence were consistently higher among those having a substance use disorder than among those not (McGue, Slutke & Iacono, 1999). In addition to this finding among men with a drug use disorder, alcoholism was significantly associated with higher rates of multiple substance abuse or dependence (op cit.).

Gambling

Gambling has already been described as a form of risk taking or sensation seeking behaviour in chapter three. Interestingly links have been made between sensation seeking behaviour, gambling and drinking. Zuckerman’s (1994) (in Gupta & Derevensky, 1998) findings suggest that individuals who score highly on sensation seeking more frequently engage in gambling activities and are more likely to engage in high risk activities such as drinking and reckless driving. Pathological gamblers are known to be high sensation seekers, scoring significantly higher than social gamblers on the Disinhibition, Boredom Susceptibility, and Experience Seeking sub-scales of Zuckerman’s Sensation Seeking Scales (Dickerson, Hinchy & Fabre, 1987). In addition to these findings in a study of adolescents by Vitaro, Arseneault & Trembley, (1999) results suggested that a self report measure of impulsiveness significantly predicted problem gambling even after controlling for socio-demographic variables and other personality variables such as aggressiveness and anxiety.

Nicotine

Eysenck (1980) has argued that nicotine has a bi-phasic action, increasing cortical arousal in smaller doses, and decreasing tension in larger doses. With reference to addictive personality these effects are thought to be reinforcing, in extroverts raising their abnormally low level of cortical arousal, and also in the emotionally unstable who are attempting to lower their tenseness. This analysis suggests that smoking may be related to personality, in the sense that people high on extraversion or neuroticism are more likely to smoke than people low on either or both these personality traits.

Eating Disorders

It has been claimed that the same personality factors which place individuals at risk for substance abuse are often found in individuals with eating disorders (Weiner, 1998). Gossop and Eysenck (1980) and De Silva (1987) investigated the personalities of anorexics and bulimics and found that they showed personality traits, which in some ways are similar to drug addicts in that they scored high on psychoticism and neuroticism and achieved low scores on social desirability and extroversion.

People with eating disorders have been characterised as exhibiting a dysfunctional personality, in particular by a sense of personal ineffectiveness (an essentially external locus of control) and by low self esteem (Mayhew & Edelmann, 1989). It is also thought that obsessive compulsive traits are likely to be present in the personality of people with eating disorders (Fahy, 1991). Other research has suggested that bulimics’ personalities are thought to be characterised by variable moods, problems in relation to locating and articulating their feelings and low self esteem in conjunction with high aspirations (Johnson & Conners, 1987).

In relation to the previously mentioned areas Bjorvell (1985) found that obese subjects were higher than the population average on impulsiveness and other variables such as somatic anxiety and monotony avoidance. This pattern was characterised as an impulsiveness syndrome, which is also found in drug addicts. Features such as difficulty with learning from experience and a tendency to act on the spur of the moment can be observed in repeated failures to lose weight, and, as in other addictions, relapse is common.

In one study (Gendall, Sullivan, Joyce, Fear & Bulik, 1997) investigating the relationships between psychopathology and personality in “food cravers”, it was found that those who experienced food cravings also tended to have higher levels of novelty seeking behaviour. This trait is associated with excitability, impulsivity, dramatisation, overspending, and thrill seeking. It is thus possible that the extreme forms of consummatory behaviour and behavioural activation seen in alcohol abusers, those with bulimia nervosa and food cravers may have a basis in a novelty seeking temperament. In these individuals this type of underlying temperament trait might also manifest itself in other behaviours that have an appetitive quality (Op cit.).

Exercise

The relationship between eating disorders and exercise dependence has already been discussed in chapter three, but, in relation to the incorporation of personality into the discussion, it has been suggested that similarities in personality exist with both groups, these being characterised by a poorly established sense of self and the use of exercise or diet as a means of gaining a sense of mastery and control (Yates, 1987). These similarities have not been accepted by all researchers and have attracted criticism (e.g. Sachs, 1987). Interestingly it is well known that the effects of moderate exercise are thought to improve mood and improve a sense of control (McDonald & Thompson, 1992) It is thought that the prime motive for obligatory exercisers is self regulation and control of athletic performance, physical appearance or both (op cit.).

While the term exercise addiction has been largely rejected in favour of, for example, exercise dependence, the association of exercise with addiction stems from Glasser (1976) who differentiated between positive and negative addiction to running, being analogous to commitment and dependence. In relation to exercise addiction the available evidence suggests that it is extraverted individuals who are more prone to this addiction (Kagan & Squires, 1985). In a study by Kagan and Squires (op cit.) the concept of an addicted personality style was assessed. Using measures of dependence, compulsiveness, Type A personality, rigidity, need for social approval and hostility, it was found that there was evidence to suggest that in terms of personality characteristics, there are consistent findings that fit with the idea that individuals can become addicted to exercise. In relation to the connection between eating disorders and exercise addiction, evidence also seemed to suggest that compulsive exercisers are very likely to score towards the extreme end of a scale on measures such as eating control, body dissatisfaction, low self esteem and self efficacy.

Other Nurturant behaviours : Work and compulsive helping

Although workaholism has received considerable attention from the media its comprehension based on research is quite limited (Burke, 1999). Links have been made with Type A personality (coronary prone) (Robinson, 1996 and 1999) and obsessive compulsive traits (Seybold & Salomone, 1994). Spence & Robbins (1992), found higher levels of perfectionism, non-delegation of responsibility and perceived work stress in workaholics than in those identified as work enthusiasts. Workaholics were defined as those experiencing high work involvement and drive with low enjoyment of work. Work enthusiasm on the other hand was defined as high work involvement and enjoyment with low drive.

Co-dependency research is in its infancy though it has been found to be related to self-defeating personality characteristics (Wells, Glickauf-Hughes & Bruss, 1998). It was seen in the cross-addiction review chapter (chapter three) that Cermak (1986) has outlined five major characteristics of co-dependency: 1. Continual investment of self esteem in the ability to influence or control feelings and behaviour in the self. 2. The assumption of responsibility for meeting the needs of others to the exclusion of his or her own needs. 3. The suffering of anxiety in periods of intimacy or separation. 4. Emotional involvement in relationships with personality disordered, drug dependent and other compulsive people. 5. Constriction of emotions, depression, hyper-vigilance, compulsions and anxiety.

8.9. Summary and conclusions of the review

In sum it seems that there is a widespread expectation of inherent sense in the link between personality and addiction. This stems from the belief that many psychiatric syndromes may in part be linked to personality variables (Deary et al, 1998) and, perhaps more importantly, common sense assumptions which prevail. The review has outlined some of the research findings from a diverse set of behaviours which is necessary before predictions can be made relating the four factors with personality variables. However, it was seen that with many of the behaviours many different personality variables have been found to be associated with the same addictive behaviours. In the next chapter these findings are discussed with a view to providing a firm basis upon which predictions will be made about the association between addictive orientations and the Big Five personality dimensions.

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