In the IDA course "Dynamics of Individual Differences", students write a blog post on a topic of their interest that is related to an aspect that differs between individuals and changes across the lifespan. Enjoy reading the blog post of Sophie!
Defining Substance Use Disorder
Currently, 2.2% of the world’s population is affected by substance use disorder (SUD), which is an enormous number of people (Castaldelli-Maia & Bhugra, 2022). Let’s first talk about what these millions of people are experiencing and what factors contribute to the diagnosis of SUD. For this, we will first turn to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-V), which is a manual that is widely used by psychologists when diagnosing and treating mental disorders, among which SUD (Hasin et al., 2013). The DSM-V defines SUD as a mental disorder that is characterized by the continuous use of one or more substances (e.g., alcohol, tobacco, drugs) despite the negative consequences that may follow from it (American Psychiatric Association, 2013). The DSM-V describes 11 specific diagnostic criteria that are categorized into social problems, impaired control, physical dependence, and risky use of the substance(s) (American Psychiatric Association, 2013).
Can We Blame Personality?
Now that you have a basic idea of the definition of SUD, attention should be devoted to the risk factors for the development of SUD. Many factors contribute to the heightened risk of developing SUD at some point in life and many of them can be linked to personality. Therefore, the focus will be on the risk factors that are associated with personality. The general theme of personality traits associated with risk factors for the development of SUD appears to be centered around facets of neuroticism and conscientiousness. Neuroticism refers to emotional instability (McCrae & Costa 1987) and a facet of neuroticism that has been shown to be a potential precursor for the development of SUD is negative emotionality (McGue et al., 1999; Swendsen et al., 2002). Negative emotionality is a personality trait that is characterized by an excessive amount of negative feelings (Swendsen et al., 2002). It has been suggested that individuals with high negative emotionality are less well able to cope with these huge amounts of negative feelings, leading them to turn to the use of substances (James & Taylor, 2007). Related to negative emotionality is the personality trait constraint. Constraint refers to the amount of control an individual can exert over their behaviors (Belcher et al., 2014) and therefore closely resembles conscientiousness, which refers to self-control and impulse control (McCrae & Costa, 1987; Swendsen et al., 2002). Research has shown that constraint is typically low in people with SUD and is related to negative emotionality in the sense that the individual is unable to control their negative emotions and unable to refrain from acting upon them (Belcher et al., 2014). Again, this may lower the boundaries of turning to the use of substances. Constraint is the inverse of impulsivity, so to say that an individual has low constraint is to say that that individual is highly impulsive (Belcher et al., 2014). Impulsivity, or low constraint, is one of the many symptoms of attention-deficit/hyperactivity disorder (ADHD; Wender et al., 2001), which is positively associated with the development of SUD at one point in life (Wilens et al., 2011). This, therefore, demonstrates the link between low conscientiousness and the development of SUD.
These personality factors are present throughout different stages in life but are expressed differently depending on the life stage. Already in early childhood, seeds for developing SUD might be planted and this is highly related to parental behaviors. Research has demonstrated a strong positive relation between adverse childhood experiences and the development of SUD in later life (Choi et al., 2017; LeTendre & Reed, 2017; Kim et al., 2021). These adverse childhood experiences include physical, emotional, and sexual abuse, as well as parental neglect (Brodsky & Stanley, 2008; LeTendre & Reed, 2017). The exhibition of these abusive and neglectful behaviors toward the child are often preceded by parental substance use, pointing to a domino effect (McCrory & Mayes, 2015). Adverse childhood experiences have been shown to heighten the risk of developing SUD in later life, as they may predispose the individual to negative emotionality (Deighton et al., 2018).
Later in life, during adolescence, the relation between negative emotionality and impulsivity as described earlier is clearly present in the risk factor typical for this life stage. Strong negative emotions can impair an individual’s ability to think clearly and rationally and this may lower the individual’s constraint, leading to impulsive behaviors such as substance use (Smith & Cyders, 2016). Early initiation of substance use, as early as early adolescence, is an important risk factor for the development of SUD (Behrendt et al., 2009). Additionally, research has shown that an impulsive individual is more likely to have many substance-using friends and is more susceptible to peer pressure, which encourages the highly impulsive individual to start using substances too (Farley & Kim-Spoon, 2015).
A last important risk factor for the development of SUD related to personality that will be discussed here is the experience of stress (Verplaetse et al., 2018). Stressful events can occur at any time during the lifespan, but studies have shown that it generally peaks in young adulthood (Hatch & Dohrenwend, 2007). Not only does stress increase the risk of developing SUD, but it also increases the maintenance of SUD once it has been developed (Verplaetse et al., 2018). Again, this can be linked to personality. Individuals scoring high on neuroticism and low on conscientiousness are extremely responsive to stress (Brouwer et al., 2015) and therefore, they are more vulnerable to developing SUD.
Sometimes We Blame Personality, Sometimes We Thank Personality
Unfortunately and sadly, a lot of people have been faced with adverse childhood experiences, peer pressure and substance use in adolescence, and stressful life events. Fortunately, however, not all of these individuals develop SUD. But how is that possible? What causes some people to develop SUD in the face of all these risk factors whereas other people do not? Despite the many associations between risk factors and personality traits as identified earlier, personality can also function as a buffer against these adverse circumstances and as a protective factor against the development of SUD. An important example of such a personality factor is resilience, which is defined as the ability to adapt to adverse and/or stressful life experiences and events (Wu et al., 2013). Resilience constitutes several personality factors, among which low neuroticism and high conscientiousness (Oshio et al., 2018). It seems logical that protective personality factors are the opposite of personality traits in relation to risk factors, but the question is how it is possible that some individuals develop the “good” combination of neuroticism and conscientiousness despite the priorly established links between adverse childhood experiences and personality development. In other words, how is it possible that some individuals manage to develop resilience, whereas others develop vulnerability to the onset of SUD?
Research has shown that although it is more likely for an individual to become more prone to developing SUD in later life in the face of adverse childhood experiences (Dubowitz et al., 2016), it is possible for the individual to become more resilient when he or she has an adult to rely and depend on (Sciaraffa et al., 2018). Most often, this adult is the child’s teacher, who is present in the child’s life from a very early age. By being responsive to the child’s needs and offering the child a safe environment, the teacher can be of great help in teaching the child resilience (Sciaraffa et al., 2018). With the increase in conscientiousness and the decrease in neuroticism that follow from an increase in resilience, the individual will automatically be less vulnerable to peer pressure and the use of substances in adolescence and stressful life events later in life.
Why Do We Care?
It is important to devote attention to the consequences of SUD as well. Apart from SUD adversely impacting the lives of individuals with the disorder and their families, SUD can also have negative societal consequences. There is a well-established positive bidirectional association between SUD and criminality (Saladino et al., 2021). Research has shown that substance use disorder is much more prevalent in prison populations than in the general population (Fazel et al., 2017). Criminal acts might be committed with the goal of getting access to substances (Mulvey et al., 2010; Saladino et al., 2021) or because inhibitions against partaking in criminality are lowered (Mulvey et al., 2010).
Because of the adverse individual and societal consequences of SUD, individuals suffering from SUD must receive the help they need. Currently, most treatments for SUD include pharmacotherapy to aid the detoxification process and decrease cravings after treatment (Douaihy et al., 2013). Additionally, most treatments make use of cognitive behavioral therapy (McHugh et al., 2010), which is a form of therapy in which it is assumed that the way we think influences how we act and that we can therefore change our behavior by changing our cognitions (Leichsenring et al., 2006). Although these methods have been shown to be effective (Douaihy et al., 2013; McHugh et al., 2010), it might be important that the treatment of SUD targets change in the traits that constitute resilience as well, with regard to the priorly identified importance of resilience in relation to SUD. Research has shown that personality traits are malleable, especially in younger people, and can be changed with the help of personality interventions if desired by the individual (Stieger et al., 2021). Since resilience consists of high conscientiousness and low neuroticism, among others, it can be argued that by targeting these personality traits during interventions, resilience can be increased. By increasing resilience during the treatment of SUD, individuals will be offered the tools to adapt to stressful events and cope with the cravings for the substance after the treatment; they will learn to adopt an active coping style (Wu et al., 2013). Apart from new steps that need to be taken when SUD has already developed, recommendations can also be made for preventing SUD from developing. As noted earlier, the presence of responsive and dependable adults in the lives of children who are facing or have been faced with adverse childhood experiences is very important (Sciaraffa et al., 2018). Usually, these adults are the teachers of the children. Therefore, a suggestion for the future might be to implement training programs for teachers to help them recognize symptoms of child maltreatment and neglect and teach them how to respond in case symptoms are recognized. However, further research is needed on this.
Many millions of people all around the world suffer from SUD, making it a serious worldwide problem. Several factors that could potentially influence the development of SUD were discussed that were related to the personality traits neuroticism and conscientiousness; low conscientiousness and high neuroticism could serve as risk factors, whereas high conscientiousness and low neuroticism could buffer the effects of adverse circumstances and protect an individual against developing SUD. It is important to emphasize that these are definitely not the only factors affecting the development of SUD, but discussing personality-related risk and protective factors is an interesting twist on the already existing body of literature on risk and protective factors for SUD.
As discussed, there are many links to be found between personality and SUD. Among these links are adverse childhood experiences that can contribute to the development of low conscientiousness and high neuroticism. This specific combination of personality traits can leave an individual more susceptible to peer pressure and substance use in adolescence and it leads to the individual not being well able to deal with stressors during the lifespan. Another important connection that was identified between personality and SUD was resilience. Resilience has been shown to have a buffering effect on the adverse circumstances in a person’s life and it may protect individuals from developing SUD.
Aside from the associations of SUD with personality, there is a strong association between SUD and criminality, making SUD a societal problem that demands attention. Based on what was discussed, it was recommended to incorporate personality interventions into the treatment of SUD and to train teachers at schools to recognize symptoms of child maltreatment and neglect and to offer the child a safe space. However, research is needed to assess the possibilities and effectiveness of these suggestions.
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