In the first part of this series, we discussed key personality traits that increase the risk for addiction. In Part 2, we will discuss the brain changes cause by addiction and strategies of treatment.
Addiction’s Own Impact
Addiction causes brain changes comparable to those seen in a traumatic brain injury. Addiction also has a toxic effect on personality that exaggerates negative aspects of personality that are already present, and even creates new problem traits.
The addict who is newly admitted to treatment may be very different from the person she was before addiction took hold. Even with prior personality risk factors for addiction, the addicted woman likely was more mentally healthy prior to addiction. Once addicted, she may become fixated on the next fix, and her personality may bear little resemblance to the person she was before substances loomed large in her life. She is generally more narcissistic than before, less flexible, and significantly less altruistic. Her levels of empathy are usually lower than they were in the pre-addiction stage.
Identifying her current personality weaknesses so she is aware of them will help her learn to become mindful of how she can change, and mindful that she indeed can change. Therapists assist with these trait shifts.
When patients are admitted to treatment, we first use the Millon Clinical Multiaxial Inventory (MCMI-III). The results of this test are held in confidence, and are compared with findings from the NEO-PI-R. We look for congruence between the two measures, because sometimes patients are deeply in denial when entering treatment and perceive themselves far differently from what they are. The MCMI-III helps us explore potential discrepancies with the patient.
Staff members discuss assessment results with the patient and talk about areas of possible improvement. We seek psychological buy-in from the patient, and the process is highly collaborative. We also provide patients with Positive Sobriety, a manual I wrote that explains addiction and helps patients zero in on areas to improve. The manual offers workbook activities to assist them in self-analysis.
At the 7-week point, a stage at which we often discharge patients, we reassess with the NEO. We often find that traits previously too high or too low have improved. After discharge, patients attend weekly groups where they talk about personality issues and actions they learned to improve problem areas. They also receive individual counseling, where they work further on personality and other issues. We test again at the 6-month, 12-month, and 2-year point. In each case, we help patients compare their results over time, and we provide information on the meaning of the test findings.
For example, at the 6-month point, a person may find he is slipping into lower levels of conscientiousness, which test scores reveal. He then can remember (or be reminded of) what worked in treatment to help him become more persistent and less impulsive, and can avoid walking off the plank into the perilous seas of addiction.
The most important area of personality among many addicted individuals is conscientiousness. With conscientiousness, the person goes to appointments and meetings—on time—and follows through on obligations. Conversely, if conscientiousness is low, the person is unlikely to do what is needed to recover from addiction and to stave off relapse. Most addicts relapse after treatment because of the now/later issue. They want what they want now and don’t want to delay gratification because of a bigger reward out there. They’re not thinking ahead and they’re not following through on plans.
Much of what we do in addiction treatment is to increase self-awareness, so that people are not operating on automatic pilot. This is where mindfulness and understanding problem traits help. When people are not in the reactive mode only, they can check out what’s going on inside. That skill is one of our primary areas of focus.
Identifying maladaptive personality traits and helping patients modify them are major steps toward helping patients with addiction issues. The combination of traditional and positive therapy allows patients to become true partners in their healing process. These skills significantly assist patients when they leave treatment.