Treatment for substance use disorders is most successful when it takes into account unique characteristics of the individual, and personality testing can be an effective aid in developing the most appropriate care plan.
Personalities are unique and extremely complex. Personality variables influence the likelihood of developing a substance use disorder, the severity of addiction and the risk for relapse. Addiction professionals largely agree that personality traits of addicted individuals are important in understanding their disease and determining treatment. Unfortunately, some physicians and therapists assume an individual’s personality is static, that nature and nurture have set the personality in stone and the course is understanding it. However, research data indicates a person’s personality traits can change, and professional experience bears that out. Personality traits change significantly with help from therapists and participation in 12-step programs.
Research shows certain personality traits increase an individual’s susceptibility to addiction and others decrease it. A person is more likely to develop an addiction if he or she has high levels of novelty-seeking, impulsivity, neuroticism and harm avoidance (the need to escape from distressing stimuli). Additionally, addicts often exhibit lower levels of positive personality traits, such as conscientiousness and persistence. C. Robert Cloninger, M.D., conducted some of the most significant research in this field. Since the 1970s, Cloninger has researched the effect of personality on individuals and confirmed personality traits affect behavior.
A landmark study published in 2014 examined how genetics and personality traits combine to lead an individual down the substance abuse path. The authors from the National Institutes of Health and the Virginia Commonwealth University School of Medicine concluded that as physicians explore the genetics of substance use disorders, the genetics are so complex that the best way to understand the subtypes of various addictions is through personality traits. That research, which confirmed clinicians’ experience using personality traits to best tailor the treatment provided to people with substance use disorders, concerned endophenotypes – indirect ways to measure genetic contributions to a trait or behavior. The authors identified three endophenotypes that indicate variable risk for addiction. The highest risk personality traits concern negative emotionality, low positive emotionality and low conscientiousness. Researchers noted likely genetic links to personality traits causing individuals to be susceptible to or resilient from substance use disorders. One example involves positive emotionality/extroversion (PEM/E), which is a condition of high motivation, positive affect and feelings of excitement and optimism. PEM/E differences may occur in the central dopaminergic system, and high levels of PEM/E are protective against addiction, researchers found.
Researchers also studied the effects of negative emotionality/neuroticism (NEM/N). People who score high on this trait are angry, anxious and depressed, and have poor responses to stress. Addicts often have high levels of NEM/N. People who are highly disinhibited and unconstrained also are more likely to experience substance abuse problems.
Does this mean some people exhibit an “addictive personality?” The link between personality traits and substance use disorder is not that sharply defined. There is no single personality type that leads to addiction; rather, a number of personality traits that vary in significance from person to person influence one’s susceptibility to addiction and experience once addicted.
Addiction actually can cause some personality deficits, such as impulsivity and poor coping skills, rather than the other way around. This leads to a “chicken or egg” debate with some patients when it is not clear which came first, the personality disorder or the addiction. Many patients with negative personality traits may exhibit some germ of that trait before sliding into substance abuse. Chronic substance abuse also creates neurological damage that affects personality traits. Because deficits in the neurochemistry and reward circuitry that involve social attachment affect personality traits, some researchers believe this influences how patients in recovery create strong, supportive social bonds.
As research further defined the link between personality traits and substance use disorders, the Institute of Medicine released a report titled “Improving the Quality of Health Care for Mental and Substance-Use Conditions,” which recommended that clinicians providing mental and substance abuse treatment “increase their use of valid and reliable patient questionnaires or other patient-assessment instruments that are feasible for routine use to assess the progress and outcomes of treatment systematically and reliably.” (REFERENCE 3)
Psychologists Paul Costa Jr. and Robert R. McCrae developed the Neuroticism, Extroversion and Openness (NEO) Personality Inventory, a tool that measures an individual’s personality traits in five areas – neuroticism, extraversion, openness to experience, agreeableness and conscientiousness. This tool captures endophenotypes in the 2014 study mentioned earlier.
There are other similar tools, but in all cases it is more productive to involve the patient in the process of identifying personality characteristics rather than simply instructing him or her to take a questionnaire and receive the results. Patients take the NEO test upon entering treatment. By working in groups and with the Positive Sobriety workbook, they can understand their personalities and how their strengths and weaknesses will affect recovery. Working with the patient both individually and in groups elucidates subtle variations in personality. Throughout treatment, there are opportunities for patients to gain a deeper understanding of their personality traits and integrate that knowledge into the group process.
Patients enjoy learning more about their personalities and how they interact with others, partly because the goal of a personality inventory is not to score well but to find out what works for the patient and what doesn’t. There is no right and wrong with personalities, but it can be extremely helpful to know that certain treatment approaches or communication methods work better with a particular patient and how that person is likely to perceive and react to recovery strategies. The clinician benefits from this knowledge, but it is equally important for the patient to understand his or her own personality.
Patients should repeat the personality test when they leave treatment so that they can understand whether they were able to improve any of their personality traits. Test patients again at six-month, 12-month and two-year intervals, allowing patients to compare their results over time and understand what they mean. If a patient realizes he is backsliding in conscientiousness, a therapist can remind the patient how he improved that trait in therapy and become less impulsive.
Patients show improvement in personality scores after treatment. Many patients said they felt more engaged in treatment programs because they used personality testing to understand their addiction better. Monitoring their progress in these personality traits is an effective way to help people with substance use disorders set goals for improvement and maintain the progress they make in therapy.