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Personality's strong influence on addiction

June 15, 2015
by Daniel Angres, MD
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Key personality traits are not immutable, and that’s exciting news for people dependent on substances and for the experts who treat them. Research has demonstrated that people with certain personality traits, in domains such as low levels of conscientiousness and high levels of neuroticism, are more likely to become addicted. These problematic traits can be identified with personality assessments, and traits that increase the risk for addiction can be modified, with hard work.

We believe that personality variables can influence the severity of addiction and the risk for relapse as well. At the Positive Sobriety Institute (PSI) in Chicago, we analyze an individual's personality traits upon admission, and the information we discover helps us provide an individualized treatment approach.

Many addiction professionals agree that the personality traits of addicted individuals matter. But the discussion usually ends there, largely because of the assumption that there is no malleability with personality, and the belief that it just happens, whether from nature, nurture or the interaction of the two. But based on my professional experience and research, I have seen personality traits change significantly, with the psychological buy-in of the patient, active help from therapists, and participation in 12-Step programs.

At PSI, we use the NEO-Personality Inventory-Revised (NEO-PI-R) instrument. This test reveals areas of personality that research has shown are common problematic traits among addicts. For example, if we note that the patient has high levels of neuroticism, we discuss particular areas of personal functioning that he needs to modify.

There are five major factors in the NEO that can be remembered with the acronym “OCEAN.” These are openness, conscientiousness, extroversion, agreeableness and neuroticism. Each factor has six sub-factors. For example, neuroticism is made up of anxiety, angry hostility, depression, self-consciousness, impulsiveness and vulnerability. Based on self-test responses, patients are rated as low, average or high in each sub-factor. Armed with this information, we help patients create a plan to improve problematic personality traits.

Research findings

Abundant research has shown that certain personality traits increase susceptibility to addiction, while others are protective against its development. Traits such as high levels of novelty-seeking, impulsivity, neuroticism and harm avoidance (the need to escape from distressing stimuli) often constitute risk factors for addiction. In addition, addicts frequently have lower levels than non-addicts of positive traits such as conscientiousness and persistence. (Note that the names of traits vary with the assessment instrument used.)

Since the mid-1970s, C. Robert Cloninger has researched the impact of personality on individuals, and also developed the Temperament and Character Inventory (TCI). He has analyzed personality traits in many populations, including addicts, prisoners and adoptees, finding significant differences in the studied populations compared to controls. Clearly, personality traits affect behavior.

In 1988, Kenneth J. Sher and colleagues studied 489 subjects prospectively and followed up with 457 of them six years later. These researchers found that impulsive sensation-seeking or behavioral disinhibition was predictive for later substance use disorders .

In 2014, Belcher, Volkow and colleagues noted likely genetic links to personality traits causing individuals to be susceptible to or resilient from substance use disorders. For example, positive emotionality/extroversion (PEM/E) is a condition of high motivation, positive affect, and feelings of excitement and optimism. PEM/E differences may be found in the central dopaminergic system. The researchers said high levels of PEM/E are protective against addiction.

Another personality trait identified by the researchers was negative emotionality/neuroticism (NEM/N). Such individuals are angry, anxious and depressed, and have poor responses to stress. People with substance abuse problems often have high levels of NEM/N. These responses may stem from connections within the prefrontal cortex and amygdala. Another factor increasing risk for substance abuse is constraint-disinhibition, which emanates from the right lateral inferior frontal gyrus. People who are highly disinhibited and unconstrained are more likely to have substance abuse problems.

These findings might cause some to wonder if connections linked to personality could be hard-wired and resistant to change. But research has demonstrated that up to 50% of personality traits can be changed.

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.

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