Personality and Alcohol Abuse
Alcohol use disorder (AUD): an alcohol-related mental health disorder in which an individual meets at least 2 of the 11 criteria of the disorder in the past year. The disorder is divided into mild, moderate, and severe classifications dependent on the number of criteria met (mild, 2–3; moderate, 4–5; severe, 6+). Criteria include being unable to cut down or stop drinking, craving alcohol, needing to drink higher quantities to achieve desired effects, experiencing withdrawal effects, noting that drinking has interfered with one’s daily life or relationships, and noting that drinking has increased one’s risk of being hurt (American Psychiatric Association 2013a).
Personality traits: characteristic patterns of thinking and feeling that influence patterns of behavior (American Psychiatric Association 2013b).
Personality disorders: a collection of mental health disorders which are classified by persistent patterns of thinking and feeling about oneself and others which deviate from cultural norms and significantly adversely impact how an individual functions across multiple domains (American Psychiatric Association 2013b).
Personality has been widely studied for its relationship to disordered alcohol use. While there is no one “alcoholic personality,” high levels of certain personality traits, or characteristic patterns of thinking and feeling that influence behavior (American Psychiatric Association 2013b), have been shown to predispose individuals to problematic drinking behaviors and alcohol dependence. Together, problematic drinking behaviors and alcohol dependence make up alcohol use disorder (AUD) in the DSM-5 (American Psychiatric Association 2013a). Further, AUD often co-occurs with personality disorders which are mental health disorders classified by persistent patterns of thinking and feeling about oneself and others which significantly adversely affect an individual’s capacity to function across many life domains (American Psychiatric Association 2013b). In this chapter, the specific traits associated with increased risk for AUD are described, as well as the potential mechanisms for how personality traits can predispose individuals to AUD. Personality disorders that commonly co-occur with AUD are also discussed.
Personality Traits and AUD
Personality traits are measured and classified in many ways. Across the myriad categories and systems of classifications, some traits consistently demonstrate a link to risk for AUD. These include impulsivity, sensation-seeking, neuroticism, and other components of behavioral undercontrol such as low agreeableness and low conscientiousness.
Impulsivity and Sensation-Seeking
Broadly, impulsivity refers to acting or reacting with little forethought or consideration of negative consequences, and sensation-seeking is the tendency to pursue novel, intense, and exciting experiences. Although the two personality traits are related and often studied together, they have independent relationships with risk for AUD (Coskunpinar et al. 2013). High levels of impulsivity and sensation-seeking are each related to increased risk for AUD (Coskunpinar et al. 2013; Patrick and Schulenberg 2013; Quinn and Harden 2013). The expression of impulsivity and sensation-seeking tends to be higher in adolescence, when alcohol experimentation is normative, and reduces into adulthood (Quinn and Harden 2013). When impulsivity and sensation-seeking do not decrease normally into adulthood, alcohol use may increase (Quinn and Harden 2013).
High Neuroticism, Low Agreeableness, and Low Conscientiousness
Personality traits are often categorized according to the five factor model (FFM) which divides traits into five global factors: neuroticism, agreeableness, conscientiousness, extraversion, and openness. When assessing risk for AUD according to the FFM, high neuroticism, low agreeableness, and low consciousness have been associated with increased risk for AUD (Haber et al. 2011). Neuroticism refers to easily experiencing unpleasant emotions, such as anxiety, anger, and depression. Agreeableness refers to how an individual interacts with others and can range from compassionate (high agreeableness) to detached or antagonistic (low agreeableness), while conscientiousness refers to the tendency to be organized, dependable, efficient, and goal-oriented. Low agreeableness and low conscientiousness are each indicators of behavioral undercontrol, a broad personality construct consistently associated with alcohol use and related problems (Haber et al. 2011).
Mechanisms Explaining the Personality Trait: AUD Link
There are several proposed mechanisms explaining how impulsivity, sensation-seeking, neuroticism, and personality trait indicators of behavioral undercontrol can put an individual at risk for disordered alcohol use (Littlefield and Sher 2010). These mechanisms are not mutually exclusive and overlap in their explanations of the relationship between personality traits and AUD. For example, a person’s genetics and early socialization may together develop a personality profile in an individual that makes him or her vulnerable to risk-taking and a host of deviant behaviors, including problematic drinking. Also, people who possess certain personality traits may respond differently to the effects of alcohol in that some experience more positive or reinforcing effects than others. Positive effects may include mood regulation, stress-dampening, and social benefits. Consequently, those experiencing more, or more intense, positive effects may be motivated to increase their frequency and intensity of alcohol use. Further, people with certain personality traits, such as sensation-seeking, may seek out environments where heavy drinking is the norm, thus increasing their exposure to and risk for problematic drinking behaviors. Finally, as individuals develop from adolescents to adults and begin to take on more adult roles, their personalities tend to mature and become more stable. As their personalities mature, heavy alcohol use typically decreases. If a person’s personality does not mature, the experimental alcohol use normative in adolescence may develop into disordered use.
Comorbidity of Personality Disorders and Alcohol Use Disorder
Alcohol use disorder commonly co-occurs with other mental health disorders, including personality disorders. Personality disorders may predispose individuals for AUD. They also are germane in predicting how individuals will respond to AUD treatment. Personality disorders commonly demonstrating co-occurrence with AUD include antisocial and borderline personality disorder (Creswell et al. 2016; Grant et al. 2015; Mellos et al. 2010). Antisocial personality disorder, also referred to as sociopathy, is associated with a consistent disregard for others’ rights and feelings and consequently is often associated with criminal behavior (American Psychiatric Association 2013b). Conversely, borderline personality disorder is associated with the inability to effectively regulate one’s emotions and thoughts, unstable relationships, and reckless behavior (American Psychiatric Association 2013b). While antisocial and borderline personality disorders may present very different internal experiences and behaviors, they each may increase an individual’s risk for developing AUD, may be exacerbated by disordered alcohol use, and/or may complicate AUD treatment and recovery.
While there is no one “alcoholic personality,” certain personality traits and disorders are predictive of an individual’s risk for AUD. There are numerous, overlapping potential mechanisms for how personality traits can predispose individuals to AUD that take into account the interplay of individuals’ genetics, environments, personalities, motivations, and behaviors. Although personality traits are measured and classified in numerous ways, traits commonly predictive of problematic drinking behaviors include impulsivity, sensation-seeking, neuroticism, and other traits associated with behavior undercontrol, such as low agreeableness and low conscientiousness. Personality disorders commonly co-occurring with AUD include antisocial personality disorder and borderline personality disorder and may complicate AUD treatment and recovery.
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