Personality disorders, depression, and substance abuse risk prediction

Personality Type as a Predictor of Addictions

Evidence linking substance abuse, either alcohol or other substances, to an increased incidence of personality disorders. This study expands on previous studies and explores the link between happiness and depression stemming from a number of personality disorders. The hypothesis postulates that a link correlation will be found between a higher incidence of depression as a result of personality disorder and alcoholism. Those that experience happiness as a result of their personality disorder are expected to be less likely to become involved in substance abuse. The study will use MCMI to assess the presence of personality disorder and happiness or depression in the participant. It will take place at a local residential substance abuse treatment program.

Introduction

The ability to predict substance abuse is an important tool for clinicians. Substance abuse is complex and difficult to treat due to the presence of a number of risk factors. One of the key arguments among clinicians is whether substance abuse caused comorbid psychological disorders, or whether substance abuse is simply just another symptom of the psychological disorder. A number of external factors have been found to increase the likelihood of substance abuse, such as an abusive childhood or low socioeconomic status. However, internal factors are considered to be a better predictor of substance abuse than external factors. Every individual is different and will react to external factors differently.

The more we know about how an individual is likely to react to external stimulus, the better we can predict complications that might arise as a result of these factors. Craig, Verinis, & Wexler, (1985) found that alcoholics scored higher on personality scales for avoidant, passive-aggressive, schizotypal, borderline, and paranoid disorders. Opiate addicts scored higher on narcissistic personality scales. This analysis demonstrated common personality traits among both groups. These similarities might alert clinicians that a person with a certain set of personality traits might also be at risk for developing co-morbidity with alcoholism. The purpose of this study will be to help identify one more factor that might help clinicians to predict and treat substance abuse in their patients with personality disorder.

Research Problem

This study will explore the relationship between depression resulting from personality disorders and substance abuse. It will demonstrate that substance is more prevalent in those with depression than those that experience happiness as a result of their personality disorder. The research question will as, "Is there a difference in the prevalence of substance between those that suffer from depression as a result of a personality disorder and those that experience happiness as a result of their personality disorder?"

Method

The rationale for the study methodology will draw from similar studies in the past (Bowden-Jones, 2004; Craig, Verinis, & Wexler, 1985). Craig, Verinis, & Wexler, (1985) conducted a similar study that compared personality traits from a selected group of alcoholics and opiate addicts in a VA rehabilitation facility. They used the Millon Clinical Multiracial Inventory (MCMI) as the scale for assessing the presence of personality types and disorders. The MCMI was used as a basis for comparison between the two groups. This study proposes to address the same set of personality disorders that was the basis of the study conducted by Craig, Verinis, & Wexler (1985). The purpose of this study is to compare two groups in s similar fashion. However, in this study, the MCMI will be used to separate the subjects into groups according to their personality disorder.

Sample Population

The sample population for this study will consist of 100 participants that are currently undergoing treatment at a residential rehabilitation treatment facility. They will consist of those with multiple substances of abuse and those that are single substance abusers. All of the participants will have been in the program for at least one week prior to administration of the MCMI. The MCMI will be used to separate out those participants that are relatively happy and those that are on the depressive end of the spectrum.

All participants will be clinically diagnosed with an addiction problem to alcohol and/or another controlled substance. Those that are addicted to prescription medicine alone will be excluded from the study as they are suspected to represent a different underlying order. Subjects will be chosen for addiction to alcohol, meth, crack, opiates and other controlled substances, other than prescription drugs. Participants may have single or multiple substances of addiction.

In order to eliminate as many potential confounding variables as possible the subjects will be males between the ages of 25-40. They will be from a number of socioeconomic backgrounds and will not be eliminated for race or other cultural attributes. However, these attributes will be considered in the final analysis to eliminate potential sources of sample bias. Participation in this study will be voluntary and all participants will be asked to sign a consent form. Participants meeting the criteria will be randomly selected from a sample pool meeting selection criteria according to hospital administration records.

Rationale

This research method is appropriate for the proposed study for several reasons. There are a number of studies found in literature that address similarly structured topics. The procedures and techniques used in this study have been successful in topics similar to the one addressed in this study. The research is a correlational study that uses quantitative research methods in order to support the hypothesis.

Procedure

After all potential study participants are identified through a hospital records search; they will be contacted and asked if they wish to participate. They will be asked to sign up by a certain deadline if they wish to participate. After 100 subjects are identified, they will be asked to sign the consent form and attend the testing session. All participants will be administered the MCMI. Tests will be collected by the researcher and tabulated at a later time. The presence of diagnosed addictive behavior involving substance abuse will serve as the independent variable.

For this study, the dependent variable will be measured by test scores on the MCMI. Using the MCMI, the participants will be divided into groups according to their placement on the happiness scale. They will range from very depressed to happy. Test scores will be used to measure the dependent variable and to place the participants into cartegories according to their test scores and where they fall on the happiness/depression scale.

The Research Instrument

The MCMI consists of 175 self-reporting diagnostic inventory items. It consists of eight personality styles including schizoid-Asocial, avoidant, dependent-submissive, histrionic-gregarious, narcissistic, antisocial-aggressive, compulsive-conforming, and passive aggressive - negativistic (Craig, Verinis, & Wexler, 1985). The scale also assess nine transient disorders. These disorders will be important in this research, as they provide clues to addicts that might be intermittent addicts that are affected by temporary bouts of happiness or depression. The nine transient disorders addressed are anxiety, somatoform, hypomania, dysthmia, alcohol abuse, drug abuse, psychotic thinking, psychotic depression and psychotic delusion (Craig, Verinis, & Wexler, 1985). This scale was chosen because there is an extensive amount of information available on its reliability and validity. This scale will be used in a similar manner to the way in which Craig, Verinis, and Wexler (1985) used it in their study. Therefore, the reliability and validity are expected to be similar to that achieved in this study.

Data Analysis

The researcher will analyze the data using SPSS statistical software package. Participants will be divided according to demographic categories, the length of time they have been treated for an addiction. In the case where there was a reoccurrence of the addiction after a period of "cure" time in treatment will be counted from the beginning of the very first treatment period.

Numerical levels will be established to classify the participants according to where they fall on the happiness/depression scale. The number of participants in each group will be compared to determine if there is a correlation between the presence of certain types of personality disorders, happiness or depression and substance addiction. Descriptive statistics will be used to describe the sample population in this study. The means, standard deviations, and ANOVA will be calculated for all 20 scales contained within the MCMI. A p-value of.05 will be used as the threshold for acceptance or rejection of the hypotheses. The Pearson Product Moments will be calculated for each of the two groups.

Discussion

Substance abuse has high costs for the individual and for society at large. Currently, treatment programs focus on the substance abuse only. The person is released from the program, but soon find themselves back in for another round of treatments. This is not a fault of the treatment facilities or the programs, but it is a result of a failure to treat the causes of the substance abuse. Focusing on the cause of substance abuse is the only way to resolve the revolving doors at treatment facilities, resulting in long-term care for the patient.

Studies that found a correlation between certain social conditions and substance abuse are of little good in the clinical field. For instance, there might be a connection between substance abuse and low socioeconomic status. However, these factors are beyond the control of the researcher and cannot be changed. These factors might help the researcher to identify those that are at risk to develop addictive behaviors. However, because external factors such as a history of child abuse or socioeconomic factors cannot be changed, they have little significance in the need to find better treatment methods. Yet, this is the area that research has focused on up until this point. If we are to find solutions to the problem of how to change behaviors in those with addictions, focusing on factors that can be changed is a more effective way of doing this.

This study has several limitations that could affect the ability to draw meaningful conclusions. The first is associated with any type of quantitative study. Quantitative research requires the ability to make predictions about potential research outcomes. This could be done if all potential confounding variables were eliminated. However, when the research involves human responses and actions, the elimination of confounding variables is unrealistic. Humans have many motivations for their actions. They place different values on certain factors that others might not find to be important. These things make if difficult to predict human behaviour.

Quantitative studies are an excellent method when the data is easily quantified. However, quantitative studies lack the ability to explore causation. They can tell if something happens, but they cannot tell why something happens. Therefore, all though the results of quantitative studies can more definitively prove the hypothesis, they lack the depth necessary to provide real solutions to the problem. This will be a limitation of the current proposed study.

Geographic location could potentially introduce bias into the sample that could affect the results. For instance, the socioeconomic status, cultural factors, and wealth in the surrounding area could affect the prevalence of depression, the ability and willingness to seek help, and other factors that are a part of the local culture. However, the facilities chosen are located in an "average" location economically and socially speaking. This will help to eliminate these biases.

This study will be limited to alcoholics that are currently seeking treatment in a residential facility. Those that are receiving treatment of this type are easily quantified through treatment facility records. Furthermore, it is easier to confirm diagnosis of personality disorders and associated conditions in this type of setting. The survey is a self-reporting instrument, but the results can be confirmed by comparison to facility records. This gives an extra measure of validity to the research study.

In a self-reporting study, the possibility exists that a person might not answer honestly. Alcoholics in a treatment facility are there for many different reasons. Some are there willingly and have a real desire to heal. However, others might be there under coercion or court order. These persons might have motivation to answer in a way that they feel the researcher wants them to answer. This could skew the results of the study. There is little way to avoid this phenomenon in a self-reporting study. However, proper sampling technique can help to reduce this potential source of violence.

In conclusion, this research study will provide valuable information that will help researchers to better understand the relationship between emotional states and addiction. Temporary emotional states are not the type likely to produce addictive behavior. This research will explore long-term emotional states that are the result of organic brain conditions. This research is the first in many research projects in the future. It will add valuable insight that will help researchers and clinicians better understand the mechanisms of addiction.