Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

Dimensional Approaches11. Polysubstance Use, Abuse, and Dependence 255In addition to the increased rates of SUD in persons with categorically definedpersonality disorders compared to controls, there are personality dimensionsthat may be predictive of increased risk for SUDs. Moreover, those with multipleSUDs tend to have more severe personality pathology, as measured ondimensional constructs, than users of single substances, independent of drug ofchoice (McCormick, Dowd, Quirt, & Zegarra, 1998; Pedersen, Clausen, &Lavik, 1989). Multiple-substance-dependent individuals tend to have highlevels of two personality characteristics particularly related to behavioraldisinhibition—impulsivity and sensation seeking (see review in Conway et al.,2003). Those with multiple substance dependence score lower in measures ofbehavioral inhibition (constraint) than those who prefer to use alcohol,cocaine, or cannabis singly (Conway, Swendson, Rounsaville, & Merikangas,2002).ImpulsivityImpulsivity/disinhibition appears to be a major factor in both SUD and BPD.Though impulsivity is associated with polysubstance use (O’Boyle & Barratt,1993), and in addition to the risks for polysubstance abuse attributable to BPD,as described earlier, impulsivity appears more highly elevated in comorbidBPD–SUD than with either disorder alone (Kreudelbach, McCormick, Schulz,& Grueneich, 1993; Morgenstern, Langenbucher, Labouvie, & Miller, 1997).As such, impulsivity may explain some of the increased risk in substance userswith BPD for polydrug use and its sequelae. In an analysis of the associationbetween personality and substance use in a nonclinical population screened foralcohol or personality disorders, partialling out trait impulsivity significantlyreduced the correlation between BPD or ASPD and the risk for SUD, suggestingthat at least part of the association between SUD and personality may bedue to underlying personality traits such as impulsivity (Casillas & Clark,2002). On the balance, increased morbidity in polysubstance abusers might alsobe explained by a constitutional insensitivity to negative feedback from theenvironment. Multiple SUD subjects’ poor performance on the Gambling Tasksuggests a heightened tendency to continue reinforced behavior in the contextof increasingly negative consequences (Grant, Contoreggi, & London, 2000).Novelty SeekingA related personality trait that has been consistently linked with the vulnerabilityto development of SUD is novelty seeking or sensation seeking. Amongchildren, those with higher sensation seeking are more likely to declare anintention to use alcohol and to have symptoms of substance abuse as adults