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

256 IV. SPECIAL POPULATIONS(Cloninger, Sigvardsson, & Bohman, 1988; Webb, Baer, & McKelvey, 1995).Generally, persons with SUD exhibit higher levels of this trait compared tothose without SUD, whether they are alcoholics or abusers of other substances(Conway et al., 2002). Moreover, users of multiple substances tend to haveeven higher levels of sensation seeking, such that the greater the involvementin multiple substance dependence, the greater the behavioral disinhibition(Conway et al., 2003; Pedersen et al., 1989). Conversely, the high sensationseekers among cocaine-dependent persons are more likely to have multipleSUD (Ball, Carroll, & Rounsaville, 1994). Conway and colleagues (2003) demonstratedthat the number of lifetime substance dependence diagnoses among325 individuals in addiction treatment was positively and linearly associatedwith broad psychological measures of behavioral disinhibition. Compared topatients who were dependent on one substance, those who were dependent ontwo or more substances had higher scores on several different instruments usedto rate behavioral undercontrol. All other things being equal (e.g., access, economicstatus), the more disinhibited a person with a vulnerability to substancedependence, the more likely the thresholds for contact with multiple drugs willbe breached, and the vulnerability linked to use of multiple drugs.Other CharacteristicsMultiple-substance-dependent patients in treatment report lower mean levelsof self-efficacy and higher mean levels of temptation regarding substance use incomparison to alcohol-only-dependent patients (Edens & Willoughby, 1999).In addition to the increased impulsivity and sensation seeking compared tonon-multiple-drug SUD patients, multiple SUD patients score higher on allmeasures of hostility and aggression (McCormick & Smith, 1995).Typologic ApproachesAnother important development in elucidating the relationship between patternsof substance use, and both categorical and dimensional approaches tomeasuring personality is the recognition of characteristic patterns, typicallygrouped into two broad categories among substance abusers, designated TypesA and B (Ball, Kranzler, Tennen, Poling, & Rounsaville, 1998). Earlier classificationsystems in reference to alcoholism had a similar typology, variouslyreferred to as Types 1 and 2 (Cloninger, 1987), which developed out of measuresin family genetic studies, or Types A and B (Babor et al., 1992), developedthrough cluster analyses of a somewhat broader set of patient characteristics.Feingold and colleagues (1996), using a schema analogous to that of Babor andcolleagues (1992), replicated the A-B classification in 521 subjects chosen fromthe community, inpatient, and outpatient drug treatment programs, or outpatientpsychiatric treatment programs. Subjects were grouped by presence of