Peter R. Martin: Historical Vocabulary of Addiction, Vol. II
Personality
According to the electronic version of the Oxford English Dictionary (OED), the noun personality is partly a borrowing from Latin (personalitas) and French (personalité). In post-classical Latin personalitas referred to “personal nature or quality” and “personal character, personal qualities.” In French personalité referred to “personal details,” “personal trait used against someone,” “a person's individual character,” “important or famous person” and “capacity for being the subject of legal rights and duties.” The primary definition of the noun personality in OED is: “Personal nature or quality; an instance of this.”
The first use of the noun personality in the English language is exemplified by a quote from Select English Works by John Wyclif (c. 1328–1384), the English philosopher and theologian (Wycliffe and Arnold 1869): “Al þe personalite of man stondiþ in þe spirit of him.” The definition of personality as used in this quotation is now obsolete: “The quality, character, or fact of being a person, as distinct from an animal, thing, or abstraction; the quality which makes a being human.”
The meaning of personality as subsequently used in Theology is: “The quality, condition, or fact ascribed to God of consisting of three distinct persons. Also: each of the natures or identities of these persons considered separately.” An example of this use can be found in the book A discussion of the popish doctrine of transubstantiation by Thomas Gataker (1574 –1654), an English clergyman and theologian (Gataker 1624): “If a perfect substance or nature (as was the humanity of Christ) could want the naturall personality and subsistence thereof, supplyed by the divine person and hypostasis of the Sonne of God.”
A later meaning of personality referred to unique characteristics of an individual: “A person, especially one considered as the possessor of individual characteristics or qualities. Also: a being resembling or having the nature of a person, especially by having self-awareness or consciousness.” This meaning of the word was used by Nathaniel Hawthorne (1804 –1864), an American novelist and short story writer, in his book The House of the Seven Gables (Hawthorne 1950): “By its remoteness, it melts all the petty personalities, of which it is made up, into one broad mass of existence.”
Among the different meanings of personality, the one that is most relevant to the field of addiction is as it is used in Psychology and Sociology: “Personal individuality as a subject of psychological and sociological study.” An example of this meaning can be found in an early review article on this topic, “The Field of Personality,” published in The Psychological Bulletin (Allport and Vernon 1930): “Now it is unquestionably safe to say that personality, as it is ordinarily understood, depends upon some sort of consistency in behavior.” Stated otherwise, an individual’s behavior is significantly influenced by characteristics of their personality — personality underpins behavior, including dysfunctional behaviors that result in addictive disorders. Therefore, reliably identifying and quantifying biopsychosocial aspects of personality as manifested in behavior under various circumstances can be applied in research seeking to describe and understand psychopathological precursors and consequences of addictive disorders (Eysenck 1997).
The first and most important feature of personality is that its determinants are foundational to everyone, enduring and mostly immutable characteristics that are typically present early in life and thus, may significantly contribute to one’s vulnerability or resilience to addictive disorders (Belcher, Volkow, Moeller et al. 2014). However, the fundamental nature and immutability of personality is not universally accepted.
It can be argued that another characteristic, namely temperament, is really the precursor of personality (Davis and Panksepp 2011). According to this view, personality evolves through life as the manifestation or product of an individual’s experiences, more specifically, one’s accumulated learning, and does not crystalize until later in life, at the conclusion of adolescence. This notion is supported by the APA classification of personality disorders, a diagnosis that is only applicable to individuals who are 18 years or older (American Psychiatric Association 1980).
Accordingly, temperament might be considered even more fundamental in a biological and genetic sense than personality, namely the precursor upon which personality is built. Based on this conceptualization, personality is considered predominantly the product of environmental factors acting on an individual’s underlying temperament. This viewpoint would imply that the term temperament should be employed when referring to the earliest manifestations of personality of individuals.
According to OED, the noun temperament is a borrowing from Latin temperāmentum which is a mixture of the verb temperāre (“to temper”) and the suffix -ment (“forming nouns from verbs [to denote the result or product of the action of the verb…], partly a borrowing from French -ment and from Latin -mentum). The earliest evidence in OED for use of temperament is from about 1412, in the Middle English period, in the writings of John Lydgate of Bury (c.1370 – c.1451), an English monk and poet, in Fabula duorum mercatorum (Lydgate and Schleich 1897): “Yiff..heete or blood passe his temperament, In to a fevere anoon a man it leedith.” This now obsolete first sense of temperament is defined within the category of meanings, “Senses relating to proportionate balance,” specifically, “A moderate and proportionable mixture of elements in a compound; the condition in which elements are combined in their due proportions.”
Among the different categories of meanings of temperament, the one that is relevant to our discussion is related to “Senses relating to constitution or condition,” specifically, “Constitution or habit of mind, especially as depending upon or connected with physical constitution; natural disposition.” An example of an early use of this sense of the word is from the British poet George Gordon Noel Byron (1788–1824) in his composition Don Juan (Byron 1821): “He was a man of a strange temperament.”
Another quotation from the work of William Boyd Carpenter (1841–1918), a Church of England cleric and Royal Chaplain to Queen Victoria, nicely conveys the meaning of temperament as now understood and germane to the present discussion (Carpenter 1894): “Temperament is a convenient phrase to describe those qualities and dispositions which belong to him from birth.”
The presence early in life of specific behavioral characteristics suggests that these are fundamental determinants with a biogenetic foundation which interact with the environment in a meaningful way to produce the behavioral repertoire of an individual. Characteristics of personality found early in life are very likely not a consequence of the lifestyle associated with addictive disorders but rather their presence may represent predisposition to development of addiction (Martin 1981). This is one reason why there has been long-term interest in examining personality and temperament in adolescents or even in childhood (Zimmering, Toolan, Safrin et al. 1952; Kandel 1978; Kellam, Ensminger and Simon 1980). Therefore, personality factors can be identified that may predict development of addictive disorders and even utilized in devising targeted strategies for prevention (Kellam, Rebok, Ialongo et al. 1994).
In a relatively early study, utilizing the standardized Minnesota Multiphasic Personality Inventory (MMPI), personality characteristics identified in adolescents with drug use disorders are not significantly different from those in adults with the same diagnosis despite many more years of using drugs in the latter. The following conclusions suggest that the shared personality features between the adolescents and adults are likely not consequences of chronic drug use but may be predisposing factors to development of addictive disorders in both groups (Hill, Haertzen and Glaser 1960):
“The present data and ancillary evidence provided the basis for several conclusions: (a) Personality characteristics of narcotic addicts are either associated with psychopathy or are predominantly psychopathic in nature, although they may include many of the classical psychoneurotic and psychotic features. (b) As indicated by the MMPI, personality characteristics of hospitalized adolescent addicts do not differ appreciably from those of adult addicts. (c) This similarity and the similarity between adolescent addicts and non-addict delinquents suggest that psychopathology has considerable significance in the etiology of addiction.”
Clinicians and researchers have taken many different approaches to the study of personality as it pertains to addiction, including biological, cognitive, learning and trait-based theories, as well as psychodynamic and humanistic approaches (Chaudron and Wilkinson 1988). A particularly useful approach to classification of behavior as well as of disordered personality development is based on the direction of targeted reactions of the individual to stressors, namely whether these responses are externalizing or internalizing (Achenbach 1974).
Accordingly, internalizing behaviors/disorders are characterized by focus of the individual on processes within the self and these typically manifest as anxiety, somatization and depression. Externalizing behaviors/disorders are primarily problem behaviors directed toward the external world, expressed clinically as poor impulse control, thrill-seeking, acting out, hostility, aggression, antisocial behavior and often underpinning low self-esteem.
Externalizing personality characteristics, as modulated by gene-environment interactions, have been identified as principal risk factors in development of addictive behaviors (Tarter, Hegedus, Goldstein et al. 1984; Cloninger 1987; Iacono, Malone and McGue 2008; Zucker, Donovan, Masten et al. 2008). These personality characteristics are associated with the susceptibility of an individual to experiment with mood and/or sensorium-altering substances or engage in other addictive behaviors. Such experimentation may progress to using these substances and behaviors to cope with stress, manage emotions and influence life decisions, thereby representing a vulnerability to developing alcohol/drug use disorders and behavioral addictions (Martin 2019a, 2020).
The neurobiological underpinnings of personality are multifactorial and incompletely understood. The biopsychosocial foundations of personality traits and their role in predisposition to addiction have been particularly fertile domains of investigation (Assary, Zavos, Krapohl et al. 2020). Contemporary research supports the notion that focused interactions of brain regions via specific neural networks are modulated by the interplay of genetic and environmental factors which can shape aspects of personality that are relevant to addiction (Na, Zhou, Montalvo-Ortiz et al. 2023). Studies have linked specific personality attributes to differences in the structure (volumes) or function (activation) of certain brain regions, such as the prefrontal cortex, amygdala and hippocampus (Allen, Hall, Schreiber et al. 2022).
In a recent neuroimaging study, the somatosensory and the primary auditory cortex were uniquely affected in externalizing disorders that predispose to addiction; in contrast, the primary motor cortex and higher-order visual association areas were only affected in internalizing disorders (Yu, Liu, Wu et al. 2023). Additionally, only youth with externalizing disorders showed decelerated cortical thinning from age 10–12 years, the peripubertal epoch during which the developmental foundations of addiction become clinically manifest. A genome-wide association study (GWAS) conducted in these subjects identified 59 genome-wide significant associated genetic variants across these regions. Cortical thickness in common regions was associated with glutamatergic neurons, while internalizing-specific regional cortical thickness was associated with astrocytes, oligodendrocyte progenitor cells and GABAergic neurons.
Aspects of personality that influence reward processing and reinforcement are mechanistically relevant to development of addiction. Predisposition to addiction associated with such personality traits as sensation-seeking and impulsivity (Stephenson, Lannoy and Edwards 2023) may stem from differences in how the brain processes rewards and reinforces behaviors through fundamental neurobiological mechanisms related to conditioning. These abnormalities in reward processing/reinforcement and conditioning can make individuals more susceptible to seeking out and repeating rewarding experiences from addictive substances or behaviors as learning represents the “currency” of addiction (Martin 2019b).
The brain regions that mediate these functions are interconnected by neural circuits in which neurotransmission occurs via dopamine, serotonin, norepinephrine and GABA (inhibitory) and glutamate (excitatory) (Hyman, Malenka and Nestler 2006). Neurobiological mechanisms, subserved by the mesolimbic dopamine system is thought to play the primary role in addictive processes although many other brain circuits also impinge upon and may modulate this system (Kalivas and Volkow 2005). Accordingly, variations in the functioning of neurotransmitter-mediated brain circuits can impact traits like impulsivity, reward sensitivity and emotional regulation which are involved in impairment of reward processing/reinforcement resulting in addictive behaviors (Cloninger 2000).
Expression of developmental processes throughout the life cycle and how the organism experiences the environment over time also has biological determinants (Martin 2020b). A particularly dynamic stage in susceptibility to addiction is development of the individual from childhood to adolescence, a period when personality traits begin to harden and start to approximate adult personality characteristics. This occurs for at least two of many potential reasons: 1) the child undergoes puberty and rapid physiological changes, including in brain maturation and 2) the child begins to explore relationships outside more deeply of their family (Gur, Moore, Rosen et al. 2019).
Mechanistically this stage of development represents the period during which the brain undergoes significant neurobiological development in regions involved in decision-making, impulse control and emotional regulation as the individual transitions from childhood to adolescence (Casey, Jones and Hare 2008). This developmental period greatly influences emergence of addictive behaviors and disorders and their long-term outcomes.
The developing brain is particularly sensitive to the effects of substances, and substance use during this period can disrupt neural circuits and impair cognitive and emotional functioning (Tapert, Caldwell and Burke 2004). Accordingly, substance use during these developmental periods can have detrimental consequences on brain development, potentially leading to long-lasting changes that increase the risk of addiction (Robert, Luo, Yu et al. 2020).
Earlier developmental stages and personality traits have also been demonstrated as crucial in laying the foundation for addiction vulnerability in adolescence (Kellam, Ensminger and Simon 1980). Adverse childhood experiences, such as trauma, neglect, abuse or a chaotic home environment, can influence personality development and increase the risk of addiction in adolescence and later in life (Zhu, Lowen, Anderson et al. 2019). Additional factors like parental substance abuse, poor parental monitoring and lack of positive role models can also contribute to the early initiation and progression of addictive behaviors.
Perhaps most important in adolescence, peer influence becomes very prominent and can impact the development of addictive behaviors. The desire for social acceptance and conformity can lead to experimentation with substances or engagement in risky behaviors (Bandura and Walters 1963). Peer groups that normalize or encourage substance use can further increase the risk of addiction. Finally, developmental transitions, such as leaving home for college or starting a new job, can also influence addiction vulnerability. These transitional periods often involve changes in social networks, increased stress and greater exposure to substance use and individuals may turn to substances as coping mechanisms.
Exposure to stress early in life, during adolescence or in adulthood and the way individuals respond to stress and cope with negative emotions are influenced by personality characteristics (Martin 2020b). Personality traits, like neuroticism, impulsivity, sensation-seeking or low self-esteem, may contribute to heightened stress response and difficulty managing emotions so that individuals may turn to substances or addictive behaviors as a way to cope with stress or regulate negative emotions. Stress exposure may ultimately influence all stages of pathogenesis of addictive disorders, including vulnerability, initiation and progression (Sinha 2001). Moreover, enhancement of an individual’s ability to manage stress exposure while cognizant of the strengths and limitations in their personality may be vital to achieve a positive response to treatment and enhanced potential for recovery (Martin 2020a).
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February 1, 2024