Dimensional Approaches

In addition to the increased rates of SUD in persons with categorically defined personality disorders compared to controls, there are personality dimensions that may be predictive of increased risk for SUDs. Moreover, those with multiple SUDs tend to have more severe personality pathology, as measured on dimensional constructs, than users of single substances, independent of drug of choice (McCormick, Dowd, Quirt, & Zegarra, 1998; Pedersen, Clausen, & Lavik, 1989). Multiple-substance-dependent individuals tend to have high levels of two personality characteristics particularly related to behavioral disinhibition—impulsivity and sensation seeking (see review in Conway et al., 2003). Those with multiple substance dependence score lower in measures of behavioral inhibition (constraint) than those who prefer to use alcohol, cocaine, or cannabis singly (Conway, Swendson, Rounsaville, & Merikangas, 2002).


Impulsivity/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 comorbid BPD-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 users with BPD for polydrug use and its sequelae. In an analysis of the association between personality and substance use in a nonclinical population screened for alcohol or personality disorders, partialling out trait impulsivity significantly reduced the correlation between BPD or ASPD and the risk for SUD, suggesting that at least part of the association between SUD and personality may be due to underlying personality traits such as impulsivity (Casillas & Clark, 2002). On the balance, increased morbidity in polysubstance abusers might also be explained by a constitutional insensitivity to negative feedback from the environment. Multiple SUD subjects' poor performance on the Gambling Task suggests a heightened tendency to continue reinforced behavior in the context of increasingly negative consequences (Grant, Contoreggi, & London, 2000).

Novelty Seeking

A related personality trait that has been consistently linked with the vulnerability to development of SUD is novelty seeking or sensation seeking. Among children, those with higher sensation seeking are more likely to declare an intention to use alcohol and to have symptoms of substance abuse as adults

(Cloninger, Sigvardsson, & Bohman, 1988; Webb, Baer, & McKelvey, 1995). Generally, persons with SUD exhibit higher levels of this trait compared to those without SUD, whether they are alcoholics or abusers of other substances (Conway et al., 2002). Moreover, users of multiple substances tend to have even higher levels of sensation seeking, such that the greater the involvement in multiple substance dependence, the greater the behavioral disinhibition (Conway et al., 2003; Pedersen et al., 1989). Conversely, the high sensation seekers among cocaine-dependent persons are more likely to have multiple SUD (Ball, Carroll, & Rounsaville, 1994). Conway and colleagues (2003) demonstrated that the number of lifetime substance dependence diagnoses among 325 individuals in addiction treatment was positively and linearly associated with broad psychological measures of behavioral disinhibition. Compared to patients who were dependent on one substance, those who were dependent on two or more substances had higher scores on several different instruments used to rate behavioral undercontrol. All other things being equal (e.g., access, economic status), the more disinhibited a person with a vulnerability to substance dependence, the more likely the thresholds for contact with multiple drugs will be breached, and the vulnerability linked to use of multiple drugs.

Other Characteristics

Multiple-substance-dependent patients in treatment report lower mean levels of self-efficacy and higher mean levels of temptation regarding substance use in comparison to alcohol-only-dependent patients (Edens & Willoughby, 1999). In addition to the increased impulsivity and sensation seeking compared to non-multiple-drug SUD patients, multiple SUD patients score higher on all measures of hostility and aggression (McCormick & Smith, 1995).

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