Typologic Approaches

Another important development in elucidating the relationship between patterns of substance use, and both categorical and dimensional approaches to measuring personality is the recognition of characteristic patterns, typically grouped into two broad categories among substance abusers, designated Types A and B (Ball, Kranzler, Tennen, Poling, & Rounsaville, 1998). Earlier classification systems in reference to alcoholism had a similar typology, variously referred to as Types 1 and 2 (Cloninger, 1987), which developed out of measures in family genetic studies, or Types A and B (Babor et al., 1992), developed through cluster analyses of a somewhat broader set of patient characteristics. Feingold and colleagues (1996), using a schema analogous to that of Babor and colleagues (1992), replicated the A-B classification in 521 subjects chosen from the community, inpatient, and outpatient drug treatment programs, or outpatient psychiatric treatment programs. Subjects were grouped by presence of alcohol, cocaine, marijuana, or opiate abuse or dependence. The authors found a consistent 60:40 ratio of Type A to Type B for each of the drug groups, suggesting clusters of personality characteristics that are independent of drug of choice. Similarly, in 370 patients attending treatment for alcoholism, cocaine, or opiate dependence, Ball and colleagues (1998) replicated the A-B classification and also found a 60:40 Type A to Type B ratio. Type A substance abusers had less multiple drug use, as well as an older age of onset, fewer years of heavy use, less family history of substance abuse, less impulsivity, and less severe substance abuse. Type B substance abusers tended to be more severe than type A abusers, scoring higher on the personality dimensions of neuroticism, novelty seeking, and harm avoidance. They also had a higher prevalence of multiple substance abuse, an earlier age of onset, more childhood psychiatric symptoms, higher incidence of all Cluster B personality disorders, and more frequent family history of substance abuse (Ball et al., 1998). The Type B profile is quite common in methadone patients, in whom there is a greater prevalence of ASPD than in the general population (Brooner, King, Kidorf, Schmidt, & Bigelow, 1997; Rounsaville et al., 1991).

Compared to drug abusers who are categorized as Type A, Type B is predictive of having multiple SUDs. This is an important refinement in the assessment of drug abusers; since multiple SUD does not occur in non-substance-abusing populations, this distinction gives some predictive power in the target subpopulation of those with SUD. As described earlier, ASPD in persons with SUD is predictive of multiple SUDs, IDU, and higher severity, and an earlier study found that ASPD was one of the best predictors of Type B membership among cocaine abusers (Ball et al., 1995). However, Ball and colleagues (1998) found that the basis for Type A and Type B distinctions in personality dimensions and disorders among the 370 patients in their study remained much the same when the cluster analysis was controlled for presence of ASPD. The typological distinction is not just of heuristic value—Type B patients have more severe SUDs and relapse more quickly after addiction treatment as compared with Type A patients (Babor et al., 1992; Ballet al., 1995). In addition, the more frequent family history of SUD and early onset in Type B patients is consistent with a stronger genetic component compared with late-onset Type A patients.

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