Personality Personality Profile in Young Current Regular

Substance Use & Misuse, 43:1378–1394Copyright © 2008 Informa Healthcare USA, Inc.ISSN: 1082-6084 (print); 1532-2491 (online)DOI: 10.1080/10826080801922652

Personality

Personality Profile in Young Current RegularUsers of Cocaine

M. JESUS HERRERO,1 ANTONIA DOMINGO-SALVANY,1

MARTA TORRENS,2 M. TERESA BRUGAL,3

FERNANDO GUTIERREZ,4 AND THE ITINEREINVESTIGATORS1,∗

1Health Services Research Unit (IMIM), Barcelona, Spain2Psychiatry Research Unit, IMIM, Barcelona, Spain3Public Health Agency (ASPB), Barcelona, Spain4Institute of Neurosciences, Hospital Clınic i Provincial, Barcelona, Spain

This study examined the relationship between the personality profile of a sample ofcocaine users and the presence of Diagnostic and Statistical Manual of Mental Disorders(DSM-IV) diagnoses and the severity of substance use. A total of 120 participants (46women, mean age: 23.8 years) from nonclinical settings in Barcelona, Spain, 2003–2006, were assessed using the Psychiatric Research Interview for Substance and MentalDisorders (PRISM) and the Temperament and Character Inventory-Revised version(TCI-R). Most of the participants had completed more than primary education, nearlyhalf of them were employed, one third lived with parents, and near a quarter hadsome criminal record. Snorting was the main route of cocaine administration. Theywere using a mean of 1.82 substances. Cocaine users with low Self-Directedness, lowCooperativeness, and high Self-Transcendence scores in the TCI-R, with high severityof substance use and psychiatric comorbidity, would be suggestive of a possible specificphenotype. The limitations and implications of the study are discussed.

Keywords Cocaine use; personality dimensions; phenotype; TCI-R; psychiatriccomorbidity

∗ITINERE Investigators include: Luis de la Fuente de Hoz, Rosario Ballesta Gomez, GregorioBarrio Anta, M Jose Bravo Portela, Daniel Lacasa, Fermın Fernandez, Francisco Gonzalez-Saiz, LuisRoyuela, Fernando Vallejo, Jose Pulido, Fernando Sanchez, Teresa C Silva.

Recruitment of the cohort was financed by the Fundacion para Investigacion y la Prevenciondel Sida en Espana (FIPSE 3035/99); the field work by Plan Nacional Sobre Drogas (PNSD 2004),the analyses by FIS-Redes de investigacion cooperativa RTICS: C03-09 (RCESP) and G03 03-005(RTA) and administrative support, by CIRIT 22001SGR00405.

Address correspondence to Dr. A. Domingo-Salvany Health Services Research Unit, InstitutMunicipal d’Investigacio Medica (IMIM), Dr. Aiguader 88, E-08003 Barcelona, Spain. E-mail:[email protected]

1378

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Personality Profile in Young Cocaine Users 1379

Introduction

Personality disorders are frequent among substance abusers in both clinical (Craig, 2000;Verheul, 2001) and nonclinical samples (Compton, Conway, Stinson, Colliver, and Grant,2005; Franques, Auriacombe, and Tignol, 2000; Grant et al., 2004). Prevalence rates ofpersonality disorders among individuals with substance use disorders are about four timeshigher than in the general population (estimates of the overall Axis II prevalence rangefrom 34.8% to 73.0% [median 56.5%]; Grant, Stinson, Dawson, Chou, and Ruan, 2005;Kokkevi, Stefanis, Anastasopoulou, and Kostogianni, 1998). Several studies have shownthat greater severity of psychopathology and drug use are associated with poorer treatmentoutcomes among cocaine users (Carroll, Power, Bryant, and Rousanville, 1993), yet findingsspecifically regarding the relationship of antisocial personality disorder with treatmentoutcomes for opioid or cocaine users are controversial (Cacciola, Alterman, Rutherford,McKay, and Mulvaney, 2001; Messina, 2003; Grella, 2005; McKay, Alterman, Cacciola,Mulvaney, and O’Brien, 2000).

Personality disorders can be assessed from a categorical approach (i.e., based on Diag-nostic and Statistical Manual of Mental Disorders [DSM-IV] criteria) or from a dimensionalapproach (finding a personality profile based on specific traits). According to DSM-IV di-agnosis, an important ongoing controversy concerns the question whether and to whatextent Axis II diagnoses in substance users are substance-related artifacts reflecting thecharacteristic lifestyles of addictive individuals rather than true personality disorders withan enduring course independent of Axis I symptoms. Clinical diagnoses from a categoricalapproach produce dichotomized outcomes and dichotomization reduces statistical powerand decreases accuracy (Skilling, Harris, Rice, and Quinsey, 2002).

On the other hand, dimensional scales consider that a continuum is present betweenpsychopathology and the normal range. Personality disorders are seen here as maladaptiveextremes of normal personality dimensions. According to the theoretical background un-derlying TCI, character scores could be used to estimate the probability for the presence orabsence of personality disorders whereas temperament scores could be used for differentialdiagnoses (Svrakic, Whitehead, Przybeck, and Cloninger, 1993). From the dimensionalapproach, the most salient variables that have been identified to characterize drug users ingeneral are sensation seeking (Zuckerman, 1974), novelty seeking, (Cloninger, 1987), im-pulsivity (Patkar et al., 2003), and harm avoidance (Wills, Vaccaro, and McNamara, 1994).In general, higher levels of these dimensions have been found in substance users than inthe controls except for harm avoidance, because some studies have reported lower levels(Wills, Vaccaro, and McNamara); and others, higher levels (de Wit and Bodker, 1994; LeBon et al., 2004).

The Temperament and Character Inventory (TCI), developed by Cloninger and hiscoworkers based on his unified biosocial theory of personality, is one of the most widelyused questionnaires that assesses personality traits from a dimensional approach (Cloninger,Przybeck, Svrakic, and Wetzel, 1994). The most prominent characteristic of this question-naire is the large number of clinical and genetic studies, which validate the TCI’s results(Ando et al., 2004; Gillespie, Cloninger, Heath, and Martin, 2003; Hirano et al., 2002; Kim,Kim, Lee, Kim, and Kim, 2006). In 1999, a revised version was proposed by Cloninger (TCI-R), and several validation studies have been performed confirming the proposed structure(Hansenne, Delhez, Cloninger, 2005; Pelissolo et al., 2005).

The study of links between personality and pattern of drug use is interesting in orderto design optimal strategies in preventive care. Because personality may be associatedwith specific neurobiological mechanisms (Cloninger, 1987), it could also serve to betterunderstand the complexities of addictive behaviors. Moreover, as a consequence of the


1380 Herrero et al.

multifactorial nature of drug abuse, recent research has strived to identify more homogenousand precise phenotypes (Conway, Swendsen, Rounsaville, and Merikangas, 2006). It hasbecome increasingly clear that typical phenotypes (including any use of a drug, drug seeking,regular or heavy use, inappropriate use of a drug, drug abuse, and drug dependence) arenot able to adequately describe, discriminate, and predict the complex nature and course ofdrug abuse. Kirisci et al. (2006) considered developing a phenotype that reflects severity ofsubstance use disorder. In this area, personality dimensions, severity of substance use, andtheir relationship, could be considered as a potential drug abuse phenotype.

The present study aims to describe the personality profile of a sample of young cocaineusers as assessed with the TCI-R (Temperament and Character Inventory-Revised version)and to analyze whether their profiles differ if DSM-IV diagnoses are present and according toseverity of drug use. This information could possibly shed some light on the description of aspecific phenotype of severe cocaine users. In particular, the study is intended to answer fourquestions: (a) Is personality profile of young cocaine users different from personality profilein general population? (b) Is personality profile of young cocaine users with personalitydisorders different from that of young cocaine users without personality disorders? (c) Ispersonality associated with severity of drug use? (d) Is personality associated with lifetimepresence of other Axis I disorders?

Material and Methods

Subjects

Young adult cocaine users were recruited from the ITINERE project cohort of currentregular users of cocaine that started by the end of 2003 until early 2006. Inclusion criteriawere age (18–30 years), resident in Barcelona, and current (having used cocaine within the90 days prior to the interview) and regular use (having taken it at least 52 days over the12 months prior to the interview, in which heroin was taken no more than 12 days). Forrecruitment a chain referral technique with different starting points at outdoor scenarioswas used.

To be included in ITINERE a candidate was evaluated through a brief Selection Ques-tionnaire and, if the inclusion criteria were met, the subject passed on to the first stage ofthe evaluation in which the objectives and procedures of the study were explained, as werethe participation incentives (20 Euro per interview completed). Then the subject signedan informed consent after which the Baseline Questionnaire was administered through aface-to-face interview. After the interview, 80% of the subjects were randomly assignedto the mental health study and given an appointment for their second interview within 30days of the first evaluation, in which the Psychiatric Research Interview for Substance andMental Disorders (PRISM) (Hasin et al., 1996, 2006) and the revised version of the TCI-R(Gutierrez-Zotes, Sangorrin, Martin-Santos, Torres, and Torrens, 2004) were completed(see below). The Institutional Bioethics Committee approved the study design.

A total of 120 individuals completed the study. Of them, 38.3% were women. The meanage was 23.8 years (SD = 3.4; range 18–31). Most of the participants had never been married(85%). Most individuals (96.7%) had completed more than primary education (46.6% wereuniversity undergraduates or graduates). Nearly 47% were currently employed, and 15%were students. Up to 53.3% lived with friends (23.3% of the total sample were squatters),33.3% were still living with parents, 10% lived with a partner, and 3.3% lived alone. Near21% had at some time been held at a police station or had been in jail or prison overnightor longer (criminal record).



These individuals had used cocaine within the 90 days prior to the interview beingsnorting the main route of cocaine administration (91.7%), followed by intravenous route(4.2%), and only 2.2% smoked it. Nevertheless, 24 individuals (20%) had smoked cocaineat some time. It is difficult to know how representative they are of the Spanish or Barcelonacocaine users as no data about them are available.

Measures

PRISM

The substance- and non-substance-use comorbid disorders were diagnosed using the Span-ish version of the PRISM (Torrens, Serrano, Astals, Perez-Domınguez, and Martın-Santos,2004). The PRISM is a semistructured clinician-administered interview that measures themajor Axis I DSM-IV diagnoses of alcohol, drug, and psychiatric disorders and two AxisII disorders: Borderline (BPD) and Antisocial Personality Disorders (APD). In the Spanishversion an extra section for attention-deficit hyperactivity disorder (ADHD) was added. Di-agnoses are made using two time frames: “current” (criteria were met within the past year)and “past” (criteria were met before the previous 12 months). Lifetime prevalence, takinginto account both current and past diagnoses, was used to present the frequency of substanceuse disorders, non-substance-use disorders, and psychiatric comorbidity. In addition to thesubstance abuse and dependence diagnoses, the PRISM differentiates “pathological use”(chronic intoxication: substance use 4 or more days a week for 3 or more weeks; and/orbinges: 3 or more consecutive days of continuous substance use) from “occasional use”(substance use less than 4 days a week, unless substance was used in a binge pattern). In thepresent study opiates refers to a group made up of heroin, methadone, and opiate painkillers.The interview was administered by an experienced psychologist who had received PRISMtraining (Table 1).

TCI-R

The revised version of TCI-R is a self-administered 5-point scale (from Strongly disagreeto Strongly agree) to rate the 240 items that measure seven independent dimensions ofpersonality: four Temperament dimensions and three of Character (Table 1).

Temperament refers to automatic emotional responses to experience that are moderatelyinheritable (i.e., genetic, biological) and stable throughout life. Temperament manifestsitself early in life and involves preconceptual or unconscious learning. Character representsconceptual or insight-based learning of self-concepts that mature in adulthood and are notlinked to particular biological processes.

The Temperament dimensions are: (1) Novelty-Seeking (NS), reflecting behavioralactivation; (2) Harm Avoidance (HA), reflecting behavioral inhibition; (3) Reward Depen-dence (RD), reflecting variations in social attachment and affiliation; and (4) Persistence(P), reflecting the ability to maintain a behavior in an extinction context.

The Character dimensions include: (5) Self-Directedness (SD), which refers to theability of an individual to control, regulate, and adapt his or her behavior to fit the situationin agreement with individually chosen goals and values; (6) Cooperativeness (C), whichwas formulated to account for individual differences in identification with and acceptanceof other people; (7) Self-Transcendence (ST), which is a character associated with spiri-tuality and generally refers to identification with everything conceived as an essential andconsequential part of a unified whole.


Tabl

e1

Stud

ym

easu

res

Nam

eTy

peA

reas

cove

red

Num

ber

ofite

ms

Skill

s/ab

ilitie

s

Ave

rage

time

need

edto

resp

ond

Adv

anta

ges

Lim

itatio

ns

Tem

pera

men

tand

Cha

ract

erIn

vent

ory-

Rev

ised

(TC

I-R

)

Pers

onal

ityse

lf-

adm

inis

tere

dqu

estio

nnai

re

Tem

pera

men

tdim

ensi

ons

Nov

elty

Seek

ing

Har

mA

void

ance

Rew

ard

Dep

ende

nce

Pers

iste

nce

Cha

ract

erdi

men

sion

sSe

lf-D

irec

tedn

ess

Coo

pera

tiven

ess

Self

-Tra

nsce

nden

ce

240

Rea

ding

skill

s30

min

utes

Eas

yto

resp

ond.

5-po

int

Lik

erts

cale

(1,d

efini

tivel

yfa

lse

to5,

defin

itive

lytr

ue).

Inst

rum

entv

alid

ated

inSp

anis

hpo

pula

tion.

Psyc

hiat

ric

Res

earc

hIn

terv

iew

for

Subs

tanc

ean

dM

enta

lD

isor

ders

(PR

ISM

)

Sem

istr

uctu

red

inte

rvie

wfo

rdi

agno

sing

diso

rder

sac

cord

ing

toD

SM-I

Vcr

iteri

a

SUD

(sub

stan

ceus

edi

sord

ers)

Moo

ddi

sord

ers

Anx

iety

diso

rder

sPs

ycho

ticdi

sord

ers

Eat

ing

diso

rder

sT

DA

H2

pers

onal

itydi

sord

ers

(bor

derl

ine

and

antis

ocia

l)

Span

ish

spea

ker

90–1

20m

inut

esP

RIS

M:

-O

btai

nsa

hist

ory

ofhe

avy

drug

and

alco

holu

se,a

ndlif

etim

etim

elin

eof

peri

ods

ofhe

avy

subs

tanc

eus

ean

dab

stin

ence

-A

sses

ses

lifet

ime

and

curr

ent

psyc

hiat

ric

sym

ptom

san

ddi

sord

ers

-Pr

ovid

esgu

idel

ines

toas

sist

indi

ffer

entia

ting

subs

tanc

e-in

duce

dfr

ompr

imar

ysy

mpt

oms,

and

tode

term

ine

the

tem

pora

lre

latio

nshi

pof

psyc

hiat

ric

sym

ptom

san

dsu

bsta

nce

use.

-A

llow

sfo

rin

terv

iew

eror

com

pute

rdi

agno

sis

Its

adm

inis

trat

ion

isre

lativ

ely

leng

thy.

1382



In the present study, we used the TCI-R in its Spanish translation, the retrotranslationhaving been accepted by the author. This version had been standardized in a sample of400 volunteers, 50% women, aged 18 to 65, representative of the Spanish general populationto obtain a mean of 50 and a standard deviation (SD) of 10 (Gutierrez-Zotes, 2004).

Data Analysis

All the statistical analyses were done with SPSS 12.0. Prior to statistical analyses, all ofthe variables were examined through various programs for accuracy of data entry, missingvalues, and fit between their distributions and assumptions of multivariate analysis. Normal-ity and linearity were checked and found to be satisfactory. Comparisons were carried outusing chi-square and Fisher Exact tests for categorical variables and analyses of variance(ANOVA) for continuous variables. The Mann-Whitney U test was used when the size ofa comparison group was too small to assume normality.

The mean scores in the total sample were computed for each of the seven dimensions ofthe TCI-R, and then compared with those from the reference population. Logistic regressionswere done with all dimensions as independent variables in a backwards step process todetermine the association of these dimensions with having or not having the differentdisorders (dependent variable). The Hosmer-Lemeshow statistic was used to assess thegoodness of fit of logistic regression models. Odds ratios and 95% confidence intervals (CIs)were reported for all predictors significant at p < .05. Likewise, statistical significance wasdetermined at p < .05 for all analyses.

To study the association between TCI-R dimensions and severity of substance use, threegroups of substance use were established: nonpathological use (neither chronic intoxicationnor binges, or no use), pathological use or substance abuse, and substance dependence. Asonly two subjects did not have any pathological use of cocaine, they were included inneither univariate nor multivariate analyses. To be able to analyze other drug severity witha multivariate approach (logistic regression), we subsumed pathological use or abuse anddependence in a unique category for alcohol and opiates. Other substances only had onestatistically different dimension and a multivariate approach was not implemented.

Results

Patterns of Drug Use and Substance Use Disorders

Only 22 subjects (18.3%) did not meet criteria for any substance use diagnosis; the rest werediagnosed with abuse or dependence on some substance. The mean number of substance usediagnoses per individual was 1.82 (SD = 1.27). Specifically, 82 subjects (68.3%) had at leastused cocaine, cannabis, and alcohol; 25 subjects (20.8%) had used cocaine and cannabis butnot alcohol and possibly other different substances; and 11 subjects (9.2%) had used cocaineand alcohol but not cannabis. Disregarding these overlapping subgroups of substance users,cocaine dependence was diagnosed in 77 subjects (64.2%), whereas 41 subjects (34.2%)presented pathological use or cocaine abuse. Cannabis abuse or pathological use of cannabiswas also diagnosed commonly (72.5%), followed by alcohol abuse or pathological use(58.3%). For the rest of substances, see Table 2.

Non-substance-use Disorders

A total of 50 subjects (41.7%) were diagnosed with a lifetime Axis I disorder other thansubstance use disorders and 15 subjects (12.5%) with a lifetime antisocial or borderline


Tabl

e2

Pers

onal

itydi

men

sion

sin

subs

tanc

eus

edi

sord

ers:

com

pari

son

ofsu

bjec

tsw

ithou

tpa

thol

ogic

alus

eor

nous

e,su

bjec

tsw

ithpa

thol

ogic

alus

e/su

bsta

nce

abus

ean

dsu

bjec

tsw

ithsu

bsta

nce

depe

nden

ce

Tem

pera

men

tdim

ensi

ons

Cha

ract

erdi

men

sion

s

NS∗

HA

∗R

D∗

P∗SD

∗C

∗ST

∗

N(%

)m

ean

(SD

)m

ean

(SD

)m

ean

(SD

)m

ean

(SD

)m

ean

(SD

)m

ean

(SD

)m

ean

(SD

)

Coc

aine

Non

path

olus

e2

(1.7

)†∗∗

Abu

se/p

atho

luse

41(3

4.2)

61.8

(7.2

)48

.2(9

.6)

49.8

(9.5

)46

.9(8

.9)

43.5

(8.6

)44

.4(8

.8)

50.4

(9.5

)D

epen

denc

e77

(64.

2)64

.4(9

.2)

50.9

(10.

4)47

.7(9

.9)

44.9

(9.2

)40

.5(1

0.6)

40.9

(9.5

)55

.7(1

0.6)

Can

nabi

sN

onpa

thol

use

11(9

.2)

61.5

(7.5

)48

.3(9

.3)

55.4

(7.2

)∗∗47

.3(1

0.1)

40.5

(10.

6)41

.4(9

.4)

55.4

(12.

8)A

buse

/pat

holu

se87

(72.

5)63

.7(8

.9)

50(9

.7)

48.6

(8.9

)45

.6(8

.6)

42.1

(10.

2)43

(9.1

)53

.3(1

0.1)

Dep

ende

nce

22(1

8.3)

62.8

(7.8

)49

.4(1

3.2)

45.3

(12.

6)45

.8(1

1.2)

42.2

(11.

3)40

(10.

9)55

(11.

4)A

lcoh

olN

onpa

thol

use

27(2

2.5)

63.8

(8.6

)47

.4(1

2.2)

53.2

(8.9

)∗∗47

.7(9

.5)

44.2

(12)

46.6

(9.6

)∗∗52

.6(9

.8)

Abu

se/p

atho

luse

70(5

8.3)

63.5

(8.2

)49

.4(8

.9)

48.2

(9.1

)46

.1(8

.5)

41.7

(10.

2)42

.4(9

.2)

54(1

0)D

epen

denc

e23

(12.

9)62

.3(1

0.1)

53.5

(11.

0)44

.3(1

1.1)

42.7

(10.

4)39

.8(8

.4)

37.5

(8.2

)55

(13)

Stim

ulan

tsN

onpa

thol

use

62(5

1.7)

62.8

(8.7

)49

.9(9

.8)

49(1

0.1)

46(9

.1)

42.2

(10.

5)41

.6(9

.8)

52.1

(10.

4)A

buse

/pat

holu

se31

(25.

8)64

(9.1

)47

.8(1

1.3)

48.3

(10.

6)47

.1(1

0.8)

41.1

(11.

7)42

.4(9

.3)

55.5

(10.

2)D

epen

denc

e27

(22.

5)64

.1(8

)51

.5(1

0.2)

48.1

(8.6

)44

(7.4

)42

.1(8

.5)

43.6

(8.9

)55

.8(1

0.5)

Hal

luci

noge

ns1

Non

path

olus

e65

(54.

2)62

.7(8

.5)

49.7

(10.

7)48

.4(9

.4)

45.4

(9.4

)42

.2(1

0.2)

41.6

(9.8

)50

.8(8

.6)∗∗

Abu

se/p

atho

luse

41(3

4.2)

63.2

(8.7

)49

.8(9

.7)

48.4

(11.

2)46

.2(9

.8)

41.5

(10.

8)42

.6(8

.8)

56.8

(11.

3)D

epen

denc

e14

(11.

7)66

.7(8

.9)

49.8

(10.

8)49

.8(7

.8)

46.1

(6.3

)41

.6(1

0.6)

44.2

(9.8

)59

.2(1

1.9)

Opi

ate

Non

path

olus

e10

7(8

9.2)

63(8

.5)

49.1

(9.9

)48

.5(9

.7)

46.5

(9.1

)∗∗42

.8(9

.7)∗∗

42(9

.4)

53.9

(10.

1)A

buse

/pat

holu

se2

(1.7

)†

Dep

ende

nce

11(9

.2)

65.2

(9.2

)53

.1(1

2.4)

49.4

(11.

1)42

.5(4

.6)

33.6

(13.

4)44

(9.2

)55

.4(1

3.6)

∗ NS,

nove

ltyse

ekin

g;H

A,h

arm

avoi

danc

e;R

D,r

ewar

dde

pend

ence

;P,p

ersi

sten

ce;S

D,s

elf-

dire

cted

ness

;C,c

oope

rativ

enes

s;ST

,sel

f-tr

ansc

ende

nce.

∗∗A

NO

VA

p<0.

05† T

CI-

Rva

lues

for

cells

unde

r5

subj

ects

are

notp

rovi

ded.

1H

allu

cino

gens

incl

ude

acid

,ecs

tasy

,MD

A,M

DM

A,a

ndM

MD

A.

1384



Table 3Description of the TCI-R dimensions by PD*1 (DSM-IV criteria), and corresponding ORs∗

Total PD non-PDn = 120 n = 15 n = 105

mean (SD) mean (SD) mean (SD) OR (CI 95%)∗

TemperamentNovelty Seeking 63.4 (8.6)∗∗ 68.8 (10.7) 62.6 (8.1) 1.09 (1.01–1.16)∗∗∗

Harm Avoidance 49.7 (10.3) 56.3 (11.9) 48.8 (9.7) 1.07 (1.01–1.12)∗∗∗

Reward Dependence 48.6 (9.8) 45.8 (13.6) 49.0 (9.1) 0.96 (0.91–1.02)Persistence 45.8 (9.2)∗∗ 38.1 (10.2) 46.9 (8.5) 0.89 (0.82–0.95)∗∗∗

CharacterSelf-directedness 41.9 (10.4)∗∗ 32.8 (13.8) 43.2 (9.1) 0.90 (0.85–0.96)∗∗∗

Cooperativeness 42.3 (9.4)∗∗ 36.7 (11.5) 43.1 (8.9) 0.92 (0.87–0.98)∗∗∗

Self-transcendence 53.8 (10.5 )∗∗ 55.4 (11.9) 53.6 (10.3) 1.01 (0.96–1.06)

∗PD, personality disorders; OR, odds ratio estimate; CI, confidence interval.∗∗ p < .05, related to the general population scores.∗∗∗ p < 0.05.1Only two PDs are included in this study: APD (antisocial personality disorder) and BPD (border-

line personality disorder).

personality disorder (APD or BPD). In Axis I, mood disorders were most common (27.5%),among which major depression was 18.3%, followed by anxiety disorders (15%), psychoticdisorders and eating disorders (5%, each), and ADHD (2.5%). With regard to personalitydisorders, APD was diagnosed in 10% of subjects; and BPD, in 4.2%. Two subjects metcriteria for both personality disorders. Only 18 subjects (15%) did not meet the criteria forany DSM-IV disorder.

Personality

TCI-R General Description. The mean scores and standard deviations of the seven di-mensions of the TCI-R are shown in Table 3. No differences by gender were observed.Compared to the reference population (mean 50; SD =10), higher mean scores were ob-served for the Novelty-Seeking and Self-Transcendence dimensions, whereas Persistence,Self-Directedness, and Cooperativeness were lower than the mean score.

TCI-R and Personality Disorders. When compared with DSM-IV personality disordersdiagnoses, TCI-R showed different profiles for subjects with personality disorders (12.5%)and for those without them (Table 3). Subjects with personality disorders were higher onNovelty-Seeking and Harm Avoidance, but lower on Persistence, Self-Directedness, andCooperativeness. As nonparametric statistical methods gave equivalent results to parametricmethods, to make interpretation easier, odd ratios (ORs) of personality disorders presencefor each TCI-R dimension are shown in Table 3.

When all dimensions were considered in logistic regression models adjusted for ageand gender with personality disorders as dependent variable, the model chosen was the oneincluding Persistence and Self-Directedness (Table 4).


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Table 4Multivariate association adjusted for age and gender between TCI-R dimensions andthe presence of mood, psychotic, substance use, and personality disorders (according to

DSM-IV criteria)

Mood PsychoticPD∗,1 SUD∗ disorders disorders

Temperament dimensionsNS∗ OR (CI 95%)HA∗ OR (CI 95%)RD∗ OR (CI 95%)P∗ OR (CI 95%) 0.90 (0.83–0.98)∗∗

Character dimensionsSD∗ OR (CI 95%) 0.92 (0.87–0.99)∗∗ 0.91 (0.86–0.96)∗∗

C∗ OR (CI 95%)ST∗ OR (CI 95%) 1.05 (1.00–1.11)∗∗ 1.11 (1.02–1.22)∗∗

χ2H-L (p)∗ 10.55 (0.23) 6.49 (0.59) 4.98 (0.76) 13.02 (0.11)∗PD, personality disorders; SUD, substance use disorders; NS, novelty seeking; HA, harm avoid-

ance; RD, reward dependence; P, persistence; SD, self-directedness; C, cooperativeness; ST, self-transcendence; χ2 H-L, Hosmer-Lemeshow test (p > .05); OR, odds ratio estimate; CI, confidenceinterval.

∗∗ (p < .05)1Only two PDs are included in this study: APD (antisocial personality disorder) and BPD (border-

line personality disorder).

TCI-R and Substance Use Disorders. Table 2 shows the differences in TCI-R dimensionsmean values according to severity of drug use. In general, Self-Transcendence increaseswith increased drug severity (significant for cocaine and hallucinogens), whereas the otherdimensions (Reward Dependence, Persistence, Self-Directedness, and Cooperativeness)decrease with higher drug use severity. In multivariate analysis, severity of cocaine usewas related with Self-Transcendence (OR, 1.072; 95% CI, 1.024–1.122) and also withCooperativeness (OR, 0.943; 95% CI, 0.900–0.987). Severity of alcohol use was relatedonly with Reward Dependence (OR, 0.930; 95% CI, 0.882–0.980) and severity of opiatesuse was related with Persistence (OR, 0.921; 95% CI, 0.854–0.994), Self-Directedness(OR, 0.921; 95% CI, 0.860–0.987), and Cooperativeness (OR, 1.076; 95% CI, 1.003–1.155).

On the one hand, Self-Transcendence was the only dimension associated with anysubstance use disorder diagnoses in a multivariate model adjusted for age and gender(Table 4), and on the other hand, with the number of substance use diagnoses (β = 0.03;95% CI, 0.01–0.05), so the higher the number of substance use disorders, the higher theSelf-Transcendence score.

TCI-R and Non-substance-use Disorders. Mood disorders were related with HarmAvoidance (OR, 1.053; 95% CI, 1.011–1.1096), Self-Directedness (OR, 0.907; 95%CI, 0.863–0.953), and Self-Transcendence (OR, 1.047; 95% CI, 1.007–1.089). WhereasSelf-Directedness and Self-Transcendence were the dimensions associated with psychoticdisorders (OR, 0.932; 95% CI, 0.870–0.999; and OR, 1.108; 95% CI, 1.026–1.197,respectively).

In a model with mood disorders as dependent variable, Self-Directedness is the only di-mension that remains statistically significant when all the univariate significant dimensions



are included. In a model with psychotic disorders as dependent variable, Self-Transcendenceis the only dimension that remains statistically significant (Table 4).

Other Variables. In corresponding logistic regressions, Reward Dependence and Self-Transcendence were also the dimensions related to presence of a criminal record (OR,0.93; 95% CI, 0.88–0.98; and OR, 1.07; 95% CI, 1.02–1.13, respectively), so subjectswho had ever been arrested or in jail scored lower in Reward Dependence and higher inSelf-Transcendence dimension.

None of the seven TCI-R dimensions were related with having ever received drug orpsychological treatment nor with the age of onset of cocaine use.

Discussion

In our sample of young users of cocaine the personality profile was significantly differentfrom the normative data in the reference population. Furthermore, it was different accordingto the presence of personality disorders following DSM-IV criteria. Finally, personalityprofile was associated to the severity of drug use and with lifetime presence of other AxisI disorders.

The study provides a first approach to the personality disorders arena from a dimensionalview using the most recent version of TCI (a validated tool that has shown its usefulness inpopulations of substance users) to figure out relationships between different personality di-mensions in young cocaine users. It is noteworthy that the present work differs notably fromearlier studies of psychopathology among cocaine users because it has focused specificallyon cocaine users who were recruited from non-treatment settings. As such, the findingsprovide additional perspective on people who are engaged in a form of drug use that isnow entrenched in the street drug scene. However, caution is needed when extrapolatingthese data to other samples of cocaine users. It is crucial to keep in mind that the data arecross-sectional, and it is not possible to know to what extent the personality traits have beeninfluenced by drug use, even though to a large degree they are inherent to the person.

One of the main findings was that the mean Novelty-Seeking, Persistence, Self-Directedness, Cooperativeness, and Self-Transcendence scores of cocaine users were dif-ferent from the general population. In part, these data are consistent with the results obtainedin a nonclinical sample of 98 substance users (students) which showed that the personalitytrait of Novelty-Seeking was associated to the consumption of the most illicit and deviantsubstances, such as heroin or cocaine (Chakroun, Doron, and Swendsen, 2004). Moreover,higher Novelty-Seeking and lower Self-Directedness were found in a study with 108 fe-male addicts (alcohol, heroin, amphetamines, and/or benzodiazepines) when compared tothe general population, although, in contrast to our results, they also found higher HarmAvoidance scores (Gerdner, Nordlander, and Pedersen, 2002). Also, a similar profile hasbeen described in a recent study on Spanish cocaine users seeking treatment (Pedrero, 2006).As has been widely documented in the literature, Novelty-Seeking is the dimension thatconsistently shows higher scores in drug use populations, suggesting behavioral disinhibi-tion (i.e., sensation seeking, novelty seeking, impulsivity, and deviance proneness) as anetiologic factor related to substance abuse (Conway, Kane, Ball, Poling, and Rounsaville,2003).

Special attention was devoted to the study of the association between two personalitydisorder diagnoses defined by DSM-IV (antisocial and borderline) and temperament andcharacter dimensions among cocaine users, because these disturbances have been abun-dantly cited among drug users. Although only 15 subjects received a personality disorder


1388 Herrero et al.

diagnosis and the characteristics of this group made it possible to find some differences,caution is recommended when interpreting these results. These results partially agree withthe findings of a previous study (Gutierrez, Sangorrin, Martin-Santos, Torres, and Torrens,2002), in which illegal substance users with a personality disorders scored higher on HarmAvoidance and lower on Self-Directedness and Cooperativeness. Moreover, our findingsdisagree with others in which no Novelty-Seeking differences were found in the TCI profilein terms of presence personality disorders or not (Fassino, Abbate, Delsedime, Rogna, andBoggio, 2004).

Although Svrakic (Svrakic, Whitehead, Przybeck, and Cloninger, 2002) postulates thatextreme character traits (specifically, low Self-Directedness, low Cooperativeness, and highSelf-Transcendence) are pathognomonic of personality disorders in the general population,in our sample of young cocaine users only low scores in Self-Directedness and Cooper-ativeness have distinguished those with personality disorders. This fact may suggest thathigh scores in Self-Transcendence are not so relevant for a personality disorder diagnosis,in a population of substance users in all of whom Self-Transcendence is high.

Research comparing the personality traits of different main “drug of abuse” subgroupshas found discrepancies: For example, some studies have considered heroin users as be-ing more impulsive and aggressive than cocaine users (Donovan, Soldz, Kelley, and Penk,1998; McCormick, Dowd, Quirk, and Zegarra, 1998), whereas others have not been ableto differentiate cocaine users from users of either heroin or cannabis on such traits (Craig,1988; Greene, Adyanthaya, Morse, and Davis, 1993). Of the many potential explanationsfor the inconsistencies, severity of substance use is considered a likely contributor to theconfusion (Conway, Kane, Ball, Poling, and Rounsaville, 2003). Moreover, there are somestudies supporting the notion of a continuum of personality risk associated to substanceabuse severity (Conway et al., 2002; McGue, Slutske, Taylor, and Iacono, 1997; Windle,1991). Although many studies defined substance abuse severity in terms of the numberof dependence symptoms for a particular substance, we considered a wider ranging cate-gorization, taking into account not only dependence but also abuse and pathological use,for every substance. Although higher severity of cocaine use was associated with lowerCooperativeness and higher Self-Transcendence scores, these results coincide only par-tially with those obtained by Le Bon et al. (2004), since they also found association withNovelty-Seeking, Harm Avoidance and Self-Directedness in patients with heroin or alcoholabuse.

As regards the relationship between Axis I disorders (according to DSM-IV) and di-mensions of TCI-R, our findings using a univariate approach are consistent with previousstudies in which high scores of Harm Avoidance and low scores of Self-Directedness werefound in depressed patients (Arkar et al., 2005; Jylha et al., 2005; Naito, Kijima, and Kita-mura, 2000; Smith, Duffy, Stewart, Muir, and Blackwood, 2005). Although several studieshave suggested that Harm Avoidance has traitlike properties (Farmer et al., 2003; Richter,Eisemann, and Richter, 2000), it is also known that Harm Avoidance scores are positivelycorrelated with depressed mood at the time of personality assessment (Farmer et al., 2003;Hirano et al., 2002). In the present study, these differences remained even when control-ling for current presence of mood disorders. The relationship between mood disorders andHarm Avoidance scores could be addressed in future longitudinal follow-up studies. Onthe other hand, little is known about personality dimensions and psychotic disorders. In thepresent study, higher scores of Self-Transcendence were found in subjects with psychoticdisorders, raising interesting questions as to whether the dimensions have the capability todistinguish between different groups of Axis I disorders. Future studies could address thispoint.



Overall, our results suggest that cocaine users with low Self-Directedness, low Coop-erativeness, and high Self-Transcendence scores in the TCI-R, who have also high severityof substance use and presence of psychiatric comorbidity, are suggestive of a specificphenotype. Future studies taking into account genetic variables will enhance the knowledgeof substance use behavior.

This study highlights the relevance of studying personality from a dimensional ap-proach and provides new data to foster further development of and enhancing knowledgeof personality disorders. Moreover, the findings underscore the utility of a phenotype de-fined according to individual differences in certain personality traits, in severity of cocaineuse and in presence of psychiatric comorbidity. A proper understanding of the role ofpersonality in substance users could help in providing adequate treatment options to thispopulation.

RESUME

Profil de personnalite dans des jeunes consommateurs actuels et reguliers de cocaıne

Dans cette etude on a examine dans un groupe de consommateurs de cocaıne, la relationentre le profil de personnalite et la presence de diagnostiques du DSM-IV et la severitede la consommation. Un total de 120 sujets (46 femmes, age moyen: 23.8 ans) provenantd’endroits non medicaux a Barcelone, Espagne, entre 2003 et 2006 furent evalues avec la(PRISM) et la TCI-R. La majorite des participants avaient termine l’education elementaire,presque la moitie etaient employes, une troisieme partie habitait chez les parents et presqueune quatrieme partie avaient des antecedents criminels. La voie d’administration la plusfrequente etait la nasale (sniffer). Ils utilisaient une moyenne de 1.82 drogues. Les consom-mateurs de cocaıne avec une basse ponctuation a Auto-Direction et Cooperation, et haute aAuto-Transcendance dans le TCI-R, avec une grande consommation de cocaıne et comor-bidite psychiatrique, suggerent un possible phenotype. Les limitations et les implicationsde l’etude sont analysees.

RESUMEN

Perfil de personalidad en jovenes consumidores actuales y regulares de cocaına

Este estudio exploro la relacion que existe entre el perfil de personalidad de una mues-tra de consumidores de cocaına y la presencia de diagnosticos DSM-IV y la intensidaddel consumo. Se evaluaron 120 participantes (46 mujeres; media de edad: 23.8 anos) decontextos no clınicos de Barcelona, Espana, 2003–2006, mediante la Psychiatric ResearchInterview for Substance and Mental Disorders (PRISM) y el Temperament and CharacterInventory-version Revisada (TCI-R). La mayorıa de los participantes tenıa estudios secun-darios como mınimo, casi la mitad trabajaba, la tercera parte vivıa con los padres y casi unacuarta parte tenıa antecedentes legales. La principal vıa de administracion era la esnifaday consumıan una media de 1.82 sustancias. Los consumidores con baja Auto-Direccion,baja Cooperacion y alta Auto-Trascendencia en el TCI-R, con un consumo elevado decocaına y comorbilidad psiquiatrica, sugieren un posible fenotipo concreto. Se comentanlas limitaciones e implicaciones del estudio.


1390 Herrero et al.

THE AUTHORS

M. Jesus Herrero Gascon, Psychologist and Master inClinical Psychology, has been working on drug abuse epi-demiology at the Institut Municipal d’Investigacio Medica(IMIM) since 2003, and is currently focusing on psychi-atric comorbidity in drug abusers. She also works in clin-ical practice.

Antonia Domingo-Salvany, physician with Ph.D. inMedicine, has been working on drug abuse epidemiologyat the Institut Municipal d’Investigacio Medica (IMIM)since 1989, and is currently focusing on psychiatric co-morbidity in drug abusers and health services research.

Marta Torrens, psychiatrist with a Ph.D. in Medicine,has been working in the drug abuse field since 1985,and currently she is Head of the Drug Abuse Unit ofthe Institut of Psychiatry & Drug Addiction-Hospital delMar in Barcelona. Her main research lines are related tomethadone treatment and dual diagnosis in drug abusers.



M. Teresa Brugal Puig, M.D., Ph.D., M.P.H. (BarcelonaAutonomous University), is a Senior researcher on epi-demiology of drug and HIV, Director of the BarcelonaDrug Information System, and Advisor of the EuropeanMonitoring Center for Drugs and Drug Addiction and theAIDS and Mobility Commission. Recently her work hasbeen oriented toward obtaining information to the plan-ning of intervention policies in the drug field, as well asto evaluate the efficacy of interventions implemented bythe different Spanish health administrations.

Fernando Gutierrez, Ph.D., spent 4 years at a Therapeutic Community for drug abusersand completed his doctorate in Psychology on this topic in 1999. Since 1998 he has beenworking as a Clinical Psychologist at the Barcelona’s Hospital Clınic. His primary interestsinclude personality, personality disorders, and psychological adaptation mechanisms.

Glossary

Novelty Seeking: One of the four temperament dimensions proposed in the personality modelof Cloninger. Individuals high in this dimension tend to be quick-tempered, excitable,exploratory, curious, enthusiastic, ardent, easily bored, impulsive, and disorderly.

Harm Avoidance: Temperament dimension in Cloninger’s personality model. Individualshigh in this dimension tend to be cautious, careful, fearful, tense, apprehensive, nervous,timid, doubtful, discouraged, insecure, passive, negativistic, or pessimistic even insituations that do not normally worry other people.

Reward Dependence: Individuals who score high in this temperament dimension tend to betender-hearted, warm, sensitive, dedicated, dependent, and sociable.

Persistence: Individuals high in this temperament dimension tend to be industrious, hard-working, persistent, and stable, despite frustration and fatigue.

Self-Directedness: One of the three character dimensions proposed by Cloninger. Highlyself-directed persons are described as mature, strong, self-sufficient, responsible, reli-able, goal-oriented, and constructive. They have good self-esteem and self-reliance.

Cooperativeness: Individuals high in this character dimension are described as empathetic,tolerant, compassionate, supportive, fair, and principled individuals.

Self-Transcendence: Individuals high in this character dimension tend to be unpretentious,satisfied, patient, creative, selfless, and spiritual. These individuals seem to tolerateambiguity and uncertainty.

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