Addictive personality

DEFINITION: Although a composite personality type predisposed to addiction has long been a popular concept, numerous studies have struggled to uncover that specific type. Prevalent in earlier literature is the notion of a character flaw that leads inevitably to addiction. This idea has been replaced by modern research into addiction and personality, which owes considerably more to neurobiology and neuroimaging than to psychodynamics. In the twenty-first century, research has focused on broad-based personality traits—primarily impulsivity and disinhibition—that are linked to addictive behavior and are anatomically seated in the brain.

Personality Components of Addiction

Unplanned, spontaneous reaction to a stimulus without regard for adverse consequences is the hallmark of impulsivity. Insensitivity to consequences is a critical prerequisite for addiction. Impulsivity impels the choice of immediate rewards over the promise of delayed, albeit greater, rewards. Early in addiction, impulsivity is a strong impetus for experimenting with drugs.

Disinhibition is closely related to impulsivity, a tendency to engage in risk-taking, sensation-seeking behaviors without constraints. Like impulsivity, disinhibition involves loosening self-regulatory controls and disregarding the potentially disastrous consequences of maladaptive behavior. Both traits closely dovetail with the salient elements of addiction: behavior that confers a pleasure, benefit, or relief from internal stress; behavior that has escaped the person’s control; and behavior that is continued despite adverse consequences.

Addiction cannot be understood without the concept of executive function. An umbrella term rather than an individual trait, executive function is a supervisory cognitive process that integrates complex processes and mechanisms that govern behavior. The purview of executive function, anchored within the prefrontal cerebral cortex, includes reasoning skills, purposeful decision-making, and the capacity to fend off distraction. Conscious control of thoughts and actions is implicit in executive function. When the interaction of emotional processing with behavioral restraints becomes impaired, addictive behavior and compulsions can take hold. Deficits in these mechanisms predispose and contribute to addiction.

Impulse-Control Disorders and Addiction

In accordance with updated research findings, the term addiction encompasses behaviors and substances. Impulse-control disorders (ICDs) are a group of related behavioral disorders listed in the fifth editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5 and DSM-5-TR). The traditional ICDs include compulsive gambling, kleptomania, and pyromania.

The person with an ICD cannot resist the impulse to engage in potentially harmful behavior despite adverse consequences—even possible criminal charges. Some internal tension precedes the behavior, which the behavior alleviates. A person with an ICD is typically a high scorer on measures of impulsivity and sensation-seeking. Descriptions of disinhibition, impulsivity, substance addiction, and behavioral addiction have obvious parallels; loosened controls and lessened restraints are integral to all. Distinctions between ICDs and substance addictions have blurred, in particular, because similarly impaired neurophysiologic mechanisms underlie both.

Compulsive gambling has been termed a behavioral, or nondrug, addiction. It has been extensively studied as a model of the addiction process, in part because it does not cause the confounding effects of drugs on the brain. Defective processing of rewards and punishment, implicated in substance addiction, is a characteristic of compulsive gamblers. Sensitivity to monetary gains and losses alike is decreased. Compulsive gamblers will choose immediate monetary gains over the promise of higher, but delayed, gains. This pattern is known as delay discounting, reflecting maladaptive decision-making, and impaired executive functioning. The trait predicts relapse in compulsive gambling.

Changes in the Brain

Whether it involves a substance or a behavior, addiction has a neurobiological basis. The compulsions and lack of control that characterize addiction have counterparts in the brain’s neurophysiology. Neuroimaging techniques have made it possible to trace addiction-related personality traits to metabolic activity in specific parts of the brain.

Regions of the prefrontal cerebral cortex exercise control over most facets of personality that participate in addiction, notably decision-making and regulation of emotion-laden behavior. In addition to inhibitory control functions, frontal cortical regions govern the reward-related behavior that is impaired in addicted persons. Chronic substance abusers have shown, in studies that measure neuropsychologic traits, deficits in decision-making and executive and inhibitory abilities. These impairments parallel abnormalities in prefrontal cortex areas observed in neuroimaging studies.

Abnormal metabolic activity in persons with substance dependence has been observed in the orbitofrontal cortex, a specific area in the prefrontal cortex (directly behind the forehead). This region is considered a significant participant in critical executive functions—emotional processing, impulse control, and working memory. Dysfunction in the orbitofrontal cortex impairs the ability to assess future consequences. The orbitofrontal cortex will direct a decision to set aside immediate gratification in favor of greater delayed rewards.

The involvement of the neurotransmitter dopamine is further evidence of neural participation in addictive processes. Dopamine is believed to act on mechanisms of expectation and reward. Cocaine and amphetamines both increase dopamine levels and dopaminergic transmission. Appetizing food and addictive drugs have a comparable effect in raising levels of extracellular dopamine.

Personality traits that pervade neurophysiologic and neuropsychologic studies of addiction have also emerged in genetic studies. Genes make an early contribution to addictive behaviors, determining the expression of the vulnerabilities that promote addiction. The finding of high heritability for behavioral disinhibition is based on samples of adolescent monozygotic and dizygotic twin pairs. Genetically determined predisposition to behavioral disinhibition, which is related to early-onset substance addiction, is expressed in parts of the brain affecting impulsivity and reward systems. Genetic studies have linked several genes to impulsivity and addiction. Alcohol, nicotine, and cocaine addictions have particularly strong genetic roots.

In the twenty-first century, research has continued into addictive personalities. Studies have further associated neuroticism—the tendency for individuals to have negative emotions and experience stress—and impulsivity with substance and behavioral addictions. Research into effective coping mechanisms has proved beneficial in this area. Studies have also increasingly pointed to the association of distinct personality types with specific addictions and behaviors. Further, genetic predisposition to addictive substances and behaviors is believed to account for between 40 and 60 percent of an individual's susceptibility to addiction, according to the Cleveland Clinic in 2022. Environmental factors, such as an individual's childhood or cultural and social contexts, are also considered essential to understanding addiction. 

Bibliography

Erickson, Carlton K. The Science of Addiction: From Neurobiology to Treatment. Norton, 2007.

Gerrettsen, Isabelle. "Is There Such a Thing as an Addictive Personality?" BBC, 8 May 2023, www.bbc.com/future/article/20230505-is-there-such-a-thing-as-an-addictive-personality. Accessed 21 Aug. 2024.

Holloran, Patricia. Impaired: A Nurse’s Story of Addiction and Recovery. Kaplan, 2009.

"Is Addiction Hereditary?" Cleveland Clinic, 28 June 2022, health.clevelandclinic.org/is-addiction-genetic. Accessed 21 Aug. 2024.

"Is There Really Such a Thing as an Addictive Personality?" Neuroscience News, 10 Aug. 2022, neurosciencenews.com/addictive-personality-21217. Accessed 16 Nov. 2022.

"New NIH Study Reveals Shared Genetic Markers Underlying Substance Use Disorders." National Institute on Drug Abuse, 22 Mar. 2023, nida.nih.gov/news-events/news-releases/2023/03/new-nih-study-reveals-shared-genetic-markers-underlying-substance-use-disorders. Accessed 20 Aug. 2024.

Zilberman, Noam, et al. "Personality Profiles of Substance and Behavioral Addictions." Addictive Behaviors, vol. 82, 2018, pp. 174–81, doi:10.1016/j.addbeh.2018.03.007. Accessed 30 Aug. 2024.