Nicolas Kambouropoulos

Should personality traits be considered when refining substance misuse treatment programs

The interplay between stable personality characteristics and environmental factors is emphasised in most contemporary approaches to individual differences. This interaction appears to be important in understanding the development of substance use and misuse. Impulsivity related personality traits such as sensation-seeking, novelty seeking, reward-sensitivity and behavioural disinhibition, are strongly linked to adolescent and adult substance use and misuse. The role of anxiety-related traits, in the development of substance misuse is less clear. Nonetheless, anxiety disorders are very common amongst adult substance misusers and almost certainly play a critical role in the maintenance of a substance use disorder and influence treatment effectiveness. The data suggest that personality influences treatment outcomes and yet these individual differences are generally not addressed in treatment. We argue in this review that interventions which are matched to these relevant personality traits may improve treatment outcomes for substance misusers.

Reactivity to alcohol-related cues: Relationship among cue type, motivational processes, and personality

This study examined the relationship between personality traits implicated in the drinking literature (i.e., sensation seeking and anxiety) and reactivity to 2 different alcohol cues. The opportunity to consume alcohol was manipulated, and differences in urge and affective reactivity were assessed. Grays (1987) model of impulsive sensation seeking and anxiety was adopted to investigate relationships between personality and responses to the appetitive (consumption) and aversive (no consumption, nonrewarding) alcohol cues in 40 regular social drinkers. The consumption cue produced increases in appetitive motivation and positive correlations with sensation-seeking traits. The no-consumption cue produced increases in aversive motivation and positive correlations with anxiety-related traits. It was concluded that Grays model of impulsive sensation seeking and anxiety may provide a useful framework for examining the personality correlates of cue reactivity to different cues.

Can emotion-focused coping help explain the link between posttraumatic stress disorder severity and triggers for substance use in young adults?

High rates of posttraumatic stress disorder (PTSD) have been reported among people seeking treatment for substance use disorders (SUDs), although few studies have examined the relationship between PTSD and substance use in young drug users. This study compared levels of substance use, coping styles, and high-risk triggers for substance use among 66 young adults with SUD, with or without comorbid PTSD. Young people with current SUD-PTSD (n = 36) reported significantly higher levels of substance use in negative situations, as well as emotion-focused coping, compared to the current SUD-only group (n = 30). Severity of PTSD was a significant predictor of negative situational drug use, and emotion-focused coping was found to mediate this relationship. The findings underscore the need for youth substance abuse treatment programs to include coping skills training and management of affect regulation for those individuals with comorbid SUD-PTSD.

When social anxiety co-occurs with substance use: Does an impulsive social anxiety subtype explain this unexpected relationship?

Although most conceptualizations of social anxiety emphasise that socially anxious individuals are overtly shy, and utilise avoidant behavioural strategies (e.g., risk-aversion, passivity, and submissiveness), there is tentative support for the existence of an approach-motivated subtype, characterised by risk taking and a greater propensity for substance misuse. It is likely that this subtype may help explain the reported co-occurrence of substance misuse and social anxiety. The current study sought to test via latent class analysis whether an approach-motivated social anxiety subtype could be identified within a community sample. A self-report questionnaire was completed by 351 participants (age: 18-74 years). Two distinct social anxiety subgroups were identified: one characterised by prototypical SAD symptomatology (i.e., behavioural inhibition and risk-avoidance), the second by elevated levels of rash impulsiveness, reward sensitivity, risk-taking and co-occurring substance use problems. The current findings provides support for the existence of a distinct approach-motivated social anxiety subtype and indicates that impulsivity may be critical to understanding the comorbid substance use symptomatology of these individuals.

Modifying the risk associated with an impulsive temperament: a prospective study of drug dependence treatment.

The evidence linking the personality trait of impulsivity and substance misuse is well established. Importantly, impulsivity not only predicts substance misuse problems but has an association with duration in treatment, likelihood of completing treatment and time to relapse. Treatment that focuses on increasing awareness and acceptance of thoughts and emotions may potentially address impulsive behaviour and in this respect improve treatment outcomes for substance misuse. The current paper investigated the relationship between the facet of impulsivity that taps into poor inhibitory control and treatment outcome. In addition, there was a specific focus on ascertaining the impact of an increase in awareness and attentional control measured in 144 adult substance users receiving treatment in a residential therapeutic community. Impulsivity predicted poorer treatment outcome (measured as drug use severity). Increases in awareness and acceptance of emotions and thoughts during treatment were related to better outcome although this was not associated with baseline levels of impulsivity. Clinical and theoretical implications are discussed.

Pathways to social anxiety: The role of reinforcement sensitivities and emotion regulation

Past research has demonstrated a strong relationship between threat sensitivity and social anxiety; however, the relationship between reward sensitivity and social anxiety is less clear. Further, the role that emotion regulation (ER) may play in the expression of social anxiety disorder (SAD) is rarely considered. The current study tested whether two emotion regulation strategies (emotional suppression and cognitive reappraisal) mediated associations between threat sensitivity and reward sensitivity and social anxiety in a community sample (402 adults, 78% female; Mage=32.49, S.D.age=11.53). Path analyses indicated that low reappraisal mediated the relationship between high threat sensitivity and high social anxiety; and both low reappraisal and high suppression mediated the relationship between low reward sensitivity and high social anxiety. These results highlight the potential role that emotion regulation plays in the relationship between trait motivation and social anxiety.

The Phenomenology of Alcohol Cue-Reactivity: A Partial Replication and Extension

Addiction researchers have emphasized that an important element of the subjective craving construct is phenomenology. A recent study conducted by Kambouropoulos and Rock (2009-2010) experimentally investigated individual differences in the phenomenology of alcohol cue-reactivity and found that various phenomenological effects were significantly more intense for the neutral (i.e., water) cue compared to the alcohol cue (i.e., the participants favorite beverage). These results appear incongruent with the ostensibly neutral nature of the water cue and may be an artefact of sequencing effects associated with standard cue-reactivity protocols. The aim of the present study, therefore, was to partially replicate Kambouropoulos and Rocks study by experimentally assessing individual variation in the phenomenology of alcohol cue-reactivity using counterbalanced sequences of neutral cue and alcohol cue presentation. Fifty-eight participants were exposed to counterbalanced sequences of neutral and alcohol cues, and urge to drink and phenomenological responses were measured. Findings indicated that exposure to the alcohol stimulus produced significant changes in volitional control, altered awareness, attention, and joy. These results suggest that examining the phenomenology of alcohol cue presentation may provide additional insights into the nature of alcohol cue responses. Finally, the results appeared to provide preliminary support for the utility of counterbalancing neutral cue and alcohol cue presentation.

Examining the affective tone of alcohol craving in young drinkers

An abundance of research has examined craving and affective responses to alcohol; however, minimal emphasis has been placed on the relationship between craving and affective states at specific time points of alcohol consumption. Fifty-nine university students (28 light drinkers, 31 heavy drinkers) completed assessments of craving, and positive and negative affect at baseline (Time 1), immediately following consumption of a standard drink of alcohol (Time 2), and 20 min post consumption (Time 3). In light drinkers, craving was positively correlated with positive affect at all 3 time points. In heavy drinkers, craving was only correlated with positive affect at Time 2. There were no associations between craving and negative affect at any time point in either group. A subsequent profile analysis revealed parallel profiles of craving and positive affect over time in light drinkers, but not heavy drinkers. At 20 min post alcohol consumption, a moderated regression showed that the relationship between craving and positive affect weakened as level of alcohol use increased. These findings suggest that craving is positively associated with positive affect in light drinkers, but as levels of drinking escalate, this association dissipates.

Motivational drive and alprazolam misuse : a recipe for aggression?

Benzodiazepine-related aggression has received insufficient research attention, in particular little is known about the motivational factors which may contribute to the development of this paradoxical response. The revised Reinforcement Sensitivity Theory provides a theoretical framework from which to understand the relevant underlying motivational processes. The current study aimed to identify the role of approach and avoidance motivational tendencies in the occurrence of benzodiazepine-related aggression. Data regarding benzodiazepine and other substance use, approach and avoidance motivation, and general and physical aggressive behaviour were collected via self-report questionnaires. Participants were a convenience sample (n=204) who reported using benzodiazepines in the previous year. Participants were primarily male (62.7%), aged 18-51 years old. Hierarchical multiple regressions indicated that general and physical aggression were predicted by alprazolam use and Drive, a facet of approach motivation. Overall, lower diazepam use significantly predicted higher levels of general aggression. However, when diazepam-preferring participants were examined in isolation of the larger sample (23.5% of sample), problematic (dependent) diazepam use was associated with greater aggression scores, as was dependence risk for alprazolam-preferring participants (39.7% of sample). The findings highlight the importance of motivational factors and benzodiazepine use patterns in understanding benzodiazepine-related aggression, with implications for violent offender rehabilitation.

Dissociation between wanting and liking for alcohol and caffeine: a test of the Incentive Sensitisation Theory

Limited human studies have directly tested the dissociation between wanting and liking with human substance users, a core tenet of the Incentive Sensitisation Theory (IST). The aim of this study is to test the dissociation between wanting and liking in humans across two commonly used licit substances, alcohol and caffeine. The STRAP-R (Sensitivity To Reinforcement of Addictive and other Primary Rewards) questionnaire was administered to 285 alcohol users (mean age=33.30, SD= 8.83) and 134 coffee users (mean age=33.05, SD=8.10) ranging in their levels of substance use to assess wanting and liking. Findings showed that in high risk alcohol users wanting may drive alcohol consumption more so than liking, compared with low risk alcohol users. However, wanting and liking did not significantly dissociate as alcohol consumption increased. These findings partially support IST. Additionally, IST was not supported in coffee users. It is possible that caffeine functions differently at the neurological level compared with alcohol, perhaps explaining the lack of dissociation emerging in coffee users as caffeine use increased. Nevertheless, the current study makes several contributions to IST research. Future studies should focus on utilising the STRAP-R with a clinically dependent sample to test the dissociation between wanting and liking.