“Leaping before you look”: Impulsivity traits associated with alcohol use for people with lifetime AA or other mutual-help group attendance

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  • “Leaping before you look”: Impulsivity traits associated with alcohol use for people with lifetime AA or other mutual-help group attendance

Greater understanding of personality traits that predict risky alcohol use for people in recovery can help inform personalized recommendations and approaches. This study investigated whether impulsivity, sensation seeking, and other personality traits were associated with alcohol use for people with both history of severe alcohol use disorder and mutual-help attendance, and how these varied by sex.

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recovery science
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WHAT PROBLEM DOES THIS STUDY ADDRESS?

Individualized approaches to treatment and recovery for alcohol use disorder may help engage more people and ultimately improve outcomes. Personality traits are patterns of behavior, thought, and emotion which are relatively stable over time, differ across individuals, are consistent over situations, and influence behavior. Importantly, they are relatively easy to measure and are helpful heuristics for many to understand typical ways they respond to different types of challenges and accomplishments.

Certain personality traits (e.g., neuroticism, broadly referring to a pattern of anxiety, depression, etc. in response to stress) are known to be associated with alcohol use disorders. In addition, research suggests that impulsivity (an inclination towards quick, unplanned actions without concerns for possible negative consequences) is associated with alcohol use outcomes. Impulsivity is a multi-dimensional construct where, in one conceptual model, consists of positive and negative urgency (a tendency to act rashly in response to positive and negative emotions), lack of premeditation (the tendency to not consider the long-term consequences of an action), lack of perseverance (difficulty completing boring/difficult tasks), and sensation-seeking (the tendency to seek excitement and novelty).

The ways in which such traits impact substance use disorder recovery varies from person to person. It is not known exactly why this is the case, but evidence suggests such variances are due to a number of factors, including a person’s sex. There is also evidence that sex assigned at birth plays a role in treatment outcomes. Males are more likely to report heavy alcohol use post-treatment than females. The present study examined how personality related to past year alcohol use in people with severe alcohol use disorder and history of Alcoholics Anonymous (AA) attendance. The authors further examined how these features varied based on participants’ sex assigned at birth.


HOW WAS THIS STUDY CONDUCTED?

This study was a secondary analysis of the Genes, Addiction, and Personality study, a cross-sectional research study that investigated genetic and environmental influences on severe alcohol use disorder. Participants were 2966 individuals who completed an online survey about personality, mental health, and substance use. Though not examined in the present study, participants also provided a DNA sample.

Participants were recruited both in person (i.e., at substance use disorder treatment facilities) and online (e.g., via Facebook advertisements). For the current analysis, however, only data from participants recruited online were used. Eligibility criteria included: 1) being an adult (i.e., 18+ years of age), 2) having a lifetime history of DSM-5 severe alcohol use disorder (6+ symptoms) based on the participant’s “heaviest drinking period”, and 3) having a history of involvement in AA or other mutual-help groups (i.e., participants indicated they had used “AA or other self-help groups” when asked about past addiction treatment).

The goal of this study was to examine how personality traits were associated with alcohol use uniquely across sex assigned at birth for people with history of severe alcohol use disorder and AA or other mutual-help attendance. To measure personality, the authors used two scales. The Big Five Inventory is designed to measure the most common personality traits. For the present study, the authors included items evaluating four traits: extraversion, agreeableness, conscientiousness, and neuroticism. Items for each trait were rated on a five-point scale from 1 (disagree a lot) to 5 (agree a lot) with scores computed for each trait (i.e., higher scores indicate a higher tendency for a specific trait). The Urgency-Premeditation-Perseverance-Sensation Seeking-Positive Urgency (UPPS-P) impulsive behavior scale is a measure of trait impulsivity (rather than “state” impulsivity which fluctuates situation to situation) and includes items for different facets of impulsivity (i.e., positive and negative urgency, lack of premeditation, lack of perseverance, and sensation-seeking). Each item was rated on a 4-point scale from 1 (disagree strongly) to 4 (agree strongly), with higher scores reflecting higher impulsivity.

The primary outcome of this study was past year alcohol use measured by the Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) measure. The AUDIT-C measures alcohol consumption frequency, intensity, and the number of occasions during which participants drank more than 6 standard drinks. Scores of 3 or greater may indicate harmful or hazardous alcohol use.

Analyses examined associations separately for males and females between each personality factor on its own and alcohol use, controlling statistically for sociodemographic factors, family history risk for alcohol problems, as well as lifetime history of depression and adult antisocial behavior. Then they examined all personality traits together at the same time, even if they were not associated with alcohol use in the simpler analyses. These analyses controlled for the following: age, race, family history, relationship status, education, number alcohol use disorder symptoms, depression, and antisocial behaviors in order to try to estimate the independent effect of personality traits on alcohol use.

About 2/3 of participants were female (65.8%) and most self-identified as White (90%) with an average age of about 46 years. The male participants (34.2%) were also predominantly White (87%) but were slightly older (average age was 50 years). Most participants had at least some post-secondary education (e.g., a college degree; 87% and 90% of female and male participants respectively). Roughly half of the participants were in a romantic relationship at the time they were surveyed (52% and 48% of female and male participants respectively). Among female and male participants, 38% and 43% respectively had an AUDIT-C score indicating harmful alcohol use.


WHAT DID THIS STUDY FIND?

Most impulsivity traits associated with alcohol use, but only urgency variables held up when all traits were considered

The figure below depicts impulsivity traits by sex, showing moderate levels of self-reported impulsivity. Regarding associations with alcohol use, when examined on their own, all impulsivity traits apart from sensation seeking were associated with alcohol use with medium-sized effects. When all traits were examined together, however, only positive and negative urgency for females, and positive urgency for males, were associated with alcohol use.

Most general personality traits associated with alcohol use, but not when all traits were considered

The figure below depicts general personality traits by sex, showing moderately high levels of neuroticism but low sensation seeking – on average, they tended to see themselves as conscientious, extraverted, and agreeable. When examined on their own, lower conscientiousness, higher neuroticism, and lower agreeableness were associated with more alcohol use, with small-sized effects. However, none of these were associated with alcohol use when all traits and other factors were analyzed together.


WHAT ARE THE IMPLICATIONS OF THE STUDY FINDINGS?

The results of this study suggest that among those with severe alcohol use disorder who attended AA or another mutual-help group at least once, acting rashly was associated with more alcohol use in both sexes while in females only, lower sensation seeking was associated with more alcohol use. This finding adds to others that also show higher levels of positive and negative urgency – acting quickly when experiencing positive or negative emotions, respectively – predict more alcohol use problems and consequences. Also of note, impulsivity facets were descriptively higher than in undergraduate students, suggesting this group of individuals with lifetime history of severe alcohol use disorder had elevated impulsivity as would be expected. It is critical to mention, however, that these data were measured at a single time point (i.e., they were cross-sectional). Therefore, it cannot be determined whether these personality traits were causally related to alcohol use or if alcohol use – which can impair executive functioning and self-control – was causally related to the experience of acting impulsively, for example. Theoretically, personality traits are long-standing and consistent across situations; however, this cannot be determined from the current research design.

Importantly, the rationale for making lifetime history of AA or other mutual-help part pf the eligibility criteria was unclear given that analyses did not examine more recent participation in AA that might impact alcohol use. It is possible that this AA variable was intended to filter only those with severe alcohol use disorder who had ever been interested in changing their alcohol use. In a related caveat, the study did not have interest in changing one’s alcohol use as a criterion – thus the study likely included a mix of people interested in change and those not interested in change. Because some participants were trying to stop alcohol use while others may not have, the overall implications for recovery, per se, are not clear. Despite these limitations, the study still offers some potential insights into personality traits among those with history of severe alcohol use disorder.

None of the general personality traits were associated with alcohol use in this community sample of individuals with history of severe alcohol use disorder. However, in clinical samples, providing personality assessment feedback may be a promising, low-resource way to engage patients and improve relationships in residential addiction treatment. There is strong rationale that immediate and ongoing feedback to patients on their self-reported indicators of health and well-being will empower patients and improve outcomes. This study highlights the potential for brief assessments of personality to improve care if added to patient measurement and feedback. Given how few studies have examined whether feedback from personality assessments can improve treatment and recovery support engagement and outcomes, and the design constraints in this study outlined above, more research is needed before such a recommendation can be made.


  1. The generalizability of the results are unclear given that the sample was predominantly White, therefore it is unclear how these results generalize to people of color with alcohol use disorders. This is especially important given there is evidence that some people of color may be less likely to attend AA than White people.
  2. It is unclear how engaged participants were in Alcoholics Anonymous (AA) or other mutual-help groups. That is, the authors assessed AA attendance with a single item about any lifetime participation. No details on frequency or duration of Alcoholics Anonymous involvement, and how recently individuals attended. Furthermore, participants may have attended similar self-help groups aside from Alcoholics Anonymous, but there is no way to disaggregate the potential effects of using such alternative treatments on past-year alcohol use.
  3. As described in the Implications section above, the current research cannot tell us about the directionality of the relationship between personality traits and alcohol use because it is cross-sectional. It is unclear if the personality traits measured may have impacted the ways in which participants responded to treatment or vice versa.

BOTTOM LINE

This finding adds to others showing higher levels of positive and negative urgency – acting rashly when experiencing positive or negative emotions, respectively – predict more alcohol use problems and consequences. It is critical to mention, however, that these data were measured at a single time point (i.e., they were cross-sectional). Therefore, it cannot be determined whether a) these personality traits were causally related to alcohol use or b) alcohol use – which can impair executive functioning and self-control – was causally related to the experience of acting impulsively, or c) merely that these things are correlated. There is the possibility that brief personality trait assessment feedback can add to measurement-based practice – but especially given the design nuances in this study, more research is needed to make this recommendation.


  • For individuals and families seeking recovery: This finding adds to others showing higher levels of positive and negative urgency – acting rashly when experiencing positive or negative emotions, respectively – predict more alcohol use problems and consequences. Individuals and families seeking recovery from alcohol use disorder may do well to consider how impulsivity, and emotional reactivity in particular, can increase risk for alcohol use and related problems. It is critical to mention, however, that these data were measured at a single time point (i.e., they were cross-sectional). Therefore, it cannot be determined whether a) these personality traits were causally related to alcohol use or b) alcohol use – which can impair executive functioning and self-control – was causally related to the experience of acting impulsively, or c) merely that these things are correlated.
  • For treatment professionals and treatment systems: This finding adds to others showing higher levels of positive and negative urgency – acting rashly when experiencing positive or negative emotions, respectively – predict more alcohol use problems and consequences. Treatment professionals and treatment systems might consider integrating brief, personality-based assessments into alcohol use disorder treatment. For example, this could be done by incorporating personality assessments into intake evaluations to identify individuals at higher risk of relapse. Some data suggests these assessments could improve patient engagement in care and relationships with staff. There is the possibility that brief personality trait assessment feedback can add to measurement-based practice – but especially given the design nuances in this study, more research is needed to make this recommendation.
  • For scientists: This finding adds to others showing higher levels of positive and negative urgency – acting rashly when experiencing positive or negative emotions, respectively – predict more alcohol use problems and consequences. It is critical to mention, however, that these data were measured at a single time point (i.e., they were cross-sectional). Therefore, it cannot be determined whether a) these personality traits were causally related to alcohol use or b) alcohol use – which can impair executive functioning and self-control – was causally related to the experience of acting impulsively, or c) merely that these things are correlated. Longitudinal studies are needed to assess how personality factors influence long-term recovery trajectories and whether tailored interventions improve outcomes.
  • For policy makers: Policymakers could prioritize initiatives that incorporate personality-based risk factors into public health strategies for alcohol use disorder prevention and treatment. Given the study’s findings on the potential influence of personality traits (e.g., impulsivity), policies could support early screening programs in healthcare and educational settings to identify at-risk individuals before problematic drinking escalates. However, because this study design does not allow for definitive conclusions about the role of personality traits in alcohol use disorder treatment and recovery trajectories, funding for personality research in substance use disorder treatment and recovery support service settings may prove fruitful.

CITATIONS

Lannoy, S., Svikis, D. S., Stephenson, M., Polak, K., Kendler, K. S., & Edwards, A. C. (2024). Personality correlates of past‐year alcohol use in individuals with severe alcohol use disorder and a lifetime history of involvement in alcoholics anonymous. Alcohol: Clinical and Experimental Research, 48(6), 1168-1175. doi: 10.1111/acer.15330.


Stay on the Frontiers of
recovery science
with the free, monthly
Recovery Bulletin

l

WHAT PROBLEM DOES THIS STUDY ADDRESS?

Individualized approaches to treatment and recovery for alcohol use disorder may help engage more people and ultimately improve outcomes. Personality traits are patterns of behavior, thought, and emotion which are relatively stable over time, differ across individuals, are consistent over situations, and influence behavior. Importantly, they are relatively easy to measure and are helpful heuristics for many to understand typical ways they respond to different types of challenges and accomplishments.

Certain personality traits (e.g., neuroticism, broadly referring to a pattern of anxiety, depression, etc. in response to stress) are known to be associated with alcohol use disorders. In addition, research suggests that impulsivity (an inclination towards quick, unplanned actions without concerns for possible negative consequences) is associated with alcohol use outcomes. Impulsivity is a multi-dimensional construct where, in one conceptual model, consists of positive and negative urgency (a tendency to act rashly in response to positive and negative emotions), lack of premeditation (the tendency to not consider the long-term consequences of an action), lack of perseverance (difficulty completing boring/difficult tasks), and sensation-seeking (the tendency to seek excitement and novelty).

The ways in which such traits impact substance use disorder recovery varies from person to person. It is not known exactly why this is the case, but evidence suggests such variances are due to a number of factors, including a person’s sex. There is also evidence that sex assigned at birth plays a role in treatment outcomes. Males are more likely to report heavy alcohol use post-treatment than females. The present study examined how personality related to past year alcohol use in people with severe alcohol use disorder and history of Alcoholics Anonymous (AA) attendance. The authors further examined how these features varied based on participants’ sex assigned at birth.


HOW WAS THIS STUDY CONDUCTED?

This study was a secondary analysis of the Genes, Addiction, and Personality study, a cross-sectional research study that investigated genetic and environmental influences on severe alcohol use disorder. Participants were 2966 individuals who completed an online survey about personality, mental health, and substance use. Though not examined in the present study, participants also provided a DNA sample.

Participants were recruited both in person (i.e., at substance use disorder treatment facilities) and online (e.g., via Facebook advertisements). For the current analysis, however, only data from participants recruited online were used. Eligibility criteria included: 1) being an adult (i.e., 18+ years of age), 2) having a lifetime history of DSM-5 severe alcohol use disorder (6+ symptoms) based on the participant’s “heaviest drinking period”, and 3) having a history of involvement in AA or other mutual-help groups (i.e., participants indicated they had used “AA or other self-help groups” when asked about past addiction treatment).

The goal of this study was to examine how personality traits were associated with alcohol use uniquely across sex assigned at birth for people with history of severe alcohol use disorder and AA or other mutual-help attendance. To measure personality, the authors used two scales. The Big Five Inventory is designed to measure the most common personality traits. For the present study, the authors included items evaluating four traits: extraversion, agreeableness, conscientiousness, and neuroticism. Items for each trait were rated on a five-point scale from 1 (disagree a lot) to 5 (agree a lot) with scores computed for each trait (i.e., higher scores indicate a higher tendency for a specific trait). The Urgency-Premeditation-Perseverance-Sensation Seeking-Positive Urgency (UPPS-P) impulsive behavior scale is a measure of trait impulsivity (rather than “state” impulsivity which fluctuates situation to situation) and includes items for different facets of impulsivity (i.e., positive and negative urgency, lack of premeditation, lack of perseverance, and sensation-seeking). Each item was rated on a 4-point scale from 1 (disagree strongly) to 4 (agree strongly), with higher scores reflecting higher impulsivity.

The primary outcome of this study was past year alcohol use measured by the Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) measure. The AUDIT-C measures alcohol consumption frequency, intensity, and the number of occasions during which participants drank more than 6 standard drinks. Scores of 3 or greater may indicate harmful or hazardous alcohol use.

Analyses examined associations separately for males and females between each personality factor on its own and alcohol use, controlling statistically for sociodemographic factors, family history risk for alcohol problems, as well as lifetime history of depression and adult antisocial behavior. Then they examined all personality traits together at the same time, even if they were not associated with alcohol use in the simpler analyses. These analyses controlled for the following: age, race, family history, relationship status, education, number alcohol use disorder symptoms, depression, and antisocial behaviors in order to try to estimate the independent effect of personality traits on alcohol use.

About 2/3 of participants were female (65.8%) and most self-identified as White (90%) with an average age of about 46 years. The male participants (34.2%) were also predominantly White (87%) but were slightly older (average age was 50 years). Most participants had at least some post-secondary education (e.g., a college degree; 87% and 90% of female and male participants respectively). Roughly half of the participants were in a romantic relationship at the time they were surveyed (52% and 48% of female and male participants respectively). Among female and male participants, 38% and 43% respectively had an AUDIT-C score indicating harmful alcohol use.


WHAT DID THIS STUDY FIND?

Most impulsivity traits associated with alcohol use, but only urgency variables held up when all traits were considered

The figure below depicts impulsivity traits by sex, showing moderate levels of self-reported impulsivity. Regarding associations with alcohol use, when examined on their own, all impulsivity traits apart from sensation seeking were associated with alcohol use with medium-sized effects. When all traits were examined together, however, only positive and negative urgency for females, and positive urgency for males, were associated with alcohol use.

Most general personality traits associated with alcohol use, but not when all traits were considered

The figure below depicts general personality traits by sex, showing moderately high levels of neuroticism but low sensation seeking – on average, they tended to see themselves as conscientious, extraverted, and agreeable. When examined on their own, lower conscientiousness, higher neuroticism, and lower agreeableness were associated with more alcohol use, with small-sized effects. However, none of these were associated with alcohol use when all traits and other factors were analyzed together.


WHAT ARE THE IMPLICATIONS OF THE STUDY FINDINGS?

The results of this study suggest that among those with severe alcohol use disorder who attended AA or another mutual-help group at least once, acting rashly was associated with more alcohol use in both sexes while in females only, lower sensation seeking was associated with more alcohol use. This finding adds to others that also show higher levels of positive and negative urgency – acting quickly when experiencing positive or negative emotions, respectively – predict more alcohol use problems and consequences. Also of note, impulsivity facets were descriptively higher than in undergraduate students, suggesting this group of individuals with lifetime history of severe alcohol use disorder had elevated impulsivity as would be expected. It is critical to mention, however, that these data were measured at a single time point (i.e., they were cross-sectional). Therefore, it cannot be determined whether these personality traits were causally related to alcohol use or if alcohol use – which can impair executive functioning and self-control – was causally related to the experience of acting impulsively, for example. Theoretically, personality traits are long-standing and consistent across situations; however, this cannot be determined from the current research design.

Importantly, the rationale for making lifetime history of AA or other mutual-help part pf the eligibility criteria was unclear given that analyses did not examine more recent participation in AA that might impact alcohol use. It is possible that this AA variable was intended to filter only those with severe alcohol use disorder who had ever been interested in changing their alcohol use. In a related caveat, the study did not have interest in changing one’s alcohol use as a criterion – thus the study likely included a mix of people interested in change and those not interested in change. Because some participants were trying to stop alcohol use while others may not have, the overall implications for recovery, per se, are not clear. Despite these limitations, the study still offers some potential insights into personality traits among those with history of severe alcohol use disorder.

None of the general personality traits were associated with alcohol use in this community sample of individuals with history of severe alcohol use disorder. However, in clinical samples, providing personality assessment feedback may be a promising, low-resource way to engage patients and improve relationships in residential addiction treatment. There is strong rationale that immediate and ongoing feedback to patients on their self-reported indicators of health and well-being will empower patients and improve outcomes. This study highlights the potential for brief assessments of personality to improve care if added to patient measurement and feedback. Given how few studies have examined whether feedback from personality assessments can improve treatment and recovery support engagement and outcomes, and the design constraints in this study outlined above, more research is needed before such a recommendation can be made.


  1. The generalizability of the results are unclear given that the sample was predominantly White, therefore it is unclear how these results generalize to people of color with alcohol use disorders. This is especially important given there is evidence that some people of color may be less likely to attend AA than White people.
  2. It is unclear how engaged participants were in Alcoholics Anonymous (AA) or other mutual-help groups. That is, the authors assessed AA attendance with a single item about any lifetime participation. No details on frequency or duration of Alcoholics Anonymous involvement, and how recently individuals attended. Furthermore, participants may have attended similar self-help groups aside from Alcoholics Anonymous, but there is no way to disaggregate the potential effects of using such alternative treatments on past-year alcohol use.
  3. As described in the Implications section above, the current research cannot tell us about the directionality of the relationship between personality traits and alcohol use because it is cross-sectional. It is unclear if the personality traits measured may have impacted the ways in which participants responded to treatment or vice versa.

BOTTOM LINE

This finding adds to others showing higher levels of positive and negative urgency – acting rashly when experiencing positive or negative emotions, respectively – predict more alcohol use problems and consequences. It is critical to mention, however, that these data were measured at a single time point (i.e., they were cross-sectional). Therefore, it cannot be determined whether a) these personality traits were causally related to alcohol use or b) alcohol use – which can impair executive functioning and self-control – was causally related to the experience of acting impulsively, or c) merely that these things are correlated. There is the possibility that brief personality trait assessment feedback can add to measurement-based practice – but especially given the design nuances in this study, more research is needed to make this recommendation.


  • For individuals and families seeking recovery: This finding adds to others showing higher levels of positive and negative urgency – acting rashly when experiencing positive or negative emotions, respectively – predict more alcohol use problems and consequences. Individuals and families seeking recovery from alcohol use disorder may do well to consider how impulsivity, and emotional reactivity in particular, can increase risk for alcohol use and related problems. It is critical to mention, however, that these data were measured at a single time point (i.e., they were cross-sectional). Therefore, it cannot be determined whether a) these personality traits were causally related to alcohol use or b) alcohol use – which can impair executive functioning and self-control – was causally related to the experience of acting impulsively, or c) merely that these things are correlated.
  • For treatment professionals and treatment systems: This finding adds to others showing higher levels of positive and negative urgency – acting rashly when experiencing positive or negative emotions, respectively – predict more alcohol use problems and consequences. Treatment professionals and treatment systems might consider integrating brief, personality-based assessments into alcohol use disorder treatment. For example, this could be done by incorporating personality assessments into intake evaluations to identify individuals at higher risk of relapse. Some data suggests these assessments could improve patient engagement in care and relationships with staff. There is the possibility that brief personality trait assessment feedback can add to measurement-based practice – but especially given the design nuances in this study, more research is needed to make this recommendation.
  • For scientists: This finding adds to others showing higher levels of positive and negative urgency – acting rashly when experiencing positive or negative emotions, respectively – predict more alcohol use problems and consequences. It is critical to mention, however, that these data were measured at a single time point (i.e., they were cross-sectional). Therefore, it cannot be determined whether a) these personality traits were causally related to alcohol use or b) alcohol use – which can impair executive functioning and self-control – was causally related to the experience of acting impulsively, or c) merely that these things are correlated. Longitudinal studies are needed to assess how personality factors influence long-term recovery trajectories and whether tailored interventions improve outcomes.
  • For policy makers: Policymakers could prioritize initiatives that incorporate personality-based risk factors into public health strategies for alcohol use disorder prevention and treatment. Given the study’s findings on the potential influence of personality traits (e.g., impulsivity), policies could support early screening programs in healthcare and educational settings to identify at-risk individuals before problematic drinking escalates. However, because this study design does not allow for definitive conclusions about the role of personality traits in alcohol use disorder treatment and recovery trajectories, funding for personality research in substance use disorder treatment and recovery support service settings may prove fruitful.

CITATIONS

Lannoy, S., Svikis, D. S., Stephenson, M., Polak, K., Kendler, K. S., & Edwards, A. C. (2024). Personality correlates of past‐year alcohol use in individuals with severe alcohol use disorder and a lifetime history of involvement in alcoholics anonymous. Alcohol: Clinical and Experimental Research, 48(6), 1168-1175. doi: 10.1111/acer.15330.


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l

WHAT PROBLEM DOES THIS STUDY ADDRESS?

Individualized approaches to treatment and recovery for alcohol use disorder may help engage more people and ultimately improve outcomes. Personality traits are patterns of behavior, thought, and emotion which are relatively stable over time, differ across individuals, are consistent over situations, and influence behavior. Importantly, they are relatively easy to measure and are helpful heuristics for many to understand typical ways they respond to different types of challenges and accomplishments.

Certain personality traits (e.g., neuroticism, broadly referring to a pattern of anxiety, depression, etc. in response to stress) are known to be associated with alcohol use disorders. In addition, research suggests that impulsivity (an inclination towards quick, unplanned actions without concerns for possible negative consequences) is associated with alcohol use outcomes. Impulsivity is a multi-dimensional construct where, in one conceptual model, consists of positive and negative urgency (a tendency to act rashly in response to positive and negative emotions), lack of premeditation (the tendency to not consider the long-term consequences of an action), lack of perseverance (difficulty completing boring/difficult tasks), and sensation-seeking (the tendency to seek excitement and novelty).

The ways in which such traits impact substance use disorder recovery varies from person to person. It is not known exactly why this is the case, but evidence suggests such variances are due to a number of factors, including a person’s sex. There is also evidence that sex assigned at birth plays a role in treatment outcomes. Males are more likely to report heavy alcohol use post-treatment than females. The present study examined how personality related to past year alcohol use in people with severe alcohol use disorder and history of Alcoholics Anonymous (AA) attendance. The authors further examined how these features varied based on participants’ sex assigned at birth.


HOW WAS THIS STUDY CONDUCTED?

This study was a secondary analysis of the Genes, Addiction, and Personality study, a cross-sectional research study that investigated genetic and environmental influences on severe alcohol use disorder. Participants were 2966 individuals who completed an online survey about personality, mental health, and substance use. Though not examined in the present study, participants also provided a DNA sample.

Participants were recruited both in person (i.e., at substance use disorder treatment facilities) and online (e.g., via Facebook advertisements). For the current analysis, however, only data from participants recruited online were used. Eligibility criteria included: 1) being an adult (i.e., 18+ years of age), 2) having a lifetime history of DSM-5 severe alcohol use disorder (6+ symptoms) based on the participant’s “heaviest drinking period”, and 3) having a history of involvement in AA or other mutual-help groups (i.e., participants indicated they had used “AA or other self-help groups” when asked about past addiction treatment).

The goal of this study was to examine how personality traits were associated with alcohol use uniquely across sex assigned at birth for people with history of severe alcohol use disorder and AA or other mutual-help attendance. To measure personality, the authors used two scales. The Big Five Inventory is designed to measure the most common personality traits. For the present study, the authors included items evaluating four traits: extraversion, agreeableness, conscientiousness, and neuroticism. Items for each trait were rated on a five-point scale from 1 (disagree a lot) to 5 (agree a lot) with scores computed for each trait (i.e., higher scores indicate a higher tendency for a specific trait). The Urgency-Premeditation-Perseverance-Sensation Seeking-Positive Urgency (UPPS-P) impulsive behavior scale is a measure of trait impulsivity (rather than “state” impulsivity which fluctuates situation to situation) and includes items for different facets of impulsivity (i.e., positive and negative urgency, lack of premeditation, lack of perseverance, and sensation-seeking). Each item was rated on a 4-point scale from 1 (disagree strongly) to 4 (agree strongly), with higher scores reflecting higher impulsivity.

The primary outcome of this study was past year alcohol use measured by the Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) measure. The AUDIT-C measures alcohol consumption frequency, intensity, and the number of occasions during which participants drank more than 6 standard drinks. Scores of 3 or greater may indicate harmful or hazardous alcohol use.

Analyses examined associations separately for males and females between each personality factor on its own and alcohol use, controlling statistically for sociodemographic factors, family history risk for alcohol problems, as well as lifetime history of depression and adult antisocial behavior. Then they examined all personality traits together at the same time, even if they were not associated with alcohol use in the simpler analyses. These analyses controlled for the following: age, race, family history, relationship status, education, number alcohol use disorder symptoms, depression, and antisocial behaviors in order to try to estimate the independent effect of personality traits on alcohol use.

About 2/3 of participants were female (65.8%) and most self-identified as White (90%) with an average age of about 46 years. The male participants (34.2%) were also predominantly White (87%) but were slightly older (average age was 50 years). Most participants had at least some post-secondary education (e.g., a college degree; 87% and 90% of female and male participants respectively). Roughly half of the participants were in a romantic relationship at the time they were surveyed (52% and 48% of female and male participants respectively). Among female and male participants, 38% and 43% respectively had an AUDIT-C score indicating harmful alcohol use.


WHAT DID THIS STUDY FIND?

Most impulsivity traits associated with alcohol use, but only urgency variables held up when all traits were considered

The figure below depicts impulsivity traits by sex, showing moderate levels of self-reported impulsivity. Regarding associations with alcohol use, when examined on their own, all impulsivity traits apart from sensation seeking were associated with alcohol use with medium-sized effects. When all traits were examined together, however, only positive and negative urgency for females, and positive urgency for males, were associated with alcohol use.

Most general personality traits associated with alcohol use, but not when all traits were considered

The figure below depicts general personality traits by sex, showing moderately high levels of neuroticism but low sensation seeking – on average, they tended to see themselves as conscientious, extraverted, and agreeable. When examined on their own, lower conscientiousness, higher neuroticism, and lower agreeableness were associated with more alcohol use, with small-sized effects. However, none of these were associated with alcohol use when all traits and other factors were analyzed together.


WHAT ARE THE IMPLICATIONS OF THE STUDY FINDINGS?

The results of this study suggest that among those with severe alcohol use disorder who attended AA or another mutual-help group at least once, acting rashly was associated with more alcohol use in both sexes while in females only, lower sensation seeking was associated with more alcohol use. This finding adds to others that also show higher levels of positive and negative urgency – acting quickly when experiencing positive or negative emotions, respectively – predict more alcohol use problems and consequences. Also of note, impulsivity facets were descriptively higher than in undergraduate students, suggesting this group of individuals with lifetime history of severe alcohol use disorder had elevated impulsivity as would be expected. It is critical to mention, however, that these data were measured at a single time point (i.e., they were cross-sectional). Therefore, it cannot be determined whether these personality traits were causally related to alcohol use or if alcohol use – which can impair executive functioning and self-control – was causally related to the experience of acting impulsively, for example. Theoretically, personality traits are long-standing and consistent across situations; however, this cannot be determined from the current research design.

Importantly, the rationale for making lifetime history of AA or other mutual-help part pf the eligibility criteria was unclear given that analyses did not examine more recent participation in AA that might impact alcohol use. It is possible that this AA variable was intended to filter only those with severe alcohol use disorder who had ever been interested in changing their alcohol use. In a related caveat, the study did not have interest in changing one’s alcohol use as a criterion – thus the study likely included a mix of people interested in change and those not interested in change. Because some participants were trying to stop alcohol use while others may not have, the overall implications for recovery, per se, are not clear. Despite these limitations, the study still offers some potential insights into personality traits among those with history of severe alcohol use disorder.

None of the general personality traits were associated with alcohol use in this community sample of individuals with history of severe alcohol use disorder. However, in clinical samples, providing personality assessment feedback may be a promising, low-resource way to engage patients and improve relationships in residential addiction treatment. There is strong rationale that immediate and ongoing feedback to patients on their self-reported indicators of health and well-being will empower patients and improve outcomes. This study highlights the potential for brief assessments of personality to improve care if added to patient measurement and feedback. Given how few studies have examined whether feedback from personality assessments can improve treatment and recovery support engagement and outcomes, and the design constraints in this study outlined above, more research is needed before such a recommendation can be made.


  1. The generalizability of the results are unclear given that the sample was predominantly White, therefore it is unclear how these results generalize to people of color with alcohol use disorders. This is especially important given there is evidence that some people of color may be less likely to attend AA than White people.
  2. It is unclear how engaged participants were in Alcoholics Anonymous (AA) or other mutual-help groups. That is, the authors assessed AA attendance with a single item about any lifetime participation. No details on frequency or duration of Alcoholics Anonymous involvement, and how recently individuals attended. Furthermore, participants may have attended similar self-help groups aside from Alcoholics Anonymous, but there is no way to disaggregate the potential effects of using such alternative treatments on past-year alcohol use.
  3. As described in the Implications section above, the current research cannot tell us about the directionality of the relationship between personality traits and alcohol use because it is cross-sectional. It is unclear if the personality traits measured may have impacted the ways in which participants responded to treatment or vice versa.

BOTTOM LINE

This finding adds to others showing higher levels of positive and negative urgency – acting rashly when experiencing positive or negative emotions, respectively – predict more alcohol use problems and consequences. It is critical to mention, however, that these data were measured at a single time point (i.e., they were cross-sectional). Therefore, it cannot be determined whether a) these personality traits were causally related to alcohol use or b) alcohol use – which can impair executive functioning and self-control – was causally related to the experience of acting impulsively, or c) merely that these things are correlated. There is the possibility that brief personality trait assessment feedback can add to measurement-based practice – but especially given the design nuances in this study, more research is needed to make this recommendation.


  • For individuals and families seeking recovery: This finding adds to others showing higher levels of positive and negative urgency – acting rashly when experiencing positive or negative emotions, respectively – predict more alcohol use problems and consequences. Individuals and families seeking recovery from alcohol use disorder may do well to consider how impulsivity, and emotional reactivity in particular, can increase risk for alcohol use and related problems. It is critical to mention, however, that these data were measured at a single time point (i.e., they were cross-sectional). Therefore, it cannot be determined whether a) these personality traits were causally related to alcohol use or b) alcohol use – which can impair executive functioning and self-control – was causally related to the experience of acting impulsively, or c) merely that these things are correlated.
  • For treatment professionals and treatment systems: This finding adds to others showing higher levels of positive and negative urgency – acting rashly when experiencing positive or negative emotions, respectively – predict more alcohol use problems and consequences. Treatment professionals and treatment systems might consider integrating brief, personality-based assessments into alcohol use disorder treatment. For example, this could be done by incorporating personality assessments into intake evaluations to identify individuals at higher risk of relapse. Some data suggests these assessments could improve patient engagement in care and relationships with staff. There is the possibility that brief personality trait assessment feedback can add to measurement-based practice – but especially given the design nuances in this study, more research is needed to make this recommendation.
  • For scientists: This finding adds to others showing higher levels of positive and negative urgency – acting rashly when experiencing positive or negative emotions, respectively – predict more alcohol use problems and consequences. It is critical to mention, however, that these data were measured at a single time point (i.e., they were cross-sectional). Therefore, it cannot be determined whether a) these personality traits were causally related to alcohol use or b) alcohol use – which can impair executive functioning and self-control – was causally related to the experience of acting impulsively, or c) merely that these things are correlated. Longitudinal studies are needed to assess how personality factors influence long-term recovery trajectories and whether tailored interventions improve outcomes.
  • For policy makers: Policymakers could prioritize initiatives that incorporate personality-based risk factors into public health strategies for alcohol use disorder prevention and treatment. Given the study’s findings on the potential influence of personality traits (e.g., impulsivity), policies could support early screening programs in healthcare and educational settings to identify at-risk individuals before problematic drinking escalates. However, because this study design does not allow for definitive conclusions about the role of personality traits in alcohol use disorder treatment and recovery trajectories, funding for personality research in substance use disorder treatment and recovery support service settings may prove fruitful.

CITATIONS

Lannoy, S., Svikis, D. S., Stephenson, M., Polak, K., Kendler, K. S., & Edwards, A. C. (2024). Personality correlates of past‐year alcohol use in individuals with severe alcohol use disorder and a lifetime history of involvement in alcoholics anonymous. Alcohol: Clinical and Experimental Research, 48(6), 1168-1175. doi: 10.1111/acer.15330.


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