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Record: 1 Do men with excessive alcohol consumption and social stability have an addictive personality? BERGLUND, KRISTINA ROMAN, ERIKA BALLDIN, JAN BERGGREN, ULF ERIKSSON, MATTS GUSTAVSSON, PETTER FAHLKE, CLAUDIA Scandinavian Journal of Psychology; June 2011, Vol. 52 Issue: Number 3 p257-260, 4p 00365564; 14679450 Department of Psychology, University of Gothenburg, Sweden Sahlgrenska Academy at University of Gothenburg, Institute of

Clinical Neuroscience and Physiology, Department of Psychiatry and Neurochemistry Sweden Department of Neurobiology, Care Science and Society,

Karolinska Institutet, Sweden Berglund, K., Roman, E., Balldin, J., Berggren, U., Eriksson, M., Gustavsson, P. & Fahlke, C. (2011). Do men with excessive alcohol consumption and social stability have an addictive personality? Scandinavian Journal of Psychology52, 257–260. 20110506 20014; 10002 23846377 E-Journals

Do men with excessive alcohol consumption and social stability have an addictive personality?

Berglund, K., Roman, E., Balldin, J., Berggren, U., Eriksson, M., Gustavsson, P. & Fahlke, C. (2011). Do men with excessive alcohol consumption and social stability have an addictive personality? Scandinavian Journal of Psychology52, 257–260. The existence of an "addictive" personality has been extensively debated. The current study investigated personality in male individuals with excessive alcohol consumption (n = 100) in comparison to a population‐based control group (n = 131). The individuals with excessive alcohol consumption were recruited by advertisements in a regional daily newspaper and controls from a population based Swedish Twin Registry. Personality was assessed by the Karolinska

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Scales of Personality (KSP). Comparisons were made with normative data. Furthermore, by using a multivariate projection‐based approach (Principal Component Analysis; PCA), hidden structures of traits and possible relationships among the individuals with excessive consumption and the controls was investigated. The individuals with excessive alcohol consumption as well as the controls had mean values within the normative range in all scales of the KSP. Moreover, the PCA analysis revealed no systematic between‐group separation. Taken together, this result demonstrates that male individuals with excessive alcohol consumption do not have a personality different from that of a general population, which supports the notion of no "addictive personality".

Keywords: men; excessive alcohol consumption; Personality

There have been several attempts to describe individuals with excessive alcohol consumption according to personality and other characteristics and then classify them into cluster groups or multidimensional typologies. Besides the typologies of alcoholism by [ 2] and [15], one of the most commonly used typology is the type 1 and type 2 alcoholism developed by [ 6]. According to this classification individuals with type 1 alcoholism are characterized by social stability with late onset of alcoholism, few psychopathological symptoms and social complications ([ 7]). In contrast, the type 2 alcoholics have an earlier onset of alcoholism, more severe dependence with serious social and medical consequences due to their drinking behavior and also a more severe psychopathology ([ 6], [ 7]; [25]). Studies have also found that type 2 alcoholics have a different personality profile in comparison to type 1 alcoholics, characterized by sensation seeking, impulsiveness, monotony avoidance and aggressiveness ([ 7]; [27]). Furthermore, they have a lower degree of harm avoidance and less feelings of guilt ([ 7], [27]). This personality pattern has some resemblance with various personality disorders. In fact, some researchers have, for example, proposed that type 2 alcoholism rather represents a separate diagnostic entity, the antisocial personality disorder, than alcoholism itself ([22]). The personality profile of type 2 individuals is thus fairly well investigated and discussed in the literature ([ 6], [ 7], [24]). Less is known whether Cloninger's type 1 alcoholics also are characterized by such a distinctive personality pattern as their type 2 counterpart.

The majority of individuals with excessive alcohol consumption have characteristics resembling those of type 1 alcoholics ([ 7]), that is, few social complications and psychopathological symptoms, and late onset of alcohol‐related problems (see [ 4]; [21]). To our knowledge, there are no studies which have investigated whether individuals with excessive alcohol consumption per se are characterized by specific personality patterns.

Aim The main objective of the present study was to investigate personality traits in a group of male individuals with excessive alcohol consumption and in controls by comparison with normative data and also by a multivariate projection‐based approach. For the latter purpose, principal component analysis (PCA) was used for pattern recognition and image compression, thus identifying the most important gradients, that is, revealing the hidden structure of traits ([11]). Personality traits were investigated by using the

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Karolinska Scales of Personality (KSP), which quantifies individual differences in habitual, overt behavior preferences, cognitive style and reaction to a given situation ([20]).

Method

Participants Male individuals (n = 100) with excessive alcohol consumption were recruited by advertisements in a regional daily newspaper. The advertisements were entitled with the questions: "Do you drink more alcohol than you actually want?" followed by "Are you male and between 18–65 years, healthy and with a permanent residence?" Excessive alcohol consumption was defined as consuming more than three standard drinks of alcohol (about 40 g of pure alcohol) per day ([16]). To be included in the study they also had to be employed or living on a pension. They had to be without physical or psychiatric disorders not associated with excessive alcohol intake or have abuse or dependence on substances other than alcohol and nicotine. The subjects in the present study have been included in earlier studies of ours, when investigating possible pharmacotherapeutical interventions for alcohol‐dependence ([ 3]; [ 9]; [10]). However, data for the personality profiles have only been published for a sub‐group (n = 33) of these individuals ([ 5]).

For the PCA analysis a control group was recruited from the ongoing population‐based Swedish Adoption/Twin Study of Ageing (SATSA), which consists of twins separated at an early age and reared apart and a matched sample of twins who were reared together ([18]). In 1995 twin pairs from the SATSA cohort born in 1935 or later were considered eligible for participation in a substudy on the relationship between personality and health ([12]). Out of 194 males in the SATSA cohort 136 gave their informed consent and answered a postal survey (response rate 70%). Of these individuals, five had too many missing data; therefore 131 individuals were included in this study as controls.

This investigation has been approved by the Ethics Committee of Göteborg and Karolinska Institutet, Stockholm.

Procedure After a telephone interview/screening, eligible individuals with excessive alcohol consumption were invited for an examination at the research center. They were examined psychiatrically using a semi‐ structured interview by an experienced psychiatrist from the alcoholism treatment unit at a University Hospital. This interview also included questions whether the subjects fulfilled the DSM‐IV criteria for alcohol abuse or dependence ([ 1]). In addition, they were requested to estimate for how long a time‐ period (in years) they had consumed this excessive level of alcohol. The age of the subjects at onset of excessive alcohol consumption could thus be calculated and recorded. Determination of illicit drugs and bensodiazepines in urine samples was also performed using suitable laboratory screening procedures in order to follow the exclusion criteria. During two weeks thereafter individuals had to record their daily alcohol consumption on a self‐monitoring form called an alco‐card (for details, see [ 3]).

After these two weeks an experienced research nurse at the research center assessed possible

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depressive and anxiety symptoms using the Hamilton Depression Scale (HDS; [14]; total sum of scores ranging from 0–52) and Hamilton Anxiety Scale (HAS; [13]; total sum of scores ranging from 0–56), respectively. The nurse also administered the self‐rating scale KSP for assessment of the personality profile, see below.

Assessment of personality The Karolinska Scales of Personality (KSP) comprises 135 items with a four‐point response format grouped in 15 scales ([19]; [20]). Four scales are related to anxiety proneness (i.e. somatic anxiety, psychic anxiety, muscular tension and psychasthenia), three scales to vulnerability for disinhibitory psychopathology (i.e. impulsiveness, monotony avoidance and socialization) and six scales to aggressiveness and hostility (i.e. verbal aggression, indirect aggression, irritability, suspicion, guilt and inhibition of aggression). The remaining two scales are detachment and social desirability.

Statistics In the present study all individual raw data from the personality test KSP was transformed into normative T‐scores (mean ± SD: 50 ± 10) ([12]; [20]).

The Soft Independent Modelling of Class Analogy (SIMCA) Principal Component Analysis (PCA) was used for pattern recognition and image compression. One advantage of this PCA is that it handles many variables and few observations as well as few variables and many observations. The SIMCA PCA is a projection method which can deal with non‐linear relationships, based on how the various measures for each individual form a multidimensional space. Thus, the individuals and not the groups (i.e. individuals with excessive alcohol consumption and controls) are tested in this model. This PCA method includes "scaling" and "mean‐centering" to facilitate that the variables are given the same weight in the model. The method is designed to extract and display the systemic variation in a data set. The PCA creates a score plot showing a summary of the relationship among the individuals and a loading plot identifying variables important for creating these relationships, that is, the different personality dimensions of KSP. How much a variable contributes can be read from the loading plot. The closer to the origin of coordinates the more the variable contributes to the pattern recognition ([11]; [29]). The SPSS 15.0 and SIMCA‐P + 11.5 software (Umetrics AB, Umeå, Sweden) were used for the analyses. Differences were considered statistically significant at p < 0.05.

Results

Background data At the time of investigation, the individuals with excessive alcohol consumption had an age (mean ± sd; range) of 49 ± 7 (28–64) years. Out of the individuals, 66 fulfilled the DSM‐IV criteria for alcohol‐ dependence and the remaining 34 the criteria for alcohol abuse. Age at onset of excessive alcohol consumption was 40 ± 10 years (n = 96) and the reported duration of such consumption was 9 ± 8 years (n = 95). The scores for HDS and for HAM were within the normal range (3.2 ± 3.9 and 7.4 ± 6.8 [n = 84], respectively).

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The age of the control group was 53 ± 7 (38–61) years. In this group 85% reported that they were married (or living together with a partner) and 84% were employed (8% non‐employed and 8% retired).

Patterns of personality profiles among male individuals with excessive alcohol consumption an... The individuals with excessive alcohol consumption as well as the controls had mean values within the normative range (T‐scores mean ± 2 SD; 30–70), in all 15 scales of the KSP, see Fig. 1a and 1b.

Graph: 1 T‐scores (mean ± SD) for personality traits as assessed by the Karolinska Scales of Personality: (a) the T‐scores for male individuals with excessive alcohol consumption (n = 100); (b) the T‐ scores for the male controls (n = 131). Note: SA = somatic anxiety, PA = psychic anxiety, MT = muscular tension, PS = psychasthenia, IM = impulsiveness, MA = monotony avoidance, SO = socialization, IA = indirect aggression, VA = verbal aggression, IR = irritability, SU = suspicion, GU = guilt, IoA = inhibition of aggression, DE = detachment and SD = social desirability.

The systematic variance of individuals with excessive alcohol consumption and controls in the scales of the KSP was investigated using the PCA. The score plot indicated no between‐group separation (see Fig. 2a). There was, however, significantly more outliers in the group of individuals with excessive alcohol consumption (n = 11; 11%) in comparison to controls (n = 4; 3%); χ = 4,94, 1 df, p < 0.05. The majority of the outliers in the group of individuals with excessive alcohol consumption had higher psychic anxiety and lower impulsiveness and monotony avoidance. Figure 2b shows how the dimensions of the KSP loaded in the model, regardless of the two groups. Dimensions appearing close to the origin are less significant, whereas dimensions appearing at some distance are more important. Psychic anxiety and impulsiveness loaded opposite with the largest span to each other, which indicates an inverse relationship between these two dimensions.

Graph: 2 (a) the PCA score plot for male individuals with excessive alcohol consumption (n = 100) and male controls (n = 131). The ellipse denotes the limit for 2 SD; (b) the PCA loading plot for the 15 dimensions of the KSP for both groups together. Note: SA = somatic anxiety, PA = psychic anxiety, MT = muscular tension, PS = psychasthenia, IM = impulsiveness, MA = monotony avoidance, SO = socialization, IA = indirect aggression, VA = verbal aggression, IR = irritability, SU = suspicion, GU = guilt, IoA = inhibition of aggression, DE = detachment and SD = social desirability.

Discussion Our hypothesis that male individuals with excessive alcohol consumption do not have a specific "addictive" personality, was confirmed in this study. Thus, this group as well as the population‐based control group had mean values within the normative range in all scales of the KSP. Furthermore the score plot in the PCA did not indicate a between‐group separation. Our findings, obtained by either norm group comparisons or through the use of the statistical method of PCA, are thus in agreement with our own previous findings ([ 5]; [ 9]) that individuals with excessive alcohol consumption do not differ in personality patterns from a general reference population as assessed by the Temperament and Character Inventory ([ 8]). These results are also in agreement with the notion that there exists little empirical evidence for a certain "addictive personality" (e.g. [17]; [23]; [26]; [28]) at least regarding individuals with excessive

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alcohol consumption resembling either type 1 alcoholics ([ 6]) or those with social stability ([ 4]; [21]).

Despite no between‐group separation in the PCA analysis, there was, however, more outliers in the group of individuals with excessive alcohol consumption (11%) as compared to controls (3%). The majority of these outliers had higher psychic anxiety and lower impulsiveness scores. According to the definition of KSP ([20]), higher scores of the dimension psychic anxiety reflect anxiousness, lack of self‐confidence and social anxiety (i.e. neuroticism or negative emotionality). Lower scores of the dimension impulsiveness reflect well‐planned behavior and less acting on the spur of the moment. Since this study is cross‐sectional, we cannot conclude whether this deviating personality pattern in the outliers had a causal role in the development of alcoholism, or if this personality pattern rather is a consequence of excessive alcohol consumption. It should, however, be emphasized that 89% of male individuals with excessive alcohol consumption have personality traits within the normal range.

There are some limitations in the present study. First, only middle‐aged men were included in this study. Secondly, they were recruited by advertisements, mainly aimed to investigate pharmacotherapeutical interventions for excessive alcohol consumption ([ 3]; [ 9], [10]). These limitations may impede the generalization of the findings to other groups of individuals with excessive alcohol consumption. Moreover, the control group was recruited from a population‐based Swedish Twin Registry ([18]). It cannot be excluded that some individuals within that group also had excessive alcohol consumption. Finally, it may be argued that the samples were relatively small for such statistical analysis as PCA. It should, however, be noted that the total sample was 231 individuals.

Conclusion The majority of male individuals with excessive alcohol consumption, recruited by advertisement and at the time of the study not participating in any treatment, do not have a personality different from that of a general population. This finding thus supports the notion that there exists no "addictive" personality. As socially stable men with excessive alcohol consumption may represent the majority of the population with alcohol problems, this finding may be of importance when formulating national guidelines for care‐giving and treatment of this group.

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~~~~~~~~ By KRISTINA BERGLUND; ERIKA ROMAN; JAN BALLDIN; ULF BERGGREN; MATTS ERIKSSON; PETTER GUSTAVSSON and CLAUDIA FAHLKE

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