We recently came across an article which satisified some of our curiosity with regards to two important theoretical and research considerations in relation to both the accurate definition of  the so-called “addictive or alcoholic personality “, which has falling out of fashion in terms of recent research but which still intrigues some researchers, while also addressing, in passing, an issue of so-called co-morbidity which is reported to be high in alcoholics, particularly generalized anxiety disorder (GAD).

We have written in the past about co-morbidities and whether the prevalence of co-occurring conditions or psychiatric disorders such as GAD are as prevalent as many researchers suggest.

We will discuss difficulties with measuring co-morbidities in later blogs. The study we cite here appears to be reporting that  so-called anxiety reported here in this participant pool of alcoholic dependent people were  transient. This tallies with our own ancedotal evidence of anxiety disappearing as recovery proceeds or in the words of this study “high state anxiety unlike those with anxiety neurosis, who have a high trait anxiety. This indicates that anxiety in alcohol-dependent individuals is transitory, varies in intensity and fluctuates over time, and can be easily modified.”

This type of finding outlines difficulties in diagnosing GAD in alcoholics and supports the idea that anxiety is transient. In fact we suggest that the symptoms of anxiety often expressed in alcoholics may be the result of escalating chronic stress and emotional dysregulation in the addiction cycle and which appears to lessen or disappear in recovery or be provoked by situations.

Potential alcoholics tend to be emotionally immature, expect a great deal of the world, require an inordinate amount of praise and appreciation, react to failure with marked feelings of hurt and inferiority, have a low frustration tolerance, and feel inadequate and unsure of their abilities to fulfil expected male or female roles.¹

This study (1) found significantly higher scores on extroversion which indicates that alcohol-dependent subjects are characterized by traits such as being more assertive, dominant, sociable, carefree and venturesome as compared to non-dependent people. This finding is in agreement with that of Mathew and Baby¹³

Alcohol-dependent patients also obtained significantly higher scores on the neuroticism dimension. This indicates that they are significantly more emotional, frequently anxious and/or depressed, moody and tense. Similar results were reported in earlier studies.^12,15

Among the personality traits studied in alcohol-dependent individuals, antisocial personality has been looked into most often.¹ In this study alcohol-dependent subjects obtained significantly higher scores which is in agreement with the findings of Neeliyara et al.¹⁶ A longitudinal study of men older than 40 years also revealed that antisocial behaviour in adolescence is the sole individual predictor of alcoholism.¹⁷  However, it must be pointed out here that the high Pd scores in alcohol-dependent patients indicate a transitory state, which may be amenable to change with treatment. Our finding that alcohol-dependent patients showed disturbances in the depression, mania, schizophrenia, psychopathic deviance and anxiety scales is consistent with previous research that the emotional disturbance in people with substance abuse is broad-based, variable and non-specific.¹⁸

Alcohol-dependent individuals also obtained significantly higher trait and state anxiety scores.  These findings support those of a few earlier studies.^14,16

This aspect may be aetiologically significant in alcohol dependence. Anxiety has been suggested to be an important factor in the initial development and subsequent maintenance of alcohol abuse and dependence. Some patients use alcohol as a medication for the treatment of anxiety. Unfortunately, an accurate diagnosis of anxiety disorders is difficult to make, since current anxiety symptoms may be secondary to alcohol withdrawal rather than reflecting underlying anxiety disorders.¹⁹ The findings of this study also reveal that alcohol-dependent individuals are different from those with anxiety neurosis, since they have a high state anxiety unlike those with anxiety neurosis, who have a high trait anxiety. This indicates that anxiety in alcohol-dependent individuals is transitory, varies in intensity and fluctuates over time, and can be easily modified.

 

One of the sources of anxiety is a low level of self-esteem, fear of disapproval from significant people, loss of position, prestige, stature or self-esteem.¹⁶ Thus, these findings also support our finding that alcoholics have low self-esteem.

Patients with alcohol dependence experience significantly more stressful life events in the past year and over their lifetime. These findings are in line with previous reports.^13,14,20.

Men who are lifelong abstainers experience fewer life events than problem drinkers. Alcoholics may offset stress-induced emotional distress by resorting to drink which, in turn, might lead to a further increase in negative life events.

A person’s self-structure is an important aspect of his personality. A healthy personality is manifested when an individual has a positive attitude towards him/herself. Studies in this area have shown that psychiatric patients have unhealthy self-structures by way of poor self-concept. In this view, alcohol-dependent individuals suffer from lowered feelings of self-esteem, pervasive feelings of inferiority and powerlessness, coupled with unusually strong inhibitions against the expression of hostile or aggressive impulses. In the present study, alcohol-dependent individuals had significantly lower self-esteem as compared with normal subjects. This finding is in agreement with that of Neeliyara et al.¹⁶ This indicates that alcohol-dependent individuals have less positive self-feelings and more feelings of alienation and isolation.

Higher numbers of alcohol-dependent subjects were identified to have alexithymia. This finding is congruent with earlier work.^15,21 

In recently sober alcoholics the alexithymic cognitive dimension—an inability to identify feelings and to distinguish them from bodily sensations—is related to depressive symptoms and suicidal ideation.

Finally this study concluded that alcohol-dependent individuals show significantly high neuroticism, extroversion, anxiety, depression, psychopathic deviation and significantly low self-esteem as compared to normal control subjects. Significantly more alcoholics were found to be alexithymic.

So what does this study tell us? It is useful in illustrating the transient nature of some co-called co-morbid disorders such as GAD. It more importantly does highlight   certain personality characteristics which we believe, based on extensive ancedotal evidence of a number of years in recovery, are relevant and pertinent to alcohol-dependent people. In fact in recovery, new comers to recovery are often warned against the very variables highlighted here such as not isolating from others in recovery.

Ultimately, however, we believe that the personality characteristics mentioned in this study come under a wider definitional umbrella of emotional regulation and processing deficits which manifest as these personality characteristics and explain not only these characteristics but also the sometimes situationally specific trait anxieties and perhaps other co-morbidities.

References

1. Chaudhury, S.K. Das, B. Ukil,  Psychological assessment of alcoholism in males Indian J Psychiatry. 2006 Apr-Jun; 48(2): 114–117. doi: 10.4103/0019-5545.31602