Psychoticism and neuroticism predict cocaine dependence and future cocaine use via different mechanisms
Introduction
Cocaine use is a major public health concern. The 2008 National Survey on Drug Use and Health (NSDUH) reported that approximately 1.9 million Americans were current cocaine users, and that 1.4 million had dependence on, or abuse of, cocaine between 2007 and 2008 (SAMHSA, 2009). These numbers are especially concerning because cocaine use is consistently associated with substantially increased mortality (SAMHSA, 2010), psychiatric illness (Conway et al., 2006), functional impairment (Lozano et al., 2008), and criminal behavior (ONDCP, 2009). Understanding factors that contribute to the etiology and maintenance of problematic cocaine use is vital to reducing the negative impact of cocaine on individuals and society.
Personality characteristics, including impulsivity (i.e., the tendency to respond without forethought; Robinson et al., 2009) and neuroticism (i.e., the tendency to experience negative emotional states; Matthews et al., 2003), have been shown to predict symptoms of substance dependence (Bottlender and Soyka, 2005, Grekin et al., 2006, Sher et al., 2000). Research concerning personality characteristics and cocaine use has been less common, but has generally supported the findings obtained by the broader substance abuse literature. For example, cocaine users have been found to be elevated on measures of impulsivity (Lane et al., 2007, Moeller et al., 2002, Sáiz et al., 2003), and neuroticism (Terracciano et al., 2008). Furthermore, rodent research has established impulsivity as a predictor of cocaine use escalation (Anker et al., 2009) and relapse (Economidou et al., 2009). Unfortunately, little research has examined the prospective relationship between personality characteristics and cocaine use in cocaine-dependent humans.
Although personality characteristics appear to be important contributors to problematic cocaine use, they are, by definition, distal factors. Little research has examined the mechanisms through which personality characteristics might impact cocaine use. One well-established proximal predictor of cocaine use, dependence, and relapse is stress (Brady and Sinha, 2005, Kreek and Koob, 1998, Sinha, 2001). Corticotropin-releasing hormone (CRH), in particular, is thought to play a critical role in cocaine dependence and relapse through its effects on the hypothalamic pituitary adrenal (HPA) axis and extended amygdala (Koob and Kreek, 2007). Recent research (Brady and McRae, 2009, Back et al., 2010) has demonstrated that individuals with cocaine dependence subjectively experience more stress in response to CRH administration than non-dependent controls, and that this elevated stress response is associated with relapse to cocaine use. Interestingly, neuroticism has also been associated with HPA dysfunction. For example neuroticism has been correlated with an increased cortisol response to CRH (Zobel et al., 2004) and naloxone (Mangold and Wand, 2006) administration (cf., McCleery and Goodwin, 2001, Oswald et al., 2006). Given that neuroticism has been associated with elevated response to CRH, and the response to CRH has been shown to predict relapse in cocaine-dependent individuals, it is possible that neuroticism may impact cocaine use via elevated reactivity to CRH. Thus, while some personality characteristics have been associated with cocaine use, the mechanisms through which personality factors impact cocaine use have not been systematically investigated.
The primary goals of the present study were: (1) to replicate past research that has demonstrated elevated impulsivity and neuroticism in cocaine-dependent individuals relative to controls, (2) to examine the ability of impulsivity and neuroticism to prospectively predict future cocaine use in cocaine-dependent individuals, and (3) to examine the magnitude of stress response to CRH as a potential mediator of the relationship between neuroticism and cocaine use.
Section snippets
Participants
Subjects were recruited through media advertisements in the local Charleston area: 53 participants were non-treatment seeking cocaine-dependent men and women; the remaining 47 participants were non-cocaine-dependent controls. Potential participants were screened by telephone, and eligible participants were asked to complete a clinical interview and physical examination. Cocaine dependent participants met DSM-IV criteria for cocaine dependence and indicated cocaine as their primary drug of
Differences between cocaine dependent (n = 53) and non-dependent individuals (n = 47)
Demographic characteristics of the overall sample are presented in Table 1. Cocaine-dependent individuals had higher rates of cigarette smoking and lower levels of educational attainment than non-dependent individuals; no other significant demographic differences were observed. Results from regression models comparing cocaine-dependent and non-dependent individuals in terms of personality and stress reactivity are presented in Table 2. Controlling for demographic differences (i.e., education,
Discussion
The present study investigated the relationship between personality characteristics and cocaine use. Consistent with previous research, cocaine-dependent individuals had elevated scores on the psychoticism (i.e., impulsivity, aggression) and neuroticism (i.e., negative affectivity) scales of the EPQ and self-reported stress reactivity to CRH administration relative to non-cocaine-dependent individuals. Within the subsample of cocaine-dependent individuals, psychoticism, neuroticism, and
Conflict of interest
No authors have any conflict of interest to disclose.
Role of funding source
Funding for this study was provided by NIMH Grants P50DA016511-07 and M01 RR001070-31; the NIMH had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication. Dr. Prisciandaro was supported by NIDA T32 DA007288.
Contributors
Dr. Brady designed the study and wrote the protocol. Dr. McRae-Clark coordinated the study implementation. Drs. Moran-Santa Maria and Hartwell assisted with manuscript revisions. Dr. Prisciandaro conducted the analyses and wrote the first draft of the manuscript. All authors contributed to and have approved the final manuscript.
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