Temperamental characteristics of adolescents with substance abuse and/or dependence: A case–control study☆
Introduction
In adolescence, several factors increase vulnerability to different types of adjustment problems, including problematic substance use. The 2008 National Survey on Drug Use and Health (NSDUH) indicated that 51.6% of the American youth aged 12+ reported concurrent alcohol use and 8.0% had used illicit drugs during the month prior to the survey (Substance Abuse and Mental Health Services Administration, 2009). All major models of substance abuse emphasize risk factors in both the environment (e.g., peer group) and the individual (e.g., temperament) (Wenar & Kerig, 2005). Identifying vulnerable youngsters is crucial for improving both prevention and intervention, because lifetime problems with substance use often have their roots in adolescence and because altering these problems prior to adulthood can be more effective than interventions later in life (Dahl, 2004).
Why are some youngsters more vulnerable to problematic substance use compared to others? Several researchers focusing on within-child traits have highlighted associations with temperament as promising avenues for understanding vulnerability to psychopathology in general (Nigg, 2006), and problematic substance use in particular (Giancola and Mezzich, 2003, Wills and Dishion, 2004). Temperament can be defined as “constitutionally based individual differences in reactivity and self-regulation, as observed in the domains of emotionality, motor activity, and attention” (Rothbart & Posner, 2006, p. 466).
Patterns of individual differences in reactivity to immediate incentive contexts have been described in terms of valence (positive/negative affectivity) as well as motivation (behavioral activation/inhibition) and generally two types of trait reactivity are distinguished (Nigg, 2006). “Approach” is the strength of the tendency to approach signals of potential reward/reinforcement. It is associated with the tendency to experience more positive affect and Extraversion. “Avoidance” is the strength of the tendency to avoid or withdraw from potentially unrewarding/uncertain contexts. It is associated with the experience of more negative affect and Neuroticism (Nigg, 2006). To refer to the motivational aspects of reactivity, we use the terms ‘sensitivity to reward’ (SR) and ‘sensitivity to punishment’ (SP), to refer to the affective aspects of reactivity, we use the terms ‘positive affectivity’ (PA) and ‘negative affectivity’ (NA). Although the framework described above suggests that motivational and affective reactivity are related (i.e., SR related to PA, SP related to NA), there are indications that these constructs are dissociable. Especially with regard to SR/PA, there is disagreement as to the neurobiological core elements (Nigg, 2006).
Because many youngsters use substances for the rewarding effect of it, particularly SR can be expected to play a role in problematic substance use (Bijttebier, Beck, Claes, & Vandereycken, 2009). Case–control studies (Franken et al., 2006, Kambouropoulos and Staiger, 2007, Loxton and Dawe, 2001) as well as studies in community samples (Franken and Muris, 2006, O’Connor et al., 2009) reported positive associations between SR and (problematic) substance use. The role of (lack of) SP, however, remains largely unclear. About half of the studies in community samples reported a significant negative association between SP and substance use problems (Franken and Muris, 2006, Genovese and Wallace, 2007), about the same number of studies failed to find a significant association (O’Connor et al., 2009) and none of the case–control studies revealed any group differences in SP (Franken et al., 2006, Kambouropoulos and Staiger, 2007, Loxton and Dawe, 2001).
Negative affect regulation models of addiction suggest that negative affective states increase the risk for substance use because users believe that the effects of alcohol and/or drugs will alleviate these aversive states (Myers et al., 2003, Sher and Trull, 1994). Several studies have indicated a positive association between NA and substance use (e.g., Colder and Chassin, 1997, Dvorak and Simons, 2008, Myers et al., 2003, Wills et al., 1999). However, other studies did not find associations between NA and motivation to drink (e.g., Colder, 2001) or drug use (e.g., Swaim, Oetting, Edwards, & Beauvais, 1989) and at least one study (Gunnarsson, Gustavsson, Tengström, Franck, & Fahlke, 2008) found that respondents with risk consumption of substances have significantly lower levels of NA compared to controls. Less research examined the role of PA. Colder and Chassin (1997) found that low PA is associated with alcohol use and alcohol-related impairment, albeit only in highly impulsive adolescents. Dvorak and Simons (2008) found that low PA is related to higher tobacco use, and compared to occasional tobacco users, non-users report more PA. Wills et al. (1999) found that PA is related to lower levels of substance use and that the impact of NA on substance use is reduced among individuals with high PA, indicating that PA operates as a buffering agent. Cheetham, Allen, Yücel, and Lubman (2010) suggest that high PA may be involved in early onset and risky use, whereas low PA may be involved in later stages of addiction.
Current theories of vulnerability to psychopathology (Nigg, 2006) also emphasize the influence of self-regulatory processes that enable individuals to modulate their emotional reactions and as such decrease the risk associated with temperamental reactivity. Related ideas have been proposed for problematic substance use (Willem, Bijttebier, & Claes, 2010). Central to regulation in the temperament field is the notion of effortful control (EC) (Rothbart, 1989), which reflects the ability to gain active or deliberate control over behavior and emotional responses.
Many studies have shown an association between a lack of self-regulation and substance use (disorders). Two studies showed that low self-control is related to higher adolescent substance use (e.g., Wills and Dishion, 2004, Wills et al., 2001). Creemers et al. (2010) found that high levels of EC buffer against the risk of lifetime and regular cannabis use. Nigg et al., 2004, Nigg et al., 2006 showed that especially poor response inhibition is a good predictor of problematic substance use in adolescence and young adulthood.
The first aim of our study is to investigate differences in reactive and self-regulatory temperament between clinically referred adolescents with substance abuse and/or dependence and a matched healthy control group. Previous case–control studies used a narrower conceptualization of temperament (i.e., either reactivity or self-regulation), did not distinguish aspects of reactivity, or were conducted in adult samples. We hypothesize that clinically referred adolescents will report more SR, less PA and less EC. Given the inconsistent findings with respect to the role of SP and NA in (problematic) substance use, we do not formulate hypotheses with respect to these traits. The second aim is to investigate which temperament dimension(s) uniquely predict(s) clinical status.
Section snippets
Participants
Sixty-eight adolescents (46 boys/22 girls) (Mage = 16.38 years, SD = 0.92, range 14.17–18.00 years) took part in the study. The clinical group (n = 34; 23 boys/11 girls) was recruited from a specialized inpatient unit for adolescent substance use problems in Belgium. Of the clinical group, 21 adolescents were court-ordered into treatment, six adolescents were referred via the committee for special youth care and seven adolescents entered treatment without referral. Furthermore, nine participants met
Group differences in the number of substances used
The clinical group (M = 5.62, SD = 2.45) used significantly more substances in the past year, compared to the control group (M = 1.32, SD = 0.91), t(41.97) = 9.58, p < .001. Chi-square tests revealed that the number of individuals using each substance differed by group for all substances, except for alcohol (due to common use) and heroin (due to low levels of use in both groups).
Construction of temperament composites
To reduce the number of statistical tests and increase the reliability of the measures, five composites were formed by averaging
Discussion
First, no group differences in SR were found, which is in contrast with the results of previous case–control studies (Franken et al., 2006, Kambouropoulos and Staiger, 2007, Loxton and Dawe, 2001). However, all three studies mentioned were conducted in adult samples. It is possible that SR is a quite normative characteristic of adolescent development. Another possible explanation is related to the difference between sensitivity for potential rewarding stimuli and a pharmacological sensitivity
Acknowledgement
The authors would like to thank Isabel D’hont for her assistance in the data collection.
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