The relationship between personality and psychological factors and drug dependence

Nevstrueva Taife Hasyamovna ORCID: 0000-0002-5233-8017 Doctor of Psychology Professor; Graduate School of Psychology; Pacific State University 136 Pacific Street, Khabarovsk, 680042, Russia, Khabarovsk Territory tamaranevst@mail.ru

Kirsanova Anna Mihailovna psychologist; Autonomous non-profit organization. Sokolniki Center for Social Adaptation 680000, Russia, Khabarovsk Territory, Khabarovsk, ul. Kedrovy lane, 4 kirsi7979@gmail.com

Introduction

The problem of drug addiction remains highly relevant both in clinical, psychological, personal and socio-psychological aspects and has a significant theoretical and empirical base (research by N.D. Volkova, G. Koob, T. Robinson, B. Everitt, R. Prochaska, N.A. Sirota, V.M. Yaltonsky, V.D. Mendelevich, Yu.P. Sivolap, I.P. Anokhina, K.S. Lisetsky, E.A. Nazarov, and others).

The problem of drug addiction remains relevant not only as a clinical disorder, but also as a violation of psychological regulation. Modern research links the formation and maintenance of addictive behavior with difficulties in managing negative affect, decreased cognitive and behavioral control, rigid ways of processing negative experiences and the use of psychoactive substances as a way to quickly change the internal state. ^{[1; 10; 13; 16; 20]}.

These problems are reflected in the theoretical and empirical substantiation of a number of psychological constructs (emotional dysregulation, maladaptive metacognitive beliefs, biased aggression, self-destruction). The general basis for their unification can be attributed to their regulatory nature, which determines the possibility of integrated use.:

– Emotional dysregulation is considered as one of the central mechanisms associated with addiction maintenance and relapse. A meta-analysis by N.H. Weiss and co-authors, which combined 95 studies and 156,025 participants, revealed a statistically significant association of emotional regulation with substance use. At the same time, the strength of the connections differed depending on the specific component of regulation and the type of use, and regulatory abilities in general were more strongly associated with use than individual strategies ^[20]. M.Å. Garke et al., in a combined clinical and general sample, showed that the severity and frequency of use are associated with greater emotional dysregulation, especially with difficulties controlling impulsive behavior in a state of emotional stress ^[13]. A systematic review and meta-analysis by J. Stellern et al. also confirm more pronounced difficulties of emotional regulation in individuals with substance use disorders ^[19], and five meta-analyses by A. González-Roz et al. link emotional dysregulation with frequency, severity, and negative consequences of use ^[14]. L.J. Hand et al. consider the negative affect and emotional control disorders as factors associated with relapse ^[16]. In a domestic review by A.V. Trusova and E.I. Fedyukovich, disorders of emotional regulation in chemical dependence are presented as a multicomponent construct, including deficits in awareness, understanding and acceptance of emotions, behavior control and access to adaptive strategies ^[8]. Empirical evidence on emotion recognition disorders ^[9] and differences in emotional intelligence and alexithymia in individuals with addiction ^[5] complement this view.

– metacognitive beliefs reflect a person's ideas about the meaning, manageability, and danger of their own thoughts. A systematic review by T. Hamonniere and I. Varescon, which included 38 studies, shows positive associations of metacognitive beliefs with various forms of addictive behavior. Beliefs about the uncontrollability and danger of thoughts, the need to control them, and lack of cognitive confidence correlated most consistently with them. At the same time, the predominance of cross-sectional studies does not allow us to establish the causal direction of these relationships ^[15]. In a study by G. Mansueto et al., in individuals with substance use disorders, emotional dysregulation was associated with rumination, repetitive negative thinking, and dysfunctional metacognitive beliefs ^[18]. E.R. Yan and E.V. Gutkevich identified dysfunctional addictive beliefs in drug addicts and differences in their content depending on the substance they primarily use. It should be emphasized that opioid addiction was more characterized by beliefs focused on alleviating the condition, while addiction to synthetic cathinones was more characterized by anticipatory beliefs ^[10]. These findings reveal cognitive schemas that can support use and attraction.

– displaced aggression is a redirection of anger from the original source of frustration to a more accessible object. The structure of the construct highlights angry thinking, revenge planning, and actually biased aggression ^[4]. Direct studies of biased aggression in drug addiction are limited. In a systematic review and meta-analysis by H.V. Laitano and co-authors, which included 12 studies, 2,294 users of psychoactive substances and 2,143 participants in control groups, consumers showed higher rates of anger ^[17]. However, anger and biased aggression are different constructs, and the samples included in the meta-analysis consisted only of men. Combined with data on the difficulties of emotional and behavioral control during substance use ^{[13; 20]}, they justify the need for a separate study of biased aggression, but do not allow us to confirm in advance its increased severity in drug addicts.

– self-destruction of personality in the integrative model of L.J. Dorfman and E.A. Kurochkin is understood as a heterogeneous construct, including dissatisfaction with oneself, authority, intolerance and isolation ^{[2; 3]}. These domains characterize stable features of attitudes towards oneself and others, and are not identical to direct self-harming or suicidal behavior. There were no publications among the verified sources in which the four-factor self-destruction questionnaire was used directly in people with drug addiction. In a related problem field, L.U. Akhan and H. Gezgin Yazıcı revealed average levels of self-esteem and internalized stigma in 233 patients with alcohol and other forms of addiction, as well as associations of self-esteem with social exclusion and resistance to stigmatization ^[11]. A.A. Bykova and co-authors showed that drug addicts undergoing rehabilitation have lower indicators of emotional intelligence and behavior control are associated with the use of dysfunctional coping strategies ^[1]. These results relate to similar aspects of self-attitude and regulation, but they do not replace a direct study of the domains of self-destruction; therefore, their connections with emotional dysregulation require separate empirical verification.

An analysis of the literature shows that the features of the interrelationships of all these phenomena in people with substance dependence have not received comprehensive empirical verification. The study of these connections will allow us to consider the emotional, metacognitive, aggressive and personal levels of regulation within the framework of one empirical model.

It can be assumed that the studied psychological phenomena will have a system of positive relationships, and the length of addiction and the number of relapses may correlate with a greater severity of impaired regulatory processes.

Organization and research methods

The study had a cross-correlation design and was conducted on the basis of a rehabilitation center. The sample consisted of 68 people with a diagnosis of substance dependence syndrome (F11.2, F12.2, F19.2 according to ICD-10) who were in hospital treatment or undergoing a long-term rehabilitation program. The age of the participants was 20-37 years (M = 30.8; SD = 3.7); the sample included 50 men (73.5%) and 18 women (26.5%). 13 people (19.1%) had secondary general education, 40 (58.8%) had secondary vocational education, and 15 (22.1%) had higher education.

The inclusion criteria were a medically documented diagnosis of addiction, a stable condition that allows meaningful performance of psychodiagnostic tasks, and voluntary informed consent. The exclusion criteria were acute psychotic states, severe withdrawal symptoms, severe organic cognitive impairment, and refusal to participate. The principles of voluntariness, confidentiality and anonymity were respected. The psychodiagnostic toolkit included four techniques:

1. The questionnaire of emotional dysregulation by N.A. Polskaya and A.Y. Razvalyaeva was used to assess rumination, avoidance, and difficulties of mentalization. The methodology includes 23 points; higher indicators correspond to a greater severity of dysfunctional ways of emotional regulation ^[6]. The severity levels of the scales were divided according to

2. The short version of the MCQ-30 Questionnaire of Metacognitive Beliefs by A. Wells and S. Cartwright-Hutton, adapted by N.A. Sirota, D.V. Moskovchenko, V.M. Yaltonsky and A.V. Yaltonskaya, includes 30 points and five scales: positive beliefs about anxiety (POS), negative beliefs about its uncontrollability and danger (NEGcognitive impairment (CC), thought control (NC), and mindfulness of one's own thought processes (CSC) ^[7].

3. The questionnaire of displaced aggression by T. Denson, W. Pedersen and N. Miller in the Russian-language adaptation by E.V. Kolyvanova and S.N. Enikolopov contains 26 items and allows assessing angry thinking (affective sphere), revenge planning (cognitive sphere), displaced aggression (behavioral sphere) and the total indicator ^[4].

4. The four-factor personality self-destruction questionnaire by L.J. Dorfman and E.A. Kurochkin consists of 42 items and includes scales of self-dissatisfaction, authority, intolerance and isolation. The scales can be analyzed separately and as a general indicator of self-destruction ^[3].

The author's questionnaire was used to register gender, age, and education, as well as three parameters characterizing the course of addiction: the length of use of psychoactive substances, the number of relapses, and the age of onset of use. The length of service and age of initiation were indicated in full years, the number of relapses was indicated by the number of marked returns to use. These indicators were considered as quantitative variables: descriptive characteristics were calculated from them, after which they were included in the correlation analysis with the indicators of the MCQ-30 and the Questionnaire of biased aggression.

Statistical processing was carried out in IBM SPSS Statistics. Indicators of descriptive statistics and the frequency of severity levels of the scales were calculated. The correspondence of the distributions to the normal law was assessed using the Kolmogorov–Smirnov criterion. The test results are presented in Table 1.

Table 1 – Verification of the normality of the distributions of the studied indicators

For most indicators, the distribution was statistically significantly different from normal. Therefore, Spearman's rank correlation coefficient was used to assess the strength and direction of the relationships. The level of statistical significance was assumed to be p < 0.05; all relationships shown in the correlation tables are significant at p < 0,01.

The results of the study

Table 2 shows the main parameters of the course of drug addiction.

Table 2 – Characteristics of the sample of people with drug addiction (in years)

The average length of use was 8.8 years (SD = 2.4), reflecting the long-term course of addiction in the study group. On average, participants reported 3.1 relapses (SD = 1.5), so the experience of stopping drinking in a significant part of the sample was accompanied by repeated returns. The average age of onset of use was 20.7 years (SD = 2.1) and occurred during early adulthood. These indicators characterized the duration and recurrence of addiction and were further used as quantitative clinical and anamnestic variables.

The frequency distribution of the scales of techniques by severity levels is shown in Table 3.

Table 3 – Frequency distribution by severity levels of scales

According to the results of the emotional dysregulation technique, rumination (72.05%) and mentalization difficulties (86.76%) were strongly pronounced, with avoidance on average (61.76%). Respondents tend to get stuck on affectively colored experiences and fixate on them, difficulties in understanding their own and others' emotions with a subjective sense of difficulties in controlling them, and an average degree of avoidance of certain emotions that are assessed as potentially dangerous.

According to OCA, there is an average level of biased aggression with a tendency to a low level (M = 56.12, SD =15.27), which shows a low tendency to maintain aggressive affect. The cognitive sphere is expressed moderately, with a tendency to a low level (M = 15.63 SD =3.06). The behavioral sphere is in the average values (M = 20.62 SD =4.45) and the affective sphere is low (M = 20.00 SD = 9.28). Thus, the respondents do not focus on the feeling of anger, do not reflect on the offender and do not harbor resentment against him, but showed an average tendency to directly shift the aggressive affect to those who were not the culprit of the initial provocation.

According to the MCQ-30, the overall level of dysfunctional metacognitive beliefs corresponds to a medium-low level (M = 68.38, SD = 9.74). The scale of negative beliefs related to uncontrollability and the danger of anxiety is of the greatest interest – the average level was found in 63.23%, the high level in 36.76% of respondents (M = 17.29, SD = 2.46). These results show that subjects are more likely to perceive anxiety as uncontrollable and dangerous. The rest of the scales are expressed on average, except for attentiveness to thoughts, which is poorly expressed in 94.12% of respondents, which indicates a lack of focus on their own thoughts. There are also scales of positive beliefs (M = 12.59, SD = 2.05) and thought control (M = 12.85, SD = 2.06), which are expressed at a medium-low level, indicating a lack of belief in the need for thought control to avoid bad events and belief in anxiety as a way to solve problems. Cognitive disability is expressed on average (M = 15.15, SD = 2.23), which is expressed in a periodic negative attitude towards one's own thought processes.

The scales of dissatisfaction with oneself (M = 56.67, SD = 7.12) and authority (M = 43.45, SD = 5.61) of the self-destruction questionnaire are expressed on average, which indicates a tendency to a negative attitude and pickiness towards oneself, with a possible fear of success with a tendency to dominate interpersonal relationships. The intolerance scale is expressed medium-low (M = 32.62, SD = 4.67), which indicates the rarity of self-criticism. Isolation is not expressed.

Thus, the sample can be characterized as having certain psychological difficulties in adaptation. A number of important characteristics can be identified: a tendency to wind oneself up together with difficulties in understanding oneself; periodic negative attitude towards oneself and one's mnestic abilities; fear of anxiety. In interpersonal relationships, respondents are likely to strive for dominance. Episodes when respondents strive to dominate a relationship, while being unable to face direct confrontation and cope with emotions. This can be expressed in the shift of aggressive affect from the offender to safer objects or subjects. In general, there are obvious difficulties in processing emotionally intense events, with a tendency to excessive internal preoccupation with affect. It is also possible to search for an environment that allows these maladaptive mechanisms to work, as indicated by the lack of isolation from people.

The correlation analysis of empirical data is presented in tables 4-7.

The relationship of clinical and anamnestic dependence parameters with metacognitive beliefs is presented in Table 4.

Table 4 – Correlations of addiction parameters with metacognitive beliefs

Note. ** p < 0,01

The length of use and the number of relapses form strong positive relationships with all MCQ-30 scales and its overall index. The correlations of seniority with the scales of the questionnaire range from Rₛ = 0.794 to rₛ = 0.884, and with the general level of metacognitive beliefs amount to rₛ = 0.857. With a longer duration of use, the severity of attentiveness to one's own thoughts increases (Rₛ = 0.884), cognitive disability (rₛ = 0.871), and negative beliefs about the uncontrollability of anxiety (rₛ = 0.854). The number of relapses is most closely associated with cognitive disability (Rₛ = 0.882) and negative beliefs (rₛ = 0.874); the links with other scales also remain strong (rₛ = 0.815–0.849). This suggests a systemic increase in dysfunctional metacognitive attitudes with a longer and more recurrent course of addiction. The age of onset of use is positively associated with all scales weaker (Rₛ = 0.520–0.683). A positive trend means that in this sample, a later start of use is associated with higher MCQ-30 scores; the specifics of this relationship require separate study and do not allow us to interpret the result as evidence of the adverse effects of early start of use.

The relationships of dependence parameters with indicators of biased aggression are presented in Table 5.

Table 5 – Correlations of dependence parameters with indicators of biased aggression

Note. ** p < 0,01

The length of use and the number of relapses are positively related to the total index of biased aggression and all its components. The correlations of seniority are in the range Rₛ = 0.817–0.882; the most pronounced links are with biased aggression (rₛ = 0.882) and angry thinking (rₛ = 0.866). The number of relapses is most closely related to revenge planning (Rₛ = 0.880), while the associations with the total index, angry thinking and biased aggression are also strong (rₛ = 0.801–0.820). This is consistent with the descriptive profile of the sample and indicates the cumulative nature of the aggressive response: as the addictive experience continues and the breakdowns repeat, the retention of the frustrating experience, the mental return to retaliatory actions and the redirection of irritation increase. The age of onset of use is associated with lower aggression indicators (Rₛ = 0.479–0.658). Since the direction of the connections is positive, higher aggression rates in this sample correspond to a later rather than an earlier start of use. However, this result requires careful interpretation, including in qualitative methodology.

The relationships of metacognitive beliefs with indicators of biased aggression are presented in Table 6.

Table 6 – Correlations of metacognitive beliefs with indicators of biased aggression

Note. ** p < 0,01

All MCQ-30 indicators form strong positive associations with the total indicator and individual components of biased aggression (Rₛ = 0.804–0.951). The overall severity of aggressive response is most closely related to mindfulness of one's own thoughts (rₛ = 0.951), the general level of metacognitive beliefs (rₛ = 0.945), cognitive disability (rₛ = 0.912) and negative beliefs about the uncontrollability of anxiety (rₛ = 0.910). Angry thinking is especially associated with mindfulness of one's own thoughts (Rₛ = 0.917); revenge planning is associated with cognitive failure (rₛ = 0.914) and negative beliefs (rₛ = 0.899); actually biased aggression is associated with mindfulness of thoughts (rₛ = 0.943) and a general level of beliefs (rₛ = 0.898). The resulting pattern corresponds to the initial assumption of cognitive-metacognitive mediation of aggressive tendencies: fixation on resentment and redirection of irritation are accompanied by the perception of one's own thoughts as difficult to control, dangerous and requiring constant monitoring.

The links between emotional dysregulation and self-destruction of personality are presented in Table 7.

Table 7 – Correlations of emotional dysregulation with self-destruction of personality

Note. ** p < 0,01

Rumination, avoidance, and mentalization difficulties form strong positive associations with the general level of self–destruction and all its domains (Rₛ = 0.720-0.787). Rumination is most closely associated with dissatisfaction with oneself and the total self-destruction index (in both cases, Rₛ = 0.787), which corresponds to the initial conclusion that getting stuck in a negative experience is related to internal criticism and dissatisfaction with oneself. Avoidance is associated with all indicators of self–destruction in the range Rₛ = 0.720-0.743: avoiding emotionally significant experiences is not accompanied by a decrease in internal tension, but is combined with more pronounced destructive attitudes towards oneself and others. Difficulties of mentalization are also associated with all domains of self–destruction (Rₛ = 0.720-0.761), especially with authority (rₛ = 0.761), intolerance (rₛ = 0.755) and dissatisfaction with oneself (rₛ = 0.753). Collectively, the connections obtained indicate that rumination, emotional avoidance, and difficulties in comprehending experiences are accompanied by increased self-criticism, interpersonal rigidity, and a tendency to distance oneself.

Discussion of the results

The severity of rumination and the difficulty of mentalization significantly exceed the values obtained by N.A. Polskaya and A.Y. Razvalyaeva in a normotypic sample ^[6]. This indicates increased tension in the emotional sphere of drug addicts. Let's emphasize that the experience persists, while its comprehension and inclusion in regulated behavior are difficult. This is consistent with reviews and meta-analyses in which drug addicts have been found to have more pronounced difficulties in emotional regulation ^{[14; 19; 20]}. Our results are consistent with the studies of emotional dysregulation by M.Å. Garke ^[13] and G. Mansueto ^[18], as one of the mechanisms supporting addictive behavior. In the examined sample, this mechanism manifests itself mainly in the long-term retention of emotionally intense experiences and a difficult understanding of one's own and others' experiences, rather than in a pronounced avoidance of them. Taking into account the role of negative affect in relapse established in the literature ^[16], these features can be considered as significant targets of rehabilitation work, however, their direct relationship with repeated use has not been verified in this study.

The metacognitive profile of the surveyed is determined by the predominance of negative beliefs about uncontrollability and the danger of anxiety with an average severity of the overall indicator and most other scales. This combination shows that disturbing thoughts are perceived as difficult to control and potentially dangerous. At the same time, constant monitoring of their own thought processes is unusual for the majority of respondents, which is consistent with the work of Hamonniere T., Varescon I. and Mansueto G. and others ^{[15; 18]}. The most vulnerable link is the attitude to anxiety, accompanied by periodic doubts about one's own cognitive viability. Taking into account the correlation analysis, an increase in dysfunctional metacognitive attitudes is accompanied by a greater severity of angry thinking, revenge planning and redirection of irritation. These data suggest that metacognitive beliefs and biased aggression are an important component of the psychological profile of drug addicts.

We also did not find a high level of biased aggression, but the behavioral component of the bias is noticeable, which may be due to the identified difficulties in understanding oneself and one's experiences. The obtained links with metacognitive beliefs suggest that the aggressive response in this sample is more associated with the cognitive processing of frustrating experiences than with an immediate affective outburst. The previously reviewed data on the increased severity of anger when using psychoactive substances ^[17] support the importance of this trend, but do not allow us to identify general anger with a specific construct of displaced aggression.

The results of the self-destruction questionnaire showed that the psychological profile of the surveyed is characterized by moderate self-criticism, dissatisfaction with certain aspects of themselves and the desire to control interpersonal interaction. Low isolation shows that the need for contacts with other people persists, although the quality and selectivity of these contacts were not evaluated separately in this study. At the same time, all indicators of emotional dysregulation form strong positive relationships with the total indicator of self-destruction and its individual domains, which indicates the difficulties of emotional regulation with the peculiarities of attitudes towards oneself and others. Rumination and mentalization difficulties may be accompanied by increased self-dissatisfaction, a desire to control interpersonal relationships, and decreased tolerance for emotionally significant situations. The average level of avoidance does not exclude its inclusion in this system of connections, but it does not allow it to be considered the leading characteristic of the surveyed group.

The data from the author's questionnaire complement the psychological profile with the characteristics of the addiction course. Correlation analysis showed that a longer period of use and a higher number of relapses are associated with an increase in dysfunctional metacognitive beliefs and indicators of biased aggression. Consequently, as the duration of use increases and breakdowns repeat, difficulties in dealing with one's own thought processes, retaining frustrating experiences, and redirecting aggressive tension become more pronounced. These results are consistent with previously reviewed data on the relationship between the severity of addictive behavior and disorders of psychological regulation ^{[13; 16]}. The associations of age of onset with metacognitive beliefs and biased aggression were positive, but less pronounced. It should be emphasized that the specifics of the collected data require that these results be treated with some caution and require additional checks.

In general, the parameters of drug addiction show that the duration and relapsing nature of addiction are more closely related to the studied psychological characteristics than the age of its onset.

Conclusion

The problem of the relationship of drug addiction with personal and psychological factors has a significant research base today, which allows us to highlight an urgent aspect of the problem, taking into account violations of personal and psychological regulation.

The research results form two meaningfully related blocks. The first one involves emotional dysregulation and self-destruction of personality: difficulties in processing emotional experience are associated with the peculiarities of self-attitude and interpersonal interaction. The second one combines metacognitive beliefs, biased aggression, and the parameters of addiction. They show the presence of several interrelated regulatory disorders that can support psychological maladaptation in drug addiction.

The practical significance of the results is related to the possibility of a more differentiated definition of rehabilitation targets.:

-pronounced rumination and difficulties of mentalization justify the need to develop skills in recognizing, verbalizing and comprehending emotional states. It is also important to reduce the recurring return to emotionally intense events.:

-the metacognitive block involves working with beliefs about the uncontrollability and danger of anxiety;

-The results on biased aggression indicate the importance of analyzing ways to experience resentment and safely express aggressive tension.;

-with an average degree of dissatisfaction with oneself, an emphasis on self-attitude is important (without first attributing pronounced autoaggression or a desire for social isolation to the surveyed).

The limitations of the study are determined by its pilot nature, the interpretation of the results is limited by the cross-correlation design, the absence of a control group, the use of only self-reporting methods and the formation of a sample based on a single rehabilitation center.

The results of the study allow us to see the prospects of possible areas of study of the problem. This is primarily a longitudinal design, and it is important to include a number of new variables: the type of substance used, the duration of remission, and the stage of the rehabilitation program. Studies on larger and clinically homogeneous samples, including control groups and repeated measurements during rehabilitation, are promising. An important area of study of the problem may be the use of qualitative methodology.

The article is published in its final version as approved following the last positive peer review recommending acceptance for publication. It incorporates revisions made by the author in response to prior negative peer review reports that did not recommend publication. All peer review reports, including initial negative reviews, are published in open access alongside the article. All versions of the author’s revisions are archived in the publisher’s repository and may be made available upon reasonable request in accordance with Elsevier’s editorial policies and applicable data availability requirements.
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