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George, S.M. and Connor, J.P. and Gullo, M.J. and Young, Ross McD. (2010) A prospective study of personality features predictive of early adolescent alcohol misuse. Personality and Individual Differences, 49(3). pp. 204‐209. Catalogue from Homo Faber 2007

A Prospective Study of Personality Features Predictive of Early Adolescent Alcohol

Misuse

George, S.M.,a Connor, J.P.,a,b Gullo, M.J.,c Young, R.McDa,d.

a Centre for Youth Substance Abuse Research, Faculty of Health Sciences, The University of Queensland, Brisbane, QLD 4029, Australia b Discipline of Psychiatry, School of Medicine, Faculty of Health Sciences, The University of Queensland, Brisbane, QLD 4029, Australia c School of Psychology, Griffith University, Brisbane, QLD 4122, Australia d Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane QLD 4059, Australia

* Corresponding Author: Associate Professor Jason Connor Director Centre for Youth Substance Abuse Research Faculty of Health Sciences The University of Queensland, Brisbane K-Floor, Mental Health Centre Royal Brisbane and Womens’ Hospital Brisbane, Queensland Australia, 4209

Ph: 0011 61 7 33655150 Fax: 0011 61 7 33655499

E-mail: [email protected]

Abstract

Personality factors implicated in alcohol misuse have been extensively investigated in adult populations. Fewer studies have clarified the robustness of personality dimensions in predicting early onset alcohol misuse in adolescence. The aim of this study was to examine the predictive utility of two prominent models of personality (Eysenck, 1975 and Cloninger,

1987) in the context of early alcohol misuse in adolescence. One hundred and ninety-two secondary school students (Mean age = 13.8 years, SD = 0.5) were administered measures of personality (Revised Junior Eysenck Personality Questionnaire – Abbreviated form;

Temperament scale of the Junior Temperament and Character Inventory) and drinking behavior (quantity and frequency of consumption, Alcohol Use Disorders Identification Test) at Time 1. At 12 month follow-up, 127 students (88.5%) were retained. Hierarchical multiple regressions revealed the dimensions of Psychoticism, Extraversion, Novelty Seeking, and Lie to be the most powerful predictors of future alcohol misuse in adolescents. Results provide support for the etiological relevance of these dimensions in the development of early onset alcohol misuse. Findings can be used to develop early intervention programs that target

personality risk factors for alcohol misuse for high risk youth.

Keywords: adolescent, personality, alcohol, drinking behavior

1. Introduction

Personality characteristics have been widely implicated in the role they play in predisposing individuals to alcohol misuse. Studies have typically demonstrated a relationship between more severe alcohol consumption and traits associated with disinhibition (Newcomb

& McGee, 1991; Sher, Trull, Bartholow, & Vieth, 1999) and negative affectivity (Colder &

Chassin, 1997; Grekin, Sher, & Wood, 2006). Such relationships have emerged across clinical

(Galen, Henderson, & Whitman, 1997) and community samples (Shedler & Block, 1990),

both cross-sectionally (Kuo, Yang, Soong, & Chen, 2002) and prospectively (Fothergill &

Ensminger, 2006).

Fewer studies have investigated the nature of these relationships in early adolescence,

in particular which personality characteristics best predict early onset drinking behavior.

Alcohol use is typically initiated in adolescence and patterns of use formed during this critical

developmental period predict alcohol-related problems and other comorbid mental disorders

in adulthood (Lewinsohn, Rohde, & Seeley, 1996; Palmer, Young, Hopfer, Corley, Stallings,

Crowley, & Hewitt, 2009). Personality has subsequently emerged as a potentially modifiable

marker for early intervention programs that aim to reduce substance use in high risk

populations (Conrod, Stewart, Pihl, Cote, Fontaine, & Dongier, 2000), as well as delay the

growth of adolescent drinking and binge drinking (Conrod, Castellanos, & Mackie, 2008). In a randomized controlled trial conducted by Conrod, Stewart, Comeau, and Maclean (2006), a brief intervention targeting personality risk factors for alcohol misuse was administered in a

sample of high risk secondary school students. At four month follow-up, those students who

had received the personality-targeted interventions were found to be consuming lower

quantities of alcohol, and experiencing fewer alcohol-related problems compared with the no

treatment control group. Rates of binge drinking were also significantly reduced. A precursor 4

to early targeted interventions is clarifying the predictive utility of personality features in

relation to early adolescent alcohol misuse.

1.1 Eysenck’s Model of Personality

Eysenck’s (1975) personality model has received considerable research attention in substance use disorder research. Eysenck and Eysenck (1975) conceptualized personality as consisting of three broad biologically based dimensions; psychoticism, extraversion, and neuroticism. The psychoticism scale of the Eysenck Personality Questionnaire (EPQ) is a strong and reliable marker for the assessment of impulsivity, sensation-seeking, and disinhibition of aggressive tendencies (Zuckerman, 1993). While extraversion has been conceptualized as being associated with dimensions of sociability and liveliness, neuroticism has been linked to traits of anxiety, depression, and guilt (Sher, et al., 1999).

In the context of substance misuse, Eysenck’s (1975) theory of personality has been predominantly assessed within adult populations, with less longitudinal research focusing on

adolescent samples. Versions of the Eysenck Personality Questionnaire (EPQ; Eysenck &

Eysenck, 1975) have been utilized in both clinical and community samples and the levels of

the three dimensions of personality have been investigated. The most consistent relationship

to emerge is the association between psychoticism and adolescent alcohol misuse. More

extensive evidence documents the relationship between early antisocial, disinhibited, and

aggressive behavior with later alcohol misuse (Conrod, Petersen, & Pihl, 1997; Shedler &

Block, 1990).

The relationship between extraversion and alcohol misuse is less clear. Some studies

suggest no difference in levels of this trait amongst clinical, high-risk, and community

samples compared with control groups (Sher, et al., 1999). In contrast, a body of research

exists demonstrating a positive relationship between extraversion and alcohol misuse when 5

assessed cross-sectionally (Flory, Lynam, Milich, Leukefeld, & Clayton, 2002) and

prospectively (Kilbey, Downy, & Breslau, 1998) in young adults. In a prospective study conducted by Hill, Shen, Lowers, and Locke (2000), extraversion was found to be an independent predictor of onset of regular drinking in high-risk male youth. One hypothesis

proposed by Sher et al. (1999) has been that extraversion may play an important role in the

development of alcohol related problems, but that this trait becomes concealed as drinking

continues to a more dependent state. On the whole, further research is needed to clarify the

role that the dimension of extraversion plays in predisposing youth to early alcohol misuse.

Similarly, inconsistencies exist throughout the literature in relation to neuroticism and

the extent to which it is associated with harmful alcohol use during early adolescence. This

inconsistency may be due, in part, to the failure of some studies to control for comorbid

internalizing symptoms (Gullo & Dawe, 2008). While there is evidence to suggest a

significant cross-sectional relationship in clinical (Brooner, Templer, Svikis, Schmidt, &

Monopolis, 1990) and community populations (Colder & Chassin, 1997), there is less clarity

regarding the directionality of this association (Sher, et al., 1999). Investigations in adolescent samples are sparse, and have yet to determine the function neuroticism plays, if

any, in predicting early onset alcohol use.

Finally, though not theoretically specified to the same extent, a lie scale is also included in Eysenck and Eysenck’s (1975) personality measure. Reported to be a measure of social

desirability, lower lie scores have been hypothesized to be associated with higher levels of

substance misuse (Eysenck & Eysenck, 1975). While there is evidence to support this claim

(Kuo, et al., 2002), contrary findings have emerged in alcohol dependent populations

(Rosenthal, Edwards, Ackermann, Knott, & Rosenthal, 1990) as well as substance dependent populations (Porrata & Rosa, 2000). High scorings have been variously interpreted as

deliberate faking (Dicken, 1959), social acquiescence (Eysenck & Eysenck, 1976), and 6

honest but imprecise self evaluation (Eysenck, Nias, & Eysenck, 1970). Extending on this last point, Eysenck et al. (1970) have suggested that high lie scores may be common in younger individuals and may reflect an underlying psychological trait associated with insight.

1.2 Cloninger’s Model of Personality

Cloninger’s (1987) tridimensional theory has been rigorously assessed in the context of alcohol misuse. Based on neurogenetic adaptive mechanisms, Cloninger (1987) states that the three personality dimensions of Novelty Seeking (NS), Harm Avoidance (HA), and

Reward Dependence (RD) are in part, genetically determined, apparent early in an individual’s development, and stable over time. Specifically, Cloninger (1987) described NS to be a heritable propensity toward exploratory activity and exhilaration that is triggered by novel or appetitive stimuli, and has been proposed to be linked to the mesolimbic dopamine system. HA reflects the genetic predisposition to react intensely to aversive stimuli, thereby controlling the learning mechanisms that facilitate inhibitive behaviors, and is associated with serotoninergic neural systems (Cloninger, 1987). RD describes the conditioning of the brain system responsible for relief of reward or punishment, and has been proposed to be regulated by norepinephrine. Subsequent factor analytic studies suggested this dimension actually comprised two factors. The first, Persistence, relates more closely to the maintenance of reward behavior and resistance to extinction, whereas the second, Reward Dependence, was revised to relate more exclusively to responses to reward cues of a social nature (Cloninger,

Svrakic, & Pryzbeck, 1993).

Cloninger (1987) proposes that constitutionally determined temperament influences patterns of alcohol consumption. In particular, the tridimensional theory has been implicated in Type 2 alcohol dependence, which is characterized by early onset alcohol misuse and related aggressive and antisocial behaviors (Cloninger, Sigvardsson, & Bohman, 1988). 7

Purported as a combination of high NS, low HA, and low RD, some support for the utility of the tridimensional theory in predicting early onset alcohol misuse exists (Wills, Vaccaro, &

McNamara, 1994). Within Cloninger’s model, NS has received the most consistent support in

the literature for the role it plays in predicting alcohol misuse and related problems in both

adult (Grekin, et al., 2006; Sher, Bartholow, & Wood, 2000), and youth populations (Masse &

Tremblay, 1997; Wills, et al., 1994).

1.4 The Current Study

The aim of the current study was to assess the predictive utility of two prominent

models of personality in the context of alcohol misuse in early adolescence. Acknowledging

some conceptual overlap, both models do offer unique formulations of personality

dimensions and their relationship with alcohol misuse (Heath, Cloninger, & Martin, 1994).

Findings will clarify the etiological role of personality in the development of problematic

alcohol use and contribute to the development of early intervention programs that specifically

target high risk youth.

2. Method

2.1 Participants

A sample of 192 secondary school students (107 females and 85 males) attending

three Catholic Education schools within Brisbane (Australia) participated in the study. Mean

age of students at baseline (Time 1) was 13.8 years (SD = 0.5). At twelve month follow-up

(Time 2), 170 (88.5%) students of the original sample were retained.

2.2 Procedure 8

Of the four schools that were invited to take part in the study, three schools agreed to participate. Active consent was obtained from students and their parents/guardians.

Researchers travelled to each school and administered a survey set to students in a designated class period, then again 12 months later. Those students who were absent on the day of assessment at Time 2 were identified and administered surveys on a separate occasion (within a 2 week period). A unique identifying code was used to track students prospectively.

2.3 Measures

2.3.1 Alcohol Consumption

Quantity and frequency of alcohol consumption are associated with different types of drinking behavior (Rehm, 1998). Quantity of alcohol consumption was assessed in this study by the self-reported item, ‘On average, how much alcohol do you consume on each drinking occasion?’. Participants were asked to report the type of alcoholic beverages they were consuming (e.g., ‘3 full strength stubbies, 2 Bacardi Breezers, etc.’). Using a table that converted these beverages to standard drinks, the quantity of each participant’s average alcohol consumption on a drinking occasion was calculated. Frequency of alcohol consumption was measured by the item, ‘On average, how many days per month do you drink alcohol i.e., 0 – 30 days?’.

2.3.2 Alcohol Use Disorders Identification Test

The Alcohol Use Disorders Identification Test (AUDIT; Saunders, Aasland, Babor, de la Fuente, & Grant, 1993) was employed in this study as a measure of harmful alcohol use.

The AUDIT is made up of 10 items that utilizes a multiple choice response format. It assesses three related constructs of alcohol consumption, alcohol dependence, and drinking related 9

problems, and yields a total score, where higher scores indicate a stronger likelihood of harmful alcohol consumption. Studies have confirmed the utility of the AUDIT as a valid and reliable means of identifying hazardous alcohol consumption in adolescent populations

(Chung, Colby, Barnett, Rohsenow, Spirito, & Monti, 2000; Knight, Sherritt, Harris, Gates,

&Chang, 2003).

2.3.3 Revised Junior Eysenck Personality Questionnaire [abbreviated form]

The Revised Junior Eysenck Personality Questionnaire [abbreviated form] (JEPQR-

A; Francis 1996) is a 24 item abbreviated form of the short form Revised Junior Eysenck

Personality Questionnaire (JEPQ-R; Corulla, 1990). The self-report scale measures the personality dimensions of Psychoticism, Neuroticism, and Extraversion. A fourth Lie scale is also included, as a measure of social desirability (Eysenck & Eysenck, 1975). Individuals respond to items using a true/false format. Junior versions of Eysenck personality measures have been previously administered in adolescent populations to investigate substance use and misuse (Francis, 1997; Kuo, et al., 2002)

2.3.4 Junior Temperament and Character Inventory

The Temperament scale of the Junior Temperament and Character Inventory (JTCI;

Luby, Svrakic, McCallum, Przybeck, & Cloninger, 1999) assesses Cloninger’s model of temperament in middle childhood. Composed of 55 items, the temperament scale is made up of four subscales that measure the purported personality dimensions of Harm Avoidance,

Novelty Seeking, Reward Dependence, and Persistence. Items adopt a true/false format.

Reliability and validity have been established in both community (Luby, et al., 1999; Laucht,

Becker, Blomeyer, & Schmidt, 2007) and clinical populations (Copeland, Landry, Stanger, &

Hudziak, 2004; Gothelf, Aharonovsky, Horesh, Carty, & Apter, 2004). 10

3. Results

3.1 Bivariate Associations

Table 1 reports Pearson’s correlation coefficients between the two personality models.

Consistent with previous findings, strong positive associations were found between JEPQR-A

Neuroticism and JTCI-Harm Avoidance, JEPQR-A Psychoticism and JTCI Novelty Seeking,

and JEPQR-A Extraversion and JTCI Novelty Seeking. A strong negative association

emerged between JEPQR-A Extraversion and JTCI Harm Avoidance. Surprisingly, a strong

negative association also was found between JEPQR-A Lie and JTCI Novelty Seeking, which

suggests that these constructs may be factorially complex. Small-to-moderate correlations

were found across most of the remaining personality constructs. In contrast, the JEPQR-A

Neuroticism scale was not found to be significantly related to JTCI Novelty Seeking, JTCI

Reward Dependence, or JTCI Persistence. JEPQR-A Lie was not significantly correlated with

JTCI Harm Avoidance or JTCI Reward Dependence.

______

INSERT TABLE 1 HERE

______

Table 2 reports zero-order correlations between personality constructs measured at

baseline and the three drinking behaviors measured 12 months later. The strongest positive associations emerged between the JEPQR-A Psychoticism scale and quantity of consumption, as well as harmful alcohol use (as measured by the AUDIT). These two

measures of drinking behavior were also found to have strong associations with JEPQR-A

Extraversion and JEPQR-A Lie. In relation to the JTCI scales, quantity of consumption and harmful alcohol use were found to be strongly correlated with Novelty Seeking and 11

Persistence. A strong association also emerged between JTCI Harm Avoidance harmful

alcohol use.

______

INSERT TABLE 2 HERE

______

3.2 Prospective Analyses

A series of hierarchical multiple regression analyses were performed to examine the

unique contribution of the JEPQR-A and JTCI scales at Time 1 to predict the three measures

of drinking behavior (quantity of consumption, frequency of consumption, harmful alcohol

use) at Time 2. For each model, the corresponding Time 1 measure of drinking behavior was

included in the first step to control for its established influence on future drinking (at 12

month follow-up) (Sher, et al., 2000). Results of these analyses are shown in Table 3.

______

INSERT TABLE 3 HERE

______

Time 1 drinking behavior was found to significantly predict corresponding drinking behavior at Time 2 across all three measures of consumption. The addition of the JEPQR-A scales was found to significantly improve prediction of quantity of consumption (Fchange(1, 4)

= 10.79, p < .001), with the final model accounting for 41.0% of the variance. The JEPQR-A

uniquely accounted for 17% of this variance. Examination of beta-weights revealed high

levels of Psychoticism and Extraversion to be the strongest predictors of quantity of alcohol

consumption at Time 2. A second hierarchical regression found the addition of the JTCI

scales significantly improved prediction of Time 2 quantity of consumption (Fchange(1, 4) = 12

3.99, p < .01), with the final model accounting for 29.1% of the variance. The JTCI was

found to uniquely account for 8% of this variance. Novelty Seeking was the strongest predictor of quantity, where higher baseline scores of Novelty Seeking predicted greater

quantities of alcohol consumption 12 months later.

In contrast, frequency of alcohol consumption was found to be significantly predicted

only by the JEPQR-A (Fchange(1, 4) = 2.90, p < .05). The final model accounted for 42.5% of

variance in frequency of consumption, with the JEPQR-A uniquely accounting for 4.4% of

this variance above that related to baseline frequency. Higher baseline levels of Psychoticism

and Lie were found to be the strongest predictors of greater frequency of consumption at

Time 2. Students’ AUDIT scores were significantly predicted by the JEPQR-A (Fchange(1, 4)

= 6.91, p < .001), with the final model accounting for 55.2% of variance. The JEPQR-A was found to uniquely account for 8.3% of this variance above that related to baseline AUDIT scores. Higher levels of Psychoticism and Extraversion emerged as the most important

predictors of greater scores on the AUDIT at 12 month follow-up.

4. Discussion

The aim of this study was to assess the utility of Eysenck’s (1975) and Cloninger’s

(1987) personality models to predict alcohol misuse in 14-year-old secondary school students

12 months post assessment. Both models uniquely predicted aspects of drinking behavior.

The Eysenck Psychoticism dimension emerged as a robust predictor of subsequent

problematic drinking. Specifically, those adolescents who scored highly on psychoticism

tended to be drinking more frequently, at greater quantities, and in a more harmful manner at

12 month follow-up. This finding is consistent with previous prospective research that has

demonstrated a relationship between early traits of disinhibition and later problematic alcohol

use (e.g., Conrod, et al., 1997). Findings of the current study have provided further evidence 13

of the etiological relevance of the dimension of psychoticism, where tendencies toward

antisocial behavior, aggression, and disinhibition during early adolescence place youth at an

elevated risk of developing alcohol use problems during middle adolescence.

Higher scores on Extraversion were predictive of higher quantities of alcohol

consumption and more harmful levels of consumption. This finding is important in the

context of the inconsistencies that have characterized extraversion and alcohol misuse

research (Sher, et al., 1999). It also lends further weight to recent two-factor models of

adolescent drinking problems, in which both extraversion and psychoticism-like traits are

proposed to convey risk (Gullo & Dawe, 2008). Extraversion appears to be an important,

unique risk factor for the development of alcohol misuse and is useful in predicting future

drinking problems in secondary students as early as 14 years of age.

The JEPQR-A Lie scale was associated with more frequent drinking episodes 12 month post assessment. Previous studies have reported a similar relationship, where higher lie scores have been found in alcohol and substance dependent populations (Porrata & Rosa,

2000; Rosenthal, et al., 1990). This is consistent with Eysenck’s et al. (1970) early assertion that lie scales are multidimensional in nature, and when administered amongst youth, may reflect an underlying trait of insight and denial.

Finally, novelty seeking emerged as a significant risk factor predicting greater quantities of alcohol consumption. Traits associated with impulsivity and sensation seeking have consistently been shown to be related to the development of alcohol misuse, and this result highlights the significant role it plays early on in the developmental trajectory of adolescents who misuse alcohol (Gullo & Dawe, 2008).

This study has highlighted the important contribution that Eysenck’s (1975) and

Cloninger’s (1987) personality models have made in the field of adolescent alcohol misuse research. Results have underscored the predictive utility of the dimensions of psychoticism, 14

extraversion, and novelty seeking, thus providing additional support for their etiological

relevance in the development of alcohol misuse in adolescence. These findings are stronger

still, when one considers the conservative statistical approach employed in this study, as well

as its prospective design, and high retention rate of participants. The current research further highlights the notion that adolescent drinking behavior is multidimensional and is predicted by different personality features. The utility of the lie scale in predicting alcohol problems in

middle adolescence continues to show promise and further research should look to explore

the psychological trait that potentially underlies this construct.

Despite its strengths, the current study should be interpreted within the context of

some limitations. Firstly, there were only three schools selected in the sample. The

generalizability of the results is thus limited to some extent, and may not be representative of

all 14 year old secondary school students. Secondly, the focus of the investigation was on the relationship between personality features and adolescent alcohol misuse, and while significant findings emerged, other variables that may have potentially impacted on the influence of personality were not analyzed. The moderating and mediating processes of factors such as peer and parental relationships should be the focus of future investigation.

The findings of the current study have highlighted the etiological relevance of personality in the development of early onset alcohol use in adolescence. Recent research has demonstrated the potentially important role personality plays in early targeted interventions amongst high risk adolescent populations (Conrod, et al., 2006). Future studies should continue to investigate the extent to which personality features can be modified through early therapeutic processes, and the subsequent impact on drinking behavior. 15

Table 1 Cross-Sectional Pearson’s Correlations between Time 1 JEPQR-A and JTCI Scales

Predictors JEPQR-A JEPQR-A JEPQR-A JEPQR-A JTCI JTCI JTCI JTCI Psychoticism Extraversion Neuroticism Lie Novelty Harm Reward Persistence Seeking Avoidance Dependence JEPQR-A - Psychoticism

JEPQR-A .24** - Extraversion

JEPQR-A -.15* -.12 - Neuroticism

JEPQR-A -.38** -.27** -.03 - Lie

JTCI .46** .47** -.02 -.47** - Novelty Seeking

JTCI -.28** -.40** .58** .10 -.32** - Harm Avoidance

JTCI -.18* .24** .07 .08 -.13 -.02 - Reward Dependence

JTCI -.35** -.16* -.02 .36** -.44** .10 .30** - Persistence * p < .05 ** p < .01

Table 2 Prospective Pearson’s Correlations between Time 1 JEPQR-A and JTCI Scales and Time 2 Drinking Behavior

Predictors JEPQR-A JEPQR-A JEPQR-A JEPQR-A JTCI JTCI JTCI JTCI Psychoticism Extraversion Neuroticism Lie Novelty Harm Reward Persistence Seeking Avoidance Dependence Quantity of alcohol .50** .33** -.06 -.32** .38** -.17* -.16* -.29** consumption

Frequency of alcohol .20** .12 .03 -.02 .12 -.13 -.04 -.20* consumption

AUDIT .51** .33** -.03 -.23** .36** -.22** -.10 -.34** * p < .05 ** p < .01

Table 3 Prospective Hierarchical Multiple Regression Analyses Predicting Drinking Behaviors from JEPQR-A and JTCI Scales Separately Quantity of Alcohol Frequency of Alcohol AUDIT Consumption Consumption

Predictor R² β R² β R² β JEPQR-A Step 1 T1 Drinking .24*** .49*** .38*** .62*** .47*** .69*** (Quan/Freq/AUDIT)

Step 2 .41*** .43* .55*** Psychoticism .37*** .16* .27***

Extraversion .17* .12 .18**

Neuroticism .02 .05 .04

Lie -.02 .21** .06

JTCI Step 1 T1 Drinking .21*** .46*** .40*** .64*** .44*** .67*** (Quan/Freq/AUDIT)

Step 2 .29** .41 .46 Novelty seeking .19* .00 .04

Harm avoidance -.05 -.04 -.04

Reward dependence -.07 .02 -.01 * p < .05 ** p < .01 ***p < .001 Persistence -.11 -.05 -.09 18

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