The Risks of Substance Misuse on Personality and Impact on Psychopathology and Emotional Regulation Deficits - Coursework Example

The Risks of Substance Misuse on Personality and Impact on Psychopathology and Emotional Regulation Deficits MSc Foundation of Clinical Psychology Name Instructor Task Date Abstract The topic of substance misuse remains a broad and open-ended one. In often times therefore, reviewers will give particular attention to specific aspects of the topic. Notably, the issue of risks associated with substance misuse is one of the most important aspects of the study as it presents a paradigm used in understanding the outcome of substance misuse, as well as understanding onward decision making that has to do with control (Lane, Sechrest & Riedel, 1998). This is because it is only possible to design the necessary interventions desired by a person after detecting the level of risk associated with a person’s engagement in substance misuse (Cole, Martin & Dennis, 2004). However, even on the subject of the risks of substance misuse, it is notable that there are different broad components of it that seek to look at specific aspects of a person’s life that risk may be measured. The Risks of Substance Misuse on Personality and Impact on Psychopathology and Emotional Regulation Deficits Introduction The literature review is an important component of the research committed purposely to collect secondary data to back any form of primary data collected in the course of the study. The use of secondary data for the literature review means that the researcher shall put a lot of emphasis on existing works of scholarly importance that relate to this area of study. In this literature review, the researcher attempts to find the relationship between key concepts and issues that affect people who misuse substance. These key issues are personality, pathology and emotional regulation. The review shall identify ways in which people’s personalities cause them to follow the habit of substance misuse, how pathology leads to diagnosing impact of substance misuse, and how substance misuse eventually affects the emotional regulation of substance misuse victims. A special approach taken towards the review will be to look at these risks along gender lines, by outlining the differences that exist between males and females in terms of the level of impact. Assessment of Personality and Pathology Alternative 5 Factor Model of Personality The alternative Five Model of Personality devised by Marvin Zuckerman is one credible definition of personality and its effects on the outcome on people. Zuckerman, Kuhlman, Thornquist and Kiers (1991) explained that the Alternative Five Model of Personality (AFFM) outlines the structure of human personality traits based on which five broad factors visible to influence the actions of people. The five broad factors given are sensation seeking, neuroticism - anxiety, aggression - hostility, sociability, and activity (Tull et al., 2009). There continues to be research that gives evidence to the relationship between the broad factors given under AFFM and maladaptive behaviour, including drug and alcohol misuse. For example, Morris et al. (2007) explained that most people are not able to attain normal personality due to the lack of ability to stimulate their neuroticism - anxiety naturally in order to satisfy normal processes such as fear, general emotionality and psychasthenia. Because of this, such people resort to the misuse of substances as a means of maintaining an emotional balance. In another research, this confirmed the claim above using a study in which used the AFFM as a model to measure levels of emotional regulation among female university studies. The conduction of this study used the Dimensional Assessment of Personality Pathology – Basic Questionnaire (DAPP-BQ). The outcome of the study showed that the lower the levels of emotional regulation recorded by respondents, the higher their dependence on substance, most of which were misused to ensure a balance. In a recent study, Cloitre, Koenen, Cohen and Han (2002) itemised key factors and issues that could possibly impact on males to cause them to go into substance misuse, and once these people do, the possible effects that they may face. In the study, it was notable that most males engage in substance misuse with the notion that masculinity is associated with superiority. As a way of gaining the said superiority, they resort to the use of enhancement drugs that enhance their abilities in several areas of their lives. Examples given are those of students, athletes and other people who generally use drugs for appealing to their egos (Berking, Ebert, Cuijpers & Hofmann, 2013). In a separate report, Staigeret al. (2009) said that some males extend their notion of superiority to issues of sex, making them resort to the use of sexual enhancement drugs, most of which have consequential effects on the emotional balance of a person. A good case example occurs in most young men when they use Viagra drugs to enhance their performance in bed without regard to the long-term negative effects of these drugs to their sexuality. Maladaptive Trait Expression A number of psychologists researched on the relationship between psychological problems and substance misuse, as well as how the level of a person’s psychological problem can determine the depth of substance misuse experienced, as well as the level of risk that the person can suffer. In such researches, the emphasis has always been ways in which a proper adaptation between a person’s psyche and the environment can result in psychological and personality problems. In one of such studies, Spielberger, Gorsuch and Lushene (1970) identified the two most dominant psychological factors are self-esteem and need for acceptance. Issues of both low self-esteem and high self-esteem can have tendencies with substance misuse and that the best way to check self-esteem is to have moderation. On their part, Cole, Martin and Dennis (2004) said that people with low self-esteem are often the worst victims because they misuse substances as a means to filling in the lost gap of self-esteem. Morris et al. (2007) related self-esteem to the need for acceptance and stated that people with low self-esteem have the tendency of feeling withdrawn and therefore the need to have an external aid to pushing them closer to acceptance. Such people would therefore misuse substances either as a way of getting companions who would accept them because they are now part of a peer group and act in the same way or by misusing substance, they will feel the urge to penetrate their social block. Other forms of psychological problems mentioned are having potential risks and relation with substance misuse including locus of control, anxiety level, eagerness to act like adults, and sensation seeking (Koole, 2009). Waller and Scheidt (2004), who investigated the causes of substance misuse in females, as well as the effects of substance misuse on females, studied the female impact with substance misuse. In the study, it showed that in comparison with males, the factors that cause most females to go into substance misuse are entirely different from what causes males to go into substance misuse. For example, it was notable that most females are likely to have a first taste of drug, alcohol, or other forms of substance easily misused as a result peer influence. This means that for most girls, external influences affects them greatly to engage in substance misuse rather than internal influences affecting them, especially those based on their persona and ego (Wupperman et al., 2011). Investigating the trend of effect of substance misuse in females, Subic-Wrana et al. (2005) noted that several girls barely have any resistance to most of the effects of substance misuse. What this means is that once the effects set in, it plagues the girls to its worse forms. Psychopathology of Personality Disorder The approach to diagnosing the effect of substance misuse, and thus the pathology of substance misuse, has always been a cause of disagreement among psychologists. In a more modern approach however, the research methodology adopted the combination of psychology and pathology in psychopathology, used as the most preferred approached to pathology. Researchers developed several models based on psychopathology. One of such models adopted from a study with the Diagnostic and Statistical Manual of Mental Disorders based on Millons personality disorder subtypes. This model which has been come to be known as the Millon’s model found that, the issue with difficulty to adjust personality with the environment is not the direct result of emotional regulation but a result of problems with mental maladaptive. Because of the problem with mental maladaptive, these people are not able to make independent decisions that emanate from the need to independently rely on their mental abilities to overcome social and personal challenges. In the end, these people resort to the use of external aids including drugs and alcohol. Relating the two studies above, it would be notable that the result of any form of maladaptive outcomes with a person’s self, environment or society leads to reliance on external aid including substance misuse. However, the bow of contention now is the actual cause of maladaptive, which is either emotional regulation problem or mental problems. A recent study carried out by Cooper, Frone, Russell and Mudar (1995) identified statistical relationship between key variables of substance misuse and the male gender. The first variable considered was the relationship between substance misuse in males and crime cases. In this, statistics showed that up to 43% of all cases of crime involving assault, theft, robbery, and rape are attributable directly to the influence of drugs or alcohol. Another 37% had indirect association with drugs and alcohol, where it judged indirect association from history of substance misuse or possession with drugs, even if not under the influence of it (Cloitre, Koenen, Cohen & Han, 2002). Figure 1. Drug Use and Their Relation to Crime Cases. Adapted From “Skills Training In Affective And Interpersonal Regulation Followed By Exposure: A Phase-Based Treatment For PTSD Related To Childhood Abuse,” By Cloitre, M, Koenen, K.C., Cohen, L.R. & Han, H., 2002, J Consult Clin Psych 70(4), 1067– 1074. Copyright 2002 Adapted With Permission. The Millon’s model relates closely to the developmental theory. Developmental theorists acknowledge that the developmental stages a person goes through in the course of growth can have so much impact on the person’s way of life in several ways. Primarily, the adolescence stage is identifiable as a crucial moment in development where people of both sexes observe several differences in their body in terms of biological and psychological changes (Cole, Martin & Dennis, 2004). Generally, both males and females experience physical and sexual development that affects their thinking, feelings, behaviour, and personal relationships (Morris et al., 2007). At this stage, there is a feeling of adulthood, that makes most of these adolescents have a feeling of experimenting and trying out on concepts that were generally associated with adults (Eisenberg et al., 2001). Critical among these is the desire to try their hands on drugs and substances that the law and society generally bans them from using owing to their age and stage of development (Spielberger, Gorsuch & Lushene, 1970). Similarly, the Livesley Dimensional Model gives the four secondary domains of development stages of the pathological personality as emotional dysregulation, disorder behaviour, inhabitedness and compulsivity to explain the first stage of pathological personality, which is the induction of the principal domains of personality. What these four secondary domains imply is that the personality degeneration associated with substance misuse is developmental and gradual rather than an event. Relationship between Psychopathology and Personality Risk Abuse of Alcohol Rate According to the National Institute on Alcohol and Alcoholism, NIAA (2013), the practice of taking in alcohol is not necessarily a problem, however, problem with the consumption of alcohol sets in when people take in alcohol at rates that are increase their blood alcohol concentration (BAC) to levels that make them exhibit impaired effects in their bloodstream. Some of the impaired effects identified by the institute include reduced inhibitions, slurred speech, coma, concentration problems, memory problems, motor impairment, confusion, and death. Meanwhile, the various psychopathological consequence of alcohol misuse on personality includes an absence of proper judgment of moderation for the consumption of alcohol, leading to abuse (Berking, Ebert, Cuijpers & Hofmann, 2013). Personality is as unique as people are. This means that all people are to exhibit their unique personalities and use these appropriately as expected by society (Gratz et al., 2006). Even though there may be personality similarities between different people, the general expectation is that the personality exhibited by a person would perfectly feed the person’s unique identity (Wupperman, Neumann, Whitman & Axelrod, 2009). Unfortunately, though, there are instances when people are indecisive about themselves and their roles (Berking, Ebert, Cuijpers & Hofmann, 2013). Once this situation arises, personality confusion takes place. Wupperman, Neumann, Whitman and Axelrod (2009) were however quick to add that it is not all the time that the confusion of personality that takes place takes the form of one who was less aggressive to being more aggressive. Rather personality confusion can also lead to withdrawn characteristics in some people who were otherwise open. The Struggle for Control Once people start abusing substance to certain levels, Leible and Snell (2004) emphasises that there begins to be a struggle for control between their personality and the effects of the substance. Right from the onset, even though level of misuse may be relative, the impact of substance misuse struggling for control with personality takes place in a gradual motion option, making it difficult for affected people to notice until it becomes too late. Whiles the struggle for control becomes persistent, Kim and Cicchetti (2010) note that the personalities of people who highly abuse drugs tend to lose the fight. In this sense, the abilities of people to determine what happens with their personalities become suspecting. Most commonly, such people exhibit characteristics that show that they have lost control over their personalities because they begin doing things that they would not do under normal circumstances (Aldao & Nolen-Hoeksema, 2011). Secondly, such people loss their sense of moderation, causing them to do things far too much or far too little (Gross & John, 2003). What is more, because of the absence of control, it is likely that these people will lose count of what the society around them generally accepts, as well as what is not acceptable within the society. In effect, they may begin doing things that generally regarded as unacceptable by the society around them. Finally, once the battle for control is lost, it is common that these people will loss a sense of frequency, causing them to do things in far too frequent ways than their normal personality pattern would have allowed them to (Gross & John, 2003). In a research that undertook a comparative analysis of key variables of substance misuse and females found that when it comes to crime cases, more girls engaged in substance misuse are likely to engage in criminal activities including robbery and assault than those who do not use such substances (Subic-Wranaet al., 2005). Comparing rates between girls and boys however, Subic-Wrana et al. (2002) said that females who at the time of crime were directly under the influence of drugs or alcohol undertook 37% of cases of crime among females. This rate is lower if compared to the records for males. However, another 39% of the females had a history of substance misuse or engaged in substance misuse, but not at the time of committing crime. What this means is that in all, 72% of crime in females are substance misuse related. On the variable of suicide, it pointed out that more females under the influence of drugs were likely to commit suicide as opposed to those who do not engage in substance misuse. Between females and males, it pointed that even though fewer females engage in suicide, greater quantities of these cases are with those who are into drugs and alcoholism (Lane, Sechrest & Riedel, 1998). Figure 2. Possibility of Suicide In Females. Adapted From “Sociodemographic Correlates of Alexithymia,” By Lane, R. D., Sechrest L., & Riedel R., 1998, Compr Psychiatry. 39 (6), 377–385. Copyright 1998 Adapted with Permission. Relationship between Personality, Pathology and Emotional Regulation Cognitive and Behaviour Model of Emotional Regulation Tull et al. (2009) defined emotional regulation as the set of techniques that allow us to behave in a manner we would most prefer to do with when we are under pressure that with situations that makes our emotions controls our actions. Such techniques including meditation bring several benefits including mood improvement and increased empathy. Waller and Scheidt (2004) asserted that there are two major models to emotional regulation namely cognitive and behavioural models. From earlier discussions where Millons personality disorder subtypes makes claim to the effect of the mind on behaviour, it is notable that cognitive models to emotional regulation generally make use of ways in which individuals are able to use suppression and reappraisal to influence their abilities to perform cognitively well when faced with cognitive causes of emotional consequence. Cognitive models therefore put emphasis on suppression and reappraisal. Meanwhile, studies that follow the alternative five model of personality emphasise on behavioural models to emotional regulation where the focus to regulation is on behaviour based personality outcomes that do not overlap (Novick-Kline et al., 2005). In order to understand the effect of substance misuse on emotional regulation, Waller and Scheidt (2004) used the Difficulties in Emotion Regulation Scale (DERS) to measure the different instances of emotional dysfunction in respondents and found the relation between these with external stimuli such as alcohol and drug. The outcome of the study showed that the absence of cognitive emotional regulation skills could influence people in misusing substance as much as absences of behavioural emotional regulation skills can (Morris et al., 2007). Onset of Social Anxiety The abuse and misuse of drugs has the potential of leading to the onset of social anxiety for people, both at the earliest and later stages of attack (Gratz et al., 2006). Social anxiety is a fear of judgment once a person is in a social group (Cloitre, Miranda, Stovall-McClough & Han, 2005). By implication, a person with social anxiety fears and has a mentality that a particular social group will not accept them because they are not fitting enough to the group. There are several causative factors associated with this phenomenon. However, in the case of drug abuse and drug misuse, it creates an atmosphere and concept of social anxiety because victims have a sense of unacceptability due to the new situation they find themselves in (Berking, Ebert, Cuijpers & Hofmann, 2013). Sharing light on the situation, Wolff, Stiglmayr and Bretz (2007) said that people who misuse drugs are often suspicious and secretive of themselves, especially those who use illegal drugs. Meanwhile, they harbour the fear that once they use these drugs, they will easily get exposed when they mingle with others. This self-made perception is the pathway way, leading to social anxiety. Writing on the same issue, Leible and Snell (2004) posited that people on drugs become socially anxious mainly because they are aware of the unacceptability of their practice, which translates into a mental state of unacceptability for their personalities as well. Cognitive Emotion Regulation Deficits A recent study identified the relationship between social anxiety deficit and cognitive emotion regulation. As part of the findings, it established that in terms of neurological arousal, all the respondents present in the study exhibited similar characteristics (Tull, Barrett, McMillan & Roemer, 2007). In terms of cognitive emotion regulation however, respondents diagnosed with social anxiety deficit demonstrated weak cognitive emotion regulation activation. It noted that cognitive emotion regulation is a feature responsible for balancing one’s negative emotional regulation to levels that best align with socially acceptable standards (Aldao & Nolen-Hoeksema, 2011). Further scrutiny of why people with social anxiety deficit had cognitive emotion regulation deficit showed that these people had a significantly reduced activity in their part of the brain that was responsible for negative emotional regulation (Staigeret al., 2009). Meanwhile, social anxiety has already been associated with drug and substance misuse. This means that cognitive emotion regulation deficit is a direct consequence of substance misuse, emanating from the fact that most forms of substances and drugs undergo often abuse and misuse has the potential of altering the scalar function of the brain region responsible for negative emotional regulation (Wolff, Stiglmayr, & Bretz, 2007). Leible and Snell (2004) on the other hand cautioned that cognitive emotion regulation deficit represents the beginning of the onset of greater mental problems as it directly relates to the functioning of the bran. Waller and Scheidt (2006) noted that when there is an emotional and psychological deficiency clash, the resulting effect for substance misuse patients is that there can be aggravated reports and issues with the normal functioning of the brain. Even though both the emotional and psychological effects of substance misuse have some level of impact on the brain, it is said that the combined effect is always bemoaning and slightly out of control (Waller & Scheidt, 2004). Aldao, Nolen-Hoeksema and Schweizer (2010) gave ratings or ranks of possible brain damage and brain related dysfunctions. According to the report, brain dysfunction resulting from substance misuse could range from mild to severe. Where the rating exceed mild, there has been a mental breakdown in the patient, resulting from substance misuse. Major Gaps in Research Searching through literature showed the existence of a major gap with control models used in the regulation of skills for people who for one reason or the other have suffered the effects of substance misuse. In line with this, the Emotion Regulation Training (ERT) is the best strategy for use as a control model for patients of various substance misuse cases. For patients with Major Depression Disorder (MDD), there is a major relationship between their cognitive behavioural skills and emotion regulation in Wupperman et al. (2011). On this basis, a systematic Emotion Regulation Training (ERT) improves the effectiveness of constant cognitive behavioural therapy (CBT) for MDD (Berking, Ebert, Cuijpers & Hofmann, 2013). There are high expectations of a major reduction in depression rates as well as remission rates once a patient receives ERT, especially those patients with various forms of emotional, cognitive and behavioural disorders. It is expected that using ERT can thus serve as 2-prone benefit that handles both cases of emotional disorder and cognitive behavioural disorder. However, for patients that cannot guarantee that there will be no remission rates after using ERT, other models that base on CBT can be combined with ERT in a combined therapy. Summary of the Review The first theme sought to identify various theoretical perspectives on the issue of substance misuse. On this, it reviewed that three major elements exist in literature on the topic of substance misuse, which are Assessment of Personality and Pathology, Relationship between psychopathology and personality risk as well as Relationship between personality, pathology and emotional regulation. Each of these domains attempt to identify particular lines of causes to the problem of substance misuse. Generally, the theories agreed that inadequate education on ways to handling growth and developmental changes is the major cause to onset of substance misuse, as well as the correlation between a person’s psyche and the environment can result in psychological and personality problems. On the theme of personality risks associated with substance misuse, it identified that personality confusion and the struggle for control were the commonest personality risks that people who misused substance faced. The theme of impact of substance misuse on psychological and emotional regulation deficit was also investigated, out of which it was realised that onset of social anxiety, cognitive emotion regulation deficits and mental breakdowns were all potential psychological and emotional regulation deficits. 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