Abstract
Previous research has suggested the prevalence of certain personality traits, some of which are related to a disorganized attachment, in substance abuse disorders. Further, frustration tolerance (FT) has been proposed as an important factor in addiction, both at the inception—following the “self-medication” hypothesis—and regarding treatment compliance. In turn, an inadequate response to frustrating events has been also associated with a disrupted attachment. Our goal is to explore the mediational role of FT in the relationship between personality traits and two different treatments for substance addiction: therapeutic community (TC) and ambulatory treatment (AT). Eighty-four subjects with substance abuse disorder were recruited in total (22 female), including 46 volunteers (13 female) in TC and 38 (9 female) in AT. They were assessed with Rosenzweig’s test for FT and the Millon Clinical Multiaxial Inventory-III (MCMI-III) test to evaluate personality factors. By comparing with a control sample (335 volunteers, 268 female), we found that FT was lower in patients. Between therapeutic groups, FT was significantly lower in TC. Depressive, antisocial, sadistic, negativistic, schizotypal, borderline, paranoid, anxiety, dysthymia, alcohol use, drug use, posttraumatic stress disorder (PTSD), thought disorder, and delusional disorder traits were suggestive of pathology in the clinical samples and were significantly different between control, AT, and TC groups. Further, anxiety and PTSD traits were higher in TC than in AT. A mediational analysis revealed that the effect of anxiety and PTSD scales on therapeutic group was partially mediated by FT. In conclusion, FT and its interplay with personality traits commonly related to disorganized attachment (anxiety and PTSD) might be important factors to consider within therapeutic programs for persons with substance addiction.
Highlights
Drug addiction withdrawal implies a set of physiological and psychological challenges that should be faced by the patient and taken into account by the therapist [1,2,3]
We do not measure attachment directly, we aim to evaluate the association between the type of withdrawal program (TC and ambulatory treatment (AT)) [56], the presence of pathological personality traits that have been previously related to a disorganized attachment [see, for example, Ref. [57]], and the role of frustration tolerance (FT) as a mediating factor between them
The whole clinical sample (AT and TC) showed a score of 16 ± 6.5 in the Rosenzweig test (Figure 1). This is considered a medium FT according to the standards, as defined by Rosenzweig and based on the Dollard et al theory of frustration–aggression [64], FIGURE 1 | Box plots showing differences in frustration tolerance (FT) between clinical and control samples, as well as between therapeutic programs. (A) Rosenzweig Picture Frustration Test (PFT) scores in the unmatched clinical and control samples. (B), median scores for the MedCalc-matched samples. (C) Rosenzweig PFT scores in therapeutic community and ambulatory treatment
Summary
Drug addiction withdrawal implies a set of physiological and psychological challenges that should be faced by the patient and taken into account by the therapist [1,2,3]. Following the self-medication hypothesis, it has been proposed that illicitdrug consumption—and subsequent addiction—could be used as a means of alleviating negative emotions such as frustration [19] Taking this into account, the ability of the patient to tolerate frustrating events might be an important factor in substance addiction, both in the development of the disorder and during treatment. Concerning humans, frustration tolerance (FT) is negatively associated with the number of relapses [22] and positively predicts recovery from alcoholism [23, 24] It is an essential component of the complex construct of distress tolerance [25], which is, in turn, an important factor of withdrawal [26,27,28]
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