Neuropsychodynamics of alcoholism and addiction: Personality, psychopathology, and cognitive style

Abstract

The literature on the neuropsychology, personality, and psychopathology of alcoholism and addiction is reviewed. Neuropsychological studies of substance abusers have found deficits in abstract concept formation, set-maintenance, set-shifting, behavioral control, and cognitive flexibility. However, the evidence that these deficits are the result of direct substance effects on the brain is slim. Both alcoholics and as-yet nondrinking offspring of alcoholics have been found to be deficient in verbal skills and language functioning. Personality studies of alcoholics and addicts have emphasized such characteristics as field dependency, external locus of control, attenuated time extension, poor ego strength, and disturbed object relations. The psychopathology of alcoholics and opiate abusers seems to be dominated by impulsive character disorder, although there may also be a subgroup of anxious, depressed substance abusers. The present review integrates brain-behavioral perspectives with the data on personality and psychopathology, focusing on the relevance of a multidimensional neuropsychological model to psychodynamic concepts of ego functioning and the substance abusers' problems in the regulation of affect and behavior. It is argued that the concept of cognitive style is useful for understanding the relationship of neuropsychological functioning to personality dynamics, and that this approach can be especially productive in understanding the addictions.