Relationship of Aggression, Sensation Seeking, and Impulsivity, With Severity of Cocaine Use (original) (raw)

Addictive Disorders & Their Treatment, 2003

Abstract

ABSTRACT We investigated whether pretreatment measures of sensation seeking, impulsivity, and aggression were related to severity of cocaine use. Assessments of sensation seeking (SSS), impulsivity (BIS), and aggression (BDHI) were obtained for 140 African-American cocaine-dependent individuals entering outpatient treatment. We explored whether these variables were associated with addiction severity measures including quantity, frequency, and duration of cocaine use, scores on the Addiction Severity Index (ASI), and the admission urine drug screen status. A significant positive association was found between the total BDHI score and duration and frequency of cocaine use. Furthermore, SSS scores showed a significant positive correlation with frequency of cocaine use and cocaine positive admission urines. The BIS scores were significantly associated with 2 of the 7 ASI scales. Multiple regression analyses showed that the 3 measures contributed significantly toward predicting severity of cocaine use, but the contribution to the overall variance was modest. Measures of aggression and sensation seeking seem to be of clinical value in the assessment of cocaine abusers. However, these measures may need to be combined with other clinical and behavioral variables to accurately predict the severity of cocaine use. Several lines of evidence support an association between traits of aggression, sensation seeking, and impulsivity, and substance abuse. First, high rates of substance abuse have been reported in clinical disorders such as bipolar disorders 1 and antisocial personality disorders 2 that are characterized by aggression and impulsivity. Lifetime prevalence rates of substance abuse have been reported to be over 90% among selected populations such as impulsive offenders. 3 Second, substance abusers have been found to exhibit significantly increased rates of impulse control disorders and violent behaviors compared with controls. 4-6 Third, studies employing psychometric assessments have found that cocaine abusers scored higher on measures of aggression and impulsivity compared with controls. 7,8 Fourth, childhood disorders associated with aggression and impulsivity such as conduct disorders and attention deficit disorders are consistently related to development of substance abuse in adolescence and adulthood. 9,10 It has been suggested that aggressive and impulsive individuals frequently experience negative emotional states such as irritability, anxiety, and dysphoria, and that substance use may be an attempt to alleviate the internal negative emotions. 11 Biologic studies also tend to support a link between aggression, impulsivity, and cocaine use. Cocaine has potent effects on cortical and subcortical dopamine systems that mediate initiation and control of behavior. 12 Chronic cocaine use has also been reported to impair serotonergic activity 13,14; serotonergic deficits have been linked to aggressive and impulsive behaviors. 15,16 These traits seem to be clinically important. Increased levels of aggression and impulsivity have been found to predict reduced retention and abstinence for cocaine abusers in treatment. 17,18 More disturbingly, self-destructive behavior, in particular violent suicide attempts, seem to be related to impulsive and aggressive traits among substance abusing patients. 16 Over the past decade, studies have examined several variables that may be associated with severity of drug use among cocaine abusers. Severity of cocaine use has been found to be related to demographic factors such as age and employment status, 19,20 anxiety and depressive symptoms, 20,21 polysubstance use, 22 antisocial personality, 23 and social stress. 24,25 Recent studies have also implicated biologic, possibly genetic factors, in determining severity of cocaine use. 26 Surprisingly, few studies have specifically studied the relationship between traits of aggression, sensation seeking, and impulsivity, and cocaine use, and the data is not consistent. In a study of 50 cocaine outpatients, Moeller et al 17 found that impulsivity was significantly correlated with severity of self-reported cocaine use and severity of cocaine withdrawal. Similarly, measures of aggression have been reported to be associated with substance abuse. 5 In contrast, Kasabrada et al 27 found no significant consistent relationship between sensation seeking and severity of cocaine use. Consistent with the literature, we had previously found that cocaine-dependent patients exhibit higher levels of aggression, sensation seeking, and impulsivity compared with controls. 28 The objective of this study was to examine whether measures of aggression, sensation seeking, and impulsivity are related to severity of cocaine use.

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