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Personality Characteristics Associated with Drinking and Beverage Preference
15 Personality Characteristics Associated with Drinking and Beverage Preference Colin R. Martin Psychology Group, Faculty of Health, Leeds Metropolitan University, Leeds, UK
Abstract The study of psychological aspects of alcohol consumption and, in particular, alcohol dependence and problem drinking has produced a vast and broad quantity of research findings over the past 50 years. However, in spite of the breadth of research conducted in this important area of applied psychology, comparatively little research has been conducted into the relationship of personality characteristics and beverage and beer preference. This chapter seeks to highlight some of the significant relationships that have been observed between alcohol beverage choice and selection and personality characteristics and style. Given the relative dearth of robust findings in the area of alcohol beverage choice and psychological factors, the context for this present state of affairs is also explored by highlighting competing and contrasting models of alcohol consumption and abuse in addition to highlighting areas of future research endeavor in this surprisingly under-researched area.
particularly beverage preferences. There are very good and rationale reasons why this has been the case to date but fortunately, the sophistication of methodological approaches used in this research arena have started to yield valuable and robust insights within the psychological processes and characteristics which influence beverage choice. To understand this fascinating and important story within a coherent and understandable context, the historical perspectives and contemporary approaches to understanding personality antecedents to drinking behavior and beverage preference will be explored. Examination of these factors within this framework will be invaluable in allowing the reader to develop an understanding of not only drinking style and beverage preferences as behavioral end-points, but also an appreciation of the contribution of psychology to separating the normal from the pathological, the hazardous from the hazard-free in the constellation of fundamental personality attributes enmeshed within the complex behavior known as drinking alcohol.
Introduction This chapter will explore personality attributes associated with drinking behavior and drinking preferences, particularly the characteristics that may influence the main beverage choice of the individual, whether it be beer, wine or spirits. To explore these issues within a coherent psychological context, it is important to establish key factors which have been influential in the development of important personality insights central to the manifestation of drinking behavior and beverage preference. Psychology as a scientific and evidence-based discipline has attempted to determine these pertinent personality characteristics through experimentation and social and clinical observation. The psychological heritage in this area is extensive and complex; however, the milestones encountered in the understanding of drinking behavior from a psychological perspective have also highlighted fundamental omissions in the understanding of personality attributes in certain areas, Beer in Health and Disease Prevention ISBN: 978-0-12-373891-2
A Psychology of Drinking Behavior Investigation of the personality and behavioral characteristics of abstinence, normative drinking and pathological drinking has been a key psychological endeavor for clinical researchers for decades (Martin and Bonner, 2005). The historical perspective of psychological study of drinking has, as a modus operandi, the main tenet of psychological science, namely to understand and predict behavior and ultimately to modify it. Unsurprisingly, this enterprise has had as a central focus, a pressing clinical agenda, brought into sharp relief by the huge social, occupational and health consequences of problematic drinking behavior, often encapsulated within the disease concept of “alcoholism” ( Jellinek, 1960; Lender, 1979; Piazza and Wise, 1988). The disease model of alcoholism has created a lasting enigma for both the practice of evidence-based medicine and the provision of effective therapeutic intervention. The disease Copyright © 2009 Elsevier Inc. All rights of reproduction in any form reserved
172 Beer Drinking
model of alcoholism has also enabled and facilitated psychological science to develop alternative approaches to the disease model of alcoholism that have the identification of personality characteristics which are consistently associated with drinking behavior and preference choice. Prior to proceeding further, it is crucial to reflect on what the disease model of alcoholism is, why it has been needed, how it has endured and how it has facilitated and often driven the development of psychological alternatives to it.
The Disease Model of Alcoholism The disease model of alcoholism represents a paradox for modern medicine and indeed modern clinical science. The paradox is patently clear within the context of modern medical practice in the area as an evidence-based discipline. The disease model of alcoholism posits that there is a key biological characteristic that distinguishes those people that drink unproblematically and socially, from those that drink hazardously, abusively and ultimately chemically dependent ( Jellinek, 1960). Despite the dominance of this model since at least the 1960s, there is absolutely no evidence at all for the notion of a unitary biological antecedent factor that causes the “disease of alcoholism.” Jellinek’s (1960) model and subsequent developments of it are paradoxical in many respects since the classification system proposed to identify clusters of drinkers includes definable group with critical psychological1 rather than biological features of presentation (alpha alcoholism) and who could stop if the individual really wanted to! To put this in perspective, the model describes these sub-types in a progressive way leading through the sub-types to increasingly catastrophic drinking. Surprisingly, the focus of this model pays no head to the particular beverage of choice, only that the disease is specific to alcohol. It is readily acknowledged that there are genetic, social, biological and psychological features which may influence the development of problematic drinking (Wallace, 1990; Orford and Velleman, 1991; Zucker et al., 1994); however, in no way could any of these characteristics can be described as having the attributes of a causative biological entity. The consequences of a disease model of alcoholism are highly constrictive to the patient with the “illness” since there is no “cure” to be had, only a lifestyle of abstinence from alcohol, punctuated with periods of “remission” and sadly, “relapse.” The disease model does satisfy an agenda of offering treatment to those who have alcohol problems as a disease rather than through choice. Thus the disease model “gives permission” to offer treatment to individuals who would be unlikely to receive medical intervention if their drinking behavior was attributed to their own choice. The focus on the disease model notion
Chemical dependency PF positive
Choices Abstinence
Pathogenic factor (PF)
Beverage choice PF negative
Choices Social drinking
Figure 15.1 The disease model of alcoholism. Only in the case of the individual without the pathogenic factor for alcoholism does beverage choice have any salience.
that alcoholics have no choice or free will in their alcohol pursuits also by implication negates any issues of beverage preference, the goal of the alcoholic being to maintain a significant blood alcohol level. The disease model is described in Figure 15.1. The medical model of alcoholism is still influential today and a central part of self-help organizations such as Alcoholics Anonymous. The insufficiencies in the evidence for a medical model have led to the development of a number of models of problematic drinking as either a psychodynamic issue or (more commonly) a behavioral problem (Wilson, 1977; Hays, 1985; Vuchinich and Tucker, 1988; Smith and Goldman, 1994; Leonard and Blane, 1999). Contemporary psychological models emphasize that hazardous and chemically dependent drinking is a behavioral problem and that the problem behavior can be modified and extinguished. This psychological perspective on the presentation of problem behavior has facilitated the development of a number of effective psychological interventions for those encountering problematic drinking (Thevos et al., 2000; Ness and Oei, 2005; Kavanagh et al., 2006). Importantly, these psychological interventions may have, as an end-point, a return to controlled responsible drinking, whereby the individual will have a choice over what to drink within firmly proscribed parameters of amount in units. However, even within the most sophisticated psychological models, including those that integrate psychological, personality and biological processes in describing problematic drinking, the issues associated with the choice of beverage is rarely seen. Indeed, the most recent model of psychobiological model of alcohol dependency that includes personality characteristics does not include beverage selection as an integral feature to its overall structure (see Figure 15.2).
Personality Traits and Beverage Choice 1
Thus, it could be argued that Jellinek’s model was actually a biopsychosocial model rather than a disease model per se.
The main substantive psychological literature in relation to beverage selection concerns personality traits. The notion
Personality Characteristics Associated with Drinking and Beverage Preference
Neurocognitive impairment
173
Kynurenine pathway Anti-social personality disorder
Alcohol typology
Gender Alcohol dependency Genetics Nutritional status Environment Anxiety
Depression
Serotonin
Figure 15.2 Martin and Bonner’s (2005) psychobiological model of alcohol dependency. Beverage choice selection is absent within the model, an omission common to psychological models of excessive drinking.
Trait
Target (T) categories of T
Intelligence Beer Self-esteem Locus of control
Alcohol preference
Wine
Introversion Anxiety Spirits Depression
Figure 15.3 A multiple logistic regression predicting beverage preference from personality trait characteristics. The relative contribution of individual traits can be evaluated in terms of their influence on alcohol preference. Cumulative effects of traits can also be evaluated using regression modeling.
of the personality trait is important to psychology because it has a number of key functions. Personality traits do not seek to explain the whole personality, rather they seek to identify key attributes which are stable, measurable, behaviorally influential and predictive. The characteristics of the attributes described are very powerful elements in accounting
for behavioral outcomes and also for identifying between groups differences, for example intelligence is a trait personality characteristic and has been found to be predictive of the choice of beer individuals choose to drink (Mortensen et al., 2005). Importantly, though personality traits generally represent uni-dimensional constructs, they can be usefully combined in predictive analysis to determine not only any (statistically) significant predictive value of a personality trait on a target behavior, but also the relative contribution of a personality trait, compared to other personality traits, in predicting a behavioral outcome. The statistical approach taken is multiple linear and multiple logistic regression. To explore which personality traits influenced drinking preference and how important they were to this target behavior, a multiple logistic regression would be used. A hypothetical model of multiple logistic regression model to determine the contribution of personality traits to alcoholic beverage choice is shown in Figure 15.3. Statistical t-values and p-values are calculated for each predictor variable (personality traits) in the model. The target variable comprises categorical classifications of beverage preference. Predictor variables are analogs to independent variables and the target variable is analogs to a dependent variable. This approach to modeling is very powerful and has been underutilized in research on alcohol beverage preference to date, though this situation is fortunately changing as the power of this approach becomes increasingly widely recognized.
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Personality Characteristics Associated with Alcoholic Beverage Preference A number of personality characteristics have been identified which discriminate between non-drinkers and drinkers, and drinkers with different beverage preferences. Some of these characteristics cover a number of personality, neurocognitive and neurophysiological domains. Intelligence is a key example of this, certainly, since it is recognized that intelligence does demonstrate the key characteristics of a personality trait including stability, measureability, and is often behaviorally predictive in combination with other personality traits. Intelligence Mortensen et al. (2005) conducted a large sample study ( 1,700) following up men who had been tested for their intelligence quotient (IQ) in early adulthood and the relationship between this and drinking preferences several years later. These researchers found a significant association between IQ and later beverage preference. It was observed that a high IQ was associated with a preference for wine over both beer and spirits. Importantly, IQ was not found to be associated with heavy drinking nor was the IQ advantage of wine drinkers over beer and spirit drinkers associated with socio-economic factors. This important and indeed provocative study has highlighted robust and impressive evidence that beer and spirit drinkers have a lower intelligence than wine drinkers. The findings of this European study were limited by a participant population that was exclusively male; however, extension of this study design to females would be highly desirable to determine how generalizable this finding may be. Intelligence is a key individual differences variable and ultimately mediated by neurophysiological processes and structures. The findings from this study therefore would indicate that preference for beer over wine or vice versa may be potentially “hardwired” within the brain and involves genetic antecedents. Contrasting with the findings of Mortensen et al. (2005), a study recently conducted in the United States by Paschall and Lipton (2005) revealed that beer drinkers were less educated than wine drinkers. A similar association between beer drinking and lower education was found by McCann et al. (2003). These findings may initially seem to support those of Mortensen et al. (2005); however, it should be acknowledged that more education is by no means equivalent to more IQ and may be more representative of social opportunity. This distinction also serves to remind that the implications of personality traits are of far greater significance than socio-demographic variables in understanding the intra-personal aspects of beverage preference. Further, the neurophysiological corollaries of personality traits such as intelligence also furnish a pathway between the psychology of beverage preference and the biology of problematic drinking.
It has, for example, been observed that beer drinkers are at greater risk of becoming excessive drinkers compared to wine drinkers (Jensen et al., 2002). It would therefore be anticipated that personality variables that have associations between both beverage preference and biological substrates (e.g. intelligence) may be potent and useful markers of broader psychobiological processes. Indeed, this informed conjecture is central to the psychobiological model of alcohol dependency proposed by Martin and Bonner (2005). Negative evaluation Negative evaluation, the individuals’ perception of how they are seen and evaluated by others, also has many characteristics common to a definition of a personality trait. Certainly, some individuals perceive and fear negative evaluation more than others, therefore negative evaluation represents an enduring individual differences variable. The concept of negative evaluation is also stable across time and conditions, thus confirming the status of the concept as a personality trait. Finally, consistent with personality traits, the fear of negative evaluation will influence behavior. Experimental work has identified a powerful effect of negative evaluation on beer selection specific to females. Corcoran and Segrist (1998) found that in a beverage selection experiment, females with elevated levels of fear of negative evaluation selected beer significantly less often from a selection that included beer among a selection of alcohol-free drinks such as Coke light, tonic water and pineapple juice. This behavioral effect of fear of negative evaluation was not observed in males suggesting an influential gender-specific role of this personality trait in beer selection. Further, research is required in this area to determine the impact of this pervasive trait on actual beer drinking behavior in social settings. Depression Depression is often considered within the context of clinical classification for diagnosis, but it should be borne in mind that there is a basal level of depression within the individual which is usually stable over time and a component part of human psychological functioning. Depression then is a personality characteristic and is related to other key psychological domains which also have enduring trait qualities, such as dispositional optimism, dispositional pessimism and anhedonia. Depression is often co-morbid with a diagnosis of alcohol dependency (Martin and Bonner, 2000; Le Fauve et al., 2004; Pettinati, 2004; Lukassen and Beaudet, 2005) and there is consequently a rich ancestry of research exploring the relationship between depression and alcohol dependency. The role of depression on beverage selection is less well explored, however tantalizing insights into the role of depression on beverage selection can be deduced by examination of data from suicide rate studies. This is based on
Personality Characteristics Associated with Drinking and Beverage Preference
the premise that depression and suicide are associated, since many individuals who chose to end their lives are clearly depressed. Gruenewald et al. (1995) in large-scale population study conducted in the United States found that suicide rates were not associated with beer drinking; however, a significant increase in suicides was associated with the purchase and consumption of spirits. This study highlights that it is not ethanol per se that impacts on the occurrence and prevalence of suicide, but the form of beverage itself is key. This leads to the very real consideration and possibility of an important association between increased depression and spirit preference compared to beer preference. Anxiety Anxiety is a key co-morbid clinical presentation associated with both alcohol dependence and alcohol abuse (Allan, 1995; Martin and Bonner, 2000; Schade et al., 2003; Baigent, 2005). Importantly, anxiety in individuals with alcohol dependency commonly comprises two distinct components. These components are either physiological autonomic manifestations of anxiety symptoms, often exacerbated during withdrawal of alcohol and detoxification, in effect a central nervous system rebound effect. However, a more enduring anxiety component has been observed in individuals with alcohol dependency which represents a relative elevated trait characteristic that is largely independent of the level of alcohol in the bloodstream or the kinetic properties of alcohol metabolism during withdrawal or consumption. This component of anxiety has been associated with relapse as alcohol may be used as a maladaptive attempt at “self-medication” by the individual (Thomas et al., 2003; Tomlinson et al., 2006). Indeed, therapeutic programs aimed at reducing relapse emphasize the importance of anxiety management techniques as integral aspect of treatment. Given the importance and relevance of anxiety to alcohol-related problems, it is surprising to discover a relative dearth of research in the area of anxiety and alcohol preference. However, given the potent effect of alcohol as a central nervous system depressant, the type of beverage, beer, wine, spirits, etc. chosen may actually be immaterial as the goal-seeking behavior of the individual may be primarily geared toward access to ethanol rather than a specific beverage to exploit the potent central nervous system effects of ethanol as a depressant. Clearly, more research is necessary to explore the possible relationships between beverage type and anxiety in selection of a drink of choice and any interaction between alcohol type, anxiety and the problematic compared to non-problematic drinking style. Motivation Increasing over recent years within the clinical and health psychology, literature on individual differences factors in relation to health and disease behaviors is a focus on
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motivational aspects. The role of motivational factors in drinking behavior has been of relevance to the study of psychological aspects of drinking behavior is of particular relevance due to the concept of motivation being key in the treatment of individuals presenting with alcohol abuse and dependency. Motivation to drink has been associated with alcohol preference and as such motivation assumes key status as a behavioral variable of important interest to understanding both normative and problematic decision making in the realm of alcohol consumption. However, before elaborating further, it is of value to reflect that in the points made to beverage preference and anxiety and depression made earlier, motivational factors will inevitably be concurrent with the affective presentation of an individual. Beer and spirit consumption has been shown to be associated with problematic drinking styles compared to other types of alcohol (Clapp and Shillington, 2001). This is an interesting finding, since it immediately raises the issues of preference beyond the constraints of the physiological aspects of the blood alcohol curve, since the profile would be different between beer and spirits as a function of proof volume. However, motivation remains an illusive and multi-factorial construct psychologically, strongly influenced by dispositional, environmental and social factors and as such, robustly implicating motivational factors causally and uni-directionally within an alcohol preference model is likely to remain difficult for some time.
Summary This chapter has highlighted some of the more interesting and relatively more important psychological dimensions that may have an influence of alcohol beverage and beer choice. A surprising finding is not only how little primary research has been conducted in the psychological arena on alcohol beverage and beer preference characteristics in relation to personality, but also the relatively small amount of research conducted compared to a strong body of evidence implicating personality characteristics and individual differences attributes with problem in drinking behavior. Consequently, no firm conclusions can be made regarding personality characteristics and beer preference. Where relationships are found to exist, these seem to represent psychological domains that often lie beyond the bounds of what may be termed exclusively a personality characteristic or attribute, for example in the case of intelligence. It is enlightening that given the huge industrial base and financial rewards associated with alcohol and beer commercial enterprise, evaluation of personality characteristics which may be associated with beverage choice seems largely ignored and under-researched. In addressing such a vacuum of research and the need and desirability to redress this in the future, the author is minded to comment that such research enterprise should be approached with both investigative zeal
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and moral responsibility since the relationship between nonproblematic alcohol use and alcohol abuse can represent a gray and overlapping area. A final recommendation is therefore that the issues of personality characteristics and beer preference require further systematic investigation to determine the relationship of these enduring psychological domains to alcoholic choice and beverage selection decision making and further, that such endeavor should be done within the context of a coherent theoretical account and psychological model.
Summary Points ●
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The relationship between alcohol beverage preference and personality characteristics is currently under-researched. A small number of personality characteristics have been found to be associated with beer/alcohol type preference. The focus of research into personality characteristics associated with alcohol consumption has largely ignored the issue of alcohol beverage type. The clinical/applied bias in research may be responsible for the dearth of research in the area of personality characteristics and alcohol beverage choice. There is a pressing need to address through systematic research the absence of robust and replicable findings in the area of personality characteristic and beverage choice.
References Allan, C.A. (1995). Alcohol Alcohol. 30, 141–151. Baigent, M.F. (2005). Curr. Opin. Psychiatr. 18, 223–228. Clapp, J.D. and Shillington, A.M. (2001). Am. J. Drug Alcohol Abuse 27, 301–313. Corcoran, K.J. and Segrist, D.J. (1998). Addict. Behav. 23, 509–515. Franken, I.H., Muris, P. and Georgieva, I. (2006). Addict. Behav. 31, 399–403. Gruenewald, P.J., Ponicki, W.R. and Mitchell, P.R. (1995). Addiction 90, 1063–1075. Hays, R. (1985). Br. J. Addict. 80, 379–384. Jellinek, E.M. (1960). The Disease Concept of Alcoholism. College and University Press, New Haven, CT.
Jensen, M.K., Andersen, A.T., Sorensen, T.I., Becker, U., Thorsen, T. and Gronbaek, M. (2002). Epidemiology 13, 127–132. Kavanagh, D.J., Sitharthan, G., Young, R.M., Sitharthan, T., Saunders, J.B., Shockley, N. and Giannopoulos, V. (2006). Addiction 101, 1106–1116. Le Fauve, C.E., Litten, R.Z., Randall, C.L., Moak, D.H., Salloum, I.M. and Green, A.I. (2004). Alcohol. Clin. Exp. Res. 28, 302–312. Lender, M.E. (1979). J. Stud. Alcohol 40, 361–375. Leonard, K.E. and Blane, H.T. (eds) (1999). Psychological Theories of Drinking and Alcoholism. Guilford Press, New York. Lukassen, J. and Beaudet, M.P. (2005). Soc. Sci. Med. 61, 1658–1667. Martin, C.R. and Bonner, A.B. (2000). Alcohol Alcohol. 35, 49–51. Martin, C.R. and Bonner, A.B. (2005). Curr. Psychiatr. Rev. 1, 303–312. McCann, S.E., Sempos, C., Freudenheim, J.L., Muti, P., Russell, M., Nochajski, T.H., Ram, M., Hovey, K. and Trevisan, M. (2003). Nutr. Metab. Cardiovasc. Dis. 13, 2–11. Mortensen, L.H., Sorensen, T.I. and Gronbaek, M. (2005). Addiction 100, 1445–1452. Ness, M.L. and Oei, T.P. (2005). Am. J. Addict. 14, 139–154. Orford, J. and Velleman, R. (1991). Br. J. Med. Psychol. 64, 189–200. Paschall, M. and Lipton, R.I. (2005). Drug Alcohol Depend. 78, 339–344. Pettinati, H.M. (2004). Biol. Psychiatr. 56, 785–792. Piazza, N.J. and Wise, S.L. (1988). Int. J. Addict. 23, 387–397. Schade, A., Marquenie, L.A., Van Balkom, A.J., De Beurs, E., Van Dyck, R. and Van Den Brink, W. (2003). Alcohol Alcohol. 38, 255–262. Smith, G.T. and Goldman, M.S. (1994). J. Res. Adolesc. 4, 229–247. Thevos, A.K., Roberts, J.S., Thomas, S.E. and Randall, C.L. (2000). Addict. Behav. 25, 333–345. Thomas, S.E., Randall, C.L. and Carrigan, M.H. (2003). Alcohol. Clin. Exp. Res. 27, 1937–1943. Tomlinson, K.L., Tate, S.R., Anderson, K.G., Mccarthy, D.M. and Brown, S.A. (2006). Addict. Behav. 31, 461–474. Vuchinich, R.E. and Tucker, J.A. (1988). J. Abnorm. Psychol. 97, 181–195. Wallace, J. (1990). West. J. Med. 152, 502–505. Wilson, A. (1977). Addiction 72, 99–108. Zucker, R.A., Ellis, D.A. and Fitzgerald, H.E. (1994). Ann. NY Acad. Sci. 708, 134–146.
Abstract The study of psychological aspects of alcohol consumption and, in particular, alcohol dependence and problem drinking has produced a vast and broad quantity of research findings over the past 50 years. However, in spite of the breadth of research conducted in this important area of applied psychology, comparatively little research has been conducted into the relationship of personality characteristics and beverage and beer preference. This chapter seeks to highlight some of the significant relationships that have been observed between alcohol beverage choice and selection and personality characteristics and style. Given the relative dearth of robust findings in the area of alcohol beverage choice and psychological factors, the context for this present state of affairs is also explored by highlighting competing and contrasting models of alcohol consumption and abuse in addition to highlighting areas of future research endeavor in this surprisingly under-researched area.
particularly beverage preferences. There are very good and rationale reasons why this has been the case to date but fortunately, the sophistication of methodological approaches used in this research arena have started to yield valuable and robust insights within the psychological processes and characteristics which influence beverage choice. To understand this fascinating and important story within a coherent and understandable context, the historical perspectives and contemporary approaches to understanding personality antecedents to drinking behavior and beverage preference will be explored. Examination of these factors within this framework will be invaluable in allowing the reader to develop an understanding of not only drinking style and beverage preferences as behavioral end-points, but also an appreciation of the contribution of psychology to separating the normal from the pathological, the hazardous from the hazard-free in the constellation of fundamental personality attributes enmeshed within the complex behavior known as drinking alcohol.
Introduction This chapter will explore personality attributes associated with drinking behavior and drinking preferences, particularly the characteristics that may influence the main beverage choice of the individual, whether it be beer, wine or spirits. To explore these issues within a coherent psychological context, it is important to establish key factors which have been influential in the development of important personality insights central to the manifestation of drinking behavior and beverage preference. Psychology as a scientific and evidence-based discipline has attempted to determine these pertinent personality characteristics through experimentation and social and clinical observation. The psychological heritage in this area is extensive and complex; however, the milestones encountered in the understanding of drinking behavior from a psychological perspective have also highlighted fundamental omissions in the understanding of personality attributes in certain areas, Beer in Health and Disease Prevention ISBN: 978-0-12-373891-2
A Psychology of Drinking Behavior Investigation of the personality and behavioral characteristics of abstinence, normative drinking and pathological drinking has been a key psychological endeavor for clinical researchers for decades (Martin and Bonner, 2005). The historical perspective of psychological study of drinking has, as a modus operandi, the main tenet of psychological science, namely to understand and predict behavior and ultimately to modify it. Unsurprisingly, this enterprise has had as a central focus, a pressing clinical agenda, brought into sharp relief by the huge social, occupational and health consequences of problematic drinking behavior, often encapsulated within the disease concept of “alcoholism” ( Jellinek, 1960; Lender, 1979; Piazza and Wise, 1988). The disease model of alcoholism has created a lasting enigma for both the practice of evidence-based medicine and the provision of effective therapeutic intervention. The disease Copyright © 2009 Elsevier Inc. All rights of reproduction in any form reserved
172 Beer Drinking
model of alcoholism has also enabled and facilitated psychological science to develop alternative approaches to the disease model of alcoholism that have the identification of personality characteristics which are consistently associated with drinking behavior and preference choice. Prior to proceeding further, it is crucial to reflect on what the disease model of alcoholism is, why it has been needed, how it has endured and how it has facilitated and often driven the development of psychological alternatives to it.
The Disease Model of Alcoholism The disease model of alcoholism represents a paradox for modern medicine and indeed modern clinical science. The paradox is patently clear within the context of modern medical practice in the area as an evidence-based discipline. The disease model of alcoholism posits that there is a key biological characteristic that distinguishes those people that drink unproblematically and socially, from those that drink hazardously, abusively and ultimately chemically dependent ( Jellinek, 1960). Despite the dominance of this model since at least the 1960s, there is absolutely no evidence at all for the notion of a unitary biological antecedent factor that causes the “disease of alcoholism.” Jellinek’s (1960) model and subsequent developments of it are paradoxical in many respects since the classification system proposed to identify clusters of drinkers includes definable group with critical psychological1 rather than biological features of presentation (alpha alcoholism) and who could stop if the individual really wanted to! To put this in perspective, the model describes these sub-types in a progressive way leading through the sub-types to increasingly catastrophic drinking. Surprisingly, the focus of this model pays no head to the particular beverage of choice, only that the disease is specific to alcohol. It is readily acknowledged that there are genetic, social, biological and psychological features which may influence the development of problematic drinking (Wallace, 1990; Orford and Velleman, 1991; Zucker et al., 1994); however, in no way could any of these characteristics can be described as having the attributes of a causative biological entity. The consequences of a disease model of alcoholism are highly constrictive to the patient with the “illness” since there is no “cure” to be had, only a lifestyle of abstinence from alcohol, punctuated with periods of “remission” and sadly, “relapse.” The disease model does satisfy an agenda of offering treatment to those who have alcohol problems as a disease rather than through choice. Thus the disease model “gives permission” to offer treatment to individuals who would be unlikely to receive medical intervention if their drinking behavior was attributed to their own choice. The focus on the disease model notion
Chemical dependency PF positive
Choices Abstinence
Pathogenic factor (PF)
Beverage choice PF negative
Choices Social drinking
Figure 15.1 The disease model of alcoholism. Only in the case of the individual without the pathogenic factor for alcoholism does beverage choice have any salience.
that alcoholics have no choice or free will in their alcohol pursuits also by implication negates any issues of beverage preference, the goal of the alcoholic being to maintain a significant blood alcohol level. The disease model is described in Figure 15.1. The medical model of alcoholism is still influential today and a central part of self-help organizations such as Alcoholics Anonymous. The insufficiencies in the evidence for a medical model have led to the development of a number of models of problematic drinking as either a psychodynamic issue or (more commonly) a behavioral problem (Wilson, 1977; Hays, 1985; Vuchinich and Tucker, 1988; Smith and Goldman, 1994; Leonard and Blane, 1999). Contemporary psychological models emphasize that hazardous and chemically dependent drinking is a behavioral problem and that the problem behavior can be modified and extinguished. This psychological perspective on the presentation of problem behavior has facilitated the development of a number of effective psychological interventions for those encountering problematic drinking (Thevos et al., 2000; Ness and Oei, 2005; Kavanagh et al., 2006). Importantly, these psychological interventions may have, as an end-point, a return to controlled responsible drinking, whereby the individual will have a choice over what to drink within firmly proscribed parameters of amount in units. However, even within the most sophisticated psychological models, including those that integrate psychological, personality and biological processes in describing problematic drinking, the issues associated with the choice of beverage is rarely seen. Indeed, the most recent model of psychobiological model of alcohol dependency that includes personality characteristics does not include beverage selection as an integral feature to its overall structure (see Figure 15.2).
Personality Traits and Beverage Choice 1
Thus, it could be argued that Jellinek’s model was actually a biopsychosocial model rather than a disease model per se.
The main substantive psychological literature in relation to beverage selection concerns personality traits. The notion
Personality Characteristics Associated with Drinking and Beverage Preference
Neurocognitive impairment
173
Kynurenine pathway Anti-social personality disorder
Alcohol typology
Gender Alcohol dependency Genetics Nutritional status Environment Anxiety
Depression
Serotonin
Figure 15.2 Martin and Bonner’s (2005) psychobiological model of alcohol dependency. Beverage choice selection is absent within the model, an omission common to psychological models of excessive drinking.
Trait
Target (T) categories of T
Intelligence Beer Self-esteem Locus of control
Alcohol preference
Wine
Introversion Anxiety Spirits Depression
Figure 15.3 A multiple logistic regression predicting beverage preference from personality trait characteristics. The relative contribution of individual traits can be evaluated in terms of their influence on alcohol preference. Cumulative effects of traits can also be evaluated using regression modeling.
of the personality trait is important to psychology because it has a number of key functions. Personality traits do not seek to explain the whole personality, rather they seek to identify key attributes which are stable, measurable, behaviorally influential and predictive. The characteristics of the attributes described are very powerful elements in accounting
for behavioral outcomes and also for identifying between groups differences, for example intelligence is a trait personality characteristic and has been found to be predictive of the choice of beer individuals choose to drink (Mortensen et al., 2005). Importantly, though personality traits generally represent uni-dimensional constructs, they can be usefully combined in predictive analysis to determine not only any (statistically) significant predictive value of a personality trait on a target behavior, but also the relative contribution of a personality trait, compared to other personality traits, in predicting a behavioral outcome. The statistical approach taken is multiple linear and multiple logistic regression. To explore which personality traits influenced drinking preference and how important they were to this target behavior, a multiple logistic regression would be used. A hypothetical model of multiple logistic regression model to determine the contribution of personality traits to alcoholic beverage choice is shown in Figure 15.3. Statistical t-values and p-values are calculated for each predictor variable (personality traits) in the model. The target variable comprises categorical classifications of beverage preference. Predictor variables are analogs to independent variables and the target variable is analogs to a dependent variable. This approach to modeling is very powerful and has been underutilized in research on alcohol beverage preference to date, though this situation is fortunately changing as the power of this approach becomes increasingly widely recognized.
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Personality Characteristics Associated with Alcoholic Beverage Preference A number of personality characteristics have been identified which discriminate between non-drinkers and drinkers, and drinkers with different beverage preferences. Some of these characteristics cover a number of personality, neurocognitive and neurophysiological domains. Intelligence is a key example of this, certainly, since it is recognized that intelligence does demonstrate the key characteristics of a personality trait including stability, measureability, and is often behaviorally predictive in combination with other personality traits. Intelligence Mortensen et al. (2005) conducted a large sample study ( 1,700) following up men who had been tested for their intelligence quotient (IQ) in early adulthood and the relationship between this and drinking preferences several years later. These researchers found a significant association between IQ and later beverage preference. It was observed that a high IQ was associated with a preference for wine over both beer and spirits. Importantly, IQ was not found to be associated with heavy drinking nor was the IQ advantage of wine drinkers over beer and spirit drinkers associated with socio-economic factors. This important and indeed provocative study has highlighted robust and impressive evidence that beer and spirit drinkers have a lower intelligence than wine drinkers. The findings of this European study were limited by a participant population that was exclusively male; however, extension of this study design to females would be highly desirable to determine how generalizable this finding may be. Intelligence is a key individual differences variable and ultimately mediated by neurophysiological processes and structures. The findings from this study therefore would indicate that preference for beer over wine or vice versa may be potentially “hardwired” within the brain and involves genetic antecedents. Contrasting with the findings of Mortensen et al. (2005), a study recently conducted in the United States by Paschall and Lipton (2005) revealed that beer drinkers were less educated than wine drinkers. A similar association between beer drinking and lower education was found by McCann et al. (2003). These findings may initially seem to support those of Mortensen et al. (2005); however, it should be acknowledged that more education is by no means equivalent to more IQ and may be more representative of social opportunity. This distinction also serves to remind that the implications of personality traits are of far greater significance than socio-demographic variables in understanding the intra-personal aspects of beverage preference. Further, the neurophysiological corollaries of personality traits such as intelligence also furnish a pathway between the psychology of beverage preference and the biology of problematic drinking.
It has, for example, been observed that beer drinkers are at greater risk of becoming excessive drinkers compared to wine drinkers (Jensen et al., 2002). It would therefore be anticipated that personality variables that have associations between both beverage preference and biological substrates (e.g. intelligence) may be potent and useful markers of broader psychobiological processes. Indeed, this informed conjecture is central to the psychobiological model of alcohol dependency proposed by Martin and Bonner (2005). Negative evaluation Negative evaluation, the individuals’ perception of how they are seen and evaluated by others, also has many characteristics common to a definition of a personality trait. Certainly, some individuals perceive and fear negative evaluation more than others, therefore negative evaluation represents an enduring individual differences variable. The concept of negative evaluation is also stable across time and conditions, thus confirming the status of the concept as a personality trait. Finally, consistent with personality traits, the fear of negative evaluation will influence behavior. Experimental work has identified a powerful effect of negative evaluation on beer selection specific to females. Corcoran and Segrist (1998) found that in a beverage selection experiment, females with elevated levels of fear of negative evaluation selected beer significantly less often from a selection that included beer among a selection of alcohol-free drinks such as Coke light, tonic water and pineapple juice. This behavioral effect of fear of negative evaluation was not observed in males suggesting an influential gender-specific role of this personality trait in beer selection. Further, research is required in this area to determine the impact of this pervasive trait on actual beer drinking behavior in social settings. Depression Depression is often considered within the context of clinical classification for diagnosis, but it should be borne in mind that there is a basal level of depression within the individual which is usually stable over time and a component part of human psychological functioning. Depression then is a personality characteristic and is related to other key psychological domains which also have enduring trait qualities, such as dispositional optimism, dispositional pessimism and anhedonia. Depression is often co-morbid with a diagnosis of alcohol dependency (Martin and Bonner, 2000; Le Fauve et al., 2004; Pettinati, 2004; Lukassen and Beaudet, 2005) and there is consequently a rich ancestry of research exploring the relationship between depression and alcohol dependency. The role of depression on beverage selection is less well explored, however tantalizing insights into the role of depression on beverage selection can be deduced by examination of data from suicide rate studies. This is based on
Personality Characteristics Associated with Drinking and Beverage Preference
the premise that depression and suicide are associated, since many individuals who chose to end their lives are clearly depressed. Gruenewald et al. (1995) in large-scale population study conducted in the United States found that suicide rates were not associated with beer drinking; however, a significant increase in suicides was associated with the purchase and consumption of spirits. This study highlights that it is not ethanol per se that impacts on the occurrence and prevalence of suicide, but the form of beverage itself is key. This leads to the very real consideration and possibility of an important association between increased depression and spirit preference compared to beer preference. Anxiety Anxiety is a key co-morbid clinical presentation associated with both alcohol dependence and alcohol abuse (Allan, 1995; Martin and Bonner, 2000; Schade et al., 2003; Baigent, 2005). Importantly, anxiety in individuals with alcohol dependency commonly comprises two distinct components. These components are either physiological autonomic manifestations of anxiety symptoms, often exacerbated during withdrawal of alcohol and detoxification, in effect a central nervous system rebound effect. However, a more enduring anxiety component has been observed in individuals with alcohol dependency which represents a relative elevated trait characteristic that is largely independent of the level of alcohol in the bloodstream or the kinetic properties of alcohol metabolism during withdrawal or consumption. This component of anxiety has been associated with relapse as alcohol may be used as a maladaptive attempt at “self-medication” by the individual (Thomas et al., 2003; Tomlinson et al., 2006). Indeed, therapeutic programs aimed at reducing relapse emphasize the importance of anxiety management techniques as integral aspect of treatment. Given the importance and relevance of anxiety to alcohol-related problems, it is surprising to discover a relative dearth of research in the area of anxiety and alcohol preference. However, given the potent effect of alcohol as a central nervous system depressant, the type of beverage, beer, wine, spirits, etc. chosen may actually be immaterial as the goal-seeking behavior of the individual may be primarily geared toward access to ethanol rather than a specific beverage to exploit the potent central nervous system effects of ethanol as a depressant. Clearly, more research is necessary to explore the possible relationships between beverage type and anxiety in selection of a drink of choice and any interaction between alcohol type, anxiety and the problematic compared to non-problematic drinking style. Motivation Increasing over recent years within the clinical and health psychology, literature on individual differences factors in relation to health and disease behaviors is a focus on
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motivational aspects. The role of motivational factors in drinking behavior has been of relevance to the study of psychological aspects of drinking behavior is of particular relevance due to the concept of motivation being key in the treatment of individuals presenting with alcohol abuse and dependency. Motivation to drink has been associated with alcohol preference and as such motivation assumes key status as a behavioral variable of important interest to understanding both normative and problematic decision making in the realm of alcohol consumption. However, before elaborating further, it is of value to reflect that in the points made to beverage preference and anxiety and depression made earlier, motivational factors will inevitably be concurrent with the affective presentation of an individual. Beer and spirit consumption has been shown to be associated with problematic drinking styles compared to other types of alcohol (Clapp and Shillington, 2001). This is an interesting finding, since it immediately raises the issues of preference beyond the constraints of the physiological aspects of the blood alcohol curve, since the profile would be different between beer and spirits as a function of proof volume. However, motivation remains an illusive and multi-factorial construct psychologically, strongly influenced by dispositional, environmental and social factors and as such, robustly implicating motivational factors causally and uni-directionally within an alcohol preference model is likely to remain difficult for some time.
Summary This chapter has highlighted some of the more interesting and relatively more important psychological dimensions that may have an influence of alcohol beverage and beer choice. A surprising finding is not only how little primary research has been conducted in the psychological arena on alcohol beverage and beer preference characteristics in relation to personality, but also the relatively small amount of research conducted compared to a strong body of evidence implicating personality characteristics and individual differences attributes with problem in drinking behavior. Consequently, no firm conclusions can be made regarding personality characteristics and beer preference. Where relationships are found to exist, these seem to represent psychological domains that often lie beyond the bounds of what may be termed exclusively a personality characteristic or attribute, for example in the case of intelligence. It is enlightening that given the huge industrial base and financial rewards associated with alcohol and beer commercial enterprise, evaluation of personality characteristics which may be associated with beverage choice seems largely ignored and under-researched. In addressing such a vacuum of research and the need and desirability to redress this in the future, the author is minded to comment that such research enterprise should be approached with both investigative zeal
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and moral responsibility since the relationship between nonproblematic alcohol use and alcohol abuse can represent a gray and overlapping area. A final recommendation is therefore that the issues of personality characteristics and beer preference require further systematic investigation to determine the relationship of these enduring psychological domains to alcoholic choice and beverage selection decision making and further, that such endeavor should be done within the context of a coherent theoretical account and psychological model.
Summary Points ●
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The relationship between alcohol beverage preference and personality characteristics is currently under-researched. A small number of personality characteristics have been found to be associated with beer/alcohol type preference. The focus of research into personality characteristics associated with alcohol consumption has largely ignored the issue of alcohol beverage type. The clinical/applied bias in research may be responsible for the dearth of research in the area of personality characteristics and alcohol beverage choice. There is a pressing need to address through systematic research the absence of robust and replicable findings in the area of personality characteristic and beverage choice.
References Allan, C.A. (1995). Alcohol Alcohol. 30, 141–151. Baigent, M.F. (2005). Curr. Opin. Psychiatr. 18, 223–228. Clapp, J.D. and Shillington, A.M. (2001). Am. J. Drug Alcohol Abuse 27, 301–313. Corcoran, K.J. and Segrist, D.J. (1998). Addict. Behav. 23, 509–515. Franken, I.H., Muris, P. and Georgieva, I. (2006). Addict. Behav. 31, 399–403. Gruenewald, P.J., Ponicki, W.R. and Mitchell, P.R. (1995). Addiction 90, 1063–1075. Hays, R. (1985). Br. J. Addict. 80, 379–384. Jellinek, E.M. (1960). The Disease Concept of Alcoholism. College and University Press, New Haven, CT.
Jensen, M.K., Andersen, A.T., Sorensen, T.I., Becker, U., Thorsen, T. and Gronbaek, M. (2002). Epidemiology 13, 127–132. Kavanagh, D.J., Sitharthan, G., Young, R.M., Sitharthan, T., Saunders, J.B., Shockley, N. and Giannopoulos, V. (2006). Addiction 101, 1106–1116. Le Fauve, C.E., Litten, R.Z., Randall, C.L., Moak, D.H., Salloum, I.M. and Green, A.I. (2004). Alcohol. Clin. Exp. Res. 28, 302–312. Lender, M.E. (1979). J. Stud. Alcohol 40, 361–375. Leonard, K.E. and Blane, H.T. (eds) (1999). Psychological Theories of Drinking and Alcoholism. Guilford Press, New York. Lukassen, J. and Beaudet, M.P. (2005). Soc. Sci. Med. 61, 1658–1667. Martin, C.R. and Bonner, A.B. (2000). Alcohol Alcohol. 35, 49–51. Martin, C.R. and Bonner, A.B. (2005). Curr. Psychiatr. Rev. 1, 303–312. McCann, S.E., Sempos, C., Freudenheim, J.L., Muti, P., Russell, M., Nochajski, T.H., Ram, M., Hovey, K. and Trevisan, M. (2003). Nutr. Metab. Cardiovasc. Dis. 13, 2–11. Mortensen, L.H., Sorensen, T.I. and Gronbaek, M. (2005). Addiction 100, 1445–1452. Ness, M.L. and Oei, T.P. (2005). Am. J. Addict. 14, 139–154. Orford, J. and Velleman, R. (1991). Br. J. Med. Psychol. 64, 189–200. Paschall, M. and Lipton, R.I. (2005). Drug Alcohol Depend. 78, 339–344. Pettinati, H.M. (2004). Biol. Psychiatr. 56, 785–792. Piazza, N.J. and Wise, S.L. (1988). Int. J. Addict. 23, 387–397. Schade, A., Marquenie, L.A., Van Balkom, A.J., De Beurs, E., Van Dyck, R. and Van Den Brink, W. (2003). Alcohol Alcohol. 38, 255–262. Smith, G.T. and Goldman, M.S. (1994). J. Res. Adolesc. 4, 229–247. Thevos, A.K., Roberts, J.S., Thomas, S.E. and Randall, C.L. (2000). Addict. Behav. 25, 333–345. Thomas, S.E., Randall, C.L. and Carrigan, M.H. (2003). Alcohol. Clin. Exp. Res. 27, 1937–1943. Tomlinson, K.L., Tate, S.R., Anderson, K.G., Mccarthy, D.M. and Brown, S.A. (2006). Addict. Behav. 31, 461–474. Vuchinich, R.E. and Tucker, J.A. (1988). J. Abnorm. Psychol. 97, 181–195. Wallace, J. (1990). West. J. Med. 152, 502–505. Wilson, A. (1977). Addiction 72, 99–108. Zucker, R.A., Ellis, D.A. and Fitzgerald, H.E. (1994). Ann. NY Acad. Sci. 708, 134–146.