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Personality, Problem Solving, and Adolescent Substance Use
Available online at www.sciencedirect.com
Behavior Therapy 40 (2009) 93 – 101
www.elsevier.com/locate/bt
Personality, Problem Solving, and Adolescent Substance Use William B. Jaffee, Harvard Medical School, McLean Hospital Thomas J. D'Zurilla, State University of New York, Stony Brook
The major aim of this study was to examine the role of social problem solving in the relationship between personality and substance use in adolescents. Although a number of studies have identified a relationship between personality and substance use, the precise mechanism by which this occurs is not clear. We hypothesized that problem-solving skills could be one such mechanism. More specifically, we sought to determine whether problem solving mediates, moderates, or both mediates and moderates the relationship between different personality traits and substance use. Three hundred and seven adolescents were administered the Substance Use Profile Scale, the Social Problem-Solving Inventory–Revised, and the Personality Experiences Inventory to assess personality, social problem-solving ability, and substance use, respectively. Results showed that the dimension of rational problem solving (i.e., effective problem-solving skills) significantly mediated the relationship between hopelessness and lifetime alcohol and marijuana use. The theoretical and clinical implications of these results were discussed.
DESPITE FLUCTUATIONS IN THE rates of substance use and substance use disorders among adolescents, these figures remain high. According to the Substance Abuse and Mental Health Services Administration's National Survey on Drug Use and Health (2005), 8.8% of youths aged 12 to 17 met DSM-IV (American Psychiatric Association, 1994) criteria for illicit drug or alcohol abuse or dependence during 2004. The two substances most commonly used by adolescents ages 12 to 17 are The authors would like to acknowledge Caitlin Ravichandran, Ph.D, for her contributions in the data imputation methods used herein. Address correspondence to William B. Jaffee, Ph.D., Harvard Medical School, McLean Hospital, 115 Mill St., Belmont, MA 02478; e-mail: [email protected]. 0005-7894/08/0093–0101$ 1.00/0 © 2008 Association for Behavioral and Cognitive Therapies. Published by Elsevier Ltd. All rights reserved.
marijuana and alcohol, with 7.6% of adolescents reporting current (past month) marijuana use and 17.6% reporting current alcohol use. Substance use in adolescence is associated with a number of adverse psychosocial outcomes, including fatal and nonfatal injuries from drug-related motor vehicle accidents, suicides, homicides, violence, delinquency (Dembo, Williams, Getreu, & Genung, 1991), psychiatric disorders (Whitmore et al., 1997), and risky sexual practices (Jainchill, Yagelka, Hawke, & DeLeon, 1999). Research that identifies risk and protective factors for adolescent substance use, as well as the relationships among these factors, may be useful in developing interventions that reduce both adolescent substance use as well as its adverse sequelae.
Personality and Substance Use Personality has been characterized as “a psychological structure underlying a relatively enduring behavioral disposition, i.e., a tendency to respond in certain ways under certain circumstances” (Tellegen, 1988). An important implication is that personality is relatively stable throughout the lifespan. Although controversial, there is considerable evidence supporting this notion (Costa & McCrae, 1997; McCrae et al., 2000; Stein, Newcomb, & Bentler, 1986; Terracciano, Costa, & McCrae, 2006). Personality has been conceptualized and assessed in several ways, and there is an extensive literature supporting the existence of a relationship between substance use and a number of models and measures of personality. Elements of both the “three-factor” and “five-factor” models of personality have shown a robust relationship between personality and substance abuse (Costa & McCrae, 1992; Digman, 1990; Eysenck, 1997; Flory, Lynam, Milich, Leukefield, & Clayton, 2002; O'Boyle & Barratt, 1993; Rosenthal, Edwards, Ackerman, Knott, & Rosenthal, 1990; Sher, Batholow, & Wood, 2000;
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Trull & Sher, 1994; Zuckerman, 1993). Similarly, research on the Millon Clinical Multiaxial Inventories (MCM-I, II, III; Millon, 1977; Millon, 1987; Millon & Davis, 1997) has demonstrated their effectiveness in identifying alcohol and other substance-abusing individuals (Bakken, Landheim, & Vaglum, 2004; Bartsch & Hoffman, 1985; Craig, 1997; Craig, Verinis, & Wexler, 1985). Cloninger (1987) identifies two types of alcoholics based in part on personality characteristics. Although the evidence of some type of relationship between personality and substance use is robust, researchers have noted that earlier models and measures are inadequate in representing the diversity that exists among substance users and substances used. Conrod, Pihl, Stewart, and Dongier (2000) have extended earlier models and developed a system of classifying substance users with the Substance Use Risk Profile Scale (SURPS) based on four different personality traits: Hopelessness, Impulsivity, Anxiety Sensitivity, and Sensation Seeking. Individuals with high levels of Hopelessness are characterized by the expectation that negative events will occur and are more likely to experience depressive disorders and abuse opiates (Joiner, 2001; Rounsaville et al., 1991). Impulsivity is characterized by a rapid response to cues for reward, as well as intolerance for negative emotion (Zuckerman & Kuhlman, 2000). Individuals having high levels of Anxiety Sensitivity tend to experience fear in response to symptoms of physical arousal such as elevated heartbeat and shortness of breath. It is hypothesized that anxiety-sensitive individuals are at risk for engaging in coping behaviors, including substance use, that permit escape from anxiety and anxiety provoking situations (Conrod et al., 2000). Finally Sensation Seeking is similar to Impulsivity in terms of sensitivity to cues for reward. However, whereas Impulsivity is associated with neuroticism and aggressiveness (Zuckerman & Kuhlman, 2000), Sensation Seeking is not. Additionally, Sensation Seeking is theoretically and empirically associated with alcohol use for its euphoric effects (Comeau, Stewart, & Loba, 2001; Conrod, Peterson, & Pihl 1997). Although a relationship between personality and substance use is well documented, the specific mechanisms by which personality might influence substance use is not clear. We hypothesize that problem-solving ability is one possible mechanism by which personality influences substance use.
Social Problem Solving and Substance Use Social problem solving is defined as qthe selfdirected cognitive-behavioral process by which a
person attempts to identify or discover effective or adaptive solutions to problems encountered in everyday livingq (D'Zurilla & Nezu, 2007). As such, social problem solving is a general and versatile coping strategy useful and effective in a wide range of stressful situations. Whereas a personality trait is considered to be a global characteristic of an individual that may influence behavior in a variety of different domains (whether problematic or not), a problem-solving dimension is a more specific characteristic of an individual that describes behavior when an individual confronts a problem in living. Also, a personality trait is considered to be a relatively stable characteristic of an individual throughout the life span, including adolescence (McCrae et al., 2000; Stein, Newcomb, & Bentler, 1986), whereas problem-solving ability is a changeable and trainable set of attributes (D'Zurilla & Nezu, 2007). Although several different conceptualizations of problem-solving abilities exist (Appel & Kaestner, 1979; Intagliata, 1978; Platt, Scura & Hanon, 1973), factor-analytic studies have established that social problem-solving ability is not a single, unitary ability but, instead, it is a multidimensional concept consisting of several different, albeit related, dimensions: Positive Problem Orientation (PPO), Negative Problem Orientation (NPO), Rational Problem-Solving (RPS), the Impulsivity/ Carelessness Style (ICS), and the Avoidant Style (AS; D'Zurilla et al., 2002). PPO measures a constructive problem-solving set that involves the general disposition to appraise a problem as a challenge rather than a threat and belief in one's own ability to solve problems. NPO measures a dysfunctional or inhibitive cognitive emotional set and a general tendency to view a problem as a threat to one's well being and an expectation that problems are unsolvable. RPS measures a constructive dimension defined as the systematic, deliberate, and skillful application of effective problem-solving principles such as problem definition and formulation, generation of alternative solutions, decision making, solution implementation and verification. ICS assesses a deficient problem-solving style characterized by hurried, careless, incomplete, and impulsive attempts to solve problems. Higher scores on this scale indicate individuals who generate and consider few alternatives, who fail to weigh consequences associated with different solutions, and fail to apply problemsolving strategies and techniques. AS measures another defective behavioral pattern characterized by procrastination, passivity, or inaction, and attempts to shift problem-solving responsibility to others.
personality, problem solving, and adolescent substance use Empirical support for an association between problem solving (measured in several different ways) and substance use is well established (Appel & Kaestner, 1979; Carey, Carey & Meisler, 1990; Dishion, Loeber, Stouthamer-Loeber, & Patterson, 1984; Intagliata, 1978; Platt et al., 1973), and research on the five dimensions of social problem solving described by D'Zurilla and colleagues (2002) using the Social Problem-Solving Inventory–Revised (SPSI-R) has identified relationships between impulsive/careless and avoidant problemsolving styles and substance use (Jaffee, Conrod, D'Zurilla, Jacobs, & Schlauch, 2000; Jaffee & D'Zurilla, 2003) in high school and college students.
Hypotheses The present study had two major hypotheses. Hypothesis 1. We hypothesized that problemsolving abilities would mediate the relationship between personality and lifetime marijuana and alcohol use. A mediator specifies the mechanism by which a given effect occurs (Baron & Kenny, 1986) or, in other words, “the independent variable influences the mediator which in turn, influences the outcome” (Holmbeck, 1997). In terms of the present study, one general hypothesis is that personality traits that develop very early in life may interfere with the development of adaptive problem-solving abilities which, in turn, could lead to maladaptive behaviors, such as substance use. For example, certain individuals with a hopelessness personality style, characterized by the belief that negative events will occur, may not exert the effort required to apply adequate rational problemsolving skills when faced with a problem, and thus not receive feedback in the form of a behavioral outcome as to whether a particular approach to problem solving is or is not effective. Thus, when faced with a problem, such individuals may not effectively apply rational problem-solving skills (i.e., might not effectively define the problem, generate, select, and implement solutions), and instead choose substance use as a means of circumventing the problem. We focused our analyses on the impulsive/ carelessness and avoidant problem-solving styles and rational problem-solving skills. Our prior research indicates that both impulsive/carelessness and avoidant problem-solving styles are associated with substance use in high school and college students (Jaffee & D'Zurilla, 2003; Jaffee et al., 2000). Additionally, we have observed that a rational problem-solving style is an important determinant of maladaptive behavioral outcomes
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(D'Zurilla, Chang, & Sanna, 2004). We focused these analyses on two outcome variables, lifetime marijuana and alcohol use, since these are the substances most frequently used by adolescents (SAMHSA, 2005). Hypothesis 2. We additionally hypothesized that certain dimensions of problem solving would moderate the effect of personality on the prediction of lifetime marijuana and alcohol use. A moderator specifies the conditions under which a given effect occurs, as well as the conditions under which the effect varies (Baron & Kenny, 1986). In terms of the present study, an alternate general hypothesis is that personality traits and social problem-solving abilities develop independently during childhood, but since both variables are related to adolescent substance use, level of social problem-solving ability may interact with personality to influence substance use. Specifically, the magnitude of the relationship between the personality traits and substance use may be less for individuals with good rather than poor problem-solving abilities. In other words, these negative personality traits may have less of an impact on substance use when problem-solving abilities are good rather than poor. For example, individuals with an impulsive personality style, having general difficulty inhibiting behaviors that have long-term negative outcomes (i.e., substance use), could be less prone to select that behavior if they also possess low-avoidance problem-solving style. Such individuals may be more likely to apply problem-solving skills to the best of their ability and select an adaptive response when faced with a problem. As with the mediational analyses, we focused our moderational analyses on the aforementioned four personality styles, the impulsive/carelessness, avoidant, and rational problem-solving dimensions, as predictors of lifetime marijuana and alcohol use. Establishing whether problem solving mediates or moderates the relationship between personality and substance use may have important theoretical and clinical implications. The presence of a mediational relationship suggests that personality influences substance use in part through its effects on problem solving. In contrast, the presence of a moderational relationship suggests that the effect of personality on substance use is affected more directly by the levels of problem-solving abilities present. Clinically, if a specific dimension of problem solving mediates or moderates this relationship, the deficient dimension of problem solving could be targeted in an intervention for an individual exhibiting a particular personality trait.
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Method participants Three hundred seven participants were recruited from a large high school in the suburban northeastern United States. In general, this sample was fairly demographically homogeneous. The sample was nearly equally split between males and females (55% male, 45% female), ranging in age from 15.0 to 20.4, with a mean of 16.9. The ethnic/racial composition was 73% Caucasian, 9% Asian, less than 2% African American, less than 2% Latino, and 14% “other” or “mixed.” Though 32% of respondents did not know their annual household income, of those responding, the modal (28%) annual household income was over $100K; 18% report annual household income between $75K and $100K; 12% between $50K-$75K; 7% between $25K-$50K; and 3% less than $25K. measures Substance Use Risk Profile Scale (SURPS; Woicik, Conrod, & Pihl, submitted for publication). The SURPS is a 28-item scale designed to measure four personality traits that have been implicated in both the vulnerability to and maintenance of substance use disorders. The four dimensions measured, each with seven items, are labeled Anxiety Sensitivity, Hopelessness, Impulsivity, and Sensation Seeking. Each item is assessed on a 4-point scale, ranging from “strongly agree” to “strongly disagree.” The factor structure, construct, convergent, and discriminant validity of this instrument as well as the internal consistency (.70–.88) and test-retest reliability (.53–.86 over a 6-week interval) have been demonstrated to be adequate in several studies detailed by college student and substance-abusing adult samples (Woicik et al., 2006). In the present sample, Cronbach's alphas were as follows: .67 for Anxiety Sensitivity, .70 for Impulsiveness, .63 for Sensation Seeking, and .66 for Hopelessness. Social Problem-Solving Inventory–Revised (SPSI-R; D'Zurilla et al., 2002). The SPSI-R is a 52-item self-report questionnaire consisting of five scales that measure five partially independent problem-solving dimensions: Positive Problem Orientation (PPO), Negative Problem Orientation (NPO), Rational Problem-Solving (RPS), Impulsivity/Carelessness Style (ICS) and Avoidant Style (AS). Greater problem-solving ability is indicated by higher scores on PPO and RPS and lower scores on NPO, AS, and ICS. Each item is assessed with a 5-point scale ranging from “not at all” to “extremely true of me.” The SPSI-R has good reliability and validity (D'Zurilla et al., 2002). Coefficient alphas ranged from .60 (PPO) to .87 (RPS) in one sample of 708
adolescents and from .76 (PPO) to .92 (RPS) in a sample of 1,053 college students. In the present sample, alphas were .73 (PPO), .91 (NPO), .91 (RPS), .78 (ICS), and .80 (AS). Readability has been estimated to be at the 4th grade level. The Personal Experience Inventory (PEI; Henley & Winters, 1988). The PEI is a multi-scale inventory that documents the onset, nature, and degree of substance involvement. The present study focused on the items assessing lifetime alcohol and marijuana use because of the relatively high rates of use of these two substances by adolescents. These items use a 7point scale with the following possible responses: 0 = never, 1 = 1 to 2 times; 3 = 3 to 5 times; 4 = 6 to 19 times; 5 = 20 to 39 times; and 6 = 40 or more times. The Infrequent Response Scale was used to identify and eliminate subjects providing invalid data.
procedure Participants were recruited through announcements in biology, chemistry, history, English, and health classes. In return for their participation, all students were automatically entered into a raffle for gift certificates for $75, $50, and $25 (one of each) to a local department store. Students who expressed interest in participating (nearly 100% of all students present) were given consent forms and a stamped return envelope addressed to the principal investigator. Approximately 50% of those expressing interest in participating obtained parental consent. Students whose parents had provided consent completed questionnaire packets containing the SPSI-R, the SURPS, and the PEI at school. To help ensure accurate reporting, all questionnaires were completed anonymously in pencil, and completed questionnaires were returned in sealed, unmarked envelopes. Students were also spaced throughout the classroom such that they could not view each others’ questionnaires. Additionally, faculty members left the classroom while questionnaires were completed. As a safeguard to confidentiality, demographic data were collected separately from the rest of the study data, and were limited in scope to further eliminate the possibility of participant identification. Data were collected in two waves, during the spring (35% of the total sample) and fall semesters (65% of sample). Participants in each of these waves did not differ on any demographic variables or on independent or dependent variables.
Results Prior to analyses, data were screened for missing values, elevated skew and kurtosis (N2), as well as for patterns of responses indicating invalid data (a
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Table 1 Means and Standard Deviations (SD) for All Study Variables (N = 274)
invalid patterns of responses, resulting in an n of 274 used in these analyses.
Variable
Mean
SD
Hopeless Personality⁎ Impulsive Personality⁎ Anxiety Sensitive Personality⁎ Sensation Seeking Personality⁎ Positive Problem Orientation⁎⁎ Negative Problem Orientation⁎⁎ Rational Problem Solving⁎⁎ Impulsive/Careless Style⁎⁎ Avoidant Style⁎⁎ Lifetime Alcohol Use⁎⁎⁎ Lifetime Marijuana Use⁎⁎⁎
1.83 2.23 2.36 2.75 2.36 1.43 2.10 1.29 1.36 2.94 1.52
0.51 0.51 0.53 0.53 0.73 0.88 0.68 0.67 0.76 2.14 2.23
descriptive statistics for problem solving, personality, and substance use Means, standard deviations, and bivariate correlations for all variables are presented in Tables 1 and 2. Over 83% reported having used alcohol in their lifetime, with the modal response (18.2%) being “40 or more.” For marijuana, the mean response for lifetime use was “2 to 3” times, with 38.3% reporting having tried marijuana. Eleven percent of the sample reported having used marijuana “40 or more” times in their lives.
Note. ⁎From the Substance Use Risk Profile Scale; ⁎⁎From the Social Problem Solving Inventory-Revised, ⁎⁎⁎From the Personal Experiences Inventory.
hypothesis 1. mediational analyses Baron and Kenny (1986) identify four basic conditions that must be met in order for a variable to be considered a mediator: (1) the predictor (personality) must be significantly correlated with the hypothesized mediator (problem solving); (2) the predictor (personality) must be significantly correlated with the dependent measure (substance use); (3) the mediator (problem solving) must be significantly correlated with the dependent variable (substance use); and (4) the impact of the predictor (personality) on the dependent variable (substance use) is no longer significant after controlling for the mediator. To determine whether this latter condition is met, a hierarchical regression is performed in which the hypothesized mediator (problem solving) is entered first and the predictor (personality) is entered second. If the predictor is no longer significantly correlated with the dependent variable (substance use), then mediation is said to have occurred. A total of six cases met the initial three conditions of mediation (p b .01). Rational problem solving was identified as a potential mediator of the
score N 1 on the PEI Infrequent Response scale). Our method for handling missing responses for items on each scale was to impute the mean value of the participant's observed items for that scale (the qseries meanq), which is equivalent to using the mean of the observed items as the scale's score. To assess the potential impact of our decision to impute the mean, we repeated our analysis using two alternate imputed values: the series mean minus the series standard deviation and the series mean plus the series standard deviation. In cases when these values were below the minimum possible value or above the maximum possible value for the scale, the scale minimum and scale maximum respectively were imputed. This method of imputation did not alter the significance of our findings. In this sample, data from 33 participants (approximately 10%) were eliminated because of Table 2 Bivariate Correlations Among All Study Variables Measures HP IMP ANX SS PPO NPO RPS AS ICS ALC MAR
1
2
3
4
5
6
7
8
9
10
11
– .29⁎⁎ .14 .02 -.47⁎⁎ .45⁎⁎ -.24⁎⁎ .29⁎⁎ .22⁎⁎ .17⁎⁎ .15⁎⁎
– .19⁎⁎ .28⁎⁎ -.26⁎⁎ .33⁎⁎ -.38⁎⁎ .35⁎⁎ .47⁎⁎ .26⁎⁎ .18⁎⁎
– -.22⁎⁎ -.16⁎⁎ .46⁎⁎ -.01 .22⁎⁎ .14 -.03 -.06
– .11 -.11 -.05 .05 .12 .36⁎⁎ .32
– -.45⁎⁎ .63⁎⁎ -.41⁎⁎ -.13 -.19⁎⁎ -.08
– -.16 .66⁎⁎ .44⁎⁎ .13 .06
– -.26⁎⁎ -.32 -.20⁎⁎ -.21⁎⁎
– .54⁎⁎ .18⁎⁎ .07
– .15 .07
– .66⁎⁎
–
Note. HP = Hopelessness Personality, IMP = Impulsive Personality, ANX = Anxiety Sensitive Personality, SS = Sensation Seeking Personality, PPO = Positive Problem Orientation, NPO = Negative Problem Orientation, RPS = Rational Problem Solving, AS = Avoidance Style, ICS = Impulsive/Careless Style, ALC = Lifetime Alcohol, MAR = Lifetime Marijuana, N = 274 for all variables except ALC (N = 271) and MAR (N = 273). ⁎⁎p b .01, two-tailed.
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FIGURE 1
Mediation of Hopelessness Personality by Rational Problem Solving in predicting Lifetime Alcohol use.
relationship between the hopelessness and impulsive personality types and both dependent variables. Avoidance style was identified as a potential mediator between the hopelessness and impulsivity personality types and lifetime alcohol use. Hierarchical regression analyses were then performed to determine whether the impact of personality type on substance use would remain significant when problem solving was controlled (condition 4 described above). To account for the increased probability of Type I error resulting from multiple significance tests, we used the Bonferoni procedure (Miller, 1966) to adjust the alpha level for these eight analyses to .008. These analyses demonstrated that rational problem solving mediated the relationship between hopelessness personality and lifetime alcohol use (ΔR2 = .027, p b .008; Figure 1) as well as lifetime marijuana use (ΔR2 = .031, p b .008; Figure 2). The overall R2 values for these models were .055 for lifetime alcohol use and .046 for lifetime marijuana use.
hypothesis 2. moderational analyses Since moderation essentially involves the interaction of two variables (Baron & Kenny, 1986), the test for moderation is identical to testing for an interaction. Prior to testing for the presence of an interaction, the two moderating variables were centered to eliminate problems stemming from multicollinearity between the first-order terms (the moderating variables) and higher-order terms (the interaction; Aiken & West, 1991). The test for an interaction involves partialling out the main effects for the two moderators (personality and problem solving) and examining the effect of the interaction term with the other effects removed.
FIGURE 2
We used a Bonferoni procedure (Miller, 1966) to adjust the alpha level for these 24 analyses, resulting in an adjusted alpha of .002. Analyses were performed that paired each of the dimensions of problem solving with each of the personality types. None of these analyses demonstrated moderational effects between any of the personality and problem-solving variables in predicting any of the dependent variables.
Discussion On a theoretical level, the intent of this study was to examine the role of social problem solving in the relationship between personality and substance use in adolescents. From a clinical point of view, the goal was to determine what dimensions of problem solving should be a clinical focus with what personality types when employing problem-solving interventions targeting adolescent substance use. Support was found for the first hypothesis of this study, that problem-solving skills would mediate the relationship between personality and adolescent substance use. Specifically, rational problem solving was found to mediate the relationship between hopelessness personality and lifetime alcohol and marijuana use. This finding is consistent with prior problem-solving research suggesting that rational problem-solving style is an important determinant of maladaptive behavioral outcomes (D'Zurilla et al., 2004). In general, these findings suggest that rational problem-solving skills serve as a link between personality and substance use in adolescents with high degrees of hopelessness. In adolescents who have the expectation that negative events may occur (hopelessness personality), these characteristics influence and impair the ability to effectively define
Mediation of Hopelessness Personality by Rational Problem Solving in predicting Lifetime Marijuana use.
personality, problem solving, and adolescent substance use problems, as well as to generate, select, implement, and evaluate solutions. This impairment, in turn, may lead to increased substance use in these individuals. Such an interpretation is consistent with Platt and Husband's (1993) explanation of the link between deficits in problem-solving abilities and substance use. It may be the case that individuals having poor rational problem-solving skills could experience higher rates of unsatisfactory outcomes leading to a high-risk affective state and the choice of substance use as a means of coping. It might also be the case that individuals having poor rational problem-solving skills could fail to effectively negotiate their way out of situations carrying a high risk of substance use behavior. No support was found in either sample for the hypothesis that problem-solving skills moderate or interact with personality in predicting substance use.
implications and future directions From a theoretical perspective, rational problemsolving skills appear to serve as a link between hopelessness personality and lifetime alcohol and marijuana use. Having a hopelessness personality influences rational problem solving, which influences substance use. Although the relatively small effect size and the homogeneous population limit the clinical utility of these findings, these results lend support to the already frequent practice of embedding problemsolving therapy (PST) in cognitive-behavioral treatments for mood and substance use disorders. Furthermore, these results suggest that emphasizing rational problem-solving skills (as is the typical approach in PST) would generally be the most effective approach in such training with adolescents exhibiting high degrees of hopelessness. It is important to note that, although the effect sizes observed in this study were within the “small” range (r = .1 to .29) as defined by Cohen (1977), a small effect size does not necessarily imply a lack of clinical significance. As Rutledge and Loh (2004) observe, “even small correlation values may sometimes have an appreciable public health impact” (p. 138). In closing, the present study has several other limitations that should be taken into account when interpreting the results. First, it is unclear the degree to which these findings are generalizable beyond this sample which consisted primarily of Caucasian youths from families having household income greater than $50K annually. More research is needed focusing on larger samples from different racial/ethnic populations and different socio-economic levels. Second, although the reliance on self-report measures is indeed a limitation, other methods of obtaining substance-use data are also limited. Parent and/or
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teacher reports of problem behaviors in general are likely to underreport such behaviors (Achenbach, Damenci, & Rescorla, 2002), and biological methods (i.e., hair sampling and urinalysis) detect only recent use and do not detect the severity or chronicity of use over time (Richter & Johnson, 2001). With respect to personality and problem solving, although other more generalized measures do exist, no other format of measurement exists to provide data on the specific personality types and the specific problem-solving dimensions of interest. In the present study, the reliability of the SURPS was relatively low, attenuating its relationship to both substance use and problem solving. Finally, as with any cross-sectional correlational study, the direction of causality is not certain. Although the present results are consistent with predictions based on personality and social problem-solving theory, it is still possible that adolescents' substance use has an influence on personality and their problem-solving instead of the other way around, or that a reciprocal relationship exists between the two variables. Future prospective and longitudinal studies are needed to confirm these causal interpretations. There are several specific lines of follow-up research suggested by the present findings. First, it is important to replicate these findings with a more heterogeneous sample of adolescents, as well as in a sample of adolescents at higher risk for substance use and abuse. Second, it is important to explore whether these findings replicate in adult samples, as well as in samples having clinical diagnoses of major depressive disorder and substance use disorders. Third, since problem-solving skills training is a central element in a number of cognitive-behavioral interventions for substance use behaviors in both adolescents and adults (Botvin, Baker, Dusenbury, & Tortu 1990; Caplan et al., 1992; Carroll, Rounsaville, & Keller, 1991; Pentz et al., 1989), it is important to determine whether applying problem-solving training in a more targeted manner can improve treatment efficacy. For example, the present findings suggest that focusing on rational problem-solving skills could be an effective approach, particularly in adolescent substance users having a hopelessness personality style. References Achenbach, T. M., Dumenci, L., & Rescorla, L. (2002). 10-year comparisons of problems and competencies for national samples of youth: Self, parent and teacher reports. Journal of Emotional and Behavioral Disorders, 4, 194–203. Aiken, L. S., & West, S. G. (1991). Multiple regression: testing and interpreting interactions. Newbury Park, CA: Sage Publications. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, 4th ed. Washington, DC: Author.
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juvenile detainees. International Journal of Addiction, 26, 121–177. Digman, J. M. (1990). Personality structure: Emergence of the five-factor model. Annual Review of Psychology, 41, 417–440. Dishion, T. J., Loeber, R., Stouthamer-Loeber, M., & Patterson, G. (1984). Skill deficits and male adolescent delinquency. Journal of Abnormal Child Psychology, 12, 37–53. D'Zurilla, T. J., & Nezu, A. M. (2007). Problem-solving therapy: A social competence approach to clinical intervention, 3rd edition New York: Springer. D'Zurilla, T. J., Nezu, A. M., & Maydeu-Olivares, A. (2002). The Social Problem-Solving Inventory-Revised: Technical manual. North Tonowanda: Multi-Health Systems. D'Zurilla, T. J., Chang, E. C., & Sanna, L. J. (2004). Social problem solving: Current status and future directions. In E. C. Chang, T. J. D'Zurilla, & L. J. Sanna (Eds.), Social problem solving: Theory, research, and training Washington, DC: American Psychological Association. Eysenck, H. J. (1997). Addiction, personality and motivation. Human Psychopharmacology, 12, S79–S87. Flory, K., Lynam, D., Milich, R., Leukefield, C., & Clayton, R. (2002). The relations among personality, symptoms of alcohol and marijuana abuse, and symptoms of comorbid psychopathology: Results from a community sample. Experimental and Clinical Psychopharmacology, 10, 425–434. Henly, G. A., & Winters, K. C. (1988). Development of problem severity scales for the assessment of adolescent alcohol and drug abuse. International Journal of the Addictions, 23, 65–85. Holmbeck, G. N. (1997). Toward terminological, conceptual, and statistical clarity in the study of mediators and moderators: Examples from child-clinical and pediatric psychology literatures. Journal of Consulting and Clinical Psychology, 65(4), 599–610. Intagliata, J. C. (1978). Increasing the interpersonal problemsolving skills of an alcoholic population. Journal of Consulting and Clinical Psychology, 67, 489–498. Jaffee, W. B., & DZurilla (2003). Problem-solving in adolescents and their parents: Predicting adolescent externalizing behavior. Behavior Therapy, 34, 295–312. Jaffee, W. B., Conrod, P., D'Zurilla, T. J., Jacobs, C., & Schlauch, R. (2000). Problem solving, personality, and substance use in a college student sample. Poster presented at the annual meeting of the Association for Advancement of Behavior Therapy New Orleans, LA. Jainchill, N., Yagelka, J., Hawke, J., & De Leon, G. (1999). Adolescent admissions to residential drug treatment: HIV risk behaviors pre- and posttreatment. Psychology of Addictive Behaviors, 13, 163–173. Joiner, T. E. (2001). Negative attributional style, hopelessness depression and endogenous depression. Behaviour Research and Therapy, 39, 139–149. McCrae, R. R., Costa, P. T., Ostendorf, F., Angleitner, A., Hrebickova, M., Avia, M. D., Sanz, J., Sanchez-Bernardos, M. L., Kusdil, M. E., Woodfeild, R., Saunders, P. R., & Smith, P. B. (2000). Nature over nurture: Temperament, personality, and life span development. Journal of Personality and Social Psychology, 78, 173–186. Miller, R. G. (1966). Simultaneous statistical inference. New York: McGraw Hill. Millon, T. (1977). Manual for the Millon Clinical Multiaxial Inventory. Minneapolis: National Computer Systems. Millon, T. (1987). Manual for the Millon Clinical Multiaxial Inventory - II. Minneapolis: National Computer Systems. Millon, T., & Davis, R. D. (1997) The MCMI-III: Present and future directions. Journal of Personality Assessment, Special
personality, problem solving, and adolescent substance use issue: Personality assessment instruments: Current status and future directions, 68, 69-85. O'Boyle, M., & Barratt, E. S. (1993). Impulsivity and DSM-IIIR personality disorders. Personality and Individual Differences, 14, 609–611. Pentz, M. A., Dwyer, J. H., MacKinnon, D. P., Flay, B. R., Hansen, W. B., Wang, E. Y., & Johnson, C. A. (1989). Multicommunity trial for primary prevention of adolescent drug abuse: Effects on drug use prevalence. Journal of the American Medical Association, 261, 3259–3266. Platt, J. J., & Husband, S. D. (1993). An overview of problemsolving and social skills approaches in substance abuse treatment. Psychotherapy, 30, 276–284. Platt, J. J., Scura, W. C., & Hannon, J. R. (1973). Problem solving thinking of youthful incarcerated heroin addicts. Journal of Community Psychology, 94, 245–251. Richter, L., & Johnson, P. B. (2001). Current methods of assessing substance use: A review of strengths, problems, and developments. Journal of Drug Issues, 31, 809–834. Rosenthal, T. L., Edwards, N. B., Ackerman, B. J., Knott, D. H., & Rosenthal, R. H. (1990). Substance abuse patterns reveal contrasting personality traits. Journal of Substance Abuse, 2, 255–263. Rounsaville, B. J., Kosten, T. R., Weissman, M. M., Prusoff, B., Pauls, D., & Merikangas, K. (1991). Psychiatric disorders in relatives of probands with opiate addiction. Archives of General Psychiatry, 48, 33–42. Rutledge, T., & Loh, C. (2004). Effect sizes and statistical testing in the determination of clinical significance in behavioral medicine research. Annals of Behavioral Medicine, 27, 138–145. Sher, K. J., Batholow, B. D., & Wood, M. D. (2000). Personality and disinhibitory psychopathology: Alcoholism and antisocial personality disorder. Journal of Abnormal Psychology, 103, 92–102.
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Stein, J. A., Newcomb, M. D., & Bentler, P. M. (1986). Stability and change in personality: A longitudinal study from early adolescence to young adulthood. Journal of Research in Personality, 20, 276–291. Substance Abuse and Mental Health Services Administration. (2005). Results from the 2004 National Survey on Drug Use and Health: National Findings (Office of Applied Studies, NSDUH Series H-28, DHHS Publication No. SMA 054062). Rockville, MD. Tellegen, A. (1988). The analysis of consistency in personality assessment. Journal of Personality, 56, 621–663. Terracciano, A., Costa, P. T., & McCrae, R. R. (2006). Personality plasticity after age 30. Personality and Social Psychology Bulletin, 32, 999–1009. Trull, T. J., & Sher, K. J. (1994). Relationships between the fivefactor model of personality and axis-I disorders in a nonclinical sample. Journal of Abnormal Psychology, 103, 350–360. Woicik, P. B., Conrod, P. J., & Pihl, R. O. Validation of a fourfactor model of substance abuse risk and The Substance Use Risk Profile Scale. Manuscript submitted for publication. Whitmore, E. A., Mikulich, S. K., Thompson, L. L., Riggs, P. D., Aarons, G. A., & Crowley, T. J. (1997). Influences on adolescent substance dependence, conduct disorder, depression, attention deficit hyperactivity disorder, and gender. Drug and Alcohol Dependence, 47, 87–97. Zuckerman, M. (1993). P-impulsive sensation seeking and its behavioral, psychophysiological biochemical correlates. Neuropsychobiology, 28, 30–36. Zuckerman, M., & Kuhlman, D. M. (2000). Personality and risk–taking: Common biosocial factors.Journal of Personality, 68 999–102. R E C E I V E D : April 6, 2006 A C C E P T E D : March 2, 2008 Available online 19 September 2008
Behavior Therapy 40 (2009) 93 – 101
www.elsevier.com/locate/bt
Personality, Problem Solving, and Adolescent Substance Use William B. Jaffee, Harvard Medical School, McLean Hospital Thomas J. D'Zurilla, State University of New York, Stony Brook
The major aim of this study was to examine the role of social problem solving in the relationship between personality and substance use in adolescents. Although a number of studies have identified a relationship between personality and substance use, the precise mechanism by which this occurs is not clear. We hypothesized that problem-solving skills could be one such mechanism. More specifically, we sought to determine whether problem solving mediates, moderates, or both mediates and moderates the relationship between different personality traits and substance use. Three hundred and seven adolescents were administered the Substance Use Profile Scale, the Social Problem-Solving Inventory–Revised, and the Personality Experiences Inventory to assess personality, social problem-solving ability, and substance use, respectively. Results showed that the dimension of rational problem solving (i.e., effective problem-solving skills) significantly mediated the relationship between hopelessness and lifetime alcohol and marijuana use. The theoretical and clinical implications of these results were discussed.
DESPITE FLUCTUATIONS IN THE rates of substance use and substance use disorders among adolescents, these figures remain high. According to the Substance Abuse and Mental Health Services Administration's National Survey on Drug Use and Health (2005), 8.8% of youths aged 12 to 17 met DSM-IV (American Psychiatric Association, 1994) criteria for illicit drug or alcohol abuse or dependence during 2004. The two substances most commonly used by adolescents ages 12 to 17 are The authors would like to acknowledge Caitlin Ravichandran, Ph.D, for her contributions in the data imputation methods used herein. Address correspondence to William B. Jaffee, Ph.D., Harvard Medical School, McLean Hospital, 115 Mill St., Belmont, MA 02478; e-mail: [email protected]. 0005-7894/08/0093–0101$ 1.00/0 © 2008 Association for Behavioral and Cognitive Therapies. Published by Elsevier Ltd. All rights reserved.
marijuana and alcohol, with 7.6% of adolescents reporting current (past month) marijuana use and 17.6% reporting current alcohol use. Substance use in adolescence is associated with a number of adverse psychosocial outcomes, including fatal and nonfatal injuries from drug-related motor vehicle accidents, suicides, homicides, violence, delinquency (Dembo, Williams, Getreu, & Genung, 1991), psychiatric disorders (Whitmore et al., 1997), and risky sexual practices (Jainchill, Yagelka, Hawke, & DeLeon, 1999). Research that identifies risk and protective factors for adolescent substance use, as well as the relationships among these factors, may be useful in developing interventions that reduce both adolescent substance use as well as its adverse sequelae.
Personality and Substance Use Personality has been characterized as “a psychological structure underlying a relatively enduring behavioral disposition, i.e., a tendency to respond in certain ways under certain circumstances” (Tellegen, 1988). An important implication is that personality is relatively stable throughout the lifespan. Although controversial, there is considerable evidence supporting this notion (Costa & McCrae, 1997; McCrae et al., 2000; Stein, Newcomb, & Bentler, 1986; Terracciano, Costa, & McCrae, 2006). Personality has been conceptualized and assessed in several ways, and there is an extensive literature supporting the existence of a relationship between substance use and a number of models and measures of personality. Elements of both the “three-factor” and “five-factor” models of personality have shown a robust relationship between personality and substance abuse (Costa & McCrae, 1992; Digman, 1990; Eysenck, 1997; Flory, Lynam, Milich, Leukefield, & Clayton, 2002; O'Boyle & Barratt, 1993; Rosenthal, Edwards, Ackerman, Knott, & Rosenthal, 1990; Sher, Batholow, & Wood, 2000;
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Trull & Sher, 1994; Zuckerman, 1993). Similarly, research on the Millon Clinical Multiaxial Inventories (MCM-I, II, III; Millon, 1977; Millon, 1987; Millon & Davis, 1997) has demonstrated their effectiveness in identifying alcohol and other substance-abusing individuals (Bakken, Landheim, & Vaglum, 2004; Bartsch & Hoffman, 1985; Craig, 1997; Craig, Verinis, & Wexler, 1985). Cloninger (1987) identifies two types of alcoholics based in part on personality characteristics. Although the evidence of some type of relationship between personality and substance use is robust, researchers have noted that earlier models and measures are inadequate in representing the diversity that exists among substance users and substances used. Conrod, Pihl, Stewart, and Dongier (2000) have extended earlier models and developed a system of classifying substance users with the Substance Use Risk Profile Scale (SURPS) based on four different personality traits: Hopelessness, Impulsivity, Anxiety Sensitivity, and Sensation Seeking. Individuals with high levels of Hopelessness are characterized by the expectation that negative events will occur and are more likely to experience depressive disorders and abuse opiates (Joiner, 2001; Rounsaville et al., 1991). Impulsivity is characterized by a rapid response to cues for reward, as well as intolerance for negative emotion (Zuckerman & Kuhlman, 2000). Individuals having high levels of Anxiety Sensitivity tend to experience fear in response to symptoms of physical arousal such as elevated heartbeat and shortness of breath. It is hypothesized that anxiety-sensitive individuals are at risk for engaging in coping behaviors, including substance use, that permit escape from anxiety and anxiety provoking situations (Conrod et al., 2000). Finally Sensation Seeking is similar to Impulsivity in terms of sensitivity to cues for reward. However, whereas Impulsivity is associated with neuroticism and aggressiveness (Zuckerman & Kuhlman, 2000), Sensation Seeking is not. Additionally, Sensation Seeking is theoretically and empirically associated with alcohol use for its euphoric effects (Comeau, Stewart, & Loba, 2001; Conrod, Peterson, & Pihl 1997). Although a relationship between personality and substance use is well documented, the specific mechanisms by which personality might influence substance use is not clear. We hypothesize that problem-solving ability is one possible mechanism by which personality influences substance use.
Social Problem Solving and Substance Use Social problem solving is defined as qthe selfdirected cognitive-behavioral process by which a
person attempts to identify or discover effective or adaptive solutions to problems encountered in everyday livingq (D'Zurilla & Nezu, 2007). As such, social problem solving is a general and versatile coping strategy useful and effective in a wide range of stressful situations. Whereas a personality trait is considered to be a global characteristic of an individual that may influence behavior in a variety of different domains (whether problematic or not), a problem-solving dimension is a more specific characteristic of an individual that describes behavior when an individual confronts a problem in living. Also, a personality trait is considered to be a relatively stable characteristic of an individual throughout the life span, including adolescence (McCrae et al., 2000; Stein, Newcomb, & Bentler, 1986), whereas problem-solving ability is a changeable and trainable set of attributes (D'Zurilla & Nezu, 2007). Although several different conceptualizations of problem-solving abilities exist (Appel & Kaestner, 1979; Intagliata, 1978; Platt, Scura & Hanon, 1973), factor-analytic studies have established that social problem-solving ability is not a single, unitary ability but, instead, it is a multidimensional concept consisting of several different, albeit related, dimensions: Positive Problem Orientation (PPO), Negative Problem Orientation (NPO), Rational Problem-Solving (RPS), the Impulsivity/ Carelessness Style (ICS), and the Avoidant Style (AS; D'Zurilla et al., 2002). PPO measures a constructive problem-solving set that involves the general disposition to appraise a problem as a challenge rather than a threat and belief in one's own ability to solve problems. NPO measures a dysfunctional or inhibitive cognitive emotional set and a general tendency to view a problem as a threat to one's well being and an expectation that problems are unsolvable. RPS measures a constructive dimension defined as the systematic, deliberate, and skillful application of effective problem-solving principles such as problem definition and formulation, generation of alternative solutions, decision making, solution implementation and verification. ICS assesses a deficient problem-solving style characterized by hurried, careless, incomplete, and impulsive attempts to solve problems. Higher scores on this scale indicate individuals who generate and consider few alternatives, who fail to weigh consequences associated with different solutions, and fail to apply problemsolving strategies and techniques. AS measures another defective behavioral pattern characterized by procrastination, passivity, or inaction, and attempts to shift problem-solving responsibility to others.
personality, problem solving, and adolescent substance use Empirical support for an association between problem solving (measured in several different ways) and substance use is well established (Appel & Kaestner, 1979; Carey, Carey & Meisler, 1990; Dishion, Loeber, Stouthamer-Loeber, & Patterson, 1984; Intagliata, 1978; Platt et al., 1973), and research on the five dimensions of social problem solving described by D'Zurilla and colleagues (2002) using the Social Problem-Solving Inventory–Revised (SPSI-R) has identified relationships between impulsive/careless and avoidant problemsolving styles and substance use (Jaffee, Conrod, D'Zurilla, Jacobs, & Schlauch, 2000; Jaffee & D'Zurilla, 2003) in high school and college students.
Hypotheses The present study had two major hypotheses. Hypothesis 1. We hypothesized that problemsolving abilities would mediate the relationship between personality and lifetime marijuana and alcohol use. A mediator specifies the mechanism by which a given effect occurs (Baron & Kenny, 1986) or, in other words, “the independent variable influences the mediator which in turn, influences the outcome” (Holmbeck, 1997). In terms of the present study, one general hypothesis is that personality traits that develop very early in life may interfere with the development of adaptive problem-solving abilities which, in turn, could lead to maladaptive behaviors, such as substance use. For example, certain individuals with a hopelessness personality style, characterized by the belief that negative events will occur, may not exert the effort required to apply adequate rational problemsolving skills when faced with a problem, and thus not receive feedback in the form of a behavioral outcome as to whether a particular approach to problem solving is or is not effective. Thus, when faced with a problem, such individuals may not effectively apply rational problem-solving skills (i.e., might not effectively define the problem, generate, select, and implement solutions), and instead choose substance use as a means of circumventing the problem. We focused our analyses on the impulsive/ carelessness and avoidant problem-solving styles and rational problem-solving skills. Our prior research indicates that both impulsive/carelessness and avoidant problem-solving styles are associated with substance use in high school and college students (Jaffee & D'Zurilla, 2003; Jaffee et al., 2000). Additionally, we have observed that a rational problem-solving style is an important determinant of maladaptive behavioral outcomes
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(D'Zurilla, Chang, & Sanna, 2004). We focused these analyses on two outcome variables, lifetime marijuana and alcohol use, since these are the substances most frequently used by adolescents (SAMHSA, 2005). Hypothesis 2. We additionally hypothesized that certain dimensions of problem solving would moderate the effect of personality on the prediction of lifetime marijuana and alcohol use. A moderator specifies the conditions under which a given effect occurs, as well as the conditions under which the effect varies (Baron & Kenny, 1986). In terms of the present study, an alternate general hypothesis is that personality traits and social problem-solving abilities develop independently during childhood, but since both variables are related to adolescent substance use, level of social problem-solving ability may interact with personality to influence substance use. Specifically, the magnitude of the relationship between the personality traits and substance use may be less for individuals with good rather than poor problem-solving abilities. In other words, these negative personality traits may have less of an impact on substance use when problem-solving abilities are good rather than poor. For example, individuals with an impulsive personality style, having general difficulty inhibiting behaviors that have long-term negative outcomes (i.e., substance use), could be less prone to select that behavior if they also possess low-avoidance problem-solving style. Such individuals may be more likely to apply problem-solving skills to the best of their ability and select an adaptive response when faced with a problem. As with the mediational analyses, we focused our moderational analyses on the aforementioned four personality styles, the impulsive/carelessness, avoidant, and rational problem-solving dimensions, as predictors of lifetime marijuana and alcohol use. Establishing whether problem solving mediates or moderates the relationship between personality and substance use may have important theoretical and clinical implications. The presence of a mediational relationship suggests that personality influences substance use in part through its effects on problem solving. In contrast, the presence of a moderational relationship suggests that the effect of personality on substance use is affected more directly by the levels of problem-solving abilities present. Clinically, if a specific dimension of problem solving mediates or moderates this relationship, the deficient dimension of problem solving could be targeted in an intervention for an individual exhibiting a particular personality trait.
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Method participants Three hundred seven participants were recruited from a large high school in the suburban northeastern United States. In general, this sample was fairly demographically homogeneous. The sample was nearly equally split between males and females (55% male, 45% female), ranging in age from 15.0 to 20.4, with a mean of 16.9. The ethnic/racial composition was 73% Caucasian, 9% Asian, less than 2% African American, less than 2% Latino, and 14% “other” or “mixed.” Though 32% of respondents did not know their annual household income, of those responding, the modal (28%) annual household income was over $100K; 18% report annual household income between $75K and $100K; 12% between $50K-$75K; 7% between $25K-$50K; and 3% less than $25K. measures Substance Use Risk Profile Scale (SURPS; Woicik, Conrod, & Pihl, submitted for publication). The SURPS is a 28-item scale designed to measure four personality traits that have been implicated in both the vulnerability to and maintenance of substance use disorders. The four dimensions measured, each with seven items, are labeled Anxiety Sensitivity, Hopelessness, Impulsivity, and Sensation Seeking. Each item is assessed on a 4-point scale, ranging from “strongly agree” to “strongly disagree.” The factor structure, construct, convergent, and discriminant validity of this instrument as well as the internal consistency (.70–.88) and test-retest reliability (.53–.86 over a 6-week interval) have been demonstrated to be adequate in several studies detailed by college student and substance-abusing adult samples (Woicik et al., 2006). In the present sample, Cronbach's alphas were as follows: .67 for Anxiety Sensitivity, .70 for Impulsiveness, .63 for Sensation Seeking, and .66 for Hopelessness. Social Problem-Solving Inventory–Revised (SPSI-R; D'Zurilla et al., 2002). The SPSI-R is a 52-item self-report questionnaire consisting of five scales that measure five partially independent problem-solving dimensions: Positive Problem Orientation (PPO), Negative Problem Orientation (NPO), Rational Problem-Solving (RPS), Impulsivity/Carelessness Style (ICS) and Avoidant Style (AS). Greater problem-solving ability is indicated by higher scores on PPO and RPS and lower scores on NPO, AS, and ICS. Each item is assessed with a 5-point scale ranging from “not at all” to “extremely true of me.” The SPSI-R has good reliability and validity (D'Zurilla et al., 2002). Coefficient alphas ranged from .60 (PPO) to .87 (RPS) in one sample of 708
adolescents and from .76 (PPO) to .92 (RPS) in a sample of 1,053 college students. In the present sample, alphas were .73 (PPO), .91 (NPO), .91 (RPS), .78 (ICS), and .80 (AS). Readability has been estimated to be at the 4th grade level. The Personal Experience Inventory (PEI; Henley & Winters, 1988). The PEI is a multi-scale inventory that documents the onset, nature, and degree of substance involvement. The present study focused on the items assessing lifetime alcohol and marijuana use because of the relatively high rates of use of these two substances by adolescents. These items use a 7point scale with the following possible responses: 0 = never, 1 = 1 to 2 times; 3 = 3 to 5 times; 4 = 6 to 19 times; 5 = 20 to 39 times; and 6 = 40 or more times. The Infrequent Response Scale was used to identify and eliminate subjects providing invalid data.
procedure Participants were recruited through announcements in biology, chemistry, history, English, and health classes. In return for their participation, all students were automatically entered into a raffle for gift certificates for $75, $50, and $25 (one of each) to a local department store. Students who expressed interest in participating (nearly 100% of all students present) were given consent forms and a stamped return envelope addressed to the principal investigator. Approximately 50% of those expressing interest in participating obtained parental consent. Students whose parents had provided consent completed questionnaire packets containing the SPSI-R, the SURPS, and the PEI at school. To help ensure accurate reporting, all questionnaires were completed anonymously in pencil, and completed questionnaires were returned in sealed, unmarked envelopes. Students were also spaced throughout the classroom such that they could not view each others’ questionnaires. Additionally, faculty members left the classroom while questionnaires were completed. As a safeguard to confidentiality, demographic data were collected separately from the rest of the study data, and were limited in scope to further eliminate the possibility of participant identification. Data were collected in two waves, during the spring (35% of the total sample) and fall semesters (65% of sample). Participants in each of these waves did not differ on any demographic variables or on independent or dependent variables.
Results Prior to analyses, data were screened for missing values, elevated skew and kurtosis (N2), as well as for patterns of responses indicating invalid data (a
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Table 1 Means and Standard Deviations (SD) for All Study Variables (N = 274)
invalid patterns of responses, resulting in an n of 274 used in these analyses.
Variable
Mean
SD
Hopeless Personality⁎ Impulsive Personality⁎ Anxiety Sensitive Personality⁎ Sensation Seeking Personality⁎ Positive Problem Orientation⁎⁎ Negative Problem Orientation⁎⁎ Rational Problem Solving⁎⁎ Impulsive/Careless Style⁎⁎ Avoidant Style⁎⁎ Lifetime Alcohol Use⁎⁎⁎ Lifetime Marijuana Use⁎⁎⁎
1.83 2.23 2.36 2.75 2.36 1.43 2.10 1.29 1.36 2.94 1.52
0.51 0.51 0.53 0.53 0.73 0.88 0.68 0.67 0.76 2.14 2.23
descriptive statistics for problem solving, personality, and substance use Means, standard deviations, and bivariate correlations for all variables are presented in Tables 1 and 2. Over 83% reported having used alcohol in their lifetime, with the modal response (18.2%) being “40 or more.” For marijuana, the mean response for lifetime use was “2 to 3” times, with 38.3% reporting having tried marijuana. Eleven percent of the sample reported having used marijuana “40 or more” times in their lives.
Note. ⁎From the Substance Use Risk Profile Scale; ⁎⁎From the Social Problem Solving Inventory-Revised, ⁎⁎⁎From the Personal Experiences Inventory.
hypothesis 1. mediational analyses Baron and Kenny (1986) identify four basic conditions that must be met in order for a variable to be considered a mediator: (1) the predictor (personality) must be significantly correlated with the hypothesized mediator (problem solving); (2) the predictor (personality) must be significantly correlated with the dependent measure (substance use); (3) the mediator (problem solving) must be significantly correlated with the dependent variable (substance use); and (4) the impact of the predictor (personality) on the dependent variable (substance use) is no longer significant after controlling for the mediator. To determine whether this latter condition is met, a hierarchical regression is performed in which the hypothesized mediator (problem solving) is entered first and the predictor (personality) is entered second. If the predictor is no longer significantly correlated with the dependent variable (substance use), then mediation is said to have occurred. A total of six cases met the initial three conditions of mediation (p b .01). Rational problem solving was identified as a potential mediator of the
score N 1 on the PEI Infrequent Response scale). Our method for handling missing responses for items on each scale was to impute the mean value of the participant's observed items for that scale (the qseries meanq), which is equivalent to using the mean of the observed items as the scale's score. To assess the potential impact of our decision to impute the mean, we repeated our analysis using two alternate imputed values: the series mean minus the series standard deviation and the series mean plus the series standard deviation. In cases when these values were below the minimum possible value or above the maximum possible value for the scale, the scale minimum and scale maximum respectively were imputed. This method of imputation did not alter the significance of our findings. In this sample, data from 33 participants (approximately 10%) were eliminated because of Table 2 Bivariate Correlations Among All Study Variables Measures HP IMP ANX SS PPO NPO RPS AS ICS ALC MAR
1
2
3
4
5
6
7
8
9
10
11
– .29⁎⁎ .14 .02 -.47⁎⁎ .45⁎⁎ -.24⁎⁎ .29⁎⁎ .22⁎⁎ .17⁎⁎ .15⁎⁎
– .19⁎⁎ .28⁎⁎ -.26⁎⁎ .33⁎⁎ -.38⁎⁎ .35⁎⁎ .47⁎⁎ .26⁎⁎ .18⁎⁎
– -.22⁎⁎ -.16⁎⁎ .46⁎⁎ -.01 .22⁎⁎ .14 -.03 -.06
– .11 -.11 -.05 .05 .12 .36⁎⁎ .32
– -.45⁎⁎ .63⁎⁎ -.41⁎⁎ -.13 -.19⁎⁎ -.08
– -.16 .66⁎⁎ .44⁎⁎ .13 .06
– -.26⁎⁎ -.32 -.20⁎⁎ -.21⁎⁎
– .54⁎⁎ .18⁎⁎ .07
– .15 .07
– .66⁎⁎
–
Note. HP = Hopelessness Personality, IMP = Impulsive Personality, ANX = Anxiety Sensitive Personality, SS = Sensation Seeking Personality, PPO = Positive Problem Orientation, NPO = Negative Problem Orientation, RPS = Rational Problem Solving, AS = Avoidance Style, ICS = Impulsive/Careless Style, ALC = Lifetime Alcohol, MAR = Lifetime Marijuana, N = 274 for all variables except ALC (N = 271) and MAR (N = 273). ⁎⁎p b .01, two-tailed.
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FIGURE 1
Mediation of Hopelessness Personality by Rational Problem Solving in predicting Lifetime Alcohol use.
relationship between the hopelessness and impulsive personality types and both dependent variables. Avoidance style was identified as a potential mediator between the hopelessness and impulsivity personality types and lifetime alcohol use. Hierarchical regression analyses were then performed to determine whether the impact of personality type on substance use would remain significant when problem solving was controlled (condition 4 described above). To account for the increased probability of Type I error resulting from multiple significance tests, we used the Bonferoni procedure (Miller, 1966) to adjust the alpha level for these eight analyses to .008. These analyses demonstrated that rational problem solving mediated the relationship between hopelessness personality and lifetime alcohol use (ΔR2 = .027, p b .008; Figure 1) as well as lifetime marijuana use (ΔR2 = .031, p b .008; Figure 2). The overall R2 values for these models were .055 for lifetime alcohol use and .046 for lifetime marijuana use.
hypothesis 2. moderational analyses Since moderation essentially involves the interaction of two variables (Baron & Kenny, 1986), the test for moderation is identical to testing for an interaction. Prior to testing for the presence of an interaction, the two moderating variables were centered to eliminate problems stemming from multicollinearity between the first-order terms (the moderating variables) and higher-order terms (the interaction; Aiken & West, 1991). The test for an interaction involves partialling out the main effects for the two moderators (personality and problem solving) and examining the effect of the interaction term with the other effects removed.
FIGURE 2
We used a Bonferoni procedure (Miller, 1966) to adjust the alpha level for these 24 analyses, resulting in an adjusted alpha of .002. Analyses were performed that paired each of the dimensions of problem solving with each of the personality types. None of these analyses demonstrated moderational effects between any of the personality and problem-solving variables in predicting any of the dependent variables.
Discussion On a theoretical level, the intent of this study was to examine the role of social problem solving in the relationship between personality and substance use in adolescents. From a clinical point of view, the goal was to determine what dimensions of problem solving should be a clinical focus with what personality types when employing problem-solving interventions targeting adolescent substance use. Support was found for the first hypothesis of this study, that problem-solving skills would mediate the relationship between personality and adolescent substance use. Specifically, rational problem solving was found to mediate the relationship between hopelessness personality and lifetime alcohol and marijuana use. This finding is consistent with prior problem-solving research suggesting that rational problem-solving style is an important determinant of maladaptive behavioral outcomes (D'Zurilla et al., 2004). In general, these findings suggest that rational problem-solving skills serve as a link between personality and substance use in adolescents with high degrees of hopelessness. In adolescents who have the expectation that negative events may occur (hopelessness personality), these characteristics influence and impair the ability to effectively define
Mediation of Hopelessness Personality by Rational Problem Solving in predicting Lifetime Marijuana use.
personality, problem solving, and adolescent substance use problems, as well as to generate, select, implement, and evaluate solutions. This impairment, in turn, may lead to increased substance use in these individuals. Such an interpretation is consistent with Platt and Husband's (1993) explanation of the link between deficits in problem-solving abilities and substance use. It may be the case that individuals having poor rational problem-solving skills could experience higher rates of unsatisfactory outcomes leading to a high-risk affective state and the choice of substance use as a means of coping. It might also be the case that individuals having poor rational problem-solving skills could fail to effectively negotiate their way out of situations carrying a high risk of substance use behavior. No support was found in either sample for the hypothesis that problem-solving skills moderate or interact with personality in predicting substance use.
implications and future directions From a theoretical perspective, rational problemsolving skills appear to serve as a link between hopelessness personality and lifetime alcohol and marijuana use. Having a hopelessness personality influences rational problem solving, which influences substance use. Although the relatively small effect size and the homogeneous population limit the clinical utility of these findings, these results lend support to the already frequent practice of embedding problemsolving therapy (PST) in cognitive-behavioral treatments for mood and substance use disorders. Furthermore, these results suggest that emphasizing rational problem-solving skills (as is the typical approach in PST) would generally be the most effective approach in such training with adolescents exhibiting high degrees of hopelessness. It is important to note that, although the effect sizes observed in this study were within the “small” range (r = .1 to .29) as defined by Cohen (1977), a small effect size does not necessarily imply a lack of clinical significance. As Rutledge and Loh (2004) observe, “even small correlation values may sometimes have an appreciable public health impact” (p. 138). In closing, the present study has several other limitations that should be taken into account when interpreting the results. First, it is unclear the degree to which these findings are generalizable beyond this sample which consisted primarily of Caucasian youths from families having household income greater than $50K annually. More research is needed focusing on larger samples from different racial/ethnic populations and different socio-economic levels. Second, although the reliance on self-report measures is indeed a limitation, other methods of obtaining substance-use data are also limited. Parent and/or
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teacher reports of problem behaviors in general are likely to underreport such behaviors (Achenbach, Damenci, & Rescorla, 2002), and biological methods (i.e., hair sampling and urinalysis) detect only recent use and do not detect the severity or chronicity of use over time (Richter & Johnson, 2001). With respect to personality and problem solving, although other more generalized measures do exist, no other format of measurement exists to provide data on the specific personality types and the specific problem-solving dimensions of interest. In the present study, the reliability of the SURPS was relatively low, attenuating its relationship to both substance use and problem solving. Finally, as with any cross-sectional correlational study, the direction of causality is not certain. Although the present results are consistent with predictions based on personality and social problem-solving theory, it is still possible that adolescents' substance use has an influence on personality and their problem-solving instead of the other way around, or that a reciprocal relationship exists between the two variables. Future prospective and longitudinal studies are needed to confirm these causal interpretations. There are several specific lines of follow-up research suggested by the present findings. First, it is important to replicate these findings with a more heterogeneous sample of adolescents, as well as in a sample of adolescents at higher risk for substance use and abuse. Second, it is important to explore whether these findings replicate in adult samples, as well as in samples having clinical diagnoses of major depressive disorder and substance use disorders. Third, since problem-solving skills training is a central element in a number of cognitive-behavioral interventions for substance use behaviors in both adolescents and adults (Botvin, Baker, Dusenbury, & Tortu 1990; Caplan et al., 1992; Carroll, Rounsaville, & Keller, 1991; Pentz et al., 1989), it is important to determine whether applying problem-solving training in a more targeted manner can improve treatment efficacy. For example, the present findings suggest that focusing on rational problem-solving skills could be an effective approach, particularly in adolescent substance users having a hopelessness personality style. References Achenbach, T. M., Dumenci, L., & Rescorla, L. (2002). 10-year comparisons of problems and competencies for national samples of youth: Self, parent and teacher reports. Journal of Emotional and Behavioral Disorders, 4, 194–203. Aiken, L. S., & West, S. G. (1991). Multiple regression: testing and interpreting interactions. Newbury Park, CA: Sage Publications. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, 4th ed. Washington, DC: Author.
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