BY NC ND

ISSN-impreso 1390-7581

ISSN-digital 2661-6742

Volumen 19

Número 1

REE 19(1) Riobamba ene. - abr. 2025

Clinical patterns of personality and family functioning in drug addicts

Patrones clínicos de personalidad y funcionamiento familiar en drogodependientes

https://doi.org/10.37135/ee.04.22.02

Authors:

Genesis Daniela Guijarro Orozco1 https://orcid.org/0009-0001-4178-4433

Diego Armando Santos Pazos1 https://orcid.org/0000-0002-3038-8021

Affiliation:

1National University of Chimborazo, Riobamba - Ecuador

Corresponding author: Genesis Daniela Guijarro Orozco. National University of Chimborazo.

Postal address: Ave. Antonio Jose de Sucre, Km 1 ½, Riobamba, Chimborazo, Ecuador. E-mail:

gdguijarro.fsp@unach.edu.ec. Phone: +593986340153.

Reibido: 6 de julio de 2024 Aprobado: 5 de diciembre de 2024

ABSTRACT

Personality patterns and family functioning can enhance or mitigate the development of addictive

behaviors, a psychosocial problem that affects vulnerable groups worldwide. This research aimed to

establish the relationship between clinical personality patterns and family functioning according to

the substance consumed in a population of drug-dependent patients admitted to rehabilitation centers

in Zone 3, Ecuador. Its design was a non-experimental, transversal, and correlational type. The data

were obtained through the documentary analysis technique from the review of medical records recor-

ded by the institute's professionals, in which psychometric instruments were applied for psychologi-

cal evaluation: Millon Clinical Multiaxial Inventory (MCMI-III) and the Family Functioning Ques-

tionnaire (FF-SIL). The avoidant, antisocial, and depressive clinical patterns predominated among

the different substances consumed. The dysfunctional family was highlighted in users of alcohol

(44.4%), marijuana (45.5%), cocaine (63.7%), and multiple substances (60.9%). No statistically

significant differences were found between the study variables concerning the consumption group.

The correlation between personality patterns and family functioning was statistically significant and

inversely proportional, with a moderate intensity between avoidance and functionality (-0.251). The-

refore, when personality patterns increased, family functioning tended to decrease.

Keywords: Substance Abuse Treatment Centers, Drug Users, Substance Dependence, Personality.

RESUMEN

Los patrones de personalidad y el funcionamiento familiar pueden potenciar o mitigar el desarrollo de

conductas adictivas, problemática psicosocial que afecta a grupos vulnerables a nivel mundial. La

presente investigación tuvo como objetivo, establecer la relación de los patrones clínicos de personalidad

y el funcionamiento familiar según la sustancia de consumo, en una población de pacientes drogo-

dependientes internados en centros de rehabilitación de la zona 3, Ecuador, su diseño fue no experimen-

tal de tipo transversal y correlacional. Los datos se obtuvieron mediante la técnica de análisis documen-

tal, a partir de la revisión de historias clínicas registradas por los profesionales del instituto, en las cuales

se aplicaron instrumentos psicométricos para la evaluación psicológica: Inventario clínico multiaxial

de Millon (MCMI-III) y el Cuestionario de funcionamiento familiar (FF-SIL). Los patrones clínicos

evitativo, antisocial y depresivo predominaron entre las distintas sustancias consumidas. La familia

disfuncional se destacó en los consumidores de alcohol (44,4 %), marihuana (45,5 %), cocaína (63,7

%) y múltiples sustancias (60,9 %). No se encontraron diferencias estadísticamente significativas

entre las variables de estudio con respecto al grupo de consumo. La correlación entre los patrones de

personalidad y el funcionamiento familiar resultó estadísticamente significativa e inversamente propor-

cional, con una intensidad moderada entre la evitación y la funcionalidad (-0,251), por lo tanto, cuando

los patrones de personalidad aumentaron el funcionamiento familiar tendió a disminuir.

Palabras clave: Centros de tratamiento de abuso de sustancias, consumidores de drogas, dependencia

de sustancias, personalidad.

INTRODUCTION

In the last decade, studies of clinical patterns of personality and family functioning in addicted

individuals have achieved a particular notability in medical sciences, both those derived from a

medical disposition and those from a psychological one. The research field addresses the complex

interaction between the personality characteristics of people with addiction and the patterns of

family interaction that influence the development, maintenance, and treatment of addictions. It

also includes the development of therapeutic strategies and intervention programs that address

both individual and contextual aspects of addiction.(1)

Accordingly, Ortiz et al.(2) define family functioning as the dynamic between members based on an

environment of harmony, cohesion, communication, affection, permeability, and adaptability. Family

functionality is also related to the human capacity to adapt to normative or relative changes in their life

cycle as a couple or family and to unexpected events that occur in daily life.(3)

Furthermore, family functioning depends on the formation perspective of each family, whether nuclear

or extended, since it may present the physical absence of one or both parents, generally related to

violence and parent-child conflicts. Likewise, the lack of authority to regulate the conduct of children

produces destabilization, which, together with the changes that children and adolescents go through,

can cause confusion and trigger addictions.(4)

Emotional neglect and lack of affection can also contribute to addiction; consequently, individuals

interact negatively with their families. Care and emotional bonding are key to emotional development

since, during childhood and adolescence, the psychic resources that provide humans with the security

and ability to make appropriate and practical decisions are acquired.(5)

In a complementary manner, personality is conceptualized as a psychological construction linked to

the cultural context of individuals and integrated by social norms, values, beliefs, customs, and

traditions that significantly influence the manifestation of their traits. Therefore, the clinical patterns

of personality are characterized by the exclusive construction in a personal and persevering manner

of the subject, where their vital areas intervene that condition the thought, perception, and the way of

interacting with others.(6) Pedrero et al.(7) describe personality as a complex pattern of deep-rooted

psychological characteristics, largely unconscious and difficult to change, as they are expressed

automatically or involuntarily in almost all areas of the functioning of each subject.

Most problematic situations that accompany consumption arise from dysfunctional patterns of

behavior. However, it is unknown whether personality is a triggering factor for drug consumption,

whether drug consumption leads to a pattern of maladaptive personalities, or whether each element is

independent.(8) Therefore, Verheul et al.(9) state that pathological personality traits contribute to and

predispose the development of a substance use disorder. In addition, the existence of a maladaptive

personality trait – such as, for example, impulsivity – is associated with a higher risk of addiction.

Likewise, the existence of high impulsivity is related to more significant psychopathological

complications in addicted patients.(10)

Likewise, the clinical personality patterns are composed of paranoid, schizoid, avoidant, depressive,

dependent, histrionic, narcissistic, antisocial, aggressive-sadistic, compulsive, negativist, and

self-destructive; each one presents symptomatology and characteristic features that differentiate

them.(11)

Meanwhile, an antisocial personality disorder shows maladaptive behaviors according to social

norms; the subjects are usually impulsive and are found more prominently in the male sex.(12) One of

its diagnostic criteria is connected with the realization of illegal activities, including drug use.(13) In

particular, anxious personality disorder produces tension, fear, and inferiority. It can alter the stability

and organization of the person so that by denying reality, it would largely explain drug-dependent

behavior and some addictions.(14)

People with personality disorders show frequent consumption of illegal substances and alcohol, are

more compulsive, and generally use them to manage their mood and increase their functioning. They

also present more significant psychopathological problems, impulsivity, isolation, and less satisfaction

with their lives.(15)

Addictions can also be understood as a symptom generated by failures in the evolutionary development

of the intrapsychic world, as well as the inconsistencies presented in the relationship with the family

nucleus.(16)

Consequently, the present research aimed to establish the relationship between clinical personality

patterns and family functioning and identify the levels of family functioning in addicted individuals.

MATERIALS AND METHODS

The research was quantitative in approach, with correlational scope, and cross-sectional, since it

was based on the theoretical foundation and information was selected from the study of the general

population, made up of 70 clinical histories of patients addicted to substances, where the psychological

batteries that were previously applied by professionals from the specialized center for the treatment of

people with problematic consumption of alcohol and other drugs (CETAD), belonging to the canton

of Puyo, province of Pastaza, are recorded.

Collecting data instruments

Millon Clinical Multiaxial Inventory (MCMI-III), developed by Theodore Millon, is an instrument

that presents a Cronbach's alpha of 0.96, which shows its reliability, and which is made up of 175

items; its objective is to identify the pathologies, disorders, patterns and clinical syndromes that

measure 12 clinical patterns of personality (Schizoid, Avoidant, Melancholic, Dependent, Histrionic,

Stormy, Narcissistic, Antisocial, Sadistic, Compulsive, Negativist, and Masochistic); 3 serious

personality pathologies (Schizotypal, Borderline, and Paranoid); 7 clinical syndromes (Generalized

Anxiety, Somatic Symptoms, Bipolar Spectrum, Persistent Depression, Alcohol Use, Substance Use,

and Post-Traumatic Stress); and three severe clinical syndromes (Schizophrenic Spectrum, Major

Depression and Delusional Disorder).(17)

- Family Functioning Questionnaire (FF-SIL), created by Ortega de la Cuesta, with a Cronbach's

alpha of 0.94, identifies problematic factors involved within the family nucleus, is made up of 14

items through which dimensions of family functioning such as cohesion, harmony, communication,

adaptability, affectivity, role, and permeability are assessed. It measures categories of functional

family (70 to 57), moderately functional (56 to 43), dysfunctional (42 to 28), and severely dysfunctional

(27 to 14 ). (18)

Procedure

The data were taken from the medical records kept at the center specializing in the treatment of

people with problematic consumption of alcohol and other drugs.

Once the permits issued by the center's director were obtained, the study subjects were selected,

which included all the clinical histories, and subjected to review to collect data relevant to the

research. These were organized in a Microsoft Excel database and analyzed using the Statistical

Program Package for the Social Sciences (SPSS) version 25, Kolmogorov-Smirnov normality tests

with nonparametric results. Descriptive statistical tests (absolute and relative frequency tables) and

inferential tests (Chi-Square test, Spearman's Rho, Kruskal Wallis H) were applied to verify the

relationship of variables and differences between groups.

Ethical requirements for the proper handling of documents depended on the standards governing the

profession, such as the confidentiality of the identity of participants and results respecting the princi-

ples of non-maleficence, justice, and autonomy.

RESULTS

Table 1. Sociodemographic characteristics of the sample

The mean age of the population is 32 years, with a standard deviation of 11.15 years, indicating

considerable dispersion in the ages of the participants. The t-statistic of 24.05 (p < 0.001) suggests

that this mean age significantly differs from zero, an expected result for age data.

Regarding marital status, we observed a non-uniform and statistically significant distribution across

categories (Chi² = 24.800, p < 0.001). The majority of the sample is married (51.4%), closely

followed by singles (42.9%), while divorced individuals represent a much smaller proportion (5.7%).

This distribution suggests a population mainly established in marital relationships, with an almost

equal proportion of single individuals, which could reflect a transitional stage in the lives of many

participants.

The educational level of the sample shows significant differences in distribution (Chi² = 30.029,

p < 0.001). Most participants have higher education (52.9%) or secondary education (44.3%), while

only a tiny fraction has only primary education ( 2.9%). This distribution indicates a generally high

educational level in the sample, which could have significant implications regarding access to

information, decision-making, and health-related behaviors.

In terms of ethnicity, we observed a clear predominance of mixed-race ones in the sample (92.9%),

with much smaller proportions of Afro-Ecuadorians (2.9%) and Indigenous people (4.3%). The high

chi-square value (111.629, p < 0.001) indicates that this distribution is highly significant and not

random.

The distribution of places of residence shows significant variations (Chi² = 82.229, p < 0.001), with

Puyo (32.9%) and Riobamba (20.0%) as the most represented cities. Guayaquil and Tena each have

10% representation, while other cities have more petite proportions.

Regarding substance use, significant differences are observed between the categories (Chi² = 13.429,

p = 0.004). Alcohol is the most commonly consumed substance (38.6%), followed by the use of

multiple substances (32.9%). Marijuana (15.7%) and cocaine (12.9%) show lower but notable levels

of consumption. These results reflect complex consumption patterns where alcohol maintains a

predominant position; as well as the use of multiple substances represents a significant concern,

mainly due to the notable presence of marijuana and cocaine use. It is essential to consider how these

consumption patterns could relate to other sociodemographic variables indicated above.

Table 2. Clinical personality patterns according to the substance of consumption

Abbreviation: f: absolute frequency, %: percentage, p-value: statistical differences

(Kruskal-Wallis).

In the descriptive analysis of the different clinical personality patterns based on the type of substance

consumed and the statistical differences by groups (as shown in Table 2), it was identified that the

avoidant and antisocial patterns were particularly prominent among individuals who consume

alcohol; in marijuana users, the depressive pattern stood out, cocaine was notably associated with

dependence; finally, in the context of multiple substance use, the dependent and antisocial patterns

were more frequently observed. It was observed that there are no differences between the groups

concerning personality patterns (p-value = > 0.05).

Table 3. Type of family functioning according to the substance consumed

Abbreviation: f: absolute frequency, %: percentage, p-value: statistical differences

(Kruskal-Wallis).

In the analysis of the type of family functioning concerning the substance consumed by the

participants and the statistical differences by groups (Table 3), high and similar percentages were

evident between the moderately functional family and the dysfunctional family in the alcohol and

marijuana consumers. In contrast, only the dysfunctional family was manifested in those who

consumed cocaine and multiple substances. The consumption of alcoholic beverages is observed

with high frequency in comparison with the other substances. No significant differences in functionality

were evident between the consumption groups (p = > 0.05).

Table 4. Correlation between clinical personality patterns and general family functioning

Note: * Statistically significant differences: p-value = < 0.05

Abbreviation: Spearman's rho, Spearman's correlation coefficient; p-value, value of statistical signi-

ficance

Regarding the correlation performed using the Spearman correlation coefficient between the variables

clinical personality patterns and family functioning (Table 4), a low inversely proportional correlation

was found between the avoidant clinical pattern and the general family functioning of the patients

(Rho= -0.251; p < 0.05); in addition, no other significant relationships were observed.

DISCUSSION

In the analysis concerning personality patterns according to substance use, it was identified that alcohol

consumers have high percentages in the avoidant and antisocial patterns, the latter and accompanied

by the depressive are representative of the use of marijuana and multiple substances, to finish the

dependent characteristic stands out in cocaine, in agreement with the study of Rodriguez and Salgado,(19)

where it shows that the personality pattern that stands out is the antisocial and avoidant. Likewise,

Santos-de Pascual and others(20) affirm the existence of a high prevalence of the antisocial pattern

(31%) in consumers at a general level. In contrast, Rodriguez-Saez and Salgado-Ruiz(21) showed that

narcissism was a pattern with a high level of frequency (41.93%) in the population of drug-dependent

adults.

Regarding family functioning and type of substance consumed, a significant predominance of participants

with moderately functional and dysfunctional families was identified concerning alcohol (the most

consumed drug), marijuana, cocaine, and multiple substances, data coinciding with those proposed by

Castaño and Páez (22) in Manizales, Colombia, where 38.7% of the sample focused on dysfunction, and

alcohol consumption was more representative with 80.3%. Similarly, Cócola (23) observed the presence

of dysfunctionality and disorganization of the family system associated with conflictual relationships

and frequent use of alcohol, tobacco, marijuana, and other drugs with 59%. Another study carried out in

Brazil (24) reflected that 57.9% of the participants consumed alcohol and tobacco and presented significant

difficulties in parent-child relationships.

Finally, the study regarding the relationship between the variables verified a negative link between the

avoidant clinical pattern and family functioning. Since it is an inverse relationship, it is understood that

avoidance increases and functionality decreases or vice versa. Peñaherrera- Vélez(25) and others showed

data similar to those found in the present investigation since families with dysfunctional extremes

significantly influenced personality; in turn, personality styles were significantly related to family

types.

In the same sense, Díaz-Camargo et al.(26) found inversely proportional relationships between avoidant

and depressive personality patterns concerning family functioning. It should be noted that, despite an

exhaustive search, limited documents were found that showed the relationship between the study variables

in the drug addict population.

CONCLUSIONS

The predominant personality patterns are avoidant, antisocial, depressive, and dependent. These are

found significantly in the different types of substances the patients consume. The family is considered a

fundamental pillar of society and plays a central role in forming the personality of its members; however,

when investigating the type of family functioning, most individuals live within dysfunctional families,

regardless of the type of substance they ingest. An inverse relationship was found between the clinical

personality pattern and family functioning, showing that family functioning decreases as personality

patterns increase.

Conflict of interest: The authors declared no conflict of interest.

Contributions: Both researchers actively participated in the research of information, scientific writing,

data processing, results, discussion, and conclusions of the article.

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