PERSONALITY DIFFERENCES AND SOCIOPATHY IN HEROIN ADDICTS AND NONADDICT PRISONERS 1

Transcription

1 Journal of Abnormal Psychology 1971, Vol. 78, No. 3, PERSONALITY DIFFERENCES AND SOCIOPATHY IN HEROIN ADDICTS AND NONADDICT PRISONERS 1 PATRICIA B. SUTKER 2 Tulane University Medical School This investigation examined measurable personality differences between carefully selected samples of 40 heroin addicts and 40 nonaddict prisoners. Composite MMPI profiles were compared for statistical differences between groups, and individual MMPI profiles were classified using a system of differential diagnosis reported by Mechlin Results suggested that there are measurable personality differences between heroin addicts and nonaddict prisoners, especially with respect to the incidence and extent of sociopathy. The two samples did not differ from each other in terms of age, educational level, intellectual level, or chronicity of antisocial behavior as indicated by lime served in prison. The diagnostic concept of "sociopathy" has provoked arguments and interest since the behaviors usually assumed under this rubric were early described by Prichard (1837) as "moral insanity." Although there are some who characterize the label as a "wastebasket".category (Pennington, 1954; White, 1956), research using heroin addicts (Astin, 1959; Gilbert & Lombardi, 1967; HiU^Haertzen, & GlaseTj 1960; Olson, 1964) supports the contention that there are a group of traits, described as sociopathic and reflected by significantly elevated Psychopathic Deviate scale (Pd or 4) scores on the Minnesota Multiphasic Personality Inventory (MMPI), which are found with significantly greater frequency in narcotic addicts. Specifically, Astin (1959) reported a mean Pd T score of 75 for drug addicts at the United States Public Health Service Hospital, Lexington, Kentucky. Hill, Haertzen, and Davis (1962) provided evidence that social deviance is a common personality factor in alcoholics and prisoners as well as in heroin addicts. Using factoranalytic techniques, these authors found a marked similarity among MMPI profile patterns for these groups and demonstrated that elevation on Scale 4 was characteristically high. They suggested that, except for the behavior 1 This research was supported in part by the National Institute of Mental Health, Health Services and Mental Health Administration, United States Department of Health, Education and Welfare, through Contract PH Requests for reprints ma}' be mailed to the author, Tulane University Medical School, Department of Psychiatry and Neurology, 1430 Tulane Avenue, New Orleans, Louisiana which is peculiarly determined by the particular addiction or criminal activity, no personality characteristic other than social deviance is associated specifically with alcoholism, narcotic addiction, or criminality. In order to test for specificity of social deviance within the addictions, Hill et al. (1962) attempted to locate a nonaddict control group of comparable socioeconomic status. They selected a representative sample of incarcerated criminals, recognizing that there might be a considerable degree of "overlapping" but assuming that the chief mode of adaptation is indicated by the referring complaint. Although these investigators deemphasized the problem of overlap, regular testing of an inmate population at the Orleans Parish Prison 3 revealed that as many as one-fourth of the prisoners may be heroin addicts. Of 108 prisoners completing psychological evaluation for a 5-mo. period, 24 were found to be known heroin addicts with a history of 2 yr. or more of addiction. It is therefore possible that sample contamination in the above study contributed to the trend toward similarity between groups, while obscuring differences. The present study was designed to investigate personality differences, especially with regard to social deviance or sociopathy as reflected by MMPI scores on Scale 4 and 3 The Orleans Parish Prison houses both sentenced and unscntenced men. Approximately 75% of sentenced men are serving 6 mo. to 1 yr. The inmates were tested as part of regular weekly psychological testing conducted by the first author, Rickie S. Gilliard, and Sandra H. Gil. Appreciation is expressed to Sheriff Louis A. Heyd, Jr., for making this program possible.

2 248 PATRICIA B. SUTKER TABLE 1 GROUP MEANS AND STANDARD DEVIATIONS FOR SUBJECT CHARACTERISTICS IN ADDICT AND NONADDICT GROUPS : SIGNIFICANCE TESTS Group Characteristic Prisoner? Heroin addicts I value X SD X SD Age Highest grade completed Shipley IQ score Years addicted to heroin Xo. convictions for nondrug offenses Xo. convictions for drug offenses Total no. mo. incarcerated in state, federal, and local prisons S , * 1.10 profile configurations, between a group of hard-core heroin addicts and a control group of nonaddict prisoners. It was hypothesized that although the groups would appear basically similar, heroin addicts would evidence significant!)' higher elevations on Scale 4 of the MMPI than would nonaddict prisoners, reflecting greater sociopathy on this dimension. Subjects METHOD A total of 80 adult men was selected: 40_unincarceratedjigrom addicts and 40 nonaddict inmates serving senl'enfe's in the Orleans Parish Prison. Of the 40 addicts, 35 were applicants to the Narcotic Addict Rehabilitation Act Program (X T ARA) administered through the Tulane Medical School Department of Psychiatry and Neurology, and the remaining 5 were patients on a local methadone maintenance program. 4 Characteristics of 5s in both groups are summarized in Table 1. Table 1 shows that the two groups did not differ significantly from each other in terms of age, educational level, intelligence, or chronicity of antisocial behavior as indicated by time served in prison. Shortterm addicts and those who are said to "chippy," or shoot heroin sporadically, were eliminated from the addict group. Only those heroin addicts who had demonstrated addictive behavior, such as daily shooting for an extended period of time, were included. As shown in Table 1, the group of addicts were well-practiced, having a mean length of addiction of 7.62 yr. Length of addiction was figured from the time the addict con- 4 The NARA program is directed by Chester B. Scrignar and includes both initial evaluation before hospitalization and aftercare treatment of heroin addicts. The methadone maintenance program is directed by William A. Bloom of the Tulane Department of Psychiatry and Neurology. sidered himself "strung out," or requiring the drug daily. Materials and Procedure In order to screen heroin addicts from the nonaddict control group, special precautions were taken. The records of all prisoners tested were carefully reviewed, and all known addicts were excluded from the study. Further, an attempt was made to interview each S included in the final 40. Each prisoner was carefully questioned regarding his drug history, assured that the information was confidential, and was asked to allow examination of his arms for scars. It is not surprising that heroin addicts would try to conceal their addiction from prison officials. It is commonly thought that heroin addiction is a life-time problem, and addicts would not likely be considered for the most desirable jobs, for work release programs, or for early release as often as nonaddict prisoners. The 5s in both groups were administered the group form of the MMPI and the Shipley Institute of Living Scale. Eor the most part, tests were completed in a group situation, with the exception of several addicts who were tested individually as they applied for the NARA program. The 5s producing technically invalid profiles with an.f elevation greater than 80 T scores were eliminated. TnTjsescormg^ifrTQ ot less tnan 75 on the Shipley scale were excluded from both samples. Data Reduction and Analyses Sixteen MMPI scales were scored for each S: the 10 standard clinical scales, the 3 validity scales, Welsh's A and R scales (Welsh, 1956; 1965), and the Cavior, Kurtzbcrg, andlipton (1967) He scale. Using standard score T values, mean group scores were determined for each scale, and / tests of significance were used to evaluate differences between groups for each scale. Profiles were categorized by the criteria outlined by Meehl (1956; see Welsh, 1956) which requires rapid inspectional diagnosis, separating profiles into normal and abnormal categories. Those defined as abnormal were

3 Scale L F K A TABLE 2 T SCORES ON MMPI SCALES SOR ADDICTS AND NONABDICTED PRISONERS R Addicts *p <. *** <.not. Prisoners 52, , HEROIN ADDICTS AND NONADDICT PRISONERS 249 i 2.99** *** 4.18*** 4.81*** 6.00*** *** 2.00* * i 2.75** ^, further divided into three classes: psychotic, psychoneurotic, and conduct disorder. RESULTS MMPI Group Profile Patients Heroin addicts responded on the MMPI in a more open and honest fashion, admitting more personal faults, more depression, anxiety, worrying, and concern about bodily ailments, than did nonaddict prisoners. As can be seen in Table 2, heroin addicts produced significantly higher elevations on Scales 1, 2, 3, 4, 7, 8, and 0 than did prisoners. They scored significantly lower on Scale L. Estimates of omega square for each of the significance tests indicated that substantial predictions of variance in the dependent variables are found for only certain of the significant elevations. Especially suggestive arc the significant elevations on 4, 1, 3, 2, and 7. Examination of the group profile patterns illustrated in Figure 1 reveals that although the profile patterns are similar in overall configuration, elevation on Scale 4 (81.25) dominates the addict profile. All mean T scores for the nonaddict prisoner group fell within the "normal" range of variance, However, the addict group scored above 70 T scores on Scales 2 and 4. Comparison of heroin addicts and nonaddict prisoners on the lie scale showed that heroin addicts scored significantly higher than did nonaddict prisoners (t = 3.59, (If = 78, j) < ). The mean for heroin addicts in this sample was (SD = 6.24) as compared to Cavior's reported mean of (SD = 4,69). The mean for nonaddict prisoners was (SD = 6.24) as compared to Cavior's reported mean of (SD = 5.27). The ranges of scores were considerably overlapped, making determination of a satisfactory cut-off classification score for the Louisiana groups impossible. MMPI Profile Classification: Diagnosis Differential Classification of MMPI profiles according to Meehl's (1956) criteria revealed that of the 40 addict profiles. 50% were classified as.conduct disorder with high point elevations on 4 or on ~ 5bTrr3irncT9 with other scales relatively lower. "Another 23^n of the jicidict profiles were cateaprizpfl "s psvcfmtic with the right end of the profile elevated and a peak onj3cale 8. Only 15J%fftLlhe addict profiles were found to fit the psychoneurotic category characterized by elevations on the left sicte^of the profile, Scale ~7 Higher than Scale 8, and milder profile elevations. Twelve percent of the profiles met the criteria for the normal group, and of these, 2 profiles had elevations above 80 on Scales 4 and 2, with a score on K of below 40. According to this classification system, these profiles were categorized within the normal group. Profiles of the nonaddict prisoners were classified very differently, with 42% falling within the normal category. Another 30% of the prisoner profiles were characterized as conduct disorder with primary elevations on 4 no ul g «H O <? 50-j ( Heroin Addicts (n=40) Nonaddici Prisoners (T= 40) "1 I II T L F K I TT A R FIG. 1. Composite MMPI profiles for heroin addicts and nonaddict prisoners (with K corrections).

4 250 PATRICIA B. SUTKER and 9, and 23% were classified as psychotic. Only 5% of the profiles fell into the psychoneurotic category. DISCUSSION Although heroin addicts and prisoners evidenced a number of common personality characteristics reflected by similar composite profile configurations, significant MMPI differences and results of the profile classification have interesting implications which are in keeping with reports of other investigations. For example, significant elevations on MMPI Scales 4, 2, and 7 were found by Gilbert and Lombard! (1967), who also reported a low percentage of normal MMPI profiles among young male narcotic addicts and a high percentage of profiles reflecting sociopathy. Heroin addicts reported more neurotic symptoms than did nonaddict prisoners. They indicated more depression, pessimism, anxiety, and concern for bodily ailments. Higher elevations on these scales cannot be attributed to a tendency to endorse deviant items more frequently, as indicated by similar scores on the F scale for the two groups. Preoccupation with physical complaints and concern for bodily functioning are likely the result of an addiction which has to be maintained under the pressures of legal surveillance and the constant threat of drug deprivation. An addict probably experiences a repeating cycle of psychological and physical changes from the satisfaction and relative absence of anxiety associated with drug injection, followed by a build-up of tension and activity concomitant with his search to acquire and find a place to shoot the drug, and then again the familiar relief associated with fixing. Thus it might be hypothesized that anxiety is a recurring state in many unincarcerated addicts, present regardless of personality type and resulting from the legal and physiological pressures of an illegal addiction. Viewed in this way, it is possible that anxiety would decrease in many addicts during incarcerated periods. Most interesting is the striking exaggeration of Scale 4 in the mean addict profile. Scale 4 is the peak elevation for addicts and exceeds the mean on Scale 4 for nonaddicts by 10 T scores. This suggests that addicts have at least a tendency to be more socially deviant than nonaddict prisoners. Whether their sociopathy is a function of years of manipulating, stealing, and conniving to acquire daily illicit drugs and to escape detection, or a precipitating factor in their becoming heroin dependent, is a problem for research. Although Hill et al. (1962) reported no significant difference between prisoners and narcotic addicts on Scale 4, personalit}' differences were likely obscured by the presence of a significant number of addicts in their prison sample. Comparison of unincarcerated heroin addicts and prisoners with no history of heroin addiction on the Cavior He scale showed a significant difference in the predicted direction. However, the cut-off score of 36 for identification of addicts suggested by Cavior et al. is 1 point higher than the mean for the Louisiana addict group. In that only the addict group seemed to differ significantly from Cavior data, it is possible that the difference is a function of the incarceration variable. Addicts in the present study were at the time of investigation "street" addicts, although as a group they did not differ from the incarcerated 5s in terms of time served in a state or local prison. It is also possible that geography is producing significant differences between the two groups of addicts. Clearly, such findings point to the possibility of differentiating addicts from nonaddicts using such a scale; however, the problem of overlapping items and similarity between groups is indeed a difficult one to overcome. Classification of MMPI profiles for addict and nonaddict groups showed that at least one-half of the addict sample can be described diagnostically as socially deviant or sociopathic, while only 30% of the nonaddict prisoners met the criteria for this category. Few "normal" individuals were found within the heroin-addicted sample, while 42% of prisoners were classified as normal. Twenty-three percent of both addicts and prisoners were classified as psychotic, and the percentage of purely neurotic individuals was surprisingly low in both groups. Even though addicts scored higher than nonaddicts on the neurotic triad, in the overall classification, only 15% were classified as neurotic. This would indicate that although there was evident in the addict group a greater tendency toward social nonconformity and a rejection of traditional values and restrictions, at least some of these sociopathic individuals were also experiencing de-

5 pression and anxiety. That narcotic users with different character structures also show measurable differences on emotion profiles has been demonstrated by Shepparcl, Fiorentino, and Merlis (1968) and Shepparcl, Fiorentino,. Collins, and Merlis (1969). In their investigation of personality characteristics of illicit LSD users, Smart and Jones (1970) found that LSD users tended to be classified in two categories: conduct disorder and psychosis. Similarly, heroin addicts displayed primarily the same two types of psychopathology, with 50% classified as conduct disorder and 23% classified as psychotic. In contrast, almost half of the prisoner sample s were classified as normal. Results of this investigation suggest that there are measurable personality differences between heroin addicts and nonaddict prisoners, especially with respect to the incidence" and extent of sociopathy. That this is not a unitary concept was demonstrated by Astin (1959), who cautioned that equally high scores on Scale 4 have different clinical implications, depending upon the internal composition of contributing factors, and by Lykken (1957), who differentiated primary and secondary sociopaths on the basis of manifest anxiety. Further, variations in profile configurations associated with elevations on Scale 4 indicate that there may be different behavioral manifestations of sociopathy. These findings demonstrate a need for greater refinement of the concept of sociopathy as well as refinement of sociopathic samples used in research investigations. Isolating similar types of individuals within the framework of sociopathy offers one avenue of approach for investigating causal factors in the development of various types of antisocial behavior. That differential exposure to criminal or drug-using behavior influences the direction of asocial activities, given the characteristic of social deviance, is not entirely explanatory in that both prisoners and addicts came from predominantly the same low socioeconomic classes in which heroin is often available on the street corner. Further, most nonaddict prisoners reported having easy access to heroin arid other drugs and even drug experimentation. Perhaps there is not yet sufficient justification to abandon the search for specific HEROIN ADDICTS AND NONADDICT PRISONERS 251 predisposing characteristics or needs which might be related to the formation of a drug habit and to years of heroin addiction and the life which this entails. REFERENCES ASTIN, A. W. A factor study of the MMPI Psychopathic Deviate scale. Journal of Consulting Psychology, 1959, 23, CAVIOR, N., KURTZBERG, R. L., & LIPTON, D. S. The development and validation of a heroin addiction scale with the MMPI. International Journal of lite Addictions, 1967, 2, GILBERT, J. G., & LOMBAKDI, D. N. Personality characteristics of young male narcotic addicts. Journal of Consulting Psychology, 1967, 31, HILL, H. E., HAERTZEN, C. A., & DAVIS, H. An MMPI ^ factor analytic study of alcoholics, narcotic addicts and criminals. Quarterly Journal of Studies in Alcohol, 1962, 23, HILL, H. E., HAERTZEN, C. A., & GLASER, R. Personality characteristics of narcotic addicts as in- - dicated by the MMPI. Journal of Genetic Psychology, I960, 62, LYKKEN, D. T. A stud}' of anxiety in the sociopathic personality. Journal of Abnormal and Social Psychology, 1957,55,6-10. MEEHL, P. E. Profile analysis of the MMPI in differential diagnosis. In G. S. Welsh & VV. G. Dahlstrom (Eds.), Basic readings on the MMPI in psychology and medicine. Minneapolis: University of Minnesota Press, OLSON, R. W. MMPI sex differences in narcotic addicts. The Journal oj General Psychology, 1964,71, PENNINGTON, L. A. Psychopathic and criminal behavior. In L, A, Pennington & I. A. Berg (Eds.), An introduction to clinical psychology. New York: Ronald Press, PKICIIARD, J. D. A (realise on insanity and other disorders affecting the mind. Philadelphia: Haswell, Parrington, & Haswell, SHEPPARD, C., FIORENTINO, D., COLLINS, L., & MERLIS, S. Comparison of emotion profiles as defined by two additional MMPI profile types in male narcotic addicts. Journal of Clinical Psychology, 1969, 25, SHEPPARD, C., FIORENTINO, D., & MERLIS, S. Affective differential: Comparison of emotion profiles gained from clinical judgment and patient selfreport. Psychological Reports, 1968, 22, SMART, R. G., & JONES, D. Illicit LSD users: Their personality characteristics and psychopathology. Journal of Abnormal Psychology, 1970, 75, WELSH, G. S. Factor dimensions A and R. In G. S. Welsh & W. G. Dahlstrom (Eds.), Basic readings on the MMPI in psychology and medicine. Minneapolis: University of Minnesota Press, WELSH, G. S. MMPI profiles and factor scales A and R. Journal of Clinical Psychology, 1965, 21, WHITE, R. W. The abnormal personality. New York: Ronald Press, (Received October 9, 1970)