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PERSONALITY CHARACTERISTICS OF ADDICTS AND NON- ADDICTS DETERMINED THROUGH RORSCHACH FINDINGS.

Byline: Muhammad Tahir Khalily

ABSTRACT

The current study aims to explore underlying personality characteristics of addicts and non-addicts examined by the Rorschach Inkblot test to differentiate between the two groups. 25 addicts were randomly selected and matched with an equal number of non -addicts. The subjects were contacted in Drug Treatment Centres, Hayat Shaheed Teaching Hospital, Govt Lady Reading Hospital and Dost Welfare Foundation (NGO), Peshawar, Pakistan. A semi-structured interview was used for the collection of demographics and drug related information. Rorschach Inkblot test was administered on the subjects and their responses for each card were recorded in their protocols and scored. A descriptive analysis was carried out for the Rorschach findings and tabulated. The results indicated that the addicts showed distinctive underlying personality characteristics compared to their counterparts. It is concluded that these personality aspects should be considered in the formulation of and during the course of treatment.

It recommends a reatment strategy based on operant conditioning to avoid highly cognitive demand treatment strategy at the initial phase to minimize relapse.

INTRODUCTION

Addiction is a global problem, reducing social and human resources in different parts of the world. It is not confined to certain social strata but appears to affect all levels of society. Drug abuse is a serious problem in Pakistan, and there is a tremendous increase in the addiction population since the early eighties; it has now reached an alarming situation and has become a public health issue. It is estimated that there are 4 million addicts in Pakistan with appalling figures of injectable drug users (Anti Narcotics Force Islamabad, 2006). It is a serious as well as a complex problem. In addition to its direct effect on health, its impact is also associated with other problems both psychological and social; it produces personality changes that affect not only the addicts but also those around them and the community at large. In spite of the terrible consequences, people are abusing drugs to escape from unpleasant experiences.

Many factors are considered responsible for this high-priced habit: health, social, personal, and psychological issues. The causes range from pharmacological to environmental, social, and psychological. However, personality characteristics are viewed as significant indicators and are pivotal to understanding the underlying structure of personality which distinguishes addicts from non-addicts. This study aims to examine personality characteristics determined by the Rorschach Inkblot test to differentiate between addicts and non-addicts in the context of planning interventions. Subsequently the findings will help the clinician to recommend an appropriate strategy that could address the underlying personality characteristics and also to avoid unrealistic cognitive demands in the initial phase of treatment, thereby minimizing the relapse rate.

Rorschach Inkblot Test

The Rorschach Inkblot test is one of the richest performance-based techniques for examination of personality characteristics in various clinical and research settings (Camera, Nathan andamp; Puente, 2000). Developed by the Swiss psychiatrist Herman Rorschach in 1921, it has been extensively used in clinical practice, teaching, and research, and is a widely used tool in diagnostic personality testing (Exner, 2001). Rorschach interpretations emphasize psychological organization and functioning in the form of a number of psychological characteristics (Exner, 2002). This exclusive distinction of Rorschach tends to focus on characteristics of the personality structure rather than of individual behaviours. It discovers the kind of information that goes beyond the detection of symptoms and investigates etiological issues that differentiate one individual from the other.

In this regard Per-Christian, Vanem, Krog and Hartmann (2008) revealed that Rorschach findings, compared to other psychological tools, explicitly explore deficient social skills indicating an inaccurate perception and cognitive deficits in substance abusers. They further revealed that substance abusers were found to be significantly different from the university students with whom they were compared, in that they thought illogically and had poor interpersonal relationships. Blatt and Berman (1984) indicated difficulties in containing and regulating affect. Grossman, Wasyliw, Benn and Gyoerkoe (2002) found that drug addicts have difficulty in establishing meaningful relationships, agreeing with another study of the Rorschach protocols of opium addicts that demonstrates antisocial characteristics in this group (Gaconon andamp; Meloy, 1994).

To recap, the Rorschach test is a performance-based technique that has the potential to explore information about unspoken, irrational motives and underlying personality characteristics that are difficult to attain by using self-report inventories (Stricker, 1999; Meyer andamp; Archer, 2001; Bornstein, 2001). Furthermore, the Rorschach test could extract more sensitively the personality characteristics that differentiate addicts and non-addicts. In addition, the Rorschach Inkblot test possesses reliability and validity similar to that of other psychological tools used for personality assessment (Board of Trustees of the Society for Personality Assessment, 2005).This unique contribution of Rorschach as a psychological tool plays a significant role in the formulation (Yoshida, Murano andamp; Satio, et al., 1995) and treatment plan for addicts (Blatt andamp; Berman, 1990), and can contribute to a deeper understanding of human behaviours in the context of management and intervention.

METHOD - Sample

The sample of this study consisted of 50 subjects including an equal number of addicts and non-addicts. Of 75 addicts, (who were getting treatment in different Drug treatment centres) 25 subjects were randomly selected for this study. Their identification and drug related information were collected through a semi-structured questionnaire specially designed for this purpose. The information relevant to their drug history is portrayed in Table 1 in the Results section. Since matched pairs (non-addicts) were not easily available, each of the addicts selected as subjects was matched with one of their attendants (friend, colleague, brother or cousin) who accompanied them to the hospital, providing variables such as education, marital status, economic status, and residential area.

Description of Measures - Semi-Structured Interview Schedule (SSIS)

SSIS was prepared to collect the relevant information of subjects concerning age, residential area, education, marital status, socio-economic status, and other information related to drug addiction i.e. duration of addiction, age when started, types of drug used, and easily availability of drugs.

Rorschach Inkblot Test

The Rorschach Ink blot test is one of the richest projective techniques to investigate personality characteristics. Developed by a Swiss Psychiatrist Herman Rorschach in 1921, it has been widely used in clinical practice, and is a most commonly used tool in diagnostic personality testing (Exner 2001). As there are no specific Rorschach schools available for learning in this country that strictly follow their own method of administration, scoring and interpretation, the clinicians and academicians have adapted a systematic approach compatible with all approaches, avoiding rigorous adherence to any one. For administration, scoring, and interpretation usually approaches were adopted by Allen (1983), Klopfer and Davidson (1962), Gilbert (1979), Rapapert (1968), and Ogden (1973). However in this study Klopfer system was used for scoring and interpretation of the protocols.

Procedure

The supervisory committee of the psychology department at the University of Peshawar, Pakistan, approved the purpose of this study. As an ethical issue, no identifying data relating to clients was included in the final description. The subjects were contacted at the drug addiction treatment centres of the Govt Lady Reading Hospital, Hayat Shaheed Teaching Hospital, and Dost-Welfare Foundation, Peshawar, an NGO. During the initial meeting each subject was given an orientation, and his consent was obtained for the administration of the test. Before administering the Rorschach Inkblot tests, necessary equipment related to the tests was organized, and standard instruction (Allen, 1983) for the administration of Rorschach was read out. Relevant questions raised by the subjects were answered. The test was administered in two phases: performance proper and detail inquiry. All the responses were recorded word to word. Each protocol was scored to portray how each subject reacted to ten inkblot cards.

Each response was assigned a scoring symbol with respect to each category such as Location, Determinants, Form Level, Contents and Popular. The author scored the recorded responses according to the standard procedures. In the mean while the other two scorer (professionally trained in administration and scoring of Rorschach) individually scored each protocol, to attain maximum agreement on scoring and ensure the inter-rater reliability.

For the purpose of inter-rater reliability (Viglione andamp; Taylor, 2003) percentages of agreement were calculated. The interrater consistency indicated 98% agreement on Location, 97.5% on Determinants, 99% on Form Level, 95 % on Popular and 99% on Content category indicating good reliability, (Cicchetti andamp; Sparrow, 1981).

A descriptive analysis was carried out of the Rorschach protocols findings, tabulated and presented in the next section.

RESULTS

There is some significant information revealed in Table 1 indicating that 53.33% of addicts used both hashish and heroin, while 13.33% and 20% used hashish and heroin respectively. The data also indicate that 69.33% considered hashish as a gateway drug to heroin. The mean onset age is 18 years, indicating a vulnerable period for the introduction of this habit; this period is very significant for personal growth and career selection. Furthermore, the mean age for both addicts and non-addicts in this study is 28 years, which is considered to be crucial age to contribute in the economic development of society.

The frequency and percentage of use of drugs, and drug first experience

Types of Drug###Frequency###%###Type of drug first used###%

Hashish###10###13.33###52###69.33

Heroin###15###20###13###17.33

Hashish and Heroin###40###53.33###-###-

Alcohol###5###6.66###5###6.66

Opium###2###2.66###2###2.66

Tranquillizers###1###1.33###1###1.3

Injection###2###2.66###2###2.6

Onset Mean Age = 18 years Mean Age = 28 years

Table 2

Descriptive Statistics for Demographic Variables

Variables###Addicts###Non-Addicts###Percentages

###(N=25)###(N=25)

Education

Matric###15###15###60

F.A / B.A###6###6###24

M.A###4###4###16

Marital Status

Married###11###11###44

Unmarried###14###14###56

Economic Status

Low Income###16###16###64

Middle Income###7###7###28

Upper Middle Income###2###2###8

Residential Area

Urban###16###16###64

Rural###9###9###36

Table 3

Descriptive Statistics for Rorschach Miscellaneous Category

Miscellaneous###Addicts###Non Addicts

Variables###Frequency###%###Frequency###%

R###264 (M= 10.56)###317(M=12.68)

P###138###52.27###169###53.31

F+###142###53.78###288###90.85

F-###122###46.21###29###9.14

A descriptive analysis was carried out, tabulated and depicted in Table 3 for Miscellaneous Category. It demonstrates that the non-addicts produced more (M=12.68) responses (R) to the Rorschach cards than the addicts, indicating a broad range of interest in the former while the low number (M=10.56) responses from the latter indicate inhibition, a meticulous striving for a few responses, or lack of motivation (Rapapert, Gill andamp; Schafer, 1968). Table 3 further depicts that the non-addicts appeared to produce more (53.31%) popular (P) responses with good quality Form (F+) level (90.85%) compared to their counterpart addicts. This reflects the frequent interaction of non-addicts along with an appropriate link with reality and accurate perception.

On the other hand the more (46.21%) F- responses and low (52.27%) P responses of the addicts are indicative of poor self-perception, inability to concentrate, lack of intellectual control and clarity in associative processes, in addition to unresponsive conventional concept (Schafer, 1954) and low sociability. Moreover, a decrement in F+ responses is indicative of difficulty in intellectual functioning and lack of spontaneity (Phillips andamp; Smith,1953).

Table 4

Descriptive Statistics for Rorschach Location Category

###Addicts###Non Addicts

Locations###Frequency###%###Frequency###%

W###59###22.34###211###66.56

W!###89###33.71###55###17.35

DW###49###18.56###16###5.04

D###36###13.63###20###6.30

d###17###6.43###12###3.78

S###14###5.30###3###0.94

In the Location category the non-addicts produced more (66.56%) W responses than the addicts, while the addicts produce more (33.71%) W ! responses with more (18.56%) DW, reflecting the ability of non-addicts to integrate and organise material in their environment while the addicts illustrated a tendency to overgeneralization without paying adequate attention (Gilbert, 1979), illogical thinking, and impulsive action without considering the consequences (Allison, Blatt andamp; Zimet, 1968; Rapapert et al., 1968). This table also indicate that addicts show more S responses (5.30 %) than the non-addicts responses (0.94 %) indicating oppositional tendency towards significant figures of the addicts (Rapaport et al., 1968)

Table 5

Descriptive Statistics for Rorschach Determinants Category

Determinants###Addicts###Non Addicts###Ratios

###(Frequency)###(Frequency)

Form (F)###160 (60.60 %)###246 (77.60 %)###___

Movement

M###7###20###1:3

FM###43###30###3:2

m###13###7###2:1

Colour

FC###8###1###8:1

C###17###5###3:1

Fc!###8###3###3:1

C!###8###5###2:1

In the Determinants category, results shown in Table 5 reveal that the non-addicts produced more (77.60%) F responses with a good number of M (1:3) and FM(3:2) and less m(2:1) responses than the addicts, indicating a stable value system, good self esteem and the ability to control social pressures intellectually and conventionally (Phillips andamp; Smith, 1953). On the other hand the addicts reported more Colour [C (3:1), FC (8:1), C!(2:1) and Fc!(3:1)] responses than their non-addict counterparts, reflecting less concern for social values, lack of secure self-control, emotional instability, and violent characteristics.

Table 6

Descriptive Statistics for Rorschach Content Category

Contents###Addicts###Non Addicts

###Frequency###%###Frequency###%

H###16###6.60###122###35.33

Hd (Including oral content)###45###17.04###21###6.62

A###90###34.09###99###31.23

An###28###10.60###14###4.41

Obj###23###8.71###14###4.41

N###8###3.03###15###4.73

Sex###30###11.36###15###4.73

Pl###15###5.68###19###5.99

Insects###3###1.13###2###0.63

Cloud###4###1.51###5###1.57

Blood###3###1.13###1###0.31

In the contents category Table 6, indicates that the non-addicts produced more (35.33%) Human (H) responses, indicating a secure interaction with the environment with good self esteem and adequate interpersonal relationships, while the greater number (17.04%) of Hd responses, including oral content, of addicts indicates poor self concept, a strong tendency towards addiction and desperate immediate gratification (Knight andamp; Prout, 1951), lack of insight to own motives (Phillips andamp; Smith, 1953), and poor interpersonal relationships (Beck andamp; Molish, 1967). Furthermore the addicts produced more (34.09%) Animals (A) responses with more (10.60%) Anatomy (An) and Blood (1.13%) responses than the non-addicts, demonstrating stereotyped thinking, inhibition, disturbed adjustment (Klopfer andamp; Davidson, 1962), narrow range of interest and negativism, and oppositional tendencies (Schafer, 1954).

In addition the addicts produced more Object (8.71%) and Sex (11.36%) responses, suggesting more pleasure seeking, sensual (Zimmering, Tollan, Safrin andamp; Wortis, 1952) and dependent characteristics on their part, while the non-addicts produced more (5.99%) Plant (Pl) and Cloud (1.57%) responses, indicating the presence of anxiety and sensitivity (Gilbert, 1979).

DISCUSSION AND CONCLUSION

Drug addiction is a serious problem in Pakistan affecting all levels of society. The current study indicated that the onset age of illicit drug use is 18 years, a crucial time for personal development and career selection for the rest of one's life. Furthermore, the average age of the addicts considered in this study is 28 years, which is also a critical span of life for the economic development of any society, including Pakistan. This is a complex and multifactorial problem and needs multifaceted strategies to deal with it. Treatment is one of the important strategies to ameliorate the situation. Many treatment strategies are practised and claim effectiveness. They explain drug addiction according to their own model, identifying causal or precipitating factors and proposing treatment strategies accordingly. However, personality characteristics are viewed as significant in the initiating, maintaining and ameliorating components in all these models to treat the addiction problem efficiently and effectively.

In this regard the current study is an attempt to explore personality characteristics to gain an insight into this complex problem beyond the apparent symptoms. The Rorschach Inkblot test was used as a performance-based technique to investigate the underlying personality characteristics, which differentiate addicts from non-addicts.

The results indicated that addicts and non-addicts were significantly different on all Rorschach variables, which are highlighted in this study. The results further indicated important underlying personality aspects that could be considered pivotal in understanding their relation to addiction and their impact as personality predictors during the course of treatment. The addicts as a group presented with a cluster of characteristics, i.e. lack of motivation, poor self-concept, inability to concentrate, lack of intellectual control and clarity in associative processes, unresponsive conventional concept, low sociability, lack of spontaneity, difficulty in intellectual functioning, lack of attention, impulsivity without considering consequences, emotional instability, poor interpersonal relationships, a strong tendency for immediate gratification, lack of insight to their own motives, narrow range of interests, dependency, disturbed adjustment, and oppositional tendency.

In contrast the non-addicts as a group presented with a cluster of characteristics including a broad range of interests, accurate perception, good interpersonal relationships and good self esteem, spontaneity in intellectual functioning, ability to control immediate desires, concern for social values, independence, confidence interacting with people in the environment, adequate attention and concentration ability, and high sociability. Nevertheless, the non-addicts showed the presence of anxiety that could be linked to the testing situation and novelty of the investigation.

To conclude, significant aspects of personality were explored by the Rorschach Inkblot test for both groups and explicitly distinguished addicts from non-addicts. These distinctive personality characteristics of addicts appear to make clear the need for putting these critical elements into the formulation during treatment on a priority basis to minimize relapse rates and to prolong the maintenance period. It further suggests that a highly cognitive demand treatment strategy in the initial phase for addicts would be counterproductive. A client treatment program embedded in the operant conditioning model (Meyers andamp; Miller, 2001; Meyers andamp; Wolf, 2004) with emphasis on social, familial and recreational activities without the use of drugs is more advantageous than a programme which puts stress on the higher intellectual functions.

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