Psychology of Addictive Behaviors

© 2021 American Psychological Association 2023, Vol. 37, No. 2, 318–330

ISSN: 0893-164X https://doi.org/10.1037/adb0000793

Big Five Personality Traits and Illicit Drug Use:

Specificity in Trait–Drug Associations
Genevieve F. Dash1, Nicholas G. Martin2, and Wendy S. Slutske1
1
Department of Psychological Sciences, University of Missouri
2
Queensland Institute of Medical Research, Herston, Queensland 4029, Australia

Objective: High neuroticism, low agreeableness, and low conscientiousness are consistent correlates of
drug use, though such patterns may be due to common familial influences rather than effects of
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

personality per se. The present study aimed to explore associations of Big Five traits with various forms
This document is copyrighted by the American Psychological Association or one of its allied publishers.

of drug use independent of confounding familial influences by leveraging differences within twin pairs
to identify potentially causal (i.e., within-pair) effects of personality on use. Method: 980 same-sex twin
pairs from the Australian Twin Registry Cohort III (Mage = 31.70, 71% female) were interviewed
regarding lifetime (mis)use of cannabis, cocaine/crack, prescription and illicit stimulants, prescription
and illicit opioids, sedatives, hallucinogens, dissociatives, inhalants, and solvents, and completed a Big
Five inventory. Co-twin control analyses predicted the use of each drug from all traits simultaneously.
Results: Individual-level analyses generally showed the expected associations of neuroticism, agree-
ableness, and conscientiousness with drug use. Familial effects were also somewhat generalized: high
neuroticism, high openness to experience, and low agreeableness were associated with the use of several
drug types. More specificity emerged for within-pair effects. High neuroticism was associated with
prescription drug misuse; high extraversion was associated with cocaine/crack and stimulant use; high
openness to experience was associated with cannabis use; low agreeableness was associated with
cocaine/crack use and illicit opioid use; and no within-pair effects emerged for conscientiousness.
Conclusions: Trait associations common across drugs may be primarily attributable to familial effects.
There appears to be more drug-specific influence of personality on use with respect to potentially causal
within-pair effects.

Public Health Significance Statement

This study indicates that certain personality traits may causally confer risk for the use of specific illicit
drugs. Commonly identified associations of high neuroticism, low agreeableness, and low conscien-
tiousness with drug use in general may be attributable to familial influences, such as genes and rearing
environment, rather than personality per se. Such insight can inform more precise prediction of risk for
illicit drug use and targeted prevention efforts.

Keywords: illicit drug use, prescription misuse, personality, Big Five, twin study

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Personality traits have long been posited as a factor underlying Kroencke et al., 2021; Slutske et al., 2005; Sutin et al., 2013;
substance use and substance use disorder, with high neuroticism, Terracciano et al., 2008). Several explanations for this have been
low agreeableness, and low conscientiousness emerging as consis- posited. Individuals high in neuroticism are prone to negative affect
tent correlates across studies (Dash et al., 2019; Kotov et al., 2010; (Lahey, 2009), and using psychoactive drugs is one method of

This article was published Online First November 11, 2021. and writing of review and editing. Nicholas G. Martin played a lead
Genevieve F. Dash https://orcid.org/0000-0002-4394-0700 role in data curation and supporting role in writing of review and
Nicholas G. Martin https://orcid.org/0000-0003-4069-8020 editing. Wendy S. Slutske played a lead role in project administration,
Wendy S. Slutske https://orcid.org/0000-0003-4502-6936 resources, and supervision, supporting role in data curation and formal
The authors declare no conflict of interest. analysis, and an equal role in conceptualization and writing of review and
This work was supported by the National Institute on Drug Abuse editing.
F31DA054701 (PI: Genevieve F. Dash) and R01DA18267 (PI: Michael Correspondence concerning this article should be addressed to Genevieve F.
T. Lynskey). Dash, Department of Psychological Sciences, University of Missouri, 210
Genevieve F. Dash played a lead role in conceptualization, formal McAlester Hall, Columbia, MO 65211, United States. Email: genevievedash@
analysis, and writing of original draft and equal role in methodology mail.missouri.edu

318
 BIG FIVE TRAITS AND ILLICIT DRUG USE 319

relieving such experiences of subjective distress (Cooper, 1994; to experience are inclined toward seeking new experiences and
Simons et al., 1998). Individuals low in agreeableness tend to be engaging in introspection (McCrae, 1993; Simons et al., 1998), and
relatively less concerned with social approval and are more likely to expansion motives for use (i.e., expansion of perceptual and cogni-
engage in antisocial behaviors, which may manifest in the form of tive experience) have indeed been found to mediate the relationship
illicit drug use (Costa & McCrae, 1992; Sutin et al., 2013). In- between openness to experience and cannabis use (Hawkins, 2012).
dividuals low in conscientiousness often display higher levels of
impulsivity and lower levels of health-oriented behavior, and may Present Study
therefore be more likely to engage in potentially hazardous beha-
viors such as drug use (Raynor & Levine, 2009). There is also Although nontwin studies of personality correlates of drug use
evidence that personality domains and drug use have some degree of behaviors are informative, it is also important to address this topic
shared genetic etiology (Agrawal et al., 2004; Littlefield & Sher, within a design addressing potential genetic and familial confounds
2016; Slutske et al., 2002). This may function such that genes inherent in data from unrelated individuals. The present study
fostering liability to higher neuroticism, lower agreeableness, sought to examine specificity in personality trait–drug use associa-
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and/or lower conscientiousness are also those that increase risk tions by implementing a co-twin control design to explore potential
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for drug use, rather than reflecting a causal effect of the phenotypic quasi-causal effects of personality traits on different forms of drug
expression of certain traits on drug use behaviors. use, building on the relatively sparse extant behavior genetic
However, shared genetic influence cannot fully account for literature in this area (e.g., Agrawal et al., 2004) by including all
associations between personality traits and substance use, and these Big Five traits and wide spectrum of drugs. It was expected that (a)
explanations do not address findings demonstrating some degree of high neuroticism would be quasi-causally related to use of drugs that
specificity in trait–drug associations (Fehrman et al., 2017; Mahu mitigate physical and/or psychological distress (opioids, sedatives),
et al., 2019). Despite genetic overlap between personality and (b) high extraversion would be quasi-causally related to use of drugs
substance use, meaningful sources of potentially differential covari- commonly used in social and club settings [cocaine, amphetamine-
ance are left unaccounted for by shared genes: nonshared environ- based stimulants, inhalants (e.g., “whippits”)], and (c) high open-
mental influences (and error) account for approximately one-third to ness to experience would be quasi-causally related to use of drugs
one-half of the variation in both Big Five traits (Vernon et al., 2008) with psychedelic properties (cannabis, hallucinogens). Other prob-
and illicit drug use (Karkowski et al., 2000; Kendler et al., 2005, ing of personality–drug associations was exploratory.
2000); further, a substantial proportion of the covariance between
many trait–drug pairs is attributable to nonshared environmental Method
influence (Agrawal et al., 2004). Such sources of influence may be
responsible for deviations from more general patterns of trait–drug Participants and Procedure
association; that is, genetic liability for illicit drug use may operate Participants were 980 complete same-sex twin pairs of known
more generally across drug types (Jang et al., 1995; Kendler et al., zygosity [396 monozygotic (MZ) female; 169 MZ male; 299
2007), while nonshared environmental liability may be more varied dizygotic (DZ) female; 116 DZ male] from the Australian Twin
in its influence across drug classes. Registry Cohort III [Mage = 31.70 (SD = 2.48), range = 27–37
Associations between sensation seeking and stimulant use, hope- (one twin pair was age 40); 71% female]. It is not standard for
lessness and opioid use, and anxiety sensitivity and tranquilizer use Australian demographic surveys to query race and ethnicity; thus,
(Mahu et al., 2019) suggest that there is some level of meaningful only data on participant ancestry were available. A majority of the
specificity in the relationship between personality traits and use of sample (84%) reported U.K. ancestry (Britain, Scotland, Wales),
particular drugs. Individuals may – consciously or not – select to and less than 2% reported indigenous Australian ancestry. See
recreationally use drugs with subjective effects that complement Lynskey et al. (2012) for more information about participants.
their trait-level cognitive and emotional processes, such that differ- Informed consent was obtained from all participants prior to data
ences in the subjective effects of various drugs foster unique collection. Participants were surveyed by computer-assisted tele-
instrumental reasons for use that differentially appeal to individuals phone interview (CATI) in 2005–2009 (participation rate = 76%)
of varying personality profiles (Conrod et al., 2000). Consistent and a follow-up survey administered via the internet or a mailed
with findings that coping motives for substance use are associated paper-and-pencil questionnaire (completion rate = 94%). The orig-
with higher trait neuroticism (Chowdhury et al., 2016; Kuntsche inal data collection was approved by the Washington University and
et al., 2006), individuals with higher trait neuroticism may be more QIMR-Berghofer Institutional Review Boards, and secondary anal-
likely to use substances such as opioids and sedatives, which serve ysis was determined to be exempt by the University of Missouri
to mitigate both physical and psychological distress (Benotsch Institutional Review Board.
et al., 2013; Chinneck et al., 2018; Delić et al., 2017; Fehrman
et al., 2017; Mahu et al., 2019). The social facilitation aspect of
drugs such as ecstasy, which imbues feelings of social connected- Measures
ness, empathy, and intimacy, may create particular appeal to Demographics
individuals high in trait extraversion (Fehrman et al., 2017;
ter Bogt et al., 2006; Vreeker et al., 2020). The association of Participants were asked to report their biological sex, age, marital
psychedelic drug use (cannabis, hallucinogens) with trait openness status, and educational attainment. Participants were also queried
to experience (Dash et al., 2019; Erritzoe et al., 2019; LaFrance & regarding their family’s relative financial stability compared to the
Cuttler, 2017) may be explained by the novel perceptual experiences average family in the community (“better off,” “about average,” or
that these drugs tend to facilitate. Individuals high on trait openness “worse off”) from when they were ages 6–13.
 320 DASH, MARTIN, AND SLUTSKE

Big Five Personality Traits predictor (e.g., personality traits) so as to permit examination of the
relationship between that predictor and an outcome (e.g., drug use)
Big Five personality traits were assessed via self-report survey free of familial confounding. Differences between co-twins (i.e.,
within 2 weeks of the CATI interview using a 74-item version of the within-pair differences), who are by nature matched on familial
NEO Five-Factor Inventory (FFI), which has been used in several past factors, can be inferred to be a potentially causal, or “quasi-causal,”
studies (e.g., Dash et al., 2019, 2020; Schermer & Martin, 2019). The result of nonshared environmental variance in the predictor.
questionnaire was composed of the original 60 NEO-FFI items, as well Additionally, the degree of familial confounding present can be
as 14 items pulled from the remaining pool of NEO-PI-R items. These ascertained by comparing models composed of individuals of
items were selected on the basis that no more than two-thirds were varying degrees of relatedness. This process aids in determining
keyed in the same direction, that they were highly correlated with their which observed effects are attributable to familial factors rather than
NEO-PI-R factor scores, and that they adequately represented all scale reflecting a potential quasi-causal association between phenotypes:
facets; psychometric evaluation demonstrated that these items models composed of unrelated individuals do not control for
improved reliability and factor structure while retaining validity familial confounding, models composed of DZ twin pairs partially
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(McCrae & Costa, 2004). Items were scored on a 1 (strongly disagree) control for familial confounding, and models composed of only MZ
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to 5 (strongly agree) scale. Scores were generated by computing twin pairs completely control for familial confounding (McGue
the item means for each scale. Reliabilities were acceptable for et al., 2010). Thus, if the magnitude of effect across samples
neuroticism, extraversion, openness to experience, agreeableness, composed of unrelated individuals, DZ twin pairs, and MZ twin
and conscientiousness (α = .89, .84, .77, .82, and .85, respectively). pairs is equivalent, one can infer that there is no familial confounding.
Conversely, if the magnitude of the effect is reduced as the genetic
Drug Use relatedness of the subjects increases to the point of elimination of the
effect among MZ pairs, one can conclude that there is complete
Participants were provided with a respondent booklet containing
familial confounding. If the magnitude of the effect is reduced as the
nine lists of drugs, with each list corresponding to a class of drug
genetic relatedness of the subjects increases, but the effect is not
[cannabis, cocaine/crack, amphetamine-based stimulants, opioids,
eliminated among MZ pairs, there is some level of familial con-
sedatives (prescription benzodiazepines), hallucinogens, dissociatives,
founding in addition to a potential effect of the exposure. When
inhalants, and solvents]. Each list contained a comprehensive collec-
modeled statistically, several other potentially explanatory predictors
tion of drugs described by name and by common slang terms, where
(e.g., biological sex, age, marital status, educational attainment, and
relevant; the stimulant and opioid classes contained both illicit drugs
socioeconomic status) are also included in the model to more
and prescription drugs with potential for misuse. Participants were
stringently test the quasi-causal effect. A within-pair effect that
asked “Have you ever used any of the items in List [1–9]?” Participants
significantly predicts the outcome of interest even after accounting
who endorsed use were asked “How many times in your life have you
for the effects of covariates provides further confidence in the
used anything from List [1–9]?” with the lists queried corresponding to
potentially causal relationship between the predictor and outcome.
those endorsed by the respondent in the previous question. Respon-
Statistical Power in the Co-Twin Control Design. Though
dents were also asked which specific drug(s) on the list they had used,
information on power to detect effects in the co-twin control design
or, for lists containing prescription drugs, “used when not prescribed or
is limited, simulations suggest that (a) a sample size of approxi-
more than prescribed” (i.e., misuse). As the number of lifetime uses
mately 1,000 twin pairs is adequate to detect small effects
was queried as a sum total across all substances within a list, only
(d = 0.10–0.15), (b) a higher MZ:DZ sample size ratio increases
dichotomous (yes/no) indicators were available for drug subtypes
power, and (c) a higher proportion of variance attributable to
(i.e., prescription and illicit opioids and stimulants).
nonshared environmental influences in both predictor and outcome
variables increases power (de Moor et al., 2011). The present
Analytic Plan sample size of 980 pairs approximately meets the recommended
threshold; the MZ:DZ ratio was >1:1 (1.36:1), and nonshared
The Co-Twin Control Design
environmental variance was significant for all personality and
The co-twin control design leverages similarities between twins drug use variables (up to 96% of the phenotypic variance). Though
to create an ex post facto analog to the gold-standard counterfactual not specific to twin data, power calculations for a 1:1 matched case–
experimental design, making it particularly useful for strengthening control design showed that the combined zygosity sample size was
causal inference in observational data (McGue et al., 2010). Under sufficient to detect an odds ratio of 1.40 or higher and that the MZ
the classical twin model, MZ co-twins fully share their segregating sample size was sufficient to detect an odds ratio of 1.55 or higher
genes (rg = 1.00), and DZ co-twins share, on average, 50% of their with 90% power (http://sampsize.sourceforge.net/iface/s3.html#cc;
segregating genes (rg = .50); co-twins of both zygosities share a Vreeker et al., 2020).
common environment (i.e., factors which make twins more similar;
rc = 1.00); and nonshared environments (i.e., factors which make Statistical Analyses
twins more different plus error) are assumed to be unique to
individual co-twins across both zygosities (re = .00). Because Analyses were conducted using SAS version 9.4 (SAS, Inc,
MZ co-twins are assumed to be perfectly matched for both genes 2014). To examine associations between Big Five traits and drug
and common environment, differences between them can be use while accommodating the clustered nature of the data (i.e., twins
inferred to be the result of nonshared environmental influences. nested within pairs), two-level random intercept generalized linear
Put simply, the co-twin control model partitions familial (genes, mixed models were run using PROC GLIMMIX. Personality predic-
shared environment) and nonshared environmental variance of a tor variables were coded to test within-pair effects (i.e., comparison of
 BIG FIVE TRAITS AND ILLICIT DRUG USE 321

twin and co-twin’s trait score deviations from their pair average) and a standard deviation among MZ twins and approximately one-half to
between-pair effects (i.e., comparison of twin pair trait score averages two-thirds of a standard deviation among DZ twins. The largest
across twin pairs; Slutske et al., 2014). The former provides insight within-pair differences emerged for neuroticism, followed by extra-
into the association between the predictor and outcome free of familial version and conscientiousness.
confounding, including any quasi-causal effects, and the latter pro- Average number of lifetime uses of each drug and the prevalence
vides insight into the aggregate influence of familial factors (genes, of lifetime use of each drug among MZ and DZ twins are presented
shared environment). A negative binomial distribution with a log link in Table 2. Cannabis was the most commonly and most frequently
function was used to model count variables (number of lifetime uses used drug, followed by stimulants, opioids, and hallucinogens.
of cannabis, cocaine/crack, any stimulant, any opioid, sedatives, Correlations between study variables and rates of discordance for
hallucinogens, dissociatives, inhalants, and solvents), which were use of each drug are available in Tables S1 and S2 of the Supple-
positively skewed and overdispersed. A binary distribution with a mental Materials, respectively.
logit link function was used to model dichotomous variables (any
lifetime [mis]use of prescription and illicit opioids and stimulants).
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Multilevel Models
Coefficients were exponentiated to produce incidence rate ratios
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(IRRs) for negative binomial models and odds ratios (ORs) for binary Although the model fitting was conducted by drug, the presenta-
models. tion of results is collapsed across personality trait and further
A series of three models were fit for each drug. As variance organized by model type. A summary of results from individual-
inflation factors (VIFs) indicated minimal multicollinearity between level effects is presented in Table 3, a summary of within-pair
traits (all VIFs ≤ 1.53), all Big Five traits were included simulta- effects is presented in Table 4, and a summary of between-pair
neously in each model so as to estimate the effect of each trait after effects is presented in Table 5. Models predicting the use of
accounting for the effects of all other traits. This approach was dissociatives and solvents did not converge and were thus omitted
preferred to modeling each trait independently, as it more clearly from the presentation of results below.
addresses the question of specificity in associations between traits
and drug use by predicting drug use from variance unique to each Neuroticism
trait (supplemental models in which traits were modeled indepen-
dently were also fit). At the first step, models were run at the In the individual-level model, high neuroticism was associated
individual level (“individual-level models”). These models ac- with number of lifetime uses of cannabis (IRR = 1.35) and seda-
counted for the clustering of twin pair data so as to approximate tives (IRR = 2.99), as well as any lifetime misuse of prescription
data from unrelated individuals. Effects with p > .05 at the individ- stimulants (OR = 2.72) and prescription opioids (OR = 1.48); the
ual level were not carried forward. At the second step, co-twin association with number of lifetime uses of any opioid (IRR = 1.71)
control models were fit in the combined sample of MZ and DZ pairs was nonsignificant after FDR correction. Though the magnitude of
(“MZ-DZ models”) to examine within-pair and between-pair effects effect for any lifetime illicit opioid use was large (OR = 5.32), the
of Big Five traits on drug use while partially controlling for genes imprecision of the estimate impeded meaningful interpretation, 95%
and common environment; we opted to use both MZ and DZ pairs at CI [ 0.40–74.14]. In the MZ-DZ model, within-pair effects of high
this step so as to optimize power while partially controlling for neuroticism emerged for number of lifetime uses of cannabis
familial confounding. At the third step, co-twin control models (IRR = 1.38) and sedatives (IRR = 3.88); the association with
including only MZ pairs were fit (“MZ-only models”) so as to fully any lifetime prescription stimulant misuse (OR = 3.16) was non-
control for familial confounding. Sex, age, marital status, educa- significant after FDR correction (Figure 1a). Within-pair effects for
tional attainment, and childhood socioeconomic status were number of lifetime uses of any opioid (IRR = 1.71) and any lifetime
included as covariates in all models; zygosity was also included prescription opioid misuse (OR = 1.34) were nonsignificant along-
as a covariate in individual-level and MZ-DZ models. side comparably robust between-pair effects (IRR = 2.08 and
False discovery rate (FDR) adjustment was calculated using the OR = 1.70, respectively). In the MZ-only model, the magnitude
Benjamini–Hochberg procedure (Benjamini & Hochberg, 1995), of the within-pair effect of neuroticism on number of lifetime uses of
under which an effect is considered statistically significant if cannabis was reduced by 20% (IRR = 1.11, ns), indicating some
p < (i/m)Q, where i is the p value rank across all tests (ordered degree of familial confounding. Interestingly, the within-pair effect
from smallest to largest), m is the total number of tests, and Q is the sizes for number of lifetime uses of sedatives (IRR = 4.60), and any
selected FDR. The FDR was set to .05, resulting in a corrected lifetime prescription stimulant (OR = 6.83) and prescription opioid
significance threshold of p < .02. Analyses were not preregistered. misuse (OR = 1.65; ns after FDR correction) were increased in the
All analyses that were conducted for this study are described here, MZ-only model (Figure 1a), though this change in magnitude is
with the exception of models conducted for the original submission difficult to interpret beyond recognition of a potential suppression
that were not retained in the manuscript revision (output for these effect in the MZ-DZ model. Between-pair effects of neuroticism
analyses is available upon request to the first author). again emerged in notable magnitude for number of lifetime uses of
any opioid (IRR = 2.15; ns after FDR correction) and any lifetime
prescription opioid misuse (OR = 1.90).
Results
Sample Characteristics Extraversion
Descriptive statistics for the Big Five traits are presented in In the individual-level model, high extraversion was quite robustly
Table 1. Within-pair differences were approximately one-half of associated with number of lifetime uses of cocaine/crack (IRR = 2.52),
 322 DASH, MARTIN, AND SLUTSKE

Table 1
Twin Pair Averages and Average Magnitudes of Discordance for Big Five Personality Traits

Full sample average Twin pair average Within-pair differencea

N = 1,960 MZ (n = 1,130) DZ (n = 830) MZ (n = 1,130) DZ (n = 830)
Trait M (SD) M (SD) M (SD) M (SD) M (SD)

Neuroticism 2.59 (0.74) 2.52 (0.68) 2.49 (0.68) 0.34 (0.30) 0.40 (0.34)
Extraversion 3.54 (0.53) 3.44 (0.59) 3.40 (0.63) 0.27 (0.33) 0.32 (0.38)
Openness to experience 3.29 (0.47) 3.20 (0.56) 3.16 (0.62) 0.22 (0.29) 0.27 (0.32)
Agreeableness 3.79 (0.47) 3.69 (0.60) 3.62 (0.63) 0.24 (0.32) 0.30 (0.38)
Conscientiousness 3.87 (0.54) 3.77 (0.64) 3.70 (0.69) 0.27 (0.35) 0.33 (0.38)
Note. MZ = monozygotic; DZ = dizygotic.
a
Corresponds to the absolute value of the difference between a co-twin’s score and their pair average (raw differences were used for primary analyses).
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any lifetime prescription stimulant misuse (OR = 2.68), and, to a (IRRs = 2.41–4.59; ORs = 3.95–6.32), with the exception of any
lesser degree, number of lifetime uses of any stimulant (IRR = 1.65; lifetime prescription opioid misuse (OR = 1.25, ns). The effect for
ns after FDR correction). In the MZ-DZ model, within-pair effects any lifetime illicit opioid use was nonsignificant, though the large
for number of lifetime uses of cocaine/crack (IRR = 2.26) and any magnitude of effect and imprecise estimate, OR = 11.65 95% CI
stimulant (IRR = 2.22) were robust; the magnitude of effect for any [0.71–192.06], suggest that this may be due to low power. In the
lifetime prescription stimulant misuse was notable (OR = MZ-DZ model, within-pair effects only emerged for number of
2.40), but imprecise and nonsignificant (Figure 1b). Between-pair lifetime uses of cannabis (IRR = 1.84) and cocaine/crack (IRR =
effects were nonnegligible (IRRs = 1.28–2.26; OR = 1.25), though 2.23; Figure 1c). Such a pattern, coupled with strong between-pair
all were nonsignificant. In the MZ-only model, within-pair effects effects of openness to experience for all drugs (IRRs = 4.05–6.76;
for number of lifetime uses of cocaine/crack and number of lifetime ORs = 9.07–20.06), suggests that familial effects were responsible
uses of any stimulant were reduced by 30%–45% (IRRs = 1.58 and for most of the associations identified in individual-level models. In
1.22, respectively) and nonsignificant, suggesting the presence of the MZ-only model, within-pair effects emerged only for number of
familial confounding. Though the magnitude of effect for any lifetime lifetime uses of cannabis (IRR = 1.97); however, the retained
prescription stimulant misuse increased by 51% in the MZ-only model magnitude of the within-pair effect for number of lifetime uses
(OR = 3.62), the imprecision of the estimate, 95% CI [0.83–15.83], of cocaine/crack (IRR = 2.41) suggests that the lack of significance
impeded meaningful interpretation of this effect (Figure 1b). Again, may be due to low power rather than familial confounding (Figure 1c).
between-pair effects were nonnegligible (IRRs = 1.17–2.26; Between-pair effects of openness to experience emerged for number
OR = 1.36), but all nonsignificant. of lifetime uses of cannabis, cocaine/crack, any stimulant, any
opioid, and sedatives (IRRs = 4.56–16.59), as well as any lifetime
Openness to Experience
illicit stimulant use (OR = 13.16); the effect for any lifetime
In the individual-level model, high openness to experience prescription stimulant misuse was large (OR = 7.02), but imprecise
showed large magnitudes of effect for all forms of drug use and nonsignificant after FDR correction.

Table 2
Average Number of Lifetime Uses and Prevalence of Use of Each Drug Type

Drug use phenotype MZ (n = 1,130) DZ (n = 830)

Number of lifetime uses M (SD) % Any lifetime use M (SD) % Any lifetime use
Cannabis 73.29 (228.19) 64.0 92.06 (250.90) 67.8
Cocaine/crack 2.38 (31.02) 14.1 2.71 (16.42) 15.8
Any stimulant 18.16 (100.49) 28.5 11.84 (66.47) 29.8
Any opioid 5.33 (60.46) 14.5 8.06 (78.45) 14.2
Sedatives 3.23 (44.37) 9.9 2.45 (36.08) 8.9
Hallucinogens 2.08 (18.09) 12.3 3.72 (41.23) 17.6
Dissociatives 0.12 (1.69) 2.7 1.75 (35.81) 3.3
Solvents 0.09 (1.04) 2.0 0.29 (4.20) 1.6
Inhalants 1.98 (30.96) 9.8 0.87 (6.94) 9.2
Any lifetime (mis)use
Prescription stimulants — 21.4 — 21.8
Illicit stimulants — 23.3 — 25.1
Prescription opioids — 14.1 — 13.1
Illicit opioids — 2.4 — 3.5
Note. MZ = monozygotic; DZ = dizygotic.
 BIG FIVE TRAITS AND ILLICIT DRUG USE 323

Table 3
Summary of Aggregate Effects From Individual-Level Models

Big Five personality trait

Drug use phenotype Neuroticism Extraversion Openness Agreeableness Conscientiousness
Number of lifetime uses IRR [95% CI] IRR [95% CI] IRR [95% CI] IRR [95% CI] IRR [95% CI]

Cannabis 1.35 [1.08––1.70] 1.31 [0.98–1.75] 3.20 [2.35–4.37] 0.62 [0.45–0.84] 0.67 [0.51–0.88]
Cocaine/crack 1.45 [0.92–2.26] 2.52 [1.44–4.39] 2.84 [1.55–5.20] 0.24 [0.13–0.42] 0.71 [0.42–1.21]
Any stimulant 1.21 [0.83–1.74] 1.65 [1.06–2.56] 4.59 [2.87–7.35] 0.33 [0.20–0.54] 0.53 [0.35–0.80]
Any opioid 1.71 [1.04–2.80] 0.82 [0.44–1.54] 2.86 [1.52–5.40] 0.28 [0.15–0.54] 0.74 [0.41–1.32]
Sedatives 2.99 [1.66–5.38] 1.65 [0.80–3.41] 2.41 [1.14–5.09] 0.37 [0.18–0.77] 0.65 [0.34–1.25]
Hallucinogens 1.44 [0.93–2.22] 0.93 [0.55–1.56] 2.54 [1.39–4.66] 0.62 [0.35–1.09] 1.26 [0.76–2.11]
Inhalants 1.61 [0.96–2.70] 1.14 [0.60–2.19] 3.36 [1.61–6.98] 0.64 [0.31–1.31] 1.38 [0.74–2.55]
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

Any lifetime (mis)use OR [95% CI] OR [95% CI] OR [95% CI] OR [95% CI] OR [95% CI]
This document is copyrighted by the American Psychological Association or one of its allied publishers.

Prescription stimulants 2.72 [1.51–4.91] 2.68 [1.31–5.45] 6.32 [2.97–13.45] 0.34 [0.17–0.71] 0.65 [0.34–1.23]
Illicit stimulants 1.33 [0.91–1.96] 1.53 [0.96–2.45] 3.95 [2.32–6.69] 0.58 [0.35–0.95] 0.58 [0.38–0.90]
Prescription opioids 1.48 [1.11–1.98] 1.07 [0.74–1.55] 1.25 [0.85–1.83] 0.56 [0.38–0.83] 0.85 [0.60–1.20]
Illicit opioids 5.42 [0.40–74.14] 1.62 [0.12–22.05] 11.65 [0.71–192.06] 0.00 [0.00–0.09] 13.48 [0.86–211.69]
Note. IRR = incidence rate ratio; OR = odds ratio; CI = confidence interval; bold type indicates significance at FDR-adjusted p value threshold.

Agreeableness (OR = 0.58). In the MZ-DZ model, strong within-pair effects of

low agreeableness emerged for number of lifetime uses of cocaine/
In the individual-level model, low agreeableness was strongly crack (IRR = 0.21), any stimulant (IRR = 0.19), and sedatives
associated with the use of most drugs (IRRs = 0.24–0.62; (IRR = 0.30), as well as any lifetime use of illicit opioids
ORs = 0.00–0.56), except number of lifetime uses of hallucinogens (OR = 0.00); the effect for any lifetime misuse of prescription
and inhalants (IRRs = 0.62–0.64); the association with any lifetime opioids (OR = 0.62) was nonsignificant after FDR correction
illicit stimulant use was nonsignificant after FDR correction (Figure 1d). Strong between-pair effects of low agreeableness

Table 4
Summary of Within-Pair Effects From Co-Twin Control Models

Big Five personality trait

Drug use phenotype Neuroticism Extraversion Openness Agreeableness Conscientiousness
Number of lifetime uses Model IRR [95% CI] IRR [95% CI] IRR [95% CI] IRR [95% CI] IRR [95% CI]

Cannabis MZDZ 1.38 [1.07–1.78] — 1.84 [1.24–2.72] 0.92 [0.64–1.33] 0.76 [0.55–1.05]
MZ 1.11 [0.81–1.50] — 1.97 [1.22–3.19] 0.86 [0.55–1.34] 0.71 [0.48–1.05]
Cocaine/crack MZDZ — 2.26 [1.25–4.10] 2.23 [1.13–4.44] 0.21 [0.11–0.39] —
MZ — 1.58 [0.66–3.74] 2.41 [0.96–6.04] 0.33 [0.13–0.83] —
Any stimulant MZDZ — 2.22 [1.20–4.10] 2.01 [1.01–3.99] 0.19 [0.10–0.37] 0.90 [0.51–1.58]
MZ — 1.22 [0.69–2.14] 1.79 [0.94–3.42] 0.71 [0.38–1.33] 0.59 [0.35–1.01]
Any opioid MZDZ 1.71 [0.90–3.26] — 1.01 [0.37–2.77] 0.46 [0.19–1.09] —
MZ 2.07 [0.87–4.89] — 0.44 [0.13–1.49] 0.66 [0.19–2.26] —
Sedatives MZDZ 3.88 [2.06–7.31] — 2.00 [0.81–4.91] 0.30 [0.13–0.71] —
MZ 4.60 [2.01–10.54] — 1.19 [0.41–3.51] 0.42 [0.14–1.25] —
Hallucinogens MZDZ — — 1.68 [0.87–3.24] — —
MZ — — 1.21 [0.46–3.19] — —
Inhalants MZDZ — — 2.16 [0.95–4.89] — —
MZ — — 0.79 [0.28–2.21] — —
Any lifetime (mis)use Model OR [95% CI] OR [95% CI] OR [95% CI] OR [95% CI] OR [95% CI]
Prescription stimulants MZDZ 3.16 [1.10–9.06] 2.40 [0.89–6.47] 2.09 [0.72–6.07] 0.43 [0.16–1.15] —
MZ 6.83 [2.24–20.78] 3.62 [0.83–15.83] 3.66 [0.61–12.83] 0.19 [0.04–0.99] —
Illicit stimulants MZDZ — — 1.59 [0.84–3.03] 0.79 [0.44–1.42] 0.81 [0.49–1.34]
MZ — — 2.95 [0.75–11.65] 0.82 [0.25–2.66] 0.36 [0.13–1.02]
Prescription opioids MZDZ 1.34 [0.95–1.89] — — 0.62 [0.39–0.97] —
MZ 1.65 [1.02–2.66] — — 0.76 [0.40–1.45] —
Illicit opioids MZDZ — — — 0.00 [0.00–0.02] —
MZ — — — 0.00 [0.00–0.65] —
Note. IRR = incidence rate ratio; OR = odds ratio; CI = confidence interval; MZDZ = model with MZ and DZ twins; MZ = model with MZ twins only;
bold type indicates significance at FDR-adjusted p value threshold; dash (—) indicates that association was not carried forward to co-twin control models.
 324 DASH, MARTIN, AND SLUTSKE

Table 5
Summary of Between-Pair Effects From Co-Twin Control Models

Big Five personality trait

Drug use phenotype Neuroticism Extraversion Openness Agreeableness Conscientiousness
Number of lifetime uses Model IRR [95% CI] IRR [95% CI] IRR [95% CI] IRR [95% CI] IRR [95% CI]

Cannabis MZDZ 0.99 [0.73–1.34] — 6.76 [4.41–10.35] 0.32 [0.20–0.50] 0.63 [0.42–0.94]
MZ 1.00 [0.67–1.50] — 6.91 [3.90–12.23] 0.40 [0.22–0.75] 0.39 [0.23–0.65]
Cocaine/crack MZDZ — 1.28 [0.55–3.01] 5.72 [2.25–14.52] 0.18 [0.07–0.48] —
MZ — 1.17 [0.37–3.69] 5.06 [1.34–19.09] 0.31 [0.08–1.16] —
Any stimulant MZDZ — 2.26 [0.89–5.68] 6.14 [2.43–15.50] 0.27 [0.10–0.74] 0.26 [0.11–0.62]
MZ — 2.26 [0.84–6.07] 16.59 [6.14–44.81] 0.24 [0.08–0.74] 0.20 [0.07–0.53]
Any opioid MZDZ 2.08 [1.23–3.53] — 4.34 [2.09–9.04] 0.18 [0.08–0.39] —
— —
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MZ 2.15 [1.12–4.12] 4.56 [1.79–11.60] 0.25 [0.09–0.64]

— —
This document is copyrighted by the American Psychological Association or one of its allied publishers.

Sedatives MZDZ 1.93 [0.91–4.10] 4.05 [1.34–12.23] 0.53 [0.18–1.56]

MZ 1.96 [0.74–5.23] — 3.66 [0.88–15.24] 0.51 [0.13–2.00] —
Hallucinogens MZDZ — — 4.19 [1.87–9.37] — —
MZ — — 2.36 [0.69–8.09] — —
Inhalants MZDZ — — 6.38 [2.27–17.90] — —
MZ — — 4.05 [0.96–17.01] — —
Any lifetime (mis)use Model OR [95% CI] OR [95% CI] OR [95% CI] OR [95% CI] OR [95% CI]
Prescription stimulants MZDZ 1.14 [0.57–2.29] 1.25 [0.49–3.14] 20.06 [5.46–73.64] 0.22 [0.08–0.59] —
MZ 1.59 [0.42–6.06] 1.36 [0.25–7.36] 7.02 [1.06–46.27] 0.35 [0.06–2.28] —
Illicit stimulants MZDZ — — 9.07 [4.40–18.70] 0.39 [0.20–0.78] 0.45 [0.25–0.81]
MZ — — 13.16 [2.35–73.79] 0.31 [0.06–1.62] 0.29 [0.07–1.23]
Prescription opioids MZDZ 1.70 [1.24–2.31] — — 0.52 [0.34–0.81] —
MZ 1.90 [1.25–2.89] — — 0.78 [0.44–1.38] —
Illicit opioids MZDZ — — — 0.38 [0.01–11.67] —
MZ — — — 0.19 [0.00–16.18] —
Note. IRR = incidence rate ratio; OR = odds ratio; CI = confidence interval; MZDZ = model with MZ and DZ twins; MZ = model with MZ twins only;
bold type indicates significance at FDR-adjusted p value threshold; dash (—) indicates that association was not carried forward to co-twin control models.

also emerged for number of lifetime uses of cannabis, cocaine/crack, lifetime uses of cannabis (IRR = 0.39) and any stimulant (IRR =
any stimulant, and any opioid (IRRs = 0.18–0.32), as well as any 0.20) were of notable magnitude (Figure 1e). The between-pair
lifetime (mis)use of prescription stimulants, illicit stimulants, and effect for any lifetime illicit stimulant use was stronger in the MZ-
prescription opioids (ORs = 0.22–0.52). In the MZ-only model, only model (OR = 0.29), though it was nonsignificant; this may be
within-pair effects for low agreeableness emerged only for number due to diminished power in the MZ-only model.
of lifetime uses of cocaine/crack (IRR = 0.33); effects for any
lifetime (mis)use of prescription stimulants (OR = 0.19), and illicit Supplemental Models
opioids (OR = 0.00) were notable, but nonsignificant after FDR
correction (Figure 1d). Magnitudes of effect for number of lifetime In addition to predicting drug use from all Big Five traits
uses of any stimulant, number of lifetime uses of sedatives, and any simultaneously, bivariate models were fit in which trait domains
lifetime prescription opioid misuse were reduced by 273%, 40%, were tested individually. Results of these analyses are available in
and 23%, respectively, indicating the presence of familial confound- Tables S3–S5 of the Supplemental Materials. When modeled
ing. Between-pair effects of agreeableness emerged for number of independently, there appeared to be more within-pair effects of
lifetime uses of cannabis (IRR = 0.40), any stimulant (IRR = personality on drug use, with less specificity in association across
0.24), and any opioid (IRR = 0.25). trait–drug pairs. This is likely attributable to overlapping variance
across trait domains that is not accounted for when traits are modeled
Conscientiousness independently. Though VIFs indicated minimal multicollinearity in
the simultaneous models, moderate correlations between some traits
In the individual-level model, low conscientiousness was associ- (up to r = −.50; see Table S1 in the Supplemental Materials)
ated with number of lifetime uses of cannabis (IRR = 0.67) and any suggest that there is some degree of overlap. As a result, the
stimulant (IRR = 0.53), as well as any lifetime illicit stimulant use independent models effectively “double dipped” personality vari-
(OR = 0.58). In the MZ-DZ model, no within-pair effects emerged, ance, which appears to have resulted in inflated estimates of trait–
suggesting that the associations identified in the individual-level drug associations.
models could possibly be attributed to familial effects (Figure 1e).
Consistent with this, between-pair effects of low conscientiousness
Discussion
emerged for number of lifetime uses of any stimulant (IRR = 0.26),
as well as any lifetime illicit stimulant use (OR = 0.45). A similar The present study sought to identify specificity in patterns of Big
pattern of effect was observed in the MZ-only model, wherein no Five trait–illicit drug use associations within a co-twin control
within-pair effects emerged but between-pair effects for number of framework. By taking such an approach, it was possible to examine
 BIG FIVE TRAITS AND ILLICIT DRUG USE 325

Figure 1
Incidence Rate Ratios (IRRs) and Odds Ratios (ORs) for Within-Pair Effects of Big
Five Personality Traits
(a) Neuroticism MZ-DZ MZ-Only

Cannabis

Any Opioids

Sedatives
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Prescription Stimulants†
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Prescription Opioids†

0 1 2 3 4 5 6 7 8
IRR/OR

(b) Extraversion MZ-DZ MZ-Only

Cocaine/Crack

Any Stimulants

Prescription Stimulants†

0 1 2 3 4 5 6 7 8
IRR/OR

(c) Openness MZ-DZ MZ-Only

Cannabis

Cocaine/Crack

Any Stimulants

Any Opioids

Sedatives

Hallucinogens

Inhalants

Prescription Stimulants†

Illicit Stimulants†

0 1 2 3 4 5 6 7 8
IRR/OR
 326 DASH, MARTIN, AND SLUTSKE

Figure 1 (continued)

(d) Agreeableness MZ-DZ MZ-Only

Cannabis

Cocaine/Crack

Any Stimulants

Any Opioids

Sedatives

Prescription Stimulants†
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Illicit Stimulants†
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Prescription Opioids†

Illicit Opioids†

0 0.2 0.4 0.6 0.8 1 1.2 1.4 1.6 1.8 2

IRR/OR

(e) Conscientiousness MZ-DZ MZ-Only

Cannabis

Any Stimulants

Illicit Stimulants†

0 0.2 0.4 0.6 0.8 1 1.2 1.4 1.6 1.8 2

IRR/OR

Note. Black marker denotes significance at FDR-adjusted p-value threshold; † indicates binary outcome
(any lifetime use) with effect presented as an OR; depiction of CIs is truncated where upper limit > 8 (a,
b, c) or > 2 (d, e); please note shifting x-axes.

the relationships between personality traits and use of specific drugs prescription drugs with potential for misuse (e.g., sedatives for
while controlling for potential familial confounding. Hypotheses anxiety disorders, stimulants for attention deficit hyperactivity
were partially supported. Within-pair effects of high neuroticism disorder). It is not uncommon for prescription misuse to occur in
were associated with sedative use; unexpectedly, strong within-pair the form of taking one’s own prescription in a manner not prescribed
effects of neuroticism also emerged for prescription stimulant (e.g., higher dose, higher frequency, via alternate route of adminis-
misuse. Negative affect encompasses many facets of anxiety, which tration; McLarnon et al., 2011; Votaw et al., 2019), making this a
may at least partially explain the relationship between neuroticism feasible explanation for this pattern of association. Though we
and sedative (benzodiazepine) use (Conrod et al., 2000; Vorspan expected to identify within-pair effects of neuroticism on prescrip-
et al., 2015). Past research has identified associations between high tion opioid misuse, the association was nonsignificant after FDR
neuroticism and prescription stimulant misuse for the purpose of correction. However, familial effects were identified. High neuroti-
cognitive enhancement (Sattler & Schunck, 2016), suggesting that cism is associated with pain experience; these phenotypes are both
one explanation for the present results may be that manifestations of moderately heritable and share genetic influences (rg = 0.18–0.70;
neuroticism such as liability to stress and low-self efficacy (Judge Meng et al., 2020; Nielsen et al., 2012). These overlapping genetic
et al., 2002) potentiate this method of achieving performance- influences may partially explain the relationship between neuroti-
dependent goals. Of relevance, individuals high in trait neuroticism cism and prescription opioid misuse, given the increased risk of
utilize mental health care services at higher rates (ten Have et al., prescription opioid misuse among adults with a history of persistent
2005) and may therefore be more likely to have access to or chronic pain (Groenewald et al., 2019; Smit et al., 2020; Sutin
 BIG FIVE TRAITS AND ILLICIT DRUG USE 327

et al., 2019). Hypotheses regarding extraversion were also partially emerges when instead predicting drug use from variance uniquely
supported: cocaine/crack and stimulant use were associated with captured by each trait domain. Future research may consider
within-pair effects of extraversion, consistent with their status as addressing this issue using multivariate outcome models that can
club drugs typically used in social environments. However, the also account for overlapping variance between correlated drug use
magnitude of these effects was reduced in the MZ-only model, outcomes, so as to even more clearly target specificity in trait–drug
suggesting that these associations may be attributable to familial associations.
confounding. While openness to experience did not emerge with
unconfounded associations with hallucinogen use as was hypothe-
Limitations
sized, quasi-causal effects did emerge for cannabis use. Such a
pattern indicates that characteristics such as curiosity and introspec- Several limitations should be noted. First, it is unclear how
tion play a direct role in cannabis use. findings from this Australian sample will generalize to other
Though agreeableness and conscientiousness are commonly populations. Drug culture can vary across social groups, cultures,
identified as traits negatively associated with substance use and countries, which may impact who is drawn toward the use of
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

(Sutin et al., 2013), their seemingly protective role in this process particular drugs and why. This sample was also quite homogenous
This document is copyrighted by the American Psychological Association or one of its allied publishers.

appeared to be largely attributable to familial factors. Agreeableness with respect to ancestry, information on racial and ethnic identity
was negatively associated with number of lifetime uses of cannabis, was not collected, and gender identity was not queried. It is thus
cocaine/crack, any stimulant, any opioid, and sedatives, as well as unclear how such identities may or may not influence the findings
any lifetime (mis)use of prescription stimulants, prescription presented here, and how these findings may generalize to other
opioids, and illicit opioids in individual-level models, but within- groups. Additionally, only dichotomized indexes of prescription
pair effects only emerged for cocaine/crack, prescription stimulant and illicit stimulant and opioid (mis)use were available, limiting a
misuse, and illicit opioid use. Surprisingly, low conscientiousness more nuanced exploration of these behaviors. Relatedly, rates of
was only associated with cannabis, any stimulant, and illicit dissociative and solvent use were too low to examine within
stimulant use in individual-level models. Though the substantive multilevel models. The uncertainty of several of the models,
between-pair effects in the co-twin control models are consistent evinced by the wide confidence intervals associated with several
with the notion that commonly identified conscientiousness–drug of the presented effects, should also be noted. This issue was
use associations are attributable to familial influences rather than particularly salient in the MZ-only models, where the restricted
causal effects of personality, it is unclear why conscientiousness was sample size diminished power to estimate effects with precision.
only associated with cannabis and stimulant (mis)use in the present Coupled with relatively low rates of use for some drugs, this created
sample. This may reflect an idiosyncrasy of the sample, methodo- challenges in gauging the true size of some associations. That is,
logical issues (e.g., power), and/or some other factor(s). despite significant associations for some trait–drug pairs, wide
The differences across simultaneously and independently esti- confidence intervals limit inference into their likely magnitude.
mated models were unexpected. Applying both methods to model- Replication of these effects is needed. Finally, the personality
ing the Big Five predictors was useful insofar as this approach assessment and drug use events were not temporally aligned.
speaks to both the specificity in trait–drug associations as concep- Thus, directional inferences must be made with caution and with
tualized as unique trait variance predicting use of a specific drug and the stipulation that the personality profiles used to predict drug use
to the broader associations of complete trait variance with illicit drug were not reported prior to the use event itself. While there is
use. This may also provide insight into how models of personality evidence that personality traits remain relatively stable over
and their assessment can introduce noise into studies of associations time, such that fluctuations that may occur beyond childhood are
between trait domains and phenotypic outcomes. While the Big Five of minimal practical significance (Ferguson, 2010; Roberts &
trait domains are theoretically orthogonal, this has been repeatedly DelVecchio, 2000; Roberts et al., 2006), and limited evidence of
demonstrated to not be the case in real-world single-respondent Big personality change following drug use (Kroencke et al., 2021), the
Five data (Franić et al., 2014); this is, at least in part, attributable to temporal ordering of the drug use behavior and the personality
respondent bias and/or common methods variance, which cannot assessment must be considered. Despite these limitations, the
be parsed without taking an often infeasibly resource-intensive present study provides novel evidence regarding the nature of
multitrait-multimethod approach (Biderman et al., 2011; Biesanz personality trait–drug use associations.
& West, 2004). The results of the present analyses may suggest that
the generalized pattern of association of high neuroticism, low
Conclusions
agreeableness, and low conscientiousness with drug use identified
in past studies may be partially due to respondent bias, method Abundant research has investigated the relationship between
factors, and/or lack of orthogonality of trait constructs in praxis. As personality traits and drug use. The present study supports the
neuroticism, agreeableness, and conscientiousness often display the notion of specificity in trait–drug use associations and further
strongest intercorrelations among the Big Five traits (rNA = −.36; substantiates the value of personality-targeted intervention ap-
rNC = −.43; rAC = .43; Van der Linden et al., 2010), including in proaches (Conrod, 2016). One challenge will be to integrate poly-
the present sample (rNA = −.35; rNC = −.40; rAC = .27), this substance use into this picture. As most drug use does not occur in
explanation represents one avenue by which the pattern of associa- isolation, it will be important for future research to extend the
tion of these three traits with drug use is consistently identified when present findings and identify how personality traits relate to more
trait domains are modeled independently (i.e., these purportedly complete patterns of drug use. Several studies have identified
independent associations are capturing much of the same variance). distinct illicit drug use typologies, typically encapsulating cannabis
As demonstrated in the present study, a strikingly different pattern use, party drug use (cocaine, stimulants, and hallucinogens),
 328 DASH, MARTIN, AND SLUTSKE

prescription misuse (opioids, sedatives), and polydrug use (Dash Davis, C. N., Slutske, W. S., Piasecki, T. M., Martin, N. G., & Lynskey, M. T.
et al., 2021; Lynskey et al., 2006; Patra et al., 2009). These typol- (2020). Comparing the potential causal influence of two indicators of early
ogies are differentially associated with substance use outcomes, alcohol use on later alcohol use disorder symptoms. Journal of Abnormal
such as use disorder and related problems. Better understanding of Psychology, 129(3), 256–265. https://doi.org/10.1037/abn0000474
the individual-level risk factors underlying the manifestation of Delić, M., Kajdiž, K., & Pregelj, P. (2017). Association of the Five-Factor
Model personality traits and opioid addiction treatment outcome. Psy-
these patterns of drug use could prove invaluable in identifying
chiatria Danubina, 29(3, Suppl. 3), 289–291.
those liable to high-risk drug use and, therefore, improving early
de Moor, M. H. M., de Geus, E. J. C., & Boomsma, D. I. (2011). Statistical
intervention efforts. power to detect causality in the co-twin control design. Behavior Genetics,
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