Putting it together
It's more complicated than one factor
Personality and gender should never be considered in isolation. Substance use sits at the intersection of biology, psychology, relationships, circumstances and opportunity.
Interactive diagram
Ten influences, one individual experience
Select any influence to see how it can contribute. Remove any one of them and the picture changes; none of them works alone.
- Personality
- Biology
- Gender & social norms
- Trauma
- Mental health
- Peer influence
- Socioeconomic factors
- Environment
- Access to substances
- Access to healthcare
Individual experience of substance use
At the centre
Individual experience of substance use
Personality and gender belong on this diagram alongside everything else — never as the whole explanation.
Factor
Biology
Genetics, tolerance, physical health, how a substance is metabolised.
No single factor on its own explains a person's substance use. They interact, and they change over time.
Why averages fail individuals
Two similar people, two different lives
Two people with similar personality characteristics can have completely different experiences, because their environments, relationships, opportunities and support systems differ.
Same trait, different environment
Two people may both score highly for sensation seeking. One grows up where that is channelled into sport and work; the other grows up where the most available outlet carries far more risk.
Same substance, different consequences
Two people may use the same substance in the same amount. One has stable housing, income and a GP; the other has none of those, so the same use produces very different harm.
Same request, different response
Two people describe uncontrolled pain. One is believed; the other is recorded as drug-seeking. The difference lies in the assumptions in the room, not in the pain.
References & further reading
Personality research
Kotov, R. et al. (2010). Linking "big" personality traits to anxiety, depressive, and substance use disorders: a meta-analysis. Psychological Bulletin, 136(5), 768–821.
Meta-analysis of trait associations across disorder groups; effects are group-level and modest.
Verdejo-García, A., Lawrence, A.J. & Clark, L. (2008). Impulsivity as a vulnerability marker for substance-use disorders. Neuroscience & Biobehavioral Reviews, 32(4), 777–810.
Review of impulsivity as both a possible precursor and a possible consequence of substance use.
Zuckerman, M. Research programme on sensation seeking and risk behaviour.
Origin of the sensation-seeking construct referred to on this page.
Gender and substance use research
McHugh, R.K. et al. (2018). Sex and gender differences in substance use disorders. Clinical Psychology Review, 66, 12–23.
Review of differences in course, consequences and treatment for substance use disorders.
Greenfield, S.F. et al. (2007). Substance abuse treatment entry, retention, and outcome in women: a review of the literature. Drug and Alcohol Dependence, 86(1), 1–21.
Review of gendered barriers to entering and staying in treatment.
World Health Organization — guidance on gender and health, and on treatment of substance use disorders.
International framing of gender as a social determinant of health rather than a predictor of individual outcome.
Open source ↗
UK guidance and policy
Drug misuse and dependence: UK guidelines on clinical management (the "Orange Book")
Department of Health and Social Care and devolved administrations, 2017. Treatment and prescribing practice for drug dependence in the UK.
Open source ↗NICE guidance on alcohol-use disorders and drug misuse
Includes CG115 (alcohol dependence and harmful drinking), CG100 (alcohol-related physical complications) and CG51 (psychosocial interventions for drug misuse).
Open source ↗Office for Health Improvement and Disparities — alcohol, drugs and tobacco collections
UK Government guidance, commissioning support and data on treatment and recovery in England.
Open source ↗Independent review of drugs (Dame Carol Black)
GOV.UK, 2020–2021. Examines treatment capacity, funding and system barriers in England.
Open source ↗Rights, respect and recovery: alcohol and drug treatment strategy
Scottish Government, 2018. Sets out a rights-based, stigma-aware approach to alcohol and drug support.
Open source ↗Medication Assisted Treatment (MAT) standards
Scottish Government / Public Health Scotland. Standards on same-day access, choice, harm reduction and retention in treatment.
Open source ↗Public Health Scotland — substance use and stigma resources
Population health information and work on reducing stigma in services.
Open source ↗NHS inform and NHS.uk
Public-facing health information and service finders for drug and alcohol support.
Open source ↗World Health Organization — alcohol, drugs and addictive behaviours
International guidance, including WHO/UNODC International Standards for the Treatment of Drug Use Disorders (2020).
Open source ↗
This website provides educational information and is not a substitute for individual medical assessment, diagnosis or treatment. Information should be interpreted alongside current clinical guidance and evidence.