Addiction associated with poor awareness of others, study shows

The study was published in the Journal of Child and Adolescent Substance Abuse.

Pagano, an associate professor of psychiatry at Case Western Reserve University School of Medicine, had a major challenge in designing this study: adolescents are self-centered. But she was convinced that she would find addiction tied to a deficit in awareness of others above and beyond the ego-centric stage of adolescence. And she did.

She recruited 585 adolescents from Cuyahoga County high schools and the largest residential treatment facility in Northeastern Ohio, and matched them by age, gender, race, and residence zip code. There were two adolescents who described little or no drug or alcohol use (n=390) for every one young addict (n=195). The study was designed to consider the relationship between the severity of the addiction and regard for others. She identified several behaviors to measure other-oriented awareness: driving under the influence, engaging in unprotected sex (even when they knew they had a sexually transmitted disease), and volunteerism.

Results showed a dose-response relationship between substance use severity and other-regard: the more severe the addiction, the more likely the young person was to endorse indices of low-regard for others. She likens it to some of the features of autism.

Most youths (88%) did not use alcohol or drugs at the time of their last intercourse, which was unprotected among 55% of the sample, and one out of five youths (26%) had a history of a driving under the influence, or DUI. The results showed a dose-response relationship between AOD severity and an increased likelihood of a DUI and having unprotected sex. Youths with a STD history who did not use protection at the time of last sex were more likely to meet diagnostic criteria for substance dependency (OR=2.1) than youths with moderate use (R=1.6), whose risk was greater than youths who had never used alcohol or drugs (OR=1.1).

Pagano believes that alcoholics and drug addicts may be hindered by a low awareness of how their actions impact others. "The addict is like a tornado running through the lives of others," said Pagano. Even when they are in recovery there is little indication that they understand how their actions impact those around them. "This is part of the illness," she added. Helping young people to get out of that self-centeredness in the service of others helps them in the recovery process. Service to others is a big part of the 12-step Alcoholics Anonymous and Narcotics Anonymous programs.

The psychologist demonstrated in previous work with adult addicts that service cuts the risk of relapse in half and also cuts in half the risk of arrest. "People must understand that the illness has a low awareness of others component that must be addressed," she added. Her work suggests that addiction could be prevented through strengthening volunteerism.

Pagano's continued research in this area is exploring how helping others may increase alcoholics' sensitivity to others and how their actions affect others. Following the treated addicts over a one-year period and monitoring their commitment to service will allow her to see whether their volunteerism helped reduce risky behaviors, she said.