No abstract

The relation between psychological characteristics and drug use was investigated in subjects studied longitudinally, from preschool through age 18. Adolescents who had engaged in some drug experimentation (primarily with marijuana) were the best-adjusted in the sample. Adolescents who used drugs frequently were maladjusted, showing a distinct personality syndrome marked by interpersonal alienation, poor impulse control, and manifest emotional distress. Adolescents who, by age 18, had never experimented with any drug were relatively anxious, emotionally constricted, and lacking in social skills. Psychological differences between frequent drug users, experimenters, and abstainers could be traced to the earliest years of childhood and related to the quality of parenting received. The findings indicate that (a) problem drug use is a symptom, not a cause, of personal and social maladjustment, and (b) the meaning of drug use can be understood only in the context of an individual's personality structure and developmental history. It is suggested that current efforts at drug prevention are misguided to the extent that they focus on symptoms, rather than on the psychological syndrome underlying drug abuse.

is argued that researchers' reliance on "objective" mental health scales and disregard for clinical judgment has led to many mistaken conclusions. Specifically, standard mental health scales appear unable to distinguish between genuine mental health and the facade or illusion of mental health created by psychological defenses. Evidence is presented indicating that (a) many people who look healthy on standard mental health scales are not psychologically healthy, and (b) illusory mental health (based on defensive denial of distress) has physiological costs and may be a risk factor for medical illness. Clinical judges could distinguish genuine from illusory mental health, whereas "objective" mental health scales could not. The findings call into question the conclusions of many previous studies that rest on standard mental health scales. They suggest new ways of understanding how psychological factors may influence health. Finally they suggest that clinical methods (which researchers often malign) may have an important role to play in meaningful mental health research.

With some exceptions, personality pathology in adolescence resembles that in adults and is diagnosable in adolescents ages 14-18. Categories and criteria developed for adults may not be the optimal way of diagnosing adolescents. Data from samples of adolescents may prove useful in developing an empirically and clinically grounded classification of personality pathology in adolescents.

These findings suggest that DSM-IV criteria for narcissistic personality disorder are too narrow, underemphasizing aspects of personality and inner experience that are empirically central to the disorder. The richer and more differentiated view of narcissistic personality disorder suggested by this study may have treatment implications and may help bridge the gap between empirically and clinically derived concepts of the disorder.