The Personality Assessment Inventory (PAI) is a broadband self-report measure of personality and psychopathology. Learn how clinicians can rely on the PAI to provide better outcomes in substance use cases. PAI insights can be used in: 

• Treatment planning
• Intervention implementation
• Evaluation
• Follow-up care

This case illustrates how PAI data was used to better understand a client's substance use, how it related to her background, and how she might respond to different treatment. By relying on the PAI, these providers were able to tailor treatment to be effective and personalized, leading to a lasting recovery.

Meet Jenny 

Jenny is a 28-year-old cashier at a convenience store. After unsuccessfully trying to stop using alcohol with the help of her outpatient therapist, she admitted herself to an alcohol detoxification center. 

While admitted, Jenny was diagnosed with alcohol dependence and major depressive disorder. Jenny’s outpatient therapist requested  testing clarification and continued treatment planning. The testing described here was conducted by the therapist in her inpatient program and shared with her follow-up team. 

Background 

Jenny was an only child whose parents divorced when she was in preschool. She lived with her mother after the divorce. She stated, “My mom and I were very close and she did her best. But she was very critical of me, so I learned to be critical of myself, too.” 

Jenny reported that her mother prioritized the needs of the men she was dating ahead of Jenny’s needs as a teenager. Her mother married three times after she divorced Jenny’s father and Jenny reported that some of these relationships were tumultuous.  

Jenny’s father died after falling down the stairs while under the influence a few years after her parents’ divorce. She remembered him as a violent person and said she had clear memories of him beating up her grandfather during an argument at her childhood home.  

At the time of the evaluation, Jenny had been married to her husband John, a Marine, for 8 years. They had two children together, a daughter who was 7 years old and a son who was 4 years old.  

“We have a strong marriage,” said Jenny. “And our kids are great—smart, well-behaved, and sweet.”  

Jenny had reflected on the past year as being particularly stressful—her mother had died of lung cancer after a long hospitalization. In addition to her mother’s death, John had been deployed to a base in Europe. Because of his deployment, they had limited contact and Jenny reported that she missed him terribly. Following her mother’s death, her grandmother moved into Jenny’s house. They had a strained relationship and Jenny described her grandmother as moody and demanding.  

“Suddenly, I was parenting without my partner,” said Jenny. “And with the time change, we rarely got to talk. My grandmother was adjusting to a new house with young kids and we both miss my mom, but it is very hard to be there for her and be there for my kids and their needs.” 

 Regarding substance use history, Jenny said she began drinking when she was a senior in high school. Before entering detox, she reported drinking 6–8 drinks at least four nights each week. This was Jenny’s first experience with psychiatric or substance-use treatment outside of her outpatient therapy. 

Jenny’s PAI Results 

Jenny’s scores on the PAI suggest that she attended to PAI item content. Although she responded somewhat inconsistently, there was no evidence of profile distortion. Therefore, her profile was considered valid and interpretable.   

Jenny's responses on the PAI resulted in elevations on scales measuring alcohol and drug use, which is expected because she was in substance-use treatment. Additionally, her responses on the PAI suggest impulsivity in areas that have high potential for negative consequences, such as substance use. However, her scores  didn't indicate that she was experiencing significant distress related to her substance use and its consequences.  

Jenny’s responses also suggest that she is a fearful and thoughtful person who is highly attuned to perceived risks in her environment. These scores seem consistent with her description of herself during the interview; specifically that she appeared to manage her anxiety by staying alert and always being prepared in case of possible threats. 

Jenny's responses suggest she has a dependent and avoidant personality style. This suggests she may be easily manipulated and may have trouble standing up for herself. Regarding treatment implications, her responses suggest an unwillingness to attribute her problems to others, but also the perception of not being up to the task of dealing with her problems (i.e., requesting hospitalization). 

Case Conceptualization 

During a clinical interview, Jenny admitted that she sometimes engaged in impulsive behaviors. . Through therapy, Jenny concluded that drinking helped her cope with anxiety-provoking situations such as interpersonal rejection.  

During the previous year when her mother had passed away and her husband was unavailable, Jenny stepped up to take responsibility for her grandmother. Her scores on the PAI and request for hospitalization are consistent with her perception that she lacked the resources to cope with her problems.   

According to the PAI, Jenny’s identity was somewhat unstable, which can be exemplified in how her view of herself was likely to shift in either times of support, during which her self-esteem probably increased, or in reaction to feelings of rejection. During these low times, she may have turned to alcohol to cope.  

Special Considerations 

Though many chronic substance users drink to cope with unhappiness or to enhance their mood, Jenny reported neither depression nor excitement-seeking. By investigating other aspects of her personality, Jenny’s PAI results paired with a clinical interview suggest a more specific function of alcohol use—a lack of confidence that she had the personal resources to maintain a stable and satisfying sense of self. By investigating these traits further, Jenny was able to recognize that she behaved in ways to invoke caretaking behaviors from others. When rejected by others, Jenny would likely use alcohol to handle her feelings.  

Outcome 

Jenny’s outpatient psychologist determined the first goal in Jenny’s ongoing treatment plan would involve reorganizing and reestablishing her coping mechanisms. It would be important for Jenny to develop coping methods other than alcohol that she could rely on when in distress. In addition to individual therapy, Jenny enrolled in a group to help develop interpersonal skills.  

Jenny approaches interpersonal encounters with fear and her scores on the PAI indicate that she approaches others somewhat submissively. However, she reported during the clinical interview that she feels that she had a supportive environment, though it was changing more rapidly than she was comfortable. In therapy, this information was used to help Jenny focus on building her confidence and assertiveness in social interactions. Understanding her fear and submissiveness helped to focus treatment goals on the development of strategies to improve her interpersonal skills.  

John returned from his deployment six months after Jenny returned home from the inpatient center. Jenny’s grandmother moved into a senior living facility shortly after that, which took some pressure off their relationship—they both report that they are enjoying spending time together now and their relationship is in a positive place. 

Jenny continues to work with her outpatient therapist to address the issues in that resulted in her substance use. They continue to focus on developing and strengthening Jenny’s self confidence in her ability to care for herself, knowing that there is a good possibility her husband may be deployed again and she will be faced with the need to care for herself and her children without the support of her spouse or mother.