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Heroin Addiction and Related Clinical Problems: 2025, 27, 27

Cyclothymia Predicts Substance Use Across Classes: From Alcohol and Opioids to Cocaine

Matteo Pacini, Marco Maiello, Filippo Della Rocca, Mario Miccoli, Icro Maremmani, and Angelo G. I. Maremmani

Digital Object Identifier:
https://doi.org/10.62401/2531-4122-2025-27

Summary: Background: Substance use disorders (SUDs) are increasingly recognised as heterogeneous conditions, often shaped by underlying temperamental traits. Among these, affective temperaments—especially cyclothymic temperament—may serve as potential endophenotypic markers for vulnerability to substance misuse. Methods: This cross-sectional observational study assessed affective temperaments in a sample of 178 individuals undergoing treatment for substance use, comprising patients diagnosed with alcohol use disorder (AUD, n=77), heroin use disorder (HUD, n=43), and cocaine use disorder (CUD, n=58). All participants completed the short version of the Temperament Evaluation of Memphis, Pisa, Paris and San Diego – Autoquestionnaire version (TEMPS-A[P]) to assess five affective temperaments: depressive, hyperthymic, cyclothymic, irritable, and anxious. Statistical analysis included non-parametric tests and logistic regression models to examine differences across groups and identify predictors of primary substance choice. Results: Cyclothymic temperament scores were significantly elevated across all three groups, with the highest values observed in the HUD and CUD subgroups. Hyperthymic temperament was more frequently associated with CUD, while depressive and anxious traits were more prevalent in AUD. Logistic regression models confirmed cyclothymic temperament as the strongest common predictor across substance categories. Conclusions: These findings suggest that cyclothymic temperament may represent a transdiagnostic vulnerability factor for substance use disorders, with distinctive temperamental profiles influencing the type of substance preferentially used. The study underscores the importance of integrating temperament-based assessments into the clinical evaluation and treatment planning of individuals with SUDs. Further longitudinal research is warranted to clarify the causal role of affective temperaments in the onset and course of addictive behaviours.

Keywords: Temperament severity; temperament typology; Substance Use Disorder patients; HUD patients; AUD patients; CUD patients; healthy controls