Personality Disorders and the 3-Year Course of Alcohol, Drug, and Nicotine Use Disorders

Department of Psychiatry, College of Physicians and Surgeons, Columbia University, NY 10032, USA.
Archives of general psychiatry (Impact Factor: 13.75). 11/2011; 68(11):1158-67. DOI: 10.1001/archgenpsychiatry.2011.136
Source: PubMed

ABSTRACT Little is known about the role of a broad range of personality disorders in the course of substance use disorder (SUD) and whether these differ by substance. The existing literature focuses mostly on antisocial personality disorder and does not come to clear conclusions.
To determine the association between the 10 DSM-IV personality disorders and the persistence of common SUDs in a 3-year prospective study of a national sample.
Data were drawn from participants in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) who had alcohol dependence (n = 1172), cannabis use disorder (n = 454), or nicotine dependence (n = 4017) at baseline and who were reinterviewed 3 years later. Control variables included demographic characteristics, family history of substance disorders, baseline Axis I disorders and treatment status, and prior SUD duration. Main Outcome Measure Persistent SUD, defined as meeting full criteria for the relevant SUD throughout the 3-year follow-up period.
Persistent SUD was found among 30.1% of participants with alcohol dependence, 30.8% with cannabis use disorder, and 56.6% with nicotine dependence at baseline. Axis I disorders did not have strong or consistent associations with persistent SUD. In contrast, antisocial personality disorder was significantly associated with persistent alcohol, cannabis, and nicotine use disorders (adjusted odds ratios, 2.46-3.51), as was borderline personality disorder (adjusted odds ratios, 2.04-2.78) and schizotypal personality disorder (adjusted odds ratios, 1.65-5.90). Narcissistic, schizoid, and obsessive-compulsive personality disorders were less consistently associated with SUD persistence.
The consistent findings on the association of antisocial, borderline, and schizotypal personality disorders with persistent SUD indicates the importance of these personality disorders in understanding the course of SUD. Future studies should examine dimensional representations of personality disorders and the role of specific components of these disorders, biological and environmental contributors to these relationships, and potential applications of these findings to treatment development.

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Available from: Katherine M Keyes, Sep 01, 2015
    • "The co-occurrence of one or more personality disorders was found to be positive correlated with the severity of addiction (Preuss et al. 2009). In patients with alcohol dependence and cannabis use disorders, BPD, ASPD and schizotypal personality disorder were diagnosed most often (Hasin et al. 2011). "
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    ABSTRACT: Substance use disorders are highly prevalent among people with schizophrenia. Dually diagnosed patients present with unfavorable course and poor long-term outcomes. Integrated, motivation-based treatment for both disorders in the same setting is considered the treatment of choice for this challenging population. Treatment programs include state-of-the-art pharmacotherapy and psychosocial interventions such as motivational interviewing, psychoeducation, and cognitive–behavioral approaches.
    Co-occurring Addictive and Psychiatric Disorders, 01/2015: pages 75-86; , ISBN: 978-3-642-45374-8
    • "Indeed, supplementary analyses at the symptom level showed that only one symptom of obsessivecompulsive PD, " rigidity and stubbornness, " is associated with ND persistence in both prediction and postdiction (results available upon request). 6 With regard to antisocial PD, which was found to be associated with the persistence of SUDs in Hasin et al. (2011) and Fenton et al. (2012), our analytic strategy does not provide clear evidence that these findings are due to the same artifact. Nevertheless, analyses involving Wave 1 antisocial PD did not yield significant associations in the predictive analyses, suggesting that the associations found in previous studies might be due to the definition that incorporates data from both waves. "
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    ABSTRACT: The purpose of this study was to examine whether published findings regarding the association of personality disorders (PDs) with the persistence of substance use disorders (SUDs) are attributable to an artifact due to time of assessment of the PD. Two previous studies analyzed data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) and found that Antisocial PD, Schizotypal PD, and Borderline PD are unique predictors of SUDs. However, a design limitation in NESARC (assessment of PDs at different waves) can potentially compromise these findings. To assess the influence of time of assessment of PDs and to identify associations that might be robust to time of assessment, we compared the association of PDs with 2 estimates of SUD persistence that were based on different populations at risk: (a) among those who were diagnosed with SUD at baseline, the proportion who continued to meet full criteria at follow-up ("prediction"); and (b) among those who were diagnosed with SUD at follow-up, the proportion who met full criteria at baseline ("postdiction"). Differences between prediction and postdiction revealed a robust pattern of higher odds ratios for postdiction among PDs assessed at baseline, and lower odds ratios for postdiction among PDs assessed at follow-up. All published significant associations between PDs and persistence of SUDs became nonsignificant in the postdiction analyses, with the exception of obsessive-compulsive PD predicting nicotine dependence persistence. The present results raise serious doubts about the validity of published findings on PDs and SUD persistence from the NESARC. Design limitations in NESARC preclude a direct comparison among PDs measured at different waves. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
    Journal of Abnormal Psychology 10/2014; 123(4). DOI:10.1037/abn0000011 · 4.86 Impact Factor
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    • "Identifying predictors of quit attempts is important because they indicate which individuals may be willing to stop alcohol use. Identifying predictors of successful quit attempts is also important because they indicate which individuals are likely to quit and which ones, despite their interest in quitting, may have difficulties doing so (Flórez-Salamanca et al., 2013; García-Rodríguez et al., 2013; Hasin et al., 2011). Groups with low successful rates may then be the focus of more targeted interventions to increase successful quit rates. "
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    ABSTRACT: Background: This study sought to identify predictors of attempting to quit and of successfully quitting alcohol abuse or dependence in the general population. Methods: Data were drawn from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Results: Approximately 10% of individuals with alcohol abuse and 18% of those with dependence attempted to quit over the three year follow-up period. Of those who tried, 38% of individuals with abuse and 30% of those with dependence successfully quit. Among individuals with alcohol abuse or dependence, being single, younger than 40 years old, having low income, a co-occurring psychiatric disorder and greater number of dependence symptoms increased the likelihood of attempting to quit. Among individuals with alcohol abuse, male gender and low educational attainment further increased the odds of quit attempts. However, greater severity of alcohol use disorder, having a co-occurring drug use disorder and greater number of psychiatric disorders decreased the odds of success among individuals with alcohol abuse, while female gender, being married and older than 40 years old increased the odds of success. Among individuals with alcohol dependence, having nicotine dependence, greater number of psychiatric disorders and personality disorders decreased the odds of success. Conclusions: Predictors of attempts to quit are different and sometimes opposite from those leading to successful quitting probably indicating that some factors that increase motivation may decrease ability to quit. These findings may help in the development of more targeted and effective interventions for alcohol use disorders. (C) 2014 Published by Elsevier Ireland Ltd.
    Drug and Alcohol Dependence 06/2014; 141. DOI:10.1016/j.drugalcdep.2014.05.019 · 3.28 Impact Factor
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