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: 14.48). 11/2011; 68(11):1158-67. DOI: 10.1001/archgenpsychiatry.2011.136
Source: PubMed


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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    • "It has also been shown that PD is associated with worse substance-related outcomes in SUD patients compared to SUD patients without PD (Van den Bosch & Verheul, 2007). Moreover, SUD is more persistent in patients with comorbid PD, especially antisocial, borderline, and schizotypal PD, while this was not found for Axis I disorders (Hasin et al., 2011). Thus, screening for PD among patients with SUD is important, because the presence of a PD informs the intensity and form of treatment that will be recommended (Zimmerman, Rothschild, & Chelminski, 2005). "

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    • "Background Impulse-control disorders and antisocial personality disorders are very common in patients affected by substance dependence, particularly alcoholics (Hasin et al. 2011; Lewis 2011). In the context of alcohol consumption there are different categories of consumers . "
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    • "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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