Personality disorders are highly prevalent among alcohol-dependent populations and result in a seriously elevated risk for non-responding to treatment; therefore, they represent a major challenge for professionals providing treatment for alcohol dependence. Personality-guided Treatment for Alcohol Dependence (PETAD), an approach that integrates cognitive therapy for addictive behaviors with strategic intervention for maladaptive personality features, may be helpful for patients with co-morbid alcohol dependence and personality disorders. Clients admitted for inpatient treatment for alcohol dependence at Ringgaarden, Denmark (n = 108) were allocated to either standard inpatient treatment with cognitive therapy for alcohol dependence, or PETAD. Both treatments were manualized. Clients were followed up by mail at six months post-treatment and administered the MCMI-I and II and the SCL-90 at intake, post-treatment, and at follow-up. PETAD was associated with better retention, longer time to first relapse, and less time spent drinking post-treatment, although few differences reached statistical significance. Differences in results were mainly found in the subgroup with higher levels of PD. The study suggests that PETAD is a promising approach that warrants further study.

Background The stability of personality disorders in substance abusers have been questioned. Previous research has suggested that personality disorder features change when substance use is reduced, but remain stable when substance use is continued. The current study extended this finding to alcohol patients. Materials and Methods Alcohol dependent subjects treated for alcohol problems were tested with the Millon Clinical Multiaxial Inventory II (MCMI-II) at intake to inpatient treatment, discharge from treatment, and at 6 months follow-up. Test-retest correlations were calculated and compared with discriminant correlations, and measures of change were calculated. The association between percent of days abstinent and change in MCMI-II personality disorder scales was assessed using hierarchical regression controlling for baseline scores. Results MCMI-II personality disorder scales were significantly correlated across assessment waves, and comparison violations were relatively few. Large changes occurred during treatment, and only small changes from discharge to follow-up. Changes were associated with percent days abstinent for avoidant, dependent, and masochistic personality disorder scales. No significant differences were observed in the stability between the control and experimental condition. Conclusions The MCMI-II was found to be stable, and little evidence was found that there was a lack of discriminant validity. Changes in personality disorder severity as measured by self-report took place during treatment, rather than after. There was some indication that decreases in personality disorder scales from discharge to follow-up were associated with abstinence from drinking during follow-up.

Per Nielsen & Steffen R⊘jskjær: Dual disorder among alcohol addicted inpatient clients This study examines the prevalence and subtypes of personality disorders among alcohol-addicted inpatients, and the impact on drop out during treatment. The study is the first phase of a prospective study of dual disorder clients (alcohol addiction and personality disorder). Subjects were 104 clients with severe alcohol problems consecutively admitted to a Danish addiction treatment center (Ring-gaarden) applying a cognitive frame of reference. Each client was tested during the first two weeks using the Millon Clinical Multiaxial Inventory (MCMI II-I). According to the psychological testing seven out of eight subjects manifested at least one personality disorder – and 65% of the clients had two or more personality disorders. Anti-social and/or passive-aggressive personality disorder was present in more than 50% of the subjects. Borderline personality disorder was found in about 30%. More than half of the subjects had elevated scores of anxiety and/or dysthymia. Cluster analysis revealed four distinct subtypes of clients: a. no/slight personality disorder, b. “avoidant/dependent”, c. “antisocial/narcissistic” and d. “borderline”. The drop-out rate was significantly higher for the “borderline” group than for the other three. The implications for treatment are discussed.