Personality Disorder and Chronicity of Addiction as Independent OutcomePredictors in Alcoholism Treatment

Krampe, Henning; Wagner, Thilo; Stawicki, Sabina; Bartels, Claudia; Aust, Carlotta; Kroener-Herwig, Birgit; Kuefner, Heinrich; Ehrenreich, Hannelore

doi:10.1176/ps.2006.57.5.708

Cited by 39 publications

(10 citation statements)

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“…20 To date, no single DSM personality profile has characterized alcoholics. However, Cluster B PDs appear to be particularly prevalent among alcoholics, 2,3,[5][6][7]10,11,13 with both ASPD and BPD overrepresented in this population. 1,6,8,11,[21][22][23][24] In turn, alcohol use disorders are highly prevalent among people with Cluster B PDs.…”

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confidence: 73%

“…While this is a diagnosis overlooked by most studies, it has been found to be as prevalent when it was considered. 2,5,13 This high proportion of PD NOS may be attributed to the inherently categorical instead of dimensional nature of DSM-IV PD diagnoses where many patients who present with longstanding maladaptive patterns of behaviour cannot be categorized neatly. Another notable finding was our sample's unexpectedly low rate of ASPD (5% of total sample), comparable to the general population rate of 3.6% found in the NESARC 42 but lower than the 7% to 23% rate reported in most clinical samples of alcoholics.…”

Section: Discussionmentioning

confidence: 99%

“…10 As for course in addiction treatment, a concurrent PD diagnosis has been associated with premature discontinuation of treatment, 10,13 earlier relapse, 9,12,13 poorer treatment response, 8,14 and worse long-term outcome. 5,25 However, few studies have looked at the impact of individual PD diagnoses (other than ASPD) on the course of alcoholism, or on the outcome of alcohol treatment. Moreover, there have been few attempts to clarify the differential impact of the seemingly more prevalent Cluster B PDs in this population.…”

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confidence: 99%

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Personality Disorders among Alcoholic Outpatients: Prevalence and Course in Treatment

2010

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Objective: To determine the prevalence of concurrent personality disorders (PDs) among alcoholic men and women seeking outpatient treatment, and to examine their effect on the course of alcohol treatment. Method:Patients with alcohol use disorders (n = 165) were assessed by clinical and semi-structured interviews, as well as self-report scales, to measure levels of psychological distress, impulsivity, social functioning, and addiction severity at treatment intake. PD diagnoses were assessed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Personality Disorder (SCID-II). Course in treatment was monitored prospectively for 12 weeks. Results:Using the results of the SCID-II (n = 138), the sample was divided into 3 groups-that is, no PD 41% (n = 57), Cluster B PD 32% (n = 44), and other PD 27% (n = 37). The 3 groups did not differ in their alcohol use severity at intake. However, the Cluster B PD group achieved alcohol milestones at a younger age. Subjects with a PD had more severe psychological and social problems at intake. The Cluster B PD group showed significantly higher levels of impulsivity at intake, greater likelihood of early treatment dropout, and quicker times to first slip and to relapse. Conclusions:This study supports the high prevalence of concurrent PDs, particularly Cluster B PDs, among treatment-seeking alcoholics. The relation between observed high levels of impulsivity and worse course in early alcohol treatment among people with a Cluster B PD merits further investigation.Can J Psychiatry. 2010;55(2):65-73. Clinical Implications· Among our outpatient treatment-seeking alcoholic sample, 59% had a PD, underscoring the importance of screening for this comorbidity. · Cluster B PDs were especially prevalent in our sample population (32%) and showed significantly higher levels of impulsivity at intake. · Subjects with Cluster B PD showed significantly poorer course in early alcohol treatment, confirming the clinical experience of difficulty engaging this population into treatment. Limitations· Our findings are not generalizable to alcohol use disorders as a whole, given that subjects were treatment-seeking outpatients with no comorbid drug dependence. · We were unable to examine outcomes for 20% of our sample owing to attrition, refusal to attend follow-up interviews, or missing data. · The current sample size limits our ability to further examine the complex relation between Cluster B PD and impulsivity, and their impact on alcoholism.

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Personality Disorders among Alcoholic Outpatients: Prevalence and Course in Treatment

2010

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“…We did not examine the infl uence of coping skills, self-esteem/self-effi cacy, social support, neurocognition and personality disorders, neurocognitive variables, or gene polymorphisms reported to predict relapse after treatment for an AUD (e.g., Bradizza et al, 2006;Krampe et al, 2006;Miller et al, 1996;Teichner et al, 2001;Walter et al, 2006;Wojnar et al, 2009). It is also likely that the magnitude and chronicity of alcohol consumption before and after treatment in our alcohol-dependent cohort were infl uenced by genetic or other premorbid and environmental factors not assessed in this research.…”

Section: Discussionmentioning

confidence: 99%

Metabolite Levels in the Brain Reward Pathway Discriminate Those Who Remain Abstinent From Those Who Resume Hazardous Alcohol Consumption After Treatment for Alcohol Dependence

Durazzo¹,

Pathak²,

Gaździński³

et al. 2010

J. Stud. Alcohol Drugs

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ABSTRACT. Objective:This study compared baseline metabolite levels in components of the brain reward system among individuals who remained abstinent and those who resumed hazardous alcohol consumption after treatment for alcohol dependence. Method: Fiftyone treatment-seeking alcohol-dependent individuals (abstinent for approximately 7 days [SD = 3]) and 26 light-drinking nonsmoking controls completed 1.5-T proton magnetic resonance spectroscopic imaging, yielding regional concentrations of N-acetylaspartate, cholinecontaining compounds, creatine-containing compounds, and myoinositol. Metabolite levels were obtained in the following component of the brain reward system: dorsolateral prefrontal cortex, anterior cingulate cortex, insula, superior corona radiata, and cerebellar vermis. Alcohol-dependent participants were followed over a 12-month period after baseline study (i.e., at 7 days of abstinence [SD = 3]) and were classifi ed as abstainers (no alcohol consumption; n = 18) and resumers (any alcohol consumption; n = 33) at follow-up. Baseline metabolite levels in abstainers and resumers and light-drinking nonsmoking controls were compared in the above regions of interest. Results: Resumers demonstrated signifi cantly lower baseline N-acetylaspartate concentrations than light-drinking nonsmoking controls and abstainers in all regions of interest. Resumers also exhibited lower creatine-containing-compound concentrations than abstainers in the dorsolateral prefrontal cortex, superior corona radiata, and cerebellar vermis. Abstainers did not differ from light-drinking nonsmoking controls on baseline metabolite concentrations in any region of interest. Conclusions: The signifi cantly decreased N-acetylaspartate and creatine-containing-compound concentrations in resumers suggest compromised neuronal integrity and abnormalities in cellular bioenergetics in major neocortical components and white-matter interconnectivity of the brain reward pathway. The lack of metabolite differences between abstainers and light-drinking nonsmoking controls suggests premorbid factors potentially contributed to the baseline brain metabolite abnormalities observed in resumers. A LCOHOL-USE DISORDERS (AUDs; i.e., alcohol dependence and abuse) are characterized by a chronically relapsing/remitting course over the lifetime (Dawson et al., 2007;Jin et al., 1998;Miller et al., 2001;Zywiak et al., 2006). The resumption of hazardous levels of alcohol consumption after treatment is common (Donovan, 1996;Maisto and Connors, 2006;Miller et al., 2001;Monahan and Finney, 1996), and appears to be mediated by a complex interplay among genetic, neurobiological, neurocognitive, psychological/psychiatric, and sociodemographic factors (Adinoff et al., 2005;Baler and Volkow, 2006;Bottlender and Soyka, 2005;Bradizza et al., 2006;Glenn and Parsons, 1991;Goodman, 2008;Heinz et al., 2003;Jin et al., 1998;Koob, 2003;Moos and Moos, 2006;Parsons et al., 1990;Sher et al., 2005;Weiss and Porrino, 2002;Zywiak et al., 2006). A considerable amount of research has inve...

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“…frequency of drinking (11-point scale from never to daily); (4) number of positive Structured Clinical Interview for DSM-IV Disorders items; and (5) chronicity (years of problematic alcohol use divided by age in years) 49. …”

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Prediction of the Risk of Comorbid Alcoholism in Schizophrenia by Interaction of Common Genetic Variants in the Corticotropin-Releasing Factor System

Ribbe

Ackermann

Schwitulla³

et al. 2011

Arch Gen Psychiatry

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Personality Disorder and Chronicity of Addiction as Independent OutcomePredictors in Alcoholism Treatment

Abstract: Their high predictive values suggest that chronicity and personality disorder rank among the most important characteristics of addiction severity.

Cited by 39 publications

References 11 publications

Personality Disorders among Alcoholic Outpatients: Prevalence and Course in Treatment

Personality Disorders among Alcoholic Outpatients: Prevalence and Course in Treatment

Metabolite Levels in the Brain Reward Pathway Discriminate Those Who Remain Abstinent From Those Who Resume Hazardous Alcohol Consumption After Treatment for Alcohol Dependence

Prediction of the Risk of Comorbid Alcoholism in Schizophrenia by Interaction of Common Genetic Variants in the Corticotropin-Releasing Factor System

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