Personality Disorders among Alcoholic Outpatients: Prevalence and Course in Treatment

Abstract

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.

Relapse (Number of Detoxifications) in Abstinent Male Alcohol-Dependent Patients as Related to Personality Traits and Types of Tolerance to Frustration

“…Number of detoxifications was associated with aggression (still observed after Bonferroni adjustment of the significance level) and as a trend with depression, but not significantly with impulsivity. For aggression, this supports findings from studies reporting personality disorders [39], particularly antisocial personality disorders [5,6], juvenile conduct disorders [40,41], high scores on the Eysenck psychoticism scale which measures non-conformity [36] or low scores on cooperativeness [20] as good predictors of relapse. In a study by Zikos et al [39], DSM IV cluster B personality disorders, including histrionic, narcistic, borderline and antisocial personality disorders did not seem to be related to amount of alcohol consumption but rather to dropout from treatment, indicating independence between the amount consumed and treatment outcome, which corresponds to the findings in our sample that correlations between aggression and glasses of alcoholic drinks before detoxification computed for comparison were also not significant (all correlations r < 0.10, p > 0.10, not presented in Results).…”

In-depth study of personality disorders in first-admission patients with substance use disorders

“…Studies of outpatients with alcohol use disorders (AUDs) have found a prevalence of PDs between 40% and 64% [1-4]. In samples of inpatients with AUD, the prevalence ranges from 34% to 78% [5-7].…”

“…In a sample of AUD outpatients, Echeburua et al found obsessive-compulsive, antisocial, paranoid, and dependent PDs to be the most prevalent [3]. In another sample of AUD outpatients, borderline PD, PD not otherwise specified (NOS), narcissistic PD, and obsessive-compulsive PD were the most prevalent [4]. In DeJong et al’s study, the order of PDs with the highest prevalence in AUD patients was histrionic, dependent, avoidant, and compulsive, while the order in DUD patients was borderline, histrionic, passive-aggressive, and antisocial [7].…”

The impact of borderline personality disorder on residential substance abuse treatment dropout among men

“…Interestingly, however, little research has examined the impact of co-occurring personality disorders (with the exception of antisocial personality disorder [ASPD]; e.g., Cacciola et al, 1996; Daughters et al, 2008; Greenberg et al, 1994; Kokkevi et al, 1998) on substance abuse treatment completion, despite evidence for a number of negative outcomes associated with co-occurring personality disorders among patients with SUDs (see Greenberg et al, 1994; Powell and Peveler, 1996; Thomas et al, 1999; Wölwer et al, 2001; Zikos et al, 2010). One personality disorder that warrants particular consideration in this regard is borderline personality disorder (BPD).…”